The document provides a comprehensive overview of community diagnosis, focusing on its definitions, purposes, and methodologies for assessing health needs within communities. It emphasizes the importance of both quantitative and qualitative data in identifying health problems and prioritizing community health initiatives. Various assessment methods, indicators, and processes are detailed, aimed at guiding health professionals in understanding and addressing the health status and needs of communities.

1. Community Diagnosis
GNU: 407
2018/19
Dr. Mathania

2. Unit Objectives
• Define community diagnosis
• Discuss aims and goals of community diagnosis
• Identify rationale and use of community diagnosis in the
community health
• Discuss types of community assessment methods
• Identify methods to assess the health risks of individuals,
families, and communities
• Identify types of data, data collection methods, presentation,
analysis and interpretation

3. Community diagnosis
WHO definition
• It is “a quantitative and qualitative description
of health of community and the factors which
influence their health. It identifies problems,
proposes areas for improvement and
stimulate action”

4. Community diagnosis…
• Quantitative: is the systematic investigation of
observable phenomena via statistical methods
– Measurement is the center to quantitative research
– It provides the fundamental connection/ relationship
between observations and statistics (e.g percentage,
proportion) which can be generalized in to the entire
population
• Qualitative: This inquires deep understanding of
specific phenomenon, with the intention of
describing and exploring meaning through text,
narrative, or visual-based data, by developing
themes exclusive to that set of participants

5. Definition-2
Community Diagnosis:
• Is a comprehensive appraisal of the state of
entire community in relation to its social,
physical and biological environment for the
purpose of determining the problems, setting
of priorities for planning, and develops
programme of care for the community
(Dreyer, M., Hattingh, and Lock, M (2000)

6. Community diagnosis:
• Refers to identification 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

7. Aims/Purposes
The aims/purposes of community diagnosis is to
• Define existing problems, determine available
resources and set priorities for planning,
implementation and evaluation of health action
by and for the community
• Analyze the health status of the community
• Assess attitude towards community health
services and issues

8. Aim/Purpose…
• Identify priorities to establish goals and determine
courses of action to improve the health status of the
community
• Establish an epidemiological baseline for measuring
improvement over time
• Assess nutritional needs, housing, health care
providers, social services etc

9. Uses of Community diagnosis
• Identify trends in illness, injury, and death and
factors which may cause these events (health
determinants)
• Identify available resources and their application
• Identify unmet needs
• Identify community perception/ attitude about
health issues

10. Uses of Community diagnosis…
• Collect data regarding specific populations
• Identify at risk and high-risk population eg.
elderly, children, women, unemployed,
pregnant women, teens, low birth weight
infants

11. Rationale of community diagnosis
• Provide baseline information about the health
status of community residents
• Ensures that decisions are based on solid
information and evidence from community
• Helps set priorities
• Helps regional health authorities assess
outcome and results in the longer term

12. Rationale of community diagnosis…
• Get community members, stakeholders and
other partners to contribute to community
health
• Involves in decision-making process in difficult
choices that need to be made
• Create ownership in any implementation plans
(due to community participation)
• Used to guide policy and program development

13. Rationale of community diagnosis…
• Assist in mapping out links between sectors
• Provide insight in identifying opportunities for
disease prevention, health promotion and
health protection

14. Community diagnosis…
• Community health nurse should know and
understand needs and characteristics of the
community in which he/she works
• Where health needs are determined
• Priorities are set

15. 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”

16. Community assessment

17. Community assessment:
• Is the process by which the community’s
health status is evaluated through the
collection of data in that community
(Dreyer, M., Hattingh, and Lock, M (2000)
• It aims is to collect health and social statistics
aggregates in the local community
• In order to determine the health needs of
the community

18. Community assessment
• Identify the strengths, assets, needs and
challenges of a specified community.
– Assets refer to the skills, talents and abilities of
individuals as well as the resources that local
institutions contribute to the community.
• Local institutions may include political,
religious, educational, recreational and youth
organizations

19. Community assessment…
• A community assessment involves
1. An evaluation of the current situation in a community
2. A judgment of what the preferred or desired situation
in that community would be
3. A comparison of the actual and desired situation for
the purpose of prioritizing concerns.

20. Community assessment…
• Community assessment is sometimes referred to as
needs assessment,
– ‘’Although these clauses differ’’
• In a needs assessment; the focus is limited to
discrepancies between what is and what should be
in a given community.
• In contrast, a community assessment seeks to
empower community members by allowing them to
take ownership in affecting the community health
instead of providing them with a prescription of
what their community needs.

21. • 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 data and the
second is analysis and interpretation of
data.

22. Key Principles of Community Assessment
1. Residents are the best experts on the community in
which they live.
2. All residents have skills, abilities and talents that
they can contribute to the community.
3. A strong community is built upon the talents and
resources of its members.

23. Why should you do a community assessment?
• To learn more about group or community needs
• Establish objectives for a program or intervention
• Identify new ideas, strategies, partners and resources
that can be used in working toward a common goal
• To make sure your future actions are in line
community needs
• To involve more people in the subsequent action

24. Conducting a Community Assessment
• The process of conducting a community
assessment can be divided into three phases:
i) Pre-assessment,
ii) Assessment and
iii) Post-assessment.

25. Questions/issues to be considered during
community assessment
• What is going to be assessed?
• What is already known?
• What data will need to be collected?
• How and by whom will data be collected?
• How and by whom will data be analyzed?
• Determine the purpose and scope of the assessment
• Decide which health topics to prioritize, limiting the scope
of the assessment
• Define the goals and objectives of the assessment
• Select data collection methods
• Prepare a timeline and budget
• Data processing, analysis and presentation

26. Where do we collect data?

27. Community sub-system assessment
• A community is a whole entity that functions through
interdependence parts or subsystems
• The subsystems which exists within the community
are:
1) Physical environment – e.g homes, water resources,
disposable sites, vegetation
2) Education – schools, colleges etc
3) Safety and transportation

28. Subsystems…
4) Political and Governance
5) Health and social services
6) Communication
7) Economics
8) Recreations

29. Types of community assessment
1. Comprehensive assessment:
• Seeks to discover all relevant community
information
• It complies all demographic, physical, social-
economic, social services, environment etc)

30. Comprehensive Assessment…
 Key informants/ participants are interviewed in every
major system education, health, religious, economic,
and others.
 The detailed surveys and intensive interviews are
performed to yield information on each
organizations/ subsystem

31. Comprehensive Assessment…
 It describes not only the systems of a community but
also
 How power is distributed throughout the system,
 How decisions are made, and how change occurs
• Because comprehensive assessment is an
expensive, time-consuming process, and waste
of resources, it is seldom performed.

32. 2. Familiarization Assessment
• Familiarization assessment involves studying data
already available on a community
• It is a gathering of a certain amount of firsthand
data, to gain a working knowledge of the community.
• Such an approach, sometimes called “windshield
survey”

33. • Nurses drive (or walk) around the community;
find health, social, and governmental services;
obtain literature and generally become
familiar with the community.
• This type of assessment is used whenever the
community health nurse works with families,
groups, organizations, or populations.
2. Familiarization Assessment….

34. 3. Problem-Oriented Assessment:
• A third type of community assessment
• Problem-oriented assessment, begins with a
single problem and assesses the community in
terms of that problem.

35. • 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. Problem-Oriented Assessment…

36. 4. Community Assets Assessment:
• This is the process of assessing assets within
the community
• It focuses on the strengths and capacities of a
community rather than its problems.
• The result focused on the community's
possibilities, strengths, and potentials.

37. Health indicators

38. Health indicators
• Community can be diagnosed by using health
indicators
• Health indicator is measure that is designed to
describe particular aspect of health or health system
performance
• Indicators are used to measure any progress towards
goals/ targets
• It shows direction where you are heading

39. Characteristic of good indicators
1. Should be valid i.e should measure what they
are intended to measure
2. Should be reliable and objective i.e the
answers should be the same if measured by
deferent people in similar circumstances
3. Should be sensitive i.e they should be
sensitive to change in situation concerned

40. Characteristic of good indicators…
4. Should be specific i.e should reflect changes
only for intended situation
5. Should be feasible i.e they should have the
ability to obtained data needed
6. Should be relevant i.e they should contribute
to the understanding of the phenomenon of
interest

41. Classification of health Indicators
• Mortality indicators
• Morbidity indicators
• Disability rates
• Nutritional status indicators
• Health care delivery indicators
• Utilization rates
• Indicators of social and mental health
• Environmental indicators
• Socio-economic indicators
• Health policy indicators
• Indicators of quality of life
• Other indicators

42. Mortality indicators
• Mortality rates
- The traditional measures of health status.
• Crude death rates
• Specific death rates: age/disease
• Life expectance
• Infant mortality rate
• Maternal mortality rate
• Proportionate mortality ratio
• Case Fatality rate

43. Morbidity Indicators
• Morbidity rates
- Data on morbidity are preferable, although
often difficult to obtain
• Incidence and
prevalence
• Attendance rates:
out-patient clinics or
health centers.
• Admission and
discharge rates
• Hospital stay
duration rates
.

44. Disability Indicators
Disability rates
• No. of days of restricted activity
• Bed disability days
• Work/School loss days within a specified
period.
• Expectation of life free of disability

45. Nutritional Indicators
• Nutritional Status Indicators
- It is an indicator of positive health
• Anthropometrics measurements
• Height of children at school entry
• Prevalence of low birth weight
• Clinical surveys: Anaemia, Hypothyroidism,
Night blindness

46. Health Care Delivery Indicators
Health Care Delivery Indicators
- Reflect the Equity / Provision of health care
• Doctor / Population ratio
• Doctor / Nurse ratio
• Population / Bed ratio
• Population / per health center

47. Utilization Indicators
Health care utilization Rates
- Extent of use of health services
- Proportion of people in need of service who
receive it in a given period
• Proportion of infants
who are fully immunized
in the 1st
year of life.
i.e..immunization
coverage.
• Proportion of pregnant
women who receive
ANC.
• Hospital-Beds occupancy
rate.
• Hospital-Beds turn-over
ratio

48. Social/Mental Health Indicators
• Indicators of Social and Mental Health
- Valid positive indicators does not often exist
- Indirect measures are commonly used
• Suicide & Homicide rates
• Road traffic accidents
• Alcohol and drug abuse.

49. Environmental Indicators
Environmental health Indicators
- Reflect the quality of environment
• Measures of Pollution
• The proportion of people having access to
safe water and sanitation facilities
• Vectors density

50. Socio-economic Indicators
Socio-economic Indicators
- Is not a direct measure of health status.
- For interpretation of health care indicators.
• Rate of population increase
• Per capita GNP
• Level of unemployment
• Literacy rates
• Family size
• Housing condition e.g. No. of persons per room

51. Health Policy Indicators
Health Policy Indicators
- Allocation of adequate resources
• Proportion of GDP spent on health services.
• Proportion of GDP spent on health related
activities.
• Proportion of total health resources devoted
to primary health care

52. Other Indicators
Other health indicators
• Indicators of quality of life.
• Basic needs indicators.
• Health for all indicators

53. Health indicators

54. Health Needs Assessment

55. Health Needs Assessment
• Is a systematic review of the health issues facing
a population
• This process of determining the real or perceived
needs of a defined community.
• Leading to agreed priorities and resource
allocation that will improve health and reduce
inequalities

56. What is need?
• What is difference between needs and
wants?
• A need is something that is necessary for
organisms to live a healthy life
• Need must be addressed to improve the
health of the population

57. Home work
Maslow’s hierarchy of needs (1954)

58. Types of Health Needs
• Perceived /Felt need: Need for health services experienced
by individual which (s)he is ready to acknowledge
• Normative/ Professional need – needs as they are
defined by experts and professionals based on research
and evidence.
• Expressed need – felt need that has become an action,
seeking out some kind of resolution to the need
• Comparative need – determined by comparing the
situation of one individual or group to that of another
with similar characteristics.

59. Types of Data and Data
Presentation

60. Types of Data
• Primary and Secondary Data
• Primary data is the data collected directly
from source
• Secondary Data is the data collected by
others

61. Primary Data - Examples
• Surveys
• Focus groups
• Personal interviews
• Experiments and field study

62. Primary Data- Advantage
• Data collected will be current.
• Data collected will detect trends.
• Methodology will answer your objectives
• Use appropriate study participants

63. Primary Data - Limitations
• Time consuming
• Expensive
• Researcher error
– Sample bias

64. Secondary Data – Examples of Sources
• District health departments
• Vital Statistics – birth, death certificates
• Hospital, clinic, school nurse records
• Private and foundation databases
• Federal and State governments
• Surveillance data from state government
programs
• National bureau of statistics (NBS)
• Department of Environment

65. Secondary Data – Advantages
• No need to reinvent the wheel.
– If someone has already found the data you
can use it
– Less expensive
– It saves time.
• Primary data collection is very time consuming.
– It may be very accurate.
• When especially a government agency has
collected the data, incredible amounts of time and
money went into it.

66. Secondary Data – Limitations
• When was it collected? For how long?
– May be out of date for what you want to
analyze.
– May not have been collected long enough for
detecting trends.
– Sample selection bias?
– Source choice bias?
– In time series

67. Categorization of Data
There are 5 categories of data
• Demographic data
• Environmental data
• Epidemiological data
• Health Service utilization data
• Socio-economic data

68. Data collection methods:
1. Observation – Is a technical of data
collection that involves watching and
recording behaviours and characters of
study participants.
• With a checklist of the things you want to
observe

69. Data collection methods…
2. Using of secondary data (record or
available information
– It is a bench research
– These data are present in records
department, library, archives etc

70. Data collection methods…
3. Survey and Interview
• These are primary data
• Data collection method involves study
participants
• Oral questions, either individually or in a
group
• Standardized tool is used to collect data
eg tool guide, questionnaire (close or open
ended)

71. Data collection methods….
4. Measurement – anthropometric - mid
upper arm circumference (MUAC), weight,
height etc
5. Experimental - is methods where the
data are obtained from experiments/ tests
– Usually research is conducted in laboratory
– It designed to investigate causal relationship
• Test hypothesis

72. Variables
Variable is anything that has quality or quantity
that varies
Two main types variables
1) Dependent variables: are variables
researchers are interested in
2) Independent variables: are variables
believed to affect the dependent variables

73. Variables to be corrected
1. Demographic variables
Personal statistics collected to describe the
nature of the community, These variables are
– Gender, educational level, location
(geographic distribution), ethnicity, race
– Age & sex composition
– Group relationship
– Life expectance
– Total population and Population projection

74. Elements of comprehensive …..
2. Socio-economic variables
• Socioeconomic status (SES) is an economic and
sociological attributes which measure a person's
work experience
• It quantifies an individual's or family's economic
and social position in the community based on
income, education, and occupation
• SES is more commonly used to depict an economic
difference in society as a whole

75. Elements of comprehensive…
2. Socio-economic
Indicators
– Social variables
• Communication network
• Transportation system
• Educational level
– Economic variables
• Poverty level
• Employment rate
• Types of industry present in the community
• Occupation work in the community

76. Elements of comprehensive…
3. Environmental Variables
• Physical/geographical characteristics
• Water supply
• Waste disposal
• Air, water and land pollution
4. Cultural Variables
• Variables that may break up people into groups
within the community
– Ethnicity/Race
– Social class
– Religion
– Language

77. Elements of comprehensive…
5. Health and illness variables
– Leading cause of mortality
– Leading cause of morbidity
– Leading to cause of infant mortality
– Leading cause of maternal mortality
– Leading cause of hospital admission

78. Elements of comprehensive…
6. Health resources
– Manpower resources
– Material resources
7. Political/ Leadership patterns
– Reflects action potential of the country
• How health needs and problems are addressed
• Sensitivity of the government to the peoples needs
for better lives

79. Data collection tools
• Research tool must be prepared for data collection
• Examples of instrument/ tools:
– Questionnaire
– Interview checklist
– Observational form
– Attitude/view scale
– Content analysis form
– Field Tools for equipments
– Interview guide form
• Depends on method of study

80. Data analysis
• Analysis is the study and examination of data.
• Analysis is necessary to determine community
health needs and strength
• As well as to identify patterns of health
responses and trends
• Statistical test gives summary of what is
happening in the research
• It gives the results of survey/ research
• Use appropriate statistical package to analyze
your data

81. Data presentation:
Three forms of presenting data
• Narration/textual
• Use of tables
• Use of graphs
Note: Don’t use two forms of data presentation
for the same information (e.g. Table and figure)

82. Use of Simple Tables:
Quality of a good tables
• HEAD – Self explanatory that gives a clear
indication of its content
• COLUMNS AND ROWS – headings
should be brief but self explanatory

83. Use of Graphs
Graphs to use? - depends on the type of
data
Frequently used:
» Bar Chart}
» Pie Chart}
» Histogram}
» Line Graph}

84. 0
10000
20000
30000
40000
50000
60000
70000
80000
Number
of
patients
1985 1986 1987 1988
Year
Medical clinic attendance from 1985 -
1988 at Kitwe Central Hospital

85. 0
10000
20000
30000
40000
50000
60000
70000
80000
Number
of
Patients
1985 1986 1987 1988
Year
Patients attendance to various clinics from
1985 – 1988 at Kitwe Central Hospital
Medical
Surgical
Gynaecolo
gy

86. PIE CHART
• Circle split into
segments
Each segment
represent one value
taken by the variable
The size of the
segment is
proportional to the
relative frequency of
the value, such that
360 degree = 100%
1st Qtr
2nd Qtr
3rd Qtr
4th Qtr

87. LINE GRAPH
0
10
20
30
40
50
60
70
80
90
100
1st
Qtr
2nd
Qtr
3rd
Qtr
4th
Qtr
East
West
North
Depicts trend of
numerical data
Independent variable
on the X-axis,
Depended variable on
the Y-axis

88. A graph showing number of Referred and Self-
referred patients who attended KCMC Hospital from
2003 - 2007
0
2000
4000
6000
8000
10000
12000
14000
16000
18000
2003 2004 2005 2006 2007
Year
Number
of
patients
Self-Referred
Referred

89. Community diagnosis
• After data presentation you will be able to
come out with community diagnosis
• Community diagnosis gives a real clinical
judgment or conclusions about human actual
or potential problems
• The community diagnosis will indicate the
basis for community based intervention.
• Setting priority is very important

90. Planning
• Planning is a logical, decision making process
of design an orderly, detailed programs of
action to accomplish specific goals and
objectives based on assessment of formulated
community diagnosis
– Set priorities
– Establish goal

91. Implementation
• Implementation is putting the plan into
actions
• Carrying out the activities delineated in the
plan
• It is the action phase of the community
interventions to solve problems, to promote
and protect the community health

92. Evaluation
• It is systematic, continuous process of comparing the
community’s response with the outcome as defined
by the plan of care
• The ultimate purpose of evaluating interventions in
community health is to determine weather planned
actions met client needs
– if so how well they were met, and if not why not

93. Evaluation…
• Evaluation requires a stated purpose, specific
standards and criteria by which to judge and
judgment skills
• If all is done well then the community will be
relieved from suffering

94. The end!