1. Program Theory and Logic Models (1) CHSC 433 Module 2/Chapter 5 Part 1 L. Michele Issel, PhD UIC School of Public Health

2. 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

3. 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 orange’s 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.

4. Learning Objectives By 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.

5. 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.

6. Use the Community Diagnosis l Factors identified from the “Community Diagnosis” are modeled as a set of relationships. l The relationships (in the diagram) constitute a working, tentative theory about the program.

7. Model of the Health Problem: Relationship of Intervention, Factors, and Health Effects

8. 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. Intervention’s strongest influence is on the determinants of the health problem.

9. 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.

10. 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

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

12. Not created all at once l Begins with a foundation of thinking and planning during which the big pieces are outlined. l Continues with detailing and tailoring to specific realities of the program implementation and evaluation. A “picture” of the parts of Program Theory 

13. Program Theory The turquoise arrow on the far left signifies “first reflect, then do the details”.

14. Functions of Program Theory l Guides program staff activities l Guides the evaluation plan l Facilitates explaining what went right or wrong and why program failure occurred l Facilitates communication among stakeholders l Necessary for making scientific contribution

15. 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. Here’s how to generate useful program theory.

16. Steps involved in Creating a Program Theory l Draw upon the scientific literature to identify which theories and interventions are known to be effective in addressing the health problem. l Involve selected stakeholders in developing the Program Theory. l Temporally sequence the causal chain of events. l Specify “dose” and “mode of administration” of the intervention delivered in the program.

17. Steps continued l Construct a logic model, with or without additional diagrams or drawings of the causal chain of events. l 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.

18. Start from where you want to end up… l Work “backwards” through the Program Theory From the health outcome goal To the intervention To the program infrastructure l Start by generating the Effect Theory

19. Effect Theory l Relationship of the intervention to determinants of the health problem. l Thus, explains how the interventions will lead to the impacts and outcomes. l Based on knowledge from the relevant sciences about the health problem.

20. Effect Theory l Takes into account contributing and antecedent factors to the health problem that will and will not be addressed. l Specifies where the causal chain--from determinants to health health--will be “broken” by the interventions, thus effecting the health problem.

21. 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 InterventionProcess Effect developing the Intervention element of Process and Effect Theories.

22. Elements of Effect Theory

23. l 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 individual’s health: physical, psychosocial, knowledge, behavior. These are a few examples. Effect Theory

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

25. Process Theory Process Theory explicates what has to be done in order to have a program. Process theory contains two major elements, or components: l Organizational plan l Service utilization plan

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

27. Service Utilization Plan Specifies how the intended target audience receives the intended amount of the intended intervention through interaction with the program’s service delivery system.

28. A word about Satisfaction… Many, many problems with relying on consumer satisfaction: 1.Measures have a ceiling effect (generally 4.5-4.8 on 1-5 scale) 2.Clients report high satisfaction to minimize dissonance 3.Dissatisfied rarely reply 4.Satisfaction says nothing about impact or outcome from the program

29. 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”.