Community Needs Assessment/Community Diagnosis

Community Diagnosis

A process by which the nursecollects data about the community in order to identify factorswhich may influence the deaths and illnesses of the population to formulate a community health nursing diagnosis and develop and implement community health nursing interventions and strategies Done to come up with aprofile of local health situation Will serve as a basisof health programs and services to be delivered to thecommunity Starts with determining the health status of the community

2 Types of Community Diagnosis1.Comprehensive Community Diagnosis- aims to obtain general information about the community

2.Problem-Oriented Community Diagnosis- type of assessment responds to a particular need

ELEMENTS OFCOMPREHENSIVECOMMUNITY DIAGNOSIS1.DEMOGRAPHIC VARIABLESi.Totalpopulation&Geographicaldistribution including Urban-Rural index& Population Densityii.Age&Sexcompositioniii.Selected vital indicators e.q. Growthrate, CBR, CDR & Life expectancy rateiv.Patternsofmigrationv.Populationprojection

Note:

Population groups that need special attentions: Indigenous people Socially dislocated groups as aresult of disasters, calamities &development programs

2.Socio-economic & Cultural variables

i.Social indicatorsCommunication networkTransportation systemEducational levelHousing conditions

ii.EconomicindicatorsPoverty level incomeEmployment rateTypes of industry present in the communityOccupation common in the community

iii.EnvironmentalindicatorsPhysical/geographical/topographical characteristicsWater supplyWaste disposalAir, Water and Land pollution

iv.Cultural factorsVariables that may break up people into groups within the community e.q.EthnicitySocial classLanguageReligionRacePolitical orientationCultural beliefs and practices that affect healthConcepts about Health and Illness

3.Health &illness patterns

Leading cause of mortalityLeading cause of morbidityLeading cause of infant mortalityLeading cause of maternal mortalityLeading cause of hospital admission

4.HealthresourcesManpower resourcesMaterial resources

5.Political/LeadershippatternsReflects the action potential of the state and its people to address thehealth needs and problems of the communityMirrors the sensitivity of the government to the peoples struggle for better lives

PROCESS OF COMMUNITY DIAGNOSISConsists of:1.Collecting, organizing & synthesizing dataIn order to identify thedifferent factors that may directly or indirectly influence the health of thepopulation

2.Analyzing& interpretinghealth dataSeek explanations for the occurrence ofhealth needs and problems of the community

3.Formulation of Community Health NursingDiagnosesWill become the bases for developing and implementing community health nursing interventions and strategies

STEPS IN CONDUCTING COMMUNITYDIAGNOSIS1. DETERMINING THE OBJECTIVES the nurse decides on the depth and scope ofthe data she needs to gather.2. DEFINING THE STUDY POPULATION the nurse identifies the population group to be included in the study.3. DETERMINING THE DATA TO BE COLLECTED the objectives will guide the nurse in identifying the specific data she will collect, and willalso decide on the sources of these data.4. COLLECTING THE DATA the nurse decides on the specific methods depending on the type ofdata to be generated. Ocular survey, interview,and records review.5. DEVELOPING THE INSTRUMENT - instruments/tools facilitate the nurses data-gathering activities.Mostcommon instruments:survey questionnaireinterview guideobservation checklist6. ACTUAL DATA GATHERING the nurse supervises the data collectors by checking the filled-up instruments in terms of completeness, accuracy and reliability of the information collected.7. DATA COLLATION the nurse is now ready to put together all the information.Numerical dataDescriptive data8. DATA PRESENTATION will depend largely on the type of data obtained.Descriptive- narrative reportsnumerical data- table or graphs9. DATA ANALYSIS aims to establish trends and patterns in terms of health needs and problems of the community.10. IDENTIFYINGCOMMUNITYHEALTH NURSINGPROBLEMSa. HealthStatusProblems Increased/decreased morbidity,mortality fertility or reduced capability for wellnessb. Health Resources Problems Lack of or absence of manpower, money, materials or institutions necessary to solve health problemsc. HealthRelated Problems Existence of social, economic, environmental and political factors that aggravate the illness-inducing situations in the community11.Priority-settinga.Nature of the condition/problem presented- Classified as health status, healthresources or health related problemsb.Magnitude ofthe problem- Severity of the problem which can be measured in terms of theproportion ofthe population affected by the problemc. Modifiability of the problem- Probability of reducing, controlling or eradicating the problemd. Preventivepotential- Probability of controlling or reducing the effects posed by the problem e. Social concern- Perception of the population or the community as they are affected by the problem and their readiness to acton the problem

PLANNING

WHAT IS PLANNING? is a process that entails formulation ofsteps to be undertaken in the future in order to achieve a desired end.Concepts of Planning: Planning is futuristic. Planning is change-oriented. Planning is a continuous and dynamic process. Planning is flexible. Planning is a systematic process.THE PLANNING CYCLE:1. Situational Analysis - gather health data, tabulate, analyze and interpret data, identify health problems, set priority2. Goal and Objective Setting - define program goals and objectives, assign priorities among objectives3. Strategy/ActivitySetting - design CHN Program, ascertain resources, analyze constraints and limitations4. Evaluation- determines outcomes, specify criteria and standards

COMMUNITY ORGANIZING

Purpose:Empowerment or building thecapability of people for future community action. Approaches to communitydevelopmenta. Socialchanges Building up social organizations(relationships, structure and resources)b. Changein ideology Knowledge, beliefs and attitudec. Changeagents Capacity to influence others by setting a good example.

>Principles of CO:1.Welfare approach- people esp. the oppressed, exploited and deprived sectors are most open to change, have the capacity to change and areable to bring about change. Hence, CO is based on theff:a.Powermust residein the peopleb. Development is from the people to thepeoplec. People participation

2.Technological approach- must be based on the poorest sectorsof society. The solutions of problems commonly shared by these sectors must be focused oncollective organizations, planning and action

3.Transformatory approah- should lead to self-reliant communities

Five stages1. Community analysis2. Design and initiation3. Implementation4. Program maintenance consolidation5. Dissemination reassessment

1.Community analysis- The process of assessing and defining needs, opportunities and resources involved in initiating community health action .- Maybe referred to as community diagnosis,community needs assessment, health education planning and mapping

5 Components Of Community Analysis: 1.Demographic,socialandeconomicprofile ofthe community derived from secondary data; 2.Health risk profile (social, behavioural and environmental risks)> Behavioural - dietary habits and other lifestyle concerns like alcohol, tobacco and drugs> Social indicators- exposure to long termunemployment, low education andisolation.3.Health/wellness out comes profile(morbidity/mortality data)4.Survey of current health promotion programs.5.Studies conducted in certain target groupsSteps in community analysisi. Definingthecommunity1.Determining the geographic boundariesof the target community

ii. Collectingdata

iii.Assessingcommunitycapacity1.Entails an evaluation of thedriving forces which may facilitate orimpede the advocated change

iv.Assessing community barriers

v.Assessingreadiness to change 1.Communityinterest2.Perceptiononthe importance of the problem

vi.Synthesis data andset priorities1.Provide a community profile of the needsand resources and will become theBasisfor designing prospective community interventions for health promotion

2. Design and initiation STEPS:1. Establish a coreplanninggroup andselect a local organizer.Requirements:Select 5-8 member sin charge forcore planning and management of the programWith management skills, good listener and conflict resolution skills.

2. Choosean organizational structure.This activates the community participation.Types:a. Leadership boardcouncil- existing local leaders working for a common causeb. Coalition- linkingorganizations and groups to work on community issues.c. lead or official agency- a single agency takes the primary responsibility of a liaison for health promotion activities inthe community.d. Grass-roots- informal structures in the community like the neighborhood residents.e. Citizens panels- a group of citizens (5-10) emerge to form a partnership with the government agency.f. Networks and consortia- networkdevelop because of a certain concerns

3.Identify, select and recruit organizational members.- As much as possible different groups, organizations sectors should be represented.- Chosen representative have power for the group they represents4.Definetheorganizationmission andgoals.- This will specify thewhat, who, where, when and extent of theorganizational objectives.5.Clarify roles and responsibilities of people involved in the organization.- This is done to establish a smooth working relationship and avoid overlapping of responsibilities.6.Provide trainingandrecognition.- Active involvement in planning and management of programs may require skills development training.- Recognition of the programs accomplishment and individuals contribution to the success of theprogram and boost morale of the members.3. Implementation-put the design plan into action.a. Generate broad citizen participationHow? Organizing task force, who, with appropriate guidance can provide the necessary support.b. Develop asequential workplan Activities should be planned sequentially. Often, times have to be modified as eventsunfold. Community members may have to constantly monitor implementation steps.c. Usecomprehensive,integratedstrategies Generally the program utilize more than one strategies that mustcomplement each other.d. Integratecommunityvalues into theprograms, materials and messages. The community language, values and norms have to be incorporated into theprogram.

4.Program maintenance consolidation- The program a this point has experienced some degree of success and has weathered through implementation problems, the organization and program is gaining acceptance in the community.Maintenance:a. Integrate intervention activities into community networks This can be affected through implementation problems. The organization and program is gaining acceptance in the community.b. Establishapositiveorganizationalculture. A positive environment is a critical element in maintaining cooperation and preventing fast turnover of members. This is a resultof good group process based on trust, respect, and openness.c. Establish an ongoing recruitment plan. It should be expected that volunteers may leave the organization. This requires a built in mechanisms for continuous recruitment and training ofnew members.d. Disseminateresults. Continuous feedback to the community on results of activities enhances visibility and acceptance of the organization. Dissemination of information is vital to gain and maintain community support.

5.Dissemination-ReassessmentContinuous assessment is part of themonitoring spect in the management of theprograma. Updatethecommunityanalysis. Is there a change in leadership, resources and participation? This may necessitate reorganization and new collaboration with other organizations.b. Assesseffectivenessofinterventions/programs. Quantitative and qualitative methods ofevaluation can be used to determine participation, support and behavior change level of decision making and other factors deemed important to theprogram.c. Chart future directories and modifications. This may mean revision of goals and objectives and development of new strategies. Revitalization of collaboration and networking may be vital in support ofnew ventures.d. Summarize and disseminate results. Some organizations die because of the lack of visibility. Thus, adisseminationplan maybe helpful in diffusion of information to further boost support to the organizations endeavor.The Health Resource DevelopmentProgramCommunity Health Organizing Utilizing COPARHRDP Was developed and sponsored by thePhilippine Center for Population andDevelopment (PCPD) To make health services available and accessible to depressed and underserved communities inthe Philippines PCPD is a non-stock, non-profit institution, which serves as a resource center assisting institutionsand agencies through programs andprojects geared toward the social human development ofrural and urban communities Formerly known as The Population Center Foundation

HISTORY OF HRDP

HRDP I Trained the faculty, medical/nursing students to provide health care services to the far flung barriosbecause of lackof man power for health services at the same time that similar activities fulfilled the curricular requirements of the students for public health The PCPDprovides seed money forthe income generating projects

The CO uses his/her own strategy or method in developing the community Short-term service

HRDP II The 2nd cycle uses the same strategy but the program could not be sustained by the schools or hospitals and the income-generating projects eventually become the hindrance to the goal of achieving the health program because the people tend to be more interested in the income generated by the projects Both HRDP I and HRDP II have brought about some changes in the community life of the people Established basic health infrastructure; basic health services were increased; there were trained workers andorganized health groups to take care ofthe needs of thecommunity

HISTORY OF HRDP

HRDP III PCPD refined the program and resulted to what is now calledHRDP III, which has these unique features: Comprehensive training of the staff and faculty of the participating agency in which the community work was initiated Periodic training program and regular assistance to the participating agency were provided to strengthen the health outreach program to become community oriented PHC as the approach with which all nursing/medical students, their CIs and indigenous healthworkers are trained for community health work and around which all other project inputs will revolve

HISTORY OF HRDP Community organizing as the main strategy to be employed in preparing the communities to develop their community health care systems and the establishment of community health organization to manage the scommunity health programs Organizing work in the communities were done in 3 phases PAR as fascinating strategy for maximum community involvement through collective identification andanalysis of community health problems and collective health action Available funds to finance community initiated projects

COPAR? Since Management Leadership andJurisprudence are courses taught in the classroom members of this group of students were trained to manage and acts asleaders ofthe different levels of the students who were involved in COPAR Principles of management were applied in carrying out primary health care The community members, CHWsand leaders were empowered to manage their own health projects Conducted seminars and trainings as well ashealth education and services needed bycommunity(exposure and immersion 6-8 weeks)