Purpose of the CHA (Vision)

The community health assessment (CHA) is the foundation of health improvement for a community. Its purpose is to identify the factors that affect the community's health and quality of life and the resources available to address these factors. The Pender County Health Department leads a CHA every four years. The process involves working collaboratively across sectors in a steering committee, collecting and analyzing health data, and setting priorities for health improvement.  By systematically identifying a county’s health resources and challenges, county leadership can make strategic choices to prioritize top areas of concern. This report provides data and priorities to support a Community Health Improvement Planning process that outlines action steps and tracks progress on identified issues. This collaborative cycle of steady, incremental progress helps create a healthier community for all.

CHA Leadership

• Carolyn Moser, Health and Human Services Director, Pender County Health Department (PCHD)
• Shirley Steele, Director of Nursing, PCHD
• Margaret Nemitz, North Carolina Institute for Public Health, UNC Gillings School of Global Public Health
• Lauren Schauer, North Carolina Institute for Public Health, UNC Gillings School of Global Public Health

Partnerships/Collaborations

With consultation from the North Carolina Institute for Public Health at the UNC Gillings School of Global Public Health, the health department formed a steering committee that represented a myriad of sectors in the community. County residents were engaged throughout the completion of the Healthy Pender Survey, review of community data, and participation in a community forum. While reviewing community data, community members voted on top priority areas which were discussed in further detail during an open community forum. The steering committee then used this community input to inform the selection of priorities.

Regional/Contracted Services

With consultation from the North Carolina Institute for Public Health at the UNC Gillings School of Global Public Health, the health department formed a steering committee that represented a myriad of sectors in the community. County residents were engaged throughout the completion of the Healthy Pender Survey, review of community data, and participation in a community forum. While reviewing community data, community members voted on top priority areas which were discussed in further detail during an open community forum. The steering committee then used this community input to inform the selection of priorities.

Theoretical Framework/Model

Together, the steering committee completed the first five steps of a community health assessment process outlined by the North Carolina Division of Public Health as shown below:

Collaborative Processes

A CHA Leadership Team comprised of Pender County Health Department leadership and North Carolina Institute for Public Health staff worked closely together throughout the CHA process to plan data collection, conduct initial data analysis, plan meetings, and produce deliverables. The steering committee provided critical input and feedback throughout the process by giving advice on data indicators, promoting the survey in the community, sharing insights through the process, reviewing data, and determining priorities. The Steering Committee met a total of six times, primarily in-person, to walk through the initial five CHA phases. These meetings included project kickoff on July 26, data planning on August 23, survey promotion on September 27, data updates on October 25, data review on December 6, and prioritization and report updates on January 31.

Comparisons and Targets

The CHA team collected new primary data from a community survey, and existing secondary data related to socioeconomic and health factors. Secondary data were disaggregated by race and other demographics when available. Pender County data was compared to Carteret and Franklin Counties due to similarities in population characteristics, density, geography, and demographics. Data were also compared to state averages and the Healthy North Carolina 2030 objectives.

Key Findings

The CHA process requires both primary and secondary data collection to assess the health status and needs of the community. PRIMARY DATA COLLECTION: Primary data refers to new data which is collected directly by the CHA Team. Using primary data provides timely data that is coming directly from community members themselves. The main 6 Chapter 1: Introduction source of primary data in this CHA cycle was a convenience-based community health assessment survey, titled the “Healthy Pender Survey,” which was distributed throughout the community with the help of steering committee promotion. The Healthy Pender Survey consisted of 37 questions and covered topics of physical health, mental health, health behaviors, community opinions, county services, housing, emergency preparedness and communication, and demographics. The full survey instrument is included in Appendix 2. Given the ongoing COVID pandemic and staff restraints, Pender County opted to use a convenience sampling strategy to collect this cycle’s data, whereas in previous years they have employed a two-stage cluster sampling method. The convenience method involved promoting the survey via social media outlets, email listservs, and in-person events. At in-person events, trained staff had both printed surveys and electronic tablets available for individuals to complete the survey. NCIPH provided the leadership team with weekly updates on survey completion data by demographic markers, which enabled the survey team to intentionally reach out to populations with fewer responses to ensure their voices were included in survey results. Full survey results are included in Appendix 2. Data collection protocol was submitted to the UNC Institutional Review Board (IRB). The Office of Human Research Ethics reviewed the protocol and determined that the submission does not constitute human subjects research as defined under federal regulations and therefore does not require IRB approval. In order to better understand the health needs and opportunities in Pender County, survey results were stratified based on age and income categories. SECONDARY DATA COLLECTION: Secondary data refers to data from other sources, including the Centers for Disease Control and Prevention, the United States Census Bureau, and the North Carolina State Center for Health Statistics. During the CHA cycle, over 80 secondary data indicators were collected, analyzed, and reviewed using an online, interactive data dashboard made available at https://go.unc.edu/PenderDashboard. These indicators were selected based on input from the steering committee at the start of the assessment, considering the timeliness of data, data quality, and overlap with the Healthy North Carolina 2030 indicators. Secondary data for Pender County were compared to the State of North Carolina and Franklin and Carteret counties as peer comparisons. These counties were selected as peer counties during the 2018 CHA cycle due to similarities in demographics, density, and other characteristics. Data are also compared to the Healthy North Carolina 2030 goals.1 To compare across regions and across time, the data are often reported as rates, which show the count of an event within a defined population during a specified time interval. This allows comparisons over time, even when the size of the population is changing from year to year. Additionally, since many health conditions are related to age and the different communities may have older or younger populations, an age-adjusted rate is often used. Factoring in the age distribution allows for comparisons of disease burdens across different communities more accurately. Finally, some secondary data are presented as 5-year averages so that events in smaller communities or less frequent events are not distorted by the natural fluctuations of a few people from year to year. For the purposes of this report, 5-year averaged data will be referenced by the final year in the range. For example, the “2019 estimate” of a 5-year average refers to the average of data from 2015-2019. Full date ranges are referenced in figure captions. Alternatively, some secondary data from infrequent events are not aggregated and are suppressed (or withheld) from official reports. Aggregation or suppression is noted where appropriate. Secondary data is a useful tool for understanding community health at the population level. However, this type of data can be delayed by a few years due to the need to collect, process, and analyze data which can be time and Chapter 1: Introduction 7 resource intensive. Efforts were made to collect the most recent data available in Fall 2022, but please be aware of a potential lag between what is happening today in the county and the latest available data. The COVID-19 pandemic has added to this challenge as data collection and reporting activities may have been negatively impacted, resulting in delays and interrupted processes. Secondly, the data presented an estimation of the true value in the population; while efforts are made to collect data using tools such as outreach and sampling, it is not possible to collect data on every single point of interest for every single resident. Citations throughout this document refer to the general source of the data, for example “U.S. Census Bureau, American Community Survey 5-year Data” with the most recent year of data included. T

Health Priorities

• Heart Health
• Substance Use
• Access to Care

Next Steps
Once the CHA results are shared throughout the community, the health department will develop community health improvement plans for each of the priority areas to complete the final two steps of the process. Pender County Health Department will lead the effort to develop and track progress on objectives, strategies, and action plans related to each priority. Collaboration with key stakeholders will be important as the activities and strategies are implemented.

Priorities

The steering committee initially reviewed all survey data and existing secondary data, comparing data to peer counties and Healthy North Carolina 2030 indicators. The CHA Team defined 14 topic areas as prioritization options with feedback from community meetings and a community forum. At community meetings, community members reviewed data summaries, followed by an opportunity to vote on their top three priorities. The forum provided an opportunity to discuss data themes in additional detail.
The steering committee met to review feedback from community meetings, forum discussion notes, and complete a voting process to determine Pender County’s priority areas for 2023-2026. Final priorities by leadership are:

1. Heart Health
2. Substance Use
3. Access to Care