A framework and process for community-engaged, mixed-methods cancer needs assessments

Abstract

Purpose: Community health needs assessments are required for most state and local public health agencies and non-profit hospitals. Typically based on community health improvement planning models, these assessments encompass overall community health and multiple diseases to inform program planning. National Cancer Institute (NCI)-designated Cancer Centers and community-based cancer-focused programs share the goal of reducing cancer burden in the catchment areas they serve. However, to date, no published models exist to guide cancer-specific needs assessments for a determined geographic area that can inform both public health and research initiatives. The purpose of this article is to outline a cancer needs assessment (CNA) framework and community-engaged, mixed-methods process, along with a case study of how we applied it in Kentucky.

Methods: We convened a steering committee of key organizational partners to provide input throughout the process. We developed a conceptual framework of multi-level determinants affecting cancer-related outcomes. We incorporated both quantitative and qualitative data gathered through a variety of means, including a novel application of group concept mapping to guide definition of priorities.

Results: The resulting CNA has helped guide strategic planning and priorities for Kentucky's Cancer Action Plan, Markey Cancer Center, state agencies, and community-based organizations.

Conclusion: This framework and process can be used collaboratively by cancer center Community Outreach and Engagement offices, public health agencies, oncology programs, and community partners to plan impactful cancer control programs and research in their catchment areas. Universities can also use them to inform the planning of community engagement and health equity research efforts.

Keywords: Catchment area; Community outreach; Needs assessment; Qualitative research; Quantitative evaluation.

Fig. 1

Multilevel determinants of cancer-related outcomes framework. Society includes social context (e.g., culture; social norms; the meaning of socially constructed concepts like race, ethnicity, and gender), economic conditions (e.g., median income, unemployment), institutions (e.g., education system, criminal justice system), and policies (e.g., Affordable Care Act, Medicaid, institutional policies). Environment includes the “natural environment” (e.g., water, air, soil) and substances (natural or man-made) that individuals are exposed to through these means, and the “built” environment constructed by humans (e.g., roads, sidewalks, parks, buildings). Community includes the local health care system (e.g., primary care, hospitals, cancer clinics, and other facilities) and interpersonal relationships (e.g., family, neighborhoods)

Fig. 2

Process workflow for performing a community-engaged, mixed-methods cancer needs assessment

Fig. 3

Bar chart showing the results of the Kentucky non-profit hospitals Community Health Needs Assessments (CHNA) review, indicating the percentage of CHNAs that include these items as a priority and/or strategy

Fig. 4

Community prioritization of needs and strategies from the 2021 Kentucky Cancer Needs Assessment

Fig. 5

Bar chart showing how individuals used the 2021 Kentucky Cancer Needs Assessment (n = 64)