A process evaluation framework, including the domains, dimensions, research questions and data

collection methods (Table 1), was developed using the process evaluation literature [47, 49, 52, 69], as
well as relevant published applications in public health [70, 71] together with complex system theory
[53]. Accordingly, this mixed methods study included quantitative measures of intervention activities
and qualitative exploration of the interaction between the three domains of intervention
implementation, participant response to the intervention, and the context that mediated this
relationship. The domain of intervention context was populated according to seven established “pillars”
(geographical, political, ethical, legal, epidemiological, socio-cultural, and socio-economic structures)
and at the macro (i.e. national systems and structures), meso (i.e. institutional and community) and
micro (i.e. participants and local surroundings) levels, according to models developed in the literature
[49, 50, 72].

Process
Core
evaluation Research Study
information Data source Data type
domains and question population
sought
dimensions
Domain 1: Implementation
1. Intervention Semi-
MSF staff
description structured
implementing
interviews
Overall design of the
(SSIs) and
the intervention intervention
intervention
including site, (e.g. field
reports and
a. What was the population, coordinators,
surveillance
design of the health care medical, Qualitative
data from the
intervention? facility and logistics,
local &
structure, WASH,
national
rationale and supply and
government
timeline health
including
promotion
georeferenced
coordinators)
maps
b. What are the Content of the   MSF cholera Qualitative
components of intervention guidelines,
the intervention? including the supply and kit
intervention catalogues,
components and intervention
selection reports and
activity records
(e.g. supply
chain freight
manifests,
purchase
orders,
distribution
 Process
Core
evaluation Research Study
information Data source Data type
domains and question population
sought
dimensions
lists,
attendance
registers)
2. Delivery MSF staff,
format local
government SSIs,
and national intervention
Qualitative/
agencies (e.g. timeline and
Quantitative
WASH and intervention
health clusters, reports
PNECHOL-
Description of
MD)
targeted area,
MSF staff,
Where and when population size,
local
was the health care
government
intervention facility structure
and other
delivered? and environment,
organisations
and timeline of SSIs,
(e.g. Save The
the intervention intervention
Children, Qualitative/
timeline and
UNICEF, Quantitative
intervention
Solidarities
reports
International,
Catholic
Relief
Services,
Action Aid)
Documentation
of other
interventions
What other locally and
MSF staff,
interventions nationally
local SSIs and
(WASH and non- including the Qualitative/
government intervention
WASH) were number of Quantitative
and other reports
provided by “competing”
organisations
MSF? programmes, or
components
reaching the
target population
What other Documentation MSF staff, SSIs and Qualitative
agencies were of the other local intervention
involved in agencies and government reports
implementation? government and other
 Process
Core
evaluation Research Study
information Data source Data type
domains and question population
sought
dimensions
structures
operating in the
targeted area,
including their organisations
roles and
perceptions on
the intervention
Documentation MSF staff Structured Qualitative/
How was the
of the delivery (e.g. CHWs) observations Quantitative
intervention
format, timing
demonstrated and MSF staff & SSIs and
and interaction
explained to intervention intervention Qualitative
with intervention
users? recipients reports
recipients
Human, material MSF staff, SSIs,
What resources
and financial local intervention
were used to Qualitative/
resources utilised government reports,
implement the Quantitative
by the and other activity records
intervention?
intervention organisations and budgets
SSIs,
Number of
intervention
interventions
How many reports and
delivered and
interventions   activity records Quantitative
number of
were delivered? and
3. Dose planned
surveillance
delivered and interventions
data
implementation
Documentation
fidelity
Was the of the content,
MSF staff & SSIs and
intervention quality, successes Qualitative/
intervention intervention
delivered as and challenges of Quantitative
recipients reports
planned? the intervention
delivered
Domain 2: Participant response
Number of
How many interventions
4. Dose Intervention
interventions received in the SSIs Qualitative
received recipients
were received? households of
recipients
5. Intervention How many Number of Intervention SSIs Qualitative
reach people interacted people in the recipients
with the household who
intervention? interacted with
 Process
Core
evaluation Research Study
information Data source Data type
domains and question population
sought
dimensions
And their uptake the
of the intervention and
intervention? use
Comprehension
of emotional
What were the responses to the
levels of intervention, Intervention
6. Acceptability SSIs Qualitative
participation and acceptability of recipients
satisfaction? the intervention
and component
preferences
Obstruction Intervention
(physical and/or recipients,
What were the emotional MSF staff,
7. Barriers barriers to using barriers) to the local SSIs Qualitative
the intervention? intervention and government
concerns with the and other
intervention organisations
How and why Retention of key
was the messages, target
Intervention Qualitative/
8. Maintenance intervention behaviours and SSIs
recipients Quantitative
sustained over reflections of the
time (or not)? intervention
What effects
Reasons for any Intervention
were not
deviation from recipients,
captured or were
the intended MSF staff,
9. Unintended there unexpected
activities, local SSIs Qualitative
consequences outcomes, both
interaction with government
related to the
and use of the and other
intervention and
intervention organisations
unrelated care?
Domain 3: Context
Context What was the Characteristics of MSF staff, SSIs, Qualitative
context? the delivery local intervention
context government reports,
(geographical, and other activity records
political, legal, organisations and budgets
ethical,
epidemiological,
sociocultural,
socioeconomic)
 Process
Core
evaluation Research Study
information Data source Data type
domains and question population
sought
dimensions
Organisational
context: culture,
agenda,
priorities,
What external MSF staff,
leadership styles
factors affected local SSIs and
and perceptions
the government intervention Qualitative
of leaders,
implementation and other reports
perceptions on
and the outcome? organisations
research and
evaluation, and
other contextual
factors