Health education- MBBS 4th year - AMDC 2013

HEALTH EDUCATIONDr. Rizwan Saeed

(MBBS, MPH, DOMS)

Assistant Professor Public health

& Community Medicine

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INFORMATION EDUCATIONCOMMUNICATION

INFORMATION

Providing scientific knowledge to people about health problems and their prevention, promotion and maintenance

And when people feel that the unfelt needs become the felt need and felt needs become their demand.

Education

Process by which behavioral changes takes place in an individual as a result of experience which he has undergone series of learning experiences individual informs and orients himself to develop skills and intelligent actions.

Communication

Process of attempting the change of behavior (general term for flow of information linking people or places)

Information, Education and Communication (IEC)

A. Concept. Aims and objectives, B. Approaches used in public health, C. Contents, principles and stages of health

education D. Communication methods, barriers and Skills in

health education E. Planning, organizing and evaluating a health

education programme F. Social Marketing

Intervention

Intervention

Any attempt to intervene or interrupt the usual sequence in the development of disease.

This may be provision of: Treatment Education Help or Social support

Five Modes of Intervention

1. Health promotion

2. Specific Protection

3. Early Diagnosis and treatment

4. Disability Limitation

5. Rehabilitation

Interventions to Promote Health

1.Health Education

2.Environmental Modification

3.Nutritional Interventions

4.Lifestyle and behavioral changes

Health + Education

Health Education

The most cost-effective intervention.A large number of diseases could be prevented

with no or little medical intervention if people are informed about them and if they are motivated to take necessary precautions in time.

Health education : Definitions

• A translation of what is known about health, into desirable behavior individual and community pattern by educational process.

• The process by which individuals and groups of people learn to behave in a manner conducive to the promotion, maintenance or restoration of health.

• “A process that informs, motivates and help people to adopt and maintain healthy practices and lifestyles, advocates environmental changes as needed to facilitate this goal and conduct professional training and research to the same end”.

DEFINITION

“Any combination of learning experiences designed to facilitate voluntary adaptation of behavior conducive to health”.

- The word “designed” refers to planned, integral, intended activities rather than casual, incident, trivial experiences

What is health education?

Process which affects changes in the health practices of people and in the knowledge and attitude related to such changes.

ORTeaching process providing basic

knowledge and practice of health, so as to be interpreted into proper health behavior.

EXPERIMENT

RANDOMISED CONTROL

DOUBLE BLIND

EVIDENCE-BASED MEDICINE

Five Modes of Intervention

1. Health promotion

2. Specific Protection

3. Early Diagnosis and treatment

4. Disability Limitation

5. Rehabilitation

Interventions to Promote Health

1.Health Education

2.Environmental Modification

3.Nutritional Interventions

4.Lifestyle and behavioral changes

Communication for Health• Communication and education are interwoven.• Communication is more than mere exchange of

information.• Communication is a two-way process of

exchanging or shaping ideas, feelings and information.

• The ultimate goal of all communication is to bring about a change in the desired direction of the person who receives the communication.

Communication

Communicator: the person or the team give the message (Educator).

Message: the contents (materials) of health education

Channel: method of carrying the messageAudience: the receivers (users or targets) of the

message

Communication Process

Sender Message Channel Receiver

FEED BACK

interactive

Student centered

Teacher centered

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

Counselling

Face to face communication “GATHER” APPROACH G Greet the client A ask needs T tell client about merit , demerit, logistics & costs of different

methods H help client in decision making E explain & educate about chosen decision R return for follow-up visits

counselling

Educator

Personnel of health services. Medical students, nursing & social

work. School personnel. Community leaders & influencials.

Requirements: Personality: popular, influential and

interested in work. Efficiency trained and prepared for the

job. Must show good examples.

Message What information to be communicated. Simple, at the level of understanding. Culturally accepted. Interested. Meet a felt need. Avoid technical jargon. Use audiovisual aids.

COMMUNICATION TYPES ONE WAY (no feed back, imposed information, passive learning, less influence) TWO WAY ( “Socratic method”, Q&A, feed back, democratic, discussions, more

influence)

1. Verbal communication only talk

2. Non-verbal communication body movements, postures, facial expressions, touch etc.

3. Formal communication forms e.g. toys, songs, games etc

4. Informal communication rigid courses

5. Visual charts, posters, maps, graphs, pictures, tables

6. Telecommunication electro-magnetic instruments, over distance e.g. satellite, radio,TV, telephone, telegraph, telex ….“point-to-point”

7. Internet HTTP, protocols, wireless, fiber optic

Practice1-IndividualFace to face Education through spoken word.

A- Occasions of health appraisal.

B- Home visits Nurses

Health visitors

Social workers

2-Groupa. Lessons and lectures in schools.b. Lectures in work places e.g. factories. c. Demonstration and training3- Mass media.1. Broadcasting: radio & TV.2. Written word: newspapers, posters, booklets.3. Others e.g. theaters

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Practice of health education Individual and family Education to general public

T.VRadio PressFilmsHealth magazinePostersHealth exhibitionHealth museum

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Group health education

LecturesFilm and chartsGroup discussionPanel discussionSymposiumWorkshop

InstituteRole playingDemonstrationProgrammed

instructionStimulation and

exercise

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Communication barriers

PhysiologicalDifficulties in hearing, expression

PsychologicalEmotional disturbance

EnvironmentalNoise, invisibility

CulturalKnowledge, custom, believe, religion

Communication Barriers Social and cultural gap between the sender and the

receiver Limited receptiveness of receiver Negative attitude (BIAS)of the sender Limited understanding and memory Insufficient emphasis by the sender (health professional) Contradictory messages Health education without identifying the “needs "of the

community

Patterns of Change in Person as a result of communication

There are three (3) levels of change:Cognitive: increase in knowledgeAffective: changing existing patterns

of behavior and attitudesPsychomotor: acquiring new skills

Aims of Health education

1. Health promotion and disease prevention.

2. Early diagnosis and management.

3. Utilization of available health services.

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Objectives

Informing peopleMotivating peopleGuiding into action

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ObjectivesEncourage people to adopt healthy life styleEncourage to make use of best available health

servicesEncourage to change attitude towards their own

health Improve the health of family and community

Specific objectives of health education1. To make health an asset valued by the community.2. To increase knowledge of the factors that affect

health.3. To encourage behavior which promotes and

maintains health.4. To enlist support for public health measures, and

when necessary, to press for appropriate governmental action.

5. To encourage appropriate use of health services especially preventive services.

6. To inform the public about medical advances, their uses and their limitations.

Approaches to Health Education

Regulatory Approach (Managed Approach) Govt. made , simplest and quickest, disease can be

controlled but cannot be eradicated by legislation (as legislation cannot force people to act e.g. to eat balanced diet)

Service Approach at door step (cheap/free, effective when there is felt need)

Health education approach AIDS preventionPrimary health care approach by, of, for ppl,

community participation, equitable distribution, intersectoral, appropriate technology, highly successful in reducing MMR, IMR etc.

CONTENTS OF HEALTH EDUCATION: Nutrition Health habits Personal hygiene Safety rules Basic (K) of disease & preventive measures Mental health Proper use of health services Sex education Special education for groups( food handlers,

occupations, mothers, school health etc. )

• Principles of healthy life style e.g. sleep, exercise• Human Biology• Family health• Disease prevention and control• Prevention of Accidents

Health Promotion:

“ Is any combination of educational, organizational, economic and environmental support for behaviors and conditions of living conducive to health.”

Health Promotion is a widely used term to encompass various activities e.g. :

Behavior & lifestyle,

Preventive health services,

Health protection directed at environment,

Health related public policy,

Economic & regulatory measures.

(Health Education is the primary and dominant measure in Health

Promotion ).

Principles of Health education

1. Interest.

2. Participation.

3. Proceed from known to unknown.

4. Comprehension.

5. Reinforcement by repetition.

6. Motivation

7. Learning by doing

8. People, facts and media.

9. Good human relations

10. Leaders

Principles of health education:

Credibility

Interest (content) clarity, consistency, channels

Participation

Motivation

Comprehension

• Proceeding from the known to the unknown

• Learning by doing• Setting an example Reinforcement through repetition

Good human relations

People, facts & media

“knowledgeable, attractive , acceptable” .

• Feedback

• Leaders

Principles of health education:

Learning by doing:

“ If I hear, I forget

If I see, I remember

If I do, I know”.

Motivation,

i.e. awakening the desire to know and learn:

- Primary motives, e.g. inborn desires , hunger, sex.

- Secondary motives,

i.e. desires created by incentives such as praise, love, recognition, competition.

Stages for health education

Stage of Sensitization (AIDS) Stage of Publicity (MEDIA) Stage of Education (for illiterates/ disinterested) Stage of Attitude change

Stage of Motivation and Action Stage of Community Transformation (social change)

HEALTH EDUCATION PLANNING MODEL In the process of health education, there is a generic set of

tasks that should be accomplished in planning regardless of the model selected or designed

1. Assess the needs of the target population.

2. Identify the problem(s).

3. Develop appropriate goals and objectives.

4. Create an intervention that is likely to achieve desired results.

5. Implement the intervention.

6. Evaluate the results.

Six principles of planning in health education

1. It is important that plans are made with the needs and context of the community in mind. You should try to understand what is currently happening in the community you work in.

2. Consider the basic needs and interests of the community. If you do not consider the local needs and interests, your plans will not be effective.

3. Plan with the people involved in the implementation of an activity. If you include people they will be more likely to participate, and the plan will be more likely to succeed.

4. Identify and use all relevant community resources.

5. Planning should be flexible, not rigid. You can modify your plans when necessary. For example, you would have to change your priorities if a new problem, needing an urgent response, arose.

6. The planned activity should be achievable, and take into consideration the financial, personnel, and time constraints on the resources you have available. You should not plan unachievable activities.

Not everything that counts can be counted, and not everything that can be counted counts.

Albert Einstein

Epidemiologists seek what counts by counting what can be counted.

Doctor Epidemiologist

Patient Person Population

Monitor health

Periodic exam

Surveillance

When the patient gets sick

Diagnose & treat

Investigate & recommend interventions

Follow-up Return visit Program evaluation

Research Clinical study or trial

Epi study

The Doctor & the Epidemiologist

AttackEarly disease (less severe)

Severe disease

Admit toHospital

Diagnosis

Report to Health Dept.

Timeline of Bioterrorism Disease

Can epidemic be detected sooner?

Challenges:• Balance timelines & sensitivity with false alarms• Identifying illness of public health importance

PUBLIC HEALTH PRACTICE

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“The strategic, organized, and interdisciplinary application of knowledge, skills, and competencies necessary to perform essential public health services and other activities to improve the population's health.

" Source: Demonstrating Excellence in Academic Public Health Practice. Association of Schools of Public Health (June 1999).

Act your way to a different way of thinking, rather than think your way to a different way of acting

Public health is about each of us taking responsibility for advancing the health of the public, our community’s health!

The Ten Essential Services1. Monitor health status

2. Diagnose and investigate health problems

3. Inform and educate

4. Mobilize communities to address health problems

5. Develop policies and plans

6. Enforce laws and regulations

7. Link people to needed health services

8. Assure a competent health services workforce

9. Evaluate health services

10. Conduct research

a) Public health practice is the collective of people, programs, and processes that contribute to the operational effectiveness of public health activities at state, local, and tribal levels;

b) The “doing” of public health, not the “researching” of public health

c) Program vs. science.

What Is Public Health, and What Is Public Health Practice?What Does Public Health Do?Four Ways to Approach Public HealthCore Functions & Essential ServicesClinical Care to Population HealthWho Will Keep The Public Healthy?The Public Health SystemPublic Health Preparedness

1. Patient

2. Practitioner

3. Chief complaint

4. History & Physical

5. Laboratory tests

6. Clinical Diagnosis

7. Treatment plan

8. Home monitoring and follow-up testing

9. Follow-up visit

1. A defined population

2. A health system

3. Community perceptions

4. Professional opinions

5. Epidemiologic analysis

6. Community Diagnosis

7. Interventions

8. Monitoring efforts

9. Modification of all the above steps.

Same Process For Both

Behavioral Science/Health Education focuses on ways that encourage people to make healthy choices. This includes the development of community-wide education programs that range from promoting healthy lifestyles in order to prevent disease and injury, to researching complex health issues.

Specialists encourage people to make healthy choices and develop educational programs that promote healthy lifestyles and prevent disease and injury. They also promote more efficient uses of health services, adopt self-care practices, and participate actively in the design and implementation of health programs. Some examples of concentrations include mental health, aging, health promotion and disease prevention, public health practice, health education and behavior change, disability and health, and social research.

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QoL Index

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SettingsSetting Primary Mission Who is Served?

School Education Children/adolescents

Worksite Produce goods and services; Make a profit (if applicable)

Consumers of products and services

Hospitals Treat illness and trauma Patients

Community primary care setting

Prevent, detect, and treat illness and trauma

Patients

Health Department Chronic and infectious disease prevention and control

Public

Voluntary health agencies

Prevention and control targeted disease/condition

Public

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Comprehensive School Health Program

Adoption of new ideas or practiceFive (5) steps1. Awareness (know)

2. Interests (details)

3. Evaluation (Advantages Vs Disadvantages)

4. Trial (practices)

5. Adoption (habit)

Contents of health education1. Personal hygiene2. Proper health habits3. Nutrition education4. Personal preventive measures5. Safety rules6. Proper use of health services7. Mental health8. Sex education9. Special education (occupation, mothers …..etc)

Major Variablesin Behavior Change

Thoughts and ideas inside a person’s mind have significant influence on an individual’s health behaviors. These variables interact with social and environmental factors and it is the synergy among all these influences that operate on behavior.

Knowledge: An intellectual acquaintance with facts, truth, or principles gained by sight, experience, or report.

Skills : The ability to do something well, arising from talent, training, or practice.

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.

Attitude: Manner, disposition, feeling, or position toward a person or thing.Values: Ideas, ideals, customs that arouse an emotional response for or against them.

Planning

is the process of making thoughtful and systematic decisions about what needs to be done, how it has to be done, by whom, and with what resources.

Planning is central to health education and health promotion activities

If you do not have a plan, it will not be clear to you how and when you are going to carry out necessary tasks.

Health Belief ModelINDIVIDUAL PERCEPTIONS MODIFYING FACTORS LIKELIHOOD

OF ACTION

Demographic Variables

Socio-psychological Variables

Perceived susceptibility

Perceived severity

Perceived benefits of

preventive action

Perceived barriers

to prevent action

Perceived threatLikelihood of taking

recommended preventive health action

Cues to Action

Information

Reminders

Persuasive communications

Experience

Categories of Belief

Perceived SeriousnessPerceived SusceptibilityPerceived BenefitsPerceived Barriers

Categories of Belief

Seriousness Relative severity of the

health problem.e.g. Seriousness of

hepatitis encourages individuals to get the hepatitis vaccine.

Susceptibility Nature and intensity of

perceptions affect willingness to take preventive action.

Categories of Belief

Benefits Anticipated value of the

recommended course of action.

Must believe recommended health action will do good if they are to comply.

Barriers Perception of negative

consequences Greatest predictive value of

whether behavior will be practiced.

Stages of Change

Pre-contemplationContemplation(inspection, observation, survey etc.)PreparationActionMaintenance

Pre-contemplation

DefinitionNot considering changing their behaviorLack of awareness

Intervention ApproachNovel information Persuasive communications Experiences

Contemplation

DefinitionPerson is beginning to consider behavior changeImportant stage of information acquisition

Intervention ApproachMotivated by role modeling and persuasive

communicationsReceptive to planned or incidental learning

experiences.

Preparation

Definition Deciding to change by preparing and

experimenting. Psychological preparation of trying on or

visualizing new behaviors and sharing the idea with others. Deciding to change.

Intervention Approach How-to get information, skill development,

attitude change

Action Definition

Actually trying the new behavior

Intervention Approach Skill Reinforcement Support Self-management Attitude and attribution change

MaintenanceDefinition

Establishment of the new behaviorTaking on the new attitudinal and environmental

supports

Intervention ApproachRelapse prevention skillsSelf-managementSocial and environmental support

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An Example of a Worksite Health Education Program - Nutrition

Level Program StrategyIndividual Nutrition information available through newsletters, books

and video; Nutrition behavior-change program.

Interpersonal Healthful food cooking contests; Nutrition classes for families; Buddy programs for weight loss; Competitions for weight loss.

Organizational

Cafeteria offers low-fat and low-calorie choices; Labeling of nutritional content of foods in cafeteria; Subsidized healthful foods; Vending machines with healthful foods.

Community Institutional food service vendors offer low-fat and low-calorie foods; Nearby restaurants offer low-fat and low-calorie foods; A community campaign focuses on good nutrition.

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An Example of Health Education in Health Care Settings – Cystic Fibrosis (CF)

Level StrategiesIndividual Educational modules including feature stories, information

about the disease process, skills, and self-monitoring.

Interpersonal Interaction with health care team members about patient concerns related to CF and goals for self-management; Family discussion and practice of self-management behaviors and symptom monitoring.

Organizational Primary care physician refers family to program; CF Family Education Program provided by CF Center

Community School nurses and teachers assist child and family in self-management of CF

THANK YOU

Social marketing is the systematic application of marketing, along with other concepts and techniques, to achieve specific behavioral goals for a social good

Social marketing is the use of marketing principles & techniques to develop & promote socially beneficial programs, behaviors, & other products. In public health, social marketing has shown great promise as a strategic planning process for developing behavior change interventions and improving service delivery.

DISTINCTIVE FEATURES DATA-DRIVEN STRATEGIC PLANNING PROCESS

RELIENCE ON MARKETING’S CONCEPTUAL FRAMEWORK Voluntary Behavior Change

Commitment to create satisfying exchanges

Use of marketing mix to design interventions

Segmentation of the target populations

Data-based consumer orientation

The primary aim of 'social marketing' is 'social good', while in 'commercial marketing' the aim is

primarily 'financial'. This does not mean that commercial marketers can not contribute to achievement of social good.

Increasingly, social marketing is being described as having 'two parents' - a 'social parent' = social sciences and social policy, and a 'marketing parent' = commercial and public sector marketing approaches

“If we want things to stay as they are, things will have to change”

Guiseppe di Lampedusa (1957)

Health Social marketing must not

be confused with Social media

marketing

Steps in the social marketing processFive (5) steps / tasks

1. Audience analysis Cause s & audience affected, formative research to understand issue from the consumers’

viewpoint

2. Strategy developmentResearch findings marketing decision, blueprint, plan to guide program development,

identifies target audience, partners to support, core product to offer, strategies to lower costs

3. Program development Interventions are developed, prototype materials, training & promotional activities

4. Program implementation

5. Program monitoring and evaluationAll aspects of program interventions are monitored to identify unforeseen problems that

may require midcourse revisions to improve their effectiveness.

applications

Family planning Breastfeeding Increase fruit and vegetable consumption Physical activity Immunization Environmental protection Variety of safety practices & healthy behaviors

slogansLove your liverSafe water saves life

APPLICATIONS SMART (Social Marketing and

Assessment Response Tool). Health promotion campaigns in the late

1980s began applying social marketing in practice

In India, especially in Kerala, AIDS controlling programmes are largely using social marketing and social workers are largely working for it. Most of the social

workers are professionally trained for this particular task

Like commercial marketing, the primary focus is on the consumer--on learning

what people want and need rather than trying to persuade them to buy what we happen to be producing. Marketing talks to the consumer, not about the product.

This refers to decisions about 1) the conception of a Product, 2) Price,3) distribution (Place), and4) Promotion.

These are often called the "Four Ps" of marketing.

Additional Social Marketing "P's"Publics--"Publics" refers to both the external and

internal groups involved in the program. External publics include the target audience, secondary audiences, policymakers, and gatekeepers, while the internal publics are those who are involved in some way with either approval or implementation of the program.

Partnership--Social and health issues are often so complex that one agency can't make a dent by itself. You need to team up with other organizations in the community to really be effective. You need to figure out which organizations have similar goals to yours--not necessarily the same goals--and identify ways you can work together.

Policy--Social marketing programs can do well in motivating individual behavior change, but that is difficult to sustain unless the environment they're in supports that change for the long run. Often, policy change is needed, and media advocacy programs can be an effective complement to a social marketing program.

Purse Strings--Most organizations that develop social marketing programs operate through funds provided by sources such as foundations, governmental grants or donations. This adds another dimension to the strategy development-namely, where will you get the money to create your program?

The planning process takes this consumer focus into account by addressing the elements of the

"marketing mix.“ As an example, the marketing mix strategy for a breast

cancer screening campaign for older women might include the following elements:

The product could be any of these three behaviors: getting an annual mammogram, seeing a physician each year for a breast exam and performing monthly breast self-exams.

The price of engaging in these behaviors includes the monetary costs of the mammogram and exam, potential discomfort and/or embarrassment, time and even the possibility of actually finding a lump.

Craig Lefebvre and June Flora introduced social marketing to the public health community in 1988

outlined eight essential components of social marketing

1. A consumer orientation to realize organizational (social) goals

2. An emphasis on the voluntary exchanges of goods and services between providers and consumers

3. Research in audience analysis and segmentation strategies

4. The use of formative research in product and message design and the pretesting of these materials

5. An analysis of distribution (or communication) channels

6. Use of the marketing mix - utilizing and blending product, price, place and promotion characteristics in intervention planning and implementation

7. A process tracking system with both integrative and control functions

8. A management process that involves problem analysis, planning, implementation and feedback functions

Kotler and Ned Roberto

“A social change campaign is an organized effort conducted by one group (the change agent) which attempts to persuade others (the target adopters) to accept, modify, or abandon certain ideas, attitudes, practices or behavior."

In recent years there has has been an important development to distinguish between 'strategic social marketing' and 'operational social marketing'

COMMUNITY DIAGNOSIS VARIOUS SOCIAL FACTORS THAT MAY BEHAVE AS

ANTECEDENTS, CONCOMITANTS OR CONSEQUENT OF DISEASES.

SOME OF THE ANTECEDENTS MAY BE RISK FACTORS THAT INREASE THE VULNERABILITY TO DISEASE

CONCOMITANTS SOCIAL FACTORS WHICH MAY ACCOMPANY DISEASES

"Social determinants of health (SDOH) Are the economic and social conditions that shape the health of individuals, communities, and jurisdictions as a whole.

Social determinants of health are the primary determinants of whether individuals stay healthy or become ill (a narrow definition of health).

Social determinants of health also determine the extent to which a person possesses the physical, social, and personal resources to identify and achieve personal aspirations, satisfy needs, and cope with the environment (a broader definition of health).

Social determinants of health are about the quantity and quality of a variety of resources that a society makes available to its members."(RAPHAEL 2008)

A list of determinants of health — only some of which are social determinants — is below:

Income & social status Social support networks / safety Education and literacy, i.e. health literacy Employment/Working conditions Social environments Physical environments Life skills

Personal health practices and coping skills Healthy child developmentBiology & genetic endowmentHealth servicesGender CultureEarly lifeHousing

The traditional 10 Tips for Better Health

1. Don't smoke. If you can, stop. If you can't, cut down. 2. Follow a balanced diet with plenty of fruit and

vegetables. 3. Keep physically active. 4. Manage stress by, for example, talking things

through and making time to relax. 5. If you drink alcohol, do so in moderation. 6. Cover up in the sun, and protect children from

sunburn. 7. Practice safer sex. 8. Take up cancer-screening opportunities. 9. Be safe on the roads: follow the Highway Code. 10. Learn the First Aid ABCs: airways, breathing,

circulation.

THINK POSITIVE

THINK BIG

THINK DIFFERENT

THANK YOUThankyou