Community health assessment via data collection and analysis is an essential constituent of community health indoctrination. One benefit of using GIS application is that it is effective in gathering community-based information about given community to understand health issues at the proletarian level (Graham, Carlton, Gaede, & Jamison, 2011). One limitation of using GIS application is the limiting capacity in developing a system and procedure that guarantee the confidentiality of community members and individuals data being assessed. Secondly, more training and user support in GIS technology need to be emphasized.
The specific example of when I might use GIS will be a community health assessment that involves assessing public health concerns of incarcerations in the Los Angeles community. This can be done by utilizing geographic information system in planning, administration, and analysis of recent public health concerns of incarcerations in Los Angeles. This will ensure a reliable and randomly distributed sample of incarcerated individuals and to allow for small geographical area analysis of the Los Angeles metro. GIS will be effective when analyzing health and population data (such as using survey analysis of incarcerated individuals and find of any health related issues) and execute numerical-spatial problem solving.
Beaulieu, L. J., & Southern Rural Development Center, M. S. (2002). Mapping the Assets of Your Community: A Key Component for Building Local Capacity. Retrieved from http://eric.ed.gov/?id=ED467309
Graham, S. R., Carlton, C., Gaede, D., & Jamison, B. (2011). The benefits of using geographic information systems as a community assessment tool. Public Health Reports, 126(2), 298-303 6p.
A study by Ku & Kegels (2014) was aimed at investigating variances in diabetes knowledge, attitudes and perceptions (KAP), self-care practices as related to assessment of chronic illness care among people with diabetes consulting, in a family physician-led tertiary hospital-based out-patient clinic versus local government health unit-based health centers in the Philippines. Interviewers were performed using questionnaires revised from previously tested and validated KAP questionnaires; and the patients’ assessment of chronic illness care (PACIC) questionnaire was also used. This study guides in re-shaping the auxiliary-related data recommendations for the implementation of the deterrence and assessment plan of type 2 diabetes in Philippines. A cross sectional survey was also conducted in the metropolitan Houston areas to show how Filipino-Americans have an increased risk for developing type 2 diabetes. The study explored high prevalence of type 2 diabetes and supports earlier studies, suggesting that Filipinos are at higher risk for type 2 diabetes than the U.S. non-Hispanic white population. Survey-based secondary data speaks of usually data composed by questionnaires that have already been examined for their original purpose. An example of a survey-based secondary data is the secondary data analyses of dietary surveys undertaken in South Africa to determine usual food consumption of the population ( Steyn, Nel & Casey, 2003). According to the data presented in the cited study, it was shown that reference tables of usually consumed foods and beverages were produced at nominal charge based on secondary data analyses of past nutritional surveys in different South African populaces.
Cuasay, L. C., Lee, E. S., Orlander, P.P., Batey, L. S., & Hanis, C. L. (2001). Prevalence and Determinants of Type 2 Diabetes Among Filipino-Americans in the Houston, Texas Metropolitan Statistical Area. American Diabetes Association. 24(12), 2054-2058. doi: 10.2337/diacare.24.12.2054
Ku, G. V., & Kegels, G. (2014). A cross-sectional study of the differences in diabetes knowledge, attitudes, perceptions and self-care practices as related to assessment of chronic illness care among people with diabetes consulting in a family physician-led hospital-based first. Asia Pacific Family Medicine, 13(1), 1-17. doi:10.1186/s12930-014-0014-z
Steyn, N. P., Nel, J. H. & Casey, A. (2003). Secondary data analyses of dietary surveys undertaken in South Africa to determine usual food consumption of the population. Public Health Nutrition, 6(7), 631-44.
In the field of public health, qualitative data can paint a detailed picture of public health problems, contributing factors, communities, and community needs. Qualitative data may be used to inform researchers about what to measure next, and provide richness to existing quantitative data by offering an understanding of a community’s true experiences. Collecting qualitative data can present an array of potential challenges. In community health assessment, it is imperative that you are able to identify and plan these challenges.
Public health research has traditionally focused on problems, deficiencies, disease, and contributing factors to public health problems. In recent years, community health assessments have also included community assets or resources. The process of identifying these contributions to the public health of a community is called asset mapping. One strategy for identifying assets is geographic information system (GIS) mapping. Although the asset-mapping approach to community health assessment is appealing for many reasons, not every asset map is successful, or yields results that would be relevant to a community health assessment or public health program. It is important to know the benefits and limitations of asset mapping regarding community health assessment.
Community stakeholders are those community members that have a stake in the health interests of such community. They play significant role in the community’s health and performance. Without community stakeholders, health assessment will not provide desired results. It is a remainder to note that community stakeholders can be internal or external in nature.
A focus on disease prevention through health promotion will not only improve the health of community members but help to decrease health care costs and improve quality of care. The additional groups that might be appropriate to include in the planning process of health assessment may include civil society (i.e. those with special interests in the field of community health promotion and wellness), the media advocacy group, public and private health facilities, and educational institutions. I am certain these groups will support the main purpose of many health promotion activities—by clearly affecting health behaviors of individuals and communities; and living and working conditions that influence their health standard (The Department of Health Promotion and Behavior, n.d.).
Civil society organizations play a significant role in impelling both community and the governmental institutions (World Health Organizations, n.d.). They are very good in having knowledge and comprehension of the local situations. They can influence and provide better information on the planning process of health assessment. Unlike the representatives of local government agencies, civil society organizations can function effectively in multiple geographical areas that my otherwise be difficult for local government agencies.
Furthermore, the media society plays additional roles in making sure information are disseminated appropriately and to the right channels of distribution/communication. Media advocacy group can promote community health promotion via physical exercise. Additionally, they use media to promote, encourage and attract community members while advantageously advocating for any policy amendment (Wallack & Dorfman, 1996). Local members of public and private health facilities should be involved in the knowledge awareness of the health promotion. Also, educational institutions can be involved in the maintenance of robust collaborative relationships that may lead to further research and training in health promotional activities. They can expand health planning process, especially in underserved members, by also steering interdisciplinary research and education to endow civil society, providers, individuals and external communities to practice and stimulate better performances.
Wallack, L., & Dorfman, L. (August, 1996). Media advocacy: A strategy for advancing policy and promoting health. Health Education Quarterly, 23(3):293-317.
Community participation is essential to the planning process—whether it entails a planning to engage community participants or delivering community health assessment outcomes. The two listening strategies observed in the Laureate Education (2012) media format was the idea that organizational leaders listen and understand the concerns and problems of the community members. The community health workers who are based in the communities understood the dynamics of the communities’ cultures. Every Friday morning, department managers and supervisors would engage in a meeting on how to better implement new ways of handling patients’ medical records. The listening problem arose when other team managers failed to appreciate inputs from Dr. John (i.e. from Ivory Coast). The team managers did not effectively listen to his comments and concerns. Some managers thought his experiences in Ivory Coast were totally different from current setting. I was always under the impression that one day they may carefully listen to the views of Dr. John, and potentially use his concepts, alas no. This whole episode went for a while until one day–a manager came and asked, “do you even understand him when he talks because I don’t?” Soon after, I went and reported the issue to the HR director. Correspondingly HR got involved and secretly participated in the weekly meeting. During the upcoming meeting, I stood up and presented the notion of teamwork and individual involvement regardless of other protective variables. It is critical for organizational managers to position themselves to an environment that appreciates diversity and improve team performances by effectively listening to the concerns/ideas of others.
Figuring out effective ways of engaging community participants translate to understanding that every listening approach has a conflict with three sides. I see active listening more like a process of conflict resolution. In his article, Christensen, K (2011) suggested the first side of the conflict, which is how I see the problem – for instance, I am right and you are wrong. The second side is how you/the assessor sees the problem – for instance, you are right and I am wrong. It is also true to see listening from two sides of the same coin. The third side is how they see the problem – for instance, the neutralizers will level the conflict in terms of differences between the flip of the coin. It is also true for us to understand that listening approach could be viewed from even outside the community landscape. I think when 99% of people begin to listen, their mind may imagine themselves unseeingly following what someone else is saying, without having a backbone to twig up for what they think is right—because someone else’s thinking of right is not always right. Therefore, assessor’s thinking mentality should not always be dependent on what he thinks is right or wrong. A perfect example of how community participation and leadership may bring about direct knowledge of the issues comes about a case study of the community of Sogoog, Bayan-Ulgii. Nault & Stapleton (2011) presented a paper, which explores a community-based ecotourism development in a small, remote community in western Mongolia. In this example, it was the roles of community leadership that helped in assessing the community’s desire to develop ecotourism, their understanding of the issues involved and the practicability of the process in a poor herding community, where 63% are herdsmen, frequently absent with their herds. I believed community participation is much more than just theories. It is the contribution that needs to be carefully tailored in enhancing development, at the basic community level—a critical tool for sustainable development and a foundation for national development.
Christensen, K. (2011). Difficult Conversations: How to Address What Matters. Rotman Magazine, 22-27.
Laureate Education, Inc. (Executive Producer). (2012). Bias and listening strategies. Baltimore, MD: Author.
Nault, S., & Stapleton, P. (2011). The community participation process in ecotourism development: a case study of the community of Sogoog, Bayan-Ulgii, Mongolia. Journal of Sustainable Tourism, 19(6), 695-712.
In addition to listening strategy, accurate reading and data interpretation are equally substantial. I encountered a situation where being mindful of potential biases was the accountability of not only those who design, participate and analyze research in public health, but also those who read the research assessment and make policy and other decisions–based on the results. Working at Department of Hospital Epidemiology and Infection Control at St. Joseph Medical Center was something I enjoyed. This is due to how strictness interpretations of control policies are. As an intern, in the special administrative section, I ensured series of educational programs pertaining to infection control for hospital staffs, trainees and physicians are well documented and reviewed before anything else. Bias analysis could simply be done by making sure information are recorded and reviewed correctly. An article by MacLehose & Werler (2014) seemed to describe and support the important of bias analysis in epidemiological research approach. They emphasized the capacity of bias analysis to bring expressive adjusted data and on the capacity of the assessor to correctly determine the structure of eradicating potential (i.e. future) bias (MacLehose & Werler, 2014).
MacLehose, R. F., & Werler, M. M. (2014). Importance of Bias Analysis in Epidemiologic Research. Pediatric & Perinatal Epidemiology, 28(5), 353-355.
Awareness of possible partialities is important for both public health assessors and policymakers, in a community health assessment: for assessors when crafting and steering studies, and for policymakers when reading study reports and making verdicts.
It is highly important to access risk of bias in all studies review irrespective of preventive unpredictability, in either the results or the authenticity of the studies (Cochrane Methods Bias, n.d.). One example of bias in community health assessment is the study of correlation between health conditions (i.e. stress level) and unemployment. Public health researchers are normally concerned about the health condition of a community or members of community, with its floating peak of unemployment. In this study, we might have a large and diverse sample of unemployed workers from the community population. For instance, how stress level can be related to unemployment amongst members of the community and surveyed the unemployed workers. However, over time those members, who are unemployed for a long period might move, perhaps find works elsewhere. Consequently, they might not be included in a follow-up estimate, a year or two later. If these members are no longer in the study, they may impact the resulted data. This is what we called attrition bias.
According to the Education Commission of the States (n.d.), some of the strategies to employ in justifying attrition researched bias or when research could be trusted are the four questions of:
What is the research question?
Does the research design match the research question?
How was the study conducted?
Are there rival explanations for the results?
I believed these questions allow community health assessor to come about trusted results, while producing unbiased evidence. Creating balanced substantiation with promoting proof-based decision making are particularly important for the prevention of misleading verdicts. I think the avoidance of self-interested ideology in an assessment process is an additional factor in providing transparent results.
One benefit of using qualitative date when conducting a community health assessment is that the assessor can broaden evidence from understanding behavior pattern and activities of information, not necessarily numerical and quantity in formation. By the same token, the approach could be one in which the assessor makes use of knowledge claim, based mainly on constructivist ideology. It is otherwise known as using different meaning of social and/or historical construction with the purpose of initiating or reshaping theory or partaking standpoints. In this regard, one limitation of using qualitative data is that the results cannot be generalized to the specific community(s). This is because the researcher works with general data, and the classification of the population is wide-ranging, such as elderly men.
Quantitative data is also beneficial because the researcher can rely on statistical/experimental analysis to analysis data (Rudestam & Newton, 2007). For example, QD include the use of descriptive and inferential statistics to find the correlation between variables. In a community health assessment, quantitative data can fail to consider human behavioral studies, such as anthropological, physiological and sociological studies. In a natural setting, quantitative data cannot be used to study things or discuss the meaning of things. For example, emotions, opinions, feelings or motives of the subject cannot be quantified to a varying degree.
A perfect example of when qualitative data may be more appropriate in community health assessment is the use of action research to describe how health needs assessment of a specified community was conducted. An action research is a research model of mostly qualitative, which lets you cultivate facts and understanding, as part of practice (Action Research and Action Learning for Community and Organizational Change, n.d.). Action research can be done in most cases where other research practices may be tough to undertake. Horne & Costello (2003) introduced a study that involved local people and a multiagency steering group, within a primary health care setting. Community development approaches were applied because of the potential it has to address some of the fundamental issues that lead to poor health. The assessment identified a need for more health promotional works to be carried out by health care professionals, i.e., annual health checks. A number of outcomes confirmed the existence of well-known difficulties in accessing health care, such as difficulties with physical distance to secondary care services, as well as the length of the waiting time at the outpatient departments.
Another example of a qualitative data suitable for community health assessment is the implementation of community health workers (CHW) programs. For example, a community health assessment was done in finding weaknesses and strengths of assigning community health workers to every village in Rwanda (Condo et al., 2014). The aim of this study was to assess the capacity of CHWs and the factors affecting the efficiency and effectiveness of the CHW programme. According to the article by Condo et al. (2014), Rwanda faces major gap in human resources placement for health. As a result, the Ministry of health expanded its community health programe, eventually placing 4 trained CHWs in every village in the country.
Another example of a qualitative data suitable for community health assessment is the implementation of community health workers (CHW) programs. For example, a community health assessment was done in finding weaknesses and strengths of assigning community health workers to every village in Rwanda (Condo et al., 2014). The aim of this study was to assess the capacity of CHWs and the factors affecting efficiency and effectiveness of the CHW programme. According to the article by Condo et al. (2014), Rwanda faces major gap in human resources placement for health. As a result, the Ministry of health expanded its community health programe, eventually placing 4 trained CHWs in every village in the country.
An example for when quantitative data may be more appropriate in community health assessment is the examination of community-level determinants of cardiovascular disease risk factors. This public health research uses the consistency of quantitative data designed to capture observations of community tobacco usage, nutrition, and social environments obtained from interviews with residents in communities in 5 countries (Corsi et al., 2012).
There is the second part of a mixed method approach to public health needs assessment that tried to quantitatively determine the impact of the closure of St. Vincent’s Medical Center, a large not-for-profit hospital in NYC on individuals who used its services ( Romera, Kwan, Nesteler & Cohen, 2012). In this example of quantitative data approach, a community survey was carried out. The questions covered topics that include demographics, health status, experiences accessing health care pre- and post-hospital closure, access to medical records, prescriptions, etc. The majority of respondents are from the community immediately surrounding the hospital.
Romero, D., Kwan, A., Nestler, S., & Cohen, N. (2012). Impact of the Closure of a Large Urban Medical Center: A Quantitative Assessment (Part II). Journal Of Community Health, 37(5), 995-1005
Corsi, D. J., Subramanian, S. V., McKee, M., Wei, L., Swaminathan, S., Lopez-Jaramillo, P., & … Schooling, C. M. (2012). Environmental Profile of a Community’s Health (EPOCH): An Ecometric Assessment of Measures of the Community Environment Based on Individual Perception. Plos ONE, 7(9), 1-7.
Horne, M., and J. Costello. 2003. “A public health approach to health needs assessment at the interface of primary care and community development: findings from an action research study.” Primary Health Care Research & Development (Sage Publications, Ltd.) 4, no. 4: 340-352. Academic Search Complete, EBSCOhost (accessed September 7, 2015).
Condo, J., Mugeni, C., Naughton, B., Hall, K., Tuazon, M. A., Omwega, A., & … Binagwaho, A. (2014). Rwanda’s evolving community health worker system: a qualitative assessment of client and provider perspectives. Human Resources For Health, 12(1), 105-119
Rudestam, K. E., & Newton, R. R. (2007). Surviving your dissertation: A comprehensive guide to content and process (3rd ed.). Thousand Oaks, CA: Sage Publications
The United States (US) has the most expensive health care system in the world. In spite of that, health care is of somewhat inconsistent in quality, and leads to poorer health outcomes relative to other, similar nations. For example, the United States has much higher infant mortality rates regardless of geographical focus. The result is that the US spends more per capita on health services than any other country in the world, but lags behind health indicators as life expectancy and infant mortality.
According to an article presented by Hummer (1993), concern over infant mortality differentials between African-Americans and Anglos persist. The African-American to Anglo infant mortality ratios were 1.6 in 1950,1.9 in 1960,2.0 in 1980, and about 2.2 by 1989. Additionally, the infant mortality rate among African Americans is not even close to meeting the 1990 goal of 12 deaths per 1,000 births that the U.S. Public Health Service set for all minority groups in 1979. Thus, despite overall reductions in infant mortality in the U.S. and much recent research and public attention devoted to the correlation between race and infant mortality, the pressing problems of the high rate of infant mortality among African Americans and large differentials between racial groups persist.
Hummer, R. A. (1993). Racial Differentials in Infant Mortality in the U.S.: An Examination of Social and Health Determinants. Social Forces, 72(2), 528-554.
