(Optional): Refer the mother to a small group session if necessary

The four steps for advising a mother, Ask-Praise-Advise-Check, cover all the essential information that most mothers will need to learn. However, there will be other important things that you may not have time to teach during an individual consultation. It is likely, for example, that some mothers will need to learn how to prepare ORS, and that others will need an additional review of the rules of case management in the home. It would probably be most useful to you, and to the mothers, to teach and discuss these subjects in a small group session.

For this you will need to be able to do three things: decide which mothers need to be referred, organize small group sessions at your facility, and carry out the sessions. It is important to note here that advice on preventing diarrhoea is also best presented in group sessions, although a mother whose child is ill is likely to be more interested in learning how to care for that child than how to prevent the diarrhoea from happening again. Sessions on prevention should be organized as regular events at your health facility or in the community.

Deciding which mothers to refer

Mentioned above are several topics which could be taught in group sessions on diarrhoea. To decide if a mother should attend a group session, think about:

1. What she needs to do for her child at home, in addition to what you have already discussed with her.

2. What she needs to learn or review in order to be able to do this, and

3. How much time you have for the individual consultation.

If you find the mother needs additional information, review, or practice, you should refer her to a group session.

Organizing small group sessions in your facility

To organize small group sessions in your facility, you will need to decide:

At what days and times should the sessions be scheduled? (Every day, or on certain days only? Should the sessions be held during or after clinic hours? Is it more realistic to ask mothers to wait at the health centre until all consultations are finished, or to come back on another day?)

What kind of space is available in your health facility where group sessions can take place? ORT corners are usually the best place for small group sessions.

What topics should be covered? Some suggestions are: ORS preparation, home fluid preparation, feeding, and a review of the three rules of home care of diarrhoea.

Who in your facility can conduct the group sessions?

Hints for conducting a group session

Much of what you have already learned about advising mothers individually also applies to group counselling. In addition to these skills, you should:

Choose an appropriate time to present an idea. For example, talk about ORS preparation or about the rules of home care when mothers whose children have diarrhoea are present. You can talk about prevention at another time.

Limit the session to one main idea or message.

Seat people comfortably, and try to sit among them.

Ask questions to get the group involved in a discussion based on their own experiences.

Present an idea through a real situation, such as a demonstration, whenever possible.