Process evaluation of a community-based program for prevention and control of non-communicable disease in a developing country: The Isfahan Healthy Heart Program, Iran

The process evaluation addresses the internal validity of IHHP by ascertaining the degree to which the program was implemented as intended. The IHHP process evaluation is a triangulated study conducted for all interventions at their respective venues. All interventional activities are monitored to determine why and how some are successful and sustainable, to identify mechanisms as well as barriers and facilitators of implementation.The results suggest that factory workers and managers are satisfied with the interventions. In the current study, success was mainly shaped by the organizational readiness and timing of the implementation. Integrating most of activities of the project to the existing ongoing activities of public health officers in worksites is suggested to be the most effective means of implementation of the health promoting activities in workplaces.The results of our experience may help other developing countries to plan for similar interventions.Cardiovascular diseases (CVD) are the leading cause of mortality worldwide [1]. It is well documented that unhealthy lifestyle may account for as much as 50% of CVD-related mortalities [2]. Lifestyle modification has long been considered essential in curbing non-communicable diseases notably cardiovascular diseases [3]. However, the efficacy of such interventions in developing countries is less clear and data from interventional studies in such countries are limited. Moreover, there is paucity of interventional studies targeting the whole community; most have selected specific groups rather than the whole community. In 1995, circulatory diseases, mainly CVD, accounted for 47.3% of all Iranian deaths, with a higher prevalence among people of lower socio-economic status [4]. As a public health response to the high prevalence of CVDs in Iran, a six-year, action oriented, comprehensive and integrated community-based study, entitled Isfahan Healthy Heart Program (IHHP), was designed and launched in 2000. This program