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Framing Public Health Systems Change: A Micro, Meso, and Macro Level Overview

Public health systems are complex and constantly evolving, requiring a nuanced understanding of how different levels of influence interact. At Impact Narrative Consulting, we present a systems-level framework that empowers public health leaders to navigate these complexities. By aligning responsibility and strategy across micro, meso, and macro levels, we can enhance community health outcomes. Discover how frontline professionals, organizations, and policymakers can work together to create sustainable change and improve public health delivery. Join us in exploring the vital connections that drive effective transformation in our communities.

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Systems Level Evaluation: Aligning Strategy, Indicators, and Accountability

Outcome evaluation is essential for understanding the effectiveness of public health initiatives, especially those aimed at systemic change. It answers the critical question: Did we achieve what we set out to do? However, in systems-level work, evaluation becomes complex, requiring alignment across multiple organizations and sectors. The Collective Impact Framework provides a robust foundation for this process, emphasizing shared measurement and collaboration. By engaging diverse stakeholders and embracing a culture of learning, we can better track progress and drive meaningful change. Discover how to design evaluations that reflect the intricacies of our interconnected systems and enhance public health outcomes.

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Outcomes vs. Outputs: Understanding the Difference in Your Program Indicators

In public health, understanding the difference between outputs and outcomes is crucial for driving meaningful change. Outputs are the tangible activities you track, like the number of workshops held or materials distributed. However, outcomes measure the real impact of your work—changes in knowledge, behavior, and community health. By adopting a systems-level approach and utilizing frameworks like the Theory of Change, you can align your efforts with broader goals and demonstrate the true value of your initiatives. Discover how to create a roadmap for success that not only counts activities but also showcases the depth of your impact.

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Sustainable Health Communications for Public Health Department Teams

Public health teams face constant pressure to communicate clearly, consistently, and credibly, often with limited time, capacity, budget, resources, or all of the above. While campaigns and one-time messages can generate bursts of attention, sustainable health communications require long-term planning, internal alignment, and systems that support continuity beyond any single staff member or funding cycle.

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Internal Infrastructure for Impact: SOPs and Data Collection as Systems Tools

Blog Read stories and case studies from our work at the intersection of strategy, design, and impact. From evaluation insights to community-driven campaigns, we break down how data and storytelling drive better public health outcomes. Internal Infrastructure for Impact: SOPs and Data Collection as Systems Tools Author: Brittany Weatherall June 19, 2025  In many mission-driven organizations and programs, day-to-day processes are often informal, undocumented, or reinvented with each staffing change. Without clear Standard Operating Procedures (SOPs) and intentional data collection practices, even the most effective initiatives risk becoming inconsistent, difficult to scale, and challenging to evaluate. SOPs provide the structure necessary for operational consistency, while data collection enables informed decision-making and impact measurement. Together, they form the foundation of sustainable, accountable, and strategic work. SOPs as a Strategic Infrastructure   SOPs are more than internal documentation—they are a critical component of organizational infrastructure. They establish the foundation for building programs and initiatives that are both scalable and sustainable. When grounded in data-informed processes, SOPs ensure that operational decisions are aligned with strategic goals. One of the primary benefits of SOPs is their ability to reduce ambiguity and minimize disruptions during staff transitions. By serving as living documents, SOPs adapt over time while maintaining continuity in how work is carried out. This helps preserve institutional knowledge and ensures that essential functions do not rely solely on individual memory or experience. Standardized workflows that are accessible to all team members promote consistency across departments and roles. They also support equitable work environments by clearly outlining expectations and procedures, making it easier for new and existing staff to contribute effectively. When internal processes are documented and repeatable, organizations are better positioned to maintain momentum—even amid staffing changes or program growth. Moreover, SOPs help strengthen organizational learning by building a shared knowledge base. Teams gain familiarity with procedures over time, which increases efficiency and supports long-term capacity-building. Ultimately, thoughtfully developed SOPs not only clarify day-to-day tasks—they reinforce the systems needed to deliver consistent, high-quality outcomes. The Strategic Value of Data Collection In addition to informing internal decision-making, strong data practices are essential for reinforcing transparency and accountability with funders, executive leadership, partners, and other stakeholders. When organizations and programs can clearly communicate the impact of their work—grounded in reliable, well-documented data—they foster trust and demonstrate responsible stewardship. This level of transparency indicates that performance is not only monitored, but also used to drive program evaluation, refinement, and strategic decision-making. It reflects an organizational culture committed to learning, accountability, and alignment with both community needs and stakeholder expectations. Moreover, when data is deliberately linked to clearly defined indicators, it becomes a strategic asset rather than a compliance task. Structured data enables stakeholders to trace outcomes back to specific activities and understand the rationale behind key program decisions. This alignment enhances the clarity, interpretability, and relevance of findings, making them actionable across diverse contexts. It also facilitates the development of shared measurement systems, supports cross-sector collaboration, and strengthens the foundation for coordinated, sustainable, and evidence-informed planning. Integrating SOPs and Data Practices SOPs and data collection systems are most effective when designed in tandem. Together, they provide the structure needed to ensure that data is collected consistently, used appropriately, and interpreted accurately. While data reflects program outcomes, SOPs define the processes that make those outcomes measurable and credible. Key benefits of integrating SOPs into your data systems include: Process clarity: SOPs outline how data should be collected, entered, stored, and analyzed, reducing ambiguity and duplication. Consistency across time and teams: Standard procedures promote reliability despite staff transitions or project shifts. Data quality assurance: SOPs support uniform methods for data validation, cleaning, and formatting. Stronger alignment with program goals: SOPs connect data collection directly to performance indicators and evaluation frameworks. Improved transparency and defensibility: Clear protocols provide documentation for how data was handled and used. Moreover, SOPs help ensure alignment with ethical, legal, and regulatory standards by clearly documenting protocols for data collection, storage, privacy, and use. When questions arise about data quality, methodology, or interpretation, a well-developed SOP provides a clear record of how decisions were made and how practices align with accepted research and evaluation frameworks. This transparency not only protects the integrity of the data but also builds credibility with stakeholders and reinforces trust in the organization’s approach. Applied Example: Lessons from Practice In a recent outcomes evaluation project, we developed a suite of SOPs to guide long-term data collection, analysis, and reporting. These documents were paired with an evaluation spreadsheet that linked survey questions developed from program evaluation to specific indicators and program goals. As a result, data collection became more structured, duplicative efforts were reduced, and the organization was better positioned to communicate its outcomes to stakeholders. The combination of technical clarity and strategic alignment increased both internal capacity and external trust. Recommendations for Implementation For teams aiming to strengthen data practices and integrate them with program evaluation efforts, consider the following: Document data collection protocols – Define when, who, and by whom data should be collected. Include procedures for managing consent, protecting data privacy, and ensuring consistent data entry across tools and platforms. Establish data quality checks – Develop SOPs for validating responses, identifying outliers, and addressing incomplete or inconsistent data before analysis. Clear thresholds and logic rules can significantly reduce the burden of cleaning data later.  Align data with evaluation indicators – Map each data point to relevant program goals, logic models, or performance indicators. This ensures that collection efforts are intentional and tied to broader evaluation frameworks. Standardize analysis and reporting procedures – Outline steps for preparing datasets, running analyses, and interpreting findings. Include formatting guidelines for charts, tables, and narrative summaries to support consistency in internal and external reporting. Incorporate feedback loops – Build in regular review points where data insights are shared with staff, leadership, and stakeholders to inform program adjustments and strategic decisions. Conclusion Standard Operating Procedures (SOPs) are more than internal checklists, they’re strategic tools that ensure consistency, clarity, and accountability across your organization. Whether you’re managing a

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Evidence-Based Survey Design for Public Health: What to Avoid

Blog Read stories and case studies from our work at the intersection of strategy, design, and impact. From evaluation insights to community-driven campaigns, we break down how data and storytelling drive better public health outcomes. Evidence-Based Survey Design for Public Health Organizations: What to Avoid Author: Brittany Weatherall June 15, 2025 Designing a survey may seem straightforward, until response rates decline, the data doesn’t align with your indicators, or the questions fail to reflect community realities. In community health work, where surveys inform programs, funding, and policy, design missteps can lead to missed opportunities—or worse, erode community trust. Here are five common pitfalls—and evidence-informed strategies to avoid them. 1. Asking Without Purpose Mistake: Collecting data with no clear plan for how it will be used, or what it aligns to.  Before drafting any questions, define a specific, attainable goal and ensure it aligns with your broader evaluation strategy. What insights are you trying to gain? What decisions will this data help inform for stakeholders? Surveys should be narrowly focused: “Ask only the questions needed to achieve your survey goal, and ask them as clearly and simply as possible.” Each item should align with your evaluation questions, indicators, or intended outcomes ¹. Establishing and following Standard Operating Procedures (SOPs) for data collection and survey design not only promotes consistency, it also builds internal capacity and ensures transparency in how your organization collects and applies data. These SOPs should reference evidence-based survey methodologies (such as IES and Dillman’s Tailored Design Method) to reinforce equity in practice and ensure your data collection is strategic, ethical, and inclusive. 2. Overloading the Survey Mistake: Asking too many questions or combining multiple topics in one tool. Poor structure and survey fatigue are common culprits behind low-quality data. Overly long or disorganized surveys discourage completion, leading to biased or incomplete results. The Institute of Education Sciences  (IES, 2023) recommends… Keeping surveys brief and specific Grouping related items into clear sections Including progress indicators to reduce fatigue Placing open-ended or demographic questions at the end Avoid poorly constructed questions, including: Loaded questions (contain assumptions) Leading questions (bias in the response) Double-barreled questions (ask two things at once) Vague questions (unclear or broad) Inappropriate response formats—such as inconsistent scales—can also hinder data cleaning and interpretation (Dillman et al., 2014). 3. Ignoring Health Literacy Mistake: Writing in academic or clinical language that confuses or alienates respondents. Use plain, accessible language. Avoid jargon, and make sure the survey is culturally and linguistically relevant. IES (2023) recommends pilot testing with members of your intended audience to identify confusing terms or unclear instructions. Inclusive surveys also consider a range of lived experiences. Ask: Is this question necessary? Is the language respectful? Are the identity and demographic options expansive enough? 4. Disseminating Too Many Surveys Mistake: Repeatedly surveying the same groups without coordination. Communities, especially those historically marginalized, are often over-surveyed and under-informed. This leads to survey fatigue, disengagement, and declining response rates. When communities are continuously asked for input without seeing change, it can feel extractive and transactional. IES recommends reviewing prior surveys, leveraging publicly available data, and coordinating with partners to prevent duplication. If a new survey is necessary, clearly communicate its purpose, intended use, and how results will be shared. Respecting participants’ time and voice is essential for maintaining trust and ensuring long-term engagement. 5. Skipping the Feedback Loop Mistake: Failing to share findings or next steps with participants. Collecting data without follow-up sends the message that community input doesn’t matter. According to IES (2023), “Build trust by closing the loop.” Share results in simple, accessible formats, infographics, summaries, short videos, and clearly communicate how the data informed your decisions, reports, or policies. Final Thoughts An effective survey is not just a data tool—it’s a trust-building tool. When designed with intention, clarity, and inclusivity, surveys produce not only better data but stronger relationships and more equitable outcomes. Citations Institute of Education Sciences (2023). Creating Effective Surveys: Best Practices in Survey Design. https://ies.ed.gov/rel-west/2025/01/handout-creating-effective-surveys-best-practices-survey-design Dillman, D. A., Smyth, J. D., & Christian, L. M. (2014). Internet, Phone, Mail, and Mixed-Mode Surveys: The Tailored Design Method (4th ed.). Wiley. Stay Informed. Stay Connected. Join our listserv for exclusive updates, practical tools, and curated resources on survey methodologies, evaluation frameworks, and best practices to strengthen your public health data collection and community engagement strategies. Sign Up

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