COMMUNICATION IN HEALTH

Communication in health is the sharing of unbiased information to facilitate optimal patient and
family cooperation for the delivery of care, professional education, and policy development toward
individual and population wellbeing. Communication, the most important skill in life, is a process for
sharing information. Hence, human communication goes far beyond just disseminating information.
Effective human communication is based on mutual trust, and aims to influence behaviour. Further,
strategic communication is the art and science of using interpersonal and technical skills for the
exchange of information among individual, group and community stakeholders to promote human
development.

Strategic communication is used in healthcare to engage all stakeholders who are critical success
factors for promoting voluntary behaviour change. Otherwise, important actions that are vital to the
overall success of health programmes can be blocked by people or groups who fear - rightly or
wrongly - that their interests will be negatively affected. In Nigeria, there are many examples of new
policies or programmes designed to improve healthcare delivery that did not work well in practice as
a result of this barrier. Communication, non-verbal and verbal, should be active, effective and
efficient and may use direct and indirect modes including ICT to make human connections. There are
three levels of communication that are useful in healthcare: interpersonal (Clinical Consultation);
community-based (Health Communication); and mass (Internet-based) communications or a
combination of all three levels (Health Informatics or Health Information Systems).

CLINICAL CONSULTATION

Clinical Consultation in routine medical practice involve interpersonal communication between the
doctor or health professional and patient or patient caregivers to facilitate service delivery.
However, it is of crucial importance that information sharing should respect confidentiality: basically,
permission must be sought and consent obtained prior to any discussion with third parties.

Patients are now increasingly knowledgeable and well-informed with a higher expectation for
information and quality care from health providers. As a result, it is important to project a positive
attitude during direct communication with clients bearing in mind that normal transmission of
messages involve 7% spoken word, 38% tone of voice and 55% body language. Listening is just as
important as talking, and conveying empathy assists patients to feel heard and understood. Good
communication enhances ethical relationships among patients and professional staff while reducing
the risk of litigation. Several factors, particularly practitioner personality traits and system issues
including patient flow and working patterns can influence communication in healthcare settings.

In routine clinical practice, patient-centred care refers to care that is respectful of and responsive to
individual patient preferences, needs and values, ensuring that patient values guide all clinical
decisions. The pivotal role of communication in ensuring patient satisfaction and sustainable
relationships even in the event of an adverse outcome cannot be over-emphasized. For instance,
while only 3% of patients who suffered negligence filed a lawsuit, 70% of litigation is related to poor
communication after an adverse outcome where patients feel that: they lacked information or were
misunderstood, they deserve an apology (and did not get one), the providers did not listen and were
unresponsive, and they want to protect others to prevent recurrence, and to seek revenge.

Always remember, a satisfied patient makes a satisfied doctor and health team. Patients do not care
how much you know until they know how much you care. Endeavour to enhance the patient feeling
of connection, being understood, and appreciated. Good communication requires practice.

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HEALTH COMMUNICATION

Health communication uses powerful human interaction techniques such as mass media,
community-based activities, and interpersonal communication, to positively influence individual and
collective behaviors that determine health and well-being of a population. There are six domains of
individual and collective health behaviors which often overlap that can be influenced by health
communication: freestanding, personal, or lifestyle behaviors (handwashing or safety helmets); care-
seeking behavior or demand; provider behavior; client adherence and collaboration; policy or
priority setting; and pro-social and anti-social behaviors (promoting child marriage or rejecting family
planning).

Interpersonal communication includes provider-to-client, peer-to-peer, or partner exchanges, and

training and skills building activities in small groups designed to provide personalized assistance,
increase self-efficacy and facilitate intentions to act. Community-based communication includes
sociocultural activities using church or mosque bulletin boards, community or parental teacher
meetings, posters, stop-and-go dramas, roadshows, rallies, cultural fairs, and community radio.
Community-based activities can stimulate community dialogue, motivate collective solutions and
foster social support. Mass media such as television, radio, newspapers, magazines, billboards,
transit advertisements; and social media or Internet platforms including Facebook, WhatsApp,
Twitter, blogs, YouTube videos, SMS, and podcasts have a high potential for messages to reach
broad audiences rapidly, repeatedly, efficiently and consistently.

The mode of health communication selected rests on a strong foundation called a situation analysis,
which is guided by research that focuses on identifying the: health issue, target audience(s), desired
changes, and factors that influence these changes. Often, it is necessary to segment an audience into
smaller groups who are alike in demographic, geographic, socio-cultural and psychosocial profile
with similar communication-related needs, preferences, and characteristics.

In Health communication, the questions that help inform mode or channel selection include:

 Who is the target audience (most important stakeholders)? What are the best channels to
use to reach each group? What are their preferences in terms of format or approach, if any?

 What are the resource constraints? What may be realistically developed and implemented
within available budget, timeline and technical expertise in-house and externally? How may
this limit (or expand!) format and channel selection?

 What format is most likely to support change in priority behavioral determinants? What is
the trend in the past, or what type of messages has been shown to work in this setting in
health communication, commercial marketing and entertainment media?

 In other settings, what type of collaboration or community engagement have been

successfully used by programmes addressing the same audience and behavior?

 How will you measure and know how effective your communication strategy has been?

In practice, health communication can improve quality of health services by enhancing client-
provider communication; increase correct knowledge and awareness of an issue, problem, or
solution; and enhance the appeal of health products and services through promotion. For example,
health communication can increase utilization of vaccination and family planning (FP) by: increasing
knowledge and awareness of FP; dispelling myths or misconceptions about FP and reproductive
health; shifting social norms to promote discussion of FP; and improving client-provider interactions.

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HEALTH INFORMATICS

Health Informatics or Health Information Management is the use of Information and

Communications Technology (ICT) as a critically necessary database and analytical tool to generate
information for evidence-based decision-making and managing complex healthcare challenges.
Health Informatics, inclusive HMIS or EMR or DHIS2, facilitates the coordination, monitoring and
evaluation, and management of information and communication in a rapidly changing complex
healthcare environment. Researchers, policy makers, providers, payers, managers and patients all
require more information and the necessary skills for to process it. In recent times, information
technologies in health has led to better quality of care, patient safety and treatment adherence, and
healthier lifestyles, surveillance of epidemics, support care for people with chronic illnesses, and
enable more efficient management of supplies and other inputs.

Currently, several ICT Applications (mHealth and eHealth) including complex integrated analytical
platforms such as the DHIS2 (District Health information System version 2) are being used in
healthcare for Patient Management, Disease Management, Quality Management, Utilization
management, Resource management, Finance and Fiduciary Management, and Population Health.
Besides improved efficiency and transparency as well as accountability, Health Informatics assures
higher levels of security and confidentiality of patient health information as they usually require
authentication to be accessed compared with easier access the patient's physical files.

Information may be disseminated by storytelling and through participatory seminars, audience-

centered materials, web-based tools, and other interactive academic and social platforms. Currently,
traditional intercoms and analogue telephone and mobile web-based communication methods such
as GSM, SMS and emails are being supplemented by data visualization, dashboards and platforms
that employ series of photos, infographics, storyboard with hand-drawn video, 3D animations, HD-
videos, and an in-person live chat via messages on WhatsApp, Facebook, Twitter, Snapchat,
Instagram, Google+, Pinterest, LinkedIn, Skype and YouTube, among others. Important
considerations for a choice of an effective communication channel should include an adequate
understanding of your audience preferences:

i. Do they communicate online or offline?

ii. If they are on social media, which sites do they use?
iii. If they have limited internet access, avoid videos and consider print materials, DVDs, or flash
drives so that they can access your data whenever needed.
iv. Are they all attending a training in person where the visualization could be shared?
v. Do you need to create translated versions of your digital messages for non-English speakers?
Aside from using Microsoft PowerPoint and Excel (or SPSS) to build graphs, charts and static maps
for a print report or format a storyboard as a slidedeck, a few infographic design tools to consider for
designing your presentations include Piktochart, Infogr.am, Easel.ly, Canva, and STATcompiler.
Data visualization medium such as posters or infographics or videographics can be a strategic
communication tool for simplifying complex health information particularly in low-literacy areas.

Online interactive graphics and maps can help to understand a data story and are being used in
global health to explore international aid projects worldwide, allowing for interpretation of regional
patterns and comparisons. DHIS2 is typically used as national health information systems for data
management and analysis purposes, for health program monitoring and evaluation, as facility
registries and service availability mapping, for logistics management and for mobile tracking of
pregnant mothers in rural communities thereby helping health organizations to manage their
operations more effectively.

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ART THERAPY

Overview

Art therapy is a form of expressive therapy that uses the creative process of making art to restore or
improve a client’s functioning towards physical, mental, and emotional well-being.

"The Healthiest Form of Projection is Art" (Fritz Perlz - Gestalt Therapist). Creating art is a very
effective way to stimulate the brain and is particularly helpful for maintaining mental health. Art
therapy, sometimes called creative arts therapy or expressive arts therapy, is a mental health
profession in which clients, facilitated by the art therapist, are encouraged to understand and
express their emotions through creative artistry. Expressive arts therapy may use performing artistry
such as poetry, dance and movement, music; and creative artistry (drawing, painting, sculpture,
carving and other art forms) in one therapeutic session. This treatment helps the clients to improve
reality orientation, increase self-esteem, develop social skills, reduce anxiety, manage behavior and
addictions, and enjoy the personal excitement of making art.

Today art therapy is widely practiced in hospitals, psychiatric and rehabilitation facilities, wellness
centers, forensic institutions, prisons, schools, crisis centers, senior communities or nursing homes,
private practice, and other clinical and community settings, corporate structures and open studios.
Basically, a master’s degree is required for entry level practice in art therapy.

Benefits of art therapy

Individuals who benefit from art therapy include those who have developmental, educational,
medical, and psychosocial impairment: severe trauma (PTSD), depression, cancer, traumatic brain
injury, eating disorders, autism, dementia, and chronically ill individuals undergoing hemodialysis
treatment have reported lower levels of stress and an increased sense of purpose.

Art Therapy Exercises

These activities briefly describe, using only materials and colors that you find calming, how to draw
or paint or mold your emotions by focusing entirely on a free artist expression of what you are
feeling without self-judgement of your work. Work collaboratively: art can be better when two work
at it together, so find a partner and collaborate on just about anything. No painting skill or
experience necessary - only a desire to relax and become more creative.

Clinically effective art therapy exercises include, but are not limited to, the following:
Emotions Deal with emotions such as anger and sadness through these helpful exercises. Use line
art Line, one of the simplest and most basic aspects of art to draw an object. Make a meditative
painting to document a spiritual experience you have had in your life. Design a postcard which you
don't ever have to send, turn a wisdom quote into something visually inspiring, or send away
negative emotions and spread positive ones by attaching a message to a balloon and setting it free.
Explore puppet therapy: puppets are not just for kids. Make your own comfortable, soft, cuddly
objects or stuffed animal and have them act out scenes that make you upset. Build a "home" or
create a family sculpture. Create a safe, warm place that feels like home to you, and make a clay
representation of each family member: mother, father, siblings, relatives and influential family
friends to explore emotional dynamics within your family.

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Happiness These activities are all about reflecting on your personal happiness. Take photographs of
things you think are beautiful. Collage your own vision of a perfect day: print and frame new photos,
old photographs or make copies, to have constant reminders of the beautiful things in life. Think up
a wild invention: For instance, build your own website or make art out of recycled items. Either way,
you'll get insights into how you can reshape and reevaluate your own life.

Portraits Create an archetype: design a past, present and future self-portrait to reflect where you
have been, who you are today, and how see yourself in the future. Draw yourself as a warrior or
superhero or a strong, capable person inspired by the people who matter most to you in life.

Relaxation Create to music: Letting your creativity flow in response to music is a great way to let out
feelings and just relax. Simply use a mandala for coloring a design in a coloring book or draw shapes
and scenes in sand. Like a Zen garden, this activity can be a great way to clear your mind.

Trauma and Loss Make art that is ephemeral: Sometimes we have a hard time letting go, but this
project will teach you that it's ok if something doesn't last. Use materials like sand, chalk, paper or
water to create art that you will destroy when it's done to reflect recovery from a loss in your life.

Collaging Create a motivational collage: If you prefer to cut and paste rather than draw or paint,
these projects will help you to create a motivational collage which can be hung somewhere you will
see it every day. Create a face collage on a mask and showcase the face you put on for the world.

Self Illustrate a fairytale: Put yourself into a happily ever after situation and create a visual
autobiography or timeline that journals the most significant moments in your life story. Then, sculpt
your ideal self or simply draw a mirror (discard your faked self and see a reflection of your true self).

Gratitude Celebrate Spirituality: sculpt spirit figures, build a personal altar or paint a rock to express
gratitude for your achievements and your support network, or to help you connect spiritually.

Mind Works Draw your dreams: keep a dream journal and use it to create a visual representation of
how your mind works. Create your own interpretation of a famous work of art such as Mona Lisa.

Miscellaneous Use your body as a canvas: Paint on your hands and feet or anywhere else. Paint for
someone else and help someone else do so as well as it can be a great way to feel good.

Recently, several self-help Apps out there that can help manage stress and anxiety on a daily basis
such as Pacifica, Happify, My Mood Tracker, The Worry Box and Self-Help Anxiety Management.

In conclusion, communication is vital for informing, equipping and motivating win-win actions.

CASE Study 1 A 24-year-old student collided with a massive object on a bike path. She had a broken
shin bone, causing her leg to be in a cast, and walked with crutches. She was intensely angry at
herself and at the object, and repeatedly blamed herself for the accident. During sessions of art
therapy, she chose a large sheet of paper to draw a large rectangle in the middle of a road, adding a
black coloured figure next to the rectangle, calling herself stupid for not seeing the object.

The art therapist suggested that she add colors to the black figure to represent different
characteristics of her personality. By adding the colors, the client noticed that even with the "black"
of her figure, her overall image was colourful and bright, and that her anger was only a small part of
herself - not her entire person. Eventually, the art process calmed her and she was able to reframe
her anger, giving her the ability to control her emotions. Effective art therapy led to healing this
woman's trauma, preventing more severe, long-term problems.

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CASE Study 2 A student who seemed to have sailed right through the clinical exam presentation of a
patient was asked by one of the examiners: “Did you note any thoughts of self-destruction?”

After a moment of horror-struck silence, the candidate quickly recovered and continued as follows:
“I completely forgot to ask my patient whether she had ever tried to kill herself or ever had any
thoughts to that effect. If I were seeing her in my practice, I'd immediately go out, bring her back
into the office, and ask her ‘Have you ever had any thoughts about harming yourself, made any
suicidal attempts.' I'd want to know all the details of any attempts—methods, degree of suicidal
intent, any physical harm. This is really important information as suicidal behavior figures in the
diagnostic criteria for the mood disorders and borderline personality disorder as well as in a number
of other conditions where it isn't a DSM-IV criterion such as schizophrenia, substance abuse, and
somatization disorder. I can't imagine forgetting to ask, except that I am pretty nervous.”

At the end of the session, the examiners instantly agreed that the candidate deserved to pass.

Questions

1. Define art therapy and list five examples of art therapy exercises that are clinically effective
for resolving the emotions of anger and sadness.

2. What are the important considerations for a choice of an effective communication for
increasing the utilization of mental health services?

References

1. American Art Therapy Association. (2013). What is art therapy? Retrieved from
http://www.arttherapy.org/upload/whatisarttherapy.pdf

2. Center for Health and Healing. (2011). Art therapy – history and philosophy. Retrieved from
http://www.healthandhealingny.org/complement/art_history.asp

3. Arts therapies. (2014, September 27). Retrieved from

http://www.mentalhealthcare.org.uk/arts_therapies 

4. Stuckey, H. L. & Nobel, J. (2010). The connection between art, healing and public health: A
review of current literature. American Journal of Public Health, 100(2), 254-263.

5. Health Communication for Managers Course, USAID, 2016.

6. Howard Green (2018): The Death of Physician-Clinician Medical Innovation in America.

Published on LinkedIn, September 29, 2018