Overview of Community Assessment

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Overview of Community Assessment

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

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

• Develop a plan to assess the needs of a target
  population.
• Justify an model used to conduct the assessment.
• Describe the differences among the types of
  assessments done for program planning.

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Assessment is

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

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Purpose of Needs Assessment

• To guide and inform decisions related to
• program prioritization and development

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What to Assess

• Levels or Units of Analysis are the familiar
  groupings
• Across the Pyramid of Services, as developed and
  used by HRSAs Bureau of Maternal and Child
  Health. Directs attention to services that
  correspond to the Levels

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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
• Populationsthe total set of individuals

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Assess Across the Pyramid of Services

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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

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Perspectives on Needs Assessment

• Epidemiological
• Social Science
• Public Health
• Asset

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Comparison of Perspectives
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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

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Community Level Elements for Assessment

• People
• Place
• Interactions

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People Population

• Assess, study, understand
• Values, belief, attitudes
• Behaviors, lifestyle patterns
• Demographic characteristics
• Health and well-being status

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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.

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Interactions Social system

• Assess, study, understand
• Communication style, language
• Political system and preferences
• Recreation and arts
• Religion, Culture
• Family patterns

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Key Types of Needs

• Expressed
• Normative
• Perceived
• Relative
• (Bradshaw, 1972)

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Expressed Need

• What people
• demonstrate as a lack through services
  utilization

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Expressed Need Measures

• Number of visits for child burn injuries (need
  for safety)
• Number of hospital admissions for whooping cough
  (need for immunization)

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Normative Need

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

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Normative Need Measures

• Rates of prematurity higher than national average
• Rate of deaths from breast cancer higher than
  Healthy People 2010 objective

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Perceived Need

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

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Perceived Need Measures

• We need a swimming pool, not another clinic.
• We dont have enough good fresh vegetables in
  our stores.
• Our children are dying from violence on the
  streets. We need jobs for our youth.

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Relative Need

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

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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

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Assessment Data Sources

• Archival data
• Public data
• Primary data collection, i.e., surveys,
  interviews
• Providers of health care
• Proprietary data, i.e., insurance claims

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Data Sources (continued)

• Case studies
• Unobtrusive or non-reactive measures, i.e.
  watching people, looking in garbage cans
• Published literature

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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.

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Go Beyond the Street Lamp

• 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.

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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.

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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.

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Statistical methods

• Descriptive and inferential statistics
• Rate and proportions
• Population parameters (CI)
• Tests of differences
• Tests of association
• Synthetic estimates

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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

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Diagnosis for Program Planning