Health Education

HEALTH EDUCATION
BY: MONIKA
II POST GRADUATE
DEPARTMENT OF PUBLIC HEALTH DENTISTRY
2

CONTENTS
Health Education
 Introduction
 Definition
 Aims and objectives
 Approaches
 Contents of health education
 Principles of health education
3

 Models of health education
 Aids in health education
 Levels of health education
 Methods of health education
Communication
 Key elements and barriers in communication
4

 Steps of health education planning
 Domains and Steps of learning
 Public health significance
 Conclusion
 References
5

Introduction
It is important that dental health professionals understand
the principles of health education and the most effective
ways of delivering it within clinical settings.
Health education messages given to the public should be
consistent and scientifically correct.
Education involves the transfer of knowledge and skills
from the educator to the student or learner.
6

Definition
The most accepted definition by national conference on
preventive medicine (1977) is “health education is a
process that informs, motivates and helps people to adopt
and maintain healthy practices and lifestyle, advocates
environmental changes as needed to facilitate this goal
and conducts professional training and research to the
same end.”
Marya CM. A Textbook of Public Health Dentistry. 1st edition. New Delhi (India): Jaypee Brothers Medical
Pub; 2011. p156.
Park K. Park’s Textbook of Preventive And Social Medicine. 23rd ed. Jabalpur (India): M/s Banarsidas
Bhanot;2015. p894.. 7

PRIMARY OBJECTIVES OF HEALTH
EDUCATION
To encourage people to adopt and sustain health promoting
lifestyle and practices
To promote the proper use of health services available to
them
To arouse interest, provide new knowledge, improve skills
and change attitudes in making rational decisions to solve
their own problems.
Bhanot;2015. p895
 To stimulate individual and community self reliance and
participation to achieve health development through
individual and community involvement at every step
from identifying problems to solving them.
8

Approaches to health education
Regulatory approach (managed prevention)
Service approach
Health education approach
Primary health care approach
Bhanot;2015. p897-898
Hiremath SS. Text book of Preventive and Community Dentistry. 2nd ed. Elsevier. New Delhi; 2011. p67-68. 9

 Regulatory approach (managed prevention)
 Regulation in the context of health education may be
defined as any government intervention, direct or indirect,
designed to alter human behaviour.
 Coercive or regulatory approach seeks change in health
behaviour and improvement
Variety of external control or laws
placed on people
Example: child marriage restraint act,
Compulsory seat belts
10

The reasons for failure of the above approach:
The cause of disease (medical or social) cannot be
eradicated by legislation at the most the government can
make laws to prevent a person spreading disease.
In areas involving personal choice no government can
pass legislation to force people to eat a balanced diet or
not to smoke
Bhanot;2015. p895
11

 Service approach
 It aimed at providing all the health services needed by the
people at their door steps on the assumption that people
would use them to improve their own health .
 Reason for failure:
 It was not based on the felt needs of people
Bhanot;2015. p896
12

Health education approach
 If the necessary behaviour changes are to take place
people must be educated through planned learning
exercises and be informed, educated and encouraged to
make their own choice of healthy life.
 Results are slow but enduring.
 We must start health education with young population.
Bhanot;2015. p896
13

Primary health care approach
 It is a radically new approach starting from the people
with their full participation and active involvement in the
planning and delivery of health services based on
principals of primary health care i.e community
involvement and intersectoral coordination.
Bhanot;2015. p896
 This in turn can be done if the people receive the
necessary guidance from health care providers in
identifying their health problems and finding workable
solution.
14

Contents of health education
Human biology:
 Understanding health, demands an understanding of the
human biology.
 How to keep physically fit – the need for exercise, rest
and sleep, effects of alcohol, smoking and drugs on body.
Park K. Park’s Textbook of Preventive And Social Medicine. 23rd ed. Jabalpur (India): M/s Banarsidas Bhanot;2015.
 The best place to teach human biology is the school and
through its sequential health curriculum which can
provide in depth learning experiences for million of
students.
15

Nutrition:
 The aim is to guide people to choose optimum and
balanced diets and promote good dietary habits.
 Nutrition education is a major intervention for prevention
of malnutrition, promotion of health and improving
quality of life.
Bhanot;2015. p896
16

Hygiene:
Two aspects
Personal
Enviromental
 Clothing
 Washing
hands after
toilet
 Inculcation of
clean habits
Domestic:
Home, need for
fresh air, light,
ventilation,
hygienic
storage of foods
e.t.c
Community:
Basic sanitary
services,
Disposal human
excreta e.t.c
17

Family health:
 The family is the first defence as well as the chief reliance for
the well being of its members.
 Health largely depends on the family’s social and physical
environment and it’s lifestyle and in prevention of disease.
18

Disease prevention and control:
 Drugs alone will not solve health problems without health
education, a person may fall sick again and again from the
same disease.
 Education of the people about the prevention and control of
locally endemic diseases is the first of eight essential activities
in primary health care.
19

Mental health:
 The aim of education in mental health is to help people to
keep mentally healthy and to prevent a mental
breakdown.
 Health workers should help people achieve mental health
by showing sympathy, understanding and by social
contact.
Park K. Park’s Textbook of Preventive And Social Medicine. 23rd ed. Jabalpur (India): M/s Banarsidas Bhanot;2015. 20

Prevention of accidents:
 Accidents are the features of the complexity of modern life.
 The predominant factor in accidents is carelessness and the
problem can be tackled through health education.
21

Use of health services:
 Many people particularly in rural areas do not know what
health services are available in the community.
 Aim of health education is to inform people about the health
services that are available in the community and how they
can utilize them.
22

Principles of health education:
23

 Credibility:
 It is the degree to which the message to be communicated is
perceived as trustworthy by the receiver.
 Good health education should be based on facts- that means
it must be consistent and compatible with scientific
knowledge and also with local culture and social goals.
Hubley J. Principles of health education. Br Med J (Clin Res Ed). 1984 Oct 20;289(6451):1054-6
24
 For example physical exercise is good for health and
reduces the chance of cardiovascular diseases, it is
scientifically proven also.

Interest:
 It is a psychological principle that people are unlikely to listen
to those things which are not to their interest.
 The health educator will have to bring about a recognition of
the needs before he proceeds to tackle them.
. Park K. Park’s Textbook of Preventive And Social Medicine. 23rd ed. Jabalpur (India): M/s Banarsidas Bhanot;2015.
Hubley J. Principles of health education. Br Med J (Clin Res Ed). 1984 Oct 20;289(6451):1054-6
25
 For example population suffering from malnutrition will
be interested to know about nutritive value of food

Participation:
 It is based on the psychological principle of active learning.
 The Alma Ata declaration states: “the people have a right and
duty to participate individually and collectively in the
planning and implementation of their health care.”
26
 For example the program of swach bharath mission will
be only successful if people will actively particpate in it.

Motivation:
 In every person, there is a fundamental desire to learn and
awakening this desire is called motivation.
 Two types:
 Primary motives: they are driving forces (e.g. hunger,
survival) initiating people into action.
 Secondary motives: based on desires created by outside forces
or incentives.
Health for all Sr. No. 1
27
 For example in a patient who uses hard tooth brush is
having cervical abrasions and is also having sensitivity
with respect to the same. When educated about the
harmful effects of hard bristles and it is also the reason in
causing sensitivity.
 He might feel motivated

Comprehension:
 In health education we must know the level of understanding,
education and literacy of people to whom the teaching is
directed.
28
 For example in a child if we tell her we are going to use
rubber dam that child would not understand.
 Then we can say, “ we are going to cover your tooth by
raincoat”.

Reinforcement:
 Repetition at intervals is necessary.
 If there is no reinforcement there is every possibility of
individual going back.
29

Learning by doing:
 Learning is an action- process; not a memorizing one in the
narrow sense.
30
 For example method of tooth brushing, if patient
practices on his own under expert guidance then there
are chances of learning proper technique is more.

Known to unknown:
 In health education work, we must proceed “from the concrete
to the abstract”; “from the particular to general”; “from the
simple to the more complicated”; “from easy to more difficult”
and “from known to unknown.”
 We start where the people are and with what they understand.
31
 E.g: a health education program with the aim of
introducing a tooth brush in rural population will be
better appreciated if the communicator starts with “what
are you using to clean your teeth at present”?

Setting an example:
The health educator should set a good example in the things he
is teaching.
For example:
If heath educator is explaining the hazards of smoking he will
not be successful if he himself seen smoking.
32

Good human relations:
Sharing of information, ideas and feelings happen most easily
between people who have a good relationship.
Feedback: it is one of the key concepts of the systems
approach. The health educator can modify the elements of
system.
33

Leaders:
 In the work of health education we try to penetrate the
community through the local leaders – the village headman,
the school teacher or the political leader.
 If the readers are convinced first about given programme the
rest of the task of implementing the programme will be easy.
34

Models of health education
Medical model
Educational model
Self empowerment model
Radical model
Health belief model and health action model
Marya CM. A Textbook of Public Health Dentistry. 1st edition. New Delhi (India): Jaypee Brothers Medical Pub; 2011
35

Medical model
Described by Vuori (1980)
Based on facts and experts knowledge given in didactic fashion.
Model uses medical profession as a teacher to control
transmission of selected knowledge.
Marya CM. A Textbook of Public Health Dentistry. 1st edition. New Delhi (India): Jaypee Brothers Medical Pub; 2011.
 The commonly used methods such as lectures, film shows
and posters.
 Most commonly used form of health education.
 Criticism:
 Reduces self reliance and disempowering the individual
 Mere passing of relevant knowledge is insufficient to
change attitude towards health and illness.
36

Educational model
Aims to provide access to learning and to guide learning
in away which promotes understanding and develops
power of reasoning.
Basis of model: voluntarism
Pub; 2011.
 Method used is discussions, role plays and debates.
 Advantage: knowledge and skills are easily transferred
amongst peers and will be valued by them and wider
society.
 Criticism:
 It is unrealistic to expect that learner will be able to access
or absorb all knowledge about health behaviour.
 It fails to take into account the influences of socialisation
process which include parental guidance, peer pressure on
the ability to make decisions.
37

Self-empowerment model
Other names: the pastoral model, the self esteem model
and the individual model.
Basis: action depends on the picture individuals have of
themselves and how they feel about themselves.
Pub; 2011.
 The concept is of self empowerment.
 Model is based on actual experiences.
 The element missing from this model is that of
enviromental influences and controls over which an
individual can have no power.
38

Radical model
This model works to enable to cooperate and work in group
to solve the problems by critical social analysis.
The fundamental feature of this model are recognition of
power control and researching ways to change the balance.
Marya CM. A Textbook of Public Health Dentistry. 1st edition. New Delhi (India): Jaypee Brothers Medical Pub;
2011.
39

Health belief model and health action model
Becker and Maiman (1984) hypothesize that decisions to
undertake health actions rely on individual’s perception of
their susceptibility and the psychological costs of taking
certain action.
 Certain factors include:
 Knowledge
 Perceived susceptibility
 Potential severity of action
 Prevention works
 Acceptability and priority
40

Health education and Propaganda
To educate means to impart knowledge by formal
instruction to teach
Propaganda means the organised dissemination of
information.
Pub; 2011.
48

Aids in health education
Can be categorized into audio, visual and combination.
Audio aids: they are based on the principles of sound and
electricity.
 Tape recorders
 Microphones
 Megaphones
 Gramophones
 Amplifiers
 Radio
 Visual aids:
 Which require projection:
 Slides
 Films
 Bioscope
 Over head projectors
 Which don’t require projection:
 Models
 Blackboard
 Posters
 Charts
49

Combined Audio Visual Aids:
 Televisions
 Cinemas
 Slide tape combinations.
Pub; 2011. 50

Levels of health education
Individual level: maximum interpersonal link and there is a
scope for discussion, clarification of doubts.
Group level: Health educator chooses relevant issues to specific
groups about an issue and the decision taken will be abided by
the group.
51

Methods of health education
Individual approach:
 Personal contact
 Home visits
 Personal letters
Hiremath SS. Text book of Preventive and Community Dentistry. 2nd ed. Elsevier. New Delhi; 2011.
 Group approach:
 Lectures
 Demonstration
 Discussion methods:
• Group discussion
• Panel discussion
• Symposium, workshop, conferences, seminars, roleplay
52

Mass approach:
 Television
 Radio
 Newspaper
 Printed material
 Posters
 Health museum
 Folk methods & Internet
• Hiremath SS. Text book of Preventive and Community Dentistry. 2nd ed. Elsevier. New Delhi; 2011.
53

Health education at individual level
It is the most reliable method and has the long lasting effect.
Advantage: facilities two way communication and health
educator can persuade to change his/her behaviour.
 Disadvantage:
 Number of people receiving it is very less.
 Example: village health workers in India.
54

Health education at group level
55

Chalk and talk lecture
 A lecture may be defined as carefully prepared oral
presentation of facts, organized thoughts and ideas by a
qualified person.
 The chalk lends a visual component
 Effectiveness depends to large extent on the speaker’s ability
to write legibly and draw with chalk on a black board.
 Topic – based on health needs of the group
 Group should not be more than 30 and talk should not
exceed 15 to 20 minutes.
 Lecture can be made more effective by flipcharts,
flannelgraph, films and charts.
 Disadvantages:
 Students are involved to a minimum extent
 Learning is passive
 Do not stimulate problem solving capacity
56

Demonstration
A demonstration is a carefully prepared presentation to show
how to perform a skill or procedure.
A procedure is carried out step by step before an audience or
the target group.
 Demonstration
 Dramatizes by arousing interest
 Persuades the onlookers to adopt recommended practices
 Upholds the principles of “seeing is believing” and
“learning by doing”
 It has been found to have a high educational value in
programmes like Enviromental Sanitation, Mother and
Child Health and Control of Disease.
57

Group discussion
A GROUP is an “aggregation of people interacting in a face to
face situation”.
It provides a wider interaction among members than is possible
with other methods .
Where long term compliance is involved e.g. cessation of
smoking) group discussion is considered valuable.
 Group should comprise of not less than 6 and not more
than 12 members.
 Participants all seated in a circle, so that each is fully
visible to all others.
 Group should observe the following rules:
 Express ideas clearly and concisely
 Listen to what others say
 Accept criticism carefully
 Help to reach conclusion
 Limitations:
 There may be unequal participation of members in a
group discussion.
 Some members may deviate from the subject and make
the discussion irrelevant
58

Panel discussion
In a panel discussion, 4 to 8 persons who are qualified to talk
about the topic sit and discuss a given problem in front of a large
group or audience.
The panel comprises of: chairman, 4-8 speakers.
 The chairman:
 opens the meeting
 Introduces topic briefly as well as panel members
 Invites panel speakers
 If members of the panel are unacquainted with this method
they may have a preliminary meeting.
 It can be an extremely effective method of education
provided if it is planned properly.
59

Symposium
A Symposium is a series of speeches on selected subject.
There is no discussion among the Symposium members
like in a panel.
The chairman makes a comprehensive summary at the
end of the entire session.
Bhanot;2015.
60

Workshop
The work shop is the name given to a novel experiment in
education.
It consist of series of meeting, usually four or more with
emphasis on individual work, with in the group, with the help of
consultants and resource personnel.
Learning takes place in a friendly, happy and democratic
atmosphere under expert guidance.
The workshop provides each participant opportunities to
improve his effectiveness as a professional worker.
61

Role playing
Role playing or socio drama is based on the assumption that
many values in a situation cannot be expressed in words and
the communication can be more effective if the situation is
dramatised by the group.
Size of group is about 25.
 It is a useful technique to use in providing discussion of
problems of human relationship.
 It is a particularly useful educational device for school
children.
62

Conferences and seminars
The programmes are usually held on a regional, state or
national level.
They range from once half a day to one week in length.
They usually use a variety of formats to aid the learning
process.
Bhanot;2015.
63

Television
It is most popular media.
Advantages:
 Coverage of large number of people
 Many topics can be conveyed
 Can cater to all groups of people
 Disadvantages:
 The high costs of television sets.
 Accessibility by all people
 Through television, communication is one way
65

Radio
Before selecting particular topic on health education, the local
language has to be considered and chosen appropriately
through radios.
 Advantages:
 Cheaper media
 They are accessible to people of all socio economic status.
66

Newspaper/Press
They are easily accessible by the community and are
available in languages they can follow.
This method may not be useful in rural areas where in
large percentage of illiterate people are residing.
67

Printed materials
Magazines, booklets and hand outs have long been in use for
health communication.
They are aimed at those who can read.
They can convey detailed information.
Hiremath SS. Text book of Preventive and Community Dentistry. 2nd ed. Elsevier. New Delhi; 2011
 They can be produced in bulk for very little cost
68

Health museums and exhibitions
They can attract large number of people.
Health museums: The three dimensional models with lighted
visuals are quite effective.
 Health exhibitions: Exhibitions can be conducted during some
fairs and festivals.
Hiremath SS. Text book of Preventive and Community Dentistry. 2nd ed. Elsevier. New Delhi; 2011
 Advantages:
 People can come across new ideas in health matters which
they have not heard otherwise.
69

Communication
DEFINITION
Daniels and Spiker (1994) define communication as
shared meaning created among two or more people
through verbal and non verbal transaction.
Pub; 2011.
70

Key elements in communication:
 Communicator
 Audience
 Message
 Channels of communication
Marya CM. A Textbook of Public Health Dentistry. 1st edition. New Delhi (India): Jaypee Brothers Medical Pub; 2011. .
71

Communicator: He is the person who has to deliver the
health message.
Audience: They are the target groups who needs the
health message.
Pub; 2011.
 MESSAGE: it is information which the communicator
passes to the audience.
 Communication channels: it is the medium of
communication
72

Types of communication
One way communication (didactic method): e.g lecture method
in classrooms.
Two way communication (Socratic method): both
communicator and audience take part.
Verbal communication: the traditional way of communication
has been by word of mouth.
Park K. Park’s Textbook of Preventive And Social Medicine. 23rd ed. Jabalpur (India): M/s Banarsidas Bhanot;2015
73
 Visual communication: the visual forms comprise of:
charts, graphs, pictograms, tablets, maps, posters e.t.c.
 Telecommunication and internet: it is the process of
communication over distances using electromagnetic
instruments.

Barriers of communication
Physiological – difficulties in hearing, expression
Psychological – emotional disturbances, neurosis e.t.c
Park K. Park’s Textbook of Preventive And Social Medicine. 23rd ed. Jabalpur (India): M/s Banarsidas Bhanot;2015..74
 Enviromental: noise, invisibility, congestion
 Cultural: customs, beliefs, religion, attitudes, social class
differences.

Steps of health education planning
Identify the needs and priorities
Set aims and objectives
Decide the best way of achieving the aims
Identify resources
Plan evaluation methods
Set an action plan
Evaluation
Marya CM. A Textbook of Public Health Dentistry. 1st edition. New Delhi (India): Jaypee Brothers Medical Pub; 2011.75

Learning domains
Cognitive: understanding factual knowledge.
Affective: feelings, emotions and beliefs associated with
health.
Behavioral: skills development.
76

Steps of learning
Unawareness
Awareness
Self interest
Attitude
Belief
Commitment
Action
77

Public health significance
In study done by Wang H et al. (2017) demonstrated that the
School-Edu Salt intervention program for salt reduction is of low
cost and highly cost-effective. The nationwide implementation
program over 10 years is predicted to prevent at least 42,720
AMI deaths and 107,512 stroke deaths and achieve significant
medical cost savings.
Li X, Jan S, Yan LL, Hayes A, Chu Y, Wang H, et al. (2017) Cost and cost-effectiveness of a school-based education program to reduce
salt intake in children and their families in China. PLoS ONE 12(9): e0183033 78

 In an economic evaluation (Pukallus et al 2013)based on a
non-randomised study in a socially disadvantaged area in
Australia estimated that oral health advice delivered by an
oral health therapist over the telephone when the child was
aged 6, 12 and 18 months would save approximately £70,000
(2012 UK £) and prevent 43 caries per 100 infants over 6
years of follow up.
Lord J et al. Economic analysis of oral health promotion approaches for dental teams.
79

In study done by locker et al 1996, this study examined papers
relating to dental health education interventions, which were
published between 1982 and 1994 (n=143). This combination of
qualitative and quantitative review techniques showed that
dental health interventions have: a small positive, but temporary
effect on plaque accumulation (reduction in plaque index=0.37
95% CI ‐0.29–0.59);and a consistent positive effect on
knowledge levels.
Kay EJ, Locker D. Is dental health education effective? A systematic review of current evidence. Community Dent Oral
Epidemiol 1996;24:231-5
80

Indian scenario
Prevention and low-cost strategies for behavioural change as
suggested by national commission, “Step up funding for health
education and IEC to launch public health campaigns for
promoting environmental hygiene, family health, anti tobacco
and alcohol, etc.
Report of the National Commission on Macroeconomics and Health
81
 The Commission recommends that the IEC budget for the
NHPs’ be increased substantially by at least twenty times
from the abysmally low amount of less than 0.5% of the
total departmental budget

CONCLUSION
Health education is a complex activity in which different
individuals and organisations play a part.
No country in the world least of all a country with a large
population and small resources such as India can afford to
employ institutionally trained health workers.
83

Therefore, health education should be the concern of
everybody engaged in any form of community welfare
work.
84

REFRENCES
Marya CM. A Textbook of Public Health Dentistry. 1st
edition. New Delhi (India): Jaypee Brothers Medical Pub;
2011. p156-163.
Park K. Park’s Textbook of Preventive And Social Medicine.
23rd ed. Jabalpur (India): M/s Banarsidas Bhanot;2015.
p891-904.
85

Hiremath SS. Text book of Preventive and Community
Dentistry. 2nd ed. Elsevier. New Delhi; 2011. p67-77.
Hubley J. Principles of health education. Br Med J (Clin Res
Ed). 1984 Oct 20;289(6451):1054-6.
Li X, Jan S, Yan LL, Hayes A, Chu Y, Wang H, et al. (2017)
Cost and cost-effectiveness of a school-based education
program to reduce salt intake in children and their families in
China. PLoS ONE 12(9): e0183033
86

Ramya K, KVV Prasad, Niveditha H. Public oral primary
preventive measures: An Indian perspective JIOH Volume
3; Issue 5: October 2011: 7-12.
Report of the National Commission on Macroeconomics
and Health
Kay EJ, Locker D. Is dental health education effective? A
systematic review of current evidence. Community Dent
Oral Epidemiol 1996;24:231-5
87

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