Applying indigenous Māori Pasifika research methodologies to frame Queensland Māori Pasifika experiences of child health service delivery: an exploration of a lack of uptake of health services.

A Queensland Health report identified Maori and Pacific Island groups in Queensland as vulnerable groups due to social disadvantage. The application of a contextual framework to analyse literature was undertaken, and one key identified deficit and inequity among Maori and Pacific Island communities in Queensland is disengagement from child and family health services. Qualitative research was undertaken to explore this issue drawing on a theoretical lens which combined Decolonization and Cultural Safety methodologies and Talanoa methods for data collection.Data interpretation revealed misconceptions and a predisposition to assume that health care delivery that engaged a transcultural approach was culturally safe.

Introduction: Maori and Pacific Islander adults in Queensland experience significantly higher rates of chronic disease and obesity compared to the rest of the Queensland population with the trend in obesity also seen in Maori and Pacific Islander children.1-6 Addressing childhood obesity during the perinatal period and throughout infancy has been found to contribute to reducing the prevalence of chronic disease and obesity.7 The lack of culturally appropriate healthcare services and resources, low levels of health literacy and a cultural reluctance to seek support presents challenges in addressing these health issues within the community.5, 7 Practice change: The Good Start program is a Queensland Health initiative which aims to improve the health and wellbeing of Maori and Pacific Islander children and families. In order to address maternal and childhood health inequalities, the Good Start program established a consumer engagement strategy and subsequently created the Good Start to Life project. Good Start to Life is a preventative health strategy that promotes optimal maternal and infant nutrition. Aim and theory: To co-design with Maori and Pacific Islander consumers in Queensland, a culturally-tailored maternal and infant health strategy to promote appropriate maternal nutrition and infant nutrition guidelines. By involving consumers from the outset, the project will develop from the consumer perspective and, by utilising a strong co-design process, will raise community awareness and build ownership.8-10 Target population and stakeholders: The target population included parents-to-be, parents and carers of Maori and Pacific Islander children aged 0-4 years living in Queensland. Additional stakeholders include maternal and child health services, and medical and allied health professionals. Timeline: Over a 12-month period the full consumer engagement strategy was developed and implemented. Highlights: Through the design of a dynamic, flexible and culturally appropriate consumer engagement strategy, various consumers were provided an opportunity to be part of the project. Different approaches were utilised in the form of forums, steering committee, and consumer review and participant groups. Each required different time investment, education background, literacy level and personal involvement. The initial stage of the project has been completed with the creation of educational resources prioritising areas identified as contributing to childhood obesity. A total of 95 consumers were directly involved, having dedicated a total of 133 hours of their time. Sustainability and transferrability: In the Good Start to Life project an additional 118 consumers have been involved thus highlighting the sustainability of the strategy. Furthermore the learning’s from this project have been applied to all projects within the Good Start program highlighting the strategy’s transferrability. As consumer engagement is a fundamental aspect of the National Safety and Quality Health Services Standards, the learning's from this project can extend to other health services. Conclusion: Consumer engagement led to the creation of user-friendly, consumer driven, culturally appropriate, low literacy resources. These resources will improve the knowledge, skills and confidence around maternal and infant nutrition and ultimately contribute to addressing childhood obesity in a vulnerable population. Building strong partnerships with consumers proved vital and set a strong precedence for future preventative healthcare strategies.

Issues in Medicaid Policy and System Transformation: Recommendations From the President's Commission

For more than a decade, the philosophy of community-based systems of care has guided the delivery of mental health services for children and adolescents served by publicly funded agencies. This philosophy supports system attributes that include a broad array of services; interagency collaboration; treatment in the least-restrictive setting; individualized services; family involvement; and services responsive to the needs of diverse ethnic and racial populations. The notion of systems of care emerged in an era when managed health care also was gaining popularity. However, the effect of managed care on the delivery of mental health and substance-abuse services--also known as behavioral health services--has not been widely studied. Preliminary results from the nationwide Health Care Reform Tracking Project (HCRTP) inform discussions about the impact of managed behavioral health care on services for children and adolescents enrolled in state Medicaid programs. Most states have used some type of "carve-out design" to finance the delivery of behavioral health services, and there is a trend toward contracting with private-sector, for-profit companies to administer these benefits. In general, managed care has resulted in greater access to basic behavioral health and community-based services for children and adolescents, though access to inpatient hospital care has been reduced. Under managed care, it also has been more difficult for youths with serious emotional disorders, as well as the uninsured, to obtain needed services. With managed care has come a trend toward briefer, more problem-oriented treatment approaches for behavioral health disorders. A number of problems related to the implementation of managed behavioral health care for children and adolescents were illuminated by the HCRTP. First, there is concern that ongoing efforts to develop systems of care for youths with serious emotional disorders are not being linked with managed care initiatives. The lack of investment in service-capacity development, the lack of coordination with other agencies serving children with behavioral health problems, and cumbersome preauthorization requirements that may restrict access to appropriate service delivery were other concerns raised by respondents about managed care. As the adoption of managed behavioral health care arrangements for Medicaid beneficiaries expands rapidly, the HCRTP will continue to analyze how this trend has affected children and adolescents with behavioral health problems and their families.

Data from the National Cancer Database indicates prostate cancer (CPa) prevalence in the Pacific Islander (PI) community to be nearly 1.6 times higher than the national standard. Recent data suggests that prostate cancer rates seen in United States PI men are comparable to that of African American men, the community with the longstanding recognition as having the highest rates of the disease in the US. PIs are defined as those originating from or being indigenous to the islands of Polynesia, Melanesia, and Micronesia including the US governed Hawaiian islands, Guam, Northern Marianas Islands, and American Samoa. PIs make up a grossly underrepresented minority group, often being overshadowed by their mainland Asian counterparts when aggregated together as a group defined as “AANHPI” in sociological and epidemiological data sets and studies. In addition, Pacific Islanders, at least in the mainland US, are considered a “new” minority population, and with the exception of those indigenous to US territories, the vast majority of the population are post 1970 first or second generation immigrants. Research into health disparities in the PI community is thus unsurprisingly sparse, and there is great work to be done to explore these alarming trends. The purposes of this study are threefold: further explore the data pertaining to prostate cancer prevalence in the pacific islander community; disaggregate the data between ethnic lines; and provide a foundation for future research that can further elucidate the causes and outcomes of this disease in the Pacific Islander community. Data was taken from the 2014 Native Hawaiian and Pacific Islander National Health Interview Survey (NHPI NHIS). The NHPI NHIS is a national survey administered by the CDC-NCHS to collect disease data including health condition and characteristics, health care access and service utilization but specific to the national NHPI population. Among 2588 participants, 4% indicated ever having been diagnosed with cancer among which prostate cancer was the second most commonly diagnosed. This study relies heavily on large-scale national questionnaires, thus future research should incorporate additional qualitative exploratory research, including targeted and ethnicity-specific canvassing and interviews in order to better understand the real life manifestations of the disease. The preliminary findings highlight an ever growing concern for the health outcomes of this community, and provide compelling evidence in support for both disaggregation of the community from Asian Americans, as well as interethnic disaggregation in data sets. A common thread of distancing between PI communities and the healthcare system was particularly evident, raising the concern that PIs are not being screened early enough and are not seeking life saving medical attention until advanced disease progression. A hopeful outcome of this study is a recognition that more outreach and community work must be done to bridge the gap between PIs and the Western healthcare system in order to mitigate the observed disparities. Citation Format: Nicholas A. Sowizral. Disparities in occurrence and outcome of male reproductive cancers in the United States Pacific Islander community [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C007.

To determine associations of unmet needs for child or family health services with (1) adverse family financial and employment impacts and (2) child behavioral functioning problems among US children with autism spectrum disorder (ASD), developmental delay (DD), and/or intellectual disability (ID). This was a secondary analysis of parent-reported data from the 2009 to 2010 National Survey of Children with Special Health Care Needs linked to the 2011 Survey of Pathways to Diagnosis and Services. The study sample (n = 3,518) represented an estimated 1,803,112 US children aged 6 to 17 years with current ASD, DD, and/or ID (developmental disabilities). Dependent variables included adverse family financial and employment impacts, as well as child behavioral functioning problems. The independent variables of interest were unmet need for (1) child health services and (2) family health services. Multivariable logistic regression models were fit to examine associations. Unmet need for child and family health services, adverse family financial and employment impacts, and child behavioral functioning problems were prevalent among US children with developmental disabilities. Unmet needs were associated with an increased likelihood of adverse family employment and financial impacts. Unmet needs were associated with an increased likelihood of child behavioral functioning problems the following year; however, this association was not statistically significant. Unmet needs are associated with adverse impacts for children with developmental disabilities and their families. Increased access to and coordination of needed health services following ASD, DD, and/or ID diagnosis may improve outcomes for children with developmental disabilities and their families.

Background: Somali Region of Ethiopia recorded the first confirmed case of SARS-CoV-2 (COVID 19) pandemic on 26th April 2020. The study aimed to assess the effect of the pandemic on the utilization of maternal new-born and child health services. Subjects and Method: This was a retrospective chart review of monthly DHIS database of health facilities in Farfan zone of Somali Region and test of association using t test was used to compare the mean reduction in utilization of maternal and child health services three months before (January – March 2020) and three months during the pandemic (April 2020 to June 2020) at p value set at significant level of 5%. The outcome measure was the utilization of maternal and child health services. Results: The mean reductions in OPD per capita for children under five, children who received first dose of pentavalent vaccines and pregnant women who received first ANC before and during the pandemic was 14.26%, t=1.07; 95% CI= 283.17 to 725.17; p= 0.325); 12.51%, t=0.74; 95% CI= 1439.33 to 2697.31; p= 0.489) and 14.43%, t=0.49; 95% CI= 2363.33 to 3543.41; p= 0.642) respectively, while the mean reduction in skilled birth deliveries conducted at the health facilities was 21.4%, t= 0.97; 95% CI= 319.26 to 736.16 ; p= 0.371). Conclusion: The study provided early effects of COVID 19 on health and health services and the need for policy development on health system strengthening and resilience to withstand future outbreaks. This study indicated that indirect health service effects are substantial and highlights the importance of maintaining routine essential health and nutrition service delivery and the need to explore innovative ways of delivering both preventive and curative essential service. Keywords: COVID 19, pandemic, maternal newborn and child health, utilization, essential services Correspondence: Olusola Oladeji. UNICEF Somali Field Office, Ethiopia. Email: ooladeji@unicef.org. Journal of Epidemiology and Public Health (2020), 05(04): 458-469 https://doi.org/10.26911/jepublichealth.2020.05.04.08

ObjectivesMedical homes, an important component of U.S. health reform, were first developed to help families of children with special health care needs (CSHCN) find and coordinate services, and reduce their children’s unmet need for health services. We hypothesize that CSHCN lacking medical homes are more likely than those with medical homes to report health system delivery or coverage problems as the specific reasons for unmet need. MethodsData are from the 2005-2006 National Survey of Children with Special Health Care Needs (NS-CSHCN), a national, population-based survey of 40,723 CSHCN. We studied whether lacking a medical home was associated with 9 specific reasons for unmet need for 11 types of medical services, controlling for health insurance, child’s health, and sociodemographic characteristics. ResultsWeighted to the national population, 17% of CSHCN reported at least one unmet health service need in the previous year. CSHCN without medical homes were 2 to 3 times as likely to report unmet need for child or family health services, and more likely to report no referral (OR= 3.3), dissatisfaction with provider (OR=2.5), service not available in area (OR= 2.1), can’t find provider who accepts insurance (OR=1.8), and health plan problems (OR=1.4) as reasons for unmet need (all p<0.05). ConclusionsCSHCN without medical homes were more likely than those with medical homes to report health system delivery or coverage reasons for unmet child health service needs. Attributable risk estimates suggest that if the 50% of CSHCN who lacked medical homes had one, overall unmet need for child health services could be reduced by as much as 35% and unmet need for family health services by 40%.

With 28% of Australia's population having a culturally and linguistically diverse (CALD) background, the health system faces an increasing challenge to provide accessible and culturally competent health care. The view that all CALD communities are homogenous and solutions can be developed for the entire nation is detrimental. Despite available health services, CALD communities are reluctant to use them due to cultural differences, perceived racism and misunderstandings leading to the existing health disparities. Therefore, gathering data from four prominent CALD communities, such as the Sudanese, Afghani, Pacific Islander and Burmese communities in Logan, Queensland, about how they perceive and use health services can provide insightful information towards development of a service model that will better suit these CALD communities. The objective of the study was to examine the extent to which four prominent CALD communities (Sudanese, Afghani, Pacific Islander and Burmese) access and use health services in Logan, Queensland. Six focus group interviews using interpreters were conducted in English with Sudanese, Afghani, Pacific Islander and Burmese people. The results indicated that even long-standing CALD communities, such as the Pacific Islander people, were unfamiliar with health services and experienced difficulties accessing appropriate health care. Most wanted doctors to use traditional healing methods alongside orthodox medicine, but did not feel respected for their beliefs. Language difficulties impeded communication with health professionals who were hindered by ineffective use of interpreters. In conclusion, a clear role for bilingual community-based navigators was identified by CALD participants to address concerns about the health system, and to improve accessibility and health service usage.

To examine collaboration in the provision of universal health services for children and families in Australia from the perspective of midwives and child health and family health nurses. Collaboration is identified as a key concept contributing to families' smooth transition between maternity and child health services. However, evidence suggests that collaboration between services is often lacking. Few studies have explored how maternity and child health and family health services or professionals collaborate to facilitate a smooth transition. This study reports on data collected in phases 1 and 2 of a three-phase mixed-methods study investigating the feasibility of implementing a national approach to child health and family health services in Australia (Child Health: Researching Universal Services study). In phase 1, consultations (via discussion groups, focus groups and teleconferences) were held with 45 midwives and 60 child health and family health nurses. Themes identified were used to develop phase 2 surveys. In phase 2, 1098 child health and family health nurses and 655 midwives returned surveys. Midwives and child health and family health nurses reported 'some collaboration'. Midwives and child health and family health nurses indicated that collaboration was supported by having agreement on common goals and recognising and valuing the contributions of others. Organisational barriers such as poor communication and information transfer processes obstructed relationships. Good collaboration was reported more frequently when working with other professionals (such as allied health professionals) to support families with complex needs. This study provides information on the nature and extent of collaboration from the perspective of midwives and child health and family health nurses providing universal health services for children and families. Both professional groups emphasised the impact of service disconnection on families. However, their ability to negotiate professional differences is affected by system constraints and differing perspectives of what constitutes collaboration. Developing the capacity to collaborate is essential to ensure smooth transition of care given ongoing changes to the system.

BackgroundDespite the need for a reduction in levels of childhood exposure to environmental tobacco smoke (ETS) being a recognised public health goal, the delivery of ETS preventive care in child health service settings remains a largely unstudied area. The purpose of this study was to determine the prevalence of ETS preventive care in child health services; differences in the provision of care by type of service; the prevalence of strategies to support such care; and the association between care support strategies and care provision.MethodOne-hundred and fifty-one (83%) child health service managers within New South Wales, Australia completed a questionnaire in 2002 regarding the: assessment of parental smoking and child ETS exposure; the provision of parental smoking cessation and ETS-exposure reduction advice; and strategies used to support the provision of such care. Child health services were categorised based on their size and case-mix, and a chi-square analysis was performed to compare the prevalence of ETS risk assessment and ETS prevention advice between service types. Logistic regression analysis was used to examine associations between the existence of care support strategies and the provision of ETS risk assessment and ETS exposure prevention advice.ResultsA significant proportion of services reported that they did not assess parental smoking status (26%), and reported that they did not assess the ETS exposure (78%) of any child. Forty four percent of services reported that they did not provide smoking cessation advice and 20% reported they did not provide ETS exposure prevention advice. Community based child and family health services reported a greater prevalence of ETS preventive care compared to other hospital based units. Less than half of the services reported having strategies to support the provision of ETS preventive care. The existence of such support strategies was associated with greater odds of care provision.ConclusionsThe existence of major gaps in recommended ETS preventive care provision suggests a need for additional initiatives to increase such care delivery. The low prevalence of strategies that support such care delivery suggests a potential avenue to achieve this outcome.

To explore young, multi-ethnic adolescents' attitudes and influences related to cigarette smoking for the purpose of developing and producing a youth-led, tobacco prevention drama. Focus groups and demographic surveys. Island of Oahu, Hawaii. Fifty-four multi-ethnic youth, ranging in age from 10 to 14 years, participated. The study was promoted in schools with a large representation of Hawaiian, Filipino, and Pacific Islander students. Each of five focus groups was audio-recorded, and an observer recorded extensive notes throughout the sessions. Content analysis consisted of coding focus group notes for recurrent themes and using the audio recording as confirmation. Just more than one quarter (n = 15) of the youth had tried smoking, and two-thirds (n = 35) currently lived with someone who smoked. Participants expressed the feeling of being surrounded by smoking influences at home, in their communities, and at school. Youth were negatively affected by family members' tobacco use, and they desired skills that could enable them to help family members stop using tobacco. Family influences may play an important role in youth attitudes toward tobacco use, especially given the cultural significance of extended family and of filial piety that are reflected in many traditional, Asian and Pacific Islander families. Interventions targeting youth in Asian and Pacific Islander communities should incorporate key cultural references to the extended family and to a respect for elders to establish relevance in the life experiences of young people in these population groups.

The role of the private sector in delivering maternal and child health services in low-income and middle-income countries: an observational, longitudinal analysis

Brucellosis is an important zoonosis in the Pacific Island community, however most countries in the Pacific island community may not consider the disease important. This is due to the fact that there has been very little literature published on the disease over the last 20 years thus it has been difficult to gauge the impact of the disease. There also are national priorities ahead of the disease Brucellosis, e.g. HIV and Tuberculosis, etc. Brucella abortus in particular has significance in the Pacific island community as it has recently re-emergence in Fiji and it has the potential to impact the cattle sectors in Papua New Guinea, Vanuatu and the Solomon Islands who all depend on cattle for food security and their livelihoods. The Fiji re-emergence of B. abortus in cattle in 2009 was most likely caused by the lapse in monitoring with poor surveillance and reporting until the disease was well established in the Tailevu province of Fiji. Thus this study sought to examine ways to improve disease surveillance and reporting using Brucellosis in cattle as a model to reduce the impacts of zoonoses and protect the livelihoods of livestock farmers within the Pacific Island Community. Five approaches (objectives) were used in this study to improve disease surveillance and reporting using Brucella abortus as the disease of interest and cattle as the animal unit studied and the countries covered were Fiji, Papua New Guinea, Vanuatu and the Solomon Islands. The five objectives were; (i) produce a better knowledge on the status of bovine brucellosis in the Pacific Island Community, using the current outbreak of the disease in Fiji as a model. (ii) Produce a better knowledge of which risk factors were associated with the outbreak of bovine brucellosis in Fiji and how some of those risks factors could be related to other Pacific Island Community countries, i.e. in terms of similarities of cultures and farming practices. (iii) Identify strengths, weaknesses, opportunities and threats (SWOT) for the current disease reporting structures in Fiji, Papua New Guinea, Vanuatu and the Solomon Islands and how they impacted their surveillance system components. (iv) Improve disease surveillance through capacity building training, survey development and apply this training through a brucellosis freedom survey in PNG, Vanuatu and the Solomon Islands and a prevalence survey in Fiji. (v) Examine the sensitivities of the surveillance system components in Fiji, Papua New Guinea, Vanuatu and the Solomon Islands to detect B. abortus in cattle. The research first sought to gain a better understanding of the status of Brucellosis in the Pacific Island Community and the region; the research also examined retrospective data to calculate the prevalence of the disease to determine its spread in Fiji since Fiji had an outbreak of the disease at that time. The methods used were a systematic literature review and a prevalence study using retrospective data from Fiji (Chapter 2). The research sought to further enhance the understanding of the disease by examining which risk factors could have been associated with the outbreak of B. abortus on Dairy farms in the Tailevu province of Fiji. The methods used were a cross-sectional survey on the risk factors associated with the farms in the locality where B. abortus re-emerged in 2009 in Fiji (Chapter 3). After completing the research studies in Chapter 2 and Chapter 3 it was evident that there was a poor understanding of the disease and disease surveillance capacities were weak, so the research documented and examined the reporting structures to identify gaps and areas that could be improved as well as on how policy support was impacting disease surveillance in the Pacific Island Community (Chapter 4). The next step was to build surveillance capacities for Fiji, PNG, Vanuatu and the Solomon Islands through the research activities as this was lacking, i.e. through the development of surveys to detect B. abortus in selected regions as funding was limited (Chapter 5). The final step was to improve disease surveillance and reporting by examining the surveillance system components (SSCs) of Fiji, PNG, Vanuatu and the Solomon Islands to analyse the sensitivity of the systems to detect B. abortus. This aspect of the work focussed on the documentation of the surveillance system components (SSCs) for Fiji, PNG, Vanuatu and the Solomon Islands enabling the analysis and identification of where weaknesses were in the reporting system, thus allowing for recommendations for improvements to be made (Chapter 6). The key findings from the research were as follows; Chapter 2, Bovine brucellosis has been present in PICTs for many years, yet it may not be considered important in many Pacific Islands and Territories. There has been very little literature published on B. abortus in the Pacific Island region over the last 20 years making it difficult to gauge the impact of the disease (Conclusion 1). The re-emergence of B. abortus in Fiji was most likely due to the lack of monitoring for the disease while disease surveillance is limited and poor in PNG, Vanuatu and the Solomon Islands (Conclusion 2). Chapter 3, the risks of brucellosis transmission within cattle on dairy farms in Fiji are high (Conclusion 3) since the existence of other animal species on the dairy farms in Fiji may harbour the B. abortus organism. Reporting of diseases to the animal health authorities was poor with the farmers (Conclusion 4). The risk of human infection was high with the farmers in Fiji (Conclusion 5). Farms having a history of reactor cattle to brucellosis and or tuberculosis were 30 times (OR= 30) more likely of being infected with the B. abortus organism (Conclusion 6). Farms that practised sharing of water sources for cattle within and with cattle from outside farms were 39 times (OR= 39) more likely of being infected with the B. abortus organism (Conclusion 7). Chapter 4, Surveillance programs and reporting structures are impeded by the lack of policy to support them (Conclusion 8). Reporting structures are affected by the vacant positions and shortage of veterinarians (Conclusion 9). Reporting structures are too long, hierarchical in nature and have multiple reporting branches which are not functioning well (Conclusion 10). Chapter 5, Lack of funds impacted surveillance programs in PICTs (Conclusion 11). Lack of technical expertise reduced disease surveillance capacities in PICTs (Conclusion 12). Outdated data on cattle population impeded the development of surveys for disease surveillance in PICTs (Conclusion 13). PNG, Vanuatu and the Solomon Islands all tested negative to B. abortus based on the survey sample sizes for selected regions (Conclusion 14). Chapter 6, the proportions of reports being made for Brucellosis and other diseases are low (Conclusion 15). The proportions of disease investigations being carried out by the animal health authorities are low (Conclusion 16). The survivability of samples collected, processed and sent to reference laboratories is low (Conclusion 17). Data for certain nodes in the country SSC's were limited affecting the countries sensitivity for detecting B. abortus (Conclusion 18). Disease surveillance and reporting in the Pacific Island community is limited and poor thus there needs to be training to build capacity to improve these. There also needs to be policy development to support disease surveillance and reporting programs in the Pacific Island community; however this is difficult as funds are limited and national governments often have other priorities ahead of disease surveillance. Thus there is an important need to improve collaboration between, donors such as FAO and ACIAR as well as academic institutions and national governments to develop projects to improve disease surveillance in the Pacific Island community. There is also a need to improve disease surveillance and reporting using a holistic and regional approach which this research has started doing in Fiji, Papua New Guinea, Vanuatu and the Solomon Islands. This allows the detailed examination of the surveillance system components (SSC's) thus identifying components that are weak and allowing for their improvement, which will increase the ability of the countries to detect diseases. A multi-sectoral approach is also needed to improve disease surveillance and reporting in the Pacific Island community, i.e. since most animal diseases are zoonotic, there is a need for the human and animal sectors to work together to develop programs to improve surveillance and reporting, e.g. using a One Health Approach.

Health and Social Care Delivery Research (HSDR) Programme is part of the National Institute for Health and Care Research (NIHR). As such, it aims to contribute to the NIHR's mission of improving the health and wealth of the nation by funding evaluative research projects that have the potential to improve the quality, accessibility and organisation of health and social care services by providing useful outputs for decision-makers, staff, service users, academic, and public audiences. More information about the programme can be found on the NIHR website. A logic model is a visual way of showing how an activity, programme or intervention is expected to work and bring about the benefits and changes it intends to achieve. By summarising the core elements, a logic model can be used to support programme planning, implementation, and evaluation. NIHR logic models presentin a linear flow diagramthe key activities, outputs, outcomes and impacts of each funding programme as a series of logical steps.