Policy, systems, and environmental (PSE) change approaches are "promising strategies to address the nation’s cancer burden because they have the broadest population impacts by changing the overall context for health-related decision making and facilitating long-lasting protective interventions."1 PSE changes are public health changes that strive to make the healthy choice the easy choice.
1Townsend, J.S., Sitaker, M., Rose J.M., Rohan, E.A., Gardner, A., Moore, AR. (2019). Capacity Building for and Implementation of Policy, Systems, and Environmental Change: Results from a Survey of the National Comprehensive Cancer Control Program. Population Health Management, 22(4):330–338. doi: 10.1089/pop.2018.0082
PSE Change Steps
In order to illustrate the process, we have broken PSE change down into seven steps. A PSE change strategy may include each of the steps, some of the steps, or may be iterative, with some steps being repeated more than once.
Each step also includes a downloadable worksheet with questions to consider in planning and implementing activities for that step. These worksheets can be used to facilitate coalition training and planning discussions.
- Step 1: Engage - Build Partnerships and Engage the Community
PSE change initiatives involve a wide variety of people, agencies and organizations from all corners of the community, working toward a common goal. As with other public health initiatives, partnerships are vital to any PSE change process. They make it possible to divide the work so it can be completed more efficiently. Working with diverse partners also strengthens your efforts by capitalizing on each member’s strengths and reaching each member’s constituencies.
Build partnerships with community stakeholders and engage partners who might be affected by the broad issue identified. Ensure that the partnerships include stakeholders who can effectively work with your team to plan, implement, and evaluate evidence-based cancer control PSE change interventions.
- Step 2: Scan - Perform Environmental Scans
After you have identified partners and built a solid partnership with community stakeholders, do your homework! Conduct an environmental scan to determine what actions should be taken within the broad health issue you want to address. The environmental scan allows you to identify gaps, trends and factors affecting the political, social, economic and legal context to help you understand the drivers of PSE change.
Scan the environment by researching grey literature (non-commercial or academic literature), program websites, legislation, funding announcements and other resources. Use the environmental scan to identify additional partners as well as supporting or opposing stakeholders you could bring to the table.
- Step 3: Assess - Identify Priority Areas
After you have scanned the external environment surrounding the health issue you want to address, you now understand the drivers and challenges of your potential PSE change initiative. However, you need evidence to support your position. Assess and review available data to determine which specific aspect of the health issue can be potentially resolved or lessened through PSE change. Your state, tribe or territory cancer control plan is a great place to start.
Data can be quantitative or qualitative and can be found in various sources including state and federal surveillance programs and published research. Review quantitative data such as cancer surveillance data for your state, tribe or territory. Look for qualitative data collected through focus groups or key informant interviews as well as anecdotes collected through community meetings and other methods. Seek local-level data to inform your community-based efforts. Use these resources to develop goals that are specific, measurable, attainable, relevant, time-based, inclusive, and equitable (SMARTIE).
- Step 4: Review - Assess Feasibility of Interventions
After you have scanned the environment and assessed available evidence to create SMARTIE goals and objectives, review the feasibility of your proposed PSE change intervention to determine if your goals and objectives can be implemented.
Work with stakeholders to develop a strategy for turning an idea, goal or objective into action, including a discussion of the political, social and economic climate and community readiness. Ensure that key champions are involved to provide their support. Consider the decision makers and key players involved, the resources that exist and that you may still need and the barriers you may face as you get ready to promote your PSE change agenda.
- Step 5: Promote - Promote Awareness, Communicate, and Educate
Now that you have established your community partnerships, determined needs and prioritized potential solutions, identified data to inform your initiative and determined a feasible strategy, you are ready to communicate the need for your PSE change effort. Communicate to all stakeholders the need for PSE change prior to implementation to help lessen potential resistance.
Consider how to frame the need for PSE change and develop a communication plan to support it. Be sure to tailor your message to your intended audience(s) and include various forms of media to educate and build support among stakeholders and the public, when appropriate.
- Step 6: Implement - Take Action
Each step so far has been leading to implementation of your goals and objectives, and thanks to your promotion efforts, stakeholders should now be aware of the need for PSE change. Some may even actively support your initiative and commit to its success.
You are ready to take action! Implement your PSE change intervention, which links directly with goals and objectives in your cancer control plan.
Think about the expected outcomes of the intervention, both in the short term and the long term. To do this, you must keep your partnerships strong, continue scanning the political, social and economic environment surrounding your initiative and keep up with new evidence pertaining to the issue you are addressing. This helps you determine if you need to invite new stakeholders or find new resources to successfully implement and sustain your work.
- Step 7: Evaluate - Measure Your Success
By now, you have engaged partners, conducted an environmental scan and assessed the existing evidence to support your position. You reviewed the feasibility of your strategy, promoted it to your stakeholders and implemented it. Welcome to the final step!
Evaluate the processes employed during the implementation of your PSE change intervention as well as the short-term, intermediate and long-term outcomes expected to result from the intervention. Evaluation can provide quantitative and qualitative data to demonstrate the change(s) that occurred.
Use this form to develop a PSE agenda (sometimes called a policy agenda) for your comprehensive cancer control coalition.