public health model

Violence, once thought inevitable, is being increasingly recognized as a preventable, public health problem. The public health model for violence prevention recommends a four-step process to systematically approach violence. Developing a prevention strategy can be relatively straightforward or rather complex. Many excellent guides and resources, such as the Community Tool Box, are available online and in print. Below you'll find basic guidance related to using risk and protective factors to begin developing or selecting a prevention strategy, specifically in the state of North Carolina. For more in-depth training on prevention program planning consider attending a prevention training provided by the North Carolina Coalition Against Domestic Violence or one of our Prevent Violence NC partners.

FIRST, GATHER DATA TO MAKE SURE YOUR PREVENTION STRATEGY IS RELEVANT FOR YOUR COMMUNITY. In order to be successful, it is important that prevention efforts  are relevant to your community and involve members of the community in a meaningful way. Before developing or selecting a prevention strategy, it is essential to assess which risk and protective factors are present, among which groups and individuals, and to understand your community’s readiness to address those risk and protective factors. There are several ways to do this.

Use existing, secondary data sources

  1. Community Heath Assessments (CHA) are powerful tools in the effort to understand which risk and protective factors are relevant for a given community. CHAs are required in every county in NC. They must be completed by the local health department at least once every 4 years. The health department uses the CHA to determine health priorities and better understand the health-related needs and resources of the community.
  2. Behavioral Risk Factor Surveillance System (BRFSS)  is a statewide, random-sample survey conducted annually among residents over 18 years of age. The survey captures information about health and risk behaviors, including violence. Data are available at the county, regional, and state level.
  3. Youth Risk Behavior Surveillance System (YRBSS) is a statewide, random-sample survey of middle and high school students conducted every two years. The survey captures information about health and risk behaviors, including violence. Data are presented at the state level only (and for Charlotte-Mecklenburg).
  4. Child Health Assessment and Monitoring Program (CHAMP) is a statewide, random-sample survey to assess the health of children age 0-17. The survey captures information about a wide variety of health-related topics. Data are presented at the state and regional level.

Collect your own data

  1. Conduct focus groups, listening sessions, or interviews.
    1. While these forms of qualitative data collection do not reveal much about the prevalence of risk and protective factors in your community, they can provide valuable insight into community priorities, values, and readiness. There are many helpful guides online for conducting these types of qualitative data collection, including those offered by the Community Tool Box at the University of Kansas. Local colleges and universities occasionally offer training in these data collection techniques, as well. For example, the Odum Institute at the University of North Carolina Chapel Hill offers a one-day course in conducting focus groups for a small fee.
  2. Engage members of your community in Community-Based Participatory Research, using techniques like Photovoice.
    1. Community-Based Participatory Research (CBPR), is a qualitative data collection practice that is guided in large part by community members, in partnership with researchers or practitioners. Through a systematic process, community participants and practitioners work to achieve a shared understanding of the important influences on violence in the community and begin to plan for how to take action, particularly to address health disparities. 
  3. Conduct surveys.
    1. Surveys can be used to understand the frequency of occurrence of particular risk and protective factors in a community. Random-sample surveys provide the most accurate data, but can be expensive to conduct on a large scale. Random-sample surveys are more feasible in more narrowly defined communities, like a school or neighborhood. Consider partnering with local data collection and analysis experts, including researchers or student interns from community colleges and universities. Whenever possible, use existing survey instruments to save time and money and ensure you are collecting valid information. Again, the Community Tool Box is a great resource.

Learn what others are doing

Understanding what other local organizations are prioritizing or working on can provide clues about which risk and protective factors may be relevant to the community – not to mention uncovering potential partners for your prevention work.

  1. Attend conferences and workshops.
  2. Join multidisciplinary task forces.
  3. Join mailing lists.
  4. Follow social media.

NEXT, PRIORITIZE. FOCUS ON RISK AND PROTECTIVE FACTORS THAT ARE IMPORTANT, CHANGEABLE, FEASIBLE, AND HAVE BROAD IMPACT. When you have determined the set of risk and protective factors relevant to your community, you will likely need to narrow your list. In order to prioritize the factors your prevention work will address, involve commmunity partners in determining:


Risk and protective factors are more important…

  1. the more common they are in your community
  2. the more closely related/strongly associated they are to your outcome of interest (e.g. being a victim of psychological or physical abuse is consistently one of the strongest predictors of perpetrating violence); the strength of association between a risk or protective factor and a given outcome can be obtained by looking to research published on the topic - meta-analyses and systematic reviews, two types of studies, provide the most complete picture on these relationships


To establish the changeability of a given risk or protective factor…

  1. Find published research or reports describing previous attempts to change it 
  2. Determine if the risk or protective factor is changeable in theory
  3. Remember that even if a risk or protective factor cannot be changed, it should not overlooked; it may act as an important indicator of individuals or populations that may benefit from enhanced intervention strategies


It is equally important to determine the feasibility of planning a prevention strategy around a given risk or protective factor. Feasibility may include considerations around…

  1. Your organization’s capacity (i.e. do you have the expertise and resources to work on this particular factor or set of factors)
  2. Community interest
  3. Political will


  1. Prevention strategies that focus on organizations, communities, and societal conditions have the potential for greater impact than those that focus on individuals or individual couples and families. The former reach a larger number of people with less effort, and they are more likely to create sustained change. By changing systems, structures, policies, and norms, you ensure that the effects of any violence prevention work will reach beyond simply the individuals directly involved in the effort.
  2. When possible, select risk and protective factors that can be addressed with a strategy that works on a larger scale. These are expected to have a greater impact on public health overall, if they are delivered with sufficient dosage. For example, strategies to enhance community connectedness work on a larger scale than those used to increase an individual’s knowledge.
  3. When possible, select risk and protective factors shared by multiple health outcomes.

Finally, it is essential to consider carefully how addressing particular risk or protective factors (or not addressing them) will affect health inequities. 


Special thanks to Dr. Beth Moracco, PhD at the University of North Carolina Gillings School of Global Public Health



Copyright © 2015 NCCADV All Rights Reserved | 3710 University Drive, Suite 140 | Durham NC 27707 | 919-956-9124 (Toll Free: 1-888-997-9124)