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Guide to writing an excellent community health assessment analysis essay, rachel r.n..

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A Community Health Assessment Analysis Essay is a comprehensive academic paper that requires nursing students to conduct an in-depth evaluation of the health status, needs, and concerns of a specific community. The primary goal is to demonstrate proficiency in data collection, analysis, and proposing evidence-based interventions to address identified health issues.

As a nursing student, you’ll likely be tasked with writing a community health assessment analysis essay. This assignment evaluates your ability to assess a community’s health needs, analyze data, and propose evidence-based solutions. To excel, you’ll need to follow a systematic approach and provide in-depth analysis. This guide will walk you through the process step-by-step.

Step 1: Choose a Specific Community Define the community you’ll focus on narrowly. For example, instead of a general “urban community,” choose a particular neighborhood like “Downtown Oakville” or a group like “Hispanic immigrants in Oakland County.”

Step 2: Gather Comprehensive Data Collect extensive data from reliable sources on the community’s:

• Demographics (age, gender, race/ethnicity, income levels)
• Health statistics (rates of diseases, infant mortality, life expectancy)
• Access to healthcare services (number of clinics, hospitals, uninsured rates)
• Environmental factors (air/water quality, toxic exposures, crime rates)
• Social determinants (education, housing, transportation, food access)

Use government databases like County Health Rankings, CDC reports, academic journals, and local non-profit organizations.

Step 3: Identify Key Health Issues Thoroughly analyze the data to pinpoint the critical health concerns. For example, if your data shows the community has high rates of obesity, diabetes, and low fruit/vegetable consumption, you could identify “Diet-related chronic diseases” as a major issue.

Step 4: Analyze Root Causes Don’t just state the issues superficially. Dive deeper to analyze the potential underlying reasons. Continuing the previous example, you could discuss:

• Lack of affordable fresh food options
• Prevalence of food deserts
• Low health literacy
• Cultural dietary patterns
• Poverty and inability to access healthy foods

Step 5: Propose Multi-Faceted Interventions Develop a comprehensive intervention plan to address the issues and root causes. For diet-related diseases, you could recommend:

• Launching community gardens and nutrition education programs
• Attracting a full-service grocery store through tax incentives
• Partnering with food banks for healthy food distribution
• Promoting corporate wellness programs and preventative screenings

Step 6: Justify with Evidence Support every recommendation using strong evidence and reasoning from authoritative sources. For example, you could cite studies demonstrating the effectiveness of community gardens for increasing vegetable consumption and reducing obesity rates.

Step 7: Structuring Your Essay Your essay should follow a clear, logical structure:

• Introduction (Describe community and health issues)
• Body Paragraphs
• Health Data Analysis (Quantitative assessments using statistics/charts)
• Root Cause Analysis (Qualitative assessments examining social factors)
• Intervention Plan (Describe multifaceted strategies in detail)
• Justifications (Provide evidence for why interventions will work)
• Conclusion (Summarize main points and importance of your proposals)

Step 8: Edit Meticulously Ensure your writing is clear, coherent, and free of errors. Use appropriate nursing terminology. Formatting and citations should comply with guidelines.

What You'll Learn

Structure of a Community Health Assessment Analysis Essay

Introduction

• Clearly define and describe the chosen community (e.g., Downtown Oakville neighborhood, Hispanic immigrants in Oakland County).
• Provide an overview of the major health concerns or issues identified through preliminary research.

Body A. Health Data Analysis

• Demographics (e.g., age, gender, race/ethnicity, income levels) from census data
• Health statistics (e.g., disease rates, infant mortality, life expectancy) from CDC reports
• Access to healthcare services (e.g., number of clinics, hospitals, uninsured rates) from local health department
• Environmental factors (e.g., air/water quality, toxic exposures, crime rates) from EPA databases
• Use charts, graphs, and tables to effectively visualize and interpret the data.
• Example: A chart showing the community has higher rates of obesity (35%) compared to the national average (27%).

B. Root Cause Analysis

• Examine the potential underlying reasons or social determinants contributing to the identified health issues.
• Explore factors such as income levels, education, housing conditions, access to healthcare, environmental exposures, cultural practices, and health literacy.
• Example: For the high obesity rates, analyze factors like prevalence of food deserts, lack of affordable fresh food options, low health literacy, and cultural dietary patterns.

C. Intervention Plan

• Develop a comprehensive, multi-faceted plan to address the health concerns and their root causes.
• Interventions may include community education programs, policy changes, improvements to healthcare access, environmental modifications, or partnerships with local organizations.
• Example: For obesity, propose interventions like launching community gardens, nutrition education, attracting a grocery store through tax incentives, promoting corporate wellness programs.

D. Justifications

• Provide evidence from authoritative sources (research studies, best practices, expert recommendations) to support the proposed interventions and their potential effectiveness.
• Explain how the interventions align with nursing principles, theories, and practices.
• Example: Cite studies demonstrating the effectiveness of community gardens for increasing vegetable consumption and reducing obesity rates.
• Summarize the main points and key findings from the assessment.
• Reinforce the importance and potential impact of the proposed interventions on improving the community’s health outcomes.
• Highlight the role of nurses in promoting community health and addressing public health challenges.

Tips for Writing a Community Health Assessment Analysis Essay

• Proficiency in data collection and analysis from various sources
• Critical thinking and ability to interpret data to identify health concerns
• Understanding of social determinants of health and their impact
• Knowledge of evidence-based interventions and strategies in community health nursing
• Effective communication and academic writing skills
• Proper use of nursing terminology, formatting, and citation styles (e.g., APA)

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Community Health Assessment Essay

50 potential community health assessment analysis essay topics:

• Assessing mental health needs in urban low-income neighborhoods
• Analysis of childhood obesity rates and interventions in your local school district
• Evaluation of prenatal care access and outcomes in rural communities
• Assessment of environmental pollution impacts on respiratory health in industrial areas
• Analyzing food insecurity and nutrition programs for senior citizens
• Assessing healthcare access barriers for immigrant and refugee populations
• Evaluation of substance abuse prevention programs for at-risk youth
• Analysis of chronic disease management resources for the uninsured
• Assessment of community resilience and disaster preparedness plans
• Evaluating workplace wellness programs and employee health initiatives
• Assessing oral health education and dental care access in underserved areas
• Analysis of community support services for new mothers and infants
• Evaluation of fall prevention programs for elderly community residents
• Assessing health literacy campaigns and impacts on preventative screenings
• Analysis of HIV/AIDS education, testing, and treatment resources
• Evaluating community violence intervention and anti-bullying programs
• Assessment of tobacco cessation services and policies in your county
• Analysis of housing conditions and effects on respiratory health
• Evaluating recreation facilities, green spaces, and community physical activity
• Assessing access to healthy food options in food deserts
• Analysis of community water quality, sanitation, and waterborne illnesses
• Evaluating mental health support services for veterans and their families
• Assessment of vaccination rates and vaccine-preventable disease outbreaks
• Analysis of noise pollution levels and impacts on cardiovascular health
• Evaluating workplace safety regulations and occupational injury rates
• Assessment of heat illness prevention for outdoor workers
• Analysis of community approach to Alzheimer’s disease and dementia care
• Evaluating drunk driving prevention and alcohol awareness programs
• Assessment of services for homeless individuals with chronic illnesses
• Analysis of support resources for children with developmental disabilities
• Evaluating community pools, water safety education, and drowning prevention
• Assessment of health education campaigns around infectious disease outbreaks
• Analysis of services for LGBTQ+ community members’ specific health needs
• Evaluating community approaches to tackling the opioid crisis
• Assessment of language barriers impacting healthcare access and compliance
• Analysis of traffic safety measures and pedestrian accident rates
• Evaluating fall prevention education and home modification programs
• Assessment of cancer screening promotion and early detection initiatives
• Analysis of mosquito control efforts and impacts on mosquito-borne illnesses
• Evaluating community gardens and their effects on nutrition and food access
• Assessment of vision and hearing screening programs for school-aged children
• Analysis of pet overpopulation and impacts on community public health
• Evaluating workplace stress management resources and mental health support
• Assessment of community preparedness for extreme weather events
• Analysis of women’s health education and breast/cervical cancer awareness
• Evaluating anti-vaping campaigns and e-cigarette prevention for youth
• Assessment of skin cancer prevention education and tanning bed regulations
• Analysis of suicide prevention resources, awareness, and crisis intervention
• Evaluating community approaches to addressing loneliness and social isolation
• Assessment of neighborhood walkability, pedestrian infrastructure, and benefits

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Health Needs Assessment

• First Online: 27 April 2016

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• Patrick Tobi 3  

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Health needs assessment (HNA) is one of the approaches used to provide intelligence and inform decision-making on the planning and deploying of resources to address the health priorities of local populations. Need is an important concept in public health but is also a multifaceted one that represents different things to different people. From a public health perspective, need is seen as the ‘ability to benefit’, which means that there must be effective interventions available to meet the need. In present-day public health practice, assessing the health needs of local populations typically involves considering not just their physical and mental health and well-being, but the wider determinants or social factors, such as housing, employment and education that influence their health. This chapter describes the historic development of health needs assessment and its use in contemporary public health practice. The different ways in which need is perceived and their implications for the health service are discussed. A step-by-step guide through the HNA process is outlined and comparisons are made with other overlapping approaches to assessment. The practical challenges of carrying out HNAs are highlighted and case studies are used to illustrate real life experiences.

By the end of this chapter, you should be able to :

Discuss the concepts of need, want and demand.

Describe what is meant by a health needs assessment (HNA) and the different approaches that currently influence thinking and practice underpinning HNA.

Identify the key steps and practical challenges involved in conducting a HNA.

Compare HNA with other overlapping assessment approaches.

Understand, through case studies, how HNA is applied in practice.

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Community Needs Assessment: Bringing Real Voices to the Health Care System

A scoping review of community health needs and assets assessment: concepts, rationale, tools and uses

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Patrick Tobi

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University of Bedfordshire, Luton, United Kingdom

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Tobi, P. (2016). Health Needs Assessment. In: Regmi, K., Gee, I. (eds) Public Health Intelligence. Springer, Cham. https://doi.org/10.1007/978-3-319-28326-5_9

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6 Healthcare needs assessment

• Published: August 2020
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Healthcare needs assessment is an evaluative process that aims to quantify population needs for healthcare. Need is defined as the capacity to benefit from healthcare. It is characterized by a deficit in health linked to the potential for effective healthcare intervention. The epidemiological approach to needs assessment considers the burden of illness in terms of the incidence, prevalence, and mortality of a disease or health condition. This approach also draws on estimates of clinical and cost effectiveness from systematic reviews of well-designed studies. These estimates can be mapped to existing patterns of service utilization to identify potential gaps in services. Needs assessment should evaluate inequalities in health needs and access to services in key population subgroups. The comparative approach to needs assessment contrasts locally derived estimates with data from comparator areas as well as national benchmarks and other normative data. The corporate approach engages with stakeholders, including service providers and patients, to understand their perspectives and concerns. Epidemiological, corporate, and comparative assessments of need should be summarized to make quantified recommendations for changes to existing services, informing the development of a business case, and being integrated into service commissioning.

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• v.316(7140); 1998 Apr 25

Health needs assessment

Development and importance of health needs assessment, john wright.

a Bradford Hospitals NHS Trust, Bradford Royal Infirmary, Bradford BD9 6RJ, b Nuffield Institute for Health, Leeds LS2 9PL, c North Yorkshire Health Authority, York YO1 1PE

Rhys Williams

John r wilkinson.

Most doctors are used to assessing the health needs of their individual patients. Through professional training and clinical experience we have developed a systematic approach to this assessment and we use it before we start a treatment that we believe to be effective. Such a systematic approach has often been missing when it comes to assessing the health needs of a local or practice population.

The health needs of individual patients coming through the consulting room door may not reflect the wider health needs of the community. If people have a health problem that they believe cannot be helped by the health service, then they will not attend. For example, many people with angina or multiple sclerosis are not known to either their local general practitioner or to a hospital specialist. 1 , 2 Other groups of patients who may need health care but do not demand it include homeless people and people with chronic mental illness.

Distinguishing between individual needs and the wider needs of the community is important in the planning and provision of local health services. If these needs are ignored then there is a danger of a top-down approach to providing health services, which relies too heavily on what a few people perceive to be the needs of the population rather than what they actually are.

Summary points

• Health needs assessment is the systematic approach to ensuring that the health service uses its resources to improve the health of the population in the most efficient way
• It involves epidemiological, qualitative, and comparative methods to describe health problems of a population; identify inequalities in health and access to services; and determine priorities for the most effective use of resources
• Health needs are those that can benefit from health care or from wider social and environmental changes
• Successful health needs assessments require a practical understanding of what is involved, the time and resources necessary to undertake assessments, and sufficient integration of the results into planning and commissioning of local services

What is health needs assessment?

Health needs assessment is a new phrase to describe the development and refinement of well established approaches to understanding the needs of a local population. In the 19th century the first medical officers for health were responsible for assessing the needs of their local populations. More recently, in the 1970s the Resource Allocation Working Party assessed relative health needs on the basis of standardised mortality ratios and socioeconomic deprivation in different populations, and it used this formula to recommend fairer redistribution of health service resources. 3 The 1992 Health of the Nation initiative was a government attempt to assess national health needs and determine priorities for improving health. 4 Health needs assessment has come to mean an objective and valid method of tailoring health services—an evidence based approach to commissioning and planning health services.

Although health needs assessments have traditionally been undertaken by public health professionals looking at their local population, these local health needs should be paramount to all health professionals. Hospitals and primary care teams should both aim to develop services to match the needs of their local populations. Combining population needs assessment with personal knowledge of patients’ needs may help to meet this goal. 5

Why has needs assessment become important?

The costs of health care are rising. Over the past 30 years expenditure on health care has risen much faster than the cost increases reported in other sectors of the economy, and health care is now one of the largest sectors in most developed countries. 6 Medical advances and demographic changes will continue the upward pressure on costs. 7

At the same time the resources available for health care are limited. Many people have inequitable access to adequate health care, and many governments are unable to provide such care universally. In addition there is a large variation in availability and use of health care by geographical area and point of provision. 8 Availability tends to be inversely related to the need of the population served. 9

Another force for change is consumerism. The expectations of members of the public have led to greater concerns about the quality of the services they receive—from access and equity to appropriateness and effectiveness.

These factors have triggered reforms of health services in both developed and developing countries. In Britain these reforms resulted in the separation of the responsibility for financing health care from its provision and in the establishment of a purchasing role for health authorities and general practitioners. Health authorities had greater opportunities to try to tailor local services to their own populations, and the 1990 National Health Service Act required health authorities to assess health needs of their populations and to use these assessments to set priorities to improve the health of their local population. 10 , 11 This has been reinforced by more recent work on inequalities in health, suggesting that health authorities should undertake “equity audits” to determine if healthcare resources are being used in accordance with need. 12

At a primary care level, through fundholding, locality commissioning, and total purchasing projects, general practitioners have become more central to strategic planning and development of health services. With this increased commissioning power has come the increased expectation from patients and politicians that decision making would reflect local and national priorities, promoting effective and equitable care on the basis of need. 13 The Labour government has committed itself to ensuring access to treatment according to “need and need alone,” and the key functions of primary care groups will be to plan, commission, and monitor local health services to meet identified local needs. 14 , 15

Doctors, sociologists, philosophers, and economists all have different views of what needs are. 16 – 20 In recognition of the scarcity of resources available to meet these needs, health needs are often differentiated as needs, demands, and supply (fig ​ (fig1). 1 ).

 Different aspects of needs

in health care is commonly defined as the capacity to benefit. If health needs are to be identified then an effective intervention should be available to meet these needs and improve health. There will be no benefit from an intervention that is not effective or if there are no resources available.

is what patients ask for; it is the needs that most doctors encounter. General practitioners have a key role as gatekeepers in controlling this demand, and waiting lists become a surrogate marker and an influence on this demand. Demand from patients for a service can depend on the characteristics of the patient or on the media’s interest in the service. Demand can also be induced by supply: geographical variation in hospital admission rates is explained more by the supply of hospital beds than by indicators of mortality 21 , 22 ; referral rates of general practitioners owe more to the characteristics of individual doctors than to the health of their populations. 23

is the health care provided. This will depend on the interests of health professionals, the priorities of politicians, and the amount of money available. National health technology assessment programmes have developed in recognition of the importance of assessing the supply of new services and treatments before their widespread introduction.

Need, demand, and supply overlap, and this relation is important to consider when assessing health needs (fig ​ (fig2 2 ). 20

Relation between need, supply, and demand—central area shows ideal relation. Modified from Stevens and Raferty. 24

Health needs

The World Health Organisation’s definition of health is often used: “Health is a state of complete physical, psychological, and social wellbeing and not simply the absence of disease or infirmity.” A more romantic definition would be Freud’s: “Health is the ability to work and to love.”

Healthcare needs

are those that can benefit from health care (health education, disease prevention, diagnosis, treatment, rehabilitation, terminal care). Most doctors will consider needs in terms of healthcare services that they can supply. Patients, however, may have a different view of what would make them healthier—for example, a job, a bus route to the hospital or health centre, or decent housing.

incorporate the wider social and environmental determinants of health, such as deprivation, housing, diet, education, employment. This wider definition allows us to look beyond the confines of the medical model based on health services, to the wider influences on health (box). Health needs of a population will be constantly changing, and many will not be amenable to medical intervention.

Influences on health

• Environment: housing, education, socioeconomic status, pollution
• Behaviour: diet, smoking, exercise
• Genes: inherited health potential
• Health care: including primary, secondary, and tertiary prevention

Assessment of health needs is not simply a process of listening to patients or relying on personal experience. It is a systematic method of identifying unmet health and healthcare needs of a population and making changes to meet these unmet needs. It involves an epidemiological and qualitative approach to determining priorities which incorporates clinical and cost effectiveness and patients’ perspectives. This approach must balance clinical, ethical, and economic considerations of need—that is, what should be done, what can be done, and what can be afforded. 25

Health needs assessment should not just be a method of measuring ill health, as this assumes that something can be done to tackle it. Incorporating the concept of a capacity to benefit introduces the importance of effectiveness of health interventions and attempts to make explicit what benefits are being pursued. Economists argue that the capacity to benefit is always going to be greater than available resources and that health needs assessment should also incorporate questions of priority setting, 26 suggesting that many needs assessments are simply distractions from the difficult decisions of rationing. 27

For individual practices and health professionals, health needs assessment provides the opportunity for:

• Describing the patterns of disease in the local population and the differences from district, regional, or national disease patterns;
• Learning more about the needs and priorities of their patients and the local population;
• Highlighting the areas of unmet need and providing a clear set of objectives to work towards to meet these needs;
• Deciding rationally how to use resources to improve their local population’s health in the most effective and efficient way;
• Influencing policy, interagency collaboration, or research and development priorities.

Importantly, health needs assessment also provides a method of monitoring and promoting equity in the provision and use of health services and addressing inequalities in health. 28 , 29

The importance of assessing health needs rather than reacting to health demands is widely recognised, and there are many examples of needs assessment in primary and secondary care. 21 , 30 , 31

There is no easy, quick-fix recipe for health needs assessment. Different topics will require different approaches. These may involve a combination of qualitative and quantitative research methods to collect original information, or adapting and transferring what is already known or available.

The stimulus for these assessments is often the personal interest of an individual or the availability of new funding for the development of health services. However, assessments should also be prompted by the importance of the health problem (in terms of frequency, impact, or cost), the occurrence of critical incidents (the death of a patient turned away because the intensive care unit is full), evidence of effectiveness of an intervention, or publication of new research findings about the burden of a disease.

Why do projects fail?

Some needs assessments have been more successful than others. Projects may fail for several reasons. 31 – 33

Firstly, what is involved in assessing health needs and how it should be undertaken may not be understood. Educational strategies can improve the understanding and necessary skills of health professionals, and local public health teams can provide valuable support and guidance. Common sense can be a more important asset than detailed methodological understanding. 34 Starting with a simple and well defined health topic can provide experience and encourage success.

Secondly, projects may fail because of a lack of time, resources, or commitment. The time and resources required can be small when shared among professionals in a team, and such sharing has the potential to be team building. Involving other organisations such as social services, local authorities, or voluntary groups can provide similar advantages and encourage multiagency working. Integration of needs assessment into audit and education can also provide better use of scarce time. Such investment of time and effort is likely to become increasingly necessary in order to justify extra resources.

A third reason is the failure to integrate the results with planning and purchasing intentions to ensure change. The planning cycle should begin with the assessment of need. 28 Objectives must be clearly defined (box) and relevant stakeholders or agencies—be they primary care teams, hospital staff, health authorities, the voluntary sector, the media, regional executives, government, or patients—must be involved appropriately (fig ​ (fig3). 3 ). Although such an assessment may produce a multitude of needs, criteria can be used to prioritise these needs—for example, the importance of a problem in terms of frequency or severity, the evidence of effectiveness of interventions, or the feasibility for change. Needs assessments that do not include sufficient attention to implementation will become little more than academic or public relations exercises.

Questions to ask when assessing health needs

• What is the problem?
• What is the size and nature of the problem?
• What are the current services?
• What do patients want?
• What are the most appropriate and effective (clinical and cost) solutions?
• What are the resource implications?
• What are the outcomes to evaluate change and the criteria to audit success?

Contributors to needs assessment

This series will describe the different approaches to assessing health needs, how to identify topics for health needs assessments, which practical approaches can be taken, and how the results can be used effectively to improve the health of local populations. It will give examples of needs assessment from primary care but will also cover the specific problems of needs assessment for hard to reach groups. Many of the techniques of community appraisals used in needs assessment originate from experience in developing countries, and some of the lessons from this experience will be described.

These articles have been adapted from Health Needs Assessment in Practice , edited by John Wright, which will be published in July

Acknowledgments

We are grateful to John Bibby and Dee Kyle for their valuable contributions and to Margaret Haigh for secretarial support.

Funding: None.

Conflict of interest: None.

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The purpose of this assignment is to complete a health needs assessment within a defined community. It will seek to explore socio-economic factors and health issues to find what conditions are most prevalent within the ward and how they impact on the community.

The assessment process will be guided by a framework which will explore all aspects of the community.Health inequalities have existed in society for at least thirty years that we know of. The first report on health inequalities was the commissioned Black Report by the then Labour government. This was then brushed aside when the conservatives came into power in 1979 (Acheson 1998).

Both the Black report (1980) and Acheson's reports (1998) where commissioned to look at health trends and trends in inequalities faced by the population of the time, and to see how government and social policy could work best to tackle and improve these outcomes.The Acheson report looks at general health trends, socio-economic position, mortality, morbidity, income, education, employment, housing, homelessness, public safety, transport, health related behaviours and ethnicity (Acheson 1998). All of these issues will be explored as part of the process within this health needs assessment of the ward being discussed to build up a health profile of the community.What is health?' [Health is] the extent to which an individual or group is able on the one hand, to realise aspirations and satisfy needs and on the other hand to change or cope with the environment.

Health is therefore seen as a resource for everyday life, not the object of living: it is a positive concept emphasising social and personal resources as well as physical capabilities...' (WHO 1984)National Institute of Clinical excellence (Nice 2005) define a health needs assessment as'.

.a systematic method for reviewing health issues facing a population, leading to agreed priories and resource allocation that will improve health and reduce health inequalities'The framework used to complete this health needs assessment is based on guidance published by NICE (2005) which details a five step process. Step one defines who the population is, step two identifies health priorities which then builds a profile about the population group to target and benefit, step three looks at identifying conditions impacting on the community and identifies any gap in service provision which would lead to a proposed change ready for steps four and five, the development and implementation of and action plan and then evaluating its effectiveness (NICE 2005). Due to word constraint, only steps one, two and three will be explored.

For purpose of this assessment only information and data within the public domain has been used to maintain confidentiality (Nursing and Midwifery Council NMC 2008).Evidence based research plays an enormous part in the way nurses practice and carry out tasks. It is ever changing so all research gathered and looked at has to be up to date and accurate. Gray, (2001) suggests that research is a process of enquiry that produces knowledge and can help us to understand and promote health care, through intervention, treatments and therapies.

So by undertaking a health needs assessment on the population not only looks at prevalence of disease but can point out a gap in service provision and point out a way of meeting this need.A health needs assessment rather than a focus needs assessment has been chosen for the purpose of this assignment. The reason for the choice of assessment come from the author being new to the practice area and new to the district with no knowledge of the community's issues and problems regarding health and social care.Step oneSocial Structure and Social ActivityThe community is a small town in the North of England with a geographical area approx 9 square miles.

In 1981 the ward was ranked 232 out of 678, by 1991 it had slipped to 176 putting it within the worst 25% of places to live in the north east. It has been difficult to find up to date data on where the ward ranks at present despite searching census and quality and outcomes framework (QOF) data bases.The last census in 2001 shows the population in the ward at that time to be 11,222 people, with an approximate gender split between male and females (ONS 2001).The wards community facilities include two nurseries, three primary schools and one senior school (Local Authority 2008), there are many local bakeries, one green grocer and two butchers but the community only has one small supermarket. The nearest large supermarket is roughly six miles away (AA route finder 2008). What is noticeable about the community's amenities is the large amount of fast food and takeaway businesses.

Since the closure of the mines in the 1980's there has been no industry within the town and the majority of those working of seeking to find jobs need to travel to the nearest city. When the mines closed many hundreds of people lost their jobs and were unable to find suitable or regular jobs due to poor education and the lack of qualifications to work in business. Unemployment within the community is higher than the nation average with most people having no qualifications to seek out permanent long term employment (ONS 2001).There is one newly built community centre which houses a library, the local housing office, a caf�, gym and nursery. The Primary Care Trust (PCT) also use the facilities to provide communities services. Facilities can also be booked for individuals to use.

The ward itself is classifies as being in the most deprived 20% of the country (STPCT2006/07).AgeThe average age of the ward population is 45-54 years of age compared to the local and national average which is 35-44 years of age (ONS 2004).The population of those aged 0-4 is 6.75% and the population of 0-14 is 22% in comparison to the nation average, this is 3.2% higher, a significant factor when looking at the health needs and future health needs of the population.The proportion of those age 65 and over are 21.

7%, 6.6% higher than the nation average which is 15.51%. With the population of those aged 65 and over being higher than the national average, this would suggest that health provision for those within this age group is well provided for and that the town is good place to retire to.

National target of life expectancy for the area is around 78-79 years of age (DH 2007) but as the figure show, this town has a significantly higher proportion of those aged over 65 in age and a slightly higher (0.8%) population of those over 80 years of age. (ONS 2004).On the other hand due to the long liverty of the population, limiting long term illnesses maybe significantly higher.

Hip fractures in those over 65 is shown to be significantly higher in the district than England (NEPHO 2008).EthnicityThe ethnic* population makes up just 2.3% of the population, an average of just over 2 in 100 people. The district also shows the ethnic population to be 4.

79% compared with the national average 21.60% which equates to 1 in 5 people (ONS 2001). This shows a major difference in culture and provision of services which may need to be provided.*For the purpose of this assignment ethnicity is anyone born outside of Great Britain and Ireland.Health CareThe community serviced by one health centre which houses 7 general practitioners, 4 Health visitors and a nursery nurse.

Midwifery service and district nursing service also share the same site. There are two Pharmacies in the ward, owned by the same company (no scope for choice), one dentist and one optician (Local NHS 2008).The location of the health centre posses issues as to were it is situated (way back off the main street on an incline). Access up to the health centre is poor. The bus stop in the town centre and a main road has to be crossed before a long walk up to the health centre.Children in the ward have higher than average tooth decay (NEPHO 2008).

The district as a whole has the worst dental health care for children within north east. Is this lack of education or only having one dentist to services a population of almost 12000 people?Data for the district shows Children are significantly more obese than in England, Child poverty is significantly higher, Obesity is higher in adults being significantly higher than the nation average for the ward (STPCT 2006/7) and Deprivation is higher. QOF data for the ward also shows that CHD, asthma, cancer, diabetes mellitus, blood pressure, Left ventricular dysfunction, mental health, cardio Vascular Accidents (CVA) and thyroid are all higher than the district average and the UK average (QOF 2005/06). The ward is among 10% of wards in England with the lowest percentages of adults eating five or more potions of fruit and vegetables a day (STPCT 2006.07).What data does show about the area is how good an uptake of the immunisation programme there is within the trust of primary vaccinations, boosters and MMR vaccinations.

It is almost 11% higher than the national average uptake (STPCT 2006/07)General healthWithin the ward there are 1693 people who report themselves to be in not so good health (15.09%), within England this figure is 9.06% a difference of 6.03% almost a third higher.

The percentage of those with limiting long tern illnesses is 29.01%, 11.08% higher than in national average. The district is also 6.12% above the national average.The biggest mortality rates for the area are Cancers, CVA and Coronary heart disease (CHD) (NEPHO 2008, STPCT 2006/07).

The north east over the last 25 years has always had a higher than average mortality rate, dating back to the 1981 census (Philimore et al 1994). In the period of 1981-1991 the north east had the highest mortality rates per ward than all of England and Wales (Philimore et al 1994).In 2003-2005 deaths by lung cancer in the district was 5% higher than anywhere else in England and of all deaths by cancer, Lung cancer accounts for more than 60% of all respiratory diseases in woman. The figure for men is on average 10% lower accounting for an average 50% of all respiratory diseases in men (STPCT 2006/07).Chronic obstructive pulmonary disease (COPD) prevalence is highest in the district by 0.4%, as well as being 1.

37% higher than the national average (STPCT 2006/07). Asthma is another area the district's prevalence is higher (0.33) although a sister district does have a higher prevalence of 0.56% (STPCT 2006/07). As with the other respiratory problems it appears the north east far out weights the rest of England for prevalence of these diseases.

Is there a gap in service provision here or could more be done locally to resolve these issues.The ward has a significantly lower rate of low birth weight babies (STPCT 2006/07) this is a common occurrence throughout the north east. Smoking whilst pregnant is known to increase the chances of having a lower birth weight baby (NICE 2008)The prevalence of smoking ranks it among the worst 20% of wards in England with the highest proportion of smokers, with 23% of the districts women smoking throughout their pregnancy (STPCT 2006/07). The number of girls aged 10-15 years old in the district who smoke is 3% higher than the national average, yet the number of boys aged 10-15 years old who smoke is 1% lower than the national average (STPCT 2006/07).

Binge drinking was also ranked within the worst 20% of wards in England with the highest proportion of individuals who binge drink weekly.Mental healthPrevalence of depression in the ward was ranked among the best 10.5-21% of wards (STPCT 2006/07). People of the district received more incapacity benefit for mental health/behaviour disorders than in any other district within England (STPCT 2006/07. It is estimated that 1 in 10 children between the ages of 5 and 16 has a recognisable mental disorder, with boys being more prone to mental illness. It is also thought that children from single parent households are more prone to mental disorders (ONS 2004).

It was difficult to find accurate ward data when completing this part of the health needs assessment. By going on data for the district as a whole may not necessarily mean it's a common theme in this ward. Had data from GP's been in the public domain a more complete and accurate picture may have been givenHousingFrom observed practice most people live in two bedroomed converted properties which were originally single story houses which have then been built upwards and extended out the back of the house. There are4800 house holds in the ward with 41% of the population live in rented or council property 10.25% higher than the national average.

Due to the type of properties on offer in the ward there is a lot of social movement in and out of the local towns surrounding the ward. Housing isn't offered on a point system from the council but on a swap for swap basis (Local Authority 2008).TransportThe number of households with access to a car or a van is 34.7 percent. This is lower than the national average by 6.

64%. The figure do however show that the percentage is higher than within the district and the north east by an average of 15.7%. Data from the 1991 census (Phillimore et al 1994) and 2001 census (ONS 2008) shows that they has been a 13.

9% increase in car or van ownership. If up to data had been available it would have been interesting to see how different again this was after eight years.

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• Open access
• Published: 17 January 2023

A scoping review of community health needs and assets assessment: concepts, rationale, tools and uses

• Hamid Ravaghi 1 ,
• Ann-Lise Guisset 2 ,
• Samar Elfeky 3 ,
• Naima Nasir 4 ,
• Sedigheh Khani 5 ,
• Elham Ahmadnezhad 6 &
• Zhaleh Abdi 7  

BMC Health Services Research volume  23 , Article number:  44 ( 2023 ) Cite this article

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Community health needs and assets assessment is a means of identifying and describing community health needs and resources, serving as a mechanism to gain the necessary information to make informed choices about community health. The current review of the literature was performed in order to shed more light on concepts, rationale, tools and uses of community health needs and assets assessment.

We conducted a scoping review of the literature published in English using PubMed, Embase, Scopus, Web of Science, PDQ evidence, NIH database, Cochrane library, CDC library, Trip, and Global Health Library databases until March 2021.

A total of 169 articles including both empirical papers and theoretical and conceptual work were ultimately retained for analysis. Relevant concepts were examined guided by a conceptual framework. The empirical papers were dominantly conducted in the  United States. Qualitative, quantitative and mixed-method approaches were used to collect data on community health needs and assets, with an increasing trend of using mixed-method approaches. Almost half of the included empirical studies used participatory approaches to incorporate community inputs into the process.

Our findings highlight the need for having holistic approaches to assess community’s health needs focusing on physical, mental and social wellbeing, along with considering the broader systems factors and structural challenges to individual and population health. Furthermore, the findings emphasize assessing community health assets as an integral component of the process, beginning foremost with community capabilities and knowledge. There has been a trend toward using mixed-methods approaches to conduct the assessment in recent years that led to the inclusion of the voices of all community members, particularly vulnerable and disadvantaged groups. A notable gap in the existing literature is the lack of long-term or longitudinal–assessment of the community health needs assessment impacts.

Peer Review reports

The population-based health approach aims to improve the population’s health, promote community resilience and reduce health inequities across the socioeconomic gradient via inter-sectoral partnerships among community groups, government, healthcare systems, and other stakeholders [ 1 ]. One key feature for adopting a population-based health approach is to ensure that it is grounded on a solid understanding of community health needs and assets by triangulating evidence from service providers and community members on services availability, accessibility, utilization and experience [ 2 , 3 ]. The process of identification of unmet health needs in a population is crucial for local authorities seeking to plan appropriate and effective programmes to meet these needs [ 3 , 4 ]. If these needs are ignored, then there is a risk of a top-down approach for providing health services, reflecting what a few people perceive to be the needs of the population rather than what they actually are [ 4 , 5 ].

In this context, community health needs assessment is a means of developing a comprehensive understanding of a community’s health and health needs as well as designing interventions to improve community health [ 6 ]. Though the process of community health needs assessment can be conducted in several ways, the primary purpose is to provide community leaders or healthcare providers with an overview of local policy, systems, and environmental change strategies currently in place and help to identify areas for improvement [ 7 ]. Community health needs assessment can provide them with a more nuanced understanding of the communities they serve, making them aware of pressing issues that require system-level changes and support their efforts for resource mobilization to initiate innovative programmes [ 8 , 9 ]. The process to gather evidence on community health needs can also serve as a springboard to strengthen community engagement [ 10 ].

In general, needs assessments are usually designed to evaluate gaps between current situations and desired outcomes, along with possible solutions to address the gaps. Recently, there has been a trend to move away from framing a community with a deficit perspective (need-based approach) to focus on community assets and resources, called community health needs and assets assessment [ 11 , 12 ]. In contrast to a need-based perspective which focuses on local deficits and resources outside the community, an asset-based perspective focuses on honing and leveraging existing strengths within the community to address community needs [ 12 , 13 , 14 ].

Studies have shown that community health needs assessment is used widely by different users and across different settings [ 15 , 16 ]. However, these studies varied widely in terms of purpose, process and methods of conducting community health needs assessment. Furthermore, the extent to which an asset-based approach is used is unclear, beyond the inclusion in guidance and recommendations. Thus, to support national or local decision-makers to make informed choices about the scope, tools, methods and use of community health needs and assets assessment, this scoping review of the literature aimed at: 1) Providing conceptual clarity on community health needs and assets assessment, 2) Determining for what purpose and with what methods community health needs and assets assessment are used globally, 3) Drawing the lessons learnt from previous experience with community health needs and assets assessment: what works in what context and under what conditions, 4) Documenting evidence of impact of community health needs and assets assessment, 5) Consolidating tools and methods used to collect evidence/data underpinning community health needs and assets assessment processes.

Search strategy

Ten databases, including PubMed, Embase, Scopus, Web of Science, PDQ evidence, NIH database, Cochrane library, CDC library, Trip, and Global Health Library were searched in February and March 2021. The search strategy was developed through discussion with experts in the field of population health, a research librarian, and a narrative review of the literature. Preliminary search terms were developed by the research team to reflect a number of core concepts including needs, population, needs assessment, assets assessment and participation. The search process was performed by a librarian with expertise in the use of literature databases (SK). The search terms were pilot-tested and agreed upon within the research team. The PubMed database search strategy presented in Additional file  1 .

Inclusion and exclusion criteria

Studies that focus on community health needs and assets assessment in terms of concepts, rationale, uses and tools were considered in both high-income countries (HICs) and low-and middle-income counties (LIMCs). We included studies in the review if they met the following criteria: 1) Papers providing conceptual clarity and explaining rationale for community health needs and (assets) assessment (This can be articles describing community health needs assessment or community assets assessment or community health needs and assets assessments at the same time or separately). The terms capabilities/ strengths/ resources can be used in place of assets and were considered.); 2) Papers describing or evaluating experiences implementing community health needs (and assets) assessment in a single site or multiple sites; 3) Methodological papers describing tools/approaches for community health needs (and assets) assessment; 4) Review of the literature on community health needs (and assets) assessment.

Types of papers not include in the review were: 1) Studies without a clear description of the community health needs and (assets) assessment methods, 2) Studies assessed a single dimension (i.e. health outcomes only, or healthcare providers’ capabilities only such as patient surveys, health outcomes dashboard, health facility assessment), 3) Studies related to a single disease or programme, 4) Studies focused only on engaging individual patient in their own care, and 5) Studies were not in English.

Three reviewers participated in the selection of the relevant studies (HR, ZA, NN). The eligibility and relevance of the articles were determined by two reviewers independently using the above predefined criteria. In the event of disagreement, a consensus was found between all the reviewers about the status of the article.

Data extraction

Separate data extraction forms were developed for the extraction of the three main categories of papers: conceptual, empirical and review papers. Totally, 121 empirical papers (including 6 review papers) and 48 conceptual and methodological papers were reviewed. Following topics were extracted for empirical papers: 1) General characteristics including author(s), year of publication, country of implementation, study objective(s) and study method; 2) Community health needs and (assets) assessment framing including rational, definitions of community health needs and (assets) assessment/ needs/ assets/ community, initiator(s) or user(s) of the process; 3) Key steps of the process, collected data, data collection tools; 4) Community engagement and the level of engagement; 5) Use of community health needs and (assets) assessment findings, impact of community health needs and (assets) assessment; 6) Facilitators and barriers. Data extraction forms are presented in Additional file  2 .

Data extraction forms were pilot-tested prior to the implementation. Two authors (ZA, HR) independently performed a pilot data extraction of a random sample of ten original articles. After piloting, the authors assessed the extracted data in relation to the scoping review questions and revised them accordingly. The content of the form was finalized by discussion within the team. Regarding conceptual papers, two authors (NN and ZA) initially extracted data from three randomly selected papers and subsequently refined and amended the form having research team inputs.

Four reviewers extracted included studies independently. The data extracted were cross-checked by one of the authors and mutual consensus resolved discrepancies. Individual data extraction forms of empirical papers were then merged into a single, unifying document used for the interpretation and presentation of the results. Following typical scoping review methods, the methodological quality of the included articles was not assessed systematically, however, only peer-reviewed articles were included in our review process [ 17 ].

Synthesis of results

Following reading and extracting conceptual papers, a preliminary conceptual framework (Fig.  1 ) was developed and discussed and agreed upon by team members. The integrative synthesis of the evidence was employed. Specifically, it involved the narrative description of concepts and definitions, key steps of the community health needs assessment and barriers and facilitators of the implementing community health needs assessment.

Conceptual framework of the review

The study selection process is summarized in Fig.  2 . Just over 12,000 records were obtained from the ten databases searched. Articles with obviously irrelevant titles were excluded, as were news items, letters, editorials, book reviews, and articles appearing in newsletters or magazines rather than peer review journals. The remaining abstracts were retrieved, read and assessed. A total of 169 articles including both empirical papers and theoretical and conceptual work were ultimately retained for analysis. A list of all studies with a short description, including the year of publication, key focus, study period, and methods, is presented in Additional files  3 and 4 . The first part of the results section focuses on definitions and concepts of community health needs assessment using both conceptual and empirical papers. In the second part of the results section, we describe key steps of the community health needs assessment and tools and methods used to collect data through content analysis of 121 included empirical papers. We also report some important challenges and facilitators faced by included studies while performing community health needs assessment. Role of community participation in the process and the spectrum and types of the participation is discussed in the last part.

Information flow in scoping review

General characteristics of the included studies

The review showed that community health needs assessment is used widely by different users and across different settings in both HICs and LMICs. Among included empirical studies, 81 (out of 121) were conducted in the  United States (US). There were papers from Australia ( n  = 4), South Africa ( n  = 3), Kenya ( n  = 3), Uinted Kingdom (UK) ( n  = 2), Canada ( n  = 2), China ( n  = 2), Dominican Republic ( n  = 2), Republic of Ireland ( n  = 2), Iran ( n  = 2), India (2), Honduras ( n  = 1), Netherland ( n  = 1), Vietnam ( n  = 1), Sudan ( n  = 1), New Zealand ( n  = 1), Madagascar ( n  = 1), Malaysia ( n  = 1), Ecuador ( n  = 1), Indonesia ( n  = 1), Uganda ( n  = 1), Taiwan ( n  = 1), Kyrgyzstan ( n  = 1), Saudi Arabia ( n  = 1), Haiti ( n  = 1), Honduras ( n  = 1) and Korea ( n  = 1).

Definition of needs

The review showed “need” was a multi-faceted concept with no universal definition. There was a differentiation between “health need” and “healthcare need” in the reviewed literature. Healthcare needs can benefit from health care (health education, disease prevention, diagnosis, treatment, rehabilitation and terminal care). Healthcare providers usually consider needs in terms of healthcare services that they can supply. However, health needs incorporate the wider social and environmental determinants of health, such as deprivation, housing, diet, education and employment. This broader definition allows looking beyond the confines of the medical model based on health services, to the wider influences on health [ 3 ].

In this review, relatively few empirical studies focus narrowly on healthcare needs, without attention to other determinants of health that can affect health [ 18 , 19 , 20 , 21 , 22 , 23 ]. Most of the included empirical studies looked beyond “physical health needs” to consider wider “social determinants of health” or non-medical factors that can affect a person’s overall health and health outcomes as the conditions—shaped by political, social, and economic forces—in which people are born, grow, live, work, and age [ 24 ]. Notably, the need was recognised as a “dynamic concept” whose definition will vary with time according to context and resources available to address these needs [ 16 ].

Definition of community

In general, “community” has been defined as “people with a basis of common interests and network of personal interactions grouped either based on locality or on a specific shared concerns or both” [ 25 ]. Shared common interests are particularly important as they can be assessed and, hopefully, met at a community level [ 26 ]. Importantly, community is a dynamic concept as individuals can belong to several communities at various times. In our review, community was defined by included studies, particularly those initiated by local authorities or healthcare providers (e.g., hospitals), based on geographical indicators such as county designations or based on the location of the hospital’s/facility’s/authority’s existing or potential service users. Some included empirical studies considered community based on shared interests or characteristics such as race/ethnicity, sexual orientation, or occupation. Medically underserved populations including rural areas [ 27 , 28 , 29 , 30 ], impoverished urban sectors [ 31 ], the homeless [ 32 , 33 , 34 , 35 ], persons in poverty or of low socioeconomic status, vulnerable children and families [ 18 , 28 , 36 , 37 , 38 ], the elderly [ 8 , 39 , 40 , 41 , 42 ], women and girls [ 43 , 44 , 45 , 46 , 47 ], LGBT (Lesbian, gay, bisexual, and transgender) individuals [ 48 , 49 , 50 , 51 ], displaced populations, immigrants and racial, ethnic and religious minority groups [ 12 , 19 , 36 , 42 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 ] and persons with severe and chronic health problems [ 79 ] were considered as a “community” by a number of included studies.

While defining community, a number of its characteristics were determined by included studies including: history, existing groups, physical aspects (i.e. geographic location, community size, its topography and etc.), infrastructure (i.e. health and social care facilities, public transportation, roads, bridges, electricity, mobile telephone services and etc.), demographics (i.e. age, gender, race and ethnicity, marital status, education, number of people in household, first language and etc.), economic conditions, deprivation and/or inequalities, government/politics, community leaders (formal and informal), community culture (formal and informal), existing institutions, crime and community safety, lifestyle and leisure, general health problems and epidemiology.

In our review, community health needs and assets assessment were performed by different organizations as the first step in community health promotion planning, including local health authorities (district/local), community entities [i.e. non-governmental organizations (NGOs), civil society organizations (CSOs), faith-based organizations (FBOs), community-based organizations (CBOs)] and hospitals (public/private). Included studies mostly conducted health needs assessment at the local level (e.g. cities, counties, or other municipalities). The broader understanding of health and its determinants suggests that many public and private entities have a stake in or can affect the community’s health. To engage stakeholders in the process, a number of included empirical studies ( n  = 56, 49%) sought representatives from the community that were best positioned to speak about community health based on their specific knowledge or line of work. These stakeholders were individuals from community and entities who may explicitly be concerned with health or not, which varied by the community context and culture. To have a comprehensive overview of a community needs, it was asserted that defining communities needs to be dynamic and socially constructed to take into account all voices and members, especially those not ordinarily included [ 80 ]. Community should be defined in a manner that does not exclude medically underserved, low-income, or minority populations. Integrating community voices is especially important in designing plans and programmes aimed at reducing health disparities in the community [ 58 , 81 , 82 ].

Definition of assets

Overall, there were limited definitions for “community assets” in the reviewed literature. Assets were described as resources, places, businesses, organizations, and people that can be mobilized to improve the community [ 11 , 83 ]. This includes members of the community themselves and their capabilities. Assets can therefore be described as the collective resources which individuals and communities have at their disposal, which protect against adverse health outcomes and promote health status [ 83 , 84 ].

Of 115 included empirical studies, 30 studies addressed community assets while performing community health needs assessment. A wide range of assets, from tangible resources to intangible ones, were considered that can be classified into seven broad categories as follows:

Community demographic characteristics: Literacy rates [ 13 ], youth population [ 58 , 68 ], and elderly population [ 68 ];

Natural capitals: Geographical location and natural resources [ 21 , 81 , 85 ];

Economic and financial capitals: Community business [ 12 , 81 ] community members’ income [ 21 ], and housing land ownership [ 13 ];

Community infrastructure: Level of technology/mobile phone coverage [ 13 , 21 ], transportation [ 86 ], parks and sidewalks [ 12 ], sport and recreational facilities [ 31 , 87 , 88 ], public libraries and community centres [ 88 ];

Community social and educational facilities: Non-profit and non-governmental organizations [ 59 , 87 ], media [ 89 ], educational institutions [ 12 , 31 , 81 , 90 ], faith communities [ 58 , 81 , 90 ], and community associations [ 31 ];

Community health and social facilities: Health and social facilities and providers [ 72 , 81 , 85 , 86 , 89 ], traditional medicine providers [ 72 ], and ongoing health programmes [ 13 , 87 ];

Community’s social and cultural values and resources: Tribal and community culture [ 58 , 68 , 74 , 91 ], cultural diversity [ 81 ], spirituality and religion [ 58 , 74 ], strong family bonds and values [ 59 , 74 ], strong community connections, teamwork and willingness to volunteer [ 21 , 81 , 86 , 91 ], mutual support, social support and networks [ 45 , 58 , 81 , 85 ], unity, community cohesion and collectivity [ 21 , 59 , 74 ], community capacity [ 58 ], community-led activities [ 86 , 91 ], and community values and traditions [ 68 , 74 , 86 ], resiliency [ 58 ], unifying power of communities [ 13 ], community administration units e.g. women’s committees [ 13 ], an existing group of dedicated healthcare providers [ 39 ], a group of concerned citizens [ 39 ], community safety [ 12 ], the knowledge base of the community members themselves [ 39 ] and members’ desire to be healthy [ 58 ].

Various qualitative methods such as individual interviews (one-on-one structured conversations) or focus groups (guided, structured, small group discussions) with community members, or key informants’ interviews (formal and informal conversations with leaders and stakeholder groups) or a combination of these methods were reported as the main methods to collect information on community’s assets among reviewed studies. Of these, focus group was the widely used method in community assets assessment [ 8 , 21 , 31 , 45 , 58 , 59 , 67 , 81 , 82 , 85 , 87 , 90 , 92 , 93 ].

Definition of community health needs (and assets) assessment

The terms “Community Needs Assessment (CNA)”, “Community Health Needs Assessment (CHNA)”, and “Community Health Needs and Assets Assessment (CHNAA)” were used interchangeably in the literature referring to the process of identifying health needs (and assets) of a given community. Since this review focuses on both community needs and assets, we will use the CHNAA term for the description of the process in this paper.

None of the papers reviewed provided a specific definition for CHNAA. In general, reviewed papers defined CHNAA as: A collaborative, community-engaged, systematic, ongoing, continuous, proactive, comprehensive, cyclical, regular, modifying method or process [ 28 , 33 , 69 , 92 , 94 , 95 , 96 , 97 , 98 ]; For the identification, collection, assembly, analysis, distribution, and dissemination of information on key health needs, social needs, concerns, problems, gaps, issues, factors, capabilities, strengths, assets, resources; About communities (or individuals) [ 21 , 23 , 28 , 31 , 33 , 37 , 41 , 45 , 54 , 79 , 89 , 94 , 95 , 96 , 97 , 99 , 100 , 101 , 102 ]; To achieve agreed priorities, create a shared vision, plan actions, garner resources, engage stakeholders, work collaboratively, establish relationships, implement culturally appropriate, multi-sectoral/multilevel intervention strategies, empower residents and enhance community capacity and participation in decision-making process [ 12 , 13 , 20 , 27 , 28 , 37 , 45 , 70 , 79 , 89 , 91 , 92 , 94 , 95 , 97 , 98 , 99 , 101 , 102 , 103 , 104 ]; Towards improving health and wellbeing, building and transforming health of the communities, increasing community benefits, reducing inequalities; Through which primary/secondary healthcare can respond to local and national priorities [ 20 , 23 , 28 , 40 , 51 , 59 , 69 , 97 , 103 , 105 , 106 ].

The included studies listed a number of reasons as the rationale for conducting CHNAA. Legislative requirements were most cited as the main rational for conducting CHNAA, particularly among studies conducted in the UK and US. Since the late 1980s, the concept of health needs assessment has gained increasing prominence within the National Health Service (NHS) in the UK. This has been prompted by a series of policy initiatives requiring health facilities to assess needs of their populations and to use these assessments to set priorities to improve the health of their local population [ 107 , 108 ]. In the US, several national, federal, state, and local funding sources require entities to conduct CHNAA to demonstrate a significant need for their services and programmes to be funded. The most important one is Patient Protection and Affordable Care Act (ACA-2010), requiring non-profit hospitals as tax-exempt entities to perform CHNAAs to maintain non-profit status regularly [ 92 ]. Other reasons were mentioned by included studies as the rationales for conducting CHNAA were: lack of information of health needs of a specific community, to facilitate health research and related interventions in a community, to inform the design of contextually relevant programmes and policies, to develop community health improvement plans or health promotion interventions, to develop or update strategic plans, and to receive resources and funds.

Key steps to conduct CHNAA

The number and nature of CHNAA process steps varied among reviewed studies. However, broadly CHNAAs involved six main steps as follow:

Formulation of a leadership team

Forming a leadership team, which was called by different names such as the steering committee/ the research advisory committee (RAC)/ the collaborative task force/ or the community advisory board (CAB), was known as the preliminary step of a CHNAA process. The steering committee was usually composed of local representatives from local agencies and organizations (e.g. non-profit organizations, community service agencies, media outlets, county and municipal governments, colleges and universities, faith-based organizations, and healthcare providers), community members, community stakeholders and leaders, academic partners, health and social officials, and representatives from the investigator body to help guide the development of the CHNAA project.

Leadership team responsibilities were reported as providing inputs on the research purpose, selecting and verifying study methodology and design, providing inputs and feedback on initial survey/topic content and selecting final survey/ topic guide questions, reviewing survey/topic guide length, and ensuring culturally relevant and resonant wording, comprehension and face validity, and monitoring the progress of the data collection. Feedback and recommendations from the steering committee were incorporated throughout the CHNAA process as well. Steering committees usually met on a regular basis.

Identification of needs, assets and prioritisation

To collect information on community health, needs and assets, both primary and secondary data were utilized by included studies. Secondary data included information on community socio-demographic and indicators on health status, access, utilization and satisfaction with health and social services at different levels (e.g. community, sub-national and national) to develop a picture of the overall community health. Primary data were collected through quantitative and qualitative methods and mixed-methods approaches.

Quantitative studies 

Some empirical studies used individual/household surveys as the only source to identify community needs and concerns ( n  = 28, 24.%). Surveys were a popular method of gathering opinions, preferences and perceptions of needs. Needs assessment surveys typically have written, closed-ended questions filled through the interview (face to face/telephone) or self-completion (paper or online) by community members. Generally, two main kinds of surveys were used by included studies: a) community health assessment survey, and b) community concerns survey. A number of included studies used health assessment surveys as the key data sources of the CHNAA process ( n  = 22, 19%) or along with other types of data, mainly qualitative data ( n  = 21, 18.%). Health assessment surveys typically collected information on demographics, socio-economic variables, respondents’ health status, choice of healthcare providers, and healthcare access issues among community members. Survey questionnaires were mostly developed with inputs from the literature review (similar health assessment surveys conducted at the local or national level), community members and project team discussions. Additional file  5 shows the most important data and indicators collected by included studies through conducting community health  assessment surveys.

Another form of surveys, used alone or in combination with qualitative methods ( n  = 15, 13.5%), was the community concerns survey in which people (community members and/or key informants) are asked to help identify what they see as the most important issues facing their community leading to an inventory of their health priorities [ 12 , 20 , 23 , 27 , 29 , 55 , 69 , 74 , 101 , 103 , 109 , 110 , 111 , 112 , 113 ]. A straightforward way to estimate the needs of a community was to simply ask residents their opinion on what particular services are most needed in the community. The focus of this methodology was to create an agenda based on the perceived needs and concerns of community residents. The concerns surveys were based on either focus group discussion with community members and experts or literature review by the researchers or both. Generally, while filling community concerns survey, individuals were asked to rate the importance of each issue in their community on a scale (e.g. 0 = not important, 5 = extremely important) [ 23 , 27 , 29 , 55 , 74 , 110 ]. Participants could also add and rate concerns or service needs that were not listed. Finally, each health problem identified by the community was weighted based on the frequency it was selected on the survey.

General coverage of the surveys was the population aged 18 or over currently residing in the community for a minimum period of time (at least a few months) and able to provide consent for participation. Most surveys were written, closed-ended questions filled through face to face or telephone interviews or self-completion by community members. In addition to the paper-form survey, some studies used email and social media platforms to allow residents to anonymously complete online surveys [ 29 , 51 , 57 , 96 , 103 , 110 , 114 ]. A few studies reported that residents received monetary or nonmonetary incentives for their participation upon survey completion [ 19 , 71 , 74 , 77 , 110 ]. Sampling techniques commonly used are those that promote participation in CHNAAs such as convenience sampling [ 20 , 35 , 40 , 51 , 52 , 57 , 64 , 65 , 71 , 74 , 75 , 77 , 86 , 96 , 101 , 103 , 104 , 110 , 114 , 115 ]. Only a few studies used random sampling or demonstrated the representativeness of their samples. Their response rates varied between 8 to 95.5%. Most surveys recruited local surveyors and provided them with research training to ensure consistent survey administration to attract community participation. Some studies that assessed health needs among immigrant communities or minority groups recruited bilingual surveyors or/and provided participants with two versions of the instruments, one in the native language to maximize community engagement [ 12 , 27 , 52 , 65 , 71 , 86 , 103 ]. Surveys that took a participatory approach to the design, content, terminology, and language level, were reported more understandable and culturally relevant to the community members [ 52 , 65 , 75 ].

Health needs assessment surveys (both concerns surveys and health assessment surveys) reported limitations to data collection based on the assessment timing, data availability, and sample response. As said earlier, using a convenience sampling and non-representative samples, small sample size and inter-rater reliability between surveyors were among some important methodological limitations reported by these studies, which limited the generalisability of the study findings to the entire community population [ 35 , 57 , 65 , 71 , 74 , 75 , 77 , 96 , 106 , 116 ]. Convenience sampling method and using community events as sampling sites led to sampling bias in some studies (e.g., an over-representation of some specific groups of the population such as women and low –income or high-income groups) [ 57 , 63 , 65 , 66 , 71 , 74 , 75 , 78 , 103 , 114 , 115 ].

Qualitative studies

Among included studies, about 34% ( n  = 39) used qualitative methods as the main source of data collection on community needs and assets. Some of these studies justified the use of qualitative approach by explaining how the overreliance on quantitative, population-level data resulted in CHNAAs failing to identify health needs and interests of all community members, particularly those of vulnerable population and underrepresented marginalized segments of the community. In addition, these studies concluded that integrating qualitative methods into the CHNAA process has the potential to involve community members in a more participatory fashion, perhaps improving future collaborations between communities and service providers. Such collaborations can help to design focused initiatives, making them more meaningful and culturally appropriate [ 12 , 59 , 91 , 102 ].

Key informant interviews, individual interviews with community members, focus groups with community members and community forums were among the qualitative data collection techniques used individually or in combination with each other by these studies to collect data on community needs and assets. They asserted that qualitative techniques specifically targeted to underrepresented segments of the population proved to be effective mechanisms to explore the participants’ perceptions on issues surrounding community health needs and assets. The most used technique to elicit community members’ opinions were focus group discussions and key informant interviews.

Small sample size and single-site setting were mentioned as the most cited limitations of  the qualitative CHNAAs that limit these studies generalisability. Because the studied communities were unique communities with unique assets, constraints, and health needs, the CHNAA findings cannot be generalised to other communities [ 32 , 39 , 62 , 70 , 72 , 73 , 91 , 117 , 118 ]. Another limitation mentioned by some studies was that the demographic composition of the focus group participants, specifically with regards to race, gender, socio-economic status and age group, did not fully reflect the population of studied community as a whole [ 13 , 61 , 62 , 72 , 97 , 119 ]. Some studies reported that they could not include all influencing key informants in the community to facilitate broader understandings of health needs [ 13 , 120 ].

Mixed- methods studies

A variety of data collection methods were used in a number of included studies to ensure that a comprehensive picture of community health needs and resources was obtained ( n  = 48, 42%). Some of these studies were two-phase explanatory mixed-methods studies, with the quantitative phase preceding the qualitative phase ( n  = 14, 12%). They conducted targeted focus groups or community listening sessions or interview with community members/key informants following needs assessment survey to supplement the findings from the survey and provide further information about health status, needs of daily living, barrier to health and access to community resources [ 8 , 21 , 41 , 53 , 55 , 66 , 67 , 93 , 94 , 95 , 99 , 113 , 114 , 121 ]. In addition to these studies, some studies used triangulation mixed-method design to obtain complementary qualitative and quantitative data on community health needs and issues ( n  = 13, 11%). These studies confirmed that using multiple data sources ensured researchers obtain a complete picture of the community health needs. Applying qualitative methods in the form of focus groups and semi-structured interviews enabled exploration of problems and needs within their social context and provided a wider perspective on issues raised. However, to conduct such studies CHNAA teams had to have members who have qualitative and quantitative expertise. There were some limitations specific to the mixed-method studies, including lack of rigor in integrating qualitative and quantitative findings, relying heavily on quantitative data for health need determination, and absence of the voices of the communities most in need [ 69 , 91 ].

Data analysis and interpretation

Qualitative data from focus group discussions and key informant interviews were mainly audio-recorded and transcribed verbatim by the research team and all identifying information was removed. Different analytical approaches, mostly content analysis and thematic analysis, were used to identify main themes related to assets, needs and gaps in the service system and priority populations.

Quantitative data from surveys were analysed using statistical software. Descriptive statistics were used to describe the sample in terms of socioeconomic background and present the prevalence of chronic diseases, risk factors, and health behaviours. Statistical analytical tests were also used to compare results between different groups of community members. Results also were compared by those at the state/ national level or from a similar community. Those diseases or risk factors that had a high prevalence among community members are regarded as priorities that to be addressed further.

Formulation of recommendations across various levels (individual, institution, community, policy levels)

Following analysis of the quantitative and qualitative data, the studies included in the review provided a thorough list of health needs and assets of the community. Included studies mainly used CHNAA outputs: 1) as a resource to provide baseline data of community’s health; 2) as a resource to prioritize and plan services; 3) as a resource for writing grant applications; 4) as a resource to guide a comprehensive health promotion strategy.

Not all included CHNAAs proposed interventions to address identified needs and issues. Some of the included studies ( n  = 45, 39%) just provided a snapshot of the most important issues faced by the studied community. They demonstrated several areas where CHNAAs provide more information to researchers, community organizations, and policy-makers. On the other hand, not all identified issues and needs were addressed by those studies performed CHNAA in order to implement interventions or strategies. In practice, specific populations or a number of specific health conditions or health risks, or overarching issues such as health inequality and disparities were prioritized by these studies.

In most cases, decisions on implementation were carried out by the CHNAA steering committees or the research teams. Only a number of studies used a clear and explicit set of criteria for deciding the importance of each issue [ 22 , 27 , 43 , 67 , 94 , 118 , 122 ]. A wide range of criteria were used by included studies such as: impact, urgency, community concern, achievability within the set time [ 94 ], seriousness, urgency, solvability, and financial burden of the problems [ 27 ], perception of survey participants on importance of the identified issues and feasibility of intervention, prevalence, fatality, social and cultural stigma [ 22 ], possible interventions, organizational capacity, and community assets and resources [ 13 ], importance and possibility of the effecting change [ 43 ], prevalence, impact on the duration of sickness, impact on mortality, and the availability of treatment [ 122 ], impact of the problem on the overall wellness, quality of life, and resources of their community [ 118 ], factors of health issue, size, seriousness, and effectiveness of available interventions [ 101 ], importance and feasibility [ 67 ].

Different techniques for ranking priorities were applied by included studies such as: 1) Multi-voting technique (decide on priorities by agreeing or disagreeing in group discussions and continuing process/rounds until a final list is developed), 2) Strategy lists (determine if the health needs are of “high or low importance” by placing emphasis on problems whose solutions have maximum impact, with the possibility of limited resource), 3) Nominal group technique (rate health problems from 1 to 10 through group discussion), and 4) Prioritization matrix (weigh and rank multiple criteria for prioritization with numeric values to determine health needs with high importance).

Overall, health priority types were categorized into four main categories by included studies:

Medical conditions (e.g. obesity, diabetes, heart diseases, asthma, mental health disorders, substance abuse, vision/ dental problems, HIV/AIDS and sexually transmitted diseases, injuries and health consultations).

Health behaviours (e.g. physical activity, eating habits/ nutrition, tobacco consumption, teen pregnancy and violence/gangs).

Community conditions (e.g. poverty and unemployment, environmental and infrastructural conditions, such as air quality/pollution, transportation, access to clean water and sanitation, community collaboration, and access to healthy food, exercise facilities and occupational concerns).

Health systems priorities (e.g. access to care, including primary care and higher levels of care, specialty care, mental/ behavioural health care and dental care, quality and acceptability of health services, lack of cultural competence in health systems, flexible hours and waiting time).

However, guided by a community-based participatory research (CBPR) approach, a number of studies involved community members and stakeholders in priority identification or ranking [ 12 , 21 , 22 , 23 , 27 , 29 , 31 , 36 , 41 , 43 , 49 , 53 , 55 , 56 , 58 , 59 , 60 , 62 , 63 , 68 , 70 , 74 , 86 , 87 , 88 , 90 , 92 , 99 , 100 , 103 , 104 , 110 , 114 , 117 , 118 , 119 , 121 , 122 , 123 , 124 , 125 , 126 , 127 , 128 , 129 ], in potential strategy selection [ 13 , 19 , 67 , 82 , 89 , 130 ], and in carrying out strategies [ 8 , 37 , 69 , 81 , 93 , 105 , 113 ]. They asserted that by involving the perspectives of the relevant stakeholders, a comprehensive overview of the issues and possible effective solutions was created.

Planning of programmes and interventions, implementation and evaluation

The results of CHNAA were used in various ways by included studies. In some studies, particularly researcher-led studies with limited support or involvement of the local authorities, CHNAA just led to the identification of new, locally relevant issues and priorities without any further actions ( n  = 45, 39%). The results of these CHNAAs provided more information to researchers, community organizations, and local policy-makers. Their results also may guide further research agenda in the community [ 18 , 21 , 23 , 29 , 35 , 39 , 40 , 42 , 44 , 48 , 49 , 50 , 52 , 54 , 55 , 62 , 64 , 65 , 66 , 69 , 70 , 71 , 72 , 73 , 76 , 77 , 78 , 85 , 96 , 106 , 122 , 123 , 131 , 132 , 133 , 134 , 135 ]. Some of these studies tried to present their results to the local authorities through various channels in the hope that it would modify existing programmes or implement new ones to meet the needs of the community residents. In addition to identification of relevant issues and priorities, included studies listed at least one outcome associated with the reported CHNAA activity as follows:

Development or modification of health and social policy and programmes: The knowledge provided by CHNAAs helped develop better tailored, and thereby potentially more effective interventions by a number of studies. Further, the information gathered from the CHNAA process was used as the baseline against which to measure future targets for assessment efforts and progress in areas were targeted ( n  = 36).

Formation of new partnership: In some cases, a new partnership among entities involved in CHNAA was formed to address health issues. One of the partnerships reported successful was the community–academic partnership in which communities used the research capacity of academic institutions to conduct the CHNAAs ( n  = 20). Another type of the partnership reported by some studies was the collaboration among healthcare organizations serving the same geographic area to conduct CHNAA jointly. Conducting a joint CHNAA may avoid duplication of planning efforts and obviate the creation of multiple community health needs assessments for the same population ( n  = 5).

Development of new recommendations: Several suggestions were proposed to be considered while designing health improvement interventions in the future by some of the included studies ( n  = 18).

Setting or altering strategic direction: Strategic agency direction was established or altered in some cases, which might indicate that the CHNAA was used to redirect resources better to meet the needs of the community ( n  = 4).

Raising awareness about health issues: One of the most important insights brought by CHNAA findings was the recognition of the health priorities and contributing factors by the community members, leaders and researchers, leading to an increased awareness of community issues among them ( n  = 8).

Engaging and motivating policy-makers and stakeholders: A few studies reported that CHNAAs provided health organizations with the opportunity to identify and interact with key policy-makers, community leaders, and key stakeholders about health priorities and concerns, which might foster a sense of collective ownership and trust in the results and increase the likelihood that the CHNAA will be used ( n  = 5).

Having an impact on obtaining resources and resource allocation: The CHNAAs provided the community partners with locally relevant information regarding the current status of health and perceived community needs to inform resource allocation and applications for new grants for the initiation of new programmes ( n  = 14)

Contribution to the development of CHNAA process: Some studies reported that the specific methods used in their CHNAA processes could contribute to more relevant and effective community health need assessment process ( n  = 10).

Dissemination of findings

Disseminating of the findings and knowledge gained to all partners involved was a foremost step of CHNAAs. The most cited product of the CHNAA process in the included studies was the community needs assessment report. This report includes information about the health of the community as well as the community’s capacity to improve the lives of residents. The report provides the basis for discussion and future actions. In addition to the final report, other channels to disseminate CHNAAs findings were reported as: publishing CHNAA main results in local newspapers, communicating research results with community members and stakeholders in public forums or meetings, presentation results to the steering committee and various stakeholders, posting the report on the local authorities websites, individual meetings with community leaders and stakeholders, posters, and presentation of findings in academic conferences.

Community participation

Among included studies, around 50 studies (44%) reported using participatory approaches and techniques to encourage community members' participation in CHNAA process. Unlike traditional approaches to health needs assessment, participatory approaches aimed to incorporate community inputs at all stages of the research process to enhance capacity building and overcome barriers to research raised by matters of trust, communication, cultural differences, power and representation. A variety of participatory approaches (e.g. community based participatory research (CBPR), participatory rural appraisal, participatory action research (PAR), rapid participatory appraisal (RPA), tribal participatory research, community-based collaborative action research (CBCAR), precede-proceed model, concept mapping and photovoice) were used by these studies to ensure that communities participate in CHNAA, from defining the community to identifying needs and assets and developing new interventions.

Pennel and colleagues classified the depth of the community participation in CHNAA activities into four main categories [ 136 ]. In this classification, depth of the community participation was assessed by the types of activities in which participants were involved throughout the assessment and planning process as follows:

No participation: No attempt to engage community stakeholders or members;

Consultation-only: Engagement of health-related stakeholders, broader community stakeholders, and/or community members to identify health needs through surveys, interviews, and/or focus groups; verified or validated health needs/priorities with local experts;

Moderate participation: Involvement of community stakeholders/ or community members in priority identification; involvement of community stakeholders in strategy selection;

Extensive participation: Involvement of community stakeholders/or community members to develop and carry out strategies.

The above classification was used to assess the depth of the community participation by included studies. Based on the content analysis, community participation in CHNAA process varied considerably across the included empirical studies, from minimal to in-depth participation (Table 1 ). Around 65% of the included studies were involved in consultation-only to identify health needs through one-way communication using tools such as surveys, interviews, and focus group to identify community needs and resources. Around 22% of the included studies solicited moderate participation from the community by involving community in verifying needs and final priority selection and only about 10% of the included studies reported a broad and deep community participation including community involvement in designing and implementing strategies to improve community health.

Three categories of challenges were cited by the reviewed studies while performing CHNAA projects.

Methodological challenges: These are mainly associated with quantitative and qualitative data collection methods, which were discussed earlier. Other methodological challenges cited were: difficulties in aggregating and making sense of data collected from various sources (triangulation), non-generalisability of site-specific data and limitations of the use of existing epidemiological data alone, which does not provide a comprehensive view of health needs, yet is often the most available source of information. Traditional approaches to data collection were challenging where language and literacy barriers existed [ 12 , 52 , 65 , 71 ]. Another major challenge reported by studies used community-based participatory research approaches was the challenge of involving the community in decisions related to research design and data collection methods while maintaining an appropriate level of methodological validity and reliability [ 56 , 81 , 121 ]. In addition, participation was not without challenges. Including the perspectives of stakeholders and residents can lead to differing accounts of what services are seen as essential, and each party may push their own agenda based on their personal or professional interests. Further, linguistic and cultural barriers may be a major factor among minority groups hindering participation in such endeavors [ 81 , 137 ].

Logistical challenges: The major logistical challenges reported were the need for a considerable amount of time (often inadequate), and resources required to conduct a comprehensive assessment [ 80 , 138 ]. Good quality local data on the needs and utilization of health services are usually difficult to obtain [ 9 ]. Financial costs are considerable and the depth of information obtained will ultimately depend upon the methods employed [ 139 , 140 ]. In addition, health professionals, managers and others involved in health services planning and delivery may not have the requisite skills to conduct CHNAAs. This goes beyond technical skills and places an emphasis on soft skills and flexibility including good listening skills, the ability to establish trusting relationships, empathy, working with diverse groups and reflexivity [ 140 , 141 ]. Moreover, limited health information infrastructure and systems in developing countries settings may have hindered the availability of good quality information to conduct CHNAAs [ 13 , 28 , 30 , 142 ].

Ethical challenges: Concerns were raised about the ethical issues associated with community consultation about felt needs followed by priority setting process that leaves many needs unaddressed and the bulk of expectations dashed. Labelling, stigma and stereo- typing are other problems raised by needs assessment [ 143 ]. Needs assessment results may not be utilised, leaving unmet expectations and may require extensive financial and political support to lead to changes in health service planning and delivery [ 9 ]. Comprehensive health needs assessment is likely to produce different, potentially conflicting needs, exposing hidden conflicts and tensions in communities without any mechanisms to address these issues [ 5 ]. Further, local participation may only allow those who are able to voice their needs to do so, leaving behind the silent or hidden voices [ 81 ]. Involvement of the community in the needs assessment process also impacts upon possible outcomes of the project especially since it is likely that expectations of changes to programmes and service delivery may have arisen from local participation [ 144 ].

Facilitators and enablers

CHNAA projects need to be organized in such a way that they have clear objectives, and are adequately resourced by experienced staff. In addition, factors such as clear objectives, decisive leadership, teamwork, communication, sound study design, adequate resourcing, skilled staff, sufficient time and ownership by stakeholders are among those factors that contribute to the successful implementation of CHNAAs [ 15 , 145 ]. Most studies cited community participation as a major facilitator of the CHNAA process and outcomes. Participation was shown to foster bidirectional learning and communications, where both health authorities and the community learnt about needs and priorities. Different benefits for community engagement were mentioned by reviewed literature including, improved participants’ recruitment, enhanced capacity among stakeholders, productive conflict resolution, increased quality of outputs and outcomes, increased sustainability of project goals beyond funding and timelines and development of linguistically and culturally appropriate measures. In addition, incorporating community voices has the potential to inform the development of sound measures to tackle health disparities in the basis of race, social class and ethnicity [ 12 , 27 , 30 , 91 , 103 , 110 , 126 , 146 ].

The main objective of our scoping review was to provide an overview of why and how community health needs and assets assessments (CHNAAs) have been used globally. Substantial variation was found among the studies reviewed concerning definitions, process, participants, methods, goals, and products, yet there were many common characteristics.

Some CHNAAs focused narrowly on health care in assessing needs, with scant attention to other community issues that can affect health. However, most of the included studies looked beyond health needs and considered social and environmental conditions influencing community health. We argue all CHNAAs should approach community health needs assessment holistically, focusing on both individual physical and mental wellbeing as well as casting a social determinants of health lens on the population health.

The review showed that community health needs assessment is used widely by different users and across different settings in both HICs and LMICs. However, in countries such as the US it has become institutionalized and has accordingly been developed, as service providers, particularly hospitals, are mandated to perform CHNAA to compliance with legislative mandates. However, though federal and state laws impose requirements on hospitals to conduct CHNAAs, the methods for needs assessments are generally left to the discretion of each hospital [ 147 ]. As a result, assessment methods vary widely. US-based CHNAAs either develop their own CHNAA processes or utilize a process developed at the state or national level to guide their efforts. A number of toolkits have been provided by different organizations across US to help healthcare providers to conduct CHNAA projects [ 6 , 148 , 149 ]. This highlights the need for consensus guidance across many countries and settings while maintaining the responsiveness to contextual needs, assets and priorities.

Both qualitative and quantitative approaches were employed to collect data on community health needs and assets. Overall, there has been a growing use of mixed-methods approaches to conduct CHNAA in recent years, owing to the recognition in the literature that using qualitative and quantitative approaches simultaneously can provide complementary insights determining community health needs and assets [ 69 , 91 , 104 ]. Although quantitative approaches yield concrete evidence of community needs and assets, qualitative approaches provide a context for how these issues can be addressed using available resources [ 91 , 102 ]. Using qualitative methods in conjunction with more traditional quantitative approaches is especially appropriate for studying complex public health issues and promotes the alignment of implementation plans with the local needs of community members [ 59 , 69 , 91 ]. The growing use of mixed-methods approaches has practical implications for research training and capacity building within entities performing CHNAAs. Organizations who wish to conduct CHNAAs will need to ensure that the competencies and expertise required for mixed-methods studies are available.

Although only a small number of studies provided definitions of assets, there is a growing interest in the literature in asset-based assessment, which examines and mobilizes community assets, instead of focusing on only the needs of communities [ 11 , 84 ]. Unlike need-based or deficit approaches, asset-based approaches document resources and focus on strengths to enhance and preserve rather than deficits to be remedied. Related to principles of empowerment, it postulates that solutions to community problems already exist within a community’s assets. By recognizing existing capacity, communities can become empowered to take ownership of their health and improve as a population [ 11 , 31 , 125 ]. An asset-based approach was recognized as essential for enhancing trust and community coalitions [ 83 ]. Further, it is more participatory in nature through involving community stakeholders throughout the needs assessment process [ 82 , 83 ]. In particular, it highlights community resilience, resources, and opportunities for positive growth rather than focusing solely on health problems or other concerns [ 14 , 84 , 88 ]. In developing countries, assets identified from within the community are crucial for later use in the implementation of health programmes. The shift from a traditional needs-based perspective to an asset-based perspective to health needs assessment can help to address resource constraints in these countries [ 13 , 30 , 150 ].

There was a growing interest in the use of participatory approaches and in their value in identifying and addressing community health needs over recent years among included studies. About half of the reviewed studies applied CBPR or other community-engaged approaches to perform CHNAA. There are several opportunities to fully engage patients, families, and communities in healthcare delivery redesign to ensure that they are provided in a way that address the community members’ needs and preferences. The CHNAA process is one mechanism for this engagement—and a good precursor to deeper engagement and collaboration [ 91 , 97 , 123 ]. Integrating community voices into CHNAA process may be crucially important for confronting health disparities at the community level, which stemming from socio-historical processes, including racial and ethnic discrimination and economic inequality [ 33 , 74 , 86 , 91 ]. To eliminate health disparities, it is critical first to understand social, cultural, and economic determinants of health. CHNAAs, particularly when they include the voices of community residents, can provide an opportunity to understand local processes contributing to health disparities. This knowledge can then be used to inform health and equity initiatives [ 91 , 110 , 126 ]. The development process and implementation of a CHNAA project is an important example of evidence-based public health practice. It is a way to address health and health care disparities experienced by medically underserved populations [ 86 , 92 , 126 ]. Those studies used a participatory approach reported that by having community participation, concerns and issues of the most marginalized and vulnerable populations were voiced. The inclusion of these voices allowed for a broader and deeper understanding of the concerns of those who are typically marginalized and that may be missed in traditional health needs assessment methodologies [ 33 , 56 , 58 , 74 , 86 , 110 , 137 , 146 ]. Hence, defining communities while performing CHNAA needs to be dynamic and socially constructed to take into account all voices and members especially those not ordinarily included. This deeper understanding is critical to move public health practice and research upstream to address structural and social determinants of health necessary for population-level reductions in health inequities [ 80 , 91 ].

Although there is widespread theoretical recognition of the importance of in-depth community participation in CHNAA, this has not been fully embraced in practice based on our review. Included studies reported community involvement in various stages of CHNAA with varying depth reflecting a continuum from no participation to extensive participation, in which most studies were located at the middle of the participation continuum. The literature review suggests while certain community stakeholders were engaged in the CHNAA process, most studies did not involve a broad range of stakeholders through adopting a full participation approach. One reason for this could be that for most studies conducted in the US, CHNAA was performed to comply with ACA requirements, which requires hospitals to incorporate inputs of the population served as part of the CHNAA process. Since community inputs as well as the process as a whole is not well-defined by these regulations [ 20 ], it seems that the majority of included US-based studies tried to meet legislative requirements by incorporating a minimum level of community and stakeholders’ participation in CHNAA process. In addition, the concept of community engagement in health services planning and implementation has evolved over recent years, from one-way consultative processes to bi-directional collaboration and shared leadership. Although undertaking an in-depth participatory approach through extensive participation of community stakeholders in CHNAAs may pose certain challenges for healthcare providers including requiring additional time and other resources to collaborate with community residents, we argue the benefits to this approach are important to improve health, as reported by some included studies [ 80 , 118 , 151 ].

A notable gap in the existing literature is the lack of long-term or longitudinal–assessment of CHNAA. The review showed that additional research into CHNAA implementation and outcomes is needed. Currently, there are limited data describing the impact of CHNAAs on health outcomes. However, there is ample evidence on different short-term impacts associated with CHNAA implementation, including, the development of health and social interventions, forming the new partnership, raising awareness on health issues, engaging policy-makers, and facilitating obtaining resources. In other words, it is unclear how CHNAA projects are linked directly to health outcomes. Furthermore, the mechanisms between the conduct and use of CHNAA remain largely unknown in the literature [ 152 , 153 ]. Clearly, not all CHNAA projects result in changes to policies or programmes, and conversely, many programme and policy decisions are made in the absence of CHNAA data [ 154 , 155 ]. Still, further research to understand these mechanisms and the long term impact of CHNAA is needed to support evidence of its use and value in addressing individual and population health needs.

This scoping review aimed to provide clarity and supplement the evidence on the key concepts, rationale, methods, tools and outcomes of community health needs and assets assessments (CHNAAs). Importantly, it highlights the need for holistic approaches to needs assessments to focus on physical, mental and social wellbeing, along with considering wider systems factors and structural challenges to individual and population health. Furthermore, the findings emphasize the inclusion of community assets in community health assessments, beginning foremost with community capabilities and knowledge. It is encouraging to see the use of pragmatic approaches including both qualitative and quantitative methods in CHNAA process in the literature. This will help to ensure that a robust and in-depth exploration of needs and assets is available to guide decision making. Although we recognize the challenges with providing consensus on definitions, processes and tools for CHNAA, we argue that more clarity is needed on the key considerations, steps and outcomes for this process across various settings. This study attempts to provide some theoretical insights and empirical information concerning the process, which hopefully will provide useful guidance to community organizations, policy- makers, health service providers and researchers seeking to develop and implement community health needs and assets assessment.

Availability of data and materials

All data generated or analysed during this study are included in this published article and its supplementary information files.

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Acknowledgements

We acknowledge contribution of the research assistants helped with data extraction.

This work was funded by department of UHC Life course/Integrated Health Services (IHS), World Health Organization (WHO) headquarter (HQ). ZA received the research grant. The authors HR, AS, and SE from WHO commissioned the study, contributed to the direction of the work, and commented on the drafts.

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AG, HR and SE conceived the study and participated in its design. SK conducted the literature search and prepared the search results for analysis. NN developed the study framework, the data abstraction forms and the manuscript outline. The literature was analysed by ZA, EA and NN under the supervision of HR and AG. ZA drafted the final version of the manuscript and HR, NN, AG and SE reviewed it. All authors read and approved the final manuscript.

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Supplementary Information

Additional file 1..

PubMed database search strategy.

Additional file 2.

Content of the extraction forms.

Additional file 3.

List of included empirical papers [ 156 – 159 ].

Additional file 4.

List of included non-empirical papers [ 160 -– 175 ] .

Additional file 5.

Health indicators collected by community health assessment surveys.

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Ravaghi, H., Guisset, AL., Elfeky, S. et al. A scoping review of community health needs and assets assessment: concepts, rationale, tools and uses. BMC Health Serv Res 23 , 44 (2023). https://doi.org/10.1186/s12913-022-08983-3

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An updated scoping review of migrant health research in Ireland

• Anne Cronin 1 ,
• Ailish Hannigan 1 ,
• Nuha Ibrahim 1 ,
• Yuki Seidler 1 ,
• Blessing Olamide Owoeye 1 ,
• Wigdan Gasmalla 1 ,
• Tonya Moyles 1 &
• Anne MacFarlane 1  

BMC Public Health volume  24 , Article number:  1425 ( 2024 ) Cite this article

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One in five people living in Ireland is a migrant. Understanding the distinctive health needs of this diverse population is essential to provide evidence-based, culturally sensitive primary care services. The aim of this review is to systematically examine changes in migrant health research in Ireland and to inform research, policy and practice in the field.

To update a 2017 scoping review of migrant health research in Ireland, we used Arksey and O’Malley’s framework, updates by Colquhoun and Peters and the PRISMA-ScR from the Joanna Briggs Institute to search 10 databases covering May 2017 - March 2023. Findings were analysed using the World Health Organisation Strategy and Action Plan for Refugee and Migrant Health 2016–2023, which identifies 9 priority strategic areas (SA). Findings were compared with the 2017 review.

62 papers were identified. There has been an increase in studies over time from an average of five per year in the previous review to an average of 10 per year in this review. There is growing interest in research about SA1: Collaborative action on migrant health issues and SA2: Advocacy for the right to health of refugees and migrants – evidenced by an increase of 13% in this review. Similarly to 2017, the majority of papers align with three of the nine WHO Strategic Areas; SA3: Addressing the social determinants of health (24%), SA4: Achieving public health preparedness (29%) and SA5: Strengthening health systems (26%). The volume of research on SA6: Communicable diseases (11%) and SA7: Noncommunicable diseases (19%) remains stable however research on SA8: Health screening and assessment (5%) and SA9: Improving health information and communication (2%) remains low.

Conclusions

The increase in the volume of research on migrant health in Ireland is notable. The analysis over time illuminates changes in the focus of research studies. Gaps in research about screening, assessment and health information warrant particular attention. It is also necessary to continue paying attention to areas of recent growth and stagnation for a balanced and comprehensive evidence base. Mobilising resources to continue this increase is needed for evidence-based policy and practice.

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Background / Introduction

Globally, one in every eight people or 13% of our global population is either a migrant or has been forcibly displaced by conflict, persecution, climate crisis, poverty, or the lack of security and opportunity [ 1 , 2 ].

There is no universally accepted definition of migrant. However, a broad and widely used definition from the International Organisation for Migration is that migrant is;

‘An umbrella term, not defined under international law, reflecting the common lay understanding of a person who moves away from his or her place of usual residence, whether within a country or across an international border, temporarily or permanently, and for a variety of reasons [ 3 ].

This broad definition also includes refugee as;

‘A person who, owing to a well-founded fear of persecution for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality and is unable or, owing to such fear, is unwilling to avail himself of the protection of that country [ 3 ].

This review focuses specifically on international migrants i.e., people who live in the Republic of Ireland (hereinafter referred to as “Ireland”) as a refugee or migrant, having moved to Ireland from another country or from the country in which they were born. We use the terms refugee and migrant in line with the WHO Strategy and Action Plan (WHO SaAP) for Refugee and Migrant Health in the WHO European region 2016–2022 [ 4 ] which is used to inform our analysis (described in more detail later).

The World Health Organisation (WHO) Global Research Agenda on Health, Migration and Displacement identifies priority areas for action and emphasises the importance of setting out country-specific priorities and documenting country-level actions, which is essential to promote progress through sharing and learning [ 5 ]. Therefore, it is important to know what evidence is available on the health of migrants in different country settings. There are examples of evidence reviews in several countries, including the United Kingdom, Norway, Canada, the European Union (EU) and Ireland, which is the focus of this paper [ 6 , 7 , 8 , 9 ].

According to the most recent Census of Population of Ireland in 2022, 20% of the resident population was born in another country. This represents over a million people, an increase of 207,031 from 2016. The biggest increases were in the number of people born in India, Brazil and Romania. In the twelve months to April 2023, over 80,000 non-Irish citizens moved to Ireland, a 16-year high [ 10 ].

Factors contributing to higher migration rates include employment opportunities in Ireland due to strong economic performance [ 11 ]. The latest Eurostat data indicates that Irish people are two-times better off than the average EU citizen based on purchasing power parities and Gross Domestic Product (GDP) per capita [ 12 ]. Opportunities to study, family reunification programmes and Ireland’s reputation as one of the richest countries in the EU also contribute.

Separately from the census figures, approximately 100,000 Ukrainian refugees were receiving temporary protection from the Irish government as Beneficiaries of Temporary Protection (BoTP) and 26,092 people from other countries were receiving International Protection (IP), at the end of 2023. These figures exclude approximately 4,500 refugees coming from countries such as Syria and Afghanistan receiving protection through the Irish Refugee Protection Programme [ 13 ].

Ireland has produced two intercultural health strategies to optimise refugees and migrants’ access to healthcare and their health outcomes; the National Intercultural Health Strategy (NIHS) 2007–2012 [ 14 ] and the Second NIHS 2018–2023 [ 15 ]. Since 2014, the NIHS is aligned with the Public Sector Equality and Human Rights Duty, which places a legal requirement on all public bodies to comply with Sect. 42 of the Irish Human Rights and Equality Act 2014 [ 16 ].

Migration and health in Ireland

Unlike many other EU countries, primary care in Ireland is not universal and incurs a cost. This can make healthcare unaffordable and consequently inaccessible [ 17 ]. New entrants to Ireland are covered by public health services (some of which are free) when they have been living in the country for one year or intend to live in the country for one year. This is called being ‘ordinarily resident’. For those seeking refugee status, the means of accessing and receiving healthcare can vary considerably depending on the level of state protection provided which influences whether or not they are considered ordinarily resident. For example, in Ireland people seeking international protection can apply for refugee status, subsidiary protection or temporary protection. The affordability of healthcare is shaped by these categorisations: each category has different implications for eligibility to a social support and, therefore, access to free general practice care or not [ 18 , 19 ]. For example, persons seeking asylum / international protection receive €38.80 per week for adults and €29.80 per week for children (if housed in state provided accommodation). They also receive a medical card which entitles them to free GP access However, individuals granted refugee status, subsidiary protection, or leave to remain have access to social welfare on par with Irish citizens. This involves a bureaucratic process that is far more complex than in other States [ 20 ].

Whilst eligibility criteria may present difficulties for some, impediments to healthcare access arising from communication barriers introduce separate challenges. The 2022 census data highlights that 751,507 people spoke a language other than English or Irish at home, representing an increase of 23% from 2016; 11% of whom indicated that they did not speak English well and 2% did not speak it at all. Accordingly, people with limited English-language proficiency accounted for 1.9% ( n  = 97,695) of the overall Irish population [ 10 ]. Ireland has low availability of trained interpreters [ 21 ] and this compromises communication in healthcare consultations, thus undermining a vital component of accessible healthcare [ 22 , 23 ].

Refugee and migrant health research in Ireland

There have been three evidence syntheses of refugee and migrant health research in Ireland. Two were in the early 2000s [ 24 , 25 ]. The third and most recent information mapped the scientific literature on migrant health in Ireland, through research studies published between 2001 and 2017 [ 26 ]. The findings of the 2017 review were analysed using theWHO-SaAP for Refugee and Migrant Health in the WHO European region 2016–2022 [ 4 ]. As presented in Fig.  1 , the 2017 review found that while strategic areas (SA) related to the social determinants of health (SA 3), public health preparedness (SA 4) and strengthening health systems (SA 5) have been well-researched, there were gaps in research about collaborative action (SA 1), advocacy and human rights (SA 2), screening (SA 8), and health information systems (SA 9), with a recommendation for more inter-disciplinary projects. The authors found that almost one in five studies did not have a primary focus on migrant health but contributed information on the topic through an analysis of data by, for example; country of birth, nationality or ethnicity.

Results from migrant health research in the republic of Ireland: a Scoping review [ 26 ]

Our review is an update of Villaroel et al., covering the period May 2017 to March 2023.

The rationale for updating the previous scoping review is four-fold. First, there have been significant changes in migration patterns in the EU and Ireland over the past six years (2017–2023). Second the pace of publication in the area of migrant health has increased significantly in an international context, and the authors wanted to investigate whether the pace had similarly increased in an Irish context. Thirdly, the National Intercultural Health Strategy 2019–2023 [ 15 ] has come to an end and Irish policy makers need the most up-to-date evidence to guide new strategic developments. Finally, the WHO-SaAP 2016–2022 [ 4 ] has also ended and it is therefore timely to conduct an updated review of the literature for this period to analyse the congruence between Irish evidence and the WHO strategic areas over time. The current Action Plan for Refugee and Migrant Health in the WHO European Region 2023–2030 was adopted in October 2023 [ 27 ].

Thus, the aim of this scoping review is to update the work completed in 2017 by incorporating the most recent contributions to migrant health research in Ireland conducted between 2017 and 2023.

Methodology

The current scoping review’s methodological approach was guided by Peters [ 28 ] and Levac and Colquhoun [ 29 ] building on Arksey and O’Malley’s 6 -stage framework [ 30 ]. The work was conducted using the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis [ 31 ] and is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) recommendations (Fig.  2 ). The protocol is registered with Open Science Framework (OSF) Registries (Cronin, A., Ibrahim, N., MacFarlane, A., Hannigan, A., & Seidler, Y. (2023, May 2). Updated Scoping Review of Migrant Health Research in the Republic of Ireland. https://doi.org/10.17605/OSF.IO/2KGMH ).

Stage 1 identifying the research question

The research question remained consistent with the research question developed in 2017; ‘What is the scope, main topics and gaps in evidence in the existing literature on health of migrants residing in the Republic of Ireland?’ The population is refugees and migrants, the context is Ireland, and the concept is research on migrants.

Stage 2 identifying relevant studies

Congruent with the original scoping review, we conducted systematic searches of 10 electronic databases; PsycINFO, Psych Articles, CINAHL, Medline, Academic Search Complete, Cochrane Library, Embase, Web of Science, Econlit and Lenus. Social Sciences Full Text (H.W. Wilson) was no longer available. The research team actively collaborated with the University of Limerick librarian to formulate a search strategy and pilot it across all databases to optimise the search process and to ensure all relevant studies were included. The final search terms are consistent with the previous scoping review and set out in Table  1 .

Given the volume of peer-reviewed literature available, the original scoping review did not include grey literature. For comparability of methods, we also excluded grey literature in this updated review.

The final and complete search was conducted on the 10th of April 2023.

Stage 3 study selection

Articles were included if the empirical research was based on primary or secondary data on the health of migrants in the Republic of Ireland; peer-reviewed publications; and articles in the English language. Since our aim was to map new knowledge against the knowledge synthesised from the first review, the timeframe was limited to articles published from May 2017 to March 2023 only.

Similar to the original scoping review, we also included studies that were not primarily focused on migrant health but collected data on, for example, country of birth, ethnicity, nationality, or citizenship and reported on these subgroups in their analysis of the data. We also included multi-country studies where Irish data was identifiable.

Stage 4 data charting

We used EndNote to manage retrieved articles from the ten databases and exported the articles to the screening tool Covidence. There were two pairs of reviewers, (AC and WG / YS and BO). Each title and abstract was independently screened by a pair of reviewers who then compared their decisions. Any disagreement was resolved by the larger group (AC, YS, WG, BO) and recorded reasons for exclusion. Once title and abstract screening was complete, the research team met bi-weekly to conduct a full text screening of the remaining articles (AC, YS, WG, BO).

Data were extracted from the studies (WG, BO) and the process reviewed, discrepancies and conflicts examined and final consensus agreed by AC and YS, who ensured the completeness and accuracy of the data extraction process. The data extraction sheet was designed in an excel format applying the same headings used in the original review; authors, publication year, title of the study, geographic location of the study, data collection period, study design, target population, target migrant group, definition of migrant group, participant group, study objective(s), data collection methods, and main study findings. However, we also included additional headings to identify whether studies with a secondary focus on migrant health analysed the demographic data on ethnicity / country of origin that they collected.

As with the original review, we carried out a quality assessment of the studies to ensure consistency and to add an extra layer of academic rigour (see supplementary file). The critical appraisal tools used include the updated Critical Appraisal Skills Programme (CASP) for qualitative studies [ 32 ]; Guidance for Reporting Involvement of Patients and the Public (GRIPP 2) for studies that reported on the involvement of migrants in their research process [ 33 ]; the Mixed Methods Appraisal Tool (MMAT) for mixed-methods studies [ 34 ]; the AXIS tool for cross-sectional studies [ 35 ]; the Newcastle Ottawa Scale for cohort studies [ 36 ]; the JBI checklist for diagnostic test accuracy studies [ 37 ] and the JBI critical appraisal tool for case series [ 31 ].

Stage 5 collating, summarising and reporting results

The team met to reach consensus on the coding process and met again once half of the papers were coded to test consistency and discuss any modifications (the coding rules are included in supplementary files). Studies were coded under the nine WHO strategic areas (see Fig.  1 ). Each study was matched with the corresponding strategic area based on its primary aim. In cases where a study had a dual focus, it was mapped to two relevant strategic areas. We documented health topic separately e.g. sexual and reproductive health, mental health, antenatal care.

Stage 6 consultation with stakeholders

In line with updated guidance on consultation with stakeholders as a required stage in scoping reviews [ 38 ], we consulted with a community partner for two purposes: first, to review and interpret findings in the context of their experience and second, to support knowledge transfer to the NGOs and migrants living in Ireland as well as policy makers that they meet through their advocacy work.

The community stakeholder (TM) is the general manager of Cairde, a community health development organisation in Dublin, with over 20 years’ experience of working with refugees and migrants. TM is a co-researcher on migrant health projects conducted with some members of the research team. TM was invited to participate and contribute to the interpretation of findings in a one-to-one meeting with AC. TM’s contribution was integrated into the write up of the results and discussion sections of this paper to present our combined interpretation and synthesis of the scoping review findings. In addition, some specific insights or considerations from the perspective of someone working in an NGO focused on refugee and migrant health are made explicit in the Discussion.

As a co- author, TM has contributed to drafting and approval of the final manuscript.

A Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) flow diagram illustrating the process is outlined in Fig.  2 . The completed PRISMA-ScR checklist is included in supplementary files.

PRISMA Flow Chart

Overall findings

429 articles were identified from the 10 databases and after removing 27 of them for duplication, 402 remained for title and abstract screening. We conducted title and abstract screening and recorded reasons for exclusion; 60% were not migrant studies ( n  = 190), 26% were conducted outside Ireland ( n  = 83) and 12% didn’t collect any primary or secondary data ( n  = 37). Less than 1% ( n  = 5) were excluded due to date of publication or non-human studies. We conducted full text screening on the remaining 87 articles and excluded a further 25 articles for reasons including; no empirical data on health of migrants (40%, n  = 10); not a migrant study (16%, n  = 4) or the date was outside the inclusion criteria (16%, n  = 4). The final number of included studies is 62, the characteristics of which are listed in Table  2 .

There has been an increase in studies over time from an average of five published, peer-reviewed studies per year in the previous review to an average of 10 per year in this review. Specifically, the volume of publications has increased over the last three years (see Fig.  3 ). 85% of included studies ( n  = 53) focused on migrant health research conducted exclusively in Ireland and 15% of studies ( n  = 9) were conducted elsewhere (other EU countries, the UK, Canada or the US) and included Ireland.

61% of studies ( n  = 38) declared their funding source and 39% of studies ( n  = 24) reported they did not receive funding or did not mention a funding source. Of those that declared funding; 76% ( n  = 29) received national funding and 24% ( n  = 9) received international funding.

Number of migrant health studies included in this review by year of publication years (2017 and 2023 incomplete years and not included)

Characteristics of included articles

We found more quantitative ( n  = 34, 55%) than qualitative studies ( n  = 23, 37%) and there were also five (8%) mixed-method studies. Quantitative studies were mostly cross-sectional ( n  = 21, 62%). Six studies were cohort studies, six used a case series methodology and one was a diagnostic study. Of all 62 studies, 13% used a participatory research approach ( n  = 8).

Forty-three studies (69%) had a primary focus on the health of migrants and 19 studies (31%) had a secondary focus where the authors collected demographic data on migrant status or ethnicity as part of a broader study that investigated a specific health issue. 63% of these studies ( n  = 12) aggregated this demographic data and reported it in their findings. A further 6 studies collected demographic data on migrant status but did not report on it separately.

In terms of how studies classified or defined what a migrant is for the purposes of their research, the 43 studies whose primary focus was migrant health used categories including country of birth, citizenship, ethnicity, international protection status. The remaining 19 studies were general population studies that collected information on ethnicity, e.g. Roma, or racial categories such as Black, White, etc.

The primary health topic in each paper was identified by asking what health topic was the research designed to address? A summary of identified health topics is illustrated in Fig.  4 .

Health Topic of included studies ( n  = 62)

The most commonly reported health topic was mental health ( n  = 14, 23%), including studies on migrant health workers that work in mental health services, participants experiences of depression, stress and perinatal mental health (#1, #11, #12, #13, #14, #19, #23, #34, #37, #39, #42, #50, #53, 58). The second most frequently reported health topic was the social determinants of health which reported on the wider socio-demographic factors that impact on health, e.g. migrants experiences of discrimination, education and housing factors (#17, #20, #21, #22, #28, #49, #52, #57, #62).

Other included studies focused on; sexual and reproductive health (#4, #5, #44, #45, #47, #60, #61); healthcare utilisation (#2, #10, #25, #26,#27, #33, #36); communicable disease (#3, #7, #16, 31, #40, #54, #56); communication barriers (#31, #32, #41, #43, #46, #55); healthcare workers (#8, #9, 35, #38); health satisfaction (#48, #51, #59); non-communicable disease (#15 and #29); child health (#24); healthcare policy (#30); health information (#18) and health screening (#6).

Studies were quality appraised using the tools and criteria already identified and categorised into low, medium or high quality; 65% of studies were assessed as high quality and 35% were considered moderate quality. No studies were assessed as low quality. The results of the quality appraisal are included separately as a supplementary file.

Collating / synthesising the data using WHO Strategy and Action Plan Strategic Areas.

Table  3 shows which study was categorised into the respective nine WHO SaAP strategic areas, and a comparison between the 2017 scoping review and our current review is shown in Fig.  5 , with some studies coded to more than one strategic area.

Categorisation of studies to WHO SaAP strategic area by year of review (2017, 2023)

Strategic Area 1: establishing a Framework for Collaborative Action

Four studies (6%) were classified under SA1 - #34, #28, #41, #34, three of which were qualitative and one was a mixed methods study, (compared to no studies in the previous review). Two studies (#41 and #43) were focused on collaborative action to improve the implementation of trained interpreters using Participatory Learning in Action combined with Normalisation Process Theory as the implementation framework. The third study (#34) also used participatory methods (online world café groups) to explore the collective roles of key stakeholders to support migrant women at risk of perinatal mental illness. The fourth study (#28) is a community-based participatory project with academic, NGO and government collaboration to improve Roma experiences in Ireland (this study was also coded to SA3).

This extensive network of collaborative partnerships encompassed a diverse range of stakeholders, involving senior primary care academics and researchers (#41), a coalition of migrants, general practice staff, and community interpreters (#43), as well as a collaboration with healthcare providers and community groups (#34), and engagement with both statutory and voluntary bodies (#28). It is noteworthy that all four studies classified under SA1 embraced participatory methodologies and in two studies facilitated the inclusion of migrants as peer researchers and stakeholders. This approach actively engaged migrants in dialogues pertaining to their healthcare experiences.

Strategic Area 2: advocating for the Right to Health of Refugees, Asylum Seekers and migrants

Four very diverse studies - #2, #17, #33, #35 (6%), focusing on eliminating barriers to healthcare, were coded to SA 2, again compared to no studies in the previous review. Two of these studies had a qualitative design (#33, #35), one was quantitative (#2) and one was mixed method (#17). The importance of peer work with migrants (and other vulnerable cohorts) to improve healthcare utilisation by making care more culturally responsive was the focus of #33. This study found a disconnect between national policy and implementation on the ground. Concerns and challenges experienced by student nurses and qualified nurses caring for migrant patients and their feelings of uncertainty, lack of knowledge, their experiences of ethnocentric approaches, stereotyping and cultural factors within their own work places was the focus of #35. A third study (#2) looked at the barriers to healthcare experienced by migrants through their utilisation of healthcare compared to participants from Ireland and UK-born patients living in Ireland, with non-Irish and non-UK residents least expected to have attended a GP. The fourth study (#17) examined the relationship between stressful experiences such as exclusion from ordinary privileges and overt discrimination, with indicators of psychological well-being experienced by what the authors referred to as “visible” immigrant women of colour and “nonvisible” White immigrant women. This study found that “visible” immigrant women reported more experiences of discrimination than “nonvisible” immigrant women.

Strategic Area 3: addressing the Social Determinants of Health

Similarly to the 2017 review where 29% of articles were categorised under SA3, fifteen studies (24%) reported on the social determinants of health; #1,#8, #9, #15, #22, #28, #38, #44, #47, #50, #52, #58, #60, #61 and #62. Six studies were qualitative in design, six were quantitative and three were mixed-methods studies.

Four studies related to occupation as a social determinant of health looking at migrant healthcare workers experiences of working across psychiatry (#1), midwifery (#9) and general practice (#8 and #38). All four studies examined satisfaction with working conditions and their plans to emigrate or return home as well as adjustment to working in Ireland (#38).

Two studies focused on the mental health and well-being of migrants ; #50 explored the issues new Syrian migrants experience building relationships with peers in Ireland in the context of perceived difference and inequality and #58 examines the experiences of programme refugees in the West of Ireland. This study focused on the psychological well-being of refugees impacted by their experience living in a refugee camp and how this changed when they were resettled and acquired new social and cultural resources.

One participatory study (#28) explored the social determinants of health through the involvement of Roma peer researchers who identified that there were educational and legal implications for parents when they require their child to interpret their GP consultations with implications for school attendance.

Strategic Area 4: Achieving Public Health Preparedness and ensuring an effective response

The largest number of studies (29%, n  = 18) focused on achieving public health preparedness and ensuring an effective response - #10, #24, #25, #30, #37, #48, #51, #14, #52, #26, #27, #29, #36, #45, #49, #54, #56, #59, of which almost 90% were quantitative in design ( n  = 16). 78% of these studies had a primary focus on migrant health ( n  = 14) and 61% ( n  = 11) were coded to one other strategic area, most notably SA 5. SA4 was also the largest category of migrant health research in the previous scoping review at 59%.

Four of these studies reported on healthcare utilisation and health preferences of migrants and revealed the ways in which there is a lack of preparedness at present; three of which were by the same lead author. Study #26 examined Polish men’s lower utilisation of preventative healthcare and #25 and #27 looked at the health preferences and the negative utility value the men placed on their health. The fourth study (#36) found lower utilisation levels of general practitioner services for children of foreign-born residents in Ireland.

Two studies categorised under this strategic area focused on communicable diseases (#54 - Covid-19 and #56 - Hepatitis B virus) and were also categorised under SA 6 preventing communicable diseases .

Factors that drive the health and emotional well-being of migrant parents was the focus of #59, and findings reported in #10 found Syrian refugees experiencing high levels of anxiety due to unsatisfactory living conditions and unmet health needs.

Satisfaction with the health service was the main topic of the research conducted in #48 and #51; #48 looked at how foreign-born rate the Irish health system positively upon first arrival in the country and #51 examined adaptation and quality of life for Croatian migrants in Austria and Ireland. Mental health was the main focus of #14 and #37, specifically survivors of torture and asylum seekers awaiting a decision on their asylum application.

Three further studies focused on maternal and child health ; #24, #45 and #52. Two studies addressed vitamin D deficiency ; #29 and #49. An examination of policy responses to migrant health care was discussed in #30, which reported on the policy environment in Ireland, Spain and Portugal. Of the three countries involved in the policy review, Ireland is the only country which treats ethnic minorities and newly arrived migrants equally while Portugal and Spain only focus on the latter, which according to this review, makes Ireland’s migrant health policies highly inclusive.

Strategic Area 5: strengthening Health systems and their resilience

Almost 26% of studies ( n  = 16) were categorised to SA5, in comparison to 49% in the previous scoping review. Fifteen studies had a primary focus on migrant health: #7, #23, #26, #27, #31, #32, #36, #41, #42, #43, #45, #46, #52, #55 and #59.

Nine of these studies are also coded to other strategic areas, namely SA4. Four studies (25%) were participatory and involved migrants as research stakeholders, representing service users of primary care services, to examine means of collaboration to strengthen the health system by improving communication and language barriers (#31, #43, 46 and #55). Study #39 focused on perinatal mental health and whilst it was a general population study, it also collected information on the health of migrants. Specifically, GPs perceived women from different ethnic and cultural backgrounds as reluctant to disclose their psychological distress and consequently GPs have concerns that they are not adequately understanding the concerns of women from ethnic and culturally diverse backgrounds.

Three studies were evaluations of participatory implementation programmes delivered through an EU research collaboration RESTORE 2011–2015 [ 39 ]; #41, #43 and #55. Three subsequent studies; #31, #32, #46 centred on the examination of communication barriers encountered by migrant populations in primary care and the use of interpreters.

Strategic area 6: preventing Communicable diseases

Seven studies (11%) were categorised to strategic area 6; #3, #6, #16, #40, #54,# 56 and #57 (compared to 15% of studies in the previous scoping review). Two of the seven were qualitative in design (#40 and #57), four were quantitative (#6, #16, 54 and #56) and one applied a mixed-method design (#3). Three of the studies had a primary focus on refugee and migrant health (#3, #16 and #57) and four studies had a secondary focus (#6, 40, #57 and 56).

All seven studies focused primarily on specific communicable diseases, e.g. COVID-19 ( n  = 3), Tuberculosis ( n  = 1), Hepatitis B virus ( n  = 1), Measles ( n  = 1) and HIV ( n  = 1). Study #57 reported on a community health partnership to prevent the spread of COVID-19 within Roma communities and potential widening of health inequities during the initial response to the COVID-19 pandemic in Ireland. Mitigation interventions implemented include targeted public health measures, culturally sensitive communications, lobbying for policy change and social support.

Barrett (#3) also reported findings involving the Roma community, specifically a measles outbreak in 2016 and the factors which facilitated onward spread of disease. This report considered the strengths and weaknesses of ongoing measles control efforts in Ireland.

Of the two COVID-19 studies; #40 looked at the health-related challenges of adults living with long-COVID of which 25% were reported to be non-White. The second study (#54) reported on multisystem inflammatory syndrome in the context of paediatric COVID-19 infection and found that ethnicity appeared to have a major influence on incidence of MIS-C.

Van Gemert (#56) reported on the epidemiology of chronic Hepatitis B virus using routine data and found that amongst 2,696 chronic cases that the most commonly reported risk factor was being born in an endemic country (as either an asylum seeker or other immigrant). This study was also coded to SA4 achieving public health preparedness and resilience .

Finnegan (#16) reported on an outbreak of Tuberculosis in a Direct Provision centre in which 82 children (50% of whom were under 5 years of age), were considered close contacts of the index case and as a result at increased risk of developing disseminated TB and TB meningitis due to living in communal settings.

The final study that primarily focused on communicable disease was #6, which reported on a pilot project offering voluntary community-based HIV testing (VCBT) aimed at capturing data for at-risk populations not already attending clinical service in Ireland. This study was also coded to SA8 ensuring ethical and effective health screening and assessment.

Strategic area 7: preventing and reducing the risks posed by Noncommunicable diseases

Twelve studies (19% - which is the same as the previous scoping review) were concerned with preventing and reducing the risks associated with noncommunicable diseases; #4, #5, #11, #12, #13, #14, #15, #19, #29, #42, #49 and #53. Over 90% were quantitative in design ( n  = 11). Six studies had a primary focus on migrant health and another six studies had a secondary focus. 25% of all studies were coded to other strategic areas, in particular SA 4. Half of all studies were concerned with mental health , psychological distress and trauma; #11, 13, #14, #19, 42 and #53. Of the six, two studies covered child and adolescent mental health . Cotter (#11) looked at a cohort of migrant youths 13 years old, as part of the Growing Up in Ireland study and their experience of stress and psychopathology, comparatively with their Irish counterparts. Haran (#19) reported on the practice of restrictive interventions (physical restraints and seclusion) in child and adolescent mental health facilities.

Four further studies reported on the mental health of adult migrants specifically; capacity and decision-making acuity of inpatients in a psychiatric facility (#13),;referrals to the national centre for victims of torture (#14); demographic characteristics of migrants presenting with first episode of psychosis in comparison to their Irish counterparts experiencing first episode of psychosis (#42); and the mental health needs of the Gypsy, Roma, Traveller population in Ireland and the UK (53).

A quarter of studies coded to SA7 covered antenatal and sexual and reproductive health ; #4, #5 and #12. Bogdanet 2022a and 2022b (#4 and #5) looked at predicting gestational diabetes in pregnant women in their first and second trimester. Neither study collected primary data on migrants but did record ethnicity and tested ethnicity as a gestational diabetes risk factor. Both studies recommended future research with a larger, more diverse cohort to examine this association further. The third study (#12) examined a cohort of new mothers from the Growing Up in Ireland study and the prevalence of depression and depressive risk factors. The study found that depression symptoms were higher among ethnic minority mothers and being an ethnic minority mother was a primary determinant of not seeking treatment for depression.

Two further studies looked at the Vitamin D deficiency ; #29 in a South East Asian population and #49 more broadly the determinants of Vitamin D deficiency of which non-White ethnicity was found to be significant. Both studies were also coded to SA4.

Finnegan (#15) was concerned with the risk factors for stroke and found that ‘originally not of Irish ethnicity’ constituted 9% of all stroke unit admissions to the acute stroke unit over a two-year period.

Strategic Area 8: ensuring ethical and effective Health Screening and Assessment

Three studies were focused on health screening and assessment; #6, #20 and #21 in comparison to five studies (6%) in the previous scoping review. All three were quantitative in design and had a secondary focus on migrant health. One (#6) was also coded to SA 6. Two of the three studies reported on colour vision deficiency in 6- to 7-year-old school children in Ireland (#20, #21) and the third study reported on a voluntary community-based HIV testing pilot project aimed at collecting data from at-risk populations not already attending clinical service in Ireland (#6).

Strategic Area 9: improving Health Information and Communication

One study; #18 reported on improving health information systems; a quantitative descriptive study which mapped the reporting of ethnicity and migration-related variables in national health and social care data collections in Ireland. Similarly one study was also categorised to SA 9 in the previous scoping review. The authors identified fourteen of 97 data collections with information on ethnicity. Country of birth was also collected in 10 of these 14 data collections. The authors found no routine recording of ethnicity in primary care, where the majority of healthcare is delivered, or for hospital inpatients, other than psychiatric inpatients.

Summary of results

This review was designed to update an earlier scoping review of evidence about the health of migrants residing in Ireland conducted in 2017 [ 26 ]. The increase in the volume of research on migrant health in Ireland is notable, rising from an average of five published, peer-reviewed studies on migrant health research per year in the period 2000–2017 to an average of 10 studies per year in this review.

The percentage of studies on general population health with a secondary focus on migrant health has increased from 20% to 30% between the 2017 review and our current review. This indicates that more general population studies are beginning to include migrant status or ethnicity when collecting demographic data.

The previous scoping review found that the majority of studies (89%) were coded to either SA3, SA4 or SA5; the social determinants of health, public health preparedness and strengthening health systems. Although the number has reduced, our findings are consistent with the previous scoping review in that 70% of current studies ( n  = 49) were coded to either SA3 ( n  = 15), SA4 ( n  = 18) or SA5 ( n  = 16).

Ensuring public health preparedness and an effective response (SA4) remains a global priority for the WHO to be addressed over the next five years [ 5 ]. Therefore, it is encouraging to see a high volume of studies (29%) reporting on the health needs of refugees and migrants in the planning and development of public health services and policies. A wide variety of migrant health needs are being reported including mental health and well-being, sexual and reproductive health, communicable disease but also health preferences, satisfaction with health services and an examination of policy responses.

Over 26% of studies were concerned with strengthening health systems and their resilience (SA5) and specifically at optimising the delivery of healthcare to migrants experiencing language and cultural barriers in primary care. The levers and barriers to the implementation of trained interpreter services in Irish healthcare systems and different methodologies and theories to support the implementation process were reported on extensively. The need for such evidence is strongly emphasised in the first and second national intercultural health strategies (NIHS) in Ireland [ 14 , 15 ].

Studies categorised to SA3 focused on the experiences of migrant healthcare workers working in psychiatry, midwifery and general practice and the environmental factors that contribute to their positive or negative associations with this work. Other studies included the experiences of Syrians building relationships with peers in Ireland and a programme for refugees resettled in the West of Ireland. Addressing health disparities and improving access to quality care for refugees and migrants extends beyond the capacity of health systems alone. Therefore, research on the influential nature of education, employment, social security, and housing to equitable access to healthcare is crucial. Study findings are compatible with evidence on the ground in the NGO sector, as described by TM, our community partner, who reports these factors have a profound impact on the health outcomes of migrants. Of particular importance to the NGO sector is that discernible attention is directed towards scrutinizing morbidity and mortality rates arising from social determinants of health within these migrant communities. This would reflect a commitment to comprehensively understanding and addressing the healthcare inequities that migrants encounter, which is aligned with the priorities set out in the first and second NIHS [ 15 ] and Global Action Plan 2019–2023 [ 40 ].

Strategic Areas 6 (preventing communicable diseases) and 7 (preventing and reducing the risks posed by noncommunicable diseases) consistently remain important topics for researchers, with a notable emphasis on noncommunicable diseases. Mental health and sexual and reproductive health emerge as the predominant and frequently studied domains within SA 7. This is notable as a recent scoping review of migrant health research in the UK found that mental health was the second highest most researched outcome for migrants in the UK [ 6 ]. The number of studies with a primary focus on the mental health or well-being of migrants or where the main health topic was mental health sits in contrast to a recent EU wide study that underscored mental health as a research priority across nine European countries [ 7 ].

The previous review found a scarcity of scientific research on collaborative action, advocating for the right to health for refugees and reported no studies relevant to either of those strategic areas. However, this review found an increase in studies focusing on SA1 and SA2 with eight (13%) studies focused on these strategic actions. In the second half of 2023, the WHO released two reports setting out the global research agenda on health, migration and displacement and promoting the health of refugees and migrants. Both reports reiterated that partnerships and interagency coordination and collaborative mechanisms remain a priority area of action [ 2 ] for WHO work around the globe and form an integral part of promoting equitable knowledge sharing and information transfer [ 5 ]. Our review reported on studies that developed innovative partnerships and collaborations between senior primary care academics and researchers; migrants, general practice staff, community interpreters, service providers, service planners from primary care; healthcare providers, community groups and NGOs, networks and associations who provide support to women and migrant communities. Interestingly two of the four studies coded to SA 1 used participatory methods to include migrants as peer researchers and stakeholders in dialogues about their healthcare.

Ethical and effective health screening, assessment and health information play a vital role in early detection and management of communicable diseases, public health threats and trust in the health system. However, this review found that there are few studies in this area. Studies coded to SA8 and SA9 were infrequently reported and there has been little change in the volume of research examining these strategic areas over the past six years. This finding points to a persistent gap in migrant health research in Ireland and a potential deficit in knowledge about prevention and early intervention through screening and assessment. It resonates strongly with the experiences of NGOs who report considerable resistance to breast cancer screening for example, due to possible stigma or fear. Conversely, NGOs see that some transient migrants without a GP remain excluded from screening programmes. IP and BoTP applicants are offered screening at accommodation centres, but those who have moved through the system, EU migrants and undocumented migrants can remain on the periphery of the health system and face challenges in connecting to screening programmes. It is also the experience of migrant NGOs that migrants without a Personal Public Service number (a unique identifier of individuals in Ireland) face exclusion from the health system, an issue that particularly affects the Roma community in Ireland and undocumented migrants. The situation is exacerbated by the limited attention paid to information systems on the health of refugees and migrants. Strengthening health information systems is a key priority within the global research agenda on health, migration and displacement and remains an issue for many countries across the globe [ 41 ].

The new Action Plan for Refugee and Migrant Health in the WHO European Region 2023–2030 [ 27 ] has 5 main action pillars, which could be used as a further benchmark when analysing the findings of this scoping review. Our findings suggest that Ireland must pay closer attention to Action Pillar 4: Strengthen Migration Health Governance and Evidence and Data-Driven Policy-Making in terms of future research in health screening, assessment, health information and communication.

Meaningful participation of refugees and migrants

The attention given to participatory approaches and action research was noted in the first review of migrant health research in Ireland in 2001, specifically methodologies such as participatory action research and participatory learning and action that support migrants to engage in and contribute to the research with migrants rather than ‘on’ them [ 24 ]. This is in line with WHO guidance for robust evidence generation in the field [ 42 ].

Recommendations from the UK and Norwegian scoping reviews of migrant health research also claim that it is critical to meaningfully involve refugees and migrants from the research design to research dissemination in order to capture their healthcare priorities and meet their needs, and to ensure that the research process is not tokenistic or harmful [ 6 ]. This may require a ‘methodological shift’ but will lead to greater clarity on the health issues affecting migrants and further insights into the social determinants of health and health inequities [ 8 ]. This review identified eight studies (13%) that used participatory approaches; categorised to SA1 and SA 5. This is in contrast with the 2017 review, which identified only one study, categorised to SA 9. Further research to explore learnings from studies that used participatory approaches would be valuable to learn about, for example, what conceptual frameworks guided the research and how best to establish partnerships for meaningful involvement of refugees and migrants in research teams.

Methodological critique

The strengths of our scoping review include a comprehensive overview of the published literature on migrant health in Ireland, rigorously following established scoping review guidelines with the addition of a quality appraisal for systematic and meticulous scoping of the literature. We replicated the use of the WHO SaAP and coding rules, which proved valuable for comparative and accumulative synthesis of evidence. The community consultation process provided an alternative voice from the perspective of migrant NGOs and is expected to strengthen the dissemination and veracity of the review’s findings [ 26 ].

There are some limitations to the scoping review including the exclusion of grey literature which would have provided additional evidence. Finally, it should be noted that even with careful development and refinement of coding rules, allocating a paper to one strategic area was not always straightforward because of cross-cutting aspects of research and/or migration health but consistency of coding was supported by regular team meetings.

Migrant health research in Ireland is growing at a significant rate and generating an expanding evidence base for Irish policy makers. This is vital for fostering social inclusion, promoting health equity, and ensuring that healthcare services are responsive to the diverse needs of the population. However gaps persist particularly in research on health screening and assessment and health information and communication. This may lead to a potential deficit in knowledge about prevention and early intervention through screening and assessment as well as ongoing gaps in health information about refugees and migrants.

In line with Goal 4 of Ireland’s current National Intercultural Health Strategy [ 15 ] which calls for a robust evidence base to inform policy making, one planned action from this research is to set-up a national database cataloguing migrant health research in Ireland. This database will provide easy access to the growing evidence base and comprehensive analysis of health trends and demands within the migrant community, contributing to public health education as well as oversight of the state of the art. This will be a useful resource for refugees and migrants, researchers, policy makers, NGOs and community stakeholders when writing submissions to government about gaps in services for migrants, and for health service planners when developing evidence-based policy responses.

Data availability

The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Beneficiaries of Temporary Protection

Critical Appraisal Skills Programme

European Union

Gross Domestic Product

General Practitioner

Guidance for Reporting Involvement of Patients and the Public

International Protection

Joanna Briggs Institute

Mixed Methods Appraisal Tool

National Intercultural Health Strategy

Non-governmental Organisation

Open Science Framework

Preferred Reporting Items for Systematic Reviews and Meta Analyses – extension for Scoping Reviews

Strategy and Action Plan

Strategic Area

World Health Organisation

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We would like to thank the University of Limerick Librarian Pattie Punch for her very valuable guidance and assistance.

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Anne Cronin, Ailish Hannigan, Nuha Ibrahim, Yuki Seidler, Blessing Olamide Owoeye, Wigdan Gasmalla, Tonya Moyles & Anne MacFarlane

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Anne Cronin School of Medicine and Health Research Institute, University of Limerick, Prof Ailish Hannigan School of Medicine and Health Research Institute, University of Limerick, Dr Nuha Ibrahim School of Medicine and Health Research Institute University of Limerick, Dr Yuki Seidler University of Vienna, Blessing Olamide Owoeye University of Limerick, Wigdan Gasmalla University of Limerick, Tonya Moyles Cairde and Prof Anne MacFarlane School of Medicine and Health Research Institute, University of Limerick.

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Cronin, A., Hannigan, A., Ibrahim, N. et al. An updated scoping review of migrant health research in Ireland. BMC Public Health 24 , 1425 (2024). https://doi.org/10.1186/s12889-024-18920-0

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Received : 19 February 2024

Accepted : 22 May 2024

Published : 28 May 2024

DOI : https://doi.org/10.1186/s12889-024-18920-0

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