Health Needs Assessment
What is a health needs assessment?
A health needs assessment (HNA) is a systematic method of identifying unmet health and health care needs of a population and making changes to meet those unmet needs. It provides information: (1) to improve health; (2) for service planning; (3) for priority setting and (4) for policy development. Health needs assessment is not a health status of population assessment. It aims to improve health and it incorporates the concept of a capacity to benefit from an intervention.
Defining Needs
An understanding of health needs assessment requires a clear definition of need. Need implies the capacity to benefit from an intervention.
The above diagram can help demonstrate how different notions of need interact.
1. A need is felt and expressed, but not identified as a normative need.
Example: Cosmetic surgery procedures where professionals do not agree that there is a medical need.
2. A need is felt, and identified as a normative need, but not expressed.
Example: Psychiatric interventions, where a need is felt, professionals would agree that there is a need, but the need is not expressed.
3. A need is felt, expressed and identified as a normative need.
Example: Someone experiencing severe chest pain and going to A&E.
4. A need is not felt, but it is expressed and identified as a normative need.
Example: Someone attending their GP to obtain a sickness certificate, even though they are over their illness.
Bradshaw's Classification of Needs
Approaches to Health Needs Assessment
There are three approaches to doing a HNA:
Comparative
This compares levels of services between different populations. It should take into account local population characteristics (demography, mortality, morbidity)
Corporate
This is based on the demands, wishes and perspectives of interested parties (professional, political and public views). This approach was encouraged by the 1989 reforms with its 'local voices' and current emphasis on partnership and collaboration (and public involvement). It is essential if policies are to be sensitive to local circumstances. A disadvantage with this approach is that it blurs the difference between need and demand and between science and vested interest.
Epidemiologically based
This combines epidemiological approaches with patient's perspectives, assesment of the effectiveness and possible cost-effectiveness of interventions.
Questions to be Answered in an Epidemiological Health Needs Assessment
1. What is the problem?
2. What is the size and nature of the problem?
3. What are the current services?
4. Identify interventions by asking patients what they want
5. Identify interventions by reviewing scientific knowledge
6. Consult professionals and other stakeholders
7. What are the most cost effective solutions?
8. What are the resource implications?
9. What are the recommendations and plan for implementation?
10.What are the outcomes to evaluate change?
Advantages of a Health Needs Assessment
1. It provides the opportunity to assess the population's health status
2. It incorporates the needs and priorities of patients and the local population
3. It highlights areas of unmet need and provides a clear set of objectives to work towards meeting these needs
4. It aids decisions regarding allocation of resources and influences policy
Health Needs Assessment Report Layout
1. Statement of problem/introduction
2. Sub-categories
3. Prevalence and/or incidence of problem/disease
4. Available services and their costs
5. Effectiveness of services and interventions
6. Quantified models of care/Recommendations
7. Outcome measures and audit, targets
8. Information and research requirements
Health Needs Mapping (HNM)
Health Needs Mapping (HNM) is an extension of HNA and can be used to design/improve services for hard-to-reach populations, e.g. South Asian population. HNM links socio-economic and lifestyle data from multiple sources with data on the incidence of illness, including hospital episodes statistics and local data sources such as disease registries and GP practice information. Communities can be broken down into postcodes if necessary.
For further reading, see National Institute of Clinical Excellence's (NICE) Health Needs Assessment: A Practical Guide at www.nice.org.uk