Health promotion -National Vector Borne Disease Control Programme
Dr Mohan Lal
Department of Community Medicine
Government Medical College
1. Importance of Health promotion
2. Understand components of communication process
3.Behaviour Change Communication
4.Diffusion of Innovation
5.Strategies & Actions to achieve health promotion
Health behaviour is determined by two interrelated factors:
a person's perception both of threat of a health problem &
of his or her accompanying appraisal of a recommended
behaviour for preventing or managing the problem.
For early detection for some conditions, such as infectious
diseases (malaria), that people might find frightening,
especially if they are uncertain about the effects of
treatment methods and therefore accept services.
" Science & art of helping people change their lifestyle
to move toward a state of optimal health”
(American Journal of Health Promotion,1986)
"The process of enabling people to increase control over
their health and its determinants, and thereby improve
their health, in addition to methods to change lifestyles.
(WHO's 2005 , Bangkok Charter ).
Comprehensive social & political process,
Not only embraces actions directed at
strengthening skills & capabilities of individuals
Action directed towards changing social,
environmental & economic conditions
To minimize impact of determinants on public &
Participation is essential to sustain health
Provision of information &/or education to individuals,
families, & communities that-encourage
Make positive contributions to health status by
changing behaviour & life styles.
Promotion of healthy ideas & concepts to motivate
individuals to adopt healthy behaviours
Own Feature Own Feature
Communication is a continuous process where sender sends
some message, concept or information through a medium
with specific objective to a receiver that create a kind of
reaction to receiver & accordingly latter reflects on that
Receiver is key in communication.
Depending on the nature of receiver, message & media are
Response or reply is what the receiver reflects after getting the
message in communication response is also significant.
If response is not made communication is not complete &
objective of communication cannot be achieved.
Only after getting response sender understands to what
extent his message is communicated & can initiate actions
Response may be immediate or delayed.
Important ingredients of communication together make
process of communication complete.
Source: CGAP Direct
To get action
To get & give
Health behaviour can be something that is done once, or
something that is done periodically—like getting JE
It can also be something that one does only to oneself, such as
using medicated bed nets in malaria endemic area, or a
behaviour that affects others, like providing bed nets to others
so that children are protected from malaria.
Sustained pattern of complex behaviour, that are called
A composite of various healthful behaviours is often referred
to as "healthy lifestyle."
Refers to systematic attempt to modify/influence
behaviour, or practices & environmental factors
related to that behaviour, which indirectly or directly
promote health, prevent illness or protect individuals
The behaviour change communication (BCC) is a
process that motivates people to adopt & sustain
healthy behaviours & lifestyles.
Sustaining healthy behaviour usually requires a
continuing investment in BCC as part of an overall
health programme .
"A fully aware, well informed and properly trained
population is best guarantee of safety and of successful
response to any disaster."
Enhances awareness , address & promote
attitudinal & value changes
Informed decision-making & modification in
Adoption of timely & Appropriate practices at
individual, family & community levels
Stimulates increased & sustained demand for
Health care services & optimal utilization of
Knowledge: (Provide information, personalize benefits & risks)
Approval: (create trust, information to appeal to head and heart)
Practice: (build skills)
Advocacy: (build social support, develop confidence to speak up)
Steps to Behaviour Change
Various activities are carried out involving community
leaders in planning process.
Role of community participation is to provide
facilities to community worst affected especially with
Providing medicated mosquito net,
Synthetic Pyrethroids Indoor Residual Spraying (IRS)
Guppy fish introduction, etc.
Public Private Partnership (PPP) work as a bridge
between Government & community.
Essential in removing myths & misconception in
Their proposed area of operation is to see
treatment seeking behaviour of community, their
participation during indoor residual spraying,
feasibility study of social marketing and creation
of awareness in biological control of malaria, etc
Robinson's solution is to identify seven steps to social change:
1. KNOWLEDGE – knowing there is a problem
2. DESIRE – imagining a different future
3. SKILLS – knowing what to do to achieve that future
4. OPTIMISM – confidence or belief in success
5. FACILITATION – resources and support infrastructure
6. STIMULATION – a compelling stimulus that promotes action
7. REINFORCEMENT – regular communications that reinforce the original
THE DIFFUSION OF INNOVATION THEORY
(Rogers - 1962)
The adoption of ideas in a community diffuses
among individuals in that community at varying rates
Early in the introduction of a new idea, it is picked up
by ‘innovators’ (between 2 and 3% of the target
population) who are venturesome, independent,
risky and daring.
They want to be the first to do things.
The second group of people, the ‘early adopters’ (about
14% of the target population) are very interested in the
innovation but they are not the first to sign up.
They wait until the innovators are already involved to
make sure the innovation is useful.
They are respected by others in the social system and
looked at as opinion leaders.
The next group ‘early majority’ (about 34% of the target
population) may be interested in the innovation but will
need external motivation to become involved.
They will deliberate for some time before making a
The ‘late majority’ (also about 34% of the target population)
are next and it will take more time to get them involved for
they are skeptical and will not adopt an innovation until
most people in the social system have done so.
The last group the ‘laggards’ (about 16% of the target
population are not very interested in innovation and would be
the last to become involved.
They are very traditional and are suspicious of innovations.
Laggards tend to have limited communication networks, so
they really do not know much about new things.
This situation calls for different strategies for different
categories of people and at different stages of the adoption
number or % of
Source: Green & MCAlister 1984.
Assess health needs
Assess social , environmental & cultural influences
on health behaviors
Lifestyle modifications is a comprehensive
approach for effective change in heath promotion
Use of Senior Citizens for propagating Health messages.
Use of executive members of the Residential Welfare Association.
Announcement through mosque loud speakers.
Preach through the priest in the temple.
Preach during poojas/festivals
Sending Leaflets regarding health messages through newspapers.
Sending health messages through sales girls and boys.
· Lack of knowledge & non –availability preventive measures
·Non- Availability of field staff & Inappropriate use of anti-malaria drugs
· Poor felt need & utilization of health services
· Lack of effective strategies for community participation
· Reluctance of local self-government & shortage of budget;
· Local beliefs of people (belief in Tantra-Mantra, Jaadu-Tona, etc.)
Install and maintain screens on windows and doors.
Consider minimizing the amount of time you spend
outdoors from dusk to dawn.
Spray exposed skin & clothing with repellents
Eliminate mosquito breeding sites.
Support community‐based mosquito control programs
Involves population as a whole in context of their every day life,
rather than focusing on people who are at risk from specific
Directed towards action on the determinants or causes of ill
Combines diverse, but complementary, methods or approaches.
Aims for public participation.
Health promotion is basically an activity in health and social fields
- and not a medical service, … but health professionals should work
outwards, in education and health advocacy.
Political process by an individual or a large
group which normally aims to Influence public-
policy & resource allocation decisions within
political, economic, and social systems and
Activities undertakes include:-
- Media campaigns
- Public speaking
- Publishing research.
Lobbying (often by lobby groups) is a form of advocacy
where a direct approach is made to legislators/policy
or decision makers on an issue which plays a significant
role in influencing health of a community.
Supports & promotes patient's health care rights
Enhance community health & policy initiatives that
- Quality of care
Actions for Health
Environment & health are interdependent & inseparable, both be
made central objectives in setting of priorities for development.
People living in extreme poverty and deprivation in an increasingly
degraded environment threatens their health, making goal of
health for all hard to achieve.
Making environment- physical environment, social environment, &
political environment-supportive to health rather than damaging to
Everyone has a role in creating supportive environments for
health-policy makers, decision makers, and community activists in
the health and environment sectors.
Initiatives have to come from all sectors that contribute to the
creation of supportive environment for health.
Health promotion puts health on the agenda of
policy makers in all sectors and at all levels,
To be aware of the health consequences of their
To accept their responsibilities for health.
Aim of healthy public policy is to
create a supportive environment to enable people to
lead healthy lives.
Effective community action in setting priorities,
making decisions, planning strategies in
implementing them to achieve better health.
At the heart of the community action is
“Empowerment of the communities -
HP supports personal and social development through providing
information, education for health, and enhancing life skills.
It increases the options available to people to exercise more
control over their own health and over their environment, and
to make choices conducive to health.
Enabling people to learn throughout life, to prepare themselves
for all of its stages and cope with illnesses and injuries is
Facilitated at schools, home, work and community settings
through educational, professional, commercial and voluntary
Role of health sector must move increasingly in a health promotion
direction, beyond its responsibility for providing clinical & curative
Health services should be sensitive & respect cultural needs.
Need to embrace an expanded mandate that should support the needs of
individuals and communities for a healthier life.
Open channels between the health sector and broader social, political,
economic & physical environmental components.
Stronger attention to health research as well as professional education
Hinweis der Redaktion
At the end of this chapter the participant will be able to:
such as MDA and use of IRS/LLINs?
The "first and best known" definition of health promotion, promulgated by the American Journal of Health Promotion since at least 1986, Health promotion has been defined by the World Health Organization's 2005 Bangkok Charter for Health Promotion in a Globalized WorldHealth promotion can be performed in various locations. Among the settings that have received special attention are the families, community, health care facilities, schools, at family level and worksites. Worksite health promotion, also known by terms such as "workplace health promotion," has been defined as "the combined efforts of employers, employees and society to improve the health and well-being of people at work".
To reach a state of complete physical, mental & social well-being, an individual or group must be able to: Identify and to realize aspirations to satisfy needs, Change or cope with the environment. An action for health using knowledge, communication & understanding
Receiver is one whom message is addressed at.
When the receiver responds he becomes sender and the original sender becomes receiver. In a two-way communication this change is obvious.
This is a strategy, which
Enhances awareness amongst vulnerable groups regarding sources, transmission, risk reduction, treatment and availability of services Address & promote attitudinal & value changes among target groups Leading to informed decision-making, Modified behaviour Adoption of timely & Appropriate practices at individual, family & community levels Stimulates increased & sustained demand for quality prevention Health care services and optimal utilization of available services.
The community has knowledge about how (malaria/filarisis) the disease spreads Can recall the message related to VBDs floated locally Can narrate the ways and means of preventing VBDs Responds favourably to various messages (appreciates the message of using the LLNs by pregnant mothers/children/other family members) Discusses prevention measures with family, friends/other net work (community awareness of not allowing water to collect in tyre/places) Agrees that family/friends/other significant people approve of and will apply the preventive measures (clean water coolers in a week) Approval of measures such as DDT spray Visits the service providers for information/receive supplies/services Applies preventive measures as suggested by the health providers Creates conditions for the community to meet the local MLA/ leaders of PRIs for initiating the DDT spray
detected were found among unvaccinated people. China and Japan have successfully implemented vaccination with impressive results. Such success stories can be shared with the community
Community Participation in Health Promotion No health programme succeeds without active participation of the community. Malaria control is the responsibility of local self-government i.e. Zilla Parishad, Taluka Panchyat and Gram Panchyat, established under Panchayati Raj System. Various activities are carried out involving community leaders in planning process. The role of the community participation is to provide facilities to the community worst affected especially with the malaria by providing medicated mosquito net, synthetic pyrethroid Indoor Residual Spraying (IRS), guppy fish introduction, etc. For example, community awareness of the symptoms of kala-azar and when to seek treatment; surveillance and monitoring of drug resistance can enable in the early detection and scaling up intervention targeting villages with a high burden of disease, if needed
Their involvement is essential in removing myths and misconception in the community. Their proposed area of operation is to see treatment seeking behaviour of the community, their participation during indoor residual spraying, feasibility study of social marketing and creation of awareness in biological control of malaria, etc
An Example of Steps to Behavior Change: Malaria You can apply the above steps to initiate social change related to aspects such as JE. For example, the health worker can encourage the parents to go for immunization of children and narrate cases of use of vaccines in Japan, Republic of Korea, Taiwan, China, Thailand and Nepal. A pilot study in Nepal found an eight-fold reduction compared with previous years and up to 88% of JE cases
Poverty and ignorance of the people
In the broadest sense,
Prevention is best done by minimizing exposure to mosquitoes. containing DEET or permethrin (always read and follow label directions) by emptying standing water from flower pots, buckets, barrels, and other containers
Motivated from moral, ethical or faith principles or simply to protect an asset of interest. Activities that a person or organization undertakes include:-
Supports & promotes patient's health care rights as well as Enhance community health & policy initiatives that focus on - Availability -Safety - Quality of care
Initiatives have to come from all sectors that contribute to the creation of supportive environment for health.
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