What are health communication and health education?
Health promotion, as defined in the WHO Ottawa Charter (1986), is the process of enabling people to increase control over, and to improve, their health. Health is treated as a resource for everyday life, and health promotion is not just the responsibility of the health sector. Within that frame, health education gives people knowledge and skills, and health communication is the way messages travel to people: through mass media, groups, individual counselling or digital channels.
WHO describes health literacy as the ability of individuals to gain access to, understand and use information in ways which promote and maintain good health for themselves, their families and their communities. It is more than reading pamphlets or following a doctor's instructions, and it is not only an individual's responsibility: governments and health systems must present clear, accurate, appropriate and accessible information for diverse audiences.
| Term | Meaning in one line |
|---|---|
| Health promotion | Process of enabling people to control and improve their health (Ottawa Charter) |
| Health education | Learning opportunities that build knowledge, understanding and skills for health; one route to higher health literacy |
| Health communication | Process by which a source sends a message through a channel to a receiver |
| Health literacy | Ability to access, understand and use information to maintain good health |
| IEC | Information, education and communication - the planned set of activities and materials for health programmes |
| BCC | Behaviour change communication - communication aimed at changing practices, not only knowledge |
What are the Shannon-Weaver and Lasswell models of communication?
In Claude Shannon's information-theory framework, as later used by Shannon and Weaver, a message is sent, encoded, passed through a communication channel, decoded and finally received. Effective transmission depends not only on what is sent but on the receiver's ability to decode it. The diagram shows an information source and transmitter, a signal that meets a noise source, then a receiver and a destination.
Noise is the prototypical barrier: a variable that lowers the fidelity of transmission, meaning the probability that the receiver decodes the message as the sender intended. Noise can be, for example, spurious information accompanying the signal. In health talks the noise can be a crowded room, jargon, rumours or a worried listener.
Lasswell's model asks five questions: who says what, in which channel, to whom, with what effect. Berlo's SMCR model, which builds on Lasswell's research, names the four components of communication as Source, Message, Channel and Receiver. Campaign planning uses the same logic: understand who the audience trusts, which arguments they find convincing, and which channels they prefer before launching.
| Model | Components | Key idea |
|---|---|---|
| Shannon-Weaver | Information source, transmitter, signal, noise, receiver, destination | Transmission can be distorted by noise; the message must be decoded |
| Lasswell | Who, says what, in which channel, to whom, with what effect | Planning checklist ending in effect |
| Berlo SMCR | Source, Message, Channel, Receiver | Builds on Lasswell; stresses the four basic components |
What are the barriers to communication, and why does feedback matter?
A barrier is any variable that reduces communication fidelity, defined in communication research as the degree of mutual understanding or shared cognition between sender and receiver. In human communication the same variable can help and hurt: a complex message makes understanding harder, but it may also make the recipient curious enough to look for more information.
- Source-related: untrusted messenger, technical jargon, no audience analysis.
- Message-related: too long, too complex, or the same standard message used for every audience.
- Channel-related: the audience does not listen to that radio station or read that print medium.
- Receiver-related: low health literacy, beliefs, competing priorities, fear or distraction.
- Environmental noise: crowds, poor acoustics, conflicting or spurious information.
Which channels are used for IEC and BCC in India?
India's Swasth Nagrik Abhiyan (SNA) is described as a strategic IEC plan designed by the Ministry of Health and Family Welfare using a 360-degree communication approach. It aims to generate demand for health services and promote health-seeking behaviour. The plan uses all possible channels, and the standardised IEC/BCC packages for national programmes are shared with states.
| Channel | Examples named in the source |
|---|---|
| Mass media | Print, television and radio |
| Mid-media | Listed alongside mass media as a separate channel in the plan |
| Interpersonal | Home visits by ASHAs and anganwadi workers, who deliver a precise message to the mother at the time of need |
| Social media | Used to disseminate information on health schemes |
The plan is organised around health days and health themes such as Ayushman Bharat, immunisation, tuberculosis management, Anaemia Mukt Bharat, diarrhoea control fortnight, breastfeeding and nutrition week, tobacco control and vaccine hesitancy. Interpersonal communication is delivered through ASHAs and anganwadi workers who make home visits, supported by tools such as the Mother and Child Protection Card, and community-led forums such as VHSNCs and Mahila Arogya Samitis.
What are the weaknesses of India's IEC and BCC approach?
A published critical analysis of the national plan lists persistent weaknesses that make good exam material for 'what is wrong with IEC campaigns' questions.
- Top-down: standardised material and messages from the national level are sent to states - a 'one size fits all' approach.
- Campaign-heavy: more stress on high-pitched, short-lived campaigns than on regular, sustained health education.
- No routine communication needs assessment in most states, and no in-house capacity for it.
- Audience segmentation is ignored: it is not stated whose behaviour has to change over what period.
- No tracking of knowledge, attitudes, beliefs and practices of key audiences; therefore no feedback loop to improve messages.
- Weak indicators: the information system mostly reports the quantity of material distributed and number of meetings held, not impact.
- Limited capacity and funds at state and district level to plan BCC.
What does the Ottawa Charter say about health promotion strategies?
The first International Conference on Health Promotion, in Ottawa on 21 November 1986, produced the Charter for action to achieve Health for All by the year 2000 and beyond. It built on the Declaration on Primary Health Care at Alma-Ata and WHO's Health for All targets. The Charter lists the fundamental prerequisites for health: peace, shelter, education, food, income, a stable eco-system, sustainable resources, and social justice and equity.
| Strategy | Meaning |
|---|---|
| Advocate | Good health is a major resource for social, economic and personal development; political, economic, social, cultural, environmental, behavioural and biological factors can favour or harm it, so advocacy makes conditions favourable |
| Enable | Reduce differences in health status and ensure equal opportunities and resources: a supportive environment, access to information, life skills and chances for healthy choices |
| Mediate | Health cannot be ensured by the health sector alone; promotion needs coordinated action by governments, health and other sectors, nongovernmental and voluntary organisations, local authorities, industry and the media; health personnel must mediate between differing interests |
WHO links higher health literacy, gained through health education and various forms of communication, to the Sustainable Development Goals. Better literacy lets citizens play an active role in their own health and in community action, and efforts focused on disadvantaged groups can reduce health inequities.
What is the GATHER approach to counselling?
GATHER is a standard framework for family-planning counselling. The letters stand for Greet, Ask, Tell, Help, Explain and Return. Studies use it to measure counselling quality, scoring each element: in a Jordanian study observers judged a session adequate when the provider applied 80% or more of the GATHER framework, and only 42.9% of sessions met that standard; in an Ethiopian study the score ranged from 0 to 25 with an adequate cut-off of 16 or more.
| Letter | Step | Usual meaning of the step |
|---|---|---|
| G | Greet | Welcome the client respectfully and make her comfortable |
| A | Ask | Ask about her needs, history and what she already knows |
| T | Tell | Give information about the available methods |
| H | Help | Help her decide which method suits her; the choice is hers |
| E | Explain | Explain how to use the chosen method and what to expect |
| R | Return | Plan a follow-up visit or return if there are problems |
What are the common exam traps in this topic?
- Noise belongs to Shannon-Weaver, not to Berlo's SMCR (which has four components: source, message, channel, receiver).
- Lasswell ends with effect; SMCR has no effect box.
- Health promotion (Ottawa, 1986) is enabling people to control and improve health, and is not the sole job of the health sector.
- Ottawa strategies: advocate, enable, mediate.
- GATHER is for counselling (family planning), and R is for Return.
- Mass media uses print, TV and radio; interpersonal communication by ASHAs and AWWs lets the worker adjust the message to the mother in front of her.
- Campaign vs education: a short, intense campaign is not the same as sustained health education.
For the delivery system and national programmes behind these activities, see health care delivery: ASHA, ANM and PHC and national health programmes in India. Levels of prevention are covered in levels of prevention.