Assessing Community Health Needs

Introduction
Community health nursing does not only refer to the nurse relationship between a client and a
nurse. According to Spradley (1990), it also emphasizes that the community is the primary client
because the community has a direct influence of the health of the individual, families and sub-
population. It is also at this level that most health service provision occurs.

As a community health nurse, you get to work with different types of clients such as families,
populations and sub groups. Every group has a distinct characteristic a community nurse must
recognize in order for him or her to be involved.

COMMUNITY HEALTH ASSESSMENT TOOLS

COMMUNITY DIAGNOSIS
2 parts
1. Community assessment
 Collection of data about the community in order to identify the different that
may directly or indirectly influence the health of the population.
 Considered as the keystone of community health nursing process

2. Data analysis and interpretation of Data

 Data gathered will be used to identify community health problems and a basis
for planning and implementing community health. Nursing interventions and
strategies.
Community health diagnosis is based on three interdependent, interacting and constantly
changing conditions (Freeman and Heinrich, 1981)

1. The health status of the community, including the population’s level of vulnerability
 An estimate of the health status relates the characteristics of two factors,
namely: the people and the environment.
 This is consistent with the epidemiologic approach that Finnegan and Ervin
(1989) described as a model for community assessment in which measurable
variable to describe the person, place and time support the presence of an actual
or potential community health problem.

2. Community health capability or the ability of the community to deal with its health
problems
 The community’s capacity to promote or sustain health depends on the extent of
its economic, institutional and human resources.
 The mere presence or availability of such resources does not necessarily
guarantee people’s health.
 People need to make out how these resources can be optimally used to their
advantage.

3. Community action potential, or the patterns in which the community is likely to work on
its health problems.

- All communities have unique ways of action to address their health needs and
problems. They develop their own approach to mobilize community participation for
health.

Important health aspect of community health action

A. Value people give to health over their other needs in life that provide the forward
motion for health actions
- Is the health problem perceived to be important to the people?
- is it perceived to need immediate attention?
- Are there other concerns in the community that take priority?
B. Community relationship with the political system and government institutions that
support health actions
- How responsive is the government to the health needs and problems of the
community?
- To what extent does the political system or government institutions allow for people’s
organizations’ participation in decision-making about planning and implementation of
health actions?
C. Habits that the community has developed for dealing with common problems
- Is there genuine partnership among all stakeholders to push for agenda of promoting
and sustaining health in the community?
 - What are the different approaches or strategies that they have developed and
implemented?

TYPES OF COMMUNITY DIAGNOSIS

A. COMPREHENSIVE COMMUNITY DIAGNOSIS

- Aims to obtain general information about the community with the intent of determining
not only prevalent. Health conditions and risk factors (epidemiologic approach) but also
socio-economic conditions (socio economic approach)

ELEMENTS OF COMPREHENSIVE COMMUNITY DIAGNOSIS

A. Demographic variables
Analysis of the community’s demographic characteristics should show the size,
composition and geographical distribution of the population as indicated by the
following:
1. The total population and geographical distribution including urban-rural index and
population density.
2. Age and sex composition
3. Household size
4. Selected vital indicators such as growth rate, crude birth rate, crude death rate, and
life expectancy at birth.
5. Patterns of migration
6. Population projection
 It is also essential to take note whether there are population groups that need special
attention like indigenous people, refugees, and other socially dislocated group brought
by disasters, calamities and development programs
B. Socio economic and Cultural variables
As a community health nurse, the following should be considered as important
information:
1. Social indicators
a. Educational background which may be indicative of poverty and may reflect on
health perception and utilization pattern of the community.
b. Housing conditions which may suggest health hazards (congestion, fire, exposure
to elements)
c. Social classes or groupings
2. Economic indicators
a. Poverty level income
b. Unemployment and underemployment rates
c. Proportion of salaried and wage earners to total economically wage earners to
total economically active population.
d. Types of industry present in the community
e. Occupation common in the community
 f. Communication network (whether formal or informal channels) necessary for
disseminating health information or facilitating referral of clients to the health
care system.
g. Transportation system including road networks necessary for accessibility of the
people to health care delivery system.
3. Environmental indicators
a. Physical/geographical/topographical characteristics of the community
 Land area that contributes to vector problems
 Terrain characteristics that contribute to accidents or pose as geohazards
zones
 Land usage in industry
 Climate/season
b. Water supply
 Percentage of the population with access to safe, adequate water supply
 Source of water supply
c. Waste disposal
 % Population served by daily garbage collection system
 % Population with safe excreta disposal system
 Types of waste disposal and garbage disposal system
d. Air, water and land pollution
 Industries within the community having health hazards associated with it
 Air and water pollution index
4. Cultural factors
a. Variables that may break up the people into groups within the community such
as:
 Ethnicity
 Social classes
 Language
 Religion
 Race
 Political orientation
b. Cultural beliefs and practices that affect health
c. Concepts about health and illness

C. Health and illness patterns

In analyzing health illness patterns, the public health nurse may collect primary data about the
leading causes of illness and deaths and their respective rates of occurrence. If she has access
to recent and reliable secondary data then she can also make use of these.

1. Leading cause of mortality

2. Leading cause of morbidity
3. Leading cause of infant and child mortality
4. Leading causes of maternal mortality
 5. Leading causes of hospital admission
6. Leading causes of clinic consultation
7. Nutritional status

D. Health resources
The resources that are available in the community are essential element in diagnosing the
community because they are important ingredient in the delivery of healthcare services. The
nurse 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 of health manpower
 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 and private)
 Quality of health manpower
 Existing manpower development/policies

1. Material resources
 Health budget expenditures
 Source of health funding
 Categories of health institutions available in the community
 Hospital bed to population ratio
 Categories of health services available

E. Political Leadership Pattern

This 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 community assessment, the public health nurse describes the following:

1. Power structure in the community (formal and informal)
2. Attitude of the people towards authority
3. Conditions/events/issues that cause social conflict/upheavals or that lead to social
bonding or unification.
 4. Practices approaches effective in settling issues and concerns within the community.

B. PROBLEM ORIENTED COMMUNITY DIAGNOSIS

 Type of assessment that responds to a particular need of a target group. (Spradley,
1990; Clark, 2003)
 The problem oriented community diagnosis deals with problems that are readily seen
and should be acted upon immediately.
Ex: If there is an epidemic in the community, what you should make is a problem-
oriented diagnosis.

Three Types of Community Nursing Problem

1. Health Status Problems
 Problem that are directly related to the community’s health (ex. Too many
breeding grounds for vectors, epidemics, malnourishment)
2. Health Resource problem
 Problems that concern a community’s health resources (ex. Understaffing in
the barangay health center, lack of hospital , lack of health transportation )

3. Health Related Problems

 Problems that indirectly influence health (ex. Lack of funding from the
government, indifference of the people)

To set Priorities, you must consider these things:

1. Nature of the condition or problem presented

2. Magnitude of the problem
3. Modifiability of the problem
4. Preventive potential
5. Social concern

https://nursingreviewer.wordpress.com/2007/12/04/community-diagnosis/