Better Understanding Our Problem: Problem-Oriented Needs Assessment William M. Sappenfield, MD, MPH Professor & Chair, Dept. of Community and Family Health USF College of Public Health Training Course in MCH Epidemiology Denver Colorado

Being Effective in Public Health

Being Effective in Public Health?

Being Effective in Public Health

Health Problem: Late PNC Entry South Carolina

Needs Assessment n Underreporting of prenatal visits n Physicians not starting to 2nd trimester n Late entry into the WIC program n Problem recognition by Community n Transportation & child care barriers n Unintended pregnancy

Potential Strategies n Underreporting of prenatal visits –Vital registration manual –Clerk training –Health department record transfer –Physician record transfer –Standardized prenatal care record –Physician & hospital education –Monthly reporting system –Hospital standards –Incentive awards

Chosen Strategies n Underreporting of prenatal visits –Vital registration manual –Clerk training –Health department record transfer –Physician record transfer –Standardized prenatal care record –Physician & hospital education –Monthly reporting system –Hospital standards –Incentive awards

Being Effective in Public Health

Health Problem: Late PNC Entry South Carolina

So Why Doesn’t It Happen? n Limited/over-committed staffing. n Limited expertise. n Lack of adequate follow-up. n Previous planning failures. n Insufficient resources for current initiatives. n Lack of political will. n Committed/focused on present activities. n Competing priorities/desires.

Being Effective in Public Health

Definition of Needs Assessment Systematic collection and examination of information… to make decisions to formulate a plan… for the next steps leading to public health action…

Needs Assessment Qualities n Visionary n Conceptual n Systematic n Resourceful n Pragmatic n Action-oriented n Cohesive

Types of Needs Assessment... n Community--Healthy Communities n Population--Title V (MCH) n Health Systems--Emergency Response n Program--Title X (Family Planning) n Health Services--Prenatal Clinic Location n Health Problem--Infant Mortality

Needs Assessment Phases  Health problem identification and measurement  Prioritization of health problems  Analysis of a particular health problem  Assess potential strategies to address targeted aspects Part 1 Part 2

What is a health problem? n Community perception? n Health status measure? n Risk Factor? n Health Service Deficiency? n Measurement? n Comparison?

Problem Identification & Verification n Stakeholders n Partners n Reports n Available Data Purpose: Search & compile

Problem Definition n Extent n Duration n Expected future course n Variation Purpose: Define, describe & validate

Types of Prioritization n Group consensus n Voting n Criteria-based rating n Q sort Purpose: Build consensus/support

Q-Sort Procedure: Priority Log Sheet for 25 MCH Needs 5th 4 th 5 th 6 th 3 rd 4 th 5 th 6 th 7 th 2 nd 3 rd 4 th 5 th 6 th 7 th 8 th 1 st 2 nd 3 rd 4 th 5 th 6 th 7 th 8 th 9 th

Part 1: Identification & Prioritization Selection Criteria n Magnitude of the problem n Trend n Severity/consequences n Perceived preventability n National/state goals n Agency capacity n Political/community acceptability

Part 1: Identification & Prioritization Real Selection Criteria n State or agency political will n Current program priority n Currently funded activity n Fits current staffing/resource patterns n People available to work on the issue n Important issue to the heart

Matrix of MCH Problems CriteriaWeightLBWPeri HIVSmoking Magnitude2 Trend2 Severity3 Preventable2 Goal1 Capacity3 Acceptable1

Clear Scoring Criteria Magnitude n Low incidence/prevalence n Moderate in some subgroups n Moderate in all groups n High in some subgroups n High in all groups

Part 1: Identification & Prioritization Real Selection Criteria n Available funding n State or agency political will n Program priority n Currently funded activity n Fits current staffing/resource patterns n People available to work on the issue n Required performance measure n Important issue to the heart

Needs Assessment Phases  Health problem identification and measurement  Prioritization of health problems  Analysis of a particular health problem  Assess potential strategies to address targeted aspects Part 1 Part 2

Being Effective in Public Health Assessment Capacity & Strategies Plan Evaluation Monitor Implement Plan Do Who? What? When?Where? How? Resources?

Bill's Steps for Problem-Oriented Needs Assessment Theoretical Framework Gather Readily Available Information Frame and Choose Critical Questions Choose and Develop Methods Analyze and Answer Your Questions Summarize Your Problem Present the Results

Gather… n Other Needs Assessments n Available Reports n Key Data People n Key Community People

Frame & Choose Critical Questions n What Are Remaining Questions? n What is Gained By Answering the Question? Do Something Different? n Can the Question Be Answered? n What Will It Cost? n Will It Be Part of the Big Picture?

Bill's Steps for Problem-Oriented Needs Assessment Theoretical Framework Gather Readily Available Information Frame and Choose Critical Questions Choose and Develop Methods Analyze and Answer Your Questions Summarize Your Problem Present the Results

Needs Assessment Results n Statement of the problem n Problem trends n Individual contributors to the problem n Individual strengths n Community contributors to the problem n Community strengths

Being Effective in Public Health

Problem Analysis Access to poison by children Ingestion of poison Death from poison consumption Program Hypothesis Reduce child poison deaths Reduce poison consumption Provide childproof containers

Program Hypothesis Reduce child poison deaths Reduce poison consumption Provide childproof containers Problem Analysis Access to poison by children Ingestion of poison Death from poison consumption

Program Hypothesis Goal Policy Program Operational Activities of the program Change in characteristics of recipients Change in health status of recipients Change in health of community

Short Term Intermediate Long Term Changes in the target population Products of the program Key actions of program staff and clients The resources needed to deliver the program Theoretical assumptions about why a program works OutcomesOutputsActivitiesInputsAssumptions Population Focus: Community(ies) Logic Model Framework

Being Effective in Public Health

Needs Assessment Debates n Qualitative or Quantitative n Assets or Problems n Assessment or Surveillance n One Time or Ongoing n Ourselves or Contract n Science or Art n Performance or Pretty