Education and communication strategies for different groups and settings
Teresa H. Stuart1
Cheryl Achterberg2
1 UNICEF Programme Officer for Information and Communication, UNICEF, Manila, Philippines.
2 Director, Penn State Nutrition Center and Associate Professor, The Pennsylvania State University, USA.
Introduction
Background
Strategies for community out-reach
School programmes
Mass media and social communication
Work-site programmes
Conclusions
Recommendations
References
Introduction
National food and nutrition policy in developed and developing countries emphasises the improvement of the quality of life of its citizens by striving to:
stimulate and sustain the production and consumption of more nutritious foods,
promote proper food habits and healthy lifestyles,
reduce the prevalence of protein-energy malnutrition,
reduce the prevalence of micronutrient deficiency, particularly vitamin A, iron, and iodine, among vulnerable groups, and
reduce over-consumption of certain nutrients, particularly fat, saturated fat, sodium, and alcohol.
With the above objectives, nutrition education and communication are now recognised as a primary form of intervention in national food and nutrition programmes. Some argue that nutrition communication is part of nutrition education. Others maintain that nutrition education is part of nutrition communication. Either way, both are viewed as integral components of other nutrition intervention approaches, such as food production, food assistance, food formulation and fortification, supplementary feeding, promotion of breast-feeding, nutrition-related health services, and the provision of a potable water supply (Stuart, 1991).
The ultimate goal of nutrition education is to produce nutritionally literate decision makers who are motivated, knowledgeable, skilled, and willing to choose proper nutrition alternatives (Lewis, 1976). To be effective, nutrition education must communicate clear messages with a specific behaviour-change goal for target groups (Guthrie, 1978 in Valdecanas, 1985).
Nutrition education and communication programmes have evolved from a one-way flow of communication, that is, a mere dissemination of information to persuade target groups to change food beliefs, attitudes, and habits. A two-way process of sharing is preferred, where participants in a nutrition programme can freely exchange knowledge, values, and practices on nutrition, food, and related areas. This view of nutrition education as a mechanism for interaction, ensures the active involvement of those who could and should take part in decision making, and in motivating and providing users with easy access to nutrition-related information, resources, and services.
Much of the present work in nutrition education and communication is now viewed from a broader framework as a process, that is, a mechanism for interaction among participants, and as a resource, applying a co-ordinated, multi-sectoral and interdisciplinary effort, toward improving and sustaining the nutritional status of the most vulnerable groups, children and women. Several approaches to nutrition education have been developed and effectively applied over the years. These include: social marketing, social mobilisation, and development-support communication. These approaches have basic commonalties: (i) the ultimate goal is to improve the quality of life of people through a participatory process of communication, (ii) there is a demand to establish a dynamic relationship among the participants of the programme: the subjects of the nutrition education intervention, the policy makers, the planners, and the implementors, as well as the evaluators, (iii) information, education and communication (IEC) strategies are built into the process, and (iv) the core elements of the process are: formative research, assessment and analysis; capacity building; development of a multi-channel communication strategy; community organising; networking, alliance-building, and co-ordination with linkage and support systems; design, pre-testing, and development of messages and materials; and monitoring and evaluation.
Social marketing
Social marketing reflects the view that merely providing information is not enough to change behaviour. A host of psychological, socio-cultural, political, environmental, and practical factors impinge on the decision making process toward behaviour change. New strategies are needed to motivate people to adopt change and take an active part in their development. Social marketing uses business marketing principles to advance a social cause or idea (Kotler & Zaltman, 1971). It is described as "a social change management technology that involves the design, implementation and control of programmes aimed at increasing the acceptability of a social idea or practice in one or more groups of target adopters" (Kotler & Roberto, 1989). The strategy adopts the four Ps of marketing, namely product, price, place, and promotion. In the last 20 years, social marketers have been involved in promoting better health and nutrition in the developing countries of Asia, Africa, and Latin America. A great deal of experience has been documented in the social marketing of breast-feeding, weaning foods, oral rehydration salts, and immunisation (McKee, 1992).
Social mobilisation
Social mobilisation is described by UNICEF as:
"a process of generating and sustaining the active and co-ordinated participation of all sectors at various levels to facilitate and accelerate the improvement of the situation of children, women, and other vulnerable groups. The need for social mobilisation is based on the following concerns: (a) children, and often women, are powerless; (b) programme resources for solving problems are limited; and (c) concerns for children and women go beyond a project basis. The aims of social mobilisation are to hasten the delivery of basic services and to promote convergence and generate resources for children and women's programmes" (UNICEF, 1995).
To generate commitment and action among those who can contribute to the solution of social problems, certain strategies are employed that put prime importance on interpersonal communication. The six strategies include the following:
Advocacy
Advocacy among policy-makers, key personalities, groups and organisations. Advocacy is a planned communication effort to persuade decision makers at policy, planning, and management levels to adopt necessary policies and allocate resources for a cause.
Information, education, and communication (IEC)
IEC approaches are used to reach target groups. Social mobilisation uses all available and potential communication approaches, resources, techniques, channels, methods, and tools. It is not a mere information campaign or communication project, but a long-term programme built into the sectoral programmes of a community. Some examples of IEC activities are:
the development, production and distribution of appropriate printed materials such as brochures, pamphlets, posters, leaflets, and flyers;
radio spots, plugs, jingles, documentaries, and schools on-the-air;
video and other audio-visual materials like slide-tape presentations and film showings; and
messages integrated into communication programmes, services, and products of allied agencies.
Training of programme implementors
Training enables personnel to acquire the necessary skills for the delivery of services. The implementor also uses training to improve people's knowledge, appreciation, and mobilisation, of community resources to achieve the desired outcome, usually for local and individual empowerment.
Community organising
Community organising to empower parents, families, groups, and the whole community, is used to build their capacity for problem solving, decision making, and collective action, thus developing and strengthening their networks. Community organising allows community members to recognise their problems and needs, decide on what they can do and how they can act collectively, that is, pool ideas as well as human and physical resources, and together benefit from all available resources and services.
Networking, establishing linkages, and building alliances
This includes networking, establishing linkages, and building alliances with those who can actually and potentially act on the problem. The implementor of social mobilisation builds alliances and linkages not only with families in the community, but also with institutions, agencies, and organisations. Among potential allies of the community are the non-governmental organisations (NGOs), people's organisations, self-help groups, and local government executives. These networks allow communities to maximise limited resources and services to a level where their inputs have a much greater impact.
Monitoring and evaluation
Monitoring and evaluation determines the efficiency of programme implementation and the effectiveness of the strategies used in achieving defined goals. The results are used to adjust the programme as needed to improve impact and maximise resources.
Development support communication (DSC)
DSC is described as "the systematic utilisation of appropriate communication channels and techniques to increase people's participation in development and to inform, motivate, and train rural populations mainly at the grassroots level" (FAO, 1987). The DSC approach is seen as a system with three sub-systems that provide the framework for planning, implementation, and evaluation. The sub-systems include: (i) DSC action plan or process model; (ii) DSC training plan; and, (iii) DSC management plan (Stuart, 1994), and are briefly described below:
The DSC action plan or DSC process model
The DSC action plan, or DSC process model, provides a systematic approach to changing and exchanging knowledge, attitudes and practices. It is adaptable to diverse development contexts and situations and thus allows room for adjustments according to local realities. It has four major stages: pre-planning, planning, implementation, and post-implementation with corresponding steps and activities.
The DSC training plan
As a sub-system, the DSC training plan recognises the importance of capability building in DSC and relevant technologies for all participants in a development programme where a DSC component is in place. The training promotes the sustainability of the programmes. There are eight steps in the training planning process: training needs assessment, setting training objectives, selection of training format, preparation of curriculum content, development of training support materials and media, training proper, evaluation, and planning for echo-trainings.
The DSC management plan
The DSC management plan is an essential part of the DSC system because orchestrating people, resources, and time requires a systematic management programme. Sound programme or project planning, implementation, and evaluation depend on good management. This involves planning, staffing, budgeting, controlling resources, guiding and co-ordinating people's activities, setting policies, guidelines and standards, and monitoring and evaluation.
Background
Currently, there are evaluations of nutrition education programmes available that support the benefits of a healthy diet. The challenge for nutrition educators is to find ways of reproducing positive results routinely and on a large scale. Given the limited resources available in most developing countries, nutrition education and communication strategies must be able to reach large sections of the population in a cost-effective manner.
Mass-reach programmes are needed, not only to address existing nutrition problems, but also to promote the general nutritional literacy and health of the population, particularly because in many countries the food supply is in transition and persuasive food advertising is increasing.
The key programmes that can reach a large number of people include:
community out-reach programmes
mass media campaigns
pre-school and school programmes
work-site programmes
Strategies for community out-reach
Identifying key nutrition issues and analysing determinants of eating behaviour
The task of planning nutrition education interventions integrated into nutrition improvement programmes, requires that the various causes and effects of nutrition issues and problems be addressed in a concerted manner. Only through a systematic analysis of the nutrition and health-related needs of a community, can an effective nutrition education programme be developed.
Any nutrition education intervention should consider the socio-cultural, economic, political, and technological environments which include food and nutrition issues. Thus, the first step is a situational analysis examining the factors that would draw out pertinent issues to be addressed through nutrition education.
The step of identifying and analysing key nutrition issues and behaviour determinants is part of baseline or background research that involves three components (FAO/WHO, 1992): (i) an epidemiological analysis of the specific nutrition issues; (ii) a policy analysis of national nutrition priorities and resources; and (iii) a behavioural analysis to identify the barriers for adopting the desired behaviours, as well as factors that favour change.
The next step applies the first two A's in UNICEF's "Triple A" Approach, consisting of Assessment, Analysis and Action (UNICEF, 1992). An assessment determines the priority issues, problems, local power structures, supporting institutions, communication resources, as well as relevant policies, and the degree to which these affect the state of nutrition and health of the community. An analysis studies the underlying factors that impinge on the issues, problems, structures, resources and policies. Action, in terms of community out-reach strategies, includes: consultations with decision makers at different levels to find out their needs for information; planning and preparation of easily understood messages and materials; and social mobilisation of the community as a way of motivating people to cooperate and share limited resources and of empowering community decision makers, be they the local leaders, teachers, mothers, or school children.
In designing appropriate community out-reach strategies, nutrition education planners need two major types of information. These are: (i) information about people, and (ii) information about local resources (Stuart, 1991).
Information about people
Information about people is sometimes referred to as audience predisposition in communication models (Gillespie, 1987). The information about people will help identify the nutritional needs of the community. It includes:
Nutritional status:
Four basic methods are employed to describe the nutritional status of "at risk" groups in the community: anthropometric studies, clinical studies, biochemical studies, and dietary intake studies.
Food consumption patterns:
This describes what and how much people usually eat. It determines whether the amount and variety of food intake is adequate for the individual and the household. It also tells if there is food scarcity at certain times of the year.
Medical information:
Morbidity and mortality rates and their causes are indicators of the interrelationships between nutrition and prevalent disease patterns, including infections and infestations.
Education:
Literacy and educational levels are guides in designing appropriate messages adjusted according to the audience's level of comprehension and language facility. It also guides planners in choosing interpersonal and mediated approaches.
Media access and exposure:
This indicates the extent to which the community has access and is exposed to certain mass media channels, while it determines the community's media habits, ownership, and preferences.
Economic status and education:
Types of occupations, incomes and educational attainment of family members, and whether women work outside the home, indicate if money is regularly available to buy food. Food expenditures also provide an index of the percentage of family income spent on food and non-food items. Child care providers should also receive nutrition education.
Cultural information:
Food habits, practices, superstitions, attitudes, social and religious customs, and breast-feeding and weaning practices are useful in determining and designing appropriate nutritional messages and activities.
Food and nutrition information networks:
The structure and flow of nutritional information or misinformation among women and men in the community help to identify specific target participants for nutrition education interventions, e.g. sources of erroneous beliefs about breast-feeding and weaning, superstitions, etc.
Studies on functional classification:
These studies relate nutrient deficient patterns to spatial, ecological, socio-economic, and demographic characteristics of a population. For example, a study of upland dwellers can yield useful information for designing intervention programmes based on an "area level", integrating a development planning approach rather than a sectoral approach.
Information about local resources
Information about local resources that will help identify problems related to food and nutrition in the community include:
Water supply:
This helps to identify possible sources of infection and whether enough water is used to maintain hygiene standards. It also indicates if it is possible to increase agricultural production.
Local food production:
This identifies the kinds of foods that are locally available for consumption, including their seasonal availability.
Markets and foods:
This gives an idea of what crops are sold locally, the process by which a quantity and quality of foods becomes available on the market, and the presence of street-food vendors, snack stands, and other outlets for prepared food.
Food storage:
It should be determined whether food storage facilities are available, whether enough food can be stored properly for future needs, and whether lack of storage facilities causes specific losses and a shortage of supplies.
Housing:
This indicates the adequacy of kitchen, toilet and other sanitation facilities. It is also used to measure space adequacy or crowding among family members.
Local institutions, policy, and support services:
This shows whether the local government officials recognise the importance of nutrition in the overall development plans and programmes in their area of jurisdiction. It also determines if there are existing policies that guide local officials, organisations, extension agents, and non-government organisations so that they can participate and provide support services for nutrition interventions.
Transportation facilities:
The availability of farm-to-market roads and public utility vehicles affects the flow of farm products to the market, the availability of food in the local market, and the mobility of individuals to visit health and educational facilities.
Educational and communication resources: