Division for Heart Disease and Stroke Prevention - Evaluation Framework

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Evaluation Framework

Section IV: Logic Model for the State Heart Disease and Stroke Prevention Program

Logic models are commonly used to graphically depict the organization, structure, assumptions, and associations underlying a program. Some logic models are fully descriptive and include all aspects of program structure, organization, and expected outcomes in addition to a theoretical framework. For instance, the logic model for the State Heart Disease and Stroke Prevention Program is based on a socioecological model, which links environmental and policy systems changes with individual–level behavioral changes (McLeroy et al., 1988). This logic model depicts relationships and actions that are expected to precede long-term changes in CVD rates.

It is important to note that logic models are often cyclical rather than linear in that information obtained during a particular activity can be used to modify another activity even if that activity precedes it in the logic model. For example, a state plan for CVH activities influences the development of a work plan for implementing CVH activities and the work plan can impact portions of the state plan. Similarly developing the state plan can affect capacity building activities. Thus the CVH logic model is dynamic with any number of activities providing input into different aspects of the model. The feedback loops in the model are the strongest anticipated influences but do not exhaust all the possible influences.

Logic models not only serve to describe the program, but they also act as a tool to guide program evaluation. By identifying the steps necessary to reach intended outcomes, the logic model helps users determine the program evaluation.

Two logic models have been developed to describe the CVH State Program and its intended effects. The overview logic model provides a general overview of the program, and the expanded logic model provides a more detailed description. These logic models primarily depict the activities and effects intended by CDC funding to states; however, because CDC may be only one of several funding sources, the logic model for a particular state’s overall CVH efforts may be more elaborate than these models. The logic models provide an explanation of how capacity building, surveillance, and intervention activities are affected by CDC and state activities.

The overview logic model, shown in Appendix B, depicts the major activities and intended outcomes of the program. The activities of capacity building, surveillance, and interventions lead to improved health status through a series of changes in policies and environments and individual behavior. "System changes" are defined as those modifications in policy and environments that take place at the state and community level that affect the population targeted. Once policies and environmental systems and infrastructure to support heart–healthy lifestyles are in place, individual behavioral change is more likely to occur. As a result of these individual behavioral changes, the health status of the targeted population is expected to improve, leading to a decrease in death and disability rates and eliminating CVD disparities between the general and priority populations.

An expanded logic model was developed to elaborate the processes and events that occur between the time state activities are implemented and the time changes in long–term health outcomes can be detected. (See Appendix C.) This model outlines CDC and state activities in terms of capacity building, surveillance, and interventions. Both the CDC and state activities are designed to produce short–term outcomes such as the development of a work plan and strategies for system level changes, the effective implementation of interventions, and actions by target audiences and change agents (those who are in the position to influence others). These outcomes are designed to change policies and environmental factors that lead to behavioral changes and improved health among members of the target population and ultimately to a decrease death and disability rates and eliminate CVD disparities between general and priority populations. For a more detailed explanation of each of the logic models, see Appendix D.