Evidence-Based Public Health: Quiz #2

Needs assessment

Systematic effort to identify needs (real and perceived) of a community.

Assets assessment

Systematic identification of resources (real or potential) that improve quality of life and impact health of a community.

Types of needs

Behavioral/individual, Social, Educational, Organizational, Environmental.

Types of assets

Human capital — knowledge and skills; Financial capital — cash, savings, liquid assets; Market capital — businesses and business development; Physical capital — buildings, housing, transportation; Natural capital — Land, water, air quality; Social capital — relationships of trust and respect.

Asset Mapping

Define the 'community', identify and involve community partners, identify community assets, and list assets (group, individual) with community partners.

Social Determinants, Behavior, & Health

Health outcomes are worst when community assets are low and inequities are high; health outcomes are best when community assets are high and inequities are low.

Benefits of a Community Assessment

Provide insight into the community context, make decisions about where to focus resources and interventions, ensure understanding of issues among partnership members, influence community support and resources, understand starting point and track contributions to change, and ensure interventions maximize benefit to the community.

Secondary data

Is collected by someone other than the user, often for purposes that may differ from the purposes you have.

Why use secondary data?

Available data may provide the 'answers', may be more 'accurate', require less money and time, useful for early-stage exploration, and may allow for tracking trends over time.

Where can you find secondary data?

Census, Health surveillance systems, Behavioral surveillance systems, Existing records, Services, Agencies, Literature.

U.S. Population Census

Purpose: Access full population numbers and characteristics for the United States as mandated in the U.S. constitution.

Method: Paper-based survey every 10 years; Coverage: Entire U.S. population; Data examples: Age, education, race, ethnicity.

American Community Survey (ACS)

Purpose: Part of Census that aims to provide deeper insight into lives of Americans and information for communities to plan services.

Method: Annual paper-based survey of a small sample of the U.S. population; Legal obligation to complete the survey; Data examples: Income, insurance, veteran benefits, disabilities, details about where live/work.

Behavioral Risk Factor Surveillance System (BRFSS)

Purpose: Provide national estimates of health behaviors, with a focus on risk.

Method: Annual telephone survey since 1993 that includes a core set of questions and state-specific questions — included cell phones since 2011.

Data examples

Smoking, alcohol, violence, sleep seatbelt use, emotional support, life satisfaction.

County health rankings

Data platforms are NOT data sources.

County Health Rankings: Strengths

Less money and time (generally) needed for data collection; may allow tracking of trends over time; may include a large sample.

County Health Rankings: Limitations

Data may be biased as certain populations may be omitted; administrative logistics can hinder access; questions may not capture the 'right' information.

Primary data

Data collected by an individual, from first-hand experience and for a specific purpose.

Best approach to data collection

Depends on factors such as topic, purpose, feasibility, resources, and availability of community.

Primary Data Collection Techniques

Interviews, community forum, focus groups, nominal group process, photovoice, community audits, surveys, epi studies.

Primary Data: Advantages

Gets the data you are really looking for; identify true needs; provides current data.

Primary Data: Disadvantages

Takes time and money; may not be feasible; low response rates.

Childhood lead exposure

Main source is lead-based paint (used pre-1978); can cause developmental delays, learning disabilities, irritability, fatigue, abdominal pain, loss of appetite, mood disorders (adults).

Asymptomatic lead exposure

Usually asymptomatic until levels are extremely high.

Highest risk for lead exposure

Children < 6 years old.

CDC Childhood Lead Prevention Program

Lead Contamination Control Act of 1988; develop policies, including those about housing hazards; education programs; funding to Departments of Health for screening; data reported to CDC through Childhood Blood Lead Surveillance System.

Childhood lead levels: PH Perspective

½ million children 1-5 yrs old estimated to have blood lead levels > 5 μg/dL, is the level at which CDC recommends intervention.

Photovoice

Technique that relies on photography, accompanying narratives, and discussion.

Goals of Photovoice

Depict community strengths and concerns; use discussion to promote critical, constructive dialogue; reach policy makers.

Photovoice Theory

Feminist theory; power accrues to those who have voice, set language, make history, and participate in decisions.

Community documentary photography

Photos reveal social justice issues; key: outside comes in to work with community to take photos.

Critical consciousness

Those who are oppressed use critical thinking about their situations to lead to social change; key: discussion about and sharing photos.

Strengths of Photovoice

Gain community insight into needs/assets; build relationships with communities; facilitate insight into settings that might otherwise be inaccessible to 'outsiders'; develop visual evidence to use when speaking with planners/policy makers.

Ethical Considerations of Photovoice

Privacy (photographs, discussion); consenting of subjects; consequences of emotional reactions.

Men On The Move

Used Sustainable Livelihoods Framework to understand how education and employment influenced health.

Strategies for making a living

Included good paying jobs, self-employment (legal and illegal), and migration.

Institutional practices and policies

Spoke about inconsistent implementation of policy in ways that favor Whites in power while creating problems for African Americans and poor whites.

Community Health and Status Assessment

Involves secondary data collection on overall population demographics and health status indicators.

Health status indicators

Includes infant mortality, teen births, life expectancy, suicides.

Health behaviors

Includes adult smoking, physical activity, binge drinking.

Social determinants of health

Includes poverty, income and employment, housing education.

Community Themes and Strengths Assessment

Primary data collection through a survey to identify community's greatest strength and health-related concerns.

Local Public Health System Assessment

Assessment of RAHD based on CDC's 10 Essential Public Health Services.

Forces of Change Assessment

Assessment of external opportunities and threats to promote health community.