The Answer May Just Be Under Your Nose

Take a look at this blog entry I wrote to introduce a project I’ve initiated.  It is a field experiment taking place in a village about eight hours away from Chennai, which tests the feasibility of children as health change agents in terms of spreading health information to their parents.  I’ll be looking at the effect of participatory learning vs. passive learning, one factor that has remained unexplored in this domain. A few days following work in the classroom with the elementary school students, we will visit the home of each student while he/she is at school, conducting a short, informal interview with whichever parent(s) is at home at the time. We will  collect what, if any, information has been disseminated from child-to-parent and assess attitudes on parents’ perceptions of children as reliable sources of information. Check out the post:


The largest gap in health education in most evident in under-resourced rural communities; yet, this group is often the most challenging to reach, given geographic and infrastructural constraints.  In rural India, this rift is further widened by an immense population fragmented into hundreds of thousands of small, widely-scattered villages, where the majority of adults lack literacy and access to mass media, the typical channels employed to reach the public with health messages.[1] Given these considerations, what innovative strategies can we employ to reach rural people with health information that may compel them to replace unhealthy and dangerous behaviors with those that will improve their health and well-being? What resources may already exist, into which we have not yet tapped?

They say the answer is often right under your nose, and in this case, we believe this may literally be true—we think children may be the solution. While few studies in the domain of disease prevention and health promotion have explored the prospect of children as health change agents, those that have often show that children are a fruitful channel through which to reach older generations.[2]

Our study expands on those of the past by exploring the cultural, social and behavioral implications of children as change agents in unprecedented ways.  Previous studies illustrate that cultural beliefs are an important determinant of parents’ perception of children’s capability to act as sources of health information.[3] Yet, the effects of children as change agents is almost entirely uncharted in India, where complex family relationships and strongly ingrained ideals of the family means it is imperative to study parents’ willingness to entertain children in this role.

More, the limited body of literature has exclusively examined conditions under which the transmission of health information is mechanical, pedagogical and contrived. We suspect that the spread of health information may flow more readily if children are participants, rather than subjects, in the learning process, and if they have a sense of ownership of the information[4]; thus, we wish to determine if a natural flow of information will take place under more organic conditions, without any overt call to action.

CDF has spent the previous one year studying many facets of Indoor Air Pollution (IAP), from household beliefs to technical aspects to work at the policy level and onward.  This experiment will look to expand our work here by exploring IAP at the behavioral level. With the hope that a successful pilot may mean plans for expansion, we have chosen a public primary school in a mid-sized village outside of Thanjore as one that is representative of schools among rural south India.

This experiment not only sets out to explore the feasibility of a new way to reach a largely inaccessible community; more, this is a call to health communicators in rural India (and elsewhere in the developing world) to use the assets of the community and the environment to engineer new ways of accessing audiences who are often beyond the reach of health workers. What other pragmatic solutions are there waiting right under our noses?

[1] As of 2009, the rural space is comprised of well over a half-million villages (585,000), and of these, approximately half hold a population between 200 and 1,000, with another 18 percent holding less than 200.1

[2] One study examining nearly 600 households demonstrated that children can influence their parents regarding diet, a health domain that is typically perceived as being the exclusive duty of adults.2 In India, a group of researchers showed that schoolchildren could successfully transmit information about leprosy to their parents.3,4 Finding success in preventative health, as well, a study in Egypt demonstrated that children successfully taught parents about how to prevent communicable diseases, with an evaluation after 6 months showing a substantial increase in parents’ knowledge.5 More, studies in Kenya (Onyango-Ouma et al., 2004)6, Macedonia (Simovska, 2004)7 and Denmark (Simovska and Jensen, 2003)8 were successful in employing children as change agents in reproductive health and substance abuse. Such outcomes put forward that children are under-utilized in health promotion practice as potential agents of health information.

[3] Looking at the feasibility of Hispanic-American and African-American mothers accepting health advice from their daughters, Mosavel (2009)9 found significant variance in the manner that these two cultures perceived the role and legitimacy of young daughters. 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.

[4] Examining the feasibility of children as change agents in Tanzania, Mwanga et. al. (2007, p. 17)12 put forth that “participation is crucial as it is the main pre-condition for the development of ownership among pupils. Without ownership, health education will have no impact on pupil’s practice and actions.” Such ownership takes place only with an action-oriented and participatory teaching and learning approach intended to promote the development of childrens’ legitimate participation, ownership of the educational process and capability to take action.


1- Shrivastava, Ashish Kumar, & Praveer, Saket Ranjan, (2009) Organised Retail in FMCG Segment: Rural Market Prospects. SCMS Journal of Indian Management, July – September, 53-64.

2- Flora, J. & Rimal, N. (1998). Bidirectional family influences in dietary behavior: test of a model of campaign influences. Health Communication Research, 24(4), 610–37.

3- Chaturvedi, R & Kartikeyan, S. (1992). Schoolchildren as conveyors of health  information for family members. World Health Forum, 13(1), 54.

4- Bhore, P., Bhore, C., Powar, S, et al. (1992). Child-to-parent education: a pilot study. Indian Journal of Leprosy, 64(1), 51–57.

5- Al Khateeb, M. (1996) Children teach parents about infectious diseases in Upper Egypt. Learning for Health, 8.

6- Onyango-Ouma, W., Aagaard-Hansen, J. & Jensen, B. B. (2004). Changing concepts of health and illness among children of primary school age in western Kenya. Health Education Research: Theory and Practice, 19, 1–14.

7- Simovska, V. (2004) Student participation: a democratic education perspective-experience from the health promoting school in Macedonia. Health Education Research, Theory and Practice, 19: 198–207.

8- Simovska, V. & Jensen, B. B. (2003). Learnt: Students’ Participation, Action and Cross-cultural Collaboration in a Virtual Classroom. Danish University of Education Press, Copenhagen.

9- Mosavel, M. (2009).The Feasibility of Mothers Accepting Health Advice from their Adolescent Daughters. Journal of Health Care for the Poor and Underserved, 20, 42-49.