Integrating Injury Prevention into Community Health Needs Assessments

Taylor Hautala, MPH
Jill Solomon, MPH, CHES
Matthew Myers, MPH
Nichole Burnside, MBA
Carrie Nie, MPH
Shelli Stephens-Stidham, MPA
Jason Goldstick, PhD
Douglas Wiebe, PhD

Community Health Needs Assessments (CHNAs) are a critical tool for hospitals to identify and address a community’s health priorities. Despite the high burden of injuries and violence in the United States, these issues are thought to be underrepresented in CHNAs. For example, in a recent study of CHNAs in 20 cities with the highest rates of violence, only 32% reported violence as a priority need. Nearly 26% of CHNAs did not mention the word “violence” at all in their report. Given that unintentional injuries are the leading cause of death for individuals aged 1-44, including pediatric populations, this lack of representation is a missed opportunity for hospitals to engage in injury prevention. We worked with Safe States Alliance to develop guidance for hospital-based injury programs on the questions to ask that could better represent injury in their assessments.

CHNAs were systematically analyzed from 40 hospitals across the U.S. to assess their inclusion of injury prevention topics. To ensure that we were selecting a geographically diverse sample of CHNAs, we geolocated and mapped the location of each hospital publishing the CHNA. Diversity, in terms of CHNA service area urban/rural classification and social vulnerability, was also considered. The project team then developed a list of injury and violence prevention keywords to flag while reviewing the community health needs assessments. The project team created and utilized a text mining software that identified the use of each keyword within each CHNA. This software counted and identified the occurrences of keywords within CHNAs. Reviewers then manually examined each keyword instance to confirm appropriate contextual use and to identify potential questions to be recommended for CHNA inclusion.

The injury domains most commonly addressed in the CHNAs included mental health and suicide (97.5% of sample used at least one term from this domain) and substance abuse (95%). Domains that were least addressed were drowning (0%) and burns (2.5%). These findings underscore the need for questions and assessments related to drowning and burns in the CHNA process, especially given their disproportionate impact on pediatric populations. Addressing these gaps may help drive the allocation of new resources toward prevention efforts in these areas.

These findings have informed the creation of sample questions for specific injury-related domains, such as abuse/neglect, concussion, violence, drowning, burns, and motor vehicle crash. We hope that these questions can act as a starting point for CHNA teams to better represent injury in their assessments. Future research might involve the development of a validated key word bank, creation of a larger list of useful questions and guidelines for CHNA development, and evaluation of changes over time.

1. Identify gaps in injury prevention representation in CHNAs and its impact on communities
2. Describe a systematic approach to assessing CHNAs for injury & violence content
3. Explore potential methods for integrating injury-related questions into CHNAs