Transcript Program Evaluation

Overview of Community
Assessment
CHSC 433
Module 2/Chapter 4
UIC School of Public Health
L. Michele Issel, PhD, RN
Learning Objectives
What you ought to be able to do by the end of this module:
1.
2.
3.
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.
Assessment is…
the procedures used to collect data
that describes the needs and
strengths of a specific
community, population, or
neighborhood.
Purpose of
Needs Assessment
To guide and inform decisions
related to
program prioritization and
development
What to Assess


Levels or Units of Analysis are the
familiar groupings
Across the Pyramid of Services, as
developed and used by HRSA’s Bureau of
Maternal and Child Health. Directs
attention to services that correspond to
the Levels
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
Populations=the total set of individuals
Assess Across the
Pyramid of Services
Direct
Health Care
Services
_____________________
Enabling Services
___________________________
Population-Based Services
___________________________________
Infrastructure Services
Assessment Types
Needs
Assessment:
Community
Assessment:
means by which to
determine the gaps, lacks,
and wants relative to a
defined population and a
defined, specific health
problem
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
Perspectives on Needs
Assessment

Epidemiological

Social Science

Public Health

Asset
Comparison of
Perspectives
Population
assessed
Data sources
Public Health
Models
States and
Communities
All available
Examples
APEXPH, PATCH
Types of needs
assessed
Normative and
relative needs can be
estimated
Advantages
Administratively
sound. Includes
focus on constituent
concerns.
Relies on other data
sources. Perceived
needs not directly
determined.
Disadvantages
Epidemiology Models
Social Science Models
Asset Models
Populations
Populations, selected
aggregates
National probability
sample surveys
Community,
neighborhoods
Qualitative,
observational
US Census
Focus groups
Relative need can be
estimated, perceived
need is directly
determined
Statistically sound,
provides information on
contributing factors to
health problem
Does not directly
measure extent of health
problem
Existing
resources are
identified
Registries, national
probability sample surveys,
existing national databases
National Health Interview
Survey (NHIS), Health Care
Utilization Profile (HCUP)
Normative, expressed, and
relative needs can be
estimated
Statistically sound and
generalizable findings
No information on perceived
needs. Local variations may
not be captures or described.
Does not
measure the
extent of health
problem
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
Community Level
Elements for Assessment
 People
 Place
 Interactions
People ~ Population
Assess, study, understand:

Values, belief, attitudes

Behaviors, lifestyle patterns

Demographic characteristics

Health and well-being status
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.
Interactions~ Social system
Assess, study, understand:

Communication style, language

Political system and preferences

Recreation and arts

Religion, Culture

Family patterns
Key Types of Needs

Expressed

Normative

Perceived

Relative
(Bradshaw, 1972)
Expressed Need
What people
demonstrate as a lack through services
utilization
Expressed Need Measures


Number of visits for child burn
injuries (need for safety)
Number of hospital admissions for
whooping cough (need for
immunization)
Normative Need


The extent to which the current
status is not at the level
recommended by experts
Lack based on comparison to health
standards
Normative Need Measures


Rates of prematurity higher than
national average
Rate of deaths from breast cancer
higher than Healthy People 2010
objective
Perceived Need


What those asked say is their need
or what they are lacking
The needs according to the
perception of those being asked
Perceived Need Measures



“We need a swimming pool, not another
clinic.”
“We don’t have enough good fresh
vegetables in our stores.”
“Our children are dying from violence on
the streets. We need jobs for our youth.”
Relative Need

The extent to which one group is
lacking in comparison to another
group
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
Assessment Data Sources

Archival data

Public data



Primary data collection, i.e., surveys,
interviews
Providers of health care
Proprietary data, i.e., insurance
claims
Data Sources (continued)
Case studies
 Unobtrusive or non-reactive
measures, i.e. watching people, looking
in garbage cans
 Published literature

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.”
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.
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.
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.
Statistical methods
 Descriptive and inferential statistics
 Rate and proportions
 Population parameters (CI)
 Tests of differences
 Tests of association
 Synthetic estimates
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
Diagnosis for Program Planning
Problem 
Risk of: Health Problem
Program  Evaluation
Program
Goal
Among: Group Population Targets
Recipients
Related to Characteristics
(Determinants):
Interventions
Secondary to Heredity, Lifestyle Interventions
(direct and indirect Environment
contributing factors) :
As Demonstrated in: Health indicators
Program
Objectives
Outcome
Sample
Impact
Intervening
variables
Impact
variables