In the 2008 User Study input from tribal health organizations was expanded to include a larger number and a greater mix of tribal health organizations, thus increasing the precision and reliability of the 2008 findings for this sample type. Tribal health organizations indicated a higher rate of awareness of Healthy People 2010 in 2008 than in 2005. However, this awareness did not translate into increased use of the initiative. This suggests that the aforementioned HHS outreach efforts were successful in increasing knowledge about the initiative but there remains a need for resources and tools to help translate this knowledge into action among this target audience.
Furthermore, responses from the tribal health organization sample indicated that the 2005 conclusion that tribes use Healthy People in a manner uniquely to that of state and local organizations/agencies was affirmed. Tribal health organizations cited the overarching goals as the most useful aspect of the initiative; an aspect the other respondent types considered the second most useful. Tribal health organizations were also the only respondent type for which Healthy People 2010 has resulted in the development of new programs and expansion of existing programs for a majority of the respondents, and were more likely than the other respondent types to report that they plan programs intentionally around the Healthy People 2010 objectives. Additionally, tribal health organizations reported the highest degree of relevance between the Healthy People 2010 objectives and the organization’s work.
These findings are particularly interesting for two reasons. First, they confirm that tribal health organization users experience Healthy People in a different way than state and local organizations/agencies. Recognizing this unique use of Healthy People may enable HHS to better respond to the needs of tribal health organizations. Tribal health organizations may be a constituent group that is very ready to use Healthy People but, they also need more targeted assistance for developing and executing implementation plans, identifying what data sources are available to them, and determining how the existing Healthy People objectives can be made applicable to their organization/agency.
Second, the results suggest that state and local health organizations use Healthy People in a way that builds on previous, established efforts. This is an important note for the implementation of Healthy People 2020, as HHS may need to consider implementation campaigns that will inform users of new ways of incorporating Healthy People into their work, rather than having users rely only on their previous experiences with Healthy People. For example, in a follow-up discussion, one local user of Healthy People 2010 stated, “You have to take the book for what it is. It gives baselines, tells you where you need to be and where you are in comparison.” Like many state and local users, this respondent’s organization/agency has been utilizing Healthy People 2010 as a benchmarking tool, with less utilization for program planning or expansion.
The results gathered from the tribal health organizations were instrumental in providing information on the unique tribal health organization uses of Healthy People, however additional insights on the tribal health community’s relationship with Healthy People was gathered from the responses provided by MTAHB. More than three-quarters of these MTAHB were aware of Healthy People 2010and, as was true for state organizations, 100 percent of the MTAHB that were aware of Healthy People 2010 reported use. This high degree of usage suggests that MATHB may be viable networks through which to disseminate information and increase use of Healthy People 2010 among tribal groups. This finding validates IHS’s conclusion that these boards may be a useful mechanism for working and communicating with tribal health organizations.
Follow-up discussions with MTAHB as well as with tribal health organizations provided additional information on how the two sample types interact and how Healthy People can better meet the needs of tribal health organizations. In conducting discussions with one MTAHB that does use Healthy People 2010, and one that is not aware of the initiative, we found that the MTAHB’s role in tribal health varies depending on the board’s and tribe’s structures. The MTAHB using Healthy People 2010 was highly involved in the tribes’ health program planning and implementation. The respondent explained that the MTAHB “works with tribes to: do community assessments and needs assessments, locate resources, funds, and training opportunities, and implement programs in each local community. [The MTAHB] provides overall coordination and management, as well as technical assistance - taking on the administration load, and letting tribes go to work.” In contrast the MTAHB unaware of Healthy People 2010 explained that each tribe conducts its own health programs, and the board serves as more broad oversight. This variation in roles indicates that outreach to tribal health organizations can be complex, but communication to MTAHBs can be vital for reaching them.
The 2008 User Study was also expanded to include a second state sample, Chronic Disease Directors. Though not directly involved with Healthy People this is a position within the state agency that is likely to be impacted by Healthy People goals. The results of the study indicate that information regarding the Healthy People initiative is in fact getting to these individuals—with 98 percent of them reporting awareness of the initiative and 100 percent of those who were aware reporting use. Perhaps not surprising, the responses for the Chronic Disease Directors did not substantially differ from HP Coordinators on any question. These results suggest that knowledge of the initiative is organization-based, not role-based at the state level. Given the similarity of their user profile future studies of Healthy People use may eliminate the Chronic Disease Director sample for reasons of cost.
Finally, the results of the current study can be helpful to policymakers in clarifying which aspects of the Healthy People initiative are most useful to various constituent groups. Specific aspects of Healthy People 2010 considered most useful varied by respondent type. HP Coordinators and Chronic Disease Directors cited that the most useful aspect of the initiative was its identification of specific health objectives. MTAHB reported leading health indicators as most useful, and tribal health organizations cited overarching goals as most useful. Local health organizations further differed from the other respondent types by indicating that the leading health indicators and data resources were the most useful aspects of Healthy People 2010. These results suggest a call for a variety of outreach and support efforts, while also emphasizing the diverse needs of users, to be met by Healthy People 2020.