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Addressing all the unmet needs and access issues
identified in the needs assessment is rarely feasible. Therefore,
it necessary
to identify the needs that are of highest priority for the community.
Determining health priorities helps direct resources to the programs
that matter most to communities. Additionally, legitimate documented
needs, including those that cannot be immediately addressed, can
be useful for responding quickly to funding opportunities that
may become available in the future.
Several priorities may be identified, some to
be addressed immediately and others to be dealt with later. It
is important to reach consensus
on oral health priorities and to then create realistic objectives
to address these priorities. A thorough priority-setting process
that is inclusive and documented can help garner widespread support
and endorsement for subsequent actions.
A. Prioritize Needs
The process of prioritizing
needs is best accomplished by a group of stakeholders who have
reviewed the analysis of
assessment
data, understand the issues, and are knowledgeable about
the community.
The more inclusive the process, the larger the group of stakeholders
who will take ownership of the problem and of proposed solutions.
The community oral health coalition can act as the core group
for this process while involving other interested stakeholders.
Although it is essential to focus efforts to make
tasks manageable and to show results, with so many competing
priorities it
is often difficult to determine where to channel resources.
To
differentiate among competing priorities, it is useful
to establish criteria
or guidelines for use in discussions about priorities.
Before discussions
begin, it is important to ensure that everyone involved
understands and accepts the criteria for recommending and adopting
priorities.
The following criteria may be helpful in making
decisions about priorities:
Impact of Addressing the Problem. Assess the feasibility
and impact of addressing the problem, and correlate
the two. For
example,
the needs assessment may have identified a lack of
oral health services available for young children. Stakeholders
would
then determine the feasibility and perceived impact
of
addressing this problem.
The Size or Extent of the Problem.
Assess and compare the perceived size or extent of the problem
(e.g.,
how many
individuals are
affected), the seriousness of the problem, and the
feasibility of implementing
evidenced-based interventions that will result in
improved outcomes.
Indicators. Compare local oral health indicators
to national oral health indicators. Use a ranking
system
(e.g., 1–5) to identify
indicators as “better than,” “same
as,” or “worse
than,” and then arrive at a consensus about
where the community should focus its efforts.
Availability
of Acceptable Interventions. Assess
the availability of interventions, the feasibility
of implementing
such
interventions, and their acceptability for addressing
a problem or issue
using the Priority Rating System for Public Health
Programs (PEARL)
Framework, a tool for assessing the socioeconomic,
legal, and political viability
of various interventions.11 The framework looks
at the following:
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P = |
Propriety; is an intervention
suitable? |
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E = |
Economics; does it make economic sense to
address this problem? |
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A = |
Acceptability; will the community agency accept
an emphasis on this problem, and will they accept the proposed
intervention? |
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R = |
Resources; are funding and other resources
available or potentially available? |
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L = |
Legality; do the current laws allow the intervention
to be implemented, and if not, is it worthwhile to expend
time, energy, and resources working for legislative and regulatory
change? |
Finally, consider a review of current
best practices; this can provide essential information and guidance
about interventions
that are effective in actual practice, including
information about the effectiveness of emerging
interventions such
as the use of
fluoride varnish in young children. It is important
to make use
of the experiences of others involved in promoting
community oral health so that time, energy,
and other resources
are not wasted.
Included in Appendix
C are tables that display
effective community and individual preventive
measures for
tooth decay prevention
and a comparison of five effective community
tooth-decay-prevention programs.
The Healthy
People 2010 Web
site contains information, toolkits, and worksheets
that can be helpful in determining priorities.
Overall,
this assessment will provide information that can be used to
determine how best to
use available time, energy,
and
resources
in working to develop, integrate, expand,
or enhance community oral health programs.
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