Skip to main content
Rural Health Information Hub

Identify Community Needs and Assets

The first step in preparing to develop a community health program is identifying community needs and priorities. Conducting a community health needs assessment can help rural programs determine where and how to use limited resources to address health-related needs. Not-for-profit hospitals must perform a community health needs assessment (CHNA) every three years and accredited local health departments must perform a community health assessment and develop a Community Health Improvement Plan (CHIP) every five years. Programs can reference these resources to determine the conditions that disproportionately impact people in their community.

Rural programs can also conduct their own needs assessments to collect more tailored information through surveys, questionnaires, focus groups, public meetings, direct observations, and interviews. Secondary data sources such as vital statistics, hospital records, morbidity and mortality reports, and literature reviews also provide valuable information.

For more information on how to conduct a needs assessment, see Conducting Rural Health Research, Needs Assessment, and Program Evaluation. For more information on data sources, see Finding Statistics and Data Related to Rural Health.

Mapping community assets can also help rural communities identify needs and priorities for health programming. Asset mapping is a systematic process of cataloging key services, benefits, and resources within the community, such as individuals' skill sets, organizational resources, physical space, institutions, associations, and elements of the local economy. Asset mapping can help to:

  • Identify community assets and strengths, so the project can leverage or build on existing strengths
  • Ensure the intervention's relevance to community needs
  • Obtain buy-in from the community

There are multiple approaches to preparing a community asset map. One approach is for the convening organization to prepare and present a draft asset map to the members of a community network for discussion and revision.

Considerations for Health Equity

When conducting a needs assessment and asset mapping, it is important to use data to understand the scope of health inequities. It is equally important to validate the data by talking with members of the community. For example, data gathered across several years may show that there has been a notable change related to health outcomes, educational attainment, or employment. Conducting a focus group with community partners or community members can help to explain the reasons why the changes have occurred. See Using Community Health Assessments to Understand the Social Determinants of Health in a Community in the Social Determinants of Health Toolkit.

Resources to Learn More

The Assessment for Advancing Community Transformation Tool
Helps communities, groups, and individuals participate together to transform health and determine what areas can be improved. Topics address collaboration, communication, advancing equity, planning for action, measures to improve, and sustainability.
Organization(s): Georgia Health Policy Center, Institute for Healthcare Improvement, County Health Ranking & Roadmaps

Community Asset Mapping: Meeting Engagement Tool
Guides communities and organizations through the process of identifying and mapping community assets.
Organization(s): National Oceanic and Atmospheric Administration, Office for Coastal Management
Date: 2018

Community Health Assessment and Improvement Planning
Describes the interrelated activities of community health assessment (CHA) and community health improvement planning process (CHIP) necessary to organize a plan and develop a partnership. Discusses sharing a community vision and common values, collecting and analyzing data, identifying and prioritizing the issues, developing an action plan, and implementation and evaluation.
Organization(s): National Association of County & City Health Officials

Community Health Assessment Toolkit: Prioritize Community Health Needs and Assets
Assists in identifying the most pressing community health needs based on established priority-setting criteria, data analysis, and selection of priorities based on a process supported by contributing participants.
Organization(s): AHA Community Health Improvement

Community Health Maps
Resources to help community-based organizations identify and use low-cost mapping tools. Includes self-paced online tutorials, reviews of mapping software, best practices, and guides on vector borne disease surveillance, web mapping, desktop GIS and field data collection.
Organization(s): Bird's Eye View, National Library of Medicine

The Community Tool Box: Chapter 3 – Assessing Community Needs and Resources
Offers step-by-step guidance in developing community building skills. Covers topics analyzing community problems, determining service utilizations, conducting surveys and interviews, using public records and data, and process development to identify community needs and resources, and set priorities.
Organization(s): University of Kansas Work Group for Community Health and Development

County Health Rankings and Roadmaps
Measures the health of nearly all counties in the U.S. and ranks them within their states to better understand the health of a community in comparison to other communities. Rankings are calculated using county-level measures collected from national and state data sources. In addition, guidance, tools, and resources are provided to support community efforts.
Organization(s): Robert Wood Johnson Foundation
A searchable database providing health data from a variety of federal sources to support improvements in health.
Organization(s): U.S. Department of Health and Human Services

Assess Needs and Resources
Offers tools and resources to help identify and leverage community strengths, resources, and assets to facilitate change.
Organization(s): County Health Rankings and Roadmaps

Processes and Outcomes of a Community-Based Participatory Research-Driven Health Needs Assessment
Explores how Community-Based Participatory Research (CBPR)-driven community health needs assessment can inform and establish community engaged research, policy, systems and environmental change approaches, and community-led grants and jobs creation.
Author(s): Akintobi, T. H., Lockamy, E., Goodin, L., et al.
Citation: Progress in Community Health Partnerships: Research, Education, and Action, 12(1), 139–147.
Date: 2018