Field Manual to conduct a Community Health Survey for the Portsmouth Health Department (PHD) in Portsmouth, VA Open Access
Earles, Michelle (Summer 2019)
Abstract
Increasingly, public health is relying on data to make informed decisions to drive resource allocation, evaluate program goals and objectives, and measure community health. In many cases, the public health department will need to collect and analyze its own data to have relevant, community-level data. Collecting community data, however, can be expensive and time consuming. The Centers for Disease Control and Prevention (CDC) created assessment tools, such as the Community Assessment for Public Health Emergency Response (CASPER), that can address this need and that are low-cost and standardized. Using the CDC’s CASPER methodology, the Portsmouth health department used just 24 staff members and 10 volunteers over 72 hours to collect enough surveys so that data is available at, not only the city level, but also the neighborhood level. While the survey was a success, the process for how to plan, implement, and analyze the data for the community health survey needs to be formalized in a Field Manual so that it can be replicated not only within the Portsmouth Health Department, but also shared with other health departments. The CDC’s CASPER Toolkit Version 2.0 provides general instruction on how to conduct the survey, but significantly more detail needed to be captured in a Field Manual to provide a step-by-step process for future surveys. By using lessons learned from the previous Portsmouth surveys and from other communities who have used the CASPER methodology, the Field Manual formalizes best practices into a comprehensive Community Health Assessment Field Manual using the CASPER methodology.
Table of Contents
Chapter I: Introduction ........................................................................................................ 1
Introduction and Rationale .............................................................................................. 1
Problem Statement .......................................................................................................... 2
Theoretical Framework ................................................................................................... 3
Purpose Statement ........................................................................................................... 3
Significance Statement.................................................................................................... 3
Definition of Terms......................................................................................................... 4
Chapter II: Literature Review ............................................................................................. 4
Introduction ..................................................................................................................... 4
Literature Review Strategy ............................................................................................. 5
Review of Literature Related to the Evidence of the Effectiveness of a CASPER .... 5
Review of Literature Related to the Rationale for using a CASPER for a Community Health Assessment .. 6
Review of Literature Related to Best Practices when Conducting a CASPER ........ 11
Chapter III: Methodology ................................................................................................. 14
Introduction ................................................................................................................... 14
Population and Sample ................................................................................................. 15
Research Design............................................................................................................ 15
Procedures ..................................................................................................................... 16
Instruments .................................................................................................................... 16
Data Analysis Methodology ......................................................................................... 17
Chapter IV: Results ........................................................................................................... 17
Introduction ................................................................................................................... 17
Key Findings ................................................................................................................. 18
The Final Version of the Field Manual for conducting a Community Health Assessment using the CASPER methodology ...18
Chapter 1: Getting Started with a CASPER ................................................................. 18
Putting together the Community Health Survey team .............................................. 19
Survey Times ............................................................................................................ 21
Resources .................................................................................................................. 22
Planning .................................................................................................................... 25
IRB Process ................................................................................................................... 25
Chapter 2: Questionnaire Development ........................................................................ 26
Stakeholders .............................................................................................................. 26
Process for proposing and vetting questions ............................................................. 27
Finalizing and testing the Questionnaire................................................................... 27
Limitations of CASPER model for Questionnaire design ........................................ 29
Common sources for Questionnaires ........................................................................ 30
Chapter 3: Determining Sample Size and Cluster Selection ........................................ 31
Determining Sample Size ......................................................................................... 31
Initial Software Requirements .................................................................................. 32
Preparation of Data for the CDC Cluster Model ...................................................... 32
Running the CDC Cluster Model .............................................................................. 40
Creating Survey Maps for the Community Health Survey ....................................... 45
Chapter 4: Data Collection............................................................................................ 65
Creative methods of collecting surveys ........................................................................ 66
Data Dictionary ............................................................................................................. 73
Chapter 5: Field Personnel and Just in Time Training ................................................. 96
Recruitment ............................................................................................................... 96
Just in Time training ................................................................................................. 97
Field Team Apparel .................................................................................................. 98
Safety in the Field ..................................................................................................... 99
Steps in the Field ..................................................................................................... 100
High-Rise or Multi-floor Apartment Complexes .................................................... 100
When no one answers ............................................................................................. 101
Inaccessible homes.................................................................................................. 101
Language Barriers ................................................................................................... 101
Tracking Form ........................................................................................................ 102
Introduction and Consent Script ............................................................................. 104
Interviewing Tips .................................................................................................... 105
Equipment for teams ............................................................................................... 105
Educational Materials ............................................................................................. 106
Training on electronic survey collection................................................................. 107
Confidentiality ........................................................................................................ 107
Check Out ............................................................................................................... 107
Check In .................................................................................................................. 108
Feedback from Field Teams.................................................................................... 109
In-between Survey Days ......................................................................................... 109
Sample of training materials ................................................................................... 109
Chapter 6: Communications Plan ............................................................................... 109
Outreach to the clusters ........................................................................................... 110
Media Campaign ..................................................................................................... 111
Chapter 7: Data Analysis ............................................................................................ 116
Response Rates ....................................................................................................... 116
Data Cleaning.......................................................................................................... 118
Weighted Analysis .................................................................................................. 119
Data Analysis in Epi Info ............................................................................................ 120
Additional Data Analysis ........................................................................................ 126
Spatial Analysis Using ESRI tools ......................................................................... 127
Empirical Based Kriging using Geostastical analysis. ........................................... 128
Creating Maps from CASPER Data ....................................................................... 142
Chapter 8: Reporting Results ...................................................................................... 152
Presenting the data .................................................................................................. 154
Chapter V: Conclusions, Implications, and Recommendations...................................... 157
Introduction ................................................................................................................. 157
Summary of Study ...................................................................................................... 158
Limitations .................................................................................................................. 158
Implications................................................................................................................. 159
Recommendations ....................................................................................................... 159
Conclusion .................................................................................................................. 160
References ....................................................................................................................... 160
Appendix A: PHD CASPER Questionnaires from 2013, 2014, and 2017 ..................... 163
Appendix B: CASPER Tracking Forms ......................................................................... 169
Appendix C: Example of Introduction Letter for PHD CASPER .................................. 171
Appendix D: Sample Slides from 2017 PHD CASPER Training .................................. 172
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