Chapter 4: Assessing Needs

Application of the Six-Step Needs Assessment Process

- Example is that a committee is set to plan a cancer prevention program for the county and the composition of the committee represents the greater community. - page 96 to 100

Step 4: Identifying the Risk Factors Linked to the Health Problem

- Parallel to the second part of Phase 2 of the PRECEDE-PROCEED model: epidemiological assessment. - Planners identify the determinants of health problem: generic, behavioral, and environmental risk factors associated with the health problem. Mainly, identify and prioritize the behavioral and environmental factors to lessen the health problem in the PP. - Environment is multidimensional and can include economic, service, social environment, psychological environment, and political environment. - Modifying behavioral and or environmental factors or determinants is the real work of health promotion.

Baranowski 8 steps to increase the accuracy of self-report data collection:

1. Select measures that clearly reflect program outcomes. 2. Select measures that have been designed to anticipate the response problems and the have been validated. 3. Conduct a pilot study with the PP. 4. Anticipate and correct ay major sources of unreliability. 5. Employ quality-control procedures to detect other sources of error. 6. Employ multiple methods. 7. Use multiple measures. 8. Use experimental and control groups with random assignment to control for biases in self-repot. enhances the accuracy of self-report and makes it an effective method of data collection

questions to determine the status of existing health promotion programs

1. What health promotion programs are presently available to the PP? 2. Are the programs being utilized? 3. How effective are programs? Are they setting goals and objectives? 4. How were the needs for these programs determined? 5. Are programs accessible to the PP? 6. Are needs of the PP being met?

Telephone Interviews

- Advantages: Offers a relatively easy method of collecting self-reported data at a moderate cost. - Disadvantages: Wireless-only households (young, living with other non related adults, renting, and being non-white). Some individuals may not have a chance of being selected and/or contacted. - Prior to wireless-only households, participants who were to be interviewed were selected using a random process. Choosing someone from a list > selecting people randomly from a list misses people with unlisted telephone number or cell phone numbers > overcome by RDD.

Step 6: Validating the Prioritized Need

- Confirm that the need that was identified is the need that should be addressed. Should be a perfunctory step. - Validation is double checking or making sure that an identified need is the actual need. Can be done through: (1) rechecking the steps followed in the needs assessment to eliminate any bias (2) conducting a focus group with some individuals from the PP to determine their reaction to the need (3) getting a second opinion.

secondary data

- Data already collected by somebody else and available for your use. - No contact methods. - Advantages: they already exist and collect time is minimal, they are usually fairly inexpensive to access compared to primary data. - Disadvantages: the information might not identify the true needs of the priority population (how the data was collected, when they were collected, what variables were considered, or from whom the data were collected. - Make sure that secondary data are applicable to the immediate situation before using them.

General Search Procedures

- Most indexes include both author and subject/title index. If the item is specific to its index is its thesaurus (listing of words that indexes used to index the subject/titles. -

Step 3: Analyzing the Data

- Planners must analyze all the data collected with the goal of identifying and prioritizing the health problems. May be difficult to complete. Data analysis can show the need as obvious or planners are faced with trying to compare data that are not easily compared. - When working with diverse communities it is important to find out more information about what is the related risk behaviors. - Analyze data by suing the first few phases of the PRECEDE-PROCEED model for guidance. - Process of setting priorities can be subjective approaches (voting, forced rankings, nominal group process) or objective (Delphi technique and basic priority rating). - After analyzing, planners should be able to list in rank order the problems/needs of the PP.

PSYCINFO

- Produced by the APA. - Abstract. Indexing database with more than 3 million records devoted to peer-reviewed literature in behavioral sciences and mental health.

CUMULATIVE INDEX TO NURSING & ALLIED HEALTH LITERATURE (CINAHL)

- Provides indexing of journals from the fields of nursing and other health disciplines. - Provides indexing for healthcare books, dissertations from the field nursing, selected conference proceedings, and standards of practice.

Searching Via the World Wide Web

- World wide web (WWW) enhance opportunities for planers to obtain variety of needs assessment data. URL (unicorn resource locator). - If planners are using a term that has more than one word (e.g. heart disease) use quotation marks because lets the search engine know that the exact phrase under the quotation is to be used when seeking sites that match. - Scrutinize sources

observer bias

- Different observes may not observe and report behaviors in the same manner. - Method of data collection requires a clear definition of the exact behavior to observe and how to record it. - Can be reduced by providing training and by determining rater reliability.

Standards for Privacy of Individually Identifiable Health Information of the HIPPA 1996

- Keepers concerned with confidentiality and release of private information. - Enacted in 2003. Tule sets national standards that health plans, health care clearinghouses, and health care providers who conduct health care transactions electronically must implement to protect and guard against the misses of individually identifiable health information. - Planners can deal with this by getting permission from all participants to use their records or by using only anonymous or de-identified data (information removed so individuals cannot be identified).

Sources of Secondary Data

- Main sources include: government agencies at multiple levels, data available from nongovernment agencies and organizations, data from existing records, and data or other evidence that are presented in the literature

Introduction

- When the planning committee is in place and planning model has been selected, identify the needs of those in the priority population. - Need to identify all needs, actual (true need) and perceived (reported needs), so they can be addressed through appropriate planning. - Needs assessment (epidemiology) - systematic procedure for determining the nature and extent of problems experienced by a specific population that affect their health directly or indirectly.

reasons for needs assessment

1. Logical place to start. Before a need can be met, it first has to be identified and measured. 2. Helps ensure that scarce resources are allocated where they can give maximum health benefit. Resources can be wasted on unsubstantiated programming. 3. Allows planners to apply the principles of equity and social justice in practice by focusing on those in greatest need. 4. Failure to perform a needs assessment can lead to a program focus that prevents or delays adequate attention directed to a more important health issue (motor vehicle accidents vs. bicycle helmets - health problem that create a high emotional response). 5. Needs assessments determines the capacity of a community to address specific needs. 6. Provides focus for developing an intervention to meet the needs of the priority population. 7. Knowing the needs of a priority population provides a reference point to which future assessment can be compared.

Observation

- "Notice taken of an indicator". People and environment are observed. - Minimal contact method of data collection because those doing the observation can see but do not interact with those in the priority. - Direct and indirect observation. - Generally more accurate than self-report, but presence of the observer may alter the behavior of the people being observed. - Windshield tours or walk throughs and photo voice used to collect data. - Disadvantages: Observer bias. - Advantages: Moderate cost.

participatory or action research

Defined as systemic inquiry, with the collaboration of those affected by the issue being studied, for the purposes of education and of taking action or effecting change.

community health needs assessment (CHNA)

Implies that all significant health problems are examined to assess their relative significance.

PUBMED

Includes citations from biomedical literature from MEDLINE, life science journals, and online books.

Advantages and disadvantages of collecting primary data

Table 4.1 page 83

direct observation

Actually seeing a situation or behavior. Time consuming. High response rate because it seldom encounters the problem of people refusing to participate. Ex. watching the eating patterns of children

PEARL

Consists of several factors that determine whether an intervention strategy can be carried out. Score of zero means intervention is economically impossible, unacceptable to the PP or planners, or illegal.

CRAAP Test

Currency Relevance Authority Accuracy Purpose - Useful for evaluating information obtained via Internet.

networking

communicating with others who may know about existing programs

capacity building

refers to activities that enhance the resources of individuals, organizations, and communities to improve their effectiveness to take action

capacity

refers to individual, organizational, and community resources that can enable a community to take action.

obtrusive observation

when people know they are being observed

Face-to-Face Interviews

- Advantages: Develop rapport with the respondents flexibility, availability of visual cues, gaining more complete data form respondents. Participation rate is high. - Disadvantages: time consuming (actual interview, travel time, waiting time), expensive, requiring more staff time and training of interviewers. Variations in the interviews and interviewers can influence results. Smaller numbers of respondents. - Interviewers must be trained to conduct the interviews in an unbiased manner and its important to explain the need for the information in order to conduct the needs assessment/evaluation and to accurately record the responses. Use methods of probing, electing additional information about an individual's response.

Group Interviews

- Advantages: Provides for economy of scale; meaning that the data can be collected from several people in a short period of time. - Disadvantages: One or more group members can influence the response of others. - Focus groups are a specific type of group interviews that is useful in collecting information for a needs assessment and can be used to determine if programs are bing implemented effectively or determine program outcomes.

Electronic Interviews

- Advantages: Reduced response time, cost of materials, ease of data collection, flexibility in the design and format of the questionnaire, control over the administration, and recipient familiarity with the format and technology. Responses can be formatted to enter directly into a spreadsheet/statistical package eliminating manual data entry or scanning. Have commercial companies to help in using this method of interviewing. - Disadvantages: Not everyone has access to the Internet, obtaining email addresses of the possible respondents, and some people lack of comfort in using a computer. Shows mixed results. Commercial companies may not meet the security policies of some potential users (medical centers).

Data Collected by Government Agencies

- Collected on regular basis. Some data collection mandated by law and others are collected voluntarily. - Program planners gain free access to them by contacting the agency that collects the data, or by finding them on the Internet, or in a library that serves as a United States government depository (university libraries and public). - Ex. Checking medical records, reviewing insurance usage, comparing academic records

significant others

- Commonly asked to respond to single-step surveys for the purpose of collecting primary needs assessment data. Includes significant others of the priority population, community opinion leaders, and key informants. - Includes family members and friends. Can elicit information that is difficult for patients to share. Ex. patients with heart disease.

primary data

- Data that you collect yourself (surveys focus groups, in-depth interviews) that answers unique questions to your specific needs assessment. - Methods of collecting primary data are the ones in which those collecting the data interact with or minimally interact with those from whom the data are being collected. - Interactive contact methods or minimal contact observational methods. - Advantages: Directly answering the questions planners want answered by those in the PP. - Disadvantages: Collecting primary data can be expensive and takes a long time.

mapping

- Defined as the visual representation of data by geography or location, linking information to a place to support social and economic change on a community level. - Powerful because (1) makes patterns based on place much easier to identify and analyze (2) provides a visual way of communicating those patterns to broad audience. - Process of mapping: (1) identifying the geographic area that the map will cover (2) collecting the necessary data (3) importing data into GIS software so data can be placed on maps (4) analyzing what is found on maps. - Mapping has been used to address number of health problems. Taken more meaning because when it come to you health zip code is more important that genetic code.

Focus Group

- Form of qualitative research that grew out of group therapy. - Used to obtain information about feelings, opinions, perceptions, insights, beliefs, misconceptions, attitudes, and receptivity of a group of people concerning an idea or issue. - Small compared to community forums (8 to 12 people). Best to have a group that don't know each other so responses are are inhibited by acquaintance. People are invited, receive general info but not the specifics to ensure that responses will be spontaneous yet accurate. Lead by a moderator who obtains responses from the group to set of predetermined questions or asks them to prioritize different responses. Responses are recorded. - Focus groups are not easy to conduct: care must be put in developing the questions and the moderator should be the one who is skilled in leading a group. Level of skills needed to conduct a focus group increases as the topic of discussion becomes more controversial. - Disadvantage: Participants in groups are usually not selected through a random-sampling process and are selected because they possess certain attributes. May not be representative of the PP, therefore results are not generalizable.

geographic information systems (GIS) t

- Helps analyze partially referenced data and make well-informed decisions based on the association between data and the geography. - Data are mapped.

Nominal Group Process

- Highly structured process in which a few knowledgeable representatives of the priority population are asked to qualify and quantify specific needs (5 to 7 people). - Those invited asked to record their reins and share it later. Facilitator is recording the responses. After the discussion, participants are asked to rank-order the responses by importance to the PP. Ranking may be considered wither preliminary or a final vote. Preliminary means it is followed with more discussion and a final vote.

Step 2: Gathering Data

- Identify the most relevant data as possible - data that are most applicable to the planning situation and that will do the best for helping planners to identify the actual needs of the PP. - Recommended that planners begin data-gathering process by trying to locate relevant secondary data because of cost and availability. - After secondary data, gather appropriate primary data to fill in data gaps to better understand the needs of the PP. Quantitative and qualitative. Primary data has a dual purpose: (a) provides valuable information about specific planning situation that cannot be obtained from secondary data (b) provide opportunity to get those in the PP actively involved and contributing to the program process. Active participation. - Planning model used to develop a program might drive the types of data collected for the needs assessment (SMART and MAPP). - Planners may want to use theoretical constructs to help guide data collection. - Desirable to have both primary and secondary need assessment data to get a clear picture of needs.

Health Impact Assessment (HIA)

- Impacts the focus of needs assessment and it is an emerging practice. - Defined as a systematic process that uses an array of data sources and analytic methods and considers input from stakeholders to determine effects of a proposed policy, plan, program, or project on the health of a population and the distribution of those effects within the population. Provides recommendations on monitoring and managing those effects. - Approach that can help identify and consider potential or actual health impacts of a proposal on a population. Results in a set of evidence-based recommendations geared to informing the decision-making process. Enhance positive aspects of a proposal, and to remove or minimize any negative impacts on health, well-being and health inequalities that may arise or exist. - WHO noted that HIAs are based on four values: democracy (all who are impacted by the proposed change get to participate in the assessment), equity (all who will be impacted by the proposed change are treated fairly in the assessment), sustainable development (both short and long term impacts of the proposed change are considered are part of the assessment), ethical use of evidence (evidence used in assessments includes both qualitative and quantitive evidence and is collected using best practices).

opinion leaders

- Individuals who are well respected in a community and who can accurately represent the views of the priority population. Leaders are: 1. Discriminating users of the media 2. Demographically similar to the priority group 3. Knowledgable about community issues and concerns 4. Early adopters of innovative behavior 5. Active in persuading others to become involved in innovative behavior - Include political figures, chief executives, union leaders, administrators, and other visible and respected individuals.

basic priority rating (BPR)

- Known as the priority rating process. - Attempt to prioritize health problems in developing countries. Provided basic direction in priority setting, but does not represent the broad array of data available to decision makers today. - Elements in the model give more weight to impact of communicable disease compared to chronic diseases. - Negier proposed changes to BPR model called BPR Model 2.0

Using Technology to Map Needs Assessment Data

- Needs assessment data are being obtained through the use of technology. More frequently is the us of the geographic information systems (GIS) to help provide meaning to collected data.

Conducting a Needs Assessment

- Needs assessment or needs of PP can be determine by informal or formal approaches. Informal used because of limited resources, time, personnel, and money. - Informal approaches are less reliable than planned and scientifically developed research approach. - 6 step process that is more formal in nature.

Written Questionnaires

- One of the most often used methods of collecting self-reported data. - Advantages: Ability to reach a large number of respondents in a short period of time, low cost with minimum staff time. - Disadvantage: Lowest response rate. Inability to clarify any questions or confusion on the part of the respondent. - Each person receives the same questions and instructions in the same format, so that the possibility of repose bias is lessened. Can improve response rates by including the questionnaire with a postcard that identifies the person (ID number or name), return the questionnaire in an envelope and send the postcard separately. Anonymity is maintained, but the planner knows who returned the questionnaire. For individuals who did not return a postcard from the first mailing, use incentives or send a letter indicating the importance of response or another copy. - Appearance of the questionnaire should be attractive, easy to read, and offer ample space for the respondents/ answers. Be easy to understand to understand and complete. Be accompanied by a cover letter to help clarify directions for completion. Short questionnaires and questionnaires that clearly explain the need for the information are more likely to be returned. Should be easy to complete and returned.

Step 5: Identifying the Program Focus

- Parallels to third phase of PRECEDE-PROCEED model: education and ecological assessment. - Planners need to identify those predisposing, enabling, and reinforcing factors that have a direct impact of risk factors. Example: skills needed to stop smoking (predisposing), access to cessation program (enabling), and people around them who support efforts to stop smoking (reinforcing). Studying these factors helps the planner decide exactly which of the factors making up the three classes deserve the highest priority as the focus of the intervention. - Planners then need to consider any existing programs to avoid duplication of efforts. Find information about other existing programs through networking and checking with someone in an organization that serves as a clearinghouse for health promotion programs or by issuing a community resource guide. Talk with people in the PP. Use community forums, focus groups, or surveys.

single-step or cross-sectional surveys

- Point-in-time surveys; means of gathering primary data from individuals or groups with a single contact. - Take in the form of questionnaires and interviews. - Single-step surveys of those in the PP, significant others, opinion leaders, and key informants data can be collected through written questionaries, telephone interviews, face-to-face interviews, electronic interviews, and group interviews.

MEDLINE

- Primary component and access through PubMed. - US National Library of Medicine's (NLM) premier bibliographic database and contains references from journals covering life science with a concentration on biomedicine. - Distinct because records are indexed with NLM's Medical Subject Headings (MeSH).

needs assessment (program planning viewpoint)

- Process of identifying, analyzing, and prioritizing the needs of the priority population. - Other terms for process of determining needs: community analysis, community diagnosis, and community assessment. - Conducting needs assessment is the most critical step in the planning process because it provides objective data to define important health problems, set priorities for program implementation, and establishing a baseline for evaluation program impact.

Delphi technique

- Process that generates consensus through a series of questionnaires, which are administered through mail or electronic mail. - Process beings with those collecting the data asking the PP to respond to one or two broad questions. Responses are analyzed and a second questionnaire with more specific questions based one the responses to the first questionnaire is developed and sent to the PP. Answers are analyzed again and another new questionnaire is create and sent requesting additional information. - If consensus is reached, process can end or can continue for another round.

indirect observation

- Proxy measure - Completed by either "observing" the outcomes of a behavior (like pills left in bottle) or by asking others to report on such outcomes. - Measures can be used to verify self-reports when observations of actual changes in behavior cannot be observed.

Community Forum

- Referred to as town hall meeting. Approach that brings together people from the PP to discuss what they see as their group's problems/needs. - Community forum can be organized by a group representing the PP. Once people arrive, moderator explains the purpose of the meeting and asks to share concerns. Recorders then take notes or record the session to document responses. Silent majority may not speak out or minority may speak too loudly. - Participants may respond in writing by answering specific questions or by completing some type of instrument.

Data From the Literature

- Referring to present literature that could reflect the need of the PP. - Ex. HIV - because seriousness of disease and there are many people who have studied and written about it. - Using available literature databases. Can expect to find comprehensive listing of citations for journal articles, book chapters, and books, and databases, abstracts of the literature. Sometimes cite sources by author and subject/title. - Example of databases: PSYCINFO, MEDLINE, EDUCATION RESOURCE INFORMATION CENTER (ERIC), CUMULATIVE INDEX TO NURSING & ALLIED HEALTH LITERATURE (CINAHL), PUBMED

Sources of Primary Data

- Single-step or cross-sectional surveys - Written questionnaires - Face-to-face interviews - Telephone interviews - Electronic interviews - Group interviews - Multistep survey - Community forum - Meetings - Focus group - Nominal group process - Observation - Self-assessments - Most commonly used in planning health promotion programs presented in Box 4.3 page 72

windshield tour or walk though

- The person doing the observations walks or drives slowly through a neighborhood, on different days of the week and times, on the lookout for a variety of useful indicators of community health and well-being - Useful indicators include: housing types and conditions, recreational and commercial facilities, private and public sector services, social and civic activities, identifiable neighborhoods or residential clusters, conditions of roads and distances most travel, maintenance of buildings, grounds, and yards.

photovoice

- Wang and Burris - Called photo novella. Form of participatory data collection in which those in the PP are provided with cameras and skills training, then use the cameras to convey their own images of the community problems and strengths. - 3 main goals: to enable people to record and reflect their community's strengths and concerns; promote critical dialogue and enhance knowledge about issues through group discussions of the photographs; inform policy makers. - Photovoice has been used a lot with marginalized groups of various ages that want their perspective seen and heard by those in power. - Process of using photo voice involves: (1) defining the goals and objectives of the project (2) identifying community participants (3) providing participants with the purpose and philosophy behind photovoice (4) provide training (5) providing a theme (6) letting participants take the pictures (7) selecting the photographs (8) engaging in meaningful dialogue about the significance of each photograph (9) contextualizing the photographs by writing caption based on mnemonic (10) codifying the results (11) identifying stakeholders (12) making the presentations (13) taking action based on results.

Step 1: Determining the Purpose and Scope of the Needs Assessment

- What is the goal of the needs assessment? What does the committee hope to gain from the needs assessment? How extensive will it be? What resources are available? - First challenge of needs assessment is determine whether an assessment should even be performed. More focused needs assessment may be appropriate to gather more specific information about the need or health problem (like collecting current information, prevalence of the condition and where it is prevalent in the population, economic costs, and general trends. - If needs assessment has never been performed, not being performed in a long period of time, or were categorical funding does not dictate what health problems should be addressed > collect wide range of data, compare importance of multiple health problems, and set priorities > aka community health needs assessment - Determining how many health problems will be analyzed will influence by how much time and how much resources can be directed to the needs assessment. - Make a decision about which those in the community where the needs assessment is being conducted will be involved in the needs assessment process. - Understanding of why a needs assessment is being performed will give proper direction to all other steps to follow.

self-reports

- When individuals or groups (respondents or participants) are answering questions about themselves, the information is self-reported. Asked to recall and report accurate information. - Self-report measures are essential for needs assessments and evaluations because of the need of subjective assessments of experiences (feelings, health status, health behavior, sex behaviors, marketing data, and capacity data). - Offers a broad appeal to those who collect the data because they are quick to administer and involve little interpretation by the investigator. - Limitation is bias. - Proxy reporter- planners collecting data indirectly by asking another or looking for indications of a behavior.

events that made the public more aware of the importance of needs assessments

1. Institute of Medicine and Public Health Accrediting Board: IOM recommended examination of health department accreditation to improve public agency performance. PHAB created an accreditation process for governmental puce health departments. Then, in order to for the health department to become accredited, it must show its works meets the standards and measures that are spread over 12 domains. First domain was needs assessment - conduct and disseminate assessments focused on population health issues facing the community. 2. Passing fo the PPACA or the ACA: Four general requirements in order for organizations to maintain 501 tax exempt status. One was to conduct a community health needs assessment (CHNA) and adopt an implementation strategy for addressing the needs at least once every three years.

seriousness of the problem

Examined using four factors: economic loss to community, family, or individuals; involvement of other people who were not affected by the problem; severity of the problem measured in mortality, morbidity, or disability; urgency of solving the problem because of additional harm.

literature search strategy flowchart

Figure 4.4 page 89 - Begins by identifying the need of the PP or topic to be searched (use a thesaurus to look for related terms) > review abstracts or entire documents online or locate hard copy > determine the quality and usefulness of the publication in needs assessment process (quality can be seen by examining the references at the end of the publication) - References can lead planners to other sources and verify exhaustiveness of the search.

Self-Assessments

- Addresses primary prevention issues (such as the assessment of risk and protective factors) and secondary prevention process of the early detection of disease symptoms. - Ex. Breast self-exams, testicular self-exams, self-monitoring, and health assessments (HAs)

effectiveness of interventions

Most difficult to measure because some efficacy of some intervention strategies is known and others are not. Need to estimate this score. Should consider the effectiveness of intervention strategies in terms of behavior change and the degree to which the PP will demonstrate interest in the intervention strategy.

size of problem

Scored using epidemiological rates or percentage of PP at risk. Higher the rate or percentage, greater the score.

Special Types of Health Assessments

Two specific types of health assessments: health impact assessment and organizational health assessment

6 step process for formal approach needs assessment

1. Determining purpose and defining the scope of the needs assessment. 2. Gathering data 3. Analyzing the data 4. Identifying the risk factors linked to the health problem 5. Identifying the program focus 6. Validating the need before continuing on with the planning process

reasons not to have needs assessment

1. If another needs assessment have been conducted recently and the funding or other resources to conduct a second needs assessment in such a short period of time were not available. 2. When the program planners are employed by an agency that deals with a specific need that is already known (cancer and the American Cancer Society), or the agency for which they work has received categorical funds that are earmarked or dedicated to a specific disease, heath determinant (RF), or program.

PRECEDE-PROCEED model

1. What is the quality of life of those in the PP? 2. What are the social conditions and perceptions shared by those in the PP? 3. What are the social indicators in the PP that reflect the social conditions and perceptions? 4. Can social conditions and perceptions be linked to health promotion? 5. What are health problems associated with the social problems? 6. Which health problem is most important to change? - Last one is asking which problem.need should get priority. Priority setting is critical in narrowing the scope of activity to reflect the availability of resources within the context of stakeholders' values and preferences and to stay focus on problems that actually affect the health status of the population. - Priority setting benefits (1) building consensus among stakeholders for the allocation of resources in areas most likely to yield positive and sustainable outcomes (2) clarifying expectations for the use of resources in a constrained environment (3) helping to establish focus on issues based on objective criteria (d) helping establish a change of accountability for stakeholders. - Priority setting obstacles (1) lack of quality data (2) conflicting political dynamics and agenda (3) stakeholder fatigue with assessment process (4) poorly developed and or understood criteria (5) lack of equity in stakeholder participation and processes.

What to Expect from a Needs Assessment

1. Who makes up the priority population? 2. What are the needs of the priority population? 3. Why does these needs exist? 4. What factors create or determine the need? 5. Which subgroups within the priority population have the greatest need? 6. Where are these subgroups located geographically? 7. What resources are available to address the needs? 8. What is currently being done to resolve identified needs? 9. How well have the identified needs been addressed in the past? - 7, 8, 9 provides information about the community capacity and whether part of the identified needs may include the need to build capacity. - Needs assessment is identifying the needs go the priority population and determine the degree to which the needs are being met. If needs are not met, there may also be a need to enhance capacity of a community.

10 questions that need to be asked when a health risk appraisal is purchased from a vendor

1. how long has the vendor been in business 2. how many other clients have used the instrument? 3. who was behind the development of the HRA? 4. What is the best price? 5. Is the vendor willing to share the names of other clients who have used the HRA? 6. Is there litigation pending against the vendor? 7. Is the vendor HIPPA compliant? 8. Will the vendor store the HRA data at a sire outside the US? 9. Is customer service/technical assistance included with the purchase of the HRA? 10. Who is the key contact within the company of the vendor and what is their emergency number?

questions to ask when setting priorities

1. what is the most pressing need? 2. are there resources adequate to deal with problem? 3. can the problem best be solved by a health promotion intervention or could it be handle better through other means? 4. are effective intervention strategies available to address the problem? 5. can the problem be solved in a reasonable amount of time?

community capacity

characteristics of communities that affect their ability to identify, mobilize, and address social and public health problems - Assessing the community capacity helps you think about existing community strengths that can be mobilized to address social, economic, and environmental conditions affecting health inequities. Look at places and organizations. - Important to identify the nature of relationships across these sectors (values and norms) with the community and among various subgroups within the community.

Organizational Health Assessment

- ACA. CHNA. Public Health Service Act. - Reasonably designed provision: (1) has reasonable change of improving the health or preventing disease in participating individuals (2) not overly burdensome (3) not subterfuge for discrimination based on health factor (4) not highly suspect in the method chosen to promote health or prevent disease. - Organizational health assessment developed to determine if best practices are in place in employer-sponsored worksite health promotion programs. Needs assessments for reasonably designed employee-sponsored worksite health promotion programs. - Includes WERO, WISCORE, OHE

BPR Model

- Requires planners to create four different component of identified need and insert ratings into formal to determine a priority rating between 0 and 100. - Size of the problem, seriousness of the problem, effectiveness of possible interventions, and propriety, economics, acceptability, resources, and legality (PEARL).

BPR Model 2.0

- An updated version of the basic priority rating - Size of problem: use incidence and prevalence data, incidence and prevalence and score each health problem, use age-adjusted cause-specific mortality rates and proportional mortality ratios, or use age-adjusted cause-specific mortality rates or proportional mortality ratios. - Seriousness of the problem: urgency. Severity: expanded definition to lethality, premature mortality, disability. Economic loss: accumulation of cost (direct or indirect) born by society associated with the health problem. Impact on others: expand definition to include communicable diseases, behavioral effects, emotional and physical impact - Effectiveness of possible interventions: limit to the evidence of a successful intervention and not rate the reach of the intervention. - PEARL remains the same unless secondary data is used.

Steps For Conducting a Literature Search

- General search procedures - Searching via the world wide web

Meetings

- Good source of information for a preliminary needs assessment or various aspects of evaluation. - Planners can see what the health issues are in the community by meeting with a small group. - Advantages: Meeting structure can be flexible to avoid limiting the scope of information gained. Cost is minimal. - Disadvantages: Possible bias when meetings are the sole source of data collection. Give socially acceptable responses rather than discussing actual concerns. Limited input if few participants are included or if one or two participants dominate the discussion.

health assessments (HAs)

- Include instruments known as health risk appraisals or health risk assessments (HRA), health status assessment (HSA), various lifestyle specific, and disease/condition status assessments. - HAs have been the most useful in the needs assessment process because from such assessments planners can obtain group data which summarize major health problems and risk factors. - HRAs are the most often included in the needs assessment process. They estimate the odds that a person with certain characteristics will die from selected causes within a given time span. Original purpose was to engage family physicians and patients in conversation about risks of premature death and preventive health behaviors. - To use a HRA as part of needs assessment, planners would have those in the PP complete a questionnaire. The resulting risk appraisals are calculated by computers or hand-scored. HRAs generate both individual and group reports. - HRA used to help motivate people to act on their health, measure health status, increase productivity, increase awareness, serves as cues to action, and to contribute to program design and evaluation. CPSTF has shown that there was insufficient evidence to recommend the use of HRAs with appropriate feedback to achieve improvements in health behavior. Found that there was sufficient evidence to recommend the use of HRAs with appropriate feedback when combined with health education programs and with or without interventions for improve health behaviors of employees.

proxy measure

- Indirect measure. Defined as an outcome that provides evidence that a behavior has occurred. Indirect measures are unmistakable signs that a specific behavior has occurred. - Examples of proxy measures: lower blood pressure of medication taking, body weight for exercise and dieting, cotinine in the blood for tobacco, empty alcoholic beverages for consumption of alcohol, or another person reporting on the compliance of his/her partner. - Proxy measurements of skills and behaviors require more resources and cooperation to obtain self-report or direct observation. - Concern is making sure the measure is both valid and reliable.

key informants

- Individuals with unique knowledge about a particular topic. - Ex. A person who had a specific problem like losing weight and being able to talk about the barriers. - Information may only represent a single experience and this be biased, planners need to be careful not to base an entire needs assessment on the data generated from a key informant survey.

EDUCATION RESOURCE INFORMATION (ERIC)

- Online digital library of education literature sponsored by the Institute of Education Sciences (IES) of the US Department of Education. - Free access to educational journal articles and other education-related materials.

random digit dialing (RDD)

- Telephone number combinations are chosen at random. - Disadvantages: Numbers include businesses, residences, and nonworking as well as valid numbers, which makes it more time consuming. People with phones may not have a telephone number with an area code in which they live (have to know the area code and exchanges, in order for the RDD to work). Resistance to answering questions over the telephone or resentment of being interrupted. Those conducting the interviews may have a difficult time reaching individuals because of unanswered phones or answering machines. Requires trained interviewers (may not be consistent). Explaining a question or offering additional information can cause the respondent to change an initial response, which creates interviewer bias. Cannot show visual cues. - Advantages: Includes the entire survey population with a telephone in the area, including people with unlisted numbers and cell phones. Does have the opportunity to clarify questions.

Multistep Survey

- Where those collecting the data contact those who will provide the data on more than one occasion. - Delphi technique

Acquiring Needs Assessment Data

- two types of data associated with a needs assessment: primary and secondary data

HIA steps

1. Screening (identify plans, projects, or policies for which an HIA would be useful) 2. Scoping (identify which health effects to consider) 3. Assessing risks and benefits (identify which people may be affected and how they may be affected) 4. Developing recommendations (suggesting changes to proposals to promote positive health effects or minimize adverse health effects) 5. Reporting (present the results to decision makers) 6. Monitoring and evaluating (determining the effect of the HIA on the decision)

unobtrusive observation

the persons being studied are not aware they are being measured, assessed, or tested - provides less biased data but some question whether this is ethical

need

the difference between the present situation and a more desirable one

bias

those data that have been distorted because of the way they have been collected

participatory data collection

those in the priority population participate in the data collection