Communication Management and Health Education – Unit 5 | B.Sc Nursing 5th Semester
- 1. Unit 5: Communication Management and Health Education Community Health Nursing 5th Semester B.Sc. Nursing By: Rakesh S Sajjan
- 2. Communication – Definition, Process, and Types
- 3. Definition of Communication Communication is the process of exchanging information, ideas, feelings, and understanding between individuals or groups to achieve a common goal. “Communication is the transfer of information from a sender to a receiver with the intention of creating understanding.” — WHO. In nursing and health education, effective communication is essential for building trust, educating patients, and changing health behaviors.
- 4. Communication Process (Cycle) The communication process involves the following components: Element Role Sender Person who initiates the message (e.g., nurse) Message The information or idea being conveyed Medium/Channel Method used to deliver the message (e.g., oral, written, visual) Receiver The person who receives the message (e.g., client, group) Feedback Response given by the receiver (verbal/non-verbal) Barriers that distort communication
- 5. Visual of the Communicati on Process (Simplified) Sender Message → → Channel Receiver → → Feedback (Back to → Sender)
- 6. Types of Communication 1. Based on Channel Used Type Description Examples Verbal Spoken or written words Health talk, counseling Non-verbal Body language, gestures, facial expressions Smile, nod, eye contact Visual Use of charts, pictures, models Flip charts, posters
- 7. 2. Based on Direction of Flow Type Description Example One-way Message flows from sender to receiver only Health campaign on TV Two-way Involves interaction and feedback Nurse-patient discussion Upward From subordinate to superior ANM reporting to PHC officer Downward From superior to subordinate Instructions from doctor to nurse Horizontal Between individuals at the same level Nurses coordinating in a ward Diagonal Across different levels or departments Nurse communicating with a pharmacist
- 8. 3. Based on Formality Type Explanation Examples Formal Structured and official communication Reports, staff meetings Informa l Casual, spontaneous conversation Tea break talk, group chats
- 9. Importance in Health Education • Helps in building trust and rapport with patients • Essential for behavior change and counseling • Aids in group teaching during community visits • Ensures clarity of health messages
- 11. What is Human Behavio ur in Health? • Human behaviour in health refers to how individuals act or respond regarding their health— such as taking medicine, maintaining hygiene, using health services, or changing lifestyle habits. • Behavior is influenced by a combination of biological, psychological, social, and environmental factors.
- 12. Why is Understandi ng Behaviour Important in Health Education? • Helps nurses and health workers understand why people act the way they do • Guides in planning appropriate communication strategies • Supports tailored counselling for specific groups (e.g., mothers, adolescents) • Aids in bringing about positive behavior change
- 13. Key Factors Influencing Health Behaviour FACTOR EXPLANATION Knowledge and awareness People who lack health knowledge may ignore symptoms or skip treatment Beliefs and attitudes Cultural or personal beliefs (e.g., food taboos during pregnancy) Perceived risk People change behavior when they feel personally at risk (e.g., HIV/AIDS) Social support Family, friends, or peer group encouragement Education and literacy Better understanding of health messages Economic status Affordability of nutritious food or health services Cultural practices May encourage or hinder healthy behaviors Accessibility of services Proximity and trust in health services
- 14. Models that Help Explain Health Behaviour • Health Belief Model • Transtheoretical Model (Stages of Change) • Theory of Planned Behaviour
- 15. Nurse’s Role in Influencing Behaviour • Identify individual/community beliefs and challenges • Provide appropriate health education • Use role models or peer educators in behavior change • Involve family or community leaders • Promote positive reinforcement (praise small improvements)
- 17. What is the Health Belief Model (HBM)? • The Health Belief Model (HBM) is a psychological framework used to understand why people do or do not take health actions (like using health services or changing habits). • ✅ It was developed in the 1950s by social psychologists to predict and explain health behaviors.
- 18. Key Concepts of the Health Belief Model COMPONENT MEANING EXAMPLE Perceived Susceptibility Person’s belief about their risk of getting a condition “I may get diabetes if I don’t control my diet.” Perceived Severity Belief about the seriousness of the condition and consequences “Diabetes can lead to kidney failure.” Perceived Benefits Belief in the value of taking preventive action “Walking daily will help manage my sugar.” Perceived Barriers Perceived obstacles to taking action “I don’t have time to exercise.” Cues to Action Triggers that prompt health behavior Reminder from nurse, health poster Self-Efficacy Confidence in one’s ability to “I believe I can quit smoking.”
- 19. Applications of the HBM in Community Health Situation Nursing Approach Using HBM Low immunization rates Explain disease risk (susceptibility), benefits of vaccine Poor antenatal visit attendance Educate on risks of complications, ease barriers like transport TB medication non-adherence Reinforce seriousness, give cues (reminders, follow-ups) Poor sanitation practices Demonstrate disease link and benefits of hygiene
- 20. How Nurses Use HBM to Influence Behaviour • Assess client beliefs during home visits or counselling • Educate to increase perceived threat and reduce perceived barriers • Offer practical solutions (e.g., free services, community support) • Use cues to action (SMS reminders, posters, group talks) • Encourage self-confidence in clients to adopt healthier habits
- 22. • Behaviour change refers to the process of adopting new, healthier habits or abandoning harmful behaviors through motivation, education, and support. • It is not a one-time event but a gradual, step-by-step process that takes time, awareness, and reinforcement.
- 23. Stages in the Behaviour Change Process (Also called Stages of Change / Transtheoretical Model) Stage Description Nurse’s Role 1. Pre- contemplation The person is not aware of the problem or denies it exists Raise awareness using facts, stories, or role models 2. Contemplation The person recognizes the problem, starts thinking about change Provide motivation, support, and simple examples 3. Preparation The person decides to take action soon Help plan small, achievable steps 4. Action The person makes specific lifestyle changes Encourage and reinforce efforts 5. Maintenance The person sustains new behavior over time Provide regular follow-up and motivation 6. Relapse (Optional) The person may go back to old habits Reassure and restart support without judgment
- 24. Real-Life Examples Behaviour Change Stages Quitting tobacco Contemplation Action Relapse → → → Maintenance Improving diet Preparation Action (e.g., eating fruits → daily) Taking iron tablets Pre-contemplation Nurse educates → → Contemplation Action →
- 25. Nurse’s Role in Each Step Assess readiness to change (Which stage?) Use counseling, education, role play to support each step Use motivational interviewing techniques Identify and reduce barriers Reinforce progress and prevent relapse
- 27. What is Behaviour Change Communication(BCC)? • Behaviour Change Communication (BCC) is an interactive process that uses educational strategies and motivational messages to help individuals and communities adopt healthy behaviors. • BCC is goal-directed communication designed to influence attitudes, beliefs, and practices
- 28. Key Techniques of Behaviour Change Communication Technique Explanation Motivational interviewing Help clients explore and resolve doubts through open-ended questions Role modeling Use peers or respected figures as examples for positive behavior Reinforcement Praise, reward, or recognize progress to strengthen behavior Demonstration Show how to do something (e.g., handwashing, ORS preparation) Problem-solving Help clients overcome practical obstacles (e.g., diet, transport) Goal setting Set small, specific, measurable, and achievable health goals Follow-up and support Monitor progress and provide emotional or practical encouragement
- 29. Guiding Principles in Planning BCC Activities Principle Application in Nursing Practice Know your audience Understand age, literacy, culture, beliefs before planning sessions Use simple and clear messages Avoid medical jargon; use pictures, stories, or drama Be culturally sensitive Respect local values, food habits, and customs Use appropriate media/tools Choose the right method: posters, flipcharts, street plays Involve the community Use peer educators, mothers’ groups, youth clubs Ensure two-way communication Allow people to ask questions and share their views Repeat and reinforce Consistent messages over time through various sessions
- 30. Examples of BCC in Action Target Behavior BCC Activity Breastfeeding awareness Skit at anganwadi centre, flipbook for new mothers Anemia prevention Food demonstration using iron-rich items Toilet use promotion Home visits, storytelling with village children TB medication adherence Peer supporter system + SMS reminders
- 31. Nurse’s Role in BCC Planning • Assess health problems and behaviors of target group • Use locally understandable language and symbols • Plan interactive group discussions, demos, or home visits • Evaluate response and adapt methods as needed • Build trust and empathy throughout communication
- 33. What Are BCC Steps? The steps of Behaviour Change Communication (BCC) provide a structured method to plan, implement, and evaluate health education strategies to bring about positive behavior change in individuals or communities.
- 34. Ten Key Steps in BCC Process Step Explanation 1. Identify the Problem Understand the health issue (e.g., low immunization, malnutrition) 2. Understand the Audience Analyze beliefs, culture, language, age, literacy, social conditions 3. Set Communication Objectives What change is expected? (e.g., increase iron tablet intake in girls) 4. Select Key Messages Choose simple, focused health messages relevant to the audience 5. Choose Communication Channels Decide method: interpersonal (home visits), mass media (radio), group talks 6. Develop and Pre-test Materials Prepare flipcharts, posters, or videos and test them with small group 7. Implement the BCC Strategy Conduct group sessions, one-on-one counseling, campaigns 8. Monitor Implementation Track participation, activity completion, material usage 9. Evaluate Impact Check behavior change outcomes (e.g., improved diet, increased ANC visits) 10. Provide Feedback and Follow-up Reinforce messages, resolve doubts, provide continued support
- 36. Example: BCC for Anemia Prevention Step Example Identify the problem High anemia rates in adolescent girls Know the audience School-going rural girls aged 12–16 Communicatio n objective Increase iron tablet intake and iron-rich diet Key message “Iron makes you strong, smart, and active” School talks, posters,
- 37. Nurse’s Role in BCC Implementation • Conduct community needs assessment • Prepare and deliver engaging health messages • Use charts, leaflets, and visual aids effectively • Maintain records of attendance and follow-up • Evaluate how behavior has changed over time
- 39. What is SBCC? • Social and Behaviour Change Communication (SBCC) is an advanced form of BCC that combines behavioral, social, and communication strategies to improve public health outcomes. • SBCC goes beyond individual behavior to address social norms, structures, and support systems that influence health.
- 40. SBCC vs. BCC Aspect BCC (Behaviour Change Communication) SBCC (Social and Behaviour Change Communication) Focus Individual behavior change Individual + social/community/system- level change Approach Health messages and education Multi-level approach: media, advocacy, community mobilization Examples Teaching ORS preparation Promoting exclusive breastfeeding with community support
- 41. SBCC Strategies Strategy Explanation Advocacy Influence policymakers and leaders to support health behaviors Community Mobilization Engage local groups, SHGs, youth clubs in planning and activities Capacity Building Train peer educators, health workers, school teachers Media Campaigns Use TV, radio, social media to spread consistent messages Interpersonal Communication (IPC) One-on-one or group sessions by nurses, ASHAs, CHOs Supportive Environment Improve access to services (e.g., iron tablets, immunization)
- 42. Collecting Social History from Clients • Collecting social history helps understand the background and environment influencing a person’s health behavior. • It is vital for tailored SBCC planning.
- 43. Elements of Social History Area Information to Gather Family background Type of family, members, support systems Living conditions Housing, water, sanitation, crowding Education and literacy Schooling status of client or caregiver Economic status Employment, income, affordability of care Cultural practices Beliefs about food, illness, treatment
- 44. Nurse’s Role in SBCC and Social History Collection • Build rapport and ask questions with empathy • Use open-ended questions during interviews or home visits • Document findings for customized communication planning • Involve community leaders in shifting harmful social norms • Integrate social history into health education or BCC sessions
- 46. What Are Communication Barriers? • Communication barriers are obstacles that interfere with the transmission, understanding, or response to a message. • They can occur at any stage of the communication process and may affect accuracy, clarity, and acceptance of health messages.
- 47. Types of Barriers in Communication Barrier Type Description Examples Physical Barriers External or environmental issues Noise, distance, poor lighting Physiological Barriers Related to physical state of sender or receiver Hearing loss, speech problems, illness Psychological Barriers Emotional or mental state affects communication Anxiety, fear, depression, anger Cultural Barriers Differences in beliefs, language, customs, values Gender roles, food taboos, superstitions Semantic Barriers Problems in understanding meaning of words or symbols Use of medical jargon, technical terms Organizational Barriers Problems in structure or hierarchy of communication in a health system Lack of coordination between nurse and doctor
- 48. Effects of Communication Barriers in Health • Misinterpretation of medical instructions • Patient non-compliance • Delayed care-seeking or refusal of treatment • Mistrust in health workers • Poor behavior change outcomes
- 49. Examples in Community Settings Situation Barrier ANM gives advice in Hindi, client speaks Kannada Language barrier (semantic) Nurse rushes health talk without listening Psychological + perceptual barrier Home visit done in noisy crowded house Physical barrier Client ignores family planning due to beliefs Cultural barrier
- 51. Why Overcome Barriers? Overcoming communication barriers is essential to ensure that health messages are clearly understood, accepted, and acted upon by individuals, families, and communities.
- 52. For Physical Barriers Barrier Solution Noisy environment Choose a quiet place for counseling or education Poor lighting Use daylight or carry torch/lamps during home visits Long distance Use mobile health services, community outreach
- 53. For Physiological Barriers Barrier Solution Hearing difficulty Speak clearly, slowly; use gestures or visuals Sick or weak patients Keep messages short, repeat later when stable
- 54. For Psychological Barriers Barrier Solution Fear or anxiety Build rapport, use friendly tone Anger or mistrust Listen empathetically, don’t argue Stress or depression Provide emotional support, involve family
- 55. For Semantic Barriers Barrier Solution Use of jargon/medical terms Use simple, local language and relatable examples Language difference Speak in local dialect; use interpreter if needed
- 56. For Cultural Barriers Barrier Solution Religious or traditional beliefs Respect views; explain benefits gently Gender roles Involve male/female elders as needed in
- 57. For Organizational Barriers Barrier Solution Lack of coordination Use regular team meetings and shared responsibilities Hierarchical communicatio n Encourage open feedback from all levels
- 58. Nurse’s Role in Overcoming Barriers • Use simple, clear, and visual teaching materials • Encourage two-way communication and allow time for questions • Be empathetic, non- judgmental, and patient • Adapt to the local context and individual needs • Continuously evaluate and modify communication strategies
- 60. Definition of Health Promotion Health Promotion is the process of enabling people to increase control over and improve their health. WHO defines it as: “The process of enabling people to increase control over, and to improve, their
- 61. Definition of Health Education Health Education is a part of health promotion that focuses on informing and motivating individuals to adopt healthy behaviors through teaching and learning. “Health education is any combination of learning experiences designed to help individuals and communities improve their health by increasing their knowledge or influencing their attitudes.”
- 62. Difference Between Health Promotion and Health Education Aspect Health Education Health Promotion Focus Informing, teaching health knowledge Empowering, creating supportive environments Methods Lectures, posters, demos Policies, community mobilization, behavior campaigns Scope Narrow – mainly educational Broad – includes education, environment, policy, services Examples Teaching about anemia Providing free iron tablets, cooking demos, policy change
- 63. Scope of Health Promotion and Education in Community Health AREA ACTIVITY Disease prevention Vaccination campaigns, hygiene promotion Nutrition improvement Health talks on balanced diet, food demos Maternal & child health Antenatal education, breastfeeding promotion Lifestyle diseases Campaigns on quitting tobacco, exercise sessions Environmental sanitation Teaching safe water use, toilet construction awareness Adolescent health Reproductive health sessions, menstrual hygiene education
- 64. Nurse’s Role in Health Promotion and Education • Conduct individual and group sessions • Use interactive and visual aids to teach • Identify local needs and prioritize topics • Coordinate with Anganwadi's, schools, panchayats • Promote healthy habits and early health-seeking behavior
- 66. Purpose of Health Education Methods The goal of choosing the right method is to make health education effective, interactive, and understandable for different individuals or groups, considering their age, literacy, and cultural background.
- 67. Broad Categories of Health Education Methods Category Examples Individual Approach One-to-one counseling, home visits Group Approach Group discussions, role plays, group talks Mass Approach Radio, TV, posters, rallies, street plays
- 68. Individual Approach ✅ Advantages: Personal, private, tailored message ❌ Disadvantage: Time-consuming Method When to Use One-on-One Counseling For specific issues like family planning, chronic illness Home Visits To educate families on hygiene, nutrition, child care
- 69. Group Approach ✅ Advantages: Economical, interactive, suitable for similar groups ❌ Disadvantage: May not meet individual needs Method Description Group Discussion Small group sharing thoughts and learning from each other Lecture/Talk Nurse gives structured info to a group Demonstration Practical teaching (e.g., ORS prep, handwashing) Role Play/Drama Acted situations to teach health messages
- 70. Mass Approach ✅ Advantages: Wide reach, good for campaigns ❌ Disadvantage: Less personal, no feedback Method Usefulness Radio/TV Programs For large audiences with limited access to health centers Posters/Charts Simple messages using visuals and slogans Street Plays/Skits Powerful tool for public awareness in open spaces Pamphlets Quick reference for literate audiences
- 71. Choosing the Right Method Factor Consideration Literacy level Use visuals and verbal messages for low- literates Cultural acceptability Respect traditions, beliefs Audience size Individual, small group, or large public? Available resources Flipcharts, audio equipment, demonstration kits Time and setting Clinics, schools, village meetings, home visits
- 73. What are Audio-Visual(AV) Aids? • Audio-Visual Aids are tools that appeal to hearing and/or sight to make health education more effective, clear, and engaging. • They help simplify complex ideas, overcome language barriers, and hold the learner’s attention.
- 75. Audio Aids (hearing- based) Aid Use Microphones Public speaking in large gatherings Radio Health programs in local language Tape recorders Pre-recorded messages for repeat education
- 76. Visual Aids (sight-based) AID USE Posters Static messages in clinics, schools Charts Show comparisons (e.g., food pyramid, growth chart) Flipcharts Step-by-step education (e.g., ORS preparation) Flashcards Single-message cards for group teaching Models 3D figures (e.g., uterus model, breast model) Pamphlets Printed handouts for self- reading Photograp Real-life images to improve
- 77. Audio-Visual Aids (both hearing and sight) Aid Use Videos/Films Demonstrate correct techniques or health messages Television Health shows, news, motivational content Projectors PowerPoint presentations during workshops
- 78. Advantages of AV Aids • Increase interest and attention in learners • Clarify difficult concepts (e.g., disease transmission) • Useful for illiterate populations • Reinforce verbal communication • Can be used repeatedly in sessions
- 79. Guidelines for Effective Use Guideline Explanation Keep it simple and clear Avoid overcrowding with too much text or graphics Ensure visibility and audibility Suitable for group size and environment Use locally appropriate content Reflect local culture and language Practice beforehand Be confident with equipment or material Combine with Don’t rely on
- 80. Nurse’s Role in Using AV Aids • Select suitable aids based on audience and setting • Prepare flipbooks, posters, or flashcards for health talks • Use videos or role plays during group education sessions • Display educational materials in waiting areas, Anganwadi's • Evaluate understanding through feedback and