Process evaluation of the implementation of scorecard-based antenatal risk assessment, care pathways and interdisciplinary consultation: the Healthy Pregnancy 4 All study

•The Healthy Pregnancy 4 All (HP4All) study was initiated to improve perinatal outcomes in The Netherlands.•The HP4All study is a complex intervention where optimal linkage was sought between curative and preventive antenatal care.•This process evaluation aims to evaluate the implementation of the risk assessment sub-study with a seven-step process.•The intervention provides a vehicle for new partnerships between the curative and preventive antenatal healthcare sector.•The results are used to get a better understanding of the associations between programme elements and programme outcomes.

ObjectiveTo evaluate the implementation of a complex intervention in the antenatal healthcare field in 14 Dutch municipalities. The intervention consisted of the implementation of a systematic scorecard-based risk assessment in pregnancy, subsequent patient-tailored care pathways, and consultations of professionals from different medical and social disciplines.MethodsSaunders's seven-step method was used for the development of a programme implementation monitoring plan, with specific attention to the setting and context of the programme. Data were triangulated from multiple sources, and prespecified criteria were applied to examine the evidence for implementation.ResultsSix out of 11 municipalities (54%) met the implementation criteria for the entire risk assessment programme, whereas three municipalities (27%) met the criteria if the three components of implementation were analysed separately.ConclusionsA process evaluation of implementation of a complex intervention is possible. The results can be used to improve understanding of the associations between specific programme elements and programme outcomes on effectiveness of the intervention. Additionally, the results are important for formative purposes to assess how future implementation of antenatal risk assessment can be improved in comparable contexts.