A Pragmatic Approach to Qualitative Formative Evaluation of an Integrated Primary Care Program in Togo, West Africa

Abstract

Despite the utility of formative evaluation in implementation research, few published projects in low-and middle-income countries have used this approach and incorporating qualitative data into implementation projects can be challenging. Implementation science and qualitative formative evaluation can help inform the delivery of evidence-based practices, specifically identifying gaps in service delivery and implementation fidelity. Including stakeholders in formative evaluation facilitates actionable feedback and practical problem-solving of real-time implementation challenges. This paper presents a real-world example of qualitative formative evaluation that was used to inform the implementation of an integrated healthcare intervention in Togo, West Africa. We organize our results around the five main advantages of implementation-focused formative evaluation that can provide context-specific data useful for implementation teams: (a) highlighting actual versus planned interventions; (b) enabling implementation through identification of modifiable barriers; (c) facilitating any needed refinements in the original implementation intervention; (d) enhancing interpretation of project results; and (e) identifying critical details and guidance necessary for replication of results in other clinical settings. We provide specific examples of how these qualitative findings provide context-specific data and result in actionable steps, with a specific focus on including program implementers and stakeholders in the process. This paper describes lessons learned from the implementation of qualitative implementation-focused formative evaluation. Clinical Trial Registration ClinicalTrials.gov, NCT03694366 (registered 10/03/2018).