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APRIL 2015

Health Education (HealthEd)


Course Code : HealthEd
Course Description
: The course includes discussions of health education concepts,
principles, theories and strategies as they apply in the clinical and
classroom situations.
Course Objectives :
At the end of the course , given relevant situations/conditions, the
student will be able to:

1. Apply principles, theories and strategies of health education in


assisting clients to promote and maintain their health
2. 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 Practice
by Susan B. Bastable

Health Education (HealthEd)


Course Outline:
1st week
A. Health Education Perspective
1. Historical development in Health Education
2. 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 lifespan
3. Theories in Health Education - (e.g. Penders Health
Promotion Theory, Banduras Self Efficacy Theory, Health
Belief Model, Greens 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 Education
Historical 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 theatomic 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

1800s

(Bacterial period of public

Health)
First half of the century diseases
continued to rage
1842 Edwin Chadwicks 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 1800s 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 Womens Crusade, later
called the Womens Christian
Temperance Union
1890s - medical inspections began
1901- Thomas Wood

1914 - Demonstration projects


began
1914 WWI, 1st large scale
measure of health status of
Americans
1920s-1930s many studies
designed to clarify the role of
health education
Great Depression, 1929-1941

1950 Health Education was


emerging as integral part of
elementary, secondary, & college
curriculum

1970s: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
Generals Report on Health Promotion
and Disease Prevention was published

1980s
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

1990s
National Health Education Standards
published
Responsibilities/competencies for
entry-level Health Educators
published
SOC designation for Health
Educators
Competencies Update Project (CUP)

2000s
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
communitys 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

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
people
information, problem solving and decision making skills to
make 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,
healthy
individuals
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

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 persons
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 bodys


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
threatto 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
resolvedas could many physical stressorsthe 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

Banduras Self Efficacy Theory


Penders Health Promotion
Theory
Health Belief Model
Greens Precede-Proceed Model

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