Posted: August 3rd, 2022

PH_WK4-1-Logic Model Development Macro-view

8/4/2022 AT 10AM

TOPIC: Logic Model Development Macro-view


The rationale for the strategic plan should be logical. As such, it should be able to be mapped as a next step following the comprehensive community health needs assessment. This mapping process can occur using a tool called a logic model, which is a one-page diagram that presents the conceptual framework for a proposed project or plan, as described in the Unit 3 ASSIGNMENT. It explains among all elements, logically connecting the dots, which is a useful tool in the design and implementation of public health strategies. While there are many versions of logic models, for the purposes of this assignment, your logic model should concisely summarize in brief phrases the connections among the inputs, goals, objectives, activities, and outcomes (both short- and long-term). Creating a logic model can be an iterative process that is revised over time.

In this assignment, you will adopt a macro-view of the overall strategic plan, its design, implementation, and evaluation. Refer back to your Assessment of the Current State assignment in Unit 2 to recall the overall purpose, scope, and approaches that will be utilized to implement the strategic plan for your community. Use the Logic Model Template in the


for this assignment.


The numbered assignment instructions outlined below correspond to the grading criteria in the assignment scoring guide, so be sure to address each point. You may also want to review the performance-level descriptions for each criterion to see how your work will be assessed.

The macro-view of the overall strategic planning process should be organized into the following sections, using the Logic Model Template provided. Use the second page of the template to write a brief, 2 paragraph summary of your logic model.

1. Recommend ways to cultivate fiscal or other resources required to achieve a strategic plan in the community. (For further background, use the Unit 4 readings on traditional and innovative ways to develop resources.)

. Identify fiscal or other resources required to achieve a strategic goal.

. What are the inputs? What resources will go into the plan to make it successful?

. What personnel are required to successfully execute and support the strategic goal?

. What are the revenue source(s) and cost(s) associated with executing the strategic goal?

. How will you solicit or encourage people or organizations to support your initiative?

· Develop distinct goals for the strategic plan in the community.

. What are the aims of the plan?

· Develop supporting objectives aligned to the distinct goals of the strategic plan.

. What are the supporting objectives (aligned to the goals) of the plan?

· Recommend appropriate interventions or approaches to meet the distinct goals of the strategic plan.

. What actions (interventions, approaches, methods, programs, and projects) will take place?

· Identity the short-term and long-term outcomes of the strategic plan.

. Short term (fewer than 3 years).

. Long term (more than 5 years).

· Write in accordance with the academic and professional requirements of the discipline, ensuring appropriate structure, grammar, usage, and style, and proper APA formatting of references.

Additional Requirements

· Written communication: Your logic model should follow the structure given above and should generally be free of errors in grammar, punctuation, and spelling.

· Format: Your logic model and summary should each be one page, in a readable font (10-point minimum), with one-half inch margins (minimum).

· Citations and references: No references are required, but if you choose to use them in your summary, be sure to cite according to APA style and include a references page.


Perovich, L. J., Ohayon, J. L., Cousins, E. M., Morello-Frosch, R., Brown, P., Adamkiewicz, G., & Brody, J. G. (2018). Reporting to parents on children’s exposures to asthma triggers in low-income and public housing, an interview-based case study of ethics, environmental literacy, individual action, and public health benefits. Environmental Health, 17, 1–12.

Moon, S., Røttingen, J., & Frenk, J. (2017). Global public goods for health: Weaknesses and opportunities in the global health system. Health Economics, Policy and Law, 12(2), 195–205.

Ottersen, T., Elovainio, R., Evans, D. B., McCoy, D., Mcintyre, D., Meheus, F., . . . Røttingen, J. (2017). Towards a coherent global framework for health financing: Recommendations and recent developments. Health Economics, Policy and Law, 12(2), 285–296.

Teklehaimanot, H. D., & Teklehaimanot, A. (2013). Human resource development for a community-based health extension program: A case study from Ethiopia. Human Resources for Health, 11, 1–12.

Gregório, J., Cavaco, A., & Velez Lapão, L. (2014). A scenario-planning approach to human resources for health: The case of community pharmacists in Portugal. Human Resources for Health, 12(58), 1–13.

· Include THREE academic references above 2017




· Due 8/4//22 at 10am

MAKE SURE TO FOLLOW ALL Logic Model Development Macro-view Scoring Guide TO GAIN GOOD GRADES






Recommend ways to cultivate fiscal or other resources required to achieve a strategic plan in the community.

Does not recommend ways to cultivate fiscal or other resources required to achieve a strategic plan in the community.

Provides limited recommendations to cultivate fiscal or other resources required to achieve a strategic plan in the community.

Recommends ways to cultivate fiscal or other resources required to achieve a strategic plan in the community.

Recommends comprehensive and feasible ways to cultivate fiscal or other resources required to achieve a strategic plan in the community.

Develop distinct goals for the strategic plan in the community.

Does not develop distinct goals for the strategic plan in the community.

Develops incomplete goals for the strategic plan in the community.

Develops distinct goals for the strategic plan in the community.

Develops distinct goals for the strategic plan in the community that are supported by theory and research.

Develop supporting objectives aligned to the distinct goals of the strategic plan.

Does not develop supporting objectives aligned to the goals of the strategic plan.

Develops objectives that are incomplete or only partially aligned to the goals of the strategic plan.

Develops supporting objectives aligned to the distinct goals of the strategic plan.

Develops supporting objectives aligned to the distinct goals of the strategic plan that are supported by theory and research.

Recommend appropriate interventions or approaches to meet the distinct goals of the strategic plan.

Does not recommend appropriate interventions or approaches to meet the goals of the strategic plan.

Recommends interventions or approaches that are not well defined or do not sufficiently meet the goals of the strategic plan.

Recommends appropriate interventions or approaches to meet the distinct goals of the strategic plan.

Recommends appropriate interventions or approaches to meet the distinct goals of the strategic plan; shows a comprehensive and in-depth understanding of the plan.

Identify the short-term and long-term outcomes of the strategic plan.

Does not identity the short-term and long-term outcomes of the strategic plan.

Identifies, at a cursory level, the outcomes of the strategic plan.

Identities the short-term and long-term outcomes of the strategic plan.

Identifies and evaluates the short-term and long-term outcomes of the strategic plan.

Write in accordance with the academic and professional requirements of the discipline, ensuring appropriate structure, grammar, usage, and style, and proper APA formatting of references.

Does not write in accordance with the academic and professional requirements of the discipline, ensuring appropriate structure, grammar, usage, and style, and proper APA formatting of references.

Writing partially meets the academic and professional requirements of the discipline; work has errors in structure, grammar, usage, style, or APA formatting of references.

Writes in accordance with the academic and professional requirements of the discipline, ensuring appropriate structure, grammar, usage, and style, and proper APA formatting of references.

Writes in full accordance with the academic and professional requirements of the discipline; work uses appropriate structure, grammar, usage, and style, and proper APA formatting of references with no errors.

Logic Model

Target Population

Insert here.

Project Goals

and Objectives





Short-Term Outcomes





Objective 1



Objective 3

Goal 2

Objective 1

Objective 2

Objective 3

Logic Model Template


Logic Model Summary

In 2 paragraphs (no more than 250–300) words, provide a brief summary of your logic model. You can utilize APA citations in your summary; if you do so, include a references page at the end.

Riverbend city ( Community Health Needs Assessment)

Martin Lewis, Parent: You know what bugs me? The panhandlers in Ruby Lake are getting so much worse. It was always kind of a problem, but now when I wait for a bus I actually feel kind of unsafe. Some of those people are aggressive and seem kind of unhinged.

Ed Kowalski, Riverbend City Police Department: It’s tough. I can tell you that, on the force, we know it’s a problem. Homelessness all over Riverbend City has gotten a lot worse in the past five years, especially in Ruby Lake.

Nicole Fernandez, Health Care Representative: Well, if we want to talk about public health needs, there you go. Spiking homelessness represents a collision of a bunch of public health issues a lot of the time. The correlation between homelessness and mental health problems is very large, and we know for a fact that access to mental health care is a glaring problem in the city. Across all populations, by the way, not just among the homeless. Same thing for substance abuse- it can be a gateway to homelessness or an endemic condition within it, and either way, we again have real problems.

Victor Maldonado, Community Activist: If we look at the Community Health Needs Assessment, the top needs all seem to pop up here. Mental health- top concern, check. Substance abuse, check. Health care access, big check.

Father Junot Rivera, Faith-Based Representative: Certainly that’s a problem among the homeless, but I think we can agree that it’s a problem throughout the neighborhood and the city. In my parish, there are very few people who feel like they have easy access to healthcare, especially preventative healthcare. And this is both among people who work and people who don’t.

Victor Maldonado, Community Activist: And the other two in the top five concerns are in the same neighborhood, thematically: programs and resources for obesity prevention, and for chronic disease. Add this up, and our citizens overwhelmingly have problems getting health care in a systematic and preventative way.

Martin Lewis, Parent: : And that’s why we need to work out how the city and county can help connect people with these services.

Ed Kowalski, Riverbend City Police Department: Whoa, there. I think that’s way beyond our brief. I’ll grant you that these problems exist, but we’re here to enforce the laws and keep the streets clean, not to hold people’s hands into mental health care.

Father Junot Rivera, Faith-Based Representative: Come on. You know as well as the rest of us that there are real-world benefits that we would see if people in Ruby Lake had better access to mental health care, and other types of long-term medical care. Nobody’s necessarily saying that the city or county needs to provide everything, but they can certainly help empower organizations that are providing services, and reduce structural barriers, and, you know, direct people towards resources that exist. What if you provided a mental health care referral to one of the panhandlers making Martin uncomfortable? What if you, as a police officer, had phone numbers you could give to people when you see obvious chronic disease or substance abuse problems when you’re performing a welfare check?

Ed Kowalski, Riverbend City Police Department: I’m a cop, not a social worker. I want to help people, sure, but I need to spend my time protecting the community from bad guys. This social help stuff would have to be a distant second. It’s not my place to save the world, and it’s not in my power.

Bruce Greenberg, Superintendent of the Riverbend City School District: : Not on your own, sure, but all of us represent organizations or points of view that can do something to reduce barriers. Even if we can’t help everybody—and of course I know we can’t—we *can* help a lot of people in actual, concrete ways. And every single person we help makes our city a little bit better.

Read (pages 14–21)

The Fuzzy Aspects of


We like to think of planning as a rational, linear process, with few ambiguities and only the rare dispute. Unfortunately, this is not the reality of health program planning. Many paradoxes inherently exist in planning as well as implicit assumptions, ambiguities, and the potential for conflict. In addition, it is important to be familiar with the key ethical principles that underlie the decision making that is part of planning.


Several paradoxes pervade health planning (Porter, 2011), which may or may not be resolvable. Those involved can hold assumptions about planning that complicate the act of planning, whether for health systems or programs. Being aware of the paradoxes and assumptions can, however, help program planners understand possible sources of frustration.

One paradox is that planning is shaped by the same forces that created the problems that planning is supposed to correct. Put simply, the healthcare, sociopolitical, and cultural factors that contributed to the health problem or condition are very likely to be same factors that affect the health planning process. The interwoven relationship of health and other aspects of life affects health planning. For example, housing, employment, and social justice affect many health conditions that stimulate planning. This paradox implies that health planning itself is also affected byhousing, employment, and social justice.

Another paradox is that the “good” of individuals and society experiencing the prosperity associated with health and well-being is “bad” to the extent that this prosperity also produces ill health. Prosperity in our modern world has its own associated health risks, such as higher cholesterol levels, increased stress, increased risk of cardiovascular disease, and increased levels of environmental pollutants. Also, as one group prospers, other groups often become disproportionately worse off. So, to the extent that health program planning promotes the prosperity of a society or a group of individuals, health issues for others will arise that require health program planning.

A third paradox is that what may be easier and more effective may be less acceptable. A good example of this paradox stems from decisions about active and passive protective interventions. Active protection and passive protection are both approaches to risk reduction and health promotion. Active protection requires that individuals actively participate in reducing their risks—for example, through diet changes or the use of motorcycle helmets. Passive protection occurs when individuals are protected by virtue of some factor other than their behavior—for example, water fluoridation and mandates for smoke-free workplaces. For many health programs, passive protection in the form of health policy or health regulations may be more effective and efficient. However, ethical and political issues can arise when the emphasis on passive protection, through laws and communitywide mandates, does not take into account cultural trends or preferences.

Another paradox is that those in need ideally, but rarely, trigger the planning of health programs; rather, health professionals initiate the process. This paradox addresses the issue of who knows best and who has the best ideas for how to resolve the “real” problem. The perspective held by health professionals often does not reflect broader, more common health social values (Reinke & Hall, 1988), including the values possessed by those individuals with the “problem.” Because persons in need of health programs are most likely to know what will work for them, community and stakeholder participation becomes not just crucial but, in many instances, is actually mandated by funding agencies. This paradox also calls into question the role of health professionals in developing health programs. Their normative perspective and scientific knowledge need to be weighed against individuals’ choices that may have caused the health problem.

A corollary to the paradox dealing with the sources of the best ideas is the notion that politicians tend to prefer immediate and permanent cures, whereas health planners prefer long-term, strategic, and less visible interventions (Reinke & Hall, 1988). Generally, people want to be cured of existing problems rather than to think probabilistically about preventing problems that may or may not occur in the future. As a consequence, the prevention and long-term solutions that seem obvious to public health practitioners can conflict with the solutions identified by those with the “problem.”

One reason that the best solutions might come from those with the problem is that health professionals can be perceived as blaming those with the health problem for their problem. Blum (1981), for example, identified the practice of “blaming the victim” as a threat to effective planning. When a woman who experiences domestic violence is said to be “asking for it,” the victim is being blamed. During the planning process, blaming the victim can be implicitly and rather subtly manifested in group settings through interpretation of data about needs, thereby affecting decisions related to those needs. Having the attitude that “the victim is to blame” can also create conflict and tension among those involved in the planning process, especially if the “victims” are included as stakeholders. The activities for which the victim is being blamed need to be reframed in terms of the causes of those activities or behaviors.

Yet another paradox is the fact that planning is intended to be successful; no one plans to fail. Because of the bias throughout the program planning cycle in favor of succeeding, unanticipated consequences may not be investigated or recognized. Theunanticipated consequences of one action can lead to the need for other health decisions that were in themselves unintended (Patrick & Erickson, 1993). To overcome this paradox, brainstorming and thinking creatively at key points in the planning process ought to be fostered and appreciated.

A final paradox of planning, not included on Reinke and Hall’s (1988) list, is that most planning is for making changes, not for creating stability. Yet once a change has been achieved, whether in an individual’s health status or a community’s rates of health problems, the achievement needs to be maintained. Many health programs and health improvement initiatives are designed to be accomplished within a limited time frame, with little or no attention to what happens after the program is completed. To address this paradox requires that planning anticipate the conclusion of a health program and include a plan for sustaining the gains achieved.


Assumptions also influence the effectiveness of planning. The first and primary assumption underlying all planning processes is that a solution, remedy, or appropriate intervention can be identified or developed and provided. Without this assumption, planning would be pointless. It is fundamentally an optimistic assumption about the capacity of the planners, the stakeholders, and the state of the science to address the health problem. The assumption of possibilities further presumes that the resources available, whether human or otherwise, are sufficient for the task and are suitable to address the health problem. The assumption of adequate capacity and knowledge is actually tested through the process of planning.

A companion assumption is that planning leads to the allocation of resources needed to address the health problem. This assumption is challenged by the reality that four groups of stakeholders have interests in the decision making regarding health resources (Sloan & Conover, 1996) and each group exists in all program planning. Those with the health problem and who are members of the target audience for the health program are one group. Another group of stakeholders is health payers, such as insurance companies and local, federal, and philanthropic funding agencies. The third group is individual healthcare providers and healthcare organizations and networks. Last, the general public is a stakeholder group because it is affected by how resources are allocated for health programs. This list of stakeholder groups highlights the variety of motives each group has for being involved in health program planning, such as personal gain, visibility for an organization, or acquisition of resources associated with the program.

Another assumption about those involved is that they share similar views on how to plan health programs. During the planning process, their points of view and cultural perspectives will likely come into contrast. Hoch (1994) suggested that planners need to know what is relevant and important for the problem at hand. Planners can believe in one set of community purposes and values yet still recognize the validity and merit of competing purposes. He argues that effective planning requires tolerance, freedom, and fairness and that technical and political values are two bases from which to give planning advice. In other words, stakeholders involved in the planning process need to be guided into appreciating and perhaps applying a variety of perspectives about planning.

Each stakeholder group assumes that there are limited resources to be allocated for addressing the health problem and is receptive or responsive to a different set of strategies for allocating health resources. The resulting conflicts among the stakeholders for the limited resources apply whether they are allocating resources across the healthcare system or among programs for specific health problems. Limitedresources, whether real or not, raise ethical questions of what to do when possible gains from needed health programs or policies are likely to be small, especially when the health program addresses serious health problems.

It is interesting that, the assumption of limited resources parallels the paradox that planning occurs around what is limited rather than what is abundant. Rarely is there a discussion of the abundant or unlimited resources available for health planning. Particularly in the United States, we have an amazing abundance of volunteer hours and interest and of advocacy groups and energy, and recently retired equipment that may be appropriate in some situations. Such resources, while not glamorous or constituting a substantial entry on a balance sheet, deserve to be acknowledged in the planning process.

Another assumption about the planning process is that it occurs in an orderly fashion and that a rational approach is best. To understand the implications of this assumption, one must first acknowledge that four key elements are inherent in planning: uncertainty, ambiguity, risk, and control. The presence of each of these elements contradicts the assumption of a rational approach, and each generates its own paradoxes.






, and


Despite the orderly approach implied by use of the term planning, this process is affected by the limits of both scientific rationality and the usefulness of data to cope with the uncertainties, ambiguities, and risks being addressed by the planning process (see TABLE 1-3).

TABLE 1-3 Fuzzy Aspects Throughout the Planning and Evaluation Cycle

Stages in the Planning and Evaluation Cycle

Community Assessment



Effect Evaluation


Unknown likelihood of finding key health determinants

Unknown likelihood of selecting an effective intervention, unknown likelihood of the intervention being effective

Unknown likelihood of the intervention being provided as designed and planned

Unknown likelihood of intervention being effective


Unclear about who is being assessed or why

Unclear about the process, who is leading planning process, or what it is intended to accomplish

Unclear about the boundaries of the program, who ought to participate, or who ought to deliver the program

Unclear about meaning of the evaluation results


Unknown possibility of the assessment causing harm

Unknown possibility of planning touching on politically sensitive issues

Unknown possibility of the intervention having an adverse effect on participants

Unknown possibility of adverse effect from the evaluation design, or from misinterpretation of the findings


Directing the process of gathering and interpreting data about the health problem

Directing the decisions about the program

Directing the manner in which the program is provided

Directing the process of data collection, analysis and interpretation

Uncertainty is the unknown likelihood of a possible outcome. Rice, O’Connor, and Pierantozzi (2008) have identified four types of uncertainty: types and amount of resources, technological, market receptivity to the product, and organizational. Each of these uncertainties is present in planning health programs. Ambiguity is doubt about a course of action stemming from awareness that known and unknown factors exist that can decrease the possibility of certainty. In this sense, ambiguity results in uncertainty. Both uncertainty and ambiguity pervade the planning process because it is impossible to know and estimate the effect of all relevant factors—from all possible causes of the health problem, to all possible health effects from program interventions, to all possible acts and intentions of individuals. A rational approach to planning presumes that all relevant factors can be completely accounted for by anticipating the effect of a program, but our experiences as humans tell us otherwise.

Ambiguity is the characteristic of not having a clear or single meaning. Change, or the possibility of change, is a possible source of ambiguity. When ambiguity is ignored, the resulting differences in interpretation can lead to confusion and conflict among stakeholders and planners, among planners and those with the health problem, and among those with various health problems vying for resources. The conflict, whether subtle and friendly or openly hostile, detracts from the planning process by requiring time and personnel resources to address and resolve the conflict. Nonetheless, openly and constructively addressing the ambiguity and any associated conflict can lead to innovations in the program.

Risk is the perceived possibility or uncertain probability of an adverse outcome in a given situation. Health planners need to be aware of the community’s perception and interpretation of probabilities as they relate to health and illness. Risk is not just about taking chances (e.g., bungee jumping or having unprotected sex) but is also about uncertainty and ambiguity (as is the case with estimates of cure rates and projections about future health conditions). Risk is pervasive and inherent throughout the planning process in terms of deciding who to involve and how, which planning approach to use, which intervention to use, and in estimating which health problem deserves attention. The importance of understanding risk as an element both of the program planning process and of the target audience provides planners with a basis from which to be flexible and speculative.

Control, as in being in charge of or managing, is a natural reaction to the presence of ambiguity, conflict, and risk. It can take the form of directing attention and allocating resources or of exerting dominance over others. Control remains a key element of management. In other words, addressing the ambiguity, uncertainty, and risk that might have been the trigger for the planning process requires less—not more—control. Those who preside over and influence the planning process are often thought of as having control over solutions to the health problem or condition. They do not. Instead, effective guidance of the planning process limits the amount of control exerted by any one stakeholder and addresses the anxiety that often accompanies the lack of control.

Introduction to the Types of Evaluation

Several major types of activities are classified as evaluations. Each type of activity requires a specific focus, purpose, and set of skills. The types of evaluations are introduced here as an overview of the field of planning and evaluation.

Community needs assessment (also known as community health assessment) is a type of evaluation that is performed to collect data about the health problems of a particular group. The data collected for this purpose are then used to tailor the health program to the needs and distinctive characteristics of that group. A community needs assessment is a major component of program planning because it is, done at an early stage in the program planning and evaluation cycle. In addition, the regular completion of community assessments may be required. For example, many states do 5-year planning of programs based on state needs assessments.

Another type of evaluation begins at the same time that the program starts. Process evaluations focus on the degree to which the program has been implemented as planned and on the quality of the program implementation. Process evaluations are known by a variety of terms, such as monitoring evaluations, depending on their focus and characteristics. The underlying framework for designing a process evaluation comes from the process theory component of the overall program theory developed during the planning stage. The process theory delineates the logistical activities, resources, and interventions needed to achieve the health change in program participants or recipients. Information from the process evaluation is used to plan, revise, or improve the program.

The third type of evaluation seeks to determine the effect of the program—in other words, to demonstrate or identify the program’s effect on those who participated in the program. Effect evaluations answer a key question: Did the program make a difference? The effect theory component of the program theory is used as the basis for designing this evaluation. Evaluators seek to use the most rigorous and robust designs, methods, and statistics possible and feasible when conducting an effect evaluation. Findings from effect evaluations are used to revise the program and may be used in subsequent initial program planning activities. Effect evaluations may be referred to as outcome or impact evaluations, terms which seem to be used interchangeably in the literature. For clarity, outcome evaluations focus on the more immediate effects of the program, whereas impact evaluations may have a more long-term focus. Program planners and evaluators must be vigilant with regard to how they and others are using terms and should clarify meanings and address misconceptions or misunderstandings.

A fourth type of evaluation focuses on efficiency and the costs associated with the program. Cost evaluations encompass a variety of more specific cost-related evaluations—namely, cost-effectiveness evaluations, cost–benefit evaluations, and cost–utility evaluations. For the most part, cost evaluations are done by researchers because cost–benefit and cost–utility evaluations, in particular, require expertise in economics. Nonetheless, small-scale and simplified cost-effectiveness evaluations can be done if good cost accounting has been maintained by the program and a more sophisticated outcome or impact evaluation has been conducted. The similarities and differences among these three types of cost studies are reviewed in greater detail in the text so that program planners can be, at minimum, savvy consumers of published reports of cost evaluations. Because cost evaluations are performed late in the planning and evaluation cycle, their results are not likely to be available in time to make program improvements or revisions. Instead, such evaluations are generally used during subsequent planning stages to gather information for prioritizing program options.

Comprehensive evaluations, the fifth type of evaluation, involve analyzing needs assessment data, process evaluation data, effect evaluation data, and cost evaluation data as a set of data. Given the resources needed to integrate analysis of various types of data to draw conclusions about the effectiveness and efficiency of the program, comprehensive evaluations are relatively uncommon. A sixth type of evaluation is a meta-evaluation. A meta-evaluation is done by combining the findings from previous outcome evaluations of various programs for the same health problem. The purpose of a meta-evaluation is to gain insights into which of the various programmatic approaches has had the most effect and to determine the maximum effect that a particular programmatic approach has had on the health problem. This type of evaluation relies on the availability of existing information about evaluations and on the use of a specific set of methodological and statistical procedures. For these reasons, meta-evaluations are less likely to be done by program personnel; instead, they are generally carried out by evaluation researchers. Meta-evaluations that are published are extremely useful in program planning because they indicate which programmatic interventions are more likely to succeed in having an effect on the participants. Published meta-evaluations can also be valuable in influencing health policy and health funding decisions.

Summative evaluations, in the strictest sense, are done at the conclusion of a program to provide a conclusive statement regarding program effects. Unfortunately, the term summative evaluation is sometimes used to refer to either an outcome or impact evaluation, adding even more confusion to the evaluation terminology and vernacular language. Summative evaluations are usually contrasted with formative evaluations. The term formative evaluation is used to refer to program assessments that are performed early in the implementation of the program and used to make changes to the program. Formative evaluations might include elements of process evaluation and preliminary effect evaluations.

Mandated and Voluntary Evaluations

Evaluations are not spontaneous events. Rather, they are either mandated or voluntary. A mandate to evaluate a program is always linked in some way to the funding agencies, whether a governmental body or a foundation. If an evaluation is mandated, then the contract for receiving the program funding will include language specifying the parameters and time line for the mandated evaluation. The mandate for an evaluation may specify whether the evaluation will be done by project staff members or external evaluators, or both. For example, the State Child Health Insurance Program (SCHIP), created in 1998, is a federally funded and mandated program to expand insurance coverage to children just above the federal poverty level. Congress has the authority to mandate evaluations of federal programs and did just that with the SCHIP. Mandated evaluations of SCHIP include an overall evaluation study by Wooldridge and associates from the Urban Institute (2003), and an evaluation specifically focused on outcomes for children with special healthcare needs (Zickafoose, Smith, & Dye, 2015).

Other evaluations may be linked to accreditation that is required for reimbursement of services provided, making them de facto mandated evaluations. For example, to receive accreditation from the Joint Commission, a health services organization must collect data over time on patient outcomes. These data are then used to develop ongoing quality improvement efforts. A similar process exists for mental health agencies. The Commission on Accreditation of Rehabilitation Facilities (CARF) requires that provider organizations conduct a self-evaluation as an early step in the accreditation process. These accreditation-related evaluations apply predominantly to direct care providers rather than to specific programs.

Completely voluntary evaluations are initiated, planned, and completed by the project staff members in an effort to make improvements. However, given the relatively low reward from, and cost associated with, doing an evaluation when it is not required, these evaluations are likely to be small with low scientific rigor. Programs that engage voluntarily in evaluations may have good intentions, but they often lack the skills and knowledge required to conduct an appropriate evaluation.

When Not to Evaluate

Situations and circumstances that are not amenable to conducting an evaluation do exist, despite a request or the requirement for having an evaluation. Specifically, it is not advisable to attempt an evaluation under the following four circumstances: when there are no questions about the program, when the program has no clear direction, when stakeholders cannot agree on the program objectives, and when there is not enough money to conduct a sound evaluation (Patton, 2008). In addition to these situations, Weiss (1972) recognized that sometimes evaluations are requested and conducted for less than legitimate purposes, namely, to postpone program or policy decisions, thereby avoiding the responsibility of making the program or policy decision; to make a program look good as a public relations effort; or to fulfill program grant requirements. As these lists suggest, those engaged in program planning and evaluation need to be purposeful in what is done and should be aware that external forces can influence the planning and evaluation processes.

Since Weiss made her observation in 1972, funders have begun to require program process and effect evaluations, and conducting these evaluations to meet that requirement is considered quite legitimate. This change has occurred as techniques for designing and conducting both program process and effect evaluations have improved, and the expectation is that even mandated evaluations will be useful in some way. Nonetheless, it remains critical to consider how to conduct evaluations legitimately, rigorously, inexpensively, and fairly. In addition, if the AEA standards of utility, feasibility, propriety, and accuracy cannot be met, it is not wise to conduct an evaluation (Patton, 2008).

Interests and the degree of influence held by stakeholders can change. Such changes affect not only how the evaluation is conceptualized but also whether evaluation findings are used. In addition, the priorities and responsibilities of the organizations and agencies providing the program can change during the course of delivering the program, which can then lead to changes in the program implementation that have not been taken into account by the evaluation. For example, if withdrawal of resources leads to a shortened or streamlined evaluation, subsequent findings may indicate a failure of the program intervention. However, it will remain unclear whether the apparently ineffective intervention was due to the design of the program or the design of the evaluation. In addition, unanticipated problems in delivering the program interventions and the evaluation will always exist. Even rigorously designed evaluations face challenges in the real world stemming from staff turnover, potential participants’ noninvolvement in the program, bad weather, or any of a host of other factors that might hamper achieving the original evaluation design. Stakeholders will need to understand that the evaluator attempted to address challenges as they arose if they are to have confidence in the evaluation findings.

The Public Health Pyramid

Pyramids tend to be easy to understand and work well to capture tiered concepts. For these reasons, pyramids have been used to depict the tiered nature of primary healthcare, secondary healthcare, and tertiary healthcare services (U.S. Public Health Service, 1994), the inverse relationship of effort needed and health impact of different interventions (Frieden, 2010), and nutrition recommendations (Gil, Ruiz-Lopez, Fernandez-Gonzalez, & de Victoria, 2014).

The public health pyramid is divided into four sections (FIGURE 1-2). The top, or the first, section of the pyramid contains direct healthcare services, such as medical care, psychological counseling, hospital care, and pharmacy services. At this level of the pyramid, programs are delivered to individuals, whether patients, clients, or even students. Generally, programs at the direct services level have a direct, and often relatively immediate, effect on individual participants in the health program. Direct services of these types appear at the tip of the pyramid to reflect that, overall, the smallest proportion of a population receives them. These interventions, according to the Health Impact Pyramid (Frieden, 2010), require considerable effort, with minimal population effects.

FIGURE 1-2 The Public Health Pyramid

At the second level of the pyramid are enabling services, which are those health and social services that support or enhance the health of aggregates. Aggregates are used to distinguish between individuals and populations; they are groups of individuals who share a defining characteristic, such as mental illness or a terminal disease. Examples of enabling services include mental health drop-in centers, hospice programs, financial assistance programs that provide transportation to medical care, community-based case management for patients with acquired immune deficiency syndrome (AIDS), low-income housing, nutrition education programs provided by schools, and workplace child care centers. As this list of programs demonstrates, the services at this level may directly or indirectly contribute to the health of individuals, families, and communities and are provided to aggregates. Enabling services can also be thought of as addressing some of the consequences of social determinants of health.

The next, more encompassing level of the public health pyramid is population-based services. At the population level of the pyramid, services are delivered to an entire population, such as all persons residing in a city, state, or country. Examples of population services include immunization programs for all children in a county, newborn screening for all infants born in a state, food safety inspections carried out under the auspices of state regulations, workplace safety programs, nutrition labeling on food, and the Medicaid program for pregnant women whose incomes fall below the federal poverty guidelines. As this list reflects, the distinction between an aggregate and a population can be blurry. Programs at this level typically are intended to reach an entire population, sometimes without the conscious involvement of individuals. In this sense, individuals receive a population-based health program, such as water fluoridation, rather than participating in the program, as they would in a smoking-cessation class. Interventions and programs aimed at changing the socioeconomic context within which populations live would be included at this population level of the pyramid. Such programs are directed at changing one or more social determinants of health. Population-level programs contribute to the health of individuals and, cumulatively, to the health status of the population.

Supporting the pyramid at its base is the infrastructure of the healthcare system and the public health system. The health services at the other pyramid levels would not be possible unless there were skilled, knowledgeable health professionals; laws and regulations pertinent to the health of the people; quality assurance and improvement programs; leadership and managerial oversight; health planning and program evaluation; information systems; and technological resources. The planning and evaluation of health programs at the direct, enabling, and population services levels is itself a component of the infrastructure; these are infrastructure activities. In addition, planning programs to address problems of the infrastructure, as well as to evaluate the infrastructure itself, are needed to keep the health and public health system infrastructure strong, stable, and supportive of the myriad of health programs.

Use of the Public Health Pyramid in Program Planning and Evaluation

Health programs exist across the pyramid levels, and evaluations of these programs are needed. However, at each level of the pyramid, certain issues unique to that level must be addressed in developing health programs. Accordingly, the types of health professionals and the types of expertise needed vary by pyramid level, reinforcing the need to match program, participants, and providers appropriately. Similarly, each level of the pyramid is characterized by unique challenges for evaluating programs. For this reason, the public health pyramid, as a framework, helps illuminate those differences, issues, and challenges, as well as to reinforces that health programs are needed across the pyramid levels if the Healthy People 2020 goals and objectives are to be achieved.

In a more general sense, the public health pyramid provides reminders that various aggregates of potential audiences exist for any health problem and program and that health programs are needed across the pyramid. Depending on the health discipline and the environment in which the planning is being done, direct service programs may be the natural or only inclination. The public health pyramid, however, provides a framework for balancing the level of the program with meeting the needs of the broadest number of people with a given need. Reaching the same number of persons with a direct services program as with a population services program poses additional expense and logistic challenges.

The pyramid also serves as a reminder that stakeholder alignments and allegiances may be specific to a level of the pyramid. For example, a school health program (an enabling-level program) has a different set of constituents and concerned stakeholders than a highway safety program (a population-level program). The savvy program planner considers not only the potential program participants at each level of the pyramid but also the stakeholders who are likely to make themselves known during the planning process.

The public health pyramid has particular relevance for public health agencies concerned with addressing the three core functions of public health (Institute of Medicine, 1988): assessment, assurance, and policy. These core functions are evident, in varying forms, at each level of the pyramid. Similarly, the pyramid can be applied to the strategic plans of organizations in the private healthcare sector. For optimal health program planning, each health program being developed or implemented ought to be considered in terms of its relationship to services, programs, and health needs at other levels of the pyramid. For all these reasons, the public health pyramid is used throughout this text as a framework for summarizing specific issues and applications of chapter content to each level of the pyramid and to identify and discuss potential or real issues related to the topic of the chapter.

The Public Health Pyramid as an Ecological Model

Individual behavior and health are now understood to be influenced by the social and physical environment of individuals. This recognition is reflected in the growing use of the ecological approach to health services and public health programs. The ecological approach, which stems from systems theory applied to individuals and families (Bronfenbrenner, 1970, 1989), postulates that individuals can be influenced by factors in their immediate social and physical environment. This perspective has been expanded into the social determinants perspective in public health, which has wide acceptance (Frieden, 2010). The individual is viewed as a member of an intimate social network, usually a family, which is a member of a larger social network, such as a neighborhood or community. The way in which individuals are nested within these social networks has consequences for the health of the individual.

Because it distinguishes and recognizes the importance of enabling and population services, the public health pyramid can be integrated with an ecological view of health and health problems. If one were to look down on the pyramid from above, the levels would appear as concentric circles (FIGURE 1-3)—direct services for individuals nested within enabling services for families, aggregates, and neighborhoods, which are in turn nested within population services for all residents of cities, states, or countries. This is similar to individuals being nested within the enabling environment of their family, workplace setting, or neighborhood, all of which are nested within the population environment of factors such as social norms and economic and political environments. The infrastructure of the healthcare system and public health system is the foundation and supporting environment for promoting health and preventing illnesses and diseases.

FIGURE 1-3 The Pyramid as an Ecological Model

The end of the chapter presents a summary of challenges or issues related to applying the chapter content to each level of the pyramid. This feature reinforces the message that each level of the pyramid has value and importance to health program planning and evaluation. In addition, certain unique challenges are specific to each level of the pyramid. The chapter summary by levels offers an opportunity to acknowledge and address the issues relat


Assessmentof the Current State

Assessment of The Current State




From; Name


local public health department

To; Staff members

North Dakota

Community Health Department

Subject; Seeking approval and feedback for public dissemination of the open letter

Dear Sir/Madam

It is to inform you of the organization’s intention to abolish the use of plastic bags to improve sanitation in North Dakota. In line with this, I am writing to seek your feedback on this matter and your approval to undertake the change process.

The organization intends to use Lewin’s theoretical Framework for organizational change strategies. The theory’s unfreezing stage will be achieved by educating the staff on the existing perceptions of the use of plastic bags, educating the team on the current alternative to plastic bags, and the advantages of the new modalities of carrier bags as opposed to the plastic bags. Secondly, the change step in Lewin’s theory will be achieved through communicating the change process to the staff and the public, consulting the team on the change process, allowing adequate time for the change process, training and educating the staff on the change process and compensating individuals who might have been disadvantaged by the change process (Hussain et al., 2018). Finally, the refreeze process will entail recruiting new employees, staffing, and reconstitution the affected departments.

Lewin’s theoretical Framework is vital in major organizations. It is a simpler theory than other approaches, yet it encompasses all the aspects of a strategic plan in only three steps. Nearly all stakeholders can easily understand the analogy of unfreezing, change, and refreezing. Therefore, it is one of the most preferred frameworks.

In conclusion, I am looking forward to a positive response from you.

Yours Faithfully,

Director, local community health Department.

Open Letter to People of North Dakota



Local community health Department

North Dakota


The public,

North Dakota Community,

RE: Abolishing the use of plastic bags

It is to bring to your attention the plan to abolish the use of plastic bags to improve sanitation in North Dakota. There has been ongoing pollution from plastic bags In North Dakota, partly brought about by increased population within the community and poor waste disposal mechanisms within the community. Consequently, it has resulted in increased incidences of fecal oral infections, contamination of water sources and air pollution resulting from burning plastic bags (McLeod et al., 2021). Therefore, the change process is a response aimed at curbing the menace.

The organizers intend to implement change in a stepwise fashion to allow the seamless transition. First, the organization wants to reach out to the public to seek their views concerning the matter, educate the public on the dangers posed by plastic bags, enlighten them on the new versions of bags that are biodegradable, and allow time to internalize the change process and finally implement new strategies ( Burnes, 2020). Therefore, the organization intends to use Lewin’s unfreezing, change, and refreezing theory.

However, every change process encounters certain challenges which we have to predict. First, the public’s resistance is anticipated, in addition to financial implications associated with a change process. Moreover, part of the community that relied on plastic bag business would be jobless. Therefore, the institution intends to conduct a thorough community awareness program to alleviate resistance. Furthermore, the institution has set aside funds to initiate the change process, with the rest of the funding expected to come from taxes obtained. Moreover, plastic bags will be made from recycled waste products, rendering them a cheaper alternative in the long run. Finally, the individuals working in plastic bag companies will be offered priority in the new biodegradable bag companies.

Therefore, the institution projects a future state in which the community will be free from plastic bags and pollution associated with plastic bags. Moreover, producing biodegradable bags locally from recycled products will render them a cheaper alternative.

I am looking forward to a positive response to the change process.

Yours faithfully,

Director, local community health Department.


Burnes, B. (2020). History of Lewin’s Three Stage Model of Behavioral Change.

An International Review of Research on Behavioral Health,

Hussain, S. T., Lei, S., Akram, T., Haider, M. J., Hussain, S. H., & Ali, M. (2018).Model change model: A critical review of the role of leadership and employee involvement in organizational change. Journal of Innovation & Knowledge. Journal of Innovation & Knowledge, 3(3), 123-127. MacLeod, M., Arp, H. P. H., Tekman, M. B., & Jahnke, A. (2021). The global threat from plastic pollution. Science, 373(6550), 61-65.




Goals and Outcomes in Context

Student Name

Institutional Affiliation



Goals and Outcomes in Context

The health need identified is the lack of access to healthcare in a systematic and preventive way by Riverbend City citizens. Access to healthcare is a glaring concern in the neighborhood. One qualitative theme from the interview is the problematic access to preventative healthcare. It shows that lack of access to healthcare is a problem since very few people feel like they have access to healthcare, especially preventive healthcare. The problem affects the people who work and those who do not. Some of the top concerns regarding preventive healthcare are the lack of sufficient programs and resources for obesity prevention and chronic disease. The other qualitative theme from the interview is structural barriers that impede individuals’ access to long-term medical care. It indicates the need for the city to empower organizations providing mental health services and reduce structural barriers by directing individuals toward existing resources.

Increased access to healthcare services such as long-term medical care and preventive healthcare is crucial in improving the health of populations, and reducing health disparities aids in improving healthcare outcomes. For instance, increased access to preventative healthcare supports individuals’ behavioral change by reducing risks and providing protective factors cutting across social and environmental contexts that help individuals and communities achieve the highest level of health (Brown et al., 2019). For instance, in the case of obesity disparities, community-based interventions will help to improve nutrition and physical activity at the individual level by ensuring the food and social environments support healthy diets and active lifestyles (Brown et al., 2019). Hence, increased access to healthcare in Riverbend City will support community-based interventions that promote population health. Reducing service inequalities in mental health is essential to effectively addressing individuals’ mental health needs (Alegria et al., 2018). Treated mental health and substance use disorders are connected to decreased premature deaths, low rates of disability, and decreased risk for chronic disease. Thus, it is essential to close existing gaps in long-term medical care in Riverbend City to improve the health outcomes of patients with mental health conditions, chronic illnesses, and other long-term health conditions.


Alegria, M., Nakash, O., & Nemoyer, A. (2018). Increasing equity in access to mental health care: a critical first step in improving service quality. World Psychiatry, 17(1), 43-44.

Brown, A. F., Ma, G. X., Miranda, J., Eng, E., Castille, D., Brockie, T., Jones, P. …& Trinh-Shevrin, C. (2019). Structural Interventions to Reduce and Eliminate Health Disparities. American Journal of Public Health, 109(Suppl 1), S72-S78.


Putting Theory into Practice

The health need identified is clinic interventions, particularly medical care. Medical care falls under the top tier of the public health pyramid. An example of intervention under medical care is the provision of cancer screening to patients to help in the early detection of cancer such as breast, cervical, and other cancer types and early prevention programs. This intervention seeks to create an environment where individuals are more likely to adapt to healthy behaviors (Movsisyan et al., 2021). Evidence-based interventions entail strategies that have proven effective. The interventions enhance the quality of cancer screening and increase the number of individuals screened within a particular area or region. Increased screening ensures early detection of cancer cases and subsequent prevention and management before the disease reaches uncontrollable and unmanageable levels.

This evidence-based intervention has been used to impact a specific health outcome. Increased screening for cervical, colorectal, and breast cancers includes actions to reach patients and those devised to reach healthcare providers. Evidence has shown that merging two or more approaches raises community demand for and access o cancer screening at no or little cost (CDC, 2021). These approaches are added to the clinic’s daily work process to ensure they are a long time and work effectively for different cancer programs.

Cancer screening-evidence-based interventions are patient/client-oriented. They include patient/client reminders that include scheduling cancer screenings for a patient during a clinic visit. Patient reminders help contact patients over their scheduled screenings, appointments, and tests. This kind of intervention has proven effective in enhancing positive health outcomes. They achieve this by decreasing paperwork, helping patients schedule appointments, offering screening at more locations, and expanding clinic and screening hours (Jin et al., 2018). Part of the client-oriented interventions may entail the application of small media such as brochures, videos, or newsletters and one-on-one group education to encourage more individuals to get screened. Implementing evidence-based interventions at the health system level is helpful in substantial reduction of health care costs and increasing the number of lives saved.


Centers for Disease Control and Prevention (2021, November 10). ScreenOutCancer: Evidence-based Interventions.

Jin, J. (2018). Screening for Cervical Cancer. JAMA, 320(7), 732-733.

Movsisyan, A., Arnold, L., Copeland, R., Evans, H., Littlecott, G., Moore, G. A., O’ Cathian, A., Pfadenhauer, J., Segrott, J., Rehfuess, E. (2021). Adapting evidence-informed population health interventions for new contexts: a scoping review of current practice. Health Research Policy and Systems, 19, 13.

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