Developing Culturally Oriented Strategies for Communicating Women's Health Issues: A Church-based Intervention

In developing countries, messages on women's health are often crafted and conveyed without due regard to the literacy and cultural context of communities. In contrast, this intervention revolved around the observation that activity-based approaches to improve the health status of the community can be effective, 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 communities and tend to reach a wide range of people. Thus, churches can serve as avenues for health promotion and, specifically, for recruiting and training non-professionals for behaviour change.

Specifically, the project used an activity-oriented workgroup discussion methodology to engage 30 participants from 15 churches (2 per church) in a 2-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 (2-day) small group workshop, conducted in an adult-learning format.

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 6 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 6 communication methods they considered useful for sharing the 6 identified modules with local church audiences. To prepare for the Day 2 task, participants were asked to form 6 groups of 5 each. Joining a group depended on an individual's interest in one of the 6 modules and on the condition that no 2 individuals from one church joined the same group.

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 3 hours after which all the 6 groups reconvened for the first presentation, followed by a feedback session that elicited discussion and contributed to the revision and repackaging of the 6 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. 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, 3 organised a workshop to increase awareness on women's health issues in their local churches within 3 months of the workshop. Participants from the those 3 churches were invited to help facilitate a similar workshop in the southwestern and northern parts of Nigeria.

Women's Health

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."

The researchers suggest that 4 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.