Data Analysis and Community Diagnosis (Nursing)

by Heide Cygan, DNP, RN

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    00:01 This presentation will focus on data analysis and diagnoses for community assessments.

    00:08 So today, we're going to talk about strategies that you can use to analyze the data that we collect during our community assessment.

    00:15 We do this as a method to identify priority community level health concerns.

    00:21 If you've already listened to my presentation on the types of community assessments, this slide should look very familiar to you.

    00:27 These are the different types of data sources that are commonly used in a community assessment.

    00:32 In addition, it's important that we also consider our own personal experiences in a community.

    00:37 So let's assume that you've collected a great deal of information in your community health assessment.

    00:42 But now what do you do? How do you decide what problem to focus on for your public health nursing intervention? Now, as you engage in this part of the process, it's important that you're working with community members to identify Community Priorities.

    00:58 I've seen some very well meaning nurses develop interventions based only on the data that they've collected.

    01:04 Now, while that might seem like a fine idea, without input from the community, we cannot assume that the issues we think are priority are actually what the community members think are the priority.

    01:15 So for example, let's take into consideration a scenario where the data show that cardiovascular disease is the leading cause of death within an area.

    01:24 A public health nurse might assume that this is a community priority.

    01:28 However, if gun violence is on the rise, community members might find this to be the most important issue to address.

    01:35 So in order to design the most impactful intervention, we need to talk to the community.

    01:39 And there's a few different ways that you can do this.

    01:43 The first way is through conducting surveys.

    01:46 Now, when we conduct surveys, we're able to gather information from a large number of people.

    01:51 And because of this, we're able to start to understand those cultural norms within the community.

    01:56 However, with most surveys, we're not asking large, open ended questions.

    02:01 We're asking yes or no questions, maybe using a Likert scale and asking questions such as: How important is this to you on a scale from one to five? By doing so, again, we can collect a lot of information from a lot of people.

    02:13 But we don't have the opportunity to engage in those in depth conversations that tell us why, why is this so important to you? On the other hand, when we conduct key informant interviews, we do have the opportunity to have those in depth conversations.

    02:30 Now, key informant interviews are simply interviews with people who hold key information in the community.

    02:36 And when you're conducting key informant interviews, it's important to include both formal and informal leaders.

    02:42 Our formal leaders are usually easier to identify.

    02:46 So for example, within a school district, the principal or superintendent, they would be a formal leader.

    02:51 However, there's other informal leaders who are part of a community who hold that important information that can really open your eyes to the priorities in the community.

    03:00 So let me share a quick example of this.

    03:02 My children started at a new school a couple years ago, and I really wanted to be a part of that community.

    03:07 So I knew that I had to figure out who the formal and informal leaders were and talk to them.

    03:12 I talked to the principal, I talked to the assistant principal, and I kept hearing people talk about this woman named Miss Bell.

    03:19 Have you talked to Miss Bell yet? Have you met her yet? What did Miss Bell tell you about that? Well, after poking around a little bit, I figured out that Miss Bell was the woman who ran the after school program at the school.

    03:29 She'd been there for almost 30 years, she'd been with the school when they shut down.

    03:33 She'd been there when the community came together to reopen the school, she was a true, informal leader in that community.

    03:41 Now, from these leaders, you can gain an understanding of local knowledge, of history, of needs or perceived needs within the community.

    03:48 This information can help you pinpoint what the priorities are for intervention.

    03:55 So once you determine the priority health issues in a community, you must decide which contributing factor you'll focus on for your intervention.

    04:03 So for example, let's say we decide that we're going to focus on cardiovascular disease.

    04:07 We need to narrow that focus to develop an effective intervention.

    04:11 Maybe we focus on availability of health services in the community, nutrition, physical activity.

    04:18 One way to determine what contributing factor you'll focus on is by examining the importance and the changeability of the issue.

    04:26 The importance of a problem or a contributing factor is defined by rating how frequently the identified behavior occurs, and how strongly it's linked to a health problem.

    04:36 So how often do we see this behavior in the community? And how closely related to a health problem is that behavior? Next we have changeability.

    04:47 The changeability of a problem is just that our ability to change a problem or a contributing factor, the most changeable problems or issues that are still developing or behave peers that are recently adopted.

    05:00 These are behaviors that do not have deep roots and culture or lifestyle for the community.

    05:05 Now, some problems may be very important, but also very difficult to change.

    05:10 So based on time, resources and community input, public health nurses have to prioritize and determine which problems are important and changeable.

    05:21 One way that we can prioritize these contributing factors is to create a matrix that looks like this.

    05:28 Here we have importance across the top and changeability along the side.

    05:33 What we do is take all of the information that we've gathered, information about issues that contribute to a health problem and add them to the matrix.

    05:41 So let's go ahead and work through an example.

    05:44 We're going to consider behaviors or contributing factors related to obesity at a local elementary school.

    05:51 So to start the matrix, you consider all the data that you've collected during the community assessment and entered into the appropriate square.

    05:59 Here, we've started with the most important and the most changeable issues.

    06:03 Now remember, the most important issues are those that impact the most number of people, and those that are the most closely associated with the poor health outcome.

    06:12 So what we've entered here are the fact that students like high fat high sugar foods, there's an increase in stress related to homework, sedentary activities after school instead of those physical activities.

    06:25 Next, we move to issues that are just as changeable, but maybe less important.

    06:30 So here we have limited sports equipment for after school and recess use.

    06:36 Next, we fill on those issues that are most important, but that we think are less changeable.

    06:42 A couple examples here are the subsidized meals that the schools get for lunches and snacks, limited physical education classes.

    06:51 And then finally, we fill in the last matrix, these are issues that we find to be less important, and less changeable.

    06:57 One of the examples we added in here was the high cost of after school sports.

    07:03 Now one thing I want to point out here is in order to accurately complete this matrix, you must have a strong understanding of the community.

    07:11 Let's focus on one of the contributing factors that's in them more important and more changeable parts of the matrix.

    07:17 We'll focus on increased stress related to homework.

    07:20 Now, if you were working with the school that had just adopted a new policy this school year, requiring all students to have one hour of homework each night, this would be a lot easier to change than if you were working with a school that's always required students to complete two hours of homework each night.

    07:36 So this is an example of why it's important that you truly understand your community when you're completing this type of matrix.

    07:43 So once complete, the area on the matrix that we really want to focus on is the more changeable, the more important square.

    07:50 This is where we really get the most bang for our buck with health promotion activities.

    07:55 Now remember, the reason that we identify problems is so that we can build a strong diagnosis to work from.

    08:01 Let's take a look at two approaches to writing a community diagnosis.

    08:06 You can have a deficit focused diagnosis or a wellness focus diagnosis.

    08:11 Here we have two examples that have nothing to do with the case study that we just looked at.

    08:15 Let's focus first on our deficit focus diagnosis.

    08:19 The example here is residents in a rural farming town are at risk for illness and injury related to exposure from pesticides, and limited safety knowledge of farm machinery used on the job.

    08:32 On the other hand, we have a wellness focus diagnosis.

    08:35 The residents in a rural farming town have the potential for achieving optimal functioning, were related to their expressed interest in exercise, and access to use of a local fitness center free of cost.

    08:48 So now that we've looked at these two examples, let's work together to write two diagnoses for our elementary school community.

    08:57 Here we have two prompts.

    08:58 One that's deficit focused and one that's wellness focused.

    09:01 What I'm going to ask you to do is to pause the video and to fill in the blanks, write one deficit focused diagnosis and one wellness focused diagnosis.

    09:17 Okay, let's take a look and see how your diagnoses compared to mine.

    09:21 For a deficit focus diagnosis, this is what I wrote.

    09:24 The students at Forest Hill Elementary School are at risk for obesity as related to stress caused by a recent increase in homework expectations.

    09:34 On the other hand, my wellness focused diagnosis reads like this, the students of Forest Hills Elementary have the potential for achieving optimal health related to community interest in creating free and low cost after school physical activity opportunities.

    09:52 Now, once you develop a strong diagnosis that lays the foundation for your program planning and implementation and those are the next steps in the nursing process.

    About the Lecture

    The lecture Data Analysis and Community Diagnosis (Nursing) by Heide Cygan, DNP, RN is from the course Community Assessment and Program Planning (Nursing).

    Included Quiz Questions

    1. The lack of access to education on the importance of physical activity and local exercise programs in the community, which most community members identified as something they would want.
    2. The community lacked green spaces and walkable areas, which the town mayor identified as something they had been trying to change for over ten years with minimal success.
    3. The lack of a gym with updated exercise equipment, which some community members identified as a priority.
    4. The lack of access to fast food restaurants serving healthy options, which several community members stated was their top priority.
    1. The nurse at the local clinic.
    2. The town mayor.
    3. The president of the local council.
    4. The head physician at the local hospital.
    1. Consulting community members to identify community priorities.
    2. Focusing on collecting data from national and international sources.
    3. Asking for assistance from nearby public health teams working on similar projects.
    4. Developing a priority diagnosis based on information collected from secondary data sources.
    1. The doctor from the next city over working in the town twice a week.
    2. A resident of the town.
    3. A representative from the public health unit serving the surrounding area.
    4. A teacher who lives in the town but works at a school in a neighboring city.
    1. The residents of the long-term care facility have the potential to achieve optimal health functioning related to their access to numerous activity programs available throughout the day.
    2. The students at the high school have the potential to optimize their health outcomes related to community interest in learning about and adopting healthy lifestyle changes.
    3. The town's residents are at risk for toxic chemical exposure related to creation of a power plant next to the town.
    4. The members of the church have the potential to be at risk for isolation related to the relocation of the community center to another neighborhood.
    5. The members of the community center are at risk for lack of access to services related to a decrease in funding for community services.

    Author of lecture Data Analysis and Community Diagnosis (Nursing)

     Heide Cygan, DNP, RN

    Heide Cygan, DNP, RN

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