Approaches to Community Health Assessment

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Approaches to Community Health Assessment
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What is a Community?

• Many definitions of community
• These may change according to specific
  circumstances
• Community as a specific geographic location
• Community as a social setting

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• Community as a social structure
• Community as sentiment/affiliation
• Community as shared risk
• Varied nature of communities requires flexibility
  when assessing them

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What do Communities Do?

• Production distribution consumption
• Socialization
• Social control
• Social participation
• Mutual support

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Why Assess Communities?

• Essential first step in the process of health
  planning
• To identify the health status of a community
• To provide a baseline to evaluate planned and
  potential interventions

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• To identify factors that may be influencing
  health status
• Both positive and negative
• To identify community resources
• To identify gaps and overlaps in existing
  resources

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• To identify key stakeholders in the community
• To solicit the opinions of community members
• To engage community members in thinking about the
  health of their community

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• To identify at-risk populations

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How Can Communities be Assessed?

• Both comprehensive and focussed assessment
  approaches can be used
• Nursing and non-nursing models exist

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Comprehensive Approaches - Nursing

• Community as Client (Allender Spradley, 2001)
• Dimensions of the Community
• Physical location
• Boundaries
• Location of health services
• Geographic features
• Climate
• Flora fauna
• Human-made environment

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

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• Population
• Size
• Density
• Composition
• Population pyramid
• Rate of growth/decline
• Social class educational level
• Mobility

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• Community as Partner (Vollman, Anderson
  McFarlane, 2004)
• Community Assessment Wheel
• Community core
• History
• Demographics
• Vital statistics

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

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• Other nursing models exist as well
• These range from the ridiculous to the sublime
• Often ineffective attempts to move nursing models
  developed to work at the individual level to the
  aggregate level

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• For example, model proposed by Kriegler Harton
• Based on Gordons 11 functional health patterns
• Health perception/health management
• Nutritional metabolic
• Elimination
• Activity/exercise
• Sleep/rest

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

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Comprehensive Approaches Non-Nursing

• Health Indicator Workbook A Tool for Healthy
  Communities (BC Ministry of Health, 1995)
• Six functions of a community ( a garden)

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

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

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• Maintenance of physical environment
• Management
• Growth development
• Support

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• Manitoba Health (1997)
• Conceptual model based on Action Research
• Uses both ethnographic (interviews) and
  epidemiological data
• Iterative process where findings in 1 data set
  informs the research process in the other data set

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• Feedback sessions
• Informants community are consulted to determine
  if information is accurate/complete
• Assumption of this approach
• Data necessary to determine health status and
  health needs of a community comes from a variety
  of sources

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• Deliberate effort to involve many community
  members not just key informants
• Non-conventional sectors may be specifically
  approaches
• Churches
• Schools
• Cultural groups
• Social groups

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• Manitoba Healths conceptual model integrates
  some of these ideas

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• Winnipeg Regional Health Authority
• Conceptual model included in report
• Familiar components integrated into this model
• Population health model
• Action research

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Problem Oriented Assessments

• Begins with identification of a specific problem
• Seeks information about it
• Identifies who requires a solution for the
  problem
• Assesses the communitys capacity to respond

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Community Subsystem Assessment

• Focuses on one specific community subsystem
• How this subsystem is conceptualized influenced
  by how the whole community is defined and
  conceptualized
• e.g. Allender Spradley
• Vollman, Anderson McFarlane

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Community Assets Assessment

• Concerns that traditional approaches focussed on
  weaknesses, problems, deficits
• As a result, we know much about programming for
  a communitys problems and little about
  programming for its possibilities.

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• Impossible for a community to be helped or help
  itself if no strengths can be identified
• Forces a community to malign itself
• All you researchers ever do is focus on the
  negative things in our neighbourhood. When are
  you going to start seeing whats right here?

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• Leads to fragmentation
• Of services
• Of efforts
• Of community
• Reinforces view that only external experts can
  solve the problems

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• Creates dependency on external funding
• Reinforces dependency

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

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• Community Assets Mapping
• Building communities from the inside out A path
  toward finding and mobilizing a communitys
  assets. (Kretzmann McKnight, 1993)

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• 5 steps in the assets mapping process
• Mapping assets
• Building relationships
• Information sharing
• Convening the community to develop a vision
  plan
• Leveraging outside resources to support locally
  driven development

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

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• Principles
• Adheres to WHO concepts of health health
  promotion
• Emphasizes social determinants of health
• Uses quality of life model
• Respects community its members
• Sees the world through the eyes and words of
  community members