Community Health Assessments for Public Health Preparedness and Response

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Community Health Assessmentsfor Public Health
Preparedness and Response

• CHA Institute
• February 1, 2008

William Service, MSPH Steven Ramsey, RS NC
Division of Public Health Office of Public
Health Preparedness and Response
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Public Health Disaster Epidemiology

• Injury and Illness Surveillance
• Mortality Surveillance
• Community Surveillance

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• Information for Public Health emergencies
• Response
• Recovery
• Mitigation

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Community Assessment for Public Health Emergency
Response(CASPER)

• Population (Census) Based Random Sample
• modified from WHO EPI (Expanded Programme on
  Immunization)
• Household Interviews to Determine Human Needs and
  Impact
• Conducted and Reported Rapidly to Guide Response
  Efforts
• lt72 hours post-event
• Target Audience
• Public Health, Emergency Management

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CASPER

• Identify needs and impact by Population
  Proportion
• Define the magnitude of the need
• population estimates using census data
• Characterize Need
• most needs are known (water, electricity)
• some may be unanticipated (food, use of
  generators)
• May be conducted in series
• Recovery
• After Action

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Community Health and Needs Assessment

• Limitations
• Access to assessment areas
• Unoccupied households
• Confidence intervals
• Estimates
• Some data may be available for other sources
• Utilities, etc
• Users must be prepared to receive assessment
  information

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Community Health and Needs Assessment

• Strengths
• Objective, representative data from a large
  population
• Generated very quickly (72 hours)
• Population proportion
• Estimated percentage of households
• Population magnitude
• Estimated number of households

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NC DPHCASPER Experience

• Hurricane Isabel, Charley (NC)
• Hurricane Wilma (FL)
• Hurricane Katrina AAR (MS)
• Carteret County Prehurricane Assessment (NC)
• 15 LHD CHAs

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Preparedness in CHA

• Survey instrument
• Household plans and preparedness?
• Communication/contact plan?
• Food/water/fuel?
• Awareness
• Generator use, food safety, water safety, driving
• Using the data
• Messages
• Communication methods

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Types of Survey Instruments

• Paper-based/Self-administered surveys
• Telephone surveys
• Web-based surveys
• Face-to-Face interviews

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Disadvantages of Survey Methods

• Paper-based surveys/Self-administered
• Language bias (both literacy and languages other
  than English)
• Effort of completing surveys
• Access to surveys and ability to return them
• Telephone surveys
• Telemarketers
• Unlisted numbers/No phone
• Increasing use of cell phones

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Disadvantages of Survey Methods(cont)

• Web-based surveys
• Access to the community
• Access by the community
• Easy to manipulate if not password protected

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Disadvantages of Face-to-Face Interviews

• Time-consuming
• Notes must be transcribed and/or entered into a
  database for analysis
• Not efficient method when interviewing a large
  number
• May not be representative of the community
• Interviewee may not trust the interviewer and may
  purposely introduce bias or give incorrect
  information

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Advantages of Face-to-Face Interviews

• Flexibility
• Ability to clarify questions and decrease
  misunderstandings
• Nonverbal cues
• Fewer incomplete responses
• Higher response rates
• Greater control over the environment

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Recommended Sampling Methods

• Convenience
• Random

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Advantages of Convenience Sampling

• Convenient Data can be collected rapidly and
  inexpensively
• This is a benefit to the agency collecting the
  sample and not necessarily a benefit to the
  community because of the potential for bias
  toward a specific group.

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Disadvantages of Convenience Sampling

• Biased results from a sample not representative
  of the community in general
• Malls
• Workplaces
• Neighborhoods
• Events

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Advantages of Random Sampling

• Ideal method
• Every person has an equal chance of being
  included
• Results can be generalized

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Disadvantages of Random Sampling

• Can be time consuming and complex
• Can be expensive

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CHNA Sample

• Randomly select 30 population weighted census
  blocks (clusters) from all of the census blocks
  in the assessment area
• 7 geographically random points generated per
  census block
• Teams navigate to the point
• Conduct interviews at 7 households within the
  census block (210 total)
• Questionnaire administered and data collected

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Historical Approach
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Historical Approach
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Rapid Response Project 516

• Mobile GIS and Electronic Data Capture project

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MHTD GIS Database
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Internet Connection
WIFI wireless data transfer
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Factors Associated with Hurricane Preparedness
Results of a Pre-Hurricane Assessment

• Jennifer Horney, MA, MPH
• Cynthia Snider, MHS
• Sandra Malone
• Laura Gammons
• Steve Ramsey

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Interview Locations
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Experiences

• Hurricane Isabel, Charley (NC)
• Hurricane Wilma (Fl)
• Hurricane Katrina AAR (MS)
• Carteret County Prehurricane Assessment (NC)
• 15 LHD Routine CHAs

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Contact Information

• William Service, MSPH
• Office of Public Health Preparedness and Response
  
• NC Division of Public Health
• will.service_at_ncmail.net
• 919-715-6431
• Steven Ramsey
• NC PHRST-5
• sramsey_at_co.guilford.nc.us
• 336-641-8192