NORC Final Report: Healthy People User Study. Non-Users of the Initiative

03/28/2010

Non-users of Healthy People 2010 (n=73) were almost entirely local and tribal health organization respondents; however two HP Coordinators did indicate their organizations/agencies did not use Healthy People 2010. In reviewing demographic information on the organizations/agencies that do not use Healthy People 2010, 44 percent of small, 31 percent of medium, and 22 percent of large organizations/agencies were found to be non-users of Healthy People 2010. Additionally, 47 percent of respondents in the Northeast, 27 percent of respondents in the Midwest, 19 percent of respondents in the South, and 40 percent of respondents in the West were non-users of Healthy People 2010.

Non-users were also given the opportunity to describe through specific answer options as well as through “free-text” fields the barriers that prevent them from using the initiative. Exhibit 21 displays the distribution of responses of potential barriers listed on the questionnaire. As was true in 2005, the most frequently cited barriers relate to organization/agency issues, such as resources and competing priorities. However, nearly 60 percent of non-users cited a lack of implementation guidance as a barrier to use.

Notably, the percentages of organizations/agencies reporting each type of barrier have greatly decreased from 2005, with the top five leading barriers showing a statistically significant decrease. For example, in 2005, 93 percent of non-users reported lack of buy-in from decision makers as a barrier that prevented them from using the initiative, compared to only 40 percent in 2008. Likewise, the percentage of non-users who reported competing priorities as a barrier decreased from 93 percent in 2005 to 67 percent in 2008. Issues related to the Healthy People initiative itself have also decreased as barriers to use. In 2005, 63 percent of respondents indicated that “too much material” was a barrier. This percentage has gone down to 39 40 percent in the 2008 User Study. Similarly, the percent reporting that lack of guidance on how to implement as a barrier to use decreased from 76 percent in 2005 to 57 56 percent in 2008.

  2005 User Assessment 2008 User Study

Exhibit 21: Healthy People 2010 Non-User Barriers

Issues Related to Organization/Agency: Insufficient resources available*

96%

86%

Competing priorities *

93%

67%

Lack of buy-in from decision-makers*

93%

40%

Issues Related to Healthy People Initiative: Lack of guidance on how to implement*

76%

56%

Too much material*

63%

40%

No data to track objectives

Not asked

34%

Too close to end of timeframe

Not asked

14%

Don’t agree with HP2010 priorities

3%

3%

Too little material

12%

0%

* Indicates that 2005>2008, p≤.05

Further information regarding barriers to use was gathered through respondents’ answers to questions about the number of focus areas and objectives in Healthy People 2010 (Exhibit 22). Both of the HP Coordinators who were non-users of Healthy People 2010 indicated that there were too many focus areas and objectives. Forty-six five percent of the local and tribal health organizations had no opinion about the number of focus areas, while 30 31 percent said there are too many, 19 18 percent said there is an appropriate number, and one respondent reported too few focus areas. Respondents felt similarly about the number of objectives; 50 51 percent had no opinion, 29 28 percent reported too many, 14 percent said it was the appropriate number, and 3 percent reported too few. When asked about the organization of objectives in Healthy People 2010, 60 percent had no opinion, 18 percent indicated reorganization would be useful, and 17 16 percent reported it is appropriately organized.

  Focus Areas Objectives

Exhibit 22: Non-Users’ Opinions on Number of Focus Areas and Objectives (Local and Tribal Health Organizations)

Too many 31% 28%
Appropriate number 18% 14%
Too Few 1% 3%
No Opinion 45% 51%

To gather a more complete understanding of how Healthy People could better meet the needs of its target audiences, non-users were asked to specify which framework(s) their organization/agency does use to set health objectives. Tribal health organizations reported reliance on tribal council strategic planning and IHS priorities. Two tribal health organizations specified the Indian Health Services Manual as a framework used by their organization/agency to set health objectives. Local health organizations cited community assessments and community health improvement plans as well as Board of Health Guidelines, the Public Health Competency Handbook, the United Health Care Foundation Index, the Public Health Core Priorities, and NACCHO’s protocol for assessing community excellence in environmental health. Non-users were also asked if they felt Healthy People 2010 was lacking in some way, and 19 percent indicated they did. Specifically, these non-users cited a lack of funding for implementation and follow-up, and non-applicability to local and small jurisdictions as ways in which Healthy People 2010 was lacking.

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