Durham County: a community diagnosis including secondary data analysis and qualitative data collection

The following section describes the community diagnosis process of Durham County during the 1999-2000 academic year. The community diagnosis was conducted by the Durham County Community Diagnosis team, six first year master’s students attending the University of North Carolina’s School of Public Health, Health Behavior and Health Education Program, in conjunction with the Durham County Health Department. This document was created to identify issues of interest that are significant for residents of Durham County, North Carolina. The document is divided into two main sections. The first section presents secondary data collected for Durham County. The second section addresses various topics that were discussed during interviews and focus groups with Durham County community members, community leaders, and services providers. During the interview process, many Durham County residents shared their thoughts, beliefs, and experiences to illustrate their most salient issues. A synopsis of the findings from both the secondary data and interviews with Durham County residents and service providers was presented at a community forum on March 4, 2000. The forum was intended as an opportunity for residents and service providers to discuss the progress of efforts to improve the quality of life of Durham County residents, applaud beneficial efforts, and offer suggestions for improvement in current strategies. Community diagnosis is an attempt by health professionals and other outsiders to gain a glimpse of what it is like to live in a particular community. The term community can be used broadly or in a more narrow sense. Community can be defined by the geographical boundaries that link individuals together; by the relational or social bonds that exist between individuals; and through the collective power that brings members together to act towards changing or maintaining the community. A community and its boundaries are self-defined by its inhabitants. Community is defined by multiple facets, including culture, values, and norms. Additionally, understanding the history of a community is instrumental to understanding patterns, norms, and activities in the community. Identification of the informal and formal leaders, their leadership style, and the power structure are also important in understanding how a community functions. Community diagnosis involves learning which health issues are most important to community members. Beyond understanding the relevant health issues, a community diagnosis also explores other factors that enhance and detract from community members’ abilities to achieve a desired quality of life. Many times decisions regarding changes in a community may result from assessments of statistical or quantitative data, such as morbidity and mortality rates, crime rates, high school drop out rates, or pregnancy rates. Statistical data provide an account of what is happening in the community. However, the numbers represented in quantitative data are unlikely to show why a certain behavior is occurring or may not be able to capture circumstances that non-numerical data provide. The purpose of the community diagnosis is to bring together these quantitative sources of data, also called secondary data, regarding community function, and qualitative data describing strengths, needs, and recommendations from service providers, community members, and community leaders. The qualitative aspect of the community diagnosis consists of interviews and focus groups with community members to provide a more personal or ethnographic approach to what is happening in the community. This qualitative or primary data is collected from residents who represent the many different segments of the community who may additionally identify with sub-groups within the community based on religion, educational status, social status, economic status, and geographic location in the community. Primary data examines community members’ thoughts and experiences to activate salient issues. It is important to note the limitations of using the secondary data presented in this document. A large portion of the available secondary data relied on 1990 U.S. census data and survey estimates that were at least five years old. As a result the available statistics may not reflect many changes that have occurred within the county, such as the rapid increase of the Hispanic/Latino population. Additionally, data regarding racial differences is presented dichotomously (“white” vs. “non-white”), and makes analysis of data in regards to the Hispanic/Latino population difficult. Lastly, statistics stratified by county make it difficult to assess more localized needs. Most prominent in the community diagnosis of Durham County is the concept of identity. In general, Durham residents do not identify themselves as county residents. Instead residents primarily identify themselves by their religious communities, local neighborhoods, schools, civic and political organizations, and by workplace. There are a great number of churches that have extensive histories in Durham and act as spiritual as well as social referents for community members. Within Durham County, there were examples of each definition of community. Attempting to address issues on the county level, it became apparent that there is a divide between perceptions of access to resources on a city level and access on a county level. While service providers noted that county services are available to rural residents, rural residents perceived their access to county services as limited. Although Durham County residents organize as several separate units to identify themselves, some common themes did emerge from our discussions. The most prominent theme was crime. Crime and its effects in an urban setting and within multiple segments of the county were brought forth. As a result, organization for larger community level change is being achieved through collaborations between neighborhoods, city officials, and county officials acting as Partners Against Crime (P.A.C.). However, residents noting the decrease in crime rates in the past year still consider crime as a top priority. It was also noted that community members residing in lower-income neighborhoods do not appear to benefit from this recent collaboration. As P.A.C. continues to grow and address crime and other issues of high priority to Durham County residents, hopefully members of lower-income neighborhoods will become more involved in this initiative and receive the benefits described by current P.A.C. members. The economy was often raised discussed during interviews and focus groups. Durham County is experiencing a booming economy, in part due to great many medical resources and technology industries. However, as job opportunities have become more technologically based and less factory and industry based, a substantial number of blue-collar jobs have been eliminated. The job prosperity available in Durham is beyond the reach of many former blue-collar workers and other residents without technical skills. Recommendations from community members imply continued support from community coalitions and suggest more training of technological skills to adult community members and in schools to meet the demands of the technological industry and the needs of Durham County residents. The Hispanic/Latino population has grown substantially and quickly in Durham County as well as the rest of the state. Understandably, there have not been adequate services and staff to address language barriers and special needs of this rapidly growing group. Several non-profit agencies have formed over the last few years to bridge this gap. On a policy level, supplemental or increased resources and staff allocations, and support and action from administrators are needed to bridge the language gap. The unmet language needs of the Latino population are likely to impact interaction between Latinos and non-Latinos in the county. In conclusion, throughout the 1999-2000 academic year, the Durham County Community Diagnosis Team’s glimpse into Durham County revealed a wealth of history, culture, knowledge, and skills. Additionally, Durham County represents several communities with a desire to increase their quality of life. Recommendations include acknowledging the needs of Durham County residents and focusing on the innate assets of Durham County residents in addressing these needs. Additionally, as a county, a multitude of resources and services are available to county residents yet are underutilized due to barriers of awareness and ease of accessibility. Increased efforts to make residents aware of existing community organizations and steps in accessing services will lead to more effective use of existing services and resources.Master of Public Healt