about the plan
The Better Together Plan (BTP) is a single, statewide plan that addresses heart disease, stroke, and diabetes in the state of Indiana. This is the first time Indiana is addressing all three of these disease states together in a single, statewide plan. The BTP identifies key priorities for Indiana and provides opportunities for individuals, organizations, agencies, and communities to join in the work while connecting with their priorities and interests. Together, the combined efforts of these entities around the state will improve cardiovascular health and prevent, effectively treat, and manage diabetes in Indiana.
The purpose of the BTP is to serve as a guide for stakeholders and partners to use to implement activities that reduce the burden of heart disease, stroke, and diabetes in Indiana. As this is a large goal, it will take a coordinated effort by individuals and organizations around the state and across sectors to make a real impact. The BTP is to serve as the tool that allows partners from different regions and areas of interest to align their efforts. Together, these partners can achieve the desired result.
The BTP planning process, which extended from March 2015 through November 2016, was funded by the ISDH, coordinated by the CADI, and facilitated by Community Solutions, Inc. (CSI). The process was designed to ensure the Plan was relevant and impactful for individuals, organizations, and communities across sectors around the state.
The structure of the BTP was developed using the Results Based Accountability (RBA) framework. RBA begins with the desired outcome for a certain population and works backward from there to identify ways to make an impact. The approach includes a population to be impacted, a desired goal for that population, primary measures to track progress toward that goal, and strategies that describe what will be done to make progress. The overall population to be impacted by the BTP is all Hoosiers. The overall goal is to improve cardiovascular health and prevent, effectively treat, and manage diabetes in Indiana.
Because this is such a large goal, it has been broken down into three goal statements, around which the Plan is organized. Each goal statement has a set of measurable objectives and a set of strategies organized by the Social Ecological Model that outline how the work will get done. The framework is shown in Figure 1. The dark boxes include the three goal statements; the lightly shaded boxes include the primary objectives for each goal; and the lightest shaded boxes include types of strategies to be implemented within that goal (the full lists of strategies are included in the Goals, Objectives, and Strategies section, which begins on page 24).
The RBA framework begins by defining the population to be served, followed by a goal statement that defines the result being sought for that population. The BTP targets three populations: (1) all Hoosiers, (2) individuals with increased risk levels for heart disease, stroke, or diabetes, and (3) individuals with heart disease, stroke, or diabetes. The desired results for each of the target populations are included in the following three goal statements around which the Plan is organized:
-1- All Hoosiers are living free of risk factors for heart disease, stroke, and diabetes.
-2- Individuals with increased risk levels for disease do not develop heart disease, stroke, or diabetes.
-3- Individuals with heart disease, stroke, or diabetes experience improved quality of life and extended years of life.
The target populations and goal statements address the life stages of heart disease, stroke, and diabetes. It all starts with preventing the risk factors from occurring. The next step is to prevent those with risk factors from developing the disease. This leads to the goal of preventing early death or loss of quality of life due to heart disease, stroke, or diabetes.
Key to this Plan is that all of the target populations included in the goals are nested, as shown in Figure 2. All Hoosiers includes individuals with elevated risk levels and individuals with disease; similarly, individuals with elevated risk levels includes individuals with heart disease, stroke, or diabetes. For this reason, the objectives and strategies within Goal 1 should also be applied to Goals 2 and 3, and those within Goal 2 should also be applied to 3. Ultimately, the BTP is about everyone in Indiana living without the burden of heart disease, stroke, and diabetes.
As RBA is a data-driven approach, measurable objectives are used to track progress toward the result and to measure success. The objectives provide evidence to suggest that there is a change in conditions. For the BTP, there are several objectives for each goal area. The specific measures are included later in the Plan, but the objectives are included in Table 1 below.
Because the objectives are higher-level measures that track overall progress toward the goals, it will take time to see any change in the measures due to the efforts of the Plan. For this reason, there are no targets included in the BTP. The expected result of the implementation of the Plan strategies is to turn the curve on the current data trends for each of the objectives so that the trend line moves downward, which would mean all of the measures are decreasing over time.
The implementation of the strategies included in the Plan will help turn the curve. The strategies are focused on specific target populations and are organized by the levels in the Social Ecological Model (SEM), which include: Policy, Community, Organizational, Interpersonal, and Individual. There are types of entities included within each level, and those entities should be implementing the strategies. See Figure 3. The strategies are organized by who should be implementing the strategy, not which level is impacted by the strategy. For that reason, there are no Individual-level strategies included in the Plan.
It should be noted that the BTP is funded by the state, so it cannot direct advocacy efforts, which are strategies that may fall under the Policy level of the SEM. However, there are evidence-based and promising policy practices that can impact population-level health. Because any public health plan that does not include Policy-level efforts to support healthy communities is incomplete, this Plan includes examples of effective policies that have been shown to improve public health, for educational purposes.