Evaluation Framework

Appendices

• Appendix A: Glossary of Terms
• Appendix B: Overview Logic Model
• Appendix C: Expanded Logic Model
• Appendix D: Logic Model Narrative

Glossary of Terms

Cardiovascular Health (CVH) Plan: A written document specifying current state–level goals, objectives, and activities for cardiovascular health promotion and disease prevention and control. Strategies should emphasize policy and environmental approaches to improving CVH as well as education to increase support for policy and environmental changes. The plan should be comprehensive, with population–based interventions. Activities should be coordinated among state's partners.

Champion: A person (either within or outside of the state health department) who advocates for legislation, policy changes, resources, or state funding to support the CVH state program. A champion has leadership skills, special status, or abilities to leverage resources or convince others of the importance of this program and its activities.

Capacity: For the CDC's Heart Disease and Stroke Prevention Program, capacity is defined as the assets, resources, and commitment necessary to improve a population's cardiovascular health by supporting population–based interventions that emphasize policy and environmental strategies. Capacity has been operationally defined as the seven components required of grantees, in addition to their CVH infrastructure.

Change agent: A person who has the ability to make changes in policies and environments. For example, a change agent in a school might be the principal and at a work site might be the manager.

Community: A social unit that usually encompasses a geographic region in which residents live and interact socially, such as a political subunit (e.g., a county or town) or a smaller area (e.g., a neighborhood or a housing complex). A community may also be a social organization (a formal or informal group of people who share common interests, such as a faith organization). In reality, an individual may be a member of several communities or subgroups defined by a variety of factors, such as age, sex, occupation, socioeconomic status, activities, culture, or history.

Basic Implementation Program: A funding level for the CDC Cardiovascular State Program that allows states to continue and enhance core capacity functions. States with basic implementation funding are expected to implement, disseminate, and evaluate intervention activities throughout and within the state, within state–level organizations, and at various settings; monitor secondary prevention strategies; complement professional education activities; and extend resources to local health agencies, communities, and organizations. Both CDC–funded Basic Implementation and Core Capacity program activities would be a part of an overall state CVH plan, although there may be strategies, objectives, and activities in the plan other than those funded by CDC.

Contact: For the purposes of evaluation reporting, a "contact" is establishing communication with a person or organization for enhancing cardiovascular health among populations to support the state cardiovascular program.

Core Capacity–funded Programs: A funding level for the CDC Cardiovascular State Program that allows sates to build capacity, commitment, and resources to develop basic CVD health promotion, disease prevention, and control functions and activities. They are asked to do this by (1) developing partnerships and coordinating program related to primary and secondary prevention, (2) developing the scientific capacity to define the CVD burden, (3) developing an inventory of policies and environments that support positive CVH behaviors, (4) developing a state plan for CVH promotion, (5) providing training and technical assistance, (6) developing population–based intervention strategies, (7) developing culturally competent strategies for addressing priority populations, and (8) developing a CVH infrastructive within the state health department.

Culturally competent Interventions: Interventions that have been designed with guidance from relevant cultural or population groups and that demonstrate sensitivity to the cultural dimensions of risk factors and behaviors important for cardiovascular health.

Environment: A community encompassing all settings for which policies, social, and physical space can be manipulated at some level. Examples include retail businesses (e.g., restaurants, grocers) and public space such as parks, sidewalks, and green ways. Environmental changes would, therefore, be those changes necessary to foster and maintain individual–level behavioral changes to improve cardiovascular health.

Environmental change interventions: Interventions designed to influence people's attitudes and health behaviors by changing or altering both the physical and social environment.

Evaluation: A process of measuring components critical to the success of a state cardiovascular health program, including surveillance, program monitoring, and formative evaluation. Evaluation should address strategy implementation, changes in policies and the physical and social environments affecting cardiovascular health, and, ultimately, changes in behavioral risk factors.

Focus areas: The areas identified for attention by the CVH State Program, including physical activity, nutrition, secondary prevention, and control of hypertension and hypercholesterolemia.

Indicators: Factors that provide a measure or index of cardiovascular health similar to the way "economic indicators" measure economic health. In the Cardiovascular Health State Program, the indicators measure policies and environmental factors associated with reduced rates of (CVD and CVD risk factors and related conditions (tobacco use, hypertension, high cholesterol, physical inactivity, and poor nutrition). Indicators include restaurants with smoke–free policies, schools with policies that require daily physical education, worksites with cafeterias and vending machines that offer heart–healthy food and beverage choices, and health care organizations that adopt quality standards of care for primary and secondary prevention of CVD. Indicators are a way to obtain information about the intermediate effects of a health promotion effort that will in turn lead to individual behavioral changes, improve people's health status, and reduce CVD rates.

Intervention: The part of a strategy, incorporating method and technique, that actually reached a person or population.

Inventory: A written assessment of existing policies and environmental conditions that either promote or impede, cardiovascular health in a specified setting at the state, regional, or community level. States must justify the geographical subunit selected in their work plan and ensure that it is appropriate for assisting them with their CVH plan. The process of conducting an inventory must be systematic and rational with face validity, but the data collection procedure need not necessarily be randomized nor must the scale be validated.

The information in an inventory is used to determine the policy and environmental interventions and activities to be addressed and evaluated by the state CVH program. For example, if the inventory shows that the state has policies requiring schools to be tobacco–free, then the program might not focus on this policy issue when working in the school setting.

An inventory should focus on one or more of the following areas: physical activity, nutrition, and secondary prevention of CVD, including reducing elevated blood pressure or an elevated cholesterol level. For example, an inventory for nutrition in the school setting could include food service policies, the existence of vending machines and their contents, and student access to fast food sites near school; an inventory for physical activity in the community setting could include the availability of sidewalks, access to walking trails and parks, and zoning policies requiring green space and bike lanes; and an inventory for secondary prevention in health care settings could include standards of care for those with cardiovascular disease or hypertension, follow–up practices used to promote compliance with medication, and insurance coverage for treating cardiovascular disease.

An inventory should be conducted when a state first enters the CVH State Program and during project years 02 to 05; additional inventories should be conducted in at least one of each of the four settings (i.e., communities, health care sites, worksites, and schools). As CVH State Program inventory tools are developed or identified by individual states, Prevention Research Centers, and CDC, the tools will be made available for use by other states.

Partnerships:

1. Partnerships within the state health department: Because organizational structures vary from state to state, program participants should list the name of the units (e.g., Office of Adult Health or Division of Nutrition), and describe how they partner with the state CVH Program. They should also provide information on how the state CVH program coordinates and works with other CDC–funded programs.
    
2. Formal Partnerships: Partnerships involving a written or verbal agreement and involvement and commitment on a committee or work group necessary for developing a state cardiovascular plan, a state CVH program, interventions, or activities specified in either.
    
3. Informal Partnerships: Partnerships involving occasional contacts and sharing of information for developing a state cardiovascular plan, a state CVH Program, or interventions or activities specified in either.
    
4. Commitment of Partners: CDC expects that partners will be involved in state CVH programs at different times and in different ways. Partners will contribute a variety of resources and skills during the development, implementation, evaluation, and modification of the state CVH plan.

Primary prevention: Preventing CVD risk factors and first cardiovascular disease events.

Policy:

1. Public Policy: A formal statement of standards by a public official, or legislative body, or by the general election of the public.
    
2. Organizational Policy: A formal rule and/or regulation that governs behavior and practice within an organization or in a particular setting.

Population–based strategies: Interventions that focus on an identified population (e.g., women age 35–65) or community (e.g., residents of Madison County) rather than on individual behavior change. Strategies should include policy and environmental approaches to improving cardiovascular health and the public education necessary to create a consensus for such approaches.

Priority Populations: Population groups that have higher documented rates of cardiovascular diseases and related risk factors, less access to services, or lower socioeconomic status than the general population.

Secondary Prevention: Activities designed to prevent further cardiovascular disease and to promote cardiovascular health, among people with established CVD. These activities include efforts to change polices and environmental factors related to CVH.

Settings: The locations or channels where interventions are implemented. The CVH State Program targets worksites, schools, health care facilities, and community settings such as churches and grocery stores.

Special State Surveys: Special one–time surveys to assess a state's cardiovascular disease burden or community awareness about CVD or to guide the formation of interventions and program planning.

Support: For purposes of the CVH State Program evaluation, "support" is defined as information sharing, and the dedication of resources or in–kind contribution to the state CVH program in that state.

Technical Assistance: The giving of advice or consultation on specific issues relating to CVH and the CVH State Program activity.

Training: The transfer of information in a structured situation that increases the skill level of public health professionals and CVH partners and enhances the ability of the CVH State Program to achieve its goals.

Overview Logic Model

Expanded Logic Model

Click HERE (PDF–1M) to view the State Heart Disease and Stroke Prevention Program Logic Model.

The Evaluation Framework guide is available in Portable Document Format (PDF). Learn more about PDFs.

Logic Model Narrative

The first logic model is an overview model that presents, in broad outline, key program and the sequence of intended effects. The second model provides more detail on activities and is intended to depict the relationship among and between the activities and the sequence of intended effects.

• Logic models are intended to represent the ideal. That is, they depict intended activities and the effects of those activities if things go as planned. Of course, reality may be much different, especially in the early years of the program.
   
• These logic models depict the activities and effects intended by CDC's funding for these CVH programs; however, CDC may be only one of several funding sources, and the logic model for the state's overall CVH efforts may be more elaborate than these models.

Overview of the Logic Model

• CDC provides or enables the provision of guidance, funds, training, and opportunities for communication and networking among the sites.
• These inputs provided by the CDC, among others, are the platform for states to undertake activities in three areas:
  • Capacity building
  • Surveillance
  • Interventions
• Over time these activities result in system–level changes including changes in policy/legislation and environmental supports. This may happen directly as a result of activities, or, more commonly, because activities change and activate key change agents who can control policy and environmental supports.
• Changes at the system level frame/encourage/channel individual behavior change, including adoption of primary and secondary prevention practices related to CVH.
• This is the engine that leads to long–term outcomes like stage at detection, age of onset, morbidity and mortality, and elimination of disparities between general and racial/ethnic populations.

Expanded Logic Model

This model provides more detail on the three types of state activities, the relationships among the activities, and relation of activities and the sequence of outcomes.

Capacity Building

• CDC provides guidance, funding, technical assistance, training, and opportunities for states to network with each other.
• This allows states to build program and managerial infrastructure; form partnerships at the state level; build the science, epidemiologic, and evaluation capacity they need to identify and monitor progress on key CVH issues; conduct ongoing inventories and assessments of current status of system supports; and develop plans for addressing CVH in priority populations, as well as permitting them to train on these same issues with their partners.
• These activities serve as a "platform" for developing a state plan, or, in the absence of a state plan, a CVH work plan and system–level strategies that address key settings and priority groups. However, in early years of a program, the work plan may mostly involve developing a state plan and/or building up capacity, rather than the way it is depicted in the model with the platform and state plan informing the work plan.
• Work plans and strategies may include coordinated efforts in communication, education, and training. These affect development, implementation, and effectiveness in various settings.
• These interventions have the following intent: (1) changing knowledge, attitudes, and behaviors of system change agents so that change agents will take action, and (2) activating key target audiences so that they will be both receptive and ready to take advantage of policy and environmental change, as well as help advocate with change agents. There is also likely to be interaction between the change agents and intended audiences which will influence the change agents to take action.
• Action taken by change agents results in policy and environmental supports at the state and local levels and in various settings and contexts.
• Activation of intended audiences also results in a readiness for change in the community and individuals which influences ability to modify policy and environmental supports.
• Impacts of efforts on system change are measured, compiled, and fed back into (1) future state work plans, and (2) CDC–compiled "models that work" and guidance to all CVH states.
• These system changes provide the environment which supports individual behavior change over time, including adopting primary prevention practices related to CVH.
• Individual behavior change leads to improvements in long–term health status, with an ultimate decrease in death and disability and eliminating CVD disparities between general and priority populations.

Surveillance

• States undertake two classes of surveillance: (1) surveillance of CVD burden, and (2) surveillance of progress on policy and environmental supports.
• CDC provides surveillance guidance to states for both burden and policy/environmental surveillance using a set of selected system–level indicators. These indicators inform, but do not necessarily exhaust, the policy and environmental support indicators a state may chose to include in its surveillance (e.g., monitoring secondary prevention strategies).
• States implement surveillance activities.
• Surveillance results provide CVH information which is used in program planning to refine and improve programs and program implementation, as well as to inform development and improvement of interventions.
• Surveillance system measures state progress on CVH status, and in the long term, may be able to detect the impact of interventions.

Interventions

• CDC provides evaluation guidance/plans, applied research, and "models that work" (best practices) information for measuring processes and impacts.
• Informed by the work plan, strategies, and CDC guidance, states and their partners develop and undertake interventions in priority settings and with priority groups.
• These interventions capitalize on efforts to sensitize/activate change agents and target audiences.
• Interventions strive to change systems at the state, local, and setting level.
• Impacts of interventions on system change are measured, compiled, and fed back into (1) future state work plans, and (2) CDC–compiled "models that work" and guidance to all CVH states.
• These system changes provide the environment which supports individual behavior change over time including adoption of primary prevention practices related to CVH.
• Individual behavior change leads to improvements in long–term health status, with an ultimate decrease in death and disability, and eliminating CVD disparities between general and priority populations.

Date last reviewed: 05/12/2006
Content source: Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion