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 Epidemiology
Denver Colorado
Being Effective in Public Health
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 Phases
Part 1
 Health problem identification and
measurement
 Prioritization of health problems
Part 2
 Analysis of a particular health problem
 Assess potential strategies to address
targeted aspects
Types of Prioritization
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Group consensus
Voting
Criteria-based rating
Q sort
Purpose: Build consensus/support
Being Effective in Public Health
Evaluation
Monitor
Plan
Who?
What?
When? Where?
How?
Assessment
Capacity &
Strategies
Resources?
Implement
Do
Plan
Needs Assessment Phases
Part 1
 Health problem identification and
measurement
 Prioritization of health problems
Part 2
 Analysis of a particular health
problem
 Assess potential strategies to
address targeted aspects
Bill's Steps for Problem-Oriented
Needs Assessment
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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
Precursors
TV/Movies
& Music
At Risk
Educational
Programs
Tertiary:
Secondary:
Social
Norms
Youth
Unemployment
Racism
Poor School
Connectedness
Direct:
Problem:
Initiation
of Sexual
Activity
After
School
Programs
Parenting
Knowledge
Unsupervised
Activities
Life Goals
Abuse
Sex/Contraceptive
Education
Poor Family
Connectedness
Partner Age
Disparity
Risk
Behaviors
Role
Models
Family
Income
Continuation
of Sexual
Activity
Teen
Pregnancy
Sex/Contraceptive
Knowledge
Peer
Group
Parental
Beliefs &
Behaviors
Access to
Confidential
Services
Acceptable
Method
Use of
Contraception
Consequences
Teen
Pregnancy
Problem:
Live Birth
Abortion
Direct:
LBW/Prematurity
Secondary:
Abortion
Consequences
School Delay
or Drop Out
Limited
Father
Involvement
Tertiary:
Poverty
Cycle
Repeat
Pregnancy
Impaired
Economic
Productivity
Day Care
Subsidy
Medicaid
Support
Medical
Complications
Poor Growth
Environment
Limited
Maternal
Skills
Economic
Difficulties
Limited
Family
Support
Slowed
Development
Social
Support
Child
Neglect
Other Theories & Frameworks
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Precede-Proceed Model
Socio-Ecological Theory
Glass Life Course Theory
Perinatal Periods of Risk
Gather…
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Other Needs Assessments
Available Reports
Key Data People
Key Community People
Frame & Choose Critical
Questions
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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
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Statement of the problem
Problem trends
Individual contributors to the problem
Individual strengths
Community contributors to the problem
Community strengths
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Program Hypothesis
Reduce child poison deaths
Death from poison consumption
Reduce poison consumption
Ingestion of poison
Provide childproof containers
Access to poison by children
Problem Analysis
Program Hypothesis
Reduce child poison deaths
Death from poison consumption
Reduce poison consumption
Ingestion of poison
Provide childproof containers
Access to poison by children
Problem Analysis
Program Hypothesis
Goal
Change in health of community
Policy
Change in health status of recipients
Program
Change in characteristics of recipients
Operational
Activities of the program
Logic Model Framework
Population Focus: Community(ies)
Assumptions
Theoretical
assumptions
about why a
program works
Inputs
The resources
needed to deliver
the program
Activities
Key actions of
program staff
and clients
Outputs
Products of the
program
Outcomes
Changes in the
target population
•Short
Term
•Intermediate
•Long
Term
Being Effective in Public Health
Needs Assessment Debates
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Qualitative or Quantitative
Assets or Problems
Assessment or Surveillance
One Time or Ongoing
Ourselves or Contract
Science or Art
Performance or Pretty