HEALTH
● “a state of complete physical, mental,
and social well-being and not merely
the absence of disease or
infirmity”(WHO,1958)
● “a state of well- being in which the
person is able to use purposeful,
adaptive responses and processes
physically, mentally,
emotionally, spiritually and socially
(Murray et al .,2009)
● “actualization of inherent and
acquired
human potential through goal-
directed
behavior, competent self care, and
satisfying relationship with others
(Pender et al.,2006)
● “a state of a person that is
characterized by soundness or
wholeness of developed human
structures and of bodily and mental
functioning (Orem,2001)
COMMUNITY
● “a collection of people who interact
with one another and whose
common interest or characteristics
form the basis for a sense of unity or
belonging(Allender et al.,2009)
● “a group of people who share
something in common and interact
with one another, who may exhibit a
commitment with one another and
may share a geographic boundary”
(Lundy and Janes,2009)
COMMUNITY HEALTH NURSING
(PHILOSOPHY OF CHN)
● Philosophy of individual’s right of
being healthy
● Philosophy of working together under
a competent leader for the common
good
● Philosophy that people in the
community have the potential for
continual development and are
capable of dealing with their own
problems if educated and helped.
● Philosophy of socialism
(Source, ANA)
8 PRINCIPLES OF CHN ADAPTED FROM
PHN (ANA,2007)
1. Focus on the community as the
unit of care
- CHN is community focused; it
is therefore essential to know
the defined community, make
a map and establish effective
working relationships
2. Give priority to community needs
- CHN is based on identified
community health nursing
needs and functions within
the total community health
programmes
- CHN Nurse has to “marry”
skills in the nursing process
with population focused skills
to produce the greatest
benefit for the majority of the
community
- Uses assessment tools such
as demographics and vital
statistics
3. Work with the community as an
equal partner of the health team
- Partnership between health
workers and community from
assessment to evaluation is
more likely to produce
effective and sustainable
results
4. In selecting appropriate activities,
focus on primary prevention
- Emphasis is given on
strategies
1. To promote optimal
health
2. Prevent disease and
disability
5. Promote a healthful physical and
psychosocial environment
- Environmental determinants
of health
1. Education
2. Socioeconomic status
3. Physical environment
4. Working conditions
5. Social support
network
 6. Reach out to all who may benefit ● It is possible to predict health
from a specific service behavior given three major
- Health team does not wait for interacting components:
people to come to the health 1. individual perceptions,
facility but goes on active 2. modifying factors, and
case - finding and outreach 3. likelihood of action
activities
7. Promote optimum use of ● Shows the direction and flow of the
resources interacting components, each of
- Limited health resources are which is further divided into
best use for strategies that subcomponents.
will produce long term effects, A. The individual perceptions
taking ethical principles into component
consideration 1. perceived susceptibility or
8. Collaborate with others working in 2. perceived severity of a specific disease
the community B. The modifying factors component
- Nurse has to work with a Demographic variables (age, sex, race,
variety of sectors in resolving ethnicity),
issues that affect health 1. Socio-psychological variables
- Community health efforts (personality, locus of control, social class,
have to be coordinated peer and reference group pressure)
among health team members 2. Structural variables (knowledge about
and other disciplines e.g and prior contact with disease).
teachers, social worker, These variables, in conjunction with cues to
finance and marketing action (mass media, advice, reminders,
experts illness, reading material), influence the
subcomponent of perceived threat of the
specific disease.
THEORETICAL MODEL/APPROACHES C. Likelihood of action
A. Health Belief Model (HBM) 1. perceived benefits of preventive action
B. Milio’s Framework for Prevention minus perceived barriers to preventive
C. Nola Pender’s Health Promotion action.
D. Lawrence Green PRECEDE-
PROCEED MODEL Final Phase
● All of the components are directed
1. PRECEDE = Predisposing, toward the likelihood of taking
Reinforcing, Enabling Constructs in recommended preventive health
Educational Diagnosis and action
Evaluation ● iIndividual perceptions and modifying
2. PROCEED = Policy, Regulatory and factors interact.
Organizational Constructs in ● An individual appraisal of the
Educational and Environmental preventive action occurs, which is
Development followed by a prediction of the
likelihood of action.
HEALTH BELIEF MODEL
● Developed by a group of social MILIO’S FRAMEWORK FOR PREVENTION
psychologists to examine why people ● Relate an individual's ability to
did not participate in health screening improve healthful behavior
programs
6 PROPOSITION SUMMARY
1. Population health deficits’ result from
deprivation and/or excess of critical
health resources
2. Behaviors of populations result from
selection from limited choices
3. Organizational decisions and policies
dictate many of the options available
to individuals and populations and
influence choices
4. Individual choices r/t health
promotion or health damaging
behaviors are influenced by efforts to
maximize valued resources.
5. Alteration in patterns of behavior
resulting from decision making of a
significant number of people in a
population can result in social
change
6. Without concurrent availability of
alternative health promoting options
for investment of personal
resources, health education will be
largely ineffective in changing
behavior patterns.
PENDER’S HEALTH PROMOTION MODEL
● Explores many biopsychosocial
factors that influence individuals to
pursue health promotion activities
● The HPM depicts the complex of
multidimensional factors with which
people interact as they work to
achieve optimum health
functional ability and better quality of
life at all stages of development.
● The final behavioral demand is also
influenced by the immediate
competing demand and preferences,
which can derail intended health-
promoting actions.
TRANSTHEORETICAL MODEL (TTM)
● is a dynamic theory of change based
on the assumption that there is a
common set of change processes
that can be applied across a broad
range of health behaviors.
● Based on the assumption that
behavior change takes place over
time, progressing through a
sequence of stages
● Each of the stages is both stable and
open to change
STAGES OF CHANGE AND DESCRIPTION
1. Precontemplation - no intention to
take action
2. Contemplation - has some intention
3. Preparation - intends to take action
4. Action - changed overt behavior for
less than 6 months
5. Maintenance - change behavior for
more than 6 months
DECISIONAL BALANCE
1. Pros- the benefits of behavior change
2. Cons-the cost of behavior change

HEALTH PROMOTION MODEL PRECEDE - PROCEED MODEL

● Each person has unique ● Provides a model for community
personal/individual characteristics assessment, health education,
and experiences that affect planning and evaluation P-
subsequent actions. redisposing
● The set of variables for behavioral- R - einforcing and
specific Cognitions and affect have E - nabling
important motivational significance C - onstructs in
and can be modified through nursing E - ducational
actions. D - iagnosis and
● Health promoting behavior is the E - valuation
desired behavioral outcome and is
the endpoint in the Health Promotion PROCEED
Model. ● A model for implementing and
● Health promoting behaviors should evaluating health programs based
result in improved health, enhanced on PRECEDE
 P - olicy
R - egulatory and
O - rganizational
C - onstructs in
E - ducational and
E - nvironmental
D - evelopment
Predisposing factors
● Refer to people characteristics that
motivate them toward health related
behavior
Enabling factors
● Refers to conditions in people and
the environment that facilitate or
impede health related behavior
Reinforcing factors
● Refer to feedback given by support
person or groups resulting from the
performance of the health related
behavior
ESTABLISHED AND RECOGNIZE FIELDS
OF PRACTICE IN CHN
1. Public health Nursing - the practice of
promoting and protecting the health
of populations using knowledge from
nursing, social, and public health
sciences
2. Occupational health Nursing -
provides for and delivers health and
safety programs and services to
workers, worker populations, and
community groups.
3. School health nursing - protects and
promotes student health, facilitates
normal development, and advances
academic success.
EMERGING FIELDS OF COMMUNITY
HEALTH NURSING IN THE PHILIPPINES
● The nurse may engage in
1. Home health care
2. Hospice home care
● EntrepreNurse
● Faith community nursing or parish
nursing
HOME HEALTH CARE
● Providing nursing care to individuals
and families in their own places of
residence mainly to minimize the
effects of illness and disability
● Patients who may benefit:
1. Chronically ill
2. Convalescent patient
3. Elderly
4. Disable who require custodial
care
5. High risk pregnant women
HOSPICE HOME CARE
● A homecare specifically rendered to
the terminally ill to:
1. provide comfort
2. improve his/her quality of life
3. provide support to the patient
and family as they go through
the processes of dying and
grieving
ENTREPRENURSE
● A project of Dept. of Labor and
Employment
● To promote nurse entrepreneurship
by introducing a home care industry
in the Phil.
AIMS:
1. Reduce the cost of health care
2. Maximize employment opportunities
3. Utilize the country’s unemployed
human resources for health services
4. Achievement of MDG on maternal
and child health
FAITH COMMUNITY NURSING OR
PARISH NURSING
● Practice of the art and science of
nursing combined with spiritual care
● Focus on health promotion and
provision of holistic care to the
members of the faith community.
Roles:
1. Health educator
2. Personal health counselor
3. Developer and coordinator of support
groups
4. Integrator of faith and healing
CONCEPT OF THE COMMUNITY
● The WHO defines community health
as: environmental, social, and
 economic resources to sustain
emotional and physical well being
among people in ways that advance
their aspirations and satisfy their
needs in their unique environment.
● A community is a social unit (a group
of living things) with commonality
such as norms, religion, values,
customs, or identity. Communities
may share a sense of place situated
in a given geographical area (e.g. a
country, village, town, or
neighborhood) or in virtual space
through communication platforms.
● Community health Nursing is the
synthesis of nursing and public
health practice applied to promote
and protect the health of the
population. It combines all the basic
elements of professional, clinical
nursing with public health and
community practice.
3 TYPES OF COMMUNITIES
1. Urban - a large community with many
people and large buildings, a city.
2. Suburb - a medium sized community
near a large city, houses are close
together, you may see parks and
malls
3. Rural - a community where houses
are far apart, there are a smaller
number of people and you may see
farms and forests
UNIVERSAL TYPE OF COMMUNITY
1. Formal
2. Informal
3. Urban
4. Rural
5. Global
6. Sectoral
7. Social space
HEALTH COMMUNITY
● A healthy community is in the context
of health promotion defined in
Ottawa charter (WHO,1986)
● “The process of enabling people to
increase control over, and to improve
their health”
● A healthy city is one that is continually
creating and improving those
physical and social environments
and expanding those community
resources that enable people to
support each other in performing all
the functions of life
AIMS:
1. To achieve a good quality of life
2. Create a health supportive
environment
3. Provide basic sanitation and hygiene
needs
4. Supply access to health care
CHARACTERISTICS OF A HEALTHY
COMMUNITY
1. A shared sense of being a community
based on history and values
2. A general feeling of empowerment
and control over matters that affect
the community as a whole.
3. Existing structures that allow
subgroups within the community to
participate in decision making in
community matters
4. The ability to cope with change, solve
problems and manage conflicts
within the community through
acceptable means
5. Open channels of communication
and cooperation among the
members of the community
6. Equitable and efficient use of
community resources, with the view
towards sustaining natural resources
COMPONENTS OF A COMMUNITY
Community development
● Community organization and
mobilization
● Community needs analysis
● Participatory community planning
● Generation and allocation of
resources (resource mobilization)
● Alliance building and multi-sectoral
partnership
Povsonoftechncalandfnancalasssancetir
(ambot unsa ni oy hahahaha)
● Upgrading of health facilities
● Capacity and capability building
Monitoring and Evaluation
● Documentation of best practices
● GIDA Indicators
GIDA - DOH
● GEOGRAPHICALLY ISOLATED and
DISADVANTAGED AREAS:
Name of Office: Bureau of Local Health
Development
The objectives of GIDA are the following:
1. To empower communities, local
government units (LGUs) and key
stakeholders toward good
governance for health.
2. To generate LGU and community
commitment to manage and sustain
health care.
3. To strengthen multi sectoral linkages
through convergence and efficient
use of resources.
4. To improve access and provision of
health services.
FACTORS AFFECTING COMMUNITY
HEALTH CAN BE GROUPED INTO:
➢ Physical factors
-Industrial development: communities that
are industrially developed are more likely to
be affected by numerous diseases due to the
toxic waste products from the industries that
are released into water bodies and the
atmosphere and due to congestion of
settlement leading to slum development
hence contagious diseases compared to
areas that are not industrially developed.
(ex: air pollution, water contamination from
industrial discharge)
-community size: a densely populated or
over populated community can easily be
attacked by communicable diseases.
(ex:overcrowding)
-geographical location: some communities
are more prone to diseases due to the
geographical location.
(ex:some communities are located in
swampy areas ARE MORE PRONE TO
DISEASES especially during heavy rains
they are affected by floods which can lead
@ manipulation of diseases causing
organisms if the water is stagnant
@ to spread of diseases causing organisms.
(ex: malaria, diarrhea diseases)
-environment: a clean environment is very
vital to the proper health of a community
which minimizes the occurrence and
transmission of diseases, unlike a dirty
environment which easily leads to outbreak
of diseases.
➢ Social/cultural factors
-tradition beliefs: beliefs or traditions
possessed by communities greatly affect the
health of its people.
(ex: FEMALE GENITAL MUTILATION)
FGM
: reasons given include
+ control over women’s sexuality
+ hygiene
+ gender-based factors (removal of ‘male’
parts
+ cultural identity
+ religion
-economy: a community that is economically
well off has low chances of suffering from
disease breakouts because they have proper
health care and water drainage systems
unlike a poor community.
-government: since the government involves
planning, implementing and provision of
community services such as water supply,
medical supplies, and other needs which can
directly affect the community health.
-community organization: ways in which
communities organize their resources such
as taxes which can be very helpful in control
of diseases and supply of sufficient and
efficient medical care even in times of crisis
unlike communities without proper
accountability of their taxes which can partly
be allocated to the health sector.
- education factors: poor education or
illiteracy affects the health of a community
when people don’t have education on how
they can prevent themselves from diseases.
(Ex: health education in the use of mosquito
treated nets to prevent malaria, health
education on the environmental hygiene so
as to prevent diseases such as cholera and
trachoma)
-individual behavior: community health is
greatly influenced by individuals, their
personal health, habits etc. and in order to
achieve a healthy community, it takes a team
work. For instance, proper disposal of waste
products from and individuals’ compound,
clearing all stagnant water in the compound
to prevent harboring of mosquitos, active
smokers to quit smoking to avoid passive
smokers thus preventing lung cancer,
abstainance from sexual activities and for
sexually active individuals to use protection
to prevent the spread of HIV/AIDS and STDs
etc. Thus, proper individual healthy living can
greatly promote a healthy community
● Community organization
● Individual behavior
Factors affecting health of the
community:
1.Characteristics of the Population
Population:
⦁ Consists not only of a specialized
aggregate, but also of all the diverse people,
who live within the boundaries of the
community.
⦁ The health of the community is greatly
influenced by the population that lives in it.
⦁ Different features of the population suggest
the health needs and provide bases for
health planning
▪ Population variables that affect the
health of the community
1.Size and density
2. composition
3. rate of growth or decline
4. Cultural characteristics
5. Mobility
6. Social class
7. Educational level
SIZE:
⦁ Influence the number and size of health
care institutions
⦁ Knowing community size provides
important information for planning
⦁ Concentration of health care institution in
urban areas
⦁ Sparsely populated like rural areas have
limited resources resulting to difficulty in
providing health services
DENSITY:
⦁ Increase population density may increase
stress. Similarly, when people are spread out
health care provision may become difficult.
Negative effects of overcrowding:
1.Easy spread of communicable diseases
2. Increased stress among members of the
community
3. Rapid degradation of housing facilities
4. Water, air and soil pollution
COMPOSITION:
Health needs vary because of differences
1. Age
2. Sex
3. Occupation
4. Level of education
⦁ Composition of the population often
determines types of health needs. ⦁ A health
community is one that takes full account of
and provides for differences in age, sex,
educational level and occupation of each
member. All of which may affect health
concerns. ⦁ Determining a community
composition is an important early step in
determining its level of health.
RAPID GROWTH OR DECLINE:
1.Rapid Growth-Results in
increased/extensive demand for services
that may find hard to cope with
2.Decline-decrease in economic activity and
lower government revenue that results to
decrease in resources accessible to
community
3.Marked decline in population may signal of
poorly functioning community.
CULTURAL CHARACTERISTICS:
1.Cultural homogeneity
2. Multicultural Cultural
CULTURAL DIFFERENCE:
o Health needs may vary among sub-
cultural and ethnic populations.
o Cultural differences can create
conflicting or competing demands for
resources and services or create
inter- group hostility

MOBILITY:
o Feeling of belongingness and
participation in community action are
less likely if composed of new and
transient residents
o Mobility of the population affects
continuity of care and availability of
resources
o Mobility has a direct effect on the
health of a community.
LEVEL OF EDUCATION AND SOCIAL
CLASS:
SOCIAL CLASS:  refers to the ranking of
groups within society by income, education,
occupation, prestige or a combination of
these factors.
EDUCATIONAL LEVEL: is a powerful
determinant of health-related behavior.
Health promotion and preventive health
services are most needed for people with low
income and educational levels
o Affect health status because of
differences in living conditions and
degree of access to resources and
opportunities
LOCATION:
Health is affected by:
1.Natural and manmade variables
Geographic features, climate, flora, fauna
2. Community boundaries Urban or rural
3. Geographic features Land, water forms
o Every physical community carries out
daily existence in a specific
geographic location. The health of a
community is affected by this location
including the placement of health
services, the geographic features,
plants, animals and animals and the
human made environment.
SIX LOCATION VARIABLES:
1.COMMUNITY BOUNDERIES: - To talk
about community in any sense, one must first
describe its boundaries. It serves as basis for
measuring incidence of wellness and illness
and for determining spread of a disease.
2.LOCATION OF HEALTH SERVICES: -
When assessing a community, the
community health nurse will want to identify
the major health centers and know they are
located. Use of health services depends on
availability and accessibility.
3.GEOGRAPHIC FEATURES: -
Communities have been constructed in
every suitable physical environment and that
environment certainly can affect the health of
a community. Injury death, and destruction
may be caused by floods, cyclones,
earthquakes volcanoes…. Etc. recreational
activities at lakes, seashores, mountains
promote health and wellness.
4.WELLNESS: - Climate has a direct effect
on health of a community e.g., extreme heat
and cold)
5.FLORA AND FAUNA: - Poisonous plants
and disease carrying animals can affect
community health.
6.HUMAN MADE ENVIRONMENT: - All
human influences on environment (housing,
dams, farming, types of industry, chemical
wastes, air pollution. Etc. ) can influence
levels of community wellness.
SOCIAL SYSTEM:
In addition to location and population, every
community has a third dimension, a social
system.
⦁ The various parts of community social
system that interact and influence the system
are called social system variable
⦁ The patterned series of interrelationships
existing between individuals, groups and
institutions and forming a coherent whole
(Merriam- Webster dictionary)
⦁ Social components that affect health
1. family, economic, educational
communication
2. Political, legal, religious, recreational and
health system (Allender et al,2009)
Social components that affect health:
1. family,
2. economic,
3. educational communication
4. Political,
5. legal,
6. religious,
7. recreational and
8. health system
9. (Allender et al,2009)
⦁ Although community health nurses must
examine all the system in the community and
how they interact, the health system is of
particular importance to promote the health
of the community
Roles and activities of Community Health
Nurse. (history)
⦁ In the past, Albularyu / Manhihilot
journeyed on foot or carabao’s to the homes
of their neighbors to provide medical
services. ⦁ These Manhihilot were crucial to
reducing the mortality rates in their
communities. ⦁ After the Filipino American
war, hospitals were built like San Lazarus
What is Community Health Nursing?
Community health nursing is: ⦁ a discipline
that incorporates evidenced based research
along with advances in science and new
approaches for improving the health. ⦁
Considering the cultural and socioeconomic
backgrounds of the people in the community
to ensure appropriate interaction and
sensitivity when working with them.
What is the role of a community Health
nursing?
 The primary role of community health
nurses is to provide treatment to patients.
 Additionally, community health nurses
offer education to community members
about maintaining their health so that they
can decrease the occurrence of diseases
and deaths.
 They plan educational assemblies,
 Hand out fliers,
 Conduct health screenings,
 Dispense medications and
 Administer immunizations.
 Nurses also may distribute health-related
items like condoms and pregnancy test
Some health issues that community
health nurses try to control or eliminate
are:
1. Infectious and sexually transmitted
diseases
2. Obesity
3. Poor nutrition
4. Substance abuse
5. Smoking
6. Teen pregnancy
7. Family Planning Program
Where do community Health Nurses
Work?
Community health nurses work in
⦁ hospitals,
⦁ community centers,
⦁ clinics, ⦁ schools and
⦁ government health agencies.
: Community health nurses are important to
regions where healthcare is not easily
accessible, so they can travel to remote
places and isolated areas of a city.
Example:
o PTB program,
o Breast feeding program (MBFH)
How do you become a community health
nurse?
⦁ To become a community health nurse, you
must first work as a registered nurse.
⦁ Nursing care should be available to every
Filipino. Throughout the country, there are
entire communities of people prone to
chronic illnesses, infectious diseases and
economic hardships.
⦁ Community health nurses have the ability
to improve the welfare of individuals and their
communities.
⦁ They are at the forefront of bringing quality
patient care to the most vulnerable and
underserved members of society.
⦁ Example: COVID 19
What is the goal of community health
nursing?
The goal of community health nursing is to
promote, protect and preserve the health of
the public. Community health nursing
involves these basic concepts:
1. Promote healthy lifestyle
2. Prevent disease and health problems
3. Provide direct care
4.Educate community about managing
chronic conditions and making healthy
choices
5.Evaluate a community’s delivery of patient
care and wellness projects
6. Institute health and wellness programs
7. Conduct research to improve healthcare
PLANNING COMMUNITY HEALTH
INTERVENTIONS:
Planning:
o A logical process of decision making
to determine which of the identified
health concerns requires more
immediate consideration
o What actions may be undertaken to
achieve goals and objectives
o Involves priority setting, formulating
goals and objectives and deciding
community intervention
Priority Setting:
WHO Criteria
1. Significance of the problem
2. Community awareness
3. Ability to reduce risk
4. Cost of reducing risk
5. Ability to identify the target population
6. Availability of resources
• The group make a list of the identified
community health problems or conditions •
Each of the identified problems is treated
separately according to a set of criteria
agreed upon by the group and as suggested
by WHO
Deciding on Community Interventions
• What may work for one community may not
be effective in another because of inherent
differences
• Group analyzes the reason for people’s
health behavior and direct strategies to
respond to the underlying causes
Example: Reason for preference of home
delivery over facility-based delivery should
be identified
▪ If majority will choose home delivery
because of cost or lack of access,
strategy then focus on improving
facility-based services
▪ If reason is socio cultural planning
team may concentrate on providing
skills dev of traditional birth attendant
➢ Home Delivery
➢ Birthing Facility
Implementing Community Health
Intervention
Action Phase:
• Most exciting
• Deal with the recognized priority health
concern
• Enhance the community’s capability in
dealing with common health
conditions/problems
• Requires common understanding of goals
and objectives and planned interventions
among members of implementing group
Nurse’s role:
To facilitate the process rather than directly
implement the planned intervention
COMMUNITY ORGANIZING:
COMMUNITY ORGANIZING (CO):
• A process, consists of steps or activities
that instill and reinforce the people’s self-
confidence on their own collective strength
and capabilities (Manalili,1990)
• A process of educating and mobilizing
members of the community to enable them
to resolve community problems
• Teaching the community to apply the
nursing process on its own, utilizing
resources that are available thereby allowing
the community to be an active participant in
the process of development rather than
being a passive recipient of care services.
• A social development approach that aims to
transform the individualistic, powerless and
voiceless poor into
– Dynamic
– Participatory
– Politically responsive communities
• Characteristics:
– Transformative
– Collective
Goals of CO
1. People empowerment
2. Development of self-reliant community
3. Improved quality of life (UST, NSTP,20120
• Building social structures – institutionalizing
of power
• Building alliances/networking – voice for
strong advocacy of issues
• Social transformation
Core Principles in Community Organizing
1. Community organizing is people centered
- People are the means and ends of
development and community empowerment
is the process and the outcome (Felix,1998)
- It is people centered (Brown,1985)
2. Community organizing is participative
- The participation of the community in the
entire process (assessment, planning,
implementation and evaluation) should be
ensure
- Community is considered as the prime
mover and determinant rather than
beneficiaries and recipients of development
3. Community organizing is democratic
- It is the process that allow the majority of
the people to recognize and critically analyze
their difficulties and articulate aspirations
- CO should empower the disadvantaged
population
4. Community organizing is
developmental
- CO should be directed toward changing
current undesirable conditions
- Organizer desires changes of the
betterment of the community and believes
that the community shares these aspirations
and that these changes can be achieve
5. Community organizing is process
oriented
- The community organizing goals of
empowerment and development are
achieved through a process of change
- Organizers need to diligently and patiently
follow the community organizing process to
achieve its goals
PHASES OF COMMUNITY ORGANIZING:
• Pre –entry
1. Involves preparation on the part of
organizer and choosing a community for
partnership
a. knowing the goals of the CO activity or
experience
b. delineates criteria or guidelines for site
selection
c. Making a list of sources of information and
possible facility
• Proper selection is crucial.
• Identification of possible barriers, threats,
strengths and opportunities at this stage is
an important determinant of the overall
outcome of CO.
Means to identify communities:
1. initial data gathered through an initial
survey
2. Review of records of a health facility
3. A review of the barangay/municipal profile
4. Referrals from other communities or
institutions or through a series of meetings
5. Consultation from LGU or private
institutions
• Entry phase
- Formalizes the start of the Organizing
process
- Organizer gets to know the community and
likewise. § Make courtesy call to local formal
leaders
- A visit to informal leader recognized
Community Integration
• Integration with the people
-Termed as pakikipamuhay
– Establishing rapport with the community by
• Living with them
• Undergo the same experience as they do
• Sharing with their aspirations and hard
• Integration style
• CO objectives: To get to know the people’s
– Culture
– History
– Economy
– Leaders
– Lifestyle of the people
Manalili, (1990) describes the following
styles of integration
1. “Now you see, now You don’t” style
a. Organizer visits the community as per the
schedule but is not able to transcend the
“guest” status.
b. Organizer cannot breakdown the barrier
2. “Boarder” style
- Organizer rent a room or house in the
village
-Does not share the life of the community
- Organizer is regarded as a guest
3. “Elitist” style
-Organizer lives with the barangay chairman
or some other prominent person, this makes
integration more
Activities in Integration
• Start where the people are
• Do house to house visit
• Seek out and converse with many people
• Lend a hand in household chores
• Participate in social activities
• Participate in direct livelihood production
• In short “IMMERSION”
People centered approach in Integration
1. Pagbabahay-bahay - Occasional home
visits are an effective way of developing a
close relationship
2. Huntahan Informal conversation
3. Participation in the production process
Organizer participates in in livelihood
activities
4. Participation in social activities Help the
organizer and people know
Social Analysis:
Process of gathering, collating and analyzing
data to
- gain extensive understanding of community
conditions,
- help in the identification of problems and
- determine the root cause of problems.
A process of systematically learning and
analyzing the various structures and forces
in the community on:
• Socio-political
• Economic
• Cultural
• Spiritual
• Environment
• Gender dimension
as well as the problems and issues that
needs immediate or long-term solution
Social analysis is also referred as:
-social investigation,
-community study,
-community analysis,
-community needs assessment,
-Community D
Identifying potential leaders:
• Characteristics of potential leader
1. They represent the target group
2. They possess or display leadership
qualities
3. They have the trust and confidence of the
community
4. They express belief in the need to change
the current undesirable situation
5. They are willing to invest time
Core Group Formation
• Forming a single core group is suggested
but as the community gets better, the 1st
group may decide have a separate group
• The process of bringing together the most
advanced indigenous leaders among the
leaders identified during the preliminary
social investigation stages
• CO objectives: To ensure the
Community Organization
• Conducts assembly with the goals of
arriving at a common understanding of
community concerns and formulating a plan
of action
• If community decide to formalize the
organization it must have the ff:
characteristics:
• An organizational name and structure
• A set bof officers recognized by the
Action /Mobilization Phase
• Refers to implementation of the
community’s planned programs and projects
• Is the actual community action undertaken
to address and resolve the identified
community issues and concerns
 • Food Safety Sanitation
Evaluation: • Vermin and Vector Control
• Systematic, critical analysis of the current • Built Environment
state of the organization or projects Monitoring and Evaluating Community
compared to desired or planned goals or Health Programs Implemented
objectives Evaluation approaches maybe directed
• It is the process of drawing out lessons from toward:
the activity ▪ Structure
• The people should sit down and review ▪ Process
what happened, whether good or bad ▪ Outcome
Ask: Did we prepare well?
• Did we go to the right person? Structure Evaluation
• Did we overestimate our strengths? Involves looking into the manpower and
• What did we learn? Etc physical resources of the agency responsible
for community health interventions
Exit and expansion phase
• When indicators of success are met, e.g., Process evaluation
high levels of socio-political awareness, Examining the manner by which
sustained participation, active leaders, clear assessment, diagnosis, planning, imple
plans and goals set by the community mentation and evaluation were undertaken

INDICATIONS OF READINESS FOR EXIT Outcome evaluation.

1. Attainment of the set goals of the Determining the degree of attainment of
community organizing efforts goals and objectives
2. Demonstration of the capacity of the
people’s organization to lead the community Types of Evaluation:
in Formative evaluation
“The people are the real heroes, while we • Judgement made about effectiveness of
ourselves are often childish and ignorant, nursing interventions as they are
and without this understanding it is implemented (Maurer and Smith,2009)
impossible to acquire even the most • This is ongoing and continuing while family
rudimentary knowledge” nursing care is implemented and family
Mao Zedong nurse interactions are taking place
"Preface and
Postscript to Rural Sur Summative Evaluation:
Determining the end results of family nursing
A people united will never be defeated care and usually involves measuring
outcomes or the degree to which goals have
Community Organizing Participatory been achieved (Maurer and Smith,2009)
Action Research
➢ A community development approach Family Health Record:
that allows the community -All records, which relate which relate to
(participatory) to : members of the family should be placed in a
▪ systematically analyze the single-family folder.
situation (research), -Gives the picture of the total services and §
• plan a solution and - helps to give effective, economic service to
• Implements project/programs the family as a whole
(action) utilizing the process of - Separate record forms may be needed for
Community different types of service such as TB,
maternity, etc.
• Proper Excreta Disposal
-All such individual records which relate to
members of one family should be placed in
one single folder
Community Profile:
-A summary of baseline conditions and
trends in a community and study area.
- It establishes the context for assessing
potential impacts and for project decision-
making.
- Developing a community profile involves
identifying community issues and attitudes,
locating notable features in the study area,
and assessing social and economic
conditions and trends in the
- Information can be collected both from
primary source
• such as interviews or field
• such as comprehensive plans or
newspaper articles
*COMMUNITYDEVELOPMENT*
“Community Devt is an attempt to bring about
a social and economic transformation of
village life through the efforts of the people
themselves” “Community Devt is the process
of assisting ordinary people to improve their
own communities by undertaking collective
action” (Twelvetrees, 1991
RURALDEVELOPMENT
URBANDEVELOPMENT
❖ CD refers to creation of social
services, human development,
community education program and
other welfare programs.
❖ The term ‘CD’ used to describe a goal
of bringing about social and
economic devt in areas which are
underdeveloped.
❖ CD can be considered as a goal and
community organization as the
process or the method by which CD
can be achieved.
❖ CD produces self-reliant, self-
sustaining and empowered
communities.
❖ CD also known as COMMUNITY
BUILDING
BACKGROUND OF CD
The term CD was first officially used
in 1948 at British Colonial Office
Cambridge Conference on Devt of
American Initiative.
The then CDP aimed at helping
British colonies in Africa prepare for
independence by improving local
govt and developing their economies.
it was initiated on 2nd Oct, 1952 with
the aim of promoting better living for
the whole community in rural areas.
The CDP was also a result of the
conclusion drawn from the ‘Grow
More Food’ enquiry report
COREOFCOMMUNITYDEVELOPMENT
Educating
Enabling
Empowering
CHARACTERISTICS OF CD
- Focuses on the whole community.
- Emphasizes public participation as
self-help.
- Uses participatory democracy as a
model for decision making.
ELEMENTS OF CD
-process
-method
-program
-movement
PRINCIPLES OF CD
Self-help and Self-responsibility are
required for successful devt.
Participation in public decision-making
should be free and open to all citizens.
Trust is essential for effective working
relationship.
Methods that produce accurate information
about the community are vital to the process.
Understanding and general agreement are
the basis for community change.
All individuals have the right to be heard in
open discussion, and the responsibility to
respect opposing viewpoints
PILLARS OF CD
-Objectives
- People
- Strategy
-Technology
CD V/S CO
PROCESS OFCD
BRANCHES OF CD
1. RURALDEVELOPMENT
2. URBANDEVELOPMENT
I.RURAL COMMUNITY DEVELOPMENT
The term ‘Rural development’ means all
round devt of rural areas with a view to
betterment of lifestyle and standard of living
in all spheres of their life.
RCD aims at improving the welfare of rural
people and their livelihoods on a sustainable
and equitable basis.
 People’s participation is the Centre-piece
in RCD
FUNDAMENTAL OBJECTIVES OF RCD
 To teach farmers how to determine their
own problems
 To help them acquire knowledge about the
problems
 To motivate them to solve their problem
To help them build up social and economic
infrastructure
To train rural unemployed youth
To empower farmers/ laboures to
discourage migration to urban
MAJOR AIMS OF RCD:
RCD:
- infant welfare
- hygiene
- Public health
PROCESS OF RCD:
1. Confirm spread problem by gathering
more information
2. Examine data from step one
3. Set goals and formulate actions for
improvement
4. Implement actions for improvement
5. Assess progress and refine actors for
improvement
6. Monitor improvements for sustainability
METHODS INVOLVED IN RCD
- PRA is the major and important method in
RCD
- It is intended to enable local communities to
conduct their own analysis and to plan and
take action
- The aim of PRA is to help strengthen the
capacity of villagers to plan, make decisions,
take action towards improving
- PLA (Participatory Learning and Action) is
often used interchangeably with PRA
II.URBANCOMMUNITYDEVELOPMENT
❖ Urban Community Devt in India
drives its origin from the Rural
Community Devt Program which
commenced on 2nd Oct. 1952.
❖ It requires the urban citizen’s efforts
like financial support and technical
assistance in areas like sanitation,
public health, education and
recreation.
 URBAN BODIES
There several types of urban bodies in
India such as Municipality, Notified Area
Committee, Town Area Committee, Special
Purpose Agency, Township, Port Trust,
Cantonment
 Nagarpalika Act came into force on
1stJune,1993.
The 74th amendment made the provisions
relating to Urban Local Govts (Nagarpalika).
Three-tier structure of Nagarpalika:-
Municipal Corporations, Municipal Council,
and Nagar Panchayat
GROUP DEVELOPMENT STAGES:
-Stages group of Development
❖ Forming
❖ Storming
❖ Norming
❖ Performing
❖ Adjourning
Forming – team acquaintances and
establishes ground rules. Formalities are
preserved and members are treated as
strangers.
Storming- Members start to communicate
their feeling but still view themselves as
individuals rather than part of the team. They
resist control by group leaders and show
hostility
Norming – People feel part of the team and
realize that they can achieve work if they
accept other viewpoints.
Performing – The team works in an open
and trusting atmosphere where flexibility is
the key and hierarchy is of little importance.
Adjourning – The team conducts an
assessment of the year and implements a
plan for transitioning roles and recognizing
members contributions.
INTERVENTIONS TO FACILITATE GROUP
GROWTH
1.Orientation structure, direction
2. Process, negotiate and resolve conflicts
3. Awareness of the effects behavior
4. Application of New Learning
TEAMWORK:
1. ATTITUDE- BASED COMPETENCIES
- cohesion
- commitment to teamwork
- trust
- psychological safety
- collective efficacy
2. SKILL-BASED COMPETENCIES:
- coordination
- communication
- conflict resolution
- shared leadership
- back up behavior
3.KNOWLEDGE-BASED
COMEPETENCIES
- situation awareness
- transactive memory system
- shared mental models
Collaborative Partnerships – are
agreements and actions made by consenting
Organizations to share resources to
accomplish a mutual goal. Rely on
participation by at least two parties who
agree to share resources, such as finances,
knowledge and people.
Collaboration and Partnership:
❖ Clear Goals – why are we forming a
partnership anyway?
❖ Trust – are we willing to depend on
one another? Is decision making
transparent?
❖ Clear roles – what will each of us do?
❖ Commitment – are we similarly
invested in the partnership success?
FRAMEWORK FOR “PARTNESHIP”
0. Delivery – “partnership” who
implement on our behalf or deliver
services to us.
1. Leverage Exchange – resources
from another organization that can
contribute to your work.
2. Combine Integrate - combine your
resources with those of a partner to
innovative and achieve more
efficiently, ore more effectively than
you could do alone.
3. Transform – multi actor approach to
tackle complex challenges through
systems transformation.
VII. Information Technology and
Community Health
eHealth is a relatively recent healthcare
practice supported by electronic processes
and communication, dating back to at least
1999. Usage of the term varies as it just not
covers the “ Internet medicine” as it was
conceived during that time, but also covers
“virtually everything related to computers and
medicine”
b) Power of data in Information
- decision Future
- wisdom
- knowledge
Past
- information
- data
c) E-Health Situation in the Philippine
d)Using e-Health in the Community
Typically, eHealth application uses the
internet to transmit and store patient data
either for a provider or payer. These eHealth
applications are used by doctors, hospitals,
insurance providers to record patient health
information, called protected health
information (PHI).
e) Roles of the Community Health Nurse
in e-Health
The primary role of community health nurses
is to provide treatment to patients. They plan
educational assemblies, handouts fliers,
conduct health screenings, dispense
medications and administer immunizations.
Nurses also may distribute health-related
items like condoms and pregnancy tests.
Electronic Health Management Information
Systems (eHMIS) is a facility-based data
aggregation system that is used for public
health-related decision making. ... Despite
these challenges though, electronic systems
are being adapted and implemented in
countries around the world.
WHAT IS E-HEALTH
Definition
❖ The use of Information and
communication technology (ICT) for
health (WHO,2012)
❖ Cost effective way of using ICT in
health care services, health
surveillance, health literature, health
education, and research.
E-Health can be considered in any of, but not
limited to the following:
 1. Communicating with a patient through a
teleconference, e mail, SMS
 2. recording, retrieving and mining data in
electronic medical record (EMR)
 3. providing patient teachings with the aid
of electronic tools such as radio, television,
computers, smartphones and tablets
Power of Data and Information
Data:
 Fundamental elements of cognition
(Gudea,2005)
 Unanalyzed raw facts that do not imply
meaning
Information
When meaning is attributed to data and
when data are processed and analyzed, the
data become information
Benefits of a well-managed patient
information system
1. Data are readily mapped, enabling more
targeted interventions and feedback
2. Data can be easily retrieved and
recovered
3. Redundancy of data is minimized
4. Data for clinical research becomes more
available
5. Resources are used efficiently
In order for information to be valuable,
data must have the ff. characteristic
1. Accuracy
Reflects the event as it happened
2. Accessibility
Ascertains data availability
3. Comprehensiveness
Data inputted should be complete
4. Consistency/reliability
Having no discrepancies
5. Currency
All data must be up to date and timely
6. Definition
Data should be properly labeled
E-situation in the Philippine
❖ Developing world suffers from
inadequate health care and medical
services
2001
Roughly 2.5 % of the country’s
population had internet access
2011
Steadily increased to 29 % selecting and applying appropriate ICT tools
(telecommunication union,2011
Health sector
1. Begun utilizing ICT to improve services
2. DOH introduced a number of health
information system that aim to improve the
access of health data such as the
- Electronic Field Health Service
Information System
- Online National electronic Injury
Surveillance System
- Philippine Health Atlas
- Unified Health management
Information System
- 5. Client Advocate
Using E-Health in the Community
1. Universal health Care and ICT
DOH through A.O No. 2010-0036, outlined
the policy directions of Universal Health
Care, KP Kalusugan Pangkahalahatan
Aim:
To attain efficiency by using IT in all aspects
of health care
2. Electronic Medical records
Comprehensive patient records that are
stored and access from a computer or server
3. Telemedicine
This is to reach and and provide better health
services to geographically isolated and
disadvantaged areas, to support MDG
attainment and to disseminate informations
to citizens and providers.
4. eLearning
The use of electronic tools to aid in teaching
Roles of a Community Health Nurse in
eHealth
Major Roles of eHealth Nurse in the
Philippine Community Setting:
1. Data and Records Manager
Monitor the trends of diseases through the
EMR allowing for targeted interventions for
health promotion, disease prevention,
curative services or rehabilitation
2.Change agent
- Nurses act as change agents by working
closely with the community and
implementing eHealth with them and not for
them
- Inform and guide the community in
- Collaborate with health leaders,policy
makers,stakeholders and other community
health professionals to determine their
knowledge and awareness on eHealth
3.Educator
Provide health education and families
through ICT tools
4. Telepresenter
In the event that a patient needs to be
referred to a remote medical specialist
through telemedicine
Nurse may need to present the pts. Case
noting salient points for case assessment,
evaluation and tx
Nurses safeguard patients’ records, ensuring
that security, confidentiality and privacy of all
patient information are being upheld.
6. Researcher
Responsible for identifying possible points
for research and developing a framework,
based on data aggregated by the system