20 Communi c tion 0

Heat
"The only thing m
---------- ---~~~~~ rr: ore expensive
-
than . 1
______-___:e:d~u'.::c~a~t~,o~n'._:is~ig~n~o~r~a~n~c~e~"- - - - - - - - -_J
C ommunication can be rega d d
. h . r e as a t
of exc h angmg or s aping ideas fe 1· Wo -way Proces
·t f "t th e countless w e ings and in
' · formatio s
Broa di y I re ers o n. THE COMMUNI CATI ON PROCESS
· t h ·th ays that h umans have of
keeping m ouc w1 one another" (1) . . of human interaction is
· h e basis
a c Communicatio
I n w h.1c h 1st
Communication is more th . omp ex process. It has the following main components
. . a process nece
It 1s an mere exc h ange of (F1g. 1) :
information. . ssary to
desire d c h anges m human beh . pave way for 1. sender (source )
individual and community par:v_iou~, and informed 2 . receiver
. d I C ic1pahon. t 0 ac h ieve (audience)
predetermme goa s. ommunicatio h 3 . message
developed into an interdisciplinary ~ . as, in rec~nt years, (content)
from social sciences. With the decie1nce drawing richly 4. channel(s) (medium)
• . ve opment of 5. feedback
metho d s o f commumcahon and inform r10 newer (effect)
mental development of the huma a ~ explosion, the
1 . Sender
considerably for clearer thinking better~~ . la~ expanded
. t· ' cia inter-sectoral The sender (communicator) is the originator of the
coord ma 10n .
message . To be an effective communicator, he must know :
Communication and. education are · t erwoven
in
. . - his objectives, clearly defined
Commumcat10n strategies can enhance Jearnin . Th ·
ultimate goal of all communication is to bring agbout ! - his audience : it's interests and needs
- his message
change in the desired direction of the person who receives
the communication. This may be at the cognitive level in - channels of communication
terms of increase in knowledge ; it may be affective in terms - his professional abilities and lim itation s
of changing existing patterns of behaviour and attitudes; The impact of the message will depend on his own social
and it may be psychomotor in terms of acquiring new status (authority) , knowledge and prestige in the communi ty.
skills. These are referred to as learning objectives (2).
Communication is part of our normal relationship with 2 . Receiver
other people . Our ability to influence others depends on our All communications must have an audience. this may be
communication skills, e .g ., speaking, writing, listening, a single person or a group of people . Without the aud ience .
reading and reasoning. These skills are much needed in communication is nothing more than mere noise. It is th is
health education. The developing countries are now element of audience and their frame o f mind {e .g .. opinions .
beginning to exploit the current "communication revolu~i?n" attitudes, prejudices) which lends meaning to all th e
to put today ' s health information at the ~isposal of _famihed different types of communication .
to help people to achieve health by their own a~ho~~ an The audience may be of two types : the controlled and
efforts . It is said that without communication an individual the uncontrolled . A controlled audien ce is one whi ch is he ld
could never become a human being, without mass together by a common interest. It is a homoge neo us group .
. . , he could never b ecome a part of modern An uncontrolled or '·free" audience is o ne? wh1 --: h has
commun1cat1on
society (3) .
Aware ness

Receiver L..;::::=__----
Interest
Channel
Sender Message }L- - -••L______. Evaluation
Adoption (behaviour change)

Feedback
FIG - 1

J
ication process
Commu n
 92
B
;:~: : - = ~C~O~M~M~U~N~l~C~AION
~FOR
T~HEALTH
~ ~EDUCATI
~~~ ON
5Q~~~~-----------------
~
gathered togeth f
a ct·
u ience poses er a chromII
m r
o ives of curiosity. This type of c. Folk media
T he more homog a enge to the ability of the educator
cha nces Every community has its own network of t . .
of an effeeneous
r the auct· . the
ience 1s, greater are the·
c ive communicati on . folk media such as folk dances , singing, drama/~ 1hona1
3 . Message Uttar Pradesh , Burrakatha in Andhra Pradesh a ' d autariki cir
in Western India besides informal group gathe/ Harikat~n
· . Th
A message is the - f . religious meetings ese are ·important Ingsch ' caste 'IQ()
which the comm i_n ormation (or "technical know-how") communication close to the cultural values t°nnels ()rf
. ,
receive understandun1cator transm I·ts to h.1s audience
.
to population . They have been the principal in~ru:e rural
form of words pictu' accep! and act upon . It may be in the preserving the cultural heritage . Health messa
fail in many c~ses /~s or signs . ~ealth communication may ents ()f
communicated through these traditional media. ges may be
A ' 1 s message 1s not adequate.
good message must be . Every channel of communicati on has its adv
limitations. For instance , knowledge of surgerintages and
- in line with the objective (s) effectively transmitted by verbal com ca~not be
meaningful demonstrations are needed . The proper selectio munication
. f
- based on felt needs channels results m success u I communicarn1 and use ()f,
-
-
clear and understanda ble
specific and accurate
effective communication is seldom achieved thro
of one method alone, an attempt should beg he Use
i~ t Since

- timely and adequate combine a variety of methods to accomplish the ed mact_e t()
purpose . Health education uses a variety of meth ducattona\
fitting the audience .
- interesting people un d erstan d t h eir own s1·t uations
. o s to h I
and choose a . ell
that will improve their health . Chons
- culturally and socially appropriate
5 . Feedbac k
at Transm_itting _the right message to the right people
th It is the flow of information from the audien
e nght time is a crucial factor in successful
communica tion . sender. It is the reaction of the audience to the m~e to the
the message is not clear or otherwise not accept s~~ge _If
4 · C hann e ls of commun ic ation audience may reject it outright. The feedback thus a e _the
.
an opportunity to t h e sen d er to modify
.
his messprovide s
By channel is implied the "physical bridges" or the media render it acceptable. In interpersona l communicaat~e and
of communica tion between the sender and the receiver.
fee db ac k ·is 1mme
· d 1a
' te . In mass communicati
on -ion the
1t k
Media systems some time to get feedback . Feedback is generally o~t ~ es
through opinion polls, attitude surveys and interview t;ned
The total communica tion effort is based on three media rectify transmission errors . s. can
systems :
a . Interperson al communicat ion TYPES OF COMMUNICATION
b . Mass media
c . Traditional or folk media 1. One-way communic ation (Didactic Method)
The ~low of commu~icat ion is "one-way" from the
a. Interperso nal communica tion
communicat or to the audience . The familiar example is th
The most common channel of communicat ion is the lecture method in class rooms. The drawbacks of the
interperson al or face-to-face communicat ion . Being didactic method are : e
personal and direct it is more persuasive and effective than - knowledge is imposed
any other form of communica tion . Interpersona l
- learning is authoritative
communica tion is particularly important in influencing the
decisions of the undecided persons. The superiority of - little audience participation
interperson al communica tion over mass media for creation - no feedback
of motivationa l effect has been well documented (4) . - does not influence human behaviour
When the message relayed uia mass media gets diffused
in the community, it is picked up by the interpersona l and 2 . Two-way communi cati on (Socratic method)
informal networks . The message is then subject to debate The Socratic method is a two-way method o!
and discussion by interperson al communica tions. On the communica tion in which both the communicat or and the
basis of this scrutiny a consensus is gradually built up in the audience take part. The audience may raise questions, and
community whether to accept or reject the message (5). add their own information ideas and opinions to the
subject. The process of learning is active and "democratic''.
b. Mass media It is more likely to influence behaviour than one-way
In mass communica tion , the channel is one or more of communica tion .
the following "mass media ", viz TV, radio, printed media,
etc . Mass media have the advantage of reaching a relatively 3. Verbal c ommunic ation
larger population in a shorter time than is possible with The traditional way of communica tion has been by wor~
other means. Being one-way channels of communica tion, of mouth . The advent of written and printed matter ~re~
mass media carry messages only from the centre to the comparative ly recent origin . Direct verbal communi~atto~t rs
periphery ; feedback mechanism s are poorly organized. word of mouth may be loaded with hidden meanings. ot
Being impersonal media , they are usually not effective in persuasive. Non-direct or written communicat ion may n
c hanging established modes of behaviour. be as persuasive as the spoken word .
 H EA LT H COMM U N ICAT IO i' I
rbal com mun icati on
f1Jon ·ve Func tions of healt h comm unic ation
I
4. unica tion can occur even witho ut wordts . t Healt h comm unica tion has to cate r to
the follow ing
Cof11n1 whole range of bodil y move ments ures
. ( . , pas needs :
des a , raised eye b '
·r,clll facial expre ssion s te .g) ., smile
s ·1 rows 1. Inform ation 5 . Coun sell in g
1ureS, . g . • ence is non-v erbai
I
ges starin g, gazm e c .
. 2 . Educa tion 6 . Rais ing m o ral s
frowr \nicat ion . It can speak loude r than words
orrifll 3 . Motiv ation 7. Heal th devel opm en t
c .,,..a) and infor mal com mun icati on 4 . Persu asion 8 . Organ iza ti on
5 for••·
· ...... unica tion has been classi fied into forma 1
Cof11•" f th •t )
and inform al (grape -vine) 1. Infor mati on
11ows lin~s o au on y tion is to
(fOrrif11unicatton ._ Inform al ~etwo rk (e.g ., gossip circles ) exists The prima ry functi on of health comm unica e abo ut
may be more know ledge or inform ation to peopl
co all organ izatio ns . The mform al chann els provi de scient ific
prom ote health .
. if the forma l chann els do not cater to the informa ton
,n,uve,
t· health probl ems and how to maint a in and
inform ation althou gh they hav e a
3 Peopl e rarely seek such
se .
11
eeds. right to know the facts about health and disea
sible to the peopl e .
Visu al com mun icati on Inform ation s hould be easily acces
6- the right kind of health inform ation can
: charts and Expos ure to
The visual forms of comm unica tion comp rise rs of
graphs , pictog rams, tables , maps , poste rs etc. elimin ate social and psych ologic al barrie
prejud ice and misco ncept ions peopl e may
ignor ance,
mun icati on and inter net have about health matte rs ;
7 . Tele com that t he y
Telec ommu nicati on is the proce ss of comm
unica ting over increa se aware ness of the peopl e to the point
desig ned for the are able to perce ive their health needs ; and
distan ce using electr omag netic instru ments felt need s
purpo se .. ~adio , !V a _n d intern et
etc. are mass influe nce peopl e to the exten t that un
dema nds .
cornrn u01ca t1on med1 ~ , w _h1le teleph one is
know n as point - becom e felt needs , and felt needs becom e
:11ca hon system s . The point- to-po int ders have an
to-poi nt teleco mmui
unica tion . With the The gover nmen t, the media and health provi
to mterp erson al comm ide factu al and
system s are close r
of electr onic impor tant social respo nsibil ity to prov
launch ing of satell ites, a big explo sion ation to the
over the world . balan ced health and health relate d inform which t hey
comm unica tion has taken place all en their intere st on the basis of
peopl e and awak
ption that the
can make inform ed decisi ons. But , the assum
chang e in an
BARR IERS OF COM MUN ICAT ION acqui sition of inform ation will mean a
fallac ious . Most
indivi dual ' s behav iour and attitu des is
comm unica tion impor tant decis ions regar ding their healt h onl y
Healt h educa tion may often fail due to peopl e make
ps over a perio d of time and a fter
tor and the comm unity - these after much thoug ht, perha
barrie rs betwe en the educa s , bel iefs and
serval educa tional conta cts . The cultur al value
be: tance of healt h
may norm s of the peopl e influe nce their accep
1. Phys iologi cal diffic ulties in hearin g , expre ssion . inform ation . Corre ct inform ation is a basic
part o f healt h

2 . Psych ologic al emoti onal distur bance s , neuro sis , educa tion .
levels of intelli gence , langu age or
comp rehen sion difficu lties . 2. Educ ation
ral part of a
noise , invisi bility, conge stion . Educa tion of the gener al publi c is an integ
3 . Envir onme ntal ntion orien ted appro ach to healt h and d iseas e
preve
4 . Cultu ral illiter acy, levels of know ledge and probl ems ; and, the basis of all educa tion
is comm un icatio n .
under stand ing, custo ms, belief s, Educa tion can help to incre ase know ledge . It is o ft en
religi on , attitu des, econo mic and assum ed that know ledge deter mine s attitu
des and attitu d es
social class differ ences , langu age determ ine behav iour (7) .
variat ions, cultur al difficu lties es in li fe sty le s
betwe en foreig ners and nation als , Healt h educa tion can br ing abou t chang
of d isease . Most of the world ' s majo r h ea lt h
betwe en urban educa tion and the and r isk factor s
death s are preve nta ble t hr o u g h
probl ems and prem ature
rural popul ation . (8) . But e du ca tio n
chang es in huma n behav iour at low cost
availa ble, the he a lth . Th e targe t
Even w h e n health servic es are readil y alone is insuff ic ient to achi eve optim um
s probl ems to to prove n p reve n tive m e as u r12 s
social and c ultu ral barrie rs can prese nt seriou popul ation must hav e a c ce ss
ieve m en t of health behav iour chang e. These barrie rs or proce dures .
the ach
shoul d b e id e n ti fied and remo ved .
3. Moti vatio n
w it h in to a ct.
It is th e powe r that dri v e s a p e rson fro n,
H EALT H COM MUN ICAT ION co m m u n ic ati o n is to m o tivate
One of th e goals of h ea lth
tio n int o perso n a l
one . Healt h indiv iduals to tran s la te h ea lth in form a
Healt h is the conce rn of e ve ryone for every behav iour and lifes ty le fo r th eir own
h e a lt h. Motiv at io n
ore an impor tant area of
comm unica tion is theref o f in teres t , e va lu a ti on and d e c is ion
tion" is ofte n includ e s th e s ta g es
comm unica tion . The term " health comm unica makin g . He a lth co mmu nica tio n assis ts
th e ind iv idual in
, which itself
used synon ymou sly with health educa tion pass ing from th e s ta te o f aw a re n ess a nd
inte rest to th e final
and down ward " comm unic~ tion of of th e n e w idea or
sugge sts "outw ard s ta g e of d ec is io n m a king and a dopti on
is the found ation of a
know ledge (6) . Healt h educa tion prog ramm e . Mot ivatio n may n ot be long- lastin g ; it may
preve ntive health care system . ,i

r: u @ ~
 8_9_ _____:C::...:O~;>..:.:_t~l--l..'U.:'.~N~'IC:::.'.,~\T'.'_1~0:::N~F:SO~R~l~--!E~"A~L::!T~H~E~-D~U~C~/\~1~·102:N~ -- - -- -- -- - -- - - -- --

diminish with I f . 8 . Health organizati o n

involve apse O _time . The best channels of success
ha programmes directed at individuals who already
. patients with chronic illness
rion , in
or ve some
a d. bTstrong mo fiva_
I
'ldb _isa ity, those facing acute crisis such as surgery or
h 1 1rth ·. This s ugges ts t hat probably the quickest pay off
cwill
come 111 th e area of patient education .
4 . Pe rs uasi o n
Persuas_ion is the art of winning friends and influencing
people . It _is an art that does not employ force or deliberate
manipulation . The sole purpose of communication is to
.influence
. . · Persuas·ion 1s .
· "a conscious attempt by one
ind1v1dual
d .to chan · fl
ge or in uence the general beliefs .
un erstanding , values and behaviour of another individuai
or group_ of . individuals in some desired way". Persuasive
communication is more effective than coercion or
authontat1ve .comm unica . can change hfe
· t·10n. persuas1on . HEALTH EDUCATION
style and modify the risk factors of disease .
When pers~asive communication is deliberately
employe~, to manipulate feelings , attitudes and beliefs, it
becomes propaganda" or "brain washing" (1) .
5 . Counse lling
Counselling is a process that can help people understand
better and deal with the ir problems and communicate better
~ith those with whom they are emotionally involved . It can
improve and reinforce motivation to change behaviour. It
can provide support at times of crisis . It helps them face up
to their problems and to reduce or solve them.
Counselling is different from advising . It implies choice ,
not force. Advising amounts to directing people and
cautioning them to some do's and dont's .
In different circumstances different people can undertake
counselling. A counsellor should be able :
- to communicate information
- to gain the trust of the people
- to listen sympathetically to people who are anxious,
distressed and possibly hostile .
- to understand other person's feelings and to respond
to them in such a way that the other person can feel
free to express his feelings
- to help people reduce or resolve their problems.
Thus counselling relies heavily on communication and
relationship skills . Counselling is an important part of
treatment, disease prevention and health promotion . It helps
people to avoid illness and to improve their lives through
their own efforts (9) . Counselling develops positive attitudes.
It is an in tegral part of all health care programmes .
6. Ra isi ng mora le
Mora le is "the capacity of a group of people (or team) to
pull together persistently or consistently. Communication -
vertical and horizontal , internal and external is the first step
in any attempt to raise morale of the health team or a group
of people .
7 . Hea lth de ve lop ment
Communication can pla y a powerful role in health
development by helping to diffu se knowledge in respect of
the goals of development and preparing the people for th e
roles expected of them . But its own role is essentially,
supportive (5) . Judicial use of communication media can
contribute to health development (10) .
Communication is the life and blood of an
. d. r . h organiz
There are two _mat!or fl trecT1ohns in w ic~ cornrnunicaatt_ion.
within an organiza 10n ow. ese are vertical and h . ions
communications . Vertical communication can bed or12onta1
or upward . Horizontal or cross communication 1 ~Wnward
usually between equals at any level. The ~ es Place
communication extends from top administrat ownward
through the hierarchy of professionals and non-prof r _do\1/n
to the beneficiaries or employees . The direction essionals
communication flows in an organization suggests it
thich
of freedom in the internal communication network /1). egree
Communication is an important dimension of h
organization . It is an important means of intra _ and . ealth
sectoral coordination . inter-
Health education is a term commonly used and ref
to by health professionals . erred
Definitions
Health education is indispensable in achieving individ 1
and community health . It can help to increase knowlet
and to reinforce desired behaviour patterns. But there is ge
sin~I~ ~ccept~ble definition of health education. A variety:~
definitions ~x_1st. Conc~pts ~f health education as a process
or an activity for inducing behavioural changes ar
e
emphasized in the following definitions :
1. Health education is the translation of what is known
about health , into desirable individual and communiiy
behaviour patterns by means of an educational
process (11).
2. The definition adopted by John M Last is "The process
by which individuals and groups of people learn to
behave in a manner conducive to the promotion,
maintenance or restoration of health " (12) .
3. Any combination of learning opportunities and teaching
activities designed to facilitate voluntary adaptations of
behaviour that are conducive to health (13).
4. The definition adopted by the National Conference on
Preventive Medicine in USA is "Health education is a
process that informs, motivates and helps people to
adopt and maintain healthy practices and lifestyles.
advocates environmental changes as needed to facili tate
this goal and conducts professional training and research
to the same end" (14) .
5. Health education is the part of health care that is
concerned with promoting healthy behaviour /9).
Alma-Ata Declaration
The Declaration of Alma-Ata (1978) by emphasizing '
th
need for "individual and community participation" gave ~
new meaning and direction to the practice of healt.10
education. The dynamic definition of health education
now as follows :
" ant to bt'
a process aimed at encouraging peo p1e to w, theV
healthy, to know how to stay hea lthy. to _do w~~ ~nd
ca n individually and collectively to maintain hea r ·'
to seek help when needed" (6) . h
t . ized t e
T he Alma-Ala Declaration has revo u ion I
concepts and aims of health education :
hasizes on
The modern concept of health education emP
health behaviour and related actions of people.
' h educ atio n and beha v·iour HE.AL.TH EDUCATION 95
•
Hea It
Th~ behaviours to be adopted or mod · . Role of h ea tt h care prov iders
that of
. ividuals, gro~ps _(su~h as families if1ed may be It is clear that d . . alone
,nd nizati ons or msht uhon s) or enr ' health professional
s, is not s ff . e ucahon 1s necessary. but educatio nrole of
orga . . ire comm unit health u icient to achieve optimum health. The
Y-
St rategi
es desig ned
·11
to influ
ence the behaviour of care providers in this regard comprise to (6 ):
. dividuals or groups w1 vary great! d the a. r;ovi?e opportunities for people to learn how
to
'\cific dise~se (or health probler:) epending upon entify and analyze health and health rela ted
conce rned and its
s~stribution m the population a prob~e_ms, and how to set their own targets and
. as upon the
~~aracteristics and _acceptability ~f well pnont1es ;
venting or controlling that disea se (or availa ble methods
pre health b
. b. make health and health related information easily
Health education can help to .increase kn Ipro lem) accessible to the community;
. d b h ow edge and to
reinforce desire e aviour patterns. c. indicate to the people alternative solutions for solvin
g
ation is necess ary, but edu t· ~he health and health -relat ed problems they have
It is clear that educ
· t to ac h'ieve optimum health . The ca ion alone is identified; and
insuffic1en
n preve ntive target population
rnust have access to
.
prove
measures or procedures . d. people must have access to proven preventive
measures.
changm g conc epts
Hist?ric~lly . health education has b
comm
.
itted to APPROACH TO HEALTH EDUCATION
dissemmatmg informatio n and cha . e:n
:
Following the Alma -Ata Decla rationgnJ uma_n behav iour. There are 4 well-known approaches to health education
emphasis has shifted from (6) : n a opted m 1978 , the
on)
1. Regu lator y appr oach (Man aged prev enti
Prevention of disease t0 promotion of healthy be
lifestyles; Regulation in the context of health education may
n , direc t or indire ct.
. defined as any governmental interventio
the modification of individ iour to designed to alter human behaviour. Regulations
may be
modification of " • 1 . ual nt"behav a varie ty of admi nistra tive
. d' 'd 11· soc1a environme in which the promulgated by the State by
m 1v1 ua 1ves ; take many forms rangi ng from
agencies. Regulations may
community participation to community prohibition to imprisonment.
veme nt; and ge in
invol The coercive or regulatory approach seeks chan
promotion of individual and community "self- throu gh a
health behaviour and improvement in health
on peop le , as for
reliance ". variety of external control or laws placed
Act in India and the
example, The Child Marriage Restraint
Aims and obj e ctiv es The
use of compulsory seat belts in the western countries.
the be simp lest and quick est
The definition adopted by WHO in 1969 (15) and legislative approach may seem to
desir ed chan ges
a usefu l bring abou t
Alma-Ata Declaration adopted in 1978 provide way to improve health or
of laws .
basis for formulating the aims and objectives
of health in society, but there are also important failures
education , which may be stated as below : e.g. , prohibition of alcohol.
are
1. to encourage people to adopt and sustain
health The reasons for the failure of the coercive approach
disea se
promoting lifestyle and practices; not far to seek; in the first place , the cause of
ation . at
2. to promote the proper use of health services availa
ble to (medical or social) cannot be eradicated by legisl
a perso n
the most the government can make laws to prevent
them ; example
improve spreading disease in his community , as for
3. to arouse interest, provide new knowledge , vaccination in an emergenc y. Secondly in areas
invol vi ng
al decis ions
skills and change attitudes in making ration ing ) no
personal choice (e .g., diet, exercise , smok
to solve their own problems; and government can pass legislation to force people
to eat a
e and
4. to stimulate individual and community self-relianc balanced diet or not to smoke . It amoun ts to takin
g awa~·
health developme nt throu gh
participation to achieve some of the rights of the individual. The
disastrous
involveme nt at every step
individual and community sterilization campaign of 1976 in India whic h led to the
from identifying problems to solving them. Congress defeat in the 1977 electi ons is a case in poin t. Th e
to be a law unles s the
The educational objectives are aimed at the group lesson learnt is that it is diffic ult to enfor ce
e. The objec tives flow r of it and if it does not
taught in the educational programm majority of people are in favou
disco vered . They idual .
from the health needs which have been interfere with the rights of the indiv
terms of
should be carefully unambiguously defined in However, laws may be use ful in ti mes of emerge ncy
or in
be acqui red or
knowledge to be acquired , behaviour to limited situations such as control of an epide mic disea se or
pertin ent if the
actions to be mastered . They must be management of fairs and festivals. Eve n in cases wher e it is
programme is to be appropriate and successful. the duty of the gove rnme nt to make laws to preve nt the
on ce laws
The focus of health education is on people and spread of disea se (e. g., AIDS) it is difficul t to enfor
nts in the cons idera ble
action (15). Its goal is to make realistic improveme without a vast administra tive infrastructure and
ammes be ready to
basic quality of life. Many health education progr expenditure. To a degre e, the people must
des_ . Th_e coun ter to
hope, in some way, to influence behaviour or attitu accept a law. In short , the coercive approach runs
ation 1s healt h
implication of these new concepts is that health educ the basic tenet of health education , that is,
in
Th: fact In specific
an integral part of the national health goals . e_duc~tion , w~ do_not force people to change .
tive health educ ation has the poten tial for can be used to reinfo rce the pressure
remains that effec situations , leg1slahon
discovery
saving many more fives than has any one research to change collective beha viour .
in the foreseeable future .
 8~9~4L_ _ __sC:SO~fv~lfv:!!
1U~N~l~C~A!Tl~O~NJ_!l~:o~R
~ H~l: .~
AL~T:.!:l-!__!
I E~: D?_!U~C~1~
\ T~I02!N~- - - - - - - - - ~~ ~~---------- ---------

diminish with lapse of time . The best channels of success 8. He alth organi zati o~
involve programmes directed at individuals who already . tion is the life and blood of an organizat·
C ommun1ca . . h. h ion
have some strong motivation . in patients with chronic illness major directions m w 1c communicar •
There are two . ation flow. These are vertical and hori ns 10
or a disability. those facing acute crisis such as surgery or
childbirth. This suggests that probably the quickest pay off within an_or~amz Vertical communication can be dow~oni.11
mumcations . . . Ward
will come in the area of patient education . com d Horizontal or cross communication takes pl
or upwar . equals at any level. The down ace
lly between d . . Ward
4 . Pe rs uasi o n usua . t· extends from top a mm1strator do
ommumca ion f . I d I.Vn
Persuasion is the art of winning friends and influencing c h the hierarchy of pro ess1ona s an ~on-?rofessionals
people . It is an art that does not employ force or deliberate throug t· . ·es or employees . The direction in wh· h
t0 the bene 1c1an . . 1c
manipulation . The sole purpose of communication is to . f flows in an orgamzahon suggests the degr
commun1ca_ iotnh internal communication network (1) . ee
influence . Persuasion is "a conscious attempt by one of freedom m e . .
individual to change or influence the general beliefs, . t·on is an important d1mens1on of health
Commumca 1 . f· t
understanding, values and behaviour of another individual . .
orgamzat1on. It 1•s an important means o m ra - and ·inter-
or group of individuals in some desired way" . Persuasive
sectoral coordination .
communication is more effective than coercion or
authoritative communication. Persuasion can change life HEALTH EDUCATION
style and modify the risk factors of disease .
When persuasive communication is deliberately Health education is a term commonly used and referred
employed to manipulate feelings , attitudes and beliefs, it to by health professionals.
becomes "propaganda" or "brain washing " (1) .
De finitions
5 . Counselling Health education is indispensable in ~chieving individual
Counselling is a process that can help people understand an d commum·ty health · It can . help to increase
B knowledge
.
• f rce desired behaviour patterns. ut there 1s no
better and deal with their problems and communicate better an d to rem o d · A •
.
with those with whom they are emotionally involved. It can smg 1e accep table definition of health e ucahon. variety of
h d r
improve and reinforce motivation to change behaviour. It definitions exist. Concepts of hea It e _uca 10n as a process
can provide support at times of crisis. It helps them face up or an ac t1·v·ity for inducing ... behavioural changes are
to their problems and to reduce or solve them . emphasized in the following defm1tions :

Counselling is different from advising. It implies choice,
not force. Advising amounts to directing people and
cautioning them to some do's and dont's .
In different circumstances different people can undertake
counselling. A counsellor should be able:
- to communicate information
- to gain the trust of the people
- to listen sympathetically to people who are anxious,
distressed and possibly hostile .
- to understand other person's feelings and to respond
to them in such a way that the other person can feel
free to express his feelings
- to help people reduce or resolve their problems.
Thus counselling relies heavily on communication and
relationship skills . Counselling is an import~nt part of
treatment disease prevention and health promotion. It helps
people to' avoid illness and to improve their _l!ves t~rough
their own efforts (9). Counselling develops pos1t1ve attitudes .
It is an integral part of all health care programmes .
6 . Raising moral e
Morale is "the capacity of a group of people (or team) to
pull together persistently or consistently. Co~muni~ation -
vertical and horizontal , internal and external 1s the first step
in any attempt to raise morale of the health team or a group
of people.
7. He alth deve lopment
Communication can play a powerful role in health
development by helping to diffuse knowledge in respect of
the goals of development and preparing the people for the
roles expected of them . But its own ~ole . 1s esse~tially,
supportive /5) . Judicial use of commumcat1on media can
contribute to health development (10).
l. Health education is the translda~i~dn o f whdat is known
about health , into desirable in 1v1 ua 1 an community
behaviour patterns by means of an educational
process (11) .
2. The definition adopted by John M Lafst is "The process
by which individuals and gro~ps o people !ear~ to
behave in a manner conducive to the promotion ,
maintenance or restoration of health" (12) .
3. Any combination of learning opportunities and teaching
activities designed to facilitate voluntary adaptations of
behaviour that are conducive to health (13) .
4 . The definition adopted by the National Conference on
Preventive Medicine in USA is "Health education is a
process that informs, motivates and helps people to
adopt and maintain healthy practices and lifestyles ,
advocates environmental changes as needed to facilitate
this goal and conducts professional training and research
to the same end" (14) .
5. Health education is the part of health care that is
concerned with promoting healthy behaviour /9).
Alma-Ata Declaration
The Declaration of Alma-Ata (1978) by emphasizing the
need for "individual and community participation" gave a
new meaning and direction to the practice of healt_h
education. The dynamic definition of health education 15
now as follows :
"a process aimed at encouraging people to want to be
healthy, to know how to stay healthy. to do what the~
can individually and collectively to maintain health. an
to seek help when needed " /6) .
The Alma -Ala Declaration has revolutionized th e
concepts and aims of health education :
The modern concept of health education emphasizes 00
health behaviour and related actions of people .

ucation and behaviour
1th ed ..
~ea . haviours to be adopted or mod1f1ed may be th t f
i:ls,
'fhe groups _(su~h as families, health professio~a~
.,div1d . ns or inst1tuttons) or entire community .
i" ·za1io
organ~tegies designed . to influence the behaviour of
St~duals or groups will vary greatly depending upon the
ind1V. disease (or health problem) concerned and -1
c hc h t· 1s
sPe 1. tion in t e popu Ia ton as well as upon th
distrtbUteristics and acceptability of available meth de
o s
charac ting or contro 11·mg th at d'tsease (or health problem) .
reven
P Health education ca~ help to increase knowledge and to
. f ce desired behaviour patterns.
rein or . .
It is clear that e?ucation ts necessary, but education a/one is
. fficient to achieve optimum health. The target population
must have access to proven preven t·tve measures or procedures.
insu
Changing concepts
Historically health education has been committed to
disseminating information and ch_anging human behaviour.
following the A_lma-Ata Declaration adopted in 1978, the
emphasis has shifted from (6) :
Prevention of disease to promotion of healthy
lifestyles;
the modification of individual behaviour to
modification of "social environment" in which the
individual lives ;
community participation to community
involvement; and
promotion of individual and community "self-
reliance".
Aims and objectives
The definition adopted by WHO in 1969 /15) and the
Alrna-Ata Declaration adopted in 1978 provide a useful
1, basis for formulating the aims and objectives of health
education , which may be stated as below :
1. to encourage people to adopt and sustain health
promoting lifestyle and practices;
2. to promote the proper use of health services available to
)fl
them;
a 3. to arouse interest, provide new knowledge, improve
lo skills and change attitudes in making rational decisions
~s,
to solve their own problems; and
1te
4. to stimulate individual and community self-reliance and
ch
participation to achieve health development through
individual and community involvement at every step
from identifying problems to solving them .
The educational objectives are aimed at the group to be
taught in the educational programme . The objectives flow
the from the health needs which have been discovered . They
ea should be carefully unambiguously defined in terms of
knowledge to be acquired , behaviour to be acquired or
altn
actions to be mastered . They must be pertinent if the
n is
Programme is to be appropriate and successful.
The focus of health education is on people and on
i be
action (15) . Its goal is to make realistic improvements in the
the! basic quality of life . Many health education programmes
and
hope, in some way, to influence behaviour or attitudes. The
implication of these new concepts is that health education is
the an integral part of the national health goals . The
remains that effective health education has the potential for
saving many more lives than has any one research discovery
in the foreseeable future .
a
HEALTH EDUCATION 895
Role of health care providers
'
. It is clear that education is necessary, but education alone
is not sufficient to achieve optimum health. The role of
health care providers in this regard comprise to (6) :
a. provide opportunities for people to learn how . to
identify and analyze health and health relate~
problems, and how to set their own targets ano
priorities ;
b. make health and health related information easily
accessible to the community;
c. indicate to the people alternative solutions for solving
the health and health-related problems they have
identified; and
d. people must have access to proven preventive
measures.
APPROACH TO HEALTH EDUCATION
There are 4 well-known approaches to health education :
1. Regulatory approach (Managed prevention)
Regulation in the context of healt~ education _ma~ b~
defined as any governmental intervention , d1Tect or mdirec ·
designed to alter human behaviour. Regulations may _be
promulgated by the State by a variety of admm1strative
agencies. Regulations may take many forms ranging from
prohibition to imprisonment.
The coercive or regulatory approach seeks change in
health behaviour and improvement in health through a
variety of external control or laws placed on people , as for
example, The Child Marriage Restraint Act in India and the
use of compulsory seat belts in the western countries . The
legislative approach may seem to be simplest and quickest
way to improve health or bring about desired changes
in society, but there are also important failures of laws.
e.g. , prohibition of alcohol.
The reasons for the failure of the coercive approach are
not far to seek; in the first place , the cause of disease
(medical or social) cannot be eradicated by legislation. at
the most the government can make laws to prevent a perso n
spreading disease in his community, as for example
vaccination in an emergency. Secondly in areas involving
personal choice (e.g., diet, exercise , smoking) no
government can pass legislation to force people to 2at a
balanced diet or not to smoke . It amounts to taking awa~•
some of the rights of the individual. The disastrous
sterilization campaign of 1976 in India which led to the
Congress defeat in the 1977 elections is a case in point. The
lesson learnt is that it is difficult to enfo rce a law unless thl:'
majority of people are in favour of it and if it does no t
interfere with the rights of the individual.
However, laws may be useful in times of em ergency or in
limited situations such as control of an epidemic dise ase or
management of fairs and fes tivals. Eve n in cases where it is
the duty of the government lo make laws to preve nt the
spread of disease (e .g.. AlDS) it is difficult to enforce laws
without a vast administrative infrastructure and considerable
expenditure. To a degree . the people must be ready to
accept a law. In short. the coercive approach runs count t
fact the ba_sic tenet of health education , that is, in h::lt~
education . Iwe· do not force people to change . In spect·f·1c
· · I •
s1tua 1t0ns, eg1s atton
. can be used to reinforce th e pressure
to change co ll echve behaviour.
 896
~
cmtML INIC ,\Tl()N F ~ ll_.!
I i~L~
-l~)l~ll!_'f~\l~'l(~)~ N - - - - - - - - : - ~== =-~ =-- - - '
. tersectoral coordination . The Und
2. Ser\l ice i'tpproa c h . help individuals to becom_e self-reliant
in erh1i"- "'-. '
('ng Obj ,
This approach was tried by the Basic . H Ith Services in This in turn , can be done 1f the Peopt n matt eei~,
ea . d d ' h Ith
1960's. It ai med at providing all the health services_neethe
t guidance from ea care provide e rec . ers i
. eive
by th e people at their door steps on t~e assu~ptl~~n Th~s health pro bl ems an d fm . d' rs in . I'•1e Off,~.
mg Work b lderir ~e~·-
people would use them to improve their own ead · th approach is a fundamental shift from t~ le soiu:;!llrig :,,
approach proved a failure because 1t· was no t base on e earlier o~1 ,
felt- needs of the people . For examp Ie, whe n water- sea 1 Hea lth e duc at ion versu s pro pag apPr~:
f t
latrine s were provided by the government, free O cos
' Health education is not health propa anda -\l,
many people in . the rural areas •d k use of them . d
mere in forma t10n or propagan a. To edu 9anda- .
d1 not ma e . , it~
because it was not their habit to use latrines . The lesso~ is .
or facilitate Iearnin g; propagan da means ~~t rnearis¾et,
simple - the people will not accept a programme or servic~ systemized doctrine . The differences O ~Pread ~o~
,
even if it is offered free of cost, unless it is based on their education and propaganda drawn up by th etweeri rt~:';;
felt-needs . Education Bureau, Government of India ar e _Central~!:::,-._
e given Int
. 'lo,~.,,~
3 . Health educ ation appr oach
MODELS OF HEALTH EDUCATION able;
There are many problems (e .g. , cessation of smoking, use
of safe water supply , fertility control) which can be solved During the past few decades, a nu b
only through health education. It is a general belief in
western democracies that people will be better off if they
education models have been developed (; er of
the following :
¼
· They inc1 ,\
have autonomy over their own lives, including health affairs 1J/,

on which an informed person should be able to make 1. Me dical mode l

decisions to protect his own health . These are the higher
goals of health education . However, if the necessary
behaviour changes are to take place, people must be
educated through planned learning experiences what to do,
and be informed , educated and encouraged to make their
own choice for a healthy life . This approach is consistent
with democratic philosophy which does not "order" the
individual. The results are slow, but enduring. The mass
media and social organizations must be mobilized to help
introduce new attitudes and new habits without conflicting
Most health education in the past has relied
transfer to achieve behaviour changes. The m ~~ kno\1/lerj~
primarily interested in the recognition ande ~cal rnodd~
disease (curing) and technological advances t fea_tnien1 ~
process. It is concerned with disease (as d~/c 1litate 11ii
doctor) or opposed to illness (as defined by the in_ed bythe
c11ent).
Originally health education developed alon th .
the bio-medical views of health and disease
was on dissemination of health informaiion \ernphas~
lh
e lines ~

with the masses and the collective reaction to particular scientific facts . The assumption was that people aseld on
change . on the information supplied by health profes ~oualsd act
·
improv e t he1r· heatI h . In th1s
· model social, sion to
Since attitudes and behavioural patterns are formed early cultural ,
psychological factors were thought to be of little and
in life. We must move back in time and start health
importance . The medical model did not bridge th or no
education with young population. The assumption is that between knowledge and behaviour.
behaviour is more easily controlled or developed in young e gap
population than adults (16) . 2 . Motiv ation mo de l
4 . Prim ary healt h c are appro ach When people did not act upon the information thev
received , health education started emphasizing "motivation:
This is a radically new approach starting from the people
with their full participation and active involvement in the as the main force to translate health information into the
planning and delivery of health services based on principals desire d health action . But the adoption of a new behaviour
of primary health care , viz. community involvement and or idea is not a simple act, it is a process consisting of
several stages through which an individual is likely, to pass

TABLE 1
Health educ at ion and propaganda
- - -- -- - - - - - - - -- - - - - -
- - - ----
Education
Propaganda or publicity
1. Kn owledge an d skills activel y acquire d. -------
Knowle dge instilled in th e minds of people.
2. M akes pe ople think for themse lves.
Pre ve nts or discour ages thinkin g by ready- made slogans.
3. Disc iplin es prim itive desires .
Arouses and stimula tes primiti ve desires .
4. Develo ps reflect ive behavi our. Trains people to use
judgem ent before actin g. . 1-ive actions.
Deve lops refle xive behavi our : aims at 1rnpu,

5. Appeal s to reason .
App eals lo em oti o n .
6. D evelops individ uality, perso nality and se lf-expre
ssion .
Develops a standa rd pattern of attitudes an d behaviours
accord ing to th e mo uld used .
7. Knowle dge acquire d through se lf-reliant activity.
Knowle dge is spoon -fed and passively received .
8. Th e process is behavi our centred - aims at develo
ping
favoura ble attitud es , habits and skills. The process is inform ation centre d - no change of
attitude or behavi our designed .
 .
gard ' soci·ol og1sts h e described . .
H::Al.TH ED GCAT
/O.\

res. A
to lead to failu .
897
,-
doption . In this fre in behav1o . ur av Reliancet·on on! Y one method . 1s likely life-
a
{0re in the process o_ch
ange_ (Fig . 2). ch
combina 10n of app aches using all methods to cessary. ange
be _ _ _ _ _ . ro be ne
sta ge _ _
5
style and a medical care w ill
3 ppropnate use of
Interest
Awareness
J. otivat.,on Evaluation F HEALTH ED
UCATIO N
r,t CONTENTS O
2. Decision-making nds beyond th
e
n exte
ptance health educatio aspect of famil
y
Adoption or acce The _scope of It covers every
3. Action _hea lth se ctor . g curr ic ula
~o~vent,ona/ defin ite trainin
FIG. 2 alth . While no may be
n iommun ,ty he content of health education
Adoption model os ed , th e ke of sim plicity.
~an e Prop g di visions for the sa
follo w in directed
h AWARE
first goes throug t or getting S~v,ded into the ion has a limited impact when rmation
The individua! ec I h NESS uc at
f mce health ed ation, most of the needed
info
ab ou t the subj
n ation, alth educ (by way of
neral informatio s of health n:e~ gene ra/ ed uc l system
!: must first cr
through a pr
ea
og
te
ra
aw
m m
ar en es
e of public
. l s an_d prob/e
'° ~rm at ,o n . M
ms
ere
rom
at ed into the educationa
must be integr material, etc.) and mus t ha ve
books, class-room incipal target.
the young

m uc h va lue unless ·ti I iv at io n. e pr

wareness is no t of
st ag es of int eta s aluati to m ot
d population as th
cludes th e eres ' .ev on an
~'otivation in Th e individual evin y
k'
decision-ma mg. ek more detailed inf~~~ i~te
I'' rest in the 1. Human biolog an ds an understanding
of the
e alth, de m e body;
su bject; he m ay se t~e'°nn about th Understanding he e structure and fu nc tions of th and
or applicability of i.e., th st
usefulness, lim
ita tio ns as etw ,Idea _ or
human biology, for exercise , re
th en eval·ua tes the various pee s . social ' keep ph ys ic al ly fit - the need d drugs on the body;
e. H e at ,·on received. ' if how to ing an
ra ct ic
· al , economic of the info
) rm of a/coho/, smok biology is
P
ch o log 1c . an ev alu at·IOn 1s a sleep; the effects y lifestyles, etc. Reproductive of the
Psy y b Y co ns u ltmg othe .
rs . Such
ak · H f' ally cultivation of he al th
intere st . U NICEF 's "S te list of
ta
necess ar · and results m decision -m g. e m curren t basic
se m
new idea another area of port 1989" has drawn up a
men·taI exerhcith t
ac ce pt or reject the rpe World 's Childre n re
s, ever y fam ily has a right
er o inte rsona1' it be lieve st-feeding ,
decides w e os al . At this stage , s)
n w hi ch
health informatio mprises of child spacing, brea grow th,
programm e or . d k pr op techni cal person t co ild
. t· n (f ne n s, i~ship groups, n le ad s to to know. The lis immunization, weaning and ch giene -
commurnca w his decision . C
onvictio d, , house hy
su pp or t to ea . Th e ne w safe motherhoo re sp iratory infections about significant
is vital to lend ptance of the
new id diarrhoeal di seas e,
to bring
ti on or ac ce s ow n ex istin g able families alth (8).
action, adop r be co m es part of hi which could en eir own and their children's he
idea or acqui_re
d ?ehavi ou n. Effect e iv in th ol. It is
ca lle d internalizatio help the improvem ents an biology is the scho um ,
1s
values . This te gy sh ou ld be evolved to teac h hu m
Th e best place to ugh its sequential health curr rien ces
icul
stra
co mmunication from one stage
to another.
only the scho ol , th ro
epth lear n in g ex pe
individu al in pa ss in g
; th ere may be e continuous in-d ation and
e no t necessarily rigid e which can provid ents . Th e provision of info rm ch new
The above st ag es ar at in the sam st ud
fo r millions of biology and hygiene is vital fo
r ea
ag es . It is a/so found th ages of the m an
skipping of st in different st advice on hu
ity , pe ople may be st and increase
as
gene ration .
co m m un
es s. A do pt io ns are slow at fir
adoption proc the practice.
people accept 2. Nutrition e people to
more and more tion education is to guid es and
d el The aim of nu balanced diets, remove prej udic miliar
tri
rv en ti o n m o an d e fa
choose optimum ary ha bits - not to teach th trien ts .
3. S o ci a l in te alized that the
public health
diet
re l promote good of nu
Soon , howev er , it w as
at the traditiona e biochemistry t the value of
us to da y ar e so comp/ex th be ha vi ou ra l jargon of calories and th abou
norance
prob/ems facing ch is insufficient to achieve lems such as ig nceptio ns
pr oa ing, adop tio n of sm al l Nutritional prob nd the first year of life. misco eness of
motivation ap re du ci ng sm ok of yo
breast feeding be ng , ignorance of the approp
riat
ample, imin ation
change , as for ex ing the age of marriage, el ab ou t prop er w eani
egna nt w om en , traditional
family no rm , ra is r infants and pr families , etc. can be best
ce rtain di ets fo in th e
dowry, etc. in a number of patte rn w ith s. th e link
ig no red th e fact that food allocation n ed ucation . In rece nt year seases of
The motiv atio n m od e/ s to be changed tio
solved by nutri habits and certain chro nic io-vascu lar
di
no t th e in di vi du al who need behaviour of ary rd
situa tions it is e di et d ca
which shap es th that people be twee n
as obesity, diab
et es an
a tion is a
en vi ro n m en t
0

bu t th e so ci al . It is of ten fo u nd mid dl e age such establis hed. Nutrition educ nutrition .

the community ething new or novel until it en
diseases has be n for the prevention of m e.
al
individual and d try so m
acce pt an p to which rv en tio ity of lif
will not readily r ap pr ov ed) by th e grou major inte
d im prov ing th e qu al
has been "legiti
m at ed " (o ings commonly promotion of he alth an
t of us pr ef er to do only th e th nc_e of group
they belong. Mos . This hi ghlights th e importa actwn . tal. The
done by our gr
o up
th e de ci sions and taking rtion 3. Hygien e pe rson al and environm en rsonal
in g reac hi ng se pe cts - pe
su pport in help ctomy or loop in This has two as ene is to promote standards of people
ne w id ea such as vase Th is gave bJrth to th e al hy gi where
Adoptio n of a pport. aim of pe rson of th e condition ng. washing
ere is a group su . of heal0th ithin th e se tting
cleanlin ess w giene in cludes bathin g. cl othi
is facilitated if th social intervention model Jed ~ hy eth ; spittin g.
i
development of
he al th ed uc at ion mod ist ba 1 0d
el live. Personal ca re of na ils . fe et and te culcatio n of l
effectiv e
education. An e of human ecology .anl d ·unde
rS an ng t;
ha nds after toile , personal appearance and in hygi ene
l, phys1ca 1an ng al
co ughing , sneezi e you ng. Training in person be carried
le dg 11:
se kn ow b
ltural, 10 og ic a
Preci be twee n th e cu clean habi ts in th e and mus t II'
th e inte ract ion a very early ag NE has two
ental facto rs. shou ld begin at e. ENVIR ONM ENTAL HYGIE hygiene
p_eed /1
social environm gy need· s to nd be deve lo
te re cogniz ag es tic
In sum , a co
he re n t st ra
bh
to through sc hool tic and com munity. Dom

involvin g allprthoa e w ay s_ to ch an ge ed;~~~::t

behaviour onse
f pact · aspects - dom
es
i
that th e ap
wan ts to ch an ge
ch w ill
. Th e nee is
di ff er
d · or
fofr aI programm e o
1
 comprises that of ti I
light d . . 1e 1ome. use of soap. need for fresh air.
d. an ve ntila ti o n: hygi e ni c storage of foods · hygienic
. isposal o f was tes . need to avoid pests rats ·mice and
msects I • . · · is a ma1or
· mprove rn e nt of environm e ntal health
conc
th ern of niany governments and related agencies
rough? u_t rh e world . In the developing countries , the
em pha~is 1s on the improvement of basic sanitary services
cons istin g o f water supply. disposal of human excreta . other
-,0 l1 d . an d 1iqu1
· ·d wastes , vector control
food sanitation· and
ho using _w hich are fundamental to he,alth. In man y areas .
po or sanitary practices among the people have their roots in
centuries -: old customs , styles of living and habits. These
are not easily altered (17) .
.A n environmental san itation programme should include
healrh
. education • It 1·s no t enoug h to provide
. sanitary
. Management must provide a safe environment and rnines
wells ,
latnnes and waste collecting facilities. People will continue
~o suffer from the diseases caused by poor sanitation if they
0 not use
the facilities . If a health education approach is
!ake~ t~e people w_ill participate from the beginning in
iden~fymg their sanitation problems and will choose the
~olutions and facilities they want. They will then be more
likely to use these fac ilities and improve their health.
4. Family health
The family is the first defence , as well as the chief reliance
for the '-'."e!l-bei~g of its members. Health largely depends on
the family ~ social and physical environment and its lifestyle
and _behaviour. The role of the family in health promotion
~nd _m prevention of disease, early diagnosis and care of the
sick 1s of crucial importance . One of the main tasks of health
educa~ion is to promote the family 's self-reliance, especially
regarding the family 's responsibilities in childbearing, child
rearing, self-care and in influencing their children adopt a
healthy lifestyle .
5. Disease prevention and control
Drugs alone will not solve health problems without health
e ducation , a person may fall sick again and again from the
sa m e disease . The experiences of western countries have
sh o wn the role of education in the eradication of cholera ,
typho id , malaria and tuberculosis etc. Education of the
people about the prevention and control of locally endemic
diseases is the first of eight essential activities in primary
health care . Several public health programmes are in
operatio n on a national scale to eradicate diseases such as
malaria, tuberculosis , leprosy, filaria , goitre , etc. The recent
experience of malaria eradication has indicated that anti-
malarial sp ra y with in se cticides cannot solve the problem
withou t health e du cati o n.
6. Mental health
Mental health pro blem s occur everywhere. They become
more prominent whe n maj o r kill er disease s are brought
under control. There is a te nden cy to an in crea se in th e
prevalence of mental di seases wh e n the re is a cha nge in the
society from an agricultural to a n indu strial eco no my, and
when people move from the warm in tima cy of a village
community to the isolation found in big cities . Th e aim of
education in mental health is to help people to kee p mentally
healthy and to prevent a mental breakdown . Pe opl e should
enjoy their relationships with others and learn to live a nd
work without mental breakdown . There are certain spec ia l
situations when mental health is of great importance -
mother after child birth; child at entry into school for the first
time , school child entering the secondary school , decision
about a future career, starting a new family and at the time of
widowhood . These are critical periods of !if:-:; - - - ,
P
ressure tends to breakdown
. mental health · Heaelth
n exter n,,
should help peop Ie ac h ieve mental health b v1(,rko .,
. sympathy. understanding and by social contact. Y sho,.,i~'.~
.
7. Prevention of accidents
Accidents are a feature of the complexity of
In the developed countries, they are taking an inmodern life
· b . Acc1·d en ts occur · h
of life and lim m t ree main creas1n g toll·
hom e. road and the place of work . Safety educat~~~as • the
be directed to these areas . It should be the con should
engineering department and also the responsib~~~ of the
police department to enforce rules of road safety A of the
occur in war ks h ops, fac tones, · rai Iways and
· ccide
. nts
general order and cleanliness . There should be a ~rornote
everything, and everything should be in its plac~ ai~e for
factory in the home , and in the office . The pred . the
factor m .' acc1'd ents 1s
. care Iessness an d th e problemorn1nant
tackled through health education . can be
8. Use of health services
Many people particularly in rural areas do not know h
health services are availa_ble in their community, and :anat
more do not know what signs to look for that indicate . Y
to the doctor is necessary. Studies indicate that the ; ~~_it
~ttitude towa:ds _health services is still apprehensive. T~e:~
1s a commurncation gap between the public and the t
health administration in the form of "feedback " for fu
improvement of health services. r er
\t
One of the declared aims of h_ealth education is to inform
the people about the health services that are available in th
community an_d how _th~y can ut_ilize the°: (e .g., screenin~
programmes, 1mmun1zation, family planning services et )
and use the health care resources . c.
PRINCIPLES OF HEALTH EDUCATION
Before we come to the practice of health education we
must know the principl_e s involved . ~ealth education br'ings
together t_h e art and science of medic ine , and the principles
and practice of general education . The link is to be found in
the social and behavioural sciences - sociology, psychologv
and social anthropology. ·
Health education cannot be "given" to one person by
another. It in volves , among other things , the teach ing.
learning and inculcation of habits concerned with the
objective of healthful living . Psychologists have given a great
deal of attention to the learn ing process. Every individual
learns and through learning develops the modes of
be haviour by w hich he lives . Learning and teaching is a two-
way process of transactions in human relations, between the
te acher and taught. The teacher cannot te ach unless the
pupil wants to le arn . Le arning takes pla ce not only in the
class room , but also outsid e in the wider world . There i:;
inte rnal le arning by whi ch a ma n grows into a n adult
individual. It is poss ible to a bs trac t cer tain pri nciples ot
lea rning and use th e m in hea lth e du cation. Th ese include :
( 1) Credibility : It is th e d e gree to wh ic h th e message to
be communi cate d is pe rce ived as trustworthy by the
rece iver. Good he alth e ducation is based on facts - that
means it must be consistent and compatible with scientific
knowledge and also with the local culture , educational
system and social goals . Unless the people have trust an_d
confidence in the communicator, no desired action will
ensue after receiving the message.
 899
I I ED UCAT IO\J
PRI NCIPLES Of- HEALT
• d. ection s In
nci ple that pe 1 ow the doctor 5 ,r . ·the
l pri foll
~ : It is a
(2) 1 to listen to those thin
psy cho log ica
gs which are not ? ~t e
fir
teaspoon
hea lth
, and cou ld
education ' we should alw
not
ays communic ateh _mh are
ds w ,cwithin
be
r
i
~nllke It is salutary to
remind ourselves th t oh th
relate to the interests of
the a
peop Ie. The
ea Ianguage people understand, and neve~ ng should
strange and new to the peo
ple . Tea chi
use wa
inter~s · should
n111.g not .interes ted ·m hea Ith slogans such a "T, k the mental capaci ty of the aud ience.
II that is newIf
teac . hea lthy " . A healths da e c~re Iearn a
~~bJic ,rs health " or "be e uca tton : Few peo ple can
h. k. d Id b (6) Reinforce.me nt
.. . t ls is necty essary.
rf you ~ e as use les s as asking people . . n at in erv a ·bl of the
o gramme of.! ,s m ~?t
mm e ask ing peo ple to in a single penod. Rep et1 t1o
re is eve ry pos s,
1 1
If the
progra re is no reinforcement , the
pr~·be healthyd·',, asHa ~~hn ,donucators must find out th the st
ness age i·kely .
to good foo f .the eapeople e
p h I e rea
"fe lt-
1
ind ivid ual goi ng back to the pre-aware ie are more ,
-eatalth needs_ o . syc o ogists call them If message is repeated in differ
ent ways, peo P
ds the peo ple fee l abo ut them se Ives . a
he d ,. that 1s nee. b d "f to remember it. ction _ process;
ee s ,
pro g~a mm e 1s ase on elt needs" people will gladly . .
,s an a The Chinese
neal th onl y the n it will be a arn in~ _by doing _: Learn ing
harticipate in the pro gra mm e; and (7) .~e row sen se. b . ·f I do I
gra mm e. Ve ry oft en, the re are groups who may not a memonzing " one in the nar , I remem er, 1 '
see
P !e's pro
eoP d of wh.IC h they are not aware . Th·1s .1s pro ver b : "If I hear, I forget; if I ng .
P health nee sd. h ce of learning by doi
have . I b
out 25 per cent of the people know" illustrates the importan fan work, we
especially true m n ia w ere a
hav e to brin g abo ut a n : In he atl h ed uca 1 " · "from the
cat or wil l (8) Known to unk now
are illiterate. The health edu ab str act · h ore
recogni tion of the nee ds bef ore he proceeds to tackle them.
is a key wo rd in health
mu
par
st
ticu
pro
lar
cee d "from the concrete to the
to the general" ; "from the difficult ; a
s!m_ple } 0
~J ,7ro
h.
m
pat ion
(3) Participation : Partici complicated ·" "from the easy to more h I · teac mg
on. It 1s bas ed o~ the psy chological principle of active ' the unk now n" . Th ese are t e ru es m at th ey·
educati
uld aim at encouraging peo
ple the known to d wt·th wh th
learning. H_ealth e?ucat1on sho rs and others in identifying We sta rt wh ere the peo ple are an
led ge ·.We useh e
to work actively with health
worke d to new know
ms and als o in dev eloping solutions understand and then procee I peg
s on whdich to. bang ·it
their own health pro ble mb ers kno wledge of the peo p e as uid
tici pat ion of fam ily me exi stin g atic kno wle ge is
and plans to work them out.
Par y system
unity for more effective, new knowledge . In this wa , ~nlarge
in patien t car e wil l cre ate opp ort
of New kno wle dge will bring about a new igh t mto the
cation. A hig h deg ree up. . can giv ·
. e nse o an t ins
al!~ bas ed hea lth edu g wh ich
practic sonal understandin ine has develop~d from
a se_nse of involvement, per m . The way in which medic as an illustrallon , .th e
participation tends to ~r~ate It pro vid es ma xim um pro ble
makmg. serves us
acceptance and dec1s1on- states : "The people religion to modern medicine is a
e Alm a-A ta De cla rat ion wle dge from the unknown to the known . It
feedback. Th ly and gro wth of kno we mu st
participate individual full of obstacles and resista
nce , and
have a right and duty to tion of the ir lon g pro ces s
and implementa
collectively in the planning an not expect quick results.
). If com mu nity participation is not lth educator should _s~t a
Setting an example : The hea ng. If he is explammg
hea lth car e" (18
pro gra mm es are unl ike ly to succeed (19). (9)
integral part, health good example in the things
he is teachi
tion : In eve ry per son , there is a fundamental sm oki ng, he will not be very successfu
l if he
(4) Motiva tiva tion . the haz ard s of all family
this desire is called mo s. If he is talking about
the "sm
desire to learn. Awakening sec ond ary . him self sm oke siz e is big . I

tives - primary and will not get very far if his ow

n family I

There are two types of mo al) are driv ing nor m" , he 1,
I

, hunger, surviv Sharing of information, ide

as
Primary motives (e.g . sex the se mo tives are inborn (10) Good human relations: hav e a
,1
•II
ple into act ion ; en peo ple wh o
forces initiating peo ed on des ires cre ate d by and fee ling s hap pen most easily betwe peo ple
I
are bas good relationship with
desires . Secondary motives of the secondary motives good relationship. Building
inc ent ive s. So me munication skills.
outside for ces or
rew ard s and pun ish me nt, and goe s han d in hand with developing com
are praise , love , rivalry, ant ck is one of the key con
cepts of
ogn ition . In hea lth edu cat ion, motivation is an import (11) Feedback : Feedba or can mo dify the
rec
for incentives is a first ste
p in lth educat
factor; that is, the need the systems approach . The hea , cha nne ls) in the light
e inc ent ive s ma y be positive (the me nts of the sys tem (e.g ., message
learning to change . Th ele communic on , ati
ativ e (th e stic k). To tell a lady, faced with the of fee dba ck from his audience. For effective
carrot) or neg she portance.
reduce her weight because feedback is of paramount im
problem of overweight, to ed
ar disease or it might red uce her
) Leaders: Psychologists
have shown and establish
might develop cardiovascul tell her tha t by (12
we res pec t and reg ard .
effect; but to learn best from people whom
life span , may have little re cha rm ing and tha t we to pen etr ate the
ht look mo cation , we try
reducing her weight she mig lth advice. When a father In the work of health edu an .
beautiful , she mig ht acc ept hea
mu nity thr oug h the loc al leaders - the village headm
ay, he com rs are agents
for getting up early everyd the political worker. Leade
promises his child a reward In hea lth the sch ool tea che r or
lth edu cation
ulcate a good habit. y can be made use of in hea
is motivating the child to inc nge beh avi our . of cha nge and the
t about a give n
motivation to cha leaders are convinced firs
education we make use of ead rk. If the
motivated per son ma y spr wo of impleme nting th e
Motivatio~ is contagious; one o hav e gra mm e, the rest of the task
motivation throughout a gro
up . For exa mp le, me n wh pro ibutes of a leade r are : ht!
adv erti sem ents pro gra mme will be easy. The attr nit v:
already had vasectomies are
am ong the bes t demands of th e commu
understands the needs and
tak es the init iati ve. is rec e ptiv to
e
for male sterilization . w provides proper guidance , ide ntif i es him self
lth education we mu st kno gestions of the peo ple :
Co mp reh ens ion : In hea the vie ws and sug sid era te
(5)
education and literacy of peo
ple partial, con
munity ; self-less, hon est. im
the level of understanding,
to whom the teaching
is directed . One barrier .
too
to
d
wit
and
h the
sin
com
cere; easily acc essible to th
e people: abl
e
e
com
to con
mu
tro
nit
l
y;
d I
rds which cannot be und ers ious factions in th i
communication is using wo foods ; the and compromise th_e_ var eliciting
ask ed the dia bet ic to cut dow n sta rch y
ses se~ the req u1s 1te s
_ kill and knowl edge of I
A doc tor ibed pos the various
rchy foods . A doctor prescr es- cooperation and achieving coordination of
Patient had no idea of sta tim
on "one teaspoonful three official and non-official org
anizations .
medicine in the familiar jarg

j
wo ma n , had nev er see n a
age
a day" ; the patient, a vill
 92_0QQ0_ __-.SC~O~f\~
1M~U~N~IS:C~AT~l_<20~N.£F:SO~R~H~E~A~L1~-H~ED~U~C~A~T~l02! N~ ---- --~ -:-- -=-= =: - - - --
----------
PRACTI CE OF HEA LTH ED UCATION 1. Indiv idua l appr o ac h
Th e are plenty of opportunities for individ
Educational material should be designed to
attention to provide new knowledge , to
focus ed ucaet~on It
1 • may be given d
in personal interv,· Ual health
.
facilitate
interpersonal and group discussion and to reinfo consu ltat
ion room of the actor or m the health cews 1·n the
rce or the homes of the peop Ie. Th . d' .d entre
clarify prior knowledge and behaviour. ~ m 1v1 ua I comes to the d or in
h centre becau se of illness . Opportunity is t 0 ctor
or hea It
1. Aud io-vi sual aids ting him on matters o f m . t
erest - d.1et, causat ·aken 1.n
e d uca
No health education can be effective without audiovisua t of illness an d 1·ts preven t·10n , personal hion. and
l na ~re mental hygiene , etc . Topics for health couYg
aids. They help to simplify unfamiliar concepts; bring environ . h iene,
about
understanding where words fail; reinforce learni be selected according to t e re Ievance of the sitnse11·.1ng
ng by ;ay h individual health teaching, we will be equipp
appealing to more than one sense , and provide a ~ation .
dynamic . yd~~cdual and the family to deal more effectively wi_
way of avoiding monotony. Modern science has m 1v1 nthg the
made health problems . The _respons1·b·t·ty f 1 th
available an endless array of audiovisual aids which I I o the attendi ne
can be
classified into three groups (20) : physician in this regard, 1s very _great _be~ause he
has th;
fidence of the patient. The patient will listen more re
(1) AUDITORY AIDS con ct·i
to the physician's heatI h. counse 11·mg. A h.mt from the doctor a IY
Radio, tape-recorder, microphones, amplifiers, earphones. may have a more lasting effect than volumes of
printed
word. The nursing staff have also ample opportunitie
(2) VISUAL AIDS sf
undertaking health education . FI~rence Nightingale said
th~;
(a) Not requi ring proje ction : Chalk-board, leafle the nurse can do more good m the h_o_me than
ts, in the
posters , charts, flannelgraph , exhibits, models, hospital. Public health nurses, health v1s1tors and
health
specimens , etc. inspectors are visitin~ h~n_dreds of homes, t~ey have
plenty
(b) Requ iring proje ction : Slides, film strips . of opportunities for md1v1dual health teaching. In
workin
with individuals , the health educa tor must first create
(3) COMBINED A-V AIDS a~
atmosphere of friendship and allow the individual to
talk as
Telev ision , sound films (Cinema) , slide- tape much as possible. The biggest advantage of individ
ual
combination . health teaching is that we can discuss, argue and persua
de
A knowledge of the advan tages , disadvantages the individual to change his behaviour. It provid
and es
limitations of each audio-visual aid is necessary in opportunities to ask questions in terms of specific interes
order to ts.
make prope r use of them . Audio-visual aids are mean The limitation of individual health teaching is that
s to an the
end, not an end in themselves. numbers we reach are small , and health education
is given
only to those who come in contact with us .
2. Meth ods in heal th com mun icati on
The meth ods in health communication may be group 2. Grou p appr oach
ed Our society contains groups of many kinds - school
as in Fig. 3.
A rundown of the assets of mass media and perso children , mothers , industrial workers , patients, etc.
nal Group
communication meth ods is as shown in Table 2 . teaching is an effective way of educating the comm
unity.
The choice of subject in group health teaching
Any one or a combination of these methods can be is very
used important; it must relate directly to the interest of the
selectively at different times , depen ding upon the objec group.
tives For example , we should not broach the subjec
to be achieved , the behav iour to be influenced and t of
available tuberculosis control to a mother who has come for deliver
funds . y;
we should talk to her abou t child-birth and baby
care.

Health Communication

Indi vidual Group

approac h app roac h Mass appro ach

1. Personal con tact 1. Lectur es 1. Television

2 Home visits 2. Demo nstrati ons 2. Radio
3. Personal Letters 3. Discus sion methods 3. News paper
- Group discussion 4. Pri nted material
- Panel discussion 5. Direc t mailin g
- Symposiu m 6. Pos ters
- Workshop 7. Health museums
- Co nferences a nd exhibitions
- Semin ars 8. Folk meth ods
- Role play 9. Intern et

FIG . 3
Methods in health communication
 - -- - -- r ~F__f:!HEA Tl~l~ED~U~C~
~ ~LI!
211
,\~TIQ_O.:_:_·,- -~9t.(Q
,.
-------- -~ R /\C:
~ :_!T~IC~Ei0
-----
~ f TABLE 2
A rundow n of asseJs o mass media ·1nd rsonal comm unicd tion
' pe
Mass Media Personal communicame tion
I (TV , rad io, ne ws pape r)
(In terpe rso nal and gro up thods )
ng
pulation 1. Capitalizes on wa
rmth and understandi
Reaches the widest po
I 1.
and knowled ge of comm
un ica tion
t.
rtunity for involvemen
2. Gets public att en tion 2. Provides the oppo pressing fears,
for ask ing questions. ex
and learni ng mo re
in pe rsonal
ter supp ort for co nc entrated 3. Ca n ge t people to make chan ges ssi on presents
3_ Gives grea those for en discu
habits more readily, whns for these changes.
programmes such as ble explana tio
a week or month reasona
ge and below
e am on g tho se wi th ab
e average 4. Mo re inn ue ntial with averael.
4. More effectiv ov average educati on al lev
educational level
mprehension of
h . -so lving capacity; the co
t
may be taught abo odraI. dyg1ene ; thinking or prob lem alth be haviour
Similarly, sc ho ol child ren
osis· ua ries with th e student ; and th e he
tuberculosis patie·d nts about tubercul • n m us- tna l a lectur e va
t necessarily affecte
d.
w t also th bl
of the listeners is no
-visua~ !~~~\ ~
lec
0
t ents . e have to se
workers a bou aw
ed uc at ion including audio
method of he alth
educ~tion. A brief
account of the (2) Demonstrations esenta tion to
success ful gr ou p he alth
: is a ca refully prepared pr
aching 1s given below A dem on str ation re a proc edure
methods of group te w to pe rfo rm a sk ill or procedure. He carri ed ou t
show ho a well) is
re, disinfection of I
(1) Chalk an d talk
(Lecture) (e.g. lumber punctu ce or th e target group, th
e
ed oral p be fo re an audien rs ta nd s
ay be de fin ed as carefully prepar ste p by ste
rta in ing th at the audien ce un de
ce
A lect_ure m ideas by a demonstrator as ce lves the au di en
, ,?r ga ni, ~ed thoughts and e demonstrator invo
pres~~tatJon of fac ts
chalk lends the vis
ual component. how to perform it. Th
n . Th e
qual1f1e d pe rso a very important in discussion. ousing interest
tal k co m munication has still to dramatizes by ar
The c~ alk an d ectiveness depends str ati on (a )
t re co m m en de d
ce m sm all gr ou p education . Its eff leg ibl y and to De m on
the onlookers to ad op g is believing "
pla to write ad es
e speaker's ability (b) pe rsu
the prin ciples of "s
eein
a large extent on th ck bo ard. The talk sh ou ld be based
practices (c) upholds n bring desira ble
alk on a bla oup. , an d (d ) ca
draw with ch h needs of the gr and "learning by do in g" use of new
nt interest or healt pertain in g to the
on a topic of curre more than 30 and
the talk should changes in the be ha vi ou r
ld no t be
The grou p sh ou too long people
15 to 20 m inutes . If the talk is practice.
ication has been
not ex ce ed
and restless . tio n as a means of commun like
may become bored De mo ns tra e in programmes
e more effective ve a hig h educational valu um p.
od can be mad fou ~d to ha
tation (e .g., installa
tion of a ha nd -p
The lecture meth ble audio-visual aids such as : v1ro n~ en tal sa ni d child he al th
by combining with
suita posters), en
tar y latrin e) ; mother an
ey co ns ist of a series of charts (or construction of a sa ni
rehydration techni
que) an d
(a) F/ipcharts : Th illustration of or al
or more, each with an (e.g. demo~ str ati on
clini cal teachi ng in
about 25 by 30 em s meant to be (e .g., scabies) . The This method h
k to be given. They are cont~ol of_ diseases io ns . as a
pertaini ng to th e tal is "flashed " or itals - 1s ba sed on demonstrat
r an ot her. Each chart hosp -
is being given . The
af te J .
shown on e
a group as the talk h.1gh mo11vatw na va Iue
dis playe d be fo re to the point. Th ese
ch ar ts mu st be bri ef and n
me ssa ge on th e ention of the group (3) Group discussio
designed to hold att n of people intera oup of
cting in a
charts are primarily ee d. (b) F/anne/graph
: A piece
is a_n ''.,a gg re ga tio
and help the lec tu re to pr oc
oden board A "gro up "_ arpl y to th e gr
i fixed over a wo n . This contrasts sh
of rough fla nn el or kh ad
playing cut-out face-to-face situatio situa tion. roup
G discussio n is
lle nt background for dis students in a cla ss ro om f hea Irh
provide s an ex ce ation s. The cut-
ings and other illustr with a rough ed a ve ry effective method o b), fre e!)•
ap hs , dr aw er
co nsid . . lo lea rn
pictur es , gr
r illustrations are pr
ovided
un ic ati on . .1t permits th e individuals . . . G
out pi ctures an d othe pasting pieces of sa nd paper, felt or co mm
ng thei. r knowled ·
ge ideas and opinion:,. ro up
surfa ce at th e back
by ex changi on g membe ~
wh en put on the d. - _a wider in terac tio n am
an d th ey adhere at once pre-arran ge d 1sc us_s1o n prov ides th other methods • 1.vvh ere 1on. g .tt> rm
rough cloth th e adva nta th at
ge ib le wi .
flann el. Fl an ne lg ra ph of fers
another he lps than 11·s po . . lved (e .g cessatio n of :,·mok·mg. obt:'S Hv
ss
res di splayed one after entation. The codmp ian ce is in vo . :· >. .
sequen ce of pi ctu pres · ) oup d1. scuss1on is consid ered valuoblt
and adds much to the is a very cheap gr
maintain co ntinuity rap h re uct1on should co m ris e
that th e flann elg cussi on. th e grouIp'J
other advantages are nspo rt an d promotes th ought and For ef fec tiv e gr ou p dis
t more than
p
Th e
il cird e . ~
tra an d no be rs .
medium , ea sy to ec im ens, etc. not less th an 6 m em
hi bi ts : Objec ts, models, sp esse ntiall y parti cipan ts ar e all se at ed in ch is lly
fu
criticism (c) Ex r. Th ey are . 4) Th . :, \thal~ ea
essage to th e viewe visibl e to all th e ot he rs (F ig
~e a grou p
co nvey a spec ific m unica tion, which ca n also be used in s th e su bje ct he lp:~h:, ~~'. :.:s1on in th e
m ate
mass me dia of com an d charts : Th ese are ma ca n be
ss media leader who in iti , e_ i:s_cu
events sid e~co nv ~a t1on:,, encourages
group teach ing . (d) Fi lm s
in ati on, th ey proper manne r, pr ate and - er
If used with discrim everyone to particip go es ;~ ;s up t e discussion !n th e
of co mmun ica tion.
small groups. ion
end_. _ff the discuss indiv ·d I . the group may arrive
at
of value in educating ounds. Their
be fau lte d on a numbe r of gr de c1s1 on s wh ic h no
bbl er woul d ha ve be en
Lectures ca n are involved . lt is a1Js~ad ~ em pe rson to
ag es inc lud e th e following : stude nts t stimula te able to make alo ne es1ra e to have a
disadvant t; lea rning is pass ive
; do no
to a minimum ex ten ,,'
9ill CO\\\\ll:\ i(.\ fl UN f Ul{ 111 ) \I l'I I t-:1 >UC\ 1I\ );\
record whatev . , ct·
report O ll . . er is iscussed . The "recorder" prepares a
group dn 1e issues discussed and agreements reached . In a
ru\ iscussion . the members should observe the following
es : (a) express ideas clearly and concisely {b) listen lo
w h
_ atk.others say {c ) d o not interrupt when others are
:.pea ·mg (d) make only relevant remarks (e) accept criticism
~racefu_lly ~nd {{) help to reach conclusions (9). Group
biscuss ion is successful if the members know each other
eforeha nd - when they can discuss freely.
A well conducted group discussion with adequate
~esources {Fig. 4) is very effective in reaching decisions .
ased on the ideas of ALL people . The decision taken by the
group tends to be adopted more readily than in situations
where the decision is a solitary one . Thus the group
acceptance has a binding effect on the individual member to
translate their acceptance into action. A well-conducted
group discussion is effective for changing attitudes and the
health behaviour of people .
FIG . 4
A good group discussion
Limitations : Group discussion is not without limitations.
Those who are shy may not take part in the discussions.
Some may dominate the discussion (Fig. 5) . Thus there may
be unequal participation of members in a group discussion ,
unless properly guided . Some members may deviate from
the subject and make the discussion irrelevant or
unprofitable .
FI G. 5
A dominated gro up. No. I and No.7 domin ate the disc ussion
(4) Panel discussion
In a panel discussion , 4 to 8 persons who are qualified to
talk about the topic sit and discuss a given problem, or the
topic, in front of a large group or audience . The panel
comprises, a chairman or moderator and from 4 to 8
speakers. The chairman opens the meeting, welcomes the
group and introduces the panel speakers. H 1. - '--.,
topic briefly an d ·1nv1·1es_th e pane I speakers et ntrodUce; '
points of view. There is no specific agendao Pre~ent lhh1:
speaking and no set speeches (21). The succe ' no Order €1!
depends upon the chairman ; he has to keep~~ of the P '.I
go ing and develop. the train I of though t. Af ler e discu~an~1
tk ,1c,
aspects of the subJect are exp ored by the p 11e rt\ n
the audience is invited to take part. The dis anel speak01 n
tura l. If members ofcuss 10 •er,
be spontaneous ~n d na_ the n shOulrj
unacquainted with this method , they rn Panel a
preliminary meeting, prepare the material on th ay have r~
decide upon the method and plan of presenet s~biect and"
discussion can be an ex treme IY effective at1on . ran n._
I
education . provided it is properly planned and g ~dethod ~f
. u1 ed.
(5) Symposium (21 ,22)
A symposium is a series of speeches on a selected s .
Each person or expert ?rese~ts an aspect of the ubJect.
briefly. There is no discussion among the subiec1
members like in panel discussion . In the end thsYmposiurn
. Th
may raise questions. e chairman
. , e audi
makes a comp h ence
summary at the end of the entire session. re ensive
(6) Workshop (21 , 22, 23)
The workshop is the name given to a novel expe .
. f • f . nment ·
education . It cons1s!s o a_se:1~s o meetings, usually fou 1n
more with emphasis on md1v1dual work within the r or
with the help of consu 1tants an d resource '
' group
personn I T ·
total workshop may be divided into small groups aned. he
group will. choose a chairman · an d a recorder. each
Th
individuals work, solve a part of the problem through th _e
personal effort with the help of consultants, contribut err
group work and group discussion and leave the work~ to
with a plan of action on the problem . Learning takes ; op
1
in a friendly, happy and democratic atmosphere, un~ce
expert guidance . The workshop provides each particip/:
opportunities to improve his effectiveness as a profession~
worker.
(7) Role playing (21 , 22)
Role playing or socio-drama is based on the assumption
that many values in a situation cannot be expressed in
words, and the communication can be more effective if the
situation is dramatised by the group. The group members
who take part in the socio-drama enact their roles as they
have observed or experienced them . The audience is not
passive but actively concerned with the drama. They are
supposed to pay sympathetic attention to what is going on.
suggest alternative solutions at the request of the leader and
if requested , come up and take an active part bv
demonstrating how they feel a particular role should be
handled , or the like . The size of the group is thought to be
best at about 25 . Role playing is a useful technique to use in
providing discussion of problems of human relationshi_p. It i;
a particularly useful educational device for school children
Role playing is followed by a discussion of the problem
(8) Conferences and seminars
This category contains a large com Ponent oire
commercialized continuing education . The programt~:ey
usually held on a regional. state or national 1te ·d maY
range from once half-day to one week in Ieng! a;ensive.
cover a single topic in depth or be broadly ~o~~:elearnin9
They usually use a variety of formats to aid
process from self instruction to multi-media.
 T
\ eg
PRACTICE OF HEAL
TH EDUCATION

line . The He al th
h - Education of th eneral s is available on f ·t
Pp roac
cie
a and 0th er health· agen the ministry of health and amr Y
~IJ. 55 d · f
relat e m ormation from
ir website .
is also available on the
j.
11
t,fiC team can mou t
Ith worker or health for the wholen an effect!ve welfare Govt. of India,
P
me
~o t,eda cation program d" un ica
community ,
tio 4. Newspapers all '.orms
he u me •a
ealt through mas~ has been rapid . Uptill t n. The
of co mm
pers are the mo st widely disseminated of inted .
~ewspa fore it is pr
:xcePt n of the media tion depended large! he early st be newsworthy be
10 ss communica Y on wh at w of literature . News mu n to radio or TV for entertainment,
tur
·,011.1t
e1 0 rna_ posters, pamp ets, books, pe
hi riod·1 1 as Whereas many people newspap~rs .
.~a s and de rs are often seeking
192 sd the radio and with newspaper rea re fac l , detailed
tua
. Th en ca m e therefore provide mo
printe ers
e. TV went a gigantic
st~ a new Newspapers should, terial (7) . Unfortuna
tely, health
ex pe rie nc P further tis tic al ma
11 e1vsP~~ n of Th and even sta Newspapers
din1e11 become a ve
ry powerful weapon sds caters little of va lue to newspapers.
radio appeals to the
e pre problems ha ve in rural ar~as
~nd h~fy to the eye , the aeadr, TaV n TV to limitatio n of ha ving low readership d group, 1.e .
al word about .radio n have limite
priniary1 e and ear.h A fin h - they They reach only a
I ff because of illiteracy.
th eclose to t e warmt and motivation ab e ect of a mmunity.
bO
unication. They have the literates in the co
come n-to-person comm ilization . ecome part
P;~~~ fabric of modern civ 5. Printed material s haveed long
unicat1·on . Th ey are s pa mp hle ts bo oklets an. d hand-out · at
o ''ass media are
a "one-way" comm Magaz ine
' health co' mmun1c . at10n . They are aim
th
·tr even in the been in use for in the fact that ey
i••
in transm T1 hm g messages to peopleo a h d d. Their usefulness lies
useful ber . of people wh re reachi eh tho se wh o ca n rea n be produ~ed m
ote st pla ce.s. . e. numTh giv e information. They ca by others m the
re)ll 11 s. e,r effectiveness ca n can convey detailed ed
usually count 1~ m1 ion money involved. g st, and can be shar
tim e an d bulk for very little co
returns for the .
gene rally inadequate 1·n c angmg
h . family and community
dia alo ne are .
Mass me ff tion, they
. t,~e health communica . The
r:-
human be h av1o u~ . ro r e ~c
er methods 6. Direct mailing alth communication
in India .
mbmation with oth inn ov ation in he
should be used m .c~ creating a political will in favour of This is a new try with
m is to rea ch the rem ote areas of the coun s on
power of mass media The intentio n d booklet
people, setting rs and newsletters an .) . These are
e he alt h _consciousness of the ising health printe d wo rd (e. g., fol de
health , rais!ng ~h pu lar nization and nutritio
n etc
~nical messages, po family planning, immu ders, literate persons, panch~~ats
I
norms, dehvering tec unity involv ement are well e lea
knowledge an d fo ste rin g co mm
should be sent directly to villag ed as opinion
ers who are consider ss media in J
bli c he alth methodologies and loc al bo die s an d oth
recogniz ed (6) . Pu ully thought-out
; they should be caref given below : g has been a succes
sful ma I
cul tur ally ap pr op ria te is leaders. Direct mailin ss. It is possibly the most personal of
unt of the mass media creating public aware
ne
before use . A brief acco tio n.
mass communica
1. Television dia. It is s an d signs
m e the most popular of all me to an 7. Posters, billboard eate awareness.
Televisi on ha s be co but also catch the eye and cr
creating awareness, These are intended to mmunicated must be iders
simple ,
effective in not only and intro du cing new ways me ssa ge to be co
public opinion Therefore, the en one cons
ext ent influe nc ing ding and helping are not expensive wh Motives such as
levels of understan and artistic . Posters le.
of life . It is raising not seen before, ge number of pe op
th things they have they are seen by a lar in order to hold
people familiarise wi lence which are shown as part of an d fea r are int roduced into posters re time
including crime and
vio l. It can only
hu mo ur
bli c . In pla ces where the exposu
me s. TV is a one-way channe the attention of the pu
ssage of the poster
should be
featur e prog ram as of learning . It ts) , the me
an aid to tea ching . It cannot cover all are is short (e .g. , str ee
d one that can be tak
en at a glance
be n. ec t an
health communicatio short, sim ple , dir
immediately. In plac
es where people
has much potential for rst an d
and ea sy to un de , railway stations.
end (e .g., bus stops
2. Radio have some time to sp ) the poster can present more
developing ntres
d nearl y in every home . In many hospitals, health ce ount of matter shou
ld be pu t up in
Radio is foun e than TV. Both e rig ht am en there is an
rad io ha s a broader audienc informa tio n. Th
right time . That is, wh
co untries the not accessible d at the
ch illiterate population the rig ht pla ce an
titis, there should be
posters displayed
radio and TV can rea is a purely didactic medium. It can c of vir al he pa poster is
It
through printed word. "putting across" useful health
ep ide mi
bu t no t on ch olera. The life of a
on viral jaund ice , frequently .
be va lua ble aid in
plays , questions ste rs shou ld be changed
m of straight talks , usually _ sh or t; po media of he alth
inf orm ati on in the for
is much cheaper wi ll los e their effect. As a
programmes . Radio otherw ise the y ect in changing
and answer~ and quiz y speak out on _ ha ve much less eff
d health workers ma educ a~ ion , po ste rs
enthusiastic users
would hope .
than TV. Doctors an s may be identified and discussed v1 ?u _r tha n its walls se rv es
ue be ha on
radio. Local health iss e of po ste rs by pasting th em
neral awareness . lndrscnmmate us wall.
leading to increased ge ose than covering the
no other useful purp
3. Internet mmunication s an d exhibitions
computer based co 8. Health museum
me an s of of knowledge , s and e..xhibitions
This ne w
ed va st capability of transfer t a~d instant If properly organiz
ed , heal th muse um enting a variety
en es
sys tem has op
ssible to get into dir
ec ers of people . By pr
and has made it po s of e-mail and even can _attract large numb rease knowledge and awareness
by me an inc
commun ica tion ac ro ss the wo rld
unication media of rdeas , t_hey do ct more persons
than graphi~
ch at. Th is is a fast growing comm major health Photogr ap hic _ pa ne ls att ra
manized touch to
a on -line
potential to become
a ca us e photos give a hu
and holds very large a fairly large number of persons in phane ls . Th is is be sional models with
. The three dimen
dy
education tool. Alrea dia, and the numbers are growing t_e com _munrcation en more effective than ph 0 t OS .
Ind ia are us ing this me ure from WHO lighted visuals are ev
am ou nt of health related literat
everyday. Vast
r rnn 111 1\ IT I \ [t)llCAl lON
904 COMMUNIC.A.T ION
C ntral Health Education Bureau in the Minist~
In exhibitions there is a big element of personal ~e; Delhi to promote and coordinate hea_lth educatione;lth,
communication through workers who explain each i_tem on . the country. Many state governments m India ha Ork
the exhibit. Printed literature explaining the exhibits is often ~ealth Education Bureaux in their Health Directorate~e no,;1
freely distributed. Health exhibitions and museums thu~ There are also other official agencies in the count
offer a package of both personal and impersonal methods 0 e Directorate of Advertising and Visual Pruybl~Uch
communication . as th . B D d 1c1ti,
(DAVP), Press !~formation _ ur~au , oor arsha~ and Al
9. Folk media . Radio which are active m health education I
Ind 1a . h I d. R Work
The term ''mass communication" ought to refer to the f
Several voluntary agenc1:s ~c ~s n . tan ed Cross ar~
totality of communication which takes within its compass not also engaged in the . ea ti t e ut~ahonl U work. At the
only the electronic media, but also folk (or indigenous) international level, there 1s an _n ern_a 1ona nio~ for Health
media such as keerthan , katha, folk songs, dances and Education with headquarters m ~ans, wh~se_main task is to
dramas and puppet shows which have roots in our culture . promote the creationE of An~tioRnal_ soc 1eBhes for health
The muslims have their own traditional folk forum like the education . The South as_t s1a eg1ona1 ureau (SEARB)
ghazals, the kawali. of the International Union for Health Education was
established in 1983 with headquarters at Bangalore.
The mass media are only "instruments". As such they are
neither good nor bad; what matters is the message they A new division of Health Education and Health
carry and the way the message is delivered (6). There is no Promotion has been established by the WHO. The division
single way to do public education . Health education is still will support regional offices of ~HO in strengthening
art rather than a science . Each community and country national capabilities in health education and promotion, and
should develop techniques that meet its own needs. develop and test new ideas and tools. (The former Division
of Public Information and Education for Health is now
PLANN ING AND MANAGEMENT called Division of Public Information and Public Relations) .
Health education cannot be planned in a vacuum. It is Health education is a complex activity in which different
planned in connection with a specific health programme or individuals and organizations play a part. Among them are
health service. Therefore, the specifics of a health education parents, teachers, friends, physicians, nurses, health
strategy in a local community have to be formulated in workers and various organizations, governmental and
accordance with its socio-cultural, psycho-social, political, non-governmental. No country in the world, least of all a
economic and situational characteristics. The planners country with a large population and small resources such as
should be fully conversant with the health education needs India, can afford to employ institutionally trained health
of the particular programme for which health education is to workers. Therefore, health education should be the concern of
be planned . everybody engaged in any form of community welfare work.
Health education planning follows the main steps in
References
scientific planning, which are :
1. Kumar, K.J . (1982). Business Communication, A Modern Approach .
1. Collecting information on specific problems as seen by Jaico Publication House Mumbai.
the community 2. Lilbert, J .J ., (1977) . Educational Hand Book for Health Personnel.
2. Identification of the problem WHO (offset publication No. 35) .
3. Deciding on priorities 3. Kumar, K.J. (1987) . Mass Communication in India, Jaico Publication
House Mumbai .
4. Setting goals and measurable objectives
4. Dr. Dubey and A.K. Devgan (1969) . Family Planning Communication
5. Assessment of resources Studies in India, NIHAE New Delhi.
6. Consideration of possible solutions 5. O.P Dahama and O.P Bhatnagar (1987) . Education and
7. Preparation of a plan of action : Communication fo r Development 2 nd Ed., Oxford and IBH New
Delhi .
(i) What will be done ?
6. TRS 690P81983 .
(ii) When? 7. TRS695 1983.
(iii) By whom ? 8. UNICEF State of World 's Children 1989.
8. Implementing the plan 9- WHO (1988), Education fo r Health : A manual on health education in
9. Monitoring and evaluating the degree to which stated primary health care .
objectives have been achieved 10 . TR S 766 1988.
10. Reassessment of the process of planning. Planning and 11. NIHAE : A Guide to Commun ication System in Hospitals Tech. Rept 16
Glossary P 33.
evaluation are essential for effective health education . 12 . Last J M Dictionary.
The subject of planning is discussed more fully in
chapter 20. 13 . Green L W (1979) Int. J . of Health Education 22: 161 - 168.
14. Somers, Anne R. ( 1977) . Preu. Medicine, 6 (3) 406.
All health education work requires continuous evaluation 15. TRS409(1969) . P8
to measure the effectiveness of health education activities in 16. Haggerty R.J . ( 1977) . Preuenti ue Medicine 6: 282 .
achieving stated objectives and to assess the importance 011 17 . WHO (1974) WHO Offset Publication No. 7.
pr~gramme per~ormance of such variables as knowledge, 18 . Hea lth For All Sr. No. 1.
attitudes, behaviour change and consumer satisfaction . l9 . TR S 782 (1982) 41 _ 42 .
20 · WHO ( l 972) . Public Health Papers No.47, p. 53 .
ADMINISTRATION AND ORGANIZATION 2 1. Subramanian, R. (1966) . Health Education. A Practical Guide for
Health Personnel , The State Health Education Bureau, Directorate of
Governments have a responsibility for assisting and Health Services Trivandrum .
22 · Garla nd , J .V. (1951). Discussion Methods M H Wilson New York.
guiding the health education of the general public . At the
23 . Kelle EC (195 ' . . ' R
national level , the Government of India in 1956 established N.Y. Y · · O) . The Workshop Way of Learning, Harper & ow.