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

Yuka Asada*, Kelsey Gilmet, Christina Welter, Gina Massuda-Barnett, Devangna A. Kapadia, Michael Fagen

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)377-387
Number of pages11
JournalHealth Education and Behavior
Issue number3
StatePublished - Jun 1 2019


  • community-based evaluations
  • policy, systems, and environmental changes
  • qualitative research
  • structural change
  • theory of change

ASJC Scopus subject areas

  • Arts and Humanities (miscellaneous)
  • Public Health, Environmental and Occupational Health

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