NAZNEEN VOHRACLINICAL INSTRUCTOR

MTIN, CHARUSAT, CHANGA

Contents• Introduction(Concept) • Definitions• Aims & objectives• Principles od health education• Process of health education• Approach to health education• Method of health education• Level of health education• Practice of health education(scope of health education)• Health educators• Opportunities for health education• Success stories

Introduction(concept) 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.Health education is an active learning process, which aims at favorably changing attitudes and influencing behavior w.r.t health practices

Introduction• It has become the integral part of various

national health programs such a RNTCP, RMNCH+A, and many communicable and non- communicable diseases.

• Health literacy is an outcome of effective health education, increasing individuals’ capacities to access and use health information to make appropriate health decisions and maintain basic health.

Definition

• 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)

Health + Education

Definition

Health education:‘‘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)

Aims(a) To encourage people to adopt and sustain health

promoting life style and practices(b) To promote the proper use of the health services

available to them(c) To arouse interest to provide new knowledge ,improve

skilled and change attitudes in making rational decisions to solve their own problems

(d) 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.

OBJECTIVES• INFORMING PEOPLE: people are informed about

the different diseases, their etiology and how to prevent them.

• MOTIVATING PEOPLE: concerned with clarifying/ changing or forming attitudes,beliefs,values or opinions. After health information is given it is necessary to motivate them alter their lifestyles so that it becomes favorable to promoting health and preventing disease. Motivation is defined as “a combination of forces which initiate, direct and sustain behavior”

PRINCIPLES OF HEALTH EDUCATION

• 1.CREDIBILITY• 2.INTEREST• 3.PARTICIPATION• 4.MOTIVATION• 5.COMPREHENSION• 6.REINFORCEMENT• 7.LEARNING BY DOING• 8.KNOWN TO UNKNOWN• 9.SETTING AN EXAMPLE• 10.GOOD HUMAN RELATIONS• 11.FEEDBACK• 12.COMMUNITY LEADERS• 13.SOIL, SEED, SOWER

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

INTEREST• If the health education

topic is of interest to the people, they will listen to it.

• 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

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

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

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

• Eg:-A statement saying “Eat food items that are cariogenic” may not be comprehensive to the layman. A better way of explaining would be “ Avoid food stuffs which are sweet and which stick to your teeth like toffees and pastries. Eat food items like fruits and raw vegetables which in addition to being healthy, also help in keeping your teeth clean.

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”

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”

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.

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

• Eg:-A health education program with the aim of introducing a toothbrush to a rural population will be better appreciated if the communicator start the program with “what are you using to clean your teeth at present” and then going in to details like “why

• are you using it” and then connecting it to the tooth brush and then providing details about the tooth brush

SETTING AN EXAMPLE• The health educator should

follow what he preaches.• He should set an example

to others to follow• Eg:- A health educator who

participate in a program highlighting the ill effects of tobacco should not be seen smoking since it sends a wrong signal and seriousness of the situation is lost

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

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

• GUIDING IN TO ACTION: concerned with development of skills and action. A person who has obtained health information might be motivated to change his behavior and lifestyle. However he might need professional help and guidance so as to bring about these changes and to sustain these altered lifestyles

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

SOIL, SEED, SOWER

• Soil is the community• Seed is information• Sower is the person giving the information

APPROACH IN HEALTH EDUCATION

1. Regulatory Approach(Managed Prevention)

2. Service Approach3. Educational Approach4. Primary health care Approach

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

• Eg: Child marriage act in India, Seat belts rule in cars etc.

• Advantages: Simple , Quick• Particularly , be useful in times of emergency or in

limited situations such as control of an epidemic disease or management of fairs and festivals

Legal or Regulatory Approach

Limitations :• In area of personal choice (alcohol , exercise

etc.) no govt. can take away their right of freedom

• Difficult to enforce laws without a vast administrative infrastructure and considerable expenditure.

Service Approach

• Intends to provide all the health facilities needed by the people at their door steps on the assumption that people would use them to improve their own health.

• Limitation :not based on the felt-needs of people

For example, when water seal latrines were provided, free of cost, in some villages in India under the Community Development Programme, people did not use them. This serves to illustrate that we may provide free service to the people, but there is no guarantee that the service will be used by them.

Educational Approach• Most effective• Gives autonomy towards their own lives• Components : 1. motivation 2. communication 3. decision making

• results slow , but permanent and enduring.• Sufficient time for an individual to bring about changes and

learning new facts as well as unlearning wrong information as well.

• Radically new approach starting from the people with their full participation and active involvement in the planning and delivery of health services based on principals of art health care via community involvement and inter-sectoral coordination

• Individuals helped to become self-reliant in matters of health

Primary health care approach

• It can be done if the people receive the necessary guidance from health care providers in identifying their health problems and finding workable solutions.

• This approach is a fundamental shift from the earlier approaches.

Practice of Health education • 1. Audio visual aids

– Audio– Visual – Audio Visual

• 2. Methods of health communication– Individual / Family– Group– General public (Mass communication )

Combination of Audio-Visual Aids

• Sound & sight combined together to create a better presentation

televisions tape and slide combinations Video Cassette Players and Recorders Motivation pictures or Cinemas Multimedia Computers

Practice of Health education • 1. Audio visual aids

– Audio– Visual – Audio Visual

• 2. Methods of health communication– Individual / Family– Group– General public(Mass communication )

METHODS OF HEALTH EDUCATION

• 1.Individual approach• 2.Group approach• 3.Mass approach

Individual and Family Health Education

Personal interviews 1.Personal contact2.Home visits3.Personal letter4.Health Counseling

– Public health supervisors, nursing staff and health visitors

– visit hundreds of homes;– opportunities for individual teaching

• INDIVIDUAL APPROACH• When an individual comes to the dental

clinic or health centre because of illness, the opportunity should be used to educate him on matters of interest such as the cause and nature of his illness, its prevention, beneficial diets, oral hygiene etc.

• This approach can also be used by public health personnel, since they will be visiting homes and can interact with the individual and their families

• Advantages• Can be done in a dentist’s consultation room• Discussion, argument and persuasion of an individual

to change his behavior is possible• Opportunity for the individual to ask questions and

clearing doubts• Disadvantages• Small number can benefit• Health education is given to only who come in contact

with the dental surgeon or with public health personnel

Methods of Group Health Education

Lectures

Demonstrations

Discussion

methods

1.LECTURES• CHALK AND TALK (LECTURES)• “A carefully prepared oral presentation

of facts, organized thoughts and ideas by a qualified person”

• Should have an opening statement• Group should not be more than 30 people• Duration of talk should not exceed 15-20

minutes• Should be based on topics of current

interest• Its effectiveness depends on ability of

speaker to write and draw legibly

• 1.Flipchart 2Flannelgraph 3.Exhibits 4. Films and charts

Demerits: • students are involved to a minimum extent; • learning is passive; • do not stimulate thinking or problem-solving capacity;• the comprehension of a lecture varies with the student;

the health behavior of the listeners is not necessarily affected.

• one way communication ,learning is passive

• 2.DEMONSTRATIONS• Procedure is carried out step-by-step in

front of sn audience• Method involves the audience in discussion

and has a high motivational value• The audience can then carry out the

procedure themselves with expert help

Merits:• Dramatization help arousing interest• persuades the onlookers to adopt recommended

practices• upholds the principles of "seeing is believing“

and "learning by doing", and• can bring desirable changes in the Behaviour

pertaining to the use of new practice.

Demonstrations

• have a high educational value in programmes like

• environmental sanitation (e.g installation of a hand pump, construction of a sanitary latrine);

• mother and child health (e.g. demonstration of oral rehydration technique) and control of diseases (e.g., scabies).

• has a high motivational value.

Demonstrations

-Group discussion -Panel discussion-Symposium -Workshop-Conferences -Seminars -Role play -Brain storming-Colloquy - Campaign- Focus group discussion -Delphi method

3.Discussion methods

• GROUP DISCUSSIONS• A group is an aggregation of people

interacting in a face-to-face situation• Process of identifying problems and

finding solutions collectively by members of group

• Consist of 6-12 members• Participants are seated in a circle• Group leader initiates the subject,

prevents side conversations, encourages everyone to participate and sums up the discussion

• There should be a recorder who prepares a report on issues discussed and agreements reached

• PANEL DISCUSSIONS• Panel of 4 to 8 experts sit

and discuss a topic in front of an audience

• Headed by a chairman who opens the session, introduces the speakers and keeps the discussion going

• Audience are allowed to ask questions

• Chairman sums up the different views presented

• SYMPOSIUM• A series of speeches on a selected topic• Each speaker presents a brief aspects of the

topic• There is no discussion among speakers• In the end, the audience may ask questions• The chairman makes a summary at the end

of the session

• WORKSHOP• It consist of series of meetings with

emphasis on individual work with the help of resource persons

• Total work shop is divided in to small groups and each groups will select a chairman and a recorder

• The individuals work, solve a part of the problem, contribute to group discussions and leave the workshop with a plan of action for the problem

CONFERENCES OR SEMINARS

Program range from half day to one week

Held on a regional, state or national level

They usually have a theme

• ROLE PLAYING/SOCIO DRAMA

• Size of the group should be 25

• The audience should take part • Situation is dramatized to

make communication more effective

• It is followed by a discussion on the problem

• Puppet shows is a type of socio drama

• Useful for children’s health education

Conference

• It composed of two to fifty persons representing several organizations, departments, or points of view within an organization, meet together exhibit a common interest and present two or more sides of their problems.

• They gather information and discuss mutual problems with a reasonable solution as the desirable end.

• The various phases of the problem may be presented by co-operative or hostile groups

Brain storming• It is a type of small group interaction designed to

encourage the free introduction of ideas on a restricted basis and without any limitations as to feasibility.

• Participants are encouraged to list for a period of time all the ideas that come to their minds regarding some problem and are asked not to judge these ideas during the session.

• Judgment of the ideas will come at a later period in which all contributions will be sorted, evaluated and perhaps later adopted.

COLLOQUY• A Colloquy is an informal method of discourse which

is a modified form of the panel, using one group of three to four persons from the audience and another group of three to four resources persons or experts on the subject to be considered.

• The panel members elected from the audience present the problem and the experts comment on various aspects of it.

• The general audience and panel members participate whenever they so desire under the guidance of a moderator

CAMPAIGN

• A campaign is an intensive teaching activity undertaken at an opportune moment for a brief period, focusing attention in a concerted manner towards a particular problem so as to stimulate the widest possible interest in the community.

• Campaign methods can be used only after an advocated practice & is found acceptable to the local people through method or result demonstrations or other extension methods.

Focus Group Discussions (FGD) • It is a group discussion of 6-20 persons guided by

a facilitator during which group members talk freely and spontaneously about a certain topic or health problem.

• The purpose of a focus group discussion is to obtain in-depth information on concept, perceptions and ideas of group on a particular topic.

FGD

• The topic should be narrowly focused • Selection of participants is also focused by

targeting individuals who meet specific criteria

• Topic should be of interest to both the investigator and respondents.

• The emphasis should be on interaction between or among the group members.

Delphi technique

• Delphi technique is “a judgmental forecasting procedure for obtaining, exchanging, and developing informed opinion about future events”

Or • a method for structuring a groups’

communication process so that the process is effective in allowing a group of individuals as a whole, to deal with a complex problem”

• The Delphi Technique typically includes at least two rounds of experts answering questions and giving justification for their answers, providing the opportunity between rounds for changes and revisions.

• The multiple rounds, which are stopped after a pre-defined criterion is reached, enable the group of experts to arrive at a consensus forecast on the subject being discussed

Delphi technique

Delphi technique

Delphi technique

The tasks that the Delphi can help to address are:• determining priorities, setting goals,

establishing future directions• designing needs assessment strategies &

improve service delivery• evaluating programs or alternative plans

Delphi technique

Successful communication as :• Avoids domination of one or more members of the

group;• Avoids pressures to conform to the group’s

opinion;• Avoids personality or interpersonal conflicts; and• Avoids the difficulty of two opposing individuals

of power

Mass communication • Mass communication literally means

communication that is given to a community where the people gathered together does not belong to one particular group.

• Communication is given to a community where the people gathered together do not belong to one particular group

• VARIOUS MASS MEDIA USED ARE• Television• Radio• News papers/press• Documentary films• Posters• Health exhibition• Health magazines• Health information booklets• Internet• mobile telephone message• satellite televisionThese are emerging and being adapted rapidly in the movement toward modernization.

Mass communication

• Method used to educating general public are called as mass media

1. Television: it’s a one – way methodIt is excellent method to change people’s

attitude, views and behaviour regarding health concern

2. Radio: it reaches to large populationDiscussion about any health related topic can

reach to remote areas

3. Internet• Health related information can be collected

from ministry of healthand family welfare gov of india and WHO

4. Newspaper5. Printed materials• Ex- magazines, pamphlet, booklets and hand-

outs prepared by different organizations and govt

6. Direct mailing• Health dept ---village local leaders, literate

peoples, infomation regarding nutrition, immunization,

7. Posters8. Health museum and exhibitions• Knowledge about the various health

problem and concern can be presented thoroug health museum and exhibition

mHealth

• mHealth involves using wireless technologies such as Bluetooth, GSM/GPRS/3G, WiFi, storage devices, and so on to transmit and enable various eHealth data contents and services.

• Usually these are accessed by the health worker through devices such as mobile phones, smart phones, PDAs, laptops and tablet PCs

• Advantages:• Large number of people can be reached• People of all socio-economic status have access to

health education • All people irrespective of their caste, creed and

religion are addressed

• Disadvantage :• One way communication

HEALTH EDUCATOR

• People specialize in health education (trained and/or certified health education specialists).

• Para-professionals and health professionals - perform selected health education functions as part of what they consider their primary responsibility (medical treatment, nursing, social work, physical therapy, oral hygiene, etc.

Responsibilities of health educator

At Hospital1. Out-patient departmentExbiting the pictures, photos, charts and

models in waiting hallArrange group discussionPamphletsStreet play 2. In-patient department

OPPORTUNITIES FOR HEALTH EDUCATION

• Information while looking after the patient

• Provide Health education to family member by live demonstration and group discussion

• Family planning, prenatal,postnatal,

• Diet ,personal hygiene, nutrition, lighting, and ventilation, health checkup, prevention of disease, health check-up

At home :

In community

• Health education regarding environmental sanitation during community survey

• Schools, factories and home

1. Human biology anatomy and physiology Importance of health Effect of smoking, drinking and drugs on the body

2. NUTRITION Balanced diet Nutritive value of food stuffs

SCOPE OF HEALTH EDUCATION

Diet for pregnant and lactating mothers and others Food sanitation Nutrition deficiencies disease and there prevention Motivation of good eating habits

3. Hygiene (personal and environmental) Personal hygiene Environmental hygiene Food hygiene

4. Mental health• Preventive measures against mental disorder, hyper-

exciability

Development of proper relationship with mothers and child at birth, at the time child go to the school, help at the time choosing a career

Guidance and counseling

5. Prevention of disease and accidents

• Prevention of communicable Ex- TB, AIDS and non communicable disease Ex- D.M., C.H.D

• Useful information about road safety

• Knowledge about accidents industrial area, offices, and their prevention

• Education regarding self screening measures• To detect and prevent cancer ex- Brest self -

examination

6. Utilization of health servicesTo Inform the community about available health

services, voluntary agencies, motivate them to participate in national health programme

7. Family planning and maternal and child health• Planned and unplanned family• Immunization of pregnant women• Growth and development of child, depression etc.• Use of contraceptives• To strengthen and improve the health of family as a unit rather

than as an individual

8. Sex education9. Health statistics• Health habits• Safety rules• Basic (K) of disease & preventive measures• Proper use of health services• Special education for groups( food

handlers, occupations, mothers, school health etc. )

• Principles of healthy life style e.g. sleep, exercise

• Etc..

Concept m

ap

ROLE OF NURSE IN HEALTH EDUCATION

The nurse should consider following points during health education:

To gain the confidence of people To arouse the interest in people about good health To motivate them to bring about chnages in habbits

in healthy living To develop sense of responsibility among people

towards good health of the whole community Motivate or encourage them to use of health

services co-operative feeling Select the subject matter according to need

Nurses role/responsibilities as a health educator

Use appropriate audio-visual aids

Use opportunities of health education wisely

It should be planned and continuous and implementation based on resources

Nurses should come forward and take Sufficient participation and cooperation of government and voluntary agencies is essential for health education

Effective communication should be maintain

SUCCESS STORIES

Polio eradication • Increased awareness about

the Vaccine • Decreased the myths

regarding the vaccine• Better sanitation and hygiene• Information about the the

immunization days• Tag lines such a “DO

BOOND ZINDAGI ke” - very effective

THANK YOU