title: A Mixed-Methods Approach to Understanding Community Participation in Community Health Needs Assessments.
abstract: Nonprofit hospitals are exempt from paying taxes. To maintain this status, they must provide benefit to the community they serve. In an attempt to improve accountability to these communities and the federal government, the Patient Protection and Affordable Care Act of 2010 includes a provision that requires all nonprofit hospitals to conduct a community health needs assessment (CHNA) and implement strategies to address identified health priorities every 3 years. This Act's provision, operationalized by a regulation developed and enforced by the Internal Revenue Service, mandates the involvement of public health agencies and other community stakeholders in the completion of the CHNA.
  
  
  
  To better understand community participation in nonprofit hospital-directed community health assessment and health improvement planning activities.
  
  
  
  Using a 2-phased, mixed-methods study design, we (1) conducted content analysis of 95 CHNA/implementation plan reports and (2) interviewed hospital and health system key informants, consultants, and community stakeholders involved in CHNA and planning processes. Community participation was assessed in terms of types of stakeholders involved and the depth of their involvement.
  
  
  
  Our findings suggest that many hospitals engaged and involved community stakeholders in certain aspects of the assessment process, but very few engaged a broad array of community stakeholder and community members in meaningful participation throughout the CHNA and health improvement planning process. Vast improvements in community participation and collaborative assessment and planning can be made in future CHNAs.
  
  
  
  On the basis of the findings, recommendations are made for further research. Practice implications include expanding community engagement and participation by stakeholder and activity type and using a common community health improvement model that better aligns hospital CHNA processes and implementation strategies with other organizations and agencies.
authors.affiliation: Department of Preventive Medicine & Community Health, University of Texas Medical Branch, Galveston (Dr Pennel); Department of Health Promotion and Community Health Sciences, School of Public Health (Drs McLeroy and Burdine), and Center for Community Health Development (Dr Burdine), Texas A&M Health Science Center, College Station; and Department of Recreation, Park and Tourism Sciences (Dr Matarrita-Cascante) and Educational Administration and Human Resource Development (Dr Wang), Texas A&M University, College Station.
authors.forename: Cara L
authors.initials: CL
authors.lastname: Pennel
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: McLeroy
authors.forename: James N
authors.initials: JN
authors.lastname: Burdine
authors.forename: David
authors.initials: D
authors.lastname: Matarrita-Cascante
authors.forename: Jia
authors.initials: J
authors.lastname: Wang
mesh_terms: D018672:Community Health Planning / Q000331:legislation & jurisprudence / Q000379:methods*; D003256:Community Participation / Q000379:methods*; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D006292:Health Priorities; D006801:Humans; D020380:Needs Assessment / Q000331:legislation & jurisprudence; D009939:Organizations, Nonprofit / Q000458:organization & administration / Q000706:statistics & numerical data; D058991:Patient Protection and Affordable Care Act / Q000458:organization & administration; D011634:Public Health / Q000379:methods / Q000706:statistics & numerical data; D036301:Qualitative Research; D012017:Referral and Consultation / Q000706:statistics & numerical data; D013781:Texas