Community Health Assessment BEST PRACTICES · The!ul/mate!goal!of!acommunity!health!...

Community Health Assessment

BEST PRACTICES

Community health assessment is a systema/c examina/on of the health status indicators for a given popula/on that is used to iden/fy key problems and assets in a community.

Turnock, B. Public Health: What It Is and How It Works. Jones and Bartle<, 2009.

Defini/on

The ul/mate goal of a community health assessment is to inform:

•  community decision-‐making

•  priori/za/on of health problems

•  strategies to address the community’s health needs and iden/fied issues


Defini/on

A variety of tools and processed may be used to conduct a community health assessment. The most essen/al ingredients are community engagement and collabora/ve par/cipa/on


Defini/on

–  Mobilize a coali/on/team

–  Assess areas of need & assets

–  Priori/ze needs

–  Develop strategic ac/on plan

•  Disseminate & ac/vate plan •  Track progress/outcomes

Common CHA Elements

Common CHA Elements

Mobilize a Coali/on

A coali/on is a group of individuals and/or organiza/ons with a common interest who agree

to work together toward a common goal

IDENTIFY KEY PARTNERS/STAKEHOLDERS

•  Those most affected by the issue

•  Formal and informal helpers –  those charged with carrying out community func/ons related to the issue

•  Policy Makers

•  Community Opinion Leaders

START WITH PEOPLE YOU KNOW!

Mobilize a Coali/on

–  Schools –  Parents –  Youth –  Elected leaders –  SDPI –  IHS/Tribal Health Programs/Facili/es –  Youth serving programs –  Local businesses –  Parks and recrea/on –  NB3 –  Tribal Epidemiology Centers –  Universi/es –  State/County Departments of Health

Iden/fy Key Partners

COALITION GUIDELINES

•  Communicate, communicate, communicate!

•  Be as inclusive and par/cipatory as you can.

•  Try to set concrete, reachable goals.

•  Be realis/c, and keep your promises.

•  Acknowledge and use the diversity of the group

•  Celebrate milestones, contribu/ons and successes.

Mobilize a Coali/on

•  Define the community/target popula/on

•  Iden/fy key indicators

•  Select indicators

•  Collect/Gather Primary Data

•  Collect/Gather Secondary Data

ASSESS NEEDS & ASSETS

•  Will guide data collec/on efforts.

•  Community can be defined in a number of ways, and depends on the overall purpose of the CHA. –  Geographic boundaries –  Demographic traits

•  Gender •  Age group •  Tribal members

–  Health condi/ons •  Diabe/cs

–  Others?

Define the Community

Iden/fy Key Indicators

–  BMI

–  Fruit and vegetable consumpHon

–  Breakfast consumpHon

–  Sugar-‐sweetened beverage consumpHon

–  Physical AcHvity –  Food insecurity –  Screen Hme

–  Knowledge, aPtudes, beliefs

–  Demographics (gender, age, grade, etc.)

–  Others?

Individual-‐Level Indicators

–  Healthy food access/cost –  PE in schools –  School lunch program –  Sugary beverage/soU drinks in schools/other community locaHons

–  AUerschool programs –  Wellness center hours –  NutriHon labeling –  Food taxes/subsidies –  RecreaHonal opportuniHes –  Community Capacity –  Exposure to unhealthy food markeHng –  Gardening –  Cultural acHviHes –  NutriHon/health classes

Other Indicators

•  Relevance/importance

•  Measurable

•  Access to data sources •  Ability to monitor over /me

•  Resources –  $ –  Time constraints –  Primary vs. secondary

Selec/ng Indicators

Body Mass Index (BMI)

How would you measure?

Fruit & Vegetable ConsumpHon


Physical AcHvity


Screen Time


Knowledge, aPtudes and beliefs


Demographics (gender, age, grade, etc.)


Healthy Food Access/Cost


PE in Schools


School lunch program


RecreaHon OpportuniHes for Youth


Exposure to Unhealthy Food MarkeHng


The mixing of more than one type of data or data collec/on methods so that diverse viewpoints cast light upon a topic and strengthen confidence in the findings.

Triangula/on

A comprehensive CHA brings together a variety of data such as:

MulH-‐level indicators: –  Individual –  Community –  System/Policy –  Environment **Needs & strengths at each level MulHple data types & sources –  QualitaHve/quanHtaHve –  Primary/secondary –  IHS/Tribal/State

Triangula/on

Approaches to collec/ng data

Data Collec/on

Quan/ta/ve

Survey/Ques/onnaire

Pre-‐/Post-‐Tests

Qualita/ve

Interviews

Focus Groups

Community Forum

Photovoice

Digital Storytelling

Mix method

•  LOCAL PROGRAMS, ORGANIZATIONS: •  Tribal Special Diabetes Programs •  Schools •  IHS

•  STATE HEALTH DEPARTMENTS: •  Youth Risk and Resiliency Survey •  Behavioral Risk Factor Surveillance System •  Vital Records

•  FEDERAL AGENCIES: •  IHS •  Centers for Disease Control •  US Census

Secondary Data Sources

•  Survey •  Pre-‐Post Test •  Focus group •  In-‐depth Interviews •  Photovoice •  ParHcipant ObservaHon •  Community forum

Primary Data Collec/on

Community Forum

•  An open mee/ng or gathering where community members discuss important concerns.

•  Also referred to as public forums or town mee/ngs.

Community Forum

This way à

Community Forum – Why? Iden/fy methods or strategies to reduce obesity among American Indian children

Community par/cipa/on

Bringing people together from diverse backgrounds

Iden/fy Facilitators/Barriers

Collec/ve problem-‐solving & planning

Linking your program with people who are able & willing to help

Organizing a Community Forum 1.  Schedule at a convenient /me

2.  Neutral & comfortable loca/on

3.  Publicize the forum widely (i.e., fliers, PSAs, press releases)

4.  Personally invita/ons

5.  Encourage par/cipants to invite others

6.  Serve refreshments

7.  Hold forums at different sites to improve par/cipa/on

10 Steps to a Produc/ve Community Forum

1.  Designate a discussion leader/facilitator & a recorder 2.  Sign-‐in sheet (name, address, phone, email)

3.  Begin with brief introduc/ons

4.  Agree upon ground rules

5.  Keep forum to < 40 par/cipants, or conduct 2 forums

6.  Provide an overview of your mission and goals

7.  Have facilitator lead the discussion with key ques/ons

8.  Record the discussion on each topic 9.  Conclude with a summary of what was achieved – a

preliminary plan for next steps and future mee/ngs 10.  Prepare a wrimen summary of the ideas discussed, and mail

with thanks to all par/cipants. Include a list of opportuni/es for further involvement.

–  Reconvene your Coali/on

–  Priori/ze Needs/Assets

– Develop Goals/Objec/ves

–  Plan Ac/vi/es

–  Implement & Evaluate Plan

Key Steps for Ac/on Planning

•  List all iden/fied needs/assets

•  Small work groups

•  Iden/fy common or overlapping needs/assets

•  Use priori/za/on matrix to order needs/assets

Priori/ze Needs/Assets

Priori/za/on Matrix

MORE IMPORTANT LESS IMPORTANT

MORE

CHANGEABLE

High Priority (Quadrant #1)

Low Priority (Quadrant #3)

LESS

CHANGEABLE

Priority for

innovaHve programs (Quadrant #2)

No Priority

(Quadrant #4)

Behavioral matrix from Green and Kreuter’s PRECEDE-‐PROCEED model

Order items into a list, consider criteria such as:

–  Should certain issues be addressed first?

– Are there issues with immediate consequences?

– Any upcoming events//me constraints that may help or hinder addressing an issue?

Address at least one simpler issue first

in an effort to build momentum and teamwork for addressing more complex issues!

Priori/ze Needs/Assets

All objectives should always be linked to your

goals(s)!

Goals are broad statements that . . .

–  Describe the desired long-‐term impacts of what you want to accomplish in the future.

–  Provide the overall direc/on of the program.

–  Lay the founda/on for the specific objec/ves and ac/vi/es that will ul/mately define the program.

Goal

•  Increase physical ac/vity among tribal youth to prevent future diabetes.

•  Create a healthy school environment for all community youth

Sample Goal Statements

A goal statement should describe a

future condition you wish to achieve . . .

Not a specific activity or task!

Objec/ves are . . .

–  The specific measurable components of your ini/a/ve.

–  Concise statements which offer specifics of how much of what will be accomplished by when.

–  SMART

•  Specific, Measurable, Achievable, Relevant, Timed

Objec/ves

Three basic targets of your objec/ves:

1. Individual Changing knowledge, aotudes, beliefs, behaviors among individual people (e.g., increased physical ac/vity, reduce body weight, etc.)

2. Community, System, Policy, Environment Changing many people, health system(s) or policy (s) (e.g. expanded healthy food op/ons, more places to exercise)

3. Process The implementa/on of your program -‐ provides the founda/on necessary to achieve your other objec/ves (e.g., develop a partnership, number of contacts, establish wrimen protocols/policies, hold a mee/ng, etc.)

Targets of Objec/ves

ü  SPECIFIC – Objec/ves should specify what they aim to achieve.

ü MEASURABLE – Objec/ves must be measurable to assess achievement.

ü  ACHIEVABLE -‐ Objec/ves should be achievable/amainable.

ü  REALISTIC – Objec/ves should be achievable with the resources you have.

ü  TIMED – Objec/ves should indicate /melines for accountability.

Objec/ves are SMART

An objecHve statement should specify:

–  What will change? (e.g., certain risk factors, behaviors, knowledge, awareness, etc.)

–  For whom? (e.g., tribal members, leaders, health providers, etc.)

–  By how much? (e.g. decrease body weight by 7%, 10% increase in wellness center amendance, 2 new policies implemented).

–  By when? (e.g. by the end of the program, six-‐month follow-‐up, by the end of the year, etc.).

Wri/ng Objec/ves

All objectives should always be linked to your

goals(s)!

By September 2015, all tribal elementary schools will provide PE to students for one full

class period at least 4 days per week.

Sample Objec/ve

Specific, Measurable, Achievable, Relevant, Timed?

–  Keeps staff working towards the same long-‐term goals.

–  Helps your agency to create specific and feasible

ways in which to carry out your vision. –  Creates manageable /melines for a project. –  Allows you to track what your program has

accomplished, and what s/ll needs to be completed.

–  Provides measurable outcome data to share with

your agency, coali/on, funders and the greater community that you are working with.

Value of Goals & Objec/ves

25% of youth will eat more fruits and vegetables.

SMART Objec/ve?

By October 2013, the hours of opera/on at the wellness center will be increased from 4 hours to 6 hours on

Sundays.

SMART Objec/ve?

Reduce the percentage of youth who watch 3 or more hours of television

arer school

SMART Objec/ve?

Increase the percentage of youth who had their physical ac/vity level assessed & documented in the past 12 months from 25% at baseline

to 40%.

SMART Objec/ve?

The Goals & Objec/ves Tool

2009 YRRS RESULTS – SELECTED DISPARITIES

ITEM

AASTEC

SCHOOLS

NATIONAL YRBS

HEALTHY

PEOPLE 2010

TOBACCO USE PAST MONTH

31.3% 19.5%

16.0%

RODE WITH DRIVER WHO HAD BEEN DRINKING ALCOHOL PAST 30 DAYS

43.1% 28.3%

30.0%

PERCENT OF PARTICIPANTS WHO ARE OBESE

22.9% 12.0%

5.0%

VIEW 2 OR LESS HOURS OF TELEVISION ON SCHOOL DAY

58.9% 67.2%

75.0%

SUICIDE ATTEMPTS WITH INJURY

4.4% 1.9% 1.0%

CARRY WEAPON ON SCHOOL PROPERTY

7.5% 5.6% 4.9%

PARTICIPATE IN DAILY SCHOOL PHYSICAL EDUCATION

34.0% 33.3%

50.0%

•  What ac/vity or event will occur to achieve our goals/objec/ves

•  Who will carry it out

•  When it will take place, and for how long

•  What resources (i.e., money, staff) are needed to carry out the change

•  CommunicaSon (who should know what)

More Ac/on Planning . . .

§  It provides an ongoing planning document that specifies who will do what, when and where.

§  Ensures that you think about all of the necessary ingredients for a good program before diving in.

§  Serves as a “to do” list to help keep everyone involved on the same page.

§  Good planning can improve implementa/on, which in turn, can lead to improved outcomes!

Value of Program Planning?

2009 YRRS RESULTS – SELECTED DISPARITIES

ITEM

AASTEC

SCHOOLS

NATIONAL YRBS

HEALTHY

PEOPLE 2010

TOBACCO USE PAST MONTH

31.3% 19.5%

16.0%

RODE WITH DRIVER WHO HAD BEEN DRINKING ALCOHOL PAST 30 DAYS

43.1% 28.3%

30.0%

PERCENT OF PARTICIPANTS WHO ARE OBESE

22.9% 12.0%

5.0%

VIEW 2 OR LESS HOURS OF TELEVISION ON SCHOOL DAY

58.9% 67.2%

75.0%

SUICIDE ATTEMPTS WITH INJURY

4.4% 1.9% 1.0%

CARRY WEAPON ON SCHOOL PROPERTY

7.5% 5.6% 4.9%

PARTICIPATE IN DAILY SCHOOL PHYSICAL EDUCATION

34.0% 33.3%

50.0%

The Ac/vity Planning Tool

ü  Ac/vi/es

ü  Timelines/Scheduled Date

ü  Who is Responsible?

ü  Collabora/ng Partners

ü  Resources

ü  Loca/on(s)

Program Planning Elements

•  List each of the ac/vi/es necessary to implement your program.

•  These ac/vi/es should be aimed to achieve your goals and objec/ves.

•  Be sure to include ac/vi/es such as recruitment of par/cipants, staff training, mee/ngs, & marke/ng

Ac/vi/es

•  When will the ac/vi/es occur?

•  By deciding on an approximate date for the comple/on of each ac/vity, a helpful /meline will emerge.

•  Use these dates to assess if your program is being implemented in a /mely fashion.

Timelines

•  Decide which staff will be involved in the implementa/on of each ac/vity.

•  Iden/fy who will be the leader/coordinator of the ac/vity.

•  Also list new staff or outside consultants who will be contracted for the ac/vity.

•  Avoid assigning one individual to lead all project ac/vi/es.

Person(s) Responsible

Balance the responsibilities so nobody is overwhelmed!

•  Iden/fy any partners who will collaborate with you on this ac/vity (e.g. IHS, school, AASTEC, DOH, university, etc.).

•  Be sure to list the roles that each partner will play in the implementa/on of your program.

•  Remember . . . collabora/on can enhance the effec/veness of your program through a mutual sharing of resources, ideas, and experFse!

Collaborators

•  Consider what resources are needed for each ac/vity.

•  Resources may be financial, service(s), equipment, transporta/on/travel, or specific supplies like food, markers, paper, etc.

•  Be sure to indicate whether items will be purchased through program funds, donated from outside agencies, etc.

Resources

•  Determine where you will hold the various ac/vi/es you have iden/fied.

•  This is especially important for loca/ons that require significant lead /me to reserve.

•  Keep in mind that the space available may determine the type of program or ac/vity that can be conducted

Loca/on

Common CHA Elements

Resources Community Tool Kit hmp://ctb.ku.edu/en CDC hmp://www.cdc.gov/stltpublichealth/cha/ MAP-‐IT hmp://www.healthypeople.gov/2020/Implement/MapIt.aspx Community Guide hmp://www.thecommunityguide.org/index.html

MAPP Framework hmp://www.naccho.org/topics/infrastructure/MAPP/framework/index.cfm

Tribal Epidemiology Centers Albuquerque Area Southwest Tribal Epidemiology Center Website: hmp://www.aastec.net/ California Tribal Epidemiology Center Website: hmp://www.crihb.org/ctec/ Great Lakes Inter-‐Tribal Epidemiology Center Website: hmp://www.glitc.org/programs/epi-‐home Inter Tribal Council of Arizona, Inc. Tribal Epidemiology Center Website: hmp://itcaonline.com/tec Navajo Epidemiology Center Phone: 928-‐871-‐6254 Northern Plains Tribal Epidemiology Center Website: hmp://www.aatchb.org/nptec/ Oklahoma Area Tribal Epidemiology Center Website: hmp://www.ocaithb.org/ Urban Indian Health InsHtute Website: hmp://www.uihi.org/

Contact Informa/on Kevin English – AASTEC Director:

505-‐962-‐2602 [email protected]

Dornell Pete – Epidemiologist

505-‐764-‐0036 [email protected]

Community Health Assessment BEST PRACTICES · The!ul/mate!goal!of!acommunity!health!...

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