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Program Theory and Logic Models (2)
CHSC 433CHSC 433
Module 3/Chapter 5 Part 2Module 3/Chapter 5 Part 2
L. Michele Issel, PhDUIC School of Public Health
Theory (Part 1) & (Part 2)
In Theory (Part 1), we cover: • Model of the Health Problem as a starting point.• What is the Program Theory• What is the Effect Theory• What is the Process Theory
In Theory (Part 2), we cover:• Good interventions• The Pyramid• Development of Program Theory• Roots of program failure
Learning ObjectivesBy the end of this module, you will be able to:
1. Define interventions and give examples of “good” interventions.
2. Outline the steps involved in developing a program theory.
3. Develop a program logic model.4. Explain two ways in which a program
can fail.
Program TheoryThe turquoise arrow on the far left signifies “first reflect, then do the details”.
Process Theory
Service Utilization Plan(Activities, Interventions)
OrganizationalPlan
(Inputs, Capacity)
Outputs(Products)
Longer termHealth Effects(OUTCOMES)
Initial HealthEffects
(IMPACT)
Planning andThinking
Foundation
Process Objectives Impact and Outcome Objectives
ProgramDelivery
andImplementa-
tionReality
Program Theory
Effect Theory
It’s all about the intervention
The Organizational Plan and the Service Utilization Plan (as the two main elements of the Process Theory) exist to enable the delivery of the intervention.
Elements of Effect Theory
Hampering factors(Assets and
INTERVENTIONS)
HelathProblem:Outcome
HealthIndicators:
Impact
Intervention Theory
Outcome Theory
Determiniant factorsof the health
problem
Causative Theory
Impact Theory
Contributing factorsto the health
problem
Antecedentfactors
EffectTheory
InterventionsInterventions
Are those actions done intentionally to have an effect on the program participants.
Are verbs. Synonyms: medical treatments,
pharmacological treatments, psychological therapy, public health regulation enforcement, policy formulation.
Technologically feasible
Health gains must result
Be politically feasibility
Addresses societal priorities
Be manipulable
Have a reasonable cost
Criteria of a Criteria of a Good InterventionGood Intervention
Interventions as ComponentsInterventions as Components
Is the intervention a single action or a series, group, package of actions?
Could each set of actions be delivered separately as a package?
Do the packages of actions have different effects?
If the intervention consists of packages, then the program has components!
Caveats to Components
For each intervention, whether delivered singularly or as a program component, there needs to be:
A connection to the overall Effect Theory
An intervention theory Supporting Organizational and
Service Utilization Plans
Considering Community
Increasing federal agency emphasis placed on changing health across entire communities, not just of individuals or groups of individuals.
Think Interventions and Program Theory Across the Pyramid
Direct Health Care
Services____________________
Enabling Services___________________________
Population-Based Services___________________________________
Infrastructure Services
Examples of Interventions for Individuals and Community
Individual LevelIndividual Level: Skills building Information giving Psychotherapy Emotional support Marital counseling Medications Medical or dental procedures
Population Level:Population Level:Water fluoridation Media campaignsImmunization programsPolicy formation Income supplements Insurance supplements Delivery system changesAir quality controlWorkplace safety
Approaches to Program Theory Development
Deductive ~ • Systematically derive from empirical literature
• Systematically derive the theory for observations and data
Inductive ~ • Articulate what is intuitively being to make a
difference, infer from what is being done
User-focused ~ • Ask the evaluation users how the program works
Deduce, Induce
Deduction as common approach to generate Effect Theory.
Induction as useful to identify the Espoused and Theory-in-Action ~ these are key to both Effect and Process Theories.
Espoused=what claim to doTheory-in-Action=what is really
done
Getting at Program Theory
Effect Theory Espoused Theory Theory in Use What It Is Explanation of how
program interventions effect participants
What staff say is how the program effects participants
What staff do to effect participants
Where Resides
Manuals and procedures; program descriptions
Minds of program staff; program manuals and descriptions
Actions of program staff; on the job training
How Identified
Review of scientific literature, program materials
Listen to staff describe the program, read program materials
Watch what staff do in providing the program
Importance Guides program and evaluation; Basis for claiming outcomes
Becomes what staff, clients, and stakeholders believe and expect of the program
Is the actual cause of program outcomes
Logic Models are ...
Graphic or tabular representation of how program processes are linked to outcomes
Required of federal program grantees, and various foundation grantees.
Revised and revised and revised as the planning evolves.
Limitations of Logic Models
! Do NOT explain how the intervention causes the effect !
Thus, the need for the Effect Theory based on the
Model of the Health Problem.
The Logic of Logic Models
Useful in: Streamlining program and
evaluation Focusing on key, critical elements Communicating complex ideas to
variety of audiences Checking that it all fits together
To Avoid Program Failures
Choose empirically tested intervention based on a biological, psychological, behavioral, or social theory that FITFIT the health problem.
Choose intervention that FITFIT the logics.
Program Theory is the reality check for those choices.
It’s all about stacking the deck in your It’s all about stacking the deck in your favor.favor.
Causes of Program Failure
Non-Program• No participants• No program activities, no interventions
Wrong intervention• Not appropriate, not effective for the
problem
Unstandardized intervention• Variations within program, across sites
Roots of Program FailureAdapted from Carol Weiss
ProgramInterventions
ProgramInterventions
ProgramInterventions
CausalProcess
Desired Effect
CausalProcess
CausalProcess
Desired Effect
Desired Effectdid not set intomotion
did not leadto
set into
motion
which led to
which would
have led to
SuccessfulProgram
Effect TheoryFailure
ProcessTheoryFailure
set into
motion
Ending with An Example…
The Model of the Health Problem for an example:
Goal of Improving Birth Outcomes.
The ProcessProcess and EffectEffect components are shown.
Effect Theory Example Goal: Improve Newborn Health Status
ASSETS: Family support, Grocerty stores
INTERVENTIONS:Prenatal vitamins, nutritioneduction
HealthProblem:
Birthdefects
HealthIndicators:Newborn
CNS,prenatalanemia
Intervention Theory
Outcome Theory
Determiniants:Poor dietary intake, age,
parity
Causative Theory
Impact Theory
Contributing factors:genetics
Antecedent factor:Lack of knowledge
Corresponding Logic ModelLogic Model elements defined in yellow row. Very
simplified!
Inputs Processes Outputs OutcomesResources, structures identified in the organizational plan
Actions and Interventions explicated in the Services Utilization Plan
Secondary products
Changes in the target audience
Health educatorsProgram budgetLocationSupervisionOrganizational commitment
Provide prenatal vitaminsProvide nutritional education
Handouts for participants
Referrals to genetic testing
No prenatal anemia
No CNS defects
Increased knowledge
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