1. COMMUNITY ASSESSMENT Prepared By: Marjorie E Ming MPH, Cert. Nsg. Ed. RHV, RN, RM Nurse Educator Nurse Educator

2. OBJECTIVES On completion of this teaching session participants will be able to : 1.Define the term Community Assessment 2.Explain the various Methods & Tools used to assess a Community 3.Utilize various sources of data including:  Family, group & environmental information  Demographic, political & socio-economic information  Bio-psychosocial information  Information about the economy & industry

3. OBJECTIVES contd.  Information about housing, water, sanitation & recreational facilities  Information about religion, beliefs & customs  Information about health laws & the availability of health services 4. Explain how the Data on housing, utilities & environment impact on Community Health 5. Utilize the Nursing Process to assess a Community

4. Community Assessment The process by which we 1.Determine values, characteristics and or factors within the community and the people which influence community health 2.Establishment of data base regarding a community’s health status, which is essential for planning and delivering health and health related services (Ming 1997)

5. Methods & Tools used for Community Assessment Community health needs maybe assessed through a variety of methods. The assessment method used varies depending upon the reasons for data collection, the goals and objectives of the study and available resources. It will also vary according to the theoretical frame work used.

6. Methods & Tools used for Community Assessment contd. 1. Observation – enables the nurse to familiarize herself with the community and to gain first hand evidence of any health problems occurring there. Simple observation can highlight problems of housing, sanitation and other environmental problems. 2. Interviewing of selected community members e.g. leaders, government and school officials and residents is another data gathering tool.

7. 3. Review of Records can also yield pertinent data about the community 4. Door to Door Survey – can be used to determine health service utilization patterns, immunization levels, demographic characteristics and health beliefs and practices 5. A Descriptive Epidemiological Study – an important methodology used for particular problem oriented needs assessment

8. Surveys Surveys are the most commonly used because  They provide a broad range of data  They are helpful when used in combination with other sources of data collection  They are valuable when other sources are not available  The survey method involves 9 steps which ensure an adequate design and appropriate collection of data (Dever 1980 p 147 in Walton Spradley 1990)

9. Steps in the Survey Method  Determine the Objectives – what information is needed; why is the information needed; how accurate does it need to be  Define the Study Population – what groups will be studied; what are their distinguishing characteristics e.g. age, occupation, location  Determine Data to be collected – what specific data i.e. behaviour, opinions, beliefs, what sources will provide the data; how will data be measured

10. Steps in the Survey Method contd.  Select Sampling Unit – individuals, households, a district, city block; state the sample size and select sampling method most appropriate and feasible  Select Contact Method – what type of data gathering tool or instrument, interview schedule (telephone or face to face), questionnaires Will any type of organization or facilities (e.g. businesses be omitted)  Develop instrument i.e. questionnaire or interview schedule or guide

11. Steps in the Survey Method contd.  Organize & Conduct the Survey – identify and train data collectors or interviewers. Preset and adjust instrument; supervise data collection process; plan to deal with non-responses or refusals  Process & Analyse Data – code, tabulate, apply appropriate statistical methods as indicated. Determine relationships and significance  Report the Results after Documenting indicating implications & recommendations

12. Purpose of Community Assessment  To compile data or information about a community’s health status from which nursing diagnosis are derived  To gain accurate assessment which forms the basis of any community endeavour and is essential to the planning of any programme designed to meet health or health related needs.

13. Purpose of Community Assessment contd.  Provides a health index for the community A summary of the health features of a community that enables us to determine health care delivery needs. A clear picture of needs helps to determine whether health care systems are meeting those needs or whether more services or adjustment to those in place are required  An important pre-requisite for effective programme planning

14. Type of Data Required will provide information about 1.The current health status and level of vulnerability of the community 2.Health capabilities of the community 3.Community action potential These can further be categorized into 6 basic classifications

15. Classification A general description of the community - See location of the community, its size and density, type of community, topography and climate. Relevant history of the community Patterns of population change, government structure and distribution of power

16. Classification contd. Population Characteristics attributes of members of the community includes the age, composition of the population, sex distribution, race and language representation, income levels, education levels, marital status and typical family composition

17. Classification contd. Environmental Characteristics/ Factors - man is essentially dependent on his environment. Environmental factors are major determinants of health and includes  Housing – related to quality of life i.e. overcrowding contributes to diseases, increase rate of crime, fires, emotional and social problems (Cassell 1974 in Dunner Clark 1984)  Sources of water supply  Waste disposal

18. Environmental Factors contd.  Protective services (fire, police)  Legal services  Consumer protection services  Accessibility to transportation  Health services  Education facilities  Communication systems  Recreation

19. Classification contd. Health Status Indicators  Biostatistics  Health promotion indicators  Availability of health services and resources  Financing of health services Obtained through the collection and analysis of vital statistics which provide indication of health and illness patterns e.g. birth, morbidity and mortality rates including specific rates, age, cause. Analysis of statistical rates provide a partial picture of the health status of the community.

20. Classification contd. Attitude towards Health  Reflected in funding of health care services  Adequate budget indicates priority consideration  Community’s definition of health, illness and the relative value placed on wellness  Community orientation to acute episodic health care or health promotion and illness prevention

21. Classification contd. Community relation with the outside world/greater society  How autonomous is the community?  Is the community self sufficient: how accessible are goods and services?  Transportation system  Level of isolation geographically or socially  Communication systems  Class structure  Types of occupations

22. Sources of Data  Records – medical; police  Vital Statistics  Census  Libraries  Surveys  Research Findings  Epidemiologic Data  Professional Views  Local Historian; Informant (village Lawyer)  Public Views: informal discussion/interviews  Local Media: point in time picture