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Medical Care Research and Review
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Using Theories of Action to Guide National Program Evaluation and Local Strategy in the Community Care Network Demonstration

Shoshanna Sofaer

Baruch College

Gloria J. Bazzoli

Virginia Commonwealth University

Jeffrey A. Alexander

University of Michigan School of Public Health

Douglas A. Conrad

Dental Public Health Services

Romana Hasnain-Wynia

Health Research and Educational Trust

Stephen M. Shortell

University of California, Berkeley

Frances Margolin

Mary Pittman

Health Research and Educational Trust

Elizabeth Casey

SRI International, Policy Division

Kala Ladenheim

National Conference of State Legislatures

D. Richard Mauery

George Washington University

Ann P. Zukoski

Oregon State University

Evaluations of multisite community-based projects are notoriously difficult to conceptualize and conduct. Projects may share an overarching vision but operate in varying contexts and pursue different initiatives. One tool that can assist evaluators facing these challenges is to developa "theory of action" (TOA) that identifies critical assumptions regarding how a program expects to achieve its goals. Community Care Network (CCN) evaluators used the TOA to refine research questions, define key variables, relate questions to each other, and identify when we might realistically expect to observe answers. In this article, the authors present their national-level CCN TOA. They also worked with sites to helpthem "surface" their local TOA; the article analyzes the results to determine the content, clarity, extent of evidence base, and strategic orientation of theories articulated by different sites.

Key Words: community health • health improvement • program evaluation • theory of action • partnership

Medical Care Research and Review, Vol. 60, No. 4 suppl, 17S-39S (2003)
DOI: 10.1177/1077558703259072
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