Journal of Preventive Medicine

Introduction
Attracting people’s participation in different parts of society is an important solution for development. The main task of each health system in the world is to solve the health problems of people. To achieve this goal, proper planning should be done to solve problems based on their priority by relying on available resources. In this regard, community health assessment is a process by which community members gain an understanding of the health concerns and the health care system by identifying, collecting, and disseminating information on the community’s strengths, resources, and needs. The final goal of the community health assessment is to promote the health of the community by promoting the healthy life of people, eliminating health problems, increasing the level of access to preventive services, protecting the general health of people, fostering positive and supportive living and working conditions in communities, and providing support to people to develop their talents and skills for achieving a healthy lifestyle. This survey aimed to identify and prioritize the problems of people in Choliche county in Chaharmahal and Bakhtiari province of Iran.

Methods
This cross-sectional study was conducted in the winter of 2021 in Choliche county, Farsan city, Chaharmahal and Bakhtiari province. The study was carried out in 8 stages based on the North Carolina community health assessment model, the first seven stages include identifying and prioritizing problems, and the eighth stage includes preparing an operational plan to solve the priority problems. In the first stage, the assessment team was established, including the working group, the consultant group, and the project supervisor. The second stage was the collection of primary data. At this stage, the assessment team collected the data directly by being among the people and completing 250 questionnaires and a focused group discussion with people visiting the comprehensive health service center in Choliche county. The third stage was the collection of secondary data from Chaharmahal and Bakhtiari Province’s Health Center, Farsan City’s Health Network, General Department of Forensic Medicine of Chaharmahal and Bakhtiari Province, Comprehensive health service center of Choliche county, Farsan City’s Education Department, and Farsan City’s General Welfare Department. In the fourth stage, the secondary data were combined and compared with the primary data; based on this, the assessment team found a comprehensive understanding of the major problems of Choliche county. In the fifth stage, the assessment team presented the results of the assessment to the community members. Then by using the nominal group technique, problems were ranked and prioritized. The sixth and seventh stages included preparing and publishing the community health assessment document.

Results
After removing the repeated concepts raised in different meetings, finally, 42 problems were identified in 6 areas: health, education and culture, economy and employment, social and civil rights, security, and urban services. Most of the problems (n=18) were related to health. Based on the meetings of the assessment team with the consultant group and paying attention to criteria such as the problem size, the problem consequences, ease of solving the problems, and the urgency of solving the problems, scoring was done for each problem using the nominal group technique. In this regard, drinking water pollution, economic problems, unemployment, and low knowledge of health issues were prioritized as the main problems of the region. The first-level priority problem was the problem of drinking water pollution due to the oldness and wear and tear of the water supply lines of Choliche and the occurrence of intermittent breaks in these pipes, followed by the leakage of sewage into the drinking water. The second-level priority problem was unemployment. Factors such as the change in people’s lifestyle, lack of agricultural water, improper planning and follow-up by officials to create jobs, and lack of knowledge and improper use of the city’s capacities can be involved in the high unemployment rate in this region.

Discussion
Ten priority problems of Choliche county include: Drinking water pollution, economic problems and unemployment, low knowledge of health issues, high prevalence of cancers, smoking (cigarettes and hookah), hypertension disease, inactivity, high-risk behaviors in teenagers, problems related to the use of virtual space in teenagers and young people, and inadequate consumption of fruits and vegetables. These problems are related to various cultural, social, educational, and health service areas. They are not limited to the health area; hence, Cross-sectoral collaboration, support from managers and officials, and active community participation are needed to solve them. Our study, in line with other community health assessment studies, identifies local issues in the community. We can improve health and achieve sustainable development in the region by solving these issues. It is suggested that community assessment be institutionalized as an organizational task in the country’s health system and that it should be done periodically and regularly; people should be involved as the key axis of this process, and should be informed about the assessments.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the ethics committee of Shahrekord University of Medical Sciences (Code: IR.SKUMS.REC.1402.040). Participation in the study was voluntary. Written informed consent to participate in the study was obtained from the participants.

Funding
This study was funded by Shahrekord University of Medical Sciences (Grant No.: 6699).

Authors' contributions
Data collection: Karim Hamid and Khadije Safi; Review: Zahra Karimi and Abdollah Mohammadian-Hafshejani; Data analysis and editing: Abdollah Mohammadian-Hafshejani; Design and writing: All authors.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgments
The authors would like to thank all participants in the study, Farsan county’s Health Center, Choliche county’s Comprehensive Health Service Center, and the Faculty of Health of Shahrekord University of Medical Sciences for their cooperation and support.

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