|Education for Health (WHO, 1988, 274 p.)|
|Chapter 3: Planning for health education in primary health care|
It is not enough to decide what will be done, by whom and when, we also need to decide how it will be done.
In Chapter I some of the reasons for people's behavior were discussed. Once a health worker understands the reasons behind behavior that is causing a health problem, he or she can use many different methods to encourage a change in that behavior. There are some important points to take into consideration when we choose a method. First of all, the method must suit the situation and the problem; it must therefore be selected carefully.
There are many methods, because these are many ways of solving a problem. Before choosing a method, the person practicing health education must understand the problem at hand. A doctor, for example, has many methods to choose from in solving medical problems. If a patient is found to have a stomach ulcer, the doctor will try to understand the problem and choose the best method to use in dealing with it. If the ulcer is not too serious, diet may be the chosen method. By controlling what, when, and how much a person eats, the problem might be overcome. If the ulcer is slightly more serious, drugs may be used. In an even more serious case the doctor may choose to do an operation. It is likely that two or more methods will be used together.
People practicing health education must make decisions about which methods should be used to help solve problems related to health behavior. There are six things to consider before choosing health education methods:
- How ready and able are people to change?
- How many people are involved?
- Is the method appropriate to the local culture?
- What resources are available?
- What mixture of methods is needed?
- What methods fit the characteristics rage, sex, religion, etc.) of the target group?
How ready and able are people to change?
Remember the story in Chapter I about three women who were asked to buy shoes for their children. The midwife gave a talk in which she provided information, ideas, and suggestions. After the talk, not all the mothers decided to buy shoes.
One mother was ready to change. She had no major problems in her way. She accepted the ideas in the talk and carried out the midwife's suggestion. When people are ready to change, posters, radio, songs, plays, stories, displays, and photographs are some of the educational methods that can be used.
A second mother was interested in changing; she liked what the midwife had to say but she did not know if the family could spare the money for buying shoes. Also she was not sure if the grandmother would approve. The talk certainly gave this woman useful ideas about helping her children, but did not help her organize her family finances.
Approaches that might have helped this woman would have been discussion with family members about how much money they earned, how much they spent, and what they spent it on. Then, through demonstration or teaching, it might have been possible to show the family how to manage their money better so that shoes could be bought for the child. Linking the father with the local farmers' cooperative or with the agricultural extension agent might have helped him find ways of earning more money. Then if money was no longer a major problem, discussion with the grandmother about her love for her grandchild could have been used to win her support.
The third mother was hard to reach. She was so worried about her problems that it was difficult for her to take an interest in what the midwife said. She also lacked money and resources. To reach this woman, the midwife needed to use methods that allowed personal contact: counselling and home visits were needed. These would have shown the woman that the midwife was concerned, and would have helped the midwife to learn more about the woman's problems. The more she was able to learn, the more she would have been able to help.
This woman might have benefited from belonging to a group or club in which people with similar problems can support and encourage each other. Links with other community agencies could have provided the resources needed to help her care for her child. She could also have been helped by training in skills that would enable her to earn more money to provide for her child.
How many people are involved?
Some methods of health education are designed for reaching a large number of people (for example a group, a neighborhood or a town) with a message or idea. These methods involve the use of such means as posters, lectures, displays, plays, role-plays, puppet shows, newspapers, radio, films, and town criers.
Providing good ideas quickly to a large number of people is a very useful step in health education. It creates awareness of a problem or idea. If the message is a good one, it will help prepare people to participate in desired action. However, other methods are usually needed to follow up the initial impression made through the mass media. Sending out health messages alone is usually not enough to change health behavior in a large number of people.
In order to make large-group methods more useful in health education, there needs to be an exchange of views and ideas between the health or community workers who use the methods, and the people who see and hear the health messages. This exchange of views and ideas is called 'interaction'.
You will probably not be working alone. Share the responsibility of interacting with the community with other health workers, particularly with community health workers and staff from other community agencies.
Here are some suggestions for developing such interaction:
- After a film or talk, divide the audience into smaller groups for discussion.
- When putting up posters around the community, make home visits and discuss the ideas on the posters with families.
- After a play, ask the actors to go into the audience to talk with people.
- Organize small groups, in various parts of the community, for radio listening combined with discussion.
- Work with an existing community council or, if one does not exist, organize a community health committee.
Activities such as practicing new skills, discussing personal feelings, values and money matters, and sharing difficult experiences are best done person-to-person or in small groups (ideally in, groups of no more than ten people).
Methods suitable for use with groups include story-telling, demonstrations, role-playing, case studies, discussions, educational games, and others that will be discussed in Chapter 5.
Teaching aids such as projectors and flip-charts may be used with groups of up to 25 people, although again it should be remembered that, when there are too many people, there will be less interaction and personal contact between the health worker and the members of the group.
Role-playing can help individuals and small groups of people understand their problems and work out solutions to them. Some members of the group act out a situation, while others watch and make comments and suggestions.
Note that posters, radio, and other media designed to reach large groups can also be used with a small number of people.
Is the method appropriate to the local culture?
In Chapter I we described culture as the way of life of people in a community. Culture will determine the educational methods that will be acceptable and understandable to people. It will also determine the methods to which people will respond by changing to healthier behavior.
For example, the role-playing method requires people to speak out freely in front of others. In one culture people may like to act and speak out. In another they may prefer to be quiet and careful about what they do or say. Role-playing would work well in the first culture. It may work in the second, but only after people in the group know and trust each other.
To take another example, photographs have different meanings in different cultures. If you are working in a community where most people are illiterate, they may not be used to seeing photos as a source of news or information, because they have little experience of books and newspapers. If you are doing a programme on breast-feeding in such a community, and show the women a picture of a mother breast-feeding her baby, their first thought may be that the photo is of your mother or sister. They would not realize that the photo is there to help them learn. Similar problems may arise in using films. We must make sure that people understand why they are being shown photographs or a film.
Role-playing and the use of photographs and films are examples of methods that will not work unless they are adapted to the culture of the community. Ways of adapting methods to culture are mentioned in Chapter 7. But we do not need to worry about adapting methods if we use some of the means by which the people themselves communicate ideas and share knowledge and skills. These include proverbs, town criers, plays, and so on. Such forms of natural communication should be part of any educational programme.
Practical demonstrations are good ways of teaching skills. In a good demonstration people will be given the chance to practice new skills.
Instead of just talking about hygiene, this health worker is showing mothers how to bath their children.
What resources are needed?
Consider the resources necessary. Some methods require only yourself and the people around you: these include the use of stories and songs, role-playing, group discussions, and community meetings.
Other methods require the use of materials or teaching aids such as posters, flannelgraphs, demonstrations, models, puppet shows, newspapers, and flip-charts.
Then there are methods that use machines: tape recorders, film or slide projectors, etc. Machines usually need electricity. Machines and materials cost money. Try to look for methods that are inexpensive and at the same time effective.
Even if you are able to borrow films, projectors, and an electricity-generating plant, the films may come from a country whose culture your people will not understand. They may not even be in the language of your people. If that should be the case, a wiser decision would be to put on a play. A play simply needs people and a few materials. The local language can be used, and members of the community have a chance to participate. Expensive machines are not required.
Think of other ways in which you can use local resources to make or provide aids to education.
What mixture of methods is needed?
Select a mixture of methods. Variety and repetition are both important. By using a variety of methods you will make your programme more interesting. If you repeat the ideas in different ways, people are more likely to remember them.
If, for example, you are telling a story you may want to show some pictures or posters that relate to the story. Then after the story, you may ask some of the listeners to do a role-play in which they act out the story for all to see.
A health talk should be more than just talk. Of course, you will do some lecturing, but you should also show posters. There should be group discussion. Demonstrations and practice will also help people learn more from the talk.
A community meeting can be made more lively if a short play is also presented. This will help make issues more clear to people, display could be added too. People coming to the meeting could look at the display and learn something about the subject before the meeting starts.
Which methods fit the group best?
You will meet different people and groups. Some will be old, some young. Some will be made up of women, some only of men and some will be mixed. Select and adapt your methods to fit the' type of people you meet.
Fables using animals might be better for children than for adults. Lectures may be better for educated people, than for those who have never been to school. If the people belong to one religion, select proverbs from the scriptures and books of that religion.