MPH 507 Week 2 Community Needs Assessment Example

Community Needs Assessment: Women Aged 30 to 65 Who Are Overdue for Cervical Cancer Screening in Tolliver County, With Their Own Account of Why

Student Name

Chamberlain University

MPH 507: Public Health Program Planning and Evaluation

Instructor Name

Month Day, Year

Community Needs Assessment: Women Aged 30 to 65 Who Are Overdue for Cervical Cancer Screening in Tolliver County, With Their Own Account of Why

The Community Defined

The community for this assessment is women aged 30 to 65 living in Tolliver County, a composite rural county of about 26,000 people used throughout this course, who have not had cervical cancer screening within the recommended interval. Age 30 to 65 is the range in which national guidance endorses three routes: an HPV test by itself at five-year intervals, cytology on a three-year cycle, or co-testing at five-year intervals (Curry et al., 2018). Primary care in the county comes from a single federally funded health center with three sites, Laurel Valley, no practicing gynecologist, and a hospital 40 minutes away in the neighboring county. Defining the community this narrowly lets the assessment count its members and ask them directly.

Secondary Data, With Years

Three sources were used, each with its year and limits. First, the health center's electronic record, extracted in March 2026, lists 3,940 women aged 30 to 65 seen at least once in the past three years. Of these, 1,180, or 30%, had no cervical screening result on file within the guideline interval. Second, the state's 2024 behavioral risk survey estimate for the county's region, which pools several counties, puts up-to-date screening at 71%, against 79% statewide. Third, the state cancer registry reports 14 cases of invasive cervical cancer among county residents from 2017 to 2021, an age-adjusted rate higher than the state's, though with wide uncertainty because the numbers are small.

These data agree in direction but not in detail. The health center data exclude women who are not patients, perhaps a third of women in the age range, who are likely to be screened even less. The survey estimate pools counties and relies on self-report, which tends to overstate screening.

What the Community Says

The assessment gathered the community's account in two ways, as the assignment allowed. Two community health workers from the health center conducted short structured interviews with 42 overdue women during home visits for other programs in February and March 2026, and the writer held one listening session with 14 women at a church in the county's eastern hollow. Questions asked what had gotten in the way of screening and what would make it easier.

The answers differed from the explanation in earlier county reports, which attributed low screening to stigma and low health literacy. The most common reasons given were practical and specific: the exam itself, described as painful or humiliating, especially after a past bad experience (26 of 42); work schedules that left no weekday time (21); having no female clinician available (18); travel time to the health center sites (15); and the cost of follow-up if something was found (12). Only four women said they did not see a reason to be screened. Several asked whether there was "a test you can do yourself," having heard of one from relatives in other states.

Table 1

Reasons Overdue Women Gave for Not Being Screened

Note. Note. Structured interviews by community health workers, February to March 2026; composite figures constructed for this course.

Assets Alongside Deficits

The county has real assets. Laurel Valley's community health workers are trusted, already visit homes for diabetes and prenatal programs and live in the hollows they serve. Churches host monthly food distributions that reach many of the same women. The health center has a contract with a regional laboratory that runs high-risk HPV tests by PCR. The regional hospital runs a monthly colposcopy clinic for referrals. And women themselves expressed interest in self-collection, which recent evidence supports: PCR-based HPV testing on self-collected samples is about as sensitive for precancer as testing on clinician samples (Arbyn et al., 2018).

Needs Stated as Gaps

Each need below is written as the distance between the current figure and the figure the county should reach. First, screening: 30% of women in the health center's panel are overdue, against a national target near 20%. Second, a screening method acceptable to women who avoid the speculum exam is not offered in the county. Third, follow-up: the health center has no system to ensure that women with a positive result reach colposcopy, and in 2025 roughly one referred woman in three never reached the colposcopy appointment. Fourth, information: women do not know that screening intervals are now longer, and several believed they needed a yearly Pap test, which made screening seem more burdensome than it is.

Criteria Applied Visibly

Four criteria were used to rank the gaps, applied in the open so the result can be checked: size of the gap, seriousness for health, changeability with available resources and what the community said mattered. The screening gap scored highest on size and seriousness. The method gap scored highest on what women said and on changeability, since self-collection uses the existing laboratory contract. The follow-up gap is serious but smaller in numbers and depends on the hospital. The information gap is real but would not by itself change screening rates.

The result is that the priority is a combined one: offer an acceptable screening method to overdue women and build follow-up into it from the start. This was not the writer's starting assumption. At the outset, the plan was a reminder letter campaign, which the community's answers made clear would not address the main barriers.

Limits of This Assessment

The assessment has three limits that affect how far its priority can be trusted. The interviews reached women already known to the health center's community health workers, so women with no contact with the center, who may face different barriers, are underrepresented. The listening session drew women from one church in one hollow. And the reasons women gave are self-reported and may favor practical explanations over ones that are harder to say aloud, such as fear of a diagnosis. The health center's own staff were also asked, and their view matched the women's on schedules and travel but placed more weight on fear than the women did. The program planned from this assessment should therefore keep asking, through its community health workers, whether the barriers it was built around are the ones women face. Programs in federally qualified health centers that rely on community health workers have generally improved screening among the patients these centers serve (Roland et al., 2017), which supports using them to gather that ongoing evidence as well as to deliver the service.

References

Arbyn, M., Smith, S. B., Temin, S., Sultana, F., & Castle, P. (2018). Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: Updated meta-analyses. BMJ, 363, k4823. https://doi.org/10.1136/bmj.k4823

Curry, S. J., Krist, A. H., Owens, D. K., Barry, M. J., Caughey, A. B., Davidson, K. W., Doubeni, C. A., Epling, J. W., Kemper, A. R., Kubik, M., Landefeld, C. S., Mangione, C. M., Phipps, M. G., Silverstein, M., Simon, M. A., Tseng, C.-W., & Wong, J. B. (2018). Screening for cervical cancer: US Preventive Services Task Force recommendation statement. JAMA, 320(7), 674-686. https://doi.org/10.1001/jama.2018.10897

Roland, K. B., Milliken, E. L., Rohan, E. A., DeGroff, A., White, S., Melillo, S., Rorie, W. E., Signes, C.-A. C., & Young, P. A. (2017). Use of community health workers and patient navigators to improve cancer outcomes among patients served by federally qualified health centers: A systematic literature review. Health Equity, 1(1), 61-76. https://doi.org/10.1089/heq.2017.0001