Community Health Needs Assessment

COMMUNITY OF CAMPBELLTON AND SURROUNDING AREAS

SUMMARY REPORTJUNE 2017

SU

MM

AR

Y R

EP

OR

T •

Ju

ne

20

17

3

INTRODUCTION

Making primary healthcare the foundation for its healthcare system is the cornerstone of the strategic plan for

the reform under way in New Brunswick. Primary healthcare represents local services designed to always meet the

health needs of communities and of the individuals who make them up. A community health needs assessment is

performed to set healthcare priorities for each community and to identify individual community assets and chal-

lenges in order to adequately and fairly establish a plan for the development and ongoing strengthening of primary

healthcare. This process uses a population-based approach focusing on the determinants of health and relies on

close cooperation with local communities and engagement from their members.

Campbellton and surrounding areas, as defined

by the New Brunswick Health Council (NBHC),

takes in the following localities: Atholville,

Campbellton, Glencoe, Glenlevit, Robinsonville,

Saint-Arthur, Squaw Cap, Tide Head and

Val d’Amour.

COMMUNITY HEALTH NEEDS ASSESSMENT

Community health needs assessment is a dynamic ongoing process undertaken to identify the strengths and needs

of the community and to enable community-wide establishment of wellness and health priorities that improve the

health status of the population. The process was carried out in compliance with the recommendations presented

in Community Health Needs Assessment Guidelines for New Brunswick (GNB 2013).

The process consists of five key activities:

1. Community engagement;

2. Data collection:

- indicators and data sources;

- gathering new information;

3. Analysis;

4. Develop recommendations/priorities:

- criteria to assess importance;

- share and facilitate CHNA findings;

5. Report back to the community.

4

Co

mm

un

ity

He

alt

h N

ee

ds

Ass

ess

me

nt

• C

OM

MU

NIT

Y O

F C

AM

PB

EL

LTO

N A

ND

SU

RR

OU

ND

ING

AR

EA

S

COMMUNITYHealthsystem

MedicalNon-

medical

Heath needs

Priorities Setting: Consultative Process

Proposition of sustainable, affordable and realistic actions

Community local capacities Proposed solutions Level of communityengagement

BusinessEducation Seniors

Youth

Community& socialservices

CON

SULT

ED S

ECTO

RS

STEP

1ST

EP 2

THEM

ES

METHOD

Community Health Needs Assessment

HEALTH DETERMINANTS FRAMEWORK (142 HEALTH INDICATORS)

Administrative and clinical data Action plan &Implementation

CAC: Community Advisory Commitee

Surveys, reports...

Experts’ opinion

Focus groups | Semi-structured interviews

CONSULTATIVEPROCESSIntegration of resultsIdentification of needs

PRESENTATIONTO CAC

Identification of local leadersOrganization of focus groups

CACPRIORITYSETTING:Classification

CategorizationWeightingRanking

Validation

The data used in this assessment comes from three sources:

1) quantitative data provided by the New Brunswick Health Council (NBHC);

2) discussion groups and interviews with key informants;

3) reports available in the region.

The data was analyzed to identify:

1) needs (problems);

2) assets (existing strengths or programs and services);

3) possibilities (proposed by the participants).

Experts’ Opinions Process

Finally, the appropriateness of services was assessed in order to determine whether existing services can meet the

needs identified and whether resource reallocation or new investments are needed.

PROCESS ANALYSIS

SU

MM

AR

Y R

EP

OR

T •

Ju

ne

20

17

5

PRIORITY NEEDS

After the quantitative and qualitative data analysis results were presented to the Community Advisory Committee,

a two-tiered approach was carried out to synthesize a list of the community’s main health needs. Next, a needs

prioritization exercise was used to establish a list of priorities according to weighted criteria.

1 HEALTH PROMOTION, PREVENTION AND HEALTH EDUCATION

• Greater public awareness and emphasis of health promotion programs

• Literacy and health literacy

• Culture and social values (social skills and competences)

• Support for children and families (overall and systemic support, integration of families into programs

for youth), intergenerational approaches

• Development of health prevention and education programs and services

• Support for behaviours that encourage health (healthy weight and sexual and reproductive health)

• Assessment of the health repercussions of public and local policies

2 MENTAL, EMOTIONAL AND SOCIAL HEALTH,

AND EMOTIONAL INTELLIGENCE

3 FOOD INSECURITY/POVERTY/SOCIAL INEQUALITIES

• Social housing (transition, for seniors [home], respite and convalescence, emergency, etc.)

• Economic crisis, recruitment and retention of employees

4 MANAGEMENT AND CONTROL OF CHRONIC ILLNESSES

5 STRENGTHENING PRIMARY CARE

• Lack of health resources (community health centre, nurse practitioner)

• Accessibility of services (telemedicine, cyberhealth, public

and volunteer transportation, etc.)

• Transition hospital-community

• Fragmentation of services and lack of coordination

• Complexity of and gaps in the health and social

services system

6

Co

mm

un

ity

He

alt

h N

ee

ds

Ass

ess

me

nt

• C

OM

MU

NIT

Y O

F C

AM

PB

EL

LTO

N A

ND

SU

RR

OU

ND

ING

AR

EA

S

OTHER NEEDS

Access to transitional care

With new approaches to outpatient care and deinstitutionalization, the transition from the hospital to the commu-

nity and vice-versa has become a key issue for the quality of services received and user satisfaction. The community

formulated various needs in this respect. Those most often discussed were related to:

1) quality of health communication;

2) continuity of healthcare;

3) adaptation to patients’ socioeconomic realities.

With respect to good and effective communication, the community brought up the lack of transmission of pertinent

information in a format that is readable to the patient (e.g., use of medical jargon, giving written documents to

patients who can’t read, etc.) and easy to implement (e.g., too much information to be assimilated rapidly, lack of

clarity and explanation).

The community is experiencing an economic crisis and major problems with housing insecurity and homelessness,

particularly among those 18 to 45. The high prevalence of chronic illnesses, especially mental health issues, in

this population subgroup is a concern and requires radical adaptation of healthcare services to the socioeconomic

realities of these patients.

Dealing with the isolation of seniors

A significant proportion of the population is over 65. One large effect of the economic crisis was the exodus of

young families to urban regions, as well as the temporary exodus of middle-aged adults (particularly men) out

West. This situation resulted in greater isolation among seniors, and this is a greater problem for those who are

vulnerable because of their health status (e.g., chronic illnesses or invalidity), economic status (e.g., poverty) psy-

chocognitive status (e.g., low health literacy, dementia, depression, etc.). Various needs were identified in this area

and they fall into three main categories:

1) local culture makes many seniors too “proud” to ask for help;

2) the geographical extent of the region and dispersion of seniors over the territory covered by local services;

3) confidentiality and protection of privacy legislation interferes with declaring that someone is vulnerable

without his or her consent.

Improved home care

Improved home care is a crying need in the community. There are various factors: lack of access to nurses from the

Extra-Mural Program (EMP), difficulty in identifying people requiring care, reductions in some services provided by

the EMP.

SU

MM

AR

Y R

EP

OR

T •

Ju

ne

20

17

7

AUTRES BESOINS

Support for caregivers

Caregivers are a major resource for keeping vulnerable persons or those with special needs at home and in the

community. However, the community decried the lack of support structures for this community resource and the

low value placed on its contribution to continuity and quality of care.

Health education and literacy

The region has a high illiteracy rate and issues related to health literacy. It is therefore important to make adequate,

adapted, person-centred health communication a major component in the quality of services, as much in health-

care as in other areas like banking or social services. Another question raised was the “expedite and prescribe”

approach used by some healthcare professionals, which leaves little room for patients to ask questions and ensure

they understand the instructions given.

Health promotion and prevention

The community decried the high prevalence of risky health behaviours and preventable chronic illnesses. With

respect to risky behaviours, the community advised investing sustained efforts in preventing smoking, the con-

sumption of energy drinks by youth, drug addiction, including cannabis, falls and involuntary injury.

Special efforts should also be invested in primary prevention to avoid problems with unhealthy weight (promotion

of healthy diet and physical activity), as well as secondary prevention to improve management of chronic illnesses

and reduce related complications.

Youth and wellness

The health and wellness of youth in the community represent a major concern. The community indicated various

causes, some socioeconomic and others individual:

1) destabilization of the family unit caused by fathers leaving to find work, more families led by single

mothers and various related problems;

2) lack of transportation for youth, interfering their access to services and programs;

3) lack of appropriate medications for youth;

4) disengagement and lack of availability of parents;

5) lack of social activities for youth;

6) lack of preparation among youth for the realities and constraints of life in society and the workplace

(professional engagement, respect for rules and individuals, etc.).

There also seem to be differences between Anglophone and Francophone districts with respect to youth health,

notably in the rate of smoking and the consumption of energy drinks, both higher in the Anglophone schools.

8

Co

mm

un

ity

He

alt

h N

ee

ds

Ass

ess

me

nt

• C

OM

MU

NIT

Y O

F C

AM

PB

EL

LTO

N A

ND

SU

RR

OU

ND

ING

AR

EA

S

Youth education on sexual health

Improved sexual health education programs for youth was identified as an important need in the community.

The main problems identified in this regard are:

1) hypersexualization of young girls;

2) the phenomenon of “sexting” and exchanging nude photos over the Internet and using cellphones;

3) the high rate of teen pregnancy, which can be explained by low self-esteem, the belief that they will

get social assistance or that having a child will solidify their relationship with their partner;

4) underutilization of sexual health services by youth.

Dealing with mental health and addictions

The community clearly expressed the need for better handling of mental health problems in the region. The preva-

lence of mental health problems in the region is among the highest in the province. “We have the highest rate of

files here, in mental health services.”

Gambling addiction is a major problem in the community. Absenteeism, food insecurity for families and theft are

some of the repercussions most commonly observed in the individuals involved.

Programs for severe chronic respiratory illness

Adequate treatment of respiratory illness is a major problem for the community. Rates of admission for respira-

tory illnesses are among the highest in the province. However, “not more COPD here, but many are more severe

and have no access to necessary care; medications but you also need activity with COPD. With oxygen at home,

patients are only allowed out of the house twice a month with reimbursement for the oxygen, and this makes the

problem worse.”

SU

MM

AR

Y R

EP

OR

T •

Ju

ne

20

17

9

Improved primary healthcare services

The various challenges in access to healthcare services include:

1) the geographic area and lack of local services, especially specialized care provided only in cities like Moncton

or Saint John;

2) overutilization of emergency departments, reflecting the inadequacy or low accessibility of primary

healthcare;

3) lack of access to medications because of low income or lack of insurance coverage;

4) restrictions on services offered by nurse practitioners;

5) lack of access to a walk-in clinic that includes a physician or nurse practitioner in Campbellton;

6) lack of access to phlebotomy services in the community (patients have to go to Emergency);

7) difficult access to healthcare services in the language of choice;

8) lack of access to healthcare services for students at the community college;

9) lack of access to family physicians.

Many problems related to the quality and effectiveness of healthcare were raised:

1) the absence of “electronic patient charts” detracts from the continuity of information and care;

2) the lack of awareness of some physicians of the needs of seniors (e.g., visit for multiple health problems,

need to be accompanied by a spouse, inability to understand multiple directions);

3) the challenge of “one problem per visit” in certain family practices (sign in the waiting room);

4) certain health services and programs are delivered using a model that does not fit the reality of the population;

5) lack of integration among mental health, public health and social development services, especially in cases of

chronic illness;

6) lack of coordination of healthcare and services, especially for patients treated both locally and by a team in

Moncton (oncology) or Saint John (cardiology);

7) lack of continuity of information, which sometimes causes multiple visits to the physician or the duplication of

medical exams and tests because of a lack of communication between physicians and healthcare professionals;

8) lack of standardization of medical practices based on Canadian recommendations, reducing the quality of

care (elements raised by different categories of health professionals: physicians, nurses and pharmacists);

9) lack of linguistic adaptation in communication during clinical visits. Beyond bilingualism or the active offer

of healthcare services in the language of the patient’s choice, the mastery of local expressions and linguistic

adaptation were often raised by the community and represent a real problem to be solved, because they

seem to sharply reduce the quality of services.

10

Co

mm

un

ity

He

alt

h N

ee

ds

Ass

ess

me

nt

• C

OM

MU

NIT

Y O

F C

AM

PB

EL

LTO

N A

ND

SU

RR

OU

ND

ING

AR

EA

S

Consolidation of intersectoral collaboration and communication

The challenges faced by professionals in setting up effective action strategies are basically related to legislation

on confidentiality and protection of privacy. It is hard to implement systems to systematically track or identify

vulnerable persons in a context of protection of information. The major need expressed by the community was for

the creation of interfaces for intersectoral collaboration adapted to the users of services rather than Departmental

mandates. “Useful to have a network that could help us in our work.”

Affordable and adequate transportation

Lack of access to transportation is raised as an important problem in this community, and it has repercussions on

access to healthcare services. Low income, lack of organized transportation and lack of promotion of volunteer

services are major challenges. Those with reduced mobility have little access to transportation because of their

special needs, creating an additional barrier for them. The challenge is even greater because numerous services are

not available locally and many patients have to travel to Bathurst, Miramichi, Moncton or Saint John.

Dealing with poverty and vulnerable populations

Poverty is a significant concern for the community (“problems are more and more complex, and affect more and

more people”), especially because of the exodus of those with better educations toward the urban centres. Many

challenges related to this problem came up during the discussions:

1) lack of access to medications and to support in this area among low-income groups;

2) lack of supports for vulnerable populations, in particular the absence of a homeless shelter,

“emergency beds” and availability of foster families;

3) placing young offenders away from the community, reducing access to nearby family support;

4) food insecurity among youth;

5) the high cost of healthy food and lack of education about it;

6) high rates of depression in vulnerable populations;

7) absence of insurance coverage, which sometimes makes access to necessary medication difficult;

8) stigmatization related to negative judgments and perceptions about vulnerable populations,

which is also an important challenge for dealing with them;

9) lack of access to psychiatric services and to appropriate overall ongoing treatment of patients,

putting them in unstable living conditions;

10) large concentration of homeless people in the community, particularly in the 18 to 45 age group,

due to the lack of support services for this population;

11) high number of young people who leave home as young as 13, worsening the problem of

homelessness in the region. The presence of abuse in the community is a worrisome problem

for this group. Abuse of women and children is an especially serious problem because of the

high number of people in the community who own firearms. Incest and child abuse are also

very present in the community.

SU

MM

AR

Y R

EP

OR

T •

Ju

ne

20

17

11

Stimulation of the local economy

The high rate of unemployment and number of families who spend more than 30% of their income on housing,

along with the low median income in the community, are major concerns for the community. Economic instability

and high debt levels in the community have a major effect on local businesses. Exodus of the population towards

urban centres for access to education or employment reduces the number of community residents, especially of

those in good health.

CONCLUSION

Community Health Needs Assessments are an excellent opportunity to

spur dialogue among the various partners and the communities. They

shed light on the priorities for which it is important to find and implement

solutions based on the fields of activity and expertise of each player.

Vitalité Health Network uses the results of these assessments to guide its

decisions and planning. They help it to provide sustainable, accessible,

fair, effective and safe high-quality care and services to the various

communities in its service area.

It goes without saying that improving public health and wellness is

everyone’s business. Many other partners have their own contributions to

make, just like Vitalité Health Network. We must get everyone involved in

order to achieve positive overall results.

Research, analysis and consultation provided by:

Jalila Jbilou, M.D., MPH, Ph.D.