Program Logic Model Research Articles

Evaluating health system resilience testing; what makes this practice successful?

Abstract Issue Health system resilience is an important and desirable attribute of health systems. We have evaluated the operationalization of our step-by-step guide for conducting a resilience test. Description of the problem Preparedness planning is often siloed and does not take the entire health system into account. The objective was to develop a new methodology for policy making that is adaptable to any health system context and shock scenario. Resilience testing uses a mixed-method approach to assess resilience by understanding health system strengths and weaknesses in relation to a hypothetical shock scenario. A programme logic model, semi-structured interviews and an online questionnaire were used to evaluate the methodology and to answer the following questions: Can resilience tests be used to identify strengths and weaknesses in different health system contexts? What are the determinants for successful resilience testing? Results Three resilience tests were conducted in Finland, Greece and the Asturias region of Spain. All resilience tests identified health system strengths and weaknesses. 97% of participants agreed that the test identified broader vulnerabilities. However, 76% thought that a different scenario would identify different strengths and vulnerabilities. 94% of participants agreed or strongly agreed that the test was a valuable exercise. The semi-structured interviews consistently found that successful resilience testing requires neutral facilitation and carefully selected test participants. Lessons Resilience test results have been used in 2 out of 3 cases to develop health policy. Resilience testing needs to be initiated and supported by the ministry of health to ensure results are considered in the policy making process. Key messages • Health system resilience tests can identify health system strengths, weaknesses, and steps towards remedial policy action to improve resilience in different European health system contexts. • Successful health system resilience testing requires carefully selected facilitators and test participants as well as support from the Ministry of Health.

A public health/hospital partnership to improve Emergency Department transitions of care for vulnerable older adults.

Community-dwelling older adults are at high risk for unmet social service needs. We describe a novel partnership embedding county services case managers in the Emergency Department (ED) to connect older adults to community services alongside their medical care. Setting: A medium-sized urban ED with 55,000 patient visits a year. Case managers from the Franklin County, Ohio Office on Aging (OA) were embedded within the ED. The OA team worked with the ED social work team to identify community-dwelling older patients, perform an in-person intake assessment, and initiate needed community services (including home-delivered meals, emergency response systems, house repairs, and transportation). Program logic model and development are reported in detail. From June to December 2023, there were 7284 ED visits for adults ≥60 years old. Referrals to the OA case manager ranged from 1 to 13 per day. The OA case managers performed 252 full intake assessments on unique patients. The population was 51% men. Only 11% (n = 28) were currently connected to OA services, and of those already connected 29% (n = 8) needed increased services. Of the remaining unconnected patients (n = 224), 8% (n = 20) were not county residents and the OA team connected them with other county OAs. Half 53% (n = 120) were accepting of services and had services from the OA or other community health programs initiated during the ED visit. The OA team made three new Adult Protective Services referrals and one referral to the long-term care ombudsman. The program did not increase ED length of stay or hospital admission rates. Embedding county service enrollment within a community ED is a cost neutral intervention that reached a population without previous services. Future plans include expansion of the program and evaluation of the program's ability to detect elder mistreatment and self-neglect.

Effectiveness of Short-term Study Abroad Programs: Employing a Program Logic Model and Fuzzy-set Qualitative Comparative Analysis of Participants' Growth Narratives

Effectiveness of Short-term Study Abroad Programs: Employing a Program Logic Model and Fuzzy-set Qualitative Comparative Analysis of Participants' Growth Narratives

Youth-led community street sport in practice: balancing programme intentions and peer leadership

ABSTRACT Peer-led sport programmes can provide supportive social relations and opportunities for role modelling and identification. These features can support the inclusion of groups who usually do not participate in sport activities and provide an environment that fosters personal and social development. However, it is important to assess the implementation of peer-led activities to understand whether such potentials are fulfilled. Therefore, we investigated the quality of delivery of peer-led street sport activities implemented by the street sport organisation GAME. The study combined quantitative and qualitative observations. Peer leader practices were assessed quantitatively with 40 observation items scored on a Likert scale. In addition, qualitative observations could be noted on the observation form. We conducted 49 observations at 15 different peer-led street sport activities delivered in low-resource neighbourhoods. We compared peer leader practices with the intentions of the programme as described in the programme logic model and explored influences on delivery in the physical and social setting. Quantitative data showed that pedagogical competencies (‘role modelling’, ‘body language’ and ‘conflict management’) scored highest for quality of delivery. Sport instruction elements, particularly the categories ‘technique’ and ‘instruction’, scored lower. The qualitative analysis suggested that programme features and structure as well as the (mostly outdoor) community setting influenced the possibility of peer leaders for implementing the programme as intended. Peer leaders were often observed to function as role models, mostly in a prosocial manner, although role modelling was also observed to not support programme intentions. The study provided insight into some of the challenges in and potentials inherent to peer-led sport activities in the setting of low-resource neighbourhoods where youth peer leaders are responsible for implementation.

Improving dementia and palliative care through the co-design of an integrated model of care.

A need exists to improve end-of-life care for people with advanced dementia, by integrating available services. Stakeholders on the Central Coast of New South Wales united to co-design an improved model of care that would integrate care across care settings. The aim of this project was to co-design a model of integrated, person-centred palliative care for people with dementia at the end of life. This case study describes seven co-design workshops which took place in 2023 to develop a program logic model. Workshops were run in a hybrid format, with stakeholders attending in person and online. Workshops were attended by an average of 26 stakeholders including people and carers with lived experience of dementia, healthcare workers from hospital and community-based services (public and private), primary care clinicians, and participants from the not-for-profit sector and academia. Stakeholders developed a shared mission and purpose and identified priority areas for improving palliative care for people with advanced dementia. This led to the development of a program logic model, which included components relating to education for people with dementia, carers, and professionals, care coordination and referrals, and regular multidisciplinary case conferences. Feedback on the model from a new audience identified areas for improvement. The stakeholder group participated in a survey to evaluate the effectiveness of the co-design. The survey found that stakeholders were satisfied with the model of care the group developed. This project highlighted the value of adopting a co-design approach with stakeholders to develop a new model of care.

Development of a new social prescribing intervention for families of children with cerebral palsy.

To co-design a social prescribing intervention (the EPIC-CP programme: Equitable Pathways and Integrated Care in Cerebral Palsy) with children with cerebral palsy (CP), their families, and clinicians to address unmet social needs. The study was conducted (August 2021 to March 2023) at the paediatric rehabilitation departments of the three tertiary paediatric hospitals in New South Wales, Australia. Eligible participants attended or worked at one of the departments, including children with CP, parents/caregivers, and clinicians. Mixed-methods co-design was used in intervention co-production and prototyping. The project was overseen by research advisors with lived experience of CP. More than 200 participants contributed to the co-design research. Families experienced a substantial burden of unmet social needs. Co-designed interventions involved systematic identification of unmet social needs with (1) targeted community resources and (2) engagement with a 'community linker' who supported children/young people and their families to access health, education, and social services that matched their identified needs and preferences. Research participants co-developed the programme logic model and prototype. This was piloted in research action cycles and iteratively refined until consensus was achieved. We co-designed a social prescribing programme responsive to the needs of its end-users and purposefully developed to be embedded in the Australian health setting. A pilot randomized controlled trial will further evaluate this intervention.

Implementing absolute cardiovascular disease risk assessment into pathology collection services.

Pathology services represent an ideal setting to integrate absolute cardiovascular disease (CVD) risk estimation when patients attend for routine cholesterol testing. This study aimed to explore the process of implementing CVD risk estimation into point-of-care service delivery by pathology staff to inform future implementation and sustainability. A new service for CVD risk estimation via a self-directed screening station was implemented into 14 pathology service sites across Tasmania, Australia. Before implementation, observations at pathology services (n = 26) and semi-structured interviews were undertaken with 26 pathology staff (88% female, 77% aged 41-60 years) to identify factors that could impact implementation of the service. The process of implementation was then evaluated using participant observations and clinical trial recruitment data. Transcripts and field notes were analysed thematically according to the Medical Research Council Framework and used to develop a programme logic model to understand how the service could be adapted to be successfully integrated into routine workflow at pathology services. Eight key themes were identified during the pre-implementation phase as important factors that could impact upon integration of CVD risk estimation into pathology services. Themes related to factors within the organisation, including available resources, logistics and workflow, as well as having sufficient time to complete the intervention. Additional factors related to the individual motivations of staff, collaborative leadership and patient characteristics. Success of implementation varied among sites, requiring the trialling of different strategies to support uptake of the service and patient recruitment. Implementing CVD risk estimation into point-of-care pathology services required an understanding of the core implementation components specific to each context, and for implementation strategies to be targeted to the individual and organisational contexts. The generated programme logic model may be useful in guiding future implementation endeavours within these services and aiding the selection of apt implementation strategies. ClinicalTrials.gov Identifier: NCT04896021, registered 19/05/2021, https://clinicaltrials.gov/study/NCT04896021.

A Web-Based Tool to Assess Social Inclusion and Support Care Planning in Mental Health Supported Accommodation: Development and Preliminary Test Study.

Individuals with severe mental illness living in supported accommodation are often socially excluded. Social inclusion is an important aspect of recovery-based practice and quality of life. The Social Inclusion Questionnaire User Experience (SInQUE) is a measure of social inclusion that has been validated for use with people with mental health problems. Previous research has suggested that the SInQUE could also help support care planning focused on enabling social inclusion in routine mental health practice. This study aims to develop a web-based version of the SInQUE for use in mental health supported accommodation services, examine its acceptability and perceived usefulness as a tool to support care planning with service users, determine the extent of uptake of the tool in supported accommodation settings, and develop a program theory and logic model for the online SInQUE. This study involved a laboratory-testing stage to assess the acceptability of the SInQUE tool through "think-aloud" testing with 6 supported accommodation staff members and a field-testing stage to assess the acceptability, utility, and use of the SInQUE tool over a 5-month period. An implementation strategy was used in 1 London borough to encourage the use of the SInQUE. Qualitative interviews with 12 service users and 12 staff members who used the tool were conducted and analyzed using thematic analysis. The use of the SInQUE was compared with that in 2 other local authority areas, 1 urban and 1 rural, where the tool was made available for use but no implementation strategy was used. Overall, 17 staff members used the SInQUE with 28 different service users during the implementation period (approximately 10% of all service users living in supported accommodation in the study area). The staff and service users interviewed felt that the SInQUE was collaborative, comprehensive, user-friendly, and relevant. Although some staff were concerned that particular questions might be too personal, service users did not echo this view. Participants generally felt that the SInQUE could help identify individuals' priorities regarding different aspects of social inclusion by prompting in-depth conversations and tailoring specific support to address service users' inclusion goals. Some interviewees also suggested that the tool could highlight areas of unmet or unmeetable needs across the borough that could feed into service planning. The SInQUE was not used in the comparison areas that had no implementation strategy. The online SInQUE is an acceptable and potentially useful tool that can be recommended to assess and support care planning to enable social inclusion of people living in mental health supported accommodation services. Despite this, uptake rates were modest during the study period. A concerted implementation strategy is key to embedding its use in usual care, including proactive endorsement by senior leaders and service managers.

The impact of a regionally based translational cancer research collaborative in Australia using the FAIT methodology

BackgroundTranslating research, achieving impact, and assessing impact are important aspirations for all research collaboratives but can prove challenging. The Hunter Cancer Research Alliance (HCRA) was funded from 2014 to 2021 to enhance capacity and productivity in cancer research in a regional centre in Australia. This study aimed to assess the impact and benefit of the HCRA to help inform future research investments of this type.MethodThe Framework to Assess the Impact from Translational health research (FAIT) was selected as the preferred methodology. FAIT incorporates three validated methodologies for assessing impact: 1) Modified Payback; 2) Economic Analysis; and 3) Narrative overview and case studies. All three FAIT methods are underpinned by a Program Logic Model. Data were collected from HCRA and the University of Newcastle administrative records, directly from HCRA members, and website searches.ResultsIn addition to advancing knowledge and providing capacity building support to members via grants, fellowships, scholarships, training, events and targeted translation support, key impacts of HCRA-member research teams included: (i) the establishment of a regional biobank that has distributed over 13,600 samples and became largely self-sustaining; (ii) conservatively leveraging $43.8 M (s.a.$20.5 M - $160.5 M) in funding and support from the initial $9.7 M investment; (iii) contributing to clinical practice guidelines and securing a patent for identification of stem cells for endometrial cell regeneration; (iv) shifting the treatment paradigm for all tumour types that rely on nerve cell innervation, (v) development and implementation of the world’s first real-time patient treatment verification system (Watchdog); (vi) inventing the effective ‘EAT’ psychological intervention to improve nutrition and outcomes in people experiencing radiotherapy for head and neck cancer; (vi) developing effective interventions to reduce smoking rates among priority groups, currently being rolled out to disadvantaged populations in NSW; and (vii) establishing a Consumer Advisory Panel and Consumer Engagement Committee to increase consumer involvement in research.ConclusionUsing FAIT methodology, we have demonstrated the significant impact and downstream benefits that can be achieved by the provision of infrastructure-type funding to regional and rural research collaboratives to help address inequities in research activity and health outcomes and demonstrates a positive return on investment.

Designing an accessible and equitable conference and the evaluation of the barriers to research inclusion for rare disease communities

Introduction: The United Kingdom Rare Diseases Framework, published in 2021, addresses the lack of diversity in rare disease research, particularly in clinical trials, due to intersecting issues related to rare disease symptoms and health inequalities. The framework outlines the government's commitment to improving the lives of the 3.5 million people living with rare conditions in the United Kingdom.Objective: The primary objective is to advance equality, diversity, and inclusion in research by developing innovative methods to engage with communities, establish trust, and enhance the participation and voices of underrepresented and underserved communities.Methods: The conference was held in May 2023, bringing together voices with lived experiences from rare and diverse communities to meet and discuss with established researchers, policy influencers and advocates. The evaluation design was developed using the Program Logic Model and utilised a conference evaluation form on barriers to inclusion.Results: The Rare Disease Community identifies disability as the primary obstacle to inclusion. Social Care and Public Health Communities and Clinical Research Communities identified a need for more cultural competency. The Diverse Community selected psychosocial issues, and the Academic Community identified funding as the most significant barrier.Conclusions: The Community of Practice workshops showed the variety of lived experiences and potential barriers people confront for inclusion in research. Listening to individual viewpoints was crucial to creating or repairing community trust. The Academic Community felt that research funders and ethics review boards must adapt their institutional practices to include financial resources for outreach and participation in research design.

What impact has the Centre of Research Excellence in Digestive Health made in the field of gastrointestinal health in Australia and internationally? Study protocol for impact evaluation using the FAIT framework

IntroductionThe need for public research funding to be more accountable and demonstrate impact beyond typical academic outputs is increasing. This is particularly challenging and the science behind this form of...

Conceptualizing Educational Comparability in Distributed Health Professions Education: A Scoping Review.

This study aimed to create greater clarity about the current understanding and formulate a model of how educational comparability has been used in the literature to inform practice. The authors conducted a literature search of 9 online databases, seeking articles published on comparability in distributed settings in health professions education before August 2021, with an updated search conducted in May 2023. Using a structured scoping review approach, 2 reviewers independently screened articles for eligibility with inclusion criteria and extracted key data. All authors participated in the descriptive analysis of the extracted data. Twenty-four articles published between 1987 and 2021 met the inclusion criteria. Most articles were focused on medical education programs (n = 21) and located in North America (n = 18). The main rationale for discussing comparability was accreditation. These articles did not offer definitions or discussions about what comparability means. The program logic model was used as an organizing framework to synthesize the literature on practices that schools undertake to facilitate and demonstrate comparability in the design (inputs), implementation (activities), and evaluation (outcomes) of distributed education. Inputs include common learning objectives, identical assessment tools and policies, governance models that enable clear communication, and reporting structure that is supported by technological infrastructure. Activities include faculty planning meetings and faculty development training. Outcomes include student experiences and academic performances. This study demonstrated that a more complex understanding of the dynamics of educational processes and practices is required to better guide the practice of educational comparability within distributed education programs. In addition to highlighting the need to develop an accepted definition of educational comparability, further elucidation of the underlying dynamics among input, activities, and outcomes would help to better determine what drivers should be prioritized when considering educational change with attention to context within distributed education.

Expanding Outcomes in Cancer Screening Safety Net Programs: Promoting Sustainability and Policy Reform.

Community-engaged patient navigation safety net programs are established as an evidence-based approach to address cancer prevention and early detection efforts, but barriers to expand and sustain such programs persist. In addition, few studies describe how these programs impact buy-in among communities and policy change within health care systems and government. We describe how we used the Capacity for Sustainability Framework to guide efforts for program sustainability and community, institutional, and policy level change in a breast cancer screening and patient navigation safety net program. The nine domains of the Capacity for Sustainability Framework were used to develop program logic models, to inform program implementation and quality improvement agendas, and to guide multi-level partner and stakeholder engagement, outreach, and dissemination of outcomes. The program is currently in its seventh year and continues to be annually funded by a city public health department. In 2021, additional 5-year renewable funding from a state public health department was secured. In addition, institutional program support was expanded for patients diagnosed with breast cancer. Program leaders worked with policymakers to draft legislation to support training certification and third-payor reimbursement for patient navigators and community health workers. The program is well-known and trusted among community members, community-based organizations, and providers. Community, organizational, and policy-level outcomes demonstrate that community-engaged patient navigation safety net programs can influence more than individual and interpersonal outcomes and can be sustained over time.

How did New Zealand’s regional District Health Board groupings work to improve service integration and health outcomes: a realist evaluation

ObjectivesIn Aotearoa New Zealand (NZ), integration across the healthcare continuum has been a key approach to strengthening the health system and improving health outcomes. A key example has been four...

Three-Year Program Evaluation of a University-Public School Collaborative Partnership.

This clinical focus article reports on an innovative program that provides classroom-based speech and language services to school children receiving speech-language therapy while addressing the need for clinical placements for graduate students in speech-language pathology. This program evaluation report centers around the logic model used to develop and implement the program. The program was implemented in partnership between a university program in speech-language pathology and a nearby school district. The program took place in two different schools within the district, each with one state licensed and American Speech-Language-Hearing Association-certified speech-language pathologist (SLP) who supervised two or three graduate student interns per year of the project for a total of 17 graduate students over 3 years. Data sources for this program evaluation included child-level data collected by graduate student interns, teacher satisfaction surveys, and semistructured interviews. Program stakeholders including graduate student interns, speech-language pathology supervisors, and the school district administrator provided converging positive feedback about the program implementation. This was corroborated by favorable ratings from teachers who collaborated with graduate student interns and an increase in the number of classroom-based intervention hours for school children receiving speech-language services. The short-, medium-, and long-term outcomes of the program's logic model were achieved in part or fully as supported by data sources used for program evaluation procedures. Clinical implications are provided about the need for innovation in school-based services with a focus on collaborative classroom-based intervention.

Enhancing Food Literacy and Food Security through School Gardening in Rural and Regional Communities.

A qualitative case study approach with in-depth, semi-structured interviews of key school staff, and student feedback was used to assess a school kitchen and garden program in the regional area of North-West Tasmania, Australia. A detailed program description was produced to conduct a realist evaluation with a Context-Mechanism-Outcome configuration, followed by a program theory evaluation through the construction of a retrospective program logic model. Dedicated kitchen and garden spaces, knowledgeable teachers committed to the program, provision of sufficient materials and consumables, and support from the school and community were found to be the basic requirements to establish a program. Additionally, it is essential to integrate both the kitchen and garden teaching components into the school curriculum. The positive outcomes (e.g., engagement, participation, knowledge, skills, behavioral change) of the program were dependent on the underlying factors, including dedicated support of school leadership, teaching staff, and the parent body for effective student engagement in the teaching spaces and for wider engagement from families and the community. The students' feedback provided supporting evidence of increased food literacy with improvements in their understanding, abilities, and attitudes towards gardening, producing healthy food, and preparing food. This may further lead to enhanced food security for students' families and the broader community.

Program logic model and impacts perceived by stakeholders in a post-school transition program for autistic young adults

BackgroundAutistic young adults frequently experience challenges in their transition to adulthood. Despite the available research base describing isolated transition practices, efforts to document comprehensive programs combining multiple components in community settings are scant. This study aimed to explore stakeholders’ experience of a post-school transition program, including their perceived program components, processes, and impacts that contributed to the program success. MethodWe conducted individual qualitative interviews with 17 program stakeholders, including autistic students, parents, mentors, community collaborators, and program staff. Findings were used to create a logic model that describes how various program components and processes effect changes in autistic youths and their parents. ResultsResults revealed that the program values are focused on student-led participation, a strength-based approach, individualization and customization, and professional development. Program activities holistically fostered development in the autistic youth through processes of imparting career-related knowledge, facilitating ecologically relevant practice, and providing supportive peers and environment. Stakeholders described heightened sense of self-awareness, self-esteem, independence, social competence, and preparedness for the future in autistic young adults, while parents also gained the trust and confidence in fostering autonomy in their adult children. ConclusionsTransition program that integrates multiple components and processes informed by the evidence-based literature can facilitate career construction and development in autistic youth. Program model developed based on stakeholders’ input can offer rich information about how a program works in a naturalistic context, which can support future program adaptaion and replication to meet the needs of diverse communities and settings.

Telephone outreach by volunteer navigators: a theory-based evaluation of an intervention to improve access to appropriate primary care

BackgroundA pilot intervention in a participatory research programme in Québec, Canada, used telephone outreach by volunteer patient navigators to help unattached persons from deprived neighbourhoods attach successfully to a family doctor newly-assigned to them from a centralized waiting list. According to our theory-based program logic model we evaluated the extent to which the volunteer navigator outreach helped patients reach and engage with their newly-assigned primary care team, have a positive healthcare experience, develop an enduring doctor-patient relationship, and reduce forgone care and emergency room use.MethodFor the mixed-method evaluation, indicators were developed for all domains in the logic model and measured in a telephone-administered patient survey at baseline and three months later to determine if there was a significant difference. Interviews with a subsample of 13 survey respondents explored the mechanisms and nuances of intended effects.ResultsFive active volunteers provided the service to 108 persons, of whom 60 agreed to participate in the evaluation. All surveyed participants attended the first visit, where 90% attached successfully to the new doctor. Indicators of abilities to access healthcare increased statistically significantly as did ability to explain health needs to professionals. The telephone outreach predisposed patients to have a positive first visit and have trust in their new care team, establishing a basis for an enduring relationship. Patient-reported access difficulties, forgone care and use of hospital emergency rooms decreased dramatically after patients attached to their new doctors.ConclusionsAs per the logic model, telephone outreach by volunteer navigators significantly increased patients’ abilities to seek, reach and engage with care and helped them attach successfully to newly-assigned family doctors. This light-touch intervention may have promise to achieve of the intended policy goals for the centralized waiting list to increase population access to appropriate primary care and reduce forgone care.

Opportunities and challenges of trilateral South‒South cooperation for transforming development assistance for health: evidence from a DRC–UNICEF–China maternal, newborn, and child health project

BackgroundTrilateral South‒South cooperation is envisioned as an equal and empowering partnership model but still faces certain challenges. This study addresses whether and how trilateral South‒South cooperation can transform traditional development assistance for health (DAH) and explores the opportunities and challenges of trilateral South‒South cooperation for transforming future DAH, in the theme of “the emerging development partner’s DAH transformation facilitated by a multilateral organization”.MethodsWe evaluate a maternal, newborn, and child health (MNCH) project involving the Democratic Republic of Congo (DRC), the United Nations Children’s Fund (UNICEF), and China (hereinafter referred to as the “DRC–UNICEF–China project”). We analyze data from project documents and seventeen semi-structured interviews using a pragmatic analytical framework based on the DAH program logic model and the OECD’s trilateral cooperation framework.ResultsEvidence from the DRC–UNICEF–China MNCH project suggests that trilateral South‒South cooperation facilitated by a multilateral organization can provide transformative opportunities for emerging development partners’ DAH to generate and deliver context-based, demand-oriented solutions, harmonize rules and procedures, institutionalize mutual learning and knowledge sharing, and increase the visibility of emerging development partners as sources for South‒South development experience transfer. However, the project revealed some challenges, including the neglect of key stakeholders in the complex governance structure, the high transaction costs needed to ensure transparency, and the harm local absence of the emerging development partner poses to long-term DAH engagement.ConclusionsThis study echoes some of the findings in trilateral SSC literature that claim power structures and philanthropic, normative justification for health equity are often juxtaposed in trilateral SSC partnerships. The opportunities offered by the DRC–UNICEF–China project align with China’s cognitive learning process for strengthening international engagement and global image building. However, challenges may arise as a result of complex governance structures and the entrustment of facilitating partners, which can threaten the effectiveness of trilateral cooperation. We call for strengthening the beneficiary partner’s ownership at all levels, engaging the emerging development partner to better understand the beneficiary partner’s local context(s) and needs, and ensuring available resources to support programmatic activities and long-term partnerships for the health and well-being of the beneficiaries.

Not Just a Free Lunch a logic model and evidence review for the Ka Ora, Ka Ako | Healthy School Lunch programme

Ka Ora, Ka Ako provides free, healthy lunches for 220,000 learners in low-equity New Zealand schools. Costing over $260 million annually, it represents the largest government investment in child nutrition in generations. Early evaluations indicate success in achieving programme aims of delivering nutritious food, improving learners’ wellbeing, and easing financial stress for families. However, international evidence and emerging local data indicate the programme can achieve the above and more. This article presents a programme logic model drawing on local data and a review of relevant international literature on universal school food provision with the aim of identifying potential long-term outcomes and impacts at multiple levels: for learners, wh`ānau, schools, communities, and food systems. Findings indicate that the Ka Ora, Ka Ako programme has the potential to:• improve children’s nutrition and educational outcomes, as well as improve child and wh`ānau food security;• enrich school learning environments; • boost local economies (through creation of jobs paying a living wage) and enhance local foodscapes (including availability and affordability of healthy foods) through food system engagement in schools, with whänau and communities; and• increase food system resilience (e.g., shorter supply chains and relationship building), and encourage broader food system transformation (e.g., reformulation, waste and packaging solutions) with leverage from new procurement models.While Ka Ora, Ka Ako can contribute to these pathways, some implementation areas within the programme demand further attention to achieve optimal results. Recognised areas for improvement include ensuring high quality of food, providing more avenues for engagement from children and parents, addressing perceived challenges to integrate Ka Ora, Ka Ako effectively with mātauranga Māori, and improving waste management. Given the high potential for Ka Ora, Ka Ako to contribute to multiple beneficial outcomes, continued investment and expansion of the programme is warranted.