Health Education

Strategies and
counseling

By

Assistant Professor. Dr/ Ferial Fouad Melika

Community Health Nursing,
Faculty of Nursing, Ain Shams University

Second Year

2018/2019
 Acknowledgments

This two-year curriculum was developed through a participatory and collaborative approach
between the Academic faculty staff affiliated to Egyptian Universities as Alexandria University, Ain
Shams University, Cairo University , Mansoura University, Al-Azhar University, Tanta University, Beni
Souef University , Port Said University, Suez Canal University and MTI University and the Ministry of
Health and Population(General Directorate of Technical Health Education (THE). The design of this
course draws on rich discussions through workshops. The outcome of the workshop was course
specification with Indented learning outcomes and the course contents, which served as a guide to
the initial design.

We would like to thank Prof.Sabah Al- Sharkawi the General Coordinator of General Directorate of
Technical Health Education, Dr. Azza Dosoky the Head of Central Administration of HR
Development, Dr. Seada Farghly the General Director of THE and all share persons working at
General Administration of the THE for their time and critical feedback during the development of
this course.

Special thanks to the Minister of Health and Population Dr. Hala Zayed and Former Minister of
Health Dr. Ahmed Emad Edin Rady for their decision to recognize and professionalize health
education by issuing a decree to develop and strengthen the technical health education curriculum
for pre-service training within the technical health institutes.

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 Contents

Course Description ............................................................... vii

Chapter 1:Health Education …………………………………………………………………….…7

Chapter 2:Educational strategies (educational methods and materials)...14

Chapter 3: Health and Human Behavior………………………………………………….27

Chapter 4: Health Counseling .................................................. 36

Chapter 5: Planning, Implementation and Evaluation of Health Education

Programs …………………………………………………………………………………………….…….49

Chapter 6: Ethical Issues in Health Education ............................... 68

References and Recommended Readings .................................... 71

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 Course Description

This course will focus on the health educations, counseling, and different types of
educational strategies for individual, groupe, and community in some health situations, .
This involves identifying, understanding and addressing appropriate health educational
sessions for a person through designing, implementing and evaluating a health education
program. Students will learn and differentiate between different types of educational
methods and materials related to any health situation.

Core Knowledge

By the end of this course, students should be able to:

 Identify the Approach to health education

 Describe the aims and basic principles of health education
 Determine the contents of health education and health education settings
 Identify the role of Health educator
 Delineate the educational Methods And Materials
 Define the behavior and its effect on human health state
 Distinguishing characteristics of culture
 Determine the five categories counseling goals and its purpose
 Determine the different fields of counseling
 Describe the ethical consideration for health educators and counselor

Core Skills

By the end of this course, students should be able to:

 Develop a health education program
 Implement the health educational cession by selection appropriate method of
education and materials

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  Apply appropriate health educations skills for the individual, group, and community in
different situations
 Apply principles of counseling skills.
 Apply the ethical issues related to health educator and counselor.

Course Overview
Methods of Teaching/Training with
Number of Total Hours per Topic

Assignment
Field Work
Interactive

Research
ID Topics

Lecture

Class

Lab
s
Health Education
1 1. Definitions
2. Approach to health education 2
3. Aims and Basic Principles of health education
4. Contents of health education
5. Health Education settings
2
6. Practice of health education
7. Role of Health educator
Health education strategies( Educational Methods And
2 Materials
1. Individual educational methods 2
2. Group Educational Methods
3. Teaching materials (Mass communication)
Health and Human Behavior
3 1. Introduction
2. Definitions of behavior and other related terms
3. Distinguishing characteristics of culture 2
4. Examples of behaviors promoting health and preventing diseases
Health and Human Behavior cont…..
5. Factors affecting human behavior
6. Predisposing factors: provide the rationale or motivation for the
7. Enabling factors: 2
8. Reinforcing factors:

Health and Human Behavior cont…..

9. The role of human behavior in prevention of disease and
promotion of health
10. Levels of prevention of disease 2
1. Primary prevention
2. Secondary prevention
3. Tertiary prevention
Health Counseling
1. Definition of Counseling
2. The importance of counseling. 2
4 3. The four types of Counseling.
Health Counseling cont…..
4. The principles of counseling
5. The Characteristics of Effective counselor 2
6 Stages of counseling
7. The fields that Counseling Address
Health Counseling cont…..
2
8. Steps of counseling.

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 9. Factors influencing counseling outcomes
Planning, Implementation and Evaluation of Health
Education Programs
1. Introduction 2
2. Planning process
3. Information gathering
Planning, Implementation and Evaluation of Health
Education Programs cont……
5 4. Defining and prioritizing problems
2
5. Setting goals and objectives
6. Identifying and obtaining resources
7. Selecting appropriate methods .
Planning, Implementation and Evaluation of Health
Education Programs cont……
2
8. Development and implementing a program
9. Evaluating the program
Ethical Issues in Health Education
1. Introduction
2. Definition 2
3. Basic ethical principles
4. The principle of autonomy
Ethical Issues in Health Education cont…….
6 5. Beneficence (doing good)
6. Non-maleficence (doing no harm)
7. Justice (fairness) 2
8. The principle of truth telling (honesty)
9. Ethics for the performance of health extension workers as health
educators
TOTAL HOURS (26) 26

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 Chapter 1
Health Education

Objectives
1. Define the health education
2. Discuss the approach to health education
3. Identify the aims and basic principles of health education
4. Describe the contents of health education
5. Identify the health education settings
6. Determine the role of Health educator

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.

Historical development

At the time of Alma Ata declaration of Primary Health Care in 1978, health education
was put as one of the components of PHC and it was recognized as a fundamental tool to
the attainment of health for all. Adopting this declaration, Egypt utilizes health
education as a primary means of prevention of diseases and promotion of health. In view
of this, the national health policy and Health Sector Development Program of Egypt have
identified health education as a major component of program services.

1- Definetion of the health education related terms

 Health: WHO defined health as ―a state of complete physical, mental, and social well
being and not the mere absence of disease or infirmity

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 Health education
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)

‗‗A process aimed at encouraging people to want to be healthy, to know how to stay
healthy, to do what they can individually and collectively to maintain health, and to
seek help when needed‘‘ Alma-Ata declaration (1978)

 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.
 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: 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.

2. The approach to health education

 Legal or Regulatory Approach

Any governmental intervention, direct or indirect, designed to alter human behavior.

 Eg: Child marriage act in rural area, Seat belts rule in cars etc.

 Service Approach
Intends to provide all the health facilities needed by the people at their door
 EG: when water seal latrines were provided, free of cost, in some villages in
Upper Egypt under the Community Development Program, people did not use
them.

 Approach in Health Education

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  Since individuals vary so much in their socio-economic conditions, traditions,
attitudes, beliefs and level of knowledge
 A single approach may not be suitable.
 Combination of approaches must be evolved depending upon local
circumstances

3- The aims and basic principles of health education

Aims and Objectives

 To encourage people to adopt and sustain health promoting life style and
practices.
 To promote the proper use of the health services available to them.
 To arouse interest to provide new knowledge, improve skilled and change
attitudes in making rational decisions to solve their own problems.
 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.

 Principles of Health Education

1) CREDIBILITY 8) KNOWN TO UNKNOWN

2) INTEREST 9) SETTING AN EXAMPLE
3) PARTICIPATION 10) GOOD HUMAN RELATIONS
4) MOTIVATION 11) FEEDBACK
5) COMPREHENSION 12) COMMUNITY LEADERS
6) REINFORCEMENT 13) SOIL, SEED, SOWER
7) LEARNING BY DOING

1) CREDIBILITY
 It is the degree to which the message is perceived as trustworthy by the
receiver
 It should be scientifically proven, based on facts and should be compatible with
local culture and goals

2) INTEREST
 If the health education topic is of interest to the people, they will listen to it.

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  Health educator should identify the ―felt needs‖ of the people and then prepare a
program that they can actively participate in to make it successful

3) PARTICIPATION
 Health educator should encourage people to participate in the program
 Once the people are given a chance to take part in the program it leads to their
acceptance of the program
 Methods like group discussion, panel discussions etc. provide opportunities for
people‘s participation

4) MOTIVATION
 ―the fundamental desire for learning in an individual‖
 Health education can be facilitated by the motivation provided by the desire to
achieve individual goals
 Eg:-for a teenager, esthetics might be a motive to take care of his teeth whereas
for an adult, the expenses of undergoing restorative care

5) COMPREHENSION
 Level of understating of the people who receive the health education
 Should first determine the level of literacy and understanding of the audience and
act accordingly
 words that are strange or new to the people should not be used
 Use of technical terms or medical terms should be avoided

6) REINFORCEMENT
 This is the principle that refers to the repetition needed in health education
 It is not possible for the people to learn new things in a short period of time
 So repetition is a good idea
 This can be done at regular intervals and it helps people to understand new ideas
or practice better
 ―booster dose in health education‖

7) LEARNING BY DOING
 If the learning process is accompanied by doing new things it is better instilled in
the minds of people
 ―if I hear, I forget; if I see, I remember; if I do, I know‖

8) KNOWN TO UNKNOWN
 Before the start of any health education program, the health educator should find
out how much the people already know and then give them the new knowledge.

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  The existing knowledge of the people can be used as the basic step up on which
new knowledge can be placed

9) SETTING AN EXAMPLE
 The health educator should follow what he preaches.
 He should set an example to others to follow

10) GOOD HUMAN RELATIONS

 This principle states that the health educator should have good personal qualities
and should be able to maintain friendly relations with the people
 The health educator should have a kind and sympathetic attitude towards the
people and should always be helpful to them in clarifying doubts or repeating
what is not understood

11) FEEDBACK
 For any program to be successful it is necessary to collect feedback to find out if
any modifications are needed to make the program more effective

12) COMMUNITY LEADERS

 Community leaders can be used to reach the people of the community and to
convince them about the need for health education
 Leaders can also be used to educate the people as they will have a rapport and
will be familiar with the people of their community
 The leader will have an understanding of the needs of the community and advice
and guide them

13) SOIL, SEED, SOWER

 Soil is the community
 Seed is information
 Sower is the person giving the information
.
4. Describe the 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.

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  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.

 Environmental Hygiene:
(a) To educate the people 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 programs 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 of Accidents: occur in three main areas: the home, road and the
place of work.

 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.

5. Identify the health education settings

When considering the range of health education interventions, they are usually
described in relation to different settings. Settings are used because interventions need
to be planned in the light of the resources and organizational structures peculiar to
each. Thus, health education and promotion takes place, amongst other locations, in:

• Communities
• Health care facilities
• Work sites
• Schools
• Prisons
• Refugee camps …etc

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Who is responsible for health education?

Health education is the duty of everyone engaged in health and community

development activities. Health Extension Workers are primarily responsible in working
with the families and community at a grass root level to promote health and prevent
disease through provision of health education.

6. Determine the role of Health educator

• Talking to the people and listening of their problems

• Thinking of the behavior or action that could cause, cure and prevent these problems.
• Finding reasons for people‘s behaviors
• Helping people to see the reasons for their actions and health problems.
• Asking people to give their own ideas for solving the problems.
• Helping people to look as their ideas so that they could see which were the most
useful and
the simplest to put into practice.
• Encouraging people to choose the idea best suited to their circumstances.

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 Chapter 2

Educational strategies

Educational Methods and Materials

Objectives

At the end of this chapter, the trainees are expected to:

1. Explain the common methods of transmitting health information
2. Describe the advantages and disadvantages of interpersonal and mass media
communication means
3. Explores the role of counseling at the grass root level
4. List major traditional as well as modern methods for group communications
5. Explain common teaching aids used for effective communication

Introduction

Basically health education helps people to make wise choices about their health and the
quality of life of their community. To do this, accurate information must be presented in
an understandable way using different methods.

Ways to put across health messages:

1. Direct – Interpersonal (Individual and groups)
2. Indirect – Mass media and visual aids.

To transmit information effectively, you have to choose appropriate educational

tools. For example, where resistance is anticipated because the changes recommended
are contrary to deeply held traditions, intensive interpersonal educational efforts may
be necessary. Where the benefits of a recommended change are so great that resistance
is low, mass media can be used.

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 The health education is more effective when achieve the effective health
communication which is seldom achieved through the use of one method alone. Nearly
always, a combination of techniques is needed to achieve behavior changes. Both
effectiveness and costs must be considered in choosing a combination of techniques.
Besides, selection of local media is appreciably useful.

Educational methods

1. 1. Individual educational methods

a) Personal interviews
b) Personal contact
c) Home visits
d) Personal letter
e) Health Counseling
This service could be given to patients at the health center, to pupils at school, to
families during a home visit or during casual visits to community (e.g. Market place, at
water well etc). This health education methods provided by :
– Public health supervisors, nursing staff and health visitors
– visit hundreds of homes;
– opportunities for individual teaching

– Advantages

 When people are in their home, they usually feel happier and more secure.
You may find that people are more willing to talk in their own homes than
when they are at the clinic.
 It also gives an opportunity to see how the environment and the family
situation might affect a person‘s behavior; thus, making observations and any
necessary suggestions for change right there.
 Keeps a good relationship with people and families
 Encourages the prevention of common diseases.

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  Enables detecting and improving troublesome situations early, before they
become big problems.
 Enhances checking on the progress of a sick person, or on progress towards
solving other problems.
 Motivate the family on how to help a sick person in which their participation is
needed.

2. Group Educational Methods

It is needless to mention that much of the problem solving in the community has to
be done by group work and cannot be attempted at individual level alone. Specifically,
working with groups is a major activity in health education. When people get together to
identify, define, and solve a problem, they have many more resources than when they
work individually.
 These methods are effective in
– Promoting behavioral change,
– Influences opinion,
– Develop critical thinking
– Increase motivation.
 What is a Group?

A group could be defined as a gathering of two or more people who have a common
interest. Example of groups often found in a community:

• A family
• A health committee
• People working at the same factory, business, or agency
• A class of school children
• A farmers‘ cooperative
• A youth club
• People attending a religious ceremony together
• Some friends getting together to relax
• A gathering of patients at a clinic

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 • People riding together on a bus

The Value of Group Education

• In a group, one can find the support and encouragement needed to promote and
maintain healthy practices.
• It permits sharing of experience and skills.
• Working in groups makes it possible to pool the resources of all members.
E.g. to dig a well, group of families can contribute enough money

Common Methods Used for Group Education

a) Group discussions
Discussion in a group allows people to say what is in their minds. They can talk
about their problems, share ideas, support and encourage each other to solve problems
and change their behavior.
Size of a group: For sharing of ideas an ideal group is the one with 5-10 members. If the
members are large every one may not have a chance to speak.

 Planning a discussion

• Identification of the discussants that do have a common interest

E.g. mothers whose child suffers from diarrhea.
• Getting a group together
• Identification of a comfortable place and time:

 Conducting the discussion

• Introduction of group members to each other

• Allow group discussion to begin with general knowledge
E.g. any health problems they have ever faced
• Encourage everyone to participate.
- Have a group act out some activity (drama, role play)
- Have a client report on a successful experience
- Limit those who talk repeatedly and encourage the quiet to contribute.
• Limit the duration of discussion to the shortest possible, usually 1-2 hrs.

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 • Check for satisfaction before concluding the session.
E.g. Do they think that they are learning?
Do they think the group should continue?

b) Meetings
Meetings are good for teaching something of importance to a large group of
people. They are held to gather information, share ideas, take decisions, and make
plans to solve problems. Meetings are different from group discussions. A group
discussion is free and informal, while meetings are more organized. Meetings are an
important part of successful self-help projects.

 Planning a meeting

• It should be need based

• Determine the time and place
• Announce the meeting through village criers or word of mouth.
• Prepare relevant and limited number of agendas.

 Conducting the meeting

• Should be led by a leader

• Encourage participation as much as possible
• Try to reach at consensus based decisions
• Use some visual aids to clarify things
• Finally, get ready to take actions to solve problems.

c) Clubs
There are many kinds of organizations to which women, men and young people
belong. Clubs are becoming popular in many areas.
They provide an opportunity for a systematic way of teaching over an extended
period of time. E.g. a group of citizens could form an association to deal with problems
related to a major local disease or to protect the environment.

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 d) Demonstrations
A demonstration is a step-by step procedure that is performed before a group.
They involve a mixture of theoretical teaching and of practical work, which makes them
lively. It is used to show how to do something. The main purpose of demonstrations is
helping people learn new skills. The size of the group should be small to let members
get the chance to practice.

 Planning the Demonstration

• Identify the needs of the group to learn

• Collect the necessary materials such as models and real objects or posters and
photographs.
• Make sure that it fits with the local culture. E.g. for nutrition demonstration
you have to use the common food items and local cooking methods.
• Prepare adequate space so that everyone could see and practice the skill.
• Choose the time that is convenient for everyone.

 Procedures
 Introduction:
 Do the demonstrations:
 Questions:
 Summarize:

Checklist to evaluate a demonstration

 Did the audience learn how to do what was demonstrated?

 What evidence was given that the audience plans to carry out this practice on
their own?
 Visit members of the audience to see if they are using the new methods
demonstrated.
 How could your demonstration be improved?

e) ‘Village’ criers
They spread information in the community in the past eras & even today in

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remote areas where modern mass media are scarce. When they have something to say,
ordered by village leaders, they may use a bell or drum to attract attention.
The following messages could be passed on:
• A reminder to mothers to immunize their children
• A request that people participate in a village sanitation campaign
• A call for people to work in a community project
• A warning about dirty water during cholera outbreak

f) Songs
In addition to expression of feelings, songs can also be used to give ideas about
health. You can give topics that you want to make popular to those persons for synthesis
and dissemination. For instance, the following issues could be entertained:
• The community without safe water
• The malnourished child who got well with the proper food to eat
• The house where no flies and mosquitoes breed

g) Stories
Story telling is highly effective, can be developed in any situation or culture, and
requires no money or equipment. It should include some strong emotions like sadness,
anger; humor, or happiness as well as some tension and surprise. Stories can entertain,
spread news and information so that people are encouraged to look at their attitudes
and values, and to help people decide how to solve their problems.

h) Proverbs
They are short common-sense sayings that are handed down from generation to
generation. They are like advice on how best to behave. Some proverbs are straight
forward- others are more complicated.
Examples
 One does not go in search of a cure for ringworm while leaving leprosy
unattended. This is to mean: �try to solve the most serious problem first.
 A young man may have as many new clothes, but not as many worn-out
clothes, as an old man. This is to mean:

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  An old man has more experience than a young one
 Prevention is better than cure.

i) Drama
Drama is less common in community, but it is a good means to entertain people in
a message. Their preparation, practice and others may incur time and money. This
means that it is somehow difficult to prepare repeatedly. Yet, they are extremely useful
for conferences, workshops and refresher courses.
Dramas should have one main learning objective but can often include 2 or 3
other less important objectives as well. Alike stories, dramas make us look at our own
behavior, attitudes, beliefs and values in the light of what we are told or shown. Plays
are interesting because you can both see and hear them.

j) Role - playing
Role-playing can be used to start off a discussion, to see what possible
consequences of a certain action are, and to develop a better understanding of why
people feel as they do.

1) 2- Teaching materials (Mass communication)

Teaching materials include all materials that are used as teaching aids to support
the communication process and bring desired effect on the audience. The following are
some selected teaching aids that are commonly used in health education programs.

1. Audios
Audios include anything heard such as spoken-word (talk), music or any other
sounds. Talks are the most commonly used audio teaching methods.
Characteristics of audios:
- Effective when based on similar or known experience
- Could be distorted or misunderstood when translated
- Easily forgotten
Health talks
The most natural way of communicating with people is to talk with them. In
health education, this could be done with one person, a family, or with groups (small or

21
large). Health talks have been, and remain, the most common way to share health
knowledge and facts. However, we need to make it more than advice and make
effective by combining it with other methods, especially visual aids, such as posters,
slides, demonstrations, video show etc.
In principle, it should be given to smaller group (5 to 10 people) though it could be given
for larger group like radio talk. In health talks, unclear points could be asked and
discussed.

In preparing a talk, consider the following points:

 Know the group: their interests and needs

 Select single and simple topic: e.g. Nutrition is too big as a topic. Thus,
select subtopic such as breast-feeding, weaning diet etc.

 Have corrected and up-to- date information.

 Limit the points to only main once.

 Write down what you will say, use examples, proverbs and stories to help
emphasize points.

 Make use of visual aids.

 Practice your whole talk

 Make the talk as short as possible - usually 15-20 minutes talk and 15
minutes discussion.

2. Visual aids

Visuals are objects that are seen. They are one of the strongest methods of
communicating messages; particularly when accompanied with interactive methods.

Advantages

• They can easily arouse interest

• Provide a clear mental picture of the message

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 • Speed up and enhance understanding
• Can stimulate active thinking
• Create opportunities for active learning
• Help memory and provide shared experience.

The Chinese proverb goes for this:

• If I hear, I forget
20% of what you hear
• If I see, I remember
• If I do, I know 50% of what you hear and
see

90% of what you hear,

see and do

3- Non-projected materials (aids) or graphics

They are shown or displayed and do not necessarily depend on any projected
equipment.

a. Leaflets:
Leaflets are unfolded sheet of printed material. Leaflets can be very appealing if
their message is simple and clear, and if the language is understood by the reader. In
preparing them, short sentences and paragraphs should be used, illustrated with simple
drawings or pictures that are easily understood. They need to be pre-tested before
distributed to the villagers.

b. Newspapers/Newsletters

Newspapers might be of some help in reaching the people. Very often, though,
the national or regional newspapers do not reach smaller communities, or the people
are unable to read them. In this case, newsletters, written by the community members
themselves, teachers and extension workers can become the communities‘ newspaper.

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 c. Photographs

Photographs can be used to show people new ideas or new skills being practiced.
They can also be used to support and encourage new behavior. They are best used with
individuals and small groups.

Advantages

• They can be photographed in the town where you work thus assuring familiarity
and recognition by the people.
• They are relatively inexpensive and reproducible for different uses (posters,
flipcharts)
• You can make them yourself.

d. Posters

A poster is a large sheet of paper, often about 60 cm wide by 90cm high with
words and pictures or symbols that put across a message. It is widely used by
commercial firms for advertising products, but can also be used for preventive purposes.

Advantages

• Give information and advice, e.g. beware of HIV/AIDS! Give directions and
instructions, e.g. how to prevent HIV / AIDS
• Announce important events and programmers, e.g. World AIDS day

Standard rules in making posters:

• All words should be in the local language
• Words should be limited and simple
• Symbols that illiterate people will also understand should be used
• Mix of colors should be used to attract attention
• Only put one idea on a poster.

General principles:

• They should contain the name of the event, date, time, and place

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 • They should be large enough to be seen from some distance;
• They could be used for small or larger groups
• Should be placed where many people are likely to pass
• Do not leave them up for more than one month, to avoid boredom
• Never use them before pre-testing.

e. Flipchart

A flipchart is made up of a number of posters that are meant to be shown one

after the other. In this way, several steps or aspects of a central topic can be presented
such as about family planning.

f. Flannel graphs

A flannel graph is a board covered with flannel cloth. The flannel graph is one of
the most effective and easily used teaching aids because it is cheap and portable.
Pictures and words can be placed on the board to reinforce or illustrate your message.

G . Displays

A display is an arrangement of real objects, models, pictures, poster, and other

items, which people can look at and learn from. Like a poster, it provides ideas and
information but where as a poster contains only one idea, a display has many. E.g. how
a child develops and grows.

4. Projected aids
Projected materials are simply educational materials that are shown to people
using a projector.
The commonly utilized once are slide projectors (color pictures on a transparent
object), overhead projectors (display written or drawn materials on a transparency),
and power point projectors. They are expensive, requires expertise and electric power.
They are useful to underline the most important points in a talk or lecture.

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 Mass Media

It is one way of giving health education. The communication that is aimed to

reach the masses or the people at large is called mass communication. The media that
are generally used for mass communication go by the name of mass media. The
commonly used mass media are microphones or public address system, radio, television,
cinema, newsprints, posters, exhibitions.
Mass media are the best methods for rapid spread of simple information and facts
to a large population at low cost.

Table1.Main characteristics of mass media and face- to- face channels

Characteristics Mass media Mass media Face to face

Speed to cover large Rapid Slow
population
Accuracy and lack of Highly accurate Easily distorted
distortion
Ability to select particular Can be highly selective
Difficult to select audience
audience
Provides non-specific Can fit to local need
Ability to fit to local needs
information
Direction
One-way Two- way
Feed back Only indirect feedback from Direct feedback possible
surveys
Change in attitudes and
Main effect Increase
behavior; problem solving.
knowledge/awareness

Selection of Teaching Methods and Materials: Depends on

1. The type of the message
2. The purpose
3. The people addressed
4. Availability of resources
5. Availability of skills.

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 Chapter 3
Health and Human Behavior

Objectives

At the end of this chapter, the trainees are expected to:

• Define behavior and related terms
• Describe the factors which affect human behavior
• Discuss on the role of human behavior in prevention of disease and promotion of
health.
4. Apply the levels of prevention of disease as primary prevention, secondary
prevention and tertiary prevention

Introduction
In the previous section, we have tried to discuss the concept of health and health
education. Human behavior is among the major determinants of the health of
individuals, families or communities.
Healthy behaviors contribute to the overall health of individuals and communities
and unhealthy behaviors adversely affect the quality of life people at different levels.
Most health issues cannot be dealt with by treatment alone. The promotion of health
and prevention of diseases will usually involve some changes in life styles or human
behavior.
Definitions of behavior and other related terms
Behavior: Is an action that has a specific frequency, duration and purpose whether
conscious or unconscious. It is what we ―do‖ and how we ―act‖. People stay healthy or
become ill, often as a result of their own action or behavior.

27
The following are examples of how people’s actions can affect their health:
• Using mosquito nets and insect sprays helps to keep mosquito away.
• Feeding children with bottle put them at risk of diarrhea.
• Defecating in an open field will lead to parasitic infection.
• Unsafe sex predisposes people to unwanted pregnancy, HIV/AIDS and other STDs.
In health education it is very important to be able to identify the practices that
cause, cure, or prevent a problem.

The words actions, practices and behaviors are different words of the same thing.

Life style: refers to the collection of behaviors that make up a person‘s way of life-
including diet, clothing, family life, housing and work.

Customs: It represents the group behavior. It is the pattern of action shared by some
or all members of the society.

Traditions: are behaviors that have been carried out for a long time and handed own
from parents to children.

Culture: is the whole complex of knowledge, attitude, norms, beliefs, values, habits,
customs, traditions and any other capabilities and skills acquired by man as a member of
society.

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Health education strategies
and counseling

Distinguishing characteristics of culture

• Culture is symbolic. It is an abstract way of referring to, and understanding ideas,
objects, feelings or behavior –the ability to communicate with symbols using language.
To convey new ideas people may invent single words to represent many different ideas,
feelings or values.
• Culture is shared. People in the same society share common behavior patterns
and ways of thinking through culture. For example people living in a society share
the same language, dress in similar styles, eat much of the same food and
celebrate many of the same holidays.
• Culture is learned. A person must learn culture from other people in a society.
For instance, people must learn to speak and understand a language and to abide
by the rules of a society.
• Culture is adaptive. People use culture to adjust flexibly and quickly to changes
in the world around them. For instance a person can adjust his diet when he
changes an area of residence.

Examples of behaviors promoting health and preventing diseases

Healthy behaviors: - actions that healthy people undertake to keep themselves

or others healthy and prevent disease. Good nutrition, breast feeding, reduction of
health damaging behaviors like smoking are examples of healthy behaviors.

Utilization behavior: - utilization of health services such as antenatal care,

child health, immunization, family planning…etc

Illness behavior: - recognition of early symptoms and prompt self referral for
treatment.

Compliance behaviors: - following a course of prescribed drugs such as for

tuberculosis.

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 Health education strategies
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Rehabilitation behaviors: - what people need to do after a serious illness to

prevent further disability.
Community action: - actions by individuals and groups to change and improve their
surroundings to meet special needs.

Factors affecting human behavior

1. Predisposing factors:
Provide the rationale or motivation for the behavior to occur. Some of these are:
 Knowledge
 Belief
 Attitudes
 Values
 Norms
E.g. For an individual to use condom, he has to have knowledge about condom and
develop positive attitude towards utilization of condom.

Knowledge

Knowledge is to know things, objects, events, persons, situations and

everything in the universe. It is the collection and storage of information or
experience. It often comes from experience. We also gain knowledge through
information provided by teachers, parents, friends, books, newspapers, etc…
E.g. knowledge about methods of prevention of HIV

Belief

Belief is a conviction that a phenomenon or object is true or real. Beliefs deal

with people understands of themselves and their environment. People usually do not
know whether what they believe is true or false. They are usually derived from our
parents, grandparents, and other people we respect. Beliefs may be helpful,

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Health education strategies
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harmful or neutral. If it is not certain that a belief is harmful, it is better to leave it

alone.
For example, a certain society may have the following beliefs:
• Holding materials made of iron by mothers during postpartum (Neutral)
• Diarrhea may end up with death (helpful)
• Measles cannot be prevented by immunization (harmful)

Attitudes
Attitudes are relatively constant feelings, predispositions or set of beliefs
directed towards an object, person or situation. They are evaluative feelings and
reflect our likes and dislikes. They often come from our experiences or from those
of people close to us. They either attract us to things, or make wary of them.

E.g. Mr. Amed had fever and visited the nearby health center.
The staff on duty that day was very busy and shouted at her, ―Do you want us
to waste our time for a mild fever? Come back when we are less busy.‖ She did not
like being shouted at. This experience gave her bad attitude toward the health
staff. This bad attitude could discourage her from attending the health center next
time she is sick.

Values
Values are broad ideas and widely held assumptions regarding what are
desirable, correct and good that most members of a society share. Values are so
general and abstract that they do not explicitly specify which behaviors are
acceptable and which are not. Instead, values provide us with criteria and
conceptions by which we evaluate people, objects and events as their relative
worth, merit, beauty or morality.
E.g. being married and having many children are highly valued in most rural
community.

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 Health education strategies
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Norms

Norms are social rules that specify appropriate and inappropriate behavior in
given situations. They tell us what we should and must do as well as what we should
not and must not do.

For Example,
• We often regard greeting as a social norm to be conformed among members
who know each other.
• Murder, theft and rape often bring strong disapproval.

2. Enabling factors:
These are characteristics of the environment that facilitates healthy behavior
and any skill or resource required to attain the behavior. Enabling factors are
required for a motivation to be realized.

Examples of enabling factors include:

• Availability and or accessibility of health resources
• Government laws, priority and commitment to health
• Presence of health related skills

E.g. : Enabling factors for a mother to give oral rehydration solution to her child
with diarrhea would be:
• Time, container, salt, sugar
• Knowledge on how to prepare and administer it In general, it is believed that
enabling factors should be available for an individual or community to perform
intended behavior.

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Health education strategies
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(Time, money and materials, skills, accessibility to health services)

Behavioral intention is willingness/ readiness to perform a certain behavior provided

that enabling factors are readily available.

3. Reinforcing factors:
These factors come subsequent to the behavior. They are important for
persistence or repetition of the behavior. The most important reinforcing factors for
a behavior to occur or avoid include:
• Family
• Peers, teachers
• Employers, health providers
• Community leaders
• Decision makers

We are all influenced by the various persons in social network.

Pressure from others can be a positive influence to adopt health promoting
practices as well as an obstacle.
Influential people significant influence to change others. In the case of
a young child, it is usually the parents who have the most influence. As a
child grows older, friends become important and a young person can feel a
powerful pressure to conform to the peer group.

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 Health education strategies
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E.g. a young man starts smoking because his friends encouraged him to do so.

The role of human behavior in prevention of disease and promotion

of health

What is prevention?
Prevention is defined as the planning for and the measures taken to forestall
the onset of a disease or other health problem before the occurrence of undesirable
health events. There are three distinct levels of prevention: primary, secondary,
tertiary prevention.

Figure 1: level of prevention

Primary prevention
Primary prevention is comprised of those activities carried out to keep people
healthy and prevent them from getting disease. Examples of important behaviors for
primary prevention includes using rubber gloves when there is a potential for the
spread of disease, immunizing against specific diseases, exercise, and brushing
teeth. And any health education or promotion program aimed specifically at
prevention of the onset of illness or health problems is also an example of primary
prevention.

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Health education strategies
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Secondary prevention
Secondary prevention includes preventive measures that lead to an early
diagnosis and prompt treatment of a problem before it becomes serious. It is
important to ensure that the community can recognize early signs of disease and go
for treatment before the disease become serious. Health problems like tuberculosis
can be cured if the diseases are detected at an early stage. The actions people take
before consulting a health worker, including recognition of symptoms, taking home
remedies (‗self-medication‘), consulting family and healers are called illness
behaviors. Illness behaviors are important examples of behaviors for secondary
prevention.
Tertiary prevention
Tertiary prevention seeks to limit disability or complication arising from an
irreversible condition. Even at this stage actions and behaviors of the patient are
essential. The use of disability aids and rehabilitation services help people from
further deterioration and loss of function. For example, a diabetic patient should
take strictly his/her daily insulin injection to prevent complications.

Figure 2: The level of prevention primary, secondary, and tertiary

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 Health education strategies
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Chapter 4
Health counseling

Objectives

At the end of this chapter, the students will be able to:

1. Define Counseling
2. Enumerate the importance of counseling.
3. Differentiate between four types of Counseling.
4. list principles of counseling
5. Enumerate the Characteristics of Effective counselor
6. List Stages of counseling
7. Enumerate fields that Counseling Address
8. Recall Steps of counseling.
9. Discuss Factors influencing counseling outcomes
Introduction
Counseling is a concept that has existed for a long time. We have sought
through the ages to understand ourselves, offer counsel and develop our
potential, become aware of opportunities and, in general, help ourselves in
ways associated with formal guidance practice.

Counseling is as old as society. In every-day life we find counseling goes

on at many levels-in a family set-up, parents counsel their children, in society
doctors counsel patients, lawyers counsel clients and teachers counsel
students. In most communities, there has been, and there still is, a deeply
embedded conviction that, under proper conditions, people can help others

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Health education strategies
and counseling

with their problems. Some people help others find ways of dealing with,
solving, or transcending problems.
In schools, if the collaboration between teachers and students is good,
students learn in a practical way. Young people develop degrees of freedom in
their lives as they become aware of options and take advantage of them. At its
best, helping should enable people to throw off chains and manage life
situations effectively.
Concepts of counseling

Counseling is a face-to-face communication that you have with your

client or couple in order to help them arrive at voluntary and informed
decisions. It is somewhat different from advice, in which you try to solve a
client‘s problem by giving information and your personal opinion.

Counseling is a collaborative effort between the counselor and client.

Professional counselors help clients identify goals and potential solutions to
problems which cause emotional turmoil; seek to improve communication and
coping skills; strengthen self-esteem; and promote behavior change and
optimal mental health.

Counseling is a process by means of which the helper expresses care and

concern towards the person with a problem, and facilitates that person's
personal growth and brings about change through self-knowledge.

Counseling is a relationship between a concerned person and a person

with a need. This relationship is usually person-to-person, although sometimes
it may involve more than two people.

Counseling: An interactive process characterized by a unique

relationship between the counselor and client that leads to change in one or
more of the following areas:
 Behavior.
 Beliefs or emotional concerns relating to perceptions.

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Health education strategies
and counseling

 Level of emotional distress.

How does counseling help?

Counseling can help in these ways:
 To learn new skills and better ways to cope.
 To understand what you are experiencing.
 To learn new ways of looking at what is happening.
 To solve problems and make decisions.
 To learn about our strengths and how to use them.
 To change an unwanted or unwelcome behavior.
 To better cope.
 To make and implement decisions.
 To enhance relationships.

Types of counseling:

A. Individual counseling
Individual counseling is a personal opportunity to receive support and
experience growth during challenging times in life. Individual counseling can
help one deal with many personal topics in life such as anger, depression,
anxiety, substance abuse, marriage and relationship challenges, parenting
problems, school difficulties, etc.

B. Couple counseling
Every couple experiences ups and
downs in their levels of closeness and
harmony over time. This can range from
basic concerns of stagnation to serious
expressions of aggressive behavior.
Marriage counseling or couples counseling

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Health education strategies
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can help resolve conflicts and heal wounds. Overall, couples counseling can
help couples slow down their spiral and reestablish realistic expectations and
goals.

C:Group counseling
Group counseling allows one to find out that they are not alone in their
type of life challenge. To be involved in a group of peers who are in a similar
place not only increases one understands of the struggles around the topic but
also the variety in the possible solutions
available. Typically, groups have up to eight
participants, one or two group leaders, and
revolve around a common topic like: anger
management, self-esteem, divorce, and
domestic violence, recovery from abuse and
trauma, and substance abuse and recovery.

D.Family Counseling
Family counseling is often sought due to a life change or stress negatively
affecting one or all areas of family closeness, family structure (rules and roles)
or communication style. This mode of counseling can take a variety of forms.
Sometimes it is best to see an entire family together for several sessions.

Common issues addressed in family counseling

are concerns around parenting, sibling conflict,
and loss of family members, new members
entering the family, dealing with a major move
or a general change affecting the family system.

General principles of counseling

These are the important principles and conditions necessary for effective
counseling:
 Privacy — find a quiet place to talk.

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 Health education strategies
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 Take sufficient time.

 Maintain confidentiality.
 Conduct the discussion in a helpful atmosphere.
 Keep it simple — use words people can understand.
 First things first — do not cause confusion by giving too much information.
 Say it again — repeat the most important instructions again and again.
 Use available visual aids like posters and flip charts, etc.
Skills and characteristics of Effective counselor
The most important characteristics are:
 Respect the dignity of others.
 Respect the client‘s concerns and ideas.
 Be non-judgmental and open.
 Show that you are being an active listener.
 Be empathetic and caring.
 Be honest and sensitive.
Stages of counseling
There are Six Stages for counseling

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Health education strategies
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Tools to aid counseling

Visual aids
Visual aids can be used to reinforce your discussion. Visual aids can also
stand alone as methods of providing information. The main disadvantage of using
them alone without discussion is that they do not allow for interactive
communication and therefore may be misunderstood. If you do give out visual aids
without having a discussion you can overcome this difficulty by providing people
with an opportunity to ask questions at a later point either in group or individual
discussions.
Visual aids and other tools for counseling
 posters
 leaflets or fact sheets
 flip charts
 overhead projector and transparencies
 slide shows
 models (such as female pelvis, penis)
 chalk or whiteboards
 pictographs (picture leaflets)
 songs, drama or poems
 real life examples, testimonies or case studies from women
 Written notes to remind you of points to cover.
What fields does Counseling Address?
People come to counseling when their attempts to deal with their concerns are
no longer effective. Counseling can be helpful areas such as:
 Addiction and abuse of alcohol and other drugs
 Adjustment issues, including adjustment to college life
 Anger management
 Anxiety
 Communication
 Depression
 Eating disorders

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Health education strategies
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 Gender identity and sexual orientation

 Grief
 Relationship difficulties, including roommates, significant others, and
professors
 Relationship violence and physical abuse
 Sexual assault
 Stress management
 Thoughts of suicide or preoccupation with death
 Trauma
SKILLS NEEDED IN COUNSELLING

1) Active Listening –
Giving full attention to what other people are saying, taking time to
understand the points being made, asking questions as appropriate, and not
interrupting at inappropriate times.

Comparison Chart between active and passive learning

Basis of Distinction Active Listening Passive Listening

Active listening means mindful
and actively hearing and
Definition
attempting to comprehend the
meaning of the speakers.
Listener connects with the world
Connectivity Level and actively participates with
the goal of problem-solving
Take responsibility for their own
Self-Responsibility
learning and growth
Sharp mind, alert to explore,
Mental Approach
reflect on information
Passive listening means
showing like listening
to the speaker but not
making an attempt to
comprehend the
meanings.
Listener disconnects
himself from the
outsiders and has
minimal interaction
with others
Avoids responsibility for
learning and problem-
solving
Accepts and retain
information as-is with
no intention to question
or challenge the idea
for improvement

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Health education strategies
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Self-Motivation Level Strong Week

Engagement Level High Low

Narrow-minded, low or
Strong willed, interested in new no will power,
Will-Power
ideas, open minded unreceptive to new
ideas

2) Social Perceptiveness Being aware of others' reactions and

-
understanding why they react as they do.

3) Reading Comprehension -- Understanding written sentences and

paragraphs in work related documents.
4) Critical Thinking -- Using logic and reasoning to identify the strengths and
weaknesses of alternative solutions, conclusions or approaches to problem.
5) Active Learning -- Understanding the implications of new information for
both current and future problem-solving and decision-making.
6) Speaking -- Talking to others to convey information effectively.

7) Writing -- Communicating effectively in writing as appropriate for the

needs of the audience.

8) Learning Strategies -- Selecting and using training/instructional methods

and procedures appropriate for the situation when learning or teaching new
things.

9) Complex Problem Solving -- Identifying complex problems and reviewing

related information to develop and evaluate options and implement
solutions.

10) Persuasion -- Persuading others to change their minds or behavior.

11) Monitoring -- Monitoring/Assessing performance of you, other individuals,

or organizations to make improvements or take corrective action.

12) Mathematics -- Using mathematics to solve problems.

13) Science -- Using scientific rules and methods to solve problems.

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 Health education strategies
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14) Judgment and Decision Making Considering the relative costs and
--
benefits of potential actions to choose the most appropriate one.

15) Systems Evaluation Identifying measures or indicators of system

--
performance and the actions needed to improve or correct performance,
relative to the goals of the system.

16) Instructing -- Teaching others how to do something.

17) Service Orientation -- Actively looking for ways to help people.

18) Coordination -- Adjusting actions in relation to others' actions.

Steps of counseling: the GATHER approach

GATHER is an acronym to help remember the 6 basic steps in the counseling process:

G Greet

R Return. A Ask

GATHER

E Explain T Tell

H Help

G — Greet the client

 In the first case, give your full attention to your clients.
 Greet them in a respectful manner and introduce yourself after offering seats.
 Ask them how you can help them.

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Health education strategies
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 Tell them that you will not tell others what they say.
 If the counseling is in a health institution, you have to explain what will happen
during the visit, describing physical examinations and laboratory tests if
necessary.
 Conduct counseling in a place where no-one can overhear your conversation.
A — Ask the clients about themselves
 Help them to talk about their needs, doubts, concerns and any questions they
might have.
 If they are new, use a standard checklist or form from your Health Management
Information system to write down their name and age, marital status, number
of pregnancies, number of births, number of living children, current and past
family planning use, and basic medical history.
 Explain that you are asking for this information in order to help you to provide
appropriate information, so that they can choose the family planning method
which is the best for them.
 Keep questions simple and brief, and look at her/them as you speak.
 Many people do not know the names of diseases or medical conditions. Ask
them specific questions. Say, ‗Have you had any headaches in the past two
weeks?‘, or ‗Have you had any genital itching?‘, or ‗Do you experience any pain
when urinating?‘ Do not say, ‗Have you had any diseases in the recent past‘.
 If you have seen the client(s) previously, ask if anything has changed since the
last visit.
T — Tell them all about family planning methods
 Tell them which methods are available.
 Ask which methods interest them and what they know about the methods.
 Briefly describe each method of interest and explain how it works, its
advantages and disadvantages, and possible side-effects.
H — Help them to choose a method
 To help them choose a method of contraception, ask them about their plans
and family situation. If they are uncertain about the future, begin with the
present situation.

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 Health education strategies
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 Ask what the spouse/partner likes and wants to use.

 Ask if there is anything they cannot understand, and repeat information when
necessary.
 When the chosen method is not safe for them, explain clearly why the method
may not be appropriate and help them choose another method.
 Check whether they have made a clear decision and specifically ask, ‗What
method have you decided to use?‘
E — Explain how to use a method
After a method has been chosen:
 Give supplies if appropriate.
 If the method cannot be given immediately, explain how, when and where it
will be provided.
 For methods like voluntary sterilization the client will have to sign a consent
form. The form says that they want the method, have been informed about it,
and understand this information. You must help the individual understand the
consent form.
 Explain how to use the method.
 Ask the client to repeat the instructions.
 Describe any possible side-effects and warning signs, and tell them what to do
if they occur.
 Ask them to repeat this information back to you.
 Give them printed material about the method to take home if it is available.
 Tell them when to come back for a follow-up visit and to come back sooner if
they wish, or if side-effects or warning signs occur.
R — Appoint a return visit for follow-up
At the follow-up visit:
 Ask the client if she is, or they are, still using the method, and whether there
have been any problems.
 Ask if there have been any side-effects.

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Health education strategies
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 Reassure the client/s concerning minor side-effects. Explain that the side
effects are not dangerous and suggest what can be done to relieve them.
 Refer for treatment in the case of severe side-effects.
 Ask the client if they have any questions.
Factors influencing counseling outcomes
These factors are divided into three broad categories.
1. Factors related to counselor
Respecting the rights of the client is essential to the quality and continuity of
counseling.
Every client has the right to:
1. Information — to learn about their reproductive health, contraception and
abortion options.
2. Access — to obtain services regardless of religion, ethnicity, age, and marital
or economic status.
3. Choice — to decide freely whether to use contraception and, if so, which
method.
4. Safety — to have a safe abortion and to practice safe, effective
contraception.
5. Privacy — to have a private environment during counseling and services.
6. Confidentiality — to be assured that any personal information will remain
confidential.
7. Dignity — to be treated with courtesy, consideration and attentiveness.
8. Comfort — to feel comfortable when receiving services.
9. Continuity — to receive follow-up care and contraceptive services and
supplies for as long as needed.
10. Opinion — to express views on the services offered.

2.Factors related to the client

 The client‘s level of knowledge and understanding may affect their choice.
 What they choose to do may also be affected by the extent to which they
trust and respect you.

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 Health education strategies
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 Their personal situation may make it difficult for them to choose some
methods, for example if their spouse or another family member has a
different preference to them.

3.External/programmatic factors
Shortage, unavailability of health services, in most health facilities the space
or room for the provision of family planning is integrated with other
reproductive health programs. This can make it really difficult for you to find a
place where privacy and confidentiality can be maintained.

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 Chapter 5
Planning, Implementation and Evaluation
Of Health Education Programs

Objectives

At the end of this chapter, the students will be able to:

1. Discuss the planning process
2. Describe how to carry out and evaluate health education programs
3. Apply sessions for an educational program.

Introduction
Effectively designed health education and health promotion programs can
improve health, reduce disease risks, manage chronic illnesses, and improve the
well-being and self-sufficiency of individuals, families, organizations and
communities. To be effective, these programs must have a clear understanding of
the targeted health behaviors, the target audience, and the environmental system.
Programs are designed using planning models and evaluated to assure program
success.
A health education programme may focus both on the individual and society
however; contemporary approaches to health education recognize the importance
of including a concern for the role of society.

49
The Scope of Health Education program:
Health education program is any combination of learning experiences designed
to facilitate voluntary adaption of behavior conducive to health.
It is intentionally directed toward knowledge levels, attitudes and/or specific
behaviors.
Goal of health education program:
The overall long-term goal of health education is to enable people to increase
control over their health and quality of life.

Steps of implementing health education program:

A. Planning process:
Before you can begin planning your health education program, you need
to have a clear understanding of what planning means.
Planning is the process of making thoughtful and systematic decisions about
what needs to be done, how it has to be done, by whom, and with what
resources.

Planning is central to health education and health promotion activities.

If you do not have a plan, it will not be clear to you how and when you are
going to carry out necessary tasks.

Everyone makes plans for looking after their family, for cooking, and so
on. You can build on experience you already have in planning, and apply it to
health education.

Key questions to ask when planning

 What will be done?
 When will it be done?
 Where will it be done?
 Who will do it?
 What resources are required?

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The purpose of planning in health education
There are several benefits to planning your activities.
1. Planning enables you to match your resources to the problem you intend to
solve.
2. Planning helps you to use resources more efficiently so you can ensure the
best use of scarce resources.
3. It can help avoid duplication of activities. For example, you wouldn‘t offer
health education to households on the same topic at every visit.
4. Planning helps you prioritize needs and activities. This is useful because your
community may have a lot of problems, but not the resources or the capacity
to solve all these problems at the same time.
5. Planning enables you to think about how to develop the best methods with
which to solve a problem.

Principles of planning in health education

Planning is not haphazard that means there is a principle, or a rule, which you
should take into account when developing your health education plans.

Six principles of planning in health education

1. It is important that plans are made with the needs and context of the
community in mind. You should try to understand what is currently happening
in the community you work in.
2. Consider the basic needs and interests of the community. If you do not
consider the local needs and interests, your plans will not be effective.
3. Plan with the people involved in the implementation of an activity. If you
include people they will be more likely to participate, and the plan will be
more likely to succeed.
4. Identify and use all relevant community resources.
5. Planning should be flexible, not rigid. You can modify your plans when
necessary. For example, you would have to change your priorities if a new
problem, needing an urgent response, arose.

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 6. The planned activity should be achievable, and take into consideration the
financial, personnel, and time constraints on the resources you have
available. You should not plan unachievable activities.

Steps involved in planning health education activities

Planning is a continuous process. It doesn‘t just happen at the start of a

project. If you are involved in improving and promoting individual, family and
community health, you should make sure that you plan your activities. Planning
can be thought of as a cycle that has six steps. In this section, you will learn the
basic steps to take when planning your health education activities.

Figure 3: Steps involved in planning health education activities

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Needs assessment
Conducting needs assessment is the first, and probably the most important, step
in any successful planning process. Sufficient time should be given for each
needs assessment. The amount of time required for a needs assessment will
depend on the time you have available to address the problem, and the nature
and urgency of the problem being assessed.
Needs assessment: is the process of identifying and understanding the health
problems of the community, and their possible causes. The problems are then
analyzed so that priorities can be set for any necessary interventions. The
information you collect during a needs assessment will serve as a baseline for
monitoring and evaluation at a later stage.

Before you begin a needs assessment, it is important to become familiar with

the community you are working in. This involves identifying and talking with the
key community members you would involve key community members throughout
the planning process, and in the implementation and evaluation of your health
education activities.

Types of need assessment:

There are various categories of needs assessment. In order to develop a
workable and appropriate plan, several types of needs should be identified,
including health needs and resource needs, which are outlined below.

Health needs assessment

In a health needs assessment, you identify health problems prevalent in your
community. In other words, you look into any local health conditions which are
associated with morbidity, mortality and disability. The local problems may
include malaria, TB, HIV/AIDS, diarrhea, or other conditions arising from the
local context, such as goiter caused by lack of iodine in the diet.
Having identified the problems, you need to think about the extent to which
local health conditions are a result of insufficient education. For example, are
people lacking in knowledge about malaria, or HIV, or diarrhea? Are they aware
that some of their behaviors may be part of the problem?

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1. Resource needs assessment

A resource needs assessment identifies the resources needed to tackle

the identified health problems in your community. You should consider whether
there is a lack of resources or materials that is preventing the community from
practicing healthy behaviors.

For example, a mother may have good knowledge about malaria and its
prevention methods, and want to use Insecticide Treated Bed Nets (ITNs).
However, if ITNs are not available, it may not be possible for her to avoid
malaria. Therefore, a bed net is a resource which is required to bring about
behavior change.

Similarly, a woman may intend to use contraception. However, if

contraceptive services are not available in her locality, she remains at risk of
unplanned pregnancies. In order to facilitate behavior change, you should
identify ways of addressing this lack of contraceptive resources.
Be aware too that education is in itself one of the great resources you can call
on. An education needs assessment should also be part of you plan.

Community resources
During a needs assessment, you also need to identify the resources
available in the community, such as labor power. This would include finding out
about the help that community leaders and volunteers could give, and the local
materials and spaces in which to conduct health education sessions.
When looking at community resources, you should include local information such
as the number of people in each household, their ages and their economic
characteristics. You would also include information on community groups and
their impact on local health activities and communication networks.

Assessment techniques
Data related to the health needs of the community can be obtained from two
main sources — these are called primary and secondary sources.

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 a. Primary sources: are data which you collect during a needs assessment,
using techniques such as observation, in-depth interviews, key informant
interviews, and focus group discussions.
b. Secondary sources: are data that were collected and documented for other
purposes, including health centre and health post records, activity reports,
and research reports. You may also be able to review data which has already
been collected by other people to identify local health problems.

Think about a health education issue you are aware of in your community. Make
a list of primary and secondary sources of information you could collect on this
issue.

1. 1- Observation
To carry out an observation, you watch and record events as they are
happening.

Observation is useful to understand

 Community cultures, norms and values in their social context.
 Human behavior that may be complex and hidden.

When you are observing households, individuals, or more general
practice or behavior in your community, you may find it useful to use a
checklist. For example, you could prepare a checklist to keep a detailed record
of household practice and environmental hygiene. Following your checklist might
help you to be more systematic about the things you are observing. You cannot
observe everything at the same time, so the checklist will help you prioritize
what to observe, and how to record what you have seen.
A checklist is a very helpful tool for observation, and more generally
with planning.
Checklist to organize observations

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A Health Extension Practitioner has prepared a checklist to help organize her
observations when she visits pregnant mothers in her community to put up new
insecticide-treated mosquito nets (ITNs).

The checklist includes the following points:

 Is the net hung above the bed? Yes/No

 Has it been tied at all four angles above the bed? Yes/No
 Is the net tucked under the mattress? Yes/No
 Does the net have a hole anywhere where an insect might get in? Yes/No

You have probably already gathered a lot of information by using observation

within your community. If you keep alert to all the things that are happening
around you, you will be able to gather a lot of very useful information.
Systematically observing and recording what you see is an important technique
that you can use to identify health problems and their possible causes.

2- Interviews

The in-depth interview is another important method of data collection.

This technique can be used when you want to explore individual beliefs,
practices, experiences and attitudes in greater detail.
It is usually conducted as a direct personal interview with one person a single
respondent.
Using in-depth interviews as a Health Extension Practitioner, you can
discover an individual‘s motivations, beliefs, attitudes and feelings about health
and illness. For example, you may want to explore a mother‘s attitudes to and
use of contraception.
It is a good idea to use open-ended questions to encourage the
respondent to talk, rather than closed questions that just require a yes or no
answer.
An in-depth interview can take around 30–90 minutes.
Steps of conducting an in-depth interview

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  Identify an individual with whom you are going to conduct an in-depth
interview, obtain their consent and arrange a time.
 Prepare your interview guide this is a list of questions you can use to guide you
during the interview. You can generate more questions during the interview if
other issues arise that you want to follow up.
 Write down the responses as accurately as you can. You can also use a tape
recorder to record the responses. However, you should ask permission from the
respondent to use a tape recorder.
 After the interview is completed, review your notes or listen to the tape and
prepare a detailed report of what you have learned.

2. 3- Key informants
Key informants are people who have first-hand knowledge about the
community. They include community leaders, cultural leaders, religious leaders,
and other people with lots of experience in the community.

These community experts, with their particular knowledge and

understanding, represent the views of an important sector of the community.
They can provide you with detailed information about the community, its health
beliefs, cultural practices, and other relevant information that might help you in
your work.

3. 4- Focus group discussions

Focus group discussions are group discussions where around 6 to 12
people meet to discuss health problems in detail. The discussion is led by a
person known as a ‗facilitator‘.

Conducting a focus group discussion

 Select 6–12 participants for your focus group discussion. For the discussion of
some sensitive issues, it might be necessary to lead one focus group of men
only, and another of women only. For other issues, a mixed group could lead
to interesting and informative discussions.

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 Prepare a focus group discussion guide. This is a set of questions which are
used to facilitate the discussion. While the discussion is going, you can also
generate more questions to ask the participants.
 There should be one person who facilitates the discussion, and another person
who takes notes during the discussion. If possible, it is also useful to record
the discussion using a tape recorder, so that you can listen and analyze it
later.
You may find it useful to use focus group discussions in the following
situations:
 When group interaction might produce better quality data. Interaction
between the participants can stimulate richer responses, and allow new and
valuable issues to emerge.
 Where resources and time are limited. Focus groups can be done more
quickly, and are generally less expensive than a series of in-depth interviews.

2. Defining and prioritizing problems

The first requirement in bringing about change is to agree that there is a
problem and that something should be done about it. Defining of specific
health problems must involve the community members.
Ask questions in an attempt to find out how they view the health
situations.
Start from the general and work down to the specific problems you have
in mind. For example, if you found a very unsanitary environment in your
survey of the community you might contact the leaders and proceed as follows:

• What needs to be done in this village to improve their life?

• What are the illnesses most common in this village?
• What is the extent of the problem? How bad is the situation?
• What do people die of? Which groups or individuals are most affected?
• Do they have diarrhea, febrile illnesses, or worms in this village? What causes
these illnesses?

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• Are there any latrines in the village? What do people use?
• Has any thought been given to building latrines?
• Why some people refuse to use them?
• Do people in the village plan together to get rid of these problems?

At times, your priority problem may not coincide with the felt need of
the community. For example, your own analysis may indicate that improved
sanitation is most needed but the community may feel that they should first
improve their road so that they can market what their produce.

In such cases, you cannot neglect the need of the community if you anticipate
good community participation and establish sustainable project.

Generally, whenever people come up with multiple needs, the following

four questions can help them see their problems more clearly and make their
choice of priorities easier.
 Which is the most serious problem? E.g. Lack of food to eat by a family.
 Where does the greatest future benefit lie?
E.g. skills training for unemployed.
 What health needs can be met with the resource available? E.g. purchasing
inexpensive, yet nutritious foods available at the local market.
 Which are the problems of greatest concern to the people? E.g. A health
post compared to a school.

3. Setting goals and Objectives

For a program to succeed, we must know clearly what we want to do
and how we are going to do it.
After people have decided upon their priority needs, they must spell out
exactly what they want, i.e. their objectives.

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 An Objective is a statement of proposed change over a fixed time
period. It should be measurable, relevant and possible to achieve. It has to
describe:
• What you want to change?
• How much change you want?
• For whom or for what you want the change?
• When? By what time or date?

Types of objectives in health education

a. Health Objectives
If measles is a serious problem in a community, a primary health care program
to solve the problem might have the following as its health objective.
 Fewer children will get measles
 Those who do get measles will recover quickly and suffer no disabilities
 No children will die from measles.
b. Educational Objectives
Since people‘s behavior affects their health, there will be certain actions that
people must carry out to solve their health problems. Such are educational
objectives of a program.
Some examples of educational objectives for a program against measles
include:
 Mothers will bring their children for immunization
 Mothers whose children get measles will bring them quickly to the
health worker for care.
 Children who get measles will be fed as well as possible to help them
recover more quickly.

4. Identifying and Obtaining Resources

4.1. Resources inside the community
It is best to find resources inside your community for two reasons: For one
thing, it saves money.

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 More importantly, people are proud to be able to help themselves, which in
turn encourage people to try to solve more problems by their own efforts.
Some of them include:
 Places to hold meetings, discussions, and trainings, such as schools, and
halls
 Some people may be able to donate money to buy materials.
 Some have skills to contribute, e.g. carpenters, teachers, masons, artists,
traditional healers, weavers and potters.
 Some may support transport: bicycle, motor cycle or vehicle.

4.2. Resources outside the community

If resources within are not adequate one may seek from outside:
 Some agencies and ministries can donate funds.
 People with special skills, such as finding underground water
for wells, may come from outside.
 Educational materials such as films and posters could be given
from outside agencies.

4.3. Health education Resources

Local Media
One should be able to identify local and traditional means of
communication such as proverbs, stories, and fables, which elders use to
pass traditional values on to the young.
 Local leaders may use village criers or bell-ringers to announce
upcoming events.
 Traditional songs or plays may communicate important ideas and
values.
 Local artists, printers, and photographers can be involved in
designing, and producing
 Educational materials.

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Outside sources
 These may include mass media such as newspapers and radio.
 Ministries of health and information could supply or loan films,
posters, and vans with loudspeakers.
 A local school teacher who is a subscriber of newspaper can use to teach
pupils and inform parents.

5. Selecting appropriate Methods

It is not enough to decide what will be done, by whom and when, we
also need to decide how it will be done.
Once a health worker understands the reason behind behavior that is
causing a health problem, he or she can use many different methods to
encourage a change in that behavior.
Generally, there are some basic issues to consider before choosing
health education methods:
 How fast do people change?
 How many people are involved?
 Is the method appropriate to the local culture?
 What resources are available?
 What combined methods are needed?
 What methods fit the characteristics (age, sex, religion etc) of the
target group?

5.1. How fast do people change?

 Some people are ready for change and are economically able to do the
advice easily. For such people provision of information through
posters, radio, songs, plays, stories or displays could sufficient.
 Some are ready but influence from others could hinder. Direct contact
with such people is the preferred method. E.g. convincing
grandmother for immunization.

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  For those who are economically unable, linking them with sectors that
help them earn money is a remedy.

5.2. How many people involved

Providing good ideas quickly to a large number of people is a very
helpful step in health education. It creates awareness of a problem or idea. But
it may not be enough to change health behavior. Posters, lectures, display,
plays, newspapers, radio, films and village criers are appropriate for large
groups.
Activities such as practicing new skills, discussing personal feelings,
values and money matters, and sharing difficult experiences are best done
person-to-person, or in small groups using story-telling, demonstrations, role-
playing, case studies, discussions and educational games.

5.3. Is the method appropriate for the local culture?

From the Previous sections, we know that culture is the way of life of
people in a community. Culture will determine the educational methods that
will be acceptable and understandable to people.

Some methods may not be accepted in one culture while it may be

effective in the others. For example Role-playing, photographs, or films may
not be adaptive to illiterate community. In such communities we can use the
most natural way of communication such as proverbs, village criers, plays,
songs and so on.

Practical demonstrations are good ways of teaching skills. For example,

instead of just talking about hygiene, a health worker can show mothers how to
bath their babies. This would motivate and enable them practice in the future.

5.4. What resources are needed?

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 Some methods require the use of machines: tape recorders, films or
slide projectors, which at the same time require electricity.
Other methods require the use of teaching aids such as posters, flannel graphs,
demonstrations, models, flip charts and the like.
On the other hand, some methods require only yourself and the people
around you; these include the use of stories and songs, role-plays, group
discussions, and community meetings. Therefore, try to look for methods that
are inexpensive, culturally acceptable, understandable, and at the same time
effective.

5.5. What combined methods are needed?

Ideally, use of mix of methods and repetition improves understanding

and people are more likely to remember them. The following combinations may
be used:
 Storytelling and asking the audience to role-play in which they act out
the story for all to see.
 Lecture assisted with posters, films or demonstrations.
 Community meeting with displays or short play.

5.6. Which methods fit the group best?

Health education could be designed for various groups of people: old,
young, women groups, children and so on. Select and adapt your methods to fit
the type of people you meet. Fables using animals might be better for children
than for adults. Lectures are more applied for educated.
If the people belong to one religion, select proverbs from the scriptures
on books of that religion.

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6. Development and implementing a program
After having analyzed the situation, define problems, prioritize and set
objectives, identify resources, and design strategy, the health extension
workers and health committee should be able to develop an action plan.

A plan of work is a picture or ―map‖ of what to do, when to do it, which

will do it, and at what cost each step of activities be accomplished. It will
serve as a guide and will help in implementing and evaluating the project and
planning another one.

The Plan of Action should include:

 Goal and objectives
 What steps are to be taken - list of activities
 Who will be responsible for each step - person in charge
 What materials, equipment, people, funds will be necessary for each
step – resources
 When each step is to be completed - target date.

7. Evaluating the program

Evaluation is the process of looking back over what has been done to be
sure that things were done the way they should.
Evaluation is not a one-time event. It is a continuous process how the
program is progressing according to a set time table in the action plan.
Information for evaluation program would be obtained from
observations, interviews, and records.
Following each step or activity, ask questions such as:
 • How well did we do?
 • Did the plans work?
 • Why did we succeed? Or fail?
 • What do we do next?
 • Did we learn from our mistakes or successes?

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 By the end of the educational activities, you should be able to measure their
successes by counting how many people are behaving according to the original
objectives: is this number more than before the program started?
At the end of the program, a final meeting can be held to discuss how far the
program succeeded.
Changes in attitude may be assessed by answering the following questions:

 Did people participate in the project as expected?

 Did people gain new skills and learn from the program?
 Was there less opposition by groups in the village who had previously
been against the program?

Changes in behavior:
 People disposing of feces and urine in latrines
 People using clean bucket for gathering water
 Increased in visits to the health post.
 Increased in the number of children immunized
 Increased number of pregnant women seeking early prenatal care.
 Increased in the number of births that occur in the health facilities.

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 Session (1)
General objectives: By the end of this session, students will be able to acquire basic knowledge
About nutrition
(Time required 1hr & 20 min)

Teaching strategies
Methods of
Time Content Specific objectives Method of
Media evaluation
teaching
 Importance of  Apply principles of Lecture &
10
adequate nutrition. adequate nutrition. Booklet &
Group Revision
Min Poster
Discussion
 Components of  Explain Components of Lecture
20 Pictures
balanced nutrition balanced nutrition Post test
Min
15  Guidelines for  Understand guidelines Lecture & Booklet&
healthy diet Feedback
for healthy diet Shared stories Brochure
Min
20  Discuss danger of Lecture
 Anemia Booklet Feedback&
anemia Group
Min post test
Discussion
 Summary,
15 Discussion & Post test
Questions and  More explanation
Min answers, plan for next
session.

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 Chapter 6

Ethical Issues in Health Education

Objectives

At the end of this chapter, the students will be able to:

 Define ethics

 State basic principles of ethics

 Describe the responsibilities of health extension workers to community.

 Describe the responsibilities of health extension workers to the health extension

package.

Introduction
From a profession point of view, ethical behavior is expected from professionals.
Ethical conduct is particularly important for health educators, since they are working with a
mission to serve the individual.
Definition
Ethics is the philosophical study of the moral value of human conduct and the rules
that govern it. It is the right thing to do for society and self.
Ethics is the discipline dealing with what is good and bad and with moral duty and
obligation.
Moral refers to those beliefs about how people ought to behave.
Ethics is a system of moral principles. They affect how people make decisions and lead
their lives.
Basic Ethical Principles
1. The principle of autonomy
This principle means that people, being individuals with individual differences must have a
freedom to choose their own ways and means of being moral with the framework of the other
four principles. Respect for autonomy involves respecting another persons rights and dignity

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 Health education strategies
and counseling

such that a person reaches a maximum level of fulfillment as a human being. In the context
of health promotion and health care this means that the relationship between health
extension worker and community member is based on a respect for him or her as a person
and with individual rights.

Rights in relation to health care are usually taken to include:

• The right to information
• The right to privacy and confidentiality
• The right to appropriate care and treatment

2. Beneficence (doing good )

Beneficence means doing or promoting good as well as preventing,
removing and avoiding evil or harm.
E.g. provide information about emergency first aid to reduce the
risks of HIV infection or accident.

3. Non-maleficence (doing no harm)

Non-maleficence holds a central position in the tradition of medical ethics and guards against
avoidable harm to subjects. In short, it refers to non-infliction of harm to others. E.g. use of
sterile needles.

4. Justice (fairness)
This principle states that human being should treat other human
being fairly and justly in distributing goodness and badness among
them. In other words justice should include:
• Fair distribution of scarce resources
• Respect for individual and group rights
• Following morally acceptable laws
5. The principle of truth telling (honesty)
At the heart of any moral relationship, there is communication. A necessary
component of any meaningful communication is telling the truth, being honest.
Ethics for the performance of health extension workers as health
educators
Health extension workers as health educators assume profound responsibility in using
educational processes to promote health and influence human well-being. They are also

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 Health education strategies
and counseling

responsible for the implementation of health extension package program. Ethical precepts
that guide these processes must reflect the right of individuals and communities to make
decisions affecting their lives.

Health extension workers responsibilities as a health educator

• Affirm an equal right, believing that health is a basic human right

for all.
• Provide people with relevant and accurate information and resources to make their
choices freely and intelligently.
• Support change by freedom of choice and self-determination, as long as these decisions
pose no threat to the health of others.
• Be advocates for healthful change and legislation, and speak out on issues deleterious to
public health.

 Avoid and take appropriate action against unethical practices and conflict of interest
situations
• Respect the privacy, dignity and culture of the individual and community and use skills
with these values.
• Share their skills, experience and vision with their clients and colleagues.
• Observe principles of informed consent and confidentiality of individuals.
• Maintain their highest levels of competence through continued study, training and
research.
• Accurately represent their capabilities and education as well as training and experience
and act within the boundaries of their professional competence;
• Ensure that no exclusionary practices be enacted against individuals on the bases of sex,
marital status, color, age, social class, religion, ethnic background, national origin,
or other nonprofessional attributes in rendering service, employing, training, or
promoting others.

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 Health education strategies
and counseling

References and Recommended Readings:

Babcock, D.M and Miller .M.A. (2011): Client Education: Theory and Practice, 3rd ed. Mosby
Books, St. Louis.

Campbell, L. F., Norcross, J. C., Vasquez, M. J. T., &Kaslow, N. J. (2013). Recognition of

psychotherapy effectiveness: The APA resolution. Psychotherapy, 50, 98–101.

Jump up to Selwyn, N., (2011): Education and Technology: Key Issues and Debates. London:
Continuum International Publishing Group.-10-22.

Stanhope, Lancaster.,(2012): community public health nursing.3rd

ed.,Mosby,London.pp273:312.

Zimmerman, M. (2013). Interview guide for evaluating DSM-5 psychiatric disorders and the
mental status examination (2nd ed.). East Greenwich, RI: Psych ProductsPress.

www.nursingworld.org: American nurses association

-www.apha.org: American public health association
-www.aapcho.org: Association of Asian Pacific Community Health

Book Coordinator ; Mostafa Fathallah

General Directorate of Technical Education for Health

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