Methodology
Primary and secondary data were collected and analyzed to inform the 2023 Washtenaw County Community Health Assessment (CHA). Primary data consisted of focus groups, key informant interviews, windshield tours, and a community survey. The secondary data included data on health outcomes, health behaviors, and social determinants of health. The methods used to analyze each type of data are outlined below. The findings from each data source were then synthesized and organized by health topic.
Summary of Secondary Data Methodology
Secondary Data Sources & Analysis
Secondary data used for this assessment were collected and analyzed from a community indicator database developed by Conduent Healthy Communities Institute (HCI). The database, maintained by researchers and analysts at HCI, includes over 150 community indicators, spanning at least 24 topics in the areas of health, determinants of health, and quality of life. The data are primarily derived from state and national public secondary data sources. The value for each of these indicators is compared to other communities, national targets, and to previous time periods, as shown in Figure 1.
FIGURE 1. INDICATOR VALUE COMPARISONS
| Michigan Counties |
| U.S. Counties |
| Michigan State Value |
| U.S. Value |
| HP2030 |
| Trend |
HCI systematically summarizes multiple comparisons and ranks indicators based on highest need. For each indicator, the Washtenaw County value was compared to a distribution of Michigan and U.S. counties, state and national values, Healthy People 2030 targets, and significant trends. Availability of each type of comparison varies by indicator and is dependent upon the data source, comparability with data collected from other communities, and changes in methodology over time. All data was analyzed in March 2023 at the county level, individual zip codes or other sub-county health data were not analyzed.
See general information on secondary data limitations here.
Data Methods and Process
Washtenaw County Health Department (WCHD) staff used four primary methods for qualitative data collection: key informant interviews, focus groups, windshield tours, and a community survey. The findings from these data expanded upon the information gathered from the secondary data analysis. These primary data collection methods were chosen based on guidance from the Mobilizing for Action through Planning and Partnerships’ (MAPP) Community Context Assessment (CCA) framework. The CCA framework is a qualitative tool that focuses on gaining deeper insights and perspectives from people with lived experience and expertise, especially those experiencing health inequities firsthand.
Questions for data collection instruments were developed around three primary domains: community strengths and assets, forces of change, and the built environment. WCHD staff prioritized populations that experience ongoing health inequities, including identity- and geographic-defined communities, based on current data and information from prior assessments. Prioritized populations included racial/ethnic groups: (African American, Latinx, Arab-American), rural communities (Whitmore Lake, Manchester), youth (primarily ages 14 – 19 years old), older adults, women of color, people experiencing homelessness, formerly incarcerated people, as well as organizers from grassroots organizations and mutual aid groups.
WCHD collaborated with several community leaders and groups with whom they have established long-standing partnerships to help facilitate, plan, and recruit people for focus groups. They also worked with members of the Community Voices for Health Equity team and staff from the Healthy Neighborhoods Team to identify participants for key informant interviews and windshield tours. Focus group participants received a $50 gift card for their participation. Interview participants received a $25 gift card. Community members involved in windshield tours were provided with compensation ($25/hour) for their time and expertise.
Key Informant Interviews
WCHD conducted ten (10) key informant interviews to gain a deeper understanding of health issues impacting community members. Interviews were conducted in March 2023 and lasted approximately 30-45 minutes each. Individuals who were asked to participate in the interviews included people who were formerly incarcerated, older adults, people identifying as Arab-American, African American, and/or Latinx, refugees, those living in Manchester and Whitmore Lake, people that have experienced homelessness, and grassroot organizers.
The overarching interview summary, questions, and key informant interview findings are located in the Overarching Interview Summary appendix.
FIGURE 2. SUMMARY OF KEY INFORMANT INTERVIEW FINDINGS
Top Health Concerns/Issues
• Access to care
• Affordable housing
• Financial stability
• Food access
• Health education
• Mental Health
• Resource navigation/connection
• STI/HIV screening and treatment
Populations Included in Interview
• African Americans
• Arab-Americans
• Grassroot organization/community activists
• Latinx community members
• Manchester residents
• Older adults
• People experiencing homelessness
• Refugees
• Returning citizens/previously incarcerated individuals
• Whitmore lake residents
• Youth
Top Forces of Change Impacting Health Issues
Access to care:
• Closure of local clinics and pharmacies
• Drivers license barriers for immigrant communities
• Language/cultural barriers
• Racism in the healthcare system
• Wait times for appropriate mental health care
Cost and availability of housing COVID-19 pandemic impact:
• Increased hostility
• Inflation
• Job loss
• Long-term health effects
• Mental fatigue
Economy
• Employment barriers such as drug testing
• Loss of local employers
Government:
• Impact of budget decisions
• Overly complex rules and regulations for community organizations
• Unfair enforcement of rules
Focus Groups
WCHD conducted four (4) focus groups to gain deeper understanding of health issues impacting residents living in Washtenaw County. Focus groups aimed to understand the different health experiences for the Latinx community, youth, and for older African American women. There was one focus group held for youth, one for older African American women, and two for Latinx community members. The two Latinx focus groups were conducted in Spanish. In-person focus groups took place in March 2023 and each had 8-10 community participants.
A questionnaire was developed to guide the conversations. Topics included community strengths and assets, top heath issues, the impact external factors have on health, and potential solutions to address barriers to health. A list of questions used for focus groups can be found in the Primary Data Collection Instrument and Methods appendix.
The WCHD team recorded transcripts of the focus group sessions. The transcripts were analyzed and text was organized by themes and analyzed for significant trends. The findings from the analysis were combined with findings from other primary and secondary data and incorporated into the data synthesis and prioritized health needs. Themes across all focus groups can be seen in Figure 3. The Overarching Focus Group Summary appendix provides a more detailed report of the main themes that trended across the individual focus group conversations.
FIGURE 3. SUMMARY OF TOP HEALTH CONCERNS FROM FOCUS GROUPS
Latinx 1
- Affordable and adequate housing
- Healthcare scheduling concerns included long appointment waitlists, long clinic waiting times, and lack of appointment flexibility to accommodate work conflicts
- Language barriers
- Need for more advocacy for Latinx community
- Need for more accessible healthcare options
Latinx 2
- Access to healthy food
- Barriers to driver's licenses, housing, and automobile insurance due to immigration status and racism which results in limited personal freedom in daily life and fear
- Cultural differences in lifestyle and diet contributing to chronic illnesses such as diabetes, high blood pressure, high cholesterol
- Financial stability
- Mental health
- Obesity
- Youth activity
African American Older Women
- Generational differences straining connection between seniors and youth: decrease in empathy and increase in societal disconnectedness
- Lack of awareness of resources and services available especially among seniors due to lack of age-appropriate, "traditional" communication mediums (abundant use of technology in communication rather than paper flyers and conversation)
- Lack of patient-provider relationships
- Loss of hope for future change/progress
- Racial disparities during COVID-19
- Social/mental health support concerns
Youth
- Access to healthy food options needed as there are local food deserts
- Impact of employment on health
- Importance of non-hostile discourse for conflict resolution
- Limited resources provided to schools
- Need for advocacy of youth concerns
- Need for health education
- Negative family dynamics create generational impacts
- Prevalence of crime / violence & its effects on mental health
Windshield Tours
WCHD conducted three windshield tours as part of their primary data collection methods. This assessment consisted of driving or walking through Superior Township, MacArthur Blvd, Downtown Ypsilanti, the southside neighborhoods of Ypsilanti, and Ypsilanti Township and noting physical attributes of these areas. WCHD staff were accompanied on each windshield tour by a community member that acted as a tour guide and was able to provide additional context on neighborhood history, things in the neighborhood that make it easier to be healthy, and things that act as barriers to health. Categories that were assessed during each windshield tour included neighborhood identity, housing, parks, streets and sidewalks, access to resources and services, faith-based organizations, community members, schools, and other notable findings.
A brief summary of each windshield tour can be located in the Overarching Windshield Tour Summary appendix and several highlights are displayed below.
Superior Township, MacArthur Blvd: This is the old Cheney School site, a vacant school lot. There is lots of community discussion/activity about the future of this site and potential for it to be transformed into a community/rec center.
Downtown Ypsilanti: Downtown Ypsilanti is home to many small businesses. Unfortunately, the pandemic shuttered many of them.
Ypsilanti Township: This is the Ypsilanti Community Schools (YCS) Resiliency Center located at the Willow Run Campus in Ypsilanti Township. The Resiliency Center is a “one-stop shopping experience for the students and families of YCS. Families can schedule an appointment to shop for clothing, shoes, toiletries, and non-perishable food items.” They also now have a small computer lab, Kids Zone and space for adults to relax. It was highlighted as a community strength/asset during the windshield tour. Additionally, partners noted the entire Willow Run campus/building is an under-utilized resource that could host more programs.
Community Survey
A 20-question survey was created with the goal of better understanding the health needs of the Washtenaw County community. The questions incorporated in the survey were focused on lived experiences and overall needs of the community, rather than individual health outcomes. The survey was available in both English and Spanish, and a total of 1,034 responses were collected. View more information about the community survey, including results, here.
Prioritization Process
State of Our Health
WCHD kicked off the community health improvement prioritization process with an inaugural State of Our Health event on November 13, 2023. This event brought together community members and partners to discuss key findings of the Community Health Assessment (CHA) and prioritize health topics for the 2024 Community Health Improvement Plan (CHIP).
During the event, the WCHD delivered a concise overview of the CHA process and findings. The CHA analyzed data from multiple sources:
- Secondary Data Analysis of 150 community indicators, spanning at least 24 topics in the areas of health, determinants of health, and quality of life.
- Community Health Survey: conducted from March-June 2023. Survey offered in English and Spanish. 993 total responses.
- Ten key informant interviews and four focus groups: conducted with approximately 40 key community members who shared their lived experiences with health assets and barriers in the county.
- Three windshield tours: conducted in and around areas primarily located on the east side of the county.
Nine significant areas of need emerged from the CHA data collection process. These areas of concern included: Access to Healthy Food, Affordable Housing, Equity in Education, Financial Stability, Health Care Access and Navigation, Infectious Disease, Mental Health, Older Adult Health, and Substance Use.
After the presentation of the nine identified areas of need, participants went into breakout discussions, with each table assigned a different topic. Participants were provided a data placemat containing relevant data to support conversation. A facilitator/moderator guided each group discussion. Participants were tasked with reviewing their table’s topic and the information on their data placemat, sharing their overall thoughts on the findings, highlighting any notable observations or surprises and providing additional context based on their lived experiences in the community.
Following the group discussions, each participant engaged in an individual prioritization activity, drawing upon their own knowledge, experience, and expertise.
The criteria for prioritization included:
- Resources & Capacity
There are __________ collaborative/system strengths and/or assets to leverage to enhance impact.
1. no/little
2. some
3. clear
- Severity of Issue
There is ____________ need for immediate intervention and/or a specific population effected.
1. no/little
2. some
3. clear
- Community Readiness
There is ____________ enthusiasm and/or willingness from the community to act on this issue.
1. no/little
2. some
3. clear
Participants assigned a score of 1-3 to each health topic and criterion, with a higher score indicating a greater need for that topic to be prioritized. In addition to considering the data from the CHA, participants were encouraged to use their own judgment and knowledge of the community in considering how well a health topic met the criteria.
Completion of the scorecard activity resulted in a numerical aggregate score for each health topic and criterion.
Additional Community Engagement Sessions
Five smaller community engagement sessions were also held to ensure the voice of the county’s historically marginalized populations was included in the prioritization process. The five sessions had a total of 45 participants and were held with the Latinx community, Survivors Speak, Whitmore Lake, Ypsilanti Township, and youth. These smaller sessions included the same key elements as the State of Our Health event: a presentation of data findings and a prioritization scorecard activity.
Priorities
The scores from the State of Our Health event and the five smaller community sessions were combined. The resulting top three health topics from the prioritization activity include Mental Health, Health Care Access and Navigation, and Access to Healthy Food.
2023 Community Health Assessment Documents
This collection contains the executive summary and appendices for the 2023 Community Health Assessment for Washtenaw County.
