Women's Health Toolkit

Take Inventory
Taking inventory requires identification of existing data, needs assessments, health services inventories, and other appropriate resources on which to build. This is an important step to help ensure you do not duplicate efforts. Creating a comprehensive starting point is a crucial step for documenting progress and building momentum.

We assessed the status of women's health using both qualitative and quantitative approaches, successfully engaging many partners as a direct result of these efforts. Both quantitative and qualitative data are important in building momentum. Qualitative analyses can poignantly emphasize points illustrated by the numbers (quantitative data). Moreover, the process of gathering qualitative data can help to build momentum. Gathering broad public input provided a platform to promote awareness messages and to identify potential partners. In this section, we describe the processes used to take inventory and highlight how each contributed to momentum

Strengths, Weaknesses, Opportunities, and Threats (also known as "SWOT Analysis") [pdf; 53.12kb]
Shortly after naming Florida's First Officer of Women's Health Strategy, we held three open forums to collect opinions about state and community-level priorities related to women's health. Having the support of a highly visible Officer of Women's Health Strategy added legitimacy to these meetings and mobilized groups interested in women's health. Having legislative authority also increased interest and participation. We generated an extensive list of interested persons from these forums and all of these individuals became partners or participants in ongoing women's health activities.

Gap Analysis of Women's Health Services
One of the first places to start building momentum is within one's agency. The decision to begin with an emphasis on mobilizing internal partners is consistent with the Association of Maternal and Child Health Programs (AMCHP) framework for developing effective partnerships. This framework promotes integration within women's health entities (e.g., Healthy Start, Family Planning Program, HIV/AIDS and STD Programs) before planning and implementing programs and policies across non-health entities. The Intra-Agency Women's Health Committee had the potential to reach all of the key women's health programs within the department, so we decided to engage this group in our mobilization efforts.

The Intra-Agency Women's Health Committee includes leaders who are responsible for advocating and overseeing nearly 30 statewide programs. It can be challenging to mobilize individuals who are typically concerned with different, single-program interests and unite them around an issue that they view as peripheral to their primary focus. Thus, mobilization centered on the need for integration of services. For details about the process, please see Mobilizing Support. [pdf; 18.3kb]

The focus on integration required a gap analysis assessment of which services are adequately available to women and which are not. Gap analyses are important tools for building momentum, and we found the action-oriented meetings focused on the gap analysis were more effective for engaging individuals and mobilizing support than education- and awareness-oriented meetings. The gap analysis [pdf; 128kb] proceeded in three distinct stages:

• defining core women's health services,

• linking services with programs, and

• validating data.

The Intra-Agency Women's Health Committee's first task in conducting a gap analyses was to identify a core set of services that are critical to women's health. While this step may sound simple enough, it was not. We found it necessary to establish an age focus for identifying services for women. We focused on women between the ages of 15 to 44, since the grant focuses on women of reproductive health age. We then decided on a definition of Women's Health:
 

"Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. Women's health involves their emotional, social, spiritual, and physical well-being and is determined by the social, political, and economic context of their lives, as well as biology." (Adapted from Platform for Action of the Fourth World Conference on Women in Beijing, September 1995)

The Intra-Agency Women's Health Committee then finalized a core set of women's health services. For details about the process, please see Defining Core Women's Health Programs and Services.  [pdf; 23.7kb]

Once we finalized this list of core services, the next step was to link those services with programs to identify the gaps. The Intra-Agency Women's Health Committee reviewed the list of departmental programs that correspond to this core set of services. For the purpose of linking core women's health services to programs, the committee defined state programs as those that support core services through funding, policy development, monitoring, or technical assistance to service providers. The committee identified a list of programs that included bureaus, programs, or activities within programs that directly provide one or more core women's health services. For consistency with other departmental documents, the group edited the list of programs so they align with the titles used in the Florida Department of Health Resource Manual, an document the department updates annually. .

The task of linking services with programs created an Inventory of Women's Health Programs [pdf; 20.4kb] using program descriptions from the resource manual. We categorized program descriptions into two groups: core women's health programs (with official documentation of core women's health services' provision), and other public health programs that are essential to the department's ability to provide the core women's health services.

The final step in conducting the gap analysis, validating the data, was the most labor-intensive and included:

• a word search of the Florida Department of Health Resource Manual cross-referencing programs to core services,

• program review and update of which core services their programs provided , and

• validation of the matched list of core women's health services and programs by cross referencing with the department's service coding manual and data collection forms (state adult and adolescent health history form, adult and adolescent physical examination form, and health promotion form).

We learned some lessons in conducting the gap analysis, which we would like to share. The first lesson was the importance of specifying and reaching agreement on inclusion criteria for services very early in the process. It is essential that everyone understands definitions and inclusion criteria BEFORE beginning the process. This will avoid rehashing and second-guessing at later stages. This step may require more time than expected. You may think everyone is in agreement, but then find that changes are necessary to the written product. Below are a few of the questions we encountered.

1. How are we defining "women" (what ages are we including)?

2. When you say "services," do you mean clinical services?

3. What about health promotion?

4. What about assessments?

5. How are you defining programs?

6. Are we talking about programs just at the state or county level?

Strategic Plan
The Intra-Agency Women's Health Committee (with 350 combined years of public health experience) reviewed the cross referenced list and identified additional gaps in core women's health services and barriers through an in-depth discussion about accessibility. For details, about the process, please see Identifying Gaps in Women's Health Services - Part 1 [pdf; 23.7kb] and Identifying Gaps in Women's Health Services - Part 2. [pdf; 25.6kb] An ad hoc sub-committee finalized the summary of gaps and barriers [pdf; 19.7kb] and the full committee approved it.

We developed a vision and several strategies related to this focus at two, meetings. For details about the process, please see Strategic Planning -- Prioritizing Needs [pdf; 17.6kb] and Strategic Planning - Brainstorming Strategies. [pdf; 17.8kb] At the first meeting, we crafted the vision and developed strategies for focus areas:

1. heightened awareness of departmental women's health programs,

2. active sharing of information,

3. coordination of program activities, and

4. increased joint efforts.

The committee then broke into four groups to brainstorm strategies related to these focus areas. We circulated results from this meeting to the full committee and solicited additional suggestions . At the next meeting, we reviewed all strategies and made a few adjustments to focus areas by combining those that were similar. For a summary of the final strategies, please see Action Ideas. [pdf; 8.34kb]

After the committee reached consensus regarding the final list of strategies, we prioritized the strategies and developed action plans. For details about that process, please see Strategic Planning - Prioritizing and Refining Strategies. [pdf; 18.2kb] We carried out two exercises to prioritize the strategies by impact and by feasibility.
The committee focused on the top three strategies and developed activities, benchmarks and strategic champions. These activities included:

1. disseminate information via new employee orientations, bulletins, and newsletters,

2. develop and promote the use of a women's health data profile in the DOH web-based Community Health Assessment Resource Tool Set, and

3. link websites of health programs that serve women with the women's health website.
   
   Tools for success with workgroups:

• When using an ongoing workgroup to develop a product over multiple meetings, strive to maintain continuity of members to avoid renegotiating previous decisions.

• Set a standing day and time for recurring meetings to reduce schedule conflicts for workgroup members and increase participation.

• If possible, spread the work over fewer but longer meetings.

Data Assessment
The Women's Health Data Report 2006 was the department's first comprehensive assessment of women's health status in Florida. This inaugural report provides analyses of morbidity and mortality data, behavioral factors, indicators of access, and reproductive health. It also summarizes the unique health issues of special populations and documents racial and ethnic disparities in women's health. A copy of the Women's Health Data Report 2006 [pdf; 1.90mb] is available on the Department of Health's Women's Health website, with hyperlinks to a number of data sources.