DEFINITION OF HEALTH
Before discussing about health education and promotion, it is imperative to conceptualize what
health itself means. Health is a highly subjective concept. Good health means different things to
different people, and its meaning varies according to individual and community expectations and
context. Many people consider themselves healthy if they are free of disease or disability.
However, people who have a disease or disability may also see themselves as being in good
health if they are able to manage their condition so that it does not impact greatly on their quality
of life.
Health is a state of complete physical, mental and social well-being and not merely the absence
of disease or infirmity (WHO 1946).
Health has also been defined in various ways; it is the general condition of a person's mind and
body, usually meaning to be free from illness, injury or pain. Health can also be explained as the
capacity of the individual to live life to the full within his or her limitation. Again, health can be
defined as a state of moral, mental and physical well being which enables a man to face any
crisis with the outmost ability and grace.
It can be deduced from the above definitions that to be healthy does not only mean the body
being fit, but the mind must also be at ease, and one must be able to live and work well with the
family and relate well with others in the community. Taking into consideration the WHOs
definition of health and other definitions, health can be described as a condition of being free
from physical, mental and social factors that predisposes one to potential or actual problems of
living, having the ability to access positive living opportunities, and being able to relate well
with other people.
The absence of health is denoted by terms such as disease, illness and sickness, which usually
mean the same thing though social scientists give them different meaning to each.
Disease is the existence of some abnormality of the body, which is capable of detection using
accepted investigation methods.
Illness is the subjective state of a person who feels aware of not being well.
Sickness is a state of social dysfunction, a role that an individual assumes when ill
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COMPONENTS OF HEALTH
Health is a state of well-being in which all of the components of health are in balance. Wellbeing (wellness) is broken down into six (6) major components. These are
1. Physical
2. Mental / Intellectual
3. Social
4. Emotional
5. Spiritual
6. Environmental
Therefore, to be truly healthy you must take care of all six components.
1. Physical health:- This is most obvious dimension of health and is concerned with
mechanistic functioning of all the parts of the body and these parts working with each
other harmoniously. Physical health refers to the anatomical and physiological
functioning of the body. This includes eating right, getting regular exercise (jog, swim,
play games and sports), having enough sleep, and being at your recommended body
weight. Physical health is also avoiding drugs and alcohol and being free of disease and
sickness.
2. Mental/Intellectual health:- This is the ability to recognize reality, learn, think clearly
and coherently and cope with the demands of daily life to be able to achieve self-esteem.
A person with good mental health is able to handle day-to-day events and obstacles, work
towards important goals, and function effectively in society.
3. Social health:- This means the ability to make and maintain the quality of your
relationships with friends, families, teachers and other people that you are in contact with.
Or social health means the ability to make and maintain acceptable interactions with
other people. E.g. To feel sad when somebody close to you passes away. This is done
with a focus to improve social and communication skills of an individual. In order to
promote social health, a person must create a positive and lasting first impression, be
distinguished, earn respect, speak in public, articulate your thoughts, make others fell
important, visit neighbours and friend etc.
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4. Emotional health:- This is the ability to recognize emotions such as fear, joy, anger,
grief and to express such emotions appropriately (i.e. expressing your emotions in a
positive, nondestructive way). This also means coping with stress, tensions, anxiety and
depression.
5. Spiritual health:- It emphasizes on spiritual renewal and inner peace. to promote
spiritual wellness, a person must be true to him/her self , build character, virtues, create a
life of order and do meditation, perform prayers, have faith, learning and give respect to
religion. This indicates that spiritual health is connected to religious beliefs and practices
as well as personal creeds, principles of behaviour and ways of achieving peace of mind
and being at peace with oneself.
6. Environmental health:- Environmental health is keeping your air and water clean, your
food safe, and the land around you enjoyable and safe. It is impossible to be healthy in a
sick society which does not provide the resources for basic physical and emotional needs
like food, clothing, and shelter and has political oppression, unemployment, crimes
among others.
WELL-BEING / WELLNESS CONTINUUM (STRIVING FOR OPTIMAL HEALTH)
This is subject to the individual or group. This is to say that, individuals have authority over their
own well-being. For instance, every individual has control over his or her own money, chooses
which food to eat and which type of house to live in. This inevitably brings differences in how
well-being may be viewed by people.
Therefore, wellness or well-being is the achievement of a person’s best in all six components of
health. Many components of health can be affected by other components. If one is weak, it can
affect his/her overall health. It is unrealistic to have complete wellness all of the time. No one is
ever completely healthy or unhealthy. The more healthy behaviors you choose the better off you
will be in the wellness continuum and achieving optimal health.
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The health of the individual is a dynamic phenomenon, varying on a continuum from improved
health to average health which is a positive sign. It can also be on the negative side of the
continuum where minimum health state may lead to illness and death which is a negative sign.
Considering the explanations for health and well being, one can attempt to say that being in a
state of health, well being does not necessarily mean the person is in a good state of health and
vice versa. An individual may be free from ill-health and also be in a good state of well being, or
a high level of ill-health with a corresponding low level of well being, or no evidence of illhealth but a feeling of low esteem, or a high level of well being despite a high level of ill-health.
As a midwife, you need to be guided by these principles when supervising and planning care for
clients in order to meet the needs of every individual in any state or level of health.
DETERMINANTS OF HEALTH
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This is a range of personal, social, economic, and environmental factors that influences the
health status of an individual.
The determinant of health helps to identify “what makes some people healthy and others
unhealthy”
Many factors combine together to affect the health of individuals and communities. Whether
people are healthy or not, is determined by their circumstances and environment. To a large
extent, factors such as where we live, the state of our environment, genetics, our income and
education level, and our relationships with friends and family all have considerable impacts on
health, whereas the more commonly considered factors such as access and use of health care
services often have less of an impact.
The context of people’s lives determines their health, and so blaming individuals for having poor
health or crediting them for good health is inappropriate. Individuals are unlikely to be able to
directly control many of the determinants of health. These determinants or things that make
people healthy or not include the above factors and many others;
i.
Physical environment – having access to safe water and clean air, healthy workplaces,
safe houses and recreational settings, communities and roads (including transportation)
all contribute to good health.
ii.
Social support networks – this determinant of health reflects the social factors in the
environment in which people are born, live, learn, play, work and age. This impacts a
wide range of health, functioning and quality of life outcomes. For example, greater
support from families, friends and communities is linked to better health. Also, the
culture (i.e. customs and traditions) and the beliefs of the family and community all affect
health.
iii.
Biology and genetics – some biological and genetic factors affect specific
more than
others. For example, older adults are biologically prone to being in poorer health than
adolescents due to the physical and cognitive effects of aging. Also, Sickle cell disease is
a common example of a genetic determinant of health. Sickle cell is a condition that
people inherit when both parents carry the gene for sickle cell. Thus, genetics
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(inheritance) plays a part in determining lifespan, healthiness and the likelihood of
developing certain illnesses. Again, personal behaviour and coping skills such as
balanced eating, keeping active, smoking, drinking, and how we deal with life’s stresses
and challenges all affect health.
Examples of biological and genetic social determinants of health include; Age, Sex, HIV
status and inherited conditions, such as sickle-cell anemia and family history of heart
disease
iv.
Health services – having both access to health services and the quality of health services
can improve the health of an individual. Lack of access or limited access to health
services greatly impacts an individual’s health status. For example, when individuals do
not have health insurance, they are less likely to participate in preventive care and are
more likely to delay medical treatment.
Barriers to accessing health services include:
-
Lack of availability
-
High cost
-
Lack of insurance coverage
-
Limited language access
These barriers to accessing health services lead to:
v.
-
Unmet health needs
-
Delays in receiving appropriate care
-
Inability to get preventive services
-
Hospitalizations that could have been prevented
Gender – men and women suffer from different types of diseases at different ages. For
example; women are prone to cervical cancer and breast cancer whiles men are prone to
prostate cancer. Again, both men and women are exposed to certain diseases depending
on the work they do.
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vi.
Individual behavior – Individual behavior also plays a role in health outcomes. For
example, if an individual quits smoking, his or her risk of developing heart disease is
greatly reduced.
Many public health and health care interventions focus on changing individual behaviors
such as substance abuse, diet, and physical activity. Positive changes in individual
behavior can reduce the rates of chronic disease in this country. Examples of individual
behavior determinants of health include;
-
Diet
-
Physical activity
-
Alcohol, cigarette, and other drug use
-
Hand washing
vii. Income and social status – higher income and social status are linked to better health.
The greater the gap between the richest and poorest people, the greater the differences in
their health.
viii. Education – low educational levels are linked with poor health, more stress and lower
self-confidence. This is because if an individual is educated he or she is more likely to be
aware of healthy behaviors.
ix.
Employment and working conditions – people in employment are healthier,
particularly those who have more control over their working conditions.
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HEALTH EDUCATION AND PROMOTION
Education is defined as the systematic training and instruction given to people in order to make
them develop special knowledge, abilities, characters, values and skills (Talabi, 2001).
It also instills into the individual skills, and abilities to perform activities that would make him or
her healthy. Education brings the human element into the developmental process of life.
HEALTH EDUCATION AS A COMPONENT OF HEALTH PROMOTION
Health Education is an important element in health promotion; however, health education has
been defined in many ways by different authors and experts. Some of these are;
1. Health education is any combination of learning experiences designed to help individuals
and communities improve their health, by increasing their knowledge or influencing their
attitudes (WHO Health topics, 2015).
2. Health Education is any combination of planned learning experiences based on sound
theories that provide individuals, groups, and communities the opportunity to acquire
information and the skills needed to make quality health decisions (Joint Committee on
Terminology, 2001).
3. Health education is any combination of learning experiences designed to facilitate
voluntary adaptations of behaviour that is conducive to health (Lawrence Green, 1990).
REASONS FOR HEALTH EDUCATION
1. To improve poor health practices. Health education is carried mostly when the practices
regarding personal and environmental cleanliness, food hygiene practices, maternal and
child care, attitude towards health care and activities of daily living leave nothing to be
desired.
2. To change some of old fashioned ideas and traditional beliefs. For example, a widow who
is made to put of black clothes even in a sunny weather can result in skin condition.
Again, there are some traditions that belief that young children are not to be given meat
or eggs; and that if given the children will become thieves.
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3. Health education is carried out when there is lack of basic information in health matters
among individuals, groups or communities. For example, many people in the rural areas
are still ignorant about HIV/AIDS and how to prevent themselves from acquiring it.
AIMS OF HEALTH EDUCATION
The aims of health education is to

Motivate people to adopt health-promoting behaviors by providing appropriate
knowledge and helping to develop positive attitude.

Help people to make decisions about their health and acquire the necessary confidence
and skills to put their decisions into practice.
The positive change effects of life styles, cultural practices and good habits must be encouraged,
while negative and harmful ones are discouraged. In effecting a change, the following must be
considered:
1. Economic background
2. Social background
3. Occupational background
Economic background
With this, the change agent must consider what the person can afford. For example, in
maintaining oral hygiene the nurse or the health educator must find out if the client can afford
chewing stick and not tooth paste and brush, since both are materials that can be used to achieve
the same effect.
Social background
People must be educated on the behavior they want to change and how the change should be
effected. For instance, a person who has never used the water closet type of toilet before must be
educated on it before being asked to use it otherwise, such a person would prefer using what he
is used to, which might not be considered healthy.
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Occupation of the individual
Knowledge about the occupation gives an idea as to the type of hazards the person is likely to be
exposed to so the health education would be geared towards that direction.
HEALTH PROMOTION
Health promotion has been defined by the World Health Organization's and other organizations
in many ways including the following; (WHO) 2005 Bangkok Charter for Health Promotion in a
Globalized World in the following ways;
1. Health promotion is the process of enabling people to increase control over, and to
improve, their health (WHOs Ottawa Charter, 1986).
2. It is the process of enabling people to increase control over their health and its
determinants, and thereby improve their health (WHO Bangkok Charter for Health
Promotion, 2005)
3. Health promotion is the process of enabling people to exert control over the determinants
of health and thereby improve their health (Health Promotion Agency for Northern
Ireland, 2009).
These definitions above therefore move health promotion beyond a focus on individual
behaviour towards a wide range of social and environmental interventions. This means that
health promotion is a process directed towards enabling people to take action. Thus, health
promotion is not something that is done on or to people; it is done by, with and for people either
as individuals or as groups. The purpose of this activity is to strengthen the skills and capabilities
of individuals to take action and the capacity of groups or communities to act collectively to
exert control over the determinants of health and achieve positive change. Thus, health
promotion will include actions directed at both the determinants of health that are outside the
immediate control of individuals, including social, economic and environmental conditions, and
the determinants within the more immediate control of individuals, including individual health
behaviours.
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OBJECTIVES OF HEALTH EDUCATION AND PROMOTION
Health education and promotion attempt to close the gap between what is known about optimum
health practice and that which is actually practiced. For example, we are told that if people did
not smoke, lung cancer could be almost eliminated. The health educationist’s responsibility is to
try to get people not to smoke so if we succeed in influencing people not to smoke then we have
been successful in influencing behaviour that is changing behaviour in a desired direction.
When the goal of health education and promotion is achieved it will enable individuals and the
community to assume a greater responsibility and awareness of what constitutes good health.
This assumes that what the receiver learns will help them to put into practices.
The goals of health education and promotion are;
1. Improve health
Health education and promotion helps people improve their health in all stages of life. Educators
work in a wide variety of settings and for a wide variety of age groups. Some educators visit
elementary schools to speak with children about the importance of proper hand washing, eating
fruits and vegetables and the need to keep the body clean at all times. Other educators work in
non-profit clinics educating senior citizens about the importance of exercise, and eating low
sugary and salty foods.
2. Improve Decision-making
Health education and promotion strives to help people make better health decisions. To do so,
health educators often tailor their message to the group they are educating. For example, because
the youth are more sexually active, health educators working with the Reproductive and Child
Health, Adolescent Health and sectors often teach the youth on safer sex and the use of condoms.
They may also explain the risks of unhealthy habits like smoking, excessive alcohol consumption
and unprotected sex. This then allow people to decide on the appropriate action that will promote
their healthy living.
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3. Fight diseases
A goal of health education promotion is to minimize the occurrence of life-threatening illnesses.
For instance, the risk of developing diabetes and heart disease can be lessened with proper diet
and exercise. A health educator or promoter might explain to adults how cutting back on foods
high in cholesterol and sugar reduces the chance of developing these ailments. During health
education, individuals and communities are also taught on primary, secondary and tertiary
prevention of diseases.
4. Fight Misconceptions
Health promoters fight common misconceptions that affect people's health during health
education and promotion. An example is diffusing peoples mind that malaria is caused by taking
too much oil, Tuberculosis is caused by witchcraft or HIV/AIDS is a spiritual disease etc. when
these misconceptions are diffused by the health promoters; the people are then told what causes
those conditions, how they can get it or they can transfer to others, as well as how to prevent and
if possible how to manage the said condition.
5. Provide Resources
Health educators often distribute educational resources in the form of posters, fliers and
pamphlets during health education and promotion sessions. They also educate groups about
public resources services that may be available for free or at a minimal cost. These resources
might include medical tests or counseling provided by government hospitals, clinics and
charitable organizations. Health educators and promoters use these occasions to empower people
to use these resources to better their health. Also, during health education and education sessions,
the people are made to understand what they can do about their own health problems with their
own resources available to them.
WHY IS HEALTH PROMOTION IMPORTANT

Health promotion improves the health status of individuals, families, communities, states
and the nation

Health promotion enhances the quality of life for all people
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
Health promotion reduces premature deaths

By focusing on prevention, health promotion reduces the costs (both financial and
human) that individuals, employers, families, insurance companies, medical facilities,
communities, the state and the nation would spend on medical treatment
HEALTH EDUCATION SETTINGS (PLACES WHERE HEALTH EDUCATION CAN
BE DELIVERED)
When considering the range of health education interventions, they are usually described in
relation to different settings (places). Settings are used because interventions need to be planned
in the light of the resources and organizational structures peculiar to each. Thus, health education
and promotion takes place, amongst other locations, in:

Communities

Health care facilities

Work sites

Schools

Prisons

Market places

Lorry stations

Homes

Churches

Mosques

Homes
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PRINCIPLES OF HEALTH EDUCATION
The following are the basic principles which have to be followed in all health education
programmes.
1. Work from known to unknown
Teaching is done from what is already known by the people to what is yet to be known. It is
important if possible to find out about what your clients already know. If this can be done in
advance then time is spent at the beginning of the session to ask few questions. If the audience
are mixed with varying degrees of knowledge then the best is to acknowledge that some people
know more than others.
2. Aim at maximum involvement
Learning is efficient if people are actually involved in the learning process instead of listening.
Clients must be involved in establishing aims and objectives of the teaching session as this will
help them to be responsible for their own learning. Clients should be involved in teaching session
such as asking questions and the educator keeping eye contact with everybody present.
3. Vary health education methods
There are various health education methods which can be used. A health educator should use
varying methods to hold the attention of the audience and to ensure relevance when teaching
clients. The information given to them should be relevant to their needs, interest, and
circumstances of the audience. Demonstration should be used to illustrate a point.
4. Organization of materials
Whether you are talking to a group or an individual, it helps if you organize your materials in a
logical manner.
5. Evaluation and feedback
It is important to get feedback on your teaching so that you can assess how much your audience
are learning and improving in future.
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TARGET AUDIENCE FOR HEALTH EDUCATION
Target audience is the recipients of health messages or information. OR
Target audience is the specific group of people that a health worker plan to give health messages
or information to.
The target audience includes;
• Individuals such as clients of services, patients, healthy individuals, couples
• Groups E.g. groups of students in a class, youth club, associations
• Community E.g. people living in a village
SELECTING
A
METHOD
FOR
TEACHING
HEALTH
EDUCATION
AND
PROMOTION
Teaching methods are processes through which learning take place. Basically health education
helps people to make wise choices about their health and the quality of life of their community.
To do this, accurate information must be presented in an understandable way using different
teaching methods.
There are two main methods used in educating people on health issues. These are:
1. Didactic (one-way) method/approach and
2. Participatory (Socratic) or two way method/approach
DIDACTIC (ONE-WAY) METHOD/ APPROACH
This is based on direct instruction to the individual or group. The individual is considered to be
an “empty vessel” into which all sort of information must be poured. The flow of information is
from one direction, which is from the expert to the learner (target audience). Example of this
method is the lecture method. This method is used to reach out to a large number of people at a
time. With this since it is one-way communication process, there is only little opportunity to
assess how much people are learning.
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PARTICIPATORY/SOCRATIC (TWO WAY) METHOD/ APPROACH
This is method is based on exchange of ideas (information) by both the learner (recipient or
target audience) and the instructor (health worker, health educator or health promoter). It is
learner-centered approach which focuses on the learners developing abilities and skills to
diagnosis and solves their own problems. This method encourages the views of others to be
heard. And also help them to ask questions from their group members. The group also provides
encouragement for people who are trying to solve problems and change their behaviour.
METHODS USED IN PARTICIPATORY APPROAH
Some of the methods used are role play, demonstrations, discussions, songs, storytelling, and
case study among others.
ROLE PLAY
Role-playing consists of the acting out of real-life situations and problems. The player tries to
behave in a way that the character might behave when faced with a given situation or problem. It
is used to show different people’s feelings about a problem and what they should do about it.
Role-playing can be used to start off a discussion, to see what possible consequences of a certain
action are, and to develop a better understanding of why people feel as they do. We learn about
our own behavior during a role-play, we can discover how our attitudes and values encourage
cooperation and problem solving or, how our attitude and values create problems.
DEMONSTRATION
A demonstration is a step by step procedure that is performed before a group. They involve a
mixture of theoretical teaching and of practical work, which makes them lively. It is used to
show how to do something. The main purpose of demonstrations is helping people learn new
skills. The size of the group should be small to let members get the chance to practice. It is
particularly useful when combined with a home visit. This allows people to work with familiar
materials available in the locality.
Planning the Demonstration

Identify the needs of the group to learn
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
Collect the necessary materials such as models and real objects or posters and
photographs.

Make sure that it fits with the local culture. E.g. for nutrition demonstration you have to
use the common food items and local cooking methods.

Prepare adequate space so that everyone could see and practice the skill.

Choose the time that is convenient for everyone.
Procedures
Introduction: Explain the ideas and skills that you will demonstrate and the need for it
Do the demonstrations: Do one step at a time, slowly. Make sure everyone can see what you
are doing. Give explanations as you go along.
Questions: Encourage discussion either during or at the end of the demonstration. Ask them
(audience) to demonstrate back (return demonstration) to you or to explain the steps.
Summarize: Review the important steps and key points briefly.
Return demonstration: Ask one person to repeat the demonstration and ask the group to
comment when the person finishes. Finally give everyone a chance to practice. If possible move
around the group and watch them. Give suggestions for improvement and motivate them. Ensure
that everyone can practice the skill correctly before leaving the venue.
Checklist to evaluate a demonstration
i.
Did the audience learn how to do what was demonstrated?
ii.
What evidence was given that the audience plans to carry out this practice on their
own?
iii.
Visit members of the audience to see if they are using the new methods demonstrated.
iv.
How could your demonstration be improved?
DISCUSSION
Health education has been quick to recognize that groups provide an ideal set-up for learning in a
way that leads to change and action. Discussion in a group allows people to say what is in their
minds. They can talk about their problems, share ideas, support and encourage each other to
solve problems and change their behavior.
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Size of a group
For sharing of ideas an ideal group is the one with 5-10 members but sometimes some people use
2-10 people. If the members are large every one may not have a chance to speak.
Planning a discussion
Planning a discussion involves:
i.
Identification of the audience (recipient) that does have a common interest. E.g. mothers
whose child suffers from diarrhea, postnatal mothers, pregnant women, tertiary students,
Nandom MW students
ii.
Getting a group together
iii.
Identification of a comfortable place and time:
Conducting the discussion
 Introduction of group members to each other
 Allow group discussion to begin with general knowledge E.g. any idea or contribution
they have concerning the topic of discussion
 Encourage everyone to participate; but try as much as possible to limit those who talk
repeatedly and encourage the quiet ones to also contribute.
 Limit the duration of discussion to the shortest possible, usually 1-2 hrs, or maximum 3
hours.
 Check for satisfaction before concluding the session. This can be done through evaluation
and feedback.
SONGS
People sing to express ideas and feelings, such as love and sadness, to tell story of a famous
person, commemorate religious days etc. Particularly village people like to sing and dance and
almost every village have someone who can sing and put works to music. In addition to
expression of feelings, songs can also be used to give ideas about health. The songs are usually
health messages turned into songs. The songs contain important health information that the
health worker/health educator/health promoter wants to pass onto the target audience.
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The song is taught by the health educator or promoter to the target audience and he/she makes
sure that the target audience is familiar with it. The target audience is encouraged to practice the
words of the song always. Sometimes, local songs can be changed into health educational songs.
The songs should be one that the target audiences language and culture accepts. They should be
simple to learn, easy to memorize and applicable to their life.
You can give topics that you want to make popular to those persons for synthesis and
dissemination. For instance, the following issues could be entertained:
The village without safe water
The malnourished child who got well with the proper food to eat
The village girl who went to school to become a Community Health Nurse
The house where no flies and mosquitoes breed
STORY TELLING
These are health messages that have been turned into stories by the health worker/health
educator/health promoter. Stories often tell about the deeds of famous heroes or of people who
lived in the village long ago. Story telling is highly effective, can be developed in any situation
or culture, and requires no money or equipment. It should include some strong emotions like
sadness, anger; humor, or happiness as well as some tension and surprise. An older person,
instead of directly criticizing the behavior of the youth, may tell stories to make his/her points.
He or she may start by saying, “I remember some years ago there were young people just about
your age…” and then continue to describe what these young people did that caused trouble.
Stories may also be a way of re-telling interesting events that happened in a village. So stories
can entertain, spread news and information so that people are encouraged to look at their
attitudes and values, and to help people decide how to solve their problems.
These stories should be in the target audiences local language(s) and should be simple to
understand and easy to be remembered. The characters in the stories should be familiar to the
community. The stories can be given before, during and after health education. After the story,
the health educator or promoter should ask views, questions, comments, contributions and others
from the target audience for feedback in order to evaluate the session.
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CASE STUDY
A case study is a study of what happened in a particular or specific situation. Case study provides
useful example to illustrate general principles. These are usually successful when based on real
cases where the health educator or promoter with some of the target audience has dealt with. It
can be given before or after a talk but should be relevant to people and the topic to be presented.
The community members are even a real life situation after which questions are asked. The
questions generate a discussion which leads to health education. The target audience is expected
to apply their previous knowledge to the current situation. The case study may come from
different sources such as news papers, magazines, radio and television.
IMPORTANCE/PURPOSE/REASONS OF CASE STUDY
1. Case study helps people to learn how to solve problems.
2. By providing or learning about a case (problem) in another group or community, people
can begin to think about how they themselves would have solved the problems.
People learn from the successes and mistakes of the people in the case study.
DIFFERENCES
BETWEEN
PARTICIPATORY
AND
DIDACTIC
TEACHING
METHODS OR APPROACHES FOR HEALTH EDUCATION AND PROMOTION
DIDACTIC METHOD
PARTICIPATORY METHOD
1. It is rigid and directive
1. It is open and flexible
2. It can read word by word
2. It needs facilitating skills
3. Little or no feedback
3. Feedback is provided or improved
4. It can be used for larger audience
4. It can be used easily for small audience
5. It saves time (for large audience)
5. It is time consuming
6. Little or no chance for audience to
6. The
participate and get answers to questions
7. The teacher is seen as a giver of all
knowledge
8. Information is passed on in one
direction
audience
participates
in
the
activities
7. There
is
opportunity
to
share
knowledge by the group members
8. Information is exchanged in a two-way
process
____________________________________________________________________________20
TEACHING MATERIALS / AIDS
Teaching materials or aids are also known as learning aids or audio visual materials. Teaching
materials include all materials that are used as teaching aids to support the communication
process and bring desired effect on the audience. Thus, teaching aids are materials or items used
together to make health education and promotion effective.
The teaching materials or aids can be combination of sound, colours, pictures and words use to
improve learning, change attitude and attract and hold the attention of the large audience. The
more visual aids are use, the more learning take place.
NB: display teaching materials only when you ready to use them.
SOME AUDIO VISUAL (TEACHING AIDS) COMMONLY USED IN HEALTH
TEACHING
1. Chart/manila sheet
2. Posters
3. Leaflet and handout
4. Models
5. Real objects
6. Chalk or white boards
7. Mass media
8. Flannel graph
9. Video tapes (VCD, DVD)
10. Audio tapes
11. LCD Projector
____________________________________________________________________________21
The following are some selected teaching aids that are commonly used in health education and
promotion programs.
1. Audios
Audios include anything heard such as spoken-word (talk), music or any other sounds. Talks are
the most commonly used audio teaching methods.
Characteristics of audios:
- Effective when based on similar or known experience
- Could be distorted or misunderstood when translated
- Easily forgotten
Health talks
The most natural way of communicating with people is to talk with or to them. In health
education, this could be done with one person, a family, or with groups (small or large). Health
talks have been, and remain, the most common way to share health knowledge and facts.
However, we need to make it more than advice and make effective by combining it with other
methods, especially visual aids, such as posters, slides, demonstrations, video show etc.
In principle, it should be given to smaller group (5 to 10 people) though it could be given for
larger group. In health talks, unclear points could be asked and discussed.
In preparing a talk, consider the following points:

Know the group: their interests and needs

Select single and simple topic: e.g. Nutrition is too big as a topic. Thus, select subtopic
such as breast-feeding, weaning diet (complementary feeding) etc.

Have correct and up-to- date information

Limit the points to only main once

Write down what you will say, use examples, and stories to help emphasize main points

Make use of visual aids

Practice your whole talk before the day

Make the talk as short as possible usually 15-20 minutes talk and 15 minutes discussion.
____________________________________________________________________________22
2. Visual aids
Visual aids are objects that are seen. They are one of the strongest methods of communicating
messages particularly when accompanied with interactive methods.
Advantages
i.
They can easily arouse interest
ii.
Provide a clear mental picture of the message
iii.
Speed up and enhance understanding
iv.
Can stimulate active thinking
v.
Create opportunities for active learning
vi.
Help memory and provide shared experience
Visuals are more effective than words alone, and it will be rather more effective when extended
to practice (action).
There is a Chinese proverb that goes like this:
 If I hear, I forget
 If I see, I remember
 If I do, I know
Likewise, it is a common understanding that you remember 20% of what you hear, 50% of what
you hear and see, and 90% of what you hear, see and do. With repetition close to 100% is
remembered.
Visual aids can basically be divided into two (2) types. These are;
a. Non-projected materials (aids)
b. Projected materials (aids)
NON-PROJECTED MATERIALS (AIDS) OR GRAPHICS
They are materials or aids that are shown or displayed and do not necessarily depend on any
projected equipment.
Examples of non-projected aids includes
a. Leaflets
Leaflets are unfolded sheet of printed material. Leaflets can be very appealing if their message is
simple and clear, and if the language is understood by the reader. In preparing them, short
____________________________________________________________________________23
sentences and paragraphs should be used, illustrated with simple drawings or pictures that are
easily understood. They need to be pre-tested before distributed to the target audience.
b. Posters
A poster is a sheet of paper (usually large), with words and pictures or symbols that put across a
message. It is widely used by commercial firms for advertising products, but it is also use for
preventive purposes. Posters can be prepared by the health educator or promoter or can be
already prepared posters and are mostly placed at public places.
ADVANTAGES FOR USING POSTERS

They are design to meet a particular health information or education

They are comparatively cheap to make and use

Give information and advice, e.g. beware of HIV/AIDS!

Give directions and instructions, e.g. how to prevent HIV / AIDS, how to prevent TB

Announce important events and programmers, e.g. World AIDS day, National
Immunization Days (NIDs)

They can raise awareness of health issues and challenge believes attitudes and behaviour
of people

They can be use always when stored well

They can attract and hold the attention of the target audience

They help in easy explanation and the understanding of the health information
Standard rules in making posters:
• All words should be in the local language (if possible)
• Words should be limited and simple
• Symbols that illiterate people will also understand should be used
• Mix of colors should be used to attract attention
• Only put one idea on a poster.
General principles:
• They should contain the name of the event, date, time, and place
• They should be large enough to be seen from some distance;
• They could be used for small or larger groups
• Should be placed where many people are likely to pass
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• Do not leave them up for more than one month, to avoid boredom
DISADVANTAGES OF POSTERS
1. It can be only used for small target audience at a time
2. It may destruct the attention of the target audience when not used appropriately
3. It can easily be damaged (spoiled)
4. Target audience who are handicap; example, the blind may not be able to see the
illustrations
c. Flipchart
A flipchart is made up of a number of posters that are meant to be shown one after the other. In
this way, several steps or aspects of a central topic can be presented such as about family
planning. Their purpose is to give information and instructions, or record information when
prepared with blank pieces of paper.
When it is required for use, the chart is opened (flipped over) so that the required page faces the
target audience and when the health worker or health educator or health promoter has finished
explaining, he/she flip the picture over the top so that it rest against the back cover or the stand.
ADVANTAGES OF FLIP CHART
i.
It can be used during health education for note and diagram.
ii.
It is good for active involvement and brain storming of the target audience producing
ideas of discussion.
iii.
It can contain a lot of information in an orderly manner.
DISADVANTAGES OF FLIP CHART
i.
It can easily get torn.
ii.
It is expensive as compared to posters
____________________________________________________________________________25
HOW TO USE FLIP CHARTS AND COUNSELING CARDS
 Position the flip charts so that everyone can see it.
 Point to the pictures, not the text.
 Face the client or audience (for group talk). Move around the room for groups with the
flip chart if the whole group cannot see it at one time. Try to involve the group.
 Ask the clients questions about the drawing to check for accurate understanding.
If the flip chart has text, use it as a guide, but familiarize yourself with the content so that you are
not dependent on the text.
PROJECTED AIDS
Projected materials (aids) are simply educational materials that are shown to people using a
projector. They are used to facilitate lectures or seminars/trainings. The commonly utilized once
are slide projectors (color pictures on a transparent object), overhead projectors (display written
or drawn materials on a transparency), and power point projectors. They are expensive, requires
expertise and electric power. They are useful to underline the most important points in a talk or
lecture.
Mass Media
It is one way of giving health education. The communication that is aimed to reach the masses or
the people at large is called mass communication. The media that are generally used for mass
communication go by the name of mass media. The commonly used mass media are
microphones or public address system, radio, television, cinema, newsprints, posters, exhibitions.
Mass media are the best methods for rapid spread of simple information and facts to a large
population at low cost. However, the major concerns with this method of communication are
availability, accessibility and popularity in a given community.
____________________________________________________________________________26
IMPORTANCE OF TEACHING AIDS
1. It helps the learner to understand things better and acquires information that will be
difficult to achieve by verbal explanation
2. It serves as a means of getting access to health information for a large number of people
at the same time. Example, a film shown to the entire community on a health topic
3. It increases the learning rate since the materials enable the health educator or promoter to
supply meaningful and understanding information to the target audience
4. It enables the health educator or promoter to overcome some physical difficulties in
communication example the use of public address system for a large number of people in
a community
5. It enables the health educator or promoter to overcome the limitations of space. A large
number of people at different areas can be reached at the same time without the health
educator or promoter going to those areas. For example, the use of T.V., radio etc.
6. It saves time in explaining information to the target audience
7. It decreases unnecessary use of words
DISADVANTAGES OF TEACHING AIDS/MATERIALS
1. Much time is needed to prepare some of the materials before use. Example, charts and
posters.
2. Equipment may be limited or scarce in some areas. Example, projector
3. Some of the equipments need electricity to function. Examples computers, T.V.,
CHARACTERISTICS OF APPROPRIATE TEACHING AIDS
 It should be affordable.
 It should be easy to make and use.
 It should be well understood to the audience.
 It should encourage the participant to participate in the discussion.
 Writings should be bold enough for easy reading.
 It should be able to catch and maintain the interest of the audience.
____________________________________________________________________________27
FACTORS TO CONSIDER WHEN CHOOSING TEACHING AIDS (MATERIALS)

Take into consideration the background of the target audience. That is their educational,
cultural and religious background.

The aims and objective of the health education must be considered whether the learning
aids will be appropriate to achieve your aims.

Choose a teaching aid that will be appropriate for the size and venue of the health
education. Example, a chart for a small group and a projector for a larger group.

Avoid using materials that tend to advertise a particular company or person as these
means that the health worker or educator or promoter is advertising those particular
products by a company or person.

The information accompanying the teaching aid must be accurate, current and important.

The teaching method should also be considered. For example, demonstration may require
the use of real object.
____________________________________________________________________________28
COMMUNICATION
Communication is from the Latin word commūnicāre, which means "to share". Communication
is the core of health education and promotion programs. In human society communication plays
an important part in daily life. We have the advantage of language, spoken words, songs, and
written scripts and so on. It is by communication that an individual makes himself/herself to be
understood by others. This act requires an appropriate design so as transmit an effective message.
WHAT IS COMMUNICATION?
Communication is the process of sharing of ideas, information, knowledge, and experience
among people to take action. OR
Communication is the process of transmitting and receiving information on a particular topic
between two or more people that share the same code (verbal or non-verbal) aimed at reaching a
mutual understanding. OR
Communication is the act or process of using words, sounds, signs, or behaviors to express or
exchange information or to express your ideas, thoughts, feelings, etc., to someone else.
Communication may take place between one person and another, between an individual and a
group or between two or more groups. Communication facilitates creation of awareness,
acceptance and action at individual, group and inter-group level. The process always involves a
sender and a receiver regardless of the number of people concerned.
COMPONENTS OF COMMUNICATION
Communication is a dialogue but not a monologue and it is a continuous process.. So, a
communication is said to be effective only if it brings the desired response from the receiver.
Pre-requisite of communication is a message. This message must be conveyed through some
medium to the recipient. It is essential that this message must be understood by the recipient in
same terms as intended by the sender. He or she must respond within a time frame. Thus,
communication is a two way process and is incomplete without a feedback from the recipient to
the sender on how well the message is understood by him or her.
____________________________________________________________________________29
The components of communication are;
1. The Source (Sender)
The source (sender) is the originator of message that is to be communicated to the receiver. The
source can be from an individual or groups, an institution or organization. People are exposed to
communication from different sources but most likely to accept a communication from a person
or organization that they trust i.e. has high source of credibility.
Depending on the recipient, trust and source of credibility of the sender may come from:
i.
Personal qualities or actions e.g. a health worker who always comes out to help
people at night
ii.
Qualification and training
iii.
A person’s natural position in the family or community, e.g. village chief or elder
iv.
The extent to which the source shares characteristics such as culture, education, and
other experiences with the receiver. A person from a similar background to the
community is more likely to share the same language, ideas and motivations and thus
be a more effective communicator. One of the main reasons for communication
failure is when the source comes from a different background from the receiver and
uses inappropriate message content and appeals.
2. The Message
The message consists of what is actually communicated including the actual appeals, words, and
pictures and sounds that you use to get the ideas across to the receiver. A message can verbal,
nonverbal or written. A message will only be effective if the information presented is in the
message is relevant, appropriate, and acceptable and is put across in an understandable way.
A message is said to be good if it:
i. Is epidemiologically correct (evidence based)
ii. Is affordable (feasible)
iii. Requires minimum time/effort
iv. Is realistic
v. Is culturally acceptable
vi. Meets a felt need
vii. Is easy to understand
____________________________________________________________________________30
3. The Channel (Medium)
A channel (medium) is a means by which message travels from a source (sender) to a receiver.
The commonest types of channels are verbal, visual, printed materials or combined audio visual
and printed materials. Your choice of channel will depend on what you are trying to achieve, the
nature of your audience and what resources are at your disposal.
4. The Receiver (Audience)
The receiver (audience) is the person or a group people for whom the communication is intended
to. The first step in planning any communication is to consider the intended audience (receiver).
Before communication, the following characteristics of the audience (receiver) should be
analyzed.
 Educational factors: Can they read? What type of appeal might convince them?
 Sociocultural factors: What do they already believe and feel about the topic of
communication?
 Patterns of communication: How people show respect when talking to another person?
What time of the day and which programs do they listen? Which places do they pass that
might be good places to put up posters?
5. The Effect and feedback

Effect is the change in receiver’s knowledge, attitude and practice or behavior.

Feedback is the mechanism of assessing what has happened on the receiver after
communication has occurred.
Thus, feedback is the response or reaction of the receiver, to a message that has been received.
Feedback is the main component of communication process as it permits the source (sender) to
analyze the efficacy of the message. It helps the sender in confirming the correct interpretation of
message by the decoder. Feedback may be verbal (through words) or non-verbal (in form of
smiles, sighs, etc.). It may take written form also in form of memos, reports, etc.
Source (sender /encoder)
Message
Channel
Receiver (audience/decoder)
Feedback
____________________________________________________________________________31
TYPES OF COMMUNICATION
People communicate with each other in a number of ways that depend upon the message and the
context in which it is being sent. Choice of communication channel and the style of
communicating also affect communication. There is variety of types of communication, and this
includes;
1. One-way communication
This is a linear type of communication in which information flows from the source to the
receiver. There is no input (feedback) from the receiver. It is commonly used in advertising. The
message is designed to persuade the receiver to take action prescribed by the sender. The model
is best used by organizations when the message is simple and needs to be communicated quickly,
for example, the date and time of a public meeting. There is no opportunity to clear up
misunderstanding and meaning is controlled by the receiver.
Sender
Message
Channel
Receiver
2. Two-way communication
As the message is more complex, two-way communication becomes essential. In this type of
communication, information flows from the source to the receiver and back from the receiver to
the source. The addition of feedback allows the sender to find out how the message is being
received and so it can be monitored and adapted to better suit the receiver’s needs.
Feedback
Sender
Message
Channel
Receiver
ADVANTAGES OF TWO WAY COMMUNICATION
i. More audience participation
ii. Learning is more democratic
iii. Open to feedback
iv. May influence behaviour change
____________________________________________________________________________32
DISADVANTAGES OF TWO WAY COMMUNICATION
i.
It is slow and delays decision making
ii.
Takes more time
METHODS OF COMMUNICATION
1. Intra - Personal communication
2. Inter - Personal communication
3. Mass communication
Intra-Personal Communication
It takes place inside a person. It includes the beliefs, feelings, thoughts and justification we make
for our actions. It is usually considered that there are three aspects of intrapersonal
communication; namely self awareness, perception and expectation.
Self awareness is the part of intrapersonal communication that determines how a person sees
him or herself and how they are oriented toward others. Self awareness involves three factors:
beliefs, values and attitudes.
Perception is about creating an understanding of both oneself and one’s world and being aware
that one’s perceptions of the outside world are also rooted in beliefs, values and attitudes.
Expectations are future oriented messages dealing with long-term roles, sometimes called ‘life
scripts’. Intrapersonal communication is used for clarifying ideas or analyzing a situation and
also reflecting on or appreciating something
E.g. a person may look at an object and develop a certain understanding. However, this could be
affected by a number of factors including previous experience, language, culture, personal needs,
etc.
Interpersonal Communication
It means interaction between two or more people who are together at the same time and place.
Even though interpersonal communication can take place where the people concern at not
together at the same place, it is most appropriate or best when the individuals concern at the
same place (face to face). This means at most interpersonal communication should be face to
face and all the parties involved are senders and receivers.
____________________________________________________________________________33
Example of interpersonal communication are, a Midwife and community members at ANC, a
teacher and students in a class. The decisive criterion for personal communication is that
communication happens at the same time and place.
Advantages

Two way communication

The communication could utilize multi-channels (both verbal and non verbal) i.e. more
channels are involved than is possible in mass communication.

Audience (recipient) have the opportunity to make clarification and also give feedback

Target audience are differentiated

Useful when the topic is a taboo or sensitive.
Disadvantages/Limitations

Requires language ability of the source.

Requires personal status.

Needs professional knowledge and preparation.
Mass Communication
It is a means of transmitting messages to a large audience, usually a large segment of the
population through the use of the mass media. Mass media includes broadcast media (radio and
television) as well as print media (newspapers, books, leaflets and posters)
Advantages
 Reaches many people quickly and timely
 They are believable especially when the source is a credible one
Disadvantages/Limitations
 One sided (linear)
 Doesn’t differentiate the target
____________________________________________________________________________34
FORMS OF COMMUNICATION
There are basically three forms of communication; oral or verbal, written, and non-verbal.
1. Oral or Verbal Communication
This is communication by word of mouth. In oral communication, speech or talk is the widely
adopted tool of communication. The message is received through our ears. It may also be
achieved through the use of mechanical devices such as telephone, radio or even a public address
system.
2. Written Communication
This involves the exchange of facts, ideas and opinions through the use of written materials.
Individuals or groups keep in touch with each other and share meaning and understanding with
each other through written materials such as letters, notes, leaflets, reports, handouts, bulletins or
newspapers.
3. Non-verbal Communication
Non-verbal communication is the process of communicating through sending and receiving
messages without words. Such messages can be communicated through gestures, body language
or posture, facial expressions, and eye contact.
____________________________________________________________________________35
EFFECTIVE COMMUNICATION
Effective communication is using the components of communication and its skills in order to
improve interactions with those you are communicating to and to increase satisfaction with those
people.
Everyone is different. We all have different parents, different upbringings and different values.
However, we also need to be around and work with other people to function in society. The key
to bridging this gap is effective communication.
COMPONENTS OF EFFECTIVE COMMUNICATION
The main components of effective communication are;
Active Listening - Although speaking is the first action that comes to mind when one hears the
word "communication," it's actually just half of the equation. Equally, and if not more important
is listening. Rather than passively listening and just letting information flow at you, you listen
actively. Relax your body, maintain eye contact and keep interruptions to a minimum. When you
do interrupt, do so at a pause and only to paraphrase to clarify what the person is saying. The
speaker will feel that his or message is being better received by an attentive listener.
Body Language - Keep your body open. Don't cross your arms or legs, but keep both
outstretched, indicating receptiveness.
Empathy and Personal Responsibility - Show empathy and take responsibility. The person
you're speaking to needs to feel that you understand what he means and not feel threatened. One
of the best ways to do this is to use the paraphrasing strategy. Taking responsibility relies on one
word: "I". Never use "you" when discussing something negative. For example, "you made a
mistake" sounds more confrontational than "I'm having a hard time understanding you," although
the message is ultimately the same.
Clarity - Clarity is so important in effective communication that it deserves its own section. It's a
tricky thing to do, too; you need to use enough words to get your point across without assuming
____________________________________________________________________________36
that the other person has information he doesn't, but you also need to economize so that your
point isn't lost or muddled in a sea of unnecessary words.
Soothing - If someone is angry, don't try to deduce the cause of or a solution to the anger until he
has calmed down. People usually just need to be heard out when they're angry, so let them talk;
only speak to give compliments. A resolution can be pursued later.
TOOLS FOR EFFECTIVE COMMUNICATION
1. Active Listening
2. Observation and non-verbal communication
3. Providing and receiving feedback
Active Listening
Active listening involves paraphrasing, summarizing, probing and reflecting. This is especially
important when dealing with a service provider-client interaction. Not correctly understanding
each other will greatly diminish the possibility of effective behaviour change. Frame messages
carefully because people select what they see, interpret, remember and forget.
Observation and Non-verbal Communication
They say action speaks louder than words so when there is a contraction between verbal and nonverbal, choose a non-verbal voice tone, body movement, facial expression, eye contact among
others.
Providing and Receiving Feedback
Communication is a fluid process that continues over time. A good communicator will keep that
process going until he/she is sure that what he/she intend to communicate is being understood.
____________________________________________________________________________37
BARRIERS TO EFFECTIVE COMMUNICATION
A breakdown can occur at any point in the communication process. Barriers (obstacles) can
inhibit communication, resulting in misunderstanding, lack of response or motivation and
distortion of the message. This can lead to conflicting of views, insecurity and the inability to
make effective decisions. Barriers can also prevent the achievement of project or program goals
if we are not aware of them or not prepared for them.
COMMON BARRIERS TO EFFECTIVE COMMUNICATION
1. Competition for attention (noise)
2. Language difference and vocabulary use
3. Age difference
4. Attitudes and Beliefs
5. Physical barriers
6. Information overload
7. Assumptions and Jumping to Conclusions
We cannot avoid or overcome all these barriers but as health educators or promoters we have to
find ways of minimizing them.
Competition for attention (noise)
Noise is a major distraction during communication. It could be;
a. Physical noise – avoidable
b. Internal noise - any physiological or psychological state that could undermine a person’s
ability to communicate effectively such as being ill, having poor eyesight, having hearing
difficulties or beset with personal problems. We may or may not be able to do anything to
help in this kind of situation
Language difference and vocabulary use
Differences in language are a barrier in communication. Different languages, vocabulary, accent
(tone of voice or pronunciation) and dialect (tongue) represents a national / regional barrier.
Language can seem like an easy one, but even people speaking the same language can have
difficulty understanding each other if they are from different generations or from different
____________________________________________________________________________38
regions of the same country. That is if you are not a native speaker of the language, you are
likely to have trouble understanding and translating a language that is foreign to you. Idioms or
slang used in the foreign language may not translate into your native language. Slangs, use of
jargon and regional colloquialisms (common spoken expression) are examples of language
barriers that can even hurt communicators with the best intentions.
Age difference
Age difference between the sender and receiver is a barrier to effective communication. For
example, if the sender is young, inexperienced and not knowledgeable the audience may not give
proper attention resulting in a communication barrier.
Attitudes and beliefs
The community or individuals may be misguided by expectation on the role of for example
health workers or of the health educator or promoter. They may either think that the health
educators or promoters are supposed to do everything for them.
Everyone comes from a different culture, family and sets of norms. Cultural beliefs of people
also influence the rate at which they accept, adopt new ideas and skills also interpret messages.
Normally the beliefs of a community may dictate what foods should be given to especially
children and pregnant women with their related taboos. In such circumstances it will be very
difficult for a health worker to convince the mothers to feed their children on certain food despite
their nutritional values. For this reason it is necessary for the health worker or health promoter to
be aware of the attitudes and beliefs of the communities they are working with. Again, in some
cultures proximity to the speaker, lack of eye contact, and hand gestures can be associated with
messages that differ from the sender's intentions. Examples include;
-
Some cultures believe that lack of eye contact is a sign of respect. Other cultures believe
that lack of eye contact is a symbol of insincerity
-
In many cultures it is common for men to kiss other men on the cheek but in the United
States and even in Ghana this would be misunderstood.
____________________________________________________________________________39
Physical barriers
Physical barriers to communication can include people being in different locations, poor or
outdated equipment used during communications, background noise, poor lighting, temperatures
that are too hot or too cold. This can be seen in many businesses, institutions or organizations
that have difficulty with interdepartmental communication.
Information overload
It takes time to process a lot of information and too many details can overwhelm and distract the
audience from the important topics or facts. Hence, to maintain effective communication the
information (message) should not contain too many details and should also keep it simple.
Assumptions and Jumping to Conclusions
This is presuming to know what the source (sender) is to talk about. This can make someone
reach a decision about something before listening to all the facts.
HOW TO OVERCOME BARRIERS OF COMMUNICATION
If there is a communication barrier, the message intended by the sender is not understood by the
receiver in the same terms and sense and that breaks down communication. Therefore, it
becomes extremely important for source (sender) to identify and know how to overcome or
minimize these communication barriers to promote a healthy communication among individuals,
groups or within an organization.
In overcoming barriers to communication;
1. The sender (source) must know his/her audience’s:
 Background
 Age and sex
 Social status
 Education
 Occupation (Job/work)
 Language
____________________________________________________________________________40
2. The messages must be:

Timely

Meaningful/relevant

Applicable to the situation
3. Don't presume beforehand: Presumption is the biggest barrier to effective
communication. After listening to half the information, we tend to presume what the rest
of the part would be, which is something that we are never supposed to do. The
stereotype approach of taking things for granted can lead to a lot of misunderstandings
and confusions. Therefore, never presume while communicating.
4. Use of simple language: Use of simple and clear words should be emphasized. This is
because the basic element in the process of communication is language, which must be
extremely simple and easy, so that there are no loopholes to misinterpret or not
understand what you are trying to put across. Try to avoid using jargons or too much of
complicated words and sentences. Remember that the basic motive is to put across the
message and making sure that people understands it.
5. Be present, not only physically, but mentally as well: Effective communication
demands the attention and presence of all those involved (i.e. both sender and receiver),
not only physically, but mentally as well. If there are any physical barriers like too much
of noise, or too many people or too much of distance, then make sure that you either
communicate away from the environment or make sure that you eliminate these
hindrances. Speaking of mental barriers, keep your mind fully alert and pay attention to
the person you are communicating with. Or else, the person will assume that you
understood his point when you have not.
6. Reduction and elimination of noise levels: Noise is the main communication barrier
which must be overcome on priority basis. It is essential to identify the source of noise
and then eliminate that source to achieve the effectiveness of your communication.
7. Active listening: To ensure effective communication, each individual should listen
attentively and carefully. There is a difference between “listening” and “hearing”. Active
listening means hearing with proper understanding of the message that is heard. By
____________________________________________________________________________41
asking questions the speaker can ensure whether his/her message is understood or not by
the receiver in the same terms as intended by the speaker.
8. Emotional state: During communication one should make effective use of body
language. He/she should not show their emotions whiles communicating as the receiver
might misinterpret the message being delivered. For example, if the conveyer of the
message is in a bad mood then the receiver might think that the information being
delivered is not good.
9. Avoid information overload: It takes time to process a lot of information and too many
details can overwhelm and distract the audience from the important topics. Hence, to
maintain effective communication the information (message) should not contain too
many details and should also be kept simple. Again, students, CHOs, tutors etc. should
know how to prioritize their work. They should not overload themselves with work and
information. They should spend quality time with their subordinates and should listen to
their problems and provide feedbacks actively.
10. Give constructive feedback: Taking a feedback from the receiving end, just to make
sure that they have interpreted the information (message) in the same manner as you
intended to is very important. It is only through proper feedback that you can understand
how far they have understood, thereby getting a chance to clarify the differences, if any.
11. Proper media selection / Right channel to communicate: The managers or people who
send messages should properly select the medium of communication. Simple messages
should be conveyed orally, like: face to face interaction or meetings. Use of writing as
means of communication should be encouraged for delivering complex messages. For
significant messages reminders can be given by using written means of communication
such as Memos, Notices etc. For example, if you want to convey a message to your
students, community members or employees, calling everyone individually and
informing them would be inappropriate. The best medium will be just putting it on the
notice board or assembly them at one point and then convey the message to them.
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BEHAVIOUR CHANGE
Behaviour change is an approach used to bring about changes in an individual’s thinking or
perception. We use this method to change the behaviour of individuals within our communities
and help them make their own health-related decisions. This approach can be applied using
locally available methods and media such as leaflets and posters.
Behaviour:- It is an observational action by an individual or a group. OR
Behaviour is a conscious or unconscious action that has a specific frequency, duration and
purpose.
This means that behaviour is what we do and how we act. People stay healthy or become ill often
as a result of their own action or behaviour.
Human behavior refers to the range of behaviors exhibited by humans and which are influenced
by culture, attitudes, emotions, values, ethics, authority, rapport, persuasion, coercion and/or
genetics.
DEFINITIONS OF HEALTH BEHAVIOUR
Health behaviour are those personal behaviour patterns, actions and habits that people perform in
order to stay healthy, in order to restore their health when they get sick and in order to improve
their health status. OR
Health behaviour are those personal attributes such as beliefs, expectations, motives, values,
perceptions, and other cognitive elements and personality characteristics, including affective and
emotional states and traits and overt behavior patterns, actions, and habits that relate to health
maintenance, to health restoration, and to health improvement (David Gochman, 1997).
TYPES OF HEALTH BEHAVIOURS
There are six different types of health behaviour that people may perform from the initial stages
of preventing diseases up to their actions that may be associated with attempts to rehabilitate
themselves after illness.
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1. Preventive health behaviours
These are actions that healthy people undertake to keep themselves or others healthy and prevent
disease or detect illness when there are no symptoms.
Examples include hand washing with soap, using insecticide treated mosquito nets, exclusive
breastfeeding for the first six months, eating balance diet, wearing of helmets, using seat belts
and wearing of condoms during sexual intercourse.
2. Illness behaviours
These include any activities undertaken by individuals who perceive by themselves to be ill. This
would include recognition of early symptoms and prompt self referral for treatment. For example
a person who feels that they are ill might visit the nearby health centre, whiles another person
might go the church for a cure with holy water or prayers.
Example of illness behaviour includes consulting with a doctor or other health worker, taking a
pain killer if you have a headache or other form of medication.
3. Sick-role behaviours
These are activities undertaken by individuals who consider themselves to be ill, for the purpose
of getting well. It includes receiving treatment from medical providers and generally involves a
whole range of potentially dependent behaviours. It may lead to some degree of exemption from
one’s usual responsibilities.
For example a person who feels that he is ill might visit the nearby health centre and receive
tablets to be taken home, and might then not do as much work as normal, cease work or
withdraw from family life temporarily.
4. Compliance behaviours
This means the person will be following a course of prescribed treatment according to the
instructions that the health worker has given them.
Examples include washing of hands after going to the latrine as suggested by the health worker,
taking medicine regularly in the case of HIV/AIDS.
5. Utilisation behaviours
This is the sort of behaviour that is described when people use their health services such as
antenatal care, family planning, immunization, taking a sick person for treatment, and HIV
testing or voluntary counselling and testing (VCT) services.
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6. Rehabilitation behaviours
This is what people need to do after a serious illness to get themselves better again and prevent
further disability. Examples include practicing walking after injuring your leg or practicing
talking after a stroke.
Characteristics of health behaviour

Action oriented

Observable

Specific (time, place, quantity, duration)

Measurable

Doable

Have a direct link to health outcome
Determinants of behaviour
i.
Benefit or reward: What people want and get out of performing behaviour example
love, peace of mind, recognition, pleasure, health, success, security, power, positive
self image, social acceptance, comfort, freedom, status and adventure. Example,
Behaviour (i.e. exclusive breastfeeding), Benefit (i.e. baby grows well without any
disease)
ii.
Barriers: Perceived obstacles or deterrents to taking the action. For example belief,
illiteracy, poverty, distance, lack of access.
iii.
Enabling factors: Factors that motivate or determine behaviour of population.
Example, access, policy, culture, actual consequences, knowledge, perceived risks,
self efficacy, perceived social norms, perceived consequences, attitudes and norms.
BEHAVIOUR CHANGE
Behaviour change is modifying a not-so-healthy behaviour or action into a healthy one. OR
It is a change from poor health behaviour to a healthier one.
Behaviour change focuses on bringing a change in specific behaviour of an individual or groups.
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BEHAVIOUR CHANGE COMMUNICATION (BCC)
BCC is an interactive process with communities to develop messages and approaches for specific
groups using a variety of communication channels to develop and maintain positive behaviours
as well as to promote and sustain individuals, communities and societal behaviour change. OR
BCC is a process of any intervention with individuals, communities and/or societies to develop
communication strategies to promote positive behaviours which are appropriate to their settings.
BCC in turn provides a supportive environment which will enable people to initiate and sustain
positive and desirable behaviour outcomes.
FACTORS INFLUENCING BEHAVIOUR CHANGE
1. Family and personal network (belief system)
2. Social structures
3. Skills
4. Physical stimuli
5. Rational stimuli
6. Emotional stimuli
Family and personal network (belief system):- This is based on the influence from family and
peers.
Social structures: - This is based on the impact of social, economic, legal and technological
factors on the daily life of a person.
Skills: - This is based on the person’s capacity to adopt and continue a new behaviour.
Physical stimuli: - This is based on a person’s current physical state, fear of future pain,
discomfort or memory of past pain.
Rational stimuli: - This is based on knowledge and reasoning. Thus, if people have the facts
they may choose to do the right thing.
Emotional stimuli: - This is based on the intensity of feeling of fear, love or hope.
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STAGES OF BEHAVIOUR CHANGE
1. Precontemplation
2. Contemplation
3. Preparation
4. Action
5. Maintenance
6. Termination
Precontemplation: In this stage the individual has no intention to make change or take action in
the near future (within next six months) and are generally unaware or under-aware of the
problems
Contemplation: This is the stage the individual intends to take action within the next six
months. He or she at this stage is aware that a problem exists but has not yet made a commitment
to take action.
Preparation: this is a stage where individuals intends to take action within the next 30 days and
has taken some behavioural steps in this direction
Action: the individual at this stage changes his or her overt behaviour for less than 6 months and
is actually practicing the change as has been planned.
Maintenance: in this stage the individual changes his or her overt behaviour for more than 6
months and works to prevent relapse and consolidate the gains attained.
Termination: the individual has no temptation to relapse and has 100 percent confidence in
maintaining the change.
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COMPONENTS OF BEHAVIOUR CHANGE STRATEGY
Behaviour change cannot be reduced to just communication. It may also include;

Service improvement: - This results in making a difference in perception to those who
use the services.

Ensuring supplies of products: - Inadequate quantity and the logistics needed to make
sure they are in the right place at the right time in the right quantity.

Training: - This addresses not just what people are suppose to do but also why it is in
their best interest to do the tasks and how they can carry them out, even when they face
obstacles.

Communication: - This can support many aspects of the above and can also be used to
influence individual’s knowledge, beliefs and behaviours.
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INTERPERSONAL COMMUNICATION (IPC) AND CONSELLING
INTERPERSONAL COMMUNICATION (IPC)
Interpersonal communication is a verbal and nonverbal exchange of information or feelings
through speech, signs, or actions, from a source to a receiver. OR
Interpersonal communication is a person to person, two-way, verbal and non-verbal interaction
that includes the sharing of information and feelings between individuals or in small groups that
establishes trusting relationships.
IPC is used to advocate, educate, motivate and counsel people.
CHARACTERISTICS OF IPC
1. Knowledge – ideas (sharing), experience
2. Interaction – verbal (reassurance), two way listening, involvement, feedback
3. Foundation – non-judgmental, non-verbal, empathy, respect, values
FACTORS AFFECTING IPC
 Perception: - Perception is how we understand what others show or say to us. It is
motivated by several factors such as age, gender, education, social status, past
experiences, culture, economic status, etc. Perception cannot be correct or incorrect. It is
unique for each individual. You should be careful not to impose your own perceptions on
your clients.
 Values: - values are beliefs, principles and standards to which we assign importance.
Principles, goals or standards held by an individual or group that influence the life
activities such as loyalty, truthfulness, hardworking, healthy living, neatness, wealth,
education and comfort. They reflect part of our lives that we prize and give a degree of
significance. Our values are often ingrained such that we are unaware of them until we
are confronted with situations that challenge them.
 Attitudes: - Attitude is the state of mind or a feeling. The mental positioning of
individuals is based on personal values and perceptions. Mental views, opinions,
dispositions, postures and behaviours.
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COUNSELLING
Counseling is the act of helping a client to make his or her own decision, by providing unbiased
information and asking questions about what the client wants and what the client thinks that he
or she can do. OR
Counselling is the face to face communication between two people whereby one person helps
another person to make a decision or plan and act on it. OR
Couselling is the process whereby one person helps another person to make an informed decision
or solve a problem with an understanding of the facts and emotions involved.
Counseling is a special process. It is a confidential dialogue between a health provider
(counselor) and a client (counselee) that helps the client to define his or her feelings and to cope
with stress. The goal of counseling is to help a patient or client to make an informed decisions
and ideally, to follow the recommendations. These decisions will affect a client’s life, so it is
very important that they are the client’s decisions, not the counselor’s decisions. Informed and
voluntary choice is the foundation of effective counseling. A well-informed client who
voluntarily chooses to complete treatment is more likely to be satisfied and to continue the
treatment; likewise a well informed client who voluntarily chooses to exclusively breastfeed will
be satisfied to breastfeed. To be informed, clients need to have clear, accurate, and specific
information. The health provider determines informational needs, provides information, and
helps the client to make the decision.
Counseling is different from education, although education can be an important part of
counseling. Counseling is not solving the client’s problem for him or her or giving advice. In the
counseling process, the health provider avoids taking on the client’s problem or telling him or
her how to solve the problem or what decision or action to take. Instead, the health provider
brings a set of skills to the interaction that can enable the client to reach a better understanding of
the problem, deal with his or her related feelings and concerns, and assume responsibility for
evaluating alternatives and making choices.
IDEAL IPC AND COUNSELLING ENVIRONMENT
1. Privacy
2. The counselling, waiting room should be spacious
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3. Reading materials should be available
4. The counselling room should be accessible
CHARACTERISTICS OF EFFECTIVE COUNSELING
1. Client-centered
2. Interactive
3. Private and confident
4. Individualized
THE ROLE AND PROCESS OF INTERPERSONAL COMMUNICATION AND
COUNSELLING
 Hospitality: Hospitality is valued by people and it is part of high quality interpersonal
communication and often missing in our IPC. Your culture may value hospitality, yet
when you enter a clinic you are not greeted with a warm smile and welcoming words.
When you pay your bill the cashier does not thank you sincerely. Your first and last
impressions do not encourage you to send your family members there for treatment.
 Consistency: This means training anybody from receptionist through to cashier in
effective IPC (courteous and helpful behaviour). It also means identifying what makes
some clinic excellence and developing those characteristic to all clinics. Is the standard
maintained throughout the week and by all.
 Satisfied clients: Are we producing satisfied clients? How can we tell? Producing
satisfied client is the end goal of communication. High dropout rates indicate a high rate
of the dissatisfy clients. Those who try the new behaviour and stop for some reason. This
is a dangerous situation because bad news often travels faster than good news. We want
satisfied clients to tell everyone the good news.
Importance or advantages of IPC and counselling
1. It brings about client satisfaction and recall
2. It improves health status
3. It leads to better health outcomes
4. It encourages client compliance
5. It also encourages the adoption of new health behaviour
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COUNSELLING TECHNIQUES INCLUDES
a. Establish rapport –
i.
Greet the client in a friendly way
ii.
Be patient with your client
iii.
Ask reason for the visit
iv.
Pay attention to physical environment (ensure privacy that is the environment
must be attractive and comfortable for the client)
v.
Maintain appropriate eye contact
vi.
Facial expression, posture, gestures (smiling, leaning forward, communicate
warmth). Remember, the person may not remember what was said, but they will
remember how you made them feel.
b. Observation – Pay attention, culturally appropriate eye contact, verbal tracking,
variation of voice and body language. When these are done it shows the client that the
provider is paying attention to him or her and that the client is the most important person
for the provider at that moment.
c. Explore clients understanding of his/her condition – Before the provider tells client
the diagnosis, it is useful to listen to clients own thoughts on the illness. Client may
reveal information and emotions that will help give client better understanding of their
discomfort.
d. Effective or active listening – This happens when you listen for meaning. Thus, the
listener says very little but conveys much interest. The listener only speaks to find out if a
statement or two or as many has been correctly heard and understood. One needs to be
attentive and concentrate on clients. Look at them, ask questions, reflect feeling and
summarize the main point. These help the listener to be sure they correctly understand the
speaker. It helps to identify non-verbal communication and feeling.
e. Use appropriate vocabulary and simple clear language and assess clients level of
understanding before choosing the ways to explain the diagnosis
f. Encourage dialogue through paraphrasing, encouraging, reflecting feeling and
summarizing
g. Avoid interruption
h. Probe for more information
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i. Discuss or give concrete behavioural change that client can accomplish. Check client
understanding. Only the client can confirm what is understood.
j. Repeat and summarize the key information (As a provider, make sure that the main
points are clear to the client)
k. Convince or motivate the client through influencing skills, directives, interpretation, self
closure, advice or information or explanation and instructional feedback. Convince client
that if they do what you have both decided the situation will improve.
l. Check on acceptability or mutuality of decision made (make sure that client understands
the decision taken and agreed)
m. Ensure privacy and confidentiality.
COUNSELLING TECHNIQUE WIDELY USED IN FAMILY PLANNING (GATHER)
G – Greet the client
A – Ask the client about him/her self and the family
T – Tell client about the methods or services available
H – Help the client to choose a method or service
E – Explain the method the client has chosen to him or her
R – Return for follow up service
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EFFECTIVE USE OF INFORMATION, EDUCATION AND COMMUNICATION (IEC)
AND BEHAVIOUR CHANGE MATERIALS AND METHODS
Information, education and communication (IEC) is the sharing of information and ideas in a
way that is culturally sensitive and acceptable to the community, using appropriate channels,
messages and methods.
IEC in health programmes aims to increase awareness, change attitudes and bring a change in
specific behaviours. This therefore means that IEC is broader than developing health education
materials, because it (IEC) includes the process of communication and building social networks
for communicating information. IEC is an important tool in health promotion for creating
supportive environments and strengthening community action, in addition to playing an
important role in changing behaviour.
BEHAVIOUR CHANGE COMMUNICATION (BCC) MATERIALS AVAILABLE TO
PROVIDERS
1. Posters on family planning, immunization, AIDS and other diseases
2. Chart on various parts of the body or diseases
3. Counselling cards
4. Flip charts
5. Brochures
BENEFITS
OF
USING
BEHAVIOUR
CHANGE
COMMUNICATION
(BCC)
MATERIALS
 Attracts and engage the clients to what is being discussed
 Helps client to bring up questions
 Triggers discussion
 Makes something small big enough to be visible (that is when using projector).
 Can be used to compare similarities and differences (models)
 Show steps in doing things (flip chart)
 Shows images (projector, posters)
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 Make complex ideas easy to understand (real objects)
 Can show something that people cannot see in real life. (model charts)
 People can take print materials home as reminders (leaflets)
 People can share print materials with spouses and friends or relations (leaflets)
BARRIERS TO USING BCC MATERIALS
Why do providers not use BCC materials?
1. Sometimes they are not available
2. Do not know the importance of using them
3. Lack of knowledge on its use
4. Language barriers
5. Assumes clients know
6. Not told to use them
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RIGHTS OF THE PATIENT / CLIENT
The Universal Declaration of Human Rights, which was formalized in 1948, recognizes “the
inherent dignity and the equal and unalienable rights of all members of the human family”. It is
on the basis of this concept of the person, and the fundamental dignity equality of all human
beings that the patient rights were developed. Patient’s rights vary in different countries and in
different jurisdictions, usually depending on prevailing cultural and social norms.
The Ghana Health Service (GHS) has the Patients Charter. With this Patients Charter, the GHS
expects health care institutions to adopt the patient’s charter to ensure that service personnel as
well as patients/clients and their families understand their rights and responsibilities.
This Charter is made to protect the Rights of the patient in the Ghana Health Service. It
addresses:
a. The Right of the individual to an easily accessible, equitable and comprehensive health
care of the highest quality within the resources of the country.
b. Respect for the patient as an individual with a right of choice in the decision of his/her
health care plans.
c. The Right to protection from discrimination based on culture, ethnicity, language,
religion, gender, age and type of illness or disability.
d. The responsibility of the patient/client for personal and communal health through
preventive, promotive and simple curative strategies.
The Patient's Rights
1. The patient has the right to quality basic health care irrespective of his/her geographical
location.
2. The patient is entitled to full information on his/her condition and management and the
possible risks involved except in emergency situations when the patient is unable to make
a decision and the need for treatment is urgent.
3. The patient is entitled to know of alternative treatment(s) and other health care providers
within the Service if these may contribute to improved outcomes.
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4. The patient has the right to know the identity of all his/her caregivers and other persons
who may handle him/her including students, trainees and ancillary workers.
5. The patient has the right to consent or decline to participate in a proposed research study
involving him or her after a full explanation has been given. The patient may withdraw at
any stage of the research project.
6. A patient who declines to participate in or withdraws from a research project is entitled to
the most effective care available.
7. The patient has the right to privacy during consultation, examination and treatment. In
cases where it is necessary to use the patient or his/her case notes for teaching and
conferences, the consent of the patient must be sought.
8. The patient is entitled to confidentiality of information obtained about him or her and
such information shall not be disclosed to a third party without his/her consent or the
person entitled to act on his/her behalf except where such information is required by law
nor is in the public interest.
9. The patient is entitled to all relevant information regarding policies and regulation of the
health facilities that he/she attends.
10. Procedures for complaints, disputes and conflict resolution shall be explained to patients
or their accredited representatives.
11. Hospital charges, mode of payments and all forms of anticipated expenditure shall be
explained to the patient prior to treatment.
12. Exemption facilities, if any, shall be made known to the patient.
13. The patient is entitled to personal safety and reasonable security of property within the
confines of the Institution.
14. The patient has the right to a second medical opinion if he/she so desires.
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The Patient's Responsibilities
The patient should understand that he/she is responsible for his/her own health and should
therefore co-operate fully with healthcare providers. The patient is responsible for:
1. Providing full and accurate medical history for his/her diagnosis, treatment, counseling
and rehabilitation purposes.
2. Requesting additional information and or clarification regarding his/her health or
treatment, which may not have been well understood.
3. Complying with prescribed treatment, reporting adverse effects and adhering, to follow
up requests.
4. Informing his/her healthcare providers of any anticipated problems in following
prescribed treatment or advice.
5. Obtaining all necessary information, which have a bearing on his/her management and
treatment including all financial implications.
6. Acquiring knowledge, on preventive, promotive and simple curative practices and where
necessary to seeking early professional help.
7. Maintaining safe and hygienic environment in order to promote good health.
8. Respecting the rights of other patients/clients and Health Service personnel.
9. Protecting the property of the Health facility.
NB:
These rights and responsibilities shall be exercised by accredited and recognized representatives
on behalf of minors and patients who are unable for whatever reasons to make informed
decisions by themselves; In all healthcare activities the patient's dignity and interest must be
paramount.
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TARGET POPULATION (TARGET AUDIENCE)
It is the population, clients or subjects intended to be identified and served by the health
education and promotion program. OR
It is a particular group of people that is identified as the recipient of an advertisement, product or
campaign.
Example of target population includes, religious leaders, pregnant women, nursing mothers,
students, food venders, market women, commercial sex workers, tutors, health promotion tutors
etc. In order for a programmed to remain focused, it must clearly define its target population to
work with. Target populations are often described using demographic features or characteristics.
Examples of demographic features are; languages spoken, races, employment status, gender
(sex), income levels, ages, geographic locations.
IDENTIFICATION OF TARGET POPULATION
Identifying the target population is to reach the largest numbers possible who have similar needs
and wants. This is the process of coming up with group of people the program will work with.
This means after identifying the target population it may make sense to further divide them into
subset of the larger population. For example, the target population might be mothers with
children under five years. You must decide to segment this into urban mother with children
under five years and rural mother with children under five years.
Segmentation is process of dividing the population into smaller groups with similar
characteristics and needs to be able to provide effective services to them. It is done so that
messages can be tailored to more specific group you might use different messages to reach urban
mothers with children less than five years and rural mothers with children under five years.
FACTORS THAT INFLUENCE TARGET POPULATION
The factors that influence target population are called Secondary population. Secondary
population are those that influence the target population, for example, friends (boy or girl
friends), parents, school, sports, good job, fear of being laughed at church or in mosque, radio,
TV, internet etc.
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FACTORS THAT INFLUENCE THE SELECTION OF TARGET POPULATION
1. Age
2. Sex
3. Language
4. The topic for discussion
5. Distance to the place of programme
6. Educational background
7. Occupation
8. The means of communication
INTEGRATED SKILLS
Listening is a skill that requires constant practice. It includes both verbal and non-verbal
responses. The verbal ones include asking questions, reflecting feelings and summarizing the
main points. It helps to confirm to the client that he/she is heard and understood. Often one is
able to point out issues or emotions of which a client may not be aware, particularly when a
feeling is communicated non-verbally.
QUESTIONING
Questioning is a sentence, phrase or gesture that seeks information through a reply (feedback).
It is an interpersonal communication, where the thinker (originator of questions) employs a series
of questions to explore an issue, idea or something intriguing.
Goals of questioning (using questioning effectively)
1. Start the dialogue
2. Encourage the client to talk
3. Communicate your interest to the other person
4. Increase verbal awareness of the other persons feeling
5. Bring out specific information
6. Give a degree of control to the client
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What we learn through questioning
 The general situation
“ what did you want to talk about”
 The fact
“ what happened”
 Feelings
“ how did you feel”
 Reasons
“ why did you do that”
 Specific
“ could you give me an example”
TYPES OF QUESTIONS OR QUESTIONING
Although there are numerous reasons for asking questions, the response (answer) we receive will
depend on the type of question that is being asked. Basically there are four (4) types of
questioning. These are;
1. Open Ended Questions
These are questions that allow client(s) to express themselves by describing and revealing
information. The client can take the lead by choosing how and where an answer will go. It helps
the provider get more information about the client. Open ended questioning helps to learn about
the client’s feelings, beliefs and knowledge. For example, ‘what do you know about family
planning?’, ‘what are the concerns of young people today?’
2. Closed Ended Questions
These are questions that do not invite elaboration but specific and short answers (response).
Closed questions are usually easy to answer as the choice of answer is limited. Closed ended
questioning can be used to start conversation in order to encourage participation by audience and
followed by open ended and probing questions. Closed questions are used in some of the
following ways;
-
Closed questions are used to force a brief, often one-word answer
-
Closed questions can simply require a ‘Yes’ or ‘No’ answer. For example: Do you
smoke?, Would you practice exclusive breastfeeding?, Did you wash your hands with
soap before eating?
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-
Closed questions can require that a choice is made from a list of possible options
(answers). For example: Would you like beef, chicken or fish?, Did you travel to school
by train, car or air today? Which of these FP methods do you like using; pills, condoms,
depo or LAM?
-
Closed questions can be asked to identify a certain piece of information with a limited set
of answers. For example: What is your name?, What time do you usually go for lunch?
When can you initiate breastfeeding?
3. Probing Questions
These are questions that take a specific point, feeling or issue and focus in-depth on it. This is
useful when client reveal a point in passing. Probing is good when talking about sensitive topics
which may be difficult for clients to reveal freely on their own. For example you can tell me
more about why you think condoms make a man impotent, why do you think that oral
contraceptives are difficult to use?, what has made you believe your daughter is sexually active?
What makes you think you cannot practice exclusive breastfeeding?
Tone of voice is important in asking probing questions. Tone should be non-judgmental.
Providers should use a tone or voice that expresses interest and concern.
4. Leading Questions
Leading questions are rarely appropriate because they act as “door closers” and discourage the
client from saying what he/she really feels. The provider risks making the client feel they must
do what the provider says even if it is not what the client wants to do. For example ‘don’t you
think you should try IUD?’, have you heard that oral contraceptives are dangerous?, did you hear
that ‘injectables stops menses?’.
5. Rhetorical Questions
Rhetorical questions are questions that are often humorous and do not require an answer.
Rhetorical questions are often used by speakers (politicians, lecturers, priest and others) in
presentations to get the audience to think.
Politicians, lecturers, priest and others use rhetorical questions when addressing large audiences
(target population) to help keep attention. For example ‘Who would not hope to stay healthy into
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old age?’, is not a question that requires an answer but our brains are programmed to think about
it thus keeping us more engaged with the speaker.
REFLECTING
This is repeating what a client says and feels. It shows that you understand and he/she is more
likely to say more about what is important to him/her. It is best to say it in a slightly different
way, so that it does not stand as though you are copying him/her. For example, ‘a mother says
my baby wants to feed very often and it makes me feels very tired’.
Reflecting: do you feel very tired all the time?. Another example is that a client says ‘I have
finished taking a pack of the pill and I have started putting on weight. Reflecting: you are
worried about your weight, is that right?
PARAPHRASING
Paraphrasing is a feedback to the client with the essence of what has just been said by shortening
and clarifying client comments. Paraphrasing is not parroting; but it is using your own words
plus important main words of the client to check accurate and understanding of what the client
has said.
Paraphrasing involves:
i.
A sentence stem: such as you appear to be saying ……. or what I hear you are saying
is …….
ii.
Key descriptors and concepts the client used to describe the situation or person.
iii.
The essence of what the client has said in summarized form
iv.
Checking for accuracy: Am I hearing you correctly? For example client: I just do not
feel well today. Provider: You are feeling ill and you are not sure why, is that right?
Example if a mother says ‘my baby was crying too much last night. Paraphrasing:
you mean your baby kept you awake crying all night?
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SUMMARIZING
This is similar to paraphrasing except that longer time period and more information are involved.
Summarizing may be used to begin or end an interview, for transition to a new topic, or to
provide clarity in lengthy and complex client issues or statements. It recaps what has been said.
____________________________________________________________________________64
STIGMATIZATION
Stigma is a process where we (society) create a “spoiled identity” for an individual or a group of
individuals. OR
Stigma is a degrading and humiliating attitude of society that discredits a person or a group
because of an attribute such as an illness, deformity, colour, nationality, religion etc.
Stigmatization can also include;
 Deep feeling one can have which makes him/her feels disrespected or unloved.
 Teasing one of something he or she says or has.
 Being blamed for an infection one has and told she/he deserves it.
 People running away from you because of a condition, disease or life style you have.
 Accepting negative judgment of the society for a condition, disease or lifestyle you have.
Stigma destroys a person’s dignity, marginalizes affected individuals, violates people’s basic
human rights and as well hinders pursuit of individual happiness and satisfaction.
TYPES OF STIGMA
1. Self stigma
2. Felt stigma
3. Enacted stigma or discrimination
Self stigma: - This is having self hatred, shame, blame etc because they feel they are being
judged by others so they isolate themselves from their friends, families and or communities. This
can lead to a relactance to seek treatment, social withdrawal, poor sel-worth, abuse of alcohol
and drugs
Felt stigma: - This is the perception or feeling towards people with same specific disease or
condition.
Enacted stigma or discrimination: - This is when there is discrimination against people with
some type of diseases in a community. Example, Tuberculosis and HIV/AIDS
____________________________________________________________________________65
PROCESS OF STIGMATIZATION
Stigmatization comes about through
1. Labeling: He/she is different from us, he/she coughs too much, look at the way he/she
dresses
2. Negative behaviour: His or her sickness is caused by his/her sinful behaviour
3. Separation: Shunning or rejection
4. Loss of status: Loss of respect, job, position in an organization
FACTORS LEADING TO FEAR AND STIGMA
1. Lack or inadequate knowledge or information received but not internalized.
2. Experienced: For full understanding, people need to compare, test and question the
information they have heard with their own experience, beliefs and common sense.
3. Belief system: They correct information people have received may be contradicted by
other beliefs (what they have learned from family, clan, tribe, church, media and may be
more persuasive than the fact provided by health workers)
4. Media: Believing wrong information from the media.
5. Life style: Societal or personal norms as against providers information.
WAYS TO CHALLENGE OR PREVENT OR CONTROL STIGMA
Stigma though powerful and enduring, is inevitable and can be challenged through;
a. Breaking the culture of silence about the particular stigma
b. Using group dynamics to discuss issues of stigma
c. Sharing knowledge on issues at stake
d. Being a role model
e. Counselling of individuals concerned.
f. Don’t discriminate when it comes to participation, housing or employment
Stigmatized statement
Stigma statement changed
1. HIV/AIDS carriers
HIV positive
2. HIV/AIDS orphans
Orphaned children affected by HIV
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3. AIDS victims
People
living
with
HIV/AIDS
(PLHIV/AIDS)
4. Full-blown AIDS
AIDS
5. Prostitutes
Commercial sex workers
6. Don’t stand too close to someone with TB
My sister had TB and now fine
7. If I get AIDS, I will kill myself
Getting AIDS is not the end of the world,
you can live a full life
FEAR
Fear is an emotion induced by a threat perceived by living entities which causes a change in
brain and organ function and ultimately a change in behaviour such as running away, hiding or
freezing from traumatic events. OR
Fear is a chain reaction in the brain that starts with a stressful stimulus and ends with the release
of chemicals that cause a racing heart, fast breathing and energized muscles among other things.
OR
Fear is an unpleasant and often strong emotion caused by anticipation or awareness of danger
Fear may occur in response to a specific stimulus happening in the present or to a future situation
which is perceived as risk to health or life, status, power, security or in the case of human’s
wealth or anything held valuable. The stimulus can be a spider, knife at your throat, pressure, fire
or sudden knock at your door.
Fear is completely natural and helps people to recognize and respond dangerous situations and
threats.
____________________________________________________________________________67
ASSESSING FEAR
1. Through observation; observe peoples non-verbal communication and behaviours.
2. Through interviewing; use open-ended questions
DEMYSTIFYING/CHANGING FEAR THROUGH EDUCATION AND COUNSELLING
1. Providing information through discussion geared directly to people’s fears and
misperception about the disease, condition or lifestyle.
2. Providing information to challenge misperception and help people fully understand the
disease condition and life style.
3. If relevant, provide information through discussion on progression of the illness
condition, treatment in order to counter views that people who get this particular disease
or condition will die immediately or will never get cured (in some cases).
4. Providing information in a practical and participatory learning process which allows
people to internalized the information to discuss it with their peers, connect it to their
own ideas and experience and apply it to the situations in their daily lives.
NOTE:
i.
Fear leads to stigma
ii.
Fear can be addressed through education and counselling
iii.
Looking after the emotional health of clients is an important role of getting healthy
and staying healthy
iv.
Stigma by other people can lead to self stigma
v.
As a health worker, we have an important role to play in challenging stigma.
WORLD WITHOUT STIGMA
-
There will be openness in talking about sex, AIDS, TB, STIs, and others.
-
There will be less gossip about families with such diseases or conditions.
-
More knowledge about transmission and less fear about casual contact.
-
There will be more hope, less feeling of fatalism (death)
-
There will be trust in and use of health services.
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EFFECTS AND CONSEQUENCES OF STIGMA
On clients
1. Rejection by family and friends
2. Isolation
3. Resort of secrecy (keeping things to him/her self)
4. Low self esteem
5. Scared to seek help and get health services
6. Blamed and judged by family and friends for negative behaviour
7. Guilt and shame of oneself
8. Self blame and depression
9. Loss of job and income
10. Loss of hope
On women
a. Perceived as source of illness
b. Image devalued
c. Low self esteem
d. Guilt and shame
e. Loss of income, partner, family and friends
f. Break up of marital relations
g. Self blame and depression
On men
i.
Loss of employment
ii.
Feel useless
iii.
Rejection by women
iv.
Loss of manhood
v.
Self stigma
vi.
Withdrawal from social contact
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On children
1. Mae to feel guilty
2. Loss of support and care
3. Dumped by relatives
4. Neglected or abused by new parent
5. Grow up without trust and love
6. Become street kids
7. Introverted (they become lonely)
8. Difficulty in handling grief
9. Depression
10. Loss of hope and sense of future
11. Isolated by friends
12. Forced to accept adult development responsibility (become care givers or bread winners).
On health service
a. Climate of silence around health care
b. Clients stop using services
c. Fear by health workers leading to poor care
On family

Shame, disgrace, and reputation at stake.

Status and honour destroyed

Rejection by community

Secrecy (i.e. hiding patients or clients from neighbours

Deny that there is a problem

Conflict – by blaming each other for loss of family reputation

Collapse of marriages

Children dumped with relatives

Loss of income when bread winner loses job

Can lose out on service due to fear of stigma
____________________________________________________________________________70
On community
1. Finger pointing
2. Gossiping
3. Rumor to condemn families
4. Isolate families perceived to have the stigmatized diseases or condition
5. Migration
6. Infection of others
7. Collapse of production
8. Blame each for bringing the problem to the community.
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SOCIAL (COMMUNITY) MOBILIZATION
COMMUNITY
It is a place or a geographical area where a group of people live and share common interests and
aspirations and have social network of relationships at the local level. OR
It is a group of people living in the same place or having a particular characteristic in common.
OR
It is a group of people living in a local area with common interest and aspirations.
Villages, towns and other residential areas are examples of communities.
TYPES OF COMMUNITY
1. Traditional
2. Solidarity
3. Neighborhood
Traditional community: These are old established settlement of people with certain common
identifiable traits such as language, religion, and customs. Individuals become a member of this
type of community by birth, culture or customs.
Neighborhood community: This is where people lives in an area for a period of time and
develop familiarities. This type of community has physical boundaries which makes it a distinct
or separate.
Solidarity or interest community: This is a group of people living together in a common
territory because of common heritage or religion. With this community individuals become a part
voluntarily.
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MOBILIZATION
It is the organization of the various resources including humans that will be needed to perform an
activity.
COMMUNITY MOBILIZATION
It is the process of engaging communities to identify community priorities, resources, needs and
solutions in such a way as to promote representative participation, good governance,
accountability and peaceful change. OR
It is a process through which action is stimulated by the community itself or by others that is
planned, carried out and evaluated by a community, individuals, groups or organizations on a
participatory and sustained basis to improve the health, hygiene and education levels so as to
enhance the overall standard of living in the community to achieve community development
goals. OR
It is a process through which a community analysis its health situations with the support of health
workers ad plans for effective organization and evaluation of health programmes.
Example of key assumption underlying this definition

It’s a process

It is aimed at achieving developed goals

It is planned with people

It is evaluated with people
COMMUNITY MOBILIZATION FOR HEALTH
It is a deliberate process of involving and motivating people, health workers and policy makers
to organize and take action for the common purpose of providing equitable and accessible health
information.
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BENEFITS OR ADVANTAGES OF COMMUNITY MOBILIZATION
1. It brings about behavior and social change
2. Brings together contribution of material and human resources from all sectors of the
community.
3. Stimulates institutionalization of indigenous groups of formal and informal community
structures.
4. Builds social support systems, particularly for disadvantaged families and groups.
5. Create ownership and involvement through shared decision making and communal
action.
6. Generates empowerment
7. Encourages sustainability of effort.
8. Leads to collaboration between individuals and groups
9. Brings about the sharing of ideas and experience
10. Brings about community development
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COMMUNITY MOBILIZATION FRAME WORK
Readiness:
Intended
behaviour change
The community must
see that there is
problem and the need
to solve it
Catalyst:
Are there people who
can spark the desire
for change?
COMMUNITY
MOBILIZATION
PROCESS
Environmental
support
Increased capacity
or community to
mobilize again for
another issue
Is there an existing
support system to
achieve desired
change?
THE COMMUNITY MOBILIZATION FRAMEWORK
The community mobilization framework provides a focus for health workers to analyze the
various factors that create the drive for community mobilization. It also leads to the identification
of the intended behaviour change that results community mobilization and the capacity to carry
out the process in future to support the development of other programmes. The key elements in
the framework are as follows:
1. Readiness: Does the community perceived a problem and the need for change?
2. Catalyst: Is there an event and or person(s) that can spark the desire for change now?
____________________________________________________________________________75
3. Environmental support: Does the existing system support the desired change? E.g.
when frequent deaths of children from preventable diseases such as measles moves the
community leadership to organize its people to build a clinic and appeals to health
authorities for a service provider.
LIMITATIONS OF COMMUNITY MOBILIZATION
1. Volunteerism versus paid work
As community members participate in working for the community voluntarily for a period of
time, the desire for formal remuneration develops. This is often the case when the volunteers feel
they are being cheated by other members of the community who benefit from the services while
contributing little or no efforts to its development. The need to create some level of reward for
voluntarism should not be downplayed. Communities should be encouraged to create their own
relevant and practical ways of recognizing and rewarding volunteerism. Care however should be
taken to avoid creating another paid work structure while mobilizing communities to support
social services as this is not sustainable.
2. Community burn out
Continual dependence on mobilizing communities for work that does not yield any
improvements in their health delivery system may create frustration among the people and cause
them to give up.
3. Maturation and maintenance
As community members continue to participate in the mobilization effort, there is a limit to how
far they could go without losing the enthusiasm and energy to support the system if their mastery
ownership of the process is not appreciated. There is therefore the need to encourage community
members to establish their own local systems and structures of organizing and maintaining the
community mobilization process. For example, through the formation of community health
committees
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WHEN DOES COMMUNITY MOBILIZATION WORK BEST?
 Crises situations such as outbreaks of diseases such as measles, cholera among others.
 Localized issues such as inability of health workers to reach isolate communities.
 Larger systems not functioning when health providers sit to static clinic to receive clients
who never turn up for their services.
MOBILIZING RESOURCES
Resources are the various items or things including humans that can be used to work to achieve
an aim. These resources are;
1. Human resources
People constitute an important resource for the success of any development activity. They are
often regarded as reasons for a certain need. The health worker or community mobilizer must
realize that most of the people in the community are potential contributors whose skills,
knowledge and ideas are important resources, which must be tapped and explored fully. In
mobilizing the human resource, one must be conscious of the norms, culture and traditions of the
people as their positive elements may enhance programme implementation while the negative
ones may tent to interfere with the programme process.
2. Natural resources
Some natural resources include, water, land, forest and others. There is no doubt that
constructive and innovative use of the resources would be helpful in supporting program
development.
For example, a community farm to generate funds for the construction and maintenance of
community health compound/home would require a fertile piece of land and adequate rainfall. It
is therefore important to encourage community members to understand that;
-
Natural resources are definite and must be used responsibly
-
Developmental projects should not lead to abuse of natural resources and
-
Development cannot be sustained if its activities harm the environment.
____________________________________________________________________________77
3. Man-made resources
These include roads, communication networks, shops, markets, factories, schools, hospitals,
houses, money among others. It is important for the community mobilizer to understand the
availability of these resources and use the information gathered on these to plan for project
implementation. Money is one of the most important man-made resources. The level of income
of a people in a community may impact on the health of the people in various ways. It may also
affect the way community members respond to the development of various facilities to support
project activities.
The implementation of programmes should be structured in such a way that the community
would be prepared to contribute money to it because they think it is worthwhile. Mobilization
should therefore ensure that the community get involved and are keenly enthusiastic in
contributing money to achieve projected goals.
SOURCES OF FUND RAISING
Ways in which funds could be raised includes
 Charges or tariffs
 Communal labour
 Contributions of from community and non-resident citizens
 Appeal for funds
 Fund raising or harvest
 Other income generating activities identified by the people
 Appeal for external funding from NGOs
Individuals and groups who may help to mobilize resources include;
a. Town or village development committees
b. Chief
c. District assemblies
d. Assemblymen or assemblywomen
____________________________________________________________________________78
e. Area counsils
f. Local associations
g. Unit committees
4. Organizational resources
The provision of most social services including health often involves partnerships with various
sectors. Organizations have their own types and level of resources they would wish to contribute.
They may include technical expertise or personnel, money, vehicles and service equipments
among others.
Efficient coordination in mobilizing these resources is required to avoid duplication and waste
fighting over ownership of programme and marginalization of community effort.
COMMUNITY PARTICIPATION
Community participation is a planned process whereby local groups are clarifying and
expressing their own needs and objectives and taking collective action to meet them. OR
Community participation is a process through which all members of a community are involved in
and have influence on decisions related to development activities that will affect them.
For health promotion to work well it must be carried out by and with people and not on or to
people.
COMMUNITY PARTICIPATION IN HEALTH
It is the process by which individuals, families, and groups and in fact the entire community
assumes responsibility for their health and well being and resolve to and get involved in
developing the capacity to contribute to solving their own and the community’s health problems.
____________________________________________________________________________79
BENEFITS OF PROMOTING COMMUNITY PARTICIPATION
1. Ensures community motivation and support
If the community is involved in choosing priorities and deciding on plans it is much more likely
to become involved in program implementation and take up of the services because they are seen
to be meeting their needs.
2. Promotes self-help and self-reliance
If community members do their own development work, they learn and become more conscious
of their needs and potentials for solving their own problems, they make use of local skills, they
learn to be responsible for projects and their maintenance, and they gain the necessary selfconfidence to tackle further and perhaps more complicated development projects.
3. Promotion of community knowledge and skills
Community participation can build community determination to act, skills and self-confidence in
undertaking activities that promote their own development activities. Community members
therefore acquire more knowledge and skills as they learn through capacity building activities to
assume varieties of roles in implementation of health programmmes.
4. Increase community self reliance
It decreases community dependence on government and non-governmental organizations thus
empowering them to use their initiatives and manage resources with greater confidence.
5. Lowering of expenditures
Community contribution of human and material resources provides savings on labour and
material cost as various members of the community offer their contributions according to what
they could afford, time, money, various forms of equipments labour among others.
____________________________________________________________________________80
6. Increase utilization of services
Community participation in defining and setting priorities ensures community ownership of
program thus facilitating utilization and support for services. Community members become
convinced that failure use the health facility amounts to wasting their own energy and resources.
7. Facilitation of behavioural change
Community participation can change the social norms necessary for individual behaviiur change
as the uncommitted are moved to act by the enthusiasm and participation of others.
8. Encouragement of government support
Community involvement can increase government support for communities and their health
programmes.
9. Creation of more culturally appropriate services
Health services provided in collaboration with community people are often more culturally
acceptable than those provided strictly by outsiders who may have little knowledge of the
traditions, norms and the values of the people. Health workers who live in communities and
work with the people have greater respect for peoples way of life and this in turn generates
greater interest in the patronage of health services in the community.
10. Facilitation of service coverage
Health workers supported by the community can facilitate coverage of health services at the
community level thus enabling many more people to benefit from the services. Easy access to
homes of community members encourages most members of households to patronize health
services.
____________________________________________________________________________81
LIMITATIONS/DISADVANTAGES OF COMMUNITY PARTICIPATION
a. Threaten political authorities
It could create sensitive political situations. Community demand may grow beyond the limits that
may in turn threaten the ability of authorities to adequately provide for all needy communities.
b. Absolves the government responsibility
There is the risk that government and non-governmental agencies will use community
participation to absolve their responsibility for health of communities that still need some outside
assistance. The active participation of community members in programmes and regular
contribution of their quota to perogramme event may lead to the neglect of such communities by
government and non-governmental organizations. This would amount to abuse of the initiative
and active participation of communities in development activities.
c. Disillusionment of community members
Community participation may cause communities to make unrealistic demand on the
implementating agency. Once communities have made contribution towards programme
objectives through participation, the failure of the project to follow through with services and
other support may lead to community member’s unwillingness to participate in the development
programmes.
CHALLENGES OF COMMUNITY PARTICIPATION
Community participation faces certain challenges including the following:
1. The ability of community members to make up for the amount of time they invest in
programme activities.
2. The need to maintain the momentum of enthusiasm of community members.
3. The need to keep programme objectives and outputs on target
4. The need to sustain the commitment of both health workers and the community members.
____________________________________________________________________________82
ASSESSING COMMUNITY PARTICIPATION
A check list of questions is necessary in assessing the level of community participation in
programmes. Some of these questions are:
i.
Is the community involved in planning, management, control and evaluation of the health
programme at community level?
ii.
Were the felt needs of the community well entertained in the planning?
iii.
To what extent have social organizations and community representatives been involved
in the decision making process?
iv.
Is there a mechanism for community dialogue between health workers and community
leadership and the people?
v.
What evidences are there of health programme personnel changing their plans as a result
of criticism from the community?
vi.
Are marginalized groups such as the poor, unemployed, women and the youth adequately
represented in the decision making process?
vii.
Are local resources such as labour, building and money utilized in programme
implementation?
viii.
Was the community involved in monitoring, assessing and evaluating the programme and
the drafting of the final report?
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COMMUNITY ENTRY AND COMMUNITY NEEDS ASSESSMENT
COMMUNITY ENTRY
Entering the community is an important task for the community health nurse to acquaint him or
herself to his or her work.
Community entry is the process of entering community spaces intending to meet people where
community members are most comfortable. OR
Community entry is the process of initiating, nurturing and sustaining a desirable relationship
with the purpose of securing and sustaining the community’s interest in all aspect of a
programme.
STEPS IN COMMUNITY ENTRY
•
Identify the community
•
Identify the contact person
•
Conduct meeting with opinion leaders
•
Let the community leaders and people know your mission
•
Brief leaders the purpose of you visit
•
Seek the approval and support of the people for your program
PREPARATIONS TO BE MADE BEFORE COMMUNITY ENTRY
1. Form a reconnaissance team
2. Read about the community (read annual reports from the DHMT, District Assembly,
news papers, health journals etc)
3. Collect informal information about the community (this is done through interview with
individuals, through focus groups discussion, through mapping, contacting opinion
leaders)
4. Having transect walk and observation
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SKILLS AND ATTITUDES REQUIRED OF HEALTH WORKERS IN UNDERTAKING
COMMUNITY ENTRY
Skills
-
Maintain good eye contact
-
Listen to both sides of an issue
-
Paraphrase
-
Show interest
-
Be empathetic
-
Encourage others to listen
Attitudes

Patience

Tolerance

Respect for other people

Good listening attitude

Humility
ADVANTAGES OF COMMUNITY ENTRY
1. Objectives will be achieved
2. Gains support
3. It ensures the establishment of good working relationship
4. It helps one to plan his or her work
5. It helps to observe all protocols
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COMMUNITY NEEDS ASSESSMENT
It is the process of finding out and prioritizing the local problem of a community. OR
It is a systematic process for determining and addressing community needs or gaps between
current conditions and desired conditions or wants.
Community needs assessment helps to identify the strengths and resources available in the
community to meet the needs of children, youth and families. The assessment focuses on the
capabilities of the community including the citizens and organizations.
TYPES OF NEEDS
Bradshaw (1972) suggests there are four (4) different types of need. It is important to tap into
each type of need to increase the chance of constructing the comprehensive picture of
community problems.
1. Normative Need
Normative need refers the need based on an expert opinion or need that is defined by experts.
Normative needs are not absolute and there may be different standards laid down by different
experts. For example, vaccinations, a decision by a surgeon that a patient needs an operation.
2. Expressed Need
Expressed need is felt needs turned into action. Expressed need refers to what can be inferred /
introduce about the health need of a community by observation of the community’s use of
services. (e.g. demand for a new service, long waiting lists). A need may exist but because there
is no service in place to meet it the expressed need may not be identified. Furthermore, long
waiting lists at a health service may be the result of inefficiency and not about the size of the
group wanting to be treated. For example, going to the dentist for a toothache
3. Comparative Need
Comparative need is a need derived from examining the services provided in one area to one
population and using this information as the basis to determine the sort of services required in
another area with a similar population. When assessing comparative need the level of service
____________________________________________________________________________86
provision in the reference area must be appropriate in the first place. Be cautious that data
collected may in fact be due to over-servicing or under-servicing by service providers rather than
an indication of true need for the service by health consumers.
4. Felt Need
Felt needs are the needs perceived by an individual; thus felt need is what people in your
community say they want or feel they need. Felt needs are limited by individual perceptions and
knowledge of services. Common methods of assessing felt needs are household opinion surveys,
phone-ins, public meetings and calling for submissions from those in the community.
HOW COMMUNITY NEEDS CAN ASSESSED
As a community worker, you can assess the needs of your community through
i.
Literature review
ii.
Semi-structured interview
iii.
Household opinion survey
iv.
Phone-ins
v.
Public meetings
IMPORTANCE OR PURPOSE OF NEEDS ASSESSMENT
1. It creates understanding of the extent of the problem
2. It helps you to determine whether your proposed work is truly necessary
3. It gather information about all the services that are available to your population
4. It identify the gaps in the services available to your target population
5. It enables allocation of resources effectively
6. It helps to separate those problems or issues that can be addressed immediately
7. It creates an opportunity to be able to probe what happened in the past when tackling
same or similar problems
8. To help health worker get information for effective planning
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9. It helps to raise the awareness of key issues
10. It helps to prioritize their health needs
THE ROLE OF MW / C H O IN NEEDS ASSESSMENT
•
Providing health education and information to groups and individuals
•
Assisting and advocating for underserved individuals and communities to receive
appropriate services
•
Support communities, agencies and organizations during needs assessment
•
Facilitate the needs assessment process
____________________________________________________________________________88
FORMAT FOR WRITING HEALTH TALK
NAME:
INDEX NUMBER:
SUBJECT: The subject that the topic was taken from. E.g. Principles of Disease Prevention and
Management, Child Health, Family Planning, Obstetric Nursing, Basic Nutrition etc
TOPIC: The topic for the discussion should be stated
AUDIENCE: The people who are going to listen to the Health Talk. E.g. Pregnant mothers,
Lactating mothers, Students, Food sellers etc
EDUCATIONAL BACKGROUND: Literates and illiterates
LANGUAGE: English, Gonja, Dagaare, Twi, etc.
PREVIOUS KNOWLEDGE: What the target audience have heard, know, done or seen about
the topic before and where they participated in the activity. E.g. Target audience have heard
about HIV/AIDS on radio before, Target audience have used condom before etc.
TEACHING METHOD: Discussion, Role play, Demonstration etc
VENUE: Bole Hospital OPD, Bole Health Centre CWC room, Kurabaso Primary School, Bole
Senior High, Pentecost Church, Bole Central Mosque etc.
SITTING ARRANGEMENTS: The manner in which the target audience is going to sit. E.g. in
rows, semi-circles
DATE: Date in which the talk will be given. E.g. 25/05/2014 This will be given to you by the
school
TIME: Time the talk will begin or given. E.g. 10:00 A.M. This will be given to you by the
school
DURATION: How long the talk is going to last, the period of giving the health talk. This is
going to be 15 minutes
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VISUAL AIDS: State all the teaching materials that you are going to use for the talk. E.g. Real
objects, models, charts on life cycle.
BROAD/GENERAL OBJECTIVE: What you want the target audience to achieve, know, do,
say, experience at the end of the talk. It is not an objective for the health educator (student). It is
for the target audience. E.g. By the end of the talk, the participants should be able to prevent
malaria in their communities; By the end of the talk, mothers should be able to practice
complimentary feeding in their homes.
SPECIFIC OBJECTIVES: This describes the specific things/actions/activities that the target
audience should be able to do at the end of the session. Thus, the health educator (student) based
on the specific objectives for discussion. The specific objectives should be followed according to
how they will be treated in the main body. It should be numbered. It should also contain an
action verb.
Example 1. By the end of the health talk, target audience should be able to;
a. explain HIV/AIDS
b. state the causative organism of HIV/AIDS
c. mention the mode of spread HIV/AIDS
d. list the signs and symptoms of AIDS
e. describe the preventive measures of HIV/AIDS
Example 2. By the end of the talk or discussion, mothers should be able to;
i.
explain exclusive breastfeeding
ii.
mention when to start exclusive breastfeeding
iii.
state the advantages of breastfeeding
iv.
demonstrate how to position and attach baby to the breast
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SAMPLE OF HEALTH TALK ON HIV/AIDS
1. INTRODUCTION
Introduction should contain the following:
 Greeting: This can be the time of the day (slogan of a group – during the actual talk)
 Introduction of the candidate: E.g. My name is …………
 Introduction of the school
 Introduction of the topic
 Reasons for choosing topic
 Some of the specific objectives to be discussed
2. MAIN BODY
This deals with the various specific objectives that have to be covered or treated in the talk.
Every specific objective should start with a question or should be in a question form, and then
the short answer to that question of the specific objective. The questions are developed from the
sets objectives. E.g.
What is AIDS?
Explain what AIDS is
………………………………………………………………………………………………………
………………………………………………………………………………………………………
………………………………………………………………………………………………………
What is the mode of transmission of HIV/AIDS?
Describe the mode (s) of transmission of HIV/AIDS
………………………………………………………………………………………………………
………………………………………………………………………………………………………
………………………………………………………………………………………………………
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What are the preventive measures of HIV/AIDS?
List or outline all the necessary means that can be used to prevent HIV/AIDS
………………………………………………………………………………………………………
………………………………………………………………………………………………………
………………………………………………………………………………………………………
3. QUESTION TIME
Here the target audiences are given the opportunity to ask questions. Depending on the available
time, audience should be given enough time to ask questions on the topic discussed. Example,
audience will be given time to ask questions or at this moment I will pause for questions,
audience will be allowed to ask questions.
4. FEEDBACK
Asking or calling the audience to tell the rest of the target audience what they have learnt from
the health talk. Example: At this point the target audience will be allowed to share what they
have learnt today. Time would be allowed/permitted for the target audience to share what they
have learnt with others.
5. SUMMARY
This is a short recap of the main points covered in the talk. It should be short as possible.
6. CONCLUSION
Showing your appreciation to the target audience for listening to the talk. Telling them that you
hope they are going to practice what you discussed with them and will share with others.
NB: Create humor.
-
Thus, appreciate the answers that are given to you by the participants (target
population/target audience).
-
Avoid jargons / use their language or the language they understand best
-
Learn the topic very well before the talk
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TRY QUESTIONS
1. Define the following
A. Health …………………………………………………………………………………..
B. Disease …………………………………………………………………………………
C. Illness ………………………………………………………………………………….
D. ………………………………………………………………………………...
2. Briefly state the components of health and explain each briefly
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
3. State and explain six (6) determinants of health
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
4. Define the following terms
A. Health education ……………………………………………………………………….
B. Health promotion ………………………………………………………………………
5. State five (5) goals or objectives of health education and health promotion
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
6. State and explain five (5) methods of teaching used in participatory approach
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
7. State and explain the five (5) basic principles for health education
i.
…………………………………………………………………………………………
…………………………………………………………………………………………
ii.
…………………………………………………………………………………………
…………………………………………………………………………………………
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iii.
…………………………………………………………………………………………
…………………………………………………………………………………………
…………………………………………………………………………………………
iv.
…………………………………………………………………………………………
v.
…………………………………………………………………………………………
…………………………………………………………………………………………
8. Differentiate between didactic and participatory methods of teaching
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
9. What is communication?
................................................................................................................................................
................................................................................................................................................
10. Explain the statement communication as a process
………………………………………………………………………………………………
………………………………………………………………………………………………
11. Mention and explain the types of communication
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
12. State and explain the three (3) methods of communication
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
13. Briefly describe the three (3) forms of communication with examples
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
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14. Briefly mention and explain seven (7) barriers to effective communication
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
15. Listen ten (10) ways of overcoming barriers to communication
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
16. Define behaviour change ………..…………………………………………………………
17. Mention the six (6) characteristics of health behaviour
……………………………………………………………………………………………..
………………………………………………………………………………………………
………………………………………………………………………………………………
18. Briefly state and explain the six (6) types of health behaviour
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
19. Briefly state and explain the stages of behaviour change with examples
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
20. Briefly state and explain the components of behaviour change strategy
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
21. What is counselling?..………………………………………………………………………
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22. State five (5) advantages of counselling
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
23. Briefly explain the counselling technique GATHER
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
24. List ten (10) benefits of BCC materials
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
25. State ten (10) rights of the patient
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
26. State eight (8) responsibilities of the patient
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
27. Mention three (3) effects and consequences of stigma on the following
a. Client
………………………………………………………………………………………………
………………………………………………………………………………………………
b. Women
………………………………………………………………………………………………
………………………………………………………………………………………………
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c. Men
………………………………………………………………………………………………
………………………………………………………………………………………………
d. Children
………………………………………………………………………………………………
………………………………………………………………………………………………
e. Health services
………………………………………………………………………………………………
………………………………………………………………………………………………
f. Family
………………………………………………………………………………………………
………………………………………………………………………………………………
g. Community
………………………………………………………………………………………………
………………………………………………………………………………………………
28. Define the following terms
A. Community mobilization ………………………………………………………………
B. Community mobilization for health ……………………………………………………
C. Community
entry
………………………………………………………………………
D. Community participation ………………………………………………………………
E. Community participation for health …………………………………………………..
F. Community needs assessment ……………………………………………………….
29. With the aid of a diagram, briefly describe the community mobilization framework
30. List ten (10) advantages of promoting community participation
………………………………………………………………………………………………
………………………………………………………………………………………………
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………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
31. State three (3) challenges of community participation
………………………………………………………………………………………………
………………………………………………………………………………………………
32. State five (5) advantages of carrying out community entry
………………………………………………………………………………………………
………………………………………………………………………………………………
……………………………………………………………………………………………....
................................................................................................................................................
33. Briefly state and explain the four (4) types of needs according to Bradshaw (1972)
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
34. Mention five (5) ways of assessing community needs
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
35. List ten (10) importance of needs assessment
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
36. State five (5) roles you will play in needs assessment as a midwife.
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
____________________________________________________________________________98
REFERENCES
2015 International conference on stigma, Howard University, Washington, DC
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Joint Committee on Terminology. (2001). Report of the 2000 Joint Committee on Health
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“Needs
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available
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