Introduction to HEP

Takele Gezahegn
(MPH, Asst. Professor)
takele.gez44@gmail.com

August 2021
Addis Ababa, Ethiopia
Outline
 The concept of Health Education

 Historical evolution of HE/HP

 The role of Health education in PHC

 Aims/Goals of health education

 Basic principles of health education

2 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 INTRODUCTION
 HE is a part of health care which are concerned with promoting healthy
behaviors.

 help peoples to understand their behaviors and how it affect their health
and
 encourage them to make their own choices for healthy life.

 Many people use HE and HP interchangeably.

 However, there are differences in their concept and application, and

many authors provide different definition of HE & HP .

3 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 Definition of HE
 “HE is any combination of learning opportunities and teaching
activities designed to facilitate voluntary adaptation of behavior
that is conducive to health.”
Green, 1985
Elaboration
 Combination: it emphasizes on the importance of matching
multiple determinants of behaviors with multiple learning
experiences or educational intervention
 Designed: distinguishes HE from incidental learning
experiences as a systematically planned and organized
activity.
 Facilitate: creating favorable condition such as predispose,
enable, reinforce.
4 By Takele G. (MPH, Asst. Prof.) 8/27/2021
 Definition of HE …
 Voluntary: - with full understanding and acceptance of the
purpose of the action.
- Without use of coercion or any manipulative
approaches.
- In HE we do not force the people to do what we want
them to do,
 Action (Behavior): behavioral steps/measures taken by
individuals, groups or community to achieve the desired health
effect.

5 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 Definition of HE …

 “HE is the transaction of what is known about health into

desirable individual, group and community behavior patterns
by means of an educational process.”
Griffiths, 1972

 “HE is 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 health
when needed.”
Alma-Ata, 1978

6 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 Definition of HE …
 “HE is a process that informs, motivates, and helps people to:
 adapt and maintain healthy practices and life styles;
 advocate environmental changes as needed to facilitate this goal
 conduct professional training and research to the same end.”
National Conference on Preventive Medicine in USA, 1994

7 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 Definition of HP
 “HP is any combination of educational, political, regulatory and
organizational supports for actions and conditions of living
conducive to health of individuals, groups or communities”
Green & Kreuter, 1991
Elaboration
 Combination: refers to the necessity of matching multiple determinants of
health with multiple intervention or sources of supports.
 Educational: refers to the communication part of HP. i.e. HE.
 Environmental: refers to the social, political, and economic, organizational,
policy and regulatory circumstances influence behavior or more directly
health.

8 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 Definition of HP …
 “HP is the process of enabling people to increase control over,
and to improve, their health”
Ottawa Charter, 1986
 To reach a state of complete physical, mental and social well being it is
beyond the activity of HE and even health sectors.

 In other words health is not just the responsibility of health sector alone.
 But the responsibility of every sectors working for development .

 Thus, the concern for health outside to the healthcare sector is the call for
health promotion.

9 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 HE and its Relationships with PH and HP
 Three of the disciplines share common primary goal that is promoting
health and quality of life.

 PH, the science and art of promoting health, preventing disease, and
prolonging life through the organized efforts of society by it self.

 HE is sub-disciplines of public health, particularly from Epidemiology

and Nursing, in addition to other disciplines, such as psychology,
behavioral & social sciences.

10 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 Relationships of HE …cont
Health Education and Health Promotion,

 These two concepts remain closely linked and over lapping,

share common historical and philosophical foundation.

 Health promotion = Health Education + Political Action to

influence health

 Conceptualization of the place of HE with in HP using the

PRECEDE-PROCEED Model.
See next slide

11 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 Health Promotion
Health Promotion
Predisposing factors

Lifestyle/ behavioral
Causes

Health Education
Reinforcing factors

Quality of
Health Life

Policy Environmental Causes

&
Regulation Enabling factors

12 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 Approaches of Health Promotion
 Health Promotion Employs Two Approaches .These are:
1) Educational Approach (Health Education):-which attempt
to influence:
o predisposing factors (through direct communication),
o reinforcing factors (through indirect communication) and
o enabling factor (through trainings and organization).
2) 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.

13 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 Approaches…
 Health education
 is one of the most important component of HP.
 It is a means of promoting health.
 It provides consciousness-raising, concern-arousing, action stimulating
impetus for public involvement and commitment to social reform
essential to its success.
 without HE; HP would be manipulative social engineering
enterprise.

 without 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.
14 By Takele G. (MPH, Asst. Prof.) 8/27/2021
 Approaches…
 HP is a structural (laws, regulation, organizational...) support for
HE to develop its full potential.

 HE is primarily focused at voluntary action people can undertake

on their own to improve their own health, their families’ health
and the community as whole.

 But HP 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.

15 By Takele G. (MPH, Asst. Prof.) 8/27/2021

Health Education/Health
Promotion

Health
Health Promotion
Promotion

Health Education

8/27/2021 By Takele G. (MPH, Asst. Prof.) 16

 Examples of HP intervention to prevent diseases and to
promote health of the community

17 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 Examples of HP intervention to prevent diseases and to
promote health of the community

18 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 Elements/Component of HP
Health education

Political environment

Social environment

Economic environment

Organizational environment

19 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 Health promotion tools
Important health promotion tools are the following ones
 Health education and health counseling

 Advocacy,

 Social and/or community mobilization,

 Social marketing, and

 Building partnerships and Net working

20 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 Historical Development of HE
 The concept of educating about health has been since the
down of human
 The history of HE as an emerging profession is only a little over
100 years old.
 1850th, Lemuel Shattuck write a book about “every child
should be taught health principles in schools by a qualified
educator”

 this take part for the emerging of HE.

 The concept of HE in Ethiopia have no clear point when it

start, but after the declaration of PHC
21 By Takele G. (MPH, Asst. Prof.) 8/27/2021
 Historical Development of HE
 Around the end of the 18th century (1779):
 A German physician, Johan Peter Frank, propagate the importance
of supervising health of school children as part of school education
program.

 At the beginning of the 20th century:

 Official formulation of education policies has been started in
Europe and USA.

 At the Global level PHC (primary health care) was designed and
many countries show their commitment to the strategy at the
time of declaration at alma- Ata in 1978.

22 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 History in Ethiopia
 The period of the pre Italo – Ethiopia war (before 2nd
world war)
 The primary focus of the HE was to increase the awareness of
people to modern medicine and encourage them to utilize the services

 The period after the Italo – Ethiopian war (after word

war II)
 Gondar pubic health college and training center was opened
 In 1965 the 1st HE work shop for secondary school science teachers
was conducted

23 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 History in Ethiopia…
 The period of the socialist revolution and after
 Courses on HE were included in most health training
program.

 HE was considered as major components of the PHC

declared at Alma-Ata.

 Ethiopia has hosted the first HE technical meeting of OAU

in Addis Ababa.

24 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 Role of Health Education in PHC
 Almost all developing countries health policies have been found
emphasizing that Primary Health Care (PHC) as the key strategy

 HE is the first and foremost component of PHC and is placed at the

prominent stage among the PHC components

 Primary health care is a means of achieving health for all

 PHC is therefore very much concerned with HP and HE

25 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 PHC is Based on Five Main Principles
1. Equity
2. Community Participation
3. Inter- Sectoral Approach
4. Appropriate Methods and Technology
5. Health Promotion and Prevention
6. Decentralization

 HE is central to PHC which in turn is the primary means of achieving

health for all, and no components of primary health care can
successfully implemented without health education. i.e. all components
of primary health care have HE

26 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 Definition of Health Information
Health information: It is any health message disseminated to the target
audience focusing on the basic facts related to the health issue under
consideration

 It is to create health literacy or awareness

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

is not necessarily required

27 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 Comparison of HE and HI
Health Education Health Information
Baseline information on current level of - are not necessarily required
multiple determinant of behaviors are
necessarily requires
Assumption- people are not relational all Assumption- people are rational and make
the times but they rationalize all the times predictable use of information available to
them (unhealthy behavior is due to
knowledge gab)
Appropriate for old problems (Problems Appropriate for newly emerging health
known to the people for long period of time) problems and during epidemics

Required at all stages in behavior change -One time telling facts provided that the
continuum (it is continues, even to prevent information reaches at all the intended
defaulter after adoption encourage people to audiences and understanding takes place ----
make their own choices for healthy life Merely telling to people to follow health
behaviors
Focus on the reason behind behaviors Blinded to the reason behind the behaviors
People not blamed for un healthy behaviors People blamed for unhealthy behaviors
Use variety of methods or educational strategy May not use a variety of methods
as appropriate
28 8/27/2021
By Takele G. (MPH, Asst. Prof.)
 Think-Pair-Share

 What are the Rationale for HE?

 Why do you think HE is important?

 What are the aims, goals and objectives of HE?

29 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 Rationale for Health Education
 “We must recognize that most of the world’s major Health problems and
premature death are preventable through changes in human behaviors
and at low cost .

 We have the know – how and technology but they have to be transformed
into effective action at the community level”.
Dr.Hiroshi Nakajiima, Director – General, WHO, 1998.

1) The continued existence and spread of CD,

 such as malaria, TB, HIV/AIDS
 Nearly 3 million people die each year from TB,
 Need the involvement of the community members and
environmental interventions.

30 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 Rationale …
 About 75% 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.
 Today’s children contain all of tomorrow’s productive public.

2) For some diseases HE is the only practical choice:

 in order to prevent the spread of the disease or to lead a normal life.

E.g. HIV/AIDS.

3) Increasing the tendency of chronic conditions and other emerging

agendas,
E.g. Hypertension, diabetes mellitus, coronary heart diseases, obesity and lung
cancer

31 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 Rationale …
4) As countries income increases (developed) there is a shift in the
major causes of death
 from infectious/communicable and treatable diseases to degenerative/non-
communicable diseases.
 Prevention is the best cure and the most cost effective intervention exists to
reduce the feature burden

5) Human behaviors are almost the single causes for the

development of such currently emerging health problems and also
the main solution
 prevention of possible only through life style modification and behavioral
changes in which health Education is the only responsible profession

32 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 Rationale …
6) Many people do not seek treatment until it is too late
 Many people are ignorant of the causes of their illnesses and may be
afraid of seeking treatment
 Hide their illness not to be considered, as an “outcast” from society
and many others do not seek treatment until it is too late.
 HE is a frontline to promote the use of preventive and curative health
services

7) Prevention is better than cure, is a statement which is generally true

especially for NCD:
 It is much cheaper, prevents economic loss of manpower hours, and
lessens worry from the money spent on health bills in the family
 Economically a nation’s health through impactful HE is a nation’s
wealth

33 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 Rationale …
8) Increasing threats to the young from new and harmful behaviors.
E.g. Tobacco use, teen-age pregnancy, substance use etc

9) Increased awareness of people on chronic health problems and the

need to know preventive actions

34 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 Premises of Health Education
1. Grounded in the values and needs of the community,
health education promotes social and environmental
justice

2. The health education profession promotes health

literacy and enables and supports healthy livesand
communities.
3. Many of the leading causes of morbidity and mortality
are behaviorallybased

4. Health literacy is an enablingfactor in promoting

healthy behavior.
8/27/2021 By Takele G. (MPH, Asst. Prof.) 35
 Aims, Principles, and Approaches to HE
Aims
 Motivating people to adopt health-promoting behaviors by providing

appropriate knowledge and helping to develop positive attitude.

 Helping people to make informed decisions about their health and

acquire the necessary confidence and skills to put their decisions into
practice.

36 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 The Goals and Objectives of HE
A) The Ultimate Goals of HE
o The ultimate goal of all service professionals (including health
educators) is to improve the quality of life

o The goal of HE is to promote, maintain and improve individuals and

community health
o In simple words the ultimate goals of HE are:
 To help each individual and family exercise the right to achieve a harmonious
development of the physical, mental and social potential.
 To promote health, prevent illness, self-adjust to live with disabilities and decrease
morbidity and mortality.

37 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 B) Educational Objectives of HE
 Many types of objectives depending on the stage and/or level of
interventions
 The following are broad educational objectives of HE:

 To provide appropriate knowledge::provision of correct knowledge,

facts and information

o E.g. facts about HIV/AIDS

 To help develop positive attitude: has a lot to do with changing

opinions, feelings and beliefs of people.

o E.g., to develop positive attitude towards the practice of HIV/AIDS

prevention behaviors such as condom use

38 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 B) Objectives of HE…
 To help exercise health practice/behavior: concerned with

helping people in decision-making and actually performing

o E.g. helping people choosing alternatives (weather to abstain, be

faithful, or use condom)

 Decision-making: means choosing between and/or among

alternatives in the future about health

39 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 Approaches to HE
 The Persuasion Approach
 Deliberate attempt to influence the other persons to do what we
want them to do

 It is good in situations where there is serious threat such as an

epidemic, and the actions needed are clear cut

 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.: FP

40 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 Dimensions/Scope of HE
 HE life long process. It is not one time affair
E.g. child caring begins while the fetus is in the mother’s womb.
 HE concerned with people at all points of health & illness continuum

Mathematical presentation of health and illness continuum

41 By Takele G. (MPH, Asst. Prof.) 8/27/2021

Dimensions of Health Education

Health Education
Education

Behavioral Public
Sciences Health

8/27/2021 By Takele G. (MPH, Asst. Prof.) 42

 Dimensions of HE …
NB:- No level of disease prevention can operate with no HE
successfully!

 Healthy individuals without Sign and symptom of disease

o To prevent the onset of illness

 Disease (illness)

o To develop Illness behavior and compliance behavior

 Disability (Impairment)

o To prevent further disability (tertiary prevention)

 Death

43 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 Dimensions of HE …
 HE is not an end by itself

 Rather a way of empowering people to understand their own

problems, identifying its solution and take appropriate action

 HE is not limited to patients in clinical setups

 It includes those who are apparently healthy and who want to

minimize the risk of having a problem

44 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 Health Education:
• is eclectic (varied) in nature.
• is an applied science.
• has a body of knowledge that comes from other
disciplines (Galli, 1976).
• is bigger than a discipline.
• is smaller than a profession.

8/27/2021 By Takele G. (MPH, Asst. Prof.) 45

The Practice of Health Education
• Understand and engage priority population
• Assess needs and assets of priority population
• Develop goals and objectives
• Create an intervention (plan)
• Implement the intervention
• Evaluate the results

8/27/2021 By Takele G. (MPH, Asst. Prof.) 46

 Basic Assumptions and Principles of HE
Basic Assumptions

 The practice of HE is based on the assumption:

“beneficial health behavior will result from a combination of

planned, consistent, integrated learning opportunities and
scientific evaluation of programs in different settings”

47 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 Principles of HE
The following points are working principles of
health education:
1) Principles of Need Based
 After real need identification
There are three types of needs
 Felt Need
 Expressed Needs: felt need + expressed need
 Agency Determined Needs

48 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 Principles of HE
2) Principles of Educational Diagnosis
 The first task in changing behaviors is to determine its causes.
 If the causes of the behaviors was understood, HE professional can intervene with
the most appropriate & efficient combination of education, reinforcement &
motivation

3) Principle of Planning and Organizing

 Planning and organizing are fundamentals for HE which distinguishes it from other
incidental learning experiences
 It involves deciding in advance the when, who, what, how, and why of HE
 It also requires the planning for resources, methods and materials to be used,
identification of target groups etc.

49 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 Principles of HE …
4) Principles of Participation
 Individual, families, community groups, etc. have been participated in identifying
their own needs for change and have selected the methods that will enable them to
take action

5) Principle of Multiple Methods

 For each of the multiple predisposing, enabling, and reinforcing factor identified, a
different methods or components of comprehensive behavioral change must be
provided

6) Principles of Segmentation
 HE should be designed for a specific group of people or specific target groups

50 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 Principles of HE …
7) Principles of Facts
 HE is given based on scientific findings/facts and current
knowledge
 This is because scientific knowledge is changing with time

E.g., it is incorrect to say I think FGM is harmful

8) Principles of Culture
 HE should not consider as artificial situation or formal teaching –learning
process.

 Therefore HE starts from where people are and slowly build up the talking point to avoid
any clash of ideas to allow for people understanding, appreciation and internalization of
fresh ideas

51 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 Principles of HE …
9) Principle of motivation
 Motivation is mental direction /desire for doing or rejecting something
 It is internal dynamics of behaviors, not external stimuli such as incentives

 In HE, we can appeals to people’s motives through motive arousing appeals but
not through external stimuli

10) Principle of Feedback

 It is a mechanism of assessing what has been happened in the target Population
after receiving the message.

 the two way communication particularly of important in HE to help people in

getting proper feedback to get the doubts cleared.

52 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 Principles of HE …
11) Principle of Reinforcement
 individuals, group who started to undertake health behaviors should verbally
encouraged or received positive feed back (positive reinforcement )

 Unhealthy behaviors should be discouraged until it disappear (negative

reinforcement )

12) Principle of Interest

 People are unlikely to listen to those things which are not to their interest

13) Principle of Credibility

 Good HE is based on facts; and must be consistent and compatible with scientific
knowledge, local culture, educational system as well as social goals

53 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 Principles of HE …
14) Principle of Comprehension
 in HE, we must know the level of understanding, educational status or literacy of the
people to whom the teaching is directed

15) Principle of Learning by Doing

16) Principle of Known to Unknown

17) Principle of Setting an Example (using role model)
18) Principle of Good Human Relations

54 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 Questions
1) Do you think that HE activities going on your
locality consider these principles of HE?

2) Which principles of HE have impressed you more?

Why?

55 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 Cases
1) Routine vaccination is among the activities you will be expected to
implement at your community level. Suppose you want to conduct
awareness creation on the advantages of childhood vaccination in your
area. Who do you think should be your target audience for a health
education session on childhood vaccination?

2) Imagine that you are conducting a health education session in your local
community. During your teaching you say ‘I think female genital mutilation
(FGM) is harmful’ or ‘I think tobacco causes cancer’. What would be a
better way of putting this?

56 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 Targets of HE
 Needs for HE are ubiquitous.
 Every stages of life, every person or social group and all occupations are
appropriate targets of health education programs

 Depending on the type of the problem there are three broadly classified
targets of HE programs (Individuals, Groups and Community);

1)Individuals: this includes clients of services (Ex. contraceptive or VCT users),

patients (E.g. Diabetic or Hypertensive patients) and healthy individuals

57 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 Targets of HE
2) Groups: includes gatherings of two or more people who have a
common interest
 a FP service for a couple
 a youth club about HIV/AIDS
 a farmers association about nutritious foods
 a class of school students about dental health
 a factory workers about occupational health hazards
 ANC attendants about dangers signs of pregnancy

3) Community: include a collection of people who have common interests, a

feeling of belongingness, and who usually share common values, culture, beliefs and
interests.
 It is not limited by area and it may be a town or a country in sparsely populated
areas or the school, work site, or neighborhood in more populous metropolitan
areas.

58 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 The Levels of HE in Disease Prevention
There are three distinct levels of disease prevention in HE:
1) Primary,
2) Secondary, and
3) Tertiary health education

1) Primary HE
 Is comprised of those preventive measures that forestall the onset of
illness or injury during the prepathogenesis period (before the
disease process begins),
E.g. Wearing safety belt
Immunization
Brushing one’s teeth
Breast feeding
59 By Takele G. (MPH, Asst. Prof.) 8/27/2021
 The Levels of HE …
2) Secondary HE
 Illness and injury can not always be prevented.

 In fact, many diseases such as cancer and heart diseases can

establish themselves in humans and cause considerable damages
before they are detected and treated.

 Aimed at promoting early diagnosis and prompt treatment of a disease

to cure or to limit disability and prevent more serious pathogenesis or
death
E.g. Breast-cancer screening
Blood pressure examination
Cholesterol level examination
Treating malaria patients.
60 By Takele G. (MPH, Asst. Prof.) 8/27/2021
 The Levels of HE …
3) Tertiary HE
 To retain, reeducate, and rehabilitate the individual who has already
incurred disability, impairment, or dependency, and

 Aimed at patients with irreversible, incurable, and chronic condition

for social and psychological adjustment

E.g. Educating after lung cancer surgery

Working with the diabetes individual to ensure the daily Injections are taking

61 By Takele G. (MPH, Asst. Prof.) 8/27/2021

The Level of Disease Prevention in Relation to Health Status

By Takele G. (MPH, Asst. Prof.)

62 Source: J.F. McKenzie, B.L. Nieger, and J.L. Smeltze, 8/27/2021
2005
 Classify the following health education activities
whether it is primary, secondary or tertiary
a) Health education on physical exercise __________
b) Health education on tooth brushing ____________
c) Early treatment seeking behavior for malaria ________
d) Post test counseling of HIV positive person _________
e) Health education for TB patients on drug compliance________

63 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 HE Settings
 HE is delivered in almost every conceivable setting including; hospital,
Schools, prison, etc.
 Formal vs. informal, political vs. religious, New vs. established
 [

 Differ in their organizational structure, the mission of the organization,

and the centrality of the mission to HE.
 The process of HE is the same across settings,
 HE takes place in the f.f. common settings:
1) Schools,
2) Worksites,
3) Health care settings and
4) Community settings
5) Special communities such as prisons and refugee settings

64 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 Responsible Bodies and Their Roles in HE
 Who is responsible to provide health education?

 Do you think environmental health professional are responsible to HE

programs? What about other HCWs?

 What are the roles and responsibilities of qualified HE and HP

professionals in HE program?

65 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 Responsible Bodies and Their Roles in HE
 Specialists (people trained to do HE work), all health
workers, non-medical and non-health personnel
 But health workers are much better fitted!
 If health and other workers are not practicing health education in their daily work they
are not doing their job correctly
 HE, then, is really the duty of everyone engaged in health and community
development activities
1) At the Highest Level
 Planning, designing strategies, programs and goals
 M and E of HE programs
 Securing financial arrangement
 Integration and harmonization of HE activities

66 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 Responsible Bodies and Their Roles in HE
2) At the lowest Level (Kebeles, Woredas, Health
Institutions)

 Providing problem oriented and need based health education to the

community

3) At the individual and/or professional level

 Health care providers, teachers, Agriculture and HEW, political &
community leaders, religious leaders, volunteers, mothers/household
heads)
 Giving health education
 Facilitating and mobilizing community
 Being role model

67 By Takele G. (MPH, Asst. Prof.) 8/27/2021

Responsibilities of Health Educators

Program
Program Planning
Planning
Implementation
Implementation
Program
Program Delivery
Delivery
Program
Program Administration
Administration
Evaluation
Evaluation

8/27/2021 By Takele G. (MPH, Asst. Prof.) 68

 Challenges to the Process of HE
 Much time, effort, practice, and on-the-job training are
required to be successful.
 No two days are the same in HE (the constant changes in settings,
resources, and priority population).

Common challenges of health education:

1) Peoples don’t worry about their health status when they are healthy
(HE is not considered as important)

2) Health education is much more than “transfer of information.”

69 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 Challenges to the Process of HE
3) Changing health behavior is conditioned by factors and difficult to deal
with it simultaneously.

4) People are preoccupied with many daily activities

5) HE does not have high prestige (treated as subordinate subject/

optional)

6) There is failure to see the value of HE by some health professionals.

7) The people charged with HE programs lack special training and are
not qualified

70 By Takele G. (MPH, Asst. Prof.) 8/27/2021

Further Reading Assignment

 PHC and Health Education

 Health Policy and Health Education

 Health Promotion Strategies/Principles & Ottawa Charter for HP

 Health education in Relation to Health Extension Programs

71 By Takele G. (MPH, Asst. Prof.) 8/27/2021

 Reference
Barnes, H. M. (2000). “Collaboration in community action: a successful partnership between
indigenous communities and researchers.” Health Promotion International 15(1): 17-25.

Boutilier, M., S. Cleverly, et al. (2000). Community as a Setting for Health Promotion. Settings
for Health Promotion. B. D. Poland, L. W. Green and I. Rootman. Thousand Oaks, Sage
Publications Inc.

Boutilier, M., R. Mason, et al. (1997). “Community action and reflective practice in health
promotion research.” Health Promotion International 12(1): 69-78.

Cousins, M. and M. I (1995). “Use of Medical Care After a Community-Based Health

Promotion Program - A Quasi-Experimental Study.” American Journal of Health Promotion
10(1): 47-53.

Defriese, G. and C. Crossland (1995). “Strategies Guidelines, Policies And Standards - The
Search For Direction In The Community Health Promotion.” Health Promotion International
10(1): 69-74.
72 By Takele G. (MPH, Asst. Prof.) 8/27/2021