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 can be used in community needs assessments to identify its unique strengths and needs. Why conduct a concerns survey? Inform your efforts to be sure pressing concerns are addressed. Additionally: It involves community members in the decision-making process early on, which increases their likelihood of getting and staying involved. It asks community members to define what they see as most important -- not just service providers and professionals. It is a systematic way to tap into information and help build consensus. 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 helps set the agenda for community work. Who should you survey? The survey should be given to as many local people as possible, especially those affected by the issues. How should you prepare your concerns survey? Give some thought before you begin to know how many surveys you'll distribute, and what sort of resources and supplies you'll need. For example, you may want to consider: If you will use an online survey mechanism to collect responses, How many hard copies will be distributed, and what partners may be able to support distribution, Who will be able to help distribute surveys, collect responses, and tabulate the results Put together a working group to design the survey Since this is a community survey, it is important that community members decide 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, those being surveyed. For example, if you are interested in general 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 concerns, race and ethnicity, income, sex, age, educational background, employment, and living conditions. To recruit working group participants, ask 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 to brainstorm 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, business leaders, and representatives of the boards that make decisions about local funds such as United Way or the Community Development Block Grant Advisory Board. You'll need to describe to them the process and the intent of the survey. Explain the survey process and why the survey is being done. Ask the decision maker if they have any particular topics or concerns they 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. Let the decisionmakers know when you expect the survey to be completed, and that you'll send them a copy of the final report. Prepare your survey There should be two types of questions for every selected issue: how important the issue is, and how much satisfaction they 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 Questions Importance Satisfaction Not Very Not Very Affordable pre-natal care for all pregnant women in our county. 0 1 2 3 4 0 1 2 3 4 After-school recreation programs for teens in our schools. 0 1 2 3 4 0 1 2 3 4 Free transportation services for all disabled citizens in our 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. 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. Go to where people are: Where are the people you are trying to reach already gathering? Where are they receiving services? Make the surveys available in waiting rooms in public places. Volunteers can help people complete surveys at community events. Set up a booth or table at your local library. This also provides some exposure for your organization. Mailings: You can directly mail the survey to people whose addresses are known. Good resources might be the public health department or relevant United Way agencies. 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. If you use this method of distributing surveys, use at least one other method of distribution, because this only surveys those who are already accessing services. Media distribution: For general distribution, publishing a link to a survey in the local paper or attaching a survey to your newsletter might be a good idea. 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, collect completed surveys, and 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. Collecting the surveys 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. 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. Promote the survey on social media. Consider hanging flyers with QR code links to the survey in public places, like the library, coffee shops, and grocery stores. Send a reminder to people. 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. How do you analyze and compile the results of your concerns survey? Once you've gathered the completed surveys, you'll need to average the importance and satisfaction reported for each item. 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 our 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 = 03 x 1 = 32 x 2 = 45 x 3 = 154 x 4 = 16 2 x 0 = 06 x 1 = 64 x 2 = 82 x 3 = 61 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 your community. Look for any patterns by geographic area and sociodemographic breakdowns. Ask yourself some of these questions in writing this report: Does your community have its core needs met? Do your available resources match your community's problems? Are there deficits in your community's resources? How can your community's existing services be better utilized to improve and promote the health and well-being of community members? What are the most important or pressing concerns? How should they be prioritized? Share the above information with partners. Get their feedback and discuss whether any further surveying needs to be done before completing. Compare the demographics of the people who responded to the survey to the demographics of the community as a whole to see who didn't respond - you may decide you need to distribute more surveys. 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 share results, come up with some plan of action for addressing strengths and issues, and 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. 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 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 Contributor Chris Hampton Resources Print Resources Fawcett, S., & associates (1980). Concerns report handbook: Planning for community health. Lawrence, KS: Schiefelbusch Life Span Institute, University of Kansas. Fawcett, S., Muiu, C., Seekins, T., Whang, P., Fletcher, R., & Hannah, T. (1982). A systematic method for identifying consumers' concerns about mental health institutions. Mental health and Mental Retardation Quarterly Digest, Volume1, No. 4. 1-4. Fawcett, S., Suarez de Balcazar, Y., Whang-Ramos, P., Seekins, T., Bradford, B., & Mathews, R. (1988). The concerns report: Involving consumers in planning for rehabilitation and independent living services. American Rehabilitation, July-August-September. 17-19. Fawcett, S., Seekins, T., Whang, P., Muiu, C., & Suarez de Balcazar, Y. (1982). Involving consumers in decision-making. Social Policy, Vol. 13, No. 2. 36 -41. Kansas Department of Health And Environment, Kansas Hospital Association, and Kansas Association of Local Health Departments (1995). Kansas Community Health Assessment Process Workbook. Topeka, KS: Kansas Department of Health and Environment. Schriner, K., & Fawcett, S. (1988). Development and validation of a community concerns report method. Journal of Community Psychology, Vol. 16. 306-316. Seekins, T., & Fawcett, S. (1987). Effects of a poverty-clients' agenda on resource allocations by community decision makers. American Journal of Community Psychology, Vol. 15, No. 3. 305-320. Suarez de Balcazar, Y., Bradford, B., & Fawcett, S. (1988). Common concerns of disabled Americans: Issues and options. Social Policy, Vol. 19, No. 2. 29-35.
