Physical Education 1

IntroductIon
The concept of physical education is generally understood as organisation of
some games, sports or physical education activities in schools. There are
schools where specific periods are allocated for this subject in the time table. It
has been noticed that during such periods, most of the students are either left
on their own to play the games in a way they like or they are taken to the field
where they engage themselves in different sports without the guidance or supervision of
teachers. In some schools, selected students play games like football, cricket, volleyball, hockey,
basketball, and so on. Annual sports are organised, but again in such activities only a few
selected students participate. All
these experiences taken together provide
a basic understanding of the physical
Definitions
1. According to Webster’s Dictionary Physical education is a integral part of education which
gives instructions in the development and care of the body ranging from simple calisthenic
exercises to a course of study providing training in hygiene, gymnastics and the performance
and management of athletics games.
2. Columbia Encyclopaedia
Physical education and training, is an organised instruction in motor activities that contribute
to the physical growth, health and body image of the individual.
3. Central Advisory Board of Physical Education and Recreation defines Physical education
as an education through physical activities for the development of total personality of the child
to its fullness and perfection in body, mind and spirit.
education as a concept. However, when we go into details of the aims, objectives and concepts
of physical education, we learn that they go beyond these traditional beliefs.
PhysIcal EducatIon
As we know, education, particularly school education, aims at the holistic development of
children. It provides students with opportunities to grow and develop as adults to be useful for
the society. It is important for us to know that one of the most important requirements for
growing into healthy adulthood is the physical growth which supports cognitive development. It
is, therefore, necessary that all children get adequate opportunity to participate in free play,
informal and formal games, sports and yoga activities. It is in this context that health has been
made a significant component of the subject of Physical Education in the school education
system of the country. The subject “Health and Physical
Physical Education

Education” adopts a holistic definition of health within which physical education and yoga
contribute to the physical, social, emotional and mental development of a child.
In view of the above, the meaning of physical education becomes a little different from what is
commonly understood. Physical education comprises holistic education for the development of
personality of the child to its fullest and perfection in body, mind and spirit through engaging in
regular physical activities. Physical education through the medium of physical activities helps
individuals to attain and maintain physical fitness. It contributes to physical efficiency, mental
alertness and the development of qualities like perseverance, team spirit, leadership and
obedience to rules. It develops personal and social skills among the learners and makes a
positive impact on their physical, social, emotional and mental development. It also contributes
to the total health of learners and the community. Physical education thus, can be defined as a
subject that is not only focused on physical fitness but is also concerned with development of a
number of skills, abilities and attitudes for leading a healthy lifestyle. It inculcates values like
cooperation, respect to others, loyalty, self-confidence, winning with grace and losing with hope.
oBjEctIvEs of PhysIcal EducatIon
As discussed above, by now it may be clear to you that the aim of physical education is not only
physical development but also to equip learners with knowledge, skills, capacities, values, and
the enthusiasm to maintain and carry on a healthy lifestyle. It promotes physical fitness,
develops motor skills and the understanding of rules, concepts and strategies of playing games
and sports. Students learn to either work as part of a team, or as individuals in a wide variety of
competitive activities. The main objectives of physical education are to:
• develop motor abilities like strength, speed, endurance, coordination, flexibility, agility and
balance, as they are important aspects for good performance in different games and sports.
• develop techniques and tactics involved in organised physical activities, games and sports.
• acquire knowledge about human body as its functioning is influenced by physical activities.
• understand the process of growth and development as participation in physical activities has
positive relationship with it.
• develop socio-psychological aspects like control of emotions, balanced behaviour, development
of leadership and followership qualities and team spirit through participation in games and
sports.
Health and Physical Education

• develop positive health related fitness habits which

can be practised lifelong so as to prevent degenerative
diseases.
actIvIty1
1. What do students do during physical education periods?
2. What type of knowledge is provided by teachers about the concerned games and sports related
skills?

scoPE of PhysIcal EducatIon

Physical education has evolved as a multi-disciplinary subject
over time and its scope is not confined to physical fitness and
knowing the rules of games and sports. It includes many topics
which belong to other subjects like science, biology, genetics,
psychology and sociology. It is possible that all the contents
that constitute the scope of physical education may not find a
place in the syllabus meant for school education. However, it
contains all the content areas as stated below.
Games and Sports as a Cultural Heritage
The games and sport activities that you play today have a
strong linkage to our culture. Sport activities which dominate
any region is embedded in the cultural milieu. Some of the
sports that reflect the culture of a region of our country are
Kho-Kho, Kabbadi, Archery, Lezim, Wrestling and so on. Our
ancestors survived on hunting with the use of throwing
Physical education
consists of:
• games and sports as a cultural heritage
• mechanical aspects in physical education
• biological contents • health education and wellness contents
• psycho-social content • talent identification and training contents.
stones as well as bow and arrows, running, jumping etc. were used for survival and recreation.
Later when man became more civilised, it took the shape of competitive sports like athletics,
wrestling, archery and so on. So, we can see a strong bonding of our culture in the present
evolution of games and sports.
Mechanical Aspects in Physical Education Physical education takes into consideration the
mechanical aspects of various physical activities being performed. You are aware that the
concepts regarding laws of motion, lever, force and its generation, maintenance of equilibrium,
centre of gravity and its impact on movements, law of acceleration, speed and
Physical Education

its development form important content areas of physical education. You will also study these
aspects in your science textbook.
Biological Contents in Physical Education
The contents drawn from the biological sciences take into consideration the areas of heredity
and environment, growth and development, organs and systems, understanding of joints
classification, and possible movements around these joints. In addition, muscles and their
properties, effect of exercise on various systems of the body (like circulatory, respiratory,
muscular, digestive and skeletal systems) are also linked to physical activities.
Health Education and Wellness Contents in Physical Education
Physical education includes contents related to the area of health education through
understanding the concept of hygiene, knowledge about various communicable and non
communicable diseases, problems relating to health and their prevention, proper nutrition and
balanced diet. Community health, school health service programme, assessment of health
status, prevention, safety and first aid for common injuries are
also included in the scope of physical education. Psycho-social Content of Physical Education
Psycho-social aspect of physical education extends to the study of areas regarding individual
differences, personality development, learning of various skills, motivation and its techniques,
anxiety management, ethical and social values, group dynamics, cooperation, cohesiveness and
learning. It also focuses on emotional development, relationships with peer/parents and others,
self concept and self esteem.
Talent Identification and Training Content in Physical Education
Physical education includes contents with regard to talent identification, development of
components in relation to specific sport, understanding of various types of activities like
aerobic, anaerobic, rhythmic and calisthenics. Training programmes, learning and perfection of
various movements, sport skills, techniques and tactical patterns, warming up, load
adaptation, recovery and cooling down are also a part of physical education.
tEachIng-lEarnIng aPProach
We have, so far, discussed the importance of physical education as a subject area in the school
curriculum. It is an integral part of Health and Physical Education which is prescribed as
Activity 2
Health and Physical Education

a compulsory subject at the Primary (Classes/Grades I-V), Upper Primary (Classes/Grades

VI-VIII) and Secondary stages (Classes/Grades IX-X) and as an optional subject at Higher
Secondary stage (Classes/Grades XI-XII). But as you may be experiencing in actual practices,
this subject has not been treated at par with other core subjects. It is not transacted
satisfactorily in majority of schools. And wherever it is transacted, either some knowledge about
games and sports is imparted or only a selected group of students are engaged in games and
sports as extra-curricular activities.
Arguments like lack of the needed infrastructure and equipments, absence of trained teachers
and paucity of time in schools are given as reasons for indifferent transaction of physical
education. In fact most significant reason is the lack of appreciation of the relevance of this area
for the holistic development of children by school authorities, teachers and parents.
Methodology of Teaching-learning
It is generally believed that the methodology of teaching learning is the concern of teachers only.
Learners have little or nothing to do with it. But this is not true. The teaching learning methods
are concerns of learners as well. Knowing and understanding that how different subjects are
taught are important for the learners of all subjects, but it has more relevance for the learners
of physical education. When we
talk about you as learners of physical education, we mean that you have actually participated in
the
(i) Why do you feel that it is important for students to know how physical education activities
are organised in school?
(ii) Should the focus of physical education be only on selected students or for all?
(iii) Seema is a differently abled girl and is on a wheelchair in the playground. What will you
do to involve her in the game you are playing?
subject area, rather than merely studied it. It needs a suitable learning environment and a
positive will for participation. As you now know, physical education does not mean organisation
of a few sports and games activities, involving only a selected number of students, and that too
occasionally. The following points are significant for the appreciation of this subject and the
need for adopting appropriate teaching – learning
methodology:
• Physical education is necessary to ensure participation of all children in free play, informal
and formal games and sports activities. All students must be involved in health and physical
education activities. Those who choose to excel in games and sports need to be provided
adequate opportunity.
• Involvement of all learners means that even those students need to be involved, who are at
the risk of marginalisation, for instance, who are differently abled. Such involvement will
empower them to overcome the
Physical Education

sense of helplessness, inferiority and stigma. Differences between students must be viewed as
resource for supporting learning rather than as a problem. Inclusion in education is one of the
components of inclusion in society.
Physical Education Cards (PEC) Methodology Various methodologies are being employed and
efforts are on to develop innovative teaching-learning methodologies, one such methodology
known as PEC-India Methodology has been developed. It is the outcome of a joint initiative of
the British Council and the Ministry of Human Resource Development, Government of India.
Other international organisations, United Nations International Children Emergency Fund
(UNICEF) and U.K. Sports were also involved. To begin with, this was developed for the primary
stage and it was scientifically tried out in schools. The tryout has proved its effectiveness. Based
on this experience, the Physical Education Cards (PEC) and Teachers’ Manual have been
developed for the upper primary and secondary stages as well. Moreover, this methodology has
also taken care of the needs of differently abled children. They should also be involved in
physical education. The notable features of this methodology are as follow:
(i) It ensures that every student
participates in physical
education activities equally.
Each card provides essential
information needed for
engaging all students of a
class in the selected game
or activity, even though the
class has larger number of
students;
(ii) Teachers as well as
students have material in
the form of cards that can
be conveniently handled
A
For instance, you have observed some students not
participating in
physical education activities including sports in your
school. How would you discuss to them that their
participation in
physical activities, individual and
sports will improve their health?

and used for a longer time and in a better way.

(iii) The cards will not only
Fig.1 : Special child playing with bat

facilitate the organisation of activities but also make it more convenient for the teacher as well
as students to comprehend the concerned vocabulary as well as pedagogical tools to organise
games, sports and activities and provide equal opportunity to every student to participate in
these; and
Health and Physical Education

(iv) Each card mentions how the impact of activities

conducted according to the proccess explained in
it will attain the objectives of Health and Physical
Education and how the achievements of students may
be evaluated.
Let’s get fit

Lead up games for

Kabaddi Track and field events
Physical Education

Assessment
Answer the following questions
1. Define physical education and discuss its main objectives.
2. What is the scope of physical education?
3. Describe a process that can ensure equal participation of all students of a class in a game of
your choice. 4. Why there's a need for a school to implement of health and physical education?
5. How the community and its sources can be used for promoting health and fitness of children?
Fill in the blanks
(i) Physical education has evolved as a multi…………… subject.
(ii) All children should get ………..to participate in games. (iii) Through physical education
activities ………..of a child is developed.
(iv) Physical education subject is at…….with other subjects.
Tick (✓) mark either Yes or No
(i) Agility, balance and coordination are fundamental movement skills that are developed
through participation in games and sports. (Yes/No)
(ii) PEC means Physical Education Codes (Yes/No) (iii) Physical Education has been made a
compulsory
subject .
(Yes/No)
(iv) Yoga is an integral part of Health and Physical Education Subject. (Yes/No) (v) PEC ensures
that every child finds equal opportunity to play game and sports. (Yes/No)
Health education

HEALTH EDUCATION
Health education as a tool for health promotion is critical for improving the health of
populations and promotes health capital. Yet, it has not always received the attention needed.
The limited interest stems from various factors, including: lack of understanding of health
education by those working in this field; lack of knowledge of and consensus on the definitions
and concepts of health education and promotion; and the difficulty health educators face in
demonstrating the efficiency and showing tangible results of the practice of health education. Of
course, there are many success stories relating to health education, particularly in the settings
approach, such as health-promoting schools, workplaces, clinics and communities. However,
where boundaries are not well defined, implementing health education becomes more
challenging.
The WHO Regional Office for Eastern Mediterranean conducted a situation analysis to assess the
health education capacity, programmes and activities in Member States of the Region. The
findings of the assessment showed a number of persisting challenges. These include access to
and knowledge of up-to-date tools that can help educators engage in effective health education
practice, and confusion about how health education can meaningfully contribute to the goals of
health promotion.
Health education: theoretical concepts, effective strategies and core competencies

Definition of key terms

Definitions provide people with a common foundation for understanding. Most people
recognize, for example, the importance of adopting “healthy behaviour” and living in “healthy
environments”. However, the difficulty arises in the interpretation of health-related terms, which
can vary greatly among different professional groups and segments of society.
Health
The WHO Constitution of 1948 defines health aspirations, to satisfy needs, and to change or
as a state of complete physical, social and cope with the environment. Health is,
mental well-being, and not merely the therefore,
absence of disease or infirmity. In addition, the Definitions provide people with a common
Ottawa Declaration states an “individual or foundation for understanding
group must be able to identify and realize

seen as a resource for everyday life, not the objective of living. Health is a positive concept
emphasizing social and personal resources, as well as physical capacities”.

Health education
“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.” The WHO health promotion glossary
describes health education as not limited to the dissemination of health-related information but
also “fostering the motivation, skills and confidence (self-efficacy) necessary to take action to
improve health”, as well as “the communication of information concerning the underlying social,
economic and environmental conditions impacting on health, as well as individual risk factors
and risk behaviours, and use of the health care system”. A broad purpose of health education
therefore is not only to increase knowledge about personal health behaviour but also to develop
skills that “demonstrate the political feasibility and organizational possibilities of various forms of
action to address social, economic and environmental determinants of health”.

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.”

Health promotion
“The process of enabling people to increase control over, and to improve, their health.”
Health education: theoretical concepts, effective strategies and core competencies

Lifestyle (lifestyles conducive to health)

“A way of living based on identifiable patterns of behaviour which are determined by the
interplay between an individual’s personal characteristics, social interactions, and
socioeconomic and environmental living conditions.”

Population risk continuum

The health of all people in a community can be considered as a health continuum between
optimal health and death. Where ones lies on the continuum is related to many risk factors and
conditions often referred to as the determinants of health (i.e. social and economic
environment, individual capacity and coping skills, personal health practices, health services,
biology and genetics). The quality of our lives and therefore our health is influenced by our
physical, economic and social environments. As well, personal behaviour that places us at risk
(e.g. eating few fruits and vegetables) increases the chance of developing health problems (e.g.
many types of cancer).

Prevention
“Measures not only to prevent the occurrence of disease, … but also arrest its progress and
reduce its consequences once it is established.”

Primary health care

“Essential health care based on practical, scientifically sound and socially acceptable methods
and technology made universally accessible to individuals and families in the community through
their full participation and at a cost that the community and country can afford.” In many
countries primary health care involves incorporating curative treatment given by the first-contact
provider along with promotional, preventive and rehabilitative services provided by
multidisciplinary teams of health care professionals working collaboratively.

Quality of Life
“An individual’s perceptions of their position in life in the context of the culture and value system
where they live, and in relation to their goals, expectations, standards, and concerns.”

Wellness
The optimalstate of health of individuals and groups; involves the realization of the fullest
physical, psychological, social, spiritual and economical potential of an individual: the fulfilment
one’s role expectations in the family, community, place of worship, workplace and other
settings.
Health education: theoretical concepts, effective strategies and core competencies

Examining the relationships: health education,

health promotion and health literacy
Much has been written over the years about the relationship, uniqueness and overlap between
health education, health promotion and other concepts, such as health literacy, primary health
care, community development and mobilization, and the role of empowerment. Attempting to
describe these various relationships is not easy; findings and consensus will not fall neatly into
place like the pieces of a jigsaw puzzle. Furthermore, discussion around these concepts can be
intense since the professional affiliation associated with them is often strong and entrenched.
Another hurdle is the frequent lack of consistency in the terminology used, which is because the
concepts themselves are either still evolving or have evolved at different times from separate
disciplines such as psychology, sociology, medicine and the field of social justice.

Health education and health promotion

Health promotion is concerned with improving health by seeking to influence lifestyles, health
services and, above all, environments (which are not limited to the physical environment but
encompass as well the cultural and socioeconomic circumstances that substantially determine
health status). There are several recognized definitions of health promotion, most of which
embrace the tenets of health, community participation and individual empowerment. The most
prominent, from the Ottawa Charter for Health Promotion, proposes a framework for action
that sets out five priority areas: building healthy public policy; creating supportive environments;
strengthening community action; developing personal skills; and reorienting health services.
Health promotion has its roots in many different disciplines. Over time it incorporated several
previously separate components, one of which was health education. Some authorities hold the
view that health promotion comprises three overlapping components: health education, health
protection and prevention These overlapping areas, as illustrated in Figure 1, are potentially
substantial: health education, for example, includes educational efforts to influence lifestyles
that guard against ill-health as well as efforts to encourage participation in prevention services.
Health protection addresses policies and regulations that are preventive in nature, such as
fluoridation of water supplies to prevent dental caries. Health education aimed at health
protection champions positive health protection measures among the public and policy-makers.
The combined efforts of all three components stimulate a social environment that is conducive
to the success of preventive health protection measures such as intensive lobbying for seat-belt
legislation.
Health education: theoretical concepts, effective strategies and core competencies

Health education

Prevention Health protection

Figure 1. A model of health promotion

But there are broader viewpoints. Green and Kreuter maintain that the defining characteristic of
health education is the voluntary participation of learners in determining their own health
practices. (12) WHO describes health education as not being limited to the dissemination of
health-related information but also “fostering the motivation, skills and confidence (self-efficacy)
necessary to take action to improve health” as well as “the communication of information
concerning the underlying social, economic and environmental conditions impacting on health,
as well as individual risk factors and risk behaviours, and use of the health care system.” A broad
purpose of health education therefore is not only to increase knowledge about personal health
behaviours but also to develop skills that “demonstrate the political feasibility and organizational
possibilities of various forms of action to address social, economic and environmental
determinants of health.”
O’Byrne makes a distinction between the aspects of an individual’s environment that are within
one’s control, such as individual health-related behaviour and the use of health services, and
aspects outside of one’s control – social, economic and environmental factors and the provision
of health services. Health promotion, says O’Byrne, encompasses both areas. Through health
education it provides “individuals and groups with the knowledge, values and skills that
encourage effective action for health”. Through healthy public policy it “generates political
commitment for health supportive policies and practices, the provision of services and increased
public interest, and demand for health”.
Tones developed the following formula to illustrate O’Byrne’s distinction:
health promotion = health education × healthy public policy
Health education: theoretical concepts, effective strategies and core competencies

Improved health outcomes

Reduced inequities

Changed health behaviour and practices

HEALTH LITERACY
guidelines
Facilities and
services Social
supports
Incentives
Consciousness-raisin
g Education Health knowledge,
Motivation beliefs and practices
Skill-building Capacity and Environmental
self-efficacy Community supports
empowerment

Individual
capacities

Rules, regulations and

HEALTH EDUCATION HEALTHY PUBLIC

POLICIES

HEALTH PROMOTION
Risk factors Risk conditions

Figure 2. Relationship between major health concepts

Health education, according to this formula, focuses on building individuals’ capacities through
educational, motivational, skill-building and consciousness-raising techniques. Healthy public
policies provide the environmental supports that will encourage and enhance behaviour change.
By influencing both these intrinsic and extrinsic factors, meaningful and sustained change in the
health of individuals and communities can be realized. This relationship is illustrated in greater
detail in Figure 2.

Relationship between health education and health

Controversy still exists as
litracy
According to Ratzan, (15) the term “health “health literacy” appeared in the WHO
literacy” was first used in the health education glossary, where it was suggested that “health
context about 30 years ago. Today it is literacy represents the
considered an important concept not only to what constitutes “health literacy”, how to
among health education practitioners but also measure it, and what methods are most
among those involved in the broader aspects effective and cost-effective in modifying
of health promotion. A definition of the term health literacy levels

cognitive and social skills which determine the motivation and ability of individuals to gain
access to, understand and use information in ways which promote and maintain good health”.
(2) As well, “health literacy means more than being able to read pamphlets and make
appointments. By improving people’s access to health information, and their capacity to use it
effectively, health literacy is crucial to empowerment”.
Health education: theoretical concepts, effective strategies and core competencies

People with low literacy have poorer overall health

Low literacy leads to misuse of medication and misunderstanding of health information
Low literacy leads to preventable use of health services, including emergency care
People with low literacy skills often wait longer to seek medical help so health problems
reach a crisis state

This definition represents a considerable expansion of the earlier definitions including “being
able to apply literacy skills to health related materials such as prescriptions, appointment cards,
medicine labels, and directions for home health care”, and “the degree to which people havethe
capacity to obtain, process, and understand basic health information and services needed to
make acceptable health decisions”.
Rootman identified several reasons for accepting the expanded definition of health literacy:
• health literacy is a “key outcome from health education” and one that health promotion
could legitimately be held accountable for
• it “significantly broadens the scope and
Health literacy, therefore, can be viewed as
content of health education and an outcome for effective health education by
communication”, (19) both of which are increasing individuals’ capacities to access
critical operational strategies in health and use health information to make
promotion appropriate health decisions and maintain
• it helps strengthen the links between the basic health.
fields of health and education. (20) Public health must base its messages on
 the theories and principles of health understood).
education (e.g., what the message says,)
health communication (e.g., how the Source: Gazmararian J, Curran JW, Parker RM, Bernhardt
JM, DeBuono BA. Public health literacy in America: an ethi
message is delivered), and the health
cal imperative. American journal of preventive medicine,
literacy of the intended audience (e.g., 2005, 28(3):317–22.
whether the message is accessed and
Health education: theoretical concepts, effective strategies and core competencies

Health education planning, implementation and

evaluation: examples of effective strategies and
barriers to success
Given the numerous health education initiatives that have occurred over the past 30 to 40 years,
the multiple target groups and issues that have been addressed, and the differing evaluation
methods that have been used, one is left with the question: what are the core ingredients of
success? What methods have stood the test of time and appear to be essential components of
health education programmes and services aimed at enhancing an individual’s and a
community’s health?
Evidence-based health education interventions are those that are most likely to be based on theory and
have been shown through empirical study to be effective. The use of theory-based interventions, evaluated
through appropriate designs, contributes to the understanding of why interventions do or do not “work”
under particular conditions. Using the definitions of evidence-based medicine and evidence-based public
health and the work of Rimer andher
colleagues, evidence-based health education practice is the “process of systematicallyfinding, appraising
and using … qualitative and quantitative research findings as the basis for decisions in the practice of
health education”.
Increasingly, health education professionals are using a concept born out of the continuous
quality improvement discipline called “best practices”. For the purposes of this document, this
notion has been slightly altered and renamed “leading practices”. Our intent is to identify solid
practices that can be of assistance to decision-makers and service providers. The logic behind
leading practices is that by sharing non-proprietary ideas/applications/processes in an organized
fashion, the diffusion of successful practices will be hastened, and thus the need to learn by trial
and error (with a high price for failure) is minimized.
Components that appear to be essential to effective community-based health education and
prevention strategies include the following.
• Participant involvement Community members should be involved in all phases of a
programme’s development: identifying community needs, enlisting the aid of community
organizations, planning and implementing programme activities and evaluating results. Wide
and comprehensive representation of community members on programme planning bodies
provides for a sense of ownership and empowerment that will enhance the programme’s
impact.
• Planning Many programmes take two or three years to move from original conceptualization
to the point at which services are delivered. Planning involves identifying the health
problems in the community that are preventable through community intervention,
formulating goals, identifying target behaviour and environmental characteristics that will be
the focus of the intervention efforts, deciding how stakeholders will be involved and building
 a cohesive planning group.
• Needs and resources assessment Prior to implementing a health education initiative, attention
needs to be given to identifying the health needs and capacities of the community and the
resources that are available.
Health education: theoretical concepts, effective strategies and core competencies
conditions that sustain this behaviour (e.g.
motivation, social environment).
• An integrated programme The programme
• A comprehensive programme The should
programmes with the greatest promise are
comprehensive, in that they deal with The tradition and culture of health education
multiple risk factors, use several different and prevention incorporates, among other
channels of programme delivery, target virtues, a growing scientific base, a sound
several different levels (individuals, families, philosophy based on great compassion and
social networks, organizations, the community dedication and a recognition that through
as a whole) and are designed to change not planned action, improved health can be
only risk behaviour but also the factors and achieved and maintained

be integrated; each component of the programme should reinforce the other components.
Programmes should also be physically integrated into the settings where people live their
lives (e.g. worksites) rather than solely in clinics.
• Long-term change Health education programmes should be designed to produce stable and
lasting changes in health behaviour. This requires longer-term funding of the programme and
the development of a permanent health education infrastructure within the community.
• Altering community norms In order to have a significant impact on an entire organization or
community, the health education programme must be able to alter community or
organizational norms and standards of behaviour. This requires that a substantial proportion
of the community’s or organization’s members be exposed to programme messages, or
preferably, be involved in programme activities in some way.
• Research and evaluation A comprehensive evaluation and research process is necessary, not
only to document programme outcomes and effects, but to describe its formation and
process, and its cost-effectiveness and benefits.

Examples of effective health education initiatives and

strategies—systematic reviews
Systematic reviews summarize the overwhelming amount of health-related research initiatives
that exist and also provide health providers and decision-makers with information on evidence
based practice. A number of systematic reviews have been done on the effects of health, health
care, education and social justice-related interventions. One of the most comprehensive tools
available to identify effective health education, health promotion and public health strategies is
the Guide to community preventive services: systematic reviews and evidence based
recommendations, prepared by the Task Force on Community Preventive Services for the US
Department of Health and Human Services in 1996. The purpose of the Guide is to provide
public health practitioners and decision-makers with recommendations regarding population
based interventions for promoting health and preventing disease, injury, disability and
premature death in communities. Its aim is to promote evidence-based public health practice by
providing best advice on which community-based health promotion and disease prevention
interventions work and which do not work, based on available scientific evidence. Although the
primary focus for the Guide is on interventions that have been evaluated in industrialized
nations, health educators in developing nations might well find the information relevant to their
situations.
Health education: theoretical concepts, effective strategies and core competencies

More than 200 interventions in the following topical areas have been reviewed, and the Task
Force on Community Preventive Services has issued recommendations for their use in the
following areas, among others:
• adolescent health
• alcohol • vaccines.
• asthma Among the areas covered are:
• birth defects
• What interventions have and have
• cancer
not worked?
• diabetes
• In which populations and settings
• violence
has the intervention worked or not?
• HIV/AIDS, STIs and pregnancy •
• What might the intervention
mental health
cost? What should I expect for my
• motor vehicle investment?
• nutrition
• Does the intervention lead to any
• obesity other benefits or harm?
• worksite
• What interventions need more
• oral health research before we know if they
• physical activity work or not?
• social environment
• tobacco

Three topic areas in which a great deal of health education activity is occurring are physical
activity, obesity and tobacco use. For illustrative purposes, the Guide provides the following
examples of health education strategies that have sufficient evidence to be designated as
recommended actions.
Health education: theoretical concepts, effective strategies and core competencies
Esample1. Physical activity (56)

Physical activity

Behavioural and social approaches to increase physical activity: individually adapted health
behaviour change programmes
Individually-adapted health behaviour change programmes for increasing physical activity teach
behavioural skills that help participants incorporate physical activity into their daily routines. The
programmes are tailored to each individual’s specific interests, preferences and readiness for
change.
These programmes teach behavioural skills such as:
• goal-setting and self-monitoring of progress toward those goals
• building social support for new behaviour
• behavioural reinforcement through self-reward and positive self-talk
• structured problem-solving to maintain the behaviour change
• prevention of relapse into sedentary behaviour.
Results from the systematic reviews
Eighteen studies qualified for review.
• In all 18 studies reviewed it was found that individually adapted health behaviour change
programmes were effective in increasing physical activity as measured by various indicators:
• time spent in physical activity – median net increase of 35.4%
• aerobic capacity (VO2 max) – median increase of 6.3%
• energy expenditure – median increase of 64.3%.
• Other measures of physical activity, such as the percentage of people starting exercise
programmes and the frequency of physical activity, also increased as a result of these
programmes.
• These interventions were effective among both men and women and in a variety of settings,
including communities, worksites and schools.
• If appropriately adapted to the target populations, these interventions should be applicable to
diverse settings and groups.

Task force recommendations and findings

The Task Force on Community Preventive Services recommends implementing individually
adapted health behaviour change programmes, based on the strong evidence of their
effectiveness in increasing physical activity and improving physical fitness among adults and
children.
Health education: theoretical concepts, effective strategies and core competencies

Worksite programmes to control overweight and obesity

Worksite nutrition and physical activity programmes are designed to improve health-related
behaviour and health outcomes. These programmes can include one or more approaches to
support behavioural change, including informational and educational; behavioural and social;
and policy and environmental approaches.

About the intervention

• Informational and educational strategies aim to increase knowledge about a healthy diet and
physical activity. Examples include:
• lectures
• written materials (provided in print or online)
• educational software.
• Behavioural and social strategies target the individual thoughts (e.g. awareness, self-efficacy)
and social factors that effect behaviour changes. Examples include:
• individual or group behavioural counselling
• skill-building activities such as cue control
• rewards or reinforcement
• inclusion of co-workers or family members to build support systems.
• Policy and environmental approaches aim to make healthy choices easier and target the entire
workforce by changing physical or organizational structures. Examples include:
• improving access to healthy foods (e.g. changing cafeteria options, vending machine
contents) • providing more opportunities for physical activity (e.g. on-site exercise facilities).
• Policy strategies could also adjust certain rules and procedures for employees (e.g. health
insurance costs or health club membership fees).
• Worksite weight control strategies may occur separately or as part of a comprehensive
worksite wellness programme that addresses several health issues (e.g. smoking cessation,
stress management, cholesterol reduction).