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What is the Take Action Cycle?
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Why use the Take Action Cycle?
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When should you use the Take Action Cycle?
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Who should use the Take Action Cycle?
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How do you use the Take Action Cycle?
What is the Take Action Cycle?
The health and well-being of a community depend on many different factors – ranging from health behaviors, education, and employment to health care, housing, transportation, the environment, and broader community conditions. County Health Rankings & Roadmaps (CHR&R), a program of the University of Wisconsin Population Health Institute, provides data and tools that help communities understand how long and how well people are living and the conditions that shape health.
CHR&R no longer assigns each county an individual rank. Instead, counties are placed into national Health Groups based on similarities and meaningful differences in Population Health and Well-being and Community Conditions. These data can help communities identify strengths, challenges, and opportunities for action.
But understanding community health data is only one part of improving health. The CHR&R Action Center provides guidance and tools that communities can use to move from information to action. The Take Action process can help groups work together to create healthier and more equitable places to live, learn, work, play, and thrive.
The current Take Action process includes seven interconnected components – Work Together, Assess Needs & Resources, Focus on What's Important, Choose Effective Policies & Programs, Communicate, Act on What's Important, and Evaluate Actions.
Why use the Take Action approach?
The Take Action approach recognizes that every community has its own strengths, resources, needs, relationships, and capacity for change. Community health improvement efforts may therefore begin at different points in the process rather than following one rigid sequence.
Each component provides guidance and tools for groups working to improve health. Improving community health requires people from different sectors to work together on a variety of activities, and the Take Action approach provides a structure for building partnerships, understanding community conditions, setting priorities, selecting strategies, taking action, communicating effectively, and evaluating progress.
When should you use the Take Action Cycle?
Use the Take Action process to start, strengthen, or improve a community health initiative. Because it is cyclical, you can enter the process at the point that best fits your current work and return to earlier steps as conditions, information, partnerships, or priorities change.
Who should use the Take Action Cycle?
The Take Action process can involve people from business, health care, public health, education, government, elected boards, advocacy organizations, faith communities, nonprofit and community-based organizations, philanthropy, community development, and other sectors. Most importantly, it should meaningfully involve community members, particularly people directly affected by the conditions or issues the effort is intended to address.
How do you use the Take Action Cycle?
The Take Action process is a guide for turning a vision of a healthier community into action. It helps communities use data, evidence, community knowledge, relationships, and available resources to guide health improvement efforts. The components are connected and may be revisited as the work develops.
Work Together
Everyone has a role to play in improving the health of communities. As you move from data to action, it is important to engage community members and partners from different sectors. Working together with a shared vision can produce better results than working separately.
Reach out to people and organizations that have an interest in improving health or are directly affected by the issues involved. Build a contact list that helps you identify people from different sectors, communities, and networks who might contribute. Consider their interests and motivations: How might improved community health connect with their goals? Who has relationships with or influence on the people and organizations whose decisions will affect the work?
Your multi-sector team should include people directly affected by the conditions or issues you are addressing. Their knowledge and lived experience can provide perspectives that may not be available through organizations or data alone. Consider whether the team reflects the racial, cultural, socioeconomic, geographic, age, disability, and other forms of diversity relevant to your community and initiative.
As you build your team and recruit participants, ask people to help identify others who should be involved. Recruitment is an ongoing process; continue asking, “Who else should we be talking to?” Use stakeholder analysis and other coalition-building tools to consider whose perspectives, knowledge, relationships, resources, and influence are important to the effort.
Once you have brought together a group of people interested in improving community health, build a shared understanding of the issues and conditions affecting health. A useful starting point is the current University of Wisconsin Population Health Institute Model of Health, which examines Population Health and Well-being, Community Conditions, Societal Rules, and Power. The model can help groups think more broadly about how community conditions are created and how they influence health.
When developing your group's vision and mission statements, make sure the brainstorming process is participatory and provides meaningful opportunities for people to contribute their ideas.
Once you have engaged core partners and established a shared vision and mission, consider the structure and leadership of the group. Organizational Structure: An Overview provides guidance for deciding what type of structure may work best. Questions might include: How will decisions be made? How will leadership be structured? Who will serve in leadership roles? How will community members participate in decisions? Will the same people oversee each part of the improvement process?
Assess Needs & Resources
Once you have assembled people who are interested in community health improvement and have explored how to work together, take stock of your community's needs, resources, strengths, and assets.
County Health Rankings & Roadmaps provides county and state data that can serve as one starting point for understanding health and community conditions. CHR&R currently provides Health Groups and data across measures organized within the University of Wisconsin Population Health Institute Model of Health. Reviewing these data over time can help identify strengths, challenges, patterns, and questions that need further investigation.
Your community can be defined geographically – for example, a neighborhood, city, county, region, state, or Tribal community – or around a population or shared experience relevant to your initiative. Before beginning an assessment, define the community in a way that is useful for your goals. Developing a Plan for Identifying Local Needs and Resources describes what community needs and resources are and how to identify them, while Understanding and Describing the Community provides additional guidance for understanding community context.
It is important to assess strengths and assets as well as needs. As you work through the Take Action process, look for ways to build on existing relationships, organizations, skills, knowledge, facilities, programs, policies, and other community resources rather than focusing only on problems or gaps.
Another tool that may be useful as you assess your community is Mobilizing for Action through Planning and Partnerships (MAPP), a community health assessment and improvement planning framework developed by the National Association of County and City Health Officials with support from the Centers for Disease Control and Prevention.
Once you have determined what you want to know about your community, identify the specific measures or categories of measures that can help answer those questions, along with possible data sources. As you select indicators, consider whether they are relevant, available, accurate, useful, and practical to collect.
Some common places to find useful information include:
- Federal government data, such as Census Bureau and public health data.
- Assessments or studies conducted by local, Tribal, state, or regional government agencies.
- Assessments or studies conducted by other organizations. Hospitals, health and human service organizations, community-based organizations, Chambers of Commerce, foundations, and other groups may conduct community assessments and may be willing to share findings.
- Studies conducted by researchers at colleges, universities, research organizations, or other institutions.
- Knowledge and lived experience shared directly by community members.
Existing information may not answer all of your questions, and your team may need to collect its own data. There are many ways to collect qualitative and quantitative information, and using multiple methods can provide a fuller picture of community conditions.
If organizations involved in your assessment are also using the process to meet federal, accreditation, or organizational requirements, coordinate the work where possible.
Community Health Needs Assessments: Charitable hospital organizations subject to federal requirements generally conduct a community health needs assessment at least once every three years and adopt an implementation strategy addressing identified needs. Collaboration can reduce duplication and broaden community participation.
Public Health Accreditation: Health departments pursuing or maintaining accreditation through the Public Health Accreditation Board may use community health assessment and improvement planning activities as part of meeting applicable accreditation requirements.
Once you've collected and analyzed your data, communicate the findings in accessible ways – through community presentations or forums, fact sheets, dashboards, websites, social media, newsletters, local media, or other appropriate channels. Sharing findings can help community members understand the issues, contribute their interpretations, and participate in decisions about what happens next.
Focus on What's Important
Once you've examined your community's needs, strengths, resources, and conditions, decide which issues or opportunities to address. Taking time to set priorities helps ensure that limited community resources are directed toward areas where focused action can make a meaningful difference.
Working with a multi-sector group brings different perspectives to the process. That makes the group stronger, but it can also make choosing priorities more complicated. A skilled, neutral facilitator can help guide priority-setting while making sure different voices have meaningful opportunities to be heard. A facilitator does not necessarily have to come from outside the group; what matters is that the person can guide the process fairly.
As you begin priority-setting, it may help to focus your group on a guiding question. Reviewing your vision and mission statements can provide a starting point. Key ideas or values in those statements can help shape the question you use to examine potential priorities.
Once you have a guiding question, brainstorm possible priorities. Ask participants what they see as the most important issues based on community knowledge, lived experience, and the data that have been reviewed. As you consider possible priorities, look beyond immediate symptoms and examine the underlying conditions or root causes contributing to the issue.
The number of priorities you select will depend on available resources, capacity, and other work already underway in the community. It may be useful to prepare a summary of the information gathered through your assessment. Matching the number of priorities to your team's ability to act is important. Choosing a manageable number of priorities and making meaningful progress may be more effective than selecting so many that resources become spread too thin.
There are a variety of processes for selecting priorities. Before choosing one, agree on the criteria you will use to judge possible issues. Criteria express the values, standards, and practical considerations your team will use when making choices and establishing priorities.
In addition to formal priority-setting methods, gather input from community members. This might include forums, presentations, conversations with community organizations, surveys, interviews, focus groups, or other forms of engagement.
Once your group has identified possible priorities, gathered community input, and reviewed how the issues fit your criteria and assessment findings, finalize the priorities. This can be done through consensus, voting, a prioritization matrix, or another transparent decision-making process.
Review the resulting priorities as a group. Do they reflect the available data and community experience? Do they make sense to community members directly affected by the issues? Are the priorities realistic enough for the community to act on? Before moving forward, make sure there is meaningful community understanding and support.
Communicate the priorities and the reasons behind them to decision-makers, partners, community members, and others whose support or involvement may affect the work.
Choose Effective Policies & Programs
Once you have decided which priority issues to address, choose policies, programs, practices, or systems changes that offer a reasonable opportunity for success.
You may already have identified some possible approaches, but it is worth examining them more closely. Rather than selecting something simply because another community uses it, consider both the evidence supporting the approach and how well it fits your community's needs, strengths, resources, history, and conditions. Communities may also develop new approaches where existing strategies do not adequately address local needs.
As you research potential strategies, you will encounter different kinds of evidence, including systematic reviews, peer-reviewed studies, expert recommendations, evaluation findings, and community experience. Terms such as evidence-based, evidence-informed, promising practice, and model program may be defined differently by different organizations. As a team, discuss what kinds of evidence will inform your decisions.
County Health Rankings & Roadmaps' What Works for Health is a searchable resource of evidence-informed strategies. Strategies include information about expected benefits, evidence ratings, implementation considerations, and potential effects on disparities.
In addition to evidence of effectiveness, consider community context:
- Are there political, legal, organizational, or practical conditions that might make a strategy more or less feasible?
- What is your community's readiness for the policy, program, or other strategy you are considering?
- The Community Readiness Model can help assess how prepared a community is to address a particular issue.
- Does your community have the people, relationships, funding, expertise, and other resources needed to implement and evaluate the strategy?
- Can you build on resources and assets already available?
- Will you need to identify additional funding or other support?
Policies and programs may sometimes need thoughtful adaptation to fit local circumstances. If no two communities are exactly alike, strategies may not look exactly alike in every setting either. At the same time, adaptations should preserve the elements that are important to a strategy's effectiveness.
As you make your selection, consider a balance of strategies. Some manageable short-term actions may help build momentum while the community also works toward more complex, long-term policy, systems, or environmental changes.
To help choose an appropriate policy, program, or strategy, consider:
- Does the strategy meet the criteria established by your group?
- Does implementation require a particular organizational structure or lead organization? If so, is that capacity available?
- What evidence suggests that the strategy can contribute to the outcomes you want?
- Which parts of the strategy are essential, and what adaptations might be appropriate for your community?
- What resources are available or can be developed to support implementation?
- How well does the strategy fit the community's context, values, priorities, and needs? What engagement may be necessary to build understanding and support?
- How will you know whether the strategy is successful in your community?
Communicate
Communication is important throughout the Take Action process, not simply after decisions have been made. Effective communication can help people understand community conditions, contribute to decisions, build support, participate in implementation, and learn from results.
Begin by identifying the purpose of your communication. What do you want people to understand, feel, discuss, or do? Then identify the people you need to reach and the people or organizations they trust as messengers.
A communication plan might include:
- Identifying the purpose of your communication.
- Identifying the people and groups you need to reach.
- Planning and designing clear, accurate, and accessible messages.
- Considering the resources available for communication.
- Planning for challenges, misinformation, or unexpected events.
- Selecting appropriate communication channels and trusted messengers.
- Creating specific communication action steps.
- Evaluating whether your communication is reaching people and producing the intended response.
Communication should also involve listening. Community members, particularly people directly affected by health inequities or by the proposed changes, should have opportunities to respond, ask questions, raise concerns, and contribute knowledge throughout the process.
Depending on your audience and purpose, communication methods might include community meetings, websites, email, social media, video, local news media, radio, printed materials, presentations, or direct conversations. The most appropriate methods will vary by community.
Stories can help people understand why an issue matters, but they should be used responsibly. Combine personal experience with relevant evidence and respect participants' consent, privacy, and dignity.
Act on What's Important
Once you've selected a policy, program, or other strategy, the next step is implementation. Build on community strengths, use available resources, and respond to local needs and conditions.
One of the first steps is to define exactly what you want to accomplish and why. Taking time to do this will make it easier to communicate about and advocate for the approach you are proposing.
You may want to use a visual tool to describe the strategy and how it is expected to contribute to long-term results:
- Logic models can help explain what you expect to accomplish and how activities are connected with outcomes.
- A theory of change describes the conditions and steps expected to contribute to a long-term goal.
- Strategy maps can show relationships among broad strategic objectives.
Some changes may already have strong support and identified funding. Others may require additional advocacy, policy change, partnership development, or resource-building. When this is the case, identify the people and organizations with the authority, influence, relationships, or resources needed to move the strategy forward.
Who do you need to influence?
Stakeholder and power-mapping tools can help identify who influences a policy or systems decision, who is directly affected by it, and what relationships may help move the issue forward.
Who are your allies?
Stakeholder and ally analysis can help identify people and organizations that care about the issue, have relevant expertise, or can contribute relationships, credibility, resources, or other forms of support.
Who holds different perspectives?
Identifying people who hold differing perspectives can help you understand their concerns, interests, influence, and reasons for supporting or opposing a proposed approach. Understanding those perspectives can help identify areas of disagreement as well as possible areas of common ground.
Create a specific action plan for implementing the strategy. Action plans describe how the community will accomplish its goals by identifying specific activities, responsible people or organizations, timelines, resources, and measures of progress.
As you begin action planning, move from the broad goal to specific and measurable objectives and then to concrete action steps. Objectives should make clear what is expected to change, how progress will be measured, and the time period involved.
An important part of implementation is creating a realistic budget and resource plan. Planning and Writing an Annual Budget provides guidance on developing a budget. If available resources are not enough to carry out the plan, consider fundraising, grant funding, partnerships, in-kind support, shared staffing, or adjustments to the scale and timing of activities.
Some useful principles for securing resources include:
- Plan ahead and understand your specific needs.
- Identify resources already available to the effort.
- If applying for external funding:
- Understand the funder's goals, priorities, and requirements.
- Describe clearly what success will look like and how it will be measured.
- Explain how effective work can be sustained beyond the initial funding period.
Once you have an action plan and resources to guide the work, begin implementation. Continue evaluating whether additional partners, community members, or expertise are needed. If people oppose or question the approach, try to understand the reasons for their concerns and address them accurately and respectfully.
Be aware of applicable rules related to lobbying and advocacy, particularly when public employees, government resources, grant funds, or tax-exempt organizations are involved.
As the work continues, recognize progress and capture lessons learned. After major activities, take time to reflect on what worked, what did not, and why. Recognize the contributions of people and organizations involved in the effort.
Monitor implementation using the measures established in your goals and action plan so that you can communicate progress to community members, partners, funders, and decision-makers. Communicating Information to Funders for Support and Accountability provides additional guidance.
Document the work – including challenges, adjustments, and lessons learned – so that your own community and others can learn from the experience. Participatory approaches such as Photovoice may also help community members document conditions and tell the story of change.
To help sustain successful changes, develop a long-term accountability plan addressing partnerships, organizational responsibility, communication, staffing, funding, and continued monitoring. As conditions change, revisit whether the measures you are using still provide useful information. If not, adjust them and document what you learn.
Evaluate Actions
Evaluation is an important part of community health improvement. It can help you understand whether the initiative is being implemented as intended, whether it is contributing to desired changes, where improvements are needed, and how resources are being used.
Although Evaluate Actions appears as one component of the Take Action process, evaluation should occur throughout community health improvement.
- As you move through the Take Action process, evaluation will serve different purposes.
- As you Work Together, evaluate how well the partnership is functioning and whether people who should be involved have meaningful opportunities to participate.
- As you Assess Needs & Resources, identify measures that can establish a baseline and track conditions over time.
- As you Choose Effective Policies & Programs, use available evidence and evaluation findings to understand what approaches may fit the community.
- As you Communicate, assess whether messages are reaching people, being understood, and creating opportunities for meaningful participation.
- As you Act on What's Important, use evaluation to improve implementation and examine the effects of the selected strategy.
There are several ways evaluation can be used:
- To gain insight (formative evaluation).
- Assess community interest, knowledge, readiness, or concerns related to a proposed policy or program, and use that information in planning.
- Identify challenges and opportunities related to the strategy and use that information to improve planning and advocacy.
- To improve a policy or program (process evaluation).
- Monitor implementation and use the findings to improve activities, procedures, or other parts of the effort.
- Gather feedback from people participating in or directly affected by the effort and use that information to improve content, access, implementation, or communication.
- To evaluate effects and outcomes.
- Measure progress on outcome indicators and use the results to strengthen the strategy and support accountability.
- Examine how benefits and outcomes are distributed among different populations and communities, particularly those most directly affected by the issue.
- Use findings to be accountable to community members, partners, funders, and decision-makers.
- As you decide how and when evaluation will be used, consider:
- What do community members and other stakeholders want to know? How will they use the information?
- What does the community need and want to know?
- What information do funders or other accountable organizations require?
Determine who will participate in the evaluation. Evaluation is often strongest when people with different forms of knowledge – including community members, program participants, staff, partners, and people with evaluation expertise – help develop and interpret the process. An outside evaluator may also be useful when appropriate and feasible.
As with the larger community health improvement process, engage stakeholders in developing the evaluation plan. Different groups may have different questions about the policy or program and different ideas about what meaningful success looks like.
The work done during implementation should help shape the evaluation. Ask: What did you set out to accomplish? Why did you select this policy or program? What activities did you carry out? What changes did you expect to see? Which questions are most important to answer?
If you have not developed a logic model or theory of change, take time to clarify what the strategy is expected to accomplish and why. Consider short-, medium-, and long-term goals. Long-term health outcomes may take years to change, so shorter-term measures can help show whether the conditions expected to lead to those outcomes are changing.
Once you have determined the goals and evaluation questions, identify indicators – specific process, impact, or outcome measures – and appropriate data sources.
Process measures describe activities and implementation and help determine whether the initiative is being carried out as intended.
Examples include:
- Participation: number and range of participants, frequency of participation, and continuity of involvement.
- Communication: reach and engagement through community meetings, media coverage, newsletters, email, social media, or other communication channels.
- Activities: number and type of meetings, workshops, services, policy discussions, outreach activities, or other planned actions completed.
- Policy or systems implementation: measures showing whether agreed-upon policies, procedures, or system changes are actually being carried out.
Impact and outcome measures examine changes associated with the work of the initiative.
Examples include:
- Participant-level indicators, such as changes in knowledge, skills, access, behavior, or perceptions relevant to the initiative.
- Community-level indicators, such as changes in community conditions, access to resources, policies, systems, environments, or relevant population health outcomes.
As you select indicators, consider whether they are useful, accurate, available, practical to collect, and relevant to your evaluation questions.
Decide where the data will come from. Sources may include people, documents, administrative records, observations, surveys, interviews, focus groups, or existing data systems. Consider whether information collected during the Assess Needs & Resources step can provide useful baseline or follow-up data. Strong evaluations often combine qualitative and quantitative information while keeping the amount of data collection realistic.
Before collecting data, determine what kinds of changes you reasonably expect for each indicator and over what period of time. Benchmarks should be meaningful and realistic while still reflecting the change the initiative is trying to achieve.
Some tips to make the data collection process go smoothly:
- Train people who will collect or manage the data.
- Schedule data collection activities and pilot methods when appropriate so the process can be improved before full implementation.
- Track and organize data as it is collected, and protect privacy and confidentiality where required.
- Collect information that has a clear purpose and plan for how it will be used.
- Check in throughout data collection to identify what is working, what could be improved, and whether the original evaluation questions are being answered.
- Periodically review data quality.
- Do the data adequately represent the people, communities, and experiences relevant to the initiative, including groups that might otherwise be underrepresented?
- Are you measuring the short-, medium-, and long-term changes that are relevant to the strategy?
- Are the findings plausible when compared with other data and community knowledge? If not, consider whether the sampling or data collection methods need to be examined.
- Develop a system for analyzing the data: What will be reviewed, by whom, and how often?
- Develop a system for sharing findings with community members and other stakeholders.
Using the data collection and analysis system you established, monitor progress toward short-, medium-, and long-term goals. Evaluation results can inform decisions about continuing, expanding, modifying, or ending a policy or program. Return to the original assessment and problem definition and ask whether the work is affecting the conditions you set out to change.
Sharing results is an important part of evaluation. Different audiences may need different forms of reporting. Evaluation findings can guide decisions about future implementation, explain what the initiative accomplished, support accountability, help funders and partners understand the work, allow other communities to learn from your experience, and contribute to knowledge about what works and under what conditions.
In Summary
County Health Rankings & Roadmaps provides data and evidence-informed resources that communities can use to understand population health and well-being and the conditions that shape health. Beginning in 2025, CHR&R replaced individual county rankings with national Health Groups, allowing communities to examine similarities and differences without treating community health as a competition between counties.
The Take Action process offers a practical way to turn that information into community action. Its current components are Work Together, Assess Needs & Resources, Focus on What's Important, Choose Effective Policies & Programs, Communicate, Act on What's Important, and Evaluate Actions.
These components are not meant to be followed as a rigid one-time sequence. Communities can begin where they are, revisit earlier work when circumstances change, and use data, evidence, community knowledge, relationships, communication, and ongoing evaluation to strengthen their efforts over time.
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