APRIL 2015

Health Education (HealthEd)

• Course Code : HealthEdCourse Description: The course includes discussions of health education concepts,principles, theories and strategies as they apply in the clinical andclassroom situations.

• Course Objectives :At the end of the course , given relevant situations/conditions, thestudent will be able to:

1. Apply principles, theories and strategies of health education inassisting clients to promote and maintain their health2. Develop an instructional design to meet the learning needs of clients

Health Education (HealthEd)Grading system: Attendance/Attitude-20% Class participation - 10% (activities) Project- 10% Performance (Health Education) - 30% Quizzes -30%

Total=100%Book: Nurse as Educator :2nd Ed

Principle of teaching and Learning for Nursing Practiceby Susan B. Bastable

Health Education (HealthEd)Course Outline:

1st weekA. Health Education Perspective1. Historical development in Health Education2. Issues and trends in Health Education 2.1 Health issues and the biological, psychological, and sociological aspects of health and disease 2.2 Contemporary health and the promotion of optimal

health throughout the lifespan3. Theories in Health Education - (e.g. Pender’s HealthPromotion Theory, Bandura’s Self Efficacy Theory, HealthBelief Model, Green’s Precede-Proceed Model

History of Health Education

MICHELLE E. FLORES, RN MAN

Definition of Terms:• WHO defined health as “a state of complete physical, mental,

and social well being and not the mere absence of disease or infirmity.”

• Physical health – refers to anatomical integrity and physiological functioning of the body. To say a person is physically healthy:• All the body parts should be there.

• All of them are in their natural place and position.• None of them has any pathology.• All of them are doing their physiological functions

properly and they work with each other harmoniously

Definition of Terms:

• Mental health - ability to learn and think clearly. A person with good– mental health is able to handle day-to-day events and obstacles, work– towards important goals, and function effectively in society.

• Social health – ability to make and maintain acceptable interactions– with other people. E.g. To feel sad when somebody close to you

passes away.– The absence of health is denoted by such terms as disease, illness

and sickness, which usually mean the same thing though social scientists give them different meaning to each.

Deinition o Terms:

• Disease is the existence of some pathology or abnormality of the body, which is capable of detection using, accepted investigation methods.

• Illness is the subjective state of a person who feels aware of not being well.

• Sickness is a state of social dysfunction: a role that an individual assumes when ill

Health Education

• Health education has been defined in many ways by different authors and experts. Lawrence Green defined it as “a combination of learning

• experiences designed to facilitate voluntary actions conducive to health.”

• The terms “combination, designed, facilitate and voluntary action” have significant implications in this definition.

• Combination: emphasizes the importance of matching the multiple determinants of behavior with multiple learning experiences or educational interventions.

• .

Health Education

• Designed: distinguishes health education from incidental learning experiences as systematically planned activity.

• Facilitate means create favorable conditions for action.• Voluntary action means behavioral measures are

undertaken by an individual, group or community to achieve an intended health effect with out the use of force, i.e., with full understanding and acceptance of purposes.

Health Education• Most people use the term health education and health promotion interchangeably. However, health promotion is

defined as a combination of educational and environmental supports for actions and conditions of living conducive to health.

• Various terms used for communication and health education activities Information, Education and Communication (IEC) is a term originally from family planning and more recently HIV/AIDS control program in developing countries. It is increasingly being used as a general term for communication activities to promote health.

• • Information: A collection of useful briefs or detailed• ideas, processes, data and theories that can be used• for a certain period of time.• • Education: A complex and planned learning• experiences that aims to bring about changes in• cognitive (knowledge), affective (attitude, belief, value)• and psychomotor (skill) domains of behavior.• • Communication: the process of sharing ideas,• information, knowledge, and experience among people• using different channels.• Social mobilization is a term used to describe a campaign approach• combining mass media and working with community groups and

Health Education

• Information: A collection of useful briefs or detailed ideas, processes, data and theories that can be used

for a certain period of time.• Education: A complex and planned learning experiences

that aims to bring about changes in cognitive (knowledge), affective (attitude, belief, value) and psychomotor (skill) domains of behavior.

• Communication: the process of sharing ideas, information, knowledge, and experience among people using different channels.

Health Education

• Social mobilization is a term used to describe a campaign approach combining mass media and working with community groups and organization.

• Health extension is an approach of promoting change through demonstration, working with opinion leaders and community based educational activities.

• Nutrition education is education directed at the promotion of nutrition and covers choice of food, food-preparation and storage of food.

Health Education

• Family Life Education refers to education of young people in a range of topics that include family planning, child rearing and childcare and responsible parenthood.

• Patient education is a term for education in hospital and clinic settings linked to following of treatment procedures, medication, and home care and rehabilitation procedures.

• Behavior Change Communication (BCC): Is an interactive process aimed at changing individual and social behavior, using targeted, specific messages and different communication approaches, which are linked to services for effective outcomes.

Health Education

• Advocacy: refers to communication strategies focusing on policy makers, community leaders and opinion leaders to gain commitment and support. It is an appeal for a higher-level commitment, involvement and participation in fulfilling a set program agenda.

Health EducationHistorical development

• While the history of health education as an emerging profession is only a little over one hundred years old, the concept of educating about health has been around since the dawn of humans. It does not stretch the imagination too far to begin to see how health education first took place during pre-historic era.

• Some one may have eaten a particular plant or herb and become ill. That person would then warn (educate) others against eating the same substance. Conversely, someone may have ingested a plant or herb that produced a desired effect. That person would then encourage (educate) others to use this substance.

Early History:

• Trial and Error (lay-referral network)• Medical lore passed down from generation to

generation• Throughout history people have always

turned to some type of medicine man or physician for counsel

Ancient Cultures:

• Good hygiene practices• Paved streets, drains, sewer systems• Code of Hammurabi• Before science enabled us to determine

pathogenic causes of disease, spiritual explanations and leadership prevailed

Greeks:

• Balance of physical, mental, and spiritual• Hippocrates and the“atomic theory” • Recorded observations between disease and geography, living conditions,climate, and diet

Romans:

• Conquered the Greeks, but retained their medical knowledge

• Exceptional builders of water and sewage systems

• Attention to where they located towns and drainage

• Advanced study of human anatomy and surgery

Middle Ages:

• In order for people to be protected, they built fortresses around their property and animals

• Overcrowding and sanitation • Little emphasis on cleanliness in early Christianity• Disease was caused by sin or disobeying God• Time of great epidemics – bubonic plague

Renaissance:

• Beginning of change• Disease and plague still rampant• Bloodletting popular• “water casting”• Barbers performed surgery and dentistry• Hygiene of royalty

Renaissance cont.

• Printing press invented so classical writing could be reproduced

• OK to study the human body and anatomy advanced• Leeuwenhoek discovered the microscope• John Graunt made advancement in epi• “health boards” began to be developed in

communities

Age of Enlightenment:

• Disease and plagues still raged• Miasmas theory of disease took hold• Mind and body were dependent on one

another• Edward Jenner discovered vaccine procedure

for smallpox

1800’s (Bacterial period of public Health)

• First half of the century diseases continued to rage• 1842 Edwin Chadwick’s report• 1849 John Snow and the Broad Street pump• Louis Pasteur – Germ theory of disease• Joseph Lister – antiseptic method

Health Education & Promotion in the United States

• Early colonial schools• By mid 1800’s schools were tax supported

and attendance was required• 1850 –first mandate to teach physiology and

hygiene in all public schools• 1850 - Shattuck Report

• 1873 – APHA started • 1874-1890 Women’s Crusade, later called

the Women’s Christian Temperance Union• 1890’s - medical inspections began• 1901- Thomas Wood

• 1914 - Demonstration projects began• 1914 – WWI, 1st large scale measure of

health status of Americans• 1920’s-1930’s many studies designed to

clarify the role of health education• Great Depression, 1929-1941• WWII, 1939-1945

• 1950 – Health Education was emerging as integral part of elementary, secondary, & college curriculum

1970’s:The Era of Prevention

• 1971 – Coalition of National Health Organizations formed

• 1974 – LaLonde Report– ** Health Field Concept **

• 1974 – CDC was established• 1979 – Healthy People: The Surgeon

General’s Report on Health Promotion and Disease Prevention was published

1980’s

• Promoting Health & Preventing Disease: Objectives for the Nation

• Initial Role Delineation study for Health Education

• Examination of professional preparation programs and professional competencies

• First Certified Health Education Specialists (CHES) recognized

1990’s

• National Health Education Standards published

• Responsibilities/competencies for entry-level Health Educators published

• SOC designation for Health Educators• Competencies Update Project (CUP)

2000’s

• Unified Code of Ethics• Report of Joint Committee on Health

Education & Promotion Terminology• Promotion of CHES• Revised national HE competencies (3 levels)

based on CUP• Outcome-Based Education & Practice

Patient Protection & Affordable Care Act

Signed into law March 2010

Expands health care coverage

Should help health education specialists Focus on prevention & preventive services Encourages & promotes worksite wellness Evidence-based community prevention & wellness programs Moves prevention toward the mainstream

Some components of the law are already in place

Major components required in 2014; not be fully implemented until 2019

Aims and principles of health education

Aims• Motivating people to adopt health-promoting behaviors by providing

appropriate knowledge and helping to develop positive attitude.• Helping people to make decisions about their health and acquire the

necessary confidence and skills to put their decisions into practice.Basic Principles• All health education should be need based. Therefore before involving

any individual, group or the community in health education with a particular purpose or for a program the need should be ascertained. It has to be also specific and relevant to the problems and available solutions.

Aims and principles of health education

Basic Principles• Health education aims at change of behavior.

Therefore multidisciplinary approach is necessary for understanding of human behavior as well as for effective teaching process.

• It is necessary to have a free flow of communication. The two way communication is particularly of importance in health education to help in getting proper feedback and get doubt cleared.

Aims and principles of health education

• The health educator has to adjust his talk and action to suit the group for whom he has to give health education. E.g. when the health educator has to deal with illiterates and poor people, he has to get down to their level of conversation and human relationships so as to reduce any social distance.

• Health Education should provide an opportunity for the clients to go through the stages of identification of problems, planning, implementation and evaluation. This is of special importance in the health education of the community where the identification of problems and planning, implementing and evaluating are to be done

Aims and principles of health education

• with full involvement of the community to make it the community’s own program.

• Health Education is based on scientific findings and current knowledge. Therefore a health educator should have recent scientific knowledge to provide health education.

• The health educators have to make themselves acceptable.• They should realize that they are enablers and not

teachers.• They have to win the confidence of clients.

Aims and principles of health education

• The health educators should not only have correct information with them on all matters that they have to discuss but also should themselves practice what they profess. Otherwise, they will not enjoy credibility.

• It must be remembered that people are not absolutely without any information or ideas. The health educators are not merely passing information but also give an opportunity for the clients to analyze fresh ideas with old ideas, compare with past experience and take decisions that are found favorable and beneficial.

Aims and principles of health education

• The grave danger with health education programs is the pumping of all bulk of information in one exposure or enthusiasm to give all possible information. Since it is essentially a learning process, the process of education should be done step-by-step and with due attention to the different principles of communication.

• The health educator should use terms that can be immediately understood. Highly scientific jargon should be avoided.

Aims and principles of health education

• Health Education should start from the existing indigenous knowledge and efforts should aim at small changes in a graded fashion and not be too ambitious. People will learn step by step and not everything together. For every change of behavior, a personal trail is required and therefore the health education should provide opportunities for trying out changed practices.

Approaches to health education

• The persuasion approach –deliberate attempt to influence the other persons to do what we want them to do (DIRECTIVE APPROACH)

• The informed decision making approach-giving peopleinformation, problem solving and decision making skills tomake decisions but leaving the actual choice to the people.E.g. family planning methods• Many health educators feel that instead of using persuasion it is

better to work with communities to develop their problem solving skills and provide the information to help them make informed choices.

Approaches to health education

• However in situations where there is serious threat such as an epidemic, and the actions needed are clear cut, it might be considered justified to persuade people to adopt specific behavior changes.

• Targets for health education• Individuals such as clients of services, patients, healthyindividuals• Groups E.g. groups of students in a class, youth club• Community E.g. people living in a village

CURRENT TRENDS & ISSUES

IN HEALTH EDUCATION

Biological, Behavioral, and Social Factors Affecting Health

BIOLOGICAL• In the early years of scientific medicine, most clinicians and researchers

thought only in terms of single causes: specific agents that cause specific disease.

• More recent research highlights the relationships between health and behavioral, psychological, and social variables.

• Acceptance of the fact that stress is linked to cardiovascular disease or to other health problems has become commonplace. However, research also reveals many reciprocal links among the central nervous system, which recognizes and records experiences; the endocrine system, which produces hormones that govern many body functions; and the immune system, which organizes responses to infections and other challenges.

• Similarly, it has long been recognized that specific behaviors are associated with increased risk of specific diseases and related conditions.

Biobehavioral Factors in Health and Disease

• Relationships between behavior and health has been aided by technology and by conceptual advances in the behavioral, biological, and medical sciences.

• Our understanding of the interactions between brain function and behavior has been enriched by advances in behavioral neurobiology, neuroscience, and neuroendocrinology

• Real-time imaging of the living human brain during different behavioral states has promoted our understanding of the links between human behavior and basic neurochemical processes or specific neuroanatomic pathways. Common availability of monoclonal antibodies, routine production of genetically altered animals, and new understanding of the genetic code have contributed to exploration of how genetics interacts with development and early experiences to influence both vulnerability to disease and resistance to age-related decline.

SOCIAL :STRESS, HEALTH, AND DISEASE

• The study of stress has provided a major link in explaining the behavioral variables and the biological factors that influence physical health. Stress both causes and modulates a diversity of physiological effects that can enhance resistance to disease or cause damage and thereby promote disease.

• The primary and secondary effects of the stress response constitute the biologic pathways along which a person’s experiences, living and working conditions, interpersonal relations, lifestyle, diet, personality traits, and general socioeconomic status can affect the body. Individual behavior is important because it increases or decreases the pathophysiological cost of stress through diet, exercise, and other activities.

SOCIAL :STRESS, HEALTH, AND DISEASE

• The stress response is an important component of the body’s regulatory systems. The maintenance of constant and appropriate internal conditions and functioning in the face of changing environmental demands is called homeostasis, an idea first developed by Walter Cannon (1936). The stress response is a rapid and pervasive adjustment of internal states to prepare an organism to adapt to a threat—to respond to the rigors of “fight or flight” (Chrousos, 1998).

• The ancient physiologic stress response is triggered when one experiences, for example, a threat to social position, damage to important interpersonal relationships, loss of possessions, or barriers to the achievement of goals. Because many difficulties of contemporary life and their accompanying stress cannot be rapidly resolved—as could many physical stressors—the stress response persists, homeostasis is not restored, and the response becomes dysfunctional rather than adaptive.

Contemporary health and the promotion of optimal health throughout the lifespan

• Health promotion and disease prevention have huge impact on health, yet given low priority, risk being overlooked in universal health coverage efforts. To effectively prioritize promotion and prevention, strong cadres of personnel are needed with expertise in legislation and health policy, social and behavior change communication, prevention and community health, health journalism, environmental health, and multisectoral health promotion.

Contemporary health and the promotion of optimal health throughout the lifespan

• Global health faces a major dilemma. On the one hand, the World Health Organization (WHO) defines health as a “complete state of physical, mental and social well-being.”1 On the other hand, universal health coverage tends to focus on health “care” and health “services,” often in the context of health “insurance.”2 That leads to an emphasis on curative care. Ironically, health promotion generally takes a back seat, despite its enormous importance for well-being. We assert health promotion should be front and center. And the surging rates of NCDIs in developing countries only strengthen the need for health promotion.

• Universal health coverage tends to focus on curative care without enough focus on health promotion and disease prevention.

Theories in Health Education

Bandura’s Self Efficacy TheoryPender’s Health Promotion Theory Health Belief ModelGreen’s Precede-Proceed Model