April 7 is World Health Day, a celebration of the founding of the World Health Organization (WHO). As we look at communications efforts to raise awareness about this year's theme of high blood pressure and to change behaviour to help prevent it, we're reminded of some valuable lessons we've learned from women in Guatemala about listening to and supporting the people we our trying to support with our health promotion messages.
Events like World Health Day are an excellent way to focus on prevention and get a groundswell of support and messages out there to reduce chronic conditions like high blood pressure. Those of us who work in the social marketing sector are so supportive of well-designed efforts like this because we know how they can play a role in contributing to an overall health improvement in a population.
But sometimes in our day-to-day public health work, the way we deliver messages can create more obstacles than we realize. Changing behaviour does not come easily to anyone and a behaviour change project requires great insight into people's lives to understand the barriers to change.
Part of our formative research on the Grand Challenges Canada project in Guatemala is to discuss with mothers what their experiences have been like during visits to a health centre with a child sick with diarrhea. We've received really important feedback about how women and their children are being counselled in the health centre.
The major issue? Hearing endlessly about hand washing.
We know that hand washing is such an important part of preventing the spread of disease -- colds, the flu, hepatitis A, pink eye and, of course, diarrhea -- and messaging about hand washing is a key tool in our health toolbox. But we could be potentially alienating these mothers and may even drive them away if all they hear about is hand washing when what they really want is treatment for their children.
"I went to see them [the health centre] when my child had diarrhea, and all they say is wash your hands -- like it is my fault, but I did wash my hands and he still got diarrhea... It makes me want to just walk away," said one mother of three from rural San Marcos.
The reality is that San Marcos is a really impoverished area of Guatemala -- there's rarely any plumbing, (indoor or out) housing is simple (often with dirt floors) and most families raise livestock to feed their families and supplement their income. These mothers are telling us that all the hand washing in the world won't entirely eliminate diarrhea. If hand washing is the primary message they're receiving when they go to a health centre, they may start to feel guilty and not want to go back the next time a child is sick.
Some of the mothers described the messages as condescending. Taking this year's World Health Day theme as an example, if someone is lying on a hospital bed suffering from a heart attack, that would not be the time to start talking to him or her about how important it is to reduce high blood pressure!
Public health clients should be respected and offered carefully chosen health messages that meet their needs and current worries. Making a mother feel guilty or suggesting blame may make her less likely to return to the health centre. It's also a missed opportunity to remind her of the positive impact she is having by bringing the child for treatment. When a child is sick with diarrhea, we have to concentrate on counselling the mother on how to heal her child with the proper use of zinc and oral rehydration salts (ORS).
This doesn't mean that good campaigns to promote hand washing aren't important. On the contrary, they definitely are. But the mothers we spoke to in Guatemala have told us loud and clear that they have to see the value in the information they're receiving -- which means delivering the right information at the right time.
The right message at the wrong time could negatively impact health promotion efforts -- and raise anyone's blood pressure.
