Health Needs Assessment (HNA) Flashcards
What is a need? Who defines needs?
Need = gap between ideal and real conditions
Who defines need?
- individual
- family
- community
- professionals
Draw out the hierachy of need (Maslow, 1954)
What is the need, supply and demand for health?
Need = ability to benefit from an intervention
Demand = what people ask for
Supply = what is provided
What are the 4 types of needs?
- Expressed* = equates to want - what people say they want or what they think are the problems that need addressing
- Felt* = equates to demand - the health needs of a population by observation of use of their services
- Normative* = what expert opinion define as need & covers a great deal of health planning
- Comparative* = gap between recipient & other groups - need derived from examining the services in one area & using this as a basis to determine the services needed in other populations
How does “health need” differ to “health care need”?
Health need
- need for health
- much more generic
e. g. measured using socio-demographic measures, morbidity, mortality
Healthcare need
- need for healthcare
- much more specific
- depends on the potential of prevention, treatment & care services to remedy health problems
- NOTE:* In practice HNA is used to cover both health needs and healthcare needs assessments
For the purposes of HNA what is need assumed to be?
Need is assumed to exist when there is an effective and acceptable intervention, or the potential of health gain
What type of factors can influence the ability to benefit from healthcare?
Epidemiology of the disease
Effectiveness of interventions
Define HNA
A systematic method for reviewing the health issues facing a population, leading to agreed priorities and resource allocation that will improve health and reduce inequalites
(NICE 2005)
Compare “health inequality” vs “health inequity”
Health inequalities : differences between individuals or groups due to biological, social, geographical and other factors.
Some difference, e.g. due to genetics, may be fixed
Others causes by social of geographical factors - known as health inequities - can be avoided/mitigated
TRUE OR FALSE
A health service that is provided may not always be effective or needed by the population
TRUE
What are the 3 approaches to a HNA?
Epidemiological
Corporate
Comparative
Describe the epidemiological approach to a HNA?
Considers
- epidemiology of the population (e.g. morbidity, incidence/prevalence, mortality)
- current service provision and use (e.g. prevention, treatment, care)
- effectiveness & cost-effectiveness of interventions
What kind of data would you consider in an epidemiological approach?
Depends on the focus of your work - health care, social care, education e.t.c
- census
- surveys
- registrations of life events (e.g. births/deaths)
- disease registries
- communicable diseases notifications
- primary care & hospital activity data
What are the drawbacks of the epidemiological approach?
- does not consider the felt need of the people affected
- data may not be available/be of poor quality (CART - how Complete, Accurate, Relevant & Timely? are the data)
- evidence-base may be inadequate
Describe the corporate approach of a HNA
Takes into account the views of stakeholders
HNAs can be an excellent opportunity to involve stakeholders in the service planning & increase ownership & sustainability
List possible stakeholders in a HNA
- politicians
- opinion leaders
- commissioners
- providers
- professionals
- patients/service users
- press
- local authorities
What are the disadvantages of a corporate approach?
- may be difficult to distinguish need from demand
- groups may have vested interests
- may be influenced by political agendas/dominant personalities
Describe the comparative approach of a HNA
Compares different populations (or subgroups)
- spatial
- social (e.g. age, gender, class, ethnicity)
May examine
- health status / outcomes (e.g. morbidity, mortality, QoL, patient satisfaction)
- service provision / utilisation
Variations in these may be influenced by a number of factors and not just differing needs
What are the disadvantages of a comparative approach?
- may be difficult to find a comparable population
- data may not be available / may be of poor quality
What are the key steps in a HNA?
Step 1 : Getting started
Step 2 : Identify health priorities
Step 3 : Identify priorities for change
Step 4 & 5 : implement the changes and develop a monitoring & evaluation stategy & measure the impact of these changes
What are the potential stumbling blocks in a HNA?
- language - not having a shared understanding of words & ideas
- believing we know all the priorities and see HNA as pointless
- over-emphasis on either local politics & community views or professionally defined needs
What are the benefits of a HNA?
- better understanding of the population
- improved care & better use of resources
- meaningful patient/community involvement in decision making
- development of relationships and skills
What are the drawbacks of a HNA?
- commitment is needed at a senior level
- data & information
- accessing the population of interest
- skills
- cross-organisational working
What is a Joint Strategic Needs Assessment (JSNA)?
Assessments of the current and future health and social care needs of the local community
These are needs that could be met by the local authority or by the NHS
It is unique to each area and produced by the Health & Wellbeing Board
