13.10.2: Needs Assessment

The first step in the generalized model is to conduct a needs assessment of the target population or community. A needs assessment is important for several reasons; whether or not the program planner is a part of the target community, they may have their own biases and priorities that may not actually reflect the needs or priorities of the community. A well-conducted needs assessment also provides justification for funding (as most community programs are funded by grants), and can also be used to get buy-in from the community members, while preventing duplication of resources or programs that already exist. It can also establish a baseline level for goals and objectives which will need to be measured at the beginning and end of the program (and sometimes mid-program) in order to evaluate whether the program is working or not. According to Seabert et al. (2021), a needs assessment includes the following 6 steps:

1. Designing the needs assessment. This includes determining both the purpose of the needs assessment, and how it will be conducted - including the personnel needed. What tools will be used (i.e. surveys, interviews, etc.)? Whom is the target population? How long will the needs assessment take to complete? Getting input from community members can be extremely helpful in designing an effective assessment, since they may have insights into the communication preferences of the target population, and how to recruit the maximum number of respondents.
2. Gathering data. Once the purpose and scope of the needs assessment have been decided on, then the data must be collected. Two main types of data can be used: primary and secondary. Primary data includes surveys, interviews, or any data gathered from the target population itself. Secondary data is information gathered on a similar population or on the target population but for a different purpose. This could include nationally representative surveys (i.e. vital statistics, behavior risk factor surveillance system data) or health insurance claims, health risk assessments etc. collected earlier from the target population. Care must be taken to respect Health Insurance Portability and Accountability Act (HIPAA) Privacy rules for health data.
3. Data analysis. Formal statistical analysis is typically only performed in research studies, since it requires more sophisticated software and controlling for potential biases and confounding factors. Many program planners do an informal analysis of the data to identify the most pressing problems for the community. Once again, getting input from community members can be invaluable in this process. Often there are many potential health problems, but a program can only be designed to address one or two, so they must be ranked according to which problems have the highest need, and can be addressed most easily and effectively.
4. Identifying risk factors. After the health problems have been prioritized, risk factors that contribute to those health problems should also be identified. There are three types of factors involved in a behavior:
   1. Predisposing factors, or those needs that a person has before starting a behavior. For example, knowledge of the health risks of smoking is a predisposing factor for smoking cessation. If someone does not know that smoking poses a risk to their health, they are unlikely to try to quit.
   2. Enabling factors, or those things that help someone perform the behavior. For example, if someone wants to start exercising, it helps if they have access to a gym, park, walking paths, exercise classes, etc.
   3. Reinforcing factors, or those that keep a person going in healthy behaviors. Social support, for example, is especially powerful in maintaining a behavior. Reinforcing factors might include workplace wellness programs, recreational clubs, or support groups (like Alcoholics Anonymous).
5. Setting the focus of the program. The program planner will now have the information needed to identify the direction of the program: which health problems are priorities, and which behavioral risk factors are going to be targeted. The planner should always pursue those problems and factors that have the greatest importance: either because of the severity of the health problem, number of people affected, and/or because community members have identified it as being important to them. But they also need to prioritize health problems that are changeable - that is there is scientific evidence that community interventions can be effective for this problem. Finally, planners should always take into account the resources available (funds, personnel, space, time, etc.) If there are not enough resources to address the problem effectively, then perhaps the particular grant funds they are working with is better used to target another priority problem on the list.
6. Validating prioritized needs. Once again community input can be helpful in double-checking the assessment results. This also allows for the planner to identify if anything is already being done to address the priority health problem, or if other interventions have been attempted in the past. Additionally, they should check for redundancies or programs that are already addressing that need in the community. Are there ways to support those programs that are already in existence and successful, rather than competing with them?

Figure \(\PageIndex{1}\): This photograph depicts Epidemic Intelligence Service (EIS) officer, Daniel Nguyen (Class of 2022), as he was interviewing community members for a Rapid Needs Assessment, after the August 2023 Maui wildfires at the Maui District Health Office in Maui, Hawaii. (Copyright; Photo credit: CDC/Daniel Nguyen.)