Using focus groups in a health impact assessment to understand social factors influencing health

Background: Health impact assessments (HIAs) are increasingly used in the United States to help determine the health effects of political decisions a priori. HIAs often synthesize data from many sources to estimate health impacts, but in some cases—particularly when dealing with social factors that affect health, such as neighborhood cohesion—no data set exists. This study describes how qualitative methods were used in an HIA to assess health impacts and make recommendations for the future siting of public housing across Galveston, Texas, following Hurricane Ike. Methods: Focus groups were conducted with individuals using Housing Choice Vouchers (HCVs) in the city of Galveston. Each group was selected from different geographic areas varying on poverty level and racial composition. After a group mapping exercise, the groups discussed what made their respective neighborhoods healthy or unhealthy, focusing specifically on social interactions. Results: Focus group participants described a wide variety of both positive and negative social interactions in their neighborhoods that they saw as critical to health. Several unexpected findings on how social factors were perceived as health-affecting emerged, including the role of informal neighborhood leaders; potential reasons for areas of high violence; interactions between youth and older residents; and the often mixed effects of living near key city attractions or low-income apartment complexes. Residents also provided valuable “ground truthing” insights on indicators used elsewhere in the HIA to estimate health impacts. Discussion: While HIAs can use existing data sets to measure critical potential health impacts of planned actions, data for important social impacts may not be available. Qualitative methods, such as in-depth interviews and focus groups, help fill this gap and provide information on hard-to-reach populations or concepts. Qualitative methods are a valuable option to create a more comprehensive understanding of health impacts.