Needs Assessment Work Group Meeting
June 16, 2003 Meeting
Attendees:
Donna Mosby, NAWG Chair
David Johnson, ORRHES Member
James Lewis, Co-Chair
Kowetha Davidson, ORRHES Member
Danny Sanders
Brenda Vowell
Bill Taylor, ATSDR
Melissa Fish, ATSDR
Theresa NeSmith, ATSDR (by telephone)
Marilyn Palmer, ATSDR (by telephone)
Jack Hanley (by telephone)
Lorine Spencer, ATSDR (by telephone)
Purpose:
The meeting was called to order at 7:00 pm. and attendance was noted
for the record. Donna Mosby explained that the NAWG is in the process
of providing feedback about the Needs Assessment. Donna noted that the
minutes for the June 12, 2003 NAWG meeting were sent out in draft form.
Donna Mosby went on to explain that the NAWG is currently in its second
meeting regarding the draft Needs Assessment document. Originally, the
group had planned to have Rebecca Parkin involved in tonight’s meeting,
but based on last week’s meeting, the NAWG changed the plan and
decided to deliberate further before including Rebecca Parkin.
Donna stated that the purposes of this meeting are to specifically focus
on pages 57-60 of the Needs Assessment, to look at the separate draft
Summary page for the Needs Assessment, and ask Theresa NeSmith questions
that will help the NAWG formulate feedback for Rebecca Parkin.
Discussion:
Donna Mosby stated that an issue from the June 12, 2003 meeting that
resulted in a lot of discussion was the various points of view regarding
a health communication outreach program versus a health education plan.
Donna explained that the reason this question came up is because the work
group is trying to figure out what the Needs Assessment document could
do for the Oak Ridge community.
Theresa NeSmith explained the difference between health communication
and health education as could be related to Oak Ridge.
- Health Communication- Theresa told the group that if there was information
available about a meeting or document that has been released, health
communication would provide that information to the community in a form
that is appropriate.
Health Education- Theresa said that health education works with other
parts of the community, such as healthcare providers to interpret the
available information and look for behavior change. Health education
looks to provide information that will result in a change in behavior.
- Theresa NeSmith told the group that she has read the minutes of the
last meeting and has seen the comments about the need for the document
to be more specific. Theresa asked that the group keep in mind that
this is not the final report or the final step in the process. The next
step is that once Rebecca Parkin has received the comments and made
the changes to the report that need to be made, ATSDR will take the
information and develop a health education plan with specific activities
of how ATSDR will address each recommendation. Theresa NeSmith told
the group that they should provide comments about the specifics that
they would like to see in the recommendations as well as other areas
of the Needs Assessment. Once again, Theresa reminded the group that
the next step will be for ATSDR to take the Needs Assessment document
and develop a plan.
Donna Mosby asked Theresa NeSmith if the work group feedback would go
to the ORRHES. Theresa NeSmith responded that she believes the intended
process is that first, the work group develops recommendations, second,
the work group recommendations are taken to ORRHES, ORRHES then decides
whether or not to adopt the recommendations, and then ORRHES recommendations
are sent to ATSDR and ultimately Rebecca Parkin will make the suggested
changes if they are appropriate.
Donna Mosby asked about the intended purpose of having Rebecca Parkin
on the telephone during the next NAWG meeting. Theresa NeSmith responded
that she thought the purpose of having Rebecca on the telephone was to
provide additional clarification for specific questions that the NAWG
might have.
After the discussion, Donna Mosby told the group that it is her understanding
that the reason Rebecca Parkin will be on the telephone at the next meeting
is to clarify any issues or questions that the NAWG may have. Donna also
told the group that the recommendations that NAWG develops will be passed
on to the ORRHES.
James Lewis stated that in the past, with large complex documents, the
work group usually creates an Ad Hoc committee for the purpose of examining
a document and bring the information back to the work group. The work
group then makes a decision and votes, based on the information that the
Ad Hoc presents. James Lewis provided the example of Tony Malinauskas
collecting the comments that related to the Y-12 Uranium Releases PHA.
David Johnson agrees with James Lewis and asked the group if the NAWG
should form an Ad Hoc committee that will look into the Needs Assessment
document further and then present the findings to the work group.
James Lewis believes that the draft minutes of the June 12th NAWG meeting
did an adequate job of capturing the issues relating to the Needs Assessment.
James Lewis went on to acknowledge that the work group may have a lack
of knowledge that requires clarification. However, at the June 12th meeting,
Kowetha Davidson said that the group should critique the methods before
trying to critique the results. James considered Kowetha’s suggestion
and is of the opinion that some disagreements may be associated with looking
at various methodologies.
James Lewis told the group that he reviewed the Needs Assessment document
and found that there were four items of key interest. The four items are
listed in the Table of Contents and include the Literature Review, Key
Resource Interviews, Telephone Surveys, and Focus Group Discussions.
James also looked at the Project Summary Report dated March 19, 2001
(See Attachment). After reviewing the Project Products portion of the
Project Summary document, James Lewis has issues and concerns about how
ORRHES will use the project products. James also reviewed the section
of the Project Summary Report titled Purposes of the Project and the portion
titled Goals of the Project. After reading the goals and purpose James
realized that a key point regarding the Needs Assessment is moving from
the transition phase to Phase II. James Lewis believes that the group
needs to voice concerns and ideas before Phase II is established.
Upon request from Donna Mosby, Theresa NeSmith provided clarification
about the process in which the Needs Assessment comments will be handled
by ATSDR. Theresa said that comments specific to the Needs Assessment
report such as comments about the focus groups or telephone survey will
be used for Phase I. Phase II is the phase in which an actual plan is
developed for the follow-up activity. An example of comments that would
be used in Phase II would include suggestions about disseminating information
to healthcare providers. Thus, depending on the comment, the comment may
be used in either Phase I or Phase II of the Needs Assessment.
Still looking at the Project Summary Report dated March 19, 2001, under
the heading Purposes of the Project, the first bullet reads Develop
new knowledge and insights about the communities’ current health
issues. When James Lewis read the first bullet, the term “new”
jumped out. James Lewis is not sure about what is new because he does
not know what went on in the past. So, in an attempt to become familiar
with information from the past, James looked at the Literature Review
section of the Needs Assessment. James assumes that what is referred to
as new is based upon the review of documents that were supposedly read
by George Washington University staff. James wondered about GWU’s
familiarity with the 1994 report titled Report
of Knowledge, Attitudes and Beliefs Survey of an Eight-County Area Surrounding
Oak Ridge, Tennessee . James added that the 1994 report
came from the Dose Reconstruction effort and that the study used focus
groups and went back into the community looking at 8 counties and contacted
3,269 individuals. James Lewis made a comparison of the 1994 document
to what he envisioned the Needs Assessment document to be.
Kowetha Davidson is unclear of how James Lewis’s remarks are critiquing
the methodology. James Lewis believes that his remarks do relate to the
methodology and he continued to explain that the information presented
to the ORRHES (March 19-20, 2001 ORRHES meeting) discussed different types
of research, quantitative and qualitative. James Lewis had an overhead
which he showed the group (see Attachment). James Lewis explained that
he looked at the Report
of Knowledge, Attitudes and Beliefs Survey of an Eight-County Area Surrounding
Oak Ridge, Tennessee as it related to challenges in the
Dose Reconstruction. This report was a quantitative report that focused
on the community and used detailed questions. But when James looked at
the Oak Ridge Needs Assessment he realized that it is more qualitative.
After listening to James Lewis, Theresa NeSmith told the group that the
intent of the Needs Assessment was for the assessment to be a qualitative
research project.
James Lewis went on to show his interest in the footnote at the bottom
of the overhead. The footnote stated: The two types of research can be
combined as in this project. However, one type or the other is emphasized.
For the Health Education Needs Assessment, qualitative methods will be
the primary method. It will be complimented with limited quantitative
information. James feels that it was indicated that “new”
data would be both qualitative and quantitative. James Lewis went on to
say that the quantitative Report of Knowledge,
Attitudes and Beliefs Survey of an Eight-County Area Surrounding Oak Ridge,
Tennessee had three objectives. One of the objectives was to investigate
people’s perceptions and attitudes about environmental contamination
and health problems related to the Oak Ridge Reservation. James Lewis
feels that the Report of Knowledge, Attitudes
and Beliefs Survey of an Eight-County Area Surrounding Oak Ridge, Tennessee
did an excellent job of providing an understanding of the issues that
relate to Oak Ridge. The quantitative method used in the Report
of Knowledge, Attitudes and Beliefs Survey of an Eight-County Area Surrounding
Oak Ridge, Tennessee provided better information than the qualitative
Needs Assessment. James Lewis feels that the quantitative effort seems
to be more in sync with the group’s expectations than the qualitative
effort of the Needs Assessment.
James Lewis reminded Theresa NeSmith that on a number of occasions he
had asked for sample documents that would relate to the Needs Assessment
document.
James Lewis believes that the Work Group should review the Community
Diagnosis: Anderson, Knox, Loudon, Meigs, Morgan, Rhea, and Roane counties
data, the Report of Knowledge, Attitudes and Beliefs
Survey of an Eight-County Area Surrounding Oak Ridge, Tennessee
, and the Needs Assessment to see how information from all three documents
can help in the Phase II process.
Kowetha Davidson feels that Needs Assessment document should be critiqued
before reviewing other data. James Lewis responded to Kowetha’s
comment by saying that the Needs Assessment does not have enough substance
to critique. James Lewis feels that there are too many generalizations
in the Needs Assessment document and that the large number of generalities
make it difficult for suggestions to be made regarding the Phase II portion.
James Lewis indicated that there are many documents on the Hanford website
that he found helpful. James Lewis provided overheads of two documents
that were printed directly off the Hanford site (See Attachments).
- Request for Medical Evaluation for Past Exposure to I-131
A handout that lists questions and comments that could be used during
an appointment with a healthcare provider
- Theresa NeSmith explained that the types of documents that James Lewis
is discussing would come from Phase II. Theresa said that the two Hanford
documents would be reflected in the final Health Education plan.
James Lewis is extremely impressed with the effort of the Report
of Knowledge, Attitudes and Beliefs Survey of an Eight-County Area Surrounding
Oak Ridge, Tennessee document. James explained that data for this
report came from focus groups. Various Community Organizations were invited
to focus groups. The ideas and concepts that were generated in the focus
groups were put into the survey. James Lewis feels that the Needs Assessment
appears to be taking some degree of credit for the products that were
produced from the Report of Knowledge, Attitudes
and Beliefs Survey of an Eight-County Area Surrounding Oak Ridge, Tennessee
report. Thus, James believes that the work group should take a closer
look at the products that resulted from the previous group’s effort.
Theresa NeSmith responded to James Lewis by saying that she does not think
that anybody, including Rebecca Parkin is taking credit for the findings
in the documents that are listed in the Literature Review section of the
Needs Assessment.
Theresa NeSmith also reminded the work group that the original study
design called for the focus groups to take place before the telephone
survey. Theresa said that the order of the process was changed based on
the ORRHES recommendations.
As James Lewis recalls, the ORRHES was interested in the questions that
would be used in the telephone survey. James said that the ORRHES wanted
to makes sure that the questions were culturally appropriate. It was George
Washington University who considered altering the process; it was not
an ORRHES recommendation or suggestion!
Theresa NeSmith disagrees with James Lewis’s recollection of how/why
the process was altered. Theresa said that GWU addressed the issue of
whether or not the questions were culturally appropriate by pilot testing
the questions. As far as changing the order of the steps involved in the
process, the Subcommittee voted on changing the process.
James Lewis told Theresa NeSmith that he believes she is correct about
ORRHES voting. However, James remembers the suggestion of adjusting the
process coming from GWU. ORRHES did not bring the issue up on its own.
James reiterated to Theresa NeSmith that ORRHES on its own did not try
to tell GWU how to structure or restructure the process.
Theresa NeSmith responded to James Lewis by saying that Rebecca Parkin
gave a presentation on the positives and negatives of changing the study
design. It was at that time that ORRHES voted to change the study design.
James Lewis told Theresa NeSmith that his point is that ORRHES did not
develop the list of positives and negatives about changing the study design,
GWU created the list.
Trying to get back to the list of comments and suggestions that the NAWG
will create for Rebecca Parkin, Donna Mosby reminded the group that at
the June 12th meeting there was agreement about the Summary page of the
Needs Assessment. Some of the issues related to the Summary page included:
- Not knowing who the intended audience was
- Juvenile language being used
- Poor organization
- Extremely vague terms being used (most people, very few people, some,
they)
Theresa NeSmith commented that the language that is used in the Summary
page is consistent with qualitative language and research because the
researchers are not trying to end at a number.
James Lewis told Theresa NeSmith that the Oak Ridge community wants quantitative
information when making decisions.
Theresa NeSmith told the group that it is important that they continue
to think about the purpose of the report. Theresa stated that the purpose
is to provide ATSDR with information that can be used as a health education
plan is developed. Theresa also added that this portion of the Needs Assessment
is only one piece of information that will be used. She also told the
group that most people will be interested in the outcome.
Bill Taylor asked Theresa NeSmith to elaborate on the intended audience
of the Needs Assessment. Who are the recommendations intended for? Theresa
NeSmith told Bill that the recommendations are intended for ATSDR.
Bill Taylor followed up by commenting that ATSDR now has the Needs Assessment
report. Bill then asked what the next step will be. Theresa NeSmith explained
that the work group has 30 days to evaluate the report. Then, ATSDR develops
a health education plan working with the Association of Occupational and
Environmental Clinics (AOEC).
Bill Taylor asked Theresa NeSmith to provide an indication of what the
health education plan will look like. Theresa told Bill Taylor that she
could only provide general ideas and nothing specific because the final
report has not been completed. Theresa said that considering the information
that is available so far, she recognizes a need to work with healthcare
providers. Working with healthcare providers will be a result of Phase
II.
Theresa NeSmith told the work group that based on feedback from the community,
she believes that the community has study fatigue.
Bill Taylor stated that what he is understanding from Theresa is that
the Needs Assessment report is only part of what will go into the health
education plan. Theresa NeSmith told Bill Taylor that he is correct and
that ATSDR will use the Needs Assessment as well as other information
when generating the education plan.
Kowetha Davidson told the group that because of the Needs Assessment
document, she learned new information. Kowetha learned that some people
want to receive health education from faith based organizations.
Theresa NeSmith told the group to keep in mind that when ATSDR is making
its decisions, the Action Plan or Recommendations are not taken as a stand
alone document. ATSDR will look at the entire document when developing
an education plan.
James Lewis stated that after reading the minutes from the last NAWG
meeting, he is reminded of a point which was made by Charles Washington.
James Lewis said that if a document did not achieve its goals then the
document contains flaws. Many people do not want to be linked to a document
with such flaws. James Lewis stated that currently there is not a comfort
level with the Needs Assessment being able to guide anything. James Lewis
added that part of the weakness of the Needs Assessment is the failure
of GWU to review existing documents.
James Lewis presented a Recommendation to the work group.
Based upon the review of the Needs Assessment and the ORRHES
Chair’s suggestion that NAWG should critique the methods before
trying to critique the results, I recommend that we establish an Ad Hoc
Committee to review the current Needs assessment to determine
- If the appropriate methodologies and/or type of surveys
were used
- If GWU met the stated goals and objectives for
- Literature Review
- Resource Interviews
- Telephone Survey
- Focus Group Discussion
- If there is a need for formal implementation of the
Phase II portion of the Community Health Education Plan
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