SUMMARY, CONCLUSIONS AND RECOMMENDATIONS ON THE
IMPACT OF COMMUNICATION CAMPAIGNS ON MENTAL HEALTH
BEHAVIOUR CHANGE AMONG SECONDARY SCHOOL STUDENTS
Summary
The first objective of this study was to assess the knowledge levels of mental health
among secondary school students in Nairobi County. The study found that knowledge
levels of mental health among secondary school students in Nairobi County were very
low. This is because out of the 334 students sampled, only 6 knew that depression,
dementia, post-traumatic stress disorder and schizophrenia were mental illnesses. The
rest indicated either one or two among these were mental illnesses. Furthermore, only
11 out of 334 students were aware of communication campaigns for mental health
conducted annually by Mathari National Teaching and Referral Hospital in conjunction
with the Ministry of Health. This represents 3% of the students sampled. In addition,
only 3 out of 334 had attended the communication campaigns for mental health. This
represents 1% of the students sampled. Still, only 5% of the respondents indicated that
mental illnesses can be caused by infections, 6% indicated that they can be caused by
injuries and 3% by other diseases. Knowledge of the causes of mental illnesses is
one of the basic facts that those who have knowledge of mental health are supposed
to have. The percentages of those who indicated these causes are low.
The fact that 97% of the students sampled lack awareness of communication
campaigns for mental health and 99% had not attended any of the communication
campaigns indicates that the students miss all the messages disseminated about
mental health issues every year. This is in line with available literature which
indicates that generally knowledge of mental health issues is low and stigma high
(Bocha, 2012; KNCHR, 2011; Atwoli, 2011; Kiima & Jenkins, 2010; Ndetei et al.,
2009; Othieno et al., 2008; Griffin, 2008; Brundtland, 2001). From the data
collected, the low knowledge levels can be attributed to various reasons. One, the
communication campaigns for mental health do not have secondary school students
as a target audience. This applies especially to the campaigns conducted prior to
and on World Mental Health Day though one of the psychiatrists had indicated
during the interviews that they send letters to several schools inviting students to
attend. The messages communicated are not tailored for any particular audience,
least of all secondary school students. Two, the campaigns are not designed with
specific objectives and clear messages that can be used to achieve them. Three, the
campaigns are only conducted in the schools around Mathari Hospital. They are not
conducted in schools throughout Nairobi County. Finally, the messages conveyed
especially during community outreach programmes seem to be the same from year
to year. They lack creativity and do not reflect the changing environment. Such
messages will not be interesting to those who might have heard them before.
The second objective was to analyze the messages communicated during
communication campaigns for mental health in Nairobi County. The messages
communicated were obtained through use of questionnaires administered on secondary
school students, interviews conducted among psychiatrists and psychiatric nurses and
analysis of the messages contained in newsletters and leaflets used when marking
World Mental Health Day in the years 2012 and 2013 at Mathari National Teaching
and Referral Hospital. The responses obtained from secondary school students who
attended communication campaigns for mental health indicate that the messages
disseminated during these communication campaigns have all the components of
the health belief model. These are perceived susceptibility, perceived severity,
perceived benefits, perceived barriers, cues to action and self efficacy. These
responses are similar to those obtained from the psychiatrists and psychiatric nurses
interviewed. However, the data obtained from newsletters and leaflets used for
communication campaigns for mental health conducted prior to and during World
Mental Health Day in 2012 and 2013 indicates that the messages did not contain all
the components of the health belief model. They lacked the components of
perceived barriers to prevention and treatment of mental illnesses, cues to action
and self-efficacy. These components are equally important in enhancing knowledge
of mental health. Without the target audience knowing what could bar them from
preventing mental illnesses or accessing treatment, and what could motivate them
to embrace the health behaviour recommended and finally how easy it is to either
prevent mental illnesses or seek treatment, they might not change their attitudes
towards mental illnesses.
The fact that students, psychiatrists and psychiatric nurses who participated in the
study provided information that differs from the information obtained from
newsletters and leaflets could be an indication of different messages about mental
health being communicated through different channels of communication. Apart
from newsletters and leaflets, the other channels used for communication of mental
health messages are posters, letters, banners, workshops and symposia. Effective
health communication is supposed to ensure that all channels used for
communication disseminate the same messages. This constitutes the attribute of
consistency in health messages (Schiavo, 2007).
The findings also showed that the messages were not tailored for any particular
audience. They were designed for all audiences. Atkin (2001) argues that such
health messages cannot be effective. This is because each audience has its own
unique health needs which are met in ways dissimilar from other audiences. The
third objective of the study was to evaluate the effectiveness of communication
campaigns for mental health conducted in Nairobi County. The data collected from the
secondary school students, printed materials used for World Mental Health Day
communication campaigns and the psychiatrists and psychiatric nurses indicates that
these communication campaigns are not effective in terms of enhancing knowledge of
mental health. First, 323 out of 334 students, representing 97% of secondary school
students indicated that they were not aware of these communication campaigns for
mental health. Secondly, 331 out of 334 students, representing 99% said that they had
never attended communication campaigns for mental health. Thirdly, the fact that these
communication campaigns are not conducted in many schools so that many students
can be reached indicates that they are not effective. This is despite the fact that
available literature indicates that adolescents and young people between 12-25 are most
at risk of mental illnesses (Seroczynski, Jacques & Cole, 2003; Wunderlich, Bronisch,
Wittchen & Carter, 2001).
The fourth reason why these communication campaigns cannot be effective is that the
newsletters used to disseminate messages on World Mental Health Day focus more on
many other issues regarding Mathari National Teaching and Referral Hospital than the
mental health theme for the year. The newsletters focus more on the various
departments at the Mathari National Teaching and Referral Hospital and what their
functions are. They also give more space to the challenges the hospital is facing in
terms of infrastructure and what has been achieved through support from donors.
Furthermore, the newsletters and leaflets express messages on mental health that lack
key components of the health belief model such as perceived barriers, cues to action
and self efficacy. They also do not contain important information regarding people’s
beliefs on mental illnesses and the language they use to describe mental illnesses and
the mentally ill. These could help to explain the meanings people give mental illnesses
and the thoughts they have about them as individuals and communities.
Communicating all these will enable people know which beliefs constitute stigma and
should be discarded and which strategies can be employed to effectively address such
stigma and enhance knowledge of mental health. Some psychiatrists confessed not to
have been involved in these communication campaigns yet they are major sources
of information about mental health. In fact, all the psychiatrists and nurses
interviewed confessed that they have never been consulted when designing
messages for these campaigns. Yet these are the people who are relied upon to
deliver these messages to audiences. The campaigns therefore lack the input of key
stakeholders. That is the fifth reason why these campaigns will not be effective in
enhancing knowledge of mental health.
Similarly, these campaigns do not involve members of the audience in identifying
their mental health needs and addressing them in a way that more people might be
reached. They are not participatory. Schiavo (2007) says that effective health
communication campaigns are participatory. They involve members of the target
audience in the designing, implementation and evaluation of the campaigns.
The sixth reason why these campaigns will not be effective is because they are not
conducted regularly. They are conducted once a year at specific periods. The
Nurses’ Week takes place in May while the World Mental Health Day takes place
in October. Community outreach programmes take place in a week set aside for the
same. Each of these campaigns takes a week. Cumulatively, these campaigns take
three weeks in a year. This period is too short to create any meaningful impact,
considering the fact that these campaigns have other limitations such as the area
they cover which is around the Mathari Hospital and the fact that they do not use
mass media such as radio, television and newspapers.
Another reason why these campaigns will not be effective is that they do not have
clear objectives which they are meant to achieve within specific timelines and the
messages are not designed in a manner that they will achieve set objectives. All
stakeholders in the mental health communication campaigns should be aware of
these objectives so that they can work towards achieving them. These stakeholders
include psychiatrists, psychiatric nurses and even members of the target audience.
The last reason why these messages lack effectiveness is that no evaluation is done to
know what has been achieved and what has not. For instance, data collected indicates
that each year during community outreach programmes which target schools, the
messages are the same: drug and substance abuse. Yet mental health issues are
many. Similarly, though the messages disseminated prior to or on World Mental
Health Day are different, the fact that there is no evaluation means that they are
communicated as routine and therefore achieve little if any impact.
The fourth objective of this study was to analyse the demographic factors that
influence mental health behaviour change. Gender, age and socioeconomic status
were found to be the major demographic factors that influence mental health
behaviour change. The data collected from secondary schools indicated that female
students had more knowledge of mental health and were more likely to have
positive mental health behaviour than male students. This is because more female
students indicated being aware of communication campaigns for mental health than
male students. Furthermore, all the students who had attended communication
campaigns for mental health were female.
In addition, the data collected from secondary school students also indicated that
older students had more knowledge of mental health than younger students. Data
from the psychiatrists and psychiatric nurses indicated that younger and middle-
aged people were more knowledgeable about mental health than older people.
Therefore younger people were likely to have positive mental health behaviour than
older people. Those who had a higher socioeconomic status were also more
knowledgeable about mental health and they were likely to have positive mental
health behaviour than those from a lower socioeconomic status.
The first objective of this study was to assess the knowledge levels of mental health
among secondary school students in Nairobi County. Based on the data collected from
secondary school students in Langata District, this study concludes that knowledge
levels among secondary school students in Nairobi County are low. This is because
most of the students do not know the types of mental illnesses and they are not aware
of communication campaigns for mental health. They also do not know
important information such as the causes of mental illnesses and consequently who
is susceptible to mental illnesses. These low knowledge levels are as a result of
communication campaigns for mental health not being conducted regularly in
schools and therefore not targeting secondary school students. Though the mental
health messages are sometimes taken to schools, psychiatrists and psychiatric
nurses indicated that they only visit schools around the hospital. Therefore
campaigns do not reach schools which are not in the neighbourhood of the hospital.
The second objective of this study was to analyze the messages communicated
during communication campaigns for mental health in Nairobi County. The study
found that the messages communicated have some components of the health belief
model such as perceived susceptibility, perceived severity and perceived benefits.
The messages lack important components such as perceived barriers to seeking
information about and treatment for mental illnesses, cues to action and self-
efficacy. The study therefore concludes that the messages conveyed during
communication campaigns for mental health are not effective since they do not
contain some of the important components of health messages. These components
will also influence attitude and behaviour change among target audience members
in regard to mental health.
Furthermore, the study found that these messages do not include the beliefs and
attitudes that constitute the meaning that people have towards mental illnesses and
the mentally ill. This meaning is expressed through language which in turn reflects
the thoughts that people have about mental illnesses and the mentally ill. These are
important premises of the symbolic interactionism theory.
The third objective of this study was to evaluate the effectiveness of communication
campaigns for mental health conducted in Nairobi County. Since the communication
campaigns for mental health in Nairobi County are conducted in three separate weeks
in a year, the study concludes that they are not effective in enhancing knowledge
among the target audience. Health communication campaigns that are effective in terms
of promoting knowledge and achieving behaviour change among
the target audience are held regularly. This refers to the element of repetition (US
Office of Disease Prevention and Health Promotion, 2000).
Another reason why the communication campaigns are not effective is because they do
not utilize the mass media effectively to reach the highest number of people. They only
use newsletters, leaflets, placards, banners and letters which can only reach a few
people, especially those who attend the campaigns and their relatives or friends.
The other reason that would make these campaigns ineffective is that their
messages are only conveyed in English. Thus, they lock out those who are unable
to read or understand English.
Additionally, the doctors and nurses at Mathari Hospital are not involved in
designing the messages that should be disseminated to their target audience. Even
the members of the target audience do not participate in the design of these
messages. Without these key stakeholders being involved in designing the
messages, their experiences and insights which constitute important information are
left out. This makes the campaigns ineffective.
Lastly, the communication campaigns also lack evaluation. There is no evaluation
done on what the messages conveyed were the previous year, what the goals and
objectives were, which strategies were used to disseminate the messages, what
outcomes were achieved and what challenges were met. Therefore the campaigns
cannot be effective since they lack evidence base, another attribute of effective
health communication campaigns (US Office of Disease Prevention and Health
Promotion, 2000).
The fourth objective was to analyse the demographic factors that influence mental
health behaviour change. The study found age, gender and socioeconomic status as
the major factors affecting mental health behaviour change. Members of the female
gender, younger people and those who have a higher socioeconomic status were
found to be more knowledgeable about mental health. They were therefore more
likely to have positive mental health behaviour.
This study found that knowledge levels of mental health among secondary school
students in Nairobi County were very low, the messages communicated during the
campaigns were inadequate and the communication campaigns were ineffective. To
enhance knowledge of mental health, the communication campaigns for mental
health should be effective and the messages communicated during the campaigns
be adequate. To achieve these objectives, the study recommends the adoption of
several strategies.
To reach many secondary school students, communication campaigns for mental
health should be conducted in as many secondary schools as possible, besides other
settings such as hospitals, sports and social events and homes. This will enhance the
knowledge levels of mental health among the secondary school students as well as
the general population. With increased knowledge, people will be able to detect
mental problems early and seek help. High levels of knowledge will also reduce the
levels of stigma against mental illnesses and the mentally ill.
In addition, this study recommends that planners of communication campaigns for
mental health target specific audiences who are vulnerable to mental illnesses with
clear, accurate and timely messages which are relevant to their cultural backgrounds
and information needs. To do this, they need to identify and segment audiences using
strategic communication approaches. In addition, they need to design the
communication campaigns recognising the important role that demographic factors
such as age, gender and socioeconomic status play. They should also design messages
using mass communication and behaviour change theories. Besides, they should
disseminate their messages through a variety of mass media that is accessible and
preferred by the vulnerable groups so that they can reach as wide an audience as
possible with similar messages. These media include use of newspapers, television,
radio and the Internet. The planners of communication campaigns for mental health can
also employ the use of community-specific media such as poetry and theatre. This will
be very effective in reaching the entire community, and more importantly young
people, as it is entertaining and participatory. The messages communicated
will be culturally competent as members of the community will be involved in
designing and disseminating them. Furthermore, the messages communicated
during communication campaigns for mental health in Nairobi County should be
expressed in both English and Kiswahili. This is to avoid locking out members of
the target audience who are unable to read and understand English.
Another recommendation that this study makes is that communication campaigns
for mental health held in Nairobi County and the entire country should be
conducted regularly and for substantial periods so that they can achieve significant
impact in terms of nationwide mass media-based publicity and information strategy
in order to achieve wide penetration, put mental health issues on the cultural agenda
and change the knowledge of and attitudes towards mental health problems.
This study also recommends that the communication campaigns involve all key
stakeholders in identifying the mental health needs of target audiences, the
objectives of the campaigns, the messages to be communicated and the
communication strategies to be used. Among these stakeholders are doctors, nurses,
and key leaders of audience segments. These will make the campaign messages
targeted and tailored to the unique needs, features and preferences of target
audiences. It will also ensure that the campaigns are participatory.
Additionally, this study recommends regular evaluation of communication
campaigns for mental health held in Nairobi County and the entire country. This
will help the government, psychiatrists, nurses and mental health communicators to
know the objectives that have been achieved and the ones that have not in order to
design effective mental health communication campaigns.
Further, this study recommends that the government increases funding for mental
health so that mental health institutions can be made more decent and have essential
equipment such as enough wards, beds and mattresses. More funds will also enable
the Ministry of Health and the psychiatric hospitals such as Mathari National
Teaching and Referral Hospital to be able to conduct regular communication
campaigns for mental health and also evaluate them.
Finally, the study recommends that the government looks for ways of increasing
knowledge of mental health among medical personnel and training more psychiatrists
in order to solve the problem of shortage. With increased knowledge of mental health
among medical personnel, stigma will be effectively addressed. More psychiatrists will
not only make mental health services available to many who need them but also help
increase knowledge levels of mental health among the population.
