Section 14. MAP-IT: A Model for Implementing Healthy People 2020

Learn how to use Healthy People 2020's MAP-IT framework to Mobilize, Assess, Plan, Implement, and Track community public health efforts.

 

 

MAP-IT (Moblize, Assess, Plan, Implement, Track) is a step-by-step method for creating healthy communities. Using MAP-IT can help public health professionals and communtiy changemakers implement a plan that is tailored to a communtiy's needs and assets. This section describes the MAP-IT framework and provides a basis for how to implement it into plans for improving communtiy health.

What is MAP-IT?

MAP-IT (Mobilize, Assess, Plan, Implement, Track) is a framework that can be used to plan and evaluate public health interventions in a community. Both seasoned and new public health professionals can utilize the steps in MAP-IT to create a healthy community. This process involves time, effort, and a series of steps to ‘map out’ the path toward the desired change in a community. Keep in mind that there is no “right” way to follow this approach, and some of the steps will need to be taken multiple times. Using MAP-IT, a step-by-step, structured plan can be developed by a coalition that is tailored to a specific community’s needs.

• Mobilize individuals and organizations that care about the health of your community into a coalition.
• Assess the areas of greatest need in your community, as well as the resources and other strengths that you can tap into to address those areas.
• Plan your approach: start with a vision of where you want to be as a community; then add strategies and action steps to help you achieve that vision.
• Implement your plan using concrete action steps that can be monitored and will make a difference.
• Track your progress over time.

Why Use the MAP-IT approach?

• It involves all stakeholders, making for a widely-supported and community-owned effort.
• It assesses assets as well as needs, and looks for ways to use them.
• Assessment means that the effort will start from the reality of the community, rather than from some preconceived idea of what’s necessary or what resources are available.
• It produces a comprehensive and specific plan, with reasonable timelines, assigned responsibility, clear objectives, and well-defined action steps related to an overall strategy.
• It incorporates evaluation from the beginning, allowing adjustment when necessary.

How do you use the MAP-IT approach?

Step 1: Mobilize

The first step in the MAP-IT process is to mobilize key individuals and organizations into a coalition.  Look for partners who have a stake in creating healthy communities and who will contribute to the process. Aim for broad representation.

Most communities already have health departments and other governmental agencies that are responsible for public health services. Many communities also have coalitions of key individuals and organizations that have come together to address specific issues, such as neighborhood watch groups. These groups often represent diverse interests and resources for addressing issues that are vital to building and maintaining the health of an entire community. A coalition will often work with the health department and other health organizations in the community. However, it can also help mobilize a wider range of resources to address health issues.

It is typically easier to engage potential coalition members around issues that are already of special concern to the community. Successful community coalitions have been built around issues such as:

• Substance use
• HIV/AIDS
• Teen pregnancy
• Maternal and child health
• Environmental health
• Domestic violence
• Neighborhood crime

Once coalition members have been identified, roles for partners should be defined and responsibilities assigned. This will help keep partners invested in the coalition. Partners can help facilitate community input through meetings, events, or advisory groups. They can also develop and present education and training programs, lead fundraising and policy initiatives, and provide technical assistance in planning or evaluation. At this stage, plan to identify:

• The vision and mission of the coalition.
• The reason for bringing people together.
• The individuals who should be represented.
• Potential partners in the community, such as organizations and businesses.

One of the biggest challenges in creating a healthy community coalition is to sustain members’ involvement in the process. This challenge can be overcome in part by agreeing as early as possible on a vision for the community.

Creating a vision: The vision should originate from the community’s most important needs, values, and goals. It should be a description of the coalition’s ideal direction for the community, and should reflect the goals of the coalition members. Creating a vision early on allows all members of the coalition to feel committed to the long-term process, and will allow the group to enter into the next stage of the process with a common mission.

Organizing a Coalition: Before you begin contacting potential partners, it is important to know exactly what you are asking of them. Here are a few questions to consider beforehand.

• How many members do you want, and what type of skills do they need to have?
• What is the expected time commitment? (How many hours per month for how long?)
• Will the members be expected to represent their agencies, communities, or constituencies?
• Which population groups should be represented?
• Where, when, and how often will you meet?
• Will the meetings be open or closed?
• Who will be the coalition leader(s)? Will they be appointed or elected?
• Who are your strongest allies?
• How will you reward great efforts?

Brainstorm Potential Partners: Who are likely stakeholders? You’ll want as broad a group as possible, representing everyone in the community with an interest either in the issue itself or in building a healthy community. It’s generally an advantage to involve as many different groups and community sectors as possible. The more participation you have in planning for and addressing the issue, the more ideas that will surface, and the more community support the effort will have.

Some obvious possibilities include:

• Those directly affected by the issue.
• Health and human service organizations that work directly with the issue or serve those affected by it.
• People whose jobs or lives may be affected by an effort directed at the issue – police or teachers, for example, in the case of an initiative aimed at youth violence.
• The business community or specific businesses that have an interest.
• The media.

Mobilization Example:
Minnesota formed the Minnesota Health Improvement Partnership, a group of individuals representing a broad sector of both public and private organizations, including members from local departments of health. This group was charged with the responsibility to develop Healthy Minnesotans: Public Health Improvement Goals for 2004.

Step 2: Assess

The next step in the MAP-IT approach is to assess both community needs and assets (resources). This will identify what the real needs are (as opposed to what most people may think the needs are), and provide a sense of what can realistically be done, versus the ideal of what people would like to see done. Plan to address the questions of who is affected and how, what resources are available, and what resources are needed. When coalition members work together to set priorities and allocate resources for those priorities, they are far more likely to continue to participate in the process and achieve measurable results.

The coalition should set priorities by identifying what community members and key stakeholders see as the most important issues. Consider feasibility, effectiveness, and measurability in determining priorities. The Healthy People 2020 objectives can serve as a starting point by providing a wide array of health and community safety issues facing the nation. Setting priorities is a matter of consensus: all coalition members should agree on which issues need to be addressed immediately and which can be put off until a specified later date.

This may be a good time to start a discussion of the determinants of health. These are factors in the individual, the community and the society that influence the individual’s and the community’s health and quality of life, sometimes directly and sometimes subtly. One or more is often the root cause of a health or quality of life issue. Healthy People 2020 sees as them as falling into five broad categories:

Policy making
Social factors
Health services
Individual behavior
Biology and genetics

Within each of these categories, there may be several determinants – particularly social determinants, such as discrimination, education, availability of healthy food and places to exercise, and socially-created environmental conditions (industrial pollution, lack of open space) – that influence health in your community.

Research has shown that most health issues are governed by a constellation of these determinants, rather than just one, and that the most effective community health programs address a number of them.

Are these important factors in the health of your community, and, if so, in what ways? Are there ways in which your coalition can address them?

Whenever possible, gather and evaluate available information about the major health issues in a community. When no data are available, the coalition may need to begin collecting State and local data to paint a realistic picture of community needs. The data collected during the assessment phase will serve as baseline data, which provide information prior to the start of a new program or intervention. Baseline data will also allow tracking of progress to determine how successful the coalition’s actions have been by comparing them with data collected later, after the community’s effort has run for a while. Documentation of progress can be a strong tool for enhancing the coalition’s actions.

There are a number of data sources that might be available. The U.S. Census collects vast amounts of information on Americans every ten years, breaking it down in almost every way possible, both geographically (by state, county, city or town, census tract, etc.) and demographically (by age, gender, race, income, education, etc.) Most states, and many counties and municipalities collect data on a range of conditions and topics as well, most of which is accessible on line. The Centers for Disease Control, the National Institutes of Health, the Department of Health and Human Services, and various other government agencies compile data (again, most available on line) by state, by county, and – sometimes – by municipality. In addition, many local organizations and institutions – hospitals, human service programs, school districts, police departments – compile data as well, and may be willing to share it for assessment purposes.

Evaluators from a university or government agency may be able to help with data analysis and measurement.

While it certainly would be helpful to have an external evaluator, not all communities may have the necessary resources for it – a nearby university, money to hire a consultant, a public health agency with the personnel, etc.  The coalition might also conduct its own evaluation.

Resources: Once a community’s needs have been assessed, develop a list of strengths and resources within that community. Resources go beyond financial—every community has a wealth of non-monetary resources that can be used to address areas of concern, including:

• Technology
• Communication
• Infrastructure, such as supermarkets, roads, parks, bus lines, housing, and office space
• Professional expertise
• Data
• Community-based organizations, such as local businesses, service organizations, faith-based communities, and community leaders
• Community institutions – schools, colleges and universities, libraries, arts institutions, sports and exercise facilities

The value of working with strong community-based organizations should not be underestimated. These groups can be vital to the success of community efforts, because of both their knowledge of the community and key people in it.

Assessment Example:

Kansas determined priority health issues through its Healthy Kansas 2000 Steering Committee, which evaluated health data, sought expert opinions, invited public comments, and conducted an opinion survey of residents. Kansas used a consensus method to limit the scope of its objectives to 7 priority health areas and 4 disease risk factors. The 7 priority health areas included alcohol and drug abuse, cancer, heart disease, HIV and other sexually transmitted diseases, infectious diseases and immunizations, injuries and violence, and maternal and infant health. The focal risk factors were lack of access to preventive care, tobacco use, poor nutrition, and lack of physical activity.

Step 3: Plan

Once priorities have been set and data have been gathered, an action plan is needed with concrete steps and deadlines. For helpful tips, visit Toolkit 4: Developing a Framework or Model of Change. In the planning phase, use the vision as a guide and include clear objectives in order to achieve them in the plan. Objectives should be specific to each issue or community, and should address the goal of the program, what is needed in order to reach the goal, and a way of measuring progress in order to know when the goal has been reached. A plan of action should include:

• Action steps.
• Assignment of responsibility.
• Information collection.
• A feasible timeline.

When setting objectives, remember to state exactly what is to be achieved: what is expected to change, by how much, and by when. The objectives should be challenging, yet realistic. Remember to include a target, which is the desired amount of change within a given amount of time (reflected by a number or percentage). Healthy People 2020 has a timeframe of one decade, but smaller increments may be more appropriate for the coalition’s community.

Remember that every target needs a baseline (where you are now—the first data point). Address strategies for how each objective will be reached. Action steps may be developed independently or as part of an overall strategy. Start by searching for best practices and evidence-based interventions, and engage coalition members in a strategy brainstorm. Strategies can serve as umbrellas under which all coalition members can contribute in some way to a given target. Remember to include ongoing data collection (monitoring) in the action plan.

The action plan also needs to indicate who will be responsible for overseeing and following up on specific action steps. Assigning specific individuals to well-defined and agreed-upon roles will facilitate the action plan. It will also help coalition members feel like important members of the team, with responsibility to fulfill their roles and help realize the overall vision for the community.

Finally, be realistic when planning the timeline. Consider how much time will be necessary to complete each part of the plan, as well as the schedules of coalition members.

Planning Example:

To achieve its year 2000 objectives, the Rhode Island Department of Health initiated the Worksite Wellness Council of Rhode Island. Rhode Island focused on increasing health promotion and disease prevention activities in work sites, where most adults spend the majority of their time. The State Wellness Council entered into an agreement with the Wellness Council of America (WELCOA) to make Rhode Island the first Well State in the United States. Through this agreement, Rhode Island aims to have 20 percent of its workforce in WELCOA-certified Work Well Sites.

Step 4: Implement

Once the action plan is established, coalition members can begin to implement the strategies and action steps identified in the plan. Coalition members should work on completing the tasks that have been assigned to them according to the set timeframe. Monitoring or routine tracking of events is key to implementation. For example, if the action plan calls for weekly reports on a certain topic, monitoring will demonstrate whether this is occurring as planned.

Remember that monitoring is most effective when it is planned before an initiative has begun, so that it can take place throughout the life of the effort.  In order to monitor your progress properly, you’ll need to identify appropriate indicators – the things that you’ll measure to check your process, performance, and outcomes.  These will show you (indicate) whether you’re doing what you planned, and how well it’s working.  Paying attention to the indicators will also help you understand why something may not be successful, and give you the information to make changes that will improve the effectiveness of your initiative.

Consider identifying a single point of contact to manage the process and ensure that things get done. Be sure to share responsibilities across coalition members. Plan to periodically bring in new partners for a boost of energy and fresh ideas, and check in regularly with existing partners to see if they have suggestions or concerns. Communication among partners and any staff that are involved is one of the keys to effective implementation.

And don’t neglect the value of publicity for your effort in the community. Get the word out by developing a communication plan, and convene kick-off events, activities, and community meetings to showcase your accomplishments (and partners).  (Healthy People offers a simple guideline for a communication plan.

Be aware that the implementation of most action plans to improve the health of a community may take longer than expected. Patience and a positive outlook can help coalition members stay invested throughout the process.

Implementation Example:

North Carolina has established an Office of Healthy Carolinians that is responsible for keeping their Healthy People initiative on track. Staff are available to North Carolina counties for support and training, particularly coalition building. There is also a governor’s task force that certifies counties in the Healthy Carolinians project. The counties do an assessment and then implement an action plan.

Step 5: Track

In the last phase of the MAP-IT process, plan regular evaluations to measure and track your progress over time. Tracking is a two-part step that involves analyzing the data and reporting on progress. Make sure to note to what extent the plan was followed, any changes that were made, and whether the goal was reached.

Evaluation and tracking are vital to the long-term success of the coalition’s efforts. Consider partnering with a local university or State center for health statistics to help with data tracking. Some things to think about when you are evaluating data over time:

• Data Quality: Be sure to check for standardization of data collection, analysis, and structure of questions.
• Limitations of Self-Reported Data: When you are relying on self-reported data (such as exercise frequency or income), be aware of self-reporting bias.
• Data Validity and Reliability: Watch out for revisions of survey questions and/or the development of new data collection systems. This could affect the validity of your responses over time. (Enlist a statistician to help with validity and reliability testing.)
• Data Availability: Data collection efforts are not always performed on a regular basis.

Remember to share your progress and successes with your community. If you see a positive trend in data, issue a press release or announcement. Make sure to involve the media so that you’ll be able to put the word out when you need to.

Tracking Example:

For its 1996 and 1999 updates to the State’s year 2000 objectives, New Jersey’s statistical and program staff assessed progress and analyzed trends. Based on their trend analysis, staff categorized each objective and subobjective as “likely to be achieved,” “unlikely to be achieved,” or “uncertain.”

In Summary

The Healthy People 2020 MAP-IT framework is designed to help communities develop local health initiatives.  Its phases of Mobilize-Assess-Plan-Implement-Track provide a logical structure for communities to address and resolve local health problems and to build healthy communities.