Communication and health education

Alshimaa Hosseny
Teaching assistant
Faculty of
Medicine
Arish University
 • Define communication
• Appreciate the value and benefits of proper communication
in health care.
• Describe communication process.
• Know how to use communication skills effectively.
• List barriers to effective communication
• Evaluate the need to apply effective consultation skills in
Objectives health care settings
• Illustrate the principles of counseling and its applications in
health care settings
• Recognize components of health education process.
• Compare between different health education methods, as
regards their characteristics, utilities and limitations
• Criticize different health education materials
• Identify relation between behavior and health
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• Know how to use Health Believe Model for behavior change
Communication
" It is the process in which information, feelings and ideas are
expressed and shared as messages sent, received and comprehended".
 Benefits of good communication in health
care
• Benefits extend to patients, health care providers and health systems, Good
communication benefits include:
• Help to build trust with patients.
• Ensure good history taking Making an accurate diagnosis and allow for
better identification of patients' needs, perceptions, and expectations.
• Facilitate comprehension of medical information.
• Increase client satisfaction and adherence to the prescribed treatment.
• Decrease length of hospital stay and the cost of treatment.
• Allow for rapid recovery.
• Saving money and time.
4 • Reducing suffering and pain.
Communication
process/ cycle

Communication process is the set

of sequential steps involved in
transferring message as well as
feedback between participants.
 Elements of communication process
1. Developing idea by the sender (the planning stage).

2. Encoding: converting or translation the idea into a perceivable form that can
be communicated to others.

3. Developing the message and Selecting the medium: The message can be
oral, written, symbolic or nonverbal.

4. Transmission of message: In this step, the sender transmits the message

through chosen medium.

5. Receiving the message by receiver: in the form of hearing, seeing, feeling

and so on.

6. Decoding: the receiver's interpretation of the sender's message. Here the

receiver converts the message into thoughts and tries to analyze and
understand it.

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7. Feedback: receiver's response to sender's message. It ensures that the
receiver has correctly understood the message. Feedback is the essence of
 Communication skills

Active
listening
Verbal and
nonverbal
communicatio
n
Information
gathering

Information
giving
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 Active listening
• Listen to the client, give him full attention, try to understand his message do not
think about what may be said after that.
• Take care of the client's feelings through observing cues
• Consider client confidentiality and privacy
• Give the client the opportunity to ask
• Respect the client's silence
• Facilitate the process of communication using verbal and non-verbal skills.
• Clarify anything that you did not understand by asking the client "what do you
mean?“
• Paraphrase what the client just said in your own words.
• Reflect on what the client has just said.
Who
• Use time effectively as possible. Doctors should interrupt at an appropriate point
should
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and try to redirect the interview. summarize
?
 Verbal and Non-verbal communication
A. Verbal Communication: B. Non-verbal Communication: "body
language"
• It depends on using language,
whether spoken or written. • Types of non-verbal communication:
1. Body movements, gestures, posture.
• Requirements:
2. Head and hand movements and
1. Clear language: The selection of touch.
accurate/specific words.
3. Facial expressions and eye contact
2. Appropriate language: use 4. Personal appearance and smell.
meaningful and suitable words.
Consider demographic factors such 5. Space and proximity.
as: age, sex, educational level, 6. Non-verbal aspects of speech: Vocal
background, culture and other cues that accompany spoken
personal factors. language (voice) include pitch
(highness or lowness), volume
3. Sound vocabulary building: choose (degree of loudness), rate or speed of
9 words that convey the meaning of speech and pauses.
the message properly.
 Be aware of the
cultural differences
in conducting
nonverbal
communication.

Functions of non-verbal
communication:
• Reinforce/complements the verbal message
• Replace the verbal message
• Regulate the verbal message
10 • Sometimes contradict the verbal message!
 Information gathering skills/Questioning
• This skills enables the health care provider to take good history and
assess client/patient needs and concerns.
• Questions are either:
1. Open ended questions: asking for details or descriptions, these
questions started by what, describe, how, why, explain,
discuss...etc.
2. Close ended questions: to get more specific information, e.g. (Yes-
No questions), or asking about facts, these questions started by;
Who-Whom-When-where-How often, etc.
• Bad or Confusing questions
1. Leading questions: questions contains the answer...e.g., Dose this
pain increase by night?
2. Complex questions: two or more questions are presented in one
11 statement...e.g. Is there any one of your family has jaundice or
suffered from it in the past?
 Tips for effective questioning skills:

Asking the question in

Asking in a voice tone Asking one question Giving open questions different ways to be
showing your care every time first sure that the client
understands

Use facilitation and Avoid leading Avoid complex

Respect and deal with non-verbal questions because questions as you well
the client's feelings: communication to they do not give the obtain confusing
shyness, worry, fear encourage the client client a chance to answer.
to talk e.g., nodding. express him/herself

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 Information giving skills

This skills is essential to perform effective consultation and

counseling.

• Sequencing the events.

• Put important things first.
• Simplify information
• Use methods/aids that promote retaining information
• Directing the flow of information
• Use verbal and nonverbal skills efficiently
• Summarize your points at the end.
13 • Ask the client to summarize the instructions
 Consultation Counseling
The whole process from meeting the A process that enables clients to make
patient, introducing self, history taking informed decisions. Education is an
integral component of the counseling
and examination, up to the
process that helps clients to make
management plan and anticipatory care. decisions and find suitable choices and
alternatives.
Steps of consultation:
Steps of Counseling:
1- Discover reasons for attendance
1- Helping the counselee to identify what
2- Define the clinical problem(s) is the problem

3- Explain the problem(s) to the patient 2- Helping the counselee to discover why
it is a problem
4- Manage the patient's problem
3- Encouraging the counselee to look for
5- Make effective use of the possible solution
14 consultation
4- Helping the counselee choose an
appropriate solution
 Communication Barriers
Sender:
Message:
• Failed to build rapport (good
• Do not respond to patients'
relation)
needs and concerns
• Talk too much or too little
• The message contains
• Use technical language
medical jargon or technical
• Failed to consider client emotions
language
• Social and cultural gap between
• Contradictory messages
the health care giver and the client
Receiver:
• Limited receptiveness of the
client: (Confusion, tiredness,
Environment:
distress, pain)
• Noise or interruptions,
• Negative attitude, client thinks he
• Physical discomfort, (cold, hot
knows everything, limited
place of interview...etc.)
understanding and memory
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• Physical impairment, hearing or
vision
 Health Education (HE)

• Any combination of learning experiences designed to help individuals

and communities improve their health, by increasing their knowledge
or influencing their attitudes (WHO).
• The process by which individuals and groups of people learn to
behave in a manner conducive to promotion, maintenance or
restoration of health.
• Educational objectives:
knowledge, Attitude and Practice(KAP), followed by Adoption, implying
no relapse from the healthy practice.
I. Knowledge is a set of understandings and information.
II. Attitude reflects learning tendency or intentions.
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III. Practices or behaviors are the observable actions of an individual in
response to a stimulus.
 Health education occurs in Components of health
many settings, including: education:
• Schools 1. The health educator

• University campus 2. Health education message

• Companies 3. Recipient/target group

• Health care settings 4. Methods of health education

• Community organizations and 5. Materials for Health

government agencies education

6. Outcomes: change in all or

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some of the KAP
 Metho
Message d
material

Audienc
Educator e
(Sender) (Receive
r)

Feedback

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Outcome
 Methods of health education

I. Direct face to face education

a. One to one contact (1:1):
• Expensive
• Good in specific situations (sensitive issues like sexually transmitted
diseases or with resistant recipients or those who lack health literacy).
• Allows interaction and response to the needs of the client. This method is
the most effective in change of practice.
b. One to more than one contact (1:>1):
• Seminar, Group discussions, Lectures, Demonstrations, Public speaking

II. Indirect education (Mass Media)

19 III. E-Health and mobile health

 Materials for Health education

Teaching aids that facilitate the education process.

• Chalk and board.
• Flip chart.
• Data show.
Special groups need
• Hand outs and written materials (posters and fliers).
innovations and creativity in
developing health education
• Videos and info graphics. materials as:
• Film projection. - Children enjoy puppet
shows, songs, drawings,
• Cassettes and tapes. puzzles...etc
- Adolescents respond to
competitions, games, social
media, mobile apps....etc.
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 Behaviour and Health

• Research has confirmed that some behaviours are major risk factors
of diseases, both communicable and non-communicable.

• Evidence is accumulating that behaviour changes to adopt healthy

lifestyle can reduce subsequent risk of developing disease.

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 Health
related
behaviour

Preventive Illness Sick role

behaviour behaviour behaviour
The logical
Preventing or
extension of
detecting illness in
A person illness behavior to
an asymptomatic
recognizes signs complete
state.
or symptoms that integration into the
- immunizations
suggest a pending medical care
- routine
illness. system.
mammogram for
How will he act? The extent to
breast cancer
which the doctor's
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advice is applied.
 Illness behaviour

Felling
sympto
ms

Complianc
cure
e
Do Go to
nothing doctor
No complication
Self complianc s
treatmen e
t
Go to
pharmac
23 y
 Factors affecting health behaviour

• Intrapersonal capacity: Individual characteristics that influence

behavior may be knowledge, attitudes, beliefs, personality traits, life
experience and rearing practice.
• Interpersonal supports: family, friends and peers that provide social
identity, support and role definition.
• Community factors: Social networks and norms, or standards, which
exist formally or informally among individuals, groups and
organizations.
• Rules, regulations, and policies: it may constrain or promote
recommended behavior. Laws that regulate or support healthy
actions and practices for disease prevention, early detection and
control are so effective in helping communities to adopt healthy
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behaviors.
 Behavior change models

• Many models were constructed to understand the roots of behaviors

and how could we help people to change their behaviors.
• In the field of health, Health Believe Model (HBM) was constructed
and used in the process of behavior change.
• The Health Belief Model originated to help predict public attitudes
and actions around health issues. There are perceived variables that
imply that health-related action is valuable, so this supports the
desired behavior change.

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 The Health Belief Model

1. Perceived susceptibility:
2. Perceived severity:
3. Perceived benefits:
4. Perceived barriers:
5. Self-efficacy:
6. Cues to action:

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 The Transtheoretical or ''stage of change'' model
(revolving door model):
1. Precontemplation stage: the person is Unaware of
the problem.
2. Contemplation stage: thinking about change in
near future. e.g., may I’ll walk next week.
3. Preparation stage: planning and serious decision
to change. e.g., Where will I walk?
4. Action stage: implementation of specific action
plans. e.g., ‘’I’m going out for a walk now’’.
5. Maintenance stage: continuation of the desired
actions & repeat recommended steps. e.g., ‘’I
walk most days’’.
6. Relapse stage: most people are still unable to exit
28 from the cycle. So, they relapse back and repeat
the cycle.
 References
• World Health Organization, Regional Office for the Eastern Mediterranean Health
education: theoretical concepts, effective strategies and core competencies: a
foundation document to guide capacity development of health educators, WHO,
2012.
• CDC, Morbidity and Mortality Weekly Report (MMWR), Appendix C: Principles for
Providing Quality Counseling. April 25, 2014/63(RR04); 45-46, Last seen 15 May
2016
• The Essential Handbook for GP Training & Education, Revisiting Models of the
Consultation, Source of this document www.essentialgptrainingbook.comLast
seen 15 May 2016
• Fragstein etal. 2008-Medical Education: UK consensus statement on the content
of communication curricula in undergraduate medical education.
• Fong Ha J, and Longnecker N: Doctor-Patient Communication: A Review, Ochsner
J. 2010 Spring; 10(1): 38-43.
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• WHO | Health educationwww.who.int/topics/health_education/en/
Thank
you