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Communication involves the transfer of information including ideas, emotions,

knowledge and skills between people.
Communication stages
Communication can involve ordinary conversation such as explaining a point,
asking a question or just talking to pass time. However, in health education we
communicate for a special purpose i.e.
To promote improvements in health through modification of human
behaviour; social and political factors that influence behaviours.
To achieve these objectives, effective communication must pass through several
stages and at each stage, communication failure can take place.

Effective communication:

People are exposed to communication from many different sources and more
likely to believe a communication from a person or organisation that they trust
i.e. has high source credibility. Think about the communities you are familiar

with and ask yourself: what special qualities make a person trusted? What can
make the commmunity lose trust in a person. Source: credibility, age and sex,
culture, language, education and communication skills
The first step in planning any communication is to consider the intended
audience. A method that will be effective with one audience may not succeed
with another. Two people may hear the same radio programme, see the same
poster or attend the same talk and interpret them quite differently.
Receiver: education, visual literacy, media habits, culture, interests, age and sex.
This is also sometimes refered to as the communication method. There are two
main groups pf methods: face-to-face and mass media. Each channel provides
opportunities to use a different combination of formats. Mass media include
broadcasting media (Radio, televion,); print media ( newspaper, booklets,
leaflets, and posters ) ; face-to-face or interpersonal methods include all those
forms of communication involving direct interaction between the source and
receiver. Examples of face-to-face methods with increasing audience size are:
one-to one, and counselling; small group, and large group. The main advantage
of face-to-face communication over mass media is that it creates opportunities
for questions, discussion, participation and feedback. It is possible to chek that
you have been understood and give further explanations. However as the size of
the group increases, it is more difficult to have feedback and discussion. In large
groups and public meetings usually only a small number take part and many
persons feel shy speaking out. So public meetings share many characteristics of
mass media in that they involve limited participation and feedback.

The message will only be effective if the advice presented is relevant,
appropraite, acceptable, and put across in an understanding way. In deciding
what advice to give, you will need to apply both an understanding of health and
disease as well as the various influences on behaviour.
Stage 1: Reaching the intended audiene

Communication cannot be effective unless it is seen or heard by its intended

audience. This may seem obvious and does not require any complex theories to
explain. But many programmes fail even at this simple stage. A communication
failure can be due to the fact that you are preaching to the converted, e.g. posters
placed at the clinic or talks given at antenatal clinics. These only reach the
people who attend the services and are already motivated.
But the group you are trying to reach may not attend clinics, nor have radios or
newspapers. They may be busy working at the time when the health education
programmes are broadcast. Communication should be directed appropriately to
the intended audience e.g. where they can see or hear the message. This requires
studying your intended audience to find out where they might see posters, what
their listening and reading habits are.
Stage 2: Attracting the audiences attention
Any communication must attract attention so that people will make the effort to
listen/read it. Examples of communication failure at this stage are:
Walking past a poster without bothering to look at it
Not paying attention to health talks or demonstration at the clinic
Not stopping at the exhibition at the show ground
Turning off the radio programme or switching over to another station
At any one time we receive a wide range of information from each other through
the five senses touch, smell, vision, hearing and taste. It is impossible to
concentrate on all this at the same time. Attention is the name of the process by
which a person selects part of this complex mixture to focus on (i.e. to pay
attention to) while ignoring others for the time being.
Stage 3: Understanding the message (perception)
Once a person pays attention to a message he/she then tries to understand it.
Another names for this stage is perception. Visual perception is the term used for
understanding of visual messages and pictorial perception for understanding
pictures. Perception is a highly subjective process. Two people may hear the
same radio programme or see the same poster and interpret the message quite
differently from each other and from the meaning intended by the sender.

A persons interpretation of a communication will depend on many things.

Misunderstandings can easily take place when complex language and unfamiliar
technical words are used, pictures containing complicated diagrams and
distracting details; shows unfamiliar subjects; or familiar objects shown from an
unusual view. Another reason for misunderstanding is when too much
information is presented and people cannot absorb it all.
Stage 4: Promoting change (acceptance)
A communication should not only be received and understood, it should be
believed and accepted. It is easier to change beliefs when they have been
acquired only recently. It is more difficult to influence a belief that has been held
for a long time or if people already have well developed beliefs on the topic. It
is usually easier to promote a belief when its effects can be easily demonstrated,
e.g. that ventilated, improved latrines do not smell. If a belief is held by the
whole community, or part of a wider belief system such as their religion, we can
predict that it will be very difficult to change by methods such as mass media
and leaflets.

Stage 5: Producing a change in behaviour

A communication may result in a change in belief and attitude but still not
influence behaviour. This can happen when the communication has not been
targeted at the belief that has the most influence on the persons attitude to the
behaviour. For example many communication programmes have emphasized the
danger of diarrhoea and failed to give enough emphasis to dehydration.A person
may have a favourable attitude and want to carry out the action, e.g. use family
planning, bring the child for immunisation e.t.c. However, pressure from other
people in the family or community may prevent the person from doing it.
Another reason a person may not perform a behaviour is a lack of enabling
factors such as money, time, skills or health services.
Stage 6: Improvement in health
Improvements in health will only take place if the behaviours have been
carefully selected so that they really do influence health. If your messages are
based on outdated and incorrect ideas, people may follow your advice but their
health will not improve.

S: Specific
M: Measurable
A: appropriate
R: Realistic
T: Time bound
Approaches in health promotion
Individual approach, group approach, population approach, issue approach,
setting approach
Key factors in health promotion
Biological, environmental, social, cultural, political,
Barriers of effective Communication
Attitude, language, environment, age, sex, religion, culture