Section 15. The County Health Rankings & Roadmaps Take Action Cycle

Learn how to use the County Health Rankings & Roadmaps Take Action Cycle, and related practical tools, to improve community health.

 

• What is the Take Action Cycle?

• Why use the Take Action Cycle?

• When should you use the Take Action Cycle?

• Who should use the Take Action Cycle?

• How do you use the Take Action Cycle?

What is the Take Action Cycle?

The health of a community depends on many different factors – ranging from individual health behaviors, education, and jobs, to the quality of health care and the environment. The County Health Rankings, published by the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation, demonstrate that where we live matters to our health. Ranking the health of nearly every county in the United States, the County Health Rankings are based on the latest data publicly available and are unique in their ability to measure the overall health of a county on the multiple factors that influence health. The Rankings include a variety of measures, such as the rate of people dying before age 75, high school graduation rates, access to healthy foods, air pollution levels, income, and rates of smoking, obesity, and teen births.

But knowing your county’s ranking is just one component of improving your community’s health – the County Health Roadmaps show how to put that knowledge into action to create healthier places to live, learn, work, and play. The Roadmaps to Health Action Center provides tools such as the Take Action Cycle to help groups work together to create healthier communities.

The Take Action Cycle has six steps – Work Together, Assess Needs & Resources, Focus on What’s Important, Choose Effective Policies & Programs, Act on What’s Important, and Evaluate Actions.

Why use the Take Action Cycle?

The Take Action Cycle is designed with the understanding that each community has its own unique set of resources and capacities, and as a result, community health improvement efforts can start at any point in the cycle. Each component of the action cycle offers tailored guidance and tools for groups undertaking health improvement efforts. Improving community health requires people from multiple sectors to work collaboratively on a variety of activities, and the Take Action Cycle provides information on how to encourage diverse stakeholders to work towards the same goal, as well where to start if all stakeholders are already dedicated to the effort.

When should you use the Take Action Cycle?

Use the Take Action Cycle to start, build, or improve your community health improvement initiative. Each step of the Take Action Cycle includes comprehensive guidance with links to specific tools. The Roadmaps to Health Action Center also includes Data Drilldown and Funding guides.

Who should use the Take Action Cycle?

People from business, healthcare, public health, education, government, elected boards, advocacy, faith-based and/or not-for-profit organizations, foundations or other investors, and anyone who cares about or is affected by the many factors that influence community health.

How do you use the Take Action Cycle?

The Take Action Cycle is a guide to transforming your vision of a healthy community into a reality, providing you with ways to use the information and resources you have to spur action and change, and guide your community health improvement initiative. The Take Action Cycle is located in the Roadmaps to Health Action Center, and you can click on various components of the cycle for tailored tools and guidance. If you’re not sure where to begin, simply click on Getting Started, and answer some basic questions about your initiative to find the best place to start and the most relevant tools. Below is an overview of the six phases of the Take Action Cycle.

 

 

Work Together

Everyone has a role to play in improving the health of communities. As you move from data to action, it’s critical to engage diverse stakeholders from multiple sectors. Working together can yield better results than working alone.

Target your outreach to those who have an investment in seeing improved health. Build a contact list to help you consider people from multiple sectors that you know, or that are in your extended network, who might be interested in working with you. Consider their unique needs and motivations; how will improving community health benefit them? The Sphere of Influence asks who you know who might have influence on the key decision-makers; your answers can help to build advocacy for the change you desire.

Your multi-sector team should include people most affected by the problem, who will have a valuable perspective to offer, and an interest in the outcome of your work. It’s also important to think about cultural and racial diversity. The Leveraging Diversity and Building Power guide can help you build cultural competency, and understand that when differences are acknowledged, appreciated, and engaged productively, the resulting relationship and enriched thinking can lead to better outcomes than might otherwise be possible.

As you build your team and recruit people, ask them to help recruit others. Recruitment is an ongoing process; you should always be asking, “Who else should we be talking to?” Use the Coalition Membership Checklist to consider who you want to engage in your efforts. Using the checklist, you can rank different sectors and organizations by the importance of their work to your team, the feasibility of getting them involved, and if they already participate, the level of their involvement. While the Checklist helps you think about who else should be at your table, the Potential Member Grid (PDF) helps you assess the activities, accomplishments, contributions, self-interests, and potential conflicts of current organizational partners. Finally, use the Identifying and Analyzing Stakeholders and their Interests Checklist throughout your work to ensure that you are continuing to recruit and keep stakeholders meaningfully involved.

Once you have recruited a diverse group of people who are all interested in working to improve the health of your community, it is important to build a common knowledge base. A good place to start is by exploring the County Health Rankings model, learning about policy and systems change approaches, and discussing why a multi-sector approach is valuable. You can view webinars on the County Health Rankings website to learn more about the Rankings and Roadmaps, and hear stories about others working together to create policy changes that improve health.

When developing your group’s vision and mission statements, it is important to make sure that the brainstorming process is participatory, and gives everyone a chance to voice their ideas.

Once you have engaged core partners and established your team’s vision and mission statements, it is time to consider the structure and leadership of your organization. Organizational Structure: An Overview: Choosing Your Organization's Structure provides criteria for how to decide which type of structure is best for your situation. Questions to consider when planning the leadership of your organization might include: How will decisions be made? How will leadership be structured (e.g. executive director, steering team, executive committee)? Decide who will serve in leadership positions, and whether the same people will be responsible for overseeing each step of the improvement process. Draft and adopt the rules, or bylaws, by which the organization will operate. To get started, see Writing Bylaws including the tools and checklists.

Assess Needs & Resources

Once you have assembled a group of people who are interested in working towards community health improvement, and have explored how best to work together, the next step is to take stock of your community's needs, resources, strengths, and assets.

The County Health Rankings provide a snapshot of a community’s health and an excellent starting point for investigating and discussing ways to improve health.  To find your county snapshot, go to the County Health Rankings website and select your state from the map, then your county (or enter your county name in the Search box). From your snapshot, you’ll be able to review data used to calculate your county’s current Rankings, and the County Health Rankings Data Drilldown Guide will help you interpret the data included in your snapshot and think about additional questions and sources of data.

Your community can be defined geographically (e.g., state, county, etc.) or by a population of interest (e.g., low-income families, elderly). Before you begin your efforts, it is important to define your community in a way that is most relevant and useful for your goals. Developing a Plan for Identifying Local Needs and Resources describes what community needs and resources are and why, when and how to identify them. And Understanding and Describing the Community provides additional guidance about how community may be defined and the type of information you might pull together to better understand your community. The County Health Rankings model provides a useful framework for thinking about additional information you might want to gather about your community.

It’s important to assess your community’s strengths and assets as well as your needs. As you work through the Take Action Cycle, you may want to focus your efforts on policies and programs that build on your community’s existing assets and resources. The Community Assets Brainstorm exercise from Healthy People 2020 is a two-page guide for brainstorming your community’s strengths.

Another tool that might be useful as you begin assessing your community is Mobilizing for Action through Planning and Partnerships (MAPP), a community-driven strategic planning tool developed by the National Association of County & City Health Officials for improving community health.

Once you have figured out what you want to know about your community, you can start to identify the specific measures or categories of measures that will answer those questions, as well as existing sources of data for those measures. As you select your indicators, consider whether they are available, accurate, possible to collect, and relevant to the initiative.

Some common places to find useful data include:

• Federal government statistics, such as census and public health data.
• Assessments or studies conducted by local or state government agencies.
• Assessments or studies conducted by other organizations. Hospitals, human service providers, Chambers of Commerce, and charitable organizations such as United Way may all conduct community assessments for their own purposes, and may be willing – or even eager – to share their results.
• Studies conducted by researchers connected to local universities.

However, you may not be able to answer all of your questions with existing data, and your team may need to collect its own data. There are a variety of ways to collect qualitative and quantitative data, and a combination of methods may give the best picture of your community.

If members of your multi-sector team are planning to use your assessment effort to meet requirements related to Community Benefits or Public Health Accreditation, you may want to review additional resources. Following are two resources intended specifically for Community Benefits and Public Health Accreditation.

Community Benefits: As a result of passage of the new Patient Protection and Affordable Care Act (PPACA), not for profit hospitals are now required to conduct a community health needs assessment at least once every three years, using public data, engaging community stakeholders, and resulting in an implementation plan that articulates both how current needs will be met and explanations of ongoing gaps.

The National Center for Rural Health Works has developed a template for the process of completing a Community Health Needs Assessment. Assessing and Addressing Community Health Needs, developed by the Catholic Hospital Association, is a comprehensive guide to community health assessments that incorporates requirements from both the PPACA and the Internal Revenue Services.

Public Health Accreditation uses standards and measures developed after a thorough process of study, vetting, and testing. The governmental entity that has the primary statutory or legal responsibility for public health in a Tribe, state, territory, or at the local level is eligible to apply for accreditation. Domain 1 (pp. 10-48) of the Public Health Accreditation Board’s Standards & Measures document discusses the accreditation requirements related to assessment.

 

Once you’ve collected and analyzed your data, you can communicate your results in a variety of ways – community presentations or forums, publishing and distributing fact sheets, via a web or social media site, and/or through the local media. Sharing your results will raise community awareness, influence public opinion, and mobilize support.

Focus on What’s Important

Once you’ve accounted for your community’s needs and resources, you will need to decide which problem(s) to tackle. It is important to take time to set priorities to ensure that you direct your community’s valuable and limited resources to the most important issues to achieve the greatest impact on health.

Working with a multi-sector team brings a variety of perspectives to the work, and while this makes your team stronger, it can also make choosing a focus difficult. A skilled, neutral facilitator can help guide your team through a priority-setting process, ensuring all voices are heard. Effective facilitators are objective, but that doesn’t mean they have to come from outside the organization or team; it simply means that for the purposes of the decision-making process, the facilitator will take a neutral stance.

As you begin your priority-setting process, it may be helpful to focus your team on a guiding question. Reviewing your vision and mission statement can provide a helpful starting point. Key words or values in these statements will help you create your guiding question. Frame your guiding question to reflect the most important elements of your vision and mission.

Once you have a guiding question, have a quick brainstorming session to begin the process. Ask participants what they see as the top two or three issues based on that question and the data they’ve reviewed. Brainstorming is an effective and simple way to come up with ideas in a group, and will get a good set of issues for your group to consider. But keep in mind when you are brainstorming that you will be most effective in your efforts if you are trying to improve the root cause of a problem, rather than just a symptom of the problem.

The number of priorities you select will depend on your resources and ongoing efforts in your community. It may be helpful to prepare a summary or overview of the information gathered from your assessment of community needs and resources to guide the priority-setting process. Matching the number of priorities with your team’s capacity to take action is most important. It is better to pick fewer priorities and succeed than to choose too many priorities and find you can’t be effective in any of them.

There are a variety of processes for selecting priorities, but before you dive into a process, it’s helpful to agree on a set of criteria by which you will judge potential issues. Criteria express the values, standards, and basic ideas your team will consider when making choices and deciding priorities.

The Prioritization section from APEXPH in Practice and Priority Setting: Four Methods for Getting to What’s Important describe several common priority-setting methods and the strengths and weaknesses of each.
In addition to a formal process, you might consider soliciting input from the public on potential priority issues. This could include holding community forums, making presentations to community organizations, and conducting community surveys.

Once your group has brainstormed possible priorities, solicited input from the community, and reviewed whether the issues fit with your criteria and the results from your community assessment, it is time to finalize your prioritized issues. You can do this informally by using your criteria as a general guide and voting on the top issues or follow a more structured process of rating each potential priority issue.

As a team, review your resulting list of priorities. Does it make sense? Does it resonate with your multi-sector members? Will these priorities resonate with the community? If you haven’t sought public input, this is the opportunity to do so. Hold final decisions until you have evidence of community support for your chosen priorities.

To ensure that your team and community can successfully act on the priorities you’ve selected, it’s important to communicate your decisions with decision makers and those who influence them.

Choose Effective Policies & Programs

Once you have decided what priority issues you are going to address in your community, it is important to choose effective policies and programs that will maximize your chances of success.

You may have already explored some options for policies and programs to address your priority issues, but it’s important to dig a little deeper to find and choose effective strategies that best suit your community. Rather than just choosing a program because other communities are using it, it is important to consider if there is evidence that the program is effective and if it will fit within the context of your community. You also have the possibility of creating a new program or policy. Choosing whether to invent your own approach or adopt one that has been shown to work will depend largely on the time and resources your community has to spend, and on the availability of evidence-informed policies and programs that could address your community’s priorities. As you begin to invent or adopt your approach, you will want to be sure to consider evidence of effectiveness.

As you research potential policies and programs to address your community’s health priorities, you will likely find a continuum of evidence, including systematic reviews, peer-reviewed studies, and expert recommendations. You may also find strategies labeled promising practices, best practices, or model programs from a variety of organizations. Each organization has its own criteria and labels based on its definition of evidence. As you discuss how your team will structure its research, decide what evidence means to you and what types of evidence your community will accept.

Additionally, the Roadmaps to Health Action Center now includes What Works for Health, a searchable database of policies and programs that can improve health. You can choose a health factor of interest (i.e. tobacco use, employment, access to health care, environmental quality) and browse through the evidence ratings for particular programs, policies, or system changes that address the particular health factor of interest. The database systematically assesses, summarizes, and rates the evidence for the policies and programs, with attention to the following questions:

• How strong is the demonstrated effect?
• Have results been replicated?
• Is it clear that the policy or program caused the reported changes?

In addition to searching databases, it is helpful to think about how policies and programs have been implemented in communities. As you hone in on the most likely candidate for implementation, you will want to evaluate what is known about its effectiveness.

In addition to evidence of effectiveness, it’s also important to consider your community context as you research policies and programs. Consider the following questions:

• Are there any political or legal constraints that might make a strategy more or less successful?
• What is your community’s readiness for the policies or programs you’re considering?
  • The Tri-Ethnic Center for Prevention Research at Colorado State University has developed a Community Readiness Model that assesses how ready a community is to address an issue.
• Does your community have resources to successfully implement and evaluate a policy or program?
  • Can you leverage existing resources and assets to ensure effective implementation?
  • Will you have to pursue funding to implement your policy or program?
  • The County Health Rankings & Roadmaps Guide to Funding Your Community Health Initiative includes a short readiness assessment tool that outlines the critical elements that should be in place before you write a funding proposal.

It’s important to recognize that policies and programs may need to be adjusted to fit your community. If it's true that no two communities are exactly alike, it should be equally true that interventions that work for them won't be exactly alike, either, though they may have many common elements.

As you make your selection, you may want to consider a balance of strategies. Choose manageable short-term strategies for early success, while also laying the groundwork to implement more complex, long-term strategies. It might also be helpful to use some of the voting or decision making procedures you used to select your priority issues to reach a consensus about the best policies and programs for your community.

To help you choose the best policy or program for your community, consider the following questions:

• Does the policy or program meet all of the criteria set by your search?
• Some programs can be complicated, which means an organization that can support the effort is needed. Are there organizations in your community that can support the effort? If not, can you create such an organization?
• What is the evidence that the policy or program will have some impact?
• Will you be able to replicate the practice? If not, how will you modify it for your community?
• What resources do you have or will you be able to generate to support the policy or program? Will a pared back version satisfy your needs?
• Is the policy or program compatible with your community's beliefs, attitudes and values (e.g., will your community support condom distribution)?
• How will this policy or program work for you? What would make it a success for your community?

Act on What’s Important

Once you’ve decided what policy or program is most effective for your community, the next step is implementation.  When implementing a program, it is important to build on inherent strengths, capitalize on available resources, and respond to unique needs.

One of the first steps should be to define exactly what you want to achieve with this program or policy, and why you want to achieve it. Taking time to do this will help you communicate about and advocate for the solution you are proposing.

You may want to choose a visual tool to describe what your selected policy or program is, and how a focus on this will link to long-term results in your community:

• Logic models can help you think through what you want to achieve and why
• A theory of change defines all the building blocks required to bring about a long-term goal
• Strategy maps link broad strategic objectives in cause and effect relationships

Some changes may not require an advocacy campaign because people are already on board and funding is assured. But, in most cases, there will need to be a campaign to secure the desired policy or program. If so, after you’ve identified what you want and why you want it, the next step is to ask, “Which organizations or individuals have the power to give you what you want?” Developing a plan for influencing decision-makers and getting the right people to join you is key to success.

Who do you want to influence?

The Simple Power Map, Sphere of Influence, Pathways of Influence, and The Policy Faces Book are all tools to help you identify who has the power on a policy or system change and how you can influence targeted decision-makers.

Who are your allies?

Using an Ally Power Grid and the Coalition Mapping Worksheet can help identify potential allies and organizations interested in your policy or program. Use these tools to identify those who care about your issue enough to help you as well as those with the specific expertise necessary for getting your proposed policy or program implemented.

Who are your opponents?

Identifying Opponents will help you understand who may “lose” or perceive they’ll lose if the solution goes through, what they will do or spend to oppose you, and what power they have over the decision-maker.

To build support for your policy change or program adoption, keep your key stakeholders and the public involved and active. Communicating continuously is important. Developing a Plan for Communication provides information on how to establish effective communication, including this eight-step process:

• Identify the purpose of your communication.
• Identify your audience.
• Plan and design your message.
• Consider your resources.
• Plan for obstacles and emergencies.
• Strategize how you’ll connect with the media and others who can help you spread your message.
• Create an action plan.
• Decide how you’ll evaluate your plan and adjust it, based on the results of carrying it out.

Connecting with the media is especially important and can seem daunting—especially if you have never worked with the media before. Media Advocacy and Developing your persuasive message: The 27-9-3 Rule worksheet will help you plan and implement your media advocacy strategy. Prevention Speaks and the Center for Digital Storytelling provide guidance for how to tell powerful stories.

Social media, such as Facebook, Twitter, YouTube, and other sharing sites can be used for outreach and engagement, communications, event management, advocacy, and/or fundraising.

Next, create a specific action plan for implementing your program or policy. Action plans describe how you’re going to accomplish your policy or program goals by identifying specific tactics, accountable leaders or teams, timelines, and budgets.

As you begin your action planning process, build on the broad goal you identified and move to specific, measurable, achievable, realistic, time-determined (SMART) objectives, and then even more specific tactics or action steps. All effective action plans will require some level of advocacy planning to think through how to influence the key decision makers. The Advocacy Institute’s Nine Questions: A Strategy Planning Tool for Advocacy Campaigns identifies this entire planning process.

An important part of implementing your plan is creating a thorough budget to map out what resources you have and how they will be allocated. Planning and Writing an Annual Budget has in-depth guidance on how to create a budget. If your budget shows that you don’t have the resources available for all the goals you want to accomplish, it might be a good idea to create a fundraising plan to support your program implementation.

The County Health Rankings & Roadmaps Guide to Funding your Community Health Initiative includes a how-to guide on identifying and accessing funding opportunities. Here are some key tips on accessing funds for your community health initiative:

• Plan ahead and know your specific needs.
• Identify what resources are already available to your effort.
• If you are applying to an external funding source:
  • Clearly understand the funder’s goals and guidelines.
  • Communicate a clear picture of success with measurable outcomes.
  • Outline your plan for sustainability.

The Potential Donors Worksheet assists you in identifying corporations and organizations, individuals, foundations, and governmental bodies that share your mission and values, care about the issues you care about, and might help fund the campaign.

Once you have an action plan and a budget to guide your effort, it is time to begin working together to implement your plan. As you work, continue to evaluate whether you need to add anyone else to your mix of partners to ensure that your policy or program moves forward. Think about who might oppose your approach and why; try to understand their concerns and reframe your message in a way that respects their perspective.

Some resources to help you engage policy makers include Coalitions & Advocacy: Working with your legislators, Legislative Heroes’ To-Do List/Contact Chart, and Administrative Heroes’ To-Do List/Contact List. But it is important to be aware of rules related to lobbying. This can be especially important if you have public employees and/or legislative aides on your coalition committees and email lists. Influencing Public Policy in the Digital Age is a publication created to address the many questions organizations have about advocacy in the new environment of dynamic digital communication and includes guidelines for public employee communications.

As you continue your work, make sure to celebrate successes along the way, and also capture lessons being learned.  After every major activity, build in time to reflect on what went well and why. Be sure to recognize the efforts of all those who are contributing to success, and be as specific as possible with praise and encouragement.

Monitor the policy or program implementation process using the measures you developed with your goals and action plans, so that you can communicate ongoing progress to key stakeholders and the public.  Communicating Information to Funders for Support and Accountability has information on why it is important to communicate your progress to others, and the different forms of communication that might be useful for different audiences.

Share your unfolding story with other communities. Document your methods and strategies—including the ups and downs—so that others can be inspired and learn from your experience. The County Health Rankings and Roadmaps has a section where you can Submit a Story to share your experiences; this includes not only “success stories” but also lessons learned from challenges and setbacks you have faced. Also consider using multi-media strategies such as Photovoice to highlight your progress.

To assure that your changes are sustained, develop a long-term accountability plan that addresses policies, partnerships, organizational strategies, communications plans, and funding. As you move forward in long-term planning, consider whether putting a separate infrastructure in place with skilled staff and resources that will stay solely focused on maintaining and improving the policy or program is necessary or beneficial to your initiative. Your decisions about staffing and infrastructure will influence your ongoing funding needs. And finally, decide whether the measures you are monitoring are helping you learn about what’s working to improve health. If they aren’t, adjust or change them. Document how you are adapting as you learn, so that you can incorporate these lessons into future activities.

Evaluate Actions

Evaluating your efforts is an important step in the community health improvement process. Evaluation allows you to be sure that what you are doing is working in the way you intended and that your efforts are as effective and efficient as possible. Accountability also increases the likelihood that funders will continue to invest in your efforts.

The Take Action Cycle shows evaluation at the end of the cycle, but in reality evaluation should be incorporated throughout your community health improvement process.

• As you move through the Take Action Cycle, your evaluation will take on different purposes.
• As you Work Together you’ll want to continuously evaluate your team
• As you Assess Needs & Resources, you will want to consider what measures are available to monitor progress over time.
• As you Choose Effective Policies & Programs, you may use evaluation tools to gain insight into how your community should address priority issues.
• As you Act on What’s Important, you may use evaluation tools to improve a policy or program. Once your selected solution has been implemented, you will want to evaluate its impacts.

There are several ways that you can use evaluation:

• To gain insight (formative evaluation).
  • Assess the level of community interest in a desired policy or program, and use that information to plan how to implement it.
  • Identify challenges to and opportunities for a desired policy or program, and use that information to advocate for it.
•     To improve a policy or program (process evaluation).
  • Monitor the implementation of your selected policy or program, and use the results to enhance components of the policy or program.
  • Survey your target audience, and use that information to improve the content and delivery of your communication, policy, or program.
• To evaluate program effects (impact, results or outcome evaluation):
  • Measure the extent to which your outcome indicators are being met, and use the results to improve your policy or program and be accountable to your funders.
  • Use information about which target populations benefited most from your policy or program to target future efforts more effectively.
  • Use outcomes to be accountable to your community and to your policy decision makers.
• As you decide how and when evaluation will be used, consider:
  •  What do stakeholders want to know? How will they use the data?
  • What does your community need and want to know?
  • What do funders require?

You will also want to determine who will do the evaluation. Evaluation is best thought of as a team effort, and you should assemble an evaluation team to develop and guide the process. You may also consider hiring an outside evaluator to work with your evaluation team.

Just as with your community health improvement process, it is important to engage stakeholders to develop and gain consensus around your evaluation plan. Each stakeholder will have a different perspective on your policy or program as well as what they want to learn from the evaluation.

The work you’ve done in implementing your program should shape your evaluation plan. Ask questions such as: What did you set out to accomplish? What was the logic that drove selection of your policy or program? What have you done to accomplish your goals? Do you need to evaluate all of the goals you’ve set?

If you haven’t developed a logic model or grounded your actions in a theory of change, you may want to take time to clearly define your strategy – what you want to achieve, and why. It is especially important to think about setting short-, medium-, and long-term goals. If you only focus on long-term goals (such as reducing obesity), you will not be able to demonstrate progress and your initiative will likely lose momentum. But if you focus on short- or medium-term goals (such as increasing physical activity by passing a policy to include sidewalks and bicycle lanes in street construction projects), you will be able to demonstrate progress throughout your initiative.

Once you’ve decided which goals you will evaluate and the evaluation questions you need to answer, you’ll next want to think about indicators (i.e., specific process or impact measures) and sources of data. For each evaluation question you pose, you will need indicators to answer that question.

Process measures are activities that take place during the initiative that help you determine how well things are going.

Examples includes:

• Participation: number of participants, frequency of participation.
• Communication: number of media stories, letters to the editor, or op-eds about your efforts, number of people on your email or mailing list, number of messages sent using email or mailing list.
• Activities: number of meetings with policymakers, number of classes or workshops held.
•  Enforcement: number of citations issued for violating policies or breaking laws.

Impact measures explain the overall impact that occurs as a result of your actions. Outcome measures highlight the changes that happen in the community as a result of the work done by your initiative.

Examples include:

• Participant-level indicators such as changes in knowledge, behavior, or perceptions of an issue.
• Community-level indicators relevant to your priority-issue such as changes in environments, laws, health status indicators.

As you select your indicators, consider whether they are available, accurate, possible to collect, and relevant to the initiative.

As you decide what indicators to use, consider where will you get the data. Sources of data include people, documents, observations, or existing data sources. Consider the data you collected in the Assess Needs and Resources step. Would collecting from these same sources help answer some of your evaluation questions? As an example, see Assessing Community Needs and Resources Possible Community Health Indicators. Strong evaluations will use both qualitative and quantitative sources, and use a large enough sample of data that the results are reliable, while still keeping the time and effort necessary for data collection at a practical level. Assessing Community Needs and Resources is devoted to different methods for collecting information; each section provides an in-depth description of what the method is and why, when, and how you should use it.

Before collecting data, you should decide on the expected effects of the policy or program on each indicator. This “goal” for each indicator, your benchmark for success, is often based on an expected change from a known baseline. Benchmarks should be achievable, but challenging, and should consider how far along the policy or program is in implementation, your logic model, and your stakeholders’ expectations. For step-by-step guidance, examples, tools, and checklists for data collection, see Some Methods for Evaluating Comprehensive Community Initiatives.

Some tips to make the data collection process go smoothly:

• Train people how to collect the data.
• Schedule data collection activities, including pilots so the data collection process can be improved.
• Track and organize the data as you go, both to keep the evaluation in progress and to protect confidentiality of the data.
• Collect only data that will be used and use all data collected.
• Check in throughout the data collection process to reflect on what’s working, what could be improved, and whether you have answered your original evaluation questions.
• Throughout the data collection process, also periodically stop to review the quality of the data you’re gathering.
  • Do the data reflect the people who live in the community? The demographics of respondents should match the demographics of the priority population.
  • Do the data reflect the behavior of the priority population? Are you measuring short- and medium-term outcomes of behavior change?
  • Are the data plausible? Sometimes sampling strategies don’t detect what is actually happening, and other methods may be needed.
• Develop a system for analyzing the data: What will be reviewed and how often?
• Develop a system for sharing information with stakeholders.

Using the data collection and analysis system you established, monitor progress toward your short-, medium- and long-term goals. You can use your evaluation results to make recommendations for continuing, expanding, redesigning or abandoning your policy or program. Go back to your initial assessment and problem definition and determine whether your efforts are impacting the problem you set out to address.

Sharing your results is an important part of your evaluation, but you may consider different reporting strategies depending on your purpose and audience. An evaluation report can be used for several different purposes, such as to guide decisions about future policy and program implementation, to tell the “story” of your efforts and demonstrate the impact of the policy or program, to advocate for your efforts with potential funders, to help other communities learn from your experiences, to contribute to the knowledge base about what works and what doesn’t work, and to show that policy or system change can effectively impact individual behaviors and health outcomes.

In Summary

The County Health Rankings rank the health of nearly every county in the nation. The County Health Roadmaps’ Take Action Cycle offers a way to transform the knowledge from your county’s ranking into action that can improve the health of your community. The Take Action Cycle offers comprehensive guidance on how to work with key partners, gather information about your community’s needs and resources, set priorities, find the most effective approaches to address priorities, act on what’s important, and evaluate those actions along the way. In each section, you will find links to relevant tools and checklists to help you through each step as you work for a healthier community.