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Into the Archive - Health Needs Assessment Tool

23 October 2025

Population health is a way to understand health outcomes and disparities in a group of people. It examines how social, economic, and environmental factors impact health and identifies interventions or policies to improve health for all. Here at King’s, experts have been studying population health for over half a century. ‘Into the Archive’ aims to amplify experts, past and present, at King’s who have worked to revolutionise health and healthcare.

Acceptability and effectiveness of a structured health needs assessment tool by Professor Dame Sarah Cowley

The 2003 study looked at the use of a structured health needs assessment tool (HNA) by health visitors in London. Health visitors work with families and community groups to promote health and wellbeing of children.

Researchers interviewed 30 health visitors, observed 21 assessments, and further interviewed 19 clients. Researchers ensured that London’s multi-ethnic population was mirrored in the study participants.

The study was the first to consider the views of health visitors and their clients on the suitability of the tool. It revealed that while HNA helps with consistency and confidence to raise difficult questions, it can hinder relationship building.

There was no standardised procedure for health visitors to introduce the HNA, and visitors almost always used the tool as a “checklist” rather than its intended use as a guideline.

The researchers found that the most vulnerable clients seemed the least likely to have their health needs correctly identified through the HNA.

The tool appeared the encourage visitors to ask questions rather than to listen or respond to client’s expressed needs, which may end up discriminating and ignoring the vulnerability and complexity of client’s situation.

This qualitative study very importantly revealed that objectivity and consistency of health provision, originally intended to reduce health inequalities, may end up doing the opposite. Nowadays, it is standard practice for health visitors to instead use both structured assessment tools and conversational, open-ended methods to assess needs. Academics across King’s have continued to research health service inequities to inform policies through our close collaboration with the NHS and King’s Health Partners.” – Professor Irene Higginson OBE. Professor of Palliative Care & Policy, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care and Co-Director, King’s Population Health Institute