+1(978)310-4246 credencewriters@gmail.com
  

For this assignment, identify an area of focus in community health within your own community.

Using Gordon’s Functional Health Patterns framework (p. 130 in your e-text), assess the health risks in your community.

In your community assessment paper, include the following:

Identify resources in your community that would enable you to complete a community assessment and submit a summary of your findings (1–2 paragraphs).

Refer to Table 8-3: Examples of Community Strengths and Concerns, and assess the strengths and concerns of your community (2–3 paragraphs).

Identify potential barriers to implementing community health plans in your community and brainstorm  ways of addressing these barriers (2–3 paragraphs).

Your paper should be 2–3 pages in length, not including the cover and reference pages. Use APA throughout.

You must include 2–3 sources that are APA cited and referenced in your paper. (Sources may include community resources such as flyers, brochures, interviews, news stories, and local research data from credible sources.)

Review the rubric for further information on how your assignment will be graded.

Points: 110

Click here to download the pdf

to learn more about community health assessments and change.

COMMUNITY HEALTH
ASSESSMENT AND GROUP
EVALUATION (CHANGE)
CDC’s Healthy Communities Program
Building a Foundation of
Knowledge to Prioritize
Community Needs
COMMUNITY ASSESSMENT
AN ACTION GUIDE
Division of Adult and Community Health
National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention
4770 Buford Highway, NE, Mailstop K-93
Atlanta, Georgia 30341
PHONE: 770-488-6452 FAX: 770-488-8488 E-MAIL: cdcinfo@cdc.gov
www.cdc.gov/HealthyCommunitiesProgram
Suggested Citation
Centers for Disease Control and Prevention. Community Health Assessment aNd Group
Evaluation (CHANGE) Action Guide: Building a Foundation of Knowledge to Prioritize
Community Needs. Atlanta: U.S. Department of Health and Human Services, 2010.
The Centers for Disease Control and Prevention (CDC), an agency of the U.S. Government,
authored this document, the substance of which is a work of the U.S. Government. All
materials appearing in this document, except where noted, are in the public domain and may
be printed or reused without permission.
April 2010
CHANGE TOOL TEAM
The CDC’s Healthy Communities Program recognizes the following individuals for their
dedication and commitment in developing the Community Health Assessment aNd Group
Evaluation (CHANGE) tool and related materials.
Shannon Griffin-Blake, PhD
Team Lead
Program Services and Evaluation Team
Healthy Communities Program
Division of Adult and Community Health
National Center for Chronic Disease
Prevention and Health Promotion
Centers for Disease Control and Prevention
Stella Cory, MD, MPH
Health Scientist
Program Services and Evaluation Team
Healthy Communities Program
Division of Adult and Community Health
National Center for Chronic Disease
Prevention and Health Promotion
Centers for Disease Control and Prevention
Andrae Ivy, MPH
Northrop Grumman
Healthy Communities Program
Division of Adult and Community Health
National Center for Chronic Disease
Prevention and Health Promotion
Centers for Disease Control and Prevention
Ann Ussery-Hall, MPH, CHES
The Ginn Group
Healthy Communities Program
Division of Adult and Community Health
National Center for Chronic Disease
Prevention and Health Promotion
Centers for Disease Control and Prevention
CHANGE ACTION GUIDE TEAM
The following individuals assisted the CHANGE tool team with step-by-step documentation
and editing of the Community Health Assessment aNd Group Evaluation (CHANGE) Action
Guide: Building a Foundation of Knowledge to Prioritize Community Needs.
Hema Desai, MMedSci
Booz Allen Hamilton
Keisha Edwards, MPH, CHES
Booz Allen Hamilton
CONTRIBUTORS
The CDC’s Healthy Communities Program recognizes the following individuals who
contributed subject matter expertise and editorial guidance to the Community Health
Assessment aNd Group Evaluation (CHANGE) Action Guide: Building a Foundation of
Knowledge to Prioritize Community Needs.
Stacy Adams
Evaluator
Healthy Communities Branch
Alabama Department of Public Health
Selma, AL
Anthony Barbagallo, III MS, MBA
Booz Allen Hamilton
Erica Barrett, MOT, MBA
The Ginn Group
Healthy Communities Program
Division of Adult and Community Health
National Center for Chronic Disease
Prevention and Health Promotion
Centers for Disease Control and Prevention
Alyssa Easton, PhD, MPH
Director
Healthy Communities Program
Division of Adult and Community Health
National Center for Chronic Disease
Prevention and Health Promotion
Centers for Disease Control and Prevention
Wayne Giles, MD, MS
Director
Division of Adult and Community Health
National Center for Chronic Disease
Prevention and Health Promotion
Centers for Disease Control and Prevention
Kurt Greenlund, PhD
Associate Director for Science
Division of Adult and Community Health
National Center for Chronic Disease
Prevention and Health Promotion
Centers for Disease Control and Prevention
Heidi Hataway
Director
Healthy Communities Branch
Alabama Department of Public Health
Montgomery, AL
Bruce Hathaway
Healthy Communities Program
Bureau of Community Chronic Disease
Prevention
New York State Department of Health
Albany, NY
Jennie Hefelfinger, MS
Action Communities for Health, Innovation,
and EnVironmental changE Project Manager
National Association of Chronic Disease
Directors
Timothy LaPier, MA
Team Lead
Translation and Dissemination
Healthy Communities Program
Division of Adult and Community Health
National Center for Chronic Disease
Prevention and Health Promotion
Centers for Disease Control and Prevention
Donna Burge Norkoli BS, CHES
Project Coordinator
Strategic Alliance for Health
Sault Tribe Community Health Services
Sault Ste. Marie Tribe of Chippewa Indians, MI
Samuel Perry, MPH
Booz Allen Hamilton
Richard Roman, MS
Associate Director
Healthy Communities Program
Division of Adult and Community Health
National Center for Chronic Disease
Prevention and Health Promotion
Centers for Disease Control and Prevention
Anne Short
Executive Director
Alliance for Health in Cleveland County, Inc.
Cleveland County, NC
Monica Hobbs Vinluan JD
Project Director
Activate America: Healthier Communities
Initiatives
YMCA of the USA
Branalyn Williams, MPH
Health Education Specialist
Healthy Communities Program
Division of Adult and Community Health
National Center for Chronic Disease
Prevention and Health Promotion
Centers for Disease Control and Prevention
We would like to thank the following organizations within the National Center for Chronic
Disease Prevention and Health Promotion (NCCDPHP) and the National Center for
Environmental Health (NCEH) at the Centers for Disease Control and Prevention for
their collaboration, teamwork, and contribution of subject matter expertise during the
development of the CHANGE tool.
Office of the Director, NCCDPHP
Division of Adolescent and School Health, NCCDPHP
Division of Nutrition, Physical Activity and Obesity, NCCDPHP
Office on Smoking and Health, NCCDPHP
Division for Heart Disease and Stroke Prevention, NCCDPHP
Division of Diabetes Translation, NCCDPHP
Division of Cancer Prevention and Control, NCCDPHP
Division of Emergency and Environmental Health Services, NCEH
Office of the Director, NCEH
In addition, we would like to recognize the following groups for their invaluable input during
the development of the CHANGE tool: ACHIEVE National Partners – National Association of
Chronic Disease Directors, National Association of County and City Health Officials, National
Recreation and Park Association, Society for Public Health Education, and YMCA of the USA,
as well as Steps, Action Communities for Health, Innovation, and EnVironmental changE,
and Strategic Alliance for Health communities. For more information about local, state, and
national partners please visit the CDC’s Healthy Community Program web site at www.cdc.
gov/healthycommunitiesprogram.
TABLE OF CONTENTS
Foreword……………………………………………………………………………………………………………………. i
Legend……………………………………………………………………………………………………………………… ii
About.the.CD.ROM…………………………………………………………………………………………………… ii
Snap.Shot.of.Action.Steps.for.Completing.the.CHANGE.Tool………………………………………….iii
Background.of.the.CHANGE.Tool………………………………………………………………………………… 1
Why the CHANGE Tool? …………………………………………………………………………………………….. 2 �
Community Change Process and the CHANGE Tool ……………………………………………………….. 4 �
Purpose of CHANGE…………………………………………………………………………………………………… 5 �
Purpose.of.the.CHANGE.Action.Guide…………………………………………………………………………. 7
How.to.Complete.the.CHANGE.Tool……………………………………………………………………………. 7
Action Step 1: Assemble The Community Team ………………………………………………………………. 8 �
Action Step 2: Develop Team Strategy ………………………………………………………………………….. 10 �
Action Step 3: Review All Five CHANGE Sectors …………………………………………………………… 10 �
Action Step 4: Gather Data…………………………………………………………………………………………. 13 �
Action Step 5: Review Data Gathered ………………………………………………………………………….. 18 �
Action Step 6: Enter Data …………………………………………………………………………………………… 21 �
Action Step 7. Review Consolidated Data……………………………………………………………………… 31 �
Action Step 8. Build the Community Action Plan ………………………………………………………….. 39 �
Looking.Beyond………………………………………………………………………………………………………. 42
Evaluation.and.Reassessment……………………………………………………………………………………… 43
Appendix.A..Glossary.of.Terms…………………………………………………………………………………… 45
Appendix.B..Sector.Participant.List…………………………………………………………………………….. 59
Appendix.C..Community.Health.Assessment.aNd.Group..
Evaluation.(CHANGE).List.of.Questions…………………………………………………………………….. 65
Appendix.D..Citations………………………………………………………………………………………………. 83
FIGURES
Figure.1..Program.Evaluation.Framework……………………………………………………………………… 2
Figure.2..The.Socio-Ecological.Model……………………………………………………………………………. 3
Figure.3..Community.Change.Process…………………………………………………………………………… 4
Figure.4..Action.Steps.to.Complete.the.CHANGE.Tool……………………………………………………. 8
Figure.5..Possible.Elements.of.a.Community.Team………………………………………………………….. 9
Figure.6..CHANGE.Dialogue.Guide……………………………………………………………………………. 12
Figure.7..Framework.for.Completing.CHANGE……………………………………………………………. 18
Figure.8..Snapshot.of.the.CHANGE.Sector.Excel.File…………………………………………………….. 24
Figure.9..Definitions.of.Terms.in.the.CHANGE.Sector.Excel.File…………………………………….. 25
Figure.10..Definitions.of.Item.Responses…………………………………………………………………….. 26
Figure.11..Item.Responses.and.Accompanying.Comment.Boxes……………………………………… 27
Figure.12..Definitions.of.Key.Terms……………………………………………………………………………. 28
Figure.13..Module.Percentages.and.Tabulated.Ratings…………………………………………………… 29
Figure.14..Module.Score.Summaries……………………………………………………………………………. 30
Figure.15..Example.CHANGE.Summary.Statement.(Community-At-Large.Sector)……………. 32
Figure.16..Designation.of.Assets.and.Needs………………………………………………………………….. 34
Figure.17..Definitions.of.Objectives.in.Community.Action.Plan……………………………………… 41
TABLES
Table.1..Advantages.and.Disadvantages.of.Data.Collection.Methods……………………………….. 14
Table.2..CHANGE.Tool.Policy.and.Environment.Scale.for.Community-At-Large.
Sector.and.Physical.Activity.Module……………………………………………………………………………. 20
Table.3..Example.of.a.Sector.Data.Grid……………………………………………………………………….. 33
Table.4..Community.Health.Improvement.Planning.Template………………………………………… 38
Table.5..Example.of.a.Community.Action.Plan…………………………………………………………….. 40
FOREWORD
Our nation faces a crisis in the burden of chronic disease. Today, 7 of the 10 leading causes of death
in the United States are chronic conditions. Nearly 50% of Americans are living with at least one
chronic disease. The Centers for Disease Control and Prevention (CDC) recognizes that the scope
and impact of chronic disease requires transforming the places and organizations that touch people’s
lives every day – communities and community organizations, work sites, health care organizations,
and schools – to improve the health of the nation. To undertake this work, states and communities
will need to address multiple factors through policy interventions including broad-based policies
such as smoking bans and laws; targeted regulations, such as those promoting breastfeeding; and
community-wide interventions, such as community-and street-scale urban design and land use
policies.
In order to effectively identify, plan, and implement needed policy, systems and environmental
changes, communities need to be able to assess the current policy landscape and monitor changes
over time. The Community Health Assessment aNd Group Evaluation (CHANGE) Action Guide:
Building a Foundation of Knowledge to Prioritize Community Health Needs was designed to meet
this need. Although the CHANGE tool is not intended to promote any specific policy, it serves
as a critical tool to help communities discover the array of approaches being used in the field.
The CHANGE tool also helps communities identify and monitor important policy, systems, and
environmental changes over time.
As the CDC collaborates with communities on the development and implications of policy, systems,
and environmental change strategies, this important CHANGE Action Guide offers communities a
valuable tool in our efforts to promote health and prevent disease.
Ursula E. Bauer, Ph.D., M.P.H.
Director
National Center for Chronic Disease Prevention and Health Promotion
i
LEGEND
Icon
Usage
Boxes marked with this light bulb icon present tips, ideas, and additional
information on implementing an action step and may also provide web
site links to helpful resources.
Boxes marked with this hurdler icon describe possible obstacles that
may occur during implementation and offer suggestions for successfully
overcoming those hurdles.
Boxes marked with this icon indicate additional resources are available
on the CD-ROM.
Boxes marked with this icon indicate questions generated by users of the
CHANGE tool and are included to assist in executing the Action Steps.
ABOUT THE CD-ROM
The CD-ROM included with this Action Guide contains resources to support your
community assessment and evaluation efforts. The resources are:
â–ª CHANGE Sector Excel Files (i.e., the CHANGE tool) that provide a list of the items and
definitions for each sector (i.e., Community-At-Large Sector, Community Institution/
Organization Sector, Health Care Sector, School Sector, and Work Site Sector).
â–ª Blank versions of the CHANGE Summary Statement, Sector Data Grid, CHANGE Strategy
Worksheets, Community Health Improvement Planning Template, and Community Action Plan
contained in Action Steps 7-8. Print and use these worksheets during strategy and brainstorming
sessions.
â–ª A template for a policy brief or one-pager to use as CHANGE activities come to a close and your
team begins to develop products to share success stories with stakeholders.
â–ª A Microsoft Office PowerPoint presentation template for town hall meetings, road shows, or site
visits with partners.
â–ª A resource list of assessment tools and evaluation guides that have been used and developed by
CDC and its partner organizations.
ii
SNAP SHOT OF ACTION STEPS FOR COMPLETING THE
CHANGE TOOL
The following is a summary of the action steps that are suggested for successfully completing the
CHANGE tool.
ACTION.STEP.1:.Assemble.the.Community.Team
Identify and assemble the community team; diverse representation is preferred. Consider the make-up
of the team to include 10-12 individuals maximum.
ACTION.STEP.2:.Develop.Team.Strategy
Decide whether to complete CHANGE as a whole team or divide into subgroups. Communities tend
to divide the team into subgroups ensuring there are two people collecting and analyzing data and
reporting back to the team to gain consensus.
ACTION.STEP.3:.Review.All.5.CHANGE.Sectors
Review all 5 sectors prior to completing them so the community team understands the total picture
of what is being assessed. These include the Community-At-Large Sector, Community Institution/
Organization (CIO) Sector, Health Care Sector, School Sector, and Work Site Sector.
ACTION.STEP.4:.Gather.Data
Use multiple methods (two or more) to gather data from each site to maximize the data quality.
Methods could include, for example, focus groups, windshield surveys, or questionnaires. Consider
the amount of time needed for each of the methods selected.
ACTION.STEP.5:.Review.Data.Gathered
Gather with the community team to review the data received. Brainstorm, debate and dialogue with
the team to gain consensus on what these data mean in terms of parameters of the CHANGE tool.
Data should be rated based on a comprehensive review of all sources and agreement of everyone
involved.
ACTION.STEP.6:.Enter.Data
Use the CHANGE Sector Excel File to enter data. Within the community team, make sure there is a
designated data manager to input the data. Complete a separate CHANGE Sector Excel File for each
site.
iii
ACTION.STEP.7:.Review.Consolidated.Data
Once ratings have been assigned to each sector, the following steps will need to be completed so the
team can begin to determine areas of improvement to develop a Community Action Plan based on
the community-level data.
ACTION.STEP.7a:.Create.a.CHANGE.Summary.Statement
ACTION.STEP.7b:.Complete.the.Sector.Data.Grid
ACTION.STEP.7c:.Fill.Out.the.CHANGE.Strategy.Worksheets
ACTION.STEP.7d:.Complete.the.Community.Health.Improvement.Planning.Template.
ACTION.STEP.8:.Build.the.Community.Action.Plan
The final step is to build a Community Action Plan. This will be organized by project period and
annual objectives, and reflect the data collected during the CHANGE process.
iv
BACKGROUND OF THE CHANGE TOOL
Community Health Assessment aNd Group Evaluation (CHANGE) is a data-collection tool and
planning resource for community members who want to make their community a healthier one. The
Healthy Communities Program (www.cdc.gov/HealthyCommunitiesProgram) within the Division
of Adult and Community Health, at the National Center for Chronic Disease Prevention and Health
Promotion of the Centers for Disease Control and Prevention (CDC) developed the CHANGE
tool. The CDC’s Healthy Communities Program designed the CHANGE tool for all communities
interested in creating social and built environments that support healthy living.
The purpose of CHANGE is to gather
and organize data on community assets
A Community Action Plan is a
and potential areas for improvement
living document, usually time
prior to deciding on the critical issues
based, that enables a community
to be addressed in a Community Action
to structure its activities around
Plan. Development of the CHANGE tool
a common purpose and to
began in fall 2007, and the first iteration
prioritize needs.
was piloted with a set of CDC-funded
communities. The tool comprises a set of
easy-to-use Microsoft Office Excel spreadsheets for collection of local-level data from schools, work
sites, community organizations, and health care facilities. CHANGE walks you through a community
assessment process and helps define and prioritize improvement areas by providing community-level
data on current policy, systems, and environmental change strategies. With CHANGE data as a guide,
you can map out a course for health improvement in your community with specific, targeted action.
The CHANGE tool improves community health with feedback on actions that should be developed
and implemented to transform communities into those that support healthy living.
CHANGE combines items that have scientific support for policy, systems, and environmental changes
with items that communities are initiating and assessing based on their practical experience but
may lack stronger scientific support. As a result, this tool should not be construed as promoting any
particular policy, systems, and environmental change strategy; it helps communities to assess potential
approaches that are innovative as well as approaches that show strong evidence of effectiveness. For
example, the scientific literature on tobacco use and exposure strongly recommends the use of a
smoke-free indoor policy as a first point of action. Communities have utilized smoke-free indoor
policies to reduce exposure to second-hand smoke as well as begun to utilize smoke-free outdoor
policies, such as smoke-free parks and beaches, and tobacco-free indoor and outdoor policies at work
sites, such as CDC’s tobacco-free campus policy.[1] Ultimately, this demonstrates CHANGE’s dual
benefit of science coupled with community innovation being documented and tracked through the
use of this assessment tool. As an annual process, the tool also allows your community to address
incremental change and track progress against key policy, systems, and environmental change
strategies.
1
CHANGE provides a foundation for utilizing CDC’s Recommended Framework for Program
Evaluation.[2] Program evaluation is important because it permits the community to measure
efforts that can inform decisions. Therefore, start with the end in mind by weaving evaluation into
your work from the very beginning. Formulate evaluation questions when you begin the process.
For example, how well was a program implemented? Did it meet expectations? If so, how can we
capitalize on the success; if not, what areas need improvement?
An accurate evaluation process is stakeholderdriven, and requires clear steps. Figure 1 shows
Assets are the community
how the steps of the evaluation process are
strengths; community areas
interrelated. The process begins with engaging
that have achieved great
stakeholders; that is, connecting with individuals
progress or environmental
and organizations within the community
change strategies.
whose interests and goals are similar (or even in
opposition). The next evaluation steps focus on
design and gathering the data needed to make decisions. Evaluators finalize the process by again
engaging stakeholder groups. CHANGE embraces this stakeholder-driven process by using credible
evidence to support and justify conclusions. CHANGE encourages your community team to share
information with all stakeholders, and to share the information on an annual basis as a projection for
future community action.
Figure 1. Program Evaluation Framework
Engage
Stakeholders
Ensure Use
and Share
Lessons Learned
Justify
Conclusions
STANDARDS
Describe
the Program
Utility
Feasibility
Propriety
Accuracy
Gather
Credible
Evidence
Focus the
Evaluation
Design
Why the CHANGE Tool?
Change can be achieved at many levels—individual, interpersonal, organizational, and community.
The CHANGE tool enables users to consider the factors needed for multi-level impact and multilevel change. By supporting the collection of data from a variety of sources, CHANGE provides a
community snapshot of the policy, systems, and environmental change strategies currently in place
2
and helps to identify areas for improvement. The Socio-Ecological Model, depicted in Figure 2,
provides a useful framework for showing the multiple influences on community health, and barriers
to health improvement. Understanding these factors and barriers aids in developing strong, actionable
strategies for your community. Examples of such strategies include tobacco-free policies at schools
and restaurants, healthy vending machine policies in work sites, safe sidewalks in all neighborhoods,
and stair use promotion in public buildings.
The CHANGE tool development began by analyzing relationships among living conditions, culture,
economics (e.g., community and/or individual wealth, financial stability), social networks, and
lifestyle factors. Community health is affected by more than just individual behavior; multiple
conditions and factors determine individual health decisions. Allowing for external issues, such as
policy, systems, and environmental changes, provides a more comprehensive view of how to impact
change at a community level.
Why is it important to consider community-level change? Community-level changes such as policy
are more sustainable, impact infrastructure, and aid in shifting social norms. For example, an effort
to educate parents on healthy food choices for children is sustainable only if parents have safe,
affordable, and accessible locations to purchase food. Education alone is not as viable a change
strategy because other factors may impede its success. Figure 2 also shows the connections among
public policy, community, and interpersonal aspects such as social networks. None of these factors
can be analyzed alone. The CHANGE tool assists you in conducting assessments, gathering data,
examining the connections, and convening community teams for action. The CHANGE tool provides
community teams with the data needed to strategize for change, identify the policies for change, and
build the partnerships for change.
Figure 2. The Socio-Ecological Model[3]
Public Policy
national, state, local laws and regulations
Community
relationships among organizations
Organizational
organizations, social institutions
Interpersonal
family, friends, social networks
Individual
knowledge, attitudes, skills
3
Community Change Process and the CHANGE Tool
Every community is different, but there are similarities in the process by which communities mobilize
to affect change. The five phases of this process are depicted in Figure 3.
â–ª Commitment.
â–ª Assessment.
â–ª Planning.
â–ª Implementation.
â–ª Evaluation.
Why is this process important to consider when completing the CHANGE tool? The process to
complete the CHANGE tool mirrors these five phases and has been used as a basis to set up this
Action Guide. Consider that, while there are five phases to the community change process, this
Action Guide focuses specifically on the first three – Commitment, Assessment, and Planning, as they
frame the step-by-step process for completing the CHANGE tool.
COMMUNITY
CHANGE
PROCESS
ASSESS
ME
NT
TION
ENTA
EM
PL
IM
COM
MI
TM
ION
AT
LU
T
EN
EV
A
Figure 3. Community Change Process
PL A N NIN G
1. Commitment involves assembling a team — or coalition — of community members to address key
issues and establish partnerships with other agencies. Coalitions and partnerships give participants
ownership of the process and a ready pool of fiscal and human resources to support policy, systems,
and environmental change strategies.
2. Assessment involves gathering data and input on what the community needs. Assessment also
provides a way for the community’s voice to be heard. Change strategies must reflect the needs of
the community to have the intended impact. As Chang has noted (1994), “a community assessment
process is not just a matter of surveying what people need, but it is a community organizing strategy.
By rigorously and creatively assessing community needs, the process gives real ‘voice’ to individuals
in the community…voices that can significantly influence program design.” [4]
4
3. Planning is the natural progression from assessing community needs. Now that the information
is available, your team takes action to develop the Community Action Plan for change.
4. Implementation is executing the plan you have developed, in collaboration with the community
team, stakeholders, and partners. Implementation requires maintenance of the commitment and
ownership established in the beginning; without this support the plan can fall apart.
5. Evaluation is woven throughout the community change process and provides the basis for
answering key questions: Are you implementing the right strategies? Are you creating the
measurable impact envisioned? Evaluation, whether formal or informal, gathers lessons from
what you are doing and provides recommendations for what can be done in the future.
Evaluation also helps to inform key decision makers. Evaluation is listed as the final component
of this cyclical process, but it should be considered from the beginning and included
throughout all phases.
Purpose of CHANGE
The purpose of the CHANGE tool is to enable local stakeholders and community team members
to survey and identify community strengths and areas for improvement regarding current policy,
systems, and environmental change strategies. The definitions of policy change, systems change, and
environmental change are below. These terms and others used in the CHANGE tool itself are in the
Glossary of Terms (Appendix A).
Policy change:
Laws, regulations, rules, protocols, and procedures, designed to guide or influence behavior. Policies
can be either legislative or organizational in nature. Policies often mandate environmental changes
and increase the likelihood that they will become institutionalized or sustainable. Examples of
legislative policies include taxes on tobacco products, provision of county or city public land for green
spaces or farmers’ markets, regulations governing the National School Lunch Program, and clean
indoor air laws. Examples of organizational policies include schools requiring healthy food options
for all students, a district ban on the sale of less than healthy foods throughout the school day, menu
labeling in restaurants, required quality assurance protocols or practices (e.g., clinical care processes),
or a human resources policy that requires healthy foods to be served at meetings.
Systems change:
Change that impacts all elements, including social norms of an organization, institution, or system;
may include a policy or environmental change strategy. Policies are often the driving force behind
systems change. Examples are implementing the National School Lunch Program across the state
school system or ensuring a hospital system goes tobacco free.
5
Environmental change (Environment):
Physical, social, or economic factors designed to influence people’s practices and behaviors. Examples
of alterations or changes to the environment include:
â–ª Physical: Structural changes or the presence of programs or services, including the presence of
healthy food choices in restaurants or cafeterias, improvements in the built environment to
promote walking (e.g., walking paths), the availability of smoking cessation services to patients or
workers, and the presence of comprehensive school health education curricula in schools.
â–ª Social: A positive change in attitudes or behavior about policies that promote health or an increase
in supportive attitudes regarding a health practice, including an increase in favorable attitudes
of community decision makers about the importance of nonsmoking policies or an increase in
nonacceptance of exposure to second-hand smoke from the general public.
â–ª Economic: The presence of financial disincentives or incentives to encourage a desired behavior,
including charging higher prices for tobacco products to decrease their use or the provision of
nonsmoker health insurance discounts.
The CHANGE tool has four key objectives and three benefits.
Objectives:
â–ª Identify community strengths and areas for improvement.
â–ª Identify and understand the status of community health needs.
â–ª Define improvement areas to guide the community toward implementing and sustaining policy,
systems, and environmental changes around healthy living strategies (e.g., increased physical
activity, improved nutrition, reduced tobacco use and exposure, and chronic disease management).
â–ª Assist with prioritizing community needs and consider appropriate allocation of available resources.
Benefits:
â–ª Allows local stakeholders to work together in a collaborative process to survey their community.
â–ª Offers suggestions and examples of policy, systems, and environmental change strategies.
â–ª Provides feedback to communities as they institute local-level change for healthy living.
In addition, CHANGE can assist you in proposing, developing, and justifying strategic areas for
improvement within your Community Action Plan. CHANGE also serves as a vehicle for developing
and operationalizing principles to guide your community team, such as decision-making and member
participation. Tips for ensuring a strong team are discussed in Action Step 1.
6
PURPOSE OF THE CHANGE ACTION GUIDE
CHANGE is a useful tool for all communities; however, many communities are new to the process
or have community teams in varying stages of formation. To support and promote use of the
CHANGE tool, CDC’s Healthy Communities Program has produced this step-by-step Action Guide
for completing the tool. It is designed to support CHANGE’s accessibility. This Action Guide is
designed to walk you through the completion of the tool, to provide resources for team building,
and to support the data-collection and review processes. The Action Guide summarizes the technical
assistance that has been provided to communities and incorporates feedback from actual users.
The guidance and supplemental resources are designed to make this process simple, seamless, and
effective. As you begin to complete the CHANGE tool, share this guide with community members.
This Action Guide:
â–ª Provides clear action steps to complete the CHANGE tool.
â–ª Provides examples of resources that users can leverage for their own communities.
â–ª Supports the consistent implementation of the CHANGE tool across communities.
HOW TO COMPLETE THE CHANGE TOOL
The CHANGE tool involves eight action steps (see Figure 4). Much of your effort should be focused
initially on establishing a strong community team. This section will walk you through these steps in
more detail. Consider the other activities being conducted in your community that may complement
the work you need to do to complete the CHANGE tool. For example, will the completion of
this tool coincide with the initial formation of your community team? Do not start the CHANGE
process without a community team. The estimated timeline to complete the CHANGE tool is 3-5
months. However, that range will vary depending on the characteristics of each community. If a
community team already exists, the process should be much faster. If there is a dedicated person who
is coordinating CHANGE activities for the community team, the process should be shorter than if
multiple or even a single person is spending only a portion of his or her time on CHANGE activities.
Keep in mind that, typically, members of the community team are donating their time and have other
commitments, which may extend or shrink the overall timeline for completing CHANGE. Pace your
activities to take full advantage of members’ time, and ensure their shared ownership of the process.
7
Figure 4. Action Steps to Complete the CHANGE Tool
ACTION STEP 1
Assemble the
Community
Team
ACTION STEP 2
Develop Team
Strategy
ACTION STEP 3
Review All 5
CHANGE Sectors
ACTION STEP 4
Gather
Data
ACTION STEP 5
Review Data
Gathered
ACTION STEP 6
Enter
Data
ACTION STEP 7
Review
Consolidated
Data
ACTION STEP 8
Build the
Community
Action Plan
Action Step 1: Assemble The Community Team
Action Step 1, assembling a community team, starts the commitment phase of the community
change process. Representation from diverse sectors is key to successful teamwork, enables easy and
accurate data-collection, and enables data assessment, which is the next phase of the community
change process. All members of the community team should play an active role in the assessment
process, from recommending sites within the sectors, to identifying the appropriate data-collection
method. This process also ensures the community team has equitable access to and informed
knowledge of the process, thereby solidifying their support. Consider the makeup of the community
team (10-12 individuals maximum is desirable to ensure the size is manageable and to account for
attrition of members). Include key decision-makers — the CEO of a work site or the superintendent
of the school board—to diversify the team and utilize the skill sets of all involved.
8
Tip! Consider the following points when forming your
community team:[5]
â–ª Set the tone by defining the purpose of the team.
â–ª Define the community capacity of the team and identify potential barriers to success.
â–ª Ensure that activities focus on policy, systems, and environmental change.
â–ª Clarify the mission of the team.
â–ª Include representatives of all identified stakeholder groups; community
representation is key.
â–ª Formalize rules, roles, procedures, and responsibilities (e.g., bylaws, standard
operating procedures, goals and objectives, memoranda of understanding).
â–ª Raise community awareness of the team and the issues it is addressing.
â–ª Generate additional funds to support the community team.
â–ª Community teams must provide benefits (e.g., solidarity, appreciation,
evidence of impact) that exceed costs (e.g., time, frustration) to sustain
membership and momentum.
â–ª Assign tasks based on skills and available resources.
When focusing on policy, consider talking with high-level decision-makers. However, be mindful
that staff and employees at all levels of the organization may be able to provide useful information.
Consider who in the community functions as a gatekeeper of information. Note the selection of
community members in Figure 5. This list is not exhaustive; form the team with a selection of
individuals that can appropriately support the team’s needs.
Figure 5. Possible Elements of a Community Team
Police
Chief
Mayor/City
Council
Member
School
Principal
Health
Insurer
Corporate
Executive
Community
Member
Faith
Leader
COMMUNITY
TEAM
Chamber of
Commerce
Member
Hospital
Administrator
Health
Promotion
Director
Foundation
Executive
Parks &
Recreation
Director
9
YMCA
CEO
Action Step 2: Develop Team Strategy
Action Step 2 involves collaboration to develop a team strategy. One approach is to meet with your
community team to determine the best way to complete the tool. For example, decide whether to
complete CHANGE as a whole team or to divide the community team into subgroups. Typically,
communities divide the team into subgroups, ensuring each has a minimum of two people collecting
and reviewing data and reporting results back to the whole team. This information sharing is
essential to build a foundation of community knowledge on needs and assets and to reach consensus
for strategy planning. At this step, your team should also use its bylaws and standard operating
procedures to create a decision-making process. For your team, does reaching consensus involve
taking a vote to see how the majority of the team feels or gaining 100% agreement? Determine which
method works best and utilize it throughout the CHANGE tool completion process.
Action Step 3: Review All Five CHANGE Sectors
CHANGE is divided into five sectors for assessment:
â–ª Community-At-Large Sector.
â–ª Community Institution/Organization (CIO) Sector.
â–ª Health Care Sector.
â–ª School Sector.
â–ª Work Site Sector.
The Community-At-Large Sector includes community-wide efforts that impact the social and built
environments, such as food access, walkability or bikeability, tobacco-free policies, and personal safety.
The Community Institution/Organization (CIO) Sector includes entities within the community
that provide a broad range of human services and access to facilities, such as childcare settings, faithbased organizations, senior centers, boys and girls clubs, health and wellness organizations, YMCAs,
and colleges and universities.
The Health Care Sector includes places people go to receive preventive care or treatment, or
emergency health care services, such as hospitals, private doctors’ offices, and community clinics.
The School Sector includes all primary and secondary learning institutions (e.g., elementary, middle,
and high schools, whether private, public, or parochial).
The Work Site Sector includes places of employment, such as private offices, restaurants, retail
establishments, and government offices.
Within each CHANGE sector are modules (i.e., leadership, chronic disease management,
demographics, physical activity, after school, district, tobacco, and nutrition) that contain the specific
questions to be asked for each sector. For example, within the Community-At-Large Sector, Physical
Activity Module, a CHANGE item is To what extent does the community maintain a network of biking
routes (e.g., institute a bike lane program to repave bike lanes when necessary)? As your team reviews the
10
sectors, it will be helpful to familiarize yourself with the modules and the information within each.
Please note District and After School are modules found only in the School Sector.
The CHANGE tool assists in gathering information about specific community health indicators
and identifying areas for improvement in each sector. The CHANGE tool enables you to document
changes made as problem areas are identified, new policies are implemented, and environmental
change strategies are put into place. Make sure to review all five sectors prior to completing the
assessment, so your community team understands what is being assessed and can brainstorm whom
to include and the sites to use. Specific instructions on how many sites to visit within each sector
are included in Action Step 4.
Question: How should the community team define the concept of “community” for
completing CHANGE?
Answer: It is up to the community team to determine how it wants to define
“community.” A community can be identified as a city, a town, a county, a
neighborhood, a development of houses and shops, a school district, or other specified
area. The determination of what a community is develops through team consensus
during the community team’s meetings and conversations. The definition should be kept
the same throughout the entire assessment process (i.e., as you complete CHANGE,
develop the Community Action Plan, and determine which individuals are most
representative of the community).
Question: Can “community” be defined by the Metropolitan Statistical Area (MSA)
or by a smaller geographic area?
Answer: It is up to the community team to decide what geographic area will be used
for CHANGE. Previously established areas (e.g., zip codes, school districts, city limits)
may be helpful, but it is up to the community team to define its own community. As
the community team decides on its community size, it should consider picking a smaller
geographic area to start; it might be easier to attain greater impact than in a larger
geographic area within the first year.
Use the Dialogue Guide shown in Figure 6 to develop “talking points” for why you are conducting
CHANGE and what help you need to complete it. Use it when identifying participants to provide
data, to introduce the concept to your community team, or to explain the process to anyone who
is curious about CHANGE activities. This Dialogue Guide also helps to standardize language being
used by the community team to discuss CHANGE activities. Community team members should
speak with one voice to ensure consistency of message.
11
Figure 6. CHANGE Dialogue Guide
â–ª CHANGE is a data-collection tool and planning resource for community members interested in
making their community a healthy community.
â–ª CHANGE provides a community snapshot of the policy, systems, and environmental change strategies
currently in place and helps identify areas for improvement. Examples of these strategies include
tobacco-free policies at schools, healthy vending machine policies at work sites, safe sidewalks in all
neighborhoods, and stair use promotion in public buildings. The strategies CHANGE measures are
all population-based; CHANGE does not measure individual-level strategies, such as health fairs and
cooking classes.
â–ª Completing CHANGE involves working together to answer questions about specific community
sectors (i.e., Community-At-Large Sector, Community Institution/Organization Sector, Health
Care Sector, School Sector, and Work Site Sector). Each sector is made up of multiple modules (e.g.,
physical activity, nutrition, tobacco use, chronic disease management, leadership). As a group, we will
decide whether to complete all sectors of CHANGE as a whole team or divide into subgroups and
report results back to the whole team.
â–ª Completing sectors involves answering questions about our community. We will decide what methods
this requires, for example talking with a community leader from this sector to gather additional
information, walking or driving through the community, calling people we know in the setting who
could answer the question for us, or other methods. We can also answer questions by reviewing results
from other community assessments we, or other community members, have conducted here. Since
CHANGE is not an interview guide, multiple methods may be required to complete the tool and gain
an accurate picture of our community.
â–ª Having broad participation from the community is important. We hope to include key persons from
the community — school superintendents and principals, school board members, business leaders,
mayors, city council members, department of health directors, city planners, departments of park and
recreation, police chiefs, hospital administrators, medical staff chiefs, faith leaders, daycare owners,
YMCA directors, and others — who have access to the information we need or can point us in the
right direction.
â–ª As we identify problem areas, implement policies, and put strategies into place, we can use CHANGE
to document this work within our community. The tool can be utilized annually to review past efforts
and offer ideas for the year ahead. Because we will be documenting and storing all data we collect to
complete CHANGE, we will be creating an important record about our community’s assets, needs,
and priorities.
â–ª CHANGE is not used to compare sectors, to compare one community to another, or to find fault in
our community for our weaknesses. Instead, it is used by us to identify areas in our own community to
highlight our strengths. It is up to us to decide if sharing CHANGE data with the public or outside
of the community team is warranted in order to rally attention or public support for our efforts.
Confidentiality is always an important element of data-collection; thus, we will not list who we
talked with or provide specific details about data that could be specifically linked to an individual,
community organization, or institution.
â–ª CHANGE has already been used by communities like ours. Users have noted how helpful the tool is
for identifying possible policy, systems, and environmental change strategies; guiding conversations
and generating ideas for community change; providing a systematic way for communities to assess and
plan for change; reviewing numerous sectors of their community, including schools, businesses, work
sites, and health care settings; and promoting collaboration among community members.
12
Action Step 4: Gather Data
Action Step 4 is data-collection and begins the assessment phase, during which information is
collected from individual sites. Sites are the locations within each sector your team will visit to collect
data. At each site, the information gathered will provide answers to the CHANGE items listed in each
module. For example, sites within the Community-At-Large Sector could be county government,
news media, restaurants, grocery stores, or the health department in your community. Remember
that your team will observe and document multiple sites when completing the Community-AtLarge Sector because items cut across community-wide indicators, including walkability, food
access, and tobacco use and exposure, which cannot be assessed by using only one site. For example,
when answering questions around physical activity for your defined community, you may need to
observe and document more than one park, neighborhood street, sidewalk network, or bike route
to understand community walkability or bikeability, which are not limited to one location but are
within the geographic boundaries of your identified community. However, with the other four
sectors, your team will collect data specific to that one particular location, such as a single work site
or health care facility. The relationship between sectors, sites, and modules will be explored in greater
detail in this action step. The CHANGE tool is not designed to grade communities on their progress,
but rather to assist you in making decisions about where change is needed and taking the steps
necessary to reach out to those individuals and organizations (including your community team) that
can help you to make an impact.
Tip! Review the CHANGE Sector Excel Files for inspiration on questions
to ask during interviews. However, do not print out the document and
ask contacts to complete it. CHANGE is designed to be a dialogue in
which questions are asked, feedback is generated, and notes are taken
to document the process. It is not designed as a self-report assessment
or a tool that individuals should fill out for their own sites.
At this action step, use a mixture of two or more data-collection methods at each site, for example,
focus groups and walkability audits. Table 1 lists the advantages and disadvantages of various datagathering methods. This is not a comprehensive list, but rather a sample of methods you can use.
Richer data enable a more effective action plan, so take this step slowly to ensure the data needed to
make decisions are available.
Perhaps your community has already gathered data for another purpose? To determine if that
information can be leveraged for the CHANGE process, consider the following:
â–ª How old are the data? If data are 6 months old or newer, they can be used. If not, it is time to
gather new data. �
â–ª Do you have all the information?
â–ª Is the information relevant?
13
â–ª Can you use the data in the existing format?
â–ª Do you need more data?
â–ª Does anyone on your team have experience with analyzing data?
Table 1. Advantages and Disadvantages of Data Collection Methods
Method
Definition
Advantages
Disadvantages
Observation
Data collection method
that allows you to use the
phenomenon around you to
gather clues and generate
conclusions about specific
locales or experiences. One
example is to stand on a
street corner to observe or
watch the ease or difficulty
with which pedestrians
can cross a busy street.
Windshield surveys are also
a form of direct observation
— making visual observations
of a neighborhood or
community while driving —
literally “looking through the
windshield”
â–ª Relatively inexpensive
â–ª Efficient
â–ª Can be conducted on foot
â–ª Provide only an overview of
community
â–ª Require closer observation
to identify previously
unrecognized assets/ issues
Photovoice [7]
Combines photography with
grassroots social action;
subjects represent their
community or point of view by
taking photographs; attempts
to bring perspectives of
those “who lead lives that
are different from those
traditionally in control of
the means for imaging the
world” into the policy-making
process
â–ª Provides a method for
describing the community
from the viewpoint of
those who live there as
opposed to those who
govern it
â–ª Enables people to record
their community’s
strengths and concerns
â–ª Promotes critical dialogue
and knowledge about
community issues
through large and small
group discussions of
photographs
â–ª Analysis of photographs
can be complex due to the
volume of information
â–ª Requires photo release form,
particularly if individuals
appear in the photographs
â–ª Can be expensive to
develop photos
Walkability
Audit [8]
Designed to broadly
assess pedestrian
facilities, destinations, and
surroundings along and near
a walking route and identify
improvements to make the
route more attractive and
useful to pedestrians
â–ª Unbiased examination of
the walking environment
â–ª Can also be performed
at different stages of
development, including
planning and designing,
construction, and on
completed or established
facilities/walking
environments
â–ª Inexperience in conducting
walkability audits
â–ª Can be time-consuming
[6]
14
Method
Advantages
Disadvantages
Focus Groups Involve gathering information
[9,10]
and opinions from a small
group of people (8 to 10
per group). These group
discussions often provide
insights that might not
emerge in interviews
â–ª Can assess body language
â–ª Observers can be present
without distracting
participants
â–ª If videotaped, can
share with others who
couldn’t attend
▪ Have participants’
undivided attention
â–ª Responders lose anonymity
â–ª Higher travel expenses when
multiple locales are used
â–ª Logistical challenge in rural
areas or small towns
Postal Survey
Mailing self-completion
questionnaires to a targeted
group of people. (e.g., a
client’s customers or people
living in a certain area)
â–ª Relatively inexpensive
â–ª Less potential for people
to give answers they
assume the interviewer
wants to hear
â–ª No interviewer
training required
â–ª Suitable only for short and
straightforward surveys
â–ª Data collection takes a
long time
â–ª Relatively low response rates
â–ª Moderate literacy
level required
Telephone
Survey [12]
Collection of data from a
sample population using a
standardized questionnaire
by telephone
â–ª Minimizes missing data
â–ª Can use open-ended
questions and
more complex
interviewing schedules
â–ª Can record reasons and
characteristics
of nonconsenters
â–ª Quick and inexpensive
â–ª Does not require a high
level of literacy
â–ª Can be hard to prevent
consultation with/
interference from others
â–ª Need to keep questions few
and short
â–ª Unable to ask questions
requiring visual cues
â–ª Some likelihood of socially
desirable responses
Face-to-face
Survey [13,14]
A face-to-face survey is a
telephone survey without the
telephone. The interviewer
physically travels to the
respondent’s location to
conduct a personal interview
â–ª Allows flexibility in number
and style of questions
â–ª Minimizes missing data
â–ª Allows physical
measurements &
direct observations
â–ª Minimizes literacy
level issues
â–ª High likelihood of socially
desirable responses
â–ª Can be hard to prevent
consultation with or
interference from others
â–ª Very expensive, especially
if respondents are
widespread geographically
â–ª Time-consuming
Web-based
Surveys [13]
A group of potential
respondents is invited to
participate in completing a
web-based survey, and their
responses are submitted
electronically via the Internet
â–ª Can be relatively
inexpensive
â–ª Relatively quick method of
data-collection
â–ª Minimizes social
desirability biases
â–ª High set-up costs
â–ª Useful only for relatively
large-scale surveys
â–ª High level of literacy
and basic computer
skills required
â–ª Requires access to good
hardware, programming,
and support services
â–ª No information on nonrespondents
â–ª Best suited to pre-coded
questions
[11,12]
15
Definition
Tip! Make sure to use the same methods (e.g., survey, focus group) from
one year to the next so that you have consistent data to analyze. You
can expand on the methods from one year to the next, but be sure to
maintain the ones from previous years.
Brainstorm sites for each sector as well as people (or key informants) in the community who
can assist you in completing the CHANGE tool by providing appropriate insight, knowledge,
or documentation. Figure 7 provides more detail on the connections between sectors and sites.
Community team members can then reach out and contact people from the community (e.g.,
school superintendent, school principal, business leaders, mayor, city planners, police chief, hospital
administrator, faith leaders, or daycare owners) who should have access to the desired information
or can point them in the right direction. You can use existing data sources, such as U.S. Census,
Behavioral Risk Factor Surveillance System (BRFSS), National Health and Nutrition Examination
Survey (NHANES), and Chronic Disease Indicators (CDI) to capture community information where
possible. These sources capture and utilize nation-wide data to reflect demographic data updated on
an annual basis. BRFSS data is especially helpful as they can be splintered to show state, county, and
metropolitan area data. These are examples of the only sources of data older than 6 months that are
acceptable to use. However, pay attention to the frequency with which the data are collected. The
next set of data from the U.S. Census, for example, will be available in 2010; BRFSS alternates asking
questions on certain key indicators (e.g., physical activity, nutrition) each year. As such, it is suggested
that your team review a 2-year range of data to ensure a complete set of data. Remember that these
sources do not provide policy, systems, and environmental change strategies, but rather a snapshot
of the types of needs located in a given community. For example, CDI data may indicate that the
prevalence of childhood obesity is higher in one county compared to a neighboring one. Using
that data, your community team may begin to devise strategies on how to address that evidencebased need. State or nation-wide data paint a bigger picture of what is happening and can be used
as a comparison for the rich, community-level data you generate using CHANGE. The data from
these sources can be used in conjunction with the original data you collect from sites to gain a more
comprehensive picture of the community needs. This strategic dialogue around identifying priorities
can drive the creation of your Community Action Plan.
Tip! For additional datasets go to the following web sites: U.S. Census–
www.census.gov; BRFSS–www.cdc.gov/BRFSS; NHANES–http://www.
cdc.gov/nchs/nhanes.htm; Chronic Disease Indicators–http://apps.
nccd.cdc.gov/cdi/.
16
You are encouraged to use a variety of data-gathering methods to access and collect information for
each site. Data come in many forms; varying data-collection methods provides a more comprehensive
assessment of your community. For example, direct observation enables you to better understand the
environment in which people interact and to see the things others may not be aware of. It may also
produce useful information that may not be apparent from your other data-collection methods, such
as a key informant interview or focus group. This type of data-collection allows you, the observer, to
choose a location or event and watch what is happening. Coupling or grouping multiple methods can
help to fill in gaps. For example, photographs of walkable streets or congested intersections unfriendly
to pedestrians may supplement the feedback from an independent survey. The goal is to reflect the
voices of the community through a diverse set of data-collection methods and to mobilize support by
demonstrating a detailed, thorough method of data-collection. Finally, 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. The file can be in multiple forms—notebooks or bound volumes, facilitator guides, field
notes, meeting minutes, or an electronic data file. The purpose of cataloguing all the data files is to
ensure that everything your team collects can be accessed and used.
Tip! Be sure to choose a variety of sites within your sector to show
the breadth of work being done in your community. Some schools, for
example, may be on the brink of passing a physical activity policy, while
others have not yet begun to consider the need. A diversity of policy
implementation enhances your data-gathering process. If you only
choose sites that are excelling it is more challenging to identify gaps
and needs for your Community Action Plan.
We suggest that you gather data from at least 13 sites. While this may seem daunting, consider there
are only five sectors in the tool. Complete one site for the Community-At-Large Sector. Complete a
minimum of three sites each for the other four sectors (i.e., Community Institution/Organization,
Health Care, School, and Work Site). The more sites completed, the greater the capacity of your team
to understand the intricacies of the community. Having more sites can be beneficial to your team as it
shows a breadth and depth of data generated. Every community has different assets and needs, so do
as much as possible with the time and resources available.
Figure 7 shows the relationship among the sectors, modules, and data-collection methods. Start with
defining the community, whether that is a county, city, or geographic area. Given the boundaries
of the community, the other four sectors will fall within those boundaries. For example, if your
community is defined as two adjoining zip codes within a county, the Community Institution/
Organization, Health Care, School, and Work Site Sectors are completed by selecting sites within
that geographic designation. Then, define the sites within each and the methods your team will use to
collect the data.
17
Figure 7. Framework for Completing CHANGE
COMMUNITY­
AT­LARGE (1)
SECTORS
MODULES
Community
Institution/
Organization
(3)
Health Care
(3)
Schools
(3)
Work Site
(3)
Leadership
Demographics
After School
Tobacco
Chronic Disease
Management
Physical Activity
District
Nutrition
METHODS
Observation
Survey
Focus
Group
Walkability
Audit
Photovoice
Once you have data that fully represent your community, identify areas for improvement within your
Community Action Plan. Specific individuals who have the information will vary depending on the
size of the organization. Use the community team members to access businesses or organizations with
which you are less familiar. Sometimes it may be challenging to choose sites. The Sector Participant
List, found in Appendix B, helps to identify key sites and the individuals to contact.
Action Step 5: Review Data Gathered
Action Step 5 is to review the data. Before you enter data into the CHANGE Sector Excel Files,
review the data collected for each site to gain consensus on how to rate each item. Teams are
discouraged from averaging ratings. The team should discuss the data, share what each person found,
and identify evidence to support the team’s rating. Refer back to Action Step 2 when your team
devised a decision-making strategy. Some examples are the Delphi method, simple voting tactics, or
a discussion among members that indicates all or most are in agreement. Choose a method based on
your team’s preference but you are encouraged to use that same method consistently throughout the
process. This is the exciting part! Yet it also represents the hard work needed prior to entering data
into the tool. Gather with your community team (in a board room, at a park, or at the local coffee
shop) to brainstorm about what was heard in town hall meetings, observed during walkability audits,
and garnered from existing data sources. There may be a pile of information in front of the group:
pictures from the walkability audit, responses from a survey e-mailed to school staff, notes from an
interview with the CEO of the local hospital. Establish consensus on what these data mean in terms
of the parameters of the CHANGE tool. Be sure to record comments in the CHANGE Sector Excel
file for every single response, to document why the decision was made. Make sure the information
18
is representative of the site you assessed so information can be used from one year to the next.
Rating the data should be based on a comprehensive review of all sources and the agreement of the
individuals on your team.
Tip! When possible, have the person who collected the data in the room
when the team reviews the information. The person’s memory and
experience are data sources that may be just as important as whatever
notes he or she may have taken.
The rating scale in each sector has been created to examine and easily determine where a site has
progressed. Allocate a number between 1 and 5 for both the policy and environment columns for
each of the five sectors. Table 2 shows a scale, with examples for scores 1–5. A response of 99 has
been incorporated into the scale to be used only when the item is not applicable at the site (e.g.,
stair promotion not suitable in a one-story building). This item response (99) does not factor into
the module’s column total or percentage calculations. During this action step, data are reviewed.
One or two members of your team should take note of what type of data was collected from the site
being discussed, where it came from, and add it to the comprehensive data file. This information
can be entered into the comment boxes and will provide valuable, historical documentation for
the reassessment phase. Table 2 also provides a detailed explanation of the rating scale for the
Community-At-Large Sector, Physical Activity Module. The module addresses the item require
sidewalks to be built for all developments (e.g., housing, schools, commercial).
19
Table 2. CHANGE Tool Policy and Environment Scale for Community-At-Large Sector and
Physical Activity Module
Policy
Response #
Environment
Item #1: Require sidewalks to be built for all developments (e.g., housing, schools, commercial)
1
This stage represents the time when the issue has
not yet been identified as a concern or a problem.
For example (examples provided correspond to
item #1), the city or county government has never
discussed instituting a sidewalk policy; complaints
have never been filed and issues have not been
raised by residents.
At this point, no elements are in place in
the environment. For example (examples
provided correspond to item #1), there
are no sidewalks that are fully accessible
to all pedestrians (including those in
wheelchairs), there is no appropriate
lighting, there are no stoplights, and
there are no crosswalks.
2
This stage involves getting a problem onto the radar
screen of the authoritative body that must deal with
the issue. This is usually done when the issue or
problem is categorized as a social or public problem.
For example (examples provided correspond to
item #1), the city or county government discusses
instituting a sidewalk policy after complaints are filed
by residents who are not able to safely walk in their
neighborhoods; policy implications and issues are
being considered.
At this point, only a few elements are in
place in the environment. For example
(examples provided correspond to item
#1), there are sidewalks that are fully
accessible to all pedestrians (including
those in wheelchairs), but there is
no appropriate lighting, there are no
stoplights, and there are no crosswalks.
3
This stage involves analyzing policy goals and
solutions, the development or creation of alternative
recommendations to resolve or address the identified
public problem, and final selection of a policy. For
example (examples provided correspond to item #1),
the city or county government developed and approved
the policy, but it has not yet been implemented. It will
be implemented in the next fiscal year.
At this point, there are some elements
in place in the environment. For example
(examples provided correspond to item
#1), there are sidewalks that are fully
accessible to all pedestrians (including
those in wheelchairs) and there is
appropriate lighting, but there are no
stoplights and there are no crosswalks.
4
This occurs within organizations directed to carry
out adopted policies. Implementation begins once
a policy has been formulated and adopted, and
administrators have made a decision about how to
deploy necessary resources (human and financial)
to actualize the policy. For example (examples
provided correspond to item #1), the sidewalk policy
was established and passed last year by the city or
county government, communicated to residents, and
implemented this year. The end of this year will be
the review and comment period of the policy.
At this point, most elements are in
place in the environment. For example
(examples provided correspond to
item #1), there are sidewalks that
are fully accessible to all pedestrians
(including those in wheelchairs), there
is appropriate lighting, and there are
stoplights, but there are no crosswalks.
5
This stage involves determining to what extent the
policy has been enforced, and what occurred as a
result of the policy. Based on the evaluation results,
adjustments can be made to the current policy
to ensure effectiveness. For example (examples
provided correspond to item #1), the sidewalk
policy was in place last year, and a comment period
was held. The policy was revamped, and is now
implemented with revisions including increased
funding for implementation and increased
punishment for violations.
At this point, all elements are in place in
the environment. For example (examples
provided correspond to item #1), there
are sidewalks that are fully accessible
to all pedestrians (including those
in wheelchairs), there is appropriate
lighting, there are stoplights, and there
are crosswalks.
99
This type of policy is not appropriate for
this community
This type of environmental change
strategy is not appropriate for
this community
20
Action Step 6: Enter Data
Designate one person as the data manager within your community team. The data manager is
responsible for entering the data for each of the sites into the CHANGE Sector Excel File. It may be helpful
if this person is familiar with Excel; extensive skill is not necessary, but a basic working knowledge of the
program (e.g., opening and closing files, entering macros, and entering data) facilitates the use of the tool.
Each site should be labeled and saved appropriately using the recommended CHANGE Sector Excel File
name.
Tip! Recommended file name.
CHANGE_sector_site#_community_year.xls;
e.g., CHANGE_school_2_Atlanta_2010.xls.
When opening a CHANGE Sector Excel File, click Enable Macros when the security warning
message below appears.
If you do not see the security message above and are therefore not able to click Enable Macros.
1. Open Excel.
2. Click the Tools menu across the top.
3. Within the Tools menu, click the Macro option.
4. Within the Macro option, click the Security option.
5. Within the Security option, select the Medium radio button.
6. Click OK.
21
7. Open the CHANGE Sector Excel File and click Enable Macros in the Security Warning.
Tip! Please note some organizations block users from changing the
security level for macros. If this is the case, ask the Information
Technology staff to follow the steps outlined here.
Using the five-point scale and the guidance provided in Action Step 5, indicate in both the
highlighted Policy and Environment response columns the most appropriate rating for each
item, based on the community team’s observations and information collected. Data managers are
encouraged to use the comment boxes in the CHANGE Sector Excel Files; providing detailed records
of how and from where the data were collected helps when you get to the reassessment phase.
Remember, CHANGE is an annual process so the data should be consistent from one year to the next
and a valid reflection of what the team observed, heard, and recorded.
22
Question: If the community team assesses four sites, are four separate Excel
files needed?
Answer: Yes. For every site, the community team should have a separate CHANGE
Sector Excel File. After gathering information and gaining community team consensus
on CHANGE item responses, the team’s data manager enters the data for each site into
the correct sector file. 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. The assessment tool automatically completes all data calculations within
each sector. Once CHANGE Sector Excel Files have been completed and saved by the data
manager, data can be included in a CHANGE Summary Statement.
Question: Can community team members simultaneously work on files while others
work on the same file?
Answer: Yes, you can simultaneously work on CHANGE sectors once data-collection
methods for their completion are determined by the community team. We recommend
that you print hard copies of CHANGE, so that all community team members can note
additions, deletions, or revisions to the data by hand. Once combined and finalized,
the data manager enters all data into the Excel files. The community team is strongly
encouraged to designate one member as data manager. The data manager is responsible for
entering and saving all data sheets. While a CHANGE Sector Excel File is open, only one
person can enter data at a time.
23
Figure 8. Snapshot of the CHANGE Sector Excel File
Figure 8 is an example of the Community-At-Large Sector and the Physical Activity Module that
you will see on opening the CHANGE Sector Excel File. Note the rating scale (1–5) for Policy and
Environment with an explanation for how the ratings are determined. For example, a rating of
1 under Policy means the item was not identified as a problem based on the data collected. Also
in this screen shot, you see a list of items related to physical activity. For example, the first item
is Require sidewalks to be built for all developments. A policy response of 1 next to item number 1
indicates Requiring sidewalks to be built for all developments has not been identified as a problem in
the community. In the neighboring tabs, you enter similar information for the other modules (e.g.,
nutrition, tobacco, and chronic disease management).
24
Figure 9. Definitions of Terms in the CHANGE Sector Excel File
Environment: Physical, social, or economic settings designed to influence people’s
practices and behaviors. Examples of alterations or changes to the environment
include:
Physical: Structural changes or the presence of programs or services, including the
presence of healthy food choices in restaurants or cafeterias, improvements in the
built environment to promote walking (e.g., walking paths), the availability of smoking
cessation services to patients or workers, and the presence of comprehensive school
health eduction curricula in schools.
Social: A positive change in attitudes or behavior about policies that promote health
or an increase in supportive attitudes regarding a health practice, including an
increase in favorable attitudes community decision makers have about the
importance of nonsmoking policies or an increase in non-acceptance of exposure to
secondhand smoke from the general public.
Economic: The presence of financial disincentives or incentives to encourage a
desired behavior, including paying higher prices for tobacco products to decrease
their use or the provision of nonsmoker health insurance discounts to encourage
smoking cessation.
The definitions of policy and environment are critical to form the basis for decisions on how each
column is scored. Definitions are embedded into the CHANGE tool. Figure 9 shows that when you
move your cursor to the corner of the Environment or Policy column (note the red marker) a box
with the definition pops up. The definitions of both terms can also be found in Appendix A, Glossary
of Terms.
25
Figure 10. Definitions of Item Responses
At this point, no elements are in place
in the environment. For example
(examples provided correspond to
item #1), there are no sidewalks that
are fully accessible to all pedestrians
(including those in wheelchairs), there
is no appropriate lighting, there are no
stoplights, and there are no
crosswalks.
Figure 10 shows the definitions for the item responses. Study these carefully to make sure your rating
is accurate based on the parameters of the response. For example, a response of 1 under Environment
indicates At this point, no elements are in place in the environment. For example (examples provided
correspond to item #1), there are no sidewalks that are fully accessible to pedestrians (including those in
wheelchairs), there is no appropriate lighting, and there are no crosswalks.
26
Figure 11. Item Responses and Accompanying Comment Boxes
Comment:
Figure 11 depicts how each item is scored for Policy and Environment. For example, if you put a
number 4 in the box under Environment, this score indicates that most elements are in place for your
community to have sidewalks. Specifically, they are fully accessible to pedestrians, even those in
wheelchairs, there is appropriate lighting, and there are stoplights but no crosswalks. The comment
box that pops up next to the item response serves as documentation on how each of the items was
rated by the team. You are highly encouraged to enter detailed comments in each of the comment
boxes for each of the items. This information augments the reassessment phase.
27
Figure 12. Definitions of Key Terms
Bike facilities: A general term denoting improvements and
provisions made by public agencies to accommodate or
encourage bicycling, including parking and storage facilities,
and shared roadways not specifically designated for bicycle
use.
Bike lanes: Portions of a roadway that have been designated
by striping, signing, and pavement markings for the
preferential or exclusive use of bicyclists.
Addditonal bike facility definitions and design
recommendations can be found in AASHTO’s Guide for the
Development of Bicycle Facilities.
http://www.sccrtc.org/bikes/AASHTO_1999_BikeBook.pdf
As you review all the items, and begin to rate them, the CHANGE tool provides additional
definitions, as shown in Figure 12. Move your cursor to the right-hand corner of the cell and a popup box appears with the definition for all underlined terms in the items. Each of these definitions can
also be found in Appendix A, Glossary of Terms.
28
Figure 13. Module Percentages and Tabulated Ratings
Continue to add the item responses per column for each of the sectors and modules for which you
have data. Be sure to confer with the team on item response, but, for accuracy and precision, rely on
the designated data manager to actually input the data. Answer every item. Do not leave anything
blank; doing so will impact the validity of the module percentages. Remember, if an item does not
apply to your community use the 99 rating, which will not tabulate into the final score. Figure 13
shows that, once you have completed all modules, your percentage scores are tabulated for both Policy
and Environment. This is an automatic process, not a manual one, and ensures the scores are accurate.
29
Figure 14. Module Score Summaries
After you have finished completing each of the item responses for all the sectors and modules for
which your team generated data, the CHANGE tool provides a summary of all the scores, as shown
in Figure 14. The percentages automatically populate into the table for each of the modules. You
can then manually enter the numbers into the CHANGE Summary Statement, Figure 15, which is
discussed in further detail in Action Step 7.
30
Action Step 7. Review Consolidated Data
After ratings have been assigned to the items in each sector, your team determines areas for
improvement, and develops a Community Action Plan. Reviewing the data is a critical process to
ensure resulting strategies are supported by evidence. Action Step 7 is divided into four tasks (7a–7d)
for ease of completion:
▪ Step 7a—Create a CHANGE Summary Statement.
▪ Step 7b—Complete the Sector Data Grid.
▪ Step 7c—Fill out the CHANGE Strategy Worksheets.
▪ Step 7d—Complete the Community Health Improvement Planning Template.
Action Step 7a: Create a CHANGE Summary Statement
CHANGE data can be transferred into a CHANGE Summary Statement (see example in Figure 15)
for quick reference of all sites with module percentages across all sectors. This is a manual process,
so double-check the work to ensure ratings are copied accurately. At this step, it is important to look
at the numbers generated using CHANGE and to identify the greatest community needs. After all
sites have been completed for the five sectors, tabulate and summarize data to prioritize key actions
to be included in your Community Action Plan. Use the data for all sites in each sector to develop
the CHANGE Summary Statement, which helps to organize and review module data (e.g., physical
activity, nutrition, chronic disease management) within each sector. A low score for a module
indicates that policy and environmental change strategies are missing from that site. A high score
indicates that the site has begun to implement strategies or has strong ones already in place.
31
Figure 15. Example CHANGE Summary Statement (Community-At-Large Sector)
Action Step 7b: Complete the Sector Data Grid
Use the CHANGE Summary Statement to fill out the Sector Data Grid. By providing a quick data
reference across all five CHANGE sectors, a completed Sector Data Grid helps communities to easily
review and determine areas to address through the Community Action Plan. Identifying sectors and related
modules with low scores is useful for informing priority areas for improvement and determining what
specific strategies to incorporate into the plan.
The grid is set up to show the sector designation for the data in the summary statement. For each sector,
indicate where each site’s module (row) percentages fall in the appropriate column. School, for example
would have the designation SP1 (for the first school site assessed for policy) and SE1 (for the first school
site assessed for environment). For Community-At-Large, place a CALP1 (remember there is only one
site assessed for this sector) in each row to denote this site’s policy module percentages across the scale
(low [0–20%] to high [81–100%]). The area of the table highlighted in red indicates the proper way to
denote the single Community-At-Large Sector. Add additional sites on the Sector Data Grid until all sites
are represented. Repeat this process for environmental change strategies for all sites (e.g., WE1, WE2, and
32
WE3). This action step supports a comprehensive view of all the data and reveals how the sites compare to
each other. It builds a spectrum against which your community team can begin thinking about gaps, needs,
assets, and areas of change. Table 3 shows an example of a completed grid. This Action Guide recommends
collecting data from a minimum of three sites, but you are encouraged to expand to more whenever
possible. In Table 3, the Work Site/Physical Activity row shows that five sites (WP1–WP5)
were evaluated.
Table 3. Example of a Sector Data Grid
LOW
Community Institution/
Organization (CIO)
Community-AtLarge (CAL)
0-20%
41-60%
81-100%
CALP1, CALE1
Chronic Disease Mgt
CALE1
CALP1
CIOE1
CIOP2, CIOE2,
CIOP3
CIOE3
CIOE1, CIOP1,
CIOE2
CIOP2, CIOE3
CIOP3
CIOP2, CIOE3,
CIOP3
CIOP1,
CIOE1,CIOE2
CIOP1
Leadership
CALE1
CALP1
Physical Activity
CIOP1
Nutrition
Tobacco
CIOP1, CIOE1
Leadership
CIOP2
CIOE2, CIOP3,
CIOE3
CIOE2, CIOP2
CIOE3
CIOP3, CIOE1
SIE
S3P
SE1
SP3
SP1
SP1,SE2
SP1, SE1, SP2,
SE2
Nutrition
S3P, S3E
SP1, SP2 SE2
Tobacco
SP3, SE3
SE2
SP2, SE1
Chronic Disease Mgt
S1P, S1E
S2P
SE2, SP3, SE3
SP1
SE1, SP3, SE3
SP1, SE1, SE3
SP2, SE2
Leadership
After-School
61-80%
CALP1, CALE1
Tobacco
Chronic Disease Mgt
HIGH
CALP1, CALE1
Nutrition
Physical Activity
School
21-40%
Physical Activity
District
33
MED
SP3
SE2, SP2
SE3
Work Site
Physical Activity
Nutrition
WP1, WE1
Tobacco
WP2
WE1, WP2,
WE5
WP1, WE2,
WP3, WP4,
WE4, WP5
WP2, WE2
WP3
WP1, WE1,
WE2, WP3,
WE3
Chronic Disease Mgt
Leadership
WE1
Health Care
Physical Activity
Nutrition
H2P
Tobacco
Chronic Disease Mgt
HP1, HE1
Leadership
CAL E1
CAL = Community-At-Large
Sector
WE3
E = Environment
WE1, WP3,
WE3, WE5
WP1, WP2,
WE2
WE2, WP3,
WE3
WP2
HE2, HP3, HE3
HP1, HE1,
HP2
HE2, HP3, HE3
HP1, HE1
HE2, HP3, HE3
HP1, HE1,
HP2
HE2, HP3, HE3
HP2
HP1, HE1, HP2
H2E2, HP3,
HE3
1= Site number (if you have multiple sites,
number them consecutively, 1, 2, 3 and so forth)
Some communities find it useful to designate a “cut-off point” between the community’s assets and
needs. In Figure 16, the red line is the cut-off point, dividing assets and needs. As a group, decide
on cut-off points. This process helps to develop Community Action Plan strategies as you move into
Action Step 7d.
Figure 16. Designation of Assets and Needs
Community-AtLarge
LOW
Physical Activity
MED
0-20%
21-40%
CALP1
CALE1
Nutrition
HIGH
61-80%
81-100%
CALP1, CALE1
Tobacco
Chronic Disease Mgt
41-60%
CALP1
CALP1
CALE1
CALE1
Leadership
CALP1
NEEDS
CALE1
ASSETS
34
Action Step 7c: Fill Out the CHANGE Strategy Worksheets
With the help of the Sector Data Grid, look across all the data for needs and assets. Identify focal
policy, systems, and environmental change strategies that are both in place (i.e., assets) and missing
(i.e., needs). Refer back to Figure 16 where your team designated a cut-off point–those elements
to the right of the line would be considered assets; those to the left are the needs. Augment both
worksheets with supplemental data gathered during the community assessment process. These
worksheets are important starting points in your community dialogue to define community needs,
inform priority areas, and create a data-driven process for the development of the Community
Action Plan. Create as many bullets as your data affords. You may consider opening the actual
CHANGE Sector Excel Files to list out the policy, systems, and environmental change strategies as
assets and needs. The bulleted list of items called for in the worksheets could be generated from this
information. The CHANGE Strategy Worksheets are built in Microsoft Office Word specifically
to expand to fit the volume of information your team may generate. The worksheets augment the
CHANGE data and serve as living documents to record thoughts, brainstorm with the team, and
prioritize the assets and needs that will shape the Community Action Plan. The data collected for the
Community Institution/Organization, Health Care, School, and Work Site Sectors should be relevant
to the geographic boundaries of your defined community. Be specific because not only will you be
able to relate the strategies back to data, but also doing so will aid in the evaluation process.
35
Policy, Systems, and Environmental Change Strategy Worksheet 1
Policy, Systems, and Environmental Change Strategies: Assets
Community-At-Large Sector:
â–ª Playgrounds and public parks are well-maintained.
â–ª Sidewalks are well-maintained and well-lit in the downtown area.
â–ª City government is proactive about developing support for healthy lifestyles due to
mayor’s Get Active initiative.
Community Institution/Organization (CIO) Sector:
â–ª Bike trail proposed (Rails to Trails considered).
â–ª Bike patrol around senior center walking paths by police department.
â–ª 3 out of the 4 child care sites assessed have voluntary tobacco-free campus policies.
Health Care Sector:
▪ Private physician’s office takes routine body mass index readings (BMIs) when patients
appear for office visits.
â–ª Patients referred to tobacco quit line; one provider is conducting a health
mentoring program.
â–ª Pediatricians are proactive about the youth obesity problem by participating in city
school board meetings regarding school compliance with 150 minutes per week of
physical education for elementary school children.
School Sector:
â–ª Joint use agreement exists for playgrounds with city in summer months.
â–ª School gardens at 2 out of the 5 elementary schools assessed supply fresh produce to
school cafeteria.
▪ Extension staff members in schools teach gardening skills to students in grades 9–12.
▪ District-wide tobacco-free campus policy is in place for grades K–12.
Work Site Sector:
â–ª Large work sites (e.g., casino and city government) make discounts to YMCA available
to employees.
â–ª Employee wellness coalition developed by local small business.
36
Policy, Systems, and Environmental Change Strategy Worksheet 2
Policy, Systems, and Environmental Change Strategies: Needs
Community-At-Large Sector:
â–ª County budget cuts threaten development of sidewalks for all new neighborhoods.
â–ª County architecture board reviewing guidelines for all new developments and sidewalks.
â–ª Bike lanes are needed in congested areas of the city, especially downtown.
Community Institution/Organization (CIO) Sector:
â–ª Need safe place to walk and bike around senior centers.
â–ª Safety issues (e.g., lighting and fences) around city-owned walking trail and
recreational areas.
â–ª 2 out of 3 churches identified a need to enhance current health ministries or create new
ones to promote healthy church environment (e.g., offering healthy food options at
church-sponsored events).
Health Care Sector:
â–ª Assessments used by health care provider speak to nutrition but not physical activity.
â–ª Primary providers addressing physical activity and nutrition through patient education
and referrals but not tobacco use and exposure.
School Sector:
â–ª No structured physical education class in grades 9-12.
â–ª Would like CPR training for teachers district-wide.
â–ª Need for fundraisers involving things other than candy bars and cookies in grades K-5.
â–ª 3 out of 5 elementary schools assessed were found to use pizza parties and candy as
rewards for school competitions (e.g., top fundraiser or class with least absences in nineweek period).
Work Site Sector:
â–ª Lack of established, marked (distance) walking areas at work sites.
â–ª Work site health screenings available but at a high cost to employees.
37
Action Step 7d: Complete the Community Health Improvement
Planning Template
Now it is time to start crafting the strategies! Using the CHANGE Strategy Worksheets, prioritize and
list the top strategies for the Community Action Plan along with crucial information about next steps
for implementation, lead or primary contact for action, and timeline for strategy completion. Teams
should not feel pressured to address every weakness and strength. The goal is to prioritize what is
doable given the time and resources. Table 4 shows examples of strategies and the timeline to execute
each. The team determines how many strategies to include. Some considerations are resources,
timing, and competing community priorities. Remember this is a roadmap: balance the enthusiasm
of the team with achievable strategies.
Consider your priorities. Decide which strategies are the most doable. Once the team has agreed on
priorities, enter the first strategy into the box. Think about the next step to achieve the change. Do you
need to speak with someone at the organization to gain additional data? Is there an existing policy that can
be leveraged? Who in the community is able to provide feedback to aid in the evaluation?
Next, identify the person within your team who is responsible for completing the strategy and enter
his or her name in the Lead/Primary Contact column. Next, estimate and enter the time to complete
the change strategy. Be specific and realistic! If the strategy’s completion depends on actions by several
individuals or organizations, allow time for stakeholder coordination. Finally, outline what can
be accomplished within the timeline. Abundant detail allows the team to come back and measure
progress against goals next year. If a different person is conducting the evaluation in the future, or
new members join the team, documentation is available.
Table 4. Community Health Improvement Planning Template
Sector: Policy/
Environmental
Change Strategy
Community-At-Large
Sector: Require
sidewalks to be built
for all developments
(e.g., housing,
schools, commercial)
Next Steps
â–ª Review sidewalk ordinance for policy
language and language gaps.
â–ª Meet with county architecture board
about sidewalk development and
share draft of revised ordinance
language for new developments.
â–ª Attend city council meeting to inquire
about stance on sidewalks for future
developments and current budget for
developing sidewalk network.
â–ª Hold town halls with neighborhood
home owners’ associations to build
local support for revised ordinance.
Lead/Primary
Contact
Timeline
â–ª John Smith
▪ 6–12 weeks from
initial planning
meeting
â–ª Amy Coleman
â–ª 6 weeks from
completion of gap
analysis
(next step #1)
â–ª Nathan Fisher
▪ 6–8 weeks from
initial planning
meeting
â–ª Geoffrey Bowker
â–ª 6 weeks from city
council meeting
38
Action Step 8. Build the Community Action Plan
The final action step for completing CHANGE is to build the Community Action Plan. Careful
execution of the previous seven action steps makes this task fairly straightforward. A quality plan
contains sufficient details to map a clear course of action. Table 5 shows an example of a Community
Action Plan. As you complete the Community Action Plan and craft the objectives, be sure they are
SMART—specific, measurable, achievable, realistic, and time-phased. The definition of a SMART
objective is explored in more detail in Figure 17. Of particular importance in this example is the
presence of two objectives: project period objective and annual objective. The project period objective
allows your team to look at the big picture of what can be accomplished over a multi-year period.
For example, in Table 5, the project period objective is by Year 3 increase the percent of total miles of
physical infrastructure for walking by 30%. Always provide a description of the project period objective
to give context for what your team hopes to achieve (e.g., the establishment of sidewalks, trails, or
walking paths across the community). As you think about your work, narrow the focus to certain
chronic diseases and conditions and their related risk factors, such as obesity and physical inactivity.
Concentrating on these priority areas rather than a broader view will enable your team to craft very
specific, actionable objectives with real impact.
Annual objectives cover a 12-month timeframe and show incremental progress toward completion
of the project period objective. As with the project period objective, it is important to provide a
description of the annual objective. In Table 5, only one annual objective, at the end of 12 months,
increase percent of developments (e.g., housings, schools, and commercial) with paved sidewalks to 100%,
is listed for the project period objective. However, your team could write two additional annual
objectives that address trails and walking paths to fully achieve the project period objective. Similar
to the Community Health Improvement Planning Template in Action Step 7, 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. While, in this example, the sector
impacted is Community-At-Large Sector, a second objective could be developing trails around senior
centers, which would impact the Community Institution/Organization Sector. For each annual
objective, indicate the number of people reached through its successful completion. Reach is the
extent to which a policy affects the intended audience. Think about how many people will be affected
by a sidewalk ordinance requiring paved sidewalks for all developments.
The final section of the Community Action Plan template is where you list the activities that support
the accomplishment of an annual objective. When listing activities, be sure to provide a title and clear
descriptions of key milestones. Avoid listing tactical tasks in this section. For example, the town hall
meeting is more significant than the telephone calls your team makes to secure the time, date, and
location of the meeting. The activities listed in Table 5 serve as examples; for each annual objective
the recommendation is to list no more than ten activities, which may limit these activities to key
actions for completing the annual objective.
39
Table 5. Example of a Community Action Plan
Project Period Objective
Description of the Objective
Priority Area
By Year 3, increase the percent of
Very few neighborhoods and community
total miles of physical infrastructure common areas have sidewalks, trails,
for walking by 30%.
or walking paths that can support
residents’ need for active transportation
to school and work and the ability to be
physically active within the majority of
the community.
Obesity and Physical Inactivity
Annual Objective
Description of the Objective
Sector
At the end of 12 months, increase
percent of developments (e.g.,
housing, schools and commercial)
with paved sidewalks to 100%.
Current sidewalk ordinance does not
require sidewalks to be paved for new
housing developments with less than
120 homes; schools and commercial
developments can receive a waiver if
building in rural areas (designated by
certain zip codes). Ordinance must
be evaluated, revised, and approved
to exclude such exceptions and begin
developing stronger sidewalk networks.
Community-At-Large
Activity Title
Description
Gap analysis on existing ordinance
Review sidewalk ordinance
for policy language and
language gaps
Meeting with county architecture board
Meet with county architecture
board about sidewalk
development and share draft
of revised ordinance language
for new developments
City Council meeting
Attend city council meeting
to inquire about stance
on sidewalks for future
developments and current
budget for developing
sidewalk network
Town hall meetings
Hold town hall meetings with
neighborhood home owners
associations to build local
support for revised ordinance
Activities
Number of People Reached
167,000
40
Figure 17. Definitions of Objectives in Community Action Plan
SMART Objectives are :
1. Specific: Objectives should provide the “who” and “what.” Use only one action verb,
because objectives with more than one verb imply that more than one activity or
behavior is being measured. Remember, the greater the specificity, the greater
the measurability.
2. Measurable: The focus is on “how much” change is expected. Objectives should
quantify the amount of change expected. The objective provides a reference point
from which a change in the target population can clearly be measured (e.g., over the
next 12 months).
3. Achievable: Objectives should be attainable within a given time frame and with
available community resources.
4. Realistic: Objectives are most useful when they accurately address the scope of the
problem and action steps that can be …
Purchase answer to see full
attachment

  
error: Content is protected !!