Health needs assessment and needs-led health service change: a survey of projects involving public health doctors.
OBJECTIVE
To describe the criteria that define an effective health needs assessment and to explore which factors are important for the delivery of effective health needs assessment in the English National Health Service (NHS).


METHODS
A postal questionnaire to all public health doctors in an English health region to describe health needs assessment activity, including initiating factors, methods and outcomes. This was followed by semi-structured interviews with public health professionals and others involved in 10 purposively selected needs assessments.


RESULTS
A response rate of 62% identified a total of 102 health needs assessments undertaken between 1993 and 1998. A number of themes emerged as being important in the impact of health needs assessments on policy and planning. These included careful design, methodological rigour, decisive leadership, good communication, involvement and ownership of the work from relevant stakeholders, support from senior decision-makers, appreciation of the political dynamics and engagement with local priorities, availability of resources and, finally, an element of chance. These themes can be categorised broadly into contextual factors and quality or robustness of the work. Our findings suggest that, although methodological and analytical quality are necessary characteristics of effective health needs assessment, they are not sufficient without a favourable political environment.


CONCLUSIONS
There appear to be conditions under which needs assessment is more likely to be effective in terms of its influence on policy and planning. However, it is clear that needs assessment does not occupy a central position in health service decision-making, remaining vulnerable to a range of factors over which those responsible for its conduct have little or no control.
Jordan
Joanne
J
Department of Sociology, University of Ulster, Jordanstown, Newtownabbey, UK.
Wright
John
J
Ayres
Philip
P
Hawkings
Martin
M
Thomson
Richard
R
Wilkinson
John
J
Williams
Rhys
R
D001291:Attitude of Health Personnel; D018672:Community Health Planning / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D003659:Decision Making, Organizational; D004739:England; D019538:Health Care Surveys; D006291:Health Policy; D006801:Humans; D007407:Interviews as Topic; D007857:Leadership; D020380:Needs Assessment / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D009936:Organizational Innovation; D011050:Policy Making; D015397:Program Evaluation; D011634:Public Health / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D013222:State Medicine; D011795:Surveys and Questionnaires