ALKAN Health Science , Business & Technology College

Health Education

Credit Hrs-3

By: Desta Debalkie (MPH)

[email protected]/[email protected]

1.Introduction to Health Education & Promotion

Mar, 2019
 Course Objectives

After the end of the course, the student is able to:-

– Explain the aims and basic principles of health education
– Described the role and the characteristics of health
education in PHC
– Define the role of human behavior in health
– Explain the basic characteristics of individual and group
behavior and behavioral changes
– Explain common teaching aids used for effective
communication
 Objectives….
– Describe the benefits of community participation in
the achievement of health education programs.
– Explain the principles of communications leadership
in health care organizations
– Describe the major issues and approaches to research
in health education.
– Describe how to carryout and evaluate health
education programs
 Course Content
Unit 1: Introduction to health education
– Definitions of terms
– Concepts of health determinants
– Historical development
– Aims and basic principles of health educations
– Approaches to health education
– Targets for health education
– Health education settings
– Who is responsible for health education?
– Role of health educator
Unit 2: Human behavior and health education
– Introduction
– Behavior and health
– Definition of behavior and other related terms
– Community behavior and behavior change
– Factors affecting human behavior
– The role of human behavior for prevention of
disease
– Group dynamics and Team work
 Unit 3:Working With Communities
(Community participation)

– Introduction
– Definition of community
– Concept of community participation
– Benefit of community participation
– Helping people to organize: The role of health
extension workers
Unit 4: Communication
– Definition of communication and health communication
– Types of communication
– Components of communication
– Communication stages
– Common communication approaches
– Methods of communication
– Basic assumptions in human communication
– Models of communications
– Methods of communications
– Barriers and communication failure
– Characteristics of effective communication
Unit 5: Educational Methods And Materials
– Introduction
– Educational methods
• Individual
• Group
– Teaching materials
• Audios
• Visual aids
– Mass media
Unit 6: Models and theories of health education and
planning

– ABCS of behavior theories/modes of behavior

– Models of health education
– PRECEDE-PROCEED model of health education
planning
Unit 7: Planning, Implementation and Evaluation Of
Health Education Programs
– Introduction
– Planning process
• Information gathering
• Defining and prioritizing problems
– Setting goals and objectives
• Identifying and obtaining resources
• Selecting appropriate methods
– Carry out and evaluate the project
• Development and implementing a project plan
• Evaluating the project
– Exercise in health education planning
 Unit 8: Research in health education

– Concepts of research
– Issue for research in health education
– Methods of research in health education
 Teaching Methods
– Lecture and discussion
– Demonstration and exercise

Evaluation & Assessment Methods

– Group assignment and preservation- 20%

– Mid-exam- 40%
– Final exam- 40%
 Assignments
1. Explain why voluntary actions are so important in health education
programs.
2. Identify and explain helpful, neutral and harmful beliefs in your locality
3. From your own local experience, describe how the ‘kebele’ heath committee
functions and the role they have ever played in the improvement of the
health of their people.
4. Identify the possible barriers in your locality that you think could affect
effective communication in the process of promotion of public health
activities/services.
5. Identify traditional communication methods used in your locality and
describe their strong aspects
6. If TB is a problem of the area you are live in, what will be your educational
objectives as part of the control program?
7. How do you get information to evaluate a certain health education program?
8. Select one health education settings found in your locality and discuss its
role in the development of communities’ health literacy.
 References
1. World health organization, education for health a manual for on
health education in primary healthcare WHO Geneva 1981.
2. Ramaxhachndran, L. and Dharmalingam. (1972) Health
education new approach vikas publishing house Pvt. lid, Dlhi.
3. Scotney, N. (1988) Health education a manual for medical
assistant and other health workers African medical and research
foundation Nairobi.
4. Metka, Getenet (2003) Health education for health science
students. Addis Ababa university, department of health.
5. Meseret Yazachew &Yihenew Alem (2004) Introduction to health
education lecture note series for health science students.
1.Introduction to Health Education& Promotion
Definitions and concepts of health
• Health is a very abstract concept to conceptualize and measure
and it is too difficult to put in words.
• It is a broad concept and its definition also differs among social
classes, cultures, religion and ethnic groups.
• Good health means different things to different people, and its
meaning varies according to individual and community
expectations and contexts.
• Many people consider themselves healthy if they are free of
disease or disability.
• However, people who have a disease or disability may also see
themselves as being in good health if they are able to manage
their condition so that it does not impact greatly on their quality
of life.
 Definition of health….

• In general, Health can be defined:-

– Lay point of view:- Persons are healthy when they are
doing their activities with no apparent symptoms of
disease in them.

– The Oxford Dictionary of English:- describes health

as “the state of being free from illness or injury”.

– Professional points of view:- Health is defined as a

measure of the state of the physical bodily organs,
and the ability of the body as a whole to function well.
• It also refers to freedom from medically defined
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diseases.
 Definitions…
• WHO definition:- ‘a state of complete physical, mental, and
social well-being, not merely the absence of disease, or
infirmity’.

• Mahler extends the WHO definition; accordingly he defined

health as;

• “The ability to lead socially and economically productive life”

and he come up with five components of health by adding the
concept of emotional health and spiritual health.

– However, the definition does not lend itself to direct

measurement, there for needs to operational as: “a
condition or quality of the human organism
expressing the adequate functioning of the organism
in given conditions, genetic or environmental”
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 Definitions…
• The absence of health is denoted by terms such as:-
disease, illness and sickness.
– which usually mean the same thing though social
scientists give them different meaning to each.
• Disease: is the existence of some pathology or
abnormality of the body, which is capable of detection
using, accepted investigation methods.
• Illness: is the subjective state of a person who feels
aware of not being well.
• Sickness: is a state of social dysfunction: a role that an
individual assumes when ill
 Definitions…
1. Physical Health:- is concerned with anatomical integrity and
physiological functioning of the body.
– It is the ability to perform routine tasks without any physical
restriction.
– E.g., Physical fitness is needed to walk from place to place.
2. Mental Health:-is the ability to learn and think clearly and
coherently. E.g., a person who is not mentally fit (retarded)
could not learn something new at a pace in which an ordinary
normal person learns.
3. Social Health:-is the ability to make and maintain acceptable
interaction with other people. E.g. to celebrate during festivals;
to mourn/cry when a close family member dies; to create and
maintain friendship and intimacy, etc.
– Conversely, social isolation has been shown to be a risk factor
for illness.
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 Definitions…
4. Emotional Health- is the ability of expressing
emotions in the appropriate way.
5. Spiritual Health- Some people relate health with
religion;
– personal values, beliefs, principles and ways of
achieving mental satisfaction, in which all are related
to their spiritual well-being.

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 Heath Determinants
What are Determinants of Health…?
• Determinants of health are factors that significantly
influence or have an impact on the health of
individuals, communities and societies.

Health determinants are factors that relate to peoples

health status.

Determinants interact in a very complex way

They may be requirements or risk factors and
determine health status and are jointly designated
health determinants. 21
 Determinants…
e.g:- Polluted water supply results in poliovirus but
if :-
– The child is vaccinated, the child can manage to
resist the virus
– Unvaccinated because the service is inadequate this
child can acquire an acute infection
– Uneducated mother may be reluctant to vaccinate
her child
– Children genetic susceptibility to developing
paralysis may also be considered …
 Determinants of health

Maintenance of good health:- Diseases can be due to:-

• Proper nutrition • Genetic traits
• Safe drinking water • Congenital deformity or
• Shelter (Ventilation and malformation
illumination) • Traumatic
• Clothing, hygiene • Infection, infestation and
• Proper work, exercise, rest inflammation
and recreation • Malnutrition
• Proper social condition • Hormonal
• Proper sexual bhr • Metabolic disorder
• Provision & utilization of • Poison
health services
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Health is broad and determinants are
complex

Individual
Services and behavior
constellation
Social
environment

Biology/
genetics Physical
environment

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 The Health Field Concept

• According to the “Health field” concept, there are

four major determinants of health or ill health.

A. Human Biology
B. Environment (Physical & social)
C. Healthcare organization
D. Life style (Behavior)

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 Historical Development of H/E

• As a practice as old as human being

• As a profession in the world ~>100 years –

USA
• Health belief model 1966: the oldest model

• As a course: Gondar Health science ~ 1954

• As a profession in Ethiopia: JU ~ 10 yrs

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 Evolution of HE/HP
There have been three revolutions in public health:-
1. The First Public Health Revolution:-
• Fight against communicable/ infectious diseases,
malnutrition and environmental factors over which
people had little control (water, basic sanitation, food
security).
• Health Education had already been taking part during
this first revolution.
2. The Second Public Health Revolution
• Fight against non-communicable diseases over which
people had some personal control, when social
conditions and contexts were favorable (obesity/ healthy
diet, sedentary lifestyles/ exercises, addictions, abuse,
mental health, risky behaviors).
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 Evolution of HE/ HP…
3. The Third Public Health Revolution

• The ‘Birth of Health Promotion’

• Is about health promotion (since 1974)
• Health promotion is viewed as a strategic activity to
promote health as a “resource for every day life”,
• Therefore, health promotion focuses on wellbeing
and quality of life, for which it is necessary to
empower communities for action
 
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 CONCEPTS OF HEALTH EDUCATION AND
HEALTH PROMOTION

• What is Health education…?

• What is Health information dissemination…?
• What is Health promotion…?
• What are the d/ce b/n HE,HI & HP….?

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 HEALTH EDUCATION
• Health education is a part of healthcare that is
concerned with promoting healthy behaviors.

• A person’s behavior may be the main causes of health

problems, but it can also be the main solution.

• It is through health education; we help peoples to

understand their behaviors and how it affect their
health and encourage them to make their own choices
for healthy life, but we do not force them to change.
 HEALTH EDUCATION…

Therefore, in health education; we encouraging

behaviors that:-
– Promote health as a part of promotive healthcare
– Promote behaviors that prevent illness or diseases as
a part of preventive healthcare
– Promote behaviors that facilitate cure diseases as
apart of curative healthcare, and
– Promote behaviors that facilitate rehabilitation as
apart of rehabilitation healthcare.
 HEALTH EDUCATION…
From this; what HE really means…?
Health Education
• “Any combination of learning experiences designed to
facilitate voluntary action conducive to health”—’Lowrence’
• Elaboration of the definition:-
• Combination: it emphasizes on the importance of matching
multiple determinants of behaviors with multiple learning
experiences or educational intervention
• Designed: distinguishes health education from incidental
learning experiences
– systematically planned and organized activity.
• Facilitate: creating favorable condition for actions such as
predispose, enable, reinforce.
 Health Education....

• Voluntary: with full understanding and acceptance of

the purpose of the action.
• In health education, we do not force the people to do
what we want them to do, instead our effort is to help
people to make decisions and choices by themselves.
[Informed decision making]……?
• Action: behavioral steps/measures taken by individuals,
groups or community to achieve the desired health effect.
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 .

HEALTH INFORMATION [HI]

• It is health facts disseminated to the target audience focusing
on the basic facts related to the health issue under
consideration.
• It is health message disseminated to the target audience
focusing on the basic facts related to the health issue under
consideration.
• In dissemination of health information, base line
information or data (currently existing level of multiple
determinants of behaviors) is not necessarily required
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• What is the difference between HE and HI….?
 Comparison of health education and health information
No Health education Health information

1 Baseline information or current level of Baseline information or data are not necessarily
Multiple determinants of behavior are required
necessarily required
2 The assumption is people are not rational The assumption is people are rational and make
all the times, but rationalize all the times. predictable use of information available to
them (unhealthy
behaviors is due to knowledge gap and knowledge
alone leads to action)
3 Appropriate for old problems (problems Appropriate for newly emerging health problems
known to the people for long period of and during epidemics
time)
4 Required at all stages in behaviors change One time telling facts provided that the
Continuum (it is continues, even to prevent information reaches at all the intended Audiences
defaulter after adoption) and understanding takes place
5 Encourage people to make their own Merely telling people to follow healthy behaviors
choices for healthy life
6 Focus on the reason behind behaviors Blind to the reason behind behaviors

7 People are not blamed for unhealthy People blamed for unhealthy behaviors
behaviors
8 Use a variety of methods or educational May not use a variety of methods.
Strategy as appropriate.
 HEALTH INFORMATION…

• Generally, HI is the scientific facts (e.g. the causes, mode of

transmission, prevention methods of particular diseases)
– It is the content of health education which primarily
aimed at increasing of knowledge on that particular
health problems;
• But; HE address the other factors that affect health
behaviors other than knowledge such as: beliefs, attitudes,
reinforcing factors etc.
• HI is not necessarily HE. However; correct HI is certainly a
basic part of HE and hence, in turn, health promotion. HE is
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beyond HI 10/28/2021
 Communication strategies in health education
activities
1. Information, Education and Communication (IEC): It is
increasingly being used as a general term for
communication activities to promote health.
• Information: A collection of useful briefs or detailed ideas,
processes, data and theories that can be used for a certain
period of time.
• Education: A complex and planned learning experiences
that aims to bring about changes in cognitive (knowledge),
affective (attitude, belief, value) and psychomotor (skill)
domains of behavior.
• Communication: the process of sharing ideas,
information, knowledge, and experience among people
using different channels.
 2. Behavior Change Communication
(BCC)
• Is an interactive process aimed at changing
individual and social behavior, using targeted,
specific messages and different communication
approaches, which are linked to services for
effective outcomes.
3.Advocacy: refers to communication strategies
focusing on policy makers, community leaders and
opinion leaders to gain commitment and support.
– It is an appeal for a higher-level commitment,
involvement and participation in fulfilling a set of
program agenda.
 HEALTH PROMOTION

Health promotion defined as:-

 “A combination of educational and environmental
supports for actions and conditions of living conducive
to health” (GREEN and KRUETR,1991).
• Elaboration of the definition based on the two
approaches:-
I. Educational:- refers to the communication part of
health promotion. That is HE.

II. Environmental:- refers to the social, political, and

economic, organizational, policy and regulatory
circumstances influence behavior or more directly
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health.
 Health Education and its Relationships with
Health Promotion and Public Health

• Health Education: is one of the strategies of Health

Promotion; whereas,

• Health Promotion: is one of the central Public Health

Disciplines.
• Health Promotion: is specifically concerned with the socio-
behavioral processes for improving personal health
behaviors and factors influencing those behaviors.

• While Public Health: is the science & art of preventing

disease, prolonging life & promoting health through the
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organized efforts of society.
 Approaches to health education
A. The persuasion approach:–deliberate attempt to
influence the other persons to do what we want them to
do (DIRECTIVE APPROACH).

B. The informed decision making approach:-giving

people information, problem solving and decision
making skills to make decisions but leaving the actual
choice to the people.
 Aims and Basic Principles of health
educations
Aims:-
• Motivating people to adopt health-promoting
behaviors by providing appropriate knowledge
and helping to develop positive attitude.

• Helping people to make decisions about their

health and acquire the necessary confidence and
skills to put their decisions into practice.
 Principles of health education
1. Principle of educational diagnosis:-

 The first task in changing behaviors is to determine its

causes.

 Just as physicians must diagnose an illness before it can

be properly treated, so, too, must a behavior be
diagnosed before it can be properly changed.

 If the causes of the behaviors understood; health

educator can intervene with the most appropriate and
efficient combination of education, reinforcement and
motivation.
 Principles of health education…
2. Principle of Participation:-
 The prospect for success in any attempt to change
behaviors will be greater if the individuals, families,
community groups,, etc…have been participated in
identifying their own needs for change and have
selected the methods that will enable them to take
action.

3. Principle of multiple methods:-

 This principle follows from the principle of educational
diagnosis.
 In so far as multiple causes will invariably be found for
any given behaviors.
 Principles…
4. Principle of planning and organizing:-

• Planning and organizing are fundamentals for

health education which distinguishes it from
other incidental learning experiences.
• It involves deciding in advance when, who,
what, how and why of health education.
• It also requires the planning for resources,
methods and materials to be used,
identification of target groups etc.
 Principles of health education…
5. Facts:-
 Health education is given based on scientific findings/
facts and current knowledge.
6. Segmentation:-
 Health education should be designed for a specific group
of people/ specific target groups
7. Need based:-
 Health education is primarily educational and real need
identification.
 Its purpose is to ensure a desired health related behavior
 Principles of health education…
There are three types of needs:-

Felt need: what the people feel, their wants, their

real needs.
Perceived by an individual
Expressed needs: It is need brought to attention of
the authorities by request, petition or complaints
etc.
Felt needs turn in to action; help seeking
Agency determined needs/ normative need: is
what external services such as health workers and
planners have decided the community needs.
 Principles of health education…
8. Culture:-
Health education should not consider as artificial
situation or formal teaching–learning process.
 One has to get into the culture of the community and
introduce novel ideas with a natural ease and caution.
Dogmatic statements particularly contrary to existing
belief, culture, practices will not be liked.
• Therefore; Health education starts from where
people are and slowly build up the talking point to
avoid any clash of ideas to allow for people
understanding, appreciation and internalization of
fresh ideas.
 Targets of health education
 Depending on the type of the problem; there are three
broadly classified targets of health education programs.
1.Individuals: this includes clients of services
(contraceptive or VCT users), patients and healthy
individuals.

E.g. diabetic or hypertensive patients.

 Targets of health education
2. Groups: includes gatherings of two or more people who
have a common interest.
 a family planning service for a couple
 a youth club about HIV/AIDS
 a farmers association about nutritious foods
 a class of school students about dental health
 a factory workers about occupational health hazards
 ANC attendants about dangers signs of pregnancy
3. Community: include a collection of people who have
common interests, a feeling of belongingness, and who
usually share common values, culture, beliefs and
interests.
E.g. a village community about the protection of spring
water, dangers of FGM
 Health education setting

 Communities
 Health care institutions
 Work sites
 Schools
 Prisons
 Refugee settings
 Clubs etc.
 The role of health educator
 Talking to the people and listening of their problems
 Thinking of the behavior or action that could cause, cure and
prevent these problems.
 Finding reasons for people’s behaviors
 Helping people to see the reasons for their actions and health
problems.
 Asking people to give their own ideas for solving the
problems
 Helping people to look as their ideas so that they could see
which were the most useful and the simplest to put into
practice.
 Encouraging people to choose the idea best suited to their
circumstances
 The role of health education…

 It is the first level of contact of individuals, the family and

the community with the national health system bringing
healthcare as close as possible to where people live and
work.

 It constitutes the first element of the continuing healthcare

process.

 Primary healthcare is a means of achieving health for all.

 Dimensions/scope of health Education
1. HE is life long process:- It is not one time affair.
–The concern caring about a child begins while the fetus is in
the mother’s WOMB
ANC delivery care PNC Immunization Death.
2. It is not an end by itself
– It is a way of empowering people to understand their own
problems, identifying its solution and take appropriate
action .
3. It is concerned with people at all points of health and
illness continuum
No level of disease prevention can operate with no
health education successfully
4. It is not limited to patients in clinical setups –
 It also includes apparently healthy and who want to minimize the risk
Thank You!