University of Gondar,

College of Medicine & Health Science

Department of Health Promotion and
Health Behavior

Course -Health Education

Department - 2nd year HO
Course ECTS- 3

Instructor: Habitu. Birhan (Bsc, MPH)

1 Habitu. B
Course Contents

1.Introduction to Health Education and disease prevention

1.1. Definition of Health &Health Education
1.2. level of prevention
1.3. primary health care(PHC)
2.Application of health education theories and models in behavior change
2.1 human behavior and health
2.2. health education theories and model
2.3. health belief model
2.4. trans theory of model
2.5 . Theory of reasoned action/planned behaviour
2.6. diffusion of innovation theory

Habitu. B 2
Cont……
2.7. Social Learning Theory
2.8. PRECEDE-PROCEED framework
3. Health Communication
4.1. Define Communication
4.2. Components of Communication
4.3. Types of Communication
4.4. Traditional means of communication
4.5. Barrier of communication
4.6. Theory on stages in adoption &diffusion of Innovation
4.7. Counseling

Habitu. B 3
Cont…..
4. Teaching Methods & Materials
4.1. Types of Teaching Methods
4.2. Types of teaching Materials
5. Health education in different settings
o Patient education
o School health education
o Prison health education

Habitu. B 4
Cont….
6. Research methods in health education

Habitu. B 5
Cont….
 Evaluation: Fixed Grading

 Quiz I & II----------------2*5% @ any time

 Attendance/partcin--------5% always
 Asgmt/Presetn------------15% in-between
 Mid Exam---------------20% in between
 Written Final Exam---50% @ the End

any comment ?

Habitu. B 6
Assignment to be Presented as ppt
Group I- Teaching Methods & Materials
Group II- Primary health care(PHC)
Group III- Patient Education and Medical/health care Errors
Group IV-Research in Health Education

7
Future roles of any health professionals
• Health Care giver
• Teacher/Instructor
• Health Manager
• Researcher
• Health Advocator
+ /- more than one of the above
Questions ????

Habitu. B 8
Health Promotion & disease prevention
concept
Learning Objectives
At the end of this chapter the students are expected to:
 Define concepts of health

 Differentiate among health education, health promotion,

diseases prevention and health information.

 Discuss the rationale of health education

 Describe levels of health education in diseases prevention.

Habitu. B 9
Concepts of health

Brainstorming
 Man’s happiness in life depends upon good health, vigour and vitality.
 Life without health is a misery.
 Health is wealth.
 “It is health that is real wealth and not pieces of gold and silver.”
(Mahatma Gandhi)
All these phrases reflect the importance of health in our lives.
What is Health for you?

10 Habitu. B
 Concepts of health
Concept of 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 is often
difficult to put a clear-cut demarcation between the
"sick" and the "not 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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 Cont..

 Generally, there are two opposing models concerning

the definition of health:
I. Negative (narrow) model
II. Positive (broad) model

12 Habitu. B
 Cont..

I. Negative model
This model views health as:
 Absence of diseases or disability or infirmity
 Biological integrity of the individual
 Physical and physiological capabilities to perform routine
tasks.

13 Habitu. B
 Cont..
According to this definition,
 Individual is healthy if all the body parts are functioning
well.

 Doctors tend to go along with this idea and are keen on active
intervention with drugs or surgery ……..rather than educational
intervention to change behavior.

 Despite its narrowness, it is a widely held view among lay man

by equating health with the absence of diseases.
Disease “A” + Medical treatment health

14 Habitu. B
 Cont..

The positive model- sees health as a broader and more

holistic concept.

 Probably the most widely known of such models is that of the

constitution of World Health Organization (1948), which
defines health, as:
 “A state of complete physical, mental, and social well-being
not merely the absence of disease or infirmity.”
 This definition may seem very attractive but still has lots of
drawbacks.

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 Cont..

 It will be seen that even after having this definition it

will be difficult to conceptualize and standardize positive
health with specific clear-cut attributes and criteria for
measurement.

Critics of WHO definition of health??

16 Habitu. B
 Aspects of health

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.

17 Habitu. B
 Cont….
Mental health; mental health refers to a human individual's
emotional and psychological well-being.
 Mental health(WHO); A state of well-being in which the
individual Who;
 Realizes his or her own abilities.
 Can cope with the normal stresses of life.
 Can work productively and fruitfully, and
 Is able to make a contribution to his or her community.

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  Social health – ability to make and maintain
acceptable interactions with other people.
E.g. To mourn when somebody close to you passes
away.

19 Habitu. B
 Cont…..

Emotional Health
 It refers to our sense of well-being and our ability
to cope with life events.
 is part of our overall health concerned with the way
we think and feel.
 Emotional health is about our ability to
acknowledge and respect our own emotions as well
as those of others.

20 Habitu. B
Cont….
 The ability of expressing emotions in the appropriate
way, for example,
to fear,
to be happy, and
to be angry.
 The response of the body/body language/ should be
congruent with that of the stimuli.

21 Habitu. B
 Cont….

Spiritual Health
It is so difficult to define, develop and maintain. But this
aspect of wellness should not be underestimated. An
individual with high level of spiritual wellness will
experience increased physical, social and emotional
health.
 Spirituality is unique to each individual.
 It is the inner most part of ours that allows us to gain
strength and hope.

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Cont….
 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.

23 Habitu. B
 Cont….

 Disease; scientifically identified health threat caused by a

bacterium, virus, fungus, parasite or other pathogen
 Illness; the subjective state of a person who feels aware of
not being well.
 Sickness; a state of social dysfunction: a role that an
individual assumes when ill.
 Disease without illness?? Vice versa

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Determinants of Health
There are four general determinants of health. These are
Human biology,
Environment,
Lifestyle, and
Healthcare Services.

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 Cont…
 determinants—or things that make people healthy or
not—include the above factors, and many others:
1. Income and social status - higher income and social
status are linked to better health. The greater the gap
between the richest and poorest people, the greater the
differences in health.
2. Education – low education levels are linked with poor
health, more stress and lower self-confidence

27 Habitu. B
 Cont…
3. Physical environment –safe water and clean air, healthy
workplaces, safe houses, communities and roads all
contribute to good health.
 Employment and working conditions – people in
employment are healthier, particularly those who have
more control over their working conditions.
4.Social support networks – greater support from
families, friends and communities is linked to better
health.
Culture - customs and traditions, and the beliefs of the
family and community all affect health.
28 Habitu. B
 Cont…
5.Genetics - inheritance plays a part in determining
lifespan, healthiness and the likelihood of developing
certain illnesses.
6. Health services - access and use of services that prevent
and treat disease influences health
7. Gender - Men and women suffer from different types of
diseases at different ages.

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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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Diseases prevention
Disease prevention is a way of interrupting or slowing the progression of
disease through appropriate intervention.
 Health education plays a central role in disease prevention by identifying
behavioral causes of disease and risk factors.
 There are three/four levels of prevention, corresponding to different phases in
the development of disease.

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Primary prevention

 The causative agent is already exists but the aim is

keeping healthy individuals from becoming sick.
 It keeps the disease process from becoming established
by eliminating causes of disease or increasing
resistance to disease.
 eg. immunizations.

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Secondary prevention
 It includes preventive measures that take place after biologic onset but before
permanent damage.
 Early detection and treatment of diseases
 The objective is to stop or slow the progression of disease aimed to reduce the
more serious consequence of disease/to prevent or limit permanent damage
 Examples:
 Prevention of blindness from Trachoma
 Early detection and treatment of breast cancer to prevent its progression to the invasive
stage

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Tertiary prevention
 It includes preventive measures after permanent damage
 The objective is:
 To prevent further disability or death and
 To limit the physical, psychological, social, and financial impact of
disability, thereby improving the quality of life.
 This can be done through disability limitation and rehabilitation.

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Health Information, Education and Promotion
Education

 Education is the process by which learning is facilitated in which an individual or

group of people are in the facilities or opportunities by an agent or educator to learn.

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 Objectives of Education
Learning domains;
I. Cognitive domain, refers to knowledge
II. Affective Domains, refers to emotions, beliefs and
attitudes
III. Psychomotor Domain, refers to practical applications

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A. Cognitive Domain

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Cognitive Domain

 It has its own components=6 components

 Knowledge; the theoretical or practical
understanding of facts, informations , and skills
through experience or education.
 Comprehension; it involves the ability to understand
something.

38 Habitu. B
Cont….

 Application or use of general ideas, principles or

methods to new situation.

 Analysis:- It consists the breakdown of material into its

constituent parts, and detection of the relationships of the
parts & of the way they are organized.

 Synthesis: - It is the ability to put parts or elements

together to form a coherent whole.

39 Habitu. B
Cont….

 Evaluation: - making of judgments about the works,

methods, and material, or values of something.
 Involves the use of criteria as well as standards for
appraising the extent to which particulars are accurate or
satisfying.

40 Habitu. B
B. Affective Domain

 There are five categories

 Receiving or Attending: - Sensitivity to the existence of
a certain phenomenon or stimulus, and awareness. It
also includes willingness to receive, or attention.

 Responding: - At this level the learner is sufficiently

involved in a subject, or activity that he will seek it out
& gain satisfaction from working with it or engaged in it.
/do something as a reaction to someone or something/

41 Habitu. B
 Cont….

 Valuing: - at this stage behavior is consistent & stable. It

involves acceptance of a value & commitment
(conviction) for a certain point of preference for a value.
 Organization: - at this level the learner constructs a
value system which guides his behavior.
 Characterization:- at this stage of internalization the
values already have a place in the individual’s value
hierarchy, are organized in to some kind of internally
consistent system.

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C. Psychomotor Domain

43 Habitu. B
 Psychomotor domain
 There are 5 categories
 Imitation- Observing and patterning behavior after someone
else.
 Performance may be of low quality.
Example: Copying a work of others.
 Manipulation- Perform an action according to instruction and not
only on the bases of observation
 Example: Creating work on one's own, after taking lessons, or
reading about it.
 Precision- Refining, becoming more exact. Few errors are
apparent.
 Example: Working and reworking something, so it will be
“just right.”
44 Habitu. B
 Psychomotor Domain
 Articulation- Involves the co-ordination of a series of
acts by the establishment of an appropriate sequence
(internal consistence)
 Naturalization- Having high level performance become
natural, without needing to think much about it.

Habitu. B
45
HEALTH INFORMATION

 It is health facts disseminated to the target audience focusing on the basic facts
related to the health issue under consideration.

 In dissemination of health information, base line information or data (currently

existing level of multiple determinants of behaviors) is not necessarily required
.

46 Habitu. B
Generally, Health information is the scientific facts (eg the causes, mode of
transmission, sign and symptoms ,prevention methods of particular diseases)

 Is the content of health education which primarily aimed at increasing of

knowledge on that particular health problems.

49 Habitu. B
HEALTH EDUCATION

 It is the process of educating people about health.

However more formal definitions have been frequently
cited in the literature as:
 ‘‘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’’ (Alma-Ata declaration,1978)

 It is a combination of learning experiences designed to

facilitate voluntary actions conducive to health.
50 Habitu. B
  Combination; emphasizes the importance of matching
the multiple determinants of behavior with multiple
learning experiences or educational interventions.
 Designed; distinguishes health education from incidental
learning experiences as a systematically planned activity.
 Facilitate; means, predispose, enable, and reinforce
 Voluntary; means without coercion and with the full
understanding and acceptance of the purposes of the action.
 Action; means behavioral steps taken by an
individual, group or community to achieve an intended
health effect

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Rationale for Health Education
1. Continued existence and spread of communicable
diseases such as malaria, TB, HIV/AIDS that need the
involvement of the community members

2. Nearly 2 million people die each year from TB, most of

which are in developing world.

3. About 3/4th of childhood illnesses are preventable

e.g. measles by immunization, malnutrition and diarrhea
by teaching mothers about good weaning foods and
promoting breast feeding up until age of two.

52 Habitu. B
 4. Increasing threats to the young from new and harmful
behaviors. E.g., tobacco use, teenage pregnancy
,substance abuse

5. Health education is the only practical option for some

diseases in order to contain the spread of disease. e. g.,
HIV/AIDS

6.The cost of health care is rising. E.g. treatment and

hospitalization costs are rising.

53 Habitu. B
 7. The tendency of increasing magnitude of chronic
conditions (diseases) that require cooperation of
individuals to deal with the problem. E.g. hypertension.

8. Increased awareness of people on chronic health

problems and the need to know preventive actions. E.g.
prevention of cardiac complications

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Settings of health education
Where Health Education Is Provided
 can be found nearly everywhere.
 The settings are important because
 they provide channels for delivering programs,
 Provide access to specific populations and gatekeepers,
 usually have existing communication systems for diffusion of programs, and
 facilitate development of policies and organizational change to support positive
health practices

55 Habitu. B
Seven major settings are particularly relevant to contemporary health education:
 schools,
 communities,
 worksites,
 health care settings,
 homes,
 the consumer marketplace, and
 the communications environment.

56 Habitu. B
Schools.
 Health education in schools includes
 classroom teaching,
 teacher training, and
 changes in school environments that support healthy behaviors

57 Habitu. B
Communities
 Community-based health education draws on social relationships and
organizations to reach large populations with media and interpersonal
strategies.
 Community interventions in churches, clubs, recreation centers, and
neighborhoods have been used to encourage healthful nutrition, reduce risk of
cardiovascular disease, and use peer influences

58 Habitu. B
Goals of Health Education
1. To provide appropriate knowledge: The goal is to
give specific knowledge and information.

2. To help develop positive attitude: concerned with

opinions of people, their feeling and beliefs.

3. To help exercise healthy practice ( behavior): is

concerned with carrying out a decision and actually doing
something about a health matter.

59 Habitu. B
 Cont,d

4. Decision making: Involves both "knowing" and

"feeling" objectives and is concerned with deciding what
to do in the future about health or a particular aspect of
health.

5. Social change: changing the physical and/or social

environment so that people are encouraged to adopt
healthier behaviour.

60 Habitu. B
 Levels of Health Education in Health-illness
continuum
1. Primary health education, it is an education
processes that is applied on apparently healthy peoples
where the primary aim is to prevent occurrence of
illness or health problems.
 Altering unhealthy or unsafe behaviors that can lead
to disease or injury, and increasing resistance to
disease or an injury .
 The target population is apparently healthy peoples.
E.g. Nutrition, immunization, and breastfeeding

61 Habitu. B
 Cont….

2. Secondary Health education, it is given after the

disease or the problem has occurred. The objective at this
level is to stop the progress of the disease to the severest
form of the problem. Targets are patients and apparently
healthy peoples.
examples
 educating TB patients about their disease conditions and
treatment,

62 Habitu. B
 Cont,d
3. Tertiary Health education: the main objective of
health education at this level is to prevent further
disabilities, complications, prolonging life and
maintenance of normal function.
 The target population is patients having irreversible,
incurable and chronic conditions

63 Habitu. B
 Why The process of health education is
often challenging ???

64 Habitu. B
 Cont…

1. People are usually preoccupied with many other

important daily activities;
2. There is a failure to see the value of health teaching
by many health professionals;
3. Health education is not considered important during
normal life. People are concerned about diseases;
4. Largely related to behavior; changing health behavior
is conditioned by many factors: social, psychological,
economic, cultural, accessibility and quality of services,
political environmental, etc.

65 Habitu. B
 PRINCIPLES OF HEALTH EDUCATION
 Principle of Definite Objectives; Health education would
be more effective if we know what it is and we want to
accomplish as a result of our educational process.
 Principle of Credibility; good health education is based
on facts; and must be consistent and compatible with
scientific knowledge, local culture, educational system as
well as social goals.

66 Habitu. B
 PRINCIPLES con…
 Principle of Comprehension; in health education, we
must know the level of understanding, educational
status or literacy of the people to whom the teaching is
directed.
 Principle of Reinforcement; few people can learn all
that is new in a single period. Therefore, in health
education repetition at interval is necessary.
 If there is no reinforcement, there is a possibility of
individuals going back to the pre awareness stage.

68 Habitu. B
 PRINCIPLES con…
 Principle of Learning by Doing – learning is an
action process; not memorizing one in a narrow sense
 Principle of Known to Unknown – in health
education we must proceed from the concrete to the
abstract; from the particular or specific to the general
 Principle of Setting an Example (using role model)
- health educator must set a good example in the
things he/she is teaching and must be a role model to
his/her clients.

69 Habitu. B
 PRINCIPLES cont…
 Principle of Successful Experiences- people tend to
adopt those practices that give them satisfaction and
reject other ones with unhappy experiences
 Principle of Feedback- feedback is one of the key
concepts in systematic approach. For effective
communication, feedback is very important
 Principle of Cumulative Learning- Behavior is the
sum of a lifetime of personal and cultural experiences.
 Soil, seed, sower – community, information, person
giving information, respectively.

71 Habitu. B
 Health promotion
 It is Any planned combination of educational, political,
environmental, regulatory, or organizational mechanisms
that support actions and conditions of living conducive to
the health of individuals, groups, and communities.

’’Health promotion is the process of enabling people to

increase control over, and to improve their health’’.

72 Habitu. B
Health promotion strategies
 1 Advocacy
 2. mediating
 3. enabling

73 Habitu. B
 Advocacy
 Is a combination of individual or social actions designed
to gain political support, social acceptance and systems
support for a particular health goal
 Good health is a major resource for social, economic and
personal development, and an important dimension of
quality of life.
 Political, economic, social, cultural, environmental,
behavioral and biological factors can all favor or harm
health.
 Health promotion aims to make these conditions
favorable, through advocacy for health.
74 Habitu. B
  Enabling
 Taking action in partnership with individuals or groups
to empower them, through the mobilization of human
and material resources, in order to take control over
those things which determine their health.
 Health promotion action aims to reduce differences in
current health status and to ensure the availability of
equal opportunities and resources to enable all people to
achieve their full health potential
 People cannot achieve their fullest health potential unless
they are able to control those things that determine their
health
75 Habitu. B
 Mediate/intervene
 Is a process through which the different interests(personal,
social, economic) of individuals and communities and
different sectors (private and public) are reconciled in
ways that promote and protect health.
 Politicians, Professionals and health personnel have a
major responsibility to mediate between differing interests
in society for the pursuit of the health of community.

76 Habitu. B
Thank you

77 Habitu. B