LECTURE NOTEBOOK

ON

BAHAVIOUR CHANGE COMMUNICATION

FOR

COMMUNITY HEALTH EXTENSION WORKERS

Compiled by

MUHAMMAD YAKUBU MUNKAILA

CERT. HED (2014), DIP. HED (2015), B.SC (Ed) HED (2019) AND M.Sc (Ed) HED (2023).

2023/24

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 INTRODUCTION
The alarming increasing rate of outbreak of communicable diseases and non-communicable
diseases and some other health challenges confronting the world today is caused by the actions
and inactions of the people. Therefore, for individuals and groups to have better health status,
they must be educated health-wise and empowered to use health information they have received
to exhibit positive health attitude and behavior. There must be change of attitude and before with
the help of a change agent (competent or capable health educator), so that they will help or
enable people to have or increase control over their health and, its determinants and thereby
improve their health.
BEHAVIOUE CHANGE COMMUNICATION
 Behavior change communication is a communication strategy which encourages
individuals/communities to change their behavior
 It is a strategy that triggers people/societies/communities to adopt healthy, beneficial and
positive behavioural practices.
 Is it an effective communication approach which helps to promote changes in knowledge,
attitudes, norms, beliefs and behavior.
 It is an interactive process with communities (as incorporated with a general program)
to create custom-fitted messages and methodologies utilizing an assortment of
correspondence channels to create positive practices, advance and support individual,
network and cultural conduct change and keep up suitable practices.
 Is a powerful and fundamental human interaction communication which positively
influences dimensions of health and well being.
 Is a direct approach towards changing behavior. It is different to traditional information
education and communication (IEC) material as IEC materials are not considered for
creating awareness and giving information as compared to behavior change
communication.
 Is described by its straight approach towards changing behavior.
CONCEPT OF COMMUNITY
1. This refer to a group of people living together within a specified geographical area some time
having different language and approved to life but often together for a common goal.
2. Community consist of people living together in some form of social organization and sharing
varying degree of political, economic, social, cultural, characteristics and expiration.
3. Community is a group of people living together within a defined geographical boundary.
A community starts from house hold unit, to hamlet to village to district, urban this occurs from
rural drift. This can said to happen when small group of people come together with other sub
group live within geographical area.
CLASSIFICATION OF COMMUNITY (TYPES)
Community is classified with the following: -

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1. RURAL COMMUNITY: - Is a collection of people or village where majority of the country’s
population live and work but lack social amenities.
2. URBAN COMMUNITY:- Is a collection of people or settlements where majority of the
countries skilled labour lives and work, it has enough social amenities.
3. CIVILIZED COMMUNITY:- A developed and literate community.
4. UN CIVILIZED COMMUNITY:- Under develop and illiterate community.
5. SMALL/MUSHROOM COMMUNITY: - Less populated with small area of land or
geographical area.
6. SCHOOL COMMUNITY: - Group of school public and staff.
7. UNIVERSITY COMMUNITY: - Group of university students lecturers and chancellors.
8. RELIGIOUS COMMUNITY: - This is group or congregation of believers and their religious
leaders.
CHARACTERISTICS OF COMMUNITY
A. HOMOGENOUS COMMUNITY: - This refer to a community or people that have the same
culture, practice, belief, views and religion living in the same geographical boundary eg. Village.
B. HETEROGENEOUS COMMUNITY: - This group refers to people or community that has
different culture, belief, views and religion living in the same geographical boundary eg. Urban
cities.
C. SUB – GROUP COMMUNITY: - Consist of different group of religion, tribal groups, ethnic
groups and occupational groups.
CONCEPT OF LEADERSHIP
It is difficult to define the term “leadership”. However, as a starting point, we may proceed with
the workable definition that a leader is one who leads others and is able to carry an individual or
a group towards the accomplishment of a common goal. He is able to carry them with him,
because he influences their behaviour. He is able to influence their behaviour, because he enjoys
some power over them. They are willing to be influenced, because they have certain needs to
satisfy in collaboration with him.
Leadership is, therefore, regarded as the process of influencing the activities of an individual or a
group in efforts towards goal achievement in a given situation.
QUALITIES OF A GOOD LEADER
1. Appreciative – A wise leader values their team and the person. Success is only achieved
with the help of others. What’s more, genuine appreciation provides encouragement,
develops confidence, and builds on strengths.
2. Confident – Trust and confidence in leadership is a reliable indicator of employee
satisfaction. Good leaders aren’t afraid of being challenged. Their confidence inspires.
3. Compassionate – Compassion is a strength. A good leader uses compassion to perceive
the needs of those they leads and to decide a course of action that is of greatest benefit to
the person and the team.

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 4. Courageous – A courageous leader is prepared to take risks when no one else will. A
courageous leader has faith in other people. A courageous leader raises difficult issues, is
ready to give difficult feedback, and share unpopular opinions.
5. Diligent – To persevere in conviction, courage, creativity, compassion, and character we
need diligence. Good leaders work hard.
6. Fair – Fairness is what people want. Good leaders don’t have favourites in the team.
They reward for results not partiality; they promise fairness.
7. Flexible – The good leader is able to flex. They alter and adapt their style according to
the situation, context and circumstances they experience. They welcome new ideas and
change.
8. Honest – Wise leaders are not afraid of communicating the truth to their people. Honesty
is about being truthful, having integrity, and building trust. Honesty leads to better more
productive relationships.
9. Impartial – Good leaders are impartial. They recognise their biases, prejudices, and
predispositions. They also recognise biases in others and face them.
10. Responsive – Good leaders are responsive to the needs of those they lead. They adjust
their behaviour to best match the situation. They listen to their team; they value their
team.
LEADERSHIP STYLES
Leadership style is the way a managerial leader applies his influence in getting work done
through his subordinates in order to achieve the organizational objectives. The main attitude or
belief that influences leadership style is the perceived role of the manager versus the role of the
subordinates. It depends upon the role of the leader whether he likes to work more of a
colleague, facilitator and decision maker and on the other hand the response of the subordinates
would determine the particular style to be in application. Broadly speaking, there are three basic
leadership styles as identified by Kurt Lewin (1939): -
- Autocratic or Dictatorial Leadership: In this leadership style the leader assumes full
responsibility for all actions. Mainly he relies on implicit obedience from the group in following
his orders. He determines plans and policies and makes the decision-making a one man show. He
maintains very critical and negative relations with his subordinates. He freely uses threats of
punishment and penalty for any lack of obedience. This kind of leadership has normally very
short life.
-Democratic/Participative Leadership: In this case, the leader draws ideas and suggestions
from his group by discussion, consultation and participation. He secures consensus or unanimity
in decision-making. Subordinates are duly encouraged to make any suggestion as a matter of
their contribution in decision-making and to enhance their creativity. This kind of leadership
style is liked in most civilized organization and has very long life.
-Laissez-faire/Delegative/Free Rein Leadership: Quite contrary to autocratic leadership style,
in this leadership style the leader depends entirely on his subordinates to establish their own
goals and to make their own decisions. He let them plan, organize and proceed. He takes

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 minimum initiative in administration or information. He is there to guide the subordinates if they
are in a problem. This kind of leadership is desirable in mainly professional organization and
where the employees are self-motivated. Leader works here just as a member of the team.
LEADERSHIP IN A COMMUNITY.
Composition of leaders in the community: -
1. FORMAL LEADERS
Are the first class individual in the community who are officially elected nominate or appointed
to rule the community eg. Chief, Ezes, Ogas, Emirs, District Head and Village Head and are
entitle to remuneration by government.
2. INFORMAL LEADERS
Are the leaders who are unofficially installed but nominated and recognize by members to lead
the in their day to day activities eg. Women leaders, market leaders, bus – stop/garage leaders
etc.
3. OPINION LEADERS
Are the elders and or religion representative group in the community eg. Imam, Pastors, Rich
person.

Community Leaders e.g Chief,

District Head

Head of Occupational Village Head Head of Social

Groups e.g Market Organization

Houses Hold Leaders

Members Members

Families

POWER AND DECISION CLASS IN A COMMUNITY

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1. FIRST CLASS INDIVIDUAL
Are the decision makers in the community e.g Leaders, chief, rich, and well to members of the
community?
2. SECOND CLASS INDIVIDUAL
Are the power jobbers, intermediates in decision making in the community eg. Sub – leader, civil
servant house hold leaders.
3. THIRD CLASS INDIVIDUAL
Constitute the lowest class which are the subject to rulers and well to do members of the
community e.g messengers who are beneficiaries of the local services in the community.
DEFINITION OF COMMUNITY MOBILIZATION
There are two different word here community and mobilization which combined together to
mean a particular thing as: -
1. It is defined as means of encouraging, influencing and arousing the interest of people to make
them actively involved in finding solution to some of their own problems.
2. Is a process of encouraging, inspiring and arousing the interest of the community to become
aware of the health problem, health need, and health related need and to prepare for health
action?
Community mobilization and participation require time, Patience and understanding on the part
of the health workers in order to achieve success. This is not one time activities an Integral
aspect of effort, aimed at initiating health action by the people out that no one can develop a
model of community mobilization that would have rigid application.
COMMUNITY INVOLVEMENT DEFINITION
Is a process of making community members to be part and parcel in finding their own health
problem and provide solution to their identified problems through community participation?
COMMUNITY PARTICIPATION DEFINITION
Is the process of making community members to be involved in assuming responsibilities to
community development and self – reliance?
CHARACTERISTICS OF COMMUNITY PARTICIPATION
1. COMMITTED COMMUNITY
Community members are to be self-committed to support PHC activities, that is to do everything
within their power to prevent if collapse.
2. COST SHARING
Community members are to share cost with government in support PHC activities in term of
view as a partner rather than funding agency because any program coming from the community
is perceived as being their own program.
3. INTER – SECTORIAL COLLABORATION
Other sector of related importance to the effective development of community are being involved
to support PHC activities eg. Agricultural extension unit, education etc.

FACTOR TO SUSTAIN COMMUNITY MOBILIZATION

For community mobilization to remain in continues existence, there should be:
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1. Patience and endurance
2. Clear line of communication
3. Co – operation between health workers and community members
4. Honesty and sincerity in the process
5. Regards, to the community culture and religion
6. Regular meeting between community leaders and health workers.
RATIONAL FOR COMMUNITY MOBILIZATION
This is simple referring to important and reasons for community mobilization, community
mobilization is important, it provide community members with following opportunities
1. To identify their own problem and related health need.
2. To plan solution to their own identified problem
3. To use their local available resources to solve their own problem.
4. To make them become initiative and self – reliance.
THE ROLES OF COMMUNITY MOBILIZATION
This is referring to the advantages of community mobilization: -
1. It makes community members aware about their health problem
2. It allows individual community members to become involve in finding solution to the identified
problems
3. It allow community members to participate in PHC activities in the community
4. It encourages the use of local available resources to solve their own health problems.
5. It develops community members initiation in planning for their health development
6. It builds confidence and reliability in community members towards their health development.
STEPS FOR COMMUNITY MOBILIZATION
1. Know the community
2. Make initial contact with the community leader
3. Communicate intention to the leader
4. Arrange meeting with the community leaders and community representatives
5. Develop agenda for the meeting
6. Attend the meeting
7. Explain the purpose of the meeting in an acceptable language
8. Request them to convey the message to other community members and bring feedback during the
subsequent meeting.
9. Encourage questions and participation from the audience.
10. Decide with the participant’s time, date and venue for the Next meeting.
11. Have as many meeting as necessary until consensus is arrived at.
BARRIERS TO COMMUNITY MOBILIZATION
1. Language difficulties
2. Distance to be covered
3. Problem of ecology flood and erosion
4. Materials to work
5. Nonchalant attitude of the community members.
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6. Poor drainage
7. Poor road network
8. Climate factor
9. Lack of finance.
THE CONCEPT OF HEALTH
Virtually everyone knows the meaning of health although not everyone may be able to define it.
As a result, many definitions of it have been given at different times. One widely accepted
definition of health is given by The World Health Organization (1948) as “a state of complete
physical, mental and social wellbeing and not merely the absence of disease or infirmity”.
 Physical health refers to anatomical integrity and physiological function of the body. To
say that a person is physically healthy means that:
 All the body parts are there
 All of them are in their natural place and position
 All of them are performing their physiological functions well and properly
and
 All of them are working with each other harmoniously
 Mental health refers to ability to learn and think clearly. A person with good mental
health is able to handle day to day events and obstacles, work towards achieving
important goals, and function effectively in the society
 Social health refers to ability to make and maintain acceptable interaction and
relationships with other people.

However, the WHO definition has been criticized in recent times by authorities in the field of
health who feels that it is wrong to judge health on the ground of “completeness” of state be it
physical, mental or social. These critics believe that a “complete state of physical, mental and
social wellbeing” does not exist and that we cannot consider physical wellbeing to mental or
social wellbeing separately because the three are inter-related. What affects one affects the other.
Despites the shortcoming of the definition, the concept of health as defined by WHO is broad
and positive in its implications. This is because it sets out the standard of ‘ideal’ health that any
people or nation should aspire to achieve. Consequently, the World Health Organization’s (1948)
definition of health is adopted everywhere.
Health is state of an individual characterized by anatomical, physiology, psychological and social
integrity, ability to deal with physical, biological and social stress, a feeling of wellbeing and
freedom from the risk of disease or infirmity.
Health is a state of dynamic balance in which an individual’s or group’s capacity to cope with all
the circumstances of disease and injury is at an optimal level. It is a state of an individual when
he functions optimally without evidence of disease or abnormality. It is the ability of an
individual to carry out his normal daily life activities without undue fatigue.

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SOME OTHER DEFINITION OF HEALTH
As early stated, people of all levels of life or ages have given various meanings to health. For
example, physicians who deals with medication see health as the ability of the body to function
well physiologically, psychologist who deals with the mind see health as appropriate operation of
a balanced mind.
Below are some other definitions of health:
 Health is an integrated method of functioning which is oriented towards maximizing the
potentials of which the individual is capable.
 Health is the complete fitness of the body, soundness of the mind and wholesomeness of
emotions which make possible the highest quality of effective living and service.
 Health is fitness for survival and self- renewal.
 Health is ability to produce and rear offspring fitted to live and efficiently to perform the
ordinary functions of their species.
 Health is a state of an individual characterized by anatomical, physiological,
psychological and social integrity.
 Health is a state of an individual when he functions optimally without evidence of disease
or abnormality.

FACTORS AFFECTING HEALTH

1. Cultural factors
2. Socio-economic factors
3. Environmental factors
4. Geographical factors
5. Personal factors

Cultural factors that affect health

a. Culture is the particular way in which people do a certain thing in their societies eg
Marriages.
b. Belief is what people hold in their mind to be the cause or solution to a particular thing in
their society eg Religion.
c. Taboo is a certain thing which people regard to be an abomination in their society.
d. Practice is a certain way in which people behave, act and respond to a particular situation
in their daily life activities.

Socio-economic factors that affect health

a. Educational level
b. Ignorance of health matters
c. Low income

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 d. Poverty

Environmental factors that affect health

a. Air pollution
b. Inadequate water supply
c. Inadequate refuse and excreta disposal
d. Poor housing
e. Poor road network

Geographical factors that affect health

a. Topography-soil, rivers, mountains

b. Deserts
c. Weather
d. Forest vegetation.

HARMFUL HEALTH PRACTICE IN OUR COMMUNITIES

1. Female circumcision
2. Early female marriage at less than 13 years
3. Expressing of colostrums (breast milk) immediately after birth
4. Cutting of umbilical cord using hot knife of blade
5. Application of cow dung after cutting umbilical cord
6. Depriving child from his mother for weaning
7. Forced feeding

Improvement of health status of a given community through the following:

a. Health education
b. Immunization
c. Boosting of agricultural production
d. Adequate ante natal care and post natal care
e. Improvement of female education
f. Adequate water supply
g. Proper environmental sanitation

MEANING OF HEALTH EDUCATION

Health education means many things to different people as such; it has never been easy to define
depending on what angle one is looking at it from in relation to his health.

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Health education is a profession of educating people about health. The profession involves
processes with intellectual, psychological and social dimensions relating to activities and
programmes that increase the abilities and provide opportunity for people to make informed
decisions affecting their personal, family and community health and general wellbeing, process
based on scientific principles and learning theories that facilitate behavioral change in both
health personnel and service consumers including children, women, youth, elderly and the aged.
Health education is the process by which individuals and groups of people learn to behave in a
manner conducive to the promotion, maintenance, or restoration of health. It is an aspect of
health care service concerned with the application of practically sound methods and technique to
educate, inform and motivate people to utilize the health knowledge, information, skills and
experiences given to them by health educators to prevent themselves from diseases and injuries
and to promote, improve and protect their health and wellbeing.
Health education involves application of methods and techniques for transferring to an individual
and the community, the knowledge, skills and experiences relating to physical health, social
health, emotional health, intellectual health, environmental health, and spiritual health, necessary
for the prevention of disease and restoration of health.
TYPES OF HEALTH EDUCATION
Basically, we have three types of health education viz:
1. Individual health education: This involves face to face process of giving health
information to patients or clients in such a way that they can apply it in everyday living.
2. Group health education: In this type of health education, health information is given to
large number of people having a common problem.
3. Mass media health education: This is a type of health education that other means such
as radio, television, newspapers, social media, magazine and other channels of
communication are used for the provision of oral health information to audiences.

WHO IS A HEALTH EDUCATOR?

Health educator is an individual who educate or gives health information to people. A health
educator is a professionally prepared individual who serves in a variety of roles and is
specifically trained to use appropriate educational strategies and methods to facilitate the
development of policies, procedures, interventions, and systems conducive to the health of
individuals, target group and communities.
The health educator teaches people about behaviors that promote wellness. He/she is someone
who is academically and professionally prepared to deliver core health information to people and
possesses required knowledge and skills based on theories and research that promote health
education and behavior change in individuals and populations to prevent diseases, disability and
premature death. He/she has training in areas described above. What sets the health educator

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apart is that they are up to date in education requisite that enables them to deploy the health
knowledge and skills into teaching wellness through sound pedagogic approaches, publishes
health education materials and information.
QUALITIES OF GOOD HEALTH EDUCATOR
A good health educator should possess the following basic qualities to become effective.
1. Knowledgeable: Health educator should have a sound knowledge about health and ill-
health, the basic knowledge (scientific sound information, education techniques and
communication skills).
2. Cheerfulness and neatness in appearance: The health educator should have an
examplenary health life for people in the community to emulate his lifestyles. Therefore,
he should be careful, happy and neat all the time.
3. Tolerance: To change community attitude and behaviour that has been passed on from
generation to generation is not easy task. The health educator should bear and endure any
behaviour for a positive change.
4. Patience: An attempt in first place to change people behaviour will be difficult
nevertheless with time and patience a change in behaviour will occur; all what is needed
is perseverance and patience.
5. Ability to choose a right topic: A good health educator should be able to choose right
topic for the target group chosen, determine the topic of the discussion as well as content.
However, choosing wrong topic would help in making the health education programs and
activities into failure.
6. Ability to consider the language, belief and traditional setting of the community:
The health educator should make sure that audience or target group understand his
language well, if not it’s necessary for him to recruits or write interpreter to translate his
message to people for easy digest above all, he should know the custom, culture and
tradition setting before embarking on health education programs in a community.
7. Ability to identify the knowledge, behaviour and belief (practice) of the community
in relation to health and ill-health: This will help the health educator to know the
direction to follow, where to start and what to do.
8. Ability to evaluate: Evaluation is a process of finding out the audience understands the
information pass to them. Evaluation can be informed of asking question orally or written
and also allowing the audience to give feedback of what has been discussed.

THE PRINCIPLE OF HEALTH EDUCATION

Principles of health education are values, fundamental truths or rules that guide actions of health
educator in the organization, planning and implementation of health education programs and

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activities in the community. For successful health education, the health educator should consider
and apply the basic principles of health education.
1. Respect for culture, traditions and religion of the people: The health educator should
know and understand the culture and traditions of the community. Especially in the area
of their traditional hierarchy, interpersonal communication and their lifestyle of approach
and views on health care and other health related matters.
2. Clarity in preparation and presentation: The health educator should state clearly the
learning objectives to the individual, target group or the community on the chosen topic.
This help to prepare the mind of the learners towards the anticipated behavioural
responses. Moreover, the area to be covered in the topic should be clearly stated and in a
systematic order. It is equally good to actively involve the learners in the process of
identifying the learning objectives.
3. Simplicity of the health information: The health educator should be able to give health
education according to the level of the individual, target group or the community. The
language should be understood by the learners. The methods and media of
communication of the learners should be according to their levels of education,
experience and age, that is, different method for literates, similarities and illiterates, the
less educated the learners are the simpler the presentation.
4. Understanding of the topic: The health educator should give a well-prepared lesson
following the rules of effective health education, it is essential for the health practitioner
to choose the right topic for the target group, select the correct methods and media allow
the learners to ask questions for clarification and evaluate and ensure that the topic has
been understood.
5. Reliability of the source of the health information: Reliable sources of health message
affect the willingness of the learners to change their opinion toward the health topic. The
health information provided should be based on facts and not speculations to enable the
audience develop confidence in the health educator. Therefore, the success in health
education depends largely on the learner’s confidence in the health educator. In addition,
the health educator should collaborate with the already trusted members of the
community like the village head, the religious leaders and leaders of the various unions
for any community-based health education activity.
6. Acceptability and adaptability of the health messages: An individual, target group or
the community may understand what they have learned but may not accept it. The health
educator should be able to employ healthful techniques to make the learners accept the
message. This should be meaningful, practiced and relevant to the learner’s life
experience and this would bring about desired result. It is after the message has been
accepted that adaptability- behaviour change- take place.
7. Effective communication: Effective communication is an educational force which
brings about the anticipated behaviour from the learners. The health educator, therefore,
should acquire adequate ability in the use of communication techniques. In addition, good

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 personal relationship is usually more effective than impersonal instructions, therefore,
face to face health educational instructions is more effective than through the media.

CONCEPT OF HEALTH COMMUNICATION

What is Communication?
Communication can be regarded as a two-way process of exchanging or shaping ideas, feelings
and information.
It is a process necessary to pave way for desired changes in human behavior, and informed
individual and the community to achieved predetermined goals.
Ultimate Goals of Communication
 Communication and education are interwoven.
 The ultimate goal of all communication is to bring about change in the desired direction
of the person who receives the communication.
 This may be at the cognitive, affective or psychomotor levels.
 Our ability to influence others depends on our communication skills i.e speaking, writing,
listening, reading and reasoning. These skills are much needed in health education.

Communication Process
The process of communication has the following components:
Sender (Source)
Message (Content)
Channel (Medium)
Receiver (Audience)
Feedback (Effect)
Sender → Message → Channels → Receiver
Sender
The sender is the originator of the message.
To be an effective communicator, he/she must know:
 His objectives, to clearly defined them
 His audience, their needs and interest
 His message
 Channels of communication
 His professional abilities and limitations

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Message
A message is the information which the communicator transmits to his audience to receive,
understand, accept and act upon. It may be in the form of words, pictures or signs.
Therefore, health communication may fail in many cases if message is not adequate.
Transmitting right message to right people at the right time is a crucial factor in successful
communication.
A good message must be:
(a) In line with objectives
(b) Meaningful
(c) Based on felt need
(d) Clear and understanding
(e) Specific and accurate
(f) Timely and adequate
(g) Fitting the audience, interesting and socially appropriate.
Channels of communication
This refers to media of communication between the sender and the receiver. Communication
effort is based on three media system, i.e interpersonal communication, mass media and
traditional or folk media
Every channel of communication has its advantage and disadvantages.
The proper selection and use of channel results in successful communication.
Effective communication cannot achieve through one method alone, hence attempt should be
made to combine variety of methods to accomplish the educational purpose.
Interpersonal communication:
The most common channel of communication is interpersonal or face – to face communication.
It is more persuasive and effective than any other communication methods.
Good in influencing the decision of undecided persons.
Mass media (Examples of mass media include: TV, radio, printed media, among others)
Mass media has the advantage of reaching a relatively large audience in a shorter possible time
than any other means.

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It a one – way channel of communication, it carries message only from the center to the
periphery; feedback mechanism is poorly organized.
Folk media
It is an important channel of communication close to the cultural values of the rural population,
i.e drama, singing and dances.
Health messages can be communicated through this traditional media.
Receiver
This simply refers to audience; it can be a single person or a group of people. Without audience,
communication will be nothing more than a mere noise.
The audience may be of two types:
Controlled audience: Is the one which communication is held by a group who have a common
interest, controlled audience is carried out to a homogeneous group. The more homogeneous the
audience is, the greater are the chances of an effective communication.
Uncontrolled audience or free audience: Is the one which has gathered together from different
motives of curiosity. This audience possesses challenge to the ability of the health educator.
Feedback
 It is the flow of information from audience to the sender.
 It is the reaction of the audience to the message.
 If the message is not clear or acceptable, the audience may react it outright.
 The feedback thus provides an opportunity to modify the message to the understanding of
the audience.

Types of Communication
One-Way Communication (Didactic Method):
In this method, the flow of communication is one-way, from the communicator to the audience.
Example of this method is a lecture method. The limitations of didactic methods are:
 Knowledge is imposed
 Learning is authoritative
 There is little audience participation
 No feedback
 Does not influence human behavior

Two-Way Communication (Socratic Method):

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In this method, both the communicator and the audience take part in the communication. The
audience may raise questions, and add their own information, ideas and opinion to the subject of
discussion. This process of learning is active and democratic. It is more likely to influence
behavior than one-way communication.
Verbal Communication
This is a traditional method of communication by words of mouth.
Direct verbal communication by word of mouth may be loaded with hidden meaning
Non-direct or written communication may not be as persuasive as spoken word.
Non-Verbal Communication
It includes a whole range of bodily movement, postures, gestures, facial expression (smile, raised
eye brows, frown, staring, gazing, etc). Silence is also nonverbal communication,
it can speak louder than words.
Formal and Informal Communication
Communication has been classified as formal, which follows lines of authority; and informal
communication through informal network such as gossip circle that exist in all organizations.
The informal channel of communication may be more active, if the formal channel cannot cater
to the information needs.
Visual Communication
The visual forms of communication comprise: charts and graphs, pictograms, tables, maps,
posters, among others.
Telecommunication and Internet
This is a process of communicating over distance using electromagnetic instruments designed for
the purpose. Radio, TV and internet are mass communication media. While telephone, telex and
telegraph are known as point – point telecommunication systems.
Barriers to Communication
Health education may often fail due to communication barriers between the educator and the
community. These may be:
 Physiological: difficulties in hearing and expression
 Psychological: emotional disturbances, neurosis, level of intelligence, language or
comprehension difficulties.
 Environmental: Noise, invisibility, congestion

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  Culture: Illiteracy, level of knowledge and understanding, customs, beliefs, religion,
attitudes, economic and social class differences, language variations, cultural difficulties
between foreigners and nationals, between urban education and the rural population.

Presence of these barriers is very challenging to achievement of any behavioural change. Hence,
they should be identified and removed.
ORIGIN OF HEALTH PROMOTION
Although the idea of health promotion is not new, its rise as an organized field can be traced to
1974 when Mac Lalonde, the Canadian minister of the time, released a paper entitled “A new
perspective on the health of Canadian”. This was the first national government policy document
to identify health promotion as a key strategy. His report was both a concept and an approach
that could be used by government, organizations, communities and individuals for health
promotion.
In 1986, the first International Conference on health promotion captured this growing interest
and endorsed the Ottawa Charter for Health Promotion. After Ottawa Charter, health promotion
movement has become a contemporary framework to the traditional focus on health protection
and disease prevention. Ottawa Charter has created the vision by clarifying the concept of health
promotion, highlighting the conditions and resources required for health promotion and
identifying key actions and basic strategies to pursue the WHO policy of Health for all by the
year 2000 and beyond. The Charter identified the pre-requisites for health to include; peace,
shelter, a stable ecosystem, social justice, equity, education, food, income and sustainable
resources. It highlighted the role of organizations, systems and communities as well as individual
behaviors and capacities in creating opportunities and choice for better health. After Ottawa
Conference, the World Health Organization organized in partnership with national governments
and associations, a series of follow up conferences, which focused on each of Ottawa’s five
health promotion strategies.
OBJECTIVES OF HEALTH PROMOTION
The objectives of health promotion are:
1. Awareness for public policies and their health impacts.
2. A concern for social and physical environments supportive of health.
3. The need for personal skills development.
4. Community involvement in all activities.
5. The need for public services to be responsive and oriented towards health.

The Ottawa Charter for Health Promotion (1986) explained the above objectives thus:
1. Build healthy public policy.
2. Create supportive environments for health.
3. Strengthen community action for health.

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 4. Develop personal skills.
5. Re-orient health services.

Build healthy public policy

Health promotion goes beyond health care. It puts health on the agenda of policy makers in all
sectors and at all levels, directing them to be aware of the health consequences of their decisions
and to accept their responsibilities for health. Health promotion policy combines diverse but
contemporary approaches including legislation, fiscal measures, taxation and organizational
change. It is coordinated action that leads to health, income and social policies that foster greater
equity. Joint action contributes to ensuring safe and healthier goals and services, healthier public
services and cleaner, more enjoyable environments.
Creating supporting environment for health
Our societies are complex and health cannot be separated from other goals. The overall guiding
principles for the world, nations, regions and communities alike, is the need to encourage
reciprocal maintenance to take care of each other, our communities and our natural environment.
The conservation of natural resources (environment) is the responsibility of every one throughout
the world. Systematic assessment of the health impact of rapidly changing environment
particularly in areas of technology, work, energy, production and urbanization is essential and
must be followed by action to ensure positive benefit to the health of the public. The protection
of the natural and built environments and the conservation of natural resources must be
addressed in any health promotion strategy.
Strengthen community action for health
Health promotion works through concrete and effective community action in setting priorities,
making decisions, planning strategies and implementing them to achieve better health. At the
heart of this process is the empowerment of communities’ health wise. Community development
draws on existing human and material resources in the community to enhance self-help and
social support and to develop flexible systems for strengthening public participation in a
direction of health matters. This requires full and continuous access to information, learning
opportunities for health as well as funding support.
Develop personal skills for health
Health promotion supports personal and social development through providing information,
education for health, and enhancing life skills. By so doing, it increases the options available to
people to exercise more control over their own health and over their environments, and to make
choice conducive to health. People should be allowed to learn throughout life, to experience and
prepare themselves for all of its stages and cope with chronic illness and injuries. This has to be
facilitated in school, home, work and community settings. Action is required through
educational, professional, voluntary bodies and within the institutions themselves.

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Re-orient health services
Health services re-orientation is characterized by a more explicit concern for the achievement of
population health outcomes in the ways in which the health system is organized and funded. This
must lead to a change of attitude and organization of health services, which focuses on the needs
of the individual as a whole person, balanced against the needs of population groups.
THE PRINCIPLES OF HEALTH PROMOTION
Health promotion is a relatively new area which seeks to enhance the health and well-being of
population groups and their members. It focuses on preventing and or reducing untimely
morbidity and mortality. It is a way of mediating between people and their environment,
combating personal choice with social responsibility, for people to create a healthier future. It
occurs in many settings such as schools, workplace, hospitals, villages, towns, cities. Health
promotion includes:
 Working with people not on them
 Addressing all aspects of health (physical, mental, spiritual e.t.c)
 Collaborating with the local community and issues
 Addressing the underlying and immediate causes of health- the determinants of health
 Working with both individuals and population groups
 Emphasizing the positive aspects of health
 Being concerned with healthy lifestyles
 Incorporating all levels and sectors of society and the environment
 Emphasizing partnerships and alliance between groups and sectors
 Building the capacity of people through education, training and work opportunities
 Being innovative and addressing challenges

HEALTH BEHAVIOR CHANGE

Health behavior change is any activity that an individual undertakes to enforce health, prevent
disease, detect and control the symptomatic stage of disease.
The process/strategies of behavior change
Strategies of health behavior change are or occur in the following phases:
 Awareness: The individual becomes aware of a new idea or practice.
 Interest: The individual then develop interest in the new idea and wants to learn more
about it.
 Evaluation: The individual weighs the advantages and disadvantages of the new idea
 Trial: The individual puts the idea to test, practice or trail basis and again assess the
advantages and disadvantages on the basis of initial experience
 Adoption: The individual adopts the practice permanently.

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  Conviction: Once an individual is convinced and accepts a new idea he/she tries the new
idea.

THE ROLE OF HEALTH EDUCATION IN PRIMARY HEALTH CARE (PHC)

For better understanding, reference has to be made to Alma-Ata declaration, where World Health
Organization (WHO) in 1978, gave us the definition of Primary Health Care as “ Essential health
care based on practical, scientifically sound and socially acceptable methods and technology
made universally accessible to individuals and families in the community and country through
their full participation and at a cost that the community and country can afford to maintain at
every stage of their development in the spirit of self-reliance and self-determination”. And they
also go further to give us the components of PHC, which are as seen below:
1. Health promotion and education
2. Promotion of food supply and proper nutrition
3. Adequate supply of portable water and basic sanitation
4. Immunization against major infectious diseases
5. Maternal and child health care, including family planning
6. Prevention and control of locally endemic diseases
7. Appropriate treatment of common diseases and injuries
8. Provision or supply of essential drugs
9. Dental health

The above mentioned or listed components, activities or functions that are carried out or
expected to be done in PHC are vital or important and cannot be achieved to the fullest without
health education. Therefore, health education has a role to play in PHC and are briefly explained
and presented in relation to each of the components:
1. Health education provides knowledge or information concerning health problems and the
methods of preventing and controlling them.
2. Health education also provides basic health facts or instructions to the general public by
means of proper or appropriate enlightenment on the right type of food to be eaten by
various groups of people in the community such as children, nursing mothers, sick people
e.t.c to build up the body and prevent nutritional diseases and other associated health
challenges.
3. Through effective health education to the community or people, the provision of adequate
and portable water to or within the general populace and basic sanitation of the
environment is always made possible.
4. Also, through health education success is or can be recorded in immunization programs
against the childhood killer diseases and other major infectious diseases in the
community, because it creates awareness or enlighten the people on the importance of
immunization in creating immunity within an individual’s body which protects or prevent
him/her from contracting infectious disease.

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 5. Effective health education also provides facts on proper maternal and child health care,
including services that enlighten the people about or on the advantages of antenatal and
post-natal visit for regular check-up and early detection of abnormalities and prompt
action taken, which prevent high maternal mortality and infant mortality rates, pre-
marital counseling and testing for inherited diseases as well as cutting down the size of
the family to a manageable one.
6. Another role of health education in PHC is the prevention and control of locally endemic
diseases, which many of them can be successfully avoided by or through appropriate
enlightenment on preventive measures or actions.
7. Health education also widens the knowledge of the community on common diseases and
injuries within locality and encourages them to seek medical assistance early to prevent
the condition from becoming chronic and difficult to treat.
8. Also, health education encourages the provision or supply of essential drugs for easy
treatment of locally disease in the community.

HEALTH TALK PRESENTATION

Health talk according to Vidya, (2005), is a lecture of group discussion on health related subject
or issues for better understanding of the subject matter/issues by the individual or group.
GUIDING POINTS IN HEALTH TALK PREPARATION /PRESENTATION
Write down the ideas that rise in your mind when thinking about the subject matter. Edit and
assemble the materials, eliminate irrelevant information or ideas and arrange the relevant ones in
a logical sequence. Then go further with these preparations:
 Title of the health talk
 Place and venue
 Date
 Time
 Target group/audience
 Previous knowledge of the topic
 Aims and objectives
 Methods/procedure
 Instructional materials to be used
 Evaluation of feedback from the audience to make sure that what you taught them
are/was fully understood and grasped.

METHODS OF HEALTH EDUCATION

Methods are planned procedures and actions that approach the participants systematically,
scientifically, pedagogically and sociologically in order to achieve the educational goals.
Basically health education helps people to make wise choices about their health and the quality

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of life of their community members. To do this, accurate information or ideas must be presented
in an understandable and acceptable way to the community members using different methods.
Methods of health education are ways in which a health educator uses for disseminating or
imparting health knowledge to consumers or audience.
The methods of health education are basically divided into two broad groups, which any other
method fall within the two, these are
1. Socratic Method: This is a one-way method in which the health educator does the talking
while the audience listens without contributing their quota and they cannot ask for
clarification.
2. Didactic Method: This is a two-way system or method in which both the parties
contribute i.e the dental health educator and audience.

SOME OF THE METHODS OF DELIVERING HEALTH EDUCATION

1. Lectures/health talks
2. Interview
3. Counseling
4. Group Discussion
5. Exhibition
6. Demonstration
7. Field Trip
8. Drama and Role Play
9. Story Telling, Songs and Dancing
10. Simulation
11. Brainstorming
12. Workshop/seminar
13. Personal Example
14. Home Visitation

LECTURES/HEALTH TALKS
This is a straight forward discussion, a pre-planned structured scheme delivered on a topic. It is a
common method of providing health instructions.
ADVANTAGES
1. It is convenient for a large target group.
2. Instruction or information can be delivered within a shortest time.
3. Have face to face contact with the audience.

DISADVANTAGES
1. If always a long lecture that must client cannot withstand.
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 2. Creative thinking is not promoted.
3. Less retentiveness.
4. Interaction is limited.

GROUP DISCUSSION
This is the sharing of ideas or argument between members of a target group who have a common
problem. The dental health educator guides such discussion and serves as resource person. This
gives room for active participation and contribution of members.
ADVANTAGES
1. Immediate feedback is achieved.
2. It allows interactions.
3. It makes learning more effective and meaningful.
4. It motivates adoption of positive health behaviour

DISADVANTAGES
1. Arguments may be extended.
2. It allows diversion of discussion.
3. It consumes time.

EXHIBITION
This is the physical presentation of items, materials and realia for clients to see. Example is salt-
sugar-solution, items, available food items (realia) and other that are self-explanatory. With the
help of the health educator to further explain to the clients how they can be used.
ADVANTAGES
1. It allows seeing real items.
2. The sense of sight is fully engaged.
3. It enhances fast learning.
4. It attracts questions and answers for clearance.

DISADVANTAGES
1. It is costly.
2. It’s difficult to avoid ruddiness of clients.
3. It time consuming

DEMONSTRATION
This is a real-life activity, this method is a sequence of steps carried out to illustrate a problem,
show a procedure or provide a basis for drawing conclusions. Demonstration allows every
participant to partake in the activity to acquire the experience and skill needed.

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ADVANTAGES
1. It is used to illustrate a procedure or a problem.
2. It uses a variety of sense (i.e sight, hearing, touch, and feeling) which reduces the chances
of forgetfulness and the client opportunity to participate.
3. It is an effective means of monitoring the acquisition of certain skills.

DISADVANTAGES
1. The method is time consuming.
2. Requires a lot of facilities.
3. The method may not be projectable unless client see the relationship

FIELD TRIP
Here is a method that a target group is taken out of the venue of the education programme to visit
or observe the first-hand experience of a process or a structure related to the topic.
ADVANTAGES
1. It gives opportunity to see and observe physically.
2. It motivates and stimulate interest.
3. It can also serve as an effective introductory, concluding or summarizing activity.

DISADVANTAGES
1. It is time consuming.
2. Long time preparation.
3. It may end up as an entertainment visit.
4. It provides clients with varied perceptual experiences that may not relate to the set
objectives.

DRAMA AND ROLE PLAY

Drama: this is when a group of people mimic a situation as close as possible to reality. It
involves a wide range of valuable experience expressed on specific subjects.
Role Play: is a specialized form of acting, it is when an individual takes part of another character,
especially as related to human functioning or daily living relations. Here the participants share in
the performance by being emotionally involved with the limit of their post experiences.
ADVANTAGES
1. Problems and experience are visually illustrated.
2. Varieties of senses are stimulated.
3. It gives clients the opportunity to contribute.
4. Learning is enjoyable and interesting.

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DISADVANTAGES
1. Not economical in terms of money and time.
2. Difficult to organize.
3. When not well acted, it become a fruitless effort other logistic is required.
4. May end up as an entertainment only.

STORY TELLING, SONGS AND DANCING

Story Telling could be a true story, or a fictional story (folk tales).
Songs provide a specific information in the form of lyrics. Songs are usually short and composed
by either the dental health educator or the client which summarizes the silent points of the health
topic.
Dancing here means a creative movement that portrays a significant information the audience.
ADVANTAGES
1. Easy to remember.
2. Pleasurable way of learning.
3. It re-enforce the silent point.

DISADVANTAGES
1. Not all people like this method.
2. There may be misinterpretation of message.

SIMULATIONS
This is where a substitute object, a subject or situation is used in the place of a real object, action
or situation. e.g the use of dolls baby to demonstrate how to bath a baby.
ADVANTAGES
1. Toys make up for shortages.
2. Allows clients to improve manual skills.
3. Learning skills take place.

DISADVANTAGES
1. It time consuming.
2. Substitute supply may be inadequate.
3. There may be confusion of substitute.

BRAINSTORMING

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This is the examination of idea, problem, situations and appraisal of issues between the clients
and/or in a committee with the aim of generating solution.
ADVANTAGES
1. Here is free expression of thought.
2. Clients participate in problem solving process.
3. Allows clients to exchange ideas.
4. Stimulates client’s initiative.
5. Generates creative thinking.

DISADVANTAGES
1. Time consuming.
2. Disagreement can interrupt the discussion.
3. It can lead to arguments.

WORKSHOP/SEMINAR
Workshop is a meeting for discussion and practice on a particular theme. Is a method for people
who are experienced in their field.
Seminar is a method whereby experts present a series of papers on different topics under the
same theme.
ADVANTAGES
1. It gives room for contribution toward development.
2. There is active participation of learners.
3. It builds up learner’s confidence and facilitates recall memory.

DISADVANTAGES
1. Not suitable for large group.
2. Could be a total failure, if members are not ready.
3. Does not cover all group of clients.

PERSONAL EXAMPLE
Personal example is the health educator’s or an individual positive practice that could be imitated
by others. In this case it should be “do as i do not as i say”. It is just being a role model
ADVANTAGE

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 1. It gives true picture or practical example of the health information or message.

DISADVANGAGES
1. Its implementation may be difficult
2. Its implementation is also time consuming
3. It requires many staffs for it to be successful.

SYMPOSIUM
A symposium is a series of speeches on a selected subject.
1. Each person or expert presents an aspect of the subject briefly.
2. There is no discussion among the symposium members like in panel discussion.
3. In the end, the audience may raise questions.
4. The chairman makes a comprehensive summary at the end of the entire session.

PANEL DISCUSSION
In a panel discussion, 4 to 8 persons who are qualified to talk about the topic sit and discuss a
given problem, or the topic, in front of a large group or audience.
1. The panel comprises, a chairman or moderator and from 4 to 8 speakers.

2. The chairman opens the meeting, welcomes the group and introduces the panel speakers.

3. He introduces the topic briefly and invites the panel speakers to present their points of
view.

4. There is no specific agenda, no order of speaking and no set speeches.

5. The success of the panel depends upon the chairman; he has to keep the discussion going
and develop the train of thought.

6. After the main aspects of the subject are explored by the panel speakers, the audience is
invited to take part.

7. Panel discussion can be an extremely effective method of education, provided it is

properly planned and guided.

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