Course title:INFORMATION EDUCATION AND

COMMUNICATION(IEC)
Course Instructor: Hufrine Ndangoh

Information:
Definition: Facts about situation, persons, and events are called as
information.
Health information:
It is an integral part of the national health system. It is a basic tool of
management and a key input for the progress of any society.
Health information system:
A mechanism for the collection, processing, analysis and transmission of
information required for organizing and operating health services and also for
research and training.
Objectives:
(1) To provide reliable, relevant, up-to-date, adequate, timely and reasonably
complete information for health managers at all levels (central, intermediate
and local)
(2) To provide at periodic intervals, data that will show the general
performance of the health services.
(3) To assist planners in studying their current functioning and trends in
demand and workload.
Information and its requirements:
A WHO Expert Committee identified the following requirements to be satisfied
by the health information system.
(1) The system should be population based.
(2) The system should avoid the unnecessary agglomeration of data.
(3) The system should be problem oriented.
(4) The system should employ functional and operational terms (e.g. episode
of illness,treatment regimens, laboratory test)
(5) The system should express information briefly and imaginatively
(6) The system should make provision for the feed-back of data.
Components of health information system: The health information system
is composed of several related subsystem. A comprehensive health
information system requires information and indicators on the following
subjects:
(1) Demography and vital events
(2) Environmental health statistics
(3) Health status: mortality, morbidity, disability and quality of life
(4) Health resources: facilities, beds, manpower
(5) Utilization and non-utilization of health services: attendance, admission,
waiting list
(6) Indices of outcome of medical care
(7) Financial statistics related to the particular objective
Uses of health information:
The important uses to which health information may be applied are:
(1) To measure the health status of the people and to quantify their health
problems and Medical and health care needs.
(2) For local, national and international comparison of health status
(3) For planning, administration and management of health services and
programmes
(4) For assessing whether health services are accomplishing their objectives
in terms of Their effectiveness and efficiency
(5) For assessing the attitude and degree of satisfaction of the beneficiary with
the health system
(6) For research into particular problems of health and disease
Management of information system:
Management information system means a formal system that provides timely
and necessary information to the manager for making decisions.
Health management information system:
It is a part of Management information system which is a formal system that
supplies timely and necessary information to the health planners through
surveillance for monitoring and making decisions in the area of health care
delivery system.
Surveillance:
Surveillance is an integral part of the Management information system. One of
the modules of the child survival and safe motherhood programme states: “
An effective surveillance system is essential to achieve the goals as reliable
epidemiological data are necessary for effective planning, monitoring the
quality services and documentation of impact”
Importance of surveillance:
The data generated through surveillance are important in planning health
services because they are:
(1) Highlight the magnitude of an illness as a public health problem.
(2) Help in planning appropriate programme interventions based on
epidemiological data.
(3) Monitor the quality of community and institutional health services being
rendered.
(4) Estimate programme needs for drugs(in terms of the country‟s national
policy)
(5) Document impact of health services, reduction in mortality and morbidity
rates, declining trends of diseases, prevention of cases, complication and
death etc.
Types of surveillance:
Surveillance is of two types
(1) Active
(2) Passive
(1) Active surveillance:
This type of surveillance, where active participation of the concerned
personnel come into play is known as active surveillance.
Eg. Collecting information on fever cases and blood slides for detection of
malaria.
(2) Passive surveillance:
Passive surveillance on the contrary is that type of surveillance, where health
data are available from hospital and other health facilities, where consumers
come on their own
seeking necessary health related interventions.
HEALTH EDUCATION
Health education defined
“Health education is a process that informs, motivates and helps people to
adopt and maintain healthy practices and lifestyles, advocates environmental
changes as needed to facilitate this goal and conducts, professional training
research to the same end”
Objectives of health education
a) Informing people:
The first objective of health education is to inform people or disseminate
scientific knowledge about prevention of disease and promotion of health.
Exposure to knowledge will melt away the barriers of ignorance, prejudices
and misconceptions, people may have about health and disease.
(b) Motivating people:
The second objective is more important than the first. Simply telling people
about health is not enough. They must be motivated to change their habits
and ways of living, since many present day problems of community health
require alteration of human behavior or changes in the health practices which
are detrimental to health, viz. pollution of water, outdoor defecation,
indulgence in alcohol, cigarette smoking, drug addiction, physical inactivity,
family planning, etc.
(c) Guiding into action:
Under the above definition, health education can and should be conducted by
a variety of health, education and communication personnel, in a variety of
settings, starting with the physician. People need help to adopt and maintain
healthy practices and life-styles, which may be totally new to them.
Approaches to public health
“There are three well known approaches to public health:
(1) REGULATORY APPROACH:
The regulatory or legal approach seeks to protect the health of the public
through the enforcement of laws and regulations, e.g., Epidemic diseases Act,
Food Adulteration Act, etc. The best laws are but waste of paper if they are
not appreciated and understood by the people. They may be useful in times of
emergency or in limited situations, e.g., fairs, festivals and epidemics; but they
are not likely to change human behaviour. In areas involving personal choice
(e.g., giving up smoking, family planning) laws have little place in a democratic
society. The legal approach has also the disadvantage that it requires vast
administrative machinery to enforce laws and also involves considerable
expenditure.
(2) SERVICE APPROACH:
The service or administrative approach aims at providing all the health
facilities needed by the community in the hope that people would use them to
improve their own health. The service approach proved a failure when it was
not based on the „felt needs” of the people. For example, when water seal
latrines were provided, free of cost, in some villages in Cameroon under
the Community Development Programme, people did not use them. This
serves to illustrate that we may provide free service to the people, but there is
no guarantee that the service will be used by them.
(3) EDUCATIONAL APPROACH:
The educational approach is a major means today for achieving change in
health practices and the recognition of health needs; It involves motivation,
communication and decision-making. The results, although slow, are
permanent and enduring. Sufficient time should be allowed to have the
desired change brought about. There are certain problems which can be
solved only through education, e.g., nutritional problems, infant and child care,
personal hygiene, family planning. The educational approach is used widely
today in the solution of community health problems. It is consistent with
democratic philosophy which does not “order” the individual..
Principles of health education
(1) INTEREST:
It is a psychological principle that people are unlikely to listen to those things
which are not to their interest. It is salutary to remind ourselves that health
teaching should relate to the interests of the people. The public is not
interested in health slogans such as “Take care of your health” or „be healthy”.
A health education programme of this kind would be as useless as asking
people to “be healthy”, as a nutrition programme asking people to “eat good
food”. Health educators must find out the real health needs of the people.
Psychologists call them ‟felt-needs”, that is needs the people feel about
themselves. If a health programme is based on “felt needs” people will gladly
participate in the programme; and only then it will be a people’s programme.
Very often, there are groups, who may have health needs of which they are
not aware. This is especially true in Cameroon where about less than 30 per
cent of the people are illiterate. The health educator will have to bring about
recognition of the needs before he proceeds to tackle them.
(2) PARTICIPATION:
It is a key word in health education. Participation is based on the
psychological principle of active learning; it is better than passive learning.
Group discussion, panel discussion, workshop all provides opportunities for
active learning. Personal involvement is more likely to lead to personal
acceptance.
(3) KNOWN TO UNKNOWN:
In health education work, we proceed from the known to the unknown i.e.,
start where the people are and with what they understand and then proceed to
new knowledge. We use the existing knowledge of the people as pegs on
which to hang new knowledge. In this way systematic knowledge is built up.
New knowledge will bring about a new, enlarged understanding which can
give rise to an insight into the problem. The way in which medicine has
developed from religion to modern medicine serves us as an illustration, the
growth of knowledge from the unknown to the known. It is a long process full
of obstacles and resistance, and we must not expect quick results.
4)COMPREHENSION:
In health education we must know the level of understanding, education and
literacy of people to whom the teaching is directed. One barrier to
communication is using words which cannot be understood. A doctor asked
the diabetic to cut down starchy foods; the patient had no idea of starchy
foods. A doctor prescribed medicine in the familiar jargon “one teaspoonful
three times a day”; the patient, a village woman, had never seen a teaspoon,
and could not follow the doctor’s directions. In health education, we should
always communicate in the language people understand, and never use
words which are strange and new to the people. Teaching should be within
the mental capacity of the audience.
(5) REINFORCEMENT:
Few people can learn all that is new in a single contact. Repetition at intervals
is extremely useful. It assists comprehension and understanding. Every health
campaign needs reinforcement; we may call it a “booster dose”.
6) MOTIVATION:
In every person, there is a fundamental desire to learn. Awakening this desire
is called motivation. There are two types of motives – primary and secondary.
Primary motives (e.g.,sex, hunger, survival) are driving forces initiating people
into action; these motives are inborn desires. Secondary motives are based
on desires created by outside forces or incentives. Some of the secondary
motives are praise, love, rivalry, rewards and punishment, and recognition.
In health education, motivation is an important factor; that is, the need for
incentives is a first step in learning to change. The incentives may be positive
or negative. To tell a lady, faced with the problem of overweight, to reduce her
weight because she might develop cardiovascular disease or it might reduce
her life span, may have little effect; but to tell her that by reducing her weight
she might look more charming and beautiful, she might accept health advice.
When a father promises his child a reward for getting up early every day, he is
motivating the child to inculcate a good habit. In health education, we make
use of motivation.
(7) LEARNING BY DOING:
Learning is an action-process; not a “memorizing” one in the narrow sense.
The Chinese proverb: “If I hear, I forget; if I see, I remember, if I do, I know”
illustrates the importance of learning by doing.
(8) SOIL, SEED AND SOWER:
The people are the soil, the health facts the seed and the transmitting media
the sower. Prior knowledge of the people-customs, habits, taboos, beliefs,
health needs- is essential for successful health education. The seed or the
health facts must be truthful and based on scientific knowledge. The
transmitting media must be attractive, palatable and acceptable.
Unless these three elements are carefully and satisfactorily interrelated the
message will not have the desired effect.
(10) SETTING AN EXAMPLE:
The health educator should set a good example in the things he is teaching If
he is explaining the hazards of smoking, he will not be very successful if he
himself smokes. If he is talking about the “Small family norm”, he will not get
very far if his own family size is big.
(11) GOOD HUMAN RELATIONS:
Studies have shown that friendliness and good personal qualities of the health
educator are more important than his technical qualifications. Good human
relations are of utmost importance in learning. The health educator must be
kind and sympathetic. People must accept him as their real friend.
(12) LEADERS:
Psychologists have shown and established that we learn best from people
whom we respect and regard. In the work of health education, we try to
penetrate the community through the local leaders-the village headman, the
school teacher or the political worker. Leaders are agents of change and they
can be made use of in health education work. If the leaders are convinced first
about a given programme, the rest of the task of implementing the programme
will be easy. The attributes of a leader are: he understands the needs and
demands of the community; provides proper guidance, takes the
initiative, is receptive to the views and suggestions of the people;
identifies himself with the community; self-less, honest, impartial,
considerate and sincere; easily accessible to the people; able to control
and compromise the various factions in the community; possesses the
requisite skill and knowledge of eliciting cooperation and achieving
coordination of the various official and non-official organizations.
METHODS OF HEALTH EDUCATION
Health education is carried out at three main levels – individual, group and
general public through mass media of communication. For effecting changes
in attitudes and behaviors‟, we rely on individual and group approach.
(1) Individual and family health education
There are plenty of opportunities for individual health education. It may be
given in personal interviews in the consultation room of the doctor or in the
health center or in the homes of the people. The individual comes to the
doctor or health center because of illness. Opportunity is taken in educating
him on matters of interest – diet, causation and nature of illness and its
prevention, personal hygiene, environmental hygiene, etc. Topics for
health counseling may be selected according to the relevance of the situation.
By such individual health teaching, we will be equipping the individual ad the
family to deal more effectively with the health problems. The responsibility of
the attending physician in this regard, is very great because he has the
confidence of the patient. The patient will listen more readily to the physician’s
health counselling. A hint from the doctor may have a more lasting effect than
volumes of printed word. The nursing staff has also ample opportunities for
undertaking health education. Florence Nightingale said that the nurse can do
more good in the home than in the hospital. Public health nurses, health
visitors and health inspectors are visiting hundreds of homes; they have plenty
of opportunities for individual health teaching.
In working with individuals, the health educator must first create an
atmosphere of friendship and allow the individual to talk as much as possible.
It is useful to remember; “Give everyone thing ear, but few thy words”. The
biggest advantage of individual health teaching is that we can discuss, argue
and persuade the individual to change his behavior. It provides opportunities
to ask questions in terms of specific interests. The limitation of individual
health teaching is that the numbers we reach are small, and health education
is given only to those who come in contact with us.
(2) Group health education
Our society contains groups of many kinds – school children, mothers,
industrial workers, patients, etc. Group teaching is an effective way of
educating the community. The choice of subject in group health teaching is
very important; it must relate directly to the interest of the group. For example,
we should not broach the subject of tuberculosis control to a mother who has
come for delivery; we should talk to her about child-birth and baby care.
Similarly, school children may be taught about oral hygiene; tuberculosis
patients about tuberculosis, and industrial workers about accidents. We have
to select also the suitable method of health education including audio-visual
aids for successful group health education. A brief account of the methods of
group teaching is given below:
(1) Lectures:
Lectures are the most widely used method of teaching, including health
education. It is not a good method because communication mostly one-way”.
There is no opportunity for the group to participate actively in learning. The
lecture should be on a topic of current health interest, based on the needs of
the group; it should not exceed 15 to 20 minutes; the subject matter should
not deal with more than 5 or 6 points; the group should not be more than 30.
The effect of the lecture depends upon the personality and performance of the
speaker. Lecture may arouse interest in a subject. It may stimulate a group
and give them basic information upon which to act.
Used alone, the lecture method may fail to influence the health behaviour of
people. The lecture method can be made effective by combining with the
following audio-visual aids.
(a) Films and charts:
These are mass media of communication. If used with discrimination, they can
be of value in educating small groups.
(b) Flannel graphs:
A piece of rough flannel or khaki fixed over a wooden board provides an
excellent background for displaying cut-out pictures, graphs, drawings and
other illustrations. The cut out pictures and other illustrations are provided with
a rough surface at the back by pasting pieces of sand paper, felt or rough
cloth and they adhere at once when put on the flannel.
Flannel graph offers the advantage that pre-arranged sequence of pictures
displayed one after another helps maintain continuity and adds much to the
presentation. The other advantages are that the flannel graph is a very cheap
medium easy to transport and promotes thought and criticism.
(c) Exhibits:
Objects, models, specimens, etc. convey a specific message to the viewer.
They are essentially mass media of communication, which can also be used
in group teaching.
(d) Flash Cards:
They consist of a series of cards, approximately 10 by 12 inches, each with an
illustration pertaining to the story or talk to be given. Each card is “flashed” or
displayed before a group as the talk is being given. The message on the cards
must be brief and to the point. Flash cards are primarily designed to hold the
attention of the group.
(2) Group discussions:
Group discussion is considered a very effective method of health teaching. It
is a “two way”communication; people learn by exchanging their views and
experiences. This method is useful when the groups have common interests
and similar problems. For an effective group discussion, the group should
comprise not less than 6 and not more than 20 people. There
should be a group leader who initiates the subject, helps the discussion in the
proper manner, prevents side-conversations, encourages everyone to
participate and sums up the discussion in the end. If the discussion goes well,
the group may arrive at decisions which no individual member would have
been able to make alone. It is also desirable to have a person to record
whatever is discussed. The “recorder” prepares a report on the issues
discussed and agreements reached. In a group discussion, the members
should observe the following rules:
(a) express ideas clearly and concisely
(b) listen to what others say
(c) do not interrupt when others are speaking
(d) make only relevant remarks
(e) accept criticism gratefully and
(f) help to reach
Group discussion is successful if the members know each other beforehand,
when they can discuss freely. There is a good deal of evidence that group
discussion is a very effective method of bringing about changes in the health
behavior of people. Further, when a group of people decide collectively to
accept an idea and act on it, the group acceptance strengthens
and reinforces and gives the individual member courage to do the same. A
well conducted group discussion is usually effective in reaching the right
decisions and securing desirable action.
(3) Panel discussions:
In a panel discussion, 4 to 8 persons who are qualified to talk about the topic
sit and discuss a given problem, or the topic, in front of a large group or
audience. The pane comprises, a chairman or moderator and from 4 to 8
speakers. The chairman opens the meeting, welcomes the group and
introduces the panel speakers. He introduces the topic briefly and invites the
panel speakers to present their point of view. There is no specific
agenda, no order of speaking and not set speeches. The success of the pane
depends upon the chairman; he has to keep the discussion going and develop
the train of thought. After the main aspects of the subject are explored by the
panel speakers, the audience is invited to take
part. The discussion should be spontaneous and natural. If members of the
panel are unacquainted with this method, they may have a preliminary
meeting, prepare the material on the subject and decide upon the method and
plan of presentation. Panel discussion can be an
extremely effective method of education, provided it is properly planned and
guided.
(4) Symposium:
A symposium is a series of speeches on a selected subject. Each person or
expert presents an aspect of the subject briefly. There is no discussion among
the symposium members unlike in panel discussion. In the end, the audience
may raise questions. The chairman makes a comprehensive summary at the
end of entire session.
(5) Workshop:
The workshop is the name given to a novel experiment in education. It
consists of a series of meetings, usually four or more, with emphasis on
individual work, within the group, with the help of consultants and resource
personnel. The total workshop may be divided into small groups and each
group will choose a chairman and a recorder. The individuals work, solve a
part of the problem through their personal effort with the help of consultants,
contribute to group work and group discussion and leave the workshop with a
plan of action on the problem. Learning takes place in a friendly, happy and
democratic atmosphere, under expert
guidance. The workshop provides each participant opportunities to improve
his effectiveness as a professional worker
(6) Role playing:
Role playing or sociodrama is based on the assumption that many values in a
situation cannot
be expressed in words, and the communication can be more effective if the
situation is dramatized by the group. The group members who take part in the
socidrama enact their roles as they have observed or experienced them. The
audience is not passive but actively concerned with the drama. They are
supposed to pay sympathetic attention to what is going on, suggest alternative
solutions at the request of the leader and if requested come up and take an
active part by demonstrating how they feel a particular role should be handled,
or the like. The size of the group is thought to be best at about 25. Role
playing is a useful technique to use in providing discussion of problems of
human relationship. It is a particularly useful
educational device for school children. Role playing is followed by a
discussion of the problem.
(7) Demonstrations:
Practical demonstration is an important technique of health education. We
show people how a particular thing is done – using a tooth brush, bathing a
child, feeding of an infant, cooking, etc. A demonstration leaves a visual
impression on the minds of the people and is more effective than the printed
words.
For education of the general public, we employ “mass media” of
communication. These are:
(a) Television:
Television bids fair to become the most potent of all media. We can mould
public attitudes through television. Television has now become the cheapest
media of mass education.
(b) Radio:
It is found nearly in every home, and has penetrated into even the remotest
villages. It is a potent instrument of education. Radio talks should not exceed
15 minutes.
(c) Press:
Newspapers are the most widely disseminated of all forms of literature. They
are an important channel of communication to the people. The local health
department ought to establish good relationship with the local press.
(d) Health Magazines:
Some are good and some not so good. Good magazines can be an important
channel of communication.
(e) Posters:
Posters are widely used for dissemination of information to the general public.
The first job of a poster is to attract attention; therefore, the material needs
artistic preparation. Motives such as humor and fear are introduced into the
posters in order to hold the attention of the public. In places where the
exposure time is short (e.g., streets), the message of the poster
should be short, simple, direct and one that can be taken at a glance and easy
to understand immediately. In places where people have some time to spend
(e.g., bus stops, railway stations, hospitals, health centers) the poster can
present more information. The right amount of matter should be put up in the
right place and at the right time. That is, when there is an
epidemic of viral hepatitis, there should be posters displayed on viral jaundice,
but not on cholera. The life of a poster is usually short; posters should be
changed frequently, otherwise they will lose their effect. As a media of health
education, posters have much less effect in changing behavior than its
enthusiastic users would hope. Indiscriminate use of posters by
pasting them on walls serves no other useful purpose than covering the wall.
(f) Health exhibition:
Health exhibitions, if properly organized and published, attract are numbers of
people who might otherwise never come in contact with the variety of new
ideas in health matters. Small mobile exhibitions are effective if used at key
points of interest, e.g., fairs and festivals. Health exhibitions enable the local
health service to arouse public consciousness.
(g) Health museums:
Health museum display material covering various aspects of health. A good
museum can be a very effective mass media of education, such
Mass media are generally less effective in changing human behavior than
individual or group methods because communication is “one-way”.
Nevertheless, they do have quite an important value in reaching large
numbers of people with whom there is no contact. The continuous
dissemination of information and views about health through all the media
contribute in no small degree to the raising of the general level of knowledge
in the community. For effective health education, mass media should
preferably not be used alone,but in combination with other methods.
COMMUNICATION
Definition of communication:
Communication is the process of exchanging the information, and the process
of generating and transmitting meanings, between two or more individuals.
Communication process:
(1) Communicator or Sender:
Sender is the originator of the message. To be effective, a communicator
must know
(a) his objectives – clearly defined;
(b) his audience – its needs, interests and abilities;
(c) his message – its content, validity and usefulness; and
(d) channels of communication.
(2) Message:
It is the information a communicator wishes his audience to receive,
understand, accept and act upon. A good message must be
(a) in line with the objectives
(b) carefully chosen, i.e., oriented to the needs of the audience
(c) clear and understandable
(d) specific
(e) timely and
(f) appealing. The message must fit into the existing framework of attitudes,
and interests of the people.

(3) Audience or receiver:

They are the consumers of the message. The audience may be the total
population or specific group within the population.
(4) Channels of communication:
By channel is implied the medium of communication. The choice of the
medium is an important factor in the effectiveness of communication. It has to
be carefully selected bearing in mind its ability to deliver the message, its cost
and availability. An attempt should be made to provide variety in selecting
channels so as to keep the teaching process interesting and entertaining. A
two-way communication is more likely to influence behavior than one-way
communication. Wherever possible, communication should be adjusted to the
local cultural patterns (folk media) of the people.

Types of communication:
(1) One way communication:
The flow of communication is one way from the communicator to audience.
The familiar example is the lecture method in the class room.
(2) Two way communication:
Communication in which both the communicator and audience take part. The
Audience may raise question, and add their own information, ideas and
opinions to the subject.
(3) Verbal communication is exchange of information using words, including
both spoken and written words. Nurses use verbal communication extensively
when providing patient care. They also speak with patient’s family members,
other nurses about patient’s report. Common verbal
communications in health care setup are:
1. Discussion,
2. Meetings,
3. Suggestions,
4. Advice
5. Announcements
6. Periodical talk between employer and employee,
7. Staff conferences
8. Social gatherings.
9. Employee counseling's
10. Records and reports

(4) Non-verbal communication:

Communication can occur even without words. It includes a whole range of
bodily movements, posture, gesture, facial expression (smile, raised eye
brows, touch, eye contact etc.)

(5) Visual communication:

The visual forms of communication comprise: charts and graphs, pictograms,
tables, maps,posters etc.

BARRIERS OF COMMUNICATION
These can be:
1. Physiological - difficulties in hearing, expression
2. Psychological - emotional disturbances, neurosis, level of intelligence
3. Environmental - noise, invisibility, congestion
4. Cultural - levels of knowledge and understanding, customs, beliefs,
Religion, attitudes, economic and social class differences, cultural difficulties
between foreigners and nationals, between urban education and rural
population. The barriers should be identified and removed for achieving
effective communication
COUNSELLING
Counselling is a process which helps the client to understand his feelings
About the problem, seek information and gain knowledge and make his own
Decisions to solve the problem in the best possible way.
Role of Health Worker as a counsellor
-become a friend to your client
-be a good listener
-be helpful by offering advice
-have good knowledge about your work
-give correct and complete information
-give the facts
-be a good communicator-use non-verbal and verbal skills effectively
-keep in constant touch with your client
-motivate the client
-build self esteem of the client
-avoid biases against the client
-ensure to enable the client to solve his/her problem
Situations for counselling
Following are certain situations for counselling
1.With couples or man/woman who need counselling about different kinds
2.With families of pregnant women at risk
3.With adolescents
4.With parents for child care etc.
Technique for counselling
Every counselling is a unique experience. This is because every client is
different from the other. Each client has a different problem and requires a
Different solution. Counselling means building a relationship during which the
Client experiences confidence in counsellor to begin with, discuss his
problems with counsellor and goes through a process of finding solutions.
This cannot be possible in just one meeting; regular visits are necessary. The
following seven steps make you understand counseling process easier.
Steps of Counselling
1.Focus your attention on your client
2.Accept the client.Do not show prejudices and interrupt the client.
3.Show empathy. Empathy means counsellor has to identify himself/herself
with the client’s situation. This facilitates better understanding of the problem
4.Do probing-Sometimes client may miss or feel shy to share some
information with the counsellor. Ask probing questions.This will give more
information that the client was not willing to offer earlier. Probing is necessary
to understand the problem better.
5.Plan best possible solution with the client
6.Paraphrasing-Repeat what your client says. This will make her/him feel that
you understand her problem completely.
7.Summarising-This is the last step. Here counsellor list out main points of
discussion. This helps to remember outcomes in a nutshell.
Counselling skills
Good interviewing skills
Eye contact
Appropriate facial expression-It should be in such a way that counselor is
interested and has concern.
Good body posture-It should show that counselor is relaxed
Use verbal propts
Use easy to understand language
Make right body movement cues-Body movement should match with what
counsellor is saying.
Do’s
1.Keep the surroundings neat and clean so that client feels relaxed.
2.Make the client comfortable by being friendly
3.Ensure that your client is relaxed and has confidence in you.
4.Listen with attention
5.Speak in a clear and audible tone.
6.Speak in soft voice especially to children
7.Dress soberly
8.Use non-verbal skills to communicate. Use empathy and understanding.
Don’ts
1.Do not counsel in dirty surroundings
2.Do not begin counselling immediately
3.Do not stop your client from talking
4.Volume of your voice should not be high
5.Do not dress against dress code of your area.
6.Do not use exaggerated gestures
7.Do not ask close ended questions (Yes/No type questions) if you need more
information
8. Do not bring in personal biases in counseling process
9.Do not forget to thank the client.
GATHER TECHNIQUE
1.G-Greeting - With a smile and in a friendly manner
2.A- Ask open ended questions
3.T-Tell benefits
4.H-Help client make own decision
5.E-Explain
6.R-Return
STYLES /APPROACHES IN DOING COUNSELING
1.Counsellor centred or Authoritarian style: Counsellor gives advices and
makes decisions based on what she/he thinks is best for the client and
expects client to follow the advice. It is completely directed by the counsellor.
2.Client centred/ Non-directive style: Here the counsellor is passive, is mainly
a listener, the client is active and expresses freely. Client tells the counsellor
what he/she wants and after careful reflection and clarification makes own
decision.
3.Non-authoritarian style: This style is neither the counsellor/client controlled.
This style in counselling lies somewhere between these first two styles, it
uses
a variety of styles.
I. Direct(take place during the face-to- face interaction with the client)
Client reflection, ventilation of feelings,providing emotional support(through
expression of interest, understanding, assurance and confidence), giving
suggestions
ii.indirect(efforts directed at the client’s environment) involving people who
can be of help [eg.family members; neighbours], referral to appropriate
community resources
RUMOURS AND MISCONCEPTIONS
Rumour is incorrect news. Misconception is related to our values and views
which we hold as a part of our socio-cultural life.
List of rumours
1.Complications developed by some women in the village after IUD insertion
yesterday
2.Children who were immunized recently in the village have become ill
3.A woman in the village had twins after being given red tablets by the JPHN
List of misconceptions/ Old beliefs
1.Sterilisation is only for women since they give birth to children
2.Sons are important since they support parents in old age
3.Educating girls is not important since their main task is to look after the
family
4.Sex of child is determined by the mother
5.Sterilization for men makes them unfit for hard work
6.Colostrum causes diarrhoea for new born
Diagnosing rumours and misconceptions
Rumours and misconceptions are to be tackled in a systematic way. Before
starting the task of solving the problem ensure the following.
-Identify types of rumours and misconceptions
-Assess how important they are
-Identify the measures needed to deal with them by involving the
community and health team
-Identify the people who believe rumours and strongly believe them
-Find out why these people believe them?
-Prepare a time frame for removing them
-Identify your associates who will help you.
Ways of removing Misconceptions and rumours using IPC skills
Convince by demonstration: The health worker can convince the clients by
showing them the effectiveness of the information that is being given to them
as against their old beliefs. Parents can be shown that good nutrition will
mean healthy children and not malnourished. It can also be shown that
immunization protects children from various diseases and they should not fear
immunization.
Advocacy : The health worker can seek the help of an acceptor of the
program to tell the people about benefits. This is called advocacy. For eg.
health worker can ask an acceptor of the family planning methods to tell the
non-acceptor couples about the usefulness of having a small family by citing
their own case. This will be more acceptable to people in the community and
strengthens the credibility of the program.
Obtain sanction: The health worker can ensure the participation of opinion
leaders in putting an end to rumours in the community
Make a visit : Depending on the spread, the health worker can decide on an
informal visit to the household or organize a group meeting with the key
members of the community.
Sustain motivation : Motivation should be sustained over a long period of
time to be effective. It may not be easy for the health worker to remove a
rumour which a person believes in at once. For this there is a need for
constant touch with clients and communities and motivation from time to time.