Cover Image
close this bookOral Rehydration Therapy and the Control of Diarrheal Diseases (Peace Corps, 1985, 566 p.)
close this folderModule Five: Working with the community
close this folderSession 13 - The impact of culture on diarrhea
View the document(introduction...)
View the documentHandout 13A: Sample diarrhea questionnaire
View the documentHandout 13B: Methods for gathering information
View the documentHandout 13C: Identifying helpful and harmful practices
View the documentHandout 13D: Role of traditional healing in diarrheal diseases control



4 hours


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 culture.


• To gather information on local knowledge, beliefs, and practices associated with the causes and treatment of diarrhea.
(Steps 2- 4)

• To identify helpful and harmful local beliefs and practices that affect diarrhea and have highest priority for change or encouragement.
(Step 4)

• To compare the local traditional approach to diarrhea treatment with the Western medical approach.
(Steps 1-4)


Community, Culture and Care, pp. 173-242
Helping Health Workers Learn, Chapters 7 and 14


- 13A Sample Diarrhea Questionnaire
- 13B Methods for Gathering information
- 13C Identifying Helpful and Harmful Practices
- 13D Role of Traditional Healing in Diarrheal Diseases Control


Newsprint, markers and any herbs or other items associated with the treatment of diarrhea you may want to show the group (optional).


Trainer Note

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 session.

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 transportation.

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 needed.

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 diarrhea?
- What did you do treat the diarrhea?
- From whom did you seek advice or care?
- What did you do to prevent future episodes of diarrhea?

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

Trainer Note

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 Trainees).

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 the information.

Trainer Note

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 interview.

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

Affecting Diarrhea

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 ones.

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 additional answers

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.

Trainer Note

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 better".

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.

Trainer Note

You may want to recommend additional general reading in Community Culture and Care (Traditional and Modern Health Systems) pp. 173-242.)

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 your local culture.