LECTURE\POWERPOINT

[TRANS] LESSON 1.2: STEPS IN CONDUCTING COMMUNITY DIAGNOSIS

o This will reflect the possible solutions of the health
OUTLINE problems based on the community's capabilities
I Steps in Conducting Community Diagnosis and resources.
A Determining the Objectives
B Defining the Study Population DEFINING THE STUDY POPULATION
C Determining the Data to be Collected
• Identify the population group to be included in the study
D Determining Methods of Collecting the Data
E Developing the Instrument • It may include the entire population in the community or
F Actual Data Gathering focused on a specific population group
G Data Collation
H Data Presentation Determining the study population will be anchored with the first
I Data Analysis step (determining the objectives)
J Identifying Community Health Nursing Problems • We must also determine the no. of households, individuals,
K Priority Setting
and families in a certain community
• We must be cautious because sometimes there are
STEPS IN CONDUCTING COMMUNITY DIAGNOSIS several families in 1 household
• Community diagnosis must be carried out in an organized • Homeless or street dwellers are not part of the study
and systematic manner population – they have their own community
• Community should take an active part in identifying
community needs & problems Table No.1 De Facto vs De Jure
• Nurse plans with the community members to create a team TYPE DESCRIPTION
that will be responsible in overseeing the planning, De Facto People were assigned to the place where
implementation of the community diagnosis they are physically present at the time of
• Nurse must emphasize importance and value of people’s census regardless of their usual place of
participation in the activity because their detailed residence; “kung sino lang madatnan”
knowledge about the community will fundamentally shape De Jure People were assigned to the place they
health actions that are responsible and relevant to their usually live regardless of where they are at
needs. the time of census; “kapag regstered ka sa
• The plan for carrying out the community diagnosis is based residence na yun counted ka sa assessment,
on the results of the rapid appraisal. kahit nasa abroad ka pa”
o Breadth and depth (comprehensive versus
a
problem-focused)
o Target population (entire community or a specific
aggregate) and
DETERMINING THE DATA TO BE COLLECTED
• Nurse together with the community members need to figure
o Problem focus
▪ These are clarified and make it easier for the out a scheme to rationalize the relevant data to be obtained
nurse and the people involved to develop an o Achieved by developing a data collection plan
arrangement that will facilitate the conduct of o Data collection plan – uses the objectives to guide
the community diagnosis. the data collectors to decide on:
• Mnemonics: OPD-MIG-CP APP ▪ Specific information or data to be collected,
o While in the OPD, MIG is using his CP APP ▪ Methods of data collection
▪ Instruments or tools for data collection
▪ Possible sources of these data
DETERMINING THE OBJECTIVES
• Data can be categorized as primary or secondary based on
• Allows us to identify the depth of the assessment we need to
the source
perform
• It is critical to determine the occurrence and distribution of
Table No.2 Primary vs Secondary Sources
selected environmental, socio-economic and behavioral
SOURCE DESCRIPTION
conditions.
Primary Data that are directly obtained by the nurse
• Important in defining the health problems of the community.
specifically to answer the community
o Later on, during the planning phase, these will serve
diagnosis objectives
as guide in directing disease control and wellness
promotion in the community. Secondary Existing data that were obtained by other
people which the nurse can use to answer the
community diagnosis objectives
In stating the objectives, the following questions should be
answered:
1. What is the present health condition of the people in the • Ensure that the following desired qualities of data has been
community? maintained:
o This will describe the prevailing disease o Timeliness of data
conditions and health needs of the target o Completeness
population. o Accuracy
2. Why are the people in the community in such condition? o Precision
What specific problems are causing these conditions? o Relevance – must be significant to the objective
o This will explain the health behaviors or risk factors o Adequacy
that give rise to the health problem.
3. What are the roots of these problems? DETERMINING METHODS OF COLLECTING THE DATA
o This will provide the analyses related to the socio- • Different methods may be utilized to generate health data.
economic, cultural and environmental factors
that sustain or allow for the perpetuation of the Table No.3 Methods of Collecting Data
health problems of the target population. METHODS DESCRIPTION
4. What solutions will address the problems? Observation • Extracting information from subjects by
observing their behavior and environment

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 [TRANS] LESSON 1.2: STEPS IN CONDUCTING COMMUNITY DIAGNOSIS
• Provide an opportunity to check the respond better when they keep
validity of many verbal statements an eye contact with the person,
• Maybe supplemented by the use of tools they talk to making the interview
(e.g., weighing scale, more fruitful and constructive
sphygmomanometer, videotapes) • Based on number of interview participants:
• Important methods when informants are a. Individual interview – takes place
unable to directly supply information or bet. a respondent and an
may likely give inaccurate information interviewer and is most useful
• There are limitations especially when when sensitive issues are being
observation periods are limited to a discussed.
specific period of time ▪ Key Informant Interview (KII)
• Prior to actual conduct of community – a person knowns to be an
diagnosis, the nurse must have a bird's eye expert or an authority on a
view or a "feel" of what the community specific subject is
looks like. This helps the nurse plans and interviewed
directs the focus and the depth of the b. Group interview – consists of 1
community diagnosis. interviewer and several
a. Ocular Survey – trying to reach all participants (10-15) which allow
the boundaries of the community the interviewer to gather data
while walking from a good number of people
b. Windshield Survey – using a at the same time.
vehicle to observe a community • Based on interview structure:
• Participant Observation – observers need a. Structured interview – follows a list
to live and fully integrated with the of question called an interview
community they are studying and be part schedule which becomes the
of what is happening in the community script in the conduct of the
a. A nurse investigating lifestyle interview; interviewer is expected
patterns is likely to affect the to adhere to the interview
people they are observing and schedule, and is not allowed to
can cause “artificial” behavior – alter the sequence of the
Hawthorne effect questions, reword or rephrase the
Records • Records are written information that are questions.
Review kept in folders, files or books which we b. Unstructured interview – useful in
often refer to as hard copies but they may collecting qualitative data that
also be kept on tape or electronic form as seek to describe opinions or
database to be retrieved or accessed for perceptions of people focusing
specific purposes. on particular issue, problem or
• These offer the data collector savings in phenomenon; use of open-
time, money, energy and effort since data ended questions and takes off
are pre-collected. from the responses elicited from
• Nurse needs to evaluate the data's worth if the person being interviewed.
they are up-to-date. Focus • A qualitative research technique utilized
• Data may be obtained by reviewing those Group for its value in understanding and
that have been compiled by health or Discussion documenting human behavior
non-health agencies from the government (FGD) • Very popular method appropriate in the
or other sources. community to elicit and explore opinions of
• The nearer one is to the source of data, the people, determine their attitudes and
better. (e.g., if the nurse is looking for data practices regarding a limited set of
about a barangay, data search will be concepts.
more productive in the barangay or in the • The participants are selected based on the
municipal records than when search is variables that are being studied.
done at the provincial or regional records) • In the conduct of focus group discussions,
Interviews • Most common and widely used methods make sure to set the characteristics of the
of data collection participants in terms of:
• Involves asking and answering questions a. those characteristics that will be
following a systematic procedure common to them, and
• Based on the presence of face-to-face b. those characteristics that will
interaction: differentiate them from each
a. Face-to-face interview – allows other
the person being interviewed to
seek clarifications about the DEVELOPING THE INSTRUMENT
questions, can pick up non- • Instruments or tools facilitate the nurse's data-gathering
verbal cues from the respondent activities. The tools or instruments to be used depend on the
to indicate congruence with method of data gathering needed to supply the information
verbal response for the community diagnosis.
b. Telephone interview – more
limitations than face-to-face Table No.4 Instruments for Data Collection
interview, to be considered of use KINDS DESCRIPTION
in gathering voluminous data. Survey • Aka survey instrument – form uses to
Telephone calls are expensive Questionnaire document the data being collected
when one calls from a mobile o Interview schedule – nurse
phone; text messages provide reads out the question and
limited data, and people

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 [TRANS] LESSON 1.2: STEPS IN CONDUCTING COMMUNITY DIAGNOSIS
records the respondent’s reply
to the question
o Self-completed or Self-
administered questionnaire –
respondents read the question
and write down their response
• It is important that the instrument are
designed in a way that they generate
date that are: honest, complete, and
accurate
Focus Group • Serves to facilitate the direction and flow
Discussion pf exchange of ideas on specific topic or
Guide concepts among the participants
• Should specify the objectives of the
discussion and the general
characteristics of the participants.
• Does not need to strictly adhere to the
sequence of the questions but makes
certain that all concepts are exhaustively
discussed.
Key Informant • Helps give direction to the person doing
Interview the interview using a set of prepared
Guide questions on a very specific subject
• Person being interviewed is selected for
known expertise or concern on the
subject matter
• Interviewer must be conversant or at
least have a working knowledge about
the issue being discussed
Observation • A list of data that are manifestations or
Checklist indicators of a health need or problem
• List could include the physical or
environmental hazards where the
community is situated
• Could also be indicators of health
resourced such as health facilities and
presence of personnel and services
ACTUAL DATA GATHERING
• Before the actual data gathering, it is suggested that the
nurse meets the team of people who will be involved in the
data collection.
• The instruments are discussed analyzed.
o If necessary, the instruments may be modified or
simplified in order not to overburden the people
who may have limitations in terms of educational
preparation or available time to finish data
collection.
• Pre-testing of the instruments is highly recommended.
• Data collectors must be oriented and trained on how they
are going to use the instruments in data gathering.
o The nurse can ask the data collectors to role-play
an interview scene so that they can place
themselves in an actual interview situation.
• As alternatives to the customary household survey which can
take long to finish, the nurse can teach the data collectors to
use participatory tools and techniques to facilitate and
simplify data gathering.
• Creative and innovative methods will likely increase people's
participation in data collection because of the non-
threatening features.
Among other participatory tools or techniques for data
gathering are the following:
a. Semi-structured interviews – informal, guided interview
sessions where only some of the questions are
predetermined and new questions or lines of questioning
arise during the interview, in response to answers from
those interviewed.
b. Analytical games – a quick means of finding out an
individual's or a group's list of priorities or preferences.
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c. Stories and portraits – are short, colorful descriptions of
situations encountered by the nurse in the field or stories
recounted by people. They describe information in ways
rural people themselves perceive local conditions,
notably problems and opportunities.
d. Diagrams – simple, schematic devices which present
information in a readily understandable visual form. These
are analytical procedures; a means of communication
between and among different people.
e. Workshop – means of bringing people together and
outsiders introduced for their skills and experience, to
participate actively in reviewing, analyzing and
evaluating the information gathered
• During the actual data gathering – nurse supervises the data
collectors by checking the filled-up instruments in terms of
completeness, accuracy and reliability of the information
collected
• If there are gaps/problems in accuracy or reliability – nurse
emphasize the need to go back to the source and secure
the appropriate information
o This is to maintain the integrity and good quality of
data for the community diagnosis
DATA COLLATION
• Nurse and the team are now ready to put together all facts
and figures to generate information about the health status
of the community.
Table No.5 Types of Data
TYPES DESCRIPTION
Numerical Those which can be counted like: age or how
many children are there in a family or how many
communal toilets are there in the community
Descriptive Those that can be described or that can reveal
characteristics of an observable facts
• Nurse and the team should have already developed a plan
for data collation
• This is done by creating or constructing categories for
classification of responses
Table No.6 Categories of Responses
CATEGORY DESCRIPTION
Mutually • Mutually exclusive choices do not overlap
Exclusive • Response can only fall in one category from
a set of choices
• This is true for both numerical and
descriptive data
Example:
Exhausting • Anticipate all possible answers that a
respondent may give
Example:
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 [TRANS] LESSON 1.2: STEPS IN CONDUCTING COMMUNITY DIAGNOSIS
Table No.7 Fixed Response and Open-Ended Questions
QUESTION DESCRIPTION
Fixed • Fixed response questions provide choices
Response the respondent will select from, the choice
will serve as categories for collating the
responses
• Data collectors use flashcards to help the
respondent choose his answer – this is useful
when dealing with young respondents or
respondents whose levels of education are
limited
• Flashcards are assigned number or letters
corresponding to a specific category of
choice, respondent will just call out or point
to the letter of number that match with the
response
Open- • Does not provide choices or categories
Ended • Categories are only constructed after data
collection is over
• Categories are constructed from response
in randomly selected questionnaires
• After categorizing the response, data will be summarized.
o There are two ways to summarize date:
▪ Manually tallying the data
▪ Tallying using the computer
• Tallying involves entering the responses into prepared tally
sheets showing all possible responses.
• When computers are going to be used in summarizing results,
a coding manual is needed where the responses are given
numbers or codes,
o Using software such as EPIINFO, the responses are
inputted into the computer for tallying
▪ Not all information can be tallied, thus, that
information has to be enumerated
DATA PRESENTATION
• Data presentation will depend largely on the type of data
obtained.
o Descriptive data – presented in narrative reports.
Examples of data appropriate for descriptive
presentation are geographic data, history of a
place or beliefs regarding illness and death
o 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.
Table No.8 Types of Graphs
GRAPHS DESCRIPTION
Line Graph Shows data trend or change sin data
with time or age with respect to some
other variable
Bar Graph or For comparison of absolute or relative
Pictograph counts and rates between categories
Histogram or Graphic presentation of frequency
Frequency Polygon distribution or measurement
Proportional or Shows breakdown of a group or total
Component Bar where the number of categories is not
Graph or Pie Chart too many
Scattered Diagram Correlation data for 2 variables
• It has to be presented to the whole community because we
want to inform them about the result of the survey and
validate whether our understanding of the result of the survey
is the same with what they experiencing
DATA ANALYSIS
• Most crucial stage in community diagnosis
• Involves quantification, description, and classification of
data
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• Triangulation – data are sorted, classified in terms of
relatedness, and interpreted for any significance or
implication; this aims to establish trends and pattern sin terms
of health needs and problems of the community
o Pattern in terms of human relations, time, and
space help the nurse view and analyze which are
indicators o health problems and which factors give
rise to health problems
o Magnitude and extent of the problem and their
implication can be derived by comparing them
with standard values or norms
• Data analysis should be done not only by the nurse or the
conducting the community diagnosis.
o It seems unthinkable that the entire community
should be present during the data analysis, but it
can be done.
o It may not be the entire population but
representatives of the sectors that comprise the
community.
• Nurse and the team should encourage the people to give
opinions, comments and reactions or seek clarification in
what and how the others viewed the data.
• Facilitate the discussion in order to deepen the analysis by
posing questions such as:
1. How are the main or central issues related to one
another
2. Which of the problems seem to be the most serious
or needing urgent attention?
3. Among the roots of the problem, which are the
easiest to address? Which are the most difficult?
4. Which of the effects should not be allowed to
continue?
5. What could possibly happen if nothing is done?
6. What should be done?
• We must be able to relate one variable to another
• After analyzing, we need to synthesize by combing all the
related information until it can lead us to identify the
community nursing problems
IDENTIFYING THE COMMUNITY HEALTH NURSING PROBLEMS
• Data analysis should lead the nurse and the team to have a
better grasp if the community’s health situation
• Defining the community health nursing problems will help the
nurse and the team to decide with the people what actions
will effectively address and improve community’s health
Table No.9 Community Health Nursing Problems
PROBLEMS DESCRIPTION
Health Status Described in terms of increased or
decreased morbidity, mortality, fertility or
reduced capability for wellness
Health Described in terms of lack of or absence of
Resources manpower, money, materials or institutions
necessary to solve health problems
Health-Related Described in terms of existence of social
economic, environmental and political
factors that aggravate the illness-inducing
situations in the community
PRIORITY SETTING
• After the problems have been identifies, the next task for the
nurse and the community is to prioritize which health
problems can be attended to considering available
resources, limitations and constraints.
Table No.10 Criteria
CRITERIA DESCRIPTION
Nature of the Problems are classified as health status,
Condition/Problem health resources or health-related
Presented problems
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 [TRANS] LESSON 1.2: STEPS IN CONDUCTING COMMUNITY DIAGNOSIS
Magnitude of the Refers to the severity of the problem Preventive Refers to the probability of controlling or
Problem which can be measured in terms of the Potential reducing the effects posed by the
proportion of the population affected by problem
the problem Social Concern Refers to the perception of the
Modifiability of the Refers to the probability of reducing, population or the community as they are
Problem controlling or eradicating the problem affected by the problem and their
readiness to the act on the problem

Table No.10.2 Prioritizing the Health Condition/Problems: Scoring System

CRITERIA SCORE WEIGHT
Nature of the Problem
 Health status 3
1
 Health resource 2
 Health-related 1
Magnitude of the Problems
 Affects 75-100% of the population 4
 Affects 50-74% of the population 3 3
 Affects 25-49% of the population 2
 Affects less than 25% of the population 1
Modifiability of the Problem
 High 3
 Moderate 2 4
 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 a problem but not needing immediate action 1
 Not a community concern 0
Table 10.2 shows the scoring system which the nurse can use to prioritize health conditions/problems. Each problem will be scored
according to each criterion and divided by the highest possible score multiplied by the weight. Then the final score for each criterion
will be added to give the total score for the problem. The problem with the highest total score is given high priority by the nurse.

REFERENCES

Notes from the discussion by Prof. Katherine Vera Santos-Lucas,

MAN, RN

Book Reference:

Manila Doctors Colleges of Nursing PowerPoint Presentation

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[TRANS] LESSON 1.2: STEPS IN CONDUCTING COMMUNITY DIAGNOSIS

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