Process evaluation of the Rapid Evidence Support System Assessment (RESSA) methodology for health policy-making in Ireland

The Rapid Evidence Support System Assessment (RESSA), developed by the Global Commission on Evidence to Address Societal Challenges, assesses evidence support systems that facilitate evidence-informed policy-making. As evidence-informed policy-making gains prominence globally, systematic assessment of these systems is increasingly important. However, process evaluation of system-level methodologies remains limited, particularly within complex policy environments. This study reports the first process evaluation of the RESSA methodology, conducted alongside an assessment of health policy-making in Ireland involving the Department of Health, the Health Research Board, Evidence Synthesis Ireland, Cochrane Ireland, and the Global Commission on Evidence to Address Societal Challenges. A qualitative process evaluation incorporating a checklist-based fidelity assessment with quantitative elements examined delivery fidelity, stakeholder acceptability, and stakeholder experiences. Three participant groups were included: key informants from the Department of Health and affiliated organizations, members of the project Oversight Group, and the RESSA lead. Delivery fidelity was assessed through qualitative exploration of the RESSA lead’s preparedness and quantitative assessment of protocol adherence to the published RESSA protocol specifications. Qualitative interviews were analysed using a hybrid inductive-deductive thematic approach framed by the pre-specified process evaluation domains, with the Theoretical Framework of Acceptability used to support interpretation of the acceptability findings. Reporting followed the COREQ checklist. The RESSA was delivered with high fidelity, with all eight protocol components implemented as specified (8/8, 100%), and was acceptable to stakeholders across all participant groups. Three cross-cutting findings emerged: internal advocacy and governance structures shaped engagement, implementation success, and potential impact; communication supported stakeholder understanding, engagement, and potential impact; and relational dynamics were central to successful implementation. The RESSA can be implemented with high delivery fidelity, and in a manner acceptable to stakeholders, within complex policy environments. Successful implementation depends not only on methodological fidelity but also on organizational context, governance structures, communication, and stakeholder relationships. This first process evaluation provides methodological insights for implementing future evidence support system assessments and offers practical recommendations to support their adaptation across diverse policy settings.