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MINISTRY OF EDUCATION AND TRAINING MINISTRY OF HEALTH HANOI MEDICAL UNIVERSITY TRAN THI NGA SITUATION OF HEALTH EDUCATION COMMUNICATION IN DISTRICT AND ASSESSMENT OF PILOT EALTH EDUCATION COMMUNICATION DEPARTMENT MODEL IN BINH LUC DISTRICT, HA NAM PROVINCE Specialization: PUBLIC HEALTH Code: 62720301 SUMMARY OF DOCTORAL THESIS HA NOI – 2020 THESIS WERE COMPLETED IN HANOI MEDICAL UNIVERSITY Preceptor: A/Prof.Dr Nguyen Van Hien A/Prof.Dr Nguyen Duy Luat Reviewer 1: A/Prof.Dr Pham Van Thao Reviewer 2: A/Prof.Dr Dam Thi Tuyet Reviewer 3: A/Prof.Dr Trinh Hoang Ha Thesis will be defended before the Assessment Committee of Hanoi Medical University Organized at the Hanoi Medical University Thesis is available at: The National Library The Library of Hanoi Medical University PUBLISHED ARTICLES RELATED TO THE THESIS Tran Thi Nga, Nguyen Van Hien, Le Thi Tai, Nguyen Duy Luat (2010) Health education communication activities in An My and Dong Du communes, Binh Luc district, Ha Nam province Journal of Medical Research, No - 2/2010, vol 66, 119-125 Tran Thi Nga, Nguyen Van Hien, Le Thi Tai, Nguyen Duy Luat (2011) The impact of health education and communication intervention on knowledge and practice on some health problems of people in An My commune, Binh Luc district, Ha Nam province Journal of Medical Research No 4, vol 75 129 - 135 Tran Thi Nga, Nguyen Van Hien, Nguyen Duy Luat (2018) Ability to maintain health education communication activities of commune health stations in Binh Luc district, Ha Nam province after intervention to build health education communication room Journal of Preventive Medicine, vol 28, No 4, 118-123 Tran Thi Nga, Nguyen Van Hien, Nguyen Duy Luat (2018) The ability to maintain and influence the Department of Health Communication and Education on health education and communication activities of Binh Luc district, Ha Nam province Journal of Vietnamese Medicine, vol 473, No & 2, 103-107 INTRODUCTION Health education communication (HEC) has an important role in community health care, so it has been ranked as the number one content of primary health care by the World Health Organization (WHO) The Ministry of Health has directed the health sector to implement and strengthen the communication to provide health information HEC media equip necessary knowledge and skills so that each person can take the initiative in preventing diseases and participation in protection and health care activities in the community In Vietnam, the health education communication system has been established from central to grassroots levels Organizing the health education communication room of the district health center formed under Decree No 172/2004 / ND-CP and defining the functions and tasks under Decision No 26/2005 / QD-BYT in order to strengthen capacity, improve the operational efficiency of the grassroots health network, especially at commune health stations (CHSs) To be able to undertake the functions and responsibilities of the HEC department and organize the implementation and management of HEC activities in the district, the HEC room must have meet the minimum resource requirements PhD students conducted research from 2008 to 2014 to answer the question: what is the state of health education communication activities at the district health center? How is the model and operation of district HEC department appropriate? After the health education communication office in Binh Luc district, Ha Nam province was established and put into operation, what is the effect of the health education communication room model? Further research is needed to consider the organizational and operational viability of the health education communication department Therefore, the thesis has been carried out since 2016 to consider the ability to maintain health communication activities in Binh Luc district like? To answer the research question we implement the research named: “Situation of district health communication and education and evaluation of a pilot model of health education and communication room in Binh Luc district health center, Ha Nam province” RESEARCH’S OBJECTIVES Describe the status of health education communication activities of 55 district health centers in provinces in 2008 Evaluating the effectiveness of the pilot model of health education communication room in Binh Luc district, Ha Nam province Evaluating the ability to maintain the health education communication activities in Binh Luc district, Ha Nam province in the period of 2009-2017 PRACTICAL MEANING AND NEW CONTRIBUTION OF THE THESIS Topical issues, practical applications, helping the health sector to have reliable data on the status of district health education and communication rooms and building an education communication room model district health contributes to protecting people's health The project is implemented at district health centers, there is no health education and communication room The thesis made new and valuable findings on the model of health education communication room of the district health center The results published by the project are evidences to help scientists and managers make more effective policies and stabilize the grassroots health model, contributing to improving the quality of health services LITERATURE OF THE THESIS The thesis is 126 pages long (excluding the table of contents, lists, references and appendices), including chapters: Chapter 1: Literature review: 32 pages; Chapter 2: Research subjects and methodology: 18 pages; Chapter 3: Results: 38 pages; Chapter 4: Discussion: 33 pages; Conclusion, Recommendation pages The thesis has 26 tables of data, 09 figures 130 references in Vietnamese and English Chapter 1: LITERATURE REVIEW Department of health education and communication of district health centers is still in the process of establishment, many districts have not set up health education communication rooms According to Tac Van Nam (2006), Bac Kan province has not established a district preventive medicine center so there is no health education and communication room In Dak Lak (2009), the organization of health education and communication activities at district level has not been completed, the health education and communication room is still integrated, communication equipment has not met the needs Human resources for health education communication are inadequate in terms of quantity and qualifications, according to a study in Bac Kan, staff of the communication group are mainly parttime, according to research by the Institute of Health Strategy and Policy In 2010, in the three provinces of Dien Bien, Ninh Thuan and Dong Thap, the number of people directly involved in the management and administration of health communication and education activities was not much and unstable, especially at the grassroots level The majority are doing part-time jobs Capacity in planning health education and communication is still very limited due to the lack of data information and the lack of qualified staff for implementation Inadequate communication funding based on research results conducted in Lao Cai, Bac Kan and Dak Lak Health education and communication activities have not been effective, according to the research of Nguyen Thi Thu in Lao Cai: district health centers have not actively developed annual communication plans, interdisciplinary coordination in communication Health education is still poor, books for monitoring communication activities are inadequate Village health workers mainly communicate at the household level In Bac Kan, commune health workers and village health workers carry out communication mainly with integrated counseling and personal counseling According to the research of author Nguyen Van Linh in Dak Lak, the frequency of implementing health education communication activities on the mass media is still low (≥1 times / month is 66.7%) Health education communication programs are often based on experience but not on identifying needs of the community and not on models of behavior change (Sharma Manoj, 2005) The management of health education communication activities has not been focused, according to the author Le Ngoc Linh, the reporting, direction and supervision of the lower levels are incomplete By Zeman C (2005), published in the international journal about health education, health education communication activities are often not planned Chapter 2: RESEARCH SUBJECTS AND METHODOLOGY 2.1 Study sites - Aim 1: provinces represent regions: delta (Ha Nam, Tien Giang), mountainous (Yen Bai, Dac Lac) and urban areas (Hai Phong, Can Tho) - Aim 2, 3: Binh Luc District of Ha Nam Province 2.2 Study subjects - Aim 1: Books, related reports of HEC bureau; Leaders of district health centers, officials of district HEC bureaus; Officials of provincial health education communication center and officials of central health education communication center - Aim 2: Leaders of Ha Nam Department of Health; Leaders of Ha Nam Province Health Education Communication Center; Leaders of district health centers, officials of district HEC departments and officials related to HECactivities; Head of the CHS; Household representatives of communes of An My and Dong Du, Binh Luc district - Aim 3: Books, reports on HEC activities in districts and communes; Leaders of district health centers; Manager and staff of the health education communication room; Station heads of CHSs; Household representatives of communes of An My (intervention commune) and Dong Du (control commune) 2.3 Methodology - Study design: cross-sectional descriptive study combining quantitative and qualitative research and comparative intervention study before and after controls - Sampling: staff of HEC department: Select all staff of HEC at district level of provinces / cities Household: random sampling system Qualitative research: provincial level: select provinces representing areas: delta (Ha Nam), mountainous (Dac Lac) and urban (Can Tho); District level: each province / city select districts - Selection of control commune: we chose Dong Du commune as the control commune because of similar economic, cultural, social and medical characteristics as An My commune (intervention commune) - Sampling size: • Qualitative research: Central HEC (1 focus group discussion - FGD); At the provincial level: interviews with the three groups of provincial health education and communication centers, 06 district health education communication staff at the district level (1 interview x districts / provinces), indepth interviews (PVS) / leaders of the provincial HEC center, PVS leaders at the provincial district health center, PVS leaders of HEC provinces • Household’s sampling size: 𝑝1 (1 − 𝑝1 ) + (𝑝2 (1 − 𝑝2 ) 𝑛 = 𝑍(𝛼,𝛽) (𝑝1 − 𝑝2 )2 p1: Estimate the rate of people who were aware of diarrhea before intervention, p1 = 64.8%; p2: Estimate the rate of people who were aware of diarrhea after intervention, p2 = 79.3% α, β: Level of statistical significance, choose α = 0.05, β = 0.5; 𝑍(𝛼,𝛽) = 3.8 We calculated n = 269, taking communes, the total number of surveyed households = 538 In fact, the survey of 600 households / communes Sampling size of commune health workers: Take all 21 heads of CHSs of the district - Research content: Aim 1: Resources, management of HEC, Advantages and difficulties in carrying out HEC activities Aim 2: Interventing on organization, equipment, facilities and materials HEC, training and operation-managing HEC Aim 3: Ability to maintain HEC activities in Binh Luc district, Ha Nam province - Techniques applied in research: + Collecting documents, books and reports related to HEC activities of the district health center + Observing facilities implementing health communication and education activities at district level according to checklist + Questionnaire interviewing health officials and people + Group discussions, in-depth interviews with leaders, officials implementing HEC from central to district levels 2.4 Data management and analysis: Quantitative data: using Excel and STATA 8.0 software Qualitative data: results are aggregated and identified according to the objectives and content of the study 2.5 Study time: from 11/2008 to 10/2017 Chapter 3: RESULTS 3.1 Situation of resources, organization and operation of the health education communication room of the district health center Table 3.1 Situation of facilities, equipment of health education and communication room (n=55) TT Content The number of districts has an independent office for the HEC Camera Cassette type has the function of receiving and playing Mixed communication set includes: Amplifier, Speaker, Microphone, Large cassette radio Speaker with battery (communication at facility) Battery amplifier + 01 speaker + 01 microphone (used for mobile communication by car) Districts 20 Percentage % 16 29.1 16 29.1 21 38.2 13 23.6 13 23.6 36.4 Only 36.4% of districts have an independent workroom for the HEC department The necessary equipment for HEC is very lacking, only 23.6 - 38.2% of districts have these facilities Table 3.2 Human resource situation of the district Health education and communication Department (n=55) Human resource situation Districts Percentage % 36 65.5 29 52.7 12.8 34 21 61.8 38.2 16.3 Payroll The number of districts with official payroll for the HEC department Inside: There are 1-2 officers There are officers Qualificatio Intermediate / Primary University or higher Được đào tạo/tập huấn 65.5% of district health centers surveyed have official payrolls for the Department of Health Education and Communication, of which the number of HEC rooms has staff (according to regulations), accounting for a very low proportion (12.8%) The majority of HEC departments have staff with intermediate / primary degree (61.8%) Most district health communication and communication departments have staff who have not been trained / trained (83.7%) Table 3.3 The situation of health education communication activities of the district health education and communication department (n=55) HEC activities Talk about health education Discussion groups Individual / group counseling Write the radio post Make panels, posters, leaflets Collaborate with other agencies and organizations to implement HEC Urban (n=74) n % 47 63.5 48 64.9 56 75.7 40 54.1 30 40.5 53 71.6 Delta (n=56) n % 55 98.2 49 87.5 51 91.1 55 98.2 40 71.4 54 96.4 Hiland (n=97) N % 68 70.1 58 59.8 64 66.0 72 74.0 54 55.7 78 80.4 Total (n=227) n % 170 74.9 155 68.3 171 75.3 167 73.6 124 54.6 185 81.5 The majority of officials participate in HEC (> 60%) The highest percentage of officials carrying out HEC activities in the two delta provinces (all activities were carried out by over 70% of the staff); lowest in two cities Most officials collaborated with other mass 10 3.2 Effective pilot HEC room at Binh Luc district health center Table 3.4 Train staff to implement health education communication Content Commune health Before After intervention intervention Effective p intervention (EI) n % n % 40 43.0 83 83.0