Prioritizing Strategies

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Section : Create a Community Action Plan INTRODUCTION

At this stage of the community needs assessment, you should have summarized the data the team has collected and are ready to identify the community assets and needs. In this final section of the workbook you will learn how to use your summary information to identify areas for improvement and then transform them into measurable action items.

The outcome of this step is a Community Action Plan which will contain Specific, Measurable, Attainable, Realistic and Timely (SMART) objectives and the activities to support those objectives.

You should present your needs assessment findings and obtain approval from stakeholders and/or community leaders on the strategies before developing an action plan.

IDENTIFY ASSETS AND NEEDS You will use the Sector Data Grids to identify focal policy, systems, and environmental change strategies that are both in place, (i.e., assets), and missing, (i.e., needs).

Your team should designate a cut-off point–the scores to the right of the line would be considered assets; those to the left would be the needs, as shown in Table 7.

Table 7: Sample Needs and Assets: Needs=0-60%, Assets=61-100%

Community-At-Large (CAL) Community Component

Low: 0-20%

Low: 21-40%

Medium: 41-60%

Medium: 61-80%

High: 81-100%

Physical Activity

CALP1, CALE14

Nutrition CALP1, CALE1

Tobacco CALP1, CALE1

Chronic Disease Mgt

CALE1 CALP1

CALE1: ‘CAL’ = Community-At-Large Sector ‘E’ = Environment ‘1’= Site number (If you have multiple sites, number them consecutively, 1, 2, 3 and so forth.)

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Community Component

Low: 0-20%

Low: 21-40%

Medium: 41-60%

Medium: 61-80%

High: 81-100%

Leadership CALP1 CALP1

Now that you have a visual depiction of each sector’s needs and assets across all the community components, you can then create a list of all the policy, systems, and environmental change strategies across sectors that are assets or needs. Table 8 shows an example of a Policy, Systems and Environmental Change Strategies Worksheet you can use to record this information.

Table 8: Sample Policy, Systems, and Environmental Change Strategies Worksheet: Assets and Needs

ASSETS NEEDS

Community-At-Large Sector: Smoke-free and tobacco-free policies implemented for indoor and outdoor places. Strategies adopted to educate residents on importance of controlling high blood pressure and cholesterol.

Community Institution/Organization (CIO) Sector:

All sites instituted healthy food and beverage options in vending machines. 3 out of 4 sites provide routine screening for cholesterol and provide counseling and education about tobacco use and exposure. 3 out of 4 sites participated in the last three years in community coalitions and partnerships related to tobacco use and physical inactivity.

Community-At-Large Sector: No policies in place that ban local restaurants and retail food establishments from cooking with trans fats. Recent budget cuts for public shared-used paths or trails.

Community Institution/Organization (CIO) Sector:

1 site did not provide any routine screenings for chronic diseases management. No sites promoted stairwell use. 1 site has never participated in community coalitions and partnerships related to tobacco use or physical inactivity.

Health Care Sector: Health care centers and private physician’s office do not take routine body mass index readings (BMIs) for routine office exams.

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ASSETS NEEDS

Health Care Sector: Two facilities promoted stairwell use to patients, visitors, and staff Patients referred to smoking cessation programs at all sites

School Sector: 1 of the schools was initiating a plan to ensure the playground equipment meets safety standards

Work Site Sector:

Employee wellness coalition developed by local small business All sites have designated, safe walking paths on building property 4 out of 5 sites implemented a referral system for tobacco cessation services

75% of the health care professionals do not provide patient education on nutrition or physical activity

School Sector: No requirements for physical activity during school day 2 of the 3 schools offered no healthy food or beverage options

Work Site Sector:

No sites promoted stairwell use No sites offered healthy food or beverage options in vending machines

Strategies:

PRIORITIZE NEEDS If you have identified many community needs, your team should prioritize those needs. Some criteria you may consider when prioritizing needs are:

Size of problem Seriousness of problem Availability of current interventions Economic or social impact Public health concern Availability of resources

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Tip

Please refer to the Prioritize Public Health Problems module for more information about how to prioritize needs.

DEVELOP STRATEGIES Using your priority list of community needs, identify a specific community strategy to address each key need. You do not have to address every weakness.

When identifying strategies, consider the community’s strengths. For example, in the sample needs assessment in Table 8 all the community institution/organization sites offered healthy food and beverage options in vending machines; however, none of the sites promoted stairwell use. Since the institutions already have a healthy nutritional environment they might be more acceptable of incorporating physical activity initiatives.

Your team can also combine similar strategies to streamline activities. For example, in the sample needs assessment, work sites also did not promote stairwell use. The community team can formulate a strategy that encourages stairwell use at work sites and community institutions/organizations. The team members responsible for this strategy can use the same promotional materials (e.g., posters on the benefits of using stairwells) for both sectors.

After developing the strategies, record them on the bottom section of the Policy, Systems and Environmental Change Strategies Worksheet. An example is shown below in Table 9.

Table 9: Sample Strategies (bottom of Policy, Systems, and Environmental Change Strategies Worksheet)

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Strategies:

Work with key stakeholders to formulate and implement a policy that bans local restaurants and retail food establishments from cooking with trans fats.

Encourage community institutions/ organizations and work sites to promote stairwell use.

Encourage health care professionals to provide patient education on nutrition and physical activity to adults with chronic disease risk factor.

Require schools to incorporate a minimum of 30 minutes of physical activity during school day.

Require schools to offer healthy food and beverage options.

PRIORITIZE STRATEGIES Once you have identified the strategies, your team will need to prioritize what can be implemented, given the time, resources, and other competing community priorities. Use any method to prioritize that your team has agreed upon. One way is to rank each strategy according to each criterion from 1 to 5 as follows:

Table 10: Example Scale for Ranking Strategy Time Resources Competing Priorities

1= Large amount of time needed to implement strategy

2 = Substantial amount of time needed to implement strategy

3 = Some amount of time needed to implement strategy

4 = A little amount of time needed to implement strategy

5 = Very little amount of time needed to implement strategy

1= Large amount of resources needed to implement strategy

2 = Substantial amount of resources needed to implement strategy

3 = Some amount of resources needed to implement strategy

4 = A little amount of resources needed to implement strategy

5 = Very little amount of resources needed to implement strategy

1= Large amount of competing priorities

2 = Substantial amount of competing priorities

3 = Some competing priorities

4 = A few competing priorities

5 = No competing priorities

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After ranking each strategy according to time, resources, and competing priorities, total the scores to determine the highest ranking strategies to implement. See Table 11 for an example of how to use this ranking method.

Table 11: Sample Prioritize Worksheet Strategy Time

(1-5) Resources

(1-5) Competing Priorities

(1-5)

Total (T x R x C)

Rank

Work with key stakeholders to formulate and implement a policy that bans local restaurants and retail food establishments from cooking with trans fats.

1 2 2 4 5

Encourage community institutions/organizations and work sites to promote stairwell use.

4 4 3 48 1

Encourage health care professionals to provide patient education on nutrition and physical activity to adults with chronic disease risk factor.

4 3 3 36 2

Require schools to incorporate a minimum of 30 minutes of physical activity during school day.

3 2 3 18 3

Require schools to offer healthy food and beverage options.

2 2 2 8 4

In the above example the top 2 strategies are: 1. Encourage community institutions/organizations and work sites to

promote stairwell use.

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2. Encourage health care professionals to provide patient education on nutrition and physical activity to adults with chronic disease risk factors.

COMMUNITY ACTION PLAN Your team will develop an action plan for each priority strategy. A quality plan contains sufficient details to map a clear course of action. Table 12 shows an example of a Community Action Plan.

Notice there are two types of objectives listed in the Community Action Plan: Project Period Objective and Annual Objective. The project period objective allows your team to look at a long term perspective of what can be accomplished over a multiyear period. For example, in Table 11 the project period objective states: In 5 years, all ministry of health providers will include NCD counseling to all patients, that includes lifestyle counseling on physical activity, nutrition and smoking.. There is also space on the worksheet to record the community component that is the area of focus, such as nutrition or physical activity.

Annual objectives cover a 12-month timeframe and show incremental progress toward completion of the project period objective. In Table 12 there is one annual objective: At 12 months, all clinics in district Y will provide lifestyle NCD counseling to all patients.

Table 12: Example of a Community Action Plan

Policy/Environmental Change Strategy

Encourage health care professionals to provide patient education on nutrition and physical activity to adults with chronic disease risk factors.

Project Period Objective Community Component(s)

In 5 years, all ministry of health providers will include NCD counseling to all patients that includes lifestyle counseling on physical activity, nutrition, and smoking.

Physical Activity

Nutrition

Annual Objective(s): Sector(s) No. of People

Reached

At 12 months all clinics in district Y will provide lifestyle NCD counseling to all patients.

Health Care 250,000

Activities Person Responsible

Timeline

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NCD counseling protocols developed J. Thomas Month 0-3

NCD counseling monitoring system developed

W. Lee Month 0-3

Health provider reward/recognition system established

Month 0-3

NCD physicians/health providers trained on protocol

W. Lee Month 3

Community interventions including establishment of exercise locations for women and the general public, and cooking classes

J. Thomas Months 6-9

A district-wide, multisectoral NCD plan will be developed and implemented

W. Lee Months 6-9

All physicians/health providers trained W. Lee Months 6-9

All clinics begin counseling J. Thomas Month 125

It is important to associate each annual objective with a particular sector. You may develop multiple annual objectives that cut across more than one sector for a project period objective. In this example, the sector impacted is health care.

For each annual objective, indicate the approximate number of people who will be affected by the strategy through its successful completion.

Tip

As you craft the objectives, be sure they are SMART—specific, measurable, achievable, realistic, and time-phased.

The last section of the Community Action Plan template is where you list the activities that support the accomplishment of the annual objective. When listing activities be sure to provide clear descriptions of key milestones. For each annual objective it is recommended that you list no

5 In reality, more activities would be listed which would include activities for years 2 through 5 (project objective).

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more than 10 activities, which may limit these activities to key actions for completing the annual objective.

Next to each activity that is listed identify the lead or primary contact person, and estimate the timeline for strategy completion. Be specific and realistic. If the strategy’s completion depends on actions by several individuals or organizations, allow time for stakeholder coordination.

Stop

Let the facilitator or mentor know you are ready for the group discussion.

Activity

TAKE OUT THE ACTIVITY WORKBOOK AND COMPLETE SKILL ASSESSMENT - ACTIVITY#4.

SECTION 6: KEY POINTS

Tip

Create a list of all the policy, systems, and environmental change strategies across sectors that are community assets or needs

Use your list of community needs to identify a specific community strategy to address each key need. You do not have to address every weakness

After identifying strategies, your team will prioritize what can be implemented given the time, resources, and other competing community priorities

On the action plan a project period objective allows your team to look at a long-term perspective of what can be accomplished over a multiyear period. Annual objectives cover a 12-month timeframe with incremental progress toward completion of the project period objective

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Conclusion IMPLEMENTING THE ACTION PLAN AND SHARING PROGRESS

Although this workbook does not cover implementing the community action plan or sharing results, it is worthwhile to briefly mention those here. After completing the community needs assessment and developing a communication action plan, coordinate your resources to make sure the activities you have identified are completed on time. Track your progress, note key successes, and document any obstacles to implementing the action plan.

You will also want to share the data and accomplishments with community leaders and other people and organizations that contributed their time and expertise to the needs assessment. Identify the best venue for sharing the results. You can organize a community meeting and/or write a policy brief or one-pager.

Anonymity is important to protect the interests of those who participated in the assessment. Community teams should not list who they talked with or provide specific details about data that could specifically link to an individual or organization. Share data in aggregate for a sector. For example, when providing results of assessing work sites you may state that “across the 6 work sites examined by the community team, 2 had policies requiring healthy food choices in vending machines, 1 was in the process of formulating a policy, and 3 had no formal policy regarding vending machine healthy food choices.”

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TAKE HOME POINTS

Tip

A community needs assessment should focus on a particular geographic area, sectors within that area such as health care and work sites, and community components to assess within each sector such as nutrition, chronic disease management, and tobacco use.

A combination of 2 or more data-collection methods is recommended at each site to confirm or support initial findings.

Keep a comprehensive file of all sources of information, key contacts, and data to review at a later date or to share with coalition members.

Rating the data should be based on a comprehensive review of all sources and the agreement of the individuals on your team.

To ensure proper data management there should be only one data manager, such as the community team’s evaluator, and all data should be forwarded to this individual.

After your team has reached consensus on the most appropriate rating for each item within a site, the data should be recorded in a table or spreadsheet along with any supporting comments. The data manager should total all the ratings, assign a percentage score, and then create a summary of all the percentage scores for each site.

Create Sector Data Grids to provide a quick data reference across all sectors.

Use your list of community needs and identify a specific community strategy to address each key need. You do not have to address every weakness.

After identifying strategies your team will prioritize what can be implemented, given the time, resources, and other competing community priorities.

On the action plan, a project period objective allows your team to look at a long term perspective of what can be accomplished over a multiyear period. Annual objectives cover a 12-month timeframe with incremental progress toward completion of the project period objective.

WORKBOOK REVIEW After completing this workbook, you should be able to:

Plan for a community needs assessment, Review and rate data collected from a community needs assessment, Summarize data, Identify areas for improvement, and, Develop a community action plan.

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Resources For more information on topics found within this workbook:

Community Health Assessment and Group Evaluation (CHANGE) data-collection tool developed by CDC’s Healthy Communities Program in the Division of Community Health at the National Center for Chronic Disease Prevention and Health Promotion. Available at: http://www.cdc.gov/HealthyCommunitiesProgram

Centers for Disease Control and Prevention. Healthier Worksite Initiative, Environmental Audits. Available at: http://www.cdc.gov/nccdphp/dnpao/hwi/programdesign/enviro nmental_audits.htm

Community Assessment Guide Book, North Carolina Department of Health (2002); retrieved on October 19, 2012 from http://www.schs.state.nc.us/schs/data/databook/2002/GuideBo ok2002.pdf