Overview of Community

Assessment

CHSC 433Module 2/Chapter 4

UIC School of Public HealthL. Michele Issel, PhD, RN

Learning ObjectivesWhat you ought to be able to do by the end of this module:

1. Develop a plan to assess the needs of a target population.

2. Justify an model used to conduct the assessment.

3. Describe the differences among the types of assessments done for program planning.

Assessment is…

the procedures used to collect data that describes the needs and strengths of a specific community, population, or neighborhood.

Purpose of Needs Assessment

To guide and inform decisions related to

program prioritization and development

What to Assess

Levels or Units of Analysis are the familiar groupings

Across the Pyramid of Services, as developed and used by HRSA’s Bureau of Maternal and Child Health. Directs attention to services that correspond to the Levels

Assess Levels

Individuals, patients, clients Families, groups that have interaction Communities, neighborhoods= individuals with

geographic or interest commonalties, have potential to interact

Aggregates= individuals who have something in common but do not interact, a segment of a population

Populations=the total set of individuals

Assess Across the Pyramid of Services

Direct Health Care

Services_____________________

Enabling Services___________________________

Population-Based Services___________________________________

Infrastructure Services

Assessment Types

Needs Assessment:

means by which to determine the gaps, lacks, and wants relative to a defined population and a defined, specific health problem

Community Assessment:establish the magnitude of selected health problems in a designated locality relative to the strengths and resources within that community, and to determine the priority given to addressing the health problem

Perspectives on Needs Assessment

Epidemiological

Social Science

Public Health

Asset

Comparison of Perspectives

Public Health Models

Epidemiology Models Social Science Models Asset Models

Population assessed

States and Communities

Populations Populations, selected aggregates

Community, neighborhoods

Data sources All available Registries, national probability sample surveys, existing national databases

National probability sample surveys

Qualitative, observational

Examples APEXPH, PATCH National Health Interview Survey (NHIS), Health Care Utilization Profile (HCUP)

US Census Focus groups

Types of needs assessed

Normative and relative needs can be estimated

Normative, expressed, and relative needs can be estimated

Relative need can be estimated, perceived need is directly determined

Advantages Administratively sound. Includes focus on constituent concerns.

Statistically sound and generalizable findings

Statistically sound, provides information on contributing factors to health problem

Existing resources are identified

Disadvantages Relies on other data sources. Perceived needs not directly determined.

No information on perceived needs. Local variations may not be captures or described.

Does not directly measure extent of health problem

Does not measure the extent of health problem

Decisions on Boundary of the Assessment

Who to assess: define the audience for program or of the problem

What to assess: define the problems to be assessed

Precursors of the problem: contributing and predisposing factors

Magnitude of the problem: quantify

Community Level Elements for Assessment

People

Place

Interactions

People ~ Population

Assess, study, understand:

Values, belief, attitudes

Behaviors, lifestyle patterns

Demographic characteristics

Health and well-being status

Place ~ Environment

Assess, study, understand: Geography, climate, traffic flow Living conditions: housing, etc. Service resources: health, human

services, educational, etc. Economic conditions: income, job

opportunities, etc.

Interactions~ Social system

Assess, study, understand: Communication style, language

Political system and preferences

Recreation and arts

Religion, Culture

Family patterns

Key Types of Needs

Expressed

Normative

Perceived

Relative

(Bradshaw, 1972)

Expressed Need

What people

demonstrate as a lack through services utilization

Expressed Need Measures

Number of visits for child burn injuries (need for safety)

Number of hospital admissions for whooping cough (need for immunization)

Normative Need

The extent to which the current status is not at the level recommended by experts

Lack based on comparison to health standards

Normative Need Measures

Rates of prematurity higher than national average

Rate of deaths from breast cancer higher than Healthy People 2010 objective

Perceived Need

What those asked say is their need or what they are lacking

The needs according to the perception of those being asked

Perceived Need Measures

“We need a swimming pool, not another clinic.”

“We don’t have enough good fresh vegetables in our stores.”

“Our children are dying from violence on the streets. We need jobs for our youth.”

Relative Need

The extent to which one group is lacking in comparison to another group

Relative Need Measures

The prematurity rate of blacks is higher than that of whites

Death rates from breast cancer are higher among blacks than whites

Children in that neighborhood have higher drop-out rates than this other neighborhood

Assessment Data Sources

Archival data Public data Primary data collection, i.e.,

surveys, interviews Providers of health care Proprietary data, i.e., insurance

claims

Data Sources (continued)

Case studies Unobtrusive or non-reactive

measures, i.e. watching people, looking in garbage cans

Published literature

Look under the street lamp…

One night a drunk lost his keys. So he began to look for them, crawling around on his hands an knees beneath a street lamp. Before long, a stranger stopped and asked “What are you doing on you hands and knees?”

He replied, “Looking for my keys.” The stranger offered to help and asked “Where did you lose your keys?” The drunk replied, “Over there”, pointing to a dark area down the block just outside the bar. So the stranger asked, “Then why are you looking over here?”

To which the drunk replied, “Because there is light over here.”

Go Beyond the Street Lamp

MoralMoral: The information you need may not be the same as the data you already have access to or have.

You need to go beyond the street lamp in your data collection.

Challenges in doing assessments

Those receiving services (and hence easy to survey) will be different from those not receiving services (and hence difficult to survey).

The act of asking may change the responses.

Assessment can be a lengthy and costly process.

Principles of Assessment

Be scientifically rigorous in data collection and sampling.

Be culturally sensitive and appropriate. Use multiple methods. Involve community members throughout

the assessment process. Get consents.

Statistical methods

Descriptive and inferential statistics

Rate and proportions

Population parameters (CI)

Tests of differences

Tests of association

Synthetic estimates

From Needs to Program

Needs assessment leads to problem statement

Problem statement leads to program development

Program development leads to implementation

Program evaluation of implementation and outcome

Diagnosis for Program Planning

Problem Program Evaluation

Risk of: Health Problem ProgramGoal

Outcome

Among: Group Population TargetsRecipients

Sample

Related to(Determinants):

Characteristics Interventions Impact

Secondary to(direct and indirect

contributing factors) :

Heredity, LifestyleEnvironment

Interventions Interveningvariables

As Demonstrated in: Health indicators ProgramObjectives

Impactvariables