Community Health Assessment: Understanding Health, Healthcare Access, and Health Experiences of High-Risk Communities in Danville
This report was sponsored by and prepared for the Dan River Region Collaborative Study Conducted & Written by The Motley Consulting Group, LLC.
Lead Author: Monica Motley, PhD, MPH, MSEd
September 20, 2016 Danville, Virginia
Keywords: health behaviors, social determinants of health, assessment, health resources, health equity
Executive Summary
Background
Marginalized racial and ethnic groups; women; low socioeconomic; individuals older than 45 and those at the intersection (i.e. having multiple marginalized identities) disproportionately carry the burden of lifestyle-related chronic disease and adverse health outcomes associated with poor health behavior. Additionally, factors such as education, income, employment, physical/built environment, and healthrelated policies contribute to these communities’ health disparities. Several needs assessments show that Black, low socioeconomic, and urban communities in Danville experience significant differences in health outcomes and access to health resources in comparison to white, middle to high socioeconomic populations.
Health initiatives that aim to better understand health, health care access, and health experiences as well as improve health inequities in high-risk populations continue to be a local, state, and national public health priority. Additionally, actively recruiting and training members of the target community to implement efforts can provide a deeper understanding of the community’s needs and interests, resulting in more culturally appropriate solutions and desired outcomes.
Aim
The primary aim of this project was to develop and conduct a needs assessment to gain a comprehensive understanding of the health, healthcare access, and health experiences of individuals in prioritized high-risk/marginalized communities in the city of Danville. The secondary aim of this project was to identify, recruit, and train individuals that shared similar identities and/or represented these communities to co-lead the development and implementation of assessment efforts.
Participants
Overall recruitment efforts focused on four communities that: 1) consist of individuals at high-risk for unhealthy behavior and health disparity (e.g. marginalized racial group, low socioeconomic, urban); 2) experience heightened challenges to access health resources (e.g. limited availability to healthy food and physical activity options); and 3) show a need to improve use of preventative and primary care services (e.g. high rates of emergency medical room use).
Further, the project’s goal was to recruit 200 community members that lived within a three-mile radius of the communities of interest, were 18 or older, and wanted to improve their health and access to health resources in the community recruited to participate.
Community members that completed community health worker course training, had professional medical training (e.g. certified nurse assistant, health companion), and currently or previously lived in the selected communities were encouraged to participate.
Methods
The mixed-methods questionnaire was formatted into 6 major sections (i.e. access and use of health care resources; health behaviors and health status; social support of family and friends; health needs and challenges; local health policies; and demographic information). Small community health assessment events were coordinated within each community. Word of mouth and flyers were used to promote the events. The questionnaire was orally administered to participants by the trained community members or they assisted participants that preferred to complete the questionnaire themselves. Quantitative and qualitative data were entered into SPSS version 23.0 for data analysis. Descriptive statistics such as frequencies and measures of central tendency were used to analyze nominal and scale data. Non-parametric tests including chi-square and Fishers exact test (p<.05) were used to explore associations between participant characteristics and specific health, healthcare access, and health experience factors.
Trained community members completed an individual capacity questionnaire prior to and after the data collection assessments to explore if individual capacity changed due to participation in the project and provide feedback about their project experience.
Results
Six community members were trained in data collection and community engagement methods and conducted the surveys. Two hundred and nine community members representing the four communities participated in the survey (Cedar Terrace=51; North Side=55; Cardinal Village=53; Pleasant View=50). The following results are selected highlights from each section.
Demographic information
The majority of the participants were between the ages of 24 and 53 years old. Ninety-two percent (n=194) of participants described themselves as Black/African American/ Afro-Caribbean/African Diaspora. Sixty-four percent of participants were female and 43% of participants attained a high school diploma or equivalent as the highest level of educational achievement.
Access and use of health care resources. Thirty-seven percent of participants have Medicaid while 32% have no health insurance coverage. Participants with no health insurance or Medicaid were more likely to seek medical attention from the Danville Regional Medical Center emergency room (n=84), in comparison to PATHS (n=20) or the free clinic (n=8).
Health behaviors/Health status. Collectively, a majority of participants believe their health is excellent, very good, or good (n=73%). However, few participants participated in more than 3 days of moderate (n=22%) or vigorous (n=32) physical activity within the past 7 days of completing the questionnaire. Regarding lifestyle-related chronic disease, more participants have been told by a health professional that they have/had mental health problems or a learning disability; respiratory disease; diabetes; or were/are overweight/obese in comparison to cancer or cardiovascular disease. Social support of family and friends. A majority of participants receive inconsistent and/or minimal (rated as “sometimes”) positive social support or modeling from their closest family and friends regarding dietary intake. Forty-six percent of participants shared that family and friends encourage
them to prevent health problems before they get sick. However, when it came to mental health, 54% of participants shared that friends and family “never” “rarely” or “sometimes” celebrate or congratulate them for taking healthy steps to improve their mental health.
Health needs and challenges. Overall, participants would like to have more choices in healthcare providers, mental health services, healthy family activities, transportation services, and women’s health services located in the community. However, healthy family activities (n=103), more choices in healthcare providers (n=110), mental health services (n=93), and healthy food options (n=99) appeared to be of greatest interest.
Local health policies. Sixty percent (n=124) of participants never attended a city council meeting or work session to highlight the need for community changes to address health issues in their community. Forty-eight percent (n=99) never participated in a community coalition and/or partnership to address health issues and needs in their community. However, 55% of participants shared they would be interested in participating in continued community conversations/efforts to address health needs.
Discussion
Resulting information provides additional insight regarding health outcomes, access, and community experiences that should be prioritized as a part of continued health/research efforts. Continued analysis regarding the association between participant demographics and their responses are encouraged. Additionally, resulting data can guide the development of culturally appropriate and community informed initiatives. Field notes also show that community members who completed the questionnaire showed interest in future data training and health assessment opportunities. Overall, results from this project show great promise, need, and interest from community and coalition partners alike to launch new or expand efforts that help these communities achieve their greatest health potential