Communication and Health

Communication

Takele Gezahegn (MPH, Asst. Professor) March 2025

takele.gezahegn@sphmmc.edu.et A.A, Ethiopia
Outline
Definition of Concepts
The goals/Purposes of communication
Component of communication process
Types of communication
Methods of communication
Principles of health communication
Communication Barriers
Major qualities of Effective communication

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Instructional objectives
At the end of this class you are expected to:
• Define communication and HC
• Discuss elements of communication process
• Describe the functions, and types of Communication
• Describe the type of Communication with Individuals, Groups and Organizations
• Identify barriers communication
• Discuss factors contribute for effective communication
• List the major qualities of effective Communicator

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 What is Communication?

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 Intro to communication
 Words and symbols have meanings
 Communication is verbal and non-verbal process
 Telling is also communicating, but not mere talking
 Any meaningful social interaction can be communication
 By communication we will solve all our problems
 Communication is an essential part of human life, it changes lives
 Communication can break down
 Oral communication needs natural ability

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 Intro to communication…
 Communication is the basic but complex process
Kill him not, let him to live!
Kill him, not let him to live!
 Without communication an individual could never become a fully functioning
human being
 But, its through communication people transfer facts, ideas, emotions, knowledge,
attitudes and skills to make informed decisions about their health

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Definitions of Communication
 Communication – Latin = communis = common
 to share information, ideas or attitude, to impart, to transmit.
 An attempt of trying to establish commonness or common understanding

 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
Allen Louis defines:
 “It is the sum of all things one person does when he wants to create
understanding in the minds of another”

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Definition…
“Communication is a process by which two or more people exchanges ideas, facts,
feelings or impressions in ways that each gains a common or mutual
understanding of the meaning and the use of the message.”
Paul Leagans
“Itis a process by which information, decisions and directions pass through a
social system, and the ways in which knowledge, opinions and attitudes are formed
or modified.”
Loomis and Beegle

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Definition…
“Communication is the force by which an individual communicator transmits stimuli
to modify the behavior of other individuals.”
Howland
It is the exchange of facts, ideas, opinions or emotions b/n two or more people
Newman and Summer
Thus, communication is giving, receiving or exchanging information, opinions or ideas
so that the “message” is completely understood by everybody involved.

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Communication Goals
To change behavior

To get and give

To get action
Information

To persuade To ensure understanding

Source: CGAP Direct

 Communication Theories/Models

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Why are models useful?

“Model” = “theory”
 They help simplify complex ideas.
 They offer an organized way of looking at a complex process.
 All the main points of the relationship or process are described.
 The description is simple and clear.
General categories of communication model
Communication model generally categorized into three;

Linear Model Interactive Model Transactional Model

One-way communication
Sender  message  Channel  Receiver Disadvantages
 Linear type of communication  No feedback/No input from
the receiver
 Quick if the message is simple and needs  Learning is authoritative
quicker communication  No opportunity to clear up
◦ e.g. date & time of meeting misunderstanding
 Meaning is controlled by a receiver  May be less effective (Does
◦ What message not influence behavior)
◦ How much communicated Examples: Message through
 Messages from experts, educators and mass Radio, Speech, Directives or
media provision of written directives or
procedures, law, regulation, etc.
 Motivation of the sender may be personal gain
or public good

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General Representation of Linear Model

noise
encoding decoding

Sender Receiver
Channel (message)

Is this an effective model of communication? Why?

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Interactive Model... This is Systems (Two-way) Model

MESSAGE
Sender Receiver
CHANNEL
Receiver FEEDBACK

Sender
 Bidirectional information flow
 Behaviour change via interactive
communication
E.g. Patient counselling/Telephone
conversation/Discussion/Panel
Fig. Interactive Model... discussion/Dialogue/Meetings,
etc.
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General Representation of Interactive Model of
Communication

Feedback is essential to good communication

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Transactional Model ….

Fig. Transactional Model

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 Two-way communication…
Advantages Disadvantages
 Feedback is added  Not orderly
 Slower (time taking)
 Allows the sender to find out how much the
message is received- can be monitored
 Can be adapted to suit the receiver’s needs
 More audience participation
 Learning is more democratic
 Sender can affect the quality and quantity of the
feedback through the type of question chosen
and the way it is asked
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Common communication theories/models
 Linear (One-way) Models

 Aristotle model of communication

 Laswell model of communication
 Shannon and Weaver model of communication
• Interactive (Two-way) Models

 Schramm’s Models of communication

 Berlo’s Model of communication
 Paul Leagan’s Model of Communication
 Process & Components of Communication

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Communication process...
 The communication process is a system that involves an interrelated,
interdependent group of elements working together as a whole to achieve a desired
outcomeorgoal.
 General Systems Theory stated that every part of the system is so related to every
other part that any change in one aspect results in dynamic changes in all other parts
of the total system.
 It is necessary to think of communication not so much as individuals functioning under
their own autonomous power but rather as persons interacting through messages.
 Is not a linear process rather it is a cyclical process that involve many elements.

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 The Basic Process of communication
A simple sequenced of 6 steps.
1. The sender wants the receiver to understand the message.
Ideation
2. The message is encoded by the sender, who structures it
into a logical form of code = language
3. When the sender is satisfied with the encoding of the
message; he/she transmits the message verbally or in
writing or electronically, etc
4. The message passes through a channel from the sender to
the receiver
5. The receiver decodes the message
6. The receiver then understands the idea that the sender
wants to convey. Reaction--- response/Feedback Fig. Communication process

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Components/Elements of communication
Communication process involves eight elements
1. Source/Sender/Encoder: “Sends Message”
2. Message/Content: “Matter of communication”
3. Channel/Medium: “Vehicle to carry message”
4. Receiver/Decoder: “Audience”
5. Feedback: “Response”
6. Barriers: “Possibilities of communication breakdown”
7. Situations: “Context”
8. System: “Relationship”
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1. Source/Sender
 Originator of message
 Can be individual, group, or institute/organization
 Makes the decision to communicate.
 Begins the communication process by forming the ideas, intentions and feelings
that will be transmitted.
 First, the source must encode, or create, a message.
 Encoding: the process of translating the meaning to be transmitted into symbolic
form (words ,sign, sounds, etc.).
 That is, the information that the source wishes to convey must be put into a form
that can be sent to the receiver.

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1. Source/Sender ….
 Should have similar background characteristics with that of receiver
 Sender are required to filter out the details that are unimportant and focus on
the most relevant information.
 Also determines the purpose of the message: to inform, educate, persuade, or
entertain.
 Source should determine how the message gets from the source to the
receiver.
 Source credibility: Communication will be effective when the source is
empathetic, credible (trusted).

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Major qualities of effective communicator
 One who is both in the situation of the sender and the receiver
 Make sure he/she has the full attention of the communication partner
 Speak in a loud and clear voice
 Formulate the message clearly in a way that can be easily understood
 Avoid jargon and/or Explain technical terms
 Be able to adapt the same (health) messages to the educational background
of the receiver

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Major qualities …
 Encourage the client to speak openly
 Give full attention to the client
 Listen carefully
 Ensure that the message is understood
 Take questions and concerns of clients seriously
 Answer any questions fully

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2. Message/Content
 Message is a piece of information, ideas, facts, opinion, feeling, attitude
or a course of action that passed from the sender to the receiver. the idea
communicated.
 In the form of words of the mouth or symbols
 It is the subject matter of communication: something that is considered
important for the audience to know or do.
 The code and content of the message should be appropriate to the receiver
and should be arranged in a way that it looks attractive.
 E.g., could be arranged in the form of audio, video, poem, simulation, picture,
symbol, etc.
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2. Message/Content …..
 The content (idea, innovation, or technology) should be appropriate to the
audiences (composed by codes)
 Treatment: The way the message is prepared, processed and
delivered(arrangement, organization and presentation of code and content).
 Coherence and Clarity
 Message appeals: The way the content of the message could be organized so
that it can persuade or convince people.
Ex: Fear arousal appeal, humor, emotional, one sided, two-sided, etc.

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 Types of Message Appeals in HC
 Fear arousal appeal
 Humour (funny)
 Logical / factual appeal
 Guilt appeal?
 Emotional appeal  Media appeal?
 One sided message (advantage)
 Two sided message (both adv and disadv)
 Positive appeals: (do something)
 Negative appeals: (don’t do something)

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 Fear arousal appeal
 The message is conveyed to frighten people into action by emphasizing the
serious outcome from not taking action.

 Symbols such as dying persons, coffins, grave stones, skulls may be used.

 It is good for a person with little or no school.

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Fear arousing appeals...

HIV/AIDS
makes you to I am here, my name HIV/AIDS Makes you
look like this is AIDS, take care to look like this
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Humour
 The message is conveyed in a funny way such as cartoon.
 Humour very good way of attracting interest & attention.
 It is good to create a lasting memory but hard to change beliefs and attitudes,
 It can also serve a useful role to lighten the tension when dealing with serious
subjects.
 Enjoyment & entertainment can result in highly effective remembering and
learning.
 However, humor does not always lead to changes in beliefs & attitudes.
Humour is also very subjective.
 What one person finds funny another person may not.
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 Logical/Factual Appeal
 The massage is conveyed to convince people by giving facts, figures and
information,

 For ex. facts related to HIV/AIDS; its causes, route of transmission,

prevention methods etc. like Telling people the percentage of people living
with HIV virus.

 It carries weight with a person of high educational level. Information on its

own is usually not enough to change behaviors

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Emotional Appeal
 The message is conveying to convince people by arousing emotions, images &
feelings rather than giving facts & figures, e.g. by showing smiling babies,
wealthy families with FP education.
 A Person with less education will often be more convinced by simple emotional
appeals from people they trust.
 Despite this, many health educators still feel that it is important to present
some factual information because it allows people to make informed-decision.
 But it is important to be realistic about the limitations of just relying on facts to
persuade people.

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Emotional Appeal ….

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 One Sided Message
 Only presents the advantages of taking action E.g.: Educating the mothers only
about benefits of oral contraceptive pill.
 Does not mention any possible disadvantages.
 One sided compared with two sided messages: Presenting only one side of an
argument may be effective: If your audience will not be exposed to different
views. However, if they are likely to hear opposing information, it may create
suspicion to take your advice such as the side-effects from a drug. It is better to
be honest to tell them rather than let people find them out for themselves.
 If our communication is through mass media such as radio, TV, newspaper etc.
because the audience may only grasp part of the message or selectively pick up
the points that they agree with (Selective perception).
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Two Sided Message
 Presents both the advantages & disadvantages (pros’ & cons’) of taking action.
Appropriate if:

 The audiences are exposed to different views.

 The audiences are literates.
 We are in face to face with individuals or groups: it is easy to present both
sides and make sure that the audience understands the issues.

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Positive Vs Negative Appeals
 Positive:- Communications that ask people to do something, e.g. breast feed your
child, use a latrine.
 Negative:- Communications that ask people not to do something, e.g. do not
bottle feed your child, do not defecate in the bush.
 Positive compared with negative appeals: Negative appeals use terms such as
“avoid” or “don’t” to discourage people from performing harmful behaviors. But
most health educators agree that it is better to be positive & promote beneficial
behavior.

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Characteristics of a effective message
(The 7 C’s of effective communication)
1) Commands attention
2) Cater to the head and the heart
3) Clarify the message
4) Create trust
5) Communicate a benefit
6) Call to action
7) Consistency count

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Hierarchy of communication effects

Clarify
Benefit and
consistence

Cater to the head

and heart
Create trust
Call to
action

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3. Channel/Medium

 The channel is the way through which a message is

sent out.
 It is the physical bridge or the media by which the
message travels between source and receiver.
 It is also called the medium of communication

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Channels include:
 The commonest types of channel are audio, visual, printed materials or combined
audio visual & printed materials.
 Audio/Verbal- Most common, e.g. Music
 Printed material/Written words
 Visual: e.g. Picture
 Non-verbal communication/Body language

 Any combination: E.g.

Combined audio visual (AV
aids are commonly use)
and printed materials

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Criteria: Channel Selection
1) Availability
2) Cost-effectiveness
3) Users’ preference and receivers’ access
4) Adaptability to the communication purpose/objective
5) Adaptability to the message content
6) Type of recipient and their stage in the adoption process

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4. Receiver/decoder – ‘Audience’
 The person or the group for whom the communication is intended or the person
who receive the message.

 Receiver decodes the message- the act of interpreting messages.

 Receivers decode messages based on past experiences, perceptions, thoughts,

and feelings.

 The 1st step in planning any communication is to consider the intended

audience.

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4. Receiver/Audience ….
 Factors which should be considered about the Receiver/Audience includes:

 Educational factors and Socio-cultural factors,

 Psychological /psychographic factors (attitudes, values, beliefs)

 It is important to understand the audience from the following perspective

Identification----Analysis .....Segmentation ....Audience Profile

 Patterns of communication- What pattern of communication already exist in the

community, do they listen to radio/TV, what traditional media are there, what is the best
timing to conduct health communication
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5. Feedback
 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.

 Negative feedback: when the message has not been understood. This kind of
feedback, conveys lack of understanding.

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5. Feedback …
 Positive feedback: when the receiver has understood the source’s message. It
does not necessarily mean that he or she agrees with the source, just that the
message was interpreted accurately.

 Effect: - is the change in the receiver’s knowledge, attitude & practice or

behavior.

 Positive Effect: - when desired change in KAP occurs;

 Negative effect: - when desired change NO change occurs.

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 Feedback ...
 Effective communicator is always;

 sensitive to feedback and

 constantly modifies his or her messages as a result of the feedback received

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6. Communication Context
 Communication context is the environment where communication takes
place

 They are source of noise which interfere with communication process

I. Physical context

II. Cultural context

III. Social-psychological context
IV. Temporal (time) context

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6. Communication Context ….
I. PHYSICAL CONTEXT II. CULTURAL CONTEXT
 Refers to the communication rules
 Tangible or concrete environment and norms, beliefs and attitudes that
e.g. Room or field. are transmitted from one generation to
another.
 Exert influence on the content
 Direct eye contact between child and
(what we say) as well as the form
adult signifies directness and honest in
(how we say it) of the message. one culture and defiance and lack of
respect in other.
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6. Communication Context ….
III. SOCIAL-PSYCHOLOGICAL CONTEXT IV. TEMPORAL CONTEXT
 Include status relationships among the  Time of day as well as time of history
participants and the cultural role of
the society in which they are
 For many people morning is not a
communicating.
time for communication; for others it is
ideal
 Include friendliness or unfriendliness,
formality or informality, and
seriousness or humorousness of the  Appropriateness and impact of messages
situation. depend, in part, on the time in which they
are uttered.
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 Forms/modes of Communication

There are three forms/modes of communication based on the

way of expression.

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1. Oral/Verbal
• It is communication by Word of mouth.

• In oral communication, speech or talk is the

widely adopted tool of communication.

• May also use mechanical devices such as

telephone, radio, PAS (Public address
system) etc.

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Oral/Verbal Communication
Use Oral Communication when;

1) The receiver is not particularly interested in receiving the message.

2) It is important to get feedback.

3) The receiver is too busy or preoccupied to read.

4) The sender wants to persuade or convince.

5) When discussion is needed.

6) When criticism of the receiver is involved.

7) When the receiver prefers one-to-one contact

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 2. Written Communication
• It involves the exchange of facts,
ideas, and opinions through a written
instrument /materials

• E.g. letters notes, leaflets, reports,

handouts, bulletins, newspaper.

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3. Non verbal Communication
 The gestures we use, how we look at people, our tone of
voice, how we are seated and our clothes can all have an
impact on the way people interpret what we say
“Action speaks louder than Words”
E.g.
 Pitch of voice
 Laughing, angry
 Pauses, speed of talking
 Stresses on particular words
 Loudness or softness of voice

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Pros and cons
Communication Pros Cons
Methods
ORAL  Faster – speedy. • No permanent record.
 Allows more interactions.
 Creates informal atmosphere.
WRITTEN  Both sender and receiver leave a  Danger of being
record of their message. misunderstood.
 Writing encourages clear thinking.  Message can become
 Best for transmitting policies and accessible to the wrong people
procedures. or at the wrong time.
NON VERBAL  Meanings are  Meaning is in the body.
reinforced/expression of feeling.  One gesture may have several
meanings and several gestures
may have the same meaning.
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 TYPES OF COMMUNICATION
THERE ARE FOUR MAJOR METHODS OF COMMUNICATION

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Cont…
1. Intrapersonal communication
Self-awareness is the part of intrapersonal communication that determines how a
person sees him or herself — and how they are oriented toward others. Self-awareness
involves three factors: beliefs, values and attitudes. Perception is about creating an
understanding of both oneself and one’s world — and being aware that one’s
perceptions of the outside world are also rooted in beliefs, values and attitudes.
Expectations

2. Interpersonal communication
3. Group communication
4. Mass communication
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Interpersonal (Face-to-Face)
 Face-to-face or interpersonal methods include all those forms of
communication involving direct interaction between the source &
receiver.
 In most instances the decisive criterion for personal communication is.
 Communication at the same time and/or
 Communication at the same place.
 Examples of face-to-face communication with increasing audience size are; one-to-
one & counseling; small group (less than 12 persons); intermediate group/lecture
(between 12 and 30); and large group lecture/ public meeting (more than 30).

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 Interpersonal…
 The powerful advantage of face-to-face communication over mass media is,
it gives the opportunity to ask the audience questions and obtain their
feedback.
 In this case, it is possible to cheek that you have been understood & give
further explanations.
 However, as the size of the group increases, it is more difficult to have
feedback & discussion.
 So, public meetings share many characteristics of mass media in that they
involve limited participation & feedback.
 Main Effect = Changes in Attitude and Behavior
 = Acquisition of problem solving skill.

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 Interpersonal…
Advantages
1) Dynamic or Bi-directional
2) Feedback:- There is a chance to raise question & discuss so that the idea is
understood at the same time and/or place.
3) Multisensory (Channel):- Since the communication is active & interactive
there is high chance of utilizing more than two senses such as seeing, hearing
& touching.
4) Useful is All Stages of Adoption of Innovation
5) Useful When the Topic is Taboo or Sensitive:- For example, it is usually
difficult to discuss about sexual matters in a group meeting as these issues
require expressions of personal feelings & experience.
6) Can Fit to Local Needs:- as it provides open-room for discussion & feed back
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 Interpersonal…
Limitations
1) Easily distorted – as we mostly rely on word-of-mouth.
2) Often needs multi-lingual
3) Needs personal status/credibility
4) Needs professional knowledge & preparation

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 Interpersonal…
For effective interpersonal communication
A. Exchange of ideas with clients;
B. Realize the importance of 1st impression when meeting a person. A saying ‘1st
impression last long’.
C. Learn to observe the person & drive useful information.
D. Keep in mind the same words mean different things to different persons;
perception is highly subjective.
E. Pay attention body language there is a saying “action speaks louder than
words”.

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Mass Media Communication
 Mass communication is a means of transmitting messages, on an electronic or
print media to a large segment of a population.
 The word media is currently used to refer not only broad cast media such as
radio & TV and print media such as papers, magazines, leaflets & wall posters
but also folk media such has art, town criers, songs, plays, puppet shows &
dance.
 The powerful advantage of mass media over face-to-face is rapid spread of
simple of facts to a large population at a low cost.

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Mass Media…
Main effects of this type of communication are:
 Increased knowledge/awareness
 Influence behaviors at the early stages.
 Useful to communicate new ideas to early adopters (opinion leaders).
Advantages
1) They can reach many people quickly.
2) They are accurate and believable e.g. article on a newspaper, or “voice” of
highly respected person.
3) They can provide continuing reminders and reinforcement.

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Mass Media…
Limitations
1) One sided /No feedback:- The broad caster transmits his message without
knowing what is going on in the receivers mind.
2) 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
3) Does not Differentiate the Target:- In mass communication some may develop
“this does not concern me type of attitude.
4) Only Provides Non-specific Information

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Mass Media…
For An Effective Mass Media Communication
1) The message/advice should be realistic and pre tested so that it is transmitted
accurately without distortion.

2) While they are useful in creating awareness, it has to be followed by individual

& group approach for an effective feedback & in turn for attitudinal &
behavioral change.

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Comparison: Interpersonal vs Mass media Communication
Characteristics Interpersonal Mass media
Speed to cover Slow Rapid
Accuracy low High
Distortion High Low
Ability to select Highly selective Difficult to select
particular audiences
Direction Two way One way
Local consideration Can fit to local need Provide non specific
information
Feedback Direct feedback possible Indirect feedback from survey
Main effect Change in attitude and behavior, Raise awareness or Increase
problem solving skill in knowledge
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