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Health Education, Advocacy and Community Mobilisation Module: 8. Components of Health Communication

Study Session 8  Components of Health Communication

Introduction

In this study session you will learn about the components of health communication. Within each component of communication (source, audience, message, channels and feedback), you will learn about the concepts, characteristics and prerequisites that you will need to consider for effective communication with your community. You will also learn different types of appeals that you can use in your delivery of health messages. The content of each message can be organised in a variety of different ways so that it can persuade or convince people. You will also learn about the processes of communication, the whole sequence of transmission and about the interchange of facts, ideas and feelings. Finally you will learn about the six stages of communication that will help you promote changes in health through the modification of the human, social and political factors that influence behaviour.

Learning Outcomes for Study Session 8

When you have studied this session, you should be able to:

8.1  Define and use correctly all of the key words printed in bold. (SAQ 8.1)

8.2  Describe the basic components and processes of health communication. (SAQs 8.2, 8.3 and 8.4)

8.3  Explain the types of appeal that can be used in health communication. (SAQs 8.3 and 8.4)

8.4  Describe the six stages of communication in health education and promotion. (SAQs 8.4 and 8.5)

8.1  The components and processes of communication

8.1.1  The source (sender)

A health worker is relaying a health message to a woman.
Figure 8.1  This picture demonstrates that the health worker (the sender of the health message) is well trusted by the woman who is receiving the health message. (Photo: UNICEF Ethiopia/Indrias Getachew)

The sender is the originator of the message. The source can be an individual or group, an institution or an organisation. People are exposed to communication from different sources, but are most likely to accept communication from a person or an organisation that they trust because they consider it to be a good source of reliable information (Figure 8.1).

Credibility can come from:

  • A person’s natural position in the family or community — for example, head, village chief or elder.
  • Through their personal qualities or actions — for example, a health worker who always comes out to help people, even at night.
  • Respect for their qualifications and training.
  • The extent to which the source of communication shares characteristics such as age, sex, education, religion or experiences with the receiver.

A person from a similar background to the members of the community is more likely to share the same language, ideas and motivations and thus be a more effective communicator.

One of the main reasons for communication failure is when the source comes from a different background from the receiver and uses inappropriate message content and appeals.

  • Look at Box 8.1. Why do you think that more overlap will make communication more effective? Give some reasons for your answer.

    Box 8.1  Communication success and failure

    Communication is likely to be successful if there is a high overlap with characteristics shared in common by the sender and the receiver.

    If there is little overlap and many differences remain between source and receiver then communication is likely to be unsuccessful.

  • When the source comes from a similar background to the receiver he or she is more likely to share the same language, ideas and motivations and be able to communicate more effectively. This will increase the credibility of the message.

  • Look at Box 8.2 and tick all the items on the list which you have observed when people are communicating with each other. After you have done this think about which items are about including the listeners and which items you think are about being clear. As you do this remember that some items might do both.

    Box 8.2  Effective communicators

    An effective health communicator:

    1. Puts himself or herself both in the situation of the sender and the receiver
    2. Makes sure that they have the full attention of the other person
    3. Speaks in a loud and clear voice
    4. Formulates the message clearly in a way that can be easily understood
    5. Explains technical terms
    6. Is able to adapt the health messages to the educational background of the receiver
    7. Encourages the receiver to speak openly
    8. Gives full attention to the receiver
    9. Listens carefully
    10. Ensures that the message is understood
    11. Takes the questions and concerns of the receiver seriously
    12. Answers any questions fully.
  • You will probably have decided that many of the items in Box 7.2 are both about being inclusive and being clear. By being clear you are actually including more people. For example by answering questions fully you are being both clear and increasing the chances of more understanding on the part of those listening to you.

8.1.2  The receiver or audience

The receiver or audience is the person or the group for whom the communication is intended, or the person who receives the message. The first step in planning any communication is to consider the intended audience. Who is your audience? Do you have a primary and a secondary audience? What information do they need in order to take action?

Examples of an audience could be those receiving a message from Health Extension Practitioners who are teaching about family planning. The primary audience would be couples from the community. The secondary audience might be grandparents and other family members, while the tertiary (third) audience are other people in the wider community.

8.2  Before you communicate

A method which is effective with one audience may not succeed with another. As the health communicator you always have to consider the following important factors before you communicate, when you are designing the message and identifying precisely who is your audience:

  1. Educational factors including the age and educational level of the audience are important. What kind of appeal might convince your audience? Pictures and diagrams that you use as teaching aids should relate to the culture of the audience and you should only use words that are used in everyday conversation.
  2. Sociocultural factors are important as you consider the beliefs of the audience about the topic of communication. What is the strength of the audience’s present beliefs? What values does that audience hold? Can you find out whose opinions and views your audience trusts?
  3. Which patterns of communication already exist in the community and what are their rules during conversation in the community? How do they show respect when talking to another person? When is the best time to conduct your health education sessions, or the best place to put posters? Consider also the community dynamics including leadership patterns at the community level and what communication materials and skills are needed for interpersonal communication and counselling.

Several methods will help you reveal the lifestyles, health status, and other characteristics of an audience (Figure 8.2). These methods include observation, informal conversations, surveys (oral and written), in-depth interviews, focus groups — or a combination of these methods. Not every method is appropriate for every audience; for example, oral surveys may be appropriate for people with limited literacy skills, while focus groups may not be appropriate in particular cultures that traditionally do not share personal opinions or feelings in a small group setting.

A group of men from the community are seated on a bench in a hut.
Figure 8.2  How will you find out about your audience and the best ways to communicate with them? (Photo: AMREF/Ephrem Yifru)
  • Suppose Ms Ayesha is a Health Extension Practitioner. She has a plan to teach the community of a village called Boke about HIV/AIDS. What are the factors that Ms Ayesha should consider about the audience before she starts health education or communication about HIV/AIDS?

  • Before she starts health education activities the first thing that Aysha should consider is the intended audience. This is because a method which is effective with one audience may not succeed with another. Some of the factors that should be considered are the age and educational level and literacy of the audience, the number of men and women in the audience, as well as the current beliefs of the audience about HIV/AIDS.

8.2.1  The message

A message is a piece of information that contains a combination of ideas, facts, opinions, feelings or attitudes. A message is something that is considered important for the audience to know or do. You may have only one message that you want to convey and you may want to modify this message for several different audiences. It is more than likely that you will have three or four key messages, and will want to tailor them for three or four audiences using different tools.

The content of the message could be organised in different ways so that it is more likely to persuade or convince people. These are called appeals. Not everyone responds in the same way. What might persuade you to do something might be quite different from what might persuade another person. The type of appeals that could convince people with little or no schooling might be different from those that convince people with a higher educational level. Children might respond to the message differently from older people and so forth.

A major error made in many health education communications is the tendency to use arguments that rely heavily on too many medical details which can confuse the audience.

8.2.2  Types of appeals in health communication

In this section, you will learn about different types of appeals that can be used in health communication. These include: fear-arousal, humour, logical/factual appeals, emotional appeals, one-sided and two sided messages, positive and negative appeals.

The fear-arousal appeal

This type of message is conveyed to frighten and arouse people into action by emphasising the serious outcome from not taking action. Symbols such as dying people, coffins, gravestones or skulls may be used. Fear-arousal appeals might be effective for a person with little or no schooling. Evidence suggests that mild fear can arouse interest, create concern and lead to behaviour change. However, creating too much fear is not appropriate.

Humour

The message in this type of health communication is conveyed in a funny way such as in a cartoon (Figure 8.3). Humour is a very good way of attracting interest and attention. It can also serve as a useful method to lighten the tension when dealing with serious subjects.

A poster message about dental hygiene.
Figure 8.3  Some poster messages are a mixture of humour and health information. (Photo: Joshua Trevino)

Enjoyment and entertainment can result in highly effective recall and learning. However, humour does not always lead to changes in beliefs and attitudes. What one person finds funny another person may not. Humour should be used sensitively so as not to offend others.

The logical/factual appeal

The message is conveyed to convince people by giving facts, figures and information — for example, facts related to HIV/AIDS, its causes, route of transmission and prevention methods. The logical/factual appeal carries weight with a person of high educational level. Information on its own is usually not enough to change behaviours and various appeals must be tried to see what works (Figure 8.4).

A community are gathered under a shelter listening to a health worker talk on health messages.
Figure 8.4  Sometimes it can be difficult to know how to communicate health messages so they appeal to most of the audience. (Source: UNICEF Ethiopia/Indrias Getachew)
The emotional appeal

The message is transmitted by arousing emotions and feelings rather than giving facts and figures. A poster or leaflet might use this approach by showing smiling babies or wealthy families with a latrine and associating such images to create a positive healthy impression. A less educated person will often be more convinced by simple emotional appeals from people they trust.

One-sided and two-sided messages

One-sided messages only present the advantages of taking action and fail to mention any possible disadvantages — for example, educating mothers only about the benefits of the oral contraceptive pill, but not explaining the side-effects or risks associated with the pill.

Presenting only one side of an argument may be effective provided your audience will not be exposed to different views at other times. However, if they are likely to hear opposing information, such as the side-effects from a drug, they may be suspicious about taking your advice in the future. It is better to be honest. If communication is through mass media such as radio, TV or newspapers, the audience may only grasp part of the message or selectively pick up the points that they agree with.

A two-sided message presents both the advantages and disadvantages of taking action. It is appropriate if:

  • The audiences are used to being exposed to different views
  • The audiences are literate
  • You are face-to-face with individuals or groups: this makes it easier to present both sides and make sure that the audience understands the issues.
  • Mrs Ayantu is a Health Extension Practitioner who works in a village called Bika. Mrs Ayantu plans to give health education sessions to her local community on certain issues which mention only the benefits of taking action. What communication appeal would be more appropriate for Mrs Ayantu to prepare?

  • The type of communication appeal that Mrs Ayantu plans to prepare are one-sided messages, but it would be more appropriate if she could prepare two-sided messages so her community can understand more about the health issues under discussion. Not only that — they will understand that she is trying to give them ‘the whole picture’.

Positive appeals and negative appeals

Positive appeals include communications that ask people to do something positive, such as exclusive breastfeeding for your child, or using a latrine. Whereas negative appeals are where the communication asks people not to do something, for example do not bottlefeed your child, or do not defacate in the bush.

Negative appeals use terms such as ‘avoid’ or ‘don’t’ to discourage people from performing harmful behaviours. But most health educators agree that it is better to be positive and promote beneficial behaviours instead of relying on negative appeals.

  • Now you have read all the different sorts of appeals, look at them again and think about occasions when you have seen them used and the sort of audience and messages that have been involved. Then answer the following questions:

    1. On the whole do you think that positive appeals are likely to be more successful?
    2. Is an appeal which draws on a great deal of fear likely to be successful?
    3. Is an appeal with lots of facts and figures likely to be more successful with an educated audience or an audience with few literacy skills?
  • We hope you were able to give answers like these:

    1. Positive appeals do seem to work better than negative one’s because they help people see the benefits of change.
    2. On the whole, mild fear may help drive home a message, but a very strong and fearful message might put people off.
    3. Facts and figures tend to work better with educated audiences.

8.3  The channel

A channel is the physical means or the media by which the message travels from a sender to a receiver. The channel used to communicate a health message influences what information can be conveyed and how.

8.3.1  Types of communication channels

  1. Interpersonal channels — such as face-to-face communication, home visits, training, group discussions, and counselling — are generally best for giving credibility to messages, providing information, and teaching complex skills that need two-way communications between the individual and the health workers.
  2. Broadcast channels, such as radio and television, generally provide broad coverage for communication of messages by reaching a large number of the target audience quickly and frequently.
  3. Print channels, such as pamphlets, flyers, and posters, are generally considered best for providing a timely reminder of key communication messages (Figure 8.5).
A poster message with a baby on the front. The baby is receiving some medicine.
Figure 8.5  Posters can be an effective way of communicating simple health messages. (Photo: Joshua Trevino)

8.3.2  The rules for selecting channels

Having the right health message, the right audience and the right products is important, but delivering them via effective channels is another thing to consider. Select channels that are accessible and appropriate for the target audience. For example, radio messages should be scheduled for those radio stations that the target audience actually listens to and that are broadcast at times when that audience listens. Print materials should be used only for literate or semiliterate audiences who are accustomed to learning through written and visual materials.

Materials should be distributed in accessible and visible places where the target audience already goes. Remember that the different channels play different roles. It may be best to use several channels simultaneously. The integrated use of multiple channels increases the coverage, frequency and effectiveness of communication messages. The combination of these channels is often called the media mix.

Select a media mix that is within the programme’s human and financial resources and use channels that are familiar to the specific target audience. The channel must be easily available and accessible to the receiver.

  • Think of an important health issue in your own community. What channels do you think might be best to deliver health messages about this subject to members of your own community?

  • Your answer might be different depending on different factors. For example, if your plan is to change behaviour, then interpersonal channels are good: face-to-face conservations, counselling, role plays and so on. If your objective is to increase awareness, then mass media (for example radio or TV) may be good channels.

8.3.3  Feedback

Feedback is the mechanism of assessing what has happened to the receivers after the communication has occurred. A communication is said to have feedback when the receiver of the message gives his or her responses back to the sender of the message. The sender must know how well the messages have been received by the receiver and whether they have been understood and acted on. It completes the process of communication.

The effect of feedback is a change in the receiver’s knowledge, attitude and practice or behaviour. There is a positive effect when a desired change in knowledge, attitude or practice occurs, and a negative effect when the desired change does not occur.

  • Think about an occasion when you have been involved in a health message being passed on in your community. Think about what the people receiving the message said to the sender. What sorts of feedback did they give him or her?

  • Feedback comes in all shapes and sizes. Two important types of feedback are approval and questions. If people say how much they have enjoyed the message or event, then the sender will know that they have pitched what they are doing so the audience has enjoyed it — and this is an important element of health communication. If people have asked lots of questions, then it is worth checking are they asking because they want to know more? This is a very good sign that they are engaged. Or is it because they have not understood the presentation?

8.4  Stages of health communication

In health education and health promotion you communicate for a special purpose — to promote improvement or change in health through the modification of the factors that influence behaviour. To achieve these objectives, successful communication must pass through several stages (Figure 8.6):

Stages in health communication.
Figure 8.6  Stages in health communication.

Stage 1  Reaching the intended audience

Communication cannot be effective unless it is seen or heard by its intended audience. A common cause of failure at this stage is ‘preaching to the converted’. An example of this would be if posters asking people to attend for antenatal care are placed at the clinic itself only, or talks on the subject are only given at antenatal clinics. These methods only reach the people who are already motivated to use the service. However the groups you are trying to reach may not attend clinics, nor have radios or newspapers. They may be busy at the times the health education programmes are broadcast on the radio. Communication should be directed where people are going to see or hear the messages (Figure 8.7). This requires careful study of your intended audience to find out where they might see posters or what their listening and reading habits are.

Sanitation posters on the side of a latrine building.
Figure 8.7  These sanitation posters are in the correct place — on the side of a latrine. (Photo: Tom Heller)

Stage 2  Attracting the audience’s attention

Any communication must attract attention, so that people will make the effort to listen or read the information. Examples of failure at this stage are:

  • Going past the poster without bothering to look at it (Figure 8.8).
  • Not paying attention to the health talk or demonstration at the clinic.
  • Turning off the radio programme or switching over to another channel.
A roadside poster about seatbelts and mobile phone use.
Figure 8.8  This message about seat belts and mobile phones would be rather complex to read if people are driving past at speed. (Photo: Tom Heller)

Stage 3  Understanding the message

Once the person pays attention to a message they will try to understand it. For example, two people may hear the same radio programme or see the same poster and interpret the message quite differently from each other — and differently from the meaning intended by the sender. A person’s interpretation of a communication will depend on many things.

Failure at this stage can take place when:

  • Complex language and unfamiliar or technical words are used
  • Pictures contain complicated diagrams and distracting details
  • Pictures contain unfamiliar or strange subjects
  • Too much information is presented and people cannot absorb it at all.

Stage 4  Acceptance of change

A communication should not only be received and understood — it should be believed and accepted.

It is usually easier to promote a change when its effects can be easily demonstrated. For example, ventilated improved pit latrines do not smell and will be more accepted by the community because of this feature.

Stage 5  Producing behaviour change

A communication may result in a change in beliefs and attitudes, but still not influence behaviour or action. This can happen when the communication has not been aimed at the factor that has most influence on the person’s behaviour. For example a person may have a favourable attitude and want to carry out the action, such as using family planning — but some people around may prevent the person from doing it. Sometimes the person might not have the means (enabling factors) such as money, skill or availability of services to take action. As a result there will be no behaviour change.

Stage 6  Improvement in health

Improvement in health will only take place if the changed behaviours have been carefully selected so that they really influence health. If your messages are based on outdated or incorrect ideas, people could follow your advice — but their health would not improve.

  • In a community dialogue some people were convinced of the importance of having a latrine and wanted to build one in their village. But they didn’t have any material for construction. Look back at the communication stages. At what communication stage has the message failed?

  • The message has failed at stage 5, which is the stage of producing a behaviour change. This is because not only are changes in beliefs and attitudes needed but enabling factors such as the availability of resources are also necessary.

  • Now look at Table 8.1(a) which shows some examples of failure at different stages of the communication process. Read each one and then write down an action in the third column that you think would lead instead to success.

    Table 8.1(a)  Examples of failure at different communication stages.
    StagesImmunization posterHow to ensure success
    1  The message reaches the intended audience. It is seen or heard.Poster is placed at the health centre and only seen by mothers who have immunized their children.
    2  Gains attention and holds interest or becomes noticed.The poster is lacking striking features and doesn’t stand out compared with attractive commercial advertisements.
    3  The message is understood and correctly interpreted.Poster showing large hypodermic syringe held by smiling doctor was thought by the community to be a devil with a knife.
    4  The message is accepted and believed, so learning takes place.People believe that measles is caused by witchcraft and do not believe the poster even though they understand the message.
    5  Changes health behaviour.The mother accepted the message and wished to take her child for immunization — but the grandmother didn’t allow it.
    6  Improves health.The vaccine was damaged when the refrigerator broke down, and the child became sick with measles after being immunized.
  • Possible ways you might ensure success are given in Table 8.1(b).

    Table 8.1(b) column three of Table 8.1(a) completed.
    How to ensure success
    1  Research target group to find out where they go and where they would see the poster.
    2  Find out interests of target group and make your poster interesting, attractive and unusual. Test it out to see if they respond positively.
    3  Make it simple and avoid confusing words and pictures. Pre-test words and pictures with a sample of your target group.
    4  Base the message on what people already believe. Pre-test messages for acceptability.
    5  Target the influential people and ensure enabling factors are available. Pre-test for feasibility.
    6  Choose the most important behaviours. Make sure support services are functioning.

    You may have also had other ideas. It is useful to keep a note of any success in the stages of communication which you have seen (or observed in other people’s work).

Summary of Study Session 8

In Study Session 8 you have learned that:

  1. Communication has five components the sender, the message, the channel, the receiver and the feedback.
  2. The sender is the originator of the messages. The receiver or audience is the person or group who receives the message.
  3. The message is a piece of information or ideas, facts and opinions that are passed from the sender to the receiver.
  4. The term ‘appeals’ refers to a situation when the content of the message is organised in ways to persuade or convince the receiver.
  5. The communication process is the whole sequence of transmission and interchange of facts, ideas or feelings.
  6. In health education and health promotion you communicate for a special purpose — to promote improvement or changes in health through the modification of the factors that influence health-related behaviour (Figure 8.9).
  7. To achieve your objectives, successful health communication must pass through certain stages: reaching the audience, gaining attention, being understood, being accepted, changing behaviour, and improving health.
A poster depicting a simple health message.
Figure 8.9  Some health messages can be clearly put across in a single poster. (Photo: Tom Heller)

Self-Assessment Questions (SAQs) for Study Session 8

Now that you have completed this study session, you can assess how well you have achieved its Learning Outcomes by answering these questions. Write your answers in your Study Diary and discuss them with your Tutor at the next Study Support Meeting. You can check your answers with the Notes on the Self-Assessment Questions at the end of this Module.

SAQ 8.1 (tests Learning Outcome 8.1)

Match the correct definition with each of the key words.

Using the following two lists, match each numbered item with the correct letter.

  1. Different ways that you can use to get your message across, including humour sometimes

  2. The information that you want to communicate as part of your health education programme

  3. Ways of getting your message to the receivers who need to hear your health education information

  4. Using lots of different ways of getting your health messages across. This may include posters or radio programmes

  5. Assesses how your health education messages have been received

  • a.Media-mix

  • b.Appeals

  • c.Messages

  • d.Feedback

  • e.Channels

The correct answers are:
  • 1 = b
  • 2 = c
  • 3 = e
  • 4 = a
  • 5 = d

SAQ 8.2 (tests Learning Outcome 8.2)

In planning health education and promotion, which communication component should be considered first? Why?

Answer

The first step in planning any communication is to consider the intended audience and while you consider the audience you need to ask yourself who is the audience? Do we have a primary and a secondary audience? What information do they need to take action on our suggestions? A method which is effective with one audience may not succeed with another. Therefore, as the health communicator you always have to consider the educational factor, culture, age literacy and media habits of the receiver while designing the message.

SAQ 8.3  (tests Learning Outcome 8.2)

Which of the following statements is false? In each case explain why it is incorrect.

A  For a source to be credible in health education activities the source should come from a different background to the community where the message is delivered.

B  An effective health communicator should put himself or herself in the situation of the sender only.

C  The content of health education messages should be organised in a variety of ways.

D  A mass media channel is better than an interpersonal channel for delivering behaviour change messages.

Answer

A is false. For a source to be credible in health education activities the source should share characteristics such as age, sex, education and religion with the community where the message is delivered.

B is false. An effective health communicator puts himself or herself both in the situation of the sender and the receiver so that they can easily understand the communication from both sides.

C is true. The content of the message should be organised in different ways so that it can persuade or convince a range of people. Not everyone responds in the same way. What might persuade you might be quite different from what might persuade another person.

D is false. It is not a choice of either/or. A combination of the two works best. Mass media sets the stage and creates demand for services and interpersonal communication provides detail and interactivity.

SAQ 8.4 (tests Learning Outcome 8.3)

Which communication appeal is most appropriate for health education workers to use? Justify your reason.

Answer

There is no single most appropriate message in health education to use — the content of the message should be organised in different ways so that it can persuade or convince the greatest number of people. For example, the appeals that might convince people with little or no schooling are different from those appropriate for people with high levels of qualifications.

SAQ 8.5 (tests Learning Outcomes 8.2, 8.3 and 8.4)

Explain the difference between communication components and communication stages.

Answer

The components of communication are sender, receiver, message, channels and feedback. The stages of communication are how these components are used in specific activities of sending health messages.