Behavior Change Communication for Health

Interpersonal Communication

Counseling

Advantages and disadvantages of interpersonal communication channels

Advantages Disadvantages Reach people face to face Allows for immediate audience feedback Very useful in influencing a group; messages may be tailored fit to the group Ideal for sharing knowledge and skills, problem-solving, reaching agreements and planning actions. Delivers message in non-threatening way; cultural acceptable.

May reach a relatively smaller number of people, may be costly Communication effectiveness may be influenced by the skill of the facilitator and the organizer or information officer

Forms Advantages Disadvantages SuggestionsDemonstrations Shows in practical way how to

do things. Makes abilities ofthe worker evident, thuspromoting community trust.Allows for brad participationthrough technique of “learn bydoing”.

Requires careful preparation.May be misleading sincesituation in real life is generallydifferent. External factors mayaffect results. In poorcommunities, it is difficult toobtain resources fordemonstration.

Have audience participate indemonstration. Establishsituation as close as possibleto real life. Testdemonstration, anticipatingpossible snags. Combine withdiscussion and writtenmaterials.

Some forms of interpersonal media

Forms Advantages Disadvantages SuggestionsHome visits Establishes good relationships

between families and staff.Useful in providing timelyrelevant information to family.Lend themselves to keeping arecord of what has beenlearned.

Very time-consuming.Tendency to visit only mostaccessible homes. Requirescareful programming, in orderto select appropriate timewhich does not interfere withwork or other family activities.

Keep record of visits andaccomplishments. Leavepamphlet or other instructionalmaterials for family. Visit thosemost in need.

Forms Advantages Disadvantages Suggestions Story telling Abundant availability in some

communities. Culturally relevant and acceptable. Stimulates participation, generates and maintain interest. Problems, outmoded customs, etc… of a community may be indicated in a simulated fashion without offending anyone.

Only useful where there is tradition of story telling and listening. Audience may feel offended by childlike treatment. Message may be lost in plot. Difficult to find pleasant narrator. If interrupted to provide clarification, train of thought may be lost.

Collect stories about and with community. Use local narrators whenever possible. Illustrate story with audio visual aids. Combine with group discussion. Use stories which are short, with simple plots and few characters.

In the area of health, interpersonal communication takes place:

using various methods and approaches

at several different levels of interaction

within a variety of environmental or social contexts.

Levels of Interaction Approaches

Counseling Provider Perspective

G Greet Establish rapport A Ask Gather information T Tell Provide information H Help Facilitate decision E Explain Demonstrate and practice

1. Client-provider Interaction To enable clients to make free and informed choice

among health options To promote the safe, effective and correct use of

contraceptive methods or new health behavior

R Reinforce Revisits for use and return satisfaction

Levels of interpersonal interaction and approaches in health

Levels of Interaction

Approaches

Counseling Client Perspective

V Value your needs A Ask provider to clarify L Lead the conversation U Understand the benefits for you and your family E Establish an action plan and encourage others

Interaction S Share conversation H Heighten client participation A Agree on mutual goals R Respect each other

1.client-provider interaction

E Equal input

Levels of interpersonal interaction and approaches in health

Levels of Interaction

Approaches

Counseling Interpersonal Communication

Persuade Negotiate Seek agreement and/or approval Share decision making Participate and learn together Appreciate each other

2. Husband-wife (Spousal communication)

Discuss together

Levels of interpersonal interaction and approaches in health

Levels of Interaction

Approaches

Counseling Interpersonal Communication

(small group) Persuade Negotiate Seek agreement and/or approval Share decision making Participate and learn together Appreciate each other Discuss together

3. Couples and Family

Educate other family members

Levels of interpersonal interaction and approaches in health

Levels of Interaction

Approaches

Counseling Group communication

Advocacy Community mobilization

4. Peer groups and social networks

Organizational mobilization peer pressure social support strengthen in numbers credibility high priority establish new norm

Levels of interpersonal interaction and approaches in health

Environment and social context

A supportive environment and social context is essential for promoting effective interpersonal communication.

Program managers and decision-makers need to enhance effective IPC by introducing and improving the following:

Clinic and Community

Budget: adequate staff, sufficient training, materials for client and providers.

Environment: clinic hours, client flow, reception, space arrangements, waiting areas, counseling areas, group meeting areas, examination areas.

Staff: job description, specific procedures, communication among staff, monitoring counseling, performance, recognition of good performance.

Mass Media

Role modeling: modeling how to talk to spouse, good questions to ask the service provider, establish the social norms.

Reinforce/Support: reminders in mass media to see service provider, testimonials to discuss new health behaviors with spouse and family, call to action to join a community mobilization effort.

Policy

Budget Support: mandates to provide financial support for IPC/C

Systems support: monitoring and supervising systems, reward systems, specific procedures

Staff support: mandate enough managers and personnel to support effective IPC/C.

Five General Principles of Motivational Counseling

Motivational counseling focuses on five general principles to identify the stage of change the client is in and to assist with change.

Express empathy Develop discrepancy Avoid argumentation Roll with resistance Support self-efficacy

Express empathy When a client presents a potential problem with following a treatment

regimen, the service provider should start by soliciting information like:

What concerns does the patient have? What barriers does he/she see? What will be the hardest thing(s) about this change? Does the patient have anyone at home to assist with the change? What does the patient understand about his/her condition and its

treatment?

Develop discrepancy Client are ambivalent or unsure about change. Therefore,

it is the job of the service provider to move the client in the direction of the desired behavior. Persuasive strategies do not work when the client is in the pre-

contemplation or contemplation stage.

The useful strategy is to develop discrepancies between a client's present behavior and the behaviors desired. People are much more highly motivated to change when

discrepancies exist between current behavior and desired personal goals.

Avoid argumentation During motivational counseling, the health service

provider increases the client’s awareness of problems and the need to do something about them.

However, the provider must be careful not to argue with the client. Arguing tends to increase resistance rather than increasing

motivation to change

Roll with resistance When dealing with patients who do not want to change,

are overwhelmed, or won't take their illnesses seriously, there is a tendency for the health service provider to become frustrated or angry. But the health service provider should avoid trying to persuade

patients even more that they have a problem. Do not force the issue.

Support self-efficacyClients have to believe that they have the knowledge and

skills or abilities to carry out the needed health behavior change. The health service provider can do this by:

1. providing and clarifying information;

2. offering realistic hope and expressing confidence in the patient's ability to succeed

3. noticing successful attempts at adherence, even if they are short-lived;

4. praising ideas that the patient comes up with to solve problems; and

5. continuing to emphasize and support the responsibilities that both the patient and provider have in improving treatment adherence and treatment outcomes.

Express empathy When a client presents a potential problem with following a treatment

regimen, the service provider should start by soliciting information like:

What concerns does the patient have? What barriers does he/she see? What will be the hardest thing(s) about this change? Does the patient have anyone at home to assist with the change? What does the patient understand about his/her condition and its

treatment?

See File: RH BCC WHCF Example