HU, CMHS, School of Public Health

Health communication
4.1 Definition of Communication
To communicate means (dictionary definition) “to impart, pass on or transmit a
message, information, etc.; to exchange ideas or information with, be in touch with, to
have access, to be connected with,” and communication means “the act of
communication, the things communicated, the means of communicating” Essentially
communication deals with transmission of information or ideas and sharing and
exchanging of information.
Communication is the process by which two or more people exchange ideas, facts,
feelings or impressions in ways that each gains a common or mutual understanding of
the meaning and the use of the message. Evert M. Rogers (1993) defined
“communication as the process by which an idea is transferred from a source to a
receiver with intent to change his/her behavior.”
4.2 What is Health communication?
Health communication is the art and technique of informing, influencing, and motivating
individuals, institutions, and large public audiences about important health issues based
on sound scientific and ethical consideration.
When communication is used strategically to disseminate messages related to health,
make people aware about diseases, encourage them to adopt healthy practices, sustain
positive healthy behavior, empower them to make healthy choices in their life……….
This process is called HEALTH COMMUNICATION. Therefore, health communications
should be included as one key element in an integrated program designed to address a
health problem or to convert health policy to action.
4.2.1 Importance of health communication
- Increase knowledge and awareness about health issue
- Influence beliefs, attitudes, and social norms
- Prompt action and develop skills
- Increase demand for health services
- Change lifestyle to fit into new environment
- Maintain changed behavior

Why health communication is important in healthcare (patient-centered care)?

Communication is essential in healthcare because it directly impacts the quality of patient
care, safety, and satisfaction. In essence, good communication is foundational to patient-
centered care, as it impacts every aspect of the healthcare journey, which includes:
a) Improves Patient Outcomes - Clear communication between healthcare providers
and patients ensures accurate information exchange, helping providers make correct
diagnoses and effective treatment plans. Consequently, when patients understand
their treatment and medication instructions, they are more likely to follow their
healthcare plan, leading to better health outcomes.
b) Enhances Patient Safety and reduces errors – Miscommunication is a common
cause of medical errors, which can be life-threatening. Clear instructions, accurate
charting, and effective handovers between shifts help reduce errors. An effective

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communication also allows patients to understand the risks and benefits of treatment
options, enabling them to make informed decisions about their care.
c) Builds Trust and Increases Patient Satisfaction – When healthcare providers
communicate effectively, patients feel valued, respected, understood, and tend to be
more satisfied with their healthcare experience, which contributes to fostering trust
and enhancing positive outcomes.
d) Promotes Team Collaboration and efficient care coordination – Good
communication among healthcare teams ensures smooth coordination, minimizes
redundancies, and promotes consistency in care. It also enhances interdisciplinary
teamwork among various healthcare professionals (doctors, nurses, midwifes, lab
professionals, pharmacists, etc.) to work together cohesively, ensuring comprehensive
and holistic patient care.
e) Supports Emotional and Psychological Wellbeing – Open communication helps
patients feel less anxious, particularly in stressful or unfamiliar healthcare situations.
Healthcare providers who communicate with empathy can offer emotional support,
which is essential for patients facing difficult diagnoses or treatments.
f) Decreased Readmissions – Effective discharge communication (instructions,
follow-up care) helps reduce hospital readmissions and associated costs.

4.2.2 Relevance to Health Education

The terms ‘health promotion’ and ‘health education’ have been used interchangeably.
Today it is a generally considered that health promotion is the broad umbrella that tries
to facilitate access to a healthy life for everyone. It encompasses transport, housing,
environment and agriculture, to name but a few. Health education is predominately
considered to be providing information to an individual or group to facilitate them to make
informed choices about their lifestyles.
Communication contributes to all aspects of disease prevention, health promotion and
health education for individuals, communities and whole populations. Health
communication many occur in different areas such as schools, home and work, and in
many different formats such as the mass media, flyers, newsletters, advertising and
posters. The choice of format for the presentation of information depends on many points
such as what the topic is, whom the target group is, who is planning to give the
information, where the information is being given and the amount of time
planned/available.
It is known that using more than one form of communication is more effective in
increasing understanding, than using only one, e.g. if providing information on
breastfeeding to a group of women, a midwife may discuss the topic with the women,
provide leaflets, show a video, provide some website addresses and invite a woman who
is breastfeeding to come to talk about her experiences.
It also helps to mobilize the community, to implement health education programs & to
coordinate with different agencies. In general, health communication is conducted with
the ultimate goal of creating behavioral change among target groups.

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4.3 Principles of Effective Communication

1. Perception: For communication to be effective the perception of the sender should
be as close as possible to the perception of the receiver. The extent of understanding
depends on the extent to which the two minds come together.
2. Sensory involvement: For effective communication there should be involvement
of more than one sensor organ for giving a cumulative effect. The more sensory
organs involved in a communication the more is its effectiveness from their
cumulative effect.
3. Face to face: The more communication takes place face-to-face the more its
effectiveness.
4. Feedback (two-way): Any communication without two-way process is less effective
because of lack of opportunity for concurrent, timely & appropriate feedback.

Effective health communication can do….

For individuals  Raise awareness of health risks and solutions
 Provide the motivation and skills needed to reduce those risk
 Help them find support from other people in similar situations
 Affect or reinforce attitudes
For community  Influence public agenda, advocate for policies and programs,
 Promote positive changes in the socioeconomic and physical
environments
 Improve the delivery of public health and health care services
 Encourage social norms that benefit health and quality of life
In general health communication interventions can:
▪ Help in bringing about desired changes in people’s belief and behavior or in their
physical and social environment
▪ Reduce disease promoting behaviour
▪ Increase health promoting behaviour

4.4 Components of communication

A. Source (sender)
The sender is the originator of the messages. It can be an individual or groups, an
institution or organization. The sender (source) should be the one who share similar
backgrounds with the receivers. People are more likely to believe and trust person or
organizations that share some characteristics with them. The sender decides the idea to
be communicated, to whom it should be communicated and the intended impact of the
communication.
Characteristics of the source of a message play an important role in the effectiveness of
communication. Credibility, attractiveness, likeability, and the power of the communicator
have been shown to affect the outcome of communication processes.
Communication fails when the source comes from a different background from that of
the receiver/target audience and uses inappropriate message content and appeals.

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Qualities of source/sender were being empathetic (putting one-self in the position of

others) and credibility, particularly, the messengers
Credibility can come from:
✓ A person’s natural position in the family or community
✓ Through their personal qualities or actions — for example, a health care worker
and other professionals who are close to the community
✓ The extent to which the source of communication shares characteristics such as
age, sex, education, religion or experiences with the receiver/audience.
B. Receiver/audience
The person or the group for whom communication is intended to or targets of the
message.
The 1st step in planning any communication is to consider the intended audience. A
method which is effective with one audience may not succeed with another. Therefore,
the communicator always has to consider the culture, age, educational level, visual
literacy and media habits of the receiver while designing the message. Additionally, the
words that the audiences use in everyday conversation; socio-cultural contexts; and
their beliefs related to the topic of communication should also be considered.

C. Message
Refers to ideas, facts, feeling, that passed from the sender to the receiver. It is the
subject matter of communication-something that is considered important for the
audience to know or do. The content of the message should be appropriate and
attractive to the receiver. The content of the message could be organized in different
ways so that it can persuade or convince people. These are called appeals.
Not everyone responds, in the same way. What might persuade you might be quite
different from what might persuade another person. For example, what type of appeals
might convince persons with little or no schooling; persons with high educational level;
children; and health workers.

Types of appeals in health communication

1) Fear arousal appeal
This type of message is conveyed to frighten and arouse people into action by emphasizing
the serious outcome from not taking action. Symbols such as dying people, coffins,
gravestones or skulls may be used. Fear-arousal appeals might be effective for a person
with little or no schooling. Evidence suggests that mild fear can arouse interest, create
concern and lead to behaviour change. However, a very strong and fearful message might
put people off.
2) Humor
The message is conveyed in a funny way such as cartoon. Humor is very good way of
attracting interest & attention. It can also serve a useful role to lighten the tension when
dealing with serious subjects and it can result in highly effective remembering and learning.
However, Humor is also very subjective /may not be funny for everyone

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3) Logical / factual appeal

The message is conveyed to convince people by giving facts, figures and information, e.g.
facts about Covid-19: its causes, number of infection, means of prevention etc. The
logical/factual appeal carries weight with a person of high educational level. Information
on its own is usually not enough to change behaviours and various appeals must be tried
to see what works best.

4) Emotional appeal
The message is transmitted by arousing emotions and feelings rather than giving facts and
figures. A poster or leaflet might use this approach by showing smiling babies or wealthy
families and associating such images to create a positive healthy impression. A less
educated person will often be more convinced by simple emotional appeals from people
they trust.
e.g. by showing smiling babies, wealthy families with latrine etc, and associating with FP
education.

5) One sided message

Only presents the advantages of taking action & does not mention any possible
disadvantages. E.g. Educating the mothers only about benefits of oral contraceptive pill but
not explaining the side-effects or risks associated with the pill.
Compared with two sided messages, presenting only one side of an argument may be
effective:
1) If your audience will not be exposed to different views.
2) If our communication is through mass media such as radio, TV, newspaper etc. because the
audience may only grasp part of a message or selectively pick up points that they agree with.
Presenting only one side of an argument may be effective provided your audience will not
be exposed to different views at other times. However, if they are likely to hear opposing
information, such as the side-effects from a drug, they may be suspicious about taking
your advice in the future. It is better to be honest. If communication is through mass media
such as radio, TV or newspapers, the audience may only grasp part of the message or
selectively pick up the points that they agree with.

6) Two-sided message
A two-sided message presents both advantages & disadvantages of taking action. It’s
appropriate if:
• The audiences are used to being exposed to different views and are literate
• You are face-to-face with individuals or groups: this makes it easier to present both
sides and make sure that the audience understands the issues.

7) Positive and Negative appeals

Positive appeals are communications that ask people to do something positive, e.g.
breastfeed your child, use a latrine. Whereas negative appeals ask people not to do
something, e.g. do not bottle feed your child, do not defecate in the bush.
Negative appeals use terms such as ‘avoid’ or ‘don’t’ to discourage people from
performing harmful behaviours. But most health educators agree that it is better to be
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positive and promote beneficial behaviours instead of relying on negative appeals. Positive
appeals do seem to work better than negative one's because they help people see the
benefits of change.

D. Channel
A channel is the physical bridge or the media by which the message travels from a
source to a receiver. The commonest types of channels are audio, visual, printed
materials or combined audio visual & printed materials.
For an effective communication to happen, the channel to be selected should be familiar
both to the communicator and communicatee; appropriate to deliver the message; and
available and accessible to the target audience.

E. Feedback
Feedback is the mechanism of assessing what has happened on the receivers after the
communication has occurred. A communication is said to have feedback when the
receiver of the message gives his/her responses to the sender of the message. The
sender must know how well the messages have been received by the receiver,
understood, interpreted, and act up on it. It completes the process of communication.
The effect of feedback is a change in the receiver’s knowledge, attitude and practice or
behaviour. There is a positive effect when a desired change in knowledge, attitude or
practice occurs, and a negative effect when the desired change does not occur.

4.5 Communication Process

Is the whole sequence of transmission and interchange of facts, ideas, feeling, etc. As
a process, it is routine and continues forever. It is an ever-ending process, cycle.

Code: is a group of symbols that can be structured in a way that is meaningful to others. e.g language.

Encoding: is the conversion of the subject matter into symbol. Encoding process
translates ideas, facts, feelings, opinions etc. into symbols, signs, actions, pictures,
audio-visuals etc.
Decoding: is a mental process by which the receiver gives meaning to the message
received through their sensory organs. The receiver converts the symbols, signs, words,
pictures etc. received from the sender and give meaning to the message in according
to their way of thinking.

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4.6 Communication models

A) Linear (one –way) model
The flow of information from the sender (source) to the receiver is one-way or
unidirectional. The communication is dominated by the “sender’s knowledge”.
“Information is poured out”. This model does not consider feedback and interaction
with the sender. A familiar example is the lecture method in classrooms.

Advantages Disadvantages
-Faster -Little audience participation
-Orderly -No feed back
-Does not influence behavior

Figure: One-way communication

B) Systems (Two –way)

Information flows from the source to the receiver & back from receiver to the source.
This is reciprocal in which the communicant (audience) becomes the communicator
(sender) & the communicator (sender) in turn becomes a communicant (audience).
Roles are interchanged. It is more appropriate in problem solving situations.

Advantages Disadvantages
-More audience participation - Slower (time taking)
-Learning is more democratic - Not orderly
-Open for feed back
-Influence behavior change

Figure: Two-way communication

4.7 TYPES OF COMMUNICATION

There are 3 main types of communication: Intrapersonal, interpersonal, & Mass media.
A) Intrapersonal
It takes place inside a person. It is silent talking all of us do in our self, such as thinking,
feelings and justification we make for our actions. It is used for clarifying ideas or
analyzing a situation and to reflect upon or appreciate something.
B) Interpersonal (face-to-face)
Form of communication involving direct interaction between the source & receiver.

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In most instances the decisive criterion for face-to-face communication is

communication at the same time & place. Example: counseling to small group or large
group, lecture/ public meeting.
Midwives spend a great deal of their time in face-to-face communication with women,
couples and families. Midwives require effective communication because good
communication can make a person feel valued and listened to and improve
understanding. Effective communication underpins health information, it reduces
anxiety and improves understanding which, in turn, helps clients to make appropriate
decision.
Advantages
- Dynamic or bi-directional information exchange
- The communication happens in both directions from the source to the receiver
& vice versa.
- Have mechanism to assess audiences feed back
- Give chance to raise question & discuss so that the idea is understood at the
same time
- Multisensory (channel)
Limitations
- Easily distorted – as we mostly rely on word-of-mouth.
- Needs personal status/ credibility
- Needs professional knowledge & preparation

C) Mass media communication

Mass communication is a means of transmitting messages, on an electronic or print
media to a large segment of a population. Main effect of this type of communication
includes increased knowledge/awareness, useful to communicate new ideas to early
adopters, and influence behaviors at the early stages.
Advantages
- They can reach many people quickly.
- They are believed to be accurate e.g. newspaper article or TV show of highly
respected person.
- They can provide continuing reminders and reinforcement.
Limitations
- One sided /no feedback
- Selective perception: Because the audience may only grasp part of the message
or selectively pick up the points that they agree with and ignore other
- Does not differentiate the target - As mass media are broad cast to the whole
population, it is difficult to make the message to fit to the local needs of the
community whose problems and needs may be different from the rest of the
country.

4.8 FORMS OF COMMUNICATION

According to the way of expression there are three types of communication: Verbal/oral
communication, Non-verbal communication and Written communication
A. Oral or Verbal communication
It is communication by Word of mouth. In oral communication, speech or talk is the
widely adopted tool of communication. The message is received through our ear. May
also use mechanical devices such as telephone, radio, etc. Factors that influence verbal
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communication -- using jargon and complex terms, pitch and tone of voice, and gender
difference.
B. Written communication
It involves the exchange of facts, ideas, and opinions through a written instrument
/material. Individuals or groups come in touch with each other and share meaning and
understanding with each other through written materials like letters notes, leaflets,
reports, handouts, newspapers.
C. Non-verbal communication
A communication that occur without a word at all. Much communication also takes place
through non-verbal communication. The main function is to give clues about what is
being said. This may be, the gestures we use (hand movements, raising eyebrows,
shape of mouth, smiling, head nodding), how we look at people, how we are seated,
and our clothes can all have an impact on the way people interpret what we say.
Non- verbal communication can be interpreted in different ways according to the culture
of the community. For example, in western culture much importance is given to looking
people straight at some one’s eye. In other cultures, looking at some ones’ eye can be
considered rude and showing lack of respect.

4.9 STAGES OF HEALTH COMMUNICATION

In health education and health promotion you communicate for a special purpose — to
promote improvement or change in health through the modification of the factors that
influence behaviour. To achieve these objectives, successful communication must pass
through several stages:

Sender Audience

For effective communication the message should be

Reaching the audience Seen or heard by its intended audience

communication must attract attention so that people

Attracting attention will make the effort to listen and read it

Once the person pays attention to a message he/she

Message Understood then tries to understand it

Promote Change/acceptance A communication should be believed & accepted

A communication should result in a change in beliefs

Behavior Change and attitudes and it influence behavior/action

Improvement in health will take place, after change

Improvement in Health in behaviour.

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4.10 EFFECTIVE COMMUNICATION

Effective communication occurs when there is shared meaning. The message that is
sent is the same with what is received. There must be mutual understanding between
the sender and the receiver for the transmission of ideas or information to be successful.
The only way communication can be effective is if the sender and the receiver attach
similar meanings to the message sent. For example, the sender shouldn’t use big terms
if the sender is illiterate or unable to understand the words. When the recipient
understands the information, then communication is complete. For an effective
communication, it is important to use language that is appropriate to others level of
understanding; make sure that other receive the intended information or knowledge;
talk with others in a way that facilitate openness, honesty and cooperation; and provide
feedback.
Qualities of communication
▪ The communicator should be knowledgeable, positive attitude, skilled and have
credibility.
▪ The message should be simple (or brief & clear) meaningful, appropriate, relevant,
and timely (SMART).
▪ The channel should be familiar, appropriate, available & accessible.
▪ The receiver should also be responsible with proper attitude to receive the
information.
Key points in communicating effectively
▪ The environment is important for effective communication to take place
▪ The methods and styles of communication should meet an individual’s needs
▪ Communication should be sensitive to the individuals needs and concerns especially
when communicating difficult, sensitive or complex information
▪ Communications should be supported with appropriate aids
▪ Culture and language difficulties should be addressed during communication

4.11 BARRIERS TO EFFECTIVE COMMUNICATION

Effective Communication takes place when the speaker delivers message clearly as well
as the listener understands the message. However, Effective communication does not
take place when there are obstacles known as COMMUNICATION BARRIERS.
Barriers to communication are the hindrances or difficulties involved in the process of
communication which distort the message from being properly understood by the
receiver. At any point in the communication process a barrier can occur. Barriers keep
us from understanding other’s ideas and thoughts.
1) Physical Barriers
Physical barriers are any kind of physical or environmental factors that hinder
communication from taking place effectively. These are obstacles present in the
environment which makes communication a difficult task to pursue, such as -difficulties

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in hearing, seeing, or inappropriate physical facilities. Some of the most common

physical barriers are space-proximity, noise, time, place and medium etc. These factors
can sabotage the value of communication as they can affect one’s ability to efficiently
process and interpret information.
2) Intellectual Barriers
- The natural ability, home background, schooling, affects the perception/
understanding of the receiver for what he sees & hears.
- The ability of the facilitator/ education/ instructor.
3) Emotional Barriers
- Readiness, willingness or eagerness of the receiver
- Emotional status of the educator
4) Environmental Barriers
- Noise, invisibility, congestion,
5) Cultural Barriers
- Customs, beliefs, religion, attitudes, economic and social class differences,
language variation.
6) Status of the source
- Status of the source either too high or too low as compared to the audience also
affects effectives
7) Inconsistencies between verbal & non- verbal communication

Overall, barriers could arise from the source, receiver, message and/or channel of
communication.

4.12 SEVEN CS OF EFFECTIVE COMMUNICATION

1. Command attention: - Attract and hold the audience’s attention. Use colors,
images, key words and design elements that make the material stand out so that it
is noticed and memorable.
2. Clarify the message: - Ensure the material conveys the message clearly, with
easy-to understand words and images
3. Communicate a benefit: - Stress how the audience will benefit from adopting the
new behavior.
4. Be consistent: - Ensure that content within and among materials does not conflict.
Repeat messages throughout the materials. Re-use the same words and phrases, as
appropriate. Also, re-use the same or related images and styles. This avoids
confusion and repetition enhances the impact of the message.
5. Carter to the heart and head: - People are swayed by both facts and emotions.
Use both to maximize the material’s persuasiveness
6. Create trust: - Trust and credibility allow and encourage the audience to heed the
message.
7. Call to action: - Include a clear call to action in materials. Tell audience members
precisely what they can do

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Competency Description on Interpersonal relationship and communication

Midwives engage in collaborative work with agencies and other health care professionals for the
benefits of women and their families. In order to achieve this outcome, the graduate is expected
to:
 Communicate clearly, sensitively and effectively with patients, their relatives or other careers,
and colleagues from the medical and other professions, by listening, sharing and responding.
 Communicate clearly, sensitively and effectively with individuals and groups regardless of their
age, social, cultural or ethnic backgrounds or their disabilities, including when the patient speaks
different language from the provider.
 Communicate by spoken, written and electronic methods (including medical records), and be
aware of other methods of communication used by patients. The graduate should appreciate
the significance of non-verbal communication in the medical consultation.
 Communicate appropriately in difficult circumstances, such as when breaking bad news, and
when discussing sensitive issues, such as alcohol consumption, smoking or obesity.
 Communicate appropriately with difficult or violent patients.
 Communicate appropriately with people with mental illness.
 Communicate appropriately with vulnerable patients.
 Communicate effectively in various roles, like as patient advocate, teacher, manager or
improvement leader.
 Work with individuals of other professions to maintain a climate of mutual respect and shared
values
 Use the knowledge of one’s own role and those of other professions to appropriately assess
and address the healthcare needs of the patients and populations served
 Communicate with patients, families, communities, and other health professionals in a
responsive and responsible manner that supports a team approach to the maintenance of health
and the treatment of disease.
 Apply relationship-building values and the principles of team dynamics to perform effectively in
different team roles to plan and deliver patient-/population-centered care that is safe, timely,
efficient, effective, and equitable

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