Level I : Conveying Suitable Messages to Selected Target Groups

In any nutrition/health education programme it is extremely important to identify suitable messages for a particular community. We must remember that different messages may be relevant for different groups within the community. For example, messages relevant for a group of young women would  be quite different from those for a preschoolers'  group. Of course the form in which a message is presented would  vary too. Presentation can be positive or negative. A positive message for a group of poor preschoolers would he-eat greens to keep your eyes healthy. An example of the same message in  negative form could be-Eat  grcens or you'll  go blind. 

Now what is the process involved in 

a)  identifying a suitable message for a particular target group and 

b) conveying the message through selected communicators and channels of communication? 

Look at the process model illustrated in. It begins with identification of the target group and relevant message in Step 1. How is this done? Information is collected about the community as a whole through interviews with field level workers and community members. A group of community members can also do a self survey. In other words they can map out the area in which  they live using stones on a piece of land or chalk on a hard floor or pen and paper (see Annexure I for details). As a result they may point out a group of people in  the area who are particularly affected by a nutrition or health problem e.g. families with  very thin and  ill infants. The group must  of course be drawn from different sections of the  community or the results would not be reliable. Listening to discussions would also bring out aspects of the  problem or may indicate the  need for talking to more people.Keeping community priorities in  mind is important. 

At the end of this process of interviewing and discussion it would become possible to identify the target group and their problem area i.e. the most important problem being faced by them. 

Level 1 : Process model for conveying suitable messages to selected target groups

Let's take an example. 

If there is'a high incidence of diarrhoea among infants mothers may have to be  told about ORS. That  seems obvious. But again we have  to discuss with the community members.  Who else looks after infants? What about older brothers or sisters? If  they too are involved, the messahe must reach them as well! So you can see that we would  have to choose between approaches, strategies and media. It's very useful at this point to involve enlightened community members to discuss aspects and find out more  from  their family, friends, community.  Again their opinion can be sought for identifying communicators as well as channels for communication (i.e. where  and how the message is  to be conveyed). With  the help of such community members or group leaders a pretest  can be carried out on a sample from  the larger target  group. On the basis of  this the-final 'form  of the  message can  be decided  on. Then remains the task of analysing impact. Free and frank discussion with the target group members can give useful  information on  how to  modify the message or its presentation. A post test would also be of great benefit. Finally programme planners would be given information about what happened and why so that the message is suitably modified before being conveyed to a larger group. 

One approach which  has gained credibility in  the health and nutrition sectors is called participatory rural appraisal or PRA. It involves local people in identifying their own problems and in planning how to resolve them.  Mapping a village or a -geographical area; ranking and scoring; listing local events in the order in which they happened; making case studies of people or situations. PRA techniques tend to give a wealth of information quickly without much expenditure. The information provided is accurate in most cases. Using local materials people have shown the capacity to "map,  model. estimaic, rank, diagram and plan". This should not  be surprising since they are more familiar with  local conditions than  we are.  There is also the advantage that as the community undertakes a self survey, discussion  ,place and information is collected and cross checked at the  same time. 

PRA techniques may  be routinely used  for: 

• group interviewing to get people's perceptions of the local health and nutrition situation. 
• village  mapping to identify target groups, non-users of services and local  health care providers. 
• individual and group interviews to get qualitative feedback on how well a service is provided or to assess effectiveness of a message. 
• gaining knowledge of what went  wrong in the case of deaths from preventable/curable illness or malnutrition so that messages can be designed accordingly. 

Perception of local people can be quite different from that of outsiders. Malnutrition, for example, may not be recognized or viewed as a major factor leading to illness and death. The community may give priority to an  illness associated with fever, on the other  hand, because it prevents them from  working and getting money or payment in the form of goods. Such situations might be necessary to first address the problem perceived by the people before they pay any attention to malnutrition, the "more important problem" from our point of  view-the  one which is silently crippling them without their recognizing it. Of course this has important implications for designing nutrition and  health messages that are relevant to the  local situation. Community members  would  be able to give detailed  information, for example, about how family food supply varies with seasons, or how incidence of a disease changes' with season. They  would also be able to relate this  to demands on their labour in the fields. This may tell us about the appropriate timing for a particular message.