Copc Manual For Teaching

Community-Oriented Primary Care; A New Approach for Teaching Health Care
(COPCTHC)
Teaching Manual
By:
Prof. Dr. Amal Ahmed El-Badawy

Prof. of Community Medicine Zagazig Faculty of Medicine
HEEPF, 1ST CYCLE

2004
Table of Contents
Page 1- Basic Concepts 2-Define and Characterize Community The Community Boundaries The Community Characteristics Health Agencies and implemented Health Programs 3-Identifying and Characterizing Community Health Status Determinants of Health Needs Assessment Health Status Assessment 4-Identify and Prioritize health Problems of our Community 5-Develop Specific Intervention Health Promotion Health Education Making the environment safe Making Healthy Choices Easy Community Partnership 6-Evaluation of the Intervention 7-Guidelines 8-Description of Teaching Activities 2 9 9 9 11 14 14 16 19 30 32 32 38 56 57 57 58 61 64
Dr. A.A.El Badawy COPC Manual
CHAPTER I BASIC CONCEPTS

If Medicine is to be effective in maintaining peoples health and well-being, it must be sensitive to the ways in which health and illness make sense within peoples lives. Also how people understand their relationship with doctors and other health care providers. Therefore, we need to understand, as best as possible, the meaning of some terms which usually may overlap: 1-Health What do we mean by health? Health as defined by the WHO is A state of complete physical mental and social well being and not merely absence of disease or infirmity. An operational definition of Health can be drawn out of this definition which emphasizes that health is the ability of the human organism to function adequately within his genetic and environmental conditions. Therefore, health does not mean in its broader sense just being free of symptoms and signs. It means being able to carry on a normal life, free of any physical or social or mental abnormalities. Nevertheless, over the past years, the concept of health has changed. The WHO definition in 1984 has stated that: Health is the extent to which an individual or group is able, on the one hand, to realize aspirations and satisfy needs; and on the other hand, to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the object of living; it is a positive concept emphasizing social and personal resources, as well as physical capacities. A spectrum of health divides it into stages: - 100% Optimal Health - Positive Health - Negative Health - Clinical Disease -Complications
3 Dr. A.A.El Badawy COPC Manual
- Death
2-Disease: If we divide the word disease, it will be: dis-ease which means being not at ease, or in other words it denotes a state of deviation from the normal status.
Thus, it is important to define: what is to be considered normal? Normality is

defined in different ways: First, statistically i.e. the usual or the average for e.g. the systolic blood pressure is normal when it is within the level of 120 which describes the level of 95% of the population according to the normal distribution curve. Second, socially which is what is usually accepted by the society as normal, for example blood in urine, due to Schistosomiasis, was considered normal by Egyptian since most of them have it. Third, health may mean different things to different person according to their life cycle (age) for example experiencing some bone ache may be considered normal in old age. 3-Medicine is particularly concerned with identifying and treating disease. Thus, Medicine by promoting health and preventing illness, endeavours to keep individuals adjusted to their community. The model of disease is called biomedicine as it mainly emphasizes on biological abnormalities. Nevertheless, biological abnormalities are not found for all diseases and thus biomedicine is only one way of looking at the illhealth that people experience. Therefore, the part of medicine that deals with promoting health and preventing diseases is preventive medicine, the part of medicine that restores health and rehabilitates patients is curative medicine, and finally addressing all aspects is the responsibility of community medicine. 4-Public Health is the art and science of preventing diseases, prolonging life, and promoting physical health and efficiency through organised community effort. Public Health is best identified as social movement concerned with protecting and promoting the collective health of the community. In public health, problems are viewed within the context of the community as a whole rather than as simply something occurring in a series of individuals.
We will only consider three main aspects of Public Health:

A-Applied Epidemiology: This will concentrate on the potential value of health data, whether previously gathered or need to be gathered. It will help on identification of characteristics of the community, its health problems and needs. Also, it will help on prioritization of health problems and in developing and implementing interventions according to population needs. B-Population-based Health Care: The value of care of population groups rather than individuals is introduced. The health care provider adds to his practice a population-based view of community needs. Therefore, he will consider: -Access issue: why some patients utilize the service while others do not? -Needs assessment issues: are patients seen reflect the community needs? -Impact issue: are patients left out of the current system are in need of care? C-Prevention: The tremendous advances in reducing morbidities and mortalities are achieved by simple approach involving the application of preventive measures such as health education, improvement of sanitation, immunization etc rather than to expensive intervention. 5-Primary Care: Primary care practice is not defined as first-contact care nor according to specialtys characteristics but on the definition that describes it as: the provision of an integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. The WHO has emphasized six characteristics that should be present: 1-Accessible: this will refer to the ability of the practice to eliminate some of the common barriers such as cost, difficulty in reaching the primary care, etc. 2-Acceptable: it will refer to the acceptance by the community of the way the service is being delivered. In order to insure it, peoples social, economic, culture, tradition etc must be taken in consideration.
3-Accountable: this represents the quality of care given and its cost effectiveness. It includes the responsibility of monitoring and improving care over time and the provision of care that ensures the least cost with the best quality. 4-Comprehensive: it indicates the provision of a full range of primary care service (preventive, curative and referral) to patients. 5-Coordinated: it describes the relationship between primary care practice and others, especially the community, the non-governmental organization, religious authorities, non-health authorities etc. In short it emphasizes community participation with all its components. 6-Continuity: it emphasizes how the development of a patient-provider relationship over time can improve the quality of care provided and enhances the opportunity to offer the patient all recommended care especially the preventive ones. 6- Community Oriented Primary Care (COPC): Community Oriented Primary Care (COPC) , is a process by which a defined populations health problems are systematically identified and addressed.
Define and Characterize The community Monitor Impact of Intervention Involve the Community Identify Community Health Problems
Develop Intervention Community Oriented Primary care (COPC) is the practice of primary care with a focus on the community in which it is practiced. It requires knowledge of the community, its demographics; the epidemiology of health problems, and sufficient knowledge of the community belief systems and value to guide appropriate interventions.
COPC requires five-step process to incorporate it into practice.

1-Determining our community 2-Characterize our community in terms of health status, 3-Prioritizing the health needs of our community, 4-Developing specific interventions to address priority needs and, 5-Evaluating the effectiveness of the interventions. 1-Determine our community: COPC focuses on a defined population within a community, it could focus on: Geographically defined population such as a town or a village; Specific population groups such as infants, mothers, elderly etc; or
People congregated at particular sites, such as workplace.

2-Characterize our community in terms of health status: COPC broadens the perspective of health care providers to include the whole community. It will focus on assessing the health status of the community as a whole. This will require knowledge of the community, its demographics, the epidemiology of health problems, and sufficient knowledge of the community belief systems and values to guide appropriate interventions. 3-Identify and Prioritize the health needs of our community: Setting priorities to address the different problems will be guided by different factors such as possibility of control, resources, population perspective, its impact on the community whether frequent or rare, whether it results on significant morbidities or mortalities etc. Health problems can be isolated at any point of time during their natural course, ranging from those at risk to those who eventually will succumb. Therefore, a list of all community problems will be created, characteristics of each will be identified, priorities will be set and the most feasible for intervention will be selected. 4-Develop specific interventions to address priority needs: In order to ensure the success of intervention, involvement of the community is a must. After identifying the problem that you are going to address, an intervention program for its control must be planned and implemented. Some criteria have to be present to ensure the success of this intervention. In short the selected intervention should be feasible, accepted by the consumers, within the available resources, respect previous successful interventions and rewards will be obvious within reasonable time. 5- Monitor and Evaluate the effectiveness of the interventions:
The final step of the process is to monitor and evaluate what have been done. An evaluation should be evaluated as rigorously as possible. The purpose of the evaluation is to determine the effect of the intervention on the community. It will provide feedback to planners, and thus assure credibility and allow the modification and the improvement of the process. The evaluation is guided by the project objectives, and must assess its structure, process and outcome as reflected by its effectiveness. 1-Complementary functions of Clinical Care and COPC: CLINICAL Individual Examination of a patient -Interview patient about history of the disease and carry out clinical examination and laboratory tests X-rays etc. Diagnosis 1-Patients complaint 2-Appraisal of a health status of a well person such as pregnant women, examination of infants, children etc Community Diagnosis 1-Usually problem-oriented. Higher frequency of a condition in the community and its causes. 2-Health status of the Community as a whole or of a definite segment of it. Treatment 1-According to diagnosis and available resources. 2-Intervention for patients seeking advice about health and illness. Monitor Therapy 1-Evaluation of patients progress and response to treatment. 2-Ongoing treatment of chronic Treatment 1-Population intervention to prevent / treat specific conditions prevailing in the community or to reduce risks. Evaluation 1-Evaluation of intervention of COPC process. Surveillance of health indicators in the
COPC Population Community Survey -Collect data about community health, using questionnaires secondary data sources etc
illness.
community. 2-Incorporation of community treatment into community health care.
2-Parallel Between Clinical Care and COPC: Clinical Care Who is the patient? Engage the patient; Initiate practitionerPatient relationship Differential Diagnosis 3 Step 1 2 COPC Define and characterize The community Involve the community; initiate the communityprofessional partnership Conduct a community Diagnosis; rank issues in priority order Treatment 4 Develop and Implement an intervention Follow-up; is the patient Improving? 5 Monitor and evaluate
Chapter II DEFINE AND CHARACTERIZE COMMUNITY

To define and characterize the community we need to identify the following: 1-Community Boundaries. 2-The community Characteristics. 3-Health Agencies and implemented Health program. 1-Community Boundaries In conceptualizing a health problem and intervention, we may need to start with the notion of a community as the residents of a geographic area . Therefore, the first step will be to map the area and define its boundaries and important landmarks. Maps are one of the types of graphic presentation that use location and geographic coordinates to provide a clear and quick method for grasping information. In epidemiology, maps may take different forms, among them we can state: 1-Density Maps: It describes the population density, which is the average number of persons per square kilometres (Km2 ). It is important in evaluating the success and coverage of different health programs. 2-Spot Maps: A spot map is used to display the geographic distribution of an event, using a dot or a symbol. 3-Chloropleth Maps: Chloropleth maps are useful for depicting rates of health condition in specific areas using different types of shading, hatching or colouring. 2-The Community Characteristics A COPC team needs a complete quantitative and qualitative understanding of the community in which an intervention is planned in order to measure health status before and after the intervention. 1-Defining the Community Denominator: In order to understand of the community in which we plan to measure the health outcome, we need to have a solid definition of its population. Denominators are determined differently for different measures of disease frequency. The two most common measures are incidence and prevalence.
1- Incidence measures the rate of occurrence of new cases (the number of new cases during a period of time) divided by population at risk to develop the disease in the same population over the same period time (denominator or population at risk). Thus, the denominator for incidence rates includes both persons and time. 2-Prevalence is the number of cases existing in a defined population at a given point of time, also requires knowledge of case numbers and persons in the population denominator. Prevalence measures are not rates and therefore do not involve time in the denominator. Their denominators include all the people at risk in a population. Prevalence reflects the proportion which has the disease at a point of time. Narrowing the Denominator toward Problem-Based Subpopulations Certain aspects of the community will be important in the process of understanding how to apply the COPC approach. Therefore, certain population may be chosen to be targeted for the COPC for several reasons: 1-School Children: School children are important subpopulation for several reasons: Schools usually enrol most of children and a large part of adolescents. Successful COPC interventions among school children offer many more years of potential healthy life than among older groups. Data can be collected easily. COPC interventions can be easily integrated with school activities.
2-Vulnearable groups: Mothers, preschool children, elderly etc can offer an excellent opportunity for the COPC team to estimate the frequency of population risk factors or health conditions. These groups place a substantial burden on the community health resources. 3-Work site: Employee demographic and health data can be obtained from work places. They are important because of risks they are exposed to, particularly accidents, exposures and disability. 4-Hospitals and Health care units: Hospitals and health centres databases can provide a good opportunity to characterize our numerator and denominator populations for different health problems such as trauma, infections, malignancies etc.
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2-Population Demography: Demography describes the population characteristics (demos = people, graphos = measure or describe). A-Population Characteristics: Some of the items that should be cover are: a-Age: it is a basic variable that is closely related to disease patterns, but it is difficult to ascertain its accuracy. b-Sex: It is important since it reflects different physiological and behavioural patterns in the two sexes. c-Marital Status: It can be important as it may reflect an important social role and life style. d-Education and occupation: these variables will be responsible for people behaviour, attitudes as well as their exposure to some health hazards. e-Other Variables: such as parity for females, religion, social class etc may help to explain the health status and problems prevailing in the community. 3-Health Agencies and Implemented Programs 1-Principle of Primary Care (PHC) in Egypt. 1-Areas of concern and components of Primary Health Care: 1-Education about prevalent health problems and methods of prevention and control. 2-Proper healthy nutrition. 3-Environmental sanitation. 4-Maternal and child health care and Family planning. 5-Immunization and control of infectious diseases. 6-Control of endemic diseases. 7-Diagnosis and treatment of common diseases and hazards. 8-Availability of basic drugs. 9-Statistics. 2-PHC administrative Boundaries in Egypt: Rural areas: 1-A rural health unit is established for every village with a population of 4000 individuals.
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2-A rural health unit, for a collection villages with a total population of 5000 individuals and at a distance of not more than three kilometres, is established in the central village. 3-For separate village which cannot be gathered and with a population size less than 3000, an outpatient clinic is established where a doctor from the nearest PHC unit can visited 2 to 3 times per week. Urban areas: 1-Maternal and Child health care centres and Family Planning. 2-School health units 3-Control of infectious diseases and Food sanitation 4-Curative and dental care by a general practitioners. 5-Emergency services. 6-Health Education These services are delivered through Urban centres. Later on the family doctor policy is now implemented. 3-Duties in PHC Units: Maternal and Child Health care Reproductive Health: -Premarital examination and genetic counselling -Family Planning. Nutrition Program Immunization Control of Communicable diseases Control of endemic diseases Laboratory Investigations Environmental Sanitation Curative and Emergency services Registration Health Education Programs Empowerment Programs Informatics, administration and quality assurance Community Partnership
Administrative duties 2-Expected Outcomes: (Target Objectives to be reached by the year 2000) 1-Eradication of poliomyelitis and Tetanus neonatorum. 2-Decrease Maternal Mortality ratio (MMR) by 50% out of the 174 per 100,000 in year 1993. 3-Decrease Infant Mortality ratio due to dehydration and Acute respiratory Infection as well as age specific mortality (1-5 years). 4-Keeep vaccination coverage to a least 90%. 5-Increase use of contraceptives to 55% and decrease general fertility rate from 3.9 to 2.9. 6-Increase use of Oral Rehydration Therapy from 60% to 80% in cases of diarrhea. 7-Promote breast feeding for two years duration. 8-Promote Maternal care during pregnancy and labour by trained personal to at least 60%. 3-Indicators for monitoring and evaluation: 1-Percentage of Coverage of Maternal care: It will reflect the number of pregnant females that came for antenatal care (first visit) compared to the number of live births in the same area and year per hundred. 2-Average Number of Antenatal periodic visits: Total No of visits of pregnant females attending antenatal periodic visits in a year / No of pregnant females in the same year. 3-Percentage of delivery under medical supervision: -Total number of delivery under medical supervision / Total No of live births in the same year * 100. - Total number of delivery under medical supervision / Total No of females who came for antenatal care in the same year * 100. 4-Disease specific prevalence rate: Total number of cases of certain disease / No population at risk in the same year * 100. Calculated for Diarrhea, Acute respiratory Infection etc. 5-Vaccination Coverage:
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Total Number of children (or pregnant females) completed the vaccine doses / Total No of live births in the same year * 100. Calculated for the third dose of polio, triple, tuberculosis and Measles and second dose of tetanus for pregnant females.
Chapter III IDENTIFY AND CHARACTERIZE COMMUNITY HEALTH STATUS

1-Determinants of Health Model of social and biological determinants of health
Community
Individual
Family
Use of Health Services and Self-care
Health status
1- Community context: The community context will comprise all factors at the community level that can affect our health.
1 -Environmental factors: which will include all factors related to the environment with its three components (biological, chemical and cultural). Several factors may be seen as an example of the importance of the environment, in general, to our health. Among them we can notice: the supply of safe water, the proper waste disposal, the control of air pollution and finally the culture and traditions which can have a great impact on our attitudes towards our health. Infection is caused a large number of micro-organisms. Certain conditions must be present such as the presence of vectors, suitable conditions as climate, bad environmental sanitation, bad health habits etc. that will allow these micro-organisms to survive and propagate. Accidents: accidents occur due to causes either related to the environment such as road construction, in the individuals such as drivers fault. Accidents in old age are due to bad home conditions while accidents in factories can be attributed to unsanitary working conditions. 2-Economic factors: this will include the different factors that are a reflection of the economic status of the community as a whole. For example availability of food, price of food, transportation, education etc. 3-Health services: this will represent the availability of health services in general and for special groups such as maternal and child health care, occupational, geriatric etc. 2-Family circumstances: The family circumstances will reflect all conditions within the household that can affect our health status. 1-Environmental factors: these will include the housing quality, the presence of safe water and sanitary facilities within the house. 2-Economic factors: describing the household income, its way of allocation, dependency burden etc. 3-Relationship and Care within the family: familial relationship such as domestic violence, perception of needed care, children raising etc. 3-Individuals attributes: The individuals attributes will have in its core the genetic factors that will determine the biological status of each particular individual. The other factors will reflect the determinants of individual behaviour as regards his health status. Education is an important determinant that will be shaped by schooling status and amount of
knowledge acquired. Work or occupation with its impact on income and exposure to hazards. Self-esteem and status and finally perception of health needs as priorities in his life. Dietary intake: dietary intake affects our health from birth to death. A lot of deficiencies can affect growth and development, our level of resistance etc. Also, overweight is responsible for a variety of diseases such as diabetes, C.V.D. etc. All these conditions originate from conditions present due to community, family or individuals conditions. Life style: for example addictions, smoking etc are responsible for many health conditions. 2-Needs Assessment Health services are changing through alteration in demand, for example changing the composition of the population (people lives longer), appearance of new diseases (A.I.D.s) and changing preferences among consumers of health care. Therefore, assessing of the different needs of the community is very important. First we have to differentiate between 1-Need for health as defined by the WHO. 2-Need for health care: which is the ability to benefit from health care or preventive services. Therefore, it is more specific and will depend on the health care and preventive services available. Therefore, what people actually want (perceived needs), might not necessary overlap with what experts decide to be the needs (normative needs). Both types have to be distinguished from that of the actual demands (expressed needs) and comparative needs across similar communities or groups.
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Normative Needs Level of services which Experts set versus desirable Standard for individual Or whole community
Felt or perceived Needs What people want but not necessary expressed needs
Health Care Provision
Expressed Needs Actual Number of people Using or demanding a Service
Comparative Needs Comparing service provision across communities or groups
Second, Providers of health care need to know: 1-What users need? 2-What is needed in a particular situation? However, when we assess needs we have to consider , whose needs do we take into consideration: 1-Present needs of people currently ill or 2-The potential future needs of the total population.
Therefore, the way a needs assessment is conducted, can have an influence on its outcome. Conducting a needs assessment among people with specific conditions will highlight needs which might be specific to them only, but not to the general population or to people with other conditions. Directing assessment to non-users will be lacking the experience and knowledge of the topic and will generally select for provision of care for more common condition. Thus it is very important to define: 1-How we define and measure needs? 2-Whose definition of needs is to be based on: lay people, professionals, researchers, politicians, managers etc ?
Needs Demand for Supply of

Health Services Health Care
We can notice from the previous figure, that it represents the needs, demands and supply. Demand in this figure can be seen as the expressed needs A potential problem that will arise is the problem of the unmet needs as well as unlimited needs. The former issue refers to missing some needs, whilst the latter refers to whether we will be able to fulfil the needs we identify. Asking people may lead to expectations that health services can not fulfil (Unmet needs).
The realization that health needs are far more than demands (expressed needs) gave rise to the idea of clinical iceberg or iceberg of diseases. It is an indication that perceived needs can lead to different reactions by different groups. Some will seek medical help, others will use self-medication or they simply ignored. Needs assessment should include the views of lay public, professionals, managers, politicians and researchers.
3-Health Status Assessment
Gathering Information about the Community

The two basic methods that can be used to describe the population are primary and/or secondary data. 1-Secondary data: Each country has its own system of collecting routine health information and reporting it. For the PHC, emphasis should on collecting the minimum amount of necessary data in the simplest possible way and the most accurate one. National census provides a wealth of demographic and economic data. Recorders such as birth, death certificates and health care registries are another important source of secondary data. Surveillance refers to special reporting system which is set up for a particular important health problem or disease. 2-Primary data: When secondary data are simply not adequate to be used to define the health problems in our community, we will need to collect primary data. Data collection can be either qualitatively or quantitatively. Qualitative data will provide us with insight on perspectives, opinions, attitudes and can be carried out by focus group. In-depth interview can specially be used for health care providers to get a good insight of the health status of the community. For quantitative data, they are best collected by survey study. The most suitable method of data collection in survey specially in our community will be structured interviewed, in which we need to develop a questionnaire. In order to develop the needed questionnaire, we have to consider several issues: 1-Define the type of information that we need to collect; it can include demographics data, attitudes, opinion etc.
2-Make a complete list of variables, that we need to collect information about. 3-Include one or more questions for each variable, organize them by topics and the topics by the flow of ideas that you want to present to the respondent. 4-All questions must be relevant to the studys goals as well as to the respondent i.e. ensure that the respondent will be able to answer the questions easily and adequately. 5-A selection must be made between open ended and close ended questionnaires, each type has its advantages: -Advantages of close-ended questionnaires: Answers are standard and can be compared from person to person. Answers are easier to code and enter in computer. Data are easier to analyze. All answers can be completed. Respondents are clear about the meaning of the question. Answers are simpler for respondents to complete. Can be used when all response categories are not known. Allow the respondent to answer adequately and in great detail. Can be used when there are too many potential answer categories to list. Are preferable for complex issues. Allow more opportunity for self-expression. Wording is too long or too complicated. Two questions in one or double-barrelled questions. Use of ambiguous terms. Leading the respondents with non-neutral information. Ask sensitive or threatening questions. Categories of responses are not mutually sensitive. Order of questions: o Ask easy questions first. o Put open ones last o Ask information needed for subsequent questions first. Vary questions in length and type to avoid boring.
-Advantages of open-ended questionnaires:
-Potentials pitfalls in asking questions:
Do not make the questionnaire too long.
5-The sample as regards its size, type must be decided upon according to our objectives. Accessible sample is a convenient way to get an overall idea of the situation. Random sample can be used if we need to get a more representative sample. Sample Size can be calculated, but a size of 100 will be sufficient to fulfil the desired objectives. Primary and secondary data collection are usually used in a complementary way to define our community health status.
3-Rapid Epidemiological Assessment: Rapid Epidemiological Assessment (REA) allows the collection of epidemiological data with the fewest resources possible in the shortest time. It can use the following methods: a-Cluster Sampling: it simplifies the random selection process. The areas under study is divided into 30 or more clusters, from which after a random start, seven or more individuals are included. Number of clusters and individuals will depend on the number of factors under study. It is useful technique for the selection of a representative sample. b-Verbal Autopsy: It allows to get information about the cause of death. It collects data from lay people using a questionnaire about the cause of death. Developing of the questionnaire is the most important step as we need first to identify the common causes of death and then after collecting demographic data we narrow our questions to explore the cause of dearth. Among other methods of REA we can state the sisterhood method and questioning the key informants. Health Indicators 1-Morbidity patterns: Morbidity data will reflect the health status of the community, as it will reveal the commonest health problems. Calculating different morbidity indices will help in determining the types of health problems as well as the level of care delivered and needed by the community. The important morbidity indices are:
-Incidence rates -Prevalence -Case Fatality rate. 2-Mortality Pattern: Mortality data will reflect the common causes of health problems. We can calculated out of death certificates, and /or records on health units. The important mortality indices are: -Crude death rate -Age specific Mortality rates -Cause specific Mortality rates. Special Consideration: Special consideration should be in our mind when handling information from PHC units: 1-Mortality data are usually more accurate than morbidity data. 2-It is possible to estimate the number of cases of certain disease out of morbidity data, such as disease specific incidence or prevalence, which can help very much in assessing the magnitude of a problem and thus help in prioritization of health problems in the community. 3-Interpretation of data from records must be carried out with caution regarding its accuracy. 3-Other Vital rates: Several vital rates can be of importance in assessing the health status of the community: -Crude Birth Rate which is can be used for assessing the population problem. How? -Fertility rates, which are good indicators of the Family Planning program. Data Processing and Analysis
Descriptive statistics:
1-Types of data The raw data of an investigation consist of observations made on individuals. Any aspect of an individual that is measured, like blood pressure, age, sex is called variable. Variables are either quantitative or qualitative.
1- Quantitative data: A quantitative variable is numerical and either discrete or continuous.
a) Discrete data: are usually whole numbers, such as number of cases of certain
disease (no decimal fraction).
b) Continuous data: Continuous data implies the measurement on a continuous scale

e.g. height, weight, age (a decimal fraction can be present). 2- Qualitative data: It is a non numerical data and is subdivided into:
a) Categorical : data are purely descriptive and imply no ordering of any kind such
as sex, area of residence.
b) Ordinal data: are those which imply some kind of ordering like
-level of education: illiterate, read and write, primary. -socio-economic status: low, middle and high -response to drug either none, fair, good, very good. -Degree of severity of disease: mild, moderate and severe. 2-Presentation Of Data: The first step in statistical analysis is to present data in an easy way to be understood. Therefore the use of tables and graphs are very important as a first step in data manipulations. The basic ways in which data are presented are: (1) Tabular presentation. (2) Graphical presentation. 1- Tabulation: It is the basic form of presentation.
1- List: is the simplest form of presentation. A table consisting of two

columns, the first giving an identification of the observational unit and the second giving the value of variable for that unit.
2- Frequency Distribution tables: they provide the most convenient

format for summarizing and presenting data. -For qualitative data, it is straightforward, the main task is to count the number of observations in each category. These counts are called frequencies. -For quantitative data, we have to form a frequency distribution which consists of a series of predetermined classes together with counts of the number of observations whose values fall within the interval of each class. Some rules for the construction of the table: 1-The table must be self-explanatory. 2-Title heading: written at the top of table to define precisely the content, the place and the time. 3-Clear heading of the columns and rows and units of measurements should be indicated. 4-Decide on the number of classes. Usually lie between 2 and 10. Its selection depending on the form of data and the requirement of the distribution. Too small may obscure some information and too many will not differ from raw data. 5-Determine the width of the class intervals. It is convenient to maintain constant width for all intervals. Choose the upper and lower limits of the class interval. List the intervals in order. Consider each observation in turn and allocate it, to the interval into which it falls. Indicate with a tally. Add the tally mark in each interval to obtain the class frequencies. 3- Relative frequency: The proportion for given class is obtained by dividing the count in each class by the total number of observation and multiply it by 100 (percent)
Age group 2535455565-
Tally 1l 1lll 1lll llll 1 1lll llll 11 1lll 1111

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Frequency 2 5 11 12 9
Percentage 2.0 7.0 18.0 30.0 39.0
75Total 2- Graphical Presentation: The diagram should be: - Simple - Self explanatory - Save a lot of word:
1 40
40.0 100.0
- Easy to understand - Fully labeled
1- Bar chart: It is used for discrete or qualitative data. It is a graphical presentation of magnitude by rectangles of constant width and lengths proportional to the frequency and separated by gaps.
- Simple: different values of variable are given as vertical or horizontal bars. - Multiple: Each observation has more than a value represented, by a group of bars. - Component: subdivision of a single bar to indicate the composition of
total divided into sections according to their relative proportion. This is an example of multiple Bar Chart.
100 80 60 40 20 0 1st Qtr 2nd Qtr 3rd Qtr 4th Qtr East West North
2- Pie diagram: Consist of a circle whose area represents the total frequency and which is
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divided into segments. Each presents the proportional composition of the total frequency.
1st Qtr 2nd Qtr 3rd Qtr 4th Qtr
3- Histogram: It is very similar to the bar chart with the difference that the rectangles are proportional in area to the class frequencies erected on the horizontal axis. The width = class interval. The highest = proportional are equal to the class frequencies. 4- Scatter diagram: Useful to represent the relationship between two measurements, each observation being represented by a point corresponding to its value on each axis. When the points are joined by a line we call it a line graph.
100 90 80 70 60 50 40 30 20 10 0 1st Qtr 2nd Qtr 3rd Qtr 4th Qtr
East West North
5- Frequency polygon: Derived from a histogram by connecting the mid points of the tops of the rectangles in the histograms. 3-Data Summarization To summarize data, we need to use one or two parameters that can describe the data.
Usually we use the averages, which describes the center of the data and the measures of dispersion which show how the data are scattered around its center. 1- Measures of central tendency: One of the most important measure, used for data summary is the average. Variable usually has a point (center) around which the observed values lie. These averages are also called measures of central tendency.
The three most commonly used averages are: 1- The arithmetic mean: Which is the sum of observation divided by the number of observations: x = x n Where : x = mean
denotes the (sum of) x the values of observation n the number of observation Example: In a study the age of 5 students were: 12 15 10 17 12 To calculate their mean = (12+15+10+17+13) / 5 =13.4 years 2- Median: It is the middle observation in a series of observation after arranging them in an ascending or descending manner. The rank of median is (n+1)/2 if the number of observation is odd and n/2 if the number is even (n = number of observation). If number of observation is odd, the median will be calculated as follow: e.g. 5, 6, 8, 9, 11 n=5
the rank of the median = (5+ 1)/ 2 = 3 So median is 8

If the number of observation is even, the median will be calculated as follows: n=4
e.g. 5, 6, 8, 9
- The rank of median = 4 / 2 = 2 The median will be the mean of observation 2 and 3 i.e.(6+8)/2 =7 3- Mode: The most frequent occurring value in the data is the mode and is calculated as follows: Examples: 5, 6, 7, 5, 10. The mode in this data is 5 Sometimes, there is more than one modes and sometimes there is no mode especially in small set of observations. Advantages and disadvantages of the measure of central Tendency: -Mean: is amenable to mathematical operation and it is usually preferred since it takes into account each individual observation but its main disadvantage is that it is affected by the value of extreme observations. -Median: it is a useful descriptive measure if there are one or two extremely high or low values. -Mode: is seldom used. 2- Measures of dispersion The measure of dispersion describes the degree of variations or scatter or dispersion of the data around its central values(dispersion = variation = spread = scatter). 1- Range: It is the difference between the largest and smallest values. It is the simplest measure of variation. Its disadvantages is that, it is based only on two of the observations and gives no idea of how the other observations are arranged between these two. Also, it tends to be large when the size of the sample increases. 2-Variance:
If we want to get the average of differences between the mean and each observation in the data, we have to deduce each value from the mean and then sum it and divided it by the number of observation. i.e. = (mean x) / n
The value of this equation will be equal to zero. Therefore to overcome this zero we square the difference. Mathematically it is better to divide by n-1. 3- Standard deviation: The main disadvantage of the variance is that it is the square of the units used. So, it is more convenient to express the variation in the original units by taking the square root of the variance. This is called the standard deviation (SD).
(X X )2 S D = n 1
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CHAPTER IV IDENTIFY AND PRIORITIZE HEALTH PROBLEMS OF OUR COMMUNITY

Health problems can be isolated at any point of time during their natural course; at each point, different subpopulations are affected, ranging from those at risk to those who eventually succumb. These subpopulations can be represented quantitatively as the numerator or denominator in measures of the incidence or prevalence of a particular health problem. Any health problem may take many forms and have different components that can be addressed in an intervention. A health problem may be viewed in the form of: -Risk factor before the disease actually occurs. -A screening finding after the disease occurs but before symptoms develop. -A symptom of disease such as headache. -A complication or consequence of the disease: diabetic foot ulcer. Therefore, it is very important to realize that health problem can be isolated at any point during its natural history.
1-Disease No disease Disease Onset Symptoms 2-Symptoms Asymptomatic 3-Preventive Stage Primary Secondary Tertiary Symptomatic Cure, Complications or death
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Health Problems and Subpopulations Each level of a health problem corresponds to a segment of the overall population. Identifying the levels of the problem will determine the subpopulation that we need to consider. We can start with the whole population then we can narrow it to those who have the risk factors, then to those with the disease / condition, and finally to those who die from the problem. Developing Health priorities: Analysis of the community health profile should cover: 1-Main Health Problems 2-High risk groups 3-Level of available health services. 4-Deficiency that we need to overcome. At this stage we need to prioritize our problems and select the problem amenable for the intervention. The following guidelines will help: 1-Develop a Priority Chart, in which each health problem is given a simple score for its relative importance. The score will be based on: -Frequency of the condition -Level of morbidity (severity) -Level of mortality (fatality) -Effectiveness and feasibility of intervention -Cost of intervention. -Time constraint. 2-Another important issue that should be considered, while setting priority for intervention, is the identification of groups at risk and the possibility of reaching them.
CHAPTER V
DEVELOP SPECIFIC INTERVENTION

The type of intervention will be decided upon not only according to the type of health problem, but also according to the stage of the health status whether we are dealing with risk factors or actual disease or complications etc. HEALTH PROMOTION Health promotion is one of the basic activities, which are carried out very early in order to control most of the community health problems before appearance of any manifestation. 1-Definition: Health promotion is all activities that are intended to prevent diseases and ill health and increase well being in the community. 2-Health promotion activities: include: 1-Making environment safe. 2-Individual protection. 3-Health education. 4-Making healthy choices easy: community development Therefore, in order to intervene at the community level, usually one or more of the previously mentioned activities should be considered. Nevertheless, before proceeding to discuss the previously mentioned activities, certain basic ideas should be discussed. Composite Model of health promotion Governmental and social action Health education
Physical environ.
Cultural environ.
B
Positive Health
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From the previous composite model, it is evident that two models can act together in an interactive way in order to accomplish the state of health promotion: 1-Empowerment Model: This implies to increase individuals ability to choose and influence their environment. It aims to equip individuals with the skills and information that will give them the power to take control over their own health. 2-Community Model: It seeks to encourage individual to act together as a community to demand changes in their environment to make it healthier. Life Style and Perception of risk and risk taking behaviour Life style refers to those individual and/or societal behavior patterns that are at least partly under individual control and that demonstrably influence personal health. Linking health and life style can be summarized in the fact that the major causes of deaths are due to chronic diseases such as heart, accidents etc. These conditions are in its majority related to personal behavior and the perception of risk and thus potentially amenable to prevention. Also, most of morbidity causes have in its etiological factors, causes that can be linked to life style. Adopting specific health-enhancing (e.g. exercise) and health-promoting behavior (e.g. screening) and changing health-damaging behaviors (e.g. smoking) are ways in which people realize their potential to enhance their health status. Ignorance is often considered to be a major barrier to following lifestyle advice. However, ignorance was not found to be always present among lay people and therefore knowledge is not always a good predictor of behavior. Perception of risk is better understood when knowledge is viewed as a part of much broader consideration of peoples life and experiences. The identification of risk factors for disease is important for prevention of ill-health and the promotion of good health. Therefore, there is increasing emphasis on the importance of life style and the role of health related behavior for certain diseases. These behaviors are termed risk-related behavior. People are responsible for their behavior and therefore can be considered responsible for their health. Nevertheless, individuals ability to control their lives and their health is limited by the social circumstances that shape peoples lives.
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If we consider for example heart diseases, we will find out that although people are aware of how to prevent it, yet they continue to act in a risky way: become fat, no exercise and they continue smoking. Another problem such as Schistosomiasis, where people continue to get in contact with canal water, for different social and economic reasons, although they know they can get the infection through this behavior. Nevertheless, people have different way to justify their risky behaviour: They smoke because this is the way to overcome stressful situation, to socialize or to get few minutes for stop working and relaxes. As for Schistosomiasis, they do not to get different from colleagues or they need to do so to get their wok done. Therefore, it is very important to recognize the social context of risk perception and risk taking behaviour. Health Belief Model A health Belief Model can explain much of this perception and behavior. In this model, we perceive that we can become susceptible and can suffer from certain illness. Following this perception, we start to realize that this illness can be severe enough to lead to serious illness. We start to adopt certain health motivation that is affected by demographic and psychological variables. This motivation will be affected by our perceptions of benefits and barriers to adopt certain health behavior. Finally, certain cues to action such as advice from a doctor or friends or propaganda will initiate our action to adopt this healthy behaviour.
Perceived Susceptibility 35 Demographic Variables
Perceived Severity
Health Belief Model
If we consider again the example of heart conditions, the situation following the health belief model will be:
Health Motivation
Psychological variables Perceived Benefits
Action
Cues to Action
Perceived Barriers 1- 1Most people experience some chest pain and it sometimes it affects their performance: perception of the risk and its seriousness
2-
Males in middle age, living in stressful situation will be motivated to consider changing their risky behaviours: demographic and psychological variables motivating their behaviour.
3- They realize that if they adopt a healthy behaviour they will be able to carry
their work, enjoy their lives and not to get ill: perceptions of benefits 4- Their commitment to work does not allow them much time to practice sport or their social events force them to eat much: perception of barriers. 5- A friend got the condition and/or the doctor warned him that he is at increasing risk to become ill: cues to action. Illness behaviour and the doctor-patient encounter 1-Deciding to consult
People act differently in front of symptoms, some fail to go to the doctor or went late although the symptoms are serious, while others can go to the doctor on trivial or minor symptoms. Understanding why people do or do not consult, is important because some doctors behave badly about inappropriate or trivial complaints and patients feel frustrated about their doctors who seem to be uninterested by their conditions. Both types of feelings will influence subsequent consulting behavior, medical treatment adherence and health. Over a two weeks period about 75% of the population will experience one or more symptoms of ill health. About one third will do nothing about their symptoms, one third will self-medicated and one third will consult their doctors. Therefore, it seems that there are more people with serious diseases and who are not seeking medical care than those asking for medical help. 2-Symptoms: Experiencing symptoms might be presented as follows: 1-Being aware of his body functions and able to monitor the way it functions thus be able to perceive any changes. 2-Once perceived it may be interpreted as indicators of ill health i.e. Symptoms. Three features of symptoms are important for peoples perceptions of their seriousness: -intensity or severity, -their familiarity with the symptoms and -the duration of frequency of the symptom. 3-These symptoms may be evaluated as requiring further action i.e. Illness behavior. 3-Illness Behavior: Patients may experience symptoms several times a week but they go to see their doctor on average only 3 or 4 times a year. The most important variables known to influence illness behavior are: 1-Visibility, recognition of signs and symptoms 2-The extent to which they are perceived as serious. 3-The extent to which symptoms disrupt personal life. 4-The persistence and frequency of signs and symptoms. 5-The personal tolerance of symptoms by different individuals. 6-Available knowledge and cultural assumption of the symptoms. 7-Needs for denial and needs to compete with illness.
8-Interpretations of symptoms once recognized (Stigma). 9-Understanding of health providers. 10-Availability of suitable health services. 4- Patient Compliance: Patients compliance or adherence refers to following the advice of health care professionals. It includes: -Preventive health behaviors. -Keeping medical appointment -Self-care actions -Taking medicated as directed. However, non-adherence was found among about 40-45% of patients. This suggests that: -Almost half of all prescribed medications has a reduced health impact. -Doctors may be only effective with about 55-60% of their patients. -Patients are becoming ill unnecessary due to non-adherence. It is estimated that 10-25% of hospital admissions are due to non-adherence. Review of adherence research has revealed that several factors are associated with adherence: First: Patient has to understand what they are being asked to do. Second: They must also remember what they are told. Third: They must be satisfied with the doctor and the consultation.
HEALTH EDUCATION A- Principles of Health Education Definition: Health education is planned opportunities for people to learn about health and make changes in their behavior.
Therefore, it includes: 1- Raising awareness 2- Providing information 3- Motivation and persuasion to make changes 4- Equipping people with the skills and confidence to make those changes. Basic Reasons for Health Education: 1- Health Knowledge is a basic human right: People need to know the potential to affect their health. However, in some circumstances they do not want to know as for example in the diagnosis of a terminal illness. 2- Health Education is the basis for health promotion: Decisions about the prevention of ill-health, recovery from illness and coping with chronic ill-health and disability should be made on the basis of a sound understanding and knowledge about health. Health education is a tool which enables people to take more control over their own health, and over the factors which affect their health. 3- Health education gets results: No professional practice can claim 100% success, but it is clear that in theory a great deal of our health problems are preventable and that there is considerable scope for prevention and health promotion. Health Education Goals: 1- Health consciousness goal: Increase awareness of health issues 2-Knowledge goal: Give information 3-Self-awareness goal: It involves clarifying values about health, i.e. helping people to identify what is really important to them 4-Attitude change goal: Change what people feel, what they believe and what their opinion is about Feeling 5-Decision making goal: Decide what to do in the future about health in general or a particular health problem Knowing and Feeling
Knowing
Knowing
Feeling
6-Behaviour change goal: Do something about health 7-Social change goal: Complex goal of making healthier behavior. Example: The example that we are going to exam is the effect of physical exercise on our health. 1- Conscious 2- Knowledge 3-Self awareness 4- Attitude Change 5- Decision making 6- Behavior Change than use elevators. 7- Social change ground etc.. 1 and 2 3 and 4 5 6 7 Know Feel Know and Feel Do Healthy choices are easier Sports facilities are cheaper, schools had play I know that exercise is healthy. Physical exercise strengths my body and heart I feel unfit, not healthy I use to believe that exercise was only for I will join a sport club I go to the club, I walk to work, I climb rather Healthy choices easier choices Changing social, physical environment so that people are encouraged to adopt Doing
young people but now I believe I would benefit from exercise.
B- Concept of Health Education: The concept of health education comprises three levels: 1-Primary: it aims to prevent illness and to improve the quality of health and life. It is directed for e.g. to improve the health of children and adults.
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2-Secondary: it help the person to restore his former state of health whenever he gets ill. For example: improve his compliance with treatment, educate people about their health status or change a harmful practice. 3-Tertiary: it is directed towards how to make the best of the remaining health potentials i.e. Rehabilitation. C- Dimensions of Health Education: 1-Health Education is concerned with the whole person: physical, mental, social etc. 2-Health Education is a life long process. 3-Health Education is concerned with people at all points of health and illness i.e. primary, secondary and tertiary. 4-Health Education is directed towards person, families, groups and communities. 5-Health Education is concerned with helping people to help themselves and help others i.e. making healthy choices, easier choices. 6-Health Education involves formal and informal teaching using several methods. 7-Health Education is concerned with a wide range of goals such as information, attitude change, behavior change and social change. D-Planning for Health Education Therefore, in order to implement a health education program several steps have to be considered, they will start from identifying of consumers till implementation of the program and evaluate its impact. They comprises: I-Planning : A-Situation Analysis: -Identify the consumers -Identify the needs and priorities -Decide on the goals and objectives -Identify resources. B-Planning of the program: -Plan content and methods -Plan evaluation methods II-Implementation: III-Evaluation: Take action and Carry out the program Evaluate the structure, the process and the outcome
Identify Consumers
Identify Needs and Implement (Action) Formulate Specific Priorities Identify Decide Resources Goals Plan Plan Evaluation Content Carry out Objectives
I-Planning: A-Situation Analysis: The situation analysis will be concerned mainly with the collection of information that will allow us to analyze and identify the basis for the development of the health education program. In all situations, we have to bear in mind the link between the knowledge, attitude and behavior. The relationship between knowledge, Attitude and Behavior: Knowledge and experience
Age Social and Class Sex Education Beliefs Peer Pressure Attitudes Culture Norms Intention Behavior
Expectations of others 1-Identifying consumers and their characteristics: The first question that we needs to answer is : WHO is our client? In other words we need to identify the different characteristics of our target audience: 1-Numbers: we need to know to whom we are directing our effort: to individuals, to special groups or to communities. Our message and methods will differ according to the numbers of our recipients. 2-Age and Sex: The age and sex of our recipients will shape our message and methods. For example young age needs that we target problems that interest them such as hazards of mobile phones while targeting the problem of
Dr. A .A. El Badawy, Teaching Manual
42
diarrhea will not interest them. Females will be interested about nutrition and childbearing, problems which are of no interest to male audiences. 3-Knowledge, culture, experience and language: The culture, the past experience, the level and type of knowledge and the type of language that the clients can use to address the educator and that the educator can use to address them. It is well known that wrong knowledge can make health educators job a difficult one. The culture of any community shapes the communitys believes attitudes and therefore can predict the behavior, what is accepted in one society may be not accepted in another one. The past experience can form a barrier to change ones attitude towards certain problem since they are more convinced by their past experiences. Finally, it is always difficult to beat and overcome wrong information and convince them with new different ones. 4-Attitudes and Motivation: Attitudes are the result of some knowledge. It is always important to develop attitudes that favor the practice of a healthy behavior. If we fail to influence someone attitude towards certain problem it will be difficult to motivate them to change their behavior. 5-Expectations and receptiveness: Recipients of the health education program have some expectations that they expect to get from the program. If these expectations are not met, their reception of the message delivered by the health education program will not be accomplished. Another aspect that needs to be considered is their abilities to receive, understand and be convinced of what is delivered to them. 6-Health problems: The type of health problems that are prevailing, will affect the success of the program. Trivial problem as well as very serious problem (has no cure for example) can undermine their acceptance of the program. It is always difficult to convince people about healthy behvior that is related to an unclear health problem. For example, it is difficult to convinve people to practice family planning while it will be easier to
43
convinve them about the importance of oral rehydration therapy for the treatment of their children. 2-Identifying Health education Needs and Priorities: Needs: A-Concepts of needs: Needs are several types, they may be Normative (expert opinion), felt (what the consumers want), expressed (reflect their demands, felt that are turned into demands), or comparative (similarity with others). B-Identifying Health education needs: In order to identify the educational needs we have to cover different areas that can formulate ones needs. 1)Scope: The scope may be well defined as in the case of a dentist who wants to inform his patient on oral hygiene, in contrast to a community health worker who has a wide scope for example he is concerned with the prevention of disease and with health promotion. 2)Reactive or Proactive: -Reactive: (client-directed approach) it means responding to needs and demands which other people make. -Proactive: (medical and behavior approach) it means taking the initiatives and decide oneself on the area of work to be done. 3)Health Information: a-Epidemiological data: It provides information on the health of the population, causes, risk factors and the potential for prevention and health education. b-Social and Environmental Indicators: Social and environmental factors such as housing, employment, income etc may indicate the needs for health education. c-Professional and Public views:
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the views of professional and the public reflect experience and perception accumulated over the years. Therefore it is necessary to consider these views. Obtaining these views can be from informal discussion and or interviews. C-Assessing Health Education Needs: It can be approached by asking a series of questions: a-What sort of need is it? Normative, felt, expressed or comparitive. b-Who decide that there is a need? Who decide: professional, consumers or both. The best is both: Professionals rase awarness to make consumers perceive the problems. c-What are the grounds for deciding that there is a need? Is there an evidence in the form of hard data, facts, figures? If not could we collect such data? d-Is health education the answer to the need? Health education cannot solve all the problems, it may not always even be a partial answer. Setting Health Education Priorities: Due to limited time, resources and energy, priorities have to be defined. There is no straight forwards method, but the following may be considered: 1-Health issue type: Is it a health promotion issue, a problem or related to social factors? 2-Effectiveness: It is going to be effective in the prevention of the conditions and can be more effective than other measures (for e.g. cholera control)? 3-Feasibility: It can be done and be successful with this group? We have the necessary resources, knowledge, relevance, skills and materials. 4-Ethics: We have to determine if it is acceptable to the expert and to the consumers. We have to find out how the outcome will affect their lives:
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-Do we have the means for prevention? -If we can do nothing on the problem, why produce worries? 5-Consumers type: Policy makers, individuals, families, selected groups or whole communities. 6-Age groups, gender: Children, young, parents or elderly. Males or females. 7-At risk groups: They are susceptible to hazards: smokers, have high pressure, unemployed, low income etc. 8-Working with others: We need to know what was done by others, do we need to continue or not? We have to be careful not to duplicate or interfere with the work of others. So Setting needs and priorities have to be specified very carefully because it will determine the objectives and the outcome of the health education program. 3-Decide on the goals and objectives Goals are the broader aims of the health education program. The goals will describe what is intended to reach by the end of the program. Objectives have to be specified. Three main characteristics of the objectives that need to be considered, are: 1-It has to stated in the learners terms i.e. understandable by the learner. 2-Describing specifically the learners terminal behavior i.e. quantitative and qualitative measure of what the learner will be able to do. 3-It has to be realistic. 4-The evaluation be build in. 4-Identify Resources: To identify resources, certain items have to be covered: 1-The educator characteristics and their roles. 2-The client capabilities so that we can build on. 3-People that can influence your client.
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4-Existing policies and or plans. 5-Facilities and materials that can be used. 1)The educator Characteristics and their roles: To some extent, every one is a health educator, because at some time or another we all discuss questions of health with somebody else. However, some agencies may be responsible formally: 1-Ministries of: environment, education, health, agriculture, social affaires etc. 2-Mass Media: TV, Radio 3-Local Health Authorities. 4-Health professionals, teachers, social workers, pharmacists, etc. 5-Non Governmental Organizations. The role of health professionals in health education has several constraints: 1-Lack of identification of the health education element in the health professionals work. 2-Overcrowdness of work items and lack of time. 3-Deficient training as regards health education and difficulty in incorporating such item in the training curriculum. 4-Some health profession consider that health education has to be in the formal way and do not take opportunities to use informal way. 5-Students consider their trained professionals as a model but these professionals may not have the necessary skills for health education. Therefore, the role of health professionals may be improved if more emphasis was given to health education during basic training. More flexible multidisciplinary approach, with more emphasis on prevention and quality of service. This would create a climate conductive to effective health education practice. 2)The client capabilities so that we can build on. Previously, we have identified the characteristics of the consumers and specially the capabilities of their level of education, language, culture, level of knowledge, expectations etc. All these will define the type of message, methods, aids, language etc that we should use in order to develop a successful health education program. 3)People that can influence the client. All people surrounding us can influence our attitude and behavior. Relatives, peers, colleagues, etc can either help the health education program if their concept is similar
47
and not contradictory or can affected it negatively if they have a different point of view. 4)Existing policies and or plans. The existing policies that are implemented by different organization, specially those related to health agencies and educational agencies. These especially can have a great impact because they can affect a sector of the population that are in need of the health education and are more liable to accept and influence others at the same time. 5)Facilities and materials that can be used. The materials and facilities in the health education program are the methods and aids that can be used and are the suitable ones for the given situation. Certain guidelines for the selection of methods and aids that can be used: 1-Will it add to the interest or understanding? 2-How will it be acceptable to the learner? 3-Will it provide the opportunity for the transfer of learning? 4-Will it involve the learner? 5-Is it appropriate to the learners age, ability and experience? 6-Is it feasible? 7-Is it readily available? 8-Is it worse the cost (Efficient) ? 9-Can the teacher use it with ease? 10-What contribution will it make to achieving the objectives? Teaching Techniques: What the Technique that teacher hopes he can use to accomplish 1-Present -Lecture Information -Reading -Audio-visual Learner s ability Status Passive Advantages -Save times -Large number -Large amount of information -Learner feels secure -Learner involvement and interaction -Facilitate evaluation by the teacher Disadvantages -No interaction -Teachers cannot check what is going on -Learner attentiveness low -High cost in time and resources -Socialization decrease concentration -Difficult to
2-Develop Skills
-Demonstration -Simulation
Active
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standardize for all learners. 3-Encourage understanding -Problem solving -Group discussion -Counseling -Group discussion Active -Same as previous one -Develop problem solving skills -Same as previous one -Learning situation highly available -Same as previous one
4-Encourage examination of attitudes and values
Active
-Same as previous one
B-Planning of the program: 1-Plan Contents and Methods: At this stage, we have to decide what exactly we are going to do, using the available resources. We have to consider: 1-Which method and aids are the best for the objectives. 2-Which method and aids will be acceptable to the consumers. 3-Which methods and aids will be suitable for the contents. 2-Plan Evaluation Methods: In any program, we evaluate the structure, the process and the outcome. The evaluation will determine the success that we were able to accomplish. At each level of the program we have plan to carry out: 1-Self-Evaluation: -What we did was well? -Are we satisfied or dissatisfied? -How can we improve? 2-Peer Evaluation: -Ask a colleague to evaluate? 3-Client Evaluation: -Whats the Feedback? -What is the type of attitude? -tense -puzzled -do they enjoy it -do they benefit. II-Implementation Take Action, Carry out:
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In order to implement a successful health education program, several aspects have to be considered: 1-The relationship between educator and clients. 2-The communication styles 3-Barriers. 1-The relationship between educator and clients. In order to explore such relationship, we have to consider the following: A-Accepting or judging: These two aspects that can help or hinder the relationship between the educator and the clients. It is evident that losing the clients can occur easily if he or she feels that we are judging him and not respecting his or her behavior. The items that reflect the attitudes of the educator are: -Accepting: 1-Recognize clients knowledge and beliefs as part of life experience. 2-Understand that the educators knowledge, values and standards are part of your profession. 3-Recognize clients points of view. 4-Recognize that differences between clients and health educators does not mean that the health professionals are better. -Judging: 1-Valuing the persons by his attitudes: he drinks so he is stupid. 2-Ranking by knowledge and behavior: I am the expert so I know more than you. B-Dependency or Autonomy: The aspects of dependency and autonomy reflect the way the educator will adopt to carry out the changes that he wants the clients to do. -Autonomy: According to this way the educator will try to: -Encourage the client to take owns decisions. -Encourage him to think for himself.
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-Respect his ideas, -Dependency: Opposite to the previous behavior the educator will: -Impose solutions. -Tell him what to do because he took too long time. -Tell him that his ideas are not good. C-One way or Two ways: The way the education process that the educator will use, can have a great impact on the acceptance of the clients about what it is taught. -One Way: This is usually carried out as a lecture and has the following drawbacks: -Clients are not encouraged to ask any questions. -Lecturer is not expecting to hear or learn anything from the client. -Two Ways: It is usually in the form of group discussions or face to face and it has the following advantages: -A trust and open atmosphere prevails. -Clients are asked about their views. -Educators are expected to learn from clients. D-Health profession: source of all knowledge: Sometimes, the educator starts to take the role of the experts and consider that he has all the necessary information and thus clients had to follow him. However this can lead to some drawbacks: -First, the educator will deny the value of the clients which can lead to a negative feeling from the client. -Second, the educator had all the answers and gave advices to the clients; again this will result in rejection from the clients. -Finally, the educator denies any possibility that the clients are able to teach one another, which can lead to
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loss of an important opportunity that can have a great impact on the acceptability of the clients. E-Clients Feeling: Positive or Negative: The clients, during the sessions of health education, will develop a feeling which will depend to a great extent on the ways the educator is handling the situation. These feelings can lead at the end to either accepting or refusing of the delivered message. Situation in which the clients adopt a negative feelings: -Educator ignores the strength and capabilities of the client. -Clients efforts and achievement are ignored. -The educator attempts to raise the sense of guilt and anxiety. Situation in which the clients adopt a positive feelings: -The educator praises any effort the clients did. -The educator does not imply that the client behavior is morally bad. -The educator adopts a behavior that explores how to overcome difficulties and thus minimizing the feeling of helpless. 2-The communication styles: The communication that the educator uses to convey the desired message to the clients can have some positive and some negative aspects. Therefore, it is very important to choose the appropriate way according to the type of clients and the type of message to be delivered. 1-Authoritarian Style: This style has a positive aspect that it implies a clear guidance and thus can easily resolves the problem, while it has a negative implication that the clients are not given any responsibility and thus adopt a passive attitude. In short it implies strict obedience from the clients. 2-Paternalistic Style: The paternalistic style is mainly protective and thus is most suitable for vulnerable groups such as children and handicapped. Its main
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drawback is the reluctant attitude that prevents the clients from taking independent action. 3-Permissive Style: Its main positive implication is that clients are reactive, they are allowed to express their feelings, they take responsibilities and the educator does not impose his own ideas and thus the learners come to his own conclusion. Its main negative aspects is that the discussed issues may be limited to subjects that the clients like most, while uncomfortable issues are not considered. 4-Democratic Style: According to this style, all resources are used to promote well being and thus the learner trusts his own judgment and respects other people rights and opinions. Its main defect is the uncoverage of strong feelings due the presence of the other opinion that can contradict these feelings. 3-Barriers. a-Social and cultural gap between educator and client: The gap between the educator and the client can be due to different aspects related to their difference in background, such as: -Different social class which can be reflected in different appearances as regards dressing, language and accent. -Different religious beliefs and different culture. -Different values and different gender. b-Limited Receptiveness of client: The ability of the client to receive and accept the message delivered can be affected by: -Mental Abilities or confusion -Illness, tiredness or pain. -Emotional distress. -Too busy or distracted by other things. -Not valuing himself or his health. c-Negative Attitude of the client towards the Educator: The client can adopt a negative attitude due to certain factors that affect his acceptance:
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-Previous bad experience. -Lack of trust. -Credibility of educator: he smokes while condemning smoking. -Educator is a threat: he criticizes all the time. -Clients believes that he knows every thing. -Client is intimidated: he cannot follow the advice. d-Limited Understanding and memory: Sometimes the client cannot follow the advice because he was unable to understand or follow it, due to: -Limited intelligence. -Use medical jargon. -Poor memory. e-Insufficient Emphasis on education by the health professional: It is possible that the educator fails to reach to the client because of his own performance, such as: -He is too confident and thus he performs in a reluctant way. -He is too busy and thus did not prepare his materials or in a hurry and thus not enthusiastic. -He does not believe in the value of health education and consider it as just talking. f-The delivered messages are contradictory: Messages delivered from different sources or people can differ and thus lead to perplexity of the clients: -Different health professionals (specialty) say different things. -Family, friends and neighbors contradict the health professionals. -Experts keep changing their minds. According to this assessment, during the actual implementation of the program we may want to change some aspects: 1-Concentrate more on a particular group. 2-Consider needs that we overlooked and have to be reconsidered.
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3-Client may not need all this knowledge. 4-Objectives may be too ambitious and we need to decrease its level. 5-We may realize that we need to change the selected methods or tools.
III Outcome Evaluation: The outcome evaluation will reflect the changes that did occur in the different stages of the process of health education: 1-Changes in Health Conscious: This will be measured by: -The level of interest shown by the consumers for example the number of asking about the services or the educational material. -The degree to which the media covered the health education activities. -Data collected from questionnaires, 2-Changes in Knowledge: Several ways can reflect the change in the knowledge of the clients: -Interviews and discussion between educator and clients. -Observation of the use of knowledge by the client. -The results of the pre and post test. 3-Changes in self-awareness and attitudes: This can be assessed by: -Observe the changes in what the client do during health education activities. -Ask the clients to rate their attitude. 4-Changes in Decision-making: This can be noted by what the client propose to do whether verbally or in writing. 5-Behavioral changes: The observation of the change in their behavior or adopting new behavior during the session can reflect the adoption of a new behavior. However another way of finding out the change in behavior can be deduced from records, for example: -Change in the number of mothers attending family planning services. -Change in the number of children brought for vaccination. -Changes in the smoking behavior as noticed from questionnaires.
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The findings from these records can be compared with their previous behavior or a comparable group (control) or national figures. 6-Social changes: The social changes that a health education program can accomplish can be reflected in: -Policy changes: for example increase areas where smoking is forbidden in public places in transportation etc. -Changes in the legislation: for example use of seat belts during riding cars become obligatory. - Increase in facilities that promote health behavior as sportive clubs etc, MAKING THE ENVIRONMENT SAFE 1-Making the environment safe: Mens total environment includes all the living and non-living elements in his surroundings. It consists of three major components: physical, biological and social. 1. Physical environment: air, water, soil and climate. 2. Biological environment: plants, animals and micro-organisms. 3. Social environment: culture, beliefs, society, laws, education, health care etc.
it is entirely man-made. Control of the environment will imply that the three components must be considered: 1-Air, water and waste disposal sanitation should be stressed upon in order to make the environment safe. 2-Control of vectors and animal reservoir of infection responsible for disease transmission, so that the cycle of transmission is interrupted. 3-Different components of the social environment that are responsible for shaping life style and behavior which can be hazardous to health are studied aiming to change or improve the health behavior of the community. INDIVIDUAL PROTECTION
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The individual protection will cover all aspects that are responsible for promoting health and preventing illness of the community. It will include the following activities: 1-Promote the adoption of healthy life style: avoid stress, physical activity, stop smoking and fight addiction etc. 2-Proper nutrition. 3-Immunization. 4-Proper care of vulnerable groups 5-Proper utilization of health services (preventive and curative). MAKING HEALTHY CHOICES EASY COMMUNITY DEVELOPMENT Its aim is to change the environment to facilitate the choice of healthier life-style, thus to make healthy choices easier choices. It involves political and social action. Therefore, the health education is directed to policy-makers and planners at all levels as well as to the general public. COMMUNITY PARTNERSHIP Community participation is critical to the success of the COPC process. To ensure cooperation with the community, the COPC team should perform the following five tasks: 1-As individuals, assess their own resources to become partners with community, including all of its culture and social background. 2-Engage the community from the start by identifying relevant networks and leaders, then structure for participation, initiate a community visioning process, and gather data about perceptions, needs and resources. 3-Identify needs and set priorities among health problems using consensus-building techniques. 4-Enlist the community for the intervention, setting goals, devising strategies, determining resources and potentials barriers, and establishing a time lime. 5-Evaluate outcomes, sharing this responsibility with the community.
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CHAPTER VI EVALUATION
Evaluation and monitoring the quality of the intervention by evaluating the quality of the structure, the process and outcome. 1-Structure: It will evaluate the quality of planning, tools used, its validity and reliability, adequacy of resources and thus identify any deficiency at this level. Monitoring will allow mid-course corrections. 2-Process: Monitoring the process will describe how the intervention has occurred and who was exposed to it. Similarly to the structure monitoring it will allow identification of barriers, constraints and will permit mid-course correction. 3-Outcomes: Outcome evaluation will measure the impact of the intervention, which can be of short term or long term effect. It measures change in outcome indicators for the problem we are dealing with. Outcome data must be associated with program activities in order to explain any changes that occur in the measurements as a result of the intervention. Evaluation Methods: Qualitative and quantitative methods of evaluation can be used for COPC evaluation depending on the type of question we are asking. 1-Qualitative Methods: such as focus group discussion, in-depth interview and participant observation can be used to Collect information to develop a quantitative instrument such as survey. Understand the range of possible responses to an issue. Better understand the result of a survey. Understand how and why instead of what and how many. Develop hypothesis for future testing. Qualitative methods are not simple, cheap, subjective, or time saving. 2-Quantitative Methods: are used when we want a numerical analysis of outcomes, a statistical model to predict outcomes or hypothesis tests. The actual quantitative
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assessment usually involves comparing numerical indicators of success of the intervention between a population or group that received the intervention and one that didnt. Indicators that we choose depend on the question being asked, the problem being addressed, and on what level of that problem the intervention is focused. Evaluation Design: In order to measure change in any indicator variable, the measurement has to be performed at least twice, before and after the intervention. The following evaluation designs are the ones most likely to be used in COPC projects: 1-Before-After Intervention, Comparison Group. Comparison Eligible Population (Measure outcome) 2-Before-After Intervention, Comparison Group from different community populations. Population A (Measure outcome) Measure Outcome Indicators Population B (Measure outcome) 3-Before-After Intervention, No comparison Group. Participant Population (Measure outcome) 4-After Intervention only, Comparison . comparison Eligible Population Randomization Intervention Measure Outcome Indicators Intervention Measure Outcome Indicators Intervention Comparison Randomization Intervention Measure Outcome Indicators
(No measurement)
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Using the information to improve the program (Feedback Loop) We evaluate the process and outcome to learn through a feedback mechanism whether we need to change something we are doing. Evaluating the process tells us if we need to change the current program. Outcome evaluation, in the other hands, suggests new or revised intervention in the future. When we have successfully evaluated an intervention, we get a feedback on whether it changed something about a health problem.
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CHAPTER VII GUIDELINES

In each session the following will be carried out: 1-Presentation of the most important topics that we are going to discuss, in 30 to 45 minutes. 2- An outline of the questions that we need to discuss will be handled to the students. 3-Students will then be divided into several groups. 4-Each group will be assigned the topics that they are going to discuss. 5-Some of the topics that are mentioned as titles will be the subjects for the practical discussion. 6-By the help of the staff, students will discuss their assigned topic and then will finish and came up with a presentation within 30 to 45 minute. 7-Each group will have a ten minutes time to present his findings. 8-At the end, the senior staff will wrap up the session in 10 to 15 minutes. Practical Application on types of data collection: 1-Small Group Discussion: 1-Students will form groups of 15. These groups will be their group for the rest of the training. 2-Two students will be nominated by the group as coordinators, responsible for the guidance of the process. 3-At the beginning of each session, one student will be responsible for the presentation at the end of the class. Rotation will be done to ensure that every student will present at least once. 4-At the end of theoretical part, a guide of the important point will be discussed to facilitate the process of discussion. 2- Focus Group: Its main advantage is to get detailed qualitative information from a relatively large number of respondents. Students will be divided into group of 8 to 10, a facilitator will be appointed and a discussion will be carried out using an unstructured interview in order to explore the problem understudy. Recording will be carried out by a
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student, who will write down the discussion and qualitative analysis and reporting will be carried out to get perspectives and opinions about the issue under study. 3-In-depth Interview: Questions are open-ended and it is usually used to get insights about problems that need exploration. Used for qualified persons that will be difficult to attend focus group and thus can be used for health care providers. Students will develop the openended questions they are going to use and try it during the sessions. 4-Survey: An accessible sample is the approach most feasible. Questionnaires, according to need, will be developed by students. A walk-on survey will be carried, till you get a sort of agreement about the problem under study. 5-Observation: There are two kinds; participatory in which you participate as you observe while in the second type, the structure observation, you use a structured form ( a check list) to collect the needed data. 6-Impressions: Finally impressions can not be ignored as a way of giving some insights of the situation. Although it is not a solid way of getting data, but a least can give the feeling of the presence of a situation that needs further exploration. Implementation of the Intervention Field work This will be carried out in five Phases: First Phase: Gain acceptance of the program Second Phase: Review the planning document and make detailed lists of tasks necessary to accomplish each objective. Third Phase: Market the project to the community, to other health related entities, to subpopulation etc. Fourth Phase: Establish a mechanism for managing the implementation of the intervention. Fifth Phase: Implement the intervention.
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Data Manipulation: 1 -Data Entry: it will be carried out using Epi6 software. It will be precede by data manipulation which it consists of revision, coding, and develop checking of data in order to minimize errors during its entry. 2 -Data Analysis: Tabulation and graphic presentation as well as simple statistical analysis will be carried out, using the computers. Interpretation and commenting will be carried out and findings will be discussed and presented in the final report. Evaluation of the Intervention Planning of the intervention will include the evaluation of the different components of the implemented intervention. 1-Monitoring: which will be carried along the course of the intervention in order to identify the pitfalls that can be corrected during the actual implementation. 2-Final Evaluation: by identification short term and long terms indicators that could reflect the success or failure of the intervention. Data collection for the evaluation will be carried by: 1-Feed Back from the team members. 2-Health care providers. 3-The community. The same data collection methods that were using before, can be used during the evaluation process.
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CHAPTER VIII COPC: DESCRIPTION OF TEACHING ACTIVITIES
Session 1:
Introduction and Basic Concepts
Theoretical: Introduction to COPC 1-Understand the definition of Medicine, Public Health, Health, Epidemiology, Community, Primary care and Community Oriented Primary Care. 2-Understand how COPC merge Medicine and Public Health.
Session 2: Introduction to Computers and Epi6, SPSS software. Practical: -Identify Different part of the computer -Recognize the different part of Epi6 -Develop a questionnaire and enter data.
Session 3: The Community Characteristics A-Theoretical: 1-How to define our community? 2-Why we need to define our community? 3- The Community: -Subpopulation -Population Demography -Community Partnership 4-Geograpical Boundaries: Mapping. B-Practical: -Mapping -Identify different landmarks and its importance Session 4 : Health Agencies: Principles of Primary Care in Egypt 1-Components: different programs 2-Administration in PHC 3-Duties in PHC 4-Expected Outcomes 5-Indicators for monitoring and evaluation. B-Practical: Small group discussion of different programs to identify its components
Session 5: Identifying and Characterizing Community Health Status A-Theoretical: -Definition and levels of Health -Determinants of Health -Needs assessment B-Practical: -Small Group discussion: Identify risk factors for some health problems -Role Play: Focus group
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Session 6: Epidemiological Health Information A-Theoretical: -Morbidity Indicators -Mortality Indicators -Other selected vital rates B-Practical: -Calculate the different rates. Session 7: Epidemiological Methods for data collection A-Theoretical: -Gathering information about your community -Define Types of Data -2ry source of data: Census, records -1ry source of data 1) Qualitative Approach: focus group 2) Quantitative Approach: Survey study: -Type of interview -Questionnaire design -Sampling B-Practical: -Design a survey questionnaire -Role Play on types of interview Session 8: Data processing and Analysis A-Theoretical: -Descriptive statistics -Presentation of data B-Practical: Application by use of computer. Session 9: Identify and Prioritize health Problems of our Community A-Theoretical: -Forms of health problems (Risk factors, etc) -How to list health problems? -How to prioritization Health Problems? B-Practical: -Small Group discussion -Role Play: Focus group
Session 10, 11: Intervention A-Theoretical: 1-Types: 1-Health Promotion 2-Health Education Program 3-Communication Skills 4-Doctor-Patient Relationship 2-Plan of action of Intervention -Statement of the Problem. -Rational for its selection
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- Expected Outcomes - Define goals and Objectives -Methods: -Subjects -Study design -Sample -Intervention description -Measurable outcomes -Data Management and Analysis -Resources and Constraints -Implementation Plan: -Activities -Team duties -Time Line -Evaluation Plan: -Design the evaluation B-Practical: Write the plan of action of your problem
Session 12: Reporting How to write and Present a Report? The report should cover the following:
1-Title page It must be clear stating what has been done, where, how and when. 2-Summary It should be limited to the main findings and recommendations and should be less than two pages. 3-Introduction and objectives Relevant review, justification for the selection of this particular problem as well as the clear objectives must be stated. 4-Methods The type of intervention is stated, together with the reasons for its selection. Full description of the activities that were carried out. Target subpopulation, operation definition of variables, etc must be specified. 5-Results Brief description of findings must be presented by simple tables and graphs. Findings must be explained and commented upon. 6-Discussion and interpretation: Results are interpreted, conclusions are drawn and comparison with relevant studies are made if possible. Limitations of the studies are indicated, how they were overcome. 7-Recommendations
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All recommendations, deduced out of the actual work are mentioned and reasons for are given. 8-References, acknowledge and appendices: They are placed at the end of the report and they form an essential part of the report. The length of the report should be not exceed 10 to 20 pages
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CHAPTER IV REFERENCES
1-Becker T. and Rhyne R. 1998: Defining and Characterizing Community Denominators Chapter 6 in Community-Oriented Primary Care: Health Care for the 21st Century Edited by Rhyne R, Bogue R, Kulkulka G and Fulmer H, pp 118-147 2-Boufford JI and Shonubi PA 1986: Community-Oriented Primary Care: Training for Urban Practice. New York, NY: Praeger Special Studies; 1986. 3-Brownson R.C., Baker E.A and Novick L.F 1999: Chanllenges in communityBased Prevention, Chapter 1 in Community Based Prevention, Programs that work pp 1-4. An Aspen Publication. 4-Cashman S, Anderson R and Fulmer H 1998: Education and Training in Community-Oriented Primary Care. Chapter 10 in Community-Oriented Primary Care: Health Care for the 21st Century Edited by Rhyne R, Bogue R, Kulkulka G and Fulmer H, pp 213-237. 5-Helitzer D., Rhyne R., Skipper B. And Kastelic L. 1998: Evaluating your intervention Chapter 8 in Community-Oriented Primary Care: Health Care for the 21st Century Edited by Rhyne R, Bogue R, Kulkulka G and Fulmer H, pp175-203. 6-Jenkins D.C. 2003: Building Better Health, A handbook of behavioural change. Pan American Health Organization. Scientific and Technical Publication No 590. 7-Kikwood B.R. 1988: Medical Statistics, Blackwell Scientific Publications. Oxford London Edinburgh Boston Melbourne, 8-Kozoll R. 1998: Identifying and Characterizing Community Health Problems. Chapter 7 in Community-Oriented Primary Care: Health Care for the 21st Century Edited by Rhyne R, Bogue R, Kulkulka G and Fulmer H, pp 148-174 9- Ministry of Health and population and WHO 2000: Manual of Primary Health Care. Egypt MOHP 10-Schneiderman N. et al 2001: Integrating Behavioral and Social Sciences with Public Health. American Psychological Association Washington DC 11-Stockman D. 1994: Community Assessment , Guidelines for Developing countries.International Technology Publications. London UK 12-Wallack L. and Dordman L. 1996: A Strategy for Advancing Policy and Promoting Health. Health Education Quartely 23 (1996): 293-317.
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Community-Oriented Primary Care; A New Approach for Teaching Health Care

Prof. Dr. Amal Ahmed El-Badawy

HEEPF, 1ST CYCLE

Dr. A.A.El Badawy COPC Manual

CHAPTER I BASIC CONCEPTS

Thus, it is important to define: what is to be considered normal? Normality is

Dr. A.A.El Badawy COPC Manual

We will only consider three main aspects of Public Health:

Dr. A.A.El Badawy COPC Manual

COPC requires five-step process to incorporate it into practice.

People congregated at particular sites, such as workplace.

community. 2-Incorporation of community treatment into community health care.

Dr. A.A.El Badawy COPC Manual

Chapter II DEFINE AND CHARACTERIZE COMMUNITY

Dr. A.A.El Badawy COPC Manual

Dr. A.A.El Badawy COPC Manual

Dr. A.A.El Badawy COPC Manual

Chapter III IDENTIFY AND CHARACTERIZE COMMUNITY HEALTH STATUS

Use of Health Services and Self-care

Dr. A.A.El Badawy COPC Manual

Health Care Provision

Expressed Needs Actual Number of people Using or demanding a Service

Comparative Needs Comparing service provision across communities or groups

Needs Demand for Supply of

3-Health Status Assessment

Gathering Information about the Community

-Advantages of open-ended questionnaires:

-Potentials pitfalls in asking questions:

Do not make the questionnaire too long.

1- Quantitative data: A quantitative variable is numerical and either discrete or continuous.

b) Continuous data: Continuous data implies the measurement on a continuous scale

1- List: is the simplest form of presentation. A table consisting of two

2- Frequency Distribution tables: they provide the most convenient

Age group 2535455565-

Tally 1l 1lll 1lll llll 1 1lll llll 11 1lll 1111

Percentage 2.0 7.0 18.0 30.0 39.0

Dr. A.A.El Badawy COPC Manual

- Easy to understand - Fully labeled

Dr. A.A.El Badawy COPC Manual

1st Qtr 2nd Qtr 3rd Qtr 4th Qtr

East West North

the rank of the median = (5+ 1)/ 2 = 3 So median is 8

Dr. A.A.El Badawy COPC Manual

CHAPTER IV IDENTIFY AND PRIORITIZE HEALTH PROBLEMS OF OUR COMMUNITY

Dr. A.A.El Badawy COPC Manual

DEVELOP SPECIFIC INTERVENTION

Dr. A.A.El Badawy COPC Manual

Dr. A.A.El Badawy COPC Manual

Perceived Susceptibility 35 Demographic Variables

Dr. A.A.El Badawy COPC Manual

Health Belief Model

young people but now I believe I would benefit from exercise.

Dr. A.A.El Badawy COPC Manual

Dr. A .A. El Badawy, Teaching Manual

Dr. A .A. El Badawy, Teaching Manual

Dr. A .A. El Badawy, Teaching Manual

Dr. A .A. El Badawy, Teaching Manual

4-Encourage examination of attitudes and values

-Same as previous one

Dr. A .A. El Badawy, Teaching Manual

Dr. A .A. El Badawy, Teaching Manual

Dr. A .A. El Badawy, Teaching Manual

Dr. A .A. El Badawy, Teaching Manual