Community Health Needs Assessment
COMMUNITY OF CAMPBELLTON AND SURROUNDING AREAS
SUMMARY REPORTJUNE 2017
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INTRODUCTION
Making primary healthcare the foundation for its healthcare system is the cornerstone of the strategic plan for
the reform under way in New Brunswick. Primary healthcare represents local services designed to always meet the
health needs of communities and of the individuals who make them up. A community health needs assessment is
performed to set healthcare priorities for each community and to identify individual community assets and chal-
lenges in order to adequately and fairly establish a plan for the development and ongoing strengthening of primary
healthcare. This process uses a population-based approach focusing on the determinants of health and relies on
close cooperation with local communities and engagement from their members.
Campbellton and surrounding areas, as defined
by the New Brunswick Health Council (NBHC),
takes in the following localities: Atholville,
Campbellton, Glencoe, Glenlevit, Robinsonville,
Saint-Arthur, Squaw Cap, Tide Head and
Val d’Amour.
COMMUNITY HEALTH NEEDS ASSESSMENT
Community health needs assessment is a dynamic ongoing process undertaken to identify the strengths and needs
of the community and to enable community-wide establishment of wellness and health priorities that improve the
health status of the population. The process was carried out in compliance with the recommendations presented
in Community Health Needs Assessment Guidelines for New Brunswick (GNB 2013).
The process consists of five key activities:
1. Community engagement;
2. Data collection:
- indicators and data sources;
- gathering new information;
3. Analysis;
4. Develop recommendations/priorities:
- criteria to assess importance;
- share and facilitate CHNA findings;
5. Report back to the community.
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COMMUNITYHealthsystem
MedicalNon-
medical
Heath needs
Priorities Setting: Consultative Process
Proposition of sustainable, affordable and realistic actions
Community local capacities Proposed solutions Level of communityengagement
BusinessEducation Seniors
Youth
Community& socialservices
CON
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STEP
1ST
EP 2
THEM
ES
METHOD
Community Health Needs Assessment
HEALTH DETERMINANTS FRAMEWORK (142 HEALTH INDICATORS)
Administrative and clinical data Action plan &Implementation
CAC: Community Advisory Commitee
Surveys, reports...
Experts’ opinion
Focus groups | Semi-structured interviews
CONSULTATIVEPROCESSIntegration of resultsIdentification of needs
PRESENTATIONTO CAC
Identification of local leadersOrganization of focus groups
CACPRIORITYSETTING:Classification
CategorizationWeightingRanking
Validation
The data used in this assessment comes from three sources:
1) quantitative data provided by the New Brunswick Health Council (NBHC);
2) discussion groups and interviews with key informants;
3) reports available in the region.
The data was analyzed to identify:
1) needs (problems);
2) assets (existing strengths or programs and services);
3) possibilities (proposed by the participants).
Experts’ Opinions Process
Finally, the appropriateness of services was assessed in order to determine whether existing services can meet the
needs identified and whether resource reallocation or new investments are needed.
PROCESS ANALYSIS
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PRIORITY NEEDS
After the quantitative and qualitative data analysis results were presented to the Community Advisory Committee,
a two-tiered approach was carried out to synthesize a list of the community’s main health needs. Next, a needs
prioritization exercise was used to establish a list of priorities according to weighted criteria.
1 HEALTH PROMOTION, PREVENTION AND HEALTH EDUCATION
• Greater public awareness and emphasis of health promotion programs
• Literacy and health literacy
• Culture and social values (social skills and competences)
• Support for children and families (overall and systemic support, integration of families into programs
for youth), intergenerational approaches
• Development of health prevention and education programs and services
• Support for behaviours that encourage health (healthy weight and sexual and reproductive health)
• Assessment of the health repercussions of public and local policies
2 MENTAL, EMOTIONAL AND SOCIAL HEALTH,
AND EMOTIONAL INTELLIGENCE
3 FOOD INSECURITY/POVERTY/SOCIAL INEQUALITIES
• Social housing (transition, for seniors [home], respite and convalescence, emergency, etc.)
• Economic crisis, recruitment and retention of employees
4 MANAGEMENT AND CONTROL OF CHRONIC ILLNESSES
5 STRENGTHENING PRIMARY CARE
• Lack of health resources (community health centre, nurse practitioner)
• Accessibility of services (telemedicine, cyberhealth, public
and volunteer transportation, etc.)
• Transition hospital-community
• Fragmentation of services and lack of coordination
• Complexity of and gaps in the health and social
services system
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OTHER NEEDS
Access to transitional care
With new approaches to outpatient care and deinstitutionalization, the transition from the hospital to the commu-
nity and vice-versa has become a key issue for the quality of services received and user satisfaction. The community
formulated various needs in this respect. Those most often discussed were related to:
1) quality of health communication;
2) continuity of healthcare;
3) adaptation to patients’ socioeconomic realities.
With respect to good and effective communication, the community brought up the lack of transmission of pertinent
information in a format that is readable to the patient (e.g., use of medical jargon, giving written documents to
patients who can’t read, etc.) and easy to implement (e.g., too much information to be assimilated rapidly, lack of
clarity and explanation).
The community is experiencing an economic crisis and major problems with housing insecurity and homelessness,
particularly among those 18 to 45. The high prevalence of chronic illnesses, especially mental health issues, in
this population subgroup is a concern and requires radical adaptation of healthcare services to the socioeconomic
realities of these patients.
Dealing with the isolation of seniors
A significant proportion of the population is over 65. One large effect of the economic crisis was the exodus of
young families to urban regions, as well as the temporary exodus of middle-aged adults (particularly men) out
West. This situation resulted in greater isolation among seniors, and this is a greater problem for those who are
vulnerable because of their health status (e.g., chronic illnesses or invalidity), economic status (e.g., poverty) psy-
chocognitive status (e.g., low health literacy, dementia, depression, etc.). Various needs were identified in this area
and they fall into three main categories:
1) local culture makes many seniors too “proud” to ask for help;
2) the geographical extent of the region and dispersion of seniors over the territory covered by local services;
3) confidentiality and protection of privacy legislation interferes with declaring that someone is vulnerable
without his or her consent.
Improved home care
Improved home care is a crying need in the community. There are various factors: lack of access to nurses from the
Extra-Mural Program (EMP), difficulty in identifying people requiring care, reductions in some services provided by
the EMP.
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AUTRES BESOINS
Support for caregivers
Caregivers are a major resource for keeping vulnerable persons or those with special needs at home and in the
community. However, the community decried the lack of support structures for this community resource and the
low value placed on its contribution to continuity and quality of care.
Health education and literacy
The region has a high illiteracy rate and issues related to health literacy. It is therefore important to make adequate,
adapted, person-centred health communication a major component in the quality of services, as much in health-
care as in other areas like banking or social services. Another question raised was the “expedite and prescribe”
approach used by some healthcare professionals, which leaves little room for patients to ask questions and ensure
they understand the instructions given.
Health promotion and prevention
The community decried the high prevalence of risky health behaviours and preventable chronic illnesses. With
respect to risky behaviours, the community advised investing sustained efforts in preventing smoking, the con-
sumption of energy drinks by youth, drug addiction, including cannabis, falls and involuntary injury.
Special efforts should also be invested in primary prevention to avoid problems with unhealthy weight (promotion
of healthy diet and physical activity), as well as secondary prevention to improve management of chronic illnesses
and reduce related complications.
Youth and wellness
The health and wellness of youth in the community represent a major concern. The community indicated various
causes, some socioeconomic and others individual:
1) destabilization of the family unit caused by fathers leaving to find work, more families led by single
mothers and various related problems;
2) lack of transportation for youth, interfering their access to services and programs;
3) lack of appropriate medications for youth;
4) disengagement and lack of availability of parents;
5) lack of social activities for youth;
6) lack of preparation among youth for the realities and constraints of life in society and the workplace
(professional engagement, respect for rules and individuals, etc.).
There also seem to be differences between Anglophone and Francophone districts with respect to youth health,
notably in the rate of smoking and the consumption of energy drinks, both higher in the Anglophone schools.
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Youth education on sexual health
Improved sexual health education programs for youth was identified as an important need in the community.
The main problems identified in this regard are:
1) hypersexualization of young girls;
2) the phenomenon of “sexting” and exchanging nude photos over the Internet and using cellphones;
3) the high rate of teen pregnancy, which can be explained by low self-esteem, the belief that they will
get social assistance or that having a child will solidify their relationship with their partner;
4) underutilization of sexual health services by youth.
Dealing with mental health and addictions
The community clearly expressed the need for better handling of mental health problems in the region. The preva-
lence of mental health problems in the region is among the highest in the province. “We have the highest rate of
files here, in mental health services.”
Gambling addiction is a major problem in the community. Absenteeism, food insecurity for families and theft are
some of the repercussions most commonly observed in the individuals involved.
Programs for severe chronic respiratory illness
Adequate treatment of respiratory illness is a major problem for the community. Rates of admission for respira-
tory illnesses are among the highest in the province. However, “not more COPD here, but many are more severe
and have no access to necessary care; medications but you also need activity with COPD. With oxygen at home,
patients are only allowed out of the house twice a month with reimbursement for the oxygen, and this makes the
problem worse.”
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Improved primary healthcare services
The various challenges in access to healthcare services include:
1) the geographic area and lack of local services, especially specialized care provided only in cities like Moncton
or Saint John;
2) overutilization of emergency departments, reflecting the inadequacy or low accessibility of primary
healthcare;
3) lack of access to medications because of low income or lack of insurance coverage;
4) restrictions on services offered by nurse practitioners;
5) lack of access to a walk-in clinic that includes a physician or nurse practitioner in Campbellton;
6) lack of access to phlebotomy services in the community (patients have to go to Emergency);
7) difficult access to healthcare services in the language of choice;
8) lack of access to healthcare services for students at the community college;
9) lack of access to family physicians.
Many problems related to the quality and effectiveness of healthcare were raised:
1) the absence of “electronic patient charts” detracts from the continuity of information and care;
2) the lack of awareness of some physicians of the needs of seniors (e.g., visit for multiple health problems,
need to be accompanied by a spouse, inability to understand multiple directions);
3) the challenge of “one problem per visit” in certain family practices (sign in the waiting room);
4) certain health services and programs are delivered using a model that does not fit the reality of the population;
5) lack of integration among mental health, public health and social development services, especially in cases of
chronic illness;
6) lack of coordination of healthcare and services, especially for patients treated both locally and by a team in
Moncton (oncology) or Saint John (cardiology);
7) lack of continuity of information, which sometimes causes multiple visits to the physician or the duplication of
medical exams and tests because of a lack of communication between physicians and healthcare professionals;
8) lack of standardization of medical practices based on Canadian recommendations, reducing the quality of
care (elements raised by different categories of health professionals: physicians, nurses and pharmacists);
9) lack of linguistic adaptation in communication during clinical visits. Beyond bilingualism or the active offer
of healthcare services in the language of the patient’s choice, the mastery of local expressions and linguistic
adaptation were often raised by the community and represent a real problem to be solved, because they
seem to sharply reduce the quality of services.
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Consolidation of intersectoral collaboration and communication
The challenges faced by professionals in setting up effective action strategies are basically related to legislation
on confidentiality and protection of privacy. It is hard to implement systems to systematically track or identify
vulnerable persons in a context of protection of information. The major need expressed by the community was for
the creation of interfaces for intersectoral collaboration adapted to the users of services rather than Departmental
mandates. “Useful to have a network that could help us in our work.”
Affordable and adequate transportation
Lack of access to transportation is raised as an important problem in this community, and it has repercussions on
access to healthcare services. Low income, lack of organized transportation and lack of promotion of volunteer
services are major challenges. Those with reduced mobility have little access to transportation because of their
special needs, creating an additional barrier for them. The challenge is even greater because numerous services are
not available locally and many patients have to travel to Bathurst, Miramichi, Moncton or Saint John.
Dealing with poverty and vulnerable populations
Poverty is a significant concern for the community (“problems are more and more complex, and affect more and
more people”), especially because of the exodus of those with better educations toward the urban centres. Many
challenges related to this problem came up during the discussions:
1) lack of access to medications and to support in this area among low-income groups;
2) lack of supports for vulnerable populations, in particular the absence of a homeless shelter,
“emergency beds” and availability of foster families;
3) placing young offenders away from the community, reducing access to nearby family support;
4) food insecurity among youth;
5) the high cost of healthy food and lack of education about it;
6) high rates of depression in vulnerable populations;
7) absence of insurance coverage, which sometimes makes access to necessary medication difficult;
8) stigmatization related to negative judgments and perceptions about vulnerable populations,
which is also an important challenge for dealing with them;
9) lack of access to psychiatric services and to appropriate overall ongoing treatment of patients,
putting them in unstable living conditions;
10) large concentration of homeless people in the community, particularly in the 18 to 45 age group,
due to the lack of support services for this population;
11) high number of young people who leave home as young as 13, worsening the problem of
homelessness in the region. The presence of abuse in the community is a worrisome problem
for this group. Abuse of women and children is an especially serious problem because of the
high number of people in the community who own firearms. Incest and child abuse are also
very present in the community.
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Stimulation of the local economy
The high rate of unemployment and number of families who spend more than 30% of their income on housing,
along with the low median income in the community, are major concerns for the community. Economic instability
and high debt levels in the community have a major effect on local businesses. Exodus of the population towards
urban centres for access to education or employment reduces the number of community residents, especially of
those in good health.
CONCLUSION
Community Health Needs Assessments are an excellent opportunity to
spur dialogue among the various partners and the communities. They
shed light on the priorities for which it is important to find and implement
solutions based on the fields of activity and expertise of each player.
Vitalité Health Network uses the results of these assessments to guide its
decisions and planning. They help it to provide sustainable, accessible,
fair, effective and safe high-quality care and services to the various
communities in its service area.
It goes without saying that improving public health and wellness is
everyone’s business. Many other partners have their own contributions to
make, just like Vitalité Health Network. We must get everyone involved in
order to achieve positive overall results.
Research, analysis and consultation provided by:
Jalila Jbilou, M.D., MPH, Ph.D.