Key Informant Interviews with Local Experts
We recognize that we cannot improve the health of our communities alone…I feel that there is a role of everyone in creating a healthy community. Services are not going to get us out of this as evidenced by the data on mortality. We are going broke. It comes back to prevention.
Key Informant – 2012
The CHNA project partners identified a panel of 18 key informants. Key informants were selected for their expertise in a broad variety of health and health-related disciplines including hospital and primary care, public health, maternal and child health, human services, business and education. Project consultants interviewed key informants individually using a standardized set of questions designed to elicit information on the local health issues of greatest concern and perspectives on local opportunities to improve population health and/or the healthcare delivery system.
Despite the diversity of the key informant group, a number of common themes emerged from the interview process.
These themes are:
- The health care system is changing due to market pressures and Health Care Reform. Many key informants expressed their support for increased integration across the health care delivery system, a renewed emphasis on primary care, continued development of patient centered medical homes and adopting a population health framework to guide enhanced collaboration and system integration.
- New financial incentives within the delivery system are key to improving health and health care. Informants believed that the Triple Aim goals of enhanced patient experience, improved health outcomes, and cost effectiveness must be supported with a system of financial incentives for health care providers at all levels.
- Changes in composition of the health care workforce are needed. Concern was expressed about the capacity of the county’s primary care system and noted that developing and training new types of health workers (promotores, home health workers, etc.) could help expand capacity and achieve greater cost effectiveness in care delivery.
- Sonoma County should strengthen collaboration and grass roots efforts to address community health and reduce health disparities. Reducing health disparities, particularly among children, is critical to health improvement. Respondents mentioned a number of local collaborations that focus on addressing health disparities, promote shared goals and aim to achieve collective impact in community health. They emphasized the need to continue the work of the Community Health Improvement Committee (CHIC), Health Action, the Care Transitions Project, the Healthy Eating Active Living Initiative (HEAL), and other upstream approaches now underway.
- The impact of social determinants on health is becoming better understood as key to population health. Inequities in education, income, access to care and other socio-economic factors lead to inequalities in health status. Place-based projects like HEAL and Health Action, that focus on changing policies and practices in schools, places of employment and other community settings are seen as promising strategies to reduce disparities and promote community health.
- Continue upstream investments that focus resources on community health and prevention. Sonoma County’s leadership has embraced the importance of making investments in the community to reduce the need for future spending for public services.
- Sonoma County does not have the infrastructure to support its rapidly growing senior population. Sonoma County’s population is aging; seniors are living longer, becoming more frail as they age and requiring more assistance. The current senior service system is fragmented and often difficult to access. The costs, both human and financial, associated with caring for seniors in institutional settings are not sustainable. Resources and attention must go to addressing the needs of this growing and vulnerable population.
A roster of key informants and the key informant interview questions utilized in the process may be found in Appendix II.
Community Based Focus Groups
During June and July 2012, St. Joseph Health System conducted a series of targeted, community-based focus groups on behalf of the project partners. The goal of the focus group process was to gather information from residents of low-income neighborhoods on their health concerns, the challenges they face in maintaining health and their ideas on how to improve their community’s health and wellbeing. Four focus groups were held, averaging 8 participants per group. Groups were facilitated in both Spanish and English, based on group make-up. The groups were conducted in the communities of Sonoma Valley, Rohnert Park, Santa Rosa, and Cloverdale and were facilitated by St. Joseph’s staff using standardized questions approved by the CHNA partnership.
The most often mentioned community conditions that contribute positively to health were: neighborhood safety, strong relations with neighbors, community members working together on issues, access to healthy foods and family recreation opportunities.
The top health concerns identified by focus group members were: Obesity, diabetes and high blood pressure, access to drugs, local markets selling alcohol and unhealthy foods, and access to healthy foods and recreational facilities.
A copy of the focus group questions utilized in the process as well as the location and a participant profiles may be found in Appendix III.
BRFSS - A Telephone Survey of Sonoma County Residents
In the spring of 2012, St Joseph Health System contacted 1500 people (839 completed the survey) using a survey tool incorporating questions from the national Behavioral Risk Factor Surveillance System (BRFSS) survey. The Survey provided valuable information on local health status, health behaviors, experience with the local health systems and highlighted the links between social determinants, predominantly income and educational attainment, and disparities in health and health care access.