needs assessment research paper

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Research Article

A guiding framework for needs assessment evaluations to embed digital platforms in partnership with Indigenous communities

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Supervision, Writing – original draft

Affiliation School of Occupational and Public Health, Toronto Metropolitan University, Toronto, ON, Canada

Roles Data curation, Formal analysis, Investigation, Software, Visualization, Writing – original draft

Affiliation School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada

Roles Conceptualization, Investigation, Project administration, Resources, Supervision, Writing – review & editing

Affiliation Île-à-la-Crosse School Division, The Northern Village of Île-à-la-Crosse, Île-à-la-Crosse, SK, Canada

Roles Conceptualization, Investigation, Resources, Supervision

Roles Conceptualization, Funding acquisition, Investigation, Methodology, Project administration, Resources, Supervision, Writing – review & editing

* E-mail: [email protected]

Affiliations DEPtH Lab, Faculty of Health Sciences, Western University, London, ON, Canada, Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada, Lawson Health Research Institute, London, Ontario, Canada

• Jasmin Bhawra, 
• M. Claire Buchan, 
• Brenda Green, 
• Kelly Skinner, 
• Tarun Reddy Katapally

• Published: December 22, 2022
• https://doi.org/10.1371/journal.pone.0279282
• Reader Comments

Introduction

In community-based research projects, needs assessments are one of the first steps to identify community priorities. Access-related issues often pose significant barriers to participation in research and evaluation for rural and remote communities, particularly Indigenous communities, which also have a complex relationship with academia due to a history of exploitation. To bridge this gap, work with Indigenous communities requires consistent and meaningful engagement. The prominence of digital devices (i.e., smartphones) offers an unparalleled opportunity for ethical and equitable engagement between researchers and communities across jurisdictions, particularly in remote communities.

This paper presents a framework to guide needs assessments which embed digital platforms in partnership with Indigenous communities. Guided by this framework, a qualitative needs assessment was conducted with a subarctic Métis community in Saskatchewan, Canada. This project is governed by an Advisory Council comprised of Knowledge Keepers, Elders, and youth in the community. An environmental scan of relevant programs, three key informant interviews, and two focus groups (n = 4 in each) were conducted to systematically identify community priorities.

Through discussions with the community, four priorities were identified: (1) the Coronavirus pandemic, (2) climate change impacts on the environment, (3) mental health and wellbeing, and (4) food security and sovereignty. Given the timing of the needs assessment, the community identified the Coronavirus pandemic as a key priority requiring digital initiatives.

Recommendations for community-based needs assessments to conceptualize and implement digital infrastructure are put forward, with an emphasis on self-governance and data sovereignty.

Citation: Bhawra J, Buchan MC, Green B, Skinner K, Katapally TR (2022) A guiding framework for needs assessment evaluations to embed digital platforms in partnership with Indigenous communities. PLoS ONE 17(12): e0279282. https://doi.org/10.1371/journal.pone.0279282

Editor: Stephane Shepherd, Swinburne University of Technology, AUSTRALIA

Received: June 1, 2022; Accepted: December 2, 2022; Published: December 22, 2022

Copyright: © 2022 Bhawra et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: Data are co-owned by the community and all data requests should be approved by the Citizen Scientist Advisory Council and the University of Regina Research Office. Citizen Scientist Advisory Council Contact: Mr. Duane Favel, Mayor of Ile-a-lacrosse, email: [email protected] ; [email protected] University of Regina Research Office contact: Ara Steininger, Research Compliance Officer; E-mail: [email protected] . Those interested can access the data in the same manner as the authors.

Funding: TRK received funding from the Canadian Institutes of Health Research (CIHR) and the Canada Research Chairs Program to conduct this research. The funding organization had no role to play in any part of the study implementation of manuscript generation.

Competing interests: The authors have declared that no competing interests exist.

Community engagement has been the cornerstone of participatory action research in a range of disciplines. Every community has a unique culture and identity, hence community members are the experts regarding their diverse histories, priorities, and growth [ 1 – 3 ]. As a result, the successful uptake, implementation, and longevity of community-based research initiatives largely depends on meaningful community engagement [ 4 – 9 ]. There is a considerable body of evidence establishing the need for ethical community-research partnerships which empower citizens and ensure relevant and sustainable solutions [ 1 – 3 , 10 ]. For groups that have been marginalized or disadvantaged, community-engaged research that prioritizes citizens’ control in the research process can provide a platform to amplify citizens’ voices and ensure necessary representation in decision-making [ 11 ]. Such initiatives must be developed in alignment with a community’s cultural framework, expectations, and vision [ 12 ] to support continuous and meaningful engagement throughout the project. In particular, when partnering with Indigenous communities, a Two-Eyed Seeing approach can provide valuable perspective to combine the strengths of Indigenous and Western Knowledges, including culturally relevant methods, technologies, and tools [ 13 – 15 ].

Many communities have a complicated relationship with research as a result of colonialism, and the trauma of exploitation and discrimination has continued to limit the participation of some communities in academic partnerships [ 16 ]. Indigenous Peoples in Canada experience a disproportionate number of health, economic, and social inequalities compared to non-Indigenous Canadians [ 17 ]. Many of these health (e.g., elevated risk of chronic and communicable diseases) [ 18 – 21 ]), socioeconomic (e.g., elevated levels of unemployment and poverty) [ 19 , 22 – 24 ], and social (e.g., racism and discrimination) [ 19 , 22 – 24 ]) inequities can be traced back to the long-term impacts of assimilation, colonization, residential schools, and a lack of access to healthcare [ 19 , 20 , 22 – 24 ]. To bridge this gap, and more importantly, to work towards Truth and Reconciliation [ 25 ], work with Indigenous Peoples must be community-driven, and community-academia relationship building is essential before exploring co-conceptualization of initiatives [ 26 ].

One of the first steps in building a relationship is to learn more about community priorities by conducting a needs assessment [ 27 , 28 ]. A needs assessment is a research and evaluation method for identifying areas for improvement or gaps in current policies, programs, and services [ 29 ]. When conducted in partnership with a specific community, needs assessments can identify priorities and be used to develop innovative solutions, while leveraging the existing knowledge and systems that communities have in place [ 30 ]. Needs assessments pave the path for understanding the value and applicability of research for community members, incorporating key perspectives, and building authentic partnerships with communities to support effective translation of research into practice.

For rural, remote, and northern communities within Canada, issues related to access (e.g., geographic location, transportation, methods of communication, etc.) pose significant barriers to participation in research and related initiatives [ 31 ]. Digital devices, and in particular, the extensive usage of smartphones [ 32 ] offers a new opportunity to ethically and equitably engage citizens [ 33 ]. Digital platforms (also referred to as digital tools) are applications and software programs accessible through digital devices. Digital platforms can be used for a variety of purposes, ranging from project management, to healthcare delivery or mass communication [ 34 ]. Digital infrastructure–the larger systems which support access and use of these digital platforms, including internet, satellites, cellular networks, and data storage centres [ 34 ]. The Coronavirus (COVID-19) pandemic has catalyzed the expansion of digital technology, infrastructure and the use of digital devices in delivering essential services (e.g., healthcare) and programs to communities [ 35 , 36 ].

While digital platforms have been used in Indigenous communities for numerous initiatives, including environmental mapping initiatives (e.g., research and monitoring, land use planning, and wildlife and harvest studies) [ 37 , 38 ] and telehealth [ 39 ], there has largely been isolated app development without a corresponding investment in digital infrastructure. This approach limits the sustainability of digital initiatives, and importantly does not acknowledge an Indigenous world view of holistic solutions [ 39 ].

Thus given the increasing prominence of digital devices [ 39 , 40 ], it is critical to evaluate the conceptualization, implementation, and knowledge dissemination of digital platforms. To date, there is little guidance on how to evaluate digital platforms, particularly in partnership with rural and remote communities [ 41 ]. A review of recent literature on community-based needs assessments uncovered numerous resources for conducting evaluations of digital platforms, however, a key gap is the lack of practical guidance for conducting needs assessments in close collaboration with communities in ways that acknowledge existing needs, resources, supports and infrastructure that also incorporates the potential role of digital platforms in addressing community priorities.

This paper aims to provide researchers and evaluators with a framework (step-by-step guide) to conduct needs assessments for digital platforms in collaboration with Indigenous communities. To achieve this goal, a novel needs assessment framework was developed using a Two-Eyed Seeing approach [ 13 – 15 ] to enable the identification of community priorities, barriers and supports, as well as existing digital infrastructure to successfully implement digital solutions. To demonstrate the application of this framework, a community-engaged needs assessment conducted with a subarctic Indigenous community in Canada is described and discussed in detail.

Framework design and development

This project commenced with the design and development of a new framework to guide community-based needs assessments in the digital age.

Needs assessments

Needs assessments are a type of formative evaluation and are often considered a form of strategic or program planning, even more than they are considered a type of evaluation. Needs assessments can occur both before and during an evaluation or program implementation; however, needs assessments are most effective when they are conducted before a new initiative begins or before a decision is made about what to do (e.g., how to make program changes) [ 29 ]. Typically, a needs assessment includes: 1) collecting information about a community; 2) determining what needs are already being met; and 3) determining what needs are not being met and what resources are available to meet those needs [ 42 ].

Framework development

Based on existing literature, community consultation, and drawing expertise from our team of evaluation experts who have over a decade of experience working with Indigenous communities on a range of research and evaluation projects, a novel framework was developed to guide community-based needs assessments focused on the application of digital platforms.

This framework (see Fig 1 ) is driven by core questions necessary to identify community priorities that can be addressed by developing and implementing digital platforms. Through team discussion and community consultation, five key topic areas for the assessment of community needs were identified: i) current supports; ii) desired supports; iii) barriers; iv) community engagement; and v) digital access and connectivity. A series of general questions across the five needs assessment topic areas were developed. Thereafter, a set of sub-questions were embedded in each key topic area.

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https://doi.org/10.1371/journal.pone.0279282.g001

The Guiding Framework outlines an approach for conducting community needs assessments which can be adapted across communities and jurisdictions. This framework offers a flexible template that can be used iteratively and applied to various community-engaged needs assessments in a range of areas, including but not limited to community health and wellness projects. The questions assigned to each topic area can be used to guide needs assessments of any priority identified by community stakeholders as suitable for addressing with digital platforms.

Needs assessment methods

The Guiding Framework was implemented in collaboration with a subarctic Indigenous community in Canada, and was used to identify key community priorities, barriers, supports, and existing digital infrastructure which could inform the design and implementation of tailored digital platforms.

Using an environmental scan of relevant documents and qualitative focus groups and interviews, a needs assessment was conducted with the Northern Village of Île-à-la-Crosse, Saskatchewan, Canada between February and May 2020.

This project is governed by a Citizen Scientist Advisory Council which included researchers, Knowledge Keepers, Elders, and youth from Île-à-la-Crosse. The study PI (TRK) and Co-Investigator (JB) developed a relationship with key decision-makers in Île-à-la-Crosse in 2020. Through their guidance and several community visits, the decision-makers introduced the research team to Elders, youth, and other community members to gain a better understanding of current priorities and needs in Île-à-la-Crosse. The research team developed relationships with these community members and invited them to join the Council to formally capture feedback and plan ongoing projects to promote health and wellbeing in the community. The Council represents the needs and interests of the community, and guides the project development, implementation, and evaluation. Council members were provided with Can $150 (US $119.30) as honoraria for each meeting to respect their time, knowledge, and contributions.

Written consent was obtained from all focus group participants and verbal consent was obtained from all key informants participating in interviews. This study received ethics clearance from the research ethics boards of the University of Regina and the University of Saskatchewan through a synchronized review protocol (REB# 2017–29).

Established in 1776, Île-à-la-Crosse is a northern subarctic community with road access in northwest Saskatchewan. Sakitawak, the Cree name for Île-à-la-Crosse, means “where the rivers meet,” hence the community was an historically important meeting point for the fur trade in the 1800s [ 43 , 44 ] The community lies on a peninsula on the Churchill River, near the intersections with the Beaver River and Canoe River systems. Île-à-la-Crosse has a rich history dating back to the fur trade. Due to its strategic location, Montreal-based fur traders established the first trading point in Île-à-la-Crosse in 1776, making the community Saskatchewan’s oldest continually inhabited community next to Cumberland House [ 45 ]. In 1821, Île-à-la-Crosse became the headquarters for the Hudson’s Bay Company’s operations in the territory. In 1860, the first convent was established bringing Western culture, medical services, and education to the community.

Île-à-la-Crosse has a population of roughly 1,300 people [ 19 ]. Consistent with Indigenous populations across Canada, the average age of the community is 32.7 years, roughly 10 years younger than the Canadian non-Indigenous average [ 19 ]. Census data report that just under half (44%) of the community’s population is under the age of 25, 46.3% are aged 25–64, and 9.3% aged 65 and over [ 19 ]. Members of the community predominantly identify as Métis (77%), with some identifying as First Nations (18%), multiple Indigenous responses (1.2%), and non-Indigenous (2.7%) [ 19 ]. Many community members are employed in a traditional manner utilizing resources of the land (e.g., hunting, fishing, trapping), others in a less traditional manner (e.g., lumbering, tourism, wild rice harvesting), and some are employed through the hospital and schools. The community currently has one elementary school with approximately 200 students from preschool to Grade 6, and one high school serving Grades 7–12 with adult educational programming. Île-à-la-Crosse has a regional hospital with Emergency Services, which includes a health services centre with a total of 29 beds. Other infrastructure of the community includes a Royal Canadian Mounted Police (RCMP) station, a village office, volunteer fire brigade, and a catholic church [ 46 ].

Needs assessment approach

Île-à-la-Crosse shared their vision of integrating digital technology and infrastructure as part of its growth, thus the needs assessment was identified as an appropriate method to provide the formative information necessary to understand what the needs are, including who (i.e., players, partners), and what (i.e., information sources) would need to be involved, what opportunities exist to address the needs, and setting priorities for action with key community stakeholders [ 47 ]. As a starting point and rationale for this needs assessment, the community of Île-à-la-Crosse values the potential of technology for improving health communication, information reach, access to resources, and care, and was interested in identifying priorities to begin building digital infrastructure. Given the timing of the COVID-19 pandemic, being responsive to community health needs were key priorities that they wanted to start addressing using a digital platform. This needs assessment facilitated and enabled new conversations around key priorities and next steps.

The evaluation approach was culturally-responsive and included empowerment principles [ 48 – 50 ]. Empowerment evaluation intends to foster self-determination. The empowerment approach [ 50 ] involved community members–represented through the Citizen Scientist Advisory Council–engaging in co-production of the evaluation design and implementation by establishing key objectives for the evaluation, informing evaluation questions, building relevant and culturally responsive indicators, developing focus group guides, leading recruitment and data collection, and interpreting results [ 51 ]. In this way, the approach incorporated local community and Indigenous Knowledges as well as Western knowledge, in a similar approach to Two-Eyed Seeing [ 13 – 15 ]. Using these needs assessment evaluation results, the community will identify emerging needs and potential application issues, and work with the researchers to continue shaping project development and implementation.

Two-Eyed Seeing to embed digital platforms

Two-Eyed Seeing as described by Elder Albert Marshall [ 13 , 14 ], refers to learning to see with the strengths of Indigenous and Western Knowledges. Our engagement and overall approach to working with the community of Île-à-la-Crosse takes a Two-Eyed Seeing lens, from co-conceptualization of solutions, which starts with understanding the needs of the community. All needs are a result of direct Indigenous Knowledge that was provided by the Advisory Council. Indigenous Knowledge is not limited to the knowledge of Elders and Traditional Knowledge Keepers; however, they play a critical role in guiding that knowledge through by providing historical, geographic, and cultural context. Moreover, the Knowledge Keepers can be key decision-makers in the community, and in our case, they were key informants who participated in this needs assessment. Every aspect of needs assessment was dependent on the Advisory Council and Key informants providing the Indigenous Knowledge that the research team needed to tailor digital solutions. As a result, Two-Eyed Seeing approach informed all aspects of the research process.

As we are working to develop, and bring digital platforms and technologies (i.e., Western methods) to address key community priorities, Indigenous Knowledge is central to the overall project. Indigenous Elders, decision-makers, and Advisory Council members are bringing both their historical and lived experience to inform project goals, key priority areas, target groups, and methods. Île-à-la-Crosse is a predominantly Metis community, which differs in culture from other Indigenous communities in Canada—First Nations and Inuit communities. Ceremony is not a key part of community functioning; thus, specific cultural ceremonies were not conducted upon advice of the Advisory Council. Instead, the knowledge of historical issues, challenges, and success stories in the community is considered Indigenous Knowledge for this needs assessment, and more importantly, this Indigenous Knowledge informed the focus areas and next steps for this project. Overall, the spirit of collaboration and co-creation which combined Western research methods/technology with Indigenous Knowledge and expertise is considered Two-Eyed Seeing in this project. This lens was taken at all phases, from the engagement stage to Advisory Council meetings, to planning and executing the needs assessment and next steps.

Data collection

In order to obtain an in-depth understanding of the key priorities and supports within the community of Île-à-la-Crosse, this needs assessment used a qualitative approach. An environmental scan was conducted in February 2020 of current school and community policies and programs. Published reports, meeting memos, community social media accounts, and the Île-à-la-Crosse website were reviewed for existing policies and programs. The Citizen Scientist Advisory Council identified appropriate data sources for the document review and corroborated which programs and initiatives were currently active in the community.

Qualitative data were collected from key decision-makers and other members within the community. A purposeful convenience sampling approach was employed to identify members of the community who could serve on the Council and participate in focus group discussions. Key decision makers and existing Council members recommended other community members who could join the focus group discussions to provide detailed and relevant information on community priorities, digital infrastructure, supports, and challenges. Two focus groups were conducted by members of the research team in Île-à-la-Crosse with the Council in May 2020. Focus group participants were asked to describe community priorities, supports, and barriers, as well as experience and comfort with digital platforms. Each focus group had four participants, were two-hours in length, and followed an unstructured approach. Three key informant interviews were conducted in Île-à-la-Crosse between February and April 2020. One-hour interviews were conducted one-on-one and followed a semi-structured interview format. The focus groups and key informant interviews were led by the study PI, TRK, and Co-Investigator, JB, who have extensive training and experience with qualitative research methods, particularly in partnership with Indigenous communities. Focus groups and key informant interviews were conducted virtually using Zoom [ 52 ]. The key informant interviews and focus groups were audio-recorded and transcribed. All data were aggregated, anonymized, and securely stored in a cloud server. Data are owned by the community. Both the Council and the research team have equal access to the data.

Data analysis

All documents identified through the environmental scan were reviewed for key themes. A list of existing school and community programs was compiled and organized by theme (i.e., education-focused, nutrition-focused, health-focused, etc.). Follow-up conversations with key informants verified the continued planning and provision of these programs.

Following the 6-step method by Braun and Clarke (2006), a thematic analysis was conducted to systematically identify key topic areas and patterns across discussions [ 53 ]. A shortlist of themes was created for the key informant interviews and focus groups, respectively. A manual open coding process was conducted by two reviewers who reached consensus on the final coding manual and themes. Separate analyses were conducted for key informant interviews and focus group discussions; however, findings were synthesized to identify key themes and sub-themes in key priorities for the community, community supports and barriers, as well as digital connectivity and infrastructure needs.

Needs assessment findings

The needs assessment guiding framework informed specific discussions of key issues in the community of Île-à-la-Crosse. Key informant interviews and focus group discussions commenced by asking about priorities–“what are the key areas of focus for the community?” In all conversations–including a document review of initiatives in Île-à-la-Crosse–health was highlighted as a current priority; hence, questions in the guiding framework were tailored to fit a needs assessment focused on community health. The following five overarching evaluation questions were used to guide the evaluation: i) What are the prominent health issues facing residents of Île-à-la-Crosse?; ii) What supports are currently available to help residents address prominent health issues in the community?; iii) What types of barriers do community members face to accessing services to manage their health?; iv) How is health-related information currently shared in the community?; and v) To what extent are health services and information currently managed digitally/electronically? The evaluation questions were kept broad to capture a range of perspectives. An evaluation matrix linking the proposed evaluation questions to their respective sub-questions, indicators, and data collection tools is outlined in Table 1 .

https://doi.org/10.1371/journal.pone.0279282.t001

Feedback on each needs assessment topic area is summarized in the sections below. Sample quotes supporting each of the key topic areas is provided in Table 2 .

https://doi.org/10.1371/journal.pone.0279282.t002

Key priorities

Four priorities were identified through the focus groups, key informant interviews, and document review ( Fig 2 ). Given the timing of the discussion, the primary issue of concern was the COVID-19 pandemic. Many community members were worried about contracting the virus, and the risk it posed to Elders in the community. Of greater concern, however, was how COVID-19 exacerbated many existing health concerns including diabetes and hypertension in the community. For example, routine procedures were postponed and community members with other health conditions were not receiving routine healthcare during the height of the pandemic. The St. Joseph’s Hospital and Health Centre services Île-à-la-Crosse and bordering communities, hence maintaining capacity for COVID-19 patients was a priority. COVID-19 exposed existing barriers in the healthcare system which are described in greater detail in the barriers to community health section.

https://doi.org/10.1371/journal.pone.0279282.g002

Another priority discussed by many community members was climate change and the environment. Community members noted that changes in wildlife patterns, land use, and early winter ice road thaw were areas of concern, particularly due to the impact these factors have on traditional food acquisition practices (i.e., hunting) and food access. For instance, the geographic location of Île-à-la-Crosse is surrounded by a lake, and the main highway which connects the community to the land has experienced increased flooding in the past few years.

In addition to posing immediate danger to community members, food security and sovereignty are also closely linked to road access. While the community produces some of its own food through the local fishery and greenhouses, Île-à-la-Crosse is still dependent on a food supply from the south (i.e., Saskatoon). During COVID-19, food access was further restricted due to limited transport and delivery of food products, which increased the risk of food insecurity for community members. Food insecurity was believed to be of bigger concern for Elders in the community compared to younger members. Younger community members expressed having the ability to source their own food in a variety of capacities (e.g., fishing in the lake), whereas Elders rely more heavily on community resources and support (e.g., grocery stores, friends, and family).

Community members also discussed issues surrounding mental health and wellbeing. This topic was of particular concern for youth and Elders in the community. Community members discussed the importance of identifying covert racism (vs. discrimination) that exists within health services that exacerbated mental health issues and care, as well as developing coping strategies, resilience, and supports to prevent mental health crises. Key informants emphasized the need to minimize the stigma around mental health and focus on holistic wellbeing as they work to develop strategies to improve community wellness.

Community health supports

Île-à-la-Crosse has been working on developing supports to improve community health through various initiatives. A document review identified a community-specific wellness model which has informed program development and planning over the past few years. The key components of the Île-à-la-Crosse wellness model are: i) healthy parenting; ii) healthy youth; iii) healthy communities; iv) Elders; v) healing towards wellness; and vi) food sovereignty. The Elders Lodge in the community provides support for holistic wellbeing by promoting intergenerational knowledge transmission, guidance to youth and community members, as well as land-based activities which improve bonding, cultural awareness, and mental and spiritual well-being among community members. The Elders Lodge hosts both drop-in and organized events.

Several initiatives have been developed to support food sovereignty in the community, including a greenhouse program where fruits and vegetables are grown and shared locally. This program is run in partnership with the school to increase food knowledge and skills among youth. In addition, after-school programs including traditional food education (i.e., cooking classes) and land-based activities (i.e., berry picking) led by Elders support the goals of the wellness model. The community is currently working on developing additional programs dedicated to improving mental wellness among adults, youth, and Elders.

Barriers to community health

When key informants were asked to identify barriers to community health, they described delays in access to timely health information. For example, daily COVID-19 tests conducted at the regional health centre in Île-à-la-Crosse were relayed to the provincial health authority; however, information about the total number of COVID-19 cases could take up to one week to be sent back to the community. This time lag restricted community decision-makers’ ability to enact timely policy (i.e., contact tracing) and rapidly respond to managing cases.

A second barrier that was raised by community members was a delay in access to timely healthcare. The Île-à-la-Crosse hospital is a regional health service centre serving the community as well as surrounding areas. Community members noted that the load often exceeded the capacity of the single hospital, and some patients and procedures were relocated to hospitals and clinics in the larger city of Saskatoon, Saskatchewan. This was reported to be challenging for many community members as it was associated with longer wait times, long commutes, and sometimes required time off work. Many of these challenges were exacerbated during the COVID-19 pandemic. As a result of the pandemic, many medical centres and hospitals postponed routine and elective medical procedures in an attempt to accommodate the overwhelming influx of patients who contracted COVID-19. In addition, community members were advised to avoid spending time in health centres to limit risk of exposure to the virus. These COVID-related changes further delayed access to timely healthcare for many community members of Île-à-la-Crosse.

Several community members reported experiencing institutional racism in healthcare and social service settings outside of Île-à-la-Crosse. This was particularly exacerbated during the COVID-19 movement restrictions, where community members faced significant difficulties in accessing services and care in larger urban centres, and experienced further discrimination due to the stigma of COVID-19-related rumours about communities in the north.

Lastly, community members discussed a lack of awareness about some health topics, including where and how to access reliable health information. Some community members attributed this lack of awareness to a general distrust in government health information due to a history of colonialism and exploitation in Canada, which likely contributed to increased misinformation about COVID-19 risk and spread.

Health communication

The primary modes of communication within Île-à-la-Crosse are radio and social media. These platforms were used throughout the pandemic to communicate health information about COVID-19 case counts and trends. Community members also reported obtaining health information from healthcare practitioners (i.e., for those already visiting a healthcare provider), Elders, and the internet. Key informants indicated an interest in improving digital infrastructure to enable sharing of timely and accurate health information with community members and minimize misinformation. Key informants also reported room for improvement in the community’s digital health infrastructure, particularly in improving timely communication with community members, and to inform decision-making in crisis situations.

Digital infrastructure and connectivity

Île-à-la-Crosse has its own cell tower which offers reliable access to cellular data. The community also has access to internet via the provincial internet provider–SaskTel, as well as a local internet provider—Île-à-la-Crosse Communications Society Inc. Key informants and community members confirmed that most individuals above 13 years of age have access to smartphones, and that these mobile devices are the primary mode of internet access. However, it was unclear whether everyone who owns smartphones also has consistent data plans or home internet connections. Key informants described the great potential of digital devices like smartphones to increase the speed and accuracy of information sharing. Discussions with both key informants and community members suggested the need for a community-specific app or platform which could provide timely health information that was tailored to the community’s needs.

Community members noted that expanding digital infrastructure had to be paired with efforts to improve digital literacy–particularly as it relates to data security, privacy, and online misinformation. A separate initiative was discussed which could work to improve digital literacy among youth and Elders, as this would improve both the uptake of digital health platforms, as well as their usefulness and application. Key informants discussed the importance of building digital infrastructure that would enable data sovereignty, self-governance, and determination. The key informants, who are also primary decision-makers in the community, described opportunities for ethical development of digital platforms that would ensure that data is owned by the community.

Needs assessments are commonly the first step in understanding specific community needs, [ 27 , 28 ]; however, few evaluation frameworks provide practical guidance on how to engage communities in needs assessments [ 41 ]. This paper provides a step-by-step guide for conducting needs assessments in collaboration with communities in the digital age. Using the series of questions outlined in the Guiding Framework, researchers and evaluators can gain an in-depth understanding of a community’s priorities, needs, existing capacity, and relevant solutions.

The Guiding Framework was critical to establishing a partnership with the community of Île-à-la-Crosse, as it enabled the research team to obtain detailed insight into their priorities–in this case, community health–as well as community capacity. Taking a Two-Eyed Seeing approach [ 15 ], conversations with the community highlighted strengths of Western digital technology and the diversity of Indigenous Knowledges for addressing priorities [ 13 ]. This approach was also important to establishing trust and respect for the variety of perspectives that could be used to address community priorities. The resulting partnership also enabled the conceptualization of tangible action items that were aligned with current and future priorities–a key factor in the sustainability and feasibility of community-based initiatives [ 4 – 8 , 54 ].

Challenges and opportunities for using digital platforms for priorities identified by needs assessment

Many rural and remote communities face similar challenges and share common priorities with Île-à-la-Crosse. For example, resource and service access, including food and other essential supplies, healthcare, and internet connectivity are issues faced by many rural and remote communities across Canada [ 55 – 60 ]. Key informants and community members from our partner community corroborated these access issues, particularly in relation to public health. Given the potential for digital technology to bridge access gaps, it has become pertinent to invest in digital infrastructure and platform development.

Research has shown that in many rural and remote communities, smartphone ownership is not the limiting factor–it is internet inequity, which is defined as differential internet access based on wealth, location (urban, rural, or remote), gender, age, or ethnicity [ 61 ]. The United Nations has declared internet access a human right [ 10 ], which makes it imperative to develop digital infrastructure such as internet connectivity to improve digital accessibility. Île-à-la-Crosse has its own cell tower which offers reliable access to cellular data. The community of Île-à-la-Crosse also has access to consistent and dedicated internet service through a provincial internet provider and local internet provider. The needs assessment showed that the universality of smartphone ownership combined with good internet connectivity lays the foundation for the development of tailored, culturally appropriate digital health platforms in communities like Île-à-la-Crosse.

In particular, the needs assessment revealed that smartphone apps, which most citizens are well-versed with, can be used to provide local services and access to resources. For example, a locally developed app can connect the Mayor’s office with community members in real-time to provide updates on COVID-19 outbreaks. Apps also have the potential to connect communities to resources within and outside of the community [ 35 , 57 ]. For example, advanced artificial intelligence algorithms can be used to anticipate community needs prior to urgent crises like COVID-19, environmental disasters, or food crises [ 35 , 62 – 65 ]. To date, the issue has not been the lack of technology or ability to bridge this gap for rural and remote communities. Instead, larger systemic inequities have limited our ability to co-create local solutions for global problems by decentralizing technology that is widely available [ 35 , 66 ], which highlights upstream inequities in developing digital platforms.

Recommendations for inclusive digital needs assessments

Given the widespread adoption of digital technology, digital platforms can provide rich data to identify and address community crises [ 2 , 3 , 35 ]. Importantly, co-created digital platforms can be used to share knowledge in real-time with community members and other stakeholders to enable remote engagement, which is especially important during crisis situations such as a pandemic [ 2 , 3 , 35 ]. As we implement creative digital platforms in varied programs or research projects, we must also integrate this digital perspective into the evaluation process. Research and evaluation literature has well established approaches to needs assessment evaluations [ 29 , 42 , 67 ]; however, in the 21st century, we need to account for the use and application of digital platforms in community-focused initiatives. To identify how and where digital platforms can play a role in addressing community priorities, we propose several recommendations for inclusive community-based needs assessments.

First, at the crux of all community-based needs assessments is relationships. A relationship built on respect, reciprocity, mutual understanding, and prioritizing the needs and vision of communities is essential for sustainable impact. The First Nations OCAP® principles [ 68 ] informed conversations between the research team and community about data ownership and control. These principles include ownership of knowledge and data, control over all aspects of research, access to information about one’s own community, and possession or control of data [ 68 ]. The OCAP® principles ensure First Nations and other Indigenous Peoples the right to their own information, and also reflect commitments to use and share information in a way that maximizes the benefit to a community, while minimizing harm. Some communities may choose to lead a project, or work closely in collaboration with experts for specific projects. Irrespective of the project dynamics, needs assessments rely on detailed information and context about a community for a project to succeed.

Second, it is important for researchers and evaluators to gain an understanding of the current digital infrastructure and connectivity in the community. The needs assessment framework ( Fig 1 ) includes relevant questions for identifying data and WIFI access in a community, penetration of digital devices, and existing digital infrastructure. Even for community-based initiatives that are not focused on a digital platforms, digital technologies will inevitably be a part of the solution, a barrier, or both. Hence the digital landscape has become part of the context that we must capture and understand in a needs assessment to better design and develop programming, policies, and other initiatives.

Third, it is important to ask the question of where and how a digital tool or platform could help. Are there gaps that digital platforms can help address or fill? In rural and remote communities, in particular, digital platforms can provide access to real-time information and services not otherwise available. For example, Telehealth [ 69 , 70 ] in the Canadian north offers citizens access to essential healthcare services, including video appointments with medical specialists. Prior to Telehealth, many residents would need to fly into bigger cities in the nearest province to access health care [ 55 ].

Lastly, an understanding of the broader context which affects a community’s ability to adopt digital platforms is critical to the success of digital initiatives. This includes, but is not limited to, capturing data on socioeconomic status and the accessibility of internet-connected digital devices. Digital platforms should help to bridge the divide in resource, service, and information access–not widen the gap. For some communities, this may require working on building digital infrastructure and obtaining dedicated funds to expand access prior to implementing digital initiatives. In addition, digital literacy cannot be taken for granted. Digital literacy refers to individuals’ ability to not only use digital devices, but according to Eshet-Alkalai [ 71 ], “includes a large variety of complex cognitive, motor, sociological, and emotional skills, which users need in order to function effectively in digital environments.” In its simplest form, digital literacy may include the ability to navigate digital platforms, download apps, and communicate electronically. Other more specific skills include ability to read and understand instructions, terms and services, as well as data privacy and security statements [ 72 – 74 ] As part of a needs assessment, identifying digital literacy within a community is an important step to safe, ethical, and relevant digital tool development.

Considering the challenges, immense potential, and learnings from applying the Guiding Framework, a tailored digital platform was conceptualized called Sakitawak Health.

Development of Sakitawak Health

Sakitawak Health is a culturally-responsive digital epidemiological platform to monitor, mitigate, and manage COVID-19 outbreaks. The needs assessment concluded that digital platforms can be used for emerging or other existing population health crises within Île-à-la-Crosse and potentially other Indigenous communities. Moreover, to co-create digital platforms, the Île-à-la-Crosse Citizen Scientist Advisory Council identified key features to embed in CO-Away, including free virtual care for citizens via a smartphone app at the frontend, and access to anonymized community data on the backend for decision-makers.

The app will provide three key precision medicine services that are specific to each citizen: 1) continuous risk assessment of COVID-19 infection; 2) evidence-based public health communication; and 3) citizen reporting of food availability, access to public services, and COVID-19 symptoms and test results. These culturally-responsive features have been co-created with Métis decision-makers in Île-à-la-Crosse based on imminent community needs and preferences. CO-Away will enable real-time data collection through continuous citizen engagement to inform municipal jurisdictional policies.

There are three guiding principles for developing Sakitawak Health: I) Citizen empowerment and data ownership: Active engagement is enabled through app features such as visualizing community risk. More importantly, the community owns the data to ensure data sovereignty; II) Privacy: Utilizing a cutting-edge methodology called federated machine learning, we will develop artificial intelligence algorithms that stores sensitive data such as participant location on mobile devices itself (i.e., sensitive data are not stored in external servers); III) Security and scalability: The backend server will be located in Cloud in Canada, which allows for horizontal and vertical scalability (i.e., the potential for developing multiple frontend apps and decision-making dashboards).

Recognizing the importance of data sovereignty and Indigenous self-governance

Data sovereignty and social justice are important aspects of community-based work, particularly for communities that have experienced discrimination or systemic inequities [ 2 , 75 ]. Data sovereignty refers to meaningful control and ownership of one’s data [ 76 ]. For Indigenous communities in Canada, self-determination and self-governance are of paramount importance given the colonial history of oppression, trauma, and disenfranchisement [ 77 ], and data sovereignty and ownership of digital platforms can promote that independence. In conducting digital community-based needs assessments, the application of a Two-Eyed Seeing lens enables us to leverage strengths of both Indigenous and Western Ways of Knowing to help focus on key priorities and develop solutions.

The engagement and overall approach to working with the community of Île-à-la-Crosse applied a Two-Eyed Seeing lens. In the needs assessment with Île-à-la-Crosse, Two-Eyed Seeing involved incorporation of Métis Knowledge during team engagements, which ensured that any digital platforms developed would incorporate Indigenous Knowledge to promote data sovereignty. All priorities identified within this manuscript are a result of direct Indigenous Knowledge that was provided by the Council. Indigenous Knowledge is not limited to the knowledge of Elders and Traditional Knowledge Keepers; however, they play a critical role in guiding that knowledge through by providing historical, geographic, and cultural context. Discussions with Île-à-la-Crosse about data sovereignty centered around citizen ownership of data, community access, and ensuring data privacy and security. The ultimate goal of this approach to data sovereignty is to facilitate decreased dependence on external systems and use digital solutions for Indigenous self-determination and self-governance.

The needs assessment represents the first phase of a larger evaluation strategy to develop and implement culturally appropriate digital platforms for community health. Phase 1 involved identifying core health priorities and desired supports in the community of Île-à-la-Crosse. Based on the needs assessment findings, Phase 2 of this project will involve the development of tailored digital health platforms and programming to support digital literacy. As part of Phase 2, digital literacy programs and tailored digital health platforms will be pilot tested and adapted prior to their implementation. In Phase 3, a process evaluation will be conducted to assess the reach, uptake, and use of digital health platforms and digital literacy programming. Integrated knowledge translation will be conducted during all phases to ensure continuous feedback, communication, and knowledge sharing with all relevant stakeholder groups.

Conclusions

Needs assessments can facilitate important conversations in community-based research and evaluation to learn about key priorities, challenges, and opportunities for growth. The Guiding Framework for Community-Based Needs Assessments to Embed Digital Platforms details a step-by-step approach to begin a conversation with communities to better understand their needs, and to tailor research and evaluation projects focused on embedding digital platforms. In Île-à-la-Crosse, the needs assessment framework has propelled the launch of a timely, community-engaged digital initiative to address key priorities, starting with COVID-19. Overall, tailored platforms can help bridge existing gaps in resource, program, and service access in Indigenous communities, irrespective of their location across the world.

Supporting information

https://doi.org/10.1371/journal.pone.0279282.s001

Acknowledgments

The authors would like to acknowledge the contributions of community members of Île-à-la-Crosse. The Elders, youth, and key decision-makers who are part of the Île-à-la-Crosse Citizen Scientist Advisory Council have been invaluable in providing support, guidance, and cultural training to the research team. The authors also acknowledge the support of the Canadian Internet Registration Authority in advancing the uptake of digital health applications.

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• Research article
• Open access
• Published: 07 March 2012

Community based needs assessment in an urban area; A participatory action research project

• Saeid Sadeghieh Ahari 1 ,
• Shahram Habibzadeh 2 ,
• Moharram Yousefi 3 ,
• Firouz Amani 1 &
• Reza Abdi 4  

BMC Public Health volume  12 , Article number:  161 ( 2012 ) Cite this article

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Community assessment is a core function of public health. In such assessments, a commitment to community participation and empowerment is at the heart of the WHO European Healthy Cities Network, reflecting its origins in health for all and the Ottawa Charter for Health Promotion. This study employs a participation and empowerment plan in order to conduct community assessment.

The method of participatory action research (PAR) was used. The study was carried out in an area of high socio-economic deprivation in Ardabil, a city in the northwest of Iran, which is currently served by a branch of the Social Development Center (SDC). The steering committee of the project was formed by some university faculty members, health officials and delegates form Farhikhteh non-governmental organization and representatives from twelve blocks or districts of the community. Then, the representatives were trained and then conducted focus groups in their block. The focus group findings informed the development of the questionnaire. About six hundred households were surveyed and study questionnaires were completed either during face-to-face interviews by the research team (in case of illiteracy) or via self-completion. The primary question for the residents was: 'what is the most important health problem in your community? Each health problem identified by the community was weighted based on the frequency it was selected on the survey, and steering committee perception of the problem's seriousness, urgency, solvability, and financial load.

The main problems of the area appeared to be the asphalt problem , lack of easy access to medical centers , addiction among relatives and unemployment of youth . High participation rates of community members in the steering committee and survey suggest that the PAR approach was greatly appreciated by the community and that problems identified through this research truly reflect community opinion.

Conclusions

Participatory action research is an effective method for community assessments. However, researchers must rigorously embrace principles of mutual cooperation, respect for public ideas, and a robust belief in community empowerment in order to pave the way for responsible and active citizen participation in the various stages of research.

Peer Review reports

Community-based participatory research (CBPR) has been identified as a key strategy for effectively reducing health disparities in underserved communities [ 1 ]. Assessing the health of a community through CBPR was identified as one of the core functions of public health in the Institute of Medicine's The Future of Public Health [ 2 ]. The Future of Public Health (1988) recommended that local public health agencies should "regularly and systematically collect, assemble, analyze, and make available information on the health of the community, including statistics on health status, community health needs, and epidemiologic and other studies of health problems [ 3 ]. However, even when assessments were completed, policy development and assurance mostly did not follow [ 4 , 5 ].

Strong historical roots of assessment can be found in England. John Graunt (1620-1674), an Englishman, is credited to be among the first demographers. His Natural and Political Observations upon the Bills of Mortality written in 1662 demonstrated that there was regularity in mortality and survivorship figures. Yet, William Farr, appointed the first "Compiler of Abstracts" at the General Register Office in July 1839, is generally said to be the first to make use of the standardized mortality rate to adjust for differences in age distribution in different subgroups [ 3 ].

Community health assessment defined

Community health assessment should not be confused with clinical needs assessments, which are routinely performed during an initial visit to a medical care provider. Community health needs assessment produces information that is relevant to groups and is not focused on the medical needs of individuals so that treatment plans can be developed accordingly. Furthermore, community health needs assessment should not be confused with assessment of disease prevention services. Since health is not seen merely as the absence of disease, community health assessment, therefore, focuses on general well-being. Of course, in many cases, disease prevention and promotion of general health overlap [ 6 ].

Definitions of community health assessment (CHA) widely vary. While some definitions focus on data collection and analysis, others highlight the use of assessment data to develop objectives and action plans for health improvement [ 3 ]. A straightforward definition for CHA is "collecting and analyzing, and using data to educate and mobilize communications, develop priorities, garner resources, and plan actions to improve public health [ 7 ]. In this article, we use the term Community Health Assessment (CHA) to describe both the process and the product of assessment, in that population health data are essential to both CHA's process and products. We identify the major components of CHA as community engagement, data access, data analysis, and interpretation.

Community participation and empowerment

Participation by local households would require optimal community engagement [ 8 ]. Assessment partnerships are encouraged in Healthy People 2010 and in state-level public health improvement plans such as Healthiest Wisconsin 2010: A Partnership Plan to Improve the Health of the Public [ 9 ]. A commitment to community participation and empowerment is at the heart of the WHO European Healthy Cities Network (WHOEHCN), reflecting its origins in health for all and the Ottawa Charter for Health Promotion [ 10 ]. Health promotion works through concrete and effective community action in setting priorities, making decisions, planning strategies and implementing them to achieve better health. At the heart of this process is the empowerment of communities, their ownership and control of their own endeavors and destinies [ 11 ]. The subsequent Jakarta Declaration (WHO, 1997) reinforces this focus, giving priority to increasing community capacity and empowering individuals. It emphasizes the necessity of participation, with actions being carried out by and with people, not on or to people [ 12 ].

Although rigorous evidence of the effectiveness of community participation in relation to health is limited, community participation is widely accepted to have many important benefits [ 13 ]. Key benefits include increasing democracy, mobilizing resources and energy, developing more holistic and integrated approaches, achieving better decisions and more effective services, ensuring the ownership and sustainability of programs, and empowering communities [ 14 ].

Participatory action research

Participatory action research (PAR) is a research process that focuses on improving the quality of service by means of a self-reflecting process of exploring and solving problems [ 15 , 16 ]. The basic structure of PAR is an ever increasing spiral process of planning, acting, observing, reflecting, developing theory and re-planning [ 15 ]. Participation, collaboration and mutuality of all participants in all levels of research is effective in identifying and defining the problem, planning the research, collecting and interpreting the data, planning and evaluating the intervention and re-evaluating the problem in light of the new information generated from the implemented activities, and, finally, disseminating the information [ 17 , 18 ]. PAR works with a community, which is defined as a group of people who share a common interest and not necessarily a common geographical location. Empowerment and social change are important goals of PAR. Equality in sharing control and power are basic values of PAR. Through participation in the research process, disempowered participants are expected to lose their fear, and shame, gain self-confidence, self-esteem and control, and develop an understanding of their own value. PAR is highly relevant for work with oppressed and disempowered communities with self-help groups and for health education [ 16 , 19 , 20 ]. The researchers become essentially facilitators or catalysts, and participants become co-learners in PAR; nobody is considered the expert [ 20 ]. Insiders and outsiders work together as equals to solve problems. PAR is subjective and therefore not always neutral [ 17 ]. PAR involves commitment from all participants and requires mutual respect, trust, humility, adaptability and a holistic approach to problem solving. Listening, dialogue and negotiating consensus are strategies to achieve mutuality and empowerment. As stated previously, the PAR process is an open process that requires constant revisiting of previous levels with newly generated knowledge from actions taken, which then help to reshape the problem and resolve it at a deeper level [ 20 ].

This paper describes a local PAR project to conduct a community health assessment in an urban region of Ardabil, a city in the northwest of Iran. The primary goals of this study were to: 1) demonstrate how health related needs could be assessed through a PAR approach to community participation in an urban community inside a developing country; and 2) encourage community groups and non-state organizations to collaborate to conduct health-related research. The broadness of the issue and diversity of community groups, made both goals challenging from the start.

Study design and community selection

A community PAR was conducted drawing on theories of community mobilization, participation, and empowerment. The steps included 1) establishing the Steering Committee 2) deciding on methods 3) identifying trusted and interested people to form Executive Committees 4) transferring knowledge 5) collecting and weighting data and 6) interpreting data and prioritizing needs.

A local requirement that stipulates that any community based program should be based on a formal demand by the community made us choose a potentially demanding area, based on the criteria of 'low socio-economic status', 'an abundance of various health problems', and a persistent demand on the part of the residents for improvement. The existence of a non-state health center and a high probability of participation were other criteria for choosing this location. At a meeting with delegates from Health Department of Ardabil Medical University, Mayoralty, and Welfare Organization, an area of about 20000 inhabitants was selected for the study site.

Our research project followed a set of prior activities that were undertaken by some members of the current project with the aim of establishing relationships with the local people and winning their trust. The earlier activities included identifying the trusted individuals, those with philanthropic interests, and those who were interested in local development and trust-building projects. Earlier projects involved repairing small open sewer canals, lighting pathways, holding leisure time classes, building sport teams, allocating library space inside the non-state health center of the region, and providing consultation services. All of the above services were made possible through cooperation between the community representatives and non-state organization agents, who managed to involve and attract the attention of the highest authority of the province in the process.

These successful experiences paved the way for this study. The research committee examined the profiles of the trusted and interested people in voluntary philanthropic activities and outlined the study procedures. Twelve Executive Committees were formed by representatives from 12 Blocks that were selected after considering physical texture and pathways following the blocking system of local community development center.

The most important challenge of this study was to encourage academic researchers and officials of health system to believe in the fact that people can participate in health domain research and be empowered to help conduct health research more effectively.

Involving the community development center and selecting executives

In order to encourage the Community Development Center (CDC) of Ardabil to participate in this study, the general outline was discussed with CDC officials, agents from Farhikhteh non-state organization, and local people, during three 2-hour face to face meetings. Finally, the Executive Team of research project was decided mostly from among the local people and a few number of university colleagues. An attempt was made to select the majority of Executive Team members of the study from among the non-state organizations and local people. The ratio of the university colleagues to other members was 1 to 7. The members of the instruction, documentation, supervision, coordination, interview, and enquiry teams were selected from among the community members of CDC and the Farhikhteh institute. Rigorous care was taken to limit the role of the academic members to instruction and other technical aspects and much of the research task were delegated to the community groups in spite of numerous difficulties.

Knowledge transfer and empowerment

The different methods of community assessment were presented through lectures to all members of the Steering Committee. The group preferred the 'focus group' technique to the other presented methods. The members of the project Executive Team and the representatives of the twelve blocks, who were selected from among interested people based on the documents of the Social Research Center , attended focus group workshops for two months. In addition, a questionnaire designing workshop and the data entering methods were hold for the community members of the project. The instruction prepared members for full participation; in practice, much of the job was delegated to ordinary members of the Executive Committees.

Method of data collection

The trained community agents of the Executive Committees held group discussions in the twelve blocks with an average attendance of 8 to 14 neighborhood residents with the retention rate of about 70%. On the whole, three group discussions were held in every block by agents who were fluent in both Turkish and Persian. 1 The invited people included local retailers, state employees, housewives, pensioners, trustees, and active youth from the local blocks. The people attending the discussions were also supposed to act as facilitators of the research and prepare the community for full participation.

A note-taker recorded the details of every discussion. The workshops took place in April through May, 2006. The venues for the workshops were decided based on the convenience of each individual group and included the neighbor's homes, local mosques or CDC rooms. During the workshops, the purpose and process of the research was thoroughly explained.

The research process was started with the following statement: " what is the most important problem in your community's health?" . The agents were asked to tell people that "As a member of our community, we want to understand the problems better. It is necessary to know the answer to this question according to your priorities, so that we can suggest an appropriate intervention to health and other officials, and then implement the intervention, and assess the results of our efforts."

From the beginning, it was made clear to the community that health system officials and relevant domains were expected to allocate considerable amounts of time and money on an annual basis to improve health condition. However, the main challenge was to decide on the priorities from the perspectives of the locals.

Each block team was given the mission to discover the most important problems in their community.

After finishing the workshops, the results were reported to the Steering Committee by the representatives of the groups. The final procedure was agreed to by the Steering Committee with the cooperation of agents of Farhikhteh Institute and representatives of twelve local areas.

Subsequently, in order to assess the needs from the perspectives of the households of the blocks, the Steering Committee planned more workshops to empower the community groups to design the questionnaire and conduct interviews. Three 1-day workshops were planned and implemented in July through August, 2006.

The Steering Committee, representatives of twelve blocks and Farhikhteh institute agreed on a questionnaire which included 60 yes-no items. The items were related to the general problems of local people such as health, security, economy, employment, and education. Subsequently, a final orientation session was held for all the local interviewers to practice completing the questionnaire.

The community interviewers of 12 local areas and their supervisors, from among the members of the Executive Committees interviewed 30 households from the 12 blocks and repeated it after a 14-day interval in order to check the reliability of the instrument, which was found to be 0.76.

Six hundred households were interviewed in September 2006. The target households were selected through cluster random sampling using the CDC database. Considering the population (20,000) and the average number of family members (4.3) in Iran [ 20 ], 600 households equaled about 15% of the households. It should be noted that the demographic information of the participants was not systematically gathered. The supervisors examined the daily delivered questionnaires and randomly checked some households for quality assurance purposes.

Method of data analysis

During the Steering Committee's meetings, the necessity of including diverse groups of people was discussed. The best method of implementing community assessment was also discussed. Finally, the Steering Committee decided to apply a mixed model containing surveys and focused group discussion in the local areas.

The first set of data was produced following analysis of the priorities offered by 12 local groups which represented each block. Then, face-to-face interviews were carried out with [almost all] 600 households of the selected area, to create a second dataset. With consistent supervision and training, the community groups entered the data into the computer as planned. They cooperated with a statistician to analyze the data. Finally, the output of the data which comprised five main problems from the perspective of 600 households was produced.

Ethical considerations

This study was approved in the research committee of Ardabil University of Medical sciences, which considers and verifies the research proposals both academically and ethically. It should also be noted that participation in this project has been voluntary for all the community representatives and the agents of Farhikhteh institute of Ardabil. In the first meeting, their option to leave or continue the study was explained to them formally at the beginning and during the study. The researcher after acknowledging their participation in the project ensured the privacy of the data. Additionally, an attempt was made to employ both female and male colleagues to observe the religious and cultural norms and values.

In the first stage of analysis, the needs of 12 local areas were identified. The number of identified needs for the neighborhoods varied from 8 to 24. As it can be seen in Table 1 , the five prioritized problems for each neighborhood are related but not limited to the health domain.

In Table 2 , the results of the analysis of frequency of the problems, from the point of view of 600 households, are displayed.

In the next stage of research, the Steering Committee decided on some more criteria to produce more practical results. The four criteria that were agreed on were: seriousness, urgency, solvability, and financial burden of the problems, which received weights (quotients) of 8.6, 7.5, 5.5, and 4.8, respectively. The frequency criterion received a weight of 6.8. To arrive at these weights, all 30 members of the Steering Committee assigned a weight score of 1-10 to the above five criteria and then the results were averaged out.

When the five criteria and relevant weights were decided, the Committee met again and all 30 members provided a value number of 1-100 to each problem (e.g. lack of adequate pathway lighting) in terms of its seriousness, urgency, solvability, and financial burden. Then, the five values were multiplied by the relevant weight to yield the final score for each problem which appears in Table 3 .

This participatory action research demonstrated that the availability of trusted and philanthropic people could be very helpful at the beginning of the project. This study also revealed that when assessment of the health problems of a community is carried out, other social problems may be observed that influence the community's general health. As confirmed by the data in Table 3 , health is influenced by an array of social factors [ 21 , 22 ].

Working "with people and for people" during the project indicated that efforts for establishing relationships, empowerment, trusting key roles to people, and involving them in health research can pave the way for high community participation. However, convincing people to trust and join the project was a real challenge at the beginning, which was resolved by the perseverance and negotiation of the certain members of the Steering Committee with the trusted group.

The results of study clarified that in working with the community, researchers should ignore their presuppositions, and let participants discover their own problems and needs, which is a crucial step in empowerment.

Participatory researchers in developing countries such as Iran allocate most of their energy to coping with local rules, getting the approval of participatory research projects, and facing objections from traditional researchers.

This study demonstrated that active community participation can be achieved if the following conditions are met:

1. Acknowledging the key role of people in designing and actually conducting studies;

2. Providing adequate training in research methods;

3. Building trust and empowerment;

4. Seriously taking the community's viewpoint into account;

5. Crating a sense of responsibility in the community;

6. Involving a non-state organization in the research as a bridge between the community and the state; and

7. Communicating research results with participants in public forums and newspaper articles.

However, this study could have been more useful if the following limitations were not present. In the first place, we could not secure a full participation of authorities from non-health departments. Secondly, the demographic details was not gathered which could have enriched the interpretation of the data. Thirdly, we could not attract a proportionate participation of women due to cultural constraints. Finally, our project was the first in type in the region both for the members of the steering committee and also the general participants, which frequently resulted in slowing the procedure.

PAR is very applicable for community assessment. However, researchers must rigorously take into account the caveats of mutual cooperation, respect for public ideas, and a robust belief in community empowerment in order to pave the way for people to feel responsible and actively take part in the various stages of research.

The native language of people in Ardabil Province is Turkish, while the official language is Persian. During late decades, the local people have used Turkish for oral conversation and Persian for written communication. Only a quite small number of people are able to read and write in Turkish. However, in accordance with the current traditions and convenience of region, the group discussions were performed in Turkish, but recorded in Persian.

Abbreviations

Social Development Center

Community-Based Participatory Research

Community Health Assessment

Institute of Medicine

WHO European Healthy Cities Network

Participatory action research.

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We express our gratitude to all residents of the region under study who even sometimes received us in their homes. Moreover, we should thank the community agents of the Steering and the Executive Committees of the project which aided us generously and taught us a lot. Finally, we appreciate Research Department of Ardabil University of Medical Sciences that financially supported this project.

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Saeid Sadeghieh Ahari & Firouz Amani

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Shahram Habibzadeh

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Moharram Yousefi

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Ahari, S.S., Habibzadeh, S., Yousefi, M. et al. Community based needs assessment in an urban area; A participatory action research project. BMC Public Health 12 , 161 (2012). https://doi.org/10.1186/1471-2458-12-161

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Quantitative needs assessment tools for people with mental health problems: a systematic scoping review

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• Irena Makivić   ORCID: orcid.org/0000-0003-2748-5522 1 ,
• Anja Kragelj 1 &
• Antonio Lasalvia   ORCID: orcid.org/0000-0001-9963-6081 2  

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Needs assessment in mental health is a complex and multifaceted process that involves different steps, from assessing mental health needs at the population or individual level to assessing the different needs of individuals or groups of people. This review focuses on quantitative needs assessment tools for people with mental health problems. Our aim was to find all possible tools that can be used to assess different needs within different populations, according to their diverse uses. A comprehensive literature search with the Boolean operators “Mental health” AND “Needs assessment” was conducted in the PubMed and PsychINFO electronic databases. The search was performed with the inclusion of all results without time or other limits. Only papers addressing quantitative studies on needs assessment in people with mental health problems were included. Additional articles were added through a review of previous review articles that focused on a narrower range of such needs and their assessment. Twenty-nine different need-assessment tools specifically designed for people with mental health problems were found. Some tools can only be used by professionals, some by patients, some even by caregivers, or a combination of all three. Within each recognized tool, there are different fields of needs, so they can be used for different purposes within the needs assessment process, according to the final research or clinical aims. The added value of this review is that the retrieved tools can be used for assessment at the individual level, research purposes or evaluation at the outcome level. Therefore, best needs assessment tool can be chosen based on the specific goals or focus of the related needs assessment.

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Mental disorders are the largest contributor to the disease burden in Europe (Wykes et al., 2021 ), and mortality related to such conditions increases the overall economic burden (McGorry & Hamilton, 2016 ). Mental disorders affect various life domains, from physical health to daily living, friends, family situations, and education, and are associated with greater unemployment and economic problems (Wykes et al., 2021 ).

In order to plan and carry out successful mental health care, it is necessary to have a good mental health information system that also includes data about related needs (Wykes et al., 2021 ). When a need is identified, an action can be (re)organized to address it. Such action, based on the needs identified by the affected individuals, professionals or society, results in either satisfaction or dissatisfaction if the needs continue to be present (Endacott, 1997 ). Assessing needs might also be used to assess the adequacy and prioritization of mental health services at the population level (Ashaye et al., 2003 ; Hamid et al., 2009 ) as well as for the evaluation of mental health care (Hamid et al., 2009 ).

When considering mental health, a need represents a gap between what is and what should be (Witkin & Altschuld, 1995 ), and any changes that are made to the system should thus work to reduce this gap. There are various definitions of both “need” and “assessment” (Royse & Drude, 1982 ). Kahn (1969) considered needs from a social perspective to represent what someone requires in a broader bio-psycho-social context to be able to fully and productively participate in a social process (Royse & Drude, 1982 ). Brewin conceptualised needs (Lesage, 2017 ) as assessing what kind of social disability an individual has for professionals to be able to use an adequate model of care. Disability in this context is the result of interactions between people and the environment, and thus a disability can be seen as a lack of appropriate care models in relation to recognized needs. The concept of “need” in mental health care may be defined according to different points of view: a “normative need” is defined by professionals, while a “felt need” is what people with mental health problems experience and ask to be met (Endacott, 1997 ). What patients request and what they really need may differ, as they can only get what is available and provided at the system level, and what is the most beneficial for them in the current situation. Moreover, what they ask for is not always feasible. However, according to Bradshaw, what an individual requests is important and should be considered as felt needs (Endacott, 1997 ). Bearing in mind Maslow’s hierarchy of needs, only a combination of assessments from different points of view can provide a comprehensive needs assessment: needs assessed at the individual level from service users, their family members, caregivers, practitioners, and other professionals (Endacott, 1997 ). Indicators of needs at the individual level include functioning on different levels, symptoms, diagnoses, quality of life and, access to services (Aoun et al., 2004 ). Patient-centredness is vital to ensure the highest quality of care through monitoring performance (Kilbourne et al., 2018 ). Taking into account the patients’ perspective is also important to assess needs correctly, since such an assessment is more than just the professionals’ perception. An assessment of needs, as Thornicroft ( 1991 ) pointed out, provides care in the community with an emphasis on the provider-user relationship as a key component through which effective care is organized (Carter et al., 1995 ). According to Slade ( 1994 ), the concept of a need in mental health has no single correct definition, but it should rather be seen s a “socially-negotiated concept” (Thornicroft & Slade, 2002 ). Additionally, needs have to be assessed through the bio-psycho-social model (Makivić & Klemenc-Ketiš, 2022 ), including not just medical needs but also a wide array of social needs.

Initially, the assessment of needs (Balacki, 1988 ) in the community was seen as an approach using different forms of analysis to gain insights into the use of services, characteristics of people, incidence and prevalence rates and indicators to recognize crucial determinants that lead to the worsening of mental health. The assessment of mental health needs in Western societies began in 1775 with the analysis of public health data contained in the case registers (Royse & Drude, 1982 ). In the mid-1970s, with the beginning of the transition to care for mental health in the community (and the launch of community mental health service organizations), needs assessment was required within the evaluation process to help meet the patients’ needs. Needs assessment also represents a crucial part of mental health planning (Royse & Drude, 1982 ), where different needs must be considered, especially those felt by individuals. At the end of seventies, Kimmel pointed out that this area of needs assessment had no systematic procedures (Royse & Drude, 1982 ). However, several mental health needs assessment tools have been developed over the last thirty years.

The MRC Needs for Care Assessment (NFCAS) (by Brewin, 1987) was the first attempt to introduce a standardized assessment of the needs of the severely mentally ill (Lesage, 2017 ). Subsequently, a reduced version of the instrument applicable to common mental disorders was developed – i.e., the Needs for Care Assessment Schedule-Community version (NFCAS-C) (Bebbington et al., 1996 ). The shortened version of NFCAS was the Cardinal Needs Schedule (CNS), which is used to assess needs to address them with appropriate interventions (Marshall et al., 1995 ). Later the self-administered Perceived Needs for Care Questionnaire (PNCQ) was developed for use at the population level (Meadows et al., 2000 ), while in 1995 the Camberwell Assessment of Need (CAN) (Phelan et al., 1995 ) was published. After this time the focus shifted more to people-centred approaches, and therefore the assessment of needs also moved beyond psychiatric symptomatology to bring in “consumers”, i.e. patients and their caregivers. Other scales have also been used as needs assessment tools, such as the HoNOS scale (Joska & Flisher, 2005 ) which was designed to evaluate the clinical and social outcomes of mental health care.

Needs assessment is not always a clear and straightforward process with one approach and one goal. Therefore, different tools and approaches may be used to assess needs from different perspectives at different levels and with the help of different tools. The problem with using different techniques is that there is a lack of comparability and a consequent danger of not using the needs assessment outcome data as intended (Stewart, 1979 ); thus, it is important to have a good overview of the available tools.

To the best of our knowledge, only six reviews on needs assessment in people with mental health problems have been published to date (Davies et al., 2018 , 2019 ; Dobrzyńska et al., 2008b ; Joska & Flisher, 2005 ; Keulen-de Vos & Schepers, 2016 ; Lasalvia et al., 2000b ). Four additional reviews focused on the general needs or general health needs of people without mental health problems (Asadi-Lari & Gray, 2005 ; Carvacho et al., 2021 ; Lasalvia et al., 2000a ; Ravaghi et al., 2023 ), which was not focus group of our review. Finally, another article was considered inadequate for this study’s purposes, as it was published in Polish (as the one above) and is not a review paper (Dobrzyńska et al., 2008a ). None of the reviews published thus far have focused on the different assessment tools available for assessing the needs of people with different mental disorders. To date, no study has attempted to review all the available published studies on the various needs assessment processes to systematize the topic. The reviews mentioned above deal with only one specific population (patients with first-episode psychosis; forensic patients), or with specific needs (need for mental health services, supportive care needs, or individual needs for care). Thus, this study aimed to review all studies addressing needs assessment tools specifically designed for people with mental health problems, regardless of their diagnoses. The added value of this study is especially because of its wholeness in presenting different tools that can be used on different populations and by different groups. Thus this study may serve as a framework for starting different needs-assessment processes.

Search strategy

A comprehensive literature search using the Boolean operators “Mental health” AND “Needs assessment” was conducted in electronic bibliographic databases PubMed [Needs Assessment (Mesh Terms) AND Mental Health (Mesh Terms); Mental Health (Title/Abstract) AND Needs assessment (Title/Abstract);] and PsychINFO [Needs assessment AND Mental health in keywords; Needs assessment AND Mental health in Title; Needs assessment AND Mental health in Abstract]. Searching was carried out with the inclusion of all results without time or other limits in August 2021. The search strategy was based on the needs from a clinical context as well as some research priorities in the field of mental health. After the first systematic search we collected additional papers with an overview of six review articles (Davies et al., 2018 , 2019 ; Dobrzyńska et al., 2008b ; Joska & Flisher, 2005 ; Keulen-de Vos & Schepers, 2016 ; Lasalvia et al., 2000b ) and their results, and by searching PubMed within all connected articles. This was important since keywords changed over all this broad timeframe.

Inclusion and exclusion criteria

Our research exclusively focused on quantitative studies. We thus excluded all theoretical/conceptual articles, editorials, books, book commentaries or dissertations. Studies assessing the needs of patients with dementia and groups of people with physical and psychological disabilities were also excluded. We did not include papers related to 1) only general health (care), 2) other needs of the general population, 3) screening, prevalence, general diagnostic tools, and 4) tools for assessing caregivers’ needs. All those steps were done comprehensively by two researchers (IM, AK) independently. When there was a disagreement on the inclusion or exclusion of an article, both researchers looked at it again before reaching a consensus. We then manually added all relevant articles that could have been missed during the electronic search. We added articles that were cited within or were related with all the six mentioned reviews, but were not yet retrieved in the first search. These review articles were not included in the final number of all the articles examined in this study with the aim of exploring the different tools used for needs assessment of people with mental health problems. The aim of this process is to first obtain an overview of all the tools available, as this will make it possible to better use them within clinical settings, as well as for research and development purposes in order to plan a system or intervention that addresses the recognized needs (Fig.  1 ).

Concept of patient-centred care based on needs

Scoping studies, as Arksey and O'Malley ( 2005 ) mentioned, follow five steps, which we also took into consideration. First (step one) we identified the research question, which was “What are all different needs assessment tools that have been used in the population of people with mental health problems within different studies”. We then identified the relevant studies within recognised databases, as well as manually searching and adding the relevant articles (step two). We selected the appropriate studies (step three) as described within the search strategy process, with all inclusion and exclusion criteria. Finally, we presented the results (step four) in the chart flow in Fig.  2 , and Tables  1 , 2 and 3 , which corresponds to the concept of patient-centred care based on needs (Fig.  1 ). Because our focus was on different tools, we prepared the tables accordingly. There was no other relevant information in the original 242 articles to be presented at this occasion, other than those about the usage of different needs assessment tools, as this was the goal of the scoping review. The presentation of the results is based on the use of all recognized needs assessment tools, since geographical studies have been presented elsewhere (Makivić & Kragelj, 2023 ).

Research process within the databases

The analysis was multi-structured to provide an overview of all the recognized tools and the related time trends, country use and population of the most frequently used assessment methods.

The study selection process is shown in Fig.  2 . PubMed provided 578 records within the Mesh search and 537 within the title/abstract search, with after duplicates were removed this gave 1,090 results. Searching in PsychINFO provided 650 results from a search within the Abstract, 232 within Keywords and 1450 within Title; after combining these and removing duplicates, a total of 1,548 results were obtained.

The first selection was made within the final database (n = 2,638) by reading the abstracts and excluding all studies covering topics not relevant for this review. After this was completed, 166 articles remained. These were reviews and research articles covering the needs assessment of people with mental disorders (MD). After this, we eliminated review articles (n = 6) and used them for additional search to manually add all relevant articles that could have been missed during the electronic search, mainly because of the use of different keywords. Specifically, we added the articles that were cited within or were related to all the six mentioned reviews, but were not found in the first search (n = 82). After this process, a total of 242 articles were included in the final review.

Most studies addressing needs assessment tools retrieved with both electronic and manual searches were published in English (n = 231), although some were published in German (n = 3), Spanish (n = 3), and Italian (n = 2). Only one article each was published in Dutch, French and Turkish. Regarding the geographical distribution, most studies were published from European groups (n = 163), while 43 studies were conducted in America, 22 in Australia or New Zealand, 11 in Asia and only three in Africa. Some of the studies were published in collaboration among researchers from different countries. Regarding the publication period, the first studies on this issue were published in 1978, 52.9% of the studies were published from 2000 to 2012, and 66.1% had been published further by 2016.

Through the search performed in this study we found 29 different needs assessment tools, as shown in Table  1 in alphabetical order. We have made and additional search in order to find original sources and the information about the validation. Original sources for each of the recognized tools are listed in Supplementary information ( SI 1 ). Some tools, additional to those 29, were developed for the purposes of a single research study and its specific aims and the information about the validation were not available (n = 11), and thus we eliminated those tools at this point, although they will later be presented elsewhere in another study.

The retrieved tools and their respective constructs of need are presented in Table  2 . The various needs assessment tools are listed in alphabetical order. The tools are presented with regard to (1) who can answer the scale, (2) who the target population is, and (3) the domains addressed. Table 2 provides information on the various needs assessment tools, listed in alphabetical order. The tools are presented with regard to (1) who can answer the scale, (2) who the target population is, and (3) the domains addressed.

Service needs (Hamid et al., 2009 ) are defined as care requirements for prevention, treatment and rehabilitation. These needs can either be assessed by waiting lists or by only asking a simple question (e.g. “Do you think that you require any professional mental health services?”) along with the screening for mental and physical health problems (Yu et al., 2019 ) or social problems, with the help of the tools listed below. Moreover, there are different bio-psycho-social needs that are related to various mental health, physical health, and quality of life factors, as well as personal interests or abilities and social factors (Keulen-de Vos & Schepers, 2016 ), and these can be measured for different purposes. Social needs can be assessed by tools such as the Social Behavioral Schedule or REHAB Schedules, and therefore the need for rehabilitation can also be assessed (Hamid et al., 2009 ) using the comprehensive tools mentioned in our review.

Most of the needs assessment tools were self-completed by the patients (n = 85), completed by professionals (n = 41), or by combination of both (n = 78). Some tools were also completed by the patients and their caregivers (n = 12) or by the patients, caregivers, and professionals at the same time (n = 12). There were few studies where the researchers completed the needs assessment tool (n = 5). The majority of the tools were developed for assessing needs in an adult population with mental health problems (n = 193), either with severe mental disorders or with some other mental health diagnosis. Seventeen studies focused on an elderly population with mental health problems, and six on children with mental health problems. Some needs assessment tools for specific populations were found, such as tools for assessing the needs of forensic patients with mental health problems (n = 18), homeless people and migrants with a mental health diagnosis (n = 4), and mothers or pregnant women with a severe mental disorder (n = 1). In some studies, there was a combination of all these different populations and even people without a diagnosis, which we assigned to each of the mentioned groups.

In the second Supplementary information ( SI 2 ) there are reported the studies found in the literature search that used recognized needs assessment tools (n = 227). In this presentation some of the studies are not presented, namely those without validated tools (n = 11) as already mentioned and all articles using mentioned three different models (n = 4). In some studies, more tools have been used and in this case the study is counted within each tool in the total number of studies. Among the different needs-assessment tool, the CAN is mentioned as the most frequently used scale and, to the best of our knowledge, it has the highest number of different versions. The tools are presented based on their frequency of recognized use within this scoping review, from the most frequent to the least.

The recognized tools can be used in different contexts. Table 3 , groups the needs assessment tools according to their use at the care, research, and system levels.

This scoping review addressed all the published needs assessment tools specifically designed for use in mental health field. Nevertheless, some of the reviewed tools had also been used on the populations without a mental health diagnosis (Carvacho et al., 2021 ). Overall, we found twenty-nine different tools measuring needs in various mental health populations. The list of authors of the originally developed scales mentioned below are provided in the Supplementary information ( SI 1 ).

The reviewed literature highlights that the majority of needs assessment tools have been developed and used in Europe as the adoption of a community psychiatry model is relatively more widespread in this region than in other world regions; some tools, however, have been also used in America, Australia, and New Zealand.

Some scales had been developed with the aim to simplify or shorten previously published needs assessment tools, such as the Camberwell Assessment of Need (CAN) derived from the MRC Needs for Care Assessment Schedule. Similarly, the Difficulties and Needs Self-Assessment Tool was derived from the CAN, where some items are identical, some are a combination of several items of the CAN and some were added as new ones (on work, public places, family and friendship). Some tools, like the Montreal Assessment of Needs Questionnaire, were also developed from the CAN and had different aims, like enhancing data variability to broaden outcome measures for service planning, or simply because the organization of the related system is different and other tools are more appropriate. On the other hand, some tools are based on the CAN, but have been designed for use on a larger scale at the population level, like the Needs Assessment Scale. While most of the tools are used within health care services, the Resident Assessment Instrument Mental Health is a tool developed to support a seamless approach to person-centred health and social care. Some of the tools can also be used outside of the mental health field – such as the Child and Adolescent Needs and Strengths, which can be used in juvenile justice, intervention applications and child welfare – and the abovementioned CAN and others.

There are slightly different ideas regarding the needs and concepts about measuring needs. Many tools include a combination of needs assessed from different perspectives, such as the Bangor Assessment of Need Profile and the CAN. In some tools, like the Community Placement Questionnaire, it is predicted that various people rate the situation for one patient to eliminate any inaccuracies. On the other hand, some tools presented here, like the Self-Sufficiency Matrix, measure needs indirectly through self-sufficiency. When there is higher self-sufficiency for a certain life domain then there is less need presented for this area. Some tools, like Services Needed, Available, Planned, Offered, are complicated to use, since they include an investigation method with the review of the tool and assessment of the service use after the needs have been recognized. But this can be a good approach for the evaluation of the performance of community mental health centres about meeting the needs of their patients. Although we must bear in mind that such a tool is not directly transferable to every community mental health centre, as this depends on how each system is organized.

Needs can be evaluated according to different points of view, from patients themselves and their caregivers, as well as professionals. Studies show there are different outcomes based on the assessor (Lasalvia et al., 2000a , b , c ; Macpherson et al., 2003 ), and that professionals may see the needs differently to the users. Therefore, it is important not only what the tool is being used, but also who can complete it. Therefore, the most useful tools are the ones that can be used by various different people, so that the needs are assessed (also) from the patients’ standpoints (Larson et al., 2001 ).

Although the CAN is the most widely used tool, the research shows that sometimes there is not a very high agreement between staff and patients about needs, as was also found with the Health of the Nation Outcome Scales (HoNOS), which is the reason why some additional scales, such as the Profile of Community Psychiatry Clients, were developed. There are also some tools, such as the HoNOS, that indirectly measure needs for care, so they can be used as either a clinical or needs assessment tool.

Needs assessment tools are generally used by community psychiatry organizations and are also used to support changes to the organizations of countries’ related systems. The tools have already been used in order to assess the needs within clinical procedures, as well as at higher organizational levels in order to supplement services and direct programming (Royse & Drude, 1982 ). Different tools have good potential to evaluate community mental health services through assessing if patients’ needs have been met. Therefore, this study also aims at answering the question of which tool(s) can be most appropriate regarding different goals.

Within this review, we identified three systematic approaches to needs assessment which encompass different tools. The first is the DISC (Developing Individual Services in the Community) Framework (Smith, 1998 ), which includes the CAN and the Avon Self-Assessment Measure. The second is the Cumulative Needs for Care Monitor (Drukker et al., 2010 ), developed in order to choose the best treatment for each person. This one also uses the CAN and other more clinical tools and outcome measures (such as quality of life). The third is the Colorado Client Assessment Record (Ellis et al., 1984 ), which includes different measures of social functioning, such as the Denver Community of Mental Health Questionnaire, the Community Adjustment Profile, the Fort Logan Evaluation Screen, the Personal Role Skills Scale and the Global Assessment Scale.

This study has several strengths. First, we searched for as many tools and articles as possible. Second, we followed the standard rules of systematic and scoping reviews to present the data in a structured and non-biased manner: we thus searched for information extensively; the search was transparent and reproducible; the data were presented in a structured way. Finally, the scoping review was carried out, since the goal was not to compare and assess the quality of the evidence in the studies, but rather to review of all potential tools that can be used within the process of assessing the needs. Third, this study considered different populations, from severe mental disorders to other mental health problems, including addiction, which produced a strong overview of different tools and versions of the same tool used in other contexts. Fourth, the use of such tools also has a different basis depending on the goals of the system, so it can reflect the organization of care for mental health in a given country. The fifth strength of this work is that in addition to the original 242 articles within the review, we have also included all original sources for development of each of the 29 recognized tools.

This study also has some limitations. First, as the keywords are not same for every study, some studies could have been left out and therefore some tools might have been unrecognized. Second, our needs assessment review focuses on all people with mental health problems, even though the group of those with severe mental illness differs from the group with less severe mental health disorders. Therefore, no conclusion can be made on which tool is better for use in different population groups or disease severities. Third, we only included tools that assess the needs of people with mental health problems, although other tools for the general population could also potentially be useful. Fourth, some tools were developed and validated in only one country, so transferability is questionable or requires additional validation.

Since this scoping review provides insight into the evidence about the existence of different tools for needs assessment, it would also be valuable to conduct additional research on the level of each tool to see if it has already been validated and culturally adapted. To the best of our knowledge, the CAN is the most frequently used tool, and has been translated and adapted into more than 33 different languages (Phelan et al., 1995 ). Some of the tools reviewed in this study use items similar to the CAN, such as the Needs Assessment Scale (de Weert-van Oene et al., 2009 ). Some tools use the same items with a few additional ones, such as the Montreal Assessment of Needs Questionnaire (Tremblay et al., 2014 ), which shows even greater use of the CAN. Thus, the concepts in this latter tool are widely applied.

There are different fields in which certain needs must be addressed to deal with the mental health of the general population or the needs of the population with mental health problems, with the latter being our main focus. This review aimed to develop a tool for needs assessment that can be applied clinically and for research purposes. It is also vital to see what kind of tools can be used to assess needs for the purpose of a formative evaluation process, and the possibility of service development following the identification of actual needs (Makivić et al., 2021 ). Therefore, this article is valuable for a variety of final users, as it can be used by service providers at the level of health or social care, researchers, policymakers and other relevant stakeholders.

Moreover, it is also necessary to assess needs in the field of communication, especially targeting anti-stigma and anti-discrimination campaigns, and to assess the needs of educational systems (Kragelj et al., 2022 ) for the representation of mental health topics (Makivić et al., 2022 ). The use of different tools for assessing needs not only gives us the possibility of identifying such needs, but also establishes the possibility of meeting those needs when these tools are used within bio-psycho-socially oriented primary care or interdisciplinary-oriented mental health care. The assessment of needs at the individual level is important for the effective development of person-centred care plans (Martin et al., 2009 ). Patient-centred psychiatric practice is also needed to increase patient empowerment, which can be done with the help of a needs assessment process.

The review of all the tools for assessing different needs for people with mental health problems presented in this work is new, and therefore fills an important gap in the scientific knowledge of the needs assessment process in the field of mental health.

Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Makivić, I., Kragelj, A. & Lasalvia, A. Quantitative needs assessment tools for people with mental health problems: a systematic scoping review. Curr Psychol (2024). https://doi.org/10.1007/s12144-024-05817-9

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A scoping review of community health needs and assets assessment: concepts, rationale, tools and uses

• Hamid Ravaghi 1 ,
• Ann-Lise Guisset 2 ,
• Samar Elfeky 3 ,
• Naima Nasir 4 ,
• Sedigheh Khani 5 ,
• Elham Ahmadnezhad 6 &
• Zhaleh Abdi 7  

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Community health needs and assets assessment is a means of identifying and describing community health needs and resources, serving as a mechanism to gain the necessary information to make informed choices about community health. The current review of the literature was performed in order to shed more light on concepts, rationale, tools and uses of community health needs and assets assessment.

We conducted a scoping review of the literature published in English using PubMed, Embase, Scopus, Web of Science, PDQ evidence, NIH database, Cochrane library, CDC library, Trip, and Global Health Library databases until March 2021.

A total of 169 articles including both empirical papers and theoretical and conceptual work were ultimately retained for analysis. Relevant concepts were examined guided by a conceptual framework. The empirical papers were dominantly conducted in the  United States. Qualitative, quantitative and mixed-method approaches were used to collect data on community health needs and assets, with an increasing trend of using mixed-method approaches. Almost half of the included empirical studies used participatory approaches to incorporate community inputs into the process.

Our findings highlight the need for having holistic approaches to assess community’s health needs focusing on physical, mental and social wellbeing, along with considering the broader systems factors and structural challenges to individual and population health. Furthermore, the findings emphasize assessing community health assets as an integral component of the process, beginning foremost with community capabilities and knowledge. There has been a trend toward using mixed-methods approaches to conduct the assessment in recent years that led to the inclusion of the voices of all community members, particularly vulnerable and disadvantaged groups. A notable gap in the existing literature is the lack of long-term or longitudinal–assessment of the community health needs assessment impacts.

Peer Review reports

The population-based health approach aims to improve the population’s health, promote community resilience and reduce health inequities across the socioeconomic gradient via inter-sectoral partnerships among community groups, government, healthcare systems, and other stakeholders [ 1 ]. One key feature for adopting a population-based health approach is to ensure that it is grounded on a solid understanding of community health needs and assets by triangulating evidence from service providers and community members on services availability, accessibility, utilization and experience [ 2 , 3 ]. The process of identification of unmet health needs in a population is crucial for local authorities seeking to plan appropriate and effective programmes to meet these needs [ 3 , 4 ]. If these needs are ignored, then there is a risk of a top-down approach for providing health services, reflecting what a few people perceive to be the needs of the population rather than what they actually are [ 4 , 5 ].

In this context, community health needs assessment is a means of developing a comprehensive understanding of a community’s health and health needs as well as designing interventions to improve community health [ 6 ]. Though the process of community health needs assessment can be conducted in several ways, the primary purpose is to provide community leaders or healthcare providers with an overview of local policy, systems, and environmental change strategies currently in place and help to identify areas for improvement [ 7 ]. Community health needs assessment can provide them with a more nuanced understanding of the communities they serve, making them aware of pressing issues that require system-level changes and support their efforts for resource mobilization to initiate innovative programmes [ 8 , 9 ]. The process to gather evidence on community health needs can also serve as a springboard to strengthen community engagement [ 10 ].

In general, needs assessments are usually designed to evaluate gaps between current situations and desired outcomes, along with possible solutions to address the gaps. Recently, there has been a trend to move away from framing a community with a deficit perspective (need-based approach) to focus on community assets and resources, called community health needs and assets assessment [ 11 , 12 ]. In contrast to a need-based perspective which focuses on local deficits and resources outside the community, an asset-based perspective focuses on honing and leveraging existing strengths within the community to address community needs [ 12 , 13 , 14 ].

Studies have shown that community health needs assessment is used widely by different users and across different settings [ 15 , 16 ]. However, these studies varied widely in terms of purpose, process and methods of conducting community health needs assessment. Furthermore, the extent to which an asset-based approach is used is unclear, beyond the inclusion in guidance and recommendations. Thus, to support national or local decision-makers to make informed choices about the scope, tools, methods and use of community health needs and assets assessment, this scoping review of the literature aimed at: 1) Providing conceptual clarity on community health needs and assets assessment, 2) Determining for what purpose and with what methods community health needs and assets assessment are used globally, 3) Drawing the lessons learnt from previous experience with community health needs and assets assessment: what works in what context and under what conditions, 4) Documenting evidence of impact of community health needs and assets assessment, 5) Consolidating tools and methods used to collect evidence/data underpinning community health needs and assets assessment processes.

Search strategy

Ten databases, including PubMed, Embase, Scopus, Web of Science, PDQ evidence, NIH database, Cochrane library, CDC library, Trip, and Global Health Library were searched in February and March 2021. The search strategy was developed through discussion with experts in the field of population health, a research librarian, and a narrative review of the literature. Preliminary search terms were developed by the research team to reflect a number of core concepts including needs, population, needs assessment, assets assessment and participation. The search process was performed by a librarian with expertise in the use of literature databases (SK). The search terms were pilot-tested and agreed upon within the research team. The PubMed database search strategy presented in Additional file  1 .

Inclusion and exclusion criteria

Studies that focus on community health needs and assets assessment in terms of concepts, rationale, uses and tools were considered in both high-income countries (HICs) and low-and middle-income counties (LIMCs). We included studies in the review if they met the following criteria: 1) Papers providing conceptual clarity and explaining rationale for community health needs and (assets) assessment (This can be articles describing community health needs assessment or community assets assessment or community health needs and assets assessments at the same time or separately). The terms capabilities/ strengths/ resources can be used in place of assets and were considered.); 2) Papers describing or evaluating experiences implementing community health needs (and assets) assessment in a single site or multiple sites; 3) Methodological papers describing tools/approaches for community health needs (and assets) assessment; 4) Review of the literature on community health needs (and assets) assessment.

Types of papers not include in the review were: 1) Studies without a clear description of the community health needs and (assets) assessment methods, 2) Studies assessed a single dimension (i.e. health outcomes only, or healthcare providers’ capabilities only such as patient surveys, health outcomes dashboard, health facility assessment), 3) Studies related to a single disease or programme, 4) Studies focused only on engaging individual patient in their own care, and 5) Studies were not in English.

Three reviewers participated in the selection of the relevant studies (HR, ZA, NN). The eligibility and relevance of the articles were determined by two reviewers independently using the above predefined criteria. In the event of disagreement, a consensus was found between all the reviewers about the status of the article.

Data extraction

Separate data extraction forms were developed for the extraction of the three main categories of papers: conceptual, empirical and review papers. Totally, 121 empirical papers (including 6 review papers) and 48 conceptual and methodological papers were reviewed. Following topics were extracted for empirical papers: 1) General characteristics including author(s), year of publication, country of implementation, study objective(s) and study method; 2) Community health needs and (assets) assessment framing including rational, definitions of community health needs and (assets) assessment/ needs/ assets/ community, initiator(s) or user(s) of the process; 3) Key steps of the process, collected data, data collection tools; 4) Community engagement and the level of engagement; 5) Use of community health needs and (assets) assessment findings, impact of community health needs and (assets) assessment; 6) Facilitators and barriers. Data extraction forms are presented in Additional file  2 .

Data extraction forms were pilot-tested prior to the implementation. Two authors (ZA, HR) independently performed a pilot data extraction of a random sample of ten original articles. After piloting, the authors assessed the extracted data in relation to the scoping review questions and revised them accordingly. The content of the form was finalized by discussion within the team. Regarding conceptual papers, two authors (NN and ZA) initially extracted data from three randomly selected papers and subsequently refined and amended the form having research team inputs.

Four reviewers extracted included studies independently. The data extracted were cross-checked by one of the authors and mutual consensus resolved discrepancies. Individual data extraction forms of empirical papers were then merged into a single, unifying document used for the interpretation and presentation of the results. Following typical scoping review methods, the methodological quality of the included articles was not assessed systematically, however, only peer-reviewed articles were included in our review process [ 17 ].

Synthesis of results

Following reading and extracting conceptual papers, a preliminary conceptual framework (Fig.  1 ) was developed and discussed and agreed upon by team members. The integrative synthesis of the evidence was employed. Specifically, it involved the narrative description of concepts and definitions, key steps of the community health needs assessment and barriers and facilitators of the implementing community health needs assessment.

Conceptual framework of the review

The study selection process is summarized in Fig.  2 . Just over 12,000 records were obtained from the ten databases searched. Articles with obviously irrelevant titles were excluded, as were news items, letters, editorials, book reviews, and articles appearing in newsletters or magazines rather than peer review journals. The remaining abstracts were retrieved, read and assessed. A total of 169 articles including both empirical papers and theoretical and conceptual work were ultimately retained for analysis. A list of all studies with a short description, including the year of publication, key focus, study period, and methods, is presented in Additional files  3 and 4 . The first part of the results section focuses on definitions and concepts of community health needs assessment using both conceptual and empirical papers. In the second part of the results section, we describe key steps of the community health needs assessment and tools and methods used to collect data through content analysis of 121 included empirical papers. We also report some important challenges and facilitators faced by included studies while performing community health needs assessment. Role of community participation in the process and the spectrum and types of the participation is discussed in the last part.

Information flow in scoping review

General characteristics of the included studies

The review showed that community health needs assessment is used widely by different users and across different settings in both HICs and LMICs. Among included empirical studies, 81 (out of 121) were conducted in the  United States (US). There were papers from Australia ( n  = 4), South Africa ( n  = 3), Kenya ( n  = 3), Uinted Kingdom (UK) ( n  = 2), Canada ( n  = 2), China ( n  = 2), Dominican Republic ( n  = 2), Republic of Ireland ( n  = 2), Iran ( n  = 2), India (2), Honduras ( n  = 1), Netherland ( n  = 1), Vietnam ( n  = 1), Sudan ( n  = 1), New Zealand ( n  = 1), Madagascar ( n  = 1), Malaysia ( n  = 1), Ecuador ( n  = 1), Indonesia ( n  = 1), Uganda ( n  = 1), Taiwan ( n  = 1), Kyrgyzstan ( n  = 1), Saudi Arabia ( n  = 1), Haiti ( n  = 1), Honduras ( n  = 1) and Korea ( n  = 1).

Definition of needs

The review showed “need” was a multi-faceted concept with no universal definition. There was a differentiation between “health need” and “healthcare need” in the reviewed literature. Healthcare needs can benefit from health care (health education, disease prevention, diagnosis, treatment, rehabilitation and terminal care). Healthcare providers usually consider needs in terms of healthcare services that they can supply. However, health needs incorporate the wider social and environmental determinants of health, such as deprivation, housing, diet, education and employment. This broader definition allows looking beyond the confines of the medical model based on health services, to the wider influences on health [ 3 ].

In this review, relatively few empirical studies focus narrowly on healthcare needs, without attention to other determinants of health that can affect health [ 18 , 19 , 20 , 21 , 22 , 23 ]. Most of the included empirical studies looked beyond “physical health needs” to consider wider “social determinants of health” or non-medical factors that can affect a person’s overall health and health outcomes as the conditions—shaped by political, social, and economic forces—in which people are born, grow, live, work, and age [ 24 ]. Notably, the need was recognised as a “dynamic concept” whose definition will vary with time according to context and resources available to address these needs [ 16 ].

Definition of community

In general, “community” has been defined as “people with a basis of common interests and network of personal interactions grouped either based on locality or on a specific shared concerns or both” [ 25 ]. Shared common interests are particularly important as they can be assessed and, hopefully, met at a community level [ 26 ]. Importantly, community is a dynamic concept as individuals can belong to several communities at various times. In our review, community was defined by included studies, particularly those initiated by local authorities or healthcare providers (e.g., hospitals), based on geographical indicators such as county designations or based on the location of the hospital’s/facility’s/authority’s existing or potential service users. Some included empirical studies considered community based on shared interests or characteristics such as race/ethnicity, sexual orientation, or occupation. Medically underserved populations including rural areas [ 27 , 28 , 29 , 30 ], impoverished urban sectors [ 31 ], the homeless [ 32 , 33 , 34 , 35 ], persons in poverty or of low socioeconomic status, vulnerable children and families [ 18 , 28 , 36 , 37 , 38 ], the elderly [ 8 , 39 , 40 , 41 , 42 ], women and girls [ 43 , 44 , 45 , 46 , 47 ], LGBT (Lesbian, gay, bisexual, and transgender) individuals [ 48 , 49 , 50 , 51 ], displaced populations, immigrants and racial, ethnic and religious minority groups [ 12 , 19 , 36 , 42 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 ] and persons with severe and chronic health problems [ 79 ] were considered as a “community” by a number of included studies.

While defining community, a number of its characteristics were determined by included studies including: history, existing groups, physical aspects (i.e. geographic location, community size, its topography and etc.), infrastructure (i.e. health and social care facilities, public transportation, roads, bridges, electricity, mobile telephone services and etc.), demographics (i.e. age, gender, race and ethnicity, marital status, education, number of people in household, first language and etc.), economic conditions, deprivation and/or inequalities, government/politics, community leaders (formal and informal), community culture (formal and informal), existing institutions, crime and community safety, lifestyle and leisure, general health problems and epidemiology.

In our review, community health needs and assets assessment were performed by different organizations as the first step in community health promotion planning, including local health authorities (district/local), community entities [i.e. non-governmental organizations (NGOs), civil society organizations (CSOs), faith-based organizations (FBOs), community-based organizations (CBOs)] and hospitals (public/private). Included studies mostly conducted health needs assessment at the local level (e.g. cities, counties, or other municipalities). The broader understanding of health and its determinants suggests that many public and private entities have a stake in or can affect the community’s health. To engage stakeholders in the process, a number of included empirical studies ( n  = 56, 49%) sought representatives from the community that were best positioned to speak about community health based on their specific knowledge or line of work. These stakeholders were individuals from community and entities who may explicitly be concerned with health or not, which varied by the community context and culture. To have a comprehensive overview of a community needs, it was asserted that defining communities needs to be dynamic and socially constructed to take into account all voices and members, especially those not ordinarily included [ 80 ]. Community should be defined in a manner that does not exclude medically underserved, low-income, or minority populations. Integrating community voices is especially important in designing plans and programmes aimed at reducing health disparities in the community [ 58 , 81 , 82 ].

Definition of assets

Overall, there were limited definitions for “community assets” in the reviewed literature. Assets were described as resources, places, businesses, organizations, and people that can be mobilized to improve the community [ 11 , 83 ]. This includes members of the community themselves and their capabilities. Assets can therefore be described as the collective resources which individuals and communities have at their disposal, which protect against adverse health outcomes and promote health status [ 83 , 84 ].

Of 115 included empirical studies, 30 studies addressed community assets while performing community health needs assessment. A wide range of assets, from tangible resources to intangible ones, were considered that can be classified into seven broad categories as follows:

Community demographic characteristics: Literacy rates [ 13 ], youth population [ 58 , 68 ], and elderly population [ 68 ];

Natural capitals: Geographical location and natural resources [ 21 , 81 , 85 ];

Economic and financial capitals: Community business [ 12 , 81 ] community members’ income [ 21 ], and housing land ownership [ 13 ];

Community infrastructure: Level of technology/mobile phone coverage [ 13 , 21 ], transportation [ 86 ], parks and sidewalks [ 12 ], sport and recreational facilities [ 31 , 87 , 88 ], public libraries and community centres [ 88 ];

Community social and educational facilities: Non-profit and non-governmental organizations [ 59 , 87 ], media [ 89 ], educational institutions [ 12 , 31 , 81 , 90 ], faith communities [ 58 , 81 , 90 ], and community associations [ 31 ];

Community health and social facilities: Health and social facilities and providers [ 72 , 81 , 85 , 86 , 89 ], traditional medicine providers [ 72 ], and ongoing health programmes [ 13 , 87 ];

Community’s social and cultural values and resources: Tribal and community culture [ 58 , 68 , 74 , 91 ], cultural diversity [ 81 ], spirituality and religion [ 58 , 74 ], strong family bonds and values [ 59 , 74 ], strong community connections, teamwork and willingness to volunteer [ 21 , 81 , 86 , 91 ], mutual support, social support and networks [ 45 , 58 , 81 , 85 ], unity, community cohesion and collectivity [ 21 , 59 , 74 ], community capacity [ 58 ], community-led activities [ 86 , 91 ], and community values and traditions [ 68 , 74 , 86 ], resiliency [ 58 ], unifying power of communities [ 13 ], community administration units e.g. women’s committees [ 13 ], an existing group of dedicated healthcare providers [ 39 ], a group of concerned citizens [ 39 ], community safety [ 12 ], the knowledge base of the community members themselves [ 39 ] and members’ desire to be healthy [ 58 ].

Various qualitative methods such as individual interviews (one-on-one structured conversations) or focus groups (guided, structured, small group discussions) with community members, or key informants’ interviews (formal and informal conversations with leaders and stakeholder groups) or a combination of these methods were reported as the main methods to collect information on community’s assets among reviewed studies. Of these, focus group was the widely used method in community assets assessment [ 8 , 21 , 31 , 45 , 58 , 59 , 67 , 81 , 82 , 85 , 87 , 90 , 92 , 93 ].

Definition of community health needs (and assets) assessment

The terms “Community Needs Assessment (CNA)”, “Community Health Needs Assessment (CHNA)”, and “Community Health Needs and Assets Assessment (CHNAA)” were used interchangeably in the literature referring to the process of identifying health needs (and assets) of a given community. Since this review focuses on both community needs and assets, we will use the CHNAA term for the description of the process in this paper.

None of the papers reviewed provided a specific definition for CHNAA. In general, reviewed papers defined CHNAA as: A collaborative, community-engaged, systematic, ongoing, continuous, proactive, comprehensive, cyclical, regular, modifying method or process [ 28 , 33 , 69 , 92 , 94 , 95 , 96 , 97 , 98 ]; For the identification, collection, assembly, analysis, distribution, and dissemination of information on key health needs, social needs, concerns, problems, gaps, issues, factors, capabilities, strengths, assets, resources; About communities (or individuals) [ 21 , 23 , 28 , 31 , 33 , 37 , 41 , 45 , 54 , 79 , 89 , 94 , 95 , 96 , 97 , 99 , 100 , 101 , 102 ]; To achieve agreed priorities, create a shared vision, plan actions, garner resources, engage stakeholders, work collaboratively, establish relationships, implement culturally appropriate, multi-sectoral/multilevel intervention strategies, empower residents and enhance community capacity and participation in decision-making process [ 12 , 13 , 20 , 27 , 28 , 37 , 45 , 70 , 79 , 89 , 91 , 92 , 94 , 95 , 97 , 98 , 99 , 101 , 102 , 103 , 104 ]; Towards improving health and wellbeing, building and transforming health of the communities, increasing community benefits, reducing inequalities; Through which primary/secondary healthcare can respond to local and national priorities [ 20 , 23 , 28 , 40 , 51 , 59 , 69 , 97 , 103 , 105 , 106 ].

The included studies listed a number of reasons as the rationale for conducting CHNAA. Legislative requirements were most cited as the main rational for conducting CHNAA, particularly among studies conducted in the UK and US. Since the late 1980s, the concept of health needs assessment has gained increasing prominence within the National Health Service (NHS) in the UK. This has been prompted by a series of policy initiatives requiring health facilities to assess needs of their populations and to use these assessments to set priorities to improve the health of their local population [ 107 , 108 ]. In the US, several national, federal, state, and local funding sources require entities to conduct CHNAA to demonstrate a significant need for their services and programmes to be funded. The most important one is Patient Protection and Affordable Care Act (ACA-2010), requiring non-profit hospitals as tax-exempt entities to perform CHNAAs to maintain non-profit status regularly [ 92 ]. Other reasons were mentioned by included studies as the rationales for conducting CHNAA were: lack of information of health needs of a specific community, to facilitate health research and related interventions in a community, to inform the design of contextually relevant programmes and policies, to develop community health improvement plans or health promotion interventions, to develop or update strategic plans, and to receive resources and funds.

Key steps to conduct CHNAA

The number and nature of CHNAA process steps varied among reviewed studies. However, broadly CHNAAs involved six main steps as follow:

Formulation of a leadership team

Forming a leadership team, which was called by different names such as the steering committee/ the research advisory committee (RAC)/ the collaborative task force/ or the community advisory board (CAB), was known as the preliminary step of a CHNAA process. The steering committee was usually composed of local representatives from local agencies and organizations (e.g. non-profit organizations, community service agencies, media outlets, county and municipal governments, colleges and universities, faith-based organizations, and healthcare providers), community members, community stakeholders and leaders, academic partners, health and social officials, and representatives from the investigator body to help guide the development of the CHNAA project.

Leadership team responsibilities were reported as providing inputs on the research purpose, selecting and verifying study methodology and design, providing inputs and feedback on initial survey/topic content and selecting final survey/ topic guide questions, reviewing survey/topic guide length, and ensuring culturally relevant and resonant wording, comprehension and face validity, and monitoring the progress of the data collection. Feedback and recommendations from the steering committee were incorporated throughout the CHNAA process as well. Steering committees usually met on a regular basis.

Identification of needs, assets and prioritisation

To collect information on community health, needs and assets, both primary and secondary data were utilized by included studies. Secondary data included information on community socio-demographic and indicators on health status, access, utilization and satisfaction with health and social services at different levels (e.g. community, sub-national and national) to develop a picture of the overall community health. Primary data were collected through quantitative and qualitative methods and mixed-methods approaches.

Quantitative studies 

Some empirical studies used individual/household surveys as the only source to identify community needs and concerns ( n  = 28, 24.%). Surveys were a popular method of gathering opinions, preferences and perceptions of needs. Needs assessment surveys typically have written, closed-ended questions filled through the interview (face to face/telephone) or self-completion (paper or online) by community members. Generally, two main kinds of surveys were used by included studies: a) community health assessment survey, and b) community concerns survey. A number of included studies used health assessment surveys as the key data sources of the CHNAA process ( n  = 22, 19%) or along with other types of data, mainly qualitative data ( n  = 21, 18.%). Health assessment surveys typically collected information on demographics, socio-economic variables, respondents’ health status, choice of healthcare providers, and healthcare access issues among community members. Survey questionnaires were mostly developed with inputs from the literature review (similar health assessment surveys conducted at the local or national level), community members and project team discussions. Additional file  5 shows the most important data and indicators collected by included studies through conducting community health  assessment surveys.

Another form of surveys, used alone or in combination with qualitative methods ( n  = 15, 13.5%), was the community concerns survey in which people (community members and/or key informants) are asked to help identify what they see as the most important issues facing their community leading to an inventory of their health priorities [ 12 , 20 , 23 , 27 , 29 , 55 , 69 , 74 , 101 , 103 , 109 , 110 , 111 , 112 , 113 ]. A straightforward way to estimate the needs of a community was to simply ask residents their opinion on what particular services are most needed in the community. The focus of this methodology was to create an agenda based on the perceived needs and concerns of community residents. The concerns surveys were based on either focus group discussion with community members and experts or literature review by the researchers or both. Generally, while filling community concerns survey, individuals were asked to rate the importance of each issue in their community on a scale (e.g. 0 = not important, 5 = extremely important) [ 23 , 27 , 29 , 55 , 74 , 110 ]. Participants could also add and rate concerns or service needs that were not listed. Finally, each health problem identified by the community was weighted based on the frequency it was selected on the survey.

General coverage of the surveys was the population aged 18 or over currently residing in the community for a minimum period of time (at least a few months) and able to provide consent for participation. Most surveys were written, closed-ended questions filled through face to face or telephone interviews or self-completion by community members. In addition to the paper-form survey, some studies used email and social media platforms to allow residents to anonymously complete online surveys [ 29 , 51 , 57 , 96 , 103 , 110 , 114 ]. A few studies reported that residents received monetary or nonmonetary incentives for their participation upon survey completion [ 19 , 71 , 74 , 77 , 110 ]. Sampling techniques commonly used are those that promote participation in CHNAAs such as convenience sampling [ 20 , 35 , 40 , 51 , 52 , 57 , 64 , 65 , 71 , 74 , 75 , 77 , 86 , 96 , 101 , 103 , 104 , 110 , 114 , 115 ]. Only a few studies used random sampling or demonstrated the representativeness of their samples. Their response rates varied between 8 to 95.5%. Most surveys recruited local surveyors and provided them with research training to ensure consistent survey administration to attract community participation. Some studies that assessed health needs among immigrant communities or minority groups recruited bilingual surveyors or/and provided participants with two versions of the instruments, one in the native language to maximize community engagement [ 12 , 27 , 52 , 65 , 71 , 86 , 103 ]. Surveys that took a participatory approach to the design, content, terminology, and language level, were reported more understandable and culturally relevant to the community members [ 52 , 65 , 75 ].

Health needs assessment surveys (both concerns surveys and health assessment surveys) reported limitations to data collection based on the assessment timing, data availability, and sample response. As said earlier, using a convenience sampling and non-representative samples, small sample size and inter-rater reliability between surveyors were among some important methodological limitations reported by these studies, which limited the generalisability of the study findings to the entire community population [ 35 , 57 , 65 , 71 , 74 , 75 , 77 , 96 , 106 , 116 ]. Convenience sampling method and using community events as sampling sites led to sampling bias in some studies (e.g., an over-representation of some specific groups of the population such as women and low –income or high-income groups) [ 57 , 63 , 65 , 66 , 71 , 74 , 75 , 78 , 103 , 114 , 115 ].

Qualitative studies

Among included studies, about 34% ( n  = 39) used qualitative methods as the main source of data collection on community needs and assets. Some of these studies justified the use of qualitative approach by explaining how the overreliance on quantitative, population-level data resulted in CHNAAs failing to identify health needs and interests of all community members, particularly those of vulnerable population and underrepresented marginalized segments of the community. In addition, these studies concluded that integrating qualitative methods into the CHNAA process has the potential to involve community members in a more participatory fashion, perhaps improving future collaborations between communities and service providers. Such collaborations can help to design focused initiatives, making them more meaningful and culturally appropriate [ 12 , 59 , 91 , 102 ].

Key informant interviews, individual interviews with community members, focus groups with community members and community forums were among the qualitative data collection techniques used individually or in combination with each other by these studies to collect data on community needs and assets. They asserted that qualitative techniques specifically targeted to underrepresented segments of the population proved to be effective mechanisms to explore the participants’ perceptions on issues surrounding community health needs and assets. The most used technique to elicit community members’ opinions were focus group discussions and key informant interviews.

Small sample size and single-site setting were mentioned as the most cited limitations of  the qualitative CHNAAs that limit these studies generalisability. Because the studied communities were unique communities with unique assets, constraints, and health needs, the CHNAA findings cannot be generalised to other communities [ 32 , 39 , 62 , 70 , 72 , 73 , 91 , 117 , 118 ]. Another limitation mentioned by some studies was that the demographic composition of the focus group participants, specifically with regards to race, gender, socio-economic status and age group, did not fully reflect the population of studied community as a whole [ 13 , 61 , 62 , 72 , 97 , 119 ]. Some studies reported that they could not include all influencing key informants in the community to facilitate broader understandings of health needs [ 13 , 120 ].

Mixed- methods studies

A variety of data collection methods were used in a number of included studies to ensure that a comprehensive picture of community health needs and resources was obtained ( n  = 48, 42%). Some of these studies were two-phase explanatory mixed-methods studies, with the quantitative phase preceding the qualitative phase ( n  = 14, 12%). They conducted targeted focus groups or community listening sessions or interview with community members/key informants following needs assessment survey to supplement the findings from the survey and provide further information about health status, needs of daily living, barrier to health and access to community resources [ 8 , 21 , 41 , 53 , 55 , 66 , 67 , 93 , 94 , 95 , 99 , 113 , 114 , 121 ]. In addition to these studies, some studies used triangulation mixed-method design to obtain complementary qualitative and quantitative data on community health needs and issues ( n  = 13, 11%). These studies confirmed that using multiple data sources ensured researchers obtain a complete picture of the community health needs. Applying qualitative methods in the form of focus groups and semi-structured interviews enabled exploration of problems and needs within their social context and provided a wider perspective on issues raised. However, to conduct such studies CHNAA teams had to have members who have qualitative and quantitative expertise. There were some limitations specific to the mixed-method studies, including lack of rigor in integrating qualitative and quantitative findings, relying heavily on quantitative data for health need determination, and absence of the voices of the communities most in need [ 69 , 91 ].

Data analysis and interpretation

Qualitative data from focus group discussions and key informant interviews were mainly audio-recorded and transcribed verbatim by the research team and all identifying information was removed. Different analytical approaches, mostly content analysis and thematic analysis, were used to identify main themes related to assets, needs and gaps in the service system and priority populations.

Quantitative data from surveys were analysed using statistical software. Descriptive statistics were used to describe the sample in terms of socioeconomic background and present the prevalence of chronic diseases, risk factors, and health behaviours. Statistical analytical tests were also used to compare results between different groups of community members. Results also were compared by those at the state/ national level or from a similar community. Those diseases or risk factors that had a high prevalence among community members are regarded as priorities that to be addressed further.

Formulation of recommendations across various levels (individual, institution, community, policy levels)

Following analysis of the quantitative and qualitative data, the studies included in the review provided a thorough list of health needs and assets of the community. Included studies mainly used CHNAA outputs: 1) as a resource to provide baseline data of community’s health; 2) as a resource to prioritize and plan services; 3) as a resource for writing grant applications; 4) as a resource to guide a comprehensive health promotion strategy.

Not all included CHNAAs proposed interventions to address identified needs and issues. Some of the included studies ( n  = 45, 39%) just provided a snapshot of the most important issues faced by the studied community. They demonstrated several areas where CHNAAs provide more information to researchers, community organizations, and policy-makers. On the other hand, not all identified issues and needs were addressed by those studies performed CHNAA in order to implement interventions or strategies. In practice, specific populations or a number of specific health conditions or health risks, or overarching issues such as health inequality and disparities were prioritized by these studies.

In most cases, decisions on implementation were carried out by the CHNAA steering committees or the research teams. Only a number of studies used a clear and explicit set of criteria for deciding the importance of each issue [ 22 , 27 , 43 , 67 , 94 , 118 , 122 ]. A wide range of criteria were used by included studies such as: impact, urgency, community concern, achievability within the set time [ 94 ], seriousness, urgency, solvability, and financial burden of the problems [ 27 ], perception of survey participants on importance of the identified issues and feasibility of intervention, prevalence, fatality, social and cultural stigma [ 22 ], possible interventions, organizational capacity, and community assets and resources [ 13 ], importance and possibility of the effecting change [ 43 ], prevalence, impact on the duration of sickness, impact on mortality, and the availability of treatment [ 122 ], impact of the problem on the overall wellness, quality of life, and resources of their community [ 118 ], factors of health issue, size, seriousness, and effectiveness of available interventions [ 101 ], importance and feasibility [ 67 ].

Different techniques for ranking priorities were applied by included studies such as: 1) Multi-voting technique (decide on priorities by agreeing or disagreeing in group discussions and continuing process/rounds until a final list is developed), 2) Strategy lists (determine if the health needs are of “high or low importance” by placing emphasis on problems whose solutions have maximum impact, with the possibility of limited resource), 3) Nominal group technique (rate health problems from 1 to 10 through group discussion), and 4) Prioritization matrix (weigh and rank multiple criteria for prioritization with numeric values to determine health needs with high importance).

Overall, health priority types were categorized into four main categories by included studies:

Medical conditions (e.g. obesity, diabetes, heart diseases, asthma, mental health disorders, substance abuse, vision/ dental problems, HIV/AIDS and sexually transmitted diseases, injuries and health consultations).

Health behaviours (e.g. physical activity, eating habits/ nutrition, tobacco consumption, teen pregnancy and violence/gangs).

Community conditions (e.g. poverty and unemployment, environmental and infrastructural conditions, such as air quality/pollution, transportation, access to clean water and sanitation, community collaboration, and access to healthy food, exercise facilities and occupational concerns).

Health systems priorities (e.g. access to care, including primary care and higher levels of care, specialty care, mental/ behavioural health care and dental care, quality and acceptability of health services, lack of cultural competence in health systems, flexible hours and waiting time).

However, guided by a community-based participatory research (CBPR) approach, a number of studies involved community members and stakeholders in priority identification or ranking [ 12 , 21 , 22 , 23 , 27 , 29 , 31 , 36 , 41 , 43 , 49 , 53 , 55 , 56 , 58 , 59 , 60 , 62 , 63 , 68 , 70 , 74 , 86 , 87 , 88 , 90 , 92 , 99 , 100 , 103 , 104 , 110 , 114 , 117 , 118 , 119 , 121 , 122 , 123 , 124 , 125 , 126 , 127 , 128 , 129 ], in potential strategy selection [ 13 , 19 , 67 , 82 , 89 , 130 ], and in carrying out strategies [ 8 , 37 , 69 , 81 , 93 , 105 , 113 ]. They asserted that by involving the perspectives of the relevant stakeholders, a comprehensive overview of the issues and possible effective solutions was created.

Planning of programmes and interventions, implementation and evaluation

The results of CHNAA were used in various ways by included studies. In some studies, particularly researcher-led studies with limited support or involvement of the local authorities, CHNAA just led to the identification of new, locally relevant issues and priorities without any further actions ( n  = 45, 39%). The results of these CHNAAs provided more information to researchers, community organizations, and local policy-makers. Their results also may guide further research agenda in the community [ 18 , 21 , 23 , 29 , 35 , 39 , 40 , 42 , 44 , 48 , 49 , 50 , 52 , 54 , 55 , 62 , 64 , 65 , 66 , 69 , 70 , 71 , 72 , 73 , 76 , 77 , 78 , 85 , 96 , 106 , 122 , 123 , 131 , 132 , 133 , 134 , 135 ]. Some of these studies tried to present their results to the local authorities through various channels in the hope that it would modify existing programmes or implement new ones to meet the needs of the community residents. In addition to identification of relevant issues and priorities, included studies listed at least one outcome associated with the reported CHNAA activity as follows:

Development or modification of health and social policy and programmes: The knowledge provided by CHNAAs helped develop better tailored, and thereby potentially more effective interventions by a number of studies. Further, the information gathered from the CHNAA process was used as the baseline against which to measure future targets for assessment efforts and progress in areas were targeted ( n  = 36).

Formation of new partnership: In some cases, a new partnership among entities involved in CHNAA was formed to address health issues. One of the partnerships reported successful was the community–academic partnership in which communities used the research capacity of academic institutions to conduct the CHNAAs ( n  = 20). Another type of the partnership reported by some studies was the collaboration among healthcare organizations serving the same geographic area to conduct CHNAA jointly. Conducting a joint CHNAA may avoid duplication of planning efforts and obviate the creation of multiple community health needs assessments for the same population ( n  = 5).

Development of new recommendations: Several suggestions were proposed to be considered while designing health improvement interventions in the future by some of the included studies ( n  = 18).

Setting or altering strategic direction: Strategic agency direction was established or altered in some cases, which might indicate that the CHNAA was used to redirect resources better to meet the needs of the community ( n  = 4).

Raising awareness about health issues: One of the most important insights brought by CHNAA findings was the recognition of the health priorities and contributing factors by the community members, leaders and researchers, leading to an increased awareness of community issues among them ( n  = 8).

Engaging and motivating policy-makers and stakeholders: A few studies reported that CHNAAs provided health organizations with the opportunity to identify and interact with key policy-makers, community leaders, and key stakeholders about health priorities and concerns, which might foster a sense of collective ownership and trust in the results and increase the likelihood that the CHNAA will be used ( n  = 5).

Having an impact on obtaining resources and resource allocation: The CHNAAs provided the community partners with locally relevant information regarding the current status of health and perceived community needs to inform resource allocation and applications for new grants for the initiation of new programmes ( n  = 14)

Contribution to the development of CHNAA process: Some studies reported that the specific methods used in their CHNAA processes could contribute to more relevant and effective community health need assessment process ( n  = 10).

Dissemination of findings

Disseminating of the findings and knowledge gained to all partners involved was a foremost step of CHNAAs. The most cited product of the CHNAA process in the included studies was the community needs assessment report. This report includes information about the health of the community as well as the community’s capacity to improve the lives of residents. The report provides the basis for discussion and future actions. In addition to the final report, other channels to disseminate CHNAAs findings were reported as: publishing CHNAA main results in local newspapers, communicating research results with community members and stakeholders in public forums or meetings, presentation results to the steering committee and various stakeholders, posting the report on the local authorities websites, individual meetings with community leaders and stakeholders, posters, and presentation of findings in academic conferences.

Community participation

Among included studies, around 50 studies (44%) reported using participatory approaches and techniques to encourage community members' participation in CHNAA process. Unlike traditional approaches to health needs assessment, participatory approaches aimed to incorporate community inputs at all stages of the research process to enhance capacity building and overcome barriers to research raised by matters of trust, communication, cultural differences, power and representation. A variety of participatory approaches (e.g. community based participatory research (CBPR), participatory rural appraisal, participatory action research (PAR), rapid participatory appraisal (RPA), tribal participatory research, community-based collaborative action research (CBCAR), precede-proceed model, concept mapping and photovoice) were used by these studies to ensure that communities participate in CHNAA, from defining the community to identifying needs and assets and developing new interventions.

Pennel and colleagues classified the depth of the community participation in CHNAA activities into four main categories [ 136 ]. In this classification, depth of the community participation was assessed by the types of activities in which participants were involved throughout the assessment and planning process as follows:

No participation: No attempt to engage community stakeholders or members;

Consultation-only: Engagement of health-related stakeholders, broader community stakeholders, and/or community members to identify health needs through surveys, interviews, and/or focus groups; verified or validated health needs/priorities with local experts;

Moderate participation: Involvement of community stakeholders/ or community members in priority identification; involvement of community stakeholders in strategy selection;

Extensive participation: Involvement of community stakeholders/or community members to develop and carry out strategies.

The above classification was used to assess the depth of the community participation by included studies. Based on the content analysis, community participation in CHNAA process varied considerably across the included empirical studies, from minimal to in-depth participation (Table 1 ). Around 65% of the included studies were involved in consultation-only to identify health needs through one-way communication using tools such as surveys, interviews, and focus group to identify community needs and resources. Around 22% of the included studies solicited moderate participation from the community by involving community in verifying needs and final priority selection and only about 10% of the included studies reported a broad and deep community participation including community involvement in designing and implementing strategies to improve community health.

Three categories of challenges were cited by the reviewed studies while performing CHNAA projects.

Methodological challenges: These are mainly associated with quantitative and qualitative data collection methods, which were discussed earlier. Other methodological challenges cited were: difficulties in aggregating and making sense of data collected from various sources (triangulation), non-generalisability of site-specific data and limitations of the use of existing epidemiological data alone, which does not provide a comprehensive view of health needs, yet is often the most available source of information. Traditional approaches to data collection were challenging where language and literacy barriers existed [ 12 , 52 , 65 , 71 ]. Another major challenge reported by studies used community-based participatory research approaches was the challenge of involving the community in decisions related to research design and data collection methods while maintaining an appropriate level of methodological validity and reliability [ 56 , 81 , 121 ]. In addition, participation was not without challenges. Including the perspectives of stakeholders and residents can lead to differing accounts of what services are seen as essential, and each party may push their own agenda based on their personal or professional interests. Further, linguistic and cultural barriers may be a major factor among minority groups hindering participation in such endeavors [ 81 , 137 ].

Logistical challenges: The major logistical challenges reported were the need for a considerable amount of time (often inadequate), and resources required to conduct a comprehensive assessment [ 80 , 138 ]. Good quality local data on the needs and utilization of health services are usually difficult to obtain [ 9 ]. Financial costs are considerable and the depth of information obtained will ultimately depend upon the methods employed [ 139 , 140 ]. In addition, health professionals, managers and others involved in health services planning and delivery may not have the requisite skills to conduct CHNAAs. This goes beyond technical skills and places an emphasis on soft skills and flexibility including good listening skills, the ability to establish trusting relationships, empathy, working with diverse groups and reflexivity [ 140 , 141 ]. Moreover, limited health information infrastructure and systems in developing countries settings may have hindered the availability of good quality information to conduct CHNAAs [ 13 , 28 , 30 , 142 ].

Ethical challenges: Concerns were raised about the ethical issues associated with community consultation about felt needs followed by priority setting process that leaves many needs unaddressed and the bulk of expectations dashed. Labelling, stigma and stereo- typing are other problems raised by needs assessment [ 143 ]. Needs assessment results may not be utilised, leaving unmet expectations and may require extensive financial and political support to lead to changes in health service planning and delivery [ 9 ]. Comprehensive health needs assessment is likely to produce different, potentially conflicting needs, exposing hidden conflicts and tensions in communities without any mechanisms to address these issues [ 5 ]. Further, local participation may only allow those who are able to voice their needs to do so, leaving behind the silent or hidden voices [ 81 ]. Involvement of the community in the needs assessment process also impacts upon possible outcomes of the project especially since it is likely that expectations of changes to programmes and service delivery may have arisen from local participation [ 144 ].

Facilitators and enablers

CHNAA projects need to be organized in such a way that they have clear objectives, and are adequately resourced by experienced staff. In addition, factors such as clear objectives, decisive leadership, teamwork, communication, sound study design, adequate resourcing, skilled staff, sufficient time and ownership by stakeholders are among those factors that contribute to the successful implementation of CHNAAs [ 15 , 145 ]. Most studies cited community participation as a major facilitator of the CHNAA process and outcomes. Participation was shown to foster bidirectional learning and communications, where both health authorities and the community learnt about needs and priorities. Different benefits for community engagement were mentioned by reviewed literature including, improved participants’ recruitment, enhanced capacity among stakeholders, productive conflict resolution, increased quality of outputs and outcomes, increased sustainability of project goals beyond funding and timelines and development of linguistically and culturally appropriate measures. In addition, incorporating community voices has the potential to inform the development of sound measures to tackle health disparities in the basis of race, social class and ethnicity [ 12 , 27 , 30 , 91 , 103 , 110 , 126 , 146 ].

The main objective of our scoping review was to provide an overview of why and how community health needs and assets assessments (CHNAAs) have been used globally. Substantial variation was found among the studies reviewed concerning definitions, process, participants, methods, goals, and products, yet there were many common characteristics.

Some CHNAAs focused narrowly on health care in assessing needs, with scant attention to other community issues that can affect health. However, most of the included studies looked beyond health needs and considered social and environmental conditions influencing community health. We argue all CHNAAs should approach community health needs assessment holistically, focusing on both individual physical and mental wellbeing as well as casting a social determinants of health lens on the population health.

The review showed that community health needs assessment is used widely by different users and across different settings in both HICs and LMICs. However, in countries such as the US it has become institutionalized and has accordingly been developed, as service providers, particularly hospitals, are mandated to perform CHNAA to compliance with legislative mandates. However, though federal and state laws impose requirements on hospitals to conduct CHNAAs, the methods for needs assessments are generally left to the discretion of each hospital [ 147 ]. As a result, assessment methods vary widely. US-based CHNAAs either develop their own CHNAA processes or utilize a process developed at the state or national level to guide their efforts. A number of toolkits have been provided by different organizations across US to help healthcare providers to conduct CHNAA projects [ 6 , 148 , 149 ]. This highlights the need for consensus guidance across many countries and settings while maintaining the responsiveness to contextual needs, assets and priorities.

Both qualitative and quantitative approaches were employed to collect data on community health needs and assets. Overall, there has been a growing use of mixed-methods approaches to conduct CHNAA in recent years, owing to the recognition in the literature that using qualitative and quantitative approaches simultaneously can provide complementary insights determining community health needs and assets [ 69 , 91 , 104 ]. Although quantitative approaches yield concrete evidence of community needs and assets, qualitative approaches provide a context for how these issues can be addressed using available resources [ 91 , 102 ]. Using qualitative methods in conjunction with more traditional quantitative approaches is especially appropriate for studying complex public health issues and promotes the alignment of implementation plans with the local needs of community members [ 59 , 69 , 91 ]. The growing use of mixed-methods approaches has practical implications for research training and capacity building within entities performing CHNAAs. Organizations who wish to conduct CHNAAs will need to ensure that the competencies and expertise required for mixed-methods studies are available.

Although only a small number of studies provided definitions of assets, there is a growing interest in the literature in asset-based assessment, which examines and mobilizes community assets, instead of focusing on only the needs of communities [ 11 , 84 ]. Unlike need-based or deficit approaches, asset-based approaches document resources and focus on strengths to enhance and preserve rather than deficits to be remedied. Related to principles of empowerment, it postulates that solutions to community problems already exist within a community’s assets. By recognizing existing capacity, communities can become empowered to take ownership of their health and improve as a population [ 11 , 31 , 125 ]. An asset-based approach was recognized as essential for enhancing trust and community coalitions [ 83 ]. Further, it is more participatory in nature through involving community stakeholders throughout the needs assessment process [ 82 , 83 ]. In particular, it highlights community resilience, resources, and opportunities for positive growth rather than focusing solely on health problems or other concerns [ 14 , 84 , 88 ]. In developing countries, assets identified from within the community are crucial for later use in the implementation of health programmes. The shift from a traditional needs-based perspective to an asset-based perspective to health needs assessment can help to address resource constraints in these countries [ 13 , 30 , 150 ].

There was a growing interest in the use of participatory approaches and in their value in identifying and addressing community health needs over recent years among included studies. About half of the reviewed studies applied CBPR or other community-engaged approaches to perform CHNAA. There are several opportunities to fully engage patients, families, and communities in healthcare delivery redesign to ensure that they are provided in a way that address the community members’ needs and preferences. The CHNAA process is one mechanism for this engagement—and a good precursor to deeper engagement and collaboration [ 91 , 97 , 123 ]. Integrating community voices into CHNAA process may be crucially important for confronting health disparities at the community level, which stemming from socio-historical processes, including racial and ethnic discrimination and economic inequality [ 33 , 74 , 86 , 91 ]. To eliminate health disparities, it is critical first to understand social, cultural, and economic determinants of health. CHNAAs, particularly when they include the voices of community residents, can provide an opportunity to understand local processes contributing to health disparities. This knowledge can then be used to inform health and equity initiatives [ 91 , 110 , 126 ]. The development process and implementation of a CHNAA project is an important example of evidence-based public health practice. It is a way to address health and health care disparities experienced by medically underserved populations [ 86 , 92 , 126 ]. Those studies used a participatory approach reported that by having community participation, concerns and issues of the most marginalized and vulnerable populations were voiced. The inclusion of these voices allowed for a broader and deeper understanding of the concerns of those who are typically marginalized and that may be missed in traditional health needs assessment methodologies [ 33 , 56 , 58 , 74 , 86 , 110 , 137 , 146 ]. Hence, defining communities while performing CHNAA needs to be dynamic and socially constructed to take into account all voices and members especially those not ordinarily included. This deeper understanding is critical to move public health practice and research upstream to address structural and social determinants of health necessary for population-level reductions in health inequities [ 80 , 91 ].

Although there is widespread theoretical recognition of the importance of in-depth community participation in CHNAA, this has not been fully embraced in practice based on our review. Included studies reported community involvement in various stages of CHNAA with varying depth reflecting a continuum from no participation to extensive participation, in which most studies were located at the middle of the participation continuum. The literature review suggests while certain community stakeholders were engaged in the CHNAA process, most studies did not involve a broad range of stakeholders through adopting a full participation approach. One reason for this could be that for most studies conducted in the US, CHNAA was performed to comply with ACA requirements, which requires hospitals to incorporate inputs of the population served as part of the CHNAA process. Since community inputs as well as the process as a whole is not well-defined by these regulations [ 20 ], it seems that the majority of included US-based studies tried to meet legislative requirements by incorporating a minimum level of community and stakeholders’ participation in CHNAA process. In addition, the concept of community engagement in health services planning and implementation has evolved over recent years, from one-way consultative processes to bi-directional collaboration and shared leadership. Although undertaking an in-depth participatory approach through extensive participation of community stakeholders in CHNAAs may pose certain challenges for healthcare providers including requiring additional time and other resources to collaborate with community residents, we argue the benefits to this approach are important to improve health, as reported by some included studies [ 80 , 118 , 151 ].

A notable gap in the existing literature is the lack of long-term or longitudinal–assessment of CHNAA. The review showed that additional research into CHNAA implementation and outcomes is needed. Currently, there are limited data describing the impact of CHNAAs on health outcomes. However, there is ample evidence on different short-term impacts associated with CHNAA implementation, including, the development of health and social interventions, forming the new partnership, raising awareness on health issues, engaging policy-makers, and facilitating obtaining resources. In other words, it is unclear how CHNAA projects are linked directly to health outcomes. Furthermore, the mechanisms between the conduct and use of CHNAA remain largely unknown in the literature [ 152 , 153 ]. Clearly, not all CHNAA projects result in changes to policies or programmes, and conversely, many programme and policy decisions are made in the absence of CHNAA data [ 154 , 155 ]. Still, further research to understand these mechanisms and the long term impact of CHNAA is needed to support evidence of its use and value in addressing individual and population health needs.

This scoping review aimed to provide clarity and supplement the evidence on the key concepts, rationale, methods, tools and outcomes of community health needs and assets assessments (CHNAAs). Importantly, it highlights the need for holistic approaches to needs assessments to focus on physical, mental and social wellbeing, along with considering wider systems factors and structural challenges to individual and population health. Furthermore, the findings emphasize the inclusion of community assets in community health assessments, beginning foremost with community capabilities and knowledge. It is encouraging to see the use of pragmatic approaches including both qualitative and quantitative methods in CHNAA process in the literature. This will help to ensure that a robust and in-depth exploration of needs and assets is available to guide decision making. Although we recognize the challenges with providing consensus on definitions, processes and tools for CHNAA, we argue that more clarity is needed on the key considerations, steps and outcomes for this process across various settings. This study attempts to provide some theoretical insights and empirical information concerning the process, which hopefully will provide useful guidance to community organizations, policy- makers, health service providers and researchers seeking to develop and implement community health needs and assets assessment.

Availability of data and materials

All data generated or analysed during this study are included in this published article and its supplementary information files.

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We acknowledge contribution of the research assistants helped with data extraction.

This work was funded by department of UHC Life course/Integrated Health Services (IHS), World Health Organization (WHO) headquarter (HQ). ZA received the research grant. The authors HR, AS, and SE from WHO commissioned the study, contributed to the direction of the work, and commented on the drafts.

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AG, HR and SE conceived the study and participated in its design. SK conducted the literature search and prepared the search results for analysis. NN developed the study framework, the data abstraction forms and the manuscript outline. The literature was analysed by ZA, EA and NN under the supervision of HR and AG. ZA drafted the final version of the manuscript and HR, NN, AG and SE reviewed it. All authors read and approved the final manuscript.

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Additional file 1..

PubMed database search strategy.

Additional file 2.

Content of the extraction forms.

Additional file 3.

List of included empirical papers [ 156 – 159 ].

Additional file 4.

List of included non-empirical papers [ 160 -– 175 ] .

Additional file 5.

Health indicators collected by community health assessment surveys.

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Ravaghi, H., Guisset, AL., Elfeky, S. et al. A scoping review of community health needs and assets assessment: concepts, rationale, tools and uses. BMC Health Serv Res 23 , 44 (2023). https://doi.org/10.1186/s12913-022-08983-3

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Learning needs assessment: assessing the need

Learning needs assessment has a fundamental role in education and training, but care is needed to prevent it becoming a straitjacket

It might seem self evident that the need to learn should underpin any educational system. Indeed, the literature suggests that, at least in relation to continuing professional development, learning is more likely to lead to change in practice when needs assessment has been conducted, the education is linked to practice, personal incentive drives the educational effort, and there is some reinforcement of the learning. 1 Learning needs assessment is thus crucial in the educational process, but perhaps more of this already occurs in medical education than we suspect. The key lesson might be for those who design new systems of education and training: for example, the postgraduate education allowance system in general practice was felt to fail the profession because it did not include needs assessment and so led to ad hoc education to fulfil the time requirements of the system rather than the needs of individual doctors or the profession as a whole. On the other hand, basing learning in a profession entirely on the assessment of needs is a dangerous and limiting tactic. So a balance must be struck.

Summary points

• Learning needs assessment is a crucial stage in the educational process that leads to changes in practice, and has become part of government policy for continuing professional development
• Learning needs assessment can be undertaken for many reasons, so its purpose should be defined and should determine the method used and the use made of findings
• Exclusive reliance on formal needs assessment could render education an instrumental and narrow process rather than a creative, professional one
• Different learning methods tend to suit different doctors and different identified learning needs
• Doctors already use a wide range of formal and informal ways of identifying their own learning needs as part of their ordinary practice
• These should be the starting point in designing formalised educational systems for professional improvement

Learning needs assessment in medicine

In 1998 both individual and organisational needs assessment became part of government policy in relation to the continuing professional development and personal development plans of all healthcare professionals. 2 Thus, it has a role in the clinical governance of the service 3 and is therefore much more than an educational undertaking. This integration of needs assessment, education, and quality assurance of the service was first made explicit in 1989 in relation to clinical audit, which would identify practices in need of improvement and ensure that educational and organisational interventions were made to address these needs. 4 Accordingly, audit was described as “essentially educational” and the educational process surrounding it described. 5

Long before these recent developments, needs assessment outside medicine was presented as an important part of managed education and learning contracts, which are the predecessors of the personal development plans to be developed for all NHS healthcare professionals. 6 In his descriptions of adult learning Knowles assumed (he did not claim to have research evidence) that learners needed to feel a necessity to learn and that identifying one's own learning needs was an essential part of self directed learning. 7 In medicine a doctor's motivation to learn would therefore derive from needs identified during his or her experience of clinical practice. So the pedigree and practice of learning needs assessment, if not the evidence, are well established.

The definition of need

As in most areas of education, for many years there has been intense debate about the definition, purpose, validity, and methods of learning needs assessment. 8 It might be to help curriculum planning, diagnose individual problems, assess student learning, demonstrate accountability, improve practice and safety, or offer individual feedback and educational intervention. Published classifications include felt needs (what people say they need), expressed needs (expressed in action) normative needs (defined by experts), and comparative needs (group comparison). 9 Other distinctions include individual versus organisational or group needs, clinical versus administrative needs, and subjective versus objectively measured needs. 10 The defined purpose of the needs assessment should determine the method used and the use made of findings.

Furthermore, even though the concept of educational needs assessment is enshrined in practice, policy, and the educational canon, several factors indicate the need for careful planning and research in this subject (see boxes ​ boxesB1 B1 and ​ andB2). B2 ). Exclusive reliance on formal needs assessment in educational planning could render education an instrumental and narrow process rather than a creative, professional one. This is especially so in a profession where there is inherent unpredictability and uncertainty. Members of any profession require wide knowledge and depth of experience—the relevance of some of which might not have been obvious at the time of learning. Certainly, learning needs can and should be identified on the basis of what has been experienced and of what more experienced members of the profession know to be relevant, but this must not deter other, more general or even speculative, learning that, at the time, seems to answer no specific need. Possibly no specific learning needs assessment would ever send a person to a large international conference on a generic subject (such as endocrinology, medical education, or management). It is, nevertheless, important that doctors attend such meetings and return with the unexpected and expected benefits that they accrue.

: Need for careful planning in needs assessment

• There is little evidence that needs assessment alone enhances educational effectiveness and outcomes, so it must be placed within the wider process of planned learning, relevance to practice, and reinforcement of learning in the appropriate context
• Formal needs assessment can identify only a narrow range of needs and might miss needs not looked for, so breadth and flexibility of needs assessment methods should be embraced
• In professional education it is not necessarily defensible to focus all learning on identified needs—wider professional learning not related to a specific need is also of fundamental value where practice is not predictable
• Individual and group learning needs are different—group learning needs may produce an average picture that fails to address important needs and interests of individual members of the group—so a balance is required. Each approach has its uses and effects, but each must be used for the right purpose
• Identifying individual learning needs, often not shared by others, may lead to an unimpressive cost-benefit analysis in terms of individually targeted use of educational resources if used inappropriately. Individual learning needs assessment is best used in the context of learning that occurs on an individual basis—such as in the relationship between general practitioner registrar and trainer

: Need for research into needs assessment in medical education

• What are the effects of and responses to needs assessment alone for students, trainees, and senior doctors at different stages of medical education?
• What is the relative validity, reliability, or utility of different formal and informal methods of learning needs assessment in medical education at any level?
• To what extent do needs assessment methods identify all important learning needs?
• What are the relative effects and efficacy of identifying group and individual learning needs?
• What methods of planning effective learning experiences are most effective on the basis of needs identified?

Methods of needs assessment

Although the literature generally reports only on the more formal methods of needs assessment, doctors use a wide range of informal ways of identifying learning needs as part of their ordinary practice. These should not be undervalued simply because they do not resemble research. Questionnaires and structured interviews seem to be the most commonly reported methods of needs assessment, but such methods are also used for evaluation, assessment, management, education, and now appraisal and revalidation. 11 Together, these formal and informal methods might make an effective battery where there is clarity of purpose. The Good CPD Guide details 46 formal and informal methods of self assessment (see box ​ boxB3 B3 ). 12

: Good CPD Guide 's classification of sources of needs assessment 12

The methods listed are both formal and informal, planned and opportunistic, showing that day to day work and encounters have the potential to generate needs as much as do formal methods. Formal needs assessment methods include critical incident techniques, gap analysis, objective knowledge and skills tests, observation, revalidation, self assessment, video assessment, and peer review. Such methods are often used to identify group needs. 14 , 15 Formal identification of needs can also arise from audit, morbidity patterns, adverse events, patient satisfaction surveys, and risk assessment. Most of these tools use quantitative methods that can generate computerised data and cover wider population ranges, but these are often unable to probe into the personal agendas and opinions of individuals.

Types of needs assessment

Methods of needs assessment can be classified into seven main types, each of which can take many different forms in practice.

Gap or discrepancy analysis

This formal method involves comparing performance with stated intended competencies—by self assessment, peer assessment, or objective testing—and planning education accordingly. 9 , 16 , 17

Reflection on action and reflection in action

Reflection on action is an aspect of experiential learning and involves thinking back to some performance, with or without triggers (such as videotape or audiotape), and identifying what was done well and what could have been done better. 18 , 19 The latter category indicates learning needs.

Reflection in action involves thinking about actual performance at the time that it occurs and requires some means of recording identified strengths and weaknesses at the time. The Canadian MOCOMP programme uses formalised reflection as its basic process. 20 Similarly, PUNs and DENs (see box ​ boxB3) B3 ) are well known in British general practice.

Self assessment by diaries, journals, log books, weekly reviews

This is an extension of reflection that involves keeping a diary or other account of experiences. 21 However, practice might show that such documents tend to be written nearer the time of their review than the time of the activity being recorded.

Peer review

This is rapidly becoming a favourite method. It involves doctors assessing each other's practice and giving feedback and perhaps advice about possible education, training, or organisational strategies to improve performance. The Good CPD Guide describes five types of peer review—internal, external, informal, multidisciplinary, and physician assessment. 11 The last of these is the most formal, involving rating forms completed by nominated colleagues, and shows encouraging levels of validity, reliability, and acceptability. 22 , 23

Observation

In more formal settings doctors can be observed performing specific tasks that can be rated by an observer, either according to known criteria or more informally. The results are discussed, and learning needs are identified. The observer can be a peer, a senior, or a disinterested person if the ratings are sufficiently objective or overlap with the observer's area of expertise (such as communication skills or management).

Critical incident review and significant event auditing

Although this technique is usually used to identify the competencies of a profession or for quality assurance, it can also be used on an individual basis to identify learning needs. 24 The method involves individuals identifying and recording, say, one incident each week in which they feel they should have performed better, analysing the incident by its setting, exactly what occurred, and the outcome and why it was ineffective.

Practice review

A routine review of notes, charts, prescribing, letters, requests, etc, can identify learning needs, especially if the format of looking at what is satisfactory and what leaves room for improvement is followed.

The difference between needs assessment and assessment

Needs assessment is not the same as assessment in the sense of examination of learning. Assessment systems that lead to academic or professional awards should show certain minimum characteristics, including measurement of performance against external criteria and standards, a decision on adequacy by an assessor, and standardised data gathering. 25 Needs assessment might sometimes have these characteristics, but it also might be based on practice, reflection, professional judgment, discussion, and informal data. Needs assessment methods that are limited by the standards of assessment will fall into the trap of assessing only a narrow range of needs.

Learning for needs

The main purpose of needs assessment must be to help educational planning, but this must not lead to too narrow a vision of learning. Learning in a profession is unlike any other kind of learning. Doctors live in a rich learning environment, constantly involved in and surrounded by professional interaction and conversation, educational events, information, and feedback. The search for the one best or “right” way of learning is a hopeless task, 1 especially if this is combined with attempting to “measure” observable learning. Research papers show, at best, the complexity of the process.

Multiple interventions targeted at specific behaviour result in positive change in that behaviour. 26 Exactly what those interventions are is less important than their multiplicity and targeted nature. On the other hand, different doctors use different learning methods to meet their individual needs. For example, in a study of 366 primary care doctors who identified recent clinical problems for which they needed more knowledge or skill to solve, 55 different learning methods were selected. 27 The type of problem turned out to be the major determinant of the learning method chosen, so there may not be one educational solution to identified needs.

Much of doctors' learning is integrated with their practice and arises from it. The style of integrated practice and learning (“situated learning”) develops during the successive stages of medical education. 28 The components of apprenticeship learning in postgraduate training are made up of many activities that may be regarded as part of practice (see box ​ boxB4 B4 ). 29 Senior doctors might also recognise much of their learning in some of these elements and could certainly add more—such as conversations with colleagues.

: Components of apprenticeship learning in postgraduate training 29

• Learning by doing
• Experience of seeing patients
• Building up personal knowledge and experience
• Discussing patients
• Managing patients
• Having errors corrected
• Making teaching points during service
• Listening to experts' explanations
• “Picking things up”
• Charismatic influences
• Learning clinical methods from practice
• Being questioned about thought and actions about patients
• Teaching by doing
• Using knowledge and skill
• Bite-size learning from “bits and pieces”
• Retrieving and applying knowledge stored in memory
• Learning from supervision
• Receiving feedback
• Presentation and summarising
• Observing experts working
• Learning from role models
• Learning from team interactions
• Hearing consultants thinking aloud
• Thinking about practice and patients

Thus, educational planning on the basis of identified needs faces real challenges in making learning appropriate to and integrated with professional style and practice. The first step in all of this is to recognise the needs assessment and learning that are a part of daily professional life in medicine and to formalise, highlight, and use these as the basis of future recorded needs assessment and subsequent planning and action, as well as integrating them with more formal methods of needs assessment to form a routine part of training, learning, and improving practice.

Editorial by Goldbeck-Wood and Peile

  Competing interests: None declared.

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• What is a needs assessment? 3 types and ...

What is a needs assessment? 3 types and examples

A needs assessment is a process for determining the needs, otherwise known as "gaps," between current and desired outcomes. When used properly, this assessment provides valuable insight into your team’s processes and highlights areas for efficiency improvements.

When you’re balancing multiple growth initiatives and new projects, it’s hard to know which team improvements to prioritize. Where do you even begin?

When in doubt, try a needs assessment. A needs assessment helps you determine the most important process gaps so you can achieve your desired outcome in the shortest amount of time. Not only will assessing your current processes give you insight into how your team works, but it can also help identify areas of potential efficiency improvements.

What is a needs assessment?

A needs assessment is a process for determining the needs, or "gaps," between a current and desired outcome. It’s a part of strategic planning—essentially, a needs assessment helps you pinpoint how you’ll accomplish your strategic goals. 

A need is an opportunity for improvement within a particular process or system. When you identify—and resolve—needs, you can act on potential new opportunities, like making processes more efficient, streamlining resource allocation , and identifying resource gaps in your current workflow .  

For example, say your team is working on a process to organize customer data. A needs assessment would be a great way to understand where gaps exist in the data collection process—such as missing or inaccurate information—and where internal resources could be better utilized.

What is the purpose of a needs assessment?

A needs assessment identifies areas within your organization that need improvement. Use a needs assessment on existing processes to analyze data and inform internal changes.

Examples of processes you might use a needs assessment to accomplish include:

A process to automate duplicative manual work

A customer journey process that is underperforming

It can be challenging to pinpoint exactly where enhancements are needed. When you’re faced with multiple areas of opportunity, a needs analysis can help you identify the best areas of improvement. 

Example of a needs assessment

A needs assessment is a great way to improve processes, but it’s not always easy to get started. Start by taking a look at some example questions to get a better understanding of the data you’re looking for.

Success rate questions

What activities must be done to accomplish our objectives? 

What is the probability our solution is a success? 

What tasks are required to successfully solve our needs?

Performance questions

Which KPIs are we using to measure performance?

What does excellent performance look like?

What does current performance look like?

Operational questions

Which stakeholders are involved?

Where does the need occur within the process?

How frequently do we observe the need?

Identifying needs requires team communication, problem solving skills, and out-of-the-box ideas. Use these questions as a jumping off point to get the ball rolling. Once you know which questions to ask, you can begin to gather data. 

How to conduct a needs assessment

A needs assessment is a great way to analyze and interpret relevant data. To do this, you need to understand your team’s baseline needs, as well as the process’s overall desired outcome. 

Success rate questions:

Performance questions:

Operational questions:

Identifying needs requires team communication, problem-solving skills, and out-of-the-box ideas. Use these questions as a jumping-off point to get the ball rolling. Once you know which questions to ask, you can begin to gather data.

6 steps for conducting a needs assessment

A needs assessment is a great way to analyze and interpret relevant data that will influence your decision-making. To do this, you need to understand your team’s baseline needs, as well as the process’s overall desired outcome. 

Enlist the help of key stakeholders, funders, and decision makers and collect feedback through meetings or brainstorming sessions. However you choose to start, here are the four steps to follow when conducting a needs assessment. 

1. Identify your team’s needs

To determine the gaps between existing and ideal processes, you first need to understand what the ideal process looks like. Clear objectives are the best way to ensure you’re creating a measurable, actionable, and results-oriented needs assessment. 

Before you can start collecting and analyzing information for your needs assessment, take some time to consider your desired outcomes. Set objectives and gather data on areas of opportunity to plan deadlines and understand the intended outcome. 

Your team members are probably closer to the process than you are, and they have valuable insight into potential process improvements. Gather feedback from your project team, or host a general brainstorming session to identify your team’s biggest gaps. 

Work with your team to answer the following questions: 

What needs are you trying to solve? 

How is this process currently implemented? 

Where are the biggest opportunity gaps? 

What are your desired outcomes? 

Are you looking to solve a specific problem or a more general process? 

Do you have clear, measurable data sources? 

How will you measure success?

2. Measure and allocate your resources

Before you start your assessment, decide exactly how much bandwidth your team has and how much you’re willing to spend on the project. Also, determine how much time you’re giving yourself to meet your goals. Do you want to fill the gaps in six months? A year? Knowing exactly how much bandwidth you have will allow you to take a systematic approach to your report. 

Your team’s availability and organizational resources will impact the comprehensiveness of your needs assessment. If you allot more time to your needs assessment, you’ll be able to spend more time on data collection. 

3. Collect internal information

Next, gather information and collect data on how to best solve the identified gaps. Remember that the goal of a needs assessment is to understand how to get from your current process to the desired outcome. 

Gather data from various departments and stakeholders who are closest to the process. At this point, you’ve already brainstormed with your close project team members, but it’s also critical to understand what your cross-functional partners need from this process improvement as well. 

In order to create a good needs assessment, you need detailed information, so encourage stakeholders to share in depth data about their specific needs. The more information you have, the more likely your needs assessment is to succeed.

Some questions to consider when gathering information include: 

Where are improvements needed?

Why are current methods underperforming?

Do we have enough resources to execute a more successful process?

These questions will help you gather the necessary details to move on to step four.

4. Gather external information

Once you’ve gathered information from your project team and from cross-functional stakeholders, all that’s left is to gather information from external sources. Getting information from external sources, in addition to your internal collaborators, gives you a bird’s-eye view of the process from start to finish. 

There are multiple ways to gather external information on your target group, including:

Customer questionnaires: Used to gather quick, high-level customer data from multiple geographical locations

Focus groups: Used to gather in-depth information from a specific geographical location

It’s also a good idea to enlist a fresh pair of eyes to follow the process from start to finish to catch additional inefficiencies. While the type of needs assessment technique you use will depend on your situation, you should opt for the one that gives you the best chance of correcting inefficiencies.

5. Get feedback

A needs assessment is all about corporate and community needs. Test your findings with diverse groups of people who might have varying perspectives (and biases ) on your data. Share it with stakeholders and community members alike to gauge how both your higher-ups and target audience are going to react to any process changes. 

A few people who may want to see your assessment include: 

Project partners

Community members

Stakeholders

With the feedback you receive, you can make any necessary adjustments to the report before you start making large-scale changes to your identified needs. 

6. Use your data

At this point, you’ve collected all of the information you can. The only thing left to do is to use your needs assessment results and insights to make a final report and an action plan.

Use the information you gathered in steps one through five to transform your needs assessment data into a cumulative report. In addition to the notes, details, and observations you’ve made during your brainstorming sessions, add a summary documenting the next steps—in particular, the phases, technical assistance, training programs, and other components that will help you implement the process changes. 

Implementing the results of your needs assessment will take time. Make sure your team has an effective process in place to guide the improvement, like:

Project management tools : Help to organize information and communicate with team members

Change management : Assists with documenting need and gap changes

Business process management (BPA) : Helps to analyze and improve processes

Process implementation planning : Outlines the steps needed to reach a shared goal

Needs assessment examples

There are many different data collection methods—from quantitative techniques like surveys to qualitative techniques such as focus groups. Your target demographic may influence your methodology, so take into account whose perspective you’re looking for before you decide. 

Needs assessments provide crucial data on existing processes and help teams create more effective systems. 

Here are three of the most popular methods of collecting needs assessment data:

Questionnaires

Questionnaires and interviews are the most popular methods for collecting data. A questionnaire is a surface-level form with general yes or no questions. This is a great way to get quick information from respondents.

Use for things like: Evaluating the effectiveness of your brand identity

Many teams use surveys to collect external information around customer experience. Surveys often include open-ended questions, so they provide more in-depth information than questionnaires. This is a great way to find accurate but quick information.

Use for things like: Evaluating the success of your post-purchase experience from the customer’s perspective

Focus groups

A focus group is an interview involving a small number of participants who share common traits or experiences. While they require considerably more time than the other two methods, focus groups provide extensive information around needs and customer experience. This is a great way to gather in-depth information.

Use for things like: Evaluating how your customers experience your brand and what they think could be improved

Identify your team’s needs with an analysis

Performing a needs assessment is a great way to understand how current processes are being handled and how you can streamline tasks and communication. Knowing which needs are most important isn’t always obvious. With a needs analysis, you can gather the data you need to make your team more efficient. 

If you’re looking to improve efficiency and productivity as a team, keep information and tasks streamlined with productivity software. From empowering collaboration to creating and sharing templates, Asana can help.

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McKinsey Global Private Markets Review 2024: Private markets in a slower era

At a glance, macroeconomic challenges continued.

McKinsey Global Private Markets Review 2024: Private markets: A slower era

If 2022 was a tale of two halves, with robust fundraising and deal activity in the first six months followed by a slowdown in the second half, then 2023 might be considered a tale of one whole. Macroeconomic headwinds persisted throughout the year, with rising financing costs, and an uncertain growth outlook taking a toll on private markets. Full-year fundraising continued to decline from 2021’s lofty peak, weighed down by the “denominator effect” that persisted in part due to a less active deal market. Managers largely held onto assets to avoid selling in a lower-multiple environment, fueling an activity-dampening cycle in which distribution-starved limited partners (LPs) reined in new commitments.

About the authors

This article is a summary of a larger report, available as a PDF, that is a collaborative effort by Fredrik Dahlqvist , Alastair Green , Paul Maia, Alexandra Nee , David Quigley , Aditya Sanghvi , Connor Mangan, John Spivey, Rahel Schneider, and Brian Vickery , representing views from McKinsey’s Private Equity & Principal Investors Practice.

Performance in most private asset classes remained below historical averages for a second consecutive year. Decade-long tailwinds from low and falling interest rates and consistently expanding multiples seem to be things of the past. As private market managers look to boost performance in this new era of investing, a deeper focus on revenue growth and margin expansion will be needed now more than ever.

Perspectives on a slower era in private markets

Global fundraising contracted.

Fundraising fell 22 percent across private market asset classes globally to just over $1 trillion, as of year-end reported data—the lowest total since 2017. Fundraising in North America, a rare bright spot in 2022, declined in line with global totals, while in Europe, fundraising proved most resilient, falling just 3 percent. In Asia, fundraising fell precipitously and now sits 72 percent below the region’s 2018 peak.

Despite difficult fundraising conditions, headwinds did not affect all strategies or managers equally. Private equity (PE) buyout strategies posted their best fundraising year ever, and larger managers and vehicles also fared well, continuing the prior year’s trend toward greater fundraising concentration.

The numerator effect persisted

Despite a marked recovery in the denominator—the 1,000 largest US retirement funds grew 7 percent in the year ending September 2023, after falling 14 percent the prior year, for example 1 “U.S. retirement plans recover half of 2022 losses amid no-show recession,” Pensions and Investments , February 12, 2024. —many LPs remain overexposed to private markets relative to their target allocations. LPs started 2023 overweight: according to analysis from CEM Benchmarking, average allocations across PE, infrastructure, and real estate were at or above target allocations as of the beginning of the year. And the numerator grew throughout the year, as a lack of exits and rebounding valuations drove net asset values (NAVs) higher. While not all LPs strictly follow asset allocation targets, our analysis in partnership with global private markets firm StepStone Group suggests that an overallocation of just one percentage point can reduce planned commitments by as much as 10 to 12 percent per year for five years or more.

Despite these headwinds, recent surveys indicate that LPs remain broadly committed to private markets. In fact, the majority plan to maintain or increase allocations over the medium to long term.

Investors fled to known names and larger funds

Fundraising concentration reached its highest level in over a decade, as investors continued to shift new commitments in favor of the largest fund managers. The 25 most successful fundraisers collected 41 percent of aggregate commitments to closed-end funds (with the top five managers accounting for nearly half that total). Closed-end fundraising totals may understate the extent of concentration in the industry overall, as the largest managers also tend to be more successful in raising non-institutional capital.

While the largest funds grew even larger—the largest vehicles on record were raised in buyout, real estate, infrastructure, and private debt in 2023—smaller and newer funds struggled. Fewer than 1,700 funds of less than $1 billion were closed during the year, half as many as closed in 2022 and the fewest of any year since 2012. New manager formation also fell to the lowest level since 2012, with just 651 new firms launched in 2023.

Whether recent fundraising concentration and a spate of M&A activity signals the beginning of oft-rumored consolidation in the private markets remains uncertain, as a similar pattern developed in each of the last two fundraising downturns before giving way to renewed entrepreneurialism among general partners (GPs) and commitment diversification among LPs. Compared with how things played out in the last two downturns, perhaps this movie really is different, or perhaps we’re watching a trilogy reusing a familiar plotline.

Dry powder inventory spiked (again)

Private markets assets under management totaled $13.1 trillion as of June 30, 2023, and have grown nearly 20 percent per annum since 2018. Dry powder reserves—the amount of capital committed but not yet deployed—increased to $3.7 trillion, marking the ninth consecutive year of growth. Dry powder inventory—the amount of capital available to GPs expressed as a multiple of annual deployment—increased for the second consecutive year in PE, as new commitments continued to outpace deal activity. Inventory sat at 1.6 years in 2023, up markedly from the 0.9 years recorded at the end of 2021 but still within the historical range. NAV grew as well, largely driven by the reluctance of managers to exit positions and crystallize returns in a depressed multiple environment.

Private equity strategies diverged

Buyout and venture capital, the two largest PE sub-asset classes, charted wildly different courses over the past 18 months. Buyout notched its highest fundraising year ever in 2023, and its performance improved, with funds posting a (still paltry) 5 percent net internal rate of return through September 30. And although buyout deal volumes declined by 19 percent, 2023 was still the third-most-active year on record. In contrast, venture capital (VC) fundraising declined by nearly 60 percent, equaling its lowest total since 2015, and deal volume fell by 36 percent to the lowest level since 2019. VC funds returned –3 percent through September, posting negative returns for seven consecutive quarters. VC was the fastest-growing—as well as the highest-performing—PE strategy by a significant margin from 2010 to 2022, but investors appear to be reevaluating their approach in the current environment.

Private equity entry multiples contracted

PE buyout entry multiples declined by roughly one turn from 11.9 to 11.0 times EBITDA, slightly outpacing the decline in public market multiples (down from 12.1 to 11.3 times EBITDA), through the first nine months of 2023. For nearly a decade leading up to 2022, managers consistently sold assets into a higher-multiple environment than that in which they had bought those assets, providing a substantial performance tailwind for the industry. Nowhere has this been truer than in technology. After experiencing more than eight turns of multiple expansion from 2009 to 2021 (the most of any sector), technology multiples have declined by nearly three turns in the past two years, 50 percent more than in any other sector. Overall, roughly two-thirds of the total return for buyout deals that were entered in 2010 or later and exited in 2021 or before can be attributed to market multiple expansion and leverage. Now, with falling multiples and higher financing costs, revenue growth and margin expansion are taking center stage for GPs.

Real estate receded

Demand uncertainty, slowing rent growth, and elevated financing costs drove cap rates higher and made price discovery challenging, all of which weighed on deal volume, fundraising, and investment performance. Global closed-end fundraising declined 34 percent year over year, and funds returned −4 percent in the first nine months of the year, losing money for the first time since the 2007–08 global financial crisis. Capital shifted away from core and core-plus strategies as investors sought liquidity via redemptions in open-end vehicles, from which net outflows reached their highest level in at least two decades. Opportunistic strategies benefited from this shift, with investors focusing on capital appreciation over income generation in a market where alternative sources of yield have grown more attractive. Rising interest rates widened bid–ask spreads and impaired deal volume across food groups, including in what were formerly hot sectors: multifamily and industrial.

Private debt pays dividends

Debt again proved to be the most resilient private asset class against a turbulent market backdrop. Fundraising declined just 13 percent, largely driven by lower commitments to direct lending strategies, for which a slower PE deal environment has made capital deployment challenging. The asset class also posted the highest returns among all private asset classes through September 30. Many private debt securities are tied to floating rates, which enhance returns in a rising-rate environment. Thus far, managers appear to have successfully navigated the rising incidence of default and distress exhibited across the broader leveraged-lending market. Although direct lending deal volume declined from 2022, private lenders financed an all-time high 59 percent of leveraged buyout transactions last year and are now expanding into additional strategies to drive the next era of growth.

Infrastructure took a detour

After several years of robust growth and strong performance, infrastructure and natural resources fundraising declined by 53 percent to the lowest total since 2013. Supply-side timing is partially to blame: five of the seven largest infrastructure managers closed a flagship vehicle in 2021 or 2022, and none of those five held a final close last year. As in real estate, investors shied away from core and core-plus investments in a higher-yield environment. Yet there are reasons to believe infrastructure’s growth will bounce back. Limited partners (LPs) surveyed by McKinsey remain bullish on their deployment to the asset class, and at least a dozen vehicles targeting more than $10 billion were actively fundraising as of the end of 2023. Multiple recent acquisitions of large infrastructure GPs by global multi-asset-class managers also indicate marketwide conviction in the asset class’s potential.

Private markets still have work to do on diversity

Private markets firms are slowly improving their representation of females (up two percentage points over the prior year) and ethnic and racial minorities (up one percentage point). On some diversity metrics, including entry-level representation of women, private markets now compare favorably with corporate America. Yet broad-based parity remains elusive and too slow in the making. Ethnic, racial, and gender imbalances are particularly stark across more influential investing roles and senior positions. In fact, McKinsey’s research  reveals that at the current pace, it would take several decades for private markets firms to reach gender parity at senior levels. Increasing representation across all levels will require managers to take fresh approaches to hiring, retention, and promotion.

Artificial intelligence generating excitement

The transformative potential of generative AI was perhaps 2023’s hottest topic (beyond Taylor Swift). Private markets players are excited about the potential for the technology to optimize their approach to thesis generation, deal sourcing, investment due diligence, and portfolio performance, among other areas. While the technology is still nascent and few GPs can boast scaled implementations, pilot programs are already in flight across the industry, particularly within portfolio companies. Adoption seems nearly certain to accelerate throughout 2024.

Private markets in a slower era

If private markets investors entered 2023 hoping for a return to the heady days of 2021, they likely left the year disappointed. Many of the headwinds that emerged in the latter half of 2022 persisted throughout the year, pressuring fundraising, dealmaking, and performance. Inflation moderated somewhat over the course of the year but remained stubbornly elevated by recent historical standards. Interest rates started high and rose higher, increasing the cost of financing. A reinvigorated public equity market recovered most of 2022’s losses but did little to resolve the valuation uncertainty private market investors have faced for the past 18 months.

Within private markets, the denominator effect remained in play, despite the public market recovery, as the numerator continued to expand. An activity-dampening cycle emerged: higher cost of capital and lower multiples limited the ability or willingness of general partners (GPs) to exit positions; fewer exits, coupled with continuing capital calls, pushed LP allocations higher, thereby limiting their ability or willingness to make new commitments. These conditions weighed on managers’ ability to fundraise. Based on data reported as of year-end 2023, private markets fundraising fell 22 percent from the prior year to just over $1 trillion, the largest such drop since 2009 (Exhibit 1).

The impact of the fundraising environment was not felt equally among GPs. Continuing a trend that emerged in 2022, and consistent with prior downturns in fundraising, LPs favored larger vehicles and the scaled GPs that typically manage them. Smaller and newer managers struggled, and the number of sub–$1 billion vehicles and new firm launches each declined to its lowest level in more than a decade.

Despite the decline in fundraising, private markets assets under management (AUM) continued to grow, increasing 12 percent to $13.1 trillion as of June 30, 2023. 2023 fundraising was still the sixth-highest annual haul on record, pushing dry powder higher, while the slowdown in deal making limited distributions.

Investment performance across private market asset classes fell short of historical averages. Private equity (PE) got back in the black but generated the lowest annual performance in the past 15 years, excluding 2022. Closed-end real estate produced negative returns for the first time since 2009, as capitalization (cap) rates expanded across sectors and rent growth dissipated in formerly hot sectors, including multifamily and industrial. The performance of infrastructure funds was less than half of its long-term average and even further below the double-digit returns generated in 2021 and 2022. Private debt was the standout performer (if there was one), outperforming all other private asset classes and illustrating the asset class’s countercyclical appeal.

Private equity down but not out

Higher financing costs, lower multiples, and an uncertain macroeconomic environment created a challenging backdrop for private equity managers in 2023. Fundraising declined for the second year in a row, falling 15 percent to $649 billion, as LPs grappled with the denominator effect and a slowdown in distributions. Managers were on the fundraising trail longer to raise this capital: funds that closed in 2023 were open for a record-high average of 20.1 months, notably longer than 18.7 months in 2022 and 14.1 months in 2018. VC and growth equity strategies led the decline, dropping to their lowest level of cumulative capital raised since 2015. Fundraising in Asia fell for the fourth year of the last five, with the greatest decline in China.

Despite the difficult fundraising context, a subset of strategies and managers prevailed. Buyout managers collectively had their best fundraising year on record, raising more than $400 billion. Fundraising in Europe surged by more than 50 percent, resulting in the region’s biggest haul ever. The largest managers raised an outsized share of the total for a second consecutive year, making 2023 the most concentrated fundraising year of the last decade (Exhibit 2).

Despite the drop in aggregate fundraising, PE assets under management increased 8 percent to $8.2 trillion. Only a small part of this growth was performance driven: PE funds produced a net IRR of just 2.5 percent through September 30, 2023. Buyouts and growth equity generated positive returns, while VC lost money. PE performance, dating back to the beginning of 2022, remains negative, highlighting the difficulty of generating attractive investment returns in a higher interest rate and lower multiple environment. As PE managers devise value creation strategies to improve performance, their focus includes ensuring operating efficiency and profitability of their portfolio companies.

Deal activity volume and count fell sharply, by 21 percent and 24 percent, respectively, which continued the slower pace set in the second half of 2022. Sponsors largely opted to hold assets longer rather than lock in underwhelming returns. While higher financing costs and valuation mismatches weighed on overall deal activity, certain types of M&A gained share. Add-on deals, for example, accounted for a record 46 percent of total buyout deal volume last year.

Real estate recedes

For real estate, 2023 was a year of transition, characterized by a litany of new and familiar challenges. Pandemic-driven demand issues continued, while elevated financing costs, expanding cap rates, and valuation uncertainty weighed on commercial real estate deal volumes, fundraising, and investment performance.

Managers faced one of the toughest fundraising environments in many years. Global closed-end fundraising declined 34 percent to $125 billion. While fundraising challenges were widespread, they were not ubiquitous across strategies. Dollars continued to shift to large, multi-asset class platforms, with the top five managers accounting for 37 percent of aggregate closed-end real estate fundraising. In April, the largest real estate fund ever raised closed on a record $30 billion.

Capital shifted away from core and core-plus strategies as investors sought liquidity through redemptions in open-end vehicles and reduced gross contributions to the lowest level since 2009. Opportunistic strategies benefited from this shift, as investors turned their attention toward capital appreciation over income generation in a market where alternative sources of yield have grown more attractive.

In the United States, for instance, open-end funds, as represented by the National Council of Real Estate Investment Fiduciaries Fund Index—Open-End Equity (NFI-OE), recorded $13 billion in net outflows in 2023, reversing the trend of positive net inflows throughout the 2010s. The negative flows mainly reflected $9 billion in core outflows, with core-plus funds accounting for the remaining outflows, which reversed a 20-year run of net inflows.

As a result, the NAV in US open-end funds fell roughly 16 percent year over year. Meanwhile, global assets under management in closed-end funds reached a new peak of $1.7 trillion as of June 2023, growing 14 percent between June 2022 and June 2023.

Real estate underperformed historical averages in 2023, as previously high-performing multifamily and industrial sectors joined office in producing negative returns caused by slowing demand growth and cap rate expansion. Closed-end funds generated a pooled net IRR of −3.5 percent in the first nine months of 2023, losing money for the first time since the global financial crisis. The lone bright spot among major sectors was hospitality, which—thanks to a rush of postpandemic travel—returned 10.3 percent in 2023. 2 Based on NCREIFs NPI index. Hotels represent 1 percent of total properties in the index. As a whole, the average pooled lifetime net IRRs for closed-end real estate funds from 2011–20 vintages remained around historical levels (9.8 percent).

Global deal volume declined 47 percent in 2023 to reach a ten-year low of $650 billion, driven by widening bid–ask spreads amid valuation uncertainty and higher costs of financing (Exhibit 3). 3 CBRE, Real Capital Analytics Deal flow in the office sector remained depressed, partly as a result of continued uncertainty in the demand for space in a hybrid working world.

During a turbulent year for private markets, private debt was a relative bright spot, topping private markets asset classes in terms of fundraising growth, AUM growth, and performance.

Fundraising for private debt declined just 13 percent year over year, nearly ten percentage points less than the private markets overall. Despite the decline in fundraising, AUM surged 27 percent to $1.7 trillion. And private debt posted the highest investment returns of any private asset class through the first three quarters of 2023.

Private debt’s risk/return characteristics are well suited to the current environment. With interest rates at their highest in more than a decade, current yields in the asset class have grown more attractive on both an absolute and relative basis, particularly if higher rates sustain and put downward pressure on equity returns (Exhibit 4). The built-in security derived from debt’s privileged position in the capital structure, moreover, appeals to investors that are wary of market volatility and valuation uncertainty.

Direct lending continued to be the largest strategy in 2023, with fundraising for the mostly-senior-debt strategy accounting for almost half of the asset class’s total haul (despite declining from the previous year). Separately, mezzanine debt fundraising hit a new high, thanks to the closings of three of the largest funds ever raised in the strategy.

Over the longer term, growth in private debt has largely been driven by institutional investors rotating out of traditional fixed income in favor of private alternatives. Despite this growth in commitments, LPs remain underweight in this asset class relative to their targets. In fact, the allocation gap has only grown wider in recent years, a sharp contrast to other private asset classes, for which LPs’ current allocations exceed their targets on average. According to data from CEM Benchmarking, the private debt allocation gap now stands at 1.4 percent, which means that, in aggregate, investors must commit hundreds of billions in net new capital to the asset class just to reach current targets.

Private debt was not completely immune to the macroeconomic conditions last year, however. Fundraising declined for the second consecutive year and now sits 23 percent below 2021’s peak. Furthermore, though private lenders took share in 2023 from other capital sources, overall deal volumes also declined for the second year in a row. The drop was largely driven by a less active PE deal environment: private debt is predominantly used to finance PE-backed companies, though managers are increasingly diversifying their origination capabilities to include a broad new range of companies and asset types.

Infrastructure and natural resources take a detour

For infrastructure and natural resources fundraising, 2023 was an exceptionally challenging year. Aggregate capital raised declined 53 percent year over year to $82 billion, the lowest annual total since 2013. The size of the drop is particularly surprising in light of infrastructure’s recent momentum. The asset class had set fundraising records in four of the previous five years, and infrastructure is often considered an attractive investment in uncertain markets.

While there is little doubt that the broader fundraising headwinds discussed elsewhere in this report affected infrastructure and natural resources fundraising last year, dynamics specific to the asset class were at play as well. One issue was supply-side timing: nine of the ten largest infrastructure GPs did not close a flagship fund in 2023. Second was the migration of investor dollars away from core and core-plus investments, which have historically accounted for the bulk of infrastructure fundraising, in a higher rate environment.

The asset class had some notable bright spots last year. Fundraising for higher-returning opportunistic strategies more than doubled the prior year’s total (Exhibit 5). AUM grew 18 percent, reaching a new high of $1.5 trillion. Infrastructure funds returned a net IRR of 3.4 percent in 2023; this was below historical averages but still the second-best return among private asset classes. And as was the case in other asset classes, investors concentrated commitments in larger funds and managers in 2023, including in the largest infrastructure fund ever raised.

The outlook for the asset class, moreover, remains positive. Funds targeting a record amount of capital were in the market at year-end, providing a robust foundation for fundraising in 2024 and 2025. A recent spate of infrastructure GP acquisitions signal multi-asset managers’ long-term conviction in the asset class, despite short-term headwinds. Global megatrends like decarbonization and digitization, as well as revolutions in energy and mobility, have spurred new infrastructure investment opportunities around the world, particularly for value-oriented investors that are willing to take on more risk.

Private markets make measured progress in DEI

Diversity, equity, and inclusion (DEI) has become an important part of the fundraising, talent, and investing landscape for private market participants. Encouragingly, incremental progress has been made in recent years, including more diverse talent being brought to entry-level positions, investing roles, and investment committees. The scope of DEI metrics provided to institutional investors during fundraising has also increased in recent years: more than half of PE firms now provide data across investing teams, portfolio company boards, and portfolio company management (versus investment team data only). 4 “ The state of diversity in global private markets: 2023 ,” McKinsey, August 22, 2023.

In 2023, McKinsey surveyed 66 global private markets firms that collectively employ more than 60,000 people for the second annual State of diversity in global private markets report. 5 “ The state of diversity in global private markets: 2023 ,” McKinsey, August 22, 2023. The research offers insight into the representation of women and ethnic and racial minorities in private investing as of year-end 2022. In this chapter, we discuss where the numbers stand and how firms can bring a more diverse set of perspectives to the table.

The statistics indicate signs of modest advancement. Overall representation of women in private markets increased two percentage points to 35 percent, and ethnic and racial minorities increased one percentage point to 30 percent (Exhibit 6). Entry-level positions have nearly reached gender parity, with female representation at 48 percent. The share of women holding C-suite roles globally increased 3 percentage points, while the share of people from ethnic and racial minorities in investment committees increased 9 percentage points. There is growing evidence that external hiring is gradually helping close the diversity gap, especially at senior levels. For example, 33 percent of external hires at the managing director level were ethnic or racial minorities, higher than their existing representation level (19 percent).

Yet, the scope of the challenge remains substantial. Women and minorities continue to be underrepresented in senior positions and investing roles. They also experience uneven rates of progress due to lower promotion and higher attrition rates, particularly at smaller firms. Firms are also navigating an increasingly polarized workplace today, with additional scrutiny and a growing number of lawsuits against corporate diversity and inclusion programs, particularly in the US, which threatens to impact the industry’s pace of progress.

Fredrik Dahlqvist is a senior partner in McKinsey’s Stockholm office; Alastair Green  is a senior partner in the Washington, DC, office, where Paul Maia and Alexandra Nee  are partners; David Quigley  is a senior partner in the New York office, where Connor Mangan is an associate partner and Aditya Sanghvi  is a senior partner; Rahel Schneider is an associate partner in the Bay Area office; John Spivey is a partner in the Charlotte office; and Brian Vickery  is a partner in the Boston office.

The authors wish to thank Jonathan Christy, Louis Dufau, Vaibhav Gujral, Graham Healy-Day, Laura Johnson, Ryan Luby, Tripp Norton, Alastair Rami, Henri Torbey, and Alex Wolkomir for their contributions

The authors would also like to thank CEM Benchmarking and the StepStone Group for their partnership in this year's report.

This article was edited by Arshiya Khullar, an editor in the Gurugram office.

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