Transcript Health Education and Communication

Faculty of Medicine
Introduction to Community Medicine Course
(31505201)
Health Education and
Communication
By
Hatim Jaber
MD MPH JBCM PhD
15+18 - 12- 2016
1
AIDS and sexually transmitted
diseases » World AIDS Day » 2016
Presentation outline
Time
Introduction to communication
12:00 to 12:10
Communication Process
12:10 to 12:20
Types of communications
12:20 to 12:40
Effective communication and its barriers
12:40 to 12:50
Health Education
Next Lecture
3
COMMUNICATION for
HEALTH EDUCATION
What is communication?
• Is it Transfer, Conveying or Exchange?
• Communication is derived from ‘communis’
which means COMMONNESS or SHARING.
Communication
• The exchange of meanings between individuals
or groups through a common system of
symbols.
• Communication takes place when one’s mind so
acts upon its environment that another mind is
influenced, and in that other mind an
experience occurs which is like the experience
in the first mind, and is caused in part by that
experience.
What is Effective Communication?
• When a sender elicits an intended response
from his/her receiver, communication is
effective.
• When a sender elicits intended response
repeatedly, he/she is not only an effective
communicator but also a successful and
influential communicator.
Objective of Communication
• To form and establish a relationship between
a sender and a receiver.
We call it communication,
but it’s really about relationship
The mechanics of good
communication are valuable as tools
to help you create a trusting doctorpatient relationship.
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Communication
• Communicator: the person or the team give
the message (Educator).
• Message: the contents (materials) of health
education
• Channel: method of carrying the message
• Audience: the receivers (users or targets) of
the message
Communication Process
• Who says what to
whom with what
effect?
• Linear model
–
–
–
–
–
–
•
source – person on phone
encoder – mouthpiece on phone
message – words the person speaks
channel – phone lines
decoder – earpiece, other end
receiver – person listening on
phone
Communication Process – cont’d
• Issues
– entropy – static in
transmission of message;
not understandable
– redundancy – repetition of
elements within a message
that prevent communication
of message
• Solution
– feedback – helps to
avoid entropy or
redundancy
Communication Process – cont’d
• Psychological effects
– Perceptions
– Attitudes and behaviors
– Cognitive dissonance
Communication Process SMCR Model
Sender
•
•
•
•
•
•
Must know: Objectives
Audience: interests & needs
Message
Channels of communication
Professional abilities
Limitations
Receiver
• Single person or Group of people
• Controlled audience
• Uncontrolled audience
Message
Must be:
• In line with the objective(s)
• Meaningful
• Based on felt needs
• Clear and understandable
• Specific and accurate
• Timely and adequate
• Fitting the audience
• Culturally and socially acceptable
Channel
• Interpersonal communication
• Mass media
• Traditional or folk media
Feedback
• Flow of information from the audience to
sender
• Opportunity to the sender to modify his
message
Steps to achieve the objective
•
•
•
•
•
Presentation of a stimulus
Perception of the stimulus by the receiver
Interpretation of the stimulus by the receiver
Trial response to the stimulus
Perception of the consequences of the trial
response
• Re‐interpretation of the consequences, and the
making of further responses
• Development of a stable stimulus‐response
relationship.
Step‐Models In Communication
• A‐I‐D‐A
Attention
• A‐I‐E‐T‐A
• Attention
• Interest
• Interest
• Desire
• Evaluation
• Action
• Trial
• Adoption
Communication Types
• Nonvocal_ nonverbal
–
–
–
–
–
–
signals
signs
symbols
icons
gestures
proxemics
• Vocal- Verbal
• Mass media
– public opinion
– attitudes
– persuasion
Types of Communication
One‐way communication (Didactic method)
Two‐way communication (Socratic method)
Verbal communication: direct and non‐direct
Non‐verbal communication
Formal and Informal communication
Visual communication
Telecommunication and Internet
Communication skills
• Communication skills are required to make communication
effective, the following are the skills required at source level.
These include:
• greeting skills,
• speaking skills,
• listening skills,
• questioning skills,
• and summarizing skills.
The non-verbal skills play an important role. It affects the
communication process.
Body language is an important constituent of non-verbal
communication and consists of gesture, postures facial
expressions, eye contact, manipulating the eyebrows etc.
Barriers of
Communication
•
•
•
•
Physiological barriers
Psychological barriers
Environmental barriers
Cultural barriers
• Barriers in Communication
• Unplanned distortion during the communication
resulting in the receiver obtaining a different
message than that sent by the sender is referred to
as barriers in communication (also called as
“Noise” or “distortions” in communication). These
can be :
• Physiological : Difficulties in hearing, expression.
• Psychological : Emotional disturbances.
• Environmental : Noise, invisibility, congestion in
the classroom, etc.
• Cultural : Level of knowledge, understanding and
receiver’s beliefs, etc.
Communication Barriers
• Social and cultural gap between the sender and the
receiver
• Limited receptiveness of receiver
• Negative attitude of the sender
• Limited understanding and memory
• Insufficient emphasis by the sender (health
professional)
• Contradictory messages
• Health education without identifying the “needs "of
the community
Good communication technique
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•
•
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Source credibility.
Clear message.
Good channel: individual, group & mass education.
Receiver: ready, interested, not occupied.
Feed back.
Observe non-verbal cues.
Active listing.
Establishing good relationship.
What is Effective Communication?
• When a sender elicits an intended response
from his/her receiver, communication is
effective.
• When a sender elicits intended response
repeatedly, he/she is not only an effective
communicator but also a successful and
influential communicator.
Standards of
Effective Communication
• Complete
– Communicate all relevant information
• Clear
– Convey information that is plainly understood
• Brief
– Communicate the information in a concise manner
• Timely
– Offer and request information in an appropriate timeframe
– Verify authenticity
– Validate or acknowledge information
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Principles of effective communication
• ensures interaction rather than direct transmission
• reduces unnecessary uncertainty
• requires planning and thinking in terms of outcomes
• demonstrates dynamism – what is appropriate for one
situation is inappropriate for another. Achieving this
dynamism requires flexibility, responsiveness and
involvement
• follows the helical model (what one person says
influences what the other says in a spiral fashion so
that communication gradually evolves through
interaction).
Mass Communication – steps needed for
individual to be persuaded to follow a
behavior
• exposure to the message
• attention to the message
• interest in/personal
relevance of message
• understanding the
message
• personalizing the behavior
to fit one’s life
• accepting the change
• remembering the message
and continuing to agree with
it
• being able to think of it
• making decisions based on
bringing the message to
mind
• behaving as decided
• receiving + reinforcement for
behavior
Successful communication of message
depends on 5 components:
•
•
•
•
•
credibility of message source
message design
delivery channel
target audience
targeted behavior
The Communication Equation
• What you hear
•
•
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Tone of voice
Vocal clarity
Verbal expressiveness
40% of the message
• What you see or feel
•
•
•
•
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Facial expression
Dress and grooming
Posture
Eye contact
Touch
Gesture
• WORDS …
50% of the message
10% of the message!
Understanding Communication
• We are going to consider:
• The 2-Way communication process
• Effective communication skills
• Barriers to effective communication
Communication is a 2-way process
•
•
•
•
Communication skills involve:
sender
Listening to others (Receiving)
message
Asserting/ Expressing (Sending)
receiver
Barriers to communication can lead to misunderstanding
and confusion
sender
values and attitudes
“generation gap”
language
Cultural differences
noise
hearing
receiver
Effective Communication Skills
Eye contact & visible mouth
Some questions
Encouragement
to continue
Body language
Effective
Communication skills
Silence
Smiling face
Summarising
what has been said
Checking
for understanding
Barriers to Effective Communication
Language
Time
Noise
Other people
Distractions
Barriers to
effective
communication
Put downs
Too many questions
Lack of interest
Distance
Discomfort
with the topic
Disability
The Art of Listening
•
“If we were supposed to talk more than
listen, we would have been given two mouths
and one ear.”
•
Mark Twain
Health Communication
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Information
Education
Motivation
Persuasion
Counseling
Raising morale
Health development
Organization
HEALTH EDUCATION
• “Health education is the process by which
individuals and group of people learn to “:
– Promote
– Maintain
– Restore health.
HEALTH EDUCATION
A process aimed at encouraging people
•to want to be healthy,
•to know how to stay healthy,
•to do what they can individually and collectively to maintain
health, and to seek help when needed.
Health education is defined as
• “Any combination of learning experiences designed
to facilitate voluntary adaptation of behavior
conducive to health”.
• ‐ The word “voluntary ”is significant for ethical reasons
• (Educators should not force people to do what they
don’t want to do )
• i.e. All efforts should be done to help people make
decisions and have their own choices.
• The word “designed” refers to planned, integral,
intended activities rather than casual, incident, trivial
experiences.
What is health education?
Process which affects changes in the health practices of
people and in the knowledge and attitude related to
such changes.
OR
Teaching process providing basic knowledge and practice of
health, so as to be interpreted into proper health
behavior.
• Health education is a process that informs , motivates and
enables people to adopt and maintain healthy practices
and lifestyles.
• It helps people to achieve health by their own actions and
efforts.
Aims of Health education
1. Health promotion and disease
prevention.
2. Early diagnosis and management.
3. Utilization of available health services.
Specific objectives of health education
1. To make health an assest valued by the
community.
2. To increase knowledge of the factors that
affect health.
3. To encourage behavior which promotes and
maintains health.
4. To enlist support for public health measures,
and when necessary, to press for appropriate
governmental action.
5. To encourage appropriate use of health
services especially preventive services.
6. To inform the public about medical
advances, their uses and their limitations.
Aims & Objectives
• To encourage people to adopt and sustain health
promoting life styles and practices.
• To promote the proper use of health services
available to them.
• To arouse interest, provide new knowledge,
improve skills and change attitudes in making
rational decisions to solve their own problems,
• To stimulate individual and community self
reliance and participation to achieve health
development.
Approach to Health Education
•
•
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Regulatory Approach (Managed Prevention)
Service Approach
Health Education Approach
Primary Health Care Approach.
Health Communication – Its intent,
what it can do
• The intent of health communications is:
– To inform, influence, and motivate individuals and
organizations to take action toward health
• Health communications can:
–
–
–
–
increase awareness of a health issue;
demonstrate or illustrate skills;
demonstrate a demand for health services; and
remind of, or reinforce, knowledge, attitudes, or
behavior
Health Communication – What it
can’t do
• Health communications can’t:
– compensate for lack of health care;
– produce behavior change without supportive
program components;
– be equally effective in addressing all issues or
relaying all messages
Contents of Health
Education
• 1. Human biology Understanding health demands an understanding of human biology.
Child spacing, breast feeding, safe motherhood, immunization, weaning and child growth, diarrheal
disease, respiratory infections, house hygiene
• 2. Nutrition To guide people to choose optimum and balanced diets. Remove prejudices and
promote good dietary habits.
• 3. Hygiene Personal Hygiene. Environmental Hygiene. Domestic Community.
• 4. Family Health. Health promotion, Disease prevention, Early diagnosis, and Care of the
sick.
• 5. Disease prevention and control: Education of the people about locally endemic
diseases. Drugs alone can not solve the problem.
• 6. Mental Health: To help people to keep mentally healthy and to prevent a mental
breakdown. Special situations: mother after child birth, decision about a future career, starting a
new family etc.
• 7. Prevention of accidents: Three main areas: the home, road and the workplace. Safety
education.
• 8. Uses of health services: Availability of health services
When to seek medical services.
Principles of Health Education
1. Credibility: Consistent and compatible with scientific knowledge, local
culture, educational system.
2. Interest: Felt‐needs
3. Participation: Based on the psychological principle of active learning.
Create a sense of involvement, personal acceptance and decision
making; provides maximum feedback.
4. Motivation: The need for incentives is a first step in learning to
change. Carrot & Stick approach and Motivation is contagious.
5. Comprehension: Always communicate in the language people understand.
6. Reinforcement. 7. Feedback. 8. Learning by doing.
9. Known to unknown: Start where the people are and with what they
understand and then proceed to new knowledge.
10. Good human relations. 11. Setting an example. 12. Leaders:
• Agents of change. Try to penetrate the community through the local
leaders.
Practice of Health Education
• Audiovisual Aids
• Auditory aids
– Radio, tape‐recorder, microphone, amplifiers, earphones.
• Visual aids
– Not requiring projection: Chalk‐board, leaflets, posters, charts,
models etc.
– Requiring projection: Slides, film strips.
• Combined A‐V aids
• Television, slide‐tape combination.
Methods in Health Communication
• Individual approach
Interpersonal communication (IPC)
• Group approach
• Mass approach
• Individual Approach
Models of Health
Education
• Medical Model
• Motivational
Model
• Social
Intervention
Model
Group Approach
• 1. Chalk and talk (Lecture)
– Flipcharts
– Flannel graph
– Exhibits
– Films & charts
Demonstrations
• Group discussion
• Panel discussion
• Symposium
• Workshop
• Role playing
• Conferences and Seminars
2. Demonstration
3. Role play
• 4. Group Discussion
5. Panel discussion
6. Symposium
7. Workshop
8. Conferences
and Seminars
•
•
•
•
Mass approach
Television
Radio
Newspapers
– Internetwww.mohfw.nic.in , www.who.int
•
•
•
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Printed material
Direct mailing
Posters, billboards and signs
Health museums and exhibitions
Folk media
Health Communications Models,
Theories, and Practices
• Social Marketing
• Health Education
– PRECEDE-PROCEED model
•
•
•
•
•
Mass Communication
Persuasive Models
Ethical Communication
Behavior Models
Diffusion of Innovations
Research shows . . .
People get health information from:
•TV
•Doctor or other health professional
•Newspaper
•Family or friends
•Magazines
•Medical or health books
•Health plan or health insurance company
•Health newsletters
•Radio
•Internet
39%
37%
28%
24%
23%
23%
21%
15%
14%
13%
NOTE: 35% spoke with a doctor about a medical condition as a result of a media
report. And 54% said they changed a health-related behavior as a result of a media
report!!
Adoption of new ideas or practice
Five steps
1.
2.
3.
4.
5.
Awareness (know)
Interests (details)
Evaluation (Advantages Vs Disadvantages)
Trial (practices)
Adoption (habit)
Stages for health education
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Stage of Sensitization
Stage of Publicity
Stage of Education
Stage of Attitude change
Stage of Motivation and Action
Stage of Community Transformation (social
change)
Principles of Health Education :
• 1. Community involvement in planning health education is essential. Without
community involvement the chances of any program succeeding are slim.
• 2. The promotion of self esteem should be an integral component of all health
education programs.
• 3. Voluntarism is ethical principle on which all health education program should
be built without it health education programs become propaganda. Health
education should not seek to coerce but should rather aim to facilitate
informed choice.
• 4. Health education should respect cultural norms and take account of the
economic and environmental constraints face by people. It should seek
positively to enhance respect for all.
• 5. Good human relations are of utmost importance in learning.
• 6. Evaluation needs to be an integral part of health education.
• 7. There should be a responsibility for the accuracy of information and the
appropriateness of methods used.
• 8. Every health campaign needs reinforcement. Repetition of messages at
intervals is useful.
Components of Health Education
Process
Health Education has three broad components
●● Levels of Health Education
●● Methods of Health Education
●● Activities undertaken in individual methods
Contents of health education
1.
2.
3.
4.
5.
6.
7.
8.
9.
Personal hygiene
Proper health habits
Nutrition education
Personal preventive measures
Safety rules
Proper use of health services
Mental health
Sex education
Special education (occupation, mothers …..etc)
Principles of Health education
1.
2.
3.
4.
5.
6.
7.
Interest.
Participation.
Proceed from known to unknown.
Comprehension.
Reinforcement by repetition.
Motivation
Learning by doing
8. People, facts and media.
9. Good human relations
10. Leaders
Educator ????????
• Personnel of health services.
• Medical students, nursing & social work.
• School personnel.
• Community leaders & influencials.
Requirements:
• Personality: popular, influential and
interested in work.
• Efficiency trained and prepared for the job.
• Must show good examples.
Message
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What information to be communicated.
Simple, at the level of understanding.
Culturally accepted.
Interested.
Meet a felt need.
Avoid technical jargon.
Use audiovisual aids.
Practice
1-Individual
Face to face
Education through spoken word.
A- Occasions of health appraisal.
B- Home visits
Nurses
Health visitors
Social workers
2-Group
a. Lessons and lectures in schools.
b. lectures in work places e.g. factories.
c. Demonstration and training
3- Mass media.
1. Broadcasting: radio & TV.
2. Written word: newspapers, posters,
booklets.
3. Others e,g, theaters.
Health Belief Model
INDIVIDUAL PERCEPTIONS
MODIFYING FACTORS
LIKELIHOOD
OF ACTION
Demographic Variables
Perceived
susceptibility
Perceived severity
Perceived benefits of
Socio-psychological
Variables
Perceived
threat
preventive action
Perceived barriers
to prevent action
Cues to Action
Information
Reminders
Persuasive
communications
Experience
Likelihood of taking
recommended
preventive health
action
Major Variables in Behavior Change
Thoughts and ideas inside a person’s mind have
significant influence on an individual’s health
behaviors. These variables interact with social
and environmental factors and it is the
synergy among all these influences that
operate on behavior.
• Knowledge: An intellectual acquaintance with
facts, truth, or principles gained by sight,
experience, or report.
• Skills : The ability to do something well,
arising from talent, training, or practice.
• Belief : Acceptance of or confidence in an
alleged fact or body of facts as true or right
without positive knowledge or proof; a
perceived truth.
• Attitude: Manner, disposition, feeling, or
position toward a person or thing.
• Values: Ideas, ideals, customs that arouse an
emotional response for or against them.
Categories of Belief
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•
•
•
Perceived Seriousness
Perceived Susceptibility
Perceived Benefits
Perceived Barriers
Categories of Belief
Seriousness
Susceptibility
• Relative severity of the
health problem.
• Nature and intensity of
perceptions affect
willingness to take
preventive action.
– E.g. Seriousness of
hepatitis encourages
individuals to get the
hepatitis vaccine.
Categories of Belief
Benefits
• Anticipated value of the
recommended course
of action.
• Must believe
recommended health
action will do good if
they are to comply.
Barriers
• Perception of negative
consequences
• Greatest predictive value
of whether behavior will
be practiced.
Stages of Change
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•
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•
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Precontemplation
Contemplation
Preparation
Action
Maintenance
Precontemplation
• Definition
– Not considering changing their behavior
– Lack of awareness
• Intervention Approach
– Novel information
– Persuasive communications
– Experiences
Contemplation
• Definition
– Person is beginning to consider behavior change
– Important stage of information acquisition
• Intervention Approach
– Motivated by role modeling and persuasive
communications
– Receptive to planned or incidental learning
experiences.
Preparation
• Definition
– Deciding to change by preparing and
experimenting.
– Psychological preparation of trying on or
visualizing new behaviors and sharing the idea
with others. Deciding to change.
• Intervention Approach
– How-to information, skill development, attitude
change
Action
• Definition
– Actually trying the new behavior
• Intervention Approach
– Skill
– Reinforcement
– Support
– Self-management
– Attitude and attribution change
Maintenance
• Definition
– Establishment of the new behavior
– Taking on the new attitudinal and environmental
supports
• Intervention Approach
– Relapse prevention skills
– Self-management
– Social and environmental support