Community Health Diagnosis (CHD): Meaning, Definition, Purpose/Objectives and Importance of CHD in Relation to Public Health 

Community Health Diagnosis (CHD)

Community

The word “community” is derived from Latin and has been used in the English language since the 14th century. The word community is derived from the Latin communitas (meaning the same), which is in term derived from communis, which means “common, public, shared by all or many.”

A community is a group of people living in the same place or having a particular characteristic in common such as norms, religion, values or sense of identity.

“A community is a social group determined by geographical boundaries and/or common values and interests. Its members know and interact with each other. It functions within a particular social structure and exhibits and creates certain norms, values and social institutions. The individual belongs to the broader society through his family and society”. -WHO

Characteristics of community

1. Distinctiveness: Having defined geographical boundaries.
2. Homogeneity: Similarity in psychosocial characteristics like language, lifestyle, customs, interests, traditions etc.
3. Closeness: Have face-to-face interaction and free communication.
4. Self-sufficiency: There is a practice of mutual support and resource sharing that helps in community self-sufficiency.
5. Solidarity or sense of togetherness: There is unity and cohesiveness among the members in the community
6. Others:

• Social unit
• Group of people
• Locality/Territory
• Sense of belongingness
• Naturality
• Shared values and common interest
• Social institutions
• Common responsibility

Concept of CHD

• The concept of community health diagnosis has evolved since 'World War II' from two major health disciplines, 'Public Health and Nursing'.
• The term 'community diagnosis' was originally used in the 1950s by physicians (Logan 1964).
• The current understanding of CHD is mainly derived from the works of Freeman (1970) and Hogue (1977).
• L.W. Green and M. Krueter’s work in the PRECEDE-PROCEED model added the component “social diagnosis which further highlighted the importance of community diagnosis
• WHO published a book in 1982 named “Handbook for Community Health Workers in Developing Countries” that discussed the concept of community diagnosis.
• In 1980, Dever introduced the community model which contributed to community diagnosis
• In 1988, Haglund wrote a manual on community diagnosis in a Swedish context.
  

In Nepal

In Nepal, the Institute of Medicine (IOM), TU started a community-oriented course In 1984, the Bachelor of Public Health course that included community diagnosis Now, community diagnosis has been a part of major health-related academic courses like public health, nursing and medical students.

Meaning of CHD

Community health encompasses the total well-being of a group of people occupying a particular geographical location; eliminating disease, poverty of the mind and establishing an atmosphere for good living meeting all their basic needs in live like light, water, good road, food and shelter.

Assessment and diagnosis:

• Assessment: refers to data collection and analysis which is the first part of the diagnostic process.
• Diagnosis: uses assessment as the basis for decision-making, and labeling that clearly and concisely describes a problem and implies its etiology.
  

Definition of CHD

• "Community diagnosis is a comprehensive assessment of the state of an entire community in relation to its economic, social, physical & biological environment. Community health diagnosis is a process or examining the pattern of disease in the community & describing it in terms of its importance factors. Such as population situation morbidity, mortality, fertility rate disease providence in the community/country”.
• “Community health diagnosis is a process or examining the pattern of disease in the community in order to promote health, prevent disease and manage health services for the community”. Health status of a community is related not only to health technology but to non-health factors. The cultural, physical, environmental & behavioural factors have also an important role in determining whether people are healthy or not.
• According to WHO 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”.
  

Community diagnosis has evolved independently from 3 basic traditions that follow different paradigms:

• Medical science approach;
• Health planning approach; and
• Community development approach

Purpose of CHD

CHD is to define existing problems, determine available resources & set priorities for planning, implementation & evaluating health action by and for the community.

1. To determine the magnitude of community health problems and the factors affecting these problems.
2. To fix priorities for health problems.
3. To effective health intervention programme.
4. To explore existing resources.

Objectives of CHD

General Objective:

To assess the health status of a community, find out the factors associated with major health problems and solve the prioritized health problems with available resources in the community by conducting a micro health project (MHP).

Specific Objectives

• To find out the demographic, geographic, socio-economic and cultural status of the community.
• To assess the environmental conditions in the community.
• To determine the nutritional status of children under 5 years old in the community.
• To evaluate the maternal health status.
• To calculate the mortality, morbidity, and disability rates in the community.
• To identify common health issues affecting the community.
• To assess the knowledge, attitudes, and practices related to common health problems.
• To examine the healthcare-seeking behaviour of the community members.
• To categorize the identified problems as either felt or observed needs.
• To explore the existing and potential resources available.
• To prioritize the needs/problems in collaboration with the community.
• To effectively plan, implement, and evaluate a micro health project within the community.

Importance of CHD

• It helps to assess the health status, resources, and vulnerability of a community or population and its sub-groups
• It helps to identify the social and environmental factors associated with that health status i.e. patterns of health-illness relationships
• It helps to assess and set priorities for health goals and intervention
• It helps people to be aware of the reasons for health problems
• It helps to realize their real health needs
• It helps to prioritize the problems and make intelligent use of resources
• It carefully explores hidden health problems
• It helps to find underprivileged people who are in particular need of health and education.

Components of CHD

1. General profile of the community consisting of physical characteristics, health-related infrastructures, sociodemographic composition of the population
2. Statuses and causes of health risk factors, morbidity and mortality by age and sex
3. Knowledge, attitude and practices of people regarding health and diseases, promotion of health, prevention of health risk factors, injuries and disease, protection of health through the immune system, control of the spread of health risk factors and disease, early detection, treatment and compliance to treatment
4. Nutritional status; basic food habits, diet and weaning practices and breast-feeding practices
5. Environmental health situations like housing, water and sanitation, waste management, vectors of diseases
6. Child health, adolescent health, reproductive health, family planning, occupational health communicable and non-communicable diseases, immunization and health risk behaviours, etc.
7. Cultural patterns and practices of a community related to health and disease.
8. Availability, accessibility and utilization of public health services (including intervention services) especially maternal and child health services
9. Availability of government and non-government health and extra health sector community resources for health development including agriculture, education veterinary and social services
10. Social stratification: existing diversities and discrimination and their effects on health and disease statuses
11. Community power structure and participation styles in health development programs
    

Difference Between Community Health Diagnosis And Clinical Diagnosis

Methods of Community Health Diagnosis

a. Quantitative methods

• Household survey (questionnaire survey)
• Secondary data review

b. Qualitative methods:

• PRA/PLA
• Focus group discussion (FGD)
• Key Informant Interviews (KII)
• Participant observation
  

Process of CHD

The process of community diagnosis requires careful planning right from the beginning. The process of community health diagnosis involves an initial phase of community exploration, followed by subsequent steps.

1. Exploration of community for CHD
2. Selection of particular community for CHD
3. Setting objectives of CHD
4. Development of CHD tools
5. Pretesting and finalizing of CHD tools
6. Entering into and understanding the community
7. Organizing community groups
8. Planning for community diagnostic survey: household sampling
9. Executing the survey
10. Analyzing and interpreting the data: qualitative and quantitative data management
11. Prioritizing health problems (needs)
12. Findings presentation in the community including techniques of data presentation
13. Recommendations for public health intervention plan and implementation
14. Report writing and submission 

Community Health Profile

A community health profile is a comprehensive and systematic overview of the health status, health determinants, and health resources within a specific community or geographic area.

Key components of a community health profile may include:

1. Demographics: Information about the population, including age distribution, gender, ethnicity, socioeconomic status, and other relevant demographic factors.
2. Health Indicators: Data on key health outcomes and measures, such as mortality rates, morbidity rates, prevalence of specific diseases, and other health-related statistics.
3. Health Determinants: Factors that influence health, including lifestyle behaviours, social determinants of health (such as education, employment, and housing), environmental factors, and access to healthcare services.
4. Healthcare Infrastructure: Details about the availability and accessibility of healthcare facilities, primary care providers, hospitals, and other health services in the community.
5. Public Health Programs and Interventions: Information on ongoing public health initiatives, interventions, and programs aimed at addressing specific health issues within the community.
6. Community Assets and Resources: Identification of community strengths, assets, and resources that can be leveraged to improve health outcomes.
7. Challenges and Barriers: Identification of health disparities, challenges, and barriers that may impede access to healthcare or contribute to poor health outcomes.
   

Different between Community Health Diagnosis and Health Profile

MCQs on Community Health Diagnosis 

1. "Community health diagnosis is a community-based practice." Which best explains this statement?

A. The service is provided in the natural environment of people

B. The health worker has to conduct community diagnosis to determine health needs and problems

C. The service are based on the available resources vain the community

D. Priority setting is based on the magnitude of health problem identified

2. ….…is a comprehensive assessment of the state of an entire community in relation to its physical, social and biological environment.

A. Epidemiology

B. Community organization

C. Community Diagnosis

D. Community participation

3. Community Health Diagnosis better indicates the:

A. Diagnosis of community health resource

B. Comprehensive assessment of a community

C. Study of distribution and determinants of disease in the community

D. None of the above

4. An approach which helps to identify problems, proposes areas for improvement and stimulate action is called:

A. Epidemiology

B. Community medicine

C. Community participation

D. Community diagnosis

5. Correct statement regarding community diagnosis is:

A. Comprehensive assessment of health status of nation

B. Comprehensive assessment of health status of community and define existing problem

C. Comprehensive assessment of health problem and make plan

D. Comprehensive assessment of health situation and report to higher center

6. The components of community diagnosis are all EXCEPT:

A. Local leaders

B. Local resources

C. National economic status

D. Population status of the community

7. The observed community health need refers:

A. Observed community health needs by health professionals and community

B. Observed community health needs by local leaders and health professional

C. Observed community health needs by local leaders

D. Observed community health needs by health professional

8. The primary source of information EXCEPT:

A. Observation

B. Health post-report

C. Focus group discussion

D. PRA

9. The sample survey means:

A. Households survey

B. Census

C. Some proportion of the total population

D. Both 'A' and 'B'

10. Lottery system is used:

A. Restricted sampling

B. Quota sampling

C. Non-probability sampling

D. Simple random sampling

11. The popular method/tools of community diagnosis is:

A. Household survey

B. RRA

C. PRA

D. All of the above

12. Health workers should know about:

A. Knowledge, concept and behaviour of community people

B. Knowledge, concept and behaviour of individuals of the community

C. Nature of the problem and causative factors

D. All of the above

13. When a researcher uses the data from another source just after the data is ready it is:

A. Primary data

B. Secondary data

C. First-hand data

D. Tertiary data

14. Which of the following is not an objective of community diagnosis?

A. To define existing problems and determine available resources

B. To specify those tasks, which are related to the community health

C. To specify the advanced health investigation facilities at the Health Post

D. To define health status

15. All of the following are the objectives of community diagnosis, EXCEPT:

A. To determine the health and demographic status

B. To study the determinants of health problem

C. To identify the causal organism of the disease

D. To prioritize the needs/problems

16. Which one of the following is not an objective of community health diagnosis?

A. To prepare the demographic profile of a community

B. To identify the community health problems

C. To prioritize community health problems

D. To conduct the medical camp in a community

17. The need perceived by the community itself is called as:

A. Real need

B. Felt need

C. Observed need

D. True need

18. Community Diagnosis is based on all the following EXCEPT:

A. Vital statistics

B. Incidence and prevalence

C. Health care delivery

D. Age and Sex distribution

19. What sorts of measurement is made in community diagnosis?

A. Morbidity

B. Mortality

C. Incidence

D. All of the above

20. What method of study to be used for community diagnosis?

A. Quantitative

B. Qualitative

C. Quantitative and qualitative

D. Non-observational

21. Which does not includes the tool of community diagnosis?

A. Questionnaire

B. Observation checklist

C. Interview guidelines

D. Health survey

22. PRA stands for:

A. Participant rural appraisal

B. Participatory rural appraisal

C. Participatory rural academy

D. Participant rural association

23. Choose the importance of health indicators:

A. To reflect changes in health over a time span

B. To diagnose community needs and perception

C. To project future

D. All of the above

24. All are the true statement about community diagnosis EXCEPT:

A. Treatment of disease

B. Described community

C. Pattern of disease

D. Influencing factors that cause disease

25. Methods of data processing as:

A. Analysis - coding - editing -tabulation

B. Coding - tabulation - editing- analysis

C. Editing - tabulation - coding - analysis

D. Editing - coding - tabulation - analysis - interpretation -presentation