Chapter one

Introduction of Health education

By Legesse T.(BSc., MPH)

Department of Public Health

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Course Description:

• Health Education Course is given for Public Health

students primarily to
• address the three educational domains (Cognitive, affective
& Psychomotor)
• on principles, methods & materials of health education,
health related behaviors, Health Communication, research
methods in health education and Health education
planning & evaluation.

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Course Goals or Learning Outcome:

• At the end of the course the students will be able to

• Define health education and explain the principles, aims,
and approaches of health education
• Describe the relationship between health and behavior and
mention the three factors that influence human health
behavior
• Define communication and describe the six elements of
communication and illustrate communication models

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Course Goals or Learning
Outcome:…..
• Explain the rationale for school health education and its
three major components
• Identify & demonstrates the methods and materials of
health education and explain the principle of their
application
• Identify methods of qualitative (Health Promotion)
research and explain their differences from quantitative
research methods.

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Chapter one
• Introduction of Health education

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Objectives
At the end of this session, you are expected to:
Understand Historical development health
education
Define health education and health promotion
List the purpose and principles of health education
Identify the role of Health Education in PHC

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Historical development of Health Education

The development of health education

 is related to the initiation of health promotion
activities for school children and
 their environment including nutrition education

At the beginning of the 20th century,

 official formulation of education policies has
been started in Europe and USA
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Historical….

• health education as an emerging profession is only a little over one hundred

years old

• But the concept of educating about health has been around since the dawn of
humans.

• The growth and development of health education

 accelerated with the initiation of Primary Health Care (PHC) concepts.

• many countries endorsed and showed their commitment at the time of

declaration of PHC at Alma Ata- Russia in 1978.

• recognized as a fundamental to the attainment of ‘Health for all’, and

• put as components of PHC.

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 Historical…..

• In Ethiopia, it was very difficult to know when and

where exactly health education has been started.

• However arbitrarily, divided into three (3) periods:

• Period one- The period of the pre Italo– Ethiopian

war
related to the introduction of modern medicine to
Ethiopia.
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Historical…..
• Period Two- The period after the Italo- Ethiopian
war
Related the involvement of missionaries in the
health services and opening of Gondar Public
Health College.
• Period Three- The period of the socialist revolution
and after which is
 related to the improved government structure
and
 policy development on PHC after Alma- Ata
declaration
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Historical…..

• Adopting Alma Ata declaration, Ethiopia

utilizes health education as a primary means of
prevention of diseases and promotion of health.
the national health policy and Health Sector
Development Program of Ethiopia have identified health
education as a major component of program services

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Definition and concepts of health
Health
• The concept of health is often difficult to define and
measure.
• It is a broad concept and experience.
Its boundary extends beyond the "sick".
• It depends on:
1) The perception of individuals
2) The threshold - e.g. pain
3) the ability to recognize symptoms and signs

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Definition and concept Health
education
Definition and concepts of health

 Generally, there are two opposing models

concerning the definition of health:
Negative (narrow) model
Positive (broad) model

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Introduction…
A. Negative model
Absence of diseases or disability or infirmity

Biological integrity of the individual

Physical and physiological capabilities to perform routine

tasks
• lay people by equating health with the absence of diseases.

• Disease “A” + Medical treatment =health

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Introduction….

B. The positive model

It is broader and more holistic concept

“A state of complete physical, mental, and social
well-being not merely the absence of disease or
infirmity.” ( WHO definition)

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Introduction…

Physical health
 It is the absence of diseases or disability on the
body parts (negative definition).
It is the biological integrity and the physiological
well functioning of the human body
It is the ability to perform routine tasks without any
physical restriction
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Introduction…
• Mental health
 Termed as psychological health by Goldstadt, etal, 1987,
and it is subjective sense of well being
• It has two major components:
A) Cognitive component
• It is the ability of an individual to learn, perceive and,
think clearly.
• E.g. A person is said to be mentally retarded if he/she
cannot learn something new at a pace in which an
ordinary person learns

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Introduction…
B) Emotional component

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

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

• Appropriate here is to emphasis that the response of

the body should be congruent with that of the
stimuli.

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Introduction…

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

the presence of stressful situations (tensions,
depression and anxiety).

• E.g. if somebody gets into coma during an

examination

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Introduction…
Social health
• Is the ability to make and maintain “acceptable” and “proper”
interaction and

• communication with other people and the social environment;

satisfying interpersonal relationship and role fulfillment.

• For example, to mourn when close family member dies, to

celebrate festivals, to create and maintain friendship etc.

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Health Education
Definition-

• Any combination of learning experiences

designed to facilitate voluntary action conducive
to health

• Health education is considered as a partnership

action between the clients and other health
professionals

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Health Education

• Combination: it emphasizes on the importance of

matching multiple determinants of behaviors with
multiple learning experiences or educational
intervention

• Designed: distinguishes health education from

incidental learning experiences as a systematically
planned and organized activity.
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Health Education…..
• Facilitate: creating favorable condition such as predispose,

enable, reinforce.

• Voluntary: with full understanding and acceptance of the

purpose of the action.
Without use of coercion or any manipulative
approaches.

• Action: behavioral steps/measures taken by individuals, groups

or community to achieve the desired health effect
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Health Promotion
Definition
HP is any combination of educational and environmental
supports for actions and conditions of living conducive to health
 the process of enabling people to increase control over, and to improve,
their health’ (
 Health is, therefore, seen as a resource for everyday life, not the objective
of living.

• health is not just the responsibility of health sector alone.

• Thus, the concern for health outside to the healthcare sector is the
call for health promotion

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Health Promotion…

Combination: refers to the necessity of matching

multiple determinants of health with

multiple intervention or sources of supports.

Educational: refers to the communication part of

health promotion. That is health education.

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Health Promotion….

Environmental: refers to the social, political, and

economic, organizational, policy and

regulatory circumstances influence behavior or more

directly health

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Health Promotion….
Component of health promotion
• Health education
• Political environment
• Social environment
• Economic environment
• Organizational environment

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 Health Promotion….
Health promotion employs two methods
A. Educational approach (health education)
attempt to influence predisposing factors through
direct communication,
 reinforcing factors through indirect communication
and
 enabling factor through trainings and organization .

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Health Promotion….
B. The ecological /environmental approach
(political action)
• It employs policy, organization, and regulation to
influence the enabling and reinforcing factors for
environmental and life style changes supportive
of health.

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 PREREQUISITES FOR HEALTH
• The fundamental conditions and resources for health
are
peace,
shelter,
education,
food,
income,
a stable eco-system,
sustainable resources,
 social justice and
equity.
• Improvement in health requires a secure foundation in
these basic prerequisites.
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PRERE--------------
• ADVOCATE :Good health is a major resource for
social, economic and personal development and
important dimension of quality of life.
• Enable: Health promotion focuses on achieving
equity in health.
• MEDIATE : The prerequisites and prospects for
health cannot be ensured by the health sector
alone.

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Health Information

• It is health facts disseminated to the target audience

focusing on the basic facts related to the health issue
under consideration.

• base line information or data is not necessarily

required.

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Comparison of health education
and health information
Health Education Health information

• Baseline information or • Baseline information or data

are not necessarily required
data necessarily required
• The assumption is people are
• The assumption is people
rational.
are not rational all the times
• Appropriate for newly
• Appropriate for old problem
emerging health problems and
during epidemics
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Comparison….
Health Education Health information

• Encourage people to make • Merely telling people to

their own choices for healthy follow healthy behaviors
life • Blind to the reason behind
• Focus on the reason behind behaviors
behaviors • People blamed for un
• People are not blamed for healthy behaviors
unhealthy behaviors
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 Rationale for health education
• The continued existence and spread of communicable diseases

• About 75% of childhood illnesses are preventable

• For some diseases health education is the only practical choice.

• The tendency of increasing magnitude of chronic conditions and

other emerging agendas

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Rationale…
• here is a shift in the major causes of death from
communicable and treatable diseases to non-communicable
diseases

• Human behaviors are almost the single causes for the

development of such currently emerging health problems and
also the main solution

• increasing threats to the young from new and harmful

behaviors
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The ultimate goals of health education

• to improve the quality of life

• helps to achieve a harmonious development of the

physical, mental and social potential.

• To promote health, prevent illness, self-adjust to

live with disabilities and decrease morbidity and
mortality.

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Educational objectives of health
education

• To provide appropriate knowledge

• To help develop positive attitude
• To help exercise health practice/behavior

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 Dimensions of health Education

• Health education is
an eclectic in nature
life long process.
 concerned with people at all points of health and
illness continuum
not an end by itself
not limited to patients in clinical setups
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Principles of health education

• All health education should be need based.

• Health education aims at change of behavior

• It is necessary to have a free flow of communication

• The health educator has to adjust his talk and action

to suit the group for whom he has to give health
education

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Principles…..

• Health Education should provide an opportunity for

the clients to go through the stages of identification of
problems, planning, implementation and evaluation

• The health educators have to make themselves

acceptable

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Principles…..

• health educators should not only have correct

information

• remembered that people are not absolutely without

any information or ideas

• use terms that can be immediately understood.

• start from the existing indigenous knowledge and

efforts
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The levels of disease prevention
Three distinct levels of disease prevention in health
education:
 Primary,
Secondary, and
Tertiary health education.

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Primary health education
Those preventive measures that forestall the onset of illness
or injury before the disease process begins.
Example
• Wearing safety belt
• Human papilloma cancer immunization
• Brushing one’s teeth

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 Secondary health education
• any health education/promotion programs that aimed
at promoting early diagnosis and prompt treatment of
a disease to cure or to limit disability and prevent
more serious pathogenesis.

Example
• breast-cancer screening
• Blood pressure examination

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 Tertiary health education
• health education programs that specifically aimed at
patients with irreversible, incurable, and chronic condition
for social and psychological adjustment

• work to retain, reeducate, and rehabilitate the individual

who has already incurred disability, impairment, or
dependency

• eg. Educating after lung cancer surgery

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Action areas of Health Promotion

Health promotion actions areas are

• Building health public policy

• Creating supportive environment

• Developing personal skills

• Reorienting health service

• Strengthening community action

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Action areas of Health Promotion
• Building health public policy : It puts health on the agenda of policy
makers in all sectors and at all levels, directing them to be aware of the
health consequences of their decisions and to accept their
responsibilities for health

• Create Supportive Environments: The protection of the natural and

built environments and the conservation of natural resources must be
addressed

• Strengthen Community Action: Health promotion works through

concrete and effective community action in setting priorities, making
decisions, planning strategies and implementing them to achieve better
health.
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Action areas of Health Promotion
• Develop Personal Skills: Health promotion supports
personal and social development through providing
information, education for health and enhancing life skills

• Reorient Health Services: The responsibility for health

promotion in health services is shared among individuals,
community groups, health professionals, health service
institutions and governments.

• The role of the health sector must move increasingly in a

health promotion direction
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Principles of health promotion
• Empowerment-enable individuals and communities to
assume more power over the personal, socio-economic
and environmental factors that affect their health

• Participative-involve those concerned in all stages of

planning, implementation and evaluation.

• Holistic- foster physical, mental, social and spiritual

health

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 Elements of health promotion:
• There are three elements of health
promotion:
• Good governance for health
• Health literacy
• Healthy cities

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 Good governance for health

• Health promotion requires policy makers

across all government departments to make
health a central line of government policy.
• This means they must factor health
implications into all the decisions they take,
and prioritize policies that prevent people from
becoming ill and protect them from injuries.

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 Good governance for health
• These policies must be supported by regulations that
match private sector incentives with public health
goals.
• For example, by aligning tax policies on unhealthy
or harmful products such as alcohol, tobacco, and
food products which are high in salt, sugars and fat
with measures to boost trade in other areas.
• And through legislation that supports healthy
urbanization by creating walkable cities, reducing air
and water pollution, enforcing the wearing of seat
belts and helmets.
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 Health literacy

• People need to acquire the knowledge, skills

and information to make healthy choices,
for example about the food they eat and
healthcare services that they need.
• They need to have opportunities to make
those choices.
• And they need to be assured of an
environment in which people can demand
further policy actions to further improve their
health.
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 Healthy cities
• Cities have a key role to play in promoting
good health.
• Strong leadership and commitment at the
municipal level is essential to healthy urban
planning and to build up preventive measures
in communities and primary health care
facilities.
• From healthy cities evolve healthy countries
and, ultimately, a healthier world.

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Approaches to health promotion

• Medical
• Behaviour change
• Educational
• Empowerment
• Social change

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Approaches…..
Medical
• Relies on a medical view of health and professional
interventions based on medical science e.g.
immunisation
• Includes primary, secondary and tertiary prevention

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Approaches….
Behaviour change

• is used to bring about changes in an individual’s thinking

or perception.

• The aim is to encourage individuals to adopt healthy

behaviours

• This is a popular approach because it is focussed on

individuals and retains a role for the professional who
gives information and advice
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Approaches….
Educational

• The aim is to provide information to enable

people to make informed choices for their health

• learning involves 3 aspects:

1. Cognitive (information and understanding)

2. Affective (attitudes and feelings)

3. Behavioural (skills)

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Approaches….
Empowerment

• Enables people to gain control over their lives

• Seen as ethically sound because it supports

autonomy and free choice

• Can be individual or community focussed

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Approaches…
Social change

• The focus is to change the socio-economic

environment to enable people to make healthier
choices and adopt healthier behaviours – to make
the healthy choice the easier choice

• This is a top-down approach including policy

change, media advocacy and legislation
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Principles….
• Inter-sectoral-involve the collaboration of agencies from relevant
sectors.

• Equitable-guided by a concern for equity and social justice

• Sustainable-bring about changes that individuals and communities can

maintain once initial funding has ended.

• Multi-strategy-use a variety of approaches in combination with one

another, including policy development, organisational change, community
development, legislation, advocacy, education and communication

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 Information, Education and
Communication (IEC)

IEC is communication strategy to promote individuals and

community positive behaviors that are appropriate to their
settings.

It focuses on providing people with information and telling

them how they should behave / “teaching them”.

To improve knowledge of problem owners’ and/or sig-others

It is not enough to bring about behavior change.

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IEC……..

Sometimes simply lack of information keeps people

from not taking action.
In this case, we have spread clear information and
facts to make the audience knowledgeable
Note: it doesn’t mean we don’t start from where
people are.

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IEC …………………Awareness

Awareness ≠ Behavior change

IEC……..text book knowledge

seldom leads to behavior change

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 IEC…
• An obvious example of the failure of this assumption is
smoking.

• If knowledge about the negative impact of smoking on

health would in itself be sufficient to achieve healthy
behavior change, no medical doctors would be
smokers

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 Behavior Change Communication
(BCC)
 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
E,g: diet in 1000 days as of pregnancy; beleifs, knowdge, social

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
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 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.
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BCC….
• behavior change communication” is
influenced by health services provision,
community and society norms and
cultures.

• IEC is thus part of BCC while BCC builds

on IEC.

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Targets of health education
• There are three broadly classified targets of health
education programs depending on the type of the
problem

• Individuals: includes clients of services

(contraceptive or VCT users), patients and healthy
individuals

• E.g. hypertensive patients

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Targets….
• Group- two or more people who have a common
interest.

• E.g. a farmers association about nutritious foods

• Community- a collection of people who have

common interests, a feeling of belongingness,

• E.g. a village community about the protection of

spring water
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Health education can:
1. Promote proper use of health services available to
them
2. encourage people to adapt healthy lifestyles and
practices
3. arouses interest, provide new knowledge, improve
skills and change attitudes in making rational
decisions to solve their own health problems
4. stimulate individual and community self-reliance
and participation to achieve health development by
involving them at every steps – empowering the
community or the general public
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Health Education & Health Promotion

• Health Promotion is broader than health education

in that it addresses policy issues, environmental
issues, economic and other social issues, etc.

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The role of health education and
promotion in Primary Health Care
• PHC- Essential health care based on practical, scientifically
sound, and socially acceptable methods and technology
made accessible to individuals and families in the
community through their full participation and at a cost that
the community and country can afford to maintain in the
spirit of self-reliance and self-determination” (WHO, 1978)

• Health education is a cornerstone of the concept of PHC

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Primary Health Care (PHC) concepts and
health education

• Health education was identified as a Primary

means of "Health for All."
• Its central role is in improving community
participation and building the capacity of
communities to make decisions.
• Therefore, health education should aim at
enabling people to make choices.

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Essential components of primary
health care
The Declaration of Alma Ata outlined the 8 essential
components of primary health care such as principles
of,
• Equitable distribution
• Community participation
• Inter-sectoral coordination

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Elements of PHC
• Education for health
• Locally endemic disease control
• Expanded program of immunization
• Maternal and child health
• Essential drugs
• Nutrition
• Treatment of communicable disease
• Safe water and sanitation

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The role of health education in the
application of PHC principles.
1. Promoting community involvement and self-reliance

2. Enhancing decision-making skill at local levels

3. Allowing diversity of objectives in formulating policy

4. Harmonizing national and local plans

5. Facilitating inter-sectoral action

6. Using appropriate technology ‘

7. Measuring the community involvement and impact of health education

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Health education settings

• Health education takes place in:

1. Schools

2. Worksites

3. Health care settings and

4. Community settings

5. Special communities: such as prisons and refugee

settings

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Ethiopian Context
• Health promotion & disease prevention & control programs
of national importance utilizing health education as a major
strategy
1. STIs/HIV/AIDS control & prevention program
2. Malaria control program
3. TB & leprosy control program
4. Vaccine Preventable Diseases
5. Nutritional surveillance program
6. F/P program
7. Adolescent health program

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 Challenges to the
process of HE
People are not concerned

Changing behavior is conditioned by many factors

People are preoccupied by many daily activities

 Health professionals cannot take HE as their part of their profession

Lack of special training

Not Following KAP Approach

The need for change of attitudes and actions not simple transfer of

information
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 THANK YOU!!

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