Integrating severity and diagnosis in needs assessment: A participatory framework.

BACKGROUND: Needs assessment is widely acknowledged as a cornerstone of program planning, yet it is often treated as a compartmentalized, pre-evaluative exercise. In complex and inequitable contexts, this fragmentation can undermine the development of grounded program theory. PURPOSE: This article proposes an integrated, beneficiary-centered framework for needs assessment that specifically combines severity documentation and causal diagnosis into a single participatory inquiry that directly informs program theory development. METHODS/APPROACH: Building on Davidson's (2005) three-phase model, we developed a five-step framework comprising: (1) orientation and stakeholder engagement; (2) integrated severity-diagnosis inquiry; (3) participatory data analysis and prioritization; (4) co-development of program theory; and (5) validation and advocacy with wider stakeholders. FINDINGS: We found the application of the framework useful in simultaneously generating evidence of the severity of need (widespread, high-intensity care burdens) and causal mechanisms (structural, spatial, and gendered drivers). This culminated in a collaboratively developed program theory linking multi-sectoral strategies to desired outcomes. IMPLICATIONS FOR EVALUATION & PROGRAM PLANNING: The framework reduces disunity across need assessment phases, strengthens alignment between evidence and program theory, and creates stronger pathways for stakeholder engagement and program design. It offers evaluators a practical approach for integrating beneficiary perspectives and systemic diagnosis into theory-driven program design.