Health Promotion and Disease

Prevention
Module Title: Health
Promotion and Disease
Prevention
Module Code: SPHM-3022
Module ECTS: 4
Module Duration:
By Tadesse Bedada (BSc, MSc, PhD Candidate)
The history and
evolution of health
promotion

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History---

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History---

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History---

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Health promotion

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 Health Promotion
 ‘’As a term was used for the first time by marc
lalonde in 1974 and quickly became an umbrella
term for a wide range of strategies designed to
tackle the wider determinants of health.
 After reviewing the evidence, the lalonde report
suggested that health care services were not the
most important determinant of health and there
were four “health fields”–
 Lifestyle,
 Environment,
 Health care organization,
 Human biology—and that major improvements in
health would result primarily from improvements in
 Lifestyle,
 Environment and
 Our knowledge of human biology.
 Health Promotion---
 Health promotion is about raising the health status of
individuals and communities.
 Promotion in the health context means improving,
advancing, supporting, encouraging and placing
health higher on personal and public agendas.
 Given that major socioeconomic determinants of
health are often outside individual or even collective
control, a fundamental aspect of health promotion is
that it aims to empower people to have more control
over aspects of their lives that affect their health.
 Health Promotion----

 Definition: ‘Health promotion is the process of

enabling people to increase control over, and to
improve, their health’.
 It moves beyond a focus on individual behaviour
towards a wide range of social and
environmental interventions.
 It is a positive concept emphasizing personal,
social, political and institutional resources, as
well as physical capacities. WHO (1990)
 Health Promotion----
Health Promotion is any combination of
health, education, economic, political,
spiritual or organizational initiative to bring
about positive attitudinal, behavioral, social,
or environmental changes conducive to
improving the health of population.
Health Promotion is directed towards action
on the determinants or causes of health.
Govt at both local and national levels has a
unique responsibility to act appropriately and
in timely way to ensure that the ‘total’
environment, which is beyond the control of
individuals and groups, is conducive to
health
Why we need Health Promotion?

Promotes quality of life

Reduce inequalities in health
 Reduces pressure on services
 “Adds life to year, Adds year to life”.
 “Health promotion is concerned with
making healthier choices, easier
choices”.
 It is cost effective and efficient
 Principles of health promotion

Health promotion combines diverse, but

complementary methods or approaches
including
Communication,
Education,
Legislation,
Fiscal measures,
Organizational change,
Community change,
Community development and spontaneous
local activities against health hazards.
 Health
education

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Introduction to health education

Health education is an important tool for

different health professionals, especially
for clinical nurses to communicate
with their clients at specific areas of
concern in health problems.
Health is a concern for individuals,
groups, families, communities and
governments, therefore these areas need
special mechanism to communicate and
give priority to the needs.
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Introduction to health
education…
 Most people do not cooperate unless they
understand why they need to do something.
 So we need to apply health education as an
instrument to solve these problems.
◦ Health education is the top of elements of PHC
and necessary for realization of the other elements
of PHC.
◦ Health education is cost-effective (i.e. prevention is
cheaper, and reduces heavy cost of curative
services) 28
 Introduction to health education…
◦ It promotes self-reliance through giving the
responsibility of health to each individuals
(meaning- HE is the part of health care that is
concerned with promoting healthy behaviour,
which includes:
 Health information
 Helps people to understand their behaviour
and how it affects their health,
 Encourage behaviour that prevents illness,
cures diseases and facilitates rehabilitation. 29
Introduction to health
education…
The causes of disease and health
problems are known to be multi-fact
oral including both intrinsic and
extrinsic factors that all infracting
each other.
Intrinsic factors- Factors relating to the
essential nature of an organism.
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Introduction to health education…
Extrinsic factors- Factors which are external or
originated from the outside
 Since the influence on health often comes from
different directions, individual and collective
problems of communities need:
 Understanding of causes of the problems
 Prioritizing among a number of problems and
 Integrating supportive actions from different
directions such as: health professionals,
communities and stake holders involved in
community development programs
E.g. protecting a spring in order to improve water
supply for a village needs a concerted effort.
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RATIONALES OF HEALTH EDUCATION
The following points help to justify the
importance of health education in the
health care delivery system
The continued existence and spread of
communicable diseases that needs the
involvement of community members and
environmental interventions
E.g. Corona virus, Diarrhoeal disease,
malaria, HIV/AIDS etc…
Increasing threats to the young from new
and harmful behaviours
E.g. Substance abuse, teenage
pregnancy, etc 32
RATIONALES OF HEALTH EDUCATION--
For some diseases, health education is the
only practical choice in order to control the
spread of disease or to lead normal life. E.g.
HIV/AIDS
The cost of health care is raising

E.g. Rx and hospitalization costs are

increasing
E) Increased awareness of people on
chronic health problems and the need to
know preventive actions.
E.g. Prevention of cardiac complications
from chronic diseases, such as
hypertension. 33
DEFINITION OF HEALTH
The concept of health is some what
difficult to understand. When we say
a person is healthy, it mean to the
layman that the person is normally
doing his/her activities and does not
outwardly show any sign of any disease
in him/her.
 However, for the medical man it
denotes the conformity to certain
standards, like physical measurements,
biochemical norms, and rates
physiological standards, etc. 34
DEFINITION OF HEALTH---

It has been extremely difficult for

scientists concerned with human
biology to lay definite criteria for
health and define the term health in a
specific manner.
In oxford dictionary health means” the
state of being free from sickness,
injury or disease, bodily conditions;
something indicating good bodily
conditions”
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 DEFINITION OF HEALTH---
WHO defined health as “a state of
complete physical, mental and social
well-being and not merely an absence
of disease or infirmity, (WHO-1948).
It will be seen that even after having this
definition it will be difficult to conceptualise
and standardise positive health with specific
clear-cut attributes and criteria for
measurement.
The definition of health also extended by
Mahler by including “the ability to lead
socially acceptable and economically
productive life” 36
DEFINITION OF HEALTH…
Physical health – Concerned with
anatomical integrity and physiological
functioning of the body. (The ability to
perform routine tasks with out any physical
restriction)
E.g. Physical fitness needed to walk place
to place
Mental Health- Is the ability to learn and
think clearly and the thinking should be
coherent
E.g. A person who is not mentally fit
(retarded) could not learn something new
at a pace in which an ordinary normal
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 DEFINITION OF HEALTH…
Social Health – The ability to make and
maintain acceptable interactions with other
people.
Very much related to the mental adjustment
of the individual to others around him/her in
the family or in the community
E.g. To celebrate during festivals
To mourn when a close family member dies
To create and maintain friendship and
intimacy
The extended definition of health includes

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DEFINITION OF HEALTH….
Emotional Health- Is the ability of expressing
emotions in the appropriate way
E.g to fear, to be happy, and to be angry
 The response of the body should be
congruent with that of the stimuli
 Related to mental health and includes feelings
 It also means maintaining one’s own integrity
in the presence of stressful situations (e.g.-
tensions, depression, and anxiety)
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DEFINITION OF HEALTH….

Spiritual Health- Some people relates

health with religion. For others it has to do
with personal values, beliefs, principles and
ways of achieving mental satisfaction.
◦ Different aspects of health are interrelated
and interdependent (i.e. physical problems
could lead to mental consequences and vice
versa
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DEFINITION OF HEALTH EDUCATIONS
LAWRENCE GREEN define health
education as “any combination of learning
opportunities designed to facilitate
voluntary adaptation of behaviour which
will improve or maintain health”
HELEN ROSS AND PAUL MICO- also
define health education as “A process with
intellectual, psychological, and social
dimensions relating to activities that
increase the abilities of people to make
informed-decisions affecting personal,
family and community well-being
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DEFINITION OF HEALTH---
◦ Combination- Emphasizes the importance
of matching the multiple determinants of
behaviour with multiple learning
experiences or educational intervention.
◦ Designed – distinguishes health education
from incidental learning experiences as a
systematic ally planned activities.
◦ Facilitate – Means create favourable
conditions such as predisposing, enabling
and reinforcing factors
◦ Voluntary- Implies with out the use of
force, i.e. with full understanding and
acceptance of purpose.
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Informed decision – making means
◦ Giving people information
◦ Giving people problem solving and
decision – making skills but leaving the
actual decision (choice) to the people
◦ It is a consciousness raising and
empowerment approach (educational and
environmental support)

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So 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.
 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 asset 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.
Adoption of new ideas or practice

Five steps

1. Awareness (know)

2. Interests (details)

3. Evaluation (Advantages Vs
Disadvantages)

4. Trial (practices)

5. Adoption (habit)
 Stages for health education

Stage of Sensitization
Stage of Publicity
Stage of Education
Stage of Attitude change
Stage of Motivation and Action
Stage of Community Transformation
(social change)
Contents of health education
1. Personal hygiene
2. Proper health habits
3. Nutrition education
4. Personal preventive measures
5. Safety rules
6. Proper use of health services
7. Mental health
8. Sex education
9. Special education (occupation,
mothers …..etc)
 Principles of Health education
1. Interest.
2. Participation.
3. Proceed from known to
unknown.
4. Comprehension.
5. Reinforcement by repetition.
6. Motivation
7. Learning by doing
8. People, facts and
media.
9. Good human relations
10. Leaders
HISTORICAL DEVELOPMENT OF HEALTH EDUCATION

INTRODUCTION
Health education has became wide in scope
and sophisticated in its application during
the last 100 years or so
The development of health education is
related to the initiation of health promoting
activities for school children and their
environment including nutrition education
The growth and development of H.E have
been accelerated with the inception of PHC
concepts, especially with child health
services, nutrition education, immunization
etc…
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INTRODUCTION---
At global level, many countries endorsed
and showed their commitment at the
time of declaration of PHC at Alma-Ata,
Russia (1978)
At this time, it was recognized as a
fundamental tool to the attainment of
health for all and was put as one of the
eight components of PHC.
In Ethiopia, it is very difficult to know
when and where exactly H.E has started.
However, the development can be
arbitrarily divided into three periods
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THE PERIOD OF THE PRE ITALO-ETHIOPIAN WAR (BEFORE THE 2 ND WORLD WAR)

◦ The beginning of health education could

be related to the introduction of modern
medicine into the country
◦ During the emperors Menelik the 2nd and
Haile Sellassie’s eras, modern medicine
had already been introduced and started
to expand in the country

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 A few hospitals have been opened and there were
a few Ethiopians working in those hospitals as a
senior staff and majority of them were expatriates.
 Obviously, this was the time when H.E was limited
to the few hospitals and to community leaders and
educated members of the community
◦ The primary focus was to increase the awareness
of people to modern medicine and encourage them
to utilize the service

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THE PERIOD AFTER THE ITALO-
ETHIOPIAN WAR (AFTER THE 2ND WORLD
WAR)
This period may be characterized by
withdrawal of expatriates and funds.
However, there were many
missionaries doing this work
The opening of the Gondar public
health college and training centre was
the most important advance in the
History of health service in Ethiopia.
The college was opened with the
assistance of the WHO, UNICEF and
point four (USAID) in 1954.
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 ITALO- ETHIOPIAN WAR---

 During this period, the medical services and

training expanded and mobile child health
centre started to give health education on child
nutrition, personal hygiene and others
 In 1965, it has been documented that the first
health education workshop for secondary
school science teachers was conducted in Addis
Ababa where over 50 papers were presented

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THE PERIOD OF SOCIALIST REVOLUTION AND AFTER

Health services have been expanded

as compared to the previous times
After the revolution, the health services
strategy focused on PHC.
Courses on H.E were included in most
of the health training programs and
health education was considered one
of the major components of PHC
following the declaration in Alma-Ata

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SOCIALIST REVOLUTION AND
AFTER---
 Health education was considered as one of the
essential means of prevention of diseases and for
health promotion
 Ethiopia has hosted the first health education
technical meeting of OAU in A,A in 1969.
 In general the concepts and practices of health
education have further developed during the last
20 years in Ethiopia, and Health education is
included almost in all categories of health
professionals training 60
APPROACHES IN HEALTH EDUCATION
 There are two major approaches in Health Education
THE PERSUASSION APPROACH
 The deliberate attempt to influence the other person
to do what we want them to-do (the directive
approach or when done forcefully coercion)
THE INFORMED DECISION – MAKING APPROACH
 Giving people information, problem-solving and
decision making skills to make decisions, but leaving
the actual choice to the people
 With groups who have been disadvantaged and
oppressed, this can also involve promoting awareness
(consciousness raising) and building confidence that
they have the power to make decisions and control
their own lives-empowerment

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LEVELS OF HEALTH EDUCAITON

 The three levels of health education includes the following

1. PRIMARY HEALHT EDUCATION
 Directed to apparently healthy people
 Primary aim is to prevent occurrence of illness/disease

E.g.- Education on nutrition

 Education on breast-feeding
 Immunization etc…
2. SECONDARY HEALTH EDUCATION
 Given after the disease or problem has occurred
 Its aim is to prevent complications (progress of the disease to sever
form)
 At this level complete recovery from disease is possible) but if
neglected company will occur
E.g. TB pt treatment compliance education
3- TERTIARY HEALTH EDUCATION
 Its aim is to prevent further disabilities and comp’s, prolonging of life,
and maintenance of normal function
 Provided to patients with irreversible, incurable and chronic
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conditions
The targets of health education
 Individuals, groups and communities

Health education setting/channels you work

through depends on the intended audience
 Communities
 Medical and nursing care institutions
 Work places and market places
 Schools, prisons and refugee settings
Who is responsible to provide health
education?
 All Health professionals (Health providers)
 Teachers and youth leaders
 Employers and politicians
 Musicians
 Community health workers 63
RELATIONSHIP OF PHC AND HEALTH
EDUCATION
Health education is one of the components primary
health care and almost all components of PHC have
a health education component (i.e. Health
education is the top of PHC components)
PRIMARY HEALTH CARE (PHC)
Defn- “PHC is essential health care based on
practical, scientifically sound and socially
acceptable methods and technologies made
universally accessible to individual and families in
the community through their full participation and of
the cost that the community and country can afford
to maintain at every stages of their development in
the spirit of self-reliance and self-determination”
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PRIMARY HEALTH CARE (PHC)
---
 PHC forms an integral part of countries
health system, of which it is the central
function and main focus, and of the over all
social and economic development of the
community
 PHC is the first level of contact of individuals,
families with the national health care delivery
system
 PHC brings health care as close as possible to
where people live and work and it constitutes
first element of continuing health care process.
 Objective of PHC at Alma-Ata, Russia (1978),
was achievement of health status consistent
with socially and economically productive life. 65
COMPONENTS OF PHC

1. Health education
2. Safe and adequate supply of water and sanitation
3. Provision of adequate nutrition
4. Immunization
5. MCH/EP services
6. Supply of essential drugs
7. Treatment of common diseases/locally endemic/
diseases
8. Prevention and control of communicable diseases
9. Controlling HIV/AIDS
10.Controlling ARI
11.Mental health
12.Dental (oral) health
The last four components (from No 9-12) were added
after the Alma- Ata declaration of PHC. 66
ROLES OF HEALTH EDUCATION IN THE APPLICATION OF PRIINCIPLES OF PHC

 Health Education is the top

one of
component (element) of PHC and almost
all other components of PHC have Health
Education components
 The following points demonstrate the role of
H.E in the application of principles of PHC
PROMOTING COMMUNITY INVOLVEMENT
AND SELF-RELIANCE
 The first step that facilitates community
involvement is provision of information through
Health Education
 Behavioural changes in individuals and
community are also as a result of effective
Health Education. 67
Enhancing decision-making
skills at the local level
Health Education is a particularly
effective approach for encouraging
and enabling communities.
Decision making skills are important for
taking actions at a community level.
Health Education should help people
to develop those skills through
discussions.
Communications and creation of
mutual understanding.
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 Allowing for a diversity of
objectives in formulating
policy
Most community health problems are
related to each other and
intertwined (e.g. Health problems are
related to
Water supply,
Levelof education,
Income health care services,
etc)
To solve major health problems that
contribute to over all conditions, plans for
intervention need to be multi-faceted. 69
Harmonizing national and local
plans
 Community involvement can ultimately
provide continues guidance to national
policy from the grass roots.
 Health education improves the participation of
people in health plans and activities; therefore,
plans will reflect local needs and local
situations under the umbrella of
national plans. 70
Facilitating inter-sectoral action
 Many actions concerning health need co-
operation with other sectors (Inter-sectoral
collaboration)
 Intersectoral collaboration needs
communication between two or more sectors.
 Communication helps to identify common
needs and possible collaboration areas to
solve problems.
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 CHALLENGES TO THE PROCESS OF HEALTH EDUCATION

 Health Education is not considered

important during relatively healthy status
 Health Education is closely related to
behaviour change and maintenance.
 Changing health behaviour is conditioned by
factors such as social, psychological, economic,
cultural, accessibility and quality of services,
political environment, etc which are often
difficult to deal with simultaneously
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 Challenges to the process of health
education
 People are usually preoccupied with many
other important daily activities to support
their life
There is a failure to see the value of
health teaching by some health
professionals.
 Even if the value is well understood by many,
few make it part of their routine professional
practice
 Health Education is much more than
“transfer of information” without
changes in attitudes and actions it remains
useless. 73
 UNIT-TWO
HEALTH AND
BEHAVIOR

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Concepts of human behaviour and health

 Identifying behaviour will be very useful to

understand the complex relationship
between health and behaviour.
 Because many human behaviours are
related to health directly or indirectly,
assessing the behaviour of an individual is
very important
 Healthy behaviours contributes to the over
all health of an individual and community.
 On the other hand unhealthy behaviours
affect the health of an individual
communities and quality of life at
different levels. 75
Concepts of human behaviour---

Defn. Behaviour: is an action that has

a specific frequency, duration and
purpose, whether conscious or
unconscious.
Associated with practice
It is what we do and how we act

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 Types of behaviour which are
related with health
Promotive and preventive behaviours
Physical exercise
Good nutrition
Recreation
Tooth brushing
Breast-feeding
Clean water collection and storage
Use of contraceptive methods etc…

Utilization behaviours
Child health services and ANC services
Immunization programs
Family planning services
Screening programs 77
Types of behaviour which are related
with health….
Illness behaviors
◦ Oral rehydration
◦ Early symptom recognition
◦ Self referral for treatment
Community action behaviours
◦ Actions by individuals and groups to change and improve their
surroundings to meet special needs.
◦ Community participation in the installation of improved
water supply and avoidance of unimproved sources
◦ Building of latrines and upgrading of unimproved
latrines to improve
Rehabilitation behaviors
 Behaviours which prevent further disabilities after
serious illness
Compliance behaviours
 Follow a course of prescribed treatment 78
 Healthy behaviours- Behaviours which can
promotes health and prevent diseases or illness
Unhealthy behaviors – Behaviours that damage
or affect health of an individual, family or
community negatively
E.g. - Excessive alcohol consumption
 Smoking
 Bottle- Feeding etc…

Behavior components
Cognitive domain
 Thinking, learning, knowledge

Affective domain
 Belief, Attitude and value
Psychomotor domain
 Practice/Action 79
BASIC CAUSES OF HEALTH BEHAVIOR (DETERMINANTS OF HEALTH BEHAVIOR)

The two major determinants of health behaviour are

INTRA-INDIVIDUAL- Intra- individual causes of health behaviour includes:
◦ Knowledge
◦ Belief
◦ Attitude
◦ Value
EXTRA-INDIVIDUAL- The extra- individual causes of health behaviour includes
A. SOCIAL PRESSURE
Significant others
Culture – The sum of values transmitted over time in a community
Shared characteristics
Traditions
Belief systems
B) RESOURCES- Time, money, human skill, service materials
C) OTHERS – Climate, natural changes, genetics, mental impairment; quality of
water etc…
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 BASIC CAUSES OF HEALTH BEHAVIOR …….

KNOWLEDGE- A clear and certain mental perception,

understanding, the fact of being aware of something;
experience of acquaintance or familiarity with information of
learning that which is known, facts learned or acquired or study of.
 It is knowing things, objects, persons,
situations and averting in the universe
 It is storage information in the brain-the means of acquiring
knowledge by the brain is by perception
 It is the collection and storage of information or experience
◦ H.E helps people to have knowledge/awareness about health related
issues
BELIEF:- is a statement or sense, implied
declared or
intellectually and/or emotionally accepted as true by a
person or group
BELIEF FORMATION:- Individual, group or community experiences
 As a wider belief system
 Primary socialization (parents, peers)
 Mass media 81
BASIC CAUSES OF HEALTH BEHAVIOR …….
ATTITUDE- Is a relatively constant feeling,
predisposition or set of beliefs directed
toward an object, person or situation.
 “Attitude is the sum total of a man’s
inclinations and feeling, prejudice or bias,
preconceived notions, ideas, fears threats,
and convictions about any specific topic”
(Luis thurstone-1928)
 It is a tendency of mind or of relatively
constant feeling toward a certain
category of objects, persons or
situations.
 It reflects our likes and dislike (+ve or-ve)
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BASIC CAUSES OF HEALTH BEHAVIOR …….
 CHARACTERSTICS OF ATTITUDE
1. Predispositions- Related to human place, situation, environment
 Know or has to have knowledge about the attitudinal object (object, person,
situation)
2. Has Direction- polar, positive or negative, good or bad
 e.g. Attitude toward polities, AIDS, theft etc…
3- Intensity (Judgment). Can be determined by intensity
(judgement)
 Favourable or unfavourable
 Convenient or Inconvenient

E.g. Strongly agree Favourable or convenient attitude

Agree
Strongly disagree Unfavourable or inconvenient attitude
Disagree
4- Changeability- Can be changed, adapted, modified, not static
5- Stability and consistency
- Stable related to time or duration
- Consistency – The same attitude towards some object, situation
or person
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BASIC CAUSES OF HEALTH BEHAVIOR …….

VALUE- It is a preference that can be shared or transmitted

with in a community
 Is a belief of the people based on self-preference
 Characteristics held to be important and prized by an
individual or community
Criteria of Value
1. Free choice
2. Alternatives
3. Selection by reason, Consideration is made based on its
advantage and disadvantage
4. Proud of selection
5. Accept openly
6. Act up on it
7. Act consistently
E.g. Being a good mother
-Being attractive to opposite sex
- Being modern, healthy, wealthy etc… 84
BASIC CAUSES OF HEALTH BEHAVIOR …….

Value clarification Vs Value conflict

Value clarification – We want our people
to value “Being Healthy”
E.g - We have to clarify the difference b/n
smokers and non-smokers
- Clarify the difference b/n unplanned family
and planned family
Value conflict- Occurs when someone is in
dilemma (conflict) b/n the advantages of
performing and not performing a particular
behaviour.
E.g. Smoking – Feels good (Excited)
- Unhealthy
- Stop smoking – Feel healthy 85
 BASIC CAUSES OF HEALTH BEHAVIOR …….

Culture – Is the sum of values transmitted

overtime in a community.
It consists of overlapping features or
components.
◦ Shared characteristics
Behaviour, values and beliefs shared by a
group of people, community or a country
◦ Traditions maintained for a long time and passed
down from parents to children.
◦ Belief systems – Behaviour beliefs exist on their
own
Part of wider beliefs exist on their own
E.g. Religion – Avoidance of pork 86
BASIC CAUSES OF HEALTH BEHAVIOR …….

Social pressure- Health behaviour is

influenced by individuals and other people
The influential people depend on:
Particular individual
Culture of the community
Social network (grand father, godfather)
◦ Health education therefore considers the
importance of those influential peoples and
identifies them
E.g. - Religious leaders
Older people
Community leaders etc …
87
 Factors affecting health behaviour

There are many factors that affect the

health behaviour of an individuals or
groups
E.g. culture affects the behaviour of an
individual or group
The health Field concept classifies the
factors into five categories:
 Human biology
 Environment
 Lifestyle
 Behaviour
 Health care organization 88
Classification that is helpful to make a diagnosis of the factors affecting
behaviour

1. Predisposing Factors- Provide the rational

or motivation for the behaviour to occur
It includes the following:
 Knowledge
 Attitudes
 Values
 Beliefs
 Confidence

E.g. Consulting a health care provider for

an illness, needs knowledge of the
services provided or develop positive
attitude towards consultation. 89
 Classification that is helpful ….
2. Enabling factors- Characteristics of the environment that
facilitates health behaviour and any skill or resource required to attain
the behaviour.
 These factors enable a motivation to be realized
 They help an individual to choose, decide and adopt behaviours

Enabling factors includes the following:

a) Availability and/or accessibility of health resources
E.g. – Presence of F/p service in health centre encourages a
mother, to utilize the services once she is aware of and is
interested in the services
b) Community, government laws, priority and commitment to
health
E.g – If HIV/AIDS is not a government priority and there are no
policies, behaviour of individuals, communities and
institutions will certainly be affected.
c) Presence of health related skills
 Presence of certain skills that are important for behaviour are
essential, one the individual has decided to practice the behaviour.
E.g .How to use condoms 90
 Classification that is helpful ….
3. Reinforcing Factors
 These factors comes subsequent to the behaviour
 Are important for persistence or repetition of the
behaviour
E.g: A mother who has started with her first ANC visit
should be reinforced to attend subsequent visits
including delivery and postnatal cares
The following are the most important groups in
our lives and able to reinforce behaviours.
 Family
 Peer
 Employers
 Teachers
 Community leaders
 Decision-makers 91
Changes in behaviour

In all communities there are already many kinds

of behaviour that promote health, prevent illness
and help in the cure and rehabilitation of sick
people.
These kinds of behaviour should be identified
and encouraged.
There is also behaviour that is harmful to health.
Because of the unhealthy results of such
behaviour, people often give it up by
themselves. 92
Changes in behaviour---
Sometimes, for various reasons, people
go on behaving in an unhealthy way.
NB: Before beginning a health
education activity, it is necessary
to have on understanding of the
difficulties people often face when
trying to make improvements in
their lives. 93
CHANGES IN BEHAVIOUR….
1. Natural Change
 Our behaviour changes all the time because of
natural events.
 When changes takes place in the community,
around us, we often change ourselves without
thinking much about it – This is natural change.
E.g – Mrs. A, usually buys red beans at the
market, but she may change her behaviour
and buy white beans if no red ones are
94
CHANGES IN BEHAVIOUR….

2. Planned change
 Sometimes we make plans to improve our lives
 Some changes can be accomplished easily and
quietly, but most of the more important
changes we want to make requires skilled and
planned health education
NB: For planned health behaviour change,
preparation and planned sequence of
steps is required
95
CHANGES IN BEHAVIOUR….
This sequence can be arranged in five-steps scheme as

follows:

Step-1- Recognition of the problem

 Identifying a certain type of behaviour that needs to be

changed, or be overcome

Step -2- Analysis of the problem or Diagnosis

 Study of the behaviour to be changed and the underlying

reason for the behaviour

Step -3- Educational prescription

 Deciding what educational effort or programme is

required, and describing how this is to be done 96

CHANGES IN BEHAVIOUR….
Step -4- Educational treatment
After receiving instructions and any necessary
training, the staff begin the new educational
programme
Step -5- Recording and review of results, with
evaluation
The work done on the educational programme and
the response that is received is recorded
The results are examined and a report written with an
analysis of progress made at the end of a period of
perhaps three or six months. E.g. of planned change:
Mr.G smokes many cigarettes each day. Now he has
started coughing a lot. He decides he will stop
smoking. He plans a date in a couple of week’s time
when he will stop smoking, and starts to prepare
himself for this. 97
CHANGES IN BEHAVIOUR….
3. Readiness to change
You may know some people who are always
quick to try something new. Other people
are very slow to change.
Not everyone is ready to change at the
same time behavioural intention is
willingness/readiness to perform a certain
behaviour provided that enabling factors are
readily available.
4. Helping people to lead healthier lives
It is natural for people to help each other.
This is especially useful when people have
to solve difficult problems
98
There are three general ways in which people can try to help other people lead healthier
lives.

1. They can force or push people to

change, and threaten punishment if the
changes are not made (using force)
2. They can give ideas or information in the
hope that people will use them to
improve their lives. (giving information)
3. They can meet with people to discuss
problems and promote their interest and
participation in choosing the best ways
to solve their own problems. (discussing
and participating)
99
 UNIT-THREE
TEACHING METHODS
AND MATERIALS

10
Introduction to different Teaching methods

Teaching methods range from what is heard to what

is seen and done
 They include modern methods and materials and
different combinations of tools
 In this context methods refer to ways messages
are conveyed
 Teaching materials includes all materials that are
used, as teaching aids to support the
communication process and bring the desired
effects on the audience. 10
Introduction to different Teaching methods …..

 The methods and materials could be classified

broadly as follows:
 Audio
 Written words
 Visuals
 Audio-visuals
 Direct experience
 Multi-sensory modalities
 We have to consider the various methods that an
educator has to employ and adopt in different
situations and with different categories of people
 The health educator must use his judgement and
discretion to choose a proper educational method
and also a proper aids, media, etc, to enable the
individual or group to learn and benefit out of the
experience. 10
a. HEALTH TALKS AND ITS PURPOSE

When talks are on a health agenda, we call it a

health talk
The most natural way of communicating with
people is to talk with them
In health education, there are many opportunities
to talk with people
Health talk may be conducted with one person,
with a family, a small group or with many people
together
Health talks have been, and remain the most
common way to share health knowledge and facts
In order to make a health talk more educational, it
must be combined with other methods, especially
visual aids, such as posters, slides and flannel
graphs 10
HEALTH TALKS AND ITS PURPOSE…

Group size – Health talks are usually

effective if given to a small gatherings
(5 to 10 people), although they are
sometimes given to much larger groups.
Participation – Discussion is important;
people can ask questions, share ideas and
be clear about the real massage of the talk
One problem is that the larger the group,
the less participation and discussion are
possible
Participation is easy in small groups
Do not accept silence as agreement or
understanding 10
HEALTH TALKS AND ITS PURPOSE…
In preparing a health talk, the following points
must be considered carefully:
1. Know the group-Find out their need and interests
2. Select on appropriate topic-single and simple
3. Have correct and up-to-date information
4. List the points you will make
5. Write down what you will say
6. Think of the appropriate visual aids
7. Practice your whole talk
8. Determine the amount of time needed
9. The whole talk, including showing visual aids, should
take about 15 to 20 minutes and allow another 15
minutes or more for questions and discussion
10. Where will you give the talk
11. The time you will give the talk
10
HEALTH TALKS AND ITS PURPOSE…

The following points should be remembered

when preparing and conducting health talk
Make sure whether you can speak the local
language or find a good interpreter
Words may not mean the same for all people
Know about the avoidance (listeners)
Build on what the listeners know
Encourage listeners to challenge, raise questions
and comments
Choose the appropriate time
Pay attention to both verbal and non-verbal
communications
Purpose of talks
◦ To share health knowledge/information/ and
facts 10
 B. CASE STUDIES

◦ Case studies are like stories except that case-studies are

real-life experiences
◦ Are based on facts and present events as they really
happened
Purpose
◦ Help people learn how to solve problems
Size of group – More interesting when read and
discussed in small group- this helps learning.
◦ Case studies are useful with groups of school children,
◦ With community development committees and.
◦ During training sessions with, for example, community
health workers.
◦ After the case study has been read or heard, encourage
group members to begin discussing it.
◦ Encourage everyone to share opinions a bout the case
studies. 10
 C. FABLES(ወሬ፣ ቧልት)
◦ Fables are make-believe stories that have been told to children for
generation
◦ The characters in a fable and often animals
Purpose – The actions of the characters in a fable of behaving
◦ Fables also show adults what values are important to the community
Group-Size – Fables can be used with individuals, or small groups
◦ They can be used in radio programmes that reach a large number of
people
Educational use
◦ Are useful when you are talking to small groups of children
◦ Are also useful for health education with parents (the parents will
then be able to tell the fable to their own children)
 A fable used for health education would describe how behaviour
affects health
◦ It would show what sort of behaviour promotes health and what is
harmful
◦ The fable should give reasons for choosing healthy behaviour
 By the end of the fable the sorts of behaviour that are best for
health should be clear to everyone 10
D. PROVERBS

◦ These are short common-sense sayings that are handed down

from generation to generation
◦ They grow out of the experiences of people in each culture
◦ They are like advice on how best to behave
 Some proverbs are straight forward (their meaning is obvious) but others
are more complicated. So the listener has to think care fully in order to
understand them.

E.g. One does not go in search of a cure

for a ringworm while leaking leprosy
unattended
Meaning- Try to solve the most serious problem first
◦ A young man may have as many new clothes, but not as many
worn-out clothes, as an old man
Meaning- An old man has more experience than a young one
Purpose
◦ To support or illustrate a point about health you want to get across
 The best way to learn proverbs is to talk with the older
people 10
 PROVERBS….

Educational uses of proverbs

◦Proverbs can be combined with talks,
demonstrations, stories, dramas, or
put on posters and flipchart to provide
information related to health.
◦People are very familiar with their
proverbs and will be impressed that
you understand their culture if you use
the proverb correctly
◦Since the proverb is familiar, people
may try to abide by the advice it gives
in relation to health. 11
E. STORIES (ታሪክ፣ ወሬ፣ ተረት)

◦ Stories often tell about the deeds of amous

heroes or of people who lived in the village long
ago.
◦ An older person, instead of directly criticizing the
behaviour of a youth, may tell a story to make
his point
◦ Stories may also be a way of re-telling interesting
events that happened in a village long ago.
◦ An older person, instead of directly criticizing the
behaviour of a youth, may tell a story to make
his point
◦ Stories may also be a way of re-telling interesting
events that happened in a village. So stories can
entertain, teach history spread information and
news, and also serve as lesson about behaviour 11
STORIES….
Purpose
◦ To give information and ideas
◦ To encourage people to look at their attitudes and values
◦ To help people decide how to solve their problems
Group size
◦ Stories can be told to individuals or to small groups as well
as large groups
◦ Can be used on he radio to reach communities, regions and
even countries
Characteristics of good stories
◦ The story should be believable
◦ The people in the story should have names
◦ The people in the story should do the kind of work that
people in the community do
◦ The actions of the people in the story should be normal,
not strange
◦ The story should be short (5 to 10 minutes) 11
STORIES….

N.B - Be sure that you do not name or describe

real people in your story
The story should make a clear point in the end
Avoid scornful and unkind words in the story
E.g – If you say, “This foolish mother did not
bring her child to the clinic in time”, some
mothers may get angry
◦ Always follow a story with discussion and Questions
Do not tell the listeners which person in the
story did the best thing. Ask the listeners for
their own opinions
By encouraging people to think a bout the
story and to discuss the points that impressed
them, you will help them to learn more
11
2. AUDIO-VISUAL AIDS

Introduction
 Communications are supported with different teaching aids or
tools depending on the purpose
 If the purpose of the communication is to transfer skills and
knowledge, combinations of different teaching aids/methods/
are used
 Audio-visuals are multisensory materials, which combines both
listening and seeing. E.g TV
 Audio-visual aids are more effective means of communication,
if they are used appropriately
 When teaching aids are effectively used, people can receive
experiences through all five senses
 In communicating messages, it is not advisable to concentrate
only one of the senses, rather on the combination of the senses
(Message is more likely to be understood and accepted if it can
appeal to more than one sense)
 The presence of teaching aids improves the communication,
but it depends on the way of utilizing the available teaching
11
aids
TYPES OF VISUALS (TEACHING
AIDS)
 There are different types of visuals which are used for
teaching purposes
 The commonest visual aids includes the following
 Posters/charts
 Demonstrations
 Role-playing/Drama
 Chalkboard
 Tours and visits
 Objects and specimens
 Models
 Projected still pictures/projection screens – slides
(filmstrip)
 Overhead projector
 Projected moving pictures – Movie films
 Puppets
 Flannel graph and other adhesive aids 11
a. Posters and charts

 Poster is a large sheet of paper with words and pictures or symbols

that includes messages on it
 Are widely used by commercial firms for advertising products.
However, in recent years, the use of posters for communicating health
messages has increased dramatically.
Purposes of posters
 To give information and advice to people E.g. – Beware of AIDS!
 To give directions and instruction for actions E.g. The ABC of HIV/AID
prevention.
 To announce important events and programmes E.g. – World AIDS
day.
Types of posters depending on the type of messages.
 There are two types of posters depending on the type of messages.

Single-glance posters
 These types of posters can be read and understood quickly with out
any spoken words
Stop-and –study posters
 In these types of posters one needs time to look at the variety of
messages
 Do not need verbal explanation 11
Posters and charts…..
Size of Target Audience
 Posters can be used both for small or large groups of
people
 In some cases posters could be used to teach
individuals such as for counselling services for people
leaving with HIV/AIDS (PLWHA)
Content of posters
 The words used on a poster should be in local
language or two languages
 Words used should be few and simple to understand
 The symbols used should be understood irrespective
of educational status
 Attentions of people could be attracted by the use of
colours
 Put on idea on a poster (Avoid including too many ideas on
a single poster) 11
Posters and charts…..
The poster should encourage practice
Posters announcing events should contain the
following information
 The name of the event
 The date and time
 The place
 The organization sponsoring the event
Placing posters:
Post them where many people can see them when
passing by E.g. Market areas – Meeting hall
Get permission before posting on a house or building
Never put posters on sacred places or worshipping
areas
Do not leave a poster up for more than one moth
11
Posters and charts…..
USE OF POSTERS IN TEACHING A GROUP
Do not hold up a poster and start explaining
it right away, instead
Ask every one to look at the poster carefully
Ask people what they see (Let them think
for themselves)
If there are words on the posters let some
one read it for the group
Add your own ideas as discussion continues
Turn to the poster again at the end of your
discussion
Ask once more about the message
11
Charts

Charts are used to present facts in visual form

Commonly there are three types of charts. These
are:
Wall charts- Are sometimes similar to stop-and –
study posters
Include more information with symbols and
diagrams E.g. Child growth monitoring chart
Teaching charts – Are accompanied by teacher’s
verbal explanation to help in formal education E.g.
Diarrhea Treatment chart
Flipcharts – Series of pictures, diagrams or titles on
a related subject
Are helpful to transmit many ideas E.g. Filpcharts
on reproductive health demonstrating reproductive
organs of male and female 12
2- DEMONSTRATIONS

 Demonstrations are a pleasant way of sharing

knowledge and skills
 Involve a mixture of theoretical teaching and of
practical work, which makes them lively (Focuses on
practice – “showing how is better than telling how”
Purpose
 Demonstration help people learn new skills E.g. Taking
blood pressure
 Using child growth monitoring chart, etc…

SIZE OF GROUP (AUDIENCE) FOR DEMONSTRATION

SESSIONS
 Demonstrations can be used to teach individuals
 Demonstration teachings are effective in small groups
 When groups are large, there is less chance to
practice and ask questions
12
GENERAL OUTLINE OF STEPES TO FOLLOW DURING
DEMONSTRATION SESSIONS
 The demonstration should be based on an immediate
local need
 Decide what you want to accomplish
 Gather information
 Talk to key people
 Gather all the necessary materials for demonstration
 Plan your demonstration step-by-step
 Rehearse and study the demonstration
 Before starting to demonstrate explains for the people
gathered what you are going to do and why it is
important for them to learn the new method
 Carry out the demonstration step –by- step
 Summarize the demonstration- (Return demonstration)
 Give leaflets and written instructions or show where to
get them. 12
Holding the Demonstration

The demonstration itself has four steps

Explain the ideas and skills that you will be
demonstrating
Do the demonstration – Do one-step at a time,
lowely
Ask one person to repeat the demonstration
(Ask the group to comment as the person works)
Given every one a chance to practice
Materials for demonstration may include the
following
 Real objects (E.g. patients, client, VIP etc)
 Models-A copy of real objects E.g. VIP models
 Posters
 Photographs etc
12
The following points should be considered for effective Demonstration

Demonstration must be realistic

Demonstration should fit the local culture
Use materials and objects that are
familiar to the people
Have enough materials for every one to
use during practice
 Adequate space is needed for everyone to see the
demonstration and to practice the skill
 Choose a time that is convenient for everyone
(Allow for enough time; do not rush)
 Check that everyone can practice the skill correctly
before he/she leaves the demonstration place.
12
3- DRAMA AND ROLE-PLAYS

DRAMA- In drama ideas, feelings, beliefs and

values are communicated to participants and to
spectators
Are valuable in subjects where personal and social
relationships are often more important than
details of appearance
Basic ideas like health can be communicated to
people of different ages, education and
experience
Are suitable teaching method, especially for
people who can not read because they often
present ideas dramatically
The duration of drama can be short or long
Could be used during training of CHWS, special
meeting, festivals, school children etc … 12
GUIDELINES FOR DRAMA

Choose on appropriate theme

Identify on appropriate place
Prepare and practice
The health team may be used as the main
characters to start with
 Make sure everybody hears
 Presentation should be based on local
culture, language, dressing styles etc…
Mix the serious with the funny
Include songs and teach the audience if possible
Conduct discussions after the drama
Plan to repeat the drama in another community

12
ROLE-PLAY

Role – playing consists of the acting- out of real

life situations and problems (unrehearsed acting-
out of real life situations)
It is a type of drama but in a simplified manner
In role-play the player, receives a description of
the character he or she is to play
Roly-play portrays expected behaviour of people
It is important for exploring and clarifying
problems and for testing alternate solutions
One can learn about himself or herself and about
how it feels to be someone else E.g A nurse
talking to a mother
After the role-play, players and watchers always
discuss it and their reactions to it 12
ROLE-PLAY….

PURPOSE
By acting-out of a real-life situation, people
can better understand
 The cause of the problems and
 The results of their own behaviour
To help an individual explore ways of improving
his/her relationship with other people
Help people to acquire experience in
communication, planning and decision-making
Helps people to reconsider their attitudes and
values
 A good Role play should fulfil the following:
Have a relaxed atmosphere
Make members of the groups know each other
12
ROLE-PLAY….

Select two or three people

Involve everyone make
Make sure everyone understand the
purpose of the role-play
Give clear instructions; what they have
to do
Remind them that they are playing only
roles
Make sure that the main issues are
drawn out and made clear to all
Allow plenty of time for discussion,
examination of feelings and evaluation 12
ROLE-PLAY….

GROUP SIZE FOR PRESENTING A ROLE-PLAY

 A role-play is usually done with small groups or
 A role- play can be done with a health worker and
one or two other people
TIME REQUIRED FOR A ROLE-PLAY
 A role-play should last a bout 20 minutes
 Allow the play to continue if the action is lively
and the audience is interested
 The role-play should be stopped if:
 The players have solved the problem or
 The players are getting confused and can not
solve the problem, or
 The audience looks bored
 Allow another 20-30 minutes for discussion
13
ROLE-PLAY….

OTHER CONCERNS/CONDITIONS TO
BE CONSIDERED FOR ROLE-PLAY
Role- playing works best when people
know and trust each other
Be sure that you have established a
good relationship with an individual
before using a role-play
Do not ask people to take parts that
might embarrass them
Role-playing involves some risk
because people may take a different
understanding 13
4. FLANNEL GRAPHS

 Flannel graph is a board covered with flannel cloth

 Pictures and words can be placed on the board to reinforce or
illustrate message
PURPOSE
 Help people see more clearly what you, are saying during a talk

GROUP SIZE
 Flannel graphs are used mostly with small groups
 Flannel graphs must be seen clearly by everyone (In large group
this would be difficult)
HOW TO USE A FLANNEL GRAPH?
 Put the flannel graph on a table, chair or easel
 Place all the pictures, words, and shapes you will need on a table
near the flannel rap so that you can see them and reach them
easily
 While you talk, place pieces on the board or remove them from
the board, as you make your points
 You may want to arrange several pieces to make a whole picture
 Encourage participation
13
SLIDE PROJECTORS

 Slides for this kind of projection are taken by camera

 Instead of being printed, like photographs, the pictures are
produced on a small pieces of clear plastic, usually mounted in
cardboard frames to protect them
 Although slides are small, the projector makes the picture
appear large against a wall or screen
 Slides can also be shown in a series. Special boxes can be
attached to the projector to hold the slides and make it easy
to show one quickly followed by another
 Slides are colour pictures that are transparent and projected
on a wall or white screen
 Slide presentation are made in a dark room (They have the
ability to absorb the attention and eyes of the audience
 Slide presentations needs preparation of slides, arrangements
in order, slide projector, white – screen or wall, plug and
electricity
 They are expensive and need maintenance
 Slide presentation should not be more than half an hour
13
Selection of Teaching methods and materials

 For any teaching-learning process, methods and supporting

materials should be selected
The selection of teaching methods and materials
depend on:
 The type of message that is transmitted
 The purpose
 The people addressed
 The circumstances
 The availability of resources:
 Presence of teaching aids that are suitable for wider use
 Choose inexpensive materials, which can be made or
obtained easily
 Availability of skills:
 Make sure that you choose the ones you can conduct
skilfully
 Select teaching aids that will make the presentation clear,
interesting and economical (save, time, money and space) 13
 Unit 5
COMMUNICATION
IN
HEALTH EDUCATION

13
Introduction

Communication is an essential part of

a human life and individuals carryout
most of their daily activates through
communication
Communication creates dynamism
and interaction with the
environment where people live

13
 Introduction---
Through communication people
learn, create mutual
understanding, establish
relationships, changes or maintain
behaviour and lead life
The purpose of communication is to
create understanding and to initiate
13
 Introduction….

Many public health programs are

connected with change in behaviour
and require communication
intervention.
Communication is Latin origin,
communis which means common.
So it is the attempt of trying to
establish commonness or common
understanding.
Communication is the process of
sharing ideas, information, knowledge
and experience among people. 13
 Introduction…
 Communication is process by which an idea
is transferred from the source to a
receiver with the intent of establishing
commonness or to change behaviour
 Communication takes place between

 One person and another

 An individual and a group
 Two groups
 The communication process always involves
a sender and a receiver regardless of the
number of people and concerned 13
B- COMMUNICATION MODELS

In order to show clearly what

communication looks like and the parts
that make up communication,
schematic presentation are used
Aristotle Model (1946)
Source → Message → Audience
The speaker (source or communicator)
The speech (Message)
The receiver (Communicate)

14
Shannon and weaver model
Source → Transmitter → signal →
Receiver → Destination
Communicate is referred to as
destination
The common application- Radio
transmitter and telephone mouth piece

14
COMMUNICATION MODELS….
Leagans Model (1963)
 Communication → Message → Channel →
Treatment → audience → Audience Response
 Feedback mechanism is provided
 Ideal in classroom situation, mass communication
and in group discussion
Fano model
 Source → Souce encoder → Channel encoder →
Channel→ Channel decoder → User decoder →
User
 Typical of telegraph system

Westly- MacLean’s model

Source →Encode →Message→ Channel →Decode →Receiver
Feedback
 Is complete communication 14
There are also other types of simple communication models

Linear (one-way) model

 Information flows from the source to the receiver
 The communication is unidirectional
 Does not consider feed back and interaction of the source
and receiver
Source Message Receiver
Systems (Two-way) model
 The communication process is dynamic and the flow is in
both direction
 Information flows from the source to the receiver and back
from the receiver to the source
Message
Source channel Receiver
feed back
14
Description of components of
communication
Source (sender)
 Person who thinks of all the idea to be
communicated, decides why it should be
communicated and also decides on the intended
impact
 Is the originator of the message
 Can be from an individual or group, an institution or
organization
 Some examples of behavioural objectives of sender:
 To get the attention of people to a specific message
 To provide new information or scientific knowledge
 To provide support or training for target group

Encoding – Translating the idea to be

communicated into message 14
 Description of components of
communication….
Message- An expressed feeling or idea
 The idea that is communicated
 Something that is considered important for people in
the communication, but is a series of transmission

◦ Many messages are expressed in the form of

language symbols including nonverbal
communications
◦ Not all messages reach the receiver as intended
by the sender (Due to different factors)

14
 Description of components of
communication….

Channel – The medium through which

the message is transmitted (Is the
physical means by which message travels
from source to receiver)
The comments types of channels are
verbal, visual, printed materials or
combined audio-visual and printed
materials 14
The receiver receives or reads the
message through the sense organs
(seeing, hearing, touching, tasting,
smelling and combination of these)

14
 Description of components of
communication….
Decoding- The seeing or hearing of the
message (Interpretation)
Receiver- The person to whom the
message should be passed to (the person or
group for whom the communication is intended)
◦ Some examples of behavioural objectives of
receiver:
Become aware of a certain idea
Gain adequate knowledge about an idea
Increase motivation to carryout a task
Learn knew skills to manage an institution
Change lifestyle to fit into a new environment
Maintain changed behaviour
14
 Description of components of
communication….
Effect and feedback
 Effect is the change in receiver’s knowledge,
attitude and practice or behaviour
 Feedback is the message from the receiver to
the source that shows the level of
understanding, acceptance or rejection (Is the
mechanism of assessing what has happened on
the receiver after communication has occurred)

14
Methods of Communication

Spoken words or verbal – The

most common method
Written words – Any printed
materials
Pictures – pictorial presentations
Music/sounds- Artistic
presentation of messages
Non-verbal communication or
body language-facial expression,
posture, movement or gestures, 15
Types of communication

1. Entra-personal communication
Occurs with in an individual and limited at
that level
Shows how people process and understand a
message within
E-g. A person can look at an object and
develop a certain understanding. However,
this could be affected by a no of factors
Previous experience
Language
Culture
Personal need etc)

15
Types of communication….

2- Inter-personal communication
Occurs between individual or with in
groups
Includes interactions that happen of ten
together or are made together at the same time
and place E.g. between health care provider
and patient
Advantages
Dynamic or bidirectional
Questions can be asked and answered
Multi sensory channel
Useful in all stages of adoption of innovation
Useful when topic is sensitive E.g To discuss
sexual matters 15
Types of communication….

Limitations
 Requires language ability of the source (often needs
multi-lingual)
 Needs personal status
 Needs professional knowledge and preparation

◦ For effective inter-personal

communication:
 Exchange of ideas with clients
 Realize the importance a of first impression when
meeting a person
 Learn to observe the person and derive useful
information
 Keep in mind that the same words mean
different things to different persons
 Pay attention to the body language- non- verbal
behaviour tells often more about people’s feelings than15
3. Mass media communication and
Its
◦ Theuses
aim of mass media communication is to
creat awareness of a problem, transmit
knowledge, to set and change norms and to
offer alternatives of behaviour
◦ The word media is used currently to refer not only
to print media, radio and television, but also
covers traditional means of communication (art,
town criers, songs, plays, puppet, shows
and dance)
◦ Combining with inter personal approach is very
useful and may be critical to the success of
communication
◦ Messages must be very carefully designed so that
the right message gets to the target audience in
a form appropriate to their needs and lifestyles 15
 Mass media communication…
Mass media have the Greatest impact At
 Creating awareness for a large no of people
 Communicating new ideas to early adopters (opinion
leaders)
 Increasing self-awareness and knowledge

Advantages
 They can reach many people quickly
 They are believable – E.g. “voice” from a highly respected
person
 They can provide continuing reminders and reinforcement

Limitations
 Mass communication is one-sided
 Does not differentiate the target
 Stimuli emanating from this type of communication oblige
the individual to develop a filtering mechanism in order to
protect him/her 15
 Communication also classified into two main types

One-way communication
◦ Is linear type of communication
◦ Has no feedback
◦ No opportunity to clear-up
misunderstanding
◦ Meaning is controlled by a receiver
◦ No input from the receiver
◦ May be less effective
Sender  message  Channel 
Receiver
15
Two-way communication
 Used for more complex message
 Feedback is added
 Allows the sender to find out how much the message
is received - can be monitored
 Can be adapted to suit the receiver’s needs
 Sender can affect the quality and quantity of the
feedback through the type of question chosen and the
way it is asked
N.B – Feedback is vital to effective communication.
Sending message is only one-third of the job. The other
tow-thirds are finding out what effect our communication
has had on the receiver, and correcting subsequent
messages until the communication objective is achieved
Sender - Message - Channel Receiver
Feed back 15
The communication process has a simple
sequence of six –stages i.e
The sender wants the receiver to understand the
message
The message is encoded by the sender, who
structures it into a logical form of code (language)
When the sender is satisfied with the encoding of
the message; it is transmitted verbally or in
writing or electronically
The message passes through the point of transfer
from the sender to the receiver
The receiver decodes the message
The receiver then understands the idea that the
sender wants to convey
15
Communication stages

In health education and health promotion, we

communicate for a special purpose: to promote
improvements in health through the modification
of the human, social and political factors that
influence behaviour. To achieve these objectives,
a successful communication must pass trough
several stages
Sender  Receiver
 Reaches sense
 Gain attention
 Message understood
 Acceptance/change
 Behaviour change
 Change in health 15
Communication stages….

Stage 1- Reaching the intended Audience

Communication can not be effective unless it is seen
or heard by the intended audience
Communication should be directed where people are
go in to see or hear them
Stage-2- Attracting the Audience‘s attention
Any communication must attract attention so that
people will make the effort to listen/read it
At any one time we receive a wide range of
information from each of our five senses, but it is
impossible to concentrate on all these at the same
time
Attention is the process by which a person selects
part of this complex mixture to focus on (i.e. to pay
attention to while ignoring others for the time being
16
Stage -3- Understanding the message (perception)
 Once a person pays attention he/she then tries to
understand it (visual perception, pictoral perception)
 Is a highly subjective process

E.g Two people may hear the same radio programme or

see the same poster and interpret the message quite
differently from each other and from the meaning
intended by the sender.
Stage-4- Promoting change/Acceptance
 A communication should not only be received and
understood, a but it should also be believed and
accepted
 It is easier to change belief when they have been
acquired only recentily
 It is usually easier to promote a belief when its effects
can be easily demonstrated
16
Stage -5- Producing a change in behaviour
 A communication may result in a change in beliefs and
attitudes, but still not influence behaviour
 When the communication has not been targeted at the belief
that has the most influence on the person’s attitude to the
behaviour
 E.g. Emphasized on danger of diarrhea and failed to give
enough emphasis to dehydration
 Pressure from other people in the family or community may
prevent from doing it
 Lack of enabling factors (E.g..- money, time, skills, health
services)
Stage -6- Improvement in health
 Improvements in health will only take place if the behaviours
have been carefully selected so that they really do influence
health
 If your messages are based on outdated and incorrect leads,
people could follow your advice but their health would not
improve-need accurate advice
16
 Barriers of effective communication

Includes factors that hinder the communication

process and result in unintended out come
A breakdown can occur at on point in the
communication process. Barriers (obstacles) can
inhibit communication resulting in:
 Misunderstanding - Conflicting
 Lack of response Can leads to: - Insecurity
 Lack of motivation - Inability to make
decision
 Distortion of messaged
 Prevent the achievement of project or programme
goals
◦ If not aware of them
◦ If not prepared for them
16
Common Barriers of effective
communication include:
Competition for attention (Noise)
Language/vocabulary
Age difference
Attitudes/belief
Socio-economic gap
◦ We can not necessarily avoid or
overcome all these barriers, but we have
to find ways of minimizing them

16
Common Barriers of effective communication include…..

Competition for Attention (Noise)

◦ Is a major distraction of communication
 Physical noise – Avoidable
 Internal noise – Any physiological and psychological
state that could undermine a person’s ability to
communicate effectively
E.g- Being ill
◦ Overworked
◦ Beset by personal problems
◦ You may or may not be able to do anything to help this
kind of situation
Language/vocabulary
◦ Words used to convey abstract state or emotions: the
meaning is less easily communicated using a lot of
emotive language at work is likely to result in
misinterpretation and misunderstanding 16
Common Barriers of effective communication include…..

Age difference
◦ Age difference b/n the sender and receiver is a barrier to
effective communication
E.g. if the sender is young, inexperienced and not
knowledgeable, their will be a communication barrier
Socio-Economic gap
◦ Socio-economic gap b/n communicator and receivers is another
barrier to communication
Attitudes and Beliefs
◦ The community may be misguided by expectations on the role
of development or health worker
◦ Either think that development or health workers are supposed
to do everything for them or that they know too much and do
not require services
◦ Cultural beliefs of a people influence the rate at which they
accept and adopt new ideas and skills
E.g.- Normally the beliefs of a community may indicate
what foods should be given to children and their related
taboos 16
How to Reduce/overcome barriers of communication

In order to reduce or overcome the barriers of

communication the following three areas must be
considered
The sender must know hi/her audience’s
 Background
 Age and sex
 Social-economical status
 Educational status
 Job/work
 Interest/problem/needs
 Language

The message must be:

 Timely
 Meaningful/relevant
 Applicable to the situation 16
Reduce/overcome barriers of
communication….
The audience must remove their own barriers
Members of the audience could be
 The non-listener type
 The know-it all type
 The impatient type
 The negative personality

N.B – Even it all the barriers have been removed,

communication could still be a failure without good
presentation
Good presentation requires
 Complete understanding of the subject
 Establishing good relation ship with the audience
 Choosing the right channels or media
 Proper utilization of the chosen media
 Using the multi-media approach
16
Characteristics of Effective communication

All barriers have been removed

The proper media has been chosen
A good presentation has been made
Two-way communication has been
established
It is only then that the sender can
establish commonness with his/her
audience

16
Inter-personal communication

Listening – Being an effective listener is a skill that can be

consciously developed and practiced in each new situation
whether in:- meeting
 Consultation
 A telephone conversation

Hearing – is passive, where as listening is an active meaning to

the sound we hear
 It requires concentration and effort
 The skills of effective listening involves
 Listening for message content
 Recognize any potential barriers to effective communication
either on your own or the sender’s part
 Listening for feeling- these will often be indicated by non-
verbal cues accompanying the words, such as the tone of the
voice
 Responding through your own social expressions or body
gestures, such as a nod or smile with interrupting the other. 17
 Basic principles of social mobilization
Mobilization strategies are •
Mobilizing decision-makers
including the organizational
infrastructure; mobilizing
communities;
 interpersonal communication:
mobilizing the community advocates;
 mobilizing the media; and
 promotional material and advertising.
Good Nutrition
Consuming food and nutrients and
using them to function healthily
Both cause and result of good or
poor health
Not the same as “food” and
“nutrients”
Food = products eaten or taken into
the body that contain nutrients for
− Development, growth, and maintenance of tissues and
cells
− Resisting and fighting infection
− Producing energy, warmth, and movement
− Carrying out the body’s chemical functions

17
Essential Nutrients

Macronutrients
−Carbohydrates
−Fats (lipids)
−Proteins
Micronutrients
−Vitamins
−Minerals
Water
17
Macronutrients: Carbohydrates
Energy-giving foods composed of
sugars
Common staple eaten regularly,
accounting for up to 80% of the diet in
developing countries
Quickly absorbed by the body
Sources
−Cereals (e.g., millet, sorghum, maize,
rice)
−Root crops (e.g., cassava, potatoes)
−Starchy fruits (e.g., bananas)
17
Macronutrients: Fats and Oils
(Lipids)
Energy-giving foods
Not produced by the body
Absorbed more slowly than
carbohydrates
Account for small part of diet in
developing countries
Fats (solids): Butter, ghee, lard,
margarine
Oils (liquids): Corn oil, soybean oil, peanut oil

17
 Macronutrients: Proteins

Body-building foods
Form main structural components of cells
Help produce and maintain tissues and
muscles
Sources
−Plants (e.g., beans, nuts, chickpeas)
−Animals (meat, poultry, fish, dairy
products, insects)

17
Micronutrients: Vitamins
Organic compounds mostly from outside
the body
Do not provide energy
Fat soluble: Dissolve in lipids, can be
stored, not needed daily (e.g., vitamins
A, D, E, K)
Water soluble: Dissolve in water,
absorbed into bloodstream immediately,
needed daily
Sources
−Fruits
−Dark leafy vegetables 17
Micronutrients: Minerals
Inorganic compounds not synthesized
by the body
Needed in very small quantities but
possibly essential
Important for biochemical processes
and formation of cells and tissues
Sources
−Plants
−Animal products

17
Water
Main component of the body (60
percent of body mass)
Needed for digestion, absorption,
and other body functions
Regularly lost through sweating,
excretion, and breathing
Approximately 1,000 ml (4−8
cups) needed each day

17
Essential Nutrient Food Products
What local foods are rich in these
essential nutrients?
−Proteins
−Carbohydrates
−Fats and oils
−Vitamins (water soluble and fat soluble)
−Minerals (including iodine and iron)

18
 Energy Requirements
Amounts needed to maintain health,
growth, and appropriate physical activity
Vary according to age, gender, and
activity
Met through an age-appropriate
balanced diet
Based on
◦ Basal metabolism: Energy needed for
basic body functions
◦ Metabolic response to food: Energy
needed to digest, absorb, and utilize
food
◦ Physical activity: Work, rest, and play
18
Energy Requirements of Adults > 19 Years Old

Basal metabolic rate (BMR) =

Number of kilocalories (kcal)
needed each day
Energy needs = BMR x activity
factor
Additional energy needed by
pregnant and lactating women

18
Energy Requirements of Children and
Adolescents < 18
Calculated based on age, physical
activity, and energy needs for growth
Increase after age 10 to support
changing body composition and growth
Kcals required per day (FAO, WHO, UNU
2004)
◦ Boys 1−18 years old: 948−3,410
◦ Girls 1−18 years old: 865−2,503

18
Energy Requirements of Infants 0−12
Months Old
Mainly for growth
Vary by age and gender
All energy and nutrient needs
met by breastmilk for the first 6
months of life

18
Protein Requirements
Needed daily to replenish continuous
depletion
May vary by age, health status,
physiological status, and occupation
◦ Higher for pregnant and lactating
women
◦ Fluctuate in children based on
weight, age, and gender

18
 Undernutrition
The manifestation of inadequate nutrition
Common in sub-Saharan Africa
◦ 1/3 of all children < 5 years old
underweight
◦ 38% of children with low height for age
Many causes
◦ Inadequate access to food/nutrients
◦ Improper care of mothers and children
◦ Limited health services
◦ Unhealthy environment
18
Conditions Associated with Under- and Over nutrition
Vitamin deficiency disorders
◦ Scurvy (deficiency of vitamin C)
◦ Rickets (deficiency of vitamin D)
◦ Mental, adrenal disorders (deficiency
of B vitamins)
Mineral deficiency
◦ Osteoporosis (deficiency of calcium)
Diet-related non-communicable
diseases
◦ Diabetes
◦ Coronary heart disease
◦ Obesity
◦ High blood pressure 18
Causes of Undernutrition

18
Nutritional Status Determined by
Anthropometry
Underweight: Low weight for age
compared to reference standard, a
composite measure of stunting and
wasting
Stunting: Low height for age
compared to reference standard, an
indicator of chronic or past growth
failure
Wasting: Low weight for height, an
indicator of short-term nutritional
stress 18
 Other Anthropometric
Measurements
MUAC (mid-upper arm
circumference)
BMI (body mass index): Compares
height and weight
BMI = Weight (kg) ÷ height
(m)2

19
Manifestations of Protein-Energy Malnutrition
(PEM)

Marasmus: Severe growth failure

◦ Weight < 60% weight for age
◦ Frailty, thinness, wrinkled skin, drawn-in face, possible
extreme hunger
Kwashiorkor: Severe PEM
◦ Weight 60−80% weight for age
◦ Swelling (edema), dry flaky skin, changes in skin and
hair, appetite loss, lethargy
Marasmic kwashiorkor: Most
serious form of PEM, combining
both conditions above
− Weight < 60% weight for age

19
Strategies to Prevent and Control
Undernutrition
Improve household food security.
Improve diversity of diet.
Improve maternal nutrition and
health care.
Improve child feeding practices.
Ensure child health care
(immunization, medical care, growth
monitoring).
Provide nutrition rehabilitation. 19
Nutritional Anemia
Most common type of anemia
Caused by malaria, hookworm,
and inadequate iron and vitamin
intake resulting in low hemoglobin
levels
Affects mainly children < 5 years
old and pregnant women
Detected by measuring blood
hemoglobin levels

19
Effects of Anemia
Adults
◦ Reduced work capacity
◦ Reduced mental capacity
◦ Reduced immune competence
◦ Poor pregnancy outcomes
◦ Increased risk of maternal death
Infants and children
◦ Reduced cognitive development
◦ Reduced immune competence
◦ Reduced work capacity

19
Strategies to Prevent and Control
Anemia
Promote iron, folic acid, and B12-rich
foods.
Treat and prevent anemia-related
diseases (malaria and worms).
Provide iron and folic acid supplements to
infants and pregnant and lactating women.
Fortify foods.
Promote vitamin C-rich foods with meals.
Discourage drinking coffee or tea with
meals. 19
 Iodine Deficiency Disorders (IDD)
Caused by inadequate intake of iodine
Only 1 tsp. needed over entire lifetime
Iodine in food sources varies by
geography.
◦ Less in highlands and mountain regions
◦ Leached from soil and carried to
lowlands

19
 Manifestations of IDD

Goiter: Enlarged neck region from

overactive thyroid gland
Hypothyroidism: Dry skin, weight gain,
puffy face, lethargy from underactive
thyroid
Hyperthyroidism: Rapid pulse and
weight loss from overactive thyroid
Cretinism: Mental retardation, physical
development problems, spasticity from
IDD in mother during pregnancy
19
Strategies to Control IDD

Iodize salt, dairy products, and

bread where iodine is deficient in
local foods.
Provide iodine drops.
Inject people with iodized oil
(expensive).

19
 Causes of Vitamin A Deficiency (VAD)
Low consumption of vitamin A-rich
foods.
Dietary deficiency due to food
processing
Limited consumption of fats and oils
Poor breastfeeding (no colostrum,
insufficient breastfeeding)
Diseases affecting absorption (e.g.,
worms, chronic diarrhea)
19
Manifestations of VAD

Xerophthalmia (eye conditions)

◦ Blindness (VAD is the leading cause of
blindness in children < 5 years old)
◦ Bitot’s spots
◦ Damage to the cornea
Slowed growth and development
Reduced reproductive health
Increased risk of anemia

20
Strategies to Control VAD

Promote vitamin A-rich foods (fruits,

vegetables, red palm oil).
Give infants and women low-dose iron
supplements according to WHO
protocols.
Improve food security.
Feed children properly.
Prevent disease and treat disease early.
Fortify foods.
20
National Nutrition Strategies, Policies, and Guidelines

General nutrition
Infant feeding
Nutrition and HIV
Food security

20
Case Study 1

Food has been in short supply in

your area. A mother brings her 3
year-old daughter to the clinic. She
is worried because the child has a
poor appetite, skin conditions that
won’t go away, and excessive
diarrhea. Her hair has gotten
lighter. You notice swelling around
the child’s ankles. What might she
suffer from? What is the
appropriate course of action?
20
Case Study 2
A 28-year-old pregnant woman
attending the antenatal clinic
complains of shortness of breath,
dizziness, a fast heart rate, and
extreme fatigue. When asked about
the foods she has been eating, she
says she’s had little access to meat
and fish since her pregnancy. What
nutrition deficiency might she be
suffering from? What action would
you recommend?
20
Case Study 3

You and another nurse are

community health workers making
rounds to households to assess the
general health of children under five.
You notice that most children seem
small or thin for their age and decide
to assess weight for age and height
for age using a hanging scale and
height board. In the first household, a
24-month-old boy weighs 13 kg and
is 80 cm tall. Using the growth charts
in the Appendix, assess this child.
20
 Conclusions

Good nutrition is essential for health and

well-being.
Daily well-balanced diets should include
foods containing essential nutrients and
meeting energy requirements.
Inadequate nutrition can lead to PEM
and vitamin and mineral deficiencies
(anemia, VAD, IDD).
Nutrition interventions include improved
household food security, food
fortification, vitamin and mineral
supplementation (for women and
children), and improved child feeding. 20
20