PUH507–COMMUNICATION FOR HEALTH AND MEDIA TECHNOLOGY (2

Units)

COURSE OUTLINE
COURSE DESCRIPTION – The course introduces the students to communication
principles, concepts, and examines the relevance of these concepts to health education
process. The course will review various communication theories, models of mass
communication. Theories of adoption of innovation would also be considered. Students
critically assess various communication strategies in planning and evaluating
communication aspects of public health programs. The course considers also a variety of
simple audiovisual methods of communication, discussing their relevance and
appropriateness in health information dissemination within the context of culture and
technology. Efforts in practical production of media materials are featured.

COURSE CONTENT - The course has been broken down into 4 sections and each
section is further broken down different sub-sections:

SECTION 1 – Communication as a Process

SECTION 2 – Principles and Concepts of Communication
SECTION 3 – Models and Theories of Mass Communication
SECTION 4 - Communication in Public Health Programs/IEC

ASSESSMENT –
Attendance – 5%
Practical - 25%
Exam - 70%
Total - 100%
(Practical project - Student prepare specified Public Health message based on assigned
topic from lecture material. 15 marks)
TEXTS FOR FURTHER READING
Baran, S. (2000). Introduction to Mass Communication. New York,
Lumsden, G. & Lumsden, D. (2006). Communication with Credibility and Confidence (3rd ed.). Boston, MA: Wadsworth Cengage
Learning
Mcquail, D. (2010). Communication Theory (5th ed.). London, Sage Publications
Parvanta, C. & Bass, S. (2020). Health Communication Strategies and Skills for a New Era. Burlington, Jones & Bartlett Learning

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SECTION 1 : COMMUNICATION AS A PROCESS
Objectives/Learning Outcomes: By the end of studying materials in this section,
students should be able to:

1. Critique some definitions of communication and attempt a to define the term from

a personal perspective

2. Make a list of the elements involved in the communication process using relevant

diagrams

3. Explain why communication is seen as a process and not an act

4. Discuss the importance of having health professionals approach communication

as a process and not an act.

Communication Process. Diagram 1 Communication is a continuous process.

The communication process is a loop that connects the sender and the receiver and
operates in both directions. Communication is not complete until the original sender
knows that the receiver understands the message.

Note that the communication process involves eight basic elements- source
(sender), encoding, message, transmission channel, receiver, decoding, noise, and
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feedback. Professionals can improve communication skills by becoming aware of
these elements and how they contribute to successful communication.
Communication can break down at any one of these elements.

1. Source (Sender):
The communication process begins with sender. Sender wishes to send a message
to the receiver. For example- a sales person making a presentation to the client, or
a mother conveying her compassion to the kid, or a teacher teaching students in a
class – all are senders in the process of communication.

2. Message:
The message is ‘what the sender wants to convey’ to the receiver. It may be an
idea, or feeling, or some information. You, as the sender, have to express your
purpose in the form of a message.

Every message has a purpose or objective. The sender intends – whether

consciously or unconsciously – to accomplish something by communicating. In
organizational contexts, messages typically have a definite objective- to motivate, to
inform, to teach, to persuade, to entertain, or to inspire. This definite purpose is, in
fact, one of the principal differences between casual conversation and managerial
communication.

3. Encoding:
To encode is to put a message into words or images. The sender organizes his
message into a series of symbols – either written words or spoken words or
gestures or any other symbolic act or a combination of these modes. This is termed
as encoding of the message. There are three encoding skills- speaking, writing, and
body language.

Encoding the matter is a very important element of communication. Using

appropriate words and symbols can make the message clear and effective.

4. Transmission Channel:
The channel is the medium of transmission from one person to another (such as air
for spoken words and paper for letters); it is often inseparable from the message.
For communication to be effective and efficient, the channel must be appropriate for
the message. A phone conversation would be an unsuitable channel for transmitting
a complex engineering diagram; overnight express mail might be more appropriate.

The needs and requirements of the receiver must also be considered in selecting a
channel. An extremely complicated message, for example- should be transmitted in
a channel that permits the receiver to refer to it repeatedly.

However, one does not always have an option to choose the mode of
communication. But when one has, the right decision can make the message

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clearer and more effective. Such choices may be guided by habit or personal
preference.

One person may use the telephone because he dislikes writing; another may
continue to use handwritten memos when electronic mail would be much more

efficient. Both modes are appropriate in certain circumstances, so the manager

must make individual decisions for each situation.

How to choose the best channel? Written and graphic communications, such as
memos, letters, reports, and blueprints, are clear and precise and provide a
permanent record. The telephone and face-to-face oral communication offer the
advantage of immediate feedback. In choosing the appropriate channel, then,
managers must decide whether clarity or feedback is more important.

Furthermore, each medium has technological features, which make it easier to use
for some purposes than for others, like written communication may be made by
letter, e- mail, fax, etc. The medium can affect both the form and the content of a
message. The medium is therefore not simply ‘neutral’ in the process of
communication.

5. Receiver:
The receiver is the person or group for whom the communication effort is intended.
The message must be crafted with the receiver’s background in mind. An engineer
in a microchip manufacturing company, for example- might have to avoid using
technical terms in a communication with someone in the company’s advertising
department; by the same token, the person in advertising might find engineers
unreceptive to communications about demographics.

If the message does not reach a receiver, communication has not taken place. The
situation is not much improved if the message reaches a receiver but the receiver
doesn’t understand it.

6. Decoding:
Decoding is the process by which the receiver interprets the message and
translates it into meaningful information. Decoding involves two things: one is
technically receiving the message as it has been sent, and the other is interpreting
the message the way sender wants receiver to understand.

Technically receiving the message means, if it is spoken, the voice has been heard
clearly and if it is written, it is readable clearly. However, it may happen that you
have received the message clearly in its form and content, but could not understand
it.

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For example you receive the following message-

You can see it. You probably guess that it’s a language maybe even that it’s written
in ‘Wingdings’ font type. You probably don’t understand it, though. In fact, it does
mean something. But you don’t understand the language. You could not decode the
message.

At times it happens that even if you understand the language of the message, you
are not able to interpret its meaning. Decoding is affected by the receiver’s past
experience, personal assessments of the symbols and gestures used, expectations
(people tend to hear what they want to hear), and mutuality of meaning with the
sender. In general, the more the receiver’s decoding matches the sender’s intended
message, the more effective the communication has been.

One decoding problem occurred when a manager asked a subordinate if she would
like to work overtime on a weekend. There were a number of other employees
available to do the work, but the manager thought the one he singled out would
appreciate an opportunity to earn extra income.

The subordinate had made special plans for Saturday, but she interpreted the
manager’s offer as a demand, cancelled her plans, and spent the weekend working.
As a result of poor communication, she interpreted the manager’s message
differently than he intended.

There are three decoding skills- reading, listening, and reasoning.

7. Feedback:
Feedback is reaction, without it, the sender of the message cannot know whether
the recipient has received the entire message or grasped its intent.

The need for feedback should be clearly understood. Feedback is the return of a
portion of the message to the sender with new information. It regulates both the
transmission and reception. The whole process is straightforward- the sender
transmits the message via the most suitable communication media; the receiver
gets the message, decodes it, and provides feedback. Feedback enables the
sender to adjust his performance to the needs and responses of the receiver(s).

Organizational feedback may be in a variety of forms, ranging from direct feedback,

such as a simple spoken acknowledgement that the message has been received, to
indirect feedback, expressed through actions or documentation. For example- a
straightforward request for a faster rate of production may be met directly with an
assenting nod of the head or indirectly with record-breaking output or a union strike.

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In most organizational communications, the greater the feedback, the more
effective the communication process is likely to be. For example- early feedback will
enable managers to know if their instructions have been understood and accepted.
Without such feedback, a manager might not know (until too late) whether the
instructions were accurately received and carried out.

8. Noise:
Noise is any disturbance that obscures, reduces, or confuses the clarity or quality of
the message being transmitted. In other words, it is any interference

that takes place between the sender and the receiver. This is why we generally
identify any communication problem that can’t be fully explained as “noise.”

To overcome the noise barrier to effective communication, one must discover its
source.

It may be:

i. Physical Noise

ii. Physiological Noise or

iii. Psychological Noise

i. Physical Noise:

External factors that distract communication fall under this category. Everyday
examples of physical noise are – a loud motorbike roaring down the road while
you’re trying to hold a conversation, your little brother standing in front of the TV
set, mist on the inside of the car windscreen, smudges on a printed page, etc.

Generally speaking, in this kind of everyday communication, we’re fairly good at

avoiding physical noise- we shout when the motorbike goes past; you clout your
little brother; cars have demisters.

ii. Physiological Noise:

Hearing disorders fall into this category, as do illness and disabilities that make it
difficult to send and receive messages. For example- it is hard to pay attention
when one is recovering from a late night study session or has the flu.

iii. Psychological Noise:

It consists of forces within sender or receiver that interfere with the understanding.
Egotism, defensiveness, hostility, preoccupation, fear, different percep tions – all

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these and more constitute psychological noise. We will be discussing these in detail
under the heading – ‘Barriers of communication’.

Once the source, or sources, of the noise has been identified, steps can be taken to
overcome it. The noise barrier can’t always be overcome but, fortunately, just the
awareness of its existence by either the sender or the receiver of a message can
help to improve the communication flow.

Communication Process. Diagram 2

F
igure 2.1: The Osgood-Schramm model of communication. Sources: Kisspng, 2018; Web Editor
4, 2017

Step 1: Idea Formation – The communication process begins when the sender has
an idea to be communicated. The idea will be influenced by complex factors
surrounding the sender. The sender must begin by clarifying the idea and purpose.
What exactly does the sender want to achieve? How is the message likely to be
perceived? Knowing this information provides a higher chance of successful
communication

Step 2: Message Encoding – The idea must be encoded into words, symbols, and
gestures that will convey meaning. Because no two people interpret information in the
exact same way, the sender must be careful to choose words, symbols and gestures
that are commonly understood to reduce the chances of misunderstanding. Therefore,
a sender must be aware of the receiver’s communication skills, attitudes, skills,
experiences, and culture to ensure clear communication.
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Step 3: Message Transmission: Choosing the medium to transmit the message is the
next step in the communication process. Messages can be transmitted in a verbal,
written, or visual manner (see Table 1). For clear communication to occur, the medium
and message must match

Table 2.1: Message Transmission Mediums

Verbal Written Visual

In-person Drawings,
Email
speech paintings

Text, Photos,
Phone
instant graphic
conversation
message designs

Body
Voice-over-
Report, language
internet
article, (e.g., eye
protocol
essay contact, hand
(VoIP)
gestures)

Radio Letter Graphs

Podcast Memo Font types

Voicemail
Blog Semaphore
message

Intercom Tweet Architecture

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Step 4: Decoding – When the message reaches the receiver, the message must be
decoded into its intended meaning. Therefore, the receiver must translate the words,
symbols, and gestures as the sender intended. Because no two people interpret
information in the exact same way, incorrectly decoding a message can lead to
misunderstanding. Successful decoding is more likely when the receiver creates a
receptive environment and ignores distractions. Alert receivers strive to understand
both verbal and nonverbal cues, avoid prejudging the message, and expect to learn
from the communication.

Step 5: Feedback – A vital part of the communication process is feedback. Feedback

occurs the sender and receiver check to ensure the message was understood as
intended. Feedback is a shared responsibility between the sender and the receiver and
can be verbal or non-verbal. For example, the sender can elicit feedback by asking,
“Do you have any questions?” The sender can also improve the feedback process by
only providing as much information as the receiver can handle. Receivers can
encourage clear communication by providing clear, timely, descriptive, and non-
judgmental feedback. For example, the receiver can shake his/her head up and down
to confirm “yes” I have a question.

Definitions of Communication

Numerous efforts have been made to define communication and to clarify its scope. As
early as 1928, the English literary critic and author I.A. Richards offered one of the first
—and in some ways still the best—definitions of communication as a discrete aspect of
human enterprise. According to Richards,

Communication takes place when one mind so acts upon its environment that another
mind is influenced, and in that other mind an experience occurs which is like the
experience in the first mind, and is caused in part by that experience.

Gordon George in Encyclopedia Brittanica, defines communication as the

exchange of meanings between individuals through a common system of
symbols. (Add one more definition)

Richards’s definition is both general and rough, but its application to nearly all kinds of
communication—including those between humans and animals (but excluding
machines)—separated the contents of messages from the processes in human affairs
by which these messages are transmitted. More recently, questions have been raised
concerning the adequacy of any single definition of the term communication as it is
currently employed. The American psychiatrist and scholar Jurgen Ruesch identified 40
varieties of disciplinary approaches to the subject, including architectural,
anthropological, psychological, political, and many other interpretations of the
apparently simple interaction described by Richards. In total, if such informal
communications as sexual attraction and play behaviour are included, there exist at
least 50 modes of interpersonal communication that draw upon dozens of
discrete intellectual disciplines and analytical approaches. Communication may
therefore be analyzed in at least 50 different ways

Interest in communication has been stimulated by advances in science and technology,

which, by their nature, have called attention to humans as communicating creatures.
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Among the first and most dramatic examples of the inventions resulting from
technological ingenuity were the telegraph and telephone, followed by others like
wireless radio and telephoto devices. The development of popular newspapers and
periodicals, broadcasting, motion pictures, and television led to institutional and
cultural innovations that permitted efficient and rapid communication between a few
individuals and large populations; these media have been responsible for the rise and
social power of the new phenomenon of mass communication.

Types of communication

Nonvocal communication

Signals, signs, and symbols, three related components of communication processes

found in all known cultures, have attracted considerable scholarly attention because
they do not relate primarily to the usual conception of words or language. Each is
apparently an increasingly more complex modification of the former, and each was
probably developed in the depths of prehistory before, or at the start of, early human
experiments with vocal language.
Signs

While signs are usually less germane to the development of words than signals, most of
them contain greater amounts of meaning of and by themselves. Ashley Montagu, an
anthropologist, has defined a sign as a “concrete denoter” possessing
an inherent specific meaning, roughly analogous to the sentence “This is it; do
something about it!” The most common signs encountered in daily life are pictures or
drawings, although a human posture like a clenched fist, an outstretched arm, or a hand
posed in a “stop” gesture may also serve as signs. The main difference between a sign
and a signal is that a sign (like a policeman’s badge) contains meanings of
an intrinsic nature; a signal (like a scream for help) is merely a device by which one is
able to formulate extrinsic meanings. Their difference is illustrated by the observation
that many types of animals respond to signals while only a few intelligent and trained
animals (usually dogs and apes) are competent to respond to even simple signs.

All known cultures utilize signs to convey relatively simple messages swiftly and
conveniently. The meaning of signs may depend on their form, setting, colour, or
location. In the United States, traffic signs, uniforms, badges, and barber poles are
frequently encountered signs. Taken en masse, any society’s lexicon of signs makes up
a rich vocabulary of colourful communications.

Symbols

Symbols are more difficult than signs to understand and to define, because, unlike
signs and signals, they are intricately woven into an individual’s ongoing perceptions of
the world. They appear to contain a dimly understood capacity that (as one of their
functions), in fact, defines the very reality of that world. The symbol has been defined as
any device with which an abstraction can be made. Although far from being a precise
construction, it leads in a profitable direction. The abstractions of the values that people
imbue in other people and in things they own and use lie at the heart of symbolism.
Here is a process, according to the British philosopher Alfred North Whitehead,
whereby

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some components of [the mind’s] experience elicit consciousness, beliefs, emotions,
and usages respecting other components of experience.
In Whitehead’s opinion, symbols are analogues or metaphors (that may include written
and spoken language as well as visual objects) standing for some quality of reality that
is enhanced in importance or value by the process of symbolization itself.

Almost every society has evolved a symbol system whereby, at first glance, strange
objects and odd types of behaviour appear to the outside observer to have irrational
meanings and seem to evoke odd, unwarranted cognitions and emotions. Upon
examination, each symbol system reflects a specific cultural logic, and every symbol
functions to communicate information between members of the culture in much the
same way as, but in a more subtle manner than, conventional language. Although a
symbol may take the form of as discrete an object as a wedding ring or a totem pole,
symbols tend to appear in clusters and depend upon one another for their accretion of
meaning and value. They are not a language of and by themselves; rather they are
devices by which ideas too difficult, dangerous, or inconvenient to articulate in common
language are transmitted between people who have acculturated in common ways. It
does not appear possible to compile discrete vocabularies of symbols, because they
lack the precision and regularities present in natural language that are necessary
for explicit definitions.

Icons

Rich clusters of related and unrelated symbols are usually regarded as icons. They are
actually groups of interactive symbols, like the White House in Washington, D.C., a
funeral ceremony, or an Impressionist painting. Although, in examples such as these,
there is a tendency to isolate icons and individual symbols for examination, symbolic
communication is so closely allied to all forms of human activity that it is generally and
nonconsciously used and treated by most people as the most important aspect of
communication in society. With the recognition that spoken and written words and
numbers themselves constitute symbolic metaphors, their critical roles in the worlds
of science, mathematics, literature, and art can be understood. In addition, with these
symbols, an individual is able to define his own identity.

Gestures

Professional actors and dancers have known since antiquity that body gestures may
also generate a vocabulary of communication more or less unique to each culture.
Some American scholars have tried to develop a vocabulary of body language,
called kinesics. The results of their investigations, both amusing and potentially
practical, may eventually produce a genuine lexicon of American gestures similar to one
prepared in detail by François Delsarte, a 19th-century French teacher of pantomime
and gymnastics who described the ingenious and complex language of contemporary
face and body positions for theatrical purposes.

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Proxemics

Of more general, cross-cultural significance are the theories involved in the study of
proxemics developed by an American anthropologist, Edward Hall. Proxemics

involves the ways in which people in various cultures utilize both time and space as well
as body positions and other factors for purposes of communication. Hall’s “silent
language” of nonverbal communications consists of such culturally determined
interactions as the physical distance or closeness maintained between individuals, the
body heat they give off, odours they perceive in social situations, angles of vision they
maintain while talking, the pace of their behaviour, and the sense of time appropriate for
communicating under differing conditions. By comparing matters like these in the
behaviour of different social classes (and in varying relationships), Hall elaborated and
codified a number of sophisticated general principles that demonstrate how certain
kinds of nonverbal communication occur. Although Hall’s most impressive arguments
are almost entirely empirical and many of them are open to question, the study of
proxemics does succeed in calling attention to major features of
communication dynamics rarely considered by linguists and symbologists. Students of
words have been more interested in objective formal vocabularies than in the more
subtle means of discourse unknowingly acquired by the members of a culture.

Vocal communication

Significant differences between nonvocal and vocal communication are matters more of
degree than of kind. Signs, signals, symbols, and possibly icons may, at times, be
easily verbalized, although most people tend to think of them as visual means of
expression. Kinesics and proxemics may also, in certain instances, involve
vocalizations as accompaniments to nonverbal phenomena or as somehow integral to
them. Be they grunts, words, or sentences, their function is to help in forwarding a
communication that is fundamentally nonverbal.

Although there is no shortage of speculation on the issue, the origins of

human speech remain obscure at present. It is plausible that man is born with an
instinct for speech. A phenomenon supporting this belief is the presence of unlearned
cries and gurgles of infants operating as crude vocal signs directed to others the baby
cannot possibly be aware of. Some anthropologists claim that within the vocabularies of
kinesics and proxemics are the virtual building blocks of spoken language; they
postulate that primitive humans made various and ingenious inventions (including
speech) as a result of their need to communicate with others in order to pool
their intellectual and physical resources. Other observers suggest similar origins of
speech, including the vocalization of physical activity, imitation of the sounds of nature,
and sheer serendipity. Scientific proof of any of these speculations is at present
impossible.

Not only is the origin of speech disputed among experts, but the precise reasons for the
existence of the numerous languages of the world are also far from clear. In the 1920s
an American linguistic anthropologist, Edward Sapir, and later Benjamin Lee Whorf,
centred attention upon the various methods of expression found in different cultures.

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Drawing their evidence primarily from the languages of primitive societies, they made
some very significant observations concerning spoken (and probably written) language.
First, human language reflects in subtle ways those matters of

greatest relevance and importance to the value system of each particular culture. Thus,
language may be said to reflect culture, or, in other words, people seem to find ways of
saying what they need to say. A familiar illustration is the many words (or variations of
words) that Eskimos use to describe whale blubber in its various states—e.g., on the
whale, ready to eat, raw, cooked, rancid. Another example is the observation
that drunk possesses more synonyms than any other term in the English language.
Apparently, this is the result of a psychological necessity to euphemize a somewhat
nasty, uncomfortable, or taboo matter, a device also employed for other words that
describe seemingly important but improper behaviour or facets of culture.

Adaptability of language

Other observations involve the discovery that any known language may be employed,
without major modification, to say almost anything that may be said in any other
language. A high degree of circumlocution and some nonverbal vocalization may be
required to accomplish this end, but, no matter how alien the concept to the original
language, it may be expressed clearly in the language of another culture. Students of
linguistic anthropology have been able to describe adequately in English
the esoteric linguistic propositions of primitive societies, just as it has been possible for
anthropologists to describe details of Western technology to persons in remote cultures.
Understood as an artifact of culture, spoken language may therefore be considered as
a universal channel of communication into which various societies dip differentially in
order to expedite and specify the numerous points of contact between individuals.

Language remains, however, a still partially understood phenomenon used to transact

several types of discourse. Language has been classified on the basis of
several criteria. One scheme established four categories on the basis of
informative, dynamic, emotive, and aesthetic functions. Informative communication
deals largely with narrative aspects of meaning; dynamic discourse concerns the
transaction of dispositions such as opinions and attitudes; the emotive employment of
language involves the evocation of feeling states in others in order to impel them to
action; and aesthetic discourse, usually regarded as a poetic quality in speech, conveys
stylistic aspects of expression.

Laughter
Although most vocal sounds other than words are usually considered prelinguistic
language, the phenomenon of laughter as a form of communication is in a category by
itself, with its closest relative being its apparent opposite, crying. The reasons for
laughter in complex social situations is another question and is answered differently by
philosophers and psychologists. The English novelist George Meredith proposed a
theory, resulting from his analysis of 18th-century French court comedies, that laughter
serves as an enjoyable social corrective. The two best-known modern theories of the
social wellsprings of laughter are the philosopher Henri Bergson’s hypothesis that
laughter is a form of rebellion against the mechanization of human behaviour and
nature and Freud’s concept of laughter as repressed sexual feeling. The writer Arthur
Koestler regarded laughter as a means of individual enlightenment, revelation, and

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subsequent freedom from confusion or misunderstanding concerning some part of
the environment.
Mass and Public communication

Effects of mass communication

Lively controversy centers on the effect of public communication upon audiences, not
only in matters concerning public opinion on political issues but in matters of personal
lifestyles and tastes, consumer behaviour, the sensibilities and dispositions of children,
and possible inducements to violence. Feelings regarding these matters vary greatly.
Some people construe the overall effects of mass communication as generally
harmless to both young and old. Many sociologists follow the theory that mass
communication seems to influence attitudes and behaviour only insofar as it confirms
the status quo—i.e., it influences values already accepted and operating in the culture.
Numerous other analysts, usually oriented to psychological or psychiatric disciplines,
believe that mass communications provide potent sources of informal education
and persuasion. Their conclusions are drawn largely from observations that many, or
most, people in technological societies form their personal views of the social realities
beyond their immediate experience from messages presented to them through public
communication.

To assume that public communication is predominantly reflective of current

values, morals, and attitudes denies much common experience. Fashions, fads, and
small talk are too obviously and directly influenced by material in the press, in films, and
in television to support this view. The success of public communication as an
instrument of commercial advertising has also been constant and noticeable. Present
evidence indicates that various instruments of mass communication produce varying
effects upon different segments of the audience. These effects seem too numerous and
short-lived to be measured effectively with currently available instruments. Much of the
enormous output on television and radio and in print is probably simply regarded as
“play” and of little consequence in affecting adult dispositions, although many
psychologists believe that the nature of children’s play experiences is critical to their
maturation.

The role of newspapers, periodicals, and television in influencing political opinion is

fairly well established in the voting behaviour of the so-called undecided voters.
Numerous studies have shown that, while the majority of citizens in the United States
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cast their votes along party lines and according to social, educational, and economic
determinants, middle-of-the-road voters often hold the balance of power that
determines the outcomes of elections. Politicians have become sensitive to
their television images and have devised much of their campaign strategy with the
television audience in mind Advertising agencies familiar with television techniques
have been brought into the political arena to plan campaigns and develop their clients’
images. The effectiveness of television campaigning cannot yet be determined reliably.

Public communication is a near-ubiquitous condition of modernity. Most reliable surveys

show that the majority of the people of the world (including those of totalitarian
countries) are usually satisfied with the kind of mass communication available to them.
Lacking alternatives to the communication that they easily and conveniently receive,
most people seem to accept what they are given without complaint. Mass
communication is but one facet of life for most individuals, whose main preoccupations
centre on the home and on daily employment. Public communication is an
inexpensive addendum to living, usually directed to low common denominators of taste,
interest, and refinement of perception. Although mass communication places enormous
potential power in the hands of relatively few people, traditional requirements for
popular approval and assent generally have prevented its use for overt subversion of
culturally sanctioned institutions. Fear of such subversion is sometimes expressed by
critics.

Revision Questions for Section 1

****With the aid of relevant diagrams, discuss the stages involved in the process
of communication.

*****Communication is not an act; it is a process. Discuss

****How important is it for health professionals to understand that

communication is not just an act but a complex process.

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SECTION 2: CONCEPTS AND PRINCIPLES OF COMMUNICATION
Objectives/Learning Outcomes

By the end of studying materials in this section, students should be able to:

1. Define the concept of communication from different perspectives and

explain the apparent focus of each definition.

2. List and apply some models of communication to their disciplines

3. Describe how communication models can be useful in public health

education program

4. List and explain some principles of effective communication

Part 1 – Concepts of Communication

Communication permeates all aspects of human endeavor and interaction.

Scholars, specialists and professionals across disciplines have had to
examine the concept of communication at varying levels of engagement-
cursory, exploratory or in-depth. This, to some extent, explains why there
are numerous definitions and conceptions of the term “communication.”
Some of such have been examined in section one. A few more will be
presented here.

 According to Denis Mc Quail, communication is a process, which

increases, commonality - but also requires elements of commonality
for it to occur at all.
 Communication is the exchange of meanings between individuals
through a common system of symbols. (I.A. Richards)
 Communication is the sum of all the things one person does when he
wants to create understanding in the mind of another. It is a bridge of

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 meaning. It involves a systematic and c continuous process of telling,
listening and understanding. (Louis Allen)
 The mechanism through which human relations exist and develop’
(Wilbur Schramm)
 Communication is the process of transmitting feelings, attitudes,
facts, beliefs and ideas between living beings. (Birvenu)`
 Communication: How people use messages to generate meanings
within and across various contexts, cultures, channels, and media.

**** Select 2 most preferable definitions from the list above.

Provide a brief argument in support of each definition.

In the bid to further explore the different dimensions of communication, scholars often
go a step further to provide elaborate conceptual ideas of communication. These are
presented as models of communication. By taking a close look at such models, the
concept of communication becomes more relatable and applicable to different
situations, settings and contexts in which effective communication is required for
success.

We’ll take a look at a few models of communication at this point. They are: The
Transactional Model of Communication, the Perceptual Process and Attribution Model,
and the Elaboration Likelihood Model.

1. The Transactional Model of Communication - In communication, something

seems to often go wrong in the details because details are misunderstood due to
a breakdown in what is referred to as the transactional model of communication.
Barnlund, the original proponent of the transactional communication model,
claims that communication “…is not a reaction to something, nor an interaction
with something, but a transaction in which man invents and attributes meaning to
realize his purposes.” Therefore, meaning is generated through a process of
encoding and decoding. A first individual (the sender) puts thoughts into words,
symbols, or gestures. This process is called encoding.

The encoded message is then transmitted through a channel by speaking,

gesturing, writing, signaling, or the like to the recipient. Upon receiving the
words, symbols, or gestures, the second individual applies meaning to them—
17
 decoding. But it is not that simple, because the message may encounter “noise.”
Noise is any type of distortion or distraction. Some examples of noise for you as
the recipient include not hearing the message because you are at a loud party;
being preoccupied with thoughts about a sick friend; or not speaking the same
language as the sender. These barriers may then prevent the message from
being received or fully understood, and miscommunication occurs.

In the transactional model, communication can be viewed as the transfer of

symbolic information within a common symbol system. And that means that a
symbol must be understood in the same way for those communicating. This can
be difficult if the symbols change or are used differently. The essential point is
that if people do not share a common symbol system, communication will be
difficult.

2. Perceptual Process and Attribution Model - We can imagine two different

persons driving through a busy road and one sees an endless line of cars moving at
an annoyingly slow speed while the other sees lines of beautifully decorated shop
windows. We can imagine that one was in a hurry for some important reasons or
generally impatient and the other was just having a leisurely ride and was in no hurry.
Mood is one of many factors that influence our ability to use our senses to take in
information. Our perceptions are influenced by our internal attitudes, motives,
experiences, and expectations. However, characteristics of the object being perceived
(e.g., its motion, sounds, size, novelty) or the context of the situation (e.g., time, place,
others present) can also influence perception. All of these often happen
subconsciously and in quick succession but they do have significant impact on how a
communication plays out on different occasions.

3. Elaboration Likelihood Model - Building on the previous models, our ability to pay
attention to new information is also affected by how much we care about it. The
elaboration likelihood model (ELM) suggests that if you are already engaged in an
issue, you will pay more attention to communication and new information about it. For
example, women who are hoping to get pregnant will pay a lot of attention to
information (e.g., advertising) about fertility or pregnancy, whereas women not
interested in getting pregnant will not elaborate on such. They are less likely to look
twice at such adverts. In the absence of engagement, other stimuli are needed to grab

18
the attention of a target audience. An example is the use of appealing images to sell
things like after shave or personal care products. Most of these ads are aimed at men
who do not spend a lot of time thinking about shampoo and body wash. Appealing
models may grab their awareness and cause them to pay attention to and “elaborate”
the product information presented by the advertiser. The ELM suggests that most
people will read the pamphlets their doctors give them if they have been diagnosed with
a disease but will throw away materials that they feel do not pertain to them.

****Make a list of the models presented above. How many are they? Which of
these do you think is most applicable to your area of specialisation? Give
reasons for your choice.

Part 2 – Principles of Communication

The principles of communication involve factors, which are necessary in making the
communication processes worthwhile and efficient. High impact health communication
triggers behavioural changes on a societal level; it galvanizes entire communities into
action, prompting them to live a healthy lifestyle by taking the necessary measures to
prevent disease and to protect, maintain and improve their own health, such as good
nutrition, regular exercise, responsible sexual behavior, eschewing destructive
behaviours such as cigarette smoking, drug abuse etc.

In order for a health communication program to have such an impact, it should be

disseminated against the background of the following principles of effective
communication.

1. Principle of Clarity

The idea or message to be communicated should be clearly spelt out. It should be

worded in such a way that the receiver understands the same thing which the sender
wants to convey. There should be no ambiguity in the message. It should be kept in
mind that the words do not speak themselves, but the speaker gives them the meaning.
A clear message will evoke the same response from the other party. It is also essential
that the receiver is conversant with the language, its inherent assumptions, and the
mechanics of communication.

2. Principle of Attention

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In order to make communication effective, the receiver’s attention should be drawn
towards the message. People are different in behaviour, attention, emotions etc. so
they may respond differently to the message. Subordinates should act similarly as per
the contents of the message. There are a variety of methods and aids which are useful
for getting and sustaining the attention of an audience. The sender is in the position to
select the most appropriate ones for each communication event.

3. Principle of Feedback

The principle of feedback is very important to make the communication effective. There
should be a feedback information from the recipient because that is the only way to truly
know if the message was understood in the same sense in which the sender has meant
it.

4. Principle of Informality

Formal communication is generally used for transmitting messages and other

information. Sometimes formal communication may not achieve the desired results,
informal communication may prove effective in such situations. In most cases, public
health education communication is best presented in an informal atmosphere. There
could be instances when the formal approach will be more relevant, for example, when
presenting public health education information to policy makers. The health
professional’s ability to recognise the uniqueness of each setting is crucial as this will
inform other choices made for effective communication.

5. Principle of Consistency

This principle states that communication should always be consistent with the policies,
plans, programs and objectives of the health institution/facility. If the messages
information are in conflict with the existing policies and programs, then there will be
confusion in the minds of both colleagues and target audience who may have had
previous encounters with professionals from the same institution. This may lead to a
breakdown of trust and eventually, relationship.

6. Principle of Timeliness

20
This principle states that communication should be done at the proper time so that it
helps in implementing plans. Delayed communication may not serve the anticipated
purpose and this can bear dire health consequences in some cases. The most useful
information is that which is received and acted on before important steps are taken.

7. Principle of Adequacy

The information communicated should be adequate and complete in all respects.

Inadequate information may delay action and create confusion. Inadequate information
also affects efficiency of the receiver. So, adequate information is essential for taking
proper decisions and making action plans.

8. Principle of Shared Perception

For communication to be effective, the perception of the sender should be as close as

possible to the perception of the receiver. The extent of understanding depends on the
extent to which the people involved share the same backgrounds in relation to the
methods used in encoding the message.

9. Sensory Involvement

The more senses involved in communication, the more effective it will be. If I hear, I
forget. If I see, I remember. If I do, I know. In order to correctly apply this principle, the
health professional has to be creative in the compilation of materials that will aid in the
communication process by appealing to as many senses as possible. These may
include charts, audiovisuals, pictures, cartoons, practical demonstrations etc.

****Describe 3 different scenarios in which 3 of the principles

discussed in part two can be applied in a public health education
program.

21
ASSESSMENT SHEET 1
NAME
REG. NUM
DEPT.

22
SECTION 3 : THEORIES OF MASS COMMUNICATION

Objectives/Learning Outcomes

By the end of studying materials in this section, students should be able to:

1. Define mass communication and mass media

2. Explain what a theory is and differentiate it from other related terms

3. List the 5 categories of mass communication theories

4. Describe how mass communication theories can be useful in the

communication of public health education information

PART 1 – Mass Communication / Mass Media

The term ‘mass communication’ came into use in the late 1930s, but its essential
features were already well known and have not really changed since, even if the media
themselves have in some ways become less massive. The most obvious feature of the
mass media is that they are designed to reach the many. Potential audiences are
viewed as large aggregates of more or less anonymous consumers, and the
relationship between sender and receiver is affected accordingly.

The ‘sender’ is often the organization itself or a professional communicator (journalist,

presenter, producer, entertainer, etc.) whom it employs. If not this, it is another voice of
society given or sold access to media channels (advertiser, politician, preacher,
advocate of a cause, etc.). The relationship is inevitably one-directional, one-sided and
23
impersonal, and there is a social as well as a physical distance between sender and
receiver.

Barker (1981) defines Mass communication as the spreading of a message to an

extended mass audience through rapid means of reproduction and distribution at a
relatively inexpensive cost to the consumer. In each case, a message is transported
from its original source to a widespread audience through an intermediary channel such
as radio, television or newspaper.

**** Discuss in detail 5 ways in which mass communication /mass media is useful
for communication in public health education.

PART 2 - Mass Communication Theories

Mass communication theories describe the relationship between the media and the
society. Theories are dynamic and are subject to change depending on certain
variables. That explains why there are postulations of different theories by experts at
different times.

Mass communication theories are explanations and predictions of social phenomena

that attempt to relate mass communication to various aspects of our personal and
cultural lives or social systems.

CHARACTERISTICS OF A THEORY

The following are characteristics of a typical theory

1. Intellectual rigour: a typical theory must be involved in obvious intellectual rigour that
they become testable, verifiable or systematic.

2. Dynamism: a theory is subject to change it is not immutable or dogmatic

3. Economy: in a theory, words are few as postulations are summarized for easy
comprehension.

Differentiating theory from myth, dogma, philosophy or belief:

i. Myth- While myth employ stories and mystery, theories are built on concrete
facts and have traceable origins.

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 ii. Dogma- dogma is a belief based on tradition and authority. It is rigid and static,
however, theories are based on logic and common sense therefore it is flexible
and reliable.
iii. Belief/philosophy- while philosophy addresses the questions of value, theory
deals with what obtains and why
**** Give 2 examples of myths, dogma and philosophy you are
aware of. Why is it better to work with theory rather than these
as health professionals?

PART 3 – Categories of Mass Communication Theories

There are 5 major categories of mass communication theories. They are:

1. Normative Theories
2. Media and Culture Theories
3. Active Audience Theories
4. Common Sense Theories
5. Behavioural Theories
Each of these theories is a broad categorisation used to label theories of
mass communication with similar focus or orientation. Under each
category, we will selectively examine theories that are seen as most
relevant to public health education communication.
1. NORMATIVE THEORIES (THEORIES OF THE PRESS)
*Authoritarian Media Theory
* Libertarian Media Theory
* Soviet Communist Media theory
* Social Responsibility Media Theory

Social Responsibility Media Theory : This theory arose in the mid 20th
century in United States of America. It is an out-growth of the Libertarian
tradition. This media theory stemmed from the American commission on the
“freedom of the press”. This theory reconciles independence with obligation
with the claim that although the media should be allowed to operate freely,
25
 they expected to perform certain essential functions in the society
especially in democratic policies hence; they should be under an obligation
to fulfill these functions. Besides, they should provide a forum for diverse
views. The media should follow the accepted standard for their work.

Ownership and control of the media should be seen as a kind of

stewardship, that is they should serve and promote the interest of the
public. Hence, the press should be open to anyone who has something to
say. The social responsibility of the press is more important than its
freedom. In this case, the control of the press is done by community
opinions, some social bodies (through their code of ethics) and the
media/press councils. Ownership of the media here is private but there is
threat of government interference to ensure public service. The society and
public have a right to expect high standards of performance and hence, can
intervene whenever there is need to secure the public good.
 The Social Responsibility Media Theory is relevant to public health
communication in that, the media is seen as under obligation to cater
for the needs of the societies in which they operate. The focus of the
media according to this theory is to operate in ways that places
priority on the public good. Such orientation will be of immense
benefit to public health educators.

2. MEDIA, CULTURE SOCIETY THEORIES

*Spiral of Silence Theory

*The Knowledge Gap Theory

*Media Dependency Theory

*Modernization Theory

The Knowledge Gap Theory - The Knowledge Gap Theory focuses on how
knowledge is distributed in the society and the role of the mass media in the
distribution. The theory posits that as the infusion of mass media information
into a social system increases, higher socioeconomic status segments tend to
acquire this information faster than lower socioeconomic-status population

26
segments so that the gap in knowledge between the two tends to increase
rather than decrease.

For instance, there is a great divide, even within a country, on the adoption and
application of modern technologies. Some people may be more digitally aware
of what is going on. The digital divide is presently the largest form of
knowledge gap in our world today. This refers to how different nations have
different limits to technology, so the more developed nations are going to have
more access and knowledge of the latest information than the less developed.
People in a society exhibit great psychological diversity due to their
psychological makeup, learned experiences, social relationships, and social
category memberships. Despite these differences, people with more education
tend to have better developed cognitive and communication skills, broader
social spheres with more and more diverse social contacts, and a greater
amount of stored information than their counterparts with less education.
People with greater education also tend to express interest in, and expose
themselves to, a broader range of topics, including serious topics like public
affairs, science, and health news.

 The Knowledge gap media theory is relevant to the communicative

engagements of public health education professionals in that it points
attention to the wide gap between the knowledge levels of people in
different social cadre across society. This understanding is vital for
effective communication during public health education programs.

3. AUDIENCE THEORIES

*Uses and Gratification Theory

*Diffusion of Innovations Theory

*Cultivation Theory

Two theories will be discussed in this section:

Uses and Gratification Theory : The focus of this theory is on media use.
The Uses and Gratification Theory is also called Functional Theory. A good
illustration of this theory is the functional use of television for
entertainment by television audience members. The needs of viewers to
27
solve or forget problems and reduce tension have always been a strong
motivation for watching television entertainment. Thus, the Uses and
Gratification Theory validates the assumption that audience members
actively seek out the mass media to satisfy individual needs. According to
the theory, media consumers have a free will to decide how they will use
the media and how it will affect them since there are as many reasons for
using the media, as there are media users.

The Uses and Gratification Theory can be seen in cases such as personal
music selection. We select music not only to fit a particular mood but also in
attempts to show empowerment or other socially conscience motives. There
are many different types of music and we choose from them to fulfil a
particular need. As a result, the audience is seen as active decision makers
who play a major role in reception of media information.

 This theory is supportive of communication in public health

education. It conceives of the audience as important end users who
should be carefully considered in the planning and presentation of
media content.

Diffusion of Innovations Theory - The Diffusion of Innovation (Multiple

Step Flow Theory) explains how ideas are spread. According to Rogers
(1996), diffusion refers to “the process by which an innovation is
communicated through certain channels over time among the members of a
social system. An Innovation is an idea, practice or object perceived as new
by an individual or other unit of adoption. The diffusion of innovations
involves both interpersonal communication or mass communication
channels which are very active in spreading information on an innovation
and also influencing people to adopt the innovation.

To change prevailing attitudes about an innovation, it is best to persuade

opinion leaders. Opinion leaders are individuals who provide advice and
information about an innovation to members of the society. These
individuals tend to support the norms of the social structure and serve as a
model for others. Opinion leaders are at the center of the communication
network and reach many people via the interconnected flow of information.

28
According to the claims of this theory, the mass media’s most powerful
effect on diffusion is that it spreads knowledge of innovations to a large
audience rapidly. It can even lead to changes in weakly held attitudes
however, strong interpersonal ties are usually more effective in the
formation and change of strongly held attitudes.

 The Diffusion of Innovations theory paints a clear picture of how the

mass media can be an agent of positive change. Innovations in health
habits to combat new health risks, innovations in the use of
equipment or facilities for the purpose of maintaining health or
curbing the spread of diseases or unhealthy choices can be properly
channelled through the mass media and opinion leaders.

4. SENSE THEORIES

* Play Theory
* Reflective Projective Theory
*Medium Theory
* Media Richness Theory

Play Media Theory - The Play Theory focuses on division of man’s

activities. The basic assumption of the theory is that people are divided into
work and play. Work involves serious activities, (reality and production)
while play are not too serious activities like (casual interactions and
entertainment). William Stephenson, a British psychologist, in proposing
this theory, explains that people use mass communication more as play than
as work, more for pleasure and entertainment than for information and
improvement.

He sees mass communication as serving two functions. The first is to

provide play, to influence customs, normalize manners, give people
something in common to talk about, so as to foster mutual socialization. The
second function is to help shake up society. The theory, however, observed
the high tendency of injecting entertainment into propaganda to sustain
audience interest and attention where the objective is mainly propaganda.
For instance, increasing numbers of both television viewers and newspaper

29
 readers are interested in entertainment programmes like movies, sports,
reality shows.

5. BEHAVIOURAL THEORIES OF MASS COMMUNICATION

*Cognitive Dissonance Theory

* Social Identity theory

*Social Support Theory

* Social Presence Theory

Social Presence Theory - The Social Presence Theory focuses on

awareness of an interaction partner. The theory measures communication
media based on the degree of awareness of the other person in a
communication interaction. In most cases, the higher the social presence
level, the better the understanding of both speaker and message. The social
presence level is altered with the removal or addition of each
communication modality, such as speech, non-verbal cues, and immediacy
of exchange or feedback.

John Short, Ederyn Williams, and Bruce Christie in 1976 developed social
presence theory as a model for analyzing the social - psychological
dimensions of mediated communication from a “social cues perspective”.
They defined social presence as “the degree of salience of the other person
in the interaction and the consequent salience of the interpersonal
relationships” (Short, et al., 1976). The idea is that a medium’s social
effects are principally caused by the degree of social presence which it
affords to its users. By social presence is meant a communicator’s sense of
awareness of the presence of an interaction partner. This is important for
the process by which man comes to know and think about other persons,
their characteristics, qualities and inner states. Thus increased presence
leads to a better person perception. They argue that the closer we get to
replicating the experience of face-to-face interaction the better the
technology is at conveying social presence, and therefore the more effective
the communication will be between the partners.
30
**** Make a list of 3 theories from each of the categories provided in
part three above .

****How is the understanding of thePlay Media Theory useful for you

in the communication of public health information?

****Explain how the Social Presence Theory can guide in the

planning and presentation of public health information.

SECTION 4: COMMUNICATION IN PUBLIC HEALTH

EDUCATION

Objectives/Learning Outcomes

By the end of studying materials in this section, students should be able to:

1. Define public health communication as a sub-set of health

communication.

2. List and explain functions and characteristics of public health

communication

3. Discuss strategies of public health communication and identify the most

applicable in different settings.

4. List and discuss levels of health communication.

5. Identify barriers to effective public health communication and how they

can be removed.

Part 1 - Health Communication

Health communication, as defined by The Community Guide, is:

The study and use of communication strategies to inform and influence
individual and community decisions that enhance health.
Health communication includes verbal and written strategies to influence and empower
individuals, populations, and communities to make healthier choices. Health
communication often integrates components of multiple theories and models to promote

31
positive changes in attitudes and behaviours. Health communication is related to social
marketing, which involves the development of activities and interventions designed to
positively change behaviours.

Furthermore, health communication is the art and technique of informing, influencing

and motivating individuals or larger audiences about important health issues based on
scientific and ethical considerations. In other words, health communication aims at
informing and influencing individual and community knowledge, attitudes and practices
(KAP) with regard to health and healthcare.

Health communication is an integral part of general healthcare in that it encompasses

the study and use of communication strategies to inform and influence individual and
community decisions that enhance health.

Public health communication is recognised as a necessary part of efforts to improve

personal and public health especially with emphasis on preventive healthcare. It ia a
subset of health communication in that, health communication broadly caters for all
communication activities between caregivers and clients within the healthcare system
while public health education communication is more concerned with reaching out to
people within and outside health facilities. Public health communication is more
interested in the communication of preventive rather than curative information.

**** What is health communication?

**** Give two practical examples of activities demonstrating the

difference between health communication and public health
communication.

Part 2 – The Function of Public Health

Communication

In any type of communication, whether you are writing or speaking, trying to persuade,
inform or educate, there are several general objectives. These include being
understood, being accepted, and influencing an action such as a change of behaviour.

32
Public health communication contributes to better health outcomes for individuals and
for the whole community. It raises awareness of health risks and solutions, and
provides the motivation and skills needed to reduce these risks. It can affect or reinforce
good health practices and attitudes, giving people the information they need to make
complex choices, such as selecting health plans, care providers and living conditions.
Public health communication also encourages social norms that benefit health and
improve quality of life.

Public health communication is useful in helping individuals to find support from other
people in similar situations. Most importantly health communication can increase
appropriate demand for and use of health services. For the community, public health
communication can be used to influence the public agenda, advocate for policies and
programs, and promote positive change. At the same time, it can help improve the
delivery of both public health and general healthcare services.

**** Make a list of all the functions of public health communication

mentioned above. How many are they? Compare your answer with
those of some of your course mates. Add two more functions to the
list based on your area of specialisation.

The roles of public health communication can be further broken down into the following
points. From this perspective, public health communication,

 Increases knowledge and awareness of a health issue, problem, or its solution

 Influences perceptions, beliefs, attitudes and social norms about health
 Generates effective action
 Demonstrates or illustrates health related skills
 Shows the benefit of behaviour change
 Increases appropriate use and demand for health services
 Reinforces knowledge, attitudes and behaviour
 Refutes myths and misconceptions
 Advocates for a health issue or a population group.

**** Write short notes explaining 5 out of the functions listed above.
Make your notes independent and original.

33
Part 3 - Strategies of Public Health
Communication

Communication in public health education is one strategy for implementing health

promotion and disease prevention programs. Public health education provides learning
experiences on various health topics. There are varying health communication
strategies out of which the health worker will have to select the most relevant suitable
for the target population. Every strategy selected on every occasion should be
audience oriented because the general objective of health education is to present
information to target populations on particular health topics, including the health
benefits of particular choices and behaviour as well as the threats they face as a result
of various prevailing factors. Beyond these, public health education also provides tools
to build capacity and support behaviour change at different levels and settings.

Public Health communication strategies can be discussed in two main categories:

1. Traditional and rural based strategies (age grade meetings, gender meetings,
town crier)
2. Broadcast Media tools (radio broadcast, television, public service
announcements, billboards and posters, social media/internet)

By extension, Public health education strategies can also be employed in the form of :

 Lectures
 Seminars
 Courses
 Webinars
 Workshops
 Classes
 Discussion Fora
 Drama Skits
 Teaching Sessions

34
  Campaigns

**** Identify 4 of the strategies for public health communication

that would be most useful in your area of specialisation. Explain the
rationale behind your choice and how these strategies can be used.

PART4 - Characteristics of Effective Health Communication

There are 3 major characteristics of effective health communication for the purpose of
public health education. They are accuracy, availability and accessibility. These two
characteristics apply in all contexts and settings where public health education is being
provided.

Let’s take a closer look at the 3 characteristics:

 Accuracy – The content, that is, information that is passed across to the
recipients/audience should be valid and without errors of fact, interpretation or
judgement. This is vital for several reasons. Firstly, such information is expected
to greatly impact people’s lives and wellbeing. Secondly, people are expected to
continue to spread the information as they share their experience and newly
acquired level of knowledge with other members of their communities. On the
basis of these, such information, if not carefully controlled for accuracy and
authenticity, could become a source of great damage and chaos within the target
community/group.
****Think up 2 or 3 more reasons why accuracy is vital in public health
education communication?

 Availability - This is also an important characteristic of public health education

communication. A logical question to ask here is, “What is the value of accurate
but unavailable information?” People saddled with the responsibility of ensuring
communication in public health education are expected to utilise existing
channels or create new ones through which content will be made available, in
practical terms, to selected target audience. One major reason why availability is
an important characteristic is that unavailability of accurate information breeds
ignorance and wherever ignorance abounds, vices abound.

35
 ****Give 2 or 3 more reasons why availability is vital in public health
education communication?

 Accessibility – After ensuring accuracy and availability, the public health

education communicator should take a step further to see that content is
delivered or placed where the audience can access it. We may pause at this
point to ask a question, “Is it possible for information to be available yet
inaccessible?” Effective communication involves identifying the right environment
to place the message in order to ensure accessibility.
****What is your response to the question in italics above? Can you think
up 2 more reasons why accessibility is vital in public health education
communication?

The following are other characteristics of effective health communication:

 Balance: The content is free of bias and presents the benefits and risks of
potential actions while at the same time recognizes different and valid
perspectives on the issue.
 Consistency: The content remains internally consistent over time and also is
consistent with information from other sources (the latter is a problem when other
widely available content is not accurate or reliable).
 Cultural Competence: The design, implementation, and evaluation process that
accounts for special issues for select population groups (for example, ethnic,
racial, religious and linguistic) Educational levels and disability should also be
given due consideration.
 Evidence-based: Information is based on relevant scientific evidence that has
undergone comprehensive review and rigorous analysis to formulate practice
guidelines and performance measures.
 Reach: The content gets to or is available to the largest possible number of
people in the target population.
 Reliability: The source of the content is credible, and the content itself is kept up
to date.
 Repetition: The delivery of/access to the content is continued or repeated over
time, both to reinforce the impact with a given audience and to reach new
generations.

36
PART 5 - Levels of Health Communication

The more levels a communication programme can influence, the greater the likelihood
of creating and sustaining the desired change. This section outlines the different levels
at which public health communication can take place.

 INDIVIDUALS

The individual is the most fundamental target for health-related change, since it is
individual behaviours that affect health status. Communication can affect an individual’s
awareness, knowledge, attitudes, self-efficacy, and skills for behaviour change. For
example, counselling on sexual risk reduction or relationship between oral health and
life expectancy are effective way to change behaviour and protect health.

 SOCIAL NETWORKS

An individual’s relationships and the groups (including family), to which they belong can
have a significant impact on his or her health. Public health communication
programmes can work to shape the information a group receives and may attempt to
change communication patterns within the group. Opinion leaders within a network are
often a point of entry for public health programmes such as dental counselling, or peer
education. Targeting public health communication at social networks may result in a
diffusion of innovations and network-based health strategies. It can also provide
opportunities for voluntary counselling and health tests for all network members.

****Mention 3 specific social networks within your reach that could be

useful targets of public health education programmes.

 ORGANISATIONS

Organisations include formal groups with a defined structure such as associations,

clubs, worksites or schools. Organisations can disseminate public health messages to
their members, provide support for individuals and make policy changes that enable
individual change. Examples include institution-based health programmes providing

37
services such as voluntary counselling and health testing, or children and adults oral
health services. These are often available within workplaces, schools and other
institutional settings.

****Mention 6 specific organisations within your reach that

could be useful targets of public health education
programmes.

 COMMUNITIES

The collective wellbeing of communities can be fostered by creating

structures and policies that support healthy lifestyles and reduce or
eliminate hazards in social and physical environments. This is often achieved
by communicating relevant health education messages first to stakeholders
within the communities and then to the general populace.

Community-level initiatives are planned and led by organisations and

institutions that can influence health such as schools, worksites, healthcare
settings, community groups and government agencies.

****Mention 5 specific communities that could be useful

targets of public health education programmes.

 SOCIETIES

Society as a whole has many influences on individual and community behaviour,

including norms and values, attitudes and opinions, and laws and policies. Society also
creates a physical, economic and cultural environment within which public health
education messages can be appropriately encoded and sent.

Communicating at the society level can include using the mass media and other types
of social mobilisation. For example, educational programmes on oral hygiene in relation
to dietary patterns can be achieved through school, church and workplace education
programmes.

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****Mention 3 specific health education messages in your area of
specialisation that can be best communicated at the society level.
Mention such societies.

PART 6 - Barriers to Effective Public Health Communication

The following are possible barriers to the completion of the communication process in
public health education.

 Low health literacy – This happens when the audience is totally incapable of
decoding the message as a result of lack of basic knowledge in the subject area.
Also, this barrier is further strengthened when the communicator works on the
basis of assumption in regards to recipients’ level of health literacy.
 Poor Research – Research is a useful tool for getting rid of assumptions. A
public health education programme should be preceded by authentic research
through which the needs and current condition of the recipient is determined.
Research itself is sometimes preceded by environmental scan. An environmental
scan is an assessment tool structured to understand context; collect information
and identify resources, links, and gaps on public health practices. This process
can be used to identify quality improvement opportunities and research priorities,
guide interventions, educate decision makers, and improve health outcomes.
When health education messages are reeled out without adequate background
information, it becomes a barrier in the communication process.
 Unqualified/Undesirable Sender/ Medium – When the medium of sending the
message is seen as unqualified or undesirable, it becomes a barrier in the
communication process. For instance, a young adolescent female serving as a
medium of communicating healthy sexual behaviour to a group of married males
is likely to be seen as unqualified and undesirable. The same can apply to other
media of passing public health related information across.
 Cultural and/or Religious Factors – Some cultural norms and religious tenets are
averse to some health-related messages that may be passed across in a public

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 health education programme. Receivers of such messages already have pre-
existing notions on the subject that often difficult to get past.

****Think up 3 other barriers to effective public health

communication. How would you handle such barriers as a
professional health worker?

INFORMATION, EDUCATION AND COMMUNICATION (IEC)

Health promotion and health education activities rely on a variety of well designed and
effective IEC materials to help ensure success. From experience, certain fundamentals
pertaining to the development of IEC materials are obvious. Every brochure, poster,
videotape or other piece of IEC material is the product of a decision, supported by
research, to deal with a specific health concern, and to be well received and persuasive
among a specific audience. The success and impact of IEC materials depends largely
on the understanding of the target audience by the IEC material design team.

Working with target audience members throughout the development of IEC materials,
and in developing usage strategies for those materials, helps ensure that IEC materials
meet the needs of the intended target audience. This involves a clear, six–step
approach, with each step supporting the next, which IEC material design teams should
endevor to follow. This approach includes:

1. Selecting the most appropriate IEC material · Types of IEC materials · Strengths and
limitations of different IEC materials · Selecting IEC materials should be based on
knowledge of the target audience · Criteria for selecting IEC materials · Mixing IEC
materials for more impact

2. Developing a creative brief · The importance of a creative brief · Elements of a

creative brief

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3. Preparing draft / prototype IEC materials — (or adapting existing materials) ·
Guidelines for developing new IEC materials, or selecting / adapting existing IEC
materials · Qualities of effective IEC materials

Mass Media Strengths and Weaknesses

· Reaches many people

· Creates a demand for health services by the target audience

· Reinforces important messages delivered through interpersonal communication by

health workers

· Provides status to the health service program

· Uses influential opinion leaders to influence target population

· May have limited rural distribution

· For television and radio requires access to electricity

· Requires substantial financial support

· Difficult to coordinate with service delivery

· Difficult to tailor messages to specific audiences

Effective IEC materials should attempt to:

1. Create a distinct look and personality — Effective IEC materials are vivid, having an
appealing personality that helps them stand out from other materials. They should
stimulate the target audience with a distinctive look and sound, making them stand out
from the "clutter" of competing materials and messages. Messages and design all must
speak with the same voice — in design, color, text and narrative.

2. Stress the most compelling benefit. Effective IEC materials should address real
needs and problems facing the target audience. The information they provide should be

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specific and single–minded. The main message and benefit to the target population
should be clear.

3. Generate trust. IEC materials that are simple, direct, and technically correct generate
trust in what they say. Credibility should never be replaced by creativity.; a
straightforward design is a better basis for trust than extravagant or fancy IEC
materials. Trust is generated by tone, presentation, believable images, and a solid
information foundation.

4. Appeal to both the heart and the head. A decision on the part of the target audience
to try something new is not made entirely in the mind — trials are often decided in part
by an emotional response. Thus, effective IEC materials and messages should be
designed to appeal to both the heart or emotions, and the head or reason.

Five variables should be measured during the pretest of draft IEC materials:
Comprehension, Attractiveness, Acceptance, Involvement, and Inducement to Action.

1. Comprehension. Understanding IEC materials and messages is essential as a prior

condition to acceptance and behavior change. Comprehension measures not only the
clarity of the content, but also the way in which it is presented. Complicated or technical
vocabulary may be responsible for the target audience's failure to understand the
message. Or, perhaps the target audience fails to understand the message because
the typeface is too small, making it difficult for the target audience to read the message.

2. Attractiveness. IEC materials should be attractive. If an IEC material is not attractive

individuals may not pay much attention to it. Attractiveness can be achieved through the
use of sounds — music, tone — in the case of radio; visuals — color and illustrations —
in the case of graphics; movement, action, illumination, and animation in the case of
video.

3. Acceptance. The messages must be acceptable to the target population. If

communication material contains something offensive, is not believable, or generates
discord among the target audience, the audience will reject the message conveyed.

4. Involvement. The target audience should be able to identify with the IEC materials.
They should recognize that the message is directed toward them. People will not pay

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 attention to messages that they consider do not involve them. Illustrations, symbols and
language should reflect the characteristics of the target audience.

5. Inducement to action. The materials should indicate clearly what the health
promotion intervention wants the target audience to do. Most IEC materials promote a
message that asks, motivates, or induces members of the target audience to carry out
or cease a particular action. Successful IEC materials transmit a message that can be
done by the target audience.

ASSESSMENT SHEET 2
NAME
REG. NUM
DEPT.

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