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
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Being Effective in Public Health?
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Implementation
Being Effective in Public Health
SC White
SC Black
Reg Black
50
40
30
97
Years
95
93
91
89
87
85
20
10
0
83
Percentage
Health Problem: Late PNC Entry
South Carolina
Needs Assessment
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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
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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
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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
Health Problem: Late PNC Entry
South Carolina
SC White
SC Black
Reg Black
40
30
20
10
Years
97
95
93
91
89
87
85
0
83
Percentage
50
So Why Doesn’t It Happen?
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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
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
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Visionary
Conceptual
Systematic
Resourceful
Pragmatic
Action-oriented
Cohesive
Types of Needs Assessment...
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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
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
What is a health problem?
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Community perception?
Health status measure?
Risk Factor?
Health Service Deficiency?
Measurement?
Comparison?
Problem Identification &
Verification
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Stakeholders
Partners
Reports
Available Data
Purpose: Search & compile
Problem Definition
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Extent
Duration
Expected future course
Variation
Purpose: Define, describe & validate
Types of Prioritization
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Group consensus
Voting
Criteria-based rating
Q sort
Purpose: Build consensus/support
Q-Sort Procedure: Priority Log
Sheet for 25 MCH Needs
5th
1st
4th
5th
6th
3rd
4th
5th
6th
7th
2nd
3rd
4th
5th
6th
7th
8th
2nd
3rd
4th
5th
6th
7th
8th
9th
Part 1: Identification & Prioritization
Selection Criteria
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Magnitude of the problem
Trend
Severity/consequences
Perceived preventability
National/state goals
Agency capacity
Political/community acceptability
Part 1: Identification & Prioritization
Real Selection Criteria
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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
Magnitude
2
Trend
2
Severity
3
Preventable
2
Goal
1
Capacity
3
Acceptable
1
LBW
Peri HIV
Smoking
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 & Prioritization
Real Selection Criteria
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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
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
Being Effective in Public Health
Evaluation
Monitor
Plan
Who?
What?
When? Where?
How?
Assessment
Capacity &
Strategies
Resources?
Implement
Do
Plan
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
Poor Growth
Environment
Limited
Father
Involvement
Tertiary:
Poverty
Cycle
Repeat
Pregnancy
Impaired
Economic
Productivity
Day Care
Subsidy
Medicaid
Support
Medical
Complications
Limited
Maternal
Skills
Economic
Difficulties
Limited
Family
Support
Slowed
Development
Social
Support
Child
Neglect
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
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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
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