1. By Hatim Jaber MD MPH JBCM PhD 15+18 - 12- 2016
Faculty of Medicine Introduction to Community Medicine Course ( ) Health Education and Communication By
Hatim Jaber
MD MPH JBCM PhD

2. AIDS and sexually transmitted diseases » World AIDS Day » 2016

3. Presentation outline Health Education Introduction to communication
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

4. COMMUNICATION for HEALTH EDUCATION
What is communication?
Is it Transfer, Conveying or Exchange?
Communication is derived from ‘communis’ which means COMMONNESS or SHARING.

5. 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.

6. 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.

7. Objective of Communication
To form and establish a relationship between a sender and a receiver.

8. 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 doctor-patient relationship.

10. 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

11. 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

12. 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

13. Communication Process – cont’d
Psychological effects
Perceptions
Attitudes and behaviors
Cognitive dissonance

14. Communication Process SMCR Model

15. Sender Must know: Objectives Audience: interests & needs Message
Channels of communication
Professional abilities
Limitations

16. Receiver Single person or Group of people Controlled audience
Uncontrolled audience

17. 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

18. 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

19. 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.

20. Step‐Models In Communication
A‐I‐D‐A
Attention
Interest
Desire
Action
A‐I‐E‐T‐A
Attention
Interest
Evaluation
Trial
Adoption

21. Communication Types Nonvocal_ nonverbal Vocal- Verbal Mass media
signals
signs
symbols
icons
gestures
proxemics
Vocal- Verbal
Mass media
public opinion
attitudes
persuasion

22. 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

24. 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.

26. Barriers of Communication
Physiological barriers
Psychological barriers
Environmental barriers
Cultural barriers
Barriers of Communication
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.

27. 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

29. Good communication technique
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.

30. 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.

31. 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

32. 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).

35. 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

36. Successful communication of message depends on 5 components:
credibility of message source
message design
delivery channel
target audience
targeted behavior

37. The Communication Equation
What you hear
Tone of voice
Vocal clarity
Verbal expressiveness % of the message
What you see or feel
Facial expression
Dress and grooming
Posture
Eye contact
Touch
Gesture % of the message
WORDS … % of the message!

38. Understanding Communication
We are going to consider:
The 2-Way communication process
Effective communication skills
Barriers to effective communication

39. Communication is a 2-way process
Communication skills involve:
Listening to others (Receiving) message
Asserting/ Expressing (Sending)
Barriers to communication can lead to misunderstanding and confusion
sender
receiver
values and attitudes
“generation gap”
Cultural differences
language
noise
hearing

40. Effective Communication Skills
Eye contact & visible mouth
Body language
Silence
Checking
for understanding
Smiling face
Summarising
what has been said
Encouragement
to continue
Some questions
Encourage participants to think about a situation where they must communicate with someone who is hard of hearing; anxious; has been put down in the past; doesn’t know who you are – what are some of the things you can do to help communication?

41. Barriers to Effective Communication
Language
Noise
Time
Distractions
Other people
Put downs
Too many questions
Distance
Discomfort with the topic
Disability
Lack of interest
Show the title of this slide and ask people to see if they can suggest some of the barriers-Then reveal the diagram when there has been 2 to 3 mins of ideas from the group

42. 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

47. Health Communication Information Education Motivation Persuasion
Counseling
Raising morale
Health development
Organization

48. 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.

49. 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.

50. 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.

51. Aims of Health education
Health promotion and disease prevention.
Early diagnosis and management.
Utilization of available health services.

52. Specific objectives of health education
To make health an assest valued by the community.
To increase knowledge of the factors that affect health.
To encourage behavior which promotes and maintains health.
To enlist support for public health measures, and when necessary, to press for appropriate governmental action.

53. 5. To encourage appropriate use of health services especially preventive services.
6. To inform the public about medical advances, their uses and their limitations.

54. 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.

55. Approach to Health Education
Regulatory Approach (Managed Prevention)
Service Approach
Health Education Approach
Primary Health Care Approach.

56. 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

57. 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

58. 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.

59. 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.

60. 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.

61. 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

62. Group Approach 1. Chalk and talk (Lecture) Flipcharts Flannel graph
Exhibits
Films & charts

63. Demonstrations • Role playing • Group discussion • Panel discussion
• Symposium
• Workshop
• Role playing
• Conferences and Seminars

64. 2. Demonstration 3. Role play
4. Group Discussion
5. Panel discussion
6. Symposium
7. Workshop
8. Conferences and Seminars

65. Mass approach
Television
Radio
Newspapers
Internetwww.mohfw.nic.in ,
Printed material
Direct mailing
Posters, billboards and signs
Health museums and exhibitions
Folk media

66. Health Communications Models, Theories, and Practices
Social Marketing
Health Education
PRECEDE-PROCEED model
Mass Communication
Persuasive Models
Ethical Communication
Behavior Models
Diffusion of Innovations

67. 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%
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!!

68. Adoption of new ideas or practice
Five steps
Awareness (know)
Interests (details)
Evaluation (Advantages Vs Disadvantages)
Trial (practices)
Adoption (habit)

69. 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)
Stage of sensitization- people are sensitized of an emerging problem, like, “AIDS causes death”. Its easy to sensitize litterate population, rather than illiterate one. If people are sensitized then they become more receptive to health education messages and try to seek more information regarding the health problem.
Stage of publicity – after sensitizing the media and all possible means of advertising are used to provide information to the public. The people who are receptive will absorb and understand the implications of the disease. The idea here is that people discuss among themselves and become more knowledgeable.
Stage of Education – this is the stage of Real education for the disinterested and illiterate population. Leaders of the local community like religious leaders and teachers should be approached first then after they are convinced the communities can be educated. During this stage, simultaneous messages on TV and the media should be continued.
Stage of Attitude change-
Stage of Motivation and Action
Stage of Community Transformation (social change)

70. 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.

71. Components of Health Education Process
Health Education has three broad components ●● Levels of Health Education ●● Methods of Health Education ●● Activities undertaken in individual methods

72. Contents of health education
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)

73. Principles of Health education
Interest.
Participation.
Proceed from known to unknown.
Comprehension.
Reinforcement by repetition.
Motivation
Learning by doing

74. 8. People, facts and media.
9. Good human relations
10. Leaders

75. 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.

76. Message What information to be communicated.
Simple, at the level of understanding.
Culturally accepted.
Interested.
Meet a felt need.
Avoid technical jargon.
Use audiovisual aids.

77. Practice 1-Individual Face to face Education through spoken word.
A- Occasions of health appraisal.
B- Home visits Nurses
Health visitors
Social workers

78. 2-Group
a. Lessons and lectures in schools.
lectures in work places e.g. factories.
Demonstration and training
3- Mass media.
Broadcasting: radio & TV.
Written word: newspapers, posters, booklets.
Others e,g, theaters.

79. Health Belief Model Perceived threat
INDIVIDUAL PERCEPTIONS MODIFYING FACTORS LIKELIHOOD
OF ACTION
Demographic Variables
Socio-psychological Variables
Perceived susceptibility
Perceived severity
Perceived benefits of
preventive action
Perceived barriers
to prevent action
Likelihood of taking recommended preventive health action
Perceived threat
Health Belief Model
The Health Belief Model was developed in the 1950’s to help understand why more people did not take advantage of an immunization program offered by the federal government. ( Rosenstock, 1990 ) The model has stood the test of time and is often used today in planning health promotion programs and explaining the reasons that individuals may or may not adopt new health habits. The focus of the model is on adapting new behaviors in times when true medical care is not warranted. Notice that the core constructs of the model are based on perceptions; you may want to go back a few slides and review our discussion on beliefs and the role of perceptions. These categories of beliefs have been shown to be strong determinants of whether or not people will adopt preventive behaviors. We will discuss each of these in detail on the next slides.
Cues to Action
Other factors that may mediate or motivate behavior have been added to the model in recent years. It was recognized that demographic and sociopsychological factors as well as information and experience also affect the likelihood of taking a preventive action.
Cues to Action
Information
Reminders
Persuasive communications
Experience

80. 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.
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.

81. 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.

82. Categories of Belief Perceived Seriousness Perceived Susceptibility
Perceived Benefits
Perceived Barriers
Mediators such as peer pressure, enabling and reinforcement will influence our behaviors.

83. Categories of Belief Seriousness Susceptibility
Relative severity of the health problem.
E.g. Seriousness of hepatitis encourages individuals to get the hepatitis vaccine.
Susceptibility
Nature and intensity of perceptions affect willingness to take preventive action.

84. Categories of Belief Benefits Barriers
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.

85. Stages of Change Precontemplation Contemplation Preparation Action
Maintenance

86. Precontemplation Definition Intervention Approach
Not considering changing their behavior
Lack of awareness
Intervention Approach
Novel information
Persuasive communications
Experiences

87. Contemplation Definition Intervention Approach
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.

88. Preparation Definition Intervention Approach
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

89. Action Definition Intervention Approach
Actually trying the new behavior
Intervention Approach
Skill
Reinforcement
Support
Self-management
Attitude and attribution change

90. Maintenance Definition Intervention Approach
Establishment of the new behavior
Taking on the new attitudinal and environmental supports
Intervention Approach
Relapse prevention skills
Self-management
Social and environmental support