Community Health Improvement Toolkit

Community Health Improvement Toolkit
The Tools
A wide array of factors can influence a community’s health and many entities in the community share responsibility for maintaining and improving its health. The Healthy Wisconsin Leadership Institute designed these practical planning tools to be used by community coalitions and workgroups as they work to address complex community health problems. By completing all of the tools contained in this kit, your coalition will be prepared to select future interventions to address a community health problem and begin immediately to implement and evaluate a specific intervention. The tools can be adapted and modified to meet each community’s needs. Steps can be repeated and need not be sequential.

Using the Community Facilitated Logic ModelAn adaptation of “The Tearless Logic Model”

Materials needed:
• Flip charts
• Magic markers
• Blue painters’ tape

Example: Complete Streets Logic Model

Target Pop / Inputs / Activities / Outputs / Short Term Outcomes / Intermediate Outcomes / Long Term Outcomes / Anticipated Impacts
Schools
Community
Families
Youth
Policy Makers
Businesses
Community Org
Retailers
Transportation Planners / Coalition
Money
Partners
Research
Time
Volunteers
Materials
Equipment
Technology
Staff
Political Influence / Grassroots campaign to gain local support for policy from community, key stakeholders
Research similar policies; develop model policy
Secure a sponsor for the policy
Develop fact sheets and talking points based on core message
Identify potential key stakeholders who might support or oppose proposed policy-both government decision-makers (county board) and others (e.g., local businesses, non-profits)
Engage stakeholders and raise awareness of Complete Streets through educational sessions and stakeholder meetings
Hold community media event
Conduct social media campaign
Present at county board meeting/s / # of related media hits
# of marketing/comm. materials created
# of endorsements for Complete Streets
Implementation feasibility/affordability study
Built Environment Task Force/ Implementation committees created
Model Complete Streets policy developed / Increased awareness of the need for safe physical activity options
Community and political support for Complete Streets policy / Complete Streets policy enacted:
% of new roads with sidewalks
% of new roads with bike lanes
% of new roads with both sidewalks and bike lanes
Increased use of walking trails and bike lanes
Increased feeling
of safety when
walking/riding
bike in
community / Population level
improvements in overall physical activity
habits
Improvements are equitably
distributed
across population
subgroups,
particularly those at greatest risk
Policy is cost effective / All Badger County residents have safe access to physical activity, are of healthy weight, and physically active
Target Pop / Inputs / Activities / Outputs / Short Term Outcomes / Intermediate Outcomes / Long Term Outcomes / Anticipated Impacts

Introduction to Root Cause Analysis

Community health problems are complex. They have many dimensions and their solutions are not clear-cut. The causes of community health problems are multi-dimensional, meaning that one agency cannot deal with them independently. These problems require a systems perspective and multi-faceted approaches.

Identifying effective solutions to a problem means understanding what the real causes of that problem are. Root cause analysis is a method aimed at identifying factors that contribute to problems or events. There are several ways to conduct a root cause analysis, but all are based on the premise that problems are best solved by attempting to correct or eliminate root causes as opposed to merely addressing the immediately obvious symptoms. Taking action without first doing a root cause analysis can lead to misdirected efforts and a waste of time and resources.

Before beginning a root cause analysis, you should complete a community health assessment and identify the problem that you want to address. Next you need to closely examine the problem and think about its primary causes. There are many tools available to help you work through a root cause analysis. In this toolkit, we offer The Affinity Diagram. This tool encourages broad thinking, allows all perspectives to be shared equally, and assures that everyone has a voice in the process, making it a good fit for the collaborative nature of the work.

Materials needed:

Flip charts or wall space (large blank work surface)

• Magic markers

• Sticky notes

Figure 2: Wisconsin Population Health Fellow Katherine Vaughn-Jehring organizes ideas produced

during an affinity process

Using the Intervention Planning Matrix:

Consider the range of possible approaches and fill in interventions that could be utilized to address the identified health issue at the individual, organization/institution, and community levels. It may be useful to use a tool like What Works for Health in Wisconsin ( to identify evidence-based strategies. Some approaches may fit into more than one box. Just decide where it fits best. Not every box needs to be filled out. An example is below and a blank tool follows.

APPROACHES / SPHERES OF INFLUENCE
TOPIC: Obesity (poor nutrition and lack of physical activity)
Individuals, Families, Social Networks / Organizations & Institutions / Community (neighborhoods, municipalities, counties or state)
Programs
Activities focused on increasing knowledge about health issues and/or promoting healthy behaviors or conditions. /

Food tastings (fruit and veggies)
Healthy cooking classes

School fruit and vegetable gardens
Worksite wellness programs
Walking school bus

10,000 step competitions

Systems Change
Change that impacts social norms of an organization, institution, or system; may include a policy or environmental change strategy. Policies are often the driving force behind systems change. /

Healthy foods at catered events
Healthy menu alternatives at restaurants

Media campaigns re: increase in physical activity

Environmental Change
Physical aspects of the environment that support healthy or discourage unhealthy behaviors and conditions. /

Television-free households

Point- of-decision prompts
Healthy vending options

Walking and biking trails
Community gardens

Policy
Policies, rules, ordinances and laws that support healthy practices, actions and behaviors. /

Sugar-sweetened beverage tax
Home junk food ban

Safe Routes to School
Physical activity requirements for schools/childcare centers
Nutrition standards for schools
Competitive pricing for health options in worksite cafeterias

Complete Streets
Joint use agreements for community use of school gyms/other rec facilities
EBT at farmer’s markets
Sugar-sweetened beverage tax

APPROACHES / SPHERES OF INFLUENCE
Individuals, Families, Social Networks / Organizations & Institutions / Community (neighborhoods, municipalities, counties or state)
Programs
Activities focused on increasing knowledge about health issues and/or promoting healthy behaviors or conditions.
Systems Change
Change that impacts social norms of an organization, institution, or system; may include a policy or environmental change strategy. Policies are often the driving force behind systems change.
Environmental Change
Physical aspects of the environment that support healthy or discourage unhealthy behaviors and conditions.
Policy
Policies, rules, ordinances and laws that support healthy practices, actions and behaviors.

Using the Action Plan:

Now that you have identified and selected an intervention to address the community health problem, you are ready to create a detailed plan that clearly describes the intervention and what you hope to accomplish. The action plan is expressed in terms of goals, objectives, and activities with expected results. It includes a target date for each activity, a description of key resources needed, and establishes accountabilities. A carefully designed and well-written action plan provides a solid basis for project evaluation.

The following provides step-by-step instructions for use of the template.

1. Goal statement

Begin with your goal. This is a broad statement of what you hope to accomplish and your approach. The statement includes two parts; a “to” and a “by or through” phrase. The “to” portion refers to what you hope to accomplish and the “by or through” phrase summarizes the approach you will take to accomplish the goal.

Example:To decrease the percentage of Badger County residents who are overweight or obese

by increasing physical activity options and healthier food choices.

2. Objectives

Next, write your objectives. These are specific and measurable end-products of the intervention often expressed in terms of changes in behavior, norms, knowledge, attitudes, capacities, or conditions. You might have one or multiple objectives outlined for your goal. Always make sure that your objectives are SMART:

Specific, Measurable, Attainable, Realistic, Timed

Example 1:By March 30, Badger High School will adopt a healthier vending policy, with 100% of options meeting adopted nutritional standards.

Example 2: By May 15, Badger County Board will adopt a “Complete Streets” policy that integrates sidewalks, bike lanes, transit amenities, and safe crossings into the initial design of all county projects.

3. Indicators

Next, jot down what you might measure to determine whether or not changes have occurred. This step serves as a quick check to assure that your objectives are truly measurable.

Healthier Vending Policy Example:

•Policy with nutritional standards is in place.

•Inventory of snack items in vending machines

•% of snack items meeting adapted nutritional standards

•Vending company sales reports

Complete Streets Policy Example:

•Complete Streets policy in place

•Number of projects that included multimodal transit in planning

•Miles of increased multimodal roads

4. Communication Needs

Then, record the communication target/s you need to reach to achieve your objective, the approach/es you will use to reach them, and the purpose of the communication. In the next step (step 5) you will include these communication activities in the activity column of the action plan template.

Healthier Vending Policy Example:

•Target: school principal; Purpose: enlist support for new policy; Approach: in-personmeeting

•Target: community members; Purpose: raise awareness of new policy and coalition’s related work; Approach: local media event, social media messaging

Complete Streets Policy Example:

•Target: community members; Purpose: raise awareness of need for complete streets policy and coalition’s related work; Approach: local media event, social media messaging

•Target: county board members; Purpose: enlist support for Complete Streets policy; Approach: presentation/s to county board

5. Activities

Now, outline the steps you will take to achieve each objective. The activities are the “how” portion of the action plan. It is best to arrange activities chronologically by start dates. Place each activity in a separate row and add as many rows as you need to the template.

Healthier Vending Policy Example:

•Develop nutritional standards for vending machines

•Develop fact sheets and talking points based on core message

•Meet with school principal to engage cooperation and support

•Enlist students to help plan and implement intervention

•Secure cooperation of vending company to test changes

•Select list of acceptable snacks to be stocked in machines

•Develop in-school publicity based on core message regarding vending changes

•Hold media event

•Conduct social media campaign

Complete Streets Policy Example:

•Research similar policies; develop model policy

•Develop fact sheets and talking points based on core message

•Identify potential key stakeholders who might be supporters and opponents of proposed policy-both government decision-makers (county board) and others (e.g., local businesses, non-profits)

•Engage stakeholders and raise awareness of Complete Streets through educational sessions and stakeholder meetings

•Secure a sponsor for the policy

•Hold community media event

•Conduct social media campaign

•Schedule presentations at county board meetings

6. Timeframe

Determine a projected start and end date for each activity.

7. Required Resources

List all resources needed to implement project activities. Be as specific as possible. Consider funding, staff time, space needs, supplies, technology, new equipment, and key partners. More than one resource will likely be listed for each activity.

8. Lead

Identify by name the key person who will initiate the activity, provide direction for the work, and monitor progress.

9. Anticipated products or results

List expected results for each activity and be very specific. The entries in this column should be the direct, tangible and measurable results of activities. They can be expressed as a product or document, number of units delivered, etc.

Healthier Vending Policy Example:

•Fact sheets and talking points documents

•Verbal agreements with high school principal

•Verbal agreement with vending company to test changes and share sales reports on high school vending machines

•At least # students will participate in planning and implementing pilot

•A list of items stocked by vendor meeting nutritional requirements

•Written policy defining acceptable foods in school vending machines

•At least # media stories will be generated

•At least # followers will be generated by social media campaign

Complete Streets Policy Example:

•Fact sheets and talking points documents

•Policy sponsor will be identified

•At least # endorsements of Complete Streets will be obtained

•At least # media stories will be generated

•At least # followers will be generated by social media campaign

•Complete Streets policy enacted

10. Date completed

As you work on the intervention over a period of time, you can use the last column to track progress on completion of activities.

Next Step

After you complete the action plan, you are ready to move on to the next step and create an evaluation plan.

Goal Statement:

Objective # 1:

Indicators (How you will measure progress toward achieving the objective):

Communication needs (Include any communication activities that will support this objective):

Target______Purpose______Approach______

Activity / Timeframe / Resources
Required / Lead / Anticipated Products or Results / Date Completed

Objective # 2:

Indicators (How you will measure progress toward achieving the objective):

Communication needs (Include any communication activities that will support this objective):

Target______Purpose______Approach______

Activity / Timeframe / Resources
Required / Lead / Anticipated Products or Results / Date Completed

Objective # 3:

Indicators (How you will measure progress toward achieving the objective):

Communication needs (Include any communication activities that will support this objective):

Target______Purpose______Approach______

Activity / Timeframe / Resources
Required / Lead / Anticipated Products or Results / Date Completed

Using the Evaluation Plan:

When you are developing your action plan, think of some of the questions you have about your objectives:

Is what we’re doing making a difference?
Is it working the way we planned?
How will we show potential funders or stakeholders what we achieved?
What are the costs and benefits?

These questions are all part of “evaluating” your work. The purpose of evaluation is to find out whether your goals and objectives are met and to see if implementation went as planned. Complete this Evaluation Worksheet while you are developing your Action Plan. You will need to list your evaluation questions and tie them to your indicators. For example, if you are working on implementing a Complete Streets policy, your grid might look like this:

Example: Complete Streets Evaluation Plan

Evaluation Question / Indicators (How will I know it?) / Data Source (Where will you get the information?)
Do key stakeholders support a Complete Streets policy? / •Sponsor identified
• # of endorsements of Complete Streets policy / •Direct communication
•Endorsement sheets
Is Complete Streets policy increasing access to safe physical activity options? / •Number of new roads in Badger County with sidewalks and/or bike lanes
•Percentage of Badger County population that is aware of increased safe physical activity options / •Government agency records
•Community-based self-report survey post implementation of Complete Streets policy
Are more Badger County residents using active transport? / •Percentage of Badger County residents who use active transport before and after implementation of Complete Streets policy
-Percentage of trips under 2 miles using active transport
-Percentage of school children walking or biking to work
-Percentage of active transport among commuters andrecreational users / •Direct observation survey of active transport users on Badger County roads
•Community-based self report survey (pre and post implementation) in a representative sample of Badger County neighborhoods

Evaluation Worksheet

Objective # 1: / Evaluation Questions / Indicators / Data Sources / Lead / Timeframe
Objective # 2: / Evaluation Questions / Indicators / Data Sources / Lead / Timeframe
Objective # 3: / Evaluation Questions / Indicators / Data Sources / Lead / Timeframe