Vision: “Benguet State University as an

International University engendering

graduates to walk the intergenerational
Benguet State University “Excellent nursing education that
provides graduates with self-direction,
highways.” competence and compassion.”
COLLEGE OF NURSING
Mission: “BSU CARES: Benguet State
University cares to: Challenge Innovation, La Trinidad, Benguet “The College of Nursing is committed to
provide a strong academic and
Advance technology and facilities, Revitalize
administration, Engender partnership, and
www.bsu.edu.ph/ 422- 2127 professional foundation for the practice
of nursing.”
Serve in sustaining intergenerational roles.”

ASSESSING COMMUNITY HEALTH NEEDS (COPAR 1)

The community health nursing process, like the nursing process in general is composed of
assessment, diagnosis, planning, implementation, and evaluation. However, in this chapter,
community assessment is already integrated in the process of community diagnosis.

COMMUNITY DIAGNOSIS

TRADITIONAL Participatory Action Research (PAR)

1. Research for purpose of identifying and 1. Research seeks social transformation

meeting individual need with existing
social systems.
2. Community problems or needs are 2. The research problems are defined by the
defined by experts or external community members themselves who are
researchers. viewed as “experts of their own and
considered reality.”

3. he research problem is studied by the 3. The community group undertakes the

researchers who control the research investigation or research from data Collection
process. to analysis. External researchers work
alongside the community group.
4. Recommendations for the community are 4. The community formulates
based on the researcher’s findings and recommendations and an action plan based
analysis. on research outcome.

What is Community Diagnosis?

As a PROFILE, it is a description of the community’s state of health as determined by the

physical, economic, political, and social factors. It defines the community and states
community problems.

Purpose: To be able to obtain a quick picture of a community which is as accurate as possible.

A community profile should:
a. summarize information;
b. present results and figures clearly; and
c. be useful for planning and evaluation.

As a PROCESS, it is a continuous learning experience for the nurse, the community people,
and other persons concerned, for the following reasons:

a. It enables the nurse and other staff to adjust or alter the program for optimum effectiveness;
b. It allows the community to gradually become aware of the solution;
c. It is an organized attempt to involve people in recognizing and resolving problems that
concern them most;
d. It enables the community to understand at its own pace the potential advantages of
change, which may eventually lead to alterations in attitudes, values, and behaviour.

1
 Vision: “Benguet State University as an
International University engendering
graduates to walk the intergenerational
Benguet State University “Excellent nursing education that
provides graduates with self-direction,
highways.” competence and compassion.”
COLLEGE OF NURSING
Mission: “BSU CARES: Benguet State
University cares to: Challenge Innovation, La Trinidad, Benguet “The College of Nursing is committed to
provide a strong academic and
Advance technology and facilities, Revitalize
administration, Engender partnership, and
www.bsu.edu.ph/ 422- 2127 professional foundation for the practice
of nursing.”
Serve in sustaining intergenerational roles.”

Why undertake community diagnosis?

To have a clear picture of the problems of the community and to identify the resources
available to the community people.

Community diagnosis enables the nurse to facilitate setting of priorities for planning and
developing programs of health care for the community. The data gathered through the
process serves as the material for analysis.

What are the types of Community Diagnosis?

a. Comprehensive community diagnosis – aims to obtain general information about the

community with the intent of determining not only prevalent health conditions and risk factors
(epidemiologic approach) but also the socio-economic conditions and lifestyle behaviors and
attitudes that have effect on health.

b. Problem-oriented community diagnosis – type of assessment that responds to a particular

need of a target group.

Example: A nurse was confronted with health and medical problems resulting from
mine tailings being disposed into river systems by a mining company. The nurse starts by
investigating the meaning of the problem to the community people, proceeds to identify
population affected, then goes on to characterize the environmental factors and other
factors relevant to the problem.

COMPREHENSIVE COMMUNITY DIAGNOSIS

What are the ELEMENTS of a comprehensive community diagnosis?

A. DEMOGRAPHIC VARIABLES- a comprehensive community diagnosis should show the size,

composition, and geographical distribution of the population, as indicated by the following:
1. Total population and geographical distribution, including urban-rural index and population
density;
2. Age and sex composition;
3. Household size
4. Selected vital indicators such as growth rate, crude birth rate, and life expectancy at birth;
5. Patterns of migration;
6. Population projections; and
7. Population groups with special needs- indigenous people, internal refugees, and other
socially dislocated groups.

B. SOCIO-ECONOMIC AND CULTURAL VARIABLES

There are no limits as to the list of socio-economic and cultural factors that may directly or
indirectly affect the health status of the community. The nurse, however, should consider the
following as essential information:
1. Social Indicators
a. Educational level which may be indicative of poverty and may reflect on health
perception and utilization pattern of the community;
b. Housing conditions which may suggest health hazards;
c. Social classes or groupings

2. Economic indicators
a. Poverty level income;
b. Unemployment and underemployment rates;
c. Proportion of salaried and wage earners to total economically active population;

2
 Vision: “Benguet State University as an
International University engendering
graduates to walk the intergenerational
Benguet State University “Excellent nursing education that
provides graduates with self-direction,
highways.” competence and compassion.”
COLLEGE OF NURSING
Mission: “BSU CARES: Benguet State
University cares to: Challenge Innovation, La Trinidad, Benguet “The College of Nursing is committed to
provide a strong academic and
Advance technology and facilities, Revitalize
administration, Engender partnership, and
www.bsu.edu.ph/ 422- 2127 professional foundation for the practice
of nursing.”
Serve in sustaining intergenerational roles.”

d. Types of industry present in the community;

e. Occupation common in the community;
f. Communication network necessary for disseminating health information or facilitating
referral of clients to the health care delivery system;
g. Transportation system including road networks necessary for the accessibility of the
community people to the health care delivery system.

3. Environmental indicators
a. Physical/topographical/geographical characteristics of the community;
Land areas that contribute to vector problems
Terrain characteristics that contribute to accidents
Land usage in industry
Climate/season
b. Water supply
% population with access to safe, adequate water supply
Source of water supply
c. Waste disposal
% population served with daily garbage collection system
% population with safe excreta disposal system
Types of disposal and garbage collection
d. Air, water, and land pollution
Industries within the community having health hazards associated with it
Air and water pollution index

4. Cultural factors
a. Variables that may break up the people into groups within the community, such as:
Ethnicity
Social class
Language
Religion
Race
Political orientation
b. Cultural beliefs and practices that may affect health
c. Concept about health and illness

C. HEALTH AND ILLNESS PATTERN

Leading causes of mortality
Leading causes of morbidity
Leading causes of Infant and child mortality
Leading causes of Maternal mortality
Leading causes of hospital admission
Leading causes of clinic consultation
Nutritional status

D. HEALTH RESOURCES
a. Manpower Resources
categories of health manpower available
geographical distribution of health manpower
manpower-population ratio
distribution of health manpower according to health facilities
distribution of health manpower according to organization
quality of health manpower
existing manpower development/policies

3
 Vision: “Benguet State University as an
International University engendering
graduates to walk the intergenerational
Benguet State University “Excellent nursing education that
provides graduates with self-direction,
highways.” competence and compassion.”
COLLEGE OF NURSING
Mission: “BSU CARES: Benguet State
University cares to: Challenge Innovation, La Trinidad, Benguet “The College of Nursing is committed to
provide a strong academic and
Advance technology and facilities, Revitalize
administration, Engender partnership, and
www.bsu.edu.ph/ 422- 2127 professional foundation for the practice
of nursing.”
Serve in sustaining intergenerational roles.”

b. Material Resources
health budget and expenditure
source of health funding
categories of health institution available in the community
hospital bed-population ratio
categories of health services available

E. POLITICAL/ LEADERSHIP PATTERN- this is a vital element in achieving the goal of high level
wellness among the people. It reflects the action potential of the state and its people to
answer the health needs and problems of the community. It also mirrors the sensitivity of the
government to the people’s struggle for better lives.
1. Power structure in the community (formal or informal) – include leadership patterns,
community organizations, and government structure
2. Attitude of people towards authority;
3. Conditions/ events/ issues that cause social conflict or that lead to social bonding or
unification;
4. Practices/ approaches effective in settling issues and concerns within the community

What is Community Diagnosis as a PROCESS?

 It consist of collecting, organizing, synthesizing, analysing, and interpreting health data.
 Before data are collected, objectives must be determined as these will direct the depth or
scope of community assessment and resolve whether a comprehensive or problem based
community diagnosis will accomplish the objectives.
 The community is an active partner and not a recipient of care. The nurse works with and
not for the community.
 In working with the community in a diagnostic exercise, use appropriate participatory
methods for mobilizing community participation.
 The nurse is not an external assessor of community needs, but a facilitator working with a
team of community members and leaders.

4
 Vision: “Benguet State University as an
International University engendering
graduates to walk the intergenerational
Benguet State University “Excellent nursing education that
provides graduates with self-direction,
highways.” competence and compassion.”
COLLEGE OF NURSING
Mission: “BSU CARES: Benguet State
University cares to: Challenge Innovation, La Trinidad, Benguet “The College of Nursing is committed to
provide a strong academic and
Advance technology and facilities, Revitalize
administration, Engender partnership, and
www.bsu.edu.ph/ 422- 2127 professional foundation for the practice
of nursing.”
Serve in sustaining intergenerational roles.”

What are the steps in conducting Community Diagnosis?

1. Determine the objectives

The following questions should be answered when formulating objectives:

a. What is the present health condition of the people in the community?
b. Why are the people in the community in such condition? What specific problems are
causing this condition?
c. What are the roots of these problem?
d. What solutions will address the problem?
* Statement of objectives should be SMART (Specific, Measurable, Attainable, Realistic,
Time-bound)

2. Define the study population

The nurse and the team identifies the population for the study, based on the objectives of
the study. It may include the entire population of the community or focused on a specific
population group like women of reproductive age group, or young children and infants. If
complete enumeration of the desired population is not possible, the data maybe collected
from a sample or subset of the target population.

3. Determine the data to be collected

Categories of data based on source:

a. Primary Data – directly obtained by the nurse and the team from community people
b. Secondary data – sources would be health center records, organizational record of
the program, and other public records

Decide on what data to gather

What are to be researched?
What are available?
Which of these are fully reflective of actual reality?
Which information needs to be confirmed, validated, or investigated yet

4. Collecting the data

Methods to collect data:
a. Observation – the nurse conducts a rapid assessment through ocular survey. Therefore,
the nurse needs to live and be fully integrated with the community.
b. Records review – review of data that have been compiled by health and non-health
agencies.
c. Interviews
Telephone interview – has more limitations than face to face
Face to face interview – people respond better making the interview more fruitful and
constructive
Key informant interview (KII)
Group interview – one interviewer with 10-15 participants
Interview may be structured or unstructured
> Structured interview– follows a list of questions which becomes the “script” in the
conduct of interview. A set of possible questions are indicated which the participants
are to choose from.
> Unstructured interview – used to gather qualitative data that seek to describe
opinions or perceptions. It makes use of open- ended questions.

5
 Vision: “Benguet State University as an
International University engendering
graduates to walk the intergenerational
Benguet State University “Excellent nursing education that
provides graduates with self-direction,
highways.” competence and compassion.”
COLLEGE OF NURSING
Mission: “BSU CARES: Benguet State
University cares to: Challenge Innovation, La Trinidad, Benguet “The College of Nursing is committed to
provide a strong academic and
Advance technology and facilities, Revitalize
administration, Engender partnership, and
www.bsu.edu.ph/ 422- 2127 professional foundation for the practice
of nursing.”
Serve in sustaining intergenerational roles.”

d. Focus Group Discussion (FGD) – is a qualitative research technique utilized for its value in
understanding and documenting human behaviour.

Let’s watch how FGD can be conducted in this link:

https://www.youtube.com/watch?v=CpLQtvcmJB4

5. Develop the instrument – instruments or tools that facilitates the collection of data.
Most common instruments used:
a. Survey questionnaire – it is important the tool generates data that are honest, accurate,
and complete.
b. Focus Group discussion guide – facilitates the direction and flow of exchange of ideas
c. Key Informant Interview guide
d. Observation checklist – list of data that are manifestations or indicators of a health need or
problem.

6. Actual Data gathering – a core group or team of people involved in data collection needs to be
oriented / trained on the use of the gathering tools. They are taught on the participatory
methods or techniques to facilitate and simplify data gathering. Among other participatory
tools for data gathering are the following:
Semi-structured interview
Analytical games
Stories and portraits
Diagrams
Workshop

7. Collation/ organization of data – there are two types of data that may be generated:
Numerical data – those that can be counted like number of children in a family
Descriptive data – those that can be described or that can reveal characteristics of an
observable fact

To facilitate data collection, the nurse must develop categories for the classification of
responses, making sure that the responses are MUTUALLY EXCLUSIVE and EXHAUSTIVE.

MUTUALLY EXCLUSIVE choices do not overlap. This means that a response can fall only into one
category from a set choices. Example:

To classify gender or sex:

Male
Female

EXHAUSTIVE CATEGORIES anticipate all possible answers that a respondent may give.

Educational Attainment:
No formal education
Elementary undergraduate
Elementary graduate
High school undergraduate
High school graduate
College undergraduate
College graduate
Postgraduate level
Others (Please specify: ______

6
 Vision: “Benguet State University as an
International University engendering
graduates to walk the intergenerational
Benguet State University “Excellent nursing education that
provides graduates with self-direction,
highways.” competence and compassion.”
COLLEGE OF NURSING
Mission: “BSU CARES: Benguet State
University cares to: Challenge Innovation, La Trinidad, Benguet “The College of Nursing is committed to
provide a strong academic and
Advance technology and facilities, Revitalize
administration, Engender partnership, and
www.bsu.edu.ph/ 422- 2127 professional foundation for the practice
of nursing.”
Serve in sustaining intergenerational roles.”

For FIXED-RESPONSE QUESTIONS, choices must be provided to serve as categories for the
respondent’s answer.

OPEN-ENDED QUESTIONS do not provide choices or categories and the answers may be given
freely by the respondent.

The next step after categorizing the responses will be to summarize the data. It can be
Manual Tallying or using the computer. Tallying involves entering the responses into
prepared tally sheets showing all possible responses.

Manual Tallying:

Diseases Tally Mark Frequency

Pneumonia IIIII – IIIII – IIIII – II 17
Diarrhea IIIII – IIIII – III 13
Cough and colds IIIII – IIIII – IIIII – IIIII – IIIII - IIII 29
Computer Tallying – responses are given number or codes

8. Presentation of Data – data collected may be presented as:

Statistical tables
Graphs
Descriptive data - are presented in narrative reports. Examples are geographic data, history
of a place, or beliefs regarding illness and death.

Line graph Pie Chart

7
 Vision: “Benguet State University as an
International University engendering
graduates to walk the intergenerational
Benguet State University “Excellent nursing education that
provides graduates with self-direction,
highways.” competence and compassion.”
COLLEGE OF NURSING
Mission: “BSU CARES: Benguet State
University cares to: Challenge Innovation, La Trinidad, Benguet “The College of Nursing is committed to
provide a strong academic and
Advance technology and facilities, Revitalize
administration, Engender partnership, and
www.bsu.edu.ph/ 422- 2127 professional foundation for the practice
of nursing.”
Serve in sustaining intergenerational roles.”

Bar Graph

9. Analysis of Data

Triangulation – the consistency and validity of data is checked since data came from different
sources.
This process aims to establish trends and patterns in terms of health needs and problems of the
community. It allows comparison of obtained data with standard values or norms.
Can use the Problem Tree analysis approach - Problem tree analysis examines the negative
aspects of an existing situation and establishes the ‘cause and effect’ relationships between
the identified problems.
Since data analysis is done after the
presentation of data, the nurse and the
team should encourage the people to
give their opinions, comments, and
reactions, or seek clarification on what and
how the others viewed the data. Facilitate
the discussion in order to deepen the
analysis by pausing questions like:
How are the main problems related to one
another?
Which of the problem seem to need urgent
attention?
Among the roots of the problem, which are
the easiest to address? Which are the most
difficult?
Which of the effects should not be allowed to continue?
What could possibly happen if nothing is done?
What should be done?

10. Identifying the Community Health Nursing Problems

Community health nursing problems are categorized as:

a. Health Status Problems – may be described in terms of increased or decreased morbidity,

mortality, or fertility. Example: 40% of the school-age children have ascariasis.

8
 Vision: “Benguet State University as an
International University engendering
graduates to walk the intergenerational
Benguet State University “Excellent nursing education that
provides graduates with self-direction,
highways.” competence and compassion.”
COLLEGE OF NURSING
Mission: “BSU CARES: Benguet State
University cares to: Challenge Innovation, La Trinidad, Benguet “The College of Nursing is committed to
provide a strong academic and
Advance technology and facilities, Revitalize
administration, Engender partnership, and
www.bsu.edu.ph/ 422- 2127 professional foundation for the practice
of nursing.”
Serve in sustaining intergenerational roles.”

b. Health Resource Problems – Described in terms of lack of or absence of manpower, money,

materials, or institutions necessary to solve health problems. Example: 25% of BHWs lack skills in
vital signs taking.

c. Health-related Problems – described in terms of existence of social, economic,

environmental, and political factors that aggravate the illness-inducing situations in the
community. Example: 30% of households dump their garbage in the river.

11. Priority-Setting

Criteria in prioritizing community health problems:

a. Nature of the problem presented – the problems are classified as health status, health
resources, or health – related problems.

b. Magnitude of the problem – refers to the severity of the problem, which can be measured in
terms of the proportion of the population affected by the problem.

c. Modifiability of the problem – refers to the probability of reducing, controlling, or eradicating

the problem

d. Preventive Potential – refers to the probability of controlling or reducing the effects posed by
the problem

e. Social concern – refers to the perception of the community as they are affected by the
problem.

STEPS IN PRIORITIZING PROBLEMS

1. Score each problem according to each criteria

2. Divide the score by the highest possible score

3. Multiply the answer by the weight of the criteria

4. Add the final score for each criterion to get the total score for the problem. The
highest possible score is 10, while the lowest is 1 5/12 (1.41).

Given the situation:

After collating the data, the nurse learned that one of the community health problem is that
40% of the school-age children have ascariasis. The mothers recognize this and are willing to
have their children undergo deworming. Majority of the mothers are so concerned that they
asked the nurse about its cause and the ways on how to prevent it.

The other problem is the lack of skills of the BHWs in the barangay. 25% of them lack the skills
in vital signs taking. The BHWs expressed their concern that they cannot perform their tasks
because of this. All of them verbalized their desire to attend health skills trainings in the future.

9
 Vision: “Benguet State University as an
International University engendering
graduates to walk the intergenerational
Benguet State University “Excellent nursing education that
provides graduates with self-direction,
highways.” competence and compassion.”
COLLEGE OF NURSING
Mission: “BSU CARES: Benguet State
University cares to: Challenge Innovation, La Trinidad, Benguet “The College of Nursing is committed to
provide a strong academic and
Advance technology and facilities, Revitalize
administration, Engender partnership, and
www.bsu.edu.ph/ 422- 2127 professional foundation for the practice
of nursing.”
Serve in sustaining intergenerational roles.”

Community health Problem: 40% of school-age children have ascariasis

Weight Score
Nature of the problem:
Health Status 3 1 1
Health Resource 2
Health Related 1
Magnitude of the problem:
75-100% affected 4 3 1 1/2
50-74% affected 3
25-49% affected 2
Less than 25% affected 1
Modifiability of the problem:
High 3 4 4
Moderate 2
Low 1
Preventive potential
High 3 1 1
Moderate 2
Low 1
Social concern
Urgent community concern 2 1 1
A problem but does need immediate 1
attention
Not a problem 0
TOTAL SCORE 8 1/2

Community health Problem: 25% of BHWs lack skills in vital signs taking
Weight Score
Nature of the problem:
Health Status 3 1 2/3 (.66)
Health Resource 2
Health Related 1
Magnitude of the problem:
75-100% affected 4 3 1 1/2
50-74% affected 3
25-49% affected 2
Less than 25% affected 1
Modifiability of the problem:
High 3 4 4
Moderate 2
Low 1
Preventive potential
High 3 1 1
Moderate 2
Low 1
Social concern
Urgent community concern 2 1 1
A problem but does need immediate 1
attention
Not a problem 0
TOTAL SCORE 8 1/6 (8.16)

10