Communicating About Health A Guide for Facilitators
Item
- Title
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Communicating About Health
A Guide for Facilitators
- extracted text
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Communicating About Health
-i
A Guide for Facilitators
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service
('enters for Disease Control
and Prevention
International Health Program Office
•
CDC
CENTERS TGR DISEASE CONTROL
AJ«D PREVENT©.*
Communicating
About Health
'lyi
v i ri'A. XUUC
A Guide for Facilitators
UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT
Africa Regional Project (698-0421)
Participating Agency Service Agreement (PASA) No. 0421 PHC 2233
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service
Centers for Disease Control
and Prevention
International Health Program Office
Atlanta, Georgia 30333
This work was supported and made possible by the Africa Bureau, Office of
Operation and New Initiatives (ONI) and The Office of Analysis,
Research and Technical Support (ARTS), United States Agency for
International Development (A.I.D.) Through The Africa Child Survival Initiative Combatting Childhood Communicable Diseases (ACSI-CCCD) Project,
Africa Regional Project (698-0421),
Washington, D.C.
This guide could not have been written without the help of the many people who assisted in
field testing, writing, and editing, among them: Dr. Adepeju Olukoya and the staff of the Continuing
Education Units in Plateau and Niger States in Nigeria, and CCCD Technical Officer Barbara Maciak;
the staff and members of the Christian Health Association of Liberia, who contributed to the
formulation of the ideas presented; and the CDC staff who gave of their time and expertise,
especially Annie Voigt, Kathy Parker, Andy Vernon, Kris Saarlas, David Gittelman, Stan Foster, and
Judi Kanne. This guide was prepared and written by Karen Tompkins Berney, Community Health
Consultant, with cartoon illustrations by Graham Anthony.
This document does not necessarily represent the views or opinions of CDC or of the United States
Agency for International Development. The views expressed are solely those of the authors.
Any parts of these materials may be copied or reproduced for non-commercial
purposes without permission if credit is properly given.
Additional copies are avdftable in English and French from:
ACSI-CCCD Technical Coordinator
International Health Program Office
k
Centers for Disease Control
and Prevention,
Atlanta, Georgia 30333
Fax (404) 639-0277
Contents
Introduction
iii
How To Use The Facilitator's Guide
v
Part I: Past Experiences And Feelings
About Health Education ..
1
Session 1: Health Education Observations
At A Clinic............
Session 2: The Story So Far.....................
Session 3: River Code..............................
4
7
8
Part II: Useful Concepts- Creating
New Ways Of Working With People
11
Session 4: What Is Ownership?...................
Session 5: What Is A Culture?.....................
Session 6: Some Cultural Conflicts..............
Session 7: Clarifying Terms.........................
Session 8: Working With People’s Problems
Session 9: Overload Or Useful Information?
Session 10: Adult And Child Learning..........
Session 11: How Adults Learn......................
Session 12: Why? Give Me A Reason..........
14
18
19
23
26
29
31
34
37
Part III: Skills Needed To Work In A New Way
41
Session 13: Assessing The Environment For
44
Teaching And Learning.............
48
Session 14: Translating “Medicalese”...........
49
Session 15: Practice Speaking Simply.........
53
Session 16: Using Discussion Starters.........
Session 17: Discussion Starter Or
54
Teaching Aid?............................
56
Session 18: Homework.................................
Session 19: How Is A Stethoscope
Like A Question?....................... 59
61
Session 20: Formulating Questions..............
64
Session 21: Listening...................................
68
Session 22: What Was Learned?................
t
Part IV: Using Concepts And Skills To
Work With Individuals....
73
Session 23: Identifying Steps In The Process
Session 24: Does The Process Work?.........
76
78
Part V: Using Concepts And Skills
To Work With Groups
83
Session 25: Identifying Steps In The
Group Process..
Session 26: Practicing The Group Process
86
91
Part VI: Setting Goals For The Work Place
93
Session 27: Writing Individual Work Plans
96
Annex: Tips For The Facilitator
101
ii
Introduction
Few health workers in Africa list patient education among their most effective skills.
Expressions of frustration are common. Facility assessment data in several countries
suggest that patient education is, indeed, the weakest component of care provided at
health facilities. There are many possible reasons for this weakness. One is the lack
of conviction on the part of health workers that patients need education or that it is
effective or even possible. Another is negative experiences with the methods they
were trained to use.
This guide suggests a new approach for health workers, encouraging them to create
their own way of working with people in order to solve health problems and promote
good health. Communicating About Health provides guidance to facilitators as they
encourage health workers to reflect on their individual experiences and strengthen
their understanding of what motivates people to learn.
The approach presented here is participatory. It supports the belief that individuals
know their own problems and it is possible, through dialogue, to share information
leading to solutions. When people feel ownership of solutions, they are more moti
vated to solve their problems. This approach helps health workers identify, discuss,
and find possible solutions to their health communication problems. At the same
time, it offers them an experience of participatory methods and suggests how these
might be used to communicate with people about health.
The activities in this guide encourage health workers to contribute their personal
experiences, understanding, and creativity. In doing so, they will acquire their own
comfortable and effective ways of communicating with patients. In turn, these new
methods can become a natural part of the way health workers perform their job.
Communicating About Health differs from other training manuals related to specific
technical skills for health workers. For example, we chose not to set specific objec
tives, but rather to outline the purpose for each session. This is because objectives
imply there are certain “right” answers or outcomes. Although some suggested
responses are included, they are placed as a reference for facilitators learning to use
the material. In addition, these responses will help facilitators focus their discussions.
This manual is designed to be a working document—therefore facilitators and partici
pants should change it with each use, making it even more relevant and practical as it
is revised.
iii
How To Use The Facilitator’s Guide
This Guide for Facilitators outlines a set of activities and provides special learning
experiences for health workers to improve their patient education skills. It is designed
as a five-day workshop. During this time, health workers will discuss and consider
many ideas, come to new conclusions, and create their own way of working with
patients. When they return to their work assignments, participants will try these new
methods. Finally, they will meet again to share experiences and examine what they
have learned.
The facilitator’s job is to provide the structure for the health workers to think about
and discuss new communication skills. This guide gives step-by-step directions to help
facilitators lead the following 27 sessions. Each session includes five sections:
Purpose:
Explains the reason for each session
Methods:
Lists the methods used in the session
Materials:
Recommends equipment and supplies needed to complete
the session
Preparations:
Describes what must be done before the session begins
Learning Activities: Discusses the session presentation *
* Note that the estimated time required for each activity is
printed to the right of each Learning Activity
Notes to the Facilitator are found in several sections. These notes include material
for review or suggest helpful methods for working with the participants. To assist the
facilitator, background information related to concepts or issues is provided in sections
as Backgroundfor the Facilitator.
Group discussion questions and summary questions are followed by some possible
responses, appearing in italics. These responses are included to assist the facilitator.
These should be used only as a guide to the type of response to look for — not as the
“correct” answer. Possible responses are meant ONLY as an aid for the facilitator.
Most workshops include learning objectives, defining what the participants will learn.
The objectives are used to develop evaluation tools, such as pre- and post-tests or
demonstrations. Many of the concepts the participants will consider in this workshop
are not “correct” or “wrong,” but rather experiences, ideas, and opinions. Therefore,
testing is not the appropriate evaluation method. Instead, participants must meet
again (following an agreed period of time) after practicing their new methods. They
can then share their accomplishments and what they learned as a result of using their
new approach. This provides the evidence of achievement. At the same time, sharing
stimulates thinking and helps to create additional ideas about teaching and learning
for everyone.
v
PART I
Past Experiences And Feelings About
Health Education
Part I
Session 1
Background for the Facilitator: Part I
Most health workers have received some training in health education and many have
tried to practice it to some extent. Some health workers provide health education on a
regular basis. Others may have attended workshops where they only learned
communication theories and practiced specific health education techniques.
Health care providers see evidence that health education is needed - probably on each
working day! However, knowing health education is needed and providing it are two
different things.
Health workers possess feelings, experiences, beliefs, and opinions about health
education. These are a valuable resource for you and all of the participants. Indeed,
these are the varied ideas that help everyone “get the picture” of the current status of
health education, reflect on the appropriateness of up-to-date methods, and clarify its
place or value in their work.
. . ideas that help everyone get the picture of the current status of health
education.”
I
3
Part I
Session 1
Session 1
Health Education Observations At A Clinic
Purpose: To observe health worker-client interaction in a typical clinic setting in
order to identify strengths and weaknesses of current patient education
practices
Methods: Field observation and discussion
Materials: 0 Transportation to clinics
0 Instructions for participants about the field visit
[7] Flip chart, markers
[7] Paper, pen, or pencil for each participant
Preparations: [7] IDENTIFY clinics near the training site for the observation
[7] NOTIFY clinic managers ahead of time about the visit, to confirm
they are expecting the participants
[7] PLAN transportation and logistics, making sure the participants will
arrive before the start of the day’s work at each clinic
[7] MAKE copies of the 4‘Instructions for the Clinic Visit”
[7] ARRANGE to send 3-4 participants to one clinic
Learning Activities
Time: 5 hours
1. INTRODUCE and EXPLAIN the field visit purpose. If possible, do this on the day
or evening before the actual visit.
2. HAND OUT, EXPLAIN, and REVIEW the instructions with the participants. Be
sure the assignment is clear to everyone.
3. MEET with the head of the facility and explain the procedure to be adopted as
soon as you arrive. The purpose of the observation, however, need not be
explained in detail.
4. OBSERVE a “health talk” if there is one, then participants should IDENTIFY a
patient and follow him or her, observing the care provided according to clinic visit
instructions.
5. GATHER in clinic groups after returning to the workshop venue. Ask the
participants to decide on one case (or more, if time permits) from each clinic and
summarize their observations.
6. ASK each group to present their findings to the class:
• A summary of the observations of the health talk
— what was the topic?
— how long did it take?
— what time did it begin?
— examples of audience participation
— content and remarkable features of the talk
4
Part I
Session 1
A description of the chosen case(s)
— client’s age, sex and reason for the clinic visit
— steps the client went through in the clinic
— advice or education received with each step
• Additional advice or information that should have been given? Were there
“missed opportunities?”
• Using the flip chart, make notes of important points during the presentations.
Write additional advice or information with a different color marking pen
(red, if possible). Ask the whole group to contribute ideas.
7. SUMMARIZE the analysis of the posters (two from each clinic group). Ask the
participants to judge:
— how useful were the posters?
— did they clearly convey the intended message?
— how effective are posters generally?
•
8. ASK the participants to give their conclusions:
— what is your assessment of the status of health education in the clinic?
— is the health education in this clinic about the same as in other clinics in your
area? How is it similar or different?
— What is your assessment of health education in your area at the present time?
5
Session 1
Part I
Directions: MAKE ONE COPY FOR EACH PERSON
CUT APART AND DISTRIBUTE
Instructions for the Clinic Visit
1. Arrive at the clinic as early as possible (before the start of the day’s work).
2. Observe the “Health Talk” if possible. Be sure to note:
— what was the topic?
— how long did it take?
— what time did it begin?
— examples of audience participation
— content and remarkable features of the talk
Avoid taking notes or writing while you are observing.
3. Follow one patient through the clinic. Note the time of arrival and departure. Note
the client’s sex, age, and reason for visiting the clinic. Observe the health worker’s
attitude. Identify each piece of health education or advice received as the patient
moves through the system. How much time does the patient spend waiting?
4. Identify additional bits of advice or information you think the client should have
received.
5. Choose a poster in the clinic and study it. Be ready to describe and analyze it.
Make notes to help you discuss the poster when you return to the workshop site.
Session 1
Part I
Instructions for the Clinic Visit
1. Arrive at the clinic as early as possible (before the start of the day’s work).
2. Observe the “health talk” if possible. Be sure to note:
— what was the topic?
— how long did it take?
— what time did it begin?
— examples of audience participation
— content and remarkable features of the talk
Avoid taking notes or writing while you are observing.
3. Follow one patient through the clinic. Note the time of arrival and departure. Note
the client’s sex, age, and reason for visiting the clinic. Observe the health worker’s
attitude. Identify each piece of health education or advice received as the patient
moves through the system. How much time does the patient spend waiting?
4. Identify additional bits of advice or information you think the client should have
received.
5. Choose a poster in the clinic and study it. Be ready to describe and analyze it.
Make notes to help you discuss the poster when you return to the workshop site.
6
Session 2
Part I
Session 2
The Story So Far
Purpose: To understand the perceptions, past experiences, and feelings about health
education enabling the group to share the same information
Methods: Large group discussion
Materials: [2 Flip chart
0 Marking pens
Learning Activities
Time: 40 minutes
1. WRITE responses to the following questions on the flip chart. Try to receive
responses to each question from several participants.
ASK:
WHAT SHOULD BE?
— What is the use or the value of health education?
— What should it do?
ASK:
WHAT WAS?
— Did you study health education in your training?
— How many hours (or how long) did you study it?
— Did you practice it then?
— How did you feel about it then?
ASK:
WHAT IS?
— What experience have you had with health education since you
qualified?
— What have you accomplished through health education?
— How do you feel about the methods you have used?
ASK:
WHAT CAN BE?
— What can we accomplish through health education?
— How can we make health education more effective?
2. SUMMARIZE the main points that have come out of the discussion. Be sure they
are written on newsprint. (Newsprint may also be called flip chart paper, big paper,
banking paper, conference paper, etc.)
3. POST the notes on a wall in the meeting room.
7
Session 3
Part I
Session 3
River Code1
Purpose: To illustrate the difference between doing FOR and working WITH people
to solve shared health education problems
Methods: Drama and discussion
Materials: 0 Chalk or string to mark the river edges
0 Pieces of paper to represent stepping stones
0 A piece of newsprint to represent the island
Preparations: 0 DRAW the river and place paper stones (see diagram below)
0 IDENTIFY three participants to act in the drama and brief them
during a break before this activity
Learning Activities
Time: 40 Minutes
1. DRAW two lines on the floor fairly wide apart in chalk or use string if you do not
want to draw on the floor.
2. PLACE the (newsprint) “island” in the middle of the river and place the pieces of
paper for “stepping stones” leading from one edge of the river to the island and
from the island to the other edge of the river.
3. ASK for three volunteers to act out the script. Give each one a copy of the
directions to study. All others should stand where they can see the action. The
story is:
•
•
Two men come to the river and look for a place to cross. The current is very
strong and they are both afraid to cross.
A third man comes along and sees their difficulty. He leads them up the river
and shows them the stepping stones. He encourages them to step on them, but
they are afraid. The third man agrees to take one on his back. By the time he
gets to the middle of the river, the man on his back seems very heavy and he
has become very tired, so he puts him on the little island.
1 River Code is reprinted by permission and adapted from Training for Transformation: A Handbook for
Community Workers by Anne Hope and Sally Timmel, Mambo Press, Gweru, Zimbabwe, 1991.
8
Part I
Session 3
• The third man goes back to fetch the second who also wants to climb on his
back. But the third man refuses. Instead he takes his hand and encourages him
to step on the stones himself. Halfway across, the second man starts to manage
alone. They both cross the river. When they get to the other side, they are
extremely pleased with themselves and they walk off together, completely
forgetting about the first man, sitting alone on the island. He tries to get their
attention, but they do not notice his frantic gestures for help.
4. INVITE the participants to regroup for a discussion. It is not necessary to write all
the answers, but you may wish to write answers from question 7 and save them for
further workshop sessions.
Discussion Questions:
1. What did you see happening in the play?
2. What different approaches were used to help the two men across?
3. Who could each person represent in real life?
4. What does each side of the river represent?
5. Why does this happen?
6. In what ways do either education or development projects build a sense of
dependence?
7. What must we do to ensure that those we work with develop a sense of
independence?
9
Part I
Session 3
Directions: MAKE ONE COPY FOR EACH ACTOR
CUT IN HALF AND DISTRIBUTE
River Code
TO THE ACTORS: This is a mime or a play without words. You can see the two
lines drawn wide apart on the floor. The pieces of paper are stepping stones and the
newsprint is an island. Here is the story you are to act out:
Two men come to the river and look for a place to cross. The current is very strong
and they are both afraid to cross.
A third man comes along and sees their difficulty. He leads them up the river and
shows them the stepping stones. He encourages them to step on them but both are
afraid, so he agrees to take one on his back. By the time he gets to the middle of the
river, the man on his back seems very heavy and he has become very tired, so he puts
him on the little island.
The third man goes back to fetch the second who also wants to climb on his back. But
the third man refuses. Instead he takes his hand and encourages him to step on the
stones himself. Halfway across the second man starts to manage alone. They both
cross the river. When they get to the other side, they are extremely pleased with
themselves and they walk off together, completely forgetting about the first man,
sitting alone on the island. He tries to get their attention, but they do not notice his
frantic gestures for help.
Part I
Session 3
River Code
TO THE ACTORS: This is a mime or a play without words. You can see the two
lines drawn wide apart on the floor. The pieces of paper are stepping stones and the
newsprint is an island. Here is the story you are to act out:
Two men come to the river and look for a place to cross. The current is very strong
and they are both afraid to cross.
A third man comes along and sees their difficulty. He leads them up the river and
shows them the stepping stones. He encourages them to step on them but both are
afraid, so he agrees to take one on his back. By the time he gets to the middle of the
river, the man on his back seems very heavy and he has become very tired, so he puts
him on the little island.
The third man goes back to fetch the second who also wants to climb on his back. But
the third man refuses. Instead he takes his hand and encourages him to step on the
stones himself. Halfway across the second man starts to manage alone. They both
cross the river. When they get to the other side, they are extremely pleased with
themselves and they walk off together, completely forgetting about the first man,
sitting alone on the island. He tries to get their attention, but they do not notice his
frantic gestures for help.
10
PART II
Useful Concepts — Creating New
Ways of Working with People
Session 4
Part II
Note to the Facilitator: Part II
This section is a collection of activities designed to help the participants identify
principles or important understandings based upon their past experiences. Questions
are written to help you lead the discussions. Read “Background for the Facilitator’’ at
the beginning of each section, then think about past experiences that can be used to
enrich the discussion. Can you think of better or additional questions that will help to
recall such experiences from you and the participants? Use them!
By the end of each discussion, the group should prepare a statement explaining the
principle or important points gained as a result of the discussion. Suggestions are
provided but should be used only as a guide for you and not as the group’s statement.
Write the participants’ points on newsprint and be sure they are posted on the wall in
the meeting room for further reference.
Ownership
Background for the Facilitator: Session 4
Our experience can help us understand that when people own something, they tend to
value and take care of it. Things, such as clothing, books, vehicles, are often owned
and cared for and these are easy to think about. In addition:
• Relationships such as my mother, my wife, my child
• Beliefs such as our belief is. . .
• Customs such as our custom is. . .
• Ideas such as my idea is. . .
Relationships, beliefs, customs, and ideas are owned as well.
In working with people to promote health, it is important to pay attention to the
amount of ownership they feel for the issue or problem you are helping them manage.
When people feel ownership regarding health problems, they are interested in solving
those problems. When they feel the solutions to their problems are their solutions,
people are more likely to implement them.
The health workers will return to this concept of ownership as they work with people
on solving health related problems. In fact, as they begin to create a new approach to
working with people, the health workers should begin to feel ownership of their
creation!
13
Session 4
Part II
Session 4
What is Ownership?
Purpose: To stimulate the participants to become aware of the issue of ownership
Method: Large group discussion
Materials: [7] Dictionary
[7] Paper and pens for participants to make notes
[7] Flip chart, markers, masking tape, scissors
Preparations:
[7] WRITE the questions in Step 6 on the flip chart (before the
session begins)
[7] REVIEW this activity before leading the discussion
Learning Activities
Time: 1 hour 15 minutes
1. ASK the participants to define ownership. What is it? (You may need to define
“own” first. USE a dictionary if necessary.) WRITE their answers on the flip
chart.
2. ASK the participants to take the piece of paper and make a list of 5 valuable things
they own. (Allow 3-4 minutes.)
3. ASK for two volunteers to read the items on their lists. If no one volunteers, ask
several people to read one item from their list. Make a list on the flip chart or
chalk board. Then ask:
“May I have your () (item) so that I can (bum) (break) (tear) it?”
If the volunteers agree, challenge them: “Why are you so willing?” If they do
not agree, ask them to think and explain: “Why?”
Special Note to the Facilitator
In many countries, government vehicles are not well cared for. Private cars are better
maintained, simply because the owners value them. The same is often true of
household toilets or wells in contrast to public toilets or wells. Using an example
from your own situation, identify an item that is not well cared for because it is
owned by the government or community. Identify a similar item that is owned
privately. Write them on a separate sheet of newsprint or the board and show them to
the group.
4. ASK the group: Which of these items is better cared for? Why? WRITE on a large
sheet of paper and post on a wall:
WE TEND TO TAKE CARE OF THINGS WE OWN
14
Session 4
Part II
5. It is easy to see that people can own things. CHECK to see if the list you made in
Learning Activity 3 includes the following:
— relationships (“My relative, friend, lover. . .")
— beliefs/knowledge/values ('"'We believe. . .,f)
— customs (“Our custom is. . .“)
— ideas (“It was my idea. . .’’)
If it does not, ask questions helping the participants to identify ownership. Be sure to
keep a record of additional responses.
6. WRITE the following questions on newsprint before the session begins. Put the
questions up now and ask the participants to spend about five minutes thinking
about them and to answer the questions on paper.
Directions: Take five minutes to think about your own experiences advising
patients to do something you believed would improve their health. Think
about cases where you saw the patients again, so you know if they took your
advice. Can you remember one who took your advice and one who did not?
Make notes to share in a group. Try to remember:
• What was the disease or problem?
• What did you advise?
• What happened? Did the person do as you suggested?
• In the “yes” case why do you think (s)he did it?
• In the “no” case, why do you think (s)he did not do it?
Share your stories with the others in your group. Then the group should
decide which story to present to the class. Choose a reporter.
7. ASK the participants to meet in groups to share their stories.
8. Reassemble the participants and ask the reporter from each group to share the
selected story. WORK with the entire group after each presentation. Decide
given by the health
whether the patient felt ownership of the problem or advice
i '
worker. Is it possible to understand why it was or was not felt? What could be
some reasons?
9. ASK what important points have we realized?
Possible answers include:
People take care of what they own:
— things
— relationships
— beliefs
— ideas
15
Session 4
Part II
Directions: MAKE ONE COPY PER TWO PARTICIPANTS
CUT IN HALF AND DISTRIBUTE
Group Directions
Take five minutes to think about your own experiences encouraging patients to do
something you believed would improve their health. Think about cases where you saw
the patients again, so you know if they took your advice. Can you remember one who
took your advice and one who did not? Try to remember:
• What was the disease or problem?
• What did you advise?
• What happened? Did the person do as you suggested?
• In the case of “yes,” why do you think (s)he did it?
• In the case of “no,” why do you think (s)he did not do it?
Share your stories with the others in your group. Then the group should decide which
story to present to the class. Choose a reporter.
Session 4
Part II
Group Directions
Take five minutes to think about your own experiences encouraging patients to do
something you believed would improve their health. Think about cases where you saw
the patients again, so you know if they took your advice. Can you remember one who
took your advice and one who did not? Try to remember:
• What was the disease or problem?
• What did you advise?
• What happened? Did the person do as you suggested?
• In the case of “yes,” why do you think (s)he did it?
• In the case of “no,” why do you think (s)he did not do it?
Share your stories with the others in your group. Then the group should decide which
story to present to the class. Choose a reporter.
16
Session 5
Part II
Medical Culture
Background for the Facilitator: Sessions 5 and 6
Health workers are members of local cultures. These cultures are easily identified and
described by the workers. Their training as nurses, paramedics or physicians, however,
makes them members of an additional culture. Few health workers realize this, since
they think of their experience as training or education. Yet, when the aspects of
culture itself are analyzed, each aspect can be found in the health worker’s
professional world. When you explore health care with the participants, you will see,
it too, is culture. Health care is more than a set of skills!
Training in any of the health care disciplines includes: learning to think in certain
ways, like the cognitive process; learning to perceive the world in a particular way
such as knowing germs are the cause of disease; learning a special way of saying
things by using the medical language; learning customs such as standing when a
superior walks into the room; learning the correct ways of doing things such as sterile
technique; learning about ethics and laws; learning a dress code; and learning about a
medical social structure or line of command.
Most health workers who are members of traditional cultures live with cultural conflict
without realizing they do so. Their training convinces them to believe and do things in
conflict with the traditions of their people. Doing or teaching things that conflict with
tradition makes health workers feel uncomfortable.
Therefore, many health workers avoid doing or teaching such things, but would find it
difficult to explain “why.” Others do or say as they were trained, but develop
negative attitudes about and relationships with their people. In this case, it is not
uncommon to hear health workers say, “The people are very stubborn,” or “they are
stupid,” or “they are uncooperative.”
As facilitator, you can help health workers to begin to see the cultural issues more
clearly. You can begin this process if you:
• ASSIST in developing a list of components comprising a culture.
• LEAD the group in evaluating the health care community compared to those
components. Do health care workers form a culture of their own?
• HELP the participants reflect upon problems that arise when two cultures focus
on the same health problem.
17
Session 5
Part II
Session 5
What is a Culture?
Purpose: To help health workers identify cultural issues in health education
Methods: Large group discussion
Materials: 0 Dictionary (use only if needed)
0 Newsprint and marking pens
Learning Activities
Time: 20 minutes
1. ASK the participants to define the term “culture.” WRITE their definitions on
newsprint.
2. ASK the participants to identify the things that make a culture. MAKE a list on
one side of a sheet of newsprint. Be sure to include:
— language
— beliefs or ideology
— customs or ways of doing things
— ethics or moral values
— laws
— ways of dressing
— political organization
3. ASK the participants to think about “us” as the health care community. REVIEW
each item on the list to see if the health care community is a culture. PLACE a
check next to any cultural aspect on the list, when participants agree it is found in
their health care community.
4. What important point can we derive from this? ASK the participants to make a
statement based on the discussion. WRITE it on a separate sheet of newsprint to be
posted on the wall of the meeting room.
We, as health care workers, have our own culture!
18
Session 6
Part II
Session 6
Some Cultural Conflicts
Purpose: To identify conflicts affecting health education efforts
Methods: Small group work
Materials: [7] At least two sheets of newsprint for each group, one of which is
prepared as in the example below
0 Marking pens: Each group needs three colors, such as black, blue,
green or red
[7] Directions for the groups
Preparations: [7] REPRODUCE group directions
[7] For each group, DRAW lines on one sheet of newsprint dividing it
vertically into thirds. Example:
Diseases
Medical
Cause
Traditional
Cause
Learning Activities
Time: 1 hour 30 minutes
1. DIVIDE the participants into area groups and give each person a copy of the
written directions. Those directions are:
• Use the sheet of newsprint, which is divided into three sections. Using the black
pen in the first column, make a list of six common diseases you see in the
clinic.
• In the second column, write down the cause of each disease, as you learned in
your training.
• In the third column, write what the traditional culture in your area believes is
the cause of each disease.
• Using the blue pen, identify where medical and traditional cultures are in
conflict.
• Using the green or red pen, identify where medical and traditional cultures have
similar ideas.
• Discuss what effect culture has on your health education efforts. Give examples.
(Use a fresh sheet of newsprint.)
2. ASK the participants to return to the large group. ASK one person from each group
to report the group’s decisions on the last three items.
19
Session 6
Part II
3. CALL the group’s attention to areas of agreement between traditional and medical
causes, where they exist. STRESS that this is the basis for helping people learn.
People learn by building on what they already believe and know. In areas
where there are conflicts between medical and traditional causes, the health worker
has a greater challenge. Is it useful to criticize the people’s ideas?
4. ASK the participants to make a statement, based on their discussions: What
important points can we identify from this?
Because we speak or think from different cultures, patients do not always understand,
believe or respect what we tell them.
“ In areas where there are conflicts between medical and traditional causes, the
health worker has a greater challenge.”
A
To help prevent
getting diarrhea
again, you could
build a latrine
and use it . . .
20
What is so
valuable about
my waste?
Why would I
want to keep it all
in one place?
Session 6
Part II
Directions: MAKE ONE COPY PER TWO PARTICIPANTS
CUT IN HALF AND DISTRIBUTE
Group Directions
1. Use the sheet of newsprint, which is divided into three sections. Using the black
pen in the first column, make a list of six common diseases you see in the clinic.
2. In the second column, write the cause of each disease, as you learned in your
training.
3. In the third column, write what the traditional culture in your area believes is the
cause of each disease.
4. Using the blue pen, identify where medical and traditional cultures are in conflict.
5. Using the green or red pen, identify where medical and traditional cultures have
similar ideas.
6. Discuss what effect culture has on your health education efforts. Give examples.
(Use a fresh sheet of newsprint.)
Session 6
Part II
Group Directions
1. Use the sheet of newsprint, which is divided into three sections. Using the black
pen in the first column, make a list of six common diseases you see in the clinic.
2. In the second column, write the cause of each disease, as you learned in your
training.
3. In the third column, write what the traditional culture in your area believes is the
cause of each disease.
4. Using the blue pen, identify where medical and traditional cultures are in conflict.
5. Using the green or red pen, identify where medical and traditional cultures have
similar ideas.
6. Discuss what effect culture has on your health education efforts. Give examples.
(Use a fresh sheet of newsprint.)
21
Part II
Session 7
Wants, Needs, And Problems
Background for the Facilitator: Sessions 7 and 8
In our clinical care training, we learn to focus on people’s needs. We speak of doing
“needs assessments” in order to develop a plan of care for the patient. In the clinical
setting, this is a valuable concept.
With health promotion, focusing on the needs of others means making a judgement
and decision for people - not only what their problem is, but what they should do
about it. The result of thinking “the patient needs to” is that the problem and solution
are identified and owned by health workers, rather than by the people who have a
problem to solve. Once we assess their needs, it is easy to give advice telling people
what to do. We are trained to do this.
As we discovered in discussing the issue of ownership, it is important for people to
decide for themselves (feel ownership of) the problem, and to be involved in
identifying the best solution. We already know we possess helpful technical
information and understanding, but we must take great care to offer this on a “sharing
of information” basis, so that ownership remains with the patient or group. When
advice or specific directions are owned by us (health workers), there is little reason
why patients should care about our advice.
In many communities, every discussion about health ends in a request for new or
improved medical services. “We need a health center.” This often happens because
the question was: “What do you need?” When the dictionary is consulted, there is a
striking similarity between need and want. The participants will discover this very
fine line for themselves by defining these words.
When the problem approach is used, it is possible to avoid the situation of needs and
wants. For example, if you ask a supervisor, “What is your problem?” (s)he might
tell you, “I do not have transportation to do my supervisory work.” There are many
possible solutions to this problem, including procuring funds for public transportation,
getting a motorcycle, or arranging for part time use of a vehicle from another division.
The best solution depends on the resources available and other circumstances.
If you ask the same supervisor, “What do you need?” (s)he is likely to tell you, “I
want the very best sort of four-wheel drive all terrain vehicle (like a Jeep, Land Rover
or Land Cruiser2).” The word need becomes an invitation to want. The following
activities help the participants distinguish between the meanings of “want,” “need,”
and “problem.”
-__________
2 Use of trade names is for identification only and does not imply endorsement by the Public Health
Service or the U.S. Department of Health and Human Services.
22
Session 7
Part II
Session 7
Clarifying Terms
Purposes: To clarify the meaning of the words “need” and “want”
To define the word “problem”
To help health workers identify whether they routinely ask patients about
wants, needs, or problems and study how patients respond to these
questions
Methods: Large group discussion and demonstration
Materials: 0 Dictionary
0 Newsprint and marking pens
0 One table and two chairs
Preparations: 0 READ through this activity before the session begins
0 ARRANGE the chairs in a semi-circle
0 REPRODUCE the questions listed for volunteers
0 IDENTIFY two volunteers to participate
0 EXPLAIN the instructions and clarify any questions
Learning Activities
Time: 30 minutes
1. REQUEST a volunteer to use the dictionary. For each of the following words, first
ask the group to offer definitions.
NEED
WANT
WRITE the definitions on newsprint, then compare with dictionary definitions.
2. ASK the participants to discuss:
• How is a need different from a want?
• How is it similar?
• Who is the owner of a need?
• Who is the owner of a want?
A NEED is usually what somebody else perceives for you.
A WANT is usually what you desire, but may not be the only solution to the
problem you face.
3. ASK a volunteer to find the definition of “problem” in the dictionary. Write the
definition on another piece of newsprint. Do not discuss it yet. Have these notes
posted on the wall for further reference.
4. ASK the two volunteers identified to come forward and proceed with the following
role play:
23
Session 7
Part II
Volunteer #1: I want you to play yourself, the health worker. Turn a chair so the
other participants can see you well. If you use a table or desk, use the one here.
Attend to the patient as you would in your clinic. I will tell you when to stop.
Volunteer #2: You are the patient. You arrive at the health center feeling ill. It is
your turn to be seen by the health worker. Take a moment to decide what your
complaint will be, then enter and take your place. Answer questions asked by the
health worker. I will tell you when to stop.
5. ASK the remaining participants to listen carefully to what the health worker and the
patient are saying.
6. CONTINUE the demonstration long enough so the health worker asks the patient:
• “What is your problem?” (“What is your trouble?”)
• “What do you need?”
• Or “What do you want?” (“How can I help you?”)
• Let the patient respond, then stop the action.
7. DISCUSS the following questions with the large group:
•
What was the question? (want, need, or problem)
•
What was the patient’s response? (want, need, or problem)
•
How is this similar to what happens in the clinic every day? Do you usually try
to find out wants, needs or problems?
Digging Deeper: If it seems the routine is to ask about the problem or trouble, ASK:
“What usually happens if a mother brings her baby with a complaint of stomach pain
or cough and when you examine the baby, you find nothing wrong? Do you send the
mother away without any treatment? Why?”
Health workers frequently focus on and respond to the “wants” of patients, even if
they ask about problems! It is rare for patients to leave the health center without
treatment.
24
Part II
Session 7
Directions: MAKE ONE COPY FOR EACH VOLUNTEER
CUT APART AND DISTRIBUTE
Instructions for the Volunteers
Volunteer #1: I want you to play yourself, the health worker. Turn a chair so the
other participants can see you well. If you use a table or desk, use one here. Attend to
the patient as you would in your clinic. I will tell you when to stop.
Volunteer #2: You are the patient. You arrive at the health center feeling ill. It is
your turn to be seen by the health worker. Take a moment to decide what your
complaint will be, then come in and take your place. Answer questions asked by the
health worker. I will tell you when to stop.
Session 7
Part II
Instructions for the Volunteers
Volunteer #1: I want you to play yourself, the health worker. Turn a chair so the
other participants can see you well. If you use a table or desk, use one here. Attend to
the patient as you would in your clinic. I will tell you when to stop.
Volunteer #2: You are the patient. You arrive at the health center feeling ill. It is
your turn to be seen by the health worker. Take a moment to decide what your
complaint will be, then come in and take your place. Answer questions asked by the
health worker. I will tell you when to stop.
25
Part II
Session 8
Session 8
Working with People’s Problems
Purposes: To explain the significance of working with the “problems” of people rather
than their “wants”
To realize their “needs” are not always what we think
Method: Brief Lecture
Preparation: [y] Review the points below before the session
Learning Activities
Time: 25 minutes
Include the following points in this activity:
• We have looked at the importance of ownership when people are working to solve
their own problems.
• Needs can be owned by outsiders as in, “You need to have a latrine,” or “You
need to boil your drinking water.”
• Needs can easily become wants as in “My child has diarrhea and I want
medicine.”
• When we focus on problems, we begin in a different place by finding freedom to
learn, putting ideas and resources together, and finding appropriate solutions.
• Discussing a problem with its many parts helps people to feel the problem and take
ownership of it.
• When people own a problem, they want to solve or take care of it.
• For each problem, there are hundreds or even thousands of possible solutions.
Write this point on newsprint and post it on a wall.
• When we (as health workers) give advice to mothers, we are choosing solutions that
belong to us. When we focus on a problem with the owner and look at possible
solutions, the owner can choose the solution that best fits his or her circumstances.
• When you work with a mother about her child’s problem and help her find the best
solution, the ownership of both the problem and the solution remain with the
mother.
26
Part II
Session 9
Learning
Background for the Facilitator: Sessions 9, 10 and 11
Life is called a learning process and when we stop learning, we die - even if we can
still walk around! We often think of learning as something that happens at school
when we are taught new information. It is easy to forget that life frequently provides
us with lessons. We are capable of learning, often without realizing it. Each time a
health worker examines a patient whose symptoms differ from the classical picture of
a specific disease, (s)he learns there can be additional or different symptoms produced
by the disease. Each day we learn things from our encounters with people, situations,
and things. Often, new learning is built upon past knowledge.
As children, and especially as students, our learning is planned, structured, and well
defined. Young girls are expected to learn how to process and prepare foods as their
mothers do. Young boys are expected to learn skills their fathers have. As students,
we are expected to learn a series of skills, facts, and so forth as outlined in a syllabus.
These are formal or structured ways of learning.
In everyday life, adults also learn - from each other, from experiences they or others
have, and from events. It is this ‘Teaming through discovery” that adults are best able
to remember and use. Often they do not recognize that they have learned, because it is
a natural process. Yet the knowledge gained in everyday life is wisdom, which is used
repeatedly to evaluate additional information or ideas.
Helping adults to learn is not like teaching children. It requires very different
approaches and methods. Adults respond when they feel they are respected, valued,
addressed as equals, or “betters!” They choose what they will learn. Most often, the
usefulness of the information is the basis for their choice. (See the handout on page
33 and review the quote from Julius Nyerere)
The following activities are designed to help participants realize:
• Adults learn what is useful and interesting to them
• Adults and children learn by different methods
• We can identify conditions that promote adult learning
Information Overload
Background For The Facilitator: Session 9
When health workers see patients whose cases are difficult to diagnose, they
sometimes attempt to treat every symptom or complaint. Frequently this results in
prescriptions for several drugs, each with different instructions. It is not uncommon to
see a mother leaving a health center with four or more types of medicine for her baby,
27
Part II
Session 9
and all to be given on different schedules. There is some doubt as to whether the
mother can or will manage to administer all of them appropriately. Many attempts are
made to encourage health workers to reduce the number of drugs they prescribe for
each patient. This problem could be considered “drug overload.”
Something similar often occurs when the health worker gives counselling or health
education. Not only is too much information provided, but usually the information is
from “medical culture,” which is where the health worker learned it in the first place.
It is too complicated and represents a reality or belief system different than the
patient’s. When the patient leaves, (s)he is unable or unwilling to implement what
(s)he has been told.
“Information Overload”
So, wash your hands, boil your water, give the malaria
medicine every morning, give the fever medicine three times a
day, give the vitamins every morning, give the cough mixture
twice a day - but, only if you think the child needs it. . . and
come back when the medicine is all gone. . .
unless, of course, the child gets very hot. . .
A
then sponge him and come right away. . .
28
Part II
Session 9
Session 9
Overload or Useful Information?
Purposes: To help the participants recognize the problem of information overload
To demonstrate that adults like to learn things they can use, particularly
when they have an interest in the topic
Method: Demonstration
Materials: 0 Flip chart
0 Markers, masking tape, scissors
Preparations; 0 DECIDE on an interesting subject for item number 4 (Topic B) and
locate the necessary resources to allow someone to give the
presentation
0 IDENTIFY a participant to present the topic and help that person to
prepare
Learning Activities
Time: 50 minutes
1. READ the complicated passage below (Topic A)3. READ the paper until you see
the participants losing interest, then stop.
Topic A:
The nasal septum divides the nose into two nasal fossae. It is cartilaginous in
front and bony behind. The septum is straight at birth and in early life but
becomes deviated or deformed in almost every adult. Only the posterior end
separating the posterior nares remains constantly in the midline. Anteriorly,
the quadrilateral or septal cartilage is frequently dislocated into one nasal
vestibule. Posteriorly the septal cartilage joins the perpendicular plate of the
ethmoid above and the vomer below. The other parts of the septum (the
palate bone, crest of the maxilla, and rostrum of the sphenoid) are small.
The lateral wall of the nose is a complicated area anatomically and a very
important area clinically. There are four nasal turbinates or conchae. Named
from below upward, they are the inferior, middle, superior, and supreme
turbinates. The supreme turbinate is small and is not seen during clinical
examination; the superior turbinate is so placed that usually it can be seen
only with a post nasal mirror.
The inferior turbinate is a separate bone whereas the other turbinates are
parts of the ethmoid bone. The mucous membrane of the inferior turbinate is
very rich in blood vessels and is semierectile. It is this structure that
vasoconstrictors affect most. Sometimes the bony part of the inferior
turbinate lies close to the lateral nasal wall, but at other times it juts out
prominently into the airway and causes nasal obstruction. Often the mucosa
of the inferior turbinate touches the septum.
3Topic A is reprinted by permission and adapted from the Textbook of Otolaryngology, by David Downs
DeWeese and William H. Saunders, published by C.V. Mosby, St. Louis, Missouri, 1960.
29
Session 9
Part II
2. ASK the participants:
— What was happening?
— How did you feel?
— Was the information relevant to you?
— Was it useful?
— Have you ever been in my position?
— Have you done this to anyone?
— How much information should one person be given during an individual patient
education session?
— Why?
The basic rule is NOT MORE THAN THREE bits of information should be
provided at one time.
3. What important points can we get from this experience?
Answers should include the following ideas:
— It is possible to give too much or too complicated information
— Information must be understandable, not too much at one time, and something
the person wants to know about
4. Many health workers have an interest in the latest research findings related to their
work. IDENTIFY a topic (Topic B) of interest and have a facilitator or other expert
GIVE a brief (5 minute) simple presentation on related current research.
Topic B:
Suggestions:
— AIDS incidence in the region
— chloroquine resistant malaria
— immunization coverage (progress)
— effects of vitamin A deficiency on childhood diseases
— a successful and innovative ARI program
— new contraceptive technology
5. ASK the entire group:
• Was Topic A interesting? Was it useful?
• How will you use the information?
• Were you the right group to receive this lecture?
• Was Topic B interesting? Was it useful?
• How will you use this information?
• Were you the right group to receive this lecture?
• Is health education in the health center like Topic A? How?
•
Which of these approaches (Topic A or B) is being used in the clinic? Which
one should be used? Why?
6. ASK what general rules can be made about the amount and level of information
that is appropriate for education in the clinic. Make a list of the rules on newsprint
and post them on the wall.
30
Part II
Session 10
Session 10
Adult and Child Learning
Purposes: To distinguish between learning methods for children and adults
To identify an effective approach to adult learning
Method: Small group work
Materials: 0 Newsprint and marking pens
0 Questions for discussion groups
0 Handout — quote from Julius Nyerere
Preparations: 0 REPRODUCE discussion questions and handout, one per
participant
Learning Activities
Time: 1 hour 30 minutes
1. ASK the participants to form into groups of about five. GIVE each group
newsprint, pens, and copies of the discussion questions and the quote from Julius
Nyerere. INFORM the groups they will have 45 minutes to work. The directions
are:
DISCUSS what you know from your own experience.
• How do children learn in your culture? Give examples:
— at home
— at school
• How do adults learn in your culture? Give examples:
— adults who have been to school
— adults who have never been to school
READ the Handout — quote from Julius Nyerere
ADDRESS the following questions:
• Do you agree with the statement? Why?
• What is the most important point Julius Nyerere makes in the quote?
IMAGINE that you have been assigned to teach the purpose of ORT to the elders in
the community where you work. None of the elders have been to school.
• How will you teach this information? Explain your reasons.
• Would you teach the third year primary students the same thing in the same
way? Why?
2. VISIT each group to be sure the discussion is proceeding smoothly. MONITOR the
time and their progress and adjust the discussion time accordingly. GIVE 10 minute
and 5 minute “wrap-up” warnings before calling time.
3. CALL for reports. TELL each group reporter to have answers written on their
newsprint. (Do not allow reporters to explain all that was
takes too much time.)
31
Part II
Session 10
4. IDENTIFY important points about learning.
Answers should include the following ideas:
— Adults and children learn in different ways
— Adults can learn new ideas by building on former knowledge
— Adults learn things that interest them
“Adults learn things that interest them.”
How often should my wife visit the
health center? We want our new
baby to be strong and healthy.
32
Session 10
Part II
Directions: MAKE ONE COPY PER PARTICIPANT OF DISCUSSION QUESTIONS AND QUOTE
Discussion Questions
Discuss what you know from your own experience about:
1. How do children learn in your culture? Give examples:
— at home
— at school
2. How do adults learn in your culture? Give examples.
— adults who have been to school
— adults who have never been to school
3. Read the quote from Julius Nyerere
4. Discuss:
• Do you agree with the statement? Why?
• What is the most important point Julius Nyerere makes in the quote?
5. Imagine that you have been assigned to teach ORT to the elders in the community
where you work. None of the elders have been to school.
• How will you teach this information? Explain your reasons.
• Would you teach the third year primary students the same thing in the same
way? Why?
“A very pleasant thing about adult education is that we can learn what
we want to learn - what we feel would be useful to us in our lives. At
school, children are taught the things which we adults decide they
should be taught. But adults are not like children who sit in classrooms
and are then taught history, or grammar, or a foreign language. As
adults, we can try to learn these things if we wish; we do not have to
do so. Instead, we can learn about growing a particular crop, about the
government, about housing or building - or about whatever interests us.
We can build on the education we already have - using the tools of
literacy or a foreign language, or an understanding of scientific
principles. Or, if we never went to school, we can start by learning
about the things of most immediate importance to us - better farming
methods, better child care, better feeding. We do not even have to start
by learning to read and write.
For literacy is just a tool; it is a means by which we can learn more,
more easily. That is its importance...”
By Julius K. Nyerere, from Freedom and Development, Oxford University Press, London, England, 1973.
33
Session 11
Part II
Session 11
How Adults Learn
Purposes: To summarize conditions that promote adult learning
To provide information on how adults learn
Methods: Discussion and lecture
Materials: 0 Newsprint and markers
0 Notes (on newsprint) from previous activities needed for this section
Preparations: 0 WRITE “How People Learn’’ (below) onto a large piece of
newsprint
0 WRITE the Chinese poem on another piece of newsprint
0 PUT both writings on a wall where everyone can see them
Learning Activities
Time: 15 minutes
1. ASK the participants to summarize adult learning, as identified so far. MAKE
notes on a sheet of newsprint titled: “ADULT LEARNING.” POST the list on a
wall where everyone can see and refer to it.
2. EXPLAIN and ASK the following:
PART A:
•
Adults have experience in life. Learning new ideas or practices is easier when
they build on their current knowledge or experience.
Question: Can you think of a new idea you want people to learn in health that
can be explained by building on earlier experiences?
•
New ideas are more credible if they are connected to what has been believed or
practiced in the past.
Question: Can you think of a new idea you want mothers to learn that you can
connect to something they already believe?
Share the following Chinese poem:
Go to the people...
Live among them...
Learn from them...
Love them...
Start with what they know...
Build on what they have;
But of the best of leaders...
When their task is accomplished...
Their work is done...
People will remark
“We have done it ourselves!”
•
(Lao Tsu of China in 700 B.C.)
Is it interesting to know this was written more than two thousand years ago?
34
Session 11
Part II
PART B:
Share this information which is reprinted and adapted from Training for
Transformation : A Handbook for Community Workers:
How People Learn
Tests have shown that people remember:
20 percent of what they HEAR,
40 percent of what they HEAR and SEE
80 percent of what they DISCOVER for themselves.
Education should stress LEARNING more than teaching. Where possible, facilitators
should create a learning situation where adults can discover answers and solutions for
themselves. People remember the things they have said themselves best, so teachers
should not speak too much. They need to give participants a chance to find solutions
before adding important points the group has not mentioned.
3. ASK what are important points to remember when teaching adults? Write the
answers on newsprint and post them on the wall.
35
Part II
Session 12
Reasons
Background for the Facilitator: Session 12
As we learned in the previous activities, children learn what teachers believe they
should learn. They are not expected to ask, “Why should I learn this?” Adults,
however, are seldom willing to learn or do anything unless they have a reason.
In the past, we identified essential or priority messages to be given to patients when
they receive care for their problems. These messages are directions such as what to
do, how to take medications, when to return to the clinic. The information is very
important, yet we find mothers often leave the clinic without understanding, even
when the health worker provides clear messages. Messages alone are not enough.
Adults need to have reasons why they should follow advice. The following activity is
designed to emphasize the importance of helping people to understand why they
should do what we advise.
“Adults need to have reasons why. . . ”
If your baby feels hot, take off his
clothes and bathe his skin with
cool water.
When my baby feels hot, he
shakes with cold. Why would I
take off his clothes and put cold
water on his skin? He will cry
and want to be warm because
he is shaking. . .
7^.
T
36
T
Session 12
Part II
Session 12
Why? Give Me a Reason
Purposes: To demonstrate the importance of giving reasons to adults
To provide practice in thinking about reasons and how to share them
simply
Methods: Large group discussion and small group work
Materials: [/] Newsprint and markers
Preparations: [7| MAKE one sheet of newsprint for each group to use in its
discussion (Step 8). Example:
_____ Problem _
Priority Message
______
Why? (Simple reason)
Learning Activity
Time: 1 hour
1. ASK one participant to come to the center of the room and stand on one leg.
WAIT until (s)he either stops or asks, “Why?” If the person stops without
questioning, ASK (s)he “Why did you stop?” ACCEPT the response and TELL
the participant to sit down.
2. ANNOUNCE to the participants: “Each of you should bring $10.00 (use local
currency) tomorrow morning when you come to the workshop.” WAIT for
someone to ask, “Why?”
3. ASK: “Why do you want to know why?”
— Why is it important to know why?
— Will you be more willing to bring the money if I give you a reason?
4. ASK the following set of questions:
— Where do you give the BCG vaccination?
— Why there?
— When do you give the measles immunization?
— Why don’t you give it at birth?
— How many doses of polio vaccine do you give to a baby?
— Why not just give one dose?
5. ASK:“Why am I asking all these questions?”
The intended response is:
To help us realize we need reasons for the things we do.
ASK: “Is it only health workers who need reasons for what they do? Who else
needs reasons?”
The responses should include:
All adults need to understand reasons why they should do something they are
advised to do.
37
Session 12
Part II
6. POINT out to the participants:
Do you remember the work you did on the medical and traditional causes of
diseases (Session 6)? Why is it that people have identified a cause for every
disease?
The responses should include:
Because people need to have a reason why diseases happen and what causes
disease. Whether in medical culture or traditional culture, the treatment depends
upon the cause.
7. EXPLAIN that people need to identify the cause (the why) of diseases and that
they need to understand why they should do what the health worker is advising.
For example: A priority message for the mother of a child brought to the clinic
with fever caused by malaria is to tepid sponge when the child is hot. Why
should she tepid sponge? The reason is quite simple. Tepid sponging brings the
temperature down and prevents convulsions.
Ask the participants: When a mother understands she can prevent convulsions by
tepid sponging, is she more or less likely to do it? Why?
8. DIVIDE the participants into groups of four or five to work on the following
assignment. GIVE each person a copy of the directions and each group a prepared
sheet of newsprint. The directions are:
•
Choose one topic from the list and write it at the top of the newsprint.
— malaria and fever
— diarrhea
— child immunizations
— tetanus toxoid
— nutrition for a 1-year-old child
•
Write one priority message in the left column. Then identify a simple reason
why and write it in the right column.
•
Continue until you identify a reason for each of the priority messages for your
topic.
Identify a reporter who will present to the other participants ONLY what your
group has written on the newsprint.
9. REASSEMBLE the participants and REQUEST tfiat each group present what is
written on their newsprint (not the discussion that took place in the group). Are
the reasons simple and accurate?
10. ASK the group to identify the important point(s) to keep in mind when advising
adults. Write the point(s) on newsprint and post it on a wall in the meeting room.
•
Adults need to have reasons why they should do something.
38
Part II
Session 12
Directions: MAKE ONE COPY PER TWO PARTICIPANTS
CUT IN HALF AND DISTRIBUTE
Group Instructions
1. Choose one topic from the list and write it at the top of the newsprint.
• malaria and fever
• diarrhea
• child immunizations
• tetanus toxoid
• nutrition for a 1-year-old child
2. Write one priority message in the left column. Then identify a simple reason why
and write it in the right column.
3. Continue until you identify a reason for each of the priority messages for your
topic.
4. Identify a reporter who will present what your group has written on newsprint to
the other participants.
Session 12
Part II
Group Instructions
1. Choose one topic from the list and write it at the top of the newsprint.
• malaria and fever
• diarrhea
• child immunizations
• tetanus toxoid
• nutrition for a 1-year-old child
2. Write one priority message in the left column. Then identify a simple reason why
and write it in the right column.
3. Continue until you identify a reason for each of the priority messages for your
topic.
4. Identify a reporter who will present what your group has written on newsprint to
the other participants.
39
Part III
Skills Needed To Work In A New Way
Part III
Session 13
Background for the Facilitator: Session 13
Many health workers learn to give health talks to patients waiting for services in a
busy clinic. Not every worker learns to assess when this setting is conducive to
learning. The activity suggested should quickly illustrate the problem of conducting
group sessions. Between the role plays taking place at the same time and the
debriefing discussion, the participants can identify conditions they must assess before
delivering group presentations. Group size, noise level, and time pressures are some of
those issues. Hopefully the participants will suggest more.
A Busy Health Clinic
. Group size, noise level, and time pressures are some of the issues.”
43
Part III
Session 13
Session 13
Assessing the Environment for Teaching and Learning
Purpose: To simulate and then assess the average clinic environment
Methods: Concurrent role plays and discussion
Materials: [7] Role play assignments for three groups
[7] Newsprint and markers
Preparation: [7] MAKE copies of the group directions
Learning Activities
Time: 40 minutes
1. DIVIDE the group into three unequal groups and GIVE each group a slip of paper
with their directions on it. First identify two persons for Group 1.
Group 1: (Two persons)
Please GO outside the meeting room to make your plan. Your assignment is to
design and present a health education session on SSS as you would in the clinic.
The other participants will act as the clinic patients and caretakers. You have
five minutes to plan what you will present to the group.
DIVIDE the remaining participants into two larger groups. Meet with them
separately. Give each group their written instructions. Read the instructions with
the group making sure participants understand what they are to do. Explain their
role should be played in response to that of the other groups, rather than
independently.
Group 2: (Approximately half of the remaining participants)
You are a group of mothers who come to the health center early in the morning
to receive treatment for your children before going to your farms or to your
business. You want to finish quickly. How will you feel when Group 1 stops
clinic business and makes you sit to hear their group presentation on SSS? What
will you do? Plan a role play. Make it realistic. Remember, mothers usually do
not show their anger or impatience quickly. Begin playing when Group 1 has
started its presentation.
Group 3: (The remaining participants)
Divide yourselves into parents and babies for this role play. You are a group of
parents who have brought sick children to the clinic. Your babies are crying. It is
hot in the waiting area. You see people trying to get ahead of you in the line. But
Group 1 is going to stop the clinic to give you a group presentation on SSS. How
will you feel? What will you do? Plan a role play. Make it realistic. Remember,
mothers usually do not show their anger or impatience quickly. Begin playing
when Group 1 has started its presentation.
2. ASK Group 1 to come in and present their role play. Allow events to unfold,
unless it becomes total confusion. Encourage all groups to play their roles.
3. WRITE the main points on newsprint for your debriefing. LISTEN for points
relating to noise, size of group, time pressures, and so forth. ASK:
44
Part III
Session 13
•
What happened? Ask each group to give their perspective.
•
•
•
Does this ever happen in real life?
Even if patients do not say something, could they be thinking or feeling it?
How much will an angry person learn from your presentation?
•
•
How much will a worried person learn?
How much will people learn if they cannot hear well?
•
What conditions do you need to assess before deciding to do a group
presentation during a clinic?
MAKE a list.
Answers should include:
— environmental considerations such as noise and room temperature
— what is going on at the clinic
— the size of the group
— why the people have come
— time consideration
— who is interested in the topic
• What conditions let you know it is a good time to do a group session?
• What will let you know it is a bad time to do a group session?
4. ASK: “What guidelines can we make about group health education sessions in the
clinic?”
• Should we always have health talks?
• Should we delay the start of clinic until all the mothers have arrived?
WRITE the points on newsprint and post them on the wall of the meeting room.
45
Session 13
Part III
Group Directions: MAKE THREE COPIES OF THIS PAGE
CUT APART AND DISTRIBUTE
Group 1: (Two persons)
Please go outside the meeting room to make your plan. Your assignment is to design
and present a health education session on SSS as you would in the clinic. The other
participants will act as the OPD patients and caretakers. You have five minutes to plan
what you will present to the group.
Session 13
Part III
Group 2:
You are a group of mothers who come to the health center early in the morning to
receive treatment for your children before going to your farms or to your business.
You want to finish quickly. How will you feel when Group 1 stops clinic business and
makes you sit to hear their group presentation on SSS? What will you do? Plan a
role play. Make it realistic. Remember, mothers usually do not show their anger or
impatience quickly. Begin playing when Group 1 has started its presentation.
Session 13
Part III
Group 3:
Divide yourselves into parents and babies for this role play. You are a group of
parents who have brought sick children to the clinic. Your babies are crying. It is hot
in the waiting area. You see people trying to get ahead of you in the line. But Group
1 is going to stop the clinic to give you a group presentation on SSS. How will you
feel? What will you do? Plan a role play. Make it realistic. Remember, mothers
usually do not show their anger or impatience quickly. Begin playing when Group 1
has started its presentation.
46
Part III
Session 14
Decoding “Medicalese”
Background for the Facilitator: Session 14
In our training, we learn to use complex and sophisticated medical language. We are
challenged to learn and use these “big” words in our work. There is a certain pride in
understanding and using “Medicalese.” The medical language serves a purpose,
allowing medical personnel to better communicate with each other.
As students, we studied hard to learn and to think in this medical language. As
professionals, we are at an advantage when we are communicating with other medical
professionals. Unfortunately, the same language often becomes a roadblock when we
try to communicate with people in the community.
Fortunately, most medical terms can be defined in simple words understood by the
general population. Health workers who want to communicate with non-medical
people can find other words to say what they want to say, but they must learn to do
so. It takes a conscious effort to identify “Medicalese” words and translate them into
a common language. The following activities suggest ways to help health workers
begin to make this effort. Although we will work in English, participants should be
encouraged to think about accomplishing this in their local languages.
We find it useful to provide monetary value to words as a measure of their simplicity.
For example: “Cough” is a 10 cent word; “pneumonia” is a $2.00 word; and
“streptococcal respiratory infection” can be worth $10.00; “facilitate” is a $2.00
word; and “lead” can be worth 10 cents. Small words equal small coins, whereas
large words equal large denominations.
Adding Monetary Value to Words
cough = 100
pneumonia = $2.00
streptococcal
respiratory
infection = $10.00
47
Part III
Session 14
Session 14
Translating “Medicalese”
Purpose: To alert participants to complicated medical terms and identify simpler,
substitute words
Method: Demonstration
Materials: [7] Newsprint and markers
Preparations: [7] LOCATE someone who can speak in a “foreign” language
[71 WRITE the paragraph beginning with “Clinical Manifestations” on
newsprint
Learning Activities
Time: 25 minutes
1. Do you speak a language the participants do not understand? If not, LOCATE a
participant who speaks a language very few other participants understand. The first
part of the demonstration is to make a short statement, about the length of one
paragraph, in a “foreign” language. MAKE the statement.
2. ASK the participants to explain what was just said. Did they understand it? Why
not? Would they have been able to understand if the same thing had been said in
English or their first language?
3. READ the following English paragraph containing complex medical terminology:4
Clinical Manifestations: Predominant symptoms are diarrhea, abdominal
pain, malaise, and fever. Stools frequently contain frank blood. Abdominal
pain may mimic appendicitis. Most patients recover in less than 1 week, but
20 percent have a relapse or a prolonged or severe illness. Persistent infection
can mimic acute inflammatory bowel disease. Convulsions develop in some
young children in association with high fever. Bacteremia is uncommon.
Reactive arthritis occasionally develops during convalescence. Mild infection
may last only 1 to 2 days and resemble viral gastroenteritis.
4. Do the participants understand it? Now show the newsprint copy to the group. Ask
them to “translate” the paragraph into simple English which can be understood by
the people living in the community where they live and work. Record their
translation on another sheet of newsprint.
5. Introduce the idea of giving monetary value to words. Give examples from the
paragraph the participants have just worked with. Work together to assign values to
the medical terms in “Clinical Manifestations” and to the simple words in the
translation.
4Reprinted by permission and adapted from The American Academy of Pediatrics Report of the
Committee on Infectious Diseases, Red Book, Elk Grove Village, Illinois, 1986.
48
Session 15
Part III
Session 15
Practice Speaking Simply
Purpose: To give the participants practice in simplifying language
Methods: Small group work
Materials: 0 Newsprint and markers for each group
0 Sets of sentences to translate
Preparations: 0 MAKE copies of the sets of sentences and cut them apart
Learning Activities
Time: 1 hour
Note to the Facilitator: Session 15
This Session is designed to give the participants practice in simplifying language, by
“translating” technical sentences. If two groups are working on the same set of
sentences, they will benefit from each other’s work and keep the reports from being
dull.
1. DIVIDE the participants into three groups. GIVE each group a sheet of paper with
five sentences on it. ASK them to take 30 minutes to “translate” the sentences into
common language that people in their community can understand. Only the
translation should be written on newsprint.
Set I:
• The most common presentation is nonspecific febrile illness.
• Enteroviruses are spread by fecal-oral, and possibly, oral-oral or respiratory
routes.
• The primary disease is caused by inflammation and obstruction of the lymphatic
channels where the adult worms develop, usually 3 months to 1 year after
exposure.
• Infection in the newborn infant usually is in the eye, but it also may be
systemic. Scalp abscesses and vaginitis are described in neonates.
• Prompt and effective treatment of acute and chronic cases is an important
adjunct to malaria control.
Set II:
• A chronic carrier state with possible chronic liver disease may result from
infection.
• Inapparent or asymptomatic infection is most common and recognized by
serologic and skin-test conversion.
• The infection is acquired through inhalation of airborne spores.
• Splenomegaly, lymphadenopathy, and skin changes consisting of darkly
pigmented, erythematous areas and other hypopigmented areas may be present.
49
Session 15
Part III
• Pertussis begins with mild, upper respiratory tract symptoms with cough
(catarrhal stage) and progresses to severe paroxysms of cough and the
characteristic inspiratory whoop often followed by vomiting.
Set III:
• Transmission of tuberculosis is usually by inhalation of respiratory droplets
produced by an adult with infectious pulmonary tuberculosis.
• It is an acute, highly communicable viral disease with prodromal fever,
conjunctivitis, coryza, cough and Koplik spots on the buccal mucosa.
The most common described anomalies associated with congenital rubella are
ophthalmologic, cardiac, auditory, and neurologic.
• The most common infection is gastroenteritis, in which diarrhea, abdominal
cramps, and tenderness and fever frequently occur.
• The disease begins with an intensely pruritic, papular eruption, usually in the
interdigital spaces.5
•
2. RETURN to large group for reports. Have each group SHARE their work with the
other participants. Discuss each group’s work. Are the translations by different
groups similar? What are the values of the words they have chosen?
3. ASK: “What important points can we identify?’’
Write the points on newsprint and post them on a wall.
Possible answers include:
— We can find simple words to say what we need to say
— It is not easy to talk simply.
— Translations can be misleading.
— Not every piece of information needs to be translated or simplified.
— If the message is not simple, it may not be understood.
*
<;r
j?r. +-■
5Sets I, II, and III are reprinted by permission and adapted from The American Academy of Pediatrics
Report of the Committee on Infectious Diseases, Red Book, Elk Grove Village, Illinois, 1986
50
Session 15
Part III
Sentences to be translated: MAKE ONE COPY PER THREE PARTICIPANTS
CUT THE SETS APART BEFORE DISTRIBUTING
Set I:
The most common presentation is nonspecific febrile illness.
• Enteroviruses are spread by fecal-oral, and possibly, oral-oral or respiratory
routes.
• The primary disease is caused by inflammation and obstruction of the lymphatic
channels where the adult worms develop, usually 3 months to 1 year after
exposure.
• Infection in the newborn infant usually is in the eye, but it also may be
systemic; scalp abscesses and vaginitis have been described in neonates.
•
Prompt and effective treatment of acute and chronic cases is an important
adjunct to malaria control.
Session 15
Part III
Set II:
A chronic carrier state with possible chronic liver disease may result from
infection.
• Inapparent or asymptomatic infection is most common and recognized by
serologic and skin-test conversion.
• The infection is acquired through inhalation of airborne spores.
• Splenomegaly, lymphadenopathy, and skin changes consisting of darkly
pigmented, erythematous areas and other hypopigmented areas may be present.
•
•
Pertussis begins with mild, upper respiratory tract symptoms with cough
(catarrhal stage) and progresses to severe paroxysms of cough and the
characteristic inspiratory whoop often followed by vomiting.
Session 15
Part III
Set III:
• Transmission of tuberculosis is usually by inhalation of respiratory droplets
produced by an adult with infectious pulmonary tuberculosis.
• It is an acute, highly communicable viral disease with prodromal fever,
conjunctivitis, coryza, cough and Koplik spots on the buccal mucosa.
• The most common described anomalies associated with congenital rubella are
ophthalmologic, cardiac, auditory, and neurologic.
• The most common infection is gastroenteritis, in which diarrhea, abdominal
cramps and tenderness and fever frequently occur.
• The disease begins with an intensely pruritic, papular eruption, usually in the
interdigital spaces.
51
Part III
Session 16
Discussion Starters
Background for the Facilitator: Session 16
It is often effective to start a discussion about a problem by getting a group such as
clinic patients or community participants'to focus on it using their senses. The goal is
to stimulate attention and thinking about the problem, through a visual image. In a
way, a “discussion starter’’ is like a mirror. When you hold it up for people to look
into, they see their problems reflected in it. Discussion starters may take various
forms. Pictures or photographs, dramas, songs, and puppet shows are some examples.
Stories may be used as well, if they present the problem, rather than a solution. Most
visual aids used in health education show the solution we are recommending, rather
than the problem that needs to be solved. Discussion starters reintroduce problems
people face and stimulate discussion and thinking.
These activities have been designed to help the participants learn to:
• Create discussion starters for use in group discussions
• Distinguish between a discussion starter and other health education visual aids
52
Session 16
Part III
Session 16
Using Discussion Starters
Purpose: To help health workers experience the use of a discussion starter for group
discussions
Method: Demonstration
Materials: [7] Picture of a child with a health problem (facilitator’s choice)
Preparations:
LOCATE a picture of a child with a health problem
0 PREPARE a written description of the same problem
Learning Activities
Time: 15 minutes
1. DESCRIBE the problem in the picture you have without showing it to the group.
For example, “I want to tell you about a child who had. .
(the common disease
in your area which you have chosen). “He was very sick and miserable and it was
sad to see him. I wouldn’t want to be his mother and see him suffer.’’
ASK: • Has anyone seen this problem before?
• What was it like?
• What happened?
• What caused it?
2. For the group, HOLD up the picture of a child with. . . (the same disease as
above).
ASK: • Has anyone seen this problem before?
• What was it like?
• What happened?
• What caused it?
3. REMOVE the visual aid from view. ASK the participants:
• Did you feel the problem more when I described it or when you saw the
picture?
• Why?
• Which was the more effective discussion starter?
Talking about or describing a problem is usually less effective than seeing it.
53
Session 17
Part III
Session 17
Discussion Starter or Teaching Aid?
Purpose: To distinguish between discussion starters and teaching aids and to clarify
the appropriate use of each
Methods: Demonstration and brief lecture
Materials: [7] Picture of a child with marasmus
0 Poster showing food groups (nutrition poster)
Preparation: [7] GET poster and picture materials ready
[7| REVIEW points to be presented below
Learning Activities
Time: 45 minutes
1. SHOW illustration A (picture of a child with marasmus).
ASK: • What is it?
• What do you see?
• Has anyone seen or experienced this problem before?
• What was it like?
• What happened?
• What caused it?
REMOVE the picture from view.
2. SHOW illustration B (Poster showing basic four food groups).
ASK: • What is it?
• What do you see?
• Has anyone seen or experienced this problem before?
• What was it like?
• What happened?
• What caused it?
3. REMOVE the pictures from view and ask:
• How was the first illustration (A) different from the second (B)?
• Are both pictures a good way to start a discussion?
• What is the best use of the second illustration?
Teaching aids seldom make good discussion starters.
4. PRESENT the following points:
• A picture is one way to “show” a problem. What value is there in
“showing” the problem to a group?
— it helps to get a common focus for discussion
— it stimulates people to think about or express feelings about the
problem
— it is a good way to start the discussion, with everyone thinking about
it together
54
Part III
Session 17
•
Discussion starters are used to reflect a problem:
— people talk and think about this problem from past experiences
— you know it is a problem for them
— the picture reflects the problem so together people look at it in a new way,
think about it, and discuss the problem
• There are other and sometimes better discussion starters - what other things
might you do?
— drama, song, puppets, and so on
— with individual clients in the clinic, the client or the child (s)he brings is
usually the most effective discussion starter - especially when immediate care
or action is needed
• How is a discussion starter different from teaching aids you have used in the
past?
— it illustrates only the problem while most health education visual aids
illustrate a solution
— it is like a mirror - people look in and see their problem
— it allows them to begin to analyze the problem
•
Discussion starters may be easy to make:
— how can you be sure that people see the problem you are trying to show
them?
— using them effectively depends upon another skill, “asking” good questions
•
Discussion starters are useless without questions to help people reflect on the
situation presented and identify it as one of their problems.
• Discussion starters are most useful when you are working with groups.
55
Session 18
Part III
Session 18
Homework
Purpose: To provide an opportunity for participants to create discussion starters
Preparation: [7| MAKE copies of the “Instructions for Homework”
[7] GIVE this assignment at the end of the day
0 USE it on the following day in Session 19
Note to the Facilitator: Session 18
The participants should create their own discussion starters for the following day. If
the workshop is residential, participants may want to work in area groups. If not, each
participant may need to work alone.
Give out the instructions and review them with the participants to be sure the
assignment is clear. Discuss whether they will work individually or in groups of not
more than four persons.
Instructions for Homework
By tomorrow, create a discussion starter for one of the following problems in children:
— diarrhea
— measles, polio, TB, tetanus (immunizable diseases)
— malaria
— acute respiratory infection (ARI)
— malnutrition
You may work individually or as a group. Your discussion starter can be:
— a role play
— a song
— a story
— a picture
— a description
— or other
Remember:
A discussion starter shows the PROBLEM, not the solution.
56
Part III
Session 18
Homework handout directions: MAKE ONE COPY PER PARTICIPANT
CUT IN HALF AND DISTRIBUTE
Instructions for Homework
By tomorrow, create a discussion starter for one of the following problems in children:
—diarrhea
—measles, polio, TB, tetanus (immunizable diseases)
—malaria
—acute respiratory infection (ARI)
—malnutrition
You may work individually or as a group. Your discussion starter can be:
—a role play
—a song
—a story
—a picture
—a description
—or other
Remember:
A discussion starter shows the PROBLEM, not the solution.
Part III
Session 18
Instructions for Homework
By tomorrow, create a discussion starter for one of the following problems in children:
—diarrhea
—measles, polio, TB, tetanus (immunizable diseases)
—malaria
—acute respiratory infection (ARI)
—malnutrition
You may work individually or as a group. Your discussion starter can be:
—a role play
—a song
—a story
—a picture
—a description
—or other
Remember:
A discussion starter shows the PROBLEM, not the solution.
57
Part III
Session 19
Asking Questions And Listening
Note to the Facilitator: Sessions 19, 20 and 21
Discussion starters are very useful because they help the group focus their attention on
specific problems. A good discussion is a teaching-and-learning event - everyone
should learn something while teaching others. But the discussion must be stimulated
and guided to keep it focused.
To facilitate good discussions, the participants must learn to:
• Make up questions that stimulate discussion
• Introduce information that provides a learning base
Participants must also listen effectively to understand other people’s points of view,
beliefs, and the rationale for their actions, or lack of actions. These are important to
the health worker to improve communications. Listening allows health workers to
understand what people know, believe, and practice. They can begin to share
information in a way that makes sense and is usable.
For the health worker’s purposes, questioning and listening skills have a counterpart in
clinical practice. We can compare these skills to the competent use of a stethoscope.
The question, like a stethoscope, is useful only if we listen well to the responses and
learn from what we hear. Once we understand the people, we can better choose health
information and plan to share it effectively.
The following activities are designed to help participants begin to develop skills in:
• Make up questions
• Listening effectively to the answers
• Evaluating whether the questions stimulate discussion
“The question, like a stethoscope is useful only if we listen to the
responses and learn from what we hear.”
58
Part III
Session 19
Session 19
How is a Stethoscope Like a Question?
Purpose: To focus attention on the function of a question and the value of listening
Methods: Demonstration and discussion
Materials: [7] Stethoscope
[7] Newsprint and markers
[7] Table and two chairs
Preparations: [7] PLACE the table and chairs to be ready for a consultation
Learning Activities
Time: 45 minutes
1. REQUEST a volunteer (a health worker with assessment skills) to join you.
PLACE the stethoscope on the table. EXPLAIN to the volunteer that you have
been coughing for a week. If the health worker asks questions, state that your
sputum is yellow and smelling. You have trouble breathing when you lie down and
you have pain in your chest. Ask him or her to assess your problem. If (s)he does
not use the stethoscope, encourage it.
2. ASK: “What are the skills(participant’s name) used to learn
about the problem?” LIST them on the flip chart.
• If the health worker asked questions, be sure they are noted
• If (s)he listened with the stethoscope and to your responses, be sure to make
note of it
3. Questions for discussion:
• How is a question like a stethoscope?
— it is a tool for listening to very specific things
— you put a stethoscope over the heart to listen to it beat, over the lobes of the
lungs to listen for crepes or wheezing, over an artery to listen for blood
pressure, or over the lower abdomen to listen for bowel sounds
— you place the stethoscope in a way that you can listen for specific information
• Both the stethoscope and questions require skill on the part of the user
• Just as you learned to use a stethoscope, you must learn to ask good questions
• Good questions:
— sincerely seek for information
— do not have correct or obvious answers
— are open-ended allowing the maximum response
• If you have a stethoscope, but do not use it to listen and learn about the
condition of the heart or intestines or take a blood pressure, what good is it?
• If you ask questions, but do not listen to what people think, know, believe and
feel, and learn from their answers, what good are the questions?
59
Session 19
Part III
Summary: How is the stethoscope like a question?
The answers should include:
— The stethoscope allows you to listen
— Questions also allow you to listen
— When you use a stethoscope, you are trying to understand your patient's problem
— Questions can help everyone in a group learn from each other about what they
believe, their experiences, and what they do when there is a problem
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60
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Session 20
Part III
Session 20
Formulating Questions
Purpose: To learn to identify effective questions that provide useful information
Method: Small group work
Materials: [7] Newsprint and markers
Preparations: [7] PLAN how groups should be formed for this activity based on
whether the homework (Session 18) was done by individuals or
groups — KEEP groups together!
[7] USE one sheet of newsprint per group and draw a line down the
center
[7] WRITE ‘‘Question” on the top left and WRITE “What will you
learn?” on the top right. Example:
Question
Learning Activities
What will you learn?
Time: 1 hour 30 minutes
1. ASK the participants to form groups of four to five persons, making sure
homework groups are together.
2. DISTRIBUTE and READ the directions for group work. ASK each group to:
• Choose a discussion starter that one or more group member(s) prepared as their
homework assignment
• Present it to the group and study it:
— “imagine” you are meeting with a group of mothers in the clinic to discuss
the problem shown in the discussion starter
• Discuss as a group what questions you can ask to help the mothers and you
learn from each other about:
— what people have experienced
— know
— believe
— do
• Working on the piece of newsprint with a line drawn down the middle, write
your questions on the left
• Be sure to number the questions
• Once you have written a question, identify what you expect to learn from the
answers for each question by writing the answer on right side of the paper.
61
Session 20
•
Part III
Consider:
— will these questions stimulate a group discussion among the mothers?
— are there more or different questions encouraging mothers to participate?
— make any changes you wish
3. REQUEST the groups to present their work after reassembling. ENCOURAGE
discussion. On a fresh sheet of newsprint, MAKE a list of useful questions to start
a health problem discussion.
Post the list on a wall in the meeting room.
I
I
(
l
I
I
I
62
Session 20
Part III
Directions for making up questions:
MAKE ONE COPY PER PARTICIPANT
Directions for Group Work
1. Choose a discussion starter that one or more group member(s) made as their
Session 18 homework assignment.
2. Present it to the group and study it.
3. Imagine you are meeting with a group of mothers in the clinic to discuss the
problem shown in the discussion starter.
4. Discuss as a group, what questions you can ask to help the mothers and you learn
from each other about:
— what people have experienced
— know
— believe
— do
5. Working on the piece of newsprint with a line drawn down the middle, write your
questions on the left.
6. Be sure to number the questions.
7. Once you have written a question, identify what you expect to learn from the
answers to each question by writing the answer on the right side of the paper.
8. Consider:
— will these questions stimulate a group discussion among the mothers?
— are there more or different questions encouraging the mothers to participate?
9. Make any changes you wish.
63
Part III
Session 21
Session 21
Listening?
Purpose: To establish the value of listening, the need for quiet people to speak up,
and the need for dominant people to be sensitive to others
Methods: Role play and discussion
Materials: 0 Newsprint, markers
Preparations: 0 READ carefully through this activity
0 IDENTIFY six volunteers to act in the following three scenes
0 MEET with the volunteers during a short break to read through
their roles and practice once
Learning Activities6
Time: 45 minutes
1. INVITE six people to prepare a short play in three scenes. It is usually better to
have all women or all men acting as this avoids people saying, “men always do
this” or “women always do that.”
Scene 1: Two people meet. One of them starts to talk and gets so excited and
involved in what (s)he is saying that (s)he pays no attention to the other. The other
tries several times to speak, to ask a question, respond or make a suggestion, but
the first person talks on, so the second person remains silent and gives up trying.
Decide on a topic beforehand.
Scene 2: Two people meet and both start telling the other what they are
concerned about. They each have a different topic. Neither is listening to the other,
and both are talking at the same time.
Scene 3: Two people meet, greet each other, and start a real dialogue. Each one
asks questions about the other’s interests, listens and responds to the other person’s
answers and shares their own news and opinions. A common topic should be
decided on beforehand.
2. PRESENT the plays in order. STOP each play when the point has been made.
Usually the first two plays take 1-2 minutes and the third takes a little longer.
3. LEAD a discussion, writing main points on the flip chart. When discussing Part 3,
be sure to list all the points and post it as the group’s “Guidelines for Good
Communication.” The questions:
Part 1:
• What did you see happening in Scene 1?
• What did you see happening in Scene 2?
• What did you see happening in Scene 3?
6Reprinted by persmission and adapted from Training for Transformation: A Handbook for Community
Workers, by Anne Hope and Sally Timmel, Mambo Press, Gweru, Zimbabwe, 1991.
64
Part III
Session 21
Part 2:
• Do these things happen in real life? How?
Part 3:
• What can we do to help make communication as good as possible in health
education sessions?
• Make a list of the group’s “Guidelines for Good Communications.”
65
Part III
Session 21
Directions for acting groups: MAKE ONE COPY
CUT SCENES APART AND GIVE EACH TEAM THEIR ASSIGNMENT
Scene 1:
Two people meet. One of them starts to talk and gets so excited and involved in what
(s)he is saying that (s)he pays no attention to the other. The other tries several times to
speak, to ask a question, respond or make a suggestion, but the first person talks on,
so the second person remains silent and gives up trying. Decide on a topic beforehand.
Session 21
Part III
Scene 2:
Two people meet and both start telling the other what they are concerned about. They
each have a different topic. Neither is listening to the other, and both are talking at the
same time. Decide on the topics beforehand.
Session 21
Part III
Scene 3:
Two people meet, greet each other, and start a real dialogue. Each one asks questions
about the other’s interests, listens and responds to the other person’s answers and
shares their own news and opinions. A common topic should be decided on
beforehand.
66
Part III
Session 22
Assessing Learning After Interaction
Note for the Facilitator: Session 22
If a session between a health worker and a patient or group is successful, each person
should learn from it. Health workers understand the idea that they “teach,” but most
are less aware that they can or should “learn” each time they provide health education
activities. Therefore, the participants must be conscious of what they have learned.
The need to find out or evaluate what the patient or group learns is not new. Learning
how to do it might be. The following session is designed to help participants identify
ways to assess learning.
67
Part III
Session 22
Session 22
What was Learned?
Purpose: To identify ways to assess what is learned
Method: Group work
Materials: 0 Newsprint and marking pens
[7] Sheets of writing paper for note-taking
13 Instructions for the role play
Preparations: [3 IDENTIFY two participants to give a role play and brief them
3 REPRODUCE instructions for the “Role Players” and the “Group
Assignment”
Learning Activities
Time: 1 hour 45 minutes
1. BEGIN with a role play of an individual patient education session. One participant
should be the health worker, the other the patient. ASK them to make the session
as good as possible from their point of view. MAKE it realistic, however. It should
not take a long time, since they would not have much time in their own work
setting. The play should deal with a problem presented by the patient and the
solution or advice should be given by the health worker. TAKE just five minutes to
plan it.
ASK the other participants to observe closely and take notes during the
presentation. Have them note:
— what is the health worker learning?
— what is the patient learning?
2. When the role play has finished:
ASK the person who played the health worker what (s)he learned from the patient.
ASK the person who played the patient to identify what (s)he learned during the
session.
FACILITATOR: WRITE THE RESPONSES ON NEWSPRINT AND
HAVE THE PARTICIPANTS WRITE THEM DOWN.
3. DIVIDE the participants into appropriate group sizes and ask them to work in
separate places (at separate ends of the room or in separate rooms, if space
permits). The following activities should take place in each group:
a) Review what the health worker learned from the patient.
b) Add additional things they felt the health worker learned based on the group’s
notes.
c) Review what the patient learned from the session.
d) Add additional things the patient learned based on the group’s notes.
e) Discuss whether it is important for the health worker to know what the patient
has learned? Why? If the answer is “yes,” what questions could the health
worker ask the patient, to find out what (s)he has learned? MAKE a list.
68
Part III
Session 22
4. Bring the groups together and ask one person from each group to share the
answers to (b), (d), and (e). Record the points from (e) on a fresh sheet of
newsprint with a title such as “QUESTIONS THAT HELP TO ASSESS
LEARNING.”
69
Part III
Session 22
Role play directions: COPY AND CUT IN HALF
GIVE ONE COPY TO EACH PLAYER
Instructions for Role Players
Plan a role play of an individual patient education session. One person should be the
health worker, the other the patient. Make the session as good as possible, from your
own point of view, but make it realistic. It should not take a long time, since you
would not have much time in your own work setting. The play should deal with a
problem presented by the patient and the solution or advice should given by the health
worker. Take just five minutes to plan it.
I
I
I
i
Session 22
Part III
Instructions for Role Players
Plan a role play of an individual patient education session. One person should be the
health worker, the other the patient. Make the session as good as possible, from your
own point of view, but make it realistic. It should not take a long time, since you
would not have much time in your own work setting. The play should deal with a
problem presented by the patient and the solution or advice should given by the health
worker. Take just five minutes to plan it.
70
Session 22
Part III
Group Assignment directions: MAKE ONE COPY PER TWO PARTICIPANTS
CUT IN HALF AND DISTRIBUTE
Instructions for the Group Assignment
a. Review what the health worker learned from the patient.
b. Add additional things you feel the health worker learned from the group’s notes.
c. Review what the patient learned from the session.
d. Add additional things you feel the patient learned.
e. Discuss whether it is important for the health worker to know what the patient has
learned? Why? If the answer is “yes,” what questions could the health worker ask
the patient, to find out what (s)he has learned? Make a list.
Session 22
Part III
Instructions for the Group Assignment
a . Review what the health worker learned from the patient.
b. Add additional things you feel the health worker learned from the group’s notes.
c. Review what the patient learned from the session.
d. Add additional things you feel the patient learned.
e. Discuss whether it is important for the health worker to know what the patient has
learned? Why? If the answer is “yes,” what questions could the health worker ask
the patient, to find out what (s)he has learned? Make a list.
71
Part IV
Using Concepts and Skills to
Work with Individuals
An Individual Patient Education Process
Session 23
Part IV
Background for the Facilitator: Part IV
So far, the participants have examined ideas and concepts, learned new things from
their past experiences, and reviewed skills needed for effective communication. Now it
is time to begin using this information.
The following activities are designed to help the participants organize and use what
they have learned. Although the activities focus on what and when the patient, client,
or caretaker has learned, the health workers should realize they must learn from the
patient before they can teach effectively. Thus, the process is not only for the benefit
of the patient, but also for the health worker.
Health workers must learn from their patients before they can communicate.
The harvest is
starting. She should
know I don’t have
time to come here
every week. . .
It is important for
you to get
checked every
week from now
until the baby is
born.
y
o
75
Session 23
Part IV
Session 23
Identifying Steps in the Process
Purposes: To help participants make a clear goal for their health education activities
with individuals
To enable participants to design a process they can use for individual
patient education
Methods: Large group task
Materials: [7] Newsprint and marking pens
Learning Activities
Time: 1 hour
1. ASK participants this question: “What do you want to be able to achieve
with individual patients or caretakers regarding health education?” You may need
to explain that a caretaker is a person who accompanies a patient or client, such as
the mother of a child, an “auntie,” the father, a sister, or significant other person.
WRITE their goal on newsprint and post it.
The discussion should include comments about the patient or caretaker such as:
— does (s)he know what the disease or problem is?
— can describe how to give or take medicines and other treatment correctly at
home?
— can they spot danger signs or side effects?
— does know what to watch for and what to do iffound?
— does know when and where to return?
— does understand why returning is important and who s(he) is to see?
2. DESCRIBE the following task. DESIGN a model process to be used by any health
worker when offering individual patient education.
3. ASSIST the participants in developing their own process for working with
individuals. Begin thinking together from the time a patient arrives in the
examining room:
• What should happen first?
•
What should the health worker do or say?
•
What should happen next? What should the health worker do or say?
On newsprint, WRITE each action, question or statement.
76
Session 23
Part IV
Below is a list of skills for individual patient education. Use it as your resource to be
sure major steps are included. The list should serve only as a guide for the
facilitator.
Individual Patient and Caretaker Education Process Guide
• ASK - Ask questions
• LISTEN - Listen attentively to responses and answers to develop an
understanding of happened and what the person knows
EXAMINE - Examine the patient - look, listen, and feel
IDENTIFY - Identify essential points this patient or caretaker must know in
order to care for or prevent the problem - remember the importance of customs,
beliefs, and attitudes
• SELECT - Select short, simple ways to present these essential points
• DEMONSTRATE AND DESCRIBE - Demonstrate and describe what the patient
or caretaker needs to do
• EXPLAIN - Explain the actions and reasons why they should be done
•
•
• ASSESS - Assess the patient's understanding by asking appropriate questions,
or asking for a return demonstration
4. Have the participants identify concepts and skills they used in this process that
were discussed in previous sessions. WRITE them on newsprint.
77
Session 24
Part IV
Session 24
Does the Process Work?
Purpose: To check the effectiveness of the individual patient education process
developed in the previous session
Make adjustments where necessary
Methods: Role play and discussion
Materials: 0 Newsprint and marking pens
0 Props as identified by the groups to represent stations in the clinic
0 Patient record cards, paper and pens, one of each per participant
Preparations: 0 REPRODUCE the “Questions for Group Discussion” and
DECIDE how many volunteers should participate in the role play
0 MAKE one copy for each volunteer
Learning Activities
Time: 1 hour 30 minutes
1. ASK for volunteers to participate in a role play. There should be one volunteer to
play the part of each person working in an average clinic in your area, plus one
volunteer to play the patient or caretaker. TAKE them aside to plan their
presentation. GIVE them directions and about 10 minutes to prepare.
Directions:
Part I:
Choose a typical disease or illness seen in the health center. As a group, decide
the following details and write them on the “Patient Record” card.
— describe your patient by age, sex, address, and so forth
— what is the chief complaint or problem?
Part II:
•
•
•
Using the process you have just designed, role play the care that an individual
patient or caretaker will receive as (s)he passes through the facility
Begin with the moment the patient or caretaker enters the clinic:
— what does the patient do or say?
— what do the health workers do or say?
Be sure to cover all the activities in the process - remember you are seeing this
person in the clinic and your time is very limited
2. Present the role play
•
78
Session 24
Part IV
3. Have the participants break into groups to discuss the following:
•
Did the players use the process you designed?
• Did the process work?
• Was it possible to follow?
• Was it effective?
• Practical?
• What changes or adjustments may be needed in the process?
4. Let the groups come together and REPORT their answers to the above questions.
DISCUSS and make final adjustments to the process. WRITE the final version of
the process on newsprint. If possible, make copies for the participants to take back
to their work sites. If it is not possible, encourage the participants to make copies
of the process and keep it.
79
Session 24
Part IV
Directions for the volunteers: MAKE ONE COPY PER TWO VOLUNTEERS
CUT IN HALF AND DISTRIBUTE
Directions for Volunteers
1. Choose a typical disease or illness seen in the health center. As a group, decide the
following details and write them on the “Patient Record” card.
• Describe your patient by age, sex, address, and so forth
• What is the chief complaint or problem?
2. Using the process you have just designed, role play the care that an individual
patient or caretaker will receive as (s)he passes through the facility.
•
Begin with the moment the patient or caretaker enters the clinic
— what does the patient do or say?
— what do the health workers do or say?
•
Be sure to cover all the activities in the process - remember you are seeing this
person in the clinic and your time is very limited
Session 24
Part IV
Directions for Volunteers
1. Choose a typical disease or illness seen in the health center. As a group, decide the
following details and write them on the “Patient Record” card.
• Describe your patient by age, sex, address, and so forth
• What is the chief complaint or problem?
2. Using the process you have just designed, role play the care that an individual
patient or caretaker will receive as (s)he passes through the facility.
80
•
Begin with the moment the patient or caretaker enters the clinic
— what does the patient do or say?
— what do the health workers do or say?
•
Be sure to cover all the activities in the process - remember you are seeing this
person in the clinic and your time is very limited
Part IV
Session 24
Group Discussion Instructions: MAKE ONE COPY PER THREE PARTICIPANTS
CUT APART AND DISTRIBUTE
Questions for Group Discussion
1. Choose a person to take notes for your group. The notes will be presented when
the class reconvenes.
2. Answer the following questions about the role play you saw as part of this session:
• Did the players use the process you designed?
•
Did the process work? Was it possible to follow?
•
•
Was it effective? Practical?
What changes or adjustments may be needed in the process?
Session 24
Part IV
Questions for Group Discussion
1. Choose a person to take notes for your group. The notes will be presented when
the class reconvenes.
2. Answer the following questions about the role play you saw as part of this session:
•
•
Did the players use the process you designed?
Did the process work? Was it possible to follow?
•
•
Was it effective? Practical?
What changes or adjustments may be needed in the process?
Session 24
Part IV
Questions for Group Discussion
1. Choose a person to take notes for your group. The notes will be presented when
the class reconvenes.
2. Answer the following questions about the role play you saw as part of this session:
• Did the players use the process you designed?
• Did the process work? Was it possible to follow?
• Was it effective? Practical?
• What changes or adjustments may be needed in the process?
81
Part V
Using Concepts and Skills
to Work with Groups
A Group Process
Session 25
Part V
Background for the Facilitator: Part V
Just as it is possible to develop a process for individual patient education, it is possible
to design a process for working with groups. First, the participants should identify
their goal for health education with groups. What do they want to achieve? Then you
can role play a session helping them to identify steps, develop their own group
process, and try it.
Working With Groups
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85
Session 25
Part V
Session 25
Identifying Steps in the Group Process
Purpose: To identify a goal for health education when working with groups
To identify steps in the group process
Methods: Group discussion and role play
Materials: [7] Newsprint and markers
0 Script for the demonstration process
0 Doll baby
Preparations: 0 CHOOSE one facilitator to lead the role play
0 SELECT another facilitator to take notes on newsprint for the
group
0 READ the script and practice it before the session
0 ARRANGE chairs in a semi-circle
Learning Activities
Time: 30 minutes
1. ASK: “What do you want to be able to achieve with groups in health education?
Let us plan a goal.” LEAD the discussion. WRITE the goal on newsprint and post
it.
The goal statement may include:
— to create awareness of a problem
— to understand the cause(s) of a common problem
— to create awareness that a problem can be prevented or solved by doing
certain things
— to decide together how to remove the cause or solve a problem
2. PRESENT the model group session, involving everyone in the role play. The
facilitator, who has practiced his or her part, should play the role of the health
worker. The participants should play the people who come to the clinic for
services. Another facilitator should participate in the mini-dramas and take notes of
the proceedings on newsprint. The notes will help in the discussion to follow.
Model Group Session
Setting: The waiting room in an average clinic in your area
The Audience: People who have come to the clinic for services. Most are mothers
with “well babies”
The Problem: Malaria
Present the discussion starter. Two facilitators should perform the mini-drama.
86
Session 25
PartV
Discussion Starter
(Mini-Drama)
This brief drama was created by health workers in Nigeria.
A woman goes to visit a friend. The friend is holding a baby. The woman observes
that the mother is miserable. They speak.
Friend: “What is wrong with you? Why are you so unhappy?’’
Mother: “My child is very sick. She refuses to eat. The body is so hot, yet she is
shivering and vomiting. I don’t know what to do.’’
Friend: Touches the child with the back of the hand. “Oh! The body is really very
hot!”
Mother: Sounding very worried says, “What am I going to do?”
STOP THE PLAY!
Note to the Facilitator: Session 25
Can you see that if you were to continue, the friend would probably advise the mother
to go to the clinic? This would be providing a solution rather than just highlighting the
problem.
[X] Ask questions and listen. In this step, the leader must ask questions allowing
him or her to listen. On the left side of the “Questions to the Group’’ example
are questions to guide you. When practicing, put the questions in your own
words and think about additional questions to ask.
[3 On the right side of the “Questions to the Group’’ example are things that might
be learned when you listen. They are not intended to be part of what you
present, but rather a guide to help you evaluate what you are learning from the
group’s responses. You should learn much more than just the answers to these
“learning questions.’’
87
Session 25
PartV
Questions for the Group
What did you see in this play?
Listen to Learn
Did the drama show fever as
intended?
What was the problem with this child?
Is this a common experience for
mothers? Do people recognize it
quickly?
Has anyone seen or experienced this
problem before?
Is it their problem? Is it a common
problem? How do people look at it?
What has been their experience?
What was it like?
What have people experienced with
fever? How does malaria make
people feel? Does fever worry or
frighten people? Why?
What did you do?
What is the common action that
people take? Do mothers think first
about coming to the clinic for help?
About tepid sponge? Do they wait to
see if it will go away? What do
adults do?
What do you think causes it?
Do people realize malaria is
frequently the cause of fever? Do
they realize mosquitoes carry the
disease?
[X] Provide additional information. The information you provide will depend on what
you learned while listening. Try to “marry” the ideas brought by the group with
your knowledge of malaria. If there are gaps in the basic information, then share
information to fill the voids.
Be sure the information you give is accurate. For example, we know today that
Anopheles mosquitos cannot easily be controlled in Africa by just removing breeding
sites. Experts now believe that personal protection against mosquito bites is the best
preventive measure available.
Past advice of getting rid of breeding places has little impact because the mosquitos
can fly great distances to get human blood. Likewise, insect sprays and coils provide
only very temporary protection. Their effect ends long before the mosquitos leave.
88
Part V
Session 25
Some examples to help you begin are listed below:
EXAMPLE A: We see a lot of children with fever here in the clinic. Most of the
fevers are caused by malaria. To connect the fever to the mother’s
experience, you can say something like:
“Have any of you brought your child here with fever?”
“Did we give you some chloroquine - those bitter tablets to give your
child every day for three days?”
“What did you do for your child in addition to giving the medicine?”
EXAMPLE B: If some people in the group knew to give a tepid sponge bath for
fever, you may want to help the entire group understand when and
why to do this. Ask questions such as:
“When you realize your child has a fever, does it make you worry?
Why?”
“Is it good for the body to be hot?”
“How can you cool the body? What can you do?”
EXAMPLE C: To help people understand how to protect children from malaria,
discuss statements such as:
“Mosquitoes carry the malaria and give it to people. Mosquitoes are
our enemy.”
“Where do mosquitoes live?”
“They live in the house, hiding in dark places during the day and
feasting on people at night.”
“They live in tall grass, banana and papaya trees, and other moist
places.”
“In the evening when the sun is gone, they come out of hiding and
bite people.”
Work with the group to look for solutions. “How can we...?” is the most important
question.
Special Note to the Facilitator: Session 25
In a real group session, you should not look, listen, or provide ALL of this
information in one discussion. It takes time, probably several discussions, for people
to understand and value all of this information.
Solution Examples:
(A) Ask: “If no mosquitoes bite my baby, will he be likely to get malaria?”
Discuss the following ideas. Points to listen for and possibly share include:
“If you can keep mosquitoes from biting you, malaria will not trouble
you.”
“How can we protect ourselves from mosquitoes?” Some ways are:
— close windows and doors when the sun is going down
— put screens on all windows and doors
— be sure mosquitoes cannot fly in under the roof and get in the house
89
PartV
Session 25
— use mosquito nets over the beds of all people in the household,
especially beds where babies and young children sleep
— keep the body covered well, especially in the evenings
(B) Ask: “Is it possible for us to get rid of the mosquitoes?”
Points to listen for and possibly share in the discussion include:
— we have used insect sprays and mosquito coils, but these only work for
a very short time, soon the mosquitoes return
Protecting the body at night, so mosquitoes cannot bite is the best defense
against malaria.
END the session. REVIEW the most important things said in the discussion. Thank
everyone for participating and wish them freedom from malaria.
Special Note to the Facilitator: Session 25
Explain to the participants that the last step in the process is called “evaluation.” It is
critical to evaluate group learning and its impact on health in order to make health
communications work.
[X] Evaluate learning. But when, where, and how will this be possible? Evaluation
possibilities will depend on the topic itself. Brainstorm on possible ways, times,
and places to evaluate this session.
3. ASK the participants to review this session and identify the steps you took to learn
about group process. Remember, they will have their own ideas.
The basic steps should include:
Present the discussion starter
Ask questions and listen
Provide additional information
Work with the group to look for solutions
Evaluate learning
90
Session 26
PartV
Session 26
Practicing the Group Process
Purpose: To provide participants with an opportunity to try their group process
Method: Small working group
Materials [7] Newsprint and markers
Preparations: [7] MAKE copies of the group directions
Learning Activities
Time: 50 minutes
1. EXPLAIN that participants will be divided into groups of five or six persons. Each
group will IDENTIFY a problem related to a topic on the list. Group members
must CHOOSE who will lead the presentation. All others are members of the group
and should actively participate.
2. ASK the participants to MOVE into their groups. READ the directions to plan their
role play.
• Identify the problem related to one of the following topics:
— diarrhea
— immunizations
— malaria
— acute respiratory infection (ARI)
— infant nutrition
• Identify one person in your group to play the “health worker” and lead the
discussion
• Plan the presentation together - use the process
• Since all but the “health worker” are to play members of the group in the
clinic, you may plan some of your responses
• How long should your presentation take? Why?
Note to the Facilitator
If the group asks you for the “correct” answer, “10 minutes, ” or at most, “15
minutes,” is the intended response.
3. INVITE each group to present their role play.
4. DISCUSS:
• Does the process work?
• How can we improve it?
• Will you try it when you return to your work site?
Write important points or revisions in the process on newsprint and post.
91
Session 26
PartV
Directions: MAKE ONE COPY FOR EACH TWO PARTICIPANTS
CUT APART AND DISTRIBUTE
Group Directions:
Take 20 minutes to plan:
1. Identify the problem related to one of the following topics:
• diarrhea
•
•
•
immunizations
malaria
acute respiratory infection (ARI)
• infant nutrition
2. Identify one person in your group to play the “health worker’’ and lead the
discussion.
3. Plan the presentation together using the process. Since all but the “health worker’’
are to play members of the group in the clinic, you may plan some of your
responses, as well.
4. How long should your presentation take? Why?
Session 26
Part V
Group Directions:
Take 20 minutes to plan:
1. Identify the problem related to one of the following topics:
• diarrhea
• immunization
• malaria
•
acute respiratory infection (ARI)
• infant nutrition
2. Identify one person in your group to play the “health worker’’ and lead the
discussion.
3. Plan the presentation together using the process. Since all but the “health worker’’
are to play members of the group in the clinic, you may plan some of your
responses, as well.
4. How long should your presentation take? Why?
92
>•
Part VI
Setting Goals for the Work Place
Part VI
Session 27
Background for the Facilitator: Part VI
Participants will need to practice individual and group processes over a period of
several months to begin to learn how, as individuals, they can use them effectively.
Each person enjoys unique gifts and talents. But every person cannot be talented or
gifted in every skill. Very personal “styles” will be developed.
It is helpful for participants to think about how they work and what they want to
accomplish when they return to their work sites. Before the end of the workshop, each
participant should write a “Plan of Activities” they hope to accomplish before coming
to a follow-up meeting. In addition, each participant should take home a notebook or
copybook, specifically for making notes about his or her activities.
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Session 27
Part VI
Session 27
Writing Individual Work Plans
Purpose: To develop a “Back Home Action Plan”
Method: Individual work
Materials: 0 Notebooks, one for each participant
0 Copies of:
— “Record of Learning”
— “Planning Questionnaire”
0 Paste
0 Scissors
Preparations: 0 MAKE copies of the “Planning Questionnaire” and the “Record of
Learning”
0 CUT to size and PASTE them in the front of the participants’
notebooks
Time: 1 hour
Learning Activities
1. EXPLAIN the following to the participants:
• Everyone is invited to return for a follow-up meeting after (give the planned
time frame) to share their experiences and what they have learned about this
approach to health education
• Each participant should think about what will be possible to accomplish in
individual and group sessions before the follow-up meeting
• Everyone should plan to work with at least two individuals each week and keep
notes on the experience
• Participants should each try to do at least four group sessions and keep a record
of them before the follow-up meeting
2. PROVIDE a copy of the “Planning Questionnaire” and a notebook (with the
“Record of Learning” pasted inside) to each participant. ASK them to take 30
minutes to think about and answer the following questionnaire. Answers may be
written in the notebook or on paper if it is clipped into their notebook. It should be
kept as their permanent record.
Planning Questionnaire:
0 Before the follow-up session, how many individuals will you try to help
by using the process that was developed here?
0 What will you need to do to organize a group session when you return to
your working place?
0 What group(s) will you work with?
0 Where will you meet them?
0 When will you meet them?
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Session 27
Part VI
[x] How many sessions will you plan before the follow-up meeting?
[3 How will you decide the topics that will be discussed? Who will assist
you? (Remember the topics should be identified beforehand, so that you
can prepare discussion starters.)
13 What special resources will you need to be able to conduct the group
sessions?
3. To help the participants carefully look at and think critically about the previous
sessions, PASTE “Keeping a Record of Learning” inside the cover of the notebook
for a quick reference. They will learn from reviewing their individual and group
discussion sessions. ASK the participants to go over the questions with you.
EXPLAIN when they keep a record of their experiences, they should try to include
all relevant information. Is there additional information for record keeping? Make
additions to the list.
Keeping a Record of Learning
Individual Process:
1. What was the problem?
2. What questions did you ask?
3. What did you learn from the patient or caretaker?
4. What were the essential bits of information you received to help solve the
problem?
5. What were the conflicts or similarities in the customs, beliefs, or
practices?
6. What information did you give?
7. Was it possible to evaluate the person’s understanding? How did you
evaluate it? What did you find?
Group Process:
1. What problem did you choose to discuss?
2. Why did you choose this problem? Whose problem was it?
3. What was your discussion starter?
4. What questions did you ask?
5. What did you learn from the group?
6. What were the essential bits of information you shared to help people
solve the problem?
7. What was the solution identified by the group?
8. Did you evaluate? How? What did you find?
4. SCHEDULE the follow-up meeting to allow participants to share experiences and
learning. Set the date before the participants depart, if possible.
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Session 27
Part VI
Planning Questionnaire: MAKE ONE COPY FOR EACH PARTICIPANT
CUT APART AND DISTRIBUTE
Planning Questionnaire
1. Before the follow-up session, how many individuals will you try to help by using
the process developed here?
2. What will you need to organize a group session when you return to your working
place?
3. What group(s) will you work with?
4. Where will you meet them?
5. When will you meet them?
6. How many sessions will you plan before the follow-up meeting?
7. With whom and how will you decide the topics that will be discussed? Remember
to identify topics beforehand, so you can prepare “discussion starters?”
8. What special resources will you need to conduct group sessions?
Session 27
Part VI
Planning Questionnaire
1. Before the follow-up session, how many individuals will you try to help by using
the process developed here?
2. What will you need to organize a group session when you return to your working
place?
3. What group(s) will you work with?
4. Where will you meet them?
5. When will you meet them?
6. How many sessions will you plan before the follow-up meeting?
7. With whom and how will you decide the topics that will be discussed? Remember
to identify topics beforehand, so you can prepare “discussion starters?”
8. What special resources will you need to conduct group sessions?
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Part VI
Session 27
Keeping a Record of Learning: PASTE INTO A NOTEBOOK
MAKE ONE COPY PER PARTICIPANT
Keeping a Record of Learning
Individual Process:
1. What was the problem?
2. What questions did you ask?
3. What did you learn from the patient or caretaker?
4. What were the essential bits of information you had that could
help solve the problem?
5. What were the conflicts or similarities in customs, beliefs, or
practices?
6. What information did you give?
7. Was it possible to evaluate the person’s understanding?
How did you evaluate? What did you find?
Group Process:
1. What was the problem you chose to discuss?
2. Why did you choose this problem? (Whose problem was it?)
3. What was your discussion starter?
4. What questions did you ask?
5. What did you learn from the group?
6. What were the essential bits of information you shared to help
people to solve the problem?
7. What was the solution identified by the group?
8. Did you evaluate? How? What did you find?
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Annex
Facilitator Tips
Tips for the Facilitator
This workshop is designed for experienced health workers who would like to improve
their health communication skills. We imagine they find the old methods are not
terribly successful and they are uncomfortable using them. The workshop activities in
Communicating About Health provides an opportunity for health workers to
consider situations, examine their experiences, and invent new ways of helping people
to solve health-related problems.
Even though you may be an experienced facilitator, some general tips and information
on conducting workshops are included here as a refresher for you. This information
has been accumulated from the experience of people working in many countries.
Training or Facilitating?
This workshop has been designed as a teaching and learning session for facilitators and
participants. It is not a training exercise. What is the difference between training and
facilitating?
A trainer’s job is to provide well defined content to students to help them achieve
specific learning objectives. Most training is linked to a job the trainee is required to
do. The content is very precise. The trainer has little freedom to explore topics or
ideas. Questions asked by a trainer usually have specific, “correct” answers.
A facilitator’s job is to lead or guide a process for the purpose of helping a group
discuss and explore their own topic. The facilitator knows the direction in which the
group should move, but there are no specific objectives. Instead, each activity has a
purpose. The facilitator does not control the content. It is determined as the process
proceeds. The facilitator is not responsible for answers, but for asking questions which
stimulate the participants to reflect on their experiences.
This workshop requires you to function as a facilitator rather than as a trainer.
Organize the Workshop Community
In every community that operates smoothly, members have taken responsibility for
various functions. They work together, sharing beneficial group tasks and building a
sense of community. This applies to the workshop, too. Any of the suitable and
needed jobs listed below can be delegated to participants on the first day of the
workshop. If you use these ideas, your responsibility as facilitator is to:
•
•
Clearly explain each committee’s job
Ask for volunteers, then simply inform the members when work is needed
• Post a “list of committees”
After posting a list of committees near the registration table, ASK each participant to
sign up to serve on one of them. Committees can choose the person who will act as
their liaison with the facilitators.
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Facilitator Tips
Suggested Committees:
* The job of POSTING: To be in charge of all newsprint and other visual aids used
during the workshop. At the end of each session, the posting committee must be
responsible to place the written notes from the session on the wall of the meeting
room. The committee should decide how to use the space available to them.
} The job of gathering NEWS: To listen to radio or read newspapers for the
previous 24 hour period and give a summary to the entire group once each day.
This is useful if done when the workshop gets underway each day, to help stimulate
people.
» The job of SOCIAL WELFARE OR HOUSEKEEPING: To coordinate the
day-to-day services of the workshop, such as liaise with food service, schedule
adjustments, lodging, and other matters that can affect how the workshop runs. The
committee should make announcements or give messages at a regular time each
workshop day.
} The job of ENTERTAINMENT ORGANIZER: This is appropriate when the
workshop is residential. The organizers plan and provide entertainment when
workshop activities are finished for the day. Depending upon available resources,
the committee might coordinate athletic games, indoor games, trips to local places
of interest, group singing, and so forth.
> The job of PHYSICAL ARRANGEMENTS: To assist with the workshop space
arrangements. Participants can reduce the burden of workshop organizers greatly.
When special “props” are required, this committee can be sure they are in place. If
the meeting space must also be used for eating, they can be responsible for
rearranging chairs and tables to meet the needs. The facilitators must make sure the
committee knows what is required.
Committees are a very effective way to spread the responsibility of running a
workshop and creating a sense of community if the participants are clear about their
responsibilities and well informed when their contributions are needed.
Large Group Discussions
Discussion is a very useful learning tool, particularly when the group members have
experience related to the topic being discussed. In a lively discussion, each person’s
contribution provides stimulation to the others so that ideas and understandings can be
developed by all. Facilitators usually learn as much as anyone!
Sometimes a large group discussion is planned and intended, but participation is weak
or slow. This is frustrating for facilitators. When questions fail to stimulate discussion,
when they are not responded to or treated as if there were “correct answers,” or when
a discussion does not follow, it is easy to provide your own ideas as answers. Another
poor alternative is lecturing to be sure the topic is covered. Don’t!
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Annex
Slow Participation
Why is participation sometimes slow? Here are some common reasons for slow
responses or poor participation and suggestions for ways to improve discussion:
} Possible reason: Participants are shy or unsure or not used to participating groups.
Suggestion: People are often shy when they do not know the other people in a
discussion group. If the participants do not know each other, use an “introduction” or
“ice-breaker” exercise at the beginning of the workshop. See the section entitled
“Ice-Breakers.”
Suggestion: Facilitators can help the participants feel secure and at ease by following
the first rule of facilitating—Never “dump” on a response. If someone contributes a
foolish idea or says something you believe is incorrect, ask questions to promote
further group discussion to get at accurate information, but be careful not to
communicate feelings that the contributor was stupid or inadequate. Guard the
dignity of each participant.
} Possible reason: Participants lack experience working with the topic.
Suggestion: In such cases, discussion is not the appropriate method to use. People do
not learn from discussing something they are not familiar with. Since this workshop is
designed for health workers who have experience in health education, but are less than
satisfied with its effectiveness, the participants should have ideas and experiences to
share and discuss.
} Possible reason: Participants are not stimulated.
Suggestion: This often happens after a meal or when participants have been working
for a long period of time. After meals, try to plan for activities that require
participants to move around or actively participate. If the participants have been
working for a long time, take a two-minute exercise break. Have everyone stand up,
stretch, and move around.
} Possible Reason: The purpose is not clear to the participants.
Suggestion: Be sure the purpose of a discussion is very clear in your own mind.
Otherwise, the discussion may become confused or get off track and the intended
learning fails to take place. Each group discussion activity described in this “Guide
for Facilitators” includes a statement of purpose.
} Possible Reason: The participants cannot see each other clearly.
Suggestion: Be sure that each participant in a discussion group is able to see the face
of each other participant. See the section entitled “Room Arrangements.”
Participation By All
The facilitator should encourage all participants to contribute to the discussion. In
every group there are some people who will respond to every question and talk a lot,
some who contribute, and others who say very little or nothing. How can the talkative
be encouraged to listen more and the quiet to contribute more? This is a difficult
105
Annex
Facilitator Tips
problem, since you want both types of participants to be comfortable and feel valued.
One technique that may help is to ask the participants a question and have them share
their responses with their neighbor. Then ask for volunteers to share their neighbor’s
idea.
By the description of their task, facilitators will realize they should not dominate the
discussion with their own contributions. It is important to correct any incorrect
information shared with the group, but at the same time, the facilitator should not pass
judgement on the value of ideas. Good ideas will be recognized by the group and so
will bad ideas.
Questions
There are three types of questions commonly used in group discussions:
Closed: These questions call for a brief, accurate reply.
Example: What are the first three foods you encourage mothers to give their babies?
There may be a variety of foods, but each person should be able to respond very
specifically in a short time.
Open: These questions do not require specific or “correct’’ answers, but rather
opinions or experiences of people. For this reason, the responses take longer. Open
questions stimulate thinking and produce ideas. That makes them especially valuable
in a group discussion.
Some open questions that can help stimulate discussion:
• “Do you agree that...?’’
•
“Why do you think that...?”
• “What experiences have you had that cause you to believe...?”
Redirected: When a question comes to the facilitator, it can be redirected to the
group:
Examples:
•
“What do you think?”
•
•
“What is your experience with this?”
“How would you deal with this situation?”
Getting Organized for Small Group Work
The participants will move into various size groups during the workshop. The amount
of time it takes to do this will depend in part on the facilitator’s skill in thinking ahead
and giving directions. During the planning and preparation phase, the facilitators
should think about the way they will divide groups, where the groups will actually
meet, and so forth. Directions must be clearly and simply given when groups need to
meet.
Example: “Group One will meet in this room. Group Two will go to the library.
Group Three will meet in the office.’’
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Directions for Group Work
There are written instructions for group work in each activity. Be sure each person has
a copy before the discussion begins. Confusion is less likely if each person is familiar
with the instructions or questions.
Time
The estimated time needed for each activity is noted at the beginning. Your group may
take a bit more or less time. Facilitators should be very sensitive and watch for signs
that groups are finishing more quickly or need more time. Do they understand their
task, or are they bored? Visit each group from time to time to keep in touch with their
progress. If they are working too slowly, remind them of their time limit. If they are
working very fast, check to be sure they are fulfilling the intended activities.
Physical Arrangements
The physical arrangement of the workshop space should promote interaction between
the facilitators and the participants and also among participants.
The following “Room Arrangement” information is suggested in Training for
Transformation: A Handbook for Community Workers, by Anne Hope and Sally
Timmel:
• Research shows the arrangement of a room has a strong effect on the
participation in a discussion. Those who can see all the other faces are at an
advantage and those who cannot are at a disadvantage. If people are sitting in
straight rows, it is very unlikely a good discussion will develop between them,
because they cannot see faces. Most questions and comments will be directed to
those facing the group.
• Every effort should be made to enable the participants to sit in one circle where
everyone can see all faces. If the circle becomes so large that people cannot hear
each other, it is better to have two concentric circles, or horseshoe shaped
semi-circles, if there are wall charts.
•••••••
••••••••
POOR
BETTER
(for large groups only)
BEST
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Annex
Facilitator Tips
Group Size
The participants are to learn through their own past experience, especially by
discussing questions you pose. Discussions can take place in a large group, in smaller
groups, or between two participants. This information is also from Training for
Transformation; A Handbook for Community Workers, and is useful in determining the
appropriate size of a group for specific activities:
The majority of people find it difficult to speak in a big group of
strangers. Also there is usually not enough time for everyone to speak.
Therefore, if everyone is to participate actively, small groups are
essential.
The majority of people find it difficult to listen very attentively for long
periods. Therefore, talks should be short and people should be given an
opportunity to discuss a topic or issue in small groups.
We all remember much better what we have discovered and said ourselves than
what others have told us. Therefore, participants should be given questions leading
them to express all they have learned from their own experience first. This needs to be
done in small groups.
A resource person or facilitator can briefly sum up the points from each group and add
their own insights later, instead of taking a long time to tell people what they know.
Pairs are useful for:
— interviews
— intimate sharing
— practicing some skills (e.g. listening or feedback)
— a quick “buzz” with one’s neighbor to stir a passive, sleepy group into
action
Three’s are very useful for:
— getting everyone thinking and participating actively, as one can be passive
in a group of five but it is unlikely in a group of three
— testing out an idea one is hesitant to present to the full group
— If two people think it is worthwhile one might risk saying it to the whole
group
Four’s, Five’s and Six’s: Will add a bit more variety for sharing ideas and
insights. Four, five or six can be a good size for a planning team, a film
discussion group, or a more complex situation. However, the bigger the group
becomes, the longer the discussion and the decision making process.
Six to Twelve: This is a good size for sharing ideas when there is plenty of
time for the group, such as a regular study or discussion group. But at this
point, a group begins to need an appointed (or accepted) animator or leader.
All members should try to be sensitive to the needs of the group.
Thirty:A group this size can develop a community spirit in a 4-5 day
workshop. Most people will be able to participate actively in whole group
sessions. As the group gets bigger, however, this becomes more difficult. It
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Facilitator Tips
Annex
will be necessary with groups this size to break into smaller groups for
different purposes.
Rule of Thumb: The bigger a group, the more skillful leadership and definite
structure it needs for everyone to contribute freely and feel satisfaction during
the meeting.
Visual Aids
Since our goal is to stimulate reflection and encourage the participants to develop
specific understandings, the most useful visual aids are the ideas and information
generated during the discussions, written on newsprint (large paper or flip chart
paper). Use newsprint and marking pens liberally! Save all the written ideas and
information and post them on meeting room walls. (See the section entitled “Use of
Newsprint.”)
Ice-Breakers
If participants arrive at the workshop and do not know each other, it may be as if they
were covered in a layer of ice - they are not warm and friendly to fellow participants
and are hesitant to speak, because they do not know them. Ice-breakers are exercises
helping the participants and facilitators become acquainted with each other, therefore
promoting interaction and communication.
The ice-breaker suggested can be accomplished quickly. It will use only limited
workshop time. Other very excellent ice-breakers are described in Training for
Transformation: A Handbook for Community Workers, listed at the end of this section.
Ice-Breaker Exercise
1. Before the workshop begins, MAKE up a list of questions that will help
participants get to know each other. You might include:
“Who are you?”
Name? Age? Family particulars such as married or children?
• “Where are you from?” Present residence? Birthplace? Other background
information?
• “What do you do?” Present job assignment? Educational background? Attended
school where?
• “Qualifications?”
• “What part of your job is most interesting to you?”
• “Why are you here?”
2. GIVE each participant a sheet of paper with the questions at registration. You
might wish to have participants fill in their own information OR you may ask them
to find someone they do not know to learn about and “interview.”
•
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3. Ask participants to choose a person they do not know and either introduce
themselves OR interview this new person. Interviewing can be done during
registration, as the participants gather, or during the first tea break.
4. Once the participants meet one another, have “introductions” next on the agenda.
ASK each participant to introduce his or her new friend by sharing the answers to
the questions on the paper.
When participants have a good idea who their fellow participants are, they are
more likely to feel free to speak and participate.
Use of Newsprint
This section is adapted from Training for Transformation: A Handbook for Community
Workers. Recording on newsprint is another important skill and not as easy as it looks.
It is very helpful when the group needs a list of the main concerns, the agenda for a
meeting, or the main insights from an exercise. When people see their suggestions
written down they get a sense their contributions are taken seriously. This, in turn,
fosters a feeling of trust.
Since the writer has his or her back to the group most of the time, two people are
needed: one to encourage sharing group ideas and one to write. When using newsprint
one should:
• Try to summarize each contribution in a few words,
• Use, when possible, the key words of the participants so they recognize their
own contributions
• Avoid slowing the process by constantly asking what to write
• When people in the group start dictating to the writer, the main point may be
lost
A visual record is important to keep ideas and goals clear. Too much newsprint can
be a distraction. Sometimes it is best to limit what is written. For example only write
the practical suggestions for action, not every point discussed by a group.
The main purpose of newsprint is to keep a record that the group can use later.
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References
Annex
Suggested Resources for Facilitators
1. Training for Transformation, A Handbook for Community Workers, A. Hope, S.
Timmel and C. Hodzi, Mambo Press, Gweru, Zimbabwe, 1984. (Books 1-3)
Distributed by:
Mambo Press
P.O. Box 779
Gweru, Zimbabwe
2. Tools for Community Participation, A Manual for Training Trainers in
Participatory Techniques, Lyra Srinivasan, PROWWESS/UNDP, New York, 1990.
Distributed by:
PACT, Inc.
777 UN Plaza
New York, N.Y. 10017
3. Health Care Together, Training Exercises for Health Workers in Community
Based Programmes, edited by Mary P. Johnston and Susan B. Rifkin, Macmillan,
London, 1987.
Distributed by:
TALC
Box 49
St. Albans,
Herts AL1 4AX
United Kingdom
4. From the Field, Tested Participatory Activities for Trainers, compiled by
Catherine D. Crone and Carman St. John Hunter, World Education, New York, 1980.
5. Options for Educators, A monograph for Decision Makers on Alternative
Participatory Strategies, by Dr. Lyra Srinivasan, PACT Communications, New York,
1992.
PM21X5699029320
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