Local Health Management Course for

First Level Care Technicians

Fifth
Modular Unit

Introduction to Health
Education

Costa Rican Social Security Fund

Center for Strategic Development and Information on Health
and Social Security (CENDEISSS)
Project to Strengthen and Modernize the Health Sector

University of Costa Rica

Vice-Rectorate for Social Action
Faculty of Medicine
School of Public Health

2004
Content authorship
Patricia Redondo Escalante

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 Table of Contents

General objective of the Fifth Modular Unit

Presentation of the Fifth Modular Unit

I. Conceptualization of Health Education

TO. The Definition and the Process

II. Levels of Intervention in Health Education

A. Levels of Intervention

B. Methodological Description of the Levels

III. Planning of Educational Programs in Health

TO. Planning

IV. Self-assessment exercise for the student

V. Response to the self-assessment exercise

Annex 1

Literature

3
 Keys

Specific
objective

Example

Partial
summary

Partial
conclusion

4
General objective of the Fifth Modular
Unit
Propose effective health education, based on the
health needs of individuals and their
communities, to achieve greater participation in
the collective construction of local health.

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 Presentation of the Fifth Modular Unit

Since time immemorial, it has been known that knowledge and practices related
to the health of individuals and communities are of utmost importance in
determining their health status. Already in the first hygiene code of the 15th
century BC (Leviticus) describes a variety of recommendations on conduct that
should be adopted by individuals and different communities.

Over time, governments have adopted measures and policies to protect Public
Health, as one of the fundamental actions in promoting and protecting the health
of the population.

This Modular Unit conceptualizes Health Education as a tool for Health Promotion
and Disease Prevention and a fundamental axis of Comprehensive Health Care.

Identifies the levels of intervention in Health Education and offers the Primary
Care Technical Assistant the tools for the construction of Health Education
Programs, jointly with the members of the Basic Comprehensive Care Teams.

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YO. CONCEPTUALIZATION OF HEALTH EDUCATION

Analyze the concept of health education as a tool

for health promotion and disease prevention.

TO. THE DEFINITION AND THE PROCESS

The primary care strategy aims for individuals and the community to know,
participate in and make decisions about their own health, thereby acquiring
responsibility for it. Both the community and individuals must become aware of
their situation, what problems they must resolve themselves and what aspects
they have the right to demand from other levels.

This awareness does not arise spontaneously in people; it must be fostered

through spaces for discussion and reflection on the problems that affect them
most. Therefore, the mission of Health Education is to create these spaces
and become an essential instrument for the development of healthy lifestyles
by incorporating behaviors favorable to health.

Health Education is a process of interpersonal communication aimed at

providing the information necessary for a critical examination of health
problems and thus making individuals and social groups responsible for
behavioral decisions that have direct or indirect effects on individual and
collective physical and mental health.

Health Education includes consciously created

Health learning opportunities that involve a form of
education communication aimed at improving health
(WHO literacy, including the enhancement of knowledge
Concept and the development of personal skills that lead
, 1998) to individual and community health.

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Over the last century, many authors have conceptualized health education,
and in all of them a common objective can be identified, which is: the
modification, in a positive sense, of the knowledge, attitudes and health
behaviors of individuals, groups and communities. This change in behavior is
achieved by modifying knowledge and attitudes.

Since the first level of care is the initial contact of individuals with the health
system, it is a priority to implement health education, based on the promotion
and prevention of disease, to direct it especially to the healthy population.

Health education should be another tool in the daily work of health personnel,
and become an inseparable part of the relationship between the individual and
the community with health services.

Health education enables the transmission of information and encourages the

motivation of personal skills and self-esteem, which are necessary for
adopting measures aimed at improving individual and collective health. It
involves communicating information and developing personal skills that
demonstrate the political viability and organizational possibilities of various
forms of action aimed at achieving social, economic and environmental
changes that favor health.

I. Health education as a communication process

Health education seen as a communication process involves the
transmission of a message between sender and receiver. Key elements of
this process are: the health educator, the message and the people or
groups to whom it is addressed.

to. Health Any person who consciously or unconsciously

educator contributes to individuals adopting a behavior that
benefits their health. In this sense it is
It is important to highlight the role of the family,
health personnel and teachers in educational
centers.

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 It must be based on scientific evidence
b. appropriate to the learning capacity of the
Message recipient.

It is transmitted directly through the

oral or written word, or through images,
and indirectly through the example that
arises from the behavior and attitudes of
the health educator.

c. Receiver It is the individual or group of people to

whom Health Education is directed.

2. Health education as an educational process

Health education is considered a pedagogical phenomenon that involves

the existence of a teaching-learning process.

Teaching activities seek to develop individual

to. Teaching
faculties to achieve the objectives of the
training action.

Effective teaching requires educational objectives adapted to the

characteristics of the people to whom the education is directed, as well
as the availability of appropriate educational resources.

It is a process that is built based on personal

experiences and when it is significant, it
b. Learning
produces a lasting change in the way people
act, think and feel.

The educational methodology must be related to the particular

characteristics of the recipients. However, in all cases, activities aimed
at building and

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 reconstruct knowledge, to participate and value opinions and attitudes,
to interact with each other, to share experiences, to show them how
they should act and apply what they have learned.

This is the case of ATAP, which gives a talk on

Nutrition to third grade children at its local school.

The goal is for children to identify which foods they

should and should not consume within a group of
foods. It is used as a learning situation

Ex the song and the

. game.

Through songs and games (where the child is),

they are taught (knowledge is transmitted), the
characteristics of certain foods and which of them
can cause harm to them, or produce a benefit for
their health.

The child learns to identify which foods they can

consume and which they cannot.

Conc

Health education is a process that informs, motivates and helps the

population to adopt and maintain healthy practices and lifestyles; it
advocates the environmental changes necessary to facilitate these
objectives.

It generates the development of all those potentialities that transform the

individual and the community into owners of their own destiny, into builders
of alternatives and solutions.

Learning fundamentally involves interaction or relationship between person

and environment; existence of information; activity or observation by
people; internalization; assimilation of something new that produces

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II. LEVELS OF INTERVENTION IN HEALTH EDUCATION

Analyze the main intervention scenarios in health

education.

TO. LEVELS OF INTERVENTION

The development of the levels of intervention in Health Education depends on

the health problem to be addressed, the person(s) to whom it is directed and
the scenario in which it will be implemented-executed or carried out.

In any intervention that is carried out and regardless of the scenario (school,
health services, work, community, social media), the following contents must
be considered:

?? Inform people and the general population

about health and illness, using methods that
allow them to protect their own health.

1. Contents to be ?? Motivate the population to change to healthier

considered in a practices and habits.
Health
Education - ?? Help acquire knowledge and the ability to
Intervention maintain healthy habits and lifestyles.

?? Advocating for changes in the environment

that facilitate healthy living conditions and
behaviour.

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 During a home visit, the ATAP detects a diabetic
person who does not wear adequate
control of your disease. ATAP speaks to you
about your diabetes and the care you should
take with this disease. (Informs: tells you that there are several people
in that community who have the same disease as you and attend a
group where they are taught about diabetes and how to improve their
lifestyle. (Motivates and helps to acquire knowledge and healthy
habits.
The same is discussed with family members and
the consequences that could occur with
inadequate control of this disease are explained
to them. (Changes occur in the environment
that facilitate healthy behavior.)

It is expected that with this intervention, a

diabetic person will be better informed about his
or her disease and will modify his or her behavior
regarding his or her health.

A comprehensive approach to health requires implementing interventions

aimed at promoting health, preventing disease and curing and rehabilitating
people from their health problems. This requires the application of health
educational activities that are developed through different levels of
intervention.

Comprehensive Care is based on three essential axes, namely: Education,

Social Participation and Integrated Evaluation. These three axes will be
developed in the Modular Units of Social Participation and Comprehensive
Care. It is not possible to speak of Comprehensive Care with the sole absence
of one of these axes. In this particular case, health education constitutes a
strategy for the social construction of health.

This process of building and implementing knowledge, habits and attitudes

towards health generally takes place in informal interactions between
individuals and their reference groups, such as: family, friends, colleagues, the
community and mass media (radio, television).

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B. METHODOLOGICAL DESCRIPTION OF THE
LEVELS
Health education programs that are most likely to be successful are those that
have interventions at all levels and are also interinstitutional and
interdisciplinary. The most commonly used levels of intervention are:

?? Mass Education
?? Group Education
?? Individual Education

Description: health intervention

used when necessary
changing deeply rooted behaviors or
attitudes in the population.

b. Objective: To implement forms of

education aimed at promoting public
health in an area, region or country.
1. Mass
Education
c. Scope of action: general population

d. Educational resources: brochur

posters, brochures, murals, es,
media: radio, television, use of
Internet.

Using radio and television to

broadcast advertisements, short films,
anti-AIDS programs
?? Using radio and television to
broadcast advertisements, short
films, and programs against domestic
?? Using
[Link] and television to
broadcast advertisements, short
films, and programs against dengue

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 The media, when used appropriately and reasonably in the field of health
education, contribute to raising the level of awareness of the population
about a particular health problem and create a current of opinion in favour of
health and the promotion of healthy lifestyles.

Working in and with the media should be an objective present in all health
programs and interventions that are designed and carried out for the general
population, since they also contribute to increasing the socio-educational
level of the population.

To achieve this, it is necessary for communicators to have training in health

education, or for health personnel to work together with communicators to
carry out these actions.

Description: interventions aimed at

homogeneous groups of people
to address certain health problems or aspects of your health.

?? Aim: Inform, motivate,

exchange knowledge and induce
behaviors and attitudes of a certain
population group in relation to their
health.
2. Group ?? Scope of action: educational centers,
Education community, workplaces, health services,
family settings, and organized groups.

?? Educational Activities: development

of activities such as workshops, talks,
courses, using various educational
techniques such as: colloquium, video
with discussion, questionnaires and
incomplete sentences. (Annex 1).

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?? Psychoprophylactic childbirth course
?? School for parents review against AIDS
?? Health promoting schools
?? Education for groups of diabetics and hypertensive patients.
?? Education for senior citizens.
?? Health education provided during the pre-consultation.
?? Health education provided in

Annex 1 briefly explains some educational techniques that can be used by

health teams in group education and they are techniques of different
types: expository techniques, techniques for analysis and techniques for
the development of skills.

?? Description: interventions aimed at

individuals to address a particular health
problem or aspects of their health.

?? Objective: To inform, motivate, exchange

knowledge and induce behaviors and attitudes
3. in individuals in relation to
Individual your
Education health.
?? Scope of action: health services, family
setting

?? Educational Activities: conversation,

professional advice, using educational
support techniques such as: posters,
brochures, leaflets.

Ex the home individually.

. ?? Health education provided by the
doctor during the consultation.

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 4. Integration of levels

The coexistence of the three levels of intervention, as mentioned above,

allows educational programs to be continuous and complementary,
which gives the opportunity to be more successful.

Campaign against dengue

fever
?? Mass education: messages on radio
and television
?? Education group: talks in
high-risk communities and schools for
dengue prevention.
?? Individual education: educating patients
with dengue about disease
management and prevention.

The application of these levels of intervention must be part of the

implementation of a specific education programme or form part of a health
promotion plan for the person or community to which it is addressed, in
order to satisfy their learning needs in relation to health and its
determinants.

The different levels of intervention in Health Education,

are part of the essential axes of Comprehensive Care, it is constituted
in a context of the social construction of health.
III. PLANNING HEALTH EDUCATION PROGRAMS

Plan health education programs based on the

prioritization of a community's health problems.

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TO. PLANNING

When planning a health education program at any level, the teaching-learning

process must be considered, which is based on the knowledge of educators
(health personnel) regarding how individuals teach and learn, as well as on
the knowledge of the health needs of the people or population group to whom
it is addressed, as well as on common practices and socio-economic and
cultural aspects.

For this process, good planning and knowledge of some educational

techniques are essential to successfully carry out an education project, as well
as the participation of all members of the Health Team.

1. Stages of planning educational programs

When planning an educational program, the following stages should be

considered:

a. Identification of health needs

b. Development of general and specific objectives
c. Definition of the content of the activities
d. Define methodological strategies
e. Material and human resources
f. Assessment

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 DEFINITION AND APPLICATION OF THE
STAGES
Concept Definition Application

to. Identification of health Each health team must have as input ?? It allows to specify the
needs either a local investigation of health priorities and move on to
problems, a health diagnosis, or a the design of the
comprehensive health situation analysis educational program.
(ASIS), which allows it to prioritize the
main health problems that require an
educational project for intervention.

?? It makes it possible to adapt

b. Development of general the tasks and functions of
and specific objectives health personnel to the
?? They are developed based on needs of the population, in
knowledge of the identified needs. relation to knowledge,
?? General objective: is what the target attitudes and skills to
population of the intervention is teach and learn.
intended to learn at the end of the
educational process. It must be
expressed in observable and
broad behavior.
?? Specific objectives: are the
immediate learnings that the target
population must acquire in the
intervention. It must be expressed
in observable, concrete and
measurable behaviors.
?? It is the information, the subject,
c. Definition of the content of experiences that are transmitted to
the activities the population through any method ?? Using lists of topics,
or medium, to achieve the systematizing
proposed objectives. experiences, problems,
and specific needs on
what is going to be
worked on, in an orderly
manner

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d. Methodological strategies ?? Organization of population
and work groups oriented
?? The systematic and orderly way of towards decision-making
on health
doing one or more activities to
teach how to learn something.
?? These are learning situations or
experiences that are designed in a
systemic and orderly manner to
incorporate new behaviors in
people or groups for which
educational techniques and
audiovisual resources can be
used.

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 Concept Definition Application

and. Material and human ?? Coordination with the

resources ?? People, equipment, materials and population in space,
infrastructure required to develop schedule, etc.
the proposed content.
?? Determine the extent to which the
F. Assessment program objectives have been
achieved, what effects have been
obtained, and what factors have
contributed to achieving the
results.
?? Determine the results and
analyze and discuss the
steps (results and
process)
?? Analyze data to change or
modify behavioral patterns
?? Explain and verify
behavioral patterns
?? Acquire and improve
teaching skills
?? Let participants know that
their contributions are
valued

2. Conditions to be considered

When planning health education programs, some elements that can cause
the program to fail must be considered:

?? The educational programme is not adapted to the needs of the local

level. For example, this is a community with dengue, but a program is
carried out for cholera.
?? Health personnel responsible for health education are not trained for
this purpose. For example, you have worked for a long time in an
operating room and you are assigned to develop an educational
program at the primary care level.
?? The aim is to motivate the population to adopt behaviours that have not
been adopted or incorporated by the Health Team. For example, the
habit of not smoking.
?? The material used is not adapted to the population to which the project
is directed. For example, written material used in front of a group of
illiterate people.

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 The initiative to develop health education programs in local health services
strengthens the capacity of the different institutions related to the well-
being of the community to identify and respond to the needs of prevention
and health promotion presented by the different groups, according to the
scope of action.

Health Education is an instrument and a tool for Health Promotion and

Disease Prevention, whose most appropriate area of application is the first
level of care, as this is the first contact that individuals and the community
have with health services.

It is aimed at modifying the behaviors, habits and attitudes of individuals and

communities, helping people and communities to take responsibility for their
own health.

To achieve this, there are three levels of intervention: individual, group and
mass. Each of them has different ways of being operationalized.

Finally, in order to make Health Education effective, educational programs

must be developed based on the health needs of a particular population
group. These educational projects are carried out by members of the Health
Teams in coordination with individuals and communities.

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IV. SELF-EVALUATION EXERCISE FOR THE STUDENT

Below is a series of statements, put in parentheses V if it is true and F if it is

false.

( ) Health education makes it easier for people to continue with

their habits, behaviors, and attitudes in relation to their health

( ) Health educator is any person who contributes to the

individuals adopt behaviors that are beneficial to their health.

( ) The teacher, the ATAP, the doctor, the community member are
health educators.

( ) The receiver in a health education process is the Area

of Health.

( ) Health education informs, motivates, helps people

to maintain healthy habits and produce changes in them.

( ) The media is a medium used in the

group education.

( ) The Psychoprophylactic Childbirth Course is a means of education

individual.

( ) The planning of educational programs is exclusive to the

doctors.

( ) Educational programs fail because educators in

health are not trained for it.

( ) The community is a favorable setting for education for the

health.

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V. ANSWERS TO THE SELF-EVALUATION EXERCISE

Health education makes it easier for people to continue with ( F )

their habits, behaviors, and attitudes in relation to their health

Health educator is any person who helps (V) individuals adopt

behaviors that are beneficial to their health.

The teacher, the ATAP, the doctor, the community member are
(V) health educators.

The receiver in a health education process is the Area (F) of

Health.

Health education informs, motivates, helps people (V) to maintain

healthy habits and produces changes in them.

The media is a medium used in the ( F ) education

group.

The Psychoprophylactic Childbirth Course is a means of education

( F ) individual.

The planning of educational programs is exclusive to the ( F

)doctors.

Educational programs fail because health educators are not trained

to do so.

The community is a favorable setting for (V) health education.

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 ANNEX 1

This appendix contains some educational techniques, as an example, that can be

used by members of the Basic Comprehensive Health Care Teams in their health
education interventions.

These techniques were adapted from. Basic methodological recommendations

for developing an educational project. National Institute of Health Madrid. 1999.

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 Y GROUP RESEARCH TECHNIQUE
O

Techniqu Description Utility Limitations

e
Brainstorming Members of a group express ideas, feelings etc. Superficial contact with the subject (few
with few words. The educator finally More useful for working on attitudes, words).
systematizes and returns the contributions to the feelings, beliefs than knowledge. Can
group. be used with a large group.
Phillips 66 More useful for working on attitudes, Increased contact and awareness on the
A large group is divided into small groups of 6 feelings, beliefs, than knowledge. topic (one idea per person in 1 minute).
people who discuss a proposed question in 6 Promotes participation Relatively short time, must be planned well.
minutes. Afterwards, a plenary session is held.
The educator finally systematizes and returns
the contributions to the group.
Rack It allows you to work in the affective Greater awareness of the topic
A small or large group expresses their feelings, area as well as in the cognitive area. (experiences, beliefs). Even longer time ++
beliefs or knowledge about different aspects (2 Group of < 12 people. +
to 5) of a topic. In the plenary session, the
educator finally systematizes and returns the
contributions to the group.
Photoword It allows you to work on deep and If deeper aspects appear, management by
In a small or large group, each person chooses a ingrained aspects of the emotional the educator may be more difficult.
photo from among several that are presented. area.
They then express the reasons why they have
chosen it.
Questionnaire It allows you to work on topics in the You only get what the questionnaire asks.
and incomplete In individual, pair or small group work, different affective area as well as the cognitive
sentences questions are answered on a topic with closed or area. Group < 12 people. It allows for
open responses. Plenary (if applicable). The reflection.
educator finally systematizes and returns the
contributions to the group.

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 II. EXHIBITION TECHNIQUES

Techniqu Description Utility Limitations

e
Talk - It is often useful to use teaching It is not useful for working in the emotional
colloquium resources as support. and skills area, nor for finding solutions to
Presentation on a topic by the educator, followed Large group. the problems raised, like the rest of these
by discussion or colloquium on the same, which techniques.
may be free or structured. When structured, the It is a passive, unidirectional technique, it
educator asks participants individually, in pairs can cause fatigue and lack of interest.
or in small groups to think of some doubts,
comments, etc. that the topic suggests to them.
Reading with The group has more autonomy to It takes more time than a talk-colloquium.
discussion gain knowledge than in the talk. Sometimes it is difficult to find the right
document.
There is no oral presentation by the educator, It is useless if the group cannot read.
but the contribution of knowledge on the subject
is a written document (leaflet, article, sheet, etc.)
that is read and discussed in small groups first
(sometimes individual reading only).
Then plenary and large group discussion.
Video with The contribution of knowledge is made through a It enables the variation of expository Sometimes it is difficult to find a video with
discussion video to a large group. techniques. It is usually motivating for useful information for the group. Requires
A discussion follows. participants. device and screen.
Participated It is indicated when it is believed that
lesson The group expresses their prior knowledge on a the group already has some It takes more time than a talk-colloquium.
topic. The educator then makes a presentation knowledge on the subject. It requires a very tolerant climate on the part
on the subject, completing the information. It of the educator, otherwise it seems like an
ends with a discussion on the topic. exam.

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 III. ANALYSIS TECHNIQUES

Techniqu Description Utility Limitations

e
Case It consists of telling a story (written, dramatized Its objective is to analyze causes, Long time.
or on video) and asking some questions. The solutions, etc. regarding a topic, as History is analyzed and discussed, not the
group (small or large, no more than 12) is asked well as to reflect on attitudes, group's own reality.
to analyze it. Plenary session and large group opinions, positions or feelings. It
analysis are held if appropriate. The educator allows us to reach different solutions
finally systematizes and returns to the group and promotes a critical attitude.
what was discussed.

Discussion A group (generally small) discusses a topic, Its objective is to delve deeper into The group's own reality is discussed.
different aspects of it. The discussion can be the topic in question.
carried out in a free or structured way (for The depth in analysis is sometimes
example: half of the large group defends one better than with case and text
position, the other half the opposite). Plenary analysis.
and large group discussion if appropriate. The
educator finally systematizes and returns to the
group what was discussed.

Text analysis The group is asked to use questions to analyse Its objective is to delve deeper into Sometimes it is difficult and laborious to find
a text, a part of it (phrases, proverbs, etc.) or the topic in question. The text the most appropriate text, phrase,
advertisements (written or on video). Plenary provides stimuli for further study. advertisement, etc. for the group.
and large group discussion if appropriate. The
educator finally systematizes and returns to the
group what was discussed.

Exercise The group is asked to work individually Its objective is to analyze a topic Long time. The level of reflection is
(sometimes in pairs, trios or small groups) to and/or reflect on one's own attitudes, sometimes high. In some groups it would be
reflect on different aspects of a topic. Plenary behaviors, solutions, etc. useful to carry out another analysis
and large group discussion if appropriate. The Allows individual work. technique beforehand.
educator finally systematizes and returns to the
group what was discussed.

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 IV. SKILLS DEVELOPMENT TECHNIQUES

Technique Description Utility Limitations

Demonstration The educator explains while carrying out a Its objective is the development of Skill development usually requires several
with training certain psychomotor skill. Then ask the group to psychomotor skills. It is a dynamic training sessions.
perform that skill and establish a training. method.

Operational Its objective is the development at an Short time. It only allows the beginning of
simulation initial or superficial level of a social skill development (it is thought that it would
The group is offered one or more common skill. be done but there is no training in doing it).
situations in which that social skill is used. You
are asked, in individual work and sometimes
later in small groups, to identify what you would
do in that situation regarding the use of skills. As
a preliminary step, it is advisable to use other
techniques that allow reflection on one's
experiences.
Role playing Another technique must be carried out Its objective is the development of Long time. It is necessary to use it after
beforehand to allow us to understand and reflect deep social skills. It allows other techniques.
on the social skill we want to work on. The progressive training, doing the It requires skilled educators in its
educator, to work on the proposed social skill, technique several times, in different management and skill of the actors. The
determines the most frequent roles. Members of situations. group must have a certain degree of
the group perform the exercises and the rest of Arouse the interest of the public. maturity.
the group observes (usually with a script) the
development of the skill. Afterwards there is a
plenary session of what was observed by the
entire group.

These techniques are adaptations of “Basic methodological recommendations for developing an educational project.
National Institute of Health, Provincial Directorate of Madrid, Spain 1999.

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 Bibliographic References

CCSS-CENDEISS-UCR. Module II Special Postgraduate Course in

Comprehensive Care for General Practitioners, 2003

Colomer Concha. Health Promotion and Social Change. Masson Publishing

House, Barcelona. 2000.

National Institute of Health. Basic methodological recommendations for

developing an educational project. Madrid. 1999.

Salleras Luis. Health Education: principles, methods, applications. Madrid, 1990.

Zurro Martin. Primary Care. Concepts, organization and clinical practice.

Volume I. Fourth Edition. Harcourt Brace Publishing House. 1999.

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