Module – 1

Communication

Table of Contents

Contents Page No.

Introduction and Objectives 1

Warm up game 2

Communication Process

Types of Communication

4

5

Effects of Communication

9Barriers to communication

Similarities and Differences

10

12

Non verbale communication 13

Counseling 14

Communication skills

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Introduction Duration: 2 Minutes

Effective communication in the field of community mobilization plays a critical role. It is essential those community workers are skilled in showing good attitude and developing better relations with people through effective communication. In this module, the communication skills of the participants will be strengthened through their involvement in role-plays, group work, brainstorming and group discussions.

Session objectivesSchedule for Trainer

Activity/Method Duration MaterialsLecture,

Transparency5 minutes

TR-1

After this session participants are expected to: Define communication and understand process and its elements. Define and understand Types of communication, verbal and non-

verbal Understand Barriers to communication and how to overcome Importance of Listening skill Group counseling

Warm up GameSchedule for Trainer

Activity/Method Duration MaterialsGame, Question &

Answer30 minutes

Chart marker,TR-2

Proposed Question:“Sherdil called from Karachi and asked to convey the message to his mother that Sher Bahadur will be coming, day after tomorrow via Khyber train at 12:00 noon”.

Method:

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Ask the participants to sit in a circle. Whisper the above sentence to the person sitting next to him/her. That person will whisper the same sentence in the next person’s ear. This act is repeated till the last participant. Inform the participants that the sentence can neither be repeated nor asked again. After this exercise the trainer will ask the last participant what did he hear. Usually the sentence heard by the last person is totally distorted.

Trainers note: Ask the participants how did they feel during the game?

Expected Answers: Embarrassed Confused Distracted

Trainer should explain and clarify why the sentence was distorted?

Difficult and unusual words were being used Sentence was too long, too many details Message was not repeated and participants were not allowed to repeat the

message. Conscious about being observed Due to noise and external disturbance Message had nothing to do with listener’s interest or needs. Listeners could not ask questions.

This session focuses on 5 basic principles of effective communication. Provide a comfortable setting with few distractions. Focus on listener’s needs or interests. Be brief; do not give too much information at one time. Use words that are familiar to the listeners..

Use two-way communications (listen as well as speak).

Communication Process and Its Elements

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Schedule for TrainerActivity/Method Duration Materials

Question & answer, Lecture,

Transparency

15 minutes TR-2, 3

Trainer’s note: Ask the participants the definition of communication? After getting feed back from participants then elaborate as:

Communication can be termed as conversation in simple language. In other words transfer of ideas, opinions, thoughts, information and knowledge from one place to another or from one person to another is called communication.

Elements of Communication Process

Communication process has five basic elements:1. Source/Sender2. Message3. Channel4. Receiver5. Feedback

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Types of CommunicationSchedule for Trainer

Activity/Method Duration MaterialsLecture, question &

answers, Transparency

15 minutesTransparency

Trainer’s Note: Ask the participant what are the different types of communication, write down the answers on a chart, and explain.

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Types of Communications

Verbal Non-ansparency erbal

Direct (IPC)

Indirect

One-way (information giving)

Two-way (Counseling)

Group Individual

Attitude and behavior

Communication is of two Types

Non verbal communication – how we behave towards others.

Verbal Communication – the way we talk to others and ask questions. It can be of two types.

i) Indirect communication (electronic/print media)ii) Direct communication (interpersonal)

One-way communication e.g. lecture, reading, speech etc. Two-way communication e.g. counseling

Trainer’s Note: Divide the participants into two groups; ask one group to discuss and write down the advantages and disadvantages of direct communication and to the other of indirect communication. After this, ask both groups to make presentations.

Difference between direct and indirect Communication

Direct Indirect Information can be given and

received Facts and related information can

be explained. Message can be given to a limited

number of people Immediate feedback Listener can participate

Information can only be conveyed Explanation is not possible.

Large number of people can receive the information.

Delayed or no feedback Participation not possible

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Trainers note: Ask the participants how can we establish a good rapport with a patient? This is where our communication skills come in:Let us explore verbal skills in the next section and concentrate now on the non-verbal skills. Please read the case study below, and then answer questions 3 and 4 that follow it.

Asking QuestionsEffective communication is a process through which we can collect information and get an idea of other person’s knowledge, attitude, opinions and feelings. The key tool for assessing other’s needs and knowledge is the way we ask questions.

Open and closed questionsWhen talking to anyone, there are broadly two sorts of questions we can ask: closed questions and open questions.

Closed questions are ones that requires the other to answer in one word or a short phrase, often with “yes” or “no” e.g.

“What is your age?” “Where do you live?” “How many children do you have?”Open questions have many possible answers and enable to give a longer reply e.g.: “What is troubling you?”(here I will add examples from education

field experiences) “What kind of medicines are you taking at the moment?” “What do you think might be causing the pain in your belly?”

How can we best use the two types of questions? Generally, you will gather much more information from one open question than you can from a closed one.

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There is another difficulty with using closed questions early in the interview-this is the danger of missing important information. Contrast this example of closed questions with the example that follows it.

Example 1 Patient: I have a pain in my tummy.Service provider: I am sorry to hear that. Where is the pain?Patient: Here.Service provider: Is the pain constant?Patient: No.Service Provider: Does it feel tender?Patient: Yes.Service provider: When did the pain begin?Patient: Last week.

Example 2Patient: I have a pain in my tummy.Service provider: I am sorry to hear that. Tell me about this pain.Patient: Well, it started a week ago. At first I just felt

tender down here, but sometimes it begins to hurt a lot. It hurts when I sit down or stand up

Service provider: What else is troubling you?In the second example, the service provider has gathered more information by using open question: “Tell me about this pain” and “What else is troubling you?”. Once you are sure that you have a complete understanding of the patient’s problem as he or she sees it, closed questions may be very helpful to draw out specific details that you need to know.

It may help to think of open and closed questions as a triangle:

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Some useful general tips for questioning:

Always phrase your questions politely and respectfully however busy or rushed you may be;

Use words that other understands. Avoid using terminology they may not understand;

Make your questions specific, so that other knows exactly how to answer you;

Ask one question at a time: double questions confuse; Keep your questions free of moral judgments; Avoid ‘leading’ questions that ask the patient to agree with you: let

people answer in their own words; Ask other’s permission to question them about their private lives.

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Start Open questions

INFORMATION

Closed questions End

Effects of CommunicationSchedule for Trainer

Activity/Method Duration MaterialsBrain storming,

Transparency15 minutes

Transparency

Effects of poor and weak Communication: Misconception Uncertainty Disappointment Loss Lack of confidence Bad relations Distress Unable to attain the desired results

Effects of good (communication) behavior: Solutions to problems Good relations Better results Satisfaction Self Confidence Achievement of the desired goal

Barriers to the process of communication

Schedule for TrainerActivity/Method Duration Materials

Question & Answer, Transparency, Group Work, Presentation

60 minutesTR-5, 6, Chart, Marker

Objectives of the session:The objective of this session is to enable the participants to:1. identify the barriers to communication2. Identify similarities and differences

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3. to remove barriers and problems in communication keeping in view the similarities and differences

(Will include an exercise)

Ask participants: What do you think are the causes of these barriers? Language problem Cultural difference (between health worker and patient) Lack of facilities Lack of interest Individual perception Gender difference Religious Barriers Noise, external disturbance Personal problems Class difference Social difference Personal likes and dislikes Hearing handicap

Similarities and Differences between Health Worker and Patient:

Ask the participants: How does this difference create a hindrance in communication?(Here need to add example from education and community related issues)

How do similarities improve communication?

Use of same language enables them to convey each others view point better

Having same social problems e.g. family pressures, joint family situation, in-laws etc.

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Trainer’s Note: Inform the participants that we are now going to see a role-play that shows how differences between HCP and patients act as a barrier to communication.

(Will change this role play …will add new one by consulting education experts)

Role Play No.1:

Patient A woman with her head and face covered with a “Dupatta” comes to the Health center. She looks into the LHVs room and sees a male HCP, after that she covers her face even more.Patient AoA, where is the Ms sahiba (LHV)HCP Yes madam what is wrong with you?Patient (Embarrassingly) I have loose motions, where is Ms. Sahiba...HCP OK you have diarrhea, come inPatient No I have to see the LHV (Ms. sahiba) I am sick and also pregnant (shyly)HCP The LHV is not herePatient I have come a long way, when will she (LHV) come back?HCP She is on leave, come in, I will give you the medicines. Come quickly there are many patients waiting.Patient We don’t go to men for check-upsHCP OK fine, then come again tomorrow, she will be here.

Trainer’s Note: Discuss with the participants what were the barriers to communication between the patient and the HCP? Did the HCP try to overcome these barriers?

Role Play No. 2:

Patient A woman with her head and face covered with a dupatta comes to the Health center. She looks into the LHVs room and sees a male HCP, after that she covers her face even more.Patient AoA, where is the LHV (Miss sahiba)HCP Come in, Miss. sahiba is on leave, what is your problem?Patient I have loose motions, where is Miss. Sahiba?HCP OK you have diarrhea, come in, Miss. sahiba is on leave and I am

working in her place

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Patient I have to see the LHV, I am sick and also pregnant (shyly))HCP Don’t you worry, I can help you. You are just like a sister to mePatient My husband would mind.HCP Sister, all patients are treated equally by a doctor whether they are male or female, has anybody accompanied you?Patient Yes my little girl is with meHCP I will also call the TBA, she will also be present you, do not worryPatient OK, (she takes a seat)HCP (male health worker looks on one side instead of looking at her face and asks) can you tell me since how long you have diarrhea?Patient Since yesterday afternoonHCP How many times you had loose motions?Patient I do not recall exactly, I think may be 6 – 7 timesHCP More than usual or….? Patient Yes, quite frequentlyHCP Did you take any thing?Patient No I did notHCP You did the right thing by coming to health center, otherwise it would have been harmful for you and your baby.Patient We are ignorant and illiterate, we do not go to the hospital until our condition gets worse.HCP No you are not illiterate, it’s only due to lack of information that we do not seek care immediately. Don’t you think when a person knows that he is going to die of this disease he will run towards a Doctor.Patient Yes, you are right.HCP Here is ORS, do you know how to use it.Patient Yes I know.HCP Along with ORS you should take extra care of your diet since you are pregnant but if your condition does not improve, then you should come immediately.Patient It will be difficult for me to come again, as my mother-in-law does not like me going to the hospital. HCP You should tell your mother-in-law that if this condition persists it will not only harm you but is also dangerous for your baby.Patient OK Dr. Sahib

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Non-verbal Communication

Schedule for TrainerActivity/Method Duration MaterialsGame, Question

Answer, Role Play90 minutes

Chart, Marker, Basket

In communication, it’s not only the way we speak, but also our attitudes and behaviors affect the communication process e.g. the way we dress, the way we sit or stand, our body movements, our facial expressions and tone of voice. Therefore, during a conversation we must take care that our body language match with what we say. Often verbal and non-verbal behavior conflict as when a colleague who looks tired or harassed tells you that he or she “is fine”. Because non-verbal behavior is often unconscious we are not always aware of the messages that we are giving to other people. It is important to develop your own awareness: when you are talking, check your hands, facial expression and body posture. What are they telling other people?How do we convey feeling such as tiredness, frustration, impatience, anger, joy and depression, for example?The key to effective non-verbal behavior is to treat other with respect, and give him or her full attention:

Establish eye to eye contacts Listen carefully to what the patient says. The value of listening is

not only hearing, what the other person is saying but also showing to that person that he/she has your full attention.

Non-verbal behaviors that shows that you are listening: Leaning forward slightly towards others Nodding your head or comment occasionally Not writing while the other is talking Repeating what he or she says and not interrupting him or her To show understanding, say “yes”, “Ok” etc. Ignoring distractions

Non-verbal signs that show that a person is not listening:

Shuffling papers on the table.

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Refraining from eye contact Turning your back from time to time Looking at the watch from time to time Interruptions for the telephone and other staff members.

Warm Up Game:Inform the participants that the purpose of this session is to describe the importance and method of non-verbal communication

Methodology:Make small slips of paper and write the following sentences. Ask the participants to read the sentences in a tone that expresses the emotion written on the slip. The same sentence can be expressed in two different ways by just altering the tone of voice and body language.

Group Communication

Schedule for TrainerActivity/Method Duration MaterialsQuestion answers, Group work, TR-

10 minutesTR- , chart marker

Group Counseling: (sir do feel is there need to add it in this training or not)Ask the participants: What is grouping counseling?A: It is a discussion by a group of people between three and twelve about a subject of mutual interest or needs. Some times group counseling are for the following reasons;

To share the problems To give each other support To identify solutions To plan joint actions To learn from each other and from the facilitator To build self-confidence and self-esteem

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What are the important points to remember for effective communication within a group:

Seat all the participants in a circle, this allows each person to see other and encourages two-way communication.

Greet and introduce yourself and the participants Encourage the discussion with open ended questions and make the

participants feel that their views are of utmost importance Discourage participants who talk amongst each other during the

group discussion. Invite all the participants to take part in the discussion Encourage

those who have not spoken, but do not force if they don’t feel like it.

If one of the participants is giving incorrect information, instead of correcting him/her, ask the opinion of others in the group, never scold or make fun.

While discussing in a group keep in mind the relationship between the participants as in the presence of others they might not be able to express themselves freely.

Listen carefully and respect everyone’s opinion, because if you disregard their views then they will not participate in the discussion again.

Repeat what they have said and try to use the same or very similar words, this lets them know that you are really listening to them and also ensures that you and others in the group has understood what has been said.

At the end of the session, summarize the salient points and always thank the participants for their participation.

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