Health Education and various health education models

Important for MBBS Students and is a must to know topic

1. HEALTH EDUCATION – Definition, Approach, Models and Principles Dr. Rajesh R. Kulkarni Associate Professor Dept. of Community Medicine, J. N. Medical College, KAHER, Belagavi

2. Contents Definitions of health education Essentials Aims and Objectives Approach Models Principles Further Contents of health education Department of Community Medicine 2 30-01-2024

3. Definitions Translation of what is known about health, into desirable individual and community behaviour pattern by means of an educational process. John M. Last- Individuals and groups of people learn to behave in a manner conducive to the promotion, maintenance or restoration of health. Combination of learning opportunities and teaching activities designed to facilitate voluntary adaptations of behaviour. Department of Community Medicine 3 30-01-2024

4. National Conference in USA- Informs, motivates and helps to adopt and maintain healthy practices and lifestyles, advocates environmental changes and conducts professional training and research. Part of health care that is concerned with healthy behaviour. 30-01-2024 Department of Community Medicine 4

5. Alma-Ata Declaration 1978 Individual and Community participation A process aimed at encouraging people to want to be healthy, to know how to stay healthy, to do what they can individually and collectively to maintain health, and to seek help when needed. 30-01-2024 Department of Community Medicine 5

6. Change Prevention of disease TO Promotion of healthy lifestyles Modification of individual behaviour Modification of ‘ social environment ’ Community participation Community involvement 30-01-2024 Department of Community Medicine 6 Promotion of individual and Community ‘ self reliance '

7. Essentials It is a Continuing education, a learning process. Proper communication of ideas. Correct knowledge of aspects of health and disease is essential. Should have working knowledge of social psychology and principles and theories of community organization. Frequency should be maintained throughout respectively. A good health educator should combine knowledge and skills of behavioural sciences with health problems from scientific and logistic point. 30-01-2024 Department of Community Medicine 7

8. Aims & Objectives Encouraging to adopt healthy practices. Proper use of available health services. Arouse interest, provide knowledge, improve skills and attitudes in making their own decisions. To achieve health development at every step. 30-01-2024 Department of Community Medicine 8

9. Role of health professionals Provide opportunities to learn, identify, analyze and prioritize. To make health and related information easily accessible. To indicate alternate solutions for solving health problems. For access to proven preventive measures. 30-01-2024 Department of Community Medicine 9

10. Approaches Regulatory approach- Govt. intervention to alter human behaviour. Regulations ranging from prohibition to imprisonment. External controls or laws. Legislative approach is simple and quick but can also be a failure. Maybe used in times of emergencies. Can be used to reinforce the pressure to change collective behaviour. 30-01-2024 Department of Community Medicine 10

11. Examples for legislature approach success- The Child Marriage Restraint Act Use of seat belts or helmets Failure of legislations- Prohibition of Alcohol 30-01-2024 Department of Community Medicine 11

12. 30-01-2024 Department of Community Medicine 12 The sterilization campaign, 1976 a disastrous failure

13. Service approach- Tried in 1960’s by the Basic Health Services. Provided services at their door steps assuming people would utilize. Ex: Unused water-seal latrines in rural areas, provided by Govt., as it was not their habit. It is said to be a failure. People will not accept a programme or service, even if it is offered free of cost, unless it is based on their felt-needs. 30-01-2024 Department of Community Medicine 13

14. Health education approach- Many problems which can be solved only through health education. People must be educated through planned learning experiences and encouraged to make their own healthy choices. Does not order the individual. Results are slow but enduring. Better to start with young population. 30-01-2024 Department of Community Medicine 14

15. Primary health care approach- New approach starting from the people with their full participation. Active involvement in the planning and delivery of health services based on principals of primary health care. Mainly- Individuals to become self-reliant. Fundamental shift from earlier approaches. 30-01-2024 Department of Community Medicine 15

16. Health education vs Propaganda Drawn up by- Central Health Education Bureau, Government of India 30-01-2024 Department of Community Medicine 16

17. Health education Propaganda Actively along with skills Through self-reliant activity Knowledge acquired Instilled in people’s minds Spoon-fed and passive Makes people think for themselves Thinking Prevents or discourages by ready-made slogans Reflective; judgement before acting Development of Behaviour Reflexive; impulsive actions To reason Appeals To emotion Individuality, self-expression Develops Standard patterns Behaviour centred Process Information centred 30-01-2024 Department of Community Medicine 17

18. Models of Health education Medical model BCC model / Transtheoretical model of change KAP model IEC model Motivation model / Health belief model / Triandis model of perceived consequences Social intervention model 30-01-2024 Department of Community Medicine 18

19. Medical model: Recognition and Rx of disease, and technological advances to facilitate the process. Concerned with disease or Opposed to illness. Dissemination of health information based on scientific facts. Assumed that people would act on the information supplied by health professionals and improve their health. Important factors were thought of no importance. Did not bridge the gap between knowledge and behaviour. Department of Community Medicine 19 30-01-2024

20. KAP / Rational model Knowledge leading to favourable changes in attitudes and practices. Attitudes- predispositions, Practices- final actions. May not always hold good. Now used to assess community regarding their health educational needs, so as to plan a IEC strategy. * Fatemah M, Muna E, Zahra K, Abdallah Y N, Perceived Knowledge, Attitude, and Practices (KAP) and Fear toward COVID-19 among patients with Diabetes attending Primary Healthcare Centers in Kuwait. Int J Environ Res Public Health.  2023 Feb; 20(3): 2369 30-01-2024 Department of Community Medicine 20

21. To reinforce a set of behaviour, target audience, a specific problem, a period of time. Multi-disciplinary. Played an important role in awareness and taking preventive measures. 30-01-2024 Department of Community Medicine 21 IEC model

22. Motivation model: ‘Motivation’ to translate health information into the desired health action. 3 stages before adoption- Department of Community Medicine 22 30-01-2024 1. Awareness Interest 2. Motivation Evaluation Decision-making 3. Action Adoption or acceptance

23. Social intervention model- Social environment shapes the behaviour of individual and community. Often found that people will not readily accept and try something new until it has been ‘legitimated’. Highlights the importance of group support. Adoption of a new idea is facilitated. 30-01-2024 Department of Community Medicine 23

24. Health education contents Human biology Nutrition Hygiene Family health Disease prevention and control Mental health Prevention of accidents Use of health services 30-01-2024 Department of Community Medicine 24

25. Human biology- Understanding health, how to keep physically fit. Reproductive biology. Best place, The School. *Textbook of Biology in Context. Learning and teaching for the twenty-first century. (pp.300-311) 30-01-2024 Department of Community Medicine 25

26. 2. Nutrition- Aim- choosing optimum and balanced diets Nutritional problems solved: Breast feeding, misconceptions about proper weaning, diets for infants and pregnant women, food allocation pattern within the families Association with NCDs Major intervention for prevention of malnutrition and improving quality of life. * Harris H, Shreshta N, Costello A, et al. Determinants of Intra-household food allocation between adults in South Asia- a systematic review. Int J Equity Health 30-01-2024 Department of Community Medicine 26

27. 3. Hygiene- 30-01-2024 Department of Community Medicine 27 Personal hygiene- Training should begin at early age and continue throughout school. Environmental hygiene- Domestic and Community aspects. Major concern of many Govts. Emphasis on sanitation services fundamental to health. Health education approach if taken by the people, they are likely to choose these facilities and improve their health.

28. 30-01-2024 Department of Community Medicine 28 4. Family health- 5. Disease prevention and control- Crucially important in prevention of diseases, early Dx and care of sick. To promote family’s self-reliance- responsibility in child bearing, rearing, self-care and influencing adoption of a healthy lifestyle. Education about prevention and control of locally endemic diseases. Several public health problems are in national scale.

29. 6. Mental health- 7. Prevention of accidents- Aim is to help people to be mentally healthy & prevent a mental breakdown. Certain special situations when mental health is of greater importance. Combat and achieved with understanding, sympathy and by social contact. Feature of complexity of modern life. Accidents at home, road, place of work. Safety education should be directed. Also concern of the engineering and police depts. Workplace- There should be a place for everything and everything should be in it’s place. 30-01-2024 Department of Community Medicine 29

30. Credibility Interest Participation Motivation Comprehension Reinforcement Learning by doing Known to unknown Setting an example Good Human Relations Feedback Community Leaders Seed, Sower and Soil The Principles of Health Education

31. It is the degree to which a message is received trustworthy by the receiver. It should be scientifically proven, based upon facts and should be compatible with local culture and social goals. 1.Credibility

32. If the health education topic is of interest to the people, they will listen to it. The health educator needs to identify the “felt needs” of the people and then prepare a program that they can actively participate in to make it successful. 2. Interest

33. The health educator should encourage people to participate in the program. Once the people are given the chance to participate in the program it leads to their acceptance of the program. Certain programs like group discussions and panel discussions provide opportunities to peoples participation. 3. Participation

34. Motivation can be defined as “the fundamental desire for learning in an individual”. Motives are of two types-Primary motive and Secondary motive. The primary motives are inborn desires like food, clothing and shelter. The secondary motives are desires due to outside forces, e.g. Gifts, love, a word of praise, rewards etc. Health education is facilitated by motivation provided by desire to achieve individual goals. For example, a teenager esthetics might be a motive to take care of his/her teeth whereas for an adult expenses may be for restorative or prosthetic needs. 4. Motivation

35. Refers to the level of understanding of the people who receive health education. The health educator should first determine the level literacy and understanding of the people and act accordingly. Words that are strange or new should not be used, usage of medical and technical terms should be avoided. E.g.: A statement saying “Eat food items which are non- cariogenic ” may not be comprehensive to the layman. A better way of explaining would be “Avoid food stuffs which are sweet and stick to your teeth like toffees and pastries. Eat food items like fruits and raw vegetables, which in addition to being healthy, also keep your teeth clean. 5. Comprehension

36. This is the principles that refers to the repetition needed in health education. It is not possible for the people to learn new things in a short period of time. So repetition is a good idea. This can be don at regular intervals of time and it helps people to understand new ideas or practices better. This principle is called “booster dose” in health education. 6. Reinforcement

37. Just by listening to new ideas or seeing new things, it might be difficult to implement them. This principle is based on the famous Chinese proverb “if I hear, I forget; if I see, I remember; if I do, I remember”. E.g. It is difficult to even remember the method of tooth brushing when heard on the radio. It might be difficult to master the act of proper tooth brushing even by watching the demonstration. However , after the demonstration, if practiced under professional guidance, proper method of tooth brushing can be learnt. 7. Learning by doing

38. Before the start of health education program, the health educator should find out how much people already know and then give them new knowledge. The existing knowledge of the people can be used as the basic step upon which new knowledge can be placed. If the health educator is in the aim of introducing toothbrush, then the communicator should start with “what are you using to clean the teeth? And then going into details like “why are you using it”? And then connecting it to the toothbrush. 8. Known to unknown

39. The health educator should follow what he preaches. He should set an example to follow. E.g. A health educator who participates in a program highlighting the ill effects of tobacco should not be seen smoking since it is a wrong thing and seriousness of the situation is lost. 9. Setting an example

40. The principle states that the health educator should have good personal qualities and should be able to maintain friendly relations with the people. The health educator should have kind and sympathetic attitude towards the people and should always be helpful to people, clarifying their doubts and repeating when not understood. 10.Good Human Relations

41. For any program to be successful, it is necessary to collect feedback to find out any modifications are need to make the program effective. 11. Feedback Soil is the community Seed is the information Sower is the person giving information 12. Seed, sower and Soil

42. Community Leaders can be used to reach the people of the community and to convince them about the need of Health Education. The Leaders can also be used to educate the people, as they will have a rapport and will be familiar with the people of their community. The leaders will have an understanding of the needs of the community and advice and guide them. The health education of the rural people can be achieved through the head of the village, where as school children approach through school teacher or Headmaster. 13. Community Leaders

43. References Park’s textbook of Preventive Social Medicine, 27 th Edition L Ramachandran & T Dharmalingam Health Education, A new approach Rajvir Bhalwar’s textbook of Community Medicine, 5 th Edition AM Khadri’s IAPSM textbook of Community Medicine, 2 nd Edition Suryakantha’s textbook of Community Medicine, 7 th Edition 30-01-2024 Department of Community Medicine 43

44. Thank you