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Step 4: Collect and Analyze Data

Purpose

Community health assessments (CHAs) include a combination of quantitative demographic and health data as well as qualitative data that reflects the experiences and opinions of community stakeholders. Summarize and synthesize these data to develop a picture of overall community health and to highlight the particular health needs of various populations in your community.

Key Components

Considerations for data collection
Defining demographic indicators - Indicators are the measures describing a community’s health that are related to desired health outcomes; they should allow for identification of health inequities by geography, age, race/ethnicity and socioeconomic status when feasible. Before gathering data, identify meaningful indicators of health and health determinants.

Detecting disparities - Aggregate data about a population can obscure subpopulation differences. Electronic health record (EHR) data may be useful for tracking and stratifying health status by race, ethnicity and language, as well as other sociodemographic characteristics (e.g., income, disability or veteran status, sexual orientation and gender).

Reaching populations facing inequities - Some segments of a population—such as individuals who lack a stable address or who do not speak English—may not be represented in existing data. Make a specific effort to engage individuals from those populations. Consider where these individuals congregate and conduct targeted outreach in these locations.

Apply research principles to the CHA process
Your CHA will include a combination of primary data that you collect yourself and secondary data that comes from other sources, such as the local health department. With both primary and secondary sources, there are two main types of data:

Community-based participatory research (CBPR) methodology is particularly applicable to the CHA process. It is a collaborative approach to research that equitably involves all partners in the research process, recognizing the unique strengths that each partner brings and facilitating collaborative partnership through the research. CBPR principles align well with the CHA process.

CBPR Principles1Relation to CHA Process
Recognizes community as a unit of identity The unit of analysis for CHAs is the geographic community.
Facilitates collaborative partnerships in all phases of the research CHA developers can foster long-term, collaborative partnerships with community members and stakeholders throughout the process.
Integrates knowledge and action for the mutual benefit of all partners The hospital gains a more nuanced perspective of community health issues.
Promotes a co-learning and empowering process that attends to social inequalities Engaging the community throughout the CHA process promotes a sense of joint ownership and equity between the hospital and community.
Involves a cyclical and iterative process The CHA process is an ongoing cycle that should include periodic reflection and course correction.
Addresses health from positive and ecological perspectives CHA developers are encouraged to target the social determinants of health in the community in order to address the upstream factors affecting health.
Disseminates findings and knowledge gained to all partners CHA results are publicly available and widely distributed to participants, stakeholders and the community at large.

Develop a data strategy
When planning the data collection process, the CHA advisory committee can discuss the following considerations:

The hospital can call on both internal and community resources to advise on data collection and provide data. This can include:

Decide what data to include
Comprehensive CHAs include a thorough review of the statistics regarding a range of population health indicators. Data collected and analyzed should reflect the clinical and non-clinical factors that impact health. Guidelines for key metrics can be found in the County Health Rankings & Roadmaps Model:

County Health Rankings & Roadmaps

Source: University of Wisconsin Population Health Institute. (2016). County Health Rankings & Roadmaps: Our approach. Accessed at http://www.countyhealthrankings.org/our-approach

Collect secondary quantitative data
Demographic and health data are compiled by local and state health departments as well as by national sources such as County Health Rankings & Roadmaps, Community Commons and the Centers for Disease Control and Prevention (CDC). Selection of data sources will depend in part on the definition of your hospital’s geographic service area. Local health department epidemiologists can assist with ensuring data quality and validity. Input from local community and neighborhood groups on access to health care, social determinants of health and other health conditions can also enhance the quality of data collected, as it is coming directly from the community.

National data sets can help you identify disparities at the local level. Notable among these are:

Access electronic health record data
EHR data can provide a unique window into the health needs of community members who have received care. Accessing the aggregate EHR data will require working with the IT department to see what data they can pull from the data warehouse. Considerations include:

Collect community-engaged primary data
Information not available in existing databases should be collected directly from your community. This is an ideal opportunity to engage your community. There are four main approaches to obtaining primary data:

Guiding principles to consider when soliciting the opinions of community members about their community health needs include:

Below are some suggested practices for engaging community members in the data collection process:

Community Surveys

Content and format

Assure respondents of confidentiality.
Collect race, ethnicity and language data in a culturally appropriate manner.
Ensure that survey questions are culturally appropriate and at a literacy level and language that respondents can understand.
Review the survey draft with community members to see what needs to be modified.
Provide versions of the survey in the languages spoken by community members.
Consider using or modifying a validated survey instrument or questions.
Assess regularity of health care usage as frequent users may have a unique perspective.
Allow space for qualitative answers.
Provide the option for respondents to be contacted for further involvement in the CHA process.
Distribute the survey online, on paper or both. Consider using both methods if there are major segments of the community’s population who do not have internet access.

Participants

Consider oversampling vulnerable populations since interventions would likely need to be focused on the needs of those groups.
Distribute the survey where people live, work, learn and play—at churches, local businesses, health fairs, etc.
Widely advertise the survey using social media, newspaper advertisements, etc.
Engage community leaders to encourage participation in the survey among their constituents.
Consider specifically surveying the patient population.

Key Stakeholder Interviews

Participants

Consider whom to interview:

  • Interview stakeholders from a variety of sectors in the community.
  • Engage clinicians—including physicians, nurses, community health workers, etc.—for interviews as they likely have insights into the health needs of patients in the hospital.
  • Interview individuals representative of the community, including subgroups experiencing health disparities.

Supplement topic areas with sparse secondary data by interviewing community stakeholders knowledgeable in that area.

Find innovative ways to recruit for stakeholder interviews:

  • Ask community leaders if they know and could provide connections to potential participants with the characteristics being targeted.
  • Engage clinicians in hospitals or any associated medical groups and practices to identify patients for interviews.
  • Talk to hospitals’ patient and family advisory councils (PFACs).
Location

Make the location easily accessible; consider factors such as proximity to public transportation, time of day, availability of parking, child care, etc.
Hold the interviews in a neutral space (i.e., not the hospital).
Consider online or phone interviews to reduce barriers to participation.

Facilitator

Ensure that the interview facilitator is culturally competent and speaks the language(s) spoken by the interviewees.
Use a facilitator who is well trained in moderating interviews, including keeping participants on topic and maintaining a neutral position.

Developing interview
questions

Develop an interview guide so the same questions are asked across all interviews.
Ask short and open-ended questions to encourage dialogue on various topics.
Review the list of questions ahead of time with community members to ensure that questions are culturally appropriate and at a level that participants would be able to understand.
Be aware that the interview facilitator cannot ask people to identify their health conditions.
If possible, provide the questions to attendees ahead of time.

Conducting the interviews

Explain to participants how their input will be used.
Establish confidentiality of the participants’ responses. Especially in small communities, participants may be worried about their names being attached to their comments.
Provide an estimated timeline of when final results will be shared.
Ask whether the individual would like to be involved in future stages of the CHA and set the process for continued engagement.
Establish realistic expectations for what the hospital and partners can do to address community needs.

Focus Groups

Participants

Consider whom to sample: a cross-section of the whole community and/or more targeted groups?
Contemplate recruiting from existing groups (e.g., PFACs, church groups).
Find innovative ways to recruit for focus groups where people live, learn, work and play (e.g., advertisements on social media, in newspapers, on the radio, at churches, local businesses, etc.).
Engage clinicians to identify patients for focus groups.
Consider members of the community who may not be easily reached and brainstorm how they can be recruited.
Encourage attendance through reminder notices.
Limit focus groups to 10 or fewer participants to ensure that everyone’s opinions can be heard.

Location

Make the location easily accessible for community members. Consider factors such as proximity to public transportation, time of day, availability of parking, child care, etc.
Hold the focus groups in a neutral space (i.e., not the hospital).
Consider holding virtual or phone focus groups to reduce barriers to participation.
Focus groups should typically last no longer than 90 minutes.

Facilitator

Use a facilitator who is well trained in moderating focus groups, including keeping participants on topic, maintaining a neutral position, and making sure that everyone participates and is listened to.
Ensure the facilitator is culturally competent and speaks the language(s) spoken by attendees.
Consider using a facilitator from a neutral third party, so participants feel more comfortable.

Developing focus
group questions

Develop a focus group question guide, so the same questions are asked across multiple focus groups.
Ask short and open-ended questions to encourage dialogue on various topics.
Review the list of questions ahead of time with community members to ensure that questions are culturally appropriate and at a level that participants would be able to understand.
If possible, provide the questions to attendees ahead of time.
Refrain from asking very sensitive questions that individuals would not want to share in a group.

Conducting the
focus groups

Establish confidentiality of the participants’ responses. Especially in small communities, participants can be concerned about their names being attached to their comments.
Explain to participants how their input will be used.
Give participants an estimated timeline of when results will be shared.
Establish realistic expectations for what the hospital and partners can do to address community needs.
Ask whether the individual would like to be involved in future stages of the CHA and set the process for continued engagement.

Town Hall Meetings

Participants

Advertise the meetings where people live, work, learn and play using social media, newspapers, radio, announcements and flyers, local organizations, support groups, PFACs, etc.
If possible, offer child care for participants.
Explain why the CHA is relevant for the whole community.

Location

Make the location easily accessible for community members. Consider factors such as proximity to public transportation, time of day, availability of parking, child care, etc.
Hold the meetings in a neutral space (i.e., not the hospital).
Consider coordinating the meeting with existing community or town meetings.

Finding a facilitator

Ensure that the facilitator is culturally competent, speaks the languages spoken by community members and is sensitive to attendees’ needs.
The facilitator should be well trained in moderating community meetings, including keeping participants on topic, ensuring that louder voices do not drown out others, and maintaining a neutral position.

Developing an agenda
and questions

Develop a draft agenda and questions and, if possible, distribute them to attendees ahead of time.
Ask participants open-ended questions to encourage dialogue about various topics.
Review the list of questions ahead of time with community members to ensure that questions are culturally appropriate and at a level that participants would be able to understand.

Meeting logistics

Tell all participants how their feedback will be used and when results will be shared.
Consider using voting devices (clickers, cell phone apps, etc.) to gain input from more community members, especially those who may not feel comfortable speaking up in a public setting.
Establish realistic expectations for what the hospital and partners can do to address community needs.
Provide the option for participants to be contacted for further involvement in the CHA process; this is an easy way to identify individuals who desire increased engagement.

Source: Health Research & Educational Trust. (2016, July). Applying research principles to the community health needs assessment process. Chicago, IL: Health Research & Educational Trust. Accessed at www.hpoe.org/researchCHNA

1. Hartwig, K., Calleson, D., and Williams, M. (2006). Unit 1, section 1.1: Definitions, rationale and key principles in CBPR. In Developing and sustaining community-based participatory research partnerships: A skill-building curriculum. Retrieved from https://depts.washington.edu/ccph/cbpr/u1/u11.php