Community Health Needs Assessment Research Articles

"Just a knife wound this week, nothing too painful": An ethnographic exploration of how primary care patients experiencing homelessness view their own health and healthcare.

Community health needs assessments (CHNA) involving qualitative techniques help tailor health services to the specific needs of the population groups for whom they are designed. In light of increasing health disparities amongst people experiencing homelessness (PEH)-and to ensure the integration of their voices into a larger CHNA-this study used an ethnographic approach grounded in a social constructivist research paradigm to explore the perspectives of PEH attending a primary care and addiction service in Ireland on their priority health and healthcare needs. Participant observations and informal interviews were conducted with clients experiencing homelessness attending the service for three hours every Monday morning between October 2022 and April 2023. Field note data from active participant observation and informal conversations were collected, anonymised, and analysed using inductive thematic analysis in accordance with the Declaration of Helsinki and the researchers' institutional Research Ethics Committee. Three main themes emerged from the analysis: self-identified priorities, satisfaction with health services, and migrant health. Clients' priority concerns relate to their mental health and personal safety, strengthening ties with children and families, finding a sense of purpose, and feeling better physically. These challenges differ from those of the general population in terms of their severity observed both prior to and during experiences of homelessness, coupled with disproportionately high levels of loss, fear, pain, fatigue, social stigma and other barriers to accessing satisfactory housing. In terms of services, clients are satisfied with their ability to access primary care and harm reduction in a social environment where positive exchanges with friends and providers take place. Conversely, barriers to accessing mental health and addiction services persist including the internalised belief that one is beyond help, lack of access to information on available services and their entry requirements, and lingering stigma within a health system that treats addiction as separate to health. Moving forward, health practitioners may consider holding more regular and open conversations with clients experiencing homelessness about the care they are receiving, its rationale, and whether or not changes are desired that can be safely made. The health needs of migrants and asylum seekers entering homelessness in Ireland are urgent and should be prioritised in future research.

Alignment of substance use community benefit prioritization and service lines in US hospitals: a cross-sectional study

BackgroundNon-profit hospitals in the U.S. are required by the 2010 Patient Protection and Affordable Care Act (ACA) to conduct a community health needs assessment (CHNA) every three years and to formulate an implementation strategy in response to those needs. Hospitals often identify substance use as a need relevant to their communities in their CHNAs and then must determine whether to create strategies to address such a need within their implementation strategies. The aim of this study is to assess the relationship between a hospital’s prioritization of substance use within its community benefit documents and its substance use service offerings, while considering other hospital and community characteristics.MethodsThis study of a national sample of U.S. hospitals utilizes data collected from publicly available CHNAs and implementation strategies produced by hospitals from 2018 to 2021. This cross-sectional study employs descriptive statistics and multivariable analysis to assess relationships between prioritization of substance use on hospital implementation strategies and the services offered by hospitals, with consideration of community and hospital characteristics. Hospital CHNA and strategy documents were collected and then coded to identify whether the substance use needs were prioritized by the hospital. The collected data were incorporated into a data set with secondary data sourced from the 2021 AHA Annual Survey.ResultsMultivariable analysis found a significant and positive relationship between the prioritization of substance use as a community need on a hospital’s implementation strategy and the number of the services included in this analysis offered by the hospital. Significant and positive relationships were also identified for five service categories and for hospital size.ConclusionsThe availability of service offerings is related both to a hospital’s prioritization of substance use and to its size, indicating that these factors are likely inter-related regarding a hospital’s sense of its ability to address substance use as a community need. Policymakers should consider why a hospital may not prioritize a need that is prevalent within their community; e.g., whether the organization believes it lacks resources to take such steps. This study also highlights the value of the assessment and implementation strategy process as a way for hospitals to engage with community needs.

Inclusion of People With Disabilities in Community Health Needs Assessments in Florida, United States.

Community health needs assessments (CHNAs) play a crucial role in identifying health needs of communities. Yet, unique health needs of people with disabilities (PWDs) are often underrecognized in public health practice. In 2010, the Patient Protection and Affordable Care Act (ACA) required the implementation of standardized data collection guidelines, including disability status, among federal agencies. The extent to which guidance from ACA and the U.S. Centers for Disease Control and Prevention has impacted disability inclusion in CHNAs is unknown. This study used a content analysis approach to review CHNAs conducted by local health councils and the top 11 nonprofit hospitals in Florida (n = 77). We coded CHNAs based on mentioning disability in CHNA reports, involving disability-related stakeholders, and incorporating data on disability indicators. Findings indicate that PWDs are widely not included in CHNAs in Florida, emphasizing the need for equitable representation and comprehensive understanding of PWDs in community health planning.

"Just a knife wound this week, nothing too painful": An ethnographic exploration of how primary care patients experiencing homelessness view their own health and healthcare.

Community health needs assessments (CHNA) involving qualitative techniques help tailor health services to the specific needs of the population groups for whom they are designed. In light of increasing health disparities amongst people experiencing homelessness (PEH)-and to ensure the integration of their voices into a larger CHNA-this study used an ethnographic approach grounded in a social constructivist research paradigm to explore the perspectives of PEH attending a primary care and addiction service in Ireland on their priority health and healthcare needs. Participant observations and informal interviews were conducted with clients experiencing homelessness attending the service for three hours every Monday morning between October 2022 and April 2023. Field note data from active participant observation and informal conversations were collected, anonymised, and analysed using inductive thematic analysis in accordance with the Declaration of Helsinki and the researchers' institutional Research Ethics Committee. Three main themes emerged from the analysis: self-identified priorities, satisfaction with health services, and migrant health. Clients' priority concerns relate to their mental health and personal safety, strengthening ties with children and families, finding a sense of purpose, and feeling better physically. These challenges differ from those of the general population in terms of their severity observed both prior to and during experiences of homelessness, coupled with disproportionately high levels of loss, fear, pain, fatigue, social stigma and other barriers to accessing satisfactory housing. In terms of services, clients are satisfied with their ability to access primary care and harm reduction in a social environment where positive exchanges with friends and providers take place. Conversely, barriers to accessing mental health and addiction services persist including the internalised belief that one is beyond help, lack of access to information on available services and their entry requirements, and lingering stigma within a health system that treats addiction as separate to health. Moving forward, health practitioners may consider holding more regular and open conversations with clients experiencing homelessness about the care they are receiving, its rationale, and whether or not changes are desired that can be safely made. The health needs of migrants and asylum seekers entering homelessness in Ireland are urgent and should be prioritised in future research.

An action research partnership in an urban Texas county to explore barriers and opportunities for collaborative community health needs assessments.

The Affordable Care Act mandated triennial community health needs assessments (CHNAs) for greater nonprofit hospital accountability in responding to community health needs. Over 10 years later, hospital spending on community benefits remains largely unchanged. While greater collaboration in CHNA implementation can increase hospital investment in community-based initiatives, nonprofit hospitals in conservative states are subject to policy, political, and economic factors that inhibit public health partnerships and magnify existing disparities in health care access. This participatory action research study explores the decision-making environment of collaborative CHNA implementation within a group of nonprofit hospitals in a north Texas urban county. In 2017 faculty from an urban anchor institution initiated an academic-community partnership with a coalition of nonprofit hospitals, public health departments, and academic institutions. An interdisciplinary research team engaged in multi-method document review and qualitative data collection to describe historical barriers for local CHNA processes and develop practical strategies for joint CHNA initiatives. Local CHNA documents were first reviewed through team-based content analysis and results applied to develop a qualitative study protocol. Key informants were recruited from county-based nonprofit hospitals, community-based nonprofit organizations, and public health systems. Seventeen senior- and mid-level professionals participated in semi-structured research interviews to describe their perspectives relating to CHNA-related planning and implementation decisions. Through iterative data collection and analysis, the research team explored CHNA-related knowledge, experiences, and processes. A constructivist lens was subsequently applied to examine historical barriers and future opportunities for local collaboration. Findings reveal CHNA implementation is a multi-stage cyclical process in organizational environments with accountability to a wide range of public and private stakeholders. This promotes varied levels of inclusivity and conservatism in data collection and community benefit implementation. Decisions to collaborate are hindered by competing priorities, including compliance with existing guidelines, administrative simplicity, alignment with health care service delivery, and efficient resource use. Efforts to promote greater CHNA collaboration may be facilitated through intentional alignment with organizational priorities and clearly communicated benefits of participation for leaders in both public and private nonprofit health systems. We consider implications for policymakers and health systems in restrictive political environments and advance a conceptual framework for greater CHNA collaboration.

Georgia Health Care Providers’ Experiences With Community Public Health Clients

Community health and human services workers play an integral role in communal public health. They are especially integral to meeting the needs of patients who are often on the margins of society. While we often conduct research from the perspective of the end-user – the patient or the client – we do not hear the voices of health and human services professionals with the same regularity. The purpose of this study is to examine the healthcare needs of public health patients from the perspective of community health providers in two Georgia counties. Through this case study, utilizing qualitative data garnered through three focus groups with the local public health department’s employees and affiliated human services providers as part of their quintennial Community Health Needs Assessment (CHNA), we call attention to several individual and systemic issues providers have identified as worthy of concern. These include health seeking information and behaviors of their clients, as well as the role of health insurance and health access for improved physical, mental, and sexual health. Systemically, providers identify the challenges of status, stigma, and consumer perceptions in the access and quality of care certain segments of the population receive and how provider bias can impede wellbeing. Although the CHNA data collection took place prior to the COVID-19 pandemic, our examination of the data took place during the height of the pandemic. As such, in this paper, we also provide practical implications and future directions for public health and human services providers who have endured the pandemic and sought to meet their patients’ needs during unprecedented circumstances.

Effects of Medicaid Expansion on Perceived Community Health Needs: Comparing and Contrasting the Content of CAH CHNAs Nationwide

The Patient Protection and Affordable Care Act (ACA) of 2010 included a requirement that every nonprofit hospital complete a Community Health Needs Assessment (CHNA) every three years. At the same time, the ACA offered significant financial incentives for states to broaden access to their Medicaid programs. Not all states took advantage of the Medicaid expansion incentives. Critical access hospitals (CAH) are deemed “critical” because they are the sole hospital in a geographic area. Such facilities are deeply enmeshed with the social determinants of health and other health-related challenges experienced by their communities. Their CHNA reports provide insight into the healthcare challenges community members cope with. The question explored in this study is: Do critical access hospital community health needs assessments in Medicaid expansion states report different community health care needs than those in non-expansion states? Both descriptive and analytic statistics indicate there are some differences between states, but there are also universal concerns in rural communities served by CAHs nationwide, regardless of Medicaid expansion status.

Hospital adoption of harm reduction and risk education strategies to address substance use disorders

ABSTRACT Background: Hospitals are well-positioned to integrate harm reduction into their workflow. However, the extent to which hospitals across the United States are adopting these strategies remains unknown. Objectives: To assess what factors are associated with hospital adoption of harm reduction/risk education strategies, and trends of adoption across time. Methods: We constructed a dataset marking implementation of harm reduction/risk education strategies for a 20% random sample of nonprofit hospitals in the U.S (n = 489) using 2019–2021 community health needs assessments (CHNAs) and implementation strategies obtained from hospital websites. We used two-level mixed effects logistic regression to test the association between adoption of these activities and organizational and community-level variables. We also compared the proportion of hospitals that adopted these strategies in the 2019–2021 CHNAs to an earlier cohort (2015–2018.) Results: In the 2019–2021 CHNAs, 44.7% (n = 219) of hospitals implemented harm reduction/risk education programs, compared with 34.1% (n = 156) in the 2015–2018 cycle. In our multivariate model, hospitals that implemented harm reduction/risk education programs had higher odds of having adopted three or more additional substance use disorder (SUD) programs (OR: 10.5: 95% CI: 5.35–20.62), writing the CHNA with a community organization (OR: 2.14; 95% CI: 1.15–3.97), and prioritizing SUD as a top three need in the CHNA (OR: 2.63; 95% CI: 1.54–4.47.) Conclusions: Our results suggest that hospitals with an existing SUD infrastructure and with connections to community are more likely to implement harm reduction/risk education programs. Policymakers should consider these findings when developing strategies to encourage hospital implementation of harm reduction activities.

Getting Further Faster: Illuminating Opportunities for Health Departments to Support Community-Driven Social Determinants of Health Interventions.

Getting Further Faster: Illuminating Opportunities for Health Departments to Support Community-Driven Social Determinants of Health Interventions.

Community engaged research to measure the impact of COVID-19 on vulnerable community member's well-being and health : Amixed methods approach.

The COVID-19 pandemic has exacerbated existing income inequality and health disparities in the United States (US). The objective of this study was to conduct timely, community-engaged research to understand the disproportionate impact of the COVID-19 pandemic on historically under-resourced communities with the goal of improving health equity. The initiative focused on priorities identified by Community Health Needs Assessments (CHNA) conducted every 3years per Federal funding requirements. These were access to healthcare, maternal/child health, obesity/food insecurity/physical activity, and mental health/addiction. In the first three quarters of 2021, we developed and employed mixed methods in three simultaneous phases of data collection. In phase1, we used purposive sampling to identify key informants from multiple stakeholder groups and conducted semi-structured interviews. In phase2, we held focus groups with community members from historically marginalized demographics. In phase3, we developed asurvey using validated scales and distributed it to diverse communities residing in the geographic areas of our healthcare system across four states. Healthcare systems may use the methodology outlined in this paper to conduct responsive community engagement during periods of instability and/or crisis and to address health equity issues. The results can inform sustainable approaches to collaborate with communities to build resilience and prepare for future crises.

Community Engagement in Nonprofit Hospital Community Health Needs Assessments and Implementation Plans.

Nonprofit hospitals are required to provide community benefits in exchange for their tax-exempt status. This includes a community health needs assessment (CHNA) to identify community needs and an implementation plan (IP) with strategies to address top needs every 3 years. In addition, hospitals are required to engage community members in these assessments. The objective of this study was to explore community engagement and representation in CHNAs and IPs. The researchers conducted a content analysis of CHNAs and IPs from a nationally representative sample of 503 nonprofit hospitals between 2018 and 2021. For CHNAs, a coding sheet was used to record the types of community members engaged by hospitals. For IPs, the team coded whether community engagement was reported at all and then performed an in-depth analysis to identify categories of community members, engagement methods used, and roles of community input. Finally, frequencies of categories across IPs were quantified. Eighty-nine percent of hospitals (n = 449) engaged community members in their CHNA, but only 14% (n = 71) engaged community members in their IP. An in-depth look at these IPs found that hospitals engaged underserved/minority populations, low-income populations, high school students, public health experts, and stakeholder organizations. Community members were involved in multiple steps, including brainstorming ideas, narrowing down needs, developing strategies, and reacting to proposed strategies. Although IPs are intended to benefit the community, there is a lack of community involvement reported in IPs. Hospitals may need incentives, resources, and personnel support to ensure representation of community members throughout the entire CHNA and IP process.

Comparison of Nonprofit Hospital Community Benefit Substance Abuse Identification and Practice Implementation in Appalachian and Non-Appalachian Counties.

As substance use continues to be a public health crisis nationally, it disproportionately affects the Appalachian region. Our research seeks to explore whether there is a greater substance use burden in Appalachia and whether that burden is being prioritized in local hospital systems' community health needs assessments (CHNAs) and implementation strategies (ISs). The setting for this study is the 13 states that are represented within the Appalachian region. This study examines CHNAs and ISs of a stratified random sample (n = 140) representing 20% of the hospital population within the identified states (those with counties within the Appalachian region). Each sampled hospital is labeled as Appalachian or non-Appalachian based on its county designation. Our main outcome measures were the percentage of hospitals listing substance abuse in their CHNAs, with comparisons between Appalachian and non-Appalachian subgroups, and percent addressing substance use in their ISs in Appalachia and non-Appalachia. Community health needs assessments and ISs produced between the years 2018 and 2021 were gathered for each hospital within the sample; each document was then coded for the inclusion of substance use. Chi-square tests and logistic regression were employed to conduct the analysis and draw conclusions. Although all non-Appalachian Counties that had substance use listed as a need within a CHNA correspondingly addressed that need in their ISs, only 75% of Appalachian counties that listed substance use a need went on to prioritize substance use in an IS. In addition, logistic regression indicated no significant link between overdose rates and addressing substance use. These findings further support other literature that suggests that lack of resources is limiting Appalachian health care organizations' ability to address substance use issues.

One Decade Later: The Generalizability, Diversity, and Inclusion of Community Health Needs Assessments.

The 2010 Patient Protection and Affordable Care Act aimed to reduce health disparities and change medicine to be more community-driven. To maintain tax-exempt status, hospitals must complete a Community Health Needs Assessment (CHNA) every 3 years. This assessment must ( a ) integrate input from individuals the community serves, ( b ) make the report publicly assessable, and ( c ) adopt an implementation strategy based on community health needs identified in the assessment. However, there is little information on how representative CHNAs are of the community. A content analysis was performed on a random sample of CHNA reports. This investigation examined nonprofit hospitals across the United States. This investigation analyzed the quality of CHNAs and described existing CHNA practices through 4 means: (1) identified the type of data included; (2) examined the frequency in the methods of data collection; (3) understood how representative those data are of the hospital's service region; and (4) explored to what extent the hospital addressed diversity and inclusion such as through recruitment. A stratified random sample was drawn of CHNAs published in the past 3 years (n = 450 reports). The sample was stratified by the US Department of Agriculture's Rural-Urban Continuum codes to balance hospital representation from metro and nonmetro areas. A series of dependent t tests revealed that these hospitals' reports represented a significantly more female, White, college-educated, and older population than the service area. In addition, only 3.12% of hospitals collected primary youth data. Finally, results also found that survey recruitment was not inclusive of individuals who did not have Internet access, could not read, or did not speak English fluently.

Exploring the Role of Community Social Capital in Not-for-profit Hospitals' Decision to Engage Community Partners in the Community Health Needs Assessment Process.

Not-for-profit hospitals (NFPs) frequently partner with community organizations to conduct internal revenue service-mandated community health needs assessment (CHNA), yet little is known about the number of partnerships that hospitals enter into for this purpose. This article uses "American Hospital Associations' 2020 Annual Survey" data to examine hospital-community partnerships around the CHNA and the role that community social capital defined as, "the networks that cross various professional, political and social boundaries to reflect community level trust needed to pursue shared objectives" plays in hospitals' choices to partner with community organizations for the CHNA. After controlling for a set of hospital, community, and state characteristics, we found that hospitals present in communities with higher social capital were likely to partner with more community organizations to conduct CHNA. Greater social capital may thus promote community health by facilitating the partnerships NFPs develop with community organizations to conduct the CHNA.

Shaping health: conducting a community health needs assessment in culturally diverse peripheral population groups

IntroductionThe impact of social determinants on health status and outcomes has been widely established. However, it is recognized that health systems' ability to address community health needs may be limited. To better understand the interrelation between social determinants of health and health outcomes, health systems need to understand the health concerns and needs of populations. The aim of this study was to map the perceived health needs of Israel's northern periphery’s diverse ethnic and religious communities and regional clusters by conducting a community health needs assessment (CHNA).MethodsThe study employed a mixed-methods approach. We conducted a CHNA in the Galilee between November 2019 to January 2020 (n = 750). Additionally, we conducted focus groups using design thinking methodology to better understand the underlying causes of existing gaps between community and healthcare representatives (n = 42). Quantitative data was analyzed using multiple logistic regressions and qualitative data was analyzed using a content and thematic analysis.ResultsGalilee residents perceived sense of community (78%) as the major strength while cancer (53%) was perceived as the major health problem followed by heart disease and stroke (28.4%). The adjusted odds ratios for the association of each predictor with each perceived social and structural determinants of health among respondents indicated that Arab respondents were more likely to report race/ethnicity discrimination, domestic violence, lack of parks and recreation, neighborhood violence, limited places to exercise, school dropout and limited access to healthy food, as determinants affecting health than Jews. Conversely, Jews were more likely than Arabs to report access to mental health services, access to transportation, lack of job opportunities and access to a doctor's office as determinants affecting their health. Qualitative analysis revealed residents felt a 'lack of health security' as a result of problematic access to specialty and mental health services, especially for elderly populations.ConclusionsCHNA can inform the design of tailored interventions that will improve health for Galilee residents addressing their socioeconomic-cultural–geographical characteristics. The study's findings raise the need to create such tailored approaches to address the lack of health security felt by residents and improve not only health services provision but the social determinants affecting their health.

The Role of Local Health Departments in Strengthening the Alignment Between Nonprofit Hospitals' Community Health Needs Assessments and Their Implementation Strategies.

Nonprofit hospitals frequently partner with their local health department on developing community health needs assessments (CHNAs); yet, little is known about the role that such partnerships play in strengthening the alignment between needs identified in hospitals' assessments and the strategies adopted by hospitals to address identified needs. Using data for 486 hospitals from the third round of CHNAs (spanning the years 2018-2021), this study showed strong alignment between the health needs identified in the CHNAs and those addressed in hospitals' implementation strategies, independent of collaboration with the local health department. One noteworthy exception to this finding was that hospital-public health collaboration remained important for improved alignment of needs related to substance use. Involvement of the local health department may strengthen hospitals' capacity to address needs outside their traditional areas of expertise, such as substance use.

Leveraging secondary data for evaluation: Planning the expansion of the Illinois asthma partnership to reduce pediatric asthma related emergency department visits

Government partnerships with community-based and healthcare organizations have historically increased the impact of public health programs. In order to strengthen and expand the Illinois Asthma Partnership (IAP), external evaluators determined the degree to which local rates of Pediatric Asthma Related Emergency Department (PARED) visits aligned with local hospital Community Health Needs Assessments (CHNA), asthma prioritization, and IAP engagement. The majority of counties with high PARED rates also had high levels of concentrated disadvantage. Combining these data enabled identification of 15 out of 102 counties where PARED visits were high and the program was not engaged. In these counties, there was an opportunity for the IAP to assist. Potential actions in these counties could include identification of a local asthma champion and development of a new program, actions to raise community awareness of asthma, and engagement with health care community leaders to discuss perceptions of need and competing priorities. This study provided a unique and cost-effective way of utilizing easily accessible data in order to plan the expansion of the IAP.

Programs to address substance use in U.S. children’s hospitals: Untapped potential for expanding community prevention and treatment resources

ObjectiveSubstance use affects Americans across the life course and there is need to understand how pediatric health care organizations implement new programs to address this need. The aim of this study was to understand what programs are currently offered and the institutional and community factors that predict hospitals undertaking this work. MethodsWe analyzed children’s hospitals’ community health needs assessments (CHNAs) and implementation strategies (2015–2019) to identify which hospitals were addressing substance use and categorized the programs they implemented. We conducted bivariate descriptive comparisons of hospitals that did or did not address substance use based on institutional, county-level, and community-benefit spending characteristics and calculated a logistic regression model to assess whether the extent of local need was associated with hospital service provision, independent of covariates. ResultsOnly 13% of children’s hospitals addressed substance use in their CHNA implementation strategies and of the 151 programs adopted, only 11 were pediatric-specific. The most common strategies hospitals outlined to address substance use included access to formal treatment and community outreach and education efforts. Children’s hospitals who did not address substance use in their communities were more likely to have worked independently on their community benefit plan and to work in counties with greater economic needs. The level of substance use needs in the community was not associated with hospital programs. Analysis of community benefit filings to the IRS confirmed that children’s hospitals not addressing substance use also spent fewer community benefit dollars on population health-related activities suggesting that overall spending may overlap with willingness to invest in complex behavioral health needs. ConclusionsFew children’s hospitals address substance use as a community health need, suggesting that these organizations are an underutilized resource for preventing and addressing the profound impact of substance use across the life course.

Abstract PO-036: Healthcare and colorectal cancer screening needs among older adults in a cancer center catchment area

Abstract Background and objective Cancer centers and healthcare systems play a pivotal role in identifying and responding appropriately to the population's cancer burden and health needs in their catchment area to reduce health inequities. Community health needs assessment (CHNA) is an integral instrument in identifying individuals' fundamental health needs in a given community. This study utilizes data from a pilot CHNA collected by a Cancer Center at community engagement events to examine cancer screening status, cancer screening education, having a primary care doctor, and barriers to healthcare among older participants. We hypothesize that screening and healthcare needs will differ by racial/ethnic groups. Methods The initial CHNA comprises data from eligible participants aged 18 years and older who attended 13 cultural and health events in Chicago from August to December 2019. The study analysis focused on Hispanic, Non-Hispanic Black (NHB), and Non-Hispanic White (NHW) participants aged 50 years and older. We examined colorectal cancer (CRC) screening and education interest questions as emblematic for both sexes in this age group based on the U.S. Preventive Services Task Force recommendations in 2019. Participants responded to (1) having received colon/rectal cancer screening with stool test (FOBT/FIT) or colonoscopy within the past ten years and (2) interests in learning more about the screening tests. We conducted descriptive bivariate analyses to examine CRC screening status and interests, having primary care, and barriers to care by race/ethnicity and used the Chi-square test of association to compare differences for the descriptive analyses. Results The study consisted of 308 men and women aged 50 years and older. Of these, 25% were Hispanic, 59% were NHB, and 16% were NHW. Compared to NHW participants, a smaller proportion of Hispanics (59.2% vs 78.4%; p=0.02) reported receiving CRC screening while no differences were observed for NHB participants (73.5% vs 78.4%; p=0.47). Compared to NHW participants, more Hispanics (31.6% vs 11.8%; p=0.01) and NHB (27.6% vs 11.8%; p=0.02) participants expressed interest in receiving education on CRC screening. Likewise, more Hispanic participants reported not having a primary care doctor (86.8% vs 94.1%; p=0.02), while no differences were observed for NHB vs NHW participants (92.3% vs 94.1%; p=0.08). Furthermore, compared to NHWs, more Hispanics and NHB participants reported barriers to screening such as transportation (NHW=0% vs Hispanics=7.9% vs NHB=16%), knowledge of screening services (NHW=1.96% vs Hispanics=7.9% vs NHB=20.4%), and lack of provider trust (NHW=3.9% vs Hispanics=11.8% vs NHB=14.3%). Conclusion The study findings show differences in CRC screening status and education interests, having primary care, and barriers to care by race/ethnicity. Minority groups reported higher screening education interests and barriers to care. This study demonstrates a means of identifying the population's healthcare needs and interests within a catchment area using a community engagement model. Citation Format: Ifeanyi B. Chukwudozie, Chibuzor Abasilim, Jessica M. Madrigal, Vida A. Henderson, Erica Martinez, Alana A. Aziz-Bradley, Jeanette Santana Gonzalez, Nasima Mannan, Ahlam Al-Kodmany, Karriem S Watson. Healthcare and colorectal cancer screening needs among older adults in a cancer center catchment area [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-036.

Using adverse childhood experiences to explore the usefulness of community health needs assessments to monitor complex determinants of health at the local level

BackgroundHospital led community health needs assessments (CHNAs) are intended to help medical care organizations assess determinants of health within the communities they serve. This study demonstrates the utility of data from non-profit hospital CHNAs to monitor complex health issues such as adverse childhood events (ACEs) at the local-level. MethodsCHNA data were collected from August to November 2019 and analyzed July 2021. A series of logistic regressions were used to analyze associations between ACEs, mental health conditions, and self-rated health from a convenience sample of 2831 adults from two regional hospitals that service five counties located in central Appalachia. ResultsACEs were associated with increased odds of experiencing all metal health conditions after adjusting for other exposures and demographics, including: bipolar disorder (AOR: 2.42, CL: 1.78, 3.30), chronic pain (AOR: 1.61, CL: 1.438, 1.87), depression (AOR: 2.05, CL: 1.76, 2.36), PTSD (AOR: 3.83, CL: 2.95, 4.98), and poor self-rated health (AOR: 1.88, CL: 1.65, 2.15). ConclusionFindings suggest hospital CHNAs are a useful way to assess local data and should include factors known to antecede disease including associated risks and outcomes. CHNAs may provide an opportunity to fill important gaps in community surveillance and inform local prevention and treatment strategies.