Holly Springs, Wake County : a community assessment including secondary data analysis and qualitative data collection

Community Diagnosis. Community diagnosis is a process that is conducted to provide a comprehensive assessment of the strengths and needs of a particular community. This assessment analyzes the ability of the community to identify its available resources to respond to conditions and situations that affect the general health and wellness of its residents. A team of first-year Master’s students in the Department of Health Behavior and Health Education of the School of Public Health at the University of North Carolina at Chapel Hill performs this diagnosis as part of a two-semester course requirement. The team collects data from written documents (quantitative or secondary data), personal interviews (qualitative or primary data), and interaction with residents at various community gatherings. Topics of investigation include any information that illuminates how living in the community affects the physical health, prosperity, and outlook of those who reside there. The compiled data are returned to the community so that it may better direct any efforts it wishes to make in reacting to challenges that it faces both now and in the future. The present community diagnosis was conducted in the town of Holly Springs, North Carolina. Team members Kim Brown, Adam Buchanan, Gina Febbraro, Yalonda Lewis, and Ana Validzic collected and analyzed data from September 1998 to March 1999. Residents responded to the assessment findings in a Town Meeting held at the end of this period. Methodology. Sources of information include population and economic reports, statistics provided by government agencies, town and local documents, newspapers, and personal interviews with Holly Springs community members and service providers. In particular, secondary data were gathered during the fall semester from the 1990 U.S. Census, a special 1998 Census of Holly Springs, the North Carolina State Center for Health Statistics, Wake County Health Department, Wake County Human Services, Holly Springs Human Services, and Holly Springs Town Hall. When compared with statistics for Wake County and for North Carolina, these Holly Springs data give a numerical picture of the overall health status of the town. Primary data were collected in a series of interviews conducted with eighteen community members and twelve local service providers during the fall and spring semesters. These interviews sought to add personal insight to the secondary data already compiled. The open-ended questions of the interviews were devised to elicit the individual stories and perspectives of those living in, or providing services for, Holly Springs. Questions to community members covered such topics as the assets and needs of the town, change and growth, the different populations within Holly Springs and how these groups interact, and the health of the community. Service providers were interviewed regarding particular groups who use their services, barriers to providing or receiving the service, and the strengths and needs of the community. Potential interviewees were referred by community leaders, other interviewees and through informal discussions with community members. The community assessment team intentionally tried to interview residents who would represent the rich diversity of Holly Springs. Two team members were present at each interview to conduct the interview and take notes. The interviews were audiotaped for future reference in identifying salient themes from the interviews. The information gained from the quantitative and qualitative assessments was presented to the community at a Town Meeting on March 18, 1999. This meeting gave community members the opportunity to digest and discuss the major themes that had been identified throughout the community diagnosis process. The presence of a few service providers at the meeting also fostered discussion on how these organizations can better serve the residents of Holly Springs. Limitations. Realizing the limitations involved in this community diagnosis process helps one understand the data in a more accurate context. One major limitation of the quantitative data collection is that the special census conducted in June 1998 does not cover the full scope of information included in the 1990 U.S. Census. Thus, much of the data that was drawn from the 1990 census may no longer give an true picture of life in Holly Springs. Given the dramatic growth in Holly Springs and Wake County since 1990, extra care should be taken when drawing conclusions from these data. Many of the morbidity and mortality health statistics were collected for the zip code 27540, which includes Holly Springs and a portion of the surrounding area. This represents another quantitative data limitation, as these data may have been influenced by those living outside the Holly Springs town limits. Thus, the information may not give a completely valid representation of the salient health problems of the town. The selection of interview candidates is a decided limitation of the qualitative data collection process. The referral method used to identify these candidates kept the sample from being a random representation of the community. Although care was taken to interview residents from all major groups living in Holly Springs, this convenience sampling method tended to lead residents to refer those with similar experiences and views. Thus, some of the themes identified as important by interviewees may not be considered so by residents from groups that the team was unable to contact. This non-representative referral method is in part a product of the relatively short amount of time allotted for data collection due to academic process. Conducting the data collection over a longer time period without the requirements of an academic process would allow investigators to spend more time in the community, thus giving a more accurate portrayal of the essence of life in Holly Springs and decreasing the potential for selection bias presented here. Still, there is much to be gained from examining the available findings. Quantitative Findings. Growth was the predominant theme present in both secondary and primary data. What was a quiet, rural, primarily poor community throughout the late 1800s and most of the twentieth century has undergone incredible expansion in the last decade. The explosion has been primarily residential, as the town has grown from 920 persons in 1990 to 6,658 persons in June 1998 (U.S. Census Bureau, 1990 & 1998). This 723% population increase has also been accompanied by a dramatic shift in the racial composition of the community. Whereas the 1990 Census showed a town that was made up of 76% African Americans and 24% Whites (U.S. Census Bureau, 1990), the 1998 Census demonstrated a marked demographic change. Currently, Holly Springs is approximately 74% White, 22% African American, 2.4% Latino, 1.2% Asian/Pacific Islander, and 0.4% Native American (U.S. Census Bureau, 1998). Additionally, many of the individuals moving into the town are younger families. These demographic changes highlight the importance of involving the long-term residents as the town evolves to meet the specific needs of its newer, younger residents. Further examination of the secondary data reveals that the town of Holly Springs is already working to respond to the various needs associated with its continued growth. The establishment of a police and fire department in 1992 and 1995, respectively, has resulted in quicker response times to emergency calls and a substantial decrease in the occurrence of severe crimes. Holly Springs Human Services now offers a variety of programs aimed at addressing the health and social needs of the town. County officials hope to avert some of the traffic that tends to bottleneck on NC Highway 55 into Holly Springs by building a bypass around Holly Springs and widening the road north of the town. Still, while there are efforts to plan accordingly for the continued growth of Holly Springs, some unrealized services and controversial conditions deserve special attention. There is currently no medical doctor within town limits. Additionally, transportation to county health care facilities is not always available to many residents. Other noted concerns include the building of the proposed South Wake Sanitary Landfill on the northwestern town border and the storage of spent fuel rods at the Shearon Harris Nuclear Plant south of Holly Springs. Furthermore, some town officials believe that the town’s current water and sewer systems may be inadequate to accommodate additional growth. Thus, the secondary data reveal directions for future work to continue to address the changing needs of the Holly Springs community. Qualitative Findings. There is a sense of excitement about the future of Holly Springs that pervades the personal interviews. Residents suggested numerous issues that should receive priority in the next few years in Holly Springs. Many mention the maintenance of the small-town feel of the community as important. Some of these individuals refer to plans for a major overhaul and rebuilding of the downtown area as a means of perpetuating this feeling. Many residents feel that building a middle and high school solely for Holly Springs’ youth would also contribute to this small-town nature. Residents list many other wishes and concerns for their community during the primary data collection. The recreational, educational, and mentoring needs of adolescent youth are discussed frequently. Some service providers and community members note that substance abuse is a problem, especially among young people. Discussions during the Town Meeting reveal a variety of community resources that the youth could draw on to help them reach their potential. In addition to youth needs, many residents mention the demand for a physician or clinic in town. Some residents also show concern for the elderly and low-income populations of Holly Springs. Access to services is the primary issue noted for these populations. Just as with the youth development, residents are quick to recognize existing community organizations that are working to improve the wellness of the elderly and low-income community members. Conclusions. Holly Springs is described by many residents as a great place to live. Both the quantitative and qualitative data support this assertion. The town has already shown promise in responding to the various needs raised due to the tremendous growth it has undergone over the last few years. New and greater challenges will surely arise as the town grows and becomes more diverse. Tapping into the resources, assets, and experiences of the native residents as well as the newcomers will help strengthen the entire town in addressing these challenges. Residents are aware of many areas on which they would like to focus energy for improvement. Service providers within Holly Springs and Wake County express a willingness to work with the community to strengthen and maintain the social, environmental, and personal health of the residents of the town. Together, these groups are in the enviable position of being able to direct the future of their community.Master of Public Healt