Participatory needs assessment

Participatory needs assessment is a way of understanding the health needs of a local population including needs relating to the wider determinants of health, such as housing, crime, employment and education. Professionals and local people form a partnership to identify community needs, set priorities and develop an action plan. The overall aim of the participatory needs assessment is to understand the health needs of the community from their own perspective rather than from the provider or commissioner’s view point.

Various sources of information can be drawn upon to inform a participatory needs assessment including:

Informal discussions with voluntary or community groups
Focus groups
Interviews with key informants and service users / patients
Household surveys
Relevant local documents about the neighbourhood or community
Observations undertaken in homes and neighbourhoods
Community mapping

Most of the information gathered will be qualitative rather than quantitative however this does not preclude the use of quantitative analysis as part of the descriptive approach. Information is analysed and presented to include a description of the community, the wider determinants of health that impact on the community, quality and level of health and social services available to the community as well as any relevant local or national policies impacting on the health needs of the community.

The information gathered is then reviewed with all participants who then prioritise their health needs, using ranking if needed. Any programmes suggested as part of the improvement programme must be acceptable to the community and also sustainable in the longer term.

As with all projects, aims and objectives of the needs assessment should be set out at the beginning of the work, along with timescales for delivery. Timescales should allow sufficient time to be spent gathering data to ensure that as many members of the community as possible have the chance to participate.

An example of some of the findings from a participatory needs assessment:

Analysis of health information reviewed as part of a participatory needs assessment for an inner London housing estate revealed high levels of obesity amongst children and adult residents. Focus groups conducted as part of the needs assessment also revealed feelings of social isolation amongst the residents. The focus groups provided an opportunity to investigate these 2 problems further. Residents revealed that they had stopped letting their children play in the communal playground, which had previously been a sociable meeting centre for local families, as dog mess had become such an issue within the playground. For older residents, poor lighting in communal areas of the estate made them fearful to leave their properties especially in the early evening and at night. In response to the findings, representatives from the local authority agreed to address the issues of dog mess and poor lighting. To ensure that the playground and lighting issues did not recur, following on from the focus groups, residents agreed to form a local committee to monitor any problems on the estate and feedback to local authority representatives on a regular basis, so that any issues were picked up at an earlier stage in the future.

Rifkin ^[1],[2] describes a checklist for assessing the levels of participation in community development projects such as participatory needs assessment:

Definition of health needs and how needs were identified

How were health needs identified?
Did the identification include only health service needs or other health needs?
What role if any was foreseen for community people in conducting the needs assessment and in analysing health needs?
Were surveys used? Who designed the surveys and who conducted them?
Were the surveys used merely to get information or also to initiate discussions with various possible beneficiaries?
Were potential beneficiaries involved in analysing results?

Use of results

Was the assessment used to further involve the beneficiaries in future plans and programmes?
Was only one assessment made or is it an exercise for change, review and further involvement of community in programme plans?
How were the results of the assessment used in the planning of the programme?

Who contributed / participated

If community people were involved in the assessment did they continue to be involved in the implementation?
Was it able to include various representatives from the wide range of possible beneficiaries for which the health programme was intended?

Participatory needs assessment provides a valuable opportunity for the views and voices of those not normally heard to be taken into account for example, ethnic minority groups, young people, homeless people. In a normal health needs assessment, the views of such groups would normally only be heard if they had raised issues formally.

Participatory needs assessment may link to or complement epidemiological (or other) needs assessment, particularly in relation to service planning and does not have to be a stand alone piece of work.

References

[1] Rifkin S Primary Health acre: on measuring participation Soc Sci Med 26, 9, 931-40.
[2] Rifkin S Paradigms lost: towards a new understanding of community participation in health programmes Acta tropica, 61(1996)79-92.