Health Needs

Assessment

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 What is need?
• A need is something that is necessary for
organisms to live a healthy life

• Need = factors which must be addressed

to improve the health of the population

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 Defining or Considering Needs

• Need is relative, but norms are established

• “A condition that limits a person from

meeting his potential” (Social Security Act,
1974)

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Theoretical Understanding of Need

• Ponsioen (1962) - society’s first responsibility is to

meet basic survival needs of its members,
biological, social, emotional and spiritual

• Ponsioen asserts that every society will identify a

level below which no one should fall

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Theoretical Understanding of Need
• Maslow (1954) Hierarchy of Needs – lower
needs must be satisfied before higher can be addressed

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 Types of Need

• Needs (gaps) are identified in 4 forms:

• Normative
• Relative
• Expressed
• Perceived

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 Types of Need

• Normative
– Defined as falling below a standard criterion
established by custom, authority, or general
consensus.
– Strength:
• Allows planners to use objective targets
– Weakness:
• Need levels change with time and must be re-
evaluated
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 Types of Need, cont.

• Relative
– Measured by the gap between the level of
service between similar communities
– Strength:
• Can lead to a priority for distribution of limited
resources
– Weakness:
• Limits resource allocation to under-performing
areas
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 Types of Need, cont.

• Expressed
– Defined in terms of the number of people who
actually have sought help
– Strength:
• Focuses on situations where people have taken action
• Helps to determine barriers
– Weakness:
• Not all people with Needs seek help
• Loss of the bigger picture
• Misses latent Needs

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 Types of Need, cont.
• Perceived
– Defined in terms of what people think their
needs are or feel their needs to be
– Strength:
• Easy to come by
– Weakness:
• Subjective
• Subject to the Dunning-Kruger effect- is a
cognitive bias wherein unskilled individuals suffer
from illusory superiority, mistakenly rating their
ability much higher than is accurate.

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 Problems must be translated into
Needs
• Strive to answer all 4 types of Need.
– Each type of need paints a different picture of
the gap.

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 What is health need?

• Health need is ‘the ability to benefit from

health care and health programs’
• It moves beyond the concept of demand
and takes account of people’s capacity
to benefit from health care and public
health programs.

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 Needs Assessment is:
• A type of applied research. Data is collected for a
purpose!
• Can be either a descriptive or exploratory study.
• Can use either quantitative or qualitative methods.
• Can use a combination of both qualitative or quantitative
data. We have more confidence in our data if we have
similar findings using both methods
• Most often involves collecting information from
community participants or existing data (indicators or
case records).
• In some cases, subjects or participants can be involved
in research design, data collection, and analysis.

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 What is a Needs Assessment?
➢ A systematic process of asking questions,
comparing answers, and making informed
decisions about what to do next to improve
human (or organizational) conditions and
performance or
➢Is a process for determining and addressing
needs, or "gaps" between current conditions and
desired conditions
➢Needs Assessment is the process of identifying
and measuring areas for improvement in a
target audience, and determining the methods to
achieve improvement.
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 What is a “Health Needs Assessment”?
‘a systematic method of identifying unmet health and
health care needs of a population and making
changes to meet these unmet needs’
Wright and Kyle, in Pencheon 2006

‘a systematic method for reviewing the health issues

facing a population, leading to agreed priorities and
resource allocation that will improve health and
reduce inequalities.'
Health Development Agency 2005
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Why Conduct a Needs Assessment?
• To guide decision-making
• To provide justification for decisions before
they are made
• To provide a systemic perspective for
decision-makers
• To allow for interdisciplinary solutions for
complex problems
• To offer a replicable process that can be
used over and over again
• To focus partners (or the network) on shared
understanding of issues and shared goals
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 Aim/Objectives of needs assessment
Aim To provide information to plan, negotiate and change
services for the better & to improve health in other ways

Objectives
1. Change services/activities for the better (effectiveness)
2. Improve equity (equal resource for equal need)
3. Target efficiency (allocate resources to those in need)
4. Set priorities
5. Gather general intelligence on population health/need
6. Corporate involvement

Stevens, Raftery, Mant

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 Levels of Needs Assessment
• Whole population

• Sub-group of population

• Sub-group suffering from specific condition

e.g. alcohol misuse, or needing specific intervention e.g.
hip replacement

• Population using particular service e.g. prison health

service

• (Individual or family)

Clarke, Powell, Lansang (2009)

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 Types of needs assessment
Subtypes/terminology
– Rapid needs assessment
– Health needs assessment
– Community needs assessment

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 Health needs assessment systematic
approach to ensuring the health services
use its resources to improve the health of
the population most efficiently
Community needs assessment evaluate
possible solutions taking problems/deficits/
weaknesses and advantages/opportunities
/strengths into consideration*

*Gupta, Kavita; Sleezer, Catherine M.; Russ-Eft, Darlene F. (2007-01-16). A

Practical Guide to Needs Assessment (2 ed.). 20
 Needs Assessment: undertaken
for all aspects of health
• Health protection / infectious diseases
• Screening and immunisation
• Health promotion and disease prevention
• Treatment for acute / chronic diseases
• Rehabilitation
• Palliative care

Clarke, Powell, Lansang (2009)

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 Framework for a Needs
Assessment
Stevens and Raftery (1997) model:

1. Epidemiological (+health economic)

approach
2. Comparative approach
3. Corporate approach

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 Epidemiological approach to Needs
Assessment - Triangle
1. SIZE of
Problem 2. What works?
(Incidence & Effectiveness (+cost) of
Prevalence) services/interventions

3. Current Services
(baseline)
Stevens, Raftery, Mant 23
 Epidemiological Needs
Assessment Or put another way
…
1. Information about local health situation
(health status & current services)

2. Interventions that 3. What does this

work and are mean for how
affordable that would existing local
address the local “health” services
health situation? should be organized?
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 Comparative Approach to
Needs Assessment
• “contrasts the services received by the population
in one area with those elsewhere”

• How do other populations (similar) provide

services for this condition? Examine models of care.

If all other things are equal, there may be:

- undermet need in underprovided area
- overmet need in overprovided area
Stevens, Raftery, Mant 25
 Corporate Approach to Needs
Assessment

• “involves the systematic collection of the

knowledge and views of informants on
healthcare services and needs”

• Stakeholders contribute corporate view of

local needs, and what should be changed
Stevens and Gillam 1998, BMJ 316, 1448-1452

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Corporate Approach to Needs assessment
Purchaser Providers

Opinion Professionals
Leaders
Corporate
View
Politicians Patients /
service users
General
Practitioners Press

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Elkheir 2007
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 Needs Assessment Protocol
1. What is the health problem?
2. What is the size & nature of the problem?
3. What are the current services?
4. Identify interventions by asking what people want
5. Consult professionals/other stakeholders
6. Identify interventions by reviewing evidence of
effectiveness / cost effectiveness
7. What are the most cost-effective solutions?
8. What are the resource implications?
9. What are the recommendations & plan for
implementation?
10. What are the outcomes to evaluate change?
Wright, in Pencheon 2001
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 When do you conduct a Needs
Assessment?

• A Needs Assessment takes place before

the activity is designed.

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 Needs Assessments are about
Evidence
• Can you answer:
– “what evidence do we have that our audience
needs this service?”
– “what evidence do we have that our solution
will yield positive results?”
– “what is the reason that we are offering
education in this format?”

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 So… what is a Needs
Assessment?
Pre-Assessment

Needs
Assessment Assessment

Action Plan

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Phases of a Needs Assessment
• Pre-Assessment
– Data collection. “What do we know?”
• This is the foundation of Gap Analysis
– What is the current state?
– Where should we be?
– How does our region compare to others?
– What’s new?
– What’s important?

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Phases of a Needs Assessment
• Assessment
– Evaluation of the data
• What are our barriers?
– Both internal and external
• What Needs have we identified?
• Are some gaps bigger than others?
– Consider both scope and severity
• What are our priorities?
• Do we have the resources to address them?
• Why do anything at all?

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Phases of a Needs Assessment
• Action Plan
– How are we going to translate what we have
into what they need?
• Which Needs can we address?
• How are we overcoming barriers?
– List additional barriers hindering progress
• Have any areas been identified for follow-up or
future opportunities for intervention?

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 HNA selection criteria
• Four criteria should be used in selecting issues for
intervention
1. Impact: which health outcomes & determinant
factors have the most impact, in terms of size &
severity, on the health functioning of the
population?
2. Changeability : can the most significant health
outcomes & determinant factors be changed
effectively by those involved in the assessment?
3. Acceptability: what are the most acceptable
changes needed to achieve the maximum impact?
4. Resource feasibility: are there adequate resources
available to make the required changes?
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 Needs Assessment and Program
Planning
Problems are translated to needs, needs are translated to
interventions
• Needs assessment starts with problem analysis
• Integrates qualitative and quantitative methods
• Informs solutions and can define the size of the
target group
• Needs are translated into measurable objectives,
resources, and criteria necessary for program
planning and evaluation

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Needs Assessment Methodologies

• Extrapolating from existing studies (normative

need)
• Using resource inventories (normative and
relative need)
• Using service statistics (expressed and relative
need)
• Conducting social surveys (perceived need)
• Holding a public forum (perceived need)

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 Remember
• Want and Need are not synonyms.
• A Needs Assessment is conducted before the
activity is planned.
• Pre-Assessment is not enough.
• The more types of need you consider, the richer
the planning process and the more effective the
education.

“What gets measured gets managed” – Peter

Drucker.

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“Being roughly right is generally more
useful than being precisely wrong”

Guha-Sapir, D. Rapid assessment of health needs in mass emergencies:

Review of current concepts and methods. World Health Stat Q.
1991;44:171-181.

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THANK YOU!

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