Health Communication: Training Programs for Semiliterate and Illiterate Populations – Swaziland Case Study
Health communication focuses on the solution of health issues through the dissemination of selected messages to communities. Most organisations apply various means to spread health messages including the use of social media and personal interactions with target audiences.
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Although communication plays a central role in th the study of health communication as an independent principle, this branch of communication intertwines with other fields of study including strategic planning, sociology, politics, and economics. This paper explores some of the essential elements involved in health communication.
The paper involves the creation of a training program for a group with limited literacy levels by using the Kingdom of Swaziland, in Africa, as a case study. The program centres on the HIV/ AIDS pandemic, which has created a health problem for in Swaziland, thus causing significant effects in the economic and social spheres of the country’s structural arrangements.
Planning a Training Program
When planning the execution and successful implementation of a training program for health communication, medical practitioners have to consider several crucial aspects including conducting research, establishing essentials for the program, identifying the participants, and planning the overall management of the program.
When conducting a research, one has to consider the target population for the program to establish the setting of the program, viz. whether formal or informal. It also helps in establishing whether there is a need to apply a multi-faceted approach to the method of dissemination of information.
For instance, one may choose to use social and print media for a large population or seminars at a central location for smaller populations. Swaziland has a population of over a million people and social or print media would thus be appropriate in comparison to seminars.
The culture of the people that make up the target population is also important as it informs the researcher on what language to use and habits that comprise the appropriate mode of interaction with the audience. It also allows the audience to connect with the researcher regarding feedback on the issue of discussion, which in this case is HIV/AIDS (4). For instance, in Swaziland, men possess an air of superiority to women; thus, it would be easier if a male researcher engaged the male audience than a female (4).
In addition, the two most common languages in the country are siSwazi and English. Therefore incorporating the use of such languages in the program using translators or people familiar with the languages ensures a wide coverage and proper transmission of the right messages to the population. Consideration of culture also earns the researcher respect and increases the possibility of success for the training program.
The researcher also has to acquaint him/herself with the local laws especially those concerning topics relevant to the program. Laws of health care management, business transactions, and social interactions are relevant in establishing the right form of communication as they affect the mode of transmission of health messages.
For instance, laws on association and assembly govern modes of communication that require people to gather at a central location while laws on freedom of the media govern social media information outlets. For this specific training program, it is also important to assess the type and number of health facilities available for use by the population. Such institutions form an integral part of the program with regard to the practical application of principles taught at the training centres and information spread through media outlets.
The economic state of the country affects the conduct of the program in several ways, and thus it is worth researching on the same. First, the status of the economy determines the level of funding that the program is likely to obtain from the local government and the need to source for capital from outside sources. Secondly, it determines the approach through which to address various issues regarding the program.
For instance, the unemployment rate in Swaziland is significantly high due to low standards of education and high-income disparity between the rich minority and the poor majority in the country.
Therefore, the use of a mode of transmission of information that enables some of the locals to earn an income would be a welcome affair. An example of such a mode of transmission of information is through door-to-door campaigns using local residents for a specific fee a day depending on the number of people who sign up as volunteers or attend seminars.
Establishing Essentials for the Program
Training Methods Useful to the Group
There are three basic essentials to running the training program, viz. theoretical training, practical training, and fieldwork and administration of the program. The theoretical training aspect mainly involves the exploration of the issue with the participants at an interpersonal level through seminars, campaign rallies, social media discussions, and counselling sessions for individuals (2).
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The theoretical training forms the most essential part of the training as it aids in demystifying some myths that surround the topic of HIV/AIDS for the country. For instance, one of the most common myths in some African nations is that having intercourse with virgins cures HIV/AIDS. Another similar myth that might help to explain the spread of the affliction in Swaziland is that HIV/AIDS infections only occur to people who practice ‘immoral sexual behaviour’ such as sex outside marriage.
Therefore, people in marriages shun the use of contraception such as condoms despite the polygamous nature of their relationships. Theoretical training also allows the target audience to voice their concerns regarding the issue, thus enabling trainers to understand the mindset of the audience and the provision of appropriate solutions.
An example of some of the concerns that may arise during theoretical training is the type of diet that a person infected with HIV/AIDS needs in order to remain healthy and reduce his or her vulnerability to other infections. Most people in Swaziland practice subsistence farming, and thus they may want to know the right types of foods to grow depending on their health status.
The practical training aspect involves the application of specific skills and knowledge taught in the theoretical training forums in addressing various issues regarding the subject matter. The audience puts to action information regarding interactions with infected individuals, hygiene measures, and consumption of medication.
Although a large portion of the population in Swaziland suffers from HIV/AIDS infection, stigma remains a major problem, thus hindering access to important information, medication, and help regarding matters relating to the infection. Some people prefer to keep their status a secret for fear of stigmatisation, which results in potential accidental infections especially for individuals in polygamous marriages and unborn children.
Considering that the majority of people, which form the target audience, is semiliterate and others illiterate, it is vital to apply methods with which most of them can associate (1). One such method is provision of demonstrations, using the local language whenever possible. Such demonstrations would entail methods of maintaining proper hygiene, interaction exercises, and consumption of anti-retroviral medication (ARVs).
The program management may also apply overseas assignments and exchange programs in addition to in country training in order to enhance exposure of the trainees to methods other countries use to combat the pandemic. Choosing a few local trainees for such assignments and incorporating them into an in-country training program, as mentors and counsellors, would help the rest of the population to understand that the problem they face is not limited to their territorial boundaries.
The importance of having the population understand the international perspective is that it would reduce the level of stigma with which they treat people with HIV/ AIDS, thus making it possible for such people to seek medical intervention without fear of societal perceptions.
The administration segment of the program involves organisational matters such as recruitment of employees and volunteers, management of finances, formulation of strategies to suit specific situations, and establishment of relevant information for dissemination. Managerial expertise is utterly valuable for the successful execution of all administrative tasks for the department.
Therefore, it might be important to set up an office where all the administrative tasks for the program take place in addition to information distribution points such as lecture halls and testing centres. Central management of the training program is important in ensuring proper coordination of all activities taking place throughout the country regarding the program, especially when such activities occur simultaneously.
Centrality of management also eases division of tasks among the program’s staff. Consideration of adoption of a collaborative style of management is also crucial to the timeframe through which the program accomplishes its goals and the overall success of the program. Collaborative management is a form of management that fosters interaction between the management staff and other parties outside the program mainly to obtain vital information that may add value to the program.
For instance, incorporation of assistance from Swaziland’s ministry of health or health centres across the country would make collection of background information about the spread of the pandemic within the population easier and provide more accuracy than reading about the same in media archives. Consultations with local organisations with similar programs also help in the determination of an effective structure for dissemination of information to the masses.
It is important for the training program’s management to consider the participants that the program involves in order to generate modes of communication that are relevant to each set of participants. This specific program involves healthcare professionals, counsellors, and individuals of different ages living with HIV/AIDS, as well as those who are infection free. Although some messages may work effectively for the entire set of participants, some messages need to target specific sets of participants for greater impact and efficacy.
For instance, messages advocating for abstinence and use of contraception would work well for the entire population as a means of reducing infections within the society. On the other hand, messages concerning the proper consumption of ARVs would fade in relevance for individuals who are infection free. Therefore, setting up separate training sessions and support groups for people living with the infection would work better in spreading the intended message.
Further, communication methods that work with adults would not necessarily be appropriate for teenagers and youths. Adults have more experience with sexual matters as compared to children, and thus they understand issues regarding contraception and safe sexual behaviour better. Children require a sensitive approach when discussing matters of a sexual nature such as sexual abuse and avoidance of sexual situations. Messages targeting such a set of participants need to appeal to their level of cognitive abilities.
The role of health practitioners in the program is to assist in spreading appropriate health messages regarding the subject matter to their patients as they attend to them in various health institutions all over the country. They serve as ambassadors for the program, who spread messages of healthy habits that mitigate the spread of the pandemic.
Counsellors work on a face-to-face basis with most people who seek their services and are thus in a better position to address individuals according to their specific needs. Such participants are assets to the program in terms of data collection on the spread of the pandemic, issues of concern for most of the population, and formulation of effective messages to relay to the public.
They also contribute to the program by spreading health messages on HIV/AIDS to their clients, which are specific to the type of client and his or her needs.
Constant review of the program’s success is crucial in establishing elements that do not work and improvement methods of message dissemination and collection of data. Evaluation of personal feedback from participants, financial costs, and achievement of objectives enables the program to stay on track and achieve its goals within the timeline within which the management hopes to run the program.
Reviewing the program also helps the management in dealing with challenges as they arise throughout the duration of the program. Some of the challenges that the program is likely to face is compliance with local culture, language barrier, recruitment of training staff from the local community, and obtaining government funding. It would take some time during the initial stages of the program for the training personnel to deal with these challenges while keeping up with other unforeseeable challenges as the program settles.
Applicable Research Methods
Ethics describe a particular code of conduct that suits specific circumstances. Research ethics dictate how individuals should behave in the conduct of their research in order to prevent the performance of activities that may result in potential infringement of the rights that other individuals possess under the law. One of the basic rights prone to infringement by research activities is the right to privacy. Every individual has a right to keep certain information about him/herself without the threat of someone else prying, obtaining, and using it for personal gain.
Research involves the publication of information that the researcher obtains and thus publication of information concerning individuals that they consider private would go against the code of ethics and cause reason for legal action. For instance, publication of personal information an interviewee volunteers during an interview would go against research ethics, possibly causing complications that may lead to the nullification of the entire research project.
The preparatory research method of choice for this program is ethnographic in nature, as it involves several modes of data collection in a bid to ensure objectivity and diversity of perspectives. Ethnographic research appeals to the cultural aspect of the target population, personal opinions that different individuals hold regarding HIV/ AIDS, and the diversity of age brackets that people involved in the research fall in. Some of the methods applicable in ethnographic research include interviews, observation, and literature review.
Interviews cover the part of the research that requires personal one-on-one discussions with various individuals in order to collect data relevant to the formulation of the program’s strategic plans.
Interviews are essential in collecting information that the population would not reveal through behavioural observation such as reasons why individuals with HIV/AIDS choose not to seek medical intervention openly. Application of observation in data collection allows the researcher to learn the behavioural patterns of people in their natural environment without interference.
Observation is one of the easiest ways through which training staff new to the region can learn what the community expects them in terms of compliance with culture. Literature review provides an informative study of the background of the problem as well as the community’s methods of addressing the issue in years preceding the establishment of the training program.
During the application of the various methods in the conduct of the research, it is critical that the researchers observe research ethics.
Research ethics ensure that researchers do not go beyond their mandate in the expression of their freedoms through acts such as expression of opinions that mount to incitement. This rule mainly applies in interview scenarios where the interviewer and interviewee usually engage in face-to-face conversations. Research code of conduct ensures that the interviewer protects the interviewee’s private information by filtering information that s/he collects before the same is available for public access.
The existence of research ethics assures an individual giving information that his or her private information remains private. The importance of this requirement for the research is that it makes the research process possible by ensuring the availability of valuable information for the enhancement of knowledge of important issues affecting society.
Main Aspects of the Research
Conducting proper research is one of the essential steps that a health practitioner needs to take when creating a training program. Research for the training program requires consideration of several variables for objectivity purposes. The first variable that requires such consideration is the population of the area of focus.
The area of focus in this case is the Kingdom of Swaziland, which is a small state located in southern Africa. Swaziland is a landlocked state capped between the Republic of South Africa and Mozambique. The country’s population matches its size. According to the country’s census statistics in 2020, the population at the time comprises approximately 1.1 million people living within a total area of approximately 17,300 square kilometres (5).
The population determines the type of research that one chooses to apply as well as the right channel through which to send health massages to the population. Both methods have to be effective, efficient, and affordable for the health practitioner conducting the program and the population, which forms the target audience.
The second variable in research is the culture of the target population. Culture is an element that displays the uniqueness of different societies.
It connotes the distinctive ways in which people live, represents their experiences, and displays the changes that different environments can have to people’s behavioural patterns. Some of the elements that constitute culture include language, traditions, religion, leadership, technology, and cuisine. Scholars explain that when people live together for a substantial length of time, they develop habits that help in defining who they are. Culture is a versatile concept that changes depending on its interaction with external elements.
The changes usually take the direction of convenience for the existing population as part of the adaptation process that most people experience when there are changes in environment and other factors. When formulating a plan for a training program, it is especially important to award due consideration to the language that most people in the population understand, as it ensures the delivery of the intended message devoid of distortion and ambiguity.
The application of the right language also ensures that the target audience understands the health issue that the message addresses as well as the changes that the health practitioners suggest for adoption. Choosing the right language also fosters easier interaction between the health practitioners developing the program and the population.
Swaziland uses two main languages for communication throughout the population. As most of the country’s inhabitants are native Swazis, the most common language of communication is siSwati. International relations between the country and other nations globally have also necessitated the adoption of a language with a wider global acceptance, thus resulting in the adoption of English as the second major language of communication in the state (5).
The behavioural interaction of the people in the population also plays a vital part in the establishment of a mode of communication that best suits the purpose of the training program. For instance, the stratification of the Swazi society in terms of gender and age results in a division of power into a system whereby men hold a lot of power. The resultant effect is the creation of a chain of command through which people interact and communicate.
Another element of culture that affects the creation of a training program is marriage. Marriage dictates the manner in which men and women interact in most societies and subsequently it affects the spread of HIV/AIDS. Marriages also present various moral, religious, and legal responsibilities. It governs gender roles and establishes status especially in the Swazi society. One of the responsibilities marriages bestow upon individuals in society is reproduction.
The Swazi culture supports women bearing many children as a sign of fertility and as a means of preservation for the population. The cultural support of reproduction has a logical reason bearing in mind that the country has the highest rate for HIV/AIDS prevalence in the world, as the move ensures preservation of the community’s legacy. However, such cultural support for reproduction increases the chances of sexually active individuals contracting sexually transmitted infections and diseases.
Additionally, the society insists on the role of men in reproduction, thus encouraging infidelity even in polygamous relationships. The Swazi believe that the role of men is to impregnate as many women as possible without consideration of raising the children that come from such activities.
As a result, Swaziland struggles with the problem of raising thousands of orphans. In most societies across the world, marriage elevates the social status of individuals by turning them into role models for the younger generations, which is one of the main reasons most individuals feel the pressure to engage in marriage at a young age, in order to earn the respect of the entire community.
Although marriage is a social concept, it also bears legal implications for the individuals in the union. For most societies, such obligations include attendance to debt and providing suitable provisions for children that result from such unions. Further, most societies prescribe to a form of marriage that comprises the union of one man and one woman, an aspect that makes it easy for society to identify individuals that deserve due respect as married couples as well s identification of individuals responsible for the welfare of the children in society.
Swaziland’s culture presents some complications regarding the legal aspect as most of the society engages in polygamy, making it difficult to track family debts and for fathers to take care of their children, hence the orphan situation.
The incorporation of marriages that allow the union of male adults and teenage females further complicates the issue, as it is hard to distinguish children and wives in the female teenage population. It therefore becomes difficult for the society’s institutions of law to intervene where situations require such intervention for the protection of the teenager in question.
Early marriages are a common occurrence in some societies especially in Africa and thus it comes as no surprise that Swaziland also subscribes to the practice. Ordinarily, early marriages occur between two teenagers. However, in some cases they do occur between adults and teenagers.
Swaziland serves as a good example of a country whose traditions foster the latter form of marriages. There are various reasons why teenage females choose to engage in early marriages, the most common of them being pregnancy. In Swaziland, teenage pregnancy is a concept that the society treats with a lot of stigma, resulting in the preference for marriage by teenagers to adult males as a strategy to save face.
Culture forms yet another reason why teenagers resort to marriage at such tender ages. For instance, Swaziland’s culture favours polygamy and detests family planning, hence the high prevalence of HIV/AIDS. Most women in the society consider marriage a privilege, as most men prefer polygamous affairs. Therefore, females in their teenage jump at the opportunity to marry older men just to attain the status of married women.
Men also perceive female teenagers as an avenue to avoid the pandemic as most of them lack sexual experience. As a result, the risk factor for contracting HIV for female teens is higher than it is for males in the same age bracket. The third reason why teenagers choose early marriage is for security, both personal and financial. Personal security refers to the need of the teenagers to have better companionship and prevent harassment from other male members of society.
Demand for teenage brides by adult males for marriages commonly known as ‘Kwendizisa’ has resulted in a culture that supports the occurrence of early marriages by teenage girls. The economic hardships most families face increase attraction of teenagers to marriages as they seek alternative lifestyles in a bid to obtain better lives. However, this is not always the case due to high rates of polygamy as part of the local traditions.
Thirdly, the type and level of education in the country is an important variable as it affects the level of understanding of basic issues concerning the population and the way the population perceives its surrounding environment, within and outside the territorial borders. Most scholars attribute the level of HIV/AIDS prevalence in Swaziland to poor quality education and lack of accessibility to advanced education. The education system covers three levels, viz. the primary level, secondary level, and tertiary level.
The primary level comprises seven individual stages (grades one to seven) in which the first two are government-sponsored, and thus free for every child. Most children join Grade 1 at six years of age while others join later depending on personal cognitive abilities and the families’ financial ability. Although most children get through the basic primary education, only about twenty percent of children get access to secondary education and the number falls below the percentage at the tertiary level.
Most parents prefer to hold their children back to attend to farms. Additionally, most families live on an income of less than two dollars a day, and thus they can only afford to send a single child at a time to school at that level. The government does make an effort to ensure children of school-going age that successfully complete the secondary level obtain tertiary education through government sponsorships.
However, such students only account for a small fraction of the population. Therefore, it is important to consider a means of communication that appeal to the semi-literate population that forms the majority of the population in Swaziland. Use of methods that the community can relate to such as using storytelling to demystify myths about HIV/AIDS has a greater impact than using formal lectures.
The economy of the country is another important aspect for consideration in the preparation of the plan for the training program. The reason for the importance of the economy is that it etches on the practicability of the program rather than the theory. It is important to consider the long-term success of the program in addition to the short-term. The economic situation in the area of operation should be viable enough to achieve the goals the training program sets for achievement.
Most training programs concerning HIV/AIDS explore issues such as the prevention of the spread of infection, outreach campaigns to demystify myths about HIV/AIDS, mitigation measures for infected individuals, and addressing stigma in the society. These elements require different forms of support, some moral, but mostly financial. Swaziland struggles with a slow economy and many important issues in need of government support such as education and creation of employment opportunities.
Therefore, it is important to explore all possible options including foreign sponsorship.
Lastly, consideration of the laws applicable on the subject of concern enables the operation of a program without breaking local laws in the process. Such consideration is important as it allows the health practitioner to conduct the training program without interference from law enforcement or hostility from the community.
Research on relevant laws such as laws on marriage, basic rights, and freedoms and the economy aid medical practitioners to avoid giving misguided advice to the population (3). For instance, in Swaziland, the law does not support sexual activities involving teenagers.
In the past, the practice was rampant and tolerable to the community to the point that it became a norm in the society. The government of Swaziland banned such sexual activity by terming the same as an offence, except in the union of marriage. However, in 2012, the Swazi government enacted the Children’s Protection and Welfare Act, which makes any sexual activity involving teenagers regardless of their marital status illegal (6).
The move was part of the government’s efforts to protect children from undue exploitation from adults as well as an avenue to curb the spread of HIV/AIDS within the society. It is also important to consider healthcare laws, especially the government’s strategic plan to curb the menace. This aspect ensures that the training program and the government’s goals run in tandem for the achievement of a common objective, viz. prevention and eradication of HIV/AIDS in the country.
The formulation of a training program that takes into account the literacy levels of the population is Swaziland requires careful consideration of several other essential factors including the culture of the region, the size of the population, the economic status of the country, relevant laws, and the education and healthcare systems in the region.
Proper research on these aspects informs the type, amount, and the mode of training that the program will focus on and allow for a review of the program for the successful achievement of the program’s objectives. Incorporation of local residents in the program as part of the training staff and seeking help from healthcare institutions within the area ensures the programs efficacy and compliance with the set timeframe for the accomplishment of proper training.
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