Module 6:
Writing Goals, Strategies, Objectives, and Activities

 

 

Module Introduction

Now that you have created the logic models and implementation plans that will guide your interventions, and the evaluation plans that will track what is accomplished, the next step is to take the information from these tools and use them to create goals, strategies, objectives, and activities.

Module 6 describes how to write goals, strategies, objectives, and activities for your state plan. To follow the gardening analogy, this is the point when you determine what your garden will look like when it is in full bloom.

Module Title	Topics Covered	Gardening Analogy
Module 1: Introducing Planning from a Public Health Perspective	An Introduction to Public Health Planning	Learning the basics of gardening
Module 2: Coordinating the Planning Process	Working Collaboratively with Partners, Pre-Planning and Launching the Planning Process with an Initial Meeting	Identifying what resources you have and what tools you need
Module 3: Using Data in Health Planning	Presenting the Data and Defining the Problem	Gathering information on weather and soil conditions in your area
Module 4: Identifying & Selecting Evidence-Based Interventions	Finding Solutions to the Problem	Finding the kinds of seeds that will grow well in the conditions in your area
Module 5: Planning for Implementation, Monitoring, and Evaluation	Preparing to implement solutions	Getting ready to plant by preparing the soil and gathering your tools
Module 6: Writing Goals, Strategies, Objectives, and Activities	Defining and Measuring Success	Determining what your garden will look like when it is in “full bloom”

Module 6 Learning Objectives:

Upon completion of this module, you should be able to:

• Define goals, strategies, objectives, and activities.
• Describe the criteria for a SMART objective.
• Write objectives using the SMART criteria.
• Explain the differences between “process objectives” and “outcome objectives.”
• Describe how to create objectives and activities based on logic models, implementation plans, and evaluation plans.

Time estimate for completion:

It should take approximately 60 minutes to complete this module.

Module Introduction, cont'd

Forward

While some planning approaches start with writing goals and objectives, and then proceed to describing intervention activities and evaluation, this course follows a different approach. Here, interventions are selected and planned out in detail in implementation and evaluation plans, before objectives and activities are written. This course has been organized this way for two main reasons:

1. It can make the process easier. Goals, strategies, objectives, and activities will naturally emerge as your coalition works through the process of completing intervention selection, implementation planning, and evaluation planning.
2. It can keep momentum going. Focusing on interventions can help the coalition spend more time on the critical decisions that will turn the state plan document into real accomplishments, instead of spending a great deal of time re-writing goals, objectives, and activities.

Section I: Writing Goals and Strategies

Goals

A goal is a broad statement that explains what is to be accomplished in the long term. Some examples of goals are:

Prevent diabetes; prevent complications, disabilities, and burden associated with diabetes; and reduce diabetes-related health disparities.

• CDC’s Division of Diabetes Translation

Increase the number of Americans who are healthy at every stage of life. 

• National Prevention Strategy

Goals for your state plan reflect the changes in the burden of chronic disease that you intend to achieve within five to ten years.

You and your partners developed preliminary goals that reflect the coalition’s vision statement for your state plan during Planning Group Meeting #2 (see Module 3: Using Data).

Goals are concise sentences that focus on how some aspect of the existing status will improve as a result of the efforts of all partners working together. Goals are organized around the critical intervention points and key populations identified in the review of your state’s population flow map.

Section I: Writing Goals and Strategies cont'd

Sample Goals

The following are two examples of diabetes-related goals a state coalition could select:

1. Reduce diabetes-related disparities among African Americans in State X.
2. Prevent the complications, disabilities, and burden associated with diabetes among low-income, high-risk populations in State X.

Section I: Writing Goals and Strategies cont'd

Strategies Defined

Strategies are summaries of the interventions selected to achieve your goals. The work your coalition has done to identify, prioritize, and select evidence-based interventions during the collaborative planning process led to the development of strategies (see Module 4: Evidence-Based Interventions). As you grouped together interventions to address each of your goals, you and your partners wrote a brief explanation of how these interventions address a specific aspect of the problem. These summary statements are strategies.

Each goal should have at least one strategy tied to it, and each strategy should reflect the purpose of each intervention that falls under it. The diagram below illustrates the relationship between goals, strategies, and interventions:

 

Section I: Writing Goals and Strategies cont'd

Sample Strategies

Your coalition’s goals provide a framework for your strategies, which explain how the goals will be achieved. For example, a coalition could develop these strategies to achieve the goals referred to earlier in this section:

1. Reduce diabetes-related health disparities among African Americans living in Counties A, B and C in State X by improving access to and use of quality clinical services and self-management education.
2. Prevent the complications, disabilities, and burden associated with diabetes among low- income, high-risk populations by improving quality of care for those persons diagnosed with diabetes or prediabetes in State X.

 

Section I: Writing Goals and Strategies cont'd

Aligning Strategies with the Four Domains of Chronic Disease Prevention and Health Promotion

CDC’s National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) is coordinating its efforts under four key domains that reflect the Health Impact Pyramid (see Module 1). Hover over each domain to see example strategies that fall under that domain.

1. Epidemiology and Surveillance: collect, analyze and share data to help identify and solve problems and evaluate public health efforts.
2. Environmental Approaches: build social and physical environments that promote healthy behaviors.
3. Health Care Systems Strategies: improve access to and use of quality clinical preventive and treatment services.
4. Community-Clinical Links: ensure that people with or at high risk of chronic diseases have access to the resources they need to prevent or manage these diseases.

These domains and their accompanying strategies reflect the continuum from primary through secondary and tertiary prevention. Strategies across the domains address the multiple levels of the socio-ecological model and the need to support evidence-based interventions in a variety of settings.

Module 6, Section I Summary & Activity

Section I discussed developing goals and strategies for your state plan. Now, think about how these concepts apply to your state planning process. Watch the video below, in which a Florida state department of health program coordinator talks about developing goals and strategies with partners, and then answer the questions that follow. Click here for a worksheet to record your answers.

1. In the video, what strategy was of particular interest to key partners? Why might this strategy not address the problem in the state, based on the data?
2. What are two specific approaches you could use in a coalition meeting to steer discussion around goals and strategies back to the data describing the problem?

The next section of Module 6 will describe writing Objectives and Activities for your state plan.

Section II: Writing Objectives and Activities

Objectives and Activities

Objectives are statements that describe the anticipated extent of the results to be achieved through your selected strategies. Activities are the specific tasks that implement the strategy and accomplish your objectives. In this section, we will focus on objectives first.

Objectives break down goals into smaller parts that provide specific, measurable actions by which the goal can be accomplished. They create measureable mileposts to be achieved in order to meet your goal. Objectives are the basis for monitoring implementation of your strategies and progress toward achieving your goals.

You will need at least one objective for each strategy selected by you and your partners. The objectives for each strategy should link to the evaluation questions you have developed. Much of the work involved in writing these objectives has already been accomplished through the development of your logic models, implementation plans, and evaluation plans (see Module 5: Planning for Implementation, Monitoring, & Evaluation).

 

Section II: Writing Objectives and Activities cont'd

Writing Objectives: Process vs. Outcome Objectives

Since you will be using your implementation plans and evaluation questions as a basis for writing your objectives, you will have both process objectives and outcome objectives.

Process Objectives:

• Are related to process evaluation questions.
• Set targets for implementation, describing what is to be done, how it will be done, and when it will be completed.
• Address reach, including participant recruitment, characteristics, and completion rates.
• Focus on performance – quality, fidelity, frequency, timeliness, reach, and completion rates.

Outcome Objectives:

• Are related to your outcome evaluation questions and the outcomes in your logic models.
• Set targets for the short-term, intermediate term, and long-term results or accomplishments.
• Express the intended results – the amount of change expected in a specific population from the baseline (pre-intervention) to another specified point in time after the intervention is completed.
• Focus on the change expected in the problem as a result of you and your partners’ work.

Section II: Writing Objectives and Activities cont'd

Writing Objectives: Setting Targets

To begin writing objectives, you will need to connect an evaluation question (what is being examined) to its associated indicators (how it is being measured). The last element you will need to write a solid objective is a target. The target is the specific numeric value attached to the indicator that states the desired amount of change you will see after activities associated with that objective are completed.

For targets to be meaningful and realistic, you and your partners should identify the amount of effort, efficiency, and change that you believe demonstrates achievement of faithful implementation and expected outcomes. When you set targets for your indicators, consider the following: your baseline, the amount of change that has occurred in previous efforts, the standards in the field, the research establishing the effectiveness of the intervention demonstrated, and your stakeholders’ expectations.

 

 

Section II: Writing Objectives and Activities cont'd

Writing SMART Objectives

For expectations to be clear, you and your partners must write clear, concise objectives. Once you have developed an objective, you will want to double check that it tells you who is going to do what, when, and to what extent. A good way to ensure your objective is well-written is to run it through the “SMART” criteria. The table below describes each component of this acronym and how it should be used to write the objective:

Specific	What are we going to do for whom living where?
Measureable	Is it quantifiable, and can we measure it?
Achievable	Can we get it done in the proposed time period with the resources and support available?
Relevant	Will this objective have an appreciable effect on the desired goal?
Time-Framed	Within what time period will this objective be accomplished?

See this CDC guide for a more detailed explanation of SMART Objectives.

 

Section II: Writing Objectives and Activities cont'd

Sample Process Evaluation Questions, Indicators, and Objectives

The following is a diabetes-related sample strategy referred to earlier in this module:

Reduce diabetes-related disparities among African-Americans living in four metropolitan counties in State X by improving access to and use of high-quality self-management education.

In the associated intervention, a federally qualified health center and regional hospital are implementing a community health worker-led diabetes self-management education program for African Americans diagnosed with diabetes living in the four counties in State X. The coalition could develop the following process objectives (sample evaluation questions and indicators are also included to show how they are all linked together):

Item	Example
Process Evaluation Question	What percentage of implementation cycles of the intervention were completed as planned?
Indicator	Percentage of implementation cycles completed with fidelity.
Process Objective	Increase the percentage of implementation cycles completed with fidelity from 70% to 80% by March 2015.
Process Evaluation Question	How many participants enrolled completed the intervention, averaged over all implementation cycles attempted?
Indicator	Completion rates for intervention cycles (averaged)
Process Objective	Increase the average participant completion rate per implementation cycle from 50% of participants completing to 65% of participants completing by March 2015.
Process Evaluation Question	What proportion of the participants enrolled were members of the target audience?
Indicator	Number/Percentage of participants enrolled possessing characteristics of target population.
Process Objective	Increase the percentage of participants possessing characteristics of the target population from 55% of participants to 75% of participants by March 2015.

Section II: Writing Objectives and Activities cont'd

Sample Outcome Evaluation Questions, Indicators, and Objectives

In addition, the coalition could develop the following outcome objectives (sample evaluation questions and indicators are also included to show how they are all linked together):

Sample Outcome Evaluation Questions, Indicators and Objectives
Short-term Outcome Evaluation Question	What percentage of participants completing the intervention demonstrated increases in knowledge about self-management practices?
Indicator	Differences in positive direction on scores on pre-test and post-test examining knowledge and current self-management practices.
Short-term Outcome Objective	Increase the average scores on completing participants’ post-tests (compared to pre-test) from 50% to 80% correct by March 2015.
Intermediate-term Evaluation Question	What percentage of participants completing the intervention demonstrated improvements in implementing self-management practices six months after completion?
Indicator	Scores on post-completion follow-up survey of participants, asking about current self-management practices (as compared to baseline, pre-test questionnaire)
Intermediate-term Outcome Objective	Increase the average number of self-management behaviors practiced routinely by at least 65% participants six months after completion from 1 to 4.
Long-term Outcome  Evaluation Question	What percentage of participants completing the intervention maintained or decreased their A1C scores at or below 7%
Indicator	A1C Scores from patient clinical records, prior to completing intervention, and at six and twelve months post-completion of the intervention.
Long-term Outcome Objective	Increase the percentage of participants completing the intervention who maintain or decrease their A1C to at/below 7% from 45% to 65%.

 

 

Section II: Writing Objectives and Activities cont'd

Activities Defined

Activities are the specific tasks that need to be taken to implement your strategy and accomplish your objectives. Activities answer the question, “To meet this objective, what actions or tasks are needed?”  Activities provide information about what will be done, who will be responsible, and the time period during which the activity will be performed. Usually, each objective has several activities associated with it. 

The logic models and implementation plans you and your coalition have created will make the process of writing activities easier. Your logic models demonstrate the relationship between activities and expected outcomes; your implementation plans include a detailed list of activities, people responsible, resources required, and a timeline. 

Section II: Writing Objectives and Activities cont'd

Summarizing Activities

The action steps in your implementation plans have been broken down into all of the tasks needed for completion and cover every phase of implementation. This level of detail is not needed for the state plan document, so you and your partners will need to summarize activities into statements that reflect the major task being completed. This process is worth the time and effort, as it may reveal gaps or duplications of efforts planned. Also, sequence of activities and time required can be double-checked to ensure that staff and other resources will not be overcommitted.

Here is a sample process your coalition can use to summarize activities for your state plan.

1. Group all of the related activities together: Each workgroup goes through implementation plan narrow down the number of activities and summarize into a single statement.
2. Examine the details: Are all of these group activities being performed by the same entity? What is the total time period covered? Remember to make the time periods inclusive of the beginning of the first to the end of the last activity you are including in the summary statement.
3. Check and align wording of the summarized activities: Ensure that it reflects the wording within the objectives, strategies, and goals for your state plan.
4. Review the associated objectives, goals, and strategies: At the end of this process, each workgroup adds the goal, strategy, and objectives to the implementation plans. Incorporating these statements reinforces shared understanding among workgroup members about how the work reflected in the implementation plans supports achieving the goals of the state plan.
5. Review the selection of summary activities: It may be helpful for workgroups to exchange their lists of objectives and activities and review them to check:
• Do the activities align with the objectives? Does it seem plausible that completing the activities will produce the amount of progress stated in the objective?
• Do the activities reflect the key strategies/interventions selected?
• Do the activities follow each other in logical, time-framed order?
• Do the objectives reflect the outcomes of the activities? Check carefully that your objectives are not re-worded activities or cumulative totals of activities.

Summary

Module 6, Section II Summary & Activity

Section II of Module 6 described how to write objectives and activities for your state plan. This section explained how objectives break down the larger goal into measureable mileposts and described how to make objectives “SMART.” This section also defined activities in the context of the state plan and a process for writing activities based on implementation plans.

Now, think about how to apply these concepts to your planning process by answering the questions below. Click here for a worksheet to record your answers.

1. A coalition developed the following objectives in order to: Improve quality of clinical care for patients with diabetes receiving health care from federally qualified health centers (FQHCs) in the four metropolitan counties in State X to improve control of A1C, blood pressure, receipt of recommended annual exams, and to promote tobacco cessation.
   
   
   1. Increase adoption of uniform diabetes screening, diagnosis, treatment, and referral guidelines and clinic operations changes (Patient Centered Medical Home Concept Components) from 5% to 100% of all participating FQHCs.
   2. Increase percentage of health care staff testing as knowledgeable on diabetes care and management at all participating FQHCs in State X by March 2015.
   3. Increase percentage of at-risk patients screened for tobacco use annually.

   Each of these three objectives can be improved using the SMART criteria. Identify which SMART criteria are missing from each one, and rewrite the objective to be more “SMART.”

2. Why is it important to have both process and outcome objectives included in your state plan?

Summary

Module 6 Summary

Module 6 described how your work to date - including examining the problem and solutions, selecting interventions, and creating logic models, evaluation plans, and implementation plans – are used to develop goals, strategies, objectives, and activities for your state plan.

You can download a PDF of helpful resources for more information on this topic.

You now have all of the pieces in place to write your state plan. Next, we will examine the content and organization of the plan, how to prepare and write the document, and methods of disseminating the plan.

Continue the course with Module 7: Creating & Disseminating the State Plan Document.