Using logic models to enhance the methodological quality of primary health-care interventions: guidance from an intervention to promote nutrition care by general practitioners and practice nursesLauren Ball A H , Dianne Ball B , Michael Leveritt C , Sumantra Ray D , Clare Collins E , Elizabeth Patterson F , Gina Ambrosini G , Patricia Lee A and Wendy Chaboyer A
A Menzies Health Institute Queensland, Griffith University, Gold Coast, Qld 4222, Australia.
B Communio Pty Ltd, North Sydney, NSW 2065, Australia.
C School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Qld 4072, Australia.
D The Need for Nutrition Education/Innovation Programme, The University of Cambridge, Cambridge, CB1 9NL, UK.
E Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, NSW 2308, Australia.
F Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Vic. 3052, Australia.
G School of Population Health, The University of Western Australia, Crawley, WA 6009, Australia.
H Corresponding author. Email: email@example.com
Australian Journal of Primary Health 23(1) 53-60 https://doi.org/10.1071/PY16038
Submitted: 19 March 2016 Accepted: 1 June 2016 Published: 27 July 2016
The methodological designs underpinning many primary health-care interventions are not rigorous. Logic models can be used to support intervention planning, implementation and evaluation in the primary health-care setting. Logic models provide a systematic and visual way of facilitating shared understanding of the rationale for the intervention, the planned activities, expected outcomes, evaluation strategy and required resources. This article provides guidance for primary health-care practitioners and researchers on the use of logic models for enhancing methodological rigour of interventions. The article outlines the recommended steps in developing a logic model using the ‘NutriCare’ intervention as an example. The ‘NutriCare’ intervention is based in the Australian primary health-care setting and promotes nutrition care by general practitioners and practice nurses. The recommended approach involves canvassing the views of all stakeholders who have valuable and informed opinions about the planned project. The following four targeted, iterative steps are recommended: (1) confirm situation, intervention aim and target population; (2) document expected outcomes and outputs of the intervention; (3) identify and describe assumptions, external factors and inputs; and (4) confirm intervention components. Over a period of 2 months, three primary health-care researchers and one health-services consultant led the collaborative development of the ‘NutriCare’ logic model. Primary health-care practitioners and researchers are encouraged to develop a logic model when planning interventions to maximise the methodological rigour of studies, confirm that data required to answer the question are captured and ensure that the intervention meets the project goals.
Additional keywords: chronic disease, general practice, intervention studies, logic model, nutritional management, nutrition therapy, primary care, research methods.
ReferencesArts and Humanities Research Council UK (2015) ‘Logic Models for Programme Planning and Evaluation.’ (AHRC: Swindon, UK)
Australian Government (2013) ‘National Primary Health Care Strategic Framework.’ (Commonwealth of Australia: Canberra)
Ball L, Hughes R, Leveritt M (2010) Nutrition in general practice: role and workforce preparation expectations of medical educators. Australian Journal of Primary Health 16, 304–310.
| Nutrition in general practice: role and workforce preparation expectations of medical educators.CrossRef | 21138698PubMed |
Ball L, Johnson C, Desbrow B, Leveritt M (2013) General practitioners can offer effective nutrition care to patients with lifestyle related chronic disease: a systematic review. Journal of Primary Health Care 5, 59–69.
Ball L, Desbrow B, Leveritt M (2014) An exploration of individuals’ preferences for nutrition care from Australian primary care health professionals. Australian Journal of Primary Health 20, 113–120.
| An exploration of individuals’ preferences for nutrition care from Australian primary care health professionals.CrossRef | 23428232PubMed |
Ball L, Leveritt M, Cass S, Chaboyer W (2015) Effect of nutrition care provided by primary health professionals on adults’ dietary behaviours: a systematic review. Family Practice 32, 605–617.
Beck RS, Daughtridge R, Sloane PD (2002) Physician-patient communication in the primary care office: a systematic review. The Journal of the American Board of Family Practice 15, 25–38.
Britt H, Mitter G, Henderson J, Bayram C, Harrison C, Valenti L, Wong C, Gordon J, Pollack AJ, Pan Y, Charles J (2015) ‘General practice activity in Australia 2014–15. General Practice Series Number 34.’ (University of Sydney: Canberra)
Cane J, O’Connor D, Michie S (2012) Validation of the theoretical domains framework for use in behaviour change and implementation research. Implementation Science 7, 37
| Validation of the theoretical domains framework for use in behaviour change and implementation research.CrossRef | 22530986PubMed |
Casey D (2007) Using action research to change health-promoting practice. Nursing & Health Sciences 9, 5–13.
| Using action research to change health-promoting practice.CrossRef |
Cass S, Ball L, Leveritt M (2014) Australian practice nurses’ perceptions of their role and competency to provide nutrition care to patients living with chronic disease. Australian Journal of Primary Health 20, 203–208.
| Australian practice nurses’ perceptions of their role and competency to provide nutrition care to patients living with chronic disease.CrossRef | 23428207PubMed |
Centers for Disease Control and Prevention (2015) Evaluation resources: manuals/assistance with specific evaluation steps – logic models. Available at http://www.cdc.gov/eval/resources/ [Verified 22 June 2016]
Chen WW, Cato BM, Rainford N (1999) Using a logic model to plan and evaluate a community intervention program: a case study. International Quarterly of Community Health Education 18, 449–458.
| Using a logic model to plan and evaluate a community intervention program: a case study.CrossRef |
Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M (2008) Developing and evaluating complex interventions: the new Medical Research Council guidance. British Medical Journal 337, a1655
| Developing and evaluating complex interventions: the new Medical Research Council guidance.CrossRef | 18824488PubMed |
Das BM, Petruzzello SJ, Ryan KE (2014) Development of a logic model for a physical activity-based employee wellness program for mass transit workers. Preventing Chronic Disease 11, 140124
| Development of a logic model for a physical activity-based employee wellness program for mass transit workers.CrossRef |
Farmer E, Weston K (2002) A conceptual model for capacity building in Australian primary health care research. Australian Family Physician 31, 1139–1142.
Friesen EL, Comino EJ, Reath J, Derrett A, Johnson M, Davies GP, Teng-Liaw S, Kemp L (2014) Building research capacity in south-west Sydney through a Primary and Community Health Research Unit. Australian Journal of Primary Health 20, 4–8.
| Building research capacity in south-west Sydney through a Primary and Community Health Research Unit.CrossRef | 23050636PubMed |
Greenhalgh, T. (2007) ‘Primary Health Care Theory and Practice.’ (Blackwell Publishing & BMJ Books: Oxford, UK)
Guttmacher S, Kelly P, Ruiz-Janecko Y (2010) ‘Community-Based Health Interventions.’ (Wiley: San Francisco, CA, USA)
Hayes H, Parchman ML, Howard R (2011) A logic model framework for evaluation and planning in a primary care practice-based research network (PBRN). Journal of the American Board of Family Medicine 24, 576–582.
| A logic model framework for evaluation and planning in a primary care practice-based research network (PBRN).CrossRef | 21900441PubMed |
Hegney DG, Patterson E, Eley DS, Mahomed R, Young J (2013) The feasibility, acceptability and sustainability of nurse-led chronic disease management in Australian general practice: the perspectives of key stakeholders. International Journal of Nursing Practice 19, 54–59.
| The feasibility, acceptability and sustainability of nurse-led chronic disease management in Australian general practice: the perspectives of key stakeholders.CrossRef | 23432889PubMed |
Hiddink GJ, Hautvast JGAJ, Van Woerkum CMJ (1997) Driving forces for and barriers to nutrition guidance practice of Dutch primary care physicians. Journal of Nutrition Education 29, 36–41.
| Driving forces for and barriers to nutrition guidance practice of Dutch primary care physicians.CrossRef |
Hopper D, Barker M (1995) Dietary advice, nutrition knowledge and attitudes towards nutrition in primary care. Journal of Human Nutrition and Dietetics 8, 279–286.
| Dietary advice, nutrition knowledge and attitudes towards nutrition in primary care.CrossRef |
Humphreys J, Wakerman J, Kuipers P (2009) ‘Improving Workforce Retention: Developing an Integrated Logic Model to Maximise Sustainability of Small Rural and Remote Health Care Services.’ (Australian Primary Health Care Research Institute: Canberra)
Imamura F, Micha R, Khatibzadeh S, Fahimi S, Shi P, Powles J, Mozaffarian D (2015) Dietary quality among men and women in 187 countries in 1990 and 2010: a systematic assessment. The Lancet. Global Health 3, e132–e142.
| Dietary quality among men and women in 187 countries in 1990 and 2010: a systematic assessment.CrossRef | 25701991PubMed |
Jacobson D, Gance-Cleveland B (2011) A systematic review of primary healthcare provider education and training using the chronic care model for childhood obesity. Obesity Reviews 12, e244–e256.
| A systematic review of primary healthcare provider education and training using the chronic care model for childhood obesity.CrossRef | 1:STN:280:DC%2BC3MvktlGhuw%3D%3D&md5=99122dc565ea7bc17ff52f04cefd4b15CAS | 20673280PubMed |
Joly BM, Polyak G, Davis MV, Brewster J, Tremain B, Raevsky C, Beitsch LM (2007) Linking accreditation and public health outcomes: a logic model approach. Journal of Public Health Management and Practice 13, 349–356.
| Linking accreditation and public health outcomes: a logic model approach.CrossRef | 17563622PubMed |
Kaplan S, Garrett K (2005) The use of logic models by community-based initiatives. Evaluation and Program Planning 28, 167–172.
| The use of logic models by community-based initiatives.CrossRef |
Kushner R (1995) Barriers to providing nutrition counselling by physicians. Preventive Medicine 24, 546–552.
| Barriers to providing nutrition counselling by physicians.CrossRef | 1:STN:280:DyaK287pslGksw%3D%3D&md5=6c903ab9e32e6721b4418e9469364df9CAS | 8610076PubMed |
Levine BS, Wigren MM, Chapman DS, Kerner JF, Bergman RL, Rivlin RS (1993) A national survey of attitudes and practices of primary-care physicians relating to nutrition: strategies for enhancing the use of clinical nutrition in medical education. The American Journal of Clinical Nutrition 57, 115–119.
Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, Al Mazroa MA, Amann M, Anderson HR, Andrews KG, Aryee M, Atkinson C, Bacchus LJ, Bahalim AN, Balakrishnan K, Balmes J, Barker-Collo S, Baxter A, Bell ML, Blore JD, Blyth F, Bonner C, Borges G, Bourne R, Boussinesq M, Brauer M, Brooks P, Bruce NG, Brunekreef B, Bryan-Hancock C, Bucello C, Buchbinder R, Bull F, Burnett RT, Byers TE, Calabria B, Carapetis J, Carnahan E, Chafe Z, Charlson F, Chen H, Chen JS, Cheng AT-A, Child JC, Cohen A, Colson KE, Cowie BC, Darby S, Darling S, Davis A, Degenhardt L, Dentener F, Des Jarlais DC, Devries K, Dherani M, Ding EL, Dorsey ER, Driscoll T, Edmond K, Ali SE, Engell RE, Erwin PJ, Fahimi S, Falder G, Farzadfar F, Ferrari A, Finucane MM, Flaxman S, Fowkes FGR, Freedman G, Freeman MK, Gakidou E, Ghosh S, Giovannucci E, Gmel G, Graham K, Grainger R, Grant B, Gunnell D, Gutierrez HR, Hall W, Hoek HW, Hogan A, Hosgood HD, Hoy D, Hu H, Hubbell BJ, Hutchings SJ, Ibeanusi SE, Jacklyn GL, Jasrasaria R, Jonas JB, Kan H, Kanis JA, Kassebaum N, Kawakami N, Khang Y-H, Khatibzadeh S, Khoo J-P, Kok C, Laden F, Lalloo R, Lan Q, Lathlean T, Leasher JL, Leigh J, Li Y, Lin JK, Lipshultz SE, London S, Lozano R, Lu Y, Mak J, Malekzadeh R, Mallinger L, Marcenes W, March L, Marks R, Martin R, McGale P, McGrath J, Mehta S, Memish ZA, Mensah GA, Merriman TR, Micha R, Michaud C, Mishra V, Hanafiah KM, Mokdad AA, Morawska L, Mozaffarian D, Murphy T, Naghavi M, Neal B, Nelson PK, Nolla JM, Norman R, Olives C, Omer SB, Orchard J, Osborne R, Ostro B, Page A, Pandey KD, Parry CDH, Passmore E, Patra J, Pearce N, Pelizzari PM, Petzold M, Phillips MR, Pope D, Pope CA, Powles J, Rao M, Razavi H, Rehfuess EA, Rehm JT, Ritz B, Rivara FP, Roberts T, Robinson C, Rodriguez-Portales JA, Romieu I, Room R, Rosenfeld LC, Roy A, Rushton L, Salomon JA, Sampson U, Sanchez-Riera L, Sanman E, Sapkota A, Seedat S, Shi P, Shield K, Shivakoti R, Singh GM, Sleet DA, Smith E, Smith KR, Stapelberg NJC, Steenland K, Stöckl H, Stovner LJ, Straif K, Straney L, Thurston GD, Tran JH, Van Dingenen R, van Donkelaar A, Veerman JL, Vijayakumar L, Weintraub R, Weissman MM, White RA, Whiteford H, Wiersma ST, Wilkinson JD, Williams HC, Williams W, Wilson N, Woolf AD, Yip P, Zielinski JM, Lopez AD, Murray CJL, Ezzati M (2012) A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the global burden of disease study 2010. Lancet 380, 2224–2260.
| A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the global burden of disease study 2010.CrossRef | 23245609PubMed |
Martin L, Leveritt M, Desbrow B, Ball L (2014) The self-perceived knowledge, skills and attitudes of Australian practice nurses in providing nutrition care to patients with chronic disease. Family Practice 31, 201–208.
| The self-perceived knowledge, skills and attitudes of Australian practice nurses in providing nutrition care to patients with chronic disease.CrossRef | 24243871PubMed |
Mazza D, Chapman A (2010) Improving the uptake of preconception care and periconceptional folate supplementation: what do women think? BMC Public Health 10, 786
| Improving the uptake of preconception care and periconceptional folate supplementation: what do women think?CrossRef | 21182797PubMed |
McKenzie JE, O’Connor DA, Page MJ, Mortimer DS, French SD, Walker BF, Keating JL, Grimshaw JM, Michie S, Francis JJ, Green SE (2010) Improving the care for people with acute low-back pain by allied health professionals (the ALIGN trial): a cluster randomised trial protocol. Implementation Science 5, 86
| Improving the care for people with acute low-back pain by allied health professionals (the ALIGN trial): a cluster randomised trial protocol.CrossRef | 21067614PubMed |
Medeiros LC, Butkus SN, Chipman H, Cox RH, Jones L, Little D (2005) A logic model framework for community nutrition education. Journal of Nutrition Education and Behavior 37, 197–202.
| A logic model framework for community nutrition education.CrossRef | 16029690PubMed |
Moore GF, Audrey S, Barker M, Bond L, Bonell C, Hardeman W, Moore L, O’Cathain A, Tinati T, Wight D, Baird J (2015) Process evaluation of complex interventions: Medical Research Council guidance. British Medical Journal 350, h1258
| Process evaluation of complex interventions: Medical Research Council guidance.CrossRef | 25791983PubMed |
Orrow G, Kinmonth AL, Sanderson S, Sutton S (2012) Effectiveness of physical activity promotion based in primary care: systematic review and meta-analysis of randomised controlled trials. British Medical Journal 344, e1389
| Effectiveness of physical activity promotion based in primary care: systematic review and meta-analysis of randomised controlled trials.CrossRef | 22451477PubMed |
Royal Australian College of General Practitioners (2015) ‘Smoking, Nutrition, Alcohol and Physical Activity (SNAP): a Population Health Guide to Behavioural Risk Factors in General Practice’, 2nd edn. (RACGP: Melbourne)
Smith SM, Soubhi H, Fortin M, Hudon C, O’Dowd T (2012) Managing patients with multimorbidity: systematic review of interventions in primary care and community settings. British Medical Journal 345, e5205
| Managing patients with multimorbidity: systematic review of interventions in primary care and community settings.CrossRef | 22945950PubMed |
Subirana M, Long A, Greenhalgh J, Firth J (2014) A realist logic model of the links between nurse staffing and the outcomes of nursing. Journal of Research in Nursing 19, 8–23.
| A realist logic model of the links between nurse staffing and the outcomes of nursing.CrossRef |
Taylor-Powell E, Henert E (2008) ‘Developing a Logic Model: Teaching and training Guide.’ (University of Wisconsin: Madison, WI)
Wholey J (1979) ‘Evaluation: Promise and Performance.’ (Urban Institute: Washington, DC)
W. K. Kellogg Foundation (2006) ‘Logic Model Development Guidance.’ (W. K. Kellogg Foundation General: Battle Creek, MI, USA)
Wynn K, Trudeau J, Taunton K, Gowans M, Scott I (2010) Nutrition in primary care: current practices, attitudes, and barriers. Canadian Family Physician Medecin de Famille Canadien 56, 109–116.