|Education for Health (WHO, 1988, 274 p.)|
|Chapter 4: Health education with individuals|
Counselling with families
People may need the help of their families to solve a problem. Counselling skills are useful whether the counsellor is working with one person or with a whole family.
Sometimes it is necessary to involve the whole family in solving a health problem. Remember that each member of the family has different responsibilities in the home and therefore can help, in different ways, to find solutions.
When working with a family, we are dealing with more than one person, therefore there may be more than one problem, more than one need, and probably more than one solution. Also, be aware that in families different people have different responsibilities and powers. The father, for example, may have the major say on how money is spent by the family. The mother may make most of the decisions about the types of food eaten. Grandparents influence the degree to which families follow traditional customs. Find and talk to the right person for each problem. Also, show respect to the recognized head of the household.
Counselling with children
In a clinic, a school, or the community, you will find children with health, emotional, or other problems. Counselling can be provided for them if they are old enough to talk.
It is better to talk to the child alone. Background information can be obtained from the parents first, then they can be politely asked to wait outside. Sometimes parents want to answer all the questions; they do not give the child a chance to speak. The child may also be afraid of saying certain things in front of parents. The counsellor should explain to the parents that the child may speak more freely without others around.
This health worker is holding a child. This inspires confidence and trust. Now the child is willing to talk to the health worker about his problems.
Begin by talking about happy things. Ask the child about his or her favourite games, for example. Once the child is relaxed, begin talking about the problem. Let the child know that everything said will be kept secret. In this way the child will trust you and speak freely. Always keep your promise of secrecy. If parents, teachers, or others find out what has been said, the child will be afraid, and never let the counsellor help again.
Follow the counselling rules with a child as you would with an adult. The child will be able to learn much about health from a good counsellor.
Counselling can be done in the clinic or at school, but home visits are also helpful. Health workers should visit all homes in their communities regularly. If a village is small, with 10-25 houses, visits can be made at least once a fortnight. In larger villages or neighborhoods, visits can be made monthly. Here are some reasons for home visits:
- Keeping a good relationship with people and families.
- Encouraging the prevention of common diseases.
- Detecting and improving troublesome situations early, before they become big problems.
- Checking on the progress of a sick person, or on progress towards solving other problems.
- Educating the family on how to help a sick person.
- Informing people about important community events in which their participation is needed.
Much can be learned from home visits. We can see how the environment and the family situation might affect a person's behavior. Does the family have resources such as a well? Which relatives stay in the house? Do they help or hinder the person's progress?
When people are in their own homes, they usually feel happier and more secure. You may find that people are more willing to talk in their own homes than when they are at the clinic. At the clinic they may fear that other people will see them or overhear the discussion. They may tell more at home, because they feel safer there.
Children are often afraid when they are sick. Before a health worker can treat and counsel a child, he or she must gain the child's trust and make the child feel comfortable.
Nutrition demonstrations, for example, may be more useful if done in a person's home. There the health worker will be able to use the exact materials and facilities that the person must use. This will make the demonstration more realistic and make learning easier. In Chapter 5 we will examine the organization of such demonstrations.
If you approach people with understanding, they will welcome you into their homes. There you will find many opportunities for health education.
When was the last time you made a home visit? What was the reason? Did the people welcome you? If people seemed afraid, what can you do next time to improve the relationship?
Did you use counselling in that home? How did the people respond? How can you make a better home visit next time?
During a home visit, a health worker can check on the progress of a sick person, meet other family members who can help care for the patient, observe new problems, and encourage preventive action.
Educational methods used in counselling
There are various educational methods that can be used to help individuals and families solve their problems. Some help people understand the cause of their problem. Some help them see possible solutions, while other methods help them reach decisions for action.
We have seen in Chapters I and 3 how important it is for us to place ourselves in the position of other people and understand why they behave as they do. But the people themselves also need to see why there is a problem. Our role therefore is first to understand the problem, and then to help the people understand it themselves. Next we need to work together with them to find solutions that are appropriate to their situations.
Sometimes people may be reluctant to take the action necessary to solve their problems. They may not feel that it is worth the time and effort. Encourage them to examine their values in order to take some decision about the importance they place on their health and welfare.
Another way to help people decide to act is the use of self-reward. People should decide on a reward that they will give themselves if they follow through with the necessary action.
It is important to help people choose solutions that will fit in with their ways of doing things, and with their beliefs. Try to help them avoid solutions that are uncomfortable. Find workable alternatives.
It may also be helpful to link a person with someone who has successfully coped with a similar problem as in the following example.
Mrs Angelino has recently learned that she has diabetes. She is worried about how she will manage the changes in her diet and activities and how she will test her urine and take her drugs. The health worker decided it would be helpful to introduce Mrs Angelino to Mrs Pedro who has been on diabetes treatment for five years. Mrs Pedro can provide support and encouragement based on her own personal experience.
Always remember that counselling calls essentially for a personal approach and for skills in listening, in providing information, and in helping people themselves determine what is best for them.
Demonstrating and displaying real objects are educational methods that can be used to counsel an individual.