PRINCIPLE OF HEALTH EDUCATION

BY: Elsabeth L. (MPH in HP/HB, Bsc in PH)

Email address: elsabethlegesse@gmail.com
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Objectives of the session

At the end of this class; you will be able to:

 Define health and its concepts

 Define Health education

 Discuss the concepts of Health Education

 Describe the aims and principles of Health Education

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Introduction

• Health education is a part of health care which are concerned

with promoting healthy behaviors.

• It is through health education we help peoples to understand

their behaviors and how it affect their health and encourage

them to make their own choices for healthy life.
• Health education is one of components of primary health care

and plays paramount roles in achieving the goal health for all.
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Cont…
• Many people use health education and health promotion

interchangeably.
• However, there are differences in their concept and application,

and many authors provide different definition of health

education and health promotion.
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Definition and concepts of health

• Before looking at the definition of health education, it is helpful

to discuss the definition of health and related terms.

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Health
• Health is a very abstract concept to conceptualize and measure

and it is too difficult to put in words.

• It is a broad concept and its definition also differs among social

classes, cultures, religion and ethnic groups.

• Generally, there are two opposing models concerning the

definition of health:
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I. Negative model
• This model views health as:

• Absence of diseases or disability or infirmity

• Biological integrity of the individual

• Physical and physiological capabilities to perform routine tasks.

• According to this definition individual is healthy if all the body

parts; cells, tissues, organs, organ systems are functioning well.

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II) The positive model

• It is broader and more holistic concept.

• Probably the most widely known of such models is that of the

constitution of World Health Organization (1948), which

defines health, as:
• “A state of complete physical, mental, and social well-being

not merely the absence of disease or infirmity.”

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Cont…
• This classic definition is important, as it identifies the vital

components of health.
• To more fully understand the meaning of health, it is important

to understand each components of health

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1. Physical health
• It is the absence of diseases or disability on the body parts

(negative definition).
• It is the biological integrity and the physiological well

functioning of the human body

• It is the ability to perform routine tasks without any physical

restriction.
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2. Mental health
• It has two major components:

A) Cognitive component
• ·it is the ability of an individual to learn, perceive and, think

clearly.
• E.g. A person is said to be mentally retarded if he/she cannot

learn something new at a pace in which an ordinary person

learns.
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B) Emotional component

• Is the ability of expressing emotions (e.g. fear, happiness,

and to be angry) in an “appropriate” way.

• Appropriate here is to emphasis that the response of the

body should be congruent with that of the stimuli.

• It is the ability to maintain one’s own integrity in the

presence of stressful situations (tensions, depression and

anxiety).
• E.g. if somebody gets into coma during an examination.
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3. Social health

• Is the ability to make and maintain “acceptable” and “proper”

interaction and communication with other people and the social

environment; satisfying interpersonal relationship and role
fulfillment.
• For example, to mourn when close family member dies, to

celebrate festivals, to create and maintain friendship etc.

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4. Spiritual wellbeing
• For some it is connected with religion, for others with personal

creeds, values, principles of behaviour and achieving peace and

being at peace.
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Cont…
• more recently, the WHO (1986, Ottawa charter) has restated

that “health is a resource for every day life, not the objective
of living.”
• In other words, good health should not be the goal of life, but

rather a vehicle to reach one’s goal in life.

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Cont…

Criticism of holistic definition:

1. Too idealistic and unrealistic to achieve
2. No person can reflect/fulfil all of the components at a point
in time
 Conclusion: All components are interdependent,
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Cont…
• Generally, the different aspects of health are interrelated and

interdependent.
• Physical problems could lead to mental consequences and vice

versa.
• Therefore, health is a holistic concept and wellness is expressed

through integrated mental, physical, emotional, spiritual and

social health at any point of health and illness spectrum.
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determinants of Health

Personal
Genetics
behavior

Health
Physical
Health
environm
care
ent
Social
environm
ent
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• Contribute for the development of some problems (eg.
Genetics:
heart disease, cancer, diabetes etc. )

Physical env’ t: •where we live, where we work, what we eat and drink, temperature, humidity, noise, pollutions, exposure to radiation (artificial) etc. all affect health.

social env’t •a physical env’t also includes cultures, norms, social variables (age, gender, education) etc all affects human health.

Health care •availability , quality , accessibility of health care-determine health. (political views & health)

policy •Policies at the local, State, and Federal level affect individual and population health.(E.g Tobacco taxes, Highway safety acts).

Personal behavior •The choice each person make with regard to health affects human health such as smoking, chewing chat, sexual behaviors etc.
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Health education
• Subsequent definitions emphasized voluntary, informed
behavior changes.
• “Any combination of learning experiences designed to
facilitate voluntary action conducive to health”
Green et al(1980)
• This is more formal and well accepted definition of HE
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Cont…
• Combination: matching multiple determinants of

behaviors with multiple learning experiences or

educational intervention
• Designed: HE is not incidental learning experiences.

It is systematically planned and organized activity.

• Facilitate: creating favorable condition such as

predispose, enable, reinforce.

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Cont…

• Voluntary: with full understanding and

acceptance of the purpose of the action. Without
use of coercion or any manipulative approaches.
• Action: behavioral steps/measures taken by
individuals, groups or community to achieve the
desired health effect.
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Health Promotion
• HP is a term of more recent origin than health education and is

broader than HE.

• GREEN AND KRUETR (1991) defined HP as:

“A combination of educational and environmental supports for

actions and condition of living conducive to health.”
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Cont…
• Combination: Matching multiple determinants of health with

multiple intervention or sources of supports.

• Educational: refers to the communication part of HP; that is HE.

• Environmental: refers to the social, political, and economic,

organizational, policy and regulatory circumstances influence
behavior or more directly health
 Create environments that support good health practices,

behaviors

HP=HE + Environmental support

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cont…
• Health promotion is defined as “the process of enabling

people to increase control over, and to improve, their

health” (Ottawa Charter for HP, 1986).
• 5 action areas identified (for people’s wellness)

 Building healthy public policy 

 Creating supportive environments 

 Strengthening community action 

 Developing personal skills 

 Re-orienting health services

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Relationship between HP and HE

HE is one of the most important component of HP.

HE provides consciousness-raising, concern-arousing,

action stimulating impetus for public involvement and

commitment to social reform essential to its success.
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cont…

• On the other hand, with out the policy support for

social change, HE is often powerless to help people to
reach their health goals, even with successful
individual change efforts.
• Therefore, health promotion is a structural (laws,

regulation, organizational...) support for health

education to develop its full potential.
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Information, Education and Communication (IEC)

IEC is communication strategy to promote individuals and

community positive behaviors that are appropriate to their

settings.
It focuses on providing people with information and telling

them how they should behave / “teaching them”.

To improve knowledge of problem owners’ and/or significant

others
It is not enough to bring about behavior change.
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Cont…

Sometimes simply lack of information keeps people

from not taking action.

In this case, we have spread clear information and

facts to make the audience knowledgeable

Note: it doesn’t mean we don’t start from where

people are.
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Cont…

IEC …………………Awareness
Awareness ≠ Behavior change
IEC……..text book knowledge
rarely leads to behavior change
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Cont…
• An obvious example of the failure of this assumption is

smoking.
• If knowledge about the negative impact of smoking on health

would in itself be sufficient to achieve healthy behavior change,

no medical doctors would be smokers
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Behavior Change Communication (BCC)

• Process of changing social and individual attitude and

behavior by providing them with relevant information,

education and motivation through appropriate channel.
• BCC is a programme or activity that is specifically designed to

change or sustain the behaviour of individuals or social groups

by using variety of communication techniques.
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Rationale for health education

“We must recognize that most of the world’s major Health

problems and premature death are preventable through
changes in human behaviors and at low cost. We have the
know–how and technology but they have to be transformed
into effective action at the community level”
Dr. Hiroshi Nakajiima, Director – General, WHO, 1998
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Rationale …

1. The continued existence and spread of communicable

diseases

2. About 75% of childhood illnesses are preventable

3. For some diseases health education is the only practical

choice in order to prevent the spread of the disease or to
lead a normal life

4. The tendency of increasing magnitude of chronic

conditions and other emerging agendas
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Rationale …

5. Prevention is the best cure and the most cost effective

intervention
6. Human behaviors are almost the single causes for the
development of most health conditions.
7. Wide spread of unhealthy behaviors
8. People’s ignorance of causes of heir illnesses
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Ultimate goals and educational objectives of HE

A) The ultimate goals of health education

• The ultimate goal of all service professionals including

health educators is to improve the quality of life.

To promote health, prevent illness, self-adjust to live

with disabilities and decrease morbidity and mortality.

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B. Educational objectives of health education

Educational objectives of health education are;

•  To provide appropriate Knowledge

• To help develop positive Attitude

• To help exercise health Practice/behavior

=KAP
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Dimensions of Health Education

• Health education is life long process.

• It is not one time affair.

• The concern caring about a child begins while the fetus is in the

mother’s womb.
• Health Education is concerned with people at all points of

health and illness continuum

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Health Education in public health

• Health education is a tool for public health promotion.

• It is through education that public health and Biomedical

information reaches the individuals, families and community
to solve their problem.
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cont…

Health education and health promotion are recognized increasingly

as ways to meet public health objectives and improve the success of

public health and medical interventions around the world.

Environmental health sciences, epidemiology, population

dynamics, and biomedical sciences are the major suppliers of

information about the nature, type and magnitude of problems that

require public health education.

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Relationship of health education to the three major

determinants of health
Individuals
(Personal
behavior and
lifestyle)

Health education

Public health Policy/

and medical decision
care makers to
practitioners influence
Environment
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cont…

• These categories are the channels through which health

education and behavior change approaches are initiated.

• Essentially, health education activities can be directed

• at the individual to influence his/her behavior and habitual

life-style OR
• at public and medical practitioners to improve care and

promote patient and public health education OR

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cont…

• at policy makers and institution to bring about improvement

in the social and physical environment affecting people's

behavior health.
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Health education in health policy

• Health education is also priority in health policy of Ethiopia.

“Information, Education and Communication (I.E.C) of health

shall be given appropriate prominence to enhance health
awareness and to propagate the important concepts and
practices of self-responsibility in health.”
Health policy document , 1993
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cont…
Health education is one of the general strategies in health

policy.
Health Education shall be strengthened generally and for

specific target populations through the mass media,

community leaders, religious and cultural leaders,
professional associations, schools and other social
organizations .

Health policy document, 1993

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cont…

• The health policy is generally prevention oriented and

hence health education plays significant role in the

policy realization
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Basic assumptions and principles of health education

• The practice of health education is based on the assumption

“that beneficial health behavior will result from a combination

of planned, consistent, integrated learning opportunities and
scientific evaluation of programs in different settings.”
• The following points are few working principles of health

education:
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Cont…
1. Principle of educational diagnosis
The first task in changing behaviors is to determine its causes

If the causes of the behaviors understood health educator can

intervene with the most appropriate and efficient combination of

education, reinforcement and motivation.
2. Principle of Participation
to change behaviors individuals, families, community groups,,

etc…should have to be participated in identifying their own needs

for change and have selected the methods that will enable them to
take action.
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Cont…

3. Principle of multiple methods

This principle follows from the principle of educational

diagnosis.
 In so far as multiple causes will invariably be found for any

given behaviors.
For each of the multiple predisposing, enabling, and

reinforcing factor identified a different methods or

components of comprehensive behavioral change must be
provided.
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Cont…
4. Principle of planning and organizing
Planning and organizing are fundamentals for health

education which distinguishes it from other incidental

learning experiences.
It involves deciding in advance the when, who, what, how

and why of health education.

It also requires the planning for resources, methods and

materials to be used, identification of target groups etc.

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cont …
5. Facts
Health education is given based on scientific findings/facts and

current knowledge.
 It is unthinkable to provide health education without scientific

and knowledge related to the topic or issues to be addressed

e.g. Health educator must know the current scientific knowledge

how HIV/ADS transmitted and prevention methods.

This is because scientific knowledge is changing with time.
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cont…

6. Segmentation
Health education should be designed for a specific group

of people/ specific target groups

7. Need based
Health education is primarily educational and its purpose

is to ensure a desired health related behavior after real

need identification.
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Cont…
8. Culture
Health education should not consider as artificial situation

or formal teaching –learning process.

One has to get into the culture of the community and

introduce novel ideas with a natural ease and carefulness.

Inflexible statements particularly contrary to existing

belief, culture, practices will not be liked.

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Cont…
• Therefore Health education starts from where people are and

slowly build up the talking point to avoid any clash of ideas to

allow for people understanding, appreciation and internalization
of fresh ideas.
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cont…
9. Principle of motivation
health education appeals to people’s motives through motive

arousing appeals but not through external stimuli.

10. Principle of reinforcement

states that those individuals, group who started to undertake

health behaviors should verbally encouraged or received

positive feedback (positive reinforcement)
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Cont…
11. Principle of feedback
It is a mechanism of assessing what has been happened in the

target Population after receiving the message.

Thank you !!!

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