This chapter will provide guidance on examining and assessing communities, with the aim of allowing midwives to play a much greater role in supporting and having input into community health needs assessment and the identification of health needs related to maternal, child and family health. When trying to see where this activity ‘fits’ within a public health approach to health care provision, it may be helpful to refer back to the continuum provided in Chapter 3 (Table 3.3). The diagram indicates that health needs assessment and community profiling are distant from the immediate activities and involvement with individuals. This can be a challenge to traditional midwifery practice since it may call for an approach which differs from traditional working boundaries. Before trying to assess a community it is crucial to try to gain some agreement and understanding about what actually constitutes a community. It is generally agreed that communities have some form of social dimension to them – a common bond or shared interest. When we think about the concept of a community as a location, then the common bond tends to be the geographical area, for example a town, street of houses or a housing estate. It is also possible to have institution-based or defined communities such as schools, universities or work places. We also define ourselves within cultural or religious communities, and finally there can be communities of interest such as professional communities, pressure groups or leisure communities. McMurray (1999) offered an interesting perspective when describing an ecological view of community which she defined as ‘an interdependent group of plants and animals inhabiting a common space’ (1999:6). This definition highlights some key areas for consideration, the issue of a common bond or interdependence and the fact that there tends often to be a geographical or land-based association is an important idea to be aware of. Health needs assessment and the identification of unmet needs is a key component or strategy in attempting to address health inequalities. The issues relating to health inequalities are discussed in Chapter 4. A key target in the Tackling Health Inequalities document (DH 2003) is to improve early antenatal booking and take-up rates for women from low-income families and black and minority ethnic groups. Midwives were one of the key professional groups identified to work with communities to ‘identify their needs, ensuring services are culturally appropriate and accessible, providing better information’ (2003:25). The document goes on to suggest (p. 28) that future practice and policy should ensure that ‘local people are involved in identifying local needs, influencing decision making and evaluating local services’. Bradshaw (1972) outlined four types of need as follows: Normative need – defined by professionals according to professional standards Felt need – individual or community perceived wants, desires and wishes Expressed need – when felt need is made clear to others or expressed as demands Comparative need – a need identified in relation to others (equity or access for example). A differing approach to exploring need was provided by Gough (1992) and is outlined in Box 6.1 – this overview of need is clearly much more aligned to physical and psychological needs and identifies needs in a staircase fashion. For example, the need for adequate food and nutrition comes before all else, and once this need is met the next dominant need is that of adequate shelter or housing. In Western societies these needs may seem far removed from your experience; however, in examining the needs of homeless people, for example, this approach does not seem quite so unrealistic.
Community spirit: looking beyond the obvious
INTRODUCTION
COMMUNITY – A KEY ASSUMPTION
IDENTIFYING NEEDS – A KEY CHALLENGE
Community spirit: looking beyond the obvious
