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Setting Priorities

After conducting the needs assessment and asset mapping, implementers of rural obesity prevention programs should set priorities to take action on problems such as barriers to healthy eating and physical activity. For an overview of the methods that can be used, see Set Goals and Priorities in the Rural Community Health Toolkit.

Many formal approaches to priority setting include a role for an outside facilitator, such as a community healthcare provider, an individual from the public health department, or a researcher who partners with community members. One formal approach is Adapted Intervention Mapping (AIM).

Adapted Intervention Mapping (AIM)

AIM is a tool designed for use by partnerships between communities and universities. It provides a framework for planning and implementing programs to increase opportunities for physical activity and healthy eating. Critical elements of AIM include:

  • Involvement of community members
  • Emphasis on partnerships
  • Identification of evidence-based practices
  • Integration of theory and findings from literature

Using AIM, researchers identify evidence-based practices, which are then considered and ranked by community members.

A key step in the AIM process involves helping a community network decide which environment and policy changes to implement using available resources. This is done by ranking importance by changeability.

  • Importance
    How important is an issue for affecting obesity in the community?
  • Changeability
    How easy or difficult will it be to change the issue?
Table 2-3: Decision Matrix for Deciding which Environmental and Policy Changes are Desired
Changeability
Importance More Changeable Less Changeable
More important High priority for intervention Low priority except to motivate community organizing efforts (“Winnable battles”)
Less important Priority for innovative intervention; evaluation crucial Not a priority

Source: Health Promotion Planning: An Educational and Ecological Approach, Third Edition
Green, L.W. & Kreuter, M.W.; Mayfield Publishing Company, Mountain View, CA. 1999

An example of how AIM has been applied in school settings is outlined in Figure 2-2, and can be adapted for other settings.

Figure 2-2: Using AIM to Choose Targets for Change (School Setting)

  1. AIM facilitators share national dietary and physical activity guidelines and recommendations;
  2. Network members brainstorms changes to help children achieve daily recommendations;
  3. AIM facilitators share best practices information from the literature;
  4. Network members individually rate each of the proposed changes based on importance (is this evidence-based strategy known to increase activity/healthy eating, will it affect the majority of students on the majority of school days) and changeability (do we have the resources, will, and capacity to do this?)
  5. Brainstorm ideas and plot them on a whiteboard with four quadrants:
    1. High importance/low changeability
    2. High importance/high changeability
    3. Low importance/high changeability
    4. Low importance/low changeability
  6. Discuss the results and have each network member vote on his or her top priorities (e.g., changes related to healthy eating, changes related to physical activity).
  7. Network members select healthy eating and physical activity changes to implement, based on the environmental/policy changes receiving the most votes.

Source: Description of the Adapted Intervention Mapping (AIM) Process
Colorado School of Public Health; Rocky Mountain Prevention Research Center