HEALTH COMMUNICATION: HED 320: AN INTRODUCTION



As far as the anthropologists are concerned, mans history finds evidence of how he communicated and chancels used. 
Although man has always wanted to communicate, and has communicated when possible, only recently, has man ventured into examining more critically the suitability of the various communication channels that could be utilized effectively and accurately in health care delivery very system in Nigeria.

To critically examine and analyze some of the various communication channels which lead themselves to use in factors which should be considered in the selection, organization and utilization of useful health communication channels, especially in health communication.
According to Thelen (1960) relevant health education provide learning experiences for the purpose of influencing knowledge, attitudes and conduct “that is related to individual and group health”.
Hanlon (1974), also described health education as the “sum of experiences which favourably influence habits, attitudes, and knowledge relating to individual community and racial health”. Health education here will be presented as the process of persuading or inducing people to adopt measures which will improve their health and to reject those (measures) which will have adverse effect on their health. Hence, health education has a number of aims, which include: provision of information about health matters, the induction of conductive attitude and behaviours, reassurance and the prevention of illness. The selling of sound health understanding and behaviour involves (a) analysis, (b) sensitization, (c) publicity, (d) education and motivation. Hanlon, health education analysis should involve a study of the problems of an area or groups, the factors responsible for the problems, and the characteristics of the individuals of sound knowledge, attitude or techniques toward the solution of all health related problems. Sensitization is the process by which the individual or community is made aware of the existence of certain things: a diseases or a service. Sensitizing procedures like slogans, spot announcements on radio or television should merely sensitize the listeners or readers so that they will be receptive to subsequent more detailed information. Publicity is related to sensitization, of health information consumer (HFC) presenting more details about the items mentions in simple concise language or exhortation. Examples of activities in this category are press releases that relate to clinics available for pregnant women and statement of certain conditions not favourable for a good community health. Education, as another phase of health education, is really accomplished only in a rather intimate manner and which involves personal contact between the one who impacts the required information and those who receive it (Effiong, 1981). Finally for health education to take its rightful. Place motivation is necessary from those who possess the knowledge, attitude and practice since mere transmission of information or knowledge, even if it is accepted, is not enough; since it does not necessarily imply permanent action or change in habit or conduct, communication process in health education is an essential component in the process of achieving the aims and objectives in health education. For clarity, it may be necessary to explain the meaning of two operative terms in this topic, namely: channel and communication.

CHANNELS OF HEALTH COMMUNICATION                                        
            According to Kelsey and Hearne (1963) communication is “the process of transferring an idea, skill or aptitude from one person to another accurately and satisfactorily”. Berlo (1960) as it was viewed by Aristotle, as the search for “all available means of persuasion”. So, the primary goal of communication was persuasion, an attempt to sway other people to the speaker’s point of view. In the eighteenth century the mind- soul dualism theorists viewed the purposes of communication as intellectual or cognitive in nature; and the other emotional. By this theory, one purpose of communication was informative – an appeal to the mind; a second was persuasive – an appeal to the emotion; and a third was entertainment. There are other basic theories to communication, but the sender-message channel –receiver (s-m-c-r theory) is of interest to us since it looks at communication (Effiong 1984) essentially as a learning process. Whether the purpose of communication is informative or persuasive or entertaining our basic purpose in communication should be to become affecting agent or change agent; to affect others, our physical environment, ourselves, to become a determining agent and to help others decide how things are. Berlc (1960) pointed out that “we communicate to influence- to affect with intent”. This purpose is inconsonance with the goal of health education i.e. that of influencing knowledge, attitudes and conduct relating to individual or group health. “therefore, all we can do, and all we should do in our attempts at effective communication is to enable our target populations, intellectually and emotionally to make their own decisions about their own behaviour, Effiong 1981, Onyeoma 1995) to guide them in reaching what we hope to be wise decisions, and to create the kind of social and physical environments which will make it possible for them to carry their decisions into actual behavioural change (Effiong 1981, Onyeoma 1995). To accomplish this task our target population must be fully and actively participating in each step of the communication process” (Hochbaum, 1969).
            All human communication has some source, some person or group of person of things with a purpose, a reason for engaging in communication. The purpose of the source has to be expressed in the form of a message. These are all ingredients of communication. The fourth ingredient is the channel.
            Channel, as used in communication, is a medium, a carrier of message (Berlo, 1960). Channel can also be referred to as the route through which message is sent from the source to the communication receiver, the target of communication. Just as a source needs an encoder to translate his purposes into a message, to express in a code, the receiver as a matter of necessity needs a decoder to retranslate, to decode the message and put into a form that the receiver can effectively use the information or message. In a person-to person communication the encoder would be the set of motor skills of the source. By the same form, the decoder can also be seen as the set of sensory skills of the receiver. When one or two persons are involved in a communication situation, the decoder can be thought of as all the senses, that play roles during the situation.
            Learning, defined as a positive change is the stable relationship between a stimulus that the individual organism perceives and a response that the organism makes, either covertly or overtly. The ingredients of learning are the organism, stimulus, perception of the stimulus, and consequence of response. When learning and communication are viewed as processes, the ingredients that are involved in learning have their analogues in the ingredients that are involved in communication. Learning occurs if the individual either continues to make some of the same responses but to a different stimulus and makes a different response to the same stimulus. This is related to communication in that the communication aims and objective of the source often is a change in the behaviour of the receiver. The source wants the receiver to change, to learn. We communicate in order to get our receivers to respond in different ways to old stimuli or to respond in old ways to different stimuli (Berlo, 1960).
            Communication, therefore, can be explained in many ways but common to most definitions and adopted for this paper is the concept of transferring required ideas or information or skills or attitude from one person (sender) to another (receiver) and vice versa. It should be regarded as a two-way process. This involves attention, understanding, acceptance and action. Channel of communication is referred to as a vehicle or route or method through which message is sent from one person to another. The channel could be spoken, sritten, visual, or a combination. (Effiong 1981).
            Having defined the relevant terms of the topic, here are some of the various channels of communication which can be effectively used in health education bearing in mind the ingredients of learning and communication.
COMMUNICATION CHANNELS  
1.         As we look on the mass media of communication – radio, Tv, telephone, telegraph, newspapers, film, magazines, the stage, the public platforms – as message vehicles, Mass media are believed to be effective tools for promoting development and social changes, focusing public attention on pressing national problems, suggesting means of over-coming them and attempting to change the attitudes of the community, form the main tasks of mass media Remadasmurthy, Clarence, Balasu –balasubramanian, 1975). The mass media therefore are acceptable means of communication especially those properly trained for it. Moreover, message through the mass media can reach so many people at a very fast speed. So, various health issues can be presented through the mass media. For instance, a health topic on cleanliness and sanitation’ can be presented to a complexity of audiences through the various mass media channels – the radio and the press, the television and even the newspapers or magazine. The ‘pulse’ is a health magazine which carries information. The purpose of the source of idea or skill besides being informative may be persuasive appealing to emotion which can lead to a change in attitudes and behaviour. The ultimate objective of health education is the promotion of healthful living which implies a positive change in behaviour. The questions which should concern us at this point is: Does the mass media brig about changes (s) individual health behaviour? Assuming that it does, another question will be: Does it actually bring about such behaviours always under varying audience? If it doesn’t, what are the likely factors which is necessary, at least to clarify issues.
            The role of the mass media in initiating, or even in helping to shape, the health opinions and actions of the public is still poorly understood among many health educators. That they are important is undeniable, for they do physically reach the majority of the people. But their modes of action, or even how do they primarily influence their audience behaviour are not clear (Kristler, 1967). In fact, different media are selectively observed or used by different social, ethnic, age and sex groups. Moreso, within a particular medium different styles are policies of presentation appeal to different socio-economic and other groups; that with a single example of a particular medium, say one newspaper or magazine there is selective reading and absorption of different types of material. Most newspapers standardize their layout to include a variety of items, so that some at least will appeal to each member of different groups. (Mixed information) other however, aim at serving a comparatively narrow audience. To change one is not simply a linear process, involving only stimulus and response. Let us use our earlier example of “cleanliness and sanitation, the presentation of a radio talk or film on it may not produce an instant behavioural change as may be conceived by the encoder. Certainly, it will involve much more than attention and responding. The organism’s or receiver’s cognitive domain the key roles in decoding the message before action is taken. In the cognitive facet, for instance it implies that materials for the mass media should be factual, well written or well planned. Its motives should be sincere. A partially or well informed person may change his level of knowledge. This may in turn affect his attitudes- leading to either the acceptance or rejection of health behaviour. The assumption of his new position in the latitudes of ‘acceptance’ or ‘rejection’ may of necessity result in a new health action or behaviour. (Effiong 1981).
            According to Child (1973) and Hanlon (1974) emphasized both the role of motivation and perception in the teaching and learning situations. However, Child, warns that “false perception can arise”, attention may not be full or the direction misguided, existing percepts may be inadequate for incoming sensory experience and lastly the wrong ‘set’ or sensory cues may be present. To answer the question: Does the mass media bring about the desired changes in individual health behaviour or action, it is essentially important to consider the essential characteristics of the ingredients of communication source of the message, the message itself, the channel and the receiver. Since the actions of the receiver are the key to effective communication one can profitably study some of the things that control his receptivity of new ideas before setting to communicate. These include (a) Some communication skills, (b) his knowledge, (c) his resources, (d) his attitudes, (e) his social situation and culture. Through a proper understanding of these, one can plan an effective communication system/model.
            Individuals or groups of individuals are unique in their characteristics, goals, social and religious beliefs thus thenees to be selective in use of words and materials. The meaning ascribed to information given about health also varies greatly according to these differences. The poor, for example, are concerned with daily problems of survival which are urgent and consuming; they have neither time nor interest in broad social or health issues or long term preventive behavior. Their own style of life allows less time or inclination to read, watch or listen to the esoteric material of no immediate relevance to their immediate need nor living. On the other hand, the better educated and more favoured socio-economic class are not concerned with survival. Their upbringing, level of education, experience of professional health care, pattern of social interaction, exposure to wide variety of media and readiness to perceive, discuss and adopt new information  gives quite different meaning to their reading, listening or viewing. Thus, this group of people or audience are ready to accept health information tent to be those who are prepared or motivated, most exposed and most able to perceive and utilize it. From the foregoing discussion, it seems that the question: Does the mass media bring about changes in health behaviour always, in given audiences, is answered.
2.         NEIGHBOURHOOD GROUPINGS/ORGANIZATION
            We live in group in community set-up. These Communities differ in sizes, components and may be unique in their general or health needs. Within each of these communities are different groups or organizations differing in numbers and types; each community may share a set of common beliefs, practices, needs and aspirations. Among these community groupings or organizations the primary aims and objectives of continuous existence may be social, economic, political, religious or educational. The different forms or such groups include the social clubs, youth organizations, age groups, women societies, cooperative societies and Better Life for Rural Women. Others include political parties, the church – including the various church organizations, education committees which may include health education committee, as if its towns and villages in some, and the local council. In the Nigerian context some are known by different indigenous or vernacular names. For instance in Nguru Community (Ross, 1965), ‘Ndi Nne” is and organization of married women; in Ibibio “Nka Iban” (Effiong 1981) is a women organization. These groups or organizations, irrespective of their primary objectives, if properly organized, can function as channels of communicating health and health related issues or problems especially as it concern that particular Society.
THE CHURCH
            Galli (1974) reported that according to Magashalal, there are “Large numbers of people who are willing to contribute to, identify with, and participate in, any constructive effort… The extent of good-will that exists is seldom recognized and seldom utilized.” He went on to say that “Active members of church denominations are usually highly motivated groups. They are keen not only to satisfy spiritual needs, but also to help improve the quality of life of the individual and the community.” This represents for health education a potential force which can be channeled towards specific and integrated community action for health improvement and development.
            The Nigerian Council of Churches, by virtue of its composition, has representatives of the various member churches and key people from the different communities including agricultural demonstrators, doctors, health educators, social workers, community development workers and members of the women’s organization and youth groups. During her regular meetings health information or ideas could be communicated to them or through them. Galli reports of how church groups in Transkei “held meeting which studies the community’s most pressing needs (Effiong 1981). Among the needs identified were the need for education relevant to there major problems especially health, nutrition and agriculture which were so “interrelated as to be completely inseparable”. The Transkei Council of Churches succeeded in influencing and persuading her members to grow more food, practice better health habits. The people became better informed about the local people’s beliefs, regarding health and sickness. Churches in Nigeria comprise of different types of professionals and opinion leaders. Communicating health ideas through them could significantly influence the behaviour belief system of the members.
PRAYER SESSIONS
            Prayer sessions or “Mass” (for Christians) or Friday noon prayer (for Muslims) deserve to be mentioned as both unique to the Nigerian community and probably highly effective in carrying health Education and Health Information. Both are rarely if ever utilized for this end. The Friday noon prayer (for Muslims) is held weekly in the Islamic communities and attended by most, if not all, adult women in a separate enclave. Similarly, there are many prayers and ‘mass’  sessions for protestants and Catholics alike, usually attended by males and females of all ages. The Islamic religious leaders, the Imam or the Pastor or the Rev. Father usually delivers sermons which deal with a matter of concern to the community’s spiritual or social Health welfare. Their position and the indisputable authority and influence they can give legitimacy and near automatic acceptance to their recommendations. The sermon is often the current subject of conversation for sometimes. The mere mention of an item in the sermon quarantines its immediate spread in the village and lends its legitimacy as an item or discussion (Effiong 1981 Onuoha and Onyeoma 1995). For any health project or campaign to be announced in the church it is essential to secure approval of the religious leaders to safeguard it against the possibility of their opposing it.
NEIGHBOURHOOD GROUPINGS: 
Each Nigerian community is divided into neighbourhoods, along family lines. This allows for inter-mingling of both women and men of the same neighbourhood under certain circumstances and for certain functions, including visiting of the sick and giving of piece of advice. Under normal circumstances, aggregation of male adult villagers is usually segregated by sex. The meeting places, usually, are the head of family’s home or community town halls. These serve as centres of social interaction where information, ideas, news, and rumours are exchanged. The health educator or health worker has natural setting for introducing and discussing ideas related to his work. Here, he may obtain approval for beginning a certain task initiating the spread of certain item of information related to health, give a brief demonstration , speak on matters directly or indirectly related to health, and generally get a sense of the community’s knowledge, attitudes and practices relative to any given health or development issue (Kanaaneh, 1997). Infact, permission or approval as a matter of necessity must be sought before initiating any of these actions, especially if the health educator or worker is an ‘outsider’ or a ‘visitor’. If a permission is approved a female or male health educator can cross the se- segregation line and enter the meeting place for specific consultations and announcements on health related issue.
Women groups and special female targets exits,  in any typical Nigerian community – the Ndi Nne in Nguru community and Ekpere Okot in Qua community of the Efiks – as a social function. (Ekpere Okot is a cultural organization bringing women together to make specific contributions to the community. Much personal communication is exchanged between the women on such occasions and this offers an opportunity for the female health educator to carryout part of her health education among these mothers. Such visits can be selectively targeted to women of special status to whom other village women look up and whom they imitate. (Effiong 1981) (a) these include the wives of village or clan heads, (b) opinion leaders and modern educated pace-setters, especially indigenous female teachers. These women are always cooperative and willing to invite neighbours and relatives when requested. They also are of special interest in so far as they themselves can implement the desired behaviour and set and example for other women in the community.
Elderly women, and men especially those with many daughter-in-laws, usually hold considerable respect and power in the family. Traditional birth attendants are still practicing in Nigeria. Essentially, elderly women’s cooperation should be solicited and due respect paid to their position; also the opinion of birth attendant is of particular significance in health matters and they should be taken into confidence and respected (Kanaanah, 1979). Their inclusion as partners in health promotion, activities is strongly urged, whenever possible, in view of their power over village women in health related matters.
The local council, usually is a community representative body which disseminates information to the populace. Similarly, cooperative societies meet on some form of regular basis. These groups meetings could serve as a medium for passing on health information applications or ideas to the people.
Within these groupings may be certain community influential – a small but might cliquish type of organization which can mar or give impetus to communication. The health  information to the very members of their community.
Members of political parties at the village level are equally considered important as those at the national level. Their opinions, suggestions and recommendations are always regarded as important. Incidentally, some health workers are themselves members of political parties. Their positions are themselves members of political parties. Their positions can be used by the health educator to advantage to explain the facts of disease prevention, or the advantages of immunization and family planning adoption during party meetings. The health educator or workers must assume a leadership role in this direction to safeguard health matters being politicized.

3.         TRADITIONAL CHANNELS OF COMMUNICATION
Some channels of communication are as old as man’s history itself. Both non-verbal and verbal forms have always been in vogue. Traditional Nigerian communities rely more on traditional indigenous forms of communication. The non-verbal ones include a wide range of wooden or metal instruments. In most Ibo communities Ikoro, Ekwe, Ogene, and Opi are used to give announcements or information to invite people for meetings. In Ibibio and Efik. Communities similar instruments are still very much in use (Effiong 1981). Ibit (the talking drum), Obodom (wooden instrument) and Ntokrok – wooden instrument used only by men for conveying information or announcement to members of the community; others include Ekere a and Obukpong (trumpet), they are metal or horn. The health worker should use his ingenuity in approaching the custodians of these channels, usually through the village chiefs, to use the in giving announcement about immunization programme or health talk, displays or demonstrations, for examples.
Another channel of communication is the verbal form. It is used either traditionally or modern. This involves person to person contact or person contact through spoken words. Personal contact is made through home visits by the health educator. He uses words to explain or discuss health mattes, say, with convalescents or with a group of nursing mothers recently discharged from the hospital or maternity clinic. A meeting may be held to discuss a demonstration. “Isolated nationality and religious leaders may required special home visits and the use of leaders selected from their own members.
Disadvantaged segments of the population with little schooling and low incomes percapite may respond to personal visits” (Kelsey and Hearne, 1963). Whether the contact or visit is to a person or a group of persons, verbal channels are necessary in communicating health ideas. During a demonstration of a health skill, for instance bathing a body, explanation is also important. The forms of spoken channels include proverbs, narratives, riddles, simple commands, requests, exclamations and direct statements. When they are used, care must be taken to ensure that the intended message reaches the person or persons, satisfactorily and effectively to ensure a feedback.

Plays/ Dramatization
            Generally, plays and theatre plays could be used as educational tools in different contexts. Professional theatres have given performances in schools and youth centres, and plays have been developed and performed by youth clubs themselves. However, the theatre performance will be a special experience which will probably be forgotten shortly afterwards. The health educator can organize youths, including school children, to make plays of their own, and performed by themselves. Besides being an important motivating factor for the group, ideas can spread to the rest of the members of the community (Nelson – Gebel, 1980).
            Songs           
Another mode of communicating new ideas and airing them to the public is through sung medium folk songs could be used at weddings, special festities or at school. Loudspeakers, when used, carry songs live to the entire village, women and children may cluster at the periphery of the village square for entertainment. This medium can be utilized for announcing immunization campaigns and for debating breast-feeding versus bottle-feeding, hospital delivery versus home delivery and  large versus small families. Encouraging and ‘befriending’ recognized folksingers and influencing their thinking and practice on health matters and urging them to bring up these issues at frequent intervals in the practice of their popular profession can go a long way in helping to shape the behaviour of members of the village.
            In a study conducted by Fehrsen et.al 91979) on “the use of traditional means of communication in an African community”, he pointed out that “that team formed for the occasion would go to the people, singing one of the more general, songs as an introduction, and ending up facing the audience in a semi-circle. More specific and health related songs were chanted; the people were told to remember that each song contained a message important for their health. Furthermore, Fehren et. al. observed that these songs became very popular in hospital wards where the staff and patients were often heard singing them; there were also used in the nutrition rehabilitation units as adjuvant to discussion. Perhaps more than any other method the use of traditional modes of communication remain the basis of health education, in the traditional setting, as it provides a kind of person-to-person situation in which sharing of anxieties, ideas and insights take place. There is respect for other people, their problems and their ways of doing things are at the root of positive results. Respect which produces a sensitivity and relevance is so essential in education.
4.         VISUAL AND AUDIO –VISUAL AIDS                    
            Another channel of communication includes:-
(a)       the visual and audio visual aids; among them are pictures, posters and displays. Hearne and Hancock (1977) emphasized their use, whether for extending information or for teaching in the classroom. According to their observation they “are indispensable” for handling down informations visually. However, they advise the use of verbal explanation with them, especially when communicating with illiterates.
            Suitable photographs or pictures, especially if combined with auditory channels, can be of immense use in communicating health ideas. Fro example, a picture of a person suffering form smallpox, aids and other diseases presented to a group of people the disease. Hearne says, when we consider how much we learn by using our eyes, it is no wonder that visual methods are again blossoming as means of certain communication. The word ‘visual’ means those means of transmitting ideas by some symbol received by the eye, but it is seldom true. In many cases visual symbols should be accompanied by some form of simultaneous or health educators, should preference be given to the audio- visual to visual alone. Audio-visual is far accurate, for who will deny that a poster or road sign may not carry a potent message. Thus the points under this discussion will be more clearly understood if we consider audio- visual as a specific synonym for a ‘philosophy of idea transmission’ rather than thinking in smaller categories of specific methods or tools.
            In this regard only selective pictures should be used in transmitting health ideas. Pictures taken by professional photographers are not always good in giving health information. This implies that health educator must edit such pictures; better still, if the health educators take their pictures. When motion pictures are used with sound, they combine visual and auditory senses. The use of multiple channels sometimes are used in such a way that the information present through one channel can be coded in the other channel (Travers, 1978). Thus, many motion pictures present visual information that is then described in words. This kind of coding appears to be very important for retention.
            Visualization will help attract attention and arouse interest in our message. Research has also shown that people learn more in less time when carefully planned visual aids are used (Workshop notes). Visualization can give meaning to words in health demonstrations or talks. Such health demonstrations can be explained more effectively when the key ideas are expressed visually as and verbally.
            Other examples of visual aids worth mentioning are posters, and displays. They can transmit useful information during health discussions or even during demonstrations. The principle is basically to unfold or spread out of viewing for the purpose of attracting, establishing identify or conveying information. A poster depicting a woman ‘burdened’ with so many unhealthy children during a family planning programme can communicate to a group of village women the evils of having too many children. Because the poster must get an idea across quickly, it should be simple and clear. There should be few words and the illustration should be vividly portrayed so as to be readily understood or perceived and consumed.
DISPLAYS
Display serves as a crowning phase for all media for communication. It is indeed a new visual meaning to word concepts. Many schools of thought have admitted that display is a powerful mass media of communication that could be used to educate and to sway the thoughts and acts of observers.
            For these reasons, display is becoming an indispensable factors in course of learning, so much so with the health educators. Simple displays mean for our purpose here, the organization of pictures, words, models of various sizes into visually readable message in order to affect a particular audience. Displays take such forms as a printed page, bulletin board, posters, charts, maps, diagrams projected materials, and actual objects. Care must be taken to see that the medium used for display is simple, comprehensible, since the impact and the power of display come from this quick flash of communication.       

FACTORS THAT SHOULD BE CONSIDERED IN SELECTING COMMUNICATION CHANNELS                                                    
In using, and analyzing the effectiveness of communications there are four aspects to consider:
(a)         the source of the message
(b)         the message itself
(c)         the channel and the receiver.
Since the actions of the receiver are the key to effective communications study on some of the things that control his receptivity be effected. These factors include:-
(a)                 his communication skills,
(b)                 his level of education
(c)                 his resources
(d)                 his attitudes and his social situation.

Through an understanding of these one can plan more effective communications system, be it in the classroom or outside the classroom setting. Knowledge of the communication skills of our audience is necessary if we are to tell anything. We need to know the language level they understand when listening or when reading. We need to know his ability to understand the pictures and to interpret charts of various kinds. It is also important to know what our audiences already understand about preventive health measures, for example. If, for instance, a person knows that vaccination will prevent disease, but refuses to utilize that knowledge for cultural reasons, it will do little good to spend additional time explaining the facts of disease prevention. Similarly, attitudes toward the human body and toward disease are important considerations when planning communications. Consideration of resources of the audience is important. Suggestions about refuse disposal, prenatal care, or better diets will not be accepted if they involve expenses that are beyond the means of the circle. Most importantly, we must understand the social situation within which our audience lives. Families, friends, community leaders and beliefs and value systems exert many pressures that affect the willingness to accept and take action on a communication. For instance, methods of feeding babies are greatly influenced by the opinion of mother-in-laws. Also, accepting modern maternity services or antenatal care and family planning programmes may be affected by the prevailing traditional methods of child delivery and family planning respectively. Lighter (1968), in his studies on “Personal Communication at Work”, emphasized the need, among others, to avoid prejudices and preconceived ideas, respect other peoples’ opinions and beliefs; to take into consideration the thinking and actions of others, to give full consideration to the psychological, sociological, culture and economic factors involved, and to communicate in the language and level of maturity of the people. However, health educators should realize that it need participation and action on the part of the receivers for communication to be effective.
This requires motivating of an individual both in communicating and learning, which has been mentioned earlier. Hanlon (1974), pointed out at that, “It is well recognized that to motivate people to use health centralized knowledge it must be comprehensible and accepted to them; taking into consideration their basic emotional needs and wants, their cultural attitudes, beliefs and prejudices, their fears, ambitions, jealousies, determinations, pride, malice, or any combination of these.
Another factor of paramount importance is the learning process. Learning process involves the stimulus, the organism and the response. But we know man to be more complex as to involve himself with only stimulus and response. This implies that an organism must be capable of perceiving the stimulus; the stimulus as perceived by the organism must be interpreted by the organism and he must produce some response to the stimulus as perceived and interpreted. For learning to occur the response must become habitual when ever the stimulus is presented. Health educators who are concerned in permanent change in habit or behaviour must always deliberately ensure that all determinants of habit strength’ are taken into consideration when planning communication. The frequency of rewarded repetition, isolation of the stimulus – response relationship, amount of reward, the time between response and reward and the effort required to make the response should be considered.
Evaluation is an indispensable tool in bringing about progress in education. Health educators should, as a rule, evaluate their health education programme, methods and techniques. Specifically, and in this context, it will involve evaluating the source of the communication, the message, the channel and the receiver. Only channels suitable and appropriate to deliver a particular message should be selected and these channels must be chosen to meet the needs of a specific audience. An audience comprising of only persons of rural characteristics, for example, may require channels which differ from those that will be effectively utilized in communicating a similar information to persons of high socio-economic levels. Knowledge of the receivers background, beliefs and practices and even their needs deserves attention and evaluation of the health educator.
Sometimes there is a block in communication, irrespective of how effective the selected channel is likely to be. Use of radio and television as media of communication is not without problems.
Also, a radio set which is damaged or affected by poor weather may lead to poor reception; this in turn may make the channel fossy, a block in communication may occur. The appearance of the health educator is important during the process of communication. First, his facial appearance and the way he sits may prevent effective communication. Proper dressing by the health educator may enhance effective communication. Simple dressing, especially if it is in agreement with that of the people will facilitate effective communication.
While various communication channels are useful in communicating health messages to an individual or a group of individuals, one need to consider certain factors which if not given careful attention could result in either a partial or no communication at all. Although, as health educators, we are concerned with changes in positive behaviour, it should be noted that absolute reliance on communication alone can be misleading since communication only stimulates intellectual and emotional processes within the individual over which we do not have control. We should help the individual to make his own inferences and reach his own decisions.

CHANNELS OF COMMUNICATION IMPLICATIONS FOR HEALTH EDUCATION     
Earlier, we have stated that communication is indispensable to health education; and effective communication should underline  the health educator’s selection of communication channels, be they modern or traditional.
Since communication is a two-way process, knowing the message, its objectives and understanding the audience is as important as skilful selection of the channel to be use.
The traditional communication instruments can be usefully employed in giving health information and rallying the audience for health lectures, or talks, campaigns, demonstrations and projects. Judicious use can be made of proverbs, requests, narratives riddles or direct statements in the local language when imparting health messages. Sung media, drama or theatre play can sometimes be employed to drive home slogans, attitudes and safely measures. Wise and optimum use can be made of the church to communicate health new and information to the public. Health meetings, seminars or health projects can effectively be announced in the church services or prayer sessions. Even the town crier can be of immense use in disseminating various health messages.
Through the local council, age groups, cooperative societies and youth organizations, health new, programmes and ideas can permeate the community. These groups can be of immense help in initiating and executing health projects.
Audio-visual aids, interviews, talks, demonstrations or exhibitions can be used to present facts about health. Printed materials or words may not have effective communicative results with a majority of the local people as would pictures, photographs, posters, drawings, songs and plays.
The health educator can select the radio and television to present health talks, especially when the language of the people are used. However, health information through the television and radio may not permeate into the very fabrics of a rural community as would in an urban community. As much as possible, the health educator should adopt a face-to-face approach with the audience through visits, conferences, field trips and demonstrations.
Finally, proper considerations should be given to the values, customs, beliefs, practices, prejudices and habits of the people as well as collaborating with other professionals or health related persons or influential persons in order to fully utilize all available avenues to communicate health ideas, practices and behaviours accurately and effectively. Furthermore, it must be realized that some communication channels lend themselves more to classroom instruction while others are more effective for community health education.
In order to reduce the existing imbalance between the urban and rural areas the meeting saw hope in the development and implementation of primary health care now being carried out by many countries throughout the region. The primary health care programmes being developed very from one country to the other but are all aimed at the rural and peril-urban populations benefiting from the equal distribution of national resources in order to lead a healthier life. This is possible through the adoption of a primary health care approach within the national system which is designed to help an individual family and a community to help themselves and to lead a healthy life. The mass media could play an effective role as a community development agent in educating and informing the communities to participate in health and management decisions regarding their community development activities.
This paper recognizes that community participation is a very long tradition among African people. It was, however, stressed that emphasis should be placed on the important of local initiative to bring about the primary health care approach to all the communities particularly in the rural areas. The mass media should develop effective methods and ways of reaching the rural communities in order to enlist their full involvement in community activities which will improve their own lives.
It is also noted that many countries in the region have embarked on special training programmes for community health workers (CHW) selected by the communities themselves. In order to prepared the mass media personnel as health agents, training courses or workshops should be organized for them at country level in order to enable them to promote Primary Health Care in the underserved communities. In addition the health personnel should have a regular dialogue with the mass media personnel and provide the latter with the relevant information for dissemination in the communities.
In conclusion it was noted that future generations would suffer from slow progress being made now if the meager allocation of resources for Primary Health Care, continues.
Mass media methods and approaches in influencing the adoption of PHC
The background on “Mass media methods and approaches in influencing socio-political change and encouraging community participation”.
The aim of this paper was to consider how mass media methods and approaches may support strategies for the attainment of health for all by the year 2000, through the Primary Health Care approach. It considers also the use of the mass media to increase the awareness of selected audiences regarding the issues involved, to mobilize political support at the national and international levels to enlist community participation and support and to raise the awareness of individuals and groups to induce behavioural change.
This discussion will also considered the role of specialized and general journalists and broadcasters and suggests ways in which common objectives between newsmen and educators” may be arrived at.
Health for all by the year 2000 is a social objective of all member states of WHO. The magnitude of the task calls for radical changes in the existing structure. These changes can only be brought about through a firm commitment by political leaders and widespread popular understanding and support through the mass media. Primary Health  Care itself is a concept which has not always been adequately explained.
Although the declaration and recommendations of the international conference on PHC, at Alma-Ata, define the essential principles and content of PHC, even well informed persons any overlook fundamentally important aspects of the process. Many of the constraints can be partially overcome if the mass media take into account certain basic principles of effective communication.
It is well known that in most countries numerous groups share responsibility for health services. Likewise, many communication groups are involved in education/information activities even within governments. Dialogue with leadership groups and the public will likely be the first major challenge in the mass communication sector. Careful selection of target audiences and locations must be made, on the basis of their direct influence in supporting the reforms and their value as channels of information.
A review of technical methods and approaches toward the population has to be balanced by an appreciation and respect for individual and community attitudes and behaviour. This places communications largely in the role of working with and supporting communities’ participation by helping them to clarify needs and providing information about how they can do something about needs.
In discussion of the working documents, the meeting felt that mass media should be considered for gaining support for PHC by both decision-makers and communities simultaneously, planners and policy-makers are increasingly sensitive to an educated and demanding community. If rural communities are stimulated and their voices are heard they will become a source of inspiration and guidance for policy-makers and politicians.
More dialogue is needed between and among the following groups:-
1                    Villages community heads and the communities;
2                    Policy-makers, planners and politicians;
3                    Health workers
4                    Medical personnel;
5                    Community development personnel, etc      
The mass media in fact have an important role in assisting this dialogue and promoting coordination.

Constraints in the use of mass media for Promoting Primary Health Care                                                            
            As it appeared that there were reasons why the mass media were not yet effective in promoting Primary Health Care it was necessary to consider these constraints.
The constraints fell under various headings:
(a)       lack of mass media
            -           not enough radios, not enough batteries;
            -           not enough transmitters
            -           not sufficient power for transmitters;
            -           insufficient funds allocated for mass media projects
-           Planners/politicians not appreciating technical problems of media and therefore not providing support;    
-           not enough trained personnel
-           limited production of newspapers and poor circulation
-           lack of regular maintenance and repair;
(b)       urban base of media personnel
-           a large proportion of media people are urban-based and the best reporters are usually stationed in the capital; those in rural areas are handicapped by poor equipment, no transport, no telephone and telephone and telex;            
(c)       Journalists and programme producers:
            -           not always trained to know the needs of the country;
-           very few are able to specialize in anything, let alone health, because of inadequate staff; 
-           training does not touch on health matters;
(d)       The community
-           the planners of mass media programmes often do not plan them in consultation with the community; the result is that some programes are broadcast at periods when the community are engaged and cannot benefit from them; 
-           high proportion of illiteracy and difficulty in getting newspapers;
-           ordinary members of the community seldom feature in news as the emphasis is on important people, and yet the villagers are interested in village matters;
(e)       Health workers
            -           few know much about the media;
-           little experience of media and some fear the media and are even hostile to it;                      
-           poor training in communication
(f)        Problems of the primary health care message itself:
-           there is often difficulty in formulating and interpreting the PHC concept so that it is meaningful to all target groups;
-           this difficulty is increased by the need to coordinate messages from the other sectors involved such as agriculture, education etc.
-           Primary Health Care is often thought of as medical care subject but it is health care subject which is equivalent to total community development.
Solutions to Constraints 
-           Purchase and distribute more portable radios in schools, women’s groups and other listening groups; ensure a supply of batteries; communication in fact needs a bigger budget and should be given higher priority;
-           more decentralized transmitters using local languages and locally-oriented programmes;
-           integrated training; this should include training in health and a period of field training the for media personnel it should be coordinated with other rural community development programems such as agriculture extension workers, etc.
-           use village correspondents and feature the problems and solutions of village people;
-           transfer allowance for media people transferred to rural areas;
-           improve living conditions for media people in rural areas;
-           provide transport for media people to be mobile in rural areas;
-           encourage some specialization in health; the employment of more staff would allow for more specialization;
-           health training seminars for journalists and also introduce health matters into journalist training institutions; continued adult education in development policy of journalists;
-           more programmes based on what villagers do and need and say;
-           solicit more reaction from villagers on health policy matters;
-           involve women groups and other existing groups more often;
-           train health people in media use and get someone experienced in working with media; the public health unit can have its own producer seconded to radio;
-           The responsibility for producing programmes could be a shared one, with one person from health and one, from media;
-           coordinated and extended programmes, e.g radio programme with listening groups, with evaluation and follow-up, leading in turn to improved radio programmes.
General Methods and Approaches 
Having discussed some of the inherent problems of communicating community health matters and having considered some solutions that would increase the effectiveness of mass media in propagating PHC, the group next set about formulating some general methods and approaches to the topic. Many approaches are of general importance and would promote both political and behavioural change in support of PHC as well as encouraging community participation.
Cooperation must be implement between health care workers and communication workers to secure understanding on both sides of the concept and the problem the other party are facing, and to secure a continuous feedback system; this should be done at all levels of the planning and decision-making system, central regional and local. The initial step to secure understanding of the problems could include seminars and workshops with participation from all information media and health care workers of all levels.
Mass media workers should participate in all PHC planning activities not just as reporters but also as participants because their contribution to the success of the plan can be very great.
There is a need to have medical information written in such a way as to avoid misinterpretation and misquotations. The radio should be given special thought because it is the medium which ensures the widest coverage. Newspapers have limited circulation and not all can read them although it is true that the policy-makers and planners read them.
Many of the solutions offered to overcome the constraints could really be classed as short-or-long- term objectives, e.g to rapidly achieve increased liaison and understanding between media and health a series of seminars on Primary Health Care could be organized, but to achieve continued long-term liaison there should be changes in curriculum and style of training for both cadres.
Factors that should be considered in all programmes are the benefits of integrating different types of media and approaches, and that feedback and evaluation will help to identify the most useful components.
Some suggestions were also made about the involvement of non-government health institutions in PHC programmes. Many non-governmental organizations, for examples, have PHC projects and this and their methods and successes could be covered by the media. The mass media have a role in creating awareness among the policy-makers and the communities of the need to coordinate isolated PHC activities.
WHO/UNICEF could assist with improving the media, e.g electronic and printing and other equipment and suppliers to allow for a wider use of all the media: radio, television, papers, pamphlets, posters, drama, films, health material in literacy campaign, songs, dance, etc. A film-producing body might providing locally relevant messages, showing local participation and describing local problems.

Methods, mechanisms and approaches to make mass media more effective in promoting political and behavioural change in support and resources allocation to PHC                                                                                        
            The need for planners of health systems and projects to always include a communications aspect and should actively get involved with the media. Ministries with “slots” for radio time should combine for joint development discussions and should bring the policy –makers into the programme.
            In Tanzania and Zambia for example policy-makers and politicians go to political school for a period of time and during this orientation period they could learn about Primary Health Care policy and also about mass media. There is in fact in many countries a need for a an active party directive to use the media more for the benefit of Primary Health Care.
            Policy-makers should be invited to inaugurate Primary Health Care activities or sit in on village committees so that they can appreciate what is involved in the rural areas. The mass media could publicize such activities to the benefit of both politician and community.
            Factual information should be included in easily understood messages and Primary Health Care information suitably interpreted in lay terms could be inserted in news papers which are usually read by policy- and decision-makers. A minister’s speech could for example be filled out with factual reporting on the actual objectives and achievements of a community project he is initiating.
            One particular problem arises in the motivation of the segment of the health profession (doctors and nurses) who do not as yet fully appreciate Primary Health Care. How does one motivate the mass media to motivate those who should be motivators?
            Due to lack of proper information, decision-makers often allocate resources in favour of urban areas where they live. These people can be informed about PHC and the problems of rural areas and lack of equity in distribution of resources; this information can reach them through newspapers, letters to the editor interviews and discussion on television and radio programmes.
            Every locally organized seminar on PHC, and every participant at out-side conferences on PHC, should make a point of informing the media with a view to arousing the interest of the decision-makers.
            Some other suggestions include: seminars on PHC for members of parliament and ministers and permanent secretaries from different sectors. Involvement of politicians continuously through planning, implementation and evaluation of health programmes.                      
                                                                                                       
                    

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