This article describes the importance and role of 4 stages of formative evaluation in our growing understanding of how to
implement research findings into practice in order to improve the quality of clinical care. It reviews limitations of traditional
approaches to implementation research and presents a rationale for new thinking and use of new methods. Developmental, implementation-focused,
progress-focused, and interpretive evaluations are then defined and illustrated with examples from Veterans Health Administration
Quality Enhancement Research Initiative projects. This article also provides methodologic details and highlights challenges
encountered in actualizing formative evaluation within implementation research.
Key words process assessment (health care) - evaluation methodology - evaluation studies
An earlier version of this article was included in materials to support the State of the Art of Implementation Conference.
The conference was conducted by the Department of Veterans Affairs, Office of Research and Development, Health Services Research
and Development Service, and was held in Washington, DC, from August 30 to September 1 2004.
The work reported here was supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services
Research and Development Service. The views expressed in this article are those of the authors and do not necessarily represent
the views of the Department of Veterans Affairs.