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Multi-level Initiatives

This guide will advise to about how to try to put together a multilevel initiative – this is more advanced than “simply” a traditional communication campaign, as it integrates tools from public affairs and stakeholder engagement – grassroots inspiration and lobbyism.

To create or carry out a multilevel initiative you should keep in mind that change is never easy – and (lack of) communication not the only challenge. So any initiative of this sort could/should be considered in a longterm perspective.

If you wish to create transformative changes then a simple communication tool or even a very creative campaign will probably not be enough – remember they are tools for you to build change – but then, as you surely know, great things can happen when good people decide to take decisive action.

1. Why, who and when?
As you may have read in the section about Campaigns here, a multilevel initiative should also start with a research and analysis phase to help you clarify why you want to use this approach, who you would like to engage, and what time frame you foresee.

Barriers
In a multi level initiative you would be using not only communication tools, but also work by other means to engage professionals, decision makers, or the public in your work.Your analysis should give you these answers; what are the prime barriers to self care in your community/region/country – people, legislation, rules, lack of education, other? The answer will probably not point to any single one issue, but probably a multitude of reasons. And may also point to the fact, that there might be barriers not quite described yet.Nevertheless – we recommend you try to choose only three of these barriers, and then ask the next hard question; how can I/we change these barriers?

For instance; How do I lobby politicians – and for what? How do I help create better dialogue between communities/municipalities and hospitals to improve preventive measures? How do I change curriculum for in natural science related educations like medicine, nursing, or perhaps biology? Or in educations for kindergardens teachers or school teachers? Or how do I help create more community based courses on healthy living?

Your answers may end up to be different than these – but a clear picture of the barriers you see and a path to change them will help you define your initiatives.

Stakeholders
After an analysis of barriers you should also try to map the relevant stakeholders. Who they are, what their interest is, level of importance, what they are doing at present, how they normally interact with others, how they might help or oppose your initiative.

Be prepared to also show your stakeholder map to others – they might help you find your blind spot, or have a valuable key to one of your central stakeholders.

You might also peruse the different good advice on the five minor ailments of the PiSCE-project here so you can try to select specific advice or areas you would like to focus on. Read more information about establishing purpose and goals here.

2. What can you do?
Establish partnerships, create debate, engage media, bring new research to the table, help create patient to patient self care courses, look for inspiration in other national og international initiatives for your own implementation – your choices are many.

What works best in your position is a decision you have to make yourself. But first of all we would recommend you try to create an overview of your existing assets (be they economical or intangible) – and especially try to create a strategy of how your intangible assets can support your intentions over time.

Waiting for a better, bigger budget is not the solution. If you would like change, initiative and action will always create better results than a reactive position.

Look at our catalogue of cases from the EU here – but this time not for what they’ve done, instead look harder at Who. Several or most of the cases are relatively small organisations with stricly limited resources. Yet they’ve managed to create communication tools and initiatives that can now inspire professionals in all the Member States – quite an achievement also.

3. Talk to stakeholders/partners/networks early on
With the intention and the idea of concrete initiatives at multiple levels you should sound of your ideas – this can give you valuable advice, start building your partnerships, and also give you a clearer idea of possible opposition to your initiative.

You should expect a certain level of opposition also. Perhaps a lack of interest in the media or among local authorities. There might be conflicting agendas or priorities in the field. Your map of barriers and stakeholders will help you foresee, but not necessarily avoid, challenges like these.

Opposition – sometimes quite strong – can certainly happen when you are working for change, regardless of the basic merit of self-care. A good advice is to try to establish personal dialogue and engage your key stakeholders as soon as possible – debating or arguing about key points via media or third party convinces very few and changes very little.

As mentioned above, a stakeholder analysis should be one of your first actions – at this point you should perhaps try to place them also in the persuasion-action matrix you see here – perhaps this will enable you to focus your efforts on key audiences and stakeholders to begin with.

4. Consider your message – and your vision
In a multi level initiative you certainly run the risk of stakeholders, outsiders – or even your insiders – losing track of your progress and direction.Part of this is a normal side effect of engaging multiple audiences in different ways over a longer period. But still, it is a thing to try to avoid.

So aside from having a clear message throughout, you should aim to describe your Why, your What and your With who from the points above in a short form. Perhaps as a mission statement, a joint declaration, a vision that you have people debate and vote for even.

To create debate and engagement are key to be able to unfold other activities in your initiative. Therefore we would recommend to include your partners and stakeholders in this process. And at this point (if not before) you should also consider how health literacy plays a role in your messages.

5. Choose your strategy and your tools
With a multi level initiative you have all the choices in the world of course. But your work so far should by now have helped you to more than one idea of how specific barriers are seen by specific stakeholders, and how initiatives and actions could change these factors.

Some might be issues that involves mostly communication tools, some mostly direct dialogue – all are useful. You might find it helpful to see your challenge as having to put together a three-dimensional puzzle. It requires looking at different pieces and seeing how they might fit. And once you find the right piece, you will often find that it unlocks new opportunities in different dimensions at the same time. You will probably also find that some parts of your puzzle progresses nicely, while other part seems stuck.

Your stakeholders and partners can be a valuable asset in trying to find the right strategy – as you will have to consider a strategy that correspond with your ressources, financial as well as strategic. If you so far feel you have neither, perhaps you should consider a less ambitious approach and see how you can change the basic interests in the field first.

6. Effect/Evaluation
The more activities and tools you use, the harder it might get to point to very specific acts of self care and use these either as proof of success or measures of progress.

In a multi level initiative other a longer period of time there are a lot of other factors to consider that might work counterproductive to your own efforts. A good idea it therefore again to possibly involve your stakeholders and partners in co-defining various metrics on your path to better self care.

You can read more about evaluation here, but in generally remember that sharing your ideas and results with others will not only potentially inspire others, but also enable them to support your work.

Inspiration
If you would like to study one such multi level initiative, look at the Self Care Week here organised by the Self Care Forum – so far held since 2011.

The Swedish webservice 1177, mentioned in the section about websites, can also be seen as a multi-level initiative, as it also incorporates other options, e.g. telenursing Swedish 1177.