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Pragmatic, formative process evaluations of complex interventions and why we need more of them
  1. Rhiannon Evans,
  2. Jonathan Scourfield,
  3. Simon Murphy
  1. DECIPHer, School of Social Sciences, Cardiff University, Cardiff, UK
  1. Correspondence to Dr Rhiannon Evans, DECIPHer, School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff CF103BD UK; EvansRE8{at}cf.ac.uk

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Recently published guidance on process evaluations by the Medical Research Council's (MRC's) Population Health Sciences Research Network (PHSRN) marks a significant advance in the evaluation of complex public health interventions.1 ,2 In presenting programmes as not just a set of mechanisms of change across multiple socioecological domains, but as an interaction of theory, context and implementation, the guidance extends the remit of evaluation and forces us to reassess the responsiveness of existing methodologies and frameworks. Process evaluations have emerged as vital instruments in reacting to these changing needs, through: the modelling of causal mechanisms; the identification of salient contextual influences; and the monitoring of fidelity and adaptations, which permits the circumvention of type 3 errors.3

While the guidance offers an instructive set of standards, the authors’ acknowledgement that there is no such thing as a ‘typical’ process evaluation1 ensures continued scope for debate and development around this framework. Specifically, the predominant focus on embedding process evaluations within definitive effectiveness trials encourages further theoretical and practical exploration of formative process evaluation. This approach is defined by the preclinical and first phase of the MRC's guidance on the development and evaluation of complex interventions.4 ,5 The preclinical phase involves the development of the intervention's theoretical rationale, primarily through consultation of the relevant literature. Meanwhile, phase 1 focuses on the modelling of processes and outcomes in order to identify underpinning …

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