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Community Diagnosis
Community Diagnosis
Caring for the community as client starts with determining its health status. We collect
data about the community in order to identify the different factors that may directly or
indirectly influence the health of the population. Then, we proceed to analyze the seek
explanations for the occurrence of health needs and problems of the community. The
community diagnoses are then derived and will become the bases for developing and
implementing community health interventions and strategies. This process is called community
diagnosis. Other call it community assessment or situational analysis.
The health stats of the community is a product of the various interacting elements such
as ‘population, “the physical and topographical characteristics,” socio-economic and cultural
factors”, health and basic social services and the power structure within the community. The
interrelationship of these elements will explain the health and illness patterns in the
community.
A. Demographic Variables
The analysis of the community’s demographic characteristics should show the
size, composition and geographical distribution of the population as indicated by the
following:
1. Total population and geographical distribution including urba-rural index and
population density
2. Age and sex composition
3. Selected vital indicators such as growth rate, crude birth rate, crude death rate and
life expectancy at birth
4. Patterns of migration
5. Population projections
It is also important to know whether there are population groups that need special
attention such as indigenous people, internal refugees and other socially dislocated
groups as a result of disasters, calamities and development programs
D. Health Resources
The health resources that are available in the community is an important
element of the community diagnosis mainly because they are the essential ingredients
in the delivery of basic health services. We needs to determine manpower, institutional
and material resources provided not only by the state but those which are contributed
by the private sector and other non-government organizations.
1. Manpower resources
categories of health manpower available
geographical distribution
manpower population ratio
distribution of health manpower according to health facilities (hospitals, rural
health units, etc)
distribution of health manpower according to type of organization (government,
non-government, health units, private)
quality of health manpower
existing manpower development/policies
2. Material resources
health budget and expenditures
sources of health funding
categories of health institutions available in the community
hospital bed-population ratio
categories of health services available
E. Political/Leadership Patterns
The political and leadership pattern is a vital element in achieving the goal of
high level wellness among the people. It reflects the action potential of the state and its
people to address the health needs and problems of the community. It also mirrors the
sensitivity of the government to the people’s struggle for better lives.
In assessing the community, we describe the following:
1. Power structures in the community (formal or informal)
2. Attitudes of the people toward authority
3. Conditions/events/issues that cause social conflict/ upheavals or that lead to social
bonding or unification
4. Practices/approaches that are effective in setting issues and concerns within the
community.
In order to generate a broad range of useful data, the community diagnosis must be
carried out in an organized and systematic manner keeping in mind that the community should
take an active part in indentifying community needs and problems.
During the actual data gathering, we supervises the data collectors by checking
the filled-up instruments in terms of completeness, accuracy and reliability of the
information collected.
7. Data Collection
After data collection, we are now ready to put together all the information.
There are two types of data that may be generated. They are either numerical data
which can be counted or descriptive data which an be described.
To classify sex:
MALE
FEMALE
Exhaustive categories mean that they anticipate all possible answers that a
respondent may give. For example:
The next step after categorizing the responses will be to summarize the data.
One can do it manually by tallying the data or by using the computer. Tallying involves
entering the responses into prepared tally sheets showing all possible responses. For
example:
Parasitism /////-/////-/////-/////- 20
Diarrhea /////-/////-/////-// 17
Cough /////-/////-/////-/////- /////-/////-/// 33
When computers are going to be used in summarizing results, the responses are
given numbers or codes. For example:
Sex Male 1
Female 2
Religion Catholic 1
INK 2
Methodist 3
Aglipayano 3
8. Data Presentation
Data presentation will depend largely on the type of data obtained. Descriptive data
are presented in narrative reports. Examples of data appropriate for descriptive
presentation are geographic data, history of a place or beliefs regarding illness and death.
Numerical data may be presented into table or graphs. Tables or graphs are useful in
showing key information making it easier to show comparisons including patterns and trends. The
choice of graphs will depend on the type of data being presented.
TYPE OF GRAPH DATA FUNCTION
Line graph Shows trend data or charges with time or age
with respect to some other variables
9. Data Analysis
Data analysis in community diagnosis aims to establish trends and patterns in terms of
health needs and problems of the community. It also allows for comparison of obtained
data with standard values. Determining the interrelationship of factors will help us view the
significance of the problems and their implications on the health status of the community.
11. Priority-setting
After the problems have been identified, the next task for us and the community is to
prioritize which health problems can be attended to considering the resources available at
the moment.
a. Nature of the condition/problem presented – The problems are classified by the health
worker as health status, health resources or health-related problems:
b. Magnitude of the problem – This refers to the severity of the problem which can be
measured in terms of the proportion of the population affected by the problem;
d. Preventive potential – This refers to the probability of controlling or reducing the effects
posed by the problem;
e. Social Concern – This refers to the perception of the population or the community as
they are affected by the problem and their readiness to act on the problem.
Below is the scoring system utilized as we are deciding which of the problems need to be
prioritized:
Criteria Weight
Nature of the problem 1
Health status 3
Health resources 2
Health-related 1
Magnitude of the problem 3
75% - 100% affected 4
50% - 74% affected 3
25% - 49% affected 2
<25% - affected 1
Criteria Weight
Modifiability of the problem 4
High 3
Moderate 2
Low 1
Not modifiable 0
Preventive potential 1
High 3
Moderate 2
Low 1
Social Concern 1
urgent community concern; expressed 2
readiness recognized as a problem but
not needing urgent attention 2
not a community concern 0
Each problem will be scored according to each criterion and divided by the
highest possible score multiplied by the weight. Then the final score for each criterion
will be added to give the total score for the problem. The problem with the highest
total score is given high priority by us.
Aside from the biophysical and social sciences, community health also synthesis in its
practice the concepts, knowledge and skills derived from public health. Tools in measuring and
analyzing community health problems such as epidemiology and biostatistics were borrowed to
form part of our assessment tools in the diagnosis of community health problems.
The health disciplines of demography, vital statistics and epidemiology are three
important tools that help us in identifying the community’s health needs.
Demography
More than just being aware of how large a population is in a community, we need to
comprehend the characteristics of the population that makes the people vulnerable to certain
health conditions. We can determine the nature and magnitude of existing and potential
community health problems if she possesses knowledge about the population’s size,
composition and distribution in space. Demography, the science of population helps to find
reasons or rationale why or how a particular population or group is influenced by a variety of
factors resulting in vulnerability to diseases.
Demography is the science which deals with the study of the human population’s size,
composition and distribution in space. Population size simply refers to the number of people in
a given place of area at a given time. When the population is characterized in relation to
certain variables such as age, sex, occupation or educational level, then the population
composition is being described. We also describe how people are distributed in a specific
geographic location.
The three events described above are affected depending on how fast or how slow
people are added to the population as a result of births, deaths and migration occurring in the
community.
Demographic information can be obtained from a variety of sources but the most
common come from censuses, sample surveys and registration systems.
There are two ways of assigning people when the census is being taken. The de jure
method is done when people are assigned to the place wherein they usually live regardless of
where they are at the time of the census. On the other hand, when the de facto method is
used, the people are assigned to the place where they are physically present at the time of the
census regardless of their usual place of residence.
Registration systems such as collected by the civil registrar’s office deal with recording
of vital events in the community. Vital events refer to births, deaths, marriages, divorces and
the like. Other registration systems can also be used to describe specific characteristics of the
population.
Population Size
We determining the population size not because we simply want to know how large or
small the population is. Knowing the population size of a place allows us to make comparisons
about population changes over time. It also helps us rationalize the types of health programs or
interventions which are going to be provided for the community.
One method of measuring the population size is by determining the increase in the
population resulting from excess of births compared to deaths. This can be done in two ways:
1. Natural increase is simply the different between the number of births and the
number of deaths occurring in a population in a specified period of time.
2. Rate of Natural Increase is the difference between the Crude Birth Rate and the
Crude Death Rate occurring in a population in a specified period of time.
The second method of measuring population size is to determine the increase in the
population using data obtained during two census periods. This implies that the increase in the
size of the population is not merely attributed to excess in births but also the effect of
migration. These are:
1. Absolute Increase per year measures the number of people that are added to the
population per year. This is computed using the following formula:
Where:
P1 = population size at a later time
P0 = population size at an earlier time
t = number of years between time 0 and time t
2. Relative Increase is the actual difference between the two census counts expressed
in percent relative to the population size made during and earlier census.
Relative Increase =
Where:
P1 = population size at a later time
P0 = population size at an earlier time
Population Composition
The composition of the population is commonly described in terms of its age and sex.
We utilizes data on age and sex composition to decide who among the population groups
merits attention in terms of health services and programs.
1. Sex Composition
To describe the sex composition or the population, we computers for the sex
ratio. The sex ration compares the number of males to the number of females in the
population using the formula below.
The sex ratio represents the number of males for every 100 females in the
population.
2. Age composition
There are two ways to describe the age composition of the population
a. Median age divides the population into two equal parts. So, if the median age is
said to be 19 years old, it means half of the population belongs to 19 years and
above, while the other half belongs to ages below 19 years old.
The age and sex composition of the population can be described at the same
time using a population pyramid. It is a graphical presentation of the age and sex
composition of the population.
Population Distribution
The distribution of the population in space can be described in terms of urban-rural
distribution, population density and crowding index. The measures help the nurse decide how
meager resources can be justifiable allocated based on concentration of population in a certain
place.
1. Urban-rural distribution simply illustrates the proportion of the people living in rural
compared to the rural areas.
2. Crowding index will describe the ease by which a communicable disease will be
transmitted from one host to another susceptible host. This is described by dividing
the number of persons in a household with the number of rooms used by the family
for sleeping
3. Population density will determine how congested a place is and has implications in
term of the adequacy of basic health services present in the community. It can be
computed by dividing the number of people living in a given land area.
VITAL STATISTICS
The table below summarizes the various vital statistical indicators the we will find useful
as she assesses the health status of the community.
FERTILITY RATES
MORTALITY RATES
MORBIDITY RATES
Incidence Rate = xF
Prevalence Rate = xF
Source: Mendoza, OM and others. (1997) Foundations of Statistical Analysis for the Health
Sciences (Volume I). Manila: Department of Epidemiology and Biostatitics, College
of Public Health, UP Manila
Epidemiology
We measure the frequency and distribution of health conditions using vital statistical
indices. Epidemiology, however is used to analyze the different factors that contribute to
disease development. We identify the factors related to time, place and person characteristics
in order to explain how the disease developed in the community. Understanding disease
causation helps us plan and develop strategies to prevent and control spread of disease
especially for high risk groups.
Epidemiology rests on two important concepts: the Multiple Causation Theory and the
Levels of Prevention of Health Problems.
Disease development does not rest on a single cause. Health conditions result from a
multitude of factors.
There are three models that explain the multiple causation theory – the wheel, the web
and the ecologic triad. Of the three, the ecologic triad is most helpful because it highlights not
only the host’s and agents roles in disease development but also regards the role of the
environment as important in disease causation.
Agent Example
Biological Virus, bacteria, fungus, parasite
Chemical lead, mercury, insecticide
Physical humidity, atmospheric pressure, radiation
Mechanical stab, trauma
Nutritive iron or iodine deficiency, cholesterol
A host is any organism that harbors and provides nourishment for another organism.
The characteristics of the host will affect his or its risk of exposure to sources of infection and
his or its susceptibility or resistance. The resistance of the host may be specific or non-specific.
Specific resistance results from an immunologic experience such as undergoing immunization
or vaccination. Nonspecific resistance results from an intack skin, mucous membrane, reflexes
as lacrimatin, coughing, diarrhea, or vomiting. They can be maintained though personal
hygienic practices, environmental sanitation, proper nutrition and a healthy lifestyle.
The environment is the sum total of all external conditions and influences that affect the
life and development of an organism. The environment both affects the agent and the host.
There are three components of the environment:
1. Physical environment is composed of the inanimate surroundings such as the
geophysical conditions or the climate;
2. Biological environment makes up the living things around us such as plant and
animal life;
3. Socio-economic environment which may be in the form of level of economic
development of the community, presence of social disruptions and the like.
The three elements of the ecologic triad interact with one another in an attempt to
maintain an equilibrium. Any major change in any one of the factors may bring about a
disturbance in the equilibrium provoking the appearance of a health problem.
Primary Prevention
Primary prevention is directed to the healthy population, focusing on prevention of
emergence of risk factors (primordial prevention) and removal of the risk factors or
reduction of their levels (specific protection).
Specific measures include provision of immunization and prohylaxis to vulnerable or at-
risk groups (e.g. chemoprophylaxis for travelers to malaria endemic areas).
Secondary Prevention
Secondary prevention aims to identify and treat existing health problems at the earliest
possible time.
Tertiary Prevention
Tertiary prevention limits disability progression.