1. Community Health Assessment: Primary Data Collection LHD TA Project – Learning Collaborative 1 Community Health Assessment Second Learning Session Sheena L. Smith, M.P.P. Kansas Health Institute October 24, 2012

2. Why Primary Data? Fill gaps in data from secondary sources Probe community perceptions Build deeper understanding of health status and needs in the community Involve the community – hear the community voice

3. Approaches to Primary Data Collection Surveys Focus groups Key informant Interviews Health Resources Inventory Asset Mapping Photo Voice

4. Community Opinion Survey Discover perceptions of community members about their health status and health of the community Good to use when the goal is to hear opinions from a wide variety of people and get a representative profile of community Usually short questions with predetermined response options Sampling method is important to ensure results can be generalized to entire community

5. Opinion Surveys - Sampling Two approaches: Non-probability (convenience) Survey made available to public through various means No control over who responds Probability (random or systematic) Each person in community has a defined probability of being sampled When done correctly, random samples are generalizable to the community

6. Opinion Surveys – Sample Size Probability sample  Sample size needed depends upon Population size Prevalence of the outcome of interest Desired precision of the estimate For a free sample size calculator: Open Epi http://www.openepi.com/OE2.3/Menu/Open EpiMenu.htm http://www.openepi.com/OE2.3/Menu/Open EpiMenu.htm

7. Opinion Surveys – Sample Size Convenience Sample  Not generalizable to the population –results represent only the survey respondents  Susceptible to bias no matter what sample size  No way to estimate reliability or precision of estimates  The sampling strategy varies based on topic, resources, and desired results  Including various groups can ensure all desired perspectives are represented in the sample

8. Opinion Surveys – Sample Size How many is enough?  Probability Sample As the number of people surveyed goes up, the margin of error goes down Sample SizeMargin of Error 20002% 1500, 1000, 900, 800 3% 700, 600, 5004% 4005% 3006% 2007% 10010% Source: www.uncp.edu

9. Opinion Surveys – Sample Size How many is enough?  Convenience Sample Attempt to achieve the highest practical number of respondents Strategize ways to reach desired audiences Target specific community groups and demographics to ensure adequate representation Attempt to receive as many responses from each group identified (at least 50)

10. Opinion Surveys - Questions Less is more (concise and clear questions) Open-ended (use sparingly) Close-ended  Yes/no  Multiple choice  Numeric answers  Rankings  Likert Scale (ratings) Unbiased, non-leading questions Avoid Double-barreled questions Pilot questionnaire and revise as necessary

11. Opinion Surveys – Execution Sending out the survey Mail Phone Email Web-based (e.g. Survey Monkey) What method is best? Surveys can be sent using one or a combination of methods Web-based surveys generally yield lower response rates than mail or phone, but are more convenient and cost effective to implement

12. Opinion Surveys - Analysis Identify themes according to responses If analyzing responses from a probability sample  The results can be generalized to the entire community If analyzing responses from a convenience sample  Analyze demographic information to understand if desired community groups are represented  Integrate results from other primary data collection methods (interviews, objective data)

13. Focus Groups Gather a greater depth and complexity of information Can yield unanticipated responses Opportunity to get opinions from diverse groups More difficult and time-consuming than surveys to organize, conduct and analyze

14. Focus Groups Small groups of 6-12 participants Participants do not know one another Session 1 ½ - 2 hours long Conduct multiple group sessions Same 7-10 open-ended questions asked of each group Discussion recorded and transcribed Analyze for themes, differing positions that emerged from discussions

15. Key Informant Interviews Structured conversations with people who have specialized knowledge A way to collect complex information, and explore a subject in depth Predetermined question guide based on identified objectives Interviewees selected based upon what CHA team wants to know Not representative

16. Key Informant Interviews Information can be analyzed in a variety of ways  Based on questions asked  Based on groups interviewed Identify themes Combine results with other primary or secondary data collection efforts

17. Health Resources Inventory 3 Components:  Identifies current agencies and organizations that have some bearing on health  Identifies resources that are needed, but lacking  Narrative to explain how existing resources and needed resources influence health of the community

18. Asset Mapping Community asset = a quality, person, or thing that is an advantage, resource of item of value to the community Asset mapping looks at different types of assets in the community  Individuals  Institutions and organizations  Governmental agencies  Physical/ land assets  Cultural opportunities

19. Health Resources Inventory Health facilities Health providers Health-related supportive services  Child care, senior centers  Law enforcement  Parks and recreation  Social Services  Public transportation

20. Asset Mapping Potential areas for assessment:  Individuals – personal skills, strengths, knowledge, experience, leadership skills…  Local citizens associations – churches, neighborhood clubs, service clubs, cultural groups…  Local institutions – schools, hospitals, banks, businesses….  Physical assets – parks, buildings, land, community centers….

21. Photo Voice Community participants are given cameras and asked to take photos of things that represent to them a specified issue or topic in the community Participants then discuss photos together and develop narratives to go with the photos Gives voice to members of the community, attempts to bring the perspectives of those "who lead lives that are different from those traditionally in control of the means for imaging the world" into the policy-making process Often used among marginalized people, intended to give insight into how they conceptualize their circumstances and their hopes for the future.

22. Questions?

23. Information for policy makers. Health for Kansans. Kansas Health Institute