Children and youth as “health change agents”
Researchers studying the effects of children in health communication tend to examine conditions under which the transmission of information is mechanical, pedagogical and contrived. However, if children are participants, rather than subjects, in the learning process, and if they feel a sense of ownership of the information being conveyed, would they be more motivated to speak to friends and family about the issue?[ii] Would the flow of information be more natural—and consequently more efficacious–under more organic conditions, without overt instructions to speak to others?
That’s Eric Saltzman, on the India Development Blog, wondering about the role of children as “health change agents” who spread health information to older generations. The idea that schools could teach children about brushing their teeth, washing their hands, and using mosquito nets, as a way of reaching entire family units is incredibly appealing. It requires no new social infrastructure, could be used in areas where media campaigns are inaccessible, and has the potential to reach tremendous amounts of people.
Saltzman cited a 2009 study about the differences in African American and Hispanic mothers’ openness to receiving health advice or education from their daughters (in a midwestern U.S. city). The cultural contrasts were stark:
While nearly half (46%) of Hispanic mothers agreed with the statement, “Daughters know more about some things than mothers do,” only 27% of African American mothers felt the same way. Even more dramatically, whereas almost all (94%) of Hispanic mothers said that they ask their daughters for advice, less than one-third (31%) of African-American mothers said that they sought out information from their daughters; and, whereas Hispanic mothers across-the-board (100%) responded that daughters can give mothers advice about health, only a little more than half (56%) of African American mothers held this attitude. Such results show strong intervening effects of culture on willingness to accept health information from sons and daughters.
This proposed method of health information dissemination has been suggested to me and my colleagues many times over the last year. It seems that every foreigner wants to know why we are focusing on married women, instead of on high school or university students. Leading our programs in schools is definitely be easier: teachers spread the word about workshops, there are no babies or young children to distract their mothers, and the participants know how to read and write. Unfortunately, with our subject matter and cultural context, I think our results would more closely mirror the responses of African-American mothers, rather than Hispanic mothers.
As far as I can tell, the young women who participate in our workshops almost never go home and teach their mothers, their aunts, or even their older sisters, about what they had learned. The cultural mores regarding age hierarchy mean that for younger women to teach their elders about reproductive health or sex is inappropriate and shameful. It’s not just embarrassment; to discuss these topics with their elders suggests that they have learned from personal experience. To know how to put on a condom, to be able to distinguish between a yeast infection and bacterial vaginosis, to know how often a sanitary pad should be changed, even to know which way to wipe to prevent urinary tract infections are all presumed to be signs that a woman is sexually self-aware. And sexually self-aware means sexually active. And if she isn’t married yet, but is already having sex, then she’s “like broken glass.” This is surely an oversimplification, but it represents a common train of thought, especially among less educated communities, that prevents a “trickle up” effect in reproductive health education.
Back to the original question that I pulled from Saltzman: Would the flow of information be more natural—and consequently more efficacious–under more organic conditions, without overt instructions to speak to others? In our context, pushing reproductive health education, I doubt it. I’d love to see it work in other places though, and regarding a topic (apparently) less stigmatized than sex, like Indoor Air Pollution (Saltzman’s research focus), the potential is huge. I hope he (or someone else) finds a way to carry out the research he proposes about the potential of children as health change agents in India and beyond.