Sustainable community health improvement often requires the implementation of complex interventions in complex systems. Drawing from the Four Keys to Success frame (theory, implementation, support, and evaluation), this article describes how we used a formative evaluation approach to foster a learning system capable of monitoring and addressing emerging community needs within the Spreading Community Accelerators Through Learning and Evaluation (SCALE) initiative—a national capacity-building effort to support 24 community coalitions’ progress toward a Culture of Health. The formative evaluation approach resulted in critical advancements to the theory, implementation, and nature of supports provided in SCALE. These improvements enabled the SCALE evaluation team to shift from the initial focus on program implementation issues to a greater emphasis on downstream factors (community-level outcomes). The ability of formative evaluation to grapple with the emerging challenges of implementing complex interventions in complex systems makes it particularly valuable for community health improvement initiatives.

中文翻译：

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形成性评估和复杂的健康改善计划：改进理论、实施、支持和评估的学习系统

可持续的社区健康改善通常需要在复杂系统中实施复杂的干预措施。本文借鉴成功的四个关键框架（理论、实施、支持和评估），描述了我们如何使用形成性评估方法来培养学习系统，该系统能够通过学习和传播社区加速器来监控和解决新兴社区需求。评估 (SCALE) 计划——一项国家能力建设工作，旨在支持 24 个社区联盟在健康文化方面取得进展。形成性评估方法使 SCALE 提供的支持的理论、实施和性质取得了重大进展。这些改进使 SCALE 评估团队能够从最初关注计划实施问题转向更加重视下游因素（社区层面的成果）。形成性评估能够应对在复杂系统中实施复杂干预措施的新挑战，这使得它对社区健康改善计划特别有价值。