Question

For this assignment, you will be required to assess a logic model from the perspective of a program evaluator and outline the initial steps of a program evaluation plan. Please complete the following for this assignment:

1. Use the internet to locate a logic model for a health program that supports one of the following: Cardiovascular Disease, Diabetes or Stroke
2. Based on the information provided, describe the purpose of the logic model.
3. Identify the stakeholders for the health program and the corresponding stakeholder interests.
4. Describe the program participants and anticipated health outcomes.
5. Describe the proposed intervention in the logic model
6. Identify and describe the contextual factors or the environment in which the program exists and the external factors that interact with and influence the program or its intervention. Contextual factors represent conditions over which there is little or no control as it relates to outcomes.
7. Describe the linkages that are apparent in the logic model.
8. What conclusions can be made about the success of the program based on your evaluation of the logic model?

Answer 1

Logic model for health program of cardiovascular disease:

The logic model for the Cardiovascular Disease and Stroke Prevention Program is based on a socio-ecological model that links environmental and policy or systems changes with individual-level behavioral changes. Logic models are tools for planning, describing, managing, communicating, and evaluating a program or intervention. They graphically represent the relationships between a program’s activities and its intended effects, state the assumptions that underlie expectations that a program will work, and frame the context in which the program operates. Logic models are not static documents. In fact, they should be revised periodically to reflect new evidence, lessons learned, and changes in context, resources, activities, or expectations.

Purpose of the Logic model

The purpose of the Logic model is intended to offer guidance, a consistent definition of terms, and aid skill-building on a wide range of general evaluation topics and selected specific topics. They were developed with the assumption that state health departments have varied experience with program evaluation and a range of resources allocated to program evaluation. In any case, these guides clarify approaches to and methods for evaluation. The Heart Disease and Stroke Prevention (HDSP) Program Evaluation Guides are a series of evaluation technical assistance tools developed by the Centres for Disease Control and Prevention (CDC), Division for Heart Disease and Stroke Prevention, to assist in the evaluation of heart disease and stroke prevention activities within states.

Heart disease and stroke, the primary components of cardiovascular disease (CVD), are the leading causes of death. As the burden of heart disease and stroke continues to increase, these conditions are projected to remain the number one and two causes of death worldwide through the year 2020.

The evaluation guide “Logic Models” offers a general overview of the development and use of logic models as planning and evaluation tools. A feedback page is provided at the end of this guide. We will appreciate your comments.

Stakeholders for the health program:

The major stakeholders in the healthcare system are patients, physicians, employers, insurance companies, pharmaceutical firms, and government. Financial Stakeholders. Medical Leaders. End-Users: Clinicians. Vendors. Billing and Audit Functions. Continued Engagement and Communication Equals Project Success. Insurance companies sell health coverage plans directly to patients or indirectly through an employer or governmental intermediaries.

The interest of the stakeholders for the health program:

The involvement of the stakeholders in key activities throughout the planning and implementation of the evaluation is necessary, as they act as an implementer, decision-maker, participant, and partners. This helps:

In reducing stakeholders’ distrust and fear of evaluation

Increases stakeholders’ awareness of and commitment to the evaluation process

Increases chances the evaluation findings will be used

Increases credibility of evaluation findings

Stakeholders provide a reality check on the appropriateness and feasibility of your evaluation questions, offer insight on and suggest methods to access the target populations, provide ongoing feedback and recommendations, and help make evaluation results actionable.

Role of program participants

Identifying and prioritizing program activities that need to be evaluated.

• Overcoming resistance to evaluation and identifying the benefits.

• Developing evaluation questions that are grounded in the perceptions, experiences, and interests of stakeholders.

• Selecting appropriate and acceptable evaluation methods.

• Reviewing evaluation findings and making program recommendations.

• Disseminating and using evaluation findings for program improvement.

Intervention in the logic model:

Inputs are the resources that go into a program or intervention, what we invest. They include financial, personnel, and in-kind resources from any source.

Inputs include various funding sources for your program. Your partners. Staff time and technical assistance. Activities are events undertaken by the program or partners to produce desired outcomes, what we do. We can include clear identification of “early” activities and “later” activities. Train health care partners and staff in clinical guidelines. Develop a community health communication campaign on signs and symptoms of a stroke. Outputs are the direct, tangible results of activities, what we get. These early work products often serve as documentation of progress. Health care professionals trained in clinical guidelines. Community health communication campaigns developed.

Contextual factor

Contextual Factors describe the environment in which the program exists and external factors that interact with and influence the program or intervention. These factors may influence implementation, participation, and the achievement of outcomes. Contextual factors are the conditions over which we have little or no control that affects success. In program or intervention planning and development, we should consider contextual factors that are likely to affect our activities and either address them or collect data on them as part of the process evaluation.

External factors:

Although we expect that controlling high blood pressure in an individual will reduce their risk for heart disease and stroke, when we apply this theory to a population, there are a number of external factors: • Risk factors for high blood pressure such as obesity and diabetes are increasing in prevalence. This is likely to cause an increase in the prevalence of high blood pressure and the number of heart disease or stroke patients. • We assume in this model that once control of high blood pressure has been achieved, it will be maintained. This might not be the case. • We assume that once the chronic care model is implemented and clinic-based changes occur, the changes are maintained.

Outcomes are the desired results of the program, what we achieve. Describing outcomes as short, intermediate, or long term depends on the objective, the length of the program, and expectations of the program or intervention.

Short-term outcomes are the immediate effects of the program or intervention activities. They often focus on the knowledge and attitudes of the intended audience. Examples include: Increase partner knowledge of HDSP priorities and strategies. Increase physician knowledge of clinical guidelines. Increase knowledge of signs and symptoms of stroke.

Intermediate outcomes are behaviour, normative, and policy changes. Examples include: HDSP State Plan has been developed and published with partner involvement. Health systems implement clinical guidelines. Decrease transport time to treatment for stroke victims.

Long-term outcomes refer to the desired results of the program and can take years to accomplish. Long-term outcomes include: Increase in state-wide policy and environmental strategies for HDSP. Increase in blood pressure control in a health centre population. Increase in early treatment for stroke.

Linkages in the logic model:

It is the lines and directional arrows in the logic model that provide the depiction of the connections, or your theory of action. All lines and arrows may be included or abbreviated and implied. These flows may be vertical and horizontal, one-direction or two-directional, and show feedback loops. It is the linkages - not just what is labelled as input, output, or outcome - that give the model its power. We began to see this when talking about outcome chains. Drawing the connections is often messy and time-consuming, but necessary. It is what helps us make sure we've addressed all the logical connections. Sometimes we simplify and only include the primary linkages; otherwise, the logic model may become too difficult to read. In the end, the final outcome theoretically links back to the beginning to make a difference, "an impact," on the originating situation. The large feedback arrow at the top right of our logic model is an attempt to illustrate this connection and the dynamics of programming. Some people like to show the circular flow of a logic model that explicitly connects the end to the beginning. In actuality, program environments are dynamic and situations change so the beginning rarely stays the same.

Success of the program:

A logic model clarifies the sequence of outcomes and the relationship between activities and specific outcomes. It helps • Examine/refine the program mission and vision, goals and objectives, preferably with stakeholders. • Identify the most important desired outcomes. • Identify the “critical path.” If efforts must be reduced, which paths are most effective, are likely to get you there quickest, and/or are most cost-effective? • Identify existing and needed, or weak and strong, components of the program and ways to enhance performance. Much of the benefit of constructing program logic models comes from the process of discussing, analysing, and justifying the expected relationships and linkages between activities and expected outcomes with staff and partners.