Community Is a cluster of people with at least one common characteristic (geographic location,

occupation, ethnicity, housing condition, etc.) A group of people with a common characteristic or interest living together within a larger

society. A functional special unit that meets people’s sustenance needs, helps form collective

identities, and patterned social interaction

Functions of Community Socialization Production, distribution, consumption of goods Social control Mutual support Social participation

Community as a client Community health nurses work with clients at several levels: as individuals, families, groups,

subpopulations, populations, and communities. Community as a client refers to the concept of community – wide group of people as the

focus of nursing services

Dimension of the community as clientCommunity having three features:

1. Location2. Population3. social system

This three-dimensional view is especially appropriate for consideration of a local community, which can vary in location if the geographic boundaries are expanded or constricted

A. Location Every physical community carries out its daily existence in a specific geographic location.

The health of a community is affected by location of health services, geographic the features, climate, plants, animals, and the human-made environment.

In assessing the health of any community, it is necessary to collect information not only about variables specific to location but also about relationships between the community and its location.

Location variables:1. Community boundaries

Serve as basis for measuring incidence of wellness and illness, and for determining spread of disease.

2. Location of health services Use of health services depends on availability and accessibility.

3. Geographic features Injury, death, and destruction may be caused by floods, earthquakes, volcanoes,

tornadoes, or hurricanes.4. Climate

Extremes of heat and cold affect health and illness. Extremes of temperature and precipitation may tax community’s coping ability.

5. Flora and fauna Poisonous plants and disease-carrying animals can affect community health. Plants and

animals offer resources as well as dangers.6. The human-made environment

All human influences on environment (housing, dams, farming, type of industry, chemical waste, air pollution, and so forth) can influence levels of community wellness

B. Population The total population of community is the second dimension to be examines. The health of

any community is greatly influenced by the attributes of its population. A healthy community has leaders who are aware of the population’s characteristics, know its

various needs, and respond to those needs. Community health nurses can better understand any community by knowing about its

population variables: size, density, composition, rate of growth or decline, cultural characteristics, social class structure, and mobility.

Population variables: 1. Population Size

The number of people influences number and size of health institutions. Size affects homogeneity of the population and its needs

2. Density Increased density may increase stress. High and low density often affect the availability of health services

3. Composition Composition of the population often determines types of health needs.

4. Rate of growth or decline Rapidly growing communities may place excessive demands on health services Marked decline in population may signal a poorly functioning community

5. Cultural differences Health needs vary among sub-cultural and ethnic population Utilization of health services varies with culture. Health practices and extent of knowledge are affected by culture.

6. Social class Class differences influence the utilization of health services Class composition influences cost of public health services.

7. Mobility Mobility of the population affects continuity of care. Mobility affects availability of service to highly mobile populations

C. Social System

Whether assessing a community’s health, developing new services for the mentally ill within the community, or promoting the health of the elderly, the community health nurse needs to understand the community as a social system.

The various parts of a community’s social system that interact and influence the system are called social system variables.

Social system variables includes:1. Health system2. Family system3. Economic system4. Educational system5. Welfare system6. Political system7. Legal system8. Communication system

The CHN needs to understand the community as a social system A social system consist of parts, such as the local government, families and hospitals that are

linked together. The parts interact and influence each other Each of the eight major systems of a community includes a number of subsystems that are

made up of organizations. Member of the community occupy roles in these organizations

Types of community needs assessment The community health nurse is ready to determine the community’s needs. Assessment is the

first step of the nursing process.

Assessment for nurses means collecting and evaluating information about a community’s health status to discover existing or potential needs as a basis for planning future action

Assessment involves two major activities: the first is collection of pertinent data, and the second is analysis and interpretation of data. These actions overlap and are repeated constantly throughout the assessment. While assessing a community’s ability to enhance its health, the nurse may simultaneously collect data on community lifestyle behaviors and interpret previously collected data on morbidity and mortality.

Community needs assessment: is the process of determining the real or perceived needs of a defined community.

The type of assessment depends on variables such as: a. the needs that exist,b. the goals to be achieved, andc. the resources available for carrying out the study.

Although it is difficult to determine the type of assessment needed in advance, the decision will be facilitated by understanding several different types of community assessment.

Types of community assessment includes:1. Familiarization or “windshield survey”

Familiarization assessment involves studying data already available on a community, and probably gathering a certain amount of firsthand data, to gain a working knowledge and general understanding of the community.

Such an approach, sometimes called a “windshield survey,” is used by nursing students in community assessment courses and by new staff members in community health agencies.

Nurses drive (or walk) around the community; find health, social, and governmental services; obtain literature; introduce themselves and explain that they are working in the area; and generally become familiar with the community.

This type of assessment is needed whenever the community health nurse works with families, groups, organizations, or populations.

Familiarization provides a knowledge of the context in which these aggregates exist and may enable the nurse to connect clients with community resource.

2. Problem – oriented assessment A second type of community assessment, problem-oriented assessment, begins with a

single problem and assesses the community in terms of that problem. The problem-oriented assessment is commonly used when familiarization is not

sufficient and a comprehensive assessment is too expensive. This type of assessment is responsive to a particular need. The data collected will be

useful in any kind of planning for a community response to the problem.3. Community subsystem assessment

In Community subsystem assessment, the community health nurse focuses on a single dimension of community life.

Community subsystem assessment can be a useful way for a team to conduct a more thorough community assessment. They could share their findings and create a more comprehensive picture of community and its needs

4. Comprehensive assessment Seeks to discover all relevant community health information. A survey compiles all the demographic information on the population, such as its

size, density, and composition. It begins with a review of existing studies and all the data presently available on the

community. It is seldom performed because it is an expensive, time-consuming process

5. Community assets assessment The final form of assessment presented here is assets assessment, which focuses on

the strengths and capacities of a community rather than its problems. The assets assessment begins with what is present in the community. The capacities

and skills of community members are identified, with a focus on creating or rebuilding relationships among local residents, associations, and institutions to multiply power and effectiveness.

It provide tools to conduct a complete functional community assessment and serves as a guide to the community for the nurse

Community assessment methods

Community health needs may be assessed by a variety of methods. Regardless of the assessment method used, data must be collected. Data collection in community health requires the exercise of sound professional judgment, effective communication techniques, and special investigative skills.

Four important methods are discussed here: surveys, descriptive epidemiologic studies, community forums or town meetings, and focus groups.

A. Survey A survey is an assessment method in which a series of questions is used to collect data

for analysis of a specific group or area. Surveys are commonly used to provide a broad range of data that will be helpful when used in conjunction with other sources or if other sources are not available.

B. Descriptive epidemiologic studies A second assessment method is a descriptive epidemiologic study, which examines the

amount and distribution of a disease or health condition in a population by person (Who is affected?), by place (Where does the condition occur?), and by time (When do the cases occur?).

In addition to their value in assessing the health status of a population, descriptive epidemiologic studies are useful for suggesting which individuals are at greatest risk and where and when the condition might occur. They are also useful for health planning purposes and for suggesting hypotheses concerning disease etiology.

C. Community forum/ town meetings The community forum or town hall meeting is a qualitative assessment method designed

to obtain community opinions. It takes place in the neighborhood of the people involved, perhaps in a school gymnasium or an auditorium. The participants are selected to participate by invitation from the group organizing the forum. Members come from within the community and represent all segments of the community that are involved with the issue.

This method is used to elicit public opinion on a variety of issues, including health care concerns, political views, and feelings about issues in the public eye.

D. Focus groups This fourth assessment method, focus groups, is similar to the community forum or town

hall meeting in that it is designed to obtain grassroots opinion. However, it has some differences. First, there is only a small group of participants, usually 5 to 15 people. The members chosen for the group are homogeneous with respect to specific demographic variables. For example, a focus group may consist of female community health nurses, young women in their first pregnancy, or retired businessmen.

Usually the group meets for 1 to 3 hours, and there be a series of meetings.

Sources of community data There are many places the community health nurse can look for data to enhance and

complete a community assessment. Data sources can be primary or secondary, and they can be from international, national, state,

or local sources.

Community diagnosis

WHO defined it is “a quantitative and qualitative description of the health of citizens and the factors which influence their health. It identifies problems, proposes areas for improvement and stimulates action”.

Community diagnosis generally refers to the identification and quantification of health problems in a community as a whole in terms of mortality and morbidity rates and ratios, and identification of their correlates for the purpose of defining those at risk or those in need of health care.

As a PROFILE, it is a description of the community’s state of health as determined physical, economic, political and social factors. It defines the community and states the community problems.

Purpose: The purpose of community diagnosis is to define existing problems, determine available resources and set priorities for planning, implementing and evaluating health action, by and for the community. To be able to obtain a quick ‘picture’ of a community’s which is as accurate as possible.

A community profile should:a. Summarize information;b. Present results and figures clearly;c. Be useful for planning and monitoring; As a PROCESS, it is a continuous learning experience for the nurse/program coordinator

and the staff, as well as the community people, for the following reasons:− It enables the nurse /program coordinator/ staff to adjust or alter the program for

optimum effectiveness.− It allows the community to gradually become aware of the solution.− It is an organized attempt to involve people in recognizing and resolving problems

that concern them most.− It enables the community to understand at its own pace the potential advantages o

change, which may eventually lead to alterations in attitudes, values, and behaviour.

Importance of Community Diagnosis It helps to find the common problems or diseases, which are troublesome to the people and

are easily preventable in the community. Community diagnosis can be a pioneer step for betterment of rural community health. It is a tool to disclose the hidden problems that are not visible to the community people but

are being affected by them. It helps to access the group of underprivileged people who are unable to use the available

facilities due to poverty, prevailing discriminations or other reasons. It helps to find the real problems of the community people which might not have perceived

by them as problems. It helps to impart knowledge and attitudes to turnover people’s problems towards the light of

solution.

The Community Diagnosis Process

“A means of examining aggregate and social statistics in addition to the knowledge of the local situation, in order to determine the health needs of the community” The mission of community diagnosis is to: Analyze the health status of the community Evaluate the health resources, services, and systems of care within the community Assess attitudes toward community health services and issues Identify priorities, establish goals, and determine courses of action to improve the health

status of the community Establish an epidemiologic baseline for measuring improvement over time.

What are the types of community diagnosis?The types of a community diagnosis may vary according to:

The objectives or degree of detail or depth of the assessment The resources, and The time available for the nurse to conduct the community diagnosis.

A. COMPREHENSIVE COMMUNITY DIAGNOSIS- aims to obtain general information about the community or a certain population group. B. PROBLEM-ORIENTED COMMUNITY DIAGNOSIS – type of assessment that responds to a particular need Why undertake community diagnosis? To have a clear picture of the problems of the community and to identify the resources

available to the community people. Community diagnosis enables the nurse/ program coordinator to set priorities for planning

and developing programs of health care for the community. The data gathered through the process serve as the material for analysis.

How is the community diagnosed? Community Analysis

Community analysis is the process of examining data to define needs strengths, barriers, opportunities, readiness, and resources. The product of analysis is the “community profile”.

To analyze assessment data is helpful to categorize the data. This may be done as following:

− Demographic

− Environmental

− Socioeconomic

− Health resources and services

− Health policies

− Study of target groups.

Community Diagnosis is done using a tool called "Health Indicators" which are the variables used for the assessment of community health. Indicators must be valid, reliable, sensitive, specific, feasible and relevant.

Health indicators can be classified as:1 Mortality indicators2 Morbidity indicators3 Disability rates4 Nutritional status indicators5 Health care delivery indicators6 Utilization rates7 Indicators of social and mental health8 Environmental indicators9 Socio-economic indicators10 Health policy indicators11 Indicators of quality of life12 Other indicators

SOURCES of data in the conduct of community diagnosis: 1. PRIMARY DATA---source would be the community people throughSurveysInterviewsFocused group discussionsObservationsActual minutes of community meetings 2. SECONDARY DATA Organizational records of the programHealth center recordsOther public records

How to conduct community diagnosis? The process of community diagnosis involves four stages: 1. Initiation 2. Data collection and analysis 3. Diagnosis 4. Dissemination

I. Initiation• In order to initiate a community diagnosis project, a dedicated committee or working

group should be set up to manage and coordinate the project. The committee should

involve relevant parties such as government departments, health professionals and non-governmental organisations.

• At an early stage, it is important to identify the available budget and resources to determine the scope of the diagnosis. Some of the common areas to be studied may include health status, lifestyles, living conditions, socioeconomic conditions, physical and social infrastructure, inequalities, as well as public health services and policies.

• Once the scope is defined, a working schedule to conduct the community diagnosis, production and dissemination of report should be set.

II. Data collection and analysis• The project should collect both quantitative and qualitative data. Moreover, Population

Census and statistical data e.g. population size, sex and age structure, medical services, public health, social services, education, housing, public security and transportation, etc. can provide background of the district. As for the community data, it can be collected by conducting surveys through self-administered questionnaires, face to face interviews, focus groups and telephone interviews.

• In order to ensure reliability of the findings, an experienced organisation such as an academic institute can be employed for conducting the study. The sampling method should be carefully designed and the sample size should be large enough to provide sufficient data to draw reliable conclusions. Therefore, study results derived can truly review the local community.

• Collected data can then be analysed and interpreted by experts. Here are some practical tips on data analysis and presentation:- statistical information is best presented as rates or ratios for comparison- trends and projections are useful for monitoring changes over a time period for future planning- local district data can be compared with other districts or the whole population- graphical presentation is preferred for easy understanding

III. Diagnosis• Diagnosis of the community is reached from conclusions drawn from the data analysis. It

should preferably comprise three areas:- health status of the community- determinants of health in the community- potential for healthy city development

IV. Dissemination • The production of the community diagnosis report is not an end in itself, efforts should be put

into communication to ensure that targeted actions are taken. The target audience for the community diagnosis includes policy-makers, health professionals and the general public in the community.

• The report can be disseminated through the following channels: - presentations at meetings of the health boards and committees, or forums organised for voluntary organisations, local community groups and the general public - press release - thematic events (such as health fairs and other health promotion programmes)

STEPS in conducting community diagnosis1. Determine the objectives

• Nurse decides on the depth and scope of data to be gathered. Nurse must determine the occurrence and distribution of selected environmental, socio- economic, and behavioural conditions important to disease prevention and wellness promotion

• STATEMENT of objectives should be SMART (Specific, Measurable, Attainable, Realistic, Time-bound)

2. Define the study population• Nurse identifies the population group based on the objectives of the study;The study

population may be the entire community population Focused on a population group

3. Prepare the community• Courtesy calls for meetings are a must to enable the nurse to formulate the community

diagnosis objectives with the leaders of the community; the following initial data are gathered through the key leaders;

• Spot map of the entire community• Initial secondary data, e.g., total numbers of household per area, total population per area

list of traditional healers, list of CHWs  4. Choose the Methodology and Instrument of Community diagnosisThree Levels of Data Gathering

a. Community people - household heads, traditional, and non- traditional leaders; 30% of the total population of household for the survey sample spread out proportionally would be ideal; representation increases or decreases proportionally depending on the size of the area ; ideally , 10% of traditional leaders (while a corresponding number of non-traditional leaders) be obtained

b. Community health workers - ideally, 20% of all enlisted CHWs as of th previous yearc. Program staff

Instrument---may be the following Survey questionnaire Observation checklist Interview guide ( CHWs, leaders, program staff )

Instrument-simplified to avoid overburden on the data gatherers in terms of educational preparation and time constraints

Instrument analyze and discuss by data gatherers Role-play an interview scene to place oneself in an actual situation

5.  Setting the Targets- involves Constructing a timetable of activities Sample size Number of personnel that will work

1. To facilitate data collection, the nurse must develop categories for the classification of the responses, making sure that the categories are MUTUALLY EXCLUSIVE and EXHAUSTIVE.a. MUTUALLY EXCLUSIVE choices do not overlapb. EXHAUSTIVE CATEGORIES anticipate all possible answers that a respondent give. For FIXED-RESPONSE questions, choices must be provided to serve as categories for

the respondent’s answer. OPEN-ENDED questions do not provide choices or categories and the answers may be

given freely by the respondent.2. The next step will be to summarize the data: Manual Tallying or counting, computer

tallying3. Presentation / organization of data= data collected may be presented as:

- Statistical tables- Graphs- Descriptive data- Examples : geographic data, history of village, health beliefs.

4. Analysis of data- aims to establish trends and patterns in terms in health needs and problem of the community. It allows comparison of an obtained data with standard values.

5. Identification of community health nursing problems- make 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. Example : 40% of the school-age children have ascariasis.

- 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. Example : 25 % of the BHWs lack skills in vital-signs taking.

- 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. Example: 30% of the households dump their garbage in the river.

6. Priority-Setting of Community Health Nursing-Problems- make use of the following criteria: Nature of the problem presented – the problems are classified by the nurse as health

status, health resources, or health- related problems. 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. Modifiability of the problem- refers to the probability of reducing, controlling, or

eradicating the problem. Preventive potential- refers to the probability of controlling or reducing the effects

posed by the problem. Social concern- refers to the perception of the population or the community as they

are affected by the problem.

STEPS IN PRIORITIZING PROBLEMS

Score each problem according to each criteria. Divide score by the highest possible score . Multiply the answer by the weight of the criteria Add the final score for each criterion to get the total score for the problem. The highest

possible score is 10, while the lowest possible score is 1 5/12. The problem with the highest total score is given high priority by the nurse.

Community level diagnosis1. Portray community focus2. Include community response and related factors3. Include response and related factors that are logically consistent.4. Wellness dx include maintenance or potential change responses5. Community nus dx include statement that narrow enough to guideinterventions6. Have logical linkage between community response and related factors7. Use a community response instead of a risk, goal or need statement8. Include factors within domain of community health nursing intervention.

COMMUNITY HEALTHThe term "community health" refers to the health status of a defined group of people, or community, and the actions and conditions that protect and improve the health of the community. Those individuals who make up a community live in a somewhat localized area under the same general regulations, norms, values, and organizations.

Healthy communityFour important characteristics of healthy community:1. Can collaborate effectively in identifying community needs and problems2. They can achieve a working consensus on goals and priorities3. Agreed on ways and means to implement the need- upon goals4. They can collaborate effectively in required actions

Guideline for assessing a healthy community1. Healthy community indicates a high degree of awareness2. Uses its natural resources3. Recognize the existence of subgroups and welcome their participation in community affairs.4. Is prepared to meet crisis5. Is problem solving community6. Has open channel of communication between sub groups in all directions7. Seeks to make each of system resources available to all members in community8. Encourage maximum citizen participation in decision-making9. Promote high level of wellness

REFERENCES:

Suhail, A.H. The community as client: assessment and diagnosis

Sulav, S. 2010. Introduction to Community Diagnosis. Retrieved September 29, 2015 from http://community.medchrome.com/2010/09/introduction-to-community-diagnosis.html