Conference: Rhodes, Greece
Abstract: Although literacy rates in developing countries have improved substantially in the past few decades, vertical health promotion programmes for rural communities still tend to pitch their messages at a low comprehension level, promoting only a few simple key messages usually to prevent only one identified disease (Loevinsohn, 1990). The overall literacy level in Zimbabwe is around 86% (Unicef, 1999) although 50% of those over 60 are illiterate (Auret, 1990). A recent study in Zimbabwe (Waterkeyn and Cairncross, 2005) has piloted an approach using Community Health Clubs to promote a culture of health by improving health knowledge and hygiene behaviour. Interviews with members indicated that the popularity of Health Clubs was largely due to a strong interest in acquiring knowledge. Consistently high attendance rates suggested that women were prepared to invest considerable effort to learn. A post intervention survey found that good knowledge of Malaria amongst health club members was 34% higher than non-members, and for Tuberculosis it was 58% higher (Waterkeyn, 2006). Taking an average of nine different topics, there was 47% difference between intervention and control areas (0>0.0001). Maslow’s Hierarchy of Needs (1954) was used to categorise suggestions from the community as to their main needs, using a method of pair-wise ranking on a matrix. In a random sample of ten community health clubs, 20% voted their highest priority as Knowledge, whilst the remaining 80% ranked Knowledge in second place, only slightly less important than their Need for Safety. These findings indicate that semi-literate communities have the capacity to assimilate multiple messages and through group decision-making can significantly change their hygiene behaviour, acting on a broad range of health issues. By addressing all preventable diseases in a more holistic approach to health, programmes would be more cost-effective and appropriate to the needs of rural communities.