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

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MAP-IT (Mobilize, Assess, Plan, Implement, Track) is a step-by-step method for creating healthy communities. MAP-IT was used as an implementation framework for Healthy People 2020 and continues to provide a practical structure for planning and evaluating community health efforts. Using MAP-IT can help public health professionals and community changemakers develop a plan tailored to a community's needs and assets. This section describes the MAP-IT framework and provides a basis for using it in plans to improve community 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 experienced and newer public health professionals and community partners can use the steps in MAP-IT to help create healthier communities. This process involves time, effort, and a series of steps to “map out” the path toward desired change in a community. Keep in mind that there is no single “right” way to follow this approach, and some steps may need to be revisited more than once. Using MAP-IT, a coalition can develop a structured plan tailored to a specific community's needs, priorities, and assets.

• 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 stakeholders and community members, helping create a broadly supported and community-owned effort.
• It assesses assets as well as needs and looks for ways to use them.
• Assessment helps the effort begin with community data, knowledge, experiences, and existing resources rather than assumptions about what is needed.
• 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 adjustments 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 government agencies involved in public health services. Many communities also have coalitions of individuals and organizations that have come together to address specific issues, such as neighborhood safety. These groups may represent different interests, experiences, and resources related to issues that are important to the health of the 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 community 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
• Pregnancies among adolescents
• Maternal and child health
• Environmental health
• Domestic violence
• Neighborhood crime and safety

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 people and perspectives that 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 sustaining members' involvement in the process. This challenge can be addressed 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, strengths, and goals. It should describe the coalition's ideal direction for the community and reflect the goals of coalition members and community participants. Creating a vision early on can strengthen members' commitment to the long-term process and allow the group to enter the next stage with a shared sense of purpose.

Organizing a Coalition (PDF): 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 types of skills, knowledge, or experience should be represented?
• What is the expected time commitment? (How many hours per month for how long?)
• Will members be expected to represent their agencies, communities, or constituencies?
• Which populations and perspectives 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 recognize members' contributions and efforts?

Brainstorm Potential Partners: Who are likely stakeholders? You'll want as broad a group as possible, with representation from people and sectors throughout the community that have an interest either in the issue itself or in building a healthy community. It's generally an advantage to involve many different groups and community sectors. The more meaningful participation you have in planning for and addressing the issue, the more knowledge and ideas can be brought to the process, and the more community support the effort may have.

Some obvious possibilities include:

• People directly affected by the issue.
• Health and human service organizations that work directly with the issue or serve people affected by it.
• People whose jobs or lives may be affected by an effort directed at the issue – law enforcement officers or teachers, for example, in the case of an initiative addressing youth violence.
• The business community or specific businesses that have an interest.
• Local media and communication partners.

Historical Mobilization Example:
Minnesota formed the Minnesota Health Improvement Partnership, a group of individuals representing a broad range of public and private organizations, including local health departments. The group was charged with developing Healthy Minnesotans: Public Health Improvement Goals for 2004. Although this example reflects an earlier Healthy People era, it illustrates the MAP-IT principle of bringing different sectors together around shared community health goals.

Step 2: Assess

The next step in the MAP-IT approach is to assess both community needs and assets (resources). This helps identify needs based on available data and community knowledge rather than assumptions and provides a sense of what can realistically be done with the resources and strengths available. Plan to address the questions of who is affected and how, what resources are available, and what additional resources may be needed. When coalition members work together to set priorities and allocate resources for those priorities, they are more likely to remain involved in the process and work toward measurable results.

The coalition should set priorities by identifying what community members and key stakeholders see as the most important issues. Consider feasibility, effectiveness, equity, and measurability in determining priorities. The current Healthy People 2030 objectives can provide a useful national reference point across a wide range of health, well-being, and community conditions. Setting priorities should be a collaborative process in which coalition members and community participants determine which issues require immediate attention and which can be addressed later.

This may be a good time to discuss the determinants of health. Health and quality of life are influenced by conditions at the individual, community, institutional, and societal levels. Social determinants of health are one important part of that picture.

Healthy People 2030 groups social determinants of health into five broad domains:

Economic Stability
Education Access and Quality
Health Care Access and Quality
Neighborhood and Built Environment
Social and Community Context

Within these domains are conditions such as employment and income, education, access to health care, housing, transportation, access to nutritious food, discrimination, violence, environmental conditions, social support, and civic participation. These conditions can influence opportunities for health and well-being in a community.

Health outcomes are rarely shaped by only one factor. Effective community health efforts often consider several interacting conditions rather than focusing only on individual behavior or a single program.

Which of these conditions are important to the health of your community, and in what ways? Are there areas in which your coalition can help create change?

Whenever possible, gather and evaluate available information about major health issues in the community. When needed data are not available, the coalition may need to begin collecting local or state data to develop a more complete picture of community needs and assets. Data gathered during the assessment phase can serve as baseline data – information collected before a new program or intervention begins. Baseline data make it possible to compare later findings and track whether conditions are changing over time. Documentation of progress can also help the coalition explain its work and make decisions about what should happen next.

A number of data sources may be available. The U.S. Census Bureau provides population, housing, social, and economic information through sources such as the decennial census and the American Community Survey, with data available at different geographic levels. States, counties, municipalities, tribal governments, and local agencies may also collect information about health and community conditions. Federal agencies such as the Centers for Disease Control and Prevention, the National Institutes of Health, and the U.S. Department of Health and Human Services provide additional data. Local hospitals, human service organizations, school systems, public safety agencies, universities, and other institutions may also have useful information and may be willing to share it for assessment purposes.

Evaluators, researchers, data specialists, or other knowledgeable partners from a university, health department, government agency, or community organization may be able to help with data analysis and measurement.

While it can be helpful to have an external evaluator, not all communities have the resources to hire a consultant or work with a university or agency evaluator. A coalition may also conduct parts or all of its own evaluation, provided it has appropriate methods and support.

Resources: Once a community's needs have been assessed, develop a list of strengths, assets, and resources within the community. Resources go beyond money – every community has nonfinancial resources that can contribute to addressing areas of concern, including:

• Technology
• Communication networks and channels
• Infrastructure, such as food retailers, roads, parks, public transportation, housing, and meeting or office space
• Professional and community expertise
• Data
• Community-based organizations, such as local businesses, service organizations, faith communities, and community groups and leaders
• Community institutions – schools, colleges and universities, libraries, arts and cultural organizations, and sports and recreation 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 their knowledge of community conditions, relationships, strengths, and priorities.

Historical Assessment Example:

Kansas used its Healthy Kansas 2000 Steering Committee to identify priority health issues by examining health data, seeking expert opinions, inviting public comments, and conducting an opinion survey of residents. Kansas used a consensus process to narrow its objectives to seven priority health areas and four risk factors. The health areas included alcohol and other substance use disorders, cancer, heart disease, HIV and other sexually transmitted infections (STIs), 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. Although the specific goals belonged to an earlier planning period, the example illustrates the MAP-IT principle of using multiple sources of information and community input to establish priorities.

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 for achieving it. Objectives should be specific to each issue or community and should describe what is expected to change, what is needed to achieve that change, and how progress will be measured. 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. Include a target when appropriate – the desired amount of change within a particular period of time, often reflected by a number, rate, or percentage. Healthy People establishes national objectives over a ten-year period, but shorter time frames may be more appropriate for local coalition goals.

Remember that every target needs a baseline – where you are now, or the first data point against which future progress will be compared. Identify strategies for reaching each objective. Action steps may be developed independently or as part of an overall strategy. Start by examining promising, evidence-based, or evidence-informed approaches and interventions, and engage coalition members and community participants in developing strategies. Strategies can serve as umbrellas under which different coalition members contribute to the same goal. Remember to include ongoing data collection and 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 people or organizations to clearly defined and agreed-upon roles can help move the plan forward. It can also help coalition members understand how their work contributes to 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 and capacity of coalition members and community partners.

Historical Planning Example:

As part of efforts related to year 2000 health objectives, the Rhode Island Department of Health initiated the Worksite Wellness Council of Rhode Island. The effort focused on increasing health promotion and disease prevention activities in workplaces, where many adults spent a substantial part of their day. The State Wellness Council entered into an agreement with the Wellness Council of America (WELCOA) as part of its effort to increase participation in worksite wellness activities. Although the specific targets reflected an earlier planning period, the example illustrates how MAP-IT planning can connect broad goals with defined strategies, partnerships, and measurable targets.

Step 4: Implement

Once the action plan is established, coalition members can begin implementing the strategies and action steps identified in the plan. Coalition members should work on the tasks assigned to them according to the agreed-upon timeline. Monitoring, or routine tracking of implementation, is important during this stage. For example, if the action plan calls for weekly reports on a particular topic, monitoring can show whether those reports are occurring as planned.

Remember that monitoring is most effective when it is planned before an initiative begins so that it can take place throughout the life of the effort. To monitor progress, identify appropriate indicators – the measures you'll use to examine process, performance, and outcomes. These will show you (indicate) whether you're doing what you planned and how well it is working. Paying attention to the indicators can also help you understand why something may not be working as expected and provide information for making improvements.

Consider identifying a point of contact or coordinating group to help manage the process and ensure that agreed-upon tasks move forward. At the same time, share responsibilities across coalition members. Periodically bring in new partners when additional perspectives or skills are needed, and check in regularly with existing partners to hear suggestions and concerns. Communication among partners and staff involved in the effort is one of the keys to effective implementation.

And don't neglect the value of communication about your effort within the community. Get the word out by developing a communication plan, and use community events, meetings, presentations, and other appropriate channels to share progress and recognize accomplishments and partners.

Be aware that implementing action plans to improve community health may take longer than expected. Patience, communication, and continued attention to the community's goals can help coalition members and partners remain engaged throughout the process.

Historical Implementation Example:

North Carolina established the Office of Healthy Carolinians to help support its Healthy People-related community health improvement work. Staff provided counties with support and training, including coalition-building assistance, and participating counties conducted assessments and implemented action plans. This example reflects an earlier state initiative, but it illustrates the MAP-IT principle of supporting local groups as they move from assessment and planning into action.

Step 5: Track

In the last phase of the MAP-IT process, plan regular evaluations to measure and track progress over time. Tracking includes analyzing information and reporting on progress. Note the extent to which the plan was followed, changes that were made during implementation, and whether objectives and goals were reached.

Evaluation and tracking are important to the long-term success of the coalition's efforts. Consider partnering with a university, public health agency, research organization, community data partner, or state health statistics program if additional help with data collection or analysis is needed. Some things to consider when evaluating data over time include:

• Data Quality: Check for consistency and standardization in data collection, analysis, and question wording.
• Limitations of Self-Reported Data: When relying on self-reported information, such as physical activity, income, or other behaviors and conditions, consider the possibility of recall, response, and other forms of self-report bias.
• Data Validity and Reliability: Changes in survey questions, definitions, or data collection systems may affect comparisons over time. Seek statistical or evaluation expertise when needed.
• Data Availability: Data may not be collected or released on the same schedule for every indicator.

Remember to share progress and lessons learned with the community. When the data show meaningful progress, communicate it through appropriate community channels. Local media and other communication partners can help share results, while community meetings, websites, newsletters, and other methods can keep participants and residents informed throughout the effort.

Historical Tracking Example:

For its 1996 and 1999 updates to New Jersey's year 2000 objectives, state statistical and program staff assessed progress and analyzed trends. Based on those analyses, staff categorized each objective and subobjective as “likely to be achieved,” “unlikely to be achieved,” or “uncertain.” Although the objectives themselves are historical, the example illustrates an important MAP-IT principle: regularly examine progress and use the findings to understand whether goals are on track.

In Summary

MAP-IT – Mobilize, Assess, Plan, Implement, and Track – provides a practical structure for developing and evaluating community health initiatives. It was used as an implementation framework for Healthy People 2020 and continues to be used as a community planning approach. The five steps encourage communities to build broad partnerships, understand needs and assets, create a specific plan, put that plan into action, and continually examine progress.

Healthy People 2030 is now the current national Healthy People initiative. Its objectives, health-equity goals, and increased emphasis on social determinants of health can serve as current reference points for communities using MAP-IT, while the MAP-IT process itself remains the same: mobilize people and organizations, assess community needs and strengths, plan collaboratively, implement concrete actions, and track what happens over time.

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