A Process Evaluation of the WV Smoking Cessation and Reduction in Pregnancy Treatment (SCRIPT) Dissemination Initiative: Assessing the Fidelity and Impact of Delivery for State-Wide, Home-Based Healthy Start Services.

Objectives Process evaluation data are essential to document the fidelity of program implementation by clinical staff and confirm patient behavior change. This report presents a process evaluation model applied to the Smoking Cessation and Reduction in Pregnancy Treatment Dissemination Initiative for the statewide, home-based West Virginia Right From The Start Project. Methods Trained RFTS Designated Care Coordinators, nurses and social workers, of 50+ primary care agencies in all 55 counties, delivered SCRIPT to Medicaid patients who smoked. Results The process evaluation defined the level of DCC delivery of seven core SCRIPT procedures to produce a Program Implementation Index: a summary performance metric. A SCRIPT PII > 0.80 was established as the RFTS adoption standard. The PII increased from 0.53 in 2004 to 0.65 in 2006-2007 to 0.77 in 2009-2010. Although the PII > 0.80 was not achieved, exposure rates were increased for all seven SCRIPT procedures. Agency and DCC turnover, a transient patient population, and recession of 2008-2010 were barriers to achieving the adoption metric and implementation of an experimental design. A quasi-experimental Stratified, Matched Comparison (C) Group Design was selected to evaluate behavioral impact differences between a RFTS-Comparison (C) Group from 2006 to 2007 and the RFTS-SCRIPT E Group from 2009 to 2010. Impact analyses of the DCC delivery of the SCRIPT Program with higher fidelity documented a statistically significant increase in the cessation rate from 4.6 % and significant reduction rate from 6.9 % for the (C) Group in 2006-2007 to 13.9 % and 11.22 % respectively for the E Group in 2009-2010. Conclusion The PEM can assist statewide, home-based prenatal care programs to improve the quality of delivery and evaluate counseling programs.