Office of Healthy Carolinians/Health Education and the State Center for Health Statistics North Carolina Department of Health and Human Services February 2002 STATE OF NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES Carmen Hooker Odom, M.S., Secretary DIVISION OF PUBLIC HEALTH Leah M. Devlin, D.D.S., M.P.H., Director OFFICE OF HEALTHY CAROLINIANS/HEALTH EDUCATION Mary Bobbitt-Cooke, M.P.H., Director www.healthycarolinians.org STATE CENTER FOR HEALTH STATISTICS STATISTICAL SERVICES UNIT Paul A. Buescher, Ph.D., Head www.schs.state.nc.us/SCHS Daniel C. Rosenberg , M.A. Editor & Margie Britnell, M.P.H. Principal Author February 2002 The NC Department of Health and Human Services does not discriminate on the basis of race, color, national origin, sex, religion, age or disability in employment or the provision of services. 300 copies of this public document were printed at a cost of $1,822.32 or $6.07 per copy. Printed on recycled paper Preface Community assessment is the foundation for improving and promoting the health of community members. The role of community assessment is to identify factors that affect the health of a population and determine the availability of resources within the community to adequately address these factors. Through collaborative efforts forged among community leaders, public health agencies, businesses, hospitals, private practitioners, and academic centers (to name a few), the community can begin to answer key questions such as (a) “What are the strengths in our community?” (b) “What health concerns do community members have?” and (c) “What resources are available and what do we need in the community to address these concerns?” In a community-based assessment, as is promoted in the North Carolina Community Health Assessment Process, community members take the lead role in forming partnerships, gathering health-related data, determining priority health issues, identifying resources, and planning community health programs. In this framework, the assessment process starts with the people who live in the community and gives the community primary responsibility for determining the focus of assessment activities at every level, including collection and interpretation of data, evaluation of health resources, identification of health problems, and development of strategies for addressing these problems. In this view, community assessment is done by the community rather than on the community. The Community Assessment Guide Book and the County Health Data Book were created by the project staff of the North Carolina Community Health Assessment Initiative (NC-CHAI) to provide communities a systematic means of engaging residents in assessing local concerns and assets. The purpose of these publications is to establish a framework for conducting a comprehensive and collaborative community-oriented assessment. The Community Assessment Guide Book provides easy-to-follow guidelines that help communities determine the health status of their local residents, establish priorities for improving health, develop effective interventions, and evaluate the impact of public health programs and policies. The Community Assessment Guide Book can be considered a resource document or toolkit for county public health departments and other community agencies. Counties start at many different places in the community health assessment process. If a county has recently completed a comprehensive community assessment, there is no reason to start from scratch and do another one. Healthy Carolinians Partnerships are required to complete a community assessment as part of the certification process. This normally involves broad representation from across the community, which is very much in the spirit of the process proposed here. There is no need to form a new community assessment team (see Phase 1) if a suitable Healthy Carolinians or other group already exists. The tools and guidance provided in this Guide Book can be used as needed to complement existing strengths. A Community Assessment Document (Phase 7) and the Community Health Action Plan (Phase 8) are required of county public health departments by the State. If a community assessment has already been recently carried out, the results of that assessment could be used to help complete these two requirements. North Carolina Community Health Assessment Initiative i It would not be possible to carry out all of the recommendations in this Guide Book in only a few months, particularly the surveys to measure community opinion and the other primary data collection methods. Community assessment is an ongoing process and the resources provided here can be used whenever time and resources permit to enhance understanding of your community’s health. Funded by a grant from the Centers for Disease Control and Prevention, the NC-CHAI is a joint project of the State Center for Health Statistics (SCHS) and the Office of Healthy Carolinians/Health Education (OHC/HE). The goal of this initiative is to build the capacity of communities to use data for public health program planning and policy making. To achieve this goal, the SCHS and the OHC/HE are working to connect and strengthen the assessment activities of county health departments, local Healthy Carolinians partnerships, and other community organizations. As a direct result of this initiative, the OHC/HE now administers the state’s public health community assessment (formerly known as Community Diagnosis) collaboratively. The SCHS supports this effort with the development of the County Health Data Book and other data assistance. This offers the opportunity for health departments to work collaboratively with Healthy Carolinians partnerships in broadening community assessment to serve the planning needs of the local health department and the community as a whole. NC-CHAI’s role is to integrate such local efforts and to promote the development of a single collaborative community health assessment process within each county. Collaborative assessments reduce the data collection and analysis required, reduce potential confusion caused by multiple studies of single counties, and broaden citizens’ involvement in assessment activities. With this grant, NC-CHAI aims to equip those that engage in this collaborative process with the skills and tools needed to assess the health of their communities, develop effective public health programs and policies, and evaluate the impact of such interventions. ii North Carolina Community Health Assessment Initiative Acknowledgments We express our appreciation to the numerous local health departments and Healthy Carolinians Partnerships across North Carolina who have helped to shape and refine this publication. Their enthusiasm, experience, and insight in community assessment have greatly informed the development of this Community Assessment Guide Book. We gratefully acknowledge the joint work of the Kansas Department of Health and Environment, the Kansas Hospital Association, and the Kansas Association of Local Health Departments in producing the Kansas Community Health Assessment Process (CHAP) Workbook. Many of the tools and text presented in this guidebook have been adapted from the Kansas CHAP Workbook. Thanks are also due to the Bureau of Community Oriented Primary Care within the Texas Department of Health. Several ideas and text from their Community Assessment Guidelines have been adapted for this guidebook. This work was funded in part by grant U82/CCU417938 from the Centers for Disease Control and Prevention. North Carolina Community Health Assessment Initiative iii Table of Contents PREFACE .................................................................................................................................................................... I ACKNOWLEDGMENTS ............................................................................................................................................... III TABLE OF CONTENTS ............................................................................................................................................... IV FREQUENTLY ASKED QUESTIONS ............................................................................................................................. VI OVERVIEW OF THE COMMUNITY ASSESSMENT GUIDE BOOK ................................................................................. XIII PHASE 1 : ESTABLISH A COMMUNITY ASSESSMENT TEAM ................................................................. 1–1 PHASE 1: ESTABLISH A COMMUNITY ASSESSMENT TEAM................................................................... 1–3 Structuring Your Community Assessment Team.............................................................................................. 1–3 Community Health Assessment Team Organization........................................................................................ 1–4 Beginning a Health Assessment Process in Your Community ......................................................................... 1–6 Gathering Community Assessment Resources................................................................................................. 1–7 Financial Resources and Budgeting................................................................................................................ 1–7 Securing Funds................................................................................................................................................ 1–9 PHASE 1 TOOLS .............................................................................................................................................. 1–11 PHASE 2 : COLLECT COMMUNITY DATA .................................................................................................... 2–1 PHASE 2: COLLECT COMMUNITY DATA .................................................................................................... 2–2 Gather Others’ Local Data ............................................................................................................................. 2–4 Interview Community Members....................................................................................................................... 2–7 Conduct Listening Sessions ........................................................................................................................... 2–11 Conduct A Community Health Opinion Survey ............................................................................................. 2–16 Inventory Community Health Resources ....................................................................................................... 2–21 Map the Assets of Your Community............................................................................................................... 2–24 PHASE 2 TOOLS .............................................................................................................................................. 2–30 PHASE 3 : ANALYZE THE COUNTY HEALTH DATA BOOK ..................................................................... 3–1 PHASE 3: ANALYZE THE COUNTY HEALTH DATA BOOK.......................................................................... 3–2 Types and Sources of Data .............................................................................................................................. 3–3 Types of Data: Quantitative vs. Qualitative Data ........................................................................................... 3–3 Sources of Data: Primary vs. Secondary Data................................................................................................ 3–4 Practicing Safe Statistics................................................................................................................................. 3–4 USING THE COUNTY HEALTH DATA BOOK WORKSHEETS ....................................................................................... 3–5 THE COUNTY HEALTH DATA BOOK STEP-BY-STEP .............................................................................................. 3–7 Section A: Population...................................................................................................................................... 3–7 Section B: Pregnancies and Births.................................................................................................................. 3–8 Section C: Mortality ........................................................................................................................................ 3–9 Section D: Morbidity ..................................................................................................................................... 3–11 Section E: Health Resources/Programs ........................................................................................................ 3–14 Section F: Education ..................................................................................................................................... 3–18 Section G: Community Health....................................................................................................................... 3–19 Trend Analysis............................................................................................................................................... 3–21 OTHER SECONDARY DATA FOR ASSESSMENT ..................................................................................................... 3–22 COUNTY HEALTH DATA BOOK WORKSHEETS ...................................................................................... 3–25 PHASE 4 : COMBINE YOUR COUNTY’S HEALTH STATISTICS WITH YOUR COMMUNITY DATA4–1 PHASE 4: COMBINE YOUR COUNTY’S HEALTH STATISTICS WITH YOUR COMMUNITY DATA ... 4–2 YOUR COMMUNITY’S HEALTH STATUS: UNDERSTANDING YOUR COUNTY HEALTH DATA BOOK........................... 4–4 Section A: Population...................................................................................................................................... 4–4 Section B: Pregnancies and Births.................................................................................................................. 4–8 Section C: Mortality ........................................................................................................................................ 4–8 iv North Carolina Community Health Assessment Initiative Section D: Morbidity ..................................................................................................................................... 4–10 Section E: Health Resources/Programs ........................................................................................................ 4–11 Section F: Education ..................................................................................................................................... 4–12 Section G: Community Health....................................................................................................................... 4–14 ANALYZING THE DATA ........................................................................................................................................ 4–15 PUTTING IT ALL TOGETHER ................................................................................................................................ 4–17 PHASE 4 TOOLS .............................................................................................................................................. 4–19 PHASE 5 : REPORT TO THE COMMUNITY ................................................................................................... 5–1 PHASE 5: REPORT TO THE COMMUNITY................................................................................................... 5–2 Report the Data ............................................................................................................................................... 5–3 PHASE 5 TOOL .................................................................................................................................................. 5–7 PHASE 6 : SELECT HEALTH PRIORITIES ..................................................................................................... 6–1 PHASE 6: SELECT HEALTH PRIORITIES ...................................................................................................... 6–2 Making the Choice........................................................................................................................................... 6–4 A Method for Choosing Health Priorities ....................................................................................................... 6–4 Another Method for Selecting Priorities - Nominal Group Technique............................................................ 6–6 Review Your Priorities..................................................................................................................................... 6–7 PHASE 6 TOOLS ................................................................................................................................................ 6–9 PHASE 7 : CREATE A COMMUNITY ASSESSMENT DOCUMENT............................................................ 7–1 PHASE 7: CREATE A COMMUNITY ASSESSMENT DOCUMENT ............................................................. 7–2 Plan for the Future .......................................................................................................................................... 7–5 PHASE 8 : DEVELOP THE COMMUNITY HEALTH ACTION PLAN......................................................... 8–1 PHASE 8: DEVELOP THE COMMUNITY HEATH ACTION PLAN.............................................................. 8–2 Keep the Community Informed ........................................................................................................................ 8–6 PHASE 8 TOOLS ................................................................................................................................................ 8–9 REFERENCES...................................................................................................................................................REF–1 APPENDIX A—SCHS STATISTICAL PRIMER: PROBLEMS WITH RATES BASED ON SMALL NUMBERS APPENDIX B—SCHS STATISTICAL PRIMER: AGE-ADJUSTED DEATH RATES APPENDIX C—SOURCES OF DATA FOR COMMUNITY PROFILES: A RESOURCE GUIDE FOR COMMUNITY ASSESSMENT IN NORTH CAROLINA COMMUNITY HEALTH ASSESSMENT EVALUATION FORM North Carolina Community Health Assessment Initiative v Frequently Asked Questions What is a Community Health Assessment? A community health assessment is a process by which community members gain an understanding of the health, concerns, and health care systems of the community by identifying, collecting, analyzing, and disseminating information on community assets, strengths, resources, and needs. A community health assessment usually culminates in a report or a presentation that includes information about the health of the community as it is today and about the community’s capacity to improve the lives of residents. A community health assessment can provide the basis for discussion and action. Why Should Your Community Conduct a Community Health Assessment? Community assessment provides the opportunity to engage multiple agencies and organizations as well as community members in identifying and evaluating health issues. The community assessment process and the resulting document have many uses that are detailed on the following page. A greater purpose of the assessment process is to improve the health of the community. The community health assessment can provide knowledge about the state of the community’s health and can create an environment for change. How can a Community Health Assessment Improve the Community’s Health? The concept that individuals and communities can improve and control their health was reinforced by the Healthy People initiative of the United States Department of Health and Human Services beginning with the 1979 publication entitled Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention. Subsequent reports, such as Healthy People 2000 and Healthy People 2010, have led to the creation of state and local initiatives, such as Healthy Carolinians 2000 and Healthy Carolinians 2010. These initiatives set an agenda for communities to work towards healthier living. The goals of Healthy Carolinians 2010 are to increase the span of healthy life of the citizens of North Carolina, remove health disparities among the disadvantaged, promote access to preventive health services, protect the public’s health, foster positive and supportive living and working conditions in our communities, and support individuals to develop the capacities and skills to achieve healthy living. Understanding your community and the beliefs, attitudes, and behaviors of the people who live there is the first step in meeting these goals. Communities often have to make critical decisions without adequate information. Examples include where to locate new health clinics, how to attract suitable new industry, or how to position the community for future growth. Community health assessment leads to knowing the community and helps concerned citizens answer questions like: What is important to the community? How do people like living in the community? What would citizens like to see changed? How have they been successful at meeting challenges in the past? Who (individuals, groups, or organizations) are important contributors in efforts to improve the community’s vi North Carolina Community Health Assessment Initiative health? What do they see as the greatest obstacles to good health? These are some examples of questions to ponder as you consider conducting a community health assessment. What are Healthy Carolinians? Healthy Carolinians are a statewide network of local partnerships that collaborate on Healthy Carolinians/Healthy People (HC/HP) 2010 objectives. Healthy Carolinians are driven and led by the energy and vision of local partnerships and facilitated by the OHC/HE with governance and oversight from the Governor’s Task Force for Healthy Carolinians (GTF-HC). By October 2001, 65 HC partnerships in North Carolina’s 100 counties have been certified by the GTF-HC. One of the steps in gaining Healthy Carolinians certification is conducting a collaborative community health assessment that engages multiple agencies and community members. HC partnerships may use the guide book to assist them in this endeavor. How can Your Community Use the Community Health Assessment? Once your Community Health Assessment has been completed and the assessment document is prepared, there are many things your team and your community can do with the information they have. The value of an assessment is in its use. The Community Assessment Document and the Community Action Plan are just the beginning of the actions to improve the health of your community. The following are some suggested ways of putting your assessment to use. • You can share a greater knowledge and understanding of the community as it is today. Because you know “What’s going on?” “Who’s involved?” • You can publish and make available the results of the assessment to the community. Because you can answer “What did you find out?” • You can provide facts upon which to base programmatic or organizational decisions. Because you know “Where are current services located?” “Is there unmet need among a part of the population?” • You can plan effective, collaborative interventions to promote better health. Because you can answer “Where are the unmet needs?” “What do we want things to be like?” “What assets do I have to work with?” • You can seek new funding. Because you can identify • “What financial resources do I need to get the task done?” You can influence and advocate for policy changes with legislators, county government, etc. Because you know “Here are the facts. We need things to be different.” “We can’t get there by ourselves. Help us change this.” North Carolina Community Health Assessment Initiative vii • You can provide a baseline by which to monitor changes. Because you can answer “What are the current conditions?” • You can develop resources and market the community. Because you know “What resources do we have?” “What’s missing?” “What can we tell others about our community?” • You can inform citizens and empower them to act. Because you know “What can we do to make a difference?” “Where can we start?” “What is here to help us?” • You can help build partnerships/coalitions? Because you can answer “Who else is/wants to be involved?” “Can we work together to make a difference?” • You can identify emerging issues. Because you know “What new concerns do community members have?” “What do the county secondary data show?” “What has changed that concerns us?” Who should be involved? Likely participants in most communities include people from the public health department, local Healthy Carolinians Partnerships, local health providers, people from hospitals and clinics, business and civic leaders, educators, social service workers, and concerned community members. Anyone in the community who has a stake in the outcome can become involved, and since health is everyone’s concern, every citizen is a potential partner. “Fostering ownership of the assessment throughout the community and seeking opportunities for public and private sector collaboration will significantly increase the chances that the assessment can be used to inform decisions to improve the community’s health, and to effect change in the local health system” (Robin, et al., 1996). How was the North Carolina Community Assessment Process developed? This process was developed by the North Carolina Community Health Assessment Initiative (NC-CHAI) to establish guidelines for the community assessment required by the state of the public health departments. To develop an assessment process that would fit the diverse needs of North Carolinians, the NC-CHAI has reviewed established community assessment methodologies and consulted local public health professionals and community members throughout the state who have been engaged in assessment. The NC-CHAI, funded by the Centers for Disease Control and Prevention, is a joint project of the Office of Healthy Carolinians/Health Education (OHC/HE) and the State Center for Health Statistics (SCHS). The viii North Carolina Community Health Assessment Initiative OHC/HE and the SCHS collaboratively administer this state-mandated process, formerly known as Community Diagnosis. How is the North Carolina Community Assessment Process done? The North Carolina Community Assessment Process engages the community in an eightphase assessment process described in the Community Assessment Guide Book. The Guide Book is a step-by-step manual for community-based health assessment that provides worksheets for analyzing county-level data, tools for collecting community data, data interpretation instructions, guidelines for prioritizing local health needs, and community health planning aids. The accompanying County Health Data Book includes a wide range of health-related county and state data. The NC-CHAI also provides training and technical assistance for communities that are engaged in local health assessments. How is this different from Community Diagnosis? As a direct result of the NC-CHAI, the OHC/HE and the SCHS now jointly administer the state’s public health community assessment (formerly known as Community Diagnosis). This offers the opportunity for health departments to work collaboratively with Healthy Carolinians partnerships (in counties that have partnerships) in broadening community assessment to serve the planning needs of the local health department and the whole community. NC-CHAI’s role is to integrate such local efforts and to promote development of a single community health assessment partnership within each county. Such partnerships avoid the duplication of effort and potential confusion caused by multiple assessments of single counties, as well as increase community members’ participation in assessment activities. What are the reporting requirements for local public health departments? The required public health community assessment and the resulting required Community Assessment Document are on a 4-year cycle, replacing the 2-year cycle that has been in place for the past 28 years. Each local health department is assigned to a specific 4-year cycle. Each year a group of counties/local health departments will engage in community assessment. Support and training from OHC/HE and SCHS will be provided each year. Each county’s 4-year community assessment cycle will be synchronized with Healthy Carolinians Certification/Recertification. Ongoing Healthy Carolinians recertification has also been changed to a 4-year cycle. The recertification will be scheduled for the year following the community assessment. During the three interim years, the local health department will issue a State-of-theCounty Report that will provide updated information about priority health issues specific to the county. The required Community Health Action Plan form(s) are due at the same time as the Community Assessment Document. The format will be the same as that used for Healthy Carolinians certification/recertification, Health Promotion fitness and nutrition plans, and other public health programs. North Carolina Community Health Assessment Initiative ix Where do I send the Community Assessment Document, State-of-the-County Report, and/or the Community Health Action Plan? Office of Healthy Carolinians/Health Education Division of Public Health 1915 Mail Service Center Raleigh, NC 27699–1915 Phone: (919) 715–4173 Fax: (919) 715–3144 Email: hcinfo@ncmail.net What’s the due date?
The Community Assessment Document and the Community Health Action Plan are due on December 2 of the year that your county is assigned to conduct an assessment. x North Carolina Community Health Assessment Initiative Whom can I contact to request technical assistance and training? Contact the Healthy Carolinians/Health Education Consultant in your region. Western Region Nichole Oocumma Phone: (828) 631-2349 Fax: (828) 631-1468 Email: Nichole.Oocumma@ncmail.net Northeastern Region post vacant Phone: Fax: E-Mail: Southeastern Region Denise Houghton Phone: (910) 328-6338 Fax: (910) 328-6279 Email: Denise.Houghton@ncmail.net Northwestern Region Dallice Joyner Phone: (336) 771–4608, ext. 338 Fax: (336) 771–4637 E-Mail: Dallice.Joyner@ncmail.net Piedmont Region Tom Milroy Phone: (919) 715-0412 Fax: (919) 715-3144 Email: Tom.Milroy@ncmail.net Or contact the Office of Healthy Carolinians at (919) 715-4198 or hcinfo@ncmail.net. Margie Britnell Project Educator NC Community Health Assessment Initiative Phone: (919) 733–4983 Fax: (919) 715–3144 Email: Margie.Britnell@ncmail.net North Carolina Community Health Assessment Initiative Mary Bobbitt-Cooke Director Office of Healthy Carolinians/Health Education Phone: (919) 715–0416 Fax: (919) 715–3144 E-Mail: Mary.Bobbitt-Cooke@ncmail.net xi Whom can I contact with questions about the Community Assessment Guide Book? Margie Britnell Project Educator NC Community Health Assessment Initiative Phone: (919) 733–4983 Fax: (919) 715–3144 Email: Margie.Britnell@ncmail.net Whom can I contact with questions about the County Health Data Book or to request additional data? Bradford Woodard Project Statistician NC Community Health Assessment Initiative Phone: (919) 715–0269 Fax: (919) 733–8485 E-Mail: Bradford.Woodard@ncmail.net xii Daniel Rosenberg Project Manager NC Community Health Assessment Initiative Phone: (919) 715-0263 Fax: (919) 733-8485 E-Mail: Daniel.Rosenberg@ncmail.net North Carolina Community Health Assessment Initiative Overview of the Community Assessment Guide Book The Community Assessment Guide Book provides communities with a systematic means of engaging residents in assessing local problems and assets. The purpose of this publication is to establish guidelines for North Carolina’s counties to carry out a community-based health assessment. The Community Assessment Guide Book takes communities through eight phases to complete a comprehensive and collaborative community assessment. The following briefly describes the activities involved in each phase. Phase 1: Establish a Community Assessment Team The first step is to establish a Community Assessment Team who will lead the community assessment process. This group should consist of motivated individuals who can act as advocates for a broad range of community members and can represent appropriately the concerns of various populations within your community. If such a group already exists, such as a Healthy Carolinians Partnership, then there is no need to establish a new one. Phase 2: Collect Community Data In this phase, your Community Assessment Team will collect data directly to discover the community’s viewpoint and concerns about life in the community, health concerns, and other issues important to the people. Community interest goes beyond the information given in the County Health Data Books and is important in assessing the status of the community according to the people. Information is included to assist you with collecting community data—Guidelines for Interviews, Guidelines for Conducting Listening Sessions, a sample Community Health Opinion Survey, Worksheets on Analyzing the Community Health Opinion Survey, and Instructions on Assets Mapping. These tools may be employed at any time, since community health assessment should be an ongoing process. Phase 3: Analyze the County Health Data Book Included in your notebooks is a tailor-made County Health Data Book that provides a wide range of heath-related secondary data for your county. In this phase, your Community Assessment Team will compare your county’s health statistics with those of the state to identify possible health problems in your community. Worksheets are provided to help you review your county’s data. Phase 4: Combine Your County’s Health Statistics with Your Community Data In this phase, your Community Assessment Team will review the data from Phases 2 and 3 in detail. The text walks you through various data issues and guides you in interpreting and fitting together your health statistics with your community data. By the end of this phase, you will have a basic understanding of your community’s major health issues. North Carolina Community Health Assessment Initiative xiii Phase 5: Report to the Community In this phase, the Community Assessment Team will report the results of the assessment to the community. The importance of this phase plus practical methods and suggestions on how to approach the community are included. Phase 6: Select Health Priorities In this phase, your Community Assessment Team will determine the priority health issues to be addressed. This section presents various methods of setting priorities to the community health issues that emerged in Phase 4. Phase 7: Create the Community Assessment Document In this phase, your Community Assessment Team will develop a stand-alone report to document the process as well as the findings of your entire assessment effort. The purpose of this report is to share your assessment results and plans with the entire community and other interested stakeholders. At the end of this phase, your community will be ready to move from assessment to action by developing the Community Health Action Plan. Phase 8: Develop the Community Health Action Plan In this phase, your Community Assessment Team will develop a plan of action for addressing the health issues deemed as priorities in Phase 6. Tools are included for developing intervention and prevention activities. xiv North Carolina Community Health Assessment Initiative PHASE 1: ESTABLISH A COMMUNITY ASSESSMENT TEAM Phase I Objective Establish a Community Assessment Team Phase 1 Activities Form and Organize Your Community Assessment Team Hold an Orientation for Team Members Form Consensus on Your Mission, Goals, Roles, and Actions Identify Needed Resources Within Your Community Develop a Budget and Secure Resources Tools Needed for Phase 1 Questions for Your Community Assessment Team Community Assessment Resources Worksheet Community Assessment Budget Worksheet Phase 1: Establish a Community Assessment Team 1–1 NORTH CAROLINA COMMUNITY HEALTH ASSESSMENT PROCESS Phase 1: Establish a Community Assessment Team Phase 2: Collect Community Data Phase 3: Analyze the County Health Data Book Phase 4: Combine Your County’s Health Statistics with Your Community Data Phase 5: Report to the Community Phase 6: Select Health Priorities Phase 7: Create the Community Assessment Document Phase 8: Develop the Community Health Action Plan 1–2 Phase 1: Establish a Community Assessment Team PHASE 1: ESTABLISH A COMMUNITY ASSESSMENT TEAM Community assessment is a process. In order for this process to be meaningful, the people from throughout the community must be mobilized and at the table throughout the assessment. While building community commitment takes lots of time and energy, there is no better way to build support for public health interventions than to engage community residents in identifying important health issues, developing strategies for addressing these issues, initiating actions and interventions, and using the skills and experiences of community members as resources. Simply stated, change “is more likely to be successful and permanent when the people it affects are involved in initiating and promoting it” (Thompson & Kinne, 1990, p. 45). In this first phase of the North Carolina Community Assessment Process, you will form a Community Assessment Team. This team should be made up of community residents and representatives from strategic organizations who have a good understanding of the community in which they live and be willing to commit the time and effort necessary to make the process a success. Your Community Assessment Team should involve a wide range of key community members who reflect all facets of your community. Members could include citizens in business and industry, the medical community, public health, the school system and local universities/colleges, civic and social organizations, the local government, the media, voluntary agencies, and other appropriate local groups. It is very important that your Community Assessment Team involve people who have significant influence in the community (for example, elected officials), as well as the people who are most affected by health problems in the community (such as residents of low-income neighborhoods). Because of the potential of assessment for bringing about change, it is essential to involve those who hold a stake in the outcome. Most North Carolina counties already have working teams with diverse members in association with their local Healthy Carolinians partnership. Such a group may be able to serve as your Community Assessment Team, and there is no need to start over. Structuring Your Community Assessment Team One structure for your Community Assessment Team is to have three levels of participants: an Advisory Group, a Work Group, and a Project Facilitator. Using this model, the Advisory Group would consist of a larger group of people who agree to serve as advisors for the project. The Work Group would include a subset of members of the Advisory Group. The Work Group would develop the community health plan by collecting, analyzing, and interpreting the county’s data, and would present the results of the project to the larger Advisory Group for approval. Finally, the Project Facilitator would have responsibility for coordinating and leading the community assessment process. Additionally, other members of your community can be called on for activities such as serving on subcommittees, participating in surveys, providing feedback on particular issues, or volunteering resources. Phase 1: Establish a Community Assessment Team 1–3 Community Health Assessment Team Organization The Advisory Group and Work Group will be well served if each include representatives who can act as advocates for a broad range of community members or who can appropriately represent the concerns of populations within your community. You may choose the size and structure of each group, but it is important that certain key people take responsibility for moving the process along. Listed below are ideas for each of the elements of your Community Assessment Team. Advisory Group. The Advisory Group may involve approximately 10 to 15 members who have an interest in community assessment and community planning and who agree to function as an advisory board throughout the process. This group should include a broad representation of your community. They should understand the process and agree on the overall goals. They will serve as the watchdog for the process, assure your community that everything is going as planned, and act as advocates of the process in the community. The following lists duties of the Advisory Group: • Agree to meet for a defined period of time (e.g., 9-12 months). • Review the North Carolina Community Assessment Process materials. • Review statistics, survey data, and other forms of information about your community. • Offer suggestions and ideas for the Community Health Action Plan. • Review recommended goals and objectives. • Provide suggestions for interventions, review proposed interventions, and make recommendations for change, if necessary. • Act as advocates for the assessment process in your community. • Work with local constituents to explain the process and provide feedback. Work Group. The Work Group may include approximately 4 to 6 people who are able to provide the majority of the work necessary to complete the process. Other names for a group like this might be the Steering Committee or the Executive Committee. Although this group is smaller than is the Advisory Group, it also should contain persons capable of representing the community as a whole. Members may also be selected from the larger Advisory Group. The Work Group must have available “support” staff in order to carry out the tasks listed below. Support staff may be several volunteers willing to make copies, prepare mass mailings, enter data, schedule meetings, etc. The following lists duties of the work group: 1–4 • Lead the process. • Become the community “experts” in the assessment process and receive training, if necessary. • Establish and meet with subcommittees as needed. • Perform or delegate data collection work. Phase 1: Establish a Community Assessment Team • Interpret findings. • Develop the Community Health Action Plan with the help of the Advisory Group and other community members. • Assure interventions are implemented and evaluated. Project Facilitator. The Project Facilitator coordinates the assessment process. The Project Facilitator is responsible for keeping the process moving and making sure that everyone is aware of the progress and tasks at hand. Within the Community Assessment Team, however, there may be others assigned to lead subcommittees to complete special tasks. For example, one member may take the lead for coordinating a group to conduct a community survey. Another member may agree to carry out listening sessions. In this way, many tasks may be occurring at the same time. The following lists duties of the Project Facilitator: • Keep the process moving! • Make sure tasks are completed on time. Delegate tasks as necessary. • Coordinate Community Assessment Team meetings. • Attend the Work Group and Advisory Group meetings. • Make sure the members of the Advisory Group and the Work Group have the information and tools they need to complete their tasks. • Coordinate access to support materials (e.g., equipment, work space, office supplies, etc.). • Serve as the central contact person for community members, the Community Assessment Team, and the media. • Assure broad representation of community members and communication links to the community. • Serve as the contact person for NC-CHAI staff providing training and technical assistance. Phase 1: Establish a Community Assessment Team 1–5 Some Points to Keep in Mind When Working With the Community ✔ Set a time limit for the project. ✔ Stay on target. ✔ Assure all populations within the community are represented. ✔ Find appropriate space and support staff to help carry out the work. ✔ Develop a method of keeping the community-at-large informed. ✔ Recognize from the beginning that you will not be able to tackle all problems. ✔ Build consensus. ✔ Reward community participants for doing a good job. ✔ Seek outside help in dealing with sensitive issues. ✔ Obtain needed training for participants. Beginning a Health Assessment Process in Your Community One way to get a community assessment process off the ground is for the local health department and/or the Healthy Carolinians partnership to host an orientation for the Community Assessment Team members. This orientation should help to solidify the group and provide a foundation for future work. Early in the process, your Community Assessment Team should define the community they are planning to assess. Many teams will be assessing the entire county; others may assess only part of a county, a city, or even a neighborhood. Make sure that everyone understands and agrees what community they are assessing. It is recommended that your Community Assessment Team take some time before delving into an assessment to think about how this process will benefit your community. Questions for the Community Assessment Team provides a set of questions that can be posed to your team to build consensus about what to do and how to do it. The purpose of this exercise is to provide a forum for members of your Community Assessment Team to voice their expectations and self-interests regarding the assessment process. These questions also should stimulate dialogue that will allow the team members to reach a shared understanding of the goals and objectives of your assessment process. Record your group’s answers to these questions so that they can be distributed along with the minutes of the meeting. 1–6 Phase 1: Establish a Community Assessment Team Recommended Discussion Items for the Orientation Meeting of Your Community Assessment Team ✔ Provide an overview of the scope and the goals of community-based assessment. ✔ Give the group time to reach common ground and develop a clearly articulated mission or purpose. ✔ Provide an opportunity for each team member to articulate their goals and perspectives regarding their own or their agency’s involvement. ✔ Engage the participants in a discussion of the resources, knowledge, and skills that each team member brings to the table so that you can maximize the assets of each person. ✔ Clarify each member’s role to avoid “turf concerns” that may be held by some of the participants. ✔ Discuss possible training and technical assistance needs. Careful thought should be given to the skills needed to guide and support a community assessment. ✔ Establish a timeline for the assessment project. Gathering Community Assessment Resources An enormous amount of time, energy, and commitment is needed to carry out a community assessment. The more people from your community that can be involved in the process, the more successful it will be. Have your Community Assessment Team record their ideas during a brainstorming session. The Community Assessment Resources Worksheet can help your team identify community resources. Financial Resources and Budgeting The financial resources needed by your community to complete your assessment process will depend on: (1) the size of your community, (2) the amount of “in-kind” resources (i.e., donated time, money, supplies, space, etc.), and (3) how extensive your community assessment is (e.g., whether a survey is done, the number of collaborating agencies and organizations, etc.). Regardless of how small your process is and how many donations you receive, you will need to set up a budget for your community assessment process before you begin. A Community Assessment Budget Worksheet is included. What does it cost to do a comprehensive and collaborative community health assessment? The answer depends on resources within the community. It requires hard work, commitment of time, and a planned budget to cover costs. The staff and volunteer time and commitment required Phase 1: Establish a Community Assessment Team 1–7 to undertake an assessment should not be underestimated. Costs can be lumped into the following categories: $ Motivated Community Assessment Team Members. Motivated persons, representative of the community, will need to give their time and talent to serve in the Advisory and Work Groups. The amount of time will depend on the task and the availability of each person. Be as accurate as possible estimating the time commitment needed so people will know what they are undertaking. It will take a great deal work to complete all of the data collection, review, and analysis and health planning tasks. $ Project Facilitator. A local Project Facilitator is needed to coordinate the assessment process. Most importantly, this person should keep the process moving along. Whether you need a full- or part-time Project Facilitator depends on how much work is done by the Work Group and other community members. The Project Facilitator may be a health educator in the health department and/or the coordinator for a Healthy Carolinians Partnership. If your county hires an external company to facilitate or implement the community assessment process, you will still need a Project Facilitator. $ Support Staff. Staff are needed for administrative support to duplicate materials, send out surveys, input data, schedule appointments, and other jobs. Volunteers can provide this service. Approximately the equivalent of one-half full-time person may be needed to complete the process. $ Office Space. Office space is needed to provide a place for the Project Facilitator to do assessment work and for the data, both gathered directly from the community and from secondary sources, to be housed. A central location so that group members can come to view and analyze data, gather needed supplies, and leave materials for others will make the assessment progress more smoothly. Look for space in the local health department. Other possibilities include space donated by your local Healthy Carolinians partnership or hospital. $ Office Equipment. Office equipment such as a computer (with appropriate software, an Internet connection, and an email account), a telephone, a fax machine, a printer, and a copy machine are needed. $ Supplies. Office supplies such as paper, envelopes, notebooks, pens, and pencils are needed. These supplies may be donated. $ Communication. Plan for expenses for telephone, mailing, faxing, and videoconferencing. $ Travel. Some reimbursement for key people may be important. Funds for mileage or overnight stays (e.g., to attend training sessions or meetings) may be necessary. $ Public Relations. It is important to keep your community informed about your assessment project. Talk with your local media about reporting your progress as part of their local news. You may also want to place an advertisement or public service announcement in your local newspapers, newsletters, or radio stations. 1–8 Phase 1: Establish a Community Assessment Team $ Training and/or Consultants. Look for resources within your own community, your local health department, your local Healthy Carolinians partnership, local educational institutions, and NC-CHAI. Many of your needed resources are available at no cost to your Community Assessment Team. In addition, your community may choose to hire an outside consultant to perform part of the assessment (e.g., conduct a community phone survey). Securing Funds If you need financial resources, develop a plan to secure the needed funds. This is a task that may be shared with others but is of concern to the team. Options include using public funds; soliciting donations from institutions, organizations, or individuals; and applying for grants. We caution against allowing one stakeholder to provide all of the needed resources (e.g., one local hospital supplying all of the needed funds, space, supplies, and support personnel time). Even with the best intentions, the outcome of the assessment may be biased in favor of that stakeholder. Try to find a way for several interested parties to contribute funding. Several Means to Secure Funds for Your Community Assessment ✔ Grants from local charitable organizations (e.g., the United Way) ✔ Donations from institutions, organizations, and individuals ✔ Public Funds Phase 1: Establish a Community Assessment Team 1–9 ✎ CHECKPOINT Before leaving Phase 1, check to see if you’ve completed the following tasks: ❏ Formed a Community Assessment Team. ❏ Designated an Advisory Group, a Work Group, and a Project Facilitator. ❏ Held an orientation for Community Assessment Team members. ❏ Formed consensus on your Team’s mission, goals, roles, and actions. ❏ Used the Community Assessment Resources Worksheet to identify additional assessment resources. ❏ Used the Community Assessment Budget Worksheet to develop an assessment budget. 1–10 Phase 1: Establish a Community Assessment Team PHASE 1 TOOLS Page • Questions for Your Community Assessment Team.................................. 1–12 • Community Assessment Resources Worksheet ...................................1–13-15 • Community Assessment Budget Worksheet.............................................. 1–16 Phase 1: Establish a Community Assessment Team 1–11 TOOLS, PHASE 1 Questions for Your Community Assessment Team 1. Why are we initiating a community health assessment process in our community? 2. What do we want to know about the community’s health and well-being? 3. How will the assessment change/benefit our community? 4. What issues of particular importance do we want to make sure our community addresses? 5. Has our involvement in the assessment process up to this point been dominated by a particular group of consumers or providers? 6. How will our community make sure that all community voices—providers and consumers— are heard? 7. How does our community identify diverse issues? What issues might our community choose not to pursue at this point because their political implications may bring our entire process to a standstill? 8. How will our community use the results of the assessment process in the development of a Community Health Action Plan, even if we are uncomfortable with the results? 1–12 Phase 1: Establish a Community Assessment Team TOOLS, PHASE 1 Community Assessment Resources Worksheet Potential Subcommittee Members. Depending on how you structure your Community Assessment Team, you may use subcommittees to focus on specific neighborhoods, types of organizations, or age groups. Alternatively, you may use subcommittees to carry out specific tasks, such as gathering secondary data, facilitating focus groups, or administering a survey. Are there persons in your community who have expertise in certain topic areas or tasks in which you need assistance? Are there persons in your community who don’t have time to participate in the Community Assessment Team, but who might be able to serve on a subcommittee for a shorter period of time or help complete or offer expertise on a specific task? Name/Organization Phase 1: Establish a Community Assessment Team Phone Number/Email Potential Subcommittee 1–13 TOOLS, PHASE 1 Potential Staff Support. Are there persons in your community who might be able to lend a hand throughout the project—or just one or two afternoons—to stuff envelopes, make copies, enter survey data, etc.? Name/Organization Phone Number/Email Potential Financial Aid. Are there persons, organizations, or businesses in your community that cannot contribute time or human resources, but may recognize the importance of the community’s assessment process and want to contribute financially? Name/Organization 1–14 Phone Number/Email Phase 1: Establish a Community Assessment Team TOOLS, PHASE 1 Potential Office Space, Equipment, and Supplies. Are there businesses or organizations within your community that may be willing to donate office workspace, office equipment (e.g., copy machine, fax machine, phone, and computer) on a temporary or intermittent basis throughout your assessment process? Are there groups who may be willing to donate supplies (e.g., paper, envelopes, and office supplies)? Name/Organization Phone Number/Email Other. Are there other needed resources that individuals or organizations in your community might be willing to donate? Name/Organization Phase 1: Establish a Community Assessment Team Phone Number/Email Resource Needed 1–15 TOOLS, PHASE 1 Community Assessment Budget Worksheet Item Resources Needed In-Kind Support Other Support (Specify) Support Staff (FTEs) Office Space Office Equipment Office Supplies Communication Travel Public Relations Training Contractual Other/Misc. TOTAL 1–16 Phase 1: Establish a Community Assessment Team PHASE 2: COLLECT COMMUNITY DATA Phase 2 Objective Collect Data From Your Community Phase 2 Activities Gather Other Local Data Interview Community Members Conduct Listening Sessions Conduct a Community Health Opinion Survey Inventory Community Health Resources Map the Assets of Your Community Tools Needed for Phase 2 Guidelines for Interviewing Guidelines for Conducting Listening Sessions Community Health Opinion Survey Worksheet: Your Community’s Perceptions Analyzing your Community Health Opinion Survey Assets Mapping Phase 2: Collect Community Data 2–1 NORTH CAROLINA COMMUNITY HEALTH ASSESSMENT PROCESS Phase 1: Establish a Community Assessment Team Phase 2: Collect Community Data Phase 3: Analyze the County Health Data Book Phase 4: Combine Your County’s Health Statistics with Your Community Data Phase 5: Report to the Community Phase 6: Select Health Priorities Phase 7: Create the Community Assessment Document Phase 8: Develop the Community Health Action Plan 2–2 Phase 2: Collect Community Data PHASE 2: COLLECT COMMUNITY DATA In Phase 2, your Community Assessment Team will collect data directly from your community. Data that are collected by the team are known as primary data. Your team may also gather data that has been collected by others in your community (e.g., the local hospital, health department, school system, law enforcement, etc.). Data originally collected by someone else are called secondary data. Secondary data can be from local groups or agencies as described above, or from state agencies such as the State Center for Health Statistics. Data provided to your county by the State Center for Health Statistics in the form of the County Health Data Book will be discussed in Phase 3. Various methods of gathering data are presented and guidelines to help the team in the process are provided. Your team may choose to collect data in one or more of these ways, depending on time, money, abilities of team members, and resources. Because Community Health Assessment is an on-going process, each method of primary data collection should be undertaken according to the time and resources of your Community Assessment Team. We recommend that you pilot test any tool before administering it. Your team may use each of the tools in the format that they are provided or modify them to better suit your needs. While this phase is potentially the most time-consuming phase of the North Carolina Community Health Assessment Process, many members of your community can become involved directly in the assessment process and the results can provide your community with a wealth of information. Adopt an inclusive approach and involve as many people as are interested in the process. This can lead to greater community understanding and cooperation. Before beginning to collect primary data, check with community agencies and organizations to find out if there have been previous assessments or efforts to gather data. If so, obtain a copy of reports done as a result of these assessments; they may prevent a duplication of effort and provide information and possible insights into the community. Collecting Data from Your Community ✔ Gather Others’ Local Data ✔ Interview Local Community Members ✔ Conduct Listening Sessions ✔ Conduct a Community Health Opinion Survey ✔ Inventory the Community Health Resources ✔ Map the Assets of Your Community Phase 2: Collect Community Data 2–3 Gather Others’ Local Data Gather local data kept by area agencies, organizations and businesses on their services, clients, students, sales, events, etc. These are local secondary data; they are not primary data because another group has collected them. These data are kept for many reasons including managing businesses, serving the clients/students/customers, reporting profits and losses, and making future decisions unique to the organization. They are not kept in the anticipation of a community health assessment. Therefore, these data may not fit neatly into the format of the data your Community Health Assessment Team is collecting. Still they can prove valuable by providing a clearer picture of the community. The information kept by these groups may be confidential. The Community Health Assessment Team needs to determine rules of confidentiality and assure that they will be followed. Since several team members may be gathering data, establish a format to keep basic descriptive data about the agency, organization, or business from which you acquire the data. Later in the assessment process you may want to identify the source of the data, credit them with cooperation, or return for more information or for clarification. Also, your team will want to thank them for their help. Suggested Format of Descriptive Information 1. Name and description of agency/organization/business: The type of agency/organization/business and its purpose. Note the name of a contact person, telephone number, and address. Obtain a copy of the annual report if available. 2. Population served: Identify that part of the population that the agency/organization serves (i.e., geographic location, gender, age, race, etc.). Note numbers. 3. Days/hours of operation. 4. Employees/directors: Number of employees, name of the owner/chief administrator/CEO. 5. Data available: What types of data do they keep? Are copies available to the assessment team? The possible sources of these local data are varied and the types of data kept may be unique. Again, think broadly. Ask if information is available. You may need to explain the assessment process and your goals. Many people don’t understand how what they do effects the health of the community. The following are some possible sources and examples of the types of data available. 2–4 Phase 2: Collect Community Data Possible Sources and Examples of Local Data Public School System Enrollment numbers Graduation/drop-out rates Test Scores Library Local History Information unique to your community Chamber of Commerce List of businesses Employment/Unemployment rates Area economic data Civic Organizations Involved community members Charitable projects Religious groups Membership numbers Needs of members and their communities Community College/ Enrollment/graduation numbers Local College/University Fields of study available to students Student studies of the community Law Enforcement Agencies Crime incidence Arrests/convictions Incidence of domestic violence Motor vehicle crashes Non-Profit Organizations (e.g., The United Way, Planned Parenthood) Number of people eligible for service Number of people served Types of services performed Plans for the future Large Employers Number of employees Products produced Economic impact to the community Phase 2: Collect Community Data 2–5 Analyze the Results of Gathering Local Data Review the local data that have been collected. Determine what the data add to your current knowledge of the community. Is the information surprising or shocking or does it confirm what team members thought? Do data from different sources conflict? Is so, try to determine why that is the case. When interpreting data, remember that the source may have influenced or biased the data. Local data may save the team time and lead them to valuable resources in the community. Note which groups supplied data and remain open to including other local data discovered during the assessment process. Summarize your findings for the team but keep the original data available. Information that may not appear helpful in the beginning may prove to be helpful later. Keep a list, possibly in a computer database, of those who contributed local data and involve them again if prudent. Provide to these groups the report to the community of the results of the completed assessment. 2–6 Phase 2: Collect Community Data Interview Community Members When you want to know what someone knows or thinks about a topic, just ask them. An interview is one of the simplest methods that your Community Health Assessment Team can use to collect data from anyone who has an opinion or knowledge that may be of value to the assessment process. The interviewer can collect opinions, facts, assumptions, and perceptions from those who are interviewed. For the purposes of this guide book, an interview is defined as a conversation that has a reason, and is conducted between two people (either face-to-face or on the telephone). Interviews can vary in length. A fact-gathering interview could collect the needed information in a short time, perhaps as little as fifteen minutes. An interview with a community expert designed to elicit in-depth information about a particular topic could take an hour. Advantages of Interviews An interview is the best way to have a precise and complete interaction of thoughts between the interviewer and the person being interviewed. Through direct conversation, the interviewer can ask what he/she wants to know, tell if questions are understood, and ensure the questions are answered. While we encourage you to develop a question guide to use throughout your interviews, another advantage of an interview is its spontaneity. Topics of importance that were not anticipated can be discussed. Also, sometimes a person will tell an individual what they wouldn’t write on a survey form. Disadvantages of Interviews Interviews are time-consuming. Busy people may find it hard to spare the time for an interview. When the interview is completed, the interviewer must transcribe notes, and if multiple interviews are being conducted, compile the results alongside what is learned from other interviews. Interviews are not the most efficient method of data collection when you want information from a large number of people. Interviews provide the thoughts, opinions, and beliefs of the individual. These may not be representative of the community. The person being interviewed may be biased and try to influence you on behalf of his or her interests. If the interviewee doesn’t trust you or your group, the information may not be accurate. Whom Should You Interview? Whom you interview will depend on what you want to know. If you’re trying to determine what health services are available and accessible in each part of the county, you may want to talk to a representative of each service provider. If you want to know if community members know about and use services that are available, you’ll want to talk to community members living in various parts of the county. Phase 2: Collect Community Data 2–7 Usually some interviews are done with people designated as key informants—gatekeepers to the community who come closest to representing the community. These might include a popular radio disc jockey, a hairdresser or barber who’s been involved in community activities, or a local minister. Because of their connections to the community or possibly because of the job they hold, they are likely to know what is going on and to know how others feel about the community. Consider interviewing people representative of the county population. If 15% of your county is Native American, be sure that you interview Native Americans. This will ensure that you don’t omit representation of a segment of the population from the information you have gathered. Prepare for the Interview The structure of your interviews can be formal, with specific, identical questions asked of each person interviewed. It can be less structured with a list of questions that guide the interview, but with time for a more relaxed conversation. Alternatively, the interview can be unstructured and the interviewer can ask questions that seem appropriate for the person being interviewed. We suggest that you have at least some structure and questions that are repeated for most if not all interviewees. This makes the comparison of interview results easier. Guidelines for Interviewing Service Providers in Your County and Guidelines for Interviewing Residents in Your County are found in the Tools for Phase 2. Determine exactly what you want to know. Remember the old adage: What gets measured gets addressed. This sounds simple, but it is an important consideration in writing survey questions. If you don’t ask questions that elicit what you want to know, you aren’t likely to learn what you need to know. Draft your questions and discuss them with others who are collecting data or who may also be conducting interviews. Pilot test your questions with community members or leaders from your own organization. Decide if you are going to interview people face-to-face or over the telephone. There are advantages to each type of interview. Face-to-face Interviews Face-to-face interviews give you the most flexibility in data collection. You can set the time and the place and make sure that all your questions have been answered before the interview ends. You can be sure that your questions are understood, and you can follow-up with another question when unanticipated information is elicited. You can pick up on nonverbal cues about the interviewee’s enthusiasm or comfort for the topic being discussed. You know who is giving you the information you are gathering (with a written survey, you can not be sure who actually completed the form.) Many of the drawbacks to face-to-face interviews are included in the Disadvantages of Interviews above. Time and money rank as probably the greatest problems to overcome. 2–8 Phase 2: Collect Community Data Telephone Interviews Telephone interviews are great tools for collecting information. Like face-to-face interviews, they offer flexibility and control over questions asked and answered. Of course, nonverbal cues cannot be observed, but the expense and time constraints of traveling to each individual interview are overcome. This is especially helpful when the person you want to interview lives a distance away. Telephone interviews should be shorter than face-to-face interviews. Most people don’t want to talk on the telephone for more than about ten minutes. You can call ahead and schedule a time to talk to the interviewee or call and ask if the present time is convenient. Identify yourself; tell your affiliation and why you are calling. Ask the interviewee if he or she has time to talk to you. If not, ask if you can call back later. If the interviewee agrees to a call-back, set a time. Not everyone has a telephone, others have unlisted numbers, and some only use cell phones. Be aware that you can not reach all of your community with a telephone interview, so the results may not be completely representative of the entire population. Conduct the Interview Once you have determined the questions you want to ask, how you’re going to ask them (face-to-face or over the telephone), and who you’re going to interview, relax and enjoy the process. Interviewing comes easier to some people than to others, but if you are prepared and genuinely want to learn from the interviewee, the interview is likely to go smoothly. The box on the following page from the Community Tool Box offers some hints. Introduce yourself and remind the interviewee the purpose of the interview. Tell the interviewee that you will not exceed the time you have agreed on and that you appreciate his or her time and involvement in the assessment process. Discuss confidentiality and assure that the interviewee’s name or position will not be tied to the information provided, and others will not be able to link any information back to the interviewee. Take good notes and include direct quotes, as they are valuable. If you want to use quotes in the report to the community or the assessment document, get permission. Most interviewers take notes rather than use a tape recorder. If you do choose to tape record the interview, then tell the interviewee that you are doing this. Realize that some people are not comfortable being recorded and may want you to turn it off for sensitive subjects. Make sure your tape recorder is working well and that you don’t have to tinker with it during the interview. This can be distracting to both of you. At the conclusion of the interview, thank the participant again. If a report of the assessment is being written, the interviewee may want a copy. Provide one if possible or at least tell when and where a copy can be obtained. If a presentation of the data is planned for after the end of the assessment process, tell the interviewee a notice will be sent regarding the time and place. It is a good idea to send a thank-you note. Phase 2: Collect Community Data 2–9 How to Conduct a Successful Interview ✔ Practice—prepare a list of interview questions in advance. Rehearse, try lines, and mock-interview friends. Practice Memorize your questions. Plan ahead the location and ways to make the setting more comfortable. ✔ Small-talk—never begin an interview cold. Try to put your interviewee at ease and establish rapport. Small-talk ✔ Be natural—even if you rehearsed your interview time and time again and have all your questions memorized, natural make it sound and feel like you’re coming up with them right there. ✔ Look sharp—dress appropriately to the setting and the kind of person you’re interviewing. Arrive on time if you sharp are conducting the interview in person. ✔ Listen—present yourself as aware and interested. If your interviewee says something funny, smile. If it’s something Listen sad, look sad. React to what you hear. ✔ Keep your goals in mind—remember mind that what you want is to obtain information. Keep the interview on track and don’t digress too much. Keep the conversation focused on your questions. Be considerate of your interviewee’s time. ✔ Don’t take “yes/no” answers answers—Monosyllabic answers don’t offer much information. Ask for an elaboration, probe, and ask why. Silence may also yield information. Ask the interviewee to clarify anything you do not understand. ✔ Respect—make interviewees feel like their answers are very important to you (they are supposed to be!) Respect and be respectful for the time they’re donating to help you. Adapted from Vilela, Marcelo. Conducting Interviews, Community Tool Box: Part B, Chapter 3, Section 12. Edited by Kate Nagy. http://ctb.lsi.ukans.education/promotion/tools/EN/sub_section_main_1047.htm Analyze the Results of your Interviews The Community Health Assessment Team or a group of team members should read the notes or transcripts from the interviews. Verify that interviewees are representative of the community as a whole or if not, what subgroup they represent (e.g., age, educational level, race, or ethnicity). Determine if any common themes or concerns emerge. If so, note them and check with other methods of data gathering to see if they appear there as well. Find out if anyone said anything unexpected or surprising. A team member should summarize the results of the analysis to document the work and to pass on to others not involved in the analysis. 2–10 Phase 2: Collect Community Data Conduct Listening Sessions A community’s definitions and understandings of health, illness, and services affect health attitudes, beliefs, and behaviors. Listening sessions are an effective means of eliciting those definitions and understandings and identifying community members’ priorities about health care. They are small-group discussions with community members that concentrate on specific topics. They are designed to allow participants to collectively articulate opinions and feelings, enable observers to understand the attitudes and beliefs that influence behaviors, and to gather data about environmental and policy factors that affect health. Listening sessions build support and “buy in” for community-based projects aimed at improving community health and community healthcare access. The Community Health Assessment Team may want to conduct several listening sessions in different areas of the county or with different populations. Listening Sessions are ✔ focused on a specific topic or topics, ✔ centered around several carefully designed open-ended questions, ✔ facilitated by a trained moderator, ✔ recorded by a trained assistant moderator, ✔ generally held in a setting familiar to participants in their own community, ✔ generally held with existing groups (e.g., volunteer fire departments or community clubs), and ✔ approximately 1½ hours in length. From Landis, S., Plaut, T., Trevor, J., & Futch, J. (1996). Building a healthier tomorrow: A manual for rural coalition building. Dubuque, Iowa: Kendall/Hunt. Advantages to Listening Sessions Listening sessions offer a depth and complexity of information not always found in other methods of data collection. Participants may stimulate each other to thoughts they would not have had individually. Listening sessions can yield a greater array of unanticipated responses to a question compared to a survey. Participants will tell you what is important to them and how they feel about a topic rather than simply responding to predetermined categories of responses. During a listening session, the moderator has the opportunity to observe interaction and discussion on a topic in a limited period of time. Nonverbal reactions can often tell observers much about participants’ opinions on a topic. Also, listening sessions are relatively easy to conduct, and in many cases, they can be done cheaply and quickly. Phase 2: Collect Community Data 2–11 Disadvantages to Listening Sessions Analyzing the results of a listening session is challenging. It requires time to transcribe the recordings or notes and give thought to the discussion. The responses to questions are often long and complex; translating this information into useful data is not easy. If you need a number or a score at the end of your analysis, listening sessions are not the best methodology. Another disadvantage is that even though a multitude of topics can be addressed during the discussion, it may be difficult to explore them in detail. Sometimes participants may feel intimidated in contributing to the discussion. An individual may be less responsive to discussing certain topics among a group of people than in a one-on-one interview. The Role of Participants Participants agree to take part in listening sessions for a variety of reasons. The organizer or moderator should make it clear what is expected of them before they agree to contribute. Participants are expected to: • Give their perceptions about the questions being considered, to voice their views. • Tell their experiences and compare experiences with each other. • Interact with other participants in an effort to understand one another’s experiences (by comparing and contrasting their own experiences with others’, they can become more explicit about their own views). • Give an insight into their emotions associated with perceptions. • Give group understandings and definitions of situations and events. What you don’t want from participants are negative comments about people, great detail about a personal situation, or information about improper or illegal behavior. Ways to handle these behaviors are included in the Role of the Moderator section of this phase. The Role of the Moderator The moderator facilitates interaction between group members and makes sure that the discussion remains on the topic at hand. Partnership members and volunteers can be trained to lead listening sessions. The moderator should make everyone feel welcome and valued. Listening sessions should be conducted in teams of two. The moderator can ask questions and direct the flow of the discussion, while the assistant moderator takes extensive notes and operates the tape recorder. There are certain intentional or unintentional biases of the moderator that can affect the validity of the listening session data. Personal bias is the predisposition to reinforce the points of view expressed by a participant that are similar to our own. For example, greeting favorable comments with nods and reinforcing remarks, and responding to unfavorable comments with indifference or looks of discomfort can produce personal bias. The need for consistency is the 2–12 Phase 2: Collect Community Data predisposition to reinforce the expression of points of view that are internally consistent. For example, in periodic summaries of group positions, understating “minority” points of view can introduce bias. In the Tools Needed for Phase 2, helpful guides for moderators and assistant moderators include Moderator Dos and Don’ts, Expectations of Moderators, Expectations of Assistant Moderators, and Note Taking Tips for Assistant Moderators. Listening Session Question Guide The questions that you ask during your listening session depend on what the goals are for your community assessment process. In the Tools for Phase 2, there are Guidelines for Conducting a Listening Session. These guidelines include sections on Equipment and Supplies, Methods, Moderator Introduction (which includes suggested welcome, overview, review of ground rules, and explanation of confidentiality), and Moderator Guide to Questions. There is also a guide for Setting up for the Listening Session that provides suggestions on the right location and surroundings for your listening session. These guides are here for you to use or modify as you choose. Incentives for Listening Session Participants A listening session can be a time-consuming event for participants. The moderators can provide incentives for participants to attract them. For some individuals, the listening session itself can be an incentive since it gives the participant a chance to voice his/her opinion regarding important community issues. However, a stimulating discussion may not be enough to entice some individuals to spend time in a listening session. It may be a good idea to serve some refreshments and snack; the presence of food can help participants relax. Providing babysitting services may also increase participation. Setting up the Session How do you choose the people who will participate in listening sessions? Identify the key constituencies in the community from different neighborhoods or geographic communities, different ethnic populations, different age cohorts, etc. It may be helpful to look at a map of the community to document not only the different geographic locations but also diversities such as ethnicity and age. Conduct a listening session in each group from which you want information. Hold the session at a place that is familiar to the chosen constituency such as a church, volunteer fire department, community club, etc. A guide for Setting up for the Listening Session is found in the Tools section of phase 2. Conduct the Session The purpose of a listening session is to learn from participants their attitudes, beliefs, opinions, and ideas about the health of the community. To maximize the possibility of obtaining responses from all members of the group, the moderator must control excessively talkative participants, activate reserved participants, and try to produce a wide array of responses from as Phase 2: Collect Community Data 2–13 many different members of the group as possible. The moderator should control a participant when the individual digresses from the topic being discussed or when the participant is monopolizing the session. The moderator may be able to redirect the conversation to a relevant topic or underscore that the group needs to hear what others think. This way, the moderator intervenes in the situation without criticizing the participant. If individuals seem generally shy and reserved, the moderator can look for behavioral and nonverbal cues of readiness to take part. There are certain phrases that the moderator can use to make sure everyone is given a chance to speak, such as, “How did the rest of you feel about that statement?” “Do any of you have other ideas on the topic?” or “Would any of you agree or disagree with that remark?” The moderator should never coerce any members of the group to speak in the listening sessions. Tape Recording and Transcribing the Session There are many benefits from tape recording listening sessions. A tape provides an accurate record of the discussion. If there is something unclear in the notes, the tape can clarify any ambiguity. Tape recording the discussions also allows the moderator/transcriber to go back and hear pertinent information that may have been missed in the notes while listening. In addition, moderators can benefit by reviewing the tapes so that they can improve their own technique. Before you begin, explain to participants why you wish to tape-record the session. State that no individual names should be mentioned during the discussion (to preserve confidentiality) and that the tapes will be destroyed after transcription and completion of the document. Ask participants if they agree. If they are reluctant, you may want to forgo the taping and take the best notes possible. Otherwise, participants will likely be reluctant to be forthcoming with their responses. Transcribing listening sessions can be very beneficial, since it provides a complete picture of the participants’ thoughts and ideas. However, it can take about 4 to 6 hours to transcribe a 90minute tape. If good notes are kept, transcribing the session may be unnecessary. The note-taker should outline the conversation and note where there are good quotes for possible later transcription. It is possible to listen to the tape a number of times, pick out sections that seem important, and transcribe those parts. Analyze the Listening Session Information Analyzing the listening session discussions can be a great challenge. If sessions have been transcribed, read the transcripts of all the sessions. If transcripts are not written, gather the moderators and note takers for each session to discuss what they heard. Group the information according to the key topics or areas of concern, such as schools, services for older people, child care, job opportunities, etc. Identify the different positions that emerged from the various topics discussed during the session. For example, the moderator can notice if there was a generally positive impression of a certain service that was being provided in the community. To supplement the positions and themes that emerged, the team can find phrases from the notes or transcriptions that support it. If transcripts of the sessions have been typed, they can be entered into one of various computer programs that analyze qualitative data. None are free, but the cost 2–14 Phase 2: Collect Community Data may be within reach of some communities. These programs can help the team find common themes and discover the community’s knowledge and opinion on various topics discussed. Such software can be used to analyze any qualitative data, such as the transcripts of interviews or listening sessions. When reporting the results from a listening session, one should not interpret the data by a head count. For example, one should not report that “85% of the listening session respondents said --------.” These statements are inaccurate due to sampling bias and group dynamics. If the data you are looking for are a head count, you should use a more quantitative approach (i.e., surveys and other objective measures). If you prepare a report on the results of the session or of all sessions, think about the purpose and objectives, and the key decisions and steps that may be taken. Based on the listening session discussions, address each key objective with recommendations and insights from the group. There are several suggested components for the listening session report: • Summary • Introduction and background • Purpose and objectives • Description of the research design chosen • Results of the listening session discussions • Conclusions/recommendations • Appendices (questionnaires, interview guides, or other materials used during the discussions) Resource Person Please contact Thomas Plaut, Ph.D., if you are interested in using or learning more about listening sessions being used throughout North Carolina. Thomas Plaut, Ph.D. Director, Center for Assessment and Research Alliances (CARA) Box 6711 Mars Hill College Mars Hill, NC 28754 (828) 689-1337 (phone) (828) 689-(fax) E-Mail: tplaut@mhc.edu Phase 2: Collect Community Data 2–15 Conduct A Community Health Opinion Survey A survey is another method your Community Health Assessment Team can use to discover what community members think about their community. Surveys usually have short questions with predetermined response categories. You could survey everyone in the community, but most often a sample of the population is surveyed. A well-designed sampled survey should reflect the thinking of all the members of the community. Many communities use sampled surveys to determine what the community as a whole is thinking. Surveys are administered (via mail, email, telephone, or given out at a place or event) to people from your sample. The sample survey in the appendix of this phase is provided in sections. Your team may decide to use the entire survey or only those pages that ask about the topics they wish to learn more about. Your team may modify any page. Advantages of Surveys Surveys are an excellent way to get the opinion of a large number of people. The cost may be less than some other methods of gathering data, and they provide a written account of the answers given, which makes tabulating responses easier. If administered by mail, no training of interviewers is necessary and possible interviewer bias is eliminated. Surveys can be completed when it is convenient for the respondent. They can provide anonymity that allows people to be honest without fear of reprisal. Disadvantages of Surveys One of the biggest problems is the low response rate. Good intentions don’t always lead to survey completion. Follow-ups and reminders may be necessary. If literacy is a concern in your community, mailed surveys may not be a good method to collect information. Surveys do not offer an opportunity to examine complex issues in depth. It may be impossible to assure that the respondent understands the questions. Also, because the choice of answers may be limited, the true opinion of the respondent may not be represented. Depending on who responds and who doesn’t, the responses may not be representative of the group as a whole. Whom Should You Survey? The target population refers to the persons to whom the survey’s findings are to be applied or generalized. The sample is a portion or subset of the target population. The best sample is representative of the target population. A sample is representative of the target population if important characteristics (e.g., age, sex, race, ethnicity, income, etc.) are distributed equally in both groups. For example, if the target population consists of 2,500 people, 70% of whom are African American, with 45% over the age of 65, then your sample should also consist of approximately 75% African Americans, with approximately 45% over the age of 65. Samples are meaningful only to the extent that they represent the target population. 2–16 Phase 2: Collect Community Data Your Community Assessment Team can sample from the entire community or collect data from community leaders. Surveying these two different target populations will tell you different things. A survey of a sample from the entire community will tell you about what the community as a whole thinks, whereas a community leader survey will tell you what those who are in leadership positions in the community think. You may survey both a sample of the entire community and community leaders and note how the answers from community leaders compare with those of the population in general. Community Sample Survey If your Community Assessment Team is interested in finding out about your community as a whole, you must decide exactly who will be surveyed to represent their opinions. Sampling only a subset of the community, rather than the entire community, is the method of choice because it would be too expensive and too time consuming to survey every person in your community. The quality and use of your data, especially the extent to which your findings can be generalized to the entire community, will depend on how you choose a sample. We suggest that you choose one of two sampling methods: random sampling or convenience sampling. The ideal method to use is random sampling. A sample is random if every person in your community has an equal chance of being included. Random samples are generalizable; meaning that you can confidently say something about your entire community based on your sample. Although random sampling can yield excellent results, this technique can be complex. If you choose to use random sampling, we recommend that you consult a survey expert to develop an appropriate strategy for generating a random sample. Because random sampling can be complicated and expensive, your Community Assessment Team may choose to do convenience sampling. In this type of sampling, respondents are included because it is convenient to do so. An example of convenience sampling is surveying people at a neighborhood shopping center or clients at a medical clinic. The main advantages of this survey technique are that data can be collected relatively rapidly and inexpensively. However, this type of method can produce biased results since the respondents that are selected may be different from the community in general. Because of this potential for bias, your data must be interpreted with caution. MISLEADING DATA IS WORSE THAN NO DATA! If you use convenience sampling, develop a sample that is, as much as possible, representative of your community as a whole. Keep track of the details of how the sample was selected so you can report them along with the results. It is important to describe whom the sample and data represent because generalizations can be made only to persons who are similar to your convenience sample. Community Leader Survey Because a community sample can require a significant amount of time and resources, your team may opt to survey only community leaders. It is relatively easy to implement and can provide you with information regarding the perception of decision-makers in your community. Knowing community leaders’ opinions and concerns is important, and involving community Phase 2: Collect Community Data 2–17 leaders in the assessment process can lead to support for any changes that are indicated by the community assessment process. Using the list of community leaders that follows as a guide, develop your own list. Include persons from all sectors of your community. For example, if your county is a mixed urban/rural county, include representatives from each geographic area. Also, include representatives from all age groups—from adolescents to older people. Suggested Community Leaders Business & Industry Managers of Farmer’s Co-Op Individual Business Owners Local Industry Executives/Reps. Attorneys Accountants Chamber of Commerce Reps. Realtors Agricultural Organizations Insurance Agents Labor Union Representatives Civic & Social Girl/Boy Scout Leaders Rotary Club Representatives Senior Citizen Organization Leaders NAACP Members Librarian Volunteer Organization Leaders Government Mayor City/County Commissioners City/County Managers Police Chief/Sheriff/Fire Chief Extension Agency Representatives Health & Welfare County Nurse/Local Health Dept. Administrator Hospital Administrator Nursing Home Administrator Emergency Medical Services Director Social Services Director Mental Health Center Director Dentists Physicians Clinic Director Child Care Providers Non-Profit Health & Welfare Organization Reps Religious Church Leaders Ministerial Alliance Representatives Education School District Administrator Principals & Teachers Student Body Representatives Peer Counselors School Counselors School Board Members PTA Representatives University Fraternities and Sororities Media News/Public Service Director for TV/radio stations or newspapers that have good local coverage Prepare for the Survey If possible, consult a person with survey experience. Such a person may be available in your community (e.g., employed by a manufacturer, marketing research company, college, or university) or known to persons in your community. 2–18 Phase 2: Collect Community Data Begin the survey by stating the purpose of the survey, why it is being done, who is conducting it, and how the information will be used. Let respondents know that their answers are confidential. Give clear instructions—remember when someone is completing the survey in writing, they can’t ask you, “What did you mean by this question?” Ask the respondent to provide demographic information that may assist in analysis. Information such as age, income, gender, education, and ethnicity are common on surveys. Prepare survey questions that can be answered quickly and easily. Give respondents a box to check or a place to circle their answer. Surveys contain several types of questions: • closed-ended questions. These can be answered with a yes or no. • multiple choice questions. Respondents choose from one of usually 4 or 5 possible answers. • Likert scale questions. Respondents rate their answer on a scale. For example, given a statement, the respondent ...
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