Information About THRIVE

• Readiness
• Planning Process
• Collaboration

Process & Instructions

• THRIVE Process
• THRIVE Tool Instructions
• Health Disparities and Community Health Glossary of Terms

Use THRIVE

Option A - Start here if you know the specific health problems in your community and want to start with these.

Option B - Go straight to the tool and the full set of factors that promote community health and wellbeing.

THRIVE: Priorities, Impact and Indicators

How do we prioritize which factors to work on?

While all of the clusters and factors support health outcomes, it is unrealistic to expect that a community could address all of them simultaneously with equal attention and success. Therefore, it is critical that the community prioritize the set of factors it wants to emphasize. The THRIVE tool allows individuals to assign priority ratings to each factor of high (h), medium (m), and low (l). Once individuals have made these assessments, it is helpful to report back to the group on the group’s average ratings, to confirm with the group that their combined ratings reflect the group consensus, and then engage the group in a process to select its highest priorities. To accomplish this, participants could set criteria for selection. Examples include:

• Relevance to major health concerns – Each of the factors is related to multiple health concerns; however consideration should be given the factors most directly associated with major health concerns or health gaps to address these in the most effective matter.
• Community readiness and buy -in – It is important that community members and stakeholders have the capacity to and interest in addressing a particular factor in order to make the needed changes.
• The need to address gaps that aren’t otherwise being filled - Many public health and safety-related organizations conduct their own systems assessments at state and local levels as well as community asset assessments. Many of these tools and approaches include performance indicators/standards. These resources can provide useful information and reduce the need for local collection as well as help identify existing gaps
• The need to build on success and/or existing efforts to maximize impact - Most communities have successful coalitions or other efforts in place to improve community health outcomes. Rather than starting from scratch or reinventing the wheel, it may be more effective and efficient to identify successes and build on those in the community.
• Consideration of cumulative effects - Strengthening one factor may strengthen other factors thereby having a cumulative effect. The clusters and factors have an interactive and synergistic relationship with each other, which must be considered as strategies are developed and implemented.
• Importance and Achievability – One model to help communities select criteria is based on the work of Larry Green and Marshall Kreuter. It takes into account importance and achievability. Each is represented on an axis, the two of which intersect to create four quadrants, shown in the following diagram.¹

THRIVE factors, as well as activities that bolster them, can be placed in the appropriate quadrant. They can then be assessed according to the following:

• Quadrant 1 : Placement in this quadrant indicates that the factor, or activity, is both unimportant and unachievable and therefore there is no reason to consider them.
• Quadrant 2: Placement in this quadrant indicates that the factor, or activity, may be important but not achievable and therefore does not warrant further attention.
• Quadrant 3 : Placement in this quadrant indicates that the factor, or activity, is both important and achievable. Further exploration is warranted.
• Quadrant 4: Placement in this quadrant indicates that the factor, or activity, is achievable but not very important. Given the achievability factor, the group may want to consider prioritizing this factor if, for example, achieving the associated outcomes could bring credibility to the group which could form the basis to attract resources or engage new members, or allow members of the existing group to feel a sense of accomplishment and empowerment, allowing them to address other issues that are of greater importance.

How can we maximize the impact of our efforts?

It is important to understand that research is still examining which community health factors may have greatest influence. However, it is clear that no single strategy, program, or policy is the answer. Multiple changes are needed to shift community norms towards healthier behaviors. Based on experience with other public health issues such as tobacco control, or reducing impaired driving, a variety of changes help to build momentum and gain traction and interest over time; incremental changes lead to others that ultimately change the overall dynamics.

To understand the necessary range of activities, practitioners have used the Spectrum of Prevention,² a tool that enables people and coalitions to develop a comprehensive plan while building on existing efforts. The Spectrum encourages movement beyond the educational or “individual skill-building” approach to address broader environmental and systems-level issues. When the six levels are used together, they produce a more effective strategy than would be possible by implementing an initiative or program in isolation. The Spectrum has been used to advance multiple efforts including, but not limited to, violence and injury prevention, physical activity and nutrition promotion, sustainability of mental health promotion, and lead prevention.

Spectrum of Prevention

Data and evaluation inform all levels of the Spectrum. Any proposed activity should be based on data showing 1) the issue is important, 2) the target population is appropriate, and 3) the intervention is promising. To develop a successful approach, it is essential to first review the data and determine an appropriate set of objectives. During implementation, ongoing evaluation of the overall approach and the individual activities at each level of the Spectrum will provide information necessary for making ongoing adjustments to the activities that are best suited to meet overall objectives.

How do we know if we are being effective?

Evaluation and assessment play an important role in ensuring that resources are being used in the most effective and efficient manner and that efforts are achieving the desired outcomes. Rather than waiting until the end of an initiative, ongoing evaluation can provide valuable feedback along the way, including identifying what needs to be changed. A good evaluation can include assessment of both the process, such as how effectively a collaborative is functioning, and of outcomes, such as whether or not the desired goal was achieved and if it made an impact.

Seeing improvements in some of the factors may take a long time, and once established, it may take years to see improvements in health outcomes. However, because of the research basis of the factors, progress on each of them can be seen as benchmarks for better health and safety outcomes.

The THRIVE tool can play a role in evaluation since it allows people to rate how well the community is doing on particular factors and includes a process for the community to establish its own indicators for each factor. The tool can be used at periodic intervals to assess progress on particular factors or all of them, particularly with respect to the established indicators.

Many public health and safety-related organizations conduct their own systems assessments at state and local levels as well as community asset assessments. Many of these tools and approaches include performance indicators/standards. These resources can provide useful information for evaluation. Also, t he Community Toolbox has valuable evaluation tools and these can be found at http://ctb.ku.edu/.

Are there specific people or needs we should take into account when selecting appropriate activities to strengthen the community?

Different people in the community have different needs based on such characteristics as age, cultural values, and physical ability. Strengthening the community environment includes paying attention to the range of needs in the community. This includes considering:

• Cultural context: Consider clusters and factors in a cultural context. Values, customs, and priorities vary from one culture to another and these differences must be accounted for in designing health strategies. Activities should be selected with great care and fit with the unique characteristics of local residents.
• Developmental needs : Consider clusters and factors in a developmental context. When designing strategies based on the clusters and factors, developmental needs should be taken into account. Seniors, adults, teens, and young children have different needs in relation to all of the factors. Further, representatives from different age groups should be included in the planning and decision-making processes to ensure that their needs and input is accounted for. Y outh, for example, are an underutilized, yet a very valuable resource
• Disability considerations : 20% percentage of Americans live with disabilities, many of which are not obvious by sight, and the rate of disabilities are higher in communities of color. People with disabilities have certain needs for accommodation, which should be considered when delineating solutions. People with disabilities should also be included in the planning and decision-making processes.

Is there a chance we could do damage to the community or its members?

The purpose of the THRIVE tool and associated process and materials is to help communities address disparities in health, promote health equity, and to improve long-term health outcomes in the local population. THRIVE has been shown to be an effective catalyst toward these goals. However, these goals are long-term and require long-term, deliberate action. In initiating and following through with this process, there are a number of considerations that communities should take into account to both reduce the risk of harm to the members of the community and to achieve maximum benefits of a community resilience approach. These include:

• Unintended consequences: Avoid unintended consequences by thoroughly thinking through the implications of an action. For example, large chain stores may be able to provide desired products; however they may bring with them traffic congestion and increased traffic and pedestrian injuries, while forcing locally-owned stores out of business. Selected actions should promote positive long-term health outcomes and do no harm in the short-term and long- term.
• Reduce gentrification: Improving community ambiance, opportunities, and health can change the make-up of the community. In particular it can result in displacement of people who the tool is designed to help. Take steps to ensure that while improving the overall community the people in the community aren’t pushed out. Current strategies to address this include promoting regional equity and systematically fostering micro business development opportunities for people who live in the community.³

What are indicators?

Indicators are markers for a particular factor; they help answer the question, what do we want this factor to look like in our community? Once a factor has been selected, people in the community can decide what that factor would look like if it were supporting health and safety outcomes. Indicators will vary by community because communities have different needs and characteristics. For example, getting around in an urban community is very different than in a very rural local, and this will have implications for the kinds of strategies that are put in place. Once indicators have been selected, they inform which strategies should be selected and can be tracked to ensure progress.

What makes a good indicator?

The characteristics of a good indicator are fairly standard, or at least there is a high degree of consensus. This consensus is based on some of the well-known national efforts to standardize indicators^4,5,6. In addition, many constructs for indicators have been developed from practical experience. Unique indicator criteria are often developed or modified to meet local or specific project needs. For example, if there is a compelling need to quantify geographic or racial/ethnic disparities, the criteria for indicators may depend on the availability of data by census tract or major racial/ethnic categories. But even these localized indicators have, or attempt to have, the agreed upon listed standard characteristics of good indicators.

Standard Criteria for Individual Indicators

• Important : measures conditions or activities identified as important by the community;
• Understandable : the indicator is easily understood by citizens and leaders;
• Measurable: data can be collected and reported in a timely manner;
• Valid : the indicator accurately measures what it’s designed to measure.
• Reliable: the data for the indicator are collected in a consistent manner that can be repeated from one time interval to another;
• Data available: data are available and there is established ongoing collection. If a selected indicator requires primary data collection, it should be cost effective and have the potential for funding;
• Demographics: data can be disaggregated by age, gender, race/ethnicity, and/or income when appropriate;
• Geographic detail: an appropriate geographic unit is specified and geographic differences (i.e., a particular city or neighborhood) can be analyzed;
• Actionable: the indicator provides information that suggests opportunities for action to address concerns, prevention of the problem and/or promotion of health and wellbeing or Measures conditions or activities that can be changed in a positive direction by local action;
• Asset orientation: where possible, the indicator measures a positive aspect of the community’s quality of life (the community’s assets rather than its liabilities) so that an increase in the indicator’s trend line reveals community improvement (e.g., high school graduation rate rather than dropout rate).

What are some sample indicators?

For more information about indicators, indicator reports, and report cards, please see: Good Health Counts: A 21 st Century Approach to Health and Community for California (May 2006) This Prevention Institute paper was prepared for The California Endowment [coming soon]

View a list of the references on this page.