| Abstract: | Survey content is necessarily limited by the investigators' foresight and by prior research on their subject of inquiry. Clinical data must supplement statistical data whenever the prior research is insufficient to delineate exactly what problems to expect. The differing perspectives on needs of patients sometimes set up competing demands. This calls for strategies based on a programmatic or population perspective that identifies the commonalities in patient educational needs from the statistical profiles, while at the same time allowing for the development of interventions that provide for as much tailoring of the educational experience based on clinical judgments as possible. By combining the community health education perspective with a clinical perspective, we were able to design interventions that responded to the educational needs of a population of low-income, black hypertensive patients. A needs assessment process that combined these perspectives began with a historical and community assessment of the problem in its most general terms. A second phase focused on the most important behavioral and organizational points for intervention. A third phase required formal assessment of predisposing, enabling, and reinforcing factors that may be determining the priority behaviors of health care organizational problems. Finally, clinical and administrative judgment sharpened and supplemented the educational interventions that were suggested by statistical data from formal surveys. Behavioral science theory was applied usefully in all these phases.At the time this study was conducted, the authors were all with the Health Services Research and Development Center and Division of Health Education, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21205. Dr. Green is now Director of the Office of Health Promotion, DHEW. Dr. Lewis is currently with the Department of Community Health Care Systems, School of Nursing, University of Washington, Seattle. Correspondence and reprint requests should be addressed to Lawrence W. Green, Office of Health Promotion, Office of the Assistant Secretary for Health, U.S. Department of Health, Education, and Welfare, Room 721B, Hubert Humphrey Building, 300 Independence Avenue, S.W., Washington, D.C. 20201.Parts of this paper were presented at the Second Annual Needs Assessment Conference, March 28–31, 1978, in Louisville, Kentucky; the National Conference on High Blood Pressure Control, Los Angeles, April 3, 1978; and Endocrinology Rounds at the Indiana University Diabetes Research and Training Institute, Indianapolis, January 29, 1979. This research was supported by Grant Nos. 1R25 HL 17016-03 and IT32-H10710 from the National Heart, Lung, and Blood Institute. The authors would like to acknowledge the support and consultation of Drs. Carol Johns and R. Patterson Russell of the Johns Hopkins Hospital and of Robert Bertera, Michael Bowler, A. Judith Chwalow, Sigrid Deeds, Marion Field Fass, Brian Flynn, Michael Gross, Donald Morisky, Patricia Mullen, and Sam Shapiro of the Health Services Research and Development Center and the School of Hygiene and Public Health, Johns Hopkins University. |
