Draw the arrows, then question them
Imagine a fictional program that trains staff to explain appointment instructions more clearly. A simple map might connect staff time to training sessions, then to clearer explanations, then to fewer missed appointments.
The arrows contain assumptions. Staff need opportunities to apply the training. Patients need to receive the explanation in an accessible form. Missed appointments need to be influenced by misunderstanding rather than only by transport, cost, or scheduling barriers.
An output is not yet an outcome
“Twenty staff completed training” is a record of activity produced. “Patients understood the next step” is a change the activity was meant to support. “Missed appointments decreased” is a further outcome.
CDC's logic-model guidance describes the relationship between resources, activities, and intended outcomes. Building a map can expose where a program's explanation skips from doing something to assuming it helped.
Add one question to each arrow
- Training to practice: did staff use the new approach?
- Practice to understanding: did patients interpret the instructions as intended?
- Understanding to attendance: could people act on the information?
Those questions can suggest evaluation measures. They also reveal where a program may need a different component, such as a more accessible booking process.
The diagram is a proposal about reality
A tidy sequence does not establish that the links are causal, equally strong, or linear. Feedback can occur: missed appointments may prompt staff to change explanations, while new constraints can alter the pathway.
The model is useful when it can be revised in response to evidence. Its job is to make the program's reasoning inspectable, including the assumptions that might fail, rather than to make an uncertain process look inevitable.
