Module 2: Community diagnosis

Community diagnosis

Community diagnosis

• obtain general information about the community’s profile to determine the community’s strength and weaknesses

• consist of collecting, organizing, synthesizing, analyzing, and interpreting data

What are the ways to collect primary data?

1. observation

2. survey

3. informant review

4. community forum

Determinants of comprehensive community diagnosis

1. demographic profile

2. socio-economic and cultural variables

3. health and illness patterns

4. health resources

5. political/leadership patterns

demographic variables

• total population and geographical distribution

• age and sex composition

• household size

• growth rate, crude birth rate, crude death rate, and life expectancy at birth

• patterns of migrations

• population projections

Social indicators

• educational level which may be indicative of poverty and may reflect on health perception

• housing conditions which suggest health hazards

economic indicators

• poverty level income

• underemployment rates

• proportion of salaries and wage earners to total economically active population

• types of industry present in the community

• occupation common in the community

• communication network

• transportation system

environmental indicators

• physical, geographical, topographical characteristics

• water supply

• waste disposal

• air, water, and land pollution

cultural indicators

1. variables that may break up the people into groups within the community: ethnicity, social class, language, religion, rave

2. cultural beliefs and practices which affect health

3. concepts about health and illness

health and illness patterns

• leading cause of mortality, morbidity, infant mortality, maternal mortality

• leading causes of hospital admission

components of health resources

1. manpower resources

2. material resources

manpower resources

• categories of health manpower available

• geographical distribution of health manpower

• distribution of health manpower to health facilities

• quality of health manpower

• existing health manpower development

material resources

• health budget and expenditures

• sources of health funding

• categories of health institutions available in the community

• hospital bed- population ratio

• categories of health services available

political/leadership patterns

reflect the action-potential of the state and its people to address the health needs and problems of the community

steps in conducting a community diagnosis

1. determining the objectives

2. defining the study population

3. determining the data to be collected

4. collecting data

5. developing of instruments

6. actual gathering

7. data collation

8. data presentation

9. data analysis

10. identifying the community health nursing problems

11. priority setting

importance of determining objectives

• describe the prevailing disease conditions and health needs

• explain the health behaviors or risk factors

• provide the analyses related to the socio-economic, cultural, and environmental actors

• reflect possible solutions of the health programs

Categories of data

1. primary data

2. secondary data

primary data

directly obtained by the nurse

secondary data

existing data that were obtained by other people

characteristics of data collected

1. timeliness of data

2. completeness

3. accuracy

4. precision

5. relevance

6. adequacy

observation

obtaining information by observing their behavior and their environment

methods of collecting data

1. observation

2. record review

3. focus group discussion

4. interview

Ocular survey/windshield survey

consists of walking around the community appreciating what can be seen and perceived among people

participant observation

practiced by the nurse by living with the community of their study

record review

reviewing folder, files, or books compiled by health or non-health agencies from the government or other sources

focus group discussion

• explore opinions of people, determine their attitudes and practices

• set the characteristics of the participant (based on the variables that are being studies)

interview

• asking and answering questions following a systematic procedure

• to gather first-hand infronation

ways of conducting an interview

• face-to-face interview

• telephone interview

• key informant interview

• individual interview

• group interview

• structured interview

• unstructured interview

face-to-face interview

interview that is conducted via in person

Telephone interview

interview that is conducted via telephone

key informant interview

an expert or an authority on a specific subject is interviewed

individual interview

between a respondent and an interviewer (usually sensitive issues)

group interview

consists of one interviewer and usually around 10-15 participants

structured interview

follows a list of questions called an interview schedule

unstructured interview

seek to describe opinions or perception of people focusing on particular issue, problem, or phenomenon

survey questionnaire

an instrument used to document the data collected

types of survey questionnaire

1. interview schedule

2. self-completed or self-administered questionnaire

3. focus group discussion guide

4. key informant interview guide

5. observation checklist

interview schedule

the interviewer reads out the question and records the respondent’s reply to the questions

self-completed or self-administered questionnaire

the respondents read the questions and write down their responses

focus group discussion guide

serves to facilitate the direction and flow of exchange of ideas on specific topics or concepts among the participants

Key informant interview guide

using a set of prepared questions on a very specific subject

observation checklist

is a list of data that are manifestation or indicators of health need or problem

Participatory tools/techniques

1. semi-structured interviews

2. analytical games

3. stories and portraits

4. diagrams

5. workshops

semi-structured interviews

some of the questions are predetermined and new questions or lines of questions arise during the interview

analytical games

finding out an individuals or group list of preferences

stories and portraits

short colorful descriptions of situations encountered by the nurse in the field

diagrams

a participatory tool that is simple and use schematic devices

workshops

means of brining people together for their skills and experience

Numerical data

• data that can be counted (age, number of rooms)

• are presented into tables or graphs to show comparison, patterns, and trends

descriptive data

• data that can be described or that can reveal characteristics of observable facts

• are presented in narrative reports

categories in data collation

1. mutually exclusive

2. exhaustive categories

mutually exclusive

choices do not overlap. this can be used both for numerical and descriptive data (gender)

exhaustive categories

anticipate all possible answers that a respondent may give

EPIINFO software

public domain statistical software for epidemiology

Line graph

• shows data trend or changes in data with time or age with respect to some other variable

• preferably five or more data points are needed for the display

Bar graph or pictograph

• for comparisons of absolute or relative counts and rates between categories

histogram or frequency polygon

• graphic presentation of frequency distribution

• mostly use in nominal or categorical data

proportional or component bar graph or pie chart

shows a breakdown of a group

scattered diagram

shows the correlation data for two variables

Data analysis

• data are sorted, classified in terms of relatedness, and interpreted for any significance or implication

• establish trends and patterns in terms of health needs and problems

health status problem

described in terms of increased or decreased morbidity, mortality, fertility, reduced capability for wellness

health resources problem

described in terms of lack or absence of manpower, materials, money, institutions necessary to solve health problems

health related problems

described in terms of existence of social, economic, environmental and political factors that aggravate the illness

components of priority setting

1. nature of the problem

2. magnitude of the problem

3. modifiability of the problem

4. preventive potential

5. social concern

magnitude of the problem

severity of the problem

modifiability of the problem

probability of reducing, controlling or eradicating the problem

preventive potential

probability of controlling or reducing the effects posed by the problem

social concern

refers to the perception of the popukation and readiness to act on the problem

factors to considering in scoring preventive potential

1. gravity of the problem

2. duration of the problem

3. current management

4. exposure of any vulnerable or high-risk group

gravity of the problem

the more severe the problem, the lower the preventive potential

duration of the problem

has a direct relationship with the gravity of the problem, when did the problem started

current management

presence of appropriate interventions increases the conditions’ preventive potential