3. Statement of the community problem/goal to
be addressed
Specific behaviors of whom that need to
change
Improvements in community-level outcomes
that should result
4. Direct observation of the problem or goal
Conducting behavioral surveys
Interviewing key people in the community
Reviewing archival or existing records
5. Targets of change or prioritized groups
for whom behaviors or outcomes should
change
Agents of change or those implementing
the intervention
6. Personal contacts - Who will you speak with about
what?
Interviews - What questions will you ask of whom
about the problem or goal and possible
interventions?
Focus groups - From what groups will you seek
what kinds of information?
Community forums - What public situations would
present an opportunity for you to discuss the
problem or goal, and how will you use the
opportunity?
Concerns surveys - What questions of whom will
you ask about the problem or goal and potential
solutions?
7. Those for whom the current situation is a problem. Who is affected
by the issue, problem, or goal?
The negative (positive) consequences for those directly affected
and the broader community. What effect does the problem or issue
have on the lives of those affected?
Personal and environmental factors to be influenced (i.e., people's
experience and history; knowledge and skills; barriers and
opportunities; social support and caring relationships; living
conditions that put them at risk for or protect them from
experiencing certain problems).
The behavior or lack of behavior that causes or maintains the
problem. What behaviors of whom would need to change for the
problem (or goal) to be eliminated (addressed).
8. A description of what success would look like. How will
the community or group be different if the intervention
is successful?
Those goals the intervention is targeted to accomplish.
How will you know if your intervention is successful?
The specific objectives the intervention will achieve.
What will change by how much and by when?
9. Potential or promising “best practices” for your
situation (consider various available databases and
lists of “best” or evidence-based practices)
How strong is the evidence that each potential “best
practice” caused the observed improvement?
(Rather than other associated conditions or
potential influences)
Whether the “best practice” could achieve the
desired results in your community
Whether the conditions (e.g., time, money, people,
technical assistance) that affect success for the
“best practice” are present
10. Providing information and enhancing skills (e.g.,
conduct a public information campaign to educate
people about the problem or goal and how to address
it)
Modifying access, barriers, exposures, and
opportunities (e.g., increase availability of affordable
childcare for those entering work force; reduce
exposures to stressors)
Enhancing services and supports (e.g., increase the
number of centers that provide health care)
Changing the consequences (e.g., provide incentives to
develop housing in low-income areas)
Modifying policies and broader systems (e.g., change
business or public policies to address the goal)
11.
12. What specific change or aspect of the
intervention will occur?
Who will carry it out?
When the intervention will be
implemented or how long it will be
maintained?
Resources (money and staff) needed/
available?
Who should know what about this?
13. Test the intervention and with whom
Assess the quality of implementation of the intervention
Assess results and consequences or side effects
Collect and use feedback to adapt and improve the
intervention