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Better Understanding Our Problem: Pro blem-Orient ed 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. - PowerPoint PPT Presentation
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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 EpidemiologyDenver Colorado
Being Effective in Public Health
Planning
Doing
Assessment
Strategies
Plan
Evaluation
Monitoring
Implement
Being Effective in Public Health?
Assessment
Implementation
Rev
iew
Plan
Planning
Doing
Assessment
Strategies
Plan
Evaluation
Monitoring
Implement
Being Effective in Public Health
Health Problem: Late PNC Entry South Carolina
01020304050
Years
Perc
enta
geSC WhiteSC BlackReg Black
Needs Assessment
Underreporting of prenatal visits Physicians not starting to 2nd trimester Late entry into the WIC program Problem recognition by Community Transportation & child care barriers Unintended pregnancy
Potential Strategies 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 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
Planning
Doing
Assessment
Strategies
Plan
Evaluation
Monitoring
Implement
Health Problem: Late PNC Entry South Carolina
01020304050
Years
Perc
enta
geSC WhiteSC BlackReg Black
So Why Doesn’t It Happen? Limited/over-committed staffing. Limited expertise. Lack of adequate follow-up. Previous planning failures. Insufficient resources for current
initiatives. Lack of political will. Committed/focused on present activities. Competing priorities/desires.
Being Effective in Public Health
Planning
Doing
Assessment
Strategies
Plan
Evaluation
Monitoring
Implement
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
Visionary Conceptual Systematic Resourceful Pragmatic Action-oriented Cohesive
Types of Needs Assessment...
Community--Healthy Communities Population--Title V (MCH) Health Systems--Emergency Response Program--Title X (Family Planning) Health Services--Prenatal Clinic Location 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?
Community perception? Health status measure? Risk Factor? Health Service Deficiency? Measurement? Comparison?
Problem Identification & Verification Stakeholders Partners Reports Available Data
Purpose: Search & compile
Problem Definition
Extent Duration Expected future course Variation
Purpose: Define, describe & validate
Types of Prioritization
Group consensus Voting Criteria-based rating Q sort
Purpose: Build consensus/support
Q-Sort Procedure: Priority Log Sheet for 25 MCH Needs
5th
4th 5th 6th
3rd 4th 5th 6th 7th
2nd 3rd 4th 5th 6th 7th 8th
1st 2nd 3rd 4th 5th 6th 7th 8th 9th
Part 1: Identification & PrioritizationSelection Criteria
Magnitude of the problem Trend Severity/consequences Perceived preventability National/state goals Agency capacity Political/community acceptability
Part 1: Identification & PrioritizationReal Selection Criteria
State or agency political will Current program priority Currently funded activity Fits current staffing/resource patterns People available to work on the issue Important issue to the heart
Matrix of MCH Problems
Criteria Weight LBW Peri HIV SmokingMagnitude 2Trend 2Severity 3Preventable 2Goal 1Capacity 3Acceptable 1
Clear Scoring Criteria
Magnitude Low incidence/prevalence Moderate in some subgroups Moderate in all groups High in some subgroups High in all groups
Part 1: Identification & PrioritizationReal Selection Criteria
Available funding State or agency political will Program priority Currently funded activity Fits current staffing/resource patterns People available to work on the issue Required performance measure 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
Problem:
Direct:
Secondary:
Tertiary:
Teen Pregnancy
Initiation of SexualActivity
Continuation of Sexual Activity
Poor School Connectedness
Life Goals
Poor Family Connectedness
Access to Confidential
Services
After School
Programs
TV/Movies& Music Parenting
Knowledge
Sex/ContraceptiveEducation
Social Norms
Partner Age Disparity
Parental Beliefs & Behaviors
UnsupervisedActivities
At RiskEducationalPrograms
Youth Unemployment
Use of Contraception
Abuse
Peer Group
Sex/ContraceptiveKnowledge
Family Income
RiskBehaviors
Racism
Role Models
Acceptable Method
Precursors
Problem:
Direct:
Secondary:
Tertiary:
Teen Pregnancy
Abortion Live Birth
School Delayor Drop Out Economic
Difficulties
Poor Growth Environment
Limited Family
Support
Social Support
Day Care Subsidy
Medicaid Support
Child Neglect
Slowed Development
Repeat Pregnancy
AbortionConsequences
LimitedMaternal
Skills
LimitedFather
Involvement
ImpairedEconomic
Productivity
PovertyCycle
LBW/PrematurityMedical
Complications
Consequences
Gather…
Other Needs Assessments Available Reports Key Data People Key Community People
Frame & Choose Critical Questions What Are Remaining Questions? What is Gained By Answering the
Question? Do Something Different? Can the Question Be Answered? What Will It Cost? 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
Statement of the problem Problem trends Individual contributors to the problem Individual strengths Community contributors to the problem Community strengths
Being Effective in Public Health
Planning
Doing
Assessment
Strategies
Plan
Evaluation
Monitoring
Implement
Problem AnalysisAccess to poison by children
Ingestion of poison
Death from poison consumption
Program Hypothesis
Reduce child poison deaths
Reduce poison consumption
Provide childproof containers
Program HypothesisReduce child poison deaths
Reduce poison consumption
Provide childproof containers
Problem Analysis
Access to poison by children
Ingestion of poison
Death from poison consumption
Program HypothesisGoal
Policy
Program
OperationalActivities 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
Planning
Doing
Assessment
Strategies
Plan
Evaluation
Monitoring
Implement
Being Effective in Public Health
Needs Assessment Debates
Qualitative or Quantitative Assets or Problems Assessment or Surveillance One Time or Ongoing Ourselves or Contract Science or Art Performance or Pretty