Health Needs AssessmentJohn O’Dowd

Scottish Government

Outline• What is HNA?

• Why do we need HNA?

• Common problems

• Implementation

• Impact evaluation 

• Resources

What is HNA?• A systematic process to gather the information required to

bring about change beneficial to the health of the population or groups within the population.

• Equity, effectiveness and efficiency:

- Identifies unmet need

- Identifies ineffective activity (stop or change)

- Identifies opportunities to improve efficiency

Why do we need HNA?• Need – capacity to benefit from a

given intervention

- Normative

- Felt

- Expressed

- Comparative

• Demand - expression of felt need

• Use - demands which are met through services

Need

DemandUse

Need

DemandUse

Types of HNA• Epidemiological - data on time, place and person

• Comparative – comparing need or effectiveness across groups

• Corporate – stakeholder views

• Usually pragmatic- a mixture of all of the above

Epidemiological HNA• Statement of problem to be addressed

• Define population of interest

• Identify data sources which provide epidemiological evidence of need

• Identify data sources which provide evidence of demand/use

• Interrogate literature sources to triangulate need, demand or clarify best practice in terms of effectiveness or efficiency

• Clarify categories/geographies, period, age bands etc

• Identify the gap between need and use

• Recommend how to bridge the gap

Data• Numerical or textual

• Routine or ad hoc

• Local or national

Examples of sources of information.

The original figure has been removed to permit this presentation to be made available electronically. The citation for the figure from the BMJ is shown below.

Stevens A , Gillam S BMJ 1998;316:1448-1452

http://www.bmj.com/content/316/7142/1448

Please review figure 2©1998 by British Medical Journal Publishing Group

Components of health needs assessment.

The original figure has been removed to permit this presentation to be made available electronically. The citation for the figure from the BMJ is shown below.

Williams R , Wright J BMJ 1998;316:1379

http://www.bmj.com/content/316/7141/1379.1

Please review Figure 1

©1998 by British Medical Journal Publishing Group

Comparative HNA•Using either quantitative or

qualitative data to compare needs across time, or between different communities of interest

Corporate HNA• Using the views of stakeholders to establish their views of

health needs and how effectively these are being met through services

• Stakeholders may include:

• Patients

• Public

• Professionals

• Policy makers

• Service managers

• Staff from other sectors

Commonest HNA•Pragmatic

•Heady mixture of epidemiological enquiry and the views of stakeholders to develop and implement the changes necessary to bring about change in the health of the target group

Examples of HNA• An epidemiological needs assessment of carotid endarterectomy in

an English health region. Is the need being met? Ferris et al BMJ 1998;317:447–51

• A comparative needs assessment of the dental health of adults attending dental access centres and general dental practices in Halton & St Helens and Warrington PCTs 2007. Milsom et al Br Dent J. 2009 Jun 13;206(11):563.

How to do HNA• What is the issue/why do the HNA?

• What is the size ofthe problem?

• What are current services?

• What do professionals, patients, public, management, policymakers and others want?

• What are the most effective and cost-effective solutions?

• What are the resource implications?

• Implementation - validity, ownership, feasibility, clarity, dissemination....

• Evaluation - part of the recommendations - schedule a review

HNA: SLCN of children•Why are SLCNs important?

•Why look at children?

•Methodology

•Results

•Recommendations

•Implementation

•Evaluation

Participatory HNA/ rapid participatory appraisal

• Informal discussions with voluntary or community groups

• Focus groups

• Interviews with key informants and service users / patients

• Household surveys

• Relevant local documents about the neighbourhood or community

• Observations undertaken in homes and neighbourhoods

• Community mapping

Joint Strategic Needs Assessment (JSNA)• Focus on a geographic population served by common

planning partners

• Wider scope than health

• Elements of epidemiological, comparative and corporate assessment of needs

• Use of priority setting

• http://www.dh.gov.uk/dr_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_081267.pdf

Problems with HNA• Scope

- mission creep

• Timescale

- think of a number, then double it

- When will decisions be made?

• Data

- Is it feasible?

• Signup

- Is it worth the time invested?

- Corporate HNA elements….

Implementation• Test the water

- Who do you need to influence?

- What is their discretion to act?

- What is the current position on this topic?

- What is the timescale?

• Resource to deliver on time

• Be pragmatic and consider a corporate element

• Write clear, modest and achievable actions to ‘bridge the gap’

Evaluating implementation• Ensure measures of need are sensitive to change

• Consider evaluation needs:

- Policy change

- Practice change

- Resources

- Governance

• Include appropriate evaluation in recommendations

• Modified repetition

Resources• http://www.nice.org.uk/media/150/35/

Health_Needs_Assessment_A_Practical_Guide.pdf

• who workbook http://www.emcdda.europa.eu/attachements.cfm/att_5865_EN_3_needs_assessment.pdf

• SNAP 1998, Needs Assessment in Primary Care: A Rough Guide. Scottish Needs Assessment Programme, Office for Public Health in Scotland, Glasgow