Healtheducation Concepts for MBBS Students

health education

1. Describe & Discuss- Concepts & Principles of Health Promotion, Health Education, IEC & BCC (CM 1.6) Prof Dr. Sanjev Dave HOD Department of Community Medicine Soban Singh Jeena Govt Institute of Medical sciences & Research,Almora ( Uttarakhand )

2. Contents Introduction Definitions of HE, HP, IEC & BCC, SBCC Approach to health education Principles o f health education Contents of health education Practice of health education Health educators Central Health Education Bureau Code of ethics Success stories

3. Introduction Health education forms an important part of the health promotion activities . These activities occur in schools, workplaces, clinics and communities and include topics such as healthy eating, physical activity, tobacco use prevention, mental health, HIV/AIDS prevention and safety.

4. Introduction Health education + educational , motivational, skill-building and consciousness-raising techniques >>>> building individuals’ capacities Healthy public policies provide the environmental supports >>>>encourage and enhance behaviour change. By influencing both, brings about meaningful and sustained change in the health of individuals and communities can occur.

5. Introduction It has become the integral part of various national health programs such a RNTCP, RMNCH+A, and many communicable and non- communicable diseases. Health literacy is an outcome of effective health education, increasing individuals’ capacities to access and use health information to make appropriate health decisions and maintain basic health.

6. Why effective Communication needed?

7. Effective Communication Requirements

8. Health Communication?

9. Health education Health education has been used interchangeably with Behaviour change communication Information, Education & Communication (IEC)

10. Definition Health promotion is the process of enabling people to increase control over, and to improve their health. Reference: Ottawa Charter for Health Promotion. WHO, Geneva,1986

11. Definition Health education is any combination of learning experiences designed to help individuals and communities improve their health, by increasing their knowledge or influencing their attitudes (WHO)

12. Health literacy: “The degree to which people are able to access, understand, appraise and communicate information to engage with the demands of different health contexts in order to promote and maintain good health across the life course.” (WHO) Definition

13. DEFINITIONS Knowledge : An intellectual acquaintance with facts, truth, or principles gained by sight, experience, or report. Attitude : Manner, disposition, feeling, or position toward a person or thing. Skills : The ability to do something well, arising from talent, training, or practice.

14. DEFINITIONS Belief : Acceptance of or confidence in an alleged fact or body of facts as true or right without positive knowledge or proof; a perceived truth . Values : Ideas, ideals, customs that arouse an emotional response for or against them.

15. Behaviour Change Communication Is a process of working with individuals, families and communities through different communication channels to promote positive health behaviours and support an environment that enables the community to maintain positive behaviours taken on.

16. Information Education and Communication Is a process of working with individuals, communities and societies to develop communication strategies to promote positive behaviours that are appropriate to their settings.

17. Health promotion model

18. Relationship between major health concepts

19. Health Education Propaganda Knowledge and skills actively acquired(active thinking) Develops reflective behavior .Trains people to use judgement before acting Appeals to reason Develops individuality ,personality and self expression Knowledge acquired through self reliant activity The process is behavior centered aims at developing favorable attitudes , habits and skills Knowledge instilled in the minds of the people(facts) Develops reflexive behavior; aims at impulsive action Appeals to emotion Develops a standard pattern of attitudes and behaviors according to would used Knowledge is spoon fed ad received The process is information centered – no change of attitude or behavior designed

20. Aims and Objectives To encourage people to adopt and sustain health promoting life style and practices To promote the proper use of the health services available to them To arouse interest to provide new knowledge ,improve skilled and change attitudes in making rational decisions to solve their own problems To stimulate individual and community self reliance and participation to achieve health development through individual and community involvement at every step from identifying problems to solving them.

21. APPROACH IN HEALTH EDUCATION Regulatory Approach(Managed Prevention) Service Approach Educational Approach Primary health care Approach

22. Legal or Regulatory Approach \ Any governmental intervention, direct or indirect, designed to alter human behaviour. Eg: Child marriage act in India, Seat belts rule in cars etc. Advantages: Simple , Quick Particularly , be useful in times of emergency or in limited situations such as control of an epidemic disease or management of fairs and festivals

23. Limitations : In area of personal choice (alcohol , exercise etc.) no govt. can take away their right of freedom Difficult to enforce laws without a vast administrative infrastructure and considerable expenditure. Legal or Regulatory Approach

24. Service Approach Intends to provide all the health facilities needed by the people at their door steps on the assumption that people would use them to improve their own health. Limitation :not based on the felt-needs of people For example, when water seal latrines were provided, free of cost, in some villages in India under the Community Development Programme, people did not use them. This serves to illustrate that we may provide free service to the people, but there is no guarantee that the service will be used by them .

25. Educational Approach Most effective Gives autonomy towards their own lives Components : motivation communication decision making results slow , but permanent and enduring. Sufficient time for an individual to bring about changes and learning new facts as well as unlearning wrong information as well.

26. Primary health care approach Radically new approach starting from the people with their full participation and active involvement in the planning and delivery of health services based on principals of art health care via community involvement and inter- sectoral coordination Individuals helped to become self-reliant in matters of health

27. It can be done if the people receive the necessary guidance from health care providers in identifying their health problems and finding workable solutions. This approach is a fundamental shift from the earlier approaches. Primary health care approach

28. Since individuals vary so much in their socio- economic conditions, traditions, attitudes, beliefs and level of knowledge A single approach may not be suitable. Combination of approaches must be evolved depending upon local circumstances APPROACH IN HEALTH EDUCATION

29. CONTENTS OF HEALTH EDUCATION Human Biology: The effects of alcohol, smoking, resuscitation and first aid are also taught. Nutrition: Eighth WHO Expert Committee on nutrition stated that education in nutrition is a major strategic method for the prevention of malnutrition. Hygiene: PERSONAL HYGIENE includes bathing, clothing, washing hands and toilet; care of feet, nails and teeth; spitting, coughing, sneezing, personal appearance and inculcation of clean habits in the young.

30. ENVIRONMENTAL HYGIENE : Objectives (a) to educate the people in the principles of environmental health with a view to bring about desired changes in health practices (b) to secure adoption, wide use and maintenance of environmental health facilities , and CONTENTS OF HEALTH EDUCATION

31. (c) to promote active participation of the people in planning, construction and operational stages of environmental improvements. Family Health Care : The aim of health education is to strengthen and improve the quality of life of the family as a unit so that it can survive the vicissitudes of rapid and complex social changes. CONTENTS OF HEALTH EDUCATION

32. Control of Communicable and Non - communicable Diseases: People are encouraged to participate in programmes of disease control, health protection and promotion. Mental health :: The aim of education in mental health is to help people to keep mentally healthy and to prevent a mental breakdown CONTENTS OF HEALTH EDUCATION

33. Prevention of Accidents : occur in three main areas : the home, road and the place of work. Safety education should be directed to these areas. It should be the concern of the engineering department and also the responsibility of the police department to enforce rules of road safety. Management must provide a safe environment, and promote general order and cleanliness. CONTENTS OF HEALTH EDUCATION

34. Use of Health Services inform the public about the health services that are available in the community, and how to use them. They should not be misused or abused CONTENTS OF HEALTH EDUCATION

35. Principles of Health Education Community involvement in planning health education is essential. Without community involvement the chances of any programme succeeding are slim. The promotion of self esteem should be an integral component of all health education programmes.

36. 3. Voluntarism is ethical principle on which all health education programme should be built without it health education programmes become propaganda. Health education should not seek to coerce but should rather aim to facilitate informed choice. Principles of Health Education

37. 4. Health education should respect cultural norms and take account of the economic and environmental constraints face by people. It should seek positively to enhance respect for all. 5. Good human relations are of utmost importance in learning. Principles of Health Education

38. 6. Evaluation needs to be an integral part of health education. 7. There should be a responsibility for the accuracy of information and the appropriateness of methods used. 8. Every health campaign needs reinforcement. Repetition of messages at intervals is useful. Principles of Health Education

39. Practice of Health education 1. Audio visual aids Audio Visual Audio Visual 2. Methods of health communication Individual / Family Group General public (Mass communication )

40. Combination of Audio-Visual Aids Sound & sight combined together to create a better presentation  televisions  tape and slide combinations  Video Cassette Players and Recorders  Motivation pictures or Cinemas  Multimedia Computers

41. Practice of Health education 1. Audio visual aids Audio Visual Audio Visual 2. Methods of health communication Individual / Family Group General public(Mass communication )

42. Individual and Family Health Education Personal interviews 1. Personal contact 2. Home visits 3. Personal letter 4.Health Counseling Public health supervisors, nursing staff and health visitors visit hundreds of homes; opportunities for individual teaching

43. Counseling Counseling- a confidential dialogue between a client and a health care provider a imed at enabling the client to cope with stress and take personnel decisions related to disease. The aim of counseling based on the needs of the client . Purpose : three fold to >>help clients manage their problems more effectively, >>to develop unused opportunities to cope more fully, and >>to help and empower clients to become more effective self helpers in the future.

44. Elements of counseling G : greet the clients and make them comfortable and give full attention. A : ask/ascertain the needs/problem or reasons for coming. T : telling different choices/options/methods to cope with problem. H : help the client to make voluntary decisions. E : explain fully the chosen decision/action/method. R : return for follow-up visit.

45. Group Health Education an effective way of educating the community. The choice of subject is very important it must relate direct to the interest of the group health. These methods are effective in promoting behavioral change, influences opinion, develop critical thinking increase motivation.

46. Metho d s of G roup H ealth Education Lectures Demonstrations Discussi o n methods

47. Lectures carefully prepared oral presentation of facts, organized thoughts and ideas by a qualified person. Aids: 1.Flipchart 2Flannelgraph 3.Exhibits 4. Films and charts Demerits : students are involved to a minimum extent; learning is passive; do not stimulate thinking or problem-solving capacity; the comprehension of a lecture varies with the student; the health behavior of the listeners is not necessarily affected.

48. are carefully prepared presentation to show how to perform a skill or procedure. Merits: Dramatization help arousing interest persuades the onlookers to adopt recommended practices upholds the principles of "seeing is believing“ and "learning by doing", and can bring desirable changes in the Behaviour pertaining to the use of new practice. Demonstrations

49. have a high educational value in programmes like environmental sanitation (e.g installation of a hand pump, construction of a sanitary latrine); mother and child health (e.g. demonstration of oral rehydration technique) and control of diseases (e.g., scabies). has a high motivational value. Demonstrations

50. -Group discussion -Symposium -Conferences -Role play -Colloquy - Focus group discussion -Panel discussion -Workshop -Seminars -Brain storming - Campaign -Delphi method Discussion methods

51. Group discussion Group is an "aggregation of people interacting in a face to face situation“ very effective method of health communication. Provides a wider interaction among members than is possible with other methods.

52. Group discussion For effective group discussion Group size - 6 -12 members. The participants are seated in a circle, so that each is fully visible to all the others. Group leader - initiates the subject, Helps the discussion in the proper manner, prevents side-conversations, encourages everyone to participate and sums up the discussion in the end .

53. express ideas clearly and concisely listen to what others say do not interrupt when others are speaking make only relevant remarks accept criticism gracefully and help to reach conclusions Group discussion Rules for members

54. Good Group discussion

55. Panel discussion 4 to 8 persons – qualified - talk and discuss about a problem or a topic in front of a large group or audience . The panel comprises a chairmen or a moderator from 4 to 8 speakers. Success of the panel discussion depends on : Chairperson to keep the train of thoughts of track. Discussion should be spontaneous and natural

56. Symposium Series of speeches on a selected subjects Each person or expert presents an aspect of the subject briefly No discussion among the symposium members. Chair person makes a comprehensive summary at the end

57. Work shop Consist of series of meetings, usually four or more with the emphasis on individual work, within the group with the help of consultants and resource personnel. Learning takes place in a friendly , happy and a democratic atmosphere, under expert guidance.

58. Role playing Socio- drama in which the situation is dramatized by a group . audience is actively concerned with the drama. Sympathetic attention to what is going on ,or suggest alternative solutions at the request of leader The size of the group 25. Best for schools.

59. Seminars A group of persons gathered for the purpose of studying a subject under the leadership of an expert or learned person. They are normally identified with learning institutions. The participants bring with them a background of training and experience in the area.

60. Conference It composed of two to fifty persons representing several organizations, departments, or points of view within an organization, meet together exhibit a common interest and present two or more sides of their problems. They gather information and discuss mutual problems with a reasonable solution as the desirable end. The various phases of the problem may be presented by co-operative or hostile groups

61. Brain storming It is a type of small group interaction designed to encourage the free introduction of ideas on a restricted basis and without any limitations as to feasibility. Participants are encouraged to list for a period of time all the ideas that come to their minds regarding some problem and are asked not to judge these ideas during the session. Judgment of the ideas will come at a later period in which all contributions will be sorted, evaluated and perhaps later adopted.

62. COLLOQUY A Colloquy is an informal method of discourse which is a modified form of the panel, using one group of three to four persons from the audience and another group of three to four resources persons or experts on the subject to be considered. The panel members elected from the audience present the problem and the experts comment on various aspects of it. The general audience and panel members participate whenever they so desire under the guidance of a moderator

63. CAMPAIGN A campaign is an intensive teaching activity undertaken at an opportune moment for a brief period, focusing attention in a concerted manner towards a particular problem so as to stimulate the widest possible interest in the community. Campaign methods can be used only after an advocated practice & is found acceptable to the local people through method or result demonstrations or other extension methods.

64. Focus Group Discussions (FGD) It is a group discussion of 6-20 persons guided by a facilitator during which group members talk freely and spontaneously about a certain topic or health problem. The purpose of a focus group discussion is to obtain in-depth information on concept, perceptions and ideas of group on a particular topic.

65. The topic should be narrowly focused Selection of participants is also focused by targeting individuals who meet specific criteria Topic should be of interest to both the investigator and respondents. The emphasis should be on interaction between or among the group members.

66. Delphi technique Delphi technique is “a judgmental forecasting procedure for obtaining, exchanging, and developing informed opinion about future events” Or a method for structuring a groups’ communication process so that the process is effective in allowing a group of individuals as a whole, to deal with a complex problem”

67. The Delphi Technique typically includes at least two rounds of experts answering questions and giving justification for their answers , providing the opportunity between rounds for changes and revisions. The multiple rounds, which are stopped after a pre-defined criterion is reached, enable the group of experts to arrive at a consensus forecast on the subject being discussed Delphi technique

68. Delphi technique

69. Delphi technique The tasks that the Delphi can help to address are: determining priorities, setting goals, establishing future directions designing needs assessment strategies & improve service delivery evaluating programs or alternative plans

70. Delphi technique Successful communication as : Avoids domination of one or more members of the group; Avoids pressures to conform to the group’s opinion; Avoids personality or interpersonal conflicts; and Avoids the difficulty of two opposing individuals of power

71. Mass communication Mass communication literally means communication that is given to a community where the people gathered together does not belong to one particular group. Advantages  large no. of people can be reached  people of all socio-economic status irrespective of their caste, creed and religion are addressed

72. Medias televisions, radios, posters, news papers, internet and other advance communication technologies such as mobile telephone message and satellite television are important channel for health information communication. These are emerging and being adapted rapidly in the movement toward modernization. Mass communication

73. mHealth mHealth involves using wireless technologies such as Bluetooth, GSM/GPRS/3G, WiFi, storage devices, and so on to transmit and enable various eHealth data contents and services. Usually these are accessed by the health worker through devices such as mobile phones, smart phones, PDAs, laptops and tablet PCs

74. Good communication technique Source: credibility. Clear message. Good channel: individual, group & mass education. Receiver: ready, interested, not occupied. Feed back. Observe non-verbal cues. Active listing. Establishing good relationship.

75. WHO PROVIDES HEALTH EDUCATION? People specialize in health education (trained and/or certified health education specialists). Para-professionals and health professionals - perform selected health education functions as part of what they consider their primary responsibility (medical treatment, nursing, social work, physical therapy, oral hygiene, etc.

76. Responsibilities of health educator

77. Central Health Education Bureau (CHEB) Central Health Education Bureau (CHEB) is an apex institute created in 1956 under the Directorate General of Health Services (DGHS) Ministry of Health & Family welfare, Govt. of India. Formed on the recommendation of the Bhore committee and the Planning commission

78. Functions Interpret the plans, programmes and achievements of the Ministry of Health and Family Welfare. Design, guide and conduct research in health Behaviour, health education processes and aids. Produce and distribute ‘proto-type’ health promotion and education material in relation to various health problems and programmes in country.

79. Functions Provide guidelines for the organizational set- up, functioning of health education units at the state, district and other levels. Render technical help to official and non- official agencies engaged in health education and health promotion and coordinate their programme. Collaborating with international agencies in promoting health education activities

80. Divisions Health Promotion & Education Division Media & Editorial Division Health Promotion & Education Division School & Adolescent Health Education Division Training, Research & Evaluation Division Administrative Division

81. IEC Bureau Since health education of the various social groups of population can be taken by state Govts, a scheme was formulated in 1958 for the establishment of State health education bureau with central assistance. The State health education bureau are called Information Education Communication Bureau (IEC).

82. Health Educators Certifies health education specialists(HES), promotes professional development, and strengthens professional preparation and practice. Certified HES are re-certified every five years based on documentation of participation in 75 hours of approved continuing education activities Lay workers learn on the job to do specific, limited educational tasks to encourage healthy behaviour. School teachers, parents, Social worker, known to unknown Community leaders & influential

83. Analyzing the Community B ac k d r op Health Care System Community Health Status NGO ‘ and Support Systems (SWOT)ANALYSIS “target communities” major health problem other “felt needs” Consolidating Data on Knowledge, Attitudes and Behaviors Assemble the Planning Group / Coordination Council; Resource Analysis Writing and disseminating the Action Plan(Implementation Plan) Identify Methods and Activities for Health Education Writing the Final Report

84. Models of health education Medical Model: dissemination of health information based on scientific facts. assumption was that people would act on the information supplied by health professionals to improve their health. In this model social, cultural and psychological factors were thought to be of little or no importance

85. Motivational model Motivation

86. Limitation: ignored the fact that in a number of situations, the social environment which shapes the behavior of individual and the community. It is often found that people will not readily accept and try something new or novel until it has been "legitimated" (or approved) by the group to which they belong Motivational model

87. Research shows that those interventions “most likely to achieve desired outcomes are based on a clear understanding of targeted health behaviors, and the environmental context in which they occur”. For help with developing, managing and evaluating these interventions, health education practitioners can turn to several strategic planning models that are based on health behavior theories. Social intervention model

88. How are health Behaviour theories useful? health behavior theory offers a number of benefits and can be seen: a toolbox a foundation a road map a guide a compass

89. Social intervention model A theory should be chosen based on the topic and target population choosing a theory should start with a “thorough assessment of the situation: the units of analysis or change, the topic, and the type of Behaviour to be addressed”. The theory should be: consistent with everyday observations similar to those used in previous successful programmes supported by past research in the same area or related ideas.

90. Social interventional model Intra personal Interpersonal Environmental Rational model Health belief model Trans-theoretical model Planned behavior theory Activated health education model Social learning (cognitive model) Communi c a tion Theory Diffusion of Innovations

91. SCHOOL HEALTH ‘‘Education for all and health for all’’ are inseparably linked. Teachers are the role model for the school children. -one hour or one period devoted to Socially useful and Productive work(SUPW). Health education of both teachers and children is best done in groups.

92. National Population Education Programme (NPEP) in school sector by NCERT Launched in 1980 Working to attain the institutionalization of population education in education system of the country. Implemented as ‘ ‘population and development education in schools’’ . Project has been implemented by NCERT at the national level and SCERT at the state level. This is now the regular activity of HRD. NCERT has also developed a module on adolescent health education in school sector .

93. 101 Worksite Health Education Programs Physical activity and fitness Nutrition and weight control Stress reduction Worker safety and health Blood pressure and/or cholesterol education and control Alcohol, smoking and drugs

94. r o f essio n al In 1976, begun by the Society of Public Health Education (SOPHE). –Approved in 1999 Article I: Responsibility to the Public Article II: Responsibility to the Profession Article III: Responsibility to Employers Article IV: Responsibility in the Delivery of Health Education Article V: Responsibility in Research and Evaluation Article VI: Responsibility in P Preparation Health Education Code of Ethics

95. The  Information, Education & Communication  (IEC) strategy aims to create awareness and disseminate information regarding the benefits available under various schemes/programmes of the Ministry and to guide the citizens on how to access them. IEC methods :   action oriented; speech; sign/symbol; or writing oriented IEC . Each approach and method has its own advantages and disadvantages in any given setting or situation. Principles of IEC?   policy and resource assessment; audience analysis; strategy design; message research and pretesting; participation and feedback; management; evaluation; and collaboration . Information Education & communication (IEC)

96. Previously known as behavior change communication (BCC), S BCC is an approach that promotes and facilitates changes in knowledge, attitudes, norms, beliefs and behaviors .  The terms BCC and SBCC are interchangeable , and both refer to a series of activities and strategies that promote healthy patterns of behavior . BCC & SBCC Behaviour Change Communication  is an interactive process of any intervention with individuals, group or community to develop communication strategies to promote positive health behaviours which are appropriate to the current social conditions and thereby help the society to solve their pressing health problems.2

97. Success Stories

98. Polio eradication Increased awareness about the Vaccine Decreased the myths regarding the vaccine Better sanitation and hygiene Information about the the immunization days Tag lines such a “DO BOOND ZINDAGI ke” - very effective

99. Achievements in RNTCP through Health Education Destigmatisation of TB by popularizing the fact that TB is curable, by using cured patients to motivate others; Making TB services more accessible to the marginalised sections of society – women, tribal and other marginalised groups through awareness generation, and the promotion of health seeking Behaviour ; Greater collaboration with private health care providers by popularizing availability of good quality diagnostic and treatment under the RNTCP;

100. Ensuring completion of treatment by patients by increasing their knowledge about the disease and their treatment, and also by creating patient-friendly environments; and Making DOTS a familiar name among different target audiences so that there is an immediate association of the term ‘DOTS’ with TB and its cure. Achievements in RNTCP through Health Education

101. References K park- The textbook of preventive and social medicine Health education theoretical concepts- WHO Suryakanta- recent advances S lal – book on community medicine www.impart.org www.youtube.com www.nrhmharyana.gov.in