An understanding of local knowledge, beliefs and practices
associated with diarrhea is critical to any work done as a part of CDD. During
this session, participants reflect on their own perceptions of diarrhea-what
causes it and how to treat it. Then, using a questionnaire, they go out into the
local community to gather information about local perception and treatment of
diarrhea. When they return, participants analyze the data to identify practices
which are helpful and harmful, and discuss how they might begin CDD and ORT
projects that build on the traditional health care beliefs and practices in the
• To gather information on local knowledge,
beliefs, and practices associated with the causes and treatment of
(Steps 2- 4)
• To identify helpful and harmful local beliefs and
practices that affect diarrhea and have highest priority for change or
• To compare the local traditional approach to diarrhea
treatment with the Western medical approach.
Community, Culture and Care, pp. 173-242
Health Workers Learn, Chapters 7 and 14
- 13A Sample Diarrhea Questionnaire
- 13B Methods
for Gathering information
- 13C Identifying Helpful and Harmful
- 13D Role of Traditional Healing in Diarrheal Diseases
Newsprint, markers and any herbs or other items associated with
the treatment of diarrhea you may want to show the group (optional).
Before the session, try to find out as much as you can about local
beliefs and practices for the treatment of diarrhea. Also collect any herbal
remedies and evidence of other cures to show participants. Use this information
during Step 4 to help participants validate what they learned from their
interviews with local community members and provide additional content to the
Nave someone translate Handout 13A (Sample Diarrhea Questionnaire)
in the language used in the local area. Make any necessary arrangements for the
community visit for interviews and observations. Some possible kinds of
arrangements include' permission from local officials and families, as well as
It is assumed that participants have already had training and
experience in how to gather information. For preservice training or other
situations where participants lack these skills use Sessions 10-13 in the
Technical Health Training Manual to provide the background
Step 1 (20 min)
Cross-Cultural Perspective On Diarrhea
Open the session by explaining that they will be gathering
information about local knowledge, beliefs and practices related to diarrhea. To
do this effectively it is helpful to begin by looking at their own beliefs and
practices as well as their assumptions about local beliefs and practices.
Ask participants to recall the last time they had diarrhea. Write
the following questions on newsprint and ask them to write their answers on a
sheet of paper.
- How did you explain the cause of that
- What did you do treat the diarrhea?
- From whom did you seek
advice or care?
- What did you do to prevent future episodes of
Ask a few participants to share their answers with the group.
Now ask participants to:
- Assume the identity of a local woman,
- Think in
terms of her cultural, religious and social background,
- Consider how she
would feel and react to having a baby with recurrent diarrhea,
- Answer the
same questions as above but from her perspective.
Have the participants write these answers beneath their initial
answers. Encourage the group to use their imagination and guess if they don't
know the answers.
Ask a few participants to share their answers with the group and
briefly discuss how different or similar the perspectives appear to be both
between cultures and among individuals. Discuss how those differences could
affect CDD projects in their communities.
Step 2 (20 min)
Introducing and Adapting the Diarrhea Questionnaire
Explain to participants that during the next 90 minutes they will
visit members of the local community and gather information related to the local
knowledge, beliefs and practices about the causes and treatment of diarrhea.
Distribute Handout 13A (Sample Diarrhea questionnaire, and ask participants to
look it over.
Ask the group to discuss and delete, odd to, or modify the
questions in the sample questionnaire so that they reflect the local situation.
When the questionnaire la ready, ask participants to pair off.
Have each pair interview and address their questions to at least two different
people or families in the community and, if possible, borrow or collect any
stems associated with diarrhea treatment they may encounter during the visit
(items such ass utensils, containers, herbs or medicines used in treatment or
ORS solution substitutes found in the home).
Before participants leave, ask them to briefly review Handout 13B
(Methods for Gathering information and ask any questions they have about how to
gather the information
You may want to spend some time reviewing the vocabulary needed
for collecting information about diarrhea.
You may want to have participants use pictures such as those in
Trainer Attachment 3B (A Story About Diarrhea from Session 3) along with their
questions to make the interview more concrete and more interesting.
If a visit to the local community is impossible, an alternative is
to invite in 3-5 community members to act as cultural resources. Divide
participants into small groups and assign a community member to each one. Have
each group do some parts or all of the diarrhea questionnaire and collect as
much information as possible about local beliefs and practices.
You may want to add questions about nutrition and sanitation
depending on the interests of the group.
For preservice training it may be necessary to enlist the help of
first or second year volunteers to accompany participants during the visits and
help out with the interviews (but not to conduct the interviews for the
For inservice training, it is effective to have Volunteers pair
off with their counterpart for this activity.
Step 3 (90 min)
Information Gather log in the Community
Have the participants conduct the interviews in the community. If
appropriate, suggest specific places to visit and/or people to talk with to find
If this session is done at the end of the day, you might consider
giving participants the evening to do their interviews and information
gathering. Then, the next morning, you can reconvene and complete the remaining
steps in the session.
Because visits to homes in the community are likely to stimulate
interest and questions about ORT, you may want to ask participants to be
prepared to tell a picture story about ORT at the end of the
Step 4 (20 min.)
Processing the Community Visit
When the participants return from their visit, reconvene the group
and ask two or three pairs to report on what they learned from asking questions
and any other general information on cultural beliefs and practices, Ask the
others to add to what these pairs report.
Ask participants to compare and discuss the differences between
their own approach to the treatment of diarrhea from Step 1, the traditional,
country-specific perceptions also from Step 1, and the points of view
encountered during the interviews
Step 5 (30 min.)
Identifying Harmful and Helpful Practices
Divide participants into four or five small groups, Distribute
Handout 13C (Identifying Helpful and Harmful Practices) and give the following
instructions to explain how to fill in the sheet:
- Identify practices that affect diarrhea.
- Indicate whether they are harmful, or helpful and who in the
community does these things,
- Examine the harmful practices and identify those which you feel
you cannot change. Briefly explain why you cannot change them.
- Rank the remaining harmful Practices in terms of priority for
change. Take into account, severity of effect on health and ease of changing the
behavior. Explain your ranking.
- For the Practices with the highest priority far change, describe
ways you might motivate people to adopt healthier practices building on existing
beliefs, practices and values in the community.
- Examine the helpful practices and list ways to encourage people
to continue them.
- Describe the people or groups with whom you could first work to
motivate people to change harmful practices and continue helpful
Ask the groups to answer each of the questions as thoroughly as
they can using the information collected from the questionnaire and interviews.
Where appropriate, provide any additional information you may have on local
beliefs and practices related to diarrhea to help the group complete the task.
Step 6 (30 min.)
Reporting on Small Group Analysis
Ask one group to report their answers. Have the other groups add
When the questions are answered, have the Trainees). focus on
their conclusions about which behaviors are considered to be important to change
first. Have them comment on why they arrived at these conclusions, how their
perceptions may differ from their communities, and how they would attempt to
resolve such differences.
This discussion should address the fact that different people in
the community have different knowledge, practices and degrees of influence over
others. Because it is necessary to recognize these differences in their later
work on planning health education projects and deciding with whom to work, it is
important to emphasize these differences here. This point will be discussed more
in Session 14 (Working with the Community).
Also make certain that participants recognize the difference
between knowledge and actual practice. People in their communities
and they themselves may know what to do, but may not always do it.
Note that people must take into account many things in deciding what actions to
take, For example lack of money or social pressures can lead to actions harmful
to children's health even though individuals or families "know
Step 7 (10 min)
Identifying Nays to Learn More About Local Beliefs and Practices
To close the session, ask participants to briefly discuss their
experience of interviewing people about their beliefs and practices - What was
easy about the interaction? What was hard? Have them discuss and list in their
notebooks other ways to gather and validate information about cultural beliefs
and practices in the treatment of diarrhea and how they can use that information
to make their health education for CDD, particularly ORT, more effective.
Finally, distribute Handout 13D (The Role of Traditional Healing in Diarrheal
Diseases Control) for supplementary reading.
You may want to recommend additional general reading in
Community Culture and Care (Traditional and Modern Health Systems) pp.
Handout 13D (The Role of Traditional Healing in Diarrheal Disease
Control) discusses a number of Brazilian cultural beliefs and practices related
to diarrhea. Because there are many similarities in traditions associated with
diarrhea cross-culturally, much of the information may be directly applicable to