Healtheducation Concepts for MBBS Students

Describe & Discuss-
Concepts & Principles of
Health Promotion, Health Education,
IEC & BCC (CM 1.6)
Prof Dr. Sanjev Dave
HOD Department of Community
Medicine
Soban Singh Jeena Govt Institute of Medical
sciences & Research,Almora (Uttarakhand)

Contents
• Introduction
• Definitions of HE, HP, IEC & BCC, SBCC
• Approach to health education
• Principles of health education
• Contents of health education
• Practice of health education
• Health educators
• Central Health Education Bureau
• Code of ethics
• Success stories

Introduction
Health education forms an important part
of the health promotion activities.
These activities occur in schools,
workplaces, clinics and communities and include
topics such as healthy eating, physical activity,
tobacco use prevention, mental health,
HIV/AIDS prevention and safety.

Introduction
• Health education + educational , motivational,
skill-building and consciousness-raising
techniques >>>> building individuals’
capacities
• Healthy public policies provide the
environmental supports >>>>encourage and
enhance behaviour change.
• By influencing both, brings about meaningful
and sustained change in the health of
individuals and communities can occur.

Introduction
• It has become the integral part of various
national health programs such a RNTCP,
RMNCH+A, and many communicable and
non- communicable diseases.
• Health literacy is an outcome of effective
health education, increasing individuals’
capacities to access and use health information
to make appropriate health decisions and
maintain basic health.

Why effective Communication needed?

Effective Communication Requirements

Health education
Health education has been used interchangeably
with
• Behaviour change communication
• Information, Education & Communication
(IEC)

Definition
• Health promotion is the process of enabling
people to increase control over, and to improve
their health.
• Reference: Ottawa Charter for Health
Promotion. WHO, Geneva,1986

Definition
• Health education is any combination of
learning experiences designed to help
individuals and communities improve their
health, by increasing their knowledge or
influencing their attitudes (WHO)

• Health literacy:
“The degree to which people are able to
access, understand, appraise and communicate
information to engage with the demands of
different health contexts in order to promote and
maintain good health across the life course.”
(WHO)
Definition

DEFINITIONS
• Knowledge: An intellectual acquaintance with facts,
truth, or principles gained by sight, experience, or
report.
• Attitude: Manner, disposition, feeling, or position
toward a person or thing.
• Skills : The ability to do something well, arising from
talent, training, or practice.

DEFINITIONS
• Belief : Acceptance of or confidence in an alleged
fact or body of facts as true or right without positive
knowledge or proof; a perceived truth.
• Values: Ideas, ideals, customs that arouse an
emotional response for or against them.

Behaviour Change
Communication
• Is a process of working with individuals,
families and communities through different
communication channels
• to promote positive health behaviours
• and support an environment that enables the
community to maintain positive behaviours
taken on.

Information Education and
Communication
• Is a process of working with individuals,
communities and societies to develop
communication strategies to promote positive
behaviours that are appropriate to their
settings.

Relationship between major health concepts

Health Education Propagan
da
Knowledge and skills
actively acquired(active
thinking)
Develops reflective behavior .Trains
people to use judgement before
acting
Appeals to reason
Develops individuality ,personality
and
self expression
Knowledge acquired through self
reliant activity
The process is behavior centered
aims at developing favorable
Knowledge instilled in the minds of
the people(facts)
Develops reflexive behavior; aims at
impulsive action
Appeals to emotion
Develops a standard pattern of
attitudes
and behaviors according to would
used
Knowledge is spoon fed ad received
The process is information centered –
no change of attitude or behavior
designed

Aims and Objectives
(a) To encourage people to adopt and sustain health
promoting life style and practices
(b) To promote the proper use of the health services
available to them
(c) To arouse interest to provide new knowledge
,improve skilled and change attitudes in making
rational decisions to solve their own problems
(d) To stimulate individual and community self
reliance and participation to achieve health
development through individual and community
involvement at every step from identifying
problems to solving them.

APPROACH IN HEALTH EDUCATION
1. Regulatory Approach(Managed Prevention)
2. ServiceApproach
3. EducationalApproach
4. Primary health careApproach

Legal or Regulatory Approach
• Any governmental intervention, direct or indirect,
designed to alter human behaviour.
• Eg: Child marriage act in India, Seat belts rule in
cars etc.
• Advantages: Simple , Quick
• Particularly , be useful in times of emergency or in
limited situations such as control of an epidemic
disease or management of fairs and festivals

Limitations :
• In area of personal choice (alcohol , exercise
etc.) no govt. can take away their right of
freedom
• Difficult to enforce laws without a vast
administrative infrastructure and considerable
expenditure.
Legal or Regulatory Approach

Service Approach
• Intends to provide all the health facilities
needed by the people at their door steps on the
assumption that people would use them to
improve their own health.
• Limitation :not based on the felt-needs of
people
For example, when water seal latrines were provided, free of
cost, in some villages in India under the Community
Development Programme, people did not use them. This serves
to illustrate that we may provide free service to the people, but
there is no guarantee that the service will be used by them.

Educational Approach
• Most effective
• Gives autonomy towards their own lives
• Components :
1. motivation
2. communication
3. decision making
• results slow , but permanent and enduring.
• Sufficient time for an individual to bring about changes and
learning new facts as well as unlearning wrong information
as well.

Primary health care approach
• Radically new approach starting from the people
with their full participation and active
involvement in the planning and delivery of
health services based on principals of art health
care via community involvement and inter-
sectoral coordination
• Individuals helped to become self-reliant in
matters of health

• It can be done if the people receive the
necessary guidance from health care providers
in identifying their health problems and
finding workable solutions.
• This approach is a fundamental shift from the
earlier approaches.
Primary health care approach

• Since individuals vary so much in their socio-
economic conditions, traditions, attitudes,
beliefs and level of knowledge
• Asingle approach may not be suitable.
• Combination of approaches must be evolved
depending upon local circumstances
APPROACH IN HEALTH EDUCATION

CONTENTS OF HEALTH EDUCATION
• Human Biology: The effects of alcohol, smoking,
resuscitation and first aid are also taught.
• Nutrition: Eighth WHO Expert Committee on
nutrition stated that education in nutrition is a major
strategic method for the prevention of malnutrition.
• Hygiene: PERSONAL HYGIENE includes bathing,
clothing, washing hands and toilet; care of feet, nails
and teeth; spitting, coughing, sneezing, personal
appearance and inculcation of clean habits in the
young.

• ENVIRONMENTALHYGIENE:
• Objectives
• (a) to educate the people in the principles of
environmental health with a view to bring
about desired changes in health practices
• (b) to secure adoption, wide use and
maintenance of environmental health facilities,
and

• (c) to promote active participation of the
people in planning, construction and
operational stages of environmental
improvements.
• Family Health Care: The aim of health
education is to strengthen and improve the
quality of life of the family as a unit so that it
can survive the vicissitudes of rapid and
complex social changes.

Control of Communicable and Non -
communicable Diseases:
• People are encouraged to participate in
programmes of disease control, health
protection and promotion.
• Mental health::The aim of education in mental
health is to help people to keep mentally
healthy and to prevent a mental breakdown

• Prevention ofAccidents:
• occur in three main areas: the home, road and the
place of work.
• Safety education should be directed to these areas.
• It should be the concern of the engineering
department and also the responsibility of the
police department to enforce rules of road safety.
• Management must provide a safe environment,
and promote general order and cleanliness.

• Use of Health Services
• inform the public about the health services
that are available in the community, and how
to use them.
• They should not be misused or abused

Principles of Health Education
1.Community involvement in planning health
education is essential. Without community
involvement the chances of any programme
succeeding are slim.
2.The promotion of self esteem should be an
integral component of all health education
programmes.

• 3. Voluntarism is ethical principle on which all
health education programme should be built
without it health education programmes
become propaganda.
• Health education should not seek to coerce but
should rather aim to facilitate informed choice.

• 4. Health education should respect cultural
norms and take account of the economic and
environmental constraints face by people. It
should seek positively to enhance respect for
all.
• 5. Good human relations are of utmost
importance in learning.

• 6. Evaluation needs to be an integral part of health
education.
• 7. There should be a responsibility for the accuracy
of information and the appropriateness of methods
used.
• 8. Every health campaign needs reinforcement.
Repetition of messages at intervals is useful.

Practice of Health education
• 1. Audio visual aids
–Audio
–Visual
–Audio Visual
• 2. Methods of health communication
–Individual / Family
–Group
–General public (Mass communication )

Combination of Audio-Visual Aids
• Sound & sight combined together to create a
better presentation
 televisions
 tape and slide combinations
 Video Cassette Players and Recorders
 Motivation pictures or Cinemas
 Multimedia Computers

Practice of Health education
• 1. Audio visual aids
–Audio
–Visual
–Audio Visual
• 2. Methods of health communication
–Individual / Family
–Group
–General public(Mass communication )

Individual and Family Health
Education
Personal interviews
1.Personal contact
2.Home visits
3.Personal letter
4.Health Counseling
– Public health supervisors, nursing staff and
health visitors
– visit hundreds of homes;
– opportunities for individual teaching

Counseling
• Counseling- a confidential dialogue between a client
and a health care provider aimed at enabling the client
to cope with stress and take personnel decisions related
to disease.
• The aim of counseling based on the needs of the client.
• Purpose: three fold to >>help clients manage their
problems more effectively, >>to develop unused
opportunities to cope more fully, and >>to help and
empower clients to become more effective self helpers
in the future.

Elements of counseling
G: greet the clients and make them comfortable
and give full attention.
A: ask/ascertain the needs/problem or reasons for
coming.
T: telling different choices/options/methods to
cope with problem.
H: help the client to make voluntary decisions.
E: explain fully the chosen decision/action/method.
R: return for follow-up visit.

Group Health Education
• an effective way of educating the community.
• The choice of subject is very important it must
relate direct to the interest of the group health.
• These methods are effective in
–promoting behavioral change,
–influences opinion,
–develop critical thinking
–increase motivation.

Methods of Group Health
Education
Lectures Demonstrations Discussion
methods

Lectures
• carefully prepared oral presentation of facts, organized
thoughts and ideas by a qualified person.
• Aids:
• 1.Flipchart 2Flannelgraph 3.Exhibits 4. Films and
charts
Demerits:
• students are involved to a minimum extent;
• learning is passive;
• do not stimulate thinking or problem-solving capacity;
• the comprehension of a lecture varies with the student;
the health behavior of the listeners is not necessarily
affected.

• are carefully prepared presentation to show how to
perform a skill or procedure.
Merits:
• Dramatization help arousing interest
• persuades the onlookers to adopt recommended
practices
• upholds the principles of "seeing is believing“ and
"learning by doing", and
• can bring desirable changes in the Behaviour
pertaining to the use of new practice.
Demonstrations

• have a high educational value in programmes
like
• environmental sanitation (e.g installation of a
hand pump, construction of a sanitary latrine);
• mother and child health (e.g. demonstration of
oral rehydration technique) and control of
diseases (e.g., scabies).
• has a high motivational value.
Demonstrations

-Group discussion
-Symposium
-Conferences
-Role play
-Colloquy
- Focus group discussion
-Panel discussion
-Workshop
-Seminars
-Brain storming
- Campaign
-Delphi method
Discussion methods

Group discussion
• Group is an "aggregation of people interacting
in a face to face situation“
• very effective method of health
communication.
• Provides a wider interaction among members
than is possible with other methods.

Group discussion
For effective group discussion
• Group size - 6 -12 members.
• The participants are seated in a circle, so that
each is fully visible to all the others.
• Group leader - initiates the subject,
• Helps the discussion in the proper manner,
prevents side-conversations, encourages
everyone to participate and sums up the
discussion in the end .

• express ideas clearly and concisely
• listen to what others say
• do not interrupt when others are speaking
• make only relevant remarks
• accept criticism gracefully and
• help to reach conclusions
Group discussion
Rules for
members

Panel discussion
• 4 to 8 persons – qualified - talk and discuss
about a problem or a topic in front of a large
group or audience .
• The panel comprises a chairmen or a
moderator from 4 to 8 speakers.
• Success of the panel discussion depends on :
• Chairperson to keep the train of thoughts of
track.
• Discussion should be spontaneous and natural

Symposium
• Series of speeches on a selected subjects
• Each person or expert presents an aspect of the
subject briefly
• No discussion among the symposium
members.
• Chair person makes a comprehensive summary
at the end

Work shop
• Consist of series of meetings, usually four or
more with the emphasis on individual work,
within the group with the help of consultants
and resource personnel.
• Learning takes place in a friendly , happy and
a democratic atmosphere, under expert
guidance.

Role playing
• Socio- drama in which the situation is
dramatized by a group .
• audience is actively concerned with the
drama.
• Sympathetic attention to what is going on ,or
suggest alternative solutions at the request of
leader
• The size of the group 25.
• Best for schools.

Seminars
• A group of persons gathered for the purpose of
studying a subject under the leadership of an
expert or learned person.
• They are normally identified with learning
institutions.
• The participants bring with them a background
of training and experience in the area.

Conference
• It composed of two to fifty persons representing
several organizations, departments, or points of
view within an organization, meet together exhibit
a common interest and present two or more sides
of their problems.
• They gather information and discuss mutual
problems with a reasonable solution as the
desirable end.
• The various phases of the problem may be
presented by co-operative or hostile groups

Brain storming
• It is a type of small group interaction designed to
encourage the free introduction of ideas on a
restricted basis and without any limitations as to
feasibility.
• Participants are encouraged to list for a period of
time all the ideas that come to their minds
regarding some problem and are asked not to
judge these ideas during the session.
• Judgment of the ideas will come at a later period
in which all contributions will be sorted,
evaluated and perhaps later adopted.

COLLOQUY
• A Colloquy is an informal method of discourse
which is a modified form of the panel, using one
group of three to four persons from the audience
and another group of three to four resources persons
or experts on the subject to be considered.
• The panel members elected from the audience
present the problem and the experts comment on
various aspects of it.
• The general audience and panel members
participate whenever they so desire under the
guidance of a moderator

CAMPAIGN
• A campaign is an intensive teaching activity
undertaken at an opportune moment for a brief
period, focusing attention in a concerted manner
towards a particular problem so as to stimulate the
widest possible interest in the community.
• Campaign methods can be used only after an
advocated practice & is found acceptable to the
local people through method or result
demonstrations or other extension methods.

Focus Group Discussions (FGD)
• It is a group discussion of 6-20 persons guided by a
facilitator during which group members talk freely
and spontaneously about a certain topic or health
problem.
• The purpose of a focus group discussion is to
obtain in-depth information on concept,
perceptions and ideas of group on a particular
topic.

• The topic should be narrowly focused
• Selection of participants is also focused by
targeting individuals who meet specific
criteria
• Topic should be of interest to both the
investigator and respondents.
• The emphasis should be on interaction
between or among the group members.

Delphi technique
• Delphi technique is “a judgmental forecasting
procedure for obtaining, exchanging, and
developing informed opinion about future
events”
Or
• a method for structuring a groups’
communication process so that the process is
effective in allowing a group of individuals as
a whole, to deal with a complex problem”

• The Delphi Technique typically includes at least
two rounds of experts answering questions and
giving justification for their answers, providing
the opportunity between rounds for changes and
revisions.
• The multiple rounds, which are stopped after a
pre-defined criterion is reached, enable the
group of experts to arrive at a consensus forecast
on the subject being discussed
Delphi technique

Delphi technique
The tasks that the Delphi can help to
address are:
• determining priorities, setting goals,
establishing future directions
• designing needs assessment strategies &
improve service delivery
• evaluating programs or alternative plans

Delphi technique
Successful communication as :
• Avoids domination of one or more members of
the group;
• Avoids pressures to conform to the group’s
opinion;
• Avoids personality or interpersonal conflicts;
and
• Avoids the difficulty of two opposing
individuals of power

Mass communication
• Mass communication literally means
communication that is given to a community
where the people gathered together does not
belong to one particular group.
• Advantages
 large no. of people can be reached
 people of all socio-economic status
irrespective of their caste, creed and
religion are addressed

• Medias
televisions, radios, posters, news papers, internet and
other advance communication technologies such as
mobile telephone message and satellite television
are important channel for health information
communication.
• These are emerging and being adapted rapidly in the
movement toward modernization.
Mass communication

mHealth
• mHealth involves using wireless technologies
such as Bluetooth, GSM/GPRS/3G, WiFi,
storage devices, and so on to transmit and
enable various eHealth data contents and
services.
• Usually these are accessed by the health
worker through devices such as mobile
phones, smart phones, PDAs, laptops and
tablet PCs

Good communication technique
• Source: credibility.
• Clear message.
• Good channel: individual, group & mass
education.
• Receiver: ready, interested, not occupied.
• Feed back.
• Observe non-verbal cues.
• Active listing.
• Establishing good relationship.

WHO PROVIDES HEALTH
EDUCATION?
• People specialize in health education (trained
and/or certified health education specialists).
• Para-professionals and health professionals -
perform selected health education functions as
part of what they consider their primary
responsibility (medical treatment, nursing,
social work, physical therapy, oral hygiene, etc.

Responsibilities of health
educator

Central Health Education Bureau
(CHEB)
• Central Health Education Bureau (CHEB) is
an apex institute created in 1956 under the
Directorate General of Health Services
(DGHS) Ministry of Health & Family welfare,
Govt. of India.
• Formed on the recommendation of the Bhore
committee and the Planning commission

Functions
• Interpret the plans, programmes and achievements
of the Ministry of Health and Family Welfare.
• Design, guide and conduct research in health
Behaviour, health education processes and aids.
• Produce and distribute ‘proto-type’ health
promotion and education material in relation to
various health problems and programmes in
country.

Functions
• Provide guidelines for the organizational set-
up, functioning of health education units at the
state, district and other levels.
• Render technical help to official and non-
official agencies engaged in health education
and health promotion and coordinate their
programme.
• Collaborating with international agencies in
promoting health education activities

Divisions
• Health Promotion & Education Division
• Media & Editorial Division
• Health Promotion & Education Division
• School & Adolescent Health EducationDivision
• Training, Research & Evaluation Division
• Administrative Division

IEC Bureau
• Since health education of the various social
groups of population can be taken by state
Govts, a scheme was formulated in 1958 for
the establishment of State health education
bureau with central assistance.
• The State health education bureau are called
Information Education Communication Bureau
(IEC).

Health Educators
• Certifies health education specialists(HES), promotes
professional development, and strengthens professional
preparation and practice.
• Certified HES are re-certified every five years based
on documentation of participation in 75 hours of
approved continuing education activities
• Lay workers learn on the job to do specific, limited
educational tasks to encourage healthy behaviour.
• School teachers, parents, Social worker, known to
unknown Community leaders & influential

Analyzing the
Community
Backdr
op
Health Care
System
Community Health Status
NGO ‘ and Support
Systems
(SWOT)ANALY
SIS
“target
communities”
major health
problem
other “felt needs”
Consolidating Data
on Knowledge,
Attitudes and
Behaviors
Assemble the Planning
Group
/ Coordination
Council; Resource
Writing and disseminating the
Action
Plan(Implementation Plan)
Identify Methods and Activities
for
Health Education
Writing the Final
Report

Models of health education
Medical Model:
• dissemination of health information based on
scientific facts.
• assumption was that people would act on the
information supplied by health professionals to
improve their health.
• In this model social, cultural and
psychological factors were thought to be of
little or no importance

• Limitation: ignored the fact that in a number of
situations, the social environment which
shapes the behavior of individual and the
community.
• It is often found that people will not readily
accept and try something new or novel until it
has been "legitimated" (or approved) by the
group to which they belong
Motivational model

• Research shows that those interventions
• “most likely to achieve desired outcomes are
based on a clear understanding of targeted health
behaviors, and the environmental context in
which they occur”.
• For help with developing, managing and
evaluating these interventions, health education
practitioners can turn to several strategic planning
models that are based on health behavior theories.
Social intervention model

How are health Behaviour
theories useful?
• health behavior theory offers a number of
benefits and can be seen:
• a toolbox
• a foundation
• a road map
• a guide
• a compass

Social intervention model
• A theory should be chosen based on the topic and
target population choosing a theory should start
with a “thorough assessment of the situation: the units
of analysis or change, the topic, and the type of
Behaviour to be addressed”.
The theory should be:
• consistent with everyday observations
• similar to those used in previous successful
programmes
• supported by past research in the same area or
related ideas.

Social
intervention
al model
Intra personal Interpersonal
Environmental
• Rational model
• Health belief model
• Trans-theoretical
model
• Planned
behavior
theory
• Activated
health
• Social learning
(cognitive
model)
• Communicatio
n Theory
• Diffusion of
Innovations

SCHOOL HEALTH
• ‘‘Education for all and health for all’’are
inseparably linked.
• Teachers are the role model for the school
children.
-one hour or one period devoted to Socially
useful and Productive work(SUPW).
• Health education of both teachers and children
is best done in groups.

National Population Education Programme
(NPEP) in school sector by NCERT
• Launched in 1980
• Working to attain the institutionalization of
population education in education system of the
country.
• Implemented as ‘ ‘population and development
education in schools’’.
• Project has been implemented by NCERT at
the national level and SCERT at the state level.
This is now the regular activity of HRD.
• NCERT has also developed a module on
adolescent health education in school sector.

10
1
Worksite Health Education Programs
• Physical activity and fitness
• Nutrition and weight control
• Stress reduction
• Worker safety and health
• Blood pressure and/or cholesterol education and
control
• Alcohol, smoking and drugs

rofessional
• In 1976, begun by the Society of Public Health
Education (SOPHE). –Approved in 1999
• Article I: Responsibility to the Public
• Article II: Responsibility to the Profession
• Article III: Responsibility to Employers
• Article IV: Responsibility in the Delivery of Health
Education
• Article V: Responsibility in Research and
Evaluation
• Article VI: Responsibility in P
Preparation
Health Education Code of Ethics

The Information, Education &
Communication (IEC) strategy aims to create
awareness and disseminate information
regarding the benefits available under various
schemes/programmes of the Ministry and to
guide the citizens on how to access them.
IEC methods : action oriented; speech;
sign/symbol; or writing oriented IEC.
Each approach and method has its own
advantages and disadvantages in any given
setting or situation.
Principles of IEC?
policy and resource assessment; audience
analysis; strategy design; message
research and pretesting; participation and
feedback; management; evaluation; and
collaboration.
Information Education & communication
(IEC)

Previously known as behavior change
communication (BCC), S
BCC is an approach that promotes and
facilitates changes in knowledge, attitudes,
norms, beliefs and behaviors.
The terms BCC and SBCC are interchangeable,
and both refer to a series of activities and
strategies that promote healthy patterns of
behavior.
BCC & SBCC
Behaviour Change Communication is an
interactive process of any intervention with
individuals, group or community to develop
communication strategies to promote positive
health behaviours which are appropriate to the
current social conditions and thereby help the
society to solve their pressing health
problems.2

Polio eradication
• Increased awareness
about the Vaccine
• Decreased the
myths regarding
the vaccine
• Better sanitation
and hygiene
• Information about the
the immunization days
• Tag lines such a “DO
BOOND ZINDAGI ke” -
very

Achievements in RNTCP
through Health Education
• Destigmatisation of TB by popularizing the fact that TB is
curable, by using cured patients to motivate others;
• Making TB services more accessible to the marginalised
sections of society – women, tribal and other marginalised
groups through awareness generation, and the promotion of
health seeking Behaviour;
• Greater collaboration with private health care providers by
popularizing availability of good quality diagnostic and
treatment under the RNTCP;

• Ensuring completion of treatment by patients by
increasing their knowledge about the disease and
their treatment, and also by creating patient-friendly
environments; and
• Making DOTS a familiar name among different
target audiences so that there is an immediate
association of the term ‘DOTS’ with TB and itscure.
Achievements in RNTCP
through Health Education

References
• K park- The textbook of preventive and social
medicine
• Health education theoretical concepts- WHO
• Suryakanta- recent advances
• S lal – book on community medicine
• www.impart.org
• www.youtube.com
• www.nrhmharyana.gov.in

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