On the advice of a marketing consultant, a network of faith-based clinics opened a new clinic in a low-income community. This community had once received widespread acclaim for its level of home ownership, the stability of its households, and the achievements of its residents. After one year of operation, the clinic still was not receiving the support it expected from the local community. Area residents were not taking advantage of the services offered by the clinic, even though demand clearly existed. The network’s marketing department designed and sent a sample survey to 200 of the community’s 3,000 households. It conducted in-depth interviews with key informants, who either lived in the area or had a long history of working with its residents. It facilitated focus groups and carried out observational research—all involving local residents.

Findings from the sample survey essentially reinforced the results of the previous market analysis: Respondents reported a high level of morbidity (particularly chronic diseases), a high level of psychiatric morbidity and substance abuse, and a low level of treatment or medical intervention. In addition, more health problems and greater unmet needs were revealed than anticipated.

Observational research added critical layers of information. While the community had a high rate of home ownership, it also had many empty, dilapidated, or abandoned single-family dwellings; trash-filled vacant lots; and crumbling buildings (including the low-rated elementary and high schools). Furthermore, residents had little or no social interaction, even among neighbors. Few adults walked and talked on the streets, and few children played outside. The sight of residents sitting on their porches or working in their yards was rare. Even vehicular traffic was light. The churches that dotted every corner had low attendance and did little community outreach. Many grocery stores and restaurants had boarded up their doors and moved out, creating a “food desert.”

The in-depth interviews and focus groups helped qualify the findings from the sample survey and observations. The observed social dysfunctions were primarily rooted in the decline of the quality of housing, which encouraged detachment from the community. Longtime residents felt marginalized, isolated from their neighbors, and afraid to leave their homes. The community’s educational system, once the pride of the neighborhood, faltered partly as a result of young families leaving the area.

Questions 

1. What factors suggested to the network of clinics that in-depth research (a “deep dive”) was required to understand the community’s characteristics?

2. Why were both quantitative research and qualitative research needed to get to the bottom of the issues facing the community?

3. How were observation, personal interviews, and focus groups used to gather information?

4. Why did the marketing researchers conclude that health problems were “symptoms” rather than the root of the environmental conditions of the community?

5. Why did community residents place a low priority on their health?