CommunityHealthNeedsAssessmentAGuideforHealthcareProfessionals

2011

ExecutiveMastersofPublicHealthClassof2012UniversityofSouthernMississippi

July292011

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Table of Contents 

 

Contributors...............................................................................................................................................................4

AboutthisGuide........................................................................................................................................................5

Purpose....................................................................................................................................................................5

HowtoUseThisGuide......................................................................................................................................5

WhatisaCommunityHealthNeedsAssessment?.....................................................................................5

RegulatoryRequirements.....................................................................................................................................6

Overview.................................................................................................................................................................6

FederalRequirements.......................................................................................................................................6

GettingStarted...........................................................................................................................................................7

CommunityConstituents..................................................................................................................................7

Methodology..........................................................................................................................................................8

DesigningandImplementingtheAssessment.............................................................................................8

PrimaryData..........................................................................................................................................................8

SecondaryData..................................................................................................................................................14

AnalyzingtheInformationCollected............................................................................................................15

Manually...............................................................................................................................................................15

Computerized.....................................................................................................................................................15

TheNextStep.....................................................................................................................................................16

PreparingandSharingtheReport.................................................................................................................16

DescribetheNeedsAssessmentProcessinDetail.............................................................................16

IdentifytheHealthStatusandNeedsoftheCommunity................................................................17

ReviewtheInformationCollected.............................................................................................................17

ListtheIdentifiedHealthPriorities..........................................................................................................17

IdentifyCurrentandNeededHealthcareServices.............................................................................17

IdentifyNecessaryTraining.........................................................................................................................17

SharetheFinalNeedsAssessmentFindingswiththeCommunity.............................................17

Appendices...............................................................................................................................................................18

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AppendixA..........................................................................................................................................................18

AppendixB..........................................................................................................................................................19

AppendixC...........................................................................................................................................................20

AppendixD..........................................................................................................................................................21

AppendixE...........................................................................................................................................................22

AppendixF...........................................................................................................................................................23

AppendixG..........................................................................................................................................................24

AppendixH..........................................................................................................................................................26

AppendixI............................................................................................................................................................27

Resources..................................................................................................................................................................29

AdditionalWebsitesReviewed...................................................................................................................30

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Contributors 

GwendolynBall,B.S.N.

CatherineBest,B.S.

PhyllisBowen,B.S,OTR/L

JophaCampbell,M.D.,CLS,CLDir(ASCP)

CorneliaCoburn,B.S.N.

JamesKevinDavisII,B.S.

AnthonyFox,MS‐PCMHT

ElizabethA.Jones,B.S.

DenaR.Karr,B.S.,RRT

RolandaMills,B.S.

KennethToddMowat,M.B.A.

JanaM.Osbey,B.S.

JamesChristopherOubre,B.S.

AmandaSchoth,B.S.

EricaThompson,M.D.

SandraTyler,B.S.N.

DavidA.Williams,B.S.,CPA,FHFMA

 

 

 

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About this Guide 

Purpose 

Thisguideprovideshealthcareprofessionalsdetailsaboutplanning,designing,developing,and implementing a Community Health Needs Assessment (CHNA). The purpose of theguide is to help local stakeholders identify strengths, weakness, current health careofferings,andareas for improvementwithin theircommunity inorder to implementandsustainpolicy,system,andenvironmentalchangesaroundhealthylivingstrategies.

How to Use This Guide 

Thisguideisintendedtoprovideaframeworktoidentifyhealthcareneedsandcommunityservices that are currently not being met. The guide provides a proven systematicapproach to conducting a CHNA. Business owners, community leaders, healthcareproviders, and other stakeholders are the key to conducting a thorough assessment, asthese committee members are the driving force behind successful implementation ofidentifiedneeds. Youwillbe instructedonproperdatacollectionmethods,analysis,andreporting that will ensure the communication of relevant information that highlightscurrentcommunityneeds. Thoroughreviewof thisguideprior tobeginning theprocesswillinsuresuccessthrougheachstepoftheCommunityHealthNeedsAssessment.

What is a Community Health Needs Assessment? 

ACommunityHealthNeedsAssessmentisanintegralpieceofthecommunityhealthcareservices puzzle. A CHNA helps to identify health issues within a community, recognizethosewhohave the greatest need, ensure health care resources are available, andmakecertain those resources are used to their maximum benefit. A CHNA is important foradjustingcurrentservicesandvital for futureplanningandimplementationofhealthcareandpublichealthprogramstoaddresstheneedsofthecommunity.

SomeobjectivesofaCHNAcouldbe:

Identifythecommunitydemographicsandwhathealthproblemsthosegroupsarecurrentlyexperiencing

Helpallocateresourcestobestmeettheneedsofthecommunity Focusonthecauseoflocalhealthproblemswithagoaltoreduceoreliminatethem Identify all local organizations and resources currently available to address the

healthproblems Documentandcommunicatethehealthcaregoalstothecommunity

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Regulatory Requirements 

Overview 

Federal laws implemented through the Patient Protection and Accountable Care Act(PPACA)containedprovisionsrequiringcertainnon‐profitstoconductCommunityHealthNeedsAssessments.Section9007(a)ofPPACAstatesthatallhospitalsseekingexemptionfrom federal income tax and other tax benefits as 501(c)(3) must follow requirementscontained in thenewInternalRevenueCodeSection501(Code("Code")Section501(r).(Nilles&Meier,2010) At thedateof thispublication technicalprovisions related to thespecifics of this Code section have not been released by the Internal Revenue Service.Therefore, organizations should routinely review the IRS.gov website for the latestissuanceofregulations.

MississippiStateandLocalauthoritieshavetraditionallynotrequiredaseparatereportingofinformationcontainedinfederaldocumentsfornon‐profits.InarecentphoneinterviewconductedwithSecretaryofStateDelbertHosemann,itwaslearnedtheStateAgencyhasno immediate intentions of requiring non‐profits to file a copy of its Community HealthNeedsAssessment.(Hosemann,2011)

Federal Requirements(Nilles&Meier,2010)HospitalsarerequiredtoconductaCommunityHealthNeedsAssessmenteverythree(3)years and adopt an implementation tomeet the needs identified. The assessmentmustinclude:

Inputfromkeypeoplewhorepresentbroadinterestofthecommunitybeingservedby the Hospital. Individualswho have specialized knowledge or expertise in theareaofpublichealthispreferred.Itshouldbenotedthatpublichealthinformationmay be collected and may include information for one or more relatedorganizations.

The Community Health Needs Assessmentmust be made widely available to thepublic.

Adoptanimplementationstrategytomeettheneedsidentified. Reportonhowthehospitalisaddressingneedsthatarebeingmetasaresultofthe

assessment. Reportontheneedsidentifiedthatarenotbeingmetasaresultoftheassessment.

Thereportwillincludewhytheneedsarenotbeingmetwithreasonsforthegaps.

FailuretoMeetFederalStatutoryRequirements

In theeventanorganization fails to complete the requiredassessmentwitha threeyearreportingperiod,theInternalRevenueServicemaylevyafineofupto$50,000againsttheHospital.(Nilles&Meier,2010)

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The Internal Revenue Service has advised organizations that reporting of communityhealthneedsassessmentsunderPartV,SectionB(“PartV.B”)ofScheduleH,Hospitals,ofthe2010Form990,ReturnofOrganizationExempt from IncomeTax, isoptional for the2010 taxyear. Thishowever,doesnotaffect theeffectivedatesofsection501(r)oranyother provision added to the Code by section 9007 of the Affordable Care Act. (Service,2011)Thus,organizationsmustmoveforwardandtweakimplementationasclarificationoftheregulationsareissued.

Addendum

TheInternalRevenueService(IRS)hasdecidedtomaketheentirePartV.Boptionalforthe2010taxyeartogivethehospitalcommunitymoretimetofamiliarizeitselfwiththetypesofinformationtheIRSwillbecollectingrelatedtocompliancewithsection9007ofthePatientProtectionandAffordableCareAct(“AffordableCareAct”),Pub.L.No.111‐148,124Stat.119(March23,2010)andtoaddressanyambiguitiesarisingfromtheextensiverevisionsoftheformandinstructions.PartV.BincludesquestionsrelatedtotheadditionalrequirementsenactedbySection9007oftheAffordableCareAct, suchasquestions regardingahospital facility’s communityhealthneedsassessment(Lines1through7,optionalfortaxyearsbeginningonorbeforeMarch23,2012), ‐ [No longer optional after thisdate,March 23,2012] ‐ (IRS.Gov, Portion ofSectionHOptionalfor2010TaxYear)

Getting Started 

Community Constituents 

ThefirstphaseofaCommunityHealthNeedsAssessmentistoidentifyaCommunityHealthAssessmentTeamorCommunityConstituentTeamthatwill conduct thesurvey thatwillallowhealthcareproviderstounderstandthecurrenthealthcareenvironment.Thisteamshouldhaveabroadrepresentationofresidentsfromagenciesandorganizationsthathaveknowledgeof the community andarewilling to commit the timeandeffortnecessary tomaketheprocessasuccess.Thedevelopmentofthecommunityconstituentteaminvolvestheparticipationofawiderangeofkeycommunitymemberswhoreflectall facetsofthecommunity.Membersofthecommunityconstituentteammayincludeindividualsfromthelocalbusinessesandindustrywherethehealthcareorganizationislocated.Itisimportanttoincludecurrentandpreviouscommunityhealthcareproviders.Thisgroupmayincludedoctors,nurses,departmentheads,andadministratorsofthefacilitydevelopingtheCHNA,aswellasthosewhoworkforcompetitivehealthcaresystemsinthecommunity.Individuals involved in the education system should be included in your assessment.Includepeopleinvolvedinelementary,secondary,andhighereducation,inthepublicandprivatesector.Localgovernmentofficials,aswellasmembersofcivic,social,religious,andvolunteeragencies,suchastheMarchofDimes,theAmericanHeartAssociation,churches,

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andtheBoysandGirlsClub,canbehelpfulwithacommunityneedsassessment.Thiswillcreate a robust CHNAwhichwill be easier to implement. We also suggest surveying asmanyof the individuals inyourcommunityaspossible, takingprecautionstoensureyouareusinglocaldemographicstoremainunbiasedinyourresults.

Methodology 

Selectateamof8‐12peoplerepresentingconcernedcitizens,avarietyofserviceproviders,andothermembersofthecommunityatlarge,whichwillbechargedwith:

a. Oversight,design,andimplementationofaCHNAb. Reviewandprovideadviceonthebudget,includingfundingsourcesc. Developrealistictimelinesd. Collectinformatione. Establishcommunityrelationshipsf. Generate,prioritize,andselectapproachestoaddresscommunityhealth

needsThis team should also have a comprehensive understanding of the following ideas andconcepts:

a. Communitybasedservicesb. Communityownershipandcitizenparticipationc. Healthycommunitiesd. Existingconcerns,interests,andexpectationse. Howtoproperlyobtainandutilizerelevantinformationf. Prioritizationofhealthneedsandtheirunderlyingcauses

To obtain the previously stated goals, the team must ensure there is a sustainablecommunity infrastructure, i.e. adequate staffing, budget, policies, and leadershipcommitmenttosupporttheimplementationstrategy.

Designing and Implementing the Assessment 

Primary and secondarydatamust be gathered, reviewed, and analyzed so that themostaccurate information is available for your needs assessment, and subsequently, yourimplementationprocess.

Primary Data 

Primary data is that data that is collected by the assessment team. Primary data iscollected using telephone surveys, electronic surveys, interviews, or focus groups. Thisdataiscollecteddirectlyfromthecommunityandisthemostcurrentinformationavailabletoresearchers.PleaseseeAppendicesB‐Hforhelpfulprimarydatatools.

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Decideonthetypeofinformationyouwant

What typeofdata is relevantornecessary toachieve the team’sgoal? It is important toidentifybarriersthatcouldinhibitreformandchangestohealthcareinthecommunity.

Decideonthedatacollectionmethodsyouwilluse

Observation isadatacollectionmethod thatprovidescluesandconclusionsrelevant toaspecific site. Theyare relatively inexpensiveandefficientandcanbeconductedon foot.However, they provide only an overview of the community and unrecognized assets.Existingproblemsmayneedfurtherscrutiny.Videographycombinesphotographywithdialoguerepresentingapointofviewthatmaybedifferent from those who govern and make policy decisions while promoting criticaldialogue and knowledge about community issues. The drawbacks to videography areincreasedexpense,thenecessityofphotoreleaseforms,andthecomplexityinvolvedintheanalysisofthevolumeofinformation.FocusGroupsallowforthegatheringofinformationandopinionsfromsmallgroupsofninetotenpeoplewhoprovideinsightsthatmaynotemergeininterviews.Thismethodallowsthe interviewer to assess body language and commands the undivided attention of theparticipants. Disadvantages to this method are loss of anonymity and the difficulty inassemblinggroupsinruralareasandsmallcommunities.PostalSurveysareself‐completedquestionnaires,relativelyinexpensive,andarelesslikelyto be biased by the interviewer. This method is suitable only for short andstraightforwardassessments thatassumemoderate literacy. Responseratesprove tobelow.TelephoneSurveysutilizeastandardizedquestionnaireforcollectionofdatabytelephone.Missed data is less likely when surveying via telephone. This method is quick andinexpensiveanddoesnotrequirehighlevelofliteracy.Interferencefromthoseotherthanresponder may present a problem and questions that require a visual cue will beineffective.Face to Face Interviews allows flexibility in number and style of questions, whileminimizingmissed data. Thismethod allows direct observation andminimizes level ofliteracyrequirements.Web‐BasedSurveyssolicitresponsesbyelectronicmedium,suchastheInternetore‐mail.Electronic surveys represent a quick and inexpensive method of data collection andminimize social desirability biases. Set‐up costs tend to be higher. Thismethodprovesmore useful for large‐scale surveys and requires a higher level of literacy and computerskill.

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PlanningaSurvey

Surveysareareliablewaytolearnaboutandlearnfromagroupofpeople. Accordingtothebook,HowtoAskSurveyQuestions(Fink,1995),thedefinitionofasurveyis,“asystemfor collecting information to describe, compare, or explain knowledge, attitudes, andpracticesorbehavior.”Doingasurveyrequiresplanning—planningwhatyouwanttoask,howtoaskit,howmanypeople tosurvey,andhowtoreach them,bymail, inperson,orbytelephone. Will teammembersaskthequestionsonyoursurveyorwilltherespondents,thosecompletingthesurvey, complete thesurvey?Thisguideaddresses these issuesstep‐by‐step, so thatyoucanmakechoicesandinitiateasurveyassystematicallyaspossible.Although surveys are a great way of learning about a population, remember that theinformationyoulearnmaynotalwaysberepresentativeoftheviewsofthepopulationthatyou are trying to assess. The smaller the sample size the greater the chances that thefindingofthesurveywillnotaccuratelyreflecttheopinionsofthecommunity’spopulationat large. Thus, it is imperative that an adequate cross‐section of the community’spopulationisadministeredthesurvey.DevelopingaSurvey

Usually,thefirstissueinvolvesthesurveydesign.Whatissurveydesign?Itisthestructureofthesurveybasedonwhatyouaretryingtoaccomplish.Ifyouweretryingtodeterminethe difference an intervention makes, such as the impact of a prevention strategy oncondom use, you might have two groups. One group would take advantage of theprevention strategy (known as the intervention group) and one group would not (alsoknown as the control group). Youmight use a questionnaire to seewhat changes havetakenplaceintheuseofcondomsbetweenthetwogroups.Youmightalsouseastrategytomeasurewhatchangedintermsoftheuseofcondomsbysurveyingagroupofpeopleasapretest,delivering thepreventionstrategy, thensurveying themagainafterwardtoseewhatchanged.Wheredowestart?

First,chooseamongthefollowingthreeoptions,andthengoontothe“Howtoasktherightquestions”SectionthatfollowsOption3.Option1:Establishasetofquestionsfromyourexperienceandknowledge.Brainstorm, compile a list of questions, and submit them to a review process. Anyquestions that you believewill not contribute to the goal of your assessment should beremoved from the survey. Questions canbemerged to eliminate redundancy as long astheydonotbecometoocomplicated.

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Option2:Developquestions.Onethingtokeepinmindaboutanymethodofgatheringinformation:noonewillgiveyouanswerstoquestionsyoudonotask.Focusgroups,interviewsandobservationscangiveyou an abundance of information and can help you define new categories of questions.Thesecategoriescanthenbeusedinaquestionnairetobeansweredbythosebeyondthegroupsofpeopleyouinterviewed.Takecaretodevelopquestionsthatdonotcontainbiastowardyourorganization.Option3:UsingexistingquestionnairesInsomesituations,youmaybeabletousequestionsfromexistingsurveys.ThequestionsfrominstrumentsdevelopedbyinstitutionssuchastheCentersforDiseaseControlortheNational Institutes of Health have been carefully researched and validated and cansometimes be of use to you. Be careful, however, to use the questions as they areintended—in the same way that the original authors did. Also, remember that theinterpretationoftheresponsesmaynotbethesameinyourpopulationastheywereintheoriginalpopulation.Howtoasktherightquestions:Open‐Endedvs.Close‐Ended

Onceyouhavedecidedwhattoask,howdoyouaskthequestionsinthebestpossibleway?First,youcangivetherespondentsalistofanswersfromwhichtochoose.Anotheroptionis toask themwhat they thinkaboutsomethingbygiving themchoices fromascale; forexample,stronglyagree,agree,disagree,orstronglydisagreetoastatement.Bothoftheseoptions assume that you want to know about very specific things and allow therespondents to give very specific answers. These types of questions also allow you tocompare the many responses you get in a more standardized way. The questions areconsideredclosedsincetheanswersarelimitedtocertainresponses.Another option is to askmore open questions. You can ask how old someone is or askhim/hertogivehis/heropiniononsomething.Thesequestionscanrevealmorethantheclosed questions, but they have onemain drawback in a survey—the respondent has towritealotor,ifsomeonewillbeaskingthequestionsverbally,theinterviewerwillhavetowrite a lot to capture everything said.These types of questions can bemore difficult tocompareacrossrespondents,unlesstheyarecarefullycoded(categorized)intothemes.

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Thefollowingareexamplesofeachoftheoptionsdescribedabove.

1. Which drugs have you used in the last six months (check all that apply)?         □ Marijuana     □ Heroin     □ Cocaine     □ Ecstasy     □ Methamphetamines  2. Use this scale to answer the following question:  

Strongly Disagree  Disagree  Agree    Strongly Agree 

         1          2        3              4 

Circle only one. 

Obesity is a problem in this neighborhood      1         2         3        4 

3. How many times have you checked your blood pressure in the last six months? __________ 

4. What do you think keeps you from losing weight? __________________________________________________________________________________________________________________________________________ 

 Questions 1 and 2 above are closed;  

Questions 3 and 4 are open.  

Let’s look at each type of question and some issues around each one. Closedquestionwithchoices(Question1)Thistypeofquestioniseasytoanswer;therespondentonlyhastochoosebycheckingtheanswers.The cautionwith this typeofquestion is somethingwebroughtup earlier—noonewilltellyouwhatyoudonotaskabout.Closedquestionmeasuringattitudeorbelief(Question2)Settingupascale like theoneabove(calleda “LikertScale”) isonewaytoassessbeliefsandgivestherespondentseveraloptions.Youcanalsochoosetohavethemanswer‘Yes’or‘No’ asanalternative.What isnot included in thisquestion isa “neutral” answer,or “noopinion,”bothofwhichyoucanadd.Togivethemamoreneutraloption,youcanmakethescalefrom1‐5,with3determinedtobethe“noopinion”option.Anotherwayofdoingthescale is touse letters insteadofnumbers; forexample, ‘SA’ insteadof ‘1’means ‘StronglyAgree.’

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OpenQuestionwithShortAnswer(Question3)This typeofquestion canprovide specific informationwithminimalwriting. If the exactnumberisnotrelevant,youcandevelopcategorieswheretheysimplyhavetocheckwheretheyfall.Forexample,theycanchoosefromamong0‐4,5‐9,or10ormore.Ifyoudecidetogowithcategories fornumerical information,makesure that thechoicesdonotoverlap;e.g.,0‐5,5‐10,or10ormore.Ifnumbersoverlap,whichonedotheychoose?OpenQuestionwithLongAnswer(Question4)Although this typeof question can give you a lot of information, there are twopotentialproblems: (1) you can get too much information and (2) too many of these types ofquestion can lead to distraction and weariness. Ideally, you would keep these types ofquestionstoaminimumand,inself‐administeredquestionnaires,wouldputthemascloseas possible to the beginning or space them out throughout the questionnaire. Anotherpotentialproblemisthatrespondentsmayfeelasiftheyarerequiredtofillinallthespaceavailabletothem.Thismayleadtorambling,unfocusedresponses.Somegeneralguidelineswhendevelopingquestionsforaquestionnaire

The guidelines below are helpful tips that can make your questionnaire easier forrespondents to complete, andcanhelpensure thatyouget thekindof answers thatyouwant.Remembertoalwayspilottestyoursurveyonmembersofyourstafforotherssothatyoucanseehowwellthequestionnaireworksbeforeyoubegingivingitouttoyourtargetpopulation.TheBasics:

Bespecificinyourquestions;avoidambiguity. Usecompletesentencesinphrasingyourquestions. Avoidabbreviations. Askonlyrelevantquestions.Ifyouwanttoknowaboutcondoms,donotaskabout

hobbies. Donotcombineissues.Forexample,donotask,“Doyouhaveaproblemwithdrugs

andusingcondoms?”Thisshouldbetwoseparatequestions. Use language thequestionnaire takerswillunderstand.Thisoftenmeansavoiding

technicalterms,andbeingcarefulwithslang.Testoutthequestionswithpotentialrespondents. Also, check the reading level—will your participants be able tounderstandthequestionsyouareasking?

Keepitshort.Fifteentotwentyminutesisideal;thirtyminutesispushingthelimit. Inmostcases,itisbesttouseshortquestions.Thishelpskeepthesurveyshortand

helpsparticipantsunderstandthequestionsbetter.

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CommonPitfalls:

Avoidnegativequestions.“Shouldpeoplenotpracticeunsafesexinordertonotgeta disease?” is a negative question. It’s often very difficult to assess what’s beingasked.

Avoidquestionswithbias.“Whatisyouropinionofdiabeticswhorefusetogetanyhelp?”isanexampleofabiasedquestion.Becarefulofleadingquestions.Aleadingquestionisaquestionthatmakesitmorelikelythatarespondentwillgivetheanswerthattheinterviewerwants:forinstance,“Don’tyouthinkthatthisareadeservesbetterhealthcareaccess?”or“Soyoubelievethatinjectingdrugsisbad?”

Developoradaptdatacollectiontools

How should the tools look for your particular community?Do you have a high illiteracyrate? Is there a largepopulation of seniorAmericans? If so, howdo you overcome thechallengeandmaintaintheintegrityoftheresearch?

Organizeandcarryoutthedatacollection

Will there be a schedule of mailings? Follow‐up mailings? Abstractly, what should thetimeframebeforallcommunications(discussiongroups,surveys,etc.)?

Secondary Data 

Secondarydataisthatdatathatiscollectedfromsourcesotherthantheassessmentteamandtheirsurveys.GoodsourcesforsecondarydatacollectionforahealthneedsassessmentaretheCentersforDiseaseControl,theStateDepartmentofHealth,ortheCensusBureau.Thisinformationhasalreadybeencollected,collated,andanalyzedandprovidesanaccuratelookattheoverallstatusofyourcommunity.AppendixAandtheExceltoolshavelinkstokeysecondarydatagatheringsources,sotheyarenotdiscussedindetailinthebodyofthisguide.

Secondarydatamightinclude:

Demographicdataaboutthetargetarea Familyincome Insurance/payermixofthepopulation Employment Employers Vitalstatisticsbyvariousindicators Healthstatusbyvariousindicators Healthcareprovidersinthearea

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Analyzing the Information Collected 

ProperanalysisofthedatacollectedwillensurearobustCommunityHealthPlan.Howyouanalysis this data is based on your method of collection and what resources you haveavailable. Someexamplesyouneed toconsider includecalculating the ratesof illnesses,birthsanddeaths,useofcurrentlyavailableservices,etc.Manycompaniescanbehiredtosupport your surveying efforts. They can provide the results of the survey in an Excelspreadsheet format,which can be used to sort and compare data. Somemay also offergraphsandcharts that canbeused tovisually identify theareasofneed. Allof thedatadevelopedneedstobecomparedagainstnationalandregionalrates. Somecommunitiesmay also find it helpful to compare various sub sectors within their own community.Communicating your finds to all shareholders in your community will result in greateradoptionandagreementwithyourhealthplan.

Manually  

If no one on the team can type or has access to a computer, you will have to rely onhandwrittenfieldnotesandobservations.Ifyouhaveacopier,makeatleasttwocopiesofthenotes. First,thinkofbroadcategories. Forinterviews,youcancutuptheanswerstothequestionsyouaskedandput them in separate stacksor folders,usingone folder foreach interview question. Keep adding to the folder as you domore interviews. Besidesorganizing the interviewdatabyquestions,othercategorychoicesarecalled themes.Forexample,cancertypecanbeatheme. Youcancreatea folderforcancertypeandcutoutanyparagraphsrelatedtothistopic.Youmaywanttomakeadditionalcopiesofyournotesandobservationssothatyoucantakethesameparagraphandputitintoseveralrelevantfolders.

Computerized 

Type up each set of interview, observation, and focus group notes and store each as aseparatefile.Putanyidentifyinginformationatthetopofthepage,forexample,thedate;the type of encounter (interview, observation, focus group); the participant(s) (using acode number or false name for each to protect confidentiality); information about thesetting,ifrelevant;andwhichresearcherconductedtheobservationorinterview.Discusswhatcategoriesareneeded.Onesetofcategoriescanbealloftheanswerstoeachinterview question. Set up a different document file for each question (i.e., have adocument called Question 1, another called Question 2, etc.), then copy and paste theanswers between themain document and the questions documents. Use the “Window”optionatthetoptomovebetweendocuments.(Howmanydocumentscanbeopenatonetime depends upon your computer and/orword processing software.) Always leave theoriginaldocumentintact.Youcanlinkthequotetotheoriginaldocumentbyaddingacodeorfalsenametothebeginningorendoftheparagraphbeforeorafteryoucopyittopaste.Many software programs are available that can assist in the collection, analysis, andinterpretationofdata. Theseprogramscancategorizeandstoreinterviewresponsesandmaintainadatabaseofyourprimarydata.

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The Next Step  

Onceyouhavefinishedtheassessment,itistimetoaskyourself,“Howdoesallofthisaffectwhatwearedoingnow?Howcanwechangeourprogramtotakeintoconsiderationwhatwehavelearned?”If you have completed a lot of activities, interviews, and observations, the amount ofinformationyougeneratecanbeoverwhelming.Thekeyistosetasideagoodamountoftime to process the information. Begin by brainstorming the important points thatemerged from the process. Use large sheets of paper and make lists of the things youlearned that emerged from the process. When the list is completed, follow a generaldiscussionwitharankingexercise,similartotheonedescribedinthe“Howtoasktherightquestions”sectionof thisguide. Alloweach teammember10pointswithwhich to ranktheir top choices formost important question. Rank the information by the number ofpointsassignedtoit.Donotthrowanythingout;justputthemintheorderofimportance.Return to the categories you created and discuss the information collected in theinterviews or observations. Does a concern, barrier, or attitude seem significant to you?Start a new list of what information comes from the exploratory process. Repeat therankingexercisethatyoudidwiththeteam’soriginalimpressions.Lastly, discusswhat youhave. The informationmay confirm thatwhat you aredoing iscorrect and there is noneed to change theprogram. Likely, some grounds for adaptingyourprogramwillbecomeapparentintheprocess.Atthatpoint,youcanchoosetopursueresources to adapt your currentprogram. Youmay also choose to do a survey to see ifsome of these points your team has identified are widespread enough to warrant aprogrammaticchange.

Preparing and Sharing the Report  

SevenStepstoSharingandPreparingtheFinalReportStep1:DescribetheneedsassessmentprocessindetailStep2:IdentifythehealthstatusandneedsofthecommunityStep3:ReviewtheinformationcollectedStep4:ListtheidentifiedhealthprioritiesStep5:IdentifycurrentandneededhealthcareservicesStep6:IdentifynecessarytrainingStep7:Sharefinalneedsassessmentfindingswiththecommunity

Describe the Needs Assessment Process in Detail 

Adetailed description of the assessment, including its purpose, data collectionmethods,andpreparationofthefinalreportshouldbeincludedintheCHNA.Allparticipantsintheassessmentshouldbedescribedcompletely,i.e.,diabeticpatientsfromJonesCountyundertheageof65.Toolsfordatacollectionaswellasnotedresourcesshouldalsobeincluded.Besuretonoteanylimitationsinthisprocessesortoolsusedthroughouttheassessment.

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Identify the Health Status and Needs of the Community 

Describethecommunityusingdemographicssuchasage,race,incomelevel,andeducationlevel.Identifylocalcommunity,religious,andhealthcarebasedresources.Itisimportanttoidentifyotherhealthcareresourcesincludinglocalstaterunfacilities,charitableefforts,visitinghealthprofessionals,andsupportgroups.

Review the Information Collected 

Review and summarize the information collected and state your conclusions about thestatusofyourcommunityhealthneeds.SharetheCHNAfindingswithcommunityleaderstoallowquestionsandclarificationofdata.SharetheCHNAfindingswiththecommunitywhen the team and community leaders have agreed upon the conclusions andrecommendations of the assessment. It is important to use charts, graphs, themes, andobjectiveswhensharinginformationwiththecommunityanditsleaders.

List the Identified Health Priorities 

Describe all health priorities as identified by the importance placed on the issue by thesurveyrespondents.Determinetheimpactoftheidentifiedissuesonthecommunity.Itisalso important to discuss the ability of the community and its resources to provideidentifiedservicespriortotheimplementationofnewprograms.

Identify Current and Needed Healthcare Services 

Onceneedshavebeen identified, services canbeprioritizedbasedon the currenthealthstatus of the community. List those services that are currently available to communitymembersandidentifyadditionalservicesthatareneededthroughoutthearea.

Identify Necessary Training 

Identifypersonnelrequirementspriortoimplementingneworadjustingcurrentservices.Itisimportanttoestablishthenumberofpersonnel,thetypesoftraining,andthelengthoftrainingsessionsrequiredforadditionsorchangesrelatedtotheneedsassessment.Makesure to discuss any training or in‐service education thatmight be necessary for currentpersonnelwhowillbeprovidingnewservices.

Share the Final Needs Assessment Findings with the Community 

Sharetheresultsoftheneedsassessmentwiththecommunitymembers.TheCHNAshouldbe presented in language that in easily understood by everyone. Present the findingthroughacommunitynewsletter, “townhall”meeting,orsocialevent. Allowcommunitymemberstheopportunitytoreviewtheinformationandoffercommentstothepreparers.

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Appendices 

Appendix A 

IncludedareInternetresourcesforsecondarydata.

TheUnitedStatesCensusBureau http://www.census.gov

o USCBStateandCountyData http://www.census.gov/did/www/saipe/county.html

TheCentersforDiseaseControlandPrevention

http://www.cdc.govo CDCDiseaseConditions

http://www.cdc.gov/DiseasesConditions/

TheMississippiStateDepartmentofHealth http://www.msdh.state.ms.us/

o MSHDCountyHealthStatistics http://msdh.ms.gov/msdhsite/_static/31,0,211.html

o MSHDStateVitalStatistics http://msdh.ms.gov/phs/2009/Bulletin/vr2009.pdf.

AgencyforHealthcareResearchandQuality

http://ahrq.hhs.gov/data/dataresources.htm

USDepartmentofHealthandHumanServices http://www.data.gov/health

19

Appendix B 

Sample Survey Spreadsheet from the Center for Disease Control website.    Community‐At‐Large Link:    Excel: tool‐calsector.xls       PDF: changetoolCAL.pdf  

20

 

Appendix C 

Sample Survey from survey company Survey Monkey   

21

Appendix D 

Sample of Survey Analysis available from survey company Survey Monkey  

22

Appendix E 

Meeting Agenda Template for a Community Health Assessment Team (CHAT) or Community 

Constituents Team (CCT) 

Community Health Needs Assessment Meeting

CHNA Meeting Agenda Time:  Location:  Called by:   I. Attendees               

 PresentY / N  

PresentY / N

1     8    

2     9    

3     10    

4     11    

5     12    

6     13    

7     14    

 II. Agenda Topics  

1.  2.  3.  

 III. Goals  

1.  2.  3.  

 IV. Assignments  

1.  2.  3.  

 V. Next Meeting Date: ________________________  

23

Appendix F 

Sample CHNA Cover Letter for Postal Survey (Organizational Logo if applicable) 

(Healthcare Institution Name) (Physical Address) 

(City), (State) (Zip Code)  

(Date)   (Name of County) County Resident (Recipient Street Address) (City), (State) (Zip Code)   Dear (Name of County) County Resident,  As the Director of Community Healthcare for (Healthcare Institution Name), I have been tasked with creating a Community Healthcare Needs Assessment for (Name of County).  As a resident of (Name of County) County, you have first hand knowledge of the concerns and issues facing the people of our county.  Knowing how people view the healthcare in our county; the current strengths and areas of need as well as where the residents would like the healthcare service and areas of focus for our county in the future, is vital to those who make decisions concerning the programs and services that are available.  You are one of a small number of people who are being asked to give their opinion about the current situation in (Name of County) County and your vision of the future.  Your name was drawn randomly from a list of all registered voters in (Name of County) County and is now identified only by (Recipient ID #).  To confirm the results of this survey truly represent the thinking of the people of (Name of County) County, it is important that you fully complete the enclosed questionnaire and return it in the envelope provided.  You may be assured of complete confidentiality.  The questionnaire has the identification number for mailing purposes only.  This is so that we may check your identification number off the mailing list when your questionnaire is returned.  Your name will never be placed on the questionnaire.  No individual responses will be reported.  As proof of this, a summary of the results will be mailed to you when completed.  If you have any questions about this survey, please contact me directly at (Director’s Phone #).  Thank you very much for your help in ensuring the healthcare needs of all of our county residents will be met, today and for years to come.    Sincerely,    John Smith Director of Community Healthcare for (Healthcare Institution Name)   

24

Appendix G 

Sample CHNA Phone Script for Telephone Survey  Hello.  My name is ________.  May I speak to Ms/Mr/Mrs________.  If Yes: Hi Ms/Mr/Mrs _____________. I am calling from (Name of Survey Company).  We have been hired by (Healthcare Institute) to conduct a survey which will be the basis of a Community Health Needs Assessment.  Your participation in the survey is voluntary and all information collected will be kept confidential and will never be matched to you.  The only way to ensure the healthcare needs of our community are met is to get insight directly from the residents.  Are you willing to participate in the 5 minute phone survey with me now?  

If Yes: Great.  Let’s get started. (Insert survey questions here). If No: Is there a more convenient time for me to contact you? 

 If Yes: (Get the time and date and reschedule call) If No: I understand there are many reasons someone might not want to participate in a phone survey.  Can I answer any questions or concerns you might have, which would allow you to reconsider?   

 If Yes: (Reference FAQ document and attempt to complete survey after answering the questions). If No: Ok.  Thank you for your time and if you reconsider and want to participate, please contact our office at (# for Survey Call Center) 

 If No (Person is Not Here): Ok, thank you. We will call back. (Enter Call Back Code)  If No (Person Does Not Live Here): Thank you for the time. (Enter Refusal Code – Don’t Call Back)  If No (Refuse to Pass the Phone On): Thank you for the time. (Enter Refusal Code – Don’t Call Back)  

25

Appendix G (Continued) 

Sample CHNA Phone Script for Telephone Survey  

If connected to A Voice‐mail or Message Machine: Hello.  I am calling from (Name of Survey Company).  We have been hired by (Healthcare Institute) to conduct a survey which will be the basis of a Community Health Needs Assessment.  Your participation in the survey is voluntary and all information collected will be kept confidential and will never be matched to you.  The only way to ensure the healthcare needs of our community are met is to get insight directly from the residents.  We will attempt to contact you later to participate.  If you have questions about the survey or you would like to participate at a time which is convenient for you, you can call (Name of Survey Company) at (toll‐free number).  Have a good day.  (Enter Call Back Code). 

26

Appendix H  

Sample CHNA survey via E‐mail from survey company Survey Monkey   We are conducting a survey, and your response would be appreciated.  This survey is being conducted by Survey Monkey for (Healthcare Institute).  You have been selected due to your knowledge of the healthcare needs in our community.  Your responses will be held in complete confidentiality.  No individual responses will be included in the report.  A copy of the completed survey will be made available to you.     Here is a link to the survey: (https://www.surveymonkey.com/s.aspx?sm=n_2bE2SzZk6fwhYnEjexDk_2fg_3d_3d )  This link is uniquely tied to this survey and your email address. Please do not forward this message.  Thank you for your participation!    Michael Jones, FACHE CEO (Healthcare Institute)  Please note: If you do not wish to receive further emails from us, please click the link below, and you will be automatically removed from our mailing list. (https://www.surveymonkey.com/optout.aspx?sm=n_2bE2SzZk6fwhYnEjexDk_2fg_3d_3d)  

27

Appendix I 

Instructions to use survey company Survey Monkey 1. Go to Survey Monkey at http://www.surveymonkey.com/ 2. Next you can choose the plan that meets your needs for this survey (See Below):

Prices as of 7/26/11

3. You will create a Username, password, and email address. This way you can log back in and make changes and evaluate the feedback to Survey Monkey.

4. Now you can start to the process by clicking the button in the upper right corner.

5. You can create a new survey by filling in the Title and selecting a category (See Below):

28

Appendix I (Continued) 6. Now click the button at the bottom. 7. Next pick a theme from the list or create a custom theme.

8. Click on the Edit Page Options and then on Edit Page Information. You can then fill out

the Page Title and the description and purpose of the page:

9. After saving the page you will be brought back to the survey so you will click on .

10. You will have to select a type of question for the survey you are building:

11. Now you can select a display format, add the question you want, and the answer choices.

This will continue until you have all the questions you want in your survey. 12. When you are done you can preview the survey or you can send the survey. To send the

survey you should choose Email on the next page. This will allow you to build or use an existing email group. You can even import your email list from another source.  

13. When responses are collected, you can click on analyze. This will show the data or download the data into Excel for further analysis. The program will create charts from data collected  

29

Resources 

Canada.CommunityHealthNeedsAssessment:AGuideforFirstNationsandInuitHealthAuthorities.,2000.Print.

CenterforHealthPolicy,PlanningandResearch,ACommunityHealthAssessment.MiddlesexHealthSystem,UniversityofNewEngland,9April2008.Web.10June2011.<http://middlesexhospital.org/files/dmfile/healthassessment2.pdf>.

CentersforDiseaseControlandPrevention.CommunityHealthAssessmentaNdGroupEvaluation(CHANGE)ActionGuide:BuildingaFoundationofKnowledgetoPrioritizeCommunityNeeds.Atlanta:U.S.DepartmentofHealthandHumanServices,2010.

Fink,Arlene.Howtoasksurveyquestions.SagePublications,Inc,1995.Print.

Hensey,MPH,Edna,DebiNelson,MAEd,RHEd,andKimAngelone‐Gaetz,MSPH."CommunityHealthAssessmentGuideBook."NorthCarolinaPublicHealth.NCDepartmentofHealthandHumanServices,December2010.Web.10June2011.<http://www.healthycarolinians.org/library/pdf/CHA_Guide_Book1‐2011.pdf>.

Hosemann,Delbert.PersonalInterview.10June2011.10June2011.

Kent,Raymond."PrimaryResearch."MarketResearchinAction,n.d.Web.10June2011.<http://www.learnmarketing.net/primaryresearch.htm>.

ManitobaHealth.(2009).CommunityHealthNeedsAssessmentGuidelines

Nilles,Kathleen,andTellyMeier."NewTaxExemptionRequirementsforNonprofitHospitalsUnderPPACA."CommunityBenefitDocuments.VHA,10June2011.Web.10June2011.<https://www.vha.com/AboutVHA/CommunityBenefit/Documents/AppendixII_HospitalRequirementsPPACA.pdf>.

"PlanningASurvey."UniversityofTexasSouthwesternMedicalCenteratDallas,n.d.Web.10June2011.<http://www.utsouthwestern.edu/vgn/images/portal/cit_56417/20/28/205319Planning_A_Survery.pdf>.

UnitedStates.Notice2011‐52;NoticeandRequestforCommentsRegardingtheCommunityHealthNeedsAssessmentRequirementsforTax‐ExemptHospitals.Washington,D.C.:IRS,2011.Print.

30

Additional Websites Reviewed 

http://www.healthycarolinians.org/library/pdf/CHA_Guide_Book1-2011.pdf

www.cdc.gov

http://www.cdc.gov/healthycommunitiesprogram

www.cdc.gov/nchs/nhanes.htm

http://apps.nccd.cdc.gov/cdi/.

http://www.activelivingresearch.org/node/10650

http://www.mihealthtools.org/checklist/

http://ctb.ku.edu/en/tablecontents/sub_section_tools_1019.htm

http://ctb.ku.edu/en/tablecontents/sub_section_tools_1020.aspx

http://www.luc.edu/curl/pdfs/A_Community_Needs_Assessment_Guide_.pd

http://www.chssn.org/en/pdf/.../community%20assessment.pdf

http://www.hc-sc.gc.ca/fniah-spnia/pubs/services/_home-domicile/2000_comm_need-

besoin/index-eng.php

http://www.hc-sc.gc.ca/fniah-spnia/pubs/services/_home-domicile/handbook-guide_2/index-

eng.php#analyze

http://middlesexhospital.org/files/dmfile/healthassessment2.pdf

http://www.irs.gov/newsroom/article/0,,id=222814,00.html

https://www.vha.com/AboutVHA/CommunityBenefit/Documents/AppendixII_HospitalRequirementsPPACA.pdf

http://www.utsouthwestern.edu/vgn/images/portal/cit_56417/20/28/205319Planning_A_Survery.pdf

http://ohioline.osu.edu/b868/pdf/b868.pdf

http://www.health.state.mn.us/communityeng/needs/needs.html

31

http://www.cdc.gov/healthyyouth/evaluation/pdf/brief14.pdf

http://people.uwec.edu/piercech/researchmethods/data%20collection%20methods/data%20collection%20methods.htm

http://learningstore.uwex.edu/assets/pdfs/G3658-4.pdf

http://www.learnmarketing.net/primaryresearch.htm

http://www.u.arizona.edu/~kimmehea/purdue/421/observation.htm

http://www.surveymonkey.com/