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

09/01/2005

Overall, 71 percent of the 189 organizations that were aware of HP2010 reported using it in their organization. One-hundred percent of the states12 reported using the initiative compared to 65 percent of local organizations, and 48 percent of tribes. These differences were statistically significant at the p≤.05 level.

In addition to the type of organization, the size of the organizations was correlated with the organization’s likelihood to use HP2010, both in terms of the number of FTEs and the size of the population served. Exhibit 19 shows that larger organizations were more likely than medium and smaller organizations to use the initiative. There were no statistically significant differences among users in terms of geographic location, although there was a slightly higher proportion of users in the South (82%) compared with the West (73%), the Northeast (69%), and the Midwest (62%).

Exhibit 19: Use of HP2010 by Organizational Size

bar chart of fte, and population divided into three categories:large(92%,82%)respectively;medium(73%,72%),respectively; small(49%),58%),respectively

HP2010 users reported the different ways in which they use the initiative at their organization in terms of use for research, collaboration and outreach, and for internal planning. As the data presented in Exhibit 20 demonstrate, there was a significant difference between how the initiatives were used depending on the type and size of the responding organization. Tribes were less likely to use HP2010 for research purposes, and states were more likely to use the initiative for internal planning (p≤.05). The organization’s size, both in terms of FTE and the population served, was also correlated with the ability to utilize HP2010 for different purposes (p≤.05). There were no significant geographical differences.

Specifically, over 80 percent of all respondents reported using HP2010 regularly to guide organizational priorities and as a framework for planning, goal-setting and agenda building. Over 80 percent of responding states and localities reported using HP2010 for building community partnerships, compared to only 67 percent of tribes. Ninety-one percent of states reported using HP2010 as a resource for comparison with organizational data, although less than 70 percent of localities and tribes reported using it for that purpose. Across all organization types, fewer respondents reported using HP2010 for internal spending decisions (< 56%) or for educating new staff (< 65%). See Appendix 3 for the detailed frequencies for organization type, size and census region. Eight organizations mentioned other uses for the initiative at their organization, which included using HP2010 as a model for a state-wide program (n=4), to monitor local progress compared to national figures (n=3), and to guide the organization’s overall mission (n=1).

Exhibit 20: HP2010 Types of Use by Organization Type and Size

bar chart of state, local, and tribal groups divided into three categories:research(90%,90%,55%)respectively;outreach/collaboration(95%,94%,100%),respectively; internal planning(100%),(92%),(90%),respectively

Exhibit 20: HP2010 Types of Use by Organization Type and Size (continued)

bar chart of large, medium, and small groups divided into three categories:research(91%,87%,81%)respectively;outreach/collaboration(100%,95%,85%),respectively; internal planning(100%),(95%),(84%),respectively

Healthy People 2010 users accessed program information in a number of different ways, as shown in Exhibit 21. Both the website and the bound HP2010 volumes were frequently accessed by users at state, local, and tribal health organizations. For localities, the state health department served as a frequently accessed source of information, while federal contacts at HHS were more often utilized by state and tribal users.

During the follow-up telephone interviews, users offered suggestions on ways to improve communications with HHS. Respondents specifically suggested that HHS maintain a HP2010 listserv for users to communicate with HHS and each other. They mentioned the inclusion of new program updates, opportunities, tools, and maybe even a “User of the Month” section to highlight different ways the program is being implemented. Some of the more policy-oriented interviewees also suggested weekly updates from HHS on various legislative and budgetary issues and decisions that could affect local HP2010 activities. Some respondents suggested greater linkages with DATA2010, email newsletters/reports, and more frequent updates of the HP2010 website. Respondents felt that articles in journals and trade newspapers about HP2010 would be useful but that they might not have time to read them. Several respondents suggested that these types of articles might do more to raise awareness than to inform or update current users.

Exhibit 21: Accessing HP2010 Information

bar chart of state, local, and tribal groups divided into six categories:bound doc(92%,85%,62%)respectively;Fed Contacts(50%,3%,32%),respectively; web(92%)(60%)(42%),respectively; state hd,(52%,(8%)respectively;cd-rom(31%,8%,8%),respectively;informal(1%,3%,22%),respectively

The HP2010 initiative was viewed by users as highly relevant. As Exhibit 22 demonstrates, users across type, size, and location rated the initiative between a 3.36 and a 4.33, with a one being “Not Relevant” and a 5 being “Extremely Relevant.” States reported the initiative as significantly more relevant than local or tribal organizations.

Exhibit 22: HP2010 Relevancy

1=Not Relevant
5=Extremely Relevant

Type

Size: FTE

Region

State
(n=43)

Local
(n=83)

Tribal
(n=11)

Large
(n=44)

Medium
(n=67)

Small
(n=22)

Northeast
(n=23)

Midwest
(n=41)

South
(n=41)

West
(n=30)

Mean

4.33

3.82

3.36

4.20

3.79

3.95

4.04

3.88

4.12

3.77

95% Confidence Interval

(4.1-4.5)

(3.6–4.0)

(2.9–3.8)

(4.0-4.4)

(3.6-4.0)

(3.5-4.4)

(3.8-4.3)

(3.6-4.2)

(3.9-4.4)

(3.4-4.1)

The initiative scored slightly lower on a similar scale for effectiveness. Depending on the type of organization, users reported a mean score between 3.09 and 3.67 on the question which asked the degree to which the HP2010 initiative affected the organization’s progress toward its own disease prevention and health promotion goals (Exhibit 23). Looking at the scores across organization type, size, or location, there were no statistically significant differences between the different groups.

Exhibit 23: HP2010 Effectiveness

1=Not Effective
5=Extremely Effective

Type

Size: FTE

Region

State
(n=43)

Local
(n=83)

Tribal
(n=11)

Large
(n=44)

Medium
(n=67)

Small
(n=22)

Northeast
(n=23)

Midwest
(n=41)

South
(n=41)

West
(n=30)

Mean

3.67

3.31

3.09

3.55

3.34

3.45

3.61

3.32

3.66

3.13

95% Confidence Interval

(3.4-3.9)

(3.1–3.5)

(2.6–3.6)

(3.3-3.8)

(3.1-3.6)

(3.0-3.9)

(3.2-4.0)

(3.0-3.6)

(3.4-3.9)

(2.8-3.5)

HP2010 users were asked to select the most useful aspect of the program to the organization. Both states and localities cited the specific health objectives as the most useful aspect, with the overarching program goals ranking second for both groups. Tribes differed significantly (p≤.05), citing the participatory goal setting process more frequently than any other aspect, as seen in Exhibit 24.

Only a minority of users contacted during the telephone follow-up were familiar with the DATA2010 website. Those who used the site characterized it as an easily used and rich data resource. A few users made some suggestions to improve the utility of the site, including more frequent updates, the ability to get regional or community/county figures, and better documentation (e.g. are all rates age-adjusted). When queried about the reasons users do not use the DATA2010 site, local respondents often said that they receive data from their state health departments or that data analysis is taken care of at the individual program offices (e.g. immunization rates in the Office of Child Health).

 

State
(n=43)

Local
(n=81)

Tribal
(n=11)

Exhibit 24: HP2010 Most Useful Aspect

Overarching Goals

35%

33%

27%

Specific Health Objectives

42%

46%

27%

Data Resources

12%

19%

9%

Participatory Goal-Setting Process

7%

1%

36%

Although there were no statistical differences between users based on the organization’s location or size, respondents that reported using HP2010 as a data source or for collaboration and outreach differed from those respondents that do not use the initiative for those purposes. The graphs in Exhibit 25 display these differences, significant at the p≤.05 level. Those reporting to use HP2010 as a data source cited the initiative’s data resources and specific health objectives more frequently. Respondents that used HP2010 for outreach and collaboration valued the initiative’s overarching goals more frequently, placing less emphasis on the initiative’s data resources.

Exhibit 25: HP2010 Most Useful Aspect by Type of Use

bar chart of use as data source(n=115)and do not use as data source, divided into four categories:overarching goals(Use 33%, do not use 38%)respectively;specific health objs(Use 48%, do not use 23%); data resources(Use 16%, do not use 8%); participatory goal-setting,(Use 3%, do not use 31%)

bar chart of use for outreach/collaboration(n=124)and do not use for outreach/collaboration(n=5), divided into four categories:overarching goals(use 35%, do not use 0%); specific health objs(use 46%, do not use 40%); data resources(use 13%, do not use 60%); participatory goal-setting,(use 6%, do not use 0%)

The Healthy People initiative was used for program development by 58 respondents and for program expansion by 54 respondents at all different types of organizations. The types of program activities were diverse, but varied little depending on an organization’s type, size, or location. Exhibit 26 presents the different categories of program activities occurring at responding state, local, and tribal HP2010 user organizations. HP2010 respondents that reported using the initiative for internal planning or outreach and collaboration were more likely to use HP2010 for program development and expansion. This was especially true for those using HP2010 for outreach and collaboration (p≤.01). Exhibit 27 displays these differences.

State

Local

Tribal

Exhibit 26: HP2010 Program Development and Expansion

20 New Programs:

4 – Statewide HP programs/goals

3 – Physical Activity/Obesity prevention

3 – Addressing chronic disease management

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

2 – Tobacco/Risky Behaviors

2 – Oral Health

1 – Community Partnerships

1 – Child Health

1 – Disabilities

34 New Programs:

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

8 – Building community partnerships/partnering with state

7 – Health Disparities

5 – Physical Activity/Obesity prevention

4 – Addressing chronic disease management

1 – Oral Health

1 – Women’s Health

4 New Programs:

3 – Physical Activity/Obesity prevention

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

22 Expanded Programs:

5 – Addressing chronic disease management

4 – Statewide Goals/Planning

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

3 – Physical Activity/Obesity Prevention

2 – Health Disparities

1 – Community Partnerships

1 – Employee Wellness

1 – Environmental Health

1 – Oral Health

26 Expanded Programs:

6 – Physical Activity/Obesity Prevention

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

4 – Health education

3 – Addressing chronic disease management

3 – Child health/immunizations

2 – Environmental Health

2 – Community partnerships

6 Expanded Programs

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

Exhibit 27: Use of HP2010 for Program Development

bar chart of yes and no, divided into four categories:internal use(65%,35%)respectively;no internal use(17%,83%),respectively; outreach use 66%,34%),respectively;no outreach use(0%,100%),respectively

bar chart of "yes" and "no", divided into four categories:internal use(65%,35%)respectively;no internal use(17%,83%),respectively; outreach use(66%,34%),respectively; no outreach use ,(0%,100%),respectively


Sixty-five percent of state users (n=26) reported planning programs specifically around one or more of HP2010’s focus areas or objectives. This was significantly higher (p≤.05) than the 42 percent of local users (n=33) and 27 percent of tribal users (n=3). The states reported using HP2010 objectives as elements in the organization’s strategic planning and goal-setting for various departments and program areas. Local and tribal users cited examples of program planning around focus areas more frequently than key objectives.

Along these same lines, states were significantly more likely (p≤.01) to measure changes in health behaviors or outcomes related to the use of HP2010 at the organization (81%) than their local (49%) and tribal counterparts (45%). This was also true for users in the Northeast and West, who measured changes in health behaviors or outcomes related to the use of HP2010 at the organization more than users in the Midwest and South. This was especially pronounced for Northeast users who reported measuring these changes 82 percent of the time, compared to 52 percent in the Midwest, 50 percent in the South, and 66 percent in the West (p≤.05). Exhibit 28 shows the different methods users were employing to measure changes in outcomes and behaviors related to the use of HP2010 at the organization. Smaller organizations were less likely to conduct new data collections, and small local organizations frequently noted (33%) that they relied on their state health department for data. Many organizations reported using the Behavioral Risk Factor Surveillance Survey as their main source of existing data at the state and local level.

 

 

State
(n=36)

 

Local
(n=41)

 

Tribal
(n=6)

Exhibit 28: Methods of Measuring Change

New outcomes data collection

64%

61%

67%

Qualitative data

33%

37%

33%

Trends in existing data

94%

76%

50%

 

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