Better Understanding for Better Health – 2024 Community Health Needs Assessment (CHNA) for Taylor-Massey Oakridge
Project Overview
Access Alliance Multicultural Health and Community Services (Access Alliance) conducts a Community Health Needs Assessment (CHNA) in the immediate neighbourhood every five years to identify the community’s strengths, assets, concerns, and priority service needs. A CHNA serves as a foundational tool for community development. This helps us understand the programs and services needed.
A CHNA gives us, as service providers, an opportunity to engage with communities and involve community stakeholders. It also provides recommendations for different community actors.
At the individual level, a CHNA empowers communities to take action to address health disparities. At the organizational and community level it strengthens partnerships and provides information about changing needs that influence program and service changes. This promotes sustainable initiatives that lead to improved health and well-being for all residents. At the systems and policy level, it helps to reframe policy and practice guidelines based on real evidence from grassroots community research.
Recently we completed a CHNA in the Taylor-Massey Oakridge (TMO) neighbourhood of Toronto in 2023-2024.
Taylor-Massey and Oakridge neighbourhoods are culturally diverse and vibrant communities located in Toronto’s east end. These neighbourhoods are designated ‘Neighbourhood Improvement Areas’ as part of the City of Toronto’s Strong Neighbourhood Strategy. On average, these neighbourhoods have lower incomes, higher unemployment, and more recent immigrants compared to Toronto overall.
Access Alliance provides health and other community services to these communities who navigate the challenges they face with resiliency and strength. Our vision is for Toronto’s diverse communities to achieve health with dignity.
Our Goals and Methods
This CHNA adopted a mixed-methods sequential approach to collect quantitative and qualitative data from the TMO community and their service providers. The CHNA is carried out with residents in the communities and not just our client population. An advisory committee and local community partner organizations supported the initiative at all stages starting from the planning process through data collection and overall implementation of the CHNA. Peer researchers (residents of the TMO community) supported data collection as Community Health Ambassadors (CHAs).
An updated Neighbourhood Profile was developed to understand TMO’s demographic and socioeconomic makeup, including an overview of the community’s health status and well-being.
The CHNA survey used a standardized well-being measurement tool based on the Canadian Index of Wellbeing. Given the context of the COVID-19 pandemic and its effects on mental health, the survey also included the Patient Health Questionnaire (PHQ-9). The PHQ-9 is a validated, standardized self-administered measure of depression severity.
The team collected responses using the Be-Well Survey and PHQ-9 tools which were available in English and six other languages. 433 survey responses were collected from TMO residents.
Based on the findings of the survey data qualitative focus group guides were developed to explore key concepts of health and well-being in more detail. We held focus groups with 19 youth, 10 working-age adults, 9 older adults, and 8 service providers. We analyzed data thematically.
What We Found/What We Learned
TMO residents have a strong sense of belonging. They also face significant challenges related to housing affordability, adequate employment, and access to affordable and healthy food. Residents also encounter barriers to accessing physical and mental health care and affordable dental care services.
Local Community Health Centres and community organizations can support the TMO community by expanding access to necessary services, facilitating service connections, and collectively advocating to address structural issues related to the cost of living, secure employment, and accessible healthcare.
Strengths and Assets
Survey and focus group findings revealed that the TMO community’s most significant strength and asset is a strong sense of belonging, as described by the feeling of connection, mutual respect, and inclusion in the community.
Additionally, residents expressed appreciation for the accessibility of amenities like shops and services, the tranquillity and cleanliness of their community, and the abundance of green spaces and parks, all of which contribute to the overall quality of life in the TMO community.
Community Concerns and Priority Service Needs
TMO community residents identified these concerns and service needs as most:
- Housing affordability was the top concern among TMO residents, particularly for those under 65. Housing support services are cited as highly needed.
- Finding a good job was a significant community concern, especially for new immigrants whose prior credentials and experience are not recognized. Employment support services were rated as the most highly needed service among 25-44-year-olds and for residents of Oakridge.
- Community safety was a significant community issue, especially for those 65 and older and for residents of Taylor-Massey. Residents noted a perceived decline in safety, particularly in the aftermath of the COVID-19 pandemic.
- Healthcare services are a notable concern, particularly for residents of Oakridge. Affordable dental care and the availability of primary care and mental health services were cited as high needs. Mental health was a particularly high concern for youth, transgender residents, and recent immigrants. Residents reported a decline in the accessibility of primary care and emergency services during and since the COVID-19 pandemic.
- Access to affordable and healthy food is also of high concern and free or low-cost food programs are of high service need. A number of residents, particularly in the 45-64 age group, and particularly for residents of Oakridge, reported reducing their food intake due to their inability to afford food and other costs of living (e.g. rent). With many eating less because they do not have enough money to buy food.
Benefits and Uses of the CHNA Findings
The Community Concerns vs. High Service Needs Matrix is a useful tool that indicates issues of highest concern and expressed service needs in the TMO neighbourhoods. It is important to note that these factors are on a continuum and individuals report their needs and concerns based on their life experience and self-identified ideas. Items listed as low service needs or concerns do not negate them as potential or actual issues affecting residents in these neighbourhoods.
When interpreting this data, it is important to consider that the ranking of issues can be impacted by broader systemic issues and stigmas such as those surrounding individuals who are immigrants or newcomers, those affected by poverty, addiction, members of the 2SLGBTQI+, etc.
We have recommendations for using community health needs assessments all levels of actors and community stakeholders:
Systems & Policy – Building Healthy Public Policy
- Decrease siloed healthcare and move towards intersectoral holistic healthcare
- Contribute to fostering a Community of Practice with equity-deserving neighbourhoods
- Leverage resources and funding on evidence-informed community needs
- Reframe policy and practice guidelines based on real evidence from grassroots
Organizational & Community Level – Community action and supporting funding for healthcare and other services
- Build staff capacity in a sequential complex model of outcome harvesting
- Update their programs and train their service provider to support changing needs
- Create a collaborative ecosystem for working together for these communities
- Use the updated Neighbourhood Profile to better understand the community
Individual Level – Creating supportive environments & developing personal skills
- Identify the barriers or challenges of individuals in the community
- Explore hidden strengths and assets of the community
- Understand the needs of the community (felt and actual) and desired actions for change and advocacy
Community Validation Sessions
Residents of TMO: We hosted a gathering with clients and community members to share the findings and hear more about their insights. The discussion identified that residents of the Taylor-Massey and Oakridge Neighbourhoods resonate with the findings. They echoed their observations regarding the strengths and assets, key concerns, and priority service needs in the community.
Residents also shared their perspectives on the importance of improved and greater funding at the community level to support access to resources for daily living and overall health and wellness needs. This included access to family Doctors and allied health (diagnostic, preventive, therapeutic, and rehabilitative services), employment, settlement, and community programs and services for different populations. They stressed the current day-to-day difficulties in having basic needs met such as securities for rent, food, and income.
Advisory Committee and Community Organization Partners: Advisory Committee members and staff of Community Organization Partners reflected that the report is accurate based on their service provision experiences. While they found the findings presented representative of assets and challenges faced by community members, one partner highlighted an observation they found surprising. They referred to a demonstrated shift in stigma around mental health. Those who do not necessarily need mental health support would like access to it. They also indicated that we are seeing ‘third-world’ problems in a ‘first-world country.
They reported the findings will be helpful in targeting their work and efforts more appropriately and in many areas, particularly programs/services, funding applications, and advocacy efforts.
Project Updates and Knowledge Mobilization Activities & Products
Download the 2023-2024 Taylor-Massey Oakridge Neighbourhood Profile.
As part of our work on the CHNA, we also created a 2023 – 2024 Taylor-Massey Oakridge Neighbourhood Profile. This profile includes indicators on the demographic, health and wellness of people living in these neighbourhoods. It is useful for the TMO residents and organizations that serve them to understand the community better and to know how to design services and interventions for the community.
Past CHNAs and Profiles can be found here:
Our Project Team
Principle Investigator: Akm Alamgir, PhD, Director of Organizational Knowledge and Learning
Project Lead and Coordinator: Courtney Kupka, Research & Evaluation Coordinator
Project Support: Rejwan Karim, Director, Community Programs and Partnerships
Project Champion: Axelle Janczur, Executive Director
Access Alliance Field (Research) Team:
- Courtney Kupka (Research and Evaluation Coordinator)
- Shirin Yilmaz (Student)
- Deepak Upreti (Student)
- Nazia Amin (Community Health Ambassador)
- Anusha Vuduthala (Community Health Ambassador)
- Norene Lach (Student)
- Laiba Adnan (Student)
- Coco Kexin Shi (Stud
For more info contact research@accessalliance.ca
Advisory Committee and Community Organization Partners members included representatives from:
- Bangladeshi-Canadian Community Services (BCS)
- Birchmount Bluffs Neighbourhood Centre (BBNC)
- East Toronto Health Partners (ETHP)
- Health Access Taylor Massey (HATM)
- South East Toronto Family Health Team
- South Riverdale Community Health Centre (SRCHC)
- Taylor-Massey Residents Wellness Council
- The Neighbourhood Group Community Services (TNGCS)
- TNO – The Neighbourhood Organization
- Toronto Community Housing
- Toronto East Health Network
- West Scarborough Neighbourhood Community Centre (WSNCC)
- WoodGreen Community Services
The above is not an exhaustive list, many organizations and individuals, including the residents of Taylor-Massey and Oakridge, contributed to this process.