The Centers for Disease Control and Prevention (CDC) provides a comprehensive framework for community health assessment through the Community Health Assessment and Group Evaluation (CHANGE) tool. This instrument is meticulously designed to empower communities in evaluating and enhancing their health environments across various sectors. Among these, the Health Care Sector component of the CHANGE tool plays a pivotal role in understanding and improving access to preventive care, treatment, and emergency services within a community.
The CHANGE tool segments community assessment into five key sectors:
- Community-At-Large Sector: This encompasses broad community-level factors influencing health, such as food accessibility, walkability, bike-friendly infrastructure, tobacco control policies, and public safety measures.
- Community Institution/Organization (CIO) Sector: This sector focuses on organizations offering human services and facilities access, including childcare centers, faith-based groups, senior centers, youth organizations like Boys and Girls Clubs, health and wellness centers, YMCAs, and educational institutions.
- Health Care Sector: This specifically examines locations where individuals seek health services, ranging from preventive care to emergency treatment. It includes hospitals, private medical practices, and community health clinics.
- School Sector: This covers all levels of primary and secondary education, from elementary to high schools, encompassing public, private, and parochial institutions.
- Work Site Sector: This sector assesses workplaces, including private offices, restaurants, retail businesses, and government offices, focusing on employee health and wellness environments.
Within each of these sectors, the CHANGE tool utilizes modules to delve into specific aspects of community health. These modules—such as leadership, chronic disease management, demographics, physical activity, tobacco use, and nutrition—provide targeted questions relevant to each sector. For instance, within the Health Care Sector, modules might explore questions related to access to care, chronic disease prevention programs, and integration of public health initiatives. Notably, the School Sector includes unique modules focusing on District-level policies and After School programs.
Utilizing the CHANGE Tool in the Health Care Sector: Examples and Applications
The CHANGE tool is instrumental in gathering detailed information about community health indicators and pinpointing areas within the Health Care Sector that require improvement. It serves as a valuable resource to document progress as communities address identified issues, implement new health policies, and introduce environmental change strategies. Before initiating an assessment, it is crucial for community teams to thoroughly review all five sectors to grasp the assessment’s scope and strategize participant engagement and site selection. Action Step 4 of the CHANGE process provides specific guidance on site selection within each sector.
To effectively introduce the CHANGE tool and engage community stakeholders, a structured Dialogue Guide is provided. This guide helps in formulating “talking points” that clearly articulate the purpose of the CHANGE initiative and the necessary collaborative efforts. It is beneficial when approaching potential data contributors, introducing the concept to community teams, or explaining the process to interested parties. Employing a Dialogue Guide ensures consistent messaging and a unified voice from the community team when discussing CHANGE activities.
Dialogue Guide Highlights: Understanding the CHANGE Tool
- CHANGE as a Community Tool: The CHANGE tool is fundamentally a data collection and planning instrument designed for community members dedicated to fostering healthier environments. It is not intended for academic research but for practical community improvement.
- Snapshot of Community Health Strategies: CHANGE provides a clear picture of existing policies, systems, and environmental change strategies within a community. It highlights strengths and identifies areas needing enhancement. Examples of strategies assessed include tobacco-free school policies, healthy vending options at workplaces, safe pedestrian infrastructure, and initiatives promoting stair usage in public buildings. It’s important to note that CHANGE focuses on population-based strategies rather than individual-level interventions like health fairs or cooking workshops.
- Sector-Based Assessment: Completing the CHANGE process involves a collaborative effort to answer questions across the defined community sectors (Community-At-Large, CIO, Health Care, School, and Work Site). Each sector is further divided into modules (e.g., physical activity, nutrition, tobacco use, chronic disease management, leadership). Teams can decide whether to tackle all sectors collectively or divide into subgroups, consolidating findings later.
- Data Collection Methods: Gathering information for the CHANGE tool is flexible and community-driven. It may involve direct conversations with community leaders within specific sectors, community walk-throughs or drives for environmental observation, phone calls to informed individuals, or leveraging data from previous community assessments. CHANGE is not an interview script; it’s a framework requiring diverse methods to paint an accurate community picture.
- Importance of Broad Community Participation: Wide-ranging community involvement is essential for the CHANGE tool’s success. Engaging key stakeholders such as school administrators, board members, business leaders, city officials, health department directors, city planners, parks and recreation departments, law enforcement, hospital executives, medical chiefs of staff, faith community leaders, childcare providers, and YMCA directors is crucial. These individuals possess vital information or can direct teams to relevant resources.
- Tracking Progress and Documenting Change: As communities identify challenges, implement policies, and enact strategies, the CHANGE tool can be used to document these developments over time. Annual utilization allows for reviewing past efforts and planning future initiatives. By systematically recording collected data, communities build a valuable repository of information about their assets, needs, and priorities.
- Focus on Internal Improvement, Not External Comparison: The CHANGE tool is designed for internal community improvement. It is not intended for comparing sectors against each other, ranking communities, or highlighting weaknesses in a negative light. Instead, it serves as a tool for communities to recognize their strengths and target areas for positive change. Decisions regarding sharing CHANGE data with the public or external entities are at the community’s discretion, guided by the need to garner support for initiatives while maintaining data confidentiality and avoiding individual or organizational identification.
- Proven Effectiveness and Community Impact: The CHANGE tool has a history of successful implementation in various communities. User feedback consistently emphasizes its effectiveness in identifying potential policy, system, and environmental change strategies. It facilitates productive conversations, sparks ideas for community betterment, and provides a structured approach to assessment and planning. Furthermore, it encourages collaboration across diverse community sectors, including schools, businesses, workplaces, and health care settings, fostering a unified approach to community health enhancement.
