摘要：Objectives. We developed the Humanitarian Emergency Settings Perceived Needs (HESPER) Scale, a valid and reliable scale to rapidly assess perceived needs of populations in humanitarian settings in low- and middle-income countries. Methods. We generated items through a literature review; reduced the number of items on the basis of a survey with humanitarian experts; pilot-tested the scale in Gaza, Jordan, Sudan, and the United Kingdom; and field-tested it in Haiti, Jordan, and Nepal. Results. During field-testing, intraclass correlation coefficients (absolute agreement) for the total number of unmet needs were 0.998 in Jordan, 0.986 in Haiti, and 0.995 in Nepal (interrater reliability), and 0.961 in Jordan and 0.773 in Nepal (test–retest reliability). Cohen’s κ for the 26 individual HESPER items ranged between 0.66 and 1.0 (interrater reliability) and between 0.07 and 1.0 (test–retest reliability) across sites. Most HESPER items correlated as predicted with related questions of the World Health Organization Quality of Life-100 (WHOQOL-100), and participants found items comprehensive and relevant, suggesting criterion (concurrent) validity and content validity. Conclusions. The HESPER Scale rapidly provides valid and reliable population-based data on perceived needs in humanitarian settings. Needs assessments in humanitarian settings (i.e., places in which a large part of the population is at risk of dying or experiencing immense suffering) are vital in enabling effective and efficient emergency relief. However, current needs assessments are often far from ideal; indeed, in 2009, heads of 26 large humanitarian donor agencies signed a letter to the United Nations asking for an improvement in the area of needs assessment (J. Isbister, G. Weinberger, J.-P. Loir, et al., unpublished letter, 2009). There have also been repeated recommendations for increased participation of affected populations in humanitarian assessment. 1–6 People’s participation in assessment is seen as a right and as essential for optimizing resource allocation, program design, and population empowerment. 6 It increases the likelihood that interventions are based on needs as expressed by the affected population. The international humanitarian community’s focus on participation is exemplified by the fact that the recently revised, influential Sphere Handbook ( 5,6 ) on standards for humanitarian aid emphasizes the involvement of affected people. Participation is recommended throughout the assessment, design, monitoring, and evaluation program cycle. 1,3–5 Additionally, in a recent ranking exercise for research priorities in the area of mental health and psychosocial support, 3 of the 10 most highly prioritized research questions in humanitarian settings included the participation of affected populations; the identification of affected populations’ stressors was ranked as top priority. 7 Related to this is the notion of accountability within the international humanitarian response, including that humanitarian action should be accountable to affected populations. 4 Within this framework of increased participation and accountability, it has been recommended that the assessment of perceived needs be used to inform project design, monitoring, and evaluation, 1–5,8,9 and perceived needs are considered a key determinant of psychosocial well-being. 1,8,10 Perceived needs are defined here as needs expressed by members of the affected population themselves. They are thus problem areas for which people would likely want help. In the humanitarian field, perceived needs are still assessed mostly through rapid participatory assessments in the early phase of a crisis; these assessments tend to involve gaining qualitative data from selected stakeholders through focus groups or key respondent interviews. 11 Although certainly valuable, such assessments cannot provide a population-level picture. Most population-based quantitative assessments are of “objective” indicators, such as mortality rates, malnutrition rates, or livelihood data. 12–14 These indicators are often defined by outsiders (i.e., nonmembers of the affected population) and do not quantify the prevalence and distribution of needs as perceived by members of the population themselves. With a few exceptions, 15–17 assessment tools in the humanitarian field tend to have unknown psychometric properties (i.e., indices of validity and reliability). Without published psychometric properties, it is unknown to what extent assessment tools are fit for purpose. To address these gaps, we developed a method and instrument to rapidly and quantitatively assess perceived needs in emergency-affected populations—the Humanitarian Emergency Settings Perceived Needs (HESPER) Scale. 18 We describe the development and psychometric properties of the scale.
