Program Theory and Logic Models (1)

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Program Theory and Logic Models (1)

• CHSC 433
• Module 2/Chapter 5 Part 1
• 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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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 oranges 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.

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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.

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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.

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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.

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Model of the Health Problem Relationship of
Intervention, Factors, and Health Effects
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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. Interventions strongest influence is on the
   determinants of the health problem.

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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.

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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

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Program Theory

• Current language for explaining
• the connection between what do (process, effort)
• and what difference the program makes (effect,
  impact/outcome).

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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 ?

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

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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.
• Heres how to generate useful program theory.

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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.

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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.

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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

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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.

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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.

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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 Intervention element of Process
  and Effect Theories.

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Elements of Effect Theory
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Effect Theory

• 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 individuals health physical,
  psychosocial, knowledge, behavior. These are a
  few examples.

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Examples of Theories Used in Effect Theory, by
Type of Individual Health Outcome
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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

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Organizational Plan

• Specifies how to garner, configure, and deploy
  resources, organize program activities so that
  the intended programmatic intervention is
  developed and maintained.

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Service Utilization Plan

• Specifies how the intended target audience
  receives the intended amount of the intended
  intervention through interaction with the
  programs service delivery system.

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A word about Satisfaction

• Many, many problems with relying on consumer
  satisfaction
• Measures have a ceiling effect (generally 4.5-4.8
  on 1-5 scale)
• Clients report high satisfaction to minimize
  dissonance
• Dissatisfied rarely reply
• Satisfaction says nothing about impact or outcome
  from the program

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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.