|ORIGINAL RESEARCH PAPER
|Year : 2011 | Volume
| Issue : 1 | Page : 398
Developing Culturally-oriented Strategies for Communicating Women's Health Issues: A Church-based Intervention
GN Aja, EN Umahi, OI Allen-Alebiosu
Department of Public & Allied Health, Babcock University, Nigeria
|Date of Submission||09-Sep-2009|
|Date of Acceptance||22-Oct-2010|
|Date of Web Publication||29-Apr-2011|
G N Aja
Department of Public & Allied Health, Babcock University
Source of Support: None, Conflict of Interest: None
Context: In developing countries, messages on maternal health are often developed and conveyed without due regard to the literacy and cultural context of communities. Culturally-acceptable approaches are, however, necessary to increase awareness on women's health issues, especially in cultures where oral tradition is important.
Objective : To describe the processes adopted to engage church-based women support groups to develop innovative culturallybased strategies for communicating women's health matters.
Methods : We utilized an activity-oriented workgroup discussion methodology to engage 30 participants from 15 churches (two per church) in a two-day workshop located in an urban community in southeast Nigeria. The recruitment process included initial visits to 25 churches with an expression of interest form, followed by an invitation letter to the 15 churches that completed and returned the form. Participants were female church leaders, 26 years of age and older, from different occupations and educational levels. They attended a 16-hour (two-day) small group workshop, conducted in an adult-learning format.
Results: Six groups of five participants each used the Women and Health Learning Package (WHLP) to create and develop a dialogue on adolescent health, a drama on violence against women, a song on nutrition and women's health, a story on use of medicines by women, a quiz on cervical cancer and a poster on family planning. Thirteen of the 15 churches submitted a written report of the workshop to their local churches one month after the workshop as well as a copy to the workshop facilitator. Of the 13 churches, three organized a workshop to increase awareness on women's health issues in their local churches within three months of the workshop.
Conclusion: Activity-oriented workshops can be a useful way of developing culturally- appropriate communication strategies for increasing awareness on women's health issues among church-based women groups.
Keywords: Church, community-based education, Women′s health, workshop
|How to cite this article:|
Aja G N, Umahi E N, Allen-Alebiosu O I. Developing Culturally-oriented Strategies for Communicating Women's Health Issues: A Church-based Intervention. Educ Health 2011;24:398
Several attempts have been made to improve the health status of women1 and to elicit global commitment to women’s health rights2. Despite these efforts, access to health information still remains a ‘mirage’ to a vast number of people in developing countries3,4. Health communication5, therefore, requires that health messages should be tailored6 to suit local needs, especially in Africa where oral tradition is common7.
To enhance teaching and learning in women’s health, The Network: Towards Unity for Health (The Network: TUFH) Women and Health Task Force (WHTF) in 2006 developed the Women and Health Learning Package as a free learning resource for use by educators, health providers and health sciences students to increase awareness on women’s health issues. Currently, the 14 learning modules include the following topics: cervical cancer; contraceptive practices; female genital mutilation; gender and health; internalization of domestic violence; menopause; men's involvement in promoting reproductive health; mother-to-child transmission of HIV/AIDS; nutrition and women's health; safe motherhood; unwanted pregnancy and unsafe abortion; use of medicines by women; violence against women; and adolescent health. To-date, the WHLP has been used to implement programs in different cultural settings8.
Activity-based approaches9 to improve the health status of the community10 are necessary, particularly in Christian churches where stories, songs, proverbs, illustrations, etc., are commonly used to convey pertinent spiritual messages - a legacy that can be extended to health promotion. Christian churches are associated with local communities11, tend to reach a wide range of people12 and seem to possess unique cultural assets13. Many studies show that churches are involved in disease prevention research12 , mammography promotion and screening14,15, breast cancer screening16 and peer counseling17. Thus, churches can serve as avenues for health promotion18 and specifically for recruiting and training non-professionals for behavior change19.
There is a need to effectively engage church members to harness their vast potential to help improve women’s health. Consequently, the purpose of this paper is to describe the processes we used to engage church-based women group workshop participants to develop culturally-oriented strategies for communicating women’s health issues and to highlight some of the challenges that resulted from the overall process.
The authors of this paper have had experience working with church groups in the area of HIV/AIDS, malaria, etc. Specifically, one of the authors worked with churches to explicate perceived church-based needs and assets20 and the importance churches attach to the assets they have to prevent and control HIV/AIDS21. He is also the author of the WHLP module on Use of Medicines by Women22.
We organized a 16-hour (two-day) small group workshop, conducted in an adult-learning format, using the Women and Health Learning Package (WHLP) developed by The Network: TUFH Women and Health Task Force as the information tool. During the initial visits, the project team with 25 church leaders discussed details regarding the purpose of the workshop, description of the steps for the development of culturally-oriented strategies for communicating women’s health issues, confidentiality issues and rights to withdraw at any time. Subsequently, this was discussed with the participants at the workshop. A written informed consent was obtained from each participant at the workshop.
Six steps were used in the recruitment process:
Step 1: Dispatch of expression of interest forms. Based on previous work with 83 churches in the area20,21, 25 churches within the city center, noted for active women’s support groups, were contacted and visited by the project team with an expression of interest form. This specified the purpose, date, time and location of the workshop. On the form, the head of the church was requested to nominate two church women leaders to participate in a two-day workshop.
Of the 25 churches, 16 were orthodox (Anglican, Baptist, Catholic, Methodist and Seventh-Day Adventist) and nine were indigenous (Christ Apostolic, Cherubin and Seraphin, Celestial, Deeper Life, Assemblies of God, Evangelical Church of West Africa and Pentecostal ministries and fellowships). To ensure that a diverse number of churches were represented at the workshop, churches were revisited and reminded a few days before the scheduled date to submit their expression of interest form signed by the church leader. Of the 15 churches that responded and agreed to participate, eight were from orthodox and seven from indigenous church groups. A total of 30 women leaders participated (two each from the 15 churches) to maximize the chances that they would extend the workshop lessons to local church members. Information on each participant’s age, education and occupation was collected using the registration sheet.
Step 2: Dispatch of invitation letters. Upon receipt of the expression of interest form, an invitation letter specifying the date, venue and incentives for participation (free lunch and transport subsidy) was sent directly to the women through their church leaders.
Step 3: ‘Talk shop’. On Day 1 of the workshop, the 14 WHLP modules were presented by an experienced facilitator (an author of one of the modules) and extensively discussed by the participants. During the discussion, participants mainly focused on six modules (adolescent health, violence against women, nutrition, proper use of medicine, cervical cancer and safe motherhood-family planning) that they thought addressed their concerns and/or the concerns of family and fellow church members. Participants also helped identify six communication methods they considered useful for sharing the six identified modules with local church audiences.
To prepare for the Day 2 task, we requested participants to form six groups of five each. Joining a group depended on an individual’s interest in one of the six modules and on the condition that no two individuals from one church joined the same group. The arrangement was intended to ensure diversity within and between the groups. Individuals who had interest in more than one module were encouraged to join only one group since they would have the opportunity of contributing their ideas during the feedback session. The list of members was submitted to the project team by each of the groups and was verified to ensure that members from the same church were in different groups. To avoid bias in the allocation of the communication methods, the participants requested the project team to randomly allocate the six communication methods to the six groups by ballot (however, a group may have chosen to use more than one method where necessary - for example, drama and song).
On a final note for the day, the groups were reminded to reflect on the key activity-based question: 'How can the topic, identified by the groups from the WHLP modules, be communicated to a local church audience using one or a combination of dialogue, drama, storytelling, quiz, song and poster?'
Step 4: Workshop. On Day 2, each group used the morning session to discuss, develop, rehearse and present their topics. Each group selected a moderator to guide the discussion and a scribe to take notes on the process of presentation development. This lasted for about three hours after which all the six groups reconvened for the first presentation, followed by a feedback session. The feedback questions were, 'What aspects of the topic were well emphasized by the group?' and 'What aspects of the topics needed to have been well emphasized by the group?' The feedback mechanism was designed to gain input from other group members, particularly participants who would have liked to join more than one group. An additional 15 minutes were allotted to the groups to make necessary revisions or modifications based on the feedback before the final presentation. The final presentation lasted for 90 minutes, or about 15 minutes for each group.
Step 5: Next Steps. During the final session, we requested each of the groups to come up with a plan on how they intended to disseminate the lessons learnt from the workshop to their local churches.
Step 6: Workshop evaluation. The project team used a one-page questionnaire to evaluate participants’ satisfaction with the two-day workshop. Items on the questionnaire were scored on a scale of 1 (Not Sure) to 5 (Strongly Agree). Provision was made for additional comments.
Overall, 30 participants representing various Christian women’s groups including Anglican, Baptist, Presbyterian, Assemblies of God, Catholic, Seventh-Day Adventists and other ministries and fellowships participated. Table 1 indicates that the participants were aged 26 years and older, from varied occupations (teaching, trading, pharmacy, nursing/midwifery) and from different educational levels (primary, secondary, university and nursing/midwifery education).
Table 1: Demographics of participants in a church-based workshop
Table 2 shows the application of the communication methods (dialogue, drama, song, storytelling, quiz and poster) by the groups to women’s health issues.
Table 2: Summary of groups, Women and Health Learning Package (WHLP) modules, communication method(s) and application of communication strategy
The feedback session elicited important discussion and contributed to the revision and repackaging of the presentations. For instance, the dialogue on adolescent health was revised to include thoughts around how HIV/AIDS can be prevented, rather than focusing solely on the devastating effects of the disease. The drama on violence against women, which focused on physical violence, was expanded to include other forms of violence such as verbal abuse, often not considered as serious in this cultural setting. The song on nutrition and women’s health was repackaged to include the importance of drinking clean water. A song on the importance of hospital care was added to the story on proper use of medicinal drugs. Questions on where to go for cervical cancer screening were included on the cervical cancer quiz. The poster on family planning was revised to include the drawing of a male figure as a major stakeholder in the family planning process.
At the workshop, participants developed an action plan. Table 3 shows the action plans, including how participants were going to take what was learned and apply it in their local churches.
Table 3: Groups’ action plans, including how they were going to take what was learned and apply it in their churches
A month after the workshop, participants from 13 of the 15 churches reported submitting a written report of the workshop to their local churches and a copy to the workshop facilitator. The report indicated that the workshop was timely, relevant and should be extended to other local churches.
Within three months following the workshop, three of the 13 churches reported organizing a similar seminar in their local churches on specific topics: cervical cancer; adolescent health; and use of medicines by women. Local participants in each of the three locations used storytelling, drama and songs to convey important lessons on cervical cancer, adolescent health and use of medicines by women respectively.
In terms of workshop evaluation, all 30 participants strongly agreed that group discussion matched with priority health problems, was consistent with the specified topics, involved all as active participants, promoted participant-to-participant interaction, was not dominated by the facilitator and concluded with satisfactory solutions in the final session. Additional comments included: 'the workshop should be extended to men to help them understand that women need special care'; 'two days are not enough for this type of workshop'; and 'organize a national women’s health communication competition.' There were several commendations to the project team for 'such a fun way of sharing health information.'
Workshops can be very useful for training and instruction in women’s health development. Group methods were adapted9 to bring about meaningful change and innovation in knowledge translation23, especially in resource-limited settings. For instance, dialogue24 is used in public health discussions9 to engage the participants to respond to the content being learned25, and drama helps to explore issues, create and stimulate discussions and connect people with real life issues26,27. In our workshop, each scenario presented in the drama provoked discussion on ways of preventing violence against women.
Song and storytelling are effective ways of communicating health messages in local communities7 and are usually thought-provoking. In our workshop, the need and importance of good maternal and child nutrition was conveyed eloquently in a song using the local language. Another group used storytelling and dancing to promote rational use of medicine, suggesting that a combination of one or more communication strategies is practicable.
Quizzes can be an innovative way of promoting critical thinking28 and were used to elicit in-depth discussion on cervical cancer. Another group presented and discussed family planning issues using a poster. Poster-based interventions have been used to promote healthy behaviors in other studies29.
Overall, our study showcases unique processes to engage church-based women groups to develop strategic ways of communicating women’s health issues. The activity-based workgroup discussion used the WHLP as the key resource material. The topics may have helped participants to focus and reflect on the health problems affecting them and women in general (the participants were middle-aged married women), thereby, enabling workshop participants to react and act on those issues by developing appropriate strategies for sharing them. The content of the dialogue, drama, song, storytelling, quiz and poster may have been influenced by individual experiences. The feedback mechanism employed at the end of the first group presentation helped to enhance active participation, expand the discussion and harvest more input from the participants that led to the revision or repackaging of the group presentations. The action plan submitted by the participants served as the template for measuring progress. As mentioned, participants from 87% of the churches (13 of 15) submitted a written report of the workshop to their churches. Participants from the three churches that reported organizing at least one similar workshop in their local churches three months after the workshop were invited to help facilitate a similar workshop in the southwestern and northern parts of Nigeria (funded by Global Health Through Education, Training and Service - GHETS). The key criteria for selecting the three facilitators included the number of activities carried out in their local churches after the initial workshop and willingness to participate.
Workshop evaluations revealed that the processes were overall successful, but with some limitations. Heads of churches were responsible for deciding who represented their churches at the workshop so perhaps relationship issues among leaders and members influenced the selection of participants. For example, women leaders who did not always support the views of their pastors/priests may have been less likely to have been selected to participate. Problems associated with travel between churches included car breakdowns and heavy traffic (since this was in a commercial city) which led to cancellation and rescheduling of prearranged meetings. Difficulty in meeting heads of churches resulted in repeated visits and more expenses. The period of the workshop may have coincided with the time churches who could not participate had weeklong evangelistic programs.
Not all the participants reported having implemented any program in their various churches. Perhaps, some did organize programs but were unable to report them to us. A more intensive follow-up plan is needed to see how those church groups that have organized and reported their programs can help support other participants from other churches to become so engaged.
Despite the observed limitations, this project showcased the ingenuity of church-based women in developing culturally appropriate tools needed to increase awareness on women’s health issues. It demonstrated that church leaders are important assets in mobilizing members for social/community action, and the diversity of the churches that participated in the workshop was a major strength. It was also a great success that three of the women who participated in the initial workshop went on to facilitate two similar interstate workshops in other parts of the country.
Four essential components may be required to effectively engage church-based women groups to develop culturally-relevant strategies for communicating women’s health issues: a recruitment process that involves church leaders in selecting participants; activity-oriented focus workgroup discussion (using the WHLP as the key resource material) to keep participants engaged on task(s); a feedback mechanism for quality improvement; and an action plan that defines the next steps. However, more workshops are needed to ascertain the applicability of these processes in diverse settings.
The workshop was funded through a mini-grant awarded by the Global Health Through Education, Training and Service (GHETS).
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