"

4 Module 4: Critical Thinking and Theory Application in Communities

Overview of Readings

  • Bonn, S. A. (2017). Beware the Power Elite https://www.psychologytoday.com/us/blog/wicked-deeds/201708/beware-the-power-elite-in-society-0
  • Taylor Jr, H. L. (2020). Disrupting market-based predatory development: Race, class, and the underdevelopment of Black neighborhoods in the US. Journal of Race, Ethnicity and the City, 1(1-2), 16-21. DOI:10.1080/26884674.2020.1798204
  • Ohmer, M. L. (2010). How theory and research inform citizen participation in poor communities: The ecological perspective and theories on self-and collective efficacy and sense of community. Journal of Human Behavior in the Social Environment, 20, 1-19. DOI: 10.1080/10911350903126999
  • Community Toolbox readings, provided below
    • Chapter 3, Section 5: Analyzing Community Problems (main section)
    • Chapter 3, Section 23: Developing and Using Criteria and Processes to Set Priorities (main section)

Community Toolbox

Chapter 3, Section 5: Analyzing Community Problems

Learn how to analyze community problems to better understand root causes and plan effective interventions.

Communities have problems, just like people

Problems are part of life. We all deal with individual problems, families have family issues, and communities have community problems. Communities must come together to solve their problems, just like families.

When communities try to solve problems, they start just like individuals do. They must reflect and analyze the issue to help come to a solution. But, before discussing solutions, problems must be identified.

So, after discussing a little bit about what problems look like, this section will explain what analyzing community problems is about, why it can be helpful, and then how to do it.

What is a community problem?

Problems can arise in any part of a community and come from any aspect of community life. There’s a long list of nominees, and you probably know some of the main contenders. Can you name the leading problems in your community? Chances are you can at least start the list.

Below are examples of community problems:

Example Community Problems: Adolescent pregnancy, access to clean drinking water, child abuse and neglect, crime, domestic violence, drug use, pollution, mismanagement of resources, lack of funding for schools and services, ethnic conflict, health disparities, HIV/ AIDS, hunger, inadequate emergency services, inequality, jobs, lack of affordable housing, poverty,  transportation, violence, racism and police brutality.

What others would you add?

Rather than aim for a complete problem list, here are some criteria you may consider when identifying community problems:

  • The problem occurs too frequently (frequency)
  • The problem has lasted for a while (duration)
  • The problem affects many people (scope, or range)
  • The problem is disrupting to personal or community life, and possibly intense (severity)
  • The problem deprives people of legal or moral rights (equity)
  • The issue is perceived as a problem (perception)

This last criterion, perception, is an important one, and can also help indicate readiness for addressing the issue within the community.

What is seen as a problem can vary from place to place and group to group in the same community. Although there’s no official definition of a community problem, the above examples and criteria above should help you begin to name and analyze community problems.

Why should I analyze a community problem?

Analyzing community problems is a way of thinking carefully about a problem or issue before acting on a solution. It first involves identifying reasons a problem exists and then, identifying possible solutions and a plan for improvement.

Example: The downtown area of a community is declining. Stores are closing, and moving out; no new stores are moving in. We want to revitalize that downtown. How should we do it?

Our thinking here is simple:

  • We should start by analyzing why the decline is taking place, that is, why the problem is occurring. Without knowing causes, we cannot fix the problem. Jumping in and trying to fix it without analysis can cause a bigger problem and waste resources.
  • An in-depth analysis will lead to better long-run solutions.

Starting with an analysis can help…

To better identify what the problem or issue is.

Kids gather on the street. Sometimes they drink, and sometimes, they get rowdy. What is the problem here? The drinking, the rowdiness, the gathering itself? Or, is it possible that kids have nowhere else to go and few positive alternatives for engagement? Before looking for solutions, you would want to clarify just what is the problem (or problems) here. Unless you are clear, it’s hard to move forward.

Problems are usually symptoms of something else. What is that something? We should find out.

To determine the barriers and resources associated with addressing the problem.

It’s good practice and planning to anticipate barriers and obstacles before they might arise. By doing so, you can mitigate them. Analyzing community problems can also help you understand the resources you need. The better equipped you are with the right resources and support, the higher your chances of success.

To develop the best action steps for addressing the problem.

Having a plan of action is always better than taking a few random shots at the problem. If you know where you are going, you are more likely to get there.

Having a deeper understanding of a problem before you start trying to solve it helps you cover all of your bases. There’s nothing worse for member involvement and morale than beginning to work on a problem, and running up against lots of obstacles, especially when they are avoidable.

When you take a little time to examine a problem first, you can anticipate some of these obstacles before they come up, and give yourself and your members better odds of coming up with a successful solution.

When should I analyze a community problem?

Every community problem benefits from analysis. The only possible exception is when the problem is an immediate crisis that requires action at this very moment. And even then, reviews should be conducted after to help plan for the next crisis.

However, there are conditions when an analysis is especially critical:

  • When the community problem is not defined clearly
  • When little is known about the community problem or its possible consequences
  • When you want to find causes that may improve the chance of successfully addressing the problem
  • When people are jumping to conclusions and solutions much too soon
  • When you need to find collaborative partners to help take action.

How should I analyze a community problem?

The ultimate goal is to understand the problem better and to deal with it more effectively, so the method you choose should accomplish that goal. We’ll offer some step-by-step guidelines here and go over a couple of specific ways to determine the causes of the problem.

1. Justify the choice of the problem.

Apply the criteria we’ve listed above – frequency, duration, range, severity, equity, perception – as well as asking yourself whether your organization or another can address it effectively, in order to decide whether the problem is one that you should focus on.

Let’s take the problem we used as an example earlier: The percentage of overweight and obese children in the community has been steadily increasing, and now approaches 25%. Since we know that childhood obesity tends to lead to adult obesity, and that obesity and being overweight are linked to chronic conditions – diabetes, heart disease, stroke – this is a problem that needs to be addressed now. Our organization has the will and the ability to do it.

2. Frame the problem.

State the problem without implying a solution or blaming anyone, so that you can analyze it without any assumptions and build consensus around whatever solution you arrive at.  One way is to state it in terms of a lack of a positive behavior, condition, or other factor, or  the presence or size of a negative behavior, condition, or other factor.

There are too many children in the community who are overweight or obese. The problem is particularly serious among low-income families.

3. Identify whose behavior and/or what and how environmental factors need to change for the problem to begin to be solved.

This can be as straightforward as individuals changing their behavior from smoking to not smoking, or as complex as persuading legislators to change laws and policies (e.g., non-smoking ordinances) in order to change others’ behavior (smokers don’t smoke in buildings or enclosed spaces used by the public) in order to benefit yet another group by changing the environment (children are protected from secondhand smoke in public.)

All, and particularly low-income, children should have the opportunity and the motivation to eat more healthily and exercise more. Parents may need to change their children’s – and perhaps their own – diets, and schools may need to adjust their lunch programs and exercise schedules. In low-income neighborhoods, there needs to be greater access to healthy food and more safe places for children to play or participate in sports, both outdoors and indoors.

4. Analyze the root causes of the problem.

The real cause of a problem may not be immediately apparent.  It may be a function of a social or political system, or may be rooted in a behavior or situation that may at first glance seem unrelated to it. In order to find the underlying cause, you may have to use one or more analytical methods, including critical thinking and the “But Why?” technique.

Very briefly, the latter consists of stating the problem as you perceive it and asking “But why?” The next step is to answer that question as well as you can and then asking again, “But why?” By continuing this process until you get an answer that can’t be reduced further, you can often get to the underlying cause of the problem, which will tell you where to direct your efforts to solve it.

The difference between recognizing a problem and finding its root cause is similar to the difference between a doctor’s treating the symptoms of a disease and actually curing the disease. Once a disease is understood well enough to cure, it is often also understood well enough to prevent or eliminate. Similarly, once you understand the root causes of a community problem, you may be able not only to solve it, but to establish systems or policies that prevent its return.

There are too many children in the community who are overweight or obese. The problem is particularly serious among low-income families. (But why?)

Because many low-income children don’t eat a healthy diet and don’t exercise enough. (But why?)

Because their parents, in many cases, don’t have the knowledge of what a healthy diet consists of, and because, even if they did, they lack access in their neighborhoods to healthy foods – no supermarkets, produce markets, farmers’ markets, or restaurants serving healthy food – and therefore shop at convenience stores and eat out at fast food places. Kids don’t play outside because it’s too dangerous – gang activity and drug dealing make the street no place for children. (But why?)

Parents may never have been exposed to information about healthy food – they simply don’t have the knowledge. Market owners view low-income neighborhoods as unprofitable and dangerous places to do business. The streets are dangerous because there are few job opportunities in the community, and young men turn to making money in any way possible.

By this point, you should have a fair understanding of why kids don’t eat healthily or get enough exercise. As you continue to question, you may begin to think about advocacy with local officials for incentives to bring supermarkets to low-income neighborhoods, or for after-school programs that involve physical exercise, or for parent nutrition education or for anti-gang programs…or for all of these and other efforts besides. Or continued questioning may reveal deeper causes that you feel your organization can tackle.

5. Identify the restraining and driving forces that affect the problem.

This is called a force field analysis. It means looking at the restraining forces that act to keep the problem from changing (social structures, cultural traditions, ideology, politics, lack of knowledge, lack of access to healthy conditions, etc.) and the driving forces that push it toward change (dissatisfaction with the way things are, public opinion, policy change, ongoing public education efforts, existing alternatives to unhealthy or unacceptable activity or conditions, etc.) Consider how you can use your understanding of these forces in devising solutions to the problem.

Forces restraining change here include:

  • The desirability and availability of junk food – kids like it because it tastes good (we’re programmed as a species to like fat, salt, and sugar), and you can get it on every corner in practically any neighborhood.
  • The reluctance of supermarket chains to open stores in low-income neighborhoods.
  • The domination of the streets by gangs and drug dealers.

Some forces driving change might be:

  • Parents’ concern about their children’s weight.
  • Children’s desire to participate in sports or simply to be outdoors.
  • Media stories about the problem of childhood obesity and its consequences for children, both now and in their later lives.

A full force field analysis probably would include many more forces in each category.

6. Find any relationships that exist among the problem you’re concerned with and others in the community.

In analyzing root causes, you may have already completed this step. It may be that other problems stem from the same root cause, and that there are other organizations with whom you could partner. Understanding the relationships among community issues can be an important step toward resolving them.

We’ve already seen connections to lack of education, unemployment, lack of after-school programs, and gang violence and crime, among other issues. Other organizations may be working on one or more of these, and a collaboration might help both of you to reach your goals.

7. Identify personal factors that may contribute to the problem.

Whether the problem involves individual behavior or community conditions, each individual affected by it brings a whole collection of knowledge (some perhaps accurate, some perhaps not), beliefs, skills, education, background, experience, culture, and assumptions about the world and others, as well as biological and genetic traits. Any or all of these might contribute to the problem or to its solution…or both.

A few examples:

  • Genetic predisposition for diabetes and other conditions.
  • Lack of knowledge about healthy nutrition.
  • Lack of knowledge/ skills for preparing healthy foods.

8. Identify environmental factors that may contribute to the problem.

Just as there are factors relating to individuals that may contribute to or help to solve the problem you’re concerned with, there are also factors within the community environment that may do the same. These might include the availability or lack of services, information, and other support; the degree of accessibility and barriers to, and opportunities for services, information, and other support; the social, financial, and other costs and benefits of change; and such overarching factors as poverty, living conditions, official policy, and economic conditions.

Sample environmental factors:

  • Poverty
  • Lack of employment and hope for young men in low-income neighborhoods
  • Lack of availability of healthy food in low-income neighborhoods
  • General availability – at school as well as elsewhere – of snack foods high in salt, sugar, and fat
  • Constant media bombardment of advertising of unhealthy snacks, drinks, and fast food

9. Identify targets and agents of change for addressing the problem.

Whom should you focus your efforts on, and who has the power to improve the situation?  Often, these may be the same people. The best solution to a particular problem may be policy change of some sort, for instance, and the best route to that may be to mount an advocacy effort aimed at officials who can make it happen. People who are suffering from lack of skills or services may be the ones who can do the most to change their situation. In other cases, your targets may be people whose behavior or circumstances need to change, and you may want to recruit agents of change to work with you in your effort. The point of this step is to understand where and how to direct your work most effectively.

Targets of change might include:

Parents of children in low-income neighborhoods (or all parents in the community) for education purposes
The children themselves
Elementary and middle school teachers
School officials responsible for school food programs
Executives and Public Relations officers of supermarket chains
Gang members and youth at risk of becoming gang members

A short list of potential agents of change:

Parents of children in low-income neighborhoods (or all parents in the community) as controllers of their children’s diets
The Superintendent of Schools, School Committee, and school administrators, as well as those directly responsible for school food programs
Local public officials who could create incentives for markets to move into underserved neighborhoods
Community Recreation Commissions, school officials, YMCAs, and other entities that might create safe outdoor and indoor physical activity programs for children
Community hospitals, clinics, and private medical practices
Public relations offices of national or regional fast food restaurant chains

With your analysis complete, you can develop a strategic plan that speaks to the real causes of the problem and focuses on those targets and/or agents of change that are most likely to contribute to improving the situation.

Going beyond the basics — does analysis really work?

Try this analysis out with a current problem in your own community setting.

What do you conclude? We hope you’ll find some value in analysis. We do know that when we have tried this method with real problems in our own communities, we have drawn some additional conclusions of our own, going beyond the basics:

  • Analyzing community problems can be hard work. It takes real mental effort. We’re not used to sitting down and thinking deeply about a problem. (We’re too busy!)
  • Real community problems are likely to be complex. Economic development may depend on the global economy, a force you can’t have much effect on. You may have opposition, either from within the community itself, or from powerful forces trying to protect their own interests.
  • When you go looking for reasons and underlying causes for significant problems, you are likely to find more than one. Several different reasons may be influencing the problem, in different amounts, all at the same time. It may not be an easy task to untangle all the reasons and their relative strengths, but it may be necessary in order to reach a solution.
  • The problem may not only have more than one reason; it may have more than one solution too. Problems often call for multi-pronged solutions. That is, difficult problems often must be approached from more than one direction. So in revitalizing the downtown, you might want to (a) beautify the streets; (b) expand the staff of the chamber of commerce; (c) run sidewalk sales; (d) look for outside loans; and (e) recruit new businesses. These are all parts of the solution. Many different types of actions might be necessary for revitalization.

When analyzing real community problems, the analysis may show multiple reasons behind the problem. The analysis may not always be easy. The solution may be more difficult still.

But that’s why problems are problems. Community problems exist precisely because they often resist clear analysis and solution. They persist despite our efforts. They can be real challenges.

Yet this doesn’t mean we are helpless. Analysis, including the analytic methods we have described, can take you a long way. With good analysis, some resources, and enough determination, we believe even the most troublesome problems can be addressed, and ultimately, solved.

Contributor
Bill Berkowitz

Online Resources

Assessment Primer: Analyzing the Community, Identifying Problems and Setting Goals is provided by the Community Anti-Drug Coalitions of America and the National Community Anti-Drug Coalition Institute. This helpful primer is designed to provide clear guidelines for anti-drug coalitions in defining their communities and assessing the real needs within them.

Best Practices to Address Community Gang Problems from HealthyPeople.gov is a report that provides guidance to communities that are considering how to address a youth gang problem.

Framing the Issue, by Trudy Rice, Cheryl Burkhart-Kriesel and Karla Trautman, is a useful resource that explains how to analyze community problems and access community data. It includes a detailed step-by-step presentation.

Print Resources

Avery, M., Auvine, B., Streibel, B., & Weiss, L. (1981). Building united judgement: A handbook for consensus decision making. Madison, WI: Center for Conflict Resolution. (Available from the Center at P.O. Box 2156, Madison, WI 53701 -2156).

Cox, F. (1995). Community problem solving: A guide to practice with comments. In Rothman, J., Erlich, J., & Tropman, J. (eds.), Strategies of community intervention (5th ed., pp. 146-162). Itasca, IL: F. E. Peacock.

Dale, D., & Mitiguy, N. (1978). Planning for a change: A citizen’s guide to creative planning and program development. Amherst, MA: University of Massachusetts, Citizen Involvement Training Project.

Johnson, D., & Johnson, F. (1997). Joining together: Group theory and group skills (6th ed.) Boston: Allyn and Bacon.

Lawson, L., Donant, F., & Lawson, J. (1982). Lead on! The complete handbook for group leaders. San Luis Obispo, CA: Impact Publishers.

Mondross, J., & Wilson, S. (1994). Organizing for power and empowerment. New York, NY: Columbia University Press.


Chapter 3, Section 23: Developing and Using Criteria and Processes to Set Priorities

Learn how to establish criteria for determining priorities in community improvement projects.

 

Image of a tiled floor with the quote: The role of leadership is to transform the complex situation into small pieces and prioritize them.

  • What do we mean by developing and using criteria and processes to set priorities?

  • Why develop and use criteria and processes to set priorities?

  • Who should be involved in developing and using criteria and processes to set priorities?

  • When should you develop and use criteria and processes to set priorities?

  • How do you develop and use criteria and processes to set priorities?

A community needs assessment is meant to bring to light issues in the community that need to be addressed. However, it’s unlikely that all those issues can be dealt with at the same time. You have to make choices about what’s most important and timely to deal with…but how do you decide what “important” means? Who gets to choose, and how? And once those choices have been made, how do you decide on the ways to address the issues you’ve identified as most urgent?

If you make those decisions well, your eventual action plan will effectively target the real needs of the community. In this section, we’ll discuss how you might go about choosing criteria for deciding which issues are most important to address and for deciding on the best strategies for addressing them. We’ll also look at how to develop processes for doing the choosing that are likely to result in good decisions and community support for your effort.

What do we mean by developing and using criteria and processes to set priorities?

First, let’s define some terms:

Criteria are standards for making a judgment. They provide guidelines for making decisions. They aren’t set in stone: the criteria you use for examining a particular set of issues may be different from those you us for another set, depending on the community you’re aiming at, the conditions that are in place at the time of the decision, the needs and concerns of the people making the decision, and other factors.

Priority is the order of importance in which one thing falls in relation to another. Like a set of criteria, priorities may change with changes in the community, or with changes in people’s concerns or knowledge.

When a community assessment has uncovered a number of issues – perhaps issues in different areas, such as health, economics, and racial attitudes – developing a set of criteria for deciding how important each one is to address is crucial to effective action. Without considering what its standards are beforehand, a planning group may be reduced to each member’s intuition or particular pet issue, and descend into argument and eventual chaos. That’s a worst-case scenario, but any level of confusion or aimless flailing can be avoided by establishing some agreed-upon criteria for determining what to tackle when.

There are two sets of criteria needed here. One will provide the guidelines for choosing one or more issues to work on. The second will help you determine what strategies and approaches are likely to be most effective in addressing the issues you’ve chosen. We’ll suggest some examples of each in the “how-to” part of the section.

The other necessary ingredient for cooking up a successful intervention or initiative is a decision-making process that will allow a planning group to choose criteria and approaches rationally and wisely.

In general, the ideal process is participatory and inclusive, involving all stakeholders – those affected by or concerned with the issues at hand – and the community at large. It’s best if it includes both people with technical expertise in the relevant fields – health, social policy, employment, etc. – and people grounded in the community. With that mix, criteria are likely to reflect best practices and good theory as well as real community needs, wishes, and norms.

To ensure community support, the fact that there is an inclusive process, developed at least in part by input from the participants in it, may be as important as the actual form of the process.

Why develop and use criteria and processes to set priorities?

  • It creates a structure that makes setting priorities more systematic and more likely to reflect the realities of the community.
  • It helps ensure the most important issues for your community are addressed. Using a set of criteria and a good decision-making process makes it much more probable that you’ll get the priorities right.
  • It provides an opportunity to involve the community in the effort and to get community buy-in. Any effort is far more likely to succeed if the community feels ownership of it and supports it.
  • An inclusive criteria-setting process makes sure you don’t miss anything that only stakeholders know. Community members, especially those most affected by issues, may have a clearer understanding of what’s important to the community and of which issues actually have the greatest impact on people’s lives.
  • Establishing criteria in a structured and inclusive way ensures that the process is an open one, and that any concerns are raised. It is essential to include those who are most affected by the problem.
  • The process of selecting criteria allows an opportunity to educate stakeholders who may not have had this kind of experience before about how to make informed, systematic decisions.

Who should be involved in developing and using criteria and processes to set priorities?

We’ve discussed involving all stakeholders…but just who are the stakeholders? There are several categories to be considered.

  • Those most affected by community issues and/or inequities. This category may include anyone, but most often involves groups with less power and influence.
    • People of low income
    • Diverse people and ethnicities, including immigrants
    • Youth
    • Seniors
    • People with disabilities
    • People living in substandard housing
    • Those most seriously at risk from or affected by particular health, economic, or social conditions
    • Those most seriously affected by negative environmental conditions
  • Organizations and institutions that serve or otherwise deal with those groups, including:
    • Health and human service providers, such as hospitals, welfare agencies, homeless shelters, and other community-based organizations
    • Faith communities
    • The business community, which needs access to a healthy and educated workforce
    • Schools and post-secondary institutions
    • Community coalitions
  • Those charged with carrying out or otherwise implementing proposed interventions, changes in policies or regulation, or preventative measures. These might include:
    • Staff of health and human service providers
    • School personnel
    • Public officials
  • Those whose jobs or lives will be affected by interventions, policy changes, or preventive measures. Some examples:
    • Police, who may have to respond to more calls
    • Landlords, who may be required to address substandard housing issues
    • Medical professionals, teachers, or others
  • Citizens concerned with the issue(s) at hand, including activists, academics, and professionals in fields related to the issues or populations of concern.
  • Local and other funders, such as United Way, state agencies, and foundations.

When should you develop and use criteria and processes to set priorities?

It is ideal to start creating a process to develop criteria for prioritizing issues as soon as you decide to conduct a community assessment. The process will go more smoothly if you’ve discussed and agreed upon criteria beforehand. Having an effective participatory decision-making process agreed to by community stakeholders as early in the process as possible is essential.

How do you develop and use criteria and processes to set priorities?

Assemble a participatory group representative of all stakeholders. The first step is to ensure participation and buy-in from the community by inviting stakeholders and other interested individuals and groups to constitute a planning group. Check with group members to make sure that there aren’t others who should be at the table. Make sure particularly that those most affected by community issues are represented, since their voices are the ones most often ignored. If only “leaders” – directors of organizations, CEOs, public officials, etc. – are part of the group, it’s likely that the community won’t feel ownership of the effort, and that the plan and intervention that result may not speak to the real needs of the people at whom they’re aimed.

Involving people who may not be used to being included in planning and implementing efforts can be time-consuming. They may need training and support before they’re comfortable speaking up in meetings and realizing that they bring a valuable perspective. They may also feel uncomfortable about not knowing the “rules” that pertain in meetings, and thus not participate for fear of getting it wrong. With support, however, these folks can become the most valuable members of a planning group because of their knowledge of the populations they belong to. The time spent to orient and support them is more than worth it.

For this reason, as well as for the smooth running of the group, it would be wise to find a facilitator who can relate to people of diverse backgrounds and who has experience with groups and with planning processes. A skilled facilitator’s presence and expertise at guiding decision-making can render the group’s tasks both shorter and more effective.

Identify the interests of various stakeholder groups in relation to the process of setting priorities and using them to plan the implementation of an intervention or initiative. Depending on their perspective – as health or human service providers, as part of the population affected by community issues, as public officials, etc. – their interests might have to do with:

  • The openness and fairness of the process
  • The use of a democratic process
  • The creation of a forum where all voices can be heard
  • The feasibility of the plan and of affecting the targeted issues
  • The costs of the plan
  • The use of proven practices
  • Whether individual or organizational certification can be obtained or enhanced by taking part in the effort
  • The involvement of particular organizations or groups
  • The need for funding or matching funds
  • The necessity of a plan that will address stakeholders’ specific areas of concern
  • The necessity of addressing social determinants
  • The importance of being respectful of all and of their concerns, even when there’s disagreement

Establish clear criteria for setting priorities for community issues to be addressed. Through discussion, brainstorming, or another method of generating ideas, the group should be able to agree on a number of criteria. Some possible examples, depending on the issues involved and the needs of the community:

  • The seriousness of the issue – the death of a homeless person due to extreme temperatures, child hunger, etc.
  • The frequency of the issue – rare, affecting a majority of the community, confined to a single area, targeting a single population group.
  • The cost of the issue to the community – in dollars, in time spent dealing with it, in social costs (people afraid to leave their houses after dark, lost productivity from illness, etc.)
  • The feasibility of affecting the issue.
  • The resources needed to address the issue adequately.
  • The community’s perception of the issue’s importance.
  • The readiness of the community to recognize and address the issue.
  • The long-term impact of the issue.
  • The long-term benefit of your effort.
  • The fit of addressing the issue with your organization’s vision and mission.
  • The possibility of an intervention causing unintended negative consequences.

Establish a process for engaging stakeholders and the broader community in setting priorities for issues to address. Once you have a list of criteria, you’ll have to decide how to apply them in determining the priority order of the issues you’ve identified in your community assessment. Creating a process for doing so will make for smoother and more effective decision-making.

  • Review the criteria and ensure that everyone understands and continues to agree on them.
  • Discuss the issues in question, again making sure that everyone understands them and their implications. Some issues may in fact be eliminated as potential targets as a result of this discussion.
  • For each issue, discuss whether an issue is strategic or not – i.e., whether addressing it is feasible, whether it has larger implications, whether it ties into other efforts, whether addressing it will bring other benefits, etc.
  • Individually or in small groups, rate each issue in terms of its importance and the feasibility of affecting it.
  • Discuss the ratings as a group, examining whether some issues can be consolidated – i.e., considered as a single issue, or as two or more issues that could be addressed by a single intervention.
  • Using the criteria the group agreed upon, rank order the issues and select the highest three to five.​

There are a number of ways to do this. One is, after the discussions described above, to simply list the issues and have the group vote to identify the top choices. This can be done by a show of hands, or by asking people to write down their selections and tabulating the results. A common method is to give each person paper dots – often color-coded for first choice, second choice, etc. – to stick on the list of issues. The number and colors of the dots then serve to record the vote and to identify the issues group members thought most important.

There are a number of more formal prioritizing methods as well. See Tool #1 for descriptions of five of the most common.

  • From the top choices, vote on the issue or issues that you’ll address.

Establish criteria for selecting an approach to address each of your priority issues. Possible criteria might include:

  • Cost-benefit
  • Feasibility of carrying out the approach
  • The likelihood that the approach will resolve the issue
  • The fit of the approach with the effort’s/organization’s/institution’s vision and mission
  • The fit of the approach with community standards
  • The compatibility of the approach with efforts already ongoing
  • Whether the approach is a best or promising practice tried successfully elsewhere
  • The availability of people with the expertise to carry out the approach or to train others to do so
  • The availability of community assets that can be used in this approach
  • The availability of adequate resources to be effective
  • The possibility of collaboration or shared workload

Establish a process for selecting approaches. Once again, you have choices to make. The basic process here is likely to be very similar to the one you used to choose the issue(s) to work on.

  • Review the criteria for selecting approaches that you agreed on, and make sure that everyone understands them clearly and still agrees.
  • Discuss the possible approaches in terms of their history of success, their fit with the community context and standards, their appropriateness in relation to your mission, etc.
  • Individually or in small groups, rate the possibilities by how well they’re likely to work and how feasible they would be to implement.
  • Discuss the ratings as a group, considering whether one or more approaches might be consolidated or combined.
  • Rank order and select priorities, using the same method as that used for prioritizing issues.
  • From the top choices, vote on which approach(es) to use.

Finalize your choices. Make sure you’ve considered such factors as what else is going on in the community, where your resources are likely to come from, who might best implement the effort, and whether people will have to be hired for the purpose.

Make sure as well that your final decisions are truly agreed-upon and participatory. As we’ve discussed, there are likely to be people in the group who have little experience with this kind of process, and who may be reluctant to speak up, especially if they disagree with the majority. Yet they may have information or emotional reactions that are extremely important because of their grounding in the community. It’s essential that the planning group’s facilitator makes sure to draw them out and that the group supports them in speaking out, regardless of the substance of their comments.

If you are working with more than one issue, try to identify factors that relate to all of them. You may find that, rather than approaching issues directly, you can be more effective by directing efforts toward social determinants or root causes that affect issues “upstream.” Looking at health issues, for example, a focus on environmental changes to enhance access to healthy food for all can help reduce cardiovascular disease and health disparities.

Look for ways in which your issue and approach might mesh with other community efforts. Look for overlap or ways to share work or collaborate with other efforts. If parts of your approach or initiatives aimed at your target are already in place and successful, make sure you’re working together rather than at cross purposes, and that you’re not trying to reinvent the wheel. The more collaborative your approach, the more likely that everyone in the community will be positively affected.

Be prepared to monitor your effort and change priorities as conditions change. Communities continue to develop and change, and your effort should change as well if it’s no longer addressing the needs that are most urgent and most important to community members. You can use your criteria and your processes whenever you think you might need to change direction.

In Summary

Establishing criteria – standards – and processes for deciding on what are the most important issues to tackle and how to tackle them makes those decisions much easier. It also allows for a participatory planning process from the very beginning of an effort, thus helping to obtain community support and ownership of the plan for addressing issues. Furthermore, it supplies a tool that the community can use both to adjust the implementation of the effort in response to changes in conditions in the community or in future endeavors.

Contributor
Phil Rabinowitz

Online Resources

The Guide to Prioritization Techniques is from the National Association of County & City Health Officials and provides five widely used options for prioritization, including guidance on which technique best fits the needs of your agency, step-by-step instructions for implementation, and practical examples.

BMC Health Services Research. Setting priorities in health care organizations: criteria, processes, and parameters of success. Jennifer L. Gibson, Douglas K. Martin, Peter A. Singer. Biomed Central, Ltd, 2004.

Strategic Issues – Overview, also from the National Association of County & City Health Officials, offers five steps for how to identify stragetgic issues.

Print Resources

Fawcett, S., Holt C., & Schultz J., Some Recommended Practice Areas for Enhancing Community Health ImprovementWork Group for Community Health and Development / World Health Organization Collaborating Centre, University of Kansas.