Archive | March 2013


Photovoice has come to be valued as an important participatory tool since it was first developed by Caroline Wang and her colleagues in 1992 (Shimshock, 2008). It was used for the Women’s Reproductive Health and Development Program in Yunnan, China (Wang, 2003). Photovoice may be defined as a “process by which people can identify, represent, and enhance their community through a specific photographic technique” (as cited in Wang, 2003). Incorporating Paul Freire’s approach towards empowerment education, Photovoice helps communities in identifying “hidden voices” or issues that can hinder their learning, exhibits characteristics of critical learning through dialogue, and facilitates problem solving within a community through strategies that can create positive change (Wang, 2003).

According to Wang and Burris (1997) Photovoice has three main goals (as cited in Wang 2003):

1. To enable people to record and reflect their community’s strengths and concerns

2. To promote critical dialogue and knowledge about important issues through large and small group discussion of photographs

3. To reach policymakers

Photovoice can in fact be a powerful tool to spur research, needs assessment, social movements, policy change etc.


The link below is for the prezi on photovoice. In addition to general concepts and steps, it also provides links for resources on photovoice and related studies.

Additionally, the following are the photoboards created during the photovoice workshop representing themes for the topic ‘The impact of community environment (both built and social) on mental well-being’.

IMG_0147                        IMG_0148IMG_0149IMG_0150IMG_0151IMG_0152


Aislin and Dhaarna


Entertainment + Education + Health

The thought of getting entertained and educated at the same time excites me. Very often, I experience one over the other. But on those occasions that I am entertained and learn something new at the same time, I tend to remember those things a lot better.

A couple of weeks ago, I watched a social documentary called “The House I Live In”, which advocates for a deeper and critical analysis of drug laws within America’s justice system. It addresses an important public health issue that affects many people. After watching the film, I couldn’t help but feel empowered in some way and ready to make a change. I’m not sure how much I can really do as one individual but I was very enlightened after leaving the theatre.

The point is, I was definitely entertained and educated.

Check out the trailer for the film:

All of this got me thinking about the importance of entertainment education and how it relates to issues of public health.

What Is Entertainment Education (EE)?

Entertainment education, as its name suggests, is all about educating people through some form of entertainment. In this case, it’s all about educating people about health issues but in an entertaining way. In essence, entertainment education is a communication strategy for social change.

Entertainment Education:
– places educational messages into popular entertainment
– raises awareness
– increases knowledge
– motivates people
– changes attitudes
– often leads to social action (KFF, 2004)


More and more public health organizations in the United States are using entertainment education as a form of health communication. EE can be conducted by health agencies or anyone who has the means to influence media and/or has a personal concern for a health issue. Hollywood-based organizations are often involved in the U.S. when it comes to entertainment education. (Check out Hollywood, Health, & Society at

Entertainment education is often a complement of the work being done by NGOs, the government, etc. It serves as an alternative means of health communication. Television (e.g. soap operas, reality shows, sitcoms, etc.) is the main source of entertainment education in the United States (KFF, 2004).


Shows such as “Friends” emphasized the issues surrounding unplanned pregnancies while “Lizzie Mcguire” (a favourite of mine!) looked at issues of self-esteem. Whatever the specific medium may be, health-related messages have been incorporated into the media for a long time and continue to be. All of this is entertainment education.

Check out the following video from the WHO’s Entertainment Education Project:

Other examples of EE include the movie “Contagion”, which I watched in a class last semester. It also left me educated and entertained. I didn’t realize until then how powerful the incorporation of health-related messaging into the popular media could be.


Whether we notice it or not, health messaging and entertainment education is all around us, even while we’re watching that late-night sitcom to release the stress of our daily lives.

Some examples of issues that EE works on,

The Art of Storytelling

Tell A Story. Change The World.

Storytelling is extremely powerful as it forms connections between ideas and presents them in a way that is appealing to the senses. Narratives help make sense of the things that people encounter in their everyday lives; they are invaluable in presenting ideas and provoking thought about a variety of issues.

Story-telling is an intrinsic part of human beings. We have been “hardwired” to engage in storytelling to create meaningful interactions. It’s no wonder then that storytelling is such an important aspect of entertainment education and public health.

From the WHO video above, “Entertainment education is as old as storytelling itself. As long as humans have told stories, they have taught lessons as well.”

Storytelling as the root of entertainment education is an aspect that I find very appealing. Storytelling is also about presenting information in a creative way. In my opinion, entertainment education is about the capacity to portray important health messages in uniquely creative or creatively unique ways. Infusing socially-relevant issues into media communication is an excellent way of getting the message across and getting people to think. I don’t know about you, but the next time I see anything on T.V. or at the movies, I’ll definitely be paying attention to any health messaging that may be shining through.

For more information, see:

Kaiser Family Foundation (2004). Entertainment Education and Health in the United States. Retrieved from

– Misha B.

Maladjusted: Using Theatre to Create Mental Health Policy

“Very few individuals or families are not touched by at least some aspects of mental dysfunction, some moments of the discouragement, disconnect or anxiety that, on a deeper level, characterizes the mind state of the mentally ill. Maladjusted, to be created with the participation of people challenged by mental illness, will serve us all by bringing their experience and insights to public awareness, giving us opportunity to examine our own attitudes towards mental health in others and in ourselves.”
 (Quote from Theatre for Living’s website)
Gabor Maté M.D. Author of In The Realm of Hungry Ghosts: Close Encounters With Addiction



maladjusted, a play by Theatre for Living, Vancouver, BC

Unfortunately, I heard about maladjusted a day too late, and didn’t get to attend the play or listen to the online Webcast. I still think it is an important idea to bring to our health communication and advocacy class, however, as it is an innovative way of initiating change in mental health policy and involving multiple players in the process.

Maladjusted was produced by Theatre for Living (formerly Headlines Theatre) in Vancouver, and ran from March 8th-24th at the Firehall Arts Centre. The theatre style used was “forum” based theatre, based on the work of the late Augusto Boal (“Theatre of the Oppressed”).

As the creators explain on the Theatre for Living website, maladjusted was released at an important time in Canada, as mental health issues are beginning to gain more discussion and consideration in policy. The Mental Health Commission of Canada recently released its national strategy “Changing Directions, Changing Lives,” which encourages multiple levels of society to work together to ensure its successful implementation.

Theatre for Living believes that forum theatre is an opportunity for creative, community-based discussions on mental health issues in Canada, particularly regarding stigmatization.

On their website, Theatre for Living explains: “If we agree that there are populations of clients (mental health) and health care providers who have poor interaction patterns due to stigmatization, and that these clients and providers are finding difficulty interacting in a healthy and productive manner, then we have the opportunity to experiment with new ways for these marginalized clients to access care and for the providers who work with these populations to be supported in both the health system and the larger mainstream culture.” [History of the Project, What Can Theatre Do?]

The production was in the style of a workshop over the course of 6 days, involving some play and some public dialogue. The participants were a mix of individuals suffering from mental health conditions and health care providers, thus the patients and the providers. Each day, participants engaged in games and exercises that helped them shed light on issues such as mental health stigma, diagnosis, treatment, among many others.

How does it work?

The scripted play is performed once, without interruptions. There is a crisis at the end, and no solutions are offered. Then, the actors run through the play again, and audience members are allowed to stop the play and offer ideas for interventions (see “What is Forum Theatre? And the Evolution of Theatre for Living” section of the Theatre for Living website). Due to equity rules, there is no recorded playback of this event.

This is a very interesting example of Entertainment Education, which we will be discussing in class next week.

A few questions to ponder: How can we use this example of Entertainment Education to target other public health issues?  Why does it work so well as a method for addressing contentious issues? How does this form of advocacy have the power to create a large “buzz” in the media?

For an example of “media buzz,” read a review of maladjusted on at the following link:




Theatre for Living Overview of maladjusted: “The Mental Health System. The People. The Play:”

Theatre for Living Blog: review of maladjusted:

Augusto Boal Wikipedia (“Theatre of the Oppressed”):

The Mental Health Commission of Canada “Changing Directions, Changing Lives” national mental health strategy:

Firehall Arts Centre Vancouver website:

Entertainment Education in the Media

Entertainment Education is a communication and health marketing strategy that aims to raise awareness and educate the public in order to change health behavior. It is based on various theories of behavior change and human behavior, and has been utilized for over 30 years.  Many formats including film, television, social media, and theater are used to connect with an audience’s emotions and inform viewers, with the hope that this will subsequently change behavior, attitudes, and social norms.


An example of this approach was used on the popular Lifetime TV drama Army Wives.  This show explores the lives and families of women in the Army.  In 2010, the character of Joan (played by Wendy Davis) was diagnosed with a traumatic brain injury (TBI).  This subject was carried out in a multi-episode storyline.  TBI is often referred to as “the signature wound of the Iraq and Afghanistan wars”.  It occurs when a sudden head injury or trauma disrupts the brains functioning.  Damage by explosive devices, vehicle or motorcycle accidents, and falls are common causes of TBI.


When writing these particular episodes, two scientists from the Centers for Disease Control and Prevention (CDC) acted as key informants in the process of storyline development.  The show first contacted Hollywood, Health & Society, a program that provides accurate health and medical information to entertainment industry professionals.  From here CDC specialists were connected to television scriptwriters at the National Center for Injury Prevention and Control where they worked together to include important health messages within the storyline.

Featuring TBI on Army Wives raised awareness about various signs and symptoms associated with the injury.  As early diagnosis has the potential to save the lives of those affected, this entertainment education strategy worked with a goal of educating viewers on an issue they may not be familiar with.

By engaging audiences in dramatic stories, such as that of Joan, entertainment education coveys significant social and health messages to large audiences.  This process helps facilitate motivation amongst viewers to change their attitude and behaviors on various issues.  By attaching education to entertainment, audiences may be more receptive to the material and the educational content may reach those that it would not otherwise be able to.


– Hannah T

3 Types of Social Mobilization used in the Global Polio Eradication Initiative

Social mobilization (SM) involves empowering the beneficiaries of health promotion activities to become “active and accountable stakeholders1.” The basic principles are empowerment, equity, sustainability, integration, and cultural sensitivity and gender fairness. SM is the processes of engagement and action that advocates for change. Although it is driven by the beneficiaries, with the help of champions, coaches, and catalysts, it involves all sectors of society including: “decision and policy makers; opinion leaders; bureaucrats and technocrats; professional groups; religious associations; commerce and industry, and; communities and individuals2.” While many theoretical definitions agree on the primary tenets of SM, there are many activities in practice labeled social mobilization. Three broad categories of SM were observed in polio eradication efforts: pragmatic SM, activist SM, and hybrid SM. Effective design and evaluation of SM efforts are dependent on understanding and being able to distinguish the 3 kinds of SM.

Pragmatic SM occurs when community leaders and groups are used in practical ways to “pass along important information to intended beneficiaries and assist the program in performing other important tasks needed to achieve program goals3.” Community actors are used as instruments to achieve predetermined public health goals, such as polio immunization, where their actions may maximize the public health activities. Pragmatic SM in these cases can be successful in increasing rates of immunization and works particularly well where heath education is low and is one of the primary barriers to care. Accordingly, pragmatic SM works poorly in situations where there is resistance to polio immunization. Sustainability is also at stake when community actors are merely used as instruments instead of taking ownership of the cause.

Activist SM, on the other hand, is characterized by community ownership. Activist SM fully commits to the basic principles of SM set out by the WHO mentioned above. Decision-making power is decentralized and rests at the community level. Activist SM is often facilitated by either local community members (as champions) or by NGOs rather than governments. Governments may by threatened by encouraging “marginalized populations to become advocates for their rights4.” Activist SM has the potential to be more sustainable than pragmatic SM, because the community actors themselves take ownership of the initiative and carry it as long as they so choose (and in whatever manner they choose). While this has been effective in examples of water and sanitation, local emergency transportation systems, and in local health insurance schemes, it may be less effective in polio immunization. In northern Nigeria, for example, local communities have taken charge of the national immunization program, choosing to support widespread opposition to polio immunization.

To combat the limited effect of top-down pragmatic approaches and the potential for activist approaches to not prioritize important public health issues (e.g. polio immunization), hybrid SM has developed. As Murphy iterates,

“It is unrealistic to expect communities in every part of the world to identify polio eradication as a high priority and then marshal the commitment, resources, and strategies to immunize all their children. What has emerged over time is a blend of pragmatist and activist elements — a hybrid form of SM — that is characteristic of the most successful polio eradication efforts5.”

In hybrid SM, goals and strategies are negotiated rather than merely predetermined and accepted; community actors are engaged in all steps of the process—planning, implementation, and evaluation—; and, in some cases, more holistic polio eradication programs have resulted in response to community demands. According to Murphy,

“Hybrid approaches combine the best of both pragmatic SM (organizing and coordinating activities) and activist SM (tapping the power and insights of the community). Combining them has resulted in greater success in reaching and immunizing children in high-risk populations. As one example, activist SM can give NGOs new insight into the community, especially on the reasons behind resistance and barriers to polio immunization on which they can build pragmatic responses6.”

Further lessons learned through observing the evolution of SM used in the Global Polio Eradication Initiative include the nature of media, as additional community actors rather than merely channels; of the power of interpersonal communication over relying on mass-media; and the significance of incorporating women in the SM initiatives. As the polio programs evolved, it became clear that the most successful SM strategy to increase polio immunization of children emphasized the roles of the community mobilizers, family visits, and engagement of religious and other influential leaders.

“A social mobilization worker calls out to the population of Popokabaka [DRC]. During polio vaccination campaigns, social mobilization workers travel through towns, using a megaphone to inform parents of the importance of vaccination and when their children can be vaccinated.” From the Global Polio Eradication Initiative ( Retrieved March 21, 2013.

“A social mobilization worker calls out to the population of Popokabaka [DRC]. During polio vaccination campaigns, social mobilization workers travel through towns, using a megaphone to inform parents of the importance of vaccination and when their children can be vaccinated (6).”

  1. WHO: Regional Office for the Western Pacific (2003). Social Mobilization for Health Promotion. Manila, Philippines: WHO, p. 2.
  2. Murphy, Elaine (2012). Social Mobilization Lessons from the CORE Group Polio Project in Angola, Ethiopia, and India. Washington, D.C.: CORE Group, p. 4
  3. (ibid, p. 4)
  4. (ibid, p. 5)
  5. (ibid, p. 6)
  6. (ibid, p. 6)
  7. The Global Polio Eradication Initiative. Retrieved March 21, 2013 from

What is Delphi method?

The Delphi method is a highly flexible problem solving process and a powerful research technique. It is used when there is an insufficient evidence base to make a decision and/or when expert experience and opinion are considered valuable. It has been used widely in numerous industry sectors including Health Care, Education, Business Management, Information Technology, Military Science, Engineering, and Transportation. Delphi technique comprises a series of questionnaires sent to a pre-selected group of experts. These questioners are usually items that can be ranked or scaled. They are designed to develop individual responses to the problems posed, and to enable the participants to revise, refine and evaluate their previous response in light of comments made by their peers.
For more information see my PDF version of my presentation on Delphi method.

Delphi Techinque

Alaa Almaiman.

More Cellphones Than Toilets!

The usual browsing through Facebook brought me this:

Here is a very interesting campaign in India that seeks to install toilets and other sanitation facilities. “No Toilet, No Bride.” There are more cellphones in India than toilets! Check out the World Bank video below:

– Misha B.

Mental Health to the Masses: The Stigma of Mental Illness and the Role of Media

Which one of the following activities do you engage in more frequently: (1) Reading the newspaper (2) Openly discussing the stigma surrounding mental illness. Chances are you spend more time reading the newspaper. Newspapers reach many individuals every day, whether it be online, at a table in a cozy coffee shop, or standing on a crowded bus. ‘What’s in the news’ pervades our daily conversations. Unfortunately, stigma and mental illness continue to go together like a morning cup of coffee and a daily newspaper. The question then becomes, how can we reduce the stigma attached to mental illness?

One approach would be to conduct scientifically relevant and rigorous research, present the findings at a conference among a small group of like minded peers, and to further publish those results in a peer reviewed journal to share the knowledge among the academic community. I would argue that this approach is already happening, and that the results have been less than impressive. Don’t get me wrong, I find tremendous value in the scientific method, but I think that if we are going to truly reduce the stigma attached to mental illness we need some help getting the word out.

Well, let’s fire up the printing presses! I recently came across four newspaper articles that I think you should take a look at. I am in no way trying to tell you what to think, I am merely offering up a subject matter that I think desperately needs and deserves your attention.

Lets start with some one stop shopping. The Globe and Mail published a special report on mental illness that is worth taking a look at if you are interested in learning more about mental illness. I find this resource to be very user friendly, with a mix of written word and visual media. It covers many different mental health issues affecting the young, the old, and everyone in between.

Now that you have completed mental illness 101, let us move on. I refer you next to a piece from the Huffington Post. This piece discusses how we might reduce the stigma of mental illness, and presents some information and skills that can help us along the way.

In case your interest in waning, let me recapture your attention with two words: Violence & Television. Still reading? Great. Unfortunately, many people associate having a mental illness with being violent. I refer you to a piece in USA Today that discusses the perception that people with a mental illness are prone to violence. The truth is that having a mental illness makes you more likely to be a victim rather than a perpetrator of violence.

The last article on my list shines the light on how mental illness is framed within television shows. If you are curious which stars have been affected by mental illness, and which current TV shows are showcasing mental illness (for better or for worse), then spend some time with this last piece.

The point of this post was to encourage us all to educate ourselves and each other about the ‘truth’ behind mental illness. One way to ‘spread the word’ is to use a media source that already makes its way into the homes of so many. You do not have to be a journalist to contribute to this cause. There are many ways to contribute to a newspaper. What if you are not someone who enjoys writing? Well then take to reading, asking questions, and sharing your thoughts. The stigma surrounding mental illness can be found all too often, and it can be difficult to separate the facts from the fiction. Ignorance is not bliss, however, and we need to hold ourselves and others accountable. Spread the word.



How Being a Public Health Student Has Made Me Forget What’s Actually Going On in the Real World

We’ve been talking about health communication, social mobilization and knowledge for the last ten weeks and in the last few weeks, we have really stressed that knowing your “topic” or issue is not enough. To get noticed, to be effective, to make an impact – all of these things actually depend on not getting sucked into your own little world of “my health issue is the most important” (even if you truly believe it is!). You have to be aware of the world around you, the context. What are people talking about, concerned about, scared, excited, nervous, or frustrated about? All of these things impact a) where your health “issue” fits in to the grand scheme of life, b) how you will go about bringing attention to it or making change in some way, and c) what are other issues, structures, beliefs, attitudes and systems that are affecting your health issue or population. In fancy schmancy terms or health jargon, the social ecological context. As I write this, I realize that all of this applies to the idea of Health in All Policies.

Tonight, however, I realized that I have been so absorbed into my own world of school, health and life, that I have not really been paying attention to what is going on in the rest of world (or even just Vancouver)! How ironic is that?

So, I decided to take a peak at a couple of different sources, from the Huffington Post to CBC to the Globe and Mail to get a feel for what is going on in the world of health for the general public. Here are just a few snapshots of what our world is talking about over the last 24 hours (March 18-19, 2013).

CBC News Health Headlines

CBC News Health Headlines

CTV News Health

CTV News Health

Huffington Post Health News

Huffington Post Health News

CBC Most viewed March 19

CBC Most viewed March 19

Huffington Post Canada Health News

Huffington Post Canada Health News

Global TV Top Health Headlines

Global TV Top Health Headlines

Food and diet, sugar and soft drinks in particular, are in the news as is New York City Mayor Bloomberg’s cigarette plan, concussions, mental health and psychology (lots of articles on happiness, meditation, and stress, as well as schizophrenia, depression and Alzheimer’s), the scope “map” of the colon, surgical wait times, and the antibiotics crisis.

As you can see, it’s difficult to see what is trending! There appears to be a little bit of everything. The interesting thing about a lot of these topics, and something that I had never thought of too much before this class, is just how much health communication and policy are intertwined. These forms of communication, the way the general public accesses health information and the way it is presented to them (including who is deciding what is allowed in the media) has a massive impact on policy. This is especially apparent now more than ever with blogs, live news feeds, Twitter, and the input the public is able to have via social media. That being said, I am still a bit puzzled about when and how an issue gets to be relevant and how to keep it relevant enough for both behavioural and policy change to occur? How much control do we actually have over making something go “viral”? I guess, at the end of the day people want to read and hear about what is affecting them (personally, environmentally, economically, etc) so the best we can do is make it (our issue) relevant, personal, and provide some sort of do-able option, answer or change. Oh my goodness, was that me just putting theories of change, health communication and policy all together in an easy and accessible way?

How to: Measure and Assess Impacts on Mental Well-being

Mental health and mental well-being are more than a lack of mental illness. Our mental well-being is impacted by a range of factors ranging from individual level psychology to wider societal determinants. In their Mental Well-being Impact Assessment (MWIA) Toolkit (2011), the National MWIA Collaborative outline an evidence-based model of metal well-being (as seen in the figure below).

MWIA’s Dynamic Model of Mental Well-being

(Figure 2.2, MWIA Collaborative, 2011,  p 16)   �

Using this model, the MWIA toolkit walks individuals and community stakeholders  through a screening and assessment process examining a proposal’s impacts on mental well-being.  It then allows stakeholders to develop monitoring indicators and make evidence-based recommendations aimed at maximizing the proposal’s positive impacts on mental well-being while minimizing its negative impacts.

For more information about Mental Well-being Impact Assessments see a pdf version of  my recent MWIA presentation or download the full MWIA toolkit from here.

-Chelsea H.