CHL 610 Week 3 Primary Data on Community Perspectives Example

Doors Knocked, Stories Heard and Photographs Taken: Collecting Residents' Perspectives for the East Side Community Health Assessment

[Student Name]

University of Phoenix

CHL/610: Community Health Assessment

Week 3 Assignment

[Instructor Name]

[Date]

The neighborhoods, survey, focus groups, interviews, photovoice project and all findings are composites written for a model paper modeled on Yakima, Washington; research findings come from the sources cited.

The hospital's previous community health needs assessment had relied on a telephone survey in English, and few east side residents answered it. This time, the steering committee decided to go to residents: on their doorsteps, in their churches and community center and through their children's cameras. This paper describes how the assessment collected primary data on community perspectives and what residents said.

Principles Guiding the Methods

The committee adopted principles of community-based research, which involve community members, organizational representatives and researchers in all aspects of the research process, combine partners' expertise and integrate the knowledge gained with action to benefit the community (Israel et al., 1998). Residents helped choose methods, write questions, collect data and interpret findings, and two residents joined the analysis team.

Method One: Household Survey

Twelve promotoras, community health workers who live on the east side, were trained over three days in survey methods, consent and confidentiality. Using a random sample of addresses from the east side's census blocks, they visited homes in the evenings and on weekends, offering the survey in Spanish or English on a tablet. They completed 612 surveys, a 54% response rate among eligible households reached.

The Survey Instrument

The 38-question survey covered health status, access to care, work, housing, food, safety, discrimination, mental health and community strengths. Many items came from national surveys to allow comparison. It was pretested with 20 residents, and confusing items were rewritten in plainer language.

Reaching People Often Missed

The team made special efforts to reach groups usually missing from assessments. Promotoras visited the farmworker housing complex on Sunday afternoons, when most residents were home. A focus group met at the flea market's community tent. Older adults were reached through the senior meal program, and youth through the high school's leadership class. Residents of the mobile home park, excluded by earlier boundaries, were surveyed at the same rate as other blocks.

Method Two: Focus Groups

Six focus groups of eight to ten people each met at the community center, two churches and a farmworker housing complex: farmworkers, parents of young children, older adults, youth, Spanish-only speakers and faith leaders. A bilingual facilitator and note-taker led each, with audio recorded by consent.

Method Three: Key Informant Interviews

Fifteen interviews were held with people who know the community well: clinic nurses, school counselors, a food bank manager, a farmworker advocate, a landlord, two pastors, a police community officer and others.

Method Four: Photovoice

Ten high school students joined a photovoice project. Photovoice enables people to record and reflect their community's strengths and concerns, promotes critical dialogue through group discussion of photographs and aims to reach policymakers (Wang & Burris, 1997). Over six weeks, students photographed what helped and harmed health in their neighborhood, then discussed and captioned their images.

Ethics and Trust

All participants gave informed consent. No names or immigration status were recorded. Survey data were stored without addresses. Residents were told that the assessment was not connected to any enforcement agency. Participants received a grocery gift card, and focus groups provided child care and a meal.

Analysis

Survey data were weighted to the age and sex of the east side population. Focus group and interview transcripts were coded by two team members, including a resident, into themes that were then reviewed with the steering committee. Students chose which photographs and captions to share publicly.

Finding One: Access to Care

In the survey, 31% of adults had no usual source of care, and 38% had delayed care because of cost in the past year. Focus group participants described long waits, clinic hours that conflict with work and difficulty getting appointments in Spanish.

Finding Two: Work

Farmworkers described heat, pesticide exposure, repetitive strain and fear of losing work if they reported injuries or took sick days. A review of farmworker health services portrays farm labor as poorly paid, frequently uninsured and among the most dangerous work in the country, and it notes how culture, the structure of services, law, cost, distance and, for many, migration or immigration status all get in the way of care (Arcury & Quandt, 2007). Several workers said they would rather work sick than lose a day's pay or a place on the crew.

Finding Three: Housing and Food

Forty-one percent of surveyed households spent more than half their income on housing. Parents described overcrowding, mold and fear of rent increases. Twenty-seven percent said that at least once in the past year their food had run out before they had money to buy more.

Finding Four: Safety and Mental Health

Residents described worry about traffic on the arterials, poorly lit parks and stress about immigration enforcement. Youth photographs showed broken playground equipment, empty lots and a crowded bus stop, but also murals and soccer games.

In Residents' Words

A few quotations captured themes. A mother said that the clinic's phone line played music for forty minutes before anyone answered. An older man said he drove his wife to appointments in the next town because the doctors there spoke Spanish. A farmworker said the heat in August made the rows feel like an oven, and water was at the end of the row. A teenager's caption read: our park has one working swing and fifty kids.

Finding Five: Strengths

Residents named strong families, churches, the community center, mutual aid networks and cultural pride. Youth captions described their neighborhood as loud, crowded and full of people who look out for each other.

Comparing With Secondary Data

Primary data confirmed secondary findings on access and chronic disease and added what the numbers missed: work hazards, housing cost burdens, fear related to immigration and the community's strengths. The survey's rate of no usual source of care was higher than city estimates suggested.

What Surprised the Team

Two findings surprised staff. Transportation, rarely mentioned in secondary data, came up in every focus group; many families share one car between several workers. And mental health concerns, including anxiety and grief after pandemic losses, came up far more often than staff expected, especially among older adults and youth.

Returning Findings

Before the draft report was written, the team held two community meetings in Spanish and English to share preliminary findings, ask whether they rang true and invite corrections. Residents added housing inspection concerns and asked that the report describe the community's strengths first.

Limits

The survey reached households at home in the evenings, which may miss night-shift workers. Focus groups rely on those willing to attend. Photovoice reflects ten students' views.

Conclusion

Going to residents through promotoras, focus groups, interviews and photovoice produced a fuller picture than the previous phone survey. Community-based research principles gave residents roles in every step, photovoice gave youth a voice with policymakers and research on farmworker health helped explain the barriers workers described. The findings join secondary data in the community health profile.

References

Arcury, T. A., & Quandt, S. A. (2007). Delivery of health services to migrant and seasonal farmworkers. Annual Review of Public Health, 28, 345-363. https://doi.org/10.1146/annurev.publhealth.27.021405.102106

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

Wang, C., & Burris, M. A. (1997). Photovoice: Concept, methodology, and use for participatory needs assessment. Health Education & Behavior, 24(3), 369-387. https://doi.org/10.1177/109019819702400309