health education

1. Introduction to Health Education
Zelalem D. (Asst. Professor)
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2. Definition and concepts of health…
I. Negative (narrow) model
II. Positive (broad) model
I. Negative (narrow) 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.
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3. Definition and concepts of health…
II.Positive (broad) model
The positive model- sees health as a broader and more holistic
concept.
 Probably the most widely known of such models is that of
the constitution of World Health Organization (1948), which
defines health, as:
“A state of complete physical, mental, and social well-being
not merely the absence of disease or infirmity.”
This classic definition is important, as it identifies the vital
components of health.
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4. HEALTH EDUCATION
• Health education is a part of health care that is concerned
with promoting healthy behaviors.
• A person’s behavior may be the main causes of health
problems, but it can also be the main solution.
• It is through health education we help people to
understand their behaviors and how it affect their health
and encourage them to make their own choices for
healthy life, but we do not force them to change.
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5. HEALTH EDUCATION…
Therefore, in health education we encourag behaviors that:
Promote health as a part of promotive health care
Promote behaviors that prevent illness or diseases as a
part of preventive health care
Promote behaviors that facilitate cure diseases as
apart of curative health care, and
Promote behaviors that facilitate rehabilitation as
apart of rehabilitation health care.
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6. HEALTH EDUCATION…
From this what HE really means?
Health Education “Any combination of learning
experiences designed to facilitate voluntary action
conducive to health”
Elaboration of the definition:-
Combination: it emphasizes on the importance of
matching multiple determinants of behaviors with
multiple learning experiences or educational intervention
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7. HEALTH EDUCATION…
Designed: distinguishes health education from incidental
learning experiences as a systematically planned and
organized activity.
Facilitate: creating favorable condition such as
predispose, enable, reinforce.
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8. HEALTH EDUCATION…
Voluntary: with full understanding and acceptance of the purpose of
the action.
 Without use of coercion or any manipulative approaches.
 In health education we do not force the people to do what we
want them to do, instead our effort is to help people to make
decisions and choices by themselves.
Action: behavioral steps/measures taken by individuals, groups or
community to achieve the desired health effect.
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9. HEALTH PROMOTION
To reach a state of complete physical, mental and social
well being it is beyond the activity of health education
and even health sectors.
In other words health is not just the responsibility of
health sector alone. But the responsibility of every
sectors working for development.
Thus, the concern for health outside to the health care
sector is the call for health promotion
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10. HEALTH PROMOTION…
GREEN AND KRUETR (1991) Defined health promotion
as:
“A combination of educational and environmental
supports for actions and condition of living conducive to
health.”
Elaboration of the definition:
Combination: refers to the necessity of matching multiple
determinants of health with multiple intervention or
sources of supports.
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11. HEALTH PROMOTION…
Educational: refers to the communication part of health
promotion. That is health education.
Environmental: refers to the social, political, and
economic, organizational, policy and regulatory
circumstances influence behavior or more directly health
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12. HEALTH PROMOTION…
Elements/component of health promotion
A. Health education and
B. Environment
Political environment
Social environment
Economic environment
Organizational environment
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13. APPROACHES IN HEALTH PROMOTION
Health promotion employs two approaches
These are;
A. Educational approach (health education):- which
attempt to influence predisposing factors through direct
communication, reinforcing factors through indirect
communication in social environments to create norms
and values that support life style conducive to health and
enabling factor through trainings and organization.
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14. APPROACHES HEALTH PROMOTION…
B. The ecological /environmental approach (political
action)
It employs policy, organization, and regulation to
influence the enabling and reinforcing factors for
environmental and life style changes supportive of health.
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15. HEALTH INFORMATION
It is health facts disseminated to the target audience
focusing on the basic facts related to the health issue
under consideration.
 In dissemination of health information, base line
information or data (currently existing level of
multiple determinants of behaviors) is not necessarily
required
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16. HEALTH INFORMATION…
Generally, Health information is the scientific facts (e.g.
the causes, mode of transmission, sign and symptoms
,prevention methods of particular diseases) content of
health education which primarily aimed at increasing of
knowledge on that particular health problems;
 but health education address the other factors that affect
health behaviors other than knowledge such as beliefs,
attitude ,reinforcing factors etc.
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17. HEALTH INFORMATION…
Health information is not necessarily health education.
But correct health information is certainly a basic part of
health education and hence, in turn, health promotion.
Health education is beyond health information.
Health communication is the process by which two or
more people exchange ideas, facts, feelings or
impressions about health in ways that each gains a
common or mutual understanding of the meaning and
the use of the message related to health under
consideration.
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18. Information, Education and Communication
(IEC)
IEC is a process of working with individuals, communities and
societies to:
• develop communication strategies to promote positive
behaviors which are appropriate to their settings.
IEC is a part of BCC while BCC builds on IEC
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19. Behavior Change Communication
• BCC is a Process of changing social and individual
attitude and behavior by providing them with
relevant information, education and motivation
through appropriate channel.
• BCC is a programme or activity that is specifically
designed to change or sustain the behaviour of
individuals or social groups by using variety of
communication techniques.
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20. Rationale for health education
A. 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.
 Nearly three million people die each year from TB, most of
which are in developing world.
About 75% 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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21. Rationale for health education…
B. 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.
C. 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.
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22. Rationale for health education…
D. Human behaviors are almost the single causes for the
development of such currently emerging health problems and
also the main solution.
E. 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.
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23. Rationale for health education…
F. Prevention is better than cure, is a statement which is
generally true especially for non communicable
diseases: it is much cheaper, prevents economic loss of
manpower hours, and lessens worry from the money
spent on health bills in the family.
G. Increasing threats to the young from new and harmful
behaviors. E.g.. tobacco use, teen-age pregnancy,
substance use, etc.
H. Increased awareness of people on chronic health
problems and the need to know preventive actions.
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24. Rationale..
MDGs and H/E
4. Reduce child mortality
5. Improve maternal health
6. Combat HIV/AIDS, malaria, TB,
7. Ensure enviromental sustainability
Is that possible to achieve MDGs
with out heath
education(behavior change
interventions?)

25. PHC concepts and health education
• Health education was identified as a primary
means of "Health for All."
• Its central role is in improving community
participation and building the capacity of
communities to make decisions.
• Therefore, health education should aim at
enabling people to make choices.

26. Importance of health education in PHC
1) Promoting community involvement and
self-reliance
2) Enhancing decision-making skills at the
local level
3) Allowing for a diversity of objectives in
formulating policy

27. (4) Harmonizing national and local plans
(5)Facilitating Inter-sectoral action
(6) Using appropriate technology
7) Measuring Community involvement and the
impact of health education.

28. Rationale..
• HE is One of the elements of PHC
• IEC is 1/8 HSDP-III health care components IV
• H/E is 1/16 Health ext. packages
• Cross-cutting issue in the other packages

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Rationale…
The health policy of Ethiopia
PRIORITIES OF THE POLICY
1. “IEC of health shall be given appropriate
prominence to enhance health awareness
and to propagate the important concepts
and practices of self-responsibility in health”

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Rationale…
GENERAL STRATEGIES of the Health policy
• 5. “Promotive and Preventive activities….”
4. “Health Education shall be strengthened
generally and for specific target populations
through the mass media, community leaders,
religious and cultural leaders, professional
associations, schools and other social
organizations for…”

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Rationale…
It is the Recommendation Part of Most Public
Health Researchers and Findings
• Awareness raising is needed…..
• IEC/BCC intervention is needed…….
• Health education is needed….
• health information is needed…
 Program strategies of malaria, HIV/AIDs…….documents

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Rationale…
“We must recognize that most of the world’s
major Health problems and premature death
are preventable through changes in human
behaviors and 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)

33. Goals of health education
1. Health consciousness :
 raise health consciousness or awareness of health
issues.
2. Knowledge :
 give specific knowledge and information.
3. Self awareness :
 Concerned with exploring feelings and being aware of
one's feeling in relation to particular health issue or to
health in general.

34. Goals of health education
4. Attitude change :
 Concerned with changing what people feel, what they
believe and what their opinion is.
5. Decision making :
 Involves both "knowing" and "feeling" objectives and
is concerned with deciding what to do in the future
about health or a particular aspect of health.

35. Goals of health education
6. Behavior change :
concerned with carrying out a decision and
actually doing something about a health matter.
7. Social change :
changing the physical and or social environment
so that people are encouraged to adopt healthier
behavior

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Goals of health education
Prevent premature deaths that are related to
lifestyles and behaviour
Promote, maintain, and improve individuals and
community health
Positive, informed changes in health behavior
To improve quality of life

37. Aims...
• To help each individual, each family to exercise
their right to achieve the harmonious development
of their physical, mental and social potential

38. Scope...
• During 1970s,1980s –individual’s behavior has
given emphasis as determinant of health status
• This has eclipsed the attention to the broader
social determinants of health.

39. Scope...
• Most recently ,experts have explicitly recommended that
interventions on social and behavioral factors related to
health should link multiple levels of influence, including
the individual, interpersonal, institutional ,community
and policy levels
• Community and societal influence on health behavior
and strategies to effect community and social policy
changes in addition to individual level.

40. Scope..
• Ecological perspective help direct to
identification of personal and environmental
leverage points for health education and health
promotion interventions.

41. Scope..
Behavior is viewed as being affected by
and affecting ,multiple levels of
influence for health related behaviors
and conditions
Intrapersonal/individual factors
Interpersonal factors
Institutional/organizational factors
Community factors
Public policy factors

42. Scope..
The possibility of reciprocal causation
between individuals and their
environments i.e., behavior is both
influences and influenced by the social
environment
HE covers the continuum from disease
prevention & promotion of health to
detection of illness to Rx, rehabilitation
and long term care

43. Principles of Health Education
1. Definite aim
• have a well defined objective.
• Know what you want to accomplish
• Plan your health education program
• Specify target audience
• Segment audience and tailor message

44. 2. Credibility
• should be based on facts
• it must be consistent and compatible with the
scientific knowledge and also with the local
culture and educational system.
3. Interest
• It is known that people are unlikely to listen to
things that are not of their interest or concern
.
• find out the real health needs of people.

45. 4. Participation
• is based on the principle of active learning.
• A high degree of participation tends to create
a sense of involvement, personal acceptance,
and decision making
5. Motivation
• Motivation is said to be contagious; one
motivated person can spread motivation
throughout a group, if not throughout a given
community.

46. 6. Comprehension
• know the level of understanding, educational
status, and literacy of the people to whom the
teaching is directed
7. Re-enforcement
• repetition of the health education program is
necessary.
• If a program is not re-enforced, the
understanding of people possibly returns to its
pre-awareness stage.

47. 8. Learning by doing
• Learning will be best when supported by
practical sessions such as demonstrations and
field attachments instead of mere explanation
of facts.
9. From known to unknown
• start from what people know (simple)
Proceeding to what people don’t know
(complex) to ensure their participation and
confidence

48. 10. Role model (setting examples)
• health educators, themselves, should be
model to what they educate.
11. Good relations
• Good relationship (rapport) with audience
should be established by sharing information,
ideas, and feelings transparently so that there
could be a process of establishing and
maintaining trust.

49. 12. Leadership
• people learn best from individuals whom they respect
and appreciate, and hence it is good to penetrate
through leaders (gate keepers) to the community in
health education intervention.
13. Feed back
• For effective communication process, response of the
audience is very important to confirm that the learning
objective is already achieved or not.

50. 14. Successive Experience
• People tend to adopt those practices that give
them satisfaction and reject that end with
unhappy experiences and hence it is
necessary to provide satisfying experience in
order to establish a new practice.
15. Group support
• Any new idea or practice will be feared at first;
it is only when many people support the new
idea that the individual members come out for
adoption

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Principles of H/E
• Principle of educational Diagnosis
• Principle of multiple methods
• Principle of planning and organizing
• Facts: H/E should be based on scientific
findings/facts and current knowledge

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Basic Principles…
behavior change should be voluntary
 Need based
 Multi- disciplinary

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Basic Principles…
• Changing behavior is a process, not an
event
• psychological factors, notably beliefs, K/ge
and values, influence how people behave

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Basic Principles…
• Principle of rewarding- the more beneficial
or rewarding an experience, the more likely
it is to be repeated; the more punishing or
unpleasant an experience, the less likely it is
to be repeated

55. Basic Principles…
• Individual health does not exist in a social
vacuum.
• behavior is not independent of the
context in which it occurs; people
influence, and are influenced by, their
physical and social environments
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56. Challenges to health education
• changing Health behavior is conditioned by
factors such as social, psychologically,
economically ,quality services. Which are
difficult to deal with simultaneously
• People are preoccupied with many daily
activities to support their life.

57. • Health education is not considered important
during normal life. People are concerned about
diseases
• People engaged with H/E programs lack special
training
• Methodological challenges,theoretical&
substantive challenges

58. Challenges to health education
 have limited specialized training and
therefore have, In some cases, restricted
their activities
 Many health educators do not have access
to the tools required to be effective
practitioners

59. Thank You for your attention
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