Better Understanding Our Problem:Problem-Oriented Needs Assessment

William M. Sappenfield, MD, MPH Professor & Chair, Dept. of Community and Family Health

USF College of Public Health

Training Course in MCH EpidemiologyDenver Colorado

Being Effective in Public Health

Planning

Doing

Assessment

Strategies

Plan

Evaluation

Monitoring

Implement

Being Effective in Public Health?

Assessment

Implementation

Rev

iew

Plan

Planning

Doing

Assessment

Strategies

Plan

Evaluation

Monitoring

Implement

Being Effective in Public Health

Health Problem: Late PNC Entry South Carolina

01020304050

Years

Perc

enta

geSC WhiteSC BlackReg Black

Needs Assessment

Underreporting of prenatal visits Physicians not starting to 2nd trimester Late entry into the WIC program Problem recognition by Community Transportation & child care barriers Unintended pregnancy

Potential Strategies Underreporting of prenatal visits

– Vital registration manual– Clerk training– Health department record transfer– Physician record transfer– Standardized prenatal care record– Physician & hospital education– Monthly reporting system– Hospital standards– Incentive awards

Chosen Strategies Underreporting of prenatal visits

– Vital registration manual– Clerk training– Health department record transfer– Physician record transfer– Standardized prenatal care record– Physician & hospital education– Monthly reporting system– Hospital standards– Incentive awards

Being Effective in Public Health

Planning

Doing

Assessment

Strategies

Plan

Evaluation

Monitoring

Implement

Health Problem: Late PNC Entry South Carolina

01020304050

Years

Perc

enta

geSC WhiteSC BlackReg Black

So Why Doesn’t It Happen? Limited/over-committed staffing. Limited expertise. Lack of adequate follow-up. Previous planning failures. Insufficient resources for current

initiatives. Lack of political will. Committed/focused on present activities. Competing priorities/desires.

Being Effective in Public Health

Planning

Doing

Assessment

Strategies

Plan

Evaluation

Monitoring

Implement

Definition of Needs Assessment

Systematic collection and examination of information…to make decisions to formulate a plan…for the next steps leading to public health action…

Needs Assessment Qualities

Visionary Conceptual Systematic Resourceful Pragmatic Action-oriented Cohesive

Types of Needs Assessment...

Community--Healthy Communities Population--Title V (MCH) Health Systems--Emergency Response Program--Title X (Family Planning) Health Services--Prenatal Clinic Location Health Problem--Infant Mortality

Needs Assessment Phases

Health problem identification and measurement

Prioritization of health problems

Analysis of a particular health problem Assess potential strategies to address

targeted aspects

Part 1

Part 2

What is a health problem?

Community perception? Health status measure? Risk Factor? Health Service Deficiency? Measurement? Comparison?

Problem Identification & Verification Stakeholders Partners Reports Available Data

Purpose: Search & compile

Problem Definition

Extent Duration Expected future course Variation

Purpose: Define, describe & validate

Types of Prioritization

Group consensus Voting Criteria-based rating Q sort

Purpose: Build consensus/support

Q-Sort Procedure: Priority Log Sheet for 25 MCH Needs

5th

4th 5th 6th

3rd 4th 5th 6th 7th

2nd 3rd 4th 5th 6th 7th 8th

1st 2nd 3rd 4th 5th 6th 7th 8th 9th

Part 1: Identification & PrioritizationSelection Criteria

Magnitude of the problem Trend Severity/consequences Perceived preventability National/state goals Agency capacity Political/community acceptability

Part 1: Identification & PrioritizationReal Selection Criteria

State or agency political will Current program priority Currently funded activity Fits current staffing/resource patterns People available to work on the issue Important issue to the heart

Matrix of MCH Problems

Criteria Weight LBW Peri HIV SmokingMagnitude 2Trend 2Severity 3Preventable 2Goal 1Capacity 3Acceptable 1

Clear Scoring Criteria

Magnitude Low incidence/prevalence Moderate in some subgroups Moderate in all groups High in some subgroups High in all groups

Part 1: Identification & PrioritizationReal Selection Criteria

Available funding State or agency political will Program priority Currently funded activity Fits current staffing/resource patterns People available to work on the issue Required performance measure Important issue to the heart

Needs Assessment Phases

Health problem identification and measurement

Prioritization of health problems

Analysis of a particular health problem Assess potential strategies to address

targeted aspects

Part 1

Part 2

Being Effective in Public Health

Assessment

Capacity & Strategies

Plan

Evaluation

Monitor

Implement

Plan

Do

Who?What?

When? Where?How?

Resources?

Bill's Steps for Problem-Oriented Needs Assessment• Theoretical Framework• Gather Readily Available Information• Frame and Choose Critical Questions• Choose and Develop Methods• Analyze and Answer Your Questions• Summarize Your Problem• Present the Results

Problem:

Direct:

Secondary:

Tertiary:

Teen Pregnancy

Initiation of SexualActivity

Continuation of Sexual Activity

Poor School Connectedness

Life Goals

Poor Family Connectedness

Access to Confidential

Services

After School

Programs

TV/Movies& Music Parenting

Knowledge

Sex/ContraceptiveEducation

Social Norms

Partner Age Disparity

Parental Beliefs & Behaviors

UnsupervisedActivities

At RiskEducationalPrograms

Youth Unemployment

Use of Contraception

Abuse

Peer Group

Sex/ContraceptiveKnowledge

Family Income

RiskBehaviors

Racism

Role Models

Acceptable Method

Precursors

Problem:

Direct:

Secondary:

Tertiary:

Teen Pregnancy

Abortion Live Birth

School Delayor Drop Out Economic

Difficulties

Poor Growth Environment

Limited Family

Support

Social Support

Day Care Subsidy

Medicaid Support

Child Neglect

Slowed Development

Repeat Pregnancy

AbortionConsequences

LimitedMaternal

Skills

LimitedFather

Involvement

ImpairedEconomic

Productivity

PovertyCycle

LBW/PrematurityMedical

Complications

Consequences

Gather…

Other Needs Assessments Available Reports Key Data People Key Community People

Frame & Choose Critical Questions What Are Remaining Questions? What is Gained By Answering the

Question? Do Something Different? Can the Question Be Answered? What Will It Cost? Will It Be Part of the Big Picture?

Bill's Steps for Problem-Oriented Needs Assessment• Theoretical Framework• Gather Readily Available Information• Frame and Choose Critical Questions• Choose and Develop Methods• Analyze and Answer Your Questions• Summarize Your Problem• Present the Results

Needs Assessment Results

Statement of the problem Problem trends Individual contributors to the problem Individual strengths Community contributors to the problem Community strengths

Being Effective in Public Health

Planning

Doing

Assessment

Strategies

Plan

Evaluation

Monitoring

Implement

Problem AnalysisAccess to poison by children

Ingestion of poison

Death from poison consumption

Program Hypothesis

Reduce child poison deaths

Reduce poison consumption

Provide childproof containers

Program HypothesisReduce child poison deaths

Reduce poison consumption

Provide childproof containers

Problem Analysis

Access to poison by children

Ingestion of poison

Death from poison consumption

Program HypothesisGoal

Policy

Program

OperationalActivities of the program

Change in characteristics of recipients

Change in health status of recipients

Change in health of community

• Short Term

• Intermediate

• Long Term

Changes in the target population

Products of the program

Key actions of program staff and clients

The resources needed to deliver the program

Theoretical assumptions about why a program works

OutcomesOutputsActivitiesInputsAssumptions

Population Focus: Community(ies)

Logic Model Framework

Planning

Doing

Assessment

Strategies

Plan

Evaluation

Monitoring

Implement

Being Effective in Public Health

Needs Assessment Debates

Qualitative or Quantitative Assets or Problems Assessment or Surveillance One Time or Ongoing Ourselves or Contract Science or Art Performance or Pretty