NEW CHALLENGESBecause the CMI is an

NEW CHALLENGES
Because the CMI is an evidence-based model that is just being introduced, its broad applicability and predictability has yet to be evaluated. One way to do this is to construct an instrument that operationalizes the CMI components and assesses its validity with other programs, which is already under way. Another way to validate the model is to consider its theoretical similarities to other established frameworks. For example, one relevant issue relates to the issue of whether the CMI is a systems model and, if so, what the implications of that classification are. We raise this issue because systems thinking has been part of the public health dialogue for the past decade. 44 In addition work advocating for the development and application of systems science45 and integrative systems models 46 to explain and assess complex public health interventions has increased. The CMI can be defined as a systems approach to program infrastructure because it is a dynamic conceptual model for understanding public health outcomes, and it exhibits many of the characteristics of complex systems identified by other researchers. 44---46 However, developing a fully realized systems model of program infrastructure remains a task for the future; our focus here was on presenting the descriptive data and examples elaborating the CMI’s core components. Finally, in the future, it would also be beneficial to compare the similarities and differences between the CMI and other significant
public health frameworks. One example would be the Public Health Accreditation Board 47
framework of voluntary standards, which was designed to evaluate how well state and local
health programs carry out the core functions of public health. It has 12 domains that apply to
all health departments, and within those domains are standards that pertain to a broad
group of public health services. Although some overlap exists between the standards and the
CMI components, a comparison is beyond the scope of this article. It is our hope that the CMI
will spur many applications and research that will advance public health goals.
At this point, the limits of the model are not completely known. We should note that data
were collected from state-level programs only. Although some partners represented local-level
programs, the CMI at this point is intended to apply to state-level program infrastructure.
FUTURE APPLICATIONS
The CMI is a practical and actionable model of infrastructure. As represented in the CMI, infrastructure is built on 5 clearly defined core components. With these components, the CMI
provides a framework for public health programs, not just TCPs, to develop and maintain
their infrastructure. The CMI can also serve as a framework for developing guidance documents
and best practices for infrastructure implementation. For example, funders across various
public health programs can use the CMI components to write funding announcements that support program infrastructure. Because the 5 core components provide a tangible foundation,funders may use the model and characteristics inproviding technical assistance.
The model can also be used as the basis for
surveillance and evaluation of infrastructure.
Public health programs can use the CMI’s components
and their defining characteristics to
assess progress on and maintenance of infrastructure.
Such measurement may indicate
movement toward public health goals when longterm
outcomes are not yet available. In addition,
surveillance data could be used to identify areas
in which sustainability may not occur.
Developing a measurement tool for the CMI
is a logical next step. Previous attempts to
measure infrastructure were initiated without
the guiding framework of a clear, evidencebased
model of infrastructure that was applicable
across public health programs.9 Therefore,
a need exists to develop and pilot test an
infrastructure measurement instrument for
surveillance and evaluation. The CMI, by defining
the characteristics of its core components
(Table 3), provides a first step for surveillance
methods to measure infrastructure. Currently,
CDC’s Office on Smoking and Health is
reviewing the combined project data to further
define the characteristics that can facilitate the
development of a such an instrument.
The CMI provides a framework for programs
seeking to further elaborate the inputs
section in the initial stages of their logic models.
By building the infrastructure components
contained in the CMI, public health programs
can create a strong programmatic foundation
and thereby position themselves to move to the
latter stages of the logic model, including the
achievement of public health outcomes. Improving
public health depends on understanding
complex adaptive models such as program infrastructure.
Because the CMI is a practical,
evidence-based model for planning, implementing
and sustaining public health programs, it
provides a solid basis for facilitating a common
understand

Hasil (Bahasa Indonesia) 1:

TANTANGAN BARUKarena CMI adalah model berbasis bukti yang hanya sedang diperkenalkan, penerapan luas dan prediktabilitas yang belum dievaluasi. Salah satu cara untuk melakukan ini adalah untuk membangun suatu instrumen yang operationalizes komponen CMI dan menilai keabsahannya dengan program lain, yang sudah berlangsung. Cara lain untuk memvalidasi model adalah untuk mempertimbangkan kesamaan yang teoritis kerangka lainnya didirikan. Sebagai contoh, salah satu masalah yang relevan berkaitan dengan masalah apakah CMI adalah model sistem dan, jika demikian, apa implikasi dari klasifikasi tersebut adalah. Kami mengangkat masalah ini karena pemikiran sistem telah menjadi bagian dari dialog kesehatan masyarakat dalam dekade terakhir. 44 selain kerja advokasi untuk pengembangan dan penerapan sistem science45 dan sistem Integratif model 46 untuk menjelaskan dan menilai intervensi kompleks kesehatan masyarakat telah meningkat. CMI dapat didefinisikan sebagai pendekatan sistem infrastruktur program karena dinamis model konseptual untuk memahami hasil kesehatan umum, dan menunjukkan banyak Karakteristik dari sistem yang kompleks yang diidentifikasi oleh peneliti lain. 44---46 Namun, mengembangkan model sistem sepenuhnya menyadari program infrastruktur tetap tugas di masa depan; Fokus kami di sini adalah pada Penyajian data yang deskriptif dan contoh-contoh yang menguraikan komponen inti CMI. Akhirnya, di masa depan, juga akan bermanfaat untuk membandingkan persamaan dan perbedaan antara CMI dan lain signifikanpublic health frameworks. One example would be the Public Health Accreditation Board 47framework of voluntary standards, which was designed to evaluate how well state and localhealth programs carry out the core functions of public health. It has 12 domains that apply toall health departments, and within those domains are standards that pertain to a broadgroup of public health services. Although some overlap exists between the standards and theCMI components, a comparison is beyond the scope of this article. It is our hope that the CMIwill spur many applications and research that will advance public health goals.At this point, the limits of the model are not completely known. We should note that datawere collected from state-level programs only. Although some partners represented local-levelprograms, the CMI at this point is intended to apply to state-level program infrastructure.FUTURE APPLICATIONSThe CMI is a practical and actionable model of infrastructure. As represented in the CMI, infrastructure is built on 5 clearly defined core components. With these components, the CMIprovides a framework for public health programs, not just TCPs, to develop and maintaintheir infrastructure. The CMI can also serve as a framework for developing guidance documentsand best practices for infrastructure implementation. For example, funders across variouspublic health programs can use the CMI components to write funding announcements that support program infrastructure. Because the 5 core components provide a tangible foundation,funders may use the model and characteristics inproviding technical assistance.The model can also be used as the basis forsurveillance and evaluation of infrastructure.Public health programs can use the CMI’s componentsand their defining characteristics toassess progress on and maintenance of infrastructure.Such measurement may indicatemovement toward public health goals when longtermoutcomes are not yet available. In addition,surveillance data could be used to identify areasin which sustainability may not occur.Developing a measurement tool for the CMIis a logical next step. Previous attempts tomeasure infrastructure were initiated withoutthe guiding framework of a clear, evidencebasedmodel of infrastructure that was applicableacross public health programs.9 Therefore,a need exists to develop and pilot test aninfrastructure measurement instrument forsurveillance and evaluation. The CMI, by definingthe characteristics of its core components(Table 3), provides a first step for surveillancemethods to measure infrastructure. Currently,CDC’s Office on Smoking and Health isreviewing the combined project data to furtherdefine the characteristics that can facilitate thedevelopment of a such an instrument.The CMI provides a framework for programsseeking to further elaborate the inputssection in the initial stages of their logic models.By building the infrastructure componentscontained in the CMI, public health programscan create a strong programmatic foundationand thereby position themselves to move to thelatter stages of the logic model, including theachievement of public health outcomes. Improvingpublic health depends on understandingcomplex adaptive models such as program infrastructure.Because the CMI is a practical,evidence-based model for planning, implementingand sustaining public health programs, itprovides a solid basis for facilitating a commonunderstand