Health Education, Advocacy and Community Mobilisation Module: 9. Methods and Approaches of Health Communication

Study Session 9  Methods and Approaches of Health Communication

Introduction

In this study session you will learn about some of the different methods of communication and how you can use them in your work within your community. Communication is often described in three different ways: intrapersonal, interpersonal and mass communication — and this study session will help you understand how each of these types of communication can be used to help people and improve their health.

Intrapersonal communication describes those methods of communication which take place within a single person — essentially it is the thoughts and ‘talking’ you do inside your head. Interpersonal communication is the type of communication that involves direct interaction between two or more people or within groups. In contrast, mass communication is a means of transmitting messages to a large number of people usually using electronic or print media.

During this study session you will also learn about other interesting forms of getting your message across. These will include verbal and non-verbal forms of communication. You will also learn how to use your non-verbal skills for effective communication during your health work. Finally, you will learn a variety of different approaches, barriers and characteristics of effective health communication in health education that will help you in your work.

Learning Outcomes for Study Session 9

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

9.1  Define and use correctly all of the key words printed in bold. (SAQ 9.1)

9.2  Discuss the most important methods of health communication. (SAQ 9.2)

9.3  Describe some of the forms of communication that are used in health education. (SAQs 9.3 and 9.4)

9.4  Describe and compare each type of communication approach. (SAQ 9.3)

9.5  Identify some of the most common barriers to effective communication. (SAQ 9.5)

9.6  Describe the characteristics of effective communication. (SAQ 9.6)

9.1  Methods of communication

9.1.1  Intrapersonal communication

Intrapersonal communication takes place within a single person. It is usually considered that there are three aspects of intrapersonal communication, self-awareness, perception and expectation. Self-awareness is the part of intrapersonal communication that determines how a person sees him or herself — and how they are oriented toward others. Self-awareness involves three factors: beliefs, values and attitudes. Perception is about creating an understanding of both oneself and one’s world — and being aware that one’s perceptions of the outside world are also rooted in beliefs, values and attitudes. Expectations are future-oriented messages dealing with long-term roles, sometimes called ‘life scripts’. Intrapersonal communication is used for clarifying ideas or analysing a situation and also reflecting on or appreciating something.

Self-awareness is a life skill that is practiced — and then applied to overcome the day-to-day challenges of life in a more positive and effective way. Self-awareness also affects one’s view of oneself in the context of either being HIV-infected or not being HIV-infected. To be effective a Health Extension Practitioner needs to know how they themselves function emotionally. Just like the people they see on a daily basis, Health Extension Practitioners must face their own inner feelings about HIV/AIDS.

9.1.2  Interpersonal communication

Interpersonal communication is the interaction between two or more people or groups. You will be using this form of communication all the time during your health work. This form of communication can be face-to-face, two-way, verbal or non-verbal interaction, and includes the sharing of information and feelings between individuals or groups.

Figure 9.1  Health workers get lots of opportunities to develop strong relationships using their interpersonal communication skills. (Photo UNICEF Ethiopia/Indrias Getachew)

The most important parts of personal communication are characterised by a strong feedback component, and it is always a two-way process. Interpersonal communication involves not only the words used, but also various elements of non-verbal communication. The purposes of interpersonal communication are to influence, help and discover — as well as to share and perhaps even play together.

The main benefits of interpersonal communication include the transfer of knowledge and assisting changes in attitudes and behaviour. It may also be used to teach new skills such as problem solving. The communication takes place in both directions from the source to the receiver and vice versa. There is a chance to raise questions and start a discussion so that the idea is understood by both parties. Since the communication is interactive there is a high chance of utilising more than two senses such as seeing, hearing and touching.

Adoption of a behaviour passes through several stages and interpersonal communication has importance at all of these stages. So if you want to help someone change their health behaviour you will certainly have to use interpersonal communication effectively. This is especially important when the topic is taboo or sensitive.

9.1.3  Mass communication

Mass communication is a means of transmitting messages to a large segment of a population. Electronic and print media are commonly used for this. The word ‘media’ is currently used to refer not only to broadcast media such as radio, the internet and television — but also to print media such as papers, magazines, leaflets and wall posters. Remember also the importance of local folk media such as local art, songs, plays, puppet shows and dance (Figure 9.2). The powerful advantage of mass media over face-to-face contact is the rapid spread of simple facts to a large population at a low cost. The main effects of mass communication are the increased knowledge or awareness of an issue, the potential influence on behaviours at the early stages and the possibility to communicate new ideas to early adopters (opinion leaders).

Figure 9.2  Sometimes getting children to make songs about a health message can help you get information to a wider audience. (Photo: Henk van Stokkom)

The other benefits of mass communication are accuracy and plausibility. Think of the influence of a newspaper article, giving the opinion of a highly respected person. However it also has limitations. These include the lack of feedback because the broadcaster transmits this message without knowing what is going on in the receiver’s mind. There is also the danger of selective perception because the audience may only grasp part of the message, or selectively pick up the points that they agree with and ignore others. Mass communication does not differentiate between targets and so some people may think. ‘This does not concern me’. It only provides non-specific information because it is broadcast to the whole population, and it is difficult to make the message fit the local needs of your community, whose problems and needs may be different from the rest of the country.

For an effective mass media communication, the message or advice should be realistic and pre-tested so that it is transmitted accurately without distortion. The message should be useful in creating awareness, and has to be followed by individual or group approaches to achieve positive behaviour change.

9.2  Forms of communication

There are usually considered to be three forms of communication; oral or verbal, written, and non-verbal. This section will consider each in turn and help you think about the ways that you use them during your health-related work.

9.2.1  Oral or verbal communication

This is communication by word of mouth. In oral communication, speech or talk is the widely adopted tool of communication. The message is received through our ears. It may also be achieved through the use of mechanical devices such as telephone, radio or even a public address system.

9.2.2  Written communication

This involves the exchange of facts, ideas and opinions through the use of written materials. Individuals or groups keep in touch with each other and share meaning and understanding with each other through written materials such as letters, notes, leaflets, reports, handouts, bulletins or newspapers.

9.2.3  Non-verbal communication

Non-verbal communication is the process of communicating through sending and receiving messages without words. Such messages can be communicated through gestures, body language or posture, facial expressions, and eye contact (Figure 9.3). Object communication such as clothing and hairstyle, as well as through a mixture of all of the above, is also very important.

Figure 9.3  In small groups there is always non-verbal as well as verbal communication to be observed. (Photo: AMREF/Sophie Zeegers)

Much communication takes place through non-verbal communication. But most of us think a great deal about choosing the words we say (verbal), when talking with another person and forget to think about our non-verbal communication. The fact is, the gestures we use, how we look at people, our tone of voice, how we are seated and our clothes can all have an impact on the way people interpret what we say.

Non-verbal communication includes body contact — touching, holding hands, greetings and shaking hands will all provide clues about the relationship between people. Also types of clothes worn, the distance between people, as well as posture, such as sitting up or leaning forward, are important to recognise. Orientation is also important; this is the angle at which people put themselves in relation to each other, for example, sitting side-by-side (Figure 9.4). More detailed observation will show the use of gestures such as hand movements, raising eyebrows or the shape of the mouth.

Figure 9.4  It is often possible to tell from non-verbal communication who in your audience is ready to learn. (Photo: Henk van Stokkom)

In face-to-face communication you have to be sensitive to the impact that your non-verbal communication might be having, because it can be interpreted in different ways according to the culture of the community. For example, in Western culture much importance is given to making eye contact, whereas in other cultures looking at someone’s eyes can be considered rude and show lack of respect. In many cultures the non-verbal communication that takes place between important people (leaders) and others has very specific forms, and it can be impolite to use your body in certain ways if you are with someone important. Box 9.1 summarises some key points about non-verbal communication.

9.3  Approaches to health communication

It is important to remember that people respond to messages differently and that what might persuade one person may not appeal to another. Generally there are four approaches to health communication.

Informative communication provides information about a new idea and makes it familiar to people. Mass media of this type is mostly used for wide coverage and reaching a large audience. Print materials and interpersonal communication are used to reinforce mass media messages and inform people in more detail and in ways that are more tailored to them as individuals.

Educative communication is where a new idea on health behaviour is explained, including its strengths and weaknesses. This approach is used when people are already aware of an issue, but need more information or clarification. In this context, interpersonal communication with individuals or small groups is probably the most appropriate way to provide more detailed information and can be reinforced by print materials such as books, pamphlets and other multimedia approaches.

In contrast persuasive communication is usually in the form of a message that promotes a positive change in behaviour and attitudes, and which encourages that audience to accept the new idea. This approach to message development involves finding out what most appeals to a particular audience. Persuasive approaches are more effective than coercive approaches in achieving behaviour change (Figure 9.5).

Figure 9.5  When health communication is persuasive it can lead to really effective health improvements. (Photo: FMOH/WT)

In prompting communication messages are designed so that they are not easily ignored or forgotten they can be used to remind the audience about something that reinforces earlier messages. Using the entertaining method draws the attention of the audience by using messages which entertain, for example, posters, songs, puppets or film.

Box 9.2 summarises the main characteristics of effective communication.

9.4  Barriers to effective communication

Figure 9.6  Stop interrupting me — I’m trying to learn. (Photo: Carrie Teicher)

A breakdown can occur at any point in the communication process. Barriers (obstacles) can inhibit communication, resulting in misunderstanding or distortion of the message (Figure 9.6). This can lead to conflicts of views and the inability to make effective decisions. Barriers can also prevent the achievement of the project or programme goals.

Generally communication barriers can be categorised as follows:

• Physical barriers include difficulties in hearing and seeing.
• Intellectual barriers may occur because of the natural ability, home background or schooling that affects the perception and understanding of the receiver.
• Emotional barriers include the readiness, willingness or eagerness of the receiver — and the emotional status of the educator.
• Environmental barriers might occur if there is too much noise or if the room is too congested.
• Cultural barriers include those customs, beliefs or religious attitudes that may cause problems. Economic and social class differences and language variation, as well as age differences, may also be difficult to overcome. Either too high or too low status of the educator (sender) compared to the audience may affect communication.

Remember that you cannot necessarily avoid or overcome all these barriers, but should try to find ways of minimising them.

To overcome communication barriers:

• The sender must know their audience’s background and be able to adjust their message (Figure 9.7).
• The messages the sender communicates must be timely, meaningful and relevant to the recipients and applicable to their situation.

Figure 9.7  In a group session you are never sure whether people will be receptive to your health messages — or whether they may present barriers. (Photo: AMREF/Thomas Somanu)

Even if all the barriers have been removed, communication could still be a failure without good presentation. Good presentation requires a firm understanding of the subject and establishing a positive relationship with the audience as well as choosing the right channels or media.

Summary of Study Session 9

In Study Session 9 you have learned that:

1. Even though there are a number of communication types, a well planned health programme will involve a carefully chosen mix of approaches to bring about sustainable behaviour change.
2. Intrapersonal communication involves methods of communication which take place within a single person, whereas interpersonal communication is interaction between two or more people or groups.
3. Mass communication is a means of transmitting messages in electronic or print media to a large segment of a population. It is a cost-effective communication method to influence behaviour at early stage.
4. There are three forms of communication: verbal, non-verbal, and written communication.
5. Generally, there are four approaches to health communication: informative, educating, persuasive and prompting.
6. A breakdown can occur at any point in the communication process and barriers can inhibit communication, resulting in misunderstanding and distortion of the message.

Self-Assessment Questions (SAQs) for Study Session 9

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.