Program Evaluation Research Articles

Trends in active hepatitis B virus infection and associated risk factors among blood donor candidates from Luanda, Angola

Hepatitis B virus (HBV) infection is a global public health concern with a high burden in the African region. Assessing trends in HBV infection over time can provide insights into the effectiveness of prevention/treatment strategies in different settings. Herein, we investigate trends in active HBV infection and associated risk factors among blood donor candidates from Luanda, Angola. This was a retrospective study conducted with 96,654 medical records of blood donors consulted between 2018 and 2022 at the Angolan National Blood Institute. Participants were screened for hepatitis B surface antigen (HBsAg). Chi-square, Prevalence Ratio, and logistic regression were used to analyse interactions between demographic variables and were deemed significant when p < 0.05. Active HBV infection was 10% (95% CI: 9.4–10.6). Men (AOR: 1.38, p < 0.001), employed (AOR: 3.25, p < 0.001) and non-urbanised regions (AOR: 1.16, p = 0.019), were more likely to contract the HBV, while aged 30 years or older (AOR: 0.78, p < 0.001) and married (AOR: 0.66, p < 0.001), were less likely to contract the infection. From 2018 to 2022, HBV infections increased from 18.2 to 21.9%. Infections increased in under 30 years (31.3–52.5%, p < 0.001), males (91.1 to 91.8%, p = 0.149), urbanised regions (2.7 to 3.3%, p = 0.538), and unmarried (93.9 to 95.8%, p = 0.019). We revealed a highly active HBV infection over the past 5 years in the adult population of Luanda, Angola. Age, gender, occupation, place of residence and marital status have influenced the dissemination of HBV in Angola. Our findings may facilitate the planning and evaluation of the HBV control program in Angola.

Program Evaluation Study of CBT Interventions for Older Adults in Adult Day Health Care Center at Los Angeles, California

This study evaluated the effectiveness of CBT interventions including supportive presence and socialization for immigrant older participants who suffered from depression and anxiety and attended an Adult Health Care Center (ADHC) at Los Angeles, California. The evaluation strived to study patients at the ADHC who receive daytime health care service for at least a year consistently. The Patient Health Questionnaire-9 (PHQ-9) was utilized to measure and monitor the severity level of depressive symptoms. The Generalized Anxiety Disorder-7 (GAD-7) was also used to measure and monitor the severity level of anxiety symptoms. Of the eighty-five participants (N=85) were selected to be involved in this study, sixty-nine were women, and men account for sixteen. The findings support the hypothesis of this study which states that the CBT intervention of the Adult Day Health Care in L.A, CA will reduce symptoms of anxiety/depression among older immigrant clients. It appears that the comprehensive nature of the CBT intervention in the ADHC, which includes supportive presence and socialization, individual therapy, and case management, is effective at improving symptoms of anxiety and depression among the participants.

Evaluation of an authorized nurse immunizer led opportunistic patient influenza and COVID-19 vaccination program under the RE-AIM framework

Abstract Background Influenza and COVID-19 are significant vaccine-preventable causes of morbidity, mortality, and healthcare costs. Hospital-based, nurse-led models can increase vaccine uptake, yet few target adults. This study evaluates the implementation of an opportunistic patient influenza and COVID-19 vaccination program in the Central Coast Local Health District (CCLHD), led by Authorized Nurse Immunizers (ANIs). Methods Evaluation of the ANI-led program was conducted using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. The 10-week program involved screening patients for vaccine eligibility, offering vaccinations and collecting quantitative data and qualitative feedback across the five RE-AIM domains. Results Of 849 patients screened alongside service encounters, 398 were vaccinated with 76% of eligible patients consenting to flu and 59% to COVID-19 vaccination. Inpatients had lower vaccination rates on admission compared to the general population and higher rates after program contact. The program was well received by patients and staff and adopted across various CCLHD settings, effectively addressing community access barriers. Conclusions Opportunistic vaccination using an ANI-led model is an effective strategy to improve vaccination coverage among higher-risk patients. This evaluation demonstrates the benefits of a dedicated nurse immunizer workforce and suggests potential for broader adoption in similar healthcare settings to improve public health outcomes.

Comparative Analysis of Online Hospitality and Tourism Management Master’s Programs as Systems Using the STAR Model

ABSTRACT Online Hospitality and Tourism Management (HTM) master’s programs in the U.S. have expanded as strategic initiatives to meet the needs of diverse learners. Despite this growth, few studies have compared these programs through a strategic lens. Guided by systems theory and the STAR model, this study conducted a comparative content analysis of 10 program characteristics drawn from the websites of 32 online HTM master’s programs across 29 U.S. institutions. The programs were conceptualized as systems with interconnected components, and the characteristics were categorized into five STAR elements: culture, people, process, structure, and strategy. The findings reveal both similarities and differences across the programs, reflecting the strategic adaptation of the characteristics in response to internal priorities and external demands. These insights advance understanding of online HTM master’s programs as strategic systems and offer practical implications for the development, evaluation, and growth of online education programs in a competitive online education marketplace.

Implementation and performance barriers in Iran’s breast cancer screening program: a qualitative case study

IntroductionCancer screening programs (CSPs) are essential for early detection and improving survival rates; however, they often encounter barriers to effective implementation. This study aims to identify the key challenges faced in implementing the Breast Cancer Screening Program (BCSP) in Iran, with the goal of providing insights to enhance the program’s effectiveness and accessibility.MethodsThis study was conducted as an observational and qualitative research to assess the implementation status and identify barriers within the Breast Cancer Screening Program (BCSP). Data were collected through a combination of interviews, process observations, and document reviews. A purposive sample of 37 participants was interviewed, including individuals involved in the management, implementation, or evaluation of the screening program. Thematic content analysis was employed to analyze the data, with saturation achieved to ensure comprehensive coverage of the study’s objectives.ResultsThe study identified several key barriers to the effective implementation of breast cancer screening programs, which were categorized into three main dimensions: infrastructural, managerial, and healthcare service delivery. The most critical issues in infrastructural category were a lack of trained healthcare personnel, insufficient screening facilities, inaccurate registration systems, fragmented databases, and poor data quality control. Key barriers in the managerial dimension include the absence of a mechanism for identifying and inviting women eligible for cancer screening, as well as inadequate monitoring of non-responders to follow-up. Overcrowding during peak times, long waiting periods, inaccurate triage, and lack of general practitioners (GPs) at the primary level of public healthcare were the identified barriers in service delivery in cancer screening. Additionally, interviews with women revealed several barriers, such as low perceived risk, fear and anxiety, lack of family support, and cultural or religious objections, all of which further hindered participation in breast cancer screening.ConclusionThis study highlights the critical barriers to the implementation of breast cancer screening programs in Iran, most of which appear to stem from systemic failures. Addressing these challenges requires a comprehensive, strategic approach that targets the identified obstacles at multiple levels. Overcoming these barriers is crucial to improving the accessibility, efficiency, and overall effectiveness of breast cancer screening programs, ultimately enhancing early detection and patient outcomes.

The Two Hearts Mindful Parenting programme for parents of autistic children: a proof-of-concept study

ABSTRACT Objective The aim of this study was to determine thesocial validity, acceptability, and preliminary effectiveness of amodified mindful parenting program on levels of parenting stress. Method A randomised, non-concurrent multiple baselinedesign with A-B replication was used to evaluate the effects of themodified mindful parenting program – Two Hearts program. Primaryoutcome measures included mindful parenting and parenting stress.Secondary outcome measures included child externalising behaviours,parent wellbeing, and parenting self-efficacy. Program evaluation andsession ratings were collected to assess acceptability and validity. Results We found support for the social validity andacceptability of the program and promising findings in terms ofimprovements in parenting stress, mindful parenting, and childexternalising behaviours for parents of autistic children who wereexperiencing clinical stress levels. Effects were maintained at threemonths follow-up. There was no significant change in parentwellbeing. At a group level, there were significant reductionsin mindful parenting between post-program and follow-up andsignificant reductions in parenting stress, and child externalisingbehaviours between pre- and post-program, which were maintained atfollow-up. Conclusion This program demonstrated promising findingsfor parents of autistic children with clinical parenting stresslevels. Results suggests further research using larger clinicaltrials is warranted.

Introduction to accreditation in pharmacy education in Türkiye: Association for evaluation and accreditation of pharmacy education programs

Introduction to accreditation in pharmacy education in Türkiye: Association for evaluation and accreditation of pharmacy education programs

توظيف الاستراتيجيات الاتصالية للعلاقات العامة في تعزيز الشراكة المجتمعية للمؤسسات الصحية التعليمية السعودية

This study aimed to explore the effectiveness of employing public relations communication strategies in enhancing community partnership within Saudi educational health institutions, with a field application on Al-Moosa College for Health Sciences. The study adopted the media survey methodology by conducting structured interviews accompanied by a questionnaire with several employees from the Public Relations and Marketing Department, as well as individuals involved in community initiatives within the college. The study sample consisted of public relations specialists who were deliberately selected due to their direct relevance to the research topic, which contributed to providing rich data and a comprehensive analysis covering various dimensions of the studied phenomenon. The results revealed a clear effectiveness in using public relations communication strategies and activities to enhance community partnership within Al-Moosa College. The findings also indicated that public relations significantly contribute to building a positive institutional image. Additionally, the results showed that the institution effectively utilizes social media platforms to strengthen its engagement with the local community and implements various forms of community partnerships, including awareness initiatives, health programs, and interactions with students and their families. The study also confirmed the presence of clear communication plans adopted by the college's Public Relations Department to support the sustainability of community partnership and enhance the institution’s social impact. In light of these findings, the study recommends the need to promote the adoption of dialogic and interactive strategies in institutional communication to ensure the active involvement of the local community in the planning, implementation, and evaluation of health and educational programs.

'They have a really good way of getting it to the kids': evaluation of a child injury prevention programme in Walgett, New South Wales.

Aboriginal community-led programmes are likely to be most effective in prevention of injury, but more evaluation is needed. This article examined participating family and community stakeholder views of the Child Injury Prevention Partnership (CHIPP) programme delivered within an existing playgroup at the Walgett Aboriginal Medical Service. This codesigned, mixed-methods evaluation adopted a decolonising Indigenous methodological approach. Aboriginal staff members provided weekly reflections on implementation, and family participation data were documented. Parents/carers provided regular feedback and, along with community stakeholders, participated in postprogramme research yarning. During 2021, playgroup sessions were facilitated by locally trained Aboriginal early childhood staff, who offered 2 hourly sessions twice a week. CHIPP implemented safety education for both adults and children through safety yarns and resources to take home focused on water, home and road safety. Parent/carer and stakeholder research yarns revealed six themes: CHIPP was feasible and culturally acceptable for families; Playgroup enabled supportive, holistic delivery of safety messages to adults and children; CHIPP provided information and resources to equip parents and carers to help teach safety at home; Approach to teaching infants and preschoolers safety was based on building confidence through fun, engaging, age-appropriate activities; Programme topics and content were relevant for families and COVID-19 impacted programme delivery but pivoted temporarily to remote delivery. The CHIPP programme was feasible, accessible, acceptable and demonstrated initial beneficial impact, despite implementation challenges during the COVID-19 pandemic, offering suggestions to inform other child injury prevention programmes in Aboriginal community-controlled settings.

Best Practice Guidelines for Preparing Simulated Patients for Telehealth Simulation.

The exponential growth of telehealth in health care, triggered by the COVID-19 pandemic, has necessitated updates to educational standards including the integration of telehealth competencies in academic curricula to prepare students for technology-enabled clinical practice. Simulation-based experiences (SBEs) are a valuable pedagogical tool for teaching and assessing telehealth skills in safe and controlled virtual learning environments. Simulated or standardized patients (SPs) are an essential component of SBEs for creating high-quality and engaging learning experiences. SPs in telehealth environments must learn to manage technical interfaces, modify communication for virtual interactions, and convey physical ailments without in-person contact. SP educators and teaching faculty have a valuable role in preparing SPs to effectively portray authentic and consistent telehealth roles while navigating technology and maintaining case fidelity. SP educators contribute critical expertise in SP methodology and are essential collaborators in the development, implementation, and evaluation of telehealth simulation programs. Telehealth SBEs have unique considerations, workflows, and technologies that differ from in-person encounters, and the complexities of these differences underscore the critical need for specialized training approaches for creating authentic and effective telehealth simulations. Formal published resources for training SPs in telehealth contexts remain limited. This article provides guidance to support comprehensive simulation programs delivering telehealth education, specifically emphasizing SP methodology for remote settings.

Teachers' ICT Competence, Techno-Efficacy, School Support, and Attitude Towards Digital Use in Teaching: A Mediation and Moderation Study

In the modern era of education, there is a greater emphasis on technology, and teachers are required to have a high level of digital proficiency. This study investigated the mediating and moderating role of techno-efficacy and school support in the relationship between teachers' ICT competence and attitude towards digital use in teaching among secondary schools in Cagayan, Philippines. It employed a correlational research design. The respondents were 118 teachers, and the results were calculated using the Lynch formula. The study found that teachers' techno-efficacy mediates the positive relationship between ICT competence and attitude towards digital use in teaching. In addition, school support moderates the strength of the relationship between ICT competence and attitude towards digital use in teaching. This implies that techno-efficacy intervenes in the relationship between ICT competence and attitude towards digital use in teaching and that school support influences the strength of this relationship. These findings highlight the importance of providing adequate ICT tools, robust infrastructure, continuous professional development, collaborative opportunities, innovative teaching methods, supportive leadership, and regular evaluation of training programs.

Engaging community pharmacy in tuberculosis case detection (ENHANCE): a study protocol for an implementation study in Indonesia

IntroductionA significant number of possible tuberculosis (TB) missing cases are still reported globally. Pharmacies are reported as a significant first point of contact for people with TB. Unfortunately, the practice of TB detection in pharmacies is still lacking. Therefore, this study aims to implement and evaluate a community pharmacy program for TB case finding in a systematic and structural approach.MethodsAn implementation study will be piloted in Bandung City, Indonesia, from February to November 2025. The program will engage pharmacy personnel in screening, educating, and referring people with presumed TB to community health centers (CHCs) for further diagnostic work-up. This study will involve selecting 20 pharmacies and 4 CHCs. Sequential research activities will be performed, incorporating quantitative and qualitative approaches, i.e., (1) building a coalition, (2) developing a conceptual program, (3) program socialization and educational intervention, and (4) program implementation and evaluation. The program outcomes will be reached according to the sequential research activities: (1) a joint agreement among the key actors and implementers, (2) a conceptual program for implementation, (3) improved capacity of implementers and availability of practice aids and system for the implementation, (4) the effectiveness of the program implementation. The Consolidated Framework for Implementation Research will be used as a framework in this study. Descriptive and multivariable analyses will be used for quantitative data, while thematic analysis will be used for qualitative data. Finally, an implementation outcome will be comprehensively analyzed, considering the quantitative and qualitative data analyses for the key factors of the successful program.

Engaging Health Professional Doctoral Students in Research Training to Expand Evidence-Based Practice in Rural Substance Use Prevention and Treatment: Curriculum for the Culturally-Centered Addictions Research Training (C-CART) Program

In Arizona, United States, long distances to services, diverse populations, and medical provider shortages impact substance use disorder (SUD) prevention and treatment for Indigenous and historically excluded populations. To address these issues, the Culturally-Centered Addictions Research Training Program (C-CART) is designed to engage doctoral students and future and practicing clinicians in culturally-centered, community-engaged, interdisciplinary team-based research. C-CART Scholars engage in team-based projects designed in collaboration with community partners and academic mentors, focusing on culturally-responsive interventions for SUD. Evaluation of the C-CART program indicates significant growth in Scholars’ research skills, cultural competency, and collaboration experiences. The C-CART Curriculum is designed with the goal of advancing health equity and improving SUD treatment outcomes in diverse healthcare settings. This paper describes the C-CART Curriculum with the hope that it will serve as a model for future initiatives that aim to train students in culturally-centered methodologies and further the interests of other diverse communities that are under or improperly served. C-CART’s model is a step toward connecting rural, community-based programs and clinics with university researchers, thereby building trust and improving practice through strong networks and culturally-centered clinical research training.

A Transition to Discharge Program for the Reduction of Early Readmission in a Mental Health Inpatient Unit: Study Protocol

Early readmission to psychiatric units poses a significant challenge for both patients and healthcare institutions. It hampers patient progress and prognosis, and the professional approach taken during discharge can greatly influence the recovery process. This paper proposes a multicomponent discharge transition intervention to mitigate the risk of early readmission to a mental health hospitalization unit (MHHU). The present proposal consists of two distinct phases with two clearly differentiated main objectives. On the one hand, following an observational design, the development of a measurement instrument to assess patients’ risk of early readmission, allowing for stratification into the high-, medium-, and low-risk categories. On the other hand, according to a quasi-experimental design, the implementation and evaluation of the intervention program, with a focus on tailored interventions to ensure adherence and continuity of care post-discharge, with a more intensive approach for high-risk patients. A post-discharge psychotherapeutic group will also be introduced for high-risk cases to support recovery. The program’s effectiveness will be evaluated by comparing the early readmission rates at the Regional Hospital of Malaga’s MHHU to those of the previous year. Two other hospitals in the province, where the intervention is not applied, will serve as control groups. Success will also be measured through pre- and post-assessments of the recovery, functionality, subjective well-being, social support, and treatment satisfaction of those participating in the psychotherapeutic group. This proposal aims to address the issue of early readmission by enhancing predictability and understanding intervention strategies to reduce readmission rates.

Planning Practices and Performance Nexus: The Context of Programme Monitoring and Evaluation

This study aims to establish the relationship between the planning practices in monitoring and evaluation and programme performance at Caritas Meru, Kenya. In this study, a theory of change provides a theoretically grounded, evidence-based approach. It ensures that interventions are systematically planned, monitored, and evaluated in a transparent and adaptable way. Mixed data collection methods were used, including questionnaires, key informant interviews, and focus group discussions. Frequencies, percentages, standard deviations and correlation coefficients were used for analysis. The study revealed a statistically significant but weak relationship between M&amp;E budgeting practice and the performance of livelihood programmes (r = 0.227, p = 0.000). Additionally, it found a very weak significant correlation (r = 0.141, p = 0.000) between monitoring and evaluation planning practices and the performance of livelihood programmes implemented by Caritas Meru, Kenya. The finding contributes to academia and practice by establishing a correlation between planning practices in monitoring and evaluation and performance in livelihood programme at Caritas Meru. Received: 15 February 2025 / Accepted: 27 April 2025 / Published: 06 May 2025

An evaluation of a US college student-athletes’ peer support training program: a pilot project

Purpose This pilot project aims to evaluate the effectiveness of peer support competency training in relation to college student-athletes’ peer support skills and well-being. Design/methodology/approach This project included four 90-min training sessions on peer support competency skills based on the Substance Abuse and Mental Health Services Administration’s peer support core competencies guidelines. A mixed-method design was used to evaluate the effectiveness of the training by measuring their peer support ability and through focus groups to gain insight into their experience. Findings A two-way analysis of variance yielded a significantly higher well-being score at the posttraining. Qualitative data revealed an increased sense of connection during the training period among participants. Research limitations/implications This pilot project had several limitations for generalization. This pilot project consisted of a small sample size, and most of the athletes were recruited from track and field, soccer, lacrosse and cross country. Ongoing peer support program evaluation and future research with student-athletes with diverse backgrounds is essential to promote student-athletes’ mental health. Practical implications Peer support or peer educator program in the athletics department represents an opportunity for universities to provide an accessible mental health resource for student-athletes. To ensure the effectiveness of the peer support program, it is important that mental health professionals in the athletics department provide basic trainings for members in empathy listening skills, self-compassion, coping strategies and mental health resources. Social implications Group experiential training could increase peer support efficacy and strengthen a sense of community. Because peer support programs are not counseling or therapy programs, it allows easy access to mental health support for student-athletes. Originality/value This work has not been submitted elsewhere or under consideration by any other publication. The authors report there are no competing interests to declare.

Characterization and Evaluation of Department of Veterans Affairs Commission on Accreditation of Rehabilitation Facilities-Accredited Interdisciplinary Pain Rehabilitation Programs: Protocol for a Mixed Methods Program Evaluation.

Veterans are more likely to experience chronic pain than civilians, with significant negative impacts on long-term health outcomes. Evidence for the effectiveness of prescription opioids for chronic pain management is limited, and chronic use of opioids is associated with an increased risk of sleep-disordered breathing, cardiovascular complications, and bowel dysfunction, as well as opioid misuse and overdose. Veterans Affairs (VA) and Department of Defense guidelines are prioritizing low-risk, evidence-based interdisciplinary pain management strategies while optimizing pain-related outcomes (PRO) for veterans. Commission on Accreditation of Rehabilitation Facilities (CARF)-Accredited VA Interdisciplinary Pain Rehabilitation Programs (IPRPs) have shared characteristics, while maintaining their unique characteristics as individual pain management programs. Though little is known about the characteristics of VA's IPRPs (eg, staffing, services, and patients served), implementation, and sustainability of these mandated programs. The goals of our operational partner-driven evaluation are to (1) characterize IPRPs across multiple program factors, including but not limited to, service delivery methods, team composition, program characteristics, services and modalities offered, and patients served; (2) triangulate data to inform data visualization that characterizes and illustrates the IPRPs individually and collectively as a system of care; and (3) identify patient-reported outcomes (PROs) and metrics to measure program effectiveness and determine overlap across IPRPs. This partnered-driven program evaluation will use a sequential mixed methods prospective design, including interviews and surveys. The Consolidated Framework for Implementation Research (CFIR), Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, and Expert Recommendations for Implementing Change (ERIC) strategies will be used to contextualize qualitative data. Rapid content analysis will be used to iteratively analyze qualitative data, while descriptive statistics will be used to analyze quantitative data. Datasets will be triangulated to support data visualization for partners to inform clinical and operational decision support. As of April 2025, All IPRP sites are engaged, and survey and interview data have been collected and prepared for analysis. The results and deliverables will inform VA CARF-accredited IPRP characterization, evaluation, and implementation as a learning health system. The results of this evaluation will characterize CARF-accredited IPRPs and identify determinants affecting the implementation of this complex intervention, made up of multiple evidence-based practices. Partner-driven data will inform the state of implementation at each site, and quantitative measures will provide options for collecting standardized outcome measures for continued program evaluation. This operational partner-driven evaluation will inform future efforts for quality improvement to improve veterans' pain management outcomes. This protocol informs the use of a mixed methods approach to evaluate a multimodal intervention (ie, IPRP), made up of multiple evidence-based practices to treat a complex comorbid condition. Future work may include data management infrastructure development and cost evaluations to inform clinical and operational decision-making. DERR1-10.2196/72091.

Evaluation of a hospital-based case management programme for patients who are experiencing homelessness: A qualitative study of health care workers’ experiences with the Navigator Programme

Introduction: People experiencing homelessness (PEH) have poorer health outcomes after hospital discharge compared with housed individuals. The Navigator Programme is a hospital-based case management programme for PEH that connects Homeless Outreach Counsellors (HOCs) with patients during their hospital admission and follows them in the community for approximately 90 days after hospital discharge. This qualitative study explores the experiences of health care workers who provided care for PEH during their hospitalization and who interacted with the Navigator Programme. Methods: As part of a larger process evaluation, we conducted in-depth, semi-structured interviews with health care workers using an iterative interview guide. We employed thematic analysis, using both a deductive and inductive approach. Results: We interviewed 14 participants at a single academic teaching hospital where the Navigator Programme had been implemented. Study participants identified several benefits of having the Navigator Programme embedded in the hospital, including ease of referral, rapid contact between programme staff and patients, high-quality communication with programme staff, and direct observation of the programme's benefits for patients. The programme helped alleviate participants’ moral distress that was triggered by the unmet needs of PEH. However, participants leveraged the Navigator Programme to offload tasks, rather than to support them in accomplishing tasks. Conclusion: Our findings highlight that a hospital-based case management programme is an innovative approach that can address the discontinuity between hospitals and community-based programmes. This programme also addresses the moral injury experienced by hospital-based workers caring for PEH. Role clarification is an important future consideration.

A Comprehensive Program Evaluation of the Little Iggy Center: Stakeholder Satisfaction and Developmental Outcomes

This study employed a Mixed-Methods Program Evaluation Design to assess the effectiveness of the Little Iggy Center, a drop-off learning facility supporting early childhood development and teacher training. Using a convergent parallel approach, the study integrated quantitative and qualitative data to evaluate stakeholder satisfaction, child progress, and program utilization. The study found high satisfaction among parents and student demonstrators, with significant improvements in children’s cognitive, motor, language, and social-emotional skills. However, the study was limited to the first term (January–May) and relied on self-reported data and observational assessments, which may affect the generalizability of the findings. Despite these limitations, the study underscores the importance of structured early childhood education programs in fostering holistic child development and hands-on teacher training. Future research should include longitudinal studies, cross-institutional comparisons, and standardized assessments to improve validity and generalizability. Keywords: Mixed-Methods Research, Early Childhood Education, Program Evaluation, Teacher Training, Child Development, Stakeholder Satisfaction, Developmental Assessment, Educational Research

Implementing User-Focused Monitoring: A Multi-Case Process Study of User Involvement in Service Development

ABSTRACT User-focused monitoring (UFM) is a method for fostering user involvement at organizational levels in the evaluation and quality development of mental health service and support programs. To enhance understanding of factors that promote or hinder the implementation of UFM, we have purposely sampled and followed five Swedish UFM projects through a case study approach, paying specific attention to key components for its sustainable implementation. We collected empirical data through interviews with involved actors during a start-up phase and shortly after the UFM projects ended, and examination of UFM reports. The acquired data were subjected to directed content analysis, guided by normalization process theory. The results highlight the importance of coherence in the goals and methodological procedures for promoting implementation of UFM projects, as well as activation of the engagement of both service users and staff in initial stages.