Measuring the implementation of health promotion programs: the case of the Breast and Cervical Cancer Program in Maryland.

This paper introduces critically important issues and benefits for measuring the extent and processes of program implementation when conducting and studying health education and health promotion programs. These methods are illustrated with reference to the Breast and Cervical Cancer Program in Maryland. We suggest using a chain of events research paradigm rather than confining community intervention research to the more frequently used experimental model. Combined roles as researchers and technical advisors serve complementary functions of gathering relevant, valid information about implementation and making these data useful to program managers. Measures of implementation should be used to examine the detailed delivery of program components, to assess organizational and environmental processes influencing the extent of implementation and to analytically link variations in program delivery to desired short-term outcomes. Measuring these processes is needed to move implementation research for health promotion programs beyond an anecdotal set of case stories about implementation problems to a fully developed area of research-based knowledge.