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

Learning Objectives What 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 l Levels or Units of Analysis are the familiar groupings l 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 l Individuals, patients, clients l Families, groups that have interaction l Communities, neighborhoods= individuals with geographic or interest commonalties, have potential to interact l Aggregates= individuals who have something in common but do not interact, a segment of a population l Populations=the total set of individuals

Assess Across the Pyramid of 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 l Epidemiological l Social Science l Public Health l Asset

Comparison of Perspectives

Decisions on Boundary of the Assessment l Who to assess: define the audience for program or of the problem l What to assess: define the problems to be assessed l Precursors of the problem: contributing and predisposing factors l Magnitude of the problem: quantify

Community Level Elements for Assessment l People l Place l Interactions

People ~ Population Assess, study, understand: l Values, belief, attitudes l Behaviors, lifestyle patterns l Demographic characteristics l Health and well-being status

Place ~ Environment Assess, study, understand: l Geography, climate, traffic flow l Living conditions: housing, etc. l Service resources: health, human services, educational, etc. l Economic conditions: income, job opportunities, etc.

Interactions~ Social system Assess, study, understand: l Communication style, language l Political system and preferences l Recreation and arts l Religion, Culture l Family patterns

Key Types of Needs l Expressed l Normative l Perceived l Relative (Bradshaw, 1972)

Expressed Need What people demonstrate as a lack through services utilization

Expressed Need Measures l Number of visits for child burn injuries (need for safety) l Number of hospital admissions for whooping cough (need for immunization)

Normative Need l The extent to which the current status is not at the level recommended by experts l Lack based on comparison to health standards

Normative Need Measures l Rates of prematurity higher than national average l Rate of deaths from breast cancer higher than Healthy People 2010 objective

Perceived Need l What those asked say is their need or what they are lacking l The needs according to the perception of those being asked

Perceived Need Measures l “We need a swimming pool, not another clinic.” l “We don’t have enough good fresh vegetables in our stores.” l “Our children are dying from violence on the streets. We need jobs for our youth.”

Relative Need l The extent to which one group is lacking in comparison to another group

Relative Need Measures l The prematurity rate of blacks is higher than that of whites l Death rates from breast cancer are higher among blacks than whites l Children in that neighborhood have higher drop-out rates than this other neighborhood

Assessment Data Sources  Archival data 4 Public data 4 Primary data collection, i.e., surveys, interviews 4 Providers of health care 4 Proprietary data, i.e., insurance claims

Data Sources ( continued)  Case studies 4 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 Moral Moral: 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 l Those receiving services (and hence easy to survey) will be different from those not receiving services (and hence difficult to survey). l The act of asking may change the responses. l Assessment can be a lengthy and costly process.

Principles of Assessment l Be scientifically rigorous in data collection and sampling. l Be culturally sensitive and appropriate. l Use multiple methods. l Involve community members throughout the assessment process. l 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 l Needs assessment leads to problem statement l Problem statement leads to program development l Program development leads to implementation l Program evaluation of implementation and outcome

Diagnosis for Program Planning