CHAPTER 3 Assessing Community Needs, Resources, and Readiness Building on Strengths CHRIS RISSEL NEIL BRACHT Assessing the Community Community analysis is the process of assessing and defining needs, possible barriers and opportunities, and resources involved in initiating community health action programs. This process is variously referred to in the literature as "community diagnosis," "community needs assessment," "health education planning," and "mapping." Analysis is a critical first step not only in shaping the design of project interventions but also in adapting implementation plans to unique community characteristics. It should define community strengths as well as potential problem areas. The product of community analysis is a dynamic community profile, blending quantitative health and illness statistics and demographic indicators with information on political and sociocultural factors. The profile includes a community's image of itself and its goals; its past history and recent civic changes; and its current resources, readiness, and capacity for health promotion activities. A review of previous (if any) community analyses and needs assessments is also important. The process of completing a comprehensive analysis of the community can also provide a unique opportunity for citizen involvement in a community health project. In genuinely empowering and participatory health projects, analysis is not done on the community but with the community. Through involvement in the study process, citizens and organizations can develop awareness and "ownership" of the program and build commitment to local action. Studies of communities can rarely be completed if local citizens do not cooperate. The level of interest in a new project can be an early indicator of community readiness. 59 60 ADVANCES IN THEORY AND PRACTICE Many communities may already have conducted some form of community analysis or general needs assessment. Typically, these broad community analyses do not provide all the planning information needed for a specific project. Original data will need to be collected. New projects can therefore be seen to contribute to the broad understanding of a community. Sustainability of programs (see Chapter 7) is more likely if these programs build on existing efforts. Also, focused needs assessments can be an efficient approach to collecting relevant and timely information for program planning and engaging those people most likely to be interested in or affected by an innovative program. In addition to its planning function, the process of conducting a community analysis is intended to lead to citizen activation and participation in a designated sustainable health intervention. In this chapter, we begin with a brief discussion on the meamng of community and then review the traditions and approaches that have influenced current community assessment and diagnostic models. This is followed by the presentation of methods for data collection, including suggestions for special studies to increase information about selected social groups in a community. What Is Community? In beginning a community analysis, one of the first questions asked is, What is a community? How is it defined? No single definition or concept of community serves all fields of investigation or professional intervention. Community has multiple meanings and has been studied from varying perspectives by sociologists, geographers, medical specialists, anthropologists, urbanologists, and social workers. However, as early as 1955 and after studying 94 definitions of community, Hillery ( 1955) found that 73% of definitions agreed that "social interaction, area, and a common tie or ties" (p. 118) were commonly found features of a community. Some define community as a psychological bond or relationship that unites individuals in a common goal or experience. Others use the term in the geographic or physical sense, as a space with political or economic boundaries. Yet space alone does not tell us all we need to know about community membership. The Internet and "virtual" communities can make physical, geographic boundaries obsolete. Many characteristics of community structure and interaction have been identified in the writings of sociologists, including such useful concepts as community complexity, horizontal and vertical linkage among institutions, centralization of authority, regional autonomy, community identitication, and social integration of the population. Theoretical underpinnings for this chapter rely principally on Warren's classic ( 1969) social systems view of the community, which focuses assessment on four important features-space or boundaries, social institutions, social interaction, and social control-and Chavis and Wanders man's ( 1990) view that communities can be identified by arbitrary geographical boundaries, by their social relationships, or through the exercise of collective political power. Sometimes these dimensions overlap, such as in isolated rural towns. For other communities, only one dimension may be present, such ac; m the case of a national coalition representing state-based grassroots organizations lobbying government for a single issue. The type of problem or intervention being planned and how community is defined will determine the nature of analysis required (see Chapter 2, pp. 31-32, for additional discussion). Assessing Community Needs, Resources, and Readiness 61 In any analysis of a community, the geographical boundaries (or their absence) must be specified and should approximate the view held by most local residents or community members. Often, government health agencies have responsibilities for populations living or working in arbitrary geographical areas. Once boundaries are determined, an assessment of social institutions (education, health, recreation, business and labor, religious, communications and media, government, and so on) is undertaken to understand which organizations currently take responsibility for providing programs and services. Service directories may well list services provided, but a more thorough assessment also allows for the estimation of the possibilities for coordinating community wide programs of health action. Social interaction patterns should also be studied for what they can reveal about community cleavages (for example, discriminatory practices), coalitions and influence networks, and sources of social support for individuals and groups (Heaney & Israel, 1997; House, Umberson, & Landis, 1988). An examination of social control mechanisms and norms is also useful. Social control is a function of many community institutions (church, school, police, and so on) and is based on values, norms, and customs. Any ethical concerns raised about a proposed community health intervention should be noted. How political power or the collective power of community members is used should be understood, as should local regulations and enforcement policies (e.g., concerning the sale of cigarettes to minors). Interviews with a variety of organizational and political representattves or key informants can provide most of this kind of assessment information. Assessment Traditions Before describing the various components of analysis, we briefly review the background of various assessment traditions. The terms community analysis and community diagnosis are used interchangeably in the literature, although analysis, strictly speaking, precedes diagnosis. The term community diagnosis surfaced in the 1950s (Morris, 1975) and was introduced to the health planning tield in the mid-1960s. The content of community diagnosis was later reformulated by Bennett ( 1979). Green, Kreuter, Deeds, and Partridge's (1980) pioneering work "Health Education Planning: A diagnostic approach" added a broader social diagnostic framework to this applied discipline. They have extended this framework further to mclude environmental, policy, and legislative perspectives (Green & Kreuter, 1991). The World Health Organit.ation (1982) has published a handbook for community health workers in the developing countries based on the community diagnosis concept. Haglund ( 1988) has written about community diagnosis within the Swedish context, and Hawe, Degeling, and Hall (1990) have described community needs assessment in the Australian context within a planning and evaluation framework. Other guides include Blum's (1981) Planning for Health and Dignan and Carr's (1986) Program Planning for Health Education and Health Promotion. Suggestions for how to approach community needs assessments can also be derived from major theories of personal and community behavior described in texts such as Glanz, Lewis, and Rimer's ( 1997). Community analysis has evolved independently from two basic traditions that follow different paradigms that can broadly be termed the health planning approach and the community 62 ADVANCES IN THEORY AND PRACTICE development approach. Some refer to them as "trickle down" or "bubble up" approaches. Elements from these two approaches can be found in assessment practice today, and the approaches can overlap. The medical or health planning approach equates health with the absence of disease and health improvement
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