Optimizing Evaluation of Older Adults With Vision and/or Hearing Loss Using the interRAI Community Health Assessment and Deafblind Supplement

Purpose: Service providers must identify and assess older adults who have concurrent vision and hearing loss, or dual sensory impairment (DSI). An assessment tool suitable for this purpose is the interRAI Community Health Assessment (CHA) and its Deafblind Supplement. This study's goal was to explore this assessment's administration process and to generate suggestions for assessors to help them optimize data collection.Methods: A social worker with experience working with adults who have sensory loss, who was also naïve to the interRAI CHA, administered the assessment with 200 older adults (65+) who had visual and/or hearing loss. The assessor evaluated the utility of the instrument for clinical purposes, focusing on sections relevant to identifying/characterizing adults with DSI.Results: Suggestions include the recommendation to ask additional questions regarding the person's functional abilities. This will help assessors deepen their understanding of the person's sensory status. Recommendations are also provided regarding sensory impairments and rehabilitation, in a general sense, to help assessors administer the interRAI CHA.Conclusions: Suggestions will help assessors to deepen their knowledge about sensory loss and comprehensively understand the assessment's questions, thereby allowing them to optimize the assessment process and increase their awareness of sensory loss in older adults.

Perceived Influence of Medical Students’ Community Health Assessment Projects

Background and Objectives: To achieve overall health, physicians must understand how community and population health impacts individual health. Although several US medical schools have incorporated community health assessment project requirements into traditional curricula, examples in longitudinal integrated clerkships are unknown. This study was designed to assess alumni perceptions of the influence of community health assessment projects, a core component of the University of Minnesota Rural and Metropolitan Physician Associate Program’s (RPAP/MetroPAP) 9-month longitudinal integrated curriculum. Methods: This 2018 study consisted of a descriptive cross-sectional survey of 480 RPAP/MetroPAP alumni who completed 457 community health assessment projects between 2004/2005 and 2016/2017. The authors administered a 14-item survey requesting date and location of RPAP/MetroPAP 9-month placement, name of project, source of project idea, and perception of project influence on professional activities. Quantitative data were collected using 4-point Likert scales. We collected qualitative data with open text boxes. Results: The survey response rate was 42.29% (203/480). A key finding was alumni perceived project ideas arising from community partners had greater impact on their acquisition of several community engagement skills. One-half reported projects influenced their professional activities, evidenced by ongoing community engagement, interest and participation in public health and preventive health initiatives, efforts to learn about specific health issues, social determinants of health and patient advocacy. Conclusions: This exploratory study suggests medical student community health assessment projects enhance community engagement and soliciting project ideas from community partners increases student acquisition of community engagement skills.

Using Community-Engaged Research to Explore Social Determinants of Health in a Low-Resource Community in the Dominican Republic: A Community Health Assessment

Introduction: Previously published community health assessments (CHA) have explored social determinants of health in low-resource, Haitian-majority Dominican communities. The present CHA was conducted in Las Malvinas II, a Dominican-majority low-resource community, and represented a first step for developing a building a healthier community process. Method: A binational community–academic partnership adapted the Centers for Disease Control and Prevention’s CHANGE (Community Health Assessment and Group Evaluation) guide to conduct a CHA through community-engaged, mixed-methods research. Data were collected on five community selected public health priorities (i.e., education, sanitation, unwanted pregnancies, chronic disease management, and vaccine-preventable diseases) and community assets through focus groups, interviews with key informants, and a household survey using GIS (geographical information systems) technology. Results: Of all five priorities, unwanted pregnancies and sanitation received the lowest average CHANGE tool ratings for both policies and Systems and Environment. However, data gathered on the five public health priorities reflect the perceived needs and assets of Las Malvinas II, and are equally important in improving the community’s health and well-being status. Community members identified as important goals the construction of a primary health clinic, as well as a bigger school, that includes pre-school and high school levels. Conclusion: A coalition emerged from the CHA to address the identified issues. The coalition used CHA findings to develop a community health improvement plan. The establishment of a primary health care center and a bigger school were identified as primary goals.

Stepping Up Active Transportation in Community Health Improvement Plans: Findings From a National Probability Survey of Local Health Departments

Background: Local health departments (LHDs) are increasingly involved in Community Health Improvement Plans (CHIPs), a collaborative planning process that represents an opportunity for prioritizing physical activity. We determined the proportion of LHDs reporting active transportation strategies in CHIPs and associations between LHD characteristics and such strategies. Methods: A national probability survey of US LHDs (<500,000 residents; 30.2% response rate) was conducted in 2017 (n = 162). LHDs reported the inclusion of 8 active transportation strategies in a CHIP. We calculated the proportion of LHDs reporting each strategy. Multivariate logistic regression models determined the associations between LHD characteristics and inclusion of strategies in a CHIP. Inverse probability weights were applied for each stratum. Results: 45.6% of US LHDs reported participating in a CHIP with ≥1 active transportation strategy. Proportions for specific strategies ranged from 22.3% (Safe Routes to School) to 4.1% (Transit-Oriented Development). Achieving national accreditation (odds ratio [OR] = 3.67; 95% confidence interval [CI], 1.11–12.05), pursuing accreditation (OR = 3.40; 95% CI, 1.25–9.22), using credible resources (OR = 5.25; 95% CI, 1.77–15.56), and collaborating on a Community Health Assessment (OR = 4.48; 95% CI, 1.23–16.29) were associated with including a strategy in a CHIP after adjusting for covariates. Conclusions: CHIPs are untapped tools, but national accreditation, using credible resources, and Community Health Assessment collaboration may support strategic planning efforts to improve physical activity.