Now that we understand the planning process, we can begin by identifying needs within our community. One of the most important parts of the planning process is the needs assessment. There are so many health issues; take a look at all the topics on the Healthy People website. 

These are all health issues that we are trying to improve in the United States of America. Have you ever considered how we decide what health issue to target with our program? The purpose of a needs assessment is to help us identify the most important health issues that are plaguing our target population. We can’t simply choose a health issue at random; we need to use credible data to show us what health issues are problems within our community.

We can look at all sorts of different data types. This is an unreliable and childishly basic graph showing the leading causes of death in Madison County, the area around Rexburg, Idaho. 

Here is a much more serious and well-studied list of the most prevalent mental health issues in my area. 

Notice that we aren’t just gathering data about the most common causes of death. We are also looking at morbidity or the health issues that are not causing death but are upsetting the quality of life of the target population. 

During the first part of the needs assessment, our job is to identify these health issues and collect data that will help us understand the underlying causes of each health issue. 

Once we have identified the most pressing health issues, we can move on to the second half of the needs assessment.

The needs assessment process of our program plan is moving along. The major health problems that are taking place in our community have been identified, and the last thing left is to identify the most important health issue to focus on. 

There are many ways to do this, and members of any given sample community (priority population and stakeholders) should be involved in helping us identify what health issues should be focused on. The constraints of the project have been set: we have one year and $100,000 to develop a public health intervention to address health concerns in this community. Due to the limited timeline and funding, the community is unable to address all the health challenges we have identified, so we must select the health issues that are the most important for the community to focus on. 

There are many options available to help prioritize one health issue to focus on, but as an example, take consensus building to prioritize the health issues that have been identified. We will be able to achieve this by meeting with the stakeholders to review the data collected and come to an agreement of what health issue should be focused on together as a community. It’s important that decision makers, funders, and those in the community that would be impacted by the program are a part of the decision-making process. You may choose to use a different method to prioritize the health issues. 

Now that we have worked with the community to identify the health issue to be focused on, we can identify the underlying causes of the health issue in our community. We need to make sure to look at the many variables that can influence the health issue in our community. Once the most changeable and important underlying causes for our health issue have been identified, we can focus our program around addressing one underlying cause of the health issue that has been identified. 

Take a look at the 2 x 2 table below that can help us see which underlying cause of the health issue we have identified is most changeable and most important to address. 

This completes the needs assessment step of our program planning process. In summary, we have researched important health information about our community, identified and prioritized  the health issue to focus on as a community, and then prioritized the most important and most changeable underlying health issue that will be the focus of our program planning efforts moving forward.

Overview: Developing a Plan for Assessing Local Needs and Resources

(Chapter 3, Section 1. Developing a Plan for Assessing Local Needs and Resources, n.d., p. 3)

Developing a plan for identifying local needs and resources can help changemakers understand how to improve their communities in the most logical and efficient ways possible. This section provides a guide for developing and implementing a plan that assesses the needs of communities and the resources available to them.

WHAT DO WE MEAN BY NEEDS AND RESOURCES?

Needs can be defined as the gap between what is and what should be. A need can be felt by an individual, a group, or an entire community. It can be concrete or abstract. An example is the need for public transportation in a community where older adults have no means of getting around town. More important to these same adults, might be a need to be valued for their experience. Examining situations closely helps uncover what is truly needed, and leads toward future improvement. In public health, we focus on health needs specifically.

Resources, or assets, can include individuals, organizations, buildings, or anything that can be used to improve the quality of life. The mother in Chicago who volunteers to organize sports for neighborhood children after school, the Kenyan farmers' cooperative that helps farmers buy seed and fertilizer, the library that provides Internet access, the walking path where city residents can exercise -- all are resources that enhance community life. Every individual is a potential community asset.

WHY DEVELOP A PLAN FOR ASSESSING LOCAL NEEDS AND RESOURCES?

Why assess needs and resources? Answers include:

• It will help you gain a deeper understanding of the community. Each community has its own needs and assets, as well as its own culture and social structure that defines it. A community assessment helps to uncover not only needs and resources, but the underlying culture and social structure.

• An assessment will encourage community members to consider their assets and how to use them, as well as needs and how to address them.  This is the first step in learning how to use their own resources to solve problems.

• It will help you make decisions about priorities for system improvement. Failing to take advantage of community resources is not using all the tools at your disposal and fails to increase the community's capacity for solving its own problems.

• It eliminates unpleasant surprises down the road.  Identifying needs and resources before starting a program helps you know from the beginning what you're dealing with.

WHO SHOULD BE INVOLVED IN DEVELOPING A PLAN FOR ASSESSING LOCAL NEEDS AND RESOURCES?

The assessment process benefits greatly when there's full participation from all community stakeholders. Among those who should be involved:

• Those experiencing needs that should be addressed. Involve those who are most directly affected by adverse conditions. They know best what effects those conditions have on their lives. Including them in the planning process will produce a plan that speaks to their needs.

• Health and human service providers. These understand the community and a connection with the populations they serve.  They can share their knowledge and recruit people from marginalized populations.

• Government officials. Elected and appointed officials can help or hinder a change effort. Engaging them in an assessment helps them to take the effort seriously and make it successful.

• Influential people. These include leaders because of their positions -- college presidents, CEOs, doctors, professors, judges, clergy -- or because they are people of intelligence, integrity, and good will who care about the community.

• People whose lives could be affected by the actions taken as a result of the assessment. These include teachers, police, emergency room personnel, and landlords who might have to react if new policies or procedures are put in place.

• Community activists. People who have addressed issues that could come up in the assessment have a stake in planning it.

• Businesses, especially those that employ people from populations of concern. The livelihoods of local business owners and their employees could be affected by the results of the assessment.

HOW DO YOU DEVELOP A PLAN FOR ASSESSING LOCAL NEEDS AND RESOURCES?

Developing a plan will allow you to use as many of the available sources of information as possible.Use the results to determine goals and devise methods to conduct a successful effort. Below are some helpful steps toward developing a plan:

1. Recruit a planning group that represents all stakeholders and mirrors the diversity of the community. Try to be as inclusive as you can, so that the group is diverse and truly representative of the community. Be sure to include people from groups that are generally not offered seats at the table, such as minorities and immigrants. It will help you get a real picture of all aspects of the community. Some of the planning group may need training.

2. Design an evaluation process for the assessment. Evaluation should start at the beginning of an effort, so that you can monitor everything you do and to make your work as effective as possible.

3. Establish the needs assessment purpose. The reasons for an assessment will affect how you gather information, what is assessed, and what you do with the information you get.  Some possible purposes are listed below:

• Determining how to address the needs of a particular underserved or neglected group.

• To launch a public health campaign or combat a particular disease or condition.

• Exploring how to steer the activities of a coalition.

• Create a guide to advocacy efforts or policy change in order to make credible policy recommendations.

• Assessing a particular issue to inform strategies for approaching it. 

4. Determine what data is already available. Here are some commonly used sources of existing data. These link out to external sources; you may want to access them when you are using your chosen source of internet. 

• WHO Health Data Hub.

• Global Health - Our World in Data.

• Centers for Disease Control and Prevention Global Health Center and Global Health Protection and Security.

• Census data, ministries of health or departments of health of the country or community you are focusing on.

• Assessments by local or state/provincial governments or government agencies.

• Studies conducted by other agencies, hospitals, and local universities.

5. Determine what other information you need. Finalize the questions you'll ask your informants, as well as the questions you hope to answer with the assessment. Those questions will depend on your purposes. 

6. Decide what methods you'll use for gathering information. Choose among many methods of gathering assessment data. Some possibilities are listed below:

• Use existing data. Secondary data is information that has been gathered by others.

• Listening sessions and public forums. Learn about the community's perspectives on local issues and options. They give people of diverse backgrounds a chance to express their views, and are also a first step toward understanding the community's needs and resources.

• Interviews and focus groups. These are less formal than forums and are conducted with either individuals or small groups. A focus group is a specialized group interview in which group members will be more likely to give answers that aren't influenced by what they think is wanted.

• Direct observation. Direct observation involves seeing for yourself.  One way to better understand an area is to become part of the culture you want to learn about.

• Surveys. There are several different kinds of surveys, any or all of which could be used as part of a community assessment. Surveys often have a low return rate, and so may not be the best way to get information, but sometimes they're the only way.

• Asset Mapping. Asset mapping focuses on the strengths of the community rather than the areas that need improvement. Focusing on assets gives the power back to the community members. When changes are made by the community and for the community, initiatives are easier to sustain.

7. Decide who will collect data. Who will do the work of interviewing, surveying, or carrying out whatever other strategies you've chosen to find information? Decide whether you will use a participatory research process, whereby community members gather data themselves or hire an individual or a group to gather information. A combination of several types of data gatherers may work best.  

8. Decide how you'll reach your informants. In order to get information from people, you'll have to contact them in one of these ways:

• Posting requests on a local website or on social media sites.

• Mailing or emailing surveys to one or more lists. Partner agencies may share lists of members or email surveys under their own names, which can make members more willing to complete and return them.

• Surveying in a public place. People may be more willing to answer questions in a shopping area or on a busy sidewalk than to fill out and return a mailed survey.

• Putting up posters and distributing flyers in public places or sending them to specific organizations.

• Using the media. This can involve holding press conferences and sending out press releases, placing public service announcements and stories in various media, or paying for media advertising.

• Directing appeal to existing community groups. A member of the planning team can make an appeal at a club meeting, a religious gathering, or a sports event for volunteers to participate in a survey or focus group.

• Personal approach. The planning group can recruit friends and family members. They can ask the people they recruit to ask others.

9. Decide who will analyze the data and how they'll do it. After collecting the information, you will need to analyze it: identify the main themes from interviews and forums, sort out the concerns, understand what your indicators show, and other analytical operations. 

10. Plan whatever training is needed. Decide what is needed and who will conduct it. 

11. Decide how you'll record the results and present them to the community. You will need to explain clearly what the assessment found, and engage people in strategizing about what to do with it. Decide how you will communicate the results to the community. 

12. Decide who will perform the assessment tasks. Make sure everyone has a role that fits their skills and preferences.  

13. Create a timeline. Each phase of the assessment should have a deadline and benchmarks.

14. Present the plan, get feedback, and adjust it to make it more workable. Once the plan is drafted it should be checked by a group to see whether the plan takes the culture of the community into account. You can adjust the plan, if needed, to make it more acceptable to the community or more workable for the assessment team.

Understanding and Describing the Community

(Chapter 3, Section 2. Understanding and Describing the Community, n.d.)

WHAT IS A COMMUNITY?

While we traditionally think of a community as the people in a given geographical location, the word can refer to any group sharing something in common. This may refer to a city or neighborhood, or to a population group. These various communities often overlap. An African American art teacher, for example, might be a member of the African American, arts, and education communities, as well as of a particular faith community. An Italian woman may become a member of the ethnic and cultural community of her Nigerian husband. Whichever community defines your work, you will want to get to know it well.

WHAT DO WE MEAN BY UNDERSTANDING AND DESCRIBING THE COMMUNITY?

You need to know more than just the geographic context. It will help to understand the community’s culture, their concerns, and relationships.

• Physical aspects. Every community has a physical presence. It's important to know the community's size, the lay of the land, and its neighborhoods. Also important are how various areas of the community differ from one another. If the community is defined by its population, then find out where they live, where they gather, the places that are important to them. Their self-image, attitudes, and aspirations are often reflected in the places where they live, work, gather, and play.

• Infrastructure. Roads, bridges, public transportation, electricity, telephone service, broadband service, and similar basics make up the infrastructure of the community.

• Patterns of settlement, commerce, and industry. Where are the physical spaces? Where there is substandard housing the value the larger community places on those residents seems clear. Are heavy industries located next to residential neighborhoods? Are some parts of the community dangerous?

• Demographics.  Who makes up the community?  Age, gender, race and ethnicity, marital status, education, number of people in household, first language -- the demographic profile gives you a picture of who community residents are.

• History. The history can afford valuable information about the community and important issues.

• Community leaders, formal and informal. Some leaders are elected, others are considered leaders because of their positions in the community -- activists, CEOs, college presidents, doctors, clergy.  Still others are leaders because they are trusted for their care for the good of the community.

• Community culture, formal and informal. This covers the spoken and unspoken rules and traditions by which the community lives. It can include everything from community events and slogans, to norms of behavior, to patterns of discrimination and exercise of power.

• Existing groups.  Most communities have an array of groups and organizations. Knowing of the existence and importance of each of these groups can pave the way for alliances or for understanding opposition.

• Existing institutions. Colleges and universities, libraries, religious institutions, hospitals -- all of these, and many others, can occupy important places in the community.

• Economics. Who are the major employers in the community? What industry is the community's base? Who exercises economic power? How is wealth distributed? What are the economic prospects?

• Government/Politics. Whatever the government structure, where does political power lie? Understanding where the real power is can be the difference between a successful effort and a vain one.

• Social structure. How do people in the community relate to one another on a daily basis? How are problems resolved? This area also includes perceptions and symbols of status and respect.

• Attitudes and values. What does the community care about, and what does it ignore? What are residents' assumptions about the proper way to behave, to dress, to do business, to treat others? What are the norms for interaction among those with different opinions or backgrounds?

Depending on your needs and information, this description might be anything from a two-or three-page outline to an in-depth portrait of the community that includes charts, graphs, and photographs. You will have a picture of the community to provide context for your assessment and to see the results of actions to bring about change.

Participatory Approaches to Planning Community Interventions

(Chapter 18, Section 2. Participatory Approaches to Planning Community Interventions, n.d., p. 18)

A participatory approach allows everyone who has a stake in the intervention to have a voice. Staff, the target population, community officials, interested citizens, and people from involved agencies, all should be invited to the table. Everyone's participation should be respected, and the process shouldn't be dominated by a single point of view.

That's the ideal. The reality may often be quite different. Some people might not want to be involved if they feel it takes too much time. Individuals or groups may feel disrespected if they're not invited to participate.

The important thing to remember here is the word participatory, that each participant becomes an important contributor to the process. It isn't assumed that the professionals know what's best. Everyone has a role in decision-making.

WHAT ARE THE LEVELS OF PARTICIPATORY PLANNING?

This process presents a trade-off between efficiency and inclusiveness. How participatory do you want to be? David Wilcox, in his excellent "Guide to Effective Participation" (David Wilcox, n.d.), sets out the following as a model of the different levels of participation:

• Information - The least you can do is tell people what is planned.

• Consultation - You offer a number of options and listen to the feedback you get.

• Deciding together - You encourage others to provide ideas and join in deciding the best way forward.

• Acting together - Form a partnership to carry it out what is decided.

• Supporting independent community initiatives - You help others do what they want within a framework of support provided by the resource holder.

WHO SHOULD BE INVOLVED IN A PARTICIPATORY PLANNING PROCESS?

There should be strong and effective representation for everyone involved, including the following:

TARGETS OF CHANGE

The people whom the intervention is intended to benefit. There are two groups to be considered:

• Members of the target community, both those on whom the intervention is specifically focused, and others who share their culture, age, language, or other characteristics.

• People whom the target community sees as significant opinion makers - clergy, advisors, politicians.

AGENTS OF CHANGE

People who make policy or influence public opinion. They can help or block an intervention by their support or opposition.

POLICY MAKERS

(community tool box, n.d.-d, p. 33)

• Local elected or appointed officials

• State or federal elected or appointed officials who have influence over the issue.

• Local public agencies who administer policy in the community. If they're involved from the beginning, they may be able to smooth the way for the intervention.

• Local researchers who are experts on the issue in question.

INFLUENTIAL PEOPLE IN THE COMMUNITY

• Members of the business community. They tend to be practical, conservative, so their credibility may be high in the community. They are often directly affected by illiteracy and employee health, so may see the need for an intervention. They also may have access to money, to help sustain the intervention over time.

• Clergy and the faith community may wield great influence and see community issues as part of their spiritual mission. Faith-based groups can be powerful forces in a community.

• The media or others who have a public platform.

• Directors of other organizations affected by the issue.

INTERESTED MEMBERS OF THE COMMUNITY

• These might include parents or school personnel for an intervention dealing with youth. Seniors may have the experience to be excellent community volunteers. People with a personal interest in the issue may want to participate, such as parents whose children have had drug problems.

WHAT DO YOU NEED TO DO TO GET A PARTICIPATORY PLANNING PROCESS UP AND RUNNING?

RECRUIT STAKEHOLDERS

(community tool box, n.d.-b, p. 7)

The first step in a participatory planning process is finding people to participate. Some of that relies simply on networking and it follows a logical process:

Identify the stakeholders

Involve community members in the planning process. Every intervention needs community support in order to succeed, and participation in planning will help to assure that support.

Get the word out

(Wadud, n.d., p. 6)

Inform the community about the process - press releases, newspaper stories, fliers, posters, public service announcements, community presentations, and mailings. Be sure that your message is simple and clear, and in the languages that the community speaks.

CONVENE THE PLANNING PROCESS

Choose someone to convene the process

Sometimes it is best to find someone from outside the group like an elected official or other respected figure to run a first meeting. This type of choice lends credibility to the intervention, and identifies it as a community effort.

If a diverse core group has initiated the process, that group could convene a first meeting. In cases where a large amount of community support is needed, a Board chair or director could convene the planning process.

Hold an initial meeting

An initial meeting might be open to the whole community or to a representative group. The time, place, and tone of this meeting will ensure that people will be willing to participate. 

In some communities, several smaller meetings may be best. A large meeting may be intimidating. Start where the participants feel comfortable, and to work from there.

MAINTAIN THE PLANNING PROCESS

Participants have to continue to be interested, support has to be provided when it's needed, conflicts have to be resolved, and goals and deadlines have to be set.

Choose someone to guide the planning process

Finding the right person to monitor what's happening and make sure that nothing derails the planning is extremely important. An outside facilitator may be needed in a situation where divisions are deep, or where no one available has the needed skills to keep the planning process on track.

Decide who will issue final approval on a plan

If the actual planning is done by a relatively small group, the plan will need to be approved by the governing body in a meeting of the community or the Board.

Determine how long the planning process will go on

If the planning group is meant to continue, an ongoing participatory approach may be even more important to the intervention's success. Remember that the planning process itself is only a beginning.

Collecting Information About the Problem - Primary and Secondary Data Processes

(Chapter 3, Section 4. Collecting Information About the Problem, n.d.)

Quantitative information and data analysis provide a concrete approach for assessing, planning, and implementing community projects. It helps us compare community problems across geographic regions and across periods of time. 

Secondary Data is information that others have collected. With access to the internet, countless sources are available for statistics on health conditions. It is generally quicker and lower cost than primary data. One drawback is that we need to evaluate the accuracy of secondary data and ensure we use only reliable sources.

Secondary Source Examples:

• The state or county health department or human service department can give many health and social determinant indicators.

• Hospital admission and exit records give information on teen fertility, causes of death, and other things. Some of the data may not be a public record, but it may be possible to arrange to use it in some form.

• Census data has demographic information for the U.S. on the Bureau of Census or on similar web sites for other countries.

• Ministries of health or departments of health of the country or community you are focusing on.

• Police records can tell you crime rates and the incidence of problems such as domestic violence or motor vehicle accidents.

• Chamber of Commerce data discusses job growth, the unemployment rate, etc.

• Nonprofit service agencies, such as the United Way, may have already conducted surveys.

• School districts or regional departments of education can tell you graduation rates, test scores, and truancy rates.

• Centers for Disease Control and WHO reportable disease files can give information on the rates of many diseases, such as AIDS.

• Your reference librarian is often a very helpful person.

• Other professional contacts you have can lead you to sources of information particular to your interest.

• Statistical Abstract of the United States and the Our World in Data are good sources for national information.

• Specialized organizations may help. If you are interested in a specific topic, consult with an organization specializing in that field. Gale's Encyclopedia of Associations is a good source, or agency websites.

COLLECTING NEW INFORMATION

Primary data is information that you collect yourself. Although the information you need is often already available, sometimes you need to create it yourself.

Data may be either:
Quantitative = numerical, measurable, factual
Qualitative = descriptive information, may include opinions

Methods of primary data collection include:

• Surveys can be written, face to face, or done by telephone.

• Focus groups, public forums, and listening sessions are better suited to finding qualitative information.

Using Small Area Analysis to Uncover Disparities

(Chapter 3, Section 22. Using Small Area Analysis to Uncover Disparities, n.d., p. 3)

When you need to know the differences among neighborhoods or groups within a city’s population, you can use small area analysis. What population(s) bear a disproportionate burden of health problems? Is there a neighborhood where disparities are particularly prevalent?

By using small area analysis you can understand where the real needs are, tailor problem solutions to the areas where they’re really needed, and divide resources so that they will be as effective as possible. 

WHAT DO WE MEAN BY SMALL AREA ANALYSIS?

The definition of a small area depends on your needs. It may be a geographic area, a political or administrative district, or even a particular group of people.

The point is to focus on specific areas or populations so that you can see differences among small areas within a larger statistical pattern. For example, the asthma statistics for the county as a whole may be average, but one or two small towns may account for the majority of the cases, with the rest of the county experiencing almost no childhood asthma. The focus ought to be on those towns where asthma is the most serious.

The difficulties in conducting small area analysis come in defining the areas you’re concerned with and in finding ways to obtain information for those areas. Small area analysis can often work best when it’s possible to involve the community in planning the assessment. Those who live in the community and are affected by the issues that the assessment reveals may have good ideas about how to divide the larger community into small areas, and about what to look for.

WHY CONDUCT SMALL AREA ANALYSIS?

• Small area analysis can identify disparities in health and services. This can uncover a lack of access for underserved areas and populations that suffer more than others from various negative health, economic, and social conditions.

• It can uncover issues you wouldn’t otherwise see. A city or province may look problem-free, but small area analysis can identify geographic or population pockets within the larger area where problems are serious.

• It helps with deciding where to allocate resources. If you know where problems are most serious, you can target scarce resources appropriately.

• Small area analysis clarifies what problems, issues, and assets exist where.

• Small area analysis can help identify causes or contributing factors to a condition. By comparing the statistics and situations of a number of areas, you may be able to see why a condition exists in one area and not in another. A nearby industrial facility may be the difference between an area of high childhood asthma rates and one where the rates are low, for example.

HOW DO YOU CONDUCT SMALL AREA ANALYSIS?

Data about small areas may be difficult to find. Choosing small areas for analysis may depend on which areas you can gather data for.

Ensure community participation. Involve community members at the very beginning of the process. Their involvement can provide information you otherwise might not have access to.

Define the small areas you’ll examine. In some cases it depends on whether it’s possible to get information on the areas you’re interested in. Defining small areas may be a matter of balancing the availability of useful data with your areas of concern. Examples of small areas you might want to examine are listed below:

• City, town, or neighborhood

• Rural village or group of villages

• City block or housing complex

• Favela or similar unincorporated living area

• Specific racial, ethnic, cultural, or faith group

• People with a particular health condition

• Service area of Public health or a hospital

• County or Census tract

• Water district

Choose the information you’ll look for. Some of these may be important to your work:

• Demographics. This category includes:

• Population size, Age

• Income, Education, Race/ethnicity

• Country of birth/citizenship

• Employment, Home ownership

• Marital status, Family size

• Environmental conditions that affect issues of concern. Some examples:

• Land use policies

• Location of industrial plants

• Density of fast food and alcohol retailers

• Access to services by location or public transportation

• Access to safe areas to walk, jog, bicycle, and so on

• Social determinants related to disparities. These can include:

• Income inequality

• Racial or ethnic prejudice

• Access to health care and health insurance

• Behavioral norms held by social groups, cultures, and religions

• Social capital, the web of social connections, trust, credits, and obligations.

• Food insecurity

Potential data sources for the small area(s) you’re concerned with include:

• The census gathers basic information on everyone and detailed information on a smaller number. Data on education, income, and employment are often available. You can search the census in a number of ways:

• By state or province, county, sub-county, city or town, parish, and so on . Some census data are broken out by administrative districts.

• Census tract. In the U.S. Census, all areas of the country are divided into census tracts with between 1,500 and 8,000 people, the average at about 4,000.

• Census block. Census tracts are further broken down into blocks that may cover large geographic areas with few or no people, or a single apartment house.

• Survey records.

• BRFSS (Behavior Risk Factor Surveillance System)—State/County-level data, with rare oversampling to represent adults in particular smaller areas.

• YRBS (Youth Risk Behavior Survey) data representing school-aged youth in the school district, with potential sub-analyses by high school catchment area.

• Optional resource:

• WHO World Health Survey Plus.

• Organizational and institutional files often contain valuable information about health, living conditions, income, and so on for very specific small areas and populations. Some organizations and institutions that might be helpful include are listed below:

• Hospitals and mental health clinics

• Human service organizations

• Schools and colleges

• Economic development organizations

• Municipal records – the records kept by cities and towns and their departments and boards – can often be helpful. Among these might be as follows:

• Police records

• Planning department files (city/town/county)

• GIS and other maps

• Vital statistics (births, marriages, deaths)

• Municipal boards (Board of Health, Zoning Board, and so on)

Actual vs. Leading Causes of Death

 (Centers for Disease Control and Prevention, 2004)

Actual causes of death are defined as lifestyle and behavioral factors such as smoking and physical inactivity that contribute to this nation’s leading killers including heart disease, cancer and stroke.

Physical Inactivity and Poor Nutrition Catching up to Tobacco as Actual Cause of Death

In 2000, the most common actual causes of death in the United States were tobacco (435,000), poor diet and physical inactivity (400,000), alcohol consumption (85,000), microbial agents (such as influenza and pneumonia, 75,000), toxic agents (such as pollutants, asbestos, and so on, 55,000), motor vehicle accidents (43,000), firearms (29,000), sexual behavior (20,000) and illicit use of drugs (17,000).

Analyzing Community Problems

(Chapter 3, Section 5. Analyzing Community Problems, n.d.)

After we have gathered data and identified problems, in this section we will cover how to consider all the issues and prioritize them, in order to decide which ones to focus on first.

COMMUNITIES HAVE PROBLEMS, JUST LIKE PEOPLE

Communities must come together to solve their problems, just like families.

When communities try to solve problems, they must reflect and analyze the issue to help come to a solution. But first, problems must be identified.

WHAT IS A COMMUNITY PROBLEM?

Problems can arise in any part of a community and come from any aspect of community life. Can you name the leading problems in your community? Below are examples of community problems:

WHAT OTHERS WOULD YOU ADD?

Below are some criteria you may consider when identifying community problems:

• The problem occurs too frequently (frequency)

• The problem has lasted for a while (duration)

• The problem affects many people (scope, or range)

• The problem is disrupting to personal or community life, and possibly intense (severity)

• The problem deprives people of legal or moral rights (equity)

• The issue is perceived as a problem (perception)

This last criterion, perception, can also help indicate readiness for addressing the issue within the community. What is seen as a problem can vary from place to place and group to group in the same community.

WHY SHOULD I ANALYZE A COMMUNITY PROBLEM?

(Lopez, n.d.; Nagy, n.d.)

Analyzing community problems is a way of thinking carefully about a problem or issue before acting on a solution. It involves identifying reasons a problem exists and then, identifying possible solutions and a plan for improvement.

STARTING WITH AN ANALYSIS CAN HELP…

To better identify what the problem or issue is. Problems are usually symptoms of something else. What is that something? We should find out.

To determine the barriers and resources associated with addressing the problem. A good practice is to anticipate barriers and obstacles before they might arise. Analyzing community problems can also help you understand the resources you need.

To develop the best action steps for addressing the problem. If you know where you are going, you are more likely to get there. There's nothing worse for member involvement and morale than beginning to work on a problem, then running up against obstacles that may be avoidable. 

HOW SHOULD I ANALYZE A COMMUNITY PROBLEM?

The ultimate goal is to understand the problem better and to deal with it more effectively, so the method you choose should accomplish that goal. Here are some step-by-step guidelines for specific ways to determine the causes of the problem:

1. Justify the choice of the problem.

Apply the criteria – frequency, duration, range, severity, equity, perception – as well as asking yourself whether the problem is one that you should focus on, or not.

Let’s take the problem we used as an example earlier: The percentage of overweight and obese children in the community has been steadily increasing, and now approaches 25%. Since we know that childhood obesity tends to lead to adult obesity, and linked to chronic conditions – diabetes, heart disease, stroke – this is a problem that needs to be addressed now.

2. Frame the problem.

(community tool box, n.d.-c, p. 32)

State the problem without implying a solution or blaming anyone, so that you can analyze it without assumptions and build consensus around a solution. One way is to state it in terms of a lack of a positive factor, or the presence of a negative factor.

There are too many children in the community who are overweight or obese. The problem is particularly serious among low-income families.

3. Identify what behavior and environmental factors need to change for the problem to be solved.

This can be as straightforward as individuals changing their behavior or as complex as persuading legislators to change laws or the environment.

4. Analyze the root causes of the problem.

(Chapter 17, Section 2. Thinking Critically, n.d., p. 17; Lopez, n.d.)

The real cause of a problem may not be immediately apparent. It may be a function of a social or political system, or it may be rooted in a situation that may seem unrelated. In order to find the underlying cause, you need to use analytical methods, including critical thinking and the “But Why?” technique. This technique consists of stating the problem as you perceive it and asking “But why?” Then answer that and ask again, “But why?” By continuing this process until you get an answer that can’t be reduced further, you may get to the underlying cause of the problem, and where to direct your efforts. Once you understand the root causes of a community problem, you may be able not only to solve it, but to establish systems that prevent its return.

There are too many children in the community who are overweight or obese. The problem is particularly serious among low-income families. (But why?)

Because many low-income children don’t eat a healthy diet and don’t exercise enough. (But why?)

Because their parents may not have the knowledge of healthy foods and have access only to fast food. Kids don’t play outside because it’s too dangerous (But why?)

Parents may never have been exposed to nutrition. Low-income neighborhoods are unprofitable places to do business. The streets are dangerous because there are few job opportunities in the community, and young men turn to making money in any way possible.

You may begin to think about advocacy to bring supermarkets to low-income neighborhoods, or after-school programs for physical exercise, or parent nutrition education or anti-gang programs. Continued questioning may reveal deeper causes that your organization can tackle.

5. Identify the restraining and driving forces that affect the problem.

(Nagy, n.d.)

This is called a force field analysis.  It is looking at the restraining forces that keep the problem from changing (social structures, cultural traditions, politics, lack of knowledge, and so on) and the driving forces that push it toward change (dissatisfaction with the way things are, public opinion, policy change, ongoing public education efforts, and so on) Consider how you can use these forces in solutions to the problem.

Forces restraining change for this example include the following:

• The desirability of junk food – kids like it because we’re programmed to like fat, salt, and sugar, and it is freely available.

• Reluctance of chains to open food stores in low-income neighborhoods.

• The domination of the streets by gangs and drug dealers.

Some forces driving change might be:

• Parents’ concern about their children’s weight.

• Children’s desire to participate in sports or simply to be outdoors.

• Media stories about childhood obesity and its consequences for children.

6. Find any relationships between the issue of concern and others in the community.

Other problems may stem from the same root cause, so you could partner with other organizations on similar issues.

Issues can be connected such as lack of education, employment, after-school programs, as well as gang violence and crime. Other organizations may be working on these, and a collaboration can help both of you to reach your goals.

7. Identify personal factors that may contribute to the problem.

(Chapter 19, Section 2. Understanding Risk and Protective Factors: Their Use in Selecting Potential Targets and Promising Strategies for Intervention, n.d.)

Whether the problem involves individual behavior or community conditions, those affected by it bring a whole collection of genetics, knowledge, beliefs, background and assumptions about the world. These might contribute to the problem or to its solution.

A few examples:

• Genetic predisposition for diabetes and other conditions.

• Lack of knowledge about healthy nutrition.

• Lack of knowledge/ skills for preparing healthy foods.

8. Identify environmental factors that may contribute to the problem.

These might include the lack of services and other support; accessibility to information; the social and financial costs and benefits of change; and other conditions.

Sample environmental factors:

• Poverty

• Hopelessness and lack of employment in low-income neighborhoods

• Lack of availability of healthy food in low-income neighborhoods

• Availability of snack foods high in salt, sugar, and fat

• Media bombardment about unhealthy snacks, drinks, and fast food

9. Identify targets and agents of change for addressing the problem.

(Chapter 18, Section 3. Identifying Targets and Agents of Change: Who Can Benefit and Who Can Help, n.d.)

The point of this step is to understand where and how to direct your work most effectively.

Targets of change:

• Parents and children in low-income neighborhoods.

• School teachers and those responsible for school food programs.

• Executives of supermarket chains.

• Gang members and youth at risk of becoming gang members.

Potential agents of change:

• Parents as controllers of their children’s diets.

• School administrators responsible for food programs.

• Local officials who could create incentives for markets in underserved neighborhoods.

• Recreation departments and other agencies that might create safe physical activity programs for children.

• Community hospitals, clinics, and private medical practices.

• Public relations offices of national or regional fast food restaurant chains.

This process will help you develop a strategic plan to reach the real causes of the problem and focus on the targets and agents of change most likely to improve the situation.

Optional Resource: video Identifying the Health Issue

Identifying Community Assets and Resources

(Chapter 3, Section 8. Identifying Community Assets and Resources, n.d.)

Many planners focus on the needs or deficits, but it is helpful to focus on assets and strengths -- emphasizing what the community has, not what it lacks. Assets and strengths can be used to improve community life, but we first need to identify the community’s assets.

WHAT IS A COMMUNITY ASSET?

A community asset or resource is anything that can be used to improve the quality of community life:

• It can be a person -- Residents can be empowered to use their abilities to transform the community. The stay-at-home mom or dad who organizes a playgroup, the informal neighborhood leader, and the firefighter who risks his life are all community assets.

• It can be a physical structure or place -- a school, hospital, church, library, or recreation center. It might also be an unused building or room ideal for community meetings. Or it might be a park, a wetland, or other open space.

• It can be a community service that makes life better - public transportation, early childhood center, recycling facilities, cultural organization.

• It can be a business that provides jobs and supports the local economy.

• Everyone in the community is a potential community asset. Everyone has some talents, and can provide knowledge, connections to the people they know, and support that every effort needs, such as making phone calls, stuffing envelopes, giving people information, moving equipment or supplies. Everyone in the community can be a force for improvement if we know what their assets are and put them to use.

IDENTIFYING THE ASSETS OF GROUPS

The first step is an inventory of all the groups and agencies in your community. Start the list with what you know. Write down anything that comes to mind. Then refine and revise your list. Break your list down in several different ways: alphabetically, geographically, and by function. This will give an inventory of group assets that can be used for community improvement.

IDENTIFYING THE ASSETS OF INDIVIDUALS

This can be more challenging than for groups because surveying large numbers of people will take a lot of time and their abilities and talents are often unknown. Below are some suggestions:

• Decide on the geographic area you want to cover.

• Do you want to focus on a specific neighborhood or broad sampling of the community?

• Decide on how many people you are going to ask within that area.

• Draft some questions that will get the information you need.

• Are you interested in skills, interests, or both? What kinds?

• Try out your questions on a sample group and revise as needed.

• Collect your data.

Using Criteria to Set Priorities

(Chapter 3, Section 23. Developing and Using Criteria and Processes to Set Priorities, n.d., p. 3)

A community-needs assessment brings to light issues that need to be addressed. But all the issues can not be addressed at the same time. You have to make choices about what’s most important and timely -- but how do you decide? And how do you decide on how you will address the issues you’ve identified?

WHAT DO WE MEAN BY DEVELOPING AND USING CRITERIA AND PROCESSES TO SET PRIORITIES?

Definition of terms:

Criteria are standards for making a judgment. They provide guidelines for making decisions. The criteria you use for examining a particular set of issues may be different from those for another set, depending on the needs of the people.

Priority is the order of importance in which one thing falls in relation to another. Like a set of criteria, priorities may change with changes in the community or with changes in people’s concerns or knowledge.

After the community assessment has uncovered issues in different areas, developing a set of criteria for deciding the importance of each one is crucial to effective action.

You will need to decide the guidelines for choosing one or more issues to work on, as well as what strategies will be most effective in addressing the issues.

 The ideal process is participatory and inclusive, involving all stakeholders – those affected by or concerned with the issues at hand – and the community at large.

(Chapter 18, Section 2. Participatory Approaches to Planning Community Interventions, n.d.)

To ensure community support, ensure there is an inclusive process, developed with input from all participants.

WHY DEVELOP AND USE CRITERIA AND PROCESSES TO SET PRIORITIES?

• It creates a structure that makes setting priorities more systematic.

• It helps ensure the most important issues for your community are addressed.

• It involves the community in the effort and obtains buy-in. Any effort is far more likely to succeed if the community feels ownership of it and supports it.

• An inclusive criteria-setting process makes sure you don’t overlook what stakeholders know. Community members who are affected by issues may have a clearer understanding of which issues have the greatest impact on people’s lives.

• Establishing criteria in a structured and inclusive way ensures an open process. It is essential to include those who are most affected by the problem.

• The process of selecting criteria allows an opportunity to educate stakeholders about how to make systematic decisions.

HOW DO YOU DEVELOP AND USE CRITERIA AND PROCESSES TO SET PRIORITIES?

Assemble a participatory group representative of all stakeholders. Ensure participation and buy-in from the community by inviting stakeholders to constitute a planning group.

Identify the interests of stakeholder groups in relation to the process of setting priorities. Stakeholders may be most concerned with the following:

• The fairness of a democratic process

• A forum where all voices can be heard

• The use of proven practices

• The involvement of particular organizations or groups

• The need for funding or matching funds

Establish clear criteria for setting priorities of which issues are to be addressed. Some possible examples of criteria that might be used:

• The seriousness or frequency of the issue.

• The cost of the issue to the community.

• The feasibility of affecting the issue.

• The resources needed to address the issue adequately.

• The community’s perception of its importance, and readiness to address the issue. (community tool box, n.d.-a)

• The long-term impact of the issue and benefit of your effort.

• The fit with your organization’s vision and mission.

Establish a process for engaging stakeholders and the community in setting priorities. Once you have a list of criteria, you can decide how to apply them in prioritization. Ensure that everyone agrees on the criteria. Below are some additional suggestions:

• Discuss the issues in question, making sure everyone understands their implications. Some issues may be eliminated if needed.

• Discuss whether each issue is strategic or not, meaning whether addressing it is feasible, whether it ties into other efforts, and whether addressing it will bring other benefits.

• Rate each issue in terms of its importance and the feasibility of affecting it.

• Decide whether some issues can be consolidated and addressed by a single intervention.

• Using the criteria the group agreed upon, rank order the issues and select the highest three to five.​

• From the top choices, vote on the issues that you will address.

Establish criteria for selecting an approach to address each of your priority issues. Possible criteria might include the following:

• Cost-benefit

• Feasibility of carrying out the approach

• The likelihood that the approach will resolve the issue

• The fit of the approach with the vision, mission and community standards

• The compatibility of the approach with efforts already ongoing

• Whether the approach is a best or promising practice tried successfully elsewhere

• The availability of adequate resources to be effective

• The possibility of collaboration or shared workload

Establish a process for selecting approaches. This basic process is likely to be very similar to the one you used to choose the issues.

• Review the criteria for selecting approaches that you agreed on.

• Discuss the possible approaches in terms of their history of success, their fit with the community context, standards, and mission.

• Rate the possibilities by how well they will work and how feasible to implement.

• Discuss the ratings as a group, considering whether any approaches might be consolidated.

• Rank order and select priorities, using the same method as that used for prioritizing issues.

• From the top choices, vote on which approaches to use.

Finalize your choices. Make sure your final decisions are participatory. Identify factors that relate to all the issues. You may be more effective by directing efforts toward social determinants or root causes.

Look for ways your issue and approach might fit with other community efforts. Look for ways to collaborate with other efforts. The more collaborative your approach, the more likely that everyone in the community will be positively affected.

Be prepared to monitor your effort and change priorities as conditions change. Communities develop and change, and your effort should change as well when needed. You can use your criteria and your processes whenever you need to change direction.

SOME DECISION-MAKING PROCESSES

(Chapter 3, Section 23. Developing and Using Criteria and Processes to Set Priorities, n.d.)

1. Relative worth. 

Each participant receives a fixed number of points (for example, 100 points). These points can be distributed among the items to be prioritized in whatever way the participant desires. Participants can distribute points in a number of ways:

• Give all points to a single, very important item.

• Distribute points evenly among all items (if none is more important than another).

• Distribute some points to some items, no points to other items.

• In the tabulation, items are given priority ranking according to the total points the group assigns.

2. Forced ranking.

• Needs are ranked separately on a scale.

• For example, if there are ten items, the most important item is assigned a “1,” the second most important item is assigned a “2,” and so on down to the least important item, which receives a “10.”

• In the tabulation, the item that receives the lowest number of points is assigned highest priority, the item that receives the second lowest number of points receives second priority, and so on.

3. Delphi method.

• The coordinating group assembles participants with knowledge and experience in the issue to be addressed.

• Needs are identified and presented to participants for feedback. A deadline for returning responses is given.

• The coordinating group records all responses and distributes them to participants.

• Participants are asked to review the responses and add additional ideas or delete ones considered not important or not feasible. Participants then choose the three or five most important ideas and rank these in descending order of importance.

• Results of the rankings are collated and analyzed.

• Findings are returned to participants who are again asked to rank the top three or five preliminary priorities. Additional rounds may be implemented if necessary.

• Results are collated and categorized. An overall ranking is determined.

Delphi enables participants to examine group responses with each succeeding round, and to alter their views or to provide a rationale for sustaining a divergent opinion.

4. Hanlon method. There are three central features of the method:

• Focuses on identifying explicit criteria to be considered in setting priorities.

• Ability to organize factors into groups that are weighted relative to each other.

• Allows for modification and individual scoring of factors.

Criteria for scoring of factors and subsequent priority setting include:

• Size of the problem

• Seriousness of the problem

• Estimated effectiveness of intervention(s) under consideration

• PEARL (such as propriety, economic feasibility, acceptability, resource availability, and legality)

• P = propriety: is an intervention suitable?

• E = economics: does it make economic sense to address the problem?

• A = acceptability: will this community accept an emphasis on this problem and will they accept the proposed intervention?

• R = resources: are resources available?

• L = legality: do the current laws allow the intervention to be implemented?

5. Delbeq method.

• The Delbeq "Two Step" method involves the use of a nominal group process to develop a detailed set of priority issues, and the subsequent sharing of issues and development of a consolidated list of priorities.

• The term "nominal group" is used to underline the highly controlled dimension of the process.

• In the first stage, participants are asked to privately record their major concerns on a sheet of paper.

• Facilitators then go around the group to elicit their priority concerns. This is usually done anonymously, by asking for a limited list (2 or 3) of priority concerns to be handed in to facilitators. These are recorded on a white board.

• An alternative is to hold a "round robin" where priority concerns are elicited from participants one at a time. No comment is permitted during this stage.

• In the second stage, facilitators take participants through a controlled discussion; first to clarify priority concerns, and then to consolidate common issues.

• Finally, for health planning efforts where large lists of priority concerns are typically generated, participants may go through a ranking process to limit the number of potential options.

6. Importance and Feasibility

(National Association of County & City Health Officials, The National Connection for Local Public Health, n.d.)

To make sure we are addressing problems that will yield the greatest results, we need to measure both importance and feasibility. This is especially useful in order to focus on areas that achieve maximum results with limited resources.

The table below is an example of an agency comparing potential projects. It could be used in a variety of ways, to identify a main priority health outcome to focus on, to prioritize which underlying factor to focus on, or to prioritize which strategy to choose, 

Suggested Steps to compare projects:

1. List the health issues the community is facing in a table, as in the example below.
   

2. Consider each health issue and its underlying factors. Assign a score of 1 to 3 (1=Low, 2=Moderate, 3=High) for each activity, for both Importance and Feasibility. 

3. Add scores in each row and compare totals.

4. Compare the scores in each category and note examples in the Table.

• High Importance/High Feasibility (as in B below) – These are the highest priority items. 

• Low Importance/High Feasibility (as in C below) – Although they might be popular, they need to be reconsidered.

• High Importance/Low Feasibility (as in D below) – Long term projects with potential but will require significant resources that can be overwhelming. 

• Low Importance/Low Feasibility (as in A below) – These are the lowest priority items and could give resources to higher priority items. 

7.  Prioritizing Causes Matrix

(Maryland Department of Health, n.d.) 

Assessing Changeability: For each intervening variable, use this 2x2 table to help you prioritize your contributing factors. First, is your contributing factor important? To what degree does this contributing factor affect opioid misuse in your community? Next, how easy or difficult is it to bring about change in the contributing factor? Based on those two questions, place your contributing factor in one of these boxes. Whatever ends up in the most important and most changeable quadrant of the 2x2 matrix is your prioritized focus. You may need to run this prioritization process a few times to narrow down to the top contributing factors to focus on.

References

Centers for Disease Control and Prevention. (2004, March 9). Physical Inactivity and Poor Nutrition Catching up to Tobacco as Actual Cause of Death. CDC. https://www.cdc.gov/media/pressrel/fs040309.htm#:~:text=Actual%20causes%20of%20death%20are,%23%20%23%20%23

Chapter 3, Section 1. Developing a Plan for Assessing Local Needs and Resources. (n.d.). Community Tool Box. https://ctb.ku.edu/en/table-of-contents/assessment/assessing-community-needs-and-resources/develop-a-plan/main

Chapter 3, Section 2. Understanding and Describing the Community. (n.d.). Community Tool Box. https://ctb.ku.edu/en/table-of-contents/assessment/assessing-community-needs-and-resources/describe-the-community/main

Chapter 3, Section 4. Collecting Information About the Problem. (n.d.). Community Tool Box. https://ctb.ku.edu/en/table-of-contents/assessment/assessing-community-needs-and-resources/collect-information/main

Chapter 3, Section 5. Analyzing Community Problems. (n.d.). Community Tool Box. https://ctb.ku.edu/en/table-of-contents/assessment/assessing-community-needs-and-resources/analyzing-community-problems/main

Chapter 3, Section 8. Identifying Community Assets and Resources. (n.d.). Community Tool Box. https://ctb.ku.edu/en/table-of-contents/assessment/assessing-community-needs-and-resources/identify-community-assets/main

Chapter 3, Section 22. Using Small Area Analysis to Uncover Disparities. (n.d.). Community Tool Box. https://ctb.ku.edu/en/table-of-contents/assessment/assessing-community-needs-and-resources/small-area-analysis/main

Chapter 3, Section 23. Developing and Using Criteria and Processes to Set Priorities. (n.d.). Community Tool Box. https://ctb.ku.edu/en/table-of-contents/assessment/assessing-community-needs-and-resources/criteria-and-processes-to-set-priorities/main

Chapter 17, Section 2. Thinking Critically. (n.d.). Community Tool Box. https://ctb.ku.edu/en/table-of-contents/analyze/analyze-community-problems-and-solutions/think-critically/main

Chapter 18, Section 2. Participatory Approaches to Planning Community Interventions. (n.d.). Community Tool Box. https://ctb.ku.edu/en/table-of-contents/analyze/where-to-start/participatory-approaches/main

Chapter 18, Section 3. Identifying Targets and Agents of Change: Who Can Benefit and Who Can Help. (n.d.). Community Tool Box. https://ctb.ku.edu/en/table-of-contents/analyze/where-to-start/identify-targets-and-agents-of-change/main

Chapter 19, Section 2. Understanding Risk and Protective Factors: Their Use in Selecting Potential Targets and Promising Strategies for Intervention. (n.d.). Community Tool Box. https://ctb.ku.edu/en/table-of-contents/analyze/choose-and-adapt-community-interventions/risk-and-protective-factors/main

community tool box. (n.d.-a). Chapter 2, Section 9. Community Readiness. Community Tool Box. https://ctb.ku.edu/en/table-of-contents/overview/models-for-community-health-and-development/community-readiness/main

community tool box. (n.d.-b). Chapter 7. Encouraging Involvement in Community Work. Community Tool Box. https://ctb.ku.edu/en/table-of-contents/participation/encouraging-involvement

community tool box. (n.d.-c). Chapter 32, Section 5. Reframing the Issue. Community Tool Box. https://ctb.ku.edu/en/table-of-contents/advocacy/encouragement-education/reframe-the-debate/main

community tool box. (n.d.-d). Chapter 33, Section 10. General Rules for Organizing for Legislative Advocacy. Community Tool Box. https://ctb.ku.edu/en/table-of-contents/advocacy/direct-action/legislative-advocacy/main

David Wilcox. (n.d.). The Guide to Effective Participation. Partnerships Online. http://www.partnerships.org.uk/guide/index.htm

Lopez, C. (n.d.). Chapter 17, Section 4. Analyzing Root Causes of Problems: The “But Why?” Technique. Community Tool Box. https://ctb.ku.edu/en/table-of-contents/analyze/analyze-community-problems-and-solutions/root-causes/main

Maryland Department of Health. (n.d.). Deliverables. https://health.maryland.gov/bha/OMPP/Documents/DeliverablesandOMPP_NeedsAssessmentReport.pdf

Nagy, J. (n.d.). Chapter 17, Section 3. Defining and Analyzing the Problem. Community Tool Box. https://ctb.ku.edu/en/table-of-contents/analyze/analyze-community-problems-and-solutions/define-analyze-problem/main

National Association of County & City Health Officials, The National Connection for Local Public Health. (n.d.). Guide to Prioritization Techniques. https://www.naccho.org/uploads/downloadable-resources/Gudie-to-Prioritization-Techniques.pdf

Wadud, E. (n.d.). Chapter 6, Section 3. Preparing Press Releases. Community Tool Box. https://ctb.ku.edu/en/table-of-contents/participation/promoting-interest/press-releases/main