Advancing Health Communication: The PCS Experience in the Field

From the Introduction

Why don't people pay more attention to their health? Why don't people who have a choice make healthier choices about personal, family, and sexual behavior? Why don't people make better use of existing health facilities? And, above all, what can public health practitioners and communication experts do to help peoplemake healthier choices? How can public health practitioners work to improve the environment in which people make their choices? New answers and approaches emerged in the last two decades that can help address and resolve some of these problems.

This guide for health communication programs is based on the worldwide experience of the Population Communication Services (PCS4) project from 1995-2002. Led by the Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs (CCP), PCS4 was supported by the U.S. Agency for International Development (USAID). U.S. partners in PCS4 included the Academy for Educational Development (AED), Save the Children, the Centre for Development and Population Activities (CEDPA) and Prospect Associates/American Institutes for Research. Building on 20 years of experience that began with the first PCS project in 1982,PCS4 offers here some practical lessons as to what works, what works better, and what does not work in the rapidly evolving and advancing field of health communication.

Health communication has changed dramatically over the last half century, passing through at least four different periods:

The clinic era, based on a medical care model and the notion that if people knew where services were located they would find their way to the clinics. “Build it and they will come” was the underlying theme(Rogers, 1973).

The field era, a more active approach emphasizing outreach workers, community-based distribution, and a variety of information, education, and communication (IEC) products. These included posters, leaflets, radio broadcasts, and mobile units (Rogers, 1973).

The social marketing era, developed from the commercial concept that consumers will buy the products they want at subsidized prices. Highly promoted brands stimulated the demand side while convenient access through local shops and pharmacies expanded the supply side (Andreasen, 1995; Rimon, 2001).

And today, the era of strategic behavior change communication, founded on behavioral science models for individuals, communities, and organizations that emphasize the need to influence social norms and policy environments so as to facilitate and empower the iterative and dynamic process of both individual andsocial change (Figueroa et al., 2002; Piotrow & Kincaid 2001).

As a result, the field of health communication has evolved and expanded greatly. From being initially a matter of high volume production of simple print material – posters and brochures for clinics– communication has become a vital strategic component of health programs. No longer simply repeating untested slogans like “A small family is a happy family” or providing pictorial instruction on whyand how to use specific contraceptive methods, communication is now a vital and indispensable guide for many interventions. It represents not only the most conspicuous part of most preventive health programs but also the strategic themes to enhance the importance of health programs for policymakers and the public alike. Today, strategic communication can serve not only to increase the demand for specific preventive health services but also to motivate the suppliers of health services – providers at all levels – toward their commitment to serve their clients.

Many factors contributed to this growing emphasis on communication, including:

• Growing evidence that well-designed communication interventions can have an impact on health behaviors and practices, not just knowledge and attitudes;
• A substantial expansion of mass media, new information technologies, and especially television to reach large audiences worldwide;
• The decentralization of health services, giving more power to local governments;
• Increased attention to the role of women, and other genderconcerns;
• Emphasis on better quality, client-centered health care services, including counseling and client-provider communication;
• The spread of HIV/AIDS and growing recognition that child health and control of many emerging diseases may depend as much on individual and community behavior as on medical technology; and
• The continuing search for behavior change models that take account of complex interactions involving individual behavior, community norms, and social/structural change.

Many organizations and programs contributed to this transformation:

• The International Planned Parenthood Federation and its member associations, which were the first to take on information, education, and communication (IEC) and advocacy for family planning programs;
• PATH, which pioneered the development and pretesting of illustrated materials for low-literate populations;
• The Academy for Education Development, which applied systematic approaches and tools to IEC for child survival and related interventions;
• Manoff Associates and Porter Novelli International, which brought professional advertising approaches to bear on health promotion;
• Population Services International, DKT Foundation, and the Futures Group, which experimented with different forms of social marketing;
• EngenderHealth, which focused on interpersonal communication and counseling for informed choice;
• Save the Children and CARE, which incorporated strong community participation and mobilization into local programs;
• The Rockefeller Foundation, which emphasized the role of communication to facilitate broad social change; and above all,
• USAID, which took the initiative in funding major strategic communication initiatives, such as the PCS project.

Other institutions and donors also advanced important approaches and opportunities that raised the field of health communication to new importance.

From IEC (information, education and communication) to BCC (behavior change communication), from informed individual choice to social change and grassroots mobilization, from branding for ready recognition to empowering for personal and collective self-efficacy, from education to entertainment-education, from multimedia campaigns to strategic communication, health communication is a field on the move. Since 1982—and especially from 1995 to 2003 — the PCS project played a significant role in that movement. PCSobserved, implemented, learned, and documented many useful lessons and can serve other ongoing programs in the future.

This report covers this progression and its challenges in a narrative fashion, appropriate to the real-world challenges of implementing a health communication program in the field. It proposes feasible actions that over the years helped PCS resolve some of the problems facing health communication programs at different stages. It also addresses the new directions health communication has taken over the last two decades. This report is designed to help organizations carry out effective communication programs by addressing step-by-step some of the major problems likely to arise and by focusing on problem-solving in the rapidly changing field of health communication.