Section 10. Conducting Concerns Surveys

Learn how to use concerns surveys to discover what issues community members feel are most urgent to address in a plan for improvement.

 

It's important to get input from members of the community when working on plans to address health problems or concerns. Actively soliciting the involvement of community members in the process as it begins and continuing to approach them for their input will help them become more interested in your work and more likely to become actively involved. In addition to helping you recruit people for your cause, soliciting community input gives you valuable insight. One effective method for gathering this information is conducting a concerns survey.

What is a concerns survey?

Concerns surveys are a form of community assessment in which people are asked to help identify what they see as the most important issues facing their community. The results can be used to help form strategies to deal with problems and maintain the things that are working well. You can also use the results to rally the community around your cause. It's a great tool for building consensus in the community.

For example, if you've done a concerns survey and concluded that 85% of the citizens in your town think there aren't enough services for senior citizens, you can then go public with this statistic to drum up support, increase community awareness, and get people involved in planning for increased services for senior citizens. Finally, the results can help set the agenda for community work that reflects people's concerns.

Concerns surveys are conducted as part of the concerns report method of community needs assessment to identify and address community concerns. Using surveys and public discussions, the unique strengths and needs of a community can be uncovered.

Why conduct a concerns survey?

Conducting a concerns survey will inform your efforts to be sure people's pressing concerns are addressed. Additional reasons to consider conducting a concerns survey:

• It involves community members in the decision-making process early on, which increases their likelihood of getting actively involved and staying involved. Helping community members start thinking about health and community development problems motivates them to get involved. These are their issues!
• It asks community members to define what they see as most important. This is the kind of information that you won't get from outside professionals.
• It can be a reliable, systematic, and easy to use way to tap into information.
• It helps coalition members and citizens realize how they view their community.
• It provides a useful source of information and direction for initiatives, funders, and participants.
• It keeps your organization's agenda from only reflecting the interests of service providers. Getting the perspective of the people your group serves is important.
• It helps set the agenda for community work.
• It builds consensus.

Who should you survey?

The survey should be given out to as many local people as possible. Using other survey methods, you might decide to do some sort of statistical sampling (e.g., surveying a specific subpopulation of the community, such as leaders, senior citizens, women, those experiencing poverty, youth, or minority groups), but this usually isn't the way a concerns survey is used. They are designed to involve as many citizens with health concerns as possible in the agenda-building process.

If you do decide to use concerns surveys to study a specific sample of the population, you'll need to give some thought to who is included and who is excluded, as well as how you can best keep the results from becoming biased.

How should you prepare your concerns survey?

Think about budget and resources

Give some thought before you begin to know how many surveys you'll distribute. Later in this section, we'll discuss different methods of distributing surveys and what the rates of return are for different methods.

You'll also need to decide what sort of resources and supplies you'll need to complete the survey.

For example, you may want to consider:

• If you will use an online survey mechanism to collect responses,
• How much it will cost to make photocopies for hard copies of the surveys that will be distributed, and
• How many people you'll need to distribute surveys, collect responses, and tabulate the results

Put together a working group to design the survey

Since this is a community-wide survey, it's important to be sure that you have help from community members in deciding what issues are most important to ask about. We suggest you select 8 to 12 representatives from the community. If you're doing a statewide survey, you might want to assemble a somewhat larger group that represents different public agencies, geographic areas, and interests.

The working group will choose items for the survey. To help ensure that relevant survey items are selected, working group members should be similar to, and representative of, the community.

For example, if you are interested in general health concerns across a community, you will want your working group to look something like the community demographically. On the other hand, if you are only interested in the issues related to a specific system or organization (e.g., a hospital), you will include a representative group associated with it (e.g., nurses, doctors, patients, relatives). Characteristics in working group members that should line up with the community at large include health concerns, income, sex, age, educational background, employment, living conditions, and community leadership.

To recruit working group participants, there are several things you could do. Ask health advocates, the local health planning council, or people who work for health and human service agencies if they know anyone who might be interested.

Once you've selected working group members, hold a meeting with them to brainstorm about items to include in the survey. You may wish to send them the list of possible categories of questions (see the Tools at the end of this section) in advance so they can think about it ahead of time. If you do this, however, be sure to remind them that the final survey should be limited to about 30 items.

Invite selected decision makers to submit additional survey items

At this point, you may wish to invite key decision makers in your community to suggest additional survey items - probably not more than five total. People you may want to approach to do this include the director of the local health department, administrators of local social service agencies, elected or appointed city or county officials interested in health concerns, business leaders interested in health issues, and representatives of the boards that make decisions about local funds such as United Way or the Community Development Block Grant Advisory Board.

If you decide to include key decision makers in writing your survey questions, you'll need to write a letter of invitation to key decision makers, describing the process, its uses, and the intent of the survey. Tell them that you'll call to invite them to submit items for the survey.

After they've had some time to receive your letter and read it, call each of these people and reintroduce yourself and explain how you're affiliated with the program conducting the survey. Briefly explain the survey process and why the survey is being done. Ask the decision maker if he or she has any particular topics or concerns he or she would like to have appear on the survey. If you can, adapt what's been suggested to what you've already got in the survey so as not to add any new survey items if at all possible.

Before you hang up, tell the decision maker about your plans for the rest of the survey process. Let him or her know when you expect it to be completed, and that you'll send them a copy of the final report when it's finished. Finally, thank the decision maker for his or her participation (as you would with any potential participant) and request an opportunity to talk again sometime, if possible.

Prepare your survey

There should be two types of questions for every selected issue: how important the issue is to citizens and how much satisfaction citizens have with the community's efforts on the issue. Items should be written as statements, not questions - for example, "Drug use is a problem in our schools'" rather than "Do you feel drug use is a problem in our schools?" You might want to have both questions listed side-by-side, as in the example below.

Example: Importance and Satisfaction Questions	Please Circle One:	Please Circle One:
	Not               Very	Not               Very
Affordable pre-natal care for all pregnant women in Sheboygan County.	0    1    2    3    4	0    1    2    3    4
After-school recreation programs for teens in Sheboygan Public Schools.	0    1    2    3    4	0    1    2    3    4
Free transportation services for all disabled citizens in Sheboygan County.	0    1    2    3    4	0    1    2    3    4

 

Make up a list of questions. Things to ask about:

• Specific conditions: For example, air quality
• Services: Accessibility and affordability
• Skills: For example, whether people have the skills needed to obtain employment
• Programs: For example, quality early-childhood education programs

To make it easier to develop a survey, indices of properly worded items that can be included in the survey have been developed.

Here are links to several such indices that might give you some ideas as to how survey items should be worded and what sort of areas to cover:

• Basic Needs and Vital Services Index
• Community Health Concerns Index
• Neighborhood Concerns Index
• Concerns Survey - sample template

Now narrow the questions down. Try to keep the survey as short as possible - the longer and more complicated the survey is, the fewer returns you'll get. The fewer pages, the better. As a rule of thumb, you should have about 30 items, not including demographic information (which should be about 8 to 10 questions). A 30-item survey takes the average person about 15 minutes to fill out.

Decide what type of demographic information (age, sex, race, number of children, income, level of education, type of job, etc.) is important to include in your survey. You may want to put the demographic questions on a separate sheet from the other part of the survey.

How should you distribute your concerns survey?

There are several strategies for distributing surveys. You may want to use a combination of methods.

Direct mail

You can directly mail the survey to people whose addresses are known. Distributing a survey by mail has a high percentage of non-responders (you're lucky if 30% respond, although it tends to be higher in small communities), but it's a lot easier than many other methods and takes less staff hours.

• Gather the items you'll need to do a direct mailing:
  • Mailing labels or a mailing list: If you're mailing the survey to everyone in town, the city's billing lists for water bills might be a good source of a mailing list. The mailing list of relevant agencies can also be useful. Good resources might be the public health department, the Salvation Army, relevant United Way agencies, emergency medical services, or companies that develop phone books. If you're using an agency's mailing list, be sure to get permission from the agency's director before doing the mailing. Give the director a sample survey and a copy of the cover letter to review and invite him or her to suggest any changes that might further protect his or her clients.
  • Two business envelopes and two stamps for each participant: One set to send the survey to the participant and one for it to be returned in. The return envelope should be pre-stamped and pre-addressed.
  • One copy of the survey, demographics sheet, and cover letter for each participant.
• Complete the cover letter. A sample cover letter you may want to use as a guide appears with the other examples at the end of this section.
• Make enough copies of the survey, demographic sheet, and cover letter for each survey recipient.
• Prepare the two business-size envelopes for each person. One should have the agency's return address and a mailing label for the survey participant; the other should have the agency's address listed as both the mailing and the return addresses. Stamp both envelopes.
• Stuff the envelopes that have the recipient's mailing address with all the survey materials - the survey, the demographic sheet, the cover letter, and the return envelope.
• If you want to track the surveys in any way - trying to see what sort of answers you get from different parts of town, for example - you may wish to code the envelopes in some way. One way you can do this is by numbering each return envelope and keeping a copy of the mailing list with matching numbers - for example, if John Doe at 123 Main Street is assigned number 007, then the number 007 will also be on his return envelope. Another option is to color code the surveys by zip code.
• Mail them out. Try to get a bulk rate to reduce costs.

Other methods of distributing or collecting surveys

• Drop boxes: Agencies that have relatively frequent contact with clients - such as once a month - you may find that setting up a drop box in their offices are a good source point for distributing surveys. For agencies that have an incomplete mailing list, this may be a good option. It can also be a good way to contact clients of other agencies who have little contact with your group or agency. However, if you use this method of distributing surveys, consider using it along with at least one other method of distribution, because this only surveys those who are already accessing services.
• Media distribution: For general distribution, publishing a survey in the local paper or attaching a survey to your newsletter might be a good idea.
• Convenience sampling: Taking surveys in a public place - setting up a booth or table in the parking lot at a local discount store, on the sidewalk in the shopping district, etc. - provides an opportunity to get some exposure for your organization.
• Group administration: If your group or organization tends to have large group gatherings, proving surveys to everyone who attends a particular gathering might be a really efficient way for you to gather information.

Examples of gatherings where you might want to distribute your concerns survey would include: immunization clinics, food pantries or commodity food distribution sites, health fairs, and meal sites for older adults. If you want to give your survey out at some sort of group meeting or gathering, get the group's director to put you on the agenda. At the meeting, introduce yourself and explain the purpose of the survey. Then distribute the survey, answer any questions, and collect completed surveys. Don't forget to thank everyone for their participation.

• Door-to-door canvassing: For those who have difficulty reading or using printed materials and can't come to the agency, going to their homes might be the most appropriate thing for you to do in order to get them to respond to your concerns survey. If your organization is in an area with a high percentage of clients who can't read, for example, door-to-door canvassing would be a good way to make sure those clients' concerns are included in your survey.
• Using multiple methods of distribution: You can combine or adapt two or more of the above methods to suit your own purposes, if you'd like. If more than one method is used, each survey should include instructions that each citizen should complete only one survey.

Collecting the surveys

Soon after the surveys are distributed, completed surveys will begin to arrive.

Here are the steps you should take to collect your surveys:

• Gather incoming surveys collected at participating sites. A representative of your organization should collect incoming surveys as they arrive in the mail or your drop box. He or she should also call or stop by collection sites from time to time to pick up any surveys that have been dropped off.
• Review returned surveys. Check for incomplete surveys. If any surveys were returned for having an improper mailing address, try to find the correct address and mail it out again, if you can.
• Secure a larger return, if necessary. If less than 10% of the distributed surveys are returned, try one or more of the following strategies:
  • Send a reminder to all or a random sample of people on the mailing list.
  • Contact the local newspaper and request an article on the survey, submit a letter to the editor about it, or publish an announcement about the survey. 
  • Contact radio stations to run announcements inviting people to take part in the survey.
  • Invite citizens to participate in the survey through announcements online, in local agency newsletters, consumer group meetings, and public community events.
  • Post announcements of the survey in public places, like the library, coffee shops, and grocery stores.

How do you analyze and compile the results of your concerns survey?

Once you've gathered the completed surveys, you'll need to figure out the results by averaging the importance and satisfaction reported for each item or issue.

Let's say this question from the last example appeared on your concerns survey:	How important is this issue to you?	How satisfied are you with the community's efforts in this area?
	Not               Very	Not               Very
Affordable pre-natal care for all pregnant women in Sheboygan County.	0      1      2      3      4	0      1      2      3      4
15 people answered this question. Here are the number of responses for each rating (e.g., in the first column, 1 person answered with a rating of 0, 3 people answered with a rating of 1, and so on)	1      3      2      5      4	2      6      4      2      1
Now, multiply the number of people who responded with each rating by the value of that rating (e.g., in the first column, 1 person answered 0, so that would be 1 x 0; 3 people answered 1, so that would be 3 x 1, and so on)	1 x 0 = 0 3 x 1 = 3 2 x 2 = 4 5 x 3 = 15 4 x 4 = 16	2 x 0 = 0 6 x 1 = 6 4 x 2 = 8 2 x 3 = 6 1 x 4 = 4
Add these figures up for each question. As you see, the numbers are 38 and 24. The overall possible score for each question is 60 (15 people responding x the total highest possible value of each question, which is 4).	0 + 3 + 4 + 15 + 16 = 38 (out of 60 possible)	0 + 6 + 8 + 6 + 4 = 24 (out of 60 possible)
Divide the total for each question by the total possible for each question, and this gives you your percentages.	38/60 = .63333, or 63.3 %	24/60 = .4, or 40%

 

What do these numbers mean? Well, you will need to look at the overall survey to see how each percentage rates relative to the others. Generally, you'll want to rank items according to the ones that have the highest percentages of importance. Then, for each of those, look at how high the percentage of satisfaction with community efforts in those areas. Strengths are items that have high ratings in both importance and satisfaction, while problems are rated high in importance but low in terms of satisfaction.

The next step is to write up a brief report - one page is sufficient - summarizing the strengths and problems as well as an overall approval rating for the community based on the average satisfaction score for all items (an example of this sort of report appears with the other examples at the end of this section). In your report, identify five to ten strengths and five to ten problems in terms of health risks, services, and public perceptions of health issues in your community. Look for any patterns - do people in a particular part of town feel more negatively about health services than those in other areas?

Ask yourself some of these questions in writing this report:

• Does your community have its minimum health services needs met?
• Do your available health resources match your community's health problems?
• Are there deficits in your community's health resources?
• How can your community's existing services be better utilized to improve and promote the health of community members?
• What are the most important or pressing concerns? How should they be prioritized?

Share the above information with your staff. Get their feedback and discuss whether any further surveying needs to be done before completing.

What do you do next with the results of your concerns survey?

Doing a concerns survey is just one part of the concerns report method for community needs assessment. To fully use the concerns report method, you will also conduct a public meeting to come up with some plan of action for addressing strengths and problems, and then you will write a concerns report.

Conduct a public meeting

Set up a public meeting and invite members of the community to discuss the results of the concerns survey and suggest alternatives for preserving the main strengths and addressing the main problems that were identified.

At the meeting, review main strengths and problems that you compiled from the concerns survey. Compare the demographics of the people at the meeting to the demographics of the community as a whole to see who didn't respond - you may decide you need to distribute more surveys. Being sure to take detailed notes, lead a separate discussion on the details of each important issue, focusing the discussion on these aspects:

• The dimensions of the issue
• Potential barriers to solving the problem or issue
• The alternatives that might be used to enhance the strengths or alleviate the problems
• Available resources

After the meeting, write up a one-page narrative for each issue discussed by the group. This narrative will make up part of the final concerns report.

Prepare a concerns report

A concerns report should be made up of a set of citizen concerns that can be used to set an agenda or guide action plans.

Your concerns report should consist of the following:

• Executive memo: one or two pages summarizing main strengths, problems, and ideas for improvements from the perspective of citizens with health concerns.
• Brief report: one-page data report summarizing the importance and satisfaction ratings for the main strengths and problems and including a graphic display of the overall approval rating of the community. This will basically be the same as the preliminary report that you made up upon finishing the surveys.
• Data table: a table displaying the ranking of all items by average satisfaction.
• Problem-solving discussion report: Summary in outline form of the discussion that took place in the public meeting. Each idea or issue that was discussed is summarized separately.
• Demographic data and other displays: Shows who has responded to the survey.
• Suggestions on how to use the report in the planning process