The Importance of Communication in PEI / EPIBy Shabnam Afzal

Communication officer UNICEF

The word communication is derived from a latin word “Communicare” means common, to give a share, to reveal to have some thing in common.

The process of exchange of ideas, feelings, facts or information between two persons or more than two persons

“It is the process in which you understand someone message and make him/her understand of yours”

What is Communication

SMCR Model

Message Channel

FEED BACK

ReceiverSender

Verbal communication involves.

GreetingsDialogue / informationCounselling

Non-verbal communication involves

Posture and expressions Paying attention Showing patienceDressing with respect to local traditions

Verbal & non-verbal communication

Print Media

News papers / Magazines Letters MemosBillboards / Posters / flyer

Electronic Media

RadioTVInternetTelephone

Channels of communication

• No person sees things exactly the same way as another. Each has a unique set of experiences , a unique perceptual filter, through which he or she compares and interprets messages., While communicating , receiver uses that filter to give meaning to or make sense out of the experience

Perception

What do you see?

PERCEPTION

Do not assume that what you say or the Visual aids you use is fully understoodby others, ask for feedback to ensure thatyour message is received as intended.

Group Exercise

VISUAL CUESDraw a quadrangle. Within the right side inside the quadrangle draw an arrow half way extended upwards. Now draw a triangle beneath the quadrangle on the right side, just touching it. On left side draw a circle beneath the quadrangle not touching any .

We only see tip of an ice berg

Behavior

Experiences

Values, believes, emotions

Submissions

How people see shape what they know

What they know shape what they believe

What they believe shape how they act

We Communicate better when we understand how people see

Attitude

• The way you think

• The way you believe

Behavior

• Collection of actions exhibited by human beings and

influenced by:• Culture – Attitude – Emotion – Authority - Genetics.

• Response ( Action or reaction ) of an individual / group to a stimuli

Attitude & Behavior

Target audiences• Primary

• Directly involved with the woman/her child:• Father• Mother• Grand father• Grand mother• Mother-in-law• Husband

• Secondary

• Not directly involved but play important role in community/society• Health care providers, LHWs• TBAs• Religious leaders• Community leaders

Isolated communication actions focusing on behavior change at individual level usually are not sustained …

Instead, a more effective approach includes:

Many different types of communication activities at different levels, for a sufficient time and according to the needs of states/districts/communities

Research on effectiveness related to behavior change shows that:

Individual

Family/household

Community

Institutions

Policy/Regulations

Orbits of Influence and Multiple Levels of Engagement or Support

Behavior Change Communication

An Interactive process with specific audiences / beneficiaries to develop tailored messages and approaches using a variety of communication channels for developing positive behaviors

Providing information that people need in a wrapping that is acceptable to them

Social Mobilization

Involves planned actions and processes to reach , influence and involve all relevant segments of society across all sectors from the national to the community level , in order to create an enabling environment and effect positive behavior and social change

Advocacy

Mobilizing support of key individuals for your cause

Advocacy is the act or process of supporting a cause or issue. We advocate a cause ore issue because we want to ;

Build support for that cause or issueInfluence others to support itTry to influence or change legislation that affects it

• Unvaccinated children tend to have uneducated mothers – which requires special attention and focus on health education with mothers

• 2/3 of mothers (rural/urban) confirmed LHWs have talked about vaccination and encouraged them to take children to health facility

• Parents of unvaccinated children have less exposure to media and rely more on face to face interaction and information sharing

Research shows:

Interpersonal Communication

IPC

Advantages:• Message can be

tailored according to area.

• Feed back is possible.

• Questions can be ensured.

Disadvantages:• Human resources

intensive.• Takes time.• Untrained

communicators can give wrong messages.

Interpersonal communication is the process of understanding b/w two or more persons.

Examples of Good Interpersonal Communication Skills ???

Good Communication Skills• Verbal and non verbal communication (explain the

difference and how both work!);

• “Active" listening in which the health worker or contact demonstrates to the parent/caregiver that they are heard and understood;

• Re-phrasing what the caregiver has said to make sure it is correctly understood;

• Use of open-ended questions. The questions require more than one word answers (examples of these?!);

• Non-threatening eye contact;

• Providing complete attention; and –

• Being polite, respectful and not showing a bad or uncaring attitude toward the child or the caregiver.

Other Basics Related to Enhanced Interpersonal Communication Skills

• Use simple clear language or local language as much as possible;• Greet people upon meeting and be courteous;• Dress appropriately and respect local culture; • Look at the person when talking and showing both

interest and concern. • Answer those questions you know the answer to

truthfully; refer to others those questions which you do not know – and don’t shy or insecure about this.

• Summarize to show that you have understood

PROBING QUESTIONS

Questions can’t be answered with a “yes” or “no” response.

• Are you Dr. Javed Iqbal?• What is your name?• Do you know how to prepare ORS?• Can you tell me how ORS is prepared?• Has your child been fully immunized?• How many and at what site your child has been

vaccinated?

NON-VERBAL COMMUNICATION

GESTURE:

Yawning. Frowning. Slouching in a chair. Looking at watch. Arms crossed.

MESSAGE:

I’m tired, bored. I don’t like you. I’m not interested. I want to leave. I’ve had enough.

The IPC Do’sPolio team members should:

• DO treat families, care-givers and community members with respect

• DO remain patient with parents and not get into arguments

• DO listen to reluctant parents’ concerns or questions

• DO answer any questions and address concerns with reason

• DO promise to bring to the attention of higher authorities any non-immunization health issues that they are concerned about

The IPC Don’tsPolio team members should never…..

• NEVER force parents into accepting OPV or any form of immunization

• NEVER be rude to parents because they are not informed or have misconceptions about immunization

• NEVER Attack a parent’s values

• NEVER Immunize without consent

• NEVER Joke that vaccine will make children sick or sterile

Addressing Concerns and Questions

IPC

• Vaccinators, Mobilizers all members of the polio team are health educators

•Must be equipped to answer the tough questions parents may have (consider approach and manner)

•Must be able to provide accurate information (and use support materials if needed)

Health Care providers interact with the community …..

• Static EPI / fixed sites

• Out Reach services

• public places and Health ceners

Barriers to Immunization

Two Types of Barriers

• Behavioral• Non behavioral

Behavioral Barriers• Lack of understanding of importance of

immunization.• Mothers don’t know about immunization

schedule.• Do not know about subsequent doses.• Fears of side effects..• Husband doesn’t want mother to take child for

immunization.• Mother’s perception of unpleasant treatment at

facility • Refusal to have child immunized for religious

beliefs.• Do Not follow immunization schedule properly –

Non – Behavioral Barriers

• Families have limited access to immunization services

• Health facilities are far away• Long waits at health facilities• Staff absent• Lack of vaccine/D. Syringes• Inappropriate vaccination timings

Possible Actions

• Orient community leaders, encourage them to promote immunization

• Improve IPC skills of health workers• Promote immunization in media• Ensure health workers can explain to parents

when to come for next immunization?• Health workers can explain possible side

effects and what to do?• Develop child-to-child programmes – students

can adopt families in community to ensure they know when to seek services

Possible Actions

a. Provide training for health workersb. Ensure parents are aware of:

• Outreach services.• Dates.• Times.• Location

Individual Exercise

What are some common questions that parents ask (or you think they may ask) about OPV, the polio program, or routine and other health services? Write down these questions – and let’s see if others can answer (and how they would answer?!) …

Possible/Sample Questions

• Does OPV cause children to become sterile?• Is the vaccine given only to Muslims or certain

groups?• Is an infant less than two months old too

young to get the vaccine?• Is it safe for a sick child to get the vaccine?• Why do vaccinators come to deliver OPV when

other health concerns are much greater?• Why do vaccinators come so often, isn’t so

much medicine harmful for the child?

Role Play

• Apply good communication skills

• Parent questions the harmful side effects of the vaccine and is concerned that the child might die if they take the vaccine. / Religious concerns

• What information shall be given to the mother when she comes to vaccinate her child

Group Role Plays Role Play Scenarios:

Group A: Parent says the child has already been immunized through routine immunization and therefore doesn’t need to be immunized again.

Group B: Parent says that her child has a fever, doesn’t want her child immunized.

Group C: Parent questions the harmful side effects of the vaccine and is concerned that the child might die if they take the vaccine.

Group D: Parent uses some “hidden resistance” – the vaccinator has seen a young child, but the parent either says the child has already been immunized in this round, that the child is older than five years old, that there is no child in the house, or that the child in the house is a neighbor’s child.

• Advocacy: To create visibility for the National Emergency Action Plan and national ownership about the threat of Polio in Pakistan and what is required to eradicate it

• Social Mobilization and IPC: Intensify efforts in highest risk UC’s, with 300+ new communication staff in UC’s and Districts by year end

• Reaching High Risk Groups: Strengthen data collection to be able to better identify high risk groups and reach them with appropriate communication strategies

• Data Collection Tools: Revise existing tools and add new tools rapidly guide communication strategy and action in the field

Improved Service Delivery

Push Pull

trateg

Immunized Child

Strategic Principles

Advocacy and TrainingIEC and Social Mobilization

Improved Service Delivery Care Taker Participation

PUSH PULL

Immunized Child

Positive Behavior

• It is important that the community feels

and understands that their children

health is their responsibility

Conclusion

• Only once barriers are analyzed, can

effective action be planned to overcome

these.

• Once barriers to immunization are

overcome, more of the population should

be demanding immunization.• .

Thank You