The Scottish Government

« Previous | Contents | Next »

Listen

Needs Assessment: A Practical Guide to Assessing Local Needs for Services for Drug Users

Chapter 4: Getting the Views of Your Target Population

Your target population should be at the very centre of needs assessment. And yet, the process of getting their views is often neglected or undertaken half-heartedly. There are a number of reasons for this.

• It can be difficult and expensive to find out about the needs of your target population, especially if the views you most want are those of people not currently in contact with services.

• There is also the concern that you might be raising people's expectations by formally asking about their needs, only to ignore them because of a lack of available resources.

• The opinions of a small number of individuals may not represent the views of the more general population.

• Finally, individuals themselves may be reluctant to explicitly state their views, either because they fear this may have a negative impact on the services they receive, or because they don't believe that their views will be taken seriously or acted upon.

Despite these potential difficulties, it is essential that any needs assessment exercise gives service users (or potential service users) the opportunity to express their needs. However, before setting out to get the views of your target population, it is important to make it clear why you are seeking their views. A short, focused set of questions, and a clear explanation of why you are asking them will help avoid raising false expectations. Further information about ways of engaging with your target population is available from the EIU Guide, 'Effective Engagement. A guide to principles and practice.' (EIU 2002c)

This chapter provides information about methods that can be used to get the views of your target population. Much of this information comes from a document published by the former Standing Conference on Drug Abuse (SCODA), now part of DrugScope. This document, entitled 'Getting drug users involved: Good practice in local treatment and planning', provides a number of practical suggestions for engaging drug users in the planning of local services (SCODA, 1997).

Methods for getting the views of your target population

Just as there is no one best way of doing needs assessment, likewise, there is no one best method for getting the views of your target population. In fact, it may be beneficial to use a variety of methods, as this will give you a clearer and more rounded perspective. It is also important to bear in mind that the use of poor methodology in the information-gathering stages will distort your results and the recommendations that can be made from them.

We have identified the following methods of obtaining the views of service users.

• Questionnaire surveys

• Interviews

• Focus groups

• Local service user groups

1. Questionnaire surveys

The design of questionnaires and surveys requires careful thought. It may be helpful to involve members of the target population in the design of the questionnaire at an early stage, not only to ensure that the questionnaire is "user friendly", but also to ensure that it covers issues that are important to them, and not just the issues that are important to the DAAT or to service providers. Consider the following points when using questionnaires (SCODA 1997):

• Questionnaires should include an explanation of why and how the information will be used.

• Questionnaires can be used to gather detailed information on the outcomes of treatment.

• Waiting areas and newsletters can be used to publicise results from questionnaires.

• Providing incentives (e.g. vouchers or prize draws) may encourage greater response.

It may be necessary in questionnaires to briefly define potentially ambiguous terms. For example, when asking drug users about their goals in seeking treatment, most will indicate that they wish to be "drug-free" or get off drugs. For some drug users, drug-free or getting off drugs will mean complete abstinence from all illicit and prescribed drugs; others may mean abstinence from illicit drugs only; while yet others may mean abstinence only from the one particular drug that is causing them the greatest problem. When asking questions, it is crucial not only to ensure that your question means the same thing to your audience as it does to you, but also to ensure that the response you get is understood by you in the way the respondent meant it to be understood.

Because of this, questionnaires should usually be piloted before official data collection begins. Piloting involves trying the questionnaire out on a small number of individuals with the same characteristics as your target population, and then, ideally, having a discussion with them about the questionnaire after they have completed it, or while they are completing it. Piloting will identify difficulties or potential ambiguities in the questionnaire, and will allow you to check that it adequately and effectively captures the information you are seeking.

Questionnaires typically use a combination of tick box and open-ended questions. Tick boxes are quick and easy to complete, and easy to analyse, but they limit the responses to those you have defined in advance. It is important, for this reason, to ensure that the response categories you provide cover all possible responses. Alternatively, you can include some open-ended questions in your questionnaire to allow individuals to reply in their own words.

With surveys, you will need to think about your sample, i.e., how many people you want to get responses from. A small, representative sample will reflect the group from which it is drawn. The larger the sample, the more precisely it reflects the target group. However, the rate of improvement in precision decreases as your sample size increases. For example, an increase in the sample size from 250 to 1,000 only doubles the precision. You must make a decision about your sample size based on factors such as: time and budget available, and the level of precision required.

2. Interviews

One-to-one interviews allow for the possibility of getting more in-depth information from the members of your target population. Interviews may be conducted face-to-face, or over the telephone. In either case, it is usually best to arrange them in advance, as the interview may last between 30 minutes and two hours. Employing an independent researcher to conduct the interviews may result in greater openness among some respondents, but it is also expensive, and it still does not guarantee that individuals will not reply in the way they think the interviewer wants them to reply.

Interviews are usually semi-structured (i.e. based on a questionnaire format but with a greater number of open-ended questions). The same questions should be asked in the same way to each interviewee. Care must be taken to not ask "leading" questions - that is, asking a question in such a way as to get an expected response.

Because of the difficulty in taking notes while interviewing, interviews are usually tape-recorded. Interviewees should always be asked for their permission to record the interview. If they object, the interviewer will have to take notes.

3. Focus Groups

Focus groups bring together a small number of people (usually less than 15) to discuss a particular issue in depth. The participants should be members of your target population. The aim is to encourage frank discussion to get people's perceptions, feelings and opinions about an issue. The extent to which this happens depends largely on the skill of the facilitator and the willingness of the participants to speak. Ideally, the facilitator should be someone not known by the members of the group. This person should prepare a short set of open-ended questions in advance, and be prepared to structure and guide the group, so that all voices are heard. The facilitator should allow time at the end of the meeting to agree with the group the main points from the discussion.

4. Local Service User Groups

The establishment of a local service-users group is another way of getting access to the views of service users. The on-going support and facilitation of this group can require time and energy, and it may be best if this task is done by an individual or organisation who does not directly provide a service to the users involved. Some DAAT areas have recently started user groups, and in some cases, these are facilitated and managed by the Scottish Drugs Forum (SDF). In other areas, service providers have set up formal mechanisms for consulting their users at regular intervals.

Getting the views of "hidden" populations

The job of needs assessment is particularly difficult if your target population is one which is not currently in contact with services. Obtaining the views of these individuals may require some ingenuity. The following are some methods for getting the views of drug users not currently engaged with services.

• Peer research: using current or former service users to find hidden drug users, and to interview or distribute questionnaires to them.

• Snowballing: a technique whereby a user is initially identified and then asked to introduce other acquaintances, who are then each asked to introduce acquaintances of theirs and so on until a sufficient sample size is reached. A "reward" or incentive is sometimes provided to the individual for each new contact.

• Outreach: employing outreach workers to engage with difficult-to-reach populations such as homeless people, prostitutes, children or young people.

In addition, many hidden drug users may be engaging with services other than drug treatment services. It may be possible to get access to hidden populations through:

• family or carer support groups

• low-threshold services such as helplines and needle exchanges

• non-drug specific services such as the police, A&E, GPs, Social Work, voluntary agencies such as Shelter or Barnardos, schools or crisis centres.

However, this will require the active co-operation and assistance of these other services.

When seeking the views of hidden populations, it is important to find out what they perceive to be the barriers for them in accessing services. Is there a problem with the accessibility of a particular service, or is it simply that people are unaware that the service exists?

The requirement for ethical approval

The task of obtaining the views of your target population is a research task. The methods described above are research methods. In its broadest sense, research is any activity that involves the acquisition of new information. Whenever you do research that involves people, you should consider whether it may be necessary to apply for ethical approval.

There is a wide spectrum of activities that service planners and providers may engage in as part of the overall task of service planning and improvement. The task of audit is at one end of this spectrum. Audit is the study of outcomes through the analysis of existing data. At the other end of the spectrum is the randomised control trial (RCT). This involves randomly allocating patients to receive a new intervention or form of treatment. The outcomes for these patients are then compared to the outcomes for patients who receive "treatment as usual."

Audit does not require ethical approval. However, if audit requires access to person-identifiable data, you will need to seek approval from your local Data Protection Officer, or a Caldicott Guardian. (See Chapter 2.) RCTs always require ethical approval.

As a research activity, needs assessment lies somewhere in the middle of the spectrum between audit and the RCT. In some cases, you should seek ethical approval before starting your needs assessment. In other cases, there is no need to seek ethical approval. The diagram on the next page shows that there is a large grey area between projects which clearly do, and those which clearly do not, require ethical review. In general, any research related to service planning, that is conducted internally by a single service provider, and does not require the users of that service to do anything different from their ordinary experience - apart from answering questions about their needs or experiences - does not require ethical approval.

Many agencies, including social work departments, and the Prison Service have their own ethical committees and these should be consulted if you want to find out about the needs of social work clients or prisoners. Within the NHS, Local Research Ethics Committees (LRECs) were established in each NHS Board area to ensure that research involving NHS patients or staff is conducted in an ethical manner. The web site of the Central Office for Research Ethics Committees (COREC) provides details of who should apply for NHS research ethical review and under what circumstances. See http://www.corec.org.uk/whenToApply.htm.

Diagram: When is research "research"?

Source: Dr David Gordon, Chair, Lanarkshire Research Ethics Committee

« Previous | Contents | Next »