Introduction to Health Education and Promotion

Introduction to
Health Education
and Promotion
BY; Hordofa Gutema (BSc, MPH/HEHP)

Learning objectives
At the end of this chapter the students are expected to:
 Differentiate among health information, health education and health
promotion.
 Discuss the rationale of health education
 Explain the ultimate goals and educational objectives of health education.
 List principles of health education.
 Describe levels of health education in diseases prevention.
 Explain the role of health education in Primary Health Care

Definition and concepts of health
– Health:-
– It is a broad concept and its definition also differs among
social classes, cultures, religion and ethnic groups.
– Generally, there are two opposing models concerning
the definition of health:
1. Negative Model
2. Positive Model

Definition …
I. Negative model
– This model views health as:
– Absence of diseases or disability or infirmity
– Biological integrity of the individual
– Physical and physiological capabilities to perform routine tasks.
– According to this definition an individual is healthy if all the
body parts; cells, tissues, organs, organ systems are functioning
well.
Disease “A” + Medical treatment = health

The positive model
– It is broader and more holistic concept.
– Widely known of such models is that of the
constitution of WHO(1948), which defines health as:
– “A state of complete physical, mental, and social well-
being not merely the absence of disease or infirmity.”
– To more fully understand the meaning of health,
– it is important to understand each components of health

Definition …
1. Physical Health
– It is the absence of diseases or disability on the body parts (negative definition).
2. Mental health
– Termed as psychological health and it is subjective sense of well being. It has two
components:
A) Cognitive component
– It is the ability of an individual to learn, perceive and, think clearly.
E.g. A person is said to be mentally retarded if he/she cannot learn something new at a pace in which an ordinary person
learns.
B) Emotional component
– Is the ability of expressing emotions like fear, happiness, and to be angry in an “appropriate” way.

Definition…
3. Social health
– Is the ability to make and maintain “acceptable” and “proper” interaction
and communication with other people and the social environment; satisfying
interpersonal relationship and role fulfillment
Mahler extends the WHO definition 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.
Spiritual health
 It is a relation of health with religion or cultural values and beliefs and is a
way of achieving mental satisfaction in stressful or in other ill- health
conditions.

– Generally, the different aspects of health are interrelated and interdependent.
– Physical and mental aspects are interrelated through:
A) Physiological pathway
– e.g. Anxiety and depression cause change in endocrine and immune functioning, and create physical
illness.
- Stress is related to causing common cold & delaying wound healing (Cohen et.al 1991)
B) Behavioral pathway.
– e.g. depression and substance dependence, are more likely to engage in high-risk
sexual behavior.
- Social aspect can be affected by physical and mental aspect and vice-versa

CONCEPTS OF HEALTH EDUCATION AND HEALTH
PROMOTION

Health Education Definition
7/13/2022
Bahirdar univerisity, Bahirdar
HE has different definitions. However, almost all of them
mentions that it is the process of behavior change towards
healthy life
1. It is bringing about behavioral changes in individuals, groups,
and larger populations from behaviors that are presumed to be
detrimental to health, to behaviors that are conducive to present
and future health.”
2. It is a process that Informs, Motivates, and Helps people
to adapt and maintain healthy practices and life styles;

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HE definition …
3. HE is “Any combination of learning experiences designed to facilitate voluntary action conducive
to health”
Elaboration of the definition:
 Combination: the importance of matching multiple determinants of behaviors with multiple learning
experiences or educational intervention
 Designed: health education is not incidental learning experiences.
 It is a systematically planned and organized activity
 Facilitate: creating favorable condition such as predispose, enable, reinforce
 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,
 We 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.

Health Education Definition
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– Through health education we help people to
understand their behavior and how it affects their
health and encourages people to make their own
choices for a healthy life
– A person’s behavior may be the main cause of a
health problem, but it can also be the main solution

Historical Development of HE
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– As a practice, it is as old as human being
– As a profession in the world ~>100 years – USA
– Health belief model 1950s: the oldest model
– As a course: Gondar Health science ~ 1954
– As a profession in Ethiopia: JU ~ >10 yrs

Evolution of HE/HP
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There have been three revolutions in public health:-
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
The Second Public Health Revolution
– Fight against non-communicable diseases over which people had some personal
control, when social conditions and context were favorable (obesity/healthy diet,
sedentary lifestyles/exercise, addictions, abuse, mental health, risky behaviors)

Evolution of HE/HP…
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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”,
– There fore, health promotion focuses on wellbeing and
quality of life, for which it is necessary to empower
communities for action

HEALTH PROMOTION
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Health promotion defined as:
A combination of educational and environmental supports for
actions and condition of living conducive to health.” (GREEN AND KRUETR ,1991)
Educational: refers to the communication part of health promotion.
That is HE
Environmental: refers to the social, political, and economic,
organizational, policy and regulatory circumstances influence
behavior or more directly health.
 It is also defined as “the process of enabling people to increase
control over, and to improve their health.

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17
Health Promotion Vs Health Education
Organization
Social
Policy
Regulatory
Economical
Political
Health Education
Health promotion
Health Promotion
Environmental
Environmental

Examples of health promotion intervention to prevent
diseases and to promote health of the community
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Health
problem
Educational intervention Environmental /ecological/political
action
Tobacco
Educating the public focusing on Health
problems related with smoking such as:-
• lung cancer through different media.
• Educating the public not to start
smoking and to persuade smokers to
stop
Establishment of stop smoking clinics.
Control of tobacco advertising
Increase taxes on price of cigarettes
Bans on smoking in public areas.
HIV/AIDS
Educating general public and specific
groups such as drivers ,sex workers,
youth, on safe sexual behaviors
Making counseling service available
Social marketing of condoms
Increasing VCT services
Setting up peer education program
Enforcing of legal protection of sex workers
and injecting users

Health Education and its Relationships with
Public Health and Health Promotion
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– Health Education is one of the strategies of Health Promotion;
whereas,
– Health Promotion is one of the central Public Health
Disciplines.
– Public Health is the science & art of preventing disease,
prolonging life & promoting health through the organized efforts
of society,
– Health Promotion is specifically concerned with the socio-
behavioral processes for improving personal health behaviors and
factors influencing those behaviors

.
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HEALTH INFORMATION [HI]
It is health message disseminated to the target audience
focusing on the basic facts related to the health issue
under consideration.
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 Multiple
determinants of behavior are necessarily required
Baseline information or data are not necessarily required
2 The assumption is people are not rational all the times,
but rationalize all the times.
The assumption is people are rational and make 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 Known to the
people for long period of time)
Appropriate for newly emerging health problems and during
epidemics
4 Required at all stages in behaviors change Continuum (it
is continues, even to prevent defaulter after adoption)
One time telling facts provided that the information reaches at all
the intended Audiences and understanding takes place
5 Encourage people to make their own choices for healthy
life
Merely telling people to follow healthy behaviors
6 Focus on the reason behind behaviors Blind to the reason behind behaviors
7 People are not blamed for unhealthy behaviors People blamed for un healthy behaviors
8 Use a variety of methods or educational Strategy as
appropriate.
May not use a variety of methods.
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HEALTH INFORMATION…
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Generally, HI is the scientific facts (e.g. the causes, mode of transmission,
prevention methods of particular diseases) 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, attitude ,reinforcing factors etc.
 HI is not necessarily HE. But correct HI is certainly a basic part of HE and
hence, in turn, health promotion. HE is beyond HI

Health Education in PHC
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Primary Health Care (PHC):- Is essential health care
based on practical, scientifically sound, and socially
acceptable methods and technology made accessible to
the community.
- It is a means of achieving health for all and very much
concerned with health promotion and education.

Components/Elements of PHC
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1.Health Education
2.Promotion of food supply and proper nutrition
3.Adequate supply of safe water and basic sanitation
4.Maternal and child health care, including family planning
5.Immunization
6.Communicable Diseases Control
7.Prevention and control of locally endemic diseases;
8.Appropriate treatment of common diseases and injuries and
9.Provision of essential drugs

Components/Elements of PHC
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Elements added after Alma Ata declaration
11.Oral health
12.Mental health promotion
13.Use of traditional medicine
14.Occupational health
15.Prevention of HIV/AIDS
16.ARI

Main Principles of PHC
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1. Equity: Services should be physically, socially, and
financially accessible to everyone

Main Principles of PHC…
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2.Community Participation:
 Creating and preserving a healthy environment,
 Maintaining preventive and Promotive health activities,
 Sharing information about their needs and wants with higher
authorities,
 Implementing health care priorities and managing clinics and
hospitals,
3.Inter-Sectoral Approach
4.Appropriate Methods and Technology

Main Principles of PHC…
5.Health Promotion and Prevention - PHC requires a comprehensive approach
that is based on :
– Promotive - addresses basic causes of ill-health at the level of society
– Preventive - reduces the incidence of disease by addressing the immediate
and underlying causes at the individual level
– Curative - reduces the prevalence of disease by stopping the progression of
disease among the sick
– Rehabilitative - reduces the long-term effects or complications of a health
problem.

Rationale for health education
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“We must recognize that most of the world’s major Health problems
and premature death are preventable through changes in human
behaviors at low cost. We have the know – how and technology but
they have to be transformed into effective action at the community
level” Dr. Hiroshi Nakajiima, Director – General, WHO, 1998.

7/13/2022
1. The continued existence and spread of communicable diseases
such as malaria, TB, HIV/AIDS that need the involvement of the
community members and environmental interventions.
2. Majority of childhood illnesses are preventable
e.g. measles by immunization, malnutrition and diarrhea by teaching mothers
about good weaning foods and promoting breast feeding up until age of two.

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3. For some diseases health education is the only practical choice in order
to prevent the spread of the disease or to lead a normal life.
– E.g. HIV/AIDS.
4. The tendency of increasing magnitude of chronic conditions and other
emerging agendas, which required the cooperation of individuals to lead
with the problem. E.g. Hypertension.
5. There is a shift in the major causes of death from infectious
(communicable) and treatable diseases to degenerative /non-communicable
diseases. Human behaviors are almost the single causes and also the main

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6. Many people are ignorant of the causes of their illnesses and may
be afraid of seeking treatment and hide their illness not to be
considered, as an “outcast” from society and many others do not
seek treatment until it is too late.
7. Increasing threats to the young from new and harmful behaviors.
Eg. tobacco use, teen-age pregnancy, substance use, etc.
8. Increased awareness of people on chronic health problems and the
need to know preventive actions.

List of Risk Factors Responsible for the Top Causes
of Death and Disabilities
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Major behavioral factors that contribute to
mortality and morbidity in Ethiopia
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– Poor personal hygiene,
– Poor environmental hygiene/sanitation,
– Imbalanced or inappropriate food intake besides food shortage,
– Contamination of safe water supply sources besides its shortage,
– Unsafe sexual behavior,
– Low health services/health care seeking behavior, and
– Low attention to health information

The ultimate goal and educational objectives of HE
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A] The ultimate goals of health education
– To help each individual and family exercise the right to
achieve a pleasant development of the physical, mental
and social potential.
– To promote health, prevent illness, self-adjust to live with
disabilities and decrease morbidity and mortality

Educational objectives of health education
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 To promote proper use of available health services
 To encourage people to adapt healthy lifestyles and practice
 To help develop positive attitude:
 has a lot to do with changing opinions, feelings and beliefs of people.
 To help exercise health practice/behavior: concerned with helping people in decision-making and
actually performing.
 To arouse interest, provide new knowledge, improve skills and change attitudes in making
rational decisions to solve their own health problems

Dimensions/scope of health Education
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– HE is life long process. It is not one time affair. The concern of caring about a
child begins while the fetus is in the mother’s WOMB
ANC delivery care PNC immunization Death.
 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 .
 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
 It is not limited to patients in clinical setups –
 It also includes apparently healthy and who want to minimize the risk of
having a problem.

Basic principles of health education
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1. Principle of educational diagnosis:
The first task in changing behaviors is to determine its causes.
If the causes of the behaviors understood health educator can
intervene with the most appropriate and efficient combination
of education, reinforcement and motivation method

Principles of health education…
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2. Principle of Participation:-
The prospect for success in any attempt to change behaviors will be
greater if the individuals, families, community groups,
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:
 In so far as multiple causes will invariably be found for any given
behaviors.
 For each of the multiple factors identified, a different methods or components of comprehensive
behavioral change must be provided

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4. Principle of planning and organizing:
– Planning and organizing are fundamentals for HE
It involves deciding in advance the 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.

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5. Facts:
HE is given based on scientific findings/facts and current
knowledge.
 It is unthinkable to provide health education without scientific and knowledge related
to the topic or issues to be addressed.
– eg. Health educator must know the current scientific knowledge how HIV/ADS transmitted
and prevention methods.
6.Segmentation: HE should be designed for a specific group
of people/ specific target groups.

7. Need based:
Health education is to ensure a desired health related behavior after
real need identification.
There are three types of needs
Felt need: what the people feel, their wants, their real needs.
Expressed needs: It is need brought to attention of the authorities
by request, petition or complaints etc.
Agency determined needs: is what external services such as health
workers and planners have decided the community needs.

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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.
 contrary to existing belief, culture, practices will not be liked.
9. Principle of motivation:
 Motivation is mental direction /desire for doing or rejecting something.
 It is something that happens within the person, not something done to a
person by others

7/13/2022 Bahirdar univerisity, Bahirdar
10. Principle of reinforcement
Those individuals who started to undertake health behaviors should
verbally encouraged or received positive feedback (positive
reinforcement ) until the started health behaviors will develop its full
potential and
 on the other hand, unhealthy behaviors should be discouraged until it disappear(negative
reinforcement )
11.Principle of feedback
It is a mechanism of assessing what has been happened in
the target Population after receiving the message..

The levels of health education in disease
prevention & control
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1. Primary health education
Is comprised of those preventive measures that expect the onset of
illness or injury during the prepathogenesis period (before the
disease process begins),
HE program that aimed specifically at preventing the onset of illness
or injury among health individuals is called primary health
education
Examples
 Wearing safety belt, Immunization, Physical exercises and Breast
feeding

The levels of health education…
7/13/2022
2. Secondary health education
It is any health education/promotion programs that aimed at
promoting early diagnosis and prompt treatment of a disease to
cure or to limit disability and prevent more serious pathogenesis.
Example
Breast-cancer screening
 Blood pressure examination
 Cholesterol level examination
 treating malaria patients

The levels of health education…
7/13/2022
3. Tertiary health education
 Health education programs that specifically aimed at patients with
irreversible, incurable, and chronic condition for social and psychological
adjustment is called tertiary health education
 It is at this level the health educator work to retain, reeducate, and
rehabilitate the individual who has already incurred disability, impairment,
or dependency.
Example
 Educating after lung cancer surgery
 Working with the diabetes individual to ensure the daily Injections are
taking

levels of health education in disease prevention
and limitation of disease
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Healthy person early signs disease disability/death
Primary
prevention
Secondary
prevention
Tertiary
prevention

Targets of health education
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Depending on the type of the problem there are three targets of health education programs.
 Individuals: this includes clients of services (contraceptive or VCT users), patients and
healthy individuals.
E.g. diabetic or hypertensive patients.
 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
 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
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 Communities, Health care institutions, Work sites, Schools, Prisons, Refugee
settings, Clubs etc.
Who is responsible of health education
 HE is the duty of everyone engaged in health and community development
activities.
 All health professionals
 Community health workers
 Other trained members, leaders, teachers, musicians

Challenges of health education
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1.For many people it is easier to sell symptomatic relief of illness or cure
than to sell health and prevention of disease.
2.Changing health behavior is conditioned by factors such as social,
psychological, economical, cultural, accessibility and quality of
services, political environment, etc. which are difficult to deal with
simultaneously.
3.People are preoccupied with many daily activities to support their life
which impedes them to give their ear the messages of health
education.

Challenges of health education …
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4.Health education does not have high prestige.
5.Charged with health education programs lack special training and are
not qualified.
6.Health education is much more than “transfer of information.” With
out changes in attitudes and actions it remains a useless exercise.

The role of health educator
7/13/2022 Bahirdar univerisity, Bahirdar
 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

References
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 John Hubley 1993. Communicating health. An action guide to health
education and health promotion.
 Lawrence W. Green et al. 1980. Health education planning a diagnostic approach
 Getnet Mitike 2003 health education for health science students. Lecture note
series. Addis Ababa University, Ethiopia.
 Randall R. Cottrell, James T. Girvan, James F. McKenzie 2006. Principles&
foundations of health promotion and education. Third ed. USA.

7/13/2022

Introduction to Health Education and Promotion

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