[Participative development calls for a participative concept of communication]

The most common approach to health communication, characterized by a top-down, one way flow of information through which individuals and communities are provided with solutions to their problems, is increasingly in question. The belief that the main goal of health communication programmes is to disseminate carefully worded messages to community target groups in order to trigger individual behaviour change is increasingly questioned in terms of both effectiveness and appropriateness. An alternative belief is that the aim of these programmes should be to involve both community members and health workers in critical analysis of health problems and potential solutions in order to develop strategies for action. This article describes two contrasting models of communication, the "information-dissemination for individual change model" and the "participatory, problem solving for action model". The two models are discussed in terms of the communication process, levels of programme intervention, communication activities and communication materials and an argument is given for the participatory model with examples of successful programmes that have adopted this approach.