Communication complete topic psm

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Communication in PSM (Community Medicine) covers how health information is shared to influence knowledge, attitudes, and practices in individuals and communities.

Topic map

Meaning, elements, and objectives of communication
Communication process and the communication cycle
Types: one-way/two-way; verbal/non-verbal; formal/informal; interpersonal, group, and mass communication
Methods and media of health communication
Barriers to communication and ways to overcome them
Principles of effective communication
Health education: definition, aims, approaches, and content
Counselling, interview techniques, and doctor-patient communication
Behavior change communication, IEC, and social and behavior change communication

Quick overview

Communication involves a sender, a message, a channel or medium, a receiver, and feedback. In health practice, its aim is not merely to provide information, but to support informed and healthy behavior.

Two-way communication with feedback is usually most effective for health education because it permits questions, clarification, and assessment of understanding. Effective messages should be simple, relevant, culturally acceptable, actionable, and delivered through an appropriate medium.

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Communication process and types
Barriers and principles
Health education methods
IEC/BCC/SBCC and counselling

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WHO health education communication principles IEC behaviour change communication

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https://www.emro.who.int/child-health/community-information/…

Communication and Health Education in PSM

1. Meaning of communication

Communication is the process of sharing ideas, information, feelings, or messages between people to produce understanding and bring about a desired change.

In PSM, communication is not just giving information. It is used to produce changes in:

Knowledge: cognitive domain
Attitude and beliefs: affective domain
Skills and practices: psychomotor domain

Ultimate aim: informed individual and community participation, leading to appropriate health behaviour.
Park's Textbook of Preventive and Social Medicine, p. 958

2. Communication process / communication cycle

Communication is a continuous two-way process.

Sender → Message → Channel / Medium → Receiver
   ↑                                      ↓
   └──────────── Feedback ────────────────┘

Components

Component	Meaning	Example in health education
Sender / source	Person who originates the message	ASHA worker, doctor, teacher
Message	Content to be conveyed	“Give ORS after each loose stool”
Channel / medium	Route through which message travels	Counselling, poster, radio, WhatsApp
Receiver / audience	Individual or group receiving message	Mother of an under-five child
Feedback	Receiver's response to the message	Mother explains how she will prepare ORS

Qualities of an effective sender

The communicator should know:

Clear objective
Audience's needs, interests, literacy, culture, and language
Content of the message
Suitable channel
Personal abilities and limitations

The credibility, knowledge, social status, and acceptance of the communicator influence message acceptance.

Receiver / audience

The audience may be:

Controlled audience: assembled for a common purpose, such as antenatal clinic attendees or schoolchildren.
Uncontrolled audience: general public exposed to television, radio, newspaper, or social media.

Feedback

Feedback is the audience's reaction to a message. It shows whether the message has been understood, accepted, or rejected.

Immediate feedback: interpersonal communication, counselling, discussion.
Delayed feedback: mass media, assessed using surveys, interviews, comments, attendance, service utilization, or behaviour indicators.

Park's Textbook of Preventive and Social Medicine, pp. 958-960

3. Channels of communication

A. Interpersonal communication

Communication between two persons, usually face to face.

Examples

Doctor-patient discussion
ASHA worker counselling a mother
Home visit
Teacher-student interaction
One-to-one family planning counselling

Advantages

Personal and direct
Trust can develop
Immediate feedback
Message can be modified according to the receiver
Very useful for motivation and behaviour change
Useful for undecided persons

Limitations

Time-consuming
Covers few people at a time
Depends on communication skills of the health worker

B. Mass communication

One source communicates with a large population using mass media.

Examples

Television
Radio
Newspapers
Posters and hoardings
Internet and social media
Public-address system
Films and health campaigns

Advantages

Reaches a large population quickly
Useful for creating awareness
Economical per person reached
Useful during epidemics and public-health emergencies

Limitations

Usually one-way
Feedback is weak or delayed
Less personal
Usually insufficient by itself to change established behaviour

C. Folk or traditional media

Culturally familiar community media.

Examples

Folk songs
Street plays
Puppetry
Folk dance
Katha, keertan, harikatha
Nautanki
Burrakatha
Community and religious gatherings

Advantages

Locally accepted and culturally appropriate
Suitable for rural and low-literacy populations
Attractive and entertaining
Can improve participation and recall

Best practice: Combine mass media for awareness with interpersonal or group communication for discussion, motivation, and sustained behaviour change.
Park's Textbook of Preventive and Social Medicine, pp. 959-960

4. Types of communication

1. One-way communication

Message moves from sender to receiver with little or no feedback.

Sender → Receiver

Examples

Lecture
Radio talk
Television advertisement
Poster
Newspaper article
Public announcement

Merits

Can reach many people
Quick
Useful for imparting factual information

Demerits

Receiver remains passive
No clarification of doubts
Feedback absent or delayed
Less effective for changing attitude or practice

Also called the didactic method.

2. Two-way communication

Both sender and receiver actively communicate.

Sender ⇄ Receiver

Examples

Counselling
Interview
Group discussion
Demonstration with return demonstration
Classroom discussion
Doctor-patient consultation

Merits

Active participation
Immediate feedback
Clarification of doubts
Better understanding and retention
More effective for attitude and behaviour change

Demerits

Time-consuming
Reaches fewer people
Requires skilled communicator

Also called the Socratic method.

3. Verbal communication

Communication using spoken or written words.

Oral: talk, lecture, counselling, interview, group discussion.
Written: leaflet, pamphlet, booklet, newspaper, notice.

4. Non-verbal communication

Communication without words.

Includes

Facial expressions
Eye contact
Posture
Gestures
Touch
Tone of voice
Silence
Personal appearance

Non-verbal signals should match spoken words. A health worker who says “Please feel free to ask” but looks rushed or disinterested gives a contradictory message.

5. Formal and informal communication

Formal communication	Informal communication
Follows official lines of authority	Occurs through unofficial social networks
Example: official circular, staff meeting	Example: gossip, peer discussion, community rumours
More structured	Often rapid and influential

Informal channels can spread rumours, but may also be used positively through community leaders, peer educators, and influencers.

6. Visual communication

Use of visual materials to convey a message.

Examples

Posters
Charts
Graphs
Pictograms
Flash cards
Flipbooks
Maps
Models
Photographs
Slides and videos

Visual aids are particularly useful for low-literacy audiences and for demonstrating procedures.
Park's Textbook of Preventive and Social Medicine, p. 960

5. Barriers to communication

A communication barrier is anything that prevents correct transmission, understanding, acceptance, or action on a message.

Type	Examples	How to overcome
Physiological	Deafness, poor vision, speech difficulty, fatigue	Speak clearly, use visual materials, ensure seating and audibility
Psychological	Fear, anxiety, anger, prejudice, low motivation, mistrust	Build rapport, listen actively, use empathetic and non-judgmental approach
Language / semantic	Technical terms, unfamiliar language, ambiguous words	Use local language and simple words
Cultural	Customs, beliefs, religion, myths, stigma, gender norms	Respect beliefs, involve local leaders, adapt message culturally
Educational	Illiteracy, low health literacy	Use pictures, demonstrations, storytelling, teach-back
Environmental	Noise, crowding, poor lighting, heat, lack of privacy	Choose quiet, comfortable, private setting
Socioeconomic	Poverty, lack of time, unavailable services	Suggest affordable actions and ensure access to services
Message-related	Long, complex, irrelevant, contradictory message	Keep it short, specific, consistent, and practical
Source-related	Lack of credibility, poor communication skill	Use trusted trained communicators and accurate information
Organizational	Delays, bureaucratic channels, poor coordination	Use clear roles, timely messages, and defined referral pathways

Exam point: Social and cultural barriers may prevent healthy behaviour even when services are available.
Park's Textbook of Preventive and Social Medicine, p. 960

6. Health communication

Definition

Health communication is the use of communication methods and principles to provide information, educate, motivate, persuade, counsel, and help people and communities adopt healthy practices.

It is closely related to health education and is a foundation of preventive health care.

Functions of health communication

Information
Provide factual knowledge about health, disease, prevention, and available services.
Education
Improve knowledge, understanding, skills, and capacity for healthy decisions.
Motivation
Encourage people to convert knowledge into action.
Persuasion
Influence people to accept a recommended health action.
Counselling
Help an individual make an informed personal decision.
Raising morale
Build confidence, hope, and community spirit.
Health development
Promote individual and community actions for health improvement.
Organization
Mobilize people, resources, and community participation for health programmes.

Important: Information alone does not guarantee behaviour change. Behaviour is also influenced by beliefs, norms, affordability, service availability, family support, and local culture.
Park's Textbook of Preventive and Social Medicine, pp. 960-962

7. Health education

Definitions

A standard definition:

Health education is the process by which individuals and groups learn to behave in a manner conducive to the promotion, maintenance, or restoration of health.

Another definition:

Health education translates knowledge about health into desirable individual and community behaviour through an educational process.

Modern concept

Health education is not merely giving advice or instructions. It is a process that enables people to:

Want to be healthy
Know how to remain healthy
Do what they can individually and collectively to maintain health
Seek help when required

It emphasizes voluntary action, informed choice, community participation, and healthy environments.
Park's Textbook of Preventive and Social Medicine, p. 962

Objectives of health education

Health education aims to:

Increase knowledge about health and disease.
Create awareness of health needs.
Correct myths, misconceptions, and harmful beliefs.
Develop favourable attitudes towards health.
Motivate people to adopt healthy practices.
Develop practical skills, such as handwashing, ORS preparation, breastfeeding technique, condom use, and mosquito-net use.
Encourage early use of available health services.
Promote individual, family, and community participation.
Help communities identify their health problems and find solutions.
Support healthy public policy and environmental improvement.

Levels / targets of health education

Health education may target:

Individual: counselling for smoking cessation.
Family: nutrition education, sanitation, family planning.
Group: pregnant women, adolescents, schoolchildren, workers.
Community: immunization campaign, vector-control activity, sanitation drive.
Policy makers / leaders: advocacy for safe water, tobacco control, road safety.

8. Approaches to health education

1. Regulatory approach

The government uses laws, regulations, restrictions, or penalties to influence health behaviour.

Examples

Ban on smoking in public places
Mandatory helmet or seat-belt laws
Food-safety regulations
Control of adulteration
Quarantine and isolation laws
Regulations during epidemics

Merits

Can produce rapid population-level action.
Useful in emergencies and where individual behaviour harms others.

Limitations

May be coercive.
Cannot alone change personal beliefs or voluntary long-term lifestyle practices.
Needs public acceptance and effective implementation.

2. Service approach

Health services are made available, assuming that people will use them.

Examples

Immunization clinics
Antenatal services
Family planning services
Screening camps
Provision of ORS, condoms, iron-folic acid tablets

Limitation

Merely providing a service does not ensure its use. People need awareness, trust, motivation, affordability, accessibility, and supportive family/community norms.

3. Health education approach

People are given relevant knowledge and encouraged to make informed choices.

Features

Non-coercive
Helps people understand health problems
Provides alternatives
Encourages voluntary action
Promotes informed decision-making

Limitation

Knowledge alone may not produce practice if barriers such as poverty, social norms, or lack of services persist.

4. Primary health care approach

This is the most comprehensive approach.

Key features

Community participation
Intersectoral coordination
Self-reliance
Equity
Appropriate technology
Health education linked with available services and community development

This approach recognizes that health behaviour cannot be changed only by advice. Social, economic, environmental, and service-related factors must also be addressed.
Park's Textbook of Preventive and Social Medicine, pp. 963-965

9. Principles of health education

These are very important for exams.

1. Credibility

The message must be scientifically correct, culturally acceptable, and delivered by a trusted communicator.

Give accurate facts.
Do not exaggerate.
Be consistent.
Respect local values while correcting harmful practices.

2. Interest

Teach what people consider relevant to their real or felt needs.

For example, instead of saying “Maintain hygiene,” discuss how handwashing can reduce a child's repeated diarrhoea and family expenses.

3. Participation

People learn better by doing. Involve the community in identifying problems, planning solutions, implementation, and evaluation.

Examples

Community meeting to identify causes of open defecation
Mothers preparing ORS themselves
Villagers planning a mosquito-control campaign

4. Motivation

Awaken the desire to learn and act.

Primary motives: survival, hunger, safety, comfort.
Secondary motives: social approval, status, achievement, affection.

Use positive motivation where possible. Avoid fear-only messaging.

5. Comprehension

The message should match the audience's language, literacy, culture, and level of understanding.

Use simple words.
Use local language.
Avoid jargon.
Use illustrations and demonstrations.

6. Reinforcement

Repeat and reinforce the message at suitable intervals. One exposure is usually not enough for sustained behaviour change.

Examples: repeated counselling at antenatal visits; repeated handwashing messages in schools.

7. Learning by doing

Practical demonstration is superior to verbal advice alone.

Examples

Demonstrate ORS preparation.
Demonstrate correct handwashing.
Ask the learner for a return demonstration.

8. Known to unknown

Start from what the audience already knows and gradually add new information.

9. Setting an example

The health educator should practise what they teach.

A health worker counselling against tobacco should not smoke in public.

10. Good human relations

Be respectful, empathetic, patient, non-judgmental, and approachable. Rapport is essential.

11. Two-way communication

Encourage questions, discussion, and feedback. Do not treat health education as a one-way lecture.

12. Use of leaders

Involve formal and informal leaders such as teachers, religious leaders, panchayat members, women's group leaders, and respected elders.

13. Feedback

Check whether the audience understood and can act on the message.

Methods

Ask open-ended questions
Teach-back: “Can you show me how you will prepare ORS?”
Observe practice
Review attendance, uptake, and follow-up indicators

Park's Textbook of Preventive and Social Medicine, pp. 966-968

10. Methods of health education

A. Individual approach

Communication with one person at a time.

Examples

Counselling
Interview
Home visit
Doctor-patient consultation
Demonstration to an individual

Advantages

Personalised
Privacy is possible
Immediate feedback
Effective for sensitive issues, such as contraception, HIV, mental health, or substance use

Limitations

Time-consuming
Small coverage

B. Group approach

Communication with a small or medium-sized group.

1. Group discussion

A guided discussion among participants on a specific health issue.

Ideal group size: usually around 6-12 persons.

Uses

Antenatal groups
Adolescent groups
Village health and sanitation committee meetings
Mothers' meetings

Advantages

Active participation
Peer learning
Clarification of doubts
Good feedback
Helps change attitudes

2. Demonstration

Shows how to perform a procedure or skill.

Examples

Handwashing
ORS preparation
Breastfeeding position and attachment
Use of a contraceptive
Preparation of nutritious complementary food

Steps

Explain what will be done.
Demonstrate slowly.
Explain each step.
Ask participants to repeat or perform it.
Correct errors and reinforce key points.

3. Lecture

A speaker gives information to a group.

Merits: quick, economical, can cover many people.
Demerits: passive audience, poor feedback, limited behaviour change.

Make it better by using local examples, visual aids, questions, and a brief discussion.

4. Panel discussion

A small group of experts discusses a topic in front of an audience, often with a moderator.

5. Symposium

Several experts give short prepared talks, each covering a different aspect of one topic.

6. Workshop

Participants actively work on a problem, develop skills, plans, or materials.

7. Role play / drama

Participants act out a situation, such as counselling a hesitant mother for immunization. Useful for attitude and communication-skill development.

C. Mass approach

Used to reach a large population.

Media

Television
Radio
Newspaper
Magazine
Posters
Leaflets
Exhibition
Film and video
Public-address system
Internet and social media
Folk media

Advantages

Wide and rapid coverage
Useful for raising awareness
Useful during outbreaks, disasters, and campaigns

Limitations

Limited personalization
Low feedback
Less effective alone for sustained practice change

11. Audio-visual aids

Audio-visual aids make learning easier, more interesting, and more memorable.

Type	Examples
Audio aids	Radio, recorded message, microphone, podcast
Visual aids	Poster, chart, flash card, flipbook, model, map, specimen
Audio-visual aids	Television, film, video, animation, slide presentation, mobile phone video

Principles for using AV aids

Keep them simple and relevant.
Use large, clear pictures and readable lettering.
Use local language.
Use culturally familiar illustrations.
Show one main idea at a time.
Ensure visibility and audibility.
Do not overcrowd a poster or slide.
Pre-test materials with the intended audience.
Combine visuals with discussion and demonstration.

12. Counselling

Definition

Counselling is a confidential, purposeful, interpersonal communication process that helps a person understand a problem, explore options, make an informed voluntary decision, and carry out that decision.

It is different from simply giving advice.

Principles of counselling

Privacy and confidentiality
Respect and non-judgmental attitude
Active listening
Empathy
Accurate, balanced information
Encourage voluntary informed choice
Avoid coercion
Clarify doubts
Agree on a feasible plan
Arrange follow-up if needed

Basic counselling steps

Establish rapport
Greet respectfully, introduce yourself, ensure privacy.
Assess needs
Ask open-ended questions and listen.
Provide relevant information
Use simple language, give correct options.
Help decision-making
Discuss benefits, limitations, concerns, and practical barriers.
Confirm understanding
Use teach-back or ask the client to explain the plan.
Plan action and follow-up
Give clear next steps, referral advice, and warning signs.

Micro-skills

Open-ended questions
Active listening
Reflection
Empathy
Summarizing
Non-verbal attentiveness
Avoiding interruption and judgment

13. IEC, BCC, and SBCC

IEC: Information, Education and Communication

IEC is a planned communication approach to change or reinforce a specific health-related behaviour in a defined target audience within a specified time.

Examples

Poster and counselling campaign for ORS use
Immunization awareness campaign
Handwashing campaign in schools

IEC planning steps

Identify the health problem.
Define the desired behaviour.
Identify target audience.
Study knowledge, attitudes, practices, barriers, and enabling factors.
Set objectives.
Develop and pre-test messages/materials.
Choose channels and communication methods.
Implement.
Monitor and evaluate.

An IEC activity requires more than producing a poster. It should include audience analysis, a clear behavioural objective, testing, follow-up, monitoring, and evaluation. The WHO IEC guidance emphasizes these components.

BCC: Behaviour Change Communication

BCC is an interactive process that uses communication to promote and sustain a specific healthy behaviour.

It goes beyond awareness and focuses on practical behaviour change.

Example: handwashing BCC

Identify barriers: no soap, lack of water, low perceived importance.
Give a simple message: “Wash hands with soap after toilet use and before handling food.”
Demonstrate technique.
Ensure soap and water access.
Reinforce through schools, homes, and community leaders.
Monitor actual practice.

SBCC: Social and Behaviour Change Communication

SBCC is broader than individual BCC. It addresses:

Individual knowledge and skills
Family influence
Peer norms
Community norms
Gender relations
Service access
Policies and social environment

Example: To improve institutional delivery, communication should target pregnant women, husbands, mothers-in-law, community leaders, transport barriers, quality of facilities, and referral systems.

14. Behaviour change: key points

A person may know what is healthy but still not practise it. Behaviour change depends on:

Knowledge
Attitude and perceived risk
Skills
Motivation
Family and peer support
Cultural norms
Availability and affordability of services
Enabling environment
Repeated reinforcement

A useful sequence is:

Awareness → Interest → Evaluation → Trial → Adoption → Maintenance

Health workers should therefore avoid assuming that one talk or poster will change behaviour.

Recent systematic reviews highlight the importance of trust, community context, accessibility, and user engagement in digital health communication, particularly for older adults and during health emergencies (PMIDs: 42555962, 39681938).

15. Example: communication plan for diarrhoea prevention and ORS use

Item	Plan
Problem	Delayed ORS use and harmful feeding practices during childhood diarrhoea
Target group	Mothers/caregivers of children under five years
Desired behaviour	Start ORS early, continue breastfeeding and feeding, seek care for danger signs
Main message	“Give ORS after every loose stool, continue feeding and breastfeeding, and visit a facility if the child is unable to drink, very sleepy, has blood in stool, or worsening illness.”
Method	Small-group meeting plus individual counselling
Materials	ORS packet, clean container, pictorial flipbook
Skill component	Demonstrate ORS preparation and obtain return demonstration
Feedback	Ask caregiver to explain danger signs and demonstrate preparation
Evaluation	Correct preparation, ORS availability, timely care-seeking, reduced harmful practices

16. High-yield differences

One-way communication	Two-way communication
Sender dominates	Sender and receiver interact
Feedback absent/delayed	Immediate feedback
Audience passive	Audience active
Good for awareness	Better for behaviour change
Example: radio talk	Example: counselling

Health education	Health communication
Learning process that supports healthy behaviour	Broader use of communication to inform, educate, motivate, persuade, counsel, and organize
Focuses on voluntary learning and behaviour	Includes information, advocacy, media, counselling, and mobilization
A component of preventive health care	A major tool of public-health programmes

IEC	BCC	SBCC
Information and educational communication	Focuses on an individual or group behaviour	Also addresses social norms, systems, and environment
Often campaign/material focused	Interactive and behaviour-focused	Most broad, ecological approach

17. Exam-ready conclusion

Communication is the foundation of health education and community participation. Effective health communication is credible, relevant, understandable, culturally acceptable, participatory, two-way, reinforced, and linked to available services. The best outcome is not merely awareness, but sustained voluntary healthy behaviour by individuals, families, and communities.

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