Professional Documents
Culture Documents
Contents
Introduction Definition Goal Importance of community diagnosis Contents of community diagnosis Process of community diagnosis Comparision patient diagnosis and community diagnosis
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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.
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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.
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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.
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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.
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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
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Goals
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
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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.
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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 peoples problems towards the light of solution.
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Cont
2. Aspects that cant be measured (soft facts): customs Beliefs Taboos Attitudes Values towards various situations.
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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,
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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.
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Cont
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.
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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.
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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.
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Cont
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
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.
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Health indicators
Indicators of health are variables used for the assessment of community health.
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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,
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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.
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Mortality indicators Morbidity indicators Disability rates Nutritional status indicators Health care delivery indicators Utilization rates
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Cont
Indicators of social and mental health Environmental indicators Socio-economic indicators Health policy indicators Indicators of quality of life Other indicators
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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
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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
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Disability Indicators
Disability rates
Nutritional Indicators
Anthropometrics measurements
Height of children at school entry Prevalence of low birth weight Clinical surveys: Anemia, Hypothyroidism, Nightblindness
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Utilization Indicators
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
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Suicide & Homicide rates Road traffic accidents Alcohol and drug abuse.
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Environmental Indicators
Measures of Pollution
The proportion of people having access to safe water and sanitation facilities Vectors density
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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
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Other Indicators
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4. Dissemination
groups and the general public Press release Thematic events (such as health fairs and other health promotion programmes).
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There are a number of SIMILARITIES between patient diagnosis and community diagnosis. These are listed below :-
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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 .
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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
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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
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