Running head: COMMUNITY ASSESSMENT 1

Community Assessment
Team Nine
Ferris State University










COMMUNITY ASSESSMENT 2

Abstract
A community health assessment is a systematic process that may use several approaches
including analysis of data on health status and health behavior indicators, observation, and
community services (Harkness & DeMarco, 2012, p. 136). The purpose of our community
health assessment is to gain an understanding of the high prevalence of two specific sexually
transmitted infections (STIs) in Mecosta County. Using data, observation, and health behavior
indicators, we developed a community nursing diagnosis to address the communitys needs
regarding the issue of STI prevalence. A full assessment is provided regarding the specific
county and resources available. Nursing interventions can be found in Appendix A.














COMMUNITY ASSESSMENT 3

Community Assessment
Analysis of Data
Benchmarks
The number of chlamydia cases in Mecosta County in 2011 was 121 cases. In the entire
district, there were 541 cases reported (District Health Department #10, 2012). This means that
Mecosta County reported 22.4% of the cases within the ten counties that make up the district.
There were only 7 gonorrhoea cases reported in 2011 in Mecosta County, with 30
reported in the entire district (District Health Department #10, 2012). That makes the Mecosta
County again reporting at nearly a quarter the cases at 23.3%.
Contributing/Causative Factors
Factors that would increase the number of cases in Mecosta County would be the
presence of the university and the poverty level of the county.
According to Koumans et al., (2005), there are approximately 15 million students
attending one of the 4,048 colleges and universities in the United States. More than half of these
are between 18 and 24 years. With this age group, most students are living away from home
and adult supervision for the first time, and often engage in high-risk sexual behaviors, have
multiple partners, and have sex without a condom (Koumans et al., 2005).
There are many reasons people choose to have unprotected sex. In a study performed by
MacDonald et al., (1990), people reported that the number of sexual partners one has influences
the decision. People are embarrassed to purchase condoms and have difficulty discussing the use
of condoms with their partner. If the woman is on some other form of birth control, they are less
likely to use condoms. There was found to be a lack of knowledge about sexually transmitted
COMMUNITY ASSESSMENT 4

diseases and the belief that condoms interfered with the sexual pleasure of intercourse
(MacDonald et al., 1990).
In 2010, Mecosta County was ranked the 11
th
poorest county in Michigan by USA.com
(2010). There are 83 counties in Michigan (SOM-Michigan Counties List, 2013). That means
72 counties have residents with a higher average income than Mecosta County.
Theory
The Systems Theory states that the community is a system of human activity conducted
within the context of the social and ecological environment (Harkness & DeMarco, 2012, p.
137). This means each family, neighborhood, school, job, anywhere one person interacts with
another is itself a system with its own boundaries, rules, and purpose. Since one person is a
member in multiple systems, each system overlaps, making it so that any change in one system
will affect another.
According to Harkness and DeMarco (2012), This interconnectedness means that health
problems identified at the local community level often have causes or contributing factors that
originate in the broader social, economic, environmental, or political systems (p. 137). This
also involves the health of individual people and families who are affected by the circumstances
within the community or other system levels (Harkness & DeMarco, 2012, p. 137). As discussed
with the contributing factors, because Mecosta County houses a university, that makes the
county at higher risk for STDs.
Groups Affected
It was found that 50% of chlamydia and gonorrhea infections are reported in those
between the ages of 15 and 24 years. People 21-24 years old may not have a regular source
of healthcare, unless their employment provides health insurance or unless they attend a college
COMMUNITY ASSESSMENT 5

or university with some healthcare services (Koumans et al., 2005). The Center for Disease
Control and Prevention (2012) estimated that 1 in 15 sexually active females aged 14-19
years has chlamydia.
Existing Resources
The resources available in Mecosta County include family planning, the public health
department office, doctors offices, as well as Planned Parenthood. The public health department
offers a STD Control Program. This program works to limit the number of STD cases, prevent
complications from STDs, and ultimately eradicate the spread of STDs through the community
(District Health Department #10, 2012).
The importance of these resources is not fully appreciated by the population because they
are uneducated about STDs. Some people may not know that the infections can be transmitted,
not only through vaginal intercourse, but also through anal and oral sex, exchanging blood, and
through shared needles. STDs can also pass to the infant during birth or through breastfeeding
from the mother (District Health Department #10, 2012). It is vital for people to make
appointments if they are experiencing any of the signs or symptoms of an STD or get themselves
and their partner tested in order to prevent the spread of an STD.
Resource Adequacy
These resources would be considered adequate if they were utilized in the manner
intended. The reason the community is not using them adequately is either they dont know
about the services or they do not qualify for free services. Therefore, they do not get tested or
treated for the STD. They also may not know they are infected, some STDs are asymptomatic.
Also, if theyve only been with one partner, they could simply trust their partner not to have an
STD.
COMMUNITY ASSESSMENT 6

Information about the cost, coverage, and prevention of diseases is not prevalent to the
community. This is a problem because it causes the community to be uneducated about the
spread of STDs and unwillingness to get tested or treated.
Evidence for Community Nursing Interventions
According to District Health Department #10 (2012), the average chlamydia cases
reported in Mecosta county from 2006 to 2010 was 102 cases. The number of cases reported
only in the year 2011 was 121 cases. The number of cases reported of gonorrhoea decreased
from an average of 10 cases to 7 cases in 2011 (District Health Department #10, 2012). When
looking at this decline, however, it must be taken into account that the 10 cases were averaged
over four years. So, the amount of cases per individual year could possibly have increased.
Because of the potential detrimental complications of STDs if left untreated, this health
problem should be addressed by community nurses. For example, chlamydia can easily be
treated with either a single dose of antibiotics or a 7 day treatment regimen. If left untreated, it
can lead to pelvic inflammatory disease, PID, and can affect a womans ability to have children,
and can be passed to the infant during delivery (Center for Disease Control and Prevention,
2012).
Disciplines Involved
The Center for Disease Control implemented STD programs in order to help develop the
Comprehensive STD Prevention Systems. The program guidelines provide a resource to assist
in the design, implementation, and evaluation of STD prevention and control programs
(Harkness & DeMarco, 2012, p. 260). Local and state health officers, epidemiologists, and
departments or boards of health use the STD programs to determine which STDs and which
COMMUNITY ASSESSMENT 7

accompanying case data should be mandated according to local needs and priorities (Harkness
& DeMarco, 2012, p. 260).
Community Group Resources
There are many community resources that address the prevention and spread of STDs.
Because Mecosta County is the home of Ferris State University, there have been numerous
seminars for incoming freshmen as well as the Birkam Health Center that offer education on
many STDs.
One thing that could help prevent the spread of STDs is advertising locations where one
can get free condoms and free or reduced cost testing. Both Planned Parenthood and the District
#10 Health Department office offer condoms to their clients.
Problem Statement
Based on the analysis of Mecosta County, we developed a community nursing diagnosis
to address the prevalence of STDs throughout the community. Our community nursing diagnosis
is as follows: People ages 20-24 living in Mecosta County are at risk for sexual transmitted
disease, specifically gonorrhoea and Chlamydia, related to social, economic, and behavioural
factors, as evidenced by a rise in these specific STDs over past years. Our problem statement
focuses on males and females in the age ranges of 20 to 24 years of age. Furthermore, 19
million new cases of STIs are reported each year in the United States alone, with almost half of
the cases occurring in young people aged 15 to 24 years (Harkness & DeMarco, 2012, p. 252).
We chose to focus on individuals in this age bracket because the presence of the university
allows for a large number of individuals to fall into this age range. We are addressing the health
risk of two specific sexually transmitted infections: gonorrhoea and Chlamydia. As referenced
above in the Contributing/Causative Factors paragraph, the presence of a university and the
COMMUNITY ASSESSMENT 8

poverty level within the community contribute to the high prevalence of STIs throughout
Mecosta County.
If the interventions in Appendix A are successfully carried out, the amount of cases of
Chlamydia and gonorrhoea should decrease. With our interventions, we would hope to see a rise
in the number of STI screenings. We would also consider seeing a higher number of individuals
in this age bracket reporting that they use a condom during sex.
SMART Objectives
After analysis of the communitys strengths, weaknesses, existing agencies, and possible
barriers, SMART objectives were derived regarding Mecosta County. SMART is an acronym
for program objectives that are specific, measurable, achievable, realistic, and time bound
(Harkness & DeMarco, 2012, pg. 148). Programs that are written in the SMART goal format can
help in planning interventions and establishing measurement systems to evaluate programs
and outcomes (Harkness & DeMarco, 2012, pg. 148). Based on this format Mecosta Countys
SMART goals are as follows: The number of cases of Chlamydia for both sexes will decrease
from 50 cases per year to 25 cases per year by 2015. Furthermore, the number of cases of
gonorrhea for both sexes will decrease from seven cases per year to zero cases per year by 2015.
In order to accomplish these goals community health nurses need to provide a broader
sense of education of gonorrhoea and Chlamydia to people living in Mecosta County ages 20-24
in order to lessen the social stigma of having, treating or talking about a sexually transmitted
disease, lessen the rate of occurrence, and provide health promotion interventions.



COMMUNITY ASSESSMENT 9

References
Centers for Disease Control and Prevention. (2012). Chlamydia-CDC fact sheet. Sexually
Transmitted Diseases. Retrieved from: http://www.cdc.gov/std/chlamydia/stdfact-
chlamydia.htm
District Health Department #10. (2012). Mecosta county. Health Profile Chartbook 2012.
Retrieved from: http://dhd10.org/images/Mecosta_Chartbook_2012_April_2_2013.pdf
District Health Department #10. (2012). Sexually transmitted diseases. Retrieved from:
http://www.dhd10.org/sexually-transmitted-diseases-stds
Harkness, G. & DeMarco, R. (2012). Community and public health nursing: Evidence for
practice. Philadelphia, PA: Lippincott, Williams, & Wilkins.
Koumans, E., Sternberg, M., Motamed, C., Kohl, K., Schillinger, J., & Markowitz, L. (2005).
Sexually transmitted disease services at US colleges and universities. Journal Of
American College Health, 53(5), 211-217.
MacDonald, N., Wells, G., Fisher, W., Warren, W., King, M., Doherty, J., et al. (1990). JAMA
Network | High-Risk STD/HIV Behavior Among College Students . JAMA | The Journal
of American Medical Association. Retrieved from:
http://jama.jamanetwork.com/article.aspx?articleid=382233.
Michigan Median Household Income County Rank Based on ACS 2006-2010 data*. (2010).
USA.com : Location information of the United States. Retrieved from:
http://www.usa.com/rank/michigan-state--median-household-income--county-
rank.htm?yr=3000&sb=ASC&tag=Poorest+Counties+by+Income+in+MI
SOM-Michigan Counties List. (2013). SOM-State of Michigan. Retrieved from:
http://www.michigan.gov/som
COMMUNITY ASSESSMENT 10

Appendix A
Assess the ability of the community to learn and the barriers currently blocking education
It is important to determine the knowledge the community already has on Chlamydia and
gonorrhea
Build on what the community already knows.
Present the most important information first. Using visual aids is always helpful for both
sides.
Teaching the screening process; how it is done, by who, where, and what the screening is
like for people going through it. Allow for questions and concerns, answer honestly and
use therapeutic communication as necessary.
To provide information about symptoms, diagnosis, and treatment of Chlamydia and
gonorrhea to the public. The point of this intervention is to go out into the community to
spread knowledge.
Surveys can be used to obtain opinions on the videos effect on their sexual behaviors and
attitudes. The effectiveness of these videos can also be evaluated by looking at the
changes in the incidence and prevalence rates after a year.
Mobilize support in obtaining resources
Writing grants for funding community programs
Increase collaboration and coordination between public health and community partners