PROBLEM IDENTIFICATION

Community diagnosis
- refers to the process of identifying or quantifying health problems in a community as a whole
for the purpose of defining those at risk or needing health care (Salama, R)

Quantitative and qualitative description of the health of citizens and the factors influencing health
(WHO)
- Identifies problems
- Proposes areas for improvement
- Stimulates action

Community Diagnosis
(includes Problem Project Project Monitoring
Project Planning
identification and Implementation and Evaluation
prioritization)

Problem identification and prioritization as part of assessing and diagnosing a community

- Essential in planning, implementing, monitoring and evaluating the project

Practical Relevance of Community Diagnosis

- Act as data reference for the community / barangay
- Provide an overall picture of the local community and the residents’ concerns
- Identify priority areas for intervention for solution generation
- Direct resource allocation
- Create opportunities for intersectoral collaboration
- Form basis for monitoring and evaluation (i.e. in setting indicators)

Community Diagnosis Process

A. Initiation
- Establish a team capable of doing community diagnosis
- Preparation of official communication materials (e.g. letters to barangay captains, key leaders)
- Assess existing resources (e.g. budget, manpower)

B. Data Collection and Analysis

- Preparation
- Courtesy visits to key leaders
- Stakeholder and SWOT analysis
- Data Collection (Primary and/or Secondary)
- Data interpretation and analysis
- Problem Identification
- Problem prioritization
C. Dissemination
- Presentation in meetings with various target audiences

Problems should be identified and prioritized

- based on evidence (e.g. data)
- with stakeholders.

Nature of a health problem

- A problem is the difference of what is and what should be
o Problems should be defined clearly and accurately in order to bridge the gap between
the status quo and the goal
- Causes of a problem may be external or internal to the community
- Problems may occur with different levels of severity
- We must work collaboratively and efficiently towards effective and equitable solutions to these
problems

Problem Identification

1. Determining the root cause of a problem

- True and underlying causes may not always be apparent, hence the importance of evidence
generation
- Start with what you know about the problem (Kansas University Community Toolbox, 2014)
o Can be perception, opinion, inference
- Gather additional information about the problem
o Can be done through generating evidence and use of data
o Allocation of limited resources and planning of interventions will be based on data
collected and evidence generated hence the importance of identifying the TRUE
problem
2. Developing a detailed problem statement that includes its effect on the population’s health
- Problem statements are tested and refined through more detailed analysis (ATAP, 2019)
- Problems should also consider constraints preventing goals and objectives from being achieved.
(ATAP, 2019)

- Stakeholders, especially community leaders and members, should be involved in problem

identification
o Increases ownership of the problem and the interventions which will be implemented
afterwards
o Widens perspective on what the problem is and what the intervention will entail
Generating Evidence and Collecting Data

Classification of Data Sources

A. Primary data collection

- Data collected first-hand through the use of appropriate and feasible qualitative and
quantitative methods
o Quantitative Research Methods
o Qualitative Research Methods

1. QUANTITATIVE RESEARCH METHODS (USC, 2019)

- The goal is to explain what is observed through the use of numerical, logical and objective
methods
o Classify features, count them and construct statistical models in an attempt to explain
what is observed
o Determine the relationship between two variables (independent and
dependent/outcome) within a population
- Can be descriptive or experimental
o Descriptive – measured only once; aims to establish associations between variables
o Experimental – use of treatment, measures before and after subjecting to treatment;
establishes causality

Quantitative Data Collection – Characteristics (USC, 2019)

- Data is gathered using structured research instruments
- Results are based on larger sample sizes that are representative of the population.
- Research study can be replicated or repeated, given its high reliability.
- All aspects of the study are carefully designed before data si collected.
- Data are in the form of numbers and statistics, often arranged and presented in tables, charts, figures
or non-textual forms.
- Project or engagement can be used to generalize concepts more widely, predict future results or
investigate causal relationships.
- Researcher uses tools, such as questionnaires or computer software, to collect numerical data.

2. QUALITATIVE RESEARCH METHODS

- Describe social phenomena as they occur naturally
- No attempt to manipulate the situation – just understand and describe
- More holistic approach, rather than looking at a set of variables
- Collected through direct encounters
o Interviews - Involves asking questions, listening to and recording answers by an
interviewer to an interviewee; may consist of closed and open-ended questions; if
structured, usually uses an interview tool which can be pre-tested to assess its validity;
can be semi-structured or a focused interview; can be unstructured
o Focus group discussions- Involves a set of questions delivered in an interactive manner
to a set of individuals (usual size does not exceed 10-12). Goal is to provide a venue for
everyone to talk and produce a diverse pool of opinions; necessitates certain skills
(facilitating and moderating a group, listening, observing, analysis)
 o Observations- Understanding phenomena using five senses; allows recognition of
recurrent patterns; can use documentation methods (photos, video recording, writing);
environmental scanning can be considered under observation
- Data collected qualitatively substantiate quantitative data, enabling us to identify problems
more comprehensively and multi-dimensionally
o We can use a determinants of health approach in providing more meat to quantitative
data

- After we have collected data either quantitatively or qualitatively, we can now list our problems
of the community
- Having data collected through systematic methods enables us to list potential problems of the
community based from different perspectives (minimizes bias)
- Potential problems can be refined, developed and stated more accurately and powerfully.

B. Second data collection

- Data collected by other entity or for another purpose (CDC, 2017)
- Can be obtained through review of journals, books, articles, policies, guidelines or any source
document
- If secondary data is available, re-collection of data may be foregone
o Focus instead on validation and assessing its applicability

Examples of Secondary Data in Health which will be found in the Community

1. FHSIS (Field Health Service Information System) Report

- includes health surveillance data on infectious diseases, maternal mortality, immunization,
nutritional supplementation, and other health-related data. Morbidity data are tabulated by age
group, sex, region, province, and city. (Institute of Health Metrics and Evaluation, 2018)

(Reports submitted on a regular basis (monthly, quarterly and annually) show data which can be later on
processed (into graphs and charts) and analyzed for trends in order to come up with a list of
gaps/challenges/problems (problem identification). From this, we can move forward with
project/program planning, implementation, monitoring and evaluation.)

2. LGU Scorecard
- A performance assessment tool of the combined efforts of stakeholders within the province-
wide health system (PWHS), which include the clients and public private providers within the
municipalities, cities and provinces. (DOH, 2018)
- Has external and internal benchmarking
o External benchmarking – comparing the performance of an LGU to a set standard (e.g.
95% coverage rate for fully immunized children), which applies nationally or globally
o Internal benchmarking – comparing the current to the past performance of an LGU (e.g.
88% coverage rate for fully immunized children for 2017, 84% in 2018)
- The LGU scorecard can suggest which problems the community might have.

(This is the LGU Scorecard from Naga City in 2015. It shows that the outlined performance indicators
are those which are measured based on external and internal benchmarks. Poor performance (those
in red) may suggest which problems the municipality/city/community has.)
 LGU Scorecard for Health
- Uses green, yellow and red color scheme to indicate accomplishments and areas for
improvement
- Those in red will suggest potential problematic or challenging areas for a municipality/city, and
which may need support in interventions
- Some of the red areas in this scorecard are the following:
o Child health – number of fully-immunized children, percent of children (0-6 months)
who are breastfed
o Support to HRH – provision of benefits in accordance to Magna Carta for Public Health
Workers

3. Morbidity and Mortality Reports

- Detail the most common conditions which cause diseased states and which cause deaths in a
certain area
- This can pinpoint which conditions pose the greatest disease burden helpful in problem
identification and prioritization

Developing the Problem Statement (CDC, 2019)

Describe how the problem occurs, how serious it is, and its outcomes and impacts.

Doing this can also help you identify any gaps in the data you have gathered.

The problem statement you develop might include:

•WHO is affected
•HOW BIG is the problem
•WHAT contributes to the problem
•WHEN and WHERE the problem is most likely to occur

HOW DO YOU KNOW YOU HAVE SUCCESSFULLY COMPLETED PROBLEM IDENTIFICATION? (CDC, 2019)
Able to collect information about the problem through combining existing research and information
from stakeholders and has collected new data from the community (if necessary)
Involved all relevant stakeholders when defining the problem
Data collected identifies the root cause of the problem and provides a complete picture of it
Problem statement includes
•WHO is affected
•HOW BIG the problem is
•WHAT contributes to the problem
•WHEN and WHERE the problem is most likely to occur
Problem is framed in a way that it helps illuminate possible policy solutions