Unit (3): Health Counseling PDF

## Unit (3): Health Counseling ### Out Lines: - Introduction - Concepts of Counseling - General principles of counseling - Skills and characteristics of effective counselor - Visual aids and other tools for counseling - Steps of Counseling (GATHER) - Factors influencing counseling outcomes ### Obj...

## Unit (3): Health Counseling ### Out Lines: - Introduction - Concepts of Counseling - General principles of counseling - Skills and characteristics of effective counselor - Visual aids and other tools for counseling - Steps of Counseling (GATHER) - Factors influencing counseling outcomes ### Objectives At the end of this unit, the students will be able to: 1. Define Counseling 2. Enumerate the importance of Counseling. 3. Differentiate between four types of Counseling. 4. List principles of counseling 5. Enumerate the Characteristics of Effective counselor 6. List Stages of counseling 7. Enumerate fields that Counseling Address 8. Recall Steps of counseling 9. Discuss Factors influencing counseling outcomes ### Introduction Counseling is a relationship between a concerned person and a person with a need. This relationship is usually person-to-person, although sometimes it may involve more than two people. Counseling: An interactive process characterized by a unique relationship between the counselor and client that leads to change in one or more of the following areas: 1. Behavior. 2. Beliefs or emotional concerns relating to perceptions. 3. Level of emotional distress ### General principles of counseling These are the important principles and conditions necessary for effective counseling: - Privacy - finds a quiet place to talk. - Take sufficient time - Maintain confidentiality - Conduct the discussion in a helpful atmosphere. - Keep it simple - use words people can understand. - First things first - do not cause confusion by giving too much information. - Say it again - repeat the most important instructions again and again. - Use available visual aids like posters and flip charts, etc. ### Skills and characteristics of effective counselor The most important characteristics are: - Respect the dignity of others. - Respect the client's concerns and ideas. Be non-judgmental and open. - Show that you are being an active listener. - Be empathetic and caring - Be honest and sensitive ### Visual aids and other tools for counseling - Posters - Leaflets or fact sheets - Flip charts - Overhead projector and transparencies - Slide shows - Models (such as female pelvis, penis) - Chalk or whiteboards - Pictographs (picture leaflets - Songs, drama or poems - Real life examples, testimonies or case studies from women - Written notes to remind you of points to cover ### Steps of Counseling: The Gather approach GATHER is an acronym to help remember the 6 basic steps in the counseling process: - **G**reet the client - **G** - In the first case, give your full attention to your clients. - Greet them in a respectful manner and introduce yourself after offering seats. - Ask them how you can help them. - Tell them that you will not tell others what they say. - If the counseling is in a health institution, you have to explain what will happen during the visit, describing physical examinations and laboratory tests if necessary. - Conduct counseling in a place where no-one can overhear your conversation. - **A**sk the clients about themselves - Help them to talk about their needs, doubts, concerns and any questions they might have. - **T**ell them all about family planning methods - Tell them which methods are available. - Ask which methods interest them and what they know about the methods. - Briefly describe each method of interest and explain how it works, its advantages and disadvantages, possible side-effects. - **H**elp them to choose a method - To help them choose a method of contraception, ask them about their plans and family situation. If they are uncertain about the future, begin with the present situation. - Ask what the spouse/partner likes and wants to use. - Ask if there is anything they cannot understand, and repeat information when necessary. - When the chosen method is not safe for them, explain clearly why the method may not be appropriate and help them choose another method. - Check whether they have made a clear decision and specifically ask, "What method have you decided to use?" - **E**xplain how to use a method - After a method has been chosen, give supplies if appropriate. - If the method cannot be given immediately, explain how, when and where it will be provided. - Explain how to use the method. - Ask the client to repeat the instructions. - Describe any possible side-effects and warning signs, and tell them what to do if they occur. - Give them printed material about the method to take home if it is available. - Tell them when to come back for a follow-up visit and to come back sooner if they wish, or if side-effects or warning signs occur. - **R**- **up-Appoint a return visit for follow** - At the follow-up visit: - Ask the client if she is, or they are, still using the method, and whether there have been any problems. - Ask if there have been any side-effects. - Refer for treatment in the case of severe side-effects. - Ask the client if they have any questions. ### Factors influencing counseling outcomes These factors are divided into three broad categories. 1. **Factors related to counselor** Respecting the rights of the client is essential to the quality and continuity of counseling. Every client has the right to: - **Information** to learn about their reproductive health, contraception and abortion options. - **Access** to obtain services regardless of religion, ethnicity, age, and marital or economic status. - **Choice** to decide freely whether to use contraception and, if so, which method. - **Safety** to have a safe abortion and to practice safe, effective contraception. - **Privacy** to have a private environment during counseling and services. - **Confidentiality** to be assured that any personal information will remain confidential. - **Dignity** to be treated with courtesy, consideration and attentiveness. - **Comfort** to feel comfortable when receiving services. - **Continuity** to receive follow-up care and contraceptive services and supplies for as long as needed. - **Opinion** to express views on the services offered. 2. **Factors related to the client** - The client's level of knowledge and understanding may affect their choice. - What they choose to do may also be affected by the extent to which they trust and respect you. - Their personal situation may make it difficult for them to choose some methods, for example if their spouse or another family member has a different preference to them. 3. **External/programmatic factors** - Shortage, unavailability of health services. In most health facilities the space or room for the provision of family planning is integrated with other reproductive health programs. This can make it really difficult for you to find a place where privacy and confidentiality can be maintained. ## Unit (4): Educational strategies ### Health Education Methods and Materials ### Out Lines: - Health education methods - Common health education methods - Information Education Communication (IEC) materials / Health Learning Materials (HLMs) - Common Information Education Communication materials - Production of Information Education Communication materials ### Learning outcomes:- At the end of this unit, the students will be able to: - Define health education method - Differentiate between methods and materials - Describe common health education methods - Discuss common Information Education Communication materials - Identify steps of Information Education Communication production ### Health Education Methods Health education methods refer to ways through which messages are conveyed to achieve desired behavioural changes in a target audience. In health education it is not enough to decide what will be done; by whom and when, we also need to decide how it will be done (methods). ### Common health education methods #### Informal methods 1. Health talks 2. Lecture 3. Brainstorming 4. Group discussion 5. Buzz group discussion 6. Demonstration 7. Role playing 8. Drama 9. Case studies 10. Traditional media #### Formal methods 1. Conference 2. Workshop 3. Seminar 4. Panel discussion 5. Symposium #### Informal methods - **1- Health talks** - When talks are on health agenda we call it health talks. - It is the most natural way of communicating with people to share health knowledge and facts. - It can be conducted with one person or with a family or group of people or through mass communication. - **2. Lecture** - It is oral, simple, quick and traditional way of presentation of the subject matter. - Presents factual material in direct, logical manner - Economical - In most causes audience is passive - **Forms of lecture** - **1) Traditional lecture: Teacher is the only speaker.** - **2) Participatory lecture: Begins with learner brainstorming and use pause in between.** - **3) Feedback lecture: Mini lectures followed by small group discussion, it gives opportunity to manipulate lecture content.** - **4) Mediated lecture: Use of media such as films, slides along with traditional methods.** - **3. Group discussion** - It is collective thinking process to solve problems. - The participants have equal chance to express freely and exchange ideas - The subject of discussion is taken up and shared equally by all the members of the group. - Extremely useful in health education. #### Strengths: - Pools ideas and experiences from group - Effective after a presentation, film or experience that needs to be analyzed - Allows everyone to participate in an active process #### Limitations: - Not practical with more than 20 people - Few people can dominate - Others may not participate - Time consuming - **4. Buzz group** - A large group is divided into small group, of not more than 10 or 12 people in each small group and they have given a time to discuss the problem. - Then, the whole group is reconvened and the reporters of the small groups will report their findings and recommendation. - **5. Brainstorming** - Instead of discussing the problem at great length, the participants encouraged to make a list in a short period of time all the ideas that come to their mind regarding the problems without discussing among themselves. - Is a means of eliciting from the participants their ideas and solution on health issues. #### Strengths: - Allows creative thinking for new ideas - Encourages full participation because all ideas equally recorded - Draws on group's knowledge and experience #### Limitations: - If not facilitated well, criticism and evaluation may occur - **6. Demonstration** - Showing how is better than telling how. - Although basically focuses on practice/skill it involves theoretical teaching as well. - If I hear, I forget If I see, I remember If I do, I know #### Note that: - You remember 20% of what you hear - You remember 50% of what you hear and see - You remember 90% of what you hear, see and do and with repetition close to 100% is remembered. - Demonstration can be used with individuals and small groups. - If the group is too large, members will not get a chance to practice the skills and ask questions. - **7. play-Role** - A type of drama in a simplified manner. It portrays expected behavior of people. - A role-play is a spontaneous and/or unrehearsed acting out of real-life situations. A script is not necessary - It is a very direct way of learning; you are given a role or character and have to think and speak immediately without detailed planning. - Few minutes for instruction and 5-10 minutes for them to plan & think - A role play should last about 20 minutes. - minutes for discussion 30-Allow another 20 - People can better understand their problem and the behavior associated with the problem. - **8. Drama** - Drama is a presentation, in which the subject matter or topic is studied well either written or in words, and then presented in educative and recreating manner. - Needs detail planning and script development. - Audiences identify with characters and settings - In a serial drama, for example, if the characters and settings are familiar to audiences, they can identify with the situations, and feelings of the characters. - Drama is very effective in behaviour change communication - Many dramas portray positive, negative, and transitional role models. - **Positive characters:** model healthy values and behavior, and they are rewarded. - **Negative characters:** model unhealthy behavior and antisocial values, and they suffer as a result. - **Transitional characters:** representing the audience, are uncertain at first about which behavior to adopt. - **9. Case study** - Case Study: is an in-depth analysis of real or simulated problems that help audiences to identify problems and suggest solutions according to their own contexts. - **10. Traditional media** - Traditional media as - Poems - Songs - Games - Stories - Traditional Medias are useful for the following reasons:- - They are realistic and based on the daily lives of local people - They can communicate attitudes, beliefs, values and feelings in powerful ways. - They can motivate people to change behavior. - They can show ways to solve problems. - Usually they are very interesting. ### Selection methods for health education Consider the following things before choosing health education method:- 1. How ready and able are people to change? - Usually they are very interesting. 2. Your ‘learning’ objectives 3. How many people are involved? 4. Is the method appropriate to the local culture? 5. What resources are available? 6. What mixture of methods is needed? 7. Subject matter (topic or problem) 8. Limitations of time 9. What methods fit the characteristics of the target group? #### Note that: - It is important thing to remember that effective health education is seldom achieved through the use of one method alone. ### Formal methods (Scientific methods):- - **1. Conference** - Conference refers to meeting for lectures of discussion where representative of various stakeholders participate. - Conference has a far broader spectrum of meaning than the other three (seminar, workshop, and symposium). - Not limited to academic activities only; beyond academic where many diverse participants participate - **2. Workshop** - It is a period of discussion and practical work on a particular subject in which a group of people share their knowledge and experiences. - It is a series of educational and work sessions (where thaifual work is done). - Small groups of people meet together over a short period of time to concentrate on a defined area of concern. - It also means a group working together, on a creative project, discussing a topic, or studying a subject. - Workshops tend to be more intense than seminars. - **3. Seminar** - A seminar is a lecture or presentation delivered to an audience on a particular topic or set of topics that are educational in nature. - Seminars are educational events - It is usually held for groups of 10-50 individuals for about an hour though usually not in practice. - **4. Symposium** - Is typically a more formal or academic gathering, featuring multiple experts delivering short presentations on a particular topic. - It is an academic in nature where experts (academicians) present their views on a particular theme. - **5:Panel discussion** - It is a meeting where experts (two or more) are invited to make short presentation or speak on different aspect of the same subject area or theme. - For example, mental health in Egypt. - Expert1: history of mental health in Egypt - Exeprt2: Mental health and health policy ☐ Expert3: - Future of mental health - ### Health Learning materials / Information Education communication materials: They are teaching aids which give information and instruction about health specifically directed to a clearly defined group of audience. ### Role of IEC materials in behaviour change communication - Speak to the people without the presence of communicator. - It serves as transferring of health message or acts as channel to carry a message to target audiences. - Enhance the understanding, the credibility and the believability of health message. - Remind the public the message they can received from different sources. - Motivate the public to seek for further information. - Some IEC materials serve as means of delivering health message on very sensitive issues. leaflets For example ### There are four types of health learning materials: 1. Printed HLMs 2. Visual HLMs 3. Audio HLMs 4. visual HLMs-Audio ### 1. Printed health learning materials - It is the production of multiple copies of an original image usually using ink pressed on to paper. - It involves the exchange of facts, ideas, and opinions through a written instrument/materials. - It can be used as a medium in its own right or as support for other kinds of media. ### Example of print IEC materials 1. Poster 2. Flipcharts 3. Leaflets 4. Booklets 5. Cards 6. News paper etc.. - **1- Poster** - Poster is a large sheet of paper ranging in size from large bill boards to small notices. - But often it has a size of 40cm wide and 60cm high. - A poster consists of; words and pictures or symbols that include a message on it. #### Content of poster - All words in a poster should be in language the community understand or in two languages. - The words should be few and simple to understand slogan -contain a maximum of 7 words. - Put only one idea on a poster. - The poster should encourage practice action oriented. - It is better to use life picture if possible - Posters should contain the following information: The year of publication The place - The sponsoring organization #### Purpose of posters - To reinforce/remind a message the public is receiving through other channels. - To give information and advice. e.g. learn more about malaria! - To give directions and instructions for actions. e.g. poster about malaria prevention methods. - To announce important events and programs. e.g. World Malaria Day. #### Poster storage and utilization - Store poster in safe place - Post them in a place where many people can see them when passing by (e.g. market places, meeting halls, etc.) - Ask permission before putting poster on a house or building. - **2- Flip charts** - They are a series of pictures that are bound together, usually at the top, and can be turned over by the educator. - A flip chart is made up of a number of posters on a related subject that are shown one after the other. - Are good to present several steps or aspects of a central topic. #### :Purpose - To give information and instructions content - There should be a single separate idea on a chart. - The arrangement should follow a logical order. - Five is a good number of charts to put in a flip chart - **3. Leaflets** - Leaflet or flyer is usually a short, often urgent, written message printed on just one side of single a standard weight paper. - Once there are more than five sheets it is common to use the term 'stelkoob - **Brochure** - Brochure is a modified leaflet - It is still a single sheet of paper but it's longer, folded up in ½ or 1/3 and printed on both sides. - It can explain things in more detail. It is useful for long-term use and is less likely to be thrown away. - We can fit more material into a brochure. - Leaflet and brochures are the most common way of using print media in health education. #### Purpose of flyers and brochures - They are useful reinforcement for individual and group sessions - Serve as a reminder of the main points that you have made. - They are also helpful for sensitive subjects. - Can provide people with enough basic information to encourage them to ask for more. #### Leaflet/brochures... - The content of the leaflet/brochures should **CARE** - **C** clear - have something to say and say it - **A** accurate - aim at precise - **R** make it readable - use familiar words, and active verbs - **E** have empathy - never forget that you are writing for another person - **2. Visual health learning materials** - Include something seen, for example models, real objects, and photographs. - Written words are not included under visuals. - Visuals are one of the strongest methods of communicating messages, especially where literacy status is low. - **Real objects** - mean things that are real. If your display is on 'family planning methods', you would display real IUDs, pills, condoms, diaphragms, and foams. - **Models** - Models are three dimensional objects which look like the real objects. - Models might be used for 3 reasons: - If the real objects are not available - If the real object is too big to display. - If the real object is too small to be seen easily. - **3. Audio Health Learning Materials** - Includes anything heard such as spoken word, health talk, music, sound, etc. - Radio and audio cassettes are common audio aids. - They are easily forgotten - Radio is a very powerful tool because no other mass media reaches more people than radio. - Radio can reinforce the advice that people receive through other channels. - **4. Audio visual Health Learning Materials** - Audio visuals are multi-sensory materials- combine both seeing and listening - They convey messages with high motivational appeals. - It show real life situation - These materials include TV, projected materials, and films or videos. ### Material production of IEC The success and impact of IEC materials depends largely on the understanding of the target audience including their characteristics, nature of the problem, stage of behavior change, barriers to behavior change and key influencers. ### Characteristic of effective IEC materials - Address real needs and problems facing the target audience. - Suitable for the audience characteristics. - Credible, believable and have solid information foundation. - Create a distinct look and appealing personality. - Stress the most compelling benefit. - Should be designed to appealdes both the heart or emotions, and the head or reason. - Should be attractive related to its color, design, size....ect. - Cost effective ### Steps in IEC materials production The process of IEC materials development is described in the following checklist that you need to complete: #### Checklist for Development Process of IEC Materials 1. Development of the material according to priorities arising from the needs assessment 2. Review of existing health education materials on the specific health issue 3. Identify target audience 4. Carrying out a focus group discussion with target audience members from target audience for comprehension 5. Carrying out pre-testing with 2-3 groups of community members from target audience for comprehension 6. Developing a creative brief including all specifications for the material 7. Aligning target audience with behavioral objectives, channels of communication and materials 8. Working with a creative agency to develop messages based on the priorities 9. Translating messages into language appropriate for the target population 10. Pilot-testing material with external audiences (2-3 group in target area) 11. Reviewing and proof reading material for final editing and print Total 'yes' answers