From a List of Needs to a Short List of Priorities: Applying the Hanlon Method and Community Voices to a County Health Needs Assessment
Student Name
RN to BSN Program, Aspen University
N493: Community Health II
Instructor Name
Month Day, Year
From a List of Needs to a Short List of Priorities: Applying the Hanlon Method and Community Voices to a County Health Needs Assessment
Every three years, nonprofit hospitals in the United States must complete a community health needs assessment and adopt a strategy to address the needs they identify, a requirement introduced by the Affordable Care Act. Health departments conduct similar assessments for their own planning. The hardest step is rarely collecting data; it is choosing which needs to act on first. This paper describes the purpose of prioritization, applies the Hanlon method to five needs identified in a composite county assessment, adjusts the result using what residents said, and reflects on the public health nurse's role in the process.
Why Prioritization Matters
Assessments vary widely in quality. A review of 95 community health needs assessment and implementation strategy reports from nonprofit hospitals in Texas found wide differences in approach and quality, and found that reports produced in collaboration with local health departments tended to be stronger (Pennel et al., 2015). Weak assessments often list many needs with no explanation of why some were chosen over others, which leaves the implementation plan unfocused and hard to evaluate.
Most assessments also rely heavily on quantitative data such as mortality and hospitalization rates. Those data show the size of a problem but not how residents experience it or what they believe would help. One hospital system addressed this gap by recording interviews with community members and analyzing them for themes, and found that residents wanted providers to treat culture as a health resource, to build community connections, and to be present in the community (Cain et al., 2017). Prioritization that ignores those voices risks choosing problems the data rank highly but the community has no energy to address.
The Hanlon Method
The Hanlon method is a widely used, structured way to rank health problems. Each problem is scored on three components, usually from 0 to 10: the size of the problem (A), its seriousness (B), and the effectiveness of available interventions (C). A basic priority rating is then calculated as (A + 2B) multiplied by C, divided by 3, so seriousness counts twice as much as size and a problem with no effective intervention scores low no matter how large it is. Problems are then screened with a feasibility test often called PEARL, for propriety, economics, acceptability, resources, and legality; a problem that fails any element is set aside or reconsidered (National Association of County and City Health Officials [NACCHO], n.d.). The method's strength is transparency: anyone can see why one problem ranked above another.
Applying the Method to a Composite County
The composite county in this example, about 95,000 residents, identified five needs in its most recent assessment: adult obesity, opioid overdose deaths, childhood asthma, limited access to mental health care, and low rates of colorectal cancer screening. A planning group of hospital, health department, and community members scored each need. Size reflects the share of residents affected, seriousness reflects death, disability, urgency, and economic impact, and effectiveness reflects the strength of evidence for interventions the partners could deliver. The scores are illustrative.
The table shows the results. Opioid overdose ranked first despite affecting fewer people than obesity, because of its seriousness and the availability of effective interventions such as naloxone distribution and access to medication for opioid use disorder. Colorectal cancer screening ranked second because screening is highly effective at reducing deaths. Obesity, the largest problem, ranked last, because the partners judged their ability to change it in three years to be limited.
| Health need | Size (A) | Seriousness (B) | Effectiveness (C) | Priority rating |
|---|---|---|---|---|
| Opioid overdose deaths | 4 | 10 | 8 | 64.0 |
| Colorectal cancer screening | 6 | 8 | 8 | 58.7 |
| Mental health care access | 7 | 8 | 6 | 46.0 |
| Childhood asthma | 4 | 6 | 7 | 37.3 |
| Adult obesity | 9 | 7 | 4 | 30.7 |
Adjusting the Ranking With Community Voices
The PEARL screen and the community input then changed the picture. All five needs passed the legal and propriety tests. Resources were a concern for colorectal screening, because the county's only gastroenterology practice has a long wait for colonoscopy, but the partners noted that stool-based screening tests can be mailed to patients and require no specialist, so the need remained on the list with a different strategy.
The community listening sessions produced the most important adjustment. Residents in two neighborhoods spoke repeatedly about mental health: long waits for counseling, stigma about seeking help, and young people struggling after the loss of peers to overdose. They saw overdose and mental health as one problem, not two. The planning group responded by combining the two top concerns into a single priority, preventing overdose deaths and improving access to mental health care, with shared strategies such as integrating counseling into the treatment program and training community members in naloxone use and mental health first aid. The final three priorities were substance use and mental health, colorectal cancer screening, and childhood asthma, with obesity addressed through existing partner programs rather than new investment.
The Public Health Nurse's Role
Nurses in public health contribute to prioritization in several ways. They bring clinical knowledge to judgments about seriousness and intervention effectiveness, such as knowing that mailed stool tests can raise screening rates where colonoscopy access is limited. They often have the relationships that make listening sessions work, because residents know them from clinics, schools, and home visits. They can also watch for equity, asking whether a need that affects a smaller, marginalized group is being overlooked because its size score is low. And once priorities are chosen, nurses are often the people who carry out the programs, so their involvement from the start makes implementation more realistic.
Conclusion
Prioritization turns a community health needs assessment into a plan. The Hanlon method provides a transparent way to weigh size, seriousness, and the effectiveness of interventions, and its feasibility screen tests whether a priority can actually be addressed. Numbers alone, however, can miss how residents experience their problems and how those problems connect. In the composite county, listening to residents joined overdose and mental health into one priority that the scoring had treated separately. The best prioritization combines a clear method with genuine community voice, and public health nurses are well placed to bring both.
References
Cain, C. L., Orionzi, D., O'Brien, M., & Trahan, L. (2017). The power of community voices for enhancing community health needs assessments. Health Promotion Practice, 18(3), 437-443. https://doi.org/10.1177/1524839916634404
National Association of County and City Health Officials. (n.d.). Guide to prioritization techniques. Retrieved from https://www.naccho.org/uploads/downloadable-resources/Gudie-to-Prioritization-Techniques.pdf
Pennel, C. L., McLeroy, K. R., Burdine, J. N., & Matarrita-Cascante, D. (2015). Nonprofit hospitals' approach to community health needs assessment. American Journal of Public Health, 105(3), e103-e113. https://doi.org/10.2105/AJPH.2014.302286
How this N 493 Module 2 example is structured
N493 covers comprehensive assessment of community risk factors and health problems, and in many sections the second module's written work turns to how an assessment is prioritized. Aspen does not publish module deliverables, so follow the prompt in your classroom. This example explains why prioritization matters with two studies, teaches the Hanlon method fully enough to reproduce, shows the scores in a table anyone can check, then adjusts the result with a feasibility screen and community listening, ending with the nurse's contributions.
N493 Module 2 questions, answered
What does N493 Module 2 usually ask for?
Early modules of N493 focus on comprehensive community assessment, and the written work commonly asks how community health needs are identified and prioritized, sometimes using a hospital or public health assessment toolkit. Aspen does not publish module deliverables, so your classroom's prompt sets the exact task.
How is the Hanlon basic priority rating calculated?
Score each problem from 0 to 10 for size (A), seriousness (B) and intervention effectiveness (C), then compute (A + 2B) times C, divided by 3. Screen the top problems with the PEARL test for propriety, economics, acceptability, resources and legality. The sample's table shows each calculation.
Why include community input if the scores already rank the needs?
Scores show the size and seriousness of problems but not how residents experience them or which efforts they will support. In the sample, residents linked overdose and mental health, which led the planners to combine two priorities, a result the scores alone would not have produced.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Aspen University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.