Division for Heart Disease and Stroke Prevention - State Program, Evaluation Guides

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State Program Evaluation Guides

Overview of the Logic Model

CDC provides or enables the provision of guidance, funds, training, and opportunities for communication and networking among the sites.

These inputs provided by the CDC, among others, are the platform for states to undertake activities in three areas:
— Capacity building
— Surveillance
— Interventions

Over time these activities result in system-level changes including changes in policy/legislation and environmental supports. This may happen directly as a result of activities, or, more commonly, because activities change and activate key change agents who can control policy and environmental supports.

Changes at the system level frame/encourage/channel individual behavior change, including adoption of primary and secondary prevention practices related to CVH.

This is the engine that leads to long-term outcomes like stage at detection, age of onset, morbidity and mortality, and elimination of disparities between general and racial/ethnic populations.

Expanded Logic Model

This model provides more detail on the three types of state activities, the relationships among the activities, and relation of activities and the sequence of outcomes.

Capacity Building

CDC provides guidance, funding, technical assistance, training, and opportunities for states to network with each other.

This allows states to build program and managerial infrastructure; form partnerships at the state level; build the science, epidemiologic, and evaluation capacity they need to identify and monitor progress on key CVH issues; conduct ongoing inventories and assessments of current status of system supports; and develop plans for addressing CVH in priority populations, as well as permitting them to train on these same issues with their partners.

These activities serve as a "platform" for developing a state plan, or, in the absence of a state plan, a CVH work plan and system–level strategies that address key settings and priority groups. However, in early years of a program, the work plan may mostly involve developing a state plan and/or building up capacity, rather than the way it is depicted in the model with the platform and state plan informing the work plan.

Work plans and strategies may include coordinated efforts in communication, education, and training. These affect development, implementation, and effectiveness in various settings.

These interventions have the following intent: (1) changing knowledge, attitudes, and behaviors of system change agents so that change agents will take action, and (2) activating key target audiences so that they will be both receptive and ready to take advantage of policy and environmental change, as well as help advocate with change agents. There is also likely to be interaction between the change agents and intended audiences which will influence the change agents to take action.

Action taken by change agents results in policy and environmental supports at the state and local levels and in various settings and contexts.

Activation of intended audiences also results in a readiness for change in the community and individuals which influences ability to modify policy and environmental supports.

Impacts of efforts on system change are measured, compiled, and fed back into (1) future state work plans, and (2) CDC–compiled "models that work" and guidance to all CVH states.

These system changes provide the environment which supports individual behavior change over time, including adopting primary prevention practices related to CVH.

Individual behavior change leads to improvements in long-term health status, with an ultimate decrease in death and disability and eliminating CVD disparities between general and priority populations.

Surveillance

States undertake two classes of surveillance: (1) surveillance of CVD burden, and (2) surveillance of progress on policy and environmental supports.

CDC provides surveillance guidance to states for both burden and policy/environmental surveillance using a set of selected system-level indicators. These indicators inform, but do not necessarily exhaust, the policy and environmental support indicators a state may chose to include in its surveillance (e.g., monitoring secondary prevention strategies).

States implement surveillance activities.

Surveillance results provide CVH information which is used in program planning to refine and improve programs and program implementation, as well as to inform development and improvement of interventions.

Surveillance system measures state progress on CVH status, and in the long term, may be able to detect the impact of interventions.

Interventions

CDC provides evaluation guidance/plans, applied research, and "models that work" (best practices) information for measuring processes and impacts.

Informed by the work plan, strategies, and CDC guidance, states and their partners develop and undertake interventions in priority settings and with priority groups.

These interventions capitalize on efforts to sensitize/activate change agents and target audiences.

Interventions strive to change systems at the state, local, and setting level.

Impacts of interventions on system change are measured, compiled, and fed back into (1) future state work plans, and (2) CDC–compiled "models that work" and guidance to all CVH states.

These system changes provide the environment which supports individual behavior change over time including adoption of primary prevention practices related to CVH.

Individual behavior change leads to improvements in long-term health status, with an ultimate decrease in death and disability, and eliminating CVD disparities between general and priority populations.