Chapter 14. Conducting a Needs Assessment
When deciding whether to provide DSMT services, an organization must first assess the level of demand for this service in the area being considered. Without adequate consumer demand, the program will surely fail. Another key factor is the number of competing programs. If the local market is currently saturated with programs, it will be difficult to achieve success when competing with other established DSMT service providers. Therefore, a complete needs assessment is necessary prior to making the initial financial commitment to start a new DSMT program.
Key Elements of a Needs Assessment
- Statement of Problem
- Prevalence and Incidence
- Sub-categories of potential participants
- Current services available and their costs to the consumer
- Evaluation of program effectiveness and cost-effectiveness of services
- Outcome measures and targets
1. Statement of Problem
The statement of the problem describes the issue that the program will address. This section of the needs assessment should include all of the major issues or controversies that are specific to the service area.
2. Prevalence and Incidence
Understanding the prevalence and incidence rates of diabetes in the service area is critical to knowing the program’s target population. Data on incidence and prevalence of diabetes can be obtained from state or local health departments. In addition, national data are available from the Centers for Disease Control and Prevention at http://www.cdc.gov/nchs/nhis.htm.
The diabetes incidence rate refers to the number of new cases of diabetes over a specific time period—usually one year. Since diabetes is a chronic condition, there are many more people who have diabetes than are indicated in the incidence rate. However, a newly diagnosed person with diabetes is the likely candidate for a DSMT program. It is also important to look at incidence rate trends. If the incidence rate is trending upward, then the program can be reasonably assured that there will be an increasing number of potential participants in the DSMT program. Another important trend is the incidence rate among specific minority groups. According to the Centers for Disease Control and Prevention, there are significant disparities among minority groups with diabetes. In many areas, African Americans, American Indians, and Latinos have a higher incidence rate of diabetes than other groups. Therefore, if the program service area has a large population of any of these groups, it is important to know the rate of diabetes among that them and target marketing efforts to them based on the observed incidence rate.
The prevalence rate provides additional information about the number of people with diabetes, within a given population. Although different from the incidence rate, the prevalence rate provides valuable information about the total number of persons with diabetes in a service area. Prevalence rates are the total number of cases of a disease in a given period of time, which includes new and existing cases of a disease. Prevalence rates are often provided over a year, similarly to the incidence rate. Assessing prevalence rate trends shows how the total population of persons with diabetes grows over time.
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3. Subcategories of participants
Your program should focus on providing services based on the need of the population served. Your potential participants will be more than just a person with diabetes. They may have specific cultural or religious practices that impact the management of their diabetes. As a result, you should document the subcategories of participants. Two categories that often have an impact on diabetes are race, ethnicity, and religion.
4. Current services available and their costs to the consumer
The availability of other programs in your area provides information about access to diabetes self-management education programs in your area. Access should be closely correlated with the prevalence of diabetes in the defined service area. Access to existing services is a key component of the needs assessment process.
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5. Evaluation of program effectiveness and cost-effectiveness of services
If there are programs that are currently providing diabetes self-management education in your community, you need to conduct an assessment about the effectiveness of these programs. Very few programs are community-based. Most follow a clinical model and are located inside large clinical facilities such as hospitals. Unfortunately, low-income vulnerable populations rarely comply with hospital-based education programs. Even if the programs are offered for free there are “opportunity costs” that must be considered. The opportunity costs are the additional costs to the consumer that must be overcome before the consumer can take part in the offering. In the case of hospital-based education, if a free diabetes self-management education program is being provided in the community and the resident must take two buses to get there and forfeit their meal at a congregate meal program, then this program has substantial cost to the consumer. If the consumer does not recognize the value of the course as being greater than the loss incurred to seize the opportunity, then the consumer will not attend the education program, because the “opportunity costs” are too great. A community-based program may have less opportunity costs associated with the program and thus have greater consumer participation. A community-based model can and should co-exist with these hospital-based clinical models. This will increase the effectiveness of both programs to meet the need of the entire community.
6. Outcome measures and targets
Outcome measures and targets are the program objectives to meet the needs of the target population. This section should detail have the program will target the needs of the consumer and measure the outcomes.
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