Community Health Improvement Plan Research Articles

A framework and process for community-engaged, mixed-methods cancer needs assessments.

Community health needs assessments are required for most state and local public health agencies and non-profit hospitals. Typically based on community health improvement planning models, these assessments encompass overall community health and multiple diseases to inform program planning. National Cancer Institute (NCI)-designated Cancer Centers and community-based cancer-focused programs share the goal of reducing cancer burden in the catchment areas they serve. However, to date, no published models exist to guide cancer-specific needs assessments for a determined geographic area that can inform both public health and research initiatives. The purpose of this article is to outline a cancer needs assessment (CNA) framework and community-engaged, mixed-methods process, along with a case study of how we applied it in Kentucky. We convened a steering committee of key organizational partners to provide input throughout the process. We developed a conceptual framework of multi-level determinants affecting cancer-related outcomes. We incorporated both quantitative and qualitative data gathered through a variety of means, including a novel application of group concept mapping to guide definition of priorities. The resulting CNA has helped guide strategic planning and priorities for Kentucky's Cancer Action Plan, Markey Cancer Center, state agencies, and community-based organizations. This framework and process can be used collaboratively by cancer center Community Outreach and Engagement offices, public health agencies, oncology programs, and community partners to plan impactful cancer control programs and research in their catchment areas. Universities can also use them to inform the planning of community engagement and health equity research efforts.

Community health improvement plan: Study protocol for Kansas City's intervention and implementation evaluation

ObjectivesCommunity health improvement plans (CHIPs) are foundational public health practice, yet no studies have been conducted to understand implementation of these plans. This evaluation study of the Kansas City CHIP aims to 1) identify implementation strategies used in the CHIP, 2) assess changes in implementation, service, and client outcomes, 3) assess contextual factors associated with implementation, and 4) understand social networks of coalitions who implement the Kansas City CHIP. Study designThis study protocol uses a unique, mixed methods approach to evaluating process and outcomes of the Kansas City CHIP. This study is supported by Proctor's Model of Implementation, RE-AIM (reach, effectiveness, adoption, implementation, maintenance), and the practical, robust implementation and sustainability model (PRISM). MethodsStaff and community members involved in implementing the Kansas City, Missouri CHIP will be invited to participate in an annual online survey, a series of focus groups, and quarterly implementation logs to assess implementation and sustainability. ResultsRE-AIM and PRISM constructs are the primary and secondary outcomes of interest. Results of this study will be available from the first year of implementation in 2023, with future results provided annually. ConclusionsThis project will fill a much-needed gap in the literature by understanding how large-scale coalitions implement projects that aim to improve population health and health equity. CHIPs have the potential to improve population health, yet few studies have been conducted on CHIPs, with no studies to date assessing outcomes. To support effective implementation and sustainability as well as improve public health outcomes, researchers need to evaluate CHIPs and develop models of implementation that can quickly be integrated into practice to improve populations’ health.

Using Community-Based System Dynamics to Address Structural Racism in Community Health Improvement.

Structural racism is a profound determinant of health resulting in pervasive health inequities for people of color. Despite the recognition of structural racism as a complex, dynamic system, we lack a shared vision of the system that would enable identification of solutions for equitable systems transformation. Through a public health-led community health improvement planning process, a cross-sector consortium implemented community-based system dynamics to provide a systems science lens to guide efforts to eliminate structural racism. In group model building sessions involving diverse stakeholders, community-based system dynamics was used to bring together cross-sector stakeholders to create causal loop diagrams of the system of structural racism. Participants identified potential leverage points for actionable focus to eliminate structural racism. Causal loop diagrams of structural racism generated through group model building demonstrate complex dynamics in the areas of criminal justice, education and economic opportunity, health and health care, quality of life, racial trauma and healing, and a promising system transformative solution through perspective transformation. Community-based system dynamics, employed in the context of local community health improvement planning, engages stakeholders in systems thinking through sharing lived experience to create system maps of structural racism and identify leverage points and transportable solutions that foster health equity. These informal maps serve as the foundation for formal computer simulation models that will guide systemic action on high-yield, community-driven solutions to eliminate structural racism.

Utilizing Healthy People 2030 to Engage Leadership, Key Constituents, and the Public Across Multiple Sectors: Opportunities for Local Health Departments and Community Partners.

Utilizing Healthy People 2030 to Engage Leadership, Key Constituents, and the Public Across Multiple Sectors: Opportunities for Local Health Departments and Community Partners.

A Holistic Evaluation of a Community Health Improvement Plan

ABSTRACT Guided by an integrated conceptual framework made up of social cognitive theory, the theory of fundamental causes, and community organizing theory, the author synthesizes quantitative and qualitative findings from process and outcomes evaluations in order to discern a holistic picture of the success and shortcomings of a Community Health Improvement Plan (CHIP), implemented in a Mid-Western region of the United States from 2016 to 2018. The aggregation and configuration of findings from a variety of data categories presented holistic meaning from evaluation results that would not be obvious in each method alone or each evaluation type alone. Findings from holistic analysis suggest a connection between social dimensions including partnership, participation, and community organizing strategy, and both plan implementation effectiveness and outcomes achievements. The results suggest that underlying contextual factors such as deficits in democratic participation, timid community organizing approaches, underlying socio-economic trends, and resource limitations might be hindering success in achieving plan outcomes and completing implementation activities. Community Health interventions should include strategies, goals, and activities that seek to build and/or improve partnerships and democratic participation related to the Community Health Improvement Plan. In addition, long-term and sustained efforts should be made to intensify collective efforts to build up resources related to capacity and poorly resourced social, economic, and health systems in the region.

Advancing health equity: Organizational characteristics emphasized by health department nurse lead executives.

To compare nurse and non-nurse lead executives' relationship with organizational characteristics supporting performance and health equity in local health departments (LHD). This was a cross-sectional quantitative study. The final national sample consisted of 1447 LHDs using the 2019 Profile of Local Health Departments survey. We used multivariable logistic and negative binomial regression analyses to explore the relationship between nurse versus non-nurse LHD lead executives and involvement in ten organizational characteristics including community health assessment (CHA) and community health improvement plan (CHIP) completion and policy activities related to the social determinants of health (SDOH). Multivariable logistic regression models showed that, for nurse lead executives, the odds of having completed a CHA is 1.49 times, and the odds of having completed a CHIP is 1.56 times, that of non-nurse lead executives. Negative binomial regression models predicted nurse lead executives, compared to non-nurses, to perform 1.18 times more SDOH-related policy activities. Results suggest that nurse lead executives are more likely than non-nurses to emphasize assessment in their work andengage in upstream-focused policy activities. As such, they are important partners in work to facilitate health equity.

Exploring Models for Youth Engagement in Community Health Planning: The Youth-led Community Health Learning Initiative.

Community health assessment and improvement planning processes (CHA/CHIP) are often challenged with developing health actions that reach across a large community, city or county and that incorporate locally informed issues and place-specific strategies. In co-learning about approaches for enhancing CHA/CHIP processes through youth stakeholder input, a partnership of academic and community leaders came together to create The Youth-Led Community Health Learning Initiative (YLCHLI), a 1-year pilot initiative aimed at identifying health needs and assets in partnership with youth leaders and two central Texas communities. To describe our approach, key findings, and lessons learned in implementing the YLCHLI in two different organizational settings: a high school-based setting and a community-based organization setting. Guided by a community advisory board and the Mobilizing for Action through Planning and Partnerships framework, the YLCHLI incorporated a mixed methods design consisting of quantitative community health indicator analysis for topics identified in the Austin/Travis County CHA followed by a youth-led qualitative assessment of selected health issues via methods that included participatory mapping, data walks, and photovoice. Youth-informed findings provided rich insights and context for understanding disparities in selected health issues, including identification of social and environmental barriers to physical activity, healthy eating, health services, and mental health, and locally informed recommendations for community health improvement. High school health science tracks and community- based organizations represent promising settings for fostering community partnerships and youth engagement in identifying local health needs and opportunities that can enhance community health improvement planning and contribute to positive youth development.

Community Health Needs Assessment Data and Community Recovery From COVID-19

IntroductionThe COVID-19 pandemic has had a significant impact beyond physical morbidity and mortality. A mid-cycle Community Health Needs Assessment survey was administered in 1 community to generate data to evaluate change in community well-being since the beginning of the pandemic.MethodsSurveys were mailed to 2,000 randomly selected residents in Olmsetd County, Minnesota. The surveys included the WHO Well-being Index (previously included in the 2018 Community Health Needs Assessment) and new subjective questions regarding behavior change. Changes in well-being were calculated using a propensity-matched cohort, and behavior change was reported as proportions of the whole. Data analysis was completed in 2021.ResultsTotal survey respondents were 569 people in 2018 and 723 people in 2021. Well-being scores from the WHO Well-being Index showed a statistically significant decrease (score reduction of −8.44) from 2018 to 2021. All the 5 questions from the WHO Well-being Index also had an individual significant decrease; with the question regarding interest in life showing the greatest decrease. Individuals reported decreased subjective physical and mental well-being and increased substance use (alcohol, marijuana, and tobacco). Households also reported decreased household incomes and worse household finances since the start of the pandemic.ConclusionsUsing the Community Health Needs Assessment infrastructure, 1 community was able to compare prepandemic with postpandemic data, which showed decreased well-being and increased substance use and financial stress. Other public health planners can similarly conduct interval surveys on the basis of their Community Health Needs Assessment questionnaires to tailor ongoing Community Health Improvement Plan programming to postpandemic needs and track community mental health and well-being recovery.

Generation and Use of Evidence by Local Health Departments: The Role of Leader Attributes.

The purpose of this study was to examine whether certain types of leaders were associated with the degree to which local health departments (LHDs) generate and use evidence to inform their service offering. Pooled, cross-sectional analysis using 4 waves (2010, 2013, 2016, and 2019) of the National Profiles of Local Health Departments sponsored by the National Association of County and City Health Officials (NACCHO). Univariate analysis was used to assess the extent to which LHDs were generating and using evidence to improve the health of their local communities and whether this changed over time. Multinomial logistic regression models were used to examine the relationships between LHD leader attributes and the extent to which LHDs were generating and using evidence. Between 1496 and 2087 (varied by survey round) LHDs from throughout the United States. Two outcome variables pertaining to the generation of evidence: (1) how recently an LHD completed a community health assessment and (2) how recently an LHD completed a community health improvement plan. A third outcome variable reflected how extensively an LHD used the Community Guide, a compendium of evidence-based findings. In 2010, 25.1% and 41.4% of all LHDs had not completed a community health assessment or a community health improvement plan, respectively; by 2019, those figures declined significantly to 14.6% and 24.7%. Similarly, in 2010, 61.7% of all LHDs were not using the Community Guide; by 2019, that percentage declined significantly to 42.5%. Multivariable analysis revealed that leader experience was a more robust correlate of evidence generation and use by LHDs than leader education. While LHDs' generation and use of evidence have grown over the past decade, there is room for improvement. Local health department leader attributes-education and experience-highlight targeted opportunities to fill gaps in the use of evidence-based public health practices.

Status of Prioritized Health Issues at Two- Year Follow up in a Community Health Improvement Plan

ABSTRACT Within an integrated conceptual framework made up of the social cognitive theory and the theory of fundamental causes, we assess the impact of 37 ecological strategies and 126 programs and action plans on three prioritized health issues in a community health improvement plan implemented in a Mid-Western Region of the United States from 2016 to 2018. We perform z tests comparing performance values to both baseline and established targets in 16 objectives which are tied to two priority health issues: healthy behavior; and healthcare capacity, access, and delivery. For three objectives tied to a third priority issue: changes in policy, system and environment, we conduct descriptive as well as thematic and interpretive analysis of responses to open-ended questions. Based on z-test results with statistically significant margins of 0.05 or less, performance values for 5 out of 16 quantitative outcome objectives met established targets and /or were better than baseline data including adult nutrition choices, adult physical activity, and capacity for both inpatient and outpatient mental health and addiction services for all ages. Qualitative data reveals an overall positive perception of performance in the changes in policies, systems, and environment priority issue area even as members desire an expansion of representation, and a strategic focus on leadership and media advocacy. Most unmet objectives are related to system capacity and resource needs. As predicted and explained in the theory of fundamental causes and the social cognitive theory, findings suggest that efforts to improve community health might have been slow or failing because of unfavorable socio-economic, resource, and structural factors that shape the micro, mezzo, and macro environments in which healthy behavior modification takes place. The results also underscore the difficulties in transforming individual risk and community health status without addressing socio-economic factors.

Creating a Nonprofit Spin-Off to Implement a Community Health Improvement Plan: A Case Study of a Midsize Health Department in the Midwest.

A common problem faced by local health departments is engaging cross-sector stakeholders to achieve shared community goals. Community engagement is critical for effective Community Health Improvement Plan (CHIP) development and implementation, while also being a standard for health department accreditation. This case study describes one city-county health department's development of a nonprofit arm to act as a catalyst for connecting community leaders to identify and collaboratively address community health goals. First, we describe our process to develop a nonprofit entity and strategically recruit community members to comprise the founding board of directors. Then, we describe methods employed by the nonprofit to create a community action plan in response to identified community health needs and how we incentivized progress. We evaluated our process using a mixed-methods approach and conclude that a nonprofit arm of a health department can be a novel strategy for effectively engaging community stakeholders to advance community health.

A low-level acetone gas sensor based on n-type ZnO/p-type CuO composite nanostructure for the diagnosis of diabetes in dynamic situations

Today, gas sensors offer a vital method to detect and monitor the level, type, and environmental information of various gases in order to guarantee the safety of life in modern civilization. In this regard, the analysis of human breath components is one of the novel applications of analytic gas sensors to monitor the body’s metabolism function, which has received a lot of attention. The detection of acetone gas concentration in the exhaled breath is a novel promising method for the diagnosis of diabetes patients in the community health improvement plan. In the present work, a gas sensor based on zinc oxide/copper oxides composite nanostructure (ZCS) has been prepared to meet low-level acetone-sensing requirements. The XRD, FESEM, EDS, and BET analysis confirmed the presence of hexagonal wurtzite ZnO and monoclinic CuO in the composite nanostructure with nanorod morphology. The response, response/recovery time, optimum operating temperature, selectivity, and stability of the sensor were examined in dynamic situations. The results show that the ZCS can efficiently detect low-level acetone concentration. The response and response time obtained around 41.57–60.86%, and 12.6–8.1 s, respectively, toward 0.5–2 ppm target gas at the optimum operating temperature of 90 °C. The possible acetone-sensing mechanism of the ZCS through physicochemical reaction, and applying a standard thermionic emission model on I–V characteristics were discussed in detail. Investigations of temperature and frequency-dependent dielectric parameters of the ZCS were also discussed. The outstanding sensing performance of the ZCS demonstrates that it is a favorable and reliable functional acetone sensor for the monitoring of diabetes at dynamic conditions.

Assessing Implementation Fidelity in a Community Health Improvement Plan

This paper describes and analyzes a pre-post non-experimental process evaluation in a Community Health Improvement Plan and the building of evidence for program improvement in the Plan, Do, Check and Act (PDCA) continuous improvement cycle with a focus on the Check and Act steps. The findings will help stakeholders to gain insight into plan implementation and consider necessary design and process adjustments. An overall mean completion rate of 60.44% was recorded with achievement scores ranging from 0% (goals 4 and 5) to 87.92% (goal 1). At the mid-point of implementation, completion for each priority issue was as follows: completion and fidelity rates for action steps addressing healthy behaviors priority issue was 78.05%, the implementation rate for action steps addressing Health Care Capacity, Access, and Delivery priority issue was 43.38%; and the completion rate for action steps addressing changes in policy systems, environment priority issue was at 50%. The level of implementation completion for each priority issue and corresponding action steps aligns with the degree of issue complexity predicted in the conceptual framework. These patterns suggest that initiatives that addressed fundamental causes of poor health status are harder to implement as evidenced by lower completion and fidelity rates.

The Usability of the Plan Quality Index to Support Evaluation of Community Health Action Plans.

The U.S. Army requires community health coalitions to develop targeted action plans in order to more effectively address top public health priorities. Reviews of community action plans indicate that they are often poorly developed and not fully implemented. To date, the U.S. Army has not implemented a standardized tool or process to evaluate action plans and provide recommendations for improvement to local installations. The Plan Quality Index (PQI) is an evidence-based, standardized tool that has been used successfully by technical experts to review and improve community action plans related to the prevention of obesity, injury and violence, and cancer. The objective of this project was to determine the usability of the PQI and to provide recommendations for improving community health action plans focused on injury prevention for the U.S. Army. Five Health Promotion Project Officers and one Health Promotion Project Assistant at Army Public Health Center were trained on the PQI and reviewed injury prevention action plans for 17 installations. After using the PQI to assess injury prevention action plans, the individuals were given a System Usability Scale (SUS) survey to assess the usability of the PQI. Results of the SUS survey can range from 0 to 100, but do not represent percentages. A score of 65 indicates "greater than average" usability. Participant scores on the SUS demonstrated that the PQI has a high degree of usability. Mean usability was calculated at 83.3 (range 72.5-97.5, median 85, sd +/- 9.3). The PQI demonstrated a high level of usability by technical experts for providing feedback and recommendations regarding community health action plans for injury prevention in the U.S. Army. As a result, the PQI may be beneficial as a standard tool for community health improvement planning and consultation throughout the Army Public Health Center.

Assessing Policy Advocacy Choice and Strategy in a Community Health Improvement Plan

SWOT analysis and an eight-item best practice assessment instrument, are utilized to asses intergovernmental public health policy development to advance tobacco free living in a Mid-Western region of the United States. Findings revealed similar patterns across methods and data sources. Compared to effective and tested practices, the tobacco free policy advocacy strategy was successful at both the statewide level and regional level. Agendas were more aligned among community partners for regional initiatives than for statewide initiatives. Also, it was clear that alignment of agendas at the community partnership level was harder when issues were tough and opposition from economic interest was high.

Using an Integrated Conceptual Framework to Clarify Health Problems and Assess A Community Health Planning Process: A Mid-Western USA Case Study

ABSTRACT Within a case study design, this paper clarifies community problems, and assesses a Community Health Improvement Plan development process using a framework of explanatory models and change theories that links the macro social model, the materialistic model, social cognitive theory, theory of fundamental causes, and community organizing theory. Properties of demographic and health status artifacts are consistent with the core constructs in both the macro social and the materialistic models. The constructs in social cognitive theory and the theory of fundamental causes seem to influence program strategies even as socio-economic factors were only minimally addressed. At the organizing level, the Plan excelled in locality development and social planning but was short on social action. The findings suggest a need for social action as a model of practice in solving persistent social and health problems, and for research that investigates if social action practice can predict success in resolving these problems.

Passing a Healthy Homes Initiative: Using Modeling to Inform Evidence-Based Policy Decision Making in Kansas City, Missouri.

Kansas City, Missouri, experiences substantial racial/ethnic health disparities, particularly associated with that city's high level of residential segregation. Among the risk factors for poor health are substandard housing, particularly common in African American neighborhoods, which lead to asthma and therefore to school absences. A 2018 ballot initiative in Kansas City, Missouri, would allow health inspectors to investigate complaints of poor or hazardous conditions in rental housing. Because the Kansas City, Missouri Health Department cannot legally advocate directly for voter support of public health policies, department staff used outside consultants to demonstrate the potential positive impact of environmental initiatives. The Win-Win model provides a standardized, unbiased economic analysis of interventions to help public health officials make informed policy and program decisions and engage in cross-sectoral collaboration. The Win-Win model found that if an asthma home remediation program were provided for almost 7000 low-income children in Kansas City, it would result in 55 000 fewer days of missed school annually among other promising outcomes. The model also showed a $1.67 return-on-investment to local and state government for each dollar spent and a 3-year breakeven point. The results from the Win-Win model were integrated into Kansas City's Community Health Improvement Plan and made available on the Win-Win Project Web site. The proposed law to promote rental inspections passed with 57% of the vote. The model results allowed for an informed, unbiased point of evidence that the health department could present to community groups and elected officials leading up to the vote on the health inspection initiative.

Partnership and participation in a community health improvement initiative

ABSTRACT This paper examines partnerships and participation in a Community Health Improvement Plan (CHIP) in a Mid-Western Region of the United States. Process and survey results reveal significant conformity with locality development and social planning models of community organizing. Partner synergy, and cultural and structural relationships were strong, but democratic participation was limited to the partnership steering committee and excludes the larger community, particularly marginalized populations. There was also very little evidence of social action. These gaps underscore limitations in the CHIP planning and implementation processes, and point to opportunities for growth in future planning and implementation efforts in the region.

NACCHO's Follow-up Assessment of Disability Inclusion Within Local Health Departments.

NACCHO's Follow-up Assessment of Disability Inclusion Within Local Health Departments.

Using Community-Engaged Research to Explore Social Determinants of Health in a Low-Resource Community in the Dominican Republic: A Community Health Assessment.

Previously published community health assessments (CHA) have explored social determinants of health in low-resource, Haitian-majority Dominican communities. The present CHA was conducted in Las Malvinas II, a Dominican-majority low-resource community, and represented a first step for developing a building a healthier community process. A binational community-academic partnership adapted the Centers for Disease Control and Prevention's CHANGE (Community Health Assessment and Group Evaluation) guide to conduct a CHA through community-engaged, mixed-methods research. Data were collected on five community selected public health priorities (i.e., education, sanitation, unwanted pregnancies, chronic disease management, and vaccine-preventable diseases) and community assets through focus groups, interviews with key informants, and a household survey using GIS (geographical information systems) technology. Of all five priorities, unwanted pregnancies and sanitation received the lowest average CHANGE tool ratings for both policies and Systems and Environment. However, data gathered on the five public health priorities reflect the perceived needs and assets of Las Malvinas II, and are equally important in improving the community's health and well-being status. Community members identified as important goals the construction of a primary health clinic, as well as a bigger school, that includes pre-school and high school levels. A coalition emerged from the CHA to address the identified issues. The coalition used CHA findings to develop a community health improvement plan. The establishment of a primary health care center and a bigger school were identified as primary goals.