During this phase you will review background materials, gather data, interpret and
summarize the data, and then report the results to the community. These results
will be used to inform the prioritization process in Phase V, in preparation of
the local public health improvement plan in Phase VI. Steps for this phase are outlined
below. A Phase III Work Plan
is provided to help organize and track
Step 1: Review background materials
To begin, review any health assessments conducted by your agency in the recent past
in order to be informed by significant findings from previous years and allow you
to investigate significant changes or trends. Review needs assessments conducted
by other organizations in your community that can supplement your health assessment,
prevent duplication of effort, and help determine what additional community-specific
data or information you may need. Consider reviewing community health assessment
reports from other jurisdictions, which are available on the CHAPS website, to build
an awareness of how similar communities have documented their assessment findings.
Become familiar with the state health priorities known as Colorado’s Winnable Battles
and the latest Statewide Public Health Improvement Plan
to assure alignment
between your assessment and statewide areas of focus.
Step 2: Determine the scope of your community health assessment
After considering the information that already exists within your community and
your agency’s capacity for conducting this process, determine the scope of your
community health assessment. Useful questions to consider include:
Step 3: Develop a community health assessment data gathering outline
- What is the timeline of our process? Are there any deadlines driving it and if so,
what can be accomplished in the allotted time frame?
- What human resources are available or obtainable to dedicate to this project? Will
we use a consultant to support any activities?
- How will any pre-existing community assessments influence the scope of this new
- Are we going to engage a community-based steering committee for ongoing participation?
- How large will our stakeholder engagement process be?
- Do we need to conduct additional community surveying or will we use the quantitative
data that is readily available?
- Will our qualitative data gathering include interviews, focus groups, and/or community
meetings, and if so, approximately how many?
An important step in creating your community health assessment is to develop or
adopt a data gathering outline or table. The purpose of this step is to identify
and document the data you wish to collect. Review community health assessments from
other jurisdictions to inform your data collection outline. A Health Indicator Collection Table
is provided as an example.
This tool lists readily available health indicators organized in alignment with
the CDPHE Health Equity Framework, featuring categories such as community description,
physical environment, population health outcomes, and health behaviors and conditions.
Note that the outline or table you use to guide your initial data collection efforts
may differ from how you ultimately choose to organize and present or publish your
community health assessment findings.
Step 4: Gather Quantitative Data
During this step you will systematically collect quantifiable information that describes
your community’s health status. The CHAPS Health Indicators Collection Table
is provided to assist
in this process. The table can be used to identify and track the majority of health
and environmental indicators you will explore in this step. A hyperlink is provided
to take you directly to the data, which is featured on the Colorado Health and Environmental Data website
. A Data Interpretation
Guide is available there to assist with data analysis and interpretation. Finally,
information is available from additional data sources such as the U.S. Census Bureau,
the U.S. Bureau of Labor Statistics, and the Colorado Health Foundation by visiting
the Quantitative Data Resource List
The bulk of your quantitative data collection will focus on exploring health indicators.
These, when looked at collectively, can comprehensively illustrate the health status
of a community. These indicators include health behaviors (e.g., smoking rates),
health conditions (e.g., percentage of overweight or obesity), and health outcomes
(e.g., leading causes of disease, injury and death). Fortunately, much data exits
on health indicators; the Colorado Department of Public Health and Environment collects
many types of health data, including birth and death data; maternal and child health
data; data on health behaviors, injuries, and communicable disease; and others.
Referencing the Health Indicators Collection Table
can be particularly helpful
in making this part of the process manageable and efficient. The story that these
data tell may then inform which categories to supplement with additional data collection.
|A closer look at health indicator data sources:
Colorado’s Health Indicators site provides county and regional
data (depending on population size), and the ability to compare your jurisdiction
to other counties, regions, the state, and national Healthy People 2020 objectives. Note that if using data
to describe health conditions in an area of low population, it may be necessary
to combine years of data, site a regional rate, or consider number of events.
Colorado Health Information Dataset (CoHID) provides the ability to query
local, regional and state-level indicator data on health behaviors, conditions and
outcomes. The user is able to combine years of data and look at the data by demographics
such as age, gender and race/ethnicity.
Colorado Environmental Public Health Tracking Network provides searchable,
county level data for indicators of environmental factors that affect health (e.g.,
air and drinking water quality) as well as health outcomes that are affected by
environmental factors (e.g., asthma and heart attack rates). You can compare data
between counties and the state as a whole, and view data trends over time.
The following examples provide suggestions for approaching Step 4 within specific
categories of data.
Example 1: Community Description
When collecting data to craft your community description, consider including information
such as the number of square miles, elevation, and geographic boarders. Maps provide
a strong visual method for displaying geographic information. The US Census Bureau
, and particularly its State and County
Quick Facts website, (www.quickfacts.census.gov
) provides this information, as
does your local county government.
Example 2: Demographics
Demographics are the statistical characteristics of the people that live in your
community, such as number, gender, race/ethnicity, age of residents, persons per
square mile, home ownership, educational level and employment status. Demographic
trends can help describe changes over time. For example, has the overall population
increased or decreased? Is the overall age of the population changing? Is the population
of specific racial and ethnic groups or those who speak a language other than English
increasing or decreasing?
Example 3: Leading Causes of Disease, Injury and Death
These indicators are quantified by number of events, that is, the number of residents
who were sick, became injured or died during a certain time period. Knowing the
number of persons impacted by a given type of event illustrates the magnitude of
an issue in relationship to other issues. Begin by collecting the data points listed
below using the state’s Colorado Health and Environmental Data
website, Colorado Health Indicator Dataset (CoHID)
and Communicable Disease Data
webpage. Note: If collecting
data for a geographical area of low population, a special data request may be submitted
to CDPHE to explore possibilities such as combining multiple years of data to generate
Example 4: Health Behaviors and Conditions
- Leading causes of death (number of events)
- Leading cause of injury hospitalizations (number of events)
- Leading causes of reported communicable disease, including sexually transmitted
infections and HIV (number of events)
- Leading sites of cancer (number of events)
- Leading cancer deaths by site (number of events)
Health outcomes are heavily influenced by health behaviors and conditions. Both
positive and negative health behaviors play a role in the leading causes of death,
injury, and disability. Data from the Colorado Behavioral Risk Factor Surveillance
System (BRFSS) provide an important look at the health-impacting behaviors reported
by residents of your community. Gathered via a random digit dial telephone survey,
the data provide self-reported information such as:
- Percentage of residents who are overweight or obese
- Percentage of residents without health insurance
- Percentage of residents who engage in leisure time activity
- Percentage of residents who have had a colonoscopy, mammogram or pap smear
- Percentage of residents reporting diabetes
BRFSS data are featured on the Colorado Health Indicators
website and are available on CoHID.
Example 5: Environmental Health
Monitoring and assessing environmental health-related data can provide important
information about how the community impacts the environment, and how the environment
impacts a community’s health.
Local sources of information, such as locally-tracked levels of E. coli in recreational
water sources or the presence or absence of a local energy conservation ordinance,
provide a window into a community’s environmental health status. Consider augmenting
your assessment efforts with information on environmental health-related citizen
complaints received on an annual basis in categories such as housing, air and water
quality, food safety, septic systems, and zoonosis. Additionally, the Environmental Health Tracking Network
provides data for
answering questions such as: How does the air we breathe compare to other areas
in the state? How many people are hospitalized for asthma in my county? Has this
changed over time? Examples of environmental health data to consider:
Example 6: Maternal and Child Health Indicators
- Air quality as compared to state and over time
- Asthma hospitalization rates compared with air quality data
- Childhood lead poisoning as compared to state and over time
- Food-borne illness rates and number of food safety violations
- Hospital admission rates for carbon monoxide poisoning
- Household radon test results
- Percentage of population with private wells
- Rates of vector borne and zoonotic disease compared to state and over time
- Water quality compared to state and over time
Health status is influenced to a great degree by what occurs during the periods
of preconception, pregnancy, and early childhood. Assessing and seeking to impact
issues such as prenatal care, breastfeeding, and unintended pregnancy rates can
provide a strong foundation for a healthy community. Examining the health indicators
listed below will provide a foundational snapshot of maternal and child health in
your county. This information can be found on Colorado Health and Environmental Data
website under Maternal and Child Health Data
Example 7: Social Determinants of Health
- Birth rate of county compared to state and over time
- Birth rate of teens in county, compared to state and over time
- Indicators such as unintended pregnancy, weight gain, breastfeeding, and smoking
- Low birth weights—overall rates compared with the state and by population (teens/race/ethnicity)
- Proportion (percentage) of births by race/ethnicity (teens and adults)
- Rates of prenatal care—first, second, third trimester, no care, compared to state,
and by population (teens/race/ethnicity)
Determinants of health are the circumstances in which people are born, grow up,
live, work, and age, and the systems put in place to deal with illness. These circumstances
are in turn shaped by wider set of forces: economics, social policies, and politics
). Health status, for example, tends to correlate highly
with socio-economic status. Population groups with lower income levels frequently
experience higher rates of disease, injury and death than the general population.
The reasons are a complex combination of everyday life experiences. For example,
an individual living in an area with higher crime rates is more likely to experience
a higher degree of overall daily stress, which can contribute to poorer health outcomes.
Income is therefore a determinant of health. Other determinants of health include
the physical environment, educational level, health care access, and social factors
such as racism/discrimination, which can be a chronic stressor. The CDPHE Health
Equity Model, a conceptual framework for the determinants of health, is provided
on the Colorado Health Indicators
website. Understanding the determinants
of your community’s health will be useful when planning how best to impact health
outcomes for population groups over the long term. Additional tools and information
related to health equity can be found on the CHAPS website under the resources tab
The Colorado Health Indicators
website provides county-level
health determinants data organized according to CDPHE’s Health Equity Model. A web-based
mapping tool is available to illustrate disparities in health determinants at sub-county,
county, and regional geographies across Colorado. This tool allows users to view
the median household income, percent of families living below poverty threshold,
and percent of adults (25+) without a high school degree from the American Community
Survey and Census 2010 estimates. Population density, sex, age, and race/ethnicity
can be viewed by census geography, and maps created of socio-demographic indicators
within communities as well as comparisons of population characteristics between
counties or regions. Visit the Quantitative Data Resource List
for additional sources of
social determinants of health data, such as the Annie E. Casey Foundation’s Kids Count
website, which provides county-level indicators
on education, economics and family structure and Headwaters Economics’ Economic Profile System-Human Dimensions Toolkit
allows users to produce free, detailed socio-economic profiles at a variety of geographic
To conclude Step 4, consider where areas exist that might require data collection
from additional sources. For example, law enforcement can provide data on DUI or
drug possession arrests. The Colorado Department of Transportation can provide the
causes of local motor vehicle crashes and demographics of the drivers involved.
Your local hospital may be able to provide the top 10 emergency department visits
to help you assess whether primary care services are being accessed in more expensive,
emergent care settings.
Step 5: Gather Qualitative Data
Incorporating qualitative data into your community health assessment will broaden
your overall findings and enrich the story you are able to tell. This type of information
may uncover health issues that the quantitative data do not illustrate. Qualitative
data can help describe factors unique to your community; capture the perceptions
of its citizens; provide a context for the quantitative data; and delve into a specific
issue more thoroughly. There are a variety of qualitative data gathering techniques
from which to choose, such as:
- Community meetings
- Focus groups/listening sessions
- Key informant interviews
- Community meetings
The following scenarios are examples of how qualitative data collection might be
incorporated into your community health assessment process.
Example 1: Identify factors impacting the public health system and community health
Examining your community in a broader context can determine factors that may assist
or hinder the public health system in general, and also your community health improvement
process. New legislation, rapid technological advances, changes in funding, differing
philosophies of elected officials, shifts in economic forces, changing family structures
and demographics are all examples. These factors are important because they either
directly or indirectly impact the health and quality of life in the community, and
the effectiveness of the local public health system. Identifying these factors early
in your process can help determine their impact and provide the opportunity to either
take advantage of or compensate for them.
Example 2: Identify community perceptions of the leading health and environmental
Gathering this type of information may uncover issues that you did not know existed.
You may also learn that issues residents perceive as problems, and to which the
community may be allocating resources, are not supported by quantitative data. You
can gather community perceptions through interviews, surveys and/or stakeholder
meetings with local organizations, staff, advisory committees and others.
Example 3: Identify community perceptions of the causes of and/or solutions to the
leading physical health and environmental health issues.
Consider conducting one-on-one interviews with subject matter experts to learn more
about these issues. Conversations of this nature may help uncover the root causes
of an issue. For example, a subject matter expert may work closely with a hard-to-reach
population and have valuable insight regarding what keeps them from engaging with
the community or accessing services. Another qualitative method is the focus group.
For example, to determine barriers to service you may decide to facilitate a group
discussion with clients.
To facilitate the process of comparing and contrasting your qualitative findings,
data may be translated into quantitative values by assigning numeric codes to the
responses, which can then be summed and analyzed to identify outliers and trends.
This type of analysis can help tease out findings such as: What percent of the issues
identified by our SWOT analysis participants fell into the category of mental health?
How many key informant interview participants identified obesity as a leading community
concern? Among those, how frequently did each respondent refer to lack of healthy
food access as a major contributor to the problem? What percent of community meeting
participants highlighted on an issue that fell into the category of injury prevention?
In summary, gathering community input regarding the leading health issues, their
causes and solutions, plus obstacles to and opportunities for your public health
improvement process can provide richness to your assessment that would not be obtainable
from quantitative data alone. In addition, the process can both educate and mobilize
your community. Helpful resources to determine and design your process are provided
in the Qualitative Data Resource List
, which points you to specific
guidance in the following techniques: focus groups, key informant interviews, nominal
group process, and SWOT (strengths, weaknesses, opportunities, and threats) analyses.
Step 6: Interpret the Data and Information
In this step you will review the data collected to identify key findings and correlations.
Use quantitative health indicator data to generate an overview of your community’s
health status, such as the leading causes of disease, disability and death as well
as health conditions and behaviors. Spot the top health issues that emerge by considering
the current rate of each health issue or indicator, the movement of that rate over
time, and the rate as it compares with those of neighboring or comparable counties,
the state as a whole, and Healthy People 2020 targets. If the population is large
enough, you may compare health indicators by age, gender and race/ethnicity to identify
Cluster your quantitative and qualitative data into categories, isolating themes
and natural connections. Use data on residents’ perceptions to see whether it supports
the quantitative data. Note health issues that are not captured in the quantitative
data, but that emerged as a significant community concern. Draw conclusions to decide
where to go next. If the number of events for a particular health issue is high
or your county has a disparate rate from the state, consider looking further into
this issue by gathering related health indicators, demographics, determinants of
health and qualitative data. The Interpretation Guide on the Health Indicators
website will help make sense of that data
and develop a picture of the community’s health status.
Below are sample questions your data interpretation process could answer:
- What are the most prominent conditions and recent trends in the community’s health?
- What are the leading causes of disease, injury and death? What health behaviors
and other factors are influencing these? Who is impacted the most?
- What concerns do community members have? Are these validated by quantitative data?
- Were emerging issues uncovered that we did not expect to find?
The following examples provide suggestions for approaching Step 6 within specific
categories of data.
Example 1: Social Determinants of Health
What groups in your community are the most vulnerable to health problems? Information
that describes the determinants of health will provide a context for community health
given the specific economic, environmental and social dynamics that influence human
behaviors and health outcomes throughout the life course. CDPHE’s Health Equity Model
identifies a number of topic
areas to consider. Sample questions your data interpretation process may answer
Example 2: Obesity
- How have economic indicators changed over time, such as median income, median home
price, unemployment and number of home foreclosures?
- Who are the invisible or hard-to-reach populations in your community and why?
- What groups are most impacted by recent changes and how might this influence health?
- Are there groups that report experiencing chronic stress or social isolation that
results in a lack of access to services or a lower rate of positive health behaviors?
If so, why (e.g., language or financial barriers, lack of information, etc.).
- What other factors might be influencing access to services and health behaviors?
- Did any local promising practices emerge through the qualitative data that could
be expanded upon during plan development (Phase VI)?
- The percentage of residents impacted is high and is trending upward.
- Our county’s rate is significantly higher than the rate of Colorado as a whole.
(Disparities exist between the local and state or neighboring county rate.)
- Young adults have the highest rate of obesity in our community. (Disparities exist
- Twenty-five percent of residents reported no physical activity during the prior
30 days. (Behavioral data contributes to these outcomes)
- Residents participating in focus groups reported a lack of access to recreational
opportunities due to: 1) weather, 2) crime and a lack of sense of safety, 3) the
expense of indoor recreation, and 4) childcare-related concerns. Corresponding to
these findings, our community’s unemployment rate has doubled and our poverty rate
and crime rates have significantly increased since the start of the economic downturn
To complete your data interpretation, synthesize the information gathered into major
findings. You might consider an issue a key finding due to a high prevalence (or
unexpected low prevalence), a disparity between groups, or the discovery of an emerging
health issue, threat or opportunity. Questions that may help determine key findings
Step 7: Report the results
- What has changed since our last assessment and did new issues emerge?
- Considering the demographic make-up of the county, its history, its culture and
health determinants, what conclusions can be drawn about 1) health indicators and
2) community perceptions related to health and the environment?
- How does the health of the community differ from the health of neighboring counties,
the state, or Healthy People 2020 targets? What are the factors that influence this?
(Consider differences in demographics and health determinants.)
- When comparing you community to other counties or the state, are there obvious areas
of disparity? Is this true for the entire population or certain sub groups (e.g.,
racial/ethnic populations, adolescents or seniors, etc.)?
- Given the data, are there health or environmental areas that have turned out to
be non-issues (e.g., perception of the problem is high but actual prevalence is
Now that you have reviewed, collected, and interpreted the data, it is time to summarize
and report the information.
When preparing to present the community health assessment findings, many communities
begin by selecting a specific framework within which to organize the information.
Examples include the Colorado Department of Public Health and Environment’s Health
Equity Framework, Colorado’s 10 Winnable Battles, and the National Prevention Strategies.
Use your results to create a unique picture of public and environmental health that
is specific to your community. Highlight surprising or not-so-surprising data trends,
paying special attention to anomalies that exist between your area and similar communities;
health outcomes impacting a large proportion of residents; and those impacting certain
segments of the population disproportionately. Assist the audience by drawing direct
links between the major health outcomes reported for your jurisdiction and the environmental
and behavioral factors that precede them. The CDPHE Health Equity Framework can
be a useful tool in connecting these key relationships. In addition to the assessment
findings, it is important to also communicate the methods used to conduct the assessment,
sources of information, limitations of the data, and the stakeholders involved.
How a community chooses to communicate their health assessment results will be based
on both the purpose and the target audience. The results will be used to educate
and mobilize stakeholders, identify priorities, create a local public health improvement
plan, and garner resources to support plan implementation. Common reporting formats
include hard copy and web-based community health profiles, community health status
reports, or online data dashboard systems. To accommodate a variety of communication
needs, communities often develop multiple presentation formats, including PowerPoint
slides, fact sheets, and executive summaries of their key findings. While the publication
of a formal document to present your findings is not required, two sample community
health assessment outlines (Sample A
and Sample B
), are provided as examples.