Over the years, many CHNAs have relied heavily on secondary data with only limited input from those communities served by the institution. This approach overemphasizes aggregate individual behaviors and underemphasizes structural patterns and systemic barriers. CHNAs provide an opportunity for significant and impactful change, making authentic incorporation of community voice critical to the process. Employing community engagement methods of assessment allows for the collection of more thorough data and builds and strengthens community partnerships.However, the critical component of community engagement often is left behind while institutions conduct this work, which risks deepening inequities. Community members are the subject matter experts on their ecosystem’s barriers and opportunities for growth, which can be leveraged to create a needs assessment that meets the true needs and concerns of the community. Obtaining input from a diverse group of community stakeholders, using multiple methods, provides the opportunity for everyone to describe the resources they need to obtain optimal health while building community trust in the health system as an anchor institution. The use of community voice transforms an institution’s CHNA from a legislative requirement to a valuable and useful tool to co-design initiatives that improve the overall community environment.
In 2023, Dayton Children’s Hospital took a new approach to conducting its CHNA to better integrate community voice and collect more inclusive and equitable data. In this article, we describe our approach and share lessons learned and recommendations for other health care organizations to consider when planning their own CHNAs, focusing specifically on how community voice can be leveraged in creating strategic priorities that impact the community ecosystem.Developing A Community Engagement PlanTo develop the community engagement plan for the CHNA, we first needed to clearly define our goals. Previous efforts focused on identifying children’s health conditions through analysis of secondary data from area public health agencies as well as directly from parents and caregivers through a mailed survey. Historically, the survey parents filled out was lengthy and focused on specific health conditions or symptoms and health behaviors. While useful, much of this information was also identifiable from our own medical records. We also recognized that some communities have been historically left out of our data collection efforts. Previous assessments have resulted in limited reach and response rates, with most feedback coming from more suburban, less diverse areas of our service region. Therefore, our goal was to understand more broadly what concerns community members, whether they were parents or not, had about keeping children healthy in their neighborhood. We also aimed to engage in more intentional and intensive efforts to capture the voices of communities that often are not asked to provide their input, including communities of color and those most burdened by health inequities.With these goals in mind, we developed a process and toolkit to guide our community engagement efforts. Our team’s community engagement coordinator, who is responsible for building and sustaining partnerships as well as managing our community outreach and engagement efforts, developed the objectives, outcomes, grassroots planning of events, marketing efforts, and partner communication and follow-up. The CHNA team developed culturally responsive survey questions, marketing tools, and other physical tools needed for data collection. Our ApproachWe sought input from families and community members in the top five counties in which 75 percent of our patients reside. We leveraged a large, existing network of partners in these counties who could distribute our online survey to understand perspectives and priorities related to children’s health. We also prioritized six ZIP codes in the Dayton, Ohio, area for more targeted outreach and data collection efforts. We selected these ZIP codes based on prevalence of children in those ZIP codes receiving care at our hospital as well as those from which limited representation was obtained in previous CHNA efforts. We developed the new role of outreach specialists, who were individuals recruited from the targeted communities, and trained them in our approach and procedures for community engagement and data collection.To reach as much of the population as possible, we developed a variety of data collection tools, including two surveys appropriate for different events throughout the community (a short five-item version and a longer 10-item version) (see exhibit 1). Our short survey was designed to be taken in-person at busy community events either using the community member’s cell phone or an iPad. The longer survey was designed to allow community members an opportunity to provide additional information and could be taken in-person at slower-paced community events as well as distributed electronically via partner list servs.
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Health Affairs LogoCookies NotificationThis site uses cookies. By continuing to browse the site you are agreeing to our use of cookies. Find out more. ×Health Affairs Forefront Related Topics:Community health Public health Hospital care Health equity Health disparities Health conditions Food Decision making Children’s healthConducting A More Equitable Community Health Needs AssessmentShannon E. Nicks Donna McCoy Tess DeVos Emily Thatcher Cynthia J. SieckJanuary 2, 2025 Doi: 10.1377/forefront.20250101.365506A health worker holds the hand of a patient.Community health needs assessments (CHNAs), also known as community health assessments, are state, tribal, territorial, or local health assessments that identify key health needs and issues through systematic, comprehensive data collection and analysis. Internal Revenue Service regulations, which began with the passing of the Affordable Care Act, require hospital organizations with a charitable designation to conduct a CHNA every three years. This assessment must gather input that provides broad representation of the community the organization serves and must include input from medically underserved, low-income, and minority populations. Areas addressed in this process can include social and structural determinants of health such as financial barriers, food and nutritional security, and environmental effects.Over the years, many CHNAs have relied heavily on secondary data with only limited input from those communities served by the institution. This approach overemphasizes aggregate individual behaviors and underemphasizes structural patterns and systemic barriers. CHNAs provide an opportunity for significant and impactful change, making authentic incorporation of community voice critical to the process. Employing community engagement methods of assessment allows for the collection of more thorough data and builds and strengthens community partnerships.However, the critical component of community engagement often is left behind while institutions conduct this work, which risks deepening inequities. Community members are the subject matter experts on their ecosystem’s barriers and opportunities for growth, which can be leveraged to create a needs assessment that meets the true needs and concerns of the community. Obtaining input from a diverse group of community stakeholders, using multiple methods, provides the opportunity for everyone to describe the resources they need to obtain optimal health while building community trust in the health system as an anchor institution. The use of community voice transforms an institution’s CHNA from a legislative requirement to a valuable and useful tool to co-design initiatives that improve the overall community environment.In 2023, Dayton Children’s Hospital took a new approach to conducting its CHNA to better integrate community voice and collect more inclusive and equitable data. In this article, we describe our approach and share lessons learned and recommendations for other health care organizations to consider when planning their own CHNAs, focusing specifically on how community voice can be leveraged in creating strategic priorities that impact the community ecosystem.Developing A Community Engagement PlanTo develop the community engagement plan for the CHNA, we first needed to clearly define our goals. Previous efforts focused on identifying children’s health conditions through analysis of secondary data from area public health agencies as well as directly from parents and caregivers through a mailed survey. Historically, the survey parents filled out was lengthy and focused on specific health conditions or symptoms and health behaviors. While useful, much of this information was also identifiable from our own medical records. We also recognized that some communities have been historically left out of our data collection efforts. Previous assessments have resulted in limited reach and response rates, with most feedback coming from more suburban, less diverse areas of our service region. Therefore, our goal was to understand more broadly what concerns community members, whether they were parents or not, had about keeping children healthy in their neighborhood. We also aimed to engage in more intentional and intensive efforts to capture the voices of communities that often are not asked to provide their input, including communities of color and those most burdened by health inequities.With these goals in mind, we developed a process and toolkit to guide our community engagement efforts. Our team’s community engagement coordinator, who is responsible for building and sustaining partnerships as well as managing our community outreach and engagement efforts, developed the objectives, outcomes, grassroots planning of events, marketing efforts, and partner communication and follow-up. The CHNA team developed culturally responsive survey questions, marketing tools, and other physical tools needed for data collection.Our ApproachWe sought input from families and community members in the top five counties in which 75 percent of our patients reside. We leveraged a large, existing network of partners in these counties who could distribute our online survey to understand perspectives and priorities related to children’s health. We also prioritized six ZIP codes in the Dayton, Ohio, area for more targeted outreach and data collection efforts. We selected these ZIP codes based on prevalence of children in those ZIP codes receiving care at our hospital as well as those from which limited representation was obtained in previous CHNA efforts. We developed the new role of outreach specialists, who were individuals recruited from the targeted communities, and trained them in our approach and procedures for community engagement and data collection.To reach as much of the population as possible, we developed a variety of data collection tools, including two surveys appropriate for different events throughout the community (a short five-item version and a longer 10-item version) (see exhibit 1). Our short survey was designed to be taken in-person at busy community events either using the community member’s cell phone or an iPad. The longer survey was designed to allow community members an opportunity to provide additional information and could be taken in-person at slower-paced community events as well as distributed electronically via partner list servs.Exhibit 1: Two forms of community health needs assessment surveysSource: Dayton Children’s Hospital 2023 community health needs assessment surveys.Our implementation focused on collaborating with partners to collect data electronically and at existing community events as described below. We developed a calendar of events, allowing outreach specialists to sign up for events that aligned with their schedules.Noticing A ChangeWe attended 67 events from March 9, 2023, to May 8, 2023, and engaged five outreach specialists (who worked 91.15 hours total). Some events were very busy, and we were only able to pass out survey postcards while others allowed time for community members to complete the survey using our iPad or their cellphone in the moment. The most commonly reported challenge was language barriers and the need for translation and interpreter services. Spanish was the most common language encountered at events, with more than 10 events needing Spanish interpreters. Other languages for which interpreters were needed were Swahili, Kinyarwanda, and Turkish.In total, we collected 2,137 surveys; 1,977 of them came from our counties of focus and 742 came from our priority neighborhoods. This represents a significant increase in the reach of and responsiveness to our data collection efforts. For example, our 2020 CHNA cycle returned only 335 surveys, primarily from suburban areas of our service region. The full 2023 CHNA report is available here. To compare these results to our previous CHNA cycle, the 2020 CHNA report is available here.Lessons Learned And RecommendationsWe learned several key lessons from our efforts. First, the outreach specialist role was essential to our effort to include populations that have not typically been reached during prior CHNA cycles. The outreach specialist allowed us to be flexible and agile and best align our data collection with particular events and populations. However, recruiting, onboarding, and training outreach specialists takes time. Internally, we needed to allocate sufficient time to define the responsibilities for this role and for our marketing department to design and print recruitment materials. Additionally, our community relationships were critical for recruiting specialists who lived in priority neighborhoods. Once recruited, the time needed to onboard a new specialist varied depending on their availability to complete in-person elements such as background checks and employee health requirements. Given this, it is important for health care institutions that want to ensure more equitable representation of their patient populations and community to consider how a role such as the outreach specialist can improve their CHNA efforts and provide the support needed to ensure this role is effective. Consider what will be needed to onboard those community members, including strategies to overcome potential barriers that could reinforce inequities. For instance, processes that require multiple in-person