Program Theory and Logic Models (2) CHSC 433 Module 3/Chapter 5 Part 2 L. Michele Issel, PhD UIC 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 Objectives By 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 Theory The turquoise arrow on the far left signifies “first reflect, then do the details”.

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

Interventions l Are those actions done intentionally to have an effect on the program participants. l Are verbs. l Synonyms: medical treatments, pharmacological treatments, psychological therapy, public health regulation enforcement, policy formulation.

l Technologically feasible l Health gains must result l Be politically feasibility l Addresses societal priorities l Be manipulable l Have a reasonable cost Criteria of a Good Intervention

Interventions as Components l Is the intervention a single action or a series, group, package of actions? l Could each set of actions be delivered separately as a package? l 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: l A connection to the overall Effect Theory l An intervention theory l 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

Examples of Interventions for Individuals and Community Individual Level Individual Level: Skills building Information giving Psychotherapy Emotional support Marital counseling Medications Medical or dental procedures Population Level: Population Level: Water fluoridation Media campaigns Immunization programs Policy formation Income supplements Insurance supplements Delivery system changes Air quality control Workplace safety

Approaches to Program Theory Development l Deductive ~ Systematically derive from empirical literature Systematically derive the theory for observations and data l Inductive ~ Articulate what is intuitively being to make a difference, infer from what is being done l 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 do Theory-in-Action=what is really done

Getting at Program Theory

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

Causes of Program Failure l Non-Program No participants No program activities, no interventions l Wrong intervention Not appropriate, not effective for the problem l Unstandardized intervention Variations within program, across sites

Roots of Program Failure Adapted from Carol Weiss

Ending with An Example… The Model of the Health Problem for an example: Goal of Improving Birth Outcomes. ProcessEffect The Process and Effect components are shown.

Effect Theory Example Goal: Improve Newborn Health Status

Corresponding Logic Model Logic Model elements defined in yellow row. Very simplified! InputsProcessesOutputsOutcomes 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