Date of Defense:
February 15, 2019
Introduction: The Scott County Health Department (SCHD) is located within the Quad Cities area (on the Mississippi river, 2 cities in Illinois and 2 cities in Iowa). The Quad Cities is a diverse community where residents have many resources available within the greater metropolitan area. Scott County area has a population of 172,474 and has slightly higher educational levels (92.6%) and median household income ($55,114) than the rest of the state (91.5% and $53,183 respectively); however, a higher percentage of the population lives in poverty (12.4% in Scott County as compared to 11.8% in Iowa) (Iowa Department of Public Health, 2016). While the Scott County population is primarily white (86.4%), significant percentages of residents are minorities including: African American (7.6%), Hispanic (6.4%), and Asian (2.4%). Fewer people in Scott County are foreign born or speak a language other than English (5.7%) as compared to the rest of the state (7.4%) (Iowa Department of Public Health, 2016). Rates of infant deaths (2.7%) and termination of pregnancies (2.7%)–both spontaneous and induced–are lower in Scott County than the rest of the state (3.7% infant deaths and 6.8% termination of pregnancies, respectively). Breastfeeding rates have trailed (64.5%) behind the rest of the state (73.1%) but have been rising steadily since 2006 (Iowa Department of Public Health, 2013). Due to a new grant for maternal health, SCHD’s Maternal, Child, and Adolescent Health (MCAH) team assessed maternal health needs in the Scott County area. The assessment was designed to identify needs of Scott County residents. Through interviews with stakeholders, the MCAH team identified key themes including: existing services that are available to residents, existing services that could benefit from improvement, and services that are not available but would be beneficial.
Experience: The purpose of this field experience was to conduct a needs assessment of maternal health, well-woman visits, and post year preventive care with community partners that review census data and relevant reports, summarize data, and identify resources for gaps in service/priorities.The MCAH team interviewed healthcare providers, nurses, and community organizations to solicit information regarding their perceptions of maternal health needs in the areas they serve. The information gathered was used to inform and develop action plans to address the needs identified.
Organization: SCHD works to promote, protect, and preserve the health of Scott County through leadership, service, education and partnerships. The Maternal Health (MH) program is interested in providing better health and care for pregnant/postpartum women and their families through the MH Program as defined by the Iowa Department of Public Health (Scott County Health Department, 2016).
Methods: Data for this needs assessment was obtained from two sources: the Iowa Vital Statistics 2015, Iowa Department of Health 2013 and 2016, United States Census Bureau and a Strengths, Weakness, Opportunities, and Threats (SWOT) Analysis with key stakeholders including health providers, public health practitioners, and members of community organizations. Stakeholders were selected from a list of professionals from the SCHD and invited to participate via telephone calls. A total of 50 individuals were invited and 30 participated in the final SWOT analysis. Interviews were conducted in person during the months of June-August 2017.
At least two members of the MCAH team travelled to each of the participants’ preferred location. Only one interview was conducted at the SCHD with an independent mental health care provider. Procedures and purpose of the interviews were explained during the phone recruitment and again before conducting the interview for the SWOT analysis. General information about the facility, hours, population served, insurance, maternal health services provided, and preventative services provided were collected first, followed by the questions in the SWOT analysis. The MCAH team asked participants to highlight all strengths, weaknesses, opportunities, and threats to maternal health in Scott County. The interview concluded with an overview of the services that the SCHD provides and exchanging of information so that resources county-wide can be shared and available when needed.
Results of the interviews were entered into a matrix on a Google Doc. The MCAH team reviewed the document and identified common strengths, weaknesses, opportunities and threats that all stakeholders interviewed shared.
Results: Data from Iowa vital statistics revealed that Scott County has slightly higher educational levels and income than the entire State of Iowa (92.% and $55,114), but ironically a higher percentage of the population lives in poverty (Scott:12.4%, Iowa:11.8%) (Iowa Department of Public Health, 2016).The Maternal Health Needs Assessment (MHNA) data showed that Scott County has a disproportionate amount of young mothers (Scott: 52.8%, Iowa: 41.4%) that are also single (Scott: 426.1 per 1,000 live births, Iowa: 352.3 per 1,000 live births) (Iowa Department of Public Health, 2016). Access to 1st trimester prenatal care (23.9%) in 2013 was much lower than the national rate (38.5%). Finally, the percentage of babies breastfed in the hospital (73.1%), while increasing from 2006-2013, is still well under the Iowa state percentage (77.69%) (Iowa Department of Public Health, 2013).
Four key themes were identified through the interviews conducted for the SWOT analysis: needs for more knowledge, education, and support of breastfeeding; better resource coordination throughout the entire county; more client and provider education of MH practices and services; and improved access to mental health services. Appendix A shows a summary of the main findings of the SWOT analysis.
Appendix A: Key findings of the SWOT Analysis with Stakeholders in Scott County, Iowa
|SWOT Analysis Category||Key Findings|
|Strengths||● Home visitation services provided by the Visiting Nurses Association (VNA)
● Women Infants and Children (WIC) has two sites in the county and “is a great resource that is very non-judgmental”
|Weaknesses||● Breastfeeding support and knowledge
● Coordination of resources
● Client and provider education
● Mental health services
|Opportunities||● Breastfeeding education and support
● Resource coordination
● Client and provider education
● Mental health services
● Capturing those of high-risk populations
Lessons Learned: As a life-long citizen of the Scott County area, I was able to see a different side of my beloved community. While acting as the MCAH intern at SCHD, I was able to put into practice key MCH skills learned during my training: needs assessment, working with stakeholders, development of tools for data collection, data analysis, and report writing. Having the opportunity to meet and develop relationships with many of the MH care providers within the Scott County area is invaluable because I was able to develop a network of public health professionals. Developing a network of public health professionals is important to me because these relationships are vital to have so that I can build on my public health experience and knowledge as I continue to work within this field. I was also able to improve my interviewing skills and develop a greater understanding of the methodology utilized for data collection and data entry. This, in turn, allowed me to learn the process of conducting and preparing a needs assessment report to present to the state of Iowa. I also became more confident in my evaluation and MCH skills.
Recommendations: Based on the results of the SWOT analysis, the following recommendations were made:
- The Maternal Health grant would help significantly in breastfeeding education by establishing an outpatient breastfeeding clinic, offer breastfeeding classes and knowledge of lactation consultants as a resource.
- Scott County would benefit from the development of a list of resources on maternal health within the area, maintaining a database of resources, and creating printable lists for each type of resource to help clients navigate where to seek assistance.
Conclusion: The information gathered during my field experience will provide guidance to the SCHD as they plan for the current MH project period. Participants of the MHNA are facing barriers to accessing services, health education, and coordination of community services. While many of the issues identified cannot be fully addressed in the upcoming MH program activities, this needs assessment serves as a guide to help prioritize and begin to address them. This field experience also developed new partnerships and knowledge that allows for continued growth and development of the SCHD’s MH programs.
- Dudley, D. A., Cotton, W. G., & Peralta, L. R. (2015). Teaching approaches and strategies that promote healthy eating in primary school children: a systematic review and metaanalysis. International Journal of Behavioral Nutrition and Physical Activity, 12 (28). Retrieved from https://doi.org/10.1186/s12966-015-0182-8
- Iowa Department of Public Health. (2013). Breastfeeding Incidence . Des Moines, IA: Data and Reports. Retrieved May 31, 2017, from https://idph.iowa.gov/Portals/1/Files/WIC/Iowa%20Breastfeeding%20Incidence%20for %202006-2013.pdf
- Iowa Department of Public Health, Bureau of Health Statistics. (2016). 2015 Vital Statistics of Iowa. Des Moines, IA: State of Iowa. Retrieved December 16, 2016, from https://idph.iowa.gov/Portals/1/userfiles/68/HealthStats/vital_stats_2015.pdf
- Professional Research Consultants, Inc. (2015). 2015 Community Health Needs Assessment. Retrieved November 30, 2017, from http://quadcities.healthforecast.net/2015%20Community%20Health%20Assessment%2 0Report%20-%20Quad%20Cities%20Area.pdf
- Scott County Health Department. (2016). FFY2017 Maternal Child and Adolescent Health Program Request for Proposals (RFP). Des Moines, IA: IowaGrants.gov.
- Scott County Health Department. (2017). Provider Database. Davenport, IA: TItle V Maternal Child and Adolescent Health Program.
- United States Census Bureau. (2016). Quick Facts for Scott County Iowa. Washington, DC: United States Department of Commerce. Retrieved December 16, 2016, from https://www.census.gov/quickfacts/table/PST045215/00