Oregon  Health  Authority  Health  Promotion  and  Chronic  Disease  Prevention  Program  |  2016

STAGE  3:  ASSESS  READINESS  FOR  POLICY  CHANGE  

 OVERVIEW    ⇒ Assess  if  there  is  political  will  and  community  support  for  policy  change  In  order  to  make  a  viable  plan  for  passing  a  policy,  it  is  critical  to  gauge  the  current  level  of  understanding  about  the  policy  issue  and  desire  for  change.  There  are  many  different  ways  to  assess  readiness  for  policy  change  and  the  time/resources  spent  in  this  stage  could  look  very  different  from  community  to  community.  Keep  in  mind  that  the  results  of  these  assessments  will  inform  Stage  #4:  Decision  Maker  Education  and  Stage  #5:  Public  /Community  Education.  Also,  planning  ahead  for  policy  evaluation  (Stage  #9)  after  the  policy  is  implemented  is  an  excellent  idea;  configure  these  assessments  so  that  they  can  also  serve  as  a  baseline  when  you  evaluate  your  policy.  Here  are  some  ideas  for  how  to  assess  readiness  for  policy  change.  

• Poll  county  commissioners  or  other  elected  officials,  the  general  public,  and  other  important  groups  

• Conduct  informational  interviews  and/or  focus  groups  

 Oregon  Health  Authority  Health  Promotion  and  Chronic  Disease  Prevention  Program  |  2016

• Collect  and  review  actions,  successes/failures  and  lessons  learned  from  other  jurisdictions  who  have  already  moved  similar  policies  forward  

• Estimate  the  health,  fiscal,  administrative,  legal,  social  and  political  implications  if  the  proposed  policy  moves  forward  

 KEY  FINDINGS  

 Almost  all  counties  (85%)  conducted  assessments  to  determine  community  and/or  decision  maker  support  

     

Assessments  conducted  to  determine  support  in  counties  with  tobacco-­‐free  policies    vs.  counties  without  a  tobacco-­‐free  policy  

   When  asked  about  important  indicators  that  helped  determine  whether  or  not  to  move  a  policy  forward,  Tobacco-­‐free  counties  listed  a  variety  of  things  including:      

• Opinion/s  of  county  commissioner/s  • Support  from  department  heads  • Support  from  staff    • Tobacco-­‐free  policies  in  place  in  other  counties  

 Counties  without  a  tobacco-­‐free  policy  most  commonly  said  the  opinions  of  county  commissioners  were  an  important  indicator/s  for  moving  a  policy  forward.  Counties  with  a  statistically  significantly  higher  tobacco  use  rate  in  comparison  to  other  counties  a  lacked  county  commissioner  support  for  tobacco-­‐free  policies.  

 Oregon  Health  Authority  Health  Promotion  and  Chronic  Disease  Prevention  Program  |  2016

More  than  half  of  all  counties  (18)  stated  they  did  not  encounter  significant  challenges  in  efforts  to  assess  readiness  for  policy  change.    Counties  with  a  statistically  significantly  higher  tobacco  use  rate  than  other  counties  reported  having  more  challenges.  The  most  frequently  cited  challenges  were:      

• Constraints  placed  on  TPEP  staff  • Problems  with  survey  implementation    • Lack  of  political  will  by  leadership  to  allow  assessment  to  move  

forward    LOCAL  EXAMPLE  FROM  THE  TOPPEC  SURVEY  When  asked:    What  were  the  most  important  indicators  that  helped  determine  whether  you  should  or  should  not  move  forward  with  a  proposed  tobacco-­‐free  county  property  policy?,    Kris  Williams  in  Crook  County  shared  the  following  experience:    

“I  felt  it  was  time  to  approach  County  Court  and  ask  for  the  adoption  of  a  tobacco-­‐free  campus  policy  after  conducting  key  informant  interviews  with  each  court  member  and  with  many  department  heads,  I  also  conducted  an  employee  survey  to  gauge  staff  support  and  a  community  survey  to  determine  community-­‐wide  support  for  a  policy.  Two  of  the  three  court  members  were  verbally  supportive  of  adopting  a  policy,  with  the  third  court  member  indicating  a  community  survey  might  change  his  mind.  Additionally,  approximately  50%  of  the  department  heads  approached  were  in  support  of  a  tobacco-­‐free  policy.    Overwhelmingly,  both  the  community  and  county  employee  surveys  indicated  support  for  a  tobacco-­‐free  campus  policy.  During  the  first  County  Court  hearing,  the  local  health  department  director  and  I  presented  local  data,  which,  along  with  the  positive  survey  results,  was  the  basis  for  asking  the  court  to  adopt  a  tobacco-­‐free  campus  policy.  Vocal  community  members  who  are  affiliated  with  the  Constitutionalist  Party  attended  the  court  session  and  were  concerned  that  as  taxpayers  they  “owned”  all  of  the  county  properties  and  that  we  were  attempting  to  take  away  their  right  to  do  as  they  wished  on  their  own  property.    They  also  objected  to  the  method  of  obtaining  survey  results  via  the  internet.    The  County  Court  then  asked  the  health  department  to  go  back  and  conduct  a  second  community  survey  using  a  paper  survey  and  advertising  the  survey  in  the  local  newspaper.    The  second  survey  was  conducted  online  via  Survey  Monkey,  in  the  local  newspaper,  via  

 Oregon  Health  Authority  Health  Promotion  and  Chronic  Disease  Prevention  Program  |  2016

paper  survey,  at  numerous  locations  in  the  county,  as  well  as  face-­‐to-­‐face  at  three  local  stores  and  county  offices.  The  second  community  survey  was  completed  by  596  respondents  and  confirmed  community  support  for  a  county  tobacco-­‐free  properties  policy.      At  the  second  reading  of  the  proposed  tobacco-­‐free  county  property  policy  the  health  department  again  shared  the  results  of  the  second  survey,  testified  as  to  the  best  practice  of  adopting  tobacco-­‐free  campus  policies  and  recruited  a  local  attorney  to  address  the  issue  of  county-­‐owned  property  and  the  rights  of  non-­‐smokers.    The  same  court  member  voiced  his  opposition  to  the  ordinance  and  the  same  citizens  who  spoke  in  opposition  to  the  policy  at  the  first  reading,  spoke  again.    At  that  time,  the  County  Judge  stated  he  would  take  all  comments  under  advisement  and  make  a  final  decision.    Almost  three  years  later,  the  Court  has  still  not  made  a  final  decision  on  the  matter.”        The  Crook  County  story  demonstrates  that  despite  program  staff/  advocates  best  efforts  to  lay  the  groundwork  for  policy  change  (and  even  in  the  face  of  overwhelming  employee  and  community  support),  sometimes  a  small  handful  of  vocal  and/or  powerful  people  can  stop  the  policy  making  process.    However,  rather  than  give  up  hope  for  a  county  tobacco-­‐free  property  policy,  Kris  decided  to  work  with  the  Crook  County  library  staff  and  Board  to  help  them  advocate  for  a  tobacco-­‐free  library  grounds  policy.    This  policy  also  had  to  go  before  the  County  Court  for  a  final  decision.    In  October  2015,  the  Court  voted  2-­‐1  in  favor  of  allowing  the  library  grounds  to  be  tobacco-­‐free.    The  Crook  County  ordinance  banning  smoking  and  e-­‐cigarette  use  within  20ft.  of  county  facilities  was  recently  updated  to  include  the  new  library  policy.    

 TIPS  

• Although  it  is  not  uncommon  to  conduct  key  informant  interviews  in  an  informal  way  (casual  dialogue  when  the  opportunity  presents  itself),  the  creation  of  an  interview  survey  tool  and  coordination  of  face-­‐to-­‐face  meetings  with  decision  makers  often  leads  to  better/more  informed  assessment  results.  

• When  possible,  invite  a  policy  supporter  to  accompany  you  to  key  informant  interview  meetings.    The  presence  of  an  additional  person  can  help  to  assure  the  conversation  is  documented  accurately  and  may  help  the  decision  maker  see  that  there  is  support  for  the  policy  that  goes  beyond  the  TPEP  program.  

 

 Oregon  Health  Authority  Health  Promotion  and  Chronic  Disease  Prevention  Program  |  2016

TOOLS      To  download  these  tools  please  go  to:  Stage  3  Tools  The  following  tools  may  be  useful  for  assessing  if/how  much  decision  maker  and  public  education  is  needed  before  moving  forward  with  a  tobacco-­‐free  property  policy;  these  tools  come  from  county  tobacco  programs  or  Health  Promotion  Chronic  Disease  Prevention  trainings.  Remember  that  determining  which  assessments  to  do  is  an  important  decision  and  these  tools  may  or  may  not  meet  your  exact  assessment  needs.  

• Tips  for  how  to  conduct  key  informant  interviews  • Tips  for  how  to  conduct  a  focus  group  • Sample  Key  Informant  Interview  tool  from  Deschutes  County  • Sample  Community  Survey  tool  from  Crook  County  • How  to  estimate  costs