2. Communication at the Core of
Effective Public Health
The health and security of the
Nation depend heavily on a
Robust Public Health System.
Effective Public Health
Communication
3. What is public health
communication?
• Public health communication - “The art
and technique of informing, influencing,
and motivating individual, institutional,
and public audiences about important
health issues.”
• Public Health - “what we, as a society,
do collectively to assure the conditions
in which people can be healthy.”
4. • For effective health care – OPD as well as IPD
• For creating Awareness on health issues
• For creating Awareness regarding available
Health Care Services
• For bringing change in behavior for positive
health
• During Emergencies/ Disasters
• For keeping updated on “know-how” on new
developments in Health
Effective Communication is needed
5. The most effective health
communications are:-
1. Relevant, Accurate and also unbiased/
nonjudgmental
2. Culturally competent (taking into consideration
the differences in the audience’s educational levels
and religious and cultural beliefs)
3. Easily accessible in terms of location, language, and
format
4. Actionable (providing resources and instructions
that allow people to act on given advice)
5. Balanced, recognizing both risks and benefits
6. Types of PH Communications
1. Health Education – orations, pamphlets, videos..
2. Health Advocacy –
a. At higher administrative level to ensure people can
access health care, (advocating for effective
healthcare policies and reforms e.g. JSSK..). OR
b. At local level to address the determinants of
health e.g. Campaign to reduce high-risk drinking
in colleges
c. Risk Communication - about the risks of certain
behaviors, such as not getting immunizations,
depends on how people perceive a particular
health risk
7. 3. Crisis and Outbreak Communication -
a. Build trust with the community.
b. Make announcements early.
c. Convey transparency.
d. Show respect for public concerns.
e. Plan in advance.
Types of PH Communications..
8. The Challenges for Effective
Communication in Healthcare Practice
• Fast pace of change in Healthcare “know-How”
– New Machines/ Technology/ Methods (lab / Tt)
• Patient care (more demanding and challenging)
– Complexity of care systems including Insurance
– Patient and relative’s health literacy
– Language barrier, cultural barriers
• Mismatch btw created demand and available supply
• Lack of Systems and Processes for sustainable support
• Ineffective monitoring and planning process
9. Process Of Behavior Change
Stages of Change Continuum
Unaware
Aware
Concerned
Knowledgeable
Motivated to Change
Try Behavior Change
Sustain Behavior
Change
Enabling factors
Providing Effective
Communication
Empowering
Community by
– Policies,
Funds,
influencing
Community
influencers
(orientation),
Role Models,
Providing User
Friendly
Accessible
Services
Mass Media
Community
Networks &
Traditional
Media
Interpersonal &
Group
Communications
Channels
12. Example –
How to create an Enabling Environment for
Nutrition Programs / Interventions for PLW?
• Social & Behaviour Change Communication
(SBCC) can be one of the answers.
• NFHS-4 (2015-16) reveals that –
– 39% Children < 5Yrs were Stunted,
– 37% were Underweight and
– 23% were wasted
– 47% Women of Reproductive age were Anemic
• Hence ‘Nourishing Rajasthan- Vision 2022’ An
SBCC strategy was Developed
13. Methodology for Developing the SBCC
Strategy
Step I: Understanding Ground Realities
Consultation workshop for building consensus
Assessment Studies
Formative Studies
Step II: Designing the strategy
Developing
conceptual
framework
Designing the
communication
Strategy
Step III: Validation Study for Products – Pilot study
Step IV: Developing Monitoring & Evaluation Plans
Audience Segmentation
Defining Behavior &
Communication Objectives
Selecting media mix & delivery
platforms
14. Step I - Formative Study
FACTORS
EXAMINED
1. Who are the
primary and
secondary audience
to be considered?
2. What are the
attributes of each
of the target
audience and their
influence on PLW?
FINDINGS
1. PLW and her Gatekeepers - Husband and
Mother-in-Law(MIL), Front Line Workers
(FLWs)
2. Husband: has become more participative
but is still evolving
Mother-in-Law: In many ways, still a
staunch traditionalist but is becoming
more open to new ideas
FLWs: Trusted by PLW as PLW believes
that FLWs use contemporary
practices and gives her an
opportunity to learn
15. Step I - Formative Study
FACTORS
EXAMINED
• What are the
characteristics,
beliefs and
attitudes of
PLW (targeted
beneficiary)?
FINDINGS
• Sacrificing - putting desires of the
family first
• Submissive, Even though a few are
finding a voice, their agency is limited
• Feels lack of emotional support
during pregnancy and
• feels guilty about adding monetary
burden on the family
• Has fears about childbirth, sex of the
child and its future
16. Step I - Formative Study
FACTORS
EXAMINED
• What are
the factors
influencing
diet-choices
of PLW?
FINDINGS
• Change in diet of PLW is mostly
about exclusion of items that
are traditionally considered
not ‘good’ during pregnancy
• Vegetables, fruits and milk is
not consumed in required
amounts
• Morning Sickness, experiencing
lack of appetite & craving a
change of taste
17. Step I - Understanding Ground Realities
POINTS OF
ENQUIRY
• What was the
socio-
economic
demographics
of the target
population?
FINDINGS
• More than 38 percent were
illiterate
• Mn age of respondents: 25 yrs
• 68% watched television
• 13% were members of Self-Help
Groups (SHGs) or Community
Based Organization (CBOs)
18. Step I - Understanding Ground Realities..
POINTS OF
ENQUIRY
• What did
the Study
Reveal
about the
Diet of
PLWs?
FINDINGS
• Prevalence of hidden hunger in PLW
• PLW and NPW consumed almost similar
meals in size, quality and frequency
• Cereals, millet, sugar, fats, and oil were
the main source of energy intake
• Absence of poultry and fruits in the diet
in almost all the cases
• Fear of abortion and difficulties caused
during the delivery of the baby, guided
food choices
• 65% of respondents had some degree of
awareness about breastfeeding
19. Step I - Understanding Ground Realities..
POINTS OF ENQUIRY
• What are the gaps
in dietary practices
viz a viz
recommendations
by WHO and
ICMR?
• How much Say do
PLW have?
FINDINGS
• More than 70% gap
between Recommended
Daily Allowance (RDA) in
Fat, Calcium, Vitamin C,
Vitamin A, and Zinc
• 92% of PLW didn’t have a
say in household purchases
and decisions to be
undertaken on their health
20. Step I.. - Identifying Behavioral Determinants..
• The study revealed that nutrient-rich food, even
though locally available, was absent from the
diet of PLW – Poverty, Myths, Status of PLW .
• It required INR 63/day for pregnant and INR
69/day for lactating women; (“Cash Transfer
Scheme”!!! )
• The study helped to identify emotional,
psychological and cultural barriers and
enablers for desired behaviours.
21. STEP II: Designing the Strategy
Consultation
workshop
Consensus on
1)Target Audience,
2)Setting Goals/
Objectives
3)Delivery Mechanics
Information to feed
into conceptual
framework
1. Audience Segmentation
• Primary Audience: PLW
• Secondary Audience:
Husband, Mother-in-law,
Frontline Workers (FLWs)
Dev. Com. Strategy
2.Defining behavior and
communication objectives
customized messages
for each of target audience
22. Communication principles for the strategy
Gatekeepers
improve food
access to PLW
Accepted
Social Roles
Using
Spousal
Bond
Packaging
nutrition
advice as
preventive
care saving
future
medical
expenses
Food
Sharing
Culture &
Exchange
Value
Framing
of critical
advice
Promotion of
readily
available
foods that do
not require
cooking and
sharing
through
meals
Relevant,
actionable,
informative,
and
aspirational
23. Husband
BEHAVIOR
OBJECTIVES
BEHAVIOR OUTCOMES
Ensure that his wife
has access to Food
Resources during
pregnancy as per
dietary norms
Be with her for ANCs, be vigilant
for all services and Danger Signs,
Enquire actions to be taken and take
Actions as and when required
Education wife and Mother via Mamta
Card
Buys foods for her.
Wife
Acts on the dietary
advice. Reminds her
husband of the food
she wants to eat.
Consume the foods recommended,
Reminds husband of foods to be
purchased and amount of food needed.
Tell Husband about any problems
MIL
Supports her son to
take care of his wife.
Supports the
daughter in law to
eat nutrient rich food.
Reminds her son to purchase
food and to go toANC; grants
her DIL the permission to eat
foods at meals, tea, and
24. STEP III: Creating and Validating the Creatives
Engagement
Quotient
How engaging
are
the messages?
Local Language &
Cultural Symbols
Can the target
group
Understand
language &
symbols
being
used?
Motivational
factor relatable
concepts
Do the
messages
convey
benefits
of behavior
change?
Are the
messages
focused on
desired
behavior &
communicatio
n
objectives
Contextualized
message
25. STEP IV: Monitoring and Evaluation Plan
Indicators to be Tracked
Beneficiary Category
Pregnant
Women
Lactating
Women
27. Key Outcomes of the Process
Govt. owned
state-specific
strategy
Commonality
of Messages
Providing a
Pathway to
Change
Rajasthan stands
amongst one of the few
states with a nutrition
specific SBCC strategy
tailormade to the
requirements of the State
To reduce confusion and
build high- recall value
among the targeted
groups.
A data-driven compass
for different
government
departments,
development partners
and civil
society members in
Rajasthan
28.
29. 1. Meal size, frequency and food groups
2. Guiding Book with Nutri-dense recipe
for demonstrations to mothers and
caregivers
3. Community mobilization
4. Multisectoral and multi-dimensional
engagement by mixed channels
Step I.. – Correctives for Behavioral
Determinants
31. What makes this strategy
replicable?
Budgetary
allocations by
the state
government to
the tune of $3
million in the
PIP for
implementatio
n
What makes this strategy
sustainable?
Wider implementation
Adoption by
partners in
Rajasthan
Availability of
tools to design
the strategy
such as TORs,
strategy decks
and proven
methodologies
for assessment
studies.
Adaptation by Dev.
Partners
Based on this,
the state
governments of
Gujarat and
Jharkhand have
shown interest in
developing state
specific and
SBCC strategies
to fight
undernutrition.
Integration in
various
Programs
Availability of funds
32. What can be achieved-
1. Increased awareness about a health
issue or solution
2. Shift social norms by influencing
attitudes, e.g.
–health communication campaigns have
helped to reduce the stigma around
HIV and AIDS, making it easier to
convince people to get tested.
33. 3. Capacity building of the community
e.g. educating how to perform monthly
self-breast exams,
4. Demonstrate the benefits of adopting
new, healthier behaviors, e.g.
campaign featuring real people’s
stories of living with smoking-related
diseases prompted many people to
quit smoking.
What can be achieved-
34. • Communication products/ materials are :-
–such as brochures, posters, newspaper
articles, television broadcasts, radio
commercials, public service
announcements, newsletters, pamphlets,
videos, digital tools, case studies, group
discussions, health fairs, field trips, and
workbooks among others media outlets.
Health communication products :
35. Communication Channels include :
• Radio
• Television
• Newspaper
• Flyers
• Brochures
• Internet
• Social media tools (i.e., Twitter, Facebook, and
YouTube)
• Word of Mouth
Use a variety of communication channels
36. Ecological Perspective
• Multilevel communication strategies and
interventions, are needed. Such as :-
– at the individual level,
– at the group level,
– social marketing at the community level,
– media advocacy at the policy level, and
media campaigns at the population level.
• PH communication strategies are often
combined with other intervention efforts, such
as community organizing or coalition building.
37. Communication Tools – Public Relations
Pub Relation Key Components Resources
Media Relations Providing direct and immediate access to news and information
for the media (TV radio, newspapers).
Key components include: regular news releases, news
conferences, media alerts, background information kits, feature
articles, editorials, designating a spokesperson.
Staff to develop and maintain a system
for media relations.
Regular and consistent contact with the
media.
Community
Relations
Regular and ongoing contact with organizations and individuals
within the service area of the organization.
Includes: Orientation Camps and presentations, Civic group
meetings, personal contacts, newsletters or direct mail.
Staff to coordinate and arrange
meetings or presentations
and follow-up and some handouts or
display boards.
Govt. Relations Regular and systematic contact with public service officials
May include mailings, personal contact, emailing, briefings
Staff to develop relationships and
maintain contact. Some materials cost
for research or printing.
Organization
Outreach
Community events such as trade shows, community [health]
fairs, or special events.
Includes displays, speeches or presentations, and a designated
spokesperson to represent the organization.
Staff to organize a calendar of events
and assign organization representatives
to attend.
Web Site Creating and maintaining a Web site for the organization with
information on all program areas and up-to-date news as it
relates to the organization and its programs.
Provides information, education and an interactive link with the
organization’s stakeholders.
Depending on the capabilities of the
organization, may incur design and
engineering costs for startup and
maintenance. Some organizations have
internal IT capacity to support
maintenance as well as development.
38. Communication Tools – Internal/Employee Relations
Internal/Employee
Relations Key Components Resources
Employee Relations For effective communication:
Always inform employees first
Give employees written and electronic
summaries of important information
Always provide a key contact person
and suggested resources where the
employee can find more information
Take the time to answer employees’
questions as soon as practical
Staff and a commitment to
systematize the flow of
employee information.
Internal
Communication
Regular staff communication via email,
electronic newsletters, staff meeting
notes, posters, bulletin boards and Pay
related information.
Staff ; the most important
factor is creating the habit and
content accountability.
39. Paid
Advertising Key Components Resources
Print
Radio
TV
Mass media advertisements can be an
effective strategy for emergency situation
or special events. The mantra is to plan
the size or frequency and placement for
optimal effectiveness.
Out-of-pocket costs are
highest for paid
advertising, but can be
very effective for reaching
specific audiences with
targeted messages.
Outdoor –
Billboards
Mass transit
Mall displays
As part of a comprehensive campaign,
these advertising strategies can be very
effective. Most importantly, match your
ads to your audience to be cost effective.
Communication Tools - Paid Advertising
40. Social marketing and PH Communication?
• Social marketing help change behavior to
improve social problems, "the application of
commercial marketing techniques to social problems."
– Instead of selling hamburgers, selling a life without
heart attacks.
– Instead of convincing teenagers to buy rugged blue
jeans, convince them to buy the advantages of
postponing pregnancy.
• Commercial marketing tries to change people's
behavior for the benefit of the marketer;
Social marketing tries to change people's behavior for
the benefit of the consumer, society as a whole.
41. For a Social marketing campaign do
the following:
1. Identify what behavior you want to change – e.g.,
increase prenatal counseling among expectant
mothers.
2. Identify your audience: - It may be that you want to
change the behavior of several different groups. Such
groups are often separated, or segmented, by age,
gender, level of education.
3. Identify the barriers to change: -
e.g. Do pregnant women feel uncomfortable at the
clinic, is the clinic too far away? Or is it their jobs?
42. 4. Reduce the barriers to change - e.g. Can the clinic stay
open longer hours? might provide incentives for
making (and sustaining) changes. JSSK!
5. Pretest your ideas on a small number of people, then
modify your plan according to your results.
6. Publicize the benefits of change, and also your
efforts– let people see it as an opportunity - the best
program in the world won't be used if people don't
know about it.
7. Assess your results and ReModel as desired
For a Social marketing campaign do
the following:
43. The basic principles of marketing
"4 Ps." - product, price, place, and promotion
1. Product -- a certain behavior you are trying to
change.
2. Price -- isn't just a question of money. It can also
be a question of time and effort.
A life-long smoker admits that smoking is an
extremely expensive habit, but may still say the
costs--in terms of effort, or nicotine withdrawal--
are too high. He just can't quit. A good social
marketing plan, try to reduce these costs- might
offer support groups to help with the effort, and
nicotine patches to reduce the pangs of withdrawal.
44. 3. Place -- If you are selling blue jeans, you want
to have them in stores across the country,
not just in one small boutique
• Likewise, if you are "selling" teen pregnancy
prevention, - ensure non-judgmental
Adolescent Friendly Health Services
• The less people need to go out of their way to
make a change, the more likely they are to
make it.
The basic principles of marketing
45. 4. Promotion -- Promotion is the advertising
you do; be it in television commercials,
letters to the editor, or cutting ribbons.
“Word of mouth” is a highly desirable part of
social marketing as good as OR may be better
than costly Advertising
• Remember, that--advertising alone
is not social marketing.
The basic principles of marketing
46. Perspectives of the consumer
• People will have different ideas and beliefs
• For example, among smokers,
– some may not believe smoking is that bad for
them,
– others might understand the risks but not care,
– still others care but may not want to take the
effort to stop smoking,
– and a final group of smokers may be actively
trying to quit.
47. How Social Marketing Works
• Changes doesn't happen overnight - Most
people won't go immediately from believing
smoking is "cool" and not really understanding
the health risks to quitting right away.
• A social marketing campaign might help them
start thinking that it's not the best thing to do--
and after that idea has had time to turn around in
their head for a while, another part of the
campaign will help them quit, and yet another
part will help them remain smoke free.
48. Strategies for Effective Health
Communication
1. Know the Issue - understanding all layers of the
issue and develop most suited Solutions
2. Have Clear Goal - “raising awareness” is too
vague
3. Know the Intended Audience - about their
attitudes, beliefs, behaviors as well as their
group dynamics, social and physical
environments. (help to identify barriers that may
prevent people from changing behaviors..)
49. 4. Use Theories and Models –
a) Social Cognitive Theory - (own /other’s
experiences on benefits)
b) Health Belief Model – perception of vulnerability
and benefits (Incentives/ Risk perception/ Benefit
Perception and Self Reliance)
5. Craft Messages Strategically - and explore
the channels that will be most influential
based on market research (distributing
free or reduced-price products related to the
health issue makes an impact)
Strategies ctd….
50. 7. Establish Partnerships - Consider the Pros and Cons of
Partnerships (Pros like additional resources, added
expertise, and more credibility and the Cons like
undesired compromises and less control)
8. Test Out Materials and Methods - Make revisions
based on audience feedback
9. Publicize - ways to bring interest to a campaign launch
10. Monitor Success
11. Overcome Budget Constraints- by collaborating with
Right people/ Institutions BUT never neglect setting
clear Goals/ objectives, assess audiences, and pretest
Strategies ctd …
51. Stages-of-Change
1. Pre-contemplation: No intention to change a behavior
2. Contemplation: Intention to make a change/ plan to do
so soon
3. Preparation: Intention to take action in the immediate
future, along with small steps to make the behavior
change
4. Action: An initial change in behavior, with the intention
to continue with the change
5. Maintenance: Ongoing behavior change, with efforts to
maintain the behavior
6. Termination: No desire to return to old behavior
