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HCET Home > On-line Training > What Works in Adolescent Sexual Health Programs > 4. Components & Integration of a Science-Based Approach > Logic Models

Logic Models

• Developing a consensus on what the program will look like, what it expects to do, and how it plans to do it.
• Providing a way to track changes so that program accomplishments may be replicated and problems or challenges may be avoided.
• Helping program planners/staff to recognize assumptions that may need validating (through research, discussion, observation, etc.).

The United Way uses a logic model that describes four components of a program (Figure 6) ^[23]:

1. Inputs (i.e. staff time)
2. Activities using the inputs (i.e. counsel teens)
3. Outputs (i.e. the exact number of counseling sessions)
4. Outcomes (i.e. the benefit the participant received from those counseling sessions)

Figure 6. United Way of America, 1996 ^[23]. Measuring Program Outcomes: A Practical Approach

The Behavior-Determinant-Intervention (BDI) Logic Model (Kirby, 2004) ^[24]

The BDI Logic Model was developed specifically for programs which are focused on teen pregnancy and/or STIs and HIV. A BDI Logic Model can be an easy and useful tool for program design, planning, implementation, and evaluation.

 The BDI logic model is used to:

• Identify the overall health goal
• Specify behaviors that need to be addressed to impact the health goal
• Determine risk and protective factors that directly influence the specific behaviors
• Describe interventions that will address each of the selected factors

To create a BDI logic model, follow these steps:

1. Establish a Health Goal: Identify all possible program goals and select one health goal to be the desired end result. The program goal should be feasible to accomplish, measurable, clearly articulated and should describe the target population.
   It is tempting to want to help every teen with every problem, however it could be an inefficient use of staff and financial resources when attempting to do so. Therefore, programs should narrow their focus to a specific health problem and a “target population.” A target population is a group of individuals to which the program will focus their interventions. This could be youth from a given location, income level, occupation, or ethnic, racial, gender, age, or social group.
   Some populations are at higher risk for contracting STIs/HIV or becoming a teen parent than others. Kirby recommends that programs should choose these high-risk youth as their target population and direct interventions to these high-risk groups ^[25].
   Example:
   By researching county statistics, it is apparent that there has been an increase in teen births among 14-18 year old Latina females in Centerville, Minnesota. The ACTION program at the local health clinic would like to address this health disparity. In creating the intervention, the ACTION program Health Goal could be:

   Reduce the number of births to 14-18 year old Latina females in Centerville High School.

2. Identify Behaviors: Determine the behaviors that are directly linked to the stated Health Goal. These behaviors should have a causal relationship to the Health Goal.
   Behaviors that are directly linked to adolescent sexual health include:
   • Abstaining from sexual activity
   • Onset or initiation of sexual activity
   • Use of contraception, including condoms
   • Frequency of sexual activity
   • Having had multiple sexual partners
   • Testing, screening, or treatment for pregnancy, STIs, or HIV
   For the logic model, a program should identify all behaviors that affect the selected health goal and focus on those behaviors which have the greatest causal impact on the stated Health Goal.
   Example:
   Health Goal: Reduce the number of births to 14-18 year old Latina females in Centerville High School.
   In the case of Centerville High School’s teen birth rate, the program should focus on behaviors that would have the greatest impact at decreasing the number of births. These behaviors could be:
   • Increase the number of 14-18 year old Latina females at Centerville High School who abstain from or delay the onset of sexual activity.
   • Increase the correct and consistent use of contraception (including condoms) by 14-18 year old sexually active Latina females at Centerville High School.
3. Identify Risk and Protective Factors (Determinants): (for definitions and examples of risk and protective factors, see the Research section above). Determine which risk and protective factors (determinants) directly influence a teen’s decision to engage in each of the behaviors listed. Identify all the determinants that affect a selected behavior and then select the factors most amenable or easiest to change. As stated earlier in the module, there are hundreds of determinants that may act together to influence a teen’s decision to engage in sexual activity or high-risk behavior. It is important to recognize those factors which are most important in changing that behavior and also recognize which ones are easiest to change. For a list of risk and protective factors and their amenability to change, see Appendix 1 ^[17].
   Example:
   Health Goal: Reduce the number of births to 14-18 year old Latina females in Centerville High School.
   Although two behaviors were listed above here we will focus on just one of those behaviors (use of condom and contraception) and identify the risk and protective factors most likely to increase the use of condom and contraception.
   Behavior:
   Increase the correct and consistent use of contraception (including condoms) by 14-18 year old sexually active Latina females at Centerville High School.

   Risk and Protective Factors (Determinants):

   1. Increase knowledge about condoms and contraceptives (what is available, where to buy them, cost benefits, etc).
   2. Improve or increase positive attitudes toward condom and contraception use among sexually active 14-18 year old Latina females at Centerville High School.
   3. Increase self-efficacy to use condoms or contraception.
4. Describe Intervention(s): An intervention can be defined as a single activity, a set of activities, or an approach to addressing the stated risk and protective factors and behaviors. If applicable, in this step of the logic model development process, a program may choose to replicate a program that has already been proven effective in addressing the determinants and impacting adolescent behavior. There are many adolescent health education curricula developed using theory and research, that address multiple determinants and behaviors which are effective in decreasing teen pregnancy, HIV, and STIs. If possible, it is always a good idea to use a program that has already been proven effective. This is not always an option, and therefore programs may have to create new activities to address their goal.
   In developing a logic model, you should identify intervention activities that will have a direct effect on the selected risk and protective factors.
   Example:
   Health Goal: Reduce the number of births to 14-18 year old Latina females in Centerville High School.
   Behavior:
   Increase the correct and consistent use of contraception (including condoms) by 14-18 year old sexually active Latina females at Centerville High School.
   Although three risk and protective factors were listed above which would address the selected behavior, here we will focus on just one of those determinants and identify the intervention activities most likely to increase the students’ knowledge of condoms and contraception.
   Risk and Protective Factors (Determinants): Increase knowledge about condoms and contraceptives (what is available, where to buy them, cost benefits, etc).

   Intervention Activities:

   1. Health Educator uses the “Becoming a Responsible Teen” curricula, which has educational sessions on condoms and contraception use.
   2. Bring in a nurse to talk about where family planning clinics and pharmacies are located in which students could access condoms or contraception. Have nurse describe a visit to the clinic.
   3. Create a scavenger hunt for students to find where the nearest store is that sells certain condoms, etc.

   Combined, the Example Logic Model should look something like Figure 7.

   Figure 7: For the ACTION Program at Centerville High School:

   

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URL: http://65.163.14.21/training/ASH/4cLM.htm
 Last update: 03/05/08