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Oak Ridge Reservation

Oak Ridge Reservation: Health Needs Assessment Work Group

Health Needs Assessment Work Group

June 16, 2003 - Meeting Minutes


Attendees:

Donna Mosby, NAWG Chair
David Johnson, ORRHES Member
James Lewis, Co-Chair
Kowetha Davidson, ORRHES Member
Danny Sanders
Brenda Vowell
Bill Taylor, ATSDR
Melissa Fish, ATSDR
Theresa NeSmith, ATSDR (by telephone)
Marilyn Palmer, ATSDR (by telephone)
Jack Hanley (by telephone)
Lorine Spencer, ATSDR (by telephone)

Purpose:

The meeting was called to order at 7:00 pm. and attendance was noted for the record. Donna Mosby explained that the NAWG is in the process of providing feedback about the Needs Assessment. Donna noted that the minutes for the June 12, 2003 NAWG meeting were sent out in draft form. Donna Mosby went on to explain that the NAWG is currently in its second meeting regarding the draft Needs Assessment document. Originally, the group had planned to have Rebecca Parkin involved in tonight’s meeting, but based on last week’s meeting, the NAWG changed the plan and decided to deliberate further before including Rebecca Parkin.

Donna stated that the purposes of this meeting are to specifically focus on pages 57-60 of the Needs Assessment, to look at the separate draft Summary page for the Needs Assessment, and ask Theresa NeSmith questions that will help the NAWG formulate feedback for Rebecca Parkin.

Discussion:

Donna Mosby stated that an issue from the June 12, 2003 meeting that resulted in a lot of discussion was the various points of view regarding a health communication outreach program versus a health education plan. Donna explained that the reason this question came up is because the work group is trying to figure out what the Needs Assessment document could do for the Oak Ridge community.

Theresa NeSmith explained the difference between health communication and health education as could be related to Oak Ridge.

  • Health Communication- Theresa told the group that if there was information available about a meeting or document that has been released, health communication would provide that information to the community in a form that is appropriate.
    Health Education- Theresa said that health education works with other parts of the community, such as healthcare providers to interpret the available information and look for behavior change. Health education looks to provide information that will result in a change in behavior.

  • Theresa NeSmith told the group that she has read the minutes of the last meeting and has seen the comments about the need for the document to be more specific. Theresa asked that the group keep in mind that this is not the final report or the final step in the process. The next step is that once Rebecca Parkin has received the comments and made the changes to the report that need to be made, ATSDR will take the information and develop a health education plan with specific activities of how ATSDR will address each recommendation. Theresa NeSmith told the group that they should provide comments about the specifics that they would like to see in the recommendations as well as other areas of the Needs Assessment. Once again, Theresa reminded the group that the next step will be for ATSDR to take the Needs Assessment document and develop a plan.

Donna Mosby asked Theresa NeSmith if the work group feedback would go to the ORRHES. Theresa NeSmith responded that she believes the intended process is that first, the work group develops recommendations, second, the work group recommendations are taken to ORRHES, ORRHES then decides whether or not to adopt the recommendations, and then ORRHES recommendations are sent to ATSDR and ultimately Rebecca Parkin will make the suggested changes if they are appropriate.

Donna Mosby asked about the intended purpose of having Rebecca Parkin on the telephone during the next NAWG meeting. Theresa NeSmith responded that she thought the purpose of having Rebecca on the telephone was to provide additional clarification for specific questions that the NAWG might have.

After the discussion, Donna Mosby told the group that it is her understanding that the reason Rebecca Parkin will be on the telephone at the next meeting is to clarify any issues or questions that the NAWG may have. Donna also told the group that the recommendations that NAWG develops will be passed on to the ORRHES.

James Lewis stated that in the past, with large complex documents, the work group usually creates an Ad Hoc committee for the purpose of examining a document and bring the information back to the work group. The work group then makes a decision and votes, based on the information that the Ad Hoc presents. James Lewis provided the example of Tony Malinauskas collecting the comments that related to the Y-12 Uranium Releases PHA.

David Johnson agrees with James Lewis and asked the group if the NAWG should form an Ad Hoc committee that will look into the Needs Assessment document further and then present the findings to the work group.

James Lewis believes that the draft minutes of the June 12th NAWG meeting did an adequate job of capturing the issues relating to the Needs Assessment. James Lewis went on to acknowledge that the work group may have a lack of knowledge that requires clarification. However, at the June 12th meeting, Kowetha Davidson said that the group should critique the methods before trying to critique the results. James considered Kowetha’s suggestion and is of the opinion that some disagreements may be associated with looking at various methodologies.

James Lewis told the group that he reviewed the Needs Assessment document and found that there were four items of key interest. The four items are listed in the Table of Contents and include the Literature Review, Key Resource Interviews, Telephone Surveys, and Focus Group Discussions.

James also looked at the Project Summary Report dated March 19, 2001 (See Attachment). After reviewing the Project Products portion of the Project Summary document, James Lewis has issues and concerns about how ORRHES will use the project products. James also reviewed the section of the Project Summary Report titled Purposes of the Project and the portion titled Goals of the Project. After reading the goals and purpose James realized that a key point regarding the Needs Assessment is moving from the transition phase to Phase II. James Lewis believes that the group needs to voice concerns and ideas before Phase II is established.

Upon request from Donna Mosby, Theresa NeSmith provided clarification about the process in which the Needs Assessment comments will be handled by ATSDR. Theresa said that comments specific to the Needs Assessment report such as comments about the focus groups or telephone survey will be used for Phase I. Phase II is the phase in which an actual plan is developed for the follow-up activity. An example of comments that would be used in Phase II would include suggestions about disseminating information to healthcare providers. Thus, depending on the comment, the comment may be used in either Phase I or Phase II of the Needs Assessment.

Still looking at the Project Summary Report dated March 19, 2001, under the heading Purposes of the Project, the first bullet reads Develop new knowledge and insights about the communities’ current health issues. When James Lewis read the first bullet, the term “new” jumped out. James Lewis is not sure about what is new because he does not know what went on in the past. So, in an attempt to become familiar with information from the past, James looked at the Literature Review section of the Needs Assessment. James assumes that what is referred to as new is based upon the review of documents that were supposedly read by George Washington University staff. James wondered about GWU’s familiarity with the 1994 report titled Report of Knowledge, Attitudes and Beliefs Survey of an Eight-County Area Surrounding Oak Ridge, Tennessee . James added that the 1994 report came from the Dose Reconstruction effort and that the study used focus groups and went back into the community looking at 8 counties and contacted 3,269 individuals. James Lewis made a comparison of the 1994 document to what he envisioned the Needs Assessment document to be.

Kowetha Davidson is unclear of how James Lewis’s remarks are critiquing the methodology. James Lewis believes that his remarks do relate to the methodology and he continued to explain that the information presented to the ORRHES (March 19-20, 2001 ORRHES meeting) discussed different types of research, quantitative and qualitative. James Lewis had an overhead which he showed the group (see Attachment). James Lewis explained that he looked at the Report of Knowledge, Attitudes and Beliefs Survey of an Eight-County Area Surrounding Oak Ridge, Tennessee as it related to challenges in the Dose Reconstruction. This report was a quantitative report that focused on the community and used detailed questions. But when James looked at the Oak Ridge Needs Assessment he realized that it is more qualitative.

After listening to James Lewis, Theresa NeSmith told the group that the intent of the Needs Assessment was for the assessment to be a qualitative research project.

James Lewis went on to show his interest in the footnote at the bottom of the overhead. The footnote stated: The two types of research can be combined as in this project. However, one type or the other is emphasized. For the Health Education Needs Assessment, qualitative methods will be the primary method. It will be complimented with limited quantitative information. James feels that it was indicated that “new” data would be both qualitative and quantitative. James Lewis went on to say that the quantitative Report of Knowledge, Attitudes and Beliefs Survey of an Eight-County Area Surrounding Oak Ridge, Tennessee had three objectives. One of the objectives was to investigate people’s perceptions and attitudes about environmental contamination and health problems related to the Oak Ridge Reservation. James Lewis feels that the Report of Knowledge, Attitudes and Beliefs Survey of an Eight-County Area Surrounding Oak Ridge, Tennessee did an excellent job of providing an understanding of the issues that relate to Oak Ridge. The quantitative method used in the Report of Knowledge, Attitudes and Beliefs Survey of an Eight-County Area Surrounding Oak Ridge, Tennessee provided better information than the qualitative Needs Assessment. James Lewis feels that the quantitative effort seems to be more in sync with the group’s expectations than the qualitative effort of the Needs Assessment.

James Lewis reminded Theresa NeSmith that on a number of occasions he had asked for sample documents that would relate to the Needs Assessment document.

James Lewis believes that the Work Group should review the Community Diagnosis: Anderson, Knox, Loudon, Meigs, Morgan, Rhea, and Roane counties data, the Report of Knowledge, Attitudes and Beliefs Survey of an Eight-County Area Surrounding Oak Ridge, Tennessee , and the Needs Assessment to see how information from all three documents can help in the Phase II process.

Kowetha Davidson feels that Needs Assessment document should be critiqued before reviewing other data. James Lewis responded to Kowetha’s comment by saying that the Needs Assessment does not have enough substance to critique. James Lewis feels that there are too many generalizations in the Needs Assessment document and that the large number of generalities make it difficult for suggestions to be made regarding the Phase II portion.

James Lewis indicated that there are many documents on the Hanford website that he found helpful. James Lewis provided overheads of two documents that were printed directly off the Hanford site (See Attachments).

  • Request for Medical Evaluation for Past Exposure to I-131
    A handout that lists questions and comments that could be used during an appointment with a healthcare provider

  • Theresa NeSmith explained that the types of documents that James Lewis is discussing would come from Phase II. Theresa said that the two Hanford documents would be reflected in the final Health Education plan.

James Lewis is extremely impressed with the effort of the Report of Knowledge, Attitudes and Beliefs Survey of an Eight-County Area Surrounding Oak Ridge, Tennessee document. James explained that data for this report came from focus groups. Various Community Organizations were invited to focus groups. The ideas and concepts that were generated in the focus groups were put into the survey. James Lewis feels that the Needs Assessment appears to be taking some degree of credit for the products that were produced from the Report of Knowledge, Attitudes and Beliefs Survey of an Eight-County Area Surrounding Oak Ridge, Tennessee report. Thus, James believes that the work group should take a closer look at the products that resulted from the previous group’s effort. Theresa NeSmith responded to James Lewis by saying that she does not think that anybody, including Rebecca Parkin is taking credit for the findings in the documents that are listed in the Literature Review section of the Needs Assessment.

Theresa NeSmith also reminded the work group that the original study design called for the focus groups to take place before the telephone survey. Theresa said that the order of the process was changed based on the ORRHES recommendations.

As James Lewis recalls, the ORRHES was interested in the questions that would be used in the telephone survey. James said that the ORRHES wanted to makes sure that the questions were culturally appropriate. It was George Washington University who considered altering the process; it was not an ORRHES recommendation or suggestion!

Theresa NeSmith disagrees with James Lewis’s recollection of how/why the process was altered. Theresa said that GWU addressed the issue of whether or not the questions were culturally appropriate by pilot testing the questions. As far as changing the order of the steps involved in the process, the Subcommittee voted on changing the process.

James Lewis told Theresa NeSmith that he believes she is correct about ORRHES voting. However, James remembers the suggestion of adjusting the process coming from GWU. ORRHES did not bring the issue up on its own. James reiterated to Theresa NeSmith that ORRHES on its own did not try to tell GWU how to structure or restructure the process.

Theresa NeSmith responded to James Lewis by saying that Rebecca Parkin gave a presentation on the positives and negatives of changing the study design. It was at that time that ORRHES voted to change the study design.

James Lewis told Theresa NeSmith that his point is that ORRHES did not develop the list of positives and negatives about changing the study design, GWU created the list.

Trying to get back to the list of comments and suggestions that the NAWG will create for Rebecca Parkin, Donna Mosby reminded the group that at the June 12th meeting there was agreement about the Summary page of the Needs Assessment. Some of the issues related to the Summary page included:

  • Not knowing who the intended audience was
  • Juvenile language being used
  • Poor organization
  • Extremely vague terms being used (most people, very few people, some, they)

Theresa NeSmith commented that the language that is used in the Summary page is consistent with qualitative language and research because the researchers are not trying to end at a number.

James Lewis told Theresa NeSmith that the Oak Ridge community wants quantitative information when making decisions.

Theresa NeSmith told the group that it is important that they continue to think about the purpose of the report. Theresa stated that the purpose is to provide ATSDR with information that can be used as a health education plan is developed. Theresa also added that this portion of the Needs Assessment is only one piece of information that will be used. She also told the group that most people will be interested in the outcome.

Bill Taylor asked Theresa NeSmith to elaborate on the intended audience of the Needs Assessment. Who are the recommendations intended for? Theresa NeSmith told Bill that the recommendations are intended for ATSDR.

Bill Taylor followed up by commenting that ATSDR now has the Needs Assessment report. Bill then asked what the next step will be. Theresa NeSmith explained that the work group has 30 days to evaluate the report. Then, ATSDR develops a health education plan working with the Association of Occupational and Environmental Clinics (AOEC).

Bill Taylor asked Theresa NeSmith to provide an indication of what the health education plan will look like. Theresa told Bill Taylor that she could only provide general ideas and nothing specific because the final report has not been completed. Theresa said that considering the information that is available so far, she recognizes a need to work with healthcare providers. Working with healthcare providers will be a result of Phase II.

Theresa NeSmith told the work group that based on feedback from the community, she believes that the community has study fatigue.

Bill Taylor stated that what he is understanding from Theresa is that the Needs Assessment report is only part of what will go into the health education plan. Theresa NeSmith told Bill Taylor that he is correct and that ATSDR will use the Needs Assessment as well as other information when generating the education plan.

Kowetha Davidson told the group that because of the Needs Assessment document, she learned new information. Kowetha learned that some people want to receive health education from faith based organizations.

Theresa NeSmith told the group to keep in mind that when ATSDR is making its decisions, the Action Plan or Recommendations are not taken as a stand alone document. ATSDR will look at the entire document when developing an education plan.

James Lewis stated that after reading the minutes from the last NAWG meeting, he is reminded of a point which was made by Charles Washington. James Lewis said that if a document did not achieve its goals then the document contains flaws. Many people do not want to be linked to a document with such flaws. James Lewis stated that currently there is not a comfort level with the Needs Assessment being able to guide anything. James Lewis added that part of the weakness of the Needs Assessment is the failure of GWU to review existing documents.

James Lewis presented a Recommendation to the work group.

Based upon the review of the Needs Assessment and the ORRHES Chair’s suggestion that NAWG should critique the methods before trying to critique the results, I recommend that we establish an Ad Hoc Committee to review the current Needs assessment to determine

  • If the appropriate methodologies and/or type of surveys were used
  • If GWU met the stated goals and objectives for
    • Literature Review
    • Resource Interviews
    • Telephone Survey
    • Focus Group Discussion
  • If there is a need for formal implementation of the Phase II portion of the Community Health Education Plan

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