Exploring the role of communication in community health in Sierra Leone

Below are extracts from an important new report from BBC Media Action, by Annabelle Wittels…

The full report [1.5 Mb] is available here: http://downloads.bbc.co.uk/rmhttp/mediaaction/pdf/research/communication-in-community-health-report.pdf

BBC Media Action, the BBC’s international development charity, uses the power of media and communication to support people to shape their own lives. Working with broadcasters, governments, other organisations and donors, we provide information and stimulate positive change in the areas of governance, health, resilience and humanitarian response.

Giving communities access to reliable and actionable health information is particularly valuable in countries where there are exceptionally few health professionals, for example Sierra Leone…

As part of the efforts to rebuild and strengthen health systems in Sierra Leone, BBC Media Action conducted two studies in late 2015 to explore the role that media and communication can play in improving health outcomes across communities. This report presents the insights gained about people’s access to health information, decision-making processes and communication networks. Previous BBC Media Action research has revealed that the most effective health communication is two-way, involving audience feedback, discussion and use of information. BBC Media Action therefore extended the research focus to explore the health-seeking and information-seeking behaviour of participants.

This report draws on two studies: first, a nationally representative quantitative survey, and, second, a qualitative study across three locations in Sierra Leone. Data for the nationally representative quantitative survey was collected between October and mid-November 2015 across the country’s 14 districts. In total, 2,500 Sierra Leoneans were interviewed for the quantitative survey. The qualitative study had a strong focus on rural communities as these tend to have worse access to health centres and to be less wealthy and less educated than urban populations – factors that are associated with more negative health outcomes. Focus group discussions (FGDs) and in-depth interviews (IDIs) were conducted in rural Port Loko, rural Kenema, Western Area Rural and Western Area Urban.

The main research findings are:

Radio and mobile phones are the media platforms that can reach the most people…

People are accessing health information. Ninety-five per cent of research participants reported accessing health information in the previous three months – 93% receiving information about Ebola and 43% receiving information about pneumonia.

There is a strong interest in health information in Sierra Leone. Eighty-six per cent of Sierra Leoneans want to receive more information on health for themselves and their families.

People are interested in receiving information on a range of health issues…

The qualitative research revealed a number of factors that explain why people do not seek formal health providers or health information. These are:

– Seriousness of health issue. If there is a perception that a health issue is not acutely life-threatening, people are less likely to seek information about it…

– Previous experience. If the individual or their family has personal experiences of informal healthcare that are better than their experiences of formal healthcare, they prefer to rely on informal services before consulting formal healthcare providers.

– Prioritise the health of their children. Parents are more inclined to seek healthcare information when their children are ill. However, Sierra Leoneans are less likely to seek information for illnesses perceived as non-urgent.

– Preference for traditional healers for some illnesses. When illnesses are believed to have a spiritual source, people initially seek help from traditional healers…

– Costs of healthcare…

– Distance to the trusted healthcare provider. With only 900 qualified health professional in the country since the Ebola crisis, formal healthcare services are not available in every community…

Nonetheless, there are opportunities to encourage Sierra Leoneans to seek and engage more with health information:

– Face-to-face communication is most trusted. People prefer face-to-face communication, which gives them time to ask questions and allows communicators to reassure themselves that information has not been misunderstood.

– Community health workers (CHWs) have the potential to reach people with face-to-face information.

– Mobile phones are used by the majority of the population… only 25% of Sierra Leoneans indicated that they would pay for health information delivered via mobile phones.

Communicators of health information such as international or national non-governmental organisations (INGOs or NGOs), health practitioners and the Sierra Leonean government can draw on these insights to guide their future interventions in the following ways:

– CHWs are well placed to provide face-to-face communication. This study and other research5 show that Sierra Leoneans prefer face-to-face and interpersonal communication, but CHWs often rely on simple one-way models of communication. They could profit from support through training and tools. Such efforts should first help CHWs to fashion their communication in a way that encourages greater dialogue and exchange. Second, the training could address the demand for more in-depth information. Training and tools for CHWs should build confidence in providing information with greater depth and breadth.

– High levels of trust for nurses and doctors could be built on to maximise the credibility of health communication…

– Radio and mobile phones, the two media with the highest access and ownership figures across Sierra Leone, appear best positioned to provide health information. Other research suggests that if mobility is compromised, as it was during the Ebola crisis, people prefer to receive information by radio.

– When using mobile phones, information that can be delivered via basic phones and is voice-based, not requiring reading skills, is more likely to reach across different strata of Sierra Leonean society.

– Although two-way communication might be easier to achieve when face-to-face, mass media in Sierra Leone should build on experiences of communication during the Ebola crisis, which illustrated that bottom-up communication facilitates positive behaviour change.

Communication efforts should equip communities with actionable information. The findings from this study suggest that communities are more likely to implement health information if it is easy, cheap and quick to implement. This is especially important in the context of preventative care, within which community members show less proactive behaviours. Providing actionable information could help communities to overcome barriers to engage and act upon health knowledge.

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org  

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