Frequently Asked Questions

General

Infographic

Tools for Successful CHI Efforts

Database of Interventions

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General

Q: What is the purpose of the CDC Community Health Improvement Navigator (CHI Navigator)?
A: The CHI Navigator was created to support hospitals, health systems, public health, and other community organizations and stakeholders that are interested in improving the health of their communities. Motivated largely by the Internal Revenue Service requirement for tax-exempt hospitals to conduct triennial Community Health Needs Assessments (CHNAs) and develop implementation strategies, the CHI Navigator is intended to provide a unifying framework and supportive tools to enable collaborative CHI work. The case examples, infographicCdc-pdf , and tools provide support for action via examples from other partnerships, a storyline for improving health, and select resources that support the CHI process. By providing examples of proven interventions, the Database of Interventions can help move partnerships from planning to implementation and action, and in the end, to improved community health and well-being.

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Q: What does the term “community health” mean? Is it the same as “population health”?
A: These terms have distinct but related meanings. In the context of the CHI Navigator, community health is “a multi-sector and multi-disciplinary collaborative enterprise that uses public health science, evidence-based strategies, and other approaches to engage and work with communities, in a culturally appropriate manner, to optimize the health and quality of life of all persons who live, work, or are otherwise active in a defined community or communities” (source: Goodman RA, Bunnell R, Posner SFExternal ).

Population health is often defined as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group” (sources: Kindig D, Stoddart, GExternal and Kindig, DAExternal ). This definition explicitly emphasizes health outcomes. The reference to the distribution of outcomes within a group implies the need to consider why differences exist, including those in patient populations or in communities, but does not specify how to achieve population health.

For the purposes of the CHI Navigator, community health includes approaches that lead to optimal health outcomes for the whole community with a particular emphasis on reaching vulnerable/underserved populations that experience the highest burden of disease. This definition includes addressing who should be involved, and how to achieve health and quality of life in communities (see definition above).

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Q: Who should use the CHI Navigator?
A: As noted above, organizations and individuals interested in improving the health of their communities, and specific populations within those communities, will find the CHI Navigator contains a wealth of resources to support their collaborative efforts. Following are descriptions of Navigator components and who might find them useful:

  • InfographicCdc-pdf : Stakeholders or partners engaged in CHI can use this storyline as an educational tool or roadmap to ensure a common starting point.
  • Making the Case for Collaborative CHI : These examples, of health systems successfully collaborating with community partners to improve the community’s health, can be used to educate decision makers within the health system, and others, of the multiple benefits of collaborative vs. independent approaches.
  • Database of Interventions and Tools for Successful CHI Efforts : Staff of organizations who are on the frontlines working to improve community health can use these resources to strengthen their efforts and improve their chances of success.

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Q: The CHI Navigator seems focused on hospitals. Are hospitals expected to be the funders or to serve as the backbone organization for CHI efforts?
A: Improving the health of a community takes the support and participation of multiple organizations and stakeholders from across the community. Hospitals are not expected to do this work alone or to serve as the sole funder. However, one of the key goals of the Navigator is to support hospitals in addressing the social determinants of health, those factors that impact patients with complex disease burdens and cost hospitals the most. CHI efforts offer a tremendous opportunity for hospitals to position themselves within a health system that is based on value and outcomes more than on the volume of services provided. By collaborating with other organizations that support or conduct community health assessments, hospitals can maximize their resources and efforts for greater impact on health and well-being. This brief from the New York Academy of MedicineCdc-pdfExternal provides examples of the complementary roles of various sectors, including health care, public health, and community partners.

Regarding a backbone organization, ideally hospitals, working with community stakeholders and other organizations, can determine a structure that benefits all who are working to improve community health.

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Q. How does the CHI Navigator relate to other CDC tools for Community Health Needs Assessments or Community Health Improvement?
A. CDC offers and supports a variety of web-based tools supportive of collaborative community health improvement. These tools have some commonalities, as well as unique and complementary strengths. Some contain content more specific to a particular target‎ audience, such as health departments, hospitals, community members, or community developers. The tools also vary in purpose, design, and intended use.

Unique features of the CHI Navigator include the infographic, hospital/health system examples‎ of collaboration with external stakeholders, key concepts to guide efforts and a targeted selection of tools for getting started on each, quotes from the Internal Revenue Service Final Rule on Community Health Needs Assessments for Charitable Hospitals, and a Database of Interventions that Work.

Other complementary tools for CHI are also available from CDC on www.cdc.gov . Tools that CDC programs have supported on other sites, such as communitycommons.org, are also available. Many of these tools are referenced at specified steps in the CHI Navigator.

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Q: If I am new to community health improvement (CHI) and the community health needs assessment (CHNA) process, where should I start?
A: We suggest first reviewing the infographicCdc-pdf , an educational tool about the storyline and roadmap for improving health.

Next, review the framework shown on Tools for Successful CHI Efforts , and apply it to your initial CHI planning efforts. Keep in mind that the tenets “Work Together, Engage the Community, Communicate, and Sustain Improvement Results” should be addressed before embarking on the five-step CHI process, and should be maintained throughout the CHI effort.

The Tools for Successful CHI Efforts section is not intended to serve as an all-inclusive reference or as a comprehensive beginner’s resource. Many such resources—created by experts in health care, public health, and community development—already exist. See Additional Tools and Resources for some of the more commonly used guide resources.

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Q: Where can I find more information on indicators or potential data sources to assess my CHI effort?
A: Please see Additional Tools and Resources for select sources of data and health indicators.

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Q: Is there a mobile app that I can download for this site?
A: The CHI Navigator is not currently available as a mobile app; however, portions of the CDC web site—including the CHI Navigator—are mobile friendly.

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Infographic

Q: What is the purpose of the infographicCdc-pdf?
A: This graphic provides a visual storyline for improving health and is intended as an educational tool to provide a common starting point for partners and spur dialogue among partner organizations.

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Q: What is the source of the proportions used in the “Know What Affects Health” pie chart?
A: The proportions come from the County Health Rankings and Roadmaps What Works for HealthExternal model of what influences the health of a community. The model depicts their estimates of the relative influences of modifiable factors on health outcomes. Genetics are not included because they are not modifiable. For more information on methodology, click hereCdc-pdfExternal.

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Q: The infographicCdc-pdf’s map implies that CHI should focus on geographic areas of greatest need rather than on populations of greatest need. Why?
A: Populations of greatest need—individuals with complex health issues who account for a large share of health care spending—frequently cluster together in certain geographic areas. These areas often have higher levels of poverty and other determinants of health. Thus, addressing root causes of health problems in such areas can lead to a tremendous impact on health outcomes and a significant reduction of health expenditures (source: Robertson TM, Lofgren RPExternal ).

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Q: How did you decide how to organize the Four Action Areas? Why are socioeconomic factors listed first?
A: In the CHI Navigator, interventions are grouped according to their influence on the modifiable factors that impact health (similar to the County Health Rankings & Roadmaps model). Research suggests that efforts addressing socioeconomic factors—such as housing, education, income, or social support—increase health equity and have the greatest positive impact on the overall health of the population. Hence, socioeconomic factors are listed first.

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Q: Is there additional information on different CHI approaches beyond what is in this graphic?
A: You can find various CHI approaches and specific suggested interventions by using the Database of Interventions. For information on the “how to” of CHI, please visit Tools for Successful CHI Efforts, especially Choose Effective Policies and Programs and Act on What’s Important.

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Tools for Successful CHI Efforts

Q: What is the purpose of the CHI Navigator Tools for Successful CHI Efforts section?
A: The Tools for Successful CHI Efforts section provides key concepts to consider in each part of the CHI process and highlights select tools to help you effectively carry out your approach. This section is intended to serve as your starting point, helping you determine what actions to take and how to carry out the work, by:

  • Providing user-friendly tools that offer guidance that incorporates key concepts.
  • Including tools with action-oriented, operational, and practical guidance for each tenet or step of the CHI process.
  • Pointing users directly to relevant sections or templates, to facilitate efficient identification of appropriate guidance.
  • Identifying a select group of unique tools relevant to the key concepts, tenets, and CHI process steps.

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Q: How can I most effectively use the Tools for Successful CHI Efforts to benefit my CHI work?
A: Review the framework shown on Tools for Successful CHI Efforts. Then, select a tenet or step from the menu below and review the key concepts (i.e., actions to take) and tools to help address the key concepts. The key concepts can serve as a readiness check to increase your chances for success, and help in identifying tools for use in your CHI efforts.

For best results, we suggest starting at “Work Together.” Review the key concepts for the four cross-cutting tenets and the key concepts for the five-step CHI process. If your CHI efforts are in progress, you can jump directly to the relevant tenet or step most closely aligned with your current activities and refer to other tenets and steps as needed as you carry out your CHI process.

Ideally, the tenets of “Work Together, Engage the Community, Communicate, and Sustain Improvement Results” should all be addressed before embarking on the five-step CHI process, and maintained throughout the CHI effort. If your CHI efforts are already underway, reflect on how you are addressing the four tenets and consider adjusting your plans to incorporate the related key concepts throughout the rest of your CHI process.

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Q: The framework shown in this section seems similar to the County Health Rankings & Roadmaps Action Cycle. Is there a difference?
A: The CHI Navigator builds on the well-known Action Cycle by incorporating a set of cross-cutting tenets and adding key concepts throughout the organizing framework. For each tenet and step, the CHI Navigator includes a focused, targeted, short list of tools aligned with the key concepts. Select excerpts from the Internal Revenue Service’s Final Rule on Community Health Needs Assessments (CHNA) for Charitable HospitalsCdc-pdfExternal are also included for reference.

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Q: What is the origin of the key concepts?
A: The key concepts stem from collaborative CHI guiding principles and were drawn from careful review and analysis of the following sources:

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Q: It seems as if some of these key concepts could apply to more than one step. Why is each key concept mapped only to one tenet or step?
A: Some key concepts can indeed be applied in more than one part of the CHI framework. For the sake of brevity and simplicity, each key concept is described in only one tenet or step. We suggest that you review the key concepts in all four tenets and five steps as you work on your CHI efforts.

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Q: Is this a comprehensive list of CHI tools?
A: Tools for Successful CHI Efforts is intended to be unique, not all-inclusive. The intent is to connect you to targeted tools with guidance, templates, or examples to help you incorporate the key concepts that will lead to success. Use this section as a quick start to inspire action, rather than a comprehensive step-by-step guide. See Additional Tools and Resources for some of the more commonly used comprehensive CHI tools lists.

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Q: How were tools selected for inclusion in the CHI Navigator site?
A: Tools related to the key concepts were selected from specified sources using a systematic approach and specific inclusion criteria. As noted elsewhere, the CHI Navigator does not contain an exhaustive list of CHI tools. Instead, the CHI Navigator tools 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 was not included here and meets the CHI Navigator’s inclusion criteria, please contact us.

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Q: Does CDC discourage use of tools not included in the section, Tools for Successful CHI Efforts?
A: Since every collaborative and community has different needs, CDC encourages you to explore tools that are suitable to your specific CHI efforts.Visit Additional Tools and Resources for resources beyond those highlighted in Tools for Successful CHI Efforts , which are specifically targeted and relevant to the key concepts, tenets, and CHI process steps that we have outlined and are not all inclusive nor the only tools to consider for your CHI efforts.

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Q: I am focused on completing a CHNA for my organization. Does the CHI Navigator contain data and tools for the assessment process?
A: Tools for Successful CHI Efforts contains tools to support needs assessment efforts. Visit Assess Needs and Resources for suggested key concepts and select tools. Additional Tools and Resources also contains a list of useful data sources and other tools and resources for this purpose, including several comprehensive resources for conducting CHNAs.

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Q: Where can I learn more about the Internal Revenue Service (IRS) language that appears in Tools for Successful CHI Efforts ?
A: Select excerpts from the IRS Final Rule on Community Health Needs Assessments (CHNA) for Charitable HospitalsCdc-pdfExternal related to the CHI key concepts are included in the Tools for Successful CHI Efforts section. See the Federal Register postingExternal and full final rule for additional information. Other organizations have also developed summaries of the final rule.

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Q: I am familiar with the Plan-Do-Study-Act (PDSA) cycle from quality-improvement efforts within my organization. How does the CHI process shown in the framework align with PDSA and other quality improvement methods and tools?
A: Quality improvement frameworks and tools, such as PDSA, can be valuable in supporting and strengthening CHI efforts. There are multiple ways this can occur.

The PDSA cycle – which stands for Plan-Do-Study-Act – is the foundational framework for continuous quality improvement (one aspect of the Evaluate Actions key concepts). When used in rapid cycle improvement, it can help organizations improve many aspects of a project, such as engaging the community, data collection activities related to evaluating actions and assessing needs and resources, or implementation (i.e., acting on what’s important). See an exampleExternal of how Comanche County, OK used PDSA and several quality improvement tools to improve their community engagement.

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Database of Interventions

Purpose
Q: What is the purpose of the CHI Navigator Database of Interventions ?
A
: The purpose of the database is to make it easy for users to identify evidence-based interventions from multiple sources. This information supports community partners in choosing the option(s) that best leverage their collective assets and address their prioritized health needs.

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Q: Who should use the database? How might they use it?
A: The CHI Navigator database is intended for staffers in organizations (e.g., hospitals and health systems; public health agencies; community health centers; community action agencies such as United Ways and Accountable Care Organizations) responsible for the frontline work of improving the health of communities. Possible uses of the database include:

  • Finding best practices and evidence-based interventions and approaches
  • Generating ideas for proven interventions aligned with the results from needs assessments (e.g., CHNAs, health needs assessment, community health assessment, etc.), community assets, and the desired health outcomes
  • Identifying evidence-based approaches to use in assessing current approaches or strategies
  • Discovering interventions to consider as part of an implementation strategy, a population health plan, a state health improvement plan, or a community health improvement plan
  • Identifying options for potential inclusion in a population management plan that includes innovative approaches to care of populations

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Q: Does CDC’s focus on evidence-based interventions mean that using new, innovative ways to target health disparities in communities is discouraged?
A: This database has identified and incorporated proven, evidence-based interventions from multiple sources to provide you with approaches that have demonstrated effectiveness. It is not intended to discourage innovative approaches. The evaluation of new, innovative efforts is critical to build the evidence base for reducing health disparities in communities.

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CHI Navigator Database Sources and Inclusion Criteria
Q: What are the source databases for the interventions and other resources found in the CHI Navigator? How were they chosen?
A: Reviews and individual studies were drawn from six source databases that met all of the following criteria:

  • Freely accessible
  • Accessible online
  • Navigable using easily accessible pre-defined filters or a table of contents
  • Complete
  • Provides an evidence rating from a clearly defined methodology
  • Provides source information/reference to the original study or studies
  • Defines outcomes assessed related to the condition(s) of interest
  • Includes interventions requiring cross-sector collaboration between two or more sectors (e.g., health care and public health)
  • Includes interventions not covered in other source databases

For a list of the source databases, visit About the Database of Interventions.

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Q: How were studies and reviews selected for inclusion?
A: Interventions in the database include systems-based, community-based, or interdisciplinary approaches that enhance the effectiveness of usual or existing clinical activities, and address one or more of the modifiable risk factors or socioeconomic risk factors of interest. For information on the evidence level of included interventions, see About the Database of Interventions.

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Q: How were the filters chosen? How were studies and reviews tagged with these filters?
A: A team at CDC developed a list of filters based on those used by the source databases.Discussions with future end users about usability also informed the choice of filters. Studies and reviews were tagged with all applicable filters by at least two team members. The tagging was then independently validated. Discrepancies were reconciled after review by a third team member and follow-up discussion and consensus among the team. For more information, please refer to About the Database of Interventions and the Database of Interventions Glossary.

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Q: How current are the data?
A: Because each of the six source databases from which the interventions are drawn has its own timing for updates, the extent to which the information is current depends on the frequency of source database updates.

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Q: How did CDC decide which intervention description to highlight when it found duplicates across databases?
A: The CHI Navigator database links users to the source database with the most recently updated entry (for reviews) or with the most detail about an individual study.

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Q: Can I submit my own interventions or studies to the CHI Navigator database?
A: You would need to contact a source database to determine their requirements for submitting interventions or studies. The CHI Navigator database is an aggregator, not an originator of content.

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Risk Factors and Outcomes Included in the Database
Q: There are many other health priorities that apply to adults and children. Why does the CHI Navigator database focus on a limited set of risk factors?
A: The current version of this database focuses on the 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. Other priority risk factors, such as mental health and substance abuse, will be considered for future releases.

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Q: Why does the database include studies and reviews that address housing, education, and transportation?
A: Modifiable factors that impact health include socioeconomic factors, the physical environment, health behaviors, and clinical care. Housing, education, and transportation can all have an impact on health and fall into the action areas of socioeconomic factors and physical environment.

The literature indicates that education is a strong positive predictor of several health behaviors and outcomes, including tobacco use, physical activity, weight, diabetes, heart disease and hypertension.1-5 As well, studies have noted an association between provision of housing and accessible transportation options and outcomes such as physical activity, healthy diet, diabetes and obesity.6-7 Therefore, while certain reviews and studies included in the database might not have explicitly targeted or documented such outcomes, this database still generally categorized education, housing, and transportation interventions as targeting many of these risk factors, so that users could consider these kinds of interventions with longer term impact.

Related References:

1. Ross, C. E., & Mirowsky, J. (1999). Refining the association between education and health: the effects of quantity, credential, and selectivity. Demography, 36(4), 445-460.
2. Ross, C. E., & Mirowsky, J. (2011). The interaction of personal and parental education on health. Social Science & Medicine, 72(4), 591-599.
3. Mirowsky, J., & Ross, C. E. (2003). Education, social status, and health. Transaction Publishers.
4. Campbell, F., Conti, G., Heckman, J. J., Moon, S. H., Pinto, R., Pungello, E., & Pan, Y. (2014). Early childhood investments substantially boost adult health. Science, 343(6178), 1478-1485.
5. Cutler, D. M., & Lleras-Muney, A. (2006). Education and health: evaluating theories and evidence (No. w12352). National Bureau of Economic Research. NBER Working Paper SeriesCdc-pdfExternal
6. Taylor, L. A., Coyle, C. E., Ndumele, C., Rogan, E., Canavan, M., Curry, L., & Bradley, E. H. (2015). LEVERAGING THE SOCIAL DETERMINANTS OF HEALTH: WHAT WORKS?.
7. Litman, T. (2011). Evaluating public transportation health benefits. Victoria Transport Policy Institute.

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Searching and Filtering
Q: Can I search for the title of a study or review?
A: At this time, it is not possible to conduct searches by title or key words. If you have a topic of interest, you may wish to begin by selecting the risk factors related to that topic. You can narrow the list of results by selecting additional filters within other categories, as applicable. You can further narrow your search by selecting reviews, individual studies, or an action area.

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Q: How do I know which filters to select?
A: If you know the risk factor(s) or health outcome(s) you wish to address, you can start with that information. You might also have a particular population in mind or wish to consider how to apply certain assets within your community. The filters are designed to allow you to quickly focus on interventions of interest to your community.

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Q: Is it possible to search for reviews and studies by a specific racial or ethnic group?
A: The database allows you to select “racial/ethnic minorities” as a filter and to browse the resulting list for specific populations of interest.

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Q: Why do searches for certain types of interventions (e.g., transportation) yield limited results?
A: It may be one of two reasons. 1) The database is a collection of the best evidence-based interventions drawn from six other databases; it relies on what is available through them. Not finding a particular type of approach might mean that there is not yet enough evidence to support the effectiveness of an intervention. 2) Selecting too many filters may narrow your search results so that no study or review meets all of the specified criteria.

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Terms Used in the Database
Q: Some of the terms used in the database seem to have the same meaning, such as action areas and intervention types. Where can I find definitions?
A: You can find definitions of various terms in the Database of Interventions Glossary.

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Next Steps
Q: I searched the database and found an intervention that I would like to use because it addresses a need in my community. Where can I find more information on how to put this intervention into action?
A: Clicking on the title of a review or study will take you to the specific entry in the source database. There you will find additional information about carrying out that intervention. Tools for Successful CHI Efforts also contain tools that can help you launch your CHI effort. Finally, you may wish to visit Making the Case for Collaborative CHI to read about collaborative efforts that have improved community health, including links to the more complete stories.

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