How can the results of a qualitative process evaluation be applied in management, improvement and modification of a preventive community trial? The IHHP Study

The study explored the overall quality of program implementation. The participants, including designers of IHHP, stakeholders and community members (n = 60) were purposefully recruited from the intervention areas. Data collected from semi-structured interviews and field notes were analyzed using a modified thematic analysis.Four main themes were identified. Our findings highlighted the key role of the resources as both facilitating and hindering factors. IHHP directors faced incompatibilities arising from negative perceptions/attitudes which resulted in decreased adherence to the program. Hence various strategies were used to motivate, strengthen and organize the human workforce implementing the program.Recommendations arising from evaluation of the program were used in subsequent stages of implementation. Qualitative research is an important component of community trials which can improve their implementation.The high prevalence of cardiovascular diseases and their associated mortality worldwide, including in Iran, have made them a major health concern [1-3]. As a public health response, a comprehensive action-oriented integrated community-based program entitled Isfahan Healthy Heart Program (IHHP) was launched in Iran in 1999-2000.This program has provided an opportunity to assess the effectiveness of lifestyle interventions designed for non-communicable diseases (NCDs) prevention and control in a developing country setting. The long-term objectives of IHHP were to decrease the incidence of NCDs and their related disability/mortality. Improving of the knowledge and awareness of the general population and health professionals about NCDs, and improvement of the skills of health professionals in controlling NCD risk factors constituted the short-term objectives of IHHP [4].Study communities were two intervention counties (Isfahan and Najafabad) and a reference area (Arak), all located in Central Iran. The program had three phases. The first phase, that was conducted