What will the nurse do when analyzing community data?

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Volume 13, Issue 4, October 2019, Pages 229-235

https://doi.org/10.1016/j.anr.2019.08.001Get rights and content

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:

• Quantitative: numerical population data that can establish a benchmark for health indicators and conditions.
• Qualitative: descriptive data based on opinions and perceptions that can illustrate how people think or feel; typically gathered from interviews, focus groups, photovoice, participatory action research or town hall meetings.

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.

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

• Is this the hospital’s first CHA or an update from previously published CHAs?
• Will the collected data be new, updated from existing data or both?
• What requirements need to be fulfilled?
• Is the hospital operating alone or with other partners?
• Is the CHA representing one community, one hospital or multiple jurisdictions?
• Will you be conducting the CHA in partnership with local health departments or other hospitals?
• Is there a system in place to store and manage CHA data?
• Does the hospital require additional support to compile, assess and publish the data?
• What level of geographic granularity is needed to identify disparities and unmet needs?

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

• Hospital staff
• Public health departments
• Local colleges/universities
• Research organizations
• Community volunteers
• Consulting firms
• Public health institutes

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:

Source: University of Wisconsin Population Health Institute. (2016). County Health Rankings & Roadmaps: Our approach. Accessed at https://www.countyhealthrankings.org/explore-health-rankings/measures-data-sources/county-health-rankings-model

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:

• Benchmarking patient data against the health indicators in the hospital’s service area
• Aligning key indicators for the CHA with the fields being collected in the EHR
• Linking patient records across the continuum of care
• Tracking emergency department use
• Documenting behavioral health issues and comorbidities with other chronic diseases in the EHR

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:

• Community surveys: written surveys distributed widely to the community on paper and/or online
• Key stakeholder interviews: one-on-one conversations between trained facilitators and community stakeholders
• Focus groups: group-based conversations of 5 to 10 participants led by a trained facilitator
• Town hall meetings: community-wide meetings led by a trained facilitator

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

• Involve community members in developing surveys or interview guides to ensure that questions are culturally appropriate, are understandable and will elicit desired responses. Do not use health care jargon, as most people outside of the field will not understand it.
• When developing questions, make sure the questions accurately and directly address what is being measured.
• Keep the wording of questions simple, with clearly defined terms. Avoid leading questions, two-part questions or questions that make assumptions about the respondent.
• Test the questions on a small sample of potential respondents so they can give feedback and identify any confusing terms or suggest modifications.
• Keep surveys short to reduce the time burden on the respondents and increase the response rate. Include only relevant, necessary questions.
• Collect responses from a large and diverse group of individuals who are representative of the community served. If there is a significant non-English-speaking population, consider approaches that would allow those individuals to participate in their native language.
• Train individuals who will be conducting interviews and focus groups to perform this work consistently and neutrally so as not to influence responses.
• Develop standard processes for analyzing data. This is particularly important when coding qualitative data, as it is a fairly subjective process.

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