3.3 Logic Models and Program Theory

Using a logic model to test whether the plan makes sense

A logic model is a planning tool that displays the expected relationship between what a program invests, what it does, what it produces, and what changes as a result. It is not just a grant attachment. For CHES work, it helps the planner confirm that assessment findings, objectives, strategies, and evaluation measures fit together before time and money are spent.

Common logic model columns include inputs, activities, outputs, short-term outcomes, intermediate outcomes, and long-term outcomes. Inputs are resources such as staff, volunteers, money, curriculum, meeting space, partner relationships, transportation support, translation services, and data systems. Activities are what the program does, such as training peer leaders, holding skill practice sessions, conducting outreach, or revising a referral workflow.

Outputs are direct products of activities. They count what happened, such as the number of classes delivered, text reminders sent, families enrolled, or partner sites trained. Outputs do not prove behavior change by themselves. They tell whether the planned work occurred at the expected dose and reach. CHES questions sometimes use outputs as distractors when the stem asks for an outcome measure.

Outcomes describe changes in participants, organizations, communities, or systems. Short-term outcomes often include awareness, knowledge, attitudes, skills, self-efficacy, intentions, or readiness. Intermediate outcomes may include behavior change, service use, policy adoption, environmental support, or improved social norms. Long-term outcomes may include reduced disease burden, improved quality of life, fewer injuries, or lower risk indicators. The longer the outcome, the more careful the planner must be about attribution and time frame.

Program theory is the reasoning behind the arrows in the logic model. It explains why a set of activities should influence the selected determinants. If assessment shows that new parents lack confidence using safe sleep practices, program theory might emphasize demonstration, practice, feedback, and social reinforcement. If assessment shows that healthy food is unavailable at meetings, the theory may involve environmental support and organizational policy rather than individual education alone.

Assumptions and external factors also belong in planning. Assumptions are beliefs the plan depends on, such as participants trusting promotores, schools allowing class time, or clinics agreeing to provide referral data. External factors are conditions outside direct program control, such as bus route changes, staffing shortages, weather, competing events, or state policy changes. Naming these factors helps the team choose realistic objectives and contingency steps.

A logic model can reveal weak alignment. Suppose a program goal is to increase colorectal cancer screening, but the activities only distribute a general cancer awareness flyer. The model would show a gap between activity intensity and behavior change. A stronger plan might include patient navigation, reminder calls, provider prompts, transportation support, and culturally appropriate messages, depending on assessment findings.

Logic models also support evaluation. Process evaluation measures inputs, activities, and outputs. Outcome evaluation measures short-term and intermediate changes. Impact evaluation may address longer-term health status or system effects. A CHES professional should be able to choose an indicator that matches the model component being assessed. For example, attendance logs measure output, while a verified appointment record may measure screening completion.

When answering exam items, ask where the proposed item belongs in the model. Staff time is an input. A workshop is an activity. Number of workshops completed is an output. Increased skill is a short-term outcome. Sustained behavior is often an intermediate outcome. Improved population health is usually long-term. This classification helps separate correct answers from plausible but misplaced choices.