Module 7:
Preparing, Reviewing, and Disseminating the Plan

Module Introduction

Now you are ready to create and disseminate your state plan.

Module 7 describes how the information generated throughout the planning process will be converted into sections of the actual plan document. Next, the module provides tips on how to write and design an organized, attractive, and reader-friendly document. Finally, the module describes how to work with the media and partners to disseminate the document to a wide variety of stakeholders. To follow the gardening analogy, this is the point at which you would plant your seeds, water them and watch them grow.

Module 7 Learning Objectives:

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

• List the core sections to be included in your state plan.
• Describe key strategies to make your plan attractive and easy-to-read.
• Define the term “health literacy” and explain how health literacy affects people’s ability to understand health information.
• Describe several strategies to use to disseminate your plan and get media attention to the plan.

Time estimate for completion:

It should take approximately 60 minutes to complete this module.

Section I: State Plan Content and Organization

Introduction

This first section of Module 7 describes the components and organization of a typical state plan. While you and your partners will ultimately decide upon the content of the plan, a typical state plan will include the following sections in this approximate order:

• Front Matter
• Introduction
• Burden
• Rationale
• Planning Process
• The Plan: Goals, Strategies, Objectives, Activities
• Optional Sections
• Appendices
• References and Resources

Section I: State Plan Content and Organization cont'd

Front Matter

The front matter helps to provide an overview of the state plan document and its organization.

Foreword messages are usually written by representatives of key stakeholders, including the chair of your coalition, the state department of public health, the health commissioner, or even the office of the governor.  These messages typically emphasize the importance of organizing key partners to address diabetes or chronic disease in your state and the significance of having the plan to help guide efforts.

Acknowledgements can be used to list all of the members of the coalition or planning group. Alternatively, some states list coalition members in an appendix attached to the end of the document.

Section I: State Plan Content and Organization cont'd

Front Matter, continued

The citation page includes all of the information relevant to the production and publication of the state plan document that should be used by someone citing the document in another publication. This information should include the preferred title, authors or editors, publisher, place, and date published.  If the planning process or the publication of the state plan was supported with funding from the CDC, that should be acknowledged here. The citation page should also include information about the availability of hard copies or how to download additional copies of the document.

The executive summary should be a one-page synopsis of the contents of the plan. It should give a reader a brief overview that is suitable for publication or quoting by the media.  

Section I: State Plan Content and Organization cont'd

The Introduction

The introduction defines diabetes, or the chronic disease of interest, and frames it as a public health problem. For the example of diabetes, the introduction should include information regarding:

• Definitions of prediabetes, Type 1 and Type 2 diabetes, and gestational diabetes
• Prevalence of the different types of diabetes nationally and in your state
• Severity of the disease in terms of morbidity, disability, and premature death
• Personal, healthcare, and economic costs associated with diabetes
• Risk factors, complications, and significant co-morbidities associated with diabetes
• Diagnosis, treatment, and self-management of diabetes and prediabetes
• Diabetes-related health disparities and how social determinants of health affect access to care

Be careful to explain any medical or scientific terminology used. It is useful to refer readers to a glossary that defines all scientific, medical, epidemiological, and other technical terms, as well as a list of commonly used acronyms. 

Section I: State Plan Content and Organization cont'd

Burden

The next section of the plan should describe the burden of diabetes or chronic disease in your state. This section will contain the majority of your tables, charts, graphs, and maps. Be careful to use plain and simple language to explain public health concepts and terms. The section should include:

• Data regarding trends in prevalence and incidence
• Data regarding trends in risk factor prevalence
• Breakdown of populations with chronic disease by age, gender, race/ethnicity, socio-economic status, and geographic location 
• Population flow maps used during the planning process

The section can be brief and highlight findings of your state’s chronic disease burden report, or it can be more extensive and function as your state’s burden report. This section will be linked to a section that describes data sources and methods located at the end of the plan in the Appendices.

Section I: State Plan Content and Organization cont'd

Rationale

The rationale section of your plan discusses why you and your partners have come together to develop a state plan. This section will provide:

• Historical information about previous plans and how this plan relates to them
• Highlights of successful changes in policies, environments,  and systems, and programs implemented as a result of previous efforts
• Information about your coalition, including composition and structure, background of key partners, planning groups, and steering committees
• A brief description of the programs and services provided by the state department of health and the role it plays in coordinating efforts to address the burden of diabetes or chronic disease statewide

After you have explained why your coalition has come together, you will explain how the planning group worked together to create the plan.

Section I: State Plan Content and Organization cont'd

The Plan: Goals, Strategies, Objectives, and Activities

This section should briefly describe the planning process, including:

• Timeframe for planning, the workgroups created, and the collaborative processes used for decision-making
• Major stages and the work accomplished during each stage
• Descriptions of the “public health approach” to planning
• Processes for developing goals, strategies, objectives, and activities
• How partners plan to implement and evaluate the plan going forward

Now that the reader has information about why diabetes or chronic disease is a problem in your state, and how your coalition has worked together to address it, next you can present the details of the plan itself.

Section I: State Plan Content and Organization cont'd

Objectives and Activities

This section is the core of your state plan. It includes:

• A summary of your goals, strategies, objectives, and activities
• Logic models for each goal
• A brief description of evidence supporting each strategy
• A timeline of when interventions will be implemented
• Information about where interventions will be implemented, including maps
• A description of the major organizations involved in implementation
• Information about the target audiences
• A discussion of how the burden will be impacted through the successful implementation, illustrated through the flow map

After writing this section, you have presented the majority of the information necessary to convey your plan. However, you may wish to convey additional information through optional sections and appendices. The references to the literature supporting the evidence-based interventions should be included with the end materials.

Section I: State Plan Content and Organization cont'd

Optional Sections

You may choose to include one or more of the following optional sections to provide readers with more information about your coalition’s progress:

• Measuring Progress: Explains how progress is being measured and when data from the evaluations will be released to the public. 
• Progress to Date: Describes progress to date in implementing the strategies/interventions. You may produce interim progress reports that contain the progress achieved to that point in time.
• How to Get Involved: Tells the reader how to become involved with state or local coalitions or partner organizations. You can include contact information that the reader can use to obtain further information or be notified of upcoming events.

Section I: State Plan Content and Organization cont'd

Appendices

Including appendices in your plan is optional. Here are examples of what some states have included as appendices in their plans:

• Glossary with definitions of all of the medical and epidemiological terms used in the text 
• List of coalition and planning group members with contact information
• Lists of national objectives, such as Healthy People 2020 or the National Prevention Strategy
• Samples of implementation and evaluation plans,along with diagrams showing the population flow map
• State maps showing where existing programs and services are located and where planned interventions will be implemented

Section I: State Plan Content and Organization cont'd

End Materials

At the end of the state plan, you will also include required materials, such as:

• Technical information on data sources and analysis techniques used to create the burden report section from the surveillance and epidemiological data.
• References and resources for your data, as well as for literature supporting the selection of evidence-based and practice-based interventions. This section may also be labeled “end notes,” if the references are tied to superscript numbers in the text. The American Public Health Association Style Guide is the preferred format for references.
• Resources with contact information, including websites.  The resources pages may be organized by audiences, including health care providers, persons with or at risk for diabetes or chronic disease, and policymakers.

Module 7, Section I Summary & Activity

While states may include slightly different content, or organize the information differently, in their state plans, Section I described the basic core and optional elements found in most plans.

Either now or after completing this module, take a moment to refer to a copy of your state’s most recent plan for diabetes or other chronic diseases of interest. Then, scan the following examples of state plans for diabetes and answer the questions below.

• Texas: http://www.dshs.state.tx.us/diabetes/tdcplan.shtm   
• South Dakota: http://doh.sd.gov/documents/diseases/chronic/diabetes/StatePlan.pdf
  
  
  1. How is your state’s most recent state plan organized?
  2. How does the content differ from the information presented in this section?
  3. How does your state’s most recent plan differ from the content and organization of the example state plans listed above?
  4. Are there elements of a plan that were presented in this section, or in the sample plans above, that you would want to include in your state plan in the future?

Section II: Preparing and Writing the Document

Introduction

Now that you have an overview of what will need to go into the state plan, Section II describes preparing for and writing the document itself. This includes:

• Selecting a managing editor
• Determining production and publication methods
• Designing and writing the plan for effectiveness
• Reviewing and editing the plan
• Completing appropriate approval processes

Each of these processes will be described in more detail in this section.

Section II: Preparing and Writing the Document cont'd

Selecting a Managing Editor

To begin the process, you will need to appoint someone to manage the flow of information – the managing editor. The managing editor’s role is to:

• Prepare a draft of the plan based on the work produced by the workgroups
• Solicit comments on the draft from coalition members
• Ensure there is consistency in the overall document
• Keep track of gaps in emerging material
• Supervise writers, editors, and designers
• Work with a publisher to produce hard copies of the plan

The managing editor can be a state department of health staff member, a partner, or an outside contractor. The selection of the managing editor will depend on the skill set available within the state department of health staff and partnering organizations, as well as which organization agrees to fund the design and publication of the plan. (If a staff person is designated as managing editor, this person will also shepherd the document through the clearance process required by the state department of health, which will be discussed later in this section).

Section II: Preparing and Writing the Document cont'd

Production and Publication Methods

Another decision that will need to be made early in the process is how the state plan will be designed and printed. Design and printing can be accomplished:

1. Internally, through the state department of health or government printing agency
2. Externally, by contracting directly with an external graphic designer and printer
3. Externally, through a partner organization that will use existing internal resources to produce and publish the plan.

Regardless of which method works for your coalition, make sure to contact your state’s webmaster about posting the document to the state’s website. You will need to be able to upload the document to the website and create content on your webpage to draw visitors’ attention to the document. If a partner agency is publishing the state plan, you should work with your webmaster to establish links so that visitors to your website can find the document quickly.

Section II: Preparing and Writing the Document cont'd

Consider the Purpose and Audience

As you are deciding the content and format of the state plan, you will need to consider two main points:

• The Plan’s Purpose
  • Internally: To organize and inspire partners to identify the major issues affecting the burden of diabetes or chronic disease in your state and implement evidence-based interventions to address them.
  • Externally: To call attention to the problem of diabetes or chronic disease in your state, informing policy-makers, key stakeholders, and the general public of the issue and engaging them in your initiatives. 
• The Plan’s Audience
  • Internally: For you and your partners, the plan serves as a written charter to regularly consult and follow through the next few years. It represents the official commitment you and your partners have made to address the burden of diabetes or chronic disease in your state.
  Thought Provoker: Why is it important to have your rationale and audience in mind when organizing and writing your plan?
  • Externally: For policymakers, key stakeholders, and the public, the state plan serves as a way to inform them of the planning efforts and the initiatives to be implemented, and ask for their support.

Throughout the process of organizing and writing the plan, you will need to keep the internal and external purposes and audiences in mind.

Section II: Preparing and Writing the Document cont'd

Organizing Content Effectively

Ideally, your state plan will be informative and persuasive. It should appropriate for multiple audiences, including policymakers, key stakeholders, people with diabetes or chronic disease, and the general public. You will need to design the document so that it is easy to understand and relevant to all of these audiences - a function of both content and format. Below are some general guidelines to consider regarding content and organization that will help ensure the document is appropriate for all of your target audiences.

Content

• In choosing which content to include, be guided by the readers’ interests, knowledge, and needs
• Show awareness of and respect for diversity among intended readers
• Limit the information to an amount that is reasonable for the intended readers

Organization

• Organize information and messages so they are easy to act on and recall
• Give the most important information first, and restate it at the end of the document
• Use headings and subheadings to group the information
• Limit the amount of information to three or four main ideas per subheading

Section II: Preparing and Writing the Document cont'd

Writing Styles

Along with what is included (content) and how it is arranged (organization), the actual writing style of the state plan document is important in engaging the target audiences and ensuring they understand the plan. When you prepare the written content for your state plan, you must consider literacy, health literacy, and numeracy levels. Even individuals with advanced education may have low health literacy or numeracy levels.

• Keep sentences simple and relatively short
• Be direct, specific, and concrete, using an active voice
• Use correct spelling and grammar
• Choose words with a single definition or connotation when possible
• Be consistent with word use
• Use analogies familiar to your audience
• Avoid unnecessary abbreviations and acronyms

Limit use of jargon, technical, scientific, or medical language. If this language must be used, define terms in the text.

Section II: Preparing and Writing the Document cont'd

Using Stories to Personalize the Issues

Consider including personal stories that appeal to the average reader. Stories make readers personalize the information and identify with the people involved.  There are three broad categories of stories you may wish to include in your state plan:

• Stories about individuals living with diabetes or chronic disease that help readers understand who is at risk, how it affects one’s life, and how individuals manage the disease.
• Stories about individuals who work with people with diabetes or chronic disease, such as those who medically treat people or those who teach people how to manage the disease. 

Stories about organizations and agencies that work to address the burden of diabetes or chronic disease, emphasizing empowerment and engagement with the community and affected populations.

When you use stories in your state plan, you should use real people and real incidents. Wherever possible, you should use the words of the persons involved (with their permission, of course!). Using stories in your plan will help readers connect with the material, making it more persuasive and relatable.

Section II: Preparing and Writing the Document cont'd

Making Your Plan Relevant to Policymakers

One audience in particular that you will want to engage is policymakers. There are two main strategies that will make your plan relevant to policymakers: 

• Bring the problem home to their constituency. 
• Break down prevalence by legislative and Congressional districts. 
• Point out gaps in services available to persons with diabetes/chronic disease in the districts.
• Highlight your initiatives’ successes in addressing the burden of diabetes/chronic disease in the districts. 
• Be explicit about how your proposed strategies will be implemented in the districts and what support is needed for success. 
• Highlight any relevant legislation and the impact it may have on people in the state and in the districts.
  
• Make a strong cost-benefit argument.
• Highlight the long-term projected trends in prevalence and health care costs if efforts are not made to prevent and control diabetes/chronic disease.
• Break out the health care costs associated with treatment of individuals with uncomplicated diabetes/chronic disease, uncontrolled diabetes/chronic disease, and complications from diabetes/chronic disease.
• Examine costs associated with losses in productivity to persons with diabetes/chronic disease.

Section II: Preparing and Writing the Document cont'd

Further Writing Resources

Below are additional resources that explain how to prepare materials for a variety of target audiences. Although many of these resources discuss developing health education materials for audiences with low literacy, they can also be useful when preparing a document with multiple audiences.

Gateway to Health Communication Website (CDC): http://www.cdc.gov/healthcommunication/. Check the “Tools and Templates” page for tools like Simply Put: A Guide for Creating Easy-to-Understand MaterialsandWhat We Know about Health Literacy.

Health Literacy Website (CDC): http://www.cdc.gov/healthliteracy/. This site has links to materials from CDC, the National Institutes of Health, the Centers for Medicare and Medicaid, and the federal government initiative, Plain Language.

Outreach & Education Page (CMS): http://www.cms.gov/Outreach-and-Education/Outreach-and-Education.html. Check out the 11-part Tool-Kit for Making Written Material Clear and Effective.

Key Elements of Clear Writing and Design: Click here to download a PDF that summarizes some of the information presented in the resources above, like Simply Put and the Tool-Kit for Making Written Material Clear and Effective

Section II: Preparing and Writing the Document cont'd

Reviewing and Editing the Plan

Once the plan has been written and organized into an initial draft, the review and editing processes can begin. The document will need to be reviewed by skilled editors and proofreaders to check content, style, spelling, punctuation, and grammar. In general, the editing process has four main steps:

1. Edit initial draft for grammar, punctuation, and spelling.
2. Circulate draft among partners and representatives from key target audiences. Give them clear guidance on the review process, as well as a deadline for comments.
3. Edit content based on feedback after all comments are received. Keep in mind that the final document represents the coalition, not any specific partner, and should reflect the public health perspective.
4. If using an external publisher, send updated draft to publisher to create proofs. Review proofs once they are available.

Once final edits have been made and the document is ready for publishing, you will need to take your plan through the appropriate approval process.

Section II: Preparing and Writing the Document cont'd

Taking Your Plan through the Approval Process

Government agencies usually have a formal approval process for published documents to determine if the content and format meet the agency’s standards of publication. The managing editor or lead staff person from the state department of health should determine your agency’s approval process requirements early, as the process can take some time. This would include identifying who must review and approve the plan and the appropriate way to submit the document to them. Based on this information, you can create a timeline for publication that will help explain the process to your partners.

Once the document has entered the approval process, check in at regular intervals to assess progress. You should keep your partners informed of progress and delays in the approval process, as it will affect the publication of your state plan.

Module 7, Section II Summary & Activity

Section II of this module described ways to make your plan easy to read, interesting, and persuasive. It also provided information on the process of reviewing, editing, and securing approval of the state plan.

Consider the content of this section as you answer the following questions:

1. In the past, has your state produced the state plan or did a partner? Who served as managing editor?
2. What kinds of personal stores could be included in your state plan that might be particularly effective in your state? How could you help gather these stories?
3. What is the document approval process in your state agency? Approximately how long does it take from when the process begins to final approval?

Module 7, Section III: Disseminating the State Plan

Introduction

After your plan has been written, reviewed, and approved, it is ready to be distributed. Even before you begin the approval process, the coalition should convene to discuss dissemination and communication plans related to releasing the state plan. This involves creating a timeline for the release, mechanisms through which the plan will be distributed, and specific approaches for working with different target audiences and the general public.

This section will describe how to distribute the plan to coalition partners, partners in public health, and policymakers, as well as getting media coverage to introduce the plan to a wider audience.

Section III: Disseminating the State Plan cont'd

Disseminating the Plan to Partners

It is important to provide sufficient hard copies of the plan to coalition partners to acknowledge the importance of their involvement and to gain their assistance in disseminating the plan to the public. Your partners can share the document with senior members of their organizations, their networks and their members.

It is also important to provide copies of the plan to public health partners at the state and local levels, including other state chronic disease programs, local health departments, and local coalitions. In addition, the plan should be provided to key staff involved in the interventions proposed in the plan.

Section III: Disseminating the State Plan cont'd

Developing Collateral Materials

In addition to distributing copies of the state plan to state and local partners, you should develop collateral materials to accompany the plan document that can be used to explain the information in the plan to the public and stakeholders. These materials could include:

• Sets of PowerPoint slides focusing on different sections of the document (e.g. burden, goals, strategies, objectives, and activities)
• Sets of PowerPoint slides intended for different audiences (e.g. policymakers, healthcare providers, general public)
• Sample press releases
• Frequently Asked Questions
• Talking points for discussions with media
• Fact sheets summarizing key burden and economic impact data
• List of partner organizations
• Background information such as pamphlets or educational materials

Providing these resources will assist your state and local partners in effectively delivering information about the state plan to stakeholders and the public.

Section III: Disseminating the State Plan cont'd

Disseminating the State Plan to Policymakers

Become familiar with the definitions and rules for lobbying (see the Alliance for Justice website at www.allianceforjustice.org) and consult your internal agency rules, as well as state and federal laws.

Policymakers, including appointed and elected officials at the state and local levels, are another important and distinct audience for your state plan. You can work with partners to educate policymakers about the burden of diabetes or chronic disease, especially its economic impact, and the importance of policy and systems change in addressing the problem.

For example, many state coalitions organize an “education day” when their state legislature is in session. Coalition members make appointments with state legislators to present the state plan and a fact sheet that defines the diabetes or chronic disease burden in specific legislative districts, examines the economic impact, and shows how evidence-based programs and policies can be effective in reducing the problem. Coalition members invite local voters to participate, so that the legislators can see that this is a critical issue to their constituents.

Section III: Disseminating the State Plan cont'd

Media Coverage

Media coverage is a way to introduce the state plan to a wide variety of audiences and the general public. You will need to develop a press release that can be distributed to media outlets in print, radio, television, and electronic media. Along with the press release, you can distribute a press kit containing copies of the state plan, additional information or fact sheets, and contact information.

Simply distributing the press kits will not guarantee media coverage. You should also consider:

• Holding a press conference featuring appointed and elected officials, public health leadership, key partners, and persons with diabetes/chronic disease.
• Inviting the media to attend a relevant conference or other special event and encouraging them to highlight your state plan as part of their coverage.
• Utilizing partners’ relationships with writers or reporters who may be willing to highlight your coalition and the state plan in a story.
• Contacting media outlets that serve specific communities or populations targeted in a proposed intervention by sending them copies of the plan and press kits.

You may find it easier to get free (earned) media coverage of your state plan if you schedule the release to coincide with an awareness observance - for example, November is American Diabetes Month. Information on annual health-related awareness observances can be found here: http://healthfinder.gov/nho/Default.aspx.

Module 7, Section III Summary & Activity

Section III described the various ways to disseminate your plan to partners, stakeholders, policymakers, and the general public.

Now, think about how these concepts apply to your state planning process. Watch the video below, in which state department of health staff and partners in Kentucky and Pennsylvania talk about disseminating their state plan, and then answer the questions that follow. Click here for a worksheet to record your answers.

1. Why is it important to bring statewide attention to implementation of the state plan?
2. What are two strategies to help get the media’s attention when disseminating your state plan?

Module 7 Summary

Module 7 described key concepts to guide the process of creating, editing, approving, and disseminating your state plan.

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

The creation of a state plan document marks the commitment that you and your partners have made to address the burden of diabetes or chronic disease in your state. You should make sure that your coalition schedules time to meet and celebrate the successful completion of the collaborative planning process and the production of the state plan! But remember, your work is not yet done. The coalition must use the plan to guide its work and keep momentum going.