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Improving emergency response.

Finally, identify contextual factors and assumptions that should be considered and stated
when developing the logic model and interventions. In the example above, 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
confounding 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.
If we put this all together in a logic model, it would look like this:
Activities Outputs Short-term

Funding Educate
Increase in
for HBP
Decrease in
heart disease &
stroke among
clinic patients
Increase in #
of patients
with HBP
under control
trained in
training to
teams in
the CCM
Assumptions: CCM changes are maintained by clinics.
Patients maintain blood pressure control.
Contextual factors: Prevalence of risk factors and
hypertension increasing.
As you develop your logic model, remember the amount and types of resources, activities, and
outcomes depicted can vary and are particular to each program. Some programs will have an
abundance of resources that allow a variety of activities and other programs may choose to
conduct fewer activities. The activities and expected outcomes are based on the type of program
or intervention you are implementing, the resources you have available and their distribution, the
needs and desires of your program or department, and your partners.
Logic Models Page 6
Theories of change
In a logic model, arrows are drawn to indicate the links between resources, activities, and
outcomes. A theory of change is used to provide a rationale for the expected links between
program resources, activities, and outcomes. It explains how and why activities are expected to
lead to outcomes in the particular order depicted.
Health promotion and prevention activities are based on numerous theories of change — a
reasonable explanation of why and how a certain set of activities leads to certain outcomes. These
theories are based on our beliefs, expectations, experience, and conventional wisdom. They
describe the set of assumptions that explain both the steps that lead to long-term objectives and
the connections between program activities and outcomes that occur at each step of the way.
Several common theories of change are used in health programming. To learn more about theories
of change, the following Web sites will be useful:
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.