Health Education Programme Evaluation: A Theory of Change Analysis of Community HIV Prevention Initiatives in Lagos State

Theory of change frameworks provide a systematic approach to evaluating whether community health education programmes are achieving their intended short-term, medium-term, and long-term outcomes. This study applied theory of change analysis to evaluate community HIV prevention health education initiatives in Lagos State, South West Nigeria. A mixed methods evaluation design was employed, drawing on programme documentation from eight non-governmental organisations implementing HIV prevention education in Alimosho, Ajeromi-Ifelodun, and Ikorodu local government areas. In-depth interviews were conducted with 18 programme managers and health educators, supplemented by a cross-sectional survey of 260 programme beneficiaries. Qualitative content analysis and descriptive statistics were applied. Results showed that programmes with well-articulated theory of change logic demonstrated stronger causal alignment between activities, outputs, outcomes, and impact compared to those without. However, outcomes related to structural determinants such as economic empowerment and gender equality were rarely addressed. Most programmes demonstrated evidence of improved HIV knowledge and condom use, but longer-term impacts on HIV incidence remained unmeasured. The study recommends adoption of theory of change as a standard planning and evaluation tool in HIV prevention health education across Lagos State. Keywords: theory of change, HIV prevention, health education evaluation, Lagos State, programme evaluation