**Preprint:** https://www.researchsquare.com/article/rs-496628/v1 **Preprint Abstract** **Background** Process evaluations of public health programs are critical to understand if programs were delivered as intended and to identify improvements for future implementations. The aim of this paper is to describe a mixed methods process evaluation of the Sundara Grama intervention, which sought to improve latrine use and safe child feces disposal among latrine-owning households in rural Odisha, India. **Methods** The Sundara Grama intervention was delivered to 36 villages in Puri district by a grassroots NGO and included eight activities: palla performance (folk theater ‘edutainment’), transect walk, community meeting, community wall painting, mother’s meeting on child feces disposal, positive deviant household recognition, household visit, and latrine repairs. The process evaluation quantitatively assessed fidelity, dose delivered, and reach, and qualitatively examined recruitment, context, and satisfaction. Quantitative data collection included an activity observation survey, activity record, and endline trial survey. Qualitative data collection included an activity observation debrief and in-depth interviews with NGO mobilizers. Data collection took place during three time periods: during intervention delivery, immediately after, and several months post-implementation. For the quantitative data, a ‘delivery score’ was calculated for each activity, as well as the proportion of target participants in attendance. Qualitative data was analyzed using thematic analysis. **Results** Mean delivery scores, reported as a percentage, were moderate to high. Household visit activities (97% general visit, 96% positive deviant visit) and the mother’s meeting (81%) had the highest delivery scores, followed by the palla (77%), transect walk (77%), and community meeting (60%). Activities were attended, on average, by 30–73% of latrine-owning households. Several factors aided delivery, including pre-intervention rapport building visits and village stakeholder support. Factors that hindered delivery included inclement weather, certain recruitment strategies, and village social dynamics related to caste and gender. With regard to satisfaction, participants and NGO mobilizers praised the palla but reported mixed reactions to other activities. **Conclusions** Overall, the Sundara Grama intervention was implemented as intended and achieved good reach. The findings suggest edutainment and multi-level communication approaches are particularly beneficial, and offer lessons for community-wide programs on the importance of examining the implementer experience and broader context. **Trial Registration** This trial is registered at clinicaltrials.gov: NCT03274245.
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