Logic Model Research Articles

A Digital Behavior Change Intervention for Health Promotion for Adults in Midlife: Protocol for a Multidimensional Assessment Study.

To support lifelong health promotion and disease prevention, Santé publique France studied the methodology for building a social marketing scheme with a digital intervention targeting middle-aged adults, specifically socioeconomically disadvantaged groups. The digital intervention aims to encourage people aged 40-55 years to look after their health in the short and medium terms by adopting small actions relating to 8 health determinants: nutrition, physical activity, smoking, alcohol, stress, cognitive health, sleep, and environmental health. In the long term, the intervention intends to prevent frailty and reduce the burden of multimorbidities in older age, particularly for lower socioeconomic groups. This study aims to measure behavior changes among registered users of the future website. The protocol assesses the impact of the website based on users' implementation of small actions relating to the 8 health determinants. Specifically, it intends to evaluate the website's performance in terms of engaging a specific population, triggering behavior change, raising awareness about a multifactorial approach to health, and encouraging user interaction with the website's resources. The methodology is based on clinical assessments developed alongside the website according to the functionalities offered to registered users in their personalized space. The assessment tool design draws on logic models for digital interventions, and their consistency for digital applications is verified. The target audience is clearly defined from the outset. The protocol sets out a 3-step assessment: upon registration, after 3 weeks of use, and after 10 weeks of use (end of assessment). Users are divided into 2 groups (socioeconomically disadvantaged users and others) to characterize differences and make corrections. The protocol uses a mixed assessment approach based on website traffic and user login data. Specific and identifiable behavior changes are documented by monitoring the same individuals from T0 to T2, using verbatim comments to classify them into profiles and conducting semistructured individual interviews with a sample of users. The protocol creates a multidimensional assessment of digital intervention, showing that during a given timeline, interactions with users can reveal their capabilities, opportunities, and motivations to adopt healthy lifestyles. The protocol's principles were integrated into the development of a personal account to assess users' behavior changes. Given the delayed launch of the website, no recruitment or effects analysis of the protocol took place. As no multidimensional assessment protocol is currently available for digital behavior change interventions, our methods reveal that the different framework stages can strengthen the effect measurement, consolidate the choice of assumptions used within the logic model and steer the digital intervention toward action while reducing the burden of information. The suitability of the assessment protocol remains to be evaluated given the delayed launch of the website. PRR1-10.2196/60559.

Using Intervention Mapping and Behavior Change Techniques to Develop a Health Promotion Intervention on Endocrine Disruptors: Development Study

Endocrine disruptors (EDs) are substances that interfere with the endocrine system, posing risks to health across various life stages, particularly during adolescence when hormonal changes are pronounced. Despite the recognition of adolescents as vulnerable, there have been few interventions targeting their exposure to EDs. This study developed the COPE ADOS program using the intervention mapping (IM) framework to enhance adolescents’ knowledge and skills in identifying and mitigating exposure to EDs. The IM framework guided the creation of the program through four steps: conducting a needs assessment, formulating program objectives, selecting relevant behavioral theories, and developing a logical model. The need assessment conducted through focus groups revealed significant knowledge gaps and misconceptions about EDs among adolescents, leading to the establishment of six performance objectives aimed at addressing attitude, knowledge, risk perception, self-efficacy, and skills. As a result, 15 educational tools were created. The COPE ADOS program represents a novel, collaborative effort tailored to the needs of students and demonstrates the potential of the IM framework in developing effective health interventions for adolescents. Future research should evaluate the impact of this program on reducing ED exposure among high school students.

How to Teach Literacy to Artificial Neural Networks Making AI intelligent by Learning from other Disciplines

What does literacy mean in AI? Generative AI, especially Large Language Models (LLM), use statistical relevance to build responses to prompts. Literacy in education means understanding cause and effect from a text and why one observation follows another. It has to do with the real world and some understanding of how the grounding behaves and works. This kind of learning can be achieved with intelligent systems that combine AI engines with traditional programming, or in terms of the Graph Model of Combinatorial Logic: Observations and Concepts with Lambda Concepts. In conclusion, it is very helpful to listen to other disciplines for making AI intelligent. The respective task list for AI engineers includes, but is not limited to, education and teaching to children and humans. Keywords: artificial intelligence, generative pretrained translators, knowledge acquisition transformation, intelligent systems

Development and evaluation of a decision aid for HPV vaccination among adults aged 27-45 years old in the United States.

To design, develop, and field test the HPV Decide decision tool to facilitate shared clinical decision-making recommendation for mid-adult HPV vaccination. The 'HPV Decide' online tool was developed through a 6-step process, involving community and provider advisory boards, usability testing with 10 end users (unvaccinated adults aged 27-45), field testing interviews with another 10, and interviews with 18 healthcare providers. The process incorporated both inductive and deductive qualitative data analyses. The logic model, based on the Ottawa Decision Support Framework, highlighted the importance of objective knowledge and managing decisional conflict. Iterative modifications were informed by the advisory boards, alpha testing, and usability testing. Field testing showed utility to end users, highlighting the straightforward design, and lack of medical jargon. Many expressed a desire to access the tool before doctor appointments, emphasizing its value in a healthcare context and in partnership with providers. Lastly, healthcare provider feedback highlighted information quality, structure, acceptability, and future implementation. While users recognized the tool's information quality and user-centric design, full evaluation focused on changes in informed decision making and clinic-based implementation are needed. The HPV Decide decision tool demonstrates promise in supporting informed decisions about HPV vaccination among mid-adults.

A qualitative study exploring depressed participants' experiences of receiving Augmented Depression Therapy (ADepT).

The current study aimed to explore participants' views on the acceptability, impact and mechanisms of change of Augmented Depression Therapy (ADepT), a novel wellbeing-focused and recovery-oriented psychological therapy for depression. A semi-structured qualitative interview design was used, with data analysed using the framework approach. 20 participants with anhedonic depression who had received up to 20 sessions of ADepT, sampled from a pilot randomised controlled trial of ADepT versus Cognitive Behavioural Therapy (CBT). A primary care psychological therapy clinic in Devon, UK, with interviews occurring between May 2018 and February 2020. Participants found the wellbeing focus of ADepT acceptable. Helpful aspects of therapy were a positive therapeutic bond, the structure and flow of therapy scaffolding the learning journey, the tools and techniques of therapy helping building wellbeing and booster sessions supporting long-term recovery. Negative aspects for some participants were therapy feeling too intense and triggering feelings of failure. Participants reported significant positive impacts of treatment on wellbeing, functioning and hope. Perceived mechanisms of change were reorienting to the positive, engaging with valued goals, taking a proactive life stance, gaining confidence and motivation for change, breaking down tasks into small steps, cultivating self-care and self-compassion, enhancing help seeking and interpersonal effectiveness, changing the relationship to depression, and rediscovering the self beyond depression. Findings suggest that the wellbeing focus of ADepT is acceptable and leads to positive impacts, supports the logic model underpinning the intervention, and warrants continuation to a definitive trial. ISRCTN85278228.

Using a Fuzzy Model to Evaluate Risks caused by Variation Orders in Construction Projects

The construction industry is the main driving sector for any country's economy. However, it is too risky due to the many risks and challenges in this industry. One of the main challenges in construction projects is variation orders, as they lead to conflicts between project parties and cause poor project performance. This study aims to evaluate the risks associated with variation orders in construction projects using fuzzy risk assessment. The targeted population is the construction contractors in Palestine. A questionnaire survey was used to collect data on the severity and frequency of the 22 identified factors of variation orders. Then, a fuzzy logic system was developed to rate these factors. The factor risk level was determined by connecting the relationship between the severity and frequency indices using If-Then rules. The determination of risk level is a critical task in the proposed fuzzy system, which depends on the complex combinations of all If-Then rules. Risk is determined not only by the If-Then rules but also by the weight of each rule. This study shows that the factors with the highest risk levels are scope change by the client, client financial problems, unavailability of required materials, poor design documents, and modification of specifications. The results can serve as guidelines for project participants who need to prepare and implement a comprehensive and effective risk management plan to meet project goals. To improve project performance, construction parties are recommended to implement the proposed method to assess risks related to construction projects. Finally, the proposed risk model demonstrates the ability to evaluate risk levels by aggregating rules and combining the project risk factors using a fuzzy logic model and MATLAB.

Arts psychotherapies for adolescents with mental health difficulties: A systematic review and logic model of mechanisms of action and outcomes

Arts psychotherapies for adolescents with mental health difficulties: A systematic review and logic model of mechanisms of action and outcomes

Deep Knowledge Tracing Integrating Temporal Causal Inference and PINN

Knowledge tracing predicts students’ future performance based on their historical performance data, which is significant for students’ learning resource recommendation, learning path prediction, and other aspects. Students’ knowledge mastery, learning ability, and question difficulty all influence the performance metrics of knowledge tracing. This paper proposes a deep knowledge tracing model that integrates temporal causal inference and the PINN (Physics-Informed Neural Network) model. The model first uses the temporal causality model to explores the causal relationships between students’ knowledge points, which is then combined with the deep learning-based knowledge tracing model for prediction. Next, it treats the logical model as a ’physical model’, adds a loss term, considers the confounding factors caused by students’ answer preferences, and adjusts students’ learning ability through backdoors to obtain more accurate predictions. In the public education datasets ASSISTment2012 and ASSISTchall, the predictive performance of the TLPKT-PINN model is superior to some classical models and LPKT. From the experimental results, we can conclude that considering the degree of mastery of causal knowledge points and adjusting the loss term can improve the accuracy of predicting student grades.

The OptiBreech Trial Feasibility Study: A Qualitative Inventory of the Roles and Responsibilities of Breech Specialist Midwives.

The safety of vaginal breech birth is associated with the skill and experience of professionals in attendance, but minimal training opportunities exist. OptiBreech collaborative care is an evidence-based care bundle, based on previous research. This care pathway is designed to improve access to care and the safety of vaginal breech births, when they occur, through dedicated breech clinics and intrapartum support. This improved process also enhances professional training. Care coordination is accomplished in most cases by a key breech specialist midwife on the team. The goal of this qualitative inventory was to describe the roles and tasks undertaken by specialist midwives in the OptiBreech care implementation feasibility study. Semistructured interviews were conducted with OptiBreech team members (17 midwives and 4 obstetricians; N = 21), via video conferencing software. Template analysis was used to code, analyze, and interpret data relating to the roles of the midwives delivering breech services. Tasks identified through initial coding were organized into 5 key themes in a template, following reflective discussion at weekly staff meetings and stakeholder events. This template was then applied to all interviews to structure the analysis. Breech specialist midwives functioned as change agents. In each setting, they fulfilled similar roles to support their teams, whether this role was formally recognized or not. We report an inventory of tasks performed by breech specialist midwives, organized into 5 themes: care coordination and planning, service development, clinical care delivery, education and training, and research. Breech specialist midwives perform a consistent set of roles and responsibilities to co-ordinate care throughout the OptiBreech pathway. The inventory has been formally incorporated into the OptiBreech collaborative care logic model. This detailed description can be used by employers and professional organizations who wish to formalize similar roles to meet consistent standards and improve care.

The Influence of Multisensory Perception on Student Outdoor Comfort in University Campus Design

The user’s experience is critical in spatial design, particularly in outdoor spaces like university campuses, where the physical environment significantly influences students’ relaxation and stress relief. This study investigates the combined impact of thermal, luminous, and auditory environments on students’ perceptions within recreational areas at Bordj Bou Arreridj University Campus. A mixed-method approach combined field surveys and on-site measurements across eleven locations within three distinct spatial configurations. The findings from this study indicate that the auditory environment had the most substantial influence on overall perceptions, surpassing luminous and thermal factors. The open courtyard (Area 1) was perceived as less comfortable due to excessive heat and noise exposure. The shaded zone (Area 2) was identified as the most vulnerable, experiencing significant thermal stress and noise disturbances. In contrast, the secluded patio (Area 3) achieved the highest comfort rating and was perceived as the most cheerful and suitable space. Correlation analysis revealed significant interrelationships between physical and perceptual dimensions, highlighting the critical role of factors such as wind velocity, sky view factor, and illuminance in shaping thermal, luminous, and acoustic perceptions. A fuzzy logic model was developed to predict user perceptions of comfort, suitability, and mood based on measured environmental parameters to address the complexity of multisensory interactions. This study highlights the importance of integrating multisensory evaluations into spatial design to optimize the quality of outdoor environments.

METHODOLOGICAL APPROACH TO THE AUDIT OF ACCOUNTING ESTIMATES

The audit of accounting estimates has its own specific features due to regulatory requirements. Accounting objects often require complex accounting estimates, so auditors should carefully review the valuation methods and assumptions used, as they may affect the financial results of the enterprise. However, the issues related to the audit of accounting estimates are not well researched in the scientific environment, and there is a lack of a conceptual model of accounting estimates and a methodological approach to the audit of accounting estimates. Therefore, the purpose of the article is to develop recommendations that could be important tools for conducting an effective audit of accounting estimates in accordance with the requirements of the International Standard on Auditing. To solve the tasks, the following methods were used: dialectical method – to form the concept of research; structural and logical modelling – to build a conceptual model of accounting estimates; logical generalization – in formulating a methodological approach to the audit of accounting estimates. A conceptual model of accounting valuation has been developed using the structural approach, with allocation of its most important components in the following blocks: data; valuation approaches and methods; assumptions: valuation uncertainty; regular review; transparency requirements. The conceptual model of accounting estimates provides for the identification of key assumptions within the selected methods, which helps to understand the degree of uncertainty in estimates and to adapt accounting estimates to changes in the external environment. methodological approach to the audit of accounting estimates. A methodological approach to the audit of accounting estimates has been developed, which is a clear multi-stage tool for auditors conducting an audit in accordance with international auditing standards. This approach is based on understanding the process by which accounting estimates are developed, identifying and assessing the risks of material misstatement; verifying accounting estimates using one or a combination of three main approaches: obtaining audit evidence from events occurring up to the date of the auditor's report; testing how management made the accounting estimate; and developing an auditor's point estimate or range. The main conclusions and further directions of research are formulated.

Development and modelling study of an evidence-based manualised intervention: PErsonalised Treatment packages for Adults with Learning disabilities who display aggressive challenging behaviour in community settings (PETAL)

Background Aggressive challenging behaviour is prevalent in adults with an intellectual disability and is associated with over-medication, physical ill-health and psychiatric hospitalisation. We urgently need interventions that can moderate this behaviour and improve quality of life in this population. We report on the development and modelling of a 7-module tailored manualised psychological intervention to support adults who display aggressive challenging behaviour in community settings (hence referred to as the PETAL therapy). Method The PETAL therapy was designed following an extensive review of existing management provisions and was co-produced with carers with lived experience and self-advocates with an intellectual disability. A logic model was developed to illustrate the theoretical approach behind the development of the PETAL intervention. A single arm multi-site modelling study was conducted in England to test the delivery and acceptability of the PETAL intervention. Seventeen NHS healthcare professionals were trained during a two-day training programme and were regularly supervised to deliver the therapy in up to 14 weeks. Following completion, we conducted qualitative interviews with stakeholders and explored the intervention’s fidelity and acceptability. Results We held seven co-production meetings and developed the PETAL therapy, consisting of the following modules: Getting to know the person, understanding aggressive challenging behaviour, communication, emotions, a calm environment, carer wellbeing and healthy habits. We then recruited ten dyads or triads (person with a learning disability and 1–2 carers) to participate in a modelling study to test delivery aspects and measure fidelity. Nineteen stakeholders were interviewed, and the findings were analysed deductively using Normalisation Process Theory and its four domains: coherence, cognitive participation, collective action and reflexive monitoring. Conclusion The PETAL therapy was possible to deliver in community services with high fidelity and was acceptable. The PETAL manual and training programme have been reviewed and refined and a cluster randomised controlled trial is underway.

Fuzzy logic modelling of the pollution pattern of potentially toxic elements and naturally occurring radionuclide materials in quarry sites in Ogun State, Nigeria

The accumulation pattern of some inorganic pollutants in quarry sites around Ogun State was modeled using a Fuzzy comprehensive assessment (FCA). Potentially toxic elements (PTEs) and naturally occurring radionuclides materials (NORMs) were assessed from soil samples collected from ten quarry sites in three districts (Odeda, Ajebo, and Ijebu Ode) in Ogun State. Three (3) NORMs (40 K, 238U, and 232Th) were assessed using gamma spectrometer with a NaI detector while ten (10) PTEs (As, Cd, Co, Cr, Cu, Fe, Mn, Ni, Pb, and Zn) were determined by digestion method using Inductively coupled plasma optical emission spectrophotometer. The FCA was used to evaluate soil contamination, and SPSS version 21.0 was used for statistical analysis. Concentration range of PTEs(mg/kg) and NORMs(Bq/kg) in all the site are: As (5.62 ± 0.85 – 15.93 ± 2.40), Cd (BDL—1.26 ± 0.60), Co (5.56 ± 1.34 – 27.25 ± 1.14), Cr (18.68 ± 1.54 -61.43 ± 6.33), Cu (12.40 ± 1.31—82.43 ± 7.94), Fe (15,035.00 ± 81.12 – 36,520.00 ± 292.20), Mn (168.97 ± 5.93 – 353.30 ± 20.84), Ni (5.63 ± 1.99- 25.54 ± 2.50),),Pb (4.44 ± 0.8 – 17.87 ± 2.80) and Zn (42.97 ± 413 – 147.00 ± 7.50); 40 K (76.78 ± 44.76—2647.88 ± 179.44), 238U (3.24 ± 1.82—55.42 ± 24.88),and 232Th (5.24 ± 3.90—244.36 ± 89.84). The results were modeled into a membership function matrix of three pollution classes. The FCA of NORMs revealed that 30, 10, and 60% of the sites were pristine, moderately polluted, and heavily polluted.In comparison, the FCA of PTEs confirmed 100% of the sites to be heavily polluted due to the accumulative effect of the PTEs. A high percentage of membership in the extremely impacted class is linked to a high concentration of Fe in all the sites due to the soil's geological structure and natural activities. At the same time, 40 K and 238U have high-impact membership in all the quarry sites. Based on the findings, there is a need for stringent pollution control measures, targeted monitoring of PTEs and NORMs and the development of region-specific environmental regulations to protect both public health and ecosystems.

Learning from the community: iterative co-production of a programme to support the development of attention, regulation and thinking skills in toddlers at elevated likelihood of autism or ADHD

Programmes designed to support children with known, or increased likelihood of, autism or ADHD often focus on reducing behaviours central to a clinical diagnosis. However, supporting children to pursue their own goals and cope with everyday life through fostering executive function (EF) development, without enforcing neuro-normative assumptions, may be more acceptable to neurodivergent people, and more beneficial. The co-production process for this neurodiversity-affirming programme involved: Review of research priorities identified during published public-and-clinician consultations; iterative programme development through two pilot rounds with a general community sample; and consultation with stakeholders (parents with a connection to autism or ADHD, alongside early years specialists, psychologists and therapists) to check acceptability of the proposal, and refine the logic model and materials. The logic model for the resultant programme—Supporting Toddlers with a connection to autism or ADHD to develop strong Attention, Regulation and Thinking skills (START)—involves three mechanisms of change: The child has appropriate play-based opportunities to practise EF skills; Parenting behaviours linked to strong EFs are encouraged; Parents are empowered to improve environmental-fit for their child so that EF stressors are reduced.

Parent-implemented early intervention design for improving speech and language skills among Mandarin-speaking infants and toddlers with cleft lip and/or palate.

Cleft lip and/or palate (CL/P) speech is a significant communication disorder with notable and enduring consequences. This study focused on developing an intervention mapping (IM)-based and parent-implemented early intervention to improve speech and language skills among infants and toddlers with CL/P in China. An IM procedure was used to develop a parent-implemented early intervention. First, parent-child interaction problems affecting language development in infants and toddlers were identified through 132 questionnaires completed by parents of children with CL/P and 30 family videos of parent-child interactions. Second, according to the problem diagnosis, the logical model of parent-child interaction behavior change was constructed. Finally, the health outcomes were transformed into intervention goals at three levels (i.e., infants and toddlers with CL/P, parents and environment), and a set of early intervention programs were designed by integrating various intervention techniques. The diagnosis of parent-child interaction problems showed that 40.91% of parents and children often use electronic media together; in parent-child interaction, 41.67% of parents presented 'lack of waiting', 29.55% overcorrected pronunciation errors. Video analysis revealed issues in parent-child interaction, such as inadequate parental skills, ineffective interactions, and an unsuitable environment. A parent-implemented early intervention was developed, including the following specific steps: health education within the hospital, 9 days of an online reading program in WeChat groups, face-to-face standardized training workshops, and individualized video feedback therapy. We have devised a parent-implemented early intervention to enhance speech and language abilities in Mandarin-speaking infants and toddlers with CL/P, overcoming the shortage of speech therapy services in China.

Living Lab Dementia: process evaluation of an academic-practice partnership in German long term care for people living with dementia - study protocol

BackgroundLiving Labs, as a type of academic-practice partnerships, possess the potential to transform care and research into a participatory partnership and narrow the research-practice gap to improve evidence-based and Person-centred care. Given the lack of systematic investigations of Living Labs in healthcare, we will establish a dementia-specific academic-practice partnership (Living Lab Dementia) in Germany and conduct a process evaluation. The aim of this study is to gain insights into the intervention itself (mechanisms of impact) and its implementation process (degree of implementation, barriers, and facilitators).MethodsThis process evaluation of the multi-center research project PraWiDem (German acronym for linking professional nursing practice and research in dementia) will be conducted applying a convergent mixed methods design and will be based on the Medical Research Council (MRC) framework for the development and evaluation of complex interventions. The intervention is presented in a logic model which describes relevant basic theoretical assumptions, intervention components, implementation aspects, mechanisms of impact, relevant outcomes, and the context in which the intervention is delivered. Data will be collected before the intervention (T0), during the intervention period, and at follow-up after 18 months (T1). Qualitative data will be collected through semi-structured interviews and focus groups. Quantitative data sources will be process documents and questionnaires.DiscussionOur study will provide important insights into the Living Lab Dementia intervention and its implementation processes. The results of this evaluation will contribute to the refinement of the intervention and its implementation processes, and will enable to measure the impact of these processes in future studies.

LGS-KT: Integrating logical and grammatical skills for effective programming knowledge tracing.

Knowledge tracing (KT) estimates students' mastery of knowledge concepts or skills by analyzing their historical interactions. Although general KT methods have effectively assessed students' knowledge states, specific measurements of students' programming skills remain insufficient. Existing studies mainly rely on exercise outcomes and do not fully utilize behavioral data during the programming process. Therefore, we integrate a Logical and Grammar Skills Knowledge Tracing (LGS-KT) model to enhance programming education. This model integrates static analysis and dynamic monitoring (such as CPU and memory consumption) to evaluate code elements, providing a thorough assessment of code quality. By analyzing students' multiple iterations on the same programming problem, we constructed a reweighted logical skill evolution graph to assess the development of students' logical skills. Additionally, to enhance the interactions among representations with similar grammatical skills, we developed a grammatical skills interaction graph based on the similarity of knowledge concepts. This approach significantly improves the accuracy of inferring students' programming grammatical skill states. The LGS-KT model has demonstrated superior performance in predicting student outcomes. Our research highlights the potential application of a KT model that integrates logical and grammatical skills in programming exercises. To support reproducible research, we have published the data and code at https://github.com/xinjiesun-ustc/LGS-KT, encouraging further innovation in this field.

Developing a social and emotional wellbeing intervention using the early childhood education and care environment: an Intervention Mapping approach

ABSTRACT The aim of this paper was to describe how Intervention Mapping Steps 1–4 were used to develop the My Sensory Experience Resource (MSER) to support children’s social and emotional wellbeing through the environment. Empirical evidence, behaviour change theory, and stakeholder feedback were combined to co-design MSER for the early childhood education and care sector using the first four steps of the Intervention Mapping framework. First, a thorough needs assessment was conducted to inform a logic model of the problem and define the intervention goals. Second, outcomes, performance objectives and change objectives were outlined at individual, interpersonal and organizational levels. Third, a practical resource was developed by mapping behaviour change theories to the resource components. Finally, relevant health knowledge was translated into the materials and resources, labelled as MSER, for educators, teams and organizations. MSER strengths, limitations and future directions are discussed.

Development of a logical model for geotechnical databases

Development of a logical model for geotechnical databases

Use of implementation logic models in the Quadruple Aim QUERI: conceptualization and evolution

BackgroundImplementation strategies are essential to deliver evidence-based programs that align with local context, resources, priorities, and preferences. However, it is not always clear how specific strategies are selected (vs. others) and strategies are not always operationalized clearly, distinctly, and dynamically. Implementation logic models provide one useful way to conceptualize the role and selection of implementation strategies, plan evaluation of their intended impacts on implementation and effectiveness outcomes, and to communicate key aspects of a project.MethodsThis paper describes our initial plans, experiences, and lessons learned from applying implementation logic models in the Quadruple Aim Quality Enhancement Research Initiative (QUERI) a large multi-study program funded by the Veterans Health Administration (VA). We began with two primary implementation strategies based on our earlier work (i.e., Iterative RE-AIM and Relational Facilitation) that were applied across three different health outcomes studies.ResultsOur implementation strategies evolved over time, and new strategies were added. This evolution and reasons for changes are summarized and illustrated with the resulting logic models, both for the overall Quadruple Aim QUERI and the three specific projects. We found that implementation strategies are often not discrete, and their delivery and adaptation is dynamic and should be guided by emerging data and evolving context. Review of logic models across projects was an efficient and useful approach for understanding similarities and differences across projects.ConclusionsImplementation logic models are helpful for clarifying key objectives and issues for both study teams and implementation partners. There are challenges in logic model construction and presentation when multiple strategies are employed, and when strategies change over time. We recommend presentation of both original and periodically updated project models and provide recommendations for future use of implementation logic models.