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BACHELOR OF SCIENCE IN NURSING

COMMUNITY HEALTH NURSING 2
COURSE COURSE WEEK
MODULE UNIT
1 9 9

COMMUNITY DIAGNOSIS

Read course and unit objectives

Read study guide prior to class attendance
Read required learning resources; refer to unit terminologies
for jargons
Proactively participate in classroom discussions
Participate in weekly discussion board (Canvas)
Answer and submit course unit tasks

At the end of this unit, the students are expected to:

Cognitive:
1. Discuss important concepts of Community Diagnosis.
2. Describe the types of community diagnosis.
3. Discuss the process of comprehensive community diagnosis.
Affective:
1. Listen attentively during class discussions
2. Demonstrate tact and respect when challenging other people’s opinions and ideas
3. Accept comments and reactions of classmates on one’s opinions openly and graciously.
4. Develop heightened interest in studying Community Health Nursing.
 Psychomotor:
1. Participate actively during class discussions and activities
2. Express opinion and thoughts during class

Maglaya, A, (2009) Nursing Practice In The Community 5th Edition, Community Health Nursing:
Context and Practice (pp 150 - 175). MarIkina: Argonauta Corporation

Community Diagnosis

Determining community health status is a process called community assessment. It is the

process of community diagnostics and a keystone in developing community health nursing
process. (Freeman and Heinrich, 1981; and Muecke, 1980)

Community Diagnosis in nursing consist of two parts.

(1) The nurse collects data about the community in order to find different factors that may
directly and indirectly influence health of the population.
(2) Analyze and seeks explanation to the occurrence of health needs and problem of the
community.

Types of Community Diagnosis

1. Problem-Oriented Community Diagnosis

• made to responds to a particular need of a target group

2. Comprehensive Community Diagnosis

• general information about the community

COMPREHENSIVE COMMUNITY DIAGNOSIS

This aims to obtain the general information of the community with the intent of determining
prevalent health conditions and risk factors (epidemiologic approach), lifestyle behaviors and
attitudes that affects their health (behavior approach) as well as their socio-economic condition
(socio-economic approach).
The elements of community diagnosis and the basic data that characterize each variable are
listed below.
Elements of Comprehensive Community Diagnosis
A. Demographic Variables. This shows the size, composition and geographical
characteristics of population. Consist of:
1. Total population, geographic 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, crude death rate and life
expectancy at birth
5. Patterns of Migration
6. Population Projections
Be sure to indicate groups needing special attention such as indigenous people. Internal
refugees and other dislocated population due to calamity, disaster and development
program

B. Socio-Economic and Cultural Variables. These affects health of the community directly
and indirectly.
1. Social Indicators
a. Educational Level –
Can be indicative of poverty, can also reflect in the perception in terms of
health and utilization of pattern of the community
b. Housing Condition
May reflect health hazards such as congestion fire, exposure to elements
c. Social Classes or groupings
2. Economic Indicators
a .Poverty Level Income
b. Unemployment and Underemployment Rate
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
f. Communication network (whether formal or informal channels) necessary for
disseminating health information or facilitating referral of clients to the health
care systems.
g. Transportation systems including road networks necessary for accessibility
of the people for health care delivery system
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 geohazards
 zones
• 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 by daily garbage collection system
• % population with safe excreta disposal system
• Types of waste disposal and garbage disposal system
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 Pattern

The nurse may collect primary data about leading causes of illness and deaths and their
respective rates of occurrence. If he accesses to recent, reliable secondary data, then she
can also make use of these:
1. Leading causes of mortality
2. Leading Causes of Morbidity
3. Leasing Causes of Infant and Child Mortality
4. Leading Causes of Hospital Admissions
5. Leading Causes of Clinic Consultation
6. Nutritional data

D. Health Resources. This is an essential element in the delivery of basic services in the
community. The nurse needs to determine manpower, institutional and material resources
provided by states and those from private sector &other NGO.
1. Manpower Resources
• Categories of health manpower available
• Geographical distribution of health manpower
• Manpower-population ratio
• Distribution of health manpower according to health facilities (hospitals,
 rural health units, etc.)
• Distribution of health manpower according to type of organization
(government, non-government, health units, private)
• Quality of health manpower
• Existing manpower development / politics
2.Material Resources
• Health budget and expenditure
• Sources of health funding
• Categories of health institutions available in the community
• Hospital to 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. This is
to address the health needs and problems of the people. It also mirrors the SENSITIVITY of
the government to the people’s struggle for better lives.
The nurse describes the following:
a. Power structures in the community (formal or informal)
b. Attitudes of the people toward authority
c. Conditions / events/ issues that cause social conflict / upheavals or that lead to social
bonding or unification
d. Practices / approaches effective in setling issues and concerns within the community

PROBLEM-ORIENTED COMMUNITY DIAGNOSIS

This is a type of assessment that responds to a particular need of a target group (Spradley,
1990, Clark, 2003).
Ex. April 2020, a reported incidence of a certain incinerator in Navotas that is expelling
huge black fumes in frequent numbers this pandemic. The residents near the area complained
and feared its effect for their health.
The nurse, in doing a problem-oriented community diagnosis will investigate the community -
i.e., the people, its environment. He will identify the population affected. Next, the nurse will
characterize the biophysical, psychological, physical environment, socio-cultural and behavioral
as well as health system factors relevant to the specific problem being investigated.

Steps in Conducting Community Diagnosis

1. Determining Objectives.
• The following questions should be answered:
o a.What is the present health condition of the people in the community?
o b.Why are the people in the community in such condition? What specific problems are
causing these conditions?
 o c.What are the roots of these problems?
o d.What solutions will address the problems?
• To define the health problems of the community, it is important to determine
the occurrence and distribution of selected environmental, socio-economic and
behavioral conditions both for comprehensive and problem - oriented community
diagnosis. (Denver, 1980). These three will also serve as a guide in the control and
wellness promotion during planning phase.

2. Defining the study population.

• This may include the:
o Entire population in the community or
o Focused on a specific population.
o Sample or sub-set of target population if a complete enumeration of the desired
population is not feasible.

3. Determining the data to be collected.

• Achieved by developing a data collection plan in which objectives are used to guide the
data collectors. Data categories are primary and secondary.
4. Collecting the Data. Different methods may be utilized to generate health data. In general, we
use the following methods of data collection:

observation records review

extracting written information
information from kept in folders, files
subjects by observing or books
behaviors &
environment.
Ocular survey /
Windshield survey
Participant
Observation

interviews
face-to-face interview
telephone interview
individual interview
group interview
Focus Group Discussion /FGD
Set a characterisitcs of the participants in
terms of:
•characteristics common to them
•characteristics that will differentiate them from
one another

key informant interview (KII) Participants are selected based on the

Structured and Unstructured
interview
variable being studied
A qualitative research technique utilize for
its value in understanding & documen ing
human behaviors
A FACILITATOR, will summarize &
synthesize the discussion to make certain
that issues have clarified rather than
confused participants

5. Developing the instrument. Instruments or tools facilitate the nurse’s data gathering activities.
The most common are: Survey questionnaire, focus group discussion guide, key informant
interview guide, observation checklist.
a.Survey Questionnaire
Or survey instrument.
The form one uses to document the date being collected.
In the form of:
o a.Interview schedule in which the PHN reads question & record
responds and a Self-completed or self-administered questionnaire in which
respondents read question & write down responses
o b.Focus Group Discussion Guide
Helps as a guide to facilitate the course and flow of ideas on definite topics or concepts among
participants.
o c.Key Informant Interview Guide
The KII is a set of guided question about the subject.
To be effective - Be conversant, have working knowledge about subject matter The person being
interviewed is selected because of his expertise or concern to the subject matter
o Observation Checklist
List of data that are manifestation of health needs or problems

6. Actual Data Gathering.

• Preparation before interview are the following:
o PHN meets teams involved in data collection.
o Instruments are discussed & analyzed. It can be modified or simplified because
of time limitation and so as not to burden those limited education. Pre-testing of
the instrument is recommended
 o Data Collectors are given orientation & training on how to use the instruments. A
role – play of data collection can be performed
The PHN can teach data collectors the use of participatory tools and technique as an
alternative to the customary household survey because it takes too long to finish. These are
creative and innovative method that will increase participation of people in data collection.
Participatory tools and techniques are as follows:

Semi-Structured Informal, guided interviews session in which some questions are pre-
Interviews determined. A new question or lines of questioning arise during the
interviews which is in response to answers from those interviewed.

Analytical This is for quick means of finding out an individual's or a group's list of
Games priorities or preferences

Stories and short, colorful descriptions of situations encountered by PHN in the field.
Portraits These also stories recounted by people

Diagrams Simple, schematic devices that presents information in readily

understandable visual forms. These are analytical procedures, a means of
communication between and among different people.

Workshop Bring people together. Outsiders can be introduced to participate actively

in reviewing, analyzing & evaluating the information gathered. An
outsider is needed for their skills and experience

o Participatory tools are non-threatening and simplify data gathering

• After the data gathering, the PHN checks filled-up instruments to see its: completeness,
accuracy and reliability of information collected. If there are problems in accuracy or
reliability, there is a need to go back & secure appropriate information. This is the only
way to maintain integrity and good quality of data for community diagnosis

7. Data Collation. This refers in putting the facts “together.”

• Two Data that are generated are Numeric and Descriptive Data. Numerical data are
counted like number of children in a family or how many are using “alkantarilya” as a
form of excreta disposal. Descriptive data are those that can described or that can
reveal characteristics of an observable facts like beliefs
• Plan for collation should have been developed prior to data collection which is done by
creating and constructing categories for classification of responses either mutually
exclusive and exhaustive.
• Mutually Exclusive Choice. The choices do not overlap. Responses fall only in one
category among set of choices. True for numeri and descriptive data.
Ex. Place of Origin
_____ Luzon
_____ Visayas
_____ Mindanao
• Exhaustive Category. It anticipates all possible answers that a respondent may give.
Ex. Types of Infant Feeding
_______ Breastfeeding
______ Bottle Feeding
Condensed Milk
Evaporated
Am
________ Mixed Feeding
Breastmilk and Am
Breastmilk and Formula Milk
• Summarizing Data from Fixed Response.
o With the aid of Flashcard in which an assigned number or letters will correspond to
specific category of choices.
o It offers CHOICES to respondent to select from & will serve as CATEGORIES for
collating responses.
o Use of flashcard to aid respondent select answer is performed for very young
respondents or respondents with limited education.
• Open – Ended Questions. Categories are created only after data collection is over. It is
constructed from responses in randomly selected questionnaires.
▪ Ex. Anung Dahilan at hindi kayu nag Family Planning?
Response 3 Mahal
Response 14 Nakakataba
Response 19 Walang pambili
Response 29 Sumasakit ulo ko pag nag-take ako ng pills

Possible categories are:

Financial : Responses 3, 9
Side Effects: Responses 14, 29

• Summarizing the data. The next step after categorizing the responses is to summarize
the data. Two (2) ways to summarize data.
(1) Manually by tallying the data
(2) By using computer
 o Tallying involves entering responses into prepared tally sheets showing all
possible responses.

Gender Tally Mark Frequency (F)

Male IIIII – IIIII- III 13
Female IIIII-II 7
Total Respondents 20

o For tallying by computers such as using software such as EPIINFO involves the
use of a Coding such as a number or codes.
Ex.

Variable Category Code

Gender Male 1
Female 2

8. Data Presentation
• Presentation will depend on the data:
o Descriptive Data are presented in narrative reports, Ex. Geographic data
history of the community, belief regarding health and illness
o Numerical Data is presented using table or graphs because it is useful in
showing key information making it easier on the type of data being
presented
o Types of Graph and its Data Function
▪ Line Graph. Shows trend or changes in data with time or
age with respect to some other variables
▪ Bar Graph or Pictograph. For comparison of absolute or
relative counts and rates between categories
▪ Histogram or Frequency Polygram. Graphic presentation of
frequency distribution or measurement
▪ Proportional or Component Bar Graph or Pie Chart. Shows
breakdown of a group or total where the number of
categories is not too many.
▪ Scattered Diagram. Correlation data for data variables.

9. Data Analysis.
• This is the MOST crucial stage in community diagnosis
• This involves the quantification, description and classification of data.
• Triangulation is performed. Consistency and validity of data is checked. This is
necessary because there are multiple sources of data which were collected using
 different methods.
• Data are sorted and classified in terms of relatedness and interpreted for any
significance or implication.
• Data analysis aims to established trend, patterns in terms of health needs and problems
of the community.
• To help the PHN view and analyze which are indicators of health problems & which
factors give rise to health problems, patterns in terms of human relations, time, and
space are analyze.
• The magnitude and extent of the problem and their implications can be derived by
comparing them with standard values or norms
• PROBLEM TREE ANALYSIS APPROACH – representative of sectors of community
should be present during data analysis. The PHN can facilitate the data analysis with
the use of the “Problem Tree Analysis Approach.” An analogy that leaves and branches
conditions are manifestations of the over state of the plant and cause by what it gets
from the soil in terms of nourishment from the roots.
o Problem Tree Analysis Approach is a participatory approach.
o The PHN writes data in 3 x 12 inches size cartolina and post it on wall
o Using manila paper or board the PHN draws a big tree that details leaves,
branches, trunk & roots.
o The PHN instructs people to look at the data written in cartolina and think which
can be considered as main / central problem then posts it in trunk; cause of
problem will be posted in roots; effects are posted in branches and leaves
o Afterwards, people are encouraged to give opinions, comments, and reactions or
seek clarifications on what or how the others view the problems.
o Questions listed below are possible to deepen analysis of community
representatives:
▪ How are the main or central issue of the problem related to one
another?
▪ Which of the problems seems to be the most serious?
▪ Among the roots of the problems, which are the easiest to
address?
▪ 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.

Defining the community health nursing problems will help the PHN and the team to decide with
the people actions that will effectively address and improve community’s health.
Categories of their health problems are as follows:
 Health Status Health Resources Health - related

• Increased / • lack of manpower, • with social,

morbidity, money, materials, economic,
mortality, institutions environmental &
fertility,reduced political factor
wellness capability

11.Priority – setting. Considering limited resources, the following criteria are used in scaling.
•Classified as Health status, health
Nature of the Condition resouces or health -related
/ Problem presented
Magnitude of the •refers to severity of the problem
This is measured in terms of
Problem proportion of population affected

Modifiability of the •The probability of reducing,

controlling or eradicating the
Problem problem

•Probability of controlling or
Preventive Potentials rerducing the effects posed by the
problem

•Refers to the perception of the

Social Concern population or the community as
they are affected by the problem

The table below shows the Scoring system in prioritizing identified health condition or problem
of the community in which each problem will be scored according to each criterion and divided
by the highest score multiplied by the weight. Afterwards, the final score for each criterion will
be added to come up with “total score for the problem.”
 The problem with the highest total score is given high priority over others by the PHN.
SCORING SYSTEM : Prioritizing Health Conditions / Problems
CRITERIA SCORE Weight

Nature of the Problem

• Health Status 3 1
• Health Resources 2
• Health Related 1

Magnitude of the Problem 4 3

• Affects 75% to 100% of the population 3
• Affects 50% to 74% of the population 2
• Affects 25 % to 49& of the population 1
• Affects less than 25% of the population

Modifiability of the Problem

• High 3 4
• Moderate 2
• Low 1
• Not Modifiable 0
Preventive Potential
• High 3 1
• Moderate 2
• Low 1
Social Concern
• Urgent community concern, expressed readiness for action 2 1
• Recognized as problem but not needing immediate attention 1
• Not a community concern 0

(UP College of Nursing, Community Health Specialty Group, 1989)

Magnitude of the Problem – In priority scaling, it refers to the severity of the problem

Modifiability of the Problem – refers to probability of solving problem

Nature of the Problem - a criteria in scaling that classifies the health problem
Preventive Potential – Refers to ability to prevent future problem

Social Concern – Refers to perception of community on scaling.

Triangulation – Data are checked for consistency and validity using different methods.

Famorca, Z. 2013. Nursing Care of the Community, a comprehensive text on community and
public health nursing in the Philippines, 2013, 134 – 150.

RLE: Making of Community Diagnosis

Famorca, Z. 2013. Nursing Care of the Community, a

comprehensive text on community and public health
nursing in the Philippines, 2013, 134 – 150.

Maglaya, A, (2009) Nursing Practice In The Community

5th Edition, Community Health Nursing: Context and
Practice (pp 150 - 175). Marikina: Argonauta Corporation

Prepared by: Aida. Garcia, MAN, RN