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PubMed2000

A taxonomy of needs assessment, elicited from a multiple case study of community nursing education and practice.

The role and expectations of community nurses in carrying out needs assessments changed when an internal quasi-market was introduced to the British health service under the National Health Service (NHS) & Community Care Act 1990. This paper reports on a study commissioned by the English National Board for Nursing, Midwifery and Health Visiting (ENB) to investigate the changing educational needs of community nurses with regard to needs assessment in the context of this legislation. A multiple case study design was utilized and four cases identified, incorporating the geographical variation in England. Recently qualified practitioners (health visitors and district nurses) were observed during a regular shift (n=134 visits), concentrating on their practice of assessing needs, and on liaison and collaboration within teams and across sectors. Participants were interviewed after the observation period (n=33 practitioners), to determine the extent of formality they attached to each assessment, and to elicit information about aspects which may be embedded in everyday practice. Single and multiple case analyses across the four cases used an iterative process of pattern-matching, replication logic and explanation building. The preliminary analysis yielded a descriptive 'taxonomy' which could serve as a basis for classifying the variants of needs assessment and help to clarify the whole phenomenon. When applied further to the data, this revealed the complex interactions between the different ideals (relating to policy, nursing and ascribed worth), the various types (purpose, formality/specificity and complexity) and timing (in relation to client, service and practice issues) within needs assessment.

Community Health Nursing↗

PubMed2003

Health needs assessment in the health visiting service and the impact on the ethnic community.

The purpose of this article is to share the experience of using a health needs assessment tool in health visiting practice in Great Britain, with clients who do not speak English. This is an important issue in developing equity of practice across the growing multi-cultural and diverse populations of the United Kingdom. The paper outlines the findings relevant to these issues drawn from a wider study that used qualitative methods to observe and interview both health visitors and clients regarding the use of the tool. It focuses on one vignette to demonstrate the practical and difficult issues when a formal system is used to assess needs in clients who do not speak English as a first language.

Adult↗

PubMedDate not supplied

Continuing education needs assessment: a brief report.

A needs assessment was conducted to quantify the need for, and the capacity to provide, public health continuing education in San Diego County, California. The study was conducted with the objective of developing public health continuing education courses to be offered by the San Diego State University Graduate School of Public Health (SDSU-GSPH) to address the unmet demands of local practitioners. Survey instruments were developed to separately assess the continuing education needs of public health practitioners and the capacity of SDSU-GSPH faculty to provide courses in San Diego County. The faculty survey was distributed to all full-time SDSU-GSPH faculty. Practitioner surveys were distributed to a systematic sample of divisions and subdivisions in the County of San Diego Department of Health Services. The overall survey response rates were 71% for faculty (22/31) and 40% for practitioners (190/470). Practitioners indicated a strong interest in several of the 64 specific course topics they were asked to rate. Reported faculty interest and capacity to teach continuing education courses appears to be limited. The analysis confirms a need to improve and increase SDSU-GSPH public health continuing education offerings. Further, our results suggest that external instructional resources will be needed to meet this educational demand.

Attitude↗

PubMed1999

Reliability of the Salford Needs Assessment Schedule for Adolescents.

BACKGROUND: For adolescents, there is no specific needs assessment instrument that assesses significant problems that can benefit from specified interventions. A new instrument (S.NASA) was developed by incorporating and adapting three well established adult needs assessment instruments. The S.NASA covers 21 areas of functioning including social, psychiatric, educational and life skills. METHOD: Client and carer interviews were conducted by different researchers. A week later the interviews were repeated using a crossover design. Significant (cardinal) problems were generated from the clinical interviews using a pre-defined algorithm. Final need status (three categories) was made by clinicians assessing the cardinal problems against defined interventions. The interventions were generated from discussions with clinicians and a survey of appropriate professionals working with adolescents. RESULTS. Pre-piloting led to the final version being administered to 40 adolescents from secure units, forensic psychiatric and adolescent psychiatric services. There were 25 males and 15 females, mean age 15.5 years. Overall there were moderate to good inter-rater and test-retest reliability coefficients, the test-retest reliability coefficients for the total scores on the needs assessment interviews ranged from 0.73 to 0.85. Consensual and face validity was good, the adolescents and staff finding the instrument useful and helpful. CONCLUSIONS: This new needs assessment instrument shows acceptable psychometric properties. It should be of use in research projects assessing the needs and the provision of services for adolescents with complex and chronic problems.

Adolescent↗

PubMed1991

Dental needs assessment survey: three Florida counties.

Dental needs assessment surveys were completed in three Florida counties (1987 - Lee County), (1988 - Pasco County) and (1989 - St. Lucie County). The data collected were then compared with the results from the national caries prevalence surveys in 1979-80 and 1986-87, by individual county and with the combined three-county total. Visual tactile examinations were done using the Radlike criteria for the DMFS index and the WHO Treatment Needs Index. Schools were selected based on the percent of students enrolled in the free or reduced lunch program and by geographic distribution. Although there were age group differences within individual counties, the combined data showed every age group except the seven year olds at a lower DMFS mean level than the data from the 1986-87 national survey for Region IV. The differences range from -.20 surfaces in 8-year-olds to -.57 surfaces in 13-year-olds. None of the differences were statistically significant from the national surveys. This indicates that these small scale surveys are a reliable method for needs assessment.

Adolescent↗

PubMed1998

Health needs assessment in primary care: the evolution of a practical public health approach.

The purpose of the paper is to place health needs assessment in its primary care context. This is a dynamic context where changes in policies, staff roles and patient expectations have all to be considered. Given this complexity and the variations between practices, it is necessary to help primary health care teams (PHCTs) to understand their stage of development and how this will directly affect any health needs assessment. The technical and methodological aspects of health needs assessment have been explored and described by others, and that work will not be duplicated here. This paper reviews the health needs assessment (HNA) work of the Ribblesdale Total Purchasing Project (RTPP) and then sets this review against the political, organisational, professional and practical pressures that currently confront primary care. Out of this analysis emerges a diagnostic and development tool which links together, and emphasises the intimate relationships between, five stages of development needed for effective primary care-oriented health needs assessment work. The emphasis is on understanding the place of health needs assessment within the general processes and systems of the primary health care team. The paper concludes by suggesting ways in which public health practitioners and specialists might approach the task of supporting and influencing the evolution of the recently proposed Primary Care Groups and Primary Care Trusts. The overall intention of the article is to stimulate debate and action.

Family Practice↗

PubMed1998

Placing the cornerstone for healthcare professionals' risk management education: an educational needs assessment.

The risk manager's performance of an educational needs assessment to assist in determining related training and development elements supports a solid, proactive risk management program designed to motivate healthcare professionals. Environmental scanning, needs assessment tool design and development, tool validation, organizational commitment and ethical considerations are examined. A sample needs assessment tool is provided.

Delivery of Health Care, Integrated↗

PubMed1995

Palliative care services: what needs assessment?

A survey of all district health authorities in England was conducted in order to describe current patterns of needs assessment and contract setting for palliative care services. Outcome measures included the completion of needs assessments in the past five years, the type of data used for needs assessment, and recommendations for service development. Copies of contracts for palliative care services were requested and analysed according to duration of contract, and audit requirements. A 74% response rate was achieved. Over half the health authorities had not carried out a needs assessment or service review of palliative care services in the past five years. Of those that had undertaken needs assessment, about one-quarter were planning more review work, and most of the reports expressed the need for more information on many aspects of palliative care. Copies of contracts with specialist palliative care providers were supplied by 38 health authorities, with the majority being of only one year's duration. Although conducted within an English context, the study findings have wider implications for the process of effective health care purchasing.

Contract Services↗

PubMed2006

Life mapping: a 'Therapeutic Document' approach to needs assessment.

This study tested the effectiveness of The Life Map designed by the authors for holistic needs assessment for the promotion of mental health based on the World Health Organisation's six Quality of Life domains (1985). Tests were conducted of test-retest reliability and validity (criterion, discriminant, construct and concurrent) compared with an existing validated needs assessment, the Camberwell Assessment of Needs Inventory CAN-R. For main analyses, 43 mental health service users (SUs) were age-sex matched with 43 of non-service users (non-SUs). The Life Map significantly discriminated between these two study groups. Non-parametric correlations in each group showed significant relationship between a general quality of life question and the 'well-being' and the 'influence over' scores in each of the six domains. Consistent significant agreement was found in test-retests conducted 2 weeks apart. Qualitative data in the Life Map was able to conceptualise the quantitative Life Map scores. This makes the Life Map a tool to improve communication between user and care-provider using a reliable felt and expressed needs assessment that empowers the service user with a 'voice' and empowers the care-provider with the capacity to compare aggregated needs between localities and for change over time. The limitations of this study, the Life Map's utility to facilitate meeting Standards 1 and 2 of the UK's National Service Framework for adult mental health and future directions are discussed.

Adolescent↗

PubMed2000

A needs assessment for a palliative care curriculum.

To ensure the success of a new curriculum at an institution, information about the educational needs of learners, available resources, and potential obstacles needs to be systematically collected and analyzed prior to the development and implementation of the actual curriculum. This process, known as needs assessment, is important in the development of palliative care training for internal medicine residents, because internal medicine has only recently begun to address these issues in a formalized way and palliative care is a relatively new topic in medical education and clinical medicine. Therefore, institutional issues and resistance, lack of knowledge and appropriate attitudes among trainees and faculty, and a paucity of educational models for individual internal medicine training programs present potential obstacles. Although curricula that have been developed by national organizations can serve as "guideposts, " these documents are unable to address the specific needs and culture of an individual institution. This paper outlines a systematic methodology of needs assessment for palliative care curricula at individual institutions that could be applied to the development and implementation of palliative care training for different groups of learners. An institution-specific needs assessment was developed based upon the findings of a systematic literature review and interviews with experts in palliative medicine and medical education. The following methods were utilized: 1) an anonymous survey; 2) focus groups; 3) topic rankings; and 4) individual interviews. The needs assessment revealed the following educational, clinical, and institutional information: 1) interns had very little exposure to palliative care in medical school; 2) there was no formalized system formal education and clinical exposure; 3) tremendous interest in palliative care education existed; 4) patients, families, physicians, and nurses perceived a need to improve the quality of palliative care; and 5) there are several political, logistical, and resource (time and financial) obstacles that needed to be addressed. An institution-specific needs assessment is an important part of the successful development and implementation of any new curriculum for medical residents and was specifically necessary for our palliative care program. As a result of the needs assessment process, a curriculum consisting of ten units of case-based and problem-based teaching was successfully implemented.

Curriculum↗

PubMed2001

Mary J. Nielubowicz Essay Award. Population-based needs assessment in the design of patient education programs.

The population-based needs assessment discussed in this paper was conducted as part of a larger study evaluating the status of the patient and family education program at a military treatment facility. The purpose of the assessment was to describe the congruence of patient epidemiologically defined educational needs with patient education program offerings. A seven-step theoretical framework for conducting population-based needs assessments by Declercq, Bichell, and Center guided data collection and data analysis. Results of the analysis were used to provide evidence-based guidance to the military treatment facility's Executive Steering Council on improving patient health care outcomes through redesign and institutionalization of the patient education program. The population-based needs assessment provides a viable avenue for delineation of disease patterns, prioritization of health education needs, and design of effective patient education, health promotion, and disease prevention programs in support of the Department of Defense Military Health System Optimization Plan.

Adolescent↗

PubMed1991

The building blocks of a quality day treatment program: the needs assessment.

This paper is the first in a series of papers which discuss the many necessary ingredients that combine to produce a quality day treatment program. The theme of this article is the assessment of market needs. Included are (1) an introduction to the concepts of needs, (2) a discussion of the movement from need to change in society, (3) an examination of the process of quantifying needs, and (4) a brief description of several different types of needs assessments. The conclusion provides a description of each salient point and indicates its use in day treatment program development.

Data Collection↗

PubMed1999

A survey of social services needs assessments for elderly mentally ill people in England and Wales.

OBJECTIVE: to examine variations in the needs assessment policies and practices of social services departments in England and Wales in dealing with elderly people who have mental illness. DESIGN: postal questionnaire survey. SUBJECTS: a random sample of 61 of 119 social services departments in England and Wales. MAIN OUTCOME MEASURE: 99-item questionnaire. RESULTS: 40 responses were received (66%). There were substantial differences in the way referrals were screened before needs assessment and in the design of needs assessment procedures. Disagreements between health and social services were common and, although mechanisms existed to respond to urgent needs, almost one-third found such responses difficult to make. CONCLUSIONS: there are national variations in the way needs assessments are performed by social services, which may lead to inequalities in provision of care to individuals. The lack of a standardized approach impedes comparisons of need between areas which might aid in the distribution of resources at a national level.

Aged↗

PubMed1982

Health education needs assessment in an HMO: a case study.

Potential health education services for HMO subscribers are numerous and varied, ranging across the entire wellness to sickness spectrum. Because of cost consciousness and limited educational resources, careful needs assessment and selection of priorities are vital to the success of HMO health education efforts. The results of utilizing six needs assessment methodologies are presented in this case study. Consumer and provider involvement in the needs assessment process revealed five top priority health problems or opportunities for health education: membership education needs; overweight/obesity; self-care needs; hypertension; and smoking. These recommendations did not include perinatal and pediatric health education services as top priority needs, an outcome at variance with the results of the other needs assessment methodologies. This variance emphasizes the importance of employing multiple techniques in the needs assessment process. Problems in implementing various needs assessment methodologies are discussed as well as implications for health education practice.

Health Education↗

PubMedDate not supplied

Tracheal suctioning: a tool for evaluation and learning needs assessment.

A 21-item observation tool developed by one of the authors was used to assess learning needs of 30 registered nurses who regularly suction intubated patients. Of the nurses observed, 97 percent had excellent regard for proper equipment utilization and 91 percent for maintenance of sterile environment. These high percentages were responsible for pulling the overall average scores to 65 percent, thus partially disguising the acute need for patient assessment (38 percent), psychological support (57 percent), and procedure (62 percent). Scores for subgroups of nurses--associate degree (group 1), diploma (group II), And baccalaureate (group III)--were 72, 69, and 65, respectively. Of particular concern were low scores in the assessment and psychological support categories. Despite increased emphasis on both of these areas in nursing programs in the last decade, AD graduates received scores of 52 and 57 percent while diploma graduates received scores of 38 and 58 percent and baccalaureate graduates received scores of 26 and 55 percent.

Asepsis↗

PubMed1996

Orthodontic concern among 11-year-old children and their parents compared with orthodontic treatment need assessed by index of orthodontic treatment need.

The aims of the study were to compare the opinions of both the children and the parents with an orthodontist's assessment of treatment need, to investigate the children's self-esteem, and parents' opinion of treatment results. The study group of 359 children (51% girls, 49% boys, mean age 10.6 years) and their parents were asked about their opinions in separate questionnaires. The self-esteem of the children was measured by the global negative self-evaluation scale (GSE). An orthodontist assessed the children's dental casts with the index of Orthodontic Treatment Need (IOTN). Allocated to the dental health component (DHC) of IOTN, 53.2% children had very great to moderate need and 46.8% had little to no need. No sex difference was noted. The children's own assessments of the aesthetic component (AC) of IOTN were closer to the attractive end of the scale than the orthodontist's (p < 0.05). Desire for treatment was more frequent than dissatisfaction with children's occlusion (p < 0.001). The patients' orthodontic concern correlated significantly with both DHC and AC grades (p < 0.001). The children's GSE scores were not correlated to components of IOTN. For children with very great need, high self-esteem was related to orthodontic concern. The parents (90.8%) perceived dental esthetics to be equally important for girls and boys. Most parents (93.0%) thought the results of orthodontic treatment were good. The results indicate meaningful association between orthodontic concern and orthodontic treatment need assessed by IOTN. However, some patients with great need do not express orthodontic concern, whereas others with near ideal occlusion express concern.

Attitude to Health↗

PubMed2001

Use of community health needs assessment for regional planning in country South Australia.

This study examined the impact of community health needs assessments used in country South Australian health service planning between 1995 and 1999. Data were collected from regional health planning officers during a Search Conference and a series of Delphi rounds. The needs assessments were found to vary from regionally to locally driven approaches. Locally driven approaches ensured local involvement but the process was slower and required more effort from the planner. It was also felt that locally driven approaches could exacerbate tension between a community's imperatives and the regional focus of regional decision-makers. In the overall regional budgets, the reallocation of health service funds according to the needs assessment findings was only small because of difficulties in refocusing from traditional clinical services in the short term. In contrast, the impact on health service thinking about population health issues was thought to have been more significant, for example, in the development of regional women's health plans. The use of community health needs assessments was useful, but for greater impact these should not now be so 'broad-brushed', but be more focused on feasible changes that health services could support. Other priority-setting techniques, such as marginal analysis, should also be used to determine where maximum health gains can be obtained.

Community Health Planning↗

PubMed2003

Empowerment or control? An analysis of the extent to which client participation is enabled during health visitor/client interactions using a structured health needs assessment tool.

The demand for explicitness in the way health visitors target their services has given rise to a plethora of different health needs assessment tools (HNATs). This paper describes an in-depth conversational analysis of the use in practice of these structured health needs assessment tools (HNATs) in two different NHS Community Trusts in England. These HNATs aimed to enable clients to participate in the assessment of their own health needs, as well as fulfilling the political requirements of justifying the expenditure of health visitor time where needs are identified. However, conversational analysis of 10 interactions showed that use of the instruments was associated with a failure to either identify needs that are relevant to the client or to enable clients to participate in the process. Use of the structured instrument simultaneously emphasises the significance of a professional lead, instead of client participation, and minimises the importance of inter-personal relationships and communication. In one site, a directly controlling style was apparent in the practice of health visitors who were, themselves, explicitly controlled by their managers. In the other site, professional expertise was emphasised, and a covert assessment style acted to disempower clients. The controlling nature of the interactions, the number of missed cues and the possibility of distress caused by the insensitivity of questioning style are all potentially harmful side effects of using structured instruments to assess needs. The problems seem to stem from the use of a pre-determined list of questions that form the basis for assuming that any family's health promotion needs can be categorised and predicted in advance. In conclusion, therefore, it is recommended that health visitors should use the open, conversational style of needs assessment that has been shown to be effective and acceptable, rather than an approach based on a structured instrument.

Communication↗