My name is Susana Morales, and I am the Director of Community Health for the Texas Health Institute (THI).
Texas is often recognized as an increasingly diverse state. It is a place where legacy communities meet new communities, each bringing a different set of values, challenges, and opportunities for growth. The differences are vast, rich, and also contributors to different health outcomes. For these reasons, a place-based approach to community health needs assessments (CHNA) is a promising approach. A place-based approach amplifies and empowers communities, leverages community assets and resources, and engages with community members who bring lived-experience and native knowledge. This approach focuses on improving the health of a community and its community members by understanding health from their perspective and lived experiences.
Case Study: Place-based Community Survey
Community surveys can take many forms. It is best practice to use validated questions used in well-known surveys in the development of the survey, but sometimes these questions do not address local issues that are important to the community and do not offer localized insights.
Case in point, we co-developed a community survey in partnership with the City of Laredo Health Department to obtain important community-level insights. Being a border city, it was important to understand where people regularly seek health care: in Laredo, in another city in Texas, across the border in Nuevo Laredo, or other cities in Mexico. The community survey team developed a series of questions to obtain a pulse in the community and further understand the health care mobility of the community. These questions underwent a rigorous place-based validation process. They were developed by THI and vetted by the City of Laredo Health Department. The Health Department tested the questions with staff, colleagues, and community partners, to ensure questions were worded correctly for community members. These questions were also translated to Spanish. The translation process was similar to the question development with one important addition. While THI staff who were native speakers translated the questions, we had native speakers from the City of Laredo Health Department review and revise the translation to focus on Spanish terms that were widely accepted and represented the community.
Lessons Learned
- Community validation: When creating survey questions to gather local data, it is important to validate the language and phrasing with the community to make sure they are asking the right question and are accurately interpreted.
- Remain flexible: The translation should use the words used in the community and this might lead to several modifications. For example, when translating “neighborhood” to Spanish is it widely accepted to translate to vecindario. However, based on the community feedback, we learned that the preferred word for neighborhoods in Laredo was colonias. This was a surprise to our research team and initially seemed incorrect, since in some places, colonias is associated with unincorporated settlements with poor conditions.
- Develop strong partnerships: The ultimate goal is to understand health from the community’s perspective and lived experiences. To achieve this, it is essential to have a strong community partner that takes the lead.
- Budget for time: The English version of the questions will take time vetting, double this time for Spanish questions.
Rad Resource
Visit here for the results and a full copy of the community survey used in Laredo. The results from the CHNAs conducted by THI are easily accessible, community facing, and actionable.
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