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PubMed1984

Assessing the need for a needs assessment.

Needs assessments are conducted with the expectation that the information obtained will be used to make rational decisions. However, appropriate planning and service delivery decisions do not always flow from needs assessment information. Assessment of the anticipated utilization of needs assessment data, and evaluation of the appropriateness of these uses prior to conducting a needs assessment may prevent inefficient use of resources. The present study evaluated the willingness and ability of community mental health leaders to use needs assessment data. A structured interview was developed which tapped into several dimensions relevant to the evaluation of the need for a needs assessment. The most striking result was that when asked how they would use future needs assessment data, all respondents indicated that the results would not influence service delivery patterns. Strategies to facilitate the constructive use of information gained from needs assessments are discussed.

Attitude of Health Personnel↗
PubMedDate not supplied

Patient-centered needs assessment: rationale for a psychometric measure for assessing needs in heart failure.

Determining an individual's unique perspective of an illness experience remains a challenge for clinicians, administrators, and researchers. A range of concepts and psychometric measures have been developed and evaluated to capture this information. These include patient satisfaction, quality of life, and utility measures. Needs assessment as a tool for evaluating perceptions of health status and determining patient satisfaction and treatment plans has been explored in oncology. Studies have demonstrated that a high proportion of patients have unmet needs in relation to activities of daily living, information sources, and comfort. Heart failure (HF), a condition with significant individual and societal burden, mirrors the illness of experience of cancer, as individuals process issues related to prognosis, treatment regimens, and decreased functional status. A needs-based assessment of health status, expectations, and perceptions is patient-centered and has the capacity to not only evaluate current health status but also plan and project care plans. Needs assessment is a dynamic construct rather than a point in time consistent with other assessment modalities, such as quality of life. Multidimensional needs assessment allows for planning and projection of needs, not only on an individual but also a population basis. Implicit in the exploration of needs is an expectation of level of care to be provided, from both the provider and recipient of care. In many instances a misalignment may exist between services and resources available to the individual. This article seeks to provide a theoretical justification for the development of a needs assessment instrument for patients with HF and to discuss the rationale of this method of assessment to create better alignment and resources with patients needs and expectations.

Colonic Neoplasms↗
PubMed1998

An epidemiological needs assessment of carotid endarterectomy in an English health region. Is the need being met?

OBJECTIVE: To compare the level of provision of carotid endarterectomy (an intervention of proved efficacy for prevention of stroke in patients with symptomatic high grade carotid artery stenosis) with estimates of need. DESIGN: Comparison of regional, district, and age-sex specific operation rates derived from hospital episode statistics with estimates of need based on demographic and epidemiological data; interviews with regional vascular surgeons and a joint provider-purchaser workshop to discuss implications. SETTING: Former Wessex Regional Health Authority, 1991-2 to 1995-6. SUBJECTS: All residents covered by Wessex region treated for carotid artery reconstruction. MAIN OUTCOME MEASURES: Regional, district, and age-sex operation rates as three year average 1993-6 (use) compared with respective estimates of need for carotid endarterectomy among those who presented with symptomatic carotid disease-transient ischaemic attack or minor stroke. RESULTS: The operation rate more than doubled between 1991-2 and 1995-6, from 35 to 89 per million population, compared with an estimated level of need in the region's general population of 153 per million population (transient ischaemic attack 77, minor stroke 76). The ratio of use to need was 0.47 (95% confidence interval 0.4 to 0.54); district ratios were 0.28 (0.19-0.38) to 0.81 (0.62 to 1.06). The annual use:need ratio rose over the three years 1993-6 from 0.38 to 0.59. Use:need ratios were lower in elderly and female patients. Providers were keen to develop guidelines for referral and to increase access to diagnostic facilities; purchasers were more reluctant, given the limited impact of this intervention on the incidence of stroke and the relatively high cost of the operation. CONCLUSION: Although treatment rates increased in Wessex there is still unmet need. Further research is needed to determine the referral pathways of patients with symptomatic carotid disease for diagnosis and operation and to evaluate strategies to improve access to diagnostic facilities.

Adolescent↗
PubMed2002

Health needs assessment and needs-led health service change: a survey of projects involving public health doctors.

OBJECTIVES: To describe the criteria that define an effective health needs assessment and to explore which factors are important for the delivery of effective health needs assessment in the English National Health Service (NHS). METHODS: A postal questionnaire to all public health doctors in an English health region to describe health needs assessment activity, including initiating factors, methods and outcomes. This was followed by semi-structured interviews with public health professionals and others involved in 10 purposively selected needs assessments. RESULTS: A response rate of 62% identified a total of 102 health needs assessments undertaken between 1993 and 1998. A number of themes emerged as being important in the impact of health needs assessments on policy and planning. These included careful design, methodological rigour, decisive leadership, good communication, involvement and ownership of the work from relevant stakeholders, support from senior decision-makers, appreciation of the political dynamics and engagement with local priorities, availability of resources and, finally, an element of chance. These themes can be categorised broadly into contextual factors and quality or robustness of the work. Our findings suggest that, although methodological and analytical quality are necessary characteristics of effective health needs assessment, they are not sufficient without a favourable political environment. CONCLUSION: There appear to be conditions under which needs assessment is more likely to be effective in terms of its influence on policy and planning. However, it is clear that needs assessment does not occupy a central position in health service decision-making, remaining vulnerable to a range of factors over which those responsible for its conduct have little or no control.

Attitude of Health Personnel↗
PubMed1991

Periodontal awareness, health, and treatment need in dental school patients. III. Treatment need.

The need for periodontal treatment in a group of dental school patients was estimated by means of the periodontal treatment need system (PTNS). The findings were related to information about the regularity of dental visits, awareness of own disease, and periodontal treatment experience. All the patients required motivation and oral hygiene instruction (treatment need, class A). All their quadrants needed scaling or adjustment of subgingival restorations (treatment need, class B). As many as 71% of the patients and about 49% of the quadrants needed periodontal surgery (treatment need, class C). The mean periodontal treatment time per patient was 279 min (4 h 39 min). The middle age group (30-59 years) required more treatment time than the oldest group (greater than or equal to 60 years). This was probably due to more missing teeth in the oldest age group. There were no significant differences in treatment need between males and females. The regular dental visitors had a greater periodontal treatment need than the individuals visiting their dentist less frequently. This finding emphasizes the responsibility of the general practitioner in diagnosing and treating periodontal disease.

Adult↗
PubMedDate not supplied

Clinic-based needs assessment of individuals with multiple sclerosis and significant others: implications for program planning--psychological needs.

The purpose of this study was to identify the psychological/psychosocial needs of patients with multiple sclerosis (MS) and their significant others (SOs) who attended an MS clinic. A quantitative questionnaire, developed from focus groups, consisted of 23 needs statements in the psychological/psychosocial needs category. Participants were randomly selected from the clinic's database. The questionnaire was completed by 353 MS patients and 240 significant others. Content analysis of the psychological category produced four themes: general psychological needs, psychological needs related to specific resource needs, psychological needs related to interaction with the medical community, and psychological needs statements displaying a difference between MS and SO responses. The data indicate the importance of psychological intervention in the care of MS patients and its implications for program planning.

Activities of Daily Living↗
PubMed1999

Clinical and social needs of schizophrenic outpatients living in the community: the relationship between needs and subjective quality of life.

BACKGROUND: The aims of this study were to assess self-perceived clinical and social needs among 120 schizophrenic outpatients, and the relationship between needs and subjective quality of life. METHOD: The Camberwell Assessment of Need instrument (CAN) was used to assess needs and the Lancashire Quality of Life Profile was employed to assess subjective quality of life. RESULTS: More than half of the patients expressed needs in areas concerning psychotic symptoms, daytime activity, company, physical health and information about their condition or treatment. The areas with the highest proportion of unmet needs were information, company, intimate relationship, physical health, daytime activity and psychological distress. A more severe need of care and support in the areas of company, psychological distress, daytime activity and sexual expression was associated with a worse subjective quality of life, controlling for the influence of symptomatology. CONCLUSIONS: The results point to a need to further emphasise interventions towards the treatment of psychotic symptoms and psychological distress as well as to focus on interventions concerning the social relations and occupational situation of long-term mentally ill patients.

Adolescent↗
PubMed1996

Inter-agency assessment of respite care needs of families of children with special needs in Fife.

BACKGROUND: In response to concern about the respite care provision for parents of children with special needs in Fife a survey was undertaken jointly by the Fife Regional Council social work department and education department and Fife Health Board. METHODS: A postal questionnaire survey was carried out of families of children with special needs in Fife and a retrospective case review of paediatric admission in two Fife hospitals undertaken to identify episodes of respite care in hospital. RESULTS: Results confirmed the considerable demand for additional respite services and the need for a variety of types of respite care provision to cater for the differing needs of families. The two most commonly requested services were a small homely respite care centre and holiday playschemes. The quality of services currently provided was generally considered to be good. The numbers of (usually multiply handicapped) children with a specific need for a health professional input during respite care are relatively few but nevertheless are an important group which often receive respite care inappropriately in a hospital setting. CONCLUSIONS: The results of the survey informed the interagency community care planning process and led to the developments of a Fife-wide family-based respite care scheme and a small residential facility in Kirkcaldy district. The latter is jointly funded by the Regional Council and Health Board. The Health Board will provide nursing support to the small residential service so that the needs of the few severely and multiply handicapped children can be better met. The project represents an example of successful interagency collaboration which was based on a joint commitment to assessing health and social care needs and planning services to meet these needs.

Adolescent↗
PubMed1995

The Cardinal Needs Schedule--a modified version of the MRC Needs for Care Assessment Schedule.

This paper describes a modified version of the MRC Needs for Care Schedule (the Cardinal Needs Schedule), for measuring needs for psychiatric and social care amongst patients with severe psychiatric disorders. The modified schedule has three new features: (i) it is quick and easy to use; (ii) it takes systematic account of the views of patients and their carers; (iii) it defines and identifies need in a way that is concise and easy to interpret. The paper describes why the three new features were considered necessary, and then gives an overview of the structure of the Cardinal Needs Schedule, together with a description of how the three new features were developed. During a study of social services care management the practicality of the modified schedule was investigated and further data were obtained on the reliability and validity of the standardized approach to measuring need, in domains not previously investigated. Because of its speed and simplicity, the Cardinal Needs Schedule offers a new choice to researchers who wish to use a standardized and practical assessment of need in evaluative studies of community care. Examples of the usage of the modified schedule are given in an Appendix.

Activities of Daily Living↗
PubMed2005

How many social workers are needed in primary care? A patient-based needs assessment example.

This study measured levels of self-reported social need in a sample of 684 veterans seen in four primary care clinics of a large Veterans Affairs health care system, using the Social Needs Checklist, and calculated levels of social work staffing to meet these needs. Data were obtained on the presence and severity of 15 areas of social needs, housing status, patient requests for social work services, and current access to other providers for social services. Data were also obtained from primary care social workers who estimated the average time needed to provide basic social work services. Nearly two-thirds of the sample had problems related to finances and personal stress. Three in four patients reported multiple needs. One-third requested social work services. Social work staffing needed for highest acuity patients was estimated to be 61 percent higher than actual staffing available. The study presents a method of estimating staffing levels based on social needs reported by patients.

Humans↗
PubMed2000

A questionnaire assessment of unmet needs for rehabilitation services and resources for people with multiple sclerosis: results of a pilot survey in five European countries. Needs Task group of MARCH (Multiple Sclerosis and Rehabilitation, Care and Health Services Research in Europe).

OBJECTIVE: To develop an international services and needs assessment instrument (SUN) for people with multiple sclerosis and their carers and to pilot this in different countries of the European Community. DESIGN: Interview study of people with multiple sclerosis, their carers and nominated key professionals examining the unmet needs of patients and carers. SETTING: Belgium, Estonia, Greece, Italy and the United Kingdom. MAIN OUTCOME MEASURES: Needs assessment questionnaire. RESULTS: The study comprised 137 people with multiple sclerosis, 125 carers and 111 professionals. Patients reported on average 2.9 unmet needs for themselves; their carers and professionals reported on average 2.4. Needs were categorized into seven broad categories. Due to difficulties experienced by the local researchers in distinguishing between needs and objectives a large proportion of needs had to be assigned to the 'other' category. CONCLUSIONS: The SUN is a valuable and practicable tool for the identification of unmet needs for people with multiple sclerosis and their carers. Formal validation and reliability testing of the different language versions is recommended.

Europe↗
PubMed2000

Reliability of the Camberwell Assessment of Need--European Version. EPSILON Study 6. European Psychiatric Services: Inputs Linked to Outcome Domains and Needs.

BACKGROUND: The five-country European Psychiatric Services: Inputs Linked to Outcome Domains and Needs (EPSILON) Study aimed to develop standardised and reliable outcome instruments for people with schizophrenia. This paper reports reliability findings for the Camberwell Assessment of Need--European Version (CAN-EU). METHOD: The CAN-EU was administered in each country, at two points in time to assess test-retest reliability, and was rated by two interviewers at the first administration. Cronbach's alpha, test-retest reliability and interrater reliability were compared between the five sites. Reliability coefficients and standard errors of measurement for summary scores were estimated. RESULTS: Sites varied in levels and spread of needs. Alphas were 0.48, 0.58 and 0.64 for total, met and unmet needs respectively. Test-retest reliability estimates, pooled over sites, were 0.85 for the total needs, 0.69 for met needs and 0.78 for unmet needs. Pooled estimates for interrater reliability were higher, at 0.94, 0.85 and 0.79 for total, met and unmet needs respectively. There were statistically significant differences in interrater reliability between sites. CONCLUSION: The results confirm the feasibility of using CAN-EU across sites in Europe and its psychometric adequacy.

Adolescent↗
PubMed1995

Validity and reliability of the family inventory of needs (FIN): measuring the care needs of families of advanced cancer patients.

Two studies balanced qualitative and quantitative data to provide evidence of satisfactory validity and reliability of the Family Inventory of Needs (FIN). The FIN is designed to measure the importance of care needs of families of advanced cancer patients (FIN-Importance of Care Needs subscale) and the extent to which families perceive that their care needs have been met (FIN-Fulfillment of Care Needs subscale). The first study involved development of the instrument and testing for clarity, apparent internal consistency (non-quantitative assessment of homogeneity of content), and content validity using a panel of six experts (family members of advanced cancer patients). The FIN met or exceeded the preset criteria specified used in this phase of testing. The second study of the project used 109 family members of advanced cancer patients from three hospice programs to test the FIN for internal consistency and construct validity. Internal consistency of the FIN-Importance of Care Needs subscale as measured by Cronbach's alpha coefficient was .83 without redundancy. Construct analysis was assessed using factor analysis techniques. An inability to extract a substantively meaningful minimum number of factors, together with the fact that a theta reliability coefficient of .85 was obtained (only .02 higher than the alpha coefficient), suggested that the items were parallel supporting the conclusion that the subscale is unidimensional. Support for the construct validity of the FIN-Importance of Care Needs subscale was also obtained using predictive modeling. The internal structure of the FIN-Fulfillment of Care Needs subscale was assessed using cluster analysis. Results suggested that the subscale is a unidimensional one. Overall, the FIN met the preset reliability and validity criteria providing promising evidence for the instrument's sound psychometric properties for use in research and clinical settings.

Adult↗
PubMedDate not supplied

Gynecologic cancer patients' psychosocial needs and their views on the physician's role in meeting those needs.

The aim of this study was to identify the psychosocial needs of patients after treatment for gynecological malignancies and their views concerning the role physicians should take in meeting those needs. Self-administered questionnaires were answered by 95 patients at least 6 months after completion of therapy. Topic areas included emotional needs, spiritual concerns, patient-family communication, patient participation in decision making, and advance directives. In addition, all participants completed the Functional Assessment of Cancer Therapy (FACT-G, version 4) quality of life questionnaire. Fifty-seven percent of respondents stated that they had needed help dealing with emotional problems, and 73% wanted the physician to ask whether help is needed. The most common emotional concerns were feeling nervous (40% of subjects), being worried (34%), fear (25%), needing someone to talk to (24%), sadness (21%), and loss of control (17%). Fifty-nine percent stated that physicians should ask whether help is needed in discussing spiritual matters. Sixty-one percent stated that physicians should ask patients whether they want help starting conversations with their families about difficult-to-raise topics such as the possibility of dying. Forty-six of 86 respondents (53%) stated that discussions about advance directives such as living wills should take place soon after the cancer diagnosis has been established. Most patients surveyed want physicians to take an active role in dealing with psychosocial needs.

Adult↗
PubMed1997

Cross-cultural comparison of need importance and need satisfaction during adolescence: Turkey and the United States.

Turkish and U.S. adolescents' views concerning the importance of different needs and instrumentality of relationships with mothers, fathers, siblings, and same-sex friends for need satisfaction were examined and compared. Questionnaires covered needs related to crucial issues of adolescence, namely, relatedness and autonomy/individuation. Participants were 12- to 17-year-old boys and girls from intact families. Cross-cultural differences in ascribed importance of needs related to some aspects of relatedness and autonomy/individuation emerged. Cross-cultural similarities in ascribed importance of needs related to feelings of basic acceptance and need for self-understanding/development also emerged. Turkish adolescents perceived mothers as more instrumental for need satisfaction than did U.S. adolescents. Gender differences in importance ascribed to different needs also emerged. Cross-cultural differences were consistent with differences in predominant values and model family dynamics of the respective countries.

Adolescent↗
PubMed2004

Assessing support needs for people with traumatic brain injury: the Care and Needs Scale (CANS).

BACKGROUND: After traumatic brain injury (TBI), many individuals have support needs, but the variety, frequency and intensity of such needs vary widely. Currently available scales do not assess all facets of required supports and the eight-category Care and Needs Scale (CANS) was developed in order to capture the range of support needs. The aim of the present study was to examine the sensitivity and validity of the CANS. METHOD: Using a sample of 67 people who sustained severe TBI 20-26 years previously, the CANS was compared with the Supervision Rating Scale (SRS), five scales from the Craig Handicap Assessment and Reporting Technique (CHART) and the Sydney Psychosocial Reintegration Scale (SPRS). RESULTS: The data showed a spread across all CANS categories: 28.4% of participants were fully independent, 46.3% had support needs on less than a daily basis (25.4% intermittently, 13.4% at least weekly and 7.5% every few days) and the remaining 25.4% had needs on a daily basis (ranging from 11.9% for up to 11 hours per day to 4.5% for 24 hours per day). By contrast, the 13-category SRS classified 61.2% in the best category and five categories did not contain any individuals. The CANS showed strong correlation with the SRS (r(s) = 0.75), as well as CHART and SPRS scores (range r(s) = -0.46 to -0.85) and statistically significant differences were found among participant sub-groups. Logistic regression analyses, using variables collected at the time of discharge from rehabilitation, were able to predict independence on the CANS with classification accuracy of 77% and presence of neuropsychological disability was an individual predictor. CONCLUSION: These results suggest that the CANS shows promise as a sensitive and valid instrument to measure care and support needs after TBI, particularly in the longer term, and further examination of its psychometric properties is warranted.

Activities of Daily Living↗