Arizona Department of Health Services
Bureau of Tobacco and Chronic Disease
Community Partner Concept Mapping Project
2012-2013

Prepared by:
Michele Walsh, PhD, Violeta Dominguez, and John Daws, PhD
Frances McClelland Institute for Children, Youth, & Families
John & Doris Norton School of Family & Consumer Sciences
The University of Arizona
PO Box 210078
Tucson, AZ 85721-0078
Phone: (520) 621-8739
Fax: (520) 621-4979
mcclellandinstitute.arizona.edu

Table of Contents
Introduction ..................................................................................................................................... 1
Concept Mapping Process............................................................................................................... 2
Generating and Structuring Ideas................................................................................................ 2
Analysis....................................................................................................................................... 3
Interpretation ............................................................................................................................... 5
Findings........................................................................................................................................... 7
Dialogue ........................................................................................................................................ 12
Reaction to Logic Model .......................................................................................................... 12
Sustainability............................................................................................................................. 12
Place in Policy Work ................................................................................................................ 14
Moving Forward ........................................................................................................................... 15
Appendix A. Brainstormed Statements......................................................................................... 17
Appendix B: Point Map ................................................................................................................ 20
Appendix C: Cluster Map ............................................................................................................. 21
Appendix D. Statements Sorted by Cluster .................................................................................. 22
Appendix E. Point Rating Map (Importance) .............................................................................. 24
Appendix F. Cluster Rating Map (Importance) ............................................................................ 25

List of Figures
Figure 1. Go Zone Analysis of Cluster 1, Comparing Importance and Feasibility ....................... 4
Figure 2. Comparison of Perceived Importance of Clusters between Stakeholder Groups ........... 5
Figure 3: Cluster Map with Labels ................................................................................................. 7
Figure 4. Summary Concept Map .................................................................................................. 8
Figure 5. Logic Model Resulting from Concept Map.................................................................... 9
Figure 6. Comparison of Perceived Importance between Stakeholder Groups, with Cluster Labels
....................................................................................................................................................... 10

ADHS BTCD Community Partners Concept Mapping

Introduction
The goal of the current project was to develop an evaluation framework for BTCD Community
Partners that could guide efforts to determine effectiveness and promote sustainability of
Arizona’s community-based tobacco control and chronic disease management programs. We
followed the guidelines set out by the Center for Disease Control and Prevention’s (CDC)
Developing an Effective Evaluation Plan, which encourages engaging stakeholders in the
development of a collaboratively-derived program description and understanding, which can
then be used to guide further program evaluation efforts.
In order to accomplish this, we used a concept mapping process which provides a structured way
to incorporate input across stakeholders to develop a visual representation of relationships among
ideas. Concept mapping has been used to develop logic models and evaluation frameworks
across a number of health and social science domains, including for the CDC Prevention
Research Centers (Anderson, et al, 2006), and the NIH-funded Transdisciplinary Tobacco Use
Research Centers (Stokols, et al., 2003). For this project, we incorporated ideas identifying
aspects of a successful community-based tobacco control project that were generated by Arizona
Department of Health Services Bureau of Tobacco and Chronic Disease (BTCD) staff and
BTCD-funded community partner agency staff.
This document outlines the concept mapping process which produced products (concept maps,
pattern matches and go-zones) that were interpreted through meetings with multiple groups of
stakeholdersi. The findings and a resultant logic model were discussed in a subsequent larger
group meeting, where further directions for program planning and evaluation were identified.
These findings and proposed next steps are summarized here.

i

These products are included in appendices for reference.

Frances McClelland Institute for Children, Youth, & Families, Norton School of Family & Consumer Sciences
The University of Arizona
1

ADHS BTCD Community Partners Concept Mapping

Concept Mapping Process
Concept mapping is an interactive technique which relies on the insights of participants to define
important issues. It is a group process of generating ideas and articulating the relationships
between those ideas. Multidimensional scaling and cluster analysis are applied to this
information resulting in a pictorial representation of the group’s thinking that displays the
group’s ideas, how they are related to each other, and which ideas are considered more relevant,
important or appropriate for study. These pictures can then be discussed by the participants and
used to convey to others the issues that the group found to be important.

Generating and Structuring Ideas
The first step in any concept mapping process is to generate a focused list of statements
representing a variety of aspects of the topic of interest, in this case, about what a successful
community-based program entails. An in-person group brainstorming session was conducted on
September 11, 2012, as part of an BTCD Community Partners Meeting. Participants from six
community partner agencies and from the majority of programs subcontracted through the Inter
Tribal Council of Arizona, one technical support agency, and BTCD staff were asked to
complete the stem: “A successful community-based tobacco control and chronic disease
management project would…”. Participants were asked to continue to reflect on the topic and to
invite any other agency staff or community members to participate in statement generation online. A total of 85 statements were generated through both in-person and on-line processes.
These 85 statements are included in Appendix A
All community partner agency leads were then sent a URL and asked to involve as many staff as
they felt appropriate (with a minimum of two requested) in a web-based process of structuring
the statements. The statement structuring process had two components: sorting (grouping) and
rating.
Sorting: Each participant was asked to group the ideas into as many virtual piles (lists) of
statements in a way that “makes sense to you,” where the statements in the same pile have more
in common with each other than they do with statements in other piles.ii They were asked not to
sort all items into one pile, not to sort each into its own pile (though some could be sorted
individually), nor to sort any item into more than one pile. They were also asked to provide a
label for the pile that “named” what they had in common in the view of that that participant.
Rating: Each participant was asked to rate each statement along three different dimensions:
importance, feasibility, and responsibility for evaluation. The prompts for each are given below:
Importance – “Rate each statement in terms of how important you believe it is as a factor in the
success of a community-based tobacco control and chronic disease management program (1=
relatively unimportant; 5= extremely important)”
Feasibility – “Rate each statement in terms of how feasible you believe it is for a communitybased tobacco control and chronic disease management program to accomplish this (1=not
feasible; 3= very feasible)”

ii

This was done by clicking on an item in the full list, and dragging it to an appropriate new grouping list

Frances McClelland Institute for Children, Youth, & Families, Norton School of Family & Consumer Sciences
The University of Arizona
2

ADHS BTCD Community Partners Concept Mapping

Responsibility – “Indicate who you think should primarily be responsible for evaluating each
item (1=community-based program; 2= BTCD)”
Participants were also asked to identify themselves as either community partner agency staff, or
BTCD staff, to allow for comparisons between stakeholder groups.
Table 1 displays the numbers of participants who began and completed each phase of the

structuring. One community agency chose to do the tasks jointly, so that although several staff
participated, they are counted as just one participant in the table. Follow-up with staff who
began but did not complete the phases indicated that they found the sorting task in particular to
be time consuming and, in some cases, difficult to understand.
Table 1. Statement Structuring Participation

Started

Finished

Sorting

16

12

Importance rating

14

14

Feasibility rating

12

11

Responsibility for evaluation

11

10

Analysis
The individual sortings were combined into a group similarity matrixiii. This matrix provides the
relational structure of the groupings and was represented graphically in three different map
formats: point maps, cluster maps, and rating maps (point and cluster).
The point map represents each statement as a separate point on the map. Statements which are
closer together on the map were sorted together more frequently, and statements which are far
apart on the map were generally sorted together less frequently. The point map is constructed by
applying two-dimensional nonmetric multidimensional scaling analysis to the group similarity
matrix. The numbers presented on the point map in Appendix B correspond with the statement
numbers in Appendix A.

iii

First, a binary matrix of similarities was constructed where for any two items i and j, a 1 was placed in Xij if the
two items were placed in the same pile by the participant, otherwise a 0 was entered (Weller and Romney,
1988).The total similarity matrix was obtained by summing across the individual Xij matrices. Any cell in this
matrix could take integer values between 0 and 12 (i.e., the 12 people who sorted the statements), with the value
indicating the number of people who placed the i,j pair in the same pile. A high value in this matrix indicates that
many of the participants put that pair of statements together in a pile and implies that the statements are conceptually
similar in some way. A low value indicates that the statement pair was seldom put together in the same pile and
implies that they are conceptually more distinct. (Trochim, 1989)

Frances McClelland Institute for Children, Youth, & Families, Norton School of Family & Consumer Sciences
The University of Arizona
3

ADHS BTCD Community Partners Concept Mapping

The cluster map displays the statements as clusters that represent the higher order conceptual
groupings of the original set of statements (Appendix C). This is accomplished using
hierarchical cluster analysis on the X-Y coordinate data obtained from multidimensional scaling.
There is not a straight-forward mathematical criterion for selecting an optimal number of
clusters. We followed the procedure outlined in Trochim, Cook, & Setze (1994), whereby a
cluster solution that on average placed five statements in each cluster was examined initially by
the research team. Successively lower and higher cluster solutions were examined, with a
judgment made at each level about whether the merger/split seemed substantively reasonable. It
was determined that the nine-cluster solution preserved the most detail and yielded substantively
interpretable clusters of statements.
The point rating map is the point map with the average individual statement rating overlaid
(Appendix E).
The cluster rating map is the cluster map with the average rating across the statements in the
cluster overlaid (Appendix F).
Go Zone Analyses allowed for within cluster analysis across two dimensions. The example in
Figure 1 below shows the ratings for importance against the ratings of feasibility for each of the
statements in Cluster 1. Those in the upper right, green, quadrant are statements which were
rated, on average, as high in both feasibility and importance. These are considered as ideas that
are in the “go-zone,” that is, items to focus on as potentially important and attainable.
Figure 1. Go Zone Analysis of Cluster 1, Comparing Importance and Feasibility

In addition, we also used pattern matching to compare how BTCD staff rated the clusters
compared to how community partner agency staff rated them, as a way to examine any
differences in priorities between the two stakeholder groups. An example of how these were used
is presented below.
Frances McClelland Institute for Children, Youth, & Families, Norton School of Family & Consumer Sciences
The University of Arizona
4

ADHS BTCD Community Partners Concept Mapping

Figure 2. Comparison of Perceived Importance of Clusters between Stakeholder Groups

Figure 2 illustrates that, overall, there is agreement that clusters 9, 2, 1 represent important

aspects of community tobacco control and chronic disease programs, and that cluster 8 represents
a relatively less important aspect. There is, however, a discrepancy in how Cluster 3 is perceived
of between stakeholder groups, with BTCD staff seeing it as a relatively more important aspect
than do community partner agency staff. These types of analyses open the door for discussions
about what the discrepancy might represent.

Interpretation
The various products (maps, go-zones and pattern matches) were presented to stakeholders in
four separate sessions for discussion and interpretation. The goals of these sessions were to
assure that the participants had a broad view of the data and the underlying relationships behind
them, and to interpret them in ways that could drive planning and evaluation processes.
Three sessions were held in the Phoenix area: one involved four BTCD staff members; one was
hosted by Tanner Community Development Corporation (Tanner) and included agency staff
Frances McClelland Institute for Children, Youth, & Families, Norton School of Family & Consumer Sciences
The University of Arizona
5

ADHS BTCD Community Partners Concept Mapping

from Tanner, from Asian Pacific Community in Action, and from La Paz Regional Hospital; and
one was hosted by the Inter-Tribal Council of Arizona, and included ITCA staff and their tribal
and urban Community Tobacco Advisory Council subcontractors. The fourth session was hosted
by Campesinos Sin Fronteras in San Luis, AZ, and included many staff whose preferred
language is Spanish; to enable all staff members to participate fully, this session was conducted
primarily in Spanish.
Participants in each session were asked to consider the statements that made up each of the
clusters (from the cluster list) and, through discussion, group consensus was established on a
name for each cluster that best captured the concepts suggested by the aggregate of the
statements.iv The cluster map was then labeled with each of the cluster names, and a general
discussion about the meaning and usefulness of the resulting graphical representation was held.
Using the cluster map as a conceptual framework, participants were then asked to review and
discuss the rest of the analyses (cluster rating maps, go zone analyses, and pattern matches)
while considering a few questions:
Although all the aspects of community programs are important, which are relatively most
important? Are there a smaller number of clear priorities?
What aspects are the most feasible to implement?
What is the relationship between importance and feasibility?
Where should the responsibility for evaluation of the different aspects lie?
Do funding staff and community partner staff see different priorities or responsibilities?
The evaluation team summarized these discussions and produced new materials that incorporated
the findings from the four sessions into materials that addressed the questions laid out above.
These materials were then reviewed and discussed at a subsequent meeting that included
representatives from each of the community partner agencies and from BTCD. The findings
from the four interpretation sessions (in Findings) and from the larger, all-partner meeting (in
Dialogue), are presented in the next sections.

iv

Due to time constraints, not every session developed a label for each cluster. However, each participant group
considered at least some clusters, and labels had been generated for each cluster by the completion of all sessions.
Frances McClelland Institute for Children, Youth, & Families, Norton School of Family & Consumer Sciences
The University of Arizona
6

ADHS BTCD Community Partners Concept Mapping

Findings
There was considerable consistency in the interpretation of the clusters across sessions and
across stakeholders. After integrating the labels across those generated in each session, the
following nine labels were suggested and reviewed at the all-partner meeting.
Cluster 1:

Community driven: includes ideas of knowing the community and being
sensitive to the needs of the community.

Cluster 2:

Community engagement: includes ideas of inclusiveness, cultural accessibility
and trust in the provider.

Cluster 3:

Organizational structure and capacity: includes ideas of strategic direction,
accountability and sustainability.

Cluster 4:

Evidence-based activities: includes ideas of public accountability.

Cluster 5:

Coordination of efforts: includes ideas having a holistic approach.

Cluster 6:

Information dissemination: includes ideas of making information accessible.

Cluster 7:

Health impacts: includes ideas of vision of the future.

Cluster 8:

Public policy and systems change: includes ideas of legal environment change
and enforcement.

Cluster 9:

Changing community norms: includes ideas of decreasing the acceptability of
smoking and creating community environments that support not smoking.

Figure 3: Cluster Map with Labels

Changing
Community
Norms

Public Policy
and Systems Change

Health
Impacts

Information
Dissemination

Evidence-based
Activities

Coordination
of Efforts

Organizational Structure
and Capacity

Community
Engagement
Community Driven

Frances McClelland Institute for Children, Youth, & Families, Norton School of Family & Consumer Sciences
The University of Arizona
7

ADHS BTCD Community Partners Concept Mapping

The resulting cluster map is shown in Figure 3. Working from this map, we incorporated
additional information from the analyses to produce a composite figure that gives a summary
snapshot of the findings from the interpretation sessions, and helps answer two of the questions
posed in the interpretation sessions:
Although all the aspects of community programs are important, which are relatively most
important?
Where should the responsibility for evaluation of the different aspects lie?
Participants identified two broad “regions” of conceptual space—clusters that represented
community partner agency characteristics that contribute to program success, and elements of
sustainable outcomes that represent program successes. The clusters in Figure 4 are color coded
green to represent areas that were seen to be primarily the responsibility of community partners
to evaluate, and orange if they were seen as areas that should be evaluated primarily by BTCD.
The deeper the color, the more important that element was seen as being in the success of a
community partner agency’s work in tobacco control and chronic disease prevention and
management.
Figure 4. Summary Concept Map

Frances McClelland Institute for Children, Youth, & Families, Norton School of Family & Consumer Sciences
The University of Arizona
8

ADHS BTCD Community Partners Concept Mapping

By essentially rotating this map clockwise, we were able to develop an outcome logic model for
considering what a “successful” community partnership would look like with regards to having
an impact on tobacco use and chronic disease management. Such a model can be useful as a
framework for program evaluation, by identifying important elements to address and measure.
Figure 5. Logic Model Resulting from Concept Map

This model suggests that, for community partner agencies, “success” means a primary focus of
their activities is on knowing and being accessible and trustworthy to the community, and so
engaging and motivating community members about the importance of tobacco control and
chronic disease management in order to change community norms around those topics. The idea
is that they produce fertile ground for public policy and systems change that can lead to health
impacts. As one partner pointed out, health impacts result “when everything else is in place and
functioning.” This is aligned with the CDC’s Best Practice Guidelines, which state “Effective
community programs involve and influence people in their homes, work sites, schools, places of
worship, places of entertainment, health care settings, civic organizations, and other public
places.”v (emphasis added).
The logic model represents the input of all the participating stakeholders, and as such, should
provide common ground for moving forward with discussions about the place of community
partner agency work in the BTCD program “portfolio.” Another question raised in the
interpretation session, however, was:
Do funding staff and community partner staff see different priorities or responsibilities?

v

CDC (2007) Best Practices for Comprehensive Tobacco Control Programs (Section 1: State and Community
Interventions, pg. 23). Accessed from
http://www.cdc.gov/tobacco/stateandcommunity/best_practices/pdfs/2007/BestPractices_SectionA_I.pdf on 2-12013
Frances McClelland Institute for Children, Youth, & Families, Norton School of Family & Consumer Sciences
The University of Arizona
9

ADHS BTCD Community Partners Concept Mapping

Figure 6 shows the pattern match between perceived importance of each cluster as reported by

BTCD staff, and perceived importance as reported by community partner agency staff. This is
identical to Figure 2, but with the clusters now labeled. The top three clusters for community
agency staff are represented in the top four clusters for BTCD staff. The cluster they do not
share in common is that for organizational structure and capacity, which was the top-rated cluster
for BTCD staff, but was placed substantially lower by community partner staff. Participants in
all four interpretation sessions saw a need for dialogue to explore this discrepancy between the
views of BTCD and community partner agency staff.
Figure 6. Comparison of Perceived Importance between Stakeholder Groups, with Cluster Labels

Overall, the interpretation sessions turned up three areas that participants saw as ripe for dialogue
between agency staff and BTCD staff:
Sustainability—need for a clearer discussion about expectations around sustainability and how
both groups see funding for tobacco and chronic disease activities beyond BTCD
Policy—need to clarify the role and expectations of community partners with respect to policy.
Where do the partner activities fit in relation to the bigger picture around policy and systems
change?
Collective impact—to what degree are BTCD and community partners willing to embrace a
collective impact model, and what might that look like in tobacco control/chronic disease?
Frances McClelland Institute for Children, Youth, & Families, Norton School of Family & Consumer Sciences
The University of Arizona
10

ADHS BTCD Community Partners Concept Mapping

The January 16, 2013, all-partner meeting was structured to begin this dialogue, and to identify
productive next steps for working with the evaluation framework. In addition to time for joint
BTCD-community partner discussion, there was also time provided for the community partner
staff to meet as a group without BTCD staff presence. This allowed the community partner staff
the opportunity to conduct frank discussions among themselves.
The issue of sustainability became very salient, as it was noted early in the meeting that the
current contracts for the community partners would be ending with the fiscal year and that the
current funding mechanism was no longer in place to renew any of them at this time. Although
community partners had been informed in the past that the current funding cycle would end with
the fiscal year, the discussion that arose at the January 16 meeting suggested it had not been clear
to them that no other competitive application process would be in place. The following section
summarizes the discussion, which incorporated this information, and the concept mapping
findings, and proposes possible steps for moving forward.

Frances McClelland Institute for Children, Youth, & Families, Norton School of Family & Consumer Sciences
The University of Arizona
11

ADHS BTCD Community Partners Concept Mapping

Dialogue
This section summarizes the themes that emerged in the BTCD-community partner all-partner
meeting on January 16, 2013. Because some of these were raised during the community partner
staff discussions that did not include BTCD staff (mentioned above), BTCD did not have the
opportunity to hear or address all of this input from community partners prior to this report.
Therefore, their perspective is less well represented in this summary.

Reaction to Logic Model
Community partners felt that the logic model was a good, if somewhat generic, representation of
how they saw their work in tobacco control and chronic disease management.
Community norms around tobacco are key. As reflected in its strong “importance” rating in
the concept map, changing community norms was seen as the most pressing issue for community
partners, and as their common challenge. Specifics of these norms vary depending on the group,
but the common ground was seen to be the need for sustained work towards changing
community norms around tobacco.
Examples that were given were that in south Yuma, Campesinos sin Fronteras struggles with a
transient population. Consequently, they feel they need to work continuously on community
awareness because they are constantly losing the “base” they work with as families move away
and they need to “start from scratch” with those that move in. In contrast, on the Hopi
reservation, the community is very stable but the challenge is around the traditional relationship
that the community has with tobacco and its cultural relevance. They find they need to raise the
awareness of the differences between commercial and traditional uses of tobacco.
Need to establish a system-wide model that places community partners within it. This is
explored in the context of sustainability in the section labeled Need for strategic direction,
below.

Sustainability
Funding ending at a time of “momentum.” Community-based partners indicated that a lot of
effort and resources have been invested in some of their projects (especially around policy) over
the last few years. Funding cuts would mean loss of momentum, even if funding is available in a
few months. A number of partners expressed concern that when (or if) funds become available
again, work might need to start from scratch. Although there was an understanding that funding
was not guaranteed beyond the end of the funding cycle, there was a sense that explicitly
discussing sustainability of efforts could, and should, have begun much longer ago. BTCD staff
recognized this concern and discussed providing more communication, trainings, grant-writing
workshops, and other opportunities to explore sustainability. BTCD also reiterated that the CDC
have changed direction, to focus less on disparate populations per se and more on broader policy
and systems change.
Limited current efforts could be continued without BTCD funds. Some community partners
talked about efforts that have been put in place and could be sustained without funding: ASHline
referrals; second-hand smoke interventions incorporated into other projects (e.g. home visitation
funded by First Things First); tobacco use screening items that have been added to intake forms
for other programs or initiatives; incorporation of tobacco control education into other chronic
Frances McClelland Institute for Children, Youth, & Families, Norton School of Family & Consumer Sciences
The University of Arizona
12

ADHS BTCD Community Partners Concept Mapping

disease management programs. However, the general consensus amongst the community
partners was that the program as it is cannot be continued without BTCD funding; they did not
see it as realistic to find other sources of funding to continue the work as it is being currently
done. One point that was raised was whether programs should be continued as they are, or
whether there is a way of working more efficiently to maximize impact with a shrinking budget.
Relevance and reach of community partners underappreciated. There was a sense among
community partners that BTCD might lack an appreciation of the role they play in reaching out
to disparate populations that county-based programs do not serve; or, at least, that the
appreciation BTCD may have for their work does not translate into tangible resources allocated
to their work in a more regular and consistent manner (i.e., from Prop 202) as it is the case with
the counties. There was also a sense that the current structure of “power and decision making”
does not necessarily represent the best interests of community-based organizations serving
disparate populations. For instance, although it was recognized that the TRUST commission
includes members from ethnic minority populations, it was stated that there was a sense that the
community-level perspective was not fully represented there.
There is a strong awareness of the fact that grassroots organizations like the community partners
serve a portion of the state’s population (ethnic or racial minorities) that has become or will
become the majority in terms of absolute population numbers. There was discussion of the
possible impact that organizing and combing forces to lobby for a more regular funding stream
that allows for continuity of work could have (i.e. a creation of a coalition of organizations
addressing health disparities/serving people of color). As one partner noted “We need to
collaborate. Otherwise, we’re competing against one another for the same funds.”
There was a suggestion that BTCD work with community-based partners as a group. For
instance, it was suggest that it may be more productive to bring the partners back together to
work through the sustainability exercise as a group rather than just individually. It was
recognized that BTCD offers to assist with more communication between partners through
webinars or live meetings (noted above) could help facilitate this group identity.
Need for strategic direction. There was a sense that one substantial barrier to sustainability
planning is a lack of strategic direction. Community partners would like to have a BTCD
definition of what a successful community-based program looks like, how it fits in the big
picture of tobacco control in the state, how it can align its programmatic work with the Bureau’s
priorities and the work being done by other stakeholders like the voluntaries.
In the more immediate sense, they felt it was unclear which of the activities that they are
currently engaged in (e.g., the various projects and planned events youth coalitions have) they
should concentrate on between now and October 1st, since not all of them can be sustained
without BTCD funding (and many of them are supposed to take place after Oct. 1st).
As one partner put it, there is “dysfunctional dialogue”: BTCD asks the community partners to
do a sustainability exercise and indicate which activities they can/plan to continue without
BTCD funding. Community partners would instead ask of BTCD: “Which ones should we work
on? Which of these are most relevant to you and to the overall big picture of tobacco control in
the state?” They felt that knowing the role of community partners in the overall tobacco control
plan in the state would also allow them to better prepare themselves for knowing how to scale
back or apply for other funding (whether BTCD or a different source).
Frances McClelland Institute for Children, Youth, & Families, Norton School of Family & Consumer Sciences
The University of Arizona
13

ADHS BTCD Community Partners Concept Mapping

Place in Policy Work
Community partners noted that policy and systems change was rated relatively low by both
BTCD and by community partners, not because policy work is not important but rather because
the larger “voluntary” organizations usually do policy work. However, there was discussion that
it would be worth asking: How can small organizations affect policy? How do the statewide
policy efforts support the work of small organizations at the local level, and vice versa? As one
community partner expressed it “With a shrinking budget, how do we maximize our impact?
That is, how can we be most efficient? Perhaps going back to the “public policy systems change”
box may be our best bet.”

Frances McClelland Institute for Children, Youth, & Families, Norton School of Family & Consumer Sciences
The University of Arizona
14

ADHS BTCD Community Partners Concept Mapping

Moving Forward
One dominant theme that ran through the discussions at the all-partner meeting on January 16,
2013 was the desire for more communication and coordination of efforts, both with BTCD and
among the community partners.
Three levels of coordination were identified, along with ways to promote it:
a. Facilitate interaction and collaboration among funded community-based
partners. A request was made that BTCD share the contact information of all
participants present during the January meeting to allow them to more freely
dialogue and collaborate with each other. BTCD could also provide opportunities
to discuss what efforts towards sustainability could look like as a shared process,
rather than with each agency individually, by reconvening an all-partner meeting
to discuss the sustainability exercise. In addition, partners may wish to convene
their own meeting to discuss the possibilities of organizing as a group for more
political leverage.
b. Facilitate interaction and collaboration between community-based programs
and county-based programs. Although community-based program staff have
had the option of participating in monthly telephone calls and annual meetings
these opportunities appear to be insufficient to promote communication and
collaboration between these two groups. Some participants shared examples of
positive exchanges of information and resources with county counterparts, after a
chance encounter. There was a sense that this coordination could be improved
upon by more deliberate communication about activities and goals.
c. Link work of community-based partners and other stakeholders. BTCD
were seen as having a role in brokering relationships among a number of
stakeholders so that priorities could be aligned. For instance, there was a lack of
awareness about what policy priorities voluntaries are currently working on, and
how they were going about that. Improved communication and coordination
could strengthen those statewide efforts by supporting them more locally. A
possible “summit” of tobacco control stakeholders was proposed.
In parallel with this desire for more communication and coordination was a reiteration of the
need for an explicit strategic direction to guide these efforts. In this context, the idea of
exploring a collective impact model for tobacco control and chronic disease management
was raised again. Collective impact has been defined as “the commitment of a group of
important actors from different sectors to a common agenda for solving a specific social
problem…collective impact initiatives are distinctly different…(in that they) involve a
centralized infrastructure, a dedicated staff, and a structured process that leads to a common
agenda, shared measurement, continuous communication, and mutually reinforcing activities
among all participants.”vi Meeting participants noted that having group consensus across
stakeholders about the state priorities would allow for more innovative and sustainable
approaches to addressing them.
vi

Kania, j. & Kramer, M (2011). Collective Impact. Stanford Social Innovation Review, Winter 2011. Accessed at
http://www.ssireview.org/articles/entry/collective_impact on 2-1-13
Frances McClelland Institute for Children, Youth, & Families, Norton School of Family & Consumer Sciences
The University of Arizona
15

ADHS BTCD Community Partners Concept Mapping

Regardless of whether a full collective impact model is adopted, it is clear that the evaluation
framework developed here has to be explicitly linked to the larger strategic plan for statewide
tobacco control and chronic disease management in order to develop meaningful evaluation
measures for community based partners. The proposed “summit” of tobacco control and chronic
disease management stakeholders may be one mechanism for developing or disseminating a
more inclusive strategic direction.

Frances McClelland Institute for Children, Youth, & Families, Norton School of Family & Consumer Sciences
The University of Arizona
16

ADHS BTCD Community Partners Concept Mapping

Appendix A. Brainstormed Statements
1.

be inclusive of all sectors of the community

2.

be community driven

3.

address all health (tobacco use, chronic disease, etc.) in a coordinated fashion

4.

have access to technical assistance on evaluation-related needs (e.g. survey development)

5.

have smoking policies in place for parks and playgrounds to protect children and adults
from secondhand smoke

6.

address what community members want or need

7.

address specific community issues

8.

address health disparities

9.

develop initiatives which would result in the reduction of chronic disease

10.

disseminate information about tobacco cessation

11.

follow best practices

12.

be a program that people want to participate in

13.

accomplish its stated goals

14.

result in decreased tobacco use

15.

translate policy and systems changes in terms which are easily understood by the public

16.

use strategies that are responsive to the cultural norms of the local community

17.

promote workplace-based cessation activities

18.

focus on health equity and health disparities

19.

allow for creativity and innovation in meeting the needs identified by outside funders

20.

have staff with the appropriate expertise

21.

develop initiatives which are sustainable and replicable

22.

support enforcement of laws and policies on tobacco sales

23.

decrease healthcare costs

24.

put some businesses (such as smoke shops) out of business

25.

be trusted by community members

26.

know how to market itself

27.

make the latest science on tobacco use available to the community

28.

have its stakeholders involved in evaluation activities

29.

advance best practices

30.

involve the entire community

Frances McClelland Institute for Children, Youth, & Families, Norton School of Family & Consumer Sciences
The University of Arizona
17

ADHS BTCD Community Partners Concept Mapping

31.

allow for activities related to that desired behavior change to be visible (e.g., you would
see people exercising)

32.

work from the latest science on the harm and consequences of tobacco use

33.

use strategies that are responsive to the nuances of the local community

34.

increase community support for smoke-free policies

35.

increase compliance with existing tobacco laws and regulations

36.

have smooth transitions whenever there is staff turnover

37.

have policies and practices to ensure sustainability

38.

could easily adapt itself to new cultures and communities

39.

meet the needs of the community

40.

share and collaborate

41.

use a wellness or "whole health" approach to reduce tobacco use

42.

be culturally accessible

43.

involve key stakeholders (e.g., faith-based, community organizations, neighborhood
associations, schools, sports teams, businesses)

44.

address the reduction of tobacco use

45.

develop youth to be future leaders

46.

result in a decrease in chronic disease

47.

be reliable because it follows evidence-based practices

48.

allow for creativity and innovation in meeting the needs of the community

49.

have a large reach by having a profound effect on a small number of people

50.

help increase use of cessation services

51.

result in physical changes

52.

use evaluation results to inform decision-making

53.

celebrate its successes

54.

allow for success to be measurable

55.

partner with other agencies and support groups

56.

be evaluated frequently

57.

have designated smoking areas away from playgrounds and parks

58.

be informed by the needs and perspectives of local residents

59.

be self-sustaining

60.

increase community awareness of policies that support cessation

61.

help decrease minors' access to commercial tobacco

Frances McClelland Institute for Children, Youth, & Families, Norton School of Family & Consumer Sciences
The University of Arizona
18

ADHS BTCD Community Partners Concept Mapping

62.

involve a large number of people in the program

63.

use a wellness or "whole health" approach to reduce chronic disease

64.

have access to evidence-based trainings

65.

be a model for other programs

66.

address social determinants of health

67.

reduce tobacco-related diseases and deaths

68.

help increase compliance with smoke-free laws and policies

69.

not assume that, as the provider, it knows best

70.

recruit people into the program by celebrating its successes

71.

produce tangible plans that can be followed

72.

have well-established mission, vision, and goals

73.

use language that matches how the local populations communicate

74.

be broad-based, involving policy, systems, and environment

75.

use media appropriate for the local populations

76.

have a large reach by affecting a large number of people

77.

have instructions for how to accomplish its goals

78.

disseminate information about second-hand smoke

79.

produce tangible products

80.

increase the evidence base

81.

have the necessary resources for conducting its activities

82.

be a trusted messenger

83.

disseminate health and wellness messages to the community

84.

be a model for other communities

85.

have leadership that reflects segments of the community it serves

Frances McClelland Institute for Children, Youth, & Families, Norton School of Family & Consumer Sciences
The University of Arizona
19

ADHS BTCD Community Partners Concept Mapping

Appendix B: Point Map

Frances McClelland Institute for Children, Youth, & Families, Norton School of Family & Consumer Sciences
The University of Arizona
20

ADHS BTCD Community Partners Concept Mapping

Appendix C: Cluster Map

Frances McClelland Institute for Children, Youth, & Families, Norton School of Family & Consumer Sciences
The University of Arizona
21

ADHS BTCD Community Partners Concept Mapping

Appendix D. Statements Sorted by Cluster
Cluster

Statement

1. Cluster 1
1.
2.
6.
7.
16.
30.
33.
39.
58.
73.
85.

be inclusive of all sectors of the community
be community driven
address what community members want or need
address specific community issues
use strategies that are responsive to the cultural norms of the local community
involve the entire community
use strategies that are responsive to the nuances of the local community
meet the needs of the community
be informed by the needs and perspectives of local residents
use language that matches how the local populations communicate
have leadership that reflects segments of the community it serves

12.
25.
38.
42.

be a program that people want to participate in
be trusted by community members
could easily adapt itself to new cultures and communities
be culturally accessible
Involve key stakeholders (e.g. faith-based, community organizations, neighborhood
associations, schools, sports teams, businesses)
allow for creativity and innovation in meeting the needs of the community
partner with other agencies and support groups
not assume that, as the provider, it knows best
use media appropriate for the local populations
have a large reach by affecting a large number of people
be a trusted messenger
be a model for other communities

2. Cluster 2

43.
48.
55.
69.
75.
76.
82.
84.
3. Cluster 3
13.
19.
20.
21.
26.
28.
36.
40.
54.
59.
70.
71.
72.
77.
81.

have access to technical assistance on evaluation-related needs (e.g. survey
development)
accomplish its stated goals
allow for creativity and innovation in meeting the needs identified by outside funders
have staff with the appropriate expertise
develop initiatives which are sustainable and replicable
know how to market itself
have its stakeholders involved in evaluation activities
have smooth transitions whenever there is staff turnover
share and collaborate
allow for success to be measurable
be self-sustaining
recruit people into the program by celebrating its successes
produce tangible plans that can be followed
have well-established mission, vision, and goals
have instructions for how to accomplish its goals
have the necessary resources for conducting its activities

11.
29.
37.
47.
49.
52.
53.

follow best practices
advance best practices
have policies and practices to ensure sustainability
be reliable because it follows evidence-based practices
have a large reach by having a profound effect on a small number of people
use evaluation results to inform decision-making
celebrate its successes

4.

4. Cluster 4

Frances McClelland Institute for Children, Youth, & Families, Norton School of Family & Consumer Sciences
The University of Arizona
22

ADHS BTCD Community Partners Concept Mapping
56.
64.
65.
79.

be evaluated frequently
have access to evidence-based trainings
be a model for other programs
produce tangible products

3.
8.
27.
45.
62.
83.

address all health (tobacco use, chronic disease, etc.) in a coordinated fashion
address health disparities
make the latest science on tobacco use available to the community
develop youth to be future leaders
involve a large number of people in the program
disseminate health and wellness messages to the community

5. Cluster 5

6. Cluster 6
10. disseminate information about tobacco cessation
allow for activities related to that desired behavior change to be visible (e.g. you
31.
would see people exercising)
78. disseminate information about second-hand smoke
80. increase the evidence base
7. Cluster 7
18.
23.
32.
41.
44.
46.
63.
66.
67.

focus on health equity and health disparities
decrease healthcare costs
work from the latest science on the harm and consequences of tobacco use
use a wellness or "whole health" approach to reduce tobacco use
address the reduction of tobacco use
result in a decrease in chronic disease
use a wellness or "whole health" approach to reduce chronic disease
address social determinants of health
reduce tobacco-related diseases and deaths

8. Cluster 8

22.
24.
35.
51.
57.
68.
74.

have smoking policies in place for parks and playgrounds to protect children and adults
from secondhand smoke
translate policy and systems changes in terms which are easily understood by the
public
support enforcement of laws and policies on tobacco sales
put some businesses (such as smoke shops) out of business
increase compliance with existing tobacco laws and regulations
result in physical changes
have designated smoking areas away from playgrounds and parks
help increase compliance with smoke-free laws and policies
be broad-based, involving policy, systems, and environment

9.
14.
17.
34.
50.
60.
61.

develop initiatives which would result in the reduction of chronic disease
result in decreased tobacco use
promote workplace-based cessation activities
increase community support for smoke-free policies
help increase use of cessation services
increase community awareness of policies that support cessation
help decrease minors' access to commercial tobacco

5.
15.

9. Cluster 9

Frances McClelland Institute for Children, Youth, & Families, Norton School of Family & Consumer Sciences
The University of Arizona
23

ADHS BTCD Community Partners Concept Mapping

Appendix E. Point Rating Map (Importance)

Frances McClelland Institute for Children, Youth, & Families, Norton School of Family & Consumer Sciences
The University of Arizona
24

ADHS BTCD Community Partners Concept Mapping

Appendix F. Cluster Rating Map (Importance)

Frances McClelland Institute for Children, Youth, & Families, Norton School of Family & Consumer Sciences
The University of Arizona
25