Participatory Communication to Strengthen the Role of Grandmothers in Child Health

In health education and communication strategies in community health programmes in developing countries the dominant approach involves the use of directive communication methods to promote expert-defined changes in individuals' health-related knowledge and practices. Another facet of most maternal and child health programmes is their focus on women of reproductive age and the systematic exclusion of older women, or grandmothers, who, in many societies, play a leading role in family health promotion. This approach is supported by most governments and international development organisations involved in the health sector. While there has been relatively limited criticism of this approach to healh education and communication, there is an extensive body of literature from adult education, development communication, feminist pedagogy, medical anthropology and community organising for health which identifies the limitations of this predominant approach and suggests the need to adopt alternative concepts and methods. Key facets of an alternative paradigm include: promoting changes in community health-related norms; working with individuals within the family context, and using participatory, empowering approaches in health education and communication.

This article reviews the literature that supports an alternative approach to health education and communication. It presents a case study based on a community project in Laos in which a participatory health education and communication strategy was used to promote changes in community norms related to child health by strengthening the role of grandmothers. Based on adult education concepts of transformative and constructivist learning, a simple, culturally-adapted methodology was used involving stories, songs and group discussion which elicited collective critical thinking and problem-solving. The outcomes of this participatory HEIHC experience include, improved health-related knowledge and empowerment of GMs, increased confidence in GMs' child health promotion abilities on the part of family members, community leaders and health workers. The positive outcomes of the project are believed to be largely attributed to its conceptual and methodological underpinnings.

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