Logic Model and Program Evaluation

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Chapter 12: Implementation: Strategies and Associated Concerns

Chapter 12 Lecture

Logic Models – 1

A logic model is a systematic and visual way for planners to share and present their understanding of the relationship among the resources they have to operate a program, the activities they plan to implement, and the outputs and outcomes they hope to achieve (CDC, 2008b; WKKF, 2004).

Can help all stakeholders understand the “big picture” of how planning, implementing, and evaluating all fit together

Logic Models – 2

Three components of a logic model:

Inputs (resources)

Human resources, partnerships, equipment, supplies, materials, and community resources

Outputs (activities)

Products, services, and infrastructure

Outcomes (results or effects)

Short-term, mid-term, and long-term

Basic Logic Model

Defining Implementation

“The act of converting planning, goals, and objectives into action through administrative structure, management activities, policies, procedures, and regulations, and organizational actions of new programs” (Timmreck, 1997, p. 328)

One of the three stages of program diffusion, with the other two being adoption and sustainability (Bartholomew et al., 2011)

Phases of Program Implementation

Phases are flexible in nature and can be modified to meet the many different situations and circumstances faced by planners.

Phases of implementation:

Adoption of the program

Identifying and prioritizing the tasks to be completed

Establishing a system of management

Putting the plans into action

Ending or sustaining a program

Phase 1: Adoption of the Program

This phase is a part of the marketing process.

Great care must go into the marketing process to ensure that a relevant product (i.e., the health promotion program) is planned so that those in the priority population will want to participate in it.

Phase 2: Identifying and Prioritizing the Tasks to Be Completed – 1

Many tasks need to be completed when implementing a program.

Examples: reserving space, ordering equipment, etc.

Tasks need to be identified and prioritized.

Planning timetables and timelines can help with this process.

Phase 2: Identifying and Prioritizing the Tasks to Be Completed – 2

Types of timetables and timelines include:

Basic timelines

Task development timelines (TDTLs; Anspaugh, Dignan, & Anspaugh, 2000)

Gantt charts

PERT charts

Critical path method (CPM)

Sample Task Development Timeline

Sample Gantt Chart

Phase 3: Establishing a System of Management – 1

Management – “the process of assembling and using sets of resources in a goal-directed manner to accomplish tasks in an organizational setting” (Hitt, Black, & Porter, 2012, p. 483)

Includes human, financial, and technical resources

“The efficient, satisfactory management of a health promotion program is vital to its long-term success” (Anspaugh et al., 2000, p. 124).

Phase 3: Establishing a System of Management – 2

Good management is needed to ensure that programs are

Effective: meet stated goals and objectives

Efficient: well-organized, cost effective

Managers need technical, interpersonal, and conceptual skills.

Human Resources Management (HRM)

Four functions (or PADS):

Planning – defining personnel

Acquisition – hiring personnel

Development – training personnel

Sanction – discipline, rewards, safety

Professional Development

Phase 3: Establishing a System of Management – 3

Financial Management

“Process of developing and using system to ensure that funds are spent for the purpose for which they have been appropriated” (Klingner et al., 2010, p. 88)

Accounting, fiscal year, fiscal accountability

Audits – internal and external

Technical Resources Management

All other resources besides human and financial

Equipment, expertise, information, material, partnerships

Phase 4: Putting Plans into Action – 1

There are three major ways of putting plans into action: by phasing them in, in small segments; and by initiating the total program all at once.

The strategies exist in a hierarchy and it is recommended that all programs go through all three.

Pilot testing – trying the program out with a small group from the priority population to identify any problems

Phasing in – limiting the number of people who are exposed, then gradually increasing the numbers; by offerings, by location, by ability, by number

Total program – all in priority population are exposed at same time

Putting Plans into Action

Phase 4: Putting Plans into Action – 2

First Day of Implementation

Also referred to as program launch, program rollout, or program kickoff

Some special planning may be necessary:

Decide on a first day.

Consider launching to coincide with other already occurring event (e.g., weight loss program and New Year’s resolution).

Phase 4: Putting Plans into Action – 3

Some special planning may be necessary (cont’d)

Kickoff in style.

Create a special event; use celebrities.

Seek news coverage, if appropriate.

Inform appropriate media representatives of your plans.

Make arrangements to meet the media representatives at the designated time and place.

Use press releases, video releases, spokespeople.

Consider a news hook; e.g., day in history.

Phase 4: Putting Plans into Action – 4

Monitoring Implementation

Program monitoring involves the ongoing collection and analysis of data and other information to determine if the program is operating as planned.

Basic monitoring data and information for a program has the following utilities (USDJ, n.d.):

It provides operating and descriptive data and information.

It provides the basic information for comparing outcomes to the program objectives.

It provides educational information about many aspects of the program.

Monitoring data serve as a preventive maintenance function by tracking indicators of critical elements.

Phase 5: Ending or Sustaining a Program

Planners should determine how long to run a program.

If the program met its goals and objectives and the priority population has been served to the fullest extent necessary, then the program can be ended.

Sustaining a program is more difficult. Six techniques include:

Working to institutionalize

Seeking feedback

Advocating for the program

Partnering with others

Revisiting and revising the rationale

Establishing a resource development committee

Implementation of Evidence-Based Interventions

The focus of implementation science is to study how interventions, which have been shown to be effective in one setting, can be applied to sustain improvements to population health (Lobb & Colditz, 2013).

Tomioka and Braun (2013) created a four-step fidelity assurance protocol:

Deconstruct the program into its components.

Identify agencies that are ready to replicate the intervention.

Closely monitor the fidelity of the program.

Use the evaluation tools of the program to track progress.

Concerns Associated with Implementation – 1

Safety and Medical Concerns

Most programs are designed to improve health; thus give attention to the safety and medical concerns associated with the program.

Informed consent

Explain nature of program.

Inform participants of risks or dangers and any possible discomfort.

Explain expected benefits.

Inform of alternative programs.

Indicate that they are free to discontinue participation at any time.

Allow participants to ask questions.

Informed consent forms (waiver of liability or release of liability) do not protect planners from being sued.

They just make participants aware of special concerns.

Example Informed Consent Form

Concerns Associated with Implementation – 2

Safety and Medical Concerns (cont’d)

If the act of participating in the program puts anyone at medical risk (e.g., cardiovascular exercise programs), then these individuals need to obtain medical clearance before participating.

Medical clearance signed by a physician

Steps must be taken to ensure the safety and health of all associated with the program:

Safe program location; appropriate security

Building codes met and facilities free from any hazards

Qualified instructors

Plan in case of emergency

Checklist of Items to Consider When Developing an Emergency Care Plan

Concerns Associated with Implementation – 3

Ethical Issues

Situations where competing values are at play and judgment must be made on what is the most appropriate course of action

Code of Ethics for the Health Education Profession guides the work of health educators.

Planners should have integrity, and be honest, loyal, and accountable.

The Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subject Research has three fundamental ethical principles:

Respect for persons

Beneficence – maximizing benefits; doing good

Justice – fairness

Concerns Associated with Implementation – 4

Legal Concerns

Negligence – failing to act in a prudent (reasonable) manner. Arises from two acts:

Omission – doing nothing when you should

Commission – doing something you should not

Concerns Associated with Implementation – 5

Reducing the Risk of Liability – key to avoiding liability is to reduce risk by planning ahead

Be aware of legal liabilities.

Be aware of professional standards.

Keep knowledge and skills up-to-date.

Use certified instructors.

Use good judgment.

Require informed consent.

Get medical clearance.

Limit work to expertise.

Provide a safe environment.

Purchase insurance.

Concerns Associated with Implementation – 6

Program Registration and Fee Collection

Establish payment procedures and a system of payment

Procedures for Recordkeeping

HIPAA

Records should be kept, but ensure anonymity/confidentiality

Concerns Associated with Implementation – 7

Procedural Manual and/or Participants’ Manual

There may be a need to create a manual for the program to:

Ensure that everyone understands the program and its parameters

Standardize the intervention so it can be replicated and avoid Type III errors

Provide ideas for facilitation

Provide additional background information on the topic

Provide citations for additional resources.

Program Participants with Disabilities

Programs should meet the needs of participants with disabilities.

Concerns Associated with Implementation – 8

Training for Facilitators

Program facilitators need to be familiar with the intervention.

Either by participating in the planning of the intervention or through a training session

Dealing with Problems

Planners should anticipate and deal with problems that might arise.

Documenting and Reporting

Keep others informed about the progress of the program for:

accountability

public relations

motivation of present participants