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Assessing and Identifying Health Needs: Theories and Frameworks for Practice

  1. Public Health Skills: A Practical Guide for Nurses and Public Health Practitioners. By: mohammad sajjad lotfi
  2. Introduction – The assessment and identification of health need is a process that helps: 1. Inform planning of health care for individuals and their families, communities and the wider population. 2. It can be a powerful learning tool for local service providers, presenting them with the rationale for re- designing services to better target assessed needs of the local population.
  3. – In recent years interest in the assessment of health care needs has increased because: • the pattern of health service will frequently reflect only partially the health needs of the population that it is serving, and those with the greatest need may receive least. • Health needs assessment also provides a method: • Monitoring and promoting equity in the provision and use of health services • Addressing inequalities in health ‫که‬ ‫کوچکی‬ ‫جمعیت‬ ‫دارد‬ ‫حداکثی‬ ‫استفاده‬ ‫که‬ ‫انبوهی‬ ‫جمعیت‬ ‫دارد‬ ‫حداقلی‬ ‫استفاده‬
  4. 1. Pressure on costs 2. Increasing willingness of politicians, managers 3. Public challenge of use healthcare service To cause: emphasis on the optimal allocation of scarce health care resources. – In order to establish a useful and effective program for a specific target population, planners, policy makers and health care practitioners must determine the needs and wants of individuals and communities. Introduction
  5. – It is recognized that most clinical health professionals are familiar with assessing the needs of individual patients needs assessment is now undertaken by people Traditionally, health needs assessments have been undertaken by public health professionals
  6. What is Health Needs Assessment? – Health needs assessment (HNA) is defined as ‘a systematic method for reviewing the health needs and issues facing a given population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities’
  7. What is aim of Health Needs Assessment? – Aims of a health needs assessment (HNA) are: 1. To gather information to plan, and change services for the better, and to improve health in other ways. 2. To build a picture of current services in order to establish the baseline of existing services from
  8. What is aim of Health Needs Assessment? which to determine what needs to be changed to meet the identified health needs. Information gained from an HNA is the basis for designing and implementing programmes of health and health care that is, as far as possible, acceptable and accessible to the local community and is based on evidence of cost-effectiveness. It is also the primary means of allocating scarce health and public health resources to individuals and communities with the greatest need.
  9. What is aim of Health Needs Assessment? Stevens and Gillam (1998) highlighted five objectives of an HNA that flow from these aims: 1. Planning: 2. Intelligence: gathering 3. Target efficiency 4. Involvement of stakeholders 5. Equity
  10. What is equity means in Health Needs Assessment? – Equity is a difficult concept to analyse. It may help to differentiate between horizontal and vertical equity: 1. Horizontal equity is concerned with the equal treatment of equal need irrespective of socioeconomic background. This means that to be horizontally equitable, the health care allocation system must treat two individuals with the same complaint in an identical way. 2. Vertical equity, is concerned with the extent to which individuals who are ‘unequal’ should be treated differently (Sutton 2002). In health care it can be reflected by the aim of unequal treatment for unequal need in order to achieve equal health status; for example, higher health care investment in areas of greatest socioeconomic need. These public health programmes are targeted to the areas of highest socioeconomic deprivation.
  11. Health, Health Need and Health Care Need – It is commonly accepted that the social and economic conditions under which people live impact on the health status of a population. – Hall and Elliman (2003) assert that in the 21st century social, economic and environmental factors are more important than biological disorders as causes of ill health. – Health needs’ incorporates these wider social and environmental determinants of health.
  12. Health – The World Health Organization’s definition holistic approach to health: – Health is a state of complete physical, psychological, and social wellbeing and not simply the absence of disease or infirmity. (WHO 1999) – The World Health Organization defined the determinants of health as: social gradient, stress, early life, social exclusion, work, unemployment, social support, addiction, food and transportation.
  13. Health – The socialization aspects of health should not be underestimated and typically reflect the wide variations within communities where both young and old live. – People’s ideas and perceptions about health will be mediated by: 1. their own experiences 2. learnt patterns of behavior 3. key figures 4. from their lives through the home, family, school and work environments.
  14. Health – Housing, income, employment and access to goods and services, including health services, have all been recognized as important components of health. – The preferred model of the determinants of health, states is 1. Dynamic 2. Interactive 3. Adopting a life course approach to health status, recognizing the complexity of the interplay between antenatal, early and later life influences on the development and maintenance of health and disease.
  15. Health – Dahlgren and Whitehead (1991) have described the factors affecting health in a ‘rainbow model’
  16. Health needs and health care needs – This wider definition allows us to look beyond the confines of the medical model based on health service provision, to the wider influences on health. – The health needs of a population will be constantly changing, and many will not be amenable to medical intervention.
  17. Health needs and health care needs – Meeting health need is not the exclusive responsibility of the health sector, but is rather the responsibility of multiple sectors and involves ongoing collaboration between health, education, housing, employment and welfare sectors. – Health care visitor may need to advocate for patients where multiple external factors are impacting on their health – for example a health visitor may advocate for a family living in substandard accommodation which is impacting on the physical health of the children.
  18. Health; Government or People – There is currently a significant debate around the responsibility of the individual to make ‘healthy’ choices. In July 2006, Tony Blair urged the nation to take more responsibility for its own health. – In the second of a series of major speeches on domestic policy, the then prime minister argued that the government cannot make decisions for people in a bid to improve their wellbeing: The government can’t be the only one with the responsibility if it’s not the only one with the power. The responsibility must be shared and the individual helped but with an obligation also to help themselves.
  19. Health; Government or People – Blair also stated that: Our public health problems are not, strictly speaking, public health questions at all. They are questions of individual lifestyle – obesity, smoking, alcohol abuse, diabetes, sexually transmitted disease. They are the results of millions of individual decisions, at millions of points in time. The issue of individual responsibility has become a topic of national debate and is likely to continue to be so into the future.
  20. Need, Demand and Supply – Need is a critical concept in the pursuit of efficient health care and is equally critical to the development of services that are equitable (Mooney et al. 2004). – In health care, need has a variety of meanings that may change over time, so it is not surprising that different groups of health professionals refer to ‘needs assessment’ in very different ways (Jordan & Wright 1997). – It is important to recognise the different perspectives illuminating the relationship between the concepts of need, and health care needs (Asardi-Lari et al. 2003)
  21. Need – In a sociological environment, divided ‘need’ into four types: 1. Normative need – distinguished by professionals, such as accination; 2. Felt need – wants, wishes and desires; 3. Expressed need – vocalized needs or how people use services; 4. Comparative need –needs arising in one location may be similar for people with similar sociodemographic characteristics living in another location. – Bradshaw’s taxonomy of need creates a definition which is more practical for health service research workers.
  22. – his taxonomy of need was constrained because of inherent problems with the concept of need. – This issue is yet to be resolved as there is still no consensus as to what constitutes ‘need’. The most widely presented definition of need favored by economists is ‘the ability of people to benefit from health care provision’, in other words, ‘need’ exists only if there is a ‘capacity to benefit’ from a particular health care service.
  23. Need, Supply and demand – Need is defined as the ability to benefit from health care, i.e. a measurable change in health status attributable to the intervention. – Demand is what people ask for. It is not necessarily what they need. GPs and consultants have a key role as gatekeepers in controlling demand. – Supply, that is the health care interventions and services that are available to the population. This will depend on the interests of health professionals, the priorities of politicians and the amount of money available.
  24. Need, Supply and demand – Need, demand and supply overlap and this relation is important to consider when assessing health needs
  25. health care need – The term ‘health care need’, according to Wright et al. (1998), can be used to describe” – a population’s need for the provision of particular health care services and those that can benefit from health care (health education, disease prevention, diagnosis, treatment, rehabilitation, end of life care). – Most doctors will consider needs in terms of the health care services that they can supply. Patients, however, may have a different view of what would make them healthier – for example, a job, decent housing or access to affordable leisure facilities. – There needs to be some consideration of the effectiveness, including cost- effectiveness, of services in which an investment is being considered. Because available resources in all health care systems are finite, and demand will always outstrip supply, prioritization of health service purchasing is necessary.
  26. Approaches to Health Needs Assessment – Wright et al. (1998) state that a comprehensive HNA involves an: 1. Epidemiological (quantitative) 2. Qualitative approach to determining priorities, and should incorporate different perspectives : 1. Clinical 2. Cost-effectiveness 3. Patients’.
  27. Approaches to Health Needs Assessment – This approach must also balance 1. Clinical 2. Ethical 3. Economic considerations of need – In practice three types of needs assessment have been described: 1. Epidemiological 2. Comparative 3. Corporate
  28. Epidemiological – Epidemiological statistics measure the total amount of ill health in the community, for example mortality and morbidity statistics. – Indicators of deprivation are used to identify groups of people who may experience social and economic disadvantage, for example unemployment rates. – enable the government to target resources to those most in need.
  29. Epidemiological approach – The epidemiological approach to HNA has three elements: 1. determining the incidence and/or prevalence of the health problem; 2. identifying the effectiveness (and cost-effectiveness) of existing interventions for the problem; 3. identifying the current level of service provision. – This combination of epidemiological (health status assessments) and evidence (effectiveness/cost-effectiveness) has also been described as an evidence-based approach to HNA.
  30. Comparative approach – Comparative need is defined as existing where the population of one area has a lower uptake of a particular intervention than that of another area, after adjustment for any differences in age or other population characteristics. – These could be cross-national comparisons, for example comparing England with other countries in Europe, or comparisons at a more local level or comparing the service provision in one town or locality with another that has similar demography.
  31. Corporate approach – The corporate approach involves the systematic collection of the expert knowledge and views of informants on health care services and needs. – In the context of the NHS, this corporate approach has been widely used, and was encouraged in the 1989 health reforms and the emphasis on partnership and collaboration in the 1997 White Paper.
  32. Approaches to Health Needs Assessment – Each of these approaches requires a considerable amount of resources and can be time intensive. – A comprehensive needs assessment usually involves a combination of all three approaches.
  33. Approaches to Health Needs Assessment – An alternative model, rapid appraisal, offers certain advantages in such circumstances. – This is a multidisciplinary approach that incorporates flexibility and innovation and which draws extensively on the views of the local community. – It involves using key informants to build up a community health profile. – This approach has been used to enhance community involvement in developed countries.
  34. Information pyramid – Information is collected on nine issues, in an ‘information pyramid’
  35. – Bottom layer: structure and composition of the community and how it is organized. – Second layer: concerned with socioeconomic influences on health. – Third layer: looks at resources in the community, including their accessibility and acceptability. – Top layer: looks at national, regional and local health policies. – This information, taken together, can then inform current service provision, identify the views of local residents and stakeholders, and make recommendations for health improvements. Information pyramid
  36. service-related assessment of need – There are other contemporary approaches to service-related assessment of need; these include: 1. social services assessments 2. individual health care needs assessment 3. population and client group surveys – increasing focus on strategies for assessing needs which allow the use of multiple data sources to interpret the diverse and wide ranging needs that are found within the community.
  37. – Assessment of need for health care, using whichever of these models is appropriate, is a prerequisite for the optimal allocation of resources. – The advantages and disadvantages of these approaches are summarized.
  38. – Epidemiology approach – Advantages: Gives overall figures of numbers likely to have specific problems (e.g. cancer, depression, hypertension) Relatively quick and easy, can be done from a desk top Identifies the broad range of clinical conditions and their likely prevalence Systematic and objective – Disadvantages: Assumes uniform prevalence, although can be weighted (crudely) for known risk factors, e.g. deprivation. Can tend toward medical rather than social needs This approach is only possible for some conditions, where there is straightforward means of identifying those with clinical indications Frequent lack of existing local epidemiological data and lack of evidence for certain interventions Carrying out new epidemiological work is also costly and time consuming – Source of information: ONS surveys of morbidity/ mortality Hospital episode statistics Compendium of clinical and health indicators Census data Screening data Public health observatories,, National statistics, Neighbourhood statistics,
  39. Comparative approach – Advantages: Sets local service provision against national norms Good for identifying inequalities. Uses existing data and multiple sources of information – Disadvantages: Relationship unclear between provision, utilization of services and actual need assumes that the intervention rate in the area where it is higher is the correct one – fails to take account of differences in disease prevalence rates or of previous treatment – Source of information: Prescribing data GP practice based data (disease registers), Hospital activity data, Screening uptake data/vaccination uptake, car ownership, employment, age profiles, housing tenure, self-reported limited illness Indices of deprivation
  40. Corporative approach – Advantages: Involves local health care providers and local people responsive to local concerns and fosters local ownership of the issues – Disadvantages: If carried out in isolation may determine demands rather than needs and stakeholder concerns may be influenced by the political agenda Risks legitimizing existing patterns of care that may have little rational basis – Source of information: Sources of information for this methodology can be drawn from any of the other three approaches – using local/ national quantitative data and qualitative data such as focus groups/interview and surveys
  41. Rapid Appraisal – Advantages: Good for community profiling Highly participative Good qualitative Information – Disadvantages: Does not generate statistics for planning purposes Subjective may raise local expectations – Source of information: Local informants Local information/ reports – practice profiles, community directories Semi structured interviews Questionnaires Focus groups Observation of community
  42. – A combination approach is more likely to reflect reality, however, than using one method alone
  43. Health Needs Assessment: Practical Approaches – There is no single best way of assessing the needs of a particular target population in a local area. – The methods that you use will be completely dependent upon who your target population is, and what you want to find out about that population.
  44. Health Needs Assessment: Practical Approaches – The HNA population can be identified: 1. geographic location – e.g. living in deprived neighborhoods or housing estates; 2. settings – e.g. schools, prisons, workplaces; 3. social experience – e.g. asylum seekers, specific age groups, ethnicity, sexuality, homelessness, 4. drug/alcohol use; 5. experience of a particular medical condition – e.g. mental illness, coronary heart disease, cancer.
  45. Health Needs Assessment: Practical Approaches – A target population can also be identified through a combination of main and subcategory groups, e.g. children under 5 years living in a deprived neighborhood. – Levels of HNA range from individual contact between the health care professional and the client, to local, national and international assessment of population health needs.
  46. Framework for Assessing the Health Needs of a Population – Various tools and guides have been produced by individuals and organizations in recent years to assist practitioners undertaking HNAs. – Cavanagh and Chadwick (2005) have produced a revised practical guide Health Needs Assessment based on the work of Hooper and Longworth (2002) outlining a five step process to undertake an HNA.
  47. – This framework has been recognized as a flexible, systematic process that has been well tried, tested and refined over several years and provides practitioners with a consistent process for undertaking an HNA – It is important to recognise that the process seldom follows a linear path through the steps and, in essence, an HNA can be approached in much the same way as doing a jigsaw, so that different pieces are put together to give a complete picture of local health
  48. Community health needs assessment Community HNA is a process that: 1- describes the state of health of local people; 2- enables the identification of the major risk factors and causes of ill health; 3- enables the identification of the actions needed to address these. – A community HNA may not be a one-off activity but can be a developmental process that is added to and amended over time. It should not be an end in itself but a way of using information to plan health care and public health programmers in the future.
  49. The steps of a community HNA are as follow 1. Profiling: the collection of relevant information that will inform the community HNA about the state of health and health needs of the population, and analysis of this information. 2. Deciding on priorities for action. 3. Planning public health and health care programmes to address the priority issues. 4. Implementing the planned activities. 5. Evaluation of health outcomes. – These stages correspond to the Cavanagh and Chadwick (2005) five-step process
  50. Individual/Patient Health Status and Health Needs Assessment – The distinction between individual needs and the wider needs of the community is important to consider when assessing needs. Commonly, the health status of patients is evaluated according to clinical tests, for example blood tests, scans and X-rays. – In recent years there has been an increasing interest in evaluating the health status of patients through self-completed responses to questions about health status.
  51. Individual/Patient Health Status and Health Needs Assessment – There are important contributions that the individual health assessment record can make to two important population-based tasks 1. The management of groups of individuals in a population in order to provide care directly to each individual 2. The management of information about a population in order to understand the population itself for purposes
  52. – The individual health assessment is now being designed to bring together information from many sources and incorporate it into a consistent single record. – Such single assessment processes are well positioned to provide information and to identify circumstances requiring action that spans providers. Furthermore, the information can also be used collectively to give health and social care information regarding neighborhoods and communities and to assist in community needs assessment and health care planning.
  53. reference
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Notas do Editor

  1. مزیت‌ها: تنظیم خدمات محلی در برابر هنجارهای ملی برای شناسایی نابرابری. از داده‌های موجود و چندین منبع اطلاعات استفاده می‌کند معایب: ارتباط بین ارایه، استفاده از خدمات و نیاز واقعی فرض می‌کند که نرخ مداخله در حوزه‌ای که بالاتر است یک نرخ صحیح است - در نظر گرفتن تفاوت‌ها در میزان شیوع بیماری یا درمان قبلی ناموفق است. منبع اطلاعات: Prescribing اطلاعات پزشک عمومی (ثبت بیماری)، داده‌های فعالیت بیمارستان، جذب داده‌ها / واکسیناسیون، مالکیت خودرو، استخدام، پروفایل‌های سن، تصدی مسکن، برداشت شخصی محدود از محرومیت
  2. مزایا: برای جمع آوری اطلاعات خوب، اطلاعات بسیار کیفی خوب است معایب: آیا آمار برای اهداف برنامه ریزی تولید نمی کند. ذینفع ممکن است انتظارات محلی را افزایش دهد منبع اطلاعات: خبرگزاران محلی اطلاعات محلی / گزارش ها - پروفایل های تمرین، دایرکتوری های اجتماعی نیمه ساخت مصاحبه ها پرسشنامه ها گروه های تمرکز نظارت بر جامعه
  3. تمایز بین نیازهای فردی و نیازهای گسترده‌تر جامعه در هنگام ارزیابی نیازها، اهمیت دارد. به طور معمول، وضعیت سلامت بیماران با توجه به آزمایش‌های بالینی، برای مثال تست‌های خون، اسکن و اشعه ایکس ارزیابی می‌شود. در سال‌های اخیر علاقه فزاینده‌ای به ارزیابی وضعیت سلامت بیماران از طریق پاسخ‌های کامل به سوالات در مورد وضعیت سلامتی وجود داشته‌است.
  4. ارزیابی سلامت فردی در حال حاضر برای گردآوری اطلاعات از منابع مختلف طراحی شده‌است و آن را به یک رکورد واحد منسجم وارد می‌کند. چنین فرآیندهای ارزیابی واحدی به خوبی موقعیت یابی اطلاعات و شناسایی شرایطی که ارائهکنندگان را در بر می‌گیرد قرار دارند. علاوه بر این، اطلاعات می‌تواند به طور جمعی برای ارایه اطلاعات بهداشتی و اجتماعی در رابطه با محله‌ها و جوامع و کمک در جامعه به ارزیابی و برنامه‌ریزی مراقبت‌های بهداشتی به کار رود.