Introduction to

Health Education
by Addisu Tesfaye(BSc, MP
H)
July 21, 2021 1
 Outline
 Definition and concepts related to Health, Health
Education and Health Promotion
 Rationale of Health Education
 Historical development of H/E and H/P in Ethiopia
 Goals and objectives of Health Education
 Principles of Health Education
 Role of Health Education in PHC
 Challenges to the practice of health education
July 21, 2021 2
 Objectives of the session
At the end of this session, you will be able to;
• Define what Health, health education, health
promotion and health communication
• Differentiate health education and health promotion
• Discuss principles of health education
• Describe the goals and objectives of Health Education.
• State the historical development of H/E in Ethiopia
• List role of health education in PHC , public health
and health policy

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Definitions and concepts

July 21, 2021 4

 Health definition….
1. Negative definition/narrow definition
Absence of diseases or disability or infirmity

Physical and physiological capabilities to perform routine

tasks.
The human body is often thought of the same terms with
mechanical devices when something is wrong you take i
t to experts who maintain it by Physicians
Focus on treatment and clinical interventions wit
h medication rather than educational interventions
to bring about behavior change
This view of health ignores many of the social an
d psychological causes of ill health.
July 21, 2021 5
Health definition Conti….

2. Positive definition/broad definition

It is broader and more holistic concept. WHO definition
is the most known definition of this model.

Health is a state of complete physical, mental and

social wellbeing not merely an absence of disease
or infirmity.
World Health Organization (1948)

To understand the full meaning of health, it is important

to understand each components of health
July 21, 2021 6
Health Conti….
Physical health
 It is the absence of diseases or disability on the body
parts (negative definition).

 It is the ability to perform routine tasks without any

physical restriction.
 It is the biological integrity and the physiolog
ical well functioning of the human body

Mental health; ability to learn and think clearly,

 a person with good mental health is able to hand
le day to day events and obstacles, work towards
important goals, and function effectively in soc
iety.
July 21, 2021 7
Health Conti….
Two components of mental health
A) Cognitive component
 It is the ability of an individual to learn, perceive and,
think clearly.
 E.g. A person is said to be mentally retarded if
he/she cannot learn something new at a pace in w
hich an ordinary person learns.
B) Emotional component
 Is the ability of expressing emotions (e.g. fear,
happiness, and to be angry) in an “appropriate” way.
 Appropriate here is to emphasis that the response of
the body should be congruent with that of the stimuli.
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Health Conti….
 Maintain one’s own integrity in the presence of st
ressful situations (tensions, depression and anxiet
y).
 E.g. if somebody gets into coma during an examinati
on.

Social health
 Is the ability to make and maintain “acceptable” and
“proper” interaction and communication with other
people and the social environment;
 satisfying interpersonal relationship and role fulfillment.
 For example, to mourn when close family member dies,
to celebrate festivals, to create and maintain friendship
etc.
July 21, 2021 9
Health Conti….
 Hanlon (1974) defined health as “a functional state which
makes possible the achievement of other goals and
activities.” and

 more recently, the WHO (1986) has restated that “health is

a resource for every day life, not the objective of living.”

 In other words, good health should not be the goal of life,

but rather a vehicle to reach one’s goal in life.

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Health Conti….
 Despite it is said a broader paradigm; different scholars criticize
this (WHO) definition.

 It is an over attractive, overambitious, ideal and unattainable

definition.
 Health is a process rather than a state
 State indicates static however, health is dynamic, it flows,
and it is a process
 The way health is defined makes it very difficult to
measure (subjective)
 In adequate to capture spiritual dimension (It is a r
elation of health with religion or cultural values an
d beliefs and is a way of achieving mental satisfacti
on in stressful or in other ill- health conditions).

July 21, 2021 11
Health Conti….

 Generally, the different aspects of health are interrelated and

interdependent.

 Physical problems could lead to mental consequences and

vice versa.

 Therefore, health is a holistic concept and wellness is

expressed through integrated mental, physical, emotional,
spiritual and social health at any point of health and illness
spectrum.
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Health Education
 Health education is the process of educating people
about health.

 However, formal definition was given by Green

lawrence;

 “Any combination of learning experiences designed

to facilitate voluntary action conducive to health”

Green and kreuter (1999)

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Health Education definition….
Combination: matching multiple determinants of
behaviors with multiple learning experiences or
educational intervention

Designed: health education is not incidental learning

experiences.
It is systematically planned and organized activity.

Facilitate: creating favorable condition such as

predispose, enable, reinforce.

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Health education….
 Voluntary: with full understanding and acceptance of the
purpose of the action. Without use of coercion or any
manipulative approaches.

 we do not force the people to do what we want them to do,

instead our effort is to help people to make decisions and
choices by themselves.

 Action: behavioral steps/measures taken by individuals,

groups or community to achieve the desired health effect.

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 Health Promotion
 To reach a state of complete physical, mental an
d social well being it is beyond the activity of
health education and even health sectors,
 so the concern for health outside to the healthc
are sector is the call for health promotion

 Health promotion is broader than health education.

 GREEN AND KRUETR (1991) Defined health
promotion as:

“A combination of educational and environmental supports

for actions and condition of living conducive to health.”
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 Health Promotion…
 Combination: refers to the necessity of matching
multiple determinants of health with multiple in
tervention or sources of supports.

 Educational: refers to the communication part of

health promotion; health education.

 Environmental: refers to the social, political,

and economic, organizational, policy and regulat
ory circumstances influence behavior or more dir
ectly health

 Health Promotion is also defined as a process of

enabling people to increase control over and imp
rove their health(WHO,1986)
July 21, 2021 17
Health promotion employs two approaches
A. Educational approach (Health Education)

It is attempt to influence
 Predisposing factors through direct communication

 reinforcing factors through indirect communication in

social environments to create norms and values that
support life style conducive to health and
 enabling factor through trainings and organization.

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Health promotion ….

B. The ecological /environmental approach (political

action)

 It employs policy, organization, and regulation to

influence the enabling and reinforcing factors for
environmental and life style changes supportive of
health
 b/c behaviors and environmental have a ful
ly cause effect relationship

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Health promotion ….
 Health education is one of the most important
component of health promotion. .
It is a means of promoting health

 with out the policy support for social change, Health

education is often powerless to help people to reach
their health goals, even with successful individual
change efforts.
 Therefore, health promotion is a structural (laws,
regulation, organizational...) support for health
education to develop its full potential.
July 21, 2021 20
Health promotion…
 Health education is primarily focused at voluntary
action people can undertake to improve
 their own health,

 their families’ health and

 the community as whole.

 But health promotion aimed at social and political

action that will facilitate the necessary organizational,
economical and other environmental supports for the
conversion of individual action into health
enhancement.
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Comparison of health education and health promotio
n
 Establishment of stop smoking
 Tobacco
clinics.
 Educating on health problems re
 Control of tobacco advertising
lated to smoking such as lung ca
 Increase taxes on price of cigar
ncer through different media
 not to start smoking and persua ettes
 Bans on smoking in public areas
de smokers to stop

  Making counseling service avail

HIV/AIDS
 Educating general public and sp able
 Increasing VCT services
ecific groups such as
  Setting up peer education progr
Drivers ,sex workers, youth, on s
afe sexual behaviors am
 Enforcing of legal protection of
sex workers and injecting users
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 Historical Development of H/E and H/P
 The development of health education is related to the
initiation of health promoting activities for school c
hildren and their environment including nutrition educ
ation
 During 1779, a German physician , Johann peter Frank,
raised and propagated the importance of supervising he
alth of school children as part of school education pr
ogram
 1796 Edward Jenner – first vaccination against smallpox.
 1830 Sanitary and social reform, growth of science.
 1854 John Snow – waterborne cholera in London:

 At the beginning of the 20th century, official formulat

ion of education policies has been started in Europe a
nd the
July 21, 2021 USA 23
 Historical…..
 The growth and development of H/E have been accele
rated with the inception of PHC concepts especiall
y with child health services, nutrition education,
immunization etc. at global level

 PHC at Alma-Ata, Russia (1978) recognized H/E as a

fundamental tool to the attainment of health for a
ll and was put as one of the eight component of PH
C in Ethiopia

 It is very difficult to know when and where exactl

y health education has started in Ethiopia. but, t
he development can be arbitrarily divided into thr
ee periods.
July 21, 2021 24
I . The period of The Pre Italo-Ethiopian war (b
efore the 2nd world war)
 The beginning of health education could be related
to the introduction of modern medicine into the co
untry.

 During the Emperors Menelik the 2nd and Haile Sella

sssie,s eras, modern medicine had already been int
roduced and started
 Health education was limited to the few hospital a
vailable and to community leaders and educated mem
bers of the community
 The primary focus was to increase the awareness of
people to modern medicine and encourage them to ut
ilize
July 21, 2021the services. 25
II) The period After the Italo-Ethiopian war (A
fter the 2nd world war)
 the opening of Gonder Public Health Collage and Train
ing Center (1954) was the most important advance in t
he history of health service in Ethiopia
 During this period, the medical services and training
expanded and Mobile Child Health Centers started to g
ive health education on child nutrition and personal
hygiene and others

 This was the time when health center (Kola-Duba H/C )

were opened to provide preventive, curative and promo
tive activities.
 In 1965, the first Health Education workshop for seco
ndary school science teachers was conducted in Addis
Ababa
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III) The period of the Socialist Revolution
and After
 During this period the health service have already expan
ded as compared to the previous times
 after the revolution the health services strategy focuse
d on primary health care. Additional schools for trainin
g for doctors and other health professional were opened.
 Courses on health education was included in most of the
health training programs
 Ethiopia has hosted the first health education technical
meeting of OAU in A.A in1969
 In general the concepts and practices of health educatio
n have further developed during the last 20 years in Eth
iopia.
 H/E is included almost in all categories of health profe
ssionals
July 21, 2021 27
Health Information

It is health facts disseminating to the communi

ty focusing on the basic facts related to the
health issue under consideration.

In dissemination of health information, base li

ne information or data (currently existing lev
el of multiple determinants of behaviors) is n
ot necessarily required.

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 Comparison of health education and health information
Health Education Health Information
1 Baseline information or current level of Baseline information or data are n
multiple determinants of behavior are ne ot
cessarily required necessarily required
2 The assumption is people are not rationa The assumption is people are ratio
l all the times, but rationalize all the nal and
times. make predictable use of informatio
n available to them
3 Appropriate for old problems(problems Kn Appropriate for newly emerging hea
own to the people for long period of tim lth
e) problems and during epidemics
4 Required at all stages in behaviors chan One time telling facts provided th
ge Continuum (it is continues, even to p at the
revent defaulter after adoption) information reaches at all the int
ended
audiences and understanding takes
place
5 Encourage people to make their own choic Merely telling people to follow he
es for healthy life althy
behaviors
6 People are not blamed for unhealthy beha
July 21, 2021 People blamed for un healthy 29
behav
The ultimate goals of health education

 The ultimate goal is to promote, maintain

and improve individuals and community heal
th.

July 21, 2021 30

 Aims and objectives of health education
 To encourage people to adopt and sustain health prom
oting lifestyle and practices.

 To arouse interest, provide new knowledge, improve s

kills and change attitudes in making rational decis
ions to solve their own problems.

 To stimulate individual and community self-reliance

and participation to achieve health development thro
ugh individual and community involvement at every st
ep from identifying problems to solving them.

Behav
ior is Key!
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Approaches to Health Education

The persuasion approach –

Deliberate attempt to influence the other persons to do what
we want them to do (Directive Approach)

The informed decision making approach-

giving people information, problem solving and decision
making skills to make decisions but leaving the actual choice
to the people.
 E.g. family planning methods

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 Rationale for Health Education/ Promotion
1.The continued existence and spread of communicable dis
eases
 Nearly 3 million people die each year from TB, most o
f which are in developing world
2. About 75% of childhood illnesses are preventable e.g.
measles by immunization,
3. For some diseases health education is the only practi
cal choice in order to prevent the spread of the dise
ase or to lead a normal life. E.g. HIV/AIDS.
4. The tendency of increasing magnitude of chronic cond
itions and other emerging agendas, E.g. Hypertension.
 As countries income increases there is a shift in the

major causes of death from communicable to non-com

municable
July 21, 2021 diseases. 33
Rationale cont.…….
 Increasing threats to the young from new and harmful
behaviors. E.g. tobacco use, teenage pregnancy, subs
tance use
 Increased awareness of people on chronic health prob
lems and the need to know preventive actions.

 Health promotion and disease prevention are strategi

es to address the health problems in a cost-effectiv
e manner as compared to the cost spent for treatment

 Human behaviors are almost the single causes for the

development of currently emerging health problems an
d also the main solution.
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Dimensions of Health Education
 Health education is an eclectic in nature. Its facts, principles
and concepts drawn from biological, behavioral, sociological
and health sciences, but interpreted in terms of human needs
and human value.
 Health education is life long process. It is not one time affair.
 The concern caring about a child begins while the fetus is in
the mother’s womb. Antenatal care---deliver care
----perinatal care---- postnatal care--- immunization ….Death.

 Health Education is concerned with people at all points of

health and illness continuum

July 21, 2021 35

Dimension …

No level of
Health -illness disease
prevention can
operate with no
health
Health

education
successfully

Illness Death

Figure mathematical presentation of health and illness continuum

07/21/21 36
Dimension …

Health education is not an end by itself.

 Rather a way of empowering people to understand their own
problems, identifying its solution and take appropriate
action.

 The scope of health promotion is not limited to

patients in clinical set up rather it is require
d at all setting, for all people and at all leve
ls of diseases prevention.

 Health education is the primary means of achievi

ng health for all
July 21, 2021 37
 Levels of disease prevention in health edu
cation:
 There are three levels of disease preventi
on
1. Primary,
2. Secondary, and
3. Tertiary health education.

July 21, 2021 38

1. Primary Health Education
 Is comprised of those preventive measures that f
orestall the onset of illness or injury during t
he pre pathogenesis period (before the disease p
rocess begins)

 health education/promotion program that aimed sp

ecifically at prevent the onset of illness or in
jury among health individuals

 e.g. Wearing safety belt, Immunization

July 21, 2021 39

 2. Secondary health education

 any health education/promotion programs that aim

ed at promoting early diagnosis and prompt treat
ment of a disease to cure or to limit disability
and prevent more serious pathogenesis

 e.g. breast-cancer screening, blood pressure exa

mination and treating malaria patients.

July 21, 2021 40

 3. Tertiary health education
 at this level the health educator work to retain
, reeducate, and rehabilitate the individual who
has already incurred disability, impairment, or
dependency

 health education programs that specifically aime

d at patients with irreversible, incurable, and
chronic condition for social and psychological a
djustment

July 21, 2021 41

Who is responsible to provide health educat
ion?
 Even though some people are trained to do
health education work;
 All health workers should concerned help p
eople to improve their health knowledge an
d skills, all health workers should practi
ce health education in their job.
 Health education, then, is really the duty
of everyone engaged in health and communit
y development activities.

July 21, 2021 42

Targets for health education
 Every stages of life, every person or soci
al group and all occupations are appropria
te targets of health education programs
 Individuals such as clients of services, p
atients, healthy individuals
 Contraceptive or VCT users
 Diabetic or hypertensive patients

 Groups -gatherings of two or more people who hav

e a common interest
 E.g. groups of students in a class, youth club
 Community E.g. people living in a village
July 21, 2021 43
 Health promotion settings
 Health education takes place in:
1. Schools,
2. Worksites,
3. Health care settings and
4. Community settings
5. Special communities: such as prisons and
refugee settings

July 21, 2021 44

Principles of Health Education..
1, Principle of diagnosis

Is the first step used to understand the health p

roblems in your community
Just as physicians must diagnose an illness befor
e it can be properly treated, so, behavior must be
diagnosed before it can be properly changed.

If the causes of the behaviors understood then it

could be intervened with the most appropriate and
efficient combination of education, reinforcement
and motivation
July 21, 2021 45
 Principles of H/E..
2, Principle of Participation

Any attempt to change behaviors will be greater if the

individuals, families, community groups,, etc…have been
participated

Helps them to identifying their own needs for change and

selects the methods and strategy that will enable them to take
action.

The participation of all community members is essential to

gain support and also to be able to use locally available
resources.
July 21, 2021 46
 Principles of H/E..
3, Principle of multiple methods
Multiple causes will be found for any given behaviors.

For each of the multiple predisposing, enabling, and

reinforcing factor identified a different methods or

components of comprehensive behavioral change must be

provided

A mix of educational methods is important to hold the

attention of your audiences and convey the messages to their
best effect.
July 21, 2021 47
 Principles of H/E..
4. Principle of planning and organizing
are fundamental to conduct effective health education and
distinguish it from other incidental learning experiences.

It also requires the planning for resources, methods and

materials to be used, identification of target groups etc.

It is very difficult and often unsuccessful when carrying out

health education program that are not planned and organized
appropriately.

July 21, 2021 48

 Principles of H/E..
5, Principles of facts

Health education is given based on scientific findings/facts

and current knowledge.

Now try this out for yourself.

During your teaching you say ‘I think tobacco causes cancer’.

What Would be a better way of putting this?

July 21, 2021 49

 Principles of H/E..
6. Audience segmentation
Health education should be audience-specific and designed
for the particular target group of people you are hoping to
reach

You should select your audience for each of your specific

health Education activities.
For example if you need to create awareness on prevention of
mother to child HIV/AIDS transmission(PMTCT) your
specific audience should be as many as possible of the
pregnant mothers in your catchment

July 21, 2021 50

 Principles of H/E..
7. Need based
Health education is best implemented after the real needs of
the community have been assessed and identified.
There are three types of needs
Felt need- what people feel, wants, their real needs.

It may be the feeling of individual or collective feeling

shared by the whole group

Expressed needs:-It is need brought to attention of the authorities by

request, petition or complaints

Agency determined needs-is what external services such as

health workers and planners have decided the community
needs.
July 21, 2021 51
 The role of Health Education in Primary Health
Care (PHC)
 Primary health care is a means of achieving health for all.

 This is possible if all individuals, families, communities,

health professionals, government and NGOS are involved in
the programs.

 A millions of daily decisions about health and diseases are

made by individuals and families at their home not by
doctors or health workers.

July 21, 2021 52

HE in PHC…

 Thus, if these millions of decisions are to be made wisely,

 individuals and families need to be equipped with the

knowledge and skills necessary to exercise these health
decisions.

 Primary health care is therefore very much concerned with

health promotion and education

July 21, 2021 53

HE in PHC…
 One of the core principles of PHC is community
participation.
 To achieve effective community participation two things
need to be done.
 1st: the Political issues or Government decision; should
create favorable climate w/h facilitate more community
involvement in decision making
 2nd : Educational issues (health education), people need to
know how to carryout this mandate for their benefits
 This involves the adoption of certain types of behaviors and
styles of living beneficial to health

July 21, 2021 54

 HE in PHC…
 Therefore, health education is central to primary health care
and
 no components of primary health care can successfully
implemented without health education.

 That means all components of primary health care have health

education
Eight components of PHC
 Health education, nutrition, maternal and child h
ealth, basic sanitation and clean water, immunizat
ion, prevention and control of endemic diseases, t
reatment of common diseases and injures, and provi
sion of essential drugs.
July 21, 2021 55
 Role of health education in PHC

07/21/21 56
 Common challenges of health education:
 H/E is not considered as important during relatively healthy
status as people are often concerned about diseases

 Changing health behavior is conditioned by factors such as

social, psychological, economical, cultural, accessibility and
quality of services, political environment, etc. which are difficult
to deal with simultaneously.

 People are preoccupied with many daily activities to support

their life
 the people charged with health education programs lack special
training and are not qualified
 Health education is much more than “transfer of information.”
July 21, 2021 57
 Thank You
Remember: The Key!