Table 2 Description of the different theoretical approaches used in the GACD process evaluations

MRC Process Evaluation Framework

The MRC Process Evaluation Framework is designed for complex interventions. The framework explains that outcomes in an intervention are a result of configuration of implementation (structures, resources, and processes), context (internal and external social, cultural and economic factors) and mechanisms (reasoning among program participants) [2, 10].

Realist Evaluation

The Realist Approach to process evaluation is based on Pawson and Tilley’s realist thinking that answers the questions “what works for whom, under what conditions and how” [10, 16, 17]. Realist evaluation examines underlying mechanisms (participants’ reasoning and how they interacted with the intervention) and how they impacted on the outcomes in different contexts [11].

Community Based Participatory Evaluation Theory

In Community Based Participatory Evaluation theory, researchers argue that participatory evaluation theory is an ideal framework for process evaluations when trials are implemented in multiple cultural settings [7]. A constructivist approach is incorporated where individuals and communities participate in focus groups to give their views and lived experiences of the intervention based on the evaluation framework [7].

RE-AIM Framework

The RE-AIM framework was developed to measure how interventions that have proved effective in one area, can be expanded to a wider scale in multiple areas [12]. The framework offers a standardized framework of five dimensions: Reach (participation of target population), Efficacy (effects of the program), Adoption (uptake of the intervention), and Implementation (extent to which the intervention is implemented as intended) and Maintenance (sustainability of the intervention’s benefits) [12].

Four Level Evaluation Model

The ‘four level’ evaluation model for training programs by Kirkpatrick & Kirkpatrick, presents different levels for evaluating training programs. The levels include: the degree to which participants react favorably, the degree to which participants acquire the intended knowledge and skills, the degree to which participants apply what they have learned and the degree to which targeted outcomes occur [13].

Phenomenology

Phenomenological research, drawn from anthropology and social sciences, describes “lived experience” and people’s perspective on a given issue (or phenomenon) and their interpretation thereof. This usually involves qualitative analysis of narrative data [14].

Framework Analysis

The Framework analysis method developed by Jane Ritchie and Liz Spencer is suitable for thematic analysis of qualitative and textual data. The approach provides a step-by-step method of structuring the data in a matrix to compare and contrast data. The steps include: transcription, familiarization with the data, coding, developing a working analytical framework, applying the analytical framework, charting data into the framework matrix and Interpreting the data [15].