Applying Theory of Change to a Structural Change Initiative: Evaluation of Model Communities in a Diverse County

Structural change approaches, also called policy, systems, and environmental change approaches, have been increasingly promoted and adopted by public ealth agencies in the past decade. These interventions require attention to multilevel, complex and contextual influences on individual and community...

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Bibliographic Details
Published in:Health education & behavior 2019-06, Vol.46 (3), p.377-387
Main Authors: Asada, Yuka, Gilmet, Kelsey, Welter, Christina, Massuda-Barnett, Gina, Kapadia, Devangna A., Fagen, Michael
Format: Article
Language:English
Subjects:
Adaptation
Capacity Building
Case studies
Change
Changes
Communities
Community
Community health
Community Programs
Community Relations
Construction
Counties
Data
Environmental changes
Environmental policy
Evaluation
Health education
Health status
Human capital
Intervention
Leadership
Matrices
Partnerships
Policy making
Policy, Environmental, and Structural Approaches
Prevention
Prevention programs
Program Evaluation
Public Health
Qualitative analysis
Qualitative research
Readiness
Structural change
Sustainability
Technical assistance
Theories
Work
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Summary:Structural change approaches, also called policy, systems, and environmental change approaches, have been increasingly promoted and adopted by public ealth agencies in the past decade. These interventions require attention to multilevel, complex and contextual influences on individual and community health outcomes, requiring a sound theoretical framework that links the many processes and outcomes over time. The Model Communities program of Cook County, Illinois Communities Putting Prevention to Work program employed a theory of change (ToC) framework to inform the evaluations’ design and execution. The main objective of this study was to apply findings from the longitudinal multiple case study evaluation to develop an adapted ToC. We conducted 97 key informant interviews across three waves, with a focus on Model Communities program participants’, Communities Putting Prevention to Work staff, and technical assistance providers’ experiences over time. Four analysts organized and coded the data using qualitative software; exploratory functions and data matrices were employed throughout three waves of analysis. Adaptations to the ToC included the addition of a construct, “change readiness,” as well as refinements to constructs: organizational capacity (human capital, technical assistance, informal and formal leadership), local partnerships, and the importance of sustainability. The findings offer a data-informed theoretical framework that may be considered for use in evaluations of structural change interventions in complex and diverse counties.
ISSN:1090-1981
1552-6127
DOI:10.1177/1090198118818233