17. CPH Domain 10: Needs Assessment, Ecological Model
After this lesson you can
- Plan a needs and resource assessment and choose among secondary data, surveys, focus groups, key informant interviews, and windshield surveys
- Classify interventions by social-ecological level, including the often-missed interpersonal level
- Distinguish cultural competence from cultural humility and apply the CLAS language-access rules
- Diagnose access barriers using Penchansky and Thomas's five dimensions
- Sort determinants into the Healthy People 2030 SDOH domains and upstream, midstream, and downstream
- Tell a disparity from an inequity
Video coming soon
Scheduled for release on December 2, 2026.
A full lesson on Domain 10, Health Outcomes and Population Perspectives, covering all eight task statements. It teaches needs and resource assessment methods, the four levels of the social-ecological model, values, cultural humility and the CLAS standards, and the five dimensions of access, built around a Harbor County immigrant community that does not use a clinic two blocks away.
Questions and answers
Questions a learner would ask about this lesson. Think through your own answer before you open each one.
- What methods does a needs and resource assessment use?
Show answer
The lesson groups them into four method families: secondary data (vital records, surveillance, surveys such as BRFSS, the Census and American Community Survey); surveys, focus groups, and community forums; key informant interviews; and windshield surveys. Secondary data are cheap and fast but often too coarse for a neighborhood. Surveys give magnitude, groups give meaning, and a windshield survey records built-environment features no dataset carries.
- What are the four levels of the social-ecological model?
Show answer
Individual (knowledge, attitudes, beliefs, skills, biology), relationship or interpersonal (family, friends, peers, close networks), community (schools, worksites, neighborhoods, the built environment), and societal (laws, policies, economic systems, cultural norms). The lesson's rule is to classify an intervention by what it operates through. Peer-led programs are interpersonal, not community, and the lesson calls the interpersonal level the most frequently missed.
- How is cultural humility different from cultural competence?
Show answer
Cultural competence is a set of knowledge, attitudes, and skills for serving diverse groups, and it implies an achievable endpoint. Cultural humility is a lifelong process of self-reflection, learning, and redressing power imbalance, with no endpoint. The lesson says competence risks treating culture as a fixed body of facts, and that the exam prefers humility language.
- Why can a clinic two blocks away still be hard to use?
Show answer
Penchansky and Thomas describe five dimensions of access: availability, accessibility, accommodation, affordability, and acceptability. A nearby clinic can still fail on accessibility (no sidewalk, an unsignaled crossing), accommodation (it closes at 4 p.m. while residents work until 6 p.m.), affordability, or acceptability. High availability with low utilization means you look at the other four dimensions.
- What is the difference between a disparity and an inequity?
Show answer
A disparity is a measurable difference in health between groups. An inequity is a difference that is unjust, avoidable, and systematic, so it carries a normative judgment about cause. Every inequity is a disparity, but not every disparity is an inequity.
Practice quiz
- Question 1A health department pays trained residents to accompany neighbors to clinic appointments as patient navigators. At which social-ecological level does this operate?
- Question 2A county adds bike lanes and a healthy corner-store program in one neighborhood. At which level does this operate?
- Question 3A clinic has enough appointment slots, but residents report that staff do not speak their language and they fear questions about immigration status. Which access dimension is most affected?
- Question 4A county has no pediatric specialist anywhere within its borders. Which access dimension does this describe?
- Question 5A health department wants several community members' views in one guided discussion where participants react to each other. Which method fits, and roughly how many people does the lesson give for it?
- Question 6In the lesson's seven steps of a needs and resource assessment, what comes immediately after "define the population and the purpose"?
- Question 7Which Healthy People 2030 social determinants of health domain includes employment, income, and housing stability?
- Question 8According to the lesson's CLAS material, which interpreter should an organization use for a patient with limited English proficiency?
- Question 9In the County Health Rankings model as the lesson presents it, which group of health factors carries the largest weight?
- Question 10Domain 10 carries a weight of 10 percent. Using the lesson's figure of 175 scored items, about how many scored items come from Domain 10?
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