Program Theory and Logic Models (2)

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Program Theory and Logic Models (2)

• CHSC 433
• Module 3/Chapter 5 Part 2
• L. Michele Issel, PhD
• UIC School of Public Health

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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

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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.

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Program TheoryThe turquoise arrow on the far
left signifies first reflect, then do the
details.
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Its 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.

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Elements of Effect Theory
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Interventions

• 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.

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Criteria of a Good Intervention

• Technologically feasible
• Health gains must result
• Be politically feasibility
• Addresses societal priorities
• Be manipulable
• Have a reasonable cost

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Interventions 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!

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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

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Considering Community

• Increasing federal agency emphasis placed on
  changing health across entire communities, not
  just of individuals or groups of individuals.

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Think Interventions and Program Theory Across
the Pyramid
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Examples of Interventions for Individuals and
Community

• Individual Level Skills building Information
  giving Psychotherapy Emotional support Marital
  counseling Medications Medical or dental
  procedures

• Population LevelWater fluoridation Media
  campaignsImmunization programsPolicy formation
  Income supplements Insurance supplements
  Delivery system changesAir quality
  controlWorkplace safety

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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

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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.
• Espousedwhat claim to do
• Theory-in-Actionwhat is really done

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Getting at Program Theory
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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.

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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.

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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

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To Avoid Program Failures

• Choose empirically tested intervention based on a
  biological, psychological, behavioral, or social
  theory that FIT the health problem.
• Choose intervention that FIT the logics.
• Program Theory is the reality check for those
  choices.
• Its all about stacking the deck in your favor.

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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

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Roots of Program FailureAdapted from Carol Weiss
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Ending with An Example

• The Model of the Health Problem for an example
• Goal of Improving Birth Outcomes.
• The Process and Effect components are shown.

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Effect Theory Example Goal Improve Newborn
Health Status
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Corresponding Logic ModelLogic Model elements
defined in yellow row. Very simplified!
Inputs Processes Outputs Outcomes
Resources, structures identified in the organizational plan Actions and Interventions explicated in the Services Utilization Plan Secondary products Changes in the target audience
Health educators Program budget Location Supervision Organizational commitment Provide prenatal vitamins Provide nutritional education Handouts for participants Referrals to genetic testing No prenatal anemia No CNS defects Increased knowledge