COMMUNICATION

Communication and Health
Communication
“If all my possessions were taken from me with one exception, I
would hope to keep my power of communication --- for by it I would
regain all the rest.”
--Daniel Webster, American Journalist
A.A, Ethiopia
1
Outline
Definition of Concepts
The goals/Purposes of communication
Component of communication process
Types of communication
Methods of communication
Principles of health communication
Communication Barriers
Major qualities of Effective communication
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Instructional objectives
At the end of this class you are expected to:
• Define communication and HC
• Discuss elements of communication process
• Describe the functions, and types of Communication
• Describe the type of Communication with Individuals, Groups
and Organizations
• Identify barriers communication
• Discuss factors contribute for effective communication
• List the major qualities of effective Communicator
What is Communication?

Concept of Communication
1. Words and symbols have meanings
2. Communication is verbal and non-verbal process
3. Telling is also communicating, but not mere talking
4. Any meaningful social interaction can be communication
5. Communication is an essential part of human life
6. Interpersonal communication = Intimate communication

7. Oral communication needs natural ability
8. By communication we will solve all our problems
9. Communication changes lives
10. Communication can breakdown
Concept of Communication…
Communication is the basic but complex process
Kill him not, let him to live!
Kill him, not let him to live!
 Without communication an individual could never become a

fully functioning human being.
 But, its through communication people transfer facts, ideas,

emotions, knowledge, attitudes and skills to make informed
decisions about their health.

Definitions of Communication
• Communication – Latin = communis = common
• OR to share information, ideas or attitude, to impart, or to
transmit
• An attempt of trying to establish commonness or
common understanding
Evert M. Rogers (1993), defined “communication
– as the process by which an idea is transferred from a
source to a receiver with intent to change his/her
behavior
Allen Louis defines
– “It is the sum of all things one person does when he
wants to create understanding in the minds of another”
Definitions…
“Communication is a process by which two or more people
exchanges ideas, facts, feelings or impressions in ways that
each gains a common or mutual understanding of
the meaning and the use of the message.”
Paul Leagans
“It is a process by which information, decisions and

directions pass through a social system, and the ways in
which knowledge, opinions and attitudes are formed or
modified.”
Loomis and Beegle

Definitions…
“Communication is the force by which an individual
communicator transmits stimuli to modify the behavior
of other individuals.”
Howland
“It is the exchange of facts, ideas, opinions or emotions b/n two
or more people”
Newman and Summer
Thus, communication is giving, receiving or exchanging

information, opinions or ideas so that the “message” is
completely understood by everybody involved.

Communication Goals
To change behavior
To get and give

To get action
Information
To persuade To ensure understanding
Source: CGAP Direct

Communication Theories/Models

Outline
 Why theory/model is important?
 Common communication theories/models?
 Linear (One-way) Models
 Aristotle model of communication

 Laswell model of communication
 Shannon &Weaver model of communication
• Interactive (Two-way) Models
 Schramm’s Models of communication

 Berlo’s Model of communication
 Paul Leagan’s Model of Communication
Theories /Models of communication
 “Model” = “theory”
Why are models useful?

 They help simplify complex ideas.
 They offer an organized way of looking at a complex

process
 All the main points of the relationship or process are described
 The description is simple and clear

Classification of Theories/Models
General categories of communication model
• Currently, communication theories/models can
generally be categorized into three;
Communication Models
• Linear Model
One-way Communication
Sender  message  Channel  Receiver
• Linear type of communication
• Quick if the message is simple and needs quicker
communication
– e.g. date & time of meeting
• Meaning is controlled by a receiver
– what message
– how much communicated
• Messages from experts, educators and mass media
• Motivation of the sender may be personal gain or public good
• No feedback/No input from the receiver
• Learning is authoritative
• No opportunity to clear up misunderstanding
• May be less effective (Does not influence behavior)
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General Representation of Linear Model
of Communication
Noise
Encoding Decoding
Sender Receiver
Channel (Message)
Is this an effective model of communication? Why?
16
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Interactive Model...
•Interactive Model...
•Receiver
•Sender
Fig. Interactive Model...

Interactive models
• Systems (Two-way) Model
MESSAGE
Sender CHANNEL Receiver
FEEDBACK
• Bidirectional information flow

• Behaviour change via interactive communication
– E.g. patient counselling/ telephone conversation/ discussion/ panel
discussion
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Transactional Model ….
Fig. Transactional Model

General Representation of Interactive
Model of Communication
Decoding Message /Channel Encoding
Noise
Sender •Physical Sender
Receiver •Symantec Receiver
•Psychological
•physiological
Encoding Message /Channel Decoding
Feedback is essential to good communication

20
Takele G. (Asst. Prof.) 2021 8/29/2021
Two-way Communication…
Advantages
• Feedback is added
• Allows the sender to find out how much the message is
received- can be monitored
• Can be adapted to suit the receiver’s needs
• More audience participation
• Learning is more democratic
• Sender can affect the quality and quantity of the feedback
through the type of question chosen and the way it is asked
Disadvantages
• Not orderly
• Slower (time taking)
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Process & Components of
Communication

Communication Process...
 The communication process is a system that involves an
interrelated, interdependent group of elements working
together as a whole to achieve a desired outcome or goal
 General Systems Theory stated that every part of the system
is so related to every other part that any change in one
aspect results in dynamic changes in all other parts of the
total system
 It is necessary to think of communication not so much as
individuals functioning under their own autonomous power but
rather as persons interacting through messages
 Is not a linear process rather it is a cyclical process that involve many
elements
 Communication process involves eight elements
Communication Process ....
The Basic Process of Communication
A simple sequenced of 6 steps.
1. The sender wants the receiver to understand the message.
Ideation
2. The message is encoded by the sender, who structures it
into a logical form of code = language
3. When the sender is satisfied with the encoding of the
message; he/she transmits the message verbally or in
writing or electronically, etc
4. The message passes through a channel from the sender to
the receiver
5. The receiver decodes the message
6. The receiver then understands the idea that the sender
wants to convey. Reaction--- response/Feedback
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Components/Elements of
communication

Components/Elements of Communication
1. Source/Sender/Encoder: “Sends Message”

2. Message/Content: “Matter of communication”
3. Channel/Medium: “Vehicle to carry message”
4. Receiver/Decoder: “Audience”
5. Feedback: “Response”
6. Barriers: “Possibilities of communication breakdown”
7. Situations: “Context”
8. System: “Relationship”
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1. Source/Sender
 Originator of message
 Can be individual, group, or institute/organization
 Makes the decision to communicate.
 Begins the communication process by forming the ideas,
intentions and feelings that will be transmitted.
 First, the source must encode, or create, a message.
 Encoding: the process of translating the meaning to be

transmitted into symbolic form (words ,sign, sounds, etc.).
 That is, the information that the source wishes to convey must
be put into a form that can be sent to the receiver.
1. Source/Sender …
 Should have similar background characteristics with
that of receiver
 Sender are required to filter out the details that are

unimportant and focus on the most relevant information
 Also determines the purpose of the message: to inform,

educate, persuade, or entertain
 Source should determine how the message gets from the
source to the receiver
 Source credibility: Communication will be effective when the

source is empathetic, credible (trusted)
Major qualities of effective communicator
• One who is both in the situation of the sender and the

receiver
• Make sure he/she has the full attention of the communication
partner
• Speak in a loud and clear voice
• Formulate the message clearly in a way that can be easily
understood
• Avoid jargon and/or Explain technical terms
• Be able to adapt the same (health) messages to the
educational background of the receiver
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Major qualities …
• Encourage the client to speak openly
• Give full attention to the client
• Listen carefully
• Ensure that the message is understood
• Take questions and concerns of clients seriously
• Answer any questions fully

2. Message/Content
 Message is a piece of information, ideas, facts, opinion,
feeling, attitude or a course of action that passed from the
sender to the receiver. the idea communicated
 In the form of words of the mouth or symbols
 It is the subject matter of communication: something

that is considered important for the audience to know or do
 The code and content of the message should be appropriate

to the receiver and should be arranged in a way that it looks
attractive
Message.....
 The content (idea, innovation, or technology) should be
appropriate to the audiences (composed by codes)
 Treatment: The way the message is prepared, processed

and delivered(arrangement, organization and presentation of
code and content).
 Coherence and Clarity

 Message appeals: The way the content of the message
could be organized so that it can persuade or convince
people
Ex: Fear arousal appeal, humor, emotional, one sided, two-sided

Types of M. appeals in HC
• Fear arousal appeal
• Humour (funny)
• Logical / factual appeal
• Emotional appeal
• One sided message (advantage)
• Two sided message (both adv and disadv)
• Positive appeals: (do something)
• Negative appeals: (don’t do something)
• Guilt appeal?
Fear arousal appeal
• The message is conveyed to frighten people into action by
emphasizing the serious outcome from not taking action.
• Symbols such as dying persons, coffins, grave stones,

skulls may be used.
• It is good for a person with little or no school.

Fear arousing appeals...
HIV/AIDS makes
I am here, my
you to look like HIV/AIDS Makes you
this name is AIDS, to look like this
take care
Humour
 The message is conveyed in a funny way such as cartoon.
 Humour very good way of attracting interest & attention.
 It is good to create a lasting memory but hard to change beliefs and
attitudes,
 It can also serve a useful role to lighten the tension when dealing with
serious subjects.
 Enjoyment & entertainment can result in highly effective remembering and
learning.
 However, humor does not always lead to changes in beliefs & attitudes.
Humour is also very subjective.
 What one person finds funny another person may not.
Logical/Factual Appeal
The massage is conveyed to convince people by giving facts,
figures and information,
 For ex. facts related to HIV/AIDS; its causes, route of

transmission, prevention methods etc. like Telling people the
percentage of people living with HIV virus.
 It carries weight with a person of high educational level.

Information on its own is usually not enough to change behaviors

Emotional Appeal
 The message is conveying to convince people by arousing
emotions, images & feelings rather than giving facts & figures,
e.g. by showing smiling babies, wealthy families with latrine
etc, and associating with FP education.
 A Person with less education will often be more convinced by
simple emotional appeals from people they trust.
 Despite this, many health educators still feel that it is important
to present some factual information because it allows people to
make informed-decision.
 But it is important to be realistic about the limitations of just
relying
8/29/2021 on facts to persuade
Takelepeople.
G. (Asst. Prof.) 2021 39
Emotional appeal
Takele G. (MPH, Asst. Prof.) 41
One Sided Message
 Only presents the advantages of taking action & does not mention any
possible disadvantages. E.g.: Educating the mothers only about benefits
of oral contraceptive pill.
 One sided compared with two sided messages: Presenting only one
side of an argument may be effective:
1) If your audience will not be exposed to different views. However, if they
are likely to hear opposing information, it may create suspicion to take
your advice such as the side-effects from a drug. It is better to be honest
to tell them rather than let people find them out for themselves.
2) If our communication is through mass media such as radio, TV,
newspaper etc. because the audience may only grasp part of the
message or selectively pick up the points that they agree with.
Two Sided Message
Presents both the advantages & disadvantages (pros’ & cons’)
of taking action. Appropriate if:
 The audiences are exposed to different views.

 The audiences are literates.
 We are in face to face with individuals or groups: it is easy to
present both sides and make sure that the audience
understands the issues.

Positive Vs Negative Appeals
Positive:- Communications that ask people to do something, e.g.
breast feed your child, use a latrine.
Negative:- Communications that ask people not to do something, e.g.

do not bottle feed your child, do not defecate in the bush.
Positive compared with negative appeals: Negative

appeals use terms such as “avoid” or “don’t” to discourage people from
performing harmful behaviors. But most health educators agree that it is
better to be positive & promote beneficial behavior.

Characteristics of a effective message
(The 7 C’s of effective communication)
1) Commands attention
2) Cater to the head and the heart
3) Clarify the message
4) Create trust
5) Communicate a benefit
6) Call to action
7) Consistency count

Hierarchy of communication effects
Clarify
Benefit and
consistence
Cater to the
head and heart
Create trust
Call to
action
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3. Channel/Medium
 The channel is the way through which a message is sent out.

 It is the physical bridge or the media by which the message travels
between source and receiver.
 It is also called the medium of communication

Channels include:
 Audio/Verbal- Most common, e.g. Music
 Printed material/Written words
 Visual: e.g. Picture
 Non-verbal communication/Body language
 Any combination: E.g. Combined audio visual (AV

aids are commonly use) and printed materials

Channel...
The commonest types of channel are audio, visual,
printed materials or combined audio visual & printed
materials.
Criteria: Channel Selection
1) Availability
2) Cost
3) Users’ preference and receivers’ access
4) Adaptability to the communication purpose/objective
5) Adaptability to the message content

6) Type of recipient and their stage in the adoption
7) process
4. Receiver/decoder – ‘Audience’
• The person or the group for whom the communication is
intended or the person who receive the message.
• Receiver decodes the message- the act of interpreting

messages.
• Receivers decode messages based on past experiences,

perceptions, thoughts, and feelings.
• The 1st step in planning any communication is to consider

the intended audience.
Receiver ....
Factors which should be considered about the Receiver/ Audience
includes Educational factors and Socio-cultural factors,
Psychological /psychographic factors (attitudes, values, beliefs)
• It is important to understand the audience from the following

perspective
Identification----Analysis .....Segmentation ....Audience Profile
• Patterns of communication- What pattern of communication

already exist in the community, do they listen to radio/TV, what
traditional media are there, what is the best timing to conduct
health communication
5. Feedback
A communication is said to have feedback when the
receiver of the message gives his/her responses to the
sender of the message.
The sender must know how well the messages have been
received by the receiver, understood, interpreted, and act up on
it.
It completes the process of communication.
Negative feedback: when the message has not been

understood. This kind of feedback, conveys lack of
understanding.
Feedback ...
 Positive feedback: when the receiver has understood the
source’s message. It does not necessarily mean that he or she
agrees with the source, just that the message was interpreted
accurately.
 Effect: - is the change in the receiver’s knowledge, attitude &

practice or behavior.
 Positive Effect: - when desired change in KAP occurs;
 Negative effect: - when desired change NO change occurs.

[
Feedback ...
 Effective communicator is always;
 sensitive to feedback and
 constantly modifies his or her messages as a result of

the feedback received
6. Communication Context
 Communication context is the environment
where communication takes place
 They are source of noise which interfere
with communication process
I. Physical context
II. Cultural context
III. Social-psychological context
IV.Temporal (time) context

I. Physical Context
• Tangible or concrete environment e.g. Room or field.
• Exert influence on the content (what we say) as well as

the form (how we say it) of the message.
II. Cultural Context
• refers to the communication rules and norms,
beliefs and attitudes that are transmitted from one
generation to another.
• Direct eye contact between child and adult signifies

directness and honest in one culture and defiance and
lack of respect in other.
III. Social-psychological Context
• include status relationships among the participants and
the cultural role of the society in which they are
communicating.
• include friendliness or unfriendliness, formality or

informality, and seriousness or humorousness of the
situation.
IV. Temporal Context
• Time of day as well as time of history
• For many people morning is not a time for

communication; for others it is ideal
• Appropriateness and impact of messages depend, in part,

on the time in which they are uttered.
Forms/modes of Communication
There are three forms/modes of communication

based on the way of expression.

1. Oral/Verbal
• It is communication by Word of
mouth.
• In oral communication, speech or
talk is the widely adopted tool of
communication.
• May also use mechanical devices
such as telephone, radio, PAS
(Public address system) etc.

Oral/Verbal Communication
Use Oral Communication when;
1) The receiver is not particularly interested in receiving the message.
2) It is important to get feedback.
3) The receiver is too busy or preoccupied to read.
4) The sender wants to persuade or convince.
5) When discussion is needed.
6) When criticism of the receiver is involved.
7) When the receiver prefers one-to-one contact

63
2.Written Communication
• It involves the exchange of facts, ideas, and opinions through a
written instrument /materials
• E.g. letters notes, leaflets, reports, handouts, bulletins,
newspaper.

3. Non verbal Communication
• The gestures we use, how we look at people, our tone of
voice, how we are seated and our clothes can all have an
impact on the way people interpret what we say
• “Action speaks larger than Words”
E.g.
. Pitch of voice
· Laughing, angry
· Pauses, speed of talking
· Stresses on particular words
· Loudness or softness of voice
65
Pros and cons
Communication Pros Cons
Methods
ORAL • Faster – speedy. • No permanent record.
• Allows more interactions.
• Creates informal atmosphere
WRITTEN • Both sender and receiver leave • Danger of being

a record of their message. misunderstood.
• Writing encourages clear • Message can become
thinking. accessible to the wrong
• Best for transmitting policies people or at the wrong time.
and procedures.
NON VERBAL •Meanings are reinforced • Meaning is in the body.

/expression of feeling. •One gesture may have
several meanings and
several gestures may have
the same meaning.

Types of communication
There are four major methods of communication

Cont…
1. Intrapersonal communication
Self-awareness is the part of intrapersonal communication that determines how a
person sees him or herself — and how they are oriented toward others. Self-awareness
involves three factors: beliefs, values and attitudes. Perception is about creating an
understanding of both oneself and one’s world — and being aware that one’s
perceptions of the outside world are also rooted in beliefs, values and attitudes.
Expectations
2. Interpersonal communication
3. Group communication
4. Mass communication
Interpersonal (Face-to-Face)
Face-to-face or interpersonal methods include all those forms of
communication involving direct interaction between the
source & receiver.
In most instances the decisive criterion for personal
communication is.
a) Communication at the same time and/or
b) Communication at the same place.
 Examples of face-to-face communication with increasing audience size
are; one-to-one & counseling; small group (less than 12 persons);
intermediate group/lecture (between 12 and 30); and large group
lecture/ public meeting (more than 30).

Interpersonal…
The powerful advantage of face-to-face communication over
mass media is, it gives the opportunity to ask the audience
questions and obtain their feedback.
In this case, it is possible to cheek that you have been
understood & give further explanations.
However, as the size of the group increases, it is more difficult to
have feedback & discussion.
So, public meetings share many characteristics of mass
media in that they involve limited participation & feedback.
 Main Effect = Changes in Attitude and Behavior
= Acquisition of problem solving skill.
Interpersonal…
Advantages
1) Dynamic or Bi-directional
2) Feedback:- There is a chance to raise question & discuss so that the idea
is understood at the same time and/or place.
3) Multisensory (Channel):- Since the communication is active & interactive
there is high chance of utilizing more than two senses such as seeing,
hearing & touching.
4) Useful is All Stages of Adoption of Innovation
5) Useful When the Topic is Taboo or Sensitive:- For example, it is usually
difficult to discuss about sexual matters in a group meeting as these
issues require expressions of personal feelings & experience.
6) Can Fit to Local Needs:- as it provides open-room for discussion & feed
back
Interpersonal…
Limitations
1) Easily distorted – as we mostly rely on word-of-mouth.
2) Often needs multi-lingual
3) Needs personal status/credibility
4) Needs professional knowledge & preparation

Interpersonal…
For effective interpersonal communication
A. Exchange of ideas with clients;
B. Realize the importance of 1st impression when meeting a
person. A saying ‘1st impression last long’.
C. Learn to observe the person & drive useful information.
D. Keep in mind the same words mean different things to different
persons; perception is highly subjective.
E. Pay attention body language there is a saying “action speaks
louder than words”.

Mass Media Communication
Mass communication is a means of transmitting messages, on
an electronic or print media to a large segment of a
population.
The word media is currently used to refer not only broad cast
media such as radio & TV and print media such as papers,
magazines, leaflets & wall posters but also folk media such
has art, town criers, songs, plays, puppet shows & dance.
The powerful advantage of mass media over face-to-face is
rapid spread of simple of facts to a large population at a
low cost.
Mass Media…
Main effects of this type of communication are:
Increased knowledge/awareness
Influence behaviors at the early stages.
Useful to communicate new ideas to early adopters (opinion
leaders).
Advantages
1) They can reach many people quickly.
2) They are accurate and believable e.g. article on a newspaper, or
“voice” of highly respected person.
3) They can provide continuing reminders and reinforcement.
Limitations
1) One sided /No feedback:- The broad caster transmits his message
without knowing what is going on in the receivers mind.
2) Selective Perception:- Because the audience may only grasp part of

the message or selectively pick up the points that they agree with and
ignore other
3) Does not Differentiate the Target:- In mass communication some

may develop “this does not concern me type of attitude.
4) Only Provides Non-specific Information

For An Effective Mass Media Communication
1) The message/advice should be realistic and pre tested so
that it is transmitted accurately without distortion.
2) While they are useful in creating awareness, it has to be

followed by individual & group approach for an
effective feedback & in turn for attitudinal & behavioral
change.

Comparison of Interpersonal & Mass
media Communication
Characteristics Interpersonal Mass media
Speed to cover Slow Rapid
Accuracy low High
Distortion High Low
Ability to select Highly selective Difficult to select
particular audiences
Direction Two way One way
Local consideration Can fit to local need Provide non specific
information
Feedback Direct feedback possible Indirect feedback from survey
Main effect Change in attitude and behaviour, Increase in knowledge

problem solving skill /awareness 78
Introduction to health
communication (HC)

Health Communication
• Define Health Communication

• List the principles of health communication
• Explain the components of health communication
• Discuss stages of communication
• Explain types of health communication
• Identify the barriers to health communication
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Brainstorming
What do you understand by these terms?
 Health Communication?
 HID
 IEC ?
 BCC ?
 SBCC?
 RCCE?
Evolution: Shifts in communication Strategies
Designation/naming Approaches Used How the Receiver was Perceived
• Information Focus on Information Audience as ‘passive

Education & Dissemination thru’ recipients’ of information
Communication Mass/Traditional Media
Behaviour Change Focus on Individual Audience input and

Communication Knowledge, Attitudes feedback necessary for
and Behaviors design of campaigns
Communication Focus on Individuals Emphasis on participatory

for Behaviour & in context of socio- approaches, community
Social Change cultural norms, social engagement in defining
networks issues & identifying
options for action
Takele G. (Asst. Prof.) 2021
8/29/2021 82 82
HC Evolution …
83
What is Health communication?
It is the art and technique of informing, influencing, and
motivating individuals, institutions, and large public
audiences about important health issues based on sound
scientific and ethical consideration (Healthy people 2010 )
It encompasses the study and use of communication
strategies to inform and influence individual and
community decisions that enhance health.
HC is the study and practice of communicating promotional health

information, such as in public health campaigns, health education,
and between doctor and patient.

Health communication …
• Is crafting and delivery of messages based on consumer’s
research to promote health of individual and community
• It attempts to change or reinforce a set of behaviors in large

scale target audience regarding specific problems in a defined
period of time
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Key Characteristics of Health Communication
 Audience-centered
 Research-based
 Multidisciplinary
 Strategic
 Process oriented
 Cost-effective
 Creative in support of strategy
 Audience and media specific
 Relationship building (HC establishes and maintains relationships with
health providers).
 Aimed at behavioral or social change
Health Communication can be used to influence…
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The Role of HC in HEP
The purpose of disseminating HI is to influence personal
health choices by improving health literacy.
• Increases knowledge and awareness of a health issue/problem,
or its solution
• Influences perceptions, beliefs, attitudes and social norms about
health (helps people understand issues and may change their health beliefs)
• Generates effective action about health behavior (initiates action)
• Demonstrates or illustrates health related skills
• Shows the benefit of behaviour change
• Increases appropriate use and demand for health services
• Reinforces/exchanges knowledge, attitude and behaviour
• Disproves myths and misconceptions
• Advocates
8/29/2021 for a health issue or(Asst.a Prof.)
Takele G. population
2021 group. 88
Communication alone cannot:
• Compensate for inadequate health care or access to health
care services
• Produce sustained change in complex health behaviors

without the support of a larger program for change,
including components addressing health care services,
technology, and changes in regulations and policy

Principles of H. communication
1) Shared perception
2) Sensory involvement
3) Face to face (Interpersonal)
4) Feedback (Two-way)
5) Clarity
6) Correct Information
7) Completeness
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Principles of Health communication
1) Shared Perception: Perception of the sender & the receiver
should be closed as much possible to create effective
communication. The extent of understanding depends on the
extent to which the two minds come together.
2) Sensory involvement/Multi-channel: The more sensory
organs involved the more is its effectiveness from their cumulative
effect.
3) Face to face/Interpersonal: The more communication takes
place face-to-face the more its effectiveness.
4) Two-way feedback : Any communication with two-way
process is effective because of opportunity for simultaneous, timely
& appropriate feedback.

Principles …..
5) Clarity of information: Ideas, facts and opinions should be
clear to the sender before communication happens. It should
be direct, simple, & in easily understandable language.
6) Correct information: The sender should have at hand correct,
current and scientific information before communication.
7) Completeness: Subject matter to be communicated must be
adequate and full which enables the receiver to understand the
central theme or idea of a message.
– Incomplete message may result misunderstandings.
NB: The ultimate goal of all health communication is

to create behavioral change.
Levels of health communication
 The more levels a communication programme can influence, the greater the
likelihood of creating and sustaining the desired change
 The different levels at which health communication can take place are;
1) Individuals (counselling on sexual risk reduction)
2) Social networks (individual’s relationships & groups (family) - family-based HIV
counselling and testing, or peer education
3) Organizations (institution-based health programmes providing services such as
VCT, or antenatal and child health services)
4) Communities (creating structures and policies that support healthy lifestyles and
reduce or eliminate hazards in social and physical environments)
5) Society (norms and values, attitudes and opinions, and laws and policies. Society also
creates a physical, economic and cultural environment).
– Using Mass media and other types of social mobilization
– HIV or TB educational programmes can be achieved through school, church and workplace education
programmes
Approaches of H.communication
1) Informative: The new idea is introduced and made
familiar to the target audience
2) Educating: The new idea is explained including its

strengths and weaknesses
3) Persuasive: The audience is given convincing argument

that motivates them to take an action or accept a new idea

Approaches …
4) Prompting: Messages are designed so that they are not
easily ignored or forgotten, or to remind the audience about
something and reinforce earlier messages.
5) Entertaining: The attention of the audience is drawn to

the new idea by stimulating the audience’s emotions
6) Edutainment?

STAGES OF COMMUNICATION
 We communicate for special purpose ; to promote
improvement/change in health through the modification of
the human, social and political factors that influence
behavior.
 To achieve these objectives, a successful communication
must pass through several stages- six stages

Communication Stages: Six Stages
Stage 1. Reaching the intended audience
– Message reach Audience (heard or seen)
Stage 2. Attracting the audiences attention
– Attract/Gain attention so that people read or see it
Stage 3. Understanding the massage
– Understood- KISS (Keep It up Short & Simple) & Avoid technical words
Stage 4: Promoting Change (Gain acceptance)
– Believed, credible source, easily demonstrated effect
Stage 5. Producing a Behavior Change
– Produce change (KABP)
Stage 6. Improvement in Health
NB. Communication failure can occur at each stage
97
Stages of Health Communication
Sender receiver
Reaches senses
Gains attention
Message understood
Acceptance /change
Behavior change
Change in health
Stage1. Reaching the Intended Audience
 Communication can not be effective unless it is seen or
heard by its intended audience.
 Communication should be directed where people are
going to see or hear them.
 This requires sound study of your intended audience to
find out where they might see posters, listening & reading
habits.
 A common cause of failure in this stage is preaching the
converted like
 Posters placed at the clinic or
 Talks given at antenatal clinics.
 These only reach to the people who are already
motivated & attended the service.
Stage 2. Attracting the Audiences
Attention
 Any communication must attract attention so that people
will make the effort to listen and read it.
 Attention: is the process by which a person selects part of
the message to focus on while ignoring others for the time
being. Attract attention ...
 Examples of failure at this stage are:
• Walking past the poster with out bothering to look at it;
• N ot p ay i n g a tte nt io n t o th e h e a l t h ta l k or
demonstration at the clinic;
• Turning off the radio programs or switching over.
Stage 3. Understanding the Message
 Once the person pays attention to a message he/she then
tries to understand it
 The message should perceived/understood as
intended by the sender
 Message may misunderstood at this stage and cause
communication failure
 Examples of failures at this stage can take place when;
 Complex language & unfamiliar technical words are used;
 Pictures containing complicated diagrams and distracting details
 Pictures containing unfamiliar/strange subjects
 Too much information is presented and people can not absorb it
at all
Understood?
Too much and strange message photo
Stage 4: Promoting Change
(Acceptance)
• A communication should be believed & accepted.
• Credible sources enhance acceptance
Stage 4: Promoting Change
(Acceptance)...
 It is usually easier to promote a change when its effects can
be easily demonstrated
 For example, ventilated improved pit latrines do not smell,
 If people become green in color when they get HIV/AIDS - it
is easier to promote change.
Stage 5. Producing a Behavior Change
 Communication should be resulted in behavior change

(change in KABP)
 However, a communication may result in a change in beliefs
and attitudes b u t s t i l l n o t i n f l u e n c e behavior/action.

 This can happen when the communication has not been aimed at the
belief that has most influence on the person’s behavior. E.g. lack of
enabling factors to realize the behavior.
Stage 6. Improvement in Health
 Communication should resulted in improvement in health
 Improvement in health will only take place if the

behaviors have been carefully selected so that they really influence
health.
 If your messages are based on outdated & incorrect ideas, people

could follow your advice but their health would not improve.
7. Barriers to communication

7. Barriers/Noise
 Barriers are any obstacles or difficulties that come in the
way of communication
 It can occur at any stage of communication
process
 The source’s information may be insufficient or unclear. Or

the message can be ineffectively or inaccurately encoded.
 The wrong channel of communication may be used
 The message may not be decoded the way it was
encoded
 Finally, the receiver may not equipped to handle the
decoded message in such a way as to produce the
response (feedback) expected by the source
Barriers...
 Barriers may be:
1. Physical:- hearing or visual impairments
2. Intellectual :- ability, home background, schooling affects the
perception/understanding of the receiver for what he sees & hears.
The ability of the facilitator/education/instructor
3. Environnemental :- Noise, invisibility, congestion,
4. Mechanical:- Lack of comm. facilities
5. Psychological:- status or Perception Gap b/n source and
receiver
6. Emotional:- emotional status of the source/receiver
7. Cultural or
8. Linguistic in nature
9. Inconsistence b/n verbal & non-verbal comm.
1. Physical Barriers
There are four main kinds of distractions act as 'physical barriers' to
the communication process. These are:
A. The Competing Stimulus in the form of another

conversation going on within hearing distance in the
background. E.g. Difficulties in hearing, seeing.
B. Environmental Stress: A high temperature and humidity, poor

ventilation, vibrations felt etc. - all can contribute to distortions in the
sending and receiving of messages. E.g. Environmental barriers like
Noise, invisibility, congestion
Physical barriers ...
C. Subjective Stress: Sleeplessness, ill health, mood
variations
• give rise to forms of subjective stress that often lead
to great difficulties in listening and interpretation.
D. Ignorance of the Medium: The use of a medium with

which
• the communicators are not familiar would turn the
medium itself into a barrier.
 In appropriate physical facilities
Physiological/Physical…
• Illness, fatigue, pain etc
• Sensory impairment
• Clothes, jeweler, perfume
• Eye contact, tattoos
• Poor listening skills and receiver distortion
• Personal problems
• Lack of common experiences
• Misreading of body language
• Age and sex difference
• Sender used too many technical words for the audience
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2. Psychological Barriers
• Each of us has a certain ‘frame of reference', a kind of
window through which we look out at the world, at
people, and events and situations-perception process
• A frame of reference to some extent controlling an

action, or the expression of any belief, attitude or idea and
interpretation of events.
• No two individuals possess exactly similar frames of

reference, even if they are identical twins.
E.g. Status of the source

Psychological.…
Attitudes/Beliefs related to:
• Sender or the information
• Lack of interest in the message
• Fear and mistrust
• Negative attitude and distorted perception
• More affinity to self rather than audience
• No entry point of agreement
• Aggressiveness
• Power play
• Communication apprehension
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Environmental
• Noise and Distractions
• Problems associated with media
• Time of day, day of the week
• Room set up, color, temperature
• Place of the education center
• Lack of services
8/29/2021 116
3. Linguistics and Cultural Barriers
When the same language is made use of in a different
culture, it takes on another color, another meaning.
Cultural
Customs, beliefs, religion, attitudes, economic and social
class differences, language variation.
4. Mechanical Barriers
 Mechanical barriers are those raised by the channels
employed for communication.
 Channels become barrier when the message is interfered

with some disturbance, which (1) increased the
difficulty in reception or (2) prevented some elements of the
message reaching its destination or both.
 The absence of communication facilities too would be a

mechanical barrier.
5. Intellectual
 The natural ability, home background, schooling affects the
perception of the receiver for what he sees & hears.
 The ability of the facilitator/ education/ instructor.
119
8/29/2021 Takele G. (Asst. Prof.) 2021
Barriers ….
• Barriers can inhibit communication result in
– Misunderstanding
– Lack of response or motivation
– Distortion of message
– Conflict of views
– Insecurity
– Inability to make effective decision
– Prevent the achievement of project/program goals
120
How to Achieve Effect Communication ?
 To maintain the quality of communication we have to how to deal with the
barriers
 Any communication process should be consider all aspects of its

components to obtain effective outcome .
 The communicator should be knowledgeable, positive attitude, skilled

and have credibility.
 The message should be simple (or brief & clear) meaningful, appropriate,
relevant, and timely (SMART).
 The channel should be familiar, appropriate, available & accessible.
 The receiver should also be responsible with proper attitude to receive the
information.
How to Achieve Effect Communication ?
 Provides opportunities for dialogue and discussion to get the
feedback on understanding and implementation.
 Communicating with small groups and being direct.

 Using language easily understood and spoken by the target
group.
 Increasing the similarities between the sender and the
receiver.
 Keeping the message short and clear.
 Putting yourself in the receiver’s shoes.
 Using multiple ways of communicating – verbal, written,
audio or visual.
 Keeping confidences and listening.
Attributes of Effective Health
Communication
1) Accuracy 7) Reliability
2) Availability 8) Reach
3) Balance
9) Repetition
4) Consistency
10) Timelines
5) Cultural competency
11) Understandability
6) Evidence base
8/29/2021 124
Elements of Effective Health Communication
Essential to planning effective health
communication is some variation on these steps:
 Review background information to define the problem (What's out there?)
 Set communication objectives (What do we want to accomplish?)
 Analyze and segment target audiences (Who do we want to reach?)
 Develop and pretest message concepts (What do we want to say?)
 Select communication channels (Where do we want to say it?)
 Select, create and pretest messages and products (How do we want to say
it?)
 Develop promotion plan/production (How do we get it used?)
 Implement communication strategies and conduct process evaluation
(Getting it out there)
 Conduct outcome and impact evaluation (How well did we do?)

Thank You!

COMMUNICATION

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COMMUNICATION

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Communication and Health

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3. Telling is also communicating, but not mere talking

4. Any meaningful social interaction can be communication

5. Communication is an essential part of human life

6. Interpersonal communication = Intimate communication

 Without communication an individual could never become a

 But, its through communication people transfer facts, ideas,

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“It is a process by which information, decisions and

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Thus, communication is giving, receiving or exchanging

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To get and give

To persuade To ensure understanding

Source: CGAP Direct

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 Linear (One-way) Models

 Aristotle model of communication

 Schramm’s Models of communication

Why are models useful?

 They offer an organized way of looking at a complex

 All the main points of the relationship or process are described

 The description is simple and clear

Is this an effective model of communication? Why?

Fig. Interactive Model...

• Bidirectional information flow

Fig. Transactional Model

Decoding Message /Channel Encoding

Encoding Message /Channel Decoding

Feedback is essential to good communication

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1. Source/Sender/Encoder: “Sends Message”

 Encoding: the process of translating the meaning to be

 Sender are required to filter out the details that are

 Also determines the purpose of the message: to inform,

 Source credibility: Communication will be effective when the

• One who is both in the situation of the sender and the

8/29/2021 Takele G. (Asst. Prof.) 2021 31

 In the form of words of the mouth or symbols

 It is the subject matter of communication: something

 The code and content of the message should be appropriate

 Treatment: The way the message is prepared, processed

 Coherence and Clarity

Ex: Fear arousal appeal, humor, emotional, one sided, two-sided

• Logical / factual appeal

• One sided message (advantage)

• Two sided message (both adv and disadv)

• Positive appeals: (do something)

• Negative appeals: (don’t do something)

• Symbols such as dying persons, coffins, grave stones,

• It is good for a person with little or no school.

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 For ex. facts related to HIV/AIDS; its causes, route of

 It carries weight with a person of high educational level.

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 The audiences are exposed to different views.

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Negative:- Communications that ask people not to do something, e.g.

Positive compared with negative appeals: Negative

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