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Developing and using logic models in reviews of complex interventions

Developing and using logic models in reviews of complex interventions. Philip Baker Daniel Francis School of Public Health, QUT Central Regional Services, DCHO, Queensland Health Cochrane Public Health Group. Acknowledgements. Laurie Anderson Erin Ueffing Eva Rehfuess Mark Petticrew

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Developing and using logic models in reviews of complex interventions

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  1. Developing and using logic models in reviews of complex interventions Philip Baker Daniel Francis School of Public Health, QUT Central Regional Services, DCHO, Queensland Health Cochrane Public Health Group

  2. Acknowledgements Laurie Anderson Erin Ueffing Eva Rehfuess Mark Petticrew Rebecca Armstrong Peter Tugwell Anderson L, Petticrew M, Rehfuess E, et al (2011). Using logic models to capture complexity in systematic reviews Research Synthesis Methods, 2011. Published Online.

  3. Outline What are logic models? Why logic models? Recent use in Cochrane Reviews Examples in SRs Conclusions

  4. What are logic models? Logic model, analytic framework, conceptual framework, concept map, influence diagram…

  5. Logic model • Logic model is a… • Picture of a program or intervention • Graphic representation • Useful of planning and evaluation • “If you don’t know where you are going, how are you gonna’ know when you get there?” • Yogi Berra

  6. INPUTS OUTPUTS OUTCOMES In its simplest form….

  7. Everyday example Eat food H U N G R Y Getfood Feel better

  8. Why logic models? Make explicit hypothesized links between determinants of health and health outcomes Examine theoretical plausibility and mechanisms of action of an intervention Identify key effect mediators or moderators Specify intermediate outcomes and potential harms, including differential effects among population subgroups

  9. Where to get content to put into the logic model? Social and behavioral theory Empirical research Social and epidemiologic data Program evaluation data

  10. Logic models can help: • Refine review question • Identify relevant intervention components • Decide on lumping or splitting a review • Identify necessary bodies of evidence: PICO • Guiding literature search strategy • Justify subgroup analyses (e.g. sex/gender, SES) • Explain rationale behind surrogate outcomes used • Interpret results based on intervention theory and systems thinking • Illustrate how harms, feasibility, and cost issues are connected with interventions

  11. The use of Logic Models in Cochrane Published Reviews and Protocols (in 2 Groups) Cochrane Effective Practice & Organisation of Care Group: • None yet into reviews • 3 of 44 protocols (first appearance 2009); Cochrane Public Health Group: • 1 of 3 Reviews (first appearance 2011) • 5 of 7 protocols

  12. Examples

  13. Capturing complexity – seeing the big picture Source: Anderson LM, Popkin B, Fielding J, Willett W, Picciano MF. 2004 Guide to Community Preventive Services

  14. Capturing key review questions Source: Harris RP et al. Am J Prev Med 2001;20(3 Suppl):21-35.

  15. Capturing complexity – key intervention strategies Ref: Baker PRA, Francis DP, Soares J, Weightman AL, Foster C. Community wide interventions for increasing physical activity. Cochrane Database of Systematic Reviews 2011, Issue 4. Art. No.: CD008366. DOI: 10.1002/14651858.CD008366.pub2

  16. Capturing complexity – key intervention strategies

  17. In our Cochrane review…. • Refined the question • Show stages: development / implementation • Definition - components of the intervention • Literature search terms • Classification of interventions and interpretation • Data extraction • Assessment of intensity Ref: Baker PRA, Francis DP, Soares J, Weightman AL, Foster C. Community wide interventions for increasing physical activity. Cochrane Database of Systematic Reviews 2011, Issue 4. Art. No.: CD008366. DOI: 10.1002/14651858.CD008366.pub2

  18. Summary • Sensible • Visually explain relationships • Improve usefulness of review • Are increasing in reviews • Require additional skills, time and understanding

  19. Further information/reading on logic models Training Erin Ueffing (Erin.Ueffing@uottawa.ca), Education Coordinator, Canadian Cochrane Centre Systematic reviews Anderson L, Petticrew M, Rehfuess E, et al (2011). Using logic models to capture complexity in systematic reviews Research Synthesis Methods, 2011. Published Online. Concept  Harris RP, Helfand M, Woolf S, et al (2001). Current methods of the U.S. Preventive Services Task Force.American Journal of Preventive Medicine 20(3S):21-35. Joffe M & Mindell J (2006). Complex causal process diagrams for analyzing the health impacts of policy interventions. American Journal of Public Health 96(3):473-479. Application  Baxter S, Killoran A, Kelly MP & Goyder E (2010). Synthesizing diverse evidence: the use of primary qualitative data analysis methods and logic models in public health reviews. Public Health 124:99-106. Equity Tugwell P, Petticrew M, Kritjansson E, et al (2010). Assessing equity in systematic reviews: realising the recommendations of the Commission on Social Determinants of Health BMJ 341:c4739

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