Defining “Community” in Community Health Evaluation: Perspectives From a Sample of Nonprofit Appalachian Hospitals

This article examines the theoretical basis of the community as it is evoked in health evaluation. In particular, we examine how hospitals carrying out Community Health Needs Assessments (CHNAs) define communities as well as the implications for these definitions for how to study and engage community problems. We present qualitative findings from a sample of Appalachian nonprofit hospitals, who we asked to describe their approach to defining the community in their most recent Internal Revenue Service–mandated CHNA. Drawing upon a theoretical debate in the history of evaluation research, the authors argue that the contemporary community cannot be circumscribed merely by geographic boundaries, nor can it be identified easily with a bounded group of clearly demarcated individuals. Instead, following the tenets of community-based health research, the authors argue for a richer, more dynamic conceptualization of the community in evaluation research in which definitions arise from community bodies themselves.