Evidence Based Communication for Health Promotion: Indian Lessons of Last Decade

"Evidence-based approaches used in risk communication should be adopted as core principles by all health providers, experts, health authorities, policy makers, and politicians when communicating information about program interventions. These approaches include engagement with and listening to stakeholders, and being transparent about decision making, and honest and open about uncertainty and risks. Decision and policy makers cannot assume what the public wants without undertaking social science and decision science research. The Global Polio Eradication Initiative has shown that monitoring of public concerns needs to be continuous and responsive, and hand in hand with the monitoring of technical strategies."

Above are some of the strategies suggested in this article, which "underscores that communication is as much a science as an art, as much process as it is about outcomes. It advocates for increased linkages between epidemiological research and social science research in planning effective health promotion interventions with quality service delivery." The author provides several case studies to illustrate this principle (footnote numbers have been removed):

1. Collective behaviour enforcement/role modeling: "In a village in Andhra Pradesh [India] a respected teacher was beating his wife. The neighbors initially were reluctant to intervene in what they perceived as a private matter....[O]ne fine day the neighbors were galvanized into action. When the teacher was beating his wife, they collectively gathered pots and pans and banged them in protest outside the couple's home. Teacher was thus publicly shamed....A private act of violence was transformed into a public action of protest and a new social behavior was modeled that exemplified collective efficacy of social learning."
2. Social mobilisation for polio eradication: The United Nations Children's Fund (UNICEF) India started post-Pulse Polio Immunization (PPI) assessment of non-acceptors via survey distributed to non-governmental organisations (NGOs) and medical college faculty. The feedback revealed a need to involve community volunteers for raising awareness of the need and urgency of taking PPI drops every time, interpersonal communication of the reluctant/refusing families, and efforts to involve various community leaders and empower them to mobilise people. Changes were then made in Moradbad (Uttar Pradesh) and neighbouring districts. "Over the years hundreds of such block and distinct level social mobilizers have become the key workforce for successful implementation of IPPI [Intensified PPI]."
3. Professional organisation endorsement: In the campaign "Hand Washing for a Healthy Life", the Indian Public Health Association IPHA partnered with Hindustan Lever Ltd. and endorsed its Lifebuoy soap. "One might feel it as an endorsement of a product for money but the social good done by this endorsement cannot be negated. We see frequent TV ads of this even today."
4. Use of celebrities for health promotion: Example: "Who does not know or has not seen Mr. Amitabh Bachan popularize 'Do Boond' for polio eradication. Many Bollywood and other regional film artists have contributed to pulse polio campaign across India and neighboring countries."
5. Use of positive deviants for communicating with peers: The concept of positive used in Integrated Child Development Services (ICDS) in West Bengal and other states "demonstrates how a positive behavior by a few individuals or families in a community (positive deviants-mothers whose babies are well nourished) who do things differently that others in the community can eventually lead to far reaching results (reduction of child under nutrition)."
6. Press and perverse consequences: Example: "In some parts of Uttar Pradesh boycotted the polio vaccine in 2001-2004, claiming that the oral polio vaccine could also cause sterilization in those vaccinated, fuelling widespread public distrust."
7. International and national professional communities' feud: "[W]e all know how the international experts blamed Indian experts for not allowing the Govt. of India to introduce Hib vaccine across the country. While the global infection and case load may justify introduction of Hib in universal immunization program (UIP), there is not enough local evidence argued the pediatricians in India. Introduction many other vaccines with low cost effectiveness have to be introduced with caution say Indian experts."
8. Use of SMS (text messaging) and toll-free call number in the Integrated Disease Surveillance Project (IDSP): "[T]he toll fee 24x7 call centers (1075) has become a boon to public in general and private doctors and health workers in particular to report on occurrence of any outbreak or unusual events, which hither to was difficult for them as they were scared of getting identified and taken to task by local health authorities."

Reflecting on these examples, the author explains that good health promotion programmes which help achieve public health goals are derived from using a mix of epidemiological and social and behavioural science research information. Dr. Suresh then explores strategic communication, exploring concepts and definitions of approaches designed to "overcome challenges of meeting human rights (rights of children and women in particular) by finding creative avenues to address resistant attitudes and ensuring community participation" through: behaviour change communication, social mobilisation, and advocacy.

Following this section of the paper, Dr. Suresh examines monitoring and evaluation of communication efforts, concluding with a list of commonly used indicators for behavioural and social change - which "can measure tangible (service delivery, training, product etc), the intangible (community empowerment) and the unanticipated or results that were not planned."