Program Theory and Logic Models (2) CHSC 433 Module 3/Chapter 5 Part 2 L. Michele Issel, PhD UIC School of Public Health.

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