INSTITUT UNIVERSITAIRE DU GOLFE DE GUINEE

INSTITUT SUPERIEUR DES SCIENCES APPLIQUEES

BP 12489 Douala – Cameroun Fax :(237) 233428902
Tel : (237) 233 43 04 52/ 233 57 58/ 233 37 50 60
Site- Web : www.iug.univ.com

NURSING DEPARTMENT (NUR 1)

COMMUNICATION FOR BEHAVIOUR CHANGE 2

COURSE INSTRUCTOR: Mr AGBOR MARK

MLS/MPH
 AN OVERVIEW OF BEHAVIOR CHANGE COMMUNICATION (BCC)

INTRODUCTION
 Behaviour Change Communication (BCC) is a communication strategy which
encourages individual/community to change their behaviour.
 It is a strategy that triggers people/society/communities to adopt healthy, beneficial and
positive behavioural practices.
 BCC is an effective communication approach which helps to promote changes in
knowledge, attitudes, norms, beliefs and behaviours
 BCC is an interactive process with communities (as incorporated with a general program)
to create custom-fitted messages and methodologies utilizing an assortment of
correspondence channels to create positive practices; advance and support individual,
network and cultural conduct change; and keep up suitable practices.
 BCC is a powerful and fundamental human interaction – communication – which
positively influences dimensions of health and well-being.
 BCC is a direct approach towards changing behaviour. It is different to traditional IEC
materials as IEC materials are not considered for creating awareness and giving
information as compared to BCC.
 BCC is described by its straight approach towards changing behaviour.
Criteria For Developing BCC Messages:
BCC messages must be:
 Research centered
 Client centered
 Benefit Leaning
 Service Interrelated
 Professionally developed, and interrelated to behavior change
Importance of BCC:
 Increase in knowledge and attitude of the people
 BCC helps to trigger and stimulate people for adopting positive behavioral approaches
 BCC promotes appropriate and essential attitude change
 As BCC strategies and messages are tailored for specific target groups, these strategies
are efficient and effective.
  BCC approaches are more sustainable and acceptable
 BCC helps to increase learning and skills
 It improve aptitudes and feeling of self-adequacy
Apart from these, importance of BCC at different levels are:
1. At individual-level
BCC helps in learning, mindfulness, convictions, and sentiments about wellbeing practices. It
plays a significant role in deciding wellbeing conduct.
2. At community-level
 BCC approach stimulates community to take ownership towards the approach.
Additionally, it will also help the community to replicate the positive practices in bigger
level.
3. At national level
 BCC will play a significant role in lobbying & advocacy of certain practices. These
approaches will support and encourage government and other stakeholders to bring a
positive whim among all the citizens for adopting positive behavioral practices.
Guiding Principles of BCC:
The guiding principles of BCC are:
 BCC should be integrated with the goal and objective of the program
 Formative BCC assessments must be carried out while developing BCC messages
 Target population must participate during BCC development
 Key and direct stakeholders need to be involved from the design stage of BCC
 Pre-testing must be done for effective BCC materials
 BCC programs must involve planning for monitoring and evaluation.
 BCC strategies must be positive and action oriented.

Strategies While Developing BCC Messages:

Steps in developing BCC strategy (FHI, 2002)
Developing BCC messages include:
1. Analysis
 Comprehend the idea of the issues and hindrances to change.
 Tune in to a potential group of spectators, survey existing project approaches, assets,
qualities, and shortcomings and investigate correspondence assets.
2. Strategic Design
 Settle on destinations, recognize crowd portions, position the idea for the group of
spectators
 Explain the conduct change model to be utilized, select channels of correspondence, plan
for relational discourse, draw up an activity plan, and structure for assessment.
3. Development, Pretesting, Revision, and Production
  Create message ideas, pretest with a group of spectator’s individuals and guards.
 Amend and produce messages/materials and pretest new and existing materials.
4. The executives, implementation, and monitoring
 Implement the BCC and carry out continuous monitoring to see the positive and negative
effects.
 Conduct critical analysis of the approach.
 Make sure that the messages coherent with the objective of the BCC.
5. Making arrangements for continuity
 Acclimate to changing conditions and plan for progression and independence.
BCC Strategies in Health
 User identification
 Community Mobilization: Mass media for making mindfulness for national projects like
adolescent wellbeing, MCH wellbeing administrations, and so forth.
 Platform: Home visits, gatherings
 Target population: Identify the key target population of the message
 Advancement of healthy behavior messages: MCH, Nutrition, Contraception,
Adolescents, Health, Hygiene, Sanitation, Epidemics, and so on.
Limitations of BCC:
a) Material-focused as opposed to conducting focused:
 In most of the cases, BCC approaches are considered as ‘material-focused’ rather than
‘conduct focused.
 This implies the greater part of the consideration; time and assets go into the generation
of materials, (for example, handouts).
 In any case, while alluring materials may grab somebody’s eye, they do not without
anyone else persuade individuals to change conduct.
b) Limited capacity within local line agencies:
 Local agencies and organizations might not have enough skills and ability to develop
triggering BCC messages.
 There may be limited abled human resource to facilitate the process of effective BCC
message generation
  BCC messages if not prepared without having proper idea about the context of the target
population might be useless and go in vain.

DETERMINANTS OF HEALTH PROBLEMS OF A COMMUNITY

Health or ill health is the result of a combination of different factors. There are different
perspectives in expressing the determinants of health of an individual or a community.
The health field concept
According to the “Health field” concept. There are four major determinants of health or ill
health.
A. Human Biology
Every Human being is made of genes. In addition, there are factors, which are genetically
transmitted from parents to offspring. As a result, there is a chance of transferring defective trait.
The modern medicine does not have a significant role in these cases.
a. Genetic Counselling: For instance, during marriage parents could be made aware of their
genetic component in order to overcome some risks that could arise.
b. Genetic Engineering: may have a role in cases like Breast cancer.
B. Environment: is all that which is external to the individual human host. Those are factors
outside the human body.
Environmental factors that could influence health include:
a. Life support, food, water, air etc
b. Physical factors, climate, Rain fall
c. biological factors: microorganisms, toxins, biological waste,
d. Psycho-social and economic e.g., Crowding, income level, access to health care
e. Chemical factors: industrial wastes, agricultural wastes, air pollution, etc
C. Life style (Behaviour): is an action that has a specific frequency, duration, and purpose,
whether conscious or unconscious. It is associated with practice. It is what we do and how we
act.
Recently life style by itself received an increased amount of attention as a major determinant of
health.
Life style of individuals affects their health directly or indirectly. For example: Cigarette
smoking Unsafe sexual practice Eating contaminated food
D. Health care organization
 Health care organizations in terms of their resource in human power, equipment’s, money and so
on determine the health of people. It is concerned with
a. Availability of health service
People living in areas where there is no access to health service are affected by health problems
and have lower health status than those with accessible health services.
b. Scarcity of Health Services leads to inefficient health service and resulting in poor quality of
health status of people.
c. Acceptability of the service by the community
d. Accessibility: in terms of physical distance, finance etc
e. Quality of care that mainly focuses on the comprehensiveness, continuity and integration of
the health care.
The other view of the determinants of health is from the ecological perspective. Accordingly,
there are four different factors affecting health.

Socio-cultural Physical determinant

Health of the Community

Community Behavioral Determinant

Organisation

Factors affecting health of a community

These are:
1. Physical Determinants -The physical factors affecting the health of a community include: the
geography (e.g., high land versus low land), the environment (e.g., manmade or natural
catastrophes) and the industrial development (e.g., pollution occupational hazards)
2. Socio – cultural determinants – The socio- cultural factors affecting the health of a
community include the beliefs, traditions, and social customs in the community. It also involves
the economy, politics and religion in the community.
3. Community organization - Community organization include the community size,
arrangement and distribution of resources (“relations of productions’)
4. Behavioural determinants- The behavioural determinants affecting health include individual
behaviour and life style affecting the health of an individual and the community. E.g. smoking,
alcoholism and promiscuity
Globalization and Health
Globalization is the process of increasing political and social interdependence and global
integration that takes place as capital, traded goods, persons, concepts, images, ideas and Values
diffuse across the stated boundaries.
Globalization must ensure that people, particularly the poor, enjoy better health that is the most
important factor in improving the economic wellbeing of the population in general and in
reducing poverty in particular.
The effects of Globalization on health are diverse; these can be positive, negative or mixed.
Some of the effects of Globalization are listed hereunder.
Effects of Globalization on health includes
 Externalities of some diseases due to increased communication decreased human
mobility
 Accelerated economic growth and technological advances have enhanced health and life
expectancy in many population
 Increasing effects of international and bilateral agencies (structural adjustment programs
and Global initiatives)
 Jeopardizing population health Via erosion of social and environmental conditions and
exacerbating inequalities
 Other health risks of Globalization include
- Fragmentation and weakening of labor markets due to greater power of mobile capital
- Tobacco induced diseases
- Food markets & obesity as well as chemicals in food
- Rapid spread of infectious diseases
- Depression in aged and fragmented population
- Adverse effects on the environment
PRIORITIZATION CRITERION
 Communication for behaviour change gives appropriate prominence to enhance healthy
awareness and to propagate the important concepts and practices of self-responsibility in
health.
Emphasis is given to
  The control of communicable disease, epidemics and diseases related to malnutrition and
poor living condition
 The promotion of occupational health and safety
 The development of environmental health
 The rehabilitation of the heath infrastructure and
 The development of an appropriate health service management system.
 Appropriate support shall be given to the curative and rehabilitative components of health
including mental health.
 Due attention shall be given to the development of the beneficial aspects of traditional
medicine, including related research and its gradual integration in to modern medicine.
 Applied health research addressing the major health problems shall be emphasized.
 Provision of essential medicines, medical supplies and equipment shall be strengthened
 Development of human resources with emphasis on expansion of the number of frontline and
middle level health professionals with community-based task-oriented team-based training
shall be undertaken.
 Special attention shall be given to the health needs of:
the family particularly woman and children,
those in the forefront of productivity,
those hitherto most neglected regions and segments of the population, including the
majority of rural population, pastoralists, the urban poor and national minorities victims
of man-made and natural disasters.
General Strategies
 Strengthening the preventive and promotive health service
o Family health care
o Community health service
o Occupational health and safety
 Curative and Rehabilitative care
 Assuring availability of Drugs, supplies and equipment’s
 Health information documentation and processing
 Organization and management of the health delivery system
 Research and development
 Financing the health case delivery

Prioritisation dimensions or criteria in the context of public health.

Health-related
problems • Number of persons affected
• Lethality
• Degree of disability
• Impact on activities of daily life
 • Costs of the disease
• Possibility of contagion

Interventions and • Effectiveness

Fairness in the distribution of the benefits (with
programmes • special attention to
the least-advantaged)
• Affordability (budget required to fund the
intervention)
• Cost-effectiveness
• Number of beneficiaries
• Appropriateness
• Sustainability
• System integration
• Cost per QALY gained
• Certainty (quality of the method and data used in
the evaluation)

HUMAN BEHAVIOURS
Human behaviour is among the major determinants of the health of individuals, families or
communities. Healthy behaviours contribute to the overall health of individuals and communities
and unhealthy behaviours adversely affect the quality-of-life people at different levels. Most
health issues cannot be dealt with by treatment alone. The promotion of health and prevention of
diseases will usually involve some changes in life styles or human behaviour.
Definitions of behaviour and other related terms
Behaviour is an action that has a specific frequency, duration and purpose whether conscious or
unconscious. It is what we “do” and how we “act”.
People stay healthy or become ill, often as a result of their own action or behaviour. The
following are examples of how people’s actions can affect their health:
• Using mosquito nets and insect sprays helps to keep mosquito away.
• Feeding children with bottle put them at risk of diarrhoea.
• Defecating in an open field will lead to parasitic infection.
• Unsafe sex predisposes people to unwanted pregnancy, HIV/AIDS and other STDs In health
education it is very important to be able to identify the practices that cause, cure, or prevent a
problem.
The words actions, practices and behaviours are different words of the same thing.
Life style: refers to the collection of behaviours that make up a person’s way of life-including
diet, clothing, family life, housing and work.
Customs: It represents the group behaviour. It is the pattern of action shared by some or all
members of the society.
Traditions: are behaviours that have been carried out for a long time and handed down from
parents to children.
Culture: is the whole complex of knowledge, attitude, norms, beliefs, values, habits, customs,
traditions and any other capabilities and skills acquired by man as a member of society.
Distinguishing characteristics of culture
• Culture is symbolic. It is an abstract way of referring to, and understanding ideas, objects,
feelings or behavior – the ability to communicate with symbols using language. To convey new
ideas people may invent single words to represent many different ideas, feelings or values.
• Culture is shared. People in the same society share common behavior patterns and ways of
thinking through culture. For example people living in a society share the same language, dress
in similar styles, eat much of the same food and celebrate many of the same holidays.
• Culture is learned. A person must learn culture from other people in a society. For instance,
people must learn to speak and understand a language and to abide by the rules of a society.
• Culture is adaptive. People use culture to adjust flexibly and quickly to changes in the world
around them. For instance, a person can adjust his diet when he changes an area of residence.
Examples of behaviours promoting health and preventing diseases
Healthy behaviours: - actions that healthy people undertake to keep themselves or others
healthy and prevent disease. Good nutrition, breast feeding, reduction of health damaging
behaviours like smoking are examples of healthy behaviours
Utilization behaviour: - utilization of health services such as antenatal care, child health,
immunization, family planning…etc Illness behaviour: - recognition of early symptoms and
prompt self-referral for treatment.
Compliance behaviours: - following a course of prescribed drugs such as for tuberculosis.
Rehabilitation behaviours: - what people need to do after a serious illness to prevent further
disability.
Community action: - actions by individuals and groups to change and improve their
surroundings to meet special needs.
Factors affecting human behaviour
1. Predisposing factors: provide the rationale or motivation for the behavior to occur.
Some of these are:
• Knowledge
• Belief
• Attitudes
• Values
E.g. For an individual to use condom, he has to have knowledge about condom and develop
positive attitude towards utilization of condom.
•Knowledge is knowing things, objects, events, persons, situations and everything in the
universe. It is the collection and storage of information or experience. It often comes from
experience. We also gain knowledge through information provided by teachers, parents, friends,
books, newspapers, etc… E.g. knowledge about methods of prevention of HIV
• Belief is a conviction that a phenomenon or object is true or real. Beliefs deal with people’s
understanding of themselves and their environment. People usually do not know whether what
they believe is true or false. They are usually derived from our parents, grandparents, and other
people we respect. Beliefs may be helpful, harmful or neutral. If it is not certain that a belief is
harmful, it is better to leave it alone. For example, a certain society may have the following
beliefs:
• Holding materials made of iron by mothers during postpartum (Neutral)
• Diarrhea may end up with death (helpful)
• Measles can not be prevented by immunization (harmful)
• Attitudes are relatively constant feelings, predispositions or set of beliefs directed towards an
object, person or situation. They are evaluative feelings and reflect our likes and dislikes. They
often come from our experiences or from those of people close to us. They either attract us to
things, or make wary of them.
E.g. w/o Almaz had fever and visited the nearby health center. The staff on duty that day was
very busy and shouted at her, “Do you want us to waste our time for a mild fever? Come back
when we are less busy.” She did not like being shouted at. This experience gave her bad attitude
toward the health staff. This bad attitude could discourage her from attending the health center
next time she is sick.
• Values are broad ideas and widely held assumptions regarding what are desirable, correct and
good that most members of a society share. Values are so general and abstract that they do not
explicitly specify which behaviors are acceptable and which are not.
Instead, values provide us with criteria and conceptions by which we evaluate people, objects
and events as their relative worth, merit, beauty or morality. E.g. being married and having many
children are highly valued in most Cameroonian community.
• Norms are social rules that specify appropriate and inappropriate behavior in given situations.
They tell us what we should and must do as well as what we should not and must not do. For
Example,
• We often regard greeting as a social norm to be conformed among members who know each
other. • Murder, theft and rape often bring strong disapproval.
2. Enabling factors: these are characteristics of the environment that facilitates healthy behavior
and any skill or resource required to attain the behavior.
Enabling factors are required for a motivation to be realized. Examples of enabling factors
include:
• Availability and or accessibility of health resources
• Government laws, priority and commitment to health
• Presence of health related skills E.g. Enabling factors for a mother to give oral rehydration
solution to her child with diarrhea would be:
• Time, container, salt, sugar
• Knowledge on how to prepare and administer it In general, it is believed that enabling factors
should be available for an individual or community to perform intended behaviour

Behaviour intention Behavioural change

Enabling Factors
(Time, money and materials, skills, accessibility to health services) Behavioral intention is
willingness/ readiness to perform a certain behavior provided that enabling factors are readily
available.
3. Reinforcing factors: these factors come subsequent to the behavior. They are important for
persistence or repetition of the behavior. The most important reinforcing factors for a
behavior to occur or avoid include:
• Family
• Peers, teachers
• Employers, health providers
• Community leaders
• Decision makers
We are all influenced by the various persons in social network. Pressure from others can be a
positive influence to adopt health promoting practices as well as an obstacle. Influential people
significant influence to change others. In the case of a young child, it is usually the parents who
have the most influence. As a child grows older, friends become important and a young person
can feel a powerful pressure to conform to the peer group.
E.g. a young man starts smoking because his friends encouraged him to do so.
The role of human behavior in prevention of disease and promotion of health
What is prevention?
Prevention is defined as the planning for and the measures taken to forestall the onset of a
disease or other health problem before the occurrence of undesirable health events. There are
three distinct levels of prevention: primary, secondary, tertiary prevention.
Healthy Person Early Signs Disease Death

Primary Prevention Secondary Prevention Tertiary Prevention

Levels of prevention of disease

Primary prevention
Primary prevention is comprised of those activities carried out to keep people healthy and
prevent them from getting disease. Examples of important behaviors for primary prevention
includes using rubber gloves when there is a potential for the spread of disease, immunizing
against specific diseases, exercise, and brushing teeth. And any health education or promotion
program aimed specifically at prevention of the onset of illness or health problems is also an
example of primary prevention.
Secondary prevention
Secondary prevention includes preventive measures that lead to an early diagnosis and prompt
treatment of a problem before it becomes serious. It is important to ensure that the community
can recognize early signs of disease and go for treatment before the disease become serious.
Health problems like tuberculosis can be cured if the diseases is detected at an early stage. The
actions people take before consulting a health worker, including recognition of symptoms, taking
home remedies (‘self-medication’), consulting family and healers are called illness behaviors.
Illness behaviors are important examples of behaviors for secondary prevention.
Tertiary prevention
Tertiary prevention seeks to limit disability or complication arising from an irreversible
condition. Even at this stage actions and behaviors of the patient are essential. The use of
disability aids and rehabilitation services help people from further deterioration and loss of
function. For example, a diabetic patient should take strictly his/her daily insulin injection to
prevent complications.
 COMMUNITY BALANCE
INTRODUCTION
The Community Balanced (CB) is a strategic performance management system to address
outcomes that require collaboration by many organizations to improve the health of the public.
The Results are based on the aspects of Team built public health CB tools on a framework of the
essential services of public health, creating a powerful methodology for improving public health
infrastructure while simultaneously focusing collaborative strategies on improving health
outcomes. County and state health departments across the country have been using CB tools. In
order to fully achieve community balance, it’s of utmost important we critically understand
community participation.
Community participation was one of the main principles of Primary Health Care (PHC), the
strategy proposed in Alma Ata in 1978 by the World Health Organization (WHO) and the United
Nations Children’s Fund (UNICEF) and adopted by 150 member states of the two organizations.
It was meant to revolutionize the practice of health care and health development, leading to
health for all by the year 2000 (WHO, 1978). Not that the concept was new; in 1950s and early
1960s, it was used within health programs and health care; but also, broadly in social practice
and development. Monopoly and control of health care delivery systems by professional health
staff resulting from technological complexity and centralization of national health services
however, culminated in the Alma Ata declaration calling for the halting, or even reversal of the
trend (Kahssay & Oakley, 1999). So by the time of the Alma Ata declaration, the environment
within United Nations agencies was focused on the involvement of people in decisions about
development.
Definition of community participation at Alma Ata
The Alma Ata definition was, as usual, lengthy and went as follows: “community participation is
the process by which individuals and families assume responsibility for their own health and
welfare and those of the community, and develop capacity to contribute to their and the
community’s development. They come to know their own situation better and are motivated to
solve their common problems. This enables them to become agents of their own development
instead of passive beneficiaries of development aid…..”. – One interpretation given of this
definition vaguely is: “… that community people would become involved in both delivery of and
decisions about health and health services in order to provide the type of care most appropriate to
their own defined needs and circumstances” (Rifkin, 1986). However, many questions remained
unanswered; for instance: ‘Why participate?’, ‘Who participates and who benefits?’, ‘How do
community people participate?’, ‘With what?’ and, ‘How would outcomes be assessed?’
Rifkin, (1996) has argued that the framers of the Alma Ata declaration purposely left the concept
of community participation vague and flexible in recognition of the fact that countries presented
diverse contexts. (Were the seeds for the abuse of the concept or those of simply more rhetoric
than reality planted then? Perhaps) anyhow, as a result, the concept became many different things
to different people; making it difficult to reach generally agreed definitions, let alone objectives,
for developing it in health care. A plethora of different interpretations and meanings were given
to the concept of community participation and its practice. What follows is illustrative.
Principles of Community Participation
Community participation means the involvement of people from the earliest stages of the
development process, as opposed to simply asking their opinion of project proposals that have
already been developed, or for their contribution to the implementation of projects imposed from
outside. Participatory approaches have been widely tested in the fields of water, sanitation and
hygiene, and experience has shown that involvement of the community can produce wide-
ranging benefits. The main principles are:
Communities can and should determine their own priorities in dealing with the problems that
they face. The enormous depth and breadth of collective experience and knowledge in a
community can be built on to bring about change and improvements. When people understand a
problem, they will more readily act to solve it. People solve their own problems best in a
participatory group process.
Community-focused programs therefore aim to involve all members of a society in a
participatory process of: assessing their own knowledge; investigating their own environmental
situation; visualizing a different future; analyzing constraints to change; planning for change; and
implementing change.
Health planners used three approaches to define community participation based on three
similarly differing definitions of health:
• The Medical approach - which defines health as absence of disease. Community participation is
then defined as activities undertaken by community people following the directions of medical
professionals in order to reduce individual illness and improve the general environment; for
example using health services or cleaning the environment. It is based on the notion that health
improves as a result of biomedical science and technology.
• The Health services approach – which defines health in the WHO sense of the word: ‘physical,
social and mental well-being of the individual’. It defines community participation as the
mobilization of community people to take an active part in the delivery of health services; for
example using community health workers (CHW), recruited from and by the community, trained
and supervised by health professionals and ‘accountable’ to the community to deliver health care;
• The Community development approach – which defines health as a human condition which is a
result of social, economic, and political development. It defines community participation as
community members being actively involved in decisions about how to improve that condition;
essentially, that health will improve with eradication of poverty brought about by a change in the
existing system of power and control relations.
The first two came to be known as the ‘top-down’ and the last and third one as the ‘bottom-up’
approaches. In the former approach, the health professionals have the predominance in
decisionmaking; in the latter, stress is placed on the importance of community people learning to
decide what is best for them and the process of how to achieve the change they desire. In short in
the latter approach, the solution is secondary to the process that leads to the change that ensues in
community members’ attitudes and behavior.
Justification:
1. Health services alone are neither enough to foster community participation nor solve health
problems;
2. Authentic community participation has to be premised on the broad needs and interests of the
community as perceived by the community; and quoting research findings (Elliott, 1975), health
services are usually not a priority to lay people except when sick. (“When lay people were asked
what they want most, more income, food, shelter, and clothing rank above health services”).
Wide community participation therefore develops as part of a process that addresses a range of
community needs;
3. Community participation is interwoven with the issue of power. It is therefore erroneous to
assume that communities are homogeneous; those leaders always act in the interest of the
communities they lead; and that government and the community share the same development
goals. Indeed, to illustrate the above, experience showed that in areas of poverty, individual
concerns often over-ride community goals; people who have been identified by the community
as having influence often use new opportunities to enrich themselves; and governments want to
mobilize local resources so as to free capital for other programs, respectively;
4. Community participation is not and should not be considered as a component of a health
program, or an intervention to improve health services and/or health care, but as a process of
change that is context- +specific. Motivation among community members seems to be the major
ingredient;
5. Community participation is heavily influenced by factors such as culture, history, government
policy, social, political and economic structures; it is therefore dynamic rather than static. A
common history of struggle seems conducive to community participation in terms of community
motivation, organization, and structures; Ministry of Health & Family Welfare has approved a
Community Support Committee (CSC) structure with the specific TOR (attached).

Focus of Community Support Committee

(1) To review and suggest measures for improvement regarding following activities:
(a) Cleanliness of Hospital premises, indoor & outdoor;
(b) Display of referral map and chain, citizen charter, Drug availability stock,
(c) Quality of Diet;
(d) To review the financial account, income & expenditure statements of CSC
(2) To encourage and appreciate the hospital staff for the good performance
(3) To constitute sub-committees for specific purposes

DEVELOPMENT OF COMMUNITY HEALTH ACTION PLAN (CHAP)

A Community Health Action Plan is a written document that lists plans for achieving health
improvements in the community. This is developed in response to needs and gaps identified from
data collection. The plan is written by the community coalition and typically includes
establishing and clarifying desired outcomes, goals, objectives, activities, assignments, and
deadlines for coalition members supporting the action plan. A CHAP offers built-in deliverables
and focuses on doing work in the community to support priority health needs.
Having an action plan:
• Lends credibility to your organization. An action plan shows members of the community
(including grant makers) that your organization is well ordered and dedicated to getting things
done.
• Prevents the possibility of overlooking details.
• Helps understand what is and isn’t possible for your organization to do.
• Helps your community be more efficient by saving time, energy, and resources.
• Increase the chances that people will do what needs to be done by making them more
accountable.
An action plan may take one, three, or even up to 10 years to complete. The number of years it
may take is determined by
1) the coalition - content of the CHAP,
2) how long it might take to reach the desired outcomes and goals, and
3) community support or resistance.
The action plan is constantly progressing. It is not something to write, lock in a file drawer, and
forget about. Keep it visible. Display it prominently. As the organization changes and grows,
continually (usually monthly) revise and update the action plan to fit the changing needs of the
community.

COMMUNITY HEALTH ACTION PLAN (CHAP) COMPONENTS

Developing the components of a CHAP that support the work of the community coalition may
seem like a lot of busy work; but if done properly, it saves money, time, and increases the odds
that the coalition’s initiative will succeed. Documenting these plans will help keep the coalition
focused on “where it is going” and “how and when it will get there” and “what to expect when it
does.”
Community Health Action Plan Terms

Vision Where the coalition is headed, what it is trying to do, what is important and
why

Mission The coalition’s principles and purpose, determines the focus and sets the
direction

Goals What is expected to be achieved in the long run

Objectives The process steps to meet the goals and how the coalition plans to achieve
them

Activities The work of the community coalition that drives and supports the objectives
and goals

Outcomes The desired effect on the community, what the measure of success would be

PLANNING STEPS
The following steps are meant to be a guide for developing a comprehensive CHAP. The plan is
to be shared with community coalition members and partners once the CHNA phase has been
completed. What things are necessary to carry out the goals and objectives determined by the
coalition? By breaking it into defined steps, developing a plan will be more manageable. The
CHAP should be complete, clear, and current.
The following steps are integral components to developing a CHAP It is important to complete
each step at some point, to ensure a comprehensive community health action plan to address
local chronic disease prevention and control.
• Review and analyse results of community assessment. By the time an action plan is
ready to be developed, there has been a substantial amount of information collected from data,
and also information collected in the CHNA. Review and analyse the feedback and information
gathered from the community; it is very significant and can provide some clues and priorities for
what needs to be addressed in the plan.
• Choose a group of people to work together on developing the CHAP. The writing of
the plan can be limited to one or two main people. The process of developing the CHAP should
be a collaborative/partnership effort; the writer(s) can translate the planning notes into a CHAP.
Too many writers can result in a fragmented plan.
• Identify outcomes that would address the issues. Outcomes are
focused at producing a healthy change in the community. It is important to think through what
would be most appropriate and achievable for those who will be carrying out the plan. After the
parameters of the overall project are determined, the next step is to set a goal for each outcome to
be addressed and add objectives and activities that support the work.
a. Choose a goal(s) that supports the outcomes and priority areas.
b. Determine short-term, intermediate, and long-term objectives for each goal; these are the
action steps that drive the work of the goals.
c. Decide activities that support the objectives.
d. Identify what sector(s) of the community will be affected.
e. Establish lead responsibility and planning team participants for each goal. f. Keep in mind that
the goals and objectives should be S.M.A.R.T. (Specific, Measurable, Attainable, Realistic, and
Time-based).
• Identify challenges, obstacles, or potential barriers to successfully implementing
interventions. Part of deciding what would be most effective and achievable is to examine
potential barriers that may exist to deter successfully implementing interventions to address and
improve the community’s health status.
• Identify necessary resources and where you will obtain them. A key task is to identify the
abilities, capacity, skill sets, duties, and responsibilities of all people that will be asked to do the
work of the CHAP. The plan requires many people and organizations to contribute their unique
assets and resources.
• Choose individuals and community partners who will support, identify with, and
implement goals and objectives. It is important for people to identify with the outcomes, goals,
and objectives of the action plan to participate in the activities that will drive it.
• Consider a timeline for conducting activities. Time is a valuable resource so it is
important to state clearly and realistically community member’s contributions to the various
parts of the plan. Creating a timeline provides everyone working on the CHAP with a clear idea
of what activities should be done and when to expect activities to be accomplished.
• Include monitoring and evaluation activities. It is essential to know how the plan is
progressing as you carry out the objectives and activities—this is where evaluation fits in.
Address these questions informally (ask yourself, discuss with friends and other people), as well
as formally (i.e. surveys, interviews, focus groups, and other evaluation methods):
- Are we doing what we said we’d do?
- Are we doing it well?
- Is what we are doing advancing the mission?
• Review the completed action plan. Carefully check for completeness, make sure you are
not leaving anything out that will affect the intended outcome(s) of the initiative
CONCLUSION
A Community Health action plan is a necessary tool to keep the work of a community on task,
outcomes obtainable, and support health improvements in the community, but it does not have to
be perfect. More important than a perfect plan is one that is supported and feasible for the
community coalition to complete within a reasonable period of time. The CHAP is a working
document that can be reviewed and modified as it is implemented. It is a starting point that the
coalition can continue to update and revise as community coalitions learn over time how to
accomplish their goals. The well-written and community utilized CHAP will be the vehicle that
drives a coalition down the road to a Good & Healthy Community.
 THE TECHNIQUES OF COMMUNICATION
Introduction
Behaviour change at individual and community levels can be complex to affect and measure.
Using evidence-based health communication strategies and best practices can streamline and
often improve behaviour change initiatives for public health. Here you’ll find resources that can
support your ongoing or upcoming health communication planning, research activities, disease
prevention efforts, and program development and evaluation.
Planning
Health communication can take many forms, both written and verbal, traditional and new media
outlets. While you might be excited to get started with your new program, you must first develop
a sound strategic plan. All strategic communication planning involves some variation on these
steps
 Identify the health problem and determine whether communication should be part of the
intervention
 Identify the audience for the communication program and determine the best ways to
reach them
 Develop and test communication concepts, messages, and materials with representatives
of the target audiences
 Implement the health communication program based on results of the testing
 Assess how effectively the messages reached the target audience and modify the
communication program if necessary
Budgets for health communication initiatives vary. If your funds are limited, there are still
opportunities to develop and implement health communications plans. Here are some tips for
working effectively and efficiently on a tight budget:
 Work with partners who can add their resources to your own
 Conduct activities on a smaller scale
  Use volunteer assistance from health communications specialists who may be able to
offer pro bono services or consider retired specialists or professors and graduate level
students from the local college/university
 Seek out existing information and approaches developed by programs that have
addressed similar issues to reduce developmental costs.
Don't let budget constraints keep you from setting objectives, learning about your intended
audience, or pretesting. Neglecting any of these steps could limit your program's effectiveness
before it starts.
The various communication strategies are see below:
1. PEER EDUCATION
Peer education is an approach to health promotion, in which community members are supported
to promote health-enhancing change among their peers. Peer education is the teaching or sharing
of health information, values and behaviour in educating others who may share similar social
backgrounds or life experiences.
Rather than health professionals educating members of the public, the idea behind peer education
is that ordinary lay people are in the best position to encourage healthy behaviour to each other.
Areas of application
Peer education has become very popular in the broad field of HIV prevention. It is a mainstay of
HIV prevention in many developing countries, among groups including young people, sex
workers, people whom practice unprotected sex, or people who use intravenous drugs.
Peer education is also associated with efforts to prevent tobacco, alcohol and other drug use
among young people. Peer educators can be effective role models for young adolescents by
promoting healthy behaviours, helping to create and reinforce social norms that support safer
behaviours, and also serve as an accessible and approachable health education resource both
inside and outside the classroom.
Peer education is useful in promoting healthy eating, food safety and physical activity amongst
marginalized populations. Peer education is also favourably used in medical education.
Some public-school districts have implemented peer-education programs. For example, New
York City schools implemented a peer-led sex education program in 1974.
The process
A peer education programme is usually initiated by health or community professionals, who
recruit members of the target community to serve as peer educators. The recruited peer educators
are trained in relevant health information and communication skills. Armed with these skills, the
peer educators then engage their peers in conversations about the issue of concern, seeking to
promote health-enhancing knowledge and skills. The intention is that familiar people, giving
locally-relevant and meaningful suggestions, in appropriate local language and taking account of
the local context, will be most likely to be able to promote health-enhancing behaviour change.
There is a great variety in the support provided to peer educators. Sometimes they are unpaid
volunteers, sometimes they are given a small honorarium, sometimes they receive a reasonable
salary. The peer educators may be supported by regular meetings and training, or expected to
continue their work without formal supports.
Theories
A variety of theories are offered regarding the question of how peer education is supposed to
achieve positive results.
Kelly's popular opinion leader theory
The popular opinion leader theory suggests a parallel between peer education and the marketing
of commercial products. Peer educators are seen as opinion leaders—respected and admired by
other members of the community. These opinion leaders espouse a certain lifestyle (such as safer
sex, or not smoking, etc.)—and their peers wish to emulate them.
Critical consciousness
Campbell argues that what peer education ought to do is to promote the kind of critical
consciousness theorized by Paulo Freire. This means that peers use the peer education process to
critically discuss their circumstances, especially the social factors impacting upon their health.
Becoming critically aware of these forces is the first step to tackling them. So, for instance, if
local norms regarding sexuality and gender put people's health at risk, this approach argues that
peers should critically discuss those norms, so that they can then collectively seek to establish
new more health-enhancing norms.
Social learning theory
Based on the work of Bandura and colleagues, social learning theory claims that modelling is an
important component of the learning process. In the most basic sense, people observe behaviour
taking place and then go on to adopt similar behaviour. Participants require the opportunity to
practice modelled behavior and positive reinforcement if it is to be adopted successfully.
Differential association theory
Based on the work of Sutherland and Cressy, differential association theory has been applied to
the study of crime. Rather than the result of biological or psychological disorders, crime is a
learned behaviour. This learning happens in social situations by associating with those who can
teach the necessary skills and techniques needed. Through this theory it can be understood that
peers can be very influential for both positive and negative behaviours. Young people can learn
both good and bad habits from each other. In differential association theory the mere association
with others provides a learning opportunity. If social learning theory is essentially psychological,
differential association theory is essentially sociological.
Role theory
Sarbin argues that peer educators will adapt to the role expectations of a tutor and behave
appropriately. Furthermore, through adopting a role, individuals develop a deeper understanding
and commitment to it. The potential is that Peer educators can develop a stronger commitment
and a greater appreciation of the relevance of the health topic. Role theory is also based on the
premise that communication can be blocked by differences in culture between the teacher and
learner. Peer educators who have a similar set of experiences and culture are therefore likely to
be more effective in promoting learning.
Communication of innovations theory
Developed by Rogers and Shoemaker, the communication of innovations theory explains how
innovations come to be adopted by communities and what factors influence the rate of adoption.
These factors include the characteristics of those who adopt the innovation, the nature of the
social system, the characteristics of the innovation and the characteristics of change agents.
Rogers and Shoemaker argue that all innovations follow a similar pattern of adoption, with one
group of people—the innovators—taking it up immediately. Then there are early adopters,
the early majority, the late majority and finally the laggards, including some who never adopt
the innovation. In this theory key people influence the opinion leaders within a community.
Change agents can be viewed as health professionals while opinion leaders correlate with peer
educators. Rogers and Shoemaker argue that effective communication occurs when the source
and receiver are homophilous, that is, are similar in certain attributes. These include beliefs,
values, education and social status. This would suggest that peers communicate better than those
who are unequal or different
Support
Peer educators are seen as credible sources of information This has been shown to be particularly
effective amongst the youth population. Peers and peer education are an important influence and
approach in changing health behaviours.
One of the beliefs of peer education is that it is cost effective. Peer education has been identified
as a more economical way to deliver health training.
A team of peer educators can extend health promotion outreach and be more accessible than paid
health professionals. Peer educators help to bridge many of the gaps in service that occur through
fear and suspicion of official health care providers, and to facilitate effective communication
with community members and professional provider. Engaging youth peer educators help
professionals to extend their outreach of programs and services to ensure their efforts are
impactful.
Peer education is empowering from both the standpoint of the peer educator and the individual
receiving service. Peer education has been operative in encouraging knowledge, attitudes and
intention to change behaviour in AIDS prevention. Furthermore, nondirective peer support has
been identified as the best way to motivate individuals in the preparation, action, or
maintenance stages of readiness to change. Researchers have acknowledged that trained peer
tutors were more effective than the untrained peers in influencing positive health outcomes. Peer
education offers the educators the opportunity to benefit from taking on meaningful roles. Peer
educators can act as enthusiastic advocates for the program and have a sense of purpose in their
community outreach efforts.
Peer education is sustainable. This has been found to be an important issue for community-based
health promotion interventions to make a difference over time. [18] A grassroots initiative
involving volunteers means that the health issue is reaching the target audience continuously
with less of a threat of financial cutbacks impacting on their work. Research findings support the
use of volunteer peer educators as a feasible and effective healthcare delivery strategy and as
having promising indicators of sustainability over time.[18] Sustainability through the engagement
of peer educators can strengthen the social environment so that it is supportive of healthy
behaviours.
Debates
Despite its popularity, the evidence about peer education is mixed, and there is no consensus on
whether it works or how it works. Researchers have questioned the validity of the assumption
that peer education influences behaviour.
One important line of inquiry suggests that peer education may work in some contexts but not in
others. A study comparing peer education among sex workers in India and South Africa found
that the more successful Indian group benefited from a supportive social and political context,
and a more effective community development ethos, rather than the biomedical focus of the
South African intervention.
A key issue concerns what a peer is and who defines this. In some instances, age is a central
factor but in other contexts, commonalities such as status may be more relevant. Caution has
been noted regarding selection of peer educators. Some argue that there can be a stigma held
against peer educators who have faced adversities in their own lives, particularly by mainstream
health service organizations and professionals. Alternatively, peers’ educators would need to
have high status within their social group to be effective. Researchers have argued that peer
educators sometimes receive inadequate training, which limits their ability to educate their peers
effectively and further state that peer selection and training is very important.
An important analysis on the development of many peer education projects is that it is led by
adult constructions of adolescence and adolescent health behaviour. A central question should
therefore be whose agenda is being served by using peer education projects which manipulate
and exploit the social worlds of young people?
2. Group discussions
Health education has been quick to recognize that groups provide an ideal set-up for learning in a
way that leads to change and action. Discussion in a group allows people to say what is in their
minds. They can talk about their problems, share ideas, support and encourage each other to
solve problems and change their behavior.
Size of a group
For sharing of ideas an ideal group is the one with 5-10 members. If the members are large every
one may not have a chance to speak.
Planning a discussion
Planning a discussion involves:
• Identification of the discussants that do have a common interest E.g. mothers whose child
suffers from diarrhea.
• Getting a group together
• Identification of a comfortable place and time: Conducting the discussion
• Introduction of group members to each other
• Allow group discussion to begin with general knowledge E.g. any health problems they have
ever faced
• Encourage everyone to participate.
- Have a group act out some activity (drama, role play)
- Have a villager report on a successful experience
- Limit those who talk repeatedly and encourage the quiet to contribute.
• Limit the duration of discussion to the shortest possible, usually 1- 2 hrs.
• Check for satisfaction before concluding the session. E.g. Do they think that they are learning?
Do they think the group should continue?
3. Meetings
Meetings are good for teaching something of importance to a large group of people. They are
held to gather information, share ideas, take decisions, and make plans to solve problems.
Meetings are different from group discussions.
A group discussion is free and informal, while meetings are more organized.
Meetings are an important part of successful self-help projects.
Planning a meeting
• It should be need based
• Determine the time and place
• Announce the meeting through village criers or word of mouth.
• Prepare relevant and limited number of agendas.
Conducting the meeting
• Should be led by a leader
• Encourage participation as much as possible
• Try to reach at consensus-based decisions
• Use some visual aids to clarify things
• Finally, get ready to take actions to solve problems.
4. BRAINSTORMING
Brainstorming is a method of generating ideas and sharing knowledge to solve a particular
Health, commercial or technical problem, in which participants are encouraged to think without
interruption. Brainstorming is a group activity where each participant shares their ideas as soon
as they come to mind. At the conclusion of the session, ideas are categorized and ranked for
follow-on action.
Brainstorming combines a relaxed, informal approach to problem solving with lateral thinking. It
encourages people to come up with thoughts and ideas that can, at first, seem a bit crazy. Some
of these ideas can be crafted into original, creative solutions to a problem, while others can spark
even more ideas. This helps to get people unstuck by "jolting" them out of their normal ways of
thinking.
Therefore, during brainstorming sessions, people should avoid criticizing or rewarding ideas.
You're trying to open up possibilities and break down incorrect assumptions about the problem's
limits. Judgment and analysis at this stage stunts idea generation and limit creativity.
Evaluate ideas at the end of the session – this is the time to explore solutions further, using
conventional approaches.
Why Use Brainstorming?
Conventional group problem solving can often be undermined by unhelpful group behaviours .
And while it's important to start with a structured, analytical process when solving problems, this
can lead a group to develop limited and unimaginative ideas.
By contrast, brainstorming provides a free and open environment that encourages everyone to
participate. Quirky ideas are welcomed and built upon, and all participants are encouraged to
contribute fully, helping them develop a rich array of creative solutions.
When used during problem solving, brainstorming brings team members' diverse experience into
play. It increases the richness of ideas explored, which means that you can often find better
solutions to the problems that you face.
It can also help you get buy-in from team members for the solution chosen – after all, they're
likely to be more committed to an approach if they were involved in developing it. What's more,
because brainstorming is fun, it helps team members bond, as they solve problems in a positive,
rewarding environment.
While brainstorming can be effective, it's important to approach it with an open mind and a spirit
of non-judgment. If you don't do this, people "clam up," the number and quality of ideas
plummets, and morale can suffer.
How to Use the Tool
You often get the best results by combining individual and group brainstorming, which we
explain below, and by managing the process according to the "rules" below. By doing this, you
can get people to focus on the issue without interruption, you maximize the number of ideas that
you can generate, and you get that great feeling of team bonding that comes with a well-run
brainstorming session!
To run a group brainstorming session effectively, follow these steps.
Step 1: Prepare the Group
How much information or preparation does your team need in order to brainstorm solutions to
your problem? Remember that prep is important, but too much can limit – or even destroy – the
freewheeling nature of a brainstorming session.
First, choose an appropriate and comfortable meeting space. This can be in the office, or virtual.
Consider what would work best for your team. Make sure you have the right resources
beforehand; you can use virtual brainstorming tools like Miro or Lucid Spark, and you'll need
pens and post-It’s for an in-person session.
Now consider who will attend the meeting. A brainstorming session full of like-minded
people won't generate as many creative ideas as a diverse group , so try to include people from a
wide range of disciplines, and include people who have a variety of different thinking styles.
When everyone is gathered, appoint one person to record the ideas that come from the session.
This person shouldn't necessarily be the team manager – it's hard to record and contribute at the
same time. Post notes where everyone can see them, such as on flip charts or whiteboards; or use
a computer with a data projector.
If people aren't used to working together, consider using an appropriate warm-up exercise, or
an icebreaker .
Step 2: Present the Problem
Clearly define the problem that you want to solve, and lay out any criteria that you must meet.
Make it clear that that the meeting's objective is to generate as many ideas as possible.
Give people plenty of quiet time at the start of the session to generate as many of their own ideas
as they can. Then, ask them to share or present their ideas, while giving everyone a fair
opportunity to contribute.
Step 3: Guide the Discussion
Once everyone has shared their ideas, start a group discussion to develop other people's ideas,
and use them to create new ideas. Building on others' ideas is one of the most valuable aspects of
group brainstorming.
Encourage everyone to contribute and to develop ideas, including the quietest people, and
discourage anyone from criticizing ideas.
As the group facilitator, you should share ideas if you have them, but spend your time and
energy supporting your team and guiding the discussion. Stick to one conversation at a time, and
refocus the group if people become side tracked.
Although you're guiding the discussion, remember to let everyone have fun while brainstorming.
Welcome creativity, and encourage your team to come up with as many ideas as possible,
regardless of whether they're practical or impractical. Use thought experiments such
as Provocation or Random Input to generate some unexpected ideas.
Don't follow one train of thought for too long. Make sure that you generate a good number of
different ideas, and explore individual ideas in detail. If a team member needs to "tune out" to
explore an idea alone, allow them the freedom to do this.
Also, if the brainstorming session is lengthy, take plenty of breaks so that people can continue to
concentrate.
Individual Brainstorming
While group brainstorming is often more effective at generating ideas than normal group
problem solving, several studies have shown that individual brainstorming produces more – and
often better – ideas than group brainstorming.
This can occur because groups aren't always strict in following the rules of brainstorming, and
bad behaviours creep in. Mostly, though, this happens because people pay so much attention to
other people that they don't generate ideas of their own – or they forget these ideas while they
wait for their turn to speak. This is called "blocking."
When you brainstorm on your own, you don't have to worry about other people's egos or
opinions, and you can be freer and more creative. For example, you might find that an idea you'd
hesitate to bring up in a group develops into something special when you explore it on your own.
However, you may not develop ideas as fully when you're on your own, because you don't have
the wider experience of other group members to draw on.

Tip:
To get the most out of your individual brainstorming session, choose a comfortable place to sit
and think. Minimize distractions so that you can focus on the problem at hand, and consider
using Mind Maps to arrange and develop ideas.
Individual brainstorming is most effective when you need to solve a simple problem, generate a
list of ideas, or focus on a broad issue. Group brainstorming is often more effective for solving
complex problems.
Group Brainstorming
Here, you can take advantage of the full experience and creativity of all team members. When
one member gets stuck with an idea, another member's creativity and experience can take the
idea to the next stage. You can develop ideas in greater depth with group brainstorming than you
can with individual brainstorming.
Another advantage of group brainstorming is that it helps everyone feel that they've contributed
to the solution, and it reminds people that others have creative ideas to offer. It's also fun, so it
can be great for team building!
Group brainstorming can be risky for individuals. Unusual suggestions may appear to lack value
at first sight – this is where you need to chair sessions tightly, so that the group doesn't crush
these ideas and stifle creativity.
Where possible, participants should come from a wide range of disciplines. This cross-section of
experience can make the session more creative. However, don't make the group too big: as with
other types of teamwork, groups of five to seven people are usually most effective.
5. COUNSELLING
Counselling is a talking therapy that involves a trained therapist listening to you and helping you
find ways to deal with emotional issues.
Sometimes the term "counselling" is used to refer to talking therapies in general, but counselling
is also a type of therapy in its own right.
What can counselling help with?
Counselling can help you cope with:
 a mental health condition, such as depression, anxiety or an eating disorder
 an upsetting physical health condition, such as infertility
 a difficult life event, such as a bereavement, a relationship breakdown or work-related
stress
 difficult emotions – for example, low self-esteem or anger
 other issues, such as sexual identity
What to expect from counselling?
At your appointment, you'll be encouraged to talk about your feelings and emotions with a
trained therapist, who'll listen and support you without judging or criticising.
The therapist can help you gain a better understanding of your feelings and thought processes,
and find your own solutions to problems. But they will not usually give advice or tell you what
to do.
Counselling can take place:
 face to face
 in a group
 over the phone
 by email
 online through live chat services
You may be offered a single session of counselling, a short course of sessions over a few weeks
or months, or a longer course that lasts for several months or years.
It can take a number of sessions before you start to see progress, but you should gradually start to
feel better with the help and support of your therapist.
6. INTERPERSONAL COMMUNICATION
Interpersonal communication is one of the foundations of quality patient care especially for
valuable trio in health care- the doctor, the nursing staff and the patient. Effective
communication skills in health care setting are a boon as they not only benefit patient but also
the health care provider, in respect to job satisfaction and prevention of work stress which affect
health. There is strong need of hour that more training, more awareness is created about barriers
to effective communication and empower them with strategies to enhance their receptivity
towards patient’s queries thereby improving nursing interventions in patient care.
Communication helps ion flow of knowledge from person to person and develop better
interpersonal relationships. Communication and interpersonal skills are the most important
factors for improving patient satisfaction, compliance and overall health outcome. Interpersonal
communication in recent years has played a pivotal role in successful job performance in any
organization, health care been no exception. Nursing staff is the backbone of health care in any
country. They are entrusted with the responsibility of delivering quality health services to patient
and are not only the primary level of contact with patient but also spend maximum time with
patients. The manner in which nursing staff communicates and takes care of patients influence
the satisfaction level of patients and notably impact the health care outcome. Nursing staff can
make patients understand their illness and treatment and being the first level of contact gain
confidence of patients making patients feel like second home. This eventually brings mental
peace and creates harmonious environment. It therefore brings good health- physical, social and
mental well being to patient’s i.e. holistic approach to patient care.
How communication affects patients and nurses
Communication failures leading to catastrophe have been well experienced in health care. One
such instance been the wrong administration of medication leading to compromised patient
safety. The type of nursing care determines the incidence of revisit of patients to the hospital and
therefore can serve as a good yardstick of goodwill and satisfaction of any health care institution
among general population.
Advantages of effective communication
1. Compliance-Better Compliance with guidelines of accreditation bodies and regional
guidelines.
2. Safety- Minimize medication errors enhancing patient safety.
3. Patient’s happiness quotient-It improves patient satisfaction, results in recovery, alleviating
anxiety, depression and seclusion.
4. Job satisfaction- The positive feedback from patients helps to reduce stress to certain extent,
imparting good job satisfaction.
5. Decision making- In times where patient autonomy and patient’s right to determine what shall
be done to his/ her body, the decision.
Interpersonal communication in nursing
Nursing staff plays the role of leader in patient care especially at times when the person (patient)
is unable to take control of his/ her day-to-day activities due to debilitating disease or infirmity.
“Caring is nursing, and nursing is caring” as stated by Kallergis. Watson defined nursing as a
Relationship between two human beings in mutual agreement, one of them as ‘provider’ and the
second one as ‘receiver’. Casey and Wallis, stressed on the importance of developing a mutually
agreed relationship and inculcating patient centric nursing skills to bring out the best in terms of
patient care. The hallmark of nursing training and practice was patient centric care. This is the
most vital interpersonal relationship in health care and it is a therapeutic interaction that ensures
that patient needs are always on top priority irrespective of patient’s attitude thereby putting the
entire onus on nursing .
There is no iota of doubt that the nursing staff is the backbone of individualized patient care.
They are entrusted with the responsibility of delivering tailored patient specific treatment,
providing necessary information to patients – attendants and by providing as well as creating an
environment that is best conducive for patient. They also have to mediate between doctor and
patient and create a communication bridge so that optimum results of treatment are achieved.
One can say that care and communication are just the two sides of the same coin they are
inseparable and are complimentary to each other.
Peplau’s theory is one of the greatest works in the field of nursing relationships and interpersonal
communications and it emphasize on reciprocity between nurses and patients.
The theory is based on following assumption:
1) Both nurse and patient can interact,
2) This interaction helps them to evolve and mature.
3) The two fundamental tools in nursing are- communication and interpersonal skills.
4) Nurses must clearly understand themselves in order to promote their patient’s growth and to
prevent the limitation of patient’s choices to those that nurse’s value.
The theory involves interactions between nursing, society or environment, health and man. It
describes the relationship into five different phases.
Phase 1: Orientation Phase
The first and foremost formal phase for building therapeutic relationship coordinated by the
nurse involving patients in their treatment addressing to their queries and information pertaining
to treatment. The manner in which the nurse introduces herself / himself to the patient showing
warmth, empathy and care in this introductory phase is the key factor that promotes interpersonal
relationship between nurse and patient. It may start by introduction of nurse to the patient and
addressing patients by their formal name initially and then can be inquired whether they prefer it
or any not. One of the important ingredients of effective communication is two-way
communication, allowing patients to speak and listen carefully as it is in this phase that
maximum data is collected. The nursing assessment requires accurate data gathered from patients
and calls for effective two-way communication between nurses and patients. Once the patient has
been greeted, their anxiety decreased the patient is primed for participation in relationship. The
nurse describes their role to patients and other information relevant to patient. As no two
individuals are alike so is their working style, the same holds true for nursing professionals. The
information gathered by them may vary and it is imperative not to overlook this part of the
relationship as the exterior part of the real work. There is need for nurse to have open mind so
that they are able understand patients’ problem and the need for the treatment, and respond
appropriately. The orientation phase commences with the decision to treat.
Phase 2: Identification Phase
The patient and nurse work together to clarify problems and set specific goal and in fact this
phase is the working one. In this phase, nurses can help patients in exploring their hidden fears
and apprehensions as well as identify their personal strengths and resources. In this way they can
direct their energy towards helpful actions. These actions have beneficial effect on patient care,
recovery and treatment effectiveness.
Phase 3: Exploitation Phase
The practical work of nurse-patient relationship happens during exploitation, the nurse guides
patient in optimum health facility utilization and attainment of mutually decided goals of
therapeutic interventions.
Phase 4: Resolution Phase
This phase culminates in ending a therapeutic relationship. The earlier targets achieved and new
targets for treatment and care come up. The relationship was originally established with purpose
and deep and meaningful sharing occurred between the nurse and patient. Whether it’s a short
term or long-term interaction both demand an end or resolution. Operating theatre nurse may
have a short-term relationship with patient, where as a nurse in oncology unit may have a longer
duration of relationship.
Phase 5: Termination Phase
The termination phase is marked by ending of professional relationship between the nurse and
patient. Although it may be brief interaction only but it gives opportunity to evaluate their mutual
achievements and revisit the time. The summary briefing to the patient can help both the parties
for perceiving their mutual goals. There could be emotional bonding at the end. This ending of
the relationship could bring emotional burst, feeling of loss, sadness but both have to accept it
and move ahead. During termination phase, the nurse and patient identify possible unmet goals
and some cases may require referral and follow-up care.
The patients may respond differently at this phase, they might show regression, anxiety, and act
strangely superficial to the nurse or even become more dependent. The nurse has to prepare the
patient for the termination of therapeutic relationship. The therapeutic nurse-patient relationship
between the nurse and patient will end with a completeness and satisfaction that is rewarding for
both the nurse and the patient.
Barriers to communication
The barriers to effective communication can be broadly classified as those related health care
professionals, patient centric and environmental. Health care provider (Nursing) related barriers
include deficiency in language particularly spoken language, excessive use of jargons, frequent
interruptions, inexperience, pre occupation with personal matters and prejudice based on
decision making. Many times, patients are illiterate or poorly educated, superstitious and with
pre conceived notions, their religious and cultural beliefs jeopardize the communication process.
Environmental factors may also hinder the effective communication process like long stay on
admission counter, lengthy discharge procedure and multiple counters for payments and reports
collection as well as ergonomically poorly designed infrastructure that further makes
communication with patients unsatisfactory.
How to improve
Communication with patients can greatly be improved by active listening to patients, keeping
oneself smiling, showing empathy towards patients, choice of soft words , use of appropriate
language which patients can understand, greeting patients with enthusiasm , maintaining honesty,
anticipating needs of patients, customizing and giving personalized care, creating a conductive
environment , ending relationship in a manner where patient’s needs are top priority, ensuring
safety of patient , helping them in decision making and meeting out challenges supported by
evidence based training.
The basic of interpersonal communication building relies on principles that they are inescapable,
irreversible, complicated and contextual. Putting in other way round, they never occur in
isolation. Nowadays, they are designated as ‘soft skills’, which in our opinion is misnomer as
these are ‘hard skills’, which need to be learnt and affect your work performance, career and
personal life. Communication has different facets. Psychological context of communication
covers employee desires, needs, values, personality etc. Relational context refers to interactions
with others. Situational context is psycho-social whereas environmental context deals with
physical attributes of place of communication like furniture, location, premises, noise, time of
day, ambience of work place. The cultural context also affects type of behaviours for instance
one can be from a culture where making a long direct eye contact may be insolent to a different
cultural background where it is considered reliable. It is imperative that designing a training for
communication skill learning, the coordinators emphasize on various domains.