Community Health Needs Assessment 2018

10 Johnston County 2018 Community Health Needs AssessmentPageTable of Contents List of Figures 5 List of Tables 7 Executive Summary 8 Service Area 8 Methods for Identifying Co mmunity Health Needs 8 Secondary Data 8 Primary Data 8 Summary of Findings 8 Selected Priority Areas 9 Conclusion 9 Introduction 10 About Health ENC 10 Member Organizations 11 Steering Committee 12 HealthENCorg 13 Consultants 14 Johnston Health and Johnston County Public Health Department Collaborative 15 Community He alth Team Structure 15 Distribution 16 Evaluation of Progress Since Prior CHNA 17 Community Feedback on Prior CHNA 17 Methodology 18 Overview 18 Secondary Data Sources & Analysis 18 Heal th and Quality of Life Topic Areas 19 Health ENC Region Comparison 19 Primary Data Collection & Analysis 19 Community Survey 20 Focus Group Discussions 24 Data Conside rations 25 Prioritization Priority Ranking Process Methodology 26 Overview of Johnston County 27 About Johnston County 27 Demographic Prof ile 28 Population 28 Age and Gender 30 Birth Rate 32 Race Ethnicity 33 Tribal Distribution of Population 34 Military Population 35 Veteran Population 36 Socioeconomic Profil e 37 NC Department of Commerce Tier Designation 37 Income 37 Poverty 40 Housing 43 Food Insecurity 45 Employment 46 SocioNeeds Index 47 Educational Profile 49 Educational Attainment 49 High School Grad uation Rates 51 Cohort High School Graduation Rates 51 High School Dropouts 52 High School Suspen sion Rate 53PageEducational System 54 Transportation Profile 55 Crime and Safety 57 Violent Crime and Prop erty Crime 57 Juvenile Crime 59 Child Abuse 61 Incarceration 62 Access to Healthcare , In surance and Health Resources Information 63 Health Insurance 63 Civic Activity 65 Political Activity 65 Findings 67 Secondary Data Scoring Results 67 Primary Data 67 Community Survey 67 Focus Group Discussions 73 Data Synthesis 74 Topic Areas Examined in This Report 75 Navigation Within Each Topic 76 Heart Disease & Stroke 77 Key Issues 77 Secondary Data 77 Primary Data 78 Highly Impacted Populations 78 Access to Health Services 79 Key Issues 79 Secondary Data 79 Primary Data 80 Respiratory Diseases 81 Key Issues 81 Secondary Data 81 Primary Data 82 Highly Impacted Populations 82 Other Chronic Diseases 83 Key Issues 83 Secondary Data 83 Primary Data 83 Highly Impacted Populations 83 Transporta tion 84 Key Issues 84 Secondary Data 84 Primary Data 84 Highly Impacted Population s 85 Mortality 85 Other Significant Health Needs 86 Economy 86 Exercise , Nutrition & Weight 87 Social Environment 87 Substance Abuse 88 A Closer Look at Highly Impacted Populations 88 Disparities by Age , Gender and Race Ethnicity 89 Geographic Disparities 90 Conclusion 90 Appendix A Impact Since Prior CHNA 91 Appendix B Secondary Data Scoring O verview 104 Comparison Score 104 Indicator Score 104 Topic Score 104 Comparison Scores 105 Comparison to a Distribution of North Carolina Counties and US Counties 1 05PageComparison to North Carolina Value and US Value 105 Comparison to Healthy People 2020 and Healthy North Carolina 2020 Targets 106 Trend Over Time 106 Missing Values 106 Indicator Scoring 106 Topic Scoring 107 Age , Gender and Race Ethnicity Disparities 107 Topic Scoring Table 108 Indicator Scoring Table 109 Sources 124PagePage pageNumber5List of Figures Figure 1 Health ENC Online Data Platform 13 Figure 2 Secondary Data Scoring 18 Figure 3 Education of Community Survey Respondents - English 21 Figure 4 Education of Community Survey Resp ondents - Spanish 21 Figure 5 Employment Status of Community Survey Respondents - English 22 Figure 6 Employment Status of Community Survey Respondents - Spanish 23 Figure 7 Health Care Coverage of Community Survey Respondents - English 23 Figure 8 Health Care Coverage of Community Survey Respondents - Spanish 24 Figure 9 Total Population US Census Bureau 28 Figure 10 Population Density of Health ENC Counties US Census Bureau , 2010 29 Figure 11 Population by Age US Census Bureau , 2016 30 Figure 12 Population 18 + and 65 + US Census Bureau , 2016 31 Figure 13 Birth Rate North Carolina State Center for Health Statistics 32 Figure 14 Population by Race Ethnicity US Census Bureau , 2016 33 Figure 15 Population in Milit ary Armed Forces American Community Survey 35 Figure 16 Veteran Population American Community Survey , 2012 - 2016 36 Figure 17 Median Household Income American Community Survey , 2012 - 2016 37 Figure 18 Median Household Income of Health ENC Counties American Community Survey , 2012 - 2016 38 Figure 19 Median Household Income by Zip Code American Community Survey , 2012 - 2016 39 Figure 20 Peo ple Living Below Poverty Level American Community Survey , 2012 - 2016 40 Figure 21 Children Living Below Poverty Level American Community Survey , 2012 - 2016 41 Figure 22 People 65 + Living Below Poverty Level American Community Survey , 2012 - 2016 41 Figure 23 Persons with Disability Living in Poverty American Community Survey , 2012 - 2016 42 Figure 24 Mortgaged Owners Median Monthly Household Costs , Health ENC Counties American Community Survey 2012 - 2016 43 Figure 25 Severe Housing Problems County Health Rankings , 2010 - 2014 44 Figure 26 Households with Children Receiving SNAP American Community Survey , 2012 - 2016 45 Figure 27 SocioNeeds Index ® Conduent Healthy Communities Institute , 2018 47 Figu re 28 People 25 + with a High School Degree or Higher and Bachelor’s Degree or Higher American Community Survey , 2012 - 2016 49 Figure 2 9 People 25 + with a High School Degree or Higher by Zip Code American Community Survey , 2012 - 2016 50 Figure 30 5 - yr Cohort High School Graduation Rates 51 Figure 31 High School Dropout Rate North Carolina Department of Public Instruction 52 Figure 32 High School Suspension Rate North Carolina Department of Public Instruction 53 Figure 33 Allocation of Johnston County Public Schools 54 Figure 34 Mode of Commuting to Work American Community Survey , 2012 - 2016 55 Figure 35 Workers who Drive Alone to Work American Community Survey , 201 2 - 2016 56 Figure 36 Violent Crime Rate North Carolina Department of Justice 57 Figure 37 Property Crime Rate North Carolina Department of Justice 58 Figure 38 Juvenile Undisciplined Rate North Carolina Department of Public Safety 59 Figure 39 Juvenile Delinquent Rate North Carolina Department of Public Safety 60 Figure 40 Child Abuse Rate Management Assistance for Child Welfare , Work First , and Food & Nutrition Services in North Carolina & University of North Carolina a t Chapel Hill Jordan Institute for Families 61PagePage pageNumber6Figure 41 Incarceration Rate North Carolina Department of Public Safety 62 Figure 42 Persons with Health Insurance Small Area Health Insurance Estimates , 2016 63 Figure 43 Persons Only Receiving Health Insurance through Medicaid , Medicare or Military Healthcare American Community Survey , 2012 - 2016 64 Figure 44 Voting Age Population American Community Survey , 2012 - 2016 65 Figure 45 Voter Turnout in the Last Presidential Election North Carolina State Board of Elections , 2016 66 Figure 46 Top Quality of Life Issues , as Ranked by Survey Respondents 68 Figure 47 Level of Agreement Among Johnston County Re sidents in Response to Nine Statements about their Community - English 69 Figure 48 Level of Agreement Among Johnston County Residents in Response to Nine Statements about their Community - Spanish 69 Figure 49 Services Needing the Most Improvement , as Ranked by Survey Resp ondents - English 70 Figure 50 Services Needing the Most Improvement , as Ranked by Survey Respondents - Spanish 71 Figure 51 Health Behaviors that Residents Need More Information About , As Ranked by Survey Respondents - English 72 Figure 52 Health Behaviors that Residents Need More Information About , As Ranked by Survey Respondents - Spanish 73 Figure 53 Data Synthesis Results 75 Figure 54 Secondary Data Scoring Overview 104 Figure 55 Score Range 104 Figure 56 Comparisons used in Secondary Data Scoring 105 Figure 57 Compare to Distribution Indicator Gauge 105 Figure 58 Distribution of County Values 105 Figure 59 Comparison to Si ngle Value 105 Figure 60 Comparison to Target Value 106 Figure 61 Trend Over Time 106PagePage pageNumber7List of Tables Table 1 Significant Health Needs 9 Table 2 Health and Quality of Life Topic Areas 19 Table 3 Survey Respondents 20 Table 4 List of Focus Group Discussions 25 Table 5 Population by Gender and Age US Census Bureau , 2016 31 Table 6 Named Tribes in North Carolina American Community Survey , 2012 - 2016 34 Table 7 Top 25 Employers 46 Table 8 SocioNeeds Index ® Conduent Healthy Communities Institute , 2018 48 Table 9 List of Charter Schools , Private Schools , and Community Colleges 54 Table 10 Secondary Data Scoring Results by Topic Area 67 Table 11 Focus Group Results by Topic Are a 73 Table 12 Criteria for Identifying the Top Needs from each Data Source 74 Table 13 Topic Areas Examined In - Depth in this Report 75 Table 14 Description of Gauges and Icons used in Secondary Dara Scoring 76 Table 15 Data Scoring Results for Heart Dis ease & Stroke 77 Table 16 Data Scoring Results for Access to Health Services 79 Table 17 Data Scoring Results for Respiratory Diseases 81 Table 18 Data Scoring Results for Other Chronic Diseases 83 Table 19 Data Scoring Results for Transportation 84 Table 20 Leading Causes of Mortality 2014 - 2016 , CDC WONDER 86 Table 21 Indicators with Significant Race Ethnic , Age , or Gender Disparities 89 Table 22 Topic Scores for Johnston County 108 Table 23 Indicator Scores by Topic Area 109 Table 24 Indicator Sources and Corresponding Number Keys 124PagePage pageNumber8Executive Summary Johnston Count y is pleased to present it i s 2018 Community Health Needs Assessment This report provides an overview of the methods and process used to identify and prioritize significant health needs in Johnston County Service Area The service area for this report is defined as the geographical boundary of Johnston County , North Carolina Johnston County is located well inland from the coastal portion of the state and has an area of 796 square miles , of which 791 square miles is land and 42 square miles is water Methods for Identifying Community Health Needs Secondary Data Secondary data used for this assessment were collected and analyzed from Conduent HCI’s community indicator database The database , maintained by researchers and a nalysts at Conduent HCI , includes over 10 0 community indicators from various st ate and national data sources such as the North Carolina Department of Health and Human Services , the Centers for Disease Control and Prevention and the American Community Survey See Appe ndix B for a full list of data sources used Indicator values for Johnston County were compared to North Carolina counties and US counties to identify a relative need Other considerations in weighing relative areas of need included comparisons to North Carolina state values , comparisons to nationa l values , trends over time , Healthy Peo ple 2020 targets and Healthy North Carolina 2020 targets Based on these s even different comparisons , indicators were systematically ranked from high to low need For a de tailed methodology of the analytic methods use d to rank secondary data indicators see Appendix B Primary Data The primary data used in t his assessment consisted of a community survey distributed through onl ine and paper submissions and four focus group discussions Over 10 00 Johnston County residents contributed their input on the community’s health and health - related needs , barriers , and opportunities , with special focus on the needs of vulnerable and underserv ed populations See Appendix C for all primary data collection tools used in this assessment Summary of Findings The CHNA findings are drawn from an analysis of an extensive set of secondary data over 100 indicat ors from national and state data sources and in - depth primary data from community leaders , health and non - health professionals who serve the community at large , vulnerable populations , and popul ations with unmet health needs Through a synthesis of the pr imary and secondary data , the significant h ealth needs were determined for Johnston County and are displayed in Table 1 PagePage pageNumber9Table 1 Significant Health Needs A ccess to Health Services Economy Exercise , Nutrition & Weight Heart Disease & Stroke Other Chronic Diseases Respiratory Diseases Social Environment Substance Abuse Transportation Selected Priority Areas This well - established partnership to assess the community needs has allowed us to collaborate on the 2018 Community Health Needs Assessment and select the following focus areas as prioritized health needs 1 Access to Health Services 2 Mental Health Substance Abuse 3 Heart Disease & Stroke 4 Respiratory Diseases 5 Transportation Conclusion This report describes the process and findings of a comprehensive health needs assessment for the residents of Johnston County , North Carolina The prioritization of the identified significant health needs will guide community health improvement efforts of Johnston County Following this process , Johnston County will outline how they plan to address the prioritized health needs in their implementation plan Page0Introduction Johnston County is pleased to present the 2018 Community Health Needs Assessment , which provides an overview of the significant community health needs identified in Johnston County , North Carolina The goal of this report is to offer a meaningful understanding of the most pressing health needs across Johnston County , as well as to guide planning efforts to address those needs Special attention has been given to the needs of vulnerable populations , u nmet health needs or gaps in services , and input gathered from the community Findings from this report will be used to identify , develop and target initiatives to provide and connect community members with resources to improve the health challenges in their communities The 2018 Johnston County Community Health Needs Assessment was developed through a partnership between the Johnston County Public Health Department , Johnston Health , Health ENC and Conduent Healthy Communities I nst itute About Health ENC Initiated in 2015 by the Office of Health Access at the Brody School of Medicine at East Carolina University , Health ENC grew out of conversations with health care leaders about improving the community health needs assessment CHNA process in eastern North Carolina Health ENC , now a program of the Foundation for Health Leadership and Innovation FHLI , coordinates a regional CHNA in 33 counties of eastern North Carolina In addition , the Health ENC Program Manager works to build c oalitions and partnerships that will address health issues identified through the regional CHNA process As part of the Affordable Care Act , not for profit and government hospitals are required to conduct CHNAs every three years Similarly , local health de partments in North Carolina are required by the Division of Public Health DPH in the NC Department of Health and Human Services DHHS to conduct periodic community health assessments as well Local health departments have been required to submit their c ommunity health needs assessments once every four years The particular year CHNA submissions are made by hospitals within a three - year cycle or by local health departments within a four - year cycle is not uniform across the state or region Additionally , a lthough local health departments and hospitals have guidance from their respective oversight authorities on how to conduct and report the results of their CHNAs , that guidance allows for wide variations in the execution of these reports The methodologies , specific data items gathered , the interpretation of the data as well as the general approach and scope of one CHNA may have little resemblance to a CHNA in another jurisdiction or conducted by another organization For these reasons , health care leaders a cross eastern North Carolina have partnered to standardize the CHNA process for health departments and hospitals in the region This effort will also sync all participant organizations on to the same assessment cycle Combining efforts of local health depar tments and hospitals in a regional CHNA will ultimately lead to an improvement in the quality and utility of population health data , the ability to compare and contrast information and interventions across geographic boundaries , and the reduction of costs for everyone involved , while maintaining local control and decision - making with regard to the selection of health priorities and interventions chosen toPage1address those priorities Simultaneously , it will create opportunities for new and better ways to colla borate and partner with one another Upon receipt of generous funding support provided by The Duke Endowment , the Office of Health Access at ECU’s Brody School of Medicine transferred administrative and operational responsibility for Health ENC to the Foun dation for Health Leadership and Innovation in 2018 The project continues to be guided by a steering committee representing local health departments , hospitals and other stakeholders committed to improving the health of the people of eastern North Carolin a Member Organizations Health ENC is comprised of more than 40 organizations Twenty - two hospitals , twenty - one health departments and two health districts participated in the regional CHNA Partner Organizations ? Foundation for Health Leadership & Innovat ion ? ECU Brody School of Medicine ? The Duke Endowment Hospitals and Health Systems ? Cape Fear Valley Health Cape Fear Valley Medical Center , Hoke Hospital and Bladen County Hospital ? Carteret Health Care ? Halifax Regional Medical Center ? Johnston Health ? UNC Lenoir Health Care ? Nash Health Care System ? Onslow Memorial Hospital ? The Outer Banks Hospital ? Pender Memorial Hospital ? Sampson Regional Medical Center ? Sentara Albe marle Medical Center ? Vidant Beaufort Hospital ? Vidant Bertie Hospital ? Vidant Chowan Hospital ? Vi dant Duplin Hospital ? Vidant Edgecombe Hospital ? Vidant Medical Center ? Vidant Roanoke - Chowan Hospital ? Wayne UNC Health Care ? Wilson Medical Center Health Departments and Health Districts ? Albe marle Regional Health Services ? Beaufort County Health Department ? Bl aden County Health Department ? Carteret County Health DepartmentPage2? Cumberland County Health Department ? Dare County Department of Health and Human Services ? Duplin County Health Department ? Edgecombe County Health Department ? Franklin County Health Department ? Greene County Department of Public Health ? Halifax County Public Health System ? Hoke County Health Department ? Hyde County Health Department ? Johnston County Public Health Department ? Lenoir County Health Department ? Martin - Tyrrell - Washington District Health Dep artment ? Nash County Health Department ? Onslow County Health Department ? Pamlico County Health Department ? Pitt County Health Department ? Sampson County Health Department ? Wayne County Health Department ? Wilson County Health Department Steering Committee Health ENC is advised by a Steering Committee whose membership is comprised of health department and hospital representatives participating in the regional CHNA , as well as other health care stakeholders from eastern North Carolina The program manager oversees d aily operations of the regional community health needs assessment and Health ENC Health ENC Program Manager ? Will Broughton , MA , MPH , CPH - Foundation for Health Leadership & Innovation Health ENC Steering Committee Members ? Constance Hengel , RN , BSN , HNB - BC - Director , Community Programs and Development , UNC Lenoir Health Care ? James Madson , RN , MPH - Steering Committee Chair , Health Director , Beaufort County Health Department ? Battle Betts - Director , Albemarle Regional Health Services ? Caroline Doherty - Chief Development and Programs Officer , Roanoke Chowan Community Health Center ? Melissa Roupe , RN , MSN - Sr Administrator , Community Health Improvement , Vidant Health ? Davin Madden – Heath Director , Wayne County Health Department ? Angela Livingood – Pharmac y Manager , Pender Memorial Hospital ? Lorrie Basnight , MD , FAAP - Executive Director , Eastern AHEC , Associate Dean of CME , Brody School of Medicine ? Anne Thomas - President CEO , Foundation for Health Leadership & InnovationPage3HealthENCorg The Health ENC web platform , shown in Figure 1 , is a resource for the community heal th needs assessment process in e astern North Carolina The website serves as a “ living ” data platform , providing public access to indicator data that is c ontinuously updated , easy to understand and includes comparisons for context Much of the data used in this assessment is available on HealthENCorg and can be downloaded in multiple formats R esults of the 2018 Ea stern North Carolina Community Health Survey can be downloaded by county or the entire Health ENC Region In addition to indicator data , the website serves as a repository for local county reports , funding opportunities , 2 - 1 - 1 resources and more Health d epartments , hospital leaders and community health stakeholders in the 33 - county region are invited to use the website as a tool for community assessment , strategic planning , identifying best practices for improvement , collaboration and advocacy Visit HealthENCorg to learn more Figure 1 Health ENC Online Data PlatformPage4Consultants Health ENC commissioned Conduent Healthy Communities Institute HCI to assist with its Community Health Needs Assessment Conduent Healthy Communities Institute is a multi - disciplinary team of public health experts , including healthcare information tech nology veterans , academicians and former senior government officials , all committed to help ing health - influencing organizations be successful with their projects Conduent HCI uses collaborative approaches to improve community health and provides web - based information systems to public health , hospital and community development sectors , to help them assess population health Conduent H CI works with clients across 38 states to drive improved community health outcomes by assessing needs , developing focused strategies , identifying appropriate intervention programs , establishing progress monitoring systems , and implementing performance evaluation processes Working with diverse clients nationwide has contributed to Conduent HCI’s national knowledge base of pop ulation health solutions In addition , by engaging directly with clients and communities through the primary data collection process and final workshops , Conduent HCI works on behalf of our clients to build trust between and among organizations and their c ommunities To learn more about Conduent HCI , please visit https wwwconduentcom community - population - health Report authors from Conduent HCI Caroline Cahill , MPH Esther Chung L iora Fiksel Zachery Flores Courtney Kaczmarsky , MPH Cassandra Miller , MPH Cara WoodardPage5Johnston Health and Johnston County Public Health Department Collaborative Johnston Health and Johnston County Public Health Department are the lead agencies for the 2018 CHNA and partnered to develop this report Since opening the county’s first public hospital in 1951 , Johnston Health has grown into a two - campus health care sy stem delivering a broad range of medical and surgical services , from labor and delivery to home health and hospice Today , the system employs more than 1,600 at its hospitals in Smithfield and Clayton and has a medical staff of 320 physicians and specialis ts Johnston Health is recognized nationally for its safety and patient satisfaction Since joining UNC Health Care in 2014 , the two systems have worked together to reduce expense , expand clinical capabilities and to improve access to care Johnston Count y Public Health Department JCPHD was established in 1922 Its mission is to provide quality healthcare , promote a safe environment , and partner with the citizens of Johnston County to foster healthy lifestyles The health department has 140 employees a nd 5 service sites that provide clinical care , behavioral and environmental health , and WIC services to the residents of the county JCPHD provides more than 22,000 preventive health , 10,000 behavioral health , and 15,000 environmental health encounters ea ch year As the community convener , the health department partners with a variety of groups , including Johnston Health , our local hospital , other providers of care , community - based organizations , the Johnston County Faith Network , our schools , and senior centers Team members also serve on a diversity of boards and coalitions that provide the opportunity for sharing of information and gathering community input Through these partnerships and collaborations , the health department strives to meet its vision Healthy Johnstonians in All Communities In 1997 , the hospital and county government joined together to build a new public health department adjacent to the hospital’s new emergency department At the time , the partnership was called one of the first of its kind in the nation It has since led to greater efficiencies inpatient service and fostered easier communication and interaction among health care professionals This Community Health Needs Assessment is the result of our continued partnership and com mitment to improving the health of the people in our community Community Health Team Structure The Johnston County Public Health Department and Johnston Health partnered with previously established community groups to engage residents and collect data for this report These included the following Johnston County groups ? Crisis Collaborative ? Diabetes Collaborative ? Faith Network Collaborative ? Network on Aging ? Opioid Task Force ? Safety Net Collaborative ? Round Table ? Truancy Intervention Partnership ? School Health Advisory CommitteePage6The leads for the CHNA are ? April Culver , JH , VP Marketing , Communications , and Strategy ? Kimetha Fulwood , JCPHD , Health Education Supervisor ? Leah Johnson , JH , Corporate and Community Outreach Coordinator ? Marilyn Pearson , MD , JCPHD , Health Director Distribution An electronic copy of this report is available on HealthENCorg Th is report will be available at j ohnstonnccom health and j ohnstonhealthorg Paper copies will be distributed to local libraries and a copy can be obtained by contacting Kimetha Fulwood , Health Education Sup ervisor , JCPHD , at 919 - 989 - 5200 or health_dept @ johnstonnccom Page7Evaluation of Progress Since Prior CHNA The community health improvement process should be viewed as an iterative cycle An important piece of that cycle is revisiting the progres s made on priority health topics set forth in the preceding community health needs assessment Johnston Health conduct s a CHNA at least every 3 years and adopt s an implementation strategy to meet the community needs During the 2016 needs assessment , th e following areas of need were identified affordability accessibility ; cancer ; mental health suicide ; coronary heart disease ; diabetes ; and physician recruitment Johnston County Public Health Department is required to assess the needs of the communit y at least every 4 years and completed its most recent CHNA in 2014 The focus areas identified were access to care both medical and behavioral health , obesity , and physical activity and nutrition to address the prevention of chronic disease and to pro mote healthy behaviors Although each assessment was completed during a different time period , the areas of need were identical — accessibility , behavioral health , and chronic disease As we worked towards common goals , progress was made in multiple areas Johnston Health has and continues to recruit primary care and subspecialty providers , offers community screenings for cancer , has expanded cardiac services and the ER now offers telemedicine and tele - psychiatry Johnston County Public Health Department p recepts and works with community providers to mentor future providers of care , partnered with our schools and churches to implement worksite wellness , walking programs and healthy nutrition programs , developed health literacy workshops , and established an opioid task force that obtained a grant to provide education , resources , and support to those affected by substance use and mental health concerns A detailed table describing the strategies action steps and indicators of improvement for each priority ar ea can be found in Appendix A Community Feedback on Prior CHNA The 2016 Johnston Health Community Health Needs Assessment was made available to the public via https johnstonhealthorg community news - resources community - health - needs - assessment and the 2014 Johnston County Public Health Department Community Health Needs Assessment was available at wwwjohnstonnccom health Community members were invited to submit feedback via online forum or to contact the health department with any comments No comments had been received on the preceding CHNA s at t he time this report was writte n Page8Figure 2 Secondary Data Scoring Methodology Overview Two types of data are analyzed for this Community Health Needs Assessment secondary data and primary data Secondary data is data that has been collected from othe r sources while primary data has been collected directly as a part of this report Each type of data is analyzed using a un ique methodology , and findings are organized by health topic areas These findings are then synthesized for a comprehensive overview of the health needs in Johnston County Secondary Data Sources & Analysis The main source of the secondary data used for this assessment is HealthENCorg 1 , a web - based community health platform developed by Conduent Healthy Communities Institute The HealthENC dashboard brings non - biased data , local resources , and a wealth of information in one accessible , user - friendly location The secondary data analysis w as conducted using Conduent HCI’s data scoring tool , and the results are based on the 154 health and quality of life indicators that were queried on the HealthENC dashboard on July 18 , 2018 The data are primarily derived from stat e and national public data sources For each indicator on the platform , there exist several comparisons to assess Johnston Countys status , including how Johnston County compares to other communities , whether health targets have been met , and the trend of the indicator value over time 1 Health ENC is an online platform that provides access to health , economic and quality of life data , evidence - based programs , funding opportunities and other resources aimed at improving community health The platform is publicly available and can be acces sed at http wwwhealthencorg Conduent HCI ’ s data scoring t ool systematically summarize s multiple comparisons to rank indicators based on highest need Figure 2 For each indi cator , the Johnston County value is compared to a distribution of North Carolina and U S counties , state and national values , Healthy People 2020 targets , Healthy North Caroli na 2020 targets , and the trend over the four most recent time periods of measure Each indicator is then given a score based on the availabl e comparisons The scores range from 0 to 3 , where 0 indicates the best outcome and 3 indicates the worst outcome A vailability of each type of comparison varies by indicator and is dependent upon the data source , comparability with data collected from other communities , and changes in methodology over time The indica tors are grouped into topic areas for a higher - level ranking of community health needs Please see Appendix B for further details on the secondary data scoring methodology Page9Health and Quality of Life Topic Areas Table 2 shows the health and quality of life topic areas into which indicators are categorized These topic areas are broadly based on the Healthy People 2020 framework , with each topic area containi ng multiple indicators The five topic areas exhibiting the most significant need as evidenced by the secondary data analysis are included for in - depth exploration in the data findings Fo ur topic areas specific to population subgroups , including Children’s Health , Men’s Health , Women’s Health , and Older Adults & Aging , include indicators spanning a variety of topics I f a particula r subgroup receive s a high topic score , it is not highlighted independently as one of the top 5 findings , but is discu ssed within the narrative as it relates to highly impacted populations T hree additional categor ies County Health Rankings , Mortality Data , and Wellness & Lifestyle are not considered for in - depth exploration , since all three are general categories that include indicators spanning a wide variety of topics Topic areas with fewer than three indicators are considered to have data gap s and do not receive topic scores These topics are indicated by an asterisk in Table 2 Table 2 Health and Quality of Life Topic Areas Access to Health Services Family Planning Prevention & Safety Cancer Food Safety Public Safety Childrens Health Heart Disease & Stroke Respiratory Diseases County Health Rankings Immunizations & Infectious Diseases Social Environment Diabetes Maternal , Fetal & Infant Health Substance Abuse Disabilities Mens Health Teen & Adolescent Health Economy Mental Health & Mental Disorders Transportation Education Mortality Data Vision Environment Older Adults & Aging Wellness & Lifestyle Environmental & Occupational Health Other Chronic Diseases Womens Health Exercise , Nutrition , & Weight Oral Health Topic area has fewer than 3 indicators and is considered a data gap No topic score is provided Health ENC Region Comparison When available , county - level data are compared to the state of North Carolina , as well as Health ENC Counties The Health ENC regi on consists of 33 counties in e astern North Carolina participating in the regional CHNA Beaufort , Bertie , Bladen , Camden , Carteret , Chowan , Cumberland , Currituck , Dare , Du plin , Edgecombe , Franklin , Gates , Greene , Halifax , Hertford , Hoke , Hyde , Johnston , Lenoir , Martin , Nash , Onslow , Pamlico , Pasquotank , Pender , Perquimans , Pitt , Sampson , Tyrrell , Washington , Wayne and Wilson Values for the Health ENC region were calculated by aggregating data from these 33 counties Primary Data Collection & Analysis To expand upon the information gathered from the secondary data , Health ENC Counties collected community input Primary data used in this assessment consists of focus groups and both an English - language and Spa nish - language community survey Page0Community Survey Commun ity input was collected via a 57 - question online and paper survey available in both English and Spanish Survey Monkey was the tool used to distribute and collect responses for the community survey Completed paper surveys were entered into the Survey Monkey tool The community survey was distrib uted across Health ENC’s entire survey area from April 18 , 2018 – June 30 , 2018 Survey Distribution The survey was made available on line through email mailchimp , Facebook sponsored posts , the hospital and county health department websites , distributed electronically to partners , faith - based organizations , community organizations , governmental entities , and collaborative s Paper copies of the survey were provided at local festivals and to clinics and other groups with limited access to computers or the internet Table 3 summarizes the number of survey respondents A total of 18,917 responses w ere collected across all 33 counties , with a survey completion rate of 865 , resulting in 16,358 complete responses across the entire survey area A total of 1 , 363 responses were collected from Johnston County residents , with a survey completion rate of 845 , resulting in 1 , 151 complete responses from Johnston County The survey analysis included in this CHNA report is based on complete responses Table 3 Survey Respondents Number of Respondents Service Area English Survey Spanish Survey Total All Health ENC Counties 15,917 441 16,358 Johnston County 1054 97 1151 Based on complete responses Survey participants were asked a range of questions related - but not limited - to what populations are most negatively affected by poor health outcomes in Johnston County , what their personal health challenges are , and what the most critical health needs are for Johnston County Demographics of Survey Respondents The following charts and graphs illustrate Johnston County demographics of the community survey respondents Among Johnston Coun ty survey participants , 522 of the English survey respondents were over the age of 50 , with the highest concentration of respondents 1 19 grouped into the 4 5 - 4 9 age group Spanish survey respondents were younger with most under the age of 40 447 The majority of respondents for both surveys were female 75 7 English , 833 Spanish 811 of the English survey respondents identified as white , 143 identified as Black and 9 14 identified as non - Hispanic , while 5 66 of Spanish survey respondents identified as white and 382 identified as other race Spanish survey participants also identified as either Mexican 4 95 or other Hispanic Latino 398 English is the primary language spoken at home for English survey participants 9 57 while Sp anish survey participants primarily do not speak English at home 8 59 Page1284 258 219 146 70 14 08 00 0 5 10 15 20 25 30 462 231 192 77 38 00 00 00 0 5 10 15 20 25 30 35 40 45 50 English survey respondents held higher levels of education than Spanish respondents , with the highest share of respondents 2 84 having a bachelor’s degree and the next highest share of respondents 2 58 having a g raduate or professional degree Figure 3 and Figure 4 Comparatively , Spanish respondents had less than a 9 th grade education 462 or had graduate d from high school 231 Figure 3 Education of Community Survey Respondents - English Figure 4 Education of Community Survey Respondents - SpanishPage2754 120 70 31 28 17 11 11 00 00 0 10 20 30 40 50 60 70 80 As shown in Figure 5 and Figure 6 , approximately three - quarters of English respondents were employed full - time 7 5 4 Nearly half of Spanish respondents were employed full time 462 and about half were homemakers The average household size was 28 individuals in the English survey compared to 4 3 individuals in the Spanish survey The majority of Spanish survey respondents household income before taxes was less than 34,999 872 English survey respondents household income was greater than 35,000 before taxes , with the highest concentration of respondents household income above 100,000 188 Figure 5 Employment Status of Community Survey Respondents - EnglishPage3500 462 38 38 00 00 00 00 00 00 0 10 20 30 40 50 60 732 130 87 59 45 31 17 14 14 03 0 10 20 30 40 50 60 70 80 Figure 6 Employment Status of Community Survey Respondents - Spanish Figure 7 and Figure 8 show the health insurance coverage of community surve y respondents Most English survey respondents have health insurance provided by their employer 732 or Medicare 1 30 and 14 have no health insurance of any kind 542 of Spanish survey respondents reported having no insurance of any kind and 250 have insurance through their employer Figure 7 Health Care Coverage of Community Survey Respondents - EnglishPage4542 250 42 42 42 42 42 00 00 00 0 10 20 30 40 50 60 Figure 8 Health Care Coverage of Community Survey Respondents - Spanish Overall , th e community survey participant population deviates greatly across the English and Spanish surveys for education , income , individuals in the home and insurance coverage The survey was a convenience sample survey , and thus the results may not representative of the community population as a whole Key findings from select questions on the community survey are integrated into this report by theme or topic area , with an emphasis on the most significant needs as evidenced by both primary and secondary data Thi s approach is intended to offer a meaningful understanding of health needs A summary of full survey results all 57 questions is available on HealthENCorg Full results can be downloaded by county or for the ent ire Health ENC Region Focus Group Discussions Another form of community input was collected through focus groups Focus groups are carefully constructed dialogues that invite diverse groups of people to discuss important and pressing issues Focus grou ps provide community members an opportunity to engage in productive learning and sharing sessions Focus group discussions focused on community strengths , opport unities for improvement , existing resources , health needs , and possible solutions for improving t he health of Johnston County The