Community Needs Assessment/ Community Diagnosis Community Diagnosis A process by which the nurse collects data about the

community in order to identify factors which may influence the deaths and illnesses of the population to formulate a community health nursing diagnosis and develop and implement community health nursing interventions and strategies Done to come up with a profile of local health situation Will serve as a basis of health programs and services to be delivered to the community Starts with determining the health status of the community

2 Types of Community Diagnosis 1.Comprehensive Community Diagnosis - aims to obtain general information about the community 2.Problem-Oriented Community Diagnosis - type of assessment responds to a particular need ELEMENTS OFCOMPREHENSIVE COMMUNITY DIAGNOSIS 1.DEMOGRAPHIC VARIABLES i . T o t a l p o p u l a t i o n & G e o g r a p h i c a l distribution including Urban-Rural index& Population Density i i .A ge & Se x c o m po s it io n i i i . S e l e c t e d v i t a l i n d i c a t o r s e . q . G r o w t h rate, CBR, CDR & Life expectancy rate iv .P a t t e r ns o f m ig rat io n v .P o p ul at io n p ro j e c t io n Note: Population groups that need special attentions: Indigenous people Socially dislocated groups as aresult of disasters, calamities &development programs 2.Socio-economic & Cultural variables i . S o c i a l i n d i c a t o r s Communication network Transportation system Educational level Housing conditions i i .E c o no m ic in d ic at o rs Poverty level income Employment rate Types of industry present in the community Occupation common in the community iii.Environmental indicators Physical/geographical/topographical characteristics Water supply Waste disposal Air, Water and Land pollution i v . C u l t u r a l f a c t o r s Variables that may break up people into groups within the community e.q. Ethnicity Social class Language Religion Race Political orientation Cultural beliefs and practices that affect health

Concepts about Health and Illness 3.Health & illness patterns Leading cause of mortality Leading cause of morbidity Leading cause of infant mortality Leading cause of maternal mortality Leading cause of hospital admission 4.Health resources Manpower resources Material resources 5.Political/Leadership patterns Reflects the action potential of the state and its people to address the health needs and problems of the community Mirrors the sensitivity of the government to the peoples struggle for better lives PROCESS OF COMMUNITY DIAGNOSIS Consists of: 1.Collecting, organizing & synthesizing data In order to identify the different factors that may directly or indirectly influence the health of the population 2.Analyzing & interpreting health data Seek explanations for the occurrence of health needs and problems of the community 3 . F o r m u l a t i o n o f C o m m u n i t y H e a l t h N u r s i n g Diagnoses Will become the bases for developing and implementing community health nursing interventions and strategies STEPS IN CONDUCTING COMMUNITY DIAGNOSIS 1. DETERMINING THE OBJECTIVES the nurse decides on the depth and scope of the data she needs to gather. 2. DEFINING THE STUDY POPULATION the nurse identifies the population group to be included in the study. 3. DETERMINING THE DATA TO BE COLLECTED the objectives will guide the nurse in identifying the specific data she will collect, and will also decide on the sources of these data. 4. COLLECTING THE DATA the nurse decides on the specific methods depending on the type of data to be generated. Ocular survey, interview, and records review. 5. DEVELOPING THE INSTRUMENT - instruments/tools facilitate the nurses data-gathering activities. Most common instruments : survey questionnaire interview guide observation checklist 6. ACTUAL DATA GATHERING the nurse supervises the data collectors by checking the filled-up instruments in terms of completeness, accuracy and reliability of the information collected. 7. DATA COLLATION the nurse is now ready to put together all the information. Numerical data Descriptive data 8. DATA PRESENTATION will depend largely on the type of data obtained. Descriptive- narrative reports numerical data- table or graphs 9. DATA ANALYSIS aims to establish trends and patterns in terms of health needs and problems of the community. 10. IDENTIFYING COMMUNITY HEALTH NURSING PROBLEMS a. H e a l t h S t a t u s P r o b l e m s - Increased/decreased morbidity,mortality fertility or reduced capability for wellness b. H e a l t h R e s o u r c e s P r o b l e m s - Lack of or absence of manpower, money, materials or institutions necessary to solve health problems c. H e a l t h R e l a t e d P r o b l e m s - Existence of social, economic, environmental and political factors that aggravate the illness-inducing situations in the community 11.Priority-setting a.Nature of the condition/problem presented - Classified as health status, healthresources or health related problems b.Magnitude of the problem - Severity of the problem which can be measured in terms of the proportion of the population affected by the problem

c. Modifiability of the problem - Probability of reducing, controlling or eradicating the problem d. Preventive potential - Probability of controlling or reducing the effects posed by the problem e. Social concern - Perception of the population or the community as they are affected by the problem and their readiness to act on the problem PLANNING WHAT IS PLANNING? - is a process that entails formulation of steps to be undertaken in the future in order to achieve a desired end. Concepts of Planning: - Planning is futuristic. - Planning is change-oriented. - Planning is a continuous and dynamic process. - Planning is flexible. - Planning is a systematic process. THE PLANNING CYCLE: 1. Situational Analysis - gather health data, tabulate, analyze and interpret data, identify health problems, set priority 2. Goal and Objective Setting - define program goals and objectives, assign priorities among objectives 3. S t r a t e g y / A c t i v i t y S e t t i n g - d esign CHN Program, ascertain resources, analyze constraints and limitations 4. E v a l u a t i o n - determines outcomes, specify criteria and standards COMMUNITY ORGANIZING Purpose: Empowerment or building the capability of people for future community action. Approaches to community development a. S o c i a l c h a n g e s - Building up social organizations(relationships, structure and resources) b. C h a n g e i n i d e o l o g y - Knowledge, beliefs and attitude c. C h a n g e a g e n t s - Capacity to influence others by setting a good example. >Principles of CO: 1.Welfare approach - people esp. the oppressed, exploited and deprived sectors are most open to change, have the capacity to change and are able to bring about change. Hence, CO is based on the ff: a. Power must reside in the people b . D e v e l o p m e n t i s f r o m t h e p e o p l e t o t h e people c. People participation 2.Technological approach - must be based on the poorest sectors of society. The solutions of problems commonly shared by these sectors must be focused on collective organizations, planning and action 3.Transformatory approah - should lead to self-reliant communities Five stages 1. Community analysis 2. Design and initiation 3. Implementation 4. Program maintenance consolidation 5. Dissemination reassessment 1.Community analysis

- The process of assessing and defining needs, opportunities and resources involved in initiating community health action . - Maybe referred to as community diagnosis,community needs assessment, health education planning and mapping 5 Components Of Community Analysis: 1.Demographic, social and economic profile of the community derived from secondary data; 2 . H e a l t h r i s k p r o f i l e ( s o c i a l , b e h a v i o u r a l a n d environmental risks) > Behavioural - dietary habits and other lifestyle concerns like alcohol, tobacco and drugs > Social indicators- exposure to long termunemployment, low education andisolation. 3 . H e a l t h / w e l l n e s s o u t c o m e s p r o f i l e (morbidity/mortality data) 4.Survey of current health promotion programs. 5.Studies conducted in certain target groups Steps in community analysis i. D e f i ni n g t he c o m m u ni t y 1 . D e t e r m i n i n g t h e g e o g r a p h i c b o u n d a r i e s of the target community i i . C o l l e c t i n g d a t a

iii.Assessing community capacity 1 . E n t a i l s a n e v a l u a t i o n o f t h e d r i v i n g forces which may facilitate or impede the advocated change iv.Assessing community barriers v.Assessing readiness to change 1 . C o m m u n i t y i n t e r e s t 2 . P e r c e p t i o n o n t h e i m p o r t a n c e o f t h e problem vi.Synthesis data and set priorities 1 . P r o v i d e a c o m m u n i t y p r o f i l e o f t h e n e e d s and resources and will become the Basisfor designing prospective community interventions for health promotion

2. Design and initiation STEPS: 1. Establish a core planning group and select a local organizer. Requirements: Select 5-8 member sin charge for core planning and management of the program With management skills, good listener and conflict resolution skills. 2. Choose an organizational structure. This activates the community participation. Types: a. Leadership board council- existing local leaders working for a common cause b. Coalition- linking organizations and groups to work on community issues. c. lead or official agency- a single agency takes the primary responsibility of a liaison for health promotion activities inthe community. d. Grass-roots- informal structures in the community like the neighborhood residents. e. Citizens panels- a group of citizens (5-10) emerge to form a partnership with the government agency. f. Networks and consortia- network develop because of a certain concerns 3 . I d e n t i f y , s e l e c t a n d r e c r u i t o r g a n i z a t i o n a l members. - As much as possible different groups, organizations sectors should be represented. - Chosen representative have power for the group they represents 4.Define the organization mission and goals. - This will specify the what, who, where, when and extent of the organizational objectives. 5 . C l a r i f y r o l e s a n d r e s p o n s i b i l i t i e s o f p e o p l e involved in the organization. - This is done to establish a smooth working relationship and avoid overlapping of responsibilities. 6.Provide training and recognition. - Active involvement in planning and management of programs may require skills development training. - Recognition of the programs accomplishment and individuals contribution to the success of theprogram and boost morale of the members.

3. Implementation-put the design plan into action. a. G e n e r a t e b r o a d c i t i z e n p a r t i c i p a t i o n How? Organizing task force, who, with appropriate guidance can provide the necessary support. b. D e v e l o p a s e q u e n t i a l w o r k p l a n - Activities should be planned sequentially. Often, times have to be modified as events unfold. Community members may have to constantly monitor implementation steps. c. U s e c o m p r e h e n s i v e , i n t e g r a t e d s t r a t e g i e s - Generally the program utilize more than one strategies that must complement each other. d. Integrate community values into the programs, materials and messages. - The community language, values and norms have to be incorporated into theprogram. 4.Program maintenance consolidation - The program a this point has experienced some degree of success and has weathered through implementation problems, the organization and program is gaining acceptance in the community. Maintenance: a. I n t e g r a t e i n t e r v e n t i o n a c t i v i t i e s i n t o c o m m u n i t y networks - This can be affected through implementation problems. - The organization and program is gaining acceptance in the community. b. Establish a positive organizational culture. - A positive environment is a critical element in maintaining cooperation and preventing fast turnover of members. - This is a result of good group process based on trust, respect, and openness. c. E s t a b l i s h a n o n g o i n g r e c r u i t m e n t p l a n . - It should be expected that volunteers may leave the organization. - This requires a built in mechanisms for continuous recruitment and training of new members. d. D i s s e m i n a t e r e s u l t s . - Continuous feedback to the community on results of activities enhances visibility and acceptance of the organization. - Dissemination of information is vital to gain and maintain community support. 5.Dissemination-Reassessment Continuous assessment is part of the monitoring spect in the management of the program a. U p d a t e t h e c o m m u n i t y a n a l y s i s . - Is there a change in leadership, resources and participation? - This may necessitate reorganization and new collaboration with other organizations. b. Assess effectiveness of interventions/programs. - Quantitative and qualitative methods of evaluation can be used to determine participation, support and behavior change level of decision making and other factors deemed important to theprogram. c. C h a r t f u t u r e d i r e c t o r i e s a n d m o d i f i c a t i o n s . - This may mean revision of goals and objectives and development of new strategies. - Revitalization of collaboration and networking may be vital in support of new ventures. d. S u m m a r i z e a n d d i s s e m i n a t e r e s u l t s . - Some organizations die because of the lack of visibility. - Thus, a dissemination plan may be helpful in diffusion of information to further boost support to the organizations endeavor. The Health Resource Development Program Community Health Organizing Utilizing COPAR HRDP - Was developed and sponsored by the Philippine Center for Population and Development (PCPD) - To make health services available and accessible to depressed and underserved communities inthe Philippines - PCPD is a non-stock, non-profit institution, which serves as a resource center assisting institutionsand agencies through programs and projects geared toward the social human development of rural and urban communities - Formerly known as The Population Center Foundation HISTORY OF HRDP HRDP I - Trained the faculty, medical/nursing students to provide health care services to the far flung barrios because of lack of man power for health services at the same time that similar activities fulfilled the curricular requirements of the students for public health - The PCPD provides seed money for the income generating projects

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

HRDP II - The 2nd cycle uses the same strategy but the program could not be sustained by the schools or hospitals and the income-generating projects eventually become the hindrance to the goal of achieving the health program because the people tend to be more interested in the income generated by the projects - Both HRDP I and HRDP II have brought about some changes in the community life of the people - Established basic health infrastructure; basic health services were increased; there were trained workers andorganized health groups to take care of the needs of the community HISTORY OF HRDP HRDP III - PCPD refined the program and resulted to what is now called HRDP III, which has these unique features: Comprehensive training of the staff and faculty of the participating agency in which the community work was initiated Periodic training program and regular assistance to the participating agency were provided to strengthen the health outreach program to become community oriented PHC as the approach with which all nursing/medical students, their CIs and indigenous healthworkers are trained for community health work and around which all other project inputs will revolve HISTORY OF HRDP - Community organizing as the main strategy to be employed in preparing the communities to develop their community health care systems and the establishment of community health organization to manage the scommunity health programs - Organizing work in the communities were done in 3 phases - PAR as fascinating strategy for maximum community involvement through collective identification andanalysis of community health problems and collective health action - Available funds to finance community initiated projects COPAR? - Since Management Leadership and Jurisprudence are courses taught in the classroom members of this group of students were trained to manage and acts as leaders of the different levels of the students who were involved in COPAR - Principles of management were applied in carrying out primary health care - The community members, CHWs and leaders were empowered to manage their own health projects - Conducted seminars and trainings as well ashealth education and services needed bycommunity(exposure and immersion 6-8 weeks)