COMMUNICATION

Yordanos T.(MPH)
SPH,AAU
COURSE OUTLINE

12/20/2022
 Definition of communication
 Principles of communication
 Types of communication
 Doctor –patient communication; Breaking Bad news
 Barriers of communication

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WHAT IS COMMUNICATION?

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DEFINITION

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 The word communication is a derivative of the latin
word "communes," which translates to sharing and
understanding.
 To communicate means “to impart, pass on or
transmit a message, information.
 It is simply the act of transferring information from one
place to another.

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DEFINITION..
Communication is a broad science and an imperfect art

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

 Aristotle's Rule that a talk (Communication ) Should have

o Ethos (credibility),
o logos (logic) and
o pathos (the art of communication)
“To ‘communicate’ is to create space where the community of truth is practiced”
Parker J. Palmer

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HEALTH COMMUNICATION

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 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

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 PRINCIPLES OF COMMUNICATION

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A) Perception
B) Sensory involvement
C) Face to face
D) Feedback
E) Clarity
F) Information
G) Completeness

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COMMUNICATION PROCESS

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ELEMENTS OF COMMUNICATION

1. Source/sender

2. Message/content
3. Channel/medium
4. Receiver/audience

5. Feedback/effect

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 1. SOURCE/ENCODER

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 The communicator is the originator of the message
 The sender begins the communication process by forming
the ideas, intentions and feelings that will be transmitted.
 Determines the purpose of the message (to inform,
persuade, or entertain) and the channel
 Source should be empathetic and credibility to the receiver

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 2. MESSAGE

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 Message is a piece of information, ideas, facts, opinion,
feeling, attitude or a course of action that passed from the
sender to the receiver.
 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 12
 MESSAGE…
Message appeals: The way the content of the message could be
organized so that it can persuade or convince people.

1. Fear arousal appeal

• The message is conveyed to frighten people into action by

emphasizing the serious outcome from not taking action.
 Appropriate with people no schooling
N.B Mild fear may be appropriate but too much fear is
inappropriate 13
MESSAGE…

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 MESSAGE…
2. Humors

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• The message is conveyed in a funny way
such as cartoon.

• Humor is very good way of attracting

interest & attention.

• It can also serve as a useful role to lighten

the tension when dealing with serious
subjects.

• Enjoyment & entertainment can result in

highly effective remembering and learning. 15
 MESSAGE…

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3. Logical / factual appeal
• The message is conveyed to convince
people by giving
facts, figures and information.
e.g. Facts related to HIV/AIDS such as
prevalence, morbidity, mortality
route of transmission etc.
 Logical appeals are good with a
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person of high educational level.
 MESSAGE…
4. Emotional appeal

• The message is conveyed 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.

• More influence a persons with less education.

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 MESSAGE…

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Emotional appeal…

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 MESSAGE…
5. One sided message/appeals

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• Only presents the advantages of
taking action & does not mention
any possible disadvantages.
 One sided message may be effective:

1) If the audience will not be exposed to

different views.

2) If the communication is through mass

media-selective perception.
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 MESSAGE…

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6. Two sided message/appeals

• Presents both the advantages &

disadvantages (pros’ & cons’) of taking
action.
 Appropriate if ;

• The audiences are literates.

• The audiences are exposed to

different views.

• We are in face-to-face with

individuals or groups. 20
 MESSAGE…
7. Positive appeals

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• Communications that ask people to do something,

e.g. breast feed your child, use a latrine.

8. Negative appeals

• Communications that ask people not to do something,

e.g. do not bottle feed your child, do not defecate in the
bush.

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3.CHANNEL/MEDIUM

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•The channel is the way through which a message is sent
out.
•It is the physical bridge or the media .It is also called the
medium of communication.
•The commonest types of channel are audio, visual,
printed materials or combined audio visual & printed
materials
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CHANNEL/MEDIUM…

Criteria: Channel selection

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• Availability

• Cost

• Users’ preference and receivers’ access

• Adaptability to the communication purpose/objective

and the message content

• Type of recipient and their stage in the adoption

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process
4. RECEIVER/DECODER –
‘AUDIENCE’

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 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.
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 5. FEEDBACK
 A communication is said to have feedback when the

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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.
 The feedback could be either negative or positive
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FUNCTIONS OF COMMUNICATION
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 Increase knowledge and awareness of a health issue

 Influence perceptions, beliefs, attitudes, and social

norms

 Prompt action

 Increase demand for health services

 Change lifestyle to fit into new environment

 Maintain changed behavior

COMMUNICATION STAGE
In health education , communication has special purpose

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
that is :

To 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

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SIX STAGES …..

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Stage 1. Reaching the intended audience

Stage 2. Attracting the audiences attention

Stage 3. Understanding the message(perception)

Stage 4. Promoting change (acceptance)

Stage 5. Producing a behavior change

Stage 6. Improvement in health

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COMMUNICATION STAGES

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Message reach audience Gain attention Understood
• Heard • Attract attention so • Avoid
• Seen that people read or technical
• Read/listen at the message see it words
• Exposure and recall method

Gain acceptance
Produce believed, credible
Improve health change(KBAP) source , easily
demonstrated effect

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TYPES OF COMMUNICATION
A. Intrapersonal communication:

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 Self talk

 all of our thought, feeling ,reaction

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B. INTERPERSONAL COMMUNICATION

 interaction between two or more people or groups

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 can be face-to-face, two-way, verbal or non-verbal
interaction
 characterized its feedback component, b/c it is always
a two-way process.
 high chance of utilizing more than two senses such as
seeing, hearing and touching.

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C. MASS COMMUNICATION

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 Is a means of transmitting messages, on an electronic
or print media to a large segment of a population
 Helps to reach more segment of population

 Increased knowledge/awareness

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 COMPARISON OF INTERPERSONAL AND 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 Increase in knowledge
behaviour ,problem solving skill /awareness

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FORMS OF COMMUNICATION

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PHYSICIAN PATIENT COMMUNICATION
 Physician-patient communication is a process by which
information is exchanged between a physician and patient
through a common system of symbols, signs, and
behaviors.
 Communication is an important component of patient care.

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Paternalistic model RESPECT Model AIDET Model

The physician who encourages open Rapport Acknowledge

communication

increases patient involvement in their Empathy Introduce

health care through negotiation and
consensus-building between the patient
and physician 

physicians use a participatory style of Support Duration

conversation, where physicians and
patients spend an equal amount of time
talking

Partnership Explanation
Explanations Thank you

Cultural
competence
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Trust
HOW TO COMMUNICATE WITH
PATIENTS ?

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• People need information for appropriate health-related
decisions
• This information should be presented in a way they can
understand
• The “right to know” has many ethical principles and
duties related to it
• The patient's right to know the truth does not mean
forcing him/her to know
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HOW TO COMMUNICATE WITH
PATIENTS ?

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 Bad news “any information which adversely and
seriously affects an individual’s view of his or her
future.”
 Recipient’s expectations and level of understanding
have an important bearing on the impact of bad news.
“The life of a sick person can be shortened not only by
the acts, but also by the words or the manner of a
physician’”

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WHAT CONSTITUTES BAD NEWS IN A
MEDICAL SETTING?

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 New diagnosis of a potentially life-threatening illness
 Patient’s condition suddenly changes or is rapidly
 declining Curative treatments are no longer effective
or not an option
 Devastating/disappointing test results
 Limited or poor prognosis

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HOW TO BREAK BAD NEWS TO
PATIENTS?

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A Guide for Health Care Professionals by Robert Buckman.
(SPIKES)
Step 1. S - SETTING UP the interview
Step 2. P - Assessing the patient's PERCEPTION
Step 3. I - Obtaining the patient's INVITATION
Step 4. K - Giving KNOWLEDGE and information to the patient
Step 5. E - Addressing the patient's EMOTIONS with
empathetic responses
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Step 6. S - STRATEGY AND SUMMARY
PATIENT AND FAMILY RESPONSE TO BAD NEWS

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Step 1. S - SETTING UP the interview

 You should create a warm and welcoming space that does

not seem cold or clinical.
 If the patient wants family or close friends to be there in
support, make sure that these people are included as well.
 It is not necessary to rush into the news like dropping a
bomb on an enemy; take a moment to connect and build
rapport with your patient. Whether you understand it or not,
you are about to change your patient’s life.
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 Take time to show empathy and emotional connection.
Step 2. P - Assessing the patient's PERCEPTION

 Perception refers to the patient’s current level of knowledge

about their medical issue and what they think about their
status on the road to recovery.
 It is important to do more listening than talking at this
stage; there is no need to challenge the patient on
inaccurate or hopeful beliefs at this point.

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Step 3. I - Obtaining the patient's INVITATION

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 At this stage, ask your patient if they want to know the
details of their condition or the treatment they might face.
 Meet your patient where they are; if they are not ready for
the details, it is not necessary to force them to listen.
 The SPIKES method acknowledges that each patient has a
right not to know the details if they are not ready for them.
 Wait for permission from your patient before proceeding
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with the news.
Step 4. K - Giving KNOWLEDGE and information to the patient

 In this stage you are sharing knowledge and information

with your patient.
 Again, it is important to ask the patient how much they
understand and meet them there.
 Your patient often will need you to speak in plain terms, not
medical jargon.
 Consider the individual before you; have they understood
what you said?

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Step 5. E - Addressing the patient's EMOTIONS with empathetic responses

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 The sharing of bad news is emotional for both doctor and
patient.
 Create space for your patient to express their emotion and
practice deep empathy.
 Put yourself in their shoes by identifying their reaction -
sadness, shock, denial—and helping them to identify it too.

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Step 6. S - STRATEGY AND SUMMARY

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 End the meeting on an intentional note:
 what will come next?
 Summarize your thoughts and your understanding of
the patient’s reaction, and
 set expectations for the next appointment. 

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BARRIER TO BREAKING BAD NEWS ?

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Why it can be hard for physician to deliver bad news:
 Lack of training; inexperience
 Anxiety
 Burden of responsibility/inadequacy
 Going back on your word; sense of failure

 Fear of negative responses and strong emotional

reactions
 Uncertainty about patient’s and family’s expectations
 Fear of destroying patient’s sense of hope

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THE OLD WAY

Doctors speaking to
patients
ASSUMPTION

Science and
Behavior
Truth
HEALTH COMMUNICATION EVOLUTION

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STRATEGIES

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 Social mobilization
 Social marketing

 Advocacy

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DIFFUSION OF INNOVATION

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 Develop by Evert roger 1962
 How to deal with social systems in communicating anew
product to target audiences
 Diffusion of effective programs and ideas is a significant
challenge for public health and health promotion so it
describes how a new idea, product or positive health
behavior spreads through a community or social
structure.

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Diffusion of Innovations by Everett Rogers

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Diffusion is the
RANKING MUNDIAL DE USUÁRIOS DE INTERNETprocess by which an
innovation is
1º 2º 3º 4º communicated
5º 6º
through
certain channels over
time among the
members of a social
system.

Innovation is any new idea, new behavior, new product,

new message i.e., a new thing that one brings to you for
your adoption. 55
BASIC ELEMENTS OF DIFFUSION
2. Channel of
1. Innovation

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communication

3. Social System 4. Time

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 Innovativeness and adopter categories

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Adopt new ideas

Innovators (technologies, concepts, and

RANKING MUNDIAL DE USUÁRIOS DE INTERNET
behaviors in early stages

Early Adopters
1º 2º 3º 4º Still5º 6º
have some traits of
innovation (risk concern)

Early Majority First sign of diffusion

Delay its adoption, must be

Late Majority clearly its advantages

Mature implementation and

Laggards risks involved are smaller

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 TIME AND THE ADOPTER CATEGORIES

Innovators

Adopter Categories Based on Innovativeness

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 INNOVATORS
 Are first to adapt an innovation (they want to be first to do
something)
 Control substantial a financial resource to absorb possible loses if
the innovation is unprofitable.
 They are venturesome, independent, risky, daring

 have the ability to understand and apply complex technical

knowledge (mostly they are literates).
 Have the ability to cope with high degree of uncertainty about
the innovation.
 Are few and changed very earlier.

 they have higher socioeconomic status than any other group

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EARLY ADAPTORS
 Are very interested in innovation, but they do not
want to be first to be involved.
 Are integrated part of the local social system.

 Possess greatest degree of opinion leader ship in most

social systems ( are respected by peers)
 And are usually successful.

 Serve as role model for other members or society

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EARLY MAJORITY
 May be interested in innovation, but will need some
external motivation to get involved.
 Interact frequently with peers (sociable and jockey)

 Seldom held the position of opinion leadership.

 Deliberate (check and discuss) before adopting a new

idea.
 One-third of the members of a system, making the
early majority the largest category.

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LATE MAJORITY
 Are skeptical and cautious and will not adopt an
innovation until most people adopt.
 one-third of the members of a system

 Pressure from peers.

 And adapt because of economical necessity.

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LAGGARD
 Will be the last to get involved in an innovation, if they get
involved in an innovation at all.
 Posses no opinion leadership.

 Isolated in the social systems

 Point of reference is in the past.

e.g. ‘Diro kere diro eko! Doro 25 santim neber’.

 Suspicious of innovation

E.g. what if the ‘whites’ put chips in the vaccine?

 But also are usually with limited resources.

 Innovation-decision making is lengthy

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THE ADOPTION PROCESS

Diffusion process: is the spread of a new idea from its

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
source of invention or creation to its ultimate users or
adopters"-occurs within society as a group process.
 Adoption process: is the mental process through which an
individual passes from first hearing about an innovation to
final adoption"- it pertains to an individuals.
 Rogers breaks the adoption process down into five main
stages. The five stages are:

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 Innovation-decision process

Knowledge(awareness,
RANKING MUNDIAL DE USUÁRIOS DE INTERNET
procedural Person becomes aware of an innovation and has

1º 2º 3º
and principle knowledge)
4º 5º
some idea of how it functions
6º
Person forms a favorable or unfavorable attitude
Persuasion toward the innovation

Person engages in activities that lead to a choice to

Decision adopt or reject the innovation

Implementation Person puts an innovation into use

Person evaluates the results of an innovation-

Confirmation decision already made
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5 critical factors influencing innovation diffusion

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Is the innovation better than what was
Relative advantage
1º 2º 3º 4º 5º
there before?
6º
Does the innovation fit with the
Compatibility intended audience?
Is the innovation easy to use?
Complexity
Can the innovation be tried before
Triability making a decision to adopt?
Are the results of the innovation
Observability visible and easily measurable?
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FACTORS THAT INFLUENCE ADOPTION (ROGERS,

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 Relative advantage: the degree to which an innovation is
perceived as better than the idea it supersedes
 Compatibility: the degree to which an innovation is
consistent with existing values, past experiences, and
needs of potential adopters
 Complexity: the degree to which an innovation is
relatively difficult to understand and use
 Trialability: the extent to which can be tested,
experimented with, or tried before adoption
 Observability: the degree to which the results are visible
to others
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 12/20/2022
Thank you!!!
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