Designing health education messages to encourage healthy behaviour, disease preventive practices and to encourage people to seek care

VEHA - Field Implementation Guidance

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Designing health education messages to encourage healthy behaviour, disease preventive practices and to encourage people to seek care

Context

Overview

Environmental factors causing/contributing to the needs and affecting the humanitarian activity

If affected populations have relocated to a place with a different climate and significantly different local environment, they will need to learn how to live sustainably within that climate and environment. For example, if people used to live in a place with abundant water resources and disease spread by mosquitoes, and the new location is drier, health messages should help them understand that whilst previous diseases may not be a threat locally, there are new diseases that they need to understand and know how to mitigate and treat. Additionally, people need to be advised against practices that can increase the risks of zoonotic diseases such as leaving standing water which increases the risk of vector-borne diseases, or unmanaged dumping of waste which can increase the number of animals nearby.

There is also a relation between hygiene, the environment, and health. Better hygiene practices increase health, while hygiene practices that have negative impacts on the environment can also be detrimental to health.

Implications

Gender, age, disability and HIV/AIDS implications

Women’s hygiene needs are different from men’s. Their specific needs should be assessed and addressed in culturally appropriate ways. Promoting reusable menstrual kits will have a significant impact on reducing waste in the environment and help women save money. Similarly, nappies/diapers cause substantial environmental waste. Promote the use of reusable nappies/diapers and effective methods of cleaning them.

Health promotion messages also need to be customized for target groups such as women, girls, persons with disabilities, and HIV/AIDS in order to highlight the relationship that their actions have with the environment. For example, women may use disposable menstrual items that require guidance for proper disposal.

Engage communities to provide information in formats and languages that are accessible for older people, persons with disabilities, women, and children. Take the time to test and validate messages on sensitive issues.

Impacts

Environmental impact categories

Air pollution
Soil pollution
Water pollution
Deforestation
Desertification
Eutrophication
Climate change
Loss of biodiversity and ecosystems
Natural resource depletion
Soil erosion
Cultural acceptance
Impact on wellbeing / mental health

Summary of Impacts

Potential environmental impacts

Poor hygiene practices can lead to mismanaged waste, leading to secondary effects such as water and soil contamination, with ensuing health consequences such as an increase in diarrheal cases.
Environmental impacts due to beneficiaries acting upon health promotion messages in ways that were not intended by humanitarian agencies, and a lack of explanation of the relationship between hygiene, the environment, associated risks, and their health.
Waste generation due to massive production of health promotion information, education, and communication materials (such as leaflets, packaging, printed paper…).

Accumulation of waste from unused delivered health and hygiene items due to misunderstanding of the perceptions, needs, coping mechanisms, capacities, existing norms, leadership structures, and priorities of affected communities, and lack of effective communication when delivering the health promotion messages.

Impact detail

Detailed potential environmental impact information

Hygiene practices are tied to social and cultural norms. Hygiene messages should be based on an identification of possible environmental degradation and environmental health risks. People should understand how their actions influence environmental health, which in turn is directly related to people’s health. For example, open defecation, or disposal of grey or black water has a much higher risk of disease spread in damp or temperate climates than it does in very hot dry climates.

The production and use of hygiene promotion materials can increase problems with general waste management that could increase disease vectors in the local community. In addition, WASH-related environmental behaviour might also include rational or irrational consumption of water, based on availability and cost in the community’s original place of origin. Hygiene and health messages will be interpreted by people against their existing frame of reference and previous environmental behaviours – that environmental behaviour may come from another place/context, or a period of a greater abundance of natural resources such as safe water.

When health promotion messages are delivered using materials that are not compatible with the preferences of the people, new waste streams may start to appear (printed paper or packaging). This may negatively affect the environment due to the accumulation of waste.

When the perceptions and needs of people are not considered, health and hygiene items may accumulate and then become waste. For example, when there are specific preferences for the type and uses of health and hygiene items, unneeded items contribute to unnecessary consumption of resources while leading to increased waste generation. This can impact the environment negatively because the accumulation of waste can lead to water and soil pollution due to spills and the accumulation of liquids. This may include plastic waste but also items such as unused sanitary towels, which can quickly block pipes and drains and contribute to flooding. This may also include abandoned soaps which can end up in rivers and streams and change the quality or pH of the water bodies in the area, killing flora and fauna. In addition, if the health and hygiene items distributed are inappropriate, it is likely that any messaging about the management and disposal of those items will be ineffective. This may lead to increased contamination associated with menstrual hygiene items, toilet paper, or similar.

Guidance

Summary

Summary of environmental activities

Integrate information into health promotion messages related to the environmental and health impacts of poor hygiene practices.
Adapt or create new health promotion messages according to the context to explain possible environmental risks and opportunities.
Compare environmental, hygiene, and health risks between previous and current population locations.

Minimize the printing of leaflets – find alternative ways to communicate health, hygiene, and environmental messages.
Consult communities to determine the most effective communication channels with communities.
Understand how communities use and perceive health and hygiene elements and provide effective communication regarding the delivery and use of health items.
Identify practices related to health and sanitation and the use of health items and their impact on the environment

Detail

Detailed guidance for implementing suggested environmental activities

Assess WASH-related environmental behaviour in point of origin and current location (for example management of different types of waste, water storage and consumption, norms and expectations about water availability and water value/scarcity);
Develop environmental messages and guidance for the population, the resources that they might need to follow that guidance, and any barriers to them adopting that guidance (barriers may be environmental, related to available resources, attitudes about the environment and resource ownership, availability or value). If people come from a context of resource abundance or from a place where it is not necessary to pay for or limit consumption of water or other resources, they may need further support to adopt new practices;

Remember that age often makes a big difference in environmental matters. Children and young people are often more concerned about environmental issues and more open to adopting new environmental practices.
Integrate messages into health promotion that explain the relationship between environment, public health, and the negative impacts of poor hygiene practices on the environment.
Together with health practices affecting health, practitioners should also tackle health practices affecting the environment. In case of doing health promotion through printed materials, include notes of how to correct disposal the material after their usage.
Menstruating women and people with chronic health conditions (including HIV/AIDS) often need greater volumes of water every day to satisfy their hygiene needs. This should be taken into account when developing public health messages related to the rational use of water and the environmental behaviours that people may have brought from other places or contexts.
Environmental determinants of health, such as air pollution and poor water quality, need to be considered when promoting good practices.
Work with other sectors to develop general prevention measures and establish integrated health and environmental promotion programmes at the community level
When delivering messages regarding health practices, the perceptions, needs, manners, and existing norms of affected communities should be taken into account as well as existing hygiene practices.
Health, hygiene, and environmental message delivery need to be adapted and contextualized to ensure understanding and acceptance by the target population.
Integrate messages into health promotion that explain the relationship between environment and public health and the negative impacts of poor hygiene practices on the environment.
Consult communities when developing these messages and look for community environmental champions who can support the design and delivery of the messaging.
Link up with local environmental education programmes regarding rational use of water and local environmental determinants of public health. Try to provide those programmes with support and facilitation to expand their reach and scope as well as replicate their messages in areas that they are unable to access. As a part of the exit strategy of the response, try to facilitate and hand over to those programmes (with sufficient resources and capacity building to allow them to operate at a greater scale than before the emergency).
Consult communities to determine the most effective methods of communicating health, hygiene, and environmental messages. These may include local radio, television, community meetings, mothers groups, farmers groups, community theatre, radio, social media, mobile loudspeakers, billboards, murals (lead-free paint), house-to-house campaigns, and other means that minimise the distribution of leaflets and materials.
When producing communication elements such as leaflets, printed papers, and packaging, determine which are the most effective ways of communicating the messages by understanding the perception and needs of people.
Create recycling or reusing campaigns for those delivered items (they can be recycled or reused in the future).
Design communications materials based on community preferences at the same time as minimising resources used and waste generated.
Assess community behaviours and preferences to ensure health items are familiar and likely to be used, or to determine any need to inform and promote the adoption and use of alternative more sustainable items.
Health promotion messages should address sustainable actions in order to protect and control the usage of the available resources to perform health and hygiene actions. For example, determine the minimum amount of water to use per type of action and encourage appropriate use. In addition, the messages should consider the delivery of culturally acceptable health items to minimise waste from unused goods.
Informational campaigns should be a complementary activity to ensure that healthcare infrastructure is properly used and maintained, thus minimizing potential environmental impacts.
Users should be informed about appropriate water usage, conservation and storage practices, and campaigns should be monitored to ensure effectiveness.
Systems for regulating water usage reduce the likelihood of irresponsible individual behaviour and water wastage, and local community structures can enforce water usage regulations. Alternatively, pricing schemes also influence behaviour while subsidizing operational and maintenance costs.

Lessons Learnt

Lessons from past experiences

Health promotion messages need to be customised to take the needs of different groups such as women, girls, people with disabilities, and HIV/AIDS into account (for example, some groups might be more dependent or more exposed to certain hazards, such as lactating women and women may use disposable menstrual items that should be disposed of properly).

Activity Measurement

Environmental indicators/monitoring examples

Percentage of affected population that received environmental messages (outlining how sustainable actions improve environmental and public health) – Referring to public health messages adapted to the environmental behaviours of the population and environmental conditions in the place where the response is being implemented.
Number of environmental champions engaged to promote environmental sanitation messaging. – Consider also the frequency of community consultations to assess the effectiveness of messages and which take into account how people respond to that message in terms of environmental behaviour. This is because the environmental impact is about people responding to public health messages in ways that might damage the environment.

Number of people/percentage of assistance recipients consulted on communication preferences.
# of sustainably sourced, re-usable items that are demonstrated to be effectively used by the community
# of new sustainable items that have been promoted to and successfully adopted by communities

Priority

Status

High

Main Focus

Focus of suggested activities

Prevention of environmental damage
Environmental mitigation

Implications

Resource implications (physical assets, time, effort)

No additional costs, just additional time to integrate environmental messages and actions into existing messaging.
Given that any effective public health campaign should be developed based on a survey of the most effective means of communicating with the target audience, there should be no significant additional cost implications. The costs of design and printing could instead be dedicated to social media management, renting mobile loudspeakers, or hiring a part-time social media officer.
Time to assess community behaviours and preferences and source sustainably produced, re-usable health items, or to develop awareness and adoption campaigns for alternative items.