I.

Community Diagnosis

• It is a comprehensive assessment of the community with regards to its social,

physical and biological environment.

• Its other names are Community Assessment and Situational Analysis

Types of Community Diagnosis:

• In the assessment of the community’s health status, the nurse considers

the degree of detail or depth she should go into.

• There are times when situations call for a comprehensive assessment and
often times, the nurse is confronted with s specific problem area like a
disaster situation or an outbreak of disease.

I. Comprehensive Community Diagnosis

• A comprehensive community diagnosis aims to obtain general information

about the community.

Elements of Comprehensive Community Diagnosis

A. Demographic variables

• It shows 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. Selected vital indicators such as growth rate, crude birth rate, crude death
rate, and life-expectancy at birth

4. Patterns of migration

5. Population projections

B. Social-Economic and Cultural Variables Indicators

1. Social Indicators

a. Social Indicators

b. Communication network

c. Transportation system

d. Educational level

e. Housing conditions suggestive of health hazards

2. Economic Indicators

a. Poverty level income

b. Unemployment and underemployment rates

c. Proportion of salaried and wage earners to total economically active

population

d. Types of industry present in the community

e. Occupation common in the community

3. Environmental Indicators

a. Physical/geographical/topographical characteristics of the community

• Land areas that contribute to vector problems

• Terrain characteristics that contribute to accidents or pose as

geographical zones

• Land usage in industry

• Climate/season

b. Water supply

• Percent population with access to safe, adequate water supply

• Source of water supply

c. Waste Disposal
 • Percent population served by daily garbage collection system

• Percent population with safe excreta disposal system

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 affect health

c. Concepts about health and illness

C. Health and Illness Patterns

1. Leading causes of mortality

2. Leading cause of morbidity

3. Leading cause of infant mortality

4. Leading cause of maternal mortality

5. Leading cause of hospital admission

D. Health Resources

• The health resources that are available in the community is an important

element of the community diagnosis mainly because they are the
essential ingredients in the delivery of basic health services.

1. 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 the type of organization

• Quality of health manpower

• Existing manpower development and policies

2. Material resources

• Health budget and expenditures

• Sources of health funding

• Categories of health institutions available in the community

• Hospital bed-population ratio

• Categories of health services available

E. Political/Leadership Pattern

• It reflects the action potential of the state and its people to address the
health needs and problems of the community.

1. Power structure in community

2. Attitudes of people toward authority

3. Conditions/events/issues that cause social conflict/upheavals

 4. Practices/approaches that are effective in setting issues and concerns
within the community.

II. Problem-Oriented Community Diagnosis

• This is a type of assessment that responds to a particular need

(Spradley, 1990)

Steps in conducting Community Diagnosis

1. Determining objectives

• In determining the objectives of the community diagnosis, the nurse

decides on the depth and scope of the data she needs to gather.

2. Defining the Study Population

• Based on the objectives of the community diagnosis, the nurse

identifies the population group to be included in the study.

• It may include the entire population in the community or focused on a

specific population group such as women in the reproductive age-group
or the infants and young children.

3. Determining the Data to be collected

• Whether the community diagnosis is going to be comprehensive or

focused on a specific problem, the objectives will guide the nurse in
identifying the specific data she will collect.

4. Collecting the Data

• The nurse decides on the specific methods depending on the type of

data to be generated.

• Methods of Data Collection

a. Records review – data may be obtained by reviewing those that have
been compiled by health or non-health agencies from the government or
other sources.
b. Surveys and observations – can be used to obtain both qualitative and
quantitative data.
c. Interviews – can yield first hand information.
d. Participant observation – is used to obtain qualitative data by allowing
the nurse to actively participate in the life of the community.

5. Developing the Instrument

• Instruments or tools facilitate the nurse’s data gathering activities.

• Common instruments use in data collection are:

a. survey questionnaire
b. interview guide
c. observation checklist

6. Actual Data Gathering

• Before the actual data gathering, it is suggested that the nurse meet the
people who will be involved in the data collection.

• The instruments are discussed and analyzed.

• The data collectors must be given an orientation and training on how

they are going to use the instruments in data gathering.

• During the 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

• After data collection, the nurse now ready to put together all the
information.

• Two types of data that may be generated during data collation: (1)
numerical data – which can be counted and (2) descriptive data -
which can be described.

• The nurse develops categories for classification of responses.

 - These are (1) Mutually Exclusive – choices which do not overlap and
(2) Exhaustive Categories – anticipate all possible answers that a
respondent may give.

• In collating fixed responses questions, choices must be provided which

will serve as categories for the respondent’s answer.

• In some community diagnosis designs, data collectors use flashcards to

help the respondent choose his answer.

• Open ended questions do not provide choices or categories.

• The next step after categorizing the responses will be to summarize the
data.

- Two ways to summarize data: (1) One can do it manually by tallying

the data or by using the computer and (2) Tallying involves entering
the responses into the prepared tally sheets showing all possible
responses.

- When computers are going to be used in summarizing results, the

responses are given numbers or codes.

8. Data Presentation

• Data presentation will depend largely on the type of data obtained

• Descriptive Data is presented in a narrative reports (example:

geographic data, history of a place or beliefs regarding illness and
death).

• Numerical Data may be presented into table or graphs.

- Tables or graphs are useful in showing key information making it

easier to show comparisons including patterns and trends.

- The choice of graphs will depend on the type of data being presented.

- Types of Graphs

Line Graph – shows trend data or changes with time or age with
respect to some other variables
 Bar Graph/Pictograph – for comparisons of absolute or relative
counts and rates between categories

Histogram/frequency polygon – graphic presentation of frequency

distribution or measurement

Proportional or component bar graph/pie chart – shows breakdown

of a group or total where the number of categories is not too many

Scattered diagram – correlation data for two variables

9. Data Analysis

• Data analysis in community diagnosis aims to establish trends and

patterns in terms of health needs and problems of the community.

• It also allows for comparison of obtained data with standard values.

• Determining the interrelationship of factors will help the nurse view the
significance of the problems and their implications on the health status
of the community.

10. Identify Community Health Nursing Problems

Category of Health Problem:

a. Health Status Problem – They may be described in terms of
increased or decreased morbidity, mortality, fertility or reduced
capability for wellness.

b. Health Resource Problem – They may be described in terms of lack

of or absence of manpower, money, materials or institutions
necessary to solve health problems.

c. Health-Related Problem – They may be described in terms of

existence of social, economic, environment and political factors that
aggravate the illness-inducing situations in the community.

11. Priority Setting

• After the problems have been identified, the next task for the nurse and the
community is to prioritize which health problems can be attended to
considering the resources available at the moment.

Criteria in Prioritizing:

a. Nature of the Problem Presented – The problems are classified

as health status, health-related or health-resources problem

b. Magnitude of the Problem – This refers to the severity of the

problem which can be measured in terms of the proportion of the
population affected by the health problem.

c. Modifiability of the Problem – This refers to the probability of

reducing, controlling or eradicating the problem.

d. Preventive Potential - This refers to the probability of controlling or

reducing the effects posed by the problem.

e. Social Concern – This refers to the perception of the population or

community as they are affected by the problem and their readiness
to act on the problem.

Scoring System

Criteria Weight
Nature of the Problem 1
Health Status 3
Health Resources 2
Health Related 1

Magnitude of the Problem 3

75% - 100% affected 4
50% - 74% affected 3
25% - 49% affected 2
<25% affected 1

Modifiability 4
High 3
Moderate 2
Low 1
Not Modifiable 0
 Preventive Potential 1
High 3
Moderate 2
Low 1

Social Concern 1
Urgent community concern; 2
express readiness
Recognized as a problem but 1
not needing urgent attention
Not a community concern 0

• Dr. Jose Fabella was named chief of the Bureau of Health ( 1936)
• Dr. Clemente S. Gatmaitan as the first health minister ( 1978)

DOH SECRETARIES

 Alfredo Bengzon (1987-1991)

 Antonio Periquet (1991-1992)
 Juan Flavier (1992-1995)
 Jaime Galvez-Tan (1995)
 Hilarion Ramiro, Jr. (1995-1996)
 Carmencita Reodica (1996-1998)
 Felipe Estrella (1998)
 Alberto Romualdez (1998-2001)
 Manuel Dayrit (2001-2005)
 Francisco Duque (2005-2010)
 Esperanza Cabral (2009-2010)
 Enrique Ona (2010-Present)