Looking for evidence to support community processes? The processes below have been identified through literature in the field as critical activities for community change and improvement.
Select a process below to access supports for implementing 12 Best Change Processes or activities that have been shown to promote community change and improvement, as well as related resources and citations.
Analyzing Information about the Problem or Goal is a process to assess needs and resources and set priorities for change so that a group's efforts are both grounded in and responsive to community needs and concerns. When groups engage in this process, they examine key behaviors (e.g., youth alcohol use) and personal and environmental factors that affect them (e.g., peer refusal skills, easy access to commercially available alcohol). They also examine community resources that can be used and/or strengthened to address the goal. The process of Analyzing Information about the Problem or Goal can help an initiative to understand why something is a problem and how to address it.
As illustrated, Analyzing Information about the Problem or Goal is a key process to help communities anchor change efforts in a thorough understanding of the problem or goal and how to address it.
Successful change efforts are more likely to occur in communities where residents recognize and support the need for some type of initiative and action. Needs and resource assessments involve community members in "agenda-setting" efforts to identify an issue that is defined as important enough to warrant attention. Community involvement in a process to define and prioritize a group's focus can spark interest, participation, and commitment to subsequent program planning and implementation (e.g., Shortell et al., 2002). The continual process of Analyzing Information about the Problem or Goal can enhance the relevance and appropriateness of a community initiative. It can also set the stage for development of appropriate interventions (see Implementing Effective Interventions) and measurement and interpretation of data for making a difference (see Documenting Progress and Using Feedback) (Israel, Schulz, Parker, & Becker, 1998).
Although the functional mechanisms have not been explicitly tested, community engagement in Analyzing Information about the Problem or Goal may help to:
Yet, community involvement to identify needs and resources for change does not necessarily encourage involvement in other project phases or lead to a sense of community ownership. When assessments exclude and/or data lacks evidence of an expressed community concern, potential collaborators may withdraw (e.g., Goodman, Steckler, Hoover, & Schwartz, 1993). Assessment activities may need not only to clarify and build community awareness and concern (e.g., deliver media or Implement a social marketing effort), but also to strengthen a skill base for taking action (see Assuring Technical Assistance and the relevant toolkits for building core competencies).
A community initiative's strategy must be based on a realistic assessment of community needs and capabilities and resources relative to those needs. For example, In an evaluation of the Community Care Network (CCN) researchers suggested that community involvement in assessment activities (assuring community input) was critical for creating a "community focus" for mobilizing broad and diverse membership and planning partnership priorities for action (Shortell et al., 2002). For example, one rural site developed an interagency council made up on government and not-for-profit agency directors who served the target populations. It also created a community health council that reached out to grassroots leaders and concerned members of the community. Although the former group met to encourage cross-sector collaboration, the latter held quarterly open forums and conducted health service consumer surveys to identify and discuss pressing community concerns. As information was shared with steering, community health, and interagency committees, the project was able to develop and implement programs to address actual community needs (e.g., getting expensive medication into the hands of people who are chronically ill).
The Healthy Cities Indiana project used a comprehensive approach to identify community issues (Ploeg et al., 1996). Project staff provided census data and vital statistics about their city and county to members of the Health Cities Committees. These data were discussed and used to identify gaps in information, which in turn were addressed by conducting local surveys. To ensure community input into the process, partners used a combination of more traditional household surveys as well face-to-face workshops aimed at children, youth, the elderly, and other hard-to-reach populations. As a result, a list of priorities and concerns specific to each city was developed and used to guide action for change.
At present, much of the information available on Analyzing Information about the Problem or Goal does not explicitly manipulate or test this process and its effects on community change and improvement. Although this process has been identified in several empirical and experiential reviews as a key ingredient for advancing change, there is a need for more systematic evaluations of its effects. Such research would provide a better understanding of the factors that enable communities to come together and address shared problems and goals.
Some key research questions include: (a) What knowledge and resources (and limitations and barriers) do key stakeholders bring to an initiative? (b) How well does current knowledge explain the determinants of community issues? And (c) How much of the context needs to be understood to design and conduct effective interventions and evaluations, and to interpret results?
Based on research and experience, we highly recommend Analyzing Information About the Problem or Goal as a key process to advance community change and improvement.
Analyzing Information about the Problem or Goal is a process to assess needs and resources and set priorities for change so that a group's efforts are both grounded in and responsive to community needs and concerns. When groups engage in this process, they examine key behaviors (e.g., youth alcohol use) and personal and environmental factors that affect them (e.g., peer refusal skills, easy access to commercially available alcohol). They also examine community resources that can be used and/or strengthened to address the goal. The process of Analyzing Information about the Problem or Goal can help an initiative to understand why something is a problem and how to address it.
As illustrated, Analyzing Information about the Problem or Goal is a key process to help communities anchor change efforts in a thorough understanding of the problem or goal and how to address it.
Successful change efforts are more likely to occur in communities where residents recognize and support the need for some type of initiative and action. Needs and resource assessments involve community members in "agenda-setting" efforts to identify an issue that is defined as important enough to warrant attention. Community involvement in a process to define and prioritize a group's focus can spark interest, participation, and commitment to subsequent program planning and implementation (e.g., Shortell et al., 2002). The continual process of Analyzing Information about the Problem or Goal can enhance the relevance and appropriateness of a community initiative. It can also set the stage for development of appropriate interventions (see Implementing Effective Interventions) and measurement and interpretation of data for making a difference (see Documenting Progress and Using Feedback) (Israel, Schulz, Parker, & Becker, 1998).
Although the functional mechanisms have not been explicitly tested, community engagement in Analyzing Information about the Problem or Goal may help to:
Yet, community involvement to identify needs and resources for change does not necessarily encourage involvement in other project phases or lead to a sense of community ownership. When assessments exclude and/or data lacks evidence of an expressed community concern, potential collaborators may withdraw (e.g., Goodman, Steckler, Hoover, & Schwartz, 1993). Assessment activities may need not only to clarify and build community awareness and concern (e.g., deliver media or Implement a social marketing effort), but also to strengthen a skill base for taking action (see Assuring Technical Assistance and the relevant toolkits for building core competencies).
A community initiative's strategy must be based on a realistic assessment of community needs and capabilities and resources relative to those needs. For example, In an evaluation of the Community Care Network (CCN) researchers suggested that community involvement in assessment activities (assuring community input) was critical for creating a "community focus" for mobilizing broad and diverse membership and planning partnership priorities for action (Shortell et al., 2002). For example, one rural site developed an interagency council made up on government and not-for-profit agency directors who served the target populations. It also created a community health council that reached out to grassroots leaders and concerned members of the community. Although the former group met to encourage cross-sector collaboration, the latter held quarterly open forums and conducted health service consumer surveys to identify and discuss pressing community concerns. As information was shared with steering, community health, and interagency committees, the project was able to develop and implement programs to address actual community needs (e.g., getting expensive medication into the hands of people who are chronically ill).
The Healthy Cities Indiana project used a comprehensive approach to identify community issues (Ploeg et al., 1996). Project staff provided census data and vital statistics about their city and county to members of the Health Cities Committees. These data were discussed and used to identify gaps in information, which in turn were addressed by conducting local surveys. To ensure community input into the process, partners used a combination of more traditional household surveys as well face-to-face workshops aimed at children, youth, the elderly, and other hard-to-reach populations. As a result, a list of priorities and concerns specific to each city was developed and used to guide action for change.
At present, much of the information available on Analyzing Information about the Problem or Goal does not explicitly manipulate or test this process and its effects on community change and improvement. Although this process has been identified in several empirical and experiential reviews as a key ingredient for advancing change, there is a need for more systematic evaluations of its effects. Such research would provide a better understanding of the factors that enable communities to come together and address shared problems and goals.
Some key research questions include: (a) What knowledge and resources (and limitations and barriers) do key stakeholders bring to an initiative? (b) How well does current knowledge explain the determinants of community issues? And (c) How much of the context needs to be understood to design and conduct effective interventions and evaluations, and to interpret results?
Based on research and experience, we highly recommend Analyzing Information About the Problem or Goal as a key process to advance community change and improvement.
1. Define the community and identify problems or goals the group is interested in addressing.
__ Identify the community of place, experience, and/or interest to focus the group's efforts.
__ Identify the broad issues the group will address in the community to focus the analysis and assessment of information.
2. Engage local people and other key stakeholders in analyzing information about the problem.
__ Provide an opportunity for local people and other stakeholders with varied interests to participate in analyzing the issue.
3. Collect and assess information about the extent of the problem or goal and its importance within the community.
__ Collect and assess information about the history and context of the community and its importance to the problem or goal.
__ Collect and assess information about the extent of the problem or goal and its importance to the community and key stakeholders.
__ Populations affected by the problem have been identified and engaged in assessing its importance.
__ The group has identified and assessed the consequences of the problem for people affected by it.
4. Identify the key behaviors of whom and related environmental factors that affect them.
__ Identify whose behavior needs to change to affect the immediate problem or conditions contributing to the problem.
__ Identify personal factors and environmental factors that put people at risk for (or protect them from) the problem.
5. Identify resources and barriers to addressing the problem or goal.
__ The group has identified potential barriers or resistance to addressing the problem or goal.
__ The group has identified organizational or community resources/assets that can be used to help address the problem or goal.
6. Identify the promising interventions that address the key factors affecting the problem or goal.
__ Provide an opportunity for local people and other key stakeholders to propose potential solutions for addressing the problem/goal.
__ Review evidence of the effectiveness of promising approaches and consider whether what worked elsewhere might work well in the local situation.
7. Use the analysis in developing, adapting, and evaluating the approach for addressing the problem or goal.
__ The group uses or references the assessment or analysis of the problem or goal to inform or support decision-making.
__ The data or information collected in the assessment or analysis is used in evaluating the efforts of the initiative or group.
1. Define the community and identify problems or goals the group is interested in addressing.
Core Supports:
2. Engage local people and other key stakeholders in analyzing information about the problem.
Core Supports:
3. Collect and assess information about the extent of the problem or goal and its importance within the community.
Core Supports:
4. Identify the key behaviors of whom and related environmental factors that affect them.
Core Supports:
5. Identify resources and barriers to addressing the problem or goal.
Core Supports:
6. Identify the promising interventions that address the key factors affecting the problem or goal.
Core Supports:
7. Use the analysis in developing, adapting, and evaluating the approach for addressing the problem or goal.
Core Supports:
Collie-Akers, V., Landry, S., Ehule, N.J. et al. Enhancing the Capacity of Local Health Departments to Address Birth Equity: The Institute for Equity in Birth Outcomes. Matern Child Health J 25, 1010–1018 (2021). https://doi.org/10.1007/s10995-021-03135-1
Florin, P., Mitchell, R., & Stevenson, J. (1993). Identifying training and technical assistance needs in community coalitions: A developmental approach. Health Education Research, 8, 417-432.
Foster-Fishman, P.G, Berkowitz, S.L., Lounsbury, D.W., Jacobson, S., & Allen, N.A. (2001). Building collaborative capacity in community coalitions: A review and integrative framework. American Journal of Community Psychology, 29, 241-261.
Goodman, R.M., Steckler, A., Hoover, S., & Schwartz, R. (1993). A critique of contemporary community health promotion approaches: based on a qualitative review of six programs in Maine. American Journal of Health Promotion, 7, 208-220.
Hogan, C., & Murphey, D. (2002). Outcomes: Reframing responsibility for well-being. A report to the Annie E. Casey Foundation. Baltimore, MD: Annie E. Casey Foundation.
Israel, B.A., Schultz, A.J., Parker, E., & Becker, A.B. (1998). Review of community-based research: Assessing partnership approaches to improve public health. Annual Review of Public Health, 19, 173-202.
Kegler, M.C., & Wyatt, V.H. (2003). A multiple case study of neighborhood partnerships for positive youth development. American Journal of Health Behavior, 27, 156-169.
Kreuter, M.W., Lezin, N.A., & Young, L.A. (2000). Evaluating community-based collaborative mechanisms: Implications for practitioners. Health Promotion Practice, 1, 49-63.
Landry, S., Collie-Akers, V., Foster, K. et al. Assessing the Development of Collective Impact Initiatives Addressing Maternal and Child Health. Matern Child Health J 24, 405–411 (2020). https://doi.org/10.1007/s10995-020-02894-7
Mattessich, P., & Monsey, B. (1992). Collaboration: What makes it work. A review of research literature on factors influencing successful collaboration. Saint Paul, MN: Amherst H. Wilder Foundation.
Mattessich, P., & Monsey, B. (1997). Community building: What makes it work. A review of factors influencing successful community building. Saint Paul, MN: Amherst H. Wilder Foundation.
Ploeg, J., Dobbins, M., Hayward, S., Ciliska, D., Thomas, H., & Underwood, J. (1996). Effectiveness of community development projects.
Shortell, S.M., Zukoski, A.P., Alexander, J.A., Bazzoli, G.J., Conrad, D.A., Hasnain-Wynia, R., et al., (2002). Evaluating partnerships for community health improvement: Tracking the footprints. Journal of Health Politics, Policy, and Law, 27, 49-108.
Sorensen, G., Emmons, K., Hunt, M.K., & Johnston, D. (1998). Implications of the results of community intervention trials. Annual Review of Public Health, 19, 379-416.
Establishing a Vision and Mission is a process of coming together to set direction and focus for the group's efforts. Participating in this process helps a group begin with the end in mind, and to stay focused on the results for which they are aiming. Establishing a vision - a statement of your dream or ideal conditions - and a mission - what you do and why - provides shared language and common purpose for targeted action and intervention.
Establishing a Vision and Mission is a key process to help groups assess, prioritize, and plan for change.
Clarifying a group's common interests -- its vision, mission, values, and principles -- is a process that builds a solid foundation for working together. It enables a group to describe why the effort matters and how it fits within a larger context. This process focuses on creating a sense of common purpose and synergy to bind people together for addressing their goals (Bergstrom, Clark, Hogue, Iyechad, Miller, Mullens, et al., 1995).
Although the functional mechanisms are not well-established, establishing a shared vision and mission may help to:
In addition, periodic renewal of the vision and mission, such as an annual review, may help a partnership adapt to emerging community concerns and create opportunities to address them (Bibeau, Howell, Rife, & Taylor, 1996).
Several studies with collaborative initiatives suggest the importance of community participation and clarifying a specific focus for the effort. For example, in one study of 10 local North Carolina Project ASSIST coalitions targeting smoking prevention, researchers reported that the process of articulating a vision for the coalition was an important factor associated with project implementation. Investigators conducted interviews, observations, document reviews, and surveys of staff and coalition members. Data indicated that coalitions for which the vision was specified had higher levels of implementation than coalitions that were lacking a local vision (e.g., less than 5 versus more than 10 prevention activities per year). By contrast, staff-dominated coalitions where members did not seem to share a vision generally had medium levels of implementation. Coalitions dependent on state-level staff for direction and leadership had the lowest levels of implementation (Kegler, Steckler, Malek, & McLeroy, 1998).
Similarly, initiatives that define a clear and specific focus (e.g., increasing childhood immunizations) bring about much higher rates of change than diffuse efforts that lack specific mission (Fawcett, Francisco, Paine-Andrews, & Schultz, 2000). For example, a comparative study with five coalitions in Massachusetts found that collaborative partnerships with a targeted mission (e.g., to reduce adolescent pregnancy) facilitated five- to six-fold higher rates of community change than initiatives with no particular focus or targeted mission (Francisco, Fawcett, Wolff, & Foster, unpublished data).
In addition, several studies of community-driven initiatives that lacked specific direction suggested the need for such focus. For example, from 1987 to 1992, the Kaiser Family Foundation funded 22 U.S. sites to mobilize communities broadly around health promotion and disease prevention issues such as substance use, teen pregnancy, heart disease, cancer, and injury prevention (Wagner et al., 1991). After five years of a range of activities to address such diverse outcomes, investigators found little evidence of positive changes resulting from interventions (Shortell, 2000; Wagner et al., 2000).The vision and mission may have been too broad for bringing about targeted changes in behaviors or particular health outcomes (e.g., Shortell). As a result, community attempts to target so many issues may have resulted in a diluted intervention that was unable to move population-level outcomes. Accordingly, research suggests the value of including establishing a shared vision and mission as part of a memorandum of collaboration for improvement efforts (Fawcett, Francisco, Paine-Andrews, & Schultz, 2000).
At present, much of the information available on Establishing a Vision and Mission does not explicitly manipulate or test this process and its effects on community change and improvement. Although this process has been identified in several empirical and experiential reviews as a key ingredient for advancing change, there is a need for more systematic evaluations of its effects. Such research would provide a better understanding of the factors that enable communities to come together and address shared problems and goals.
Some key questions for further research include: (a) What kinds of technical assistance activities are effective for helping a group clarify its vision and mission? (b) How can mission statements be geared to address needs of specific sub-groups who may present cultural or other contextual differences? And (c) Under what conditions does establishing vision and mission advance community change (e.g., project activities may not be guided by expressions of value and purpose)?
Based on research and experience, we recommend Establishing a Vision and Mission as a key process to advance community change and improve.
Establishing a Vision and Mission is a process of coming together to set direction and focus for the group's efforts. Participating in this process helps a group begin with the end in mind, and to stay focused on the results for which they are aiming. Establishing a vision - a statement of your dream or ideal conditions - and a mission - what you do and why - provides shared language and common purpose for targeted action and intervention.
Establishing a Vision and Mission is a key process to help groups assess, prioritize, and plan for change.
Clarifying a group's common interests -- its vision, mission, values, and principles -- is a process that builds a solid foundation for working together. It enables a group to describe why the effort matters and how it fits within a larger context. This process focuses on creating a sense of common purpose and synergy to bind people together for addressing their goals (Bergstrom, Clark, Hogue, Iyechad, Miller, Mullens, et al., 1995).
Although the functional mechanisms are not well-established, establishing a shared vision and mission may help to:
In addition, periodic renewal of the vision and mission, such as an annual review, may help a partnership adapt to emerging community concerns and create opportunities to address them (Bibeau, Howell, Rife, & Taylor, 1996).
Several studies with collaborative initiatives suggest the importance of community participation and clarifying a specific focus for the effort. For example, in one study of 10 local North Carolina Project ASSIST coalitions targeting smoking prevention, researchers reported that the process of articulating a vision for the coalition was an important factor associated with project implementation. Investigators conducted interviews, observations, document reviews, and surveys of staff and coalition members. Data indicated that coalitions for which the vision was specified had higher levels of implementation than coalitions that were lacking a local vision (e.g., less than 5 versus more than 10 prevention activities per year). By contrast, staff-dominated coalitions where members did not seem to share a vision generally had medium levels of implementation. Coalitions dependent on state-level staff for direction and leadership had the lowest levels of implementation (Kegler, Steckler, Malek, & McLeroy, 1998).
Similarly, initiatives that define a clear and specific focus (e.g., increasing childhood immunizations) bring about much higher rates of change than diffuse efforts that lack specific mission (Fawcett, Francisco, Paine-Andrews, & Schultz, 2000). For example, a comparative study with five coalitions in Massachusetts found that collaborative partnerships with a targeted mission (e.g., to reduce adolescent pregnancy) facilitated five- to six-fold higher rates of community change than initiatives with no particular focus or targeted mission (Francisco, Fawcett, Wolff, & Foster, unpublished data).
In addition, several studies of community-driven initiatives that lacked specific direction suggested the need for such focus. For example, from 1987 to 1992, the Kaiser Family Foundation funded 22 U.S. sites to mobilize communities broadly around health promotion and disease prevention issues such as substance use, teen pregnancy, heart disease, cancer, and injury prevention (Wagner et al., 1991). After five years of a range of activities to address such diverse outcomes, investigators found little evidence of positive changes resulting from interventions (Shortell, 2000; Wagner et al., 2000).The vision and mission may have been too broad for bringing about targeted changes in behaviors or particular health outcomes (e.g., Shortell). As a result, community attempts to target so many issues may have resulted in a diluted intervention that was unable to move population-level outcomes. Accordingly, research suggests the value of including establishing a shared vision and mission as part of a memorandum of collaboration for improvement efforts (Fawcett, Francisco, Paine-Andrews, & Schultz, 2000).
At present, much of the information available on Establishing a Vision and Mission does not explicitly manipulate or test this process and its effects on community change and improvement. Although this process has been identified in several empirical and experiential reviews as a key ingredient for advancing change, there is a need for more systematic evaluations of its effects. Such research would provide a better understanding of the factors that enable communities to come together and address shared problems and goals.
Some key questions for further research include: (a) What kinds of technical assistance activities are effective for helping a group clarify its vision and mission? (b) How can mission statements be geared to address needs of specific sub-groups who may present cultural or other contextual differences? And (c) Under what conditions does establishing vision and mission advance community change (e.g., project activities may not be guided by expressions of value and purpose)?
Based on research and experience, we recommend Establishing a Vision and Mission as a key process to advance community change and improvement.
1. Convene key stakeholders to guide the development of the group’s vision and mission.
__ Engage key leaders and stakeholders in the development of the vision statement by providing an express what was important, including to the people in the community and other stakeholders.
__ The group has engaged key leaders and stakeholders in the development of the mission statement by providing opportunity to express what the group was going to do and why, including the people in the community and other stakeholders.
2. Establish a vision statement based on ideas that are proposed and accepted by members of the group.
__The group has a written vision statement (usually a few words) for the initiative that is clear, concise, and positive.
__ The vision statement communicates the dream or ideal conditions for the community.
__ The vision statement is understood and shared by members of the community and other stakeholders.
3. Establish a mission statement based on ideas that are proposed and accepted by members of the group.
__ The group has a written mission statement for the initiative.;
__ The mission statement communicates the outcome or end that the group has in mind & the broad approaches used to get there.
4. Review the vision and mission statements for relevance and consistency with the organization’s purpose, and make adjustments as necessary.
__The final vision & mission statement(s) were reviewed & approved by the group for consistency with the group’s purpose.
__ The group regularly reviews the vision and mission statements and makes necessary adjustments.
5. Apply and use the vision and mission statements.
__ Members of the group can recite or paraphrase the mission statements of the organization.
__ The group or effort routinely communicates the mission statement to others.
__ The mission statement is referred to by the organization or group when making decisions.
1. Convene key stakeholders to guide the development of the group’s vision and mission.
Core Supports:
2. Establish a vision statement based on ideas that are proposed and accepted by members of the group.
The group has a written vision statement (usually a few words) for the initiative that is clear, concise, and positive.
Core Supports:
3. Establish a mission statement based on ideas that are proposed and accepted by members of the group.
Core Supports:
4. Review the vision and mission statements for relevance and consistency with the organization’s purpose, and make adjustments as necessary.
Core Supports:
5. Apply and use the vision and mission statements.
Core Supports:
Bergstrom, A., Clark, R., Hogue, T., Iyechad, T., Miller, J., Mullen, S., Perkins, D., Rowe, E., Russell, J., Simon-Brown, V., Slinski, M., Snider, A., & Thurston, F. (1995). Collaboration framework--addressing community capacity. Fargo, ND: National Network for Collaboration. Available at: http://www.uvm.edu/extension/community/nnco/collab/framework.html
Bibeau, Howell, Rife, & Taylor (1996). The role of a community coalition in the development of health services for the poor and uninsured. International Journal of Health Services: Planning, Administration, Evaluation. 26(1): 93-110.
Collie-Akers, V., Landry, S., Ehule, N.J. et al. Enhancing the Capacity of Local Health Departments to Address Birth Equity: The Institute for Equity in Birth Outcomes. Matern Child Health J 25, 1010–1018 (2021). https://doi.org/10.1007/s10995-021-03135-1
Fawcett, S. B., V. T. Francisco, et al. (1999). "Working Together for Health Communities: A Research-Based Memorandum of Collaboration."
Fawcett, S.B., Francisco, V.T., Paine-Andrews, A., & Schultz, J.A. (2000). A model memorandum of collaboration: A proposal. Public Health Reports, 115, 174-179.
Foster-Fishman, P.G, Berkowitz, S.L., Lounsbury, D.W., Jacobson, S., & Allen, N.A. (2001). Building collaborative capacity in community coalitions: A review and integrative framework. American Journal of Community Psychology, 29, 241-261.
Gottlieb, N. H., Brink, S. G., & Gingiss, L. P. (1993). Correlates of coalition effectivness: The Smoke Free Class of 2000 Program. Health Education Research, 8(3), 375-384.
Herman, K. A., Wolsfon, M., & Forster, J. L. (1993). The evolution, operation and future of Minnesota SAFPLAN: A coalition for family planning. Health Education Research, 8(3), 331-344.
Hogan, C., & Murphey, D. (2002). Outcomes: Reframing responsibility for well-being. A report to the Annie E. Casey Foundation. Baltimore, MD: Annie E. Casey Foundation.
Johnston, J.A., Marmet, P.F., Coen, F.S., Fawcett, S.B., Harris, K.J. Kansas LEAN: An effective coalition for nutrition education and dietary change. J Nutr Edu, 1996;115–118.
Kreuter, M.W., Lezin, N.A., & Young, L.A. (2000). Evaluating community-based collaborative mechanisms: Implications for practitioners. Health Promotion Practice, 1, 49-63.
Kumpfer, K. L., Turner, C., Hopkins, R., & Librett, J. (1993). Leadership and team effectiveness in community coalitions for the prevention of alcohol and other drug abuse. Health Education Research, 8(3), 359-374.
Landry, S., Collie-Akers, V., Foster, K. et al. Assessing the Development of Collective Impact Initiatives Addressing Maternal and Child Health. Matern Child Health J 24, 405–411 (2020). https://doi.org/10.1007/s10995-020-02894-7
Mattessich, P., & Monsey, B. (1992). Collaboration: What makes it work. A review of research literature on factors influencing successful collaboration. Saint Paul, MN: Amherst H. Wilder Foundation.
Nezlek & Galano (1993). Developing and maintaining state-wide adolescent pregnancy prevention coalitions: a preliminary investigation. Health Educ Res. 1993 Sep;8(3):433-47
Rogers, Howard-Pitney, Feighery, Altman, Endres, & Roesler (1993).
Roussos, S.T., & Fawcett, S.B. (2000). A review of collaborative partnerships as a strategy for improving community health. Annual Review of Public Health, 21, 369-402.
Schorr, L., K. Sylvester, et al. (1999). Strategies to Achieve a Common Purpose: Tools for Turning Good Ideas into Good Policies. Washington, D.C., Institute for Educational Leadership.
Shortell, S.M., Zukoski, A.P., Alexander, J.A., Bazzoli, G.J., Conrad, D.A., Hasnain-Wynia, R., et al., (2002). Evaluating partnerships for community health improvement: Tracking the footprints. Journal of Health Politics, Policy, and Law, 27, 49-108.
Wagner et al (1991).
Wagner et al (2000).
Defining Organizational Structure and Operating Mechanisms is a process of establishing and arranging clear ways to work together and get things done. When groups engage in Defining Organizational Structure and Operating Mechanisms, they take steps to (a) Organize the effort (i.e., form a structure, determine clear roles and responsibilities, levels of authority) and (b) Support the members (i.e., establish protocols for decision-making and conflict resolution, create a communication plan). The process of Defining Organizational Structure and Operating Mechanisms helps create a collaborative team that is both cohesive and task focused.
Defining Organizational Structure and Operating Mechanisms is a key process to help groups come together to plan and take effective action for change.
Defining a structure and operating procedures can help to create logistical conditions and social relationships to support collaborative action for change. Participation in this process can help groups develop an actual infrastructure for getting the work done, and also build a level of "relational capacity" that is necessary for working together, sharing power, minimizing differences, and valuing diversity (Foster-Fishman, Berkowitz, Lounsbury, Jacobson, & Allen, 2001). Such clarity and formality help to create a stable structure and operating procedures for strategic action.
Although the exact mechanisms are not clear for how Defining Organizational Structure and Operating Mechanisms contribute to the success of an initiative, participation in this process may help groups to:
Issues related to the management of community health initiatives have been identified as critical for implementation. In a multiple case study of five neighborhood partnerships, investigators identified mechanisms for communication as a critical factor associated with community mobilization. For example, in addition to project updates at meetings, the HEART of OKC partnership kept members informed about task force activities through the Vietnamese newspaper (especially a full-page youth forum), letters to remind members about meetings and activities, and personal contacts through emails, phone calls, and informal conversations (Kegler & Wyatt, 2003). By contrast, similar but less effective groups relied predominantly on meetings and minutes to keep people involved. Other important organizational factors related to implementation included decision-making and conflict management procedures.
Problems associated with governance and management of community health initiatives have been cited as possible reasons for the inability of these efforts to demonstrate significant, measurable outcomes (Mitchell & Shortell, 2000). On one hand, evaluation of the Community Care Network (CCN) partnership project indicated that development of committee structures and operating procedures was associated with successful implementation of the plan for change. Partnerships that achieved greater progress on their action plans used a number of strategies to manage and channel conflict in more positive directions (e.g., clear and shared guidelines regarding attendance criteria prior to membership suspension) than those that were less successful (Shortell et al., 2002). In addition, projects that created a process of decision-making that was perceived as fair and open to all, and provided updated information to participants to keep everyone informed, reported higher levels of progress. By contrast, those partnerships least successful in addressing their priorities did not create mechanisms to actively manage community input or effectively focus member efforts toward collective action. In the absence of such mechanisms, groups lacked a level of "social capital," relationships through which resources flow, to set the stage for moving forward collectively.
At present, much of the information available on Defining Organizational Structure and Operating Mechanisms does not explicitly manipulate or test this process and its effects on community change and improvement. Although this process has been identified in several empirical and experiential reviews as a key ingredient for advancing change, there is a need for more systematic evaluations of its effects. Such research would provide a better understanding of the factors that enable communities to come together and address shared problems and goals.
Some key research questions include: (a) What framework can describe a systematic way of thinking about the contribution of governance and management to effectiveness? (b) How do governance and management issues affect an effort's ability to obtain needed resources, implement activities, and sustain efforts? And (c) What organizational structures and operating mechanisms lend themselves best for producing plans and implementing activities that successfully affect outcomes?
Based on research and experience, we highly recommend Defining Organizational Structure and Operating Mechanisms as a key process to advance community change and improvement.
Defining Organizational Structure and Operating Mechanisms is a process of establishing and arranging clear ways to work together and get things done. When groups engage in Defining Organizational Structure and Operating Mechanisms, they take steps to (a) Organize the effort (i.e., form a structure, determine clear roles and responsibilities, levels of authority) and (b) Support the members (i.e., establish protocols for decision-making and conflict resolution, create a communication plan). The process of Defining Organizational Structure and Operating Mechanisms helps create a collaborative team that is both cohesive and task focused.
Defining Organizational Structure and Operating Mechanisms is a key process to help groups come together to plan and take effective action for change.
Defining a structure and operating procedures can help to create logistical conditions and social relationships to support collaborative action for change. Participation in this process can help groups develop an actual infrastructure for getting the work done, and also build a level of "relational capacity" that is necessary for working together, sharing power, minimizing differences, and valuing diversity (Foster-Fishman, Berkowitz, Lounsbury, Jacobson, & Allen, 2001). Such clarity and formality help to create a stable structure and operating procedures for strategic action.
Although the exact mechanisms are not clear for how Defining Organizational Structure and Operating Mechanisms contribute to the success of an initiative, participation in this process may help groups to:
Issues related to the management of community health initiatives have been identified as critical for implementation. In a multiple case study of five neighborhood partnerships, investigators identified mechanisms for communication as a critical factor associated with community mobilization. For example, in addition to project updates at meetings, the HEART of OKC partnership kept members informed about task force activities through the Vietnamese newspaper (especially a full-page youth forum), letters to remind members about meetings and activities, and personal contacts through emails, phone calls, and informal conversations (Kegler & Wyatt, 2003). By contrast, similar but less effective groups relied predominantly on meetings and minutes to keep people involved. Other important organizational factors related to implementation included decision-making and conflict management procedures.
Problems associated with governance and management of community health initiatives have been cited as possible reasons for the inability of these efforts to demonstrate significant, measurable outcomes (Mitchell & Shortell, 2000). On one hand, evaluation of the Community Care Network (CCN) partnership project indicated that development of committee structures and operating procedures was associated with successful implementation of the plan for change. Partnerships that achieved greater progress on their action plans used a number of strategies to manage and channel conflict in more positive directions (e.g., clear and shared guidelines regarding attendance criteria prior to membership suspension) than those that were less successful (Shortell et al., 2002). In addition, projects that created a process of decision-making that was perceived as fair and open to all, and provided updated information to participants to keep everyone informed, reported higher levels of progress. By contrast, those partnerships least successful in addressing their priorities did not create mechanisms to actively manage community input or effectively focus member efforts toward collective action. In the absence of such mechanisms, groups lacked a level of "social capital," relationships through which resources flow, to set the stage for moving forward collectively.
At present, much of the information available on Defining Organizational Structure and Operating Mechanisms does not explicitly manipulate or test this process and its effects on community change and improvement. Although this process has been identified in several empirical and experiential reviews as a key ingredient for advancing change, there is a need for more systematic evaluations of its effects. Such research would provide a better understanding of the factors that enable communities to come together and address shared problems and goals.
Some key research questions include: (a) What framework can describe a systematic way of thinking about the contribution of governance and management to effectiveness? (b) How do governance and management issues affect an effort's ability to obtain needed resources, implement activities, and sustain efforts? And (c) What organizational structures and operating mechanisms lend themselves best for producing plans and implementing activities that successfully affect outcomes?
Based on research and experience, we highly recommend Defining Organizational Structure and Operating Mechanisms as a key process to advance community change and improvement.
1. Assess organizational needs and resources and develop goals to enhance the functioning of the organization.
__ The group regularly assesses organizational strengths and weaknesses.
__ The group regularly assesses organizational resources and community assets
__ The group regularly identifies organizational needs or barriers.
__ Assess organizational needs and resources include diverse stakeholders with varied roles and responsibilities within the group
__ The organization has stated goals and objectives for improving the internal structure and operations of the organization.
2. Develop an organizational structure.
__ Establish a clear governing structure appropriate for the goals of the organization and its stage of development.
__ Establish a clearly defined structure or method for operating to support the functions and activities of the organization or group.
__ There are formal roles and responsibilities established for all levels of the organizational structure.
__ The group regularly reviews the structure of the organization to identify potential needs.
3. Establish operating mechanisms for doing things within the organization.
__ The organization has bylaws.
__ The organization has a document that summarizes the responsibilities and procedures of the organization including protocols and rules for decision making, information sharing, conflict resolution, and financial policies.
__ The group uses and regularly reviews the operational procedures and makes any necessary changes.
__ The group holds regular and consistent meetings at all appropriate levels.
__ There is a clear method and protocol for communication in the organization across multiple levels.
__ The organization appropriately documents and records organizational activities.
__ The group has adequate access to technology including: (a) communication technology and (b) computer equipment and software.
__ The group has an appropriate working environment and sufficient resources necessary to support the operations of the group.
4. Determine how volunteers will be recruited and used in the organization.
__ Decide whether volunteers are appropriate to be used in the organization at the current stage of development.
__ The organization has a process or plan for identifying and recruiting volunteers
__ The organization or group recruits volunteers with diverse skills, professional expertise, background, and experience.
__ The organization provides orientation, training, and supervision for all volunteers.
__ All volunteer positions have written roles and responsibilities that are clearly stated.
__ Volunteers are screened as appropriate for their roles and responsibilities in the organization.
__ There is a process for ensuring that volunteers are matched with appropriate volunteer opportunities that maximize the interest, skills, knowledge, expertise, and experience of the volunteers.
__ The organization has identified and protected volunteers from any liabilities.
5. Determine how the organization will recruit, hire, and use paid employees.
__ The organization has identified which roles and responsibilities are better served by staff, consultants, and/or volunteers.
__ The organization has written job descriptions and responsibilities for all paid positions.
__ The organization has a fair process and written protocol for recruiting and hiring staff and consultants.
__ The organization regularly identifies the training and technical support needs of staff and develops ongoing plans to assure necessary training or technical support for staff members.
__ The organization has an appropriate division of labor in which tasks are appropriately delegated to staff and other paid positions.
__ All staff are adequately supervised and supported and have some form of accountability for work performance.
__The organization formally recognizes and rewards the performance and contributions of volunteers.
6. Evaluate and recognize the performance of staff and volunteers.
__ The organization formally recognizes and rewards the performance and accomplishments of staff on a regular basis.
__ Volunteers and staff are given formal opportunities to regularly assess/provide feedback to management regarding the group.
__ There is a clear evaluation process used by the group to assess performance of staff and volunteers (including board members.
__ Establish clear benchmarks and a written statement for all staff and volunteers (including board members) regarding how individual performance will be measured and assessed.
7. Monitor financial resources of the organization.
__ The organization has clearly identified and written roles and responsibilities for the governing structure - staff for monitoring the financial resources of the organization.
__ The organization has an operational budget that indicates all income and expenses from all revenue sources.
__ Written policies and procedures are established and followed to assure appropriate financial procedures and fiscal controls.
__ The organization or group has identified an appropriate level for cash operating reserves.
__ The governing structure of the organization understands the financial position of the organization and regularly reviews financial statements and reports.
__ Conduct regular audit and review of financial records by a finance professional with no vested interest in the organization.
__ The governing body monitor requires financial reports and assures reporting requirements of appropriate federal and state agencies and funding agencies are appropriately filed and submitted.
__ The organization has and uses a plan for securing financial resources for the organization
Primary Community Tool Box Supports for this Process:
1. Assess organizational needs and resources and develop goals to enhance the functioning of the organization.
Core Supports:
2. Develop an organizational structure.
Core Supports:
3. Establish operating mechanisms for doing things within the organization.
Core Supports:
4. Determine how volunteers will be recruited and used in the organization.
Core Supports:
5. Determine how the organization will recruit, hire, and use paid employees.
Core Supports:
6. Evaluate and recognize the performance of staff and volunteers.
Core Supports:
7. Monitor financial resources of the organization.
Core Supports:
Collie-Akers, V., Landry, S., Ehule, N.J. et al. Enhancing the Capacity of Local Health Departments to Address Birth Equity: The Institute for Equity in Birth Outcomes. Matern Child Health J 25, 1010–1018 (2021). https://doi.org/10.1007/s10995-021-03135-1
Florin, P., Mitchell, R., & Stevenson, J. (1993). Identifying training and technical assistance needs in community coalitions: A developmental approach. Health Education Research, 8, 417-432.
Foster-Fishman, P.G, Berkowitz, S.L., Lounsbury, D.W., Jacobson, S., & Allen, N.A. (2001). Building collaborative capacity in community coalitions: A review and integrative framework. American Journal of Community Psychology, 29, 241-261.
Goodman, Wheeler, & Lee (1995). Evaluation of the Heart To Heart Project: lessons from a community-based chronic disease prevention project. Am J Health Promot. 1995 Jul-Aug;9(6):443-55.
Goodman, Liburd, & Green-Phillips (2001). The formation of a complex community program for diabetes control: lessons learned from a case study of Project DIRECT. J Public Health Manag Pract. 2001 May;7(3):19-29.
Israel, B.A., Schultz, A.J., Parker, E., & Becker, A.B. (1998). Review of community-based research: Assessing partnership approaches to improve public health. Annual Review of Public Health, 19, 173-202.
Kegler, M.C., Steckler, A., Malek, S.H., & McLeroy, K. (1998). A multiple case study of implementation in 10 local Project ASSIST coalitions in North Carolina. Health Education Research, 13, 225-238.
Kegler, M.C., & Wyatt, V.H. (2003). A multiple case study of neighborhood partnerships for positive youth development. American Journal of Health Behavior, 27, 156-169.
Kreuter, M.W., Lezin, N.A., & Young, L.A. (2000). Evaluating community-based collaborative mechanisms: Implications for practitioners. Health Promotion Practice, 1, 49-63.
Landry, S., Collie-Akers, V., Foster, K. et al. Assessing the Development of Collective Impact Initiatives Addressing Maternal and Child Health. Matern Child Health J 24, 405–411 (2020). https://doi.org/10.1007/s10995-020-02894-7
Mattessich, P., & Monsey, B. (1992). Collaboration: What makes it work. A review of research literature on factors influencing successful collaboration. Saint Paul, MN: Amherst H. Wilder Foundation.
Mattessich, P., & Monsey, B. (1997). Community building: What makes it work. A review of factors influencing successful community building. Saint Paul, MN: Amherst H. Wilder Foundation.
Merzel, C., & D'Afflitti, J. (2003). Reconsidering community-based health promotion: Promise, performance, and potential. American Journal of Public Health, 93, 557-574.
Mitchell, S.M., & Shortell, S.M. (2000). The governance and management of effective community health partnerships: A typology for research, policy, and practice. Milbank Quarterly, 78, 241-289.
Parker, E.A., Eng, E., Laraia, B., Ammerman, A., Dodds, J., Margolis, L., et al. (1998). Coalition building for prevention: Lessons learned from the North Carolina community-based public health initiative. Journal of Health Management Practice, 4, 25-36.
Ploeg, J., Dobbins, M., Hayward, S., Ciliska, D., Thomas, H., & Underwood, J. (1996). Effectiveness of community development projects.
Shortell, S.M., Zukoski, A.P., Alexander, J.A., Bazzoli, G.J., Conrad, D.A., Hasnain-Wynia, R., et al., (2002). Evaluating partnerships for community health improvement: Tracking the footprints. Journal of Health Politics, Policy, and Law, 27, 49-108.
The Tamarack Institute. (2018, February 9). OTF Collective Action Webinar: Collaborative Governance. YouTube. https://www.youtube.com/watch?v=Hj9xHg_nWWI
Arranging for Community Mobilizers is a process that assures that people are available to help plan, take action, and adapt the community change and improvement effort. It involves (a) Arranging needed financial and human resources, (b) Engaging and prompting people to do things themselves, and (c) Helping people to plan, take action, and evaluate the effort. The process of Arranging for Community Mobilizers helps groups prioritize resources for organizing efforts that promote community involvement and commitment to the effort. When groups engage in this process, they are mobilizing community support and engaging in ongoing relationship-building for change.
Arranging for Community Mobilizers is a key process to help communities implement targeted action for community and system change and related improvements.
The work of community change and improvement requires people --- known as community mobilizers or organizers --- who "start where people are" and help maintain the effort long enough to effect intended outcomes (Sorensen, Emmons, Hunt, & Johnston, 1998). In particular, community organizers or mobilizers play a critical role to activate and sustain support for collaborative action and follow-through on priorities in the action plan. Community mobilizers are critical collaborators who take the particular lead on (a) Building relationships with key constituents and (b) Implementing particular intervention strategies to pursue community and system change as outlined by the action plan (Fawcett, Francisco, Paine-Andrews, & Schultz, 2000; Israel, Schulz, Parker, & Becker, 1998).
Although the exact contribution of community mobilization remains unclear, Arranging for Community Mobilizers may help groups to:
Successful community health and development efforts often include community organizers who take the lead on implementing programs, policies, and practices for community improvement. In particular, leading with a community organizing approach can enable efforts to create and enhance efforts of other agents of change. For example, Ploeg et al. (1996) described the important contribution of community organizers to three community development efforts. In the first, an effort in Toronto involved low-income seniors who worked with a community organizer from a community health center to initiative services such as recycling, recreation, and transportation in their community. In the second, residents in a Mexican American community were trained as community health organizers, and developed a community immunization clinic to increase the number of fully immunized children. Finally, in the Tenderloin Senior Outreach Project, low-income seniors living in single-room occupancy hotels in San Francisco worked with community mobilizers to address issues related to crime. Through leadership training and coalition building, the seniors established mini-markets and safe-houses to address identified concerns of access to food and crime. Overall, investigators clarified the community organizer's role in "professional advocacy" as acting with community members, not for them. Their aim was to enable individuals and communities to set their own agendas and develop skills to become their own advocates.
In the East Side Village Health Worker Partnership of the Detroit Community-Academic Prevention Research Center, particular resources were devoted to selecting and training community members as community organizers. Engagement of these members who were familiar and conducted outreach with the community was essential for several reasons:
Their community experience, credibility, and support contributed to the successful response rate (81%). In particular, community mobilizers also facilitated a bridge between researchers and disenfranchised communities who are often challenged by differences in ethnicity, class, and issues of trust (Schultz, Parker, Israel, Becker, Maciak, & Hollis, 1998).
In a review of exemplars in community-based research for preventing cardiovascular disease, Mittelmark, Hunt, Heath, & Schmid (1993) named the process of arranging for community mobilizers as the centerpiece of a community change and improvement effort. Among "first" and "second" generation programs, they identified the process of selecting, training, and providing technical support to a community mobilizer as the most critical decisions and resources for a community prevention program. Most often, the results of this process included (a) multi-sectoral involvement by business, government, education, and health leaders and (b) leveraged resources (e.g., technical assistance, time, space, and incentives). Overall, the enduring lesson from these exemplar programs emphasized the process of community mobilization as the core of successful programs. Investigators suggested greater attention to the process rather than the material aspects of community change and improvement.
At present, much of the information available on Arranging for Community Mobilizers does not explicitly manipulate or test this process and its effects on community change and improvement. Although this process has been identified as a key ingredient for advancing change, there is a need for more systematic evaluations of its implementation and effects. Such research would provide a better understanding of the factors that enable communities to come together and address shared problems and goals.
Some key research questions include: (a) What activities characterize the work of effective mobilizers or organizers? (b) What is the role of local people as agents (champions) of change?(c) What knowledge and resources (and limitations and barriers) do key stakeholders bring to the effort? And (d) What strategies (e.g., skills training) prepare community members to be effective as agents of community change and improvement efforts?
Based on research and experience, we recommend Arranging for Community Mobilizers as a key process to advance community change and improvement.
Arranging for Community Mobilizers is a process that assures that people are available to help plan, take action, and adapt the community change and improvement effort. It involves (a) Arranging needed financial and human resources, (b) Engaging and prompting people to do things themselves, and (c) Helping people to plan, take action, and evaluate the effort. The process of Arranging for Community Mobilizers helps groups prioritize resources for organizing efforts that promote community involvement and commitment to the effort. When groups engage in this process, they are mobilizing community support and engaging in ongoing relationship-building for change.
Arranging for Community Mobilizers is a key process to help communities implement targeted action for community and system change and related improvements.
The work of community change and improvement requires people --- known as community mobilizers or organizers --- who "start where people are" and help maintain the effort long enough to effect intended outcomes (Sorensen, Emmons, Hunt, & Johnston, 1998). In particular, community organizers or mobilizers play a critical role to activate and sustain support for collaborative action and follow-through on priorities in the action plan. Community mobilizers are critical collaborators who take the particular lead on (a) Building relationships with key constituents and (b) Implementing particular intervention strategies to pursue community and system change as outlined by the action plan (Fawcett, Francisco, Paine-Andrews, & Schultz, 2000; Israel, Schulz, Parker, & Becker, 1998).
Although the exact contribution of community mobilization remains unclear, Arranging for Community Mobilizers may help groups to:
Successful community health and development efforts often include community organizers who take the lead on implementing programs, policies, and practices for community improvement. In particular, leading with a community organizing approach can enable efforts to create and enhance efforts of other agents of change. For example, Ploeg et al. (1996) described the important contribution of community organizers to three community development efforts. In the first, an effort in Toronto involved low-income seniors who worked with a community organizer from a community health center to initiative services such as recycling, recreation, and transportation in their community. In the second, residents in a Mexican American community were trained as community health organizers, and developed a community immunization clinic to increase the number of fully immunized children. Finally, in the Tenderloin Senior Outreach Project, low-income seniors living in single-room occupancy hotels in San Francisco worked with community mobilizers to address issues related to crime. Through leadership training and coalition building, the seniors established mini-markets and safe-houses to address identified concerns of access to food and crime. Overall, investigators clarified the community organizer's role in "professional advocacy" as acting with community members, not for them. Their aim was to enable individuals and communities to set their own agendas and develop skills to become their own advocates.
In the East Side Village Health Worker Partnership of the Detroit Community-Academic Prevention Research Center, particular resources were devoted to selecting and training community members as community organizers. Engagement of these members who were familiar and conducted outreach with the community was essential for several reasons:
Their community experience, credibility, and support contributed to the successful response rate (81%). In particular, community mobilizers also facilitated a bridge between researchers and disenfranchised communities who are often challenged by differences in ethnicity, class, and issues of trust (Schultz, Parker, Israel, Becker, Maciak, & Hollis, 1998).
In a review of exemplars in community-based research for preventing cardiovascular disease, Mittelmark, Hunt, Heath, & Schmid (1993) named the process of arranging for community mobilizers as the centerpiece of a community change and improvement effort. Among "first" and "second" generation programs, they identified the process of selecting, training, and providing technical support to a community mobilizer as the most critical decisions and resources for a community prevention program. Most often, the results of this process included (a) multi-sectoral involvement by business, government, education, and health leaders and (b) leveraged resources (e.g., technical assistance, time, space, and incentives). Overall, the enduring lesson from these exemplar programs emphasized the process of community mobilization as the core of successful programs. Investigators suggested greater attention to the process rather than the material aspects of community change and improvement.
At present, much of the information available on Arranging for Community Mobilizers does not explicitly manipulate or test this process and its effects on community change and improvement. Although this process has been identified as a key ingredient for advancing change, there is a need for more systematic evaluations of its implementation and effects. Such research would provide a better understanding of the factors that enable communities to come together and address shared problems and goals.
Some key research questions include: (a) What activities characterize the work of effective mobilizers or organizers? (b) What is the role of local people as agents (champions) of change?(c) What knowledge and resources (and limitations and barriers) do key stakeholders bring to the effort? And (d) What strategies (e.g., skills training) prepare community members to be effective as agents of community change and improvement efforts?
Based on research and experience, we recommend Arranging for Community Mobilizers as a key process to advance community change and improvement.
1. Identify the need for community mobilization.
__ The group has identified a need for an individual or multiple individuals to serve as a community mobilizer for the initiative and be responsible for (a) building relationship with constituents and key stakeholders and (b) facilitating changes in the community.
__ The group currently has an individual or multiple individuals that as a core function of their job are responsible for (a) building relationship with constituents and key stakeholders and (b) facilitating changes in the community.
2. Define the roles and responsibilities of the community mobilizer or organizer.
__ The community mobilizer (or individuals serving in this capacity) has a written position description that defines the expected roles and responsibilities necessary to bring about change in the community related to the initiative’s mission.
__The community mobilizer (or individuals serving in this capacity) has the qualities, experience, knowledge, and skills appropriate for working in the target community or with the target population.
__ The mobilizer (or individuals serving in this capacity) is responsible for building and enhancing relationships with the community and its partners as a function of the position.
__ The mobilizer (or individuals serving in this capacity) is responsible for facilitating changes in the community.
3. Arrange for a community mobilizer.
__ The group considered if the community mobilizer function is already or could be fulfilled by current staff or volunteers.
__ The group has determined an appropriate arrangement for the community mobilizer position.
__ An appropriate work environment and resources have been designated to support the community mobilizer(s) (or a similar position).
__ The group has recruited, hired, or designated person(s) to serve as a mobilizer for the initiative.
4. Assure the effective functioning of the community mobilizer.
__ The group provides training, support, and feedback for the community mobilizer.
__ The community mobilizer is knowledgeable of the history of the organization, community, and initiative.
__ The current community mobilizer works effectively with diverse members and representatives of the targeted community/population.
__ The community mobilizer has helped the group to establish or enhance relationships with key stakeholder including partners and individuals with influence, resources, and authority in the community.
__ The community mobilizer has helped the group to implement activities and changes related to the initiative’s mission.
__ The community mobilizer is considered a resource or asset by the target community or population.
__ The community mobilizer(s) has a presence in the target community or with the target population
1. Identify the need for community mobilization.
Core Supports:
2. Define the roles and responsibilities of the community mobilizer or organizer.
Core Supports:
3. Arrange for a community mobilizer.
Core Supports:
4. Assure the effective functioning of the community mobilizer.
Core Supports:
Collie-Akers, V., Landry, S., Ehule, N.J. et al. Enhancing the Capacity of Local Health Departments to Address Birth Equity: The Institute for Equity in Birth Outcomes. Matern Child Health J 25, 1010–1018 (2021). https://doi.org/10.1007/s10995-021-03135-1
Fawcett, S.B., Francisco, V.T., Paine-Andrews, A., & Schultz, J.A. (2000). A model memorandum of collaboration: A proposal. Public Health Reports, 115, 174-179.
Florin, P., Mitchell, R., & Stevenson, J. (1993). Identifying training and technical assistance needs in community coalitions: A developmental approach. Health Education Research, 8, 417-432.
Foster-Fishman, P.G, Berkowitz, S.L., Lounsbury, D.W., Jacobson, S., & Allen, N.A. (2001). Building collaborative capacity in community coalitions: A review and integrative framework. American Journal of Community Psychology, 29, 241-261.
Israel, B.A., Schultz, A.J., Parker, E., & Becker, A.B. (1998). Review of community-based research: Assessing partnership approaches to improve public health. Annual Review of Public Health, 19, 173-202.
Landry, S., Collie-Akers, V., Foster, K. et al. Assessing the Development of Collective Impact Initiatives Addressing Maternal and Child Health. Matern Child Health J 24, 405–411 (2020). https://doi.org/10.1007/s10995-020-02894-7
Mattessich, P., & Monsey, B. (1992). Collaboration: What makes it work. A review of research literature on factors influencing successful collaboration. Saint Paul, MN: Amherst H. Wilder Foundation.
Mittelmark, M.B., Hunt, M.K., Heath, G.W., & Schmid, T.L. (1993). Realistic outcomes: Lessons from community-based research and demonstration programs for the prevention of cardiovascular diseases. Journal of Public Health Policy, 14, 437-462.
Ploeg, J., Dobbins, M., Hayward, S., Ciliska, D., Thomas, H., & Underwood, J. (1996). Effectiveness of community development projects. Retrieved May 16, 2002
Roussos, S.T., & Fawcett, S.B. (2000). A review of collaborative partnerships as a strategy for improving community health. Annual Review of Public Health, 21, 369-402.
Schultz, A. P., E.; Israel, B.; Becker, A; Maciak, B.; and Hollis, R. (1998). "Conducting a participatory community-based survey: Collecting and interpreting data for a community health intervention on Detroit's East Side." Journal of Public Health Management and Practice 4(2): 10-24.
Sorensen, G., Emmons, K., Hunt, M.K., & Johnston, D. (1998). Implications of the results of community intervention trials. Annual Review of Public Health, 19, 379-416.
Tireless 'Ms. Jessie' Cultivates Next Generation of Neighborhood Leaders from Flatland.
Developing and Using Action Plans is a process of identifying what to do or change and who will do what by when to do it. The process and resulting plan may develop over several meetings within a month, or it can take well over a year before activities are implemented. When groups engage in this process, they are defining goals, objectives, and action statements that are concrete, clear, attainable, and measurable. Subsequently, groups can use these specific goal statements to direct project activities and set priorities. The process of Developing and Using Action Plans defines the effort's purpose as well as the specific tasks or projects defined as necessary by the group to accomplish its shared vision and mission.
Developing and Using Action Plans is a key process to help groups implement targeted action and intervention for change.
Developing and Using Action Plans enables groups to focus and collaboratively act on priorities to resolve issues, and work towards common goals (Fawcett, Francisco, Paine-Andrews, & Schultz, 2000; Roussos & Fawcett, 2000). Through this process, groups identify real strategies for addressing problems considered important to local collaborators. The process of Developing and Using Action Plans engages community partners in creating the task focus needed to achieve a common set of targeted goals and objectives (Foster-Fishman, Berkowitz, Lounsbury, Jacobson, & Allen, 2001; Israel, Schulz, Parker, & Becker, 1998), and even experience a progression of immediate and subsequent successes that can aid in establishing enthusiasm and project momentum.
Although the functional mechanisms have not been explicitly tested, Developing and Using Action Plans may help groups to:
As with other processes that engage community partners, action planning may lead to internal conflicts or invite potential opposition, especially when (a) time constraints force decisions before relationships have been built (e.g., Goodman, Steckler, Hoover, & Schwartz, 1993) or (b) certain community constituents are overlooked or excluded such as low-income or minority communities (Parker et al., 1998).
Action planning often constitutes the critical missing link in the ability of partnerships to advance beyond talk to implementation to maintenance of change and effects. Planning is often the most essential but time-consuming task for matching interventions and strategies to community needs and objectives for change (Kreuter, Lezin, & Young, 2000). From 1990-present, the Work Group for Community Health and Development has used a consistent measurement system and naturally-occurring time series designs to identify factors associate with discontinuities in rates of community change (Fawcett, Francisco, Paine-Andrews, & Schultz, 2000; Roussos & Fawcett, 2000). Action planning is consistently associated with accelerated rates of change for a wide variety of community efforts such as substance abuse and adolescent pregnancy.
Similarly, the process of establishing concrete, attainable goals and objectives gave six public/private collaborative projects in a 1983 study a roadmap of specific tasks for action and reporting on progress. Defining success in terms of measurable goals and specific problems, instead of contrived means of cooperation, was a contributing factor to success.The real products of intergovernmental negotiations were the solutions of problems considered important to local actors - such as group-home zoning ordinances, housing units for the mentally ill, the provision of emergency shelter for persons who were homeless, new types of classroom instruction, and increased access to services resulted from careful attention to implementing strategies to address unmet needs (Mattessich & Monsey, 1992).
At present, much of the information available on Developing and Using Action Plans does not explicitly manipulate or test this process and its effects on community change and improvement. Although this process has been identified as a key ingredient for advancing change, there is a need for more systematic evaluations of its implementation and effects. Such research would provide a better understanding of the factors that enable communities to come together and address shared problems and goals.
Some key research questions include: (a) Who needs to be involved in action planning efforts to maximize change efforts (i.e., programs, practices, and policies)? (b) What is the role of local people as agents for or champions of community change and improvement? And (c) Under what conditions (e.g., frequency, intensity) does action planning enhance ongoing action and implementation?
Based on research and experience, we highly recommend Developing and Using Action Plans as a key process to advance community change and improvement.
Developing and Using Action Plans is a process of identifying what to do or change and who will do what by when to do it. The process and resulting plan may develop over several meetings within a month, or it can take well over a year before activities are implemented. When groups engage in this process, they are defining goals, objectives, and action statements that are concrete, clear, attainable, and measurable. Subsequently, groups can use these specific goal statements to direct project activities and set priorities. The process of Developing and Using Action Plans defines the effort's purpose as well as the specific tasks or projects defined as necessary by the group to accomplish its shared vision and mission.
Developing and Using Action Plans is a key process to help groups implement targeted action and intervention for change.
Developing and Using Action Plans enables groups to focus and collaboratively act on priorities to resolve issues, and work towards common goals (Fawcett, Francisco, Paine-Andrews, & Schultz, 2000; Roussos & Fawcett, 2000). Through this process, groups identify real strategies for addressing problems considered important to local collaborators. The process of Developing and Using Action Plans engages community partners in creating the task focus needed to achieve a common set of targeted goals and objectives (Foster-Fishman, Berkowitz, Lounsbury, Jacobson, & Allen, 2001; Israel, Schulz, Parker, & Becker, 1998), and even experience a progression of immediate and subsequent successes that can aid in establishing enthusiasm and project momentum.
Although the functional mechanisms have not been explicitly tested, Developing and Using Action Plans may help groups to:
Action planning often constitutes the critical missing link in the ability of partnerships to advance beyond talk to implementation to maintenance of change and effects. Planning is often the most essential but time-consuming task for matching interventions and strategies to community needs and objectives for change (Kreuter, Lezin, & Young, 2000). From 1990-present, the Center for Community Health and Development has used a consistent measurement system and naturally-occurring time series designs to identify factors associate with discontinuities in rates of community change (Fawcett, Francisco, Paine-Andrews, & Schultz, 2000; Roussos & Fawcett, 2000). Action planning is consistently associated with accelerated rates of change for a wide variety of community efforts such as substance use and adolescent pregnancy.
Similarly, the process of establishing concrete, attainable goals and objectives gave six public/private collaborative projects in a 1983 study a roadmap of specific tasks for action and reporting on progress. Defining success in terms of measurable goals and specific problems, instead of contrived means of cooperation, was a contributing factor to success.The real products of intergovernmental negotiations were the solutions of problems considered important to local actors - such as group-home zoning ordinances, housing units for the mentally ill, the provision of emergency shelter for persons who were homeless, new types of classroom instruction, and increased access to services resulted from careful attention to implementing strategies to address unmet needs (Mattessich & Monsey, 1992).
At present, much of the information available on Developing and Using Action Plans does not explicitly manipulate or test this process and its effects on community change and improvement. Although this process has been identified as a key ingredient for advancing change, there is a need for more systematic evaluations of its implementation and effects. Such research would provide a better understanding of the factors that enable communities to come together and address shared problems and goals.
Some key research questions include: (a) Who needs to be involved in action planning efforts to maximize change efforts (i.e., programs, practices, and policies)? (b) What is the role of local people as agents for or champions of community change and improvement? And (c) Under what conditions (e.g., frequency, intensity) does action planning enhance ongoing action and implementation?
Based on research and experience, we highly recommend Developing and Using Action Plans as a key process to advance community change and improvement.
1. Convene key stakeholders to develop the group’s strategic plan.
__ Key stakeholders, including members of the group and representatives of the target community affected by the issue, were brought together to plan the initiative or effort.
2. Establish and use the group’s vision statement to guide the development of the strategic plan.
__ The group has a written vision statement that is clear, concise, and positive.
__ The vision statement is referenced or included in the written strategic plan.
3. Establish and use the group’s mission statement to guide the development of the strategic plan.
__ The group has a written mission statement.
__ The mission statement communicates the outcome or end that the group has in mind and the broad approaches used to get there.
__ The final vision and mission statement(s) were reviewed and approved by the group for consistency with the group’s purpose.
__ The group regularly reviews the vision and mission statements and makes necessary adjustments.
__ The mission statement is referenced or included in the written strategic plan.
4. Develop objectives that serve as a marker of accomplishments and provide benchmarks for accountability.
__ Collect data and established benchmark measures to assess the baseline level of the issue and to serve as a measure or indicator of progress in addressing the issue.
__ The group has written objectives to guide the efforts of the initiative
__ The objectives are written in a way that indicate how much (e.g., percentage, number) of what (e.g., specific goal or behavior) by when (e.g., month, year) will be accomplished to meet the objective.
__ The group has established measurable outcomes or objectives to be brought about in the target community or population to support the mission.
__ The group has established measurable objectives related to changes in behaviors of the target population or other populations or groups that would need to change their behavior to address the issue.
5. Identify strategies (i.e., intervention components and elements) that will be used to ensure the initiative will reach its objectives.
__ The group has written and approved strategies that indicate how the group will accomplish its stated objectives.
__ The group has identified strategies to be used at various levels targeted by the initiative.
__ The group has identified andconsidered the personal & environmental factors and/or the risk and protective factors targeted by the group when selecting strategies.
__ Each strategy identifies the new or modified program, policy, or practice to be sought in the community.
__ The group has identified the targets of change and agents of change to implement each strategy.
__ The group prioritized the strategies based on the importance and feasibility of implementing each strategy.
6. Identify action steps for each strategy (program, policy, practice) to be implemented by the group.
__ Action steps were specified to support the implementation of the identified strategies.
__ Action plans were developed that identified the person responsible, proposed completion date, and resources needed for implementing the components of the strategic plan.
7. Develop, implement, and review the strategic/action plan.
__ The group has a written strategic plan that is current and details the specific objectives, strategies, and action steps for achieving the identified vision and mission of the group.
__ The group regularly reviews and makes necessary modifications and updates to the strategic plan.
__ The group systematically tracks or documents progress towards achieving the strategic plan.
__ The group regularly communicates progress toward completing the strategic plan to the staff, board, and other key stakeholders.
Primary CTB Supports for this Process:
1. Convene key stakeholders to develop the group’s strategic plan.
Core Supports:
2. Establish and use the group’s vision statement to guide the development of the strategic plan.
Core Supports:
3. Establish and use the group’s mission statement to guide the development of the strategic plan.
Core Support:
4. Develop objectives that serve as a marker of accomplishments and provide benchmarks for accountability.
Core Supports:
5. Identify strategies (i.e., intervention components and elements) that will be used to ensure the initiative will reach its objectives.
Core Supports:
6. Identify action steps for each strategy (program, policy, practice) to be implemented by the group.
Core Supports:
7. Develop, implement, and review the strategic/action plan.
Core Supports:
Bibeau, Howell, Rife, & Taylor (1996). The role of a community coalition in the development of health services for the poor and uninsured. Int J Health Serv. 1996;26(1):93-110.
Bracht et al (1994).
Collie-Akers, V., Landry, S., Ehule, N.J. et al. Enhancing the Capacity of Local Health Departments to Address Birth Equity: The Institute for Equity in Birth Outcomes. Matern Child Health J 25, 1010–1018 (2021). https://doi.org/10.1007/s10995-021-03135-1
Fawcett, S. B., R. K. Lewis, et al. (1997). "Evaluating community coalitions for the prevention of substance abuse: The case of Project Freedom." Health Education & Behavior 24(6): 812-828.
Fawcett, S.B., Francisco, V.T., Paine-Andrews, A., & Schultz, J.A. (2000). A model memorandum of collaboration: A proposal. Public Health Reports, 115, 174-179.
Florin, P., Mitchell, R., & Stevenson, J. (1993). Identifying training and technical assistance needs in community coalitions: A developmental approach. Health Education Research, 8, 417-432.
Foster-Fishman, P.G, Berkowitz, S.L., Lounsbury, D.W., Jacobson, S., & Allen, N.A. (2001). Building collaborative capacity in community coalitions: A review and integrative framework. American Journal of Community Psychology, 29, 241-261.
Gottlieb, N. H., Brink, S. G., & Gingiss, L. P. (1993). Correlates of coalition effectivness: The Smoke Free Class of 2000 Program. Health Education Research, 8(3), 375-384.
Goodman, R.M., Steckler, A., Hoover, S., & Schwartz, R. (1993). A critique of contemporary community health promotion approaches: based on a qualitative review of six programs in Maine. American Journal of Health Promotion, 7, 208-220.
Hogan, C., & Murphey, D. (2002). Outcomes: Reframing responsibility for well-being. A report to the Annie E. Casey Foundation. Baltimore, MD: Annie E. Casey Foundation.
Israel, B.A., Schultz, A.J., Parker, E., & Becker, A.B. (1998). Review of community-based research: Assessing partnership approaches to improve public health. Annual Review of Public Health, 19, 173-202.
Johnston, J.A., Marmet, P.F., Coen, F.S., Fawcett, S.B., Harris, K.J. Kansas LEAN: An effective coalition for nutrition education and dietary change. J Nutr Edu, 1996;115–118.
Kass, D., & Freudenberg, N. (1997). Coalition building to prevent childhood lead poisoning: A case study from New York City. In M. Minkler (Ed.), Community organizing and community building for health (pp.278-288). New Brunswick, NJ: Rutgers University Press.
Kegler, M.C., Steckler, A., Malek, S.H., & McLeroy, K. (1998). A multiple case study of implementation in 10 local Project ASSIST coalitions in North Carolina. Health Education Research, 13, 225-238.
Kreuter, M.W., Lezin, N.A., & Young, L.A. (2000). Evaluating community-based collaborative mechanisms: Implications for practitioners. Health Promotion Practice, 1, 49-63.
Landry, S., Collie-Akers, V., Foster, K. et al. Assessing the Development of Collective Impact Initiatives Addressing Maternal and Child Health. Matern Child Health J 24, 405–411 (2020). https://doi.org/10.1007/s10995-020-02894-7
Lewis, R. K., A. Paine-Andrews, et al. (1999). "Reducing the risk for adolescent pregnancy: Evaluation of a school/community partnership in a midwestern military community." Family and Community Health 22(2): 31.
Mattessich, P., & Monsey, B. (1992). Collaboration: What makes it work. A review of research literature on factors influencing successful collaboration. Saint Paul, MN: Amherst H. Wilder Foundation.
Paine-Andrews, A. and e. al Community Coalitions to Prevent Adolescent Substance Abuse: The Case of the "Project Freedom" Replication Initiative. Adolescent Health Care: Program Designs and Services. J. F. Wodarski, MD; Ferrari, JR, The Haworth Press: 81-99.
Paine-Andrews, A., K. J. Harris, et al. (1997). "Evaluating a Statewide Partnership for Reducing Risks for Chronic Diseases." Journal of Community Health 22(5): 343.
Parker, E.A., Eng, E., Laraia, B., Ammerman, A., Dodds, J., Margolis, L., et al. (1998). Coalition building for prevention: Lessons learned from the North Carolina community-based public health initiative. Journal of Health Management Practice, 4, 25-36.
Ploeg, J., Dobbins, M., Hayward, S., Ciliska, D., Thomas, H., & Underwood, J. (1996). Effectiveness of community development projects. Retrieved May 16, 2002
Rohrbach, Johnson, Mansergh, Fishkin, & Neumann (1997).
Roussos, S.T., & Fawcett, S.B. (2000). A review of collaborative partnerships as a strategy for improving community health. Annual Review of Public Health, 21, 369-402.
Shediac-Rizkallah, M.C., & Bone, L.R. (1998). Planning for the sustainability of community-based health programs: Conceptual frameworks and future directions for research, practice, and policy. Health Education Research, 13, 87-108.
Shortell, S.M., Zukoski, A.P., Alexander, J.A., Bazzoli, G.J., Conrad, D.A., Hasnain-Wynia, R., et al., (2002). Evaluating partnerships for community health improvement: Tracking the footprints. Journal of Health Politics, Policy, and Law, 27, 49-108.
Sorensen, G., Emmons, K., Hunt, M.K., & Johnston, D. (1998). Implications of the results of community intervention trials. Annual Review of Public Health, 19, 379-416.
Developing a Framework or Model of Change is a process of mapping out what will be done regarding an intended effort for change. This process helps groups outline the relationship among inputs (i.e., resources), outputs (i.e., proposed interventions), impact (i.e., immediate results of those outputs), and outcomes (i.e., indicators of community change, behavior changes, and population-level improvements). When groups engage in this process, they are addressing "How will we get from here to there?" The process of Developing a Framework or Model of Change can help groups consider how to get from "where we are" (i.e., features of the problem, current resources) to arrive logically and systematically at "where we want to be" (i.e., a continuum of outcomes that describe resolution of the problem). Developing a Framework or Model of Change is a key process to help communities outline and connect a sequence of events for bringing about change, and can help a group propose an integrated [and testable] model for making a difference based on how they understand underlying mechanisms of change.
Developing a Framework or Model of Change helps us organize our thinking and orient program development by intended outcomes rather than by [often limited] resources. This process aims to develop a visual representation or roadmap (i.e., theory of the problem, theory of action, logic model, or framework). It takes participants on a journey of "walking back" from intended outcomes to clarify what needs to be in place to get there. Developing a Framework or Model of Change helps an initiative specify an intervention's proposed mechanisms for making a difference, and helps to articulate where and how change needs to happen for improvements in more distant outcomes to occur. It can also be helpful for naming indicators of success - the answers to "how will we know it when we see it?" - that can be useful for Documenting Progress and Sharing Feedback.
Although the exact mechanisms are unclear, participation in Developing a Framework or Model of Change can help a group to:
When logic models recognize and clearly link what needs to change with intervention strategies that can do so, they increase an intervention's chances for success. For example, teen pregnancy prevention interventions are now more directed toward factors contributing to the problem. During the 1980s, many schools implemented sex education programs to increase knowledge about sexuality and contraception; yet evaluations of these knowledge-based programs revealed that they did increase knowledge, but did not change behaviors. Interventions focused on personal factors such as knowledge that they were able to change, but one that was not markedly associated with adolescent sexual and contraceptive behavior (Kirby, 2001). By contrast, a more recent generation of programs focuses more clearly on specific behaviors and research and theory that identify environmental factors to be changed. For example, a change in clinic policy that authorizes more time for teen patients may enable staff to allocate and spend sufficient time for youth clients, thereby increasing youth use of birth control (Kirby, 2002). When intervention strategies are based on a clear logic model for change (e.g., behavior change resulting from environmental interventions), they are more likely to actually change behaviors - which is necessary for population-level outcomes to improve.
Similarly, logic models can be powerful tools to communicate grounded and integrative program strategies - for funding and evaluation purposes. For example, with limited time and no opportunity for a formal presentation, staff for Project WISEUP (a juvenile justice intervention) successfully used their logic model to articulate their ideas so government officials would understand and see its value as a preventive intervention. They used a visual representation to outline a step-by-step plan of expectations, action-strategies, and outcome measures. Their theory of action was that juvenile justice required an ecological model that involved parents, siblings, counselors, teachers, police, and community agencies; a set of programs to build good study skills (measured by grade point averages), self-discipline (decreased suspensions), and regular attendance at school could improve arrest outcomes and reduce incarceration. Consequently, they provided a logical and sound argument that was met with curiosity, support, and subsequent funding (Cato, Chen, & Corbett-Perez, 1998).
At present, much of the information available on Developing a Framework or Model of Change does not explicitly manipulate or test this process and its effects on community change and improvement. Although this process has been identified in empirical and experiential reviews as a key ingredient for advancing change, there is a need for more systematic evaluations of its effects. Such research would provide a better understanding of the factors that enable communities to come together and address shared problems and goals.
Some key research questions to consider include: (a) How can we better integrate knowledge from various disciplines (e.g., community psychology, public health, social work, urban studies) to develop multi-level program theories and models to guide this work of community change and improvement? (b) How can we use logic models to help us better assess how program outcomes are obtained from comprehensive interventions? And (c) What hypotheses for future research can we draw from candidate pathways outlined in logic model of comprehensive community change efforts?
Based on research and experience, we recommend (with qualifications) Developing a Framework or Model of Change as a key process to advance community change and improvement.The process is suggested by many researchers and practitioners as an important tool for designing, strengthening, and evaluation community change and improvement interventions. Yet, the prevalence of empirical and experiential evidence regarding its effectiveness is at an early stage compared to what is known about other Best Processes.
Developing a Framework or Model of Change is a process of mapping out what will be done regarding an intended effort for change. This process helps groups outline the relationship among inputs (i.e., resources), outputs (i.e., proposed interventions), impact (i.e., immediate results of those outputs), and outcomes (i.e., indicators of community change, behavior changes, and population-level improvements). When groups engage in this process, they are addressing "How will we get from here to there?" The process of Developing a Framework or Model of Change can help groups consider how to get from "where we are" (i.e., features of the problem, current resources) to arrive logically and systematically at "where we want to be" (i.e., a continuum of outcomes that describe resolution of the problem). Developing a Framework or Model of Change is a key process to help communities outline and connect a sequence of events for bringing about change, and can help a group propose an integrated [and testable] model for making a difference based on how they understand underlying mechanisms of change.
Developing a Framework or Model of Change helps us organize our thinking and orient program development by intended outcomes rather than by [often limited] resources. This process aims to develop a visual representation or roadmap (i.e., theory of the problem, theory of action, logic model, or framework). It takes participants on a journey of "walking back" from intended outcomes to clarify what needs to be in place to get there. Developing a Framework or Model of Change helps an initiative specify an intervention's proposed mechanisms for making a difference, and helps to articulate where and how change needs to happen for improvements in more distant outcomes to occur. It can also be helpful for naming indicators of success - the answers to "how will we know it when we see it?" - that can be useful for Documenting Progress and Using Feedback.
Although the exact mechanisms are unclear, participation in Developing a Framework or Model of Change can help a group to:
When logic models recognize and clearly link what needs to change with intervention strategies that can do so, they increase an intervention's chances for success. For example, teen pregnancy prevention interventions are now more directed toward factors contributing to the problem. During the 1980s, many schools implemented sex education programs to increase knowledge about sexuality and contraception; yet evaluations of these knowledge-based programs revealed that they did increase knowledge, but did not change behaviors. Interventions focused on personal factors such as knowledge that they were able to change, but one that was not markedly associated with adolescent sexual and contraceptive behavior (Kirby, 2001). By contrast, a more recent generation of programs focuses more clearly on specific behaviors and research and theory that identify environmental factors to be changed. For example, a change in clinic policy that authorizes more time for teen patients may enable staff to allocate and spend sufficient time for youth clients, thereby increasing youth use of birth control (Kirby, 2002). When intervention strategies are based on a clear logic model for change (e.g., behavior change resulting from environmental interventions), they are more likely to actually change behaviors - which is necessary for population-level outcomes to improve.
Similarly, logic models can be powerful tools to communicate grounded and integrative program strategies - for funding and evaluation purposes. For example, with limited time and no opportunity for a formal presentation, staff for Project WISEUP (a juvenile justice intervention) successfully used their logic model to articulate their ideas so government officials would understand and see its value as a preventive intervention. They used a visual representation to outline a step-by-step plan of expectations, action-strategies, and outcome measures. Their theory of action was that juvenile justice required an ecological model that involved parents, siblings, counselors, teachers, police, and community agencies; a set of programs to build good study skills (measured by grade point averages), self-discipline (decreased suspensions), and regular attendance at school could improve arrest outcomes and reduce incarceration. Consequently, they provided a logical and sound argument that was met with curiosity, support, and subsequent funding (Cato, Chen, & Corbett-Perez, 1998).
At present, much of the information available on Developing a Framework or Model of Change does not explicitly manipulate or test this process and its effects on community change and improvement. Although this process has been identified in empirical and experiential reviews as a key ingredient for advancing change, there is a need for more systematic evaluations of its effects. Such research would provide a better understanding of the factors that enable communities to come together and address shared problems and goals.
Some key research questions to consider include: (a) How can we better integrate knowledge from various disciplines (e.g., community psychology, public health, social work, urban studies) to develop multi-level program theories and models to guide this work of community change and improvement? (b) How can we use logic models to help us better assess how program outcomes are obtained from comprehensive interventions? And (c) What hypotheses for future research can we draw from candidate pathways outlined in logic model of comprehensive community change efforts?
Based on research and experience, we recommend (with qualifications) Developing a Framework or Model of Change as a key process to advance community change and improvement.The process is suggested by many researchers and practitioners as an important tool for designing, strengthening, and evaluation community change and improvement interventions. Yet, the prevalence of empirical and experiential evidence regarding its effectiveness is at an early stage compared to what is known about other Best Change Processes.
1. Convene key stakeholders to develop a logic model for the effort.
__ Involve key stakeholders including representatives of the community who are affected by the problem or goal in developing framework or logic model components.
2. Identify the intended uses for the logic model.
__ The group has identified both internal and external audiences and uses for the logic model.
__ The group has identified the appropriate scope or level(s) of the logic model.
__ The group has developed a logic model or framework, a visual picture for how it will get from here (present conditions) to there (intended outcomes), at the appropriate level(s) consistent with its intended purpose or use.
3. Outline the key components of the logic model.
__ The logic model includes the vision and/or mission statement established by the group.
__ The framework includes a brief description of the context and conditions of the community or effort related to the problem and goal.
__ The framework includes a description of key inputs accessible by the group.
__ The logic model includes a description of activities or components of the project or intervention.
__ The logic model includes a description of intended outputs of the activities or intervention components.
__ The logic model includes outcomes or intended effects related to the objectives of the intervention or initiative.
4. Draw a picture of the logic mode or framework that visually displays relationships between activities, outputs, and intended outcomes.
__ The logic model conveys the purpose and direction of the organization or effort.
__ The logic model shows relationships and an expected time sequence of the components and elements of the logic model.
__ The logic model shows connections between activities and effects over time.
5. Use the logic model to guide the work, making adaptations as appropriate.
__ The group uses the logic model to communicate and convey the approach of the organization or effort for addressing the problem/goal.
__ The group regularly reviews and updates the logic model(s) of the initiative or program.
Primary Community Tool Box Supports for this Process:
1. Convene key stakeholders to develop a logic model for the effort.
Core Supports:
2. Identify the intended uses for the logic model.
Core Supports:
3. Outline the key components of the logic model.
Core Supports:
4. Draw a picture of the logic mode or framework that visually displays relationships between activities, outputs, and intended outcomes.
The logic model conveys the purpose & direction of the organization or effort.
The logic model shows relationships & an expected time sequence of the components & elements of the logic model.
The logic model shows connections between activities & effects over time.
Core Supports:
5. Use the logic model to guide the work, making adaptations as appropriate.
The group uses the logic model to communicate & convey the approach of the organization or effort for addressing the problem/goal.
The group regularly reviews & updates the logic model(s) of the initiative or program.
Core Supports:
Cato, Chen, & Corbett-Perez (1998). Logic Model: A Tool for Planning and Evaluating Health and Recreation Prevention Projects. JOPERD--The Journal of Physical Education, Recreation & Dance, Vol. 69, 1998
Collie-Akers, V., Landry, S., Ehule, N.J. et al. Enhancing the Capacity of Local Health Departments to Address Birth Equity: The Institute for Equity in Birth Outcomes. Matern Child Health J 25, 1010–1018 (2021). https://doi.org/10.1007/s10995-021-03135-1
Hogan, C., & Murphey, D. (2002). Outcomes: Reframing responsibility for well-being. A report to the Annie E. Casey Foundation. Baltimore, MD: Annie E. Casey Foundation.
Kirby, Douglas (2001). Emerging Answers: Research Findings On Programs to Reduce Teen Pregnancy.
Kirby, Douglas (2002). The Impact of Schools and School Programs upon Adolescent Sexual BehaviorJournal of Sexual Research 39: 27 - 33
Landry, S., Collie-Akers, V., Foster, K. et al. Assessing the Development of Collective Impact Initiatives Addressing Maternal and Child Health. Matern Child Health J 24, 405–411 (2020). https://doi.org/10.1007/s10995-020-02894-7
Ploeg, J., Dobbins, M., Hayward, S., Ciliska, D., Thomas, H., & Underwood, J. (1996). Effectiveness of community development projects.
Developing Leadership is a process of enabling, enhancing, focusing, and sustaining engagement of people in a common purpose. This process creates opportunities for people affected by a problem and other stakeholders to participate, build relationships, and have influence on the change effort. Sometimes leaders are full-time paid staff responsible for organizing and managing partnership activities. In grassroots initiatives, leaders may be volunteers who organize and mobilize community members around a common concern. When groups engage in Developing Leadership, they enable diverse individuals and organizations to be involved in a range of program activities (e.g., planning, implementation, evaluation) to work together toward common goals.
Developing Leadership is a key process to help communities mobilize for targeted action and intervention.
Developing Leadership is central to mobilizing sustainable efforts for change and improvement (Foster-Fishman, Berkowitz, Lounsbury, Jacobson, & Allen, 2001). Leadership is often reported as the most critical organizational factor for a partnership's effectiveness in creating community and system change (Roussos & Fawcett, 2000). Overall, Developing Leadership can help create (a) community buy-in, ("I want to be part of this") (b) Community empowerment ("We can bring about change and improvement"), (c) a sense of inclusiveness ("We are in this together"), and (d) a sense of personal efficacy ("I can change things") and collective efficacy ("Together, we can make a difference").
Although the functional mechanisms have not been explicitly tested, Developing Leadership may help groups to:
Leadership - activated across people and organizations - is a critical factor associated with successful community initiatives. Continuity of leadership has been consistently associated with high levels of community change (Fawcett et al., 1997; Roussos & Fawcett, 2000). By contrast, a change in leadership to those with strong social ties to affected communities may also facilitate change (Lewis et al., 1999).
In a study among five neighborhood partnerships addressing youth development, the three projects with no leadership opportunities for participants did not survive into the second implementation year. By contrast, those with shared leadership for adults and youth to lead different activities had the highest levels of mobilization (e.g., meetings, attendance, member input into action plan) (Kegler & Wyatt, 2003). In another study, the San Francisco Transgender Community Health Project relied on community members' involvement to develop protocols and assessment instruments to document social problems such as suicide and high levels of HIV infection, and also identify and activate community strengths. As a result, the project helped secure funding for new health and prevention services, improve protection against gender discrimination, change gender categories on existing data collection forms, and pave the way for a San Francisco Health Department resolution to improve that system's sensitivity for handling the health care needs for transgender people (Clements-Nolle & Bachrach, 2003).
In a study of public-private partnerships in the Community Care Network (CCN), Shortell et al. (2002) examined factors accounting for progress and successful implementation. In addition to focus (See Establishing Vision and Mission) as well as partnership management and operations (See Defining Organizational Structure and Operating Mechanisms), investigators identified three components of leadership that tended to differentiate sites making the most progress from those making the least progress: (1) Committed core leadership, (2) A consistent "organizational driver," and (3) Subsidiary leadership. Sites making the most progress had a dedicated executive director and an organization that provided stability and legitimacy for the effort. They also regularly delegated to people and groups closest to a given problem the authority and resources to address needs and concerns. For example, in a Midwest partnership, (a) the executive director provided strong and established connections to community partners, (b) directors of the local hospital and health department convened different sectors of the community and negotiated terms of collaboration and handling conflict, and (c) other members designed and implemented key projects such as an intensive case management program. By contrast, partnerships that lacked the ability to make progress toward their vision lacked one or multiple components of leadership. One southern partnership experienced three different coordinators over a three-year period. No single person appeared to lead the effort. I addition, in the first year, organizational leadership changed from a one-county community agency to a nine-county university. Amidst potential expansion and lack of applied focus, tasks became predominantly staff driven, and subsidiary leadership withdrew from the effort.
At present, much of the information available on Developing Leadership does not explicitly manipulate or test this process and its effects on community change and improvement. Although this process has been identified as a key ingredient for advancing change, there is a need for more systematic evaluations of its implementation and effects. Such research would provide a better understanding of the factors that enable communities to come together and address shared problems and goals.
Some key research questions include: (a) What strategies enable stigmatized and vulnerable populations to participate in community change and improvement efforts? (b) What is the optimal configuration of a leadership team (e.g., community members, agency and organizational leaders, youth) for addressing different community change missions (e.g., service provision, policy change)? And (c) Under what conditions do lead or sponsoring organizations enable community change and improvement?
Based on research and experience, we highly recommend Developing Leadership as a key process to advance community change and improvement.
Developing Leadership is a process of enabling, enhancing, focusing, and sustaining engagement of people in a common purpose. This process creates opportunities for people affected by a problem and other stakeholders to participate, build relationships, and have influence on the change effort. Sometimes leaders are full-time paid staff responsible for organizing and managing partnership activities. In grassroots initiatives, leaders may be volunteers who organize and mobilize community members around a common concern. When groups engage in Developing Leadership, they enable diverse individuals and organizations to be involved in a range of program activities (e.g., planning, implementation, evaluation) to work together toward common goals.
Developing Leadership is a key process to help communities mobilize for targeted action and intervention.
Developing Leadership is central to mobilizing sustainable efforts for change and improvement (Foster-Fishman, Berkowitz, Lounsbury, Jacobson, & Allen, 2001). Leadership is often reported as the most critical organizational factor for a partnership's effectiveness in creating community and system change (Roussos & Fawcett, 2000). Overall, Developing Leadership can help create (a) community buy-in, ("I want to be part of this") (b) Community empowerment ("We can bring about change and improvement"), (c) a sense of inclusiveness ("We are in this together"), and (d) a sense of personal efficacy ("I can change things") and collective efficacy ("Together, we can make a difference").
Although the functional mechanisms have not been explicitly tested, Developing Leadership may help groups to:
Leadership - activated across people and organizations - is a critical factor associated with successful community initiatives. Continuity of leadership has been consistently associated with high levels of community change (Fawcett et al., 1997; Roussos & Fawcett, 2000). By contrast, a change in leadership to those with strong social ties to affected communities may also facilitate change (Lewis et al., 1999).
In a study among five neighborhood partnerships addressing youth development, the three projects with no leadership opportunities for participants did not survive into the second implementation year. By contrast, those with shared leadership for adults and youth to lead different activities had the highest levels of mobilization (e.g., meetings, attendance, member input into action plan) (Kegler & Wyatt, 2003). In another study, the San Francisco Transgender Community Health Project relied on community members' involvement to develop protocols and assessment instruments to document social problems such as suicide and high levels of HIV infection, and also identify and activate community strengths. As a result, the project helped secure funding for new health and prevention services, improve protection against gender discrimination, change gender categories on existing data collection forms, and pave the way for a San Francisco Health Department resolution to improve that system's sensitivity for handling the health care needs for transgender people (Clements-Nolle & Bachrach, 2003).
In a study of public-private partnerships in the Community Care Network (CCN), Shortell et al. (2002) examined factors accounting for progress and successful implementation. In addition to focus (See Establishing Vision and Mission) as well as partnership management and operations (See Defining Organizational Structure and Operating Mechanisms), investigators identified three components of leadership that tended to differentiate sites making the most progress from those making the least progress: (1) Committed core leadership, (2) A consistent "organizational driver," and (3) Subsidiary leadership. Sites making the most progress had a dedicated executive director and an organization that provided stability and legitimacy for the effort. They also regularly delegated to people and groups closest to a given problem the authority and resources to address needs and concerns. For example, in a Midwest partnership, (a) the executive director provided strong and established connections to community partners, (b) directors of the local hospital and health department convened different sectors of the community and negotiated terms of collaboration and handling conflict, and (c) other members designed and implemented key projects such as an intensive case management program. By contrast, partnerships that lacked the ability to make progress toward their vision lacked one or multiple components of leadership. One southern partnership experienced three different coordinators over a three-year period. No single person appeared to lead the effort. I addition, in the first year, organizational leadership changed from a one-county community agency to a nine-county university. Amidst potential expansion and lack of applied focus, tasks became predominantly staff driven, and subsidiary leadership withdrew from the effort.
At present, much of the information available on Developing Leadership does not explicitly manipulate or test this process and its effects on community change and improvement. Although this process has been identified as a key ingredient for advancing change, there is a need for more systematic evaluations of its implementation and effects. Such research would provide a better understanding of the factors that enable communities to come together and address shared problems and goals.
Some key research questions include: (a) What strategies enable stigmatized and vulnerable populations to participate in community change and improvement efforts? (b) What is the optimal configuration of a leadership team (e.g., community members, agency and organizational leaders, youth) for addressing different community change missions (e.g., service provision, policy change)? And (c) Under what conditions do lead or sponsoring organizations enable community change and improvement?
Based on research and experience, we highly recommend Developing Leadership as a key process to advance community change and improvement.
1. Identify the composition of the ideal leadership team.
__ The group has specified (in the bylaws if appropriate) the appropriate number of leaders, including board members and staff positions, necessary to support the current efforts of the group.
__ The board is inclusive as evidenced by the majority of the board members having diverse skills, experience, background, interest, or professional expertise.
__ Staff leadership is inclusive as evidenced by the majority of staff members having diverse and complementary skills, experience, background, interest, or professional expertise.
__ Current leadership including board members and staff have sufficient skills, experience, and professional expertise appropriate to support the initiative at its current stage of development.
__ Current leadership including board members and staff have sufficient resources and supports to lead the organization.
__ The group regularly assesses the composition of the leadership team, including the board and staff and identifies and recruits leaders based on the identified needs of the leadership team.
2. Recruit new leaders to the leadership team.
__ The group has identified the core leadership tasks and related skills necessary to support the initiative.
__ The group regularly assesses the strengths and weaknesses of the current leadership team including the board and staff to identify and recruit leaders based on the identified needs of the leadership team.
__ When recruiting new leaders, including both board and staff, the leadership skills of potential leaders are matched with the skills needed for the activities that the group has to conduct.
__ The group has a formal process for recruiting, identifying, nominating, and selecting new leaders to the board and staff.
3. Develop a plan for leadership development.
__ The group has a written plan to support the development of leadership within the group, including both the board and staff.
__ The group has written goals for leadership development to support diverse leadership within the group.
__ Key leaders including staff and board officers regularly assess their leadership skills and develop individual leadership goals and plans to support the initiative.
__ The group has written goals for leadership development to enhance the skills and expertise of the leadership team.
4. Identify methods to support leadership development goals.
__ The group regularly reviews and identifies appropriate methods for supporting leadership development goals.
__ Board members have ongoing opportunities to regularly participate in trainings, workshops, or other methods to improve their skills to enhance the initiative.
__ All staff have ongoing opportunities to regularly participate in trainings, workshops, or other methods to appropriately improve their skills to enhance the initiative.
__ Volunteers have ongoing opportunities to regularly participate in trainings, workshops, or other methods to appropriately improve their skills to enhance the initiative.
__ The group allocates and sets aside resources in the budget to support leadership development.
__ New members of the group including board members, staff, and volunteers receive appropriate training and an orientation to the initiative.
__The current leadership team, including board and staff, is committed to working together.
5. Support a great leadership team.
__ The group collaborates and shares risks, resources, responsibilities, and rewards.
__ Leaders are able to guide important processes and act as facilitators.
__ All leaders including the board and staff have clearly defined roles, responsibilities, and expectations for leading in the group.
__ Leaders including board, staff, and volunteers, are regularly recognized and rewarded for their contributions to the initiative.
__ The group was able to effectively identify, respond, and adapt to new or important situations.
__ Leadership, including both the board and staff, was able to connect the group to appropriate resources.
1. Identify the composition of the ideal leadership team.
Core Supports:
2. Recruit new leaders to the leadership team.
Core Supports:
3. Develop a plan for leadership development.
Core Supports:
4. Identify methods to support leadership development goals.
Core Supports:
5. Support a great leadership team.
Core Supports:
Clements-Nolle K, Bachrach A. Community-Based Participatory Research with a Hidden Population: The Transgender Community Health Project. In: Minkler M, Wallerstein N, eds. Community-Based Participatory Research for Health. San Francisco, CA: Jossey-Bass, 2003:332-44.
Fawcett, S. B., R. K. Lewis, et al. (1997). "Evaluating community coalitions for the prevention of substance abuse: The case of Project Freedom." Health Education & Behavior 24(6): 812-828.
Collie-Akers, V., Landry, S., Ehule, N.J. et al. Enhancing the Capacity of Local Health Departments to Address Birth Equity: The Institute for Equity in Birth Outcomes. Matern Child Health J 25, 1010–1018 (2021). https://doi.org/10.1007/s10995-021-03135-1
Fawcett, S.B., Francisco, V.T., Paine-Andrews, A., & Schultz, J.A. (2000). A model memorandum of collaboration: A proposal. Public Health Reports, 115, 174-179.
Foster-Fishman, P.G, Berkowitz, S.L., Lounsbury, D.W., Jacobson, S., & Allen, N.A. (2001). Building collaborative capacity in community coalitions: A review and integrative framework. American Journal of Community Psychology, 29, 241-261.
Hogan, C., & Murphey, D. (2002). Outcomes: Reframing responsibility for well-being. A report to the Annie E. Casey Foundation. Baltimore, MD: Annie E. Casey Foundation.
Israel, B.A., Schultz, A.J., Parker, E., & Becker, A.B. (1998). Review of community-based research: Assessing partnership approaches to improve public health. Annual Review of Public Health, 19, 173-202.
Kegler, M.C., Steckler, A., Malek, S.H., & McLeroy, K. (1998). A multiple case study of implementation in 10 local Project ASSIST coalitions in North Carolina. Health Education Research, 13, 225-238.
Kegler, M.C., & Wyatt, V.H. (2003). A multiple case study of neighborhood partnerships for positive youth development. American Journal of Health Behavior, 27, 156-169.
Kreuter, M.W., Lezin, N.A., & Young, L.A. (2000). Evaluating community-based collaborative mechanisms: Implications for practitioners. Health Promotion Practice, 1, 49-63.
Landry, S., Collie-Akers, V., Foster, K. et al. Assessing the Development of Collective Impact Initiatives Addressing Maternal and Child Health. Matern Child Health J 24, 405–411 (2020). https://doi.org/10.1007/s10995-020-02894-7
Lewis, R. K., A. Paine-Andrews, et al. (1999). "Reducing the risk for adolescent pregnancy: Evaluation of a school/community partnership in a midwestern military community." Family and Community Health 22(2): 31.
Mattessich, P., & Monsey, B. (1992). Collaboration: What makes it work. A review of research literature on factors influencing successful collaboration. Saint Paul, MN: Amherst H. Wilder Foundation.
Mattessich, P., & Monsey, B. (1997). Community building: What makes it work. A review of factors influencing successful community building. Saint Paul, MN: Amherst H. Wilder Foundation.
Merzel, C., & D'Afflitti, J. (2003). Reconsidering community-based health promotion: Promise, performance, and potential. American Journal of Public Health, 93, 557-574.
Mitchell, R.E., Florin, P., & Stevenson, J.F. (2002). Supporting community-based prevention and health promotion initiatives: Developing effective technical assistance systems. Health Education & Behavior, 29, 620-639.
Minkler M, Wallerstein N. Community-based participatory research for health. San Francisco, CA: Jossey-Bass, 2003.
Nezlek & Galano (1993)
Parker, E.A., Eng, E., Laraia, B., Ammerman, A., Dodds, J., Margolis, L., et al. (1998). Coalition building for prevention: Lessons learned from the North Carolina community-based public health initiative. Journal of Health Management Practice, 4, 25-36.
Ploeg, J., Dobbins, M., Hayward, S., Ciliska, D., Thomas, H., & Underwood, J. (1996). Effectiveness of community development projects. Retrieved May 16, 2002
Rogers et al (1993).
Roussos, S.T., & Fawcett, S.B. (2000). A review of collaborative partnerships as a strategy for improving community health. Annual Review of Public Health, 21, 369-402.
Schulz, A. J., B. A. Israel, et al. (2003). "Instrument for evaluating dimensions of group dynamics within community-based participatory research partnerships." Evaluation and Program Planning 26(3): 249-262.).
Shortell, S.M., Zukoski, A.P., Alexander, J.A., Bazzoli, G.J., Conrad, D.A., Hasnain-Wynia, R., et al., (2002). Evaluating partnerships for community health improvement: Tracking the footprints. Journal of Health Politics, Policy, and Law, 27, 49-108.
Implementing Effective Interventions is a process of assuring that key aspects of promising approaches are put into practice as intended and to meet local needs. When groups engage in this process, they prioritize and implement intervention strategies based on what has been learned through research and experience in community contexts. "Best practices" are proven programs or policies shown to be effective with a particular issue and specific population. Despite evidence indicating their effects, "best practices" are not always effective in new or different situations. For example, increasing access to health services by lengthening clinic hours may not improve outcomes if language issues are the actual barriers. Implementing Effective Interventions often requires Assuring Technical Assistance and adapting interventions to different or changing conditions, especially when programs or policies are applied in different populations, places, and situations. The process of Implementing Effective Interventions can help community initiatives combine their understanding of what has worked elsewhere with local conditions and opportunities to improve outcomes for a "real-world" impact.
Implementing Effective Interventions is a key process to help communities target and change community conditions for behavioral and population-level improvements.
Extensive resources have been devoted to prevention research for over 20 years, and programs and strategies that work have been identified. A number of online resources have been developed to increase access to these evidence-based programs and practices and to disseminate effective "program packages" such as curricula manuals and technical assistance guidance (See Best Practices: Links to Intervention Reviews and Recommendations). Review and use of "best practices" can increase selection and application of effective strategies by decision-makers, practitioners, and program funders who must choose among potential innovations to address complex and challenging problems (Brownson, Baker, Leet, & Gillespie, 2003). Yet, there is no perfect program package that can be directly applied across all communities and achieve desired effects. The strict application of evidence-based interventions that emerge from science to community practice does not guarantee success. A "one-size-fits-all" approach will not work (Glasgow, Klesges, Dzewaltowski, Bull, & Estabrooks, 2003; Sorensen, Emmons, Hunt, & Johnston, 1998). Different settings and populations present a range of cultural, economic, and other environmental circumstances that affect behavior and outcome. As such, the process of implementing interventions that work includes respect for both scientific evidence regarding effective programs and experiential knowledge of what would likely work in a particular context. The process of Implementing Effective Interventions aims to fit effective strategies with local context.
The debate continues regarding the appropriate balance between "implementation of evidence-based programs with fidelity" and "adaptation to different community contexts" (e.g., Aos, Lieb, Mayfield, Miller, & Pennucci, 2004). Accordingly, an integrated process of Implementing Effective Interventions may help community initiatives to:
Matching intervention strategies to fit needs, objectives, and context is critical for the success of community change and improvement efforts. Few community mobilization efforts have developed and implemented the kind of "upstream" environmental changes (e.g., social and policy influences) that can provide the necessary strength and penetration to effect population-level improvements (Merzel & D'Affliti, 2003). For example, many substance abuse prevention partnerships in the 1990s gravitated toward "Red Ribbon" and other public information and awareness campaigns (despite no evidence that these information-provision strategies reduced alcohol or drug use); and these activities often occurred at the expense of more intensive social policy or regulation efforts to reduce access to alcohol and other drugs (Florin, Mitchell, & Stephenson, 1993; Kreuter, Lezin, & Young, 2000). Yet, through assessment and strategic planning activities, other groups such as a Minnesota farm injury prevention coalition determined that farmers in their area first needed to understand and believe that farm injuries were not random acts of fate; accordingly, their public information interventions occurred simultaneously or sequentially with other strategies to change worker behaviors (Lexau et al., 1993). Similarly, Project Northland, a community and school-based alcohol prevention study, targeted community and policy levels, and achieved significant reductions in alcohol and tobacco use among youth populations (Perry et al., 1996). In addition, Project ASSIST and Tobacco Policy Options for Prevention reported reductions in smoking prevalence rates, suggesting that effectively implementing policy changes provided the basis for a health-promoting environment (Sorensen, Emmons, Hunt, & Johnston, 1998).
Adapting interventions to fit population and context also appears to be a critical factor related to effectiveness. Many interventions aim to target multiple levels for change such as individual, family, organizational, state policy. This ecological approach is based on the idea that communities are made up of individuals who interact in a variety of social networks and within various contexts (Brownson, Baker, Leet, & Gillespie, 2003; Roussos & Fawcett, 2000). In Project COMMIT, community planning boards and coalitions were involved in public education, media programs, policy changes, and other programmatic strategies for smoking prevention (Thompson, Corbett, Bracht, & Pechacek, 1993; Thompson, Wallack, Lichtenstein, & Pechacek, 1991). Yet, standardized intervention and research protocols mandated program activities. The program had no impact on quit rates or the smoking behaviors of heavy smokers, the primary target population (COMMIT Research Group, 1995a, 1995b). Herein, protocols may have constrained communities from adapting the program to meet local needs (Merzel & D'Affliti, 2003; Sorensen, Emmons, Hunt, & Johnston, 1998). Similarly, in the absence of effects, community members criticized the South Carolina Heart to Heart Project for not tailoring physical activity programs to reach African Americans who represented 35% of the target population (Goodman, Wheeler, & Lee, 1995).
In a recent effort to transfer research knowledge to practice, investigators attempted to extend the effectiveness of a "popular opinion leader" (POL) approach for HIV prevention from rural white gay men to other populations and settings. Original research indicated the efficacy of this social network intervention, delivered and modeled in outreach fashion by members of one's own social peer group, to reduce HIV infection (Kelly et al., 1991, 1992, 1997). After one-year in the Mpowerment Project, the proportion of intervention men engaging in unprotected anal intercourse decreased by 27% from baseline (p<.05) compared to a 3% increase in a matched comparison (Kegles, Hays, & Coates, 1996). Sikkema et al. (2000) extended the efficacy of the POL approach to target sexual risk behaviors of African American women. By contrast, POL studies targeting male prostitutes and patrons of New York City huster bars (Miller, Klotz, & Eckholdt, 1998) and gay men in London and Scotland (Elford, Hart, Sherr, Williamson, & Bolding, 2002; Flowers, Hart, Williamson, Frankis, & Der, 2002) reported no changes in sexual risk taking behaviors. Originally designed to target cohesive, explicit, social networks, the POL approach (a) was less able to affect behaviors among non-gay-identified men who have sex with men, and (b) did not generalize to peer interactions among non-United States gay cultures. Accordingly, the successful implementation of interventions such as POL appears to require (1) Defining and understanding targeted groups and social networks, and (2) Matching effective intervention strategies to the local context.
Overall, community change and improvement efforts, often unstaffed and dependent on volunteer labor, may be poorly equipped to accomplish the time-consuming tasks of selecting, tailoring, and sustaining effective implementation of interventions for long-term outcomes (Kreuter, Lezin, & Young, 2000). Other key processes that can build capacities to address these challenges include Developing a Framework or Model of Change, Developing and Using Action Plans, Assuring Technical Assistance, and Making Outcomes Matter.
At present, much of the information available on Implementing Effective Interventions does not explicitly manipulate or test this process and its effects on community change and improvement. Although this process has been identified as a key ingredient for advancing change, there is a need for more systematic evaluations of its implementation and effects. Such research would provide a better understanding of the factors that enable communities to come together and address shared problems and goals.
Some key research questions include: (a) What conditions influence selection and faithful implementation of effective interventions? (b) What differential effects result from practitioner versus researcher implemented strategies? (c) What "promising," yet un- or under-evaluated interventions are associated with improvements in behavioral and population-level outcomes? (d) What are the cost-benefits of policy strategies (e.g., legislative mandates, pricing policies, restrictions on advertising) on population-level outcomes? (e) What does current knowledge suggest about how interventions should balance adoption and effective use of evidence-based and community-recommended strategies for change? And (f) How can use of evidence-based interventions be made easier and more likely by community practitioners?
Based on research and experience, we recommend Implementing Effective Interventions as a key process to advance community change and improvement.
Implementing Effective Interventions is a process of assuring that key aspects of promising approaches are put into practice as intended and to meet local needs. When groups engage in this process, they prioritize and implement intervention strategies based on what has been learned through research and experience in community contexts. "Best practices" are proven programs or policies shown to be effective with a particular issue and specific population. Despite evidence indicating their effects, "best practices" are not always effective in new or different situations. For example, increasing access to health services by lengthening clinic hours may not improve outcomes if language issues are the actual barriers. Implementing Effective Interventions often requires Assuring Technical Assistance and adapting interventions to different or changing conditions, especially when programs or policies are applied in different populations, places, and situations. The process of Implementing Effective Interventions can help community initiatives combine their understanding of what has worked elsewhere with local conditions and opportunities to improve outcomes for a "real-world" impact.
Implementing Effective Interventions is a key process to help communities target and change community conditions for behavioral and population-level improvements.
Extensive resources have been devoted to prevention research for over 20 years, and programs and strategies that work have been identified. A number of online resources have been developed to increase access to these evidence-based programs and practices and to disseminate effective "program packages" such as curricula manuals and technical assistance guidance (See Best Practices: Links to Intervention Reviews and Recommendations). Review and use of "best practices" can increase selection and application of effective strategies by decision-makers, practitioners, and program funders who must choose among potential innovations to address complex and challenging problems (Brownson, Baker, Leet, & Gillespie, 2003). Yet, there is no perfect program package that can be directly applied across all communities and achieve desired effects. The strict application of evidence-based interventions that emerge from science to community practice does not guarantee success. A "one-size-fits-all" approach will not work (Glasgow, Klesges, Dzewaltowski, Bull, & Estabrooks, 2003; Sorensen, Emmons, Hunt, & Johnston, 1998). Different settings and populations present a range of cultural, economic, and other environmental circumstances that affect behavior and outcome. As such, the process of implementing interventions that work includes respect for both scientific evidence regarding effective programs and experiential knowledge of what would likely work in a particular context. The process of Implementing Effective Interventions aims to fit effective strategies with local context.
The debate continues regarding the appropriate balance between "implementation of evidence-based programs with fidelity" and "adaptation to different community contexts" (e.g., Aos, Lieb, Mayfield, Miller, & Pennucci, 2004). Accordingly, an integrated process of Implementing Effective Interventions may help community initiatives to:
Matching intervention strategies to fit needs, objectives, and context is critical for the success of community change and improvement efforts. Few community mobilization efforts have developed and implemented the kind of "upstream" environmental changes (e.g., social and policy influences) that can provide the necessary strength and penetration to effect population-level improvements (Merzel & D'Affliti, 2003). For example, many substance use prevention partnerships in the 1990s gravitated toward "Red Ribbon" and other public information and awareness campaigns (despite no evidence that these information-provision strategies reduced alcohol or drug use); and these activities often occurred at the expense of more intensive social policy or regulation efforts to reduce access to alcohol and other drugs (Florin, Mitchell, & Stephenson, 1993; Kreuter, Lezin, & Young, 2000). Yet, through assessment and strategic planning activities, other groups such as a Minnesota farm injury prevention coalition determined that farmers in their area first needed to understand and believe that farm injuries were not random acts of fate; accordingly, their public information interventions occurred simultaneously or sequentially with other strategies to change worker behaviors (Lexau et al., 1993). Similarly, Project Northland, a community and school-based alcohol prevention study, targeted community and policy levels, and achieved significant reductions in alcohol and tobacco use among youth populations (Perry et al., 1996). In addition, Project ASSIST and Tobacco Policy Options for Prevention reported reductions in smoking prevalence rates, suggesting that effectively implementing policy changes provided the basis for a health-promoting environment (Sorensen, Emmons, Hunt, & Johnston, 1998).
Adapting interventions to fit population and context also appears to be a critical factor related to effectiveness. Many interventions aim to target multiple levels for change such as individual, family, organizational, state policy. This ecological approach is based on the idea that communities are made up of individuals who interact in a variety of social networks and within various contexts (Brownson, Baker, Leet, & Gillespie, 2003; Roussos & Fawcett, 2000). In Project COMMIT, community planning boards and coalitions were involved in public education, media programs, policy changes, and other programmatic strategies for smoking prevention (Thompson, Corbett, Bracht, & Pechacek, 1993; Thompson, Wallack, Lichtenstein, & Pechacek, 1991). Yet, standardized intervention and research protocols mandated program activities. The program had no impact on quit rates or the smoking behaviors of heavy smokers, the primary target population (COMMIT Research Group, 1995a, 1995b). Herein, protocols may have constrained communities from adapting the program to meet local needs (Merzel & D'Affliti, 2003; Sorensen, Emmons, Hunt, & Johnston, 1998). Similarly, in the absence of effects, community members criticized the South Carolina Heart to Heart Project for not tailoring physical activity programs to reach African Americans who represented 35% of the target population (Goodman, Wheeler, & Lee, 1995).
In a recent effort to transfer research knowledge to practice, investigators attempted to extend the effectiveness of a "popular opinion leader" (POL) approach for HIV prevention from rural white gay men to other populations and settings. Original research indicated the efficacy of this social network intervention, delivered and modeled in outreach fashion by members of one's own social peer group, to reduce HIV infection (Kelly et al., 1991, 1992, 1997). After one-year in the Mpowerment Project, the proportion of intervention men engaging in unprotected anal intercourse decreased by 27% from baseline (p<.05) compared to a 3% increase in a matched comparison (Kegles, Hays, & Coates, 1996). Sikkema et al. (2000) extended the efficacy of the POL approach to target sexual risk behaviors of African American women. By contrast, POL studies targeting male prostitutes and patrons of New York City huster bars (Miller, Klotz, & Eckholdt, 1998) and gay men in London and Scotland (Elford, Hart, Sherr, Williamson, & Bolding, 2002; Flowers, Hart, Williamson, Frankis, & Der, 2002) reported no changes in sexual risk taking behaviors. Originally designed to target cohesive, explicit, social networks, the POL approach (a) was less able to affect behaviors among non-gay-identified men who have sex with men, and (b) did not generalize to peer interactions among non-United States gay cultures. Accordingly, the successful implementation of interventions such as POL appears to require (1) Defining and understanding targeted groups and social networks, and (2) Matching effective intervention strategies to the local context.
Overall, community change and improvement efforts, often unstaffed and dependent on volunteer labor, may be poorly equipped to accomplish the time-consuming tasks of selecting, tailoring, and sustaining effective implementation of interventions for long-term outcomes (Kreuter, Lezin, & Young, 2000). Other key processes that can build capacities to address these challenges include Developing a Framework or Model of Change, Developing and Using Action Plans, Assuring Technical Assistance, and Making Outcomes Matter.
At present, much of the information available on Implementing Effective Interventions does not explicitly manipulate or test this process and its effects on community change and improvement. Although this process has been identified as a key ingredient for advancing change, there is a need for more systematic evaluations of its implementation and effects. Such research would provide a better understanding of the factors that enable communities to come together and address shared problems and goals.
Some key research questions include: (a) What conditions influence selection and faithful implementation of effective interventions? (b) What differential effects result from practitioner versus researcher implemented strategies? (c) What "promising," yet un- or under-evaluated interventions are associated with improvements in behavioral and population-level outcomes? (d) What are the cost-benefits of policy strategies (e.g., legislative mandates, pricing policies, restrictions on advertising) on population-level outcomes? (e) What does current knowledge suggest about how interventions should balance adoption and effective use of evidence-based and community-recommended strategies for change? And (f) How can use of evidence-based interventions be made easier and more likely by community practitioners?
Based on research and experience, we recommend Implementing Effective Interventions as a key process to advance community change and improvement
1. Engage community members and other key stakeholders in designing the intervention.
__ The group regularly provides opportunities for stakeholders, including those from the target community or population, to be involved in developing, selecting, or providing feedback regarding potential and current interventions facilitated by the initiative.
2. Identify the objectives to be attained by the intervention.
__ The group identifies the target population (or community) and the target behaviors that are desired to be changed by an intevention when selecting or assessing the appropriateness of an intervention.
__When assessing the appropriateness of a potential intervention, the group identifies the specific factors such as (a) personal factors, (b) environmental factors, (c) risk factors, and/or (d) protective factors to be targeted or addressed by the intervention.
__ The group has specific objectives or measures of success to be achieved by potential or current interventions implemented by the initiative.
3. Review candidate interventions or “best practices” related to your problem/goal before choosing or adapting an intervention.
__ The group considers effective approaches or best practices related to the issue when selecting or adapting an intervention.
__ The group considers “what works” or “what doesn’t work”, especially in the target community or with the target population, when selecting, developing, or adapting an intervention.
__ The group considers how the intervention needs to be developed or adapted to fit the needs of the local people, context, and resources.
4. Identify core components, elements, and modes of delivery for the intervention.
__ Identify core intervention components and modes of delivery based on the analysis of the problem/goal and available resources.
__ The group has secured or allocated appropriate financial, human, and material resources necessary for implementing the potential and/or current intervention(s) supported by the initiative.
__ The group has identified how and by whom the intervention components for all interventions supported by the initiative will be implemented and delivered.
__ The group has and uses established timelines or schedules to guide the implementation of the intervention over time.
__ The group has identified and established appropriate relationships and agreements with other collaborators and key stakeholders necessary for implementing and supporting the intervention.
__ The persons or groups responsible for implementing the intervention(s) have received appropriate training and technical support.
5. Evaluate the implementation of the intervention and its contributions towards improving outcomes related to the issue.
__ The group has a structured system to track data regarding the implementation of the group’s activities and accomplishments.
__ The group implements intervention(s) with fidelity, makes adjustments as needed, and assures conditions for its success.
__ Organizational leaders, including the board and staff, regularly review and assess data on documented activities to assess the progress of the initiative in implementing the intervention.
__ The group collects outcome data to assess the contribution of the intervention towards change and improvement in behaviors and longer-term outcomes targeted by the intervention(s)
__ Organizational leaders, including the board and staff, regularly review and assess outcome data related to the implementation of the intervention(s).
__ The group collects and analyzes pre-intervention, during and post-intervention outcome data to assess the level of the issue.
6. Use information on the implementation of the intervention to celebrate, make adjustments, and assure effectiveness of the intervention.
__ The group, including staff and board members, uses data and other information to assess the implementation of the intervention and to make necessary adjustments to the intervention(s).
__ The group is effective in identifying and responding to barriers and opposition experienced in implementing the intervention.
__ The group regularly celebrates successes and accomplishments for progress in implementing the intervention.
__ The group regularly shares data regarding the implementation of the intervention and related outcomes data with key leaders, partners, and stakeholders in the community to enhance support for the intervention(s).
Some Primary CTB Supports for this Process:
1. Engage community members and other key stakeholders in designing the intervention.
Core Supports:
2. Identify the objectives to be attained by the intervention.
Core Supports:
3. Review evidence-based interventions or “best practices” related to your problem/goal before choosing or adapting an intervention.
Core Supports:
4. Identify core components, elements, and modes of delivery for the intervention.
Core Supports:
5. Evaluate the implementation of the intervention and its contributions towards improving outcomes related to the issue.
Core Supports:
6. Use information on the implementation of the intervention to celebrate, make adjustments, and assure effectiveness of the intervention.
Core Supports:
Aos, S., Lieb, R., Mayfield, J., Miller, M., & Pennucci, A. (2004, July). Benefits and costs of prevention and early intervention programs for youth. Olympia: Washington State Institute for Public Policy.
Brownson, RC.;Baker, EA.;Leet, TL.; Gillespie, KN. Evidence-based public health. New York: Oxford University Press; 2003.
Collie-Akers, V., Landry, S., Ehule, N.J. et al. Enhancing the Capacity of Local Health Departments to Address Birth Equity: The Institute for Equity in Birth Outcomes. Matern Child Health J 25, 1010–1018 (2021). https://doi.org/10.1007/s10995-021-03135-1
COMMIT Research Group. Community Intervention Trial for Smoking Cessation (COMMIT): I. Cohort results from a four-year community intervention. American Journal of Public Health 85: 183-192, 1995a.
COMMIT Research Group. Community Intervention Trial for Smoking Cessation (COMMIT): II. Changes in adult cigarette smoking prevalence. American Journal of Public Health 85: 193-200, 1995b.
Elford, Hart, Sherr, Williamson, & Bolding (2002). Peer led HIV prevention among homosexual men in Britain. Sex Transm Inf 2002;78:158-159
Florin, P., Mitchell, R., & Stevenson, J. (1993). Identifying training and technical assistance needs in community coalitions: A developmental approach. Health Education Research, 8, 417-432.
Flowers P, Hart G, Williamson L, Frankis J, Der G. Does bar-based, peer-led sexual health promotion have a community-level effect amongst gay men in Scotland? International Journal of STD & AIDS 2002; 13:102-108.
Foster-Fishman, P.G, Berkowitz, S.L., Lounsbury, D.W., Jacobson, S., & Allen, N.A. (2001). Building collaborative capacity in community coalitions: A review and integrative framework. American Journal of Community Psychology, 29, 241-261.
Glasgow, Klesges, Dzewaltowski, Bull, & Estabrooks (2003).
Goodman, R. M., F. C. Wheeler, et al. (1995). "Evaluation of the Heart To Heart Project: lessons from a community-based chronic disease prevention project." Am J Health Promot 9(6): 443-55.
Kegeles, S. M., Hays, R. B., & Coates, T. J. (1996). The empowerment project: A community-level HIV prevention intervention for young gay men. American Journal of Public Health, 86, 1129–1136.
Kelly, J.A., St. Lawrence, J.S., Diaz, Y.E., Stevenson, L.Y., Hauth, A.C., Brasfield, T.L, Kalichman, S.C., Smith, J.E., & Andrew, M.E. (1991). HIV rish behavior reduction following intervention with key opinion leaders of a population: An experimental community level analysis. American Journal of Public Health, 81, 168-171.
Kelly, J.A., St. Lawrence, J.S., Stevenson, L.Y., Hauth, A.C., Kalichman, S.C., Murphy, D.A. et al. (1992). Community AIDS/HIV risk reduction: The effects of endorsements by popular people in three cities. American Joural of Public Health, 82, 1483-1489.
Kelly, J.A. (1997). HIV risk reduction intervention for persons with serious mental illness. Clinical Psychology Review, 17, 293-309.
Kreuter, M.W., Lezin, N.A., & Young, L.A. (2000). Evaluating community-based collaborative mechanisms: Implications for practitioners. Health Promotion Practice, 1, 49-63.
Landry, S., Collie-Akers, V., Foster, K. et al. Assessing the Development of Collective Impact Initiatives Addressing Maternal and Child Health. Matern Child Health J 24, 405–411 (2020). https://doi.org/10.1007/s10995-020-02894-7
Lexau et al (1993).
Merzel, C., & D'Afflitti, J. (2003). Reconsidering community-based health promotion: Promise, performance, and potential. American Journal of Public Health, 93, 557-574.
Mitchell, R.E., Florin, P., & Stevenson, J.F. (2002). Supporting community-based prevention and health promotion initiatives: Developing effective technical assistance systems. Health Education & Behavior, 29, 620-639.
Miller, Klotz, & Eckholdt. HIV Prevention with Male Prostitutes and Patrons of Hustler Bars: Replication of an HIV Preventive Intervention. American Journal of Community Psychology. Volume 26, Number 1.
Perry, C. L., C. L. Williams, et al. (1996). "Project Northland: outcomes of a community-wide alcohol use prevention program during early adolescence." Journal of Public Health 86: 956-965.
Roussos, S.T., & Fawcett, S.B. (2000). A review of collaborative partnerships as a strategy for improving community health. Annual Review of Public Health, 21, 369-402.
Sikkema et al (2000). Outcomes of a randomized community-level HIV prevention intervention for women living in 18 low-income housing developments. American Journal of Public Health, Vol 90, Issue 1 57-63.
Sorensen, G., Emmons, K., Hunt, M.K., & Johnston, D. (1998). Implications of the results of community intervention trials. Annual Review of Public Health, 19, 379-416.
Thompson, Corbett, Bracht, & Pechacek (1993). Community mobilization for smoking cessation: lessons learned from COMMIT. Health Promotion International, Vol. 8, No. 2, 69-83.
Thompson, Wallack, Lichtenstein, & Pechacek (1991).
Ferretti, Lisa A., & Brick, Mari T. (2006) Maintaining Program Fidelity: A Guide to Strategies for Improving Program Quality in the Chronic Disease Self-Management Program. Center for Excellence in Aging and Community Wellness.
Assuring Technical Assistance is a process of connecting groups to expertise and resources that address needs and provide support over phases of a community improvement effort. Participation in this process can enhance competencies (i.e., in planning or evaluation) and specialized knowledge (e.g., child development), and increase a group's potential to affect change. The process of Assuring Technical Assistance secures and provides support to communities over time as they plan, implement, evaluate, and sustain efforts for making a difference. When groups engage in this process, they are strengthening their own capacities to learn, practice, and subsequently implement effective prevention strategies.
Assuring Technical Assistance is a key process to help groups create conditions for being effective in their community improvement effort.
Community researchers and practitioners have repeatedly expressed the need for timely and accessible technical assistance to support the often complex process of community change and improvement. Technical assistance may be needed and requested for different purposes, including: (a) Using data to set priorities and establish goals and objectives, (b) integrating individual and environmental approaches for change, (c) selecting and implementing effective programs at the local level, and (d) incorporating outcome evaluations into the effort. Timely and appropriate technical assistance can create conditions for communities to address these and other challenges. Groups that build and support core skills and knowledge via technical assistance can strengthen "member capacity" and become more effective at producing desired changes (Foster-Fishman, Berkowitz, Lounsbury, Jacobson, & Allen, 2001).
Although the exact forms of effective technical assistance remains uncertain, Assuring Technical Assistance may helps groups to:
In a study of six community programs implementing the Planned Approach To Community Health (PATCH), technical assistance mostly focused on collecting data for a needs assessment (e.g., Behavioral Risk Factor Survey). Similar levels of technical support were not provided to analyze and interpret data, build consensus to determine priorities, or plan and implement relevant and effective strategies. This type of "front loading" disproportional support for data gathering dampened planning efforts and the abilities of projects to implement substantial interventions (Goodman, Steckler, Hoover, & Schwartz, 1993). Despite this challenge, projects with the greatest implementation successes were those with leaders who had experiences and training in the work of community health promotion. Consequently, in the absence of such skills, efforts to build community capacities (e.g., workshops, mentoring, and other training) and transfer professional expertise to community members are essential for success.
Effective and systematic provision of technical assistance is also critical for implementing proven interventions (see Implementing Effective Interventions). Overall, little research is directed at how to disseminate and increase community adoption of interventions shown to be effective in research settings. Many "technology transfer" efforts fail to change implementation behaviors because they rely on providing information, a relatively weak strategy, as their primary dissemination approach. By contrast, in a randomized trial of 74 organizations, Kelly et al. (2000) reported that dissemination packages that included (a) Implementation manuals, (b) staff training workshops, and (c) follow-up consultation resulted in more frequent adoption and use of research-based HIV prevention interventions. As such, if research findings are to be used by providers, technical assistance and support activities must go beyond developing a compendium of effective interventions. Additional support might also involve community members and organizations in determining unmet needs and strategies to address them.
Internet-based technical assistance and support also makes the work of community change and improvement easier and more rewarding (Fawcett, Schultz, Carson, Renault, & Francisco, 2003). The Community Tool Box is an online resource that includes (a) information and tools to guide the work, (b) a documentation system to understand and improve targeted intervention, (c) forums and other learning communities for co-learning and problem-solving, and other resources for developing core competencies and building capacity. Although no substitute for face-to-face contact, these Internet-based tools are a relevant method for community-based participatory research and action. They also serve a multiplier role by enabling efforts to expand and go to scale.
It is important to note that several barriers such as denied funding can limit access to technical assistance, especially when support is organized by external sources. As such, what we are learning about the effects of Assuring Technical Assistance often comes from support provided to funded communities.
At present, much of the information available on Assuring Technical Assistance does not explicitly manipulate or test this process and its effects on community change and improvement. Although this process has been identified as a key ingredient for advancing change, there is a need for more systematic evaluations of its implementation and effects. Such research would provide a better understanding of types of technical assistance and support mechanisms that effectively assist community initiatives as they pursue community change and improvement.
Some key research questions include: (a) What are necessary components of and indicators to measure effective technical assistance? (b) A what level (e.g., individual, organization, community) or to what end (e.g., changes in context, activities, outcomes) should technical assistance support be directed? (c) What are the gaps or unmet needs in current technical assistance efforts? (d) Under what conditions (e.g., frequency, duration, content) is the provision of technical assistance associated with program improvements (e.g., program implementation, changes in more distant outcomes)? (e) How can communities, technical assistance providers, and funders work together to determine effective technical assistance arrangements? And (f) How can "unfunded" communities secure support and technical assistance to address their needs?
Based on research and experience, we highly recommend Assuring Technical Assistance as a key process to advance community change and improvement.
Assuring Technical Assistance is a process of connecting groups to expertise and resources that address needs and provide support over phases of a community improvement effort. Participation in this process can enhance competencies (i.e., in planning or evaluation) and specialized knowledge (e.g., child development), and increase a group's potential to affect change. The process of Assuring Technical Assistance secures and provides support to communities over time as they plan, implement, evaluate, and sustain efforts for making a difference. When groups engage in this process, they are strengthening their own capacities to learn, practice, and subsequently implement effective prevention strategies.
Assuring Technical Assistance is a key process to help groups create conditions for being effective in their community improvement effort.
Community researchers and practitioners have repeatedly expressed the need for timely and accessible technical assistance to support the often complex process of community change and improvement. Technical assistance may be needed and requested for different purposes, including: (a) Using data to set priorities and establish goals and objectives, (b) integrating individual and environmental approaches for change, (c) selecting and implementing effective programs at the local level, and (d) incorporating outcome evaluations into the effort. Timely and appropriate technical assistance can create conditions for communities to address these and other challenges. Groups that build and support core skills and knowledge via technical assistance can strengthen "member capacity" and become more effective at producing desired changes (Foster-Fishman, Berkowitz, Lounsbury, Jacobson, & Allen, 2001).
Although the exact forms of effective technical assistance remains uncertain, Assuring Technical Assistance may helps groups to:
In a study of six community programs implementing the Planned Approach To Community Health (PATCH), technical assistance mostly focused on collecting data for a needs assessment (e.g., Behavioral Risk Factor Survey). Similar levels of technical support were not provided to analyze and interpret data, build consensus to determine priorities, or plan and implement relevant and effective strategies. This type of "front loading" disproportional support for data gathering dampened planning efforts and the abilities of projects to implement substantial interventions (Goodman, Steckler, Hoover, & Schwartz, 1993). Despite this challenge, projects with the greatest implementation successes were those with leaders who had experiences and training in the work of community health promotion. Consequently, in the absence of such skills, efforts to build community capacities (e.g., workshops, mentoring, and other training) and transfer professional expertise to community members are essential for success.
Effective and systematic provision of technical assistance is also critical for implementing proven interventions (see Implementing Effective Interventions). Overall, little research is directed at how to disseminate and increase community adoption of interventions shown to be effective in research settings. Many "technology transfer" efforts fail to change implementation behaviors because they rely on providing information, a relatively weak strategy, as their primary dissemination approach. By contrast, in a randomized trial of 74 organizations, Kelly et al. (2000) reported that dissemination packages that included (a) Implementation manuals, (b) staff training workshops, and (c) follow-up consultation resulted in more frequent adoption and use of research-based HIV prevention interventions. As such, if research findings are to be used by providers, technical assistance and support activities must go beyond developing a compendium of effective interventions. Additional support might also involve community members and organizations in determining unmet needs and strategies to address them.
Internet-based technical assistance and support also makes the work of community change and improvement easier and more rewarding (Fawcett, Schultz, Carson, Renault, & Francisco, 2003). The Community Tool Box is an online resource that includes (a) information and tools to guide the work, (b) a documentation system to understand and improve targeted intervention, (c) forums and other learning communities for co-learning and problem-solving, and other resources for developing core competencies and building capacity. Although no substitute for face-to-face contact, these Internet-based tools are a relevant method for community-based participatory research and action. They also serve a multiplier role by enabling efforts to expand and go to scale.
It is important to note that several barriers such as denied funding can limit access to technical assistance, especially when support is organized by external sources. As such, what we are learning about the effects of Assuring Technical Assistance often comes from support provided to funded communities.
At present, much of the information available on Assuring Technical Assistance does not explicitly manipulate or test this process and its effects on community change and improvement. Although this process has been identified as a key ingredient for advancing change, there is a need for more systematic evaluations of its implementation and effects. Such research would provide a better understanding of types of technical assistance and support mechanisms that effectively assist community initiatives as they pursue community change and improvement.
Some key research questions include: (a) What are necessary components of and indicators to measure effective technical assistance? (b) A what level (e.g., individual, organization, community) or to what end (e.g., changes in context, activities, outcomes) should technical assistance support be directed? (c) What are the gaps or unmet needs in current technical assistance efforts? (d) Under what conditions (e.g., frequency, duration, content) is the provision of technical assistance associated with program improvements (e.g., program implementation, changes in more distant outcomes)? (e) How can communities, technical assistance providers, and funders work together to determine effective technical assistance arrangements? And (f) How can "unfunded" communities secure support and technical assistance to address their needs?
Based on research and experience, we highly recommend Assuring Technical Assistance as a key process to advance community change and improvement.
1. Assess the stage of development and readiness of the effort to use technical assistance.
__ The group has identified specific areas or processes that could be enhanced through technical assistance and support.
__ The group, including staff and board members, values external assistance and support.
__ The group has assessed the internal capacity of the staff, board members, and partners to provide technical assistance and support based on their areas of knowledge and expertise.
__ The group has identified organizational processes that are more appropriate to be facilitated through external rather than internal sources of technical assistance or support.
__ The effort is currently engaged in a form of technical assistance.
2. Identify appropriate technical assistance and support providers for the initiative.
__ The group, including staff and board members, has decided on the form or method of technical assistance that is most appropriate for the initiative at its current stage of development.
__ The group has decided upon either a formal technical assistance provider, or a knowledgeable staff or partner to provide or assure needed trainings, information, and technical support for the effort.
__ The group considered the appropriateness or fit of potential technical assistance providers based on the context, history, experience, and interest of the organization and community.
__ The group has a plan that includes a timetable, activities, and resulting product (if applicable) for each form of technical assistance to be provided.
__ The group has secured and allocated sufficient resources necessary to support the technical assistance.
3. Establish regular feedback mechanisms and use the feedback to improve technical assistance efforts.
__ The technical support provider(s) give regular feedback and appropriate support to the group.
__ The group provides the technical assistance provider with regular feedback to make necessary adjustments and adaptations.
Assuring Technical Assistance is a process of connecting groups to expertise and resources that address needs and provide support over phases of a community improvement effort. Participation in this process can enhance competencies (i.e., in planning or evaluation) and specialized knowledge (e.g., child development), and increase a group's potential to effect change. The process of Assuring Technical Assistance secures and provides support to communities over time as they plan, implement, evaluate, and sustain efforts for making a difference. When groups engage in this process, they are strengthening their own capacities to learn, practice, and subsequently implement effective prevention strategies.
1. Assess the stage of development and readiness of the effort to use technical assistance.
Core Supports:
2. Identify appropriate technical assistance and support providers for the initiative.
Core Supports:
3. Establish regular feedback mechanisms and use the feedback to improve technical assistance efforts.
Core Supports:
Collie-Akers, V., Landry, S., Ehule, N.J. et al. Enhancing the Capacity of Local Health Departments to Address Birth Equity: The Institute for Equity in Birth Outcomes. Matern Child Health J 25, 1010–1018 (2021). https://doi.org/10.1007/s10995-021-03135-1
Fawcett, S. B., J. A. Schultz, et al. (2003). Using Internet Based Tools to Build Capacity for Community-Based Participatory Research and Other Efforts to Promote Community Health and Development. Community-Based Participatory Research for Health. M. Minkler, Wallerstein, N. San Francisco, Jossey-Bass: 155-178.
Fawcett, S.B., Francisco, V.T., Paine-Andrews, A., & Schultz, J.A. (2000). A model memorandum of collaboration: A proposal. Public Health Reports, 115, 174-179.
Florin, P., Mitchell, R., & Stevenson, J. (1993). Identifying training and technical assistance needs in community coalitions: A developmental approach. Health Education Research, 8, 417-432.
Foster-Fishman, P.G, Berkowitz, S.L., Lounsbury, D.W., Jacobson, S., & Allen, N.A. (2001). Building collaborative capacity in community coalitions: A review and integrative framework. American Journal of Community Psychology, 29, 241-261.
Goodman, R.M., Steckler, A., Hoover, S., & Schwartz, R. (1993). A critique of contemporary community health promotion approaches: based on a qualitative review of six programs in Maine. American Journal of Health Promotion, 7, 208-220.
Holder, H. D., R. F. Saltz, et al. (1997). "A community prevention trial to reduce alcohol-involved accidental injury and death: Overview." Addiction(Supplement 2): S155-S171.
Israel, B.A., Schultz, A.J., Parker, E., & Becker, A.B. (1998). Review of community-based research: Assessing partnership approaches to improve public health. Annual Review of Public Health, 19, 173-202.
Kelly, J.A., Somlai, A.M., DiFranceisco, W.J., Otto-Salaj, L.L., McAuliffe, T.L., Hackl, K.L., et al. (2000). Bridging the gap between the science and serving HIV prevention: Transferring effective research-based HIV prevention interventions to community AIDS service providers. American Journal of Public Health, 90, 1082-1088).
Kreuter, M.W., Lezin, N.A., & Young, L.A. (2000). Evaluating community-based collaborative mechanisms: Implications for practitioners. Health Promotion Practice, 1, 49-63.
Landry, S., Collie-Akers, V., Foster, K. et al. Assessing the Development of Collective Impact Initiatives Addressing Maternal and Child Health. Matern Child Health J 24, 405–411 (2020). https://doi.org/10.1007/s10995-020-02894-7
Mattessich, P., & Monsey, B. (1992). Collaboration: What makes it work. A review of research literature on factors influencing successful collaboration. Saint Paul, MN: Amherst H. Wilder Foundation.
Mattessich, P., & Monsey, B. (1997). Community building: What makes it work. A review of factors influencing successful community building. Saint Paul, MN: Amherst H. Wilder Foundation.
Mitchell, R.E., Florin, P., & Stevenson, J.F. (2002). Supporting community-based prevention and health promotion initiatives: Developing effective technical assistance systems. Health Education & Behavior, 29, 620-639.
Nezlek & Galano (1993).
Parker, E.A., Eng, E., Laraia, B., Ammerman, A., Dodds, J., Margolis, L., et al. (1998). Coalition building for prevention: Lessons learned from the North Carolina community-based public health initiative. Journal of Health Management Practice, 4, 25-36.
Roussos, S.T., & Fawcett, S.B. (2000). A review of collaborative partnerships as a strategy for improving community health. Annual Review of Public Health, 21, 369-402.
Documenting Progress and Using Feedback is a process of gathering and using "data as an energizer" (Hogan & Murphey, 2002). When groups engage in this process, they measure, communicate, and use early and ongoing indicators of progress to assess and improve an initiative (rather than waiting until the intervention is over to assess what has changed). Because it can take many years to change population-level outcomes, indicators of long-term outcomes are not very useful to guide day-to-day activities and adjustments. This process helps groups to engage in early and ongoing communication about goals, their project's theory of change, accomplishments, and their current and potential contribution toward making a difference. Participation in this process can help initiatives identify and market successes that can help in Sustaining the Work.
Documenting Progress and Using Feedback is a key process to help groups understand what they are doing, how it contributes to their goals, and areas for adjustment.
Community initiatives are complex and dynamic, and present ongoing opportunities for a "continuous learning orientation" (Foster-Fishman, Berkowitz, Lounsbury, Jacobson, & Allen, 2001). As their work unfolds, participants often adapt to shifting conditions, dialogue about problems, and seek information and expertise to improve their intervention. By engaging in a process of Documenting Progress and Using Feedback, community initiatives consistently seek and respond to information and evaluation data (e.g., more intermediate outcomes or program effects) to improve their functioning and impact. This focus on documentation of more intermediate outcomes can help to (a) Document progress (e.g., community and system changes), (b) celebrate accomplishments, (c) identify barriers to progress, and (d) redirect efforts to potentially more effective activities (Fawcett et al., 1996; Francisco, Paine, & Fawcett, 1993).
Although the functional mechanisms have not been explicitly tested, Documenting and Using Feedback may help groups to:
Summative evaluations at the end of a community intervention's funding often indicate modest impacts due to weaknesses in delivery such as limited duration, intensity, insufficient scope of activities, and inadequate penetration into the community (Merzel & D'Affliti, 2003). Accordingly, the regular process of Documenting Progress and Using Feedback can enable collaborators to regularly review what they are doing, what it means, and how they can adjust to improve - rather than conclude at the end that, upon review, their activities were insufficient.
An initiative is unable to assess the degree of implementation or its impact without criteria and data for documentation, assessment, and evaluation. More importantly, this kind of regular assessment is critical for taking corrective/adaptive actions. For example, in the COMMIT randomized trial of 22 communities for tobacco use cessation, smoking behaviors of heavy smokers - the primary target population - did not change (COMMIT Research Group, 1995a, 1995b). Upon data analyses at project completion, intervention worksites reported an average level of project implementation at only 37% (e.g., implementation of cessation workshops or smoke-free policies). Similarly, other evaluation data from summative project evaluations repeatedly indicated that participants reported exposure to intervention activities that reflected less intensive forms of behavior change strategies. For example, in the Pawtucket Heart Health Program, 55% of program participants reported receiving screening services only, while only 10% of the city's population participated in exercise programs over the project's seven year duration (Elder et al., 1986). In the Minnesota Heart Health Program, 60% of adults participated in screening services, 87% reported exposure to mass media health messages, yet only 4.1% of smokers participated in smoking cessation programs (Lando et al., 1995). Alternatively, early and ongoing documentation and feedback regarding the reach and penetration of intervention components may have suggested the need to improve the quality and intensity of interventions that were necessary for changing complex behaviors such as heavy smoking.
Similarly, the Fighting Back Initiative mobilized citizen task forces around a broadly defined and community-driven intervention focused on alcohol and other drug use prevention (Saxe et al., 1997). Communities had extreme latitude in implementing programs, policies, and practices to address outcomes. Summative evaluations indicated that, after ten years, intervention sites were not significantly different from matched comparison communities on 30-day alcohol use, binge drinking, and other indicators (Hallfors et al., 2002). At the project's end, experts in the field, in an attempt to describe the dose of the intervention, assigned implementation scores based on the relative strength of strategy implementation within a site (i.e., from zero, indicating no activity, to 5, indicating extensive activity). Across 14 communities, average implementation scores ranged from 1.1 to 3.9. Most sites scored minimally (2 or less) on their use of practices such as reducing youth access to tobacco and alcohol. The most used strategy across all sites was public information, one of the weakest forms of behavior-change strategies. More regular feedback regarding the intensity of intervention delivery could have prompted sites to adjust to more effective program strategies.
By contrast, Kansas communities in the School-Community Sexual Risk Reduction Initiative participated in a comprehensive and ongoing evaluation. Sites tracked community change - new or modified programs, policies, and practices - as a metric that reflects changing conditions in the environment that support widespread behavior change and subsequent population-level outcomes. Monthly, sites documented and reflected on the (a) amount (number reported), (b) intensity (use of behavior change strategies beyond providing information, (c) duration (length of time in place), and (d) penetration (delivery through different sectors and geographic areas). Unlike evaluations of previous community initiatives, investigators were able to establish a link between these intermediate outcomes and birth rates. Results indicated that birth rates decreased in Target Area A and not Target Area B. The intervention was more intensive and comprehensive in terms of attention to program components, risk factors, and distribution by sector in Area A versus B (Paine Andrews et al., 2002).
Overall, the study of community initiatives, especially systematic measurement of their complex and dynamic interventions and intermediate outcomes, can aid in better understanding their effectiveness. The process of Documenting Progress and Using Feedback can help to distinguish intervention failure from implementation failure, often called Type 3 error (Cook & Campbell, 1979). Without data on implementation of the intervention and intermediate outcomes, it is difficult to establish an association between an intervention and reported effects. Similarly, in the face of no results, it can be unclear if the study design was without merit, implementation was flawed, or large populations were reached by a weak intervention (Boothroyd, Fawcett, & Foster-Fishman, 2003).
At present, much of the information available on Documenting Progress and Using Feedback does not explicitly manipulate or test this process and its effects on community change and improvement. Although this process has been identified in several empirical and experiential reviews as a key ingredient for advancing change, there is a need for more systematic evaluations of its effects. Such research would provide a better understanding of the factors that enable communities to come together and address shared problems and goals.
Some key research questions include: (a) What is the most effective dose of a community intervention (e.g., duration, penetration, exposure)? (b) How might interactions between intervention dose and population characteristics affect program planning and implementation? (c) What quantitative and qualitative methods best address stakeholders' questions and interests? (d) How, by whom, and under what circumstances are data best communicated to ensure maximum impact? And (e) How can we measure and analyze how intervention components are contributing to best practices for prevention?
Based on research and experience, we highly recommend Documenting Progress and Using Feedback as a key process to advance community change and improvement.
Documenting Progress and Using Feedback is a process of gathering and using "data as an energizer" (Hogan & Murphey, 2002). When groups engage in this process, they measure, communicate, and use early and ongoing indicators of progress to assess and improve an initiative (rather than waiting until the intervention is over to assess what has changed). Because it can take many years to change population-level outcomes, indicators of long-term outcomes are not very useful to guide day-to-day activities and adjustments. This process helps groups to engage in early and ongoing communication about goals, their project's theory of change, accomplishments, and their current and potential contribution toward making a difference. Participation in this process can help initiatives identify and market successes that can help in Sustaining the Work.
Documenting Progress and Using Feedback is a key process to help groups understand what they are doing, how it contributes to their goals, and areas for adjustment.
Community initiatives are complex and dynamic, and present ongoing opportunities for a "continuous learning orientation" (Foster-Fishman, Berkowitz, Lounsbury, Jacobson, & Allen, 2001). As their work unfolds, participants often adapt to shifting conditions, dialogue about problems, and seek information and expertise to improve their intervention. By engaging in a process of Documenting Progress and Using Feedback, community initiatives consistently seek and respond to information and evaluation data (e.g., more intermediate outcomes or program effects) to improve their functioning and impact. This focus on documentation of more intermediate outcomes can help to (a) Document progress (e.g., community and system changes), (b) celebrate accomplishments, (c) identify barriers to progress, and (d) redirect efforts to potentially more effective activities (Fawcett et al., 1996; Francisco, Paine, & Fawcett, 1993).
Although the functional mechanisms have not been explicitly tested, Documenting and Using Feedback may help groups to:
Summative evaluations at the end of a community intervention's funding often indicate modest impacts due to weaknesses in delivery such as limited duration, intensity, insufficient scope of activities, and inadequate penetration into the community (Merzel & D'Affliti, 2003). Accordingly, the regular process of Documenting Progress and Using Feedback can enable collaborators to regularly review what they are doing, what it means, and how they can adjust to improve - rather than conclude at the end that, upon review, their activities were insufficient.
An initiative is unable to assess the degree of implementation or its impact without criteria and data for documentation, assessment, and evaluation. More importantly, this kind of regular assessment is critical for taking corrective/adaptive actions. For example, in the COMMIT randomized trial of 22 communities for tobacco use cessation, smoking behaviors of heavy smokers - the primary target population - did not change (COMMIT Research Group, 1995a, 1995b). Upon data analyses at project completion, intervention worksites reported an average level of project implementation at only 37% (e.g., implementation of cessation workshops or smoke-free policies). Similarly, other evaluation data from summative project evaluations repeatedly indicated that participants reported exposure to intervention activities that reflected less intensive forms of behavior change strategies. For example, in the Pawtucket Heart Health Program, 55% of program participants reported receiving screening services only, while only 10% of the city's population participated in exercise programs over the project's seven year duration (Elder et al., 1986). In the Minnesota Heart Health Program, 60% of adults participated in screening services, 87% reported exposure to mass media health messages, yet only 4.1% of smokers participated in smoking cessation programs (Lando et al., 1995). Alternatively, early and ongoing documentation and feedback regarding the reach and penetration of intervention components may have suggested the need to improve the quality and intensity of interventions that were necessary for changing complex behaviors such as heavy smoking.
Similarly, the Fighting Back Initiative mobilized citizen task forces around a broadly defined and community-driven intervention focused on alcohol and other drug use prevention (Saxe et al., 1997). Communities had extreme latitude in implementing programs, policies, and practices to address outcomes. Summative evaluations indicated that, after ten years, intervention sites were not significantly different from matched comparison communities on 30-day alcohol use, binge drinking, and other indicators (Hallfors et al., 2002). At the project's end, experts in the field, in an attempt to describe the dose of the intervention, assigned implementation scores based on the relative strength of strategy implementation within a site (i.e., from zero, indicating no activity, to 5, indicating extensive activity). Across 14 communities, average implementation scores ranged from 1.1 to 3.9. Most sites scored minimally (2 or less) on their use of practices such as reducing youth access to tobacco and alcohol. The most used strategy across all sites was public information, one of the weakest forms of behavior-change strategies. More regular feedback regarding the intensity of intervention delivery could have prompted sites to adjust to more effective program strategies.
By contrast, Kansas communities in the School-Community Sexual Risk Reduction Initiative participated in a comprehensive and ongoing evaluation. Sites tracked community change - new or modified programs, policies, and practices - as a metric that reflects changing conditions in the environment that support widespread behavior change and subsequent population-level outcomes. Monthly, sites documented and reflected on the (a) amount (number reported), (b) intensity (use of behavior change strategies beyond providing information, (c) duration (length of time in place), and (d) penetration (delivery through different sectors and geographic areas). Unlike evaluations of previous community initiatives, investigators were able to establish a link between these intermediate outcomes and birth rates. Results indicated that birth rates decreased in Target Area A and not Target Area B. The intervention was more intensive and comprehensive in terms of attention to program components, risk factors, and distribution by sector in Area A versus B (Paine Andrews et al., 2002).
Overall, the study of community initiatives, especially systematic measurement of their complex and dynamic interventions and intermediate outcomes, can aid in better understanding their effectiveness. The process of Documenting Progress and Using Feedback can help to distinguish intervention failure from implementation failure, often called Type 3 error (Cook & Campbell, 1979). Without data on implementation of the intervention and intermediate outcomes, it is difficult to establish an association between an intervention and reported effects. Similarly, in the face of no results, it can be unclear if the study design was without merit, implementation was flawed, or large populations were reached by a weak intervention (Boothroyd, Fawcett, & Foster-Fishman, 2003).
At present, much of the information available on Documenting Progress and Using Feedback does not explicitly manipulate or test this process and its effects on community change and improvement. Although this process has been identified in several empirical and experiential reviews as a key ingredient for advancing change, there is a need for more systematic evaluations of its effects. Such research would provide a better understanding of the factors that enable communities to come together and address shared problems and goals.
Some key research questions include: (a) What is the most effective dose of a community intervention (e.g., duration, penetration, exposure)? (b) How might interactions between intervention dose and population characteristics affect program planning and implementation? (c) What quantitative and qualitative methods best address stakeholders' questions and interests? (d) How, by whom, and under what circumstances are data best communicated to ensure maximum impact? And (e) How can we measure and analyze how intervention components are contributing to best practices for prevention?
Based on research and experience, we highly recommend Documenting Progress and Using Feedback as a key process to advance community change and improvement.
1. Identify key stakeholders, their questions of interest, and other reporting needs (if applicable) for the documentation and feedback system.
__ Key stakeholders of the organization were involved in designing or adapting the documentation system for the initiative.
__ The group has identified the types of data and information that are important to key stakeholders and other audiences.
__ The group has identified the primary purposes, functions, and uses of data that is documented for the initiative.
__ The group has developed a key set of evaluation questions that are important to stakeholders and other important audiences.
2. Identify the measures to be used in the documentation and feedback system.
__The group collects process measures.
__ The group documents the activities (implementation of the intervention) or efforts of the initiative in addressing the issue.
__ The group collects longer-term or outcomes measures.
__ The group has identified the data sources and assured access to various types of measures to be collected by the initiative.
__ The types of data that are collected and documented are consistent with the measures indicated in the logic model or strategic plan.
__ The group has a protocol established for collecting and documenting data that specifies all of the following: (a) the types of data to be collected; (b) who is responsible for documenting data; (c) how often data will be collected.
3. Document or collect the data using systematic methods.
__ The group has an established process for regularly assessing the reliability and the validity of the data that is collected and documented by the initiative.
4. Analyze, communicate, and use the data to make improvements in the initiative.
__ The group, including both the staff and board members, regularly reviews and provides feedback on data that is documented by the initiative to assure the accuracy and completeness of the data.
__ The group, including both the staff and board members, regularly reviews the evaluation questions and documented data to assess progress.
__ The group regularly analyzes (make sense of data) to help make adjustments and improvements to the initiative.
__ The group reviews and uses data that is documented by the initiative as a tool for celebrating accomplishments and acknowledging individuals for their contributions to the initiative.
Primary Community Tool BoxSupports for this Process:
1. Identify key stakeholders, their questions of interest, and other reporting needs (if applicable) for the documentation and feedback system.
Core Supports:
2. Identify the measures to be used in the documentation and feedback system.
Core Supports:
3. Document or collect the data using systematic methods.
Core Supports:
4. Analyze, communicate, and use the data to make improvements in the initiative.
Core Supports:
Boothroyd, R. I., S. B. Fawcett, et al. (2004). Community Development: Enhancing the Knowledge Base Through Participatory Action Research. Participatory Community Research: Theories and Methods In Action. L. K. Jason, CB; Suarez-Balcazar, Y; et al. Washington, DC, American Pyschological Association.
Collie-Akers, V., Landry, S., Ehule, N.J. et al. Enhancing the Capacity of Local Health Departments to Address Birth Equity: The Institute for Equity in Birth Outcomes. Matern Child Health J 25, 1010–1018 (2021). https://doi.org/10.1007/s10995-021-03135-1
COMMIT Research Group. Community Intervention Trial for Smoking Cessation (COMMIT): I. Cohort results from a four-year community intervention. American Journal of Public Health 85: 183-192, 1995a.
COMMIT Research Group. Community Intervention Trial for Smoking Cessation (COMMIT): II. Changes in adult cigarette smoking prevalence. American Journal of Public Health 85: 193-200, 1995b.
Cook, T. D. and D. T. Campbell (1979). Quasi-experimentation : design & analysis issues for field settings. Boston, Houghton Mifflin.
Elder et al (1986).
Fawcett, S. B., A. Paine-Andrews, et al. (1996). Empowering community health initiative through evaluation. Empowerment evaluation: Knowledge and tools for self-assessment and accountablility. D. M. Fetterman, S.J. Kafterian, and A. Wandersman. Thousand Oaks, Sage Publications: 161-187.
Fawcett, S.B., Francisco, V.T., Paine-Andrews, A., & Schultz, J.A. (2000). A model memorandum of collaboration: A proposal. Public Health Reports, 115, 174-179.
Fawcett, S. B., R. Boothroyd, et al. (2003). "Building Capacity for participatory evaluation within community initiatives." Journal of Prevention and Intervention in the Community 26(2): 21-36.
Florin, P., Mitchell, R., & Stevenson, J. (1993). Identifying training and technical assistance needs in community coalitions: A developmental approach. Health Education Research, 8, 417-432.
Foster-Fishman, P.G, Berkowitz, S.L., Lounsbury, D.W., Jacobson, S., & Allen, N.A. (2001). Building collaborative capacity in community coalitions: A review and integrative framework. American Journal of Community Psychology, 29, 241-261.
Francisco, V. T., A. L. Paine, et al. (1993). "A methodology for monitoring and evaluating community health coalitions." Health Educ Res 8(3): 403-16.
Goodman, Wandersman, Chinman, Imm, & Morrissey (1996). An ecological assessment of community-based interventions for prevention and health promotion: Approaches to measuring community coalitions. American Journal of Community Psychology. Volume 24, Number 1.
Green, L. (2001). From research to “best practices” in other settings and populations. American Journal of Health Behavior.
Hallfors, D. (2002). "Fighting back against substance use: Are community coalitions winning?" American Journal of Preventive Medicine 8(3): 375-384.
Hogan, C., & Murphey, D. (2002). Outcomes: Reframing responsibility for well-being. A report to the Annie E. Casey Foundation. Baltimore, MD: Annie E. Casey Foundation.
Kreuter, M.W., Lezin, N.A., & Young, L.A. (2000). Evaluating community-based collaborative mechanisms: Implications for practitioners. Health Promotion Practice, 1, 49-63.
Lando et al (1995).
Landry, S., Collie-Akers, V., Foster, K. et al. Assessing the Development of Collective Impact Initiatives Addressing Maternal and Child Health. Matern Child Health J 24, 405–411 (2020). https://doi.org/10.1007/s10995-020-02894-7
Mattessich, P., & Monsey, B. (1997). Community building: What makes it work. A review of factors influencing successful community building. Saint Paul, MN: Amherst H. Wilder Foundation.
Merzel, C., & D'Afflitti, J. (2003). Reconsidering community-based health promotion: Promise, performance, and potential. American Journal of Public Health, 93, 557-574.
Minkler M, Wallerstein N. Community-based participatory research for health. San Francisco, CA: Jossey-Bass, 2003.
Paine-Andrews, A., J. L. Fisher, et al. (2002). "Analyzing the contribution of community change to population health outcomes in an adolescent pregnancy prevention initiative." Health Educ Behav 29(2): 183-93.
Ploeg, J., Dobbins, M., Hayward, S., Ciliska, D., Thomas, H., & Underwood, J. (1996). Effectiveness of community development projects.
Rogers, E. M. (2006). Communication of innovations.Sage Publications Pvt. Ltd
Roussos, S.T., & Fawcett, S.B. (2000). A review of collaborative partnerships as a strategy for improving community health. Annual Review of Public Health, 21, 369-402.
Rowe (1997).
Saxe et al (1997). Think globally, act locally: Assessing the impact of community-based substance abuse prevention. Evaluation and Program Planning. Volume 20, Issue 3. 357-366.
Shaw, Rosatim, Salzman, Coles, & McGeary (1997).
Shortell, S.M., Zukoski, A.P., Alexander, J.A., Bazzoli, G.J., Conrad, D.A., Hasnain-Wynia, R., et al., (2002). Evaluating partnerships for community health improvement: Tracking the footprints. Journal of Health Politics, Policy, and Law, 27, 49-108.
Sorensen, G., Emmons, K., Hunt, M.K., & Johnston, D. (1998). Implications of the results of community intervention trials. Annual Review of Public Health, 19, 379-416.
Making Outcomes Matter is a process of using incentives and disincentives to promote sustained activities that lead to change and improvement. This process integrates regular updates on project accomplishments and needed adjustments into assessments of progress, accountability, and co-learning. When groups engage in Making Outcomes Matter, they agree to (a) Organize and review interim evidence of progress and impact (e.g., community and system change; community-level indicators of health and development), and (b) assess findings with partners to determine next steps for continuous improvement. Procedures to put this process into action can range from informal practices (e.g., marketing information and data to increase its use in decision making) to formal contingencies on behavior (e.g., grant installments based on achievement of a minimum number of programs or changes delivered each quarter).
Making Outcomes Matter is a key process to help communities create and change conditions for behavior change and population-level improvements.
Making Outcomes Matter is a process that uses feedback on progress and differential rewards (i.e., incentives and disincentives) for change and improvement. It is not simply about "accountability" - a thumbs-up or thumbs-down final assessment of the merit of the effort. Rather, the process of Making Outcomes Matter occurs over the lifespan of an initiative, and aims to use information about progress to prompt action and make adjustments. Feedback --- on levels of change and improvement and incentives for progress --- are used to enhance levels of organizational capacity, implementation, and community change and population-level improvements (Fawcett, Francisco, Paine-Andrews, & Schultz, 2000; Paine Andrews, Francisco, & Fawcett, 1994). This process works best when linked to other key processes that help to (a) outline the conceptual roadmap and indicators for change (Developing a Framework or Model of Change) and (b) measure and understand what an initiative is doing (Documenting Progress and Sharing Feedback).
Although the exact mechanisms for Making Outcomes Matter are uncertain, participation in this process may help groups to:
Linking resources to progress in implementation, levels of change, and improvement on outcomes can have powerful effects. For example, with a substance abuse coalition known as Project Freedom, the rate of community change (i.e., new programs, policies, and practices) facilitated by the effort was rather modest. Following announcement by a grantmaker that annual renewal of the groups' funding would be based, in part, on the changes brought about by the effort, the rate of community changes increased dramatically (Fawcett et al., 1997). Similarly, the Ewing Marion Kauffman Foundation incorporated reporting on community outcomes into their funding arrangement with communities. As a result, and after visioning and leadership training, subsequent community planning, implementation, and documentation efforts focused on accomplishing change (Kreuter et al., 2000). Sites used regular evaluation data on community changes to reveal progress and target areas not yet showing desired changes. In addition, they were able to use evaluation data to seek more funding and sustain ongoing programming. The process of linking resources with funding was successful after both parties understood the aim and procedures for documenting evidence of work toward achieving outcomes.
Similarly, United Way of American shifted from a fundraising organization to a community impact organization that is focused on improving community outcomes (Essential Attributes, 2003). Outcome-focused planning ("name and frame impact") helps initiatives align data about various issues with current activities to address challenges that may impede change. Then, by focusing meetings, action teams, and other implementation and sense-making steps on indicators and results, groups focus efforts on achieving meaningful impact on community -dentified concerns. For example, drop-out rates have been cut in half through a multi-sector partnership that changed the way community systems deal with truancy and student alienation. In Wichita, Kansas, almost 4000 uninsured people have enrolled to receive coordinated, low-cost health care through Project Access.
In the state of Vermont, when a state agency and community members infused data regarding alcohol-related motor vehicle deaths into multiple levels of community decision-making, they saw a drastic improvement over time (Hogan & Murphey, 2002). Vermont went from ranking worst (1996 and 1997) to second best (1999) in the nation in the proportion of teen crash deaths that involved alcohol. When media coverage, community members' prevention activities, and legislative bodies (governor, departments of safety and public safety) instigated a widespread conversation about this indicator, they helped make outcomes matter. Data in media profiles of alcohol-related teen deaths and other public conversations resulted in incremental material resources, community interception to break up teen drinking parties, and improved enforcement, court referrals, and stiffened sanctions for alcohol possession. In summary, the presence of contingencies such as material rewards and social consequences can affect the array of activities associated with change and improvement.
At present, much of the information available on Making Outcomes Matter does not explicitly manipulate or test this process and its effects on community change and improvement. Although this process has been identified as a key ingredient for advancing change, there is a need for more systematic evaluations of its implementation and effects. Such research would provide a better understanding of the factors that enable communities to come together and address shared problems and goals.
Some key research questions include: (a) What criteria are used to decide whether an effort merits continued or enhanced support? (b) How does the evaluation contribute to the sustainability and institutionalization of the effort and its core components? (c) What combination of material rewards (e.g., bonus grants contingent on progress) and social consequences (e.g., media promotions of success stories) are associated with increased community change and improvement?
Based on research and experience, we recommend (with qualifications) Making Outcomes Matter as a key process to advance community change and improvement.The process is suggested by many researchers and practitioners as an important tool for designing, strengthening, and evaluation community change and improvement interventions. Yet, the prevalence of empirical and experiential evidence regarding its effectiveness is at an early stage compared to what is known about other Best Processes.
Making Outcomes Matter is a process of using incentives and disincentives to promote sustained activities that lead to change and improvement. This process integrates regular updates on project accomplishments and needed adjustments into assessments of progress, accountability, and co-learning. When groups engage in Making Outcomes Matter, they agree to (a) Organize and review interim evidence of progress and impact (e.g., community and system change; community-level indicators of health and development), and (b) assess findings with partners to determine next steps for continuous improvement. Procedures to put this process into action can range from informal practices (e.g., marketing information and data to increase its use in decision making) to formal contingencies on behavior (e.g., grant installments based on achievement of a minimum number of programs or changes delivered each quarter).
Making Outcomes Matter is a key process to help communities create and change conditions for behavior change and population-level improvements.
Making Outcomes Matter is a process that uses feedback on progress and differential rewards (i.e., incentives and disincentives) for change and improvement. It is not simply about "accountability" - a thumbs-up or thumbs-down final assessment of the merit of the effort. Rather, the process of Making Outcomes Matter occurs over the lifespan of an initiative, and aims to use information about progress to prompt action and make adjustments. Feedback --- on levels of change and improvement and incentives for progress --- are used to enhance levels of organizational capacity, implementation, and community change and population-level improvements (Fawcett, Francisco, Paine-Andrews, & Schultz, 2000; Paine Andrews, Francisco, & Fawcett, 1994). This process works best when linked to other key processes that help to (a) outline the conceptual roadmap and indicators for change (Developing a Framework or Model of Change) and (b) measure and understand what an initiative is doing (Documenting Progress and Using Feedback).
Although the exact mechanisms for Making Outcomes Matter are uncertain, participation in this process may help groups to:
Linking resources to progress in implementation, levels of change, and improvement on outcomes can have powerful effects. For example, with a substance use coalition known as Project Freedom, the rate of community change (i.e., new programs, policies, and practices) facilitated by the effort was rather modest. Following announcement by a grantmaker that annual renewal of the groups' funding would be based, in part, on the changes brought about by the effort, the rate of community changes increased dramatically (Fawcett et al., 1997). Similarly, the Ewing Marion Kauffman Foundation incorporated reporting on community outcomes into their funding arrangement with communities. As a result, and after visioning and leadership training, subsequent community planning, implementation, and documentation efforts focused on accomplishing change (Kreuter et al., 2000). Sites used regular evaluation data on community changes to reveal progress and target areas not yet showing desired changes. In addition, they were able to use evaluation data to seek more funding and sustain ongoing programming. The process of linking resources with funding was successful after both parties understood the aim and procedures for documenting evidence of work toward achieving outcomes.
Similarly, United Way of American shifted from a fundraising organization to a community impact organization that is focused on improving community outcomes (Essential Attributes, 2003). Outcome-focused planning ("name and frame impact") helps initiatives align data about various issues with current activities to address challenges that may impede change. Then, by focusing meetings, action teams, and other implementation and sense-making steps on indicators and results, groups focus efforts on achieving meaningful impact on community -dentified concerns. For example, drop-out rates have been cut in half through a multi-sector partnership that changed the way community systems deal with truancy and student alienation. In Wichita, Kansas, almost 4000 uninsured people have enrolled to receive coordinated, low-cost health care through Project Access.
In the state of Vermont, when a state agency and community members infused data regarding alcohol-related motor vehicle deaths into multiple levels of community decision-making, they saw a drastic improvement over time (Hogan & Murphey, 2002). Vermont went from ranking worst (1996 and 1997) to second best (1999) in the nation in the proportion of teen crash deaths that involved alcohol. When media coverage, community members' prevention activities, and legislative bodies (governor, departments of safety and public safety) instigated a widespread conversation about this indicator, they helped make outcomes matter. Data in media profiles of alcohol-related teen deaths and other public conversations resulted in incremental material resources, community interception to break up teen drinking parties, and improved enforcement, court referrals, and stiffened sanctions for alcohol possession. In summary, the presence of contingencies such as material rewards and social consequences can affect the array of activities associated with change and improvement.
At present, much of the information available on Making Outcomes Matter does not explicitly manipulate or test this process and its effects on community change and improvement. Although this process has been identified as a key ingredient for advancing change, there is a need for more systematic evaluations of its implementation and effects. Such research would provide a better understanding of the factors that enable communities to come together and address shared problems and goals.
Some key research questions include: (a) What criteria are used to decide whether an effort merits continued or enhanced support? (b) How does the evaluation contribute to the sustainability and institutionalization of the effort and its core components? (c) What combination of material rewards (e.g., bonus grants contingent on progress) and social consequences (e.g., media promotions of success stories) are associated with increased community change and improvement?
Based on research and experience, we recommend (with qualifications) Making Outcomes Matter as a key process to advance community change and improvement. The process is suggested by many researchers and practitioners as an important tool for designing, strengthening, and evaluation community change and improvement interventions. Yet, the prevalence of empirical and experiential evidence regarding its effectiveness is at an early stage compared to what is known about other Best Processes.
1. Identify indicators of success for the initiative.
__ The group has specific agreed upon outcomes to guide the work of the initiative.
__ There is a clear audience or identified stakeholders who care about the outcomes of the initiative.
__ The group has identified the key questions of interest for each identified target audience.
2. Specify reporting requirements about the activities and outcomes of the initiative.
__ The group regularly communicates or reports the progress or status of the initiative internally to key leaders, members, and partners of the initiative.
__ The group is responsible for regularly communicating or providing reports regarding the progress of the initiative to important external audiences.
__ There are clear expectations and conditions for communicating or reporting the outcomes of the initiative to key stakeholders and target audiences.
3. Use incentives and disincentives to encourage outstanding implementation of activities and improvement in outcomes.
__ The group has clearly established consequences associated with the performance or actions of the group.
__ There are clear consequences including incentives and disincentives associated with the attainment of the initiative's outcomes.
__ The group has identified the appropriate conditions for which the use of incentives and disincentives would enhance the efforts of the initiative.
__ The group has identified incentives or disincentives that are appropriate to be used by the initiative.
__ The group has identified the appropriate level within the initiative to use incentives or disincentives.
__ The rewards for the group are administered or supported by key stakeholders in positions of relative influence or authority for the initiative.
__ The group has incentives and disincentives to support the work of the initiative at multiple levels of the initiative.
__ The distribution or allocation of rewards is appropriate for the initiative’s current stage of development.
__ There is a timeline or schedule associated with the distribution or allocation of the majority of incentives and disincentives related to the efforts of the initiative.
__ The incentives or disincentives that are used matter to the group receiving the rewards.
__ The distribution of identified incentives/disincentives is based on the attainment of the intended objectives.
4. Develop a system for documenting and providing feedback to monitor the activities and outcomes of the initiative.
__ The group documents the activities (implementation of the intervention) or efforts of the initiative in addressing the issue.
__ The group collects longer-term indicators or outcomes measures.
__ The group, including both the staff and board members, regularly review the evaluation questions and documented data to assess the progress of the initiative.
__ The group regularly shares and communicates data to key stakeholders and others with a stake in the initiative’s success.
5. Arrange celebrations and public recognition for those who bring about change and improvement.
__ The group regularly celebrates the progress of the initiative in attaining anticipated outcomes.
__ The group regularly provides formal recognition for stakeholders for their contribution towards progress in attaining outcomes.
1. Identify indicators of success for the initiative.
Core Supports:
2. Specify reporting requirements about the activities and outcomes of the initiative.
Core Supports:
3. Use incentives and disincentives to encourage outstanding implementation of activities and improvement in outcomes.
Core Supports:
4. Develop a system for documenting and providing feedback to monitor the activities and outcomes of the initiative.
Core Supports:
5. Arrange celebrations and public recognition for those who bring about change and improvement.
Core Supports:
Collie-Akers, V., Landry, S., Ehule, N.J. et al. Enhancing the Capacity of Local Health Departments to Address Birth Equity: The Institute for Equity in Birth Outcomes. Matern Child Health J 25, 1010–1018 (2021). https://doi.org/10.1007/s10995-021-03135-1
Essential Attributes (2003).
Fawcett, S. B., R. K. Lewis, et al. (1997). "Evaluating community coalitions for the prevention of substance abuse: The case of Project Freedom." Health Education & Behavior 24(6): 812-828.
Fawcett, S.B., Francisco, V.T., Paine-Andrews, A., & Schultz, J.A. (2000). A model memorandum of collaboration: A proposal. Public Health Reports, 115, 174-179.
Gerry, Fawcett, & Richter (1996).
Hogan, C., & Murphey, D. (2002). Outcomes: Reframing responsibility for well-being. A report to the Annie E. Casey Foundation. Baltimore, MD: Annie E. Casey Foundation.
Kreuter, M.W., Lezin, N.A., & Young, L.A. (2000). Evaluating community-based collaborative mechanisms: Implications for practitioners. Health Promotion Practice, 1, 49-63.
Landry, S., Collie-Akers, V., Foster, K. et al. Assessing the Development of Collective Impact Initiatives Addressing Maternal and Child Health. Matern Child Health J 24, 405–411 (2020). https://doi.org/10.1007/s10995-020-02894-7
Paine-Andrews, A., V. T. Francisco, et al. (1994). "Assessing Community Health Concerns and Implementing a Microgrant Program for Self-Help Initiatives." American Journal of Public Health 84(2): 316-318.
Roussos, S.T., & Fawcett, S.B. (2000). A review of collaborative partnerships as a strategy for improving community health. Annual Review of Public Health, 21, 369-402.
Walker, G., & Grossman, J.B. (1999). Philanthropy
Sustaining the Work is a process of developing financial, community, and organizational supports for interventions to remain viable in the long-term. The changes that communities seek often require more time than typically funded by an external agent. In addition, although not all efforts merit continuation, problems may return when the interventions - and even the collaborative processes that support them - are no longer in place. Many foundations and other external funding agencies expect efforts to leave something behind to continue successful change interventions and improvements. Yet when funding and support end, it is up to the community to find ways to maintain successful programs and effects. The process of Sustaining the Work can help community initiatives plan and implement efforts for the long haul. When groups engage in the process of Sustaining the Work, they can develop the necessary commitment, capacity, and resources (e.g., funds, community leaders, and organizations) to ensure (a) that the values, ideas, and processes of the effort are widely shared and deeply felt, (b) that important relationships are nurtured and remain strong, (c) that policy and practice innovations are instiitutionalized and become the norm, and (d) that needed financial and human resources are secured for the long term (Cornerstone Consulting Group, 2002).
Sustaining the Work is a key process to help groups advance toward the behavioral changes and population-level improvements they seek.
Population-level change often requires more time than is funded by external funding agents, so enabling communities to maintain interventions and their effects is a priority (Thompson, Lichtenstein, Corbett, Nettekoven, & Feng, 2000). Yet promising, early results do not naturally lead to a desire or the capacity to continue intervention activities. Maintenance of community participation, project activities, and effects are difficult to attain in the absence of sufficient time, funding, community support, and other resources (Merzel & D'Affliti, 2003). The process of Sustaining the Work can help communities "institutionalize" the effort - that is, continue the process of building capacities to maintain processes, programs, and their effects (Sorensen, Emmons, Hunt, & Johnston, 1998).
Although the exact mechanisms are unclear for how Sustaining the Work contributes to change and improvement, participation in this process can help groups to:
In addition, it is unrealistic to assume that community members are willing and/or able to sustain a community intervention long-term. Community change and improvement efforts require passion for the issues, expertise in planning and program development, and appreciation for existing community networks, leadership skills, and time (Goodman, Steckler, Hoover, & Schwartz, 1993). Likewise, funders are not necessarily willing to finance, on a continual basis, the very things needed for a strong community effort - competencies and processes such as strategic planning, capacity building, data and feedback (Cornerstone Consulting Group, 2002). The process of Sustaining the Work may also require attention to Assuring Technical Assistance.
Attention to the issue of sustaining community initiatives and interventions is increasing, but little consensus exists about what to sustain and its contributions to effectiveness. Among the few published data-based studies on maintenance (also known as durability, institutionalization, or sustainability), the COMMIT study examined tobacco control activities two years after the end of the intervention phase. Previously, all 11 intervention communities wrote a plan for continuation of project activities at the beginning of the final project year. Overall, intervention and comparison communities both reported similar amounts of prevention activities; intervention communities showed slight gains in availability of smoking cessation events and enforcement of prohibitions against youth smoking. Investigators suggested that COMMIT did not spend enough time planning for sustainability Communities received little or not training or technical assistance to assure continuation of activities. In addition, efforts to institutionalize programs competed with the time-consuming task of fund-raising, which may have reduced energy to create conditions for ongoing activities (Thompson, Lichtenstein, Corbett, Nettekoven, & Feng, 2000).
By contrast, empirical analysis of community initiatives funded by the Kansas Health Foundation suggested that early and ongoing support for sustainability resulted in institutionalization of programs, policies, and practices (community change). During four-year teen pregnancy and substance use prevention interventions in six Kansas communities, members participated in technical assistance and support activities (e.g., sustainability workshops, site visits, development of a financial sustainability plan) to facilitate concrete steps toward sustainability after grant termination. One year after funding, survey and interview data indicated that communities had relied on 7 out of 13 suggested strategies for sustainability (e.g., leveraging shared positions, grant writing, incorporating activities into organizations with similar missions) (Paine-Andrews, Fisher, Campuzano, Fawcett, & Berkley-Patton, 2000). Accordingly, at one-year post intervention, many different efforts, such as mentoring programs and health department policies, were institutionalized with different organizations throughout the communities. Lead agency support and community leadership were factors often associated with sustainability. Five years after intervention funding concluded, subsequent interview data indicated that certain components (e.g., certain programs and community leaders) continued to address teen pregnancy prevention priorities, and that trends in estimated pregnancy rates continued to decrease beyond state and county comparisons (Boothroyd, Paine-Andrews, Fisher, & Ransom, 2003).
More often, sustainability is a latent concern. Despite ideas of expansion, commitment by some community organizations, and other best intentions, resources are too few and planning too late to successfully transition a group's efforts (Shediac-Rizkallah & Bone, 1998). As such, the potential impact of this process on effectiveness remains unclear.
At present, much of the information available on Sustaining the Work does not explicitly manipulate or test this process and its effects on community change and improvement. Although this process has been identified in empirical and experiential reviews as a key ingredient for advancing change, there is a need for more systematic evaluations of its effects. Such research would provide a better understanding of the factors that enable communities to come together and address shared problems and goals.
Some key research questions include: (a) How does the structure of initiative funding - required community matches, grant size, reductions in annual awards - influence community ownership and planning for sustainability? (b) What characteristics of lead agency or sponsoring organizations - size, structure, relationship in the community - influence an initiative's continuation opportunities? (c) How do community characteristics - rural/urban, income, available resources - influence program institutionalization and financial sustainability efforts? And (d) What capacity building areas are needed to make an initiative sustainable?
Based on research and experience, we recommend (with qualifications) Sustaining the Work as a key process to advance community change and improvement. The process is suggested by researchers and practitioners as an important tool for extending the impact of community change and improvement interventions. Yet, the prevalence of empirical and experiential evidence regarding its effectiveness is at an early stage compared to what is known about other Best Processes.
Sustaining the Work is a process of developing financial, community, and organizational supports for interventions to remain viable in the long-term. The changes that communities seek often require more time than typically funded by an external agent. In addition, although not all efforts merit continuation, problems may return when the interventions - and even the collaborative processes that support them - are no longer in place. Many foundations and other external funding agencies expect efforts to leave something behind to continue successful change interventions and improvements. Yet when funding and support end, it is up to the community to find ways to maintain successful programs and effects. The process of Sustaining the Work can help community initiatives plan and implement efforts for the long haul. When groups engage in the process of Sustaining the Work, they can develop the necessary commitment, capacity, and resources (e.g., funds, community leaders, and organizations) to ensure (a) that the values, ideas, and processes of the effort are widely shared and deeply felt, (b) that important relationships are nurtured and remain strong, (c) that policy and practice innovations are institutionalized and become the norm, and (d) that needed financial and human resources are secured for the long term (Cornerstone Consulting Group, 2002).
Sustaining the Work is a key process to help groups advance toward the behavioral changes and population-level improvements they seek.
Population-level change often requires more time than is funded by external funding agents, so enabling communities to maintain interventions and their effects is a priority (Thompson, Lichtenstein, Corbett, Nettekoven, & Feng, 2000). Yet promising, early results do not naturally lead to a desire or the capacity to continue intervention activities. Maintenance of community participation, project activities, and effects are difficult to attain in the absence of sufficient time, funding, community support, and other resources (Merzel & D'Affliti, 2003). The process of Sustaining the Work can help communities "institutionalize" the effort - that is, continue the process of building capacities to maintain processes, programs, and their effects (Sorensen, Emmons, Hunt, & Johnston, 1998).
Although the exact mechanisms are unclear for how Sustaining the Work contributes to change and improvement, participation in this process can help groups to:
In addition, it is unrealistic to assume that community members are willing and/or able to sustain a community intervention long-term. Community change and improvement efforts require passion for the issues, expertise in planning and program development, and appreciation for existing community networks, leadership skills, and time (Goodman, Steckler, Hoover, & Schwartz, 1993). Likewise, funders are not necessarily willing to finance, on a continual basis, the very things needed for a strong community effort - competencies and processes such as strategic planning, capacity building, data and feedback (Cornerstone Consulting Group, 2002). The process of Sustaining the Work may also require attention to Assuring Technical Assistance.
Attention to the issue of sustaining community initiatives and interventions is increasing, but little consensus exists about what to sustain and its contributions to effectiveness. Among the few published data-based studies on maintenance (also known as durability, institutionalization, or sustainability), the COMMIT study examined tobacco control activities two years after the end of the intervention phase. Previously, all 11 intervention communities wrote a plan for continuation of project activities at the beginning of the final project year. Overall, intervention and comparison communities both reported similar amounts of prevention activities; intervention communities showed slight gains in availability of smoking cessation events and enforcement of prohibitions against youth smoking. Investigators suggested that COMMIT did not spend enough time planning for sustainability Communities received little or not training or technical assistance to assure continuation of activities. In addition, efforts to institutionalize programs competed with the time-consuming task of fund-raising, which may have reduced energy to create conditions for ongoing activities (Thompson, Lichtenstein, Corbett, Nettekoven, & Feng, 2000).
By contrast, empirical analysis of community initiatives funded by the Kansas Health Foundation suggested that early and ongoing support for sustainability resulted in institutionalization of programs, policies, and practices (community change). During four-year teen pregnancy and substance use prevention interventions in six Kansas communities, members participated in technical assistance and support activities (e.g., sustainability workshops, site visits, development of a financial sustainability plan) to facilitate concrete steps toward sustainability after grant termination. One year after funding, survey and interview data indicated that communities had relied on 7 out of 13 suggested strategies for sustainability (e.g., leveraging shared positions, grant writing, incorporating activities into organizations with similar missions) (Paine-Andrews, Fisher, Campuzano, Fawcett, & Berkley-Patton, 2000). Accordingly, at one-year post intervention, many different efforts, such as mentoring programs and health department policies, were institutionalized with different organizations throughout the communities. Lead agency support and community leadership were factors often associated with sustainability. Five years after intervention funding concluded, subsequent interview data indicated that certain components (e.g., certain programs and community leaders) continued to address teen pregnancy prevention priorities, and that trends in estimated pregnancy rates continued to decrease beyond state and county comparisons (Boothroyd, Paine-Andrews, Fisher, & Ransom, 2003).
More often, sustainability is a latent concern. Despite ideas of expansion, commitment by some community organizations, and other best intentions, resources are too few and planning too late to successfully transition a group's efforts (Shediac-Rizkallah & Bone, 1998). As such, the potential impact of this process on effectiveness remains unclear.
At present, much of the information available on Sustaining the Work does not explicitly manipulate or test this process and its effects on community change and improvement. Although this process has been identified in empirical and experiential reviews as a key ingredient for advancing change, there is a need for more systematic evaluations of its effects. Such research would provide a better understanding of the factors that enable communities to come together and address shared problems and goals.
Some key research questions include: (a) How does the structure of initiative funding - required community matches, grant size, reductions in annual awards - influence community ownership and planning for sustainability? (b) What characteristics of lead agency or sponsoring organizations - size, structure, relationship in the community - influence an initiative's continuation opportunities? (c) How do community characteristics - rural/urban, income, available resources - influence program institutionalization and financial sustainability efforts? And (d) What capacity building areas are needed to make an initiative sustainable?
Based on research and experience, we recommend (with qualifications) Sustaining the Work as a key process to advance community change and improvement. The process is suggested by researchers and practitioners as an important tool for extending the impact of community change and improvement interventions. Yet, the prevalence of empirical and experiential evidence regarding its effectiveness is at an early stage compared to what is known about other Best Processes.
1. Determine whether the initiative or activities should be sustained.
__ The group has determined who makes decisions regarding sustainability of the initiative or its efforts.
__The group has determined the appropriate level of the initiative to be sustained. The group has determined if the initiative or the efforts of the initiative should be sustained.
__ The group has determined the intended duration or the length of time that is appropriate for the initiative or effort to be sustained.
__ The initiative has sufficient support (both internal and external) to maintain the initiative or the efforts of the initiative, if desired.
__ There is sufficient commitment from the group to maintain the efforts of the initiative, if desired.
2. Assess the current situation for sustaining the initiative.
__ The group has identified current or potential resources needed to sustain the initiative or its efforts.
__ The group currently has sufficient human resources necessary to sustain the initiative or its efforts.
__ The group currently has sufficient financial resources necessary to sustain the initiative or its efforts.
__ The group assessed its activities and products, its benefits and competition.
3. Clarify the goals and context for sustaining the efforts of the initiative.
__ The group has a clear mission and a common agenda to guide the sustainability of the initiative or its efforts.
__ The group has assessed its progress in attaining its anticipated goals and objectives related to the mission of the initiative.
__ The group has determined if the initiative’s current objective(s) need to be expanded or changed to support the sustainability of the initiative or its efforts.
__ The group has decided what aspects of the initiative or effort should be maintained or altered.
__ The group has established written goals and objectives related to sustaining the initiative or its efforts.
__ The group has determined the specific activities and services to be maintained by the initiative.
__ The group has identified the target community or population to participate or benefit from the sustained efforts of the initiative.
4. Develop a sustainability plan that includes what resources will be necessary and how they will be attained.
__ The group has established specific short-term and long-term financial goals and a budget including all projected income and expenses.
__ The group has identified specific and appropriate strategies to be used to sustain itself.
__ The group has identified the current and potential basis and sources of resources including human and financial resources.
5. Implement an action plan for sustaining the initiative or its activities.
__ The group has developed and implemented an action plan for each of the strategies and tactics chosen.
__ Action plans were developed that identified the person responsible, a clear timeline, and resources needed for implementing the components of the sustainability plan.
__ The group systematically documents the activities and results of efforts to secure and maintain resources.
__ The group regularly reviews the results of implementation in reaching its short and long-term goals for sustainability.
__The group has developed relationships and networks with potential partners including funders that may be interested in supporting the efforts of the initiative.
1. Determine whether the initiative or activities should be sustained.
Core Supports:
2. Assess the current situation for sustaining the initiative.
Core Supports:
3. Clarify the goals and context for sustaining the efforts of the initiative.
Core Supports:
4. Develop a sustainability plan that includes what resources will be necessary and how they will be attained.
Core Supports:
5. Implement an action plan for sustaining the initiative or its activities.
Core Supports:
Boothroyd, Paine-Andrews, Fisher, & Ransom (2003).
Collie-Akers, V., Landry, S., Ehule, N.J. et al. Enhancing the Capacity of Local Health Departments to Address Birth Equity: The Institute for Equity in Birth Outcomes. Matern Child Health J 25, 1010–1018 (2021). https://doi.org/10.1007/s10995-021-03135-1
Cornerstone Consulting Group (2002). Eng games: The challenge of sustainability. Baltimore, MD: Annie E. Casey Foundation.
Goodman, R.M., Steckler, A., Hoover, S., & Schwartz, R. (1993). A critique of contemporary community health promotion approaches: based on a qualitative review of six programs in Maine. American Journal of Health Promotion, 7, 208-220.
Landry, S., Collie-Akers, V., Foster, K. et al. Assessing the Development of Collective Impact Initiatives Addressing Maternal and Child Health. Matern Child Health J 24, 405–411 (2020). https://doi.org/10.1007/s10995-020-02894-7
Lewis, R. K., A. Paine-Andrews, et al. (1996). "Evaluating the effects of a community coalition's efforts to reduce illegal sales of alcohol and tobacco products to minors." Journal of Community Health 21(6): 429.
Merzel, C., & D'Afflitti, J. (2003). Reconsidering community-based health promotion: Promise, performance, and potential. American Journal of Public Health, 93, 557-574.
Mittelmark, M.B., Hunt, M.K., Heath, G.W., & Schmid, T.L. (1993). Realistic outcomes: Lessons from community-based research and demonstration programs for the prevention of cardiovascular diseases. Journal of Public Health Policy, 14, 437-462.
Paine-Andrews, A., J. L. Fisher, et al. (2000). Promoting sustainability of community health initiatives: An empirical case study.
Shediac-Rizkallah, M.C., & Bone, L.R. (1998). Planning for the sustainability of community-based health programs: Conceptual frameworks and future directions for research, practice, and policy. Health Education Research, 13, 87-108.
Sorensen, G., Emmons, K., Hunt, M.K., & Johnston, D. (1998). Implications of the results of community intervention trials. Annual Review of Public Health, 19, 379-416.
Thompson, B., Lichtenstein, E., Corbett, K., Nettekoven, L., & Feng, Z. (2000). Durability of tobacco control efforts in the 22 Community Intervention Trial for Smoking Cessation (COMMIT) communities 2 years after the end of intervention. Health Education Research, 15, 353-366.