Background: While Healthy People outlines a national framework for improving the health of the nation, many states develop State Health Improvement Plans (SHIPs) to set priorities to improve the health of their residents. The purpose of this study was to understand the processes that states use to develop their SHIPs, how states align their SHIPs with Healthy People, and challenges that states face using Healthy People. Methods: NORC conducted semistructured interviews with 9 state health department representatives who were responsible for SHIPs. The responses were analyzed using qualitative thematic analysis. Results: State health departments used similar approaches to develop their SHIPs. Generally, states began the SHIP development process by performing community health assessments and then assembling diverse stakeholders to recommend key priority areas that should be addressed in the SHIP. States used a similar framework for their SHIPs, outlining priority areas, indicators, and targets. All respondents reported that they referenced Healthy People during the development of their SHIPs. Some states reported aligning their state plans with the Healthy People Framework, while others focused more on the specific Healthy People objectives or target setting guidance. Conclusions: Both the federal government and state public health agencies rely on input from stakeholders and cross-sector collaboration to ensure their initiatives reflect the diverse needs of their population. Stakeholder engagement is increasingly important as public health professionals are shifting toward a health equity approach that considers social determinants outside of the health care sector. Healthy People continues to strengthen this perspective by outlining national priorities on well-being while incorporating language around health equity issues. Reinforcing relationships between the federal government and state public health can help states better understand the role of Healthy People as well as encourage further dissemination of creative strategies and best practices.

Healthy People continues to be a valued resource among public health stakeholders; however, continued outreach is needed to promote the use of tools and resources available on healthypeople.gov for this decade and beyond. Healthy People is a national initiative used most frequently as a data source by state and local health departments, tribal organizations, and other public health practitioners.