The Challenge: To work with a state government agency in conducting one of the largest multi-county CHNAs in the entire country – despite the doubts of some stakeholders who felt burned by a previous effort.
The Background:
Eastern North Carolina is dotted with small, rural counties where local health departments feel perpetually underfunded and overworked, making it nearly impossible to complete a substantive Community Health Needs Assessment every three to four years, as required by law. To streamline the process and improve outcomes, nonprofit funders teamed up several years ago with Eastern AHEC, a regional government agency, to conduct a large-scale CHNA spanning 34 counties, 2.1 million residents, and some 21,000 square miles.
Despite the clear benefits of a regional CHNA process, previous efforts had proven unwieldy and contentious, to the point that some counties no longer wished to participate. Smaller counties, in particular, wanted a simple, streamlined process, while the state wanted to get beyond checklists and proformas for detailed, county-level assessments focused on community health and health equity.
Balancing comprehensiveness and efficiency would be key.
Our Work:
With 13 professionals on the project team – including experts in qualitative and quantitative data analysis and regulatory writing – we laid out an aggressive, 11-month plan for completing one of the largest regional CHNA efforts ever attempted. Primary research looked daunting, and we set out immediately to develop a set of core survey questions that would yield comparable data all across Eastern North Carolina. But beyond the core questions, we also created a deep well of alternate survey items that individual counties could mix and match based on their local health needs and barriers. Unlike previous CHNA efforts in the region, our process allowed every county to field its own customized survey, which boosted engagement and yielded more actionable results.
For purposes of data integrity and health equity, we gave every county specific targets that were needed for statistical significance – not just an overall response rate, but target rates that were disaggregated by demographic factors such as age and race. Throughout the survey collection period, we tracked each county week by week and provided benchmarks to help them hit targets. With structured support and regular check-ins, counties knew exactly where they stood at all times, avoiding the last-minute scramble that had plagued previous CHNA efforts.
Based on feedback from earlier efforts, we also focused heavily on trainings and tools. Every county received detailed training on conducting primary research, and despite some initial misgivings, 96% of focus groups were successfully led by county representatives, without facilitation by Ascendient.
Because priorities are a major focus of any CHNA, we conducted another training midway through the process to help counties understand how to interpret and use their data in prioritization, and we provided templates and other tools that each county could adapt to ensure that all community partners felt heard and were on the same page.
The Outcome:
Nine months after our kickoff meeting, we delivered 34 draft reports for review by county leaders. Though Ascendient provided the Steering Committee with high-level findings for comparison across the region, the project’s greatest value lay in the localized approach to research and reporting. Every county received highly individualized data and published a highly customized assessment. Though the exact content varied somewhat – number of priorities, level of focus group detail, etc. – all 34 reports were meticulously researched, community driven, and equity focused.
Participants felt they came away with a clear grasp of their local health needs and priorities, and they praised the streamlined, supportive process that got them there. In an exit survey, 81% of participants gave Ascendient the highest possible score on financial value, 86% on project coordination, and 95% on communication.
In the words of one county leader: “Best CHNA process to date. Communication was wonderful. In prior years, the process has been stressful, but not this year. My team and I were blown away after every meeting and deliverable.”
The Takeaway:
Regional CHNAs can offer significant economies of scale, but success is not guaranteed, and the quality of the process will determine the quality of the final product. In Eastern North Carolina, state leaders offered a clear vision and a powerful online portal for quantitative data, setting the stage for success. With that foundation, Ascendient was able to provide research tools and analytical expertise to 34 counties that varied widely in their interest level and internal resources. Flexibility, customization, and experience will be the keys to success for any CHNA effort on such a large scale.
