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Theories of change allow us to hypothesize that a program’s intermediate and long-term outcomes are a result of short-term outcomes, which are a result of the activities implemented. The logic model for the State Heart 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. The “systems” interventions of HDSP result in policy or environmental change that can lead to changes in knowledge and attitudes that reinforce behavior change among individuals and gatekeepers. For example, implementing the Chronic Care Model in a health care system would include use of electronic medical records that remind physicians of services needed to increase the number of patients who have their high blood pressure under control. This, in turn, leads to changes in patient behavior that result in better management of their high blood pressure. Use of the logic model as a planning tool As a planning tool, a logic model clarifies the sequence of outcomes and the relationship between activities and specific outcomes. It helps you: • 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, analyzing, and justifying the expected relationships and linkages between activities and expected outcomes with staff and partners. Use of the logic model as an evaluation tool A logic model is often used to guide evaluation planning. It can help you: • Determine what to evaluate. • Identify appropriate evaluation questions based on the program. • Know what information to collect to answer these questions—the indicators. • Determine when to collect data. • Determine data collection sources, methods, and instrumentation. Logic Models Page 7 Using a logic model we can identify four areas, or domains, on which we can focus evaluation activities. The four evaluation domains embedded within the logic model shown in Figure 2 are: 1. Implementation (Process): Is the program or intervention implemented as planned? Were all of the activities carried out as expected? 2. Effectiveness (Outcome): Is the intervention achieving its intended short-, intermediate-, and/or long-term effects/outcomes? 3. Efficiency: How much “product” is produced for a given level of inputs/resources? 4. Causal Attribution: Is progress on outcomes due to your program or intervention? In public health practice, causal attribution is often difficult to ascertain, especially for your more distant outcomes. However, determining causality between your activities/outputs and your short-term outcomes can often be accomplished without too much effort. Usually, surveys and interviews, or analysis of records can establish causality at that level. And the brief time duration for short-term outcomes usually insures that causal results can be determined in a relatively small amount of time. By using theories of change to develop your logic model you can assume, with more confidence, that intermediate and long-term outcomes are a result of your short-term outcomes. Therefore, it is important to establish causality between at least the activities (and resulting outputs) you carry out and the short-term outcomes.