Custom needs assessment

At this point, you have probably collected some helpful information from existing sources, focus groups and interviews. However, a key strategy to achieving meaningful, long-term change is to base your action plan on detailed evidence collected from a complete range of community stakeholders, particularly older adults, caregivers and service providers.

Taking a grassroots approach, any community can create a custom needs assessment designed for their unique set of circumstances, with questions addressing local realities. By completing four tasks, you will be able to select specific questions for your assessment from the existing AFC and QoL surveys (described in Appendix III). The guide has also categorized these questions using the WHO ’s eight age-friendly dimensions (see Section 3) so you can find questions related to the priorities you have developed. As a result, the guide provides tips for creating a balanced and thorough assessment, and allows you to create content that meets the unique needs of your community.

Objectives

• Collect more detailed information about age-friendly priorities in your community
• Identify your community’s person-environment (p-e) fit

Key skills

• Experience conducting a community needs assessment:
•  
  • community surveys
  • community mapping
  • conducting focus groups
• Basic proficiency with spreadsheet software
• Basic data analysis skills (e.g., data input, calculating averages, making graphs)

Key tasks

• Examine your tool set
• Create a draft list of questions
• Create person-environment
• question pairs
• Finalize the needs assessment

If your local government is leading or supporting your AFC movement, your efforts will benefit greatly from the experience of municipal staff or town/city councillors. Other successful strategies that committees have used include:

1. Collaborating with a university or college in their community or region. Faculty and students are often looking for ways to integrate their research with meaningful community initiatives, and most will have the skills needed to facilitate a needs assessment.
2. Getting advice and technical assistance from professionals in a relevant field (e.g., teachers, professors or accountants), or from a community-based research organization.
3. Accessing the experience and expertise of AFC committees that have already completed a needs assessment in their community. A shared commitment to the value of the AFC movement has been, and will continue to be, central to its success.
4. Submitting a grant to obtain funding to hire an individual with the skills needed to complete a needs assessment.

Task 1: Examine Your Tool Set

Selecting appropriate research and information-gathering tools — or instruments — is the most important task during the needs-assessment step. A poor fit between a tool and what a community is trying to measure can often hinder data collection. Make sure you are familiar with the concepts you are measuring and the specific context of the community you are evaluating. Review the AFC dimension descriptions in Section 3, paying careful attention to how they relate to issues you may have discussed during your community’s focus groups (see Section 4). Use these questions to guide your discussion. As you proceed, use your focus group results to list specific issues related to each dimension.

• What AFC dimensions did your community identify as priorities for meeting the goals of your initiative? What dimensions are lower priorities?
• Are there dimensions that do not apply to your community? Are there unique circumstances related to specific dimensions?
• What issues in your community relate to the dimensions you feel are most important?

Next, select the instruments that will form the basis of your custom needs assessment. To do this, use Appendix II (AFC and QoL Instrument Comparison), which compares all 17 instruments in the guide:

• The relative proportion of person-centred and environment-centred questions each instrument contains;
• The level of objectivity of each instrument;
• Whether each instrument focuses more on the built or the social environment.

You will also need the charts in Appendix III as they relate to the needs-assessment comparison and present a more detailed summary of instruments. They include surveys that measure Quality of Life (QoL) and nine surveys that measure a community’s age-friendliness. Along with each chart, you will also find a description of the instrument that summarizes its strengths, weaknesses and details about its creation and use.

A close examination of many AFC and QoL instruments reveals that AFC instruments emphasize the measurement of community resources (environment-centred) while QoL instruments focus more on individuals’ abilities (person-centred) (see Appendix II). As a result, this guide includes both types of instruments to enhance your ability to create a needs assessment that accurately identifies gaps in your community’s p-e fit.

There are no set rules for selecting instruments for your custom needs assessment. The goal is to identify which of the instruments are strongest (measured in the total number of questions) in the dimensions you prioritized during your focus groups. This will give you access to the greatest range of questions that focus on your community’s needs. Once you have selected the instruments, note each instrument name for future reference. You may also want to consider the following recommendations:

• Select four to six instruments to start. Different instruments contain similar questions and choosing to go through each one will not necessarily yield a better result.
• Choose a set of questions that can help you determine your community’s p-e fit. This is critical to finding the gaps in your community’s age-friendliness. Since the QoL and AFC instruments focus on persons and environments respectively, you will find it helpful to select several instruments of each type.
• Come back to explore other instrument options if you feel you need to expand or fill in any gaps. The instruments you select now are just a starting point.
• Take note of the fact that some instruments’ creators do not allow you to reproduce their content, or only grant access to their content at a cost. You may need to commit extra time or money to gain access to them. The instrument descriptions (Appendix III) will tell you whether the questions are freely available.

Task 2: Create a Draft List of Questions

By creating a short list of instruments, you have taken the first task in developing a set of initial questions that will ultimately become your community’s AFC needs assessment. Review these instruments and select relevant questions that match your identified priorities. These steps will result in an instrument uniquely suited to the needs of your community.

On the University of Waterloo website you will find a downloadable Excel file containing questions and their recommended responses from most of the QoL and AFC instruments in Appendix III. If you have engaged the community to establish priorities and issues, you are ready to use the questions database to start building your needs assessment. Your local priorities and key issues represent the local knowledge in your community. Use them to select questions to make sure your needs assessment is measuring the realities of your community.

The AFC questions database gives access to a range of questions, but does not prescribe what questions you should ask. Its role is to save you the time of crafting questions from scratch, which allows you to spend more time determining what issues need deeper investigation. As you proceed, use the results of your focus groups to gauge the importance and appropriateness of various questions.

Choose relevant questions, along with the associated dimension, p-e rating information and so on, from the database. You will use this information in a later step to assess the balance of your needs assessment. You may also find these tips helpful:

• Age-friendliness is about the fit between people and their community environment, so collect questions about both. Consider that older adults’ relationships with their social environments are just as important as their relationships with their physical environments. Try to reflect this when selecting questions about the community. While certain dimensions may be more important to your community, your assessment should also ideally address all eight dimensions.
• The online database contains questions about mental and physical health — try to cover both subjects in your needs assessment.
• The method you choose to survey older adults and other community members will influence the length of your assessment. Consider the table above as a guide to the number of questions to include, but remember that what makes sense in your community will ultimately drive the overall length.

Task 3: Create Person-Environment Question Pairs

The path to age-friendliness requires a community to find the gaps between its resources (in other words, the environment) and the needs, preferences and abilities of its older adults (in other words, the persons). Your needs assessment must contain a balance of person-centred questions and environment-centred questions in order to identify your community’s p-e fit. Two questions are essential:

1. What do older adults need to do, what do they prefer to do and what are they able to do?
2. What resources does the community environment offer and how does it offer them?

Each question you took from the online database during task 2 contains a code that identifies it as a person-centred, environment-centred or fit-centred question. To make sure you can determine your community’s p-e fit, pair each of the questions you selected with a relevant counterpart. One exception to this is the fit-centred questions, which already focus on the relationship between persons and their environments. If you included any fit-centred questions in your initial list, you do not need to pair them.

You can use two approaches to developing your person-environment (p-e) pairs:

1. The Needs Assessment Comparison (Appendix II) illustrates the ratio of person-centred to environment-centred questions contained in each of the 17 instruments included in the guide. Use the graph on page 76 in conjunction with Appendix III. Find an instrument that has a high number of questions in the dimension you are working with, and that also has a high proportion of either person-centred or environment-centred questions.
2. Use the questions database to search for an appropriate match. Task 4 asks you to complete some calculations to examine the balance of your instrument, and these calculations will be easier if you follow this recommendation.

Use the three examples of developing a p-e match on the following page as a guide to writing your own matching questions. If you need more examples, refer to the questions database to see how person-centred and/or environment-centred questions are generally worded. You should store these new questions on a separate sheet.

Thinking about Audience

As you craft your needs assessment, reflect on the questions you are including and who can provide the most helpful information — older adults and others in your community.

Southwestern Ontario

Brantford’s Age-friendly Community Experience

Succeeding Through Providing a Forum for Open Communication

What has Brantford done?

Through the support of volunteers, grants and in-kind donations, Brantford has developed a Master Aging Plan, an Implementation Plan and is currently implementing its recommendations. Funding was used to focus on the needs of the community. The needs were identified through focus groups conducted across the City and Brant County that helped with developing key informant interviews, a community demographic profile, and several planning sessions. Separate sub-committees on housing and transportation explored the needs of Brantford’s older adult populations. A transportation subcommittee survey assessed the community’s current resources and transportation capacity and explored key service partnerships to use existing transportation resources more efficiently. Two housing forums have opened the lines of communication about accessible and appropriate housing. These are part of the City of Brantford’s broad community engagement campaign involving older adults, city staff, caregivers and members of the local development community. The aim is to clarify, from the perspective of older adults, what constitutes locally appropriate housing design.

Key initiatives include a new bi-weekly column in the Brantford Expositor featuring interviews with older adults and a series of wellness meetings to help bring independent seniors together to learn about health and wellness in Brantford and become better informed on the various community supports available. As a result of the needs assessments, strategies have been implemented to help move Brantford towards becoming an age-friendly community.

How did Brantford get there?

2007: Proposal submitted to the Ontario Trillium Foundation to develop a Master Aging Plan

2008: Development of the Master Aging Plan (MAP) with a grant from the Ontario Trillium Foundation grant

2009: Development of the Implementation plan with the support of the second Ontario Trillium Foundation grant

2010: Grand River Council on Aging (GRCOA) was established

2011 – Present: A third Trillium Foundation grant (2011–2013) supports overseeing the implementation of the recommendations of the Master Aging Plan

What are Brantford’s next steps?

Brantford’s AFC planning experience has led to one key conclusion: the need to look beyond ‘age’ as a determinant of appropriate action. If the focus is placed more on an individual’s functional capacity and social capital, it becomes possible to not only generate more effective solutions, but to generate solutions that benefit people at all stages of the life course.

To learn from other community experiences, visit http://healthy.uwaterloo.ca/~afc/community_stories.html

Example 1

Start with a person-centred question from the LEIPAD instrument:

1. How much do your feelings of anxiety (if any) stand in the way of doing the things you want to do?

Create an environment-centred question to complete the pair:

2. Is there a program in your community designed to help older adults cope with feelings of anxiety that might be unique to an older adult?

Example 2

Start with an environment-centred question from the AARP instrument:

1. Does the community have a regulation about snow removal from the sidewalks?

Create a person-centred question to complete the pair:

2. Do you have any difficulties getting around in the winter because sidewalks have not been cleared of snow?

Example 3

Start with a person-centred question from the WHO QoL instrument:

1. How satisfied are you with the conditions of your living place?

Create an environment-centred question to complete the pair:

2. Does your community have a program to help seniors with home repairs and modifications?

An Example Of Why P-e Fit Is Important

A community has reached a consensus and decided to use an existing AFC instrument to collect data. The chosen instrument has a strong focus on health, which focus groups identified as a priority area. After committing resources to distributing the instrument, the community has reached a representative sample of questions. During analysis, however, it realizes that much of the data is not well suited to specific recommendations for changes in the community.

For example, while they now know that over 80 per cent of older adults in the community feel isolated and lonely, they did not ask what social events are offered for older adults or why they are not attended. Likewise, the assessment found that many mental health programs in the community deal with depression, but older adults were not asked whether depression affected their QoL. Simply put, the community failed to identify the fit between its resources and the needs of its older adults.

At this point, the community has two options. It can write its action plan with the existing evidence, making arbitrary recommendations, or it can spend more time and resources to go back and collect the data it needs to fill in the holes in the evaluation. Neither of these options is desirable to a community that wants to make meaningful change, but has limited human and financial resources to do so.

Fortunately, you can avoid this situation by developing a needs assessment that you have carefully crafted to identify a proper person-environment fit.

Task 4: Finalize the Needs Assessment

Before starting this step, let’s review what you have accomplished thus far:

• You have used the discussions from your community’s focus groups to identify those instruments that served as the foundation for your custom needs assessment.
• Using these instruments, you consulted the questions database and created an initial list of questions tailored to the circumstances and interests of your community.
• You paired all of the questions in your initial list with their p-e fit counterpart and enhanced the capacity of your assessment to find the gaps in your community’s age-friendly infrastructure.

You now have a complete list of questions that resembles a custom-built AFC needs assessment. However, you still need to evaluate your needs assessment before collecting data in your community. Consider the following steps:

Evaluate the Instrument’s Balance

As Section 1 discussed, many interrelated issues related to age-friendly dimensions (as covered in Section 3) affect the lives of older adults. Evaluate your needs assessment for a balance of:

• Questions covering each of the eight dimensions;
• Questions about mental and physical health;
• Questions about the social and physical environment.

The guide helps arrive at a balance of questions by coding each question in the database according to these factors. If you copied these codes into a spreadsheet, calculating a few quick totals can tell you how balanced your instrument is. To do this, you should base all of your calculations only on your draft questions list — the questions you had before completing your p-e pairs. You don’t have to include questions you added during p-e pairing because omitting them will not affect the outcome. Review these suggestions and the graphs below that illustrate the common balance of these factors in the instruments that you have selected. If you feel your needs assessment is unbalanced, use the resources in the previous steps to add or replace questions. Keep in mind:

• No AFC instrument contains a perfect mix of questions and your assessment should reflect the unique priorities of your community.
• Unless you have an explicit reason not to do so, represent each of the eight dimensions in your final product.
• The dimension codes associated with each question that you copied into your spreadsheet will help you calculate the number and proportion of questions for each dimension. You can use these proportions, calculated from the existing AFC instruments that this guide contains, as a rough reference.

Low-Priority Dimensions: Four to nine per cent of the total questions in one instrument.Medium-Priority Dimensions: Ten to 17 per cent of the total questions in one instrument.High-Priority Dimensions: Eighteen to 35 per cent of the total questions in one instrument.

Pretest Your Assessment

Before you are ready to collect data, make sure to review your assessment for important questions or areas that may need clarification. Review the strengths and weaknesses of your assessment with several members of the final audience before collecting data. This process — called pretesting — is one of the most critical checks in a well-designed instrument:

• Select a pretest group that reflects all subgroups that you might ultimately collect data from (e.g., older adults, caregivers, service providers). Consider recruiting participants from the list of individuals who participated in the focus groups in your community.
• Identify individuals who are not currently aware of the AFC initiative, since most individuals in your final sample will likely fit this category.
• Test your assessment with this small group of participants (approximately five to 10 per cent of your final sample) and then discuss opportunities for improvement.

The following resources contain a great overview of the pretesting process and can help you determine what you need to ask to achieve a clear and comprehensive final assessment.

SPSS - 13 important tips to help you pretest your surveys, available on the University of Guelph’s website.

Designing Surveys: A Guide to Decisions and Procedures (Authors: Czaja & Blair).

Appendix IV outlines a process for completing a descriptive analysis of your needs assessment. If your needs assessment includes a set of questions about older adults’ “Independence and Life Satisfaction,” it may be possible to examine how much the other dimensions contribute to this outcome. Appendix IV contains references to additional materials.

Southwestern Ontario

Waterloo’s Age-friendly Community Experience

Amplifying Strengths and Addressing Weaknesses

What has Waterloo done?

One important highlight of Waterloo’s age-friendly initiative has been the creation of a comprehensive and representative needs assessment. Through a number of public forums and a customized survey produced by the University of Waterloo, the City gained an intimate understanding of its level of age-friendliness. This has led the Advisory Committee to point out that “recognizing and building on existing strengths is as important to community improvement as a willingness to examine and discuss weaknesses”. Waterloo’s strengths include pleasant public areas, meaningful volunteer opportunities, and diverse, convenient, and affordable social events. The City plans to address concerns about housing affordability, high curbs, and a lack of outreach to socially isolated seniors.

How did Waterloo get there?

2009: Mayor Brenda Halloran hosted a forum on aging issues

2010: An Advisory Committee to the Mayor was established

Three public forums were hosted

The Advisory Committee undertook a needs assessment with the help of City staff

A customized survey was distributed to the community and results were analyzed by the University of Waterloo

2012: Waterloo became a member of the World Health Organization Global Network of Age-friendly Cities and Communities

2013: In the process of creating an Age-Friendly Community action plan

Exploring funding opportunities

2011: Five subcommittees reviewed the collected data and produced a report containing recommendations for the City of Waterloo

What are Waterloo’s next steps?

The Advisory Committee will continue to develop an Action Plan. It then anticipates submitting it to council for approval, implementing the plan, and eventually evaluating its results. As a member of the WHO Global Network of Age-friendly Cities and Communities, Waterloo is required to demonstrate continual improvement. As such, Waterloo will continue to assess the needs of its residents and respond to those needs, in the pursuit of becoming more age-friendly.

To learn from other community experiences, visit http://healthy.uwaterloo.ca/~afc/community_stories.html