L19 Community Health Assessment

What is the definition of community ?

It is simply a collection of people who share some important features of their lives.

What are the 3 types of communities in relation to public health nursing practice ?

• Geographic

• Common interest

• Health problem

What are the components of healthy communities should have ? (8)

• Low crime rates

• Good schools

• Strong family life

• Robust economy / good jobs

• High environmental quality (clean air, water)

• Accessible and quality health service

• Civic involvement 公民參與

• Good transportation (roads, public transit)

• Wide variety of leisure activities

Define what is community assessment ?

It is the process of determining the health status, resources, and the real or perceived needs of a defined community of people.

Suggest 3 purpose of community assessment

• To identify the health care needs of a community.

• As a basis for resource allocation decisions.

• To demonstrate the need for specific program to justify program funding.

List the 3 steps of community assessment

1. Gathering relevant existing data and generating missing data

2. Developing a composite database

3. Interpreting the data to identify community problems and strengths

What are the 3 aspects to assess in community assessment in the Community-as-partner Model ?

• Community core

• Community subsystems

• Community perceptions

What are the elements in community core of the Community-as-partner Model ? (7)

• History

• Demographics (age, sex, income…)

• Household types

• Marital status

• Vital Statistics (e.g. Birth rates, death rates…)

• Values and beliefs

• Religion

What are the 8 community subsystems in community core of the Community-as-partner Model ?

• Physical Environment

• Education

• Safety and Transportation

• Politics and Government

• Health and Social Services

• Communication

• Economics

• Recreation

How to assess the physical environment (one of the community subsystems in Community-as-partner Model) ?

⎼ Inspection
⎼ Walk through community
⎼ Listen to community sounds/residents
⎼ Observe climate, natural boundaries, and resources

How to assess the education (one of the community subsystems in Community-as-partner Model) ?

• The educational status

• The educational sources

  • Intracommunity or Extracommunity ?

• Adequacy, accessibility, and acceptability of education to community

How to assess the safety and transportation (one of the community subsystems in Community-as-partner Model) ?

Safety

• Protection Services

• Crime Statistics

• Air Quality

Transportation

• Private

• Public

• Rail Service

*population density affects these items !!

How to assess the politics and government (one of the community subsystems in Community-as-partner Model) ?

⎼ LEGCO (Legislative Council) Representatives

⎼ Community Groups
⎼ Political Activism 政治活動主義
⎼ Senior’s Groups

How to assess the health and social services (one of the community subsystems in Community-as-partner Model) ?

• Extracommunity or Intracommunity facilities

  • Group into categories

• Adequacy, accessibility, and acceptability of facility.

How to assess the communication (one of the community subsystems in Community-as-partner Model) ?

• Newspapers

• Radio and television

• Telephone status

• Community bulletin boards 社區公告欄

• Dissemination: Word of mouth 傳播方式：口耳相傳

How to assess the economics (one of the community subsystems in Community-as-partner Model) ?

Financial Characteristics

• Median Household income

• Monthly costs for households

• Individual Per capita income 個人人均收入

Labor Force

• Employment status

• Occupational categories (% of people employed)

How to assess the recreation (one of the community subsystems in Community-as-partner Model) ?

• Intracommunity or extracommunity

• Recreational facilities

• Sports facilities

What questions should ask to assess the community perceptions ?

• How do people feel about community?

• What do they identify as its strengths?

• What do they identify as its problems?

Suggest 8 tools for community assessment

• Windshield Survey

• Key Informant Interviews

• Surveys of Community Members

• Literature Review

• Government Documents and Reports

• Demographic and Epidemiological Data

• Focus Groups

• Participant Observation

How to use Windshield Survey (a tool) for community assessment ?

• Learning about the community on foot.

• Observing a community by driving or walking through the community.

• Observations of such things as housing quality, recreation facilities, movement of people, etc.

• Do at various times of day.

How to use Key informant interviews (a tool) for community assessment ?

• ie. what are the 3 groups of Key informants ?

Key informants = community leaders in various fields.

• People in key positions in community due to their professions

• People who are leaders within the community

• People who are centrally placed because of their social roles in the community

How to use Surveys of Community Members (a tool) for community assessment ?

• Assessment method in which a series of questions is used to collect specific data for analysis of a specific group or area.

• Used to ask residents about unmet health needs or to solicit opinions on existing services.

• Can use face-to-face interviews of self- administered questionnaires.

• Method depends on size and composition of group being surveyed.

How to use Literature Review (a tool) for community assessment ?

• Key component to community assessment.

• Key information generated from findings of others.

• Useful for identifying strategies to address health problems.

List examples of Government Documents and Reports (a tool) for community assessment ?

• Major government reports

  • Behavioural risk factor survey

  • Thematic household survey

• Health-care Policy Documents

  • Harvard report

  • ‘Your Health Your Life’ consultative document

List examples of Demographic and Epidemiological Data (a tool) for community assessment ?

• Population statistics and demographic data

• Health status indicators

  • Mortality rates, death rates, birth rates, life expectancy at birth ….

How to use Focus Group (a tool) for community assessment ?

• Small discussion group

• Help explore community resident’s perceptions of their community and its health needs

• Can be done after collecting some secondary data

• Eight to twelve people in a group with one person acts as facilitator

How to use Participants Observation (a tool) for community assessment ?

• Participates in the life of the community or target group

• Observes the community dynamics and individual interactions of community members from within.

Suggest 4 strategies to increase community participation

• Community members views and opinions are solicited 徵求.

• Involve community members.

• Information collected is returned to community.

• Work from perceived or felt needs of community members.

What are the steps of community analysis ?

1. Categorize Characteristics related to demographic, geographic, socioeconomic, health resources and services

2. Summarize: Summary measures, use of charts and graphs

3. Compare: Identify gaps, compare data to see if trends exists

4. Draw Inference: Draw conclusion from the evidence

What are the 2 major outcomes measures after community assessment ?

• Community Needs: “What should be,” or the desired state

• Community Problems

How to determine the community needs after the assessment ?

• Perceived needs

  • What the community residents say they need

• Determined needs

  • Needs determined by “experts” on basis of professional analysis

Both are included in the process of identifying needs

What is Community Diagnosis ? What is included inside ?

• It is the last stage of the assessment process

• Initiates and sets stage for planning process.

• Diagnosis is a hypothesis or statement of the outcome of the analysis summarizes data gathered in the assessment process.

  • A quantitative and qualitative description of the health of citizens and the factors which influence their health. It identifies problems, proposes areas for improvement and stimulates action

  • Problem, Etiology, Signs & Symptoms

What are the etiology of the problem: High infant and childhood morbidity from chickenpox

(Related to:)

• Low educational level of mothers
• Crowded living conditions
• Poor infection control and sanitary conditions

What are the etiology of the problem: Potential for increased mental health problems (e.g., alcohol and substance abuse, domestic violence, suicide, etc.) among young adults

(Related to:)

• High rates of unemployment
• Low education levels in the working population

What are the etiology of the problem: Increase in health problems associated with air pollution (e.g., exacerbation of asthma, COPD, and other respiratory conditions)

(Related to:)

• Increased environmental air pollution

• Lack of knowledge regarding personal action required during air pollution advisories.

What are the s/s of the problem Potential for increased mental health problems (e.g., alcohol and substance abuse, domestic violence, suicide, etc.) among young adults

• Increased demand for free counselling services at local clinic

• Increase in the number of families on social assistance

• Increase in demand on charities for free food and clothing

What are the s/s of the problem High infant and childhood morbidity from chickenpox

• Two times higher incidence rates for all childhood communicable diseases

• Three times higher incidence rate for chickenpox in the past year

• Low rates of immunization coverage in children under two years of age

What are the s/s of the problem Increase in health problems associated with air pollution (e.g., exacerbation of asthma, COPD, and other respiratory conditions)

• API indices reflecting increased pollution levels

• Increase in hospital admissions and A & E visits on days with increased API levels

• Community members’ concern on increased API levels and deteriorating respiratory conditions