This article is part of a series on U.S. Department of Veterans Affairs Quality Enhancement Research Initiative (QUERI), edited by (Internal Series) Cheryl B Stetler, Brian S Mittman, Joseph Francis. (Journal Series) Martin P Eccles, Ian Graham .

Research article

Using formative evaluation in an implementation project to increase vaccination rates in high-risk veterans: QUERI Series

Carolyn M Wallace^* and Marcia W Legro^*

Health Services Research & Development, VA Puget Sound Health Care System, Seattle, Washington, USA

author email corresponding author email* Contributed equally

Implementation Science 2008, 3:22doi:10.1186/1748-5908-3-22

Published:	22 April 2008

Abstract

Background

Implementation of research into practice in health care systems is a challenging and often unsuccessful endeavor. The United States Department of Veterans Affairs (VA) Quality Enhancement Research Initiative (QUERI) research teams include formative evaluations (FE) in their action-oriented VA implementation projects to identify critical information about the processes of implementation that can guide adjustments to project activities, in order to better meet project goals. This article describes the development and use of FE in an action-oriented implementation research project.

Methods

This two-year action-oriented implementation research project was conducted at 23 VA Spinal Cord Injury (SCI) Centers, and targeted patients, staff and the system of care, such as administration and information technology. Data for FE were collected by electronic and paper surveys, semi-structured and open-ended interviews, notes during conference calls, and exchange of e-mail messages. Specific questions were developed for each intervention (designed to improve vaccination rates for influenza in veterans with spinal cord injury and disorder); informants were selected for their knowledge of interventions and their use in SCI Centers.

Results

Data from FE were compiled separately for each intervention to describe barriers to progress and guide adjustments to implementation activities. These data addressed the processes of implementing the interventions, problem-solving activities and the status of interventions at SCI Centers.

Conclusion

Formative evaluations provided the project team with a broad view of the processes of implementing multi-targeted interventions as well as the evolving status of the related best practice. Using FE was useful, although the challenges of conducting FE for non-field researchers should be addressed. Work is needed to develop methods for conducting FE across multiple sites, as well as acknowledging variations in local contexts that affect implementation of interventions.