After thorough research, careful analysis and sleepless nights, I finally came up with a research proposal.
Communicating Health ~ Promoting Maternal and Child Health Care in Barangay Tawang, La Trinidad Benguet
Introduction
Many of us consider health as one of our valuable assets. Most of us do our best to eat nutritious and well balanced-diet, practice healthy lifestyle and make our surroundings clean and free from insect carrying diseases. But despite all the efforts, there are still illness and diseases we cannot prevent such as tetanus, diphtheria, hepatitis, polio, influenza, measles and so much more. Women especially pregnant mothers and children are susceptible to these diseases. Mothers’ have a very significant role in the family that their absence can lead to a bigger problem. Their health is as important as their children. According to the Department of Health, pregnancy and childbirth are among the leading causes for death, disease and disability in women of reproductive age in developing countries (DOH, 2011). This is true in the case of the Philippines as data shows that the target to reduce maternal death is deliberately slow as it only reaches 22 per cent, way below the 75 per cent target. An estimated 11 women die every day in from complications of childbirth. Neonatal/newborn deaths are also widespread as neonatal mortality rate went down by only two percentage points, while under-5 deaths dropped by 46%. Half of Filipino children who die before their fifth birthday are newborns (UNICEF Philippines, 2011). This only mean that as far as government and non-government organizations intensify their campaign in reducing maternal and child mortality rate, there are still barriers that are preventing them achieve their goals.
In line with this, Barangay Health Centers served by the Barangay Health Workers (BHWs) which are regulated by the Department of Health play a very important role in promoting Maternal and Child Health Care. They are the frontline public health professionals in their community who delivers services and programs of government and non-government health organization. Maternal and Child Health Care are one of the many services offered by Barangay Health Centers. Maternal Health refers to the health of a woman before, during and after pregnancy. The Department of Health’s (DOH), Maternal Health Program aims to improve the survival and health of mother and unborn child by providing quality pre and post natal, immunization and micronutrient supplementation. Under pre -natal care, pregnant women are advised to have at least four pre-natal visits during the period of pregnancy in order to monitor their health and manage any disease that might occur. This would also reduce women’s exposure to health risk especially to women less than 18 years of age and over 35 years of age, low educational and financial resources, with chronic illness and who just gave birth in the last 18 months are given appropriate advice on related issues to prevent future health risk (Vera, 2012). On the other hand, Child Health Care refers to the protection of child’s health from birth and under five (5) years of age against malnutrition and infectious diseases. It also includes the protection of the child from discrimination, exploitation and abuse. The 1976, Expanded Program of Immunization (EPI) of the Department of Health ensures that infant, children and mothers have access to the recommended vaccines (DOH, 2011).
We live in the communication age where access to information is easy and connecting with people is real-time. Communication had affected us positively and negatively, had played a very important role in our everyday life with our family, friends, colleagues etc. Communication does not only give us information but also educate us in so many aspects that are helpful in our well-being such as health. Is communication essential in improving our health? According to Gwyn, we learn our own illness through the language of health professionals, friends, neighbors and relatives. When we open the newspapers, health magazines or turn on the television or radio, we encounter numerous programs giving information, advice and warnings about health (Gwyn, 2001). We are privilege to have this information because of health communication. But is health communication?
According to Corcoran, health communication is the forefront of any effort to promote health or prevent ill health. Health practitioners who are engage in health communication through health promotion or public health practices are all part of it (Corcoran, 2013). Healthy People 2010 stated that health communication as “the art and technique of informing, influencing, and motivating individual, institutional, and public audiences about important health issues (Bernhardt, 2004). While the United States Department of Health and Human Services view health communication as relevant in every human aspect of health and well-being including disease prevention, health promotion and quality of life ( Rimal & Lapinski, 2009). This is true in the case of Ghana, western part of Africa which is faced with diseases such as malaria, syphilis, leprosy, dysentery and worms. People were informed though songs and dances using various channels of media forms, personal testimonies which has been a success health communication strategy (Prilutski, 2010).
Health according to World Health Organization is a state of complete physical, mental and social well-being and including the absence of illnesses (WHO, 1948). Health is an asset. It’s the ability of a person to develop its capability and make use of it in productive ways. Health is our source living, the absence of it makes us a liability to our family or community. It hinders us in the performance our duties and responsibilities, it pulls us down to poverty, hunger and worse to death. Good health plays a significant role in economic growth. Improved health of family members means having more time with children and family. Study shows that spending time with children is significant in developing their cognitive, emotional, and social and communication skill. According to the Commission on Macroeconomics and Health, healthy and well-nourished children will perform better in school and a better performance in school will positively impact their future income. If parents ensure that their children have a high probability of reaching adulthood, in general they will have fewer children and they will be able to invest more in health and education for each of them (CHM, 2004). Therefore, a healthy mother makes a healthy child, a healthy child can grow healthy and a healthy adult tend to be a healthy worker making him fewer absences at work that result to higher production , a mentally and physically fit worker demonstrate effectively at work therefore producing quality output. On a final note, a healthy person does not only contribute to the development to his family but also to his community and to his country. A healthy community plays a very important role in combating and reducing poverty.
But despite our effort to maintain good health to women and children, there are still problems that impede stakeholders on achieving this goal. Some factors that affect women’s health are insufficient knowledge on pregnancy and childbirth, ignorance of the on-going health programs and lack and accuracy of maternal and children health care information. Therefore, strategies in promoting Maternal and Child Health Care are vital in informing, educating target audience.
Statement of the problem
Statement of the problem
This study focuses on the assessment of communication approaches and health promotional materials used by the Barangay Health Workers (BHWs) of Tawang, La Trinidad in raising awareness and educating target audience on Maternal and Child Health Care. It specifically sought to answer the following questions.
1. What are the Maternal and Child Health related services offered by the barangay health center in Brgy. Tawang?
2. What is the level of awareness of the target audience on the Maternal and Child care offered by the barangay health center?
3. What communication approaches do the Barangay Health Workers (BHW) used in communicating the Maternal and Child Health Care services of the barangay health center?
4. What is the effectiveness of communication approaches used in promoting the Maternal and Child Health Care services of the barangay health center?
Objectives of the study
Objectives of the study
This study focuses on the assessment of communication approaches and health promotional materials used by the Barangay Health Workers (BHWs) of Tawang, La Trinidad in raising awareness and educating target audience on Maternal and Child Health Care This study aims to:
1. To identify the services offered by the barangay health center in relation to Maternal and Child Health in Brgy. Tawang.
2. To assess the knowledge level and level of awareness of the target audience on the Maternal and Child Health Care services offered by the barangay health center in Brgy. Tawang.
3. To identify communication approaches used by the Barangay Health Workers (BHW) in communicating Maternal and Child Health Care to the target audience.
4. To assess the effectiveness of the communication approaches used Barangay Health Workers (BHW) in communicating Maternal and Child Health to the target audience.
Hypothesis of the Study
Hypothesis of the Study
The following are the hypothesis for the research proposal based on the different literature reviewed:
1. Factors affecting the level of awareness of target audience are due the communication approaches used by the Barangay Health Workers (BHWs) in promoting on Maternal and Child Health Care services.
2. Factors affecting the effectiveness of communication approaches are due to competencies of Barangay Health Workers (BHWs) in promoting Maternal and Child Health Care services.
3. There is a positive relationship between the effectiveness of communication approaches used and awareness of the target audience on the Maternal and Child Health Care services offered by the Barangay Health Center.
Conceptual Framework
Conceptual Framework
The systemic flow of communication in the provision of health care services in the Philippines starts with the Department of Health (DOH) Central Office down to its Regional Offices. From the Regional Offices, the information/directives are passed on to the Provincial and City Health Offices under each region and then down to the Barangay Health Centers (BHCs) managed by a government-paid midwife and volunteer residents called Barangay Health Worker. The Central Office also provides a Manual on Interpersonal Communication and Counseling as basis for the BHWs in implementing various health care programs. (Sumaylo et.al, 2013).
Figure 1: Conceptual Framework
The input diagram shows the flow of communicating health care services from the Department of Health to the community. From Municipal Health Office the program is then communicated to the Barangay Health Center, where the midwife and Barangay Health Workers (BHWs) then organize the program and develop strategies on how to implement the program to the target audience or to the barangay. In addition to the posters, leaflet and brochures given by the Central Office, the Barangay Health Center has to come up with appropriate communication approaches that are usable in promoting the program to the community.
Local Health Unit: The front-line of community health
Primary health care was approved as the health policy of WHO member states in 1978. In 1979, former President Ferdinand Marcos issued Letter of Instruction 949 mandating the implementation of Primary Health Care. Primary Health Care strengthens the promotion of health care through the training of barangay health workers where they were stationed in their own barangays (Quitevis, 2011). Community Health Worker (CHW) or popularly known as Barangay Health Worker (BHW) in the Philippines is a person who has undergone training programs under any accredited government and non-government organization and who voluntarily renders primary health care services in the community after having been accredited to function as such by the local health board in accordance with the guidelines promulgated by the DOH (DOH, 2011). They are the frontline public health care professionals. They are the trusted member of their community who has knowledge on the community they serve. They are the bridge between the health and other social services and the community. They link the community to have access to services provided by government and non-government organizations. They are responsible on providing culturally appropriate and accessible health education and information, conduct community outreach for health organizations to implement programs in the community that promote, maintain, and improve individual and community health (Lehmann & Sanders, 2007). Qualified Barangay Health Workers (BHWs) according to the Civil Service Commission (CSC) are those who have who has completed at least two (2) years of college education leading to a college degree and has voluntarily rendered at least five (5) years of continuous active and satisfactory service as an accredited BHW to the community (CSC, 1999).
Despite the active participation of Barangay Health Workers (BHWs), some studies showed that there is still a need to improve their skills and continue training in order to better serve their own community. Quitevis recommended that BHW should be given more training on teaching basic health care services to be prepared and equipped in performing their role as health educator (Quitevis, 2011). While it is appropriate to look at the ability of the BHW in relation to designing communication tools as the lack of training is the major problem in communicating health followed by lack of resources. Barangay Health Workers need to improve their delivery of health services with regards to event and strategic communication planning and message development (Sumaylo, Escano & Abrio, 2013). Although a great deal of literature on the Community Health Worker appearing there has not been enough sharing of experiences in a systematic way. If this can be done, it will be a major boost to the process of the Community Health Worker system as well on their performance.
Promoting Maternal and Child Health Care
Progress on health and reducing child and maternal mortality are crucial for development within the household, community and country. The need to pay attention on the health pregnant women and children below 5 years of age is as important as the economy of the country. Delivering health services effectively requires the public sector management policies that provide adequate incentives to health care providers; procurement and distribution policies for pharmaceuticals so that these are available in sufficient quantities in the right places; public health measures to protect the population; and suitable regulation and quality control of private providers, who often deliver more health services than public providers (Baird & Shetty, 2003).
Study in Peru showed that maternal education modifies a woman’s beliefs about the cause and cure of a disease thus influences both child-care practices and use of modern health-care services (Elo, 1992). Some previous studies had reported that many Nigerian women, mostly those in rural areas, rate the services of the traditional birth attendants (TBAs) as being of higher quality than that of medical healthcare practitioners, particularly with regards to interpersonal communications and relationships. In addition, women in rural Guatemala have similarly been reported as being less likely to deliver in medical settings because of lack of social support provided by health-care professionals compared with traditional midwives (Babalola & Fatusi, 2009). This only emphasize that utilization of maternal health care can only be a success if only health workers are sincere and affectionate enough in dealing with their target audience.
The promotion of Child Health initiated by Resources Education and Care in the Home program (REACH- Futures) in Chicago through home visit had shown progressive effect where in only 2 infant deaths occurred during the course of study, lower date rate than the previous program of the city. Boyd then concluded that the use of community workers in promoting the Child Health care program through home visits is effective in meeting the needs of families at high-risk of infant mortality (Boyd, 2001). While the Government of the Republic of Zambia‘s commitment in the promotion of maternal and child health in cooperation of UNICEF had shown significant growth. According to UNICEF-Zambia, immunization campaigns provide access to millions of mothers and children to immunizations, micro nutrient supplementation (Vitamin A), malaria prevention (distribution of free or low-cost insecticide-treated bed nets), and growth monitoring and promotion. HIV counseling and testing coupled with provision of antiretroviral treatment. Campaign materials such as flags and banners with the campaign logo were posted at each targeted health center in the seven provinces in Bangladesh, where a woman who might be pregnant could go for care. According to the UNICEF, ante natal care visits increased from 69 to 89 per cent, delivery by skilled birth attendant from 44 to 71 percent and delivery in health facilities from 22 to 53 per cent between 2005 and 2010 (UNICEF, 2013).
Communication Approaches: Important factors in promoting health
Most of us obtain health information from different media such as printed and broadcast as well as from word of mouth. The need to plan and develop clear, comprehensible tools and approaches in disseminating information and educating target audience is a must in order to create change. But there are certain factors to consider when developing communication materials for the target audience. One is the cultural beliefs and practices of a certain community since this often affects the way medical information are disseminated (Prilutski, 2009). For instance, the use of traditional medicine versus biomedical medicine in Ghana, people in Ghana normally uses traditional medicine because it’s what they are used to. This stresses that there is a need to fully understand the Ghanaian culture when communicating health. On the other hand, according to John Hopkins University, information delivered in an effective manner both culturally and linguistically is needed (Hu et.al, 1989). Certainly, language has a great impact in the functionality of communication materials. In the case of Hispanics living in the United States, a survey showed that they have high incidence of Acquired Immunodeficiency Syndrome (AIDS) compared to the Americans as they tend to have fewer access to information. This is because most of the use of only English in communicating about AIDS which the Hispanics have less understanding. Some of the communication approaches that are widely used in promoting health care are Information, Education, and Communication (IEC), mass media, the internet and social networking sites and interpersonal communication.
IEC has long been used by World Health Organization for two decades in communicating health around the world. Health communicators often develop posters, flyers, leaflets, brochures, booklets, messages for health education sessions, radio broadcast or TV spots, etc. as a means of promoting desired, positive behaviors in the community. “IEC” according to World Health Organization refers to a public health approach aiming at changing or reinforcing health-related behaviors in a target audience, concerning a specific problem and within a pre-defined period of time, through communication methods and principles (WHO, 2001). According to the Ministry of Water and Sanitation, the use of IEC involving communities and grassroots organization can accelerate the process of change and hasten the adoption of sanitary practices. However these efforts must involve sociocultural attitudes towards health practice (MDWS, 2011).
Radio and television are the most often used form of mass media. Although behavioral change brought by mass media campaigns were very small, existing evidence show that mass media efforts to improve public health has increased awareness, raise level of health information, make health topic and problem become noticeable, stimulate interpersonal conversation with family, friends and health professionals, generate initiative to seek more information and strengthen existing attitudes and behavior (Schlinger, 1976). Much of our understanding about health is not necessarily from our experience, most of it came from what we see and hear from broadcast media. According to Friedman, media channels, including print journalism, advertisements, fiction films, television shows, documentaries, and computer technology affect the healthcare system and individuals’ use of that system (Friedman, 2004). Obviously, media representations of health and illness shape our understanding of the experience of illness, health, and healthcare and influence health beliefs, health behaviors, healthcare practices, and policy-making (Seale, 2002). Therefore, health information, when delivered effectively in mass mediated contexts, has considerable potential to promote the health of individuals, communities and populations.
The internet has been recognized for many years as significant source of health information. At present, many government and non-government organizations have their own websites that circulate health campaigns and information which is easier for people to access anytime they need, wherever they are. Moreover, more than 70, 000 websites disseminate health information in excess of 50 million people seek health information online (Cline & Hynes, 2001). However, according to BMJ, information and communication technologies have not been harnesses systematically to improve health of people in the developing countries but these technologies empower those who use information by providing them the choice the information they need and allowing them to put their own information in the web (BMJ, 2000). In addition, researchers conducted a systematic literature review to identify the use of SNSs for public health research and practice and to identify existing knowledge gaps. According to Capurro, number of publications about public health uses for SNSs has been increasingly growing for the past five years. Various studies have fully explored the communication tools embedded in SNSs and study their possibility to produce significant effects in the overall population’s health are needed (Capurro, 2014).
Last but not the least, interpersonal communication according to the Center for Global and Health Communication and Marketing is defined as person-to-person or small group interaction and exchange, is a critical skill for health care providers, hotline call respondents, and others who have direct contact with those we are trying to reach - in order to influence their decisions and help improve their behaviors. It can be both verbal and non-verbal communication, negotiation, and classic counseling techniques (CGHCM, 2015). Communication in health care is not simply social interaction, but an interaction that can affect people’s health and even their survival. Poor communication during patient and health professional conversation can lead to complications (Greenwood, 2015). Therefore, information must all fit together to send the right message that the communicator intends the target audience to understand. Thompson wrote that, understanding the potential role of everyday communication about health may help in discovering points of intervention and successful strategies for health promoting and disease preventing social influence (Thomson, 2003).
The aim to empower target audience through different communication approaches would only become successful if right information is communicated to right people. In addition, improved communication does not mean well-informed people. Not all health information communicated reach target audience due to some factors like for example language, culture, human behavior and location. Therefore the need to develop communication approaches that suit the need of target audience is necessary. That is to make sure that these target audience have easy access and understanding on health information.
Awareness on Maternal and Child Health
To women of reproductive age and mothers of children below 5 years old, it is very important to have knowledge on maternal and child health. Knowledge, information about maternal and child health is one of the key to have a healthy pregnancy, healthy baby and child. Thus awareness about health is significant in sustaining a health, physically and mentally. Health awareness provides health related knowledge to the people for preventing and curing disease. In addition, health awareness has the power to change people’s lives, it creates a new environment to realize their goals and help them to get beyond our problem.
There has been a study on antenatal care in Gambia assessing the awareness of pregnant women concerning antenatal care and results show that ninety percent of those interviewed had attended the antenatal clinic more than once and 52% four or more times. Most pregnant women (70.5%) said they spent 3 minutes or less with the antenatal care provider. About 35% recalled they were informed or educated on diet and nutrition, 30.4% on care of the baby, 23.6% on family planning, 22.8% on place of birth and 19.3% on what to do if there was a complication (Enya et al., 2008). This indicates that pregnant women are not well informed to make appropriate choices especially when they are in danger. In the study conducted in Madhya Pradesh in India, Tiwari further added that about half of the total pregnant women had at least 3 antenatal checkups,85% children were immunized, more than 50% deliveries were institutional and 22% people did not responded regarding the practice of contraception. Therefore, we can say that in spite of proper availability of services we still need to increase the awareness and utilization of the various maternal and child health services (Tiwari et al., 2014).
Studies conducted in Northern China shows the levels of folic acid awareness, knowledge and use among Chinese women mostly less educated and from rural areas, living in a high NTD prevalence area during early pregnancy were very low and folate deficiency was quite prevalent. (Zhang et al., 2006). While in the American Journal of Obstetrics and Gynecology, awareness of folic acid benefits increased from 0 in 1988 to 50% in 1996 and thereafter. The use of folic acid in the periconceptional period increased from 15% in 1988 to 40% in the last few years (Mitchell et al., 2005). Again, campaigns are essential to increase awareness and knowledge on the use not only of folic acid but all the basic vitamins and immunization that a pregnant woman need to have a healthy baby. It should be intensified to reach the target audience especially disadvantaged groups to further decrease the prevalence of neural tube defects. Wide gaps exist between awareness and practices related with maternal and child health due to lack of information, low education or non-adoption of knowledge into actual practice. An adequate understanding of a woman during pregnancy, especially during lactation can be helpful in improving maternal and child health (Kumar et al., 2008).
There has been good evidence that health communication has created high level of awareness that affected health behavior. According to Hornik, there’s large amount of health behavior change in many important areas (e.g. The National High Blood Pressure Education Program, the Dutch AIDS Communication Program, the Philippines National Immunization Program etc.). Despite the ambiguous evidence from controlled trials, he further added that public agencies assumed that public health communication is a powerful tool in changing behavior (Hornik, 2002).
Operational Definition
Maternal Health ~ refers to the health of a woman before, during and after pregnancy. It involves maintaining the health of mother and unborn child by providing quality pre and post natal care, immunization and micronutrient supplementation.
Child Health ~ refers to the protection of child’s health from birth and under five (5) years of age against malnutrition and infectious diseases by monthly monitoring providing basic immunization, deworming and vitamin A supplementation.
Awareness ~ the state of having knowledge and information about maternal and child health care.Communication approaches ~ these are tools and ways the BHWs use in communicating the Maternal and Child Health care services.
Health communication ~ is a key strategy to inform the public about health concerns and to maintain important health issues on the public agenda. The use of the mass and multimedia, traditional media and other technological innovations to disseminate useful health information to the public, increases awareness of specific aspects of individual and collective health as well as importance of health in development.
Health education - comprises consciously constructed opportunities for learning involving some form of communication designed to improve health literacy, including improving knowledge and developing life skills which are conducive to individual and community health.
Research Design
The proposed study will use qualitative method which will involve describing, surveying and interpreting data base on the questionnaires that will be given to the respondents. The study will focus on determining the awareness of target audience on the Maternal and Child Health Care services offered by the Barangay Health Center and effectiveness of communication approaches used by the BHWs in promoting the Maternal and Child Health Care.
Respondents and Locale of the Study
The respondents of this proposed study will be 30 percent of the population aging 15 to 49 and the Barangay Health Workers (BHWs) of Barangay Tawang, La Trinidad, Benguet. Tawang is one of the 16 barangay of the municipality of La Trinidad, province of Benguet. It is low-lying mountain overlooking the La Trinidad Valley. It is known for its famous Mount Kalugong (the local term for hat) was taken from a set of rocks which look like a hat, which is very visible from the valley when looking up the heights of the Tawang area. According to Mila T. Pagcial, the midwife of Barangay Tawang; the population of the barangay as of December 2014 has reached 9, 333 with 2, 098 number of households.
Collection of Data
The researcher will distribute questionnaires to the respondents during clinic days on Monday, Wednesday and Friday at Central Tawang , Tuesday and Thurday at Banig, Tawang and during field clinic on 5 different sitios of Barangay Tawang such as Banig, Boted, Central, Densi and Papasok scheduled on weekdays once a month. The questionnaires will be explained in one or group discussion to ensure a better understanding and quality responses from the respondents.
Data Analysis
This study will use both qualitative and quantitative method of data analysis. After gathering the needed data, the researcher will tabulate the data and will use descriptive statistical analysis such as percentage and frequency to determine awareness on Maternal and Child Health care from the residents. Also the weighted mean will be employed to interpret the responses of the respondents on the effectiveness of the communication approaches. Respondents will rate effectiveness of the communication approaches from 1 to 5, where 1 is the least effective and 5 is the most effective. Finally, the researcher will compare the relationship between the awareness of the respondents on Maternal and Child Health Care and the effectiveness of the communication approaches.
Appendix A: Survey Questions
Literature CitedAmerican Institute for Research. n.d. Health and social development program. Retrieved May 20, 2015, from http://www.air.org/program/health-and-social-development-programBabalola, S. & Fatusi A. (2009). Determinants of use of maternal health services in Nigeria - looking beyond individual and household factors [Abstract]. BMC Pregnancy and Childbirth, 9:43. Retrieved May 30, 2015, from http://www.biomedcentral.com/1471-2393/9/43Civil Service Commission. (2014). Barangay health worker eligibility. Retrieved May 22, 2015, from http://web.csc.gov.ph/cscsite2/barangay-health-worker-eligibility-bhwCommunity Health Worker Initiative of Sonoma County. n. d. CHW Core Competencies. Retrieved May 22, 2015 from http://chwisc.org/CHW_Core_Competencies.htmlDepartment of Health. (2011). Expanded program on immunization. Retrieved May 21, 2015, from http://www.doh.gov.ph/node/1067.htmlDepartment of Health. (2011). National safe motherhood program. Retrieved May 21, 2015, from http://www.doh.gov.ph/content/national-safe-motherhood-program.htmlElo, I. (1992). Utilization of maternal health-care services in Peru: the role of women's education [Abstract]. Health Transition Review, 2(1), 49-69. Retrieved May 30, 2015, from http://www.jstor.org/stable/40652032?seq=1#page_scan_tab_contentsEnya et al. (2008). Antenatal care in The Gambia: Missed opportunity for information, education and communication. BioMed Central. Retrieved May 29, 2015 from http://www.biomedcentral.com/1471-2393/8/9(2004). Investing in health for economic development. (1st ed., ISBN 968-6254-66-8). Puebla, Mexico. Printed in Mexico Retrieved May 20, 2015 from http://www.who.int/macrohealth/action/sintesis15novingles.pdfKumar, D. et al. (2008). Gap between awareness and practices regarding maternal and child health among women in an urban slum community. SpringerLink 2008; 75(5): 455-458. Retrieved May30, 2015, from http://link.springer.com/article/10.1007%2Fs12098-008-0072-zLehmann, U., & Sanders, D. (2007, January). Community health workers: What do we know about them? Retrieved May 22, 2015 from www.who.int/hrh/documents/community_health_workers.pdfMinistry of Drinking Water and Sanitation. (2011). Information, education and communication. Retrieved May 22, 2015, from http://www.mdws.gov.in/iecOlayinka, O. et al. (2013). Awareness and barriers to utilization of maternal health care services among reproductive women in Amassoma community, Bayelsa State, 6(1): 15-16. Retrieved May 28, 2015 from http://www.academicjournals.org/article/article1387269411_Onasoga%20et%20al.pdfPedagogies for Change. n. d. Explore the theory and practice of community education. Retrieved May 22, 2015, from http://www.infed.org/guides/community_education.htmPowell, E. (1996). Analyzing quantitative data. Program Development and Evaluation. Retrieved June 2, 2015, from http://learningstore.uwex.edu/assets/pdfs/g3658-6.pdfTiwari S, Nigam R, Waware RS, Chandorkar RK. Health Care Seeking Behavior and Awareness of Maternal and Child Health Practices in a Rural Village of Madhya Pradesh. Nat’l J Community Med 2014; 5(1): 105-108.UNICEF Philippines. n. d. Health and nutrition. Retrieved May 20, 2015, from http://www.unicef.org/philippines/health_nutrition_9233.html#.VV8MtdK4TDcVera, M. (2012, February 10). DOH maternal health program. Nurseslabs. Retrieved May 21, 2015, from http://nurseslabs.com/doh-maternal-health-program/Werler M. et al. (2006). Trends and predictors of folic acid awareness and periconceptional use in pregnant women. ScienceDirect 2005; 192(1): 121–128. Retrieved May 29, 2015, from http://www.sciencedirect.com/science/article/pii/S0002937804005733World Health Organization. n. d. Health. Retrieved May 20, 2015, from http://www.who.int/trade/glossary/story046/en/World Health Organization. n. d. Information, education and communication. Retrieved May 22, 2015, from http://www.emro.who.int/child-health/community/information-education-communication.htmlWorld Health Organization. n. d. Maternal Health. Retrieved May 21, 2015, from http://www.who.int/topics/maternal_health/en/Zhang L. et al. (2006). Awareness and use of folic acid, and blood folate concentrations among pregnant women in northern China—An area with a high prevalence of neural tube defects. ScienceDirect 2006; 22(3): 431–436. Retrieved May 29, 2015, from http://www.sciencedirect.com/science/article/pii/S089062380600058XCatajan, M.E. (2014, May 1). La Trinidad’s best kept secret. Sunstar Baguio. Retrieved June 01, 2015 from http://archive.sunstar.com.ph/baguio/feature/2014/05/01/la-trinidad-s-best-kept-secret-340763
Local Health Unit: The front-line of community health
Primary health care was approved as the health policy of WHO member states in 1978. In 1979, former President Ferdinand Marcos issued Letter of Instruction 949 mandating the implementation of Primary Health Care. Primary Health Care strengthens the promotion of health care through the training of barangay health workers where they were stationed in their own barangays (Quitevis, 2011). Community Health Worker (CHW) or popularly known as Barangay Health Worker (BHW) in the Philippines is a person who has undergone training programs under any accredited government and non-government organization and who voluntarily renders primary health care services in the community after having been accredited to function as such by the local health board in accordance with the guidelines promulgated by the DOH (DOH, 2011). They are the frontline public health care professionals. They are the trusted member of their community who has knowledge on the community they serve. They are the bridge between the health and other social services and the community. They link the community to have access to services provided by government and non-government organizations. They are responsible on providing culturally appropriate and accessible health education and information, conduct community outreach for health organizations to implement programs in the community that promote, maintain, and improve individual and community health (Lehmann & Sanders, 2007). Qualified Barangay Health Workers (BHWs) according to the Civil Service Commission (CSC) are those who have who has completed at least two (2) years of college education leading to a college degree and has voluntarily rendered at least five (5) years of continuous active and satisfactory service as an accredited BHW to the community (CSC, 1999).
Despite the active participation of Barangay Health Workers (BHWs), some studies showed that there is still a need to improve their skills and continue training in order to better serve their own community. Quitevis recommended that BHW should be given more training on teaching basic health care services to be prepared and equipped in performing their role as health educator (Quitevis, 2011). While it is appropriate to look at the ability of the BHW in relation to designing communication tools as the lack of training is the major problem in communicating health followed by lack of resources. Barangay Health Workers need to improve their delivery of health services with regards to event and strategic communication planning and message development (Sumaylo, Escano & Abrio, 2013). Although a great deal of literature on the Community Health Worker appearing there has not been enough sharing of experiences in a systematic way. If this can be done, it will be a major boost to the process of the Community Health Worker system as well on their performance.
Promoting Maternal and Child Health Care
Progress on health and reducing child and maternal mortality are crucial for development within the household, community and country. The need to pay attention on the health pregnant women and children below 5 years of age is as important as the economy of the country. Delivering health services effectively requires the public sector management policies that provide adequate incentives to health care providers; procurement and distribution policies for pharmaceuticals so that these are available in sufficient quantities in the right places; public health measures to protect the population; and suitable regulation and quality control of private providers, who often deliver more health services than public providers (Baird & Shetty, 2003).
Study in Peru showed that maternal education modifies a woman’s beliefs about the cause and cure of a disease thus influences both child-care practices and use of modern health-care services (Elo, 1992). Some previous studies had reported that many Nigerian women, mostly those in rural areas, rate the services of the traditional birth attendants (TBAs) as being of higher quality than that of medical healthcare practitioners, particularly with regards to interpersonal communications and relationships. In addition, women in rural Guatemala have similarly been reported as being less likely to deliver in medical settings because of lack of social support provided by health-care professionals compared with traditional midwives (Babalola & Fatusi, 2009). This only emphasize that utilization of maternal health care can only be a success if only health workers are sincere and affectionate enough in dealing with their target audience.
The promotion of Child Health initiated by Resources Education and Care in the Home program (REACH- Futures) in Chicago through home visit had shown progressive effect where in only 2 infant deaths occurred during the course of study, lower date rate than the previous program of the city. Boyd then concluded that the use of community workers in promoting the Child Health care program through home visits is effective in meeting the needs of families at high-risk of infant mortality (Boyd, 2001). While the Government of the Republic of Zambia‘s commitment in the promotion of maternal and child health in cooperation of UNICEF had shown significant growth. According to UNICEF-Zambia, immunization campaigns provide access to millions of mothers and children to immunizations, micro nutrient supplementation (Vitamin A), malaria prevention (distribution of free or low-cost insecticide-treated bed nets), and growth monitoring and promotion. HIV counseling and testing coupled with provision of antiretroviral treatment. Campaign materials such as flags and banners with the campaign logo were posted at each targeted health center in the seven provinces in Bangladesh, where a woman who might be pregnant could go for care. According to the UNICEF, ante natal care visits increased from 69 to 89 per cent, delivery by skilled birth attendant from 44 to 71 percent and delivery in health facilities from 22 to 53 per cent between 2005 and 2010 (UNICEF, 2013).
Communication Approaches: Important factors in promoting health
Most of us obtain health information from different media such as printed and broadcast as well as from word of mouth. The need to plan and develop clear, comprehensible tools and approaches in disseminating information and educating target audience is a must in order to create change. But there are certain factors to consider when developing communication materials for the target audience. One is the cultural beliefs and practices of a certain community since this often affects the way medical information are disseminated (Prilutski, 2009). For instance, the use of traditional medicine versus biomedical medicine in Ghana, people in Ghana normally uses traditional medicine because it’s what they are used to. This stresses that there is a need to fully understand the Ghanaian culture when communicating health. On the other hand, according to John Hopkins University, information delivered in an effective manner both culturally and linguistically is needed (Hu et.al, 1989). Certainly, language has a great impact in the functionality of communication materials. In the case of Hispanics living in the United States, a survey showed that they have high incidence of Acquired Immunodeficiency Syndrome (AIDS) compared to the Americans as they tend to have fewer access to information. This is because most of the use of only English in communicating about AIDS which the Hispanics have less understanding. Some of the communication approaches that are widely used in promoting health care are Information, Education, and Communication (IEC), mass media, the internet and social networking sites and interpersonal communication.
IEC has long been used by World Health Organization for two decades in communicating health around the world. Health communicators often develop posters, flyers, leaflets, brochures, booklets, messages for health education sessions, radio broadcast or TV spots, etc. as a means of promoting desired, positive behaviors in the community. “IEC” according to World Health Organization refers to a public health approach aiming at changing or reinforcing health-related behaviors in a target audience, concerning a specific problem and within a pre-defined period of time, through communication methods and principles (WHO, 2001). According to the Ministry of Water and Sanitation, the use of IEC involving communities and grassroots organization can accelerate the process of change and hasten the adoption of sanitary practices. However these efforts must involve sociocultural attitudes towards health practice (MDWS, 2011).
Radio and television are the most often used form of mass media. Although behavioral change brought by mass media campaigns were very small, existing evidence show that mass media efforts to improve public health has increased awareness, raise level of health information, make health topic and problem become noticeable, stimulate interpersonal conversation with family, friends and health professionals, generate initiative to seek more information and strengthen existing attitudes and behavior (Schlinger, 1976). Much of our understanding about health is not necessarily from our experience, most of it came from what we see and hear from broadcast media. According to Friedman, media channels, including print journalism, advertisements, fiction films, television shows, documentaries, and computer technology affect the healthcare system and individuals’ use of that system (Friedman, 2004). Obviously, media representations of health and illness shape our understanding of the experience of illness, health, and healthcare and influence health beliefs, health behaviors, healthcare practices, and policy-making (Seale, 2002). Therefore, health information, when delivered effectively in mass mediated contexts, has considerable potential to promote the health of individuals, communities and populations.
The internet has been recognized for many years as significant source of health information. At present, many government and non-government organizations have their own websites that circulate health campaigns and information which is easier for people to access anytime they need, wherever they are. Moreover, more than 70, 000 websites disseminate health information in excess of 50 million people seek health information online (Cline & Hynes, 2001). However, according to BMJ, information and communication technologies have not been harnesses systematically to improve health of people in the developing countries but these technologies empower those who use information by providing them the choice the information they need and allowing them to put their own information in the web (BMJ, 2000). In addition, researchers conducted a systematic literature review to identify the use of SNSs for public health research and practice and to identify existing knowledge gaps. According to Capurro, number of publications about public health uses for SNSs has been increasingly growing for the past five years. Various studies have fully explored the communication tools embedded in SNSs and study their possibility to produce significant effects in the overall population’s health are needed (Capurro, 2014).
Last but not the least, interpersonal communication according to the Center for Global and Health Communication and Marketing is defined as person-to-person or small group interaction and exchange, is a critical skill for health care providers, hotline call respondents, and others who have direct contact with those we are trying to reach - in order to influence their decisions and help improve their behaviors. It can be both verbal and non-verbal communication, negotiation, and classic counseling techniques (CGHCM, 2015). Communication in health care is not simply social interaction, but an interaction that can affect people’s health and even their survival. Poor communication during patient and health professional conversation can lead to complications (Greenwood, 2015). Therefore, information must all fit together to send the right message that the communicator intends the target audience to understand. Thompson wrote that, understanding the potential role of everyday communication about health may help in discovering points of intervention and successful strategies for health promoting and disease preventing social influence (Thomson, 2003).
The aim to empower target audience through different communication approaches would only become successful if right information is communicated to right people. In addition, improved communication does not mean well-informed people. Not all health information communicated reach target audience due to some factors like for example language, culture, human behavior and location. Therefore the need to develop communication approaches that suit the need of target audience is necessary. That is to make sure that these target audience have easy access and understanding on health information.
Awareness on Maternal and Child Health
To women of reproductive age and mothers of children below 5 years old, it is very important to have knowledge on maternal and child health. Knowledge, information about maternal and child health is one of the key to have a healthy pregnancy, healthy baby and child. Thus awareness about health is significant in sustaining a health, physically and mentally. Health awareness provides health related knowledge to the people for preventing and curing disease. In addition, health awareness has the power to change people’s lives, it creates a new environment to realize their goals and help them to get beyond our problem.
There has been a study on antenatal care in Gambia assessing the awareness of pregnant women concerning antenatal care and results show that ninety percent of those interviewed had attended the antenatal clinic more than once and 52% four or more times. Most pregnant women (70.5%) said they spent 3 minutes or less with the antenatal care provider. About 35% recalled they were informed or educated on diet and nutrition, 30.4% on care of the baby, 23.6% on family planning, 22.8% on place of birth and 19.3% on what to do if there was a complication (Enya et al., 2008). This indicates that pregnant women are not well informed to make appropriate choices especially when they are in danger. In the study conducted in Madhya Pradesh in India, Tiwari further added that about half of the total pregnant women had at least 3 antenatal checkups,85% children were immunized, more than 50% deliveries were institutional and 22% people did not responded regarding the practice of contraception. Therefore, we can say that in spite of proper availability of services we still need to increase the awareness and utilization of the various maternal and child health services (Tiwari et al., 2014).
Studies conducted in Northern China shows the levels of folic acid awareness, knowledge and use among Chinese women mostly less educated and from rural areas, living in a high NTD prevalence area during early pregnancy were very low and folate deficiency was quite prevalent. (Zhang et al., 2006). While in the American Journal of Obstetrics and Gynecology, awareness of folic acid benefits increased from 0 in 1988 to 50% in 1996 and thereafter. The use of folic acid in the periconceptional period increased from 15% in 1988 to 40% in the last few years (Mitchell et al., 2005). Again, campaigns are essential to increase awareness and knowledge on the use not only of folic acid but all the basic vitamins and immunization that a pregnant woman need to have a healthy baby. It should be intensified to reach the target audience especially disadvantaged groups to further decrease the prevalence of neural tube defects. Wide gaps exist between awareness and practices related with maternal and child health due to lack of information, low education or non-adoption of knowledge into actual practice. An adequate understanding of a woman during pregnancy, especially during lactation can be helpful in improving maternal and child health (Kumar et al., 2008).
There has been good evidence that health communication has created high level of awareness that affected health behavior. According to Hornik, there’s large amount of health behavior change in many important areas (e.g. The National High Blood Pressure Education Program, the Dutch AIDS Communication Program, the Philippines National Immunization Program etc.). Despite the ambiguous evidence from controlled trials, he further added that public agencies assumed that public health communication is a powerful tool in changing behavior (Hornik, 2002).
Operational Definition
Maternal Health ~ refers to the health of a woman before, during and after pregnancy. It involves maintaining the health of mother and unborn child by providing quality pre and post natal care, immunization and micronutrient supplementation.
Child Health ~ refers to the protection of child’s health from birth and under five (5) years of age against malnutrition and infectious diseases by monthly monitoring providing basic immunization, deworming and vitamin A supplementation.
Awareness ~ the state of having knowledge and information about maternal and child health care.Communication approaches ~ these are tools and ways the BHWs use in communicating the Maternal and Child Health care services.
Health communication ~ is a key strategy to inform the public about health concerns and to maintain important health issues on the public agenda. The use of the mass and multimedia, traditional media and other technological innovations to disseminate useful health information to the public, increases awareness of specific aspects of individual and collective health as well as importance of health in development.
Health education - comprises consciously constructed opportunities for learning involving some form of communication designed to improve health literacy, including improving knowledge and developing life skills which are conducive to individual and community health.
Methodology
Research Design
The proposed study will use qualitative method which will involve describing, surveying and interpreting data base on the questionnaires that will be given to the respondents. The study will focus on determining the awareness of target audience on the Maternal and Child Health Care services offered by the Barangay Health Center and effectiveness of communication approaches used by the BHWs in promoting the Maternal and Child Health Care.
Respondents and Locale of the Study
The respondents of this proposed study will be 30 percent of the population aging 15 to 49 and the Barangay Health Workers (BHWs) of Barangay Tawang, La Trinidad, Benguet. Tawang is one of the 16 barangay of the municipality of La Trinidad, province of Benguet. It is low-lying mountain overlooking the La Trinidad Valley. It is known for its famous Mount Kalugong (the local term for hat) was taken from a set of rocks which look like a hat, which is very visible from the valley when looking up the heights of the Tawang area. According to Mila T. Pagcial, the midwife of Barangay Tawang; the population of the barangay as of December 2014 has reached 9, 333 with 2, 098 number of households.
Collection of Data
The researcher will distribute questionnaires to the respondents during clinic days on Monday, Wednesday and Friday at Central Tawang , Tuesday and Thurday at Banig, Tawang and during field clinic on 5 different sitios of Barangay Tawang such as Banig, Boted, Central, Densi and Papasok scheduled on weekdays once a month. The questionnaires will be explained in one or group discussion to ensure a better understanding and quality responses from the respondents.
Data Analysis
This study will use both qualitative and quantitative method of data analysis. After gathering the needed data, the researcher will tabulate the data and will use descriptive statistical analysis such as percentage and frequency to determine awareness on Maternal and Child Health care from the residents. Also the weighted mean will be employed to interpret the responses of the respondents on the effectiveness of the communication approaches. Respondents will rate effectiveness of the communication approaches from 1 to 5, where 1 is the least effective and 5 is the most effective. Finally, the researcher will compare the relationship between the awareness of the respondents on Maternal and Child Health Care and the effectiveness of the communication approaches.
Appendix A: Survey Questions
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