To create best-practice health needs assessments, NWMPHN listens for the voices unheard

  4 July 2024  NWMPHN   

Health needs assessments are critical tools used by primary health networks, hospitals, and policy-makers at all levels of government.

They provide evidence-based insights into the availability of health services, and to the types and distribution of unmet health needs for consumers.

By analysing multiple datasets and taking into account the social determinants of health, which describe non-medical factors affecting health outcomes, they present a picture of supply and demand that is detailed and nuanced.

North Western Melbourne Primary Health Network (NWMPHN), through its Insight, Performance and Digital Services (IPDS) team, is recognised as a leading source of these innovative and informative assessments.

Every three years, NWMPHN produces a health needs assessment covering its entire 3,200 square kilometre catchment. The team also investigates more tightly defined subjects, such as mental health and wellbeing. It also produces major reports for other primary health networks.

To compile any type of assessment, the IPDS team needs access to several very large datasets – some publicly accessible, others limited to authorised users. These range from census information compiled by the Australian Bureau of Statistics, to de-identified material recording emergency department presentations, mental health diagnoses, and demand for general practice appointments.

But one of the most important insights to emerge from this process – ironically, perhaps – concerns what the data doesn’t reveal.

“All the material available to us is extremely valuable, and yields very important insights when cross-referenced and synthesised by our analysts,” says IPDS executive director Emma McKeown.

“But every dataset has its limitations and what is critical for us, given NWMPHN’s commitment to health equity, is to identify the communities that are under-represented in the numbers, or perhaps even absent.

Click ↑ to download the Mental Health – Health Needs Assessment

“If you like, we have to listen for the people whose voices are silent.”

Ms McKeown said her team’s work found that some communities were often downplayed in the data for a variety of reasons.

“Where people are asked to disclose particular things about themselves, impressions of cultural safety play a very important part,” she said.

“For instance, in some settings members of Aboriginal or Torres Strait Islander communities may opt not to disclose their heritage if they feel that doing so might adversely impact the way they are treated.

“Research from several institutions has found that First Nations people are often inadequately represented in datasets. For this reason, NWMPHN interprets them with caution, given that data for Aboriginal people is likely under-estimated.”

And while members of some cohorts feel safer not answering questions, for some others the question is simply not asked in the first place.

This is often the case for gender-diverse people, explained Ms McKeown.

Some datasets, she said, allow sex to be recorded only as a strict male-female binary. This means that transgender, non-binary and intersex people are not recorded.

“This is very unfortunate,” she said. “Gender-diverse people represent some of the most at-risk members of the community, particularly in matters such as mental ill health and being exposed to violence.

“Yet some data collections either don’t allow for anything other than a male or female record, or perhaps offer only an undifferentiated alternative of ‘other’.”

There are signs of change in this area, with the Victorian Government mandating that hospitals must change from asking patients to nominate their sex to a more nuanced and informative two tier system asking for “sex at birth” and “gender”. Nevertheless, perceived lack of awareness remains a factor in dissuading gender-diverse people from disclosing.

“If people don’t feel safe disclosing – if, rightly or wrongly, they suspect that telling a person about their gender might lead to a negative health care experience – it is perfectly understandable that they opt to stay silent on the matter,” she said.

While social change over the past few decades has resulted in much greater community recognition and acceptance of same-sex-attracted people, there are still some circumstances where disclosure might be considered risky.

“Another area where data is likely deformed by cultural concerns is among communities that cohere around certain faiths, languages or shared trauma-based diaspora,” said Ms McKeown.

“The northern and western regions of Melbourne, in which our focus is mainly set, is wonderfully multicultural, with more than 200 languages spoken in the home. About 40 per cent residents were born overseas.”

This points to another challenge faced by the IPDS team.

The Australian Bureau of Statistics, and others, classifies people born overseas in predominantly non-English-speaking countries as ‘culturally and linguistically diverse’, or CALD.

“CALD is sometimes quite a blunt instrument that fails to distinguish or identify very real differences between communities,” said Ms McKeown.

“I think without the extra checks and balances that our team has developed that can be a real risk.”

By using multiple data sources – all of which have slightly different strengths and limitations – the NWMPHN team is able to mitigate this type of distortion to a significant extent. Casting the net wide, as it were, also helps detect the sometimes faint presence of under-represented cohorts.

To further aid this process, the team insists on collecting “qualitative data” for every health needs assessment. This comes from conducting interviews and focus groups with consumers. NWMPHN maintains a pool of resident volunteers, known as People Bank, for this purpose.

“We are also exploring new ways of reaching people, because sometimes the traditional modes of consultation aren’t ideal for reach the seldom heard,” said Ms McKeown.

“It’s critical for primary health networks to hear the answers of the most vulnerable in our communities.”

“And I’m pleased to see that, increasingly, the guardians of the various data repositories are starting to ask the questions.”

To learn more about NWMPHN’s approach to health needs assessments visit this page.