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•
KEY CONCEPTS
• Community is a member of the
The Community health team
• Partnership between health
• groups of people that may or may not be workers and the community from
spatially connected, but who share assessment to evaluation
common interests, concerns or identities • For effective and sustainable
(WHO) results
• local, national, or international with 2. In selecting appropriate activities, focus on
specific or broad interest primary prevention
• has common interests or characteristics: • Strategies to promote optimal
o interacts with one another. health and prevent disease and
o has a sense of unity or belonging. disability and preventive
o functions collectively within a treatment of disease
defined social structure to address
common concerns. 1. Promote a healthful physical and
• Described in terms of: aggregate of people, psychosocial environment
location in space and social system • Strategies to concentrate on the
determinants of health
AGGREGATE 2. Reach out to all who may benefit from a
specific service
• a community composed of people who • Active case-finding and outreach
have similar demographic characteristics activities
(age, sex, ethnic background, or common 3. Promote optimum use of resources
activities concerns and goals • Use resources for strategies that
• Examples: senior citizens, pregnant teens, will produce long-term effects,
out-ofschool youth – the nurse can take consider ethical principles
each one as a community 4. Collaborate with others working in the
community
LOCAL IN SPACE • Work with variety of sectors in
resolving issues
• Physical location or geographical
boundaries, geopolitical communities
(barangays, cities) CHARACTERISTICS OF A HEALTH
COMMUNITY

SOCIAL SYSTEM • A shared sense of being a

community based on history and
• the relationship of members that forms one
values.
another
• A general feeling of empowerment
• Interaction of members to fulfill their
and control over matters that
essential functions
affect the community as a whole
• a school, marketplace, workplace
• Existing structures that allow
subgroups within the community
THE PRINCIPLE OF CPHN
to participate in decision making
1. Work with the community as an equal in community matters
partner of the health team • The ability to cope with change,
• Team approach solve problems, and manage

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conflicts within the community
through acceptable means.
• Open channels of communication
and cooperation among members
of the community.
• Equitable and efficient use of
community resources, with the
view towards sustaining natural
resources.
COMMUNITY ASSESSMENT
DIAGNOSIS
Assessing community health
• A process of understanding the community,
identifying its needs or weaknesses and
assets or strengths
• The fundamental steps to support the
action of the community health nurse in
planning and implementing interventions
• Aka community health needs assessment
COMMUNITY ASSESSMENT
• Data to be collected depends on the
objectives of the community assessment
• Data collection on the 3 features: people,
location/place and social system
• Planned Approach To Community Health
(PATCH) could be used
1. Community Profile
2. Morbidity and Mortality
3. Behavioral Data
4. Opinion data from community leaders
APPROACHES TO COMMUNITY
ASSESSMENT
1. Comprehensive needs assessment
• gathers information about the
entire community
• a systematic process
• data are collected regarding all
aspects of the community
• to identify actual and potential
health problems
• requires much time, effort and
resources
• useful if assessment is done for the
first time
2. Problem – oriented needs assessment
• focused on a particular aspect of
health
• gather information from the
aggregate vulnerable group
• doable when a comprehensive
& assessment has been done
To consider in community assessment:
➢The size of the
community/aggregate
➢ The resources available
DATA SOURCES
1. Primary data
- from the community itself
- collected by the nurse through
observation, survey, informant
interviews, community forum,
FGDs
2. Secondary data
- taken from existing data sources
- vital registries, health
records/reports, publications
- Allows the nurse a picture of
what is already known
COLLECTING PRIMARY DATA
❖ OBSRVATION
- environmental conditions and
facilities
- nurse spots vulnerable groups: the
young, the elderly, the pregnant
women
- Terrains, general conditions of
homes, housing densities,
cleanliness
- barangay halls, health facilities,
schools, places of worship,
recreational places
- Participant observation
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❖ SURVEY
- A series of questions for systematic
collection of information from samples
- Random or purposive samples
- Written or oral
- Used to determine community attitudes,
knowledge, health behaviors
- Could be used to identify patterns of
utilization of health services
❖ INFORMANT INTERVIEW
- Purposeful talks with key informants or
ordinary members if the community
- Key informants: formal and informal
leaders, persons with position and
influence
- Structured or unstructured
❖ COMMUNITY FORUM
- Open meeting of the members of the
community
- Ex: Pulong-pulong sa barangay
- Provides the people a medium to express
their opinions, express their views and
develop their capacity to influence
decision-makers
- Also a venue for informing the community,
data validation, getting feedbacks
❖ FOCUS GROUP
- Made up of a smaller group (6-12 members)
- Homogeneous
- Assessment in health needs of specific
groups in the community
SOURCES OF SECONDARY DATA
❖ Registry of civil status
- Local civil registry
- PSA
- Provides a realistic basis for program
planning and implementation
- Birth and death registry
- Low compliance rate to registration
requirements
- Increase people’s awareness on civil
registration and guide them through the
process
- Facility-based births – the facility is
responsible to register within the next 30
days
- Death certificate before burial – certificate
prepared by the physician and forwarding
to the health officer within 48 hours; if not
attended to – the closest relative
- Registration of death – made within 30
days
❖ HEALTH RECORD AND
REPORTS
- Field Health Service Information
System (FHSIS) is the official
recording and reporting system of the
DOH and is used by the PSA for
health statistics as specified by the EO
352
- FHSIS – an essential tool in
monitoring the health status of the
population at different levels, a basis
for
1. priority setting of the LGU
2. planning and decision-making
3. monitoring and evaluating health
program implementation
❖ DISEASE REGISTRIES
- Listing of persons diagnosed with a specific
type of disease in a defined population
- For monitoring, decision-making and
program management
- HIV/AIDS, NCDs
❖ CENSUS DATA
- A periodic government enumeration of the
population
- PSA
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8 STEP TO COMMUNITY
ASSESSMENT
Step 1: Identify and engage stakeholders
- Total population? Aggregate?
Step 2: Define the community
- Is the community rural or urban?
- Environmental condition – sanitation,
congestion
Step 3: Collect and analyze data
Collection
COMMUNITY DIAGNOSIS
- What are the appropriate data to be
collected?
- Primary and/or secondary data?
- Timeliness, completeness, accuracy,
precision, relevance and adequacy
Analysis
- Sort, classify/group data
- Relate and interpret for significance
- Compare data
Step 4: Select priority health issues
- Which problem is of importance to the
community
- Ability to reduce risk
- The cost
- Target population
- Availability of resources
Step 5: Document and communicate
- Through a community assemble
- All the community health concerns are
presented
- How they will act on the concerns
Step 6: Plan improvement strategies
- Encourage all active community members
to come together
- Identify strategies to reduce/solve their
health concern
Step 7: Implement improvement plans
- All community members as possible
headed by active members
- Healthcare team facilitates
implementation
Step 8: Evaluate progress
- The healthcare team and the community
- Determines whether the objective sets
were implemented as planned
- Utilization of resources (time, money,
effort)
- The process of determining the health
status of the community
- Applied both to the process of
determination and to its findings
- A quantitative and qualitative description
of the health of citizens and the factors that
influence their health
- Making a judgement about the
community’s health status, resources, and
health action potential or the likelihood
that the community will act to meet health
needs or resolve health problems C
❖ NANDA
- Adaptation of the nursing diagnosis format
for population group
- Statement: The health risk or specific
problem to which the community is
exposed + the specific aggregate or
community with whom the nurse will be
working with to deal with the risk/problem
+ related factors that influence how the
community will respond to the health
risk/problem
- Example: Risk of maternal complications
leading to maternal mortality among
pregnant women of Brgy. A related to cost
and inaccessibility of skilled birth
attendance and the community members’
perception that SBA and facility-based
delivery are not necessary during childbirth.
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❖ THE OHAMA SYSTEM
A comprehensive and research-based classification
system for client problems

❖ SOCIAL DIAGNOSIS
Represents the impact of the health problem in
terms of overall quality of life of the people in the
community

IDENTIFYING OF THE
COMMUNNITY HEALTH NURSING
PROBLEM
A. Health status problems
- morbidity, mortality, fertility or reduced
capability for wellness
B. Health resources problems
- Lack of or absence of manpower, money,
materials or institutions necessary to solve
health problems
C. Health-related problems
- Existence of social, economic,
environmental and political factors that
aggravate the illness-inducing situation/s
PRIORITY SETTING
A. Nature of the condition/problem
presented
- Health status, health resources or health-
related problems
B. Magnitude of the problem
- Severity of the problem in terms of the
proportion of the population affected
C. Modifiability of the problem
- Probability of reducing, controlling or
eradicating the problem
D. Preventive potential
- Probability of controlling or reducing the
effects posed by the problem
E. Social concern
- Perception of the population/community
as they are affected by the problem and
their readiness to act on the problem
PLANNING, IMPLEMENTING AND
EVALUATING COMMUNITY
HEALTH INTERVENTIONS
PLANNING
- Based on findings from assessment and
diagnosis
- A logical process of decision making to
determine which of the identified health
concerns require more immediate
consideration (priority-setting) and what
actions may be undertaken to achieve goals
and objectives
- Involves priority-setting, formulating goals
and objectives and identifying community
interventions
- Require active participation of the people
- Ensure that representatives from the
community are involved at all stages of
planning and implementation
1. PRIORITY SETTING
- Requires the joint effort of the community,
the nurse and other stakeholders (other
members of the healthcare team)
- Each member is to be given equal voice in
decision making
CRITERIA FOR PRIORITY SETTING
(WHO)
• Significance of the problem – based on the
number of people affected; prevalence rate;
people at risk

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• Level of community awareness of the - Assists in designing, implementing, and
problem and the priority its members give evaluating health promotion and public
to the health concern - community health programs to meet those needs
motivation to act on the problem or is this - PRECEDE (Predisposing, Reinforcing,
important to the community? and Enabling Constructs in Educational
• Ability to reduce risk and/or influence Diagnosis and Evaluation) assesses the
the solution – related to the availability of diagnostic and planning process to assist in
expertise (health team and community); the development of focused public health
health team’s level of influence in decision programs
making - PROCEED (Policy, Regulatory, and
• Cost of risk reduction – Organizational Constructs in Educational
economic/financial, social, and ethical and Environmental Development) guides
requisites and consequences of health the implementation and evaluation of the
concern programs
• Ability to reduce risk – related to the - an approach to planning that examines
availability of expertise factors contributing to behavior change:
Predisposing factors, Enabling factors, and
• Ability to identify the target population
Reinforcing factors
for the intervention – availability of data
- These factors require that individuals be
sources (FHSIS, census, survey reports,
considered in the context of their
casefinding, screening tools ▪ Availability
community and social structures, and not
of resources to intervene
in isolation, in the planning of
2. Formulating goals and objectives
communication or health education
- Goals: desired outcomes at the end of
strategies
interventions
- Objectives: short-term changes that are
observed towards attainment of the goals
- Active participation of the community
- SMART objectives: specific, measurable,
attainable, relevant and time-bound
3. DECIDING ON COMMUNITY
INTERVENTIONS
- Analyze the reasons for people’s health
behavior and directs strategies to respond
to the underlying causes
- Consider demographic, psychological,
social, cultural and economic
characteristics of the target population and • Predisposing factors: the knowledge,
the available health resources attitudes, behavior, beliefs, and values
before intervention that affect willingness
PLANNING MODEL IN to change
COMMUNITY HEALTH • Enabling factors: the
INTERVENTIONS environment/community of individual
that facilitates or presents obstacles to
PRECEDE-PROCEED Model change
• Reinforcing factors: The positive and
- Provides structure for assessing health and
negative effects of adapting new behavior
quality of life need
(including social support).

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A. Predisposing, Reinforcing, and Enabling
Constructs in Educational Diagnosis and
Evaluation (PRECEDE). It involves
assessing the following community factors:
❖Social assessment: Determine the social
problems and needs of a given population
and identify desired results.
❖ Epidemiological assessment: Identify
the health determinants of the identified
problems and set priorities and goals.
❖ Ecological assessment: Analyze
behavioral and environmental
determinants that predispose, reinforce,
and enable the behaviors and lifestyles are
identified.
❖ Identify administrative and policy
factors that influence implementation and
match appropriate interventions that
encourage desired and expected changes.
❖ Implementation of interventions.
B. Policy, Regulatory, and Organizational
Constructs in Educational and
Environmental Development
(PROCEED). It involves the identification
of desired outcomes and program
implementation:
❖ Implementation: Design intervention,
assess availability of resources, and
implement program.
❖ Process Evaluation: Determine if
program is reaching the targeted
population and achieving desired goals.
❖ Impact Evaluation: Evaluate the change
in behavior.
❖ Outcome Evaluation: Identify if there is
a decrease in the incidence or prevalence of
the identified negative behavior or an
increase in identified positive behavior
PATCH MODEL
- Planning Approach to Community Health
- Based on the PRECEDE model
- Health promotion is a process that enables
the population to have more control over
its own health
- Elements:
• Community participation
• Use of data to develop
comprehensive health strategies
PATCH MODEL
A. Mobilizing the community
B. Collecting health data
C. Selecting health priorities
D. Developing a comprehensive intervention
plan
E. Evaluating the process
Other Models
➢ Assessment Protocol for Excellence in
Public Health (APEX-PH) program
➢ Mobilizing for Action Through Planning
and Partnerships (MAPP) model
4. Planning strategies for community health
interventions
- Planning strategy: a disciplined process
aimed at producing fundamental decisions
and actions that will shape and guide what
an organization is, what it does, and why it
does.
- Overall goal: To enhance community
access to healthcare in order to improve
productivity and thus reducing poverty,
hunger, and child and maternal deaths;
and to improve education performance
across all stages of the life cycle
5 STEPS STRATEGY TO PLANNING
1. Determine where you are.
✓ Conduct external and internal audits of
the community
✓ Audit your real competencies
2. Identify what is important.
✓ Focus on where you want to take your
community
✓ Define your vision/mission
3. Define what you must achieve.
4. Determine who is accountable.
5. Review.
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IMPLEMENTATION • Focus: the population and not individuals
• Follows the scientific method
- The action phase • Scope: diseases and health-related states or
- Intended to enhance the community’s events
capacity in dealing with common health
conditions/problems.
- Nurse is to facilitate the process

EVALUATION
- an important component for determining
the success or failure of a project and
understanding the factors that contributed
to its success or failure
- Structure evaluation: looking into the
manpower and physical resources of the
agency responsible for community health
intervention
- Process evaluation: examining the
manner by which assessment, diagnosis,
planning, implementation and evaluation
were undertaken; aka formative evaluation
- Outcome evaluation: determining the USES OF EPIDEMIOLOGY
degree of attainment of goals and ➢ Assessment of health status of populations
objectives - to describe the health status of population
- Monitoring/Ongoing evaluation: done groups
during the implementation to provide - to determine priority health programs
feedback on compliance to the plan as well - to understand diseases and health-related
as on need for changes in the plan to behaviors that lead to poor health
improve the process and outcomes of
interventions
LEVEL OF DISEASE OCCURRENCE
Sporadic - infrequently and irregularly
STANDARD OF EVALUATION
A. UTILITY – usefulness of results; insight Endemic - constant presence and/or usual
into strengths, and weaknesses of the plan prevalence in a population within a geographic area
and the manner of its implementation
B. Feasibility – whether plan is doable or not, Epidemic - increase in cases above what is normally
considering available resources expected in a population in an area
C. Propriety – ethical and legal matters
Outbreak - same with epidemic but often used for
D. Accuracy – accuracy and validity of the
a more limited geographic area
results of evaluation
Cluster - aggregation of cases greater than the
EPIDEMIOLOGY expected

the study of the distribution and determinants of Pandemic - an epidemic that has spread over
health-related states or events in specified several countries or continents, affecting a large
populations, and the application of this study to the number of people
prevention and control of health problems

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NATURAL HISTORY O F DISEASES
- the progression of diseases in an individual
over time in the absence of treatment

SCREENING AND SURVEILLANCE

Screening
- Active search or process of detection for
disease or disorders among apparently
healthy people
- To identify risk factors and diseases in their
earliest stage
Surveillance
- The systematic, ongoing and analytic
process of monitoring to scrutinize disease
condition
- Involves investigating the distribution and
possible causes of diseases and conditions
within the population

MODELS OF DISEASES CAUSATION LEVELS OF PRENVENTION IN THE

CONTEXT OF EPIDEMIOLOGY
risk factors and the conditions that surround them
that lead to a disease or poor health

TYPES OF STUDIES IN
EPIDEMIOLOGY
Descriptive epidemiology

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• Describes disease distribution by
characteristics relating to time, place, and
people
• Review of records, routine data collection
or ecological surveys
• Evaluates frequency and pattern
• What = health issue of concern
• Who = person
• Where = place
• When = time Why/how = causes, risk
factors, modes of transmission

Analytical epidemiology

• Aims to understand the quality and the

amount of influence that determinants
have on the occurrence of disease or
health-related event
• experimental
• observational

vital statistics

the study of the characteristics of human

populations HEALTH EDUCATION AND
LITERACY
• Population indicators
• Mortality indicators Morbidity rates HEALTH EDUCATION

• Health education is any combination of

learning experiences designed to 4
predispose, enable, and reinforce
voluntary behavior conducive to health in
individuals, groups, or communities
• Gardner (1936) emphasized that health
teaching is one of the most fundamental
nursing principles and that "a nurse, in
even the most obscure position must be a
teacher of no mean order."
• Its goal is to understand health behavior
and to translate knowledge into relevant
interventions and strategies for health
enhancement, disease prevention, and
chronic illness management
• Nurses have significant roles in providing
contextually appropriate health education,
which involves practical, relevant, and
scientifically sound methods that fit the

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lives and learning needs of diverse groups
across the lifespan
THEORITICAL UNDERPLANNING OF
HEALTH EDUCATION
Kowles’s Assumptions about Adult learner
• Need to know - why they need to learn
• Concept of self - create an environment to
expresxs self
• Experience - facilitate connection between
past and present experience
• Readiness to learn - development taks and
social roles
• Orientation to learning - learning needs
• Motivation - what promotes and block
motivation
HEALTH EDUCATION MODELS
BEHAVIORISM
• "Behaviorism is only concerned with
observable stimulus-response behaviors, as
they can be studied in a systematic and
observable manner.
• Learning is based on a system of routines
that "drill" information into a student's
memory bank, as well as positive feedback
from teachers and an educational
institution itself. If students do an excellent
job, they receive positive reinforcement
and are signaled out for recognition.
CONSTRUCTIVISM
• The learner builds upon previous
experience and understanding to
"construct" a new understanding.
• Learners construct meaning only through
active engagement with the world (such as
experiments or real-world problem
solving)."
HUMANISM
• A "learner centric approach" in which the
potential is the focus rather than the
method or materials
• Focuses on creating an environment
conducive to self-actualization
• Learners' needs are met and they are then
free to determine their own goals while the
teacher assists in meeting those learning
goals.
CONNECTIVISM
• Informed by the digital age, connectivism
departs from constructivism by identifying
and remediating gaps in knowledge.
• Learner's ability to frequently source and
update accurate information.
• Knowing how and where to find the best
information is as important as the
information itself.
HEALTH EDUCATION & COMMUNITY
ENGAGEMENT PRACTICE
KEY CONCEPTS
• Empowerment - nurse works with the
community Relevancy - discuss with the
community to define their issues
• Participation - active rather than passive
• Issues selection - problem solving with the
community
• Critical consciousness - dialogue to
understand root issues
• Social capital - work together to improve
networks
HEALTH LITERACY
• empowerment' on health having access to
information, knowledge and innovations
• the capacity to obtain, interpret and
understand basic health information and
services to enhance health (National
Academy of Medicine)
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FRAMEWORK FOR DEVELOPING
HEALTH COMMUNICATIONS
Stage I: Planning and Strategy Development
• Who is the intended audience?
• What is known about the audience and
from what sources?
• What are the communication and
education objectives and goals?
• What evaluation strategies will the nurse
use?
• What are the issues of most concern? (Note:
these may not necessarily be health issues
but may be important ones to link to the
health issue when planning, e.g., safety,
transportation
• What is the health issue of interest?
• Review available data
• Get community partners involved.
• Obtain new data (e.g., interviews, surveys,
and focus groups using problem-posing
dialogue format).
• Determine the intended group's needs and
perceptions of health problems (i.e.,
identify audiences).
• Determine the community's assets and
strengths:
• Physical (e.g., gender, age, and health
history)
• Behavioral (e.g., lifestyle characteristics
and health-related activities)
Stage II: Developing and Pretesting Concepts,
Messages, and Materials
• What channels are best?
• What formats should be used?
• Are there existing resources?
• How can the nurse present the message?
• How will the intended audience react to
the message?
• Will the audience understand, accept, and
use the message?
• What changes can improve the message?
Identify messages and materials.
• Decide whether to use existing materials or
produce new ones.
• Select channels and formats.
• Develop relevant materials with the target
audience.
• Pretest the message and materials and
obtain audience feedback (e.g., through
interviews, questionnaires, focus groups,
and readability testing). Pretesting helps
ensure comprehension, acceptability, and
cultural relevance
Stage III: Implementing the Program
• How should the health education
program/message be launched?
• How do we maintain interest and
sustainability?
• How can we use process evaluation?
• What are the strengths of the health
program?
• How can we keep on track within the
timeline and budget?
• How can we find out whether we have
reached the intended audience?
• How well did each step work (i.e., process
evaluation)?
• Are we maintaining good relationships
with our community partners?
• Work with community organizations,
adult education centers, businesses, media,
and other health agencies to enhance
effectiveness.
• Monitor and track progress.
• Establish process evaluation measures (e.g.,
follow-up with users of the service, number
of community members who used the
service, and expenditures).
Stage IV: Assessing Effectiveness and Making
Refinements
• What was learned?
• How can outcome evaluation be used to
assess effectiveness?
• What worked well, and what did not work
well?
• Has anything changed within the intended
audience?
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• How might we refine the methods, • Ideal for groups combining patients and
channels, or formats? Overall, what lessons families. Nurses, health professionals, or
were learned, and what modifications lay members can lead the groups.
could strengthen the health education • Facilitator must be comfortable with group
activity? method and familiar with group
• Conduct outcome evaluations (e.g., characteristics.
randomized experiment, evaluation
studies, definition of data needed for data Individual discussion
collection).
• Allows individual assessment and
• Reassess and revise goals and objectives.
identification of cultural barriers, physical
• Modify unsuccessful strategies or activities.
impairments, learning needs, literacy, and
• Generate continual support from
anxiety.
businesses, health care agencies, and other
• Promotes the tailoring of health education
community groups for ongoing
plans.
collaboration and partnerships.
• Ideal to capture "teachable moments."
• Does not allow sharing and support from
TEACHING-LEARNING FORMATS others
Brainstorming session • High cost in terms of staff time.

• Allows participants the freedom to Role playing

generate ideas and discuss them in a group
setting. • Effective in influencing attitudes and
opinions.
• Cultivates creativity.
• Encourages problem-solving and critical
• Fosters empowerment to allow members to
thinking skills.
identify the issue and find solutions.
• Enhances learner participation. Some
Community-wide programs members may be hesitant to become
involved.
• Can reach large numbers of community
members through a systematic plan.
• May include individual or group
approaches with a defined intended
audience.

Demonstration

• Effective in learning perceptual motor

skills
• Aids in visual identification

Group discussion

• Members can learn from each other and

receive support.
• Nurses can personalize teaching content to
group needs.

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