What To Do

Now that you have described the problem and the subgroups, you will need to write a new problem statement for any subgroup that you plan to address.

These new statements clearly state the difference between what is expected and what is observed for each subgroup.

For example, if your original problem statement indicated that a particular city has been experiencing a higher than expected rate of cardiovascular heart disease among men ages 45-55, further analysis may reveal that this unexpectedly high rate was largely accounted for by four subgroups:

• cigarette smokers,
  
• overweight individuals,
  
• inactive individuals (those failing to engage in at least moderate physical activity), and
  
• individuals having a total cholesterol higher than 260.

After considering many factors, including program goals or official mandates, you may decide to focus your attention on three subgroups:

• the overweight group,
  
• the inactive group, and
  
• the group with high cholesterol levels.

You will now write three new problem statements that state the "gap" between what is expected and what is observed according to health status indicators.

As in your first general statement, your new problem statements should answer some important questions:

• What should be happening?
  
• What is happening?
  
• What will or could happen if the problem is not addressed?

How To Do It

Write a problem statement for each subgroup.

As explained in Step 1.1, there are many ways to describe the difference between what is expected and what is observed using the following health indicators:

• death rate (mortality)
  
• disease rate (morbidity)
  
• disability rates
  
• biological risk factors
  
• psychological risks factors
  
• social risk factors
  
• environmental risk factors

As with the broader problem statement, you can find data that will give you an idea of what the experts and the community find acceptable. Some places to look for this information are:

• Vital records
  
• Hospital records
  
• Primary care records
  
• Reportable disease statistics
  
• Accident reports
  
• Data registries (for example, birth and death registry data)
  
• Surveillance systems
  
• Reports and surveys
  
• Results of situation analyses
  
• Summaries of collected data
  
• Interviews
  
• Questionnaires and focus group discussions
  

Do not forget primary information gathering tools found in the Tools for Research section.

Most of the data sources listed above can be accessed through these sites or organizations:

• Centers for Disease Control and Prevention (http://www.cdc.gov)
  
  
  • National Center for Health Statistics (http://www.cdc.gov/nchs/)
    
  • Behavioral Risk Factor Surveillance System (http://www.cdc.gov/brfss/)
    
  • Morbidity and Mortality Weekly Report (http://www.cdc.gov/mmwr/)
    
    
• National Institutes of Health (http://www.nih.gov)
  
  
• State and local health departments (See Resources)

When you completed this step, you should have an idea of how the problem has affected the various subgroups you identified in the previous step.