Community analysis for health planning with vulnerable populations

This article describes how advanced practice nurses used a theory-based community health analysis process to examine the healthcare services most needed and used by an adult public housing community and to examine the satisfaction of the community with those services. The goal of the project was to determine if the identified needs would be amenable to an alternative healthcare delivery model, such as an academic nursing clinic. Data were collected using the Health Needs and Health Status Survey, Center for Epidemiological Studies-Depression scale, interactive participant interviews, key informant interviews and observations. Community residents (N = 242) were typically unmarried, middle-aged, and low income and had multiple chronic physical illnesses, serious and persistent mental illnesses, and/or disabilities. Despite the high identified service need, use of preventative or routine healthcare services was low, with residents using emergency services inappropriately or delaying care until requiring more expensive intensive healthcare services.