Studies conducted by Peter Tugwell (2006) and colleagues related to ‘Reduction of inequalities in health: assessing evidence-based tools’ identified five assessment tools which were valuable and should be included in health assessments, considering how individual health assessments differ from community ones. They include development of a database with systematic reviews showing influences pertaining to educational, legal, social, and health interventions. These strategies must be aimed at reducing unfair distribution of healthcare services and breaking accessibility barriers by adapting the Cochrane and Campbell Collaborations model of assessment (Tugwell, et.al, 2006).
Secondly, designing a decision making process whereby health coaches facilitate discussions and gather primary data as well as empowering individuals and groups within the community to be involved in decisions that affect health care within their social environment. Precisely, they can become negotiators, and navigators of a more equitable healthcare system (Tugwell, et.al, 2006).
A third valuable technique identified by these researchers was applying CIET cycle to the assessment process. The purpose is to support evidence- based community/ individual assessment. This cycle combines cluster survey techniques with qualitative methods, which support evidence-based decisions at both local and national levels. At the end of each community or individual survey assessment a CIET map is drawn for separate clusters identified applying data emerging from the investigation. This data is further used as evidence for other communities/individual intervention programs. The community health nurse has the options of displaying complex data as attractively as possible highlighting important elements of the community and individual’s health (Tugwell, et.al, 2006).
(Andersson & Mitchell, 2002).
Nine elements make up this cycle beginning with framing the health issue, which encompasses making a community or nursing/wellness diagnosis. Next is analyzing previous data as it relates to the epidemiology; designing instrument such as questionnaires; pre-testing them to ensure validity; conduct the survey; analyze the feedback; analyze data retrieved from the survey assessment, communication findings with stakeholders and take action to resolve then dysfunction (Tugwell, et.al, 2006).
The fourth key technique and activity that should be included in health assessments, considering how individual health assessments differ from community ones is applying the Ottawa Equity Gauge within the Global Equity Gauge Alliance framework to an industrialized country setting. Four distinct pillars integrate community with individual evidence based assessment models. They include as evaluation of equity needs; planning interventions to meet those needs; empowering individuals and community to address needs and forming an advocacy network to maintain achievements.
(Global Equity Gauge Alliance (GEGA), 2003)
Fifthly, a valuable technique and activity that should be included in health assessments, considering how individual health assessments differ from community ones is the ‘Needs-Based Health Assessment Toolkit.’ This device was created for to assembling data which could provide evidence for in assisting the clinical and health policy decisions making process. It focuses on identifying important health indicators as well as how health is distributed with a community or in an individual context (Tugwell, et.al, 2006).
Nardi and Peter (2012) offers a concise approach to this aspect of community assessment positing a four step guide similar to Trickett’s (2002) model, which encompasses obtaining informed consent before beginning the process. First step is definition and description of the problem which is be linked to framing the issue; next step two determining what information is required associated with analyzing exiting data in CIET model. Thirdly, information gathering which combines designing instrument, pretesting and cross-sectional survey from CIET model mentioned earlier (Tugwell, et.al, 2002) ( Nardi & Peter, 2012).
Fourthly, analysis of the information which Trickett (2002) expands into four distinct groups that should be included should be included in health assessments, considering how individual health assessments differ from community ones. They are analyze the feedback; analyze data retrieved from the survey assessment, communicate findings with stakeholders and take action to resolve then dysfunction (Tugwell, et.al, 2002) ( Nardi & Peter, 2012).
Describe health assessment activities and techniques that can be used to determine assets or gaps of an agency to meet community needs.
According to Trickett (2002) interventions cannot be implemented before obtaining an adequate understanding of the targeted community requiring the intervention; the requirements of the intervention and the capacity of the agency executing it to implement it efficiently (Trickett, 2002). Therefore, appropriate assessment activities and techniques must be conducted to determine assets or gaps with the agency’s ability to meet community needs (Trickett, 2002).
More importantly, one technique employed in accomplishing this task is adapting a relevant theoretical evidence based model to conduct the assessment process. While various theoretical models exist all would not be applicable to all agencies. Major elements which are integral to this model are those which effectively describe the assessment process; offer guidance on preparation of interventions and implementing from a scientific approach. Community asset mapping is one of the first recommended activities (Trickett, 2002).
As cited by both Trickett (2002) and Gandelman et.al (2006) community asset mapping produces a wealth of valuable information which can provide evidence based data that determine assets or gaps of an agency to meet community needs. The focus on understanding the community enough to relate the agency’s capability in executing the product/intervention it is aiming to offer (Trickett, 2002).
The authors cited HIV programs, but in explaining alternative products, if one takes for example, a self-care administered diabetic program to be executed by a non-profit agency, an assessment of that organizations’ assets must be a prerequisite activity for administering the program. Consequently, the applicable technique is adapting a suitable evidence based model in conducting the assessment. Essentially, it is assessing the target population readiness; multilevel factors that may affect the administrative process inclusive of participants’ reaction to the agency and intervention techniques in themselves and agency capacity to deliver the program (Trickett, 2002).
This includes investigating available skills and receptivity of human resources towards training for the intervention. After completing an integrated community and agency activity then measures could be taken to close gaps through evidence based health promotion education prerequisite interventions between both stake holders (Trickett, 2002)
Andersson, N., & Mitchell, S. (2002). CIETmap: free GIS and epidemiology software from CIET group, helping to build the community voice into planning. World Congress of Epidemiology: Montreal, Canada.
Global Equity Gauge Alliance (GEGA) and Health Systems Trust (2003). The Equity Gauge Concepts, Principles, and Guidelines. Global Equity Gauge Alliance (GEG) and health Systems trust. Retreieved May 11th from http://www.gega.org.za/download/gega_guide.pdf
Nardi, A., & Peter, J. ( 2012). Community Health and Wellness: A Step by Step Guide. Centage Learning
Trickett, E. (2002). Context, culture, and collaboration in AIDS interventions: ecological ideas for enhancing community impact. Journal of Primary Prevention, 25(2), 157 – 174.
Tugwell, P. O’Connor, A. Andersson, N. Mhatre, S. Kristjansson, E. Jane Jacobsen, M.Robinson, V. Hatcher-Roberts, J.Shea, B. Francis, D. Beardmore, J.Wells, G., & Losos, J(2006). Reduction of inequalities in health: assessing evidence-based tools. Int J Equity Health, 5: 11