Assessment of the Uses and Users of Healthier US and Healthy People 2010. Barriers and Recommendations

09/01/2005

The questionnaire asked HealthierUS users to think about issues that might prevent the organization from using the initiative more. The response options were broken down into two categories; those related to the program itself, and those related to the organizations. As Exhibit 15 shows, users overwhelmingly cited barriers at the organization. Only a small minority of respondents, less than 4 percent, cited problems with the initiative’s priorities, and less than 50 percent cited problems with the amount of material. However, a large proportion of users reported that the initiative lacks implementation guidance. Tribes and small organizations in terms of FTEs were more likely to report the lack of implementation guidance as a barrier (p≤.05).

Most users (> 80%) reported a lack of financial and staff resources as a barrier to greater implementation of HealthierUS at their organization. This included four out of the five users receiving Steps grants. Tribes were the only group to have a majority of users report a lack of buy-in from primary decision makers as a major barrier (80%). Competing priorities were also frequently reported, especially for small organizations (p≤.05).


Exhibit 15: HealthierUS Barriers to Implementation

i

bar chart of state, local, and tribal groups divided into four categories:insufficient financial resources(95%,80%,98%)respectively;insufficient staff resources(82%,82%,98%),respectively; lack of buy-in(13%),(19%),(77%),respectively; competing priorities,(76%),(55%),(97%).

i

bar chart of state, local, and tribal groups divided into four categories:insufficient financial resources(95%,80%,98%)respectively;insufficient staff resources(82%,82%,98%),respectively; lack of buy-in(13%),(19%),(77%),respectively; competing priorities,(76%),(55%),(97%).


The questionnaire also afforded users with several opportunities to provide suggestions for ways HHS could improve HealthierUS to encourage greater utilization. Exhibit 16 shows how different forms of technical assistance (TA) might be valued at state, local, and tribal health organizations. Looking across the different types of organizations, best practices and implementation tools were in high demand (> 55%). Examples of how others are using HealthierUS was the only form of TA selected by a majority of Steps grantees.

 

State (n=27)

Local (n=27)

Tribal (n=5)

Exhibit 16: HealthierUS Technical Assistance

Translating HealthierUS into action

70%

56%

60%

Prevention guidelines

59%

48%

60%

Examples of how others are using HealthierUS

78%

63%

60%

HHS contacts

41%

26%

20%

Curriculum materials

56%

52%

100%

Data collection tools

52%

63%

80%

Data evaluation tools

56%

70%

100%

Using HealthierUS for partnering/coalition building

37%

30%

40%

Examples of programs demonstrating progress toward HealthierUS areas

56%

44%

20%

Users were also given the opportunity to provide recommendations to HHS on ways it could encourage progress toward the HealthierUS goals. Two-thirds of respondents commented on the need for more financial resources at the state, local, and tribal levels. Four respondents from state and local organizations, including a Steps grantee, commented that if HHS cannot provide direct dollars, the department should coordinate training sessions and/or provide implementation tools and products that can be easily adapted to existing programs. Five respondents commented that implementation could be improved if HHS would clarify the relationships between HealthierUS, HP2010, and other programs. Somewhat similarly, three respondents noted that formal partnering agreements between HHS, IHS, state, local, and tribal health organizations would help ensure that all the key stakeholders are working together and efficiently.

This theme re-emerged during the follow-up telephone interviews when users were asked the general concluding question, “Do you have any other suggestions or comments for HHS on anything we haven’t covered?” Respondents who were HealthierUS and HP2010 users remained confused regarding how to link the two programs. Many were confused regarding the overlap and wondered how to link the goals of both programs effectively and efficiently. One HealthierUS and HP2010 user with a Steps grant said, “We really need linkages between HealthierUS and HP2010. I’m not sure if those linkages are as clear right now as they could be. It would be nice if [HHS] identified a contact person [for HealthierUS] in each state, similar to the HP2010 contact person.” The same respondent went on to say, “Our HealthierUS [program] is primarily through the Steps to a HealthierUS program. Because those are smaller scale, we can certainly shoot for the goals of HP2010 in those communities. I’m not really aware of any major coordination between the two.” One state user said that the HealthierUS and HP2010 programs in their state were not coordinated and wondered, “Why are we all working separately from each other?” When asked how their locality coordinates its HealthierUS and HP2010 programs, a local user stated that “There is overlap, but I don’t understand the differences, to me it’s one big set of information.” However one state user indicated that their state HP2010 program integrated HealthierUS as another aspect of its overall state 2010 initiative and did not find a conflict in that.

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