Intro To HE

Module 1: Introduction to Health
Education/promotion
INTRODUCTION TO HEALTH EDUCATION
BY:- HENOK S.
By: Yohannes K. (MPH, Assistant
Professor)
For MPH students, Jan 2015
Introduction to Health Education 1

Outlines of the lecture
• Definitions and concepts, Health Education, Health Promotion

1
• Rationale for Health Education

2
• Goals and objectives of Health Education

3
4 • Scope of Health Education
• Principles of Health Education

5
• Challenges to Health Education

6

Learning objectives
At the end of the session, learners will be able to
• Describe concept of Health Education &
promotion
• Explain rationale of HE
– The role of HE in PHC & national strategies
• Discuss basic principles and scope of HE

1.Definition of Health
• Progressively defined
• Two models of defining health
 Narrow – Human beings as mechanical device
Broad– Holistic state of wellbeing (WHO, 1948)
• Health is not just a state, but also "a resource

for everyday life (Quality life), not the
objective of living. (WHO's 1986, Ottawa
Charter)
Determinants of Health
Genetics
Personal Physical
environme
behavior nt
Health
Social
Health
environme
care
nt

Health determinants…
5. Personal Behaviors: The choice each person make

with regard to health affects human health
 Human behaviors are almost the single causes for the
development of emerging health problems and also the main
solution.
 Unhealthy behaviors such as smoking, chewing chat, sexual
behaviors etc.
 Behavioral risk factors are the main cause of death globally

2. Definition of health education
Health education is a systematic educational activity to
change behaviors.
It builds knowledge of principles of health living
assists people to understand their heath status,
recognize factors harming health.
 It makes people
Change their ill life habits, and adopt the behaviors and
life styles conducive to health
Eliminate the health risk factors in order to prevent
illness, promote health and increase the quality of life.
Definitions of health education
…Some of the definitions;
“Health education attempts to close the gap between what

is known about optimum health practice and that which is
actually practiced.” (Griffiths , 1972)
 “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.” (Simonds, 1976)

…Health Education
…of the many definitions;

An American health educator Lawrence Green and
etal (1981)defined health education as:
“Any combination of learning experiences designed to

facilitate voluntary actions conducive to health”

Elaboration of the definition
 Combination: it emphasizes on the importance of

matching multiple determinants of behaviors with
multiple learning experiences/educational interv. (PER)
 Learning experiences: Opportunities that result in

 Perception of significance of Health Information- e.g;
knowledge, beliefs- (predispositions)
 Perceiving personal & societal relationship of HI &
 ability to positively apply the HI to self & society.

Elaboration…
 Designed: refers to planned, integral, intended activities

rather than casual, incident, trivial experiences.
 Facilitate: creates favorable condition for b/r change
 Voluntary: implies full understanding and acceptance of

the purpose of the action. Without use of any
manipulative approaches-significant for ethical reasons
 Action: behavioral steps taken by individuals/groups/
community
…health education
 ….of the many definitions

“the process of assisting individuals, acting
separately or collectively, to make informed
decisions about matters affecting their
personal health and that of others”
(U.S National Task Force on the Preparation and Practice of Health

Educators; The Role Delineation Project, 1985).

….Health education
• ….Of the many definitions,
• It is consciously constructed opportunities for
learning designed to facilitate changes in behavior
towards a predetermined goal, and involving some
form of communication designed to improve
health literacy, knowledge, and life skills conducive
to individual and community health (WHO, 1998).
 it emphasized health communication ingredients
 E.g IEC/BCC for change (comm. Strategies for HE)
 Behavior that most influence health (goal)
…Health education
 …. of the many definitions
‘’Any combination of learning experiences based on

sound theories and provide individuals, groups, &
communities the opportunity to acquire information
and skills needed to make quality health decisions”.
(Joint committee on HE & P, 2001)
 Two things: 1) theories of learning, motivation etc (2)

information important, accurate for decision
3. Information, Education and Communication (IEC)
 IEC is a process of working with individuals, communities and

societies to develop communication strategies to promote
positive behaviors that are appropriate to their settings.
 It focuses on providing people with information and telling

them how they should behave / “teaching them”.
 It is not enough to bring about behavior change.

IEC ………………………Awareness
Awareness = Behavior change

4. Behavior Change Communication (BCC)
 BCC is a process of working with individuals, communities

and societies to:
• develop communication strategies to promote positive
behaviors that are appropriate to their settings; AND
• provide a supportive environment that will enable people to
initiate and sustain positive behaviors.
 It goes beyond information giving rather consider factors that
might influence behaviors /the environment
 While providing information to help people to make a
personal decision is a necessary part of behavior change, BCC
recognizes that behavior is not only a matter of having
information and making a personal choice.
 Behavior change also requires a supportive environment.
 BCC is influenced by health services provision, community and
society norms and cultures.
 IEC is thus part of BCC while BCC builds on/realized by IEC.
5. Health Promotion
 To reach a state of complete physical, mental and social well

being it is beyond the activity of health education. (This so b/c
behavior is not just a personal choice)
 Thus, with rising criticism that H.E. was too narrow (focused
on individual’s lifestyle) and could become “victim blaming”.
 More work was done about wider issues eg. social policy,
environmental measure
( EMERGENCE of HEALTH PROMOTION )

Health Promotion…
Green and Kreutor (1991) Defined health promotion as:
“Is any combination of educational and environmental

support for behaviors and conditions of living conducive to
health .”
Combination: refers to the necessity of matching multiple

determinants of health with multiple intervention.
NB: IT takes human behavior as one of the determinants of health
Educational Health education

Health Promotion…
• Environmental: refers to the social, political, and economic,

organizational, policy and regulatory circumstances influence
behavior or more directly health

Elements/component of health promotion
I. Health education e.g IEC/BCC

II. Political environment E.g policy
III. Social environment e.g HL, norms, Health
IV. Economic environment e.g SM Educati
on
V. Organizational environment e.g NGO’s
VI. Regulation e.g monitoring policy
Environments
 HE is the core component in the sense that HP is its

ultimate goal.
IMPORTANT AREAS FOR HP (Ottawa Charter, plus)
4. Building a healthy public 2. Creating supportive

policy, partnership/allies environments (BCC+)
-advocacy,  organizational change
5. Strengthening  Economic change

community action e.g: Social marketing
 Community
mobilization/organizati
on
1. Developing personal 3. Reorienting health

skills (IEC) services
 H/communication  H/engineering
 Health literacy  Accessing health care

 Health Education is the primary and dominant measure in
Health Promotion
 Health education is primarily focused at voluntary action

people can undertake on their own to improve their own
health. But
 Health promotion aimed at social and political action that will
facilitate the necessary organizational, economical and other
environmental supports for the conversion of individual action
into health enhancement. (Root cause: example of McKinley)
e.g Examples of health promotion intervention to prevent

diseases and to promote health of the community

Health Educational intervention Environmental /ecological/political action
problem
china’s Health education was provided through mass  one child population policy
high media, small group and counseling to develop The government also offer bonuses and
populatio understanding of china`s population problems, incentives for the couple accept the policy
n how the population growth affect the including special provision for the first born
economic and developmental goal and the child such as priority housing and pre school
advantage and disadvantages of small and enrolment. if the couple subsequently had a
large families second child the bonus were with drawn
Tobacco educating the public focusing on Establishment of stop smoking clinics.

Health problems related with smoking such as Control of tobacco advertising
lung cancer through different media. Increase taxes on price of cigarettes
Educating the public not to start smoking and Bans on smoking in public areas.
to persuade smokers to stop.
HIV/ educating general public and specific groups Making counseling service available
AIDS such as drivers ,sex workers, youth, on safe Social marketing of condoms
sexual behaviors Increasing VCT services
Setting up peer education program
Enforcing of legal protection of sex
workers and injecting users

6. HEALTH INFORMATION
• It is health facts disseminated to the community focusing on

the basic facts related to the health issue under consideration.
• In dissemination of health information, base line information

or data (currently existing level of multiple determinants of
behaviors) is not necessarily required .
• Appropriate for newly emerging health problems and during

epidemics, may not bring behavioral change

7. Rationale for health education
The following points justify the rationale for health education

 The continued existence and spread of communicable diseases
 About 75% of childhood illnesses are preventable, Health

Education is vital intervention
 For some diseases health education is the only practical choice
 Emerging agendas beside unfinished agenda , which required

the cooperation of individuals to deal with the problem

Rationale
• As country develops, there is a shift in the major causes of

death from infectious to degenerative diseases. For such
diseases, prevention is the best cure and the most cost
effective intervention- to bring behavioral change.
• Human behaviors are almost the single causes for the
development of such currently emerging health problems
and also the main solution. (40% of causes of mortality, WHO
2002)
Rationale …
• Many people are ignorant of the causes of their illnesses and

may be afraid of seeking treatment and hide their illness not
to be considered out casted. In this case, health education is a
frontline to promote the use of preventive and curative health
services.
• Increasing threats to the young from new and harmful
behaviors. Eg. Smoking, chat chewing …

…rationale
 Group discussion points;
1. PHC initiative in 1978 as rationale

2. Health for all by 2000 & beyond
3. National policy priorities of Ethiopia
4. HSDP e.g: HEP as rationale

8. The ultimate goals of health education
 The ultimate goal of all service professionals including health

educators is to improve the quality of life.
 The highest goal in life is to die young, at as old an age is
possible. To that end the goal of health education is to
promote, maintain and improve individuals and community
health.
 In other words, to promote health, prevent illness, self-adjust
to live with disabilitiesIntroduction

and decrease morbidity and mortality.33
to Health Education
9. Educational objectives of health education
Broad educational objectives of health education

• To provide appropriate knowledge: provision of correct
knowledge, facts and information.
• To help develop positive attitude: has a lot to do with

changing opinions, feelings and beliefs of people.
• To help exercise health practice/behavior: concerned with
helping people in decision-making and actually performing.

10. Dimensions of health Education
10.1. 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. Antenatal care deliver care
postnatal care immunization …. Death.

10.2. Health Education is concerned with people at all points of
health and illness continuum
 Health is a process; can be viewed as the opposite ends
of a health continuum
To avoid the We all are walking on

diseases of tomorrow the path today that
we must act today may result in disease
of tomorrow
Good health extremely poor health/death

….10.2 Levels of health education
healthy onset of advanced disability

person symptoms symptoms death
(reversible) (not reversible )
Primary Secondary Tertiary

HE HE HE
Reduce risk behaviours health seeking rehabilitation

10.3. Health education is not an end by itself.
 Rather a way of empowering people to understand their own
problems, identifying its solution and take appropriate action.
10.4. Health education is not limited to patients in clinical

setups. It includes those who are apparently healthy and who
want to minimize the risk of having a problem.
10.5: Different setting for health education e.g in school
curriculum for health literacy

11. Health education settings-where HE practiced
 The process of health education is the same across settings,

although the emphasis on content areas and the target population
for health education will differ.
11.1.Health education activities in school
 School health education primarily involves instructing school-age
children about health and health-related behaviors.
 They pass significant proportion of their time in the school
environment and there are a potential for occurrence of spread of
communicable diseases .
Rationale of school health education
• An opportunity for the health care system to include this

young community in their health programme.
• The most crucial approach needed to improve the wellbeing of
the children and the adolescent.
• Education and health are interrelated.

• The only institutions that involve all children and their families

11.2. Health education activities in worksites
• recent origin when compared to other settings.

• Focuses in physical activity and fitness, nutrition and weight
control, stress reduction, worker safety and health, alcohol
and smoking reduction, blood pressure and cholesterol
education and control, and back pain protection

11.3. Health education activities in health care institutions
 patient education
 The focus of these programs is on life-style health behaviors,
communicable and non-communicable disease
4. Community settings. Public gathering, social institutions

home visits etc… e.g creates demand for H/service,
5. Special communities: such as prisons and refugee settings

12. 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”
Few working principles of health education
1) Principles of diagnosis
1.1)Behavioral diagnosis: assessing behaviors related to problem
1.2) Principle of educational /ecological diagnosis
The first task in changing behaviors is to determine its causes.
2) Principle of participation.
 The prospect for success in any attempt to change behaviors will

be greater if the individuals, families, community groups
participate in the process of identifying problem, implementing
healthy behaviors.
3) Principle of planning and organizing
 Planning and organizing are fundamentals for health education
which distinguishes it from other incidental learning
experiences. (strategic focus & careful designing of message)
4. Principle of educational specificity/tailoring: Learning
experiences should be specific to audiences based on audience
segmentation mechanisms.
44
Introduction to Health Education
5. Principle of multiple methods: This principle follows from
the principle of educational diagnosis. For each of the
multiple factor of a b/r a comprehensive b/r change
intervention/methods must be provided.
5.1 Principle of superiority: exploit use of mix of different

methods & materials for no method/material is superior.
6) Principle of need based: felt need ????
7) Principle of teaching and learning step by step: Start from

where people are
8) Culture –respect community cultures, step by step

introduction of novel ideas e.g exchange in SM 45
Introduction to Health Education
9.Facts…. Polonius says ’’be not the 1st by whom the new is tried nor yet the last to cast the old aside’’
• Apply true, important, comprehensible,

acceptable & usable facts.
• True-avoid crude errors e.g impression of papers
on the street as fertile source of infection
• Important- e.g heated milk vs tuberculin tested
cattle milk for a child health
• Comprehensible-e.g 1) instead of saying ‘open
windows when you are passenger….clear the
importance of cool and moving air to develop
resistance against respiratory infection.
• E.g 2) Diet as fruits & veg. are good for
health…….help them know the fruit,veg. it self.
• Try to build a knowledge of principles of Health

living
d) acceptable-cater to hearts beyond intellectual
convictions….what can motivate learners?
e)Usable or sync- pragmatic, realizable
 telling use of industrial milk…if it is not available
 creating fear if no action can reverse

Approaches of HE
• 1. Persuasive Approach- influencing to a goal
• 2. Non judgmental approach – empowering

The role of health education and promotion in PHC
• Primary health care is a means of achieving health for all
• For the truth, a millions of daily decisions about health and

diseases are made by individuals and families at their home not
by doctors or health workers. Thus, if these millions of
decisions are to be made wisely, individuals and families need
to be equipped with the knowledge and skills necessary to
exercise these health decisions.
• Primary health care is therefore very much concerned with

health promotion and education.

The role of health education…
• One of the core principles of primary health care is

community participation. To achieve effective community
participation two things need to be done.
• First: the political issues or government decision: the

government should commit itself for community
participation in health and development, and should create
favorable climate which facilitate more community
involvement in decision making.

• Second: educational issues (health education):- people need

to know how to carryout this mandate for their benefits. This
involves the adoption of certain types of behaviors and styles
of living beneficial to health in individuals, families and
community. (For self determination)
• Therefore health education is central to primary health care

which in turn is the primary means of achieving health for
all, and no components of primary health care can
successfully implemented without health education. That
means all components of primary health care have health
education
• One thing that makes health education unique from the rest
of PHC component is that, in fact it does not replace the
other health services, but it is needed to promote the proper
use of these services.
• One examples of this is immunization: scientists have made

many vaccines to prevent diseases, but this achievement is of
no value unless people go to receive the immunization.

PHC and HE Vectors
Illness
and
Immunization injury
Health
Education
Water and
sanitations
MCH
Food and
Essential Nutrition
drugs

Challenges to the process of health education
• Good health education does not just happen. Much time,

effort, practice, and on-the-job training are required to be
successful.
• Even the most experienced health educators find program
development challenging because no two days are the same
in health education (the constant changes in settings,
resources, and priority population).

Challenges …
 The following points justify common challenges of health

education
1. Health education is not considered as important during
relatively healthy status as people are often concerned about
diseases.
 Asks for high creativity to influence e.g methods/evidence & appeals
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. (try to do in hierarchy)

Challenges …
3. People are preoccupied with many daily activities to support

their life which impedes them to give their ear to the
messages of health education.
 IEC for health motivation should be an agenda?????
4. People charged with health education programs lack special

training and are not qualified and even if the value of health
education is well understood by many health professionals,
few make it part of their routine professional practice.

Challenges …
6. Health education is much more than “transfer of

information.” With out changes in attitudes and actions it
remains a futile exercise.

14.Who provide HE?
• Since all health workers are concerned with helping people

to improve their health knowledge and skills, all health
workers should practice health education in their job.
• Health education, then, is really the duty of everyone engaged

in health and community development activities.

14.Who provide HE?
• Health workers must realize that their own personal

example serves to educate others.eg.midwife and dispensers
who do not wear a clean uniform are bad example.
• A medical doctor when treating someone can practice

health education to the patient about the cause of the illness
and its preventive measures. >>>>ethical obligation
• Any one who knows what is good for preservation of health

can impart health education. But health workers are much
better fitted to give health education than lay community.

Thank you!!

Intro To HE

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Module 1: Introduction to Health

Introduction to Health Education 1

• Definitions and concepts, Health Education, Health Promotion

• Rationale for Health Education

• Goals and objectives of Health Education

4 • Scope of Health Education

• Principles of Health Education

• Challenges to Health Education

Introduction to Health Education 2

• Discuss basic principles and scope of HE

• Health is not just a state, but also "a resource

Introduction to Health Education 5

5. Personal Behaviors: The choice each person make

Introduction to Health Education 8

“Health education attempts to close the gap between what

 “Bringing about behavioral changes in individuals, groups,

Introduction to Health Education 10

…of the many definitions;

“Any combination of learning experiences designed to

Introduction to Health Education 11

 Combination: it emphasizes on the importance of

 Learning experiences: Opportunities that result in

 ability to positively apply the HI to self & society.

 Designed: refers to planned, integral, intended activities

 Voluntary: implies full understanding and acceptance of

 ….of the many definitions

(U.S National Task Force on the Preparation and Practice of Health

Introduction to Health Education 14

‘’Any combination of learning experiences based on

 Two things: 1) theories of learning, motivation etc (2)

 IEC is a process of working with individuals, communities and

 It focuses on providing people with information and telling

Introduction to Health Education 17

Introduction to Health Education 18

 BCC is a process of working with individuals, communities

 To reach a state of complete physical, mental and social well

( EMERGENCE of HEALTH PROMOTION )

Green and Kreutor (1991) Defined health promotion as:

“Is any combination of educational and environmental

Combination: refers to the necessity of matching multiple

NB: IT takes human behavior as one of the determinants of health

Educational Health education

Introduction to Health Education 22

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

Introduction to Health Education 23

I. Health education e.g IEC/BCC

 HE is the core component in the sense that HP is its

4. Building a healthy public 2. Creating supportive

5. Strengthening  Economic change

1. Developing personal 3. Reorienting health

 Health literacy  Accessing health care

Introduction to Health Education 25

 Health education is primarily focused at voluntary action

e.g Examples of health promotion intervention to prevent

Introduction to Health Education 26

Tobacco educating the public focusing on Establishment of stop smoking clinics.

Introduction to Health Education 27

• It is health facts disseminated to the community focusing on

• In dissemination of health information, base line information

• Appropriate for newly emerging health problems and during

Introduction to Health Education 28

The following points justify the rationale for health education

 About 75% of childhood illnesses are preventable, Health