Positioning for Sustainability: Developing a Logic Model Page 1
Welcome! he Developing a Logic Model Quick Course is provided by the Georgia Health Policy Center (GHPC) to assist you and your local partners in undertaking the process of developing a logic model. he quick course includes a process to use in developing a logic model, suggestions to consider for each step in the process, and examples of logic models to use as a reference. he information in this quick course is intended to help you take action in developing a logic model. For more background information and understanding of logic models, see the CHSD e-learning module, Logic Models available on ruralhealthlink.org at http://ruralhealthlink.org/resources/e- Learning.aspx. hat module reviews the basics of logic models and explains how they can be used strategically. Whether you are brand-new to logic models or have completed them for years, this course can help you develop a logic model that is more useful, effective, and targeted to the needs of your organization. A well-developed logic model can serve as both a compass and measuring stick for your organization keeping you moving in the proper direction and giving you an indication of your progress toward your goals. his quick course is designed to help you produce a well-designed logic model. he course is organized into the following sections: 1. Getting Ready 2. Approaching the Development of a Logic Model 3. Developing Your Logic Model 4. Reviewing Your Initial Draft Appendix: Examples of Completed Logic Models & Blank emplate For maximum impact, review the quick course in its entirety before determining who to engage in helping you develop your logic model. Who you choose to include in the development process is a strategic decision one that should align to the desired purpose(s) of the logic model. Page 2
1. Getting Ready Using Logic Models Strategically: Defining the Purpose of your Logic Model Logic models are effective tools for organizations because they present a simplified picture of a program; show the logical relationships among resources invested, the activities that take place, and the outcomes that occur as a result; and they help explain the theory of change (how and why we expect a program to produce results.) Logic models can be used for more than just evaluation. hey can be used strategically to contribute to improved program impact, partner collaboration, and communication efforts. When you have a strategic mindset in developing your logic model it helps you see opportunities to use it. hese opportunities may arise in the following ways: Building Collaboration: Involving stakeholders and incorporating broad perspectives in early logic model discussions creates a shared sense of why you are doing what you are doing in the way that you are doing it. Planning: Creating a logic model helps you plan for success by setting priorities, establishing realistic goals, and selecting interventions supported by solid rationale. Management: Logic models can inform daily decisions by creating a touchstone for managers and staff, creating a shared language, and developing a persistent focus on how day-to-day activities can translate into stated goals. Communication: Logic models can help convey otherwise complex ideas and activities for a broad range of audiences and serve as a snapshot of your entire program. Evaluation: A logic model helps you test the connections between the things your program does and the impact those programs create. his makes it easier to decide what and where to measure. It is important for you to be clear about the purpose of the logic model before beginning the actual development of it. he purpose serves as your touchstone and helps inform who is involved and how you will use it after completion. Questions to consider: 1. Reflecting on some of the uses listed above, describe your purpose for developing a logic model. Page 3
Identifying and Engaging Stakeholders Engaging the right stakeholders in your logic model development process can help foster input, participation and power-sharing among those people and organizations that have an investment in the design, implementation, and outcomes of the program. his activity helps increase the chances that the program design and evaluation will be successful. Further, it can improve the evaluation s credibility, clarify roles and responsibilities, enhance cultural competence, identify opportunities to leverage existing resources, and avoid real or perceived conflicts of interest. Consider the following groups when identifying stakeholders to invite and engage in the logic model development process: Internal leaders and staff Community and civic leaders Clients and program users Funders and potential funders Related organizations, especially those that represent less powerful groups or individuals Evaluators Questions to consider: 2. Based on your intended purpose and use(s) of the logic model, who needs to be involved in the logic model development process? 3. How will you recruit and engage key stakeholders to be a part of the logic model process? Page 4
Gathering Evidence he logic model development process is aided greatly by compiling information that stakeholders perceive as trustworthy and relevant for answering their questions about your program approach. Such evidence can be from a variety of sources that may include: peer reviewed articles, evidencebased/promising practices, evaluation data from a similar program, or discussions with program coordinators or participants. Consideration should be given to whether the evidence is credible, relevant, and accessible to the stakeholders you intend to engage. Questions to consider: 4. What types of information or data do you need to support your particular program approach? 5. Where will you find information, evidence, theory, and examples of what others have done/are doing to inform your particular program approach? 6. Describe your plan to collect, catalog and share this evidence with stakeholders engaged in the logic model development process. Page 5
2. Approaching the Development of a Logic Model Logic models are more effective when developed collaboratively utilizing the perspectives and experience of staff and stakeholders. One key to identifying the right people to bring to the table is to have clearly identified the scope of the logic model. Logic models can be narrow or broad and organizations may use multiple logic models at once perhaps one for the entire organization and one for each, unique program. In planning the development of your logic model, it s very useful to have clearly answered the question, What is the scope? For a single intervention or program? For a multi-year intervention? For an entire area of programming? For your entire organization? With the scope defined, you can evaluate the options for approaching the development process. he approach you choose should best fit your current situation. Generally, there are two approaches to developing a logic model: We are already in the implementation stage but need to clarify and/or revise strategies and outcomes o If this is the case, then you may find using the Forward Logic Approach, a left-toright method of developing a logic model, more useful. We are in the early stages of planning and have a great deal of flexibility in defining strategies and outcomes o If this is the case, then you may find using the Reverse Logic Approach, a right-toleft method of developing a logic model, more useful. However, these are general guidelines and you may find that you prefer to always use one or the other because it seems to make more sense to you and your group. Questions to consider: 7. What is the scope of your logic model and which approach do you think will be most useful to you as you develop your own logic model? Page 6
3. Developing Your Logic Model Given the approach identified in the previous step, use the corresponding steps below to take your team through the development process. his process is more fully explained in the e-learning module available at http://ruralhealthlink.org/resources/e-learning.aspx. he template shown in this quick course is available as a Word attachment in the module. We have included a blank logic model template in the appendix section of the Quick Course which you can print and use as a worksheet as you develop your logic model. Some of information shared in this section is from a CDC program evaluation guide found at http://www.cdc.gov/dhdsp/programs/nhdsp_program/evaluation_guides/docs/logic_model.pdf. Forward Logic Approach his is a left-to-right process (when viewing a logic model) of connecting a series of If, then statements that help you identify and connect activities to anticipated outcomes. Ask yourself how you can complete the following to describe your program: If we have and, we can (do) and, which will result in and. he first two blanks list the resources available to conduct your program, the third and fourth blanks describe the activities to be conducted, and the final two blanks list the expected results of those activities. Page 7
Example of the Forward Logic Approach If we have an evidenced-based diabetes self-management program, trained diabetes educators, and clinical partners, then we can offer self-management education to diabetic patients. If patients participate in diabetes self-management education, then they will increase their knowledge about lifestyle factors that affect diabetes, improve their diets, and increase their physical activity which will result in improving their A1c levels and other clinical measures, which will ultimately improve health status and quality of life for diabetics. Put Into Action Start with the Resources/Inputs section of the logic model template, complete it, and then ask your team to help answer the series of If-then questions to work across the template until you define the Impact. Reverse Logic Approach his is a right-to-left process (when viewing a logic model) of connecting a series of but how statements that help you identify anticipated outcomes and connected activities based on the desired impact. Ask yourself how you can complete the following to describe your program: Our intended impact is, and that occurs when which is a result of when we do which requires. he first blank lists the impacts, the second blank lists the outcomes, the fourth describes the outputs, the fifth identifies the activities, and the final blank lists the resources/inputs. Page 8
Example of the Reverse Logic Approach Our intended impact is to improve the health status and quality of life for diabetics, and that occurs when A1c and other clinical measures are at recommended levels. hese measures will improve as a result of increased knowledge, improved diets, and increased physical activity, resulting from participation in diabetes self-management education that requires clinical partners, trained diabetes educators, and an evidenced-based diabetes self-management program. Put Into Action Start with the Impact section of the logic model template, complete it, and then ask your team to help answer the series of but how? questions to work across the template until you define the Resources/Inputs. Page 9
4. Reviewing Your Initial Draft he process of arriving at the initial draft of your logic model with your stakeholders may only require a single meeting of a few hours or it may take multiple conversations over the course of weeks. Either way, it is good practice to conduct a review of the initial draft before using it to plan, manage and communicate. It can be challenging to maintain both perspectives that of the overall approach/plan and that of the definition of each element during the development process. his review allows for thoughtful reflection that may find areas for improvement prior to use. Answer questions of yourself/group in three areas: 1. Leaps of Logic o Does it make sense/is it logical? o Do the relationships between elements make sense? Can these activities be expected to produce these outcomes? o Will this program work given some of the contextual factors (i.e., those things external to the program that can impact implementation, positively or negatively)? 2. Effectiveness as a Communication ool o Is it clear and concise? o Could someone outside of the development process understand your logic model? 3. Process Check o How will you build re-visiting your logic model into your program management cycle? o Review your original purpose for doing the logic model. How can you make sure that you will use it in that way? If needed, make any further revisions to your logic model based on your review of the initial draft. Page 10
Appendix Examples of Completed Logic Models and Blank emplate he two examples listed are good examples of logic models that fulfilled the purpose for each organization. A summary of the organization s purpose, process for engaging stakeholders, and evidence gathered is provided to help demonstrate the importance of these components in developing a logic model. Following the two examples is a blank template you can use as a worksheet to develop your logic model. It is available as a Word attachment in the Logic Models e-learning module found at http://ruralhealthlink.org/resources/e-learning.aspx. Example 1: Georgia Southern University Project ADEP Diabetes logic model Program Description: Project ADEP (Applied Diabetes Education Program using elehealth) seeks to improve the health status of diabetics in rural southeast Georgia by using telehealth to bring evidence-based diabetes education services to a high-need four-county service area. Purpose: he Project ADEP logic model was developed to serve as a foundation for the program evaluation plan, providing a clear picture of program activities and expected outcomes. Ultimately, the project intends to use this evaluation data to make the case for program continuation and support. Engagement of Stakeholders: he logic model was developed through a process that included leadership staff from each of the three primary implementing agencies (i.e., the university, local FQHC network, and state telehealth partnership), as well as community input via the FQHC s Advisory Board. he partners provided input on what data they currently collect that could be used for the program evaluation, what staff they could dedicate to the effort and the best way to collect information from the program participants. Gather research/evidence: Project ADEP is based upon the evidence-based AADE7 Self- Care Behaviors framework developed by the American Association for Diabetes Educators to create measurable behavior change among diabetic patients. he framework, supported by extensive scientific literature, guides patients through seven self-management behaviors critical in effective diabetes self-management. hey used the framework to help identify the health indicators that they would measure. Page 11
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Example 2: Rural Health Network Logic Model Program Description: Health and Wellness Cooperative of Northern Region (HWCNR) was created to address the identified need to strengthen primary care in the northern corner of a Midwest state. he goals of the Network Development project are to increase access to quality care for residents and visitors, collaborate to strengthen the health care delivery system, and empower patients and providers through education. Activities focus on chronic disease care coordination, collaboration with providers, and adoption of the Patient-Centered Medical Home (PCMH) model. Purpose: he Network logic model was developed to serve as a snapshot of the two main focus areas where Network partners were focusing their efforts: the development of a formalized structure to support their collaboration, and the creation of a program to support the implementation of a PCMH model across the region. he partners use the logic model as a check to ensure that they are minding infrastructure and partnership development while simultaneously developing materials and supports to further the adoption of the PCMH model. Engagement of Stakeholders: he logic model was developed as part of a larger strategic planning process. A representative from each Network member organization participated in the development of the logic model. hey worked together to define the key long term outcomes and impacts for this project and ensured that they aligned with the Network s mission and vision. From there, they worked backwards to develop outcomes, outputs and activities. Gather research/evidence: Network partners dedicated time to look at some of the literature on health network development and structure. Additionally, Network partners reached out to other more mature networks and conducted brief, informal interviews with them to gather insights and lessons learned related to the development of their networks. he Network chose the Chronic Care Model developed by the McColl Institute as the model for their program approach as it considers the complex interrelationships driving health outcomes. he Network used this model to focus its program strategies at the individual, community, and systems level with the ultimate goal of achieving a quality, integrated primary care delivery system and improved outcomes for patients. Page 13
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In order to accomplish our set of activities, we will need the following: Logic Model emplate INPUS ACIVIIES OUPUS OUCOMES IMPACS In order to address our problem, we will accomplish the following activities: We expect that once accomplished these activities will produce the following evidence of service delivery: We expect that if accomplished these activities will lead to the following changes in both the short and long-term: We expect that if accomplished these activities will lead to the following changes in 7 10 years: PROGRAM: Page 15 Adapted from the W.K. Kellogg Foundation Logic Model Development Guide http://ww2.wkkf.org/default.aspx?tabid=75&cid=281&nid=61&languageid=0
Congratulations on completing an important step toward sustainability. As you continue your important work in the community, continue to think and act strategically, and build your capacity related to the components of the Sustainability Framework. In a year or so you may choose to reassess your performance, taking time to both celebrate progress and make new plans for continued improvement. Your logic model will serve as a key tool in tracking your progress and adjusting your plans moving forward. Positioning for sustainability is an ongoing effort and a focus on these components will greatly expand your options in the future. I Community Health Systems Development I Georgia Health Policy Center I 14 Marietta Street, NW I Suite 221 I Atlanta, GA 30303 I (404) 413-0314 2013 by Board of Regents of the University System of Georgia by and on behalf of Georgia State University and the Georgia Health Policy Center Page 16