JMIR Publications

ABSTRACT

Background:

The application-based salt reduction intervention program in school children and their families (AppSalt) is a multi-component mobile health (m-health) intervention program, which will involve multiple stakeholders, including students, parents, teachers, school heads, and local health and education authorities. The complexity of AppSalt program highlights the need for process evaluation to investigate how the implementation will be achieved at different sites.

Objective:

This paper presents a process evaluation protocol of the AppSalt program, which aims to monitor the implementation of the program, explain its causal mechanisms, and provide evidence for scaling up the program nationwide.

Methods:

Mixed methods will be used to collect data relating to five process evaluation dimensions: fidelity, dose delivered, dose received, reach, and context. Quantitative data, including app usage logs, activity logs and routine monitoring data, will be collected alongside the intervention process to evaluate the quantity and quality of intervention activities. The quantitative data will be summarized as medians, means, and proportions as appropriate. Qualitative data will be collected through semi-structured interviews of purposely selected intervention participants and key stakeholders from local health and education authorities. Thematic analysis technique will be used for analysing the qualitative data with the support of NVivo 12. The qualitative data will be triangulated with the quantitative data during the interpretation phase to explain the five process evaluation dimensions.

Results:

The intervention activities of the AppSalt program was initiated at 27 primary schools in three cities since October 2018. We have completed the one-year intervention of this program. The quantitative data for this study, including app usage log, activity logs and the routine monitoring data have been collected and organized during the intervention process. After completing the intervention, we conducted semi-structured interviews with 32 students, 32 parents, 9 teachers, 9 school heads, and 8 stakeholders from local health and education departments. The data analysis is currently underway.

Conclusions:

Using m-health technology for salt reduction among primary school students is an innovation in China. The findings of this study will help researchers understand the implementation of the AppSalt program and similar m-health interventions in real-world settings. Furthermore, this process evaluation will be informative for other researchers and policymakers interested in replicating the AppSalt program and design their salt reduction intervention. Clinical Trial: Trial registration number: ChiCTR1800017553.