Health Needs Assessment

Question 1

What is the Health Needs assessment?

Answer 1

When we want to improve the health of a population or population subgroup, we ideally start with a heath needs assessment, followed by the other phases of the planning cycle.

Question 2

Whats the planning cycle of the Health Needs assessment?

Answer 2

Needs assessment > Planning > Implementation > Evaluation > Planning

Question 3

As doctors, what 2 main ways will we improve the health of our patients?

Answer 3

Treating individual patients

Influencing the services available to patients

Question 4

What kind of service are offered at a GP?

Answer 4

MH practioners
Social prescribers
ANPs
Clinical pharmacist
Healthcare assistant
Physiotherapist

Question 5

What is the sociological perception of need (Bradshaw 1972)

Answer 5

Felt: Individuals perceptions of variation from normal health
Expressed: Individuals seeks help to overcome variation in normal health
Normative: Professional defines intervention appropriate for the expressed need
Comparative: comparison between severity, range of interventions and cost

Question 6

What is the capacity to benefit?

Answer 6

Individual’s capacity to benefit from an intervention - importance of effectiveness of health interventions

Make explicit what benefits are being pursued (Wright et al, 1998)

There can be no rational need for an individual or a population to receive care that has no benefit (Stevens & Gabbay, 1991

Question 7

What is the taxonomy of need?

Answer 7

Wants (Felt needs) > Demands (expressed needs) > Needs (normative needs) > met + unmet

From the met needs we take SUPPLY

Question 8

How do we identify unmet needs?

Answer 8

requires a public health focus.
Can be expressed as the relationship between :
Needs (unidentified, unmet, and met)
Services(appropriate and inappropriate)

Question 9

What is the inverse care law?

Answer 9

‘the availability of good medical care tends to vary inversely with the need for it in the population served.’ Tudor Hart Lancet 1971; i: 405-412

Question 10

What is Need, supply and demand?

Answer 10

Need is the ability to benefit from an intervention
Supply is what we actually provide
Demand / want is what people ask for

Question 11

What are the 3 main approaches to Health Needs Assessment?

Answer 11

Epidemiological
Corporate
Comparative

Question 11

What is considered in the epidemiological approach to a Health Needs assessment?

Answer 11

Person - Who are the affected people - age, gender, occupation, SEGP
Place - Where + When they get diseases, and do prevalence and incidence vary geographically?
Time - When do people get diseases? - Vary by season or cycles

Question 11

What is the outline of the epidemiological approach?

Answer 11

Statement of the problem - case definition
Prevalence and incidence
Services available and their costs
Effectiveness and cost-effectiveness of services
Quantified models of care and recommendations
Information and research requirements

Question 12

What is the disadvantage of the epidemiological approach?

Answer 12

Re-enforces a biomedical model.
Reliant on the quality and availability of data
Requires suitably trained staff to analyse data

Question 13

What are the different sources of Data?

Answer 13

Routine information sources

Survey Data

Question 14

What is involved in Routine Information Sources?

Answer 14

Population and census data
- Including measures of deprivation

Mortality data
- National registration of deaths
- Perinatal/infant mortality “rates”

Morbidity data
- Local/national registries
- Primary care data
- Prescribing data
- Health Care
- Hospital activity data

Question 15

What is show in Survey data?

Answer 15

Survey Data
Cross sectional or longitudinal
Clear aim
Case definition and population at risk
Staff and resources needed
Sample size
Precision v resources
Representativeness
Valid, reliable instrument

Question 16

What is the corporate approach to Health Needs Assessment?

Answer 16

Structured collection of knowledge and views of stakeholders – focus group, interviews used.

Based on the demands, wishes and perspectives of interested parties - professional, political and user/public views

Recognition of importance of knowledge available from those who have been involved in local service

Question 17

What are the disadvantages of the Corporate approach to Health Needs Assessment?

Answer 17

Blurs difference between need and demand, and between science and vested interest
if used in isolation it may reflect demand and supply rather than ‘need’
stakeholders concerns may be influenced by political agendas

Question 18

What are the factors that are taken into account for the corporate approach to Health Needs Assessment?

Answer 18

Doctors
Nurses
PH Doctors
Commissioning manager
Voluntary organisations
Community health councils
Trust managers
Patients
GPs

Question 19

What is the comparative approach to a Health Needs Assessment?

Answer 19

Compares health performance across or between communities, disease groups, service providers.
Measure variation in cost and service use
Fairly quick and inexpensive to achieve

Question 20

What are the disadvantages of the comparative approach to Health Needs Assessment?

Answer 20

Hard to find similar comparator
Often knowledge of optimum service not known (try to base on national recommendations)
Usage rates may vary markedly, for unexplained reasons
Link between usage rates and health outcomes may be hard to demonstrate

Question 21

Who should do the HNA?

Answer 21

Public Health Staff?
Health visitors?
Voluntary organisation staff?
Community workers?

Question 22

What are the benefits of HNA?

Answer 22

Strengthening community involvement in decision making
Improved public participation
Improved team & partnership working
Professional development of skills
Improved patient care
Improved communication with other agencies and public
Better use of resources

Question 23

What are the challenges of HNA?

Answer 23

Professional boundaries may prevent power & information sharing
Lack of shared language between sectors
Lack of commitment from top-down
Problems accessing local data
Difficulty accessing target population
Difficulty maintaining impetus and commitment

Question 24

What are some examples of HNA frameworks?

Answer 24

2 Stage (Harvey and Taylor 2013)
5 Stage (Cavanagh & Chadwick 2005)
Developmental approaches to HNA (Harvey & Taylor 2013)

Question 25

What is involved in Stage 1 In 2 stage HNA?

Answer 25

Health profiling and identifying properties

Health Indicators
Population
Service utilisation
Choosing priorities

Question 26

What happens in Stage 2 of 2 stage HNA?

Answer 26

In-depth assessment of a health priority
Component one:
Size of the problem: Incidence and prevalence of disease, and how many people will need the service and /or intervention

Component two:
Effectiveness and cost effectiveness of interventions

Component three:
Provision of current services

Question 27

What is the 5 stage approach to HNA?

Answer 27

1. Getting started - What pop? What u tryna achieve? Who needs to be involved?
2. Identifying health priorities - Population profiling, gathering data, perceptions of needs,
3. Assessing a healthy priority for action
   4 Planning for review
4. moving on/review

Question 28

Stage 1 of 5 stage HNA

Answer 28

What Population?
Why have you chosen this Population?
What are you trying to achieve? (Not as easy as it sounds but essential)
Who needs to be involved?
Resources?
Barriers/Problems?

Question 29

Theory and Practice of HNA

Answer 29

Look at slide 48 of phase 3a Health needs assessment

Question 30

What is the health equity audit?

Answer 30

Purpose:
To help services narrow health inequalities by using evidence on inequalities to inform decisions on investment, service planning, commissioning and delivery and to review the impact of action on inequalities
How:
Identification of how fairly services or other resources are distributed in relation to the health needs of different groups and areas
Prioritising actions to provide services relative to need

Question 31

What is the Health equity Audit cycle?

Answer 31

1. Agree partners and issue
2. Equity profile: Identify the gap
3. Agree high impact local action to narrow the gap
4. Agree priorities for action
5. Secure changes in investment and local delivery
6. Review progress and assess impact

Question 32

Overall health impact assessment

Answer 32

Aims:
To systematically assess the potential health impacts, both positive and negative, intended and unintended, of projects, programmes and policies
To improve the quality of public policy decisions by making recommendations that are likely to enhance predicted positive health impacts and minimize negative ones
Four procedures:
Screening: Selection of potential projects, programmes and/or policies:
Economic
Outcome
Impact
Setting up a Steering Group:
Membership
Terms of reference
Scope of the HIA
Implementation, Monitoring, Evaluation:
Process
Outcome
Starts at the ‘Action’ stage to predict outcomes

Question 33

Explain what is meant by the comparative approach to health needs assessment.

Question 34

Give three potential limitations of the epidemiological approach to health needs assessment.

Question 35

Give one health related example of something that you consider is demanded but not needed or supplied, clearly explaining the reasoning for your example.