Defining “Community” in Community Health Evaluation

Abstract

This article examines the theoretical basis of the community as it is evoked in health evaluation. In particular, we examine how hospitals carrying out Community Health Needs Assessments (CHNAs) define communities as well as the implications for these definitions for how to study and engage community problems. We present qualitative findings from a sample of Appalachian nonprofit hospitals, who we asked to describe their approach to defining the community in their most recent Internal Revenue Service–mandated CHNA. Drawing upon a theoretical debate in the history of evaluation research, the authors argue that the contemporary community cannot be circumscribed merely by geographic boundaries, nor can it be identified easily with a bounded group of clearly demarcated individuals. Instead, following the tenets of community-based health research, the authors argue for a richer, more dynamic conceptualization of the community in evaluation research in which definitions arise from community bodies themselves.

A framework and process for community-engaged, mixed-methods cancer needs assessments

“…These individuals represented key population Fig. 4 Community prioritization of and strategies from the 2021 Kentucky Cancer Needs Assessment subgroups in the and provided crucial feedback in setting priorities and strategies-reflecting an "interpretive approach" to defining community as highlighted by Franz et al [38]. Although a simple look at incidence and mortality rates reveals the disproportionate burden of cancer in Kentucky, the KY CNA findings illustrate that the causes of this problem and the avenues for addressing it require a much deeper analysis.…”

Initiatives to Support the Transition of Patients With Substance Use Disorders From Acute Care to Community-based Services Among a National Sample of Nonprofit Hospitals

“…Community benefit reporting also only applies to nonprofit hospitals; therefore, these findings may not generalize to all US hospitals. Although we explored the association of hospital care transition practices with characteristics of counties based on where hospitals are physically located—as this is the most common definition of the community served in our sample and in other studies of hospital CHNAs 36 —it is important to note that some hospitals may serve patients across multiple counties or within a specific region of a county. Finally, the community benefit documents in our study spanned from 2019 to 2021, which was also a time in which hospitals may have been highly focused on and strained by COVID-19.…”

The intersection of neighborhood and race in urban adolescent health risk behaviors

“…Second, this study captured census tracts that have limited within‐neighborhood heterogeneity and thus precluded the detection of variability in subjective perceptions of neighborhood disorder. Third, census tracts may be inconsistent with perceived neighborhoods borders (Coulton et al, 2001), given that humans view neighborhood community boundaries organically based on social ties (Franz et al, 2018). Lastly, the current study measured neighborhood disorder as a combination of physical and social disorder, which may confound specific associations derived from different constructs within neighborhood disorder.…”