PHLT 8450 Week 8 Capacity Analysis Example

Who Can Act on Each Priority and With What: A Capacity Analysis of Diabetes Control, Drinking Water and Road Flooding Across Seven Colonias, Their Clinic and the Public Bodies That Hold the Purse

Student Name

Walden University

PHLT 8450: Community Health Assessment

Instructor Name

Month Day, Year

Who Can Act on Each Priority and With What: A Capacity Analysis of Diabetes Control, Drinking Water and Road Flooding Across Seven Colonias, Their Clinic and the Public Bodies That Hold the Purse

What This Analysis Asks

The steering group's Hanlon ranking put three problems on top: diabetes that is not well managed, household water that cannot be counted on and road flooding that cuts off the schools and the clinic. A ranking says what matters most; it does not say whether anyone can act. This analysis asks, for each priority, what capacity already exists among residents, the clinic and outside bodies, where that capacity falls short and whether residents could close the gap themselves. It uses the dimensions of community capacity set out by Goodman et al. (1998), among them participation, leadership, resources, networks, community power and critical reflection, and it builds on the asset inventory from Week 5, so every strength cited here was named by one person and confirmed by another.

Six Columns, Three Priorities

The table makes one pattern plain. The three priorities sit at very different points. For diabetes, the people with the skills, the money and the authority are largely the same people, the clinic and its promotoras. For water and flooding, residents have leadership and participation but not the authority, which rests with bodies outside the colonias.

Table 1

Capacity by Priority (Composite Assessment)

Note. Composite assessment drawn from the asset inventory, steering group discussion and interviews with the clinic, the cooperative and the county road department.

Diabetes: Capacity Inside the Clinic's Walls

The clinic already runs a diabetes self-management program and a mobile unit that visits three colonias twice a month. Its promotoras live in four colonias, speak Spanish as a first language and are trusted by neighbors who distrust institutions. These are strong assets. The gap is reach: the mobile unit does not stop in the three colonias without an association, and the program meets on weekday mornings, when many adults are at work in fields and packing sheds. Both gaps are within the clinic's own authority to fix, which makes diabetes the priority where action can begin soonest. The retired bus driver who organizes rides, listed in the inventory, could connect residents of the unserved colonias to evening sessions if the clinic adds them.

Water: Power Without Staff

The water cooperative in one colonia is the clearest example of resident capacity in the assessment. Its volunteer board collects fees, keeps a small reserve and has maintained a shared well for over a decade. Cooperative meetings draw more households than any clinic event. Yet the cooperative cannot extend municipal water lines; the utility and the county decide that, and residents of the six colonias outside the cooperative depend on hauled water or private wells of uncertain quality. Residents have organized power in the sense Goodman et al. (1998) describe, the ability to act together, but no staff, no engineers and no seat where extension decisions are made. Capacity here means helping that organized power reach the decision makers, for example by supporting cooperative leaders to present the assessment's water findings to the county commission.

Flooding: A Hospital Commitment as Capacity

No local body holds resources for drainage. The county road department maintains paved roads and has a list of flood-prone segments, but most colonia streets are unpaved and were platted before the county accepted maintenance responsibility. One association negotiated a repair, which shows that residents can win concessions, but the other colonias have not joined it. The regional hospital is a possible source of capacity. Nonprofit hospitals must adopt an implementation strategy responding to their needs assessment, and Lopez et al. (2021) reported gaps between the needs hospitals identified and the needs their strategies went on to address. A written commitment from the hospital to fund a drainage engineering study, or to join residents in requesting county action, would add resources the community lacks. The steering group can advise the hospital but not decide, so the analysis treats such a commitment as possible capacity, not existing capacity.

Readiness, Staged

Readiness differs by priority. The analysis uses a simple three-step description agreed with the steering group. For diabetes, the community is acting: programs exist and residents use them. For water, the community is organized but waiting: residents have leadership and a clear ask, and the next move belongs to the utility. For flooding, the community is aware but not organized: residents in every colonia describe the problem, but only one association has acted. Readiness tells the group what kind of help fits. Adding sessions suits diabetes; advocacy support suits water; organizing across colonias suits flooding.

Gaps Residents Could Fill

Three gaps could be closed largely by residents themselves. First, an alliance of colonia associations on flooding would turn seven separate complaints into one request, and the association that already won a repair could lead it. Second, cooperative board members could train residents of other colonias in record keeping and water testing, extending skills the cooperative already has. Third, promotoras could recruit participants for evening diabetes sessions in the colonias without associations. Each draws on capacity already confirmed in the inventory, consistent with the asset-based approach of Kretzmann and McKnight (1993).

Gaps Residents Cannot Fill

Water line extensions, road drainage and new clinic staff require money and authority residents do not hold. Wallerstein and Duran (2006) argue that participatory work should name these structural limits rather than placing responsibility for them on communities. The analysis therefore lists the specific bodies that control each gap, the utility, the county commission, the road department and the hospital, so the dissemination plan can direct findings to them.

Summary

Capacity is strongest where residents, skills and authority coincide, as with diabetes care through the clinic. It is weakest where residents are organized but the authority lies elsewhere, as with water and flooding. The analysis recommends starting action on diabetes at once, supporting the cooperative's advocacy on water and helping associations organize together on flooding, while asking the hospital to commit resources in its implementation strategy.

References

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

Kretzmann, J. P., & McKnight, J. L. (1993). Building communities from the inside out: A path toward finding and mobilizing a community's assets. ACTA Publications.

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

Wallerstein, N. B., & Duran, B. (2006). Using community-based participatory research to address health disparities. Health Promotion Practice, 7(3), 312-323. https://doi.org/10.1177/1524839906289376