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Community assessment and diagnosis: data, participation and priorities

  • Safe practice

The team gathers data about a community, with its people, to name its main health problems and decide together which to tackle first.

Updated

What it is

Community assessment is the nursing process applied to a population. The team combines existing data (local diagnoses, census and health information systems) with data it collects itself: windshield surveys, key-informant interviews, focus groups, surveys, public forums and participant observation. It then writes a community diagnosis, sets priorities, plans interventions with the community and evaluates the results. In Colombia, MinSalud guidance for basic health teams adds social mapping of the micro-territory and criteria such as poverty, child malnutrition, maternal and infant deaths, adolescent pregnancy, suicide attempts, hypertension and dengue to decide where to act first.

What it requires

  • Respect for the community's own definition of itself and of its problems.
  • Data from several sources, compared over time and with similar communities.
  • Attention to vulnerable subgroups and to the barriers they report.
  • Agreement with local leaders and with the territorial health authority.

Components

  • Assessment: secondary data (local diagnoses, DANE, SISPRO) and primary data (observation, interviews, focus groups, surveys, forums).
  • Social mapping: a map of homes, community resources, environmental hazards and access routes, ideally guided by a community leader.
  • Community diagnosis: problem + affected group + effects + indicators.
  • Priorities, plan, implementation and evaluation.

How it is applied (and why)

  1. Define the community and meet its leaders and organisations — entry and trust come before data.
  2. Review existing data on population, illness, deaths and service coverage — avoids repeating work and shows trends.
  3. Walk or drive the area with a windshield survey and a social map — shows housing, hazards, services and access.
  4. Hold key-informant interviews, focus groups or a public forum at times and places people can attend — adds the community's view.
  5. Write each diagnosis with the problem, the group, the effects and the indicators — makes the problem clear and measurable.
  6. Rank problems with the community using size, severity, vulnerable groups and feasibility — resources go where they matter most.
  7. Plan SMART objectives and interventions with the community and other sectors — shared plans are more likely to last.
  8. Evaluate results against the objectives and share them with the community — shows what worked and what to change.

In nursing practice

  • Example of a diagnosis: higher need for sexual-health education among adolescents of a district, shown by a rising adolescent pregnancy rate.
  • Key informants give depth at low cost but take time and can be biased.
  • Focus groups of about six to ten people with similar backgrounds reveal values and perceptions.
  • Assets matter: schools, churches, community kitchens and leaders are part of the solution.

Common mistakes

  • Using only official statistics and never asking the community.
  • Writing a diagnosis that does not name the affected group or the evidence.
  • Choosing priorities alone in the office.
  • Planning interventions that duplicate what another programme already does in the same territory.
  • Not returning the results to the community.

Test yourself

Think of the answer, then tap the question to see it.

What four parts should a community diagnosis include?

The problem, the affected population or vulnerable group, the effects of the problem on that group, and the indicators that show the problem in the community.

What is a windshield survey?

Direct observation of a community while moving through it, noting housing, pollution, parks, transport, services, shops, schools and places of worship.

What are three ways to collect primary data in a community assessment?

Any three of: key-informant interviews, focus groups, surveys, public forums, windshield surveys and participant observation.

Why should the community take part in setting priorities?

Because it knows its own needs and resources, and plans built with it are more accepted and more likely to last.

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Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: Nursing: Mental Health and Community Concepts, 16.3 Applying the Nursing Process to Community Health (Open RN, CC BY 4.0) (Open Resources for Nursing (Open RN) / LibreTexts, 2022); Lineamientos para la organización y operación de los Equipos Básicos de Salud (Resolución 2788 de 2022): priorización, cartografía social y valoración comunitaria (Ministerio de Salud y Protección Social, Colombia, 2023); Nursing: Mental Health and Community Concepts, 16.2 Community Health Concepts (Open RN, CC BY 4.0) (Open Resources for Nursing (Open RN) / LibreTexts, 2022).

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Representative model, for educational purposes only.