Approaches to Community Health Assessment

What is a Community?

• Many definitions of community

• These may change according to specific circumstances

• Community as a specific geographic location

• Community as a social setting

• Community as a social structure

• Community as sentiment/affiliation

• Community as shared risk

• Varied nature of communities requires flexibility when assessing them

What do Communities Do?

• Production – distribution – consumption

• Socialization

• Social control

• Social participation

• Mutual support

Why Assess Communities?

• Essential first step in the process of health planning:

• To identify the health status of a community

• To provide a baseline to evaluate planned and potential interventions

• To identify factors that may be influencing health status– Both positive and negative

• To identify community resources

• To identify gaps and overlaps in existing resources

• To identify key stakeholders in the community

• To solicit the opinions of community members

• To engage community members in thinking about the health of their community

• To identify at-risk populations

How Can Communities be Assessed?

• Both comprehensive and focussed assessment approaches can be used

• Nursing and non-nursing models exist

Comprehensive Approaches - Nursing

Community as Client (Allender & Spradley, 2001)

Dimensions of the Community• Physical location

– Boundaries– Location of health services– Geographic features– Climate– Flora & fauna– Human-made environment

• Social system– Health– Family– Economic– Education– Religious– Welfare– Political– Recreation– Legal– Communication

• Population– Size– Density– Composition

• Population pyramid

– Rate of growth/decline– Social class & educational level– Mobility

Community as Partner (Vollman, Anderson & McFarlane, 2004)

• Community Assessment Wheel

• Community core– History– Demographics– Vital statistics

• 8 community subsystems– Physical environment– Education– Safety & transportation– Politics & government– Health & social services– Communication– Economics– Recreation

• Other nursing models exist as well

• These range from the ridiculous to the sublime

• Often ineffective attempts to move nursing models developed to work at the individual level to the aggregate level

• For example, model proposed by Kriegler & Harton

• Based on Gordon’s 11 functional health patterns– Health perception/health management– Nutritional metabolic– Elimination– Activity/exercise– Sleep/rest

– Cognitive/perceptual– Self perception/self-concept– Role relationship– Sexuality/reproductive– Coping/stress/tolerance– Value/belief

Comprehensive Approaches: Non-Nursing

Health Indicator Workbook: A Tool for Healthy Communities (BC Ministry of

Health, 1995)

• Six functions of a community (& a garden)

• Production– Examples of indicators:

• Percentage of families with low incomes• Average family income• Employment rate• Diversity of employers

• Consumption– Examples of indicators

• Cost of Agri-Food Canada Nutritious Food Basket• Cost of affordable housing• Affordable energy for home heating• Number of food banks• Percentage of population requiring food ade

• Maintenance of physical environment

• Management

• Growth & development

• Support

Manitoba Health (1997)

• Conceptual model based on Action Research

• Uses both ethnographic (interviews) and epidemiological data

• Iterative process where findings in 1 data set informs the research process in the other data set

• Feedback sessions– Informants & community are consulted to

determine if information is accurate/complete

• Assumption of this approach– Data necessary to determine health status

and health needs of a community comes from a variety of sources

• Deliberate effort to involve many community members; not just key informants

• Non-conventional sectors may be specifically approaches– Churches– Schools– Cultural groups– Social groups

• Manitoba Health’s conceptual model integrates some of these ideas

Winnipeg Regional Health Authority

• Conceptual model included in report

• Familiar components integrated into this model– Population health model– Action research

Problem Oriented Assessments

• Begins with identification of a specific problem

• Seeks information about it

• Identifies who requires a solution for the problem

• Assesses the community’s capacity to respond

Community Subsystem Assessment

• Focuses on one specific community subsystem

• How this subsystem is conceptualized influenced by how the whole community is defined and conceptualized– e.g.: Allender & Spradley– Vollman, Anderson & McFarlane

Community Assets Assessment

• Concerns that traditional approaches focussed on weaknesses, problems, deficits

“As a result, we know much about programming for a community’s problems and little about programming for its possibilities.”

• Impossible for a community to be helped or help itself if no strengths can be identified

• Forces a community to malign itself

“All you [researchers] ever do is focus on the negative things in our neighbourhood. When are you going to start seeing what’s right here?”

• Leads to fragmentation– Of services– Of efforts– Of community

• Reinforces view that only external experts can solve the problems

• Creates dependency on external funding

• Reinforces dependency

• The beauty of looking for strengths/assets is that, by virtue of the way that the community has been assessed, the actors needed to move to the next stage – program planning and community development – are already identified and mobilized

Community Assets Mapping

• Building communities from the inside out: A path toward finding and mobilizing a community’s assets. (Kretzmann & McKnight, 1993)

5 steps in the assets mapping process

1. Mapping assets

2. Building relationships

3. Information sharing

4. Convening the community to develop a vision & plan

5. Leveraging outside resources to support locally driven development

Community Quality of Life

• How to carry out a community quality of life project: A manual: A health promotion approach to understanding communities. (Raphael, Steinmetz & Renwick, 1998).

Principles

1. Adheres to WHO concepts of health & health promotion

2. Emphasizes social determinants of health

3. Uses quality of life model

4. Respects community & its members

5. Sees the world through the eyes and words of community members