About the CHI Navigator

Tools for Successful Community Health Improvement (CHI) Efforts:

Purpose:
The Tools for Successful Community Health Improvement (CHI) Efforts section is designed to help you organize your work for each part of the CHI process and connect you to targeted tools—including guidance, templates, or examples—to help you effectively incorporate key concepts and carry out your approach. This section is intended to serve as a starting point to determine what actions to take and how best to carry out the work. The tools mentioned in this section comprise a select, focused set to help achieve the key concepts.

Please note, this section is not intended to serve as an all-inclusive reference or as a comprehensive beginner’s resource, as many such resources—created by experts in health care, public health, and community development—already exist. See the Additional Tools and Resources section for commonly used overview resources.

Use this section as a quick-start guide to inspire action, rather than a comprehensive step-by-step manual.

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Key Concept Origins:
The key concepts that you will find in the Tools for Successful Community Health Improvement (CHI) Efforts web pages will help guide CHI activities toward greater success. They stem from CHI guiding principles and are drawn from the following sources after careful review and analysis:

• County Health Rankings and Roadmaps
• Georgia Health Policy Center Sustainability Framework
• Improving Community Health through Hospital–Public Health Collaboration: Insights and Lessons Learned from Successful Partnerships (University of Kentucky 2014)
• Primary Care and Public Health: Exploring Integration to Improve Population Health (Institute of Medicine 2012)
• Principles to Consider for the Implementation of a Community Health Needs Assessment Process (Rosenbaum 2013)
• Robert Wood Johnson Foundation Culture of Health Prize Criteria
• Discussions with partners, including hospital and public health organizations

Analysis of the CHI guiding principles also identified the following four tenets to consider throughout the CHI process:

• Work Together
• Engage the Community
• Communicate
• Sustain Improvement Results

Each of these tenets applies to each of the five steps within the County Health Rankings &  Roadmaps Action Cycle (Assess Needs & Resources, Focus on What’s Important, Choose Effective Policies & Programs, Act on What’s Important, and Evaluate Actions).

The key concepts were mapped to an adapted version of the Action Cycle framework. To learn more, visit the Tools for Successful CHI Efforts section.

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About the Tools:

The user-friendly tools in this section are intended to:

• Help you incorporate the key concepts (e.g., how to work collaboratively, efficiently, sustainably) into your CHI efforts.
• Provide you with action-oriented, operational, and practical guidance for each tenet and/or step of the CHI process.
• Connect you to a small group of focused tools as a starting point for working through the key concepts, tenets, and CHI process steps.
• Provide a unique, value-added resource to complement existing CHI tools and tool lists.
• Point you directly to a specific relevant template, or guidance section for quick reference.
• Avoid duplicating comprehensive CHI process guides.

The tools selected are from specified sources using a systematic approach and specific inclusion criteria. As noted elsewhere, Tools for Successful CHI Efforts does not contain an exhaustive list of CHI tools. Instead, the tools in this section have been carefully chosen to provide you with a starting point in line with the key concepts and tenets.

If you find a useful tool that that is not included here and meets the CHI Navigator’s inclusion criteria please email us. We encourage you to visit the Additional Tools and Resources page for other resources that may be suitable to your specific CHI effort(s).

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Sources of Tools:
Primary sources:
The following two websites are widely known for the depth and breadth of their Community Health Improvement (CHI) tools and resources, and serve as the primary sources of tools included in the CHI Navigator:

• Community Tool Box
• County Health Rankings and Roadmaps–Tools and Resources Page

Additional sources include the following:

• Assessing and Addressing Community Health Needs
• Community Health Assessment Toolkit
• MAP-IT
• Mobilizing for Action through Planning and Partnerships (MAPP)
• Practical Playbook

The primary sources above were reviewed by two independent teams of reviewers. Community Tool Box chapters, sections, and toolkits related to each CHI key concept were chosen with guidance from the Community Tool Box team.

Tools and resources referenced on the County Health Rankings & Roadmaps site were identified using a key-term search. Phrases from each key concept were entered into the search box on the Tools and Resources page, and search results were recorded.

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Tools Inclusion Criteria:

Two independent teams reviewed and assessed tools for potential inclusion in the CHI Navigator. They used the following criteria during their preliminary review:

• Operationalizes a key concept; provides the “how to”; is action-oriented.
• Contains straightforward, user-friendly template(s) or sample(s) that can be customized.
• Is easy to access, or to point to, from the CHI Navigator (i.e., the specific relevant tool can be linked to directly).
• Reflects current thinking on the subject matter (i.e., the date when the tool was developed or was last updated was considered, as was whether the tool operationalizes the key concept consistently with current thinking).
• Is freely available online (i.e., there is no fee charged to access the tool).

Once the broader pool of tools was narrowed using the criteria above, the following factors were considered in selecting the final CHI Navigator tool set:

• The strength and usability of the action-oriented description, template(s), or customizable examples, and alignment to key concepts.
• Number of clicks needed to arrive at the specific, relevant section of the tool; the fewer clicks the better.
• Having at least one tool for each key concept, within each tenet or step.
• For each tenet or step, having both informational, narrative tools describing the operationalization of a key concept, and operational tools with tangible features that can be used or applied by the user to carry out a key concept (e.g., a template, checklist, an example).
• Ensuring minimal overlap in content and templates provided by selected tools, thereby keeping the set concise.

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Database of Interventions:

About the Database:
This database allows you to search for evidence-based interventions that use a collaborative approach to community health to address specific, underlying risk factors for the leading causes of morbidity and mortality in the United States. Those factors include tobacco use and exposure, physical inactivity, unhealthy diet, high cholesterol, high blood pressure, diabetes, and obesity.

The interventions profiled leverage cross-sector partnerships for the greatest impact on community health. Findings are grouped by areas of action and impact, including socio-economic environment, physical environment, health behaviors, and clinical care. Implementation of interventions in multiple areas of action can maximize the positive impact on the health and well-being of the broader population.

Read the MMWR Vol. 65, Supplement, No. 2 article for more detailed information about the development of the database.

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Sources of Reviews and Studies:
Reviews (summary recommendations based on systematic review or synthesis of current evidence from multiple studies and other evidence-based sources) and individual studies (scientific evaluation of the efficacy of an intervention in a single study) are drawn from six source databases meeting defined criteria for level of evidence and accessibility. Systematic reviews provide evidence an intervention strategy works, while evidence from an individual intervention shows the particular intervention works. Users match both strategy and individual intervention with the needs, preferences, and resources of their community. Reviews are drawn from the following:

• The Guide to Community Preventive Services (The Community Guide-TCG)
• The Robert Wood Johnson Foundation-funded University of Wisconsin County Health Rankings and Roadmaps What Works for Health site (CHRR)
• The American Heart Association (AHA) Guide for Improving Cardiovascular Health at the Community Level (2013 Update, published in Circulation)

Individual studies were drawn from the following:

• The Agency for Healthcare Research and Quality (AHRQ) Health Care Innovations Exchange
• The Healthy Communities Institute (HCI) Promising Practices Database
• The New York Academy of Medicine (NYAM) and Trust for America’s Health Compendium of Proven Community-Based Prevention Programs

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Criteria for Inclusion:
Interventions had to meet at least one of the following evidence ratings from one of the original six sources in order to be included in this database:

• TCG: “Recommended”
• CHRR: “Scientifically supported” or “Some evidence”
• AHRQ: “Strong” or “Moderate”
• HCI: “Evidence-based”
• NYAM and AHA: All items met the minimal evidence threshold criteria.

Included interventions also described systems-level and/or community-based or interdisciplinary approaches that enhance effectiveness of usual or existing clinical activities, and addressed one or more of the modifiable risk factors or social/economic risk factors of interest for the database.

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Filters/Tags:
Filters/tags for the database are described in a glossary available here . Filter categories include the following:

• Target Risk Factors
• Target Populations
• Target Outcomes/Indicators
• Intervention Settings/Locations
• Intervention Types
• Assets: People or Organizations
• Assets: Physical or Virtual Space

All reviews and individual studies are tagged with all applicable filters. In addition, all individual studies are linked to related review areas that they exemplify.

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User’s Guide

• Select filters of interest: As you select filters, results will appear on the right side of the screen. The list of results changes with each selected or de-selected filter.
• Select high-priority risk factor(s): You may wish to begin by selecting the risk factors that you would like to address.
• Select additional filters: You may choose as many filters within a given category as applicable. Adding filters within a category increases the number of results returned, as the search results include reviews and studies related to ANY of the selected filters within a category.
• Selecting filters from multiple filter categories (e.g., target risk factor and intervention type): Filters selected from multiple categories will help narrow the search results, as results listed must be tagged with at least one selected filter from chosen categories.
• Filter results: You can further narrow your search by selecting either reviews, or individual studies, or an area of action.
• For more information on a review or individual study: Click on the title and a new page will open, including a direct link to the source database and to the specific page for that intervention.

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