Process evaluation of the Lung Health Ambassador Program in Baltimore schools: Perspectives of school staff and volunteers using the RE-AIM framework

Objective: To evaluate the Lung Health Ambassadors Program (LHAP), a school-based public health programme designed to enhance students’ knowledge, self-efficacy, and advocacy skills regarding lung health, including electronic cigarettes (e-cigarettes), climate change (CC), and rare respiratory diseases. Design: Process evaluation using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Setting: Schools in Baltimore, Maryland, that had implemented the LHAP. Method: We conducted 22 semi-structured interviews with 12 school staff members and 9 LHAP volunteers (LVs). School staff were individuals employed by participating schools who hosted LHAP sessions, while LVs were trained Johns Hopkins University students and affiliated staff responsible for delivering the LHAP curriculum. Interviews explored perceived programme strengths and challenges. We used a combined inductive and deductive analytic approach to identify themes and organise findings using the RE-AIM framework. Results: Overall, staff from the five schools and the LVs who participated were satisfied with LHAP. Adoption of LHAP was facilitated by the programme developer’s existing school/community connections, flexible scheduling, and curricular alignment. Regarding implementation, while many found LHAP relevant and engaging, this varied by grade level and LV delivery, highlighting the need for more age-appropriate content and standardised training. In terms of maintenance, educators hoped for LHAP’s continuation, and LVs valued the programme for skills development without incurring costs, as personal transport was covered, removing participation barriers. Conclusion: LHAP and future public health campaigns should allow flexibility in logistical planning of sessions such as length of time and teaching modality to increase reach. Furthermore, developing a context-specific curriculum was highly beneficial. Identifying and ensuring a standard for the training of teachers may help improve consistency in the future execution of programmes.