Community Diagnosis
Content
Community Diagnosis
Presented by: Menuka Shrestha M. Sc Nursing , Batch 2011
Contents
Introduction Definition Goal Importance of community diagnosis Contents of community diagnosis Process of community diagnosis Comparision patient diagnosis and community diagnosis
4/23/2013 2
Introduction
A community is a cluster of people with at least one common characteristic (geographic location, occupation, ethnicity, housing condition, etc.).
A group of people with a common characteristic or interest living together within a larger society comprises a community.
4/23/2013
3
Cont…
Community diagnosis is a comprehensive assessment of health status of the community in relation to its social, physical and biological environment. The purpose of community diagnosis is to define existing problems, determine available resources and set priorities for planning, implementing and evaluating health action, by and for the community.
4/23/2013
4
Cont…
Community diagnosis generally refers to the identification and quantification of health problems in a community as a whole in terms of mortality and morbidity rates and ratios, and identification of their correlates for the purpose of defining those at risk or those in need of health care.
4/23/2013
5
History of community diagnosis
The concept of diagnosis has evolved since second world war. Two major disciplines of health that are public health and nursing are background for the development of commu nity health diagnosis approach. It is originally used by physicians in 1950s. The current approach of community diagnosis originally derieved from the work of Freeman in 1970 & Hogue in 1977.
4/23/2013
6
Definition
it is “a quantitative and qualitative description of the health of citizens and the factors which influence their health. It identifies problems, proposes areas for improvement and stimulates action”. - WHO
4/23/2013
7
Goals
Analyze the health status of the community
Evaluate the health resources, services, and systems of care within the community
Assess attitudes toward community health services and issues Identify priorities, establish goals, and determine courses of action to improve the health status of the community Establish an epidemiologic improvement over time. baseline for measuring
4/23/2013
8
Importance of Community Diagnosis
It helps to find the common problems or diseases, which are troublesome to the people and are easily preventable in the community.
Community diagnosis can be a pioneer step for betterment of rural community health. It is a tool to disclose the hidden problems that are not visible to the community people but are being affected by them.
4/23/2013 9
Cont…
It helps to access the group of underprivileged people who are unable to use the available facilities due to poverty, prevailing discriminations or other reasons.
It helps to find the real problems of the community people which might not have perceived by them as problems.
It helps to impart knowledge and attitudes to turnover people’s problems towards the light of solution.
4/23/2013 10
Content of community diagnosis
A program coordinator should know the following facts about the community: 1. Hard measurable facts age sex distribution literacy status Prevalence of disease Land holdings Irrigation facilities Sanitary condition others
4/23/2013 11
Cont…
2. Aspects that can’t be measured (soft facts): customs Beliefs‘ Taboos Attitudes Values towards various situations.
4/23/2013
12
Cont…
3. Overall organizational pattern of the community within which there are several sub organization.
E.g. castes with their own values and pattern of conduct. Each sub organization is intricately interrelated to the other and to the overall community, thereby affecting its entire behaviour,
4/23/2013
13
Cont…
The process of community diagnosis is a continuous learning experience both for the program coordinator and the community. When considered in all its aspects community diagnosis may seem an unassailable task, yet it is a simple process that develops gradually and only requires keen perceptiveness, observation, and the study of the facts obtained.
4/23/2013
14
Process of Community Diagnosis
How is the community diagnosed?
4/23/2013
15
Cont…
The process of community diagnosis involves four stages: 1. Initiation
2. Data collection and analysis
3. Diagnosis 4. Dissemination
4/23/2013 16
1. Initiation
A dedicated committee or working group should be set up to manage and coordinate the project. The committee should involve government departments, health professionals and nongovernmental organizations. At an early stage, it is important to identify the available budget and resources to determine the scope of the diagnosis.
4/23/2013 17
Cont….
Some of the common areas to be studied include health status, lifestyles, living conditions, socioeconomic conditions, physical and social infrastructure, inequalities, as well as public health services and policies. Once the scope is defined, a working schedule to conduct the community diagnosis, production and dissemination of report should be set.
4/23/2013
18
2. Data collection and analysis
Population Census and statistical data as for the community data, it can be collected by conducting surveys through self-administered questionnaires, face to face interviews, focus groups and telephone interviews.
4/23/2013
19
Cont…
Community analysis is the process of examining data to define
Needs Strengths Barriers Opportunities Readiness Resources
The product of analysis is the “community profile”.
4/23/2013 20
Cont….
To analyze assessment data is helpful to categorize the data. This may be done as follows:
Demographic Socioeconomic Environmental Health resources and services Health policies Study of target groups
Collected data can then be analysed and interpreted by experts.
4/23/2013 21
3. Diagnosis
Diagnosis of the community is reached from conclusions drawn from the data analysis. It should preferably comprise three areas:
Health status of the community Determinants of health in the community Potential for healthy city development.
4/23/2013
22
Community is diagnosed using
Health indicators
Indicators of health are variables used for the assessment of community health.
4/23/2013
23
Characteristics of health indicators
should be valid, i.e., they should actually measure what they are supposed to measure;
should be reliable and objective, i.e., the answers should be the same if measured by different people in similar circumstances; should be sensitive, i.e., they should be sensitive to changes in the situation concerned,
4/23/2013
24
Cont…
should be specific, i.e., they should reflect changes only in the situation concerned, should be feasible, i.e., they should have the ability to obtain data needed, and; should be relevant, i.e., they should contribute to the understanding of the phenomenon of interest.
4/23/2013
25
Classification of health indicators
Mortality indicators Morbidity indicators Disability rates Nutritional status indicators Health care delivery indicators Utilization rates
4/23/2013
26
Cont…
Indicators of social and mental health Environmental indicators Socio-economic indicators Health policy indicators Indicators of quality of life Other indicators
4/23/2013
27
Mortality Indicators
Mortality Rates Crude death rates Specific death rates: age/disease Expectation of life Infant mortality rate Maternal mortality rate Proportionate mortality ratio Case Fatality rate
4/23/2013
28
Morbidity Indicators
Morbidity rates
Data on morbidity are preferable, although often difficult to obtain.
Incidence and prevalence Notification rates Attendance rates: outpatient clinics or health centers. Admission and discharge rates Hospital stay duration rates
29
4/23/2013
Disability Indicators
Disability rates
No. of days of restricted activity
Bed disability days Work/School loss days within a specified period. Expectation of life free of disability
4/23/2013 30
Nutritional Indicators
Nutritional Status Indicators
Anthropometrics measurements
Height of children at school entry Prevalence of low birth weight Clinical surveys: Anemia, Hypothyroidism, Nightblindness
4/23/2013 31
- It is an indicator of positive health
Health Care Delivery Indicators
Health Care Delivery Indicators
- Reflect the Equity / Provision of health care
Doctor / Population ratio
Doctor / Nurse ratio Population / Bed ratio Population / per health center
4/23/2013
32
Utilization Indicators
Health care utilization Rates
- Extent of use of health
services - Proportion of people in need of service who actually receive it in a given period
Proportion of infants who are fully immunized in the 1st year of life. i.e..immunization coverage. Proportion of pregnant women who receive ANC. Hospital-Beds occupancy rate. Hospital-Beds turn-over ratio
4/23/2013
33
Social/Mental Health Indicators
Indicators of Social and Mental Health
- Valid positive indicators does not often exist - Indirect measures are commonly used
Suicide & Homicide rates Road traffic accidents Alcohol and drug abuse.
4/23/2013
34
Environmental Indicators
Environmental health Indicators
- Reflect the quality of environment
Measures of Pollution
The proportion of people having access to safe water and sanitation facilities Vectors density
4/23/2013
35
Socio-economic Indicators
Socio-economic Indicators
health status.
Rate of population increase Per capita GNP Level of unemployment Literacy rates - females Family size Housing condition e.g. No. of persons per room
36
- Is not a direct measure of
- For interpretation of health care indicators.
4/23/2013
Health Policy Indicators
Health Policy Indicators - Allocation of adequate
resources.
Proportion of GNP spent on health services.
Proportion of GNP spent on health related activities.
Proportion of total health resources devoted to primary health care
4/23/2013
37
Other Indicators
Other health indicators
Indicators of quality of life. Basic needs indicators. Millennium goal indicators
4/23/2013
38
4. Dissemination
The report can be disseminated through the
Presentations at meetings of the health boards and committees, or forums organized for voluntary organisations, local community
groups and the general public Press release Thematic events (such as health fairs and other health promotion programmes).
4/23/2013
39
Flowchart describing the community diagnosis process
4/23/2013
40
Comparing patient diagnosis & community diagnosis
There are a number of SIMILARITIES between patient diagnosis and community diagnosis. These are listed below :-
4/23/2013
41
Similarities
Patient Diagnosis
1) Obtain a history of the patient symptoms
2) Examine the patient & look for signs 3) Perform laboratory testes X ray & other investigations 4) To infer causation from the history make diagnosis. 5) Provide Treatment
Community Diagnosis
1) Obtain information about the community meetings & discussions
2)Obtain hard measurable fact 3)Conduct specific surveys based on findings of basic demographic survey 4)Make inference from the data to make the community through basic demographic survey. 5)Prescribe community health action as part of a community health programme 6) Evaluation the effect of community health action .
4/23/2013 42
6) Follow up & assess the effectiveness of the treatment .
Differences
Patient Diagnosis
1. Patient aware of their problems 2. Takes initiative for problems 3. Clinicians usually examines pt. after dz. has started. 4. Submit to remedial measures
Community Diagnosis
1. Community may or may not be aware of the problems 2. Community rarely takes collectively initiative of seeks advice 3. Attempts are made to understand why the dz. exists & how can be prevented. 4. Remedial measures cannot be prescribed or imposed on a community
5. Pathological condition affects 5. Cannot be treated as isolated occurrences. patient alone. It is often unrelated Each condition is linked to other to environment interrelated factors in the environment
4/23/2013 43
References
World Health Organization. City Health Profiles: how to report on health in your city. ICP/HSIT/94/01 PB 02. Available at: www.euro.who.int/document/wa38094ci.pdf Garcia P, McCarthy M. Measuring Health: A Step in the Development of City Health Profiles. EUR/ICP/HCIT 94 01/PB03. Available at: www.euro.who.int/document/WA95096GA.pdf
4/23/2013
44
Presented by: Menuka Shrestha M. Sc Nursing , Batch 2011
Contents
Introduction Definition Goal Importance of community diagnosis Contents of community diagnosis Process of community diagnosis Comparision patient diagnosis and community diagnosis
4/23/2013 2
Introduction
A community is a cluster of people with at least one common characteristic (geographic location, occupation, ethnicity, housing condition, etc.).
A group of people with a common characteristic or interest living together within a larger society comprises a community.
4/23/2013
3
Cont…
Community diagnosis is a comprehensive assessment of health status of the community in relation to its social, physical and biological environment. The purpose of community diagnosis is to define existing problems, determine available resources and set priorities for planning, implementing and evaluating health action, by and for the community.
4/23/2013
4
Cont…
Community diagnosis generally refers to the identification and quantification of health problems in a community as a whole in terms of mortality and morbidity rates and ratios, and identification of their correlates for the purpose of defining those at risk or those in need of health care.
4/23/2013
5
History of community diagnosis
The concept of diagnosis has evolved since second world war. Two major disciplines of health that are public health and nursing are background for the development of commu nity health diagnosis approach. It is originally used by physicians in 1950s. The current approach of community diagnosis originally derieved from the work of Freeman in 1970 & Hogue in 1977.
4/23/2013
6
Definition
it is “a quantitative and qualitative description of the health of citizens and the factors which influence their health. It identifies problems, proposes areas for improvement and stimulates action”. - WHO
4/23/2013
7
Goals
Analyze the health status of the community
Evaluate the health resources, services, and systems of care within the community
Assess attitudes toward community health services and issues Identify priorities, establish goals, and determine courses of action to improve the health status of the community Establish an epidemiologic improvement over time. baseline for measuring
4/23/2013
8
Importance of Community Diagnosis
It helps to find the common problems or diseases, which are troublesome to the people and are easily preventable in the community.
Community diagnosis can be a pioneer step for betterment of rural community health. It is a tool to disclose the hidden problems that are not visible to the community people but are being affected by them.
4/23/2013 9
Cont…
It helps to access the group of underprivileged people who are unable to use the available facilities due to poverty, prevailing discriminations or other reasons.
It helps to find the real problems of the community people which might not have perceived by them as problems.
It helps to impart knowledge and attitudes to turnover people’s problems towards the light of solution.
4/23/2013 10
Content of community diagnosis
A program coordinator should know the following facts about the community: 1. Hard measurable facts age sex distribution literacy status Prevalence of disease Land holdings Irrigation facilities Sanitary condition others
4/23/2013 11
Cont…
2. Aspects that can’t be measured (soft facts): customs Beliefs‘ Taboos Attitudes Values towards various situations.
4/23/2013
12
Cont…
3. Overall organizational pattern of the community within which there are several sub organization.
E.g. castes with their own values and pattern of conduct. Each sub organization is intricately interrelated to the other and to the overall community, thereby affecting its entire behaviour,
4/23/2013
13
Cont…
The process of community diagnosis is a continuous learning experience both for the program coordinator and the community. When considered in all its aspects community diagnosis may seem an unassailable task, yet it is a simple process that develops gradually and only requires keen perceptiveness, observation, and the study of the facts obtained.
4/23/2013
14
Process of Community Diagnosis
How is the community diagnosed?
4/23/2013
15
Cont…
The process of community diagnosis involves four stages: 1. Initiation
2. Data collection and analysis
3. Diagnosis 4. Dissemination
4/23/2013 16
1. Initiation
A dedicated committee or working group should be set up to manage and coordinate the project. The committee should involve government departments, health professionals and nongovernmental organizations. At an early stage, it is important to identify the available budget and resources to determine the scope of the diagnosis.
4/23/2013 17
Cont….
Some of the common areas to be studied include health status, lifestyles, living conditions, socioeconomic conditions, physical and social infrastructure, inequalities, as well as public health services and policies. Once the scope is defined, a working schedule to conduct the community diagnosis, production and dissemination of report should be set.
4/23/2013
18
2. Data collection and analysis
Population Census and statistical data as for the community data, it can be collected by conducting surveys through self-administered questionnaires, face to face interviews, focus groups and telephone interviews.
4/23/2013
19
Cont…
Community analysis is the process of examining data to define
Needs Strengths Barriers Opportunities Readiness Resources
The product of analysis is the “community profile”.
4/23/2013 20
Cont….
To analyze assessment data is helpful to categorize the data. This may be done as follows:
Demographic Socioeconomic Environmental Health resources and services Health policies Study of target groups
Collected data can then be analysed and interpreted by experts.
4/23/2013 21
3. Diagnosis
Diagnosis of the community is reached from conclusions drawn from the data analysis. It should preferably comprise three areas:
Health status of the community Determinants of health in the community Potential for healthy city development.
4/23/2013
22
Community is diagnosed using
Health indicators
Indicators of health are variables used for the assessment of community health.
4/23/2013
23
Characteristics of health indicators
should be valid, i.e., they should actually measure what they are supposed to measure;
should be reliable and objective, i.e., the answers should be the same if measured by different people in similar circumstances; should be sensitive, i.e., they should be sensitive to changes in the situation concerned,
4/23/2013
24
Cont…
should be specific, i.e., they should reflect changes only in the situation concerned, should be feasible, i.e., they should have the ability to obtain data needed, and; should be relevant, i.e., they should contribute to the understanding of the phenomenon of interest.
4/23/2013
25
Classification of health indicators
Mortality indicators Morbidity indicators Disability rates Nutritional status indicators Health care delivery indicators Utilization rates
4/23/2013
26
Cont…
Indicators of social and mental health Environmental indicators Socio-economic indicators Health policy indicators Indicators of quality of life Other indicators
4/23/2013
27
Mortality Indicators
Mortality Rates Crude death rates Specific death rates: age/disease Expectation of life Infant mortality rate Maternal mortality rate Proportionate mortality ratio Case Fatality rate
4/23/2013
28
Morbidity Indicators
Morbidity rates
Data on morbidity are preferable, although often difficult to obtain.
Incidence and prevalence Notification rates Attendance rates: outpatient clinics or health centers. Admission and discharge rates Hospital stay duration rates
29
4/23/2013
Disability Indicators
Disability rates
No. of days of restricted activity
Bed disability days Work/School loss days within a specified period. Expectation of life free of disability
4/23/2013 30
Nutritional Indicators
Nutritional Status Indicators
Anthropometrics measurements
Height of children at school entry Prevalence of low birth weight Clinical surveys: Anemia, Hypothyroidism, Nightblindness
4/23/2013 31
- It is an indicator of positive health
Health Care Delivery Indicators
Health Care Delivery Indicators
- Reflect the Equity / Provision of health care
Doctor / Population ratio
Doctor / Nurse ratio Population / Bed ratio Population / per health center
4/23/2013
32
Utilization Indicators
Health care utilization Rates
- Extent of use of health
services - Proportion of people in need of service who actually receive it in a given period
Proportion of infants who are fully immunized in the 1st year of life. i.e..immunization coverage. Proportion of pregnant women who receive ANC. Hospital-Beds occupancy rate. Hospital-Beds turn-over ratio
4/23/2013
33
Social/Mental Health Indicators
Indicators of Social and Mental Health
- Valid positive indicators does not often exist - Indirect measures are commonly used
Suicide & Homicide rates Road traffic accidents Alcohol and drug abuse.
4/23/2013
34
Environmental Indicators
Environmental health Indicators
- Reflect the quality of environment
Measures of Pollution
The proportion of people having access to safe water and sanitation facilities Vectors density
4/23/2013
35
Socio-economic Indicators
Socio-economic Indicators
health status.
Rate of population increase Per capita GNP Level of unemployment Literacy rates - females Family size Housing condition e.g. No. of persons per room
36
- Is not a direct measure of
- For interpretation of health care indicators.
4/23/2013
Health Policy Indicators
Health Policy Indicators - Allocation of adequate
resources.
Proportion of GNP spent on health services.
Proportion of GNP spent on health related activities.
Proportion of total health resources devoted to primary health care
4/23/2013
37
Other Indicators
Other health indicators
Indicators of quality of life. Basic needs indicators. Millennium goal indicators
4/23/2013
38
4. Dissemination
The report can be disseminated through the
Presentations at meetings of the health boards and committees, or forums organized for voluntary organisations, local community
groups and the general public Press release Thematic events (such as health fairs and other health promotion programmes).
4/23/2013
39
Flowchart describing the community diagnosis process
4/23/2013
40
Comparing patient diagnosis & community diagnosis
There are a number of SIMILARITIES between patient diagnosis and community diagnosis. These are listed below :-
4/23/2013
41
Similarities
Patient Diagnosis
1) Obtain a history of the patient symptoms
2) Examine the patient & look for signs 3) Perform laboratory testes X ray & other investigations 4) To infer causation from the history make diagnosis. 5) Provide Treatment
Community Diagnosis
1) Obtain information about the community meetings & discussions
2)Obtain hard measurable fact 3)Conduct specific surveys based on findings of basic demographic survey 4)Make inference from the data to make the community through basic demographic survey. 5)Prescribe community health action as part of a community health programme 6) Evaluation the effect of community health action .
4/23/2013 42
6) Follow up & assess the effectiveness of the treatment .
Differences
Patient Diagnosis
1. Patient aware of their problems 2. Takes initiative for problems 3. Clinicians usually examines pt. after dz. has started. 4. Submit to remedial measures
Community Diagnosis
1. Community may or may not be aware of the problems 2. Community rarely takes collectively initiative of seeks advice 3. Attempts are made to understand why the dz. exists & how can be prevented. 4. Remedial measures cannot be prescribed or imposed on a community
5. Pathological condition affects 5. Cannot be treated as isolated occurrences. patient alone. It is often unrelated Each condition is linked to other to environment interrelated factors in the environment
4/23/2013 43
References
World Health Organization. City Health Profiles: how to report on health in your city. ICP/HSIT/94/01 PB 02. Available at: www.euro.who.int/document/wa38094ci.pdf Garcia P, McCarthy M. Measuring Health: A Step in the Development of City Health Profiles. EUR/ICP/HCIT 94 01/PB03. Available at: www.euro.who.int/document/WA95096GA.pdf
4/23/2013
44
