Standard 11: Collection of Data on Communities (guideline)
“Health care organizations should maintain a current demographic, cultural, and epidemiological profile of the community as well as a needs assessment to accurately plan for and implement services that respond to the cultural and linguistic characteristics of the service area.”
The Importance of Collecting Data on Communities
The purpose of this standard is to ensure that healthcare organizations obtain a variety of baseline data and update those data regularly to better understand their communities, and to accurately plan for and implement services that respond to the cultural and linguistic characteristics of the service area. In addition to individual factors such as genetics, home environment, and behavior, a host of community factors influence an individual’s health—eg, the physical, social, and cultural, dimensions of the community. [Stokols D, Grzywacz JG, McMahan S, Phillips K. Increasing the health promotive capacity of human environments. Am J Health Promot. 2003;18(1):4-13.] This means that effective healthcare organizations need to develop an understanding of the communities that they serve, as well as of the individual patients in those communities.
Many residents of a service area, especially those with limited English proficiency (LEP), may not be aware of an organization’s services and therefore never enroll in its programs, underlining the need to collect data about potentialas well as current patient populations. With the evolution of community characteristics, organizations also need to keep those data on up to date with regular reassessments of community needs.
Types of Relevant Data
The types of data that a healthcare organization collects may vary from one community to another, depending on size, demographic characteristics, and so forth. Following are some of the types of data that OCR, the Health Resources and Services Administration (HRSA), and other agencies suggest could be valuable to collect:
- Descriptions of geographic, demographic, and socioeconomic status
- Languages spoken in the community
- Population densities
- Ecological factors
- Analysis of the cultural needs and health practices and behaviors of ethnic groups
- Requests for culture-specific services, such as preferred languages
Other characteristics that some organizations may want to learn about may include:
- Literacy and educational levels
- Epidemiological data
- Evidence of health disparities
- Health beliefs, including attitudes toward health and illness
- Use of alternative medicine and practitioners
Some organizations may find that it is important to compile certain more specific types of information:
- Numbers of people with asthma or heart disease
- Number of teenagers attempting suicide
- Length of time patients have been in the United States and number of trips taken back to their country of origin
- Numbers of people with physical or mental disabilities or of different sexual orientations
Development of a thorough understanding of a community’s CLAS-related resources and needs also requires knowledge of other community socioeconomic factors:
- Economic conditions (eg, unemployment rates)
- Social norms and values (eg, health decision-making processes and behaviors)
- Formal and informal leadership structures
- Key organizations and institutions
- Linkages among relevant organizations, groups, and individuals
Learning about a community’s experiences in dealing with health, cultural, and linguistic issues (such as groups focused on HIV) and the successes and failures associated with those experiences may give some indication of the extent to which the community is willing to become involved in other collaborations.
A technique called “community mapping” offers an approach to understanding and describing a community and its resources. [Kretzmann JP, McKnight JL. Building Communities from the Inside Out: A Path Toward Finding and Mobilizing a Community's Assets. ACTA Publications; Chicago, Illinois; 1993.] Community mapping identifies human and material assets—public schools and higher education institutions, cultural organizations, businesses and business associations, public health agencies, religious organizations, and citizens associations—that can contribute to solving community problems, including healthcare services.
Collaboration to Develop Community Profiles and Needs Assessments
Some healthcare organizations may lack the capacity to develop and maintain community profiles, and others that have the capacity may not currently collect certain CLAS-related data. These situations may offer opportunities to work with state or local health departments in developing community profiles and needs assessments. For example, health departments could collect quantitative data such as basic demographic information in a specific geographic area and then make those data available to local healthcare organizations. Those organizations could then work with their communities to gather further information about community needs. By taking such a collaborative approach, organizations can minimize the need to expend limited resources in overlapping efforts to collect data on the same populations, while also enabling them to become more cognizant of the needs of their communities.
Moreover, community involvement in developing profiles and needs assessments can educate healthcare providers about the issues the community considers important and ways to make data collection instruments and processes culturally sensitive. Involving community members in collecting the data could help ease mistrust among community groups, such as undocumented residents, who may fear reprisals resulting from information collected by the organization.
Potential Uses for Community Data
The community profiles and needs assessments that organizations develop can be used to customize services and to flesh out assessments of quality and outcomes. Community epidemiological information can help healthcare organizations plan for and implement population-based interventions and health education campaigns. By developing a catalogue of the community’s cultural needs, resources, and assets, an organization can work with community-based organizations and private providers to plan and implement outreach efforts and linkages to service for different population groups.