TOOLS USED IN COMMUNITY DIAGNOSIS

Cristina G. Juan
 Tools in Community Diagnosis
1.DEMOGRAPHY
- The study of the characteristics of human populations size, composition and distribution in
space.
-helps the nurse find reasons or rationale why or how a particular population or group is
influenced by a variety of factors resulting in vulnerability to diseases.
SOURCES OF DEMOGRAPHIC DATA
• Census – official and periodic enumeration of population.
Two ways of assigning people when the census is being taken
a. de jure method – done when people are assigned to the place where they usually live
regardless of where they are at the time of the census.
b. de facto method – people are assigned to the place where they are physically present at
the time of the census regardless of their usual place of residence.
• Sample survey
• Registration system
 Components of Demography

POPULATION SIZE – number of people in a given place at a given time

Method of Measuring Population Size

• Determine increase in the popu lation resulting from excess of birth
compared to deaths.
Nutural increase = Number of births – Number of deaths
(specified year) (specified year) (specified year)

Rate of Natural Increase = Crude Birth Rate – Crude Death Rate

(specified year) (specified year) (specified year)
 a. Determine the increase in the population using data obtained during two census periods.
• Absolute increase per year measures the number of people that are added to the population per
year.

Absolute per year = Pt – Po

T
where : Pt = population size at the later time
Po = population size at an earlier time
t = number of years between time o and time t

Relative increase is the actual difference between the two census counts expressed in percent relative
to the population size made during an earlier census.

Relative increase = Pt - Po
Po
where: Pt = population size at a later time
Po = population size at an earlier time
2.POPULATION COMPOSITION – described in terms of its age
and sex.
a. Sex Composition – the sex ratio compares the number of
males to the number of females in the
population.

Sex Ratio = number of males

Number of females

The sex ratio represents the number of males for every 100
female in the population.
b. Age Composition population into two equal parts.
1. Median age
2. Dependency Ratio compares the number of economically
dependent (0-14 and 65 and above age groups) with the
economically productive group ( within 15-64 age group) in the
population. The dependency ratio represents the number of
economically dependent for every 100 economically productive.
c. Age and Sex Composition
- Can be described at the same time using a population pyramid.
It is a graphical
presentation of the age and sex composition of the population.
POPULATION DISTRIBUTION
• Urban-Rural Distribution - illustrates the proportion of the
people living in urban compared to the rural areas.
• Crowding Index – described by dividing the number of
persons in a household with the number of rooms used by
the for sleeping.
• Population Density – will determine how congested a place is
and has implications in terms of adequacy of basic health
services present in the community.
Divide the number of people living in a given land area.
2. VITAL STATISTICS
- are the information maintained by a
government, recording the birth and death of
individuals within that government's
jurisdiction. These data are used by
public health programs to evaluate how
effective their programs are.
- use to determine health status
3. EPIDEMIOLOGY
- the study of the occurrence and distribution of health
conditions such as disease, death, deformities or
disabilities on human populations.
- also concerned with the study of probable factors
that influence the development of these health
conditions.
-used to analyze the different factors that contribute to
disease development.
 USES OF EPIDEMIOLOGY (Morr
1. Study the history of the health population and the rise and fall of disease and
changes n their character.
2. Diagnose the health of the community and the condition of people to measure the
distribution and dimension of illness in terms of incidence, prevalence, disability and
mortality, to set health problems in perspective and to define their relative
importance and to identify groups needing special attention.
3. Study the work of health services with a view of improving them.
4. Estimate the risk of disease, accident, defects and the chances of avoiding them.
5. Identify syndromes by describing the distribution and association of clinical
phenomena in the population.
6. Complete the clinical picture of chronic disease and describe their natural history.
7. Search for cause of health and disease by comparing the experience of groups that
are clearly defined by their composition, inheritance, experience, behaviour and
environments.
EPIDEMIOLOGIC CONCEPTS AND PRINCIPLES

1. Multiple Causation Theory/Ecologic Concept of Disease

- “ Disease development does not rest on a single cause”
- Health condition results from a multitude of factors

2. Levels of prevention of health Problems

Models of Multiple Causation Theory

• Wheel
• Web
• Ecologic Triad (most helpful to the nurse)
 The Ecologic Triad

ENVIRONMENT
-sum total of all external
conditions and influences:
Physical, Biological,
Socio-economi
AGENT
-Any element, substance or
force, animate or inanimate,
presence or absence of
which may serve as stimulus
to initiate/ perpetuate a disease
process.

HOST
-any organism that harbors and
nourishes another organism
-characteristics of host will affect
its susceptibility or resistance
Web of Causation
Wheels of Causation
• Disease factors in singular or plural (necessary and/or
sufficient) are required for disease occurrence.
• If "A" is "necessary", then disease will not occur without it,
but "A" may require other factors to be sufficient
(example: TB). Several factors together may be sufficient
for disease but no one factor may be necessary in itself
(example: CHD); several sufficient wheels may exist for a
disease.
• Wheel of causation illustrates how disease may occur
through the interplay of several causal factors without any
being necessary in itself.
wding; another wheel might include contact with a carrier, having AIDS, poor hygiene. Both wheels are sufficient to produce disease, but factors diffe

Wheel of Causation
TB again: One sufficient wheel might include:
contact with a carrier, low immunity, and
crowding; another wheel might include contact
with a carrier, having AIDS, poor hygiene. Both
wheels are sufficient to produce disease, but
factors differ. But for TB, both wheels must
have the TB organism, is a necessary factor for
TB to occur.
•
• The three elements of the triad interact with
one another in an attempt to maintain an
equilibrium.
• Any major change in any one of the factors
may bring about a disturbance in the
equilibrium provoking the appearance of a
health problem.
•
• LEVELS OF PREVENTION OF HEALTH PROBLEMS
“Promoting health and preventing health problems make
up most of the nurse’s activity in the community.”
• Prevention refers to identification of potential
problems and further eradication or minimization of
disability in a population-at-risk to a NEGATIVE
EXPOSURE FACTOR.
•
•
PRIMARY PREVENTION
• Directed to the healthy population.
• Prevention of emergence of risk factors
• Interventions before agent enters host .
• Aims to strengthen host resistance, inactivate the
agent, interrupt the chain.
• Health Promotion activities: provision of proper
nutrition, safe water supply and waste disposal
system.
SECONDARY PREVENTION
• Aims to identify and treat existing health
problems at the earliest possible time.
• Interventions: screening, case finding, disease
surveillance, promt and appropriate treatment.
• Disease Prevention: health teaching on risk
factors and risk behaviours that contribute to
development of disease.
TERTIARY PREVENTION
• Limits disability progression
• Nurse attempts to reduce magnitude or
severity of the residual effects.
•
• “ In explaining the interrelationship of factors that bring about community
health problems, epidemiological approach is being used, specifically
DESCRIPTIVE EPIDEMIOLOGY.’

DESCRIPTIVE EPIDEMIOLOGY
• Aims to describe the occurrence of health conditions in the community in terms
of person, place and time characteristics.
• Various existing patterns s aspects involved in descriptive epidemiology include:
1. Observation and recording of existing patterns of occurrence of health
conditions.
2. Description of the condition as to person, place and time characteristics.
3. Analysis of the general pattern of occurrence.