INTRODUCTION

The ultimate purpose of the Newfoundland Heart Health Project (NHHP) was to develop and incorporate into the existing community health system, programming which will contribute to a sustained reduction in heart disease incidence, morbidity and mortality, for the population of Newfoundland and Labrador. The major approaches to program development were those suggested by community development; program implementation was guided by the tenets of innovation-diffusion theory. These theories therefore also guided the evaluation strategies utilized in the NHHP. In addition, the evaluation guidelines developed by the Federal-Provincial Heart Health Initiative identified a "standard minimum core" of evaluative information which could be collected by all Heart Health Programs in order to facilitate interprovincial comparison of program processes and outcomes. Selected key processes, as well as short and long term outcomes within the five strategies (public health system leadership, public education, healthy public policy, strengthening preventative health services and community development) were incorporated into the NHHP evaluation strategy wherever appropriate and feasible.

The evaluation approaches utilized in the Newfoundland and Labrador Heart Health Program were designed to assess both (a) the outcome of the program and (b) the process of program development, implementation and maintenance. Outcome evaluation answers the question "what happened" and in the context of the NHHP, this evaluation strategy examined the extent to which stated program goals (for the project as a whole, and selected subcomponent projects) were achieved. However, the determination of end-point outcomes of the NLHHP was not the primary evaluation focus. Instead, the questions "why or how did it happen" received the major investment of evaluation resources. The Newfoundland and Labrador Heart Health Program, with its emphasis on community development and innovation diffusion, undertook a somewhat different approach to cardiovascular risk reduction than the other Heart Health Programs. Both community-development and innovation-diffusion theories stressed the importance of documenting the factors which impact on process in order to (1) provide timely feedback to program personnel which permits adjustments as necessary and (2) establish blueprints for transferring successful programs/approaches to other jurisdictions. Furthermore, it is generally recognized within the field of health promotion that the nature of the relationships between strategies, environments and outcome is not clearly understood (Epp, 1986). The process evaluation components of the NHHP attempted to provide new information regarding these interrelationships.

As this is the final evaluation report for the NLHHP, the focus of discussion will be on the major learnings from the project (given that numerous sub-project evaluation reports have been submitted with the previous annual reports). This report is organized as follows. First the goals and the objectives for the program are presented. Then, the overall impact of the NLHHP will be reviewed in the context of the program's primary goals and objectives. Next, the discussion will highlight the major findings related to process and implementation of the program. Concluding remarks will summarize the significance of the project in terms of its (a) impact on the health system in the province and (b) contribution to knowledge in the field of health promotion.