Accelerating Best Practices in Peer Support Around the World

Program Development Guide

Assessing Community Needs, Strengths and Resources

Chapter Navigation

1. Organizational Readiness

2. Assessing Community Needs, Strengths and Resources

3. Assessing Community Readiness for Innovative Strategies

4. Building Community Partnerships


Assessing Community Needs, Strengths and Resources

Conducting a community assessment is a prerequisite to developing an intervention that is acceptable, effective, and sustainable. Although there are a variety of peer support models that can serve as the core of your intervention, a community assessment is necessary to adapt and tailor any given model to your local realities. With the growing emphasis on patient-centered outcomes in health care, bringing patient and community perspectives to the table will help your intervention produce outcomes that are not only valuable to your clinic but also to the community you serve.

Many program planners interested in developing a peer support program have already determined key aspects of their program, such as population demographics, rural/urban setting, and disease condition(s) addressed. Therefore, instead of an exploratory, comprehensive community needs assessment, the appropriate assessment should be highly focused on demographic and socio-economic factors of the target population. For example, your clinic serves a predominantly urban, Latino population that has high rates of heart disease and diabetes. A community assessment will help you decide: 1) specific subpopulations to target, high risk individuals, older adults, families, etc.; 2) whether to deliver the intervention through clinic or community settings, such as religious institutions and civic organizations; and 3) how to harness community resources to address socioeconomic and structural barriers to the health issues in question.

There are different methods for conducting a community assessment for a peer support or community health program, and each method follows different steps. Below is the list of some common methods:


Community Toolbox 6-Step Process

  1. Describe the makeup and history of the community to provide a context within which to collect data on its current concerns.
  2. Describe what matters to people in the community as it relates to the health condition in question
  3. Describe what matters to key stakeholders
  4. (For each candidate problem/goal) Describe the evidence indicating whether the problem/goal should be a priority issue
  5. Describe the barriers and resources for addressing the identified issue(s)
  6. (Based on the assessment) Select and state the priority issue (or issues) to be addressed by the group

Check out Chapter 3 of the Community Toolbox, Assessing Community Needs and Resources for more details, including descriptions of various needs assessment strategies such as focus groups.


Association for Community Health Improvement 6-Step Process

  1. Identifying the Team and Resources
  2. Defining the Purpose and Scope
  3. Collecting and Analyzing Data
  4. Selecting Priorities
  5. Documenting and Communicating Results
  6. Planning for Action and Monitoring Progress


Connecticut Community Health Needs Assessment 7-Step Process

  1. Identifying the Team and Resources
  2. Define the Purpose and Scope
  3. Data Collection
  4. Selecting Priorities
  5. Documenting and Communicating Assessment Results
  6. Planning, Implementation, and Strategy
  7. Monitoring Progress and Evaluating Results


CCF/SCF Community Assessment 6-Step Process

  1. Define the Scope
  2. Go Solo or Collaborate
  3. Collect Data
  4. Determine Key Findings
  5. Set Priorities and Create an Action Plan
  6. Share your Findings


The Public Health Institute's Best Practices for Community Health Needs Assessment and Implementation Strategy Development: A Review of Scientific Methods Current Practices and Future Potential This report reviews scientific methods and current practices for community health needs assessment and implementation strategy development.
California Department of Public Health's Southern California Promotores (Community Health Workers) Needs Assessment San Diego and Imperial Counties This document reports a needs assessment to determine existing barriers and challenges employers may perceive and/or experience when utilizing promotores or community health workers

© 2021 | Peers for Progress

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