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Social Basis For Community And Primary Health Programs Essay.

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Social Basis For Community And Primary Health Programs Essay.
Community health needs assessment is a process that:
describes the state of health of local people;
enables the identification of the major risk factors and causes of ill health; and
enables the identification of the actions needed to address these.
A community health needs assessment is not a one-off activity but a developmental process
that is added to and amended over time. It is not an end in itself but a way of using
information to plan health care and public health programmes in the future.
The steps of community health needs assessment are as follows.
the collection of relevant information that will inform the nurse about the state
of health and health needs of the population; and
analysis of this information to identify the major health issues.
Deciding on priorities for action
Planning public health and health care programmes to address the priority issues
Implementing the planned activities
Evaluation of health outcomes
Why do it?
Needs assessment will enable the nurse to:
plan and deliver the most effective care to those in greatest need;
apply the principles of equity and social justice in practice;
ensure that scarce resources are allocated where they can give maximum health
benefit; and
The term “nurse” is used as a generic term throughout this pack to cover all nurses, midwives and public
health nurses.
work collaboratively with the community, other professionals and agencies to
determine which health issues cause greatest concern and plan interventions to
address those issues.
Concepts and principles of health needs assessment
Defining “health” and “need”
This pack uses a holistic model of health, emphasizing the social, economic and cultural
factors that affect health as well as individual behaviour. The concept of “need” used in this
pack incorporates those needs felt and expressed by local people as well as those defined by
professionals. It moves beyond the concept of demand and takes account of people’s
capacity to benefit from health care and public health programmes.  Social Basis For Community And Primary Health Programs Essay.
Factors affecting health
Health is affected by a number of factors:
the physical environment in which people live, such as the quality of the air they
breathe and the water they drink;
the social environment – the level of social and emotional support people receive
from friends and/or family;
poverty, a significant factor worldwide, which shortens and reduces enjoyment of
behaviour and lifestyle – for example, smoking causes lung cancer and coronary
heart disease so a reduction in this behaviour will reduce the disease; and
family genetics and individual biology – if you come from a healthy family you
have a better chance of staying well.
This pack will encourage the nurse to consider all these risk factors in relation to a
community and make an assessment of their importance.
Involving the community
It is assumed that the nurse using this pack has responsibility for providing nursing
services to a caseload of individual patients and a wider responsibility for improving the
health of the community.
The pack also assumes that the nurse wishes to work in partnership with local people and
will be looking for ways to involve others in her/his work. Community needs assessment
incorporates many of the principles of community development (Appendix 1), which has
been defined as: “…a way of tackling a community’s problems by using the energy and
leadership of the people who live there” (Thomas 1995). Social Basis For Community And Primary Health Programs Essay.
Involving other professionals and agencies
If people feel involved in developing a local health plan they will be more committed to
putting it into action. It is therefore important that all those who will be involved in using
the plan are also involved in the health needs assessment process. For the nurse this means
collaborating with other professionals and the local community. Nurses will also need to
agree with their employers on the flexibility and autonomy to change their work patterns
according to the needs identified through the community needs assessment process.
Format of the pack
The pack takes a user-friendly approach to community health needs assessment, guiding
the beginner through the process. Section One outlines the type of information a nurse
needs to think about when creating a profile of the community. Reasons are given for the
inclusion of each piece of information. Section Two gives practical advice on how a nurse
might find this information. Section Three helps the nurse to analyse and use the
information, decide on priorities and create action plans. By working through the pack, the
nurse will gain a basic knowledge of the health needs assessment process and will be able
to begin this task within his/her own work setting. Social Basis For Community And Primary Health Programs Essay.
Before starting
1. The nurse should read through this pack to become familiar with the complete
health needs assessment process.
2. Other key local people and professionals whom the nurse would like to be
involved in the work should be approached. Ideally, these people will form a
working group to develop the community health needs assessment together.
3. The scope and purpose of the health needs assessment should be decided on. Will
this be a way of planning work for local community nurses, or will it identify
health service needs on a wider scale and make recommendations to other
providers of services? These decisions will influence the approach taken.
4. People who will be able to help with the community health needs assessment
should be identified. These may be local community leaders, whose approval may
allow greater access to communities, or local administrative staff who may have
useful information. Access to someone with an understanding of epidemiology or
statistics would also be helpful, but is not vital.
5. The nurse must decide how much time and resources he/she is realistically able to
give to the work, and adapt each stage of the process to take account of this.
6. Consideration should be given to the ethical issues regarding ownership and use
of information, confidentiality, raised expectations versus unmet needs, and the
dangers of stigmatizing groups and communities.
Section One: Profiling the population
Think about what you want to find out about your local population. What information will
help you define and describe the community and its health needs? You may find it helpful
to ask yourself the following questions.
1. What are the key characteristics of the population?
2. What is the health status of the people?
3. What local factors are affecting their health and what impact do they have (good
and bad)?
4. What services are currently being provided?
5. What do local people see as their health needs
6. What are the national and local priorities for health?
This section describes the type of information that you may find useful when answering
these questions. What you choose to include in your profile is up to you and will depend on
local circumstances and the availability of information. Do not be tempted to collect too
much information; this is time consuming and makes it difficult to use the profile. It is
more important to define clearly the questions you want to answer and spend the time
acting on the information you have collected.
Characteristics of the population
A number of elements will enable you to describe the community you work in:
Geography: which area/population does this profile cover?
A description of a community includes its location. It is assumed that the community
identified will coincide with the nurse’s area of responsibility. You may be responsible for
a village with distinct and recognizable boundaries, a section of a town with named roads
marking the outer limits, or a refugee camp. If you are responsible for a population with no
fixed location, such as nomadic or homeless people, describe the people themselves rather
than the location. Defining the boundaries is necessary to identify who is included within a
community and to aid information collection. If possible, match the boundaries you choose
with administrative ones, especially if information is already collected on that basis or
other local workers share responsibility for the same population.
Numbers: how many people?
The total number of people within the community should include all people from birth to
death. This will show the number of people the community assessment is designed to
Age distribution: what age are they?
It is important to examine the age distribution of a community because this will have a
major influence on health needs. Most profiles divide the community into the following
age bands:
pre-school children
school-age children and young people
elderly people. Social Basis For Community And Primary Health Programs Essay.
The old and young age groups in a population have greater health care needs. This does not
necessarily imply, however, that a community that has a large dependent population (i.e.
many children and elderly people) will use the majority of its resources to care for those
groups. It may instead choose to invest resources in maintaining the health of adults, as
their ability to work and function is key to maintaining the dependent groups.
Gender distribution: how many males and females?
The ratio of males to females in a community obviously also has a major bearing on the
community’s health needs. Gender distribution has some standard patterns on a large scale,
such as more boys are born than girls and there are more women than men in the very old
age group. It is important to know whether your community fits this pattern, as this will
affect the range of services required. Gender is also important when looking at specific
health issues, such as family planning, maternity services or diseases that are genderspecific, such as ovarian cancer.
Ethnicity and religion
Minority ethnic and religious groups can be marginalized within a community; a lack of
awareness can result in a community health needs assessment that may not include the
most vulnerable groups. Nurses need to be aware of the different ethnic and cultural groups
within the community. Ethnic groups can be classified by racial origin, religion, colour or
nationality. You may choose to use the national classification so that you can make
comparisons with other areas. Different groups face different problems and require services
that are sensitive to their cultural and linguistic background. This can be seen in diseases
that are specific to one group such as sickle cell anaemia and thalassaemia. Religious
groupings are useful to know, as they can have a powerful influence over people’s lives
and are often a source of community support and influence health behaviour.
Ethnicity and cultural background have a significant impact on health, and individuals,
whatever their ethnic background, are entitled to equal access to health care. Even if the
numbers are small, nurses should take action to ensure equality of access to health care and
health programmes that are culturally and linguistically appropriate.
Population trends: patterns over a period of time
Population trends give an indication of patterns of disease and the need for services. The
birth rate (Appendix 2) going up or down may suggest that a population is increasing or
decreasing, and may also indicate a need for service changes. The mortality rate
(Appendix 2) can give information about the size of a population and its state of health. Social Basis For Community And Primary Health Programs Essay.
Language and literacy
There may be one or many languages in use within the community, together with local or
regional dialects. Language and literacy are essential for communicating health
information and for accessing services. If literacy is a problem within the community, be
sensitive to this and take account of it when deciding on methods of community
participation. Knowledge of local minority languages is vital to ensure equity and to enable
the whole community to become involved in the community health needs assessment
The health status of the population
There are different ways of finding out about the health status of the community:
people’s own views of their health
statistical information
qualitative surveys
the knowledge of local health care workers and other agencies.
There are a number of measures commonly used to identify the health of a population.
Mortality data
This generally describes patterns of death in relation to age, gender and cause of death. It is
a basic measure of epidemiology – the study of disease in populations. Information is
collected nationally, regionally and sometimes at local level, usually from death
certificates. It indicates deaths from disease, accidents, suicides and homicides, and the
general health of the population in terms of life expectancy (Appendix 2). Mortality rates
work best for large populations; in small communities a little change can produce large
statistical distortions. A problem in using mortality rates is that they depend on a shared
understanding of cause of death and do not describe the health of the living.
Morbidity data
This is information on types of illness and disability, their incidence and prevalence. It can
be taken from a wide range of sources including hospital records, infectious disease
notifications and disability registers, sickness records, general medical practice, child
health records, census material and other surveys. Information collected in this way should
be treated with care, as it may be a measure of health service activity rather than true
disease patterns. It is a reflection of illness and not health.
Behaviour measures
These are often used as indicators of health. Smoking is one of the best examples. This is
an activity proven to cause ill health, so if a lot of people smoke it shows a large potential
for illness in the population. Breastfeeding is considered the best of all infant feeding
methods, so it is taken as an indication of good health. These measures should be treated
carefully as they are about behaviour, yet are sometimes used as proxy measures for health.
“Quality of life” measures
These are a means of assessing physical health, functional ability and psychological
wellbeing. The assessment scales are based primarily on an individual’s own assessment.
These have been developed mostly in North America and the United Kingdom to measure
health outcomes based on people’s perception of their health. The reliability and validity of
these tools vary, but they are still useful in providing people-based measures of health.
Examples include the Barthel Index, the Nottingham Health Profile and the Index of
Activities of Daily Living. Social Basis For Community And Primary Health Programs Essay.
Use of service information
This information can help build a picture of morbidity as it can describe the diseases that
are being treated by the health services. It will cover both treatment, for example hospital
admissions, and uptake of preventive services, such as immunization and screening
programmes. Care may need to be taken, however, as some health problems may not yet
have any services. In countries where access to services is limited through inadequate
provision or an individual’s ability to pay for treatment, this information will often be
unreliable as an indicator of population health.
Health inequalities
It is essential to collect information, not only about health and disease but also about health
inequalities. This applies to rich and poor countries alike. Most disease and illness patterns
relate closely to economic circumstances, so that those in poverty suffer disproportionately
high rates of poor health. Health statistics reveal that, even where death rates improve for a
disease, this is less likely to be true for the poorer sections of the population. For this reason
it will be important to record patterns of health inequality in your local population. When
considering equity you may find it useful to ask yourself the following questions.
Who is disadvantaged in this community?
Why are they disadvantaged?
What can I do about it?
Who has unmet needs in this community?
Who does not access care in this community?
Local factors affecting health
A number of local factors may affect health. In each community this will be different. You
will need to think about collecting the following information for your profile:
BOWLING, A. Measuring health: a review of quality of life measurement scales. Buckingham, Open
University Press, 1991.
Work and employment
Work and levels of employment and unemployment in a community are fundamental to
health for the following three reasons.
Occupational diseases. All work affects health, both positively and negatively. However,
some work is known to cause disease, such as silicosis in mine and quarry workers and
machinery accidents among farm workers. New work-related illnesses are also being
recognized, such as repetitive strain injury for keyboard operators.
Income levels. The amount of income people earn has an important influence on their
health, affecting their ability to choose a healthy lifestyle and to access health services.
Levels of income also have an impact on the local economy within a community.
Self worth. The status of an occupation affects how people feel about themselves. People’s
level of satisfaction at work contributes to their wellbeing. Many define people by their
work or lack of it. The unemployed may feel excluded, and lack of paid employment has
been shown to contribute to poor health. Social Basis For Community And Primary Health Programs Essay.
Poverty and income
Poverty can be absolute (i.e. inadequate to sustain health) or relative (i.e. how poor one
person is compared to another). In health terms, it is not only the level of poverty that
counts but also the gap between richest and poorest. A large gap results in a big difference
in health and life expectancy between rich and poor. This is known as health inequality. It
is one of the most significant factors affecting health across the world and therefore
information on this issue will be essential.
The surroundings we live and work in directly affect health. A number of factors should be
monitored here.
Pollution. Pollution of air and water causes disease and death and this is evident throughout
the world, whether it is lead in petrol or a chemical spill from a factory, or drinking-water
contaminated by sewage.
Sanitation. Good sanitation eliminates some diseases such as cholera and dysentery
completely, and where this breaks down gastrointestinal illnesses are quickly evident. In
communities lacking basic sanitation, threats to health will arise from the contamination of
water supplies by human excrement.
Housing. The lack of a home affects all aspects of health – shelter from the weather, an
environment to sustain a family, a place to feel safe. The availability and type of housing
will reflect local history, culture, the economy and political climate, with a wide range of
housing existing across Europe such as tents in the Negev desert, tower blocks in cities,
new housing estates, private housing, refugee camps and hostels. The type, quality and
suitability of housing will have an important affect on health. Look for factors such as
overcrowding, dampness and poor heating, as these are significant factors affecting health.
Also consider how far homes are from work, pharmacies, schools and shops.
Transport. Transport systems are important to record, as they can influence people’s access
to services, social support networks and employment. Transport may also have an impact
on health through accidents, noise and air pollution. Social Basis For Community And Primary Health Programs Essay.
Social cohesion
Social support is essential for the well being of a community. There are a number of
elements that need to be taken into consideration when describing the extent of social
cohesion in a community.
Networks. Family and friendship networks provide people with the emotional support that
is fundamental to wellbeing. Social networks can be hard to describe and quantify. The best
way is to ask local people. It may be possible for them to describe social networks through
flow diagrams, maps, drawings, stories and drama. Match the methods you choose with
local customs and educational experience.
Migration. Migration causes disruption to a population, as large numbers of people move
location. It is often the younger working-age population who emigrate, and this is a loss to
the population left behind while a gain to the community they move to. Migration of
workers may be daily, weekly or longer. Population movements can be traumatic owing to
the upheaval caused, especially if forced by armed conflict, threat of discrimination or
severe economic necessity. Immigrants are usually poorer than the native population and
may not be able to communicate because of language difficulties. They may also be
marginalized socially, culturally and economically as a result of racism. All these
experiences will significantly affect the health of a community.
Marginal groups. Marginal groups are outside the dominant community, yet may form a
distinct population themselves. Some groups, such as religious sects, travellers and gypsies
may choose to remain outside mainstream society. Others, such as the homeless, may be
forced into that position. Access to health care is often more difficult for both these groups,
who may have greater need for services.
Pleasure and leisure. The opportunities for non-work social activities are signposts that can
be used to indicate the extent of social cohesion and support in a community. Such
activities reinforce a community’s identity and the emotional wellbeing of individuals.
Destabilizing factors
War, economic recession and natural disasters such as earthquakes, floods or drought affect
health directly through their impact on mortality, disease patterns and lifestyle change.
They also affect health indirectly by reducing the resources available for health services,
increasing poverty and lowering the social and economic wellbeing of a population. They
may radically lower population numbers and increase fear and mental ill health. For these
reasons a record of destabilizing factors and their effects need to be included in a
community health needs assessment profile.
Resources, formal and informal
All communities have existing resources and assets with which they respond to the needs of
individuals, families or social groups. These resources may be formal services or informal
networks. It is important to assess the extent of both types of resource as part of the profile
information. It is too easy to focus on the problems and needs of a community; by ignoring
the strengths there is a danger that existing assets can be undermined.
Informal. Social Basis For Community And Primary Health Programs Essay.Families deliver the greatest part of all care services in the community. In these
circumstances, the burden of care normally falls primarily on women and can have
significant effects on their health status. State private and voluntary systems of care to a
greater or lesser degree supplement the family or fill in where no family network exists.
There may be a comprehensive welfare system or a patchwork system of charitable and
voluntary organizations.
Formal. Formal services can be provided at a variety of levels and by many agencies. A
health profile should assess how effective they are and how much of the population has
been reached. How accessible are services to those without transport or who are disabled?
These will include both health services and those provided by other sectors that have an
impact on health. For example, WHO has highlighted links between women’s literacy and
improvements in family health, demonstrating that educational resources in a community
are an important resource for health (Rifkin 1990). Many political and religious
organizations also have resources that communities use to provide economic assistance and
health and social care.
Current nursing work
The nursing work within the local community, either caring for the sick or maintaining the
health of the well population, will be an important source of health information. By
compiling the information contained in your nursing records you can gain additional insight
into the current health status of the community. The following are questions you may like
to ask yourself in relation to the community you work with.
What illnesses do I see most of?
What problems occupy most of my time?
Do people I meet see themselves as sick?
What do people tell me about their worries and health?
What nursing interventions am I using and how well do they work?
How many people are using the nursing services?
Are they from across all sections of the community?
Do I see those whose needs are greatest?
What changes have I seen take place in the community and in the services I
The nursing information is important because it is up to date and comes directly from
individuals and families.
Local people’s views of their health needs and health services
A central part of health needs assessment is gathering information on local people’s views
of their health needs and resources. Involving local people will ensure that any service
developed will be based on need and be more likely to be acceptable to the population.
There will always be a great deal of expertise and knowledge to draw on among the local
population, in particular on what assets exist, the factors that influence their health, what is
most important, local health beliefs and solutions to problems. Social Basis For Community And Primary Health Programs Essay.
It is important that people are able to describe health problems and solutions in their own
terms. This may involve using less conventional methods such as photographs, drawings or
personal stories. Be flexible and ask the community which methods are most suitable. The
community view or perspective is important to include, and involving local people initiates
their involvement and participation in improving the health of their own community.
Local and national priorities
National priorities are often set by governments and influenced by the political and
economic agenda. Local priorities will reflect national priorities as well as issues identified
by local groups, practitioners and communities. When undertaking a needs assessment you
will need to discover what these priorities are in relation to health. Sometimes there can be
a conflict between the national top-down agenda and the needs identified locally.
Section Two: How do you find out?
Section One described the type of health information you may need in order to identify
health needs; the next stage is to collect this information. The easiest way to begin to create
your population health profile is to assemble the information that already exists. You may
like to use the form at the end of this section to record the information, and the source, as
you acquire it. The missing parts will then be clearer and you can then collect your own
information to complete the profile. Social Basis For Community And Primary Health Programs Essay.
This section provides simple guidelines on how to collect information. As information
sources and types are so variable across Europe, it is only possible to give general advice
on data collection. For more detailed help and support seek out local experts, such as other
nurses, public health specialists, health researchers, and health service planners and
Describing the community
Maps are good pictorial representations of a community’s geography and are usually easy
to obtain. Sometimes local people can draw their own map, this can also be useful in
finding out what they think is important in the community as well as encouraging
ownership of the needs assessment. The local administrative department should have access
to census information, including births and deaths. If this is not available it may be possible
to trace it through a local registration scheme. It will help to talk to people responsible for
data collection, as they can reveal the strengths and weaknesses of the information, such as
whether it includes all births and deaths, or the accuracy of the census information.
Local views
These can be obtained using a variety of methods that allow for different perspectives.
Approaching local individuals or groups
Try to ensure that a wide range of people are included, particularly minority groups, and try
to have a schedule of topic areas for each group to consider. The key to accessing these
groups is often through community leaders. Try to involve such people in the process as
much as possible. Local individuals or groups, such as social clubs or self-help groups, also
provide a good source of information. Social Basis For Community And Primary Health Programs Essay.A structured approach such as questionnaires or
surveys is useful when compiling this information – it will be more comprehensive and
reliable. Appendix 3 gives a suggested interview schedule. If literacy is a problem, use
pictures, flow charts, diagrams or taped interviews. Another approach is to ask local people
to represent their view of local health issues through drawings or photographs.
Professional views
Other professionals working locally, such as teachers, dentists, pharmacists,
social/community workers and religious leaders will also have views to give. Again, if the
same methodology is used to collect the information it will make it easier to understand and
analyse. Social Basis For Community And Primary Health Programs Essay.
Local surveys
Surveys of local opinion may already have been done by statutory or voluntary agencies.
For example, a disease-focused support group may have mapped the extent of the illness
and care provision. Disease registers used for chronic illnesses, such as diabetes, can
provide a database when conducting patient-based surveys, if confidentiality can be
assured. It is important to remember when collecting local views that as far as possible the
sample should reflect all of the population, and it may be necessary to seek out minority
groups to find out about their concerns. This is also a good way of establishing contacts
with a local community, and involving them in health care decision-making and public
health programmes.
Newspaper reports
These are easily accessible and can show current issues of concern.
Measures of health and of health inequalities
To obtain a full picture of health, information about health should come from a variety of
sources. A public health department is a good place to begin. This may be national or local.
Some have very detailed information covering diseases, health service use and inequality in
service provision, as well as mortality and morbidity rates. This information should also
contain some analysis of national, regional and local information, providing a comparative
picture. If it is not possible for you to obtain all the information you require, identify the
gap and move on to collect what is available. Local health and social care managers may
keep information for administrative purposes. However, this may be service-orientated
rather than people-focused, providing information on services rather than health. Social Basis For Community And Primary Health Programs Essay.
Nevertheless, proxy measures like these are useful in the absence of other data.
Government departments are valuable sources of data regarding social and economic
structures in the local community. Wherever there is a tax collection system there should be
information about income distribution and wealth. Planning departments provide
information about housing and public amenities, industry and local hazards. Welfare
providers may collect information about the recipients of their services and these are
usually specific to a group of people. This does not just apply to government agencies but
also to charities and private agencies that provide services.
When looking at a small population do not rely too much on quantitative data as the
numbers will be too small for meaningful comparisons. When in doubt seek the advice of
experts in epidemiology.
Nursing information
This will be a significant section of any community health needs assessment that the nurse
compiles. You can also draw on information from other members of the team.
Nursing knowledge
This is made up of three major strands.
Observations. Good observation is fundamental to all nursing assessments. It is a baseline
for assessing the state of people’s health and their progress. This information should not be
difficult to obtain. At community level observation involves an informal nursing
assessment of the wellbeing of the community. Simply walk in the local area and ask
yourself the following questions:
What am I seeing?
What can I hear and smell?
What, if anything, is missing?
What is this telling me?
Record the observations made. Social Basis For Community And Primary Health Programs Essay.
Interviews and questionnaires. If any piece of information is missing, it may be necessary
to conduct a small piece of research yourself in order to obtain it. Questionnaires can be
used on a large scale to investigate a specific aspect of a community’s health status, such as
the spread of a disease, or exposure to particular risks or health damaging behaviour such as
smoking. Interviews are generally used to give deeper insight into why or how conditions
or illnesses affect people.
Casework information. This is the information contained in nursing records. It may relate to
disease patterns, wellbeing, social behaviour, uptake of services or social characteristics.
This may only relate to a small section of the community or group, or it may be
representational of a larger population. The nurse should make clear the relationship of
her/his client group to the wider community. This can provide focused and detailed
knowledge that is extremely relevant in identifying health needs.
The family health assessment
This is a nursing tool with three aims:
to assess family health needs in partnership with the family;
to enable the family to identify the services they need; and
to gain information for assessing need at a community level.
An example of a family health assessment tool is given in Appendix 4.
Families’ perceptions of health tend to differ from those of health professionals. Many
people consider themselves healthy, even with chronic conditions, until there is a problem.
The family health assessment covers physical, social, emotional and environmental health
and is completed by the family members themselves. The outcomes of the assessment are
discussed by the family and the nurse, and actions are agreed jointly.
A family health assessment made in partnership with a nurse can be empowering for a family.
It can give them the means by which to demand or refuse services. Families have the right
to make choices and this should influence local service provision. The information that
families provide about their community at micro level is of good quality and can build into
an overall picture of the community if a sufficient number of assessments are completed.
Profile information
1. Characteristics of the population
Age distribution
Gender distribution
Ethnicity and religion
Population trends
Language and literacy
2. Health status of the population
Measures of health
3. Local factors affecting health (positive and negative)
Work and employment
Poverty and incomes
Social cohesion
Destabilizing factors
Resources, formal and informal
4. Current nursing work
5. Local people’s views of their health needs and health services
6. Local and national priorities
Section Three: What to do with the information
A community health needs assessment is incomplete if nothing is done after the
information has been collected. It must be analysed and used to plan, implement and
evaluate health services. Social Basis For Community And Primary Health Programs Essay.The process is cyclical and should be repeated, with the
information updated so that it continues to reflect the needs of local people.
Section Two enabled you to collect the information you need to give you insight into the
health needs of the community. Section Three will help you to analyse the information to
identify the key health issues and plan actions to address them. This work, like all other
parts of the process, should be undertaken collaboratively if at all possible. This would
ideally involve a group of people working together, but could include one person
undertaking the analysis and then consulting with others about the outcome, gaining their
views and interpretations. Feedback can be given in many ways: through the local media,
by attending local groups, by circulating a written report, or from a newsletter, videotape or
audiotape summary. This collaboration acknowledges local people’s contribution and
encourages their continued participation.
What is the information telling you?
The way to approach the task of analysis is firstly to read the collected information as a
whole and note the obvious. What are the issues that “jump off the page”? To make sense
of the information you have acquired you need to:
compare your population with a larger group to ascertain whether a health issue or
disease rate is higher or lower than expected;
compare current information with that collected in previous years to identify
trends over time; Social Basis For Community And Primary Health Programs Essay.
identify significant gaps in the information;
compare and contrast different types of information e.g. statistics, client and
professional views, surveys and questionnaires; and
look for positive features as well as problems; even the most disadvantaged
communities have strengths that can form the building blocks for change.
It is important to seek the help and views of others as you undertake this process, ensuring
that your personal views have not distorted the analysis. At the end summarize and make a
list of the health issues you identify, as these will be the main conclusions to be
communicated to others.
Deciding on priorities
By now you will have identified a number of health needs in the community. But resources
are always limited and it will be necessary to determine which needs should be a priority.
In order to reach agreement this process should be undertaken with others.
There are a number of considerations that will help you decide which needs should be a
priority. Try to answer the following questions in relation to each health need or issue you
have identified.
How many people are affected?
For example, coronary heart disease is a major issue in health care in the western world,
because it is one of the main causes of death and disease. Its significance is due to the
number of people who die prematurely from coronary heart disease and the number of
people affected. Infectious diseases such as tuberculosis can have a profound effect because
of the potential number of people who could be affected.
What is this information telling you about equity?
Are there disadvantaged groups with high needs for care? Are some people less able to
access services? Are those whose needs are greatest receiving the services they need?
What is the impact on people’s lives?
Some health needs may only affect a small number of people but the impact for those
people may be so severe that a response is required. Significant minority groups, such as
those with learning difficulties or with rare chronic diseases, would fall into this category.
Minority groups such as the homeless or refugees, who have significantly greater health
risks than average, should also be highlighted.
Are there appropriate and effective interventions?
Effectiveness means that an intervention does what it intended to do. Many health gains have
been delivered through improvements in the standard of living, such as nutrition and
sanitation, and not directly through health services. It may be necessary to look beyond
health services when planning action to address a health problem. Where a health intervention
is planned it is important to know that it will improve health. Sometimes you will find that
research has been reviewed and summarized by others; alternatively it may be necessary for
you to review research findings yourself or consult others for specialist expertise.
Health care interventions should not only be effective but should also be targeted at the
right people and be acceptable to local people. It is necessary to think about the cost as well
– any use of resources has to be justified in terms of cost and benefits to health.
Are the services adequate?
Asking whether services are adequate is a key question in community health needs
assessment. Analysis of the information may highlight a lack of services or duplication in
terms of treatment, prevention or services for a particular age or disease group. The
population profile might describe a growing elderly population but the services might not
have developed in response to this change.
Does the health need identified coincide with known priorities and strategies?
The national and local priorities and health programmes will influence whether a local
health need will be acted on. It may be that action on an issue is already being taken as part
of a national strategy, or it may be that local action is required by such a strategy.
Is the expertise and training available?
There may be people working or living in the community who have skills and knowledge
that are not being used to the full. Skills and knowledge are just as much a resource as
buildings and money, so knowing about these assets will help in deciding how to deal with
needs raised through the assessment. For example, the “community mothers” scheme in
Dublin, Ireland, was developed following the identification of the need for parenting advice
and support. The skills and expertise of local mothers has been used to fill that need, i.e. an
effective local solution was found to a problem by utilizing local skills. Social Basis For Community And Primary Health Programs Essay.
Planning what to do
The final and most important part of the community health needs assessment process is
planning and implementing the actions that will address the priority health needs you have
identified. The measure of a good assessment process will be the success or failure of the
actions taken to improve health. There are a number of important considerations to be taken
into account when planning your interventions.
Being creative
When devising your action plan, try to think widely and creatively about potential solutions
to the issues you are tackling. For example, if you wish to address the number of people
with chronic diseases, you may need to consider not only their access to care, but also the
needs of their informal carers. You may also need to think about their housing and
economic needs and their access to local employment. The more people you involve in this
process, the greater the scope for potential solutions.
Involving the community
A community health needs assessment belongs to the local community and those who work
in it. These people will want to have a say in the process of planning local services.
Involving the community will ensure that plans are appropriate and that people are
committed to their implementation.
It will often not be possible for a single agency or individual to bring about change on his
or her own. Work needs to be planned with others, agreeing who the key people are and
deciding together what needs to be done and by when.
Health promotion
WHO defines health promotion as “the process of enabling people to increase control over
and to improve their health” (WHO 1985). It is a model of empowerment for individuals
and communities. Health promotion covers a range of activities:
creating healthy public policies
building supportive environments
strengthening community action
developing personal skills
reorganizing health services
addressing inequalities. Social Basis For Community And Primary Health Programs Essay.
If undertaken with local people, community health needs assessment can be a way of
practising health promotion. You might like to check whether your proposed actions are
meeting the range of activities noted above.
Actions to improve health will include both treatment and care of those who are ill, as well
as activities that will keep the community healthy. Strategies for preventing ill health are
usually put into the following three categories.
Primary prevention aims to stop the onset of a disease or a condition. Examples are
pregnancies prevented by a contraception programme or coronary heart disease prevented
by smoking cessation work.
Secondary prevention works by early detection and treatment of a disease or condition,
usually through screening programmes. Examples are screening women for cervical cancer
and the early treatment of first symptoms.
Tertiary prevention is the management of diseases to control symptoms or prevent
recurrence of a disease or condition, for example, rehabilitation programmes.
Measuring success
Whatever the action plan agreed, it is necessary to monitor and record the changes that are
taking place and evaluate successes and failures. These are a few simple guidelines that
should help. Be clear about recording:
where you are now (baseline measures)
where you are going (aim and objectives)
how to get there (action plan)
how you will know you have arrived (evaluation/outcome measures).
Aim for small, achievable, measurable goals, as this increases the chance of success.
Measure your progress against them regularly. Share and celebrate your successes with
others. Where plans are not having the desired effect, consider them again and consult with
others to develop changes.  Social Basis For Community And Primary Health Programs Essay.
You should now create your action plans. You might like to use the table provided at the
end of the section to record your agreed plans.
Taking action
You should now put your plans into action. If the plans demand that you work differently in
the future, think through with others how you will make this possible. Do you need further
training? Have you the authority to change your working practices, or do you need to agree
this with others? The community health needs assessment will demonstrate the need for
change, so do not be hesitant about raising the issue. Planning your work on the basis of
local health needs will ensure that you are using your skills and knowledge for the benefit
of the community. Social Basis For Community And Primary Health Programs Essay.
Record of action plans
Community development
Community development is central to WHO’s health for all principles and is reiterated in
the HEALTH21 policy framework (WHO 1999), i.e. equity, community participation,
empowerment, collaborative working and local primary health services. It involves working
alongside local people to find ways of addressing the issues that they see as affecting their
health, by generating local partnerships and action. The health worker establishes a basis of
equality and collaboration in relationship to others, and works with a community when
agreeing plans for local health care. Social Basis For Community And Primary Health Programs Essay.
This approach works best in small defined areas such as villages or housing estates. It is
important that the whole community is involved or represented. The priority health issues
identified by the community may not coincide with those of the professionals, and it can be
difficult to develop agreement. Nevertheless, if a community becomes involved in actions
to protect the health of its own people, this will be a powerful force for change.
A community development approach, building up trusting relationships and developing the
confidence of local people, can take time. For the nurse this can have exciting outcomes as
she/he sees the growing potential of the community to address its own health needs.
Appendix 2: Health measures
Birth rate, i.e. number of live births for a population. The formula for calculating this is:
All live births in an area during the year x 1000
Total population in the area at mid-year
Mortality rates are usually presented in one of three ways:
Crude mortality rates, i.e. number of deaths in an entire population. The formula
for calculating this is:
All deaths during a specified period____ × k (usually1000 or 10 000)
Total population at mid-point of the period
Specific mortality rates, i.e. for a particular group of the population (e.g.
children). The formula for calculating this is:
All deaths in the group in a specified period____ × k (usually1000 or 10 000)
Total group population at mid-point of the period
Standardized mortality ratios (SMRs), i.e. where the age and sex structure of the
population has been taken account of (standardized) so that rates can be
compared between geographical areas. The formula for calculating this is:
Observed number of deaths × 100
Expected number of deaths
An SMR of 100 indicates that the observed number of deaths is the same as the expected
number. An SMR of more than 100 indicates a higher than expected number of deaths, and
when less than 100 a lower than expected number is indicated. SMRs are especially used in
international comparison.
Appendix 3: Example of an interview schedule
when asking people their views of local health
A. How would you describe the health of the community?
B. What do you think affects peoples’ health here?
The good things are:
The bad things are:
C. Which three things would you change her
THOMAS, D.N. In: Freeman, R. et al., ed. Community development and involvement in primary
care. London, King’s Fund, 1995.
RIFKIN, S.B. Community participation in maternal and child health/family planning programmes. Social Basis For Community And Primary Health Programs Essay.
An analysis based on case study materials. Geneva, World health Organization, 1990.
WORLD HEALTH ORGANIZATION. Journal of the Institute of Health Education, 23(1) (1985).
HEALTH21. The health for all policy framework for the WHO European Region. Copenhagen, WHO
Regional Office for Europe, 1999 (European Health for All Series, No. 6).
Further sources of information on health needs
APPLETON, J. & COWLEY, S., ED. The search for health needs. Basingstoke, Macmillan Press, 2000.
BARKER, J. ET AL. Reference manual for public involvement. Bromley, Bromley Health, 1999.
BEAGLEHOLE, R. ET AL. Basic epidemiology, Geneva, World health Organization, 1993.
BLACKBURN, C. Poverty profiling: a guide for community nurses. London, Health Visitors
Association, 1992.
BOWLING, A. Measuring health: a review of quality of life measurement scales. Buckingham, Open
University Press, 1991.
BYWATERS, P. & MCLEOD, E. Working for equality in health. London, Routledge, 1996.
CAREY, L., ED. Practice nursing. London, Bailliere Tindall, 2000.
GASTRELL, P. & EDWARDS, J., ED. Community health nursing: frameworks for practice. London,
Balliere Tindall, 1996.
HEALTH21. The health for all policy framework for the WHO European Region. Copenhagen, WHO
Regional Office for Europe, 1999 (European Health for All Series, No. 6).
HOOPER, J. & LONGWORTH, P. Health needs assessment in primary care: a workbook for primary
health care teams. Calderdale and Kirklees Health Authority, 1997.
Listen up! Effective community consultation. Oxford, Audit Commission, 2000.
NAIDOO, J. & WILLS, J. Health promotion: foundations for practice. London, Harcourt, 2000.
Needs assessment in primary care: a rough guide. Scottish Health Needs Assessment Programme,
1998. Social Basis For Community And Primary Health Programs Essay.
PERKINS, L. ET AL. Evidence based health promotion. Chichester, Wiley, 1999.
PICKIN, C. & LEGER, S. Assessing health need using the life cycle framework. Buckingham, Open
University Press, 1997.
POPAY, J. & WILLIAMS, G. Researching the people’s health. London, Routledge, 1994.
ROBINSON, J. & EKLAN, R. Health needs assessment: theory and practice. London, Churchill
Livingstone, 1996.
ROWE, A. ET AL. Health profiling: all you need to know. Liverpool, John Moores University and
Premier Health NHS Trust, 1997.
STEVENS, A. & RAFTERY, J. Health care needs assessment. Oxford, Radcliffe Medical Press, 1994.
TWINN, S. ET AL. Community health care nursing: principles for practice. Oxford, Butterworth
Heinemann, 1996.
WHITEHEAD, M. The concepts and principles of equity and health. International journal of health
services, 22: 429–445 (1992).
WRIGHT, J. Health needs assessment in practice. London, BMJ Books, 1998. Social Basis For Community And Primary Health Programs Essay.

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