| Course | HLTH 5043 Evaluation of Determinants of Health |
|---|---|
| Module | Module 4 |
| Paper type | Program logic model |
| Length | 1,220 words, about 4 pages plus title and reference pages |
| Format | APA 7 student paper |
| School | American College of Education |
| Program | Master of Public Health |
| Updated | September 2026 |
Free sample paper for HLTH 5043 Module 4
From Doula Visits to First Birthdays: A Logic Model for a County Birth Equity Program, With the Evidence Behind Each Arrow
Student Name
American College of Education
HLTH5043: Evaluation of Determinants of Health
Module 4 Assignment
Instructor Name
October 26, 2026
Purpose of the Model
The previous module recommended building a logic model for the county's birth equity program together with an evaluation committee of east-side mothers, doulas and hospital staff. This paper presents the model that committee would start from. A logic model describes how a program is expected to produce its results, linking resources to activities, activities to outputs, and outputs to short-term, intermediate and long-term outcomes (W.K. Kellogg Foundation, 2004). Its value lies less in the diagram than in the reasoning behind each arrow, so for every major link the paper states the assumption it rests on and the evidence for it.
The program serves pregnant Black women living in the county's eleven east-side census tracts, where the first module found the highest infant death rates. It has three components: community doulas, group prenatal care and a postpartum safe sleep visit.
Inputs
The program's resources are both material and relational. Funding comes from a state maternal health grant and county levy, with Medicaid reimbursement for doula services now available in the state. Staffing includes six community doulas recruited from east-side neighborhoods and trained in birth support, lactation basics and system navigation; a doula coordinator; two midwives and a nurse who facilitate group prenatal care at the community hospital; and a home visiting nurse. Other inputs are clinic space for group sessions, 250 portable cribs a year, a referral agreement with the hospital's obstetric clinic, and, most important and least measurable, relationships of trust with east-side churches, the tenants' association and the WIC office, which will be the main sources of referrals.
Activities and Outputs
Each component has defined activities and countable outputs. Doulas meet each mother at least four times during pregnancy, attend the birth when possible and visit twice in the first six weeks after birth; outputs are the number of mothers enrolled, visits completed and births attended. Group prenatal care brings eight to twelve women at similar stages of pregnancy together for ten two-hour sessions that combine a clinical check with discussion of nutrition, stress, labor and infant care; outputs are groups formed, sessions held and the share of mothers attending at least seven sessions. The postpartum visit delivers a portable crib, reviews the sleep space in the family's actual home and connects the family to a pediatric provider; outputs are visits completed and cribs delivered. Across components, a shared output is the proportion of enrolled mothers who started prenatal care in the first trimester or entered care within two weeks of enrollment.
Outcomes
Short-term outcomes, expected within the pregnancy, are greater trust in care, reduced perceived stress, knowledge of warning signs, and a birth plan and safe sleep plan. Intermediate outcomes, measured at birth and in the first months, are fewer preterm births and low birth weight infants, fewer cesarean births without medical indication, higher breastfeeding initiation, consistent back sleeping in a separate safe sleep space, and completed well-child visits. The long-term outcomes are a lower infant death rate among Black infants on the east side and a narrower Black-White gap in infant mortality across the county. The long-term outcome is the reason the program exists, but the intermediate outcomes are what the program can be held to in its first years.
The Evidence Behind the Arrows
The link from group prenatal care to fewer preterm births is the best supported. In a randomized trial, women assigned to group prenatal care had a preterm birth rate of 9.8% compared with 13.8% in standard care, and among African American women the rates were 10.0% and 15.8%; group care also improved prenatal knowledge, readiness for labor, satisfaction and breastfeeding initiation (Ickovics et al., 2007).
The link from doula support to better birth outcomes rests on observational evidence. Among Medicaid beneficiaries supported by a community doula program, Kozhimannil et al. (2013) found cesarean rates of 22.3% compared with 31.5% among Medicaid births nationally, with 41% lower adjusted odds of cesarean delivery; the preterm birth rate was also lower, 6.1% compared with 7.3%, although that comparison was not adjusted. The link from reduced stress and discrimination to fewer preterm births is supported by research on chronic stress and discrimination discussed in the second module, but it is the least directly tested arrow in the model. The link from the safe sleep visit to fewer sudden unexpected infant deaths rests on the national safe sleep recommendations and on the plausible effect of removing the barrier of having no crib, rather than on a trial of crib distribution.
Dose and Reach Targets
A logic model is more useful when it says how much of each activity is needed and for how many people. The program's first-year targets are drawn from the county's birth numbers. About 1,600 babies are born each year to Black mothers living in the east-side tracts, and the program's capacity in its first year is about 250 mothers, roughly one in six. The committee chose to prioritize enrollment of mothers with a prior preterm birth, those entering care after the first trimester and those without stable housing, because they carry the highest risk and would otherwise be least likely to find the program. Dose targets follow the evidence: at least seven of ten group sessions, at least four prenatal doula visits and a postpartum visit within two weeks of birth. If fewer than 60% of enrolled mothers receive that dose, the evaluation will treat the program as under-delivered rather than ineffective. At full scale in year three, with doula caseloads stable and a second group care site, the program aims to reach about 40% of east-side Black births, the level at which its effects could plausibly show up in population rates.
Assumptions and External Factors
The model depends on assumptions that could fail. It assumes that mothers at highest risk will enroll, which requires referrals through trusted community channels rather than only the hospital clinic. It assumes that doulas can be retained, although turnover in community doula programs is often high when pay is low. It assumes that the hospital's clinicians will value group care and refer to it. And it assumes that families can use a portable crib in housing that may be crowded.
External factors outside the program's control can also shape results: changes in Medicaid eligibility or doula reimbursement, closure of obstetric units, housing costs and evictions on the east side, and broader patterns of discrimination in care. The model names these so that the evaluation can watch for them and so that the program is not judged alone for trends it cannot control.
Using the Model
The logic model will serve three purposes. For planning, it shows staff and partners how each activity is meant to contribute, and it exposes gaps, such as the need for a referral pathway through community organizations. For communication, it gives funders and the board of health a one-page account of the program's reasoning. For evaluation, it tells the team what to measure at each stage and where to look first if outcomes disappoint: at reach and dose before concluding that the program's ideas are wrong. The evaluation committee should revise the model after the first year, since experience will show which assumptions held.
References
Ickovics, J. R., Kershaw, T. S., Westdahl, C., Magriples, U., Massey, Z., Reynolds, H., & Rising, S. S. (2007). Group prenatal care and perinatal outcomes: A randomized controlled trial. Obstetrics & Gynecology, 110(2), 330-339. https://doi.org/10.1097/01.AOG.0000275284.24298.23
Kozhimannil, K. B., Hardeman, R. R., Attanasio, L. B., Blauer-Peterson, C., & O'Brien, M. (2013). Doula care, birth outcomes, and costs among Medicaid beneficiaries. American Journal of Public Health, 103(4), e113-e121. https://doi.org/10.2105/AJPH.2012.301201
W.K. Kellogg Foundation. (2004). Logic model development guide.
The HLTH 5043 Module 4 assignment instructions
In many sections, HLTH 5043 Module 4 asks you to build a logic model for a public health program. Prompts typically ask for the model's components, inputs, activities, outputs and short-term, intermediate and long-term outcomes, along with assumptions and external factors, and for a narrative explaining how the pieces connect and how the model will guide evaluation. Some versions require a diagram; others accept a table. Graders expect outcomes to follow logically from activities and to be measurable, and they reward evidence supporting the key links. Base the model on the program and determinants from your earlier modules, and see in Canvas whether a specific template is required.
How this HLTH 5043 Module 4 example is built
The model starts by stating its purpose and population and committing to test each link. Inputs are listed specifically, including relationships the program depends on. Activities are defined with their dose and content, each paired with countable outputs. Outcomes are organized by time horizon with measurable indicators, separating what the program can be held to early from its long-term goal. The core section grades the evidence behind each arrow, from a randomized trial to observational data to plausibility. Assumptions and external factors are named, and a closing section explains how the model will be used for planning, communication and evaluation, including a first-year revision once experience shows which assumptions held.
Where the points sit in the HLTH 5043 Module 4 rubric
Logic model rubrics usually reward complete components, logical flow, measurable outcomes and a supporting narrative. Graders check that outputs and outcomes are not confused and that each outcome could plausibly follow from the activities listed. They also look at whether the time frames are realistic, since infant mortality will not move in a single program year. Measurability earns points when outcomes have indicators. Evidence for the main links often separates the strongest papers, particularly when the strength of evidence is judged honestly. Naming assumptions and external factors is commonly required. A narrative explaining use for evaluation completes the core criteria, and a clear diagram or table with APA 7 formatting finishes the rubric.
HLTH 5043 Module 4 help from the desk
Logic models most often lose points when outcomes are vague, such as improved health, or when outputs are listed as outcomes. Another common problem is a model with no evidence behind its arrows, which makes it a wish list. Students also leave out assumptions, so the model cannot explain a disappointing result. Give each outcome an indicator. Put a number on each output. Rate the evidence for your key links. Name at least three assumptions and say how you would know if one failed. Tobacco cessation, school nutrition and vaccination programs can be modeled the same way; list the program's parts, add the instructions, and a Module 4 logic model can be sketched with you around them.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official American College of Education document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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HLTH 5043 Module 4 questions, answered
What does HLTH5043 Module 4 usually ask for?
In many sections, the fourth HLTH5043 module asks you to build a logic model for a public health program, with inputs, activities, outputs, outcomes, assumptions and external factors, and to explain how it will guide evaluation. The program is usually the one you have followed through the course.
What is the difference between outputs and outcomes?
Outputs are the direct products of activities, such as sessions held or cribs delivered; outcomes are the changes that follow in people or conditions, such as fewer preterm births.
Does group prenatal care reduce preterm birth?
In a randomized trial, women assigned to group prenatal care had fewer preterm births than those in standard care, with a larger difference among African American women.
Where can I find a free HLTH 5043 Module 4 sample paper?
The complete Module 4 logic model for a county birth equity program is on this page, with inputs, activities, outputs, outcomes, assumptions and the evidence behind each link.
Why include assumptions in a logic model?
Because every link rests on beliefs about how change happens. Naming them lets the evaluation test them and explains results if the program falls short.