COMMUNICATION AND COMMUNICATION AND HEALTH BEHAVIORHEALTH BEHAVIOR

Dr. Amany R. Abo-El-SeoudDr. Amany R. Abo-El-SeoudProfessor of Community Professor of Community

MedicineMedicineZagazig University.egyptZagazig University.egypt

Definitions Definitions

Communication: Communication: It is a It is a requirement for life in any society.requirement for life in any society. It It is the process in which feelings or is the process in which feelings or ideas are expressed as messages: ideas are expressed as messages: sent, received and comprehended. sent, received and comprehended.

The process of communication is The process of communication is dynamic, continuous, irreversible and dynamic, continuous, irreversible and transactional. transactional.

Health educationHealth education: To raise : To raise awareness of people to prevent awareness of people to prevent disease and to improve knowledge, disease and to improve knowledge, attitude and practice of individuals attitude and practice of individuals for healthy living.for healthy living.

Knowledge:Knowledge: confident confident understanding of a subject with the understanding of a subject with the ability to use it for a specific purpose. ability to use it for a specific purpose. المعرفةالمعرفة

Attitude:Attitude: positive, negative or neutral positive, negative or neutral view of a person, behavior or event. view of a person, behavior or event. موقفموقف

Belief:Belief: a subjective mental a subjective mental interpretation derived from perception, interpretation derived from perception, reasoning or communication. reasoning or communication. اعتقاداعتقاد

BehaviorBehavior: actions or reaction of a : actions or reaction of a person in relation to certain person in relation to certain circumstances. circumstances. تصرفتصرف

COMMNUICATIONCOMMNUICATION

Human communication is the process Human communication is the process of creating meaning between two or of creating meaning between two or more people. more people.

It is to transfer Ideas - Information - It is to transfer Ideas - Information - Norms Norms نماذجنماذج- Values - Attitudes - Values - Attitudes through message to another party through message to another party so that it can be understood and so that it can be understood and acted upon.acted upon.

Why do we communicateWhy do we communicate??

The importance of communication:The importance of communication:To make people understand us and To make people understand us and

to understand others.to understand others.To make us accepted.To make us accepted.To undertake something.To undertake something.To strengthen the human To strengthen the human

relationships and social links.relationships and social links. To spread the human spirit of To spread the human spirit of

friendship and cooperation.friendship and cooperation.

Benefits in the medical fieldBenefits in the medical field

To improve patient compliance To improve patient compliance To improve patient satisfaction To improve patient satisfaction To improve health outcomes for To improve health outcomes for

patients patients To improve the accuracy and To improve the accuracy and

efficiency of the consultation and efficiency of the consultation and hence is more rewarding for the hence is more rewarding for the doctordoctor

Elements of communicationThe Sender Who Sends the message: doctor, nurse,

parents, actor, teacher The Message What Ideas, Information, Feelings,

Emotions. Can be at personal hygiene, nutrition guide, safe motherhood, risk factors etc

The Channel How Means of message transmission. Face-face, group discussion, radio, newspaper, conference, T.V,internet.

The Receptor To whom The person to whom we talk or the one who receives the message. Illiterate or highly educated, culture, habits, traditions, language.

The Feedback With What Effects

The information or the reaction given to the receptor

Let us think

• You perform a health education program in x village for family planning to increase the users of pills. 2 weeks after the message there was no increase in pill users……why?

What can hinder What can hinder communicationcommunication??

1- 1- At the source or sender levelAt the source or sender level Does not know or convinced with the subject.Does not know or convinced with the subject. Cannot communicate the message.Cannot communicate the message. Does not formulate clearly the objectives or the Does not formulate clearly the objectives or the

message.message. Does not choose the suitable language of the Does not choose the suitable language of the

receptor.receptor. Does not change the tone.Does not change the tone.The communicator must :The communicator must :CLEAR=CLEAR= C: Clarify L: Listen E: Encourage A: C: Clarify L: Listen E: Encourage A:

Appreciate R: ReassureAppreciate R: Reassure Do notDo not give orders. Do not attack. Do not be give orders. Do not attack. Do not be

aggressive or ridiculousaggressive or ridiculous..

2- 2- At the message levelAt the message levelDifficult words.Difficult words. Is not of interest to the receiver.Is not of interest to the receiver. Is not related to the stated objectives.Is not related to the stated objectives.Unclear, confusing.Unclear, confusing.

3- 3- At the channel levelAt the channel levelNoise.Noise.Not adapted to the message Not adapted to the message

transmission.transmission.Not accessible to the receptor.Not accessible to the receptor.

4- 4- At the receptor levelAt the receptor level Indifferent to the message.Indifferent to the message. Could not decode (understand) the Could not decode (understand) the

message.message. Cannot receive the message.Cannot receive the message. Poor listening conditions.Poor listening conditions.

5- 5- At the feedback levelAt the feedback level Feedback not well prepared.Feedback not well prepared. Limited time.Limited time. Selection of those who respond.Selection of those who respond. Question poorly formulated. Question poorly formulated.

Forms (channels) of Forms (channels) of communicationcommunication

Verbal: Verbal: By saying or writing words By saying or writing words e.g.e.g. talk, discussion, conferencestalk, discussion, conferences, , or or PresentationPresentation, , books, newspapersbooks, newspapers . .

NonNon––verbal: verbal: Intentional (signs and movements).Intentional (signs and movements).

Unconscious (Feelings) as way of Unconscious (Feelings) as way of clientclient’’s walking, sitting, hand s walking, sitting, hand movements, facial expression, vocal movements, facial expression, vocal characteristics (pitch, volume, rate).characteristics (pitch, volume, rate).

Communication skills used in Communication skills used in the medical fieldthe medical field::

(1)(1)Skills of history takingSkills of history taking(2)(2) Skills of Counseling Skills of Counseling (3)(3)Skills of health educationSkills of health education

HEALTH EDUCATIONHEALTH EDUCATION

Aims at changing behavior of individuals towards healthy Aims at changing behavior of individuals towards healthy behavior. It gives new information (unknown before) or behavior. It gives new information (unknown before) or change old wrong knowledge. change old wrong knowledge.

Health education covers all the areas of community Health education covers all the areas of community medicine, in health promotion (to give information to medicine, in health promotion (to give information to people how to be healthy) in prevention of health hazards people how to be healthy) in prevention of health hazards (give information about vaccination, smoking hazards) in (give information about vaccination, smoking hazards) in control of disease (to take treatment according to doctor control of disease (to take treatment according to doctor advice) and in rehabilitation (to use the remaining health advice) and in rehabilitation (to use the remaining health capabilities).capabilities).

Health education is concerned with physical, mental and Health education is concerned with physical, mental and social wellbeingsocial wellbeing

It is life long processIt is life long process It can be directed to individual, family or communityIt can be directed to individual, family or community

Stages of behavioral Stages of behavioral changechange::

Health belief modelHealth belief model::Awareness of the problem: to perceive Awareness of the problem: to perceive

that there is a problem (to be aware of that there is a problem (to be aware of the bad effect of obesity on health) the bad effect of obesity on health)

Interest: to show an interest in the Interest: to show an interest in the problem (he becomes interested in that problem (he becomes interested in that subject and he considers that he may subject and he considers that he may be victim of that complication/ disease). be victim of that complication/ disease).

Knowledge: need to know more to Knowledge: need to know more to decide to change and adopt an decide to change and adopt an innovation .(to know more about obesity innovation .(to know more about obesity hazards).hazards).

Attitude: to decide to take action (he Attitude: to decide to take action (he forms positive opinion about the bad forms positive opinion about the bad outcome of obese persons).outcome of obese persons).

Legitimization: is that subject in line with Legitimization: is that subject in line with legal, cultural, financial and social legal, cultural, financial and social acceptance? If yes it is easily to practice .acceptance? If yes it is easily to practice .(are friends know that obesity is bad? Is it (are friends know that obesity is bad? Is it costly? Can I do it? What are the barriers costly? Can I do it? What are the barriers to change?)to change?)

Practice (action): try it to see its Practice (action): try it to see its feasibility and effectiveness.( I try to feasibility and effectiveness.( I try to decrease fatty diets to see its effect on decrease fatty diets to see its effect on my health).my health).

Sustainability : to keep the change for Sustainability : to keep the change for life.(keep eating healthy diet, with low fat life.(keep eating healthy diet, with low fat content). content).

Let us thinkLet us think

Apply the health belief model on Apply the health belief model on prevention of smokingprevention of smoking

Health belief modelHealth belief modelAwarenessAwareness InterestInterestKnowledgeKnowledgeAttitudeAttitudeFeasibility of practicingFeasibility of practicingPracticePracticeSustainability Sustainability

Q : Q : When can we intervene by a health When can we intervene by a health

education program in this model?education program in this model?

Health belief modelHealth belief model

To know disease And Severity

Motivation attitude

Internal/personal variavles

external

cancel

action relapse

Healthybehavior

Behavior at illnessBehavior at illness

Do nothing & wait

Feeling

of illness

Self treatment, folk medicine

Ask pharmacy doctor

Go to physician

Non compliance to ttt

Compliance to ttt and cure

Factors that affect Factors that affect health/illness behaviorhealth/illness behavior

Age, sex, level of education, culture, religion, past Age, sex, level of education, culture, religion, past experienceexperience

Recognition of symptoms, signs.Recognition of symptoms, signs. Seriousness of symptoms/signsSeriousness of symptoms/signs If these symptoms affect his ordinary lifeIf these symptoms affect his ordinary life Persistence and frequency of symptomsPersistence and frequency of symptoms Personal tolerance to symptomsPersonal tolerance to symptoms Level of knowledge, cultural opinion about these symptomsLevel of knowledge, cultural opinion about these symptoms Fear of illness to be fatal.Fear of illness to be fatal. Stigma : community opinion towards patients of that illnessStigma : community opinion towards patients of that illness Availability of medical servicesAvailability of medical services Trusted services and health providersTrusted services and health providers

Planning for health Planning for health education programeducation program

"who says what and when to whom "who says what and when to whom by which channel" by which channel"

therefore we should consider the therefore we should consider the following: the message, sender, following: the message, sender, recipient, method, barriers for recipient, method, barriers for change change

Evaluation of H.E. programEvaluation of H.E. program

* Pre and post testing: for the same * Pre and post testing: for the same group or for 2 groupsgroup or for 2 groups

Every thing should be evaluated (the Every thing should be evaluated (the educator, message, method and the educator, message, method and the persons who are educated)persons who are educated)

* Increased number of good behaviors* Increased number of good behaviors

* Change in the morbidity & mortality * Change in the morbidity & mortality ratesrates

* *

How to design A How to design A questionnairequestionnaire

Brief introduction, aim and gentle Brief introduction, aim and gentle asking for co-operationasking for co-operation

Simple language, direct questionsSimple language, direct questionsNot ask for 2 things in the same q.Not ask for 2 things in the same q.Don’t use negative negative q.Don’t use negative negative q.Short answers, closed q.Short answers, closed q.Not too long questionnaireNot too long questionnaire It must be reliable, validIt must be reliable, valid

2 types of questions:2 types of questions:Qualitative (Likert’s scale) for Qualitative (Likert’s scale) for

attitude or yes/noattitude or yes/noQuantitative: giving % or numberQuantitative: giving % or numberMultiple choices are easierMultiple choices are easier

Let us thinkLet us think

Design a questionnaire for assessing Design a questionnaire for assessing SE standard of living?SE standard of living?

Design a questionnaire for knowing Design a questionnaire for knowing feedback of students on Community feedback of students on Community Medicine?Medicine?

Design a questionnaire for pre test Design a questionnaire for pre test for health education program for for health education program for hepatitis C?hepatitis C?

My Best WishesMy Best Wishes

Thank youThank you