Phase 3: The Four Assessments

Each assessment will yield important information for improving community health, but the value of the four MAPP Assessments is multiplied by considering the findings as a whole. Disregarding any of the assessments will leave participants with an incomplete understanding of the factors that affect the local public health system and, ultimately, the health of the community.

What are the four MAPP Assessments?

The four MAPP Assessments—the third phase of MAPP—and the issues they address are described below:

The Community Themes and Strengths Assessment provides a deep understanding of the issues that residents feel are important by answering the questions: "What is important to our community?" "How is quality of life perceived in our community?" and "What assets do we have that can be used to improve community health?

Organizing the Assessment

  • Information Gathering Mechanisms Matrix: This matrix is designed to help MAPP teams compare the advantages and disadvantages of gathering data through community meetings, community dialogues, focus groups, and walking or windshield surveys.
  • Community Mapping Best Practices Brief: This four-page document provides an introduction to community mapping and includes information on community asset mapping, uses of mapping for youth development, and other forms of conceptual mapping including mapping public capital, cultural mapping, and community relationship mapping. This information is particularly relevant for planning approaches to the community themes and strengths assessment.
  • Asset-Based Community Development Introductory Article: This seven-page document introduces John P. Kretzmann and John L. McKnight's guidebook, "Building Communities from the Inside Out: A Path Toward Finding and Mobilizing a Community's Assets."  Kretzmann and McKnight describe the problems associated with needs mapping and present capacity-focused development as a more productive alternative for community building. Kretzmann and McKnight's guidebook describes a community building path that is asset-based, internally focused, and relationship-driven. This article will be particularly useful for planning and designing the community themes and strengths assessment.
  • Photovoice Manual: Photovoice is a participatory data gathering process which combines photography with grassroots social action. The process can be used by researchers to gain insight into how community members conceptualize their circumstances. Photovoice has three goals.  It enables people to record and reflect their community’s strengths and problems.  It promotes dialogue about important issues through group discussion and photographs.  Finally, it engages policymakers.
  • Handbook for Participatory Community Assessments: This handbook guides community partnerships through a series of steps for undergoing participatory community assessments. The handbook was developed by the Alameda County Public Health Department in California and includes vignettes of their experiences facilitating participatory community assessment processes.

Survey Instruments

  • Community Health Survey 2014: Developed by the East Central District Health Department, this survey is designed to help identify the most pressing health issues that can be addressed through community action.
  • Multiple Choice Survey Instrument (Extended): This five-page survey was created and used in Columbus, Ohio's MAPP process. The survey includes questions about quality of life, healthcare, environmental health, and traffic safety.
  • Community Health Survey Template: This two-page survey template will assist MAPP teams in gathering information about the community's perceptions of local public health.
  • Quality of Life Survey Questions: When posed to community members, this list of 12 questions will help MAPP teams assess the overall quality of life in their community.
  • Example Health Survey: This four-page survey created in Mendocino County is designed to gather information regarding community perceptions of local public health. The survey also asks questions about personal experiences interfacing with the local public health system.

Conducting the Assessments

  • Focus-Group Guidelines: Using the example of a Latino community in Columbus, these guidelines provide sample introduction and conclusion statements for the moderator, guide questions, and probe topics.

Survey Reports

  • Example Survey Analysis: This two-page document is an analysis of the community themes and strengths/quality of life survey results in Columbus, OH.
  • Example Final CTSA Report: This 64-page document is a compilation of all the information gathered from Sullivan County's CTSA surveys. The information is displayed in graph and table format. The report includes copies of the survey in English and Spanish as well as a description of how the survey was conducted.
  • Community Themes and Strengths Assessment Results Presentation: This 33-slide presentation is a clear and straightforward analysis of Apache County's (AZ) community themes and strengths assessment data. The information is broken down by question and topic, providing the audience with background information as well as an understanding of the next steps.


  • Linn County Iowa CTSA Boards: The community themes and strengths assessment seeks to obtain qualitative information on how community members perceive their health and quality of life concerns, as well as their knowledge of community resources and assets.

The Local Public Health System Assessment (LPHSA) focuses on all of the organizations and entities that contribute to the public''s health. The LPHSA answers the questions: "What are the components, activities, competencies, and capacities of our local public health system?" and "How are the Essential Services being provided to our community?"

Understanding the NPHPS

  • NPHPS Fact Sheet: This Web-based fact sheet provides background information on the National Public Health Performance Standards (NPHPS). This program developed the local instrument, also known as the Local Public Health System Assessment (LPHSA) in MAPP.
  • Ten Essential Services Flyer: This flyer produced in Oneida County, N.Y., lists the Ten Essential Public Health Services and provides information regarding the history and purpose of the services.
  • Ten Essential Services Poster: This brightly colored poster lists the Ten Essential Public Health Services and was designed to raise awareness of the services.

Getting Ready to Begin

  • Example Cover Letter to Health Department Staff: The Greenwich Department of Health sent this cover letter to staff members involved in an upcoming LPHSA meeting. The letter briefs the staff on what to expect and provides information regarding supplementary preparatory materials.
  • Example LPHSA Invitation Letter: Greenwich Department of Health (CT) sent this letter to potential public and private partners inviting them to participate in the LPHSA assessment. The letter explains the theory behind the process and provides meeting details.
  • Example LPHSA Meeting Agenda: This is a sample agenda from Greenwich Department of Health's LPHSA meeting. The agenda ties in specific essential services and includes breakout sessions for participants.
  • NPHPS Local Implementation Guide (Version 3.0): This guide is intended to provide NPHPS users with practical guidance, helpful tips, and sample tools for planning and implementing the performance standards assessments in local public health systems.

Orienting Your Partners

  • Example Assessment Process Presentation: This 10-slide PowerPoint presentation provides basic information on the assessment process, including motivation, purpose, and a discussion of the Ten Essential Public Health Services. This presentation is useful for familiarizing partners with the process and could be used to kick off an assessment meeting.
  • Essential Services Pre-Conference Worksheet: This two-page worksheet is a useful tool for group brainstorming prior to an assessment conference. The worksheet shows how the Greenwich MAPP team divided each health service into specific components important to their community and then listed examples within the community.

Conducting the Assessment

Organizing and Presenting the Data

  • National Public Health Performance Standards Results Report: This document, an initiative of the Greater Williamsburg community's local health department, the Peninsular Health District, provides a summary of results collected from conducting the NPHPS LPHSA. It is an example of an adaptation of a report automatically generated to suit the unique needs of a community. The NPHPS results report incorporates the qualitative discussion information that emerged from the assessment process. Please note, this was used for Version 2.0 and will need to be modified for Version 3.0

Evaluating the Process

  • LPHSA Feedback Form: This two-page survey can be used to evaluate the LPHSA process by gathering feedback from LPHSA committee participants.
  • LPHSA Worksheet: This Northern Kentucky worksheet can serve as a template for evaluating challenges and opportunities revealed by the LPHSA. Please note, this was used for Version 2.0 and will need to be modified for Version 3.0.
  • Process Evaluation Question Bank: These evaluation questions can be used for assessing your performance standards or MAPP process. These questions can help to develop an evaluation form to suit your needs.


  • Example NPHPS Position Statement: Produced by the Kentucky Public Health Association (KPHSA), this one-page position statement offers KPHSA's insights on the meaning and value of the NPHPS.
  • Sample Note-taking Sheet: This note taking template was used in Jackson, WY during their LPHSA meetings for participants to gather their thoughts at each assessment meeting.

The Community Health Status Assessment identifies priority community health and quality of life issues. Questions answered include: "How healthy are our residents?" and "What does the health status of our community look like?"

Designing and Disseminating Your Surveys

  • Example Survey for Community Members: The questions in this survey cover topics ranging from community demographics to quality of life. The survey is available in both English and Spanish.

Data Sources and Indicators

  • American Community Survey: The American Community Survey (ACS) provides data that help determine how more than $400 billion in federal and state funds are distributed each year. The ACS is conducted by the U.S. Census Bureau.
  • Center for Applied Research and Environmental Systems: The Center for Applied Research and Environmental Systems is an interdisciplinary center in Missouri that utilizes the latest technologies in geographic information systems, satellite imagery, environmental modeling, and the Internet to better understand human, natural resource, and environmental issues and problems.
  • Community Indicators Consortium (CIC) Project Database: The CIC Indicator Project database is a collection of health indicator projects from around the world. This database is a helpful resource for those interested in using indicators to improve community conditions and is meant to foster informed discussions about local, national, and global priorities.
  • County Health Rankings: The County Health Rankings is a collection of 50 reports – one per state – that helps community leaders see what factors contribute to how healthy we are and how long we live. The Robert Wood Johnson Foundation collaborated with the University of Wisconsin Population Health Institute to develop these rankings for each state's counties.
  • Healthy People 2020: Healthy People provides evidence-based, 10-year objectives for improving the health of all Americans. Healthy People 2020 establishes benchmarks for the next decade of health and monitors progress over time. Healthy People 2020 is a project of the U.S. Department of Health and Human Services.
  • National Center for Health Statistics: The National Center for Health Statistics' website contains a variety of data systems and surveys that help inform health status. The health statistics may be used to document the health status of a population, identify disparities, monitor trends, identify health problems, or evaluate the impact of health policies and programs. NCHS is part of the Centers for Disease Control and Prevention.
  • Webinar Series: Health Indicators: This four-part webinar series from the National Library of Medicine provides an overview of health indicators, an in-depth review of a county-level indicator project, practical approaches for using health indicator data to engage communities, and an exploration of several important new indicator efforts expected to be available in 2010.
  • Youth Risk Behavior Surveillance System: The Youth Risk Behavior Surveillance System (YRBSS) includes a national school-based survey conducted by CDC and state, territorial, tribal, and local surveys conducted by state, territorial, and local education and health agencies and tribal governments. The YRBSS monitors six types of health-risk behaviors that contribute to the leading causes of death and disability among youth and adults. More »

Compiling the Data

  • CHSA Core Indicator List: This 10-page document is designed to assist MAPP teams in recording their CHSA data. The worksheet is divided into five pages of data collection tables and five pages of information regarding core indicators.
  • CHSA Extended Indicator List: This five-page document builds on the CHSA core indicator list by providing an extended indicator list in a similar format.
  • Data Worksheets: This compilation of worksheets is designed to assist in collecting data in accordance with a broad range of health indicators. The worksheets can help MAPP teams identify important data sets and may also be a useful reference during other phases of the process. More »

Presenting the Data

  • Data Presentation Tip Sheet: This two-page tip sheet provides helpful hints for presenting data in both written reports and oral presentations.
  • Florida CHARTS Website: Visit the Florida Community Health Assessment Resource Tool Set (CHARTS) website to see how Florida has addressed coordinating community health data. The website presents local health statistics from throughout the state on interactive, county-level maps.


  • Collaborating through Community Health Assessment to Improve the Public's Health: This issue brief is a four page report describing the current state of community health assessment across the country and encourages continued and expanded collaborative work between local health departments, hospitals, and other partners. The report is divided into three sections: assessment, a systems-collaborative approach, and epidemiologic and community considerations. Resources for additional information are also provided.
  • NACCHO's Community Health Assessment and Health Reform Webpage:Provisions of the Affordable Care Act require each non-profit hospital facility in the United States to conduct a community health needs assessment and adopt an implementation strategy to meet identified community health needs. The Community Health Assessment and Health Reform webpage provides resources to help LHDs and non-profit hospitals conduct collaborative community health assessment and improvement processes.

The Forces of Change Assessment focuses on identifying forces such as legislation, technology, and other impending changes that affect the context in which the community and its public health system operate. This answers the questions: "What is occurring or might occur that affects the health of our community or the local public health system?" and "What specific threats or opportunities are generated by these occurrences?"

Conducting the Assessment

FOC Brainstorming Worksheet: This two-page worksheet defines forces of change and provides a space for assessment teams to brainstorm a list of forces relevant to their own community.

FOC Threats and Opportunities Worksheet: This one-page worksheet provides a space for assessment teams to think about the forces of change present in their community and list the threats and opportunities posed by these forces.

Summarize Your Findings

Example FOC Categories – Matrix: San Antonio's MAPP partnership developed this matrix to categorize forces of change. The matrix describes each force in terms of the event, factors, and trends. More »

Example FOC Summary – Matrix: This matrix, designed by Mendocino's MAPP partnership, shows the impact of the forces of change assessment on a community-specific and county-wide level.

  • Example Neighborhood Health Report: This 68-page report was created in Columbus, OH, to serve as a resource for partner organizations working together to identify and address the community's health priorities. The report provides a baseline for understanding the community's health status.
  • Example Assessment Data Report: Mendocino County put together this 37-page report of all health and demographic regional data collected throughout the assessment process. The analysis includes suggestions for the identified primary health concerns.
  • Example Four Assessments Summary Report: Northern Kentucky convened subcommittees to discuss each of the four assessments. From each subcommittee's discussion, a set of themes emerged. This five-page report reflects the themes that informed the Identify Strategic Issues phase of Northern Kentucky's MAPP process.
  • Handbook for Participatory Community Assessments: This handbook guides community partnerships through a series of steps for undergoing participatory community assessments. The handbook was developed by the Alameda County Public Health Department in California and includes vignettes of their experiences facilitating participatory community assessment processes. More »

  • The Life Course Metrics Project: This project is funded by the W.K. Kellogg Foundation. It is a project designed to identify and promote standardized set of indicators that can be applied to measure progress using the life course approach to improve maternal and child health.

Public Health Infrastructure

Phases 1 and 3 Online Training Module

This module from NACCHO helps you better plan and organize for success during the MAPP process.

Public Health Infrastructure

Phases 1 and 3 Online Training Module

Public Health Infrastructure

Phase 4: Identify Strategic Issues

Phase four of the MAPP program helps you identify strategic issues before continuing the process.

Public Health Infrastructure

Phase 4: Identify Strategic Issues