CHAPTER 2

Theoretical Foundations 
of Community Health 
 OBJECTIVES

1. Describe different theories and their application to community/public health nursing.

2. Critique a theory in regard to its relevance to population health issues.
3. Explain how theory-based practices achieves the goals of community/public health nursing by
protecting and promoting the health of the public.
 History

– - Florence Nightingale was the first nurse to formulate a conceptual foundation for nursing
practice
– - Nola Pender developed the Health Promotion Model (1980), which was revised in 1996.
 THE GOAL OF 
THEORY IS TO 
IMPROVE NURSING 
PRACTICE
What is a theory?

– A systemic vision of reality; a set of interrelated concepts that is useful for

prediction and control. (Woods & Catanzaro, 1988)
– A conceptual system or framework invented for some purpose; and as the
purpose varies, so too must the structure and complexity of the system. (Dickoff
& James, 1968)
– A creative and rigorous structuring of ideas that projects a tentative, purposeful
and systematic view of phenomena. (Chinn & Kramer, 1999)
GENERAL SYSTEMS THEORY

– 1ST of the theories taken up in this section

– Being the basis
– Applicable to the different levels of the community health nurse’s client:
– INDIVIDUALS
– FAMILIES
– GROUPS OR AGGREGATES
– COMMUNITIES
GENERAL SYSTEMS THEORY

– Open system
– Client is considered as a set of interacting elements that exchange energy, matter, or
information w/ the external environment to exist.
Individual
is a set of several dimensions: physical, psychological, social and spiritual, that are
interdependent and interrelated.
Family/Group/Aggregate
set of interrelated individuals
Geographic community
set of families
GENERAL SYSTEMS THEORY

– the family has the basic structures that all open systems have
– Boundaries – separate it from its environment
– Culture & Family Code – dictate the boundaries of the Filipino family
– The family gets inputs of:
– Matter (food,water)
– Energy (sunlight, electricity)
– Information (news on community events, health teachings)
These are resources taken from its environment~
GENERAL SYSTEMS THEORY

– Outputs refer to material products, energy and information that may result
from the family’s processing (throughput) of inputs.
– Example. Health practices and the health status of family members are output

– Feedback is information from the environment directed back to the system.

– Subsystems, components of systems, interact to accomplish their own purpose
for which the system exists.
– Suprasystems, such as the community, is a bigger system composed of families.
SOCIAL LEARNING THEORY 
AND MODELS
– Community health nurses may use when planning for health promotion and
disease prevention.
– MODELS
– Health Belief Model
– Millio’s Framework for Prevention
– Nola Pender’s Health Promotion Model
– Transtheoretical Model
– Lawrence Green’s PRECEDE-PROCEED Model
SOCIAL LEARNING THEORY

– Discovered By Albert Bandura

– Based on the belief that learning takes place in a social context
– Learning is promoted by modeling or observing other people
– Nurse applies this theory in different ways:
– by serving as a live model (demonstrating infant care procedures)
– By giving detailed verbal instruction (teaching a patient how to collect an early
morning sputum specimen)
– By using a print or multimedia strategies for health education
THE HEALTH BELIEF MODEL

– Initially proposed in 1958

– Developed by a group of social psychologist (why the public failed to participate
in screening for tuberculosis)
– Basis on the practice of health education and health promotion
– HBM is based on the assumption that the major determinant of preventive
health behavior is disease avoidance.
THE HEALTH BELIEF MODEL

– HBM is used by the nurse to determine clients’ misperceptions that serve as

barriers to appropriate health action.
– HBM does not challenge the nurses to examine the root causes of health
opportunities and behaviors in the communities we serve.
– HBM has several constructs: perceived severity, perceived susceptibility,
perceived benefits of treatment, perceived barriers to treatment, cues to action,
and self-efficacy.
THE HEALTH BELIEF MODEL

– Key concepts and Definitions of the HBM

CONCEPT DEFINITION
Perceived susceptibility One’s belief regarding the chance of
getting a given condition
Perceived severity One’s belief regarding the seriousness of
a given condition
Perceived benefits One’s belief in the ability of an advised
action to reduce the health risk or
seriousness of a given condition
Perceived barriers One’s belief regarding the tangible and
psychological costs of an advised action
THE HEALTH BELIEF MODEL

– Key concepts and Definitions of the HBM

CONCEPT DEFINITION
Cues to action Strategies or conditions in one’s
environment that activate readiness to
take action
Self-efficacy One’s confidence in one’s ability to take
action to reduce health risks
 Individual Perceptions
Perceived susceptibility
to disease “X”
Perceived seriousness
(i.e., severity) of Disease
“X”
Modifying factors Likelihood of Action
Demographic variables (age, sex, Perceived benefits of preventive
race) action
Sociopsychological variables
(personality, social class, peer) Minus
Structural variables (knowledge about
disease and prior contact with the Perceived barriers to preventive
disease) action
Likelihood of taking
Perceived threat of disease “X” recommended preventive
health action
Cues to action
Mass media campaigns
Advice from others
Reminder postcard from physician or
dentist
Illness of family member or friend
Newspaper or magazine article
MILIO’S FRAMEWORK FOR 
PREVENTION
– 1976
– Provides a complement to the HBM
– Provides a mechanism for directing attention upstream and examining
opportunities for nursing intervention at the population level
– Nancy Milio outlined 6 propositions that relate an individual’s ability to improve
healthful behavior to a society’s ability to provide accessible and socially
affirming options for healthy choices.
MILIO’S FRAMEWORK FOR 
PREVENTION
– MILIO’S PROPOSITION SUMMARY
1. Population health deficits’ result from deprivation and/or excess of critical
health resources.
2. Behaviors of populations result from selection from limited choices; these
arise from actual & perceived options available as well as beliefs and
expectations resulting from socialization, education and experience.
3. Organizational decisions and policies (governmental and nongovernmental)
dictate many of the options available to individuals and populations and
influence choices.
MILIO’S FRAMEWORK FOR 
PREVENTION
4. Individual choices related to health promotion or health damaging behaviors
are influenced by efforts to maximize valued resources.
5. Alteration in pattern of behavior resulting from decision making of a significant
number of people in a population can result in social change.
6. Without concurrent availability of alternative health-promoting options for
investment of personal resources, health education will be largely ineffective
in changing behavior patterns.
PENDER’S HEALTH 
PROMOTION MODEL
– Developed by Nola Pender (1980), revised in 1996
– Explores many biopsychosocial factors that influence individuals to pursue
health promotion activities.
– The model does not include threat as a motivators, as threat may not be a
motivating factor for clients in all age groups.
– there are 13 theoretical statements in the model
PENDER’S HEALTH 
PROMOTION MODEL
Individual characteristics and experiences Each person’s unique characteristics and
experiences affect his or her actions.
Prior related behavior Includes perceived self-efficacy, benefits,
barriers, and affects related to activity. Habit
can also indicates future behavior
Personal factors It may influence behavior
-Biological factors (age, body mass index,
strength, agility)
-Psychological factors (self-esteem, self-
motivation)
-Sociocultural factors (race, ethnicity,
education, socioeconomic status)
PENDER’S HEALTH 
PROMOTION MODEL
Behavior-specific cognitions and affect
Perceived benefits of action
Perceived barriers to action
Perceived self-efficacy
These variables are very significant to the
behavior motivation.
These are strong motivators of that behavior.
-intrinsic benefits (increased energy and
decreased appetite)
-extrinsic benefits (social rewards,
compliments, monetary rewards)
Barriers are perceived unavailability,
inconvenience, expense, difficulty, or time
regarding health behaviors.
Self-efficacy is one’s belief that he or she is
capable of carrying outa health behavior.
PENDER’S HEALTH 
PROMOTION MODEL

Activity-related affect The feeling associated with behavior will

likely affect whether an individual will repeat
or maintain the behavior.
Interpersonal influences These are feeling/thoughts regarding the
beliefs or attitudes of others. Primary
influences are family, peers, and health care
providers
Situational influences These are perceived options available,
demand characteristics and aesthetic
features of the environment where the
behavior take place
PENDER’S HEALTH 
PROMOTION MODEL
Commitment to plan of action
Immediate competing demands and
preferences
Health- promoting behavior
this commitment will compel one into the
behavior until completed, unless a
competing demand or preference
intervenes.
These are alternative behaviors that one
considers as possible optional behaviors
immediately prior to engaging in the
intended, planned behavior.
This is the goal or outcome of the HPM. The
aim of the health-promoting behavior is the
attainment of positive health outcomes.
THE TRANSTHEORETICAL 
MODEL
– Combines several theories of intervention, thus the name transtheoretical
– Based on the assumption that behavior change takes place over time,
progressing through a sequence of stages.
– people resist change for many reasons
– Unpleasant
– Require giving up pleasure
– Painful
– Stressful
THE TRANSTHEORETICAL 
MODEL
– Jeopardize social relationships
– Not seem important anymore
– Require change in self-image
THE TRANSTHEORETICAL 
MODEL
– STAGES OF CHANGE
– Precontemplation
– no intention to take action in the next 6 months
– Lack of information
– Failure on previous attempts
– Contemplation
– Some intention to take action in the next 6 months
– Weighing pros and cons
THE TRANSTHEORETICAL 
MODEL
– Preparation
– Intends to take action in the next 6 months
– Has taken steps toward behavior change
– Has plan of action
– Action
– Changed overt behavior less than 6 months
– Reduce risk of disease
THE TRANSTHEORETICAL 
MODEL
– Maintenance
– Changed over behavior more than 6 months
– Strives to prevent relapse
– Phase may last months to years
– DECISIONAL BALANCE
– Pros – benefits of behavior change
– Cons – costs of behavior change
 Stable improved
Action
Preparation lifestyle
(making changes)

Thinking Maintenance
(contemplation)

Relapse
No thinking
(precontemplation)
PRECEDE­PROCEED MODEL

– Developed by Dr. Lawrence W. Green & colleagues

– Model for community assessment, health education, planning and evaluation
– Predisposing
– Reinforcing
– Enabling Used for community
– Constructs in diagnosis

– Educational
– Diagnosis
– Evaluation
PRECEDE­PROCEED MODEL

– Policy
– Regulatory
– Organizational Model for
– Constructs in implementing and
evaluating health
– Educational programs
– Environmental
– Development
PRECEDE­PROCEED MODEL

– Predisposing factors
– People’s characteristics that motivate them toward health-related behavior
– Enabling factors
– Condition’s in people and the environment that facilitate or impede health-related
behavior
– Reinforcing factors
– Feedback given by support persons/groups resulting from the performance of the
health-related behavior
PRECEDE­PROCEED MODEL

– STEPS
1. SOCIAL DIAGNOSIS
– defined by community in terms of unemployment, days lost from work or school,
family disruption, and other dimensions.
2. EPIDEMIOLOGICAL DIAGNOSIS
– Defined by health professionals in terms of morbidity, mortality., fertility, etc.
3. BEHAVIORAL DIAGNOSIS
– Defined in terms of timing, frequency, quality, range and duration.
PRECEDE­PROCEED MODEL

– STEPS
4. EDUCATIONAL DIAGNOSIS
– These factors need to be analyzed for each behavior
5. ADMINISTRATIVE DIAGNOSIS
– Interventions are matched with educational and behavioral objectives from steps 3
and 4, budgeted, sequenced, and coordinated.
 Health Education Components of Community Health

Training and community Indirect communications:

Direct Communication
organization training, consultation, etc

PREDISPOSING FACTORS ENABLING FACTORS REINFORCING FACTORS

Attitudes Skills Support from family, peers,
Beliefs Availability teachers, employers,
Values Accessibility health care providers
Referrals

Motivation Facilitation Reinforcement

BEHAVIORAL CAUSES

Environmental factors
Health Problem

Social problem Nonhealth factors

 CHAPTER 3
PRIMARY
HEALTH CARE
 OBJECTIVES

1. Define primary health care (PHC)

2. Explain the definition of health by the WHO
3. Outline the historical background of PHC
4. Enumerate the key principles of PHC
5. Relate the application of the PHC key principles in the implementation of public health programs
HISTORY

– September 6-12, 1978

– Health leaders from around 200 countries attended the International Conference for
Primary Heath Care held at Alma Ata, USSR initiated by WHO and United Nations
Children’s Fund.
– Alma Ata Conference made the ff declarations:
1. Health is a basic fundamental right
2. There exists global burden of health inequalities among populations
3. Economic and social development is basic importance for the full attainment of
health for all.
4. Governments have a responsibility for the health of their people
HISTORY

– Letter of Instruction (LOI) 949 of 1979

– Philippines is the 1st country in Asia to embark on meeting the challenge of PHC
– President Marcos signed the LOI 949 that has an underlying theme, “Health in
the Hands of the People by 2020”.
What is Primary Health Care?

– It is the essential health care based on practical scientifically sound and socially
acceptable methods and technology made universally accessible to individuals
and families in the community through their full participation and at a cost that
the community and country can afford to maintain at every stage of their
development in the spirit of self-reliance and self-determination.
– (Alma Ata Declaration)
The universal goal is “health for 
all” by the year 2000
– 3 main objectives
– Promotion of health lifestyles;
– Prevention of disease; and
– Therapy for existing conditions
5 key elements in achieving the 
goal “health for all” by WHO
– Reducing exclusion and social disparities in health
– Organizing health services around people’s needs and expectations
– Integrating health into all sectors
– Pursuing collaborative models of policy dialogue
– Increasing stakeholder participation
8 essential health services by 
Alma At Declaration
– Education for health
– Locally endemic disease control
– Expanded program for immunization
– Maternal and child health including responsible parenthood
– Essential drugs
– Nutrition
– Treatment of communicable and noncommunicable diseases
– Safe water and sanitation
KEY PRINCIPLES OF PHC

– Accessibility, affordability, acceptability, and availability (4As)

– Support mechanisms
– Multisectoral approach
– Community participation
– Equitable distribution of health resources
– Appropriate technology
4A’s of PHC

1. ACCESSIBILITY
– Physical distance of a health facility of the travel time required for people to get the
needed or desired health services
– Must be 30 minutes from the communities
2. AFFORDABILITY
– Particularly for public health services
– Community and government can afford these services
– Out-of-pocket expenses for health care
4A’s of PHC

3. ACCEPTABILITY
– Health care offered is in consonance with the prevailing culture and traditions of the
population
4. AVAILABILITY
– basic health services required by the people must be offered in the health care
facilities
HEALTH PROGRAMS

– Botika ng Bayan and the Botika ng Barangay

– “Ligtas sa Tigdas ng Pinas” mass measles immunization campaign
SUPPORT MECHANISMS

– Sources for the essential health services come from 3 MAJOR ENTITIES
– The people themselves
– The government
– Private sector like NGOs and socio-civic and faith groups
MULTISECTORAL APPROACH

– PHC requires communication, cooperation and collaboration within and among

various sectors
– Intrasectoral linkages
– Communication, cooperation and collaboration between the health sector: among
the members of the health team and among health agencies
– Intersectoral linkages
– Communication, cooperation and collaboration between the health sector and other
sectors of society like education, public works and agriculture and local government
officials.
COMMUNITY 
PARTICIPATION
– An educational and empowering process in which people in partnership with
those who are able to assist them, identify the problem and the needs and
increasingly assume responsibilities themselves to plan, manage, control and
assess the collective actions that are proved necessary
EQUITABLE DISTRIBUTION 
OF HEALTH RESOURCES
– Accdg to the Health Manpower Development and Training Services, the
Philippines has an oversupply of graduates of medicine and nursing, but they
tend to flock to the urban rather than to the rural areas
– Health-reacted college programs prefer to work abroad than to stay in the
country
2 PROGRAMS TO ENSURE EQUITABLE 
DISTRIBUTION F MANPOWER TO THE RURAL
AREAS

– Doctor to the Barrios (DTTB) Program

– Registered Nurses Health Enhancement and Local Service (RN HEALS)
APPROPRIATE TECHNOLOGY

– Technology (applied science)

– Health technology (tools, drugs, methods, procedures, techniques)
– Appropriate technology (technology that is suitable to the community that will
use it)
– Also known as “people’s technology” and “indigenous technology”
APPROPRIATE TECHNOLOGY 
CRITERIA
1. SAFETY (more positive outcomes than negative effects)
2. EFFECTIVENESS (must be accomplish what it is meant to accomplish)
3. AFFORDABILITY (cost-effective)
4. SIMPLICITY (simple materials, simple methods and must be adapt by the
community easily)
5. ACCEPTABILITY (effective only when it is used by those who need it)
6. FEASIBILITY AND RELIABILITY (easy to apply)
7. ECOLOGICAL EFFECTS (helps the ecology)
8. POTENTIAL TO CONTRIBUTE TO INDIVIDUAL AND COMMUNITY DEVELOPMENT
TRADITIONAL AND 
ALTERNATIVE HEALTH CARE
– RA 8423 (Traditional and Alternative Medicine Act of 1997)
– Traditional Medicine
– Is the sum total of knowledge, skills and practice on healthcare, not necessarily
explicable in the context of modern, scientific philosophical framework, but
recognized by the people to help maintain and improve their health towards the
wholeness of their being, the community and society, and their interrelations based
on culture, history, heritage and consciousness
TRADITIONAL AND 
ALTERNATIVE HEALTH CARE
– Alternative health care modalities
– Other forms of nonallopathic, occasionally nonindigenous or imported healing
methods, though not necessarily practiced for centuries not handed down from one
generation to another.
10 MEDICINAL PLANTS BY 
DOH
MEDICINAL PLANTS USE/INDICATION PREPARATION
Lagundi Asthma, cough, colds, fever, Decoction; wash affected site
dysentery, pain, skin with decoction
diseases, wounds
Terba Buena Headache, stomachache, Decoction; Infusion; Massage
cough, colds, rheumatism, sap
arthritis
Sambong Antiedema/Antiurolithiasis Decoction
Tsaang gubat Diarrhea, stomachache decoction
Niyog-niyogan Anthelminthic Seeds are used
Bayabas Washing wounds, Diarrhea, Decoction
gargle, toothache
10 MEDICINAL PLANTS BY 
DOH
MEDICINAL PLANTS USE/INDICATION PREPARATION
Ulasimang bato/Pansit- Lowers blood uric acid, Decoction; eating raw
pansitan rheumatism, gout
Akapulko Antifungal Poultice
Bawang Hypertension, lowers blood Eating raw; fried; apply on
cholesterol, toothache part
Ampalaya Diabetes mellitus (mild non- Decoction; steamed
insulin-dependent)
MEDICINAL PLANT 
PREPARATIONS
PREPARATION PROCEDURE
Decoction Boil for 20 mins
Infusion Soaked in hot water about 10-15 mins
Poultice Directly apply on the part affected such as
wounds, bruises or rashes
Tincture Mix plant material in alcohol
ALTERNATIVE HEALTH CARE 
MODALITIES PRACTICED
TERM DEFINITION
Acupressure Application of pressure on acupuncture
points without puncturing the skin
Acupuncture Using special needles to puncture on the
anatomical points on the body
Aromatherapy Aromatic oils are combined and applied to
the body
Chiropractic Healing that is concerned with pathogenesis,
diagnosis, therapy and prophylaxis of
functional disturbances effects related to the
static and dynamic of the locomotor system,
especially of the spine and pelvis
ALTERNATIVE HEALTH CARE 
MODALITIES PRACTICED
TERM DEFINITION
Herbal Medicine/ Phytomedicine Medicinal products that contain as active
ingredients aerial or underground parts of
the plant, may be crude state or as plant
preparations
Massage Soft parts of the body are rubbed, stroked,
kneaded or trapped for remedial, aesthetic,
hygienic or limited therapeutic purposes
Nutritional therapy Synonymous with nutritional healing, use of
food as medicine
Pranic healing A holistic approach of healing that follows
the principle of balancing energy
ALTERNATIVE HEALTH CARE 
MODALITIES PRACTICED
TERM DEFINITION
Reflexology Application of therapeutic pressure on the
body’s reflex points to enhance the body’s
natural healing mechanisms and balance
body function.
PRIMARY HEALTH CARE VS 
PRIMARY CARE
– PHC is a strategy for the delivery of health programs
– PC includes health promotion, disease prevention, health maintenance,
counseling, patient education and diagnosis and treatment of acute and chronic
illnesses in a variety of health care settings
– PC is performed and managed by a personal physician
PRIMARY HEALTH CARE VS 
PRIMARY CARE
DIFFERENCES BETWEEN PRIMARY HEALTH CARE AND PRIMARY CARE
POINT OF COMPARISON PHC PC
Focus client Family and community Individual
Focus of care Promotive and preventive Curative, provided by health
through community professionals
participation
Decision-making process Community-centered/ Health worker driven
consultative-participative
Outcome Self-reliance/ self-help Reliance on health
professionals to restore/
regain health
PRIMARY HEALTH CARE VS 
PRIMARY CARE
DIFFERENCES BETWEEN PRIMARY HEALTH CARE AND PRIMARY CARE
POINT OF COMPARISON PHC PC
Settings for services Rural-based satellite clinics, Most urban-based: hospitals,
community health centers, clinics
health posts that are
accessible to all
Goal Development and preventive Absence of disease
care
 CHAPTER 4

COMMUNITY ORGANIZING: ENSURING 
HEALTH IN THE HANDS OF THE PEOPLE
 OBJECTIVES

1. Define community organizing

2. Given a situation, illustrate the core principles of community organizing
3. Outline the steps to be taken in applying the community organizing approach in relation to
community health problems
4. Compare community organizing participatory action research to the traditional research
approach
 Community Organizing
 Is a process consists of steps or activities that instill and reinforce the
people’s self-confidence on their own collective strengths and
capabilities.
 It is the development of the people’s collective capacities to solve its own
problems and aspire for development through its own efforts.
 It entails harnessing and developing the community’s capacities to
recognize a community problem, identify and implement solutions, and
monitor and evaluate the efforts in resolving the problem.
 A process of educating and mobilizing members of the community to
enable them to resolve community problems.
 Community Organizing
 Community Organizing is teaching the community to apply the nursing
process on its own, utilizing resources that are available to it, thereby
allowing the community to be an active participant in the process of
development, rather than just being a passive recipient of services or
care.
 Community Organizing and community health nursing practice have
common goals:
• People empowerment
• Development of a self-reliant community
• Improved quality of life
3 Basic Values in Community Organizing:
1. Human Rights – are universally held principles anchored mainly on the belief in the
worth an dignity of people; these includes the right to life, self-determination, and
development as persons and as a people.
2. Social Justice – means equitable access to opportunities for satisfying people’s basic
needs and dignity; it requires an equitable distribution of resources and power
through people’s participation in their own development.
3. Social Responsibilities – is premised on the belief that people as social beings must
not limit themselves to their own concerns but should reach out to and move jointly
with others in meeting common needs and problems; society has the responsibility
to ensure an environment for the fullest development of its members.
 Community organizing is people-centered – the process of
critical inquiry is informed by and responds to the experiences
and needs of the marginalized sectors/people.
 Concerned with improving the quality of life in the different
dimensions of community – social, political, economic,
environmental, cultural, and spiritual.
 The educational processes are interactive, empowering both
the learners (the members of the community) and the
teacher (the nurse), leading to decision making that plays a
part in human development.
Core Principles 
in Community 
Organizing
 Community Organizing is participative – the community
is considered as the prime mover and determinant rather
than beneficiaries and recipients, of development
efforts, including health care.
 Community is an active participant, learning more from
what they do and experience, rather than from what is
said to them.
 Evident in the involvement of many people in community
activities

Core Principles 
in Community 
Organizing
 Community Organizing is democratic – it is the process that
allows the majority of people to recognize and critically
analyse their difficulties and articulate their aspirations.
– Their decisions must reflect the will of the whole, more so the
will of the common people, than that of the leaders and the
elite.
– Organizer and community leaders requires skills to effectively
process and manage conflicts.

Core Principles 
in Community 
Organizing
 Community Organizing is developmental – Community
organizing should be directed towards changing current
undesirable conditions.
 Community organizing affords empowerment of the
marginalized people.
 the organizer desires changes for the betterment of the
community and believes that the community shares these
aspirations and that these changes can be achieved

Core Principles 
in Community 
Organizing
 Community Organizing is process-oriented – the community
organizing goals of empowerment are achieved through a
process of change.
 Organizers need to diligently and patiently follow the
community organizing process to achieve its goals.

Core Principles 
in Community 
Organizing
 Pre-entry – involves preparation on the part of the organizer
and choosing a community for partnership.
― Preparation includes knowing the goals of the community
organizing activity or experience.
― Making a list of sources of information and possible facility
resources, both government and private, is recommended.
― Identification of possible barriers, threats, strengths, and
opportunities at this stage is an important determinant of
the overall outcome of community organizing.
Phases of 
Community 
Organizing
 Entry into the Community - formalizes the start of the
organizing process.
― This is the stage where the organizer gets to know the
community likewise gets to know the organizer.
― the important point during this phase is to make courtesy
calls to local formal leaders.

 Considerations in the entry phase – a clear explanation of

the vision, mission, goals, programs, and activities must be
given in all initial meetings and contacts with the Phases of 
community
Community 
Organizing
 Community Integration – termed as pakikipamuhay
― Is the phase when the organizer may actually live in the
community in an effort to understand the community better
and imbibe community life.
― the establishment of rapport between the organizer and the
people indicates successful integration.
― At this time, the organizer must consciously discard the
“visitor” or “guest” image.

Phases of 
Community 
Organizing
Integration Styles:
 “Now you see, now you don’t” style. – The organizer visits
the community as per the schedule but is not able to
transcend the “guest status”
 “Boarder” style. – The organizer rents a room or a house in
the village, lives his/her own life, and does not share the life
of the community.
 “Elitist” style. – The organizer lives with the barangay
chairman, or some other prominent person in the
community.
Community 
Integration
People-centered approach in integration:
 Pagbabahay-bahay or occasional home visits. – this is an
effective way of developing a close relationship with the
community.
 Huntahan. – Informal conversations help a lot in integrating
with the community.
(e.g., village poso during laundry time, basketball court and sari-sari
store)
 Participation in the production process. – the organizer
participates in livelihood activities, such as farming in an
agricultural community. Community 
Integration
―continued.
 Participation in social activities. – Social functions and
activities help the organizer and the people to get to know
each other through face-to-face encounter.
(e.g., Fiestas, weddings, baptismal celebrations, funeral wakes,
etc.)

Community 
Integration
 Social analysis – is the process gathering, collating, and
analyzing data to gain extensive understanding of community
conditions, help in the identification of problems of the
community, and determine the root causes of these
problems.
― This process is also referred to as social investigation,
community study, community analysis, or community needs
assessment.

Phases of 
Community 
Organizing
 Identifying potential leaders – these interactions provide the
organizer with the opportunity to identify prospective allies in
the organizing efforts, particularly credible and influential
members of the community who have expressed willingness
to participate in community activities.
 Core group formation – as the organizer works with the
potential community leaders, the membership of the group
expanded, as necessary by asking them to invite one or two
of their neighbors or friends.
Phases of 
Community 
Organizing
 Community organization – through various means of
information dissemination, the core group, with the
assistance of the organizer, instills awareness of common
concerns among other members of the community.
 Action phase – also known as mobilization phase, refers to
implementation of the community’s planned projects and
programs.
Important consideration are as follows:
• Allow the community to determine the pace and scope of
project implementation
Phases of 
• The process is as important as an output
• Regular monitoring and continuing community formation
Community 
program are essential. Organizing
 Evaluation – is a systematic, critical analysis of the current
state of the organization and/or projects compared to
desired or planned goals or objectives.
2 major areas of evaluation in community organizing:
1. Program-based evaluation
2. Organizational evaluation
 Exit and expansion phase – from the start, the organizer
must have a clear vision of the end with the general time
frame in mind.
Phases of 
Community 
Organizing
 Exit and expansion phase – from the start, the organizer
must have a clear vision of the end with the general time
frame in mind.
Indications of readiness for exit by the community organizer
should include:
• Attainment of the set goals of the community organizing
efforts,
• Demonstration of the capacity of the people’s organization to
lead the community in dealing with common problems, and
• People empowerment as manifested by collective involvement Phases of 
in decision making and community action on matters that
impact their lives. Community 
Organizing
 People’s empowerment. – community organizing is aimed at
achieving effective power for the people.
― People learn to overcome their powerlessness and develop
their capacity to maximize their control over the situation
and start to place the future in their own hands.
 Building relatively permanent structures and people’s
organization – community organizing aims to establish and
sustain relatively permanent organizational structures that
best serve the needs and aspirations of the people.
 Improved quality of life – community organizing also seeks Goals of 
to secure short- and long-term improvements in the quality
of life of the people.
Community 
Organizing
Participatory Action Research (PAR)
– An approach to research that aims at promoting change among the
participants
– PAR was introduced during the mid-1990s

Community Organizing Participatory Action Research (COPAR)

– a community development approach that allows the community
(participatory) to systematically analyse the situation (research), plan a
solution, and implement projects/programs (action) utilizing the process of
community organizing.

Community 
Organizing 
Participatory Action 
Research
 COMPARISON OF TRADITIONAL RESEARCH AND COPAR
POINTS OF COMPARISON TRADITIONAL RESEARCH
Decision making Top-down
Emphasis -expert/ nurse-driven process
-much premium is placed on the
data & output
Roles -nurse as researcher
-data analysis is done by the
nurse then presented to the
community
Methodology -research tools and
methodologies are
predetermines/prepackaged by
the nurse-organizer
Output -study is packages, submitted to
the agency and published.
Recommendations are made by
the researcher based on the
findings of the study
COPAR
Bottom-up
-community-driven
-premium is placed on the
process
-community members as
researchers
-data analysis is done
collectively by the community
-research tools and
methodologies are identified
and developed by the
community
-conclusions and
recommendations are made by
the community
PARTICIPATORY DATA-GATHERING METHODS FOR COPAR
METHODS PROCEDURE
Transect walk Nurse requests the community members
to take a the lead in the inspection or
pasyal
Mapping 1. Resource Map
• Show the sources of their
livelihood
2. Health Map
• Barangay health workers may
draw a spot map of the
community, highlighting
households with identified
health problems
3. Seasonal map or Calendar
• Make a calendar showing various
activities and events in the
community
PARTICIPATORY DATA-GATHERING METHODS FOR COPAR
METHODS PROCEDURE
Venn diagram Focuses on the relationships within the
community and between community and
outside groups/ agencies

The diagram provides the community

with a visual representation of the social
support systems within the community

Provides a clear idea of social resources

that can be tapped for the future efforts
 CHAPTER 5

HEALTH PROMOTION, RISK REDUCTION 
AND CAPACITY­BUILDING STRATEGIES
 OBJECTIVES

1. Demonstrate an understanding of the difference between health promotion and health

protection
2. Define risk
3. Discuss the relationship of risk to health and health promotion activities.
HEALTH PROMOTION AND 
COMMUNITY HEALTH NURSING
– Nursing has focused on helping individuals, groups, and communities to
maintain and protect their health
– Florence Nightingale and other nursing pioneers recognize the importance of
nutrition, rest and hygiene in maximizing and protecting one’s state of health
HEALTH PROMOTION AND 
COMMUNITY HEALTH NURSING

– Health promotion
– Any combination of health education and related organizational, economic, and
environmental supports for behavior of individuals, group, or communities conducive
to health
– Health protection
– Refers to behaviors in which one engages with the specific intent to prevent disease,
to detect disease in early stages, or to maximize health within the constrains of
disease
RISK AND HEALTH

– Risk
– The probability that a specific event will occur in a given time frame
– Risk factor is an exposure that is associated with a disease
– Health
– Is directly related to the activities in which we participate, the food we eat, and
substances to which we are exposed daily.
THE RELATIONSHIP BETWEEN RISK TO 
HEALTH AND HEALTH PROMOTION 
ACTIVITIES

– 2 types of risk:
1. MODIFIABLE RISK FACTORS
– are those aspects of health risk over which an individual has some control such as
smoking, sedentary or lifestyle, type and amount of food and other activities.
2. NONMODIFIABLE RISK FACTORS
– Are those aspects of risk over which one has little or no control such as genetic
makeup, gender, age, and environmental exposure.
THE RELATIONSHIP BETWEEN RISK TO 
HEALTH AND HEALTH PROMOTION 
ACTIVITIES

– RISK REDUCTION
– Proactive process where an individual enable to react to actual or potential threats to
their health.
– RISK COMMUNICATION
– Process through which the public receives information about the possible or actual
threats to health.
DIET AND HEALTH

– DIET
– one of the most modifiable of risk factors
– A healthy diet contributes to the prevention of chronic diseases
PHYSICAL ACTIVITY AND 
HEALTH
– Reasons people engage to physical activities:
– To achieve weight management
– Increased energy
– Better appearance
– To fit into favorite clothes
– To prevent development or worsening of a chronic health condition
– To manage stress
– To improve mood and self-esteem
THE PARAMETERS APPLIED IN THE 
WALKABILITY SURVEY ARE THE 
FOLLOWING

– Walking path modal conflict

– Availability of walking paths
– Availability of crossings
– Grade crossing safety
– Motorist behavior
– Amenities
– Disability infrastructure
– Obstructions
– Security from crime
SLEEP

– Sleep is an essential component of chronic disease prevention and health

promotion
– 74% of adults report having a sleeping problem one or more nights per week
PRACTICING SLEEP HYGIENE WILL 
HELP ACHIEVE OPTIMUM SLEEP

– By National Sleep Foundation

– Avoid caffeine and nicotine close to bedtime

– Avoid alcohol as it can cause sleep disruptions
– Retire and get up at the same time everyday
– Exercise regularly, exercise and vigorous activity, at least 3 hours before bedtime
– Establish a regular, relaxing bedtime routine
PRACTICING SLEEP HYGIENE WILL 
HELP ACHIEVE OPTIMUM SLEEP

– Create a dark, quiet, cool sleep environment

– As much as circumstances allow, have comfortable beddings
– Use the bed for sleep only; do not read, listen to music, or watch TV in bed
– Avoid large meals before bedtime
TOBACCO AND HEALTH RISK

– Smoking cessation
– Important step in achieving optimum health
– More than half of the world’s smokers live in 14 countries and Philippines is one of
them (Global Adult Tobacco Survey, 2009)
– Smoker
– Trying to quit experience withdrawal symptoms such as anxiety, increased appetite,
irritability, and difficulty concentrating
ALCOHOL CONSUMPTION 
AND HEALTH
– Heavy drinking
– Consuming more than 2 drinks per day (men) and more than 1 drink per day (woman)
– Binge drinking
– Drinking 5 or more drinks on a single occasion (men), 4 or more drinks on a single
occasion (women)
– Excessive drinking
– Can take the form of heavy drinking, binge drinking or both
TEN TARGET AREAS FOR NATIONAL 
ACTION TO REDUCE THE HARMFUL USE OF 
ALCOHOL

– Leadership, awareness and commitment

– Health service response
– Community action
– Drink-driving policies and countermeasures
– Availability of alcohol
– Marketing of alcohol beverages
– Pricing policies
– Reducing the public health impact of unrecorded alcohol
– Reducing the negative consequences of intoxication
– Monitoring surveillance
THE OTTAWA CHARTER FOR 
HEALTH PROMOTION
– The charter defined health promotion as “the process of enabling people to
increase control over, and to improve, their health, which requires that an
individual or group must be able to identify and realize aspirations to satisfy
needs, and to change or cope with the environment”.
3 BASIC STRATEGIES FOR 
HEALTH PROMOTION
– Advocacy for health to provide for the conditions and resources essential for
health
– Enabling all people to attain their full health potential
– Mediating among the different sectors of society in efforts to achieve health
PREREQUISITES FOR 
HEALTH
– Fundamental conditions and resources for health are:
– Peace
– Shelter
– Education
– Food
– Income
– A stable ecosystem
– Sustainable resources
– Social justice and equity
ALCOHOL CONSUMPTION 
AND HEALTH
– Alcohol
– Very common in the society, and serving alcohol beverages is considered customary
in social of alcohol by Filipinos aged 15 years and older was estimated at 6.4 liters per
capita
– Health
– Moderation as not more than 2 drinks a day for the averaged-sized man and not
more than one drink a day for the averaged-sized woman
5 PRIORITY ACTION AREAS PROVIDE 
SUPPORT TO THE 3 STRATEGIES

– Build healthy public policy

– Health promotion puts health on the agenda of policy makers in all sectors and at all
level directing them to be aware of the health consequences of their decisions and to
accept their responsibilities or health
– Create supportive environments
– Health cannot be separated from goal. Health promotion generates living and
working conditions that are safe, stimulating, satisfying and enjoyable
5 PRIORITY ACTION AREAS PROVIDE 
SUPPORT TO THE 3 STRATEGIES

– Develop personal skills

– Health promotion supports persona and social development through providing
information, education for health and enhancing life skills
– Reorient health services
– The responsibility for health promotion in health services is shared among
individuals, community, groups, health professionals, health service, institutions, and
government
– Moving into the future
– Health is created and lived by people within the settings of their everyday life, where
they learn, work, play and love.
HEALTH EDUCATION

– Health education
– Is the process of changing people’s knowledge, skill, and attitudes for health
promotion and risk reduction
– Patient education
– Usually refers to a series of planned teaching-learning activities designed for
individuals, families, or groups with an identified alteration of health
EFFECTIVE NURSE 
EDUCATOR
– Basic principles that guide the effective nurse educator:
– Message
– Format
– Environment
– Experience
– Participation
– Evaluation
COMPETENCY­BASED TRAINING OF 
COMMUNITY/BARANGAY HEALTH WORKERS

– Training of community health workers is an important aspect of the community

especially in health
– CHWs embrace a variety of community health aids selected, trained, and
working and carrying out functions related to health care in the community
– Community health workers must be the members of the communities