+

Introduction to Health Education

and promotion

BY: Emaway B.(Bsc,MPH)

Key Questions
What is Health?
What is Health Information, Health Education ,Health
Promotion & BCC/ IEC?
What are the rationales of HEP?
What are the scopes of Health Education & promotion?
What is Health education in Ethiopia?
What are the relation ship between PHC and health
Education?
What are principle of Health Education& Promotion?
What are the aims of health Education.?.
What is Health?
Defining Health

 Different people may give different

definition of health based on their
circumstances

 Lay and professional definition of health

 To the general public, being healthy mean

“ not being ill”
WHO definition of health
In 1948 WHO defined health as ‘ a state of complete
physical, mental, and social well-being and not the
absence of disease or infirmity’

Is this definition holistic?

What other components you need to add?
What is Health education??
According to Griffiths (1972), “health education
attempts to close the gap between what is known about
optimum health practice and that which is actually
practiced.”

Simonds (1976) defined health education as aimed at

“bringing about behavioral changes in individuals,
groups, and larger populations from behaviors that are
presumed to be detrimental to health, to behaviors that
are conducive to present and future health
Continue…
Health education is any combination of learning
experiences designed to facilitate voluntary actions
conducive to health (Green, 1991)
Combination: emphasises the ‘importance of
matching the multiple determinants of behaviour
with multiple learning experiences or educational
interventions’
Design: distinguishes HE from incidental
learning as a systematic planned activity
Continue…
Facilitate: predispose, enable and reinforce

Voluntary: is without coercion and full understanding

and acceptance of the purpose of the action

Action: is behavioural steps taken to achieve an intended

health effect
What is Health Promotion??
To reach a state of complete physical, mental and
social well being it is beyond the activity of health
education and even health sectors.
Health is not just the responsibility of health sector
alone.
The responsibility of every sectors working for
development .
Thus, the concern for health outside to the healthcare
sector is the call for health promotion
Health Promotion
Health promotion is the combination of
educational and environmental supports for actions
and conditions of living conducive to health

In this definition:

Combination refers to the importance of matching the
multiple determinants of health with multiple
interventions or sources of support

Educational refers to health education

Continue…
Environmental refers to the dynamic social forces
than the physical services.
Such as: social, political, economic, organizational,
policy, and regulatory circumstances bearing on the
behaviour or more directly on the health

Living conditions: referee to the complex web of

culture, norms and socioeconomic environment
associated with lifestyle
Components of health promotion
Health education
Political environment
Social environment
Economic environment
Organizational environment
What is Health Information??

MacDonald (1992) stated that HI is a series of

messages transmitted to the public focusing on the
basic facts related to the health.
Characteristics of HI
 Base line information or data is not necessarily
required.
 The assumption is people are rational &make
predictable use of information available to them.
 Unhealthy behaviors is due to knowledge gap and
knowledge alone leads to action
Continue…
 Appropriate for newly emerging health problems and
during epidemics
 Merely telling to people to follow health Behaviors
 Blind to the reason behind behaviors
 People blamed/Responsible for unhealthy behaviors
 May not use a variety of methods
What is Behavioral change in communication
(BCC)??
 BCC is process of changing social and individual
attitude and behavior by providing them with relevant
information, education and motivation through
appropriate channel.

 Is an interactive process with communities integrated

into an overall program designed to develop tailored
messages and approaches using a variety of
communication channels to develop positive behaviors
to promote and sustain behavior change
What is Information Education
Communication (IEC)??
 Is a process of working with individuals, communities
and societies to develop communication strategies to
promote positive behaviors which are appropriate to
their settings.
Difference b/n BCC & IEC
 BCC need supportive environment
 It Moves People From Awareness to Action
 It is more “outcome oriented”
 It includes role of participatory methods and
motivation in the behavior change process
 What are the Rational of HEP
An estimated 40-70 percent of all premature deaths;
A third of all cases of acute disability;
Two thirds of all causes of chronic disability are
caused due to behavioural and lifestyle risk factors:
Substance abuse;

Poor diet;

Sedentary work, and leisure;

Stress related conditions (suicide, violence)

Continue…
The continued existence and spread of
communicable diseases
Increasing threats to the young from new and
harmful behaviors.
 For some diseases health education is the only
practical choice.
The cost for health care is rising.
The tendency of increasing magnitude of chronic
conditions
History of health education.
In 1779 a German physician Johann Peter Frank
raised & propagated the importance of supervising
health of school children as part of a school education

The growth & development of Health Education has

been accelerated with the beginning of Primary Health
Care concept

It was recognized as a fundamental tool to the

attainment of “health for all by year 2000”
Health Education in Ethiopia.
At the time of Alma Ata declaration of Primary Health Care
in 1978, health education was put as one of the components
of PHC
It was recognized as a fundamental tool to the attainment of
health for all.
 Adopting this declaration, Ethiopia 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 Ethiopia have identified health
education as a major component of program services.
Dimensions of Health Education
Health education touches upon many fields: medical
sciences, behavioral sciences, politics, demography,
management, etc.

 Health education has its roots in medical sciences and

medical practice. Patients were encouraged to comply
with treatments and recommended behaviors.

Health education is a life long process; the concern

begins from birth.
Continue…
Health education is concerned with people at all points
of the health and illness continuum.
Health education is concerned with helping people to
help themselves.
Health education involves formal and informal teaching
using a variety of methods and materials. Education on
health could be given anywhere depending on the
purpose and circumstances.
Health education is concerned with a range of
educational objectives (Cognition, Attitude and Skills or
Practice).
Continue…
Most health problems are the result of complex
interactions with the environment. The causes of
many problems are multiple.
Health is an asset for the individual and the
community. People tend to give value to health when
they lose it. Being healthy is valuable to an individual.
PRIMARY HEALTH CARE (PHC)
Definition & Back ground
The international conference on PHC held at Alma-Ata
USSR in 1978 defines PHC as

Essential health care (practical and socially acceptable)

provided for individuals and the community or made
universally accessible for them (through their
participation and with affordable cost) in order to
promote health and prevention of the disease
Continue….
Its approach is to bring health care as close as possible
to where people live and work

The World Health Organization/WHO established in

1948
Major objective: The attainment by all people of the
highest possible level of health / health for all

Due to political and socio-economic factors the

various health care approaches/strategies implemented
in different countries between 1948 and 1978 did not
enable WHO to meet the stated objectives
Continue….
 The magnitude of health problems
 Inadequate distribution of health resources
 The previous strategies stressed only on curative
care and
 The community have not participated in the actual
service they receive
 All of these reasons and others called for a new
approach and concept of PHC
Continue…
In the 1978 meeting it was declared that the PHC
strategy is the key to meet the goal of “Health for all
by the Year 2000”

Since the declaration of PHC, Health education was

identified as a primary means of "Health for All"

Its central role is improving community participation

in problem identification, priority settings and making
decisions
Continue….
PHC COMPONENTS/ELEMENTS
It has at least 8 elements
1. Health Education
2. Provision of Essential Drugs
3. Immunization
4. MCH/FP (Family Health)
5. Treatment of common/endemic diseases & injuries
6. Adequate supply of safe water & basic sanitations
7. Communicable diseases control
8. Food supply and proper nutrition
Continue…
In 1988 ten years after Alma-Ata, WHO, UNICEF and
other parties decided to review the program
Most countries have made considerable gains in
 Improving the health or well-being of their population
 Improvements in coverage, effectiveness and quality
of health service
 Immunization rates increased
 Decreasing infant, under five and maternal mortality
rates
Continue…
But, no country can solve all of its health problems
until 2000 and new problems continue to emerge in
every country
Health for all remains a permanent goal of all nations
up to and beyond the year 2000.
Role of health education in the
primary health care unit(PHCU).
Promoting Community Involvement and Self-Reliance
eg community “Edir” has strong community involvement.
Enhancing Decision-Making Skills at the Local Level
eg: a young man who uses tobacco could be helped to
stop smoking.
Allowing for a Diversity of Objectives in Formulating
Policy: Most community health problems are related to
each other and intertwined
Harmonizing National and Local Plans: Health
education improves the participation of people in health
plans and activities
Continue….
Facilitating Inter-Sectoral Action: Inter-sectoral
collaboration needs communication between two or
more sectors.
Using Appropriate Technology: Policies are required to
ensure the use of appropriate technology in health
education. Appropriate technology is one of the
prerequisites of primary health care.
Measuring Community Involvement and the Impact of
Health Education: Health education provides models
and frameworks to diagnose a problem, to draw a plan,
to implement an action plan and to evaluate a program
What are the Principles of Health
Education?.
1.Principle of educational diagnosis-
 Diagnose an illness before it can be properly treated.
 Must a behavior be diagnosed before it can be
properly changed.
2. Principle of Participation
Individuals, families, community have been participated
 In identifying their own needs for change
 For selected the methods that will enable them to take
action.
Continue…
3.Principle of multiple methods
 Multiple causes will always be found for any given
behaviors.
 For each of the multiple predisposing , enabling ,and
reinforcing factor identified a different methods.
4. Principle of planning and organizing
 Involves deciding in advance when, who, how, what
and why of health education
 Resources, methods and materials to be used,
identification of target groups
Continue…
5. Facts
 Health education is given based on scientific
findings/facts and current knowledge
 It is unthinkable to provide health education without
scientific knowledge
6. Segmentation
 Health education should be designed for a specific
group of people
Continue…
7. Need based
 Before involving any individual, group or the
community in health education, the felt need of the
community should be ascertained.
8. Culture
 Health education should not considered as artificial
situation or formal teaching.
 It is better to starts from where people are
Continue…
9. Principle of motivation
 Motivation is mental direction /desire for doing or
rejecting something.
 Happens within the person, not something done to a
person by others
 Is internal dynamics of behaviors
10. Principle of reinforcement
 Individuals undertake health behaviors should verbally
encouraged or received positive feed back
11. Principle of feedback : two way communication
Continue…
12.Principle of hierarchy
There is a natural priority in the sequence of factors affecting/influencing
health (predisposing, enabling, and reinforcing factors)
13.Principle of cumulative learning
Behaviors results from the cumulative learning experiences of an individuals.
Formal and informal education, life experiences etc
14.Principle of educational specify
There is nothing inherently superior or inferior about any method of
intervention to achieve behavioral change .
The change always depend on the circumstances, the target audience, time etc
15. Principle of individualization (tailoring)
Adaptation of learning experiences to each individual’s
Everybodyies have same tendency to learn
Ultimate Goals of Health Education

To help each individual and family to exercise the right

to achieve the harmonious development of the
physical, mental and social potential.
Promote health, prevent illnesses, self adjust to live
with disabilities, and decrease sufferings and deaths
Educational Objectives of Health Education

To provide appropriate knowledge: Provision of

specific knowledge, facts and information.
To help develop positive attitude: Concerned with
opinions of people, their feelings and beliefs.
To help exercise healthy practice (behavior): Involves
making decisions and actually performing
Decision making
Social change
Health Education Settings
 Medical care institutions
 Communities
 Work site
 Special communities like schools, prisons and refugee
settings
In Ethiopia the medical care setting and rarely
community and school settings are used
Quite recently a few work site settings are used for
health education
Who is responsible to provide Health
Education?.
All health professionals and those trained are
responsible to provide health education
At a community level
 Community health workers
 Trained members
 Leaders
 Teachers are involved in providing health education
Challenges of Health Education.

1.For many people it is easier to sell symptomatic relief

of illness or cure than to sell health and prevention of
disease.

2.Changing health behavior is conditioned by factors

such as social, psychological, economical, cultural,
accessibility and quality of services, political
environment, etc. which are difficult to deal with
simultaneously
Continue…
3.People are preoccupied with many daily activities to
support their life which impedes them to give their ear
the messages of health education.
4.Health education does not have high prestige.
5. Charged with health education programs lack special
training and are not qualified.
6. Health education is much more than “transfer of
information.” With out changes in attitudes and actions
it remains a useless exercise
Thanks.