Introduction

Community assessment involves describing a community and people living in it. It may be referred to as a Community Health Assessment (CHA) if the research is based on significant health issues and needs. Community assessment gives community members an opportunity to express their needs and the way they feel about the impact of these needs on their quality of life (NACCHO, 2015). Community assessment also gives the reasons why these needs should be addressed. When doing a community health assessment, a researcher may choose a variety of health aggregates or issues to help him carry out the assessment. Community diagnosis is a depiction of people’s health, as well as the factors affecting their health. The description may be qualitative or quantitative (Hanser, 2010). Therefore, community health assessment and community diagnosis are almost the same things. Health promotion entails empowering people to exercise some control over conditions and factors that affect the state of their health (Maville & Huerta, 2008). This paper is a diagnosis that analyzes the areas in which it is necessary to have health promotion activities among pregnant women. It will involve a community assessment, where the aggregate will be 30 pregnant women with low income in the North East zone of Calgary, Alberta (Canada). It mainly utilizes the community-as-partner model.

The Community-as-Partner Model

The community-as-partner approach is built on a long practice of public health, nursing, health promotion and community health. It is an improvement of the community-as-client model. The community-as-client model defined public health nursing as a combination of both nursing and public health (Anderson & McFarlane, 2011). However, in a bid to lay an emphasis on primary health care, the community as client model was renamed to the community as partner model. The model is considered a systems model. It is important to recognize that, in the operations of a system, the whole system is considered to be greater than the total sum of its constituent parts. The community, as partner model, is based on the four main nursing concepts. They include: person, health, environment and nursing (Anderson & McFarlane, 2011). A person may refer to an aggregate or a population/community. A population is considered to be everyone in a defined community, while an aggregate may be teenagers in the community, elderly people or even nurses. In this assessment, the sample population is a group of 30 pregnant women who are living with low income in Calgary, Canada.

In this model, health is considered to be a resource to facilitate the day-to-day life as opposed to an objective for living. It emphasizes personal, social and physical capacities or resources. Regarding this assessment, it is in the best interest of these pregnant women to have access to good health, so as to deliver healthy babies. Another concept in the community as partner model is environment. It is usually considered to be a community that is made up of people and the surroundings. People may be linked to their ethnicity, the way of life, the area of residence and other factors which they mutually share or have in common. This assessment focuses on pregnant women living in Calgary with low income, considering that the city is in Canada, and is located in a developed state. Finally, there is the nursing concept. Nursing is considered to be a way of prevention. The preventive measures may either be primary, secondary or tertiary. Primary prevention aims at strengthening the defense mechanisms or reducing the probable encounters with the stressor agents. For example, immunizations may be offered. Secondary prevention usually takes place when a stressor agent crosses the defense line and starts causing a reaction. Therefore, secondary prevention aims at detecting this as early as possible in order to prevent any further damages. For example, treating a child infected with an immunizable disease. Finally, there is tertiary prevention. Its primary objective is to maintain and restore a stable, healthy state. This may take many forms, rehabilitation and meditation, to name a few. For this assessment, these women need to be protected from diseases, physical and mental, as well as receive treatment from professionals if they get sick.

The Assessment Wheel

The community assessment wheel is a central factor in the community as partner model. It incorporates people in the community as the core element. The wheel consists of a variety of elements. These include: recreation, education, economics, health and social services, communication, politics and government, safety and transportation, and physical environment (The University of Minnesota Duluth, 2000). However, this discussion will focus on three main elements: namely health and social services, education and economics in relation to pregnant women with low income in Calgary.

The health state of pregnant women is an issue that is very significant in a community. Healthy pregnant women will most probably deliver healthy babies. Pregnant women should eat right. This means that they should eat a balanced diet. There are even times when supplements are required, notwithstanding the fact that they should see a doctor or a midwife now and then for the relevant check-ups (Farrugia et al., 2009). Therefore, there are quite a number of expenses involved during this period. Low-income pregnant women may not be in a position to afford such expenses. In Calgary, many pregnant women are struggling with income, food, housing and security. Some do not have enough income to cater for their basic needs. It is important to note that most of these women are teens, that is, they are 19 years old or less. Research shows that more than 500 babies are born to teen mothers in Calgary each year; 15% of these teens had two or more kids before they turned 20 (Smart & Schroeder, 2011). Like elsewhere in Canada, a significant majority of pregnant teens are surviving on low incomes and live in precarious housing. They have an annual income of less than $20,000. Approximately 75% of these pregnant women find it difficult to meet their basic needs. Many pregnant women are living with low income in this city and are enormously vulnerable to homelessness. In 2010, approximately 40 women, 20 of whom were teens, were taken up by Alex’s Youth Health Centre for prenatal health care (Smart & Schroeder, 2011).

Young pregnant women are at a high risk of poverty. In most instances, these women are single parents. Moreover, most of them have not even completed high school and, therefore, the possibility of them being employed is quite low. In today’s economy, the minimum requirement for one to join the workforce is having a high school degree, which will only provide a low skill job that pays poorly. In regard to this, it can be found that most of these young pregnant women have very low incomes, and, in extreme cases, none at all. One of the elements of the assessment wheel is health and social services. Access to social services is an essential factor for these pregnant women. It would be important to consider a number of factors related to this. Are there hospitals, clinics, public health services, nursing homes, social service facilities, emergency centers, practitioners’ offices? In Calgary, there are many institutions that help pregnant women with low income. A good example is the Canopy Society. It offers group and individual services to pregnant women, living on a low income (Smart & Schroeder, 2011). Some of these services include: prenatal care, support education, and individual consultations, either from a nurse, a social worker or a nutritionist on various issues. Another institution is the Calgary Women’s Center. They provide these vulnerable pregnant women with basic needs items, which include: emergency food, bus tickets, and personal care supplies. They also offer referral services to other agencies for housing, clothing, food and recreation services. They also have volunteers who help to prepare taxes for these low-income women and advice these women on how they can access benefits likes GST rebate, Canada child tax, and provincial child health.

Another critical factor that relates to these women is education. It is evident that most of these low-income pregnant women in Calgary and Canada, as a whole, are not well educated (Smart & Schroeder, 2011). This is because if they were, they would be in a position to get good paying jobs. It is important to ask yourself a set of questions when analyzing this factor. Are there schools in the region? Are there libraries? If there is a local board of education, how does it function? What are the major educational issues? These pregnant women living with low income may not be accessing these education services, and this may account for the reason they are not educated. There is a probability that the local education board is not effective enough since if it were, it would ensure that every child was educated at least to a minimum level of high school. It could also be that these women were not interested in being educated, and this may partially account for their current state. It would, therefore, be good if there would be adult education classes to help these young women catch up. This would mean that they would get educated and, hence, improve their potential to acquire a well-paying job or at least a job with a decent salary.

Another variable of relevance is the economics of the region in question. When assessing these pregnant women living with low income, it would be important to consider the overall economy of the region. One would want to know whether the economy is stable. Moreover, are there employment opportunities? One needs to consider whether there are industries, stores or other places where people can seek employment opportunities. It is necessary to know the unemployment rate in the area. When the economy is good, there will be higher incomes. Therefore, there will be less pregnant women living with low income. When the economy is poor, it can be found that a high number of pregnant women will be living on low income.

Process of Community Diagnosis

The process of community diagnosis involves critical analyses of health experiences facing a particular group in line of availing the much needed change (Clemen, McGuire, & Eigsti, 2002).

Community Diagnosis for Calgary’s Case

The process of community assessment or diagnosis among pregnant women living on low income will involve a series of stages. The first step involves identifying the team that will carry out the research and the resources needed. At this stage, one has to develop a budget, a timeline and a plan of how the assessment will be done. The budget should include fees for meeting points and the internal budget for data collection and its analysis. For example, when dealing with pregnant women with low income, one should consider issues like fees for meeting points or spaces, especially if a researcher intends to use the community meeting method. Catering fees may also be involved. In the second stage, a researcher defines the purpose and the scope of assessment. In this case, the scope is a sample of 30 pregnant women living with low income. The aim of doing the assessment is to determine how these women survive and possibly how they can be helped. A researcher may also want to identify whether there is already a measure that has been put in place to cater for their needs.

The third stage will involve the data collection. This data may be collected using a variety of community assessment methods or tools. The methods best suited for assessing pregnant women living with a low income include: surveys, questionnaires, interviews, and community meetings. The community meeting method will involve bringing together all the community members, of which, in this case, is the 30 pregnant women living with low income. A researcher asks them to voice their concerns, as well as discusses various issues that affect them. A facilitator will lead the discussion and encourage these women to participate vocally. It would be in the best interest to have a member of the community be the facilitator, as this will increase participation, as opposed to a new person. For example, a researcher can choose a lady who is well known by these women to facilitate his or her meeting. This method is good in that it allows one participant to build upon another participant’s responses. It also avails participants with a chance to express their views, hence there is firsthand information. However, the community meeting method may be disadvantageous in that the conversation may be dominated by maybe one or two participants who might be vocal. This will mean that the rest will be excluded and, hence, the information collected will not be accurate for the whole sample of 30 women. In the event of this, it would be essential to ask other women for their ideas. When a researcher is doing this assessment, it is important that a researcher pays a lot of attention to group dynamics, as these will give some information on the issue at hand.

The second method of community assessment is surveying. This may involve the use of questionnaires. This method is cost effective in its administration and may give information that may be relatively true. This is because of the anonymity aspect that will encourage candid responses. When using this method, it is important to ensure that the questionnaire has questions that will give a researcher the information he or she needs. The questions may be open-ended whereby respondents use their own words when answering the questions. They may also be closed whereby respondents obtain the answers by selecting the options in a list. It is important to ensure that the questionnaire has rating scales that respondents use to rate their opinions regarding the issue at hand. It is helpful to explain why these questions are asked, and the reason should motivate respondents to give their answers or fill the questionnaire. It is also important to have questions that are specific, brief and simple. The questions should also be unbiased meaning that there is no need to give leading questions. A questionnaire that is well-designed can gather a lot of information if it is administered effectively.

Another method of community assessment is the use of interviews. This will be a one-on-one conversation between an interviewer and respondents who, in this case, are pregnant women living with low income. This method will allow getting a deeper understanding of the opinions and feelings of these women. This method would be effective since it will allow even illiterate women to participate. When interviewing, one must learn to be an active listener and establish a rapport with women. This will make them feel comfortable while an interviewer interacts in the process of the interview. All the notes should be accurate by, for example, asking a participant to elaborate where necessary. For instance, an interviewer may ask them: Which is your nearest hospital? Is it easy to get medical assistance at the hospital? Do you go for prenatal care visits? Does it have facilities that are convenient to low-income pregnant women? Is it affordable?

The fourth stage in community assessment will involve the selection of priorities. The team carrying out the assessment will review the data they collected and analyze it in order to choose the right priorities. The priorities should be the strategic issues that women have raised. The priorities should be selected after the data has been thoroughly evaluated. The top priorities are then identified so that they can be acted upon. For example, women may give an issue that affects them all, and therefore, it becomes a top priority. This may be food, clothing, housing, prenatal care, mental health, and counseling, to name but a few.

The fifth stage in community assessment involves documentation. In this stage, the results of the assessment should be communicated to the relevant parties. A full report is prepared. The report should entail the process of data collection and the methods that were utilized. It should also give the results and various interpretations/ inferences. In addition to this, the report should give the implementation strategy that should outline the top issues or gaps in the assessment of these pregnant women. It should also have an implementation strategy plan of action. The findings should then be publicized. It would be recommended that the information is publicized using websites, newsletters, public meetings and ensuring that the paper copy is availed to any organization or individual who requests to have the information. To ensure that there is never going to be a gap in the information to the public, this information should be made available until the time another community assessment in pregnant women living with low income is carried out.

The sixth stage of community assessment involves planning, implementation and strategizing. First, an interviewer analyzes an issue that was raised by pregnant women, develops a plan which can be used to improve the issue and then implements the chosen plan or the strategy. From that point forward, an interviewer monitors how the strategy is working and the results it is giving. For example, pregnant women living with low income may have the issue of accessing affordable prenatal services. One may decide to liaise with a number of institutions offering these services in Calgary. For instance, the hospital directors or management can be asked to subsidize these prices for this group of women. Afterward, one can monitor the effects of this if it is implemented. The last stage of community assessment encompasses monitoring the progress of the strategy one implemented and evaluating the results. In this stage, there is the need to clarify some questions, especially in the evaluation. What are the objectives of the initiative? Are the objectives being achieved?  How can you prove that they are being achieved? Monitoring will give information that is essential when the government and other institutions that have services related to pregnant women with low income are making decisions.