Assessment of the Uses and Users of Healthier US and Healthy People 2010. Use of the Initiative

09/01/2005

Of the 124 organizations aware of the HealthierUS initiative, slightly less than half, or 47 percent, reported using the initiative. Again, distinct differences existed in the likelihood of using the initiative in terms of the type, size, and location of the organization. Twenty-seven states, or 71 percent of states aware of the initiative, reported using HealthierUS at their organization. However, only 38 percent (n=28) of local health organizations and 31 percent (n=5) of tribal organizations aware of the initiative reported using it. States were significantly more likely to use the initiative compared to their local and tribal colleagues (p≤.05).

Furthermore, the size of the organization led to a statistically significant difference in the likelihood that the organization would use HealthierUS. Two-thirds of the large organizations (as measured by number of FTEs) and slightly less than half of the medium organizations (47%) reported using the initiative, compared with only a quarter of the small organizations. This same pattern holds true when examining differences by size of the respondent organization in terms of the population it serves, with 53 percent of all large and medium organizations using the initiative compared to only a quarter of the small organizations.
There were also a few significant geographical differences among all of the respondents using HealthierUS. Users in the South were significantly more likely to use the initiative compared with those users in the Midwest and West (p≤.05).

Exhibit 7: Geographical Differences in HealthierUS Use

bar chart: northest 40%(n=27),midwest 30%(n=42),south 60%(n=31), west 38%(n=24)

The questionnaire contained a question for all HealthierUS users to describe how the initiative is used at their organization.11 The question included eight response options classified as either use for internal planning or for collaboration and outreach, as well as a free-text field for other uses. Respondents reported using HealthierUS for outreach and collaboration more often than for internal planning at the organization. Exhibit 8 displays the prevalence of each use according to the type of organization. The table indicates that HealthierUS was used for a variety of purposes among the respondents. However, use of the initiative for guiding spending priorities or for educating the medical community was low. Very few respondents, only seven, offered alternative uses in the free-text field. These included, program integration (n=3), collaboration with other agencies (n=2), and community planning (n=2).

There were very few statistically significant differences according to the organization’s size or regional location. Medium-sized organizations used HealthierUS for internal planning more often than small or large organizations. Respondents in the West used HealthierUS more frequently for outreach and collaboration, but less frequently for internal planning than respondents in other areas of the country. Appendix 3 includes the detailed frequencies of use according to organizational size and location.

Three out of the five Steps grantees reported using HealthierUS for internal planning, and 4 used it for outreach and collaboration. None of the grantees used the program to guide spending decisions at their health department. Three used the initiative for internal planning, including collaboration with other statewide health initiatives and program offices. Four of the five grantees (80%) used HealthierUS to promote prevention and raise public awareness. Sixty percent used it for building community partnerships, and 40 percent used it for guiding priorities, training new staff, and outreach to the medical community.

Exhibit 8: Uses of HealthierUS

 

State

Local

Tribal

N

%

N

%

N

%

Internal Planning

20

74

23

82

4

80

Use as a guide to set spending priorities

2

8

13

52

3

60

Use as a framework for planning, goal-setting, or decision making

19

70

20

80

3

75

Collaboration/Outreach

25

93

26

96

4

80

Guide priorities for the organization

15

56

19

83

4

80

Mechanism for building community partnerships for promoting health

22

81

23

92

3

60

Learning tool for new staff

16

59

12

50

2

67

Raise public awareness

22

81

22

88

4

80

Improve the quality of medical care by educating medical community

8

30

11

48

4

80

Tool to promote utilization of preventive services

18

67

21

78

4

80

HHS provides a number of mechanisms for users to access HealthierUS program information. Exhibit 9 shows the proportion of state, local, and tribal respondents that reported utilizing each method. As the graph shows, states relied most frequently on the website, while local health organizations looked toward their state health department, and tribes to their contacts at HHS. During the follow-up telephone interviews, users indicated they were unsure about who to contact at HHS for questions or other implementation concerns. Thus, several users suggested that the website offer names and contact information for staff members at HHS. Users also suggested including links for funding opportunities open to state, local, and tribal health organizations associated with disease prevention and health promotion activities.

Regional health administrators appear to be an underutilized source of information. Only seven HealthierUS users reported their RHA as an information source. Data collected during the follow-up telephone interviews confirm this finding. Respondents typically did not have a clear understanding of who specifically their RHA was, as well as who they could contact from HHS regarding HealthierUS and HP2010. This did not appear to differ between state and local users, and even Steps grantees stated no contact with the RHA regarding HealthierUS and HP2010, though some reported interaction with their RHA on other projects. After stating that their organization had received no assistance from their RHA regarding HealthierUS and HP2010, one respondent was asked about how useful that type of contact might be. The respondent replied saying, “On other initiatives, we have worked with the RHA and it’s been very productive. We were one of the pilot sites for [another HHS] initiative and the folks from Region 2 were very helpful to us.” “They came out and were very supportive of us. They were a great morale boost…”

Another respondent stated that the only contact they had received from their RHA was to confirm contact information for the HP2010 person in the state. The respondent went on to say, “I think personal contact with state coordinators has gone down the tubes. When Secretary Thompson created HealthierUS, I became very confused as to whether that meant HP2010 was gone. When that happened, my personal contact with HHS precipitously dropped. There were less communications coming. I think if they could restore it to the way it was, that would be good. I do think personal contact has gone by the wayside.” When asked about contact with the RHA regarding HP2010, that respondent said “…They don’t ever respond. I told them that what they ought to do is to convene states in the region and talk about how states were doing with HP2010 and how it was being implemented, and what we could learn from one another but there has been no invitational meeting set up….there’s no personal contact.”

Another state respondent did not even know what an RHA was and stated, “I don’t even have a contact person and when we do have questions, it’s hard. Once in a great while, we’ll get a phone call, but besides that I don’t know how to find someone. I didn’t know who to send my report to.” Only one local user, participating in a state Steps grant, had any contact with their RHA and most local users did not know what an RHA was. All the tribal users relied on Indian Health Services for this type of support, so therefore did not utilize their RHA. Many respondents discussed their desire for more regional meetings with other health departments to learn more about best practices and regional health concerns.

Exhibit 9: Accessing HealthierUS Information

bar chart:website-state(90%),local(65%),tribal(39%);state HD-local(72%),tribal(19%);HHS-state(61%),local(60%),tribal(59%);RHA-state(10%),local(11%),tribal(0%);Informal-state(11%),local(10%),tribal(19%); other-state(29%),local(2%),tribal(0)

Overall, HealthierUS users considered the initiative relevant to the work performed at their organization. Exhibit 10 displays the mean scores and confidence intervals for the question that asked users to note the relevancy of HealthierUS to their work, with one being “Not Relevant,” and a five being “Extremely Relevant.” Mean scores fell between 3.60 and 4.19 depending on the type, size, or location of the organization, however, there are no statistically significant differences as seen in the overlapping confidence intervals. Steps grantees did not differ either, with a mean score of 3.6 and a range of 3.0 – 5.0.

Exhibit 10: HealthierUS Relevancy

1=Not Relevant
5=Extremely Relevant

Type

Size: FTE

Region

State
(n=27)

Local
(n=28)

Tribal
(n=5)

Large
(n=24)

Medium
(n=28)

Small
(n=7)

I
(n=12)

II
(n=16)

III
(n=21)

IV
(n=10)

Mean

3.85

3.75

3.80

3.75

3.82

4.14

3.75

4.19

3.62

3.6

95% Confidence Interval

(3.5–4.2)

(3.4–4.1)

(2.8–4.8)

(3.3-4.2)

(3.5-4.2)

(3.6-4.7)

(3.2-4.3)

(3.9-4.5)

(3.2-4.1)

(2.9-4.3)

Users were also asked to identify the most useful aspect of the HealthierUS initiative to the organization. Media campaigns, promotion of physical activity, and promotion of preventive health were cited most frequently by state and local users. Eighty percent of the five responding tribal users selected the promotion of physical activity as the most useful aspect, with only one tribal user selecting the promotion of preventive health (see Exhibit 11 below). Steps grantees responded similarly to other state users with two of the five (40%) choosing the promotion of physical activity, and the remaining three selecting media campaigns, promotion of preventive health, and a free-text selection of program integration across the department. No statistically significant differences existed between users based on organization size or regional location. However, respondent organizations that cited use of HealthierUS for internal planning purposes differed significantly from organizations that did not use the initiative for that purpose. As seen in Exhibit 12, respondents that used HealthierUS for internal planning cited the promotion of preventive health as the most useful aspect more frequently, while those respondents who only used the initiative for outreach and collaboration cited the media campaigns more frequently (p≤.05).

 

State
(n=27)

Local
(n=27)

Tribal
(n=5)

Exhibit 11: Most Useful Aspect of HealthierUS

Media Campaigns

26%

22%

0%

Promotion Physical Activity

26%

30%

80%

Promotion Nutrition

4%

4%

0%

Promotion Healthy Choices

7%

15%

20%

Promotion Preventive Health

26%

30%

0%

Exhibit 12: Most Useful Aspect of HealthierUS by Type of Use

bar chart:media-internal planning(18%),non-internal planning(45%);physical activity-internal planning(32%),non-internal planning(36%);nutrition-internal planning(5%),non-internal planning(0);healthy choices-internal planning(9%),non-internal planning(18%); preventive health-internal planning(36%),non-internal planning(0)-

Forty-four percent of HealthierUS users (n=25), including two Steps grantees, reported using the initiative to develop new programs such as a partnership with community-based organizations for nutrition education, and 26 users reported expanding existing programs as a result of using HealthierUS at their organization. Several HealthierUS users also reported planning programs intentionally around one or more of the HealthierUS pillars (physical activity, nutrition and diet, preventive health, and healthy choices).

Those respondents that reported using HealthierUS for collaboration and outreach at their organization were more likely to use the initiative for program development or expansion (p≤.01). Seventy percent of users engaged in outreach and collaboration activities used the initiative for program development or expansion, compared to none of those users not engaged in outreach and collaboration.

There were no statistical differences between users’ likelihood to develop or expand programs based on HealthierUS depending on their type, size, or location. Furthermore, the types of program activity showed little variability across these dimensions. Exhibit 13 describes the types of program development occurring at state, local and tribal respondent health organizations as a result of HealthierUS.

State

Local

Tribal

Exhibit 13: HealthierUS Program Development

8 New Programs:

3 – Physical Activity/Obesity prevention

2 – Steps to a HealthierUS grants

2 – Building community partnerships

1 – Addressing health disparities across chronic disease programs

14 New Programs:

6 – Prevention (CVD, Diabetes, Asthma, etc)

3 – Building community partnerships

3 – Physical Activity/Obesity Prevention

2 – Tobacco/Risky Behaviors

3 New Programs:

1 – Physical Activity/Obesity prevention

1 – Women’s Health

1 – Prevention (CVD, Diabetes, Asthma, etc)

11 Expanded Programs:

5 – Increase collaboration across program areas and localities

3 – Physical Activity/Obesity Prevention

1 – Employee Wellness

1 – Tobacco/Risky Behaviors

1 – Women’s Health

12 Expanded Programs:

4 – Physical Activity/Obesity Prevention

3 – Tobacco/Risky Behaviors

3 – Prevention (CVD, Diabetes, Asthma, etc)

2 – Increase collaboration across program areas

3 Expanded Programs

3 - Prevention (CVD, Diabetes, Asthma, etc)

Users in all types and sizes of organizations reported evaluating the use of HealthierUS at their organization by measuring changes in health behaviors or outcomes related to HealthierUS activities. Overall 37 users, 63 percent, reported measuring change using existing data or new data collections. There were no statistically significant differences between different types or sizes of organizations. Exhibit 14 displays the methods different types of organizations were employing to measure change.

 

State

Local

Tribal

Exhibit 14: Methods to Measure Changes from HealthierUS

New outcomes data collection

71%

59%

75%

Qualitative data

35%

41%

25%

Trends in existing data

100%

71%

50%

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