Chapter 4

Health Communication

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 Objectives

At the end of this chapter, the students will be able to:

Define communication and health communication
Discuss about communication models
Explore methods of communication
Explain stages of communication
Identify barriers to effective communication and how to
overcome them

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 1. Communication and health communication
Definition of communication:
o Communication is the process of sharing of ideas, information,

knowledge, and experience among people to take action.

o Communication may take place between one person and another,

between an individual and a group or between two groups.

o Communication facilitates creation of awareness, acceptance and action

at individual, group and inter-group level. The process always involves a
sender and a receiver regardless of the number of people concerned.

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 Defin….
 Communication refers to the transmission or exchange of information
and implies the sharing of meaning among those who are communicating.

 So communication uses/helps to share information, give instruction, give

feed back and express feeling

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 Encoding – The process of converting the message/ subject
matter into communication symbols.

 Encoding process translates ideas, facts, feelings, opinions etc. into

symbols, signs, actions, pictures, audio-visuals etc.
 Decoding – The receiver translates the words and symbols used in
the message into idea and interprets it to obtain its meaning.

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Health communication
 Health communication is the application of communication to
communicate health message based on communication principles.

 Health communication is the art and technique of informing,

influencing, and motivating individuals, institutions, and large
public audiences about important health issues based on sound
scientific and ethical consideration.

 That means health communication can take place at a number of

different levels : The individual , Social networks (family) , The
organization , Communities and Society level

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2. Models of communication
What are models?
 Models are a proven framework to guide practice
 Model is a systematic representation of an object or event in idealized and abstract
form.
 There are different models of communication ,these are
 Aristotle model of communication
 Hypodermic Needle Or Bullet model
 Laswell model of communication
 Shannon and Weaver model of communication

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Aristotle model of communication

 One of the earliest recorded models is attributed to the ancient Greek philosopher
Aristotle.
 Aristotle represented communication as might an orator who speaks to large
audiences. e.g. public meeting
 His model incorporates few elements.
I. Speaker
II. Message
III. Listener

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Aristotle model of communication…

Figure : Aristotle’s Model of Communication

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 Aristotle model of communication…

 The factors which played a role in determining persuasive effects

were the contents of the speech, its arrangement and the manner
in which the speech was delivered.
 Persuasion is effected through the audience when they are
brought by speech in to a state of emotion.

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 Hypodermic Needle Or Bullet model
 The Hypodermic Needle Model postulated that the mass Media had
direct, immediate and powerful effects on a mass audience. The media
were pictured as sending Forth messages to atomize Masses without any
intervention.
 that means that the messages of the media are accepted by the people
without any hindrance just as the drug in the injection needle mixes with
the blood stream after an injection
 This model had been primarily on intuitive theorizing and that it would
not be suitable to study the mass media effects

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Hypodermic Needle Or Bullet model…

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 Laswell model of communication

 Harold Laswell 1948, posed the question, “Who says what in which
channel with what effect?” .
 This model includes considerations of a variety of factors being considered to
determine the impact of a communication.
 To illustrate the significance of each element of the model, try visualizing
what effect some dynamic speaker would have if the medium were print, or
what would happen if the audience didn’t speak the same language.

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Laswell model of communication…

Figure : Laswell’s (1948) Model of Communication

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3. Shannon and Weaver model of communication
 The model introduces three elements: a transmitter, a receiver, and
sources of noise.
Their example is telecommunications:
In telecommunication:
 the transmitter and receiver : would be the hardware used by the
sender and receiver during the act of communication
 Noise may come from static sources (like solar flares), unusual weather
conditions, or electron equipment that interferes with the signal.

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The Shannon and Weaver Communication Model
Modified S&W Model of Human Communication
Noise in the Modified Shannon and Weaver Model
 Physical:
 Occurrences in the physical surroundings or in the media that can distort a message
 Physiological:
 Physical discomfort in the body of either the sender or the receiver
 Psychological:
 Negative feelings in the mind of either the sender or the receiver
 Perceptual
 - Incorrect perceptions of the message and the receiver by the sender, and vice-versa

 Semantic
 Misinterpretation of words and sentences by the sender or receiver

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Shannon and Weaver…

 Assumptions of Shannon-Weaver
 Communication breakdown is caused by ‘noise’
 The model is developed to separate noise from information-carrying signals
 For example, in any face-to-face situation, there may be environmental or
other sources of noise that interfere with the communication.

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Schramm’s Models of communication

 One contribution Schramm made was to consider the fields of experience

of the sender and receiver.
 The sender encodes the message, based upon the sender’s field of
experience. The user’s field of experience guides decoding.
 If there is no commonality in the sender’s and receiver’s field of
experience, then communication does not take place.

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 Cont….
 The extent to which the signal is correctly decoded depends on the
extent of the overlap of the two fields of experience.
 For instance, a lecture on neurophysiology delivered to an
audience of sixth graders may result in little or no communication.
 Because, no overlap in the field of experience of the lecturer and
the receivers (students)

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 Schramm’s …
 The extent to which the signal is correctly decoded depends on the
extent of the overlap of the two fields of experience.
 For instance, a lecture on neurophysiology delivered to an audience of
sixth graders may result in little or no communication.
 Because, no overlap in the field of experience of the lecturer and the
receivers (students)

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 Schramm’s …

The colored overlapping ovals represent the fields of experience of

the sender and receiver.

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 Schramm’s …

 Schramm’s models introduced the idea of feedback from the receiver to the
sender.
 Communication becomes a continuous process of messages and feedback. It
allows for interaction.

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Schramm’s …

Figure : Another Model from Schramm

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 Berlo’s Model of communication
 Berlo (1960) took a different approach to constructing a communication model.
 Rather than attempting to identify elements of interest, and relationships
between those elements, he created what he called “a model of the
ingredients of communication”.

 This model identifies four elements of communication: Source, Message,

Channel, and Receiver.

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Figure: Berlo’s communication Model

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Communication model generally:

A) Linear (one –way) model

 The flow of information from the sender (source) to the receiver is one-way or
unidirectional.

 The communication is dominated by the “sender’s knowledge”. “Information is

poured out”.

 This model does not consider feedback and interaction with the sender.

 A familiar example is the lecture method in class rooms.

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 Communication model…
Advantages Disadvantages

-Faster - Little audience participation

-Orderly - Learning is authoritative
-No feed back
-Does not influence behavior

S M R
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 Communication model…
B) Systems (Two –way) model
 Information flows from the source to the receiver & back from receiver
to the source.
 This is reciprocal in which the communicant (audience) becomes the
communicator (sender) & the communicator (sender) in turn becomes
a communicant (audience).
 Roles are interchanged.
 It is more appropriate in problem solving situations.

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 Communication model…

Advantages Disadvantages
-More audience - Slower (time taking)
participation - Not orderly
-Learning is more democratic
- Open for feed back
- Influence behavior change
M
S F
R
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Component and process communication
Msg = message

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2. Forms/methods of communication

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When to use oral communication?
 Use Oral Communication when;
1. The receiver is not particularly interested in receiving the message.
2. It is important to get feedback.
3. The receiver is too busy or preoccupied to read.
4. The sender wants to persuade or convince.
5. When discussion is needed.
7. When criticism of the receiver is involved.
8. When the receiver prefers one-to-one contact
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Non-verbal communication…
 Non-verbal communication refer to using a non spoken symbol to
communicate a specific message
Nonverbal messages can;
 support verbal messages (clarify)
 contradict verbal messages (mixed messages)
 replace verbal messages (secrets)
 It is easy to lie with word much more difficult with non-verbal
communication

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3. Written communication
 It involves the exchange of facts, ideas, and opinions through a written
instrument /materials.
 Successful written communication requires careful thought and clear
planning.
 A plain writing style should be used for easy understand and reduces the
chances of misunderstanding and ambiguity.

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Cont…..
 A useful tool in improving your writing skills is writing
 Start writing in simple, plain English, then move on from some thing
concrete to something abstract and expressive.
 In written communication, there are four common errors which
should be avoided, Judith (1993)

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Common errors in written
communication

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 Principles of written communication
1. use a plain language approach to communications
2. Know the purpose of your written communication
3. only include important and directly relevant information
use simple language
5. keep sentences and paragraphs short
6. make it personal
7. use the active voice
8. use easy-to-read design techniques
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Advantages of Written Disadvantages of Written
communication communication
1.Highly technical topics can 1. People seldom take the time and effort to
read technical materials.
be presented using words and 2. The preparation of written communication
diagrams. is time-consuming.
2. Written material provides a 3. Once prepared in large quantities, printed
permanent record that can be documents are difficult to change.
4. Written material provides little feedback
referred to from time to time for the sender.
or passed on to others. 5. Technical materials are often too long and
3. Written material can be complex for the majority of readers.
duplicated in large quantities 6. A portion of the population may not be
able to read written material.
4. It is fairly easy to distribute 7. Too much reliance on written material as a
written material to many communication method may obscure the true
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3. Component of Communication

 In order to say communication process is complete, the following

elements should exist:
source, encoding, audience, message, decoding, feed back

and effect.

Each component will be discussed below.

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A. Source (sender)

 person who thinks of all idea to be communicated,

decides why it should be communicated and also decides
on the intended impact.
 The sender is the originator of the messages.
 The source can be from an individual or groups, an
institution or organization.
 People most likely to accept a communication from a

person or organization that they trust i.e. has high source

credibility.

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 Source (sender)…

source credibility can come from:

A person’s natural position in the family, community, e.g. head,
village chief or elder;
Through their personal qualities or actions, e.g. a health worker
who always comes out to help people even at night;
Qualifications and training;
The extent to which the source shares characteristics such as age,
sex, education, religion, experiences with the receiver.

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 Cont….
A person from a similar back ground to the community is more likely to
share the same language, ideas and motivations and thus be a more
effective communicator.

One of the main reasons for communication failure is when the source
comes from a different background from the receiver and uses
inappropriate message content and appeals.

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B. Audience/Receiver

 The first step in planning any communication is to consider the intended audience.
 Audience is the person or the group for whom the communication is intended or
the person who receive the message through channels.
 Who is our audience? Do we have a primary and a secondary audience? What
information do they need to take action on our work? Understanding audiences is
fundamental.
 There may be several different “types,” each with their own likes, needs and
abilities.
 Therefore, the communicator always has to consider all aspects of the audience by
doing audience analysis.
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Audience analysis

 Audience analysis is “the process of examining information about the

listeners whom you expect to hear your speech.”
 Determining the important characteristics of an audience in order to choose
the best style, format and information for communication

Audience Segmentation
 The process of categorizing audiences into logical groups to enhance a
better fit among: Audiences, Messages, Media and Services or products
 the audience segmentation can be as the primary, secondary, and
influencing audiences.
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c. Message

 Message is a piece of information, ideas, facts, opinion, feeling,

attitude or a course of action that passed from the sender to the
receiver with the intention to change their understanding or health
related behavior .
 The content of the message could be organized in different ways so
that it can persuade or convince people. These are called appeals.

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 Types of appeals in health communication…
1. Fear arousal appeal
 The message is conveyed to frighten people into action by emphasizing the
serious outcome from not taking action.
 Symbols such as dying persons, coffins, grave stones, skulls may be used.

2. Humour
 The message is conveyed in a funny way such as cartoon.
 Humour is very good way of attracting interest & attention.
 It is good to create a lasting memory but hard to change beliefs and
attitudes.
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 Types of appeals…
3. Logical / Factual appeal
 The message is conveyed to convince people by giving facts, figures and information.
 For example facts related to HIV/AIDS; its causes, route of transmission, prevention methods, Telling
people the percentage of people living with HIV virus etc...
 It carries weight with a person of high educational level.

4. Emotional appeal
 The message is conveying to convince people by arousing emotions, images & feelings rather than
giving facts & figures,
 Example by showing smiling babies, wealthy families with latrine etc, and associating with FP
education.
 A Person with less education will often be more convinced by simple emotional appeals from people
they trust.
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 Types of appeals…
5. One sided message
 Only presents the advantages of taking action & does not mention any possible
disadvantages. E.g. educating the mothers only about benefits of oral contraceptive pill.
 One sided compared with two sided messages Presenting only one side of an
argument may be effective:
6. Two sided message
 Presents both the advantages & disadvantages (pros’ & cons’) of taking action. Appropriate
if:
 The audiences are exposed to different views.
 The audiences are literates.
 We are in face to face with individuals or groups: it is easy to present both sides and make
sure that the audience understands the issues.
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Types of appeals…

7. Positive appeals
 Communications that ask people to do something, e.g. breast feed your
child, use a latrine.
8. Negative appeals
 Communications that ask people not to do something, e.g. do not bottle feed
your child, do not defecate in the bush.
 Positive compared with negative appeals. Negative appeals use terms
such as “avoid” or “don’t” to discourage people from performing harmful
behaviors. But most health educators agree that it is better to be positive &
promote beneficial behavior.
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D. Channel

 A channel is the physical bridge or the media by which the message

travels from a source to a receiver.
 The channel used to communicate influences what information can be
conveyed and how.
 The commonest types of channel are face to face, audio, visual, printed
materials or combined audio visual & printed materials.
 Your choice of channel will depend on what you are trying to achieve,
the nature of your audience and what resources are at your disposal.

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 Types of Communication Channels
1. Interpersonal channels –
E.g. home visits, group discussions, and counselling
2. Broadcast example, Radio and television
3. Print channels - such as pamphlets, flyers, and posters- are generally considered
best for providing a timely reminder of key communication messages.

The impact to be achieved

 Reach Vs Frequency? What determines this decision?
 Reach- The number or proportion of the intended audience to receive the message.
 Frequency- The number of times the message reaches the intended audience.

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media mix

Proposed media mix

 Do we need to use a mix of media? Why? Which media to mix?
 Media Mix/ Multi media approach is the use of two or more channels for a single
communication program.
Advantages of Media Mix-
 Compensates for messages not received by another channel
 Addresses the media behaviour or media habits of different audience segments
 Potentiates frequency of messages
 Increases reach
 Promotes Trust/credibility of the message
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 E. Effect and feedback

Effect: is the change in the receiver’s knowledge, attitude & practice or behavior.
 Positive effect: when desired change in knowledge, attitude, practice occurs;

 Negative effect: when desired change in knowledge, attitude & practice does not
occurs.
Feedback: - is the mechanism of assessing what has happened on the receivers
after the communication has occurred by sender.
 A communication is said to have feedback when the receiver of the message gives
his/her responses to the sender of the message.
 It completes the process of communication. 05/14/2024
 Communication stages

In health education and health promotion we communicate for special

purpose:–To promote improvement/change in health through the
modification of the human, social and political factors that influence
behavior.
 To achieve these objectives, a successful communication must pass
through several stages.

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 Sender receiver

Reaches senses

Gains attention

Message understood

Acceptance /change

Behavior change

Change in health

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 Stage1. Reaching the intended audience

 Communication can not be effective unless it is Seen or heard by its

intended audience.

A common cause of failure in this stage is preaching the

converted, e.g. posters placed at the clinic or talks given at antenatal
clinics.
 These only reach to the people who are already motivated & attended
the service.

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Stage2. Attracting the audiences attention

 Any communication must attract attention so that people will make the effort to listen
and read it.

 Attention: is the process by which a person selects part of the message to focus on
while ignoring others for the time being.
Examples of failure at this stage are:
 Walking past the poster with out bothering to look at it;

 Not paying attention to the health talk or demonstration at the clinic;

 Turning off the radio programs or switching over.

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 Stage 3. Understanding the massage

 Once the person pays attention to a message he/she then tries to

understand it. Another name for this stage is perception.
 Perception is a highly subjective process.
For example, two people may hear the same radio program or see
the same poster and interpret the message quite differentially from
each other and from the meaning intended by the sender.
A person’s interpretation of a communication will depend on many
things.

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 Stage 3. Understanding the massage…

Examples of failures at this stage can take place when:

 Complex language & unfamiliar technical words are used;
 Pictures containing complicated diagrams and distracting details
 Pictures containing unfamiliar/strange subjects.
 Too much information is presented and people can not absorb it at all.

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 Stage 4: Promoting Change (acceptance)

A communication should not only be received and understood – it

should be believed & accepted.
 It is usually easier to promote a change when its effects can be easily
demonstrated.
For example:
ventilated improved pit latrines do not smell.
 if people become green in color when they get HIV/AIDS it is easier to promote
change.

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 Stage 5. Producing a Behavior Change

A communication may result in a change in beliefs and attitudes but

still not influence behavior/action.
 This can happen when the communication has not been aimed at the
belief that has most influence on the person’s behavior.
 e.g. A person may have favorable attitude & want to carry out the
action e.g. using FP but the people around may prevent from doing it
or no means (enabling factor) such as money, skill and availability of
the service to do as a result there will be no behavior change.

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 Stage 6. Improvement in Health

 Improvement in health will only take place if the behaviors have

been carefully selected so that they really influence health.

 Ifyour messages are based on outdated & incorrect ideas, people

could follow your advice but their health would not improve.

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 Barriers to effective communication
1. Physical
 Difficulties in hearing, seeing
 In appropriate physical facilities
2. Intellectual
 The natural ability, home background, schooling affects the perception/
understanding of the receiver for what he sees & hears.
 The ability of the facilitator/ education/ instructor.
3. Emotional
 Readiness, willingness or eagerness of the receiver
 Emotional status of the educator
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 Cont….
4. Environmental
 Noise, invisibility, congestion

Noise is a major distraction during communication.

a. Physical noise – avoidable

b. Internal noise - any physiological or psychological state that could undermine

a person’s ability to communicate effectively:
 Being ill
 Overworked
 Beset by personal problems.
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 Cont……

5. Cultural
 Customs he beliefs, religion, attitudes, economic and social class differences,
language/vocabulary variation.
6. Status of the source
 Status of the source either too high or too low as compared to the audience also
affects effectives
7. Inconsistencies between verbal & non- verbal communication

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 ! ! ! !
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