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2. HEALTH EDUCATION CONCEPTS & APPLICATIONS By
Dr Abdulaziz Al Kabbaa
MBBS, DCH, ABFM, JBFM
Consultant in Family Medicine
3. Objectives At the end of this lecture, you should know:
What Health Promotion is
What Health Education is
The Principles of Health Education
How to carry out Health Education
Elements of Health Education
4. Definition of Health Promotion Motivations & encouragement of individuals & the community to see good health as a state that should be maintained through the adoption of health practice.
5. IMPORTANCE H/E is the most important PHC activity.
H/E is the cement that binds together the bricks of any health program.
H/E is the main pillar of health promotion.
19 - 41% of all direct patient care time is devoted to health education & counseling activities in PHC practices.
6. IMPORTANCE OF H.E. (Evidence Base) Giving patients handouts about tetanus increased the rate of immunization against tetanus among adults threefold.
(Cates CJ, BMJ, 1990; 300 (6727):789-90),
7. IMPORTANCE OF H.F. (Evidence Base) An educational booklet on back pain for patients reduced the number of consultations made by patients over the following year & 84% said that they found it useful.
(Ronald M, Dixon M, JR Coll GP, 1989; 39(323):244-6).
8. IMPORTANCE OF H.E. (Evidence Base) There is no evidence that H.E. has a harmful effect.
Patient education about S/E of drugs did not show any detectable adverse effects. (JFP, 1990, 31(1) 62-64).
9. IMPORTANCE OF H.E. (Evidence Base) American survey of 360 patients done in 1991 shows:
90% wanting pamphlets at some or all of their office visits.
67% reading or looking through & saving pamphlets received.
10. 30% read & looked through them & then threw them away.
Only 2% threw them away without review.
(Shunk et al, Fam.Med., 23(6) 429-32).
11. ESSENCE Health education is a complex activity in which NOT only the members of the health team participate as educator, BUT also parents, teachers, friends, related sectors & other important community members have a teachers role.
13. DEFINITION OF HEALTH The state of complete physical, mental & social well-being & not merely the absence of disease or infirmity.
Complete: Not partial or deficient in any one of the following:
Physical: Body problems (disease or infirmity)
14. Mental: Organic brain malfunctions or psychological disturbances.
Social: Effects of the surroundings of the human being & their relationship to him/her.
Well-being: Healthy, happy, safe & not complaining.
15. Not merely the absence of disease & infirmity:
Not only physical well-being at the present time, but also mental & social well-being in the present & in the future (promotion, prevention, treatment & rehabilitation).
16. DEFINITION OF HEALTH EDUCATION A process that informs, motivates & helps people to adopt & maintain healthy practices & lifestyles.
National Conference on Preventive Medicine 1977, USA
17. A process which affects changes in health practices & in the knowledge & attitudes related to such changes.
18. AIMS OF HEALTH EDUCATION (WHO) To ensure that health is valued as an asset in the community.
To equip the people with skills, knowledge & attitudes to enable them solve their health problems by their own actions & efforts.
To promote the development & proper use of health services.
19. OBJECTIVES OF HEALTH EDUCATION Informing people to impart knowledge, this will:
Clear the barriers of ignorance, prejudice & misconceptions.
20. Lead to assuming more responsibility towards ones health care.
Induce awareness about health needs, minimizing the gap between needs & demands.
21. Motivating people:
The emphasis should be on motivating the consumer to choose his own alternatives about the health actions (cafeteria approach).
22. Guiding into action:
The suggested technology must be available, culturally acceptable & economically affordable.
The stimulus to continue with the change should be persistent.
Seek help when needed
23. APPROACHES FOR ACHIEVING AIMS Cognitive Model Telling people
Health
Illness
Ways to improving & protecting health & efficient use of the delivery system.
Is it enough?
Why?
24. Motivation Model:
Reluctance or inability of people to translate information received into practice.
Shortcomings:
Other elements needed
= social & economic factors
25. MOTIVATION MODEL
26. Social Intervention Model:
Pre-requisites for health:
Income
Food
Shelter
Education
Peace
Justice
Equity
27. Effect change in life styles of individuals:
Home
School
Workplace
28. Q. Who shall perform Health Education? All members of the team must participate positively in the process of health education inside & outside the health care centre, e.g.
Male & female doctors, male & female nurses
29. Social workers, health inspectors, health & even administrative supervisor
In addition to the health education officer
30. Q. What are the characteristics of the health educator? The health educator must:
Have technical qualifications in health education.
Be familiar with the traditions & popular customs of the recipient society.
31. Be a good example for the message of H/E he is presenting, i.e. He should not smoke at the time he asks others to quit smoking.
Believe in & be actively committed to the message of health education.
Have initiative & motivation as well as the capacity to communicate & convince others with his message.
Speak the recipients language.
Pay attention to the backgrounds & culture of the recipient.
32. PRINCIPLES OF H/E INTEREST: people are unlikely to listen to those who are not of their interest.
PARTICIPATION: based on active learning - How? Group discussion, workshops, panel discussions.
33. Start from the KNOWN & lead the people to the UNKNOWN, i.e. knowledge. This will enable the community to develop an in-depth insight into their own health problems.
COMPREHENSION:
Make the learner understand what you are saying now? Adjust your level as a teacher with the educational background of the learner.
Teaching should be within the mental capacity of the audience.
34. REINFORCEMENT: By repetition of the information in the same session or during subsequent sessions.
Remember: Few people can learn all that is new in a single sitting.
MOTIVATION: By creating the desire in a person to learn through incentives like praise, love, rivalry, rewards, etc.
35. LEARNING BY DOING:
Usually leaves a lasting imprint & leads towards positive action
SOIL, SEED & SOWER:
The people are soil, the health facts are the seeds & the educator is the sower.
All the components of this triad will influence the outcome.
The 3 factors should be carefully & satisfactorily interrelated.
36. GOOD HUMAN RELATIONSHIPS:
People must accept you as a friend & well-wisher & have the confidence to confide to you.
The personal qualities of the health educator are more important than his technical qualifications.
37. LEADERS:
People learn best from people who they respect & admire.
Try to make use of Sheikh, Omda, School Teachers, etc.
39. ELEMENTS OF H/E Education is primarily a matter of communication
MESSENGER (Communicator):
Must be clear about his objectives, specific in his approach & aware of his audiences needs & abilities.
40. MESSAGE: (the information you wish your audience to perceive, understand, accept & act upon or practice)
Must be limited to the objectives oriented to the needs of the audience. Clear, understandable, specific, timely, appealing & fitted into the socio-cultural level of the people.
41. RECIPIENTS (Audience):
The consumers with varied interests, needs & expectations.
CHANNELS (Tools):
You can use a variety of channels in a single session to avoid monotony.
42. AUDIO-VISUAL AIDS Auditory: tape records, microphones
Visual: blackboard, flannel graph, flip charts, models, posters, specimens, slides, projectors
Combined: film, videos, TV, CDs, internet
43. EQUIPMENT REQUIRED FOR PERFORMING HEALTH EDUCATION Tools & Devices:
Overhead projector, slide projector, display screen, video & TV.
Booklets & pamphlets, illustrative panels, forms & frames.
44. Records for planning & feedback:
To evaluate the effectiveness of Health Education
To be audited periodically.
Premises, e.g. rooms, halls, etc.
45. Health Education The Process of Change 5 Stages:
1. Awareness:
Influenced by:
The educational approaches adopted
The ability of the person to perceive
The recipient learns some general information about the new idea or practice (its usefulness, limitations & applicability)
46. Interest:
The recipient seeks more detailed information
He is willing to listen or read more about it
Evaluation:
The recipient weighs the pros & cons of the practice, its usefulness to him or his family resulting in a decision to try or reject the proposed practice.
47. Trial:
When the decision is put into practice
The recipient needs additional information so as to overcome the problems in implementing the idea.
Adoption:
The recipient is convinced & decides that the new practice is good & adopts it.
48. The above-mentioned stages are not rigid compartments. Skipping stages may occur.
Following exposure to the same information, different people may be in different stages of the adoption process.
49. PRACTICE OF H.E. PIE
50. Planning & Implementation:
Pre-requisites:
Identification of the community health problems.
Identification of the vulnerable & at-risk groups.
51. Identification of resources & defining the required inputs from:
The health centre
The local governmental sectors
The community
Identification of possible barriers, inadequacies & constraints & alternative methods to overcome them.
52. Set up objectives:
The priority health problems to be tackled
The priority groups to be educated
Choose your methods of communication & material (the message to be passed on in detail)
Schedule your activities on a time basis (weekly, monthly, biannual, annual), e.g. day/date/time, Group/#, Venue, Subject, Media, Educator, comment.
53. Evaluation:
Should not be left to the end, but should be made from time to time to assess the progress.
Evaluate by using indicators for monitoring:
Structure:
Manpower
Materials (media & facilities)
54. Process:
Measure its relevancy by:
The number participating
The frequency of sessions
Outcome:
In terms of achievements vis--vis plan objectives, e.g. reduction to disease, incidence measured in terms of numbers, rates & percentages.
56. 4 Levels of Health Education Individual H.E.
Family H.E.
Group H.E.
H.E. of the General Public
57. INDIVIDUAL H.E. Either in PHC centers or during home visits
2 major issues are involved:
Specific health problem related to the individual.
58. A message of general interest, either on the PHC system or on common community practices related to health & disease.
Should be visible in every PHC service area.
Every member of the PHC team should give relevant messages to the client on each encounter.
59. Areas of H.E.:
Diet
Body weight,
Personal hygiene
Smoking cessation
Causation & nature of illness & its prevention
Maternal & child care (70% of health centre attendants).
60. Family H.E. All or the majority of family members are involved.
Areas of H.E. include
Dieting, housing, general hygiene, food storage, cooking practices, child birth, infant weaning, etc.
61. GROUP H.E. A group means people with some similar characteristics who are either exposed or affected by common health problems based on sex, age, occupation, vulnerability, etc, e.g. school children, mothers, food handlers, industrial workers, smokers, etc)
62. Methods of H.E.
Lectures using audiovisual aids Group discussions.
Role-playing (socio-drama) where both the educator & the group participate in imitating a health situation/improvement.
Demonstrations: preparing ORS, tooth- brushing.
Simulation exercise
63. Areas of H.E.:
Child birth for antenatal group
Child care for post-natal group
Personal hygiene for school children
Hazards of smoking for smokers
Brucellosis for cattle owners
64. Mass media, despite reaching large numbers of people, is less effective than individual or group methods simply because the communication is only one way.
65. IMPORTANCE OF H.E. (Evidence Base) The provision of systematic patient education on cough significantly changed the behavior of patients to follow practice guidelines & did not result in patients delaying consultation when they had a cough lasting > 3 weeks or one with serious symptoms.
(Rutten et al, BJGP, 1991; 41(348)284-92).
66. THANK YOU
