A non-cringey survey that helps coalitions understand themselves

Today, I’m going to talk about surveys.

Does that make you cringe?

I understand if it does. Surveys get a bad rap.

We’re often trying to get participants in a program or members of a community to take a survey, and - often - we don’t provide enough context for them to buy into the value of the information they’re sharing or for them to believe any changes will result from their input. To be fair, and to make matters worse, oftentimes there aren’t changes made as a result of survey responses.

There is a time and place for participant/community surveys, we certainly use them in our work here at PoP Health, and we have some thoughts on how to make them less painful and more impactful - more to come on that in a later newsletter.

But today, I’m here to talk about a kind of survey that doesn’t have quite as many potential pitfalls. A non-cringey survey, if you will.

This is a survey that coalitions and collaboratives can use to reflect on themselves. For lack of a better name, we call them partnership surveys.

These surveys are solely for members of the coalition, and the results help coalition members understand who they are and what they bring to the table, where they already have a lot of energy and expertise to move things forward, and where they may have gaps that need to be filled.

As per the latest guidance from the National Association of City and County Health Officials (NACCHO)’s, by way of their Mobilizing Action through Planning and Partnerships 2.0 process, local health departments are encouraged to begin their community health improvement assessment process with exactly this kind of survey (they call it a Community Partners Assessment).

I mentioned this briefly in the last issue of Community Threads, but we used this kind of survey in advance of our kick-off meeting with the Perry County Health Coalition in Pennsylvania earlier this month. At the meeting, we shared the survey results - which painted a picture of:

• Top action planning priorities;

• What members hope to accomplish via participation in the coalition;

• Current coalition composition, sectors and topics represented, populations touched by coalition member organizations, and suggestions around organizations, individuals, and communities to engage (either directly as coalition members or at other levels of engagement);

• Alignment between member organization focus areas and focus areas identified in the 2022 health assessment the coalition completed;

• Current and desired levels of engagement in the coalition;

• Activities and tasks members are most interested in supporting;

• Desired meeting format, frequency, and scheduling.

As you can imagine, by gathering this information ahead of the meeting and then sharing the synthesized responses and drawing out the key takeaways, we were able to facilitate a much more meaningful, nuanced discussion about where to go from here.

And since we were only surveying members of the coalition - who were already bought into the work of the coalition and wanted to actively use the results to inform their work - this survey rated pretty high on the non-cringey scale.

Have I convinced you that partnership surveys are non-cringey? Feel free to disagree with me (or share other examples of non-cringey surveys!) - drop me a line!

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Leveraging the power of in-person gathering

I’ve been thinking a lot about the power of in-person gathering on the professional end as well. After a long summer vacation, this Fall has been a period of reconvening in person.

Last month, we had an in-person kick off for a DC School Behavioral Health Consortium that drove home the energy and sense of community that can come simply from sitting around the same table. I also loved the icebreaker the meeting conveners used to set the stage for our time together - they shared a collage of different images representing collaboration and asked each person, as we went around the room for introductions, to share which image resonated most with them and why. What a great way to orient the group to the reason we had come together and unearth some key distinctions and nuances in how each person at the table might approach this work. We’ve gotten used to “setting the stage” activities in virtual spaces, but they are just as valuable in in-person gatherings.

Last week, we had our second annual set of Ignite presentations and data sensemaking sessions for our work (in partnership with the Center for Health and Healthcare in Schools at GW) as the Monitoring, Evaluation, and Learning partner for an antiracist, whole child development initiative in DC schools. Although this kind of sharing of our work and making sense of data visuals could, technically speaking, be done virtually, there is something about the power of being seated in a circle and lending our full attention to the discussion at hand that is hard to recreate on Zoom. There is also perhaps something even more powerful about the “sideline” conversations that occur between partner organizations during an in-person gathering, especially one that includes time to share meals together and catch up informally, as we did on both days of this convening. One of our partners emailed us after the event, “I wanted to thank you all for such an impactful convening this week. It was really inspiring to be around such a thoughtful group of educators/advocates and to be able to more deeply connect the dots across the entire project. I was even able to leave with immediate steps to further collaborate with [two of the other partner organizations on particular projects].” This is exactly what we hope can arise from bringing people together.

And finally, later this week, we are kicking off our partnership with the Perry County Health Coalition in Pennsylvania with an in-person convening of the coalition - the first time they’ll be gathering in person since 2019! So we’re trying to be thoughtful about how we make this brief time together as meaningful as possible. One thing we did is send around a survey and conduct a few interviews several weeks in advance of the meeting. We’ll be sharing our findings from the survey and interviews at the meeting as a launchpad for further discussion - this approach allows us to get the more obvious and consensus-y ideas shared quickly, leaving more of our precious in-person time to navigate the areas where there is complexity, uncertainty, or disagreement.

None of this is to say there is not unique power in virtual gathering - here at PoP Health, we love facilitating virtual convenings and have lots of tips and tools to make that time meaningful, engaging, and productive.

It’s just that this past month in particular, we’ve also been thinking a lot about the power of in-person gathering and how we can leverage that.

Reader, curious to hear your thoughts - in your experience, what’s the unique value-add of gathering in person? And how can we best leverage the power of those (sometimes rare) opportunities to be together in the same physical space? Drop me a note!

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How to keep people engaged in community health improvement efforts

Have you ever struggled to keep people engaged in a community health improvement effort (or any effort, for that matter)?

I work with a lot of community coalitions and collaboratives, and most of them are volunteer-based, which makes this question of how to maintain engagement especially important. But even those that compensate their members for their involvement need to consider the question of how to keep people involved and inspired and motivated to participate and act in meaningful ways.

In my line of work, with public health focused coalitions, people are generally at the table because they care - they care about the health of the community and they want to help make it better. But there are so many services and supports to coordinate and so many partners to collaborate with; it’s hard to know where to start; and there is simply not enough time in the day, especially since most coalition members have their actual day jobs to do.

Whether you are recruiting members or trying to hold onto the ones you already have, what’s the secret to keeping folks engaged?

This week, I came across an interview with Arthur C. Brooks (a Harvard professor who studies, teaches, and writes about happiness) about “the secrets to happiness at work,” and I think it’s spot on and extremely relevant to this question of how we keep coalition members engaged in the work of the coalition.

Here’s what he says on this topic: “The two parts of work that really matter [for happiness at work] are not title, not money, not admiration, not power, [but] earned success and serving other people.”

Here’s how he describes these two concepts among workers: “They feel like they’re earning their success, which is to say that they’re creating value with their lives and with their work lives, that their accomplishments are moving the needle and they’re being recognized for those accomplishments. And number two, they feel like they’re serving people so that they’re needed.”

Do these two concepts resonate with you?

They did for me - when I think of the jobs I’ve been least satisfied with and the ones I’ve loved the most (including what I do now!), earned success and serving other people do seem like distinguishing factors.

In this interview, Brooks goes on to say, “The number one thing that you can do for recruitment, for retention, the ultimate rewards that go far beyond money are making sure that you have a system where people are earning their success through their merit and personal accomplishment. They know it, they see it, and so do their friends. And they actually feel like they’re serving other people and they can see the faces of the people for whom they’re creating value.”

And this, I think, is what community coalitions and collaboratives (and public health organizations and agencies more broadly) should be thinking about. How can we give people clear roles and responsibilities, where accomplishments they are striving for are clearly defined and celebrated once achieved? How can we make meaningful connections between the members/employees of our coalitions/organizations and the community members we serve, so the value we’re creating can be truly seen and felt?

These are the questions I leave you with today- I would love to hear your thoughts!

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The shifts that come from listening

I've talked about the difference between hearing and listening to community before.

And even though it's something I believe in deeply, I'm still surprised at the shifts that happen when we truly do that.

A couple weeks ago, for work I'm doing in DC around systems-level shifts to school mental health, we brought together youth to generate ideas around how to improve youth engagement in the school context.

Here are some of the ideas that came up repeatedly:

• "Having an area where we can take a break/chill"

• "I WANT A MENTAL HEALTH DAY"

• "Having more relatable/trusted adults"; "Respect is a two way street"

If we asked adults how we can improve youth engagement in the school context, what answers would we have gotten? I'm willing to bet this list would have been completely different.

So far, we've just heard these young people. How can we listen to them? By figuring out how to make more of these things happen! One thing that struck me about these ideas that bubbled to the top are that in theory, they shouldn't be that hard to make happen - but it does require adults setting aside their own perspectives and egos and prioritizing what young people most want.

One student shared how one of their teachers opens their room to students during lunch time, and how deeply they appreciate that space to chill - and only when I heard that did I remember some of my favorite memories from high school were in Mrs. Fort's English lit classroom, where a handful of us would go at least a few times a week to have our lunch.

Several students talked about specific teachers or other adults in the building that made them feel respected. What did that boil down to? The adult cared what the students had to say. They didn't talk down to the students. They made things fun. They listened. The conversation made me think of my favorite teachers through the years - they checked all those boxes too.

We were all young people once, but we quickly forget the day-to-day of that experience and how we felt about things.

If we can truly listen to and act upon what we hear from young people - or whoever your community members are - we might shift not only our solutions but even how we define problems.

But listening isn't always easy.

I've been thinking a lot about how we practice listening. We recently had a friend visit who loves birdwatching and taught our six year old more about birds in a weekend than we could have taught her, well...ever. But my favorite part of the whole experience was the emphasis on being still and listening - it's amazing what you hear when you do that.

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A fish, an elephant, and an iceberg: Orienting community towards root causes and systems

When a community is trying to address a public health problem, the immediate causes are often the most apparent.

Too many youth aren't physically active. Why? They don't understand the value of physical activity or the consequences of not being active. What should we do? An education and mass communication campaign to help them understand this value and these consequences, so that they are motivated to be more active.

Not only are immediate causes often the most apparent, the solutions required to address them are often (relatively) non-controversial and don't require the upheaval of established systems.

But to truly transform health in communities, we need to move beyond the immediate. We need to 1) drill down to root causes and 2) fly up for a systems wide view.

On the first point -

WHY are too many youth not physically active? Do they have safe spaces to run and play in their neighborhood, and do their schedules allow them to do so? Are the costs of joining recreational sports leagues prohibitive? Are the apps on their phones designed to be addictive, so they have less time for everything else?

To get community members thinking about root causes, one exercise I have found quite helpful is a fishbone diagram (where you start with the problem, which is the "head" of the fish, and then brainstorm multiple causes, as well as causes of causes). This diagramming is often paired with the "5 whys" facilitation strategy (where you keep asking "why" five times to drill down to deeper root causes). The idea here is that this process can help identify countermeasures (things that prevent root causes) instead of merely solutions (things that might just put a bandaid on the problem by treating a symptom instead of a root cause).

On the second point -

HOW might systems be transformed to encourage more physical activity among youth?

First, we need to be able to take a step back and see the system as a whole. I find the elephant analogy an incredibly helpful way to remind ourselves and our communities to do this. It’s an ancient parable you may have heard before about blind/blindfolded individuals encountering an elephant for the first time. Each person feels only one part of the elephant and comes to a conclusion about what they are encountering based on that. It leads to a lot of misconceptions and no single person who has the full and accurate picture.

To take community thinking a step further, from recognizing there is a broader system to understanding how we can improve that system, I love using the iceberg model of systems thinking. It's a great way to reminder ourselves that what we can see of a problem is usually only the tip of the iceberg. "We know that an iceberg has only 10 percent of its total mass above the water while 90 percent is underwater. But that 90 percent is what the ocean currents act on, and what creates the iceberg’s behavior at its tip." Most public health issues are like this as well! I especially appreciate the way this model helps community members walk through the process of identifying trends, underlying structures, and ultimately mental models.

I've often had clients point to a fairly surface-level approach or solution and say, "This is what our community said they want to see." This may be true, and I'm 100% on board with community-driven approaches. However, we also need to ask ourselves if we've walked ourselves and our communities through the kind of tools above to make sure that the solutions we're brainstorming are oriented towards root causes and systems.

Have you had success with setting the stage to approach problems in a way that is focused on root causes or systems? Or have you tried using any of the tools mentioned above? Please share your experience with me!

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Hearing vs. Listening to community

You want to transform health in your community. And you recognize that can’t be done without communities in the center and in the lead.

But how do we actually DO that?

We’ve talked about meeting community where they literally, physically are and these strategies are great to hear what they have to say, but today, I want to push us a little further. Because there is a HUGE difference between hearing and truly listening.

Merriam-Webster defines hearing as “the process, function, or power of perceiving sound, specifically: the special sense by which noises and tones are received as stimuli”.

On the other hand, the definition of listening reads, “to pay attention to sound; to hear something with thoughtful attention: give consideration”.

There’s a lot of lip service being paid to community voice these days, as well as genuine efforts to elevate community voice. But either way, community voice isn’t enough if we merely hear it, but don’t listen to and act on it.

The “act on it” piece is vital - I’d take the definition of “listening” and argue for us to take it one step further than paying thoughtful attention and giving consideration to actually internalizing and acting on what community has to say.

I’ve had the pleasure of working with the Allegheny County infant health equity coalition over the last couple years, and we’ve been incredibly intentional about trying to do this. What does this look like in practice?

• The coalition is composed of moms, doulas and other birth workers, nutrition advocates, community leaders, as well as nonprofit, healthcare, and government leaders;

• We used strategies like focus groups in a box that put community members and leaders in the driver’s seat of leading discussions with community members;

• As we continue to gather community input (as we just did a couple months ago during a community kick off event for implementation of the action plan), we reflect back what we’re hearing to community in ways that are easily digestible (you can see our summary of input from the kick off here);

• We directly link the input we receive through these strategies to our action, implementation, and learning/evaluation plans and we make these connections explicit (for example, you’ll see we quoted community members directly throughout our action plan to demonstrate the connections between what we heard from community and what ended up in the action plan);

• We’ll be capturing community feedback in learning and evaluation activities that directly ask them whether they felt listened to and their input acted upon - and we’ll modify our approach to reflect what we learn.

How are you and your coalitions/organizations working to go beyond hearing from community members to actually listening to them? Drop me a line and let me know!

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How to meet community where they (literally) are

One of my favorite parts of my work with community coalitions and collaboratives is working with them to meet the community where they are.

As a recovering academic, let me tell you why communities don’t trust academics and researchers - even when academics are trying to get community input, the typical model is that they bring folks together in a new space where the researcher has all the power and then ask community members to answer a bunch of questions to serve their own research needs and then the community never hears from them again.

Harsh, right?

I’m not trying to throw academics under the bus, I used to be right there with them, and their hearts are often in the right place. But we’re generally not trained in academia to share power with community members and meet them where they are.

You know who does that well? Community coalitions and collaboratives!

Working hand in hand with these groups over the last several years, here are some of my favorite strategies we’ve employed to meet community members where they are:

• Listen where community is already gathering. I’m part of a coalition where I live in Fairfax, Virginia, and last year, we launched our very first community-wide event called Healthy Together Fairfax. We knew we wanted this to be an event by the community, for the community, so we started by…listening. Just listening. Sounds simple, but it’s a step many skip! We knew there were dozens of community groups already gathering regularly to talk about health, so we simply reached out to them, attended meetings, and listened. We took notes, drew out key themes from what we were hearing, and let those themes drive the planning process.

• Focus the conversation through Focus Groups in a Box. In the first phase of my work with the Allegheny County Infant Health Equity Coalition, our top priority was crafting a community-driven action plan. The Coalition awarded small research grants to community partners that were already gathering places for community members, so that they could lead their own focus groups. I helped develop a standard focus group guide and reporting template that was then shared with these partners, and they shared back insights gathered through the conversations they led to inform the development of the plan. This is an approach that checked a bunch of boxes: we put the power in the hands of community members (they led the groups and were compensated for their time), we met community members where they already were, we heard from dozens of additional marginalized community members that we wouldn’t have reached otherwise, and we got meaningful feedback that could be incorporated directly into the plan. So many wins.

• Widen your reach with Street Stalls. There’s a problem with the two approaches I just shared - there’s a certain type of community member that’s already part of existing groups and community organizations. There’s another type - actually many types - of community members that aren’t part of those groups. And sometimes - scratch that, most of the time - those are the folks we most need to hear from. Knocking door to door isn’t typically an option, but what we can do is gather community input on-site at community locations and events (think community centers, recreation centers, festivals, farmer’s markets). We used this approach last year to gather input to inform the Children’s Behavioral Health Blueprint led by Healthy Minds Fairfax. I designed and set up a tri-fold poster board (don’t underestimate the low-tech options!) with various categories of resources and had teens/children use green dots and caregivers/parents use pink dots to vote on the community resources they find most helpful. Another section the board had an open-ended question about what they’d most like to add/change in their community to support children’s mental health, with blank post-it-notes and markers available for passers-by to add their responses. End result: we got helpful input from a wider range of community members and not just those that would self-select into completing a survey or participating in a focus group.

These strategies are great to meet community where they literally, physically are and hear what they have to say. But there is a difference between hearing and truly listening - find that in our next post!

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