Health Services Survey
The agency we partnered with is a nonprofit organization committed to serving the needs of women and their families who are experiencing unstable or absent housing. They help to provide emergency shelter to families across five locations in the Seattle area and provide services surrounding housing, healthcare, employment, and community. They also have specialty programs aimed at providing services to children who are medically fragile and require specialized care, and families who have recently given birth and are still in the recovery and bonding stages. All this work is delivered with the values of love, equity, stewardship, collaboration, responsiveness, and accountability. After learning more about the agency and touring their facilities, they shared their need for a tool that would help them evaluate the usefulness and satisfaction, and identify any unmet needs provided by the Health Services team. The goal of our project was to create a survey that was informative, easy to read, accessible in a variety of languages, and sustainable for future use.
The guest populations at the shelter consist of mainly women and children, with some households that include men, who are experiencing or struggling with the lack of safety, stability, and housing. According to our agency’s 2021 Annual Report, more than 80% of their guests identify as Black, Indigenous, or People of Color, and 30-40% of our guests are immigrants or refugees with the majority from East Africa (Mary’s Place, n.d.). Ranging from newborns to seniors, the guests represent diverse backgrounds in race, ethnicity, class, sexual orientation, education, and life experience. Additionally, the shelter welcomes and provides accommodations for guests with disabilities and mental health issues.
People experiencing unstable or absent housing face a variety of unique medical and behavioral health needs that commonly go unmet due to a wide range of barriers to accessing routine, as well as preventative care (Thorndike et al., 2022). Data gathered from surveys and interviews with individuals experiencing homelessness showed that 73% of the respondents reported at least one unmet health need. Some of these needs included an inability to obtain needed medical or surgical care (32%), prescription medications (36%), mental health care (21%), eyeglasses (41%), and dental care (41%; Baggett et al., 2010). Furthermore, given the agency’s target population is it important to note that women have higher rates of mental health diagnoses and suicidal thoughts and attempts. (Kneck et al., 2022). All these statistics helped form our survey to address the specific healthcare needs of the agency's target population.
Activities and Methods
The rationale behind our project was focused on a clear expression from our agency liaison that this survey was a necessary piece for the agency to understand any unmet health needs of their guests, as well as gain an understanding of guest satisfaction with the Health Services team. Moreover, we conducted a review of the literature which showed that most health survey tools operate under the assumption that the participants are equipped with stable housing, and therefore are equipped with resources such as running water, electricity, and access to food and safe food storage (Gordon et al., 2019). Knowing that a health survey tool fitting the needs of the organization was not available for them to utilize, our goal in creating the survey was to curate it to the diverse population served by the agency.
First, we conducted an assessment by using the windshield survey (Stanley, 2021). This allowed us to familiarize ourselves with the community and take inventory of the resources present. We collected data on the physical environment, economic features, available services, and social aspects of the community. We also utilized the agency’s website and annual report to gather additional assessment data. Our group used a logic model outline to help craft our goals and equip us with a roadmap to follow throughout our project. A Gantt chart was also utilized weekly to plan out our activities and determine as a group who was responsible for a given task (Agency for Healthcare Research and Quality, n.d.). We then crafted a nursing diagnosis that was appropriate for the need that the agency wanted us to fill: Readiness for enhanced knowledge related to the organization’s desire to increase health service use and evaluate satisfaction by guests. We also utilized the socio-ecological model (SEM) as a framework for our project. The SEM model is used to identify influences of community engagement in health programs to better understand systematic barriers and enablers to community engagement (Caperon et al., 2022). This model was relevant to our project since we sought to create a tool that would increase guest engagement with the current health services offered by our agency and identify barriers to guests accessing care at the shelter.
Our group conducted a literature review to help identify the specific topics and questions we would include in our survey as well as specific topics to be covered that were requested by the agency. With the communication of feedback from the Health Services team, we successfully completed our goal of creating a final survey that will be translated into a variety of languages and will continue to be sustainable for future use. We placed value and importance on equality by not administering the English version of the survey until the survey was fully translated into a multitude of languages that aligned with the population at the agency. With that in mind, we also were aware of translation and possible educational barriers of the guest population which we addressed by running our survey through the Flesch-Kincaid Grade Level (FKGL) calculator that 5 analyzes the readability of a text according to the years of education typically required for that level of literacy (Wrigley Kelly et al., 2021). To ensure the survey is readable and widely accessible, we kept it at a “secondary language” (L2) level which is explained as the reading literacy of grades fourth through sixth (Commissaire & Demont, 2021). Though our group was not able to administer and analyze the final survey ourselves due to the time limitation, we ultimately generated the evidence-based tool that the agency will administer when the translated versions are all available.
Overall, the intended outcome of this project was to create a sustainable tool for the agency. This tool will allow them to evaluate the usefulness of their health services and the satisfaction of the guests. They expressed that the goal is to utilize this tool at all of their locations and at regular intervals in the future. The data collected from this tool would be used to delegate resources to the services guests find most useful, identify gaps where guests’ needs are not being met and adjust their programming accordingly to fill any of those gaps. Ultimately, the greater impact of our project in improving the agency’s health service usage and delivery would be to increase positive health outcomes and improve health literacy among their guests. These changes could help create new partnership opportunities and increase funding that would then expand the agency’s reach to better serve more families in the Greater Seattle area.
Agency for Healthcare Research and Quality. (n.d.). Gantt Chart. https://digital.ahrq.gov/healthit-tools-and-resources/evaluation-resources/workflow-assessment-health-it-toolkit/allworkflow-tools/gantt-chart
Baggett, T. P., O’Connell, J. J., Singer, D. E., & Rigotti, N. A. (2010). The unmet health care needs of homeless adults: A national study. American Journal of Public Health, 100(7), 1326–1333. https://doi.org/10.2105/AJPH.2009.180109
Caperon, L., Saville, F., & Ahern, S. (2022). Developing a socio-ecological model for community engagement in a health program in an underserved urban area. PLoS ONE, 17(9), 1–18. https://doi.org/10.1371/journal.pone.0275092
Commissaire, E., & Demont, E. (2022). Investigating L2 reading aloud and silent reading in typically developing readers and dyslexic adolescents from grades 6 to 9. Dyslexia (Chichester, England), 28(1), 40–59. https://doi.org/10.1002/dys.1693
Gordon, S. J., Grimmer, K., Bradley, A., Direen, T., Baker, N., Marin, T., Kelly, M. T., Gardner, S., Steffens, M., Burgess, T., Hume, C., & Oliffe, J. L. (2019). Health assessments and screening tools for adults experiencing homelessness: A systematic review. BMC public health, 19(1), 994. https://doi.org/10.1186/s12889-019-7234-y
Kneck, Å., Klarare, A., Mattsson, E., & Salzmann-Erikson, M. (2022). Reflections on health among women in homelessness: A qualitative study. Journal of Psychiatric and Mental Health Nursing, 29(5), 709–720. https://doi.org/10.1111/jpm.12859
Mary’s Place. (n.d.). About Us. https://www.marysplaceseattle.org/about-us
Rector, C. L., & Stanley, M. J. (2021). Community and public health nursing: Promoting the public's health (10th ed.). Wolters Kluwer, Philadelphia.
Thorndike, A. L., Yetman, H. E., Thorndike, A. N., Jeffrys, M., & Rowe, M. (2022). Unmet health needs and barriers to health care among people experiencing homelessness in San Francisco’s Mission District: A qualitative study. BMC Public Health, 22(1), 1–8. https://doi.org/10.1186/s12889-022-13499-w
Wrigley Kelly, N. E., Murray, K. E., McCarthy, C., & O'Shea, D. B. (2021). An objective analysis of quality and readability of online information on COVID-19. Health and Technology, 11(5), 1093–1099. https://doi.org/10.1007/s12553-021-00574-2
Le, Doan (Delaney); Gries, Hannah; Roy, Cassandra; Rabago, Lesley; and Macaspac, Franzelle, "Health Services Survey" (2022). Nursing Leadership in Community Engagement Projects. 21.
Additional Rights Information
Copyright held by authors, except where otherwise noted.
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.