CHAPTER-TWO

Health Communication

By : Tenagnework Eseyneh (MPH/HP)

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 Learning Outcomes
At the end of this chapter the students are expected to
correctly:
 Define communication & health communication
 Discuss communication model
 Identify communication principles
 Discuss Process of communication and its components
 Explain forms & types of communication
 Know barriers to effective communication

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 What is Communication?

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3 Communication
 Brain storming
 Is communication mere talking???????????

 When does talking become

communication??????????

Only when it is understood!!!!!!!!!!

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 Definition
 Communication; is the process by which two or more
people exchange ideas, facts, feelings or impressions
with the intent to gains common or mutual
understanding of the meaning and the use of the
message or to change behavior.

 So communication uses/helps to share information, give

instruction, give feed back and express feeling

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What is Health communication…
 Health communication is the art and technique of informing,
influencing, and motivating individuals, institutions, and large
public audiences about important of health issues based on
sound scientific and ethical consideration.

 It applies the principles, strategies methods of communication to

convey health messages, to inform and influence individual and
community decisions that enhance health.

 It links the domains of communication and health.

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Communication…
 The ultimate goal of all health communication is to create
behavioral change.

 Communication have four general objectives:

 To be received (heard or read)

 To be understood

 To be accepted

 To get action (change of behavior)

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 Principles of communication
1)Perception
 For communication to be effective the perception of the sender
should be as close as possible to the perception of the receiver.
 The extent of understanding depends on the extent to which the

two minds come together.

2) Sensory involvement
 The more sensory organs involved in a communication the more

is its effectiveness from their cumulative effect.

3) Face to face
 The more communication takes place face-to-face the more its

effectiveness.

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Communication
 Principles of communication…
4) Feedback
 Any communication without two-way process is less effective
because of lack of opportunity for timely & appropriate
feedback.
5) Clarity: Ideas, facts, opinions in the mind of communicator
should be clear before communication. It should be direct, simple,
easily understandable language.
6) Information: the sender should have at in hand correct, current
and scientific information before communicating it.
7) Completeness: the subject matter to be communicated must be
adequate and full which enable the receiver to understand the
central theme or idea of message.
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 The role of health communication
 Increase knowledge and awareness of a health issue, problem, or
solution
 Influence perceptions, beliefs, attitudes, and social norms
 Prompt action
 Demonstrate or illustrate skills
 Show the benefit of behavior change
 Increase demand for health services
 Reinforce knowledge, attitudes, and behavior
 Disprove myths and misconceptions
 Advocate for a health issue or a population group

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 Communication model
A) Linear (one –way) model

 The flow of information from the sender (source) to the

receiver is one-way or unidirectional

 The communication is dominated by the “sender’s knowledge”.

“Information is transferred out”

 A familiar example is the lecture method, many mass media

communication

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Communication model…

Advantages disadvantages
-faster - little audience participation
-orderly -no feed back
-does not influence behavior
- Learning is authoritative

S M R
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 Communication model…
B) Systems (Two –way) model
 Information flows from the source to the receiver & back from
receiver to the source which is Two –way or bidirectional.
 This is reciprocal in which the communicant (audience) becomes
the communicator (sender) & the communicator (sender) in
turn becomes a communicant (audience)
 Roles are interchanged
 It is more appropriate in problem solving situations
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 Communication model…

Advantages Disadvantages
-More audience - Slower (time taking)
participation - Not orderly
-Learning is more democratic
- Open for feed back
- Influence behavior change

M
S F
R
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 Communication Process
 Is the whole sequence of transmission and interchange of
facts, ideas, feeling, etc.
 As a process it is routine and continues forever.

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 Component of communication Process

 1. Source/Sender/Encoder
2. Receiver/Audience/Decoder
3. Message
4. Channel
5. Effect and Feedback

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 1. Source /sender/Encoder

 Person who thinks of all idea to be communicated, decides

why it should be communicated and also decides on the
intended impact.
 The sender is the originator of the messages.
 The sender should be as close as possible to the target
audiences and from high credible source.
 The source can be from an individual or groups, an
institution or organization.
 Encoding – The process of converting the message/ subject
matter into communication symbols, signs, actions, pictures,
audio-visuals etc. .
 Encoding process translates ideas, facts, feelings, opinions
etc. into symbols, signs, actions, pictures, audio-visuals etc.
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 In which cases in the figure do you think that
communication will be more effective?

SOURCE
RECEIVER

High overlap- many similarities of Source & receiver in communication (share a lot of
characteristics common

SOURCE RECEIVER

Little overlap- many difference of sources and receiver in communication

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 2. Receiver/Audience/decoder
 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 message.

 Decoding – The receiver translates the words, symbols, signs,

actions, pictures, audio-visuals etc used in the message into idea
and interprets it to obtain its meaning.

 It is a mental process by which the stimuli that has been

received through the sensory organs are given a proper
meaning according to the individual's way of thinking.

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 2. Receiver/Audience/decoder…
 Factors which should be considered about the
audience during message design are:
Educational factors (age, education level, type of
appeal needed)
Socio-cultural factors (values, beliefs about topic,
opinion leaders)
Patterns of communication (already exist rules &
traditional media )

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 3. Message
 Message is a piece of information, ideas, facts, opinion,
feeling, attitude or a course of action that passed from the
sender to the receiver with the intention to change their
understanding or health related behavior .

 It is the subject matter of communication –

 It exists in the mind of the communicator. It is what to say.

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 Appeal in health communication
 The appeal-is the way we organize the content of the
message to convince people. (way of message organization)
 For example what type of appeals might convince persons
with:-
 little or no schooling ?
 persons with high educational level ?
 children ?
 health workers?

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Types of appeals in health communication…
1.Fear arousal appeal

 The message prepared to convince people by frighten

people into action by emphasizing the serious outcome from
not taking action

 E.g. Symbols such as dying persons, skulls…

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

 Evidence suggests that: Mild fear can arouse interest, create

concern & lead to change.

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 Fear…
 However, too much fear is not appropriate for two
reasons;
 1st: It can lead to denying & rejecting the message and
results in laughter & failure to take action
 2nd: It also involves ethical issues
 Therefore many health educators feel that it is wrong to try to
frighten people into action -unless there is clear evidence that
a benefits in health would result and that the means (i.e.
enabling factors) are readily available to perform the action.

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 Types of appeals…
2.Humor appeal
Message prepared to convince people in a funny way
such as cartoon, enjoyment & entertainment.
It is 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.
Mostly apply for child But it may not be funny for

everyone

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 Types of appeals…
3.Logical/Factual appeal
The message prepared to convince people by giving

facts, figures and information.

For example facts related to HIV/AIDS; its causes,

route of transmission, prevention methods etc. 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.

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 Types of appeals…
4.Emotional appeal

 The message prepared to convince people by

arousing emotions, images & feelings rather than
giving facts & figures.

 Example: showing smiling babies associating with

FP education, healthy families with latrine etc.

 A Person with less education will often be more

convinced by simple emotional appeals from people
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Types of appeals…
5.One sided message
 The message prepared to convince people by only presenting
the advantages of taking action & does not mention any
possible disadvantages.
 E.g. educating the mothers only about benefits of oral
contraceptive pill.
 Presenting only one side of an argument may be effective:

1) If audience will not be exposed to different views.

2) If the communication is through mass media. Because the

audience may only grasp part of the message or selectively
pick up the points that they agree with.
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 Types of appeals…
6. Two sided message

 The message prepared to convince people by presenting

both the advantages & disadvantages of taking action.

 Appropriate if

1. The audiences are exposed to different views

2. The audiences are educated

3. During face to face communication: it is easy to present both

sides and make sure that the audience understands the issues.

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 Types of appeals…
7.Positive appeals: The message prepared to convince
people by asking people to do something.
e.g. breast feed your child, use a latrine etc.
8.Negative appeals: The message prepared to convince
people by asking people not to do something,
e.g. do not bottle feed your child, do not defecate in the
bush.
Use words like: “avoid” or “don’t” to discourage
people from harmful behavior
 Most health educators agree that it is better to
be positive & promote beneficial behavior.

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4. Channel/Medium
 A channel is the physical bridge or the media by
which the message travels from a source to a
receiver.

 Your choice of channel will depend on;

• Your objectives

• The nature of your audience &

• Resources at your hand.

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Types of Communication Channels
1. Interpersonal channels –

 Such as face to face communication, home visits,

group discussions, and counselling
 Are generally best for:-

 Giving credibility to messages

 Providing information and
 Teaching complex skills that need two way
communications.

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Types of Communication Channels…

2. Broadcast channels:

 Generally provide broad coverage for communication

messages, reaching a large number of the target audience
quickly and frequently. For example, Radio and television

3. Print channels:

 Written material such as Broucher, flyers, and posters: are

generally considered best for providing a timely reminder of
key communication messages.
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5. Effect and feedback
Effect: is the change in the receiver’s knowledge, attitude &
practice or behavior.
 Positive effect: when the desired change in knowledge, attitude,
practice occurs.
 Negative effect: when desired change in knowledge, attitude &
practice does not occurs.
Feedback: - is the mechanism of assessing what has happened on
the receivers after the communication has occurred by sender.
 A communication is said to have feedback when the receiver
of the message gives his/her responses to the sender of
the message.
 It completes the process of communication.

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  Effective communicator is always-
 Sensitive to feedback &
 Constantly modifies his or her message as a result of
the feedback received

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 Levels (Types) of communication
A. Intra-Personal communication

 It takes place inside a person. It includes the beliefs,

feelings, thoughts and justification we make for our actions.

 Main effect= clarifying ideas or analyzing a situation and to

reflect upon or appreciate something.

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 Levels (Types)…
B) Interpersonal (face-to-face) communication
 include all those forms of communication involving direct
interaction between the source & receiver.
Examples : one-to-one & counseling; small group (<12
persons), intermediate (12-30), large group lecture/ public
meeting(>30 people).
 In most instances the decisive criterion for interpersonal
communication is:
a. Communication at the same time and/or
b. Communication at the same place
 Main effect=changes in attitude and behavior

= acquisition of problem solving skill.

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 Levels (Types) …
Advantages
1.Dynamic or bi-directional
2. Feed back
3. Multisensory (channel)
4. Useful in all stages of adoption of innovation
5. Useful when the topic is taboo or sensitive.
6. Can fit to local needs

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 Levels (Types) …
Limitations
 Easily distorted – as we mostly rely on word-of-

mouth.
 Often needs multi-lingual

 Needs personal status/ credibility

 Needs professional knowledge & preparation

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Levels (Types) …
C) Mass media communication
 is a means of transmitting messages on an electronic or print
media to a large segment of a population.
Main effect is:
 Increased knowledge/awareness

 Influence behaviors at the early stages.

 Useful to communicate new ideas to early adopters (opinion

leaders).

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 Levels (Types) …
Advantages
1. reach many people quickly.
2. accurate and believable e.g. article on a newspaper, or
“voice” of highly respected person.
3. provide continuing reminders and reinforcement.
Limitations
1. One sided /no feedback
2. Selective perception, only grasp part
3. Does not differentiates the target
4. Only provides non-specific information
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Forms of communication
According to the way of expression
1. Oral/Verbal communication

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Forms of communication…

 It is the spoken, oral way of communicating message.

Use oral communication when;
 The receiver prefers one-to- one contact

 The receiver is not interested in receiving the message

 It is important to get feedback

 The receiver is too busy or preoccupied to read

 The sender wants to convince

 Discussion is needed

 Criticism of the receiver is involved

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 2.Written Communication

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 Forms of communication…
 It involves the exchange of facts, ideas, and opinions
through a written instrument /materials such as letters
notes, leaflets, reports, handouts and newspaper..

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 Forms of communication…
 Use Written communication when;

 The receiver prefers written

 The sender wants a record for future references

 The message is complex & requires study by the receiver

 The message includes a step by step procedure

 If there are many receivers

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 3.Non-verbal communication
 Much (65%) communication also takes place through non-
verbal communication.
 Types of Non-verbal communication are:

1. voice and 2. body language (talk).

 Body language can be:

Facial expression, Eyes

Gestures (hand movements, raising eyebrows, shape of mouth)
Postures (sitting up, leaning forward)
Body contact (touching, holding hands, greetings, shaking hands)
Closeness (distance between persons)
Appearance (clothes, hair, cleanliness)
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 Action speaks louder than words

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 Facial expression...
 Facial expressions reflect emotion, feelings and attitudes
Characteristics of non verbal communication

 Always communicating

 Powerful

 It reveal the inner thoughts & feeling

 It expresses attitude

 Show for cultural differences

 Less to control
 Forms of Pros Cons
Communic
ation
ORAL • Faster – speedy. • No permanent record.
• Allows more interactions.
• Creates informal atmosphere

WRITTEN • Both sender and receiver • Danger of being

leave a record of their message. misunderstood.
• Writing encourages clear • Message can become
thinking. accessible to the wrong people
• Best for transmitting policies or at the wrong time.
and procedures.
NON •Meanings are reinforced • Meaning is in the body.
VERBAL /expression of feeling. •One gesture may have several
meanings and several gestures
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 Barriers to effective communication
Any obstacles or difficulties that come during communication
1.Physical
 Difficulties in hearing, seeing

 Inappropriate physical facilities (High tem., poor

ventilation…)
2. Intellectual
 The natural ability, home background, schooling affects the
perception/ understanding of the receiver
 The ability of the facilitator/ educator/ instructor.

3. Emotional
 Readiness, willingness or eagerness of the receiver

 Emotional status of the educator

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Barriers to effective communication…
4. Environmental
 Noise, invisibility, congestion

Noise is a major distraction during communication.

a. Physical noise – avoidable
b. Internal noise - any physiological or psychological state that
could undermine a person’s ability to communicate
effectively: Being ill, Overworked, Beset by personal
problems.

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Barriers to effective communication
5. Cultural: Beliefs, religion, attitudes, economic and social class
differences, language/vocabulary variation.

6. Status of the source

 Status of the source either too high or too low as compared to

the audience also affects effectives

7. Inconsistencies between verbal & non- verbal

communication
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 Differences in perception

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 Lack of fundamental knowledge

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 Emotions

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 Prejudice or bias

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 Poor atmosphere

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 Reference
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 John Hubley 1993. Communicating health. An action guide to

health education and health promotion.
 Lawrence W. Green et al. 1980. Health education planning a diagnostic
approach

 Getnet Mitike 2003 health education for health science students.

Lecture note series. Addis Ababa University, Ethiopia.
 Randall R. Cottrell, James T. Girvan, James F. McKenzie 2006.
Principles& foundations of health promotion and education. Third
ed. USA.

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