HEALTH COMMUNICATION

Dr Pramod P. Kulkarni
Associate Professor
Community Medicine Dept
Symbiosis Medical College For Women, Pune.
 Outlines/Learning objectives
• Introduction
• Definition of communication
• Elements of communication
• Communication process
• Types of communications
• Characteristics of effective communication
• Barriers to effective communication
• Tools for effective counseling
 What is Communication?
Communication can be defined as the
process by which people share ideas, experience,
knowledge and feelings through the transmission
of symbolic messages.

The means of communication are usually

spoken or written words, pictures or symbols. But
we also give information through body language,
gestures, and looks, facial expressions can show
how we feel and what we think about an issue or
another person.
 What are the most common ways
we communicate?

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Elements of Communication
• All three elements are essential.
1. Message
2. sender
3. Receiver
• Without any one element, communication cannot occur.
 Communication Key Elements
•Message
•Source (sender)
•Channel
•Receiver
•Filter
•Feedback
 The Communication Process

Medium

Barrier
SENDER RECEIVER
(encodes) (decodes)
Barrier

Feedback/Response
 Characteristics of effective communications

Effective communication requires the message to be:

• Clear and concise
• Accurate
• Relevant to the needs of the receiver
• Timely
• Meaningful
• Applicable to the situation
• credible
Characteristics of effective communications

Effective communication requires the sender to:

• Know the subject well like educational & socio-economic

status.
• Be interested in the subject and empathetic
• Know the audience members and establish a rapport with
them
• Speak at the level of the receiver
• Choose an appropriate communication channel
 Characteristics of effective communications

The channel should be:

• Appropriate
• Affordable
• Appealing
 Characteristics of effective communications

The receiver should:

• Be aware, interested, and willing to accept the message
• Listen attentively
• Understand the value of the message
• Provide feedback
Characteristics of effective
communicator
An effective verbal An effective nonverbal
communicator: communicator:
• Clarifies • Relaxes
• Listens • Opens up
• Encourages empathically • Leans toward the other
• Acknowledges person
• Restates/repeats • Establishes eye contact
• Shows appropriate facial
expressions
Listening
• Essential part of effective communication.
• Paying attention to and making an effort to hear
what the other person is saying.
• Requires constant practice.
• Being a good listener makes you a better health care
worker.
Listening
• Good listening skills:
• Show interest and concern for what the speaker is saying.
• Be alert and maintain eye contact with the speaker.
• Avoid interrupting the speaker.
• Pay attention to what the speaker is saying.
• Avoid thinking about how you are going to respond.
Listening
• Try to eliminate your own prejudices and see the other
person’s point of view.
• Eliminate distractions by moving to a quiet area for the
conversation.
• Watch the speaker closely to observe actions that may
contradict what the person is saying.
• Reflect statements back to the speaker to let the speaker
know that statements are being heard.
Listening
• Ask for clarification if you do not understand part
of a message.
• Keep your temper under control and maintain a
positive attitude.
• Good listening skills also help you follow directions,
make good observations of patients, and understand
your fellow workers.
Behavioral objectives of communication – the receiver

• Became aware about certain idea

• Gain adequate knowledge about an idea
• Increase motivation to carry out task
• Learn new skills to do something
• Change lifestyle to fit into new environment
• Maintain changed behaviour
Feedback
• Used to determine if the communication is
successful.
• Occurs when the receiver responds to the message.
• Allows the sender to evaluate how the message was
interpreted and to make any necessary adjustments
or clarification.
• Can be verbal or nonverbal.
 Types of Communication
Downwards Communication : Highly Directive, from Senior
to subordinates, to assign duties, give instructions, to inform to
offer feed back, approval to highlight problems etc.
Upwards Communications : It is non directive in nature from
down below, to give feedback, to inform about
progress/problems, seeking approvals.
Lateral or Horizontal Communication: Among colleagues,
peers at same level for information level for information
sharing for coordination, to save time.
HIERARCHY LEVEL
Executive Director Manager

Vice President
Supervisor 1 Supervisor 2 Supervisor 3
A.G.M.

Manager

Supervisor Horizontal Comm.

Forman
Communication Styles
• Passive communication:
-Allows others to control the conversation.
• Aggressive communication:
-Takes power away from others and
communication breaks down.
• Most people communicate in all three styles,
depending on their feelings or thoughts at the time.
• Most effective style is Assertive.
Communication Styles
• Assertive Communication:
• An honest and direct way to say what you feel or think.
• You have the right to be heard and believed by others.
• You must understand that it is OK for you and for
others to say no when it is appropriate.
• Does not take power or authority away from others.
• Empowers you to speak up and be heard.
Types of Communication
 Components of “face to face”
communication
Three major parts in human face to face

communication:
 55% of impact is determined by body

language
postures

gestures

eye contact

 38% by the tone of voice

 Nonverbal Communication
• Ideas and feelings are
communicated by more than the
words we speak or write.
• Messages are also sent nonverbally
by:
paralanguage (how the voice

sounds),
kinesics (facial expressions, eye

contact, posture, and gestures),

 Nonverbal Communication

Becoming aware of nonverbal

signals helps individuals improve

ability to control these elements in
their own communication.
Individuals can also become more

skilled at interpreting nonverbal

cues, thus enhancing their
 Eye Contact
The interpretation of much nonverbal
communication is culture dependent.
Eyes are the most expressive element in face-
to-face communication.
 Individuals who maintain direct eye contact
are usually considered to be open, honest,
and trustworthy.
"Shifty" eyes suggest dishonesty.
 Downward gaze may be interpreted as a
sign of submission, inferiority, or humility.
 Gestures
The interpretation of gestures depends
greatly on the situation and also on the
culture.
Some hand gestures are recognized and
easily interpreted.
Shaking the index finger indicates a
warning,
Showing the palm symbolizes a peaceful
greeting.
Crossed arms mean "I will not let you
in”.
Rubbing the nose with a finger
 Posture
The way individual stands and hold
their body sends messages about
self confidence.
Stooped or bowed shoulders may
signal that the individual
burdened, self conscious, lacking
confidence, submissive, beaten,
guilty, or afraid.
A straight back with squared
shoulders typifies strength and
 Image /Appearances
The image an individual projects and the

objects surrounding that person can

communicate nonverbally
Clothing, for example, tells a great deal

about an individual's status, occupation,

self-image, and aspirations. Clothing
communicates a nonverbal message
indicating worth, integrity, and
trustworthiness.
 Proxemics
Proxemics refers to the amount of space
that individuals naturally maintain
between each other.
Sociologists report four territorial zones:
 intimate space (up to 50 cm),
 personal space (30-75 cm),
 social space (120 to 200 cm ),
 public space (300 cm or more).
Individual resent when their territorial
space invaded.
Business conversations may take place in
personal or social space, but never in
Communication Styles
• Assertive Communication:
• An honest and direct way to say what you feel or think.
• You have the right to be heard and believed by others.
• You must understand that it is OK for you and for
others to say no when it is appropriate.
• Does not take power or authority away from others.
• Empowers you to speak up and be heard.
Communication Styles
• Passive communication:
-Allows others to control the conversation.
• Aggressive communication:
-Takes power away from others and
communication breaks down.
• Most people communicate in all three styles,
depending on their feelings or thoughts at the time.
• Most effective style is Assertive.
 Platforms of
Communication skills
• Every platform for communicating is a communication
event. This includes:
Formal meeting, seminars, workshops, trade fairs, etc.
The communication media such as radio, TV,
newspapers, etc.
The communication technologies include pagers,
phones, etc.
The communication professionals include advertisers,
journalists, camera crew, etc.
Communication approaches

• Individual
• Group
• Mass
Methods in Health Communication

Individual approach
• Personal contacts
• Home visits
• Personal letters
Methods in Health Communication
Group approach
Lectures
Demonstrations
Discussion method
-Group discussion
-Panel discussion
-Symposium
-Workshops
-Conferences
-seminars
-Role play
Methods in Health Communication
Mass approach
T.V., Radio, Newspaper
Printed Material, Direct
Mailing,posters
Exhibition,museum
Folk Methods,Inter-net
 The Doctor-Patient
Relationship
• The doctor-patient relationship is central to the
practice of medicine and is essential for the
delivery of high-quality health care in the
diagnosis and treatment of disease.

• Rapport maintains a professional relationship

with patients, uphold patients’ dignity, and
respect their privacy.
 The Doctor-Patient
Relationship
• A patient must have confidence in the
competence of their doctor.
• Some medical specialties, such as psychiatry and
family medicine, emphasize the doctor-patient
relationship more than others, such as pathology
or radiology.
• The doctor-patient relationship forms one of the
areas of contemporary medical ethics.
 What can doctors do?
 Cultivate a patient-centred partnership:
“The patient desires to be known as a human being”, not
merely to be recognized as the outer wrappings for a
disease.
 Check posture and body language.
A study of time perception found that when doctors sat
down during an office visit, the patients always thought
the visit was longer than when the doctors remained
standing, even though the length of both visits was
exactly the same.
 What can doctors do?
• Solicit the patient’s concerns and opinions through open-
ended questions, such as:
“What’s been going on since you were here. last?”.
• Work on mutual trust.
Research confirms that the health of the doctor-patient
relationship is the best predictor of whether the patient will
follow the doctor’s instructions and advice.
• Develop a system to communicate test results to patients.
About half the
doctors surveyed thought it was important to inform
patients of normal results, but only 28% always did so .
 What can doctors do?
• Respect patients as experts in the experience of illness.
Traditionally, doctors have
been taught to view the patient as “an unreliable narrator”
and to chart patient observations in subjective language that
implies a certain skepticism, such as “the patient believes”
or “the patient denies.”
• A patient-centered relationship accepts the patient’s unique
knowledge as just as important to outcome as the doctor’s
scientific knowledge.
“The medical visit is considered a meeting between experts.”
 What can patients do?
• Know how to tell illness storey.
• Many patients tend to start with interpretation, “I think I have
bronchitis” rather than plain facts, “I’ve been coughing for two
weeks.”
• Study your doctor’s individual style.
• What are his/her likes and dislikes, strengths and weaknesses?
Optimistic or pessimistic? Intense or mellow? Organized or absent-
minded? Cautious or a risk-taker? The more you understand how
your doctor thinks, the more likely you’ll know which approaches will
work and which won’t.
 What can patients do?
• Learn about illness so you can ask the right questions and
help make decisions. Patients who take an active role in
their care do better and earn more respect from the
doctor.
• Be willing to demonstrate the attitudes that you want from
your doctor.
For example, if you would like more give and take in the
relationship, demonstrate your own flexibility by offering
to negotiate and make concessions.
• Accept realistic treatment goals.
“Many chronic diseases can be managed, but not cured”.
 Relationships with patients
GMC Good Medical Practice

• Relationships based on openness, trust and good

communication will enable you to work in partnership with
your patients to address their individual needs.
• To fulfil your role in the doctor-patient partnership you must:
–be polite, considerate and honest
–treat patients with dignity
–treat each patient as an individual
–respect patients’ privacy and right to confidentiality
–support patients in caring for themselves to improve and
maintain their health
–encourage patients who have knowledge about their
condition to use this when they are making decisions about
their care.
 Outcome of Effective Use of
Communication Skills
• When doctors use communication skills effectively, both they and
their patients benefit. The effect can be that:
Patients' problems are identified more accurately;
Patients are more satisfied with their care and can better
understand their problems;
Patients are more likely to comply with treatment or lifestyle
advice;
Patients' distress and the vulnerability to anxiety and
depression are lessened;
 Outcome of Effective Use of
Communication Skills
The overall quality of care is improved by ensuring that
patients' views are taken into account;
Doctors' own wellbeing is improved;

Fewer clinical errors are made;

Patients are less likely to complain;

There is a reduced likelihood of doctors being sued.

Characteristics of Good advice
• Epidemiologically Correcet
• Affordable
• Culturally Acceptable
• Realistic
• Meets Felt Need
• Easy To Understand
Barriers to communication

Definition of the Barrier to Communication:

• ‘Any obstacle or problem in the process of Communication
which hinders/obstructs the process of Communication is
called Barrier.’
 Barriers to communication
• Language
• Values and beliefs
• Sex/gender and age
• Economic status
• Educational level
• Physical barriers
• Attitude
• Timing
• Understanding of message
• Trust
 Personal barriers to effective communication

A lack of skill and understanding - for example

the failure to understand the importance of using
clear and simple language, giving structured
explanations and listening to patients' views and
encouraging two-way communication;
Undervaluing the importance of communicating -
for example not appreciating the importance of
keeping patients adequately informed;
 Personal barriers to effective
communication
Negative attitudes by doctors towards communication
and giving it a low priority due to their concern
primarily to treat illness rather than focus on patients'
other needs which may be psychological or related to
social wellbeing;
A lack of inclination to communicate with patients.
This can be due to a lack of time, uncomfortable topics,
lack of confidence and concerns relating to
 Personal barriers to effective
communication
Human failings, such as tiredness and stress;

Inconsistency in providing information.

patient is given conflicting information by different
healthcare providers;
Language competence.
Organisational barriers to effective
communication
Organisational barriers are usually outside a doctor's direct
control and include:
having a lack of time,

pressure of work

being subjected to interruptions.

Overcoming Communication
Barriers
• Use of Simple Language
• Reduction and elimination of noise levels
• Active Listening
• Emotional State
• Simple Organizational Structure
• Avoid Information Overload
• Give Constructive Feedback
• Proper Media Selection
 Overcoming Communication
Barriers
How to overcome the Physical Barriers:
• By overcoming defects in communication system ,by
controlling noise ,physical distance Physical Barriers can be
overcome to some extent. Though we can’t overcome some
physical barriers such as time , distance or defects in machine,
we can control Physical barriers to some extent. Efforts are
required by all people to overcome physical barriers.
 Overcoming Communication
Barriers
Language Barrier:
• There should be respect for any language before learning new
language.
• It requires many efforts to learn foreign language.
• So learning the correct pronunciation and accent and
improving vocabulary [word power]we can master a language.
• We have to improve listening skills and then only language can
be understood properly.
 Overcoming Communication
Barriers
Socio –Cultural Barriers: These Barriers can be overcome by proper
study of other cultures . It is very much essential to learn new cultural
values and observing people and accepting their cultures .We have to
develop open mindedness in this regard. We have to understand the
mannerisms of other people.
 Overcoming Communication
Barriers
Psychological Barriers:
• There must be acceptance of ones mistakes or limitations.
• We have to be humble and respectful towards other people.
• Many times the sender and the receiver are not in proper frame of
mind. So this creates problems in Communication.
• Misunderstanding, lack of interests, mental and physical disturbance.
• Efforts should be taken by superiors and all reporting people to
overcome the problems
 Success for YOU…

…in the new global and diverse

workplace requires
excellent communication skills!
Questions
Thank you