COMMUNITY DIAGNOSIS -1.pptx

Community diagnosis topic enabling members of the community to be aware of health issues affecting them

1. COMMUNITY DIAGNOSIS BCM 128

2. Community is a cluster of people with at least one common characteristic (geographic location, occupation, ethnicity, housing condition……) A group of people with a common characteristic or interest living together within a larger society. A community is a whole entity that functions because of the interdependence of its parts or subsystems. Eight subsystems plus the community core are identified.

3. Community core : Includes the following: history, socio-demographic characteristics, vital statistics, values/beliefs/religions. Eight subsystems: includes: Physical environment Education Safety and transportation Politics and government Health and social services Communication Economics recreation

4. Community Diagnosis 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. It is a systematic process in which Health workers together with the community members determine health problems & needs of the community. It is a problem solving technique & tries to answer the following questions;

5. Cont’ 1. What are the most pressing health problems & needs in the community? 2. What is the extend of the disease burden hence look at the commonest diseases. 3,.Who are the most affected in terms of certain characteristics or variables e.g. age, sex, occupation & social economic status 4. Where are the problems & the diseases mostly found in terms of Geographical distribution & environment? 5. When did the problems occur to see the pattern of the disease occurrence & act early before it occurs again hence take appropriate action. 6. Look at the seasonal variations hence do the problems/ diseases occur when it is hot or cold. 7. Is there a pattern of disease occurrence

6. Cont’ 8. Why do these problems/ diseases occur? 9. What are the causative factors for proper intervention eg is it water bone, vector etc 10. Are there some predisposing factors to the problems 11. Look at the factors that worsen the problem/ condition or situations. 12. What is currently being done by the community & health workers in regard to the existing problem/condition/ situation , If it is positive then encourage it, but if it is negative then intervene from that point.

7. AREAS OF INTEREST IN COMMUNITY DIAGNOSIS OR PURPOSE OF COMMUNITY DIAGNOSIS 1, Social Demographic Characteristics; - These are variable or characteristics that have an influence/ relationship with health status e.g. age, sex, occupation. - In community diagnosis, the unit of study is a household where people eat & share things under one roof. - In the house hold , find out the head of the house hold, marital status, age, sex, religion, family size, economic status to include occupation & education.

8. CONT…………………………… 2, Environment & physical infrastructure. Look at the sanitation hence refuse disposal, human waste, sewage disposal , water sources, methods of water treatment & purification & adequacy of water. - Infrastructure hence look at the type of housing, whether temporary, semi-permanent or permanent, type of ventilation & lighting. - Number of health facilities, no of schools to determine their literacy levels. - Number of recreational facilities & type of roads.

9. Cont’ 3, Nutrition - Determine the foods available, food habits & food taboos, nutritional values & believes affecting the health of the individual family members. - Identify common nutritional problems e.g. malnutrition, obesity, marasmus, kwashiorkor or PEM. - Identify weaning habits & child feeding practices. - Examine the preparation, storage & preservation of the food.

10. Cont’ 4, Health Status of Women. - Look at the believes & practices in regards to pregnancy, child birth, postpartum period & diet for lactating mothers. - Identify knowledge, attitudes & practices in regards to Family Planning. - Identify level of utilization of MCH services.

11. Cont’ 5 , Health of Infants, Children & Adolescents; - Identify the existing child care practices. - Determine the growth & development pattern. a, Growth monitoring using road to cards hence C - Child H - Health A - And N - Nutrition I - Information S - Systems b, Anthropometric measures hence Age of the baby against the body weight to know if the baby is under or overweight - Height against the body weight to rule out wasting - Age against height hence for stunted growth - Upper Mid Arm circumference to rule out Malnutrition, obesity, PEM. - Head circumference

12. Cont’ c, Developmental milestones; - This is to know the development of the baby d, Immunization Status; - Overall immunization coverage if fully, partially & tally in the CWC & in the permanent Immunization Register. - Determine factors leading to low immunization coverage.

13. Cont’ e, Adolescents - Identify problems related to the adolescents eg teenage pregnancy, drugs, school dropouts, early marriages. - Identify existing community services focusing on the youth like youth clubs, groups & youth friendly services. - Identify any voluntary activities that are there to occupy them. - Recreational facilities eg games where they direct their energies.

14. Cont’ 6, Common community Problems or Diseases; - Examine/identify the top ten common diseases from community members from the health records. - Interview the community members on their pressing problems or diseases. - Find out what they know about their problems or diseases.

15. Cont’ 7, Assess the problems associated to special groups of people in the community; - These special groups include the physically challenged, visually, mentally challenged & the elderly. - Identify existing facilities for special care to these people. Examine the referral system in case of other illness or further care for these people. Determine the knowledge, attitude & practices of the people in relation to certain diseases eg HIV/AIDS, TB, Epilepsy, Leprosy etc.

16. PROCESS OF COMMUNITY DIAGNOSIS “A means of examining aggregate and social statistics in addition to the knowledge of the local situation, in order to determine the health needs of the community” The mission of community diagnosis is to: 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 baseline for measuring improvement over time.

17. Community analysis is the process of examining data to define needs strengths, barriers, opportunities, readiness, and resources. The product of analysis is the “community profile”. To analyze assessment data is helpful to categorize the data. This may be done as following: Demographic Environmental Socioeconomic Health resources and services Health policies Study of target groups.

18. community is diagnosed using health indicators. Indicators of health are variables used for the assessment of community health. Characteristics of health indicators includes : a. should be valid , i.e., they should actually measure what they are supposed to measure; b. should be reliable and objective , i.e., the answers should be the same if measured by different people in similar circumstances; c. should be sensitive , i.e., they should be sensitive to changes in the situation concerned,

19. d. should be specific , i.e., they should reflect changes only in the situation concerned, e. should be feasible , i.e., they should have the ability to obtain data needed, and; f. should be relevant , i.e., they should contribute to the understanding of the phenomenon of interest.

20. THE STEPS/PROCESS OF COMMUNITY DIAGNOSIS 1, Exploration of the community inventory 2, Planning for the survey or Community Diagnosis 3, Training of data collectors/ interviewers 4, Pretesting of the tools 5, Reworking/reformulation of the tool 6, Implementation/execution of the study 7, Data entry, cleaning & analysis 8, Compilation of the report 9, Feedback to the stakeholders 10, Carry out a community health action.

21. Exploration of the community inventory - This is the first step where the team meets with the government officials/leaders or community leaders to brief them on the purpose of the exercise hence to seek for clearance since they are the gate keepers of the community. - After accepting they assist in creating awareness about the survey through a chief’s baraza or a community meeting. - If meeting had taken place the chief provides people to introduce you to the house holds. - The community will be briefed about the purpose of the survey so as to gain your co-operation. - General information of the area e.g. schools, health facilities, recreational facilities & generally the geography of the area hence baseline data ( mapping )

22. Cont’ - Take a walk within the location & do your own personal observation. - Examine the census record - Examine the Health facility records to determine the nature of the disease burden. - The purpose of this is to obtain baseline information which is important in planning the survey.

23. Planning for the Survey - Specific objectives for the study or survey. S - Specific M - Measurable A - Attainable R - Realistic T - Time bound - Who is to be interviewed in order to give you general information of the community? - What will be a representative sample in order to be able to generalize the findings? - How long will the study take, it should take the shortest time possible hence 2 weeks to avoid disrupting the community /interfering with the daily routine.

24. CONT…………………. - What methods will be used to collect data e.g. participant observation, interviewing by asking questions, physical examinations, laboratory investigations, the scrutinizing the records. - Determine the tool for data collection & then you formulate or design the tool e.g. questionaire, interview schedule, checklist, focused group discussion ( FGD ) which should comprise people ( 5-15 ) with same characteristics, should share same information e.g. CHW & record the information.

25. Training of data collectors This is the training of everybody who will be involved in the data collection on the expectation of the survey, following ethical considerations of the research. - In case of interpreters, their role should be well defined. - Pretest with them on the interpretations. - Go with them through each question - One can as well collect the data alone.

26. Pretesting the Tools Reason for pretesting 1, Validity – Is the tool able to gather the information its intended to gather. 2, Reliability – The ability of the tool to have consistent results 3, Precision – accurate results e.g. age 0-2yrs, 3-5yrs - Its important to pretest the tools to be used with individuals who have the same characteristics like the study population. - Its done before the actual data collection exercise.

27. Cont………………………… - The purpose is to determine the faults or weaknesses in the tool. - To determine the validity of the tool hence the ability of the tool to gather information its intended to cover. - To determine reliability of the tool - the ability of the tool to give consistent results even if the tool is used on a different site or elsewhere. - To determine precision – the ability of the tool to give accurate results

28. Reworking or reformulation of the tool - The purpose of this step is to make corrections on the tool when necessary to validate the tool - Also produce enough copies of the tool depending on the sample size

29. Implementation/ execution of the study - The actual home visit is done & the purpose is to collect the data. - The community members should know when this exercise is being carried out to ensure their presence in their homes & participate in offering the data required.

30. Data entry, cleaning & analysis - Data entry involves organization of the data, grouping & categorization of the data - Data analysis means making meaning of the data collected.

31. Compilation of the report - This is basically report writing by the researcher for further necessary action to be taken. - The report is based on the findings of the study.

32. Give out feedback to the stakeholders - This could be the community itself. - Start the report with the positive points then move to the negative points. - The district health management team(DHMT) should also be given the report. - If the exercise/community diagnosis was funded, the donor should also be given a copy of the report.

33. Carry out a Community Health Action - This is providing health services to the community based on the problems identified during the study. - Its normally in two fold: Short Term Action Long Term Action .

34. Cont………………. Short Term Action - Conduct outreach services, provide curative service e.g. issue drugs hence for coughs, colds, antimalarials etc, carry out preventive services e.g. immunization. - Carry out promotive services e.g. health education, sharing health messages, nutritional demonstrations etc.

35. Cont………………………… Long Term Activities - These are activities to combat health problems but need Involvement by the local leaders or politicians e.g. in case of shortage of water, there is need to mobilize the community to sink boreholes to harvest rain water, build schools, hospitals, tarmac roads etc.

36. Evaluation - This is taking stock or checking whether a positive health change has been achieved. - If positive continue embarking on it but if negative think of other options to embrace a positive change to the existing health problem.

37. SAMPLING METHODS IN COMMUNITY DIAGNOSIS - The best methods to use include; Probability Sampling Methods Simple random Systematic random. Cluster. Multistage. Stratified.

38. Cont………………………….. Non Probability Sampling Methods Purposive. Convenience. Snow balling. Expert. Quota sampling.

39. METHODS OF DATA PRESENTATION IN COMMUNITY DIAGNOSIS Narrative way. Tabular method. simple. compound complex. Chart method by use of the following. histograms. bar charts. pie charts. frequency polygons. graphs.

40. TYPES OF FEEDBACK /STEPS IN COMMUNITY DIAGNOSIS FEEDBACK Individual Results. Preliminary Reports. Non-Medical Reports. Medical Reports.

41. INDIVIDUAL RESULTS - This report is given to the subjects who form part of the survey sample or those who provide specimens e.g. stool or those whose any other tests were taken from. - Incase anything abnormal is found you treat immediately according to the results. - Refer where appropriate if you cannot manage/treat at that point. - Inform the MOH about any specific notifiable diseases.

42. PRELIMINARY REPORT Given to the community & the purpose is to thank them for their co-operation & increase their awareness on their real health needs & how they can be solved. This report is given immediately after completion of their field work. Its given in Chiefs Baraza, women groups, youth groups, in schools etc.

43. cont……………………………. . - Type of report is just preliminary with minimal details, general & not specific. - Content of the report is based on obvious points eg disease outbreak, hygiene, sanitation, attitudes of the community on health services, nutrition, practices & utilization of Health Services.

44. NON MEDICAL REPORT This is given to the non-medical people e.g. politicians. Its given after analysis, conclusions & recommendations of the survey. Its importance is that its message can influence social & political leaders to start doing something about improving the health of the population.

45. MEDICAL OR COMMUNITY DIAGNOSIS REPORT . - It is a detailed Scientific report which provides an account of the planning & execution of the survey as well as the result. - It has the data collected & accurate interpretation of the analysis. - This report is given in seminars & workshops. Reasons for Community Diagnosis/Survey. Specific findings which help to define the situation. Conclusions & recommendations that are of practical significance.

46. CONTENT OF THE MEDICAL REPORT A title which should be short, simple & informative . - It gives the reader information about the survey conducted. Table of Content. - This helps the reader access various sections of the survey report quickly & easily. List of Tables & Figures. - This gives a list of the tables & figures used in the report & their corresponding page number.

47. Cont’ List of Abbreviations & acronyms; - List of all the abbreviations & acronyms used in the explanation with a full explanation of what they stand for. Definition of Terms; - Give a full description of the medical terms used.

48. CONT………………………… Acknowledgement. Acknowledge all those who made it possible for you to accomplish the task & the role played e.g. names of individuals, organizations, institutions, administration, community etc. Introduction or background information. - Give the background of the study, purpose of the study, study questions, main & specific objectives.

49. CONT………………….. Materials/ Methods -Describe the survey design, instruments, tools for data collection. - Sources of data e.g. records hence where you got them from e.g. hospital facility, if from people you describe the characteristics of those people & the village they come from. - Selection & training of the interviewers, sampling procedures & sample size.

50. CONT…………………. Limitations - These are based on honesty & openness in admitting difficulties. - Purpose is to help other researchers not to make some mistakes that you made; - Common difficulties include; Sampling methods Standardization of tests & measurements Observation Variation Incomplete records due to poor supervision Inaccessibility to the target population Time factor.

51. CONT…………………….. Results - This is presentation of the results in any format e.g. Narrative Table or tabular method hence simple, compound, complex. Chart presentation e.g. bar graphs, histograms, pie chart, frequency polygons.

52. Cont…………………………. Discussions This is data interpretation in logical thinking, judgment & use of common questions to ask how reliable & valid the observations are. Is there any association between variables which may indicate a casual of relationship & compare the results with other studies done on the same topic.

53. Cont…………………………… Conclusions. - This is a brief summary of the main findings. - Conclusions are related to specific objectives. Recommendations -This is saying what another person or researcher should do on the same topic that you did not finish.

54. Cont……………………… List of references - This is any material that you access to or Bibliography.

55. Cont………………………. Appendices /Annexes e.g. Appendix i is Annex i Appendix ii is Annex ii Hence pictures of the study you are doing Map of Kenya Map of province Map of location Letter of Authority Data collection tool Photographs of the study - They are attachments to the report to help the reader understand some statements appearing in the body report. - Examples are annexes or appendixes as above.

56. REQUIREMENTS FOR COMMUNITY ENTRY BEFORE DATA COLLECTION - Tool for data collection that focuses on areas of interest. - Create awareness to the community members about the survey, purpose & benefits so as to gain their co-operation. - Need an identification letter from the institution or sponsor. - Letter of Authority from the local administration though at times it can be given oral permission & people to take you round. - Map of the area.