Community assessment,

diagnosis and community

needs assessment
• By
M.Zubair
Lecturer Kmu
 Need assessment
• A needs assessment is a systematic
process for determining and
addressing needs, or "gaps" between
current conditions and desired conditions
or "wants". The discrepancy between the
current condition and wanted condition
must be measured to appropriately
identify the need.
 Definition
Community health needs assessment is a
process that:
•Describes the state of health of local
people;
•Enables the identification of the major risk
factors and causes of ill health; and
•Enables the identification of the actions
needed to address these
 Needs assessment
• A community health needs assessment is
not a one-off activity but a developmental
process
that is added to and amended over time.
• It is not an end in itself but a way of using
information to plan health care and public
 Steps of community health needs
assessment
Profiling
• the collection of relevant information that will
inform the nurse about the state of health and
health needs of the population; and
• Analysis of this information to identify the major
health issues.
•
Deciding on priorities for action
•
Planning public health and health care programs
to address the priority issues
•
Implementing the planned activities
•
Evaluation of health outcomes
 Need of community need
assessment
• Plan and deliver the most effective care to
those in greatest need;
• Apply the principles of equity and social
justice in practice;
• Ensure that scarce resources are allocated
where they can give maximum health
benefit; and
• Work collaboratively with the community,
other professionals and agencies to
determine which health issues cause
greatest concern and plan interventions to
address those issues.
 Concepts and principles of health
needs assessment
• In this context holistic model of health,
emphasizing the social, economic and
cultural factors that affect health as well as
individual behavior.
• The concept of “need” incorporates those
needs felt and expressed by local people as
well as those defined by professionals. It
moves beyond the concept of demand and
takes account of people’s capacity to benefit
from health care and public health programs.
 Factors affecting health
• The physical environment in which people
live, such as the quality of the air they
breathe and the water they drink;
• The social environment – the level of
social and emotional support people
receive from friends and/or family;
• Poverty, a significant factor worldwide,
which shortens and reduces enjoyment of
life;
 Ctd..
• Behavior and lifestyle – for example,
smoking causes lung cancer and coronary
heart disease so a reduction in this
behavior will reduce the disease; and
• Family genetics and individual biology – if
you come from a healthy family you have a
better chance of staying well.
 Community Assessment
(continued)
Basic concepts:
1. CHNs work at 6 levels: individual, family,
group, subpopulations, populations and
communities.
2. Working with communities is primary
because the community directly influences
the other levels, and because provision of
health services mostly occurs at the
community level.
 Community as a client
• Refers to the concept of a community-wide
group of people as the focus of nursing
service.
 Community Assessment
• Features of a community (Lynd 1939):
1. Location (geographic) health of community
affected by:
a. location of health services
b. geographic features
c. Climate
d. Plants
e. Animals
f. human-made environment (resources vs. threats)
Barker 1994 and Neuman 1995
 a. Location
The healthy community is one that makes wise use of
its resources and is prepared to meet threats and
dangers
 Community Profile Relating to
location variables?
Boundaries (incidence of wellness and illness and
spread of disease)
1. Where is the community located?
2. What is its boundaries?
3. Is it part of a larger community?
4. What smaller communities does it include?
Health services locations (availability and accessibility)
1. Where are the main health services?
2. Are there necessary health services outside the
community? Where?
 Community Profile Relating to
location variables? (continued)
Geographic features
1. Major landforms near the community
2. What geographic features pose threats,
opportunities for healthful activities?
Climate
• Average temperature and precipitation? Extremes?
What climatic features affect health and fitness?
• Is the community prepared to cope with
emergencies?
 Community Profile Relating to
location variables? (continued)
Flora and Fauna
1. What plants and animals pose possible threat to
health?
Human- made environment
1. What are the major industries?
2. How have air, land, water been affected by
humans?
3. What is the quality of housing?
4. Access to health institutions?
 Community Profile Relating to
location variables? (continued)
General
1. Do groups cooperate to identify threats?

1. Do health agencies cooperate to prepare

for an emergency such as flood or
earthquake?
 Community Assessment-
Population
2. Population: Not of The health of any community is greatly
influenced by the population that lives in it
a specialised
aggregate but of
population
all the diverse
people who live
Location
within the
boundaries of this
community A healthy community has leaders who are
aware of its population characteristics,
know its needs and respond to those
needs
 Population Variables
• Size: Affects number and size of health care
institutions
– Homogeneity of population and its needs
– What is the population? Is it urban suburban or rural?
• Density: What is the density per square mile?
Increased density increases stress. High and low
density affect the availability of health services
• Composition: What is the age composition? Sex
composition? Marital status? Occupations and %
• Rate of growth or decline: How has population size
changed over the past two decades? Health
implications of this change?
 Population Variables
• Cultural differences, social class: refers to ranking groups by income,
education, occupation, prestige or a combination of these factors (Bond
& Bond 1993).
• Educational level is closely associated with social class and is a
powerful determinant of health-related behaviour ( Institute of Medicine
1997)
• Generally, health promotion and preventive health services are most
needed by low-income groups.
• What subcultural groups populations exist in the community? Any of
them has unique health needs and practices?
• % of population in each class? What do class differences suggest for
health needs and services?
• Mobility: How frequently do members move in and out of the
community? (seasonal swings, internal migration) Within the
community? Are there specific populations (e.g. migrant workers that
are highly mobile?
• How does pattern of mobility affect health of community?
• Is the community organised to meet health needs of mobile groups?
 Community Assessment-Social
System
3. Social system variables (Dever, 1997):
– Health system
– Family systems
– Economic system
– Educational system
– Religious system
– Welfare system
– Political system
– Recreational system
– Legal system
– Communication system
 Community Dynamics
• Dynamic = Changing quality
• Three important factors affecting
community dynamics:
1. Citizen participation in community health
programs (CHN need to promote health
education and awareness).
• Assessing type and extent of citizenship
praticipation.
• Promoting self-care concept (empowerment
based on the right to make decisions, have
adequate information and consult widely
about their own health).
 Community Dynamics
2. Power and decision-making structure: Community
self-care is CHN goal.
– Do not assume that what is known about one community
will be true of another
– The leaders within the health system have different
degrees of power and varying spheres of influence.
Knowing these differences is a pre-requisite of your work
in this community
– Power does not necessarily flow through the established
bureaucratic channels. Locate the informal pattern of
power and decision-making
– Beware of leaders who speak authoritatively on issues
outside their sphere of power.
– Do not overestimate the support of key leaders or power
cliques. Much organisational work needs to be done.
 Community Dynamics
3. Community collaboration efforts (Corrigan &Udas
1996)
– Those leaders whose power is in the health system have a
network of contacts with similar leaders in other systems
– Learn to distinguish between political, economic, and
social power; use the combination needed to promote
community health issues
– Try to encourage participation in the decision-making
process at every level from citizen to key leader
– Leaders in one part of the community might be ignorant
of needs and problems in other parts of the system. They
will have to be educated in community health issues
 Community Collaboration
• The ability of the community to work
together as a team of citizens,
professional and lay people alike, in
order to meet an identified need in the
community.
• Broad principles for community
collaboration efforts (Connell, Kubish,
Schorr & Weiss 1995; Hooper-Briar &
Lawson, 1994)
1. Public policy are beyond any single
person or profession’s responsibility 
community members need to be
involved to change the status quo People work in Teams
• Results-based accountability
emphasizing program or project
“effectiveness” as the goal
• Cultural competence is the norm.
Program design, delivery and
evaluation must respect the local
identity and cultural norms.
• Ethical behavior is fundamental in
collaborative relationships
 Application of the Nursing Process
Activities in Community Needs Assessment

1. Assessment is the first step of the nursing

process = To collect and evaluate
information about a community’s health
status to discover existing or potential
needs as a basis for planning future action
(Barton, Smith, Brown and Supples, 1993)
– Two activities (overlapping and are repeated
throughout the assessment):
A. Collection of pertinent data
B. Analysis and interpretation of data
 Community Needs
Assessment
• Definition: The process of determining the
real or perceived needs of a defined
community of people
• Asset assessment: Focuses on the
strengths of the community and not its
deficits
• Type of assessment depends on:
1. Needs
2. Goals to be achieved
3. Resources available
 Types of Community Needs
Assessment
1. Familiarisation or “Windshield Survey”
• It is the most necessary type.
• Nurses drive or walk around the community, find
health, social and governmental services, obtain
literature, introduce themselves as working in the
area, and become familiar with the community
2. Problem-oriented assessment
• Begins with a problem and then assesses the
community in terms of that problem.
• Used when a familiarisation assessment is not
enough and a comprehensive assessment is too
expensive.
• Responds to a particular need
 Types of Community Needs
Assessment
3. Community subsystem assessment: CHN focuses
on a single dimension of community life
4. Comprehensive assessment: To discover all
relevant community health information.
A. Begins with a review of existing studies and all data
available now in the community.
B. Survey (demographics),
C. key informants interviewed in every major system;
D. Then more detailed interviews and surveys to get more
information on organisations and their various roles
within.
NB: It is seldom performed because expensive and time
consuming
 Types of Community Needs
Assessment
5. Community Assets Assessment “focuses on the strengths
and capacities of the community rather than the problems
alone” ( Ammerman & Parks 1998)
• It begins with what is present in the community
• Capacities and strengths of community members are
identified, focusing on creating relationships among local
residents, associations, and institutions to multiply power and
effectiveness
• Three levels:
• Inventory of specific skills, talents, interests and experiences
of individual community members
• Inventory of local citizens organizations and associations
• Inventory of local institutions
 Community Assessment Methods
• Surveys: Series of questions is used to collect data
• Three phases
1. Planning phase: to determine sampling and tools for data collection
– Determine the what and why
– Determine precise data to be collected
– Select population (household, block, neighborhood)
– Select survey method / instrument (interview, telephone call,
questionnaire)
– Sampling size ( % of the total population in question)
2. Data collection phase
– Identify and train data collectors
– Pre-test and adjust instrument
– Supervise actual collection, planning for non responses or refusals
3. Data analysis and presentation phase
– Organize data for tabulation and analysis
– Apply appropriate statistical methods
– Determine relationships and significance
– Report the results and include implications, recommendations and next
steps, providing a feedback to the community surveyed through a
community forum
 Community Forum / Town Hall
meeting
• A qualitative assessment method designed
to obtain community opinions
• Members are invited representing all
segments of the community involved with the
issue
• Inexpensive method and results are obtained
quickly (Krueger 1994)
• Disadvantage: Power structure within
community and vocal members are heard
only.
• Used to elicit public opinion on a variety of
issues
• TV programs with a “yes” or “no” vote on an
issue
 Focus Groups
• Designed to obtain grassroots opinions.
• It is a small group process (5 to 15 people) Polit &
Hungler 1999
• Members chosen for the group are homogeneous in
terms of demographic variables
• Leadership skills are used and small group process
to promote discussion
• The interviewer guides the discussion according to a
pre-determined set of questions or topics (Krueger
1994)
• Group meets for 1-3 hours and may meet in a series
• Assessment data can be collected from several
groups over a period of time
• Efficient and low cost method
 Sources of Community Data
1. Primary Sources: obtained directly from the
community
2. Secondary source: health team members, client
records, community health statistics, Census
Bureau Data, reference books, research reports,
community health nurses
3. International Sources WHO, UNICEF, Internet
sources,
4. National Sources: MOH, Bureau of the Census,
UNRWA
• Local sources: Chamber of commerce, hospitals,
social service agencies, School districts,
municipalities, universities or colleges,
 Data Analysis and Diagnosis
• Data must be validated: Are they accurate?
• Data can be rechecked by the community
assessment team
• Can be rechecked by others
• Subjective and objective data can be
compared
• Community members can verify the findings
• Validated data are categorised in physical,
social and environmental sectors
• Before making a diagnosis ALL assumptions
must be validated!
Assessment and Diagnosis Phases of the
Nursing Process

Data Interpretation
Validation Analysis
Inference

Data collection
Assessments
Familiarisation validation
Problem-oriented Nursing Diagnosis
Subsystem Statements
Comprehensive Logical linkages
Community Assets Community responses
Surveys Stays within the domain of nurses
Expected Outcomes
Descriptive epidemiological studies
Focus groups
Community forums/ town hall meetings
 Community Diagnosis
Neufield & Harrison (1994)
• Is the community’s ineffective coping ability and
potential for enhanced coping.
• Statements should include :
• Strengths, identifying sources of solutions, as well as
community’s weaknesses or problem areas
• Diagnosis guide communities towards maximising or
improving their health, as they plan, implement and
evaluate changes that will be measured by outcome
criteria
• Outcome criteria are measurable standards
community members will use to measure their
success as they work towards improving the health
of their community.
• Nursing diagnosis changes over time as it reflects
the community health status, therefore they need to
be periodically reevaluated and redefined
What is a Healthy Community?
Ten descriptors of a healthy community
(Carlson 1997; Kang 1997)
1. A healthy community is one where members
have a high degree of awareness that “ we are a
community”
2. A healthy community uses its natural resources
while taking steps to conserve them for future
generations
3. A healthy community openly recognises the
existence of subgroups and welcomes their
participation in community affairs
4. A healthy community is prepared to meet crisis
5. A healthy community is a problem-solving
community
 What is a Healthy Community?
(continued)
6. A healthy community has open channels of
communication allowing information flow among
all subgroups and in all directions
7. A healthy community seeks to make its systems
resources available to all members of the
community
8. A healthy community has legitimate and effective
ways to settle disputes that arise
9. A healthy community encourages maximum citizen
participation in decision-making
10. A healthy community promotes high level of
wellness among all its members
 “Community”
A body of persons having a common history,
ethnicity, culture, geography, or interests.
– Communities of Place: Defined by distinct
boundaries and bound by a common political,
economic and social system.

– Communities of Interest: A group of individuals

that share common interests, goals, or knowledge
about something.
Community Needs Assessment
A way of gauging opinions, assumptions,
needs, key issues, and/or assets within a
defined community.
Needs Assessment purpose

3 Identify community needs, concerns and issues

3 Target outreach programs

3 Empower grass-roots Action around needs

3 Determine if needs have changed?

3 Collect communities’ hopes/dreams/desires

Community Assessment Tools
• Focus Group Interview
• Public Issues Forum
• Secondary Data Analysis
• Community Survey Questionnaire
• Interviews
• Asset Mapping
Focus Group Interview
The focus group is a way to gather the opinions/
ideas from a small, targeted group of citizens.
The intention of focus groups is perhaps more to
build a synergy of thoughts and ideas than it is to
make projections about the community.

Advantages Disadvantages
• easy to conduct • ideas generated not
• Provides detailed info necessarily prevalent
• allows for issue probing • small sample for effort
• stimulates thinking and • difficult to analyze
discussion • quiet folks suppressed
• requires participation
Public Issues Forum
Community forums are public meetings that
involve residents to express their concerns about
community issues, problems, and needs.

Advantages Disadvantages
• Diverse members can • requires skill/time
share ideas • opinions obtained only
• Provides quick look at from those who attend
community issues • may generate more
• involves local citizens questions or conflict
• inexpensive
Steps: Preparing for the Forum
1. Form representative steering committee (5-15 people)
2. Identify pressing issue(s) to form the focus of forum
3. Select a trained facilitator
4. Set a time and place:
• Seating arrangement should encourage dialogue
• have appropriate acoustics (i.e., microphone)
• make sure the location is neutral (school is a great place)
5. Publicize the forum
6. Hit all the major media outlets
 Steps: Conducting the Forum Event
1. Facilitator outlines process, what the results will be used
for, and their role as facilitator.
2. Do an ice-breaker to build trust.
3. Brainstorm: The purpose of brainstorming is to generate
ideas (if issues have already been identified go to step 5)
4. Prioritize issues (you may want to do this via voting)
5. Once issues have been identified, next step is to mobilize
action groups (allow time for groups to meet and plan).
6. Provide each group with action planner worksheet which
gets them to write goal, objectives, planned activities,
timeline, and persons responsible for activities.
Steps: Followup after the Forum
1. Develop a written report
• If action is the goal, the report may be used as the basis for
a plan
• If change in policy is the goal, the report should emphasize
priorities or final decisions.

2. Disseminate the report using multi-media

Secondary Data Analysis
Secondary data is data that is collected about a
particular audience without having direct contact
with that audience. It can often provide insight
.
about emerging trends or issues in a particular
community.
Advantages Disadvantages
• data already exists • representative sample
• fast & easy to access may not be accurate
• data available for many • gaps in data
geographic levels • requires inferences
• Lack of Data Richness
Community Survey
Community surveys help one to gather
info about local attitudes regarding precisely
defined issues, problems or opportunities.
Surveys may be open ended or multiple choice.

Advantages Disadvantages
• wide distribution • expensive
• good for data analysis • requires skill/time
• strong sample of the • suffers low return rate
population • poor qualitative tool
Interviews
An interview is a conversation with a purpose,
designed to help you gather information about
peoples assumptions/perceptions of activities in
your community. They are useful when looking for
in-depth information on a particular topic.

Advantages Disadvantages
• detailed information • Time-consuming
• allows for clarification/ • requires skill/time
followup on questions • Information is hard to
• personal contact builds summarize
rapport • Little quantitative value
 Steps in an Interview Process
1. Form a Steering Committee to guide process
2. Determine who is to be interviewed
3. Select a skilled Interviewer
4. Select questions
5. Decide on an interview format/delivery method
• Formal or informal structure
• Face-to-face, telephone, or email delivery
6. Inform the participants
7. Practice
8. Steer / guide the interview session (take notes)
9. Write a summary report
10. Thank the interviewees
Steps in an Interview Process
1. Form a Steering Committee to guide process
2. Determine who is to be interviewed
3. Select a skilled Interviewer
4. Select questions
5. Decide on an interview format/delivery
method
– Formal or informal structure
– Face-to-face, telephone, or email delivery
6. Inform the participants
7. Practice
8. Steer / guide the interview session (take
notes)
9. Write a summary report
10. Thank the interviewees
Developing and Asking Interview Questions
• Don’t ask defensive questions.
• Avoid the two-in-one question.
• Avoid complex questions.
• Keep it short.
 Asset Mapping
Asset mapping is a technique for cataloguing
local community assets/resources to meet
community objectives. The goal is to identify
and utilize assets to better the community
rather than to focus on problems and needs.
Advantages Disadvantages
• Focuses on what • Community assets may
community already has. not match key issues.
• Provides diverse look • People tend to respond
at community assets. to crises rather than
• Involves multiple possibilities.
stakeholders.
Assets Come in Many Forms
• Human Assets
• Associational Assets
• Institutional Assets
• Local Business Assets
• Outside Resources
 Asset-Based Community Development

Step 8 Step 1
Identify Opportunities Form a Steering
& Mobilize Community Committee

Step 7 Step 2
Cross Reference Commit Resources
Needs with Assets
Step 3
Step 6 Identify your
Develop Resource Community
List
Step 5 Step 4
Administer Asset Decide on Inventory
Assessment Tool Method
Community Asset Inventory
1. Personal Skills Inventory
2. Institution/Organization/Business Inventory
3. Previous Efforts Inventory
4. Community Development Opportunities
5. Development of a Plan
Factors for Choosing your Assessment Tool
3 Purpose of Assessment
3 Type of Data Needed
3 Time Commitment
3
Cost
3 Skills needed
3 Target Audience
3 Sources of Bias
Review: Steps for Conducting an Assessment
1. Form a Steering Committee
2. What need(s)/issue(s) are you addressing?
3. Determine the community you are assessing.
4. Determine assessment tool
5. Develop a plan (who, what, when, where, how).
6. Implement the assessment tool (see next page)
7. Analyze the results
8. Report the results
9. Implement or instigate follow-through
Using the Web to Administer Assessments
The internet is increasingly being used to administer
surveys and other types of needs assessments. Programs,
such as Cold Fusion, enable one to build interactive web
interfaces. In other words, as people fill out surveys on the
web, the information is sent directly to a central
spreadsheet where it can be analyzed on an ongoing basis.
Web surveys are ideally suited to statewide or national
assessments where on-the-ground techniques might be
difficult.
Presenting the Data
• Clear and Concise
• Combine numbers with text and graphics
• Focuses on most important findings
• Don’t try to put too much in it
 Assessment Tool
Asset Mapping
Concerns Survey
Needs Survey
Focus Groups Interviews:
Public Forum