Overview of Community Assessment CHSC 433 Module 2/Chapter 4 UIC School of Public Health L. Michele Issel, PhD, RN
Jan 20, 2016
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