Program Theory and Logic Models (1) CHSC 433 Module 2/Chapter 5 Part 1 L. Michele Issel, PhD UIC School of Public Health.

Program Theory and Logic Models (1)

CHSC 433CHSC 433

Module 2/Chapter 5 Part 1Module 2/Chapter 5 Part 1

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

Slicing Oranges

There are many ways to slice an orange: longitudinally, across the “equator” or diagonally. You can peel it and pull it a part.

Each type of slice lets you see a different aspect of the orange’s structure. You gain the best understanding of an orange from having sliced an orange all these directions.

So it is with Program Theory. Each theory, model “picture” is a type of slice of the future program.

Learning ObjectivesBy the end of this module, you will be able to:

1. Identify the major elements of a Program Theory.

2. List key characteristics of the Process Theory.

3. List key characteristics of the Effect Theory.

4. Explain the relationship of program theory to the implementation and evaluation.

Theory is...

A set of statements (hypotheses) about the relationships among concepts.

A description (made in the form of hypotheses) of how concepts are related, interact, and are temporally sequenced.

Use the Community Diagnosis

Factors identified from the “Community Diagnosis” are modeled as a set of relationships.

The relationships (in the diagram) constitute a working, tentative theory about the program.

Model of the Health Problem: Relationship of Intervention, Factors,

and Health Effects

Hampering factors(Assets and

INTERVENTIONS)

HelathProblem

HealthIndicators

Risk of:

Determiniant factors ofthe health problem

As demonstrated in

Contributingfactors to the

health problem

Antecedentfactors

Among target audience

The Model of the Health Problem Reveals:

1. That the interventions do not really go “upstream” to address antecedent causes.

2. That interventions generally do not address contributing factors.

3. Intervention’s strongest influence is on the determinants of the health problem.

From Model of the Health Problem

to Program Model

The Model of the Health Problem is a working theory.

This working theory is the beginning, and becomes formalized and explicated as the Program Theory.

Program Theory

A set of relationships between what is done and what will change for program participants• What is done is Process Theory• What will change is Effect Theory

Program Theory

Current language for explaining

the connection between what do

(process, effort)

and what difference the program

makes (effect, impact/outcome).

Not created all at once

Begins with a foundation of thinking and planning during which the big pieces are outlined.

Continues with detailing and tailoring to specific realities of the program implementation and evaluation.

A “picture” of the parts of Program Theory

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

Functions of Program Theory

Guides program staff activities Guides the evaluation plan Facilitates explaining what went right or

wrong and why program failure occurred Facilitates communication among

stakeholders Necessary for making scientific

contribution

Program Theory Use

Enables explanations of what went right or wrong, in other words why the program failed to achieve the desired effect.

This is critical for an evaluation to be useful and informative.

Here’s how to generate useful program theory.

Steps involved in Creating a Program Theory

Draw upon the scientific literature to identify which theories and interventions are known to be effective in addressing the health problem.

Involve selected stakeholders in developing the Program Theory.

Temporally sequence the causal chain of events.

Specify “dose” and “mode of administration” of the intervention delivered in the program.

Steps continued

Construct a logic model, with or without additional diagrams or drawings of the causal chain of events.

Check the model against• Assumptions held by program staff and

stakeholders• Available resources and commitments• The science behind the final intervention, health

problem and target audience.

Start from where you want to end up…

Work “backwards” through the Program Theory • From the health outcome goal • To the intervention• To the program infrastructure

Start by generating the Effect Theory

Effect Theory

Relationship of the intervention to determinants of the health problem.

Thus, explains how the interventions will lead to the impacts and outcomes.

Based on knowledge from the relevant sciences about the health problem.

Effect Theory

Takes into account contributing and antecedent factors to the health problem that will and will not be addressed.

Specifies where the causal chain--from determinants to health health--will be “broken” by the interventions, thus effecting the health problem.

Connections among Components of Program Theory

The next slide is a diagram of the

causative theory, intervention theory, impact theory, and outcome theory

as related and useful in

developing the InterventionIntervention element of

ProcessProcess and EffectEffect Theories.

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

Interventions are chosen and designed based on existing theories about health and illness

Next slide lists theories as they pertain to four domains of an individual’s health: physical, psychosocial, knowledge, behavior. These are a few examples.

Effect Theory

Examples of Theories Used in Effect Theory,

by Type of Individual Health Outcome

Physical Health

Psychosocial Health

Knowledge and Abilities

Self-Care and Lifestyle Behaviors

Patho- physiology Immunology Endocrinology Pharmacology Wound healing Biochemistry Metabolism

Psychopathology Social cognition Stress and coping Family functioning Addiction Violence

Learning Communication Cognition Attention Memory Diffusion of innovation Acculturation

Peer pressure Decision making Self-efficacy Self-worth Risk taking Social stratification

Process Theory

Process Theory explicates what has to be

done in order to have a program.

Process theory contains two major

elements, or components:

Organizational plan

Service utilization plan

Organizational Plan

Specifies how to garner, configure,

and deploy resources, organize

program activities so that the

intended programmatic

intervention is developed and

maintained.

Service Utilization Plan

Specifies how the intended target

audience receives the intended

amount of the intended

intervention through interaction

with the program’s service delivery

system.

A word about Satisfaction…

Many, many problems with relying on consumer satisfaction:

1. Measures have a ceiling effect (generally 4.5-4.8 on 1-5 scale)

2. Clients report high satisfaction to minimize dissonance

3. Dissatisfied rarely reply4. Satisfaction says nothing about impact

or outcome from the program

Not really done…

This is end of Theory (1). Theory (2) is a continuation of this presentation on Program Theory.

Please take a short break. Then continue with the Theory (2) PowerPoint presentation. Then you will have covered the Theory “lecture”.