Azrieli Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel.
Int J Equity Health. 2022 Sep 12;21(1):131. doi: 10.1186/s12939-022-01735-z.
The impact of social determinants on health status and outcomes has been widely established. However, it is recognized that health systems' ability to address community health needs may be limited. To better understand the interrelation between social determinants of health and health outcomes, health systems need to understand the health concerns and needs of populations. The aim of this study was to map the perceived health needs of Israel's northern periphery's diverse ethnic and religious communities and regional clusters by conducting a community health needs assessment (CHNA).
The study employed a mixed-methods approach. We conducted a CHNA in the Galilee between November 2019 to January 2020 (n = 750). Additionally, we conducted focus groups using design thinking methodology to better understand the underlying causes of existing gaps between community and healthcare representatives (n = 42). Quantitative data was analyzed using multiple logistic regressions and qualitative data was analyzed using a content and thematic analysis.
Galilee residents perceived sense of community (78%) as the major strength while cancer (53%) was perceived as the major health problem followed by heart disease and stroke (28.4%). The adjusted odds ratios for the association of each predictor with each perceived social and structural determinants of health among respondents indicated that Arab respondents were more likely to report race/ethnicity discrimination, domestic violence, lack of parks and recreation, neighborhood violence, limited places to exercise, school dropout and limited access to healthy food, as determinants affecting health than Jews. Conversely, Jews were more likely than Arabs to report access to mental health services, access to transportation, lack of job opportunities and access to a doctor's office as determinants affecting their health. Qualitative analysis revealed residents felt a 'lack of health security' as a result of problematic access to specialty and mental health services, especially for elderly populations.
CHNA can inform the design of tailored interventions that will improve health for Galilee residents addressing their socioeconomic-cultural-geographical characteristics. The study's findings raise the need to create such tailored approaches to address the lack of health security felt by residents and improve not only health services provision but the social determinants affecting their health.
社会决定因素对健康状况和结果的影响已得到广泛证实。然而，人们认识到卫生系统解决社区健康需求的能力可能有限。为了更好地理解健康决定因素与健康结果之间的相互关系，卫生系统需要了解人群的健康关注和需求。本研究旨在通过进行社区健康需求评估（CHNA），描绘以色列北部边缘地区不同种族和宗教社区以及区域群体的感知健康需求。
该研究采用混合方法。我们于 2019 年 11 月至 2020 年 1 月在加利利进行了 CHNA（n=750）。此外，我们还采用设计思维方法进行了焦点小组讨论，以更好地了解社区和医疗保健代表之间现有差距的根本原因（n=42）。使用多项逻辑回归分析对定量数据进行分析，使用内容和主题分析对定性数据进行分析。
加利利居民将社区意识（78%）视为主要优势，而癌症（53%）被认为是主要健康问题，其次是心脏病和中风（28.4%）。受访者感知的社会和结构性健康决定因素与每个预测因素之间关联的调整后比值比表明，阿拉伯受访者更有可能报告种族/族裔歧视、家庭暴力、缺乏公园和娱乐设施、邻里暴力、锻炼场所有限、辍学和获得健康食品的机会有限，这些因素被认为是影响健康的决定因素。相比之下，犹太人比阿拉伯人更有可能报告获得心理健康服务、获得交通、缺乏就业机会和获得医生办公室作为影响其健康的决定因素。定性分析显示，居民感到“缺乏健康保障”，因为获得专业和心理健康服务存在问题，尤其是对于老年人群体。
CHNA 可以为量身定制的干预措施提供信息，以改善加利利居民的健康，解决他们的社会经济文化地理特征。研究结果表明，需要制定这种针对性的方法来解决居民感到的缺乏健康保障问题，并不仅改善卫生服务的提供，而且改善影响其健康的社会决定因素。
