HLTH 5483 Module 1 Needs Assessment Report Example

Stiff Knees, Missing Steps: A Needs Assessment for Arthritis-Friendly Physical Activity Among Older Adults Served by a County Senior Center Network

Student Name

American College of Education

HLTH5483: Health and Wellness Program Assessment and Evaluation

Module 1 Assignment

Instructor Name

October 5, 2026

Purpose

A composite county's department of aging runs five senior centers serving about 6,000 adults aged 55 and older. Center directors have noticed that many members attend meals and card games but avoid exercise classes, often citing knee pain. Before investing in a new program, the department asked its health educator to conduct a needs assessment: to determine how many members live with arthritis, how it affects their activity, what they want and what already exists. This paper reports the assessment's purpose, methods, findings and priorities. It follows the general approach described by Altschuld and Kumar (2010), who defined a need as a gap between the current state and a desired state and emphasized using several sources of data and involving stakeholders in setting priorities.

The Desired State

A needs assessment requires a standard against which to measure the current state, and for physical activity the obvious standard is the federal guidance. Its weekly target for adults is a total of 150 minutes or more of activity that raises breathing and heart rate, with muscle work added on at least two days; older adults are asked to include activities that challenge balance, and people whose chronic conditions make the full amount unrealistic are encouraged to do whatever their bodies allow (Piercy et al., 2018). The same guidance notes that regular activity can ease pain and improve function for people with osteoarthritis. The desired state for this assessment, then, is that older adults with arthritis move regularly in ways that suit their joints.

National and County Data

Arthritis is common and disabling. Drawing on three years of the National Health Interview Survey, Fallon et al. (2023) estimated that roughly one American adult in five, more than 53 million people in all, carried a clinician's diagnosis of arthritis, that prevalence was higher among women than men and that adults aged 45 and older made up 88.3% of those affected; arthritis was also common among adults with heart disease, diabetes and other chronic conditions. County estimates drawn from the state's behavioral risk factor survey show that about half of residents aged 65 and older report diagnosed arthritis and that many report that arthritis limits their usual activities. The county's older population is growing, as it is in many suburban counties.

Methods

The assessment used four methods. First, secondary data from national and state surveys and the county's aging plan described the population. Second, a one-page survey was offered to members at all five centers over three weeks, in English and Spanish, with large print and volunteer help for those who needed it; 412 members completed it. It asked about diagnosed arthritis, joint pain, weekly activity, barriers and interest in different types of programs. Third, five focus groups, one at each center, brought together 38 members with arthritis to discuss their experiences and preferences. Fourth, the health educator interviewed six key informants: two primary care physicians, a physical therapist, a rheumatology nurse, a senior center director and a representative of the county's parks and recreation department. An inventory listed existing activity programs in the county, their cost, location and suitability for people with joint pain.

Findings

Survey results showed that 57% of respondents reported diagnosed arthritis, most often in the knees, and that 44% said joint pain limited their activity. Among respondents with arthritis, only 19% reported meeting the aerobic activity recommendation, compared with 34% of those without arthritis, and 62% said they had avoided an exercise class because they feared it would hurt. Respondents with arthritis most often chose tai chi, water exercise and walking groups as programs they would join. Focus group members described fear of making their knees worse, embarrassment about keeping up with others, difficulty getting down to and up from the floor and cost as barriers. They wanted gentle, slow classes led by instructors who understood arthritis, close to home and free or low cost.

Key informants confirmed that many older patients with knee osteoarthritis are told to exercise but receive little guidance. The physical therapist noted that insurance limits the number of therapy visits, leaving patients without ongoing support. The inventory found that the county's only warm-water pool charges a fee and is far from two of the centers, that existing exercise classes at the centers are general fitness classes not adapted for arthritis and that no evidence-based arthritis program is offered.

The Gap and Its Causes

Comparing the current state with the desired state reveals a clear gap: most center members with arthritis are far less active than national guidance recommends, and fear of pain, lack of suitable programs, cost and distance keep them from closing it. The gap is not caused by lack of interest; members expressed clear preferences for gentle programs. It is caused mainly by the absence of accessible, arthritis-appropriate options and by uncertainty about what is safe.

Differences Within the Population

Averages can hide groups with greater need, so the assessment looked at differences within the membership. Members aged 75 and older reported more pain-related limits and lower activity than those aged 55 to 74, and they were more likely to rely on others for transportation. Women made up about two thirds of respondents with arthritis, consistent with national patterns, but the few men who took part described more reluctance to join group classes they saw as intended for women. Spanish-speaking members, concentrated at one center, reported similar arthritis rates but much lower awareness of any exercise options and a strong preference for classes taught in Spanish. Members who lived alone were less active than those who lived with a spouse or family, and several said a class would also offer company. Members with lower incomes, identified by their participation in the centers' subsidized meal program, cited cost as a barrier more often. These differences suggest that a new program should offer at least one class in Spanish, arrange transportation for older members, keep costs at zero and be promoted in ways that invite men as well as women.

Priorities

With a stakeholder group of center directors, three members with arthritis and the physical therapist, the health educator ranked possible responses using four criteria: size of the need, strength of evidence, feasibility for the centers and members' preferences. An evidence-based tai chi program ranked highest. In a randomized trial of adults with knee osteoarthritis, Wang et al. (2016) found that 12 weeks of tai chi reduced pain and improved function about as much as standard physical therapy, with benefits maintained up to a year and greater improvements in depression and physical quality of life. Tai chi can be taught standing, requires no equipment, fits the centers' rooms and matches members' stated interest. Water exercise ranked second but was limited by pool access; walking groups ranked third and could complement tai chi. The department therefore decided to pilot a twice-weekly tai chi program at two centers, with walking groups at all five, and to evaluate the pilot carefully before expanding.

Limitations and Next Steps

The assessment has limits. The survey reached members who attend centers, not older adults who stay home, who may have greater needs. Self-reported activity is often overestimated. The focus groups included more women than men, reflecting center membership. Despite these limits, the consistency of findings across methods gives confidence in the main conclusions. The next module will build a logic model for the tai chi program, making explicit how its activities are expected to lead to outcomes, which will guide the evaluation design.

References

Altschuld, J. W., & Kumar, D. D. (2010). Needs assessment: An overview (Vol. 1). SAGE Publications.

Fallon, E. A., Boring, M. A., Foster, A. L., Stowe, E. W., Lites, T. D., Odom, E. L., & Seth, P. (2023). Prevalence of diagnosed arthritis: United States, 2019-2021. MMWR. Morbidity and Mortality Weekly Report, 72(41), 1101-1107. https://doi.org/10.15585/mmwr.mm7241a1

Piercy, K. L., Troiano, R. P., Ballard, R. M., Carlson, S. A., Fulton, J. E., Galuska, D. A., George, S. M., & Olson, R. D. (2018). The Physical Activity Guidelines for Americans. JAMA, 320(19), 2020-2028. https://doi.org/10.1001/jama.2018.14854

Wang, C., Schmid, C. H., Iversen, M. D., Harvey, W. F., Fielding, R. A., Driban, J. B., Price, L. L., Wong, J. B., Reid, K. F., Rones, R., & McAlindon, T. (2016). Comparative effectiveness of tai chi versus physical therapy for knee osteoarthritis: A randomized trial. Annals of Internal Medicine, 165(2), 77-86. https://doi.org/10.7326/M15-2143