PH

1. Role of Effective Public Health
Communication
Amita Kashyap
Professor and Head (Com. Medicine)
SMS Medical College, Jaipur

2. Communication is at the Core of
Effective Public Health System
The Health and Security of the
Nation depend heavily on a
Robust Public Health System.
Role of Effective Public Health
Communication

3. Public Health Communication?
• Public Health - “what we, as a society;
do collectively to assure the conditions
in which people can be healthy.”
• Public health communication - “The art
and technique of informing, influencing,
and motivating individual, institutional,
and public audiences about important
health issues.”

4. • Effective health care – OPD as well as IPD
• Creating Awareness
– On health issues
– About available Health Care Services/ support
systems
• Bringing change in behavior for positive health
• Addressing Emergencies/ Disasters
• Capacity Building (“know-how”)
– Health functionaries
– Community
Effective Communication is needed For..

5. 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. 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.

9. What can be achieved-
1. Increased awareness about a health issue or
solution
2. Shift social norms by influencing attitudes,
e.g. voluntary HIV testing
3. Capacity building of the community e.g.
educating how to perform self-breast exams,
4. Demonstrate the benefits of adopting new,
healthier behaviors, e.g. featuring real people’s
stories of living with smoking-related diseases
prompted many people to quit smoking.

10. – Pamphlets/ Brochures, Posters,
– Newspaper articles, newsletters,
– Television and Radio broadcasts/ Commercials
– Public service announcements,
– Videos, digital tools,
– Case studies,
– Group discussions,
– Health fairs, field trips, and workbooks.
Health communication products :

11. 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

12. 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

13. 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
-Role Models,
Providing User
Friendly
Accessible
Services
Mass Media
Community
Networks &
Traditional
Media
Interpersonal &
Group
Communications
Channels

14. 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.

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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)

21. 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

22. 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

23. 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.

24. 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

25. 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

26. 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

27. 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

29. STEP IV: Monitoring and Evaluation Plan
Indicators to be Tracked
Beneficiary Category
Pregnant
Women
Lactating
Women

30. Infant
and
Children
< 5 Years
Adolesce
nts
Ctd..

31. 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

32. 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
Correctives for Behavioral
Determinants

33. 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