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.