PHLT 8450 Week 11 Assessment Report Example

The Colonia and County Seat Health Assessment, Final Report: Three Priorities Chosen by Residents, the Evidence Behind Each, the Power Residents Were Promised Against the Power They Held and a Way to Challenge Any Finding

Student Name

Walden University

PHLT 8450: Community Health Assessment

Instructor Name

Month Day, Year

The Colonia and County Seat Health Assessment, Final Report: Three Priorities Chosen by Residents, the Evidence Behind Each, the Power Residents Were Promised Against the Power They Held and a Way to Challenge Any Finding

Summary in Two Languages

This report sets out a term of assessment work in a composite town on the border and the seven colonias that send children to its schools. A steering group of nine colonia residents chose the assessment's questions and its ranking method, then ranked eight health problems. Three came first: diabetes, household water supply and road flooding that isolates the schools and the clinic. The clinic can act on diabetes now; water and flooding depend on the county and the water utility, so residents will carry those findings to them directly. The same summary appears in Spanish on the facing page of the printed report and is read in full on the Spanish-language radio program, because a report that most residents cannot read has not been returned to them.

How the Community Was Defined

The assessment used the school district boundary, which includes the county seat and the seven colonias, rather than city limits, which exclude every colonia. No federal dataset follows that line, so figures were assembled from census tracts, district records, county measures and model-based tract estimates, each labeled with its source, period and limits. Tract estimates from the American Community Survey carry wide margins in small areas, and the report prints those margins beside every colonia figure.

What the Data Show

The standard sources show a colonia population that is poorer, less often insured and more likely to have diabetes than the city beside it. They are silent on what residents raised first. Only the assessment's own survey and listening sessions measured water hauling, septic failures and flooded roads, which is why those methods were added.

Table 1

Selected Indicators, Colonia Tracts Against City Tracts (Composite Figures)

Note. Composite figures. The modeled diabetes figure is a prediction from population characteristics, not a count (Greenlund et al., 2022), and the hauling figure comes from a July survey that missed households away for seasonal work.

How Priorities Were Set

The steering group adopted the Hanlon method at its third meeting and saw the data book only at its fourth. Each problem was scored on how many people it reaches, how gravely it harms them and how well known remedies work (Hanlon & Pickett, 1984). Residents alone rated seriousness. Diabetes scored 259, water 240 and flooding 210; access to care without a car, at 196, is held in reserve. Every score, the rules signed before scoring and the one rescoring request with its written answer appear in Appendix A.

Capacity to Act

Capacity, in the sense used by Goodman et al. (1998), is uneven. Where the skills, money and authority sit with one actor, as with the clinic and diabetes, action can start quickly. Where residents are organized but the authority is held elsewhere, the realistic task is to bring their organized voice to the bodies that decide.

Table 2

Who Holds What for Each Priority (Composite Assessment)

Note. Composite summary of the Week 8 capacity analysis.

Actions Decided, Requested and Under Consideration

A stakeholder reading of the draft found that it implied commitments no one had made. This section separates them.

Decided

The clinic will add one evening diabetes session a month in the largest colonia, beginning next quarter. The steering group will continue meeting quarterly for a year to track the actions below.

Requested

Residents have asked the hospital to pay for an engineering study of colonia drainage as part of its implementation strategy and to support evening sessions in two more colonias. The cooperative has asked the county commission to place water line extension on its agenda.

Under consideration

The clinic is weighing new mobile unit stops in the three colonias without associations. No decision has been made.

Planned Power Beside Actual Power

The participation plan promised residents final say over two decisions and a shared say over two more. The report records how each promise was kept.

On the ladder of participation Arnstein (1969) described, the two delegated decisions reached the rung of delegated power, and the shared decisions reached partnership, with one lapse. The report names the lapse because a participatory assessment that reports only its successes invites the same distrust the last hospital-led assessment earned.

Table 3

Decision Rights Promised and Exercised

Note. Composite record assembled from meeting minutes.

Dissent in Members' Own Words

The steering group did not agree on everything. Two members argued that septic failures, ranked sixth, belong in the top three because county records undercount them; the group kept the Hanlon result but agreed to collect better data. One member wrote: "Pipes that back up into a yard where children play are not a sixth-place problem. The numbers are low because nobody counts them." Another member questioned whether a health clinic should lead on roads at all. These views are printed in full in Appendix B, unedited except for translation, because Israel et al. (1998) describe shared ownership of findings as a principle of participatory work, and ownership includes the right to disagree on the record.

Every Section Traced Back

Each section of this report links to the term's working documents: the community definition, the profile, the participation plan, the asset inventory, the priority memo, the capacity analysis, the dissemination plan and the stakeholder critique. A reader who doubts any claim can follow it to the document, the data and the meeting where it was decided. Colonia residents have long been studied and described by outsiders (Mier et al., 2008); a traceable report lets them check that description themselves.

How Findings Will Reach Decision Makers

Residents see the findings first, at data walks in three colonias after the harvest, and through a one-page summary sent home from the schools. Chen et al. (2010) found that research participants frequently never learn what was found, and the plan is built to prevent that. Only after residents' corrections are entered will the hospital board, the county commission and the utility receive the report.

A Way to Challenge the Report

Any resident may challenge a finding by calling or messaging the number on the summary, by telling a promotora or by speaking at a steering group meeting. Each challenge is logged with a date and answered in writing within two weeks. If a challenge shows a finding is wrong, the online report will be corrected and the correction dated, and the printed copies held at the community center and schools will carry an insert. The log will be reviewed at every quarterly steering group meeting.

Limits

The assessment's figures are composites, and real tract estimates for areas this small would carry wide margins. The summer survey missed households away for seasonal work. Hanlon scores are structured judgments by nine people, not measurements. Finally, the hospital's implementation strategy, which will determine much of the funding, is the hospital's decision, and Lopez et al. (2021) reported gaps between what hospitals identify in assessments and what their strategies address. Residents can advise on that strategy; they cannot require it.

Conclusion

The assessment set out to let residents of the colonias decide what was asked, how problems were ranked and how they were described. On the evidence of this report, they did, with one documented lapse. What remains is action, and for two of the three priorities that action depends on bodies outside the community. The report's job is to make residents' findings difficult to ignore and easy to check.

References

Arnstein, S. R. (1969). A ladder of citizen participation. Journal of the American Institute of Planners, 35(4), 216-224. https://doi.org/10.1080/01944366908977225

Chen, P. G., Diaz, N., Lucas, G., & Rosenthal, M. S. (2010). Dissemination of results in community-based participatory research. American Journal of Preventive Medicine, 39(4), 372-378. https://doi.org/10.1016/j.amepre.2010.05.021

Goodman, R. M., Speers, M. A., McLeroy, K., Fawcett, S., Kegler, M., Parker, E., Smith, S. R., Sterling, T. D., & Wallerstein, N. (1998). Identifying and defining the dimensions of community capacity to provide a basis for measurement. Health Education & Behavior, 25(3), 258-278. https://doi.org/10.1177/109019819802500303

Greenlund, K. J., Lu, H., Wang, Y., Matthews, K. A., LeClercq, J. M., Lee, B., & Carlson, S. A. (2022). PLACES: Local data for better health. Preventing Chronic Disease, 19, E31. https://doi.org/10.5888/pcd19.210459

Hanlon, J. J., & Pickett, G. E. (1984). Public health administration and practice (8th ed.). Times Mirror/Mosby College Publishing.

Israel, B. A., Schulz, A. J., Parker, E. A., & Becker, A. B. (1998). Review of community-based research: Assessing partnership approaches to improve public health. Annual Review of Public Health, 19, 173-202. https://doi.org/10.1146/annurev.publhealth.19.1.173

Lopez, L., Dhodapkar, M., & Gross, C. P. (2021). US nonprofit hospitals' community health needs assessments and implementation strategies in the era of the Patient Protection and Affordable Care Act. JAMA Network Open, 4(8), e2122237. https://doi.org/10.1001/jamanetworkopen.2021.22237

Mier, N., Ory, M. G., Zhan, D., Conkling, M., Sharkey, J. R., & Burdine, J. N. (2008). Health-related quality of life among Mexican Americans living in colonias at the Texas-Mexico border. Social Science & Medicine, 66(8), 1760-1771. https://doi.org/10.1016/j.socscimed.2007.12.017