HEALTH

EDUCATION
NCM 102
WELCOME TO
MODULE 1
WEEK 1
www.menti.com
 OBJECTIVES
After 1.5 hrs. of active and interactive student-teacher discussion and
interaction the BSN level 1 students will be able to acquire adequate
knowledge, beginning skills and positive attitude.
1. Review the historical development in Health Education
2. Identify issues and trends in Health Education
3. Discuss theories in Health Education.
◦ 3.1 Pender’s Health Promotion theory
◦ 3.2 Bandura’s Self Efficacy Theory
◦ 3.3 Health Belief Model
◦ 3.4 Green’s Precede-Proceed Model
HEALTH EDUCATION
EDUCATION THAT PROMOTES AN
UNDERSTANDING OF HOW TO MAINTAIN
PERSONAL HEALTH.
The World Health Organization defined
Health Education as:

"comprising of consciously constructed

opportunities for learning involving some
form of communication designed to improve
health literacy, including improving
knowledge, and developing life skills which
are conducive to individual and community
health."
1. HISTORICAL
DEVELOPMENT
 HISTORICAL EVOLUTION OF NURSING
I. Period of Intuitive Nursing/Medieval Period

❑ Nursing was “untaught” and instinctive. It was

performed of compassion for others, out of the
wish to help others.
❑ Nursing was a function that belonged to women. It
was viewed as a natural nurturing job for women.
She is expected to take good care of the children,
the sick and the aged.
HISTORICAL EVOLUTION OF NURSING
❑ No caregiving training is evident. It was
based on experience and observation.
❑ Primitive men believed that illness was
caused by the invasion of the victim’s
body of evil spirits.
❑ They believed that the medicine man,
Shaman or witch doctor had the power to
heal by using white magic, hypnosis,
charms, dances, incantation, purgatives,
massage, fire, water and herbs as a mean
of driving illness from the victim.
II.Period of Apprentice Nursing/Middle Ages

❑ Care was done by crusaders, prisoners, religious orders.

❑ Nursing care was performed without any formal education

and by people who were directed by more experienced
nurses (on the job training). This kind of nursing was
developed by religious orders of the Christian Church.
❑ Nursing went down to the lowest level
-wrath/anger of Protestantism confiscated properties of
hospitals and schools connected with Roman
Catholicism.
❑ Nurses fled their lives; soon there was shortage of people to care
for the sick
❑ Hundreds of Hospitals closed, there was no provision for the sick,
no one to care for the sick
❑ Nursing became the work of the least desirable of women –
prostitutes, alcoholics, prisoners
❑ Pastor Theodore Fliedner and his wife, Frederika established the
Kaiserswerth Institute for the training of Deaconesses (the 1st
formal training school for nurses) in Germany.

This was where Florence Nightingale received her 3-month course of

studies in nursing.
HISTORICAL DEVELOPMENT
Mid- 1800’s –nursing was recognized
as unique discipline. Teaching has been
recognized as an important health care
initiative assumed by the nurses.
 Focus is not only on the care of the
sick but also on education other nurses
for professional practice.
III.Period of Educated Nursing/Nightingale Era 19th-20th
century
❑ The development of nursing during this period was
strongly influenced by:
a.) trends resulting from wars – Crimean, civil war
b.) arousal of social consciousness
c.) increased educational opportunities offered to
women.
❑ Florence Nightingale was asked by Sir Sidney Herbert of
the British War Department to recruit female nurses to
provide care for the sick and injured in the Crimean War.
 Florence Nightingale is the ultimate
educator because she dedicated a large
portion of her career in educating those
who are involve in the delivery of health
care (Physicians, nurses, health officials)
• Florence Nightingale (1900s)

➢ Founder of modern nursing

➢ Developed the first school of nursing

➢ Devoted a large portion of her career to teaching nurses, physicians

and health officials about the importance of proper conditions in
hospitals and homes to improve the health of people.

➢ Emphasized the importance of teaching patients of the need for

adequate nutrition, fresh air, exercise, and personal hygiene to
improve their well-being.
❑ In 1860, The Nightingale Training School of Nurses
opened at St. Thomas Hospital in London.

–The school served as a model for other training schools. Its

graduates traveled to other countries to manage hospitals and
institute nurse-training programs.

–Nightingale focus vision of nursing Nightingale system was more

on developing the profession within hospitals. Nurses should be
taught in hospitals associated with medical schools and that the
curriculum should include both theory and practice.

–It was the 1st school of nursing that provided both theory-based
knowledge and clinical skill building.
 St. Thomas Hospital in London.

· Nursing evolved as an art and science

· Formal nursing education and nursing service begun
IV.Period of Contemporary Nursing/20th Century

❑ Licensure of nurses started

❑ Specialization of Hospital and diagnosis

❑ Training of Nurses in diploma program

❑ Development of baccalaureate and advance

degree programs
❑ Scientific and technological development as well as
social changes mark this period.
a) Health is perceived as a fundamental human right
b) Nursing involvement in community health
c) Technological advances – disposable supplies and
equipments
d) Expanded roles of nurses was developed
e) WHO was established by the United Nations
f) Aerospace Nursing was developed
g. Use of atomic energies for medical diagnosis, treatment

h. Computers were utilized-data collection, teaching,

diagnosis, inventory, payrolls, record keeping, billing.

i. Use of sophisticated equipment for diagnosis and therapy.

Tracing the history of health education to ancient times,

Rubinson and Alles (1984) concluded that the health
education profession has been helping people for a very long
time now.
 Credentialing

• Credentialing is the process by which the qualifications of

licensed professionals, organizational members or an
organization are determined by assessing the individuals or
group background and legitimacy through a standardized
process.

• Accreditation, licensure, or certifications are all forms of

credentialing.
 Credentialing

• In 1978, Helen Cleary, the president of the Society for Public

Health Education (SOPHE) started the process of
certification of health educators.

• Prior to this, there was no certification for individual health

educators, with exception to the licensing for school health
educators.

• The only accreditation available in this field was for school

health and public health professional preparation programs.
➢To ensure that the commonalities
between health educators across the
spectrum of professions would be
sufficient enough to create a set of
standards.
 Teaching today is now within the
scope of nursing practice
responsibilities.
Nurses are expected to provide instruction
to assist the consumers in:
◦ Maintaining optimal level of wellness
◦ Prevention of diseases, manage illness,
and
◦ Develop skills to give supportive care to
family members.
 From disease oriented... we now focus on
prevention-oriented patient education to
ultimately become health-oriented patient
education. The role of nurse educator
evolved from healer to expert
advisor/teacher to facilitator of change.
Another role of nurses educator is training
the trainer.
 Early 1900 – public health nurses in the US
began to understood the importance of
education in the prevention of disease and
maintenance of health
1918 – NLNE (National League for Nursing
Education) observed the importance of health
teaching as a function where in the scope of
nursing practice.
 1950 – NLNE identified the course content
dealing with teaching skills, developmental and
educational psychology, and principles of
educational process of teaching and learning as
areas in the curriculum common to all nursing
schools.
 Nurse Educator’s role evolved from: Disease-
oriented approach to Prevention-oriented
approach Wise healer to expert advisor/teacher
to facilitator of change.
Grueninger, 1995

➢ Described the transition toward wellness from “disease-

oriented patient education (DOPE) to prevention-oriented
patient education (POPE), to ultimately become health-
oriented patient education (HOPE)”.

➢ Instead of the traditional aim of simply imparting

information, the emphasis is now on empowering patients
to use their potentials, abilities, and resources to the
fullest.
➢In 1980, health education instruction was
operationally defined by the members of
the role delineation project as:
“the process of assisting individuals, acting
separately and collectively, to make
informed decisions on matter affecting
individual, family, and community health.”
• In 1985, the Wisconsin department of public
instruction’s guide to curriculum planning in health
education adapted the term Total Health in
connection with health education.

• The term refers to the lifelong interdependence,

constant interaction, and balance of the physical,
emotional, social, and intellectual dimensions of
human growth and development.
➢ Instead of the traditional aim of simply imparting
information, the emphasis is now on empowering
patients to use their potentials, abilities, and
resources to the fullest.
• The Pew Health Professions Commission (1998)

➢ Recommends the following pertaining to the importance of Patient &

Staff Education and to the Role of the Nurse as Educator:

1. Provide clinically competent and coordinated care to the public

2. Involve patients and their families in the decision making process
regarding health intervention
3. Provide clients with education and counseling on ethical issues
4. Expand public access to effective care
5. Ensure cost effective and appropriate care for the consumer.
6. Provide for prevention of illness and promotion of healthy lifestyles for
all.
• The role of today’s educator is preparing nursing staff through:

1. continuing education
2. in-service programs, and
3. staff development to maintain and improve their clinical skills and
teaching abilities
2.Issues and trends
in Health Education
 Trends Affecting Health Care
Social, economic, and political forces that effect a nurse’s role in
teaching:
❑federal initiatives
❑growth of managed care
❑increased attention to health and well-being of everyone in society
❑cost containment measures to control
❑healthcare expenses
❑concern for continuing education as vehicle to prevent malpractice
and incompetence
❑expanding scope and depth of nurses’ practice
responsibilities
❑consumers demanding more knowledge and skills for self-
care
❑demographic trends influencing type and amount of
health care needed
❑recognition of lifestyle related diseases which are largely
preventable
❑health literacy increasingly required
❑advocacy for self-help groups
Social and economic trends
impacting heath care
❑National health care goals (healthy people 2000).
❑Established objectives to develop effective health education
programs to assist individuals :
➢recognize and change risk behaviors,
➢adopt and maintain protective health practices,
➢make appropriate use of health care delivery system
❑Nurses can play a role in educating people about healthy and
protective lifestyles.
❑Growth of managed care, shift in payer coverage, led to
emphasis on outcome measures, which is achieved by
patient education
❑Importance of economic and social values in preventive
measures
❑Political emphasis on reducing costs of health care
delivery, through preventive measures.
❑Nurses are defining their role with a focus on patient
education as central to the practice of nursing
❑Consumers are demanding an increase in knowledge and
skills on how to care for themselves and how to prevent
disease.
❑The increase in chronic and incurable conditions requires
that individuals and families become informed participants
to manage their own illnesses
❑Increase in the number of older people, created the need
for consumers to rely more on self care to maintain health.
❑Major causes of death are diseases that are lifestyle
related and can be prevented through health education
❑Advance technology increased complexity of care, and
gave clients ability to move away from health care setting
❑Early hospital discharge made families and client
more self reliant.
❑Patient education is believed to improve
compliance and thus improve health status.
❑Emergence of successful self help groups led to the
public and nurse involvement and support for
educational activities
❑During the past 30 years, Health Education has
been taking place in a variety of ways.
❑awareness campaigns towards the prevention,
monitoring and control of potentially epidemic
diseases.
❑Some have targeted specialists, by sharing
information on the progress and problems
surrounding the control of epidemics.
❑Others were addressed to the public:
❑ for example prevention campaigns on
tuberculosis, leprosy, polio, etc., following in
the wake of 19th century hygiene
campaigns.
❑The use of radio, cinema, television and other
communication media were called for in such
cases.
3.Theories in Health
Education
Health Education
 Health Education

 The process of changing people’s

knowledge, skills, and attitudes for
health promotion and risk reduction.
 Patient education

 Refers to a series of planned teaching-

learning activities designed for
individuals, families, or groups with
an identified alteration in health.
Pender’s Health
Promotion Model
What is Health Promotion?

Health Promotion-is the process of empowering people to

make healthy lifestyle choices and motivating them to become
better self-managers. To accomplish this, health promotion
strategies should focus on patient education, counseling, and
support mechanisms.
◦ Examples of health promotion approaches include education and
counseling programs that promote physical activity, improve
nutrition, or reduce the use of tobacco, alcohol, or drugs.
HEALTH PROMOTION
➢Health Promotion Model (HPM) is used universally for research,
education, and practice.
➢The health promotion model focuses on helping people achieve
higher levels of well-being.
➢ It encourages health professionals to provide positive resources to
help patients achieve behavior specific changes.
➢The goal of the HPM is not just about helping patients prevent
illness through their behavior, but to look at ways in which a person
can pursue better health or ideal health.
According to Pender, the HPM makes
four assumptions:
•Individuals strive to control their own behavior.
•Individuals work to improve themselves and their environment.
•Health professionals, such as nurses and doctors, comprise the
interpersonal environment, which influences individual
behaviors.
•Self-initiated change of individual and environmental
characteristics is essential to changing behavior.
Major Concepts of the Health Promotion
Model
Individual characteristics and experiences (prior
related behavior and personal factors).
Behavior-specific cognitions and effect (perceived
benefits of action, perceived barriers to action,
perceived self-efficacy, activity-related affect,
interpersonal influences, and situational influences).
Behavioral outcomes (commitment to a plan of
action, immediate competing demands and
preferences, and health-promoting behavior).
 Subconcepts of the Health Promotion
Model
Personal Factors
Personal factors categorized as biological, psychological and socio-
cultural. These factors are predictive of a given behavior and shaped
by the nature of the target behavior being considered.
• Personal biological factors. Include variables such as age gender body
mass index pubertal status, aerobic capacity, strength, agility, or
balance.
• Personal psychological factors. Include variables such as self-
esteem, self-motivation, personal competence, perceived health
status, and definition of health.
• Personal socio-cultural factors. Include variables such as race,
ethnicity, acculturation, education, and socioeconomic status.
Perceived Benefits of Action
Anticipated positive outcomes that will occur from health behavior.
Perceived Barriers to Action
Anticipated, imagined or real blocks and personal costs of
understanding a given behavior.
Perceived Self-Efficacy
Judgment of personal capability to organize and execute a health-
promoting behavior. Perceived self-efficacy influences perceived
barriers to action so higher efficacy results in lowered perceptions
of barriers to the performance of the behavior.
Activity-Related Effect
Subjective positive or negative feeling that occurs before,
during and following behavior based on the stimulus properties
of the behavior itself.
Activity-related affect influences perceived self-efficacy, which
means the more positive the subjective feeling, the greater the
feeling of efficacy. In turn, increased feelings of efficacy can
generate a further positive affect.
Interpersonal Influences
Cognition concerning behaviors, beliefs, or attitudes of
the others. Interpersonal influences include norms
(expectations of significant others), social support
(instrumental and emotional encouragement) and
modeling (vicarious learning through observing others
engaged in a particular behavior). Primary sources of
interpersonal influences are families, peers, and
healthcare providers.
Situational Influences
Personal perceptions and cognitions of any given
situation or context that can facilitate or impede
behavior. Include perceptions of options available,
demand characteristics and aesthetic features of the
environment in which given health promoting is
proposed to take place. Situational influences may has
direct or indirect influences on health behavior.
Commitment to Plan of Action
The concept of intention and identification of a planned
strategy leads to the implementation of health
behavior
Immediate Competing Demands and Preferences
Competing demands are those alternative behaviors
over which individuals have low control coz their are
environmental contingencies such as work or family
care responsibilities. Competing preferences are
alternative behaviors over which individuals exert
relatively high control, such as choice of ice cream or
apple for a snack
Health-Promoting Behavior
A health-promoting behavior is an endpoint or
action outcome that is directed toward attaining
positive health outcomes such as optimal wellbeing,
personal fulfillment, and productive living.
4. Health Promotion
Theory
Albert Bandura’s Self Efficacy Theory
➢Along with goal setting, self-efficacy is one of the
most powerful motivational predictors of how well a
person will perform at almost any endeavor.
➢Determines effort, persistence and strategy in the
accomplishment of task.
Your beliefs become your thoughts. Your thoughts
become your words. Your words become your
actions. Your actions become your habits. Your
habits become your values. Your values become
your destiny.
-Mahatma Gandhi
Social Learning Theory
 People learn from one another and
that learning is promoted by
modeling or observing other people.
 Persons are thinking beings with
self-regulatory capacities, capable of
making decisions and acting
according to expected consequences
of their behavior.
 Attention, Retention, Reproduction,
Motivation
5. Health Belief
Model
 THE HEALTH BELIEF MODEL
 HBM is a psychological model that attempts to explain and predict
health behaviors.
 HBM was first developed by social psychologists Hochbaum,
Rosenstock and Kegels working in the U.S. Public Health Services
inspired by a study of why people sought X-ray examinations for
tuberculosis.
 The model was developed in response to the failure of a free
tuberculosis (TB) health screening program.
 The study of social sciences helps to improve the care of the patient
by increasing the nurse’s understanding of human behaviour and
to stimulate intellectual and emotional growth and self knowledge.
THE HEALTH BELIEF MODEL
 Green’s Precede-Proceed Model
➢is a cost–benefit evaluation framework proposed in 1974
by Lawrence W. Green that can help health program
planners, policy makers and other evaluators, analyze
situations and design health programs efficiently.
➢Provides a model for community assessment, health
education planning, and evaluation.
➢In this framework, health behavior is regarded as being
influenced by both individual and environmental factors,
and hence has two distinct parts:
PRECEDE stands for:
Predisposing
Reinforcing and
Enabling Constructs in
Educational
Diagnosis and
Evaluation
PROCEEDE stands for:
Policy,
Regulatory, and
Organizational Constructs in
Educational and
Environmental
Development
 The PRECEDE–PROCEED planning model consists of four
planning phases, one implementation phase, and 3 evaluation
phases:
PRECEDE phases PROCEED phases

Phase 1 – Social Diagnosis Phase 5 – Implementation

Phase 2 – Epidemiological, Behavioral & Environmental

Phase 6 – Process Evaluation
Diagnosis

Phase 3 – Educational & Ecological Diagnosis Phase 7 – Impact Evaluation

Phase 4 – Administrative & Policy Diagnosis Phase 8 – Outcome Evaluation

PRECEDE Phases
Phase 1: Defining the ultimate
outcome
 Community surveys
 Focus groups
 Phone interviews
 Face-to-face interviews
 Questionnaires in public places
Phase 2: Identifying the issue
 Phase 3: Examining the factors that
influence behavior, lifestyle, and
responses to environment.
 Phase 4: Identifying “best practices” and
other sources of guidance for intervention
design, as well as administrative,
regulation, and policy issues that can
influence the implementation of the
program or intervention.
PHASE 4 FACTORS TO CONSIDER:
 Predisposing factors
 People’s characteristics that motivate them
toward health-related behavior
 Includes knowledge, attitude, beliefs, personal
preferences, existing skills, self-efficacy towards
behavior change.
Enabling factors
 Conditions in people and the environment
that facilitate or impede health-related
behavior
 Are skills or physical factors, such as
availability and accessibility of resources
or services that facilitates achievement of
motivation.
 Reinforcing factors
 Feedback given by support persons or groups
resulting from the performance of the health-
related behavior
 Factors include factor that rewards, or
reinforce the desired behavior change, social
support, economic rewards, and changing social
norms.
PROCEED PHASES
 Phase 5: Implementation
 In Phase 5, administrative and policy diagnosis,
you identify (and adjust where necessary) the
internal administrative issues and internal and
external policy issues that can affect the
successful conduct of the intervention.
 Those administrative and policy concerns include
generating the funding and other resources for the
intervention
 Phase 6: Implementation
-implementation, you carry
out the intervention.
 Phase 7: Process Evaluation

-you evaluate the process of

the intervention – i.e., you
determine whether the
intervention is proceeding
according to plan, and adjust
accordingly.
 Phase 8: Impact Evaluation
- you evaluate whether the intervention
is having the intended impact on the
behavioral and environmental factors
it’s aimed at, and adjust accordingly.
 Phase 9: Outcome Evaluation
-outcome evaluation, you evaluate whether
the intervention’s effects are in turn producing
the outcome(s) the community identified in
Phase 1, and adjust accordingly.
Synthesis
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EVALUATION
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References:
Bandura, A. (1997). Self-efficacy. The exercise of control. New York:
W.H.Freeman and Company.Emory University, Division of Educational Studies, Information on
Self-Efficacy: A Community of Scholars.
http://www.des.emory.edu/mfp/self-efficacy.htmlMaddux, J.E. (2005). Self-efficacy: Teh power
of believing you can. In C.R
Snyder & S.J. Lopez, (Eds.), Handbook of positive psychology (pp. 227-287). New York: Oxford
University Press.
https://en.wikipedia.org/wiki/PRECEDE%E2%80%93PROCEED_model
References:
Green L, Kreuter M. (2005). Health program planning: An educational and ecological approach.
4th edition. New York, NY: McGrawhill.
https://www.scielo.br/scielo.php?script=sci_arttext&pid=S0074-02762000000700009
https://www.ncbi.nlm.nih.gov/books/NBK43745/