- The 

Health Belief Model (HBM) is a social

COMMUNITY HEALTH NURSING-II
psychological health behavior change model developed
to explain and predict health-related behaviors,
Community Health Nursing
- World Health Organization: Community Health Nursing particularly in regard to the use of health services.

- The HBM was developed in the 1950s by social

is a special eld of nursing that combines skills of
psychologists at the U.S. Public Health Service and
nursing, public health, and social assistance and
remains one of the best known and most widely used
function.

- Dr. Ruth B. Freeman: Community Health Nursing is a theories in health behavior research

- The HBM suggests that people's beliefs about health

service rendered by a professional nurse with the
problems, perceived bene ts of action and barriers to
community, groups, families, and individuals at home, in
action, and self-e cacy explain engagement (or lack of
health centers, clinics, schools, place of work for the
engagement) in health-promoting behavior. A stimulus,
promotion of health, prevention of illness, care of the
or cue to action, must also be present in order to trigger
sick at home and rehabilitation.

- Dr. Charles Edward Winslow: It is a science and art of the health-promoting behavior.

- According to this model, your individual beliefs about

3Ps — Promotion of Health, Prevention of Illness,
Prolonging of Life
- “Every citizen has his birthright to good health and
health and health conditions play a role in determining
your health-related behaviors. Key factors that a ect
your approach to health include:

longevity.”

- Dr. Aracelie Maglaya: The utilization of the nursing ● Perceived Severity - refers to the subjective
assessment of the severity of a health problem and its
process in the di erent levels of clientele, individual,
potential consequences

family, community, and population group, and is - The HBM proposes that individuals who perceive
concerned with the promotion of health, prevention of
a given health problem as serious are more likely
disease and disability, and rehabilitation.

to engage in behaviors to prevent the health

problem from occurring (or reduce its severity). 

Fundamental Concepts of CHN - Total Number of COVID-related death in the

Philosophy, Principles, and Features
- According to Dr. Margaret Shetland, the philosophy of Philippines (As of March 19, 2021): 12, 900

- Example: If you are well aware that the total

Public Health Nursing is based on the worth and dignity
number of COVID related deaths in the Philippines
of man

- Primary Goal of CHN: To enhance the capacity of
individuals, families, and communities to cope with their
health needs.
has already gone up to almost 13,000 cases, you
may already feel the severity of the pandemic and
you will surely take caution and practice minimum

- Primary Focus of CHN: Health Promotion

health protocols.

- Ultimate Goal of CHN: To raise the level of health of the

citizenry
● Perceived Susceptibility - refers to subjective
assessment of risk of developing a health problem

- The HBM predicts that individuals who perceive

Basic Concepts and Principles of CHN Practice
that they are susceptible to a particular health
1. The Family is the unit of care; the Community is the
problem will engage in behaviors to reduce their
patient and there are four levels of clientele in
risk of developing the health problem.

community health nursing

2. The goal of improving community health is realized

through multidisciplinary e ort

3. Care must be available to all regardless of race, creed,

and status.

4. The community health nurse works with and not for

the individual patient, family, group or community. The
latter are active partners, not passive recipients of care

5. There should be an emphasis on the importance of the

“greatest good for the greatest number”

6. Priority should be given to health-promotive and

disease preventive strategies over curative
interventions

7. CHN make uses of the available community health

resources. There should be accurate recording and
reporting.
- Example: If you are an older adult and you were
8. Health teaching is a primary responsibility of a
able to see this statistic, you would probably take
community health nurse.

precaution in order not to have the disease because

you already know that people of your age group are
Theoretical Foundations of CHN Practice
most susceptible of dying from the COVID19 virus.

1. Health Belief Model

❗ Perceived Severity + Perceived Susceptibility =

Perceived Threat
- The combination of perceived severity and perceived
susceptibility is referred to as perceived threat.
Perceived severity and perceived susceptibility to a
given health condition depend on knowledge about the
condition.The HBM predicts that higher perceived
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 threat leads to a higher likelihood of engagement in
health-promoting behaviors.
in one's ability to e ect change in outcomes (i.e.,
● Perceived Bene ts
- Developers of the model recognized that con dence
self-e cacy) was a key component of health
behavior change

- Health-related behaviors are also in uenced by the

perceived bene ts of taking action.
● Modifying Factors
- If an individual believes that a particular action will - Individual characteristics, including demographic, 

reduce susceptibility to a health problem or psychosocial, and structural variables, can a ect
decrease its seriousness, then he or she is likely to perceptions (i.e., perceived seriousness,
engage in that behavior regardless of objective susceptibility, bene ts, and barriers) of health-related
facts regarding the e ectiveness of the action.
behaviors.

- Example: Individuals who believe that wearing face - Demographic variables include age, sex, race,
masks prevents COVID19 infection are more likely ethnicity, and education, among others.

to wear face mask than individuals who believe that - Psychosocial variables include personality, social
wearing face mask will not prevent infection from class, and peer and reference group pressure,
COVID19.
among others.

- Structural variables include knowledge about a

● Perceived Barriers - refer to an individual's given disease and prior contact with the disease,
assessment of the obstacles to behavior change
among other factors.

- Even if an individual perceives a health condition as
threatening and believes that a particular action will
e ectively reduce the threat, barriers may prevent
engagement in the health-promoting behavior.
barriers.
- The HBM suggests that modifying variables a ect
health-related behaviors indirectly by a ecting
perceived seriousness, susceptibility, bene ts, and

- Health-related behaviors are also a function of

perceived barriers to taking action.
2. Framework of Prevention (Nancy Milio)

- In other words, the perceived bene ts must - Nancy Milio developed a framework for prevention
outweigh the perceived barriers in order for that includes concepts of community – oriented,
behavior change to occur.
population-focused care.

- Perceived barriers to taking action include the
perceived inconvenience, expense, danger (e.g.,
side e ects of a medical procedure) and discomfort
(e.g., pain, emotional upset) involved in engaging in
the behavior.
that a main determinant for unhealthful behavioural
- Example: Lack of access to a ordable health care
- Milio stated that behavioural patterns of the
populations and individuals who make up
populations are a result of habitual selection from
limited choices. She challenged the common notion
choice is lack of knowledge.

and the perception that a COVID19 vaccine shot
will cause signi cant pain may act as barriers to
receiving the COVID19 vaccine.
determinants of a community’s health and attempt to
- Milio’s framework described a sometimes neglected
role of community health nursing to examine the
in uence those determinants through public policy.

● Cues to Action
- The HBM posits that a cue, or trigger, is necessary
for prompting engagement in health-promoting
behaviors. Cues to action can be internal or external.

- Physiological cues (e.g., pain, symptoms) are an

example of internal cues to action.

- External cues include events or information from

close others, the media, or health care providers
promoting engagement in health-related behaviors.

- Examples: A reminder postcard from a dentist, the

illness of a friend or family member, mass media
campaigns on health issues, and product health
warning labels

- Example: Let’s take for example our current situation

here in the Philippines. Recently, our country was on
headlines for having one of the longest lockdown in
the world. Ironically however, cases of positive
COVID19 continue to rise even reaching all time high
record of 7000 cases in a day. Was this caused by
the irresponsibility of the Filipino people? Are we
really hard headed citizens? Or do we just fail to see
the bigger picture that somehow, outside forces may
● Self-E cacy - refers to an individual's perception of have caused our situation, such as perhaps the
his or her competence to successfully perform a incompetence of the government? Or the lack of
behavior.
proper policies? This is exactly what Milio’s
- Self-e cacy was added to the HBM in an attempt to framework wants to highlight. Milio’s framework for
better explain individual di erences in health prevention outlines propositions that force the focus
behaviors.
of attention from an individual level to a broader level
to examine the community or society’s role. It
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 enables the CH nurse to reframe our view by 6. Positive a ect toward a behavior results in
understanding the role of social forces that have greater perceived self-e cacy, which can in turn,
limited the choices available to the parties involved.
result in increased positive a ect.

7. When positive emotions or a ect are associated

3. Health Promotion Model (Nola Pender)
with a behavior, the probability of commitment
- The Health Promotion Model was designed by Nola and action is increased.

J. Pender to be a “complementary counterpart to 8. Persons are more likely to commit to and engage
models of health protection.”
in health-promoting behaviors when signi cant
- It de nes health as a positive dynamic state rather others model the behavior, expect the behavior to
than simply the absence of disease.
occur, and provide assistance and support to
- Health promotion is directed at increasing a patient’s enable the behavior.

level of well-being.
9. Families, peers, and health care providers are
- The health promotion model is somehow very similar important sources of interpersonal in uence that
to the Health Belief Model and describes the can increase or decrease commitment to and
multidimensional nature of persons as they interact engagement in health-promoting behavior

within their environment to pursue health.

10. Situational in uences in the external environment
- Pender’s model focuses on three areas: can increase or decrease commitment to or
1. Individual characteristics and participation in health-promoting behavior.

experiences
11. The greater the commitments to a speci c plan of
2. Behavior-speci c cognitions and a ect
action, the more likely health-promoting
3. Behavioral outcomes behaviors are to be maintained over time.

12. Commitment to a plan of action is less likely to

result in the desired behavior when competing
demands over which persons have little control
require immediate attention.

13. Persons can modify cognitions, a ect, and the

interpersonal and physical environment to create
incentives for health actions.

- Community health care setting is the best avenue in

promoting health and preventing illnesses. Using
Pender’s Health Promotion Model, community
programs may be focused on activities that can
improve people’s well-being. Health promotion and
disease prevention can more easily be carried out in
the community than programs that aim to cure
disease conditions.

4. PRECEDE-PROCEED Model

- The PRECEDE-PROCEED model is a comprehensive

structure for assessing health needs for designing,
implementing, and evaluating health promotion and
- The theory notes that each person has unique other public health programs to meet those needs.

personal characteristics and experiences that a ect - PRECEDE provides the structure for planning a
subsequent actions. The set of variables for behavior targeted and focused public health program.

speci c knowledge and a ect have important - PROCEED provides the structure for implementing
motivational signi cance. The variables can be and evaluating the public health program.

modi ed through nursing actions. Health promoting

behavior is the desired behavioral outcome, which ● PRECEDE - stands for Predisposing, Reinforcing, and
makes it the end point in the Health Promotion Enabling Constructs in Educational Diagnosis and
Model. 
Evaluation

- Thirteen Theoretical Statements that come from - It involves assessing the following community
the model. They provide a basis for investigative factors:
work on health behaviors.
✺ Social Assessment: Determine the social problems
1. Prior behavior and inherited and acquired and needs of a given population and identify desired
characteristics in uence beliefs, a ect, and results.

enactment of health-promoting behavior.

✺ Epidemiological Assessment: Identify the health
2. Persons commit to engaging in behaviors from determinants of the identi ed problems and set
which they anticipate deriving personally valued priorities and goals.

bene ts.
✺ Ecological Assessment: Analyze behavioral and
3. Perceived barriers can constrain commitment to environmental determinants that predispose,
action, a mediator of behavior as well as actual reinforce, and enable the behaviors and lifestyles
behavior.
are identi ed.

4. Perceived competence or self-e cacy to execute
a given behavior increases the likelihood of
commitment to action and actual performance of
the behavior.
changes.
✺ Identify administrative and policy factors that
in uence implementation and match appropriate
interventions that encourage desired and expected

5. Greater perceived self-e cacy results in fewer ✺ Implementation of interventions.

perceived barriers to a speci c health behavior.

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 ● PROCEED - stands for Policy, Regulatory, and 3. Community-Mental Health Nursing

Organizational Constructs in Educational and - Community mental health nursing involves

Environmental Development
specialized nurses who provide wholistic nursing
- It involves the identi cation of desired outcomes services for people with mental health issues, in a
and program implementation: community setting. They usually provide caring and
✺ Implementation: Design intervention, assess con dential supports for clients, using the recovery
availability of resources, and implement program.
model for care.

✺ Process Evaluation: Determine if program is - The services provided by the Community Mental

reaching the targeted population and achieving Health Nursing Program include:
desired goals.
● Treatment Planning

✺ Impact Evaluation: Evaluate the change in ● Medication Management

behavior.
● Assessment

✺ Outcome Evaluation: Identify if there is a decrease ● Counseling

in the incidence or prevalence of the identi ed ● Family Support

negative behavior or an increase in identi ed ● Education

positive behavior.
● Group Support

● Facilitate services with visiting Psychiatrists

- The PRECEDE–PROCEED model is a participatory

model for creating successful community health Community
promotion and other public health interventions. It is - It is a social group determined by geographical
based on the premise that behavior change is by and boundaries and/or common values and interest.

large voluntary, and that health programs are more likely
to be e ective if they are planned and evaluated with the
active participation of those who will implement them,
and those who are a ected by them.
2009)
- A collection of people who interact with one another and
whose common interests or characteristics form the
basis for a sense of unity or belonging (Allender et.al.,

- Thus, it looks at health and other issues within the
context of the community. Interventions designed for
behavior change to prevent injuries and violence, to
improve heart health, and to improve and increase
scholarly productivity among health education faculty,
are among more than 1000 published applications
developed or evaluated using the PRECEDE–PROCEED
- A group of people who share common interests, who
interact with each other  and who function collectively
within a de ned social structure to address common
concerns and a locality-based entity, composed of
systems of formal organizations re ecting society’s
institutions, informal groups and aggregates (Shuster and
Goeppinger, 2008).

model as a guideline.

Types of Communities
Di erent Fields of Community Health Nursing 1. Geopolitical/Territorial Communities

1. School Health Nursing

- Formed by both natural and man-made boundaries

- School nursing is a specialized practice of - Ex: Barangays, municipalities, cities, provinces,

professional nursing that advances the well being, regions and nations

academic success, and life-long achievement of

students. To that end, school nurses facilitate 2. Phenomenological Communities

positive student responses to normal development; - Relational/ interactive group; functional communities

promote health and safety; intervene with actual and - People share a group perspective or identity based on
potential health problems; provide case management culture, values, history, interest and goals

services; and actively collaborate with others to build - Ex: Schools, colleges, universities, churches,
student and family capacity for adaptation, self mosques

management, self advocacy, and learning.

- This de nition was adopted at the NASN Board of 3. Urban

Directors meeting in Providence, Rhode Island in - High density, a socially homogenous population and a
June 1999
complex structure, non-agricultural occupations;
something di erent from an area characterized by
2. Occupational Health Nursing
complex interpersonal social relations

- The American Association of Occupational Health - Quality of life that is typically found in cities

Nurses describes occupational health nursing as a - A number of people are not engaged in the collection/
way to provide for and deliver health and safety production of food

programs and services to workers, worker

populations and community groups.
4. Rural

- The practice focuses on promotion and restoration - Usually small and the occupation of the people is
of health, prevention of illness and injury, and usually farming, shing and food gathering

protection from work-related and environmental - It is peopled by simple folks characterized by primary
hazards. 
group relation, well- knit and having a degree of group
- Occupational health nurses work in manufacturing feeling

and production facilities, hospitals and medical

centers as well as in other employment sectors, 5. Rurban

including government.
- A combination of rural and urban community

- Workplace activities might include health and
wellness, case management, ergonomics, workplace
safety, infection control, disaster preparedness and
others such as travel health.
often clash
- Outskirts; can be described as the "landscape
interface between town and country", or also as the
transition zone where urban and rural uses mix and

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 De ning Attributes 9. A healthy community promotes a high-level wellness
● People - “core” that makes up the community
among all its members.

● Place
● Interaction - From Hunt, 1997; Duhl, 2002
● Common characteristics, interests, and goals 10. A shared sense of being a community based on history
and values.

Subsystems of a Community 11. A general feeling of empowerment and control over

1. Housing
matters that a ect the community as a whole

- The type and characteristics of housing facilities in 12. Existing structures that allow subgroups within the
the community
community to participate in decision making in
- Availability of housing facilities
community matters.

- Presence of housing laws/ regulations governing the 13. The ability to cope with change, solve problems and
people.
manage con icts within the community through
acceptable means.

2. Education
14. Open channels of communication and cooperation
- Laws, regulations, facilities, activities a ecting among the members of the community

education
15. Equitable and e cient use of community resources

- Ratio of health educators to learner

- Distribution of educational facilities in the community

Conditions in the Community A ecting Health
- Presence of informal educational facilities and 1. PEOPLE

activities existing in the community

● Size and Density - a ects the number and size of health
care institutions

3. Fire and Safety

✺Overcrowding

- Availability and accessibility of re protection and - Easy spread of communicable diseases

safety services and facilities

- Increase stress among members of the community

- Rapid degradation of housing facilities, water, air,

4. Politics and Government
and soil pollution

- Existing political structure, decision-making process/ ✺Sparsely Populated Areas

pattern, leadership styles observed
- Limited Resources - di culty in providing health
services

5. Health

- Health facilities and services/ activities

● Composition
- Availability and accessibility
- Health needs of a community may vary because of
- Ratio of providers and clients availing of the service
di erences in population composition by:

✺Age

6. Communication
✺Sex

- Systems, types of forms of communication existing ✺Occupation

and how these in uence community health

✺Level of education

- Ex 1: A community with a large number of WRA has

7. Economics
di erent needs compared to a community with a large
- Occupation, types of economic activities engaged by number of elderly people

the people
- Ex 2: Community of farmers vs large number of
professionals

8. Recreation

- Recreational activities and facilities including types of ● Rapid Growth of Population

consumers, appropriateness of recreational activities
to consumers
in population ➞ Increase demands for health services
Characteristics of a Healthy Family
- Migration of large number of people ➞ Rapid increase
that some existing health care institutions may nd hard
to cope with

1. A healthy community prompts its members to have a

high degree of awareness that “we are community”.
● Rapid Decline of Population
2. A healthy community uses its natural resources while - Disasters, political instability, economic changes ➞
taking steps to conserve them for future generations.
Decrease economic activity in the community and lower
3. A healthy community openly recognizes the existence of government revenue ➞ Decrease resources accessible
sub-groups and welcomes their participation in to the community

community a airs.

4. A healthy community is prepared to meet crises.

● Multicultural
5. A healthy community has open channels of - Challenging and requires cultural competence on the part
communication that allows information to ow among of the nurse and other members of the health care team

all sub-groups of its citizens and in all directions.

6. A healthy community seeks to make each of its ● Mobility - the feeling of belongingness and participation
system’s resources available to all members of the in community action are less likely if there’s a large
community.
number of new or transient residents

7. A healthy community has legitimate and e ective ways

to settle disputes and meet needs that arise within the ● Social Class and Educational Level
community.
- A ects health because of di erences in living conditions
8. A healthy community encourages maximum citizen and degree of access to resources and opportunities

participation in decision-making
- Distinctive health problems

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 2. LOCATION
● Physical Determinants of Health
● Climate ✺ Natural environment (trees, grass)

- (Tropical climate - Philippines)

✺ Built environment (buildings, sidewalks, bike lanes.
- Temperature and humidity
Roads)

- Climate change
✺ Worksites, school, recreation settings

- E ects of Climate Change: ✺ Housing and community designs

✺Temperature spike ✺ Exposure to toxic substances and physical hazards

✺Seasonal diseases - sore eyes, heat stroke, skin ✺ Physical barriers (person with disabilities)

conditions like prickly heat during hot seasons, ✺ Aesthetic elements (good lighting, trees, benches)

increase cases of respiratory and vector0borne ✺ Economic stability

infections
1. Employment

2. Food security

● Flora and Fauna 3. Housing

● Community Boundaries (Urban/Rural) 4. Poverty

- Open spaces
✺ Education
- Quality of soil
1. Early Childhood Education and Development

- Air and water

2. Enrollment in Higher Education

- Location of health facilities

3. High school Graduation

4. Language and Literacy

● Geographic Features ✺ Health and Healthcare

- Land and water forms that in uence food sources and 1. Access to health care

prevalent occupations in the community

2. Access to Primary Care

3. Health Literacy

- The National Statistical Coordination Board of the ✺ Neighborhood and Built in Environment
Philippines (NSCBP) rede ned an urban area as a 1. Access to foods that support healthy eating
barangay that has a:
patterns

● Population of 5,000 or more

2. Crime and violence

● At least one business establishment with a minimum 3. Quality of Housing

of 100 employees or 5 or more establishments with a

minimum of 10 employees
Principles of Community Health Nursing
● 5 or more facilities within the 2-km radius from the 1. Focus on the community as the unit of car

barangay hall
- The nurse’s responsibility is to the community as a
whole.

3. SOCIAL SYSTEM - is the patterned series of

interrelationships existing between individuals, groups 2. Give priority to community needs

and  institutions forming a coherent whole

- The CHN marry skills in the nursing process with
● Social Determinants of Health
- Conditions in the environments in which people are born,
live, learn, work, play, worship and age that a ect a wide
range of health, functioning and quality of life outcomes
population-focused skills to produce the greatest
bene t for the majority of the community. The use of
assessment tools such as demographics and vital
statistics to determine health needs of the community
as a whole.

and risks

- Conditions (economic, social and physical) in various 3. Work with the community as an equal partner of the
environments and settings (church, workplace and health team

neighborhood)
- Team approach is evident in community health work.
- Examples:
The nurse serves as a liaison o cer of the health
✺ Availability of resources to meet daily needs (safe team. Partnership between health workers and the
housing)
community from assessment to evaluation is more
✺ Access to educational, economic and job likely to produce e ective and sustainable results

opportunities

✺ Access to health care services

4. In selecting appropriate activities, focus on primary
✺ Quality of education and job training
prevention

✺ Availability of community-based resources in support - Strategies to promote optimal health, prevent disease
of community living and opportunities for recreational and disability

and leisure-time activities

✺ Transportation options
5. Promote a healthful physical and psychosocial
✺ Public safety
environment

✺ Social support
- Strategies to concentrate on environmental
✺ Social norms and attitudes (discrimination, racism, determinants of health

distrust of government)

✺ Exposure to crime, violence and social disorder 6. Reach out to all who may bene t from a speci c
(presence of trash, lack of cooperation in the service

community)
- Active case nding and outreach activities

✺ Socioeconomic conditions (concentrated poverty)

✺ Residential segregation
7. Promote optimum use of resources

✺ Language literacy
- Results of studies on best practices in community
✺ Access to mass media and emerging technologies health should be disseminated and utilized where
(cellphones, internet, social media
applicable

✺ Culture

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 8. Collaborate with others working in the community
- The model implies that each must be analyzed and
- Nurse must work with a variety of sectors. understood for comprehensions and prediction of
Community health e orts have to be coordinated.
patterns of a disease.

- A change in any of the component will alter an existing

Epidemiology equilibrium to increase or decrease the frequency of the
Epidemiology disease.

- Originated from the Greek words “epi” meaning upon,

“demos” meaning people and “logos” meaning study
● Host - any organism that harbors and provides
- Study of occurrences and distribution of diseases as well nourishment for another organism

as the distribution of the determinants of health states or ● Agent - intrinsic property of microorganism to survive
events in speci ed population and the application of this and multiply in the environment to produce disease.

study to the control of health problems

● Environment - the sum total of all external condition and
● Study of the distribution of disease - distribution of in uences that a ects  the development of an organism
health status in terms of age, gender, race, geography, which can be biological, social and physical

time etc.

● Search for the determinants (causes) of the - Epidemiology approach is based on the interaction of the
disease - explanation of patterns of disease host, causative agent, and the environment

distribution in terms of causal factors

- Classi cation of Agent, Host, and Environment
- Backbone of the prevention of disease
A. Agents of Disease

- In order to control a disease e ectively, the conditions ● Nutritive elements (Cholesterol, vitamins, protein)

surrounding its occurrence and the factors favoring ● Chemical agents (Carbon monoxide, drugs)

the development of the disease must be rst known.

● Physical agents (Heat, light, radiation)

● Infectious agents (Virus, bacteria, fungi)

- Practical Application of Epidemiology

● Assessment of the health status of the community/ B. Host Factors (Intrinsic)

community diagnosis
● Genetic

● Elucidation of the natural history of disease

● Age

● Immunology

Stage of Stage of Stage of Resolution

● Human behavior (Hygiene, food handling)

Susceptibility Subclinical Clinical Stage

Disease Disease
C. Environmental Factors

A.k.a ● Physical Environment (Geology, climate)

Prepathogene ● Biologic Environment (Human population, source

sis Stage of food)

● Socio-economic Environment (Occupation,

Person is not Person is Patient Patient disruptions-wars)

yet sick but healthy. manifest either

maybe Pathologic recognizabl recovers Disease Distribution
exposed to the changes e signs and completely, 1. Time - refers both to the period during which the
risk factors of have symptoms
becomes cases of the disease being studied were exposed to
the disease
occurred.
chronic the source of infection and during which the illness
case with occurred

Primary level or without ● Epidemic Period - period during which the reported
of prevention Secondary Tertiary disability or number of cases of a disease exceed the unexpected
(health level of level of dies. or usual number for that period

education, prevention prevention ● Year - frequency of occurrence

immunization) ● Period of Consecutive Years - predicting the

probable future incidence of disease

- Examples:

✺Prepathogenesis Stage - multiple sex partners

2. Persons - characteristics of the individual who were
✺Subclinical Stage - Pap smear
exposed  and who contacted the infection or the
✺Clinical Disease - Vaginal bleeding — limit disease in question

disability and restore functional capability of the - Examples: Sex, occupation, age — considered the
patient. (e.g. Support group)
single most useful variable associated in describing
the occurrence and distribution of disease

● Determination of disease causation

● Prevention, control, monitoring and evaluation of health 3. Place - refers to the features, factor or conditions
interventions
which existed in or described the environment in
● Provision of evidence for policy formulation
which the disease occurred.

- Geographic area (street, address, city, municipality,
Epidemiologic Triangle province, region, country)

- Example: Urban/Rural Area - disease spreads more

rapidly in urban areas than in rural areas — greater
population density

Patterns of Occurrence and Distribution

1. Sporadic - Intermittent occurrence of few isolated and
unrelated cases in a given locality

- Occurs infrequently/irregularly

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 - Example: Rabies, polio, meningitis, tetanus, food- - Use of Vital Statistics:
borne pathogens (Salmonella, E. coli)
1. Indices of the health and illness status of a
community

2. Endemic - continuous occurrence throughout a period - Statistics of disease (morbidity) and death
of time of the usual number of cases in a given locality
(mortality) indicate the state of health of a
- Always occurring in the municipality
community and the success or failure of health
- Level of occurrence maybe high or low; already work.

identi able
2. Serves as a basis for planning, implementing,
- Examples: Schistosomiasis (Leyte and Samar); monitoring, evaluating community health nursing
Filariasis (Sorsogon)
programs and services

3. Epidemic - unusually large number of cases in a Sources of Data

relatively short period of time
● Census

- Example: Dengue
● Hospital data

● Vital registration system

4. Pandemic - simultaneous occurrence of epidemic of ● Disease noti cation

the same disease in several countries

● Disease registries - compilation of information about a
- Examples: Coronavirus, AIDS EBOLA virus, SARS.. particular disease

AH1N1
● Surveillance system

● Health insurance

5. Cluster - refers to a disease that occurs in larger ● School health program

numbers even though the actual number/ cause may ● Surveys (morbidity, demographic)

be uncertain
● Downloadable data sets

- Example: Cluster of cancer cases reported after a

chemical/nuclear plant disaster
A. Rate - shows the relationship between a vital event
Health Indicators - quantitative measures, usually
expressed as rates, rations or proportions that describe and
and those persons exposed to the occurrence of said
event within a given area and during a speci ed unit of
time

summarize various aspects of the health status of the - Numerator - person experiencing the event

population
- Denominator - total population exposed to the risk
- Types:
of same event

1. Heath Status Indicators (Morbidity)

● Prevalence
B. Ratio - used to describe the relationship between two
● Incidence
(2) numerical quantities or measures of events without
2. Health Status Indicator (Mortality)
taking particular considerations to the time or place

● Crude death rate

● Speci c death rate

C. Crude/General Rates - referred to the total living
● Maternal mortality rate
population

● Infant mortality rate

● Neonatal mortality rate

D. Speci c Rate - the relationship is for speci c
population class/group

Morbidity Indicators - based on the disease-speci c

incidence or prevalence for the common and severe E. Crude Birth Rate - a measure of one characteristic of
diseases
the natural growth or increase of a population

- Examples: Malaria, diarrhea, leprosy, dengue, diabetes

- Measures how fast are people added to the
- 10 leading causes of morbidity and mortality
population through births.

- Measure of population growth

● Prevalence - Measures the total number of existing - Formula:

cases of a disease at a particular point in time

● Incidence - Number of new cases, episodes or

events occurring over a speci ed period of time

Mortality Indicators F. Crude Death Rate - a measure of one mortality from

- Death is the most serious outcome of a morbid episode, all causes which may result in a decrease in 
mortality statistics provide important information of the population

health status of the people in the community.

- Formula:

- The pattern of causes of death indicate the most-life

threatening diseases that are prevalent in the
community.

Vital Statistics G. Infant Mortality Rate - measures the risk of dying

● Statistics - systematic approach of obtaining, during the rst year of life

organizing and analyzing numerical facts so that - Good index of the general health condition of a
conclusion may be drawn from them
community since it re ects the changes in the
environment and medical condition of a community

● Vital Statistics - systematic study of vital events such - Good index of the level of health in a community
as births, illnesses, marriages, divorce, separation and because infants are very sensitive to adverse
deaths
environmental conditions

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 - High IMR = low levels of health standards secondary 3. Area Diagram/Pie Charts - shows the relative
to maternal health, child care, nutrition, sanitation, importance of parts to the whole

health care delivery service

- Pie Chart - show percentage distribution or
- Formula:
composition of a variable

- Diagram - show correlation between two variables

Functions of the Nurse

1. Collect data

H. Maternal Mortality Rate - measures the risk of dying 2. Tabulates data

from causes related to pregnancy, childbirth and 3. Analyze and interpret data

puerperium
4. Evaluates data

- Index of the obstetrical care needed and received by 5. Recommends redirection/ strengthening of speci c
woman in a community
areas of health programs as needed
- Formula:

I. Fetal Death Rate - measures pregnancy wastage

- Death of the product of conception occurs prior to

its complete expulsion, irrespective of duration of
pregnancy

- Formula:

J. Neonatal Death Rate - measures the risk of dying

during the rst month of life

- It serves as an index of the e ects of prenatal care

and obstetrical management of the newborn.

- Formula:

● Speci c death rate (Speci c population groups)

● Case speci c death rate (Speci c causes)

● Age speci c death rate

● Sex speci c death rate

❗ Denominator - always total population of the same

calendar y

K. Incidence Rate - measures the frequency of

occurrence of the phenomenon during a given period
of time

- Formula:

L. Prevalence Rate - measures the proportion of the

population which exhibits a particular disease at a
particular time

- Formula:

Presentation of Data
1. Line or Curved Graphs - shows peaks, valleys, and
seasonal trends

- Visual image of data over time or age-appropriate for

time series

2. Bar Graph - represents or expresses a quantity in

terms of rates or percentages of a particular
observation

- Compare values across di erent categories of data

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