HEALTH OF LOCAL COMMUNITIES: DIAGNOSING, IDENTIFYING GAPS AND NEEDS

© Yu. M. Petrashyk, H. S. Saturska, N. O. Terenda, L. V. Lishtaba, N. O. Slobodian, O. N. Lytvynova, 2021 A community is a set of people characterized by a certain territorial or other proximity that allows interaction, and this interaction determines the common values or culture [1]. The de ning characteristic of a community is people who have the potential to interact. Without the possibility to interact, common values and norms are impossible. In today’s world of electronic communications, interaction can be virtual, as well as apply a more traditional individual approach. If many people interact with each other and share values and culture, the community can exist even in electronic form. Of course, virtual communities that exist through electronic means go beyond traditional anthropological ideas about the community. The purpose of diagnosing health and assessing the needs of local communities is to obtain information for decision-making on priority issues and action planning. In essence, diagnosing the health of local communities is used to collect data on the needs and strengths of a particular group, community or population [7]. Methods. The study makes use of the current data on approaches to identifying gaps and needs in Ukraine and the world. Results and discussion. When assessing needs, four types thereof should be taken into account: expressed, normative, conscious and relative needs [2]. Expressed need is a problem that is manifested through behavior, demand for services, and is measured as the number of people who apply for services, types of services, utilization rates. A norУДК 614.2 DOI 10.11603/1681-2786.2021.3.12618


HEALTH OF LOCAL COMMUNITIES: DIAGNOSING, IDENTIFYING GAPS AND NEEDS
Ivan Horbachevsky Ternopil National Medical University, Ternopil, Ukraine Purpose: to identify features of diagnosing the health of local communities, to examine the current state and changes in the approaches to identifying gaps and needs for action planning.
Materials and Methods. The study makes use of the current data on approaches to identifying gaps and needs health diagnostics of local communities in Ukraine and the world.
Results. There are ve types of models for health diagnosis and needs assessment: epidemiological diagnosis, public health diagnosis, social diagnosis, asset diagnosis, and rapid diagnosis. Each model has its own vision, as well as advantages and disadvantages. In practice, the selected model can be supplemented with elements of other models in accordance with the resources and purpose of the assessment. Determining the population to be assessed is an important early stage in assessing community health. It can be determined geographically, by a speci c area, place of work, residence, or study. The state health department can target the entire population, while a small local non-pro t agency is likely to focus only on potential customers. The use of very speci c parameters to determine the population makes the assessment more focused and detailed, allows very speci c adaptation of health measures.
Conclusions. When assessing community health, the boundaries of the target audience may change during data collection and analysis. Analysis and interpretation of epidemiological data may reveal that only working mothers are at high risk for health problems that the organization can address. This re nement of the target audience can occur because of a community health assessment.
KEY WORDS: community health; diagnosing health; identifying gaps; identifying needs. mative need is a de cit, shortage, or surplus identied by experts and health professionals based on a scienti c understanding of what should be. A conscious need is a lack based on the feelings and perceptions of the population, that is, the look through the eyes of the person experiencing it. Relative need is a shortage or de cit identi ed by comparison between advantaged and disadvantaged groups.
There are ve types of models for health diagnosis and needs assessment: epidemiological diagno sis, public health diagnosis, social diagnosis, asset diagnosis, and rapid diagnosis (Table 1). Each model has its own vision, as well as advantages and disadvantages. In practice, the selected model can be supplemented with elements of other models in accordance with the resources and purpose of the assessment [3].
The epidemiological model focuses on the quanti cation of health problems, the use of national databases, and the application of epidemiological methods and statistics. This model seeks to answer epidemiological questions, such as "What is the scale of the problem?", "What disease trends are obvious?", "What patterns are manifested in the distribution of the problem?", "Can the problem be prevented?" Thus, epidemiological models often include an emphasis on identifying hazards, risks, and predictors of health problems.
The epidemiological model uses tools such as disease and death registries and national surveys. The advantage of epidemiological models is that ISSN 1681-2786. Вісник соціальної гігієни та організації охорони здоров'я України. 2021. № 3 (89) they provide data to determine the severity, importance, and prevalence of a health problem. However, these models do not provide much data, which may also be key to prioritizing health problems [5].
The public health model focuses on quantifying health problems in order to prioritize them because resources are limited. This model seeks to answer the following questions: "What is the severity of the problem?", "What factors contribute to its occurrence?", "What resources are available to solve the problem?" The public health approach usually relies on available epidemiological data, using speci c tools or models. The public health approach and the epidemiological approach have much in common. Although these models are quite comprehensive, they have a limited ability to consider sociocultural aspects of health [4].
The social model focuses on quantitative characteristics that provide the socio-cultural, economic, and political context of the impact on human health. This approach addresses questions that address the socio-environmental determinants of health, such as: "What is the relationship between health problems and social characteristics?", "What social trends are manifested in health care beha vior?", "What is the relationship between the problem and the use of social and medical resources?", "How have social and health policies affected the scale, distribution or trends of the problem?". The main feature of the social approach is the focus on collecting data on social characteristics, such as income, other speci c social and economic characteristics.
In the eld of health care, planning based solely on social indicators is considered incomplete. Without health indicators, the assessment of community needs is incomplete. However, assessments that include socio-environmental data do provide important information that can help identify predictors or conditions that lead to health problems [6].
The asset model focuses on existing strengths, assets, social capital, capabilities, and resources, rather than on the needs, shortages, shortcomings and differences between the healthy and the sick. It is designed to answer the following questions: "What social and medical resources does a community with health problems have?", "What do community members consider to be the strengths and resources of their community?", "To what extent are resources mobilized or can be mobilized for solving health problems?" Taking into account the social context for assessing health problems stems from an earlier view of health, in which the environment was seen as one of the four forces that promote health or lead to disease: the environment, genetics, the health care system and lifestyle, and opinions that both risk factors and risk minimization factors should be taken into account. The asset model also includes the concept of community competence, i.e. the process by which a community can identify problems and take action to address them. Greater community competence is associated with both improving community health and greater social capital. The community asset valuation model aims to identify and then develop opportunities for the community to address health issues. However, collecting data on assets can be a dif cult task, as there is no generally accepted set of asset indicators, and information on assets is rarely available at the time of valuation, making data collection necessary. Therefore, asset models are used less frequently and are poorly integrated into more widely used needs assessment models. Rapid diagnosis uses many methods -such as focus groups, available data, surveys, and mapping -to rapidly develop the community and implement the necessary medical interventions, as speed is sometimes needed or desired in the assessment. The rapid assessment aims to answer the key question: "What are the most pressing needs with availab le resources?" As follows from this question, the focus is on rapid response rather than on providing depth or breadth of assessment.
The community health assessment is used to determine the extent of certain health problems in a particular community, district, or other designated locality considering community strengths and resources, and to prioritize health issues. The community health assessment covers all aspects of community life, examines resources and assets in the eld of health and services, as well as health issues and other community weaknesses. This assessment aims to answer the question: "What are the main health problems and what resources are available to solve them?" In this sense, community health assessment encompasses and integrates all the previously described assessment models. The workforce assessment is not usually considered part of the community health assessment. However, at the infrastructural level of the public health pyramid, labor assessments are particularly relevant. The workforce assessment seeks to answer the question: "What human resources of what skill level are there to meet health care needs?" This assessment examines the current competencies of the workforce, trends and change factors related to its quantity and quality, and builds scenarios to understand the potential size of the gaps between projected needs and projected available labor.
Scientists' assessments of the workforce in all medical professions have revealed a dire health situation. There is a shortage of nurses, occupational health, environmental, medical and public health professionals in the near future [8]. These projections require a local assessment before any public health measures are developed to identify the current and future workforce that will be used to support the envisaged measures. After all, it doesn't make sense to develop great measures on paper if it is impossible to hire health professionals with the skills needed to successfully implement activities in the real world.
There is no one-size-ts-all way to assess a community's health. However, all approaches to assessing community health have some major milestones. The rst stage is to involve community members in the development and evaluation. The next step is to determine the community or population for evaluation, and then decide what data to collect about the nature of the health problem: the scale of the problem, the predictors of the health problem, and the demographic and behavioral characteristics. The next step is to collect this data using a variety of sources and approaches. Once the data has been collected, the evaluation and planning team should analyze the data using statistical procedures to obtain statistical reports on community health issues. The last stage is aimed at developing a generalized statement of need or problem based on these data and statistics obtained from their analysis.
Ideally, planners will take the time to develop a community engagement strategy to assess the health of the community. The participation of community members strengthens both their ability to assist in the evaluation and their ownership of the data collected and the results of the evaluation. This involvement applies to all stages of health program planning and evaluation. From a practical point of view, the involvement of those who may be affected by the assessment has immediate and direct implications for how the community health assessment will take place; the involvement of community members may even in uence the issues raised in the needs assessment.
There is no best way to engage community members, but many strategies are needed that evolve as community health is assessed. In addition to strategies to directly reduce barriers to community participation, other strategies may include obtaining lists of key names, providing nutrition as an incentive, conducting non-formal learning, identifying speci c tasks for community members, and scheduling dates and times for regular meetings.
Sometimes community involvement may be unwise when there are strict time or scal constraints on health assessments, when high commitment can affect the quality of community interactions, or when leadership skills are lacking to initiate and support community participation. Determining the population to be assessed is an important early stage in assessing community health. It can be determined geographically, by a speci c area, place of work, residence, or study. The state health department can target the entire population, while a small local non-pro t agency is likely to focus only on potential customers. The use of very speci c parameters to determine the population makes the assessment more focused and detailed, allows very speci c adaptation of health measures.
The term target audience refers to a part of the population at risk, i.e. people who have a certain social, physical or other status, which increases the likelihood of adverse health effects.

Conclusions
When assessing community health, the boundaries of the target audience may change during data collection and analysis. For example, when a community health assessment begins, an entire neighborhood or area is considered a target audience. Analysis and interpretation of epidemiological data may reveal that only working mothers are at high risk for health problems that the organization can address. This re nement of the target audience can occur because of a community health assessment.
Prospects for further research are to study the target groups for the implementation of health technologies at the community level.