COMMUNITY DIAGNOSIS

Definition:
Community diagnosis - is a statement of the
health and health related problems of the
community or which have a high risk of
developing, the possible causes or causative
organisms and the contributory factors.
It is the end result of data collection and
analysis.

COMMUNITY DIAGNOSIS AS:

PROFILE- description of the communitys
state of health as determined by its physical,
economic, political and social factors
Purpose: obtain a fast picture of a
community which is as accurate as
possible.
PROCESS, it is a continuous learning
experience for the nurse/program coordinator
and the staff, as well as the community
people for the ff. reasons:
a. adjust or alter the program for optimum
effectiveness.
b. Allows the community to gradually become
aware of the solution

Com. Diagnosis as a Process (cont).

c. involve people in recognizing and resolving
problems that concern them most
d. the community to understand at its own
pace the potential advantages of change
which may eventually lead to alterations in
attitude, values and behavior.

Purposes of Community Diagnosis

Have a clear picture of the community ;
identify the resource available to the
community.
Enables the nurse/program coordinator to set
priorities for planning and developing programs
of health care for the community.

Types of Community Diagnosis

1. Comprehensive community diagnosis aims
to obtain a general information about the
community or a certain population grp. It is
in knowing its profile, like demographic
variables, socio-economic/cultural, health and
illness pattern, health resources,
political/leadership pattern
2. Problem-oriented or Focused Com.
Diagnosis type that responds to a particular
need
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Elements of Comprehensive Com Diagnosis:

A. Demographic Variables

1.

2.
3.

4.
5.

size, composition and geographical

distribution of the populations indicated by
the ff:
Total population and geographical distribution
including urban- rural index and population
density.
Age and sex composition
Selected vital indicators such as growth rate,
crude birth rate, crude death rate, and life
expectancy at birth.
Patterns of migration
Population projection
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Elements of Comprehensive Com Diagnosis (Cont)

B. Socio-Economic and Cultural Variables
1. Social indicators
a.Communication network-formal or informal
channels necessary for disseminating health
information or facilitating referral of clients to the
health care system.
b.Transportation system including road networks
necessary for accessibility of the people to health
care delivery system.

c. Educational level which may be indicative of

poverty and may reflect on health perceptions

and utilization pattern of the community.
d. Housing conditions which may suggest health
hazards (congestion, fire, exposure to elements)

2.. Economic indicators

Poverty level income
Unemployment and underemployment
Proportion of salaried and wage earners to
total economically active population.
Types of industry present in the community
Occupation common in the community.

10

3. Environmental indicators
a. Physical/geographical/topographical
characteristics of community
Land areas that contribute to vector
problems.
Terrain characteristics that contributes
to accidents or pose as geohazard
zones
Land usage industry
Climate/season
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Environmental Indicators (Cont)

b. Water supply
% population with access to safe,
adequate water supply.
Source of water supply
c. Waste disposal
% population served by daily garbage
collection system
% population with safe excreta disposal
system
Types of waste disposal and garbage
disposal system
12

d. Air, water and land pollution

Industries within the community having health
hazards associated with it
Air and water pollution index

13

4. 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
health
c. Concepts about health and illness
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Elements of Comm. Diagnosis:

(Cont.)
C. Health and Illness Pattern- may collect
primary data about :
leading causes of illness and deaths and their
respective rates of occurrence
access to recent and reliable secondary data,
and make use of these.
-Leading causes of mortality
-Leading causes of morbidity
-Leading cause of infant mortality
-Leading causes of maternal mortality
-Leading causes of hospital admission

15

D. Health Resources
Are assets , means, strengths, and skills that are
contributory to the promotion of health and well
being that exist within communities to meet the
needs of the indvl, families or social grps.
Refers to manpower, institutional and material
resources provided not only by the state but those
which are contributed by the private sector and
other NGOs.

16

 Types of resources:
1. Informal families deliver he greatest part of all
care services in he community.
a. The burden of care normally and primarily
falls on women and have a significant effects
on their health.
b. Govt., private and voluntary systems of care
supplement the family or fill in where no family
network exists.
2. Formal provided by variety of levels and
agencies including both health services and other
sectors that have an impact on health such as
eductl, political, and religious organizations that can
help provide economic assistance and health and
social care.
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 The kind of resources a community will

have include the ff:
1. Knowledge and skills in caring and
promoting health.
2. Health careers (family and friends).
3. Social support networks; communitybased org.
4. Resources- money, shops food , transport
5. The ability to cope often in a very difficult
circumstances ( supportive interpersonal
relationships).
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D. Political/Leadership Patterns
reflects the action potential of the state
and its people to address the health
needs and problems of the community.
also mirrors the sensitivity of the govt to
the peoples struggle for better lives

19

In assessing the political/leadership patterns the

nurse describes:
1. Power structures in the com. (formal or
informal)
2. Attitudes of the people toward authority
3. Conditions/events/issues that cause social
conflict/upheavels or that lead to social
bonding or unification.
4. Practices/ approaches that are effective in
setting issues and concerns within the
community
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Community Diagnosis: The Process

The process of community diagnosis
consists of collecting, organizing,
synthesizing, analyzing and interpreting
health data.
The process reflects the CHN competencies
essential for assessment and analysis in
public health.
The community shld take active
participation in identifying their needs and
problems.
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 Initial tasks by the nurse prior the community

diagnosis includes:
Prepare materials and tools needed for
interview ( e.g survey forms, household list,
ballpen, etc.).
Organize the community diagnosis team (e.g
activities and function); and
Inform the community.
Inform the barangay chairman and key leaders
about the forthcoming activities for the
community diagnosis, who in turn assign a
barangay worker to inform each household.
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Sources of data
Primary data community people
through survey, interview, focused grp
discussions, observation, and through the
actual minutes of community meetings.
Secondary data- organizational records
of the program, health center records and
other public records through review of
records.

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Steps on Conducting Com. Diagnosis

1. Planning
a. Determining the objectives
Decide on the depth and scope of the data
to be gathered
Nurse determines the occurrence and
distribution of the select impt to disease
prevention and wellness promotion
Objective shld be SMART.

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(Planning Cont)
b. Defining the study population- :
Based on the objectives the nurse identifies the
population grp to be included in the study.
It may be the entire population, or grp such as women in
the reproductive age-grp or infants

c. Preparation of the community enables the

nurse to formulate the com. diagnosis objectives
with the key leaders
Courtesy calls for meetings must with the key
leaders
Spot map of the entire com.
Initial secondary data total no. of
households/area, total population/area, list of
traditional healers, CHWs.
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(Planning cont)

d. Choosing the methodology and

instrument
Primary data may be gathered through
surveys, interviews, community meetings,
and observations while secondary data
may be gathered through review of
program and public records.
Instruments:
Survey questionnaire
Observance of checklist
Interview guide
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2. IMPLEMENTATION
1. Actual data gathering- supervises the
data collectors by checking the filed- up
instruments in terms of completeness,
accuracy and reliability of the information
collected. Data gathered shld cover the ff:
a. Community dimensions secondarily related to
health
Demographic data
Economic characteristics
Social indicators
Political char
Cultural char
Environmental char
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b. Community Dimensions Directly

Related to Health
General health indicators- birth, death,
mortality, morbidity rates
Maternal and child health care- FP,
midwifery services, child care
Immunization status
Food and nutrition- daily food budget, daily
food intake, knowledge of basic food grps.
Illness and injury type of sickness, medical
personnel attending to the sick, where the
sick go for consultation and treatment, types
and sources of medicines, dental care,
accidents, causes of death.

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 Water and environment: water supply and

storage, food storage, sanitation (excretas,
garbage and waste disposal, pets and
vermin control).
Endemic diseases
Essential drugs
Health education
Health resources- (govt/private) health
manpower, health centers, health services.
Perception of health Problems -concept of
health, perceived health problem, solutions
to health problems.
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Implementation (cont)
2. Collation/ organization of data
The first step in the data processing.
Data from the questionnaires are organized
and the number of times each answer is
given is counted.
There are two types of data that may be
generated
Numerical data can be counted
Descriptive data- can be described
To facilitate data collation, develop categories
for classification of responses, either mutually
exclusive (choices do not overlap), and
Exhaustive (choices do not overlap)
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 Ex: Mutually exclusive

To classify monthly income
Below P1,000
P1,001 P5,000
P5,001 P10,00

Ex: Exhaustive categories anticipate all possible

answers that a respondent may give
Educational Attainment
No formal education
Elem. Undergraduate
Elem. Graduate
High sch undergraduate
High sch graduate
ect
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Exhaustive categories
Ex: Family Planning methods:
Lactational amenorrhea
Natural
BBT
Cervical mucus method
Symptothermal method
Standard days Method
Others (specify)

Artificial
IUD
Pills
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 In collating fixed response questions,

choices must be provided which will
serve as categories for the
respondents answer
After categorizing the responses,
summarize the data.
Two ways to summarize the data:
Manual tallying
Using the computer (SPSS)
responses are given codes
Ex: Male 1

Female -2
Tallying involves entering the
responses into prepared tally sheet

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c. Presentation of data
Results of the community diagnosis may be
presented to the members of the community or
the key leaders.
Findings shld be simple and easy to understand.
Descriptive data is merely presented in a
narrative reports (e.g. geographic data, beliefs
regarding illness/death).
Numerical data are presented in table or graph
showing key information, comparisons
including patterns or trends.
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TYPE OF GRAPH

DATA FUNCTION

Line graph

Show trend data or changes with time or

age with respect to some other variable

Bar graph
/pictograph

For comparisons of absolute or relative

counts and rates between categories

Histogram or
frequency

Graphic presentation of frequency

distribution or measurement

Proportional or
component bar
graph/pie graph
Scattered
Diagram

Shows breakdown of a group or total

where the number of categories is not
too many
Correlation data of two variables

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d. Analysis of data
aims to establish trends and patterns
in terms of health needs and problems
if the community.
allows for comparison of obtained
data with standard values.
Determining the interrelationship of
factors will shed light on the
significance of the problems and their
implications on the health status of the
community
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e. Identifying the community health problemsmake a list of the health problems and categorize them
as:

Health status problems- may be described in terms

of increased or decreased morbidity , mortality or fertility.
Ex: 405 of the sch age children have ascariasis.

Health resources problems- described in terms of

lack of or absence of manpower, money, materials, or
institutions, necessary to solve health problems. Ex:
255 of the BHWs lack skills in v/s taking.

Health related problems described in terms of

existence of social, economic, environmental, and
political factors that aggravate the illness-inducing
situations in the community. Ex: 30% of the

households dump their garbage in the river.

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f. Priority setting of community health nursing

problems make use of the ff. criteria
1. Nature of the problem - the problems are classified by
the nurse as health status, health resources or health
related problems.
2. Magnitude of the problem refers to the severity of
the problem which can be measured in terms of the
proportion of the population affected by the problem.
3. Modifiability of the problem refers to the probability
of reducing, controlling, or eradicating the problem.
4. Preventive potential refers to the probability of
controlling or reducing the effects posed by the problem
5. Salience or Social concern refers to the perception
and evaluation of the problem in terms of seriousness
and urgency of attention needed. It is the degree of
seriousness or importance as perceived by the
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community.

Scoring system in prioritizing the

problem
Criteria

Nature of the problem

Health status
Health resources
Health related
Magnitude of the Problem
affects 75% -100% of the population
affects 50% - 74% of the population
affects 25% - 49% of the population
affects <25% of the population
Modifiability of the problem
High
Moderate
Low
Not Modifiable

score

3
2
1

4
3
2
1

3
2
1
0

Weight

4
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Criteria
Preventive Potential
High
Moderate
Low
Social Concern
Urgent community concern; Expressed
readiness for action
Recognized as a problem but not needing
urgent attention
Not a community concern

Score Weight

3
2
1

2
1
0

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Steps in prioritizing the Problem:

1. Score each problem according to each criterion
2. divide the by the highest possible score
3. Multiply the answer by the weight of the criteria
4. Then the final score for each criterion will be added to
give a total score for the problem. The highest possible
score is 10, while the lowest possible score is 1 5/12.
5. The problem with the highest total score is given high
priority by the nurse
score

Criteria score ____________________________

= score
Highest possible score x weight
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 Problem : 30% of the sch age children have

ascariasis
Prioritizing:
Nature of the Problem
(3 / 3) x 1 - 1
(health status)
Magnitude of the problem (2 /4 x 3 = 1 1/2
(25 % -49% affected )
Modifiability of the problem
(3 /3 x 4 = 4
(High)
Preventive Potential
(3 / 3) x 1 = 1
(High)
Social concern
(2 /2) x 1 = 1

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 g. Feedback to the community

Community meetings are held to
inform the community people of the
results of the community diagnosis.
- help increase their awareness on their
health status as an entire community
and will help enhance community
participation in action planning

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h.

Action planning Action programs are the activities

necessitated by the results of the
community diagnosis.
It may serve as a basis for introducing
corrections or revisions to the action
program.
Impact can also be evaluated to
provide concrete basis for the validity
and appropriateness of the action
plan.
Since impact evaluation entails
thorough investigation of the
community, a follow-up to the
community diagnosis is necessary.
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 2.Problem-oriented Community Diagnosis

Problem-oriented community diagnosis
(Spradley, 1990) is a type of assessment that
responds to a particular need.

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