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I. THE BASICS
Descriptive Statistics
Involves summarizing data by describing the average or mean and the minimums and maximum. e.g.
tabulation, graphical presentation, computation of averages as well as measures of variability
Inferential Statistics
Used to make predictions or infer things from data (usually using a sample, taken from a larger group
which is referred to as a population).
Parameters & Statistics
When we want to make inferences about populations, we use samples taken from that population
(more cost-efficient and practical). We use the average from a sample as our best guess at the
population average.
Parameter Statistic
(Unknown Population Average) (Known Sample average)
Mean μ !
Variance σ2 s2
Standard Deviation σ s
Proportion π p
Difference between two means μ 1- μ 2 x 1- x 2
Difference between two proportions
π 1- π 2 p1-p2
Estimation
A point estimate of a population parameter is a single value of a statistic. [e.g. sample statistics (s or p),
reliability coefficient (z-value or t-value), standard error]
An interval estimate is defined by two numbers, between which a population parameter is said to lie.
e.g. a < < b is an interval estimate of the population mean μ. It indicates that the population mean is
greater than a but less than b. [e.g. confidence intervals]
Population Sample
Standard Deviation
summation - Σ each value - x
mean - μ or ! number of values - N or n
Standard Error (i.e. SD of the distribution of sample means)
> measures variability, or the amt. of error we can expect due to using a
sample mean to estimate a population mean
Example:
Assuming that the distribution of systolic blood pressure of non-hypertensive men has a mean of 110
mmHg and a standard deviation of 15 mmHg. What is the proportion of non-hypertensive men who have
systolic blood pressure above 120 mmHg? Proportion of non-hypertensive men with systolic blood pressure
of less than 90 mmHg ?
RSMV 2
_ a Sample Mean
Z-score for _ Example:
Suppose a health care provider wants to detect adverse
effects of systolic BP in a random sample of 25 patients using
a drug that causes vasoconstriction. The provider decides that
a mean systolic BP in the upper 5% of the distribution is cause
Example: for alarm; therefore, the provider must determine the value that
Suppose a health care provider studies a randomly selected divides the upper 5% of the sampling distribution from the
group of 25 men and women between 20 and 39 years of lower 95%
age and finds that their mean systolic BP is 124 mmHg.
How often would a sample of 25 patients have a mean
systolic BP this high or higher?
Assuming that the systolic BP is a normally distributed
random variable with a known mean of 120 mmHg. and a
standard deviation of 10 mmHg in the population of normal
healthy adults.
(0.023)
Example: Percentiles
Most IQ tests have means of 100 and standard deviations of 15. Let's say you take an IQ test and get the score of 125.
Which percentile do you belong to?
z = (125-100)/15 = 1.6667
*1.667 in a table of normal values = 0.9522
Therefore, you’re in the 95% percentile.
Maybe you think many of your friends might score between 115 and 125. What percent of the population would we
expect to score between these values?
RSMV 3
IV. HYPOTHESIS TESTING - Formal procedures used by statisticians to accept or reject statistical
hypotheses.
Steps in Hypothesis Testing
1) State the research question in terms of statistical hypotheses
Null hypothesis – HO; sample observations result purely from chance (always incl. ʻ=ʼ sign)
Alternative hypothesis - H1 or HA; sample observations are influenced by some non-random cause. May or
may not have direction (one-tailed or two-tailed).
One-tailed (directional) Two-tailed (no direction) - more conservative, since α/2
Is one mean < or > than the other? Is there a difference between two means?
Reject Ho if...
Computed value > critical value (é common)
Computed value < α
Left or Right rejection region?
Check your HA…
Less than sign ! gReater than sign
Left-sided Rejection !
Region Right-sided
Rejection Region
RSMV 4
V. P-VALUES TRUE STATE OF NATURE
Decision Errors
Type I error: rejecting the null hypothesis when it is true. The probability of committing a Type I error
deals with the significance level (or alpha, α).
Type II error: failing to reject a null hypothesis that is false. The probability of committing a Type II
deals with the Power of the test (or beta, β).
95% Confidence Interval for z-test 95% Confidence Interval for t-test 95% Confidence Interval for single
pop. proportion
EXAMPLES
= =
= 22 ± 1.96 (2.1213) = 96 ± 2.1448 (9.04)
= 22 ± 4.16 = 96 ± 19.4 = .41 ± 1.96 x .0289
17.84, 26.16 76.6, 115.4 = .41 ± .06
= .35, .47
Hypothesized parameter μ0 = 25 Hypothesized parameter μ0 = 120 Hypothesized parameter μ0 = .5
CANNOT REJECT HO REJECT HO REJECT HO
z-test 5
RSMV Sample
proportion
Example: z-test for Mean w/ Unknown Pop. Variance, n
Example: z-test for Mean w/ Known Pop. Variance
> 30
Suppose a researcher, interested in obtaining an estimate of
In a health survey of a certain community 150 persons were
the average level of some enzyme in a certain human
interviewed. One of the items of information obtained was the
population, takes a sample of 10 individuals, determine the
number of prescriptions each person had had filled during the
level of the enzyme in each, and computes sample mean x =
past year. The average number for the 150 people was 5.8
22. Suppose further it is known that the variable of interest is
with a standard deviation of 3.1. The investigator wishes to
approximately normally distributed with a variance of 45. Can
know if these data provide sufficient evidence to indicate that
we conclude that the mean enzyme level in this population is
the population mean is greater than 5. Let α = .05
different from 25 ? Use α = .05
1. State the hypothesis 1. State the hypothesis
Ho: The population mean enzyme level is = 25 Ho: The average number of prescriptions is ≤ 5
HA: The population mean enzyme level is ≠ 25 HA: The average number of prescriptions is > 5
2. Select the appropriate test statistic – Z test 2. Select the appropriate test statistic – Z test
3. Select the level of significance - .05 3. Select the level of significance - .05
4. Determine the critical ratio/value - z(α/2) = ±1.96 4. Determine the critical ratio/value z(α) = 1. 645
5. Do the computation of the test statistic 5. Do the computation of the test statistic
6. Draw and state the conclusion 6. Draw and state the conclusion
We are unable to reject Ho since -1.41 is not in the rejection Reject Ho since 3.2 is the region of rejection. The average
region. We conclude that μ may be equal to 25. number of prescriptions is greater than 5.
Example: t-test for Mean w/ Unknown Pop. Variance, Example: z-test for single Pop. Proportion (assuming
n <30 normal dist. in accordance w/ CLT
Researchers collected serum amylase values from a random Suppose we are interested in knowing what proportion of
sample of 15 apparently healthy subjects. They want to know automobile drivers regularly wear seat belts. In a survey of
whether they can conclude that the mean of the population 300 adult drivers, 123 said they regularly wear seat belts.
from which the sample of serum amylase determinations Can we conclude from these data that in the sampled
came is different from 120. The mean and standard deviation population the proportion who regularly wear seat belts is
computed from the sample are 96 and 35 units/100 ml, not .50 ? Let α = .05.
respectively. Use α =.05.
1. State the hypothesis 1. State the hypothesis
Ho: The population mean serum amylase is = 120units/100ml Ho: The pop. proportion who regularly wear seat belts = .50
HA: The population mean serum amylase is ≠ 12units/100ml HA: The pop. proportion who regularly wear seat belts ≠ .50
2. Select the appropriate test statistic – z test
2. Select the appropriate test statistic – t test
OR
3. Select the level of significance - .05 3. Select the level of significance - .05
4. Determine the critical ratio/value - t(α/2, n-1)=±2.1448 4. Determine the critical ratio/value - z(α/2) = ±1.96
5. Do the computation of the test statistic 5. Do the computation of the test statistic
6. Draw and state the conclusion 6. Draw and state the conclusion
Reject Ho since -2.65 falls in the rejection region. The Reject Ho since -3.11 is in the region of rejection. The pop.
population mean is not equal to 120 units/100ml. proportion who regularly wear seat belts is not equal to 0.5.
RSMV 6
1
Example: z-test for independent samples, normal Example: t-test for independent samples, normal
distribution, known pop variances OR non-normal distribution, unknown pop variances but assumed to be
distribution, n > 30 (just substitute σ for s) equal**
A hospital administrator wished to know if the population which A research team collected serum amylase data from a sample of
patronizes hospital A has a larger mean family income than does the health subjects and froma sample of hospitalized subjects. They wish
population which patronizes hospital B. The data consist of the family to know if they would be justified in concluding that the population
incomes of 75 patients admitted to hospital A and of 80 patients means are different. The data consist of serum amylase
admitted to hospital B. The sample means are x1= Php 6,800.00 and determinations of n2=15 health subjects and n1=22 hospitalized
x2= Php 5,450.00. The standard deviations are s1= Php 600.00 and s2= subjects. Let α = 0.5
Php 500.00. Let α = .01. x1 = 120 units/ml x2 = 96 units/ml
s1 = 40 units/ml s2 = 35 units/ml
1. State the hypothesis 1. State the hypothesis
Ho: The mean diff. in family income between the two pops is ≤ zero Ho: The mean diff. in serum amylase bet. healthy and hosp. = 0.
H : The mean diff. in family income between the two pops is > zero H : The mean diff. in serum amylase bet. healthy and hosp. ≠ 0.
A A
2. Select the appropriate test statistic 2. Select the appropriate test statistic
μ1 - μ2 always
defaults to 0
2
**Pooled Sample Variance, s p:
2 2
weighted average of the variances (s1 and s2 )
RSMV ! We pool the variances because the larger sized sample would account for 7
more
2
Example: t-test for independent samples, normal Example: paired t-test (usually used for before and after
distribution, unknown and unequal pop variances comparisons)
The objective: eliminate a maximum number of sources of
extraneous variation by making the pairs similar with respect to as
many variables as possible.
Researchers wish to know if two populations differ with respect to the Twelve subjects participated in an experiment to study the
mean value of total serum complement activity (C H50). Data was collected effectiveness of a certain diet, combined with a program of exercise,
on apparently normal subjects (n2=20) and subjects with disease in reducing serum cholesterol levels. Do the data provide sufficient
(n1=10). Let α = 0.05. The sample means and standard deviations are: evidence to conclude that the diet exercise program is effective in
reducing serum cholesterol levels? Let a = .05
x1 = 62.6 x2 = 37.2
s1 = 33.8 s2 = 10.1 Serum Cholesterol Difference (d)
Subject Before (x ) After (x ) (after–before)
1 2
1 201 200 -1
1. State the hypothesis 2 231 236 +5
Ho: The mean diff. in value of C H50 between normal and diseased 3 221 216 -5
4 260 233 -27
subjects is = zero 5 228 224 -4
H : The mean diff. in value of CH50 between normal and diseased 6 237 216 -21
A
subjects is ≠ zero. 7 326 296 -30
8 235 195 -40
2. Select the appropriate test statistic
9 240 207 -33
10 267 247 -20
11 284 210 -74
12 201 209 +8
RSMV 8
Example: z-test for difference between two proportions
In a study designed to compare a new treatment for migraine headache with the standard treatment, 78 of 100 subjects who
received the standard treatment responded favorably. Of the 100 subjects who received the new treatment 90 responded
favorably. Do these data provide sufficient evidence to indicate that the new treatment is more effective than the standard? Let
α = .05
1. State the hypothesis 5. Perform the calculation for the test statistic
Ho: The difference in proportion between the standard and
new treatment is ≤ zero p = 78 / 100 = .78 p = 90 / 100 = .90
1 2
H :. The difference in proportion between the standard and
A
new treatment is > zero
2. Select the appropriate test statistic
RSMV 9
1. State the hypothesis 5. Perform the calculation of the test statistic
Ho: In the population from which the sample was drawn, inpatient - Compute for the mean and standard deviation of the sample
occupancy ratios are normally distributed x = 69.91 and s = 19.02
HA: The sampled population is not normally distributed - Compute for the expected frequencies in each cell
see above
2. Select the appropriate test statistic
6. Draw and state the conclusion
Reject Ho since 25.854 is in the region of rejection.
Conclude that in the sampled population, inpatient occupancy
3. Select the level of significance = .005 ratios are not normally distributed.
4. Determine the critical ratio or critical value:
2
x (.005, 6 df) = 18.548
(
e.g. Expected frequency for A1B1
(R x C)/n = (9x14)/29 = 4.344
EXAMPLE: 1. State the Hypothesis
A sample of 500 elementary school children in a certain school Ho: Nutritional status and academic performance are
system were cross-classified by nutritional status and academic independent
performance. The researchers wished to HA: The two variables are not independent
know if they could conclude that there is arelationship between
nutritional status and academic performance. 2. Select appropriate test statistic
Let α = .05
Academic Nutritional Status
Performance Total OR
Poor Good
Poor 105 15 120
Satisfactory 80 300 380
Total 185 315 500 3. Select the level of significance = .05
4. Determine the critical ratio α,d.f.=(r-1)(c-1) =
Observed Expected 3.841
frequency frequency (Oi – Ei)2 (Oi – Ei)2 / 5. Perform the calculation of the test statistic
(Oi) (Ei) Ei
105 44.4 3672.36 82.71
15 75.6 3672.36 48.58
80 140.6 3672.36 26.12
300 239.4 3672.36 15.34
6. Draw and state conclusion
Total 172.75 Reject Ho since 169.907 is in the rejection region
Conclude that the two variables are not independent
RSMV 10
VIII. HYPOTHESIS TESTING FOR THREE POPULATIONS
Completely randomized
design (one-way ANOVA)
Population
mean (Analysis
of Variance) Factorial experiment
(Two-way ANOVA)
Three
Populations Randomized block design
Population
proportion X2 test
RSMV 11
PREVMED2: Introduction to Community Health II Bambam2017
CODE:
Normal Font: Slides from Lectures It’s more expensive than it should be, when we see
Italicized: Side Notes, Trans ng Recordings patients at the following stages:
Purple: Lalabas daw sa quiz.
STAGE 2 (Screening for symptomacity)
COMMUNITY HEALTH II STAGE 4 (Rehabilitation, Outcome)
STAGE 1 (Wellness)
Meeting 1: Social Mobilization
PHC (Primary Health Care) Q: What are the traits of a THOMASIAN PHYSICIAN?
Meeting 2: National Health Situation
Healthcare Delivery 1. Competence
Meeting 3: Comprehensive Community Health 2. Compassion
3. Commitment
Development
- Community Profiling However, meron din tayong tinatawag na 5-star
- Community Diagnosis physician. Ano yon?
- Community Health Worker’s
Training “STAR PHYSICIAN”
COPAR PAFP, Inc., 1994
Meeting 4: Situational Analysis APMC Internship Program
Meeting 5: Community Health Workers
Communication Skills 1. Health Care Provider
a. we are exposed to the clinical sciences
Submission Deadlines: in med school
Individual (Case Analysis): 15 Oct 2014 b. kaya tayo may clinical cases
Group (Community Health Development 2. Educator/Teacher
Program): 31 Oct 2014 3. Scientist/Researcher
a. why we have the subject Clinical
TODAY’S COVERAGE: Epidemiology (1st yr to 4th yr in
Social Mobilization medical school)
Primary Health Care 4. Admin/Manager
5. Social Mobilizer
Okay, so we are familiar with terms: Health,
Community. For example, for a person with HPN and diabetes, we
So, what do we mean by good health care? Ha? What? could prevent possible morbid/mortal outcomes by:
There should be a balance in all Health Elements.
What are these elements? RRR – Relative Risk reduction
ARR – Absolute Risk reduction
1. Societal
2. Intellectual Possible morbid/mortal outcomes:
3. Psychological
4. Spiritual 1. organ damage (retinopathy, etc.)
5. Sexual 2. premature death
6. Environmental 3. heart attack (myocardial infarction)
7. Ecologic
Exercise Medicine: use of exercise to prevent target
DOCTOR’S NOTE organ damages
So, anong pinakaimportante dyan? Ung B and C. MORBIDITY: LEADING CAUSES (2010)
Modification of help-seeking behaviors at Opportunistic
health promotions. 1. Acute Respiratory Infection**
2. Acute Lower Respiratory Tract Infection and
We have two types of.. (illness yata). Pneumonia*
3. Bronchitis
1. Acute cases communicable diseases 4. HPN
2. Chronic cases lifestyle diseases, 5. Acute Water Diarrhea
noncommunicable 6. Influenza
7. UTI
In UK, the following are included in primary care: 8. TB Respiratory
9. Injuries
culposcopy (OB) 10. Disease of the Heart
threadmill (cardio)
*In 2008, the leading cause of morbidity is Pneumonia
NEW MILLENIUM **In 2010, Acute Respiratory Infection was added.
Population will continue to be young Oh eto, pang two points nyo sa quiz.
Increasing elderly population due to high life
expectancy Leading communicable cause of morbidity:
Emerging health problems Respiratory infections (in general)
Q: In the Philippines, what do you expect of the Life
Leading noncommunicable cause of morbidity:
Expectancy in the future?
Hypertension
Life expectancy will continually increase (male
and female Filipinos will reach 70+) because: MORTALITY: LEADING CAUSES (2009)
o technology, new medicine, etc.
1. Diseases of the Heart*
o Remember: our pyramid is EXPANSIVE
2. Diseases of the Vascular System
o The base is young Filipinos, if they
3. Malignant Neoplasms
will be able to survive, life
4. Pneumonia
expectancy increases
5. Accidents
Advances in Changes in
*In 2002, the leading cause of mortality is CVD
Technology and Fields (cultural, (Cardiovascular disease).
Communication biological)
Medical Science Mortality Figures
and care (decrease TB - #6 cause of death
mortality rate) Diabetes - #8 cause of death
Health Indicators cousins: #1, #2 and diabetes (Okay sorry, di ko
(birth rate alam kung anong table ung tinutukoy nya dito.
remains high) I don’t know kung ano ung #1 and #2 na sinabi
nya. And di ko alam kung anong year pa tong
DISEASE PATTERNS statistics na tinutukoy nya.)
! ! ! 1
RSMV
Health Promotion Process according to WHO, 1986 Community Organizing Participatory Action
i.e. Steps in Effective Development Planning Research (CO-PAR) for Community Health
0.5) Needs assessment (maximize limited resources) Development
1) Set priorities - Sr. Carmen Jimenez, 2005 (Philippines)
2) Make decisions “Social development approach that aims to transform
3) Plan strategies (! more effective and efficient) the apathetic, individualistic and voiceless poor into
4) Implement them to achieve better health dynamic, participatory and politically responsive
(achieve desired objectives) community”
5) Evaluation Participatory action research
- At the heart of this process is empowerment of - Investigation on problems and issues concerning life
communities, their ownership and control of their own and environment of the underprivileged. The
endeavors and destinies. underprivileged collaborate on research work with their
representatives and professional researchers
Objectives - Encourage consciousness, develop competence for
Specific – state desired results changing situations and support in organization
Measurable – observable building
Appropriate – approaches relate to problem being - Community – directed process of gathering and
solved; not contrary to the health policy of analyzing information on an issue for the process of
an organization // Attainable taking actions and making changes
Realistic - Consider resources, costs, etc.
Time-bound – set a time frame and target deadlines Emphases of CO-PAR**
- Community works to solve their own problems
Planning Paradigm - Internally directed (rather than externally)
- J Thomas Butler, 2000 (UK) - Development of the capacity to establish a project is
more important than the project
Needs Assessment - There is a consciousness-raising to perceive health
- Population analysis and medical care within the total structure of society
- Determination of
health problems Phases of CO-PAR
- Prioritizing needs 1) Pre-Entry - identify site of development work
Evaluation 2) Entry - work with community
- Assess results 3) Community Study/diagnosis phase (Research
Development of - Determine phase) – facilitate change process by helping
Program plan whether community identify critical areas
- Goals & objectives objectives have 4) Community Organization and Capability-
- Policy formulation been met Building Phase
- Methods & techniques - Determine if 5) Community Action Phase
- Implementation methods used 6) Sustenance and Strengthening Phase
were appropriate
and efficient UK Planning Paradigm CO-PAR Phase
Implementation Needs Assesment 1-3
Development of program Plan 4
RECALL: Implementation 5-6
Criteria for Evaluation
• Effectiveness – the extent to which aims and Traditional PAR
objectives are met - Identify and Research Seek social
• Appropriateness – the relevance of the intervention meet individual Objectives transformation
to needs needs within the
• Acceptability – whether it is carried out in a context of existing
sensitive way social systems
• Efficiency – whether time, money and resources are Defined by Needs Community
well spent, given the benefits researchers or Assessment defines their
• Equity – equal provisions for equal need health care (community needs; becomes
professionals problems – ‘experts of their
(Normative) template for own reality’
analysis) (Felt needs)
Handled and Research Community!
controlled by Problem Data collection to
professionals (responsible analysis
entity)
Based on findings Recommend Community!
and analysis of -ations for recommendations
professionals Actions & action plan
! ! ! 2
RSMV
Arnstein’s Ladder of Participation (1969) Community Profile
8 Citizen control Degrees of Citizens are - A comprehensive description of the needs of a
7 Delegated power citizen power involved in population that is defined, or defines itself, as a
6 Partnership planning and community, and the resources that exist within a
decision-making community, carried out with the active involvement of
through join the community itself
committees, Purpose: Aid in the development an action plan or
delegated other means of improving the quality of life
representatives
or complete Community Diagnosis
control - Discover a community’s health problem
5 Placation Degrees of Citizens have a - Evaluate measures instituted for their solution
4 Consultation tokenism voice but may - Aids in determining:
3 Informing not be headed - Difference in health of the people served
2 Therapy No Those with - Programs are appropriate for the region/area
1 Manipulation participation power educated - New problems produced as a result of
or cure, citizens elimination of old ones
are recipient
- UK & CO-PAR- seek to attain a high level on the Adequate Community Diagnosis requires answers
Ladder by encouraging participation and greater to SEVEN MAJOR QUESTIONS:
degree of ownership among community
1) What are the magnitude and extent of
Community Action Community Health Problems?
- Any activity undertaken by a community in order to - Health needs of community (4 different types)
effect change and includes lobbying authorities to ! Explore indicators of health (prevalence, incidence,
provide services and the provision of voluntary or self- etc.)
help services to address needs = strengthen
community organizations 2) What is the Extent of Current attempts to
- e.g. medical missions (based on normative needs but alleviate these community health problems?
beneficial when it is incorporated in a development ! Current interventions and programs
program)
3) What are the correlates of community health
Community Profiling (" Helps you choose a problems?
community to work with) ! Social determinants and variables associated with
- Provides a systematic assessment of needs rather health outcomes e.g. economic status, education, etc.
than the subjective view of the health worker
4) What procedures of techniques will be needed
MAIN to effect the desired changes?
ELEMENTS - Based on the answers to the first 3 questions
Health Policy Health Policy - Effectiveness and - Decision-making by both professionals and
implications of community itself
implemented
regulatory 5) What data are needed for program management
measures and evaluation?
Health and Health Service - Statistical indices - Data necessary for management of cases,
Environmental Provision and e.g. morbidity, accounting purposes and assessment of the program
Services Impact mortality, etc.
Social Services (Health - e.g. health 6) What methods of data gathering, recording and
Disease, indices) improvement processing are needed?
disability, death programs ! INCORPORATE 4-6: Primary, secondary data,
Socio- Socio- - Extent of Qualitative vs. Quantitative, etc.
Economic ecological economic activity &
Environment environment unemployment, car 7) To what extent is the program accomplishing its
Physical ownership, objectives?
Environment housing, transport, - Checked at regular intervals
air pollution, etc. - Is the program making a difference? Encouraging
Community The - Age and gender changes which Improve health status?
composition ‘Community’ profile, the way the
(demographics) community is
Community organized and its
organization & capacity to control
Structure its own health
Community
Capacity
! ! ! 3
RSMV
Process, Impact & Outcome Evaluation Schemes e.g. National Objectives for Health, 2005-2010
(Discussed in lecture but the following is from Naidoo - Information collection usually begins with the
& Wills, 2000) available ones of the year immediately preceding the
year when the analysis is being made (in our example,
Process Evaluation data collected from1999-2004 was used in planning for
- Formative or illuminative evaluation 2005-2010).
-Concerned with assessing the process of program - The same set of information for Year 1 must be
implementation (step by step monitoring; tedious) collected as they occurred in the last year ! used for
- Addresses participants perceptions and reactions to estimating trends
health promotion interventions
- Acceptability, integrity, quality of health program e.g. A 4 year plan
- Methods: interviews, diaries, etc. - Year 0: The year during which the plan is being
e.g. 5 year program ! all throughout (e.g. yearly formulated
intervals) - Year 1, Year 2, Year 3, etc.: The past years
- Year 4: the last year is called the planning horizon
Impact Evaluation
Impact – the immediate effects such as increased Levels of Analysis
knowledge or shifts in attitude Community ! District ! Provincial ! Regional !
- Tends to be the most popular choice, as it is easier National
to do
- Can be built into a program as the end stage Analysis of Population
- Can assess difference between end results and - Composition, geographical distribution and the
baseline differences in the magnitude of certain selected vital
- Measure efficiency and effectiveness indices* among different geographical areas.
- Were objectives reached? - Provides the necessary basis for computation of
e.g. 5 year program ! Impact analysis done in Year 5 disease occurrence rates and accomplishment of
programs.
Outcome Evaluation - Includes Total population, age and sex structure,
Outcome – the longer-term effects such as changes in population projection (annual rate of pop. increase)
lifestyle - Sources of data: censuses, vital statistical reports,
- More difficult as it involves monitoring and surveys
assessment of behavior change *Crude birth rate, death rate, natural growth rate, infant
- More complex and costly mortality, maternal mortality, etc. " can be used to
- Often the preferred evaluation method as it measures assess health status inequality among different
sustained changes that have stood the test of time geographical areas
- e.g. 5-year program ! 10, 15 years later
Analysis of Health Status
e.g. Evaluation in CO-PAR - Includes Leading causes of mortality, morbidity,
- In between Phases = Process infant/maternal mortality, hospital admission/use,
- End of program = Impact consultation
- Several years after CO-PAR exposure = Outcome - May include lists of important causes of disease e.g.
endemic diseases in certain areas
Situational Analysis - May group together similar morbidities e.g. Upper
! Diagnosis of health situation by collection of current Respiratory infections ! includes pneumonia,
data and examining the status of the different bronchitis, etc.
components of the Health Ensemble (below) - Sources of data: surveys, research, statistical
- Health Status = Interaction of Health Sector + reports
Population + Health related SE factors
Analysis of Related Socioeconomic Factors
Health Sector** - Broad category; almost everything relates to health
Health ! need to be very selective
Status Population - Includes:
- Economic Indices (GNP, unemployment, active
!
workforce %)
Health-related - Social Indices (communication and transport,
Socioeconomic education, housing, electrification)
Factors - Environmental indices (safe water supply, human
! waste disposal, industrial waste disposal, food
- Provides the basis for: establishments)
1) Describing the current health situation - Nutritional Status (average calorie/protein intake
2) Making a forecast of the future status compared to minimum requirements, level of iron-
3) Identifying the problems, gaps and seeking deficiency anemia among pregnant women)
explanations for their occurrence
! ! ! 4
RSMV
- Sources of data: relevant govt agency/department,
annual reports, surveys, national development plan
Sources
- Community Health Handbook (Revised May 2011)
- Dr. Pinedaʼs lecture (2014)
- Jimenez, Sr. Carmen, (2005),
Community Organizing Participatory Action Research (CO-PAR) for
st
Community Health Development (1 ed), Paranaque, Philippines .
- Naidoo J, Wills J. (2000) Health Promotion: Foundations for
Practice. 2nd ed. Edinburgh.
! ! ! 5
RSMV
CO-PAR Framework
Phases Activities
- Community consultations/dialogues
- Setting of issues/considerations related to site selection
- Development of criteria for site selection
Pre – entry phase - Site selection
- Preliminary social investigation (PSI)
- Networking with local government units (LGUʼs), NGOs, and
government agencies.
- Integration with the community
- Sensitization of the community/information campaigns
- Continuing social investigation
Entry phase - Core group (CG) formation
• Development of criteria for selection of CG members
• Defining the roles/functions/tasks of the CG
- Coordination/dialogue/consultation with other community organizations
- Self-awareness and leadership training(SALT)/action planning
- Selection of the research team
- Training on data collection methods and techniques/capability-building
(includes development of data collection tools)
Community study/diagnosis phase - Planning for the actual gathering of data
(Research phase) - Data gathering
- Training on data validation (includes tabulation and preliminary
analysis of data)
- Community validation
- Presentation of the community study/diagnosis and recommendations
- Prioritization of community needs/problems for action
- Community meetings to draw up guidelines for the organization of the
community health organization (CHO).
- Election of officers
- Development of management systems and procedures, including
Community Organization and Capability – delineation of the roles, functions and tasks of officers and members of
Building Phase the CHO
- Team building/Action-Reflection-Action (ARA)
- Working out legal requirements for the establishment of the CHO
- Organization of working committees/task groups (e.g., education and
training, membership of committees)
- Training of the CHO officers/community leaders
- Organization and training of community health workers (CHWs)
• Development of criteria for the selection of CHWs
• Selection of CHWs
• Training of CHWs
Community Action Phase - Setting up of linkage/network referral systems
- PIME (planning, implementation, monitoring and evaluation) of health
services/intervention schemes and community development projects
- Initial identification and implementation of resource mobilization
schemes
- Formulation and ratification of constitution and by-laws
- Identification and development of “secondary” leaders
- Setting up and institutionalization of financing scheme for community
health program/activities
Sustenance and strengthening phase - Formalizing and institutionalization of linkages, networks and referral
systems
- Development and implementation of viable management systems and
procedures, committees, continuing education/training of leaders,
community health workers, community residents
! ! ! 6
RSMV
LEC 4. Learning + Communication Example:
RED = from lecture Smoking
BLACK = Community Med Handbook Pre- Introduction/No intro Not aware of
Contemplation to new concept no hazards of
Learning: four things to consider intention on changing cigarette
- Information behavior smoking,
- Requirement for information dedma
Contemplation Aware a problem Considers
- Requirement for skills
exists, no pros/cons of
- Requirement for behavior commitment to action quitting
Preparation Think of ways to Telling
Three Domains of Learning into Action change behavior w/ others that
- Cognitive, Affective, Psychomotor intent on taking he plans to
- Can be converted into objectives or questioning action quit
(i.e. cognitive/affective/psychomotor objectives or (accountabi-
questions lity)
Action Active modification of Stops
1) Cognitive (Knowledge) behavior smoking;
- Learning (acquiring information) uses
- Knowledge (facts, truths, principles) nicotine
gum, patch
Bloom’s Taxonomy of Educational Objectives Maintenance Termination: Quit
Knowledge Naming, defining, listing, Sustained change smoking
identifying (old new) successfully
Comprehension Explaining, describing, interpreting Relapse: Return to Go back to
Application Illustrating, predicting, applying old behaviors smoking
Analysis Analyzing, categorizing,
classifying, differentiating 3) Psychomotor (Skills)
Synthesis Concluding, proposing, - Physical skills (application of accumulated knowledge
synthesizing & attitudes)
Evaluating Contrasting, comparing, evaluating
Sources