Unit- IX

Information, Education and Communication

• Health behaviour & health education.
• Planning for health education.
• Health education with individuals, groups and community.
• Communicating health messages.
• Methods & media for communicating health messages
• Using mass media
 INTRODUCTION
• Community health nurse or public health nurse is engaged in the delivery
of health services to the public or community.
• Health education constitutes major thrust area of community nursing
services.
• The focus of health education is on the risk factors to health problems,
and behavioral modification of the individual or group to achieve the
desired health goals.
• Since an individual's own actions or behavior can make him/her healthy
or ill, modification of health behavior is the ultimate aim of health
education.
Health Behaviour
 Health Behaviour

 Health behavior refers to the actions taken by an individual to attain,

maintain, and regain good health and to prevent illness.
 Health behavior is any activity undertaken by an individual, regardless of
the actual or perceived health status, for the purpose of promoting,
protecting, or maintaining health.
 Certain people behave in a healthy way while others do not.
 Given below is the list of factors that affect the health behavior of a
person.

 Beliefs
 Values
 Culture
 Thoughts
 Feelings
 Knowledge
 Attitudes
 A person has many different thoughts, feelings, and ideas in his/her
mind about the world. Furthermore, these thoughts or feelings are shaped
by knowledge, beliefs, and attitudes of a person.
 Belief
• Belief is something which is accepted on the basis of faith not on
objective evidences.
• The factors that affect the belief of a person include the influence of
parents, relatives, friends, and significant others. It affects the health
status of a person as it can be beneficial, injurious, or neutral.
For example, if parents have the habit of smoking, then it can lead to a
positive belief in the mind of child that smoking is something which is
not injurious, and this may encourage the child to start smoking
 Values
• Values constitute another factor that affects the health behavior of a
person.
• It refers to thoughts and feelings to which one attaches the most worth
and importance.
 Culture
• The culture to which a person belongs also has an impact on the health
behavior of a person.
• Each culture has its own way of doing things and has its own system of
beliefs
• For example, in some culture there is belief that mother's first milk
(colostrums) should be discarded as it is for the God and is not beneficial
for the child.
 Health Behavior Modification

• Health education in terms of “health behavior modification” aims to

encourage positive behaviors and to discourage negative health behavior
among people.
• Modification in health behavior is not as easy as it seems theoretically. It
is the most difficult and cumbersome task because the human behavior is
deeply rooted in the thinking, attitude, values, and health beliefs of a
person.
• A nurse can use different strategies to help a person or community to
modify their health behavior and adopt a behavior that is good for health.
• Forceful/punishment: A democratic government can control the health
behavior of the citizens by enacting law, rules, and regulations.
For example, the government of India has banned smoking at public places
and helmet and seat belts are necessary for all the drivers.
• Informed choices: Nurses’ help people to make informed choices by
providing them all the necessary information relating to their health.
 Health Belief Model

• HBM was first developed in 1950s by social psychologists Hochbaum,

Rosenstock and Kegels working in the U.S. Public Health Services.
• The model was developed in response to the failure of a free tuberculosis
(TB) health screening program.
• The model focuses on the attitude and beliefs of an individual to explain
and predict their health behaviors.
The principal components of Health Belief Model are:
Individual perception:
Perceived Threat:
It is further divided into two parts: perceived susceptibility and perceived
severity of a health condition.
• Perceived susceptibility: It is the subjective perception of the risk of
contracting a health condition.
• Perceived severity: It refers to feelings that are concerned with the
seriousness of getting a disease or of leaving it untreated which includes
evaluations of medical, clinical, and social consequences.
 Modifying factors
Includes demographic, psychosocial, and structural variables, can affect
perceptions (i.e., perceived seriousness, susceptibility, benefits, and
barriers) of health-related behavior
• Demographic variables include age, sex, race, ethnicity, and education,
among others.
• Psychosocial variables include personality, social class, and peer and
reference group pressure among others.
• Structural variables include knowledge about a given disease and prior
contact with the disease, among other factors. 
The HBM suggests that modifying variables affect health-related behaviors
indirectly by affecting perceived seriousness, susceptibility, benefits, and
barriers.

 Cues to Action: Cues to action are those events or happenings which may
be either bodily (physical signs and symptoms of a disease) or
environmental (public awareness camp) that motivate an individual to
take action.
 Likelihood of action
• Perceived Benefits: It refers to the perceived benefit of the strategies
designed to reduce the threat of disease or illness.
• Perceived Barriers: These are the consequences that may happen due to
the particular health actions, including physical, psychological, and
financial demands.
 HEALTH EDUCATION

 Health education is an educational program or process which is directed

to improve, maintain, and safeguard the health care of the community.
 It is the process by which individuals and groups of people learn to
behave in a manner that is conducive to the promotion, maintenance, or
restoration of their health.
 It is a social science that stems from the biological, environmental,
psychological, physical, and medical sciences to promote health and
prevent disease, disability and premature death through education-driven
voluntary behavior change activities.
 DEFINITION

The World Health Organization defined Health Education as “comprising

of consciously constructed opportunities for learning involving some
form of communication designed to improve health, including improving
knowledge, and developing life skills which are conducive to individual
and community health

The definition of health education as per Alma Ata declaration is “a process

which is aimed at encouraging people to want to be healthy, to know
how to stay healthy, to do what they can individually and collectively to
maintain health, and to seek help when needed.”.
 Purposes of Health Education

• To promote health and prevent diseases

• For early diagnosis, management, and referral.
• To promote the use of the available health services in the community.
• To develop a sense of self-responsibility among community people for
health and health behavior
• To promote good health practices among individual patients as well as in
the community. For example, sanitation, clean drinking water, etc.
• To promote use of preventive services. For example, immunization,
mammography, antenatal and child health clinics.
• To promote the correct use of medications and the pursuit of
rehabilitation regimens.
• To improve the health status of individuals, families, communities,
states, and the nation.
• By focusing on prevention, health education reduces the costs of medical
treatment.
 Characteristics of Effective Health Education

• While planning for health education, the following characteristics of

effective health education should be given due emphasis:
• Health education should be directed at those people who have influence
in the community (e.g., Sarpanch, Patel, Mukhiya, etc.).
• It uses simple local language with local expressions to communicate the
health messages.
• It avoids jargons, technical words that are not understandable by the lay
persons.
• It is adaptable and uses existing channels of communication.
For example, songs, drama, and story telling.
• It should be repeated and reinforced over time using different methods.
• It uses demonstrations, role play, and nukkad natak to show the benefits
of health behavior modification.
 Contents of Health Education

• The content of the health education is determined by the need of the

individual or community.
• Given below are some important areas of health education which a nurse
encounters in daily practices of clinical or community work.
 Biological changes
 Nutrition
 Personal hygiene
 Personal habits
 Safety rules
 Knowledge of common disease
 Preventive measures
 Proper use of health services
 Sex education
 Special education for groups
 Breast feeding
 Immunization
 Oral rehydration
 Principles of healthy lifestyle (e.g., sleep, exercise)
 Planning of Health Education

• Planning of health education is based on the need of an individual or

group for health education.
• Decision has to be made regarding what the desired change in health
behavior should be, where the health education should take place (ward,
school, community), and how it should be done.
• The following steps can be taken in planning of the health education
session:
 Identify the need for health education by an individual or group
 Determine the purposes of the health education for an individual or a
group.
 Determine the content for the education
 Prepare AV aids to communicate effectively with the general public
 Identify the settings/locations where the education can be delivered
effectively
 Conduct the health education session
 Evaluate the health education
 Identifying the Need for Health Education

• The first step in the planning of health education is to decide the key
health problems of the individual or group and the advices that should be
given.
• Any proposal for a change of health behavior should be simple to put
into practice with the existing knowledge and skills.
• It should not conflict with local cultural beliefs, and more importantly, it
should meet a felt need of the individual or community.
• A good health education programme should modify the routine advices
to fit in with people's circumstances. For example, education about
nutrition should be based on foods that are available locally, aids for the
disabled made from local materials, and latrines built with traditional
methods.
• If the planned change in health behavior is hard to promote, it may be
wise to start with a simple change that does fit in and meets an
immediate need of the individual or community.
• Once immediate need has been met and the individual perceives clear-
cut benefits, it may help in achieving a more difficult objective
 Planning for Venues of Health Education

• Every encounter between a nurse and the patient or community provides

an opportunity for health education.
• It can be delivered in outpatient department, clinics, wards, bedside,
schools, antenatal clinics, immunization clinics, and homes.
• A nurse must decide about where the group is more easily available and
at what location the surrounding and waiting areas for displays and
demonstration will be helpful in communicating health messages.
• Quiet areas where talks and small group discussions can be held are
valuable.
• It is important to remember that the most powerful way to implement
change is role modeling (practicing the preventive measures that are
recommended to the community).
 Communicating Health Message
• There are varieties of approaches to communicate the health
message to the target group in health education.
• A most useful strategy is demonstration which is proven to be
helpful if “satisfied users” (e.g., successful users of weight reduction
exercises and family planning) are used to show the benefits of
modified health behavior in health education session.
• All items used in demonstrations must be cheap and available
locally; otherwise, people will not accept it and will consider it
irrelevant to their situation.
• Word-of-mouth or oral publicity is another valuable way to influence
actions of the community.
• In many rural societies of India, oral traditions are strong and people
more easily accept the message conveyed by means of puppets, drama,
and storytelling (e.g., the traditional Caribbean calypso song has been
used to promote family planning and oral rehydration solutions in some
country).
• The effectiveness of one-to-one communication or small group
discussion may be increased with the use of AV aids such as leaflets,
charts, posters, flash cards, flip charts, and flannel graphs, etc.
• Films, slides, and film strips may be useful but have the disadvantage
i.e., projectors are expensive, and people may become so excited by the
novelty of AV aid that they will pay no attention to the content of health
education.
• Radio programmes and recorded cassette are another good way to put
over simple information related to large populations
 Individual and Group approach to Health
Education Individual Approach
• This is the approach of health education which is directed to an
individual patient or family member.
• It is a specific type of health education which is tailored to the need of
the particular patient or family member.
• The important feature of individual health education is that it is
especially designed and planned for a particular patient. For example,
health education on hypertension may have different content for Mr.
Ramesh and Mr. Ganesh as per the need of the patient. There are a
number of opportunities in the clinical area where a nurse can deliver
health education to an individual patient.
Group Approach to Health Education

• Group health education is an important area of work of a community

health nurse.
• It is the type of health education which is delivered to a group of
community who has similar health needs for health education.
• It can also be planned in connection with particular national health
programme or health services or epidemics for a particular community
area.
• A community health nurse has to identify these groups in community and
plan health education for them.
For example, it can be planned for commercial sex workers, antenatal
mothers, school children, eligible couples, and so on. .
• Group health education focuses on special requirements of a particular
group, for instance, topic on oral hygiene for school children, dietary
requirement for antenatal mothers, barriers methods of contraception for
eligible couples, and so on.
 Principles of Health Education

There are certain principles that should be kept in mind by every staff nurse
or public health nurse while delivering health education to the individual
patient or the community.
• Credibility
• Interest
• Participation
• Motivation
• Comprehension
• Reinforcement
• Learning by doing
• Known to unknown
• Simple Language
• Setting an example
• Human relations
• Feedback
1.Credibility
• It is the degree to which the message to be communicated is perceived as
trustworthy by the receiver
• Good health education must be consistent and compatible with scientific
knowledge and also with the local culture, educational system and social
goals
2. Interest
• Health teaching should be related to the interests of the people
• Health programme should be based on the “FELT NEEDS”, so that it
becomes “people’s programme
Felt needs are the real health needs of the people, that is needs the people
feel about themselves
3.Motivation
• In every person, there is a fundamental desire to learn. Awakening this
desire is called motivation
• Two types of motives
– primary motives-are driving forces initiating people into action
– secondary motives –are created by outside forces or incentives
• Main aim of motivation is to change behavior
• Motivation is contagious: one motivated person may spread motivation
throughout a group
• The important thing that should be communicated is “what to do” and
not “what not to do.” “Fear of disease” as a motive should not be used
regularly or perpetually in delivering health education.
 The people are not interested in health slogans such as “take care of your
health.” Therefore, it must focus on the need of the community (felt
need) so that they will be interested to listen and learn the health
information.

4. Principle of Participation
 This principle is based on the psychological principle of active learning.
 Health education must ensure the active participation of the community
people that will lead to better learning.
5. Principle of Comprehension
• The public health nurse must know the level of understanding of the
group member for which the teaching is directed.
• One barrier to communication is the use of jargons or technical words
which are difficult to be comprehended by the lay person.

6. Principle of Reinforcement
• Repetition and reinforcement of the health information at intervals is
extremely useful to make the learning long lasting.
If the message is repeated in different ways, people are more likely to
remember it.
7. Principle of Learning by Doing
• Learning is an active process.
• The Chinese proverb “If I hear, I forget, if I see, I remember, if I do, I
know” illustrates the importance of “doing” for effective and active
learning.
8. Principle of Known to Unknown
It is a very well-known maxim of teaching which emphasizes that the nurse
should proceed from known to the unknown content of the health topic
while delivering health education to a group.

9. Principle of Simple Language

• Health education must be delivered in simple local language and should
be free from jargons that may not be understood by the public.
10. Principle of Role Model
• Health educator should exhibit the behavior that is compatible with the
intended health message.
11. Principle of human relation
• Effective human relation promotes health education process.
12.Feedback
• The health educator can modify the elements of the system (e.g.,
message, channels) in the light of feedback from his audience
• For effective communication, feedback is of paramount importance.
 Mass Media/Mass Approach of Health Education

• Mass communication occurs when a small number of people send

message to a large anonymous and usually heterogeneous audience
through the use of specialized communication media.
• It is a one-way flow of information, not interactive, and is mediated by
sophisticated technology.
• Mass media can be used for various purposes including health education.
• Channels for mass communication include radio, television, print,
internet, video, films, pamphlets, role play, and telecommunication.
 Developing Media Strategy for Health Education
• The audience varies in their needs and motives so it is necessary to
develop multiple messages to cater to the various needs of the audiences.
• For high-risk group, the message should persuade them to go for the
screening test. Similarly, youth should be educated about causes of a
disease and how the risk could be minimized.
• The local, social values, and customs should be kept in mind while
designing message.
• A message that fails to attract the attention of the target audience goes
waste.
• The picture selected for a message must be a complete story in itself.
• To invite attention by arousing curiosity, a headline should generally be
made up of three or four words.
• Use of positive emotions like humor and joy can catch the audience's eye
and convince individuals to watch something that they might otherwise
avoid.
• Combined media should be used to strengthen and reinforce information
propagated by one media.
 Mass Media Campaign
1.Use High-Quality Messages, Sources, and Channels
In order to develop better message, the campaign planner should acquire
knowledge about the problems they are addressing, target audience, and
relevant social issues.
Messages should be pretested with a sample of target audience before
final production. The channel of communication should be such, which
can easily reach to target audiences.
2. Disseminate the Messages Well
There are five mediators of effective message dissemination: media gate
keepers, political and social supports, financial supports, and target
audience characteristics.
3.Attract the Attention of Target
Audience target audience must be exposed to it, attend to it, process, and
remember it.
The most profound and complex events and issues can be communicated
simply and concisely.

4. Cause Individual Change

A mass communication campaign can change the awareness, opinion,
knowledge, values, attitudes, behaviors, and health of target audience.
5. Cause Societal Change
The long-term maintenance of individual level effects and ultimate
effectiveness of a campaign require parallel changes in the society.
 Important Mass Media
1. Television
• It can reach to people regardless of sex, age, income, or educational
level.
• It offers sight and sound and makes dramatic life like representations of
people and products.
• It is an excellent means of transmitting persuasive messages and
eliciting a high degree of recall.
• Television is used by media units of the ministry of information and
broadcasting to disseminate messages regarding family planning,
immunization, promotion of healthy lifestyle, and prevention of various
communicable diseases.
• Certain cable networks also devote significant amounts of broadcast time
to health.
Advantages of Television as Mass Media
 Good mass market coverage
 Low cost per exposure
 Combines sight sound and motion
2. Radio
• Radio can also reach to mass and diverse audiences.
• The specialization of radio stations by listener's age, taste, and even
gender permits more selectivity in reaching different audience segments.
• Placement and production costs are lesser for radio than for TV.
• Thus, radio is sometimes considered to be more efficient then the
television.
• It has been and is still being used to create information regarding family
planning, communicable diseases, mother and child health.
Advantages of Radio as Mass Media
• Good local acceptance
• High geography and demographic selectivity
• Low cost
• Different time of broadcasting
Disadvantages of Radio as Mass Media
• Audio only
• Fleeting exposure
• Low attention
• Easy to forget
• Shallow reception
• Limited range
• Fragmented audiences
3. Newspaper
It is another important mass media as it deals every day with dissemination
of current information pertaining to different aspects of human life such
as social, economic, political, and cultural.
In a democratic country like India, the newspaper acts as powerful weapon
in exposing the irregularities, shortcomings, failures of government
policy and also functions as an eye opener of the public to various
national issues.
Health messages contained in newspapers can reach many people and
diverse groups.
• Unfortunately, the print media is currently underutilized as a
communication channel for highlighting health issues among urban
population.
Other Print Media
• Pamphlets, brochures, and posters constitute other print media used to
disseminate health messages.
• These devices are readily found in most public health agencies, offices of
private practitioners, health care institutions, and voluntary health
organizations.
• Various organizations such as WHO and Centre for Health Education are
bringing about various publications aimed at various groups such as
general population, media population, medical professional, and policy
makers.
• The usefulness of print media has been found to be limited.
• According to estimates, only 7.1% of the Indian rural population are
exposed to any form of print media.
 Strengths of Print Media
• Flexibility
• Mass reach
• Repetitive effect
• Reader's convenience
• Economy
• Broad acceptability; high believability
 Weakness of Print Media
• Short life of message
• Poor reproduction quality
• Language barrier
• Out of reach for illiterate
Outdoor Media
It includes posters, small hoardings, wall writing, billboards and signs,
and electric sign boards.
• The posters and small hoardings can be installed at railway stations, in
buses, and at subways.
• For persons who regularly pass by billboards or use public
transportation, these media may provide repeated exposure to messages
Advantages of Outdoor Media
• 24-hour exposure
• Mass audience
• medium high penetration public coverage
• Cost-effective
• Simple to understand
• Flexible
• High daytime visibility