Health Education Methods and Concepts

 HEALTH EDUCATION
 Aims
 Principles
 Methonds of health promotion
 Audio visual aids
 Role plays

 Barazars
 Schools
 Women and men groups
 Youth groups
 Steps in an organized community dialogue

 HEATH COMMUNICATION
 Health communication
 Health education and communication
 Behavior change communication
 Factors affecting behavior change
 Advocacy
 Networking

On the successful completion of this lesson,
students will be able to
• Define relevant terms and concepts in health
education and promotion
• Discuss the goal and the purpose of health
education

What is health?
 Traditionally health and illness were viewed as
two separate entities
 1946 W.H.O. (World Health Organization) “the
state of complete physical, mental, and social
well-being and not merely the absence of disease
or infirmity”
 health is a state of physical, mental, and social
functioning that realizes a person's potential.

What is disease?
 failure of a person's adaptive mechanisms to
counteract stimuli and stresses adequately
that results in functional or structural
disturbance.

what is illness?
 a social construct in which people are in an imbalanced,
unsustainable relationship with their environment and are
failing in the ability to survive and to create a higher
quality of life-- a state of being in a person containing
social, biomedical and psychological components.
what is wellness?
 state involving progression toward a higher level of
functioning, challenge of fuller potential and integration of
whole being
Definition of terms/concepts

PRIMARY prevention
 Precedes disease or dysfunction; health,
sex, or other education; use of specific
IMZ, protection from accidents.
 Nurses role: encourage individuals and
groups to become more aware of means
of improving health by teaching
appropriate behaviors.

SECONDARY prevention
 Early diagnosis and prompt treatment;
screening, disability limitations, adequate
tx to arrest disease process and prevent
further complications, applied w/ person or
population with existing disease.
 Nurse role: provide clinical skills and
educationally sound health info during the
process.

TERTIARY prevention
 Occurs when defect or disability is
permanent and irreversible; focuses on
rehab.
 Nurses role: ensure that people with
disabilities receive services that enable
them to live and work according to the
resources that are still available to them.

 Health education is the profession of
educating people about health.
 It can be defined as the principle by which
individuals and groups of people learn to
behave in a manner conducive to the
promotion, maintenance, or restoration of
health.
 However, as there are multiple definitions
of health, there are also multiple
definitions of health education.


Health education has been defined as
▫ any combination of planned learning experiences
based on sound theories that provide individuals,
groups, and communities the opportunity to
acquire information and the skills needed to make
quality health decisions.

The World Health Organization defined Health
Education
• comprises 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.

 It is a process that informs, motivates and
helps people to adopt and maintain healthy
practices and lifestyles, advocates
environmental changes as needed to
facilitate this goal and conducts professional
training and research to the same end.

 It is a process which brings about changes in
the knowledge and attitudes of the people
thereby affecting change in health practices.

1. To enable people to change their perceptions to
disease causation
2. To enable them to change attitudes towards the
various aspects of disease causation and
subsequently change their lifestyle towards the
aspect of the environment and lifestyle that can
cause disease

3.To change people’s knowledge and
understanding on disease prevention and
control
4. To help people to acquire skills that can help in
change of behaviour

Purpose of Health education
5. To encourage people to adopt and sustain
healthful life patterns to use judiciously and wisely
the health services available to them and to make
their own decisions, both individually and
collectively to improve their health status and
environment.

• The Purpose of H/E is to develop a nurse capable of
helping the individuals, families and community
achieve good health through their own action and
efforts.
• A well trained nurse will attain this through;-
• Talking and listening to the people as they tell their problems
• Think the possible cause the problems, cure and prevention.
• Finding reasons for such cause.
• Help people to give their own ideas for solving the stated
problem.
• Help peoples see the reason for their action
• Encourage the peoples to choose their ideas.

1. Interest – help people develop interest in their
own living conditions. Focus on felt needs
2. Active learning – encourage participation
3. Move from known to unkown
4. Communication – understand levels
understanding/literacy/cultural background
5. Reinforcement – repeat messages using
different methods and media
6. Help to motivate people to desire a change in
attitudes and behaviours

7. Doing – provide opportunities for people to
learn by doing.
8. Have prior knowledge of the people; customs,
habits, labours, health needs and then provide
facts to them thru attractive, palatable and
acceptable transmitting media
9. Maintain good human relations
10. Involve community leaders

• Communicate and advocate for health and HE
• Assess individual and community needs for HE
• Plan HE strategies, interventions and programs
• Implement HE strategies, intervention and
programs
• Administer HE strategies, intervention and
programs
• Conduct evaluation and research related to HE
• Serve as a HE resource person

• Health education is an educationally oriented
process of planned change which focuses on
those behaviours or problems that directly or
indirectly affect people’s health.
• The main areas of focus are:
1.In some cases, it may be focused on individuals
themselves in face-to-face or small-group
settings

2. In others, the focus may be on the structures
and procedures by which people organize
themselves into such social systems as teams,
organizations, coalitions, communities, or larger
system networks in order to achieve common
goals.
▫ procedures by which people organize themselves
into such social systems as teams, organizations,
coalitions, communities, or larger system
networks in order to achieve common goals

W.H.O (1954) stated the objectives of H/E as follows:
 To make health an asset valued by the individual,
family and community.
 Help individual, family and community become
competent in identifying their health problem and
assume responsibility in solving them.
 Help them find ways and take appropriate action to
prevent illness.
 Promote the development and proper use of available
health services.

 Health education is carried out in three levels:
 Individual
 Group/ family
 mass method/ community
 1. INDIVIDUAL METHOD
 a) Counseling
 b) Interview

 2. GROUP METHOD
 a) Group discussion
 b) Role play
 c) Brain storming
 d) Work shop/ seminar
 e) Demonstration
 f) Mini lecture
 g) Problem solving
 h) Panel discussion
 i) Field trip/ educational tour
 j) Symposium


 3. MASS METHOD
 a) Lecture
 b) Exhibition
INDIVIDUAL METHOD:
 There are plenty of opportunities for
individual health education. It may be
given in personal interview and
counseling in the consultation room of
the doctor or in the health services centre
or in the home of the people.

 Individual method involves person to
person or face to face communication
which provides maximum opportunities for
two ways communication of ideas,
knowledge and information.
a) Counseling: Counseling is the process of
helping a person with problems to discover
and develop his or her own capacity to solve
the problems Counseling is a means by
which one person helps another through
purposeful conve

 advantages Specific to the needs, issues and
circumstances of each individual client ,
collaborative and respectful process , Goal
centered and developing action plans ,
Developing autonomy and self-responsibility
in clients , Considerate of interpersonal
situation, socio cultural context, readiness to
change 

 Asking question, Feel listened to and
supported  Understand their situation
more clearly , Identify a range of options
for improving the situation , Makes
choices which fit their values, feelings and
needs , Make their own decisions and act
on them , Cope better with problems
Qualities of a good counselor, buids Self
confident/ self aware and self disciplined
 Caring, warm and genuine ,

 Demonstrates professionalism  Tolerates
values that differ from one’s own
 . Disadvantages: • Time consuming •
Difficult to cover wide range of target people
with limited manpower.

 b) Interview method: Interview is an
effective technique of investigation of
disease diagnosis as well as giving health
education as it is a method of finding
internal view on his/her health related
problems. The main purpose of interview
is:

 I. To gain information through face to face
association and to gain social and
psychological background.
 II. To perform hypothesis.
 III. To collect personal data for quantitative
purpose.

 Advantages:
 • Helpful to know individuals knowledge,
attitude and behavior.
 • Easy to conduct with less cost and
limited facilities.
 • Helpful to reach to a better conclusion
for the solution of the problem
 .• Easy to make follow-up studies on the
basis of interview to find out the impact
of teaching.
 • Even illiterate people can be taught by
this method.

 Disadvantages:
 • Time consuming
 • Difficult to cover wide range of target
people with limited manpower. Advantage
of Individual Method The advantage of
individual method of health education is
that we can discuss, argue and persuade
the individual

 to change his/her behavior. It also
provides the opportunity for asking
question, expressing fears and learning
more.
 Disadvantage of Individual Method The
disadvantage or limitation of the
individual method is that the numbers of
person who are given health education are
small and health education is given only
to those who come in contact.

2 GROUP METHOD:
 In a society there are many kinds of
group: school children, mothers,
industrial workers, patient etc. The choice
of subject in a group health teaching is
very important. For example, school
children may be taught about oral hygiene
and industrial workers about accident.
Different methods about group teaching
are:

 a) Group Discussion: A group is an
aggregation of people interacting in a face
to face situation. It is a two way
communication where people learn by
exchanging their views and experiences.
This method is useful when the group
have common interest and similar
problems. For an effective group
discussion, the group should comprise
not less than six and not more than
twelve members

 In a group discussion, there should be a
group leader who initiates the subject,
helps the discussion in proper manner,
prevents side conversation, encourages
everyone to participate and sums up the
discussion in the end. There should be a
person to record whatever is discussed
and agreement reached. In group
discussion, the members should observe
the following rules:

 I. Express ideas clearly and concisely
 II. Listen to what others say
 III. Do not interrupt when others are speaking
 IV. Make only relevant remarks
 V. Accept criticism gracefully
 VI. Helps to reach conclusions

 Advantages:
• Develops creativity, confidence and ability
of judgment in the members of learners.
• Helps learners to come to a group
decision and solve their common problem.
Group decision is better than individual
decision.
• Helps members to become active learners
and learn new knowledge, ideas and
experiences about their subject of concern
through a cooperation process.

• Provides adequate communication among
all the members with exchange of ideas and
experiences. Their potentialities can be
explored through discussion. Person-to
person influence in small group is the
stepping stone to change or develop
attitude.
• The health educator can make a closer
study of the members of target group
regarding their need, interest, attitude,
ability and other potentialities. He can
identify their real problems and help them
to solve them.

 Disadvantages:
 • Some self conscious members may not
venture to bring forth their valid idea for fear
of disapproval by other members.
 • Sometimes discussion may be prolonged
without any fruitful result, or it may take
longer time to come to the conclusion or
decision.
 • Somebody may not feel personally
responsible for the result of discussion. So,
they may not participate well.
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 b) Role Play:
 Role playing is a process of acting of any
imaginary person and conditions by own
knowledge, ideas and experiences. 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 in the
situation is dramatized by the group.
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 The size of the group is a useful technique to use
in providing discussion of problems of human
relationship. Role playing consists of the acting
but of real situation and problems. By acting out
of a real situation people can better understand
the cause of their problems and the result of
their own behavior
 Advantages:
 • Gives learners opportunity to express their
ideas based on real life situation and can learn
from each other.
 • Develop careful listening habit.
 • It is not expensive and can easily be conducted
at different situations.
 • Enables the learners to see things through the
eyes of others.
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 Disadvantages:
 • Not everybody can successfully act like
somebody else due to shyness, lack of
experience, lack of confidence and
expression skills.
 • Sometimes it may turn into a recreational
activity and may not achieve educational
objectives.
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 c) Brain Storming:
 This is a method to draw out the idea and
solution from participants on current
problems. The participants are encouraged to
make a list of all the ideas that come to their
mind regarding some problem in a short
period of time. Then, the list of ideas is
passed on to the chairman or secretary of the
group. Then the selected persons discuss
about the idea given by different participants
and try to get the best idea for the solution of
problems. Whatever may be the idea given by
participants, they are not criticized
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 Advantages:
 • Provides varieties of useful ideas in a short
time for quick group decision. • Enable
individuals to think and response quickly.
 • Decision made by group thinking is better than
by individual thinking.
 Disadvantages:
 • Ideas pulled out may not always be relevant
and helpful to make group decision. It may
happen especially with the new learners.
 • It might take some longer time and may not be
appropriate for packed program
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 READ AND MAKE NOTES ON FOLLOWING
METHODS: advantages disadvantages
 Work shop/ seminar
 Demonstration
 Mini lecture
 Problem solving
 Panel discussion
 Field trip/ educational tour
 Symposium
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 3. MASS METHOD:
 a) Lecture: Lecture is an oral presentation of
information and ideas by a person to a large
group of people or mass at a particular place.
So it is a popular method of health education.
Lecture is organized at a particular time
usually for the people who come together for
common purpose. Though it is face to face
presentation there is no adequate opportunity
for interpersonal reaction between the
speaker and audience.
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 Techniques of giving lecture effectively: • The
subject of the lecture should be related to the
needs and interest of the target audience. •
The speaker should get a thorough and up to
date knowledge of the content. • The
language should be correct, simple, clear and
understandable. • Avoid monotony in voice.
The speaker can raise his voice while
expressing important points. The lecturer
should try to know the feedback of the
audience by watching their gestures. • The
speaker should be sincere, pleasing and
properly dressed up.
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 HEALTH EDUCATION MEDIA
 Media are the teaching aids by which
knowledge, information and ideas are
communicated. They provide varieties of
learning experiences. They are used in
different situations of individuals, group and
mass teaching. Media are of different types.
They are audio aids, visual aids and audio-
visual aids
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 1. Audio aids: In this type, learning occurs by
hearing. The examples of audio aids are radio,
tape recorder or cassette player etc. Radio is
most widely used in mass teaching where
cassette player is used in individual and group
teaching. Audio aids are considered less effective
for providing health education(Radio, tape
recorder, microphones, amplifiers, earphones)
 2. Visual aids: Visual aids are the media through
which people learn by seeing. Poster, bulletin
board, flannel graph, slides, pamphlets, diagram
etc are the example of visual aids. Visual aids are
more effective than audio as we know that
learning by seeing is better than learning by
hearing.
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 A)Non projected: Chalk board, bulletin board, black
board, whit board, leaflets, posters, flip charts,
flannel graph, specimens, flash cards, newspapers,
magazine, photograph etc.
 b) Projected: Over head projector, slide projector, film
strips, projector etc.
a) Poster: A poster is a picture or drawing designed for
public display to convey message on certain subject. A
poster must contain the following four basic parts: •
Caption • Picture • Course of action suggested • Logo
(official symbol or name of the office for validity of the
poster) Sometimes, poster can be made even without
picture but they are not useful for illiterates. A good
poster should carry only one unit of message.
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 Colored poster is more natural, attractive and
clear to understand. Posters are usually
displayed on the side walls of busy streets,
community centre, waiting halls or places,
school complex and other public gathering
places. Advantages: • Pictorial and colored
posters are attractive and effective. • Posters
can be carried easily from one place to
another to distribute and display widely. •
Many people (both literate and illiterate) can
learn something from limited number of
posters on display. • Can be used to motivate
or to open discussion on health education. •
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 • Helps to develop creativity in the learners
by involving them in designing and making
posters. • Helps to communicate ideas
quickly. Disadvantages: • Poster provides
only one-way communication. It may create
misunderstanding and confusion. • Takes
time to print in large scale. • Coloured
posters are expensive to print. • Printing
services may not available in rural places and
small towns. • Can’t be sure if the intended
group have seen or read the display posters.
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 3. Audio-Visual aids: In this type of media,
learning occurs both by seeing and hearing.
Television, Video Tape, Movie film with sound
etc are the example of audio-visual aids.
These are more effective to give health
education than audio or visual media alone
because the process of hearing and seeing
takes place at a time. Classification of
different health education media:
 a) Non projected: Drama, puppet show, role
play etc
 b) Projected: Television, cinema (sound film),
documentary/videos etc.
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 A particular method or media may get failure
to achieve its educational objective simply
because of its inappropriateness and
impracticability in certain situationThe
appropriateness of particular method or
media should be determined on the light of
certain criteria. These criteria should be well
considered in choosing and applying a
particular method or media. The criteria are
described below
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 1. Feasibility or practicability: A method or media
should be feasible to apply from the point of
view of transportation, economic factor,
availability of necessary equipment and other
facilities.
 2. Nature of the audience: A method or media
should be chosen to suit the educational status,
culture etc of the target group. Teaching about
the importance of eating meat will mean nothing
to the vegetarian group who has taboo against
taking meat. In the same way distributing
pamphlets to illiterate people will not help to
provide information to them.
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 3. People’s attitude and belief on the method
or media: People have different kinds of
interest for different kinds of methods or
media. So, each method or media should be
chosen according to the interest and belief of
people on them. People take radio
broadcasting, television telecast, government
published pamphlets, etc as valid messages
and tend to ignore individual lectures
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 4. Accessibility: The method or media that a health
educator chooses must be able to reach to the people
concerned. In fact a health education program or
message should be accessible to each member of the
target group in the community
 5. Subject or purpose of teachings: The purpose of
teaching also affects in the selection of particular
method or media. The subject and purpose of the
teaching will be based on audience need. If it is for
conveying some health message or knowledge a
lecture can help but when there is a need of skill and
attitude development, demonstration method has to
be applied.
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 Def: A community dialogue session is a way
for members of the community to come
together and discuss important issues.
 Steps
 identify the issue to be adressed
 Find location
 Invite people to attend.
 Gather materials
 Set up the room.
 Host the community dialogue.
 Serve food.
 Prepare an agenda.

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• Concept was first introduced in USA 1979
• Has evolved to include the educational,
organizational, procedural, environmental,
social, and financial supports that help
individuals and groups reduce negative health
behaviors and promote positive change
among various population groups in a variety
of settings
66

• Health promotion programs are designed to
help people who are healthy, but engaging in
– risky behaviors (i.e., smoking, drinking, risky
sexual behaviors)
– or actions that increase their susceptibility to
negative health consequences (i.e., physical
inactivity, unhealthy diets)
• to change their behaviors
67

Health promotion
 Health promotion has been defined by the World
health Organization's 2005 Bangkok charter for
health promotion in a globalized world as
 "the process of enabling people to increase
control over their health and its determinants,
and thereby improve their health“
 It empowers people to exercise their rights and
responsibilities in shaping environments,
systems and policies that are conducive to their
health and well-being.

• Health promotion is therefore enlightened
health activism.
• It is carried out through acts of
interventions such as advocacy,
empowerment of people and building of
social support systems.

• The primary means of health promotion occur
through developing healthy public policy
that addresses the pre-requisities of
health such as income, housing, food
security, employment, and quality
working conditions.
• Sometimes Health promotion has been defined
by public health practitioners as health
education and social marketing focused
on changing behavioral risk factors

Role of health promoter
• Health promotion specialists, sometimes called
health education specialists, help people to
improve their health and increase their control
over it.
• They plan policies and strategies to promote
health, working in a specialist setting, on a
specific issue or with a particular population
group, and follow up with policy implementation
and evaluation.

• They are closely involved with:
▫ delivering the prevention and promotion
aspects of national service frameworks and
strategic plans for public health,
▫ and the development of community strategies,
▫ local strategic partnerships,
▫ and health improvement partnerships

• They work to ensure effective practice by:
▫ building capacity and
▫ enabling a range of agencies
▫ committed to tackling inequalities in health
▫ promoting anti-discriminatory practice.

 Health promotion specialists may work in
particular settings, such as workplaces,
communities, schools, or prisons, or with a
particular issue, such as drugs, healthy
eating, the dangers of smoking or
excessive alcohol consumption.
 They may also work with specific
populations such as young men, the
elderly, teenage mothers or people with
disabilities.

 The work is diverse and there is no
standard role, but typical activities
include:
 developing policies and strategies for
promoting health at local, regional or national
level;
 planning, developing, implementing,
monitoring, and evaluating projects to
promote health improvement;
 facilitating and supporting a wide range of
statutory, voluntary, charitable, and
commercial organizations in their delivery of
health promotion activities;

 developing the public health skills and
capacities of individuals, groups and
organisations and empowering them to
make healthy choices;
 leading, supporting, or cooperating in
multi-agency projects to promote a healthy
context or social environment;
 running training courses and workshops in
areas such as mental health, accident
prevention, cancers and heart disease;

 developing and supporting local
partnerships to broaden the local response
to health inequalities;
 identifying training needs arising from
strategic and local agendas and
developing and delivering appropriate
training for, e.g., health professionals and
volunteers;
 providing specialist advice and resources
to other agencies, such as schools and
local communities;

 ensuring that work is underpinned by
sound, up-to-date knowledge of health
promotion theory and making sure that
projects are based on evidence of
effectiveness;
 lobbying for increased recognition of
preventative and promotional measures
that can take place at a population level
and which have a positive impact on the
health of a community;
 writing and producing leaflets, posters,
videos and brochures to aid health
promotion in different environments.

Health promotion approaches
• Health Education/Educational approach
• Medical/preventive approach
 Nutritional Interventions
• Life Style And Behavioural Changes
• Social change/societal change
 Environmental Modifications
• Empowerment/client centred approach

Model and theories of health
promotion and education

 There are a number of significant theories
and models that underpin the practice of
health promotion.
 It would be useful to make a
differentiation between theories and
models

Theory definition
 An integrated set of propositions that
serves as an explanation for a
phenomenon
 Introduced after a phenomenon has
already revealed a systematic set of
uniformities
 A systematic arrangement of
fundamental principles that provide a
basis for explaining certain happenings
of life

Examples of theories
1. Theory of Reasoned action
2. Social Cognitive Theory,
3. Theory of Planned Behaviour (an
individual’s positive or negative evaluation
of self-performance of the particular
behavior. It is determined by the total set
of accessible behavioral beliefs linking the
behavior to various outcomes and other
attributes).

Model
 A sub-class of a theory. It provides a
plan for investigating and or
addressing a phenomenon
 Does not attempt to explain the
processes underlying learning, but only
to represent them
 Provides the vehicle for applying the
theories

Examples of models
 Health Belief Model (attempts to explain and
predict health behaviors. This is done by
focusing on the attitudes and beliefs of
individuals)
 Transtheoretical Model (assesses an
individual's readiness to act on a new
healthier behavior, and provides strategies, or
processes of change to guide the individual
through the stages of change to action and
maintenance).

 The main models and theories utilised
can be summarised as follows
 1. Those theories that attempt to explain
health behaviour and health behaviour
change by focusing on the individual.
Examples include:
 Health Belief Model
 Theory of Reasoned Action – cognitive theory
 Transtheoretical (stages of change ) Model
 Social Learning Theory

 2. Theories that explain change in
communities and community action for
health.
Examples include
 Community mobilisation
 social planning
 social action
 community development
 Diffusion of innovation
 theory of how, why, and at what rate new
ideas and technology spread through
cultures

 3. Models that explain changes in
organisations and the creation of health-
supportive organisational practices.
Examples include:
 Theories of organisational change

Summary of Theories: Focus and Key Concepts
Level of
application
Theory Focus Key concepts
Individual
Level
Stages of
Change
Model/devel
opmental
Individual's
readiness to
change or
attempt to
change
toward
healthy
behaviours
Precontemplation
Contemplation
Decision/determinati
on
Action
Maintenance

Individual
Level
Health
Belief
Model
Person's
perception of the
threat of a health
problem and the
appraisal of
recommended
behaviour(s) for
preventing or
managing the
problem
Perceived
susceptibility
Perceived severity
Perceived benefits
of action
Cues to action
Self-efficacy

Interpersonal
Level
Social
Learning
Theory
Behaviour is
explained via a 3-
way, dynamic
reciprocal theory in
which personal
factors,
environmental
influences and
behaviour
continually interact
Behaviour
capability
Reciprocal
determinism
Expectations
Self-efficacy
Observational
learning
Reinforcement

Community
Level
Community
Organisation
Theories
Emphasises
active
participation
and
development of
communities
that can better
evaluate and
solve health
and social
problems
Empowerment
Community
competence
Participation
and relevance
Issue selection
Critical
consciousness

Community
Level
Organisation
al Change
Theory
Concerns
processes and
strategies for
increasing the
chances that
healthy policies
and programmes
will be adopted
and maintained
in formal
organisations
Problem
definition
(awareness
stage)
Initiation of
action (adoption
stage)
Implementation
of change
Institutionalisati
on of change

Community
Level
Diffusion of
Innovations
Theory
Addresses how
new ideas,
products and
social
practices
spread within a
society or from
one society to
another
Relative
advantage
Compatibility
Complexity
Trialability
Observability

Health Belief Model
 The Health Belief was a psychological model
developed by Rosenstock in the 1966 for
studying and promoting the uptake of
services offered by social psychologists.
 Originally, the model was designed to predict
behavioral response to the treatment
received by acutely or chronically ill patients,
but in more recent years the model has been
used to predict more general health
behaviors.

Constructs
 The original Health Belief Model, constructed by
Rosenstock (1966), was based on four constructs
of the core beliefs of individuals based on their
perceptions:
 Perceived susceptibility
 Perceived severity
 Perceived barriers
 Perceived benefits
A variant of the model include the perceived costs of
adhering to prescribed intervention as one of the
core beliefs.

 Perceived susceptibility (an individual's
assessment of their risk of getting the
condition)
 Perceived severity (an individual's assessment
of the seriousness of the condition, and its
potential consequences)
 Perceived barriers (an individual's assessment
of the influences that facilitate or discourage
adoption of the promoted behavior)
 Perceived benefits (an individual's assessment
of the positive consequences of adopting the
behavior).

Constructs of mediating factors
Constructs of mediating factors were later added
to connect the various types of perceptions
with the predicted health behavior:
1. Demographic variables (such as age, gender,
ethnicity, occupation)
2. Socio-psychological variables (such as social
economic status, personality, coping
strategies)
3. Perceived efficacy (an individual's self-
assessment of ability to successfully adopt the
desired behavior)

4. Cues to action (external influences promoting the
desired behavior, may include information provided
or sought, reminders by powerful others,
persuasive communications, and personal
experiences)
5. Health motivation (whether an individual is driven to
stick to a given health goal)
6. Perceived control (a measure of level of self-
efficacy)
7. Perceived threat (whether the danger imposed by
not undertaking a certain health action
recommended is great)
The prediction of the model is the likelihood of the
individual concerned to undertake recommended
health action (such as preventive and curative
health actions).

Core Assumptions and Statements
• The HBM is based on the understanding that a
person will take a health-related action (i.e.,
use condoms) if that person:
1. feels that a negative health condition (i.e., HIV)
can be avoided,
2. has a positive expectation that by taking a
recommended action, he/she will avoid a
negative health condition (i.e., using condoms
will be effective at preventing HIV), and
3. believes that he/she can successfully take a
recommended health action (i.e., he/she can
use condoms comfortably and with
confidence).

Conceptualization of health belief model
Concept Definition Application
Perceived
Susceptibility
One's opinion
of chances of
getting a
condition
Define
population(s) at
risk, risk levels;
personalize risk
based on a
person's features
or behavior;
heighten
perceived
susceptibility if
too low.

Perceived
Severity
One's opinion of
how serious a
condition and its
consequences are
Specify
consequences of
the risk and the
condition

Perceived
Benefits
One's belief in
the efficacy of
the advised
action to
reduce risk or
seriousness of
impact
Define action to
take; how,
where, when;
clarify the
positive effects
to be expected.

Perceived
Barriers
One's opinion of
the tangible
and
psychological
costs of the
advised action
Identify and
reduce barriers
through
reassurance,
incentives,
assistance.

Cues to Action Strategies to
activate
"readiness"
Provide how-to
information,
promote
awareness,
reminders.

Self-Efficacy Confidence in
one's ability to
take action
Provide
training,
guidance in
performing
action.

INDIVIDUAL PERCEPTION MODIFYING FACTOR LIKELIHOOD OF
ACTION
Age, sex, ethnicity
Personality
Socio- economics
Knowledge
Perceived benefits
Versus
Barriers to behavioral change
Perceived threat
of disease
Likelihood of behavior
change
Perceived
susceptibility/
seriousness of
disease
Cues to action
•Education
•Symptoms
•Media information

 Favorite Methods
 Surveys.
 Scope and Application
 The Health Belief Model has been applied to a broad
range of health behaviors and subject populations.
 Three broad areas can be identified (Conner &
Norman, 1996):
 1) Preventive health behaviors, which include health-promoting
(e.g. diet, exercise) and health-risk (e.g. smoking) behaviors as
well as vaccination and contraceptive practices.
 2) Sick role behaviors, which refer to compliance with
recommended medical regimens, usually following professional
diagnosis of illness.
 3) Clinic use, which includes physician visits for a variety of
reasons.

Concept Condom use
Education
example
STI Screening or
HIV Testing
Perceived
susceptibility
Youth believe they can
get STIs or HIV or
create a pregnancy
Youth believe they may
have been exposed to
STIs or HIV.
Perceived Severity Youth believe that the
consequences of
getting STIs or HIV or
creating a pregnancy
are significant enough
to try to avoid.
Youth believe the
consequences of
having STIs or HIV
without knowledge or
treatment are
significant enough to
try to avoid.

Concept Condom use
Education
example
STI Screening or
HIV Testing
Perceived Benefits Youth believe that the
recommended action
of using condoms
would protect them
from getting STIs or
HIV or creating a
pregnancy.
Youth believe that the
recommended action
of getting tested for
STIs and HIV would
benefit them —
possibly by allowing
them to get early
treatment or
preventing them from
infecting others.

Concept Condom use
Education
example
STI Screening or
HIV Testing
Perceived Barriers Youth identify their personal
barriers to using condoms
(i.e., condoms limit the
feeling or they are too
embarrassed to talk to
their partner about it) and
explore ways to eliminate or
reduce these barriers (i.e.,
teach them to put lubricant
inside the condom to
increase sensation for the
male and have them
practice condom
communication skills to
decrease their
embarrassment level).
Youth identify their personal
barriers to getting tested
(i.e., getting to the clinic
or being seen at the clinic
by someone they know)
and explore ways to
eliminate or reduce these
barriers (i.e., brainstorm
transportation and disguise
options).

Concept Condom use
Education
example
STI Screening or
HIV Testing
Cues to Action Youth receive reminder
cues for action in the
form of incentives (such
as pencils with the
printed message "no
glove, no love") or
reminder messages
(such as messages in
the school newsletter)
Youth receive reminder
cues for action in the
form of incentives (such
as a key chain that says,
"Got sex? Get tested!")
or reminder messages
(such as posters that
say, "25% of sexually
active teens contract
an STI. Are you one of
them? Find out now")

Concept Condom use
Education
example
STI Screening or
HIV Testing
Self-Efficacy Youth confident
in using a
condom correctly
in all
circumstances
Youth receive
guidance (such as
information on
where to get
tested) or training
(such as practice
in making an
appointment)

Theory of Reasoned action -Definition
 Derived from the social psychology setting, the theory
of reasoned action (TRA) was proposed by Ajzen and
Fishbein (1975 & 1980).
 The components of TRA are three general constructs:
 behavioral intention (BI),
 attitude (A), and
 subjective norm (SN).
 TRA suggests that a person's behavioral intention
depends on the person's attitude about the behavior
and subjective norms (BI = A + SN).
 If a person intends to do a behavior then it is likely that
the person will do it.

 Furthermore a person's intentions are
themselves guided by two things:
 the person's attitude towards the behavior
and
 the subjective norm.

 Behavioral intention measures a person's relative
strength of intention to perform a behavior.
 Attitude consists of beliefs about the
consequences of performing the behavior
multiplied by his or her valuation of these
consequences.
 Subjective norm is seen as a combination of
perceived expectations from relevant individuals or
groups along with intentions to comply with these
expectations.
 In other words, "the person's perception that most people
who are important to him or her think he should or should
not perform the behavior in question" (Azjen and Fishbein,
1975).

 To put the definition into simple terms:
 a person's volitional (voluntary) behavior
is predicted by his/her attitude toward
that behavior and how he/she thinks
other people would view them if they
performed the behavior.
 A person’s attitude, combined with
subjective norms, forms his/her
behavioral intention.

 Miller (2005) defines each of the three
components of the theory as follows and uses
the example of embarking on a new exercise
program to illustrate the theory:
 Attitudes: the sum of beliefs about a particular
behavior weighted by evaluations of these
beliefs
 You might have the beliefs that exercise is good
for your health, that exercise makes you look
good, that exercise takes too much time, and that
exercise is uncomfortable.
 Each of these beliefs can be weighted (e.g.,
health issues might be more important to you
than issues of time and comfort).

 Subjective norms: looks at the influence of
people in one’s social environment on his/her
behavioral intentions; the beliefs of people,
weighted by the importance one attributes to
each of their opinions, will influence one’s
behavioral intention
 You might have some friends who are avid
exercisers and constantly encourage you to join
them. However, your spouse might prefer a more
sedentary lifestyle and scoff at those who work
out. The beliefs of these people, weighted by the
importance you attribute to each of their opinions,
will influence your behavioral intention to
exercise, which will lead to your behavior to
exercise or not exercise.

 Behavioral intention: a function of both
attitudes toward a behavior and
subjective norms toward that behavior,
which has been found to predict actual
behavior.
 Your attitudes about exercise combined with
the subjective norms about exercise, each
with their own weight, will lead you to your
intention to exercise (or not), which will then
lead to your actual behavior.

Schematic presentation of the theory of
reasoned change
 .
Attitude towards
Act or behavior
Subjective norm
Behavioural intention
Behaviour

Limitations of the theory
 1. Goals Versus Behaviors: distinction
between a goal intention (an ultimate
accomplishment such as losing 10 pounds) and
a behavioral intention (taking a diet pill)
 2. The Choice Among Alternatives: the
presence of choice may dramatically change
the nature of the intention formation process
and the role of intentions in the performance of
behavior
 3. Intentions Versus Estimates: there are
clearly times when what one intends to do and

 The model has some limitations including
 a significant risk of confounding between
attitudes and norms since attitudes can often be
reframed as norms and vice versa.
 A second limitation is the assumption that when
someone forms an intention to act, they will be
free to act without limitation.
 In practice, constraints such as limited ability,
time, environmental or organizational limits,
and unconscious habits will limit the freedom to
act.
 The theory of planned behavior (TPB) attempts
to resolve this limitation.

Definitions of health communication
• The process of promoting health by dissemin
ating messages through mass media, interpe
rsonal channels and events.
• Communication is a two-way process. It is
not simply a matter of transmitting
information and assuming it will be
understood and acted upon.
• Communication involves the sharing of
ideas, attitudes and feelings

• The process of communication involves;-
• Giving/Sending out messages
• Receiving
• Recording
• Giving feedback
• Sender Message Channel Receiver
feedback Source Idea Media Audience
Information

1. Source/sender
• Might be one person or many people.
• Characteristics:
i. Should be knowledgeable
ii. Positive personality
iii. Respectable
iv. Listener
v.Self confidence
vi. Willing to share knowledge
vii. Follow on what you say
viii.Use multiple channels
ix. Know audience
x. Anticipate objection .etc

2. Message
• Includes the information one wants to put
across to audience.
• Should be selected bearing in mind the
nature of the audience.
• Characteristics;-
i. Practical
ii. Clear
iii. Simple to understand
iv. Timely
v. Positive

3. Channel
• Includes the media one will use to pass
message.
• Message can be heard, seen, felt, or tested
depending on the channel used.
• People remember;-
• 10% of what they read
• 20% of what they hear
• 30% of what they see
• 40% of what they hear & see

• It is evidenced that one should use multiple
channels for effective communication.
• Characteristics
• Cheap
• Relevant
• Simple to use
• Built strong stimuli i.e attractive to audients

4. Receiver (audience)
• The final link in communication process.
• Characteristics
• Prepared for communication process.
• Have positive attitudes.
• Prepared to participate.
• Over come own barriers
• Open to change.
• Cooperative
• Give feedback

Causes of communication Breakdowns
• Channel used may only reach part of target
audience
• Message may be received but not understood
– dialect/language/technical terms/jargon
• Message received may be misinterpreted and
applied incorrectly
• New knowledge may conflict with existing
attitudes and beliefs

• Message may be received and understood
but not acted upon due to poverty
• There may be just temporary change related
to disappointment with the results
associated with the new knowledge

• Persuasive or behavioural communications (w
hich may employ social marketing strategies)
• Risk communication
• Media advocacy
• Entertainment education
• Interactive health communication
• Communication for social change

• Define clearly what health behavior you are
trying to promote
• Decide exactly who in the population you are
trying to influence
• Ask whether the new health behavior
requires new skills
• Learn about the present health knowledge,
beliefs and behavior of the target audience
•

• Enquire whether the behavior you are trying
to promote has already been introduced in
the community
• Investigate the target audience’s present
sources of information about health
• Select the communication channels and
media that are most capable of reaching and
influencing the target audience

• Design health messages that are:
• Easily undestandable
• Culturally and socially appropriate
• Brief
• Relevant
• Technically correct
• Positive
• Develop and test your educational materials
• Synchronize your educational programme
with other health and development services

• Evaluate whether the intended new behavior
is being carried out
• Repeat and adjust the message at intervals
over several years. The message may be
adjusted as people’s health knowledge
behavior change over time

 IN YOUR GROUPS DISCUSS AND MAKE NOTES
ON THE FOLLOWING
 Behavior change communication
 Factors affecting behavior change
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 •Advocacy is the act or process of supporting
a cause or issue.
 •An advocacy campaign is a set of targeted
actions in support of a cause or issue. We
advocate a cause or issue because we want
to:
• build support for that cause or issue;
• influence others to support it; or
• try to influence or change legislation that
affects it
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•Advocacy is speaking up, drawing a
community’s attention to an important issue,
and directing decision-makers toward a
solution.
•Advocacy is working with other people and
organizations to make a difference.
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 Advocacy is an action directed at changing
the policies,
 positions or programs of any type of
institution.
 • Advocacy is putting a problem on the
agenda,
 providing a solution to that problem and
building
 support for acting on both the problem and
solution.
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 • Advocacy can aim to change an
organization internally
 or to alter an entire system.
 •Advocacy can involve many specific, short-
term
 activities to reach a long-term vision of
change.
 • Advocacy consists of different strategies
aimed at
 influencing decision-making at the
organizational,
 local, provincial, national and international
levels
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 •Advocacy strategies can include
lobbying, social marketing, information, education
and communication (IEC), community organizing,
or many other tactics.
 •Advocacy is the process of people
 participating in decision-making processes
 which affect their lives.
 •Advocacy is a continuous process which leads
to positive change in attitudes, behavior, and
relationships within the family, workplace,
and community, and state and society, i.e. all
 social institutions
6/23/2023
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 Benefits of advocacy
•Challenging the structural causes of ill-
health; moving away from addressing the
symptoms.
•More sustainable approach to achieving
organization's mission.
•Greater continuing impact on the living
conditions of beneficiaries.
•Increased awareness of the issues.
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•Better informed and enabled supporters.
•Involvement in civil society, acting on ethics by
encouraging action.
•Opening up new sources of funding.
•Increased profile of organization.
•Improved links with other organizations through
networks and coalitions.
•Wider relations and improved dialogue with
decision making bodies.
•Better understanding of our organization and its
role in wider policy debates.
6/23/2023
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Risks of advocacy
•Diversion of scarce resources.
•Over extended capacity.
•Loss of organizational focus.
•Duplication of effort amongst agencies.
•Alienation of existing support by becoming overtly
political.
•Creation of an internal elite of advocates.
•Distortion of message because of
oversimplification.
•Conflict of interest with partners.
•Reduction in partner security.
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•Damage to reputation.
•Loss of external and internal legitimacy if
program work is
displaced by advocacy.
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Types of advocacy
 1.Policy advocacy
 2.Public advocacy
 3.Media advocacy
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1. Policy advocacy
• Policy advocacy initiatives focus exclusively
on the policy agenda and a specific policy goal
by directly influencing policymakers. This type
of advocacy usually assumes that policy
change will produce real change on the
ground.
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2. Public advocacy
• Public advocacy utilizes the strength of
numbers of citizens affected by a policy issue
by relying on their organized efforts to bring to
the attention of policymakers the necessity of
policy change.
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3. Media advocacy
• Media advocacy is utilizing the various media
forms to obtain visibility to a policy issue in order
to inform the public of its content, gain allies, and
influence opinion leaders and policymakers.
•The crucial element in media advocacy is to tap
media practitioners who are already sympathetic
to the cause and to educate and inform those who
are still new to the issue for them to provide more
coverage and space to it in the news, opinion and
 feature stories.
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Advocacy process
1.Issue identification
2.Stakeholder analysis
3.Scanning the environment
4.Analysis of problems, objectives and
strategies
5.Interrelated steps to determine cause-effect,
6.Message development and identifying
channels of communication
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 7. Advocacy action planning
 8. Advocacy implementation
 9. Data collection and analysis
6/23/2023
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 1.Establish sufficient awareness of the policy issue
or issues being considered.
 2.Define the sector to which the issue belongs
 3.Define the geographical focus.
 4.Rank issues that can be solved by advocacy by
asking the following questions:
 5.Identify issues that have not been ranked highest
that can be incorporated as part of the selected
issue.
 6.Relate the organizational situation, priorities, and
 resources that can help in singling out an issue.
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 A network as used consists of organizations,
groups and/or individuals who are willing to
assist each other and collaborate in the
advocacy of a policy issue.
 •It is often temporary and is disbanded after
the success or failure of the advocacy
initiative.
•The lowest form of a network is that which is
banded together in a communication
relationship.
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 1.Equity
 2.Transparency
 3.Mutual Benefit
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 Equity means an equal right to in terms of
interests, power, influence and resources and
decide and be recognized for the
contributions that an organization imparts to
the network or partnership that are not just
measured by the amount of cash or role in
the advocacy initiative.
 •Equity is not the same as equality.
 •Treat people in a way that is appropriate to
their needs
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 Transparency
 • Transparency includes honesty and
openness as its most important ingredients
and are vital to the success of any network or
partnership.
 • These are the necessary pre-conditions in
building trust and confidence among its
members.
 •With transparency, responsibility and
accountability to its members, as well as to
the final beneficiaries, target groups and
other stakeholders.
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Mutual Benefit
 • Why do organizations come together in the first
place? It is to optimize in a network or partnership
what it could not do if acting alone.
 •Therefore, what an organization brings and
contributes to the network or partnership it most
certainly expects to have an entitlement to its
benefits.
 •Aside from realizing success for the common
goals that will be beneficial to all members of the
network or partnership it must also create the
condition to bring specific benefits to everyone of
its members.
 •In this way, continuing commitment is developed
among the members and makes the network or
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 Advantages and Disadvantages of Working
Through Networks and Partnerships
 •Enlarges your base of support . You can win
together what you cannot win alone.
 •Provides safety for advocacy efforts and
protection for members who may not be able to
take action alone.
 •Magnifies existing resources by pooling them
together and by delegating work to others in
coalition
 •Increases financial and programmatic resources
for an advocacy campaign.
 •Enhances the credibility and influence of an
advocacy campaign as well as that of individual
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 •Helps develop new leadership
 •Assists in individual and organizational
networking.
 •Broadens the scope of work.
 Disadvantages
 •Distracts you from other work. Can take too
much time away from regular organizational
tasks
 •May require you to compromise your
position on issues or tactics
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 •May require you to give in to more powerful
organizations. Power is not always distributed
equally among coalition members. Larger and
wider organization can have more say in
decision making.
 You may not always get credit for your work
sometimes the coalition as a whole gets
recognition rather than individual members.
Well run coalitions should strive to highlight
their members as often as possible.
 •If the coalition process breaks down it can
harm everyone’s advocacy by damaging
members credibility.

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Sources of obstacles to networking
 1.The general public
 2.Actual or perceived negative sectoral
characteristics
 3.Personal limitations of individuals leading
the network or partnership
 4.Organizational limitations of partner
organizations
 5.Wider external constraints
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