Moving from perception to action in the United Health Foundation's State Health Rankings

The United Health Foundation (UHF) produces an annual State Health Rankings (SHR) report, generating substantial media and public attention. The report uses a methodology that weights the contributions of several risk factors and outcome measures to produce an overall score for each state; the states are then ranked according to their score. The overall purpose of the SHR report is to activate public conversation concerning health, to provide information to facilitate citizen participation, and to stimulate news stories. While some states have adapted the rankings for informing or changing health policies, gaps in awareness of this resource, as well as the knowledge of how to use the SHR to improve health still exist.; The goals of this study were to investigate how the UHF SHR influences state policymakers. The study's aims included: (1) evaluating the communication campaign for the UHF SHR; (2) identifying activities and short-term outcomes initiated by policymakers or decision-makers who have used the UHF SHR to facilitate policy change; (3) examining the significance of the SHR as a format for presenting health information.; The study used a qualitative evaluation approach. Semi-structured interviews were conducted with state-level policymakers who have used the SHR to affect policy change in their state. Purposive sampling was used to recruit subjects in this study. Study subjects were recruited from among people who contacted UHF about using the SHR for policymaking, state Chief Information Officers, and members of the Association of Health Care Journalists and the Association of State and Territorial Health Officers. UHF publicity materials, dissemination materials, and news reports were reviewed as part of the process evaluation.; Interviews suggested alternative explanatory frameworks that focused on key components or themes in relating policymakers to the SHR, including: data entrepreneurs, policy communities, and the symbolic nature of the rankings. The study hypothesizes that the consistency of SHR information allows data entrepreneurs to translate the overall ranking into a symbol that can be used to engage others in action. The study intends to demonstrate that effective data entrepreneurs can transform the overall state ranking to specific components to facilitate local action.