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This thesis paper tries to figure out 'the importance of health communication and telemedicine technology for the integral growth of healthcare management in the rural and remote area of India'. In some of the rural areas of India the telemedicine technology is implemented successfully and the people in that area are receiving better healthcare services than before. This technology is quite new in the country like India and lot of work has to be done in future to increase the use of this newly developed technology to deliver quality of healthcare service and thus to improve the health status rural and remote population.
India is having a huge population and most of the people live in rural areas. Majority of them don't have proper access to education and healthcare services. So there is need of good health communication to improve delivery of healthcare services. By this, necessary knowledge can be imparted to the people that will help them to improve their own health status all the time. Telemedicine might be useful in these areas as it helps to have a successful communication in between the healthcare professionals and patients who are present at different places. This paper points out the actual necessity of telemedicine technology which is one of the tools of having health communication and the opinion of the healthcare professionals as well as the patients regarding its importance.
In this interpretive study based thesis, fourteen interviews of healthcare professionals and a survey of twenty patients by using a questionnaire have been conducted to illustrate the importance of health communication (mainly health education) and telemedicine.
First and foremost, I am heartily thankful to my honourable supervisor Eivor Oborn, whose encouragement, guidance and support from the initial to the final level enabled me to develop an understanding of the subject. Your active cooperation and valuable inspiration have been highly important for me to complete this study. I have learnt a lot from you.
I would like to convey my sincere thanks to Dr Neminath Magadum, the Chairman of "The Gomtesh Education Society's Ashirwad Hospital" for supporting me throughout this study. I thanks to all the interviewees for spending their precious time with me and providing valuable information.
I owe my deepest gratitude to beloved Course director, Professors, Administrator, Librarians and classmates of Kingston University for their continuous help, support and guidance.
I very cordially thank my classmates during bachelors study Manjunath, Shantesh, Harish & Kadir. Without them it would have not been possible for me to conduct survey of the patients.
I am also thankful to my brothers Ameetakumar and Anand; my friends Jamir, Arun, Sunil, Sandeep, Yakub, Abhijeet, Gaurav and Saket for encouraging me throughout my studies.
I dedicate this paper to my parents Bhupal & Kasturi, sisters Sanmati and Deepali whose contribution and support forced me to reach to the present level.
Lastly I thank to all of those who supported me in any respect during the completion of this project.
-WARDHAMAN BHUPAL BANAWANE.
In this rapidly developing world, the parameters of health care are also being broadened and the focus is shifted to promotion of wellness & prevention of diseases in community as well as home based care rather than only hospital based care. This shift can be facilitated by implementing telemedicine technology which is a method of health care carried out at a distance at even real time (Jones, 1997).
Health is a concern of everyone for everyone. Healthy people 2010 define health communication as "the art and technique of informing, influencing and motivating individual, institutional and public audiences about important health issues." The terms 'health communication & health education' are used synonymously most of the times. In this era the importance of health education is realized increasingly because of which today 'health education' became speciality in itself. The healthcare systems seem to be inefficient without proper health education programmes even though lot of planning is done in implementation of healthcare services. It shows that health communication is not only mere exchange of health information but also much more than that.
Health communication is means of facilitating the interaction between healthcare professionals and patients or in between the two or more healthcare professionals irrespective of working together in same or different organizations situated at distance places. Most of the organizations mainly focus on adopting advanced technologies used for diagnostic and surgical procedures to meet expectations of the patients and to improve organization's capacity. But they often forget the importance of communicating with the people in rural and remote areas to provide health education and create health awareness in them which in turn can prevent number of diseases. Telemedicine will help the healthcare professionals working at district and regional hospitals or multispecialty private hospitals to communicate with the people in rural areas who don't have proper access to healthcare services. It will help these professionals to know the problems of rural and remote population.
Telemedicine is a broad concept. Here the delivery of health services depends upon application of telecommunication. Sharing or transfer of knowledge in terms of distance education and remote consulting & diagnosis within different medical fields can be included in the concept of telemedicine. AIM (1990) defines telemedicine as "the investigation, monitoring, management and education of the patients as well as staff which allows ready access to expert advice and patient information irrespective of location of patient or relevant information". Public and private health sectors have to do much by making use of effective telemedicine technology. It can definitely contribute a lot to health sectors by making utilization of available resources more effectively in various telemedical services (Nymo, 1993).
An upcoming challenge mainly for the public health services will be to meet the demand of tremendously increasing population especially in the developing countries with the use of available resources (funds, healthcare professionals & technology). It is not possible to replace the physician or other healthcare professionals involved in a patient relation by using this technology. But the thing is that it can facilitate in delivering integrated health care service to the patients. Thus telemedicine can play a vital role by providing economical benefits to the healthcare system of respective country.
Telemedicine technology can act as a lifeline for most of the people who come under poor economical background mainly from developing country like India where there is inequality in delivery of healthcare services. More than 70% of the population live in rural area. On the other hand these people don't receive quality of healthcare services due to insufficient number of healthcare professionals especially in public healthcare centres and lack of infrastructure. Because of lack of facilities in these areas makes it more difficult to retain speciality healthcare professionals in rural and remote areas. That's why most of the specialists are situated in district and capital places. The rural people have to spend more time and money as well to get consultation from specialists. Telemedicine will help to reduce the unnecessary wastage of cost and time by bridging rural health centres with the district and multispecialty hospitals situated in big cities (Kuppuswamy & Pandian, 2008).
All researchers dealing with information technology and healthcare have said that information technologies play a vital role in making a healthcare system more successful. Nowadays in early stage of onset of disease, people in rural and remote area where there is unavailability of specialists in healthcare need not to visit directly to the specialists in cities to get consulted from them. Development of advanced communication technologies like telemedicine will make it possible for these people to get treatment at initial stage without travelling to cities which will reduce further complications related to respective diseases.
But development and implementation of any IT system in healthcare is not an easy task. As Collen (1995) have stated, "developing a comprehensive medical information system is a more complex task than putting a man on the moon had been". Many organizations have faced problematic situations while implementing telemedicine or any other e-Health systems because of different reasons. Before implementing any change within the organizational set up it is very important to know the views of stakeholders who are going to involved in the process. It needs good planning and management to make the change successful. According to Collins (2000), it is necessary to understand views, experiences and purposes of the providers as well as users of healthcare services to address the issues and resolve the problems before full implementation of telemedicine.
Identifying, understanding and describing the key aspects of effective health communication and information system (Telemedicine) as well as making the use of findings as a basis for the success of healthcare management in both private and public sector are the main aims of this research study. In this thesis paper I will discuss the importance of health communication (especially providing needed health education to the under and uneducated people in remote and rural area of India) and use of telemedicine to deliver better healthcare services to the rural population. I will try to understand the thoughts of healthcare professionals and patients regarding this topic. The main purpose behind this is to make further development for the integral growth of healthcare management in rural and remote areas of India.
This research is aimed to find out the answers relevant to the following research questions:
What do we know about effective health communication and telemedicine?
How will it be possible to communicate with the people in rural areas?
What are the opinions of healthcare professionals and patients regarding 'importance of health education and use of telemedicine system'?
In what ways might telemedicine influence information seeking, communicating and creating health awareness in a rural community of India?
According to the above research questions, this thesis will firstly try to discuss the important notions of health communication and telemedicine and secondly interpretation of the findings of interviews of healthcare professionals and feedback of the patients from questionnaire. The overall aim of this research is to know the importance of health communication and telemedicine through qualitative research and make use of that knowledge for the further growth of healthcare management in rural community of India.
Objectives of this research study are-
To study the role of health communication and telemedicine in rural health care.
To know various methods those are used by healthcare professionals to provide health education to the people of rural area.
To understand how health communication and telemedicine can play a vital role in changing behaviour of rural population.
Review of Literature
Health communication: -
Health communication addresses, how individual and community decisions about knowledge of health and practices are informed and influenced through communication. As stated by Rai (1999), communication is the means through which we practice and influence to bring changes in the views and attitudes of others, motivate them and maintain a healthy relation with them. In other words it is the cycle of exchanging emotions, ideas and opinions in the form of information in between sender and receiver. Health communication links the regions of health and communication and considered as an important component of efforts in improving public and personal health status (Jackson & Duffy, 1998).
There is specific purpose behind doing any act. Communication is done to make someone think in a particular way, to do something or take action. There are different functions of communication as stated by Andal (1998).
To achieve something.
To find out or explain something.
Social Contact Function
To make enjoyable environment.
To get someone to behave in a particular way.
To express the feelings or present oneself in a particular way.
Role Related Function
Situation requires it.
To transmit knowledge.
To bring interest.
To provide leisure activity.
Cultural Promotion Function
To reinforce cultural rites.
Effective communication: -
The main purpose of having communication is the exchange or transfer of information in the form of thoughts and ideas (Ramchandran & Dharmalingam, 2001). It is the most important aspect of educational process which aims at change in behaviour or attitude and improves level of knowledge. We can say communication was effective only if the message is correctly interpreted by the receiver and utilized it for improvement of the knowledge. Thus effective communication means not only reaching of information but also enabling the receiver to have change in information or improvement in knowledge.
Health communication includes understanding and use of communication strategies to enhance community and individual decisions to improve the current health status. It binds the domains of health and communication to improve the health of the population. Health communication can contribute largely in prevention and promotion of diseases, to improve health provider-patient relations, in movement of public and individual health risk information, formulation of public health messages, in providing education o the population about how to find access to the public healthcare delivery system and total development of telemetric applications as well as attachment of individuals to clinical recommendations (Feng H, 2006).
"Health communication is the use of communication techniques and technologies to positively influence organizations, individuals and population for the purpose of promoting conditions conducive to human and environmental health. It may include various activities such as physician-patient interactions, self help groups, classes, mailings, mass media events and campaigns" (US department of health and human services, 2000).
"Health communication is the dissemination and interpretation of health related messages" (Donohew & Ray 1990, Steinberg 2007).
"Health communication is a hybrid field that derives from communication studies, marketing, journalism and public relations and also overlaps with health education and health promotion" (Cline, 2003).
As stated by WHO (1946), "Health is a state of complete physical, mental and social well being and not merely the absence of disease or infirmity". Health encircles the essence of health education by making communities as well as individuals as equal partners in the process of assuring freedom from illness or diseases and achieving the highest level of physical, social and mental health (Gupta & Mahajan, 1991). In determining the Physical well being of the individuals, the factors such as where they work, with whom they interact and what kind of work they do should be considered to improve health.
A series of operational tasks have to be completed in the process of development of any health communication. At the basic level, these tasks may contain choosing credible sources, selecting a strategy of message and deciding the ideal channels or settings through which the communication is to be delivered (Kreuter & Wray, 2003). Each single activity of these provides an opportunity to improve the application of communication to its intended audience. Communication may contain planned or unplanned content which has the ability to convey positive, negative or neutral health messages to the community. Usually specific strategies are followed behind planned messages for its formulation and placement. These are intended to change behaviour, beliefs and attitudes of the people.
Thus health communication is an important part of healthcare which is aimed at promoting healthy behaviour. Health education is a type of medium which is used to make people aware of healthy behaviour patterns and its importance. But the success of health communication or health education programs depends upon the interest of the people. It is very important that they should involve actively in it. We can't enforce people to change; we can motivate them to adopt healthy life. It is a notoriously complex and problematic task to change one's health related behaviour (Lawrence, 1999). It is demonstrated through research that client's attachment to their own health status is the important factor in their adoption to a behavioural health change (Callaghan, 1999).
Health communication may take place between health care providers and patients or health care providers and people in the community. It may take place directly or indirectly at even real time. Development of information systems is really important to make health communication successful at broader level. People in rural and remote areas don't receive proper healthcare services due to many problems. So it is very important to communicate with them to know the problems they are facing and make the necessary planning and implementation to resolve those.
By means of communication technologies like telemedicine it will be possible to have communication between the healthcare professionals at speciality hospitals situated in cities and people of rural and remote areas. This will help to solve many health problems of rural population. Other than this it will make possible for healthcare professionals at public primary health centres or even who doing private practice in rural areas to have communication with specialists in multispecialty hospitals. It will help these professionals in making the decisions, diagnosis and treatment. It will also help these professionals to update their own knowledge.
Various channels used for having health communication are as below,
Health related articles in newspaper are important channels to distribute information.
If information is presented well in the magazines then these can become valuable mean of communication.
These are made colourful to attract the attention of the people and convey the health messages to them. This is the easiest and cheapest way of disseminating information to the people. These are widely used by the healthcare professionals at hospital and community to provide health information to a small group of people.
These are expensive and difficult to acquire. On the other hand are suitable to audience. Can convey intended health message to a large number of people in less time.
An important channel of providing health education. But health talks should not be too long.
It is quite expensive at the beginning of establishment but after that it becomes the most effective channel as message can be delivered to huge number of people within short time.
Can be effective.
If it is well targeted and arranged properly then can attract and arouse large number of people.
Difficult to implement but can reach to remote and rural population easily.
Easy and cheap way of communication. But less effective in a country with low literacy rate.
(Babu S 2004. Review in community medicine; pg 181)
Health Education: -
Health education programs related to behavioural change are considered as a mainstay of healthcare activity. The effect of these programs depends up on the nature of their intention and the way they are delivered (Whitehead & Russel, 2004). Health education is a social science that draws from the medical, biological, physical, environmental and psychological sciences to prevent the onset of diseases and promote health through education driven behaviour changing activities. In other words, health education is the development of an individual or group or community health knowledge, skills and behaviour with the help of systemic strategies.
Throughout this century health education has been an important element of action in prevention of diseases and promotion of health. Health campaigns to prevent communicable diseases, to promote maternal and child health, to promote immunization, to educate about family planning methods as well as its importance and other preventive health services have long history. Health education directed towards these goals in most of the developing countries remains an essential weapon in prevention of diseases and promotion of health (Nutbeam D, 2000). The main objective behind providing health education is to positively influence health related behaviour of the community and individuals. It also helps to influence living and working conditions that enhance their health.
"Health education is the process which includes activities like providing information, motivating and helping people to adopt and maintain healthy lifestyles, advocates environmental variations that are required to facilitate this goal and conduct research and professional training" (Baride & Kulkarni, 1998).
Health education is related to changes in feelings, knowledge and behaviour of people. It focuses on developing healthy lifestyles and believed to attend the best possible state of well being (Dharmalingam & Ramchandram, 2001). It is the process carried through the active involvement of people targeted at initiation of healthy behaviour and knowing the people's prejudices and practices that are determent to health for achieving the goal of health.
A series of stages and people efforts by themselves are involved in the process of health education. Health education is an activity which may be required for each individual at any time. It is a continuous ongoing process of learning from others. Anyone who knows that what is necessary for the maintenance of good health can provide health education to the others by using proper communication channel and ideas. As health education has to do with health, it is very important to have wide and correct knowledge regarding health and diseases for disseminating or transmitting ideas for the purpose of developing necessary behaviour and attitude.
In the process of health education theories and principles of education and learning are applied. That's why a person who is trained properly for delivering healthcare is better fit to provide health education to the community. It doesn't mean that any person who is from non medical background cannot play a role of health educator but only indicates the importance of possession of correct and complete knowledge related to health, diseases and their application. As the main motto of health education is to change behaviour of the people, health educator must learn and cultivate skills to communicate, educate, involve and motivate them. Health educator should be known to theories of community organization as well as knowledge and principles of social psychology.
Different planning models are used for the development of health education interventions. Public health models used in social medicine and epidemiology are slightly different from public health models used in health education. As stated by Kok and et al (1997), interventions of behaviour focused health promotion and health education are usually based on planning models of following type,
Behaviour that is determinant of the problem
Psychosocial and environmental determinants of behaviour
Development and implementation of the intervention
Not only epidemiologic analysis but also a behavioural science approach to intervention implementation and psycho-social analysis is needed in this type of planning model. If behaviour is an important factor behind existence of health problem then it is necessary to analyze the determinants of the behaviour. These determinants may be environmental or psycho-social (emotional resistance, risk perception, perceived norms, knowledge etc.). Most of the times the focus is given only on individual behaviour but it's important to target social as well as physical environment for health education interventions.
Approaches to health education:-
According to Tones (1986), there are three approaches to health education as follow,
It focuses on individual. Its goal is to convince the individual to adopt needed lifestyle to prevent onset of diseases and hence reduce morbidity and mortality in the population. The reason behind this is; in the Western industrialized society the curative medicine cannot deal effectively with the contemporary burden of disease. And not only high technology is ineffective but also it is iatrogenic and expensive.
Health education have major role in secondary as well as tertiary prevention apart from its potential for primary prevention. Another advantage of it is that it offers financial savings to the government by reducing the demands on health service.
According to this approach health education is concerned with freedom of choice and rationality. It states that only provision of information regarding health issues is not sufficient to bring behavioural change. To facilitate decision making is considered as the primary goal of health education irrespective of the nature of decision which might be made ultimately. The principle of voluntarism has been adopted by the Society of Public Health Educators of America in its code of ethics. Thus it can be argued that this model of health education has 'Official' approval. Writers such as Green (1980) have consistently supported fostering informed health choices and protecting free will.
This approach has its critics regarding the nature of genuine free choice. It is clear in many ways that freedom of choice can be limited. It is less apparent fact that an individual's capacity for making rational and voluntaristic choices can be reduced by particular kinds of socialization especially which occurs in the context of the 'culture of poverty'. On the other hand, individuals have greater degree of genuine choice whose socialization has provided them with self empowering skills and
experiences. In many instances freedom of choice is cut short
manifestly by adverse social circumstances. It is therefore will be ineffective and unethical to educate people in such circumstances.
Nutbeam,d Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century , Health Promotion International, Vol. 15, No. 3, 259-267, September 2000
Steinberg, S (2007). An introduction to communication studies, Juta and co. Publication, Cape town.
Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.