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BDI LOGIC MODELS:
A Useful Tool for Designing,
Strengthening and Evaluating Programs to
Reduce Adolescent Sexual Risk-Taking,
Pregnancy, HIV and Other STDs
Specified
Intervention
Components
and
Activities
Affect
Chosen
Determinants
(Risk and
Protective
Factors)
That
Affect
Important
Sexual
Behaviors
Which,
in Turn,
Reduce
Teen
Pregnancy,
STD and
HIV
by
Douglas Kirby, PhD
ETR Associates
Version: August 18, 2004*
© Copyright 2004 by Douglas Kirby. All rights reserved.
*Note: Occasionally, I update and add to this manuscript. Thus, I welcome your suggestions for improvement.
Table of Contents
Acknowledgements……………………………………………………………………………………………………… iii
Availability of on-line interactive course ……………………………………………………………………….. iii
Introduction ………………………………………………………………………………………………………………… 1
What are logic models, specifically BDI logic models?……………………………………………….. 1
How can BDI logic models be useful to you? …………………………………………………………….. 3
When should you create BDI logic models? ………………………………………………………………..4
The Assumptions that Underlie BDI Logic Models and their Development ……………………….. 5
Assumptions underlying BDI models ……………………………………………………………………….. 5
Assumptions involving the recommended process for creating the model …………………….. 5
Important Elements and Steps in Creating BDI Logic Models ………………………………………….. 7
Step #1: Identify possible health goals and select the health goal(s) to be achieved ……….. 8
Step #2: Identify potentially important behaviors that affect the selected health goal
and then select the particular behaviors to be targeted ………………………………………………… 9
Step #3: Identify potentially important determinants of the selected behaviors and
then select those determinants to be targeted ……………………………………………………………. 11
Step #4: Identify possible interventions and then select the particular intervention
components or activities ……………………………………………………………………………………….. 15
What do BDI logic models actually look like? …………………………………………………………. 16
More Complex BDI Models: Adding Columns and Nesting Models ……………………………….. 18
Adding an additional column …………………………………………………………………………………..18
Nesting logic models ……………………………………………………………………………………………. 19
Addressing disparate health goals or behaviors ………………………………………………………… 20
Criteria for Assessing Logic Models ……………………………………………………………………………. 20
Planning For and Using Logic Models …………………………………………………………………………. 21
Who should be involved in the development of BDI logic models? ……………………………. 21
What do we do with a logic model after we create it? ……………………………………………….. 21
Guide for the Specification of Indicators for Process and Impact Evaluations …………………… 22
What should be measured? ……………………………………………………………………………………. 23
How can measurement of these indicators help us understand how or why
our programs did or did not work? …………………………………………………………………………. 23
Unsuccessful and Successful Applications of BDI Models ……………………………………………… 24
i
Building a Cumulative Body of Theory and Understanding of What Works and
Why It Works ……………………………………………………………………………………………………………. 26
What is an example of how logic models advance theory? ………………………………………… 26
Conclusions ………………………………………………………………………………………………………………. 27
References ………………………………………………………………………………………………………………… 28
Figure 1: An Example of a BDI Logic Model Identifying the Major Components
of an Initiative To Reduce Unintended Teen Pregnancy…………………………………..29
Figure 2: A More Detailed Example of a BDI Logic Model to Delay or Reduce
Sexual Activity and Thereby Reduce Teen Pregnancy by Implementing
an Abstinence-Only Programs in Churches …………………………………………………….30
Figure 3: Examples of Health Goals and Behaviors That Affect Those Goals …………………. 32
Figure 4: Examples of Determinants that Affect Sexual Behaviors That in turn Affect
Teen Pregnancy …………………………………………………………………………………………. 33
Figure 5: An Example of a BDI Logic Model to Reduce Pregnancy by Implementing
a School-based Sexuality Education Curriculum …………………………………………… 38
Figure 6: An Example of a BDI Logic Model to Reduce Pregnancy through Youth
Development Programs ………………………………………………………………………………. 42
Figure 7: An Example of a BDI Logic Model to Reduce Pregnancy by Making Clinics
More “Adolescent Friendly” ……………………………………………………………………….. 44
Figure 8: An Example of a “Nested” BDI Logic Model to Reduce Pregnancy by
Implementing a School-based Intervention …………………………………………………… 48
Figure 8A: An Example of a Model Nested Within Figure 6: A Model to
Decrease Use of Alcohol ……………………………………………………………. 50
Figure 8B: An Example of a Model Nested Within Figure 6: A Model to
Increase Parent-Child Communication about Sex ………………………….. 51
Figure 9: Criteria for Assessing Logic Models and Their Development …………………………. 52
ii
Acknowledgements
Both this paper and my work on BDI logic models more generally have benefited enormously from
my collaborative work with the Department of Child and Adolescent Health and Development at
the World Health Organization (WHO). After I gave a brief presentation on BDI logic models,
WHO immediately recognized their importance in program design and measurement and organized
multiple meetings and trainings throughout the world on BDI logic models. Those meetings and
trainings raised many important issues, stimulated thoughtful discussions, raised my consciousness,
and forced me to clarify my own thinking on BDI logic models. While WHO did not directly fund
the writing of this paper, it did fund many other activities which stimulated the writing of this
paper.
I am also indebted to Guy Parcel at the University of Texas Houston School of Public Health. In a
joint HIV, other STD and pregnancy prevention project, Dr. Parcel encouraged us to use a process
to develop and evaluate the Safer Choices intervention that effectively reduced adolescent sexual
risk-taking behavior. At ETR, we subsequently utilized that process in our development of other
effective interventions, and I ultimately tried to codify that process in what this paper calls “BDI
logic models.”
The latest versions of this paper also benefited from the excellent volume titled Intervention
Mapping: Designing Theory- and Evidence-Based Health Promotion Programs by L. Kay
Bartholomew, Guy S. Parcel, Gerjo Kok, and Nell H. Gottlieb.
Finally, I wish to acknowledge my sociology professors at UCLA who trained me in causal
modeling, which provided one of the theoretical bases for BDI logic models.
Availability of On-Line Interactive Course
ETR has developed an interactive course on how to develop BDI logic models. It is based on this
paper, but is designed as a beginner’s course and greatly simplifies some of the material in this
paper. It also provides templates and other resources that can be used to create BDI logic models.
The course is available free of charge and can be accessed at:
http://www.etr.org/recappreview/logicmodelcourse/.
It can also be purchased from ETR on a CD ROM. For more information, please call Pat Rex at
831 438-4060, ext 106.
iii
“Would you tell me, please, which way I ought to go from here?”
“That depends a good deal on where you want to get to,” said the Cat.
“I don’t much care where –” said Alice.
“Then it doesn’t much matter which way you go,” said the Cat.
“— so long as I get somewhere,” Alice added as an explanation.
“Oh, you’re sure to do that,” said the Cat, “if only you walk long enough.”
From Alice’s Adventures in Wonderland by Lewis Carroll
Alice in Wonderland did not know where she wanted to go or how to get there. Far too often
people in our own communities may not be entirely clear about the health goals they wish to
achieve and/or do not have clear and effective directions for how to achieve their health goals. BDI
logic models help people identify where they want to go (what health goal they wish to achieve in
their community) and then help them create a clear, effective and strategic map for getting there.
Introduction
When a community is faced with a particular health problem, such as teenage pregnancy, sexually
transmitted disease, substance abuse, poor nutrition, insufficient exercise or violence, that
community can implement promising programs or initiatives to address that health problem. Both
the process of creating BDI logic models and the logic models themselves can help communities
design and implement large comprehensive initiatives as well as specific programs or components
within those initiatives. BDI logic models can also improve the evaluation of community programs
and initiatives.
What are logic models, specifically BDI logic models?
Figure 1 provides an example of a logic model for a community initiative to reduce unintended
teenage pregnancy. It specifies that the community will implement sex education programs in
schools and youth serving agencies (including churches), sports programs for girls, mentoring
programs for all youth, and parent programs to help them monitor their teenage children more
effectively and to discourage their school-aged children from going steady with other older youth.
The model also specifies the particular determinants that each component is designed to change and
that previous research has demonstrated have an impact on sexual behaviors. Finally, it specifies
the particular sexual behaviors that will be affected by changes in these determinants and that will
in turn reduce teen pregnancy.
Figure 2 provides an example of a more detailed logic model for a particular component in the
broader initiative. A more detailed logic model could (and often should) be created for each of the
components in a larger initiative. Figure 2 provides a possible logic model for church-based
1
abstinence-only programs. Like the model in Figure 1, this model specifies particular activities that
will be implemented, the determinants that the activities will improve and that in turn will increase
abstinence, and finally the goal of reducing teen pregnancy.
As both of these examples illustrate, logic models are graphic depictions that show clearly and
concisely the causal mechanisms through which specific interventions can affect behavior and
thereby achieve a health goal. One might think of them as road maps specifying the causal
pathways between programs and behaviors. Like road maps, logic models should be based upon the
best available data and evidence. Otherwise, they may provide poor or misleading directions. Logic
models can also portray the “theories of change” that people sometimes develop for interventions.
Occasionally, logic models are called causal models or path models.1
While there are many types of logic models, some logic models include a specification of 1) the
health goal to be achieved, 2) the behaviors that need to be changed to achieve a health goal, 3) the
determinants (i.e., the risk or protective factors) of each of those behaviors, and 4) the intervention
components or activities designed to change each selected determinant. Henceforth, this paper will
refer to these particular logic models as behavior-determinant-intervention logic models, or “BDI
models” for short. BDI models must also include the causal linkages among the health goal, the
behaviors affecting that goal, their determinants, and their respective intervention components. That
is, they specify which particular intervention components affect which determinants that, in turn,
affect which behaviors that achieve the health goal.
These components of a BDI logic model can be depicted graphically as follows:
Specified
Intervention
Components
and Activities
Affect
Chosen
Determinants
(Risk and
Protective
Factors)
That
Affect
Important
Sexual
Behaviors
Which,
in Turn,
Reduce
Teen
Pregnancy,
STD and
HIV
Although this depiction has grouped intervention components, determinants, behaviors and health
outcomes into each of their respective boxes, in fact, actual BDI logic models must specify
separately the interventions designed to affect each of the determinants, the determinants that affect
each of the behaviors, etc. This is illustrated in the figures at the end of this paper.2
1
2
For readers familiar with logframe models, logic models are similar to, but different from, logframe models.
Logframe models typically do not identify the determinants of behavior (as do BDI logic models), but do identify
the steps for implementing a program. When developing a logframe model, it would be useful to develop a BDI
logic model first.
This paper is designed especially for those who are interested in reducing teen pregnancy or STD rates, and this
focus is reflected in the figures at the end of the paper. However, some readers of this paper may be interested in
using BDI models to help achieve other health goals, and accordingly, in the text of this paper, examples involving
other health goals are also provided.
2
While many logic models include these four components, they sometimes use different words to
describe them. Some may use the language of “interventions,” “determinants,” “behaviors,” and
“health goals,” while others may refer to “activities,” “short-term objectives” and “long-term
outcomes,” or “processes,” “outcomes,” and “impacts” respectively.
There are also other variations among these BDI models. Some include only these four minimum
components, while others may specify far more complex causal models, with some determinants of
behavior affecting other determinants, with reciprocal causality acknowledged (e.g., determinants
affecting behaviors and vice versa) and with some models nested within other models (examples are
discussed later in this paper). Some BDI models may target youth while others target adults or
people of any age. Some models describe individuals while others describe groups, communities,
institutions or entire countries. In fact, BDI logic models can even be used effectively to change the
behavior of other species. In general, they are useful whenever one needs to change individual or
group animal behavior in order to achieve some desired outcome. Some BDI models may summarize
the impact of large multi-component programmatic initiatives upon major goals (e.g., the model in
Figure 1), while others describe in much greater detail the impact of specific activities upon
particular behaviors (e.g., the example in Figure 2). BDI models are sufficiently flexible and robust
to handle all these situations. However, by definition, BDI models must include some version of the
same basic concepts, and must specify the causal linkages among intervention components, the
mediating determinants, the behaviors that lead to a health goal, and, of course, the health goal.
How can BDI logic models be useful to you?
BDI models can serve a variety of useful functions. In general, they provide a framework for the
development of more effective programs and for the evaluation of those programs. More
specifically, if developed properly and used properly, BDI models can:
•
Link key intervention components and activities to key determinants of important behaviors, the
behaviors themselves, and health goals.
•
Make explicit the implicit theories behind programs and thereby provide a clear rationale for
program activities, a rationale that will facilitate funding and provide guidance to program staff or
to different organizations involved in the initiative.
•
Encourage program designers and program implementers to not only recognize the complexity of
reality, but also to focus on the most important program elements, determinants and behaviors.
•
Encourage evidence-based programming.
•
Help determine what additional information needs to be gathered or what research needs to be
conducted in order to design or improve a program.
•
Guide both the design of a program and the refinement of an existing program.3
3
Logic models can be a particularly useful tool when using participatory learning and action research strategies for
bringing different groups in a community together to design new interventions that address the needs of youth.
They can summarize in an organized manner some of the thoughts expressed by different groups.
3
•
Provide guidance to evaluators on which process and outcome indicators to measure.
•
Reduce unreasonable pressure to demonstrate impact upon a health goal, if effects upon
important determinants or health behaviors are demonstrated.
•
Help health educators and researchers realize that they may not know which determinants are
the most important determinants of behavior, and thereby stimulate appropriate research to
identify the most important determinants.
•
Help integrate program design and program research, and facilitate cooperation between
program designers and researchers.
•
Provide the foundation for the cumulative building of theory and understanding of what works
and why it works.
•
And ultimately, help programs serve people more effectively and efficiently and thereby
improve the use of limited resources and more effectively achieve health goals.
When should you create BDI logic models?
When designing a larger initiative to achieve a health goal, it is almost always useful to complete
the process of developing a logic model and to then use the logic model to inform participants in
the initiative about how their activities are part of a larger initiative.
When selecting or designing a particular program or component in a larger initiative, it is often, but
not always, productive to create a logic model. Sometimes the single most promising strategy for
selecting or designing a program does not involve creating a logic model and developing a new
program, but instead involves implementing one or more programs that have already been
developed and demonstrated to have a desired impact among a population similar to the
community’s target population. For example, to reduce teen pregnancy or teen STD rates, a
community might implement with fidelity specific sex or HIV education curricula that have been
demonstrated to be effective with similar teenagers. When effective programs already exist, then it
is less important to develo …
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