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Community Assessment Where do We Stand? Assessing your Community Establishing Goals & Objectives; Planning for Evaluation Finding Evidence Selecting Best Fitting EBAs Adapting Implementing & Evaluating Session Objectives • Discuss how community assessment can improve processes for selecting, adapting, and evaluating an evidence-based approach • Know what types of questions to answer using community assessment • Identify sources of secondary and primary data • Know how to develop health goals and behavioral/environmental objectives based on community assessment data Definition A Community Assessment is a systematic data collection to look at the difference between what is and what should be in a group and situation of interest, AND the identification of resources available to address this gap. (Adapted from Gilmore & Cambell cited in Green & Kreuter, 2005) Why Community Assessment? • Identify and prioritize health problems in your community • Describe target population - including their health goals and priorities • Identify community strengths, needs & available resources - including behavioral & environmental factors that may support or inhibit goal attainment Why Community Assessment? • Identify factors that affect health in a target population (e.g., determinants of health) - especially modifiable factors that you may work to change • Locate service gaps and opportunities for your organization • Obtain data - to inform program planning - for evaluation - for use in grant writing Activity: Community Assessment Worksheet Brainstorming Activity Instructions: Community Assessment 1. List three things that you would like to know about your community before developing a health promotion plan. Ex. For obesity prevention activities, you may want to know the proportion of people in a group or community that meet minimal physical activity guidelines 2. Where can you find this information? Ex. You could find this information in the CDC’s Behavioral Risk Factor Surveillance System (BRFSS) Assessment Questions A Community Assessment can be conducted in a community by addressing the constructs of the PRECEDE phases in the PRECEDE-PROCEED Model. Phase 4: Determinants of Behaviors Phase 3: Behavioral and Environmental Factors Phase 2: Health Problems Phase 1: Quality of Life Sources: Green & Kreuter, 2006; Bartholomew et al., 2006 PRECEDE: Predisposing, Reinforcing, and Enabling Constructs in Educational/Environmental Diagnosis & Evaluation (leads up to the intervention) PROCEED: Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development Determinants of Health Behaviors The range of social, environmental and personal factors that influence health behaviors • Social factors E.g., social support for change • Environmental factors E.g., parks, access to healthy foods • Personal factors E.g., Socio-economic position, religious & cultural values, knowledge, attitudes & beliefs about health risks and behaviors Questions to Answer about Your Community Phase 1: Quality of Life Life expectancy Example Questions What is the average lifespan? Phase 2: Health Problems Chronic disease rate Which diseases are most prevalent? Phase 3: Behavioral Factors Behaviors What behaviors put people at risk? Social factors Where do people spend most of their time? Phase 3: Environmental Factors (e.g., social, built, and media environment) Environmental What facilitates/hinders healthy behaviors? Demographics Where do they live? Communication Where do people obtain health information? Sources: Emory Prevention Research Center & Bartholomew et al., 2006 Questions to Answer about Your Community Phase 4: Determinants of Behaviors Health problems What are their health problems? What are barriers to improving health care? Values What is important to them? Individual factors What are the personal knowledge/attitudes regarding the health issue/behavior? Social and cultural factors What are commonly held beliefs and attitudes about health, health care, or particular health behaviors such as exercise? Demographics of target population Where do people live? What are the ethnicities, education levels, ages, etc.? Sources: Emory Prevention Research Center & Bartholomew et al., 2006 Asset-focused Assessment A community asset or resource is: anything that improves the quality of community life. Assets include: – Capacities and abilities of community members. – A physical structure or place. For example, a school, hospital, church, library, recreation center, or social club. Other places such as parks or open spaces are also relevant. – A business that provides jobs & supports the local economy. – Civic or Cultural associations (a Neighborhood Watch or a Parent Teacher Association) – Local private, public, & nonprofit organizations. Community Assessment Data Collection Methods • Primary: Data that you collect • Secondary: Data that has already been collected and published in a report, website, publicly available dataset or journal article Data from Secondary Sources • Demographics (U.S. Census) • Vital statistics (State and Local Health Departments) • Disease prevalence & incidence • Morbidity and mortality reports • Behavioral risk factors What other sources would YOU include? List of Secondary Sources: Handout #1 National Data Source Example: Cancer Control P.L.A.N.E.T. Example: What is the CRC Incidence in Salt Lake County? Scroll down to Salt Lake National Data Source Example: BRFSS National Data Source Example: CDC National Center for Health Statistics Conducting Literature Reviews • A summary of the knowledge about a topic area • Before you begin, ask yourself: – What is the specific problem/question that I want to address? – What type of literature should I review? – What issues should I be looking at more closely? – What are the key words? Literature Reviews Journals versus magazines: – Peer review How to search: – Key words – Use of quotes – Publication Year – Combining terms Web sites: – .gov, .org, & .edu vs .com – PubMed.gov Primary Data Collection Methods • Qualitative Data – Unstructured or semi-structured interviews – Focus Groups (small group discussions) – Public meetings or forum – Direct observation of community or people • Quantitative Data – Structured interviews – Surveys Primary Data Collection Methods • Interviews • Public Meetings/ Forums • Focus Groups • Direct Observation • Surveys Important considerations: – Participants Representative of the group you want to learn about? – Methods used to collect data (e.g., Mail, Online, Phone, In Person) Influence types of people who will respond – Resources Needed (e.g., Cost, time, incentives, and human resources) Vary depending on methods used Definition A Community Assessment is a systematic data collection to look at the difference between what is and what should be in a group and situation of interest, AND the identification of resources available to address this gap. (Adapted from Gilmore & Cambell cited in Green & Kreuter, 2005) Creating Goals Goals -Broad, long-term aim - May not be time specific Objectives -Specific, short-term aim -May focus on knowledge, attitude, or behavior Creating SMART Objectives “SMART” Objectives Specific: Who and What? Measurable: How much/many? Achievable: Attainable w/ given time frame & available resources. Realistic: Address the scope of the problem and programmatic steps that can be implemented w/in the time frame. Time specific: By When? “What Should Be” in a Community (i.e., Target) National Goal (Healthy People 2020): CRC Screening: Increase the proportion of adults who receive a colorectal cancer screening based on the most recent guidelines. • “What is” (Baseline): 54.2% of adults aged 50 to 75 years received CRC screening based on the most recent guidelines in 2008. • “What should be” (Target): 70.5% Goals & Objectives Example Goal: – “Reduce cervical cancer mortality in the community”. Example Objectives: – Knowledge: “By the end of the first education session, at least 80% of the participants will be able to list three risk factors for cervical cancer”. – Attitude: “By the end of the program, at least 80% of the participants will answer “strongly agree” or “agree” to whether they think cervical cancer screening is important to their health”. – Behavior: “5 months after the program ends, at least 50% of the participants will have obtained cervical cancer screening.” Logic Model of Change Objectives Goal Determinants Knowledge: >80% can list 3 CRC screening types Attitude: >90% rate CRC screening as very important Self-efficacy: >80% express confidence in their ability to obtain CRC screening Behavior: >60% will obtain CRC screening Health Goal: Reduce CRC morbidity & mortality Environment: Free or low cost fecal tests are available Take-home Points: Importance of Knowing Your Audience • Understand determinants or factors that affect a health behavior or issue • Have information to better select programs, policies or strategies to meet the needs of your community • Gain data to assist in adapting programs or strategies to make them more relevant to the community • Know the community context and issues when implementing or evaluating a new program, policy or strategy Questions?