Keywords
Health needs assessment, community engagement, scoping review, participatory methods
Health Needs Assessments (HNAs) are pivotal in aligning health and social care services with the evolving needs of populations. Incorporating community perspectives in HNAs is recognised as a strategy to enhance their relevance and effectiveness. However, the methodologies employed to integrate these perspectives vary, especially in high-income countries (HICs). Understanding these methodologies is crucial to inform the development of a comprehensive model for community engagement in HNAs. This scoping review will identify and map methodologies employed in HICs to integrate community perspectives into HNAs, focusing on facilitators, challenges, and indicators of success associated with these approaches. Studies will include those published in English between 2015 and 2025 that have been conducted in high-income countries (HICs) and focus on methodologies for community involvement in HNAs. Eligible study designs will include observational studies, including methodologically qualitative, quantitative, and mixed methods studies encompassing both published and grey literature. A systematic search will be conducted across PubMed, Embase, CINAHL, Google Scholar and other selected grey literature repositories. Two independent reviewers will screen titles, abstracts, and full texts; data will be extracted using a piloted charting form and will be analysed descriptively. Findings will be disseminated through peer-reviewed publications, presentations at conferences, and engagements with community interest-holders involved in or planning HNAs.
Health needs assessment, community engagement, scoping review, participatory methods
Population-based planning is a key strategy used in high-income countries (HICs) to align health and social care services with the evolving needs of the population, aiming to improve overall wellbeing and reduce health inequalities1. Central to this approach is the Health Needs Assessment (HNA), which is defined as a systematic approach to identifying and prioritising unmet health needs of a specific population, using evidence-based methods and collaborative partnerships, to inform service planning, promote health equity, and enable cross-sectoral collaboration2.
This scoping review will be undertaken, in part, to inform the conduct of research concerning HNAs in Ireland. Within the Irish context, the Health Service Executive (HSE) has developed a high-level framework for conducting HNAs to support new health regions in prioritising and planning services that meet the needs of their populations2. This framework emphasises the involvement of community members in the service-planning process to ensure services align with needs and preferences. While various assessments enable population-based planning, the HSE’s A Strategic Framework for Population-Based Planning within Health Regions in Ireland highlights the importance of community voice in a whole-system approach. However, specific methodologies for engaging and including the community in HNAs have yet to be fully developed1. Overall, there remains limited available evidence across literature indicating how to effectively include the community perspective on health and wellbeing in HNAs in HICs.
The definition of ‘community’ in community-based HNA generally includes “people with a basis of common interests and network of personal interactions grouped based on either locality or on a specific shared concern or both”3. For the purposes of this project, community will be defined based on locality and/or groups of people with specific shared concerns, with a focus on members of the public as well as other relevant community members4. These may include informal caregivers, patient advocates, community leaders, marginalised or underserved populations whose voices are essential in understanding needs. Importantly, our definition of community will include members from the community and voluntary sector in HICs (e.g., non-governmental organisations, charities, etc.). An important element of improving population level health and social outcomes is collaborative partnership, as it acts as a catalyst for change5. Relevant to our project, the community and voluntary sectors will play a pivotal role in capturing broad engagement to promote sustainable change in a shared interest; community health in HICs will be reflected in the membership of the Steering Committee to be established to oversee our engagement with the relevant HNA projects in Ireland. The Steering Committee will feature representation from knowledge-users across the community and voluntary organisations in Ireland, including the Irish Heart Foundation, the Disability Federation of Ireland, and The Wheel. The Wheel is Ireland’s national association of community and voluntary sector organisations, charities, and social enterprises.
The level of community engagement in a HNA is understood on a continuum, with 'passive participation' on one end, and 'active participation' on the other, as outlined by Arnstein’s Ladder of Participation6,7. Passive participation entails community members being involved in a HNA as subjects and sources of data, rather than co-producers of knowledge or as decision-makers6. Research methods employed in passive participation in HNAs are typically quantitative (e.g., participation in surveys). On the other end of this continuum was 'active participation', such as partnership or citizen control, which empowers interest-holders to influence decisions and co-create solutions, ensuring their perspectives are central to the process and outcome6. This includes fully community-led approaches to community engagement. Community Based Participatory Research (CBPR) is considered to sit at the active participation end of the continuum4. CBPR is known as a collaborative approach to research that equitably involves community members, organisational representatives, and researchers in all aspects of the research process7,8. The benefits of CBPR include enhancing the relevance and application of the research data, providing expertise to complex problems at all stages of research, overcoming community distrust, and improving community health7,8. In Ireland, for example, the community and voluntary sectors have historically engaged in service planning to meet health needs9. Understanding how the community perspective are integrated into HNAs can provide a resource that HNAs operating under similar as well as divergent structures across diverse HIC settings can apply.
A scoping review is considered optimal for this study as it will systematically map diverse methodologies used to incorporate community perspectives into HNAs in HICs. This approach was particularly suitable given the limited evidence on effective community engagement in HNAs within these contexts. By identifying and charting existing methodologies, this review will highlight knowledge gaps and will inform the development of inclusive, community-centred models for HNA practice. Given the varied methodologies used to incorporate community perspectives in HNAs, particular attention was given to define and differentiate study designs during the review process to accurately map evidence and identify methodological gaps. This scoping review helped to inform the development of a HNA model, as it identified challenges and opportunities for including community voices and perspectives at each stage of this project.
Scoping review
Justification for the scoping review: The aim of this research is to broadly collate and describe the methods utilised to incorporate community voices and perspectives into HNAs alongside any challenges or facilitators noted within the research. This aim aligns with guidance regarding scoping review utilisation10.
The review protocol will follow the JBI guidance for scoping reviews and will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines11. The protocol has been structured using the PRISMA-ScR Protocols checklist12,13 and has been registered on Open Science Framework (DOI: https://doi.org/10.17605/OSF.IO/8VABH).
We will include specific study designs (e.g., observational studies utilising quantitative and/or qualitative methods) describing methodologies for community involvement in health needs/health needs and assets assessments (concept). Studies will be included that focus on community members or local interest-holders engaging with HNAs (participants) in HICs or among special interest groups in HICs11 (context). Studies will be required to be published between 2015–2025 and language will be restricted to English. It is anticipated that contemporary methodological approaches will be informed by key works pre-dating this timeframe. Inclusion and exclusion criteria are detailed in Table 1.
| Inclusion Criteria | Exclusion Criteria | |
|---|---|---|
| Intervention/focus | Health needs assessments that will involve the community (i.e., public, informal caregivers, community leaders, representatives of marginalised populations, voluntary or community sectors, etc.) | Studies that will not focus on HNAs and/or will not or will not be able to successfully not able to successfully involve the community |
| Population | Studies that will be conducted in high-income countries, according to World Bank classifications22 | Studies conducted in low- or middle-income countries |
| Study Design | Population-based observational studies, reviews, interventional studies that will focus on increasing community engagement, case studies focusing on HNA + community involvement contexts. Methodologically qualitative, quantitative, and mixed-methods studies focusing on HNA + community involvement contexts. Methodologically qualitative, quantitative, and mixed-methods studies that will focus on HNA + community involvement contexts | Case reports, opinion pieces, editorials, commentaries, conference abstracts, interventional studies that will focus on health outcomes/intervention development, |
| Outcomes | Methodologies that will be used for community involvement in HNAs, barriers/facilitators to community involvement in HNAs, measure of community involvement | Studies that will not report on their community involvement methodology, where attempts to contact the author for supplementary information will be unsuccessful |
| Language | English language publications | Non-English language publications |
| Date | January 2015 – April 2025 | Papers published before January 2015 |
The search strategy, developed with an information specialist, will be applied to PubMed, Embase, and CINAHL. Grey literature will be reviewed via Google Scholar, utilising the first 400 hits14. Google Scholar was chosen as it utilises full text searches and algorithm-based best matches within a web search engine format that incorporates academic writing which would not otherwise be included in a peer-reviewed, scholarly, or academic database. Furthermore, three purposively selected government and non-governmental repositories will be searched, namely The King’s Fund (available at: https://www.kingsfund.org.uk/, accessed 15 April 2025), Open Access Thesis and Dissertations (OATD) (available at: https://oatd.org/, accessed 15 April 2025), and the United States Centers for Disease Control and Prevention (CDC) Stacks (available at: https://stacks.cdc.gov/, accessed 15 April 2025). The search combined terms like “community”, “mixed methods”, “qualitative” and “quantitative”, and the phrase “health needs assessment.” A publication date range of 2015–2025 will be applied. The full search strategy for each database is detailed in Appendix A and available on OSF.
Study records will be imported into Zotero15 and uploaded to Covidence16. Duplicates will be removed within Covidence. Two reviewers will independently screen titles and abstracts, and disagreements will be resolved by a third reviewer. Prior to title and abstract screening, a pilot screening of 10% of documents will be carried out between the 2-3 reviewers who will review each title and abstract independently to ensure consistency of the application of the inclusion/exclusion criteria and assess inter-rater reliability (Appendix B). Reviewers will carefully assess study designs, resolving any ambiguities to ensure the consistent application of inclusion or exclusion criteria through team discussions, particularly to differentiate studies that focused solely on health outcomes from those which addressed community engagement. Other ambiguous situations that may occur during title and abstract screening, such as records without abstracts, will be supplemented with information from reliable online databases to ensure accurate assessment, with all sources documented for transparency17,18. A PRISMA flow diagram will map the number of records identified, included, and excluded. Reasons for exclusion at full text stage will be recorded and reported in the final review.
The data extraction table will be piloted by two independent reviewers using a subset of included reviews (e.g., 10% of eligible reviews, selected to represent all study designs and data types). The tool will be iteratively refined in line with the inclusion criteria to ensure consistent and accurate capture of eligible sources (Appendix C)19. This process will be informed by Cochrane Handbook’s guidance on data extraction and synthesis20. The charting tool will be accompanied by a detailed coding book outlining definitions and coding instructions to standardise data interpretation across reviewers. Data extraction will be treated as an iterative process as suggested in literature17, and, as such, a wider team discussion will be conducted following the pilot to discuss the quality and applicability of the data extraction process. Based on feedback, the data extraction tool will be amended as needed before proceeding with the full data extraction. Data extraction, using the tool (Table 2), will be carried out by 2–4 reviewers. Each evidence source will be reviewed by one reviewer, and the final datasheet will be reviewed to assure accuracy and completeness18,20. All reviewers will undergo training on the data extraction tool to ensure consistency of application and will operate under the supervision of the two primary reviewers and the third external reviewer. In cases of missing or incomplete information, the review team will attempt to contact the original study author/s up to three times via email. If no response was received after these attempts, the missing data will be noted as unavailable. Data will be managed using Microsoft Excel21. Consistent with Cochrane Handbook recommendation for scoping reviews, no critical approach of individual studies will be conducted20, and as such inclusion will not be predicated on health equity considerations.
Given the nature of scoping review data extraction, targeted information will be presented in the methods, results, and discussion/findings sections and/or the abstract sections of included resources. However, as needed, data will be extracted from supplementary materials, appendices, and communication with authors. Given the stated aim of this research, as well as the methodological recommendation that risk of bias assessment is not undertaken for scoping reviews, a risk of bias assessment will not be conducted11.
Descriptive statistics, tables, and figures will be used as appropriate to describe the articles included. A summary of the methodologies used in the included studies to engage community perspectives in HNAs, facilitators/challenges, and any information about perceived success will be produced. This summary will aim to identify, extract, and describe information about community involvement methodologies and barriers/facilitators therein. The summary will highlight the key features, strengths, and limitations of the identified methodologies. Within the purview of a scoping review, this summary will include the quantification of text and frequency counts of discrete extraction items (e.g., number of studies using a specific method, where this method falls on pre-determined scales of community involvement, frequency of stated challenges/facilitators, and, if appropriate, geographic distribution of said frequencies). For challenges/facilitators, basic qualitative content analysis will be undertaken within the remit of a scoping review17.
As this was a scoping review, data analysis and presentation will not assess effectiveness, meaningfulness, or accuracy of the described methodologies and associated challenges/facilitators17. As such, statistics such as risk ratios, p-values, etc. will not be presented.
Ethical approval is not required for this scoping review, as it involved synthesising publicly available literature without direct interaction with participants or the use of identifiable personal data.
Knowledge-users, including community interest-holders and project partners, will be engaged at various stages throughout the review process to ensure the inclusion of community perspectives. This engagement will be facilitated through our Steering Committee. In brief, community partners from organisations such as the Irish Heart Foundation, The Wheel, and the Disability Federation of Ireland will be engaged through an ongoing, consultative process. Numerous methods will be employed for dissemination. Peer-reviewed publications, presentation at national and international conferences, and presentations to community groups and interest-holders engaging in or planning HNAs will be the primary methods to disseminate the results to both scholarly and practice-oriented audiences. A final dataset, representing the list of included articles, will be presented both in published works as well as updated on the OSF page.
At time of publication of this protocol, database searches have been carried out and title and abstract screening is currently underway. Data collection and results are anticipated by the end of 2026.
The aim of this scoping review is to describe the methodologies previously utilised to incorporate community voices and perspectives into HNAs in HICs and identify key challenges and facilitators. Community involvement methodologies are expected to range from “passive” to “active,” and it is important to understand how different methodologies have been utilised, along with barriers and facilitators to their success, to achieve more active community involvement. Describing methodologies used to better incorporate communities and their diverse perspectives into HNAs in HICs will help to facilitate co-creation of health initiatives that truly reflect community needs and priorities.
Open Science Framework. Extended data for: Scoping review protocol to inform development of a model for integrating participatory approaches into population-based health needs assessment in High-Income Countries. https://doi.org/10.17605/OSF.IO/8VABH23.
This project contains the following underlying data:
Appendix A: Scoping review search strategies (detailed search terms and database-specific search strings planning for this scoping review).
Appendix B: Screening instructions (instructions, inclusion/exclusion guidance and decision rules for title/abstract and full-text screening).
Appendix C: Data extraction instructions (guidelines, variable definitions, and standardized procedures for planned data extraction).
Data is available under the terms of the Creative Commons Attribution 4.0 International license (CC-By 4.0).
The authors would like to thank Information Specialists Killian Walsh and Patrick Keegan (RCSI University of Medicine and Health Sciences) for their assistance with the development of the search strategy.
Is the rationale for, and objectives of, the study clearly described?
Yes
Is the study design appropriate for the research question?
Yes
Are sufficient details of the methods provided to allow replication by others?
Yes
Are the datasets clearly presented in a useable and accessible format?
Yes
Competing Interests: No competing interests were disclosed.
Reviewer Expertise: Implementation Science, Community-Based Participatory Research
Alongside their report, reviewers assign a status to the article:
| Invited Reviewers | |
|---|---|
| 1 | |
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Version 1 05 Feb 26 |
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