CURRENT STATUS, TRENDS AND CHALLENGES OF COMMUNITY

HEALTH NURSING

INTRODUCTION

Forces affecting health care in the future will also affect the role of the nurse. One
can only speculate about what that future will be. Some broad changes can almost certainly
be predicted. Nurses will seek to learn from the past and to avoid known pitfalls, even as
they seek successful strategies to meet the complex needs of today’s vulnerable populations.
As plans for the future are made, as the public health challenges that remain unmet are
acknowledged, it is the vision of what nursing can accomplish that sustains these nurses.

CURRENT STATUS OF COMMUNITY HEALTH NURSING

In India

Even after 67 years of independence, we do not have a health care system that can
efficiently look after the health status of our people. India has a large share of poor, illiterate,
and malnourished of the world. Majority of our people do not have basic health care
facilities. There is always the dichotomy between the affluent opting for five stars - treatment
at institutions having world class infrastructure, while the poor go to over -crowded public
care facilities where no adequate care is provided forcing them to leave everything to fate.
Health care is expensive and beyond their reach.

A deep analysis of the lifestyle of people would help in assessing some aspects of the
prevailing public health situation in India. With the ever - increasing life expectancy, the
epidemiological transition points towards greater incidence of non-communicable or life
style diseases. India is an exception to other countries in that nearly 4/5 th of its health care
expenditure is out of pocket.

Communicable and non communicable diseases have still to be brought under

effective control as well as eradicated. Blindness, leprosy and tuberculosis continue to have a
high incidence. HIV/ AIDS pandemic make the situation worse.

1
. Communicable and non communicable diseases have still to be brought under effective
control as well as eradicated. Blindness, leprosy and tuberculosis continue to have a high
incidence. HIV/ AIDS pandemic make the situation worse.
High incidence of diarrhoeal disease as well as other preventive and infectious
disease, especially among infants and children, lack of clean and safe drinking water, poor
hygiene and sanitation, poverty and ignorance are among the major contributory causes of
the high incidence of disease and mortality. Only 31% of the rural population has access to
potable water and only 0.5% of people enjoy basic sanitation.
In Tamilnadu
Trends in Health Status in Tamil Nadu
The demography and vital statistics provide the base information on the health status
of any region or community. Life Expectancy at Birth (LEB), Infant Mortality Rate (IMR),
Crude Birth Rate (CBR) and Crude Death Rate (CDR) are the important indicators that
reflect the health status and human development. The comparison of these health indicators
for Tamil Nadu and All India average reveal the advantageous position of the state.

Life Expectancy Infant Mortality (per 1000 Birth Rate Death Rate
at birth live births (per 1000) (per 1000)
(2007- 12)
Male Female Male Female total
Tamil
67.00 69.75 46 43 44 18.5 7.4
Nadu

All India 63.87 66.91 62 65 63 25 8.1

Goals of Puducherry State Health Mission by 2012 for improving Health Status:

National Level Puducherry

To reduce Infant Mortality Rate to Achieved 25 /1000 live births

30/1000 live births

To reduce Maternal Mortality Ratio MMR achieved 18 / 1 lakh

2
 to 100/1,00,000 live births population

Total Fertility Rate reduced to 2.1 Total Fertility Rate – 1.6

Malaria Mortality reduction rate 50% No Malarial Death reported in UT

upto 2010, additional 10% by 2012

Filaria / Micro Filaria reduction rate Achieved 0.06%, elimination will

70% by 2010, 80% by 2012 and be declared as non endemic state
elimination by 2015 for filariasis

Dengue Mortality reduction rate 50% No mortality due to dengue

by 2010 and sustained at that level
until 2012

Cataract operation increasing to 46 Achieve more than the annual

lakhs per year until 2012 target form Cataract operations

Leprosy prevalence rate reduce from Achieved Leprosy elimination by

1.8 / 10000 in 2005 to less than 1 / March 2005, prevalence Rate 0.31
10000 there after / 10,000 population

Tuberculosis DOTS Services: Achieved 85% cure rate

Maintain 85% cure rate through
entire mission period

Upgrading Community health Being implemented

Centres to Indian Public Health
Standards

CURRENT TRENDS IN COMMUNITY NURSING

Forces affecting health care in the future will also affect the role of the nurse. One
can only speculate about what that future will be. Some broad changes can almost certainly
be predicted. These include: emphasis on cost containment resulting from market-driven
economic policy; advancements in technology; knowledge explosion; expanded use of
alternative and complementary therapies; and demographic shift.

3
The future of nursing care

Nurses must be prepared to used critical thinking skills to solve problems and make
independent clinical judgments regarding care based on the most recent evidence. They must
be knowledgeable about making age-appropriate referrals to other disciplines and community
agencies. Because more acute care will be provided in the home and clinics, nurses must be
more technically advanced in their skills, able to practice autonomously, and adept at detailed
documentation to ensure payment for services. As a larger number and percentage of the
population are living with chronic conditions and managing symptoms at home, there will be
a need for competent, skilled nursing practitioners who are comfortable practicing
independently in the area of disease management.

In home care nursing, this is evidenced by nurse doing venipunctures (a laboratory

technician’s role) and teaching and monitoring administration of oxygen (a respiratory
therapist’s role). To prepare for the home care role, nurses must be competent case managers
and health educators.

In the last decade, our profession has made major process in several areas of public
policy. The issue of delegating duties to no licensed personnel has been addressed and
continues to need clarification. Today, advanced practice nurses (APNs) can bill directly
through Medicare and in most states can prescribe medication. In some states hospitals are
mandated to maintain a safe level of staffing registered nurses based on the research on
staffing ratio and hospitals mortality.

Educational preparation and advanced practice nursing

Specialty areas of nurse practitioners have expanded to numerous subspecialties in the

last 3 decades. These include adult, gerontologic, neonatal, occupational, pediatric,
psychiatric, school or college student, and women’s health. Nurse practitioners work in both
rural and urban areas, from rural North Dakota to New York City. They practice in diverse
settings such as community health centers, hospitals, college student health clinics, physician
offices, nursing homes and hospices, home health care agencies, and nursing schools.

4
Technology and information

Computer technology has freed the nurse from some paper work, allowing more time
for client care and teaching about self-care. The expanding implementation of computer-
based client records allows the preservation of a client’s history from birth to death.

Alternative and complementary therapies

To follow the holistic perspective, nurses must be knowledgeable about alternative

therapies. With such knowledge, they can monitor care and treatment and provide
information about benefits and potential harm for clients.

In the future, nurses will increasingly be called on to provide knowledge about and
use of alternative therapies. Therefore, it is imperative that nurses continue to build their
knowledge and skill base about alternative therapies. As the population becomes more
diverse ethnically, it is anticipated that more methods of promoting health and treating illness
will be necessary.

Research provides evidence that some alternative therapies enhance health and
promote recovery from illness for both the client and family caregivers (Research in
Community-Based Nursing Care). While some caregivers still support only Western
methods of health care and continue to ignore or repudiate the value of more traditional or
alternative methods, the use of these practices has persisted and grown because people find
them useful.

Shifting demographics

The nursing shortage is the latest demographic trend that will impact community-based care
in the future. One national survey of RNs indicated that 82% of nurses reported a shortage in
their hospital or community. These nurse did not have positive expectations of the impact of
the shortage on work conditions, believing that some tasks currently assigned to nurses will
shift to other staff. They anticipate the shortage will result in nurses leaving nursing for non-
nursing jobs, thus intensifying the shortage. These changes could result in lower quality of
care provided.

Because community-based nursing practice will be central to the care of a population

of aging and chronically ill people, nurses will be confronted will many challenges. In the
future, regardless of the nurse’s own ethnic background, the nurse must be proficient at

5
transcultural nursing to be an effective caregiver. Nurses will play a major role in promoting
self-care and addressing health promotion and disease prevention issues for elderly clients.

Collaboration is even more important when working with diverse populations.

Collaboration across disciplines is always challenging, but it is particularly so if the
interdisciplinary team members are from several cultural backgrounds.

Preventive care

Focusing on prevention will be particularly challenging as the percentage of the

population ages and is living with chronic conditions. Growing trends in alternative health
therapies allow more culturally sensitive options in preventive care. There are different ways
that nurses can operationalize the concepts of health promotion and disease prevention in
community-based nursing. Nurses can position themselves as the first link between clients
and the hospitals, thus developing long-term relationships. This involves developing systems
and models of care that require periodically contacting clients with chronic problems.

Continuity of care and collaborative care

The hospital of the future may be known as a health care organization or an integrated
health care system. These systems already exist in many parts of the country. More
community-based care programs will come from these integrated systems. Another them
used is seamless care, in which all levels of care are available in an integrated form.
Continuity allows quality care to be preserved in a changing health care delivery system.

Current trends in nursing employment

As a result of cost-containment measures and medical practice modifications, nursing
employment has changed over the past several years. The Public Health Service’s Division of
Nursing has chronicled this change in practice settings through periodic survey of Registered
Nurses.

The 2004 National Sample Survey of Registered Nurses (RNs) discovered the following:

 Rate for RNs who is working outside of hospitals 43.8% (up from 33.5% in 1992 and
an increase of 2.9% since 2000).
 Although the number of RNs working in hospitals increases, the proportion of nurses
working in hospitals declined significantly.

6
  The number of nurses employed in public health and community health settings
increased by 128.8%.

Community based employment opportunities for registered nurses

Ambulatory care

 Adult day care centres

 Day care centres for ill children

 Mental health clinics

 Family planning clinics

 Cardiac rehabilitation programs

 Geriatric clinics Migrant health clinics

 AIDS clinics

 Diabetes management and education services

 Pulmonary clinics (asthma, chronic obstructive pulmonary disease, cystic fibrosis)

 Genetic screening and counselling services

 Bloodmobiles

 Freestanding diagnostic centers

 Diagnostic imaging centers

 Mobile mammography centers

Health department services

 Maternal/child clinics

 Family planning clinics

 Communicable disease control programs

 HIV/AIDS (testing, counselling, and treatment)

7
  Tuberculosis (testing, treatment, and surveillance)

 Sexually transmitted diseases (testing, counselling, and treatment)

 Immunization clinics

 Mobile clinics serving disenfranchised populations

 Substance abuse programs

 Jails and prisons

 Indian health service (American Indians and Alaska natives)

Home health care services

 Skilled nursing care

 Intravenous therapy

 High-risk pregnancy/neonate care

 Maternal/child newborn care

 Private duty (hourly care)

 Respite care

 Hospice care

Long-term care

 Skilled nursing facilities

 Hospital-based facilities

 Freestanding/nursing home-based facilities

 Hospice facilities

 Nursing homes

 Skilled nursing care

 Assisted living

8
Other community health settings

 School health programs

 Occupational health programs

 Parish nursing programs

 Summer camp programs

 Childbirth education programs

CHALLENGES OF COMMUNITY HEALTH NURSING

Autonomy:

Rural community health nurse have the opportunity to use autonomy in daily practice.
Nurses must rapidly assume independent and interdependent decision-making roles because
of the small workforce and large workload. Rural community health nurses learn to prioritize
tasks quickly and work efficiently with others to “get the job done”. Referrals to other rural
providers are facilitated because providers frequently know one another. The rural
community health nurse has an advantage over urban nurses in that the rural health care
system is smaller and easier to influence and change.

“Always a Nurse”:

Anonymity is not easy for the rural community health nurse, who is always “on duty”.
A trip to the grocery store on a Saturday morning may include interactions with rural clients
and their families about their pressing health concerns. Rural community health nurses may
have confidentiality and personal/professional boundary issues that need to be addressed.
However, rural community health nurses are often respected, known, and trusted by the
populations they serve.

Funding for Education:

Some of the educational loans available to you at the under-graduate and graduate
levels may be reduced or forgiven if you practice in a rural community after graduation. You
should inquire through your nursing program about the possibility. It is also possible to

9
contact a specific rural community as to whether they can offer some monetary support in
return for a pledge to return to the host community to work for several years.

Isolation:

Rural community health nurses may experience the challenge of physical isolation
from personal and professional opportunities associated with urban area. Travel to cities for
basic and continuing education can be a barrier. Rural nurses may also feel isolated in their
clinical practices because of the scarcity of professional colleagues. Many rural community
health nurses overcome these barriers and learn to appreciate the benefits of clinical practice
in a rural setting by discussing their concerns with peers and seeking ways to combat
isolation.

Dollars and “Sense”:

The rural community health nurse often receives a salary that is lower than that of
urban nurses in comparable positions. However, there are benefits to rural nursing. Housing
costs are usually less than in larger cities, and long commutes to and from work on congested
highways are avoided. Rural communities are great places to live and raise a family. The
slower pace of life, open spaces, clean air, and friendly atmosphere may make more “sense”.

Many Possibilities:

The smaller system of health care in a rural community can be an advantage to the
community health nurse. It may be easier to “understand the system” and initiate planned
change. For example, if a rural nurse wants to continue his or her education, c college of
nursing could be contacted to offer the needed classes. There are many possibilities to
enhance rural nursing practice, including continuing education by satellite or Internet,
partnerships with larger medical centres and invitations to clinical experts to provide on-site
workshops. Grants can be written to facilitate these endeavours.

Challenges in the area of demographic and mortality Profile in our country:

Large population base and tapering top in the age pyramid is a typical sign of under
developed country. 32% of the population between 0-14 years in the base of the pyramid
reflects the need for Health care services in abundance as morbidity and mortality among
them are high in our country.

10
Ageing Population
In the rapidly growing world were 8 % of the current population are elderly healthy
ageing has become a vital need in the country.

The country will face a heavy double burden of infectious and non-communicable
diseases with existing lack in significant resources including comprehensive ageing policies
to cope.

Fertility related challenges:

Fertility rate of 2.8 per women (2007) is comparatively high than that of the
developed countries.

The combination of high fertility rate along with a 34 % of non-literate population

and a Adolescent fertility rate of 45 per 1000 women when compared to 4 and 7 in the
developed countries are all considered the major leads for population explosion. The
challenge reflected here is high birth rate and declining death rate [9.4% to 7.5 % (2004)] in
our country which is a vicious cycle not very easy to break.

Hence population explosion is the greatest challenge for the health care sector to
match the resources with need.

Climate change and communicable diseases: the challenge ahead

The global warming induced by climate change has added a new dimension to the
burgeoning problem of communicable diseases in particularly in South-East Asia Region.
The countries of this Region must be prepared to respond to this challenge.
The changes in weather will have direct and indirect health consequences such as greater
morbidity and mortality resulting from heat stroke, skin and eye diseases An increase in
vector borne, water borne and respiratory diseases besides eye and skin diseases are expected
to rise.
Diarrhoea is the second most common cause of death among children under the age
of five in the developing world.India is major contributor to the global disease burden.

We don't have to look back too long to see what happened during the Plague outbreak
in Surat (Gujarat) in India in 1994 where strong monsoon following an immense heat wave,
led to intense animal and human interface.

11
  The onset of Chicken guinea in India is the result of climate changes.

 Droughts can lead to malnutrition and starvation.

 This can affect the growth and development of children.

Reduced crop yields are bound to put farmers and their families into difficult
circumstances and cause psychological stress as they may not be able to pay their debts
during extended and repeated droughts.

Changes in the frequency of extreme weather events as heat waves, cold spells,
hurricanes, floods, cyclones and storms can cause loss of life, injuries and lifelong
disabilities

BIBLIOGRAPHY

1. Kamalam S. Essentials in community health nursing practice. 2nd edition. New Delhi.
Jaypee brothers medical publishers; 2012: 340-1.

2. Park K. Preventive and social medicine. 24th edition. Jabalpur. Banarasidas bhanot;
2017: 493-4.

3. Veerbhadrappa GM. The short textbook of community health nursing. New Delhi.
The health sciences publisher; 2016: 50-52.

4. Govt. of India. National Population Policy 2000. Government of India Ministry of

Health & Family welfare.
5. Lal Sundar, Adarsh, Pankaj. Textbook of community medicine. Preventive & social
medicine. 3rd edition. New Delhi. CBS publisher;2011: 165-9.

6. Kishore J. National health Programs of India. National Policies and legislation related
to health. 11th edition. New Delhi; 637-45.

https://www.slideshare.net>mobile>national

12
 TELEMEDICINE

INTRODUCTION:

Secondary and tertiary medical expertise is not available in several areas of the world.
Quite often, many patients are sent elsewhere at considerable expense. In a number of these
cases the treatment could have been carried out by the local doctor with advice from a
specialist. Even Within a country there is a tendency for specialists to concentrate in the big
cities making medical care in suburban and rural areas sub optimal Using a PC, a scanner, a
digital camera networking, appropriate software and telecommunications it will be possible to
transfer clinical data from any part of the world to any other part.

Offering medical advice remotely, using state of the art telecommunication tools is
now a regular feature in several parts of the world. Telemedicine is becoming an integral part
of health care services in several countries including the UK, USA, Canada, Italy, Germany,
Japan, Greece, and Norway and now in India.

Several studies ; have shown telemedicine to be practical, safe and cost effective.
Telemedicine hinges on transfer of text, reports, voice, images and video, between
geographically separated locations. Success relates to the efficiency and effectiveness of the
transfer of information.

Telemedicine is primarily focused on providing support towards curing an illness.

Today we have expanded the scope of telemedicine to include the preventive and promotive
aspects of healthcare. This new avatar is called Telehealth, Tele-Health, EHealth or E-Health.

BASICS

The term 'telemedicine' has been derived from the Greek 'tele’. meaning 'at a distance'
and 'medicine' which is from the Latin word 'mederi. meaning 'healing'. Time magazine
called Telemedicine “healing by wire". Though initially considered “futuristic” and
“experimental” Telemedicine is today a reality and has come to stay. This phrase was first
coined in the 70s by Thomas Bird.

The European Commission's health care telematics programme defines telemedicine

as: "rapid access to shared and remote medical expertise by means of telecommunications

13
and information technologies, no matter Where the patient or relevant information is
located."

A major goal of telemedicine is to eliminate unnecessary travelling of patients and

their escorts. Image acquisition, image storage, image display and processing, and image
transfer represent the basis of telemedicine. In plain speak, telemedicine is a process by
which a patient is able to communicate his problems (along with, if necessary, details of
medical investigations) to a doctor many miles away and receive necessary and relevant
medical advice. In a lighter vein, when your doc, on the phone, told you to 'take an aspirin
and call me in the morning' he was actually practicing telemedicine!

The terms e-health and telehealth are at times wrongly interchanged with
telemedicine. Like the terms "medicine" and "health care", telemedicine often refers only to
the provision of clinical services while the term telehealth can refer to clinical and non-
clinical services such as medical education, administration, and research. The term e-health is
often, particularly in the UK and Europe, used as an umbrella term that includes telehealth,
electronic medical records, and other components of health IT.

DEFINITION

Telemedicine can be defined as, “the use of modern information technology,

especially two-way interactive audio/video telecommunications, computers, and telemetry to
deliver health services to remote patients and to facilitate information exchange between
primary care physicians and specialists at some distance from each other.” (Telemedicine:
Theory and Practice)

Telemedicine is a rapidly developing application of clinical medicine where medical

information is transferred via telephone, the Internet or other networks for the purpose of
consulting, and sometimes remote medical procedures or examinations.

Telemedicine is a method, by which patients can be examined, investigated,

monitored and treated, with the patient and the doctor located in different places. In
Telemedicine one transfers the expertise, not the patient. Hospitals of the future will drain
patients from all over the world without geographical limitations.

Telemedicine may be as simple as two health professionals discussing a case over the
telephone, or as complex as using satellite technology and video-conferencing equipment to

14
conduct a real-time consultation between medical specialists in two different countries.
Telemedicine generally refers to the use of communications and information technologies for
the delivery of clinical care.

SPECIALTIES

Telemedicine covers a growing number of medical specialties such as:

 Cardiology

 Home Care

 Radiology

 Emergency Care

 Surgery

 Dermatology

 Psychiatry

 Oncology

 Pathology

 Ophthalmology

 Hematology

 ENT

 Nephrology

 Prehospital Care

GROWTH OF TM APPLICATIONS

2001 : Tele-radiology -still images

2002 : Tele-cardiology Moving images

2003 : Tele-pathology, Tele-ophthalmology

15
2004 : Tele-oncology, Tele-surgery

2005 : Mobile TeleHealth-augmentation

2006 : Telemedicine for Primary healthcare --VRC

HISTORY OF TELEMEDICINE

Care at a distance (also called in absentia care), is an old practice which was often
conducted via post; there has been a long and successful history of in absentia health care,
which thanks to modern communication technology = has metamorphosed into what we
know as modern telemedicine.

In its early manifestations, African villagers used smoke signals to warn people to
stay away from the village in case of serious disease. In the early 1900s, people living in
remote areas in Australia used two-way radios, powered by a dynamo driven by a set of
bicycle pedals, to communicate with the Roya1 Flying Doctor Service of Australia.

The idea of performing medical examinations and evaluations through the

telecommunication network is not new. Shortly after the invention of the telephone, attempts
were made to transmit heart and lung sounds to a trained expert who could assess the state of
the organs. However, poor transmission systems made the attempts a failure.

1906: ECG Transmission

Einthoven, the father of electrocardiography, first investigated on ECG transmission

over telephone lines in 1906‘. He wrote an article “Le telecardiogramme” at the “Archives
Internationales Physiologic” 4:132, 1906

1920:: Help for ships

Telemedicine dates back to the 1920s. During this time, radios were used to link
physicians standing watch at shore stations to assist ships at sea that had medical
emergencies.

1924: The first exposition of Telecare

Perhaps it was the cover showed below of "Radio News" magazine from April 1924.
The article even includes a spoof electronic circuit diagram which combined all the gadgets

16
of the day into this latest marvel! (Information and photo by courtesy of Dennis J . Streveler
Ph.D. Healthcare IT Consultant).

1955: Telepsychiatry

The Nebraska Psychiatric Institute was one of the first facilities in the country to have
closed-circuit television in 1955 In 1971 the Nebraska Medical Center was linked with the
Omaha Veterans Administration Hospital and VA facilities in two other towns.

1967: Massachusetts General Hospital This station was established in 1967 to provide
occupational health services to airport employees and to deliver emergency care and medical
attention to travelers.

1970s: Satellite telemedicine Via ATS-6 satellites. In these projects, paramedics in remote
Alaskan and Canadian villages were linked with hospitals in distant towns or cities.

1971, Japan: First time implemented in two areas: Nakatsu-mura and Kozagawa-cho,
Wakayama using telephone line for Voice and Fax transmission and CATV system for image
transmission.

1972, Japan: Between Aomori Teishin Hospital and Tokyo Teishin Hospital over 4 Mhz TV
channel and several telephone lines.

Other systems came up for teleradiology in several places in Japan like, Nagasaki, Tokai etc.

APPLICATIONS IN DIFFERENT FORMS

> Information exchange between Hospitals and Physicians.

> Networking of group of hospitals, research centers.

> Linking rural health clinics to a central hospital.

> Videoconferencing between a patient and doctor, among members of healthcare teams.

> Training of healthcare professionals in widely distributed or remote clinical settings.

> Instant access to medical knowledgebase, technical papers etc.

TYPES OF TELEMEDICINE

Telemedicine is practiced on the basis of two concepts:

17
  Real time (synchronous)

 Store-and-forward (asynchronous).

Real time telemedicine could be as simple as a telephone call or as complex as robotic

surgery. It requires the presence of both parties at the same time and a communications link
between them that allows a real-time interaction to take place. Video-conferencing equipment
is one of the most common forms of technologies used in synchronous telemedicine. There
are also peripheral devices which can be attached to computers or the video-conferencing
equipment which can aid in an interactive examination. For instance, a tele-otoscope allows a
remote physician to 'see' inside a patient's ear; a tele-stethoscope allows the consulting remote
physician to hear the patient's heartbeat. Medical specialties conducive to this kind of
consultation include psychiatry, family practice, internal medicine, rehabilitation, cardiology.
pediatrics, obstetrics, gynecology, neurology, and pharmacy.

Store-and-forward telemedicine involves acquiring medical data (like medical images,

biosignals etc) and then transmitting this data to a doctor or medical specialist at a convenient
time for assessment offline. It does not require the presence of both parties at the same time.
Dermatology (eg; teledermatology) , radiology, and pathology are common specialties that
are conducive to asynchronous telemedicine. A properly structured Medical Record
preferably in electronic form should be a component of this transfer.

Telemedicine is most beneficial for populations living in isolated communities and

remote regions and is . currently being applied in virtually all medical domains. Specialties
that use telemedicine often use a "tele-" prefix; for example, telemedicine as applied by
radiologists is called Teleradiology. Similarly telemedicine as applied by cardiologists is
termed as telecardiology, etc.

Telemedicine is also useful as a communication tool between a W and a specialist

available at a remote location.

Monitoring a patient at home using known devices like blood pressure monitors and
transferring the information to a caregiver is a fast growing emerging service. These remote
monitoring solutions have a focus on current high morbidity chronic diseases and are mainly
deployed for the First World.

18
 In developing countries a new way of practicing telemedicine is emerging better known
as Primary Remote Diagnostic Visits whereby a doctor uses devices to remotely examine and
treat a patient. This new technology and principle of practicing medicine holds big promises
to solving major health care delivery problems in for instance Southern Africa because
Primary Remote Diagnostic Consultations not only monitors an already diagnosed chronic
disease, but has the promise to diagnosing and managing the diseases a patient will typically
visit a general practitioner for.

TECHNOLOGY TRENDS IN TELEMEDICINE

The concept of telemedicine was introduced more than 30 years ago through the use
of telephone, facsimile machine, and slow-scan images. However, the enabling technology
has grown considerably in the past decade. The term telemedicine, in short refers to the
utilization of telecommunication technology for medical diagnosis, treatment and patient
care.

Telemedicine enables a physician or specialist at one site to deliver health care,

diagnose patients, give intra-operative assistance, provide therapy, or consult with another
physician or paramedical personnel at a remote site. Telemedicine system consists of
customized medical software integrated with computer hardware, along with medical
diagnostic instruments connected to the commercial VSAT (Very Small Aperture Terminal)
at each location or fibre optics.

Although, telemedicine could potentially affect all medical specialties, the greatest
current applications are found in radiology, pathology, cardiology and medical education.
Perhaps the greatest impact of telemedicine may be in fulfilling its promise to improve the
quality, increase the efficiency, and expand the access of the healthcare delivery system to the
rural population and developing countries.

Third-generation wireless cellular systems will offer video telephony that can
facilitate the transfer of real-time images to help with communications between a patient or a
caregiver and a health-care professional. Interestingly, this technology offers exactly the kind
of cost effective solutions for the specific needs arise in rural area situation. Being cost
effective, it opens an innovative way to connect rura1 areas to the cities that already have
connectivity to the Internet or have resources available on LAN. Thus, it enables to bridge the
digital divide and provides a channel for communication to the rural mass. It also makes it

19
possible to get a timely feedback of the health problems taking place in remote areas. In
situations of epidemic outbreaks such timely information can save a significant number of
lives.

As wireless technology becomes more ubiquitous and affordable, applications such as

video-telephony over POTS will gradually migrate towards third-generation wireless
systems. These techniques promise to greatly improve the cost and convenience associated
with long-term outpatient monitoring, and could potentially extend monitoring to the broader
healthy population for preventative diagnostics and alerts.

Virtual reality as most of us are aware of is the ultimate simulation, like entering the
rabbit hole in Alice in Wonderland.

Applications in virtual reality for medicine pertain to the planning of surgeries and
use of data fusion, i.e., to fuse virtual patients onto real patients as navigation aid in surgery.
While research into tele-surgery helps to jump-start robotics in the operating room, distant
operations have remained an elusive application. However, it may eventually prove to be one
of the most significant uses of robotic surgery.

MEDISOFT TELEMEDICINE PVT. LTD. COMPANY

Medisoft Telemedicine Pvt. Ltd. is a research based development company.

OBJECTIVE

To improve health care delivery by setting the highest standards in the field of public health
with the help of telemedicine and ehealth.

GOAL To provide accessibility of medical practitioners to the remotest regions through state
of the art technologies with optimal economical outcomes. At Medisoft, we firmly believe
that quality healthcare is the right to all.

TELEMEDICINE IN INDIA

 Existing system limited only to private hospital ' APPOLO Group of Hospitals. '

 RN Tagore Cardiac Hospital, Calcutta (Asia Heart Foundation)

 No Telemedicine system for public health care .

20
  Corporate Sectors Offering Telemedicine Systems

 APPOLO Group

 Online Telemedicine System, Ahmedabad.

 WlPROGE

 SIEMENS

TELEMEDICINE AT APOLLO

Apollo Hospitals have been the pioneer in the field of telemedicine in India. It was the fist to
set up the Rural telemedicine Centre in the village of Aragonda in the state of Andhra
Pradesh. It has now evolved as the single most and largest solution provider for telemedicine
in India.

Telemedicine Services at Apollo

Telemedicine reduces the burden of inferior medicine access by utilizing technology,

reducing time and cost for transportation of patients, incorporates direct clinical, preventive,
diagnostic, and therapeutic services and treatment, consultative and follow-up services,
remote monitoring of patients, services for rehabilitation and education for patients.

The expertise at Apollo is widely appreciated throughout the world and brings in
patients form all around to the Apollo clinics. Apollo telemedicine facilities can help the
patients sitting outside India to consult the doctors at the Apollo and communicate with him
through telephone, video conferences and other communication technologies. That way, the
patients are equipped with knowledge and information prior to their medical tours. Even
after the treatment is over and the patients go back, follow up and post treatment reviews and
consultation can be done through telemedicine. Telemedicine in India can meet the
challenges of health care delivery in an organized and cost efficient manner providing better
exchange of information, medical expertise and health care access.

TELEMEDICINE TECHNOLOGY EVOLUTION IN INDIA:

 Point to point

 Point to multipoint

21
  Multipoint to multipoint

 Tele-education

ADVANTAGES OF TELEMEDICINE:

COMPETITIVE ADVANTAGES

 Better quality: e.g. faster treatments with lower level of contamination for the patient;

 Reduction of cost: e.g. e : nomies of scale and scope;

 Information procurement; e.g. university-level diagnostic competence for small

hospital standardization: e.g. organizational and administrative processes;
specialization: e.g. telemedicine -based networks will support professionalization, and
specialization (Gogan, 1999)

 I T competence: e.g. increasing number of digital modalities telemedicine will

penetrate the local routine processes in hospitals and to sustain the IT competence
required.

 Availability of human resources: e.g. better coordination Enlistment periods for

radiologists across a teleradiology network;

 Shared digital archives: e.g. digital archives are an expensive resource and build
boundaries for new entrants;

 Procurement: e.g. telematics-based networks change the bargaining power of

healthcare institutions;

 Continued development of treatments: e.g. much better date base of patient records
through telematics-based networks.

Imagine the advantages it confers upon a patient who is miles away from the nearest medical
aid post, in some cases this could even be life saving.

FOR THE PATIENT.

 Availability of selected basic, intermediate and advanced medical facilities within 3

to 5 KMs of a patient's residence.

22
  Reduction in travel to distant referral medical centers.

 Reduction in cost of medicare.

 Better diagnoses of disease due to availability of specialist opinions.

 Increased and better monitoring of chronic cases.

 Increased domiciliary care.

 Tele-counselling of selected psychiatric cases.

 Telemedicine can thus avoid unnecessary travel and expense for the patient and the
family improve outcomes and even save lives.

 Once the “virtual presence" of the specialist is acknowledged, a patient can access
resources in a tertiary referral centre without the constraints of distance.

 Telemedicine allows patients to stay at home ensuring much needed family support.

BARRIERS TO TELEMEDICINE

There are several barriers to the practice of telemedicine such as The lack of procedural
proficiency and unavailability of resources,

 High infrastructure costs.

 Many potential telemedicine projects have been hampered by the lack of appropriate
telecommunications technology.

 Regular telephone lines do not supply adequate bandwidth for most telemedical
applications.

 Many rural areas do not have cable wiring or other kinds of telecommunications
access required for more refined uses, so those who could most benefit from
telemedicine may not have access to it.

 Pressure on the appropriate government and legislative agencies will surely increase
as more people realize the benefits of telemedicine.

23
DISADVANTAGES

Kokesh sees only One disadvantage to telemedicine-perhaps it might best be called too mu of
a good thing. “It’s really hard to match your capacity to do telemedicine with what can be an
unpredictable growth rate,” he notes. “When we started, we had two to three cases a week.
Now, we have 80 to 90 cases a week .”

TELE NURSING

Definition

Telenursing refers to the use of telecommunications technology in nursing to enhance

patient care. It involves the use of electromagnetic channels (e.g. wire, radio and optical) to
transmit voice, data and video communications signals.

It is also defined as distance communications, using electrical or optical

transmissions, between humans and/or computers

Telenursing, the delivery of nursing care and services using telecommunications,

increases access to nursing care interventions for clients in remote or distant locations
(Chaffee, 1999; Helmlinger & Milholland, 1997; Yensen, 1996).

Telenursing is a component of telehealth that occurs when nurses meet the health
needs of clients, using information, communication and web-based systems. It has been
defined as the delivery, management and coordination of care and services provided via
information and telecommunication technologies (CNO, 2005).

Technologies used in telenursing may include but are not 1imited to:

 Telephones (land lines and cellphones)

 Personal digital assistants (PDAs)

 Facsimile machines (faxes)

 Internet

 Video and audio conferencing

 Teleradiology

24
  Computer information systems

 Telerobotics

Principles:

These guidelines are based on the principles of telenursing, which state that effective
telenursing should:

 Augment existing healthcare services

 Enhance optimum access arid, where appropriate and necessary, provide immediate
access to healthcare services

 Follow position descriptions that clearly define comprehensive, yet flexible roles
responsibilities

 Improve and/or enhance the quality of care

 Reduce the delivery of unnecessary health services

 Protect the confidentiality/privacy and security of information related to nurse client

interactions

Types:

Telephone nursing is the use of the nursing process to provide care to patients over
the telephone (AAACN, 1997). First used by nurses in the late 1800s, the telephone is now
used to deliver an . extraodinary variety of nursing care and services nationwide.

Telephone triage is the largest and most recognized component of telephone nursing.
Telephone triage, a staple in nursing, is considered the forerunner of telemedicine (Connors,
1997; Pond, 2000). In addition to telephone triage, telephone nursing services include advice
and information, appointments and referrals, symptom management, demand management,
and disease management.

The role of telephone nursing has become increasingly central to the delivery of cost-
effective, quality care for disease management populations .

25
Registered Nurse's practicing tele-nursing be concerned about liability and risk
management:

Whether nurses engage in e-health, internet-based .practice or other technologies, they

will face new and constant challenges, including potential issues of liability. Although a lack
of legal precedents creates uncertainty about liability in telehealth clearly defined
accountabilities will be key to dealing with several recognized categories of liability,
including those related to:

 health professionals involved

 specific technologies/applications used

 organizations or institutions involved

 Human resources and training

Nurses providing care via telehealth also need to be involved in the development and
documentation of risk management plans and related policies.

Risk management in terms of telehealth could include ensuring the security and integrity
of relevant websites, with the use of disclaimers being of particular importance. Disclaimers
on websites and/e-mail messages help define accountabilities and minimize liability. For
example, if a registered nurse has created a website to assist in the delivery of nursing
services, a disclaimer might indicate that the nurse is not accountable for sites which may be
linked to her/his site. While the nurse could, and should, ensure that all links or endorsed sites
are credible, the sites to which her/his site are linked could also be linked to non-credible
sites from which clients could receive misleading or inaccurate information that may be
harmful when followed.

Liabilities protection an issue In telenursing:

Face-to-face interactions are still considered to be the best way to ensure accurate
communications between nurses and clients (CNPS, 1997). Given this, the importance of
developing policies to support safe, competent, compassionate and ethical' telenursing cannot
be overstated. Examples of further policy development and/or practices needed to help
reduce liability risks include:

 Using consistent tools to collect data (see CNPS infoLaw Telephone Advice)
26
  Using evidence-based, protocol-driven software or data to support telenursing

 Consulting other care providers when appropriate (e.g., "when in doubt, check it out")

 Employers generally provide insurance protection for registered nurses.

However, liability protection is provided by CNPS, for nurses who hold active practicing
status with a member association of CNPS and who are practicing nursing in accordance with
their provincial nursing legislation (the College of Registered Nurses of Nova Scotia is a
member association). The need for additional liability protection for nurses practicing
telenursing depends on a number of factors, such as the: Types of technology to be used (e.g.,
Internet) Services to be provided (e.g., expanded scope of practice) Location of the clients
(e.g., outside of Canada) Employment status of the registered nurse (e.g., self-employed).

RNs practicing or considering practicing telenursing are encouraged to discuss

liability issues with their employers, legal counsel, and/or CNPS.

Legal, ethical and regulatory issues Telenursing are fraught with-legal, ethical and a
regulatory issue, as it happens with telehealth as a whole. In many countries, interstate and
inter country practice of telenursing is forbidden (the attending nurse must have a license
both in her state/country of residence and in the state/country where the patient receiving
telecare is located). Legal issues such as accountability and malpractice, etc. are also still
largely unsolved and difficult to address.

Competencies are required to safe telenursing practice:

In general, the competencies required in telenursing practice mirror the competencies

required of all registered nurses (e.g., clinical competence and assessment skills in the
nurses" area of practice; an understanding of the scope of service being provided). However,
registered nurses practicing telenursing should also possess:

 Personal characteristics (e.g., positive attitude, open-mindedness towards technology

and good people skills) that will facilitate their involvement and advance the
telehealth program

 Knowledge and ability to navigate the technology system and environment (e.g.. the
knowledge and skill to properly operate hand-held cameras, videoconferencing
equipment, computers, etc.)

27
  An understanding of the limitations of the technology being used (e.g.. able to
determine if vital signs are being monitored accurately by specific equipment)

 The ability to recognize when telehralth approaches are not appropriate for a ‘ clients,
needs (i.e.. not 'reasonably" equivalent to any other type of care that can be delivered
to the client, considering the specific context, location and timing, and relative
availability of traditional care), includes assessment of a client's level of comfort with
telehealth

 Ability to modify clients" care plans based on above noted assessments " awareness
of client risks associated with telehealth and willingness to develop back-up plans and
safeguards

 Knowledge, understanding and application of telehealth operational protocols and

procedures

 Competent enhanced communication skills

 Appropriate video/telephone behaviours Awareness of the evidence base for their

practice and areas of practice in need of research

 The ability to deliver competent nursing services by regularly assessing their own
competence, identifying areas for learning, and addressing knowledge gaps in relation
to the area of practice and relevant decision-based software and technology.

Nurse needs specialized preparation or education for telenursing:

As is the case for all registered nurses, those providing telehealth services should have the
necessary education and competencies to provide safe, competent, compassionate and ethical
care. The required amount/type of formal education and on the-job training will depend on
the nature of the telehealth service offered. In light of the evolving nature of telehealth
services there is a need for continuing education/professional development in this area, and
already certificate programs in telehealth are becoming more common in Canadian
universities and colleges

28
Application

 One of the most distinctive telenursing applications is home care. For example,
patients who are immobilized, or live in remote or difficult to reach places. citizens
who have chronic ailments, such as chronic-obstructive, pulmonary disease, diabetes,
congestive heart disease or disabilitating diseases, such, as neural degenerative
diseases (Parkinson's disease, Alzheimer's disease. ALS). etc.. May stay at home and
be "visited" and assisted regularly by a nurse via Videoconferencing, internet,
videophone, etc. Still other applications of home care are the care of patients in
immediate post-surgical situations, the care of wounds. ostomies, handicapped
individuals, etc. In normal home health care, one nurse is able to visit up to 5-7
patients per day. Using telenursing. one nurse can “visit" 12-16 patients in the same
amount of time.

 A common application of telenursing is also used by call centers operated by

managed care organizations, which are staffed by registered nurses who act as, case
managers or perform patient triage, information and counselling as a means of
regulating patient access and flow and decrease the use of emergency rooms.

 Telenursing can also involve other activities such as patient education, nursing
teleconsultations, examination of results of medical tests and exams ,and assistance to
physicians in the implementation of medical treatment protocols.

 Clinical information can be shared with other professional colleagues including

national and international experts.

 A common application of telenursing is also used by managed care organizations

which are staffed by registered nurses who act as case managers or perform patient
triage, information and counselling as a means of regulating patient access and flow
and decrease the use of emergency rooms.

 Telenursing can also involve other activities such as patient education, nursing
teleconsultations, and examination of results of lab tests and assistance to physicians
in the implementation of medical treatment protocols.

29
TYPES OF TRADITIONAL MEDIA

Traditional media however, exists in various forms as seen and practised in different parts of
India. Some of the forms still exists in some places but may not be in its original form and
content. They have been reinvented according to the modern environment. There are many
such forms which plays a vital role in our daily lives.

TYPES OF TRADITIONAL MEDIA:

 Drama

 Street theatre

 Puppetry

 Dance

 Story telling

 Song

 Music

 Painting

 Motifs and symbols

DRAMA:

Most of you may have heard of the term ‘drama’. Have you ever seen a drama being
performed in your neighbourhood or in a theatre?

Drama is one of the most popular forms of traditional media. Let us understand this
form by using an example from the rural areas. After completing the work in the fields, you
very often find that farmers celebrate their joy of leisure. They use different types of art
forms for this. They use natural colours for makeup. Performance themes are from their own
sufferings, daily work, future dreams and mythology. Here the viewers can also participate as
and when they feel like.

Let us study about some of these forms of drama performed in different states.

30
Tamasha:

If you happen to watch a tamasha performance in Maharashtra, you will come to

know more about their ancient rulers, Maratha heroism, their rugged landscape, their music
etc. The philosophical and aesthetic scheme of tamasha incorporates three basic elements: the
entertainment tradition, the more serious propagandist tradition & the devotional tradition.
Have you ever watched a Tamasha performance?

Nautanki:

The Nautanki form found in northem India entertain their audiences with often vulgar
and disrespectful stories. Rooted in the peasant society of pre-modern India, this theatre
vibrates with lively dancing ,pulsating drumbeats & full throated singing .Unlike other styles
of Indian theatre, the nautanki does not depend on Indian religious epics such as Ramayana or
Mahabharata for its subject.

Khayal:

Khayal is mainly performed in Rajasthan. It is a combination of song, dance and

drama. Music is an important aspect in this form of folk theatre. It is performed not only for
entertainment purpose but it is used mainly as an essential means of communication between
actors. There is an immense variety in the use of singing-sometimes by the characters
individually or in the chorus. Instrumental music is also used in the beginning of the
performance to create a favourable atmosphere for the play.

STREET THEATRE:

This is a performance medium drawing its techniques from traditional drama forms in
India. They are performed in any nukkad (street corner), street, market place etc.

In such a situation, the audience and the performers are on the same level,
emphasizing the fact that the performers are not different from the audience themselves. This
also leads to the establishment of a rapport between the performers and the audience. Close
eye-contact with the audience is an important element in street theatre which keeps them busy
with the action of the play. Even an actor is under the eagle eye of the audience who surround
him on all sides. So together they feel a sense of belonging and responsibility to each other.
Sometimes the audience is invited to join the chorus for the singing.

31
 The sole purpose of street theatre is to motivate the audience to take a quick and
required action on a particular issue. In India, waysides, streets, village markets, open-air
grounds, fair-sites, country yards and other public areas have remained the ideal spaces to
perform street plays.

A majority of street plays in India are based on socio-political issues. Some of these
are based on current events, others are on subjects like communalism, terrorism, police
atrocities, bride burning, dowry system, caste inequalities, elections, industrial and
agricultural exploitation, alcoholism, illiteracy, drug addition and female feoticide.

In India, where there is a high degree of illiteracy, poverty and diversity of language
and dialects, a theatre form of this sort, versatile and adaptable, cheap and mobile becomes
more important and relevant. Do you know why street theatre is called a mobile theature
medium?

The mobile form of street theatre helps it to reach people who normally do not go to
the theatre. This suits the type of audience it tries to reach who are mostly the poorer section
for whom theatre is a luxury. The total absence of a proper stage, lights, properties, costumes
and make-up makes it even more flexible.

Some of the best street theatre artists from India include Safdar Hashmi, Utpal Dutt,
Sheela Bhatia, Habib Tanvir, Shombu Mittra, Bijon Bhattacharya and many more.

Street theatre artists try to spread positive menages in the society. For example in
Punjab, Gursharan Singh through street theatre is spreading a message of understanding,
patience and tolerance. He took to the streets to use plays as a means of awakening the people
to their fundamental and political rights. In the early eighties, when Punjab was swept by
terror waves, Singh went out into the streets with his classic street plays such as ‘Baba Bolda
Hai’, ‘Sadharan Log’ and main Ugarvadi Nahi Hu’.

PUPPETRY

Have you seen puppets or even wondered what they are ?

The word puppet comes from the French ‘Poupee’ or the Latin ‘Pupa’, both meaning ‘dolls’.
In Sanskrit, puppets are termed ‘Putraka’, ‘Putrika’ or ‘Puttalika’, all of which are derived
from the root Putta equivalent to Putra (son). It is derived from ancient Indian thoughts that
puppets have life.

32
Puppet theatre is a form of entertainment found practically in all parts of the world. In puppet
theatre, various forms known as puppets, are used to illustrate the narratives. Let us find out
more about them.

There are four basic kinds of puppets :

 Glove puppets

 String puppets

 Rod puppets

 Shadow puppets

GLOVE PUPPETS :

Glove puppets are mostly found in Orissa, Kerala and Tamilnadu. Puppeteers wear
them on the hand and manipulate their heads and arms with their fingers. The puppeteer
narrates his story in verse or prose, while the puppets provide, the visual thread. With a little
effort and imagination, you can make your own glove puppet. Glove puppets are also known
as sleeve puppets, hand puppets or palm puppets.

The glove puppet in Orissa is called , kundahei Nach. The glove puppets of Kerala are
more ornate, colourful . ad resemble the actors on the Kathakali stage in their make-up and
costume. Their performance is known as Pava Koothu 0r Pawa Kathakali. The stories of this
theatre are mainly based on Radha and Krishna and n Ramayana.

STRING PUPPETS :

The string puppet (or marionetter) is a figure with multiple joints and suspended by a
string which is controlled.

ROD PUPPETS :

Rod puppets are an extension of glove puttets but often much larger. They are fixed to
heavy bamboo sticks which are tied to the puppeteer’s Waist. These are three-dimensional
moving figures that are manipulated with the help of rods.

33
SHADOW PUPPETS :

In this form, shadows of puppets are used in black and white or in colour. The flat
figures, usually made of leather, are lightly pressed on a transparent screen with a strong
source of light behind. The screen thus forms the barrier between the audience and the
puppet, creating the projection of image. The impact on the audience, surrounded by darkness
all around, is quite dramatic. The screen in India is a simple sheet stretched on an adjustable
frame. Shadow puppets are mostly found in Andhra Pradesh, Kerala, Karnataka, Tamilnadu,
Maharashtra and Orissa.

MUSIC AND DANCE:

Music and dance in India are among the oldest forms of classical arts with a tradition that
dates back to several centuries. These traditions are fundamentally similar but they have
different names and are also performed in different styles.

 Dance puts the rhythm and movement in the play and continuously captures audience
attention.

 Ours is possibly the only country in which music, more than any other art, is so
intimately interwoven with the life of people. It would not be an overstatement to say
that music in India has played a crucial part in everyday life from time immemorial.
It has been an integral part of marriages, festivals and celebrations of every hue and
character. No religious ceremony has been complete without music.

 There are songs to celebrate the seasonal rhythms in nature, songs of the ploughman
and boatman, of the shepherd and camel driver. There are even songs of villages and
of the forests. It is music which has always lent harmony to the pulse of human
activity in India. India’s musical culture has its source in the tradition of the masses.

 Traditional music of India is the most natural representation of the emotions of the
masses. Songs are associated with every event of life. Be it festivals, advent of new
seasons, marriages, births or even every day affairs like attracting a loved one or
admiring nature. Can you recall a few such songs that you may have heard?

 Although folk music originated within small regions, it has reached out to touch the
hearts of masses across India.

34
 THE ROLE OF MASS MEDIA COMMUNICATION IN PUBLIC HEALTH

INTRODUCTION:

Mass media campaigns have long been a tool for promoting public health (Noar,
2006) being widely used to expose high proportions of large populations to messages through
routine uses of existing media, such as television, radio, and newspapers. Communication
campaigns involving diverse topics and target audiences have been conducted for decades.
Some reasons why information campaigns fail’ is an early landmark in the literature.
Exposure to such messages is, therefore, generally passive (Wakefield, 2010). Such
campaigns are frequently competing with factors, such as pervasive product marketing,
powerful social norms, and behaviours driven by addiction or habit.

Mass media campaigns have general , aimed primarily to change knowledge,

awareness and attitudes, contributing to the goal of changing behaviour. There has not
normally been a high expectation that such campaigns on their own would change people’s
behaviour. Theory suggests that, as with other preventive health efforts, mass media
campaigns are most likely to reduce unhealthy attitudes if their messages are reinforced by
other efforts. Reinforcing factors may include law enforcement efforts, grassroots activities,
and other media messages.

2. Communication campaigns VS mass media campaigns

There is often confusion between the labels campaign, communication campaign or

program, media or mass media campaign, and intervention. No particular definition
adequately covers current practice, and there are many local variations of what is meant by
these labels. Indeed, a variety of definitions exists in the literature but the following elements
of a communication campaign are essentia1(Rogers and Storey 1987).

Firstly, a campaign is purposive. The specific outcomes can be extremely diverse

ranging from individual level cognitive effects to societal or structural change.

Secondly, a communication campaign is aimed at a large audience. Rogers and Storey

(1987) note that ‘large’ is used to distinguish campaigns from interpersonal persuasive
communications by one individual (or a few people) aiming to seek to influence only a few
others.

35
 Thirdly, communication campaigns have a specified time limit. This is not to state
that all campaigns are short lived. For example, the initial Stanford Heart Disease Prevention
Program ran for three years, however follow-up investigations were conducted over decades.

The fourth point is that a communication campaign comprises a designed set of

organised activities. This is most evident in message design and distribution. Messages are
organised in terms of both form and content, and responsibility is taken for selecting
appropriate communication channels and media. As Rogers and Storey (1987) point out, even
those campaigns whose nature or goal is emancipation or participation involve organised
message production and distribution.

Content and delivery of‘mass media campaigns

Several aspects of mass media campaigns may influence their effectiveness. These
can be categorized into variables related to message content and to message delivery.

Message content

One important aspect of message content involves the themes used to motivate the desired
behavior change. Some common motivational themes in mass media campaigns to prevent
unhealthy behaviors include:

 fear of legal consequences

 promotion of positive social norms

 fear of harm to self, others, or Property

 and stigmatizing unhealthy behaviours as irresponsible and dangerous

Message delivery:

A mass media campaign cannot be effective unless the target audience is exposed to,
attends to, and comprehends its message. Two important aspects of message delivery are
control over message placement and production quality. Control over message placement
helps to ensure that the intended audience is exposed to the messages with sufficient
frequency to exceed some threshold for effectiveness.

It also allows for the optimal timing and placement of those messages. This control
can only be assured with paid campaigns. Those that rely solely on donated public service

36
time may attain adequate exposure, but message placement and frequency are ultimately left
to media schedulers and station management; paid advertising time always gets preferential
placement. Assuming that the target audience is adequately exposed, high production quality
of the campaign messages may maximize the probability that the audience will pay attention
to them. High production quality may also improve the chances of eliciting the intended
emotional impact.

Message pretesting

Pretesting of campaign themes and messages is also thought to be important for a

successful outcome (Homik & Woolf, 1999). Pretesting can help to assess which themes or
concepts are most relevant to the target audience. It can also help to ensure that the target
audience will attend to and comprehend the specific messages presented. The importance of
pretesting is highlighted by an evaluation of a mass media campaign designed to prevent
alcohol-related problems by encouraging drinking in moderation. No pretesting of ads was
done for this campaign and a survey conducted at midcampaign found that over a third of
respondents thought that the ads were promoting alcohol consumption. Many mistook them
for beer ads.

Changing knowledge and awareness

Changing behaviour is the highest priority in any public health campaign, however,
most of the mass media will change knowledge and awareness more easily than behaviour.
Theoretically, the mass media are supposed to be most effective in achieving awareness. This
review supports that expectation. When measuring awareness as simple recognition of the
message, up to 83% levels of awareness have been reported, with a median of 48%.
Although, without a pre message measure, some of this (perhaps up to 9%) may be
measurement error, e.g., a desire to please the interviewer.

Lessons about implementing mass media campaigns

A report published by the National Health Services in UK (2004) on anti-smoking

campaigns in the 1990s high-lighted lessons, some of which may be of general value:

-Campaigns need to contain a variety of messages ‘threatening’ and ‘supportive’ styles of

delivery can complement each other

37
-Anti-smoking advertising has to compete in a crowded media marketplace a hook is needed
to engage the emotions of the target audience

-Emotions can be engaged using humour, fear, sympathy or aspiration

-TV advertising, in particular, is better at jolting smokers than delivering encouraging or

supportive messages

-Smokers want help and encouragement to quit

-Advertising should not tell people what they should do

-Smokers are motivated by knowing that they are not alone, and that support and help are
available they need reminding of the benefits of not smoking

-Content and style of delivery are of equal importance smokers can accept unpalatable
messages if the context is encouraging and supportive.

Conclusion

Telemedicine will soon be just another way to see a health care professional, just as
seeing friends and family while talking to them on the phone is becoming commonplace.
Technology manufacturers and telecommunications companies are already vying with each
other to produce the low-cost equipment and bandwidth needed. Distance education is
common place and most educational institutions, and many companies allay travel costs for
meetings by using video. Ten years or fifteen years ago we had no idea we would rely heavily
on faxes, answering machines and e-mail, tools which are now low-tech and taken for
granted. Since early 2000, the ramifications of E-Health (a general term encompassing health
care delivery, administration and information dissemination) and its relationship to
telemedicine are being analyzed.

Mass media health campaigns clearly can be an effective tool for health promotion
whether the effort is on a national or local scale. We should stop arguing whether they are
more or less effective than other strategies or whether one channel is better than another.
Instead we should carefully formulate our conceptual model of how we expect an
intervention to work and then evaluate it accordingly. Health promotion interventions are not
like pills they are much more complex and indirect in the way they work. Therefore our

38
evaluation designs may be very different allowing us to track a social influence process and
document its effects on social and political institutions as well as on individuals.

BIBLIOGRAPHY

1. Basvnthappa .B.T (2011) Nursing Administration, 2nd Edition, Jaypee Publications;

New Delhi

2. Piyush Gupta O.P Ghai. preventive And Social Medicine, 2nd Edition

3. www.telemed.com

4. www.AMDTelemedicinecom

5. www.medisoftTelemedicine.com

6. www.telemedindia.org/

7. www.thamburaj .com/telemedicine

39
 SEMINAR ON

CURRENT STATUS,
TRENDS AND
CHALLENGES OF
COMMUNITY HEALTH
NURSING
SUBMITTED TO SUBMITTED BY
MRS.R.PORKODI A.ANGAYARKANNI

SISTER TUTOR MSC.NURSING

JIPMER JIPMER

DATE:

8.04.19

40
 SEMINAR ON

TELEMEDICINE,

TELENURSING, FOLK
MEDIA AND ITS TYPED
AND ROLE IN SPREADING
INFORMATION TO
COMMUNITY
SUBMITTED TO SUBMITTED BY

MRS.VEMBU A.ANGAYARKANNI

TUTOR MSC (N)- 1 YEAR

JIPMER JIPMER

DATE:8/4/19
41