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ANM / Multi-Purpose Health Assistant (Female) · Chapter 10

Health Education and Communication

What to remember

  • Health education is a planned learning process that helps people adopt healthy behaviour. It is not just giving information; it aims to change knowledge, attitude and practice.
  • Communication has a sender, message, channel, receiver and feedback. Choose the method (individual, group or mass) to suit the audience and the topic.
  • Good counselling listens first, uses simple language, and helps the person decide. The ANM uses it in every home visit and session.

Definitions and aims

  • Health education: any combination of planned learning experiences that helps individuals and communities to improve health by changing knowledge, attitudes and behaviour.
  • Health promotion: the process of enabling people to increase control over their health and improve it. The Ottawa Charter (1986) is the key document on health promotion.
  • IEC is Information, Education and Communication. BCC is Behaviour Change Communication, which focuses on actual change in behaviour.
  • Aims: make health a valued asset, help people manage their own health, promote proper use of services, and build community participation.
  • Principles: credibility, interest, participation, motivation, comprehension, reinforcement, learning by doing, good human relations, known to unknown, and feedback.

The communication process

  • Sender (communicator): the person who starts the message.
  • Message: the content, which should be clear, short, correct and relevant.
  • Channel (medium): how it is sent: speech, poster, radio, television, phone or social media.
  • Receiver (audience): the person or group who gets the message.
  • Feedback: the reply that shows if the message was understood. Without feedback, communication is one-way.
  • Barriers: language, noise, cultural beliefs, illiteracy, wrong timing, unclear message, and emotional state of the receiver.
  • Verbal communication uses words; non-verbal communication uses body language, eye contact, tone and gestures. Most of the emotional message is carried non-verbally.
  • Good communication rules (the "Cs"): clear, concise, correct, complete, courteous and concrete.
  • Types: one-way (lecture, radio) and two-way (discussion, counselling). Two-way communication is more effective for behaviour change.

Methods of health education

ApproachMethodsBest use
IndividualPersonal talk, counselling, home visitSensitive topics such as family planning, one-to-one advice
GroupLecture, group discussion, demonstration, role play, panel, symposium, workshop, field tripMothers' groups, school children, self-help groups
MassRadio, television, newspapers, posters, films, folk media, social mediaReaching large audiences quickly, creating awareness
  • Lecture: quick, but the audience is passive. Use for large groups.
  • Group discussion: 6 to 12 people discuss a topic with a leader. It helps participation.
  • Demonstration: showing how to do a task, such as hand washing, ORS preparation or breastfeeding position. It teaches skills and follows "show, tell, let them do".
  • Role play: acting out a situation to learn attitudes and skills.
  • Panel discussion: a few experts discuss in front of an audience. Symposium: each expert gives a short talk on one part of a topic. Workshop: a working group to solve a problem or learn skills.
  • Folk media (street plays, songs, puppet shows, Burrakatha, Harikatha) are powerful in villages because they use the local language and culture.
  • Counselling is a two-way, face-to-face process that helps a person solve problems and decide.

Audio-visual aids

  • Audio aids: radio, public address system, audio recording.
  • Visual aids: charts, flip charts, posters, flannel graph, flash cards, models, specimens, pictures and blackboard.
  • Audio-visual aids: television, film, video, slides with commentary.
  • Edgar Dale's cone of experience: learning is better when the learner does the activity. From most concrete to most abstract: direct experience, demonstration, field trips, exhibits, films, pictures, radio, then words.
  • A good poster carries one message, uses large, clear letters and images, bright colours and a call to action.
  • A flip chart is a set of pages on a stand, turned as the talk proceeds.
  • Models show three-dimensional structure, such as a pelvis model for midwifery training.
  • Select the aid by audience, objective, cost and availability. Pre-test it. Do not overload with text.

Planning health education

  • 1. Assess the need: find the health problem and the people's knowledge and beliefs.
  • 2. Set objectives: specific and measurable.
  • 3. Select content and methods: suit the audience.
  • 4. Prepare aids and a lesson plan.
  • 5. Implement: conduct the session.
  • 6. Evaluate: check if the objectives were met, using questions, observation or changes in practice.
  • Evaluation has three types: process (was it carried out as planned), outcome (what changed in knowledge, attitude, practice) and impact (long-term change in health).
  • Adoption stages: awareness, interest, evaluation, trial and adoption. People move through them step by step. Early adopters become the community leaders for others.
  • Behaviour change models: the Health Belief Model says people act if they feel at risk, think the problem is serious, see benefits of action and face few barriers. The stages of change model has pre-contemplation, contemplation, preparation, action and maintenance.

Counselling skills for the ANM

  • Listen actively, do not interrupt, use open questions, keep eye contact, show respect and keep privacy.
  • Avoid blame, judgement and difficult words.
  • Empathy means understanding the person's feelings; sympathy is feeling sorry for the person.
  • Give correct, simple information in small amounts and check understanding by asking the person to repeat the key points.
  • Informed choice: present options, benefits and risks, then let the person decide.
  • Confidentiality must be kept at all times.
  • For breastfeeding counselling, teach positioning and attachment, early start, frequent feeds and no pre-lacteal feeds.

Community participation and key health messages

  • Community participation means involving people in planning, running and evaluating health work. Use mothers' groups, self-help groups, village leaders and school teachers.
  • Key messages to remember:
  • Wash hands with soap: before eating or feeding, after toilet and after cleaning a baby. The WHO handwashing technique (six steps) takes about 40-60 seconds with soap and water, with at least 20 seconds of scrubbing.
  • Use ORS and zinc for diarrhoea. Use safe, boiled or chlorinated water.
  • Complete childhood immunisation and exclusive breastfeeding for six months.
  • Use a toilet and keep surroundings clean.
  • Eat a balanced diet, including leafy vegetables, pulses and iron-rich foods.
  • Cover water containers to stop mosquito breeding.
  • Complete the full course of tuberculosis treatment.
  • Antenatal check-up, delivery at a health facility, and postnatal care.
  • School health: health education in schools is effective because children carry messages home.
  • Special days: World Health Day is 7 April. World AIDS Day is 1 December. World Breastfeeding Week is 1 to 7 August.

Health education in the field

  • At the sub-centre: use waiting time for short talks, display posters at eye level, and give one or two key messages to each woman.
  • During a home visit: observe the house, water storage, toilet and kitchen. Teach by pointing to real things the family can change.
  • At the VHND or anganwadi: use demonstrations of breastfeeding, complementary feeding and ORS, and invite mothers to practise.
  • Using local helpers: train ASHA and anganwadi workers to repeat the same message so the community hears it again and again (reinforcement).
  • Language: use the local language, short sentences, local examples and familiar food names.
  • Timing: choose a time when women are free, and keep sessions short, about 15 to 20 minutes.
  • Follow-up: meet again to check whether the family has begun the new practice, and praise small improvements.
  • Records: note the topic, number of participants and feedback in the register for later evaluation.

Exam traps

  • Communication without feedback is only one-way communication.
  • IEC gives information; BCC aims at behaviour change.
  • Ottawa Charter relates to health promotion (1986), Alma-Ata to primary health care (1978).
  • Role play is used to teach attitudes and skills, but a lecture mainly passes knowledge.
  • Symposium has several short talks; panel discussion is a conversation among experts.
  • Demonstration is a skill method, but exhibition is a display.
  • Empathy differs from sympathy.
  • Evaluation is the last step in planning, not the first.
  • Individual approach is best for sensitive topics.
  • Mass media reach many, but feedback is weak.

One-liners

  • 1. Health education changes knowledge, attitude and practice.
  • 2. IEC means Information, Education and Communication.
  • 3. Five parts of communication: sender, message, channel, receiver, feedback.
  • 4. Best method for sensitive topics is individual counselling.
  • 5. Demonstration teaches skills.
  • 6. Ottawa Charter was in 1986.
  • 7. Alma-Ata declaration was in 1978.
  • 8. Cone of experience is by Edgar Dale.
  • 9. Hand washing with soap should last at least 20 seconds.
  • 10. World Health Day is 7 April.
  • 11. World AIDS Day is 1 December.
  • 12. Adoption stages begin with awareness.

Practice questions

  1. Health education mainly aims to change:

    1. knowledge, attitude and practice
    2. only the weather
    3. only the drug prices
    4. only the hospital buildings
    Answer

    A. knowledge, attitude and practice

    Behaviour change is the goal of health education.

  2. IEC stands for:

    1. Immunisation, Education and Care
    2. Information, Evaluation and Care
    3. Instruction, Example and Counselling
    4. Information, Education and Communication
    Answer

    D. Information, Education and Communication

    IEC = Information, Education, Communication.

  3. Which element makes communication two-way?

    1. Noise
    2. Channel
    3. Language barrier
    4. Feedback
    Answer

    D. Feedback

    Feedback lets the sender know if the message was understood.

  4. The person who receives the message in the communication process is the:

    1. feedback
    2. sender
    3. receiver
    4. channel
    Answer

    C. receiver

    Receiver is the audience.

  5. Edgar Dale is known for the:

    1. Health Belief Model
    2. Ottawa Charter
    3. cone of experience
    4. Alma-Ata declaration
    Answer

    C. cone of experience

    The cone ranks learning experiences from concrete to abstract.

  6. The Ottawa Charter (1986) is related to:

    1. family planning
    2. health promotion
    3. drug laws
    4. immunisation schedule
    Answer

    B. health promotion

    Ottawa Charter defines health promotion.

  7. Which method is most suitable for sensitive topics such as family planning?

    1. Individual counselling
    2. Poster exhibition
    3. Public lecture
    4. Mass media
    Answer

    A. Individual counselling

    Privacy is needed for sensitive issues.

  8. Teaching a mother how to prepare ORS by showing her the steps is a:

    1. symposium
    2. lecture
    3. survey
    4. demonstration
    Answer

    D. demonstration

    Demonstration teaches skills by showing.

  9. A group of experts giving short talks on different parts of one topic is a:

    1. symposium
    2. panel discussion
    3. role play
    4. brainstorming only
    Answer

    A. symposium

    Symposium: short talks on parts of a topic.

  10. Acting out a situation to learn skills and attitudes is called:

    1. exhibition
    2. poster
    3. lecture
    4. role play
    Answer

    D. role play

    Role play is a participatory group method.

  11. Folk media such as street plays are effective in villages because they:

    1. need no participation
    2. use local language and culture
    3. need electricity always
    4. are very costly
    Answer

    B. use local language and culture

    Familiar form and language build trust.

  12. Which is a mass-media method?

    1. Demonstration to three mothers
    2. Home visit
    3. Radio
    4. Personal counselling
    Answer

    C. Radio

    Radio reaches large audiences.

  13. A good health poster should carry:

    1. one clear message
    2. all messages on the topic
    3. long paragraphs
    4. only scientific terms
    Answer

    A. one clear message

    Single, simple message with large letters.

  14. Which of the following is an audio-visual aid?

    1. Radio
    2. Poster
    3. Flannelgraph
    4. Television film
    Answer

    D. Television film

    Audio-visual aids combine sound and picture.

  15. The first step in planning health education is:

    1. evaluation
    2. giving a lecture
    3. assessing the need
    4. printing posters
    Answer

    C. assessing the need

    Start with needs and knowledge of the audience.

  16. The correct order of adoption stages is:

    1. interest, adoption, awareness, trial
    2. awareness, interest, evaluation, trial, adoption
    3. trial, awareness, adoption, interest
    4. adoption, trial, interest, awareness
    Answer

    B. awareness, interest, evaluation, trial, adoption

    People move from awareness to adoption.

  17. Hand washing with soap and water should last at least:

    1. 2 seconds
    2. 20 seconds
    3. 10 seconds
    4. 5 seconds
    Answer

    B. 20 seconds

    A proper wash takes at least 20 seconds.

  18. World Health Day is observed on:

    1. 7 April
    2. 8 March
    3. 1 May
    4. 1 December
    Answer

    A. 7 April

    7 April is World Health Day.

  19. World AIDS Day is observed on:

    1. 10 October
    2. 7 April
    3. 1 December
    4. 1 January
    Answer

    C. 1 December

    1 December.

  20. The Health Belief Model says a person is more likely to act when they:

    1. feel no risk
    2. find the action costly and hard
    3. are given no information
    4. feel at risk and see benefits with few barriers
    Answer

    D. feel at risk and see benefits with few barriers

    Perceived risk and benefits drive action.

  21. Which statement about empathy is correct?

    1. It means feeling sorry for someone
    2. It means avoiding conversation
    3. It means giving advice at once
    4. It means understanding the other person's feelings
    Answer

    D. It means understanding the other person's feelings

    Empathy is understanding; sympathy is feeling sorry.

  22. An ANM wants to teach 40 mothers about exclusive breastfeeding at the anganwadi. A suitable method is:

    1. group talk with a demonstration of positioning
    2. a personal letter to each mother
    3. a newspaper advertisement
    4. a single poster left in the room
    Answer

    A. group talk with a demonstration of positioning

    Group demonstration suits skill teaching in a group.

  23. A woman looks worried while the ANM explains a method. The best response is to:

    1. end the visit
    2. pause, ask about her concern and listen
    3. tell her not to worry
    4. continue faster
    Answer

    B. pause, ask about her concern and listen

    Observing feedback and listening are key counselling skills.

  24. To check if a mother understood ORS preparation, the ANM should:

    1. ask 'Do you understand?' only
    2. give a pamphlet
    3. assume she understood if she nods
    4. ask her to prepare it and explain
    Answer

    D. ask her to prepare it and explain

    Teach-back checks real understanding.

  25. A village has low immunisation because of rumours. The most useful approach is:

    1. involve local leaders and give clear facts in the local language
    2. use only technical English posters
    3. ignore the rumours
    4. punish absent parents
    Answer

    A. involve local leaders and give clear facts in the local language

    Community participation and clear messages counter rumours.

  26. A poster for an illiterate audience should mainly use:

    1. statistics tables
    2. long printed paragraphs
    3. clear pictures with few words
    4. small English text
    Answer

    C. clear pictures with few words

    Pictures communicate across literacy levels.

  27. Match: Which pairing is correct?

    1. Poster: personal counselling
    2. Role play: radio broadcast
    3. Panel discussion: a few experts talk together before an audience
    4. Lecture: two-way discussion
    Answer

    C. Panel discussion: a few experts talk together before an audience

    Panel discussion involves a few experts conversing.

  28. Which of the following statements is/are correct? 1. Communication without feedback is one-way communication. 2. Counselling is a two-way process.

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    C. Both 1 and 2

    Both are correct.

  29. Which of the following statements is/are correct? 1. BCC focuses on actual change in behaviour. 2. IEC is the same as BCC in all respects.

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    A. 1 only

    BCC goes beyond information to behaviour change.

  30. Which of the following statements is/are correct? 1. The Ottawa Charter was adopted in 1986. 2. The Alma-Ata declaration was in 1948.

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    A. 1 only

    Alma-Ata was 1978.

  31. Which of the following statements is/are correct? 1. Mass media provides immediate feedback. 2. Individual counselling allows strong feedback.

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    B. 2 only

    Mass media gives weak feedback.

  32. Which of the following statements is/are correct? 1. A flip chart is a set of pages turned as the talk goes on. 2. A model shows three-dimensional structure.

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    C. Both 1 and 2

    Both are correct.

  33. Which of the following statements is/are correct? 1. A symposium is the same as a panel discussion. 2. Evaluation is the first step in planning health education.

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    D. Neither 1 nor 2

    Both are wrong.

  34. Which of the following statements is/are correct? 1. Confidentiality must be maintained in counselling. 2. Informed choice means the counsellor decides for the client.

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    A. 1 only

    In informed choice the client decides after getting information.

  35. Which of the following statements is/are correct? 1. Verbal communication uses words. 2. Non-verbal communication includes eye contact and tone.

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    C. Both 1 and 2

    Both are correct.

  36. Which of the following statements is/are correct? 1. The cone of experience places direct experience at the base as the most concrete. 2. The cone places words at the most concrete level.

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    A. 1 only

    Words are the most abstract.

  37. Which of the following statements is/are correct? 1. World Breastfeeding Week is observed in the first week of August. 2. World Health Day is on 7 April.

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    C. Both 1 and 2

    Both are correct.

  38. Which of the following statements is/are correct? 1. Barriers to communication include noise and language differences. 2. Wrong timing is not a barrier.

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    A. 1 only

    Timing can be a barrier.

  39. Which approach is used to reach a large audience quickly?

    1. Home visit
    2. Mass media
    3. Counselling
    4. Personal demonstration
    Answer

    B. Mass media

    Mass media reaches many at once.

  40. The 'R' in the GATHER counselling steps stands for:

    1. reporting
    2. return visit planning
    3. registration
    4. rejection
    Answer

    B. return visit planning

    G greet, A ask, T tell, H help, E explain, R return.

  41. Which one is a visual aid?

    1. Radio
    2. Public address system
    3. Telephone call
    4. Flash card
    Answer

    D. Flash card

    Flash cards, charts and posters are visual aids.

  42. Which stage comes last in the stages of change model?

    1. pre-contemplation
    2. maintenance
    3. contemplation
    4. preparation
    Answer

    B. maintenance

    Order: pre-contemplation, contemplation, preparation, action, maintenance.

  43. Panel discussion differs from lecture because it:

    1. has one speaker only
    2. involves several speakers talking with each other
    3. has no audience
    4. needs no planning
    Answer

    B. involves several speakers talking with each other

    A panel has a few experts discussing a topic.

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