Evidence-Based Public Health: A Course in Chronic Disease Prevention MODULE 2: Community Assessment Beth Baker Mar

1. Evidence-Based Public Health: A Course in Chronic Disease Prevention MODULE 2: Community Assessment Beth BakerMarch 2011

2. Learning Objectives: 1. Understand importance of conducting a community assessment. 2. Understand the types of data that are appropriate for assessing the needs and assets of the population/community of interest. 2

3. What is a community assessment? �A balance of studies and stories� Hancock and Minkler, 1997 3

4. Why? Provide insight into the community context Ensures that interventions will be designed, planned, and carried out in a way that maximizes benefit to the community Make decisions about where to focus resources and interventions Ensure that all members of the partnership have a common understanding of the issues 4

5. Why? Influence others in the community and command support and resources for your efforts Understand the kinds of things you want to track along the way in order to determine how your efforts are contributing to change. 5

6. How does it inform us? Tells us: The main health concerns in the community The main reasons for these health concerns The strengths/assets in the community Where we might want to intervene to create change 6

7. Ecological framework Individual � knowledge, beliefs, attitudes, skills Social � family, friends (social support and social networks) Governmental & Organizational policies Environmental � access to infrastructures & resources 7

8. Social conditions include, but are not limited to: economic inequality, urbanization, mobility, cultural values, attitudes and policies related to discrimination and intolerance on the basis of race, gender, and other differences. b Other conditions at the national level might include major sociopolitical shifts, such as recession, war, and governmental collapse. c The built environment includes transportation, water and sanitation, housing, and other dimensions of urban planning. FIGURE S-1 A guide to thinking about the determinants of population health. Social conditions include, but are not limited to: economic inequality, urbanization, mobility, cultural values, attitudes and policies related to discrimination and intolerance on the basis of race, gender, and other differences. b Other conditions at the national level might include major sociopolitical shifts, such as recession, war, and governmental collapse. c The built environment includes transportation, water and sanitation, housing, and other dimensions of urban planning. FIGURE S-1 A guide to thinking about the determinants of population health.

9. Local Health Center Hired a consultant to help them determine their focus areas moving forward. In particular they wanted to know the health needs of homeless St. Louis residents. The only data available as public use data was from the BRFSS, hospital records, MICA information The Health Center said this data was not helpful. What might be some of their concerns? Do these tell us about individual, social, or gov�t/organizational, environmental factors influencing health? 9 Phones, no BRFSS data, many who are sick do not utilize health clinics, says nothing about behaviors or resources in the community that help people make healthy choices..doesn�t reflect the kinds of activities people may do or the food they may eatPhones, no BRFSS data, many who are sick do not utilize health clinics, says nothing about behaviors or resources in the community that help people make healthy choices..doesn�t reflect the kinds of activities people may do or the food they may eat

10. Decide what you need to know See handout

11. Review existing data Morbidity/mortality Behavior Social indicator � particularly important as we move toward environmental and policy changes More on this in Quantifying the Issue 11 q������� Morbidity/mortality: There are numerous data systems available to evaluate the rates of morbidity (sickness) and mortality (deaths) within your community. To the extent possible, it may be useful to examine these data by race or income to better understand how social determinants could be influencing health disparities in your community. These data may be available through the Centers for Disease Control and Prevention website (www.cdc.gov). q������� Behavioral factors: Various groups in your community might have different rates of health-related/risk behaviors. Even if you wish to focus on the social determinants of health, it could be useful to also have information about health-related behaviors among different groups in your community. These data may be important in understanding the extent to which social determinants influence health behaviors and health outcomes. These data may be available through the Centers for Disease Control and Prevention (www.cdc.gov) and include the Behavioral Risk Factor Surveillance System (BRFSS), the Youth Risk Behavior Surveillance, and the Global Youth Tobacco Survey. Social indicator data: A number of data sources can give information on various social, economic, and environmental conditions in your community, including employment, education, housing, transportation, and parks and recreation. It may be useful to have a researcher or other partner familiar with how to access and work with such data (through Web sites or other sources) develop a table indicating the rates of various social determinants in your community as compared with the state as a whole or the nation (e.g., high school drop out rates, median income among various groups, percentage of population below poverty, unemployment rates, business census indicating the change in the number of grocery stores in your community). The benefit of these data is that they provide information about places or communities on a wide variety of indicators, rather than just individual-level information (e.g., area level unemployment rates or percent of families living below poverty). q������� Morbidity/mortality: There are numerous data systems available to evaluate the rates of morbidity (sickness) and mortality (deaths) within your community. To the extent possible, it may be useful to examine these data by race or income to better understand how social determinants could be influencing health disparities in your community. These data may be available through the Centers for Disease Control and Prevention website (www.cdc.gov). q������� Behavioral factors: Various groups in your community might have different rates of health-related/risk behaviors. Even if you wish to focus on the social determinants of health, it could be useful to also have information about health-related behaviors among different groups in your community. These data may be important in understanding the extent to which social determinants influence health behaviors and health outcomes. These data may be available through the Centers for Disease Control and Prevention (www.cdc.gov) and include the Behavioral Risk Factor Surveillance System (BRFSS), the Youth Risk Behavior Surveillance, and the Global Youth Tobacco Survey. Social indicator data: A number of data sources can give information on various social, economic, and environmental conditions in your community, including employment, education, housing, transportation, and parks and recreation. It may be useful to have a researcher or other partner familiar with how to access and work with such data (through Web sites or other sources) develop a table indicating the rates of various social determinants in your community as compared with the state as a whole or the nation (e.g., high school drop out rates, median income among various groups, percentage of population below poverty, unemployment rates, business census indicating the change in the number of grocery stores in your community). The benefit of these data is that they provide information about places or communities on a wide variety of indicators, rather than just individual-level information (e.g., area level unemployment rates or percent of families living below poverty).

12. Collect new data Survey � behavioral, organizational, partnership Record review � hospital records, housing records, community agencies, policies and their enforcement Observations Community audits Photovoice or photography Qualitative interviews (covered in Evaluation section) 12

13. Observations

14. Class Exercise Please take a few moments to observe what is around you�and write down what you observe 14

15. Tell me what you observed�

16. Photography and video clips Take photographs or video clips of things in the community that influence physical activity Can be done by researchers and community members 16

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19. Community Audits A tool to assist in documenting observations Type of food, quality of food, placement of food Grocery store Restaurant Social & physical structures supporting physical activity Sidewalks, trails, lighting, scenery, safety People walking, talking, fighting, gang and drug related activity 19

20. Community Audit Tool

23. Observations Level of detail Duration of observation People versus surrounding; behaviors versus environment Race/class/ethnicity Assumptions - family, friends, husband/wife Observations vs. interpretations Senses - sight, sound, smell, touch Awareness of our own biases and tendencies Did you tell people you were observing them? Did you participate? 23

24. Community Assessment Decide what to assess Decide the best method to collect the data to answer your questions Develop a work plan that identifies tasks to accomplish, partner roles and responsibilities, and a time frame for completion Organize information as it is collected so that it can be shared with all partners, community stakeholders, and community members. 24

25. Community Assessment Present information gathered and summarized from the community assessment back to partners Coalition/partnership Community forum Meetings with community groups Move to Action Planning � what do we do to create the desired changes? 25

26. The Planning Cycle 26