COMMUNITY DIAGNOSIS

 Aka “COMMUNITY ASSESSTMENT/SITUATIONAL

ANALYSIS”
 The process of determining the health
status of the community and the factors
responsible for it.
 Aims to obtain general information about
the community’s profile to determine the
community’s strength and weaknesses.
TYPES OF COMMUNITY
DIAGNOSIS
1. COMPREHENSIVE COMMUNITY
DIAGNOSIS
 Aims to obtain a general information
about the community.
2. PROBLEM-ORIENTED COMMUNITY
DIAGNOSIS
 Type of assessment that responds to a
particular need.
 For example, a nurse is confronted
with health and medical problems
resulting from mine tailings being
disposed into the river systems by a
ELEMENTS OF COMPREHENSIVE
COMMUNITY DIAGNOSIS
A.DEMOGRAPHIC VARIABLES
B.SOCIO-ECONOMIC AND CULTURAL
VARIABLES
C.ENVIRONMENTAL INDICATORS
D.HEALTH & ILLNESS PATTERNS
E.HEALTH RESOURCES
F. POLITICAL/LEADERSHIP PATTERN
ELEMENTS OF COMPREHENSIVE
COMMUNITY DIAGNOSIS
A.DEMOGRAPHIC VARIABLES
1.Total Population and geographical
distribution including urban-rural
index and population density
2.Age and sex composition
3.Selected vital indicators such as
growth rate, crude birth rate, crude
death rate and life expectancy at
birth
4.Patterns of migration
5.Population projections
6.Household size
 ELEMENTS OF
COMPREHENSIVE
COMMUNITY DIAGNOSIS
B. SOCIO-ECONOMIC AND CULTURAL VARIABLES
1. SOCIAL INDICATORS
a. Educational level which may be indicative of poverty
and may reflect on health perception and utilization
pattern of the community (includes schools, types of
education, literacy rates, day care centers)
b. Housing conditions which may suggest health
hazards (congestion, fire, exposure to elements)
c. Social Classes or groupings
 ELEMENTS OF
COMPREHENSIVE
COMMUNITY DIAGNOSIS
B. SOCIO-ECONOMIC AND CULTURAL VARIABLES
1. SOCIAL INDICATORS
2. ECONOMIC INDICATORS
a) Poverty level income
b) Unemployment and underemployment rates
c) Proportion of salaried and wage earners to total economically active population
d) Types of industry present in the community e. Occupation common in the
community.
e) Communication network (whether formal or informal channels) necessary for
disseminating health information or facilitating referral of clients to the health
care system
f) Transportation system including road networks necessary for accessibility of
the people to health care delivery system
 ELEMENTS OF COMPREHENSIVE
COMMUNITY DIAGNOSIS
B. SOCIO-ECONOMIC AND CULTURAL VARIABLES
C. ENVIRONMENTAL INDICATORS
1. Physical/geographical/topographical characteristics of the community
• Land areas that contribute to vector problems LRA/FEU-NRMF
• Terrain characteristics that contribute to accidents or pose as geohazard
zones
• Land usage in industry
• Climate/season
2. Water supply
• % population with access to safe, adequate water supply
• Source of water supply
3. Waste disposal
• % population served by daily garbage collection system
• % population with safe excreta disposal system
• Types of waste disposal and garbage disposal system
ELEMENTS OF COMPREHENSIVE COMMUNITY
DIAGNOSIS
D. Air, water and land pollution
• Industries within the community having health
hazards associated with it
• Air and water pollution index
E. Cultural Factors
a. Variables that may break up the people into groups within
the community such as:
• Ethnicity • Social class
• Language • Religion
• Race • Political orientation
b. Cultural beliefs and practices that affect
c. Concepts about health and illness
 ELEMENTS OF
COMPREHENSIVE
COMMUNITY DIAGNOSIS
B. SOCIO-ECONOMIC AND CULTURAL VARIABLES
1. SOCIAL INDICATORS
2. ECONOMIC INDICATORS
3. ENVIRONMENTAL INDICATORS
4. HEALTH & ILLNESS PATTERNS
a) Leading causes of mortality
b) Leading causes of morbidity
c) Leading causes of infant mortality
d) Leading causes of maternal mortality

e) Leading causes of hospital admission

5. HEALTH ELEMENTS
RESOURCESOF
COMPREHENSIVE
1. Manpower resources
a. Categories of health manpower available
COMMUNITY DIAGNOSIS
b. Geographical distribution of health manpower
c. Manpower-population ration
d. Distribution of health manpower according to type of
organization (government, non-government, health units, private)
e. Quality of health manpower
f. Existing manpower development/policies
2. Material resources
a. Health budget and expenditures
b. Sources of health funding
c. Categories of health institutions available in the community
d. Hospital bed-population ration
e. Categories of health services available
 ELEMENTS OF
COMPREHENSIVE
COMMUNITY DIAGNOSIS
6. POLITICAL/LEADERSHIP PATTERN
a) 1. Power structures in the community (formal or informal)
b) 2. Attitudes of the people toward authority
c) 3. Conditions/events/issues that cause social
conflict/upheavals or that lead to social bonding or
unification
d) 4. Practices/approaches that are effective in settling
issues and concerns within the community.
 COMMUNTIY DIAGNOSIS:
THE PROCESS
 This process reflects the community health
nurse competencies essential for
assessment and analysis in public health.
 The initial tasks done by the nurse prior to
community diagnosis includes: 1. Prepare
materials and tools needed for interview
(e.g. survey forms, household list, local
calendar, clip board and ballpen) 2.
Organize the community diagnosis team
(e.g. activities and function) and 3. Inform
the community
 COMMUNTIY DIAGNOSIS:
THE PROCESS

 The process of community diagnosis

consists of:
Collecting
Organizing
Synthesizing
Analyzing
Interpreting health data.
 COMMUNTIY DIAGNOSIS:
THE PROCESS
 The initial tasks done by the nurse
prior to community diagnosis includes:
1. Prepare materials and tools
needed for interview (e.g. survey
forms, household list, local calendar,
clip board and ballpen)
2. Organize the community
diagnosis team (e.g. activities and
function)
3.Inform the community
 STEPS IN CONDUCTING COMMUNITY
DIAGNOSIS
1.DETERMINING THE OBJECTIVES
2.DEFINING THE STUDY POPULATION
3.DETERMINING THE DATA TO BE COLLECTED
4.COLLECTING THE DATA
5.DEVELOPING THE INSTRUMENT
6.ACTUAL DATA GATHERING
7.DATA COLLATION
8.DATA PRESENTATION
9.DATA ANALYSIS
10.IDENTIFYING THE COMMUNITY HEALTH NURSING PROBLEM
11.PRIORITY SETTING
 STEPS IN CONDUCTING COMMUNITY
DIAGNOSIS
1.DETERMINING THE OBJECTIVES
 This is the precise statement of the
community’s problem.
 The nurse decides on the depth and scope
of the data he needs to gather.
 Based and most important is to achieve his
goal on health promotion and disease
prevention. The nurse gathers data on the
geographic, economic, political, social,
cultural and behavioral conditions important
to disease control and wellness promotion.
 STEPS IN CONDUCTING COMMUNITY
DIAGNOSIS
1.DETERMINING THE OBJECTIVES
2.DEFINING THE STUDY POPULATION
 Based on the objectives of the
community assessment, the nurse
identifies the population group to be
included in the study.
 It may include the entire population or
focused on a specific population (e.g.
infant and young children or elderly
population
 STEPS IN CONDUCTING COMMUNITY
DIAGNOSIS
1. DETERMINING THE OBJECTIVES
2. DEFINING THE STUDY POPULATION
3. DETERMINING THE DATA TO BE COLLECTED

 Establishing guidelines on what needs to

be assessed help the nurse organize the
data collection process and to identify
factors that influence a community’s
state of wellness.
 Basically, the objective set in first step,
will guide the nurse in identifying the
specific data to be collected and the
sources of these data.
 STEPS IN CONDUCTING COMMUNITY
DIAGNOSIS
4. COLLECTING THE DATA
 A systematic approach to data collection is needed
in order to obtain a comprehensive profile of
community’s level of functioning or competence.
 Methods to collect data
Records review
Surveys and observations
Interviews
Participant observation
 STEPS IN CONDUCTING COMMUNITY
DIAGNOSIS
5. DEVELOPING THE INSTRUMENTS
 Instruments or tools facilitates the
nurse’s data-gathering activities.
 The following are the most common
instruments that the nurse use in her
data collection:
a. Survey questionnaire
b. Interview guide
c. Observation checklist
 STEPS IN CONDUCTING COMMUNITY
DIAGNOSIS
6. ACTUAL DATA GATHERING
 The process of obtaining existing, readily available data.
 It usually describes the demographic characteristics such as age, gender,
socioeconomic status.
 It includes vital statistics, such as selected morbidity and mortality rate.
 Prior to data gathering, the nurse meet the individuals who will be involved in
the data collation to familiarize them on the instruments to be used.
 During the actual data gathering, the nurse supervises and monitors the data
collectors by checking the filled up instruments in terms od completeness,
accuracy and reliability of the information collected.
STEPS IN CONDUCTING COMMUNITY
DIAGNOSIS

7. DATA COLLATION
 The first step of the processing of data.
 The data from the questionnaire are organized and the
number of times each answer is given is counted.
 There are two types of data that may be generated:
1. Numerical data
2. Descriptive data
STEPS IN CONDUCTING COMMUNITY
DIAGNOSIS
8. DATA PRESENTATION
 Results of the community diagnosis may be presented to
members of the community or to the key leaders.
 Descriptive data is merely presented in narrative reports
(e.g. geographic data, beliefs regarding illness/death)
 Numerical data are presented in table or graphs, showing
key information, showing comparisons including patterns
and trends.
 Your findings when presented shall be simple and easy to
understand.
STEPS IN CONDUCTING COMMUNITY
DIAGNOSIS

9. DATA ANALYSIS
 Critical reflection and data analysis in community
diagnosis aims to establish trends and patterns in terms
of health needs and problems of the community.
 The nurse identifies the origins and effects of the
problem, the points at which intervention might occur,
and the parties that have an interest in the problem and
its solution
 STEPS IN CONDUCTING COMMUNITY
DIAGNOSIS
10. IDENTIFYING THE COMMUNITY HEALTH NURSING
PROBLEMS
 Community health nursing problems are categorized as:
1. Health status problems – they maybe described in terms of increased
or decreased morbidity, mortality, fertility or reduced capability for
wellness
2. Health resources problems – they may be described in terms of lack of
or absence of manpower, money, materials or institutions necessary
to solve health problems
3. Health related problems – they may be described in terms of existence
of social, economic, environmental and political factors that aggravate
the illness-inducing situations in the community.
 STEPS IN CONDUCTING COMMUNITY
DIAGNOSIS
11. PRIORITY SETTING
 After the problems have been identified, the next
task for the nurse and the community is to
prioritize which health problems can be attended
to considering the resources available at the
moment.
 STEPS IN CONDUCTING COMMUNITY
DIAGNOSIS
11. PRIORITY SETTING
 In priority setting the nurse makes use of the following criteria:
a. Nature of the condition/problem presented – the problems are classified by the
nurse as health status, health resources or health related problems
b. Magnitude of the problem – this refers to the severity of the problem which can be
measured in terms of the proportion of the population affected by the problem
c. Modifiability of the problem – this refers to the probability of reducing, controlling or
eradicating the problems
d. Preventive potential – this refers to the probability of controlling or reducing the
effects posed by the problem
e. Social concern – this refers to the perception of the population or the community as
they are affected by the problem and their readiness to act on the problem
 APPLLICATION OF PUBLIC
HEALTH TOOLS IN COMMUNITY
HEALTH NURSING

• Tools in measuring and analyzing

community health problems,
such as demography,
epidemiology, and biostatistics
are applied to form a part of
assessment tools in the diagnosis
of community health care needs.
 APPLLICATION OF PUBLIC HEALTH
TOOLS IN COMMUNITY HEALTH
NURSING
• Demography is the science that deals with
the study of human population size,
composition and distribution in space.

• Population Size refers to the number of

people in a given place or area at a given
time.
SOURCES OF DEMOGRAPHIC DATA

• Census is the official and periodic enumeration of

population.
• De jure method is done when people are assigned to
the place they usually live in regardless of where they
are at the time of the census
• De facto method is done when people are assigned to
the place where they are physically present at the time
of the census regardless of their usual place of
residence

• *Instead of a census, demographic information

can still be collected from a sample of a given
population. This is called a Sample Survey.
 Population Size – knowing the
population size of a place allows
the nurse to make comparisons
about population changes overtime.
 Increase in the population due to excess
of births compared to deaths

Natural Increase – the difference

between the number of births and deaths
occurring in a specified period of time
Rate of Natural Increase - the
difference between the Crude Birth rate
and the Crude Death Rate occurring in a
population in a specified period of time
 NATURAL INCREASE = Number of births – Number of deaths
(specified year) (specified year)

Crude Birth Rate – Crude Death Rate

Rate of Natural increase = (specified year) (specified year)
Using data from two census periods

• Absolute increase per year – measures the number of

people that are added to the population per year.

• Relative increase – the actual difference between the

two census counts expressed in percent relative to
the population size made during an earlier census
Absolute increase per year

Pt – Po
t

Where:
Pt = population size at a later time
Po = population size at an earlier time
t = number of years between time o and
t
Relative increase

Pt – Po
Po

Where:
Pt = population size at a later
time
Po = population size at an earlier
time
Population Composition is described in terms
of its age and sex.

Sex Composition – compares the number of males

to the number of females in the population.

Age Composition
Median Age – divides the population into two equal parts.
Dependency Ratio – compares the number of economically
dependent with the economically productive group in the population.

Age and Sex Composition – can be illustrated

though a population pyramid.
 SEX COMPOSITION

Sex ratio = Number of males

x100
Number of females
Age and Sex composition
 Population Distribution – described in terms of:

1. Urban-Rural Distribution
2. Population Density - determines how congested a
place is and has implication in terms of the adequacy of
basic health services present in the community.
3. Crowding Index - the ease by which communicable
diseases can be transmitted from one hose to another
susceptible host.

Vital Statistics is an essential tool in

forecasting, implementing, monitoring, and
COMMUNITY ORGANIZING
PARTICIPATORY ACTION
RESEARCH (COPAR)
 a process where people who live in
proximity to each other or share some
common problem come together into an
organization that acts in their shared self-
interest.
 A social development approach that aims to
transform the apathetic, individualistic, and
voiceless poor into dynamic, participatory
COMMUNITY ORGANIZING
PARTICIPATORY ACTION RESEARCH
A process by which a community
identifies its needs and objectives,
develops confidence to take action in
respect to them and in doing so, extends
and develops cooperative and
collaborative attitudes and practices in
the community
 COMMUNITY ORGANIZING
PARTICIPATORY ACTION RESEARCH
(COPAR)
Importance of COPAR:
 COPAR maximizes community participation and involvement
 COPAR could be an alternative in situations wherein health
interventions in Public Health Care do not require direct
involvement of modern medical practitioners
 COPAR gets people actively involved in selection and support
of community health workers
 Through COPAR, community resources are mobilized for
selected health services
 COPAR improves both projects effectiveness during
implementation.
COMMUNITY ORGANIZING
GOALS
A social development approach that aims
to transform the apathetic,
individualistic and voiceless poor into
dynamic, participatory and politically
responsive community.
COPAR Processes/ Methods Used
 A Progressive Cycle of Action- Reflection- Action
which begins with small, local, concrete issues,
identified by the people and the evaluation and
reflection of and on the action taken by them
 Consciousness – RAISING through experiential
learning is central to COPAR process because it places
emphasis on learning that emerges from concrete
action and which enriches succeeding action
 COPAR is Participatory and Mass-Based because
it is primarily directed towards and biased in favor of
the poor, the powerless and the oppressed
 COPAR is Group-centered and not Leader-
oriented. Leaders are identified, emerge and are
tested through action rather than appointed or
EMPHASIS OF COPAR:
Community working to solve its own problem

1. Direction is established internally and

externally
2. Development and implementation of a
specific project less important than the
development of the capacity of the
community to establish the project
3. Consciousness raising involves perceiving
health and medical care within the total
structure of society
 PHASES OF THE COPAR
PROCESS

Pre-Entry Phase
Entry Phase
Diagnosis Phase
Organization – Building
Community Action Phase
Phase
Sustenance and
 PROCESS

Pre-Entry
Phase
The initial phase of the organizing
process where the community
organizer looks for communities to
serve/help
Designing criteria for the selection
of site
Actually selecting the site for
community care
Pre-Entry Phase “FIRST ACTION”

Formulation of objectives & target for the program

Institutional goals
Revision of curriculum
S eek & coordinate participation of other department
within institution
T raining of faculty in COPAR

At the community level, encourage dialogues w/ the people

C riteria for site selection development
ACTIVITIES
T he actual “Site Selection”
Initial/preliminary social investigation
Occular survey noting accessibility, geography, & available
resources
 CRITERIA FOR SITE SELECTION
Depressed and exploited rural community
Ensure acceptance ( NO strong resistance from the
community)
Poor
Residents must be 100-200 families
Economically depressed
Safe (no serious peace & order problem)
Shows high morbidity and infant mortality cases
Ensure no similar agency holding same program
D o not have BHW/ nearby hospital
PHASES OF THE COPAR
PROCESS

Entry Phase
 Sometimes called the social preparation
phase as the activities done here include
the sensitization of the people on the
critical events in their life , motivating them
to share their concerns and eventually
mobilizing them to take collective action on
these
 Entry
Phase
Phase for “ SOCIAL PREPARATION”
Actual entry of nurse/community organizer into
community
Sensitization of the people on the critical events
in their life
Organizer motivates the people to share their
dreams & ideas
Known as “CRUCIAL PHASE”
 Entry
GUIDELINE for ENTRY into
community Phase
Pay courtesy call upon entry to the community &
local authorities (brgy officials)
Let them know your project objectives/goals
Ensure to be a “ROLE MODEL”
Avoid raising expectations/consciousness of the the
community residents
Speech, behaviors & lifestyle should be in keeping
w/ those of the community residents
Ensure to adopt a low key profile
ACTIVITIES FOR “ENTRY PHASE”
Immersion/Integration/Sensitization w/ the community.
-Established Rapport
-Converse w/ people in the community
-Living w/ community
-Participation in livelihood activities
-Information campaign on health programs
-Support & lend hand in household chores
-Ensure to be a role model (avoiding
inappropriate activities)
Deepening Social Investigation Low profile
Potential leader spotting (LEADS) Education at least basic primary education
Core group formation Approachable/respected by both
forma/informal sectors
Self awareness & leadership trainings
Develops a good communication skills
Serve willfully
 PHASES OF THE COPAR
PROCESS

Organization – Building
Phase Entails the formation of more formal
structures and the inclusion of more
formal procedures of planning,
implementing, and evaluating
community-wide activities
Conduct of trainings for the organized
leaders or groups to develop their asks in
RECOMMENDED ACTIVITIES for
ORGANIZATION BUILDING Phase

 Meeting with the officials.

 Identifying problems.
 Spreading awareness and soliciting solution
or suggestion.
 Analysis of the presented solution.
 Planning of the activities.
 Organizing the people to build their own
organization.
 Registration of the organization.
 Implementing of the said activities.

 PHASES OF THE COPAR
PROCESS
Sustenance and
Occurs when the community organization has already been
Strengthening Phase
established and the community members are already actively
participating in community- wide undertakings
 The different committees set-up in the organization-building
phase are already expected to be functioning by way of planning,
implementing and evaluating their own programs, with overall
guidance from the community- wide organization
 Strategies:
*education and training
*networking and linkages
*developing secondary leaders
Sustenance and
Strengthening Phase
• Key Activities
o Training of CHO for monitoring and
implementing of community health program.
o Identification of secondary leaders.
o Linkaging and networking.
o Conduct of mobilization on health and
development concerns.
o Implementation of livelihood projects.