Blue Nile College

Department Of Nursing
Module Title: Community Mobilization
and
Health Education For Level III Nursing
Students

By: Tewodros Teshome

2024
10/01/2024 1
 Course syllabus
 Module Title: Community Mobilization

and Health Education

 Credit hour: 4

 Course instructor: Tewodros T.

 Email address: teddyteshome173@gmail.com

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 Course Description
• This learning guide introduces the fundamental
concepts and skills necessary to Perform
Community Mobilization and Provide Health
Education.

• This module covers unit of competency of

Performing Community Mobilization and Provide
Health Education among the national
occupational standard in nursing.
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• It addresses conducting health education and
communication, training model families, and
Plan and Undertake advocacy on identified
health issues.
• It addresses Knowledge and skill are
separately discussed by using information
sheet and operation sheet supplemented with
self-check and LAP (Learning Activity
Performance) test.
• The learning guide is prepared on self-
contained methods of module preparation with
minimal resource-based approach based on
January 2021, version I OS and January 2022
version I curriculum.
• Information sheet, Self-cheek, Operation sheet
and LAP Tests are the main components of this
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Teaching method and
material
 Teaching method
 Interactive presentation
 Group discussion
 Group assignment and presentation
 Reading assignment
 Teaching Aids
 Printedmaterials
 LCD projectors

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 Course Policy
• Attendance: this course will involve numerous
discussion and class activities students are
expected to attend all classes
• Assignments: students must do given
assignments on time
Late assignment submission will not be accepted
• Cheating/plagiarism: Students must do their
own work
Cheating or Plagiarism will result in
disqualification of the result

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 Course Policy….
Assessment
• Continuous Institute Assessment Result (70%/LO)
• Test1…………………………..........………….70%
• Test 2…………………….………………………70%
• Test 3………………………………..…………..70%
• Industry Assessment Result ………30%/LO
• Total-------------------------------------------100%
• Grading system- Based on the college’s grading policy

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 Module units

Conduct health education and

communication
Train model families

Plan and undertake advocacy on

identified health issue

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 Learning objectives of the
Module
At the end of the module the
learner will be able to:
Conduct health education and
communication
Train model families
Plan and undertake advocacy on
identified health issues

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 Course contents
Unit One: Conduct health education and
communication
• Concept of health and health education
• Performing assessment and identify gaps
• Organize or mobilized community and available
resources
• Target groups Identification
• Prepare health education plan
• Designing methods and approaches of health
communication
• Provide Health education service
• Monitor service utilization and evaluation of behavioral
change
• Develop, promote, implement and review strategies
• Maintain work related network and relationship
• Approaches to meet communication needs
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Unit two: Train model family
•Identifying better performing
households
•Establish space and time for
training
•Identifying and collecting resources
for training
•Providing training according to MOH
guidelines
•Provide post training follow up and
monitoring
•Evaluating and certifying well
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Unit Three: Plan and Undertake advocacy
on identified health issues
• Prepare advocacy plan to address health
issues
• Consult community representatives health
needs and priorities
• Identify and consult influential community
representatives and health development
armies to disseminate IEC-BCC activities
• Planning, implementation and evaluation of
advocacy and community mobilization
• Organizing and providing continuous advocacy
services in partnership with stakeholders
• Using feedback for planning
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Unit One: Conduct health education & communication

oInstruction sheet
This learning unit is developed to provide the trainees the
necessary information regarding the
 following content coverage and topics:
 Concept of health and health education
 Performing assessment and identify gaps
 Organize or mobilized community and available resources
 Target groups Identification
 Prepare health education plan
 Designing methods and approaches of health
communication
 Provide Health education service
 Monitor service utilization and evaluation of behavioral
change
 Develop, promote, implement and review strategies
 Maintain work related network and relationship
 Approaches
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to meet communication needs
13
 1.1. Concept of health and health
education
1.1.1. Introduction to Health education
and Communication
• Before discussing about health education, it is
imperative to conceptualize what health itself
means.
• Health is a highly subjective concept.
• Good health means different things to different
people, and its meaning varies according to
individual and community expectations and
context.
• Many people consider themselves healthy if
they are free of disease or disability.
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•However, people who have a
disease or disability may also see
themselves as being in good health
if they are able to manage their
condition so that it does not impact
greatly on their quality of life.
•WHO defined health as a state of
complete physical, mental, and
social wellbeing and not the mere
absence of disease or infirmity.

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oPhysical health – refers to anatomical
integrity and physiological functioning of the
body.
oTo 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.
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oMental health - ability to learn and think
clearly.
oA person with good mental health is able to

handle day-to-day events and obstacles,

work towards important goals, and function
effectively in society.

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oSocial health – ability to make and
maintain acceptable interactions with other
people. E.g.:-
• To feel sad when somebody close to you
passed away.
• 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.
• Disease is the existence of some pathology
or abnormality of the body, which is capable
of detection using, accepted investigation
methods.
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• Illness is the subjective state of a person
who feels aware of not being well.
• Sickness is a state of social dysfunction:
a role that an individual assumes when ill
• While the history of health education as
an emerging profession is only a little
over one hundred years old, the concept
of educating about health has been
around since the dawn of humans.
• It does not stretch the imagination too
far to begin to see how health education
first took place during pre-historic era.

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• Someone may have eaten a particular plant or
herb and become ill.
• That person would then warn (educate) others
against eating the same substance.
• Conversely, someone may have ingested a
plant or herb that produced a desired effect.
• That person would then encourage (educate)
others to use this substance.
• At the time of Alma Ata declaration of Primary
Health Care in 1978, health education was put
as one of the components of PHC and it was
recognized as a fundamental tool to the
attainment of health for all.
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• Adopting this declaration, Ethiopia utilizes health
education as a primary means of prevention of diseases
and promotion of health.
• In view of this, the national health policy and Health
Sector Development Program of Ethiopia have identified
health education as a major component of program
services.
• Health education has been defined in many ways by
different authors and experts.
• Lawrence Green defined it as ―a combination of learning
experiences designed to facilitate voluntary actions
conducive to health.

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• The terms ―combination, designed,
facilitate and voluntary action have
significant implications in this definition.
• 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
systematically planned activity.
• Facilitate means create favorable conditions
for action.

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• Voluntary action means behavioral
measures are undertaken by an individual,
group or community to achieve an
intended health effect without the use of
force, i.e., with full understanding and
acceptance of purposes.
• Most people use the term health education
and health promotion interchangeably.
• However, health promotion is defined as a
combination of educational and
environmental supports for actions and
conditions of living conducive to health.
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• Information, Education and
Communication (IEC) is a term originally
from family planning and more recently
HIV/AIDS control program in developing
countries.
• It is increasingly being used as a general
term for communication activities to
promote health.
Information: A collection of useful briefs
or detailed ideas, processes, data and
theories that can be used for a certain
period of time.
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Education: A complex and planned learning
experiences that aims to bring about changes in
cognitive (knowledge), affective (attitude, belief,
value) and psychomotor (skill) domains of
behavior.
Communication: the process of sharing ideas,
information, knowledge, and experience among
people using different channels.
Behavior Change Communication (BCC): Is
an interactive process aimed at changing
individual and social behavior, using targeted,
specific messages and different communication
approaches, which are linked to services for
effective outcomes.
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 1.1.2. Definition of terms
Health- according to WHO is defined as a state of
complete physical, mental and social well-being
and not the mere absence of disease or infirmity.
Public Health- is a science & art of promoting
health, preventing diseases and protecting the
health of the public through organized community
effort.
Health Promotion- according to Green &
Kreuter, is defined as any combination of
educational, political, regulatory and
organizational supports for action and condition of
living conducive to health of individuals, groups &
communities
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Education- according to Socrates, is defined
as dispelling error and discovering truth
Health Education- according to Green, is
defined as any combination of learning
opportunities and teaching activities designed
to facilitate voluntary adaptation of behavior
that is conducive to health.
Advocacy- is simply defined as an act or
process of supporting a cause or an issue to
influence decision makers for program or
policy change

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Social Mobilization-Social mobilization is the
process of bringing together all feasible inter-
sectorial partners and social allies to raise
people‘s awareness and demand for particular
development program to assist in the delivery
of resources & services and to strengthen
community participation for sustainability and
self-reliance
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Social Marketing- Social marketing is a process
concerned with introducing and disseminating
new or re branded marketable ideas and
services; i.e. product (Material or idea),
transaction (Mutual relationship where two
parties benefit by exchange of product or
service), and consumer(Client or partner which
uses a product by buying it but based on his/her
free will).
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I.E.C- is a process which involves the
provision of information, conduct of
educational activities, and effective
communication of health messages to
enable individuals, families or
communities to promote their health as
well as to preserve their health.
B.C.C- is a process of changing social and
individual attitudes and behaviors by
providing relevant information, education
and motivation through appropriate
communication strategies.
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 1.1.3. Concepts and principles of health
education and communications

Concepts of health education and

communications
• When providing health education, it is
crucial to know:
the aims of health education,
targets for health education,
health education settings,
the roles of health educator

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Aims of health education
Motivating people to adopt health-
promoting behaviors by providing
appropriate knowledge and helping to
develop positive attitude.
Helping people to make decisions about
their health and acquire the necessary
confidence and skills to put their
decisions into practice.

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Targets for health education
Individuals such as clients of services,
patients, healthy individuals
Groups E.g. groups of students in a
class, youth club
Community E.g. people living in a
village

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Health education settings
• Settings are used because interventions need
to be planned in the light of the resources and
organizational structures peculiar to each.
• Thus, health education and promotion takes
place, amongst other locations, in:
Communities
Health care facilities
Work sites
Schools
Prisons
Refugee camps …etc.

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Roles of health educator
Talking to the people and listening of their
problems
Thinking of the behavior or action that could
cause, cure and prevent these problems.
Finding reasons for people‘s behaviors
Helping people to see the reasons for their
actions and health problems.
Asking people to give their own ideas for
solving the problems.
Helping people to look as their ideas so that
they could see which were the most useful and
the simplest to put into practice.
Encouraging people to choose the idea best
suited to their circumstances.
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Basic principles of health education and
communications
A. All health education should be need based.
Therefore before involving any individual, group or the
community in health education with a particular purpose
or for a program the need should be ascertained.
 It has to be also specific and relevant to the problems and
available solutions.
B. Health education aims at change of behavior.
Therefore multidisciplinary approach is necessary for
understanding of human behavior as well as for effective
teaching process.
C. It is necessary to have a free flow of communication.
The two way communication is particularly of importance
in health education to help in getting proper feedback and
get doubt cleared.
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D. The health educator has to adjust his talk and action
to suit the group for whom he has to give health
education.
E.g. when the health educator has to deal with illiterates and
poor people, he has to get down to their level of conversation
and human relationships so as to reduce any social distance.
E. Health Education should provide an opportunity for
the clients to go through the stages of identification of
problems, planning, implementation and evaluation.
This is of special importance in the health education of the
community where the identification of problems and
planning, implementing and evaluating are to be done with
full involvement of the community to make it the
community‘s own program.
F. Health Education is based on scientific findings and
current knowledge.
Therefore a health educator should have recent scientific
knowledge to provide health education.

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J. The grave danger with health education programs is the
pumping of all bulk of information in one exposure or
enthusiasm to give all possible information.
Since it is essentially a learning process, the process of
education should be done step-by-step and with due
attention to the different principles of communication.
K. The health educator should use terms that can
be immediately understood.
Highly scientific jargon should be avoided.
L. Health Education should start from the existing
indigenous knowledge and efforts should aim at
small changes in a graded fashion and not be too
ambitious.
People will learn step by step and not everything
together.
For every change of behavior, a personal trail is required
and therefore the health education should provide
opportunities for trying out changed practices
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G. The health educators have to make themselves
acceptable.
They should realize that they are enablers and not
teachers.
They have to win the confidence of clients.
H. The health educators should not only have
correct information with them on all matters that
they have to discuss but also should themselves
practice what they profess.
Otherwise, they will not enjoy credibility.
I. It must be remembered that people are not
absolutely without any information or ideas.
The health educators are not merely passing
information but also give an opportunity for the clients
to analyze fresh ideas with old ideas, compare with past
experience and take decisions that are found favorable
and beneficial.
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1.2. Performing assessment and identify gaps
1.2.1. Assessment Techniques
• Community‘s especially rural communities have
limited resources to address many health related
needs.
• Conducting a community health needs
assessment can help your program to determine
where and how resources may best be targeted.
• A community health needs assessment serves as the starting
point to address a community‘s needs and advocate for
improvement.
• The assessment identifies factors that impact a population‘s
health and resources available to help resolve these issues.
• This assessment will help to identify topics and issues
relevant to a community.
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• Data for determining community needs can be
collected through surveys, questionnaires, focus
groups, public meetings, direct observations, and
interviews.
• Secondary data sources such as demographic data,
vital statistics, hospital records, morbidity and
mortality reports, and literature reviews also provide
valuable information.
• Community health needs assessment data can be
collected from a variety of sources.
• It is important to talk to members of the community to
understand the data.
• For example, data gathered across several years may
show that there has been a notable change related to
health outcomes, educational attainment, or
employment.
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• Conducting a focus group with community
partners or community members can help to
explain the reasons for why the changes have
occurred.

• Combining quantitative and qualitative data

can help to explain community trends.

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1.3. Organizing community and
all available resources
1.3.1. Community organizations

• Community could be defined as organized

groups of people who share a sense of
belonging, beliefs, norms, and leadership and
who usually interact within a defined
geographical area.

E.g. People living in a Kebele‖ or Woreda, People

organized under one religion etc.
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• Community organizing is the process by
which community groups are helped to identify
common problems or goals, mobilize resources,
and develop and implement strategies to reach
goals they have set collectively.
• Community organization is important in health
education, partially because it reflects one of
the field‘s most fundamental principles, that of
“starting where the people are”.
• The health education professional who begins
with the community‘s felt needs is more likely
to be successful in the change process and in
fostering true community ownership of
programs and actions.
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• Community organizing also is important in
light of evidence that social involvement and
participation can themselves be significant
factors in improving perceived control,
empowerment, individual coping capacity,
health behaviors, and health status.
• Finally, the heavy emphasis on community
partnerships and community-based health
initiatives by government agencies and
foundations suggests the need for further
refining theory, methods, and measurement
techniques.

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• Although no single unified model of community
organization or community building exists,
some key concepts are central to the most
often used models.
• These concepts are empowerment, critical
consciousness, community capacity, issue
selection, and participation and relevance.

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Empowerment: Social action process for people to
gain mastery over their lives and the lives of their
communities.
Community members assume greater power or
expand their power from within to create desired
changes.
Critical consciousness: A consciousness based on
reflection and action in making change.
Engage people in dialogue that links root causes and
community actions
Community capacity: Community characteristics
affecting its ability to identify, mobilize, and address
problems.
Community members actively participate in
identifying and solving their problems and become
better able to address future problems collaboratively
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Social capital: Relationships between
community members including trust,
reciprocity(mutual exchange of rights,
privileges or obligations), and civic
engagement.
Application: Community members collectively
improve leadership, social networks, and
quality of neighborhood life
Issue selection: Identifying winnable and
specific targets of change that unify and build
community strength.
Identify issues through community
participation; decide targets as part of larger
strategy Participation and
Relevance: Community organizing should
’’start where the people are’’ and engage
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 Helping people to organize:
• Success in community participation involves a
series of overlapping stages.
• They include:
• Knowing the community
Learning about the community (its
structure and pattern)
Contacting with families, leaders and
community groups.
Discussing on concerns and felt needs.

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• Taking some actions
Actions on achievable, short-term aims based
on felt needs which bring the community
together and build confidence.
• Further activities and organization building
Build up-on existing community organization
or associations.
Formation of committee e.g. Health
committee
Educational in-puts
Select and train volunteers
Decision making on priorities
Further actions by the community themselves

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 1.3.2. Available resources

• For health education activities to reach the

stated goals and objectives, they must be
supported with appropriate resources.
• There are several different types of
resources that may be used in health
education activities.
• They can be broadly classified into three
items:
A. Personnel or labor power
B. Material resources, including
educational materials
C. Financial resources
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 A. Personnel or labor power

• The key to any successful health education

activities will always be the individuals needed
to carry them out.
• It is difficult to carry out every task individually.
• Identify volunteer individuals from the
community, such as community leaders, Kebele
leaders and possibly religious leaders.
• In addition, leaders of different community
organizations such as idir, iquib and mehber
may be very helpful.
• They may be able to assist in organizing the
community, arranging schedules for health
education, mobilizing the community for
participation, and even possibly delivering
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• Other non-governmental organizations may
be available in the community, and may be
important sources of personnel for different
activities.
• They may be able to assist in different ways.
• For example, they may help in providing
training for peer educators or for households.

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B. Material resources, including educational materials

• Educational materials are crucial resources

that will help to carry out health education
activities.
• Some materials can help to take message to
the community, and also support
communication with all the people for whom
you are responsible.
• It may be essential to use posters, leaflets, flip
charts, cards, audio cassettes, videos, and
other resources.
• In addition, one can prepare educational
materials from locally available materials.
• For example: Preparing posters by working
with people who are good at drawing pictures.
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• Knowing people in the community who have
special skills at writing poems and songs, or
who are good at drawing pictures, or who
have other abilities could be important for
creating health education materials.
• Knowing local materials that could be relevant
for health education activities, such as audio-
visual equipment or other relevant resources?

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 C. Financial resources

• Financial resources are also very important to

support health education activities.
• However, financial support is often difficult to
find specifically for health education activities.
• To secure money for these activities, trying a
variety of different options may be needed.
• The first one is to request community
contributions.
• This is not to suggest that they should
necessarily pay money towards the activities.

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• But they may be able to contribute locally
available resources in kind.
• For example, they may be able to prepare coffee
while the community members are gathered in
the village for health education meetings.
• Government and non-governmental
organizations may also be able to provide
financial support for these activities.
• So working closely with them is essential.
• For example, non-governmental organizations
working in the area where health education
provided might sponsor some of activities.

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• They may provide financial support for
training heads of households about the proper
use of bed nets.
• Other resources available in the community
may include provision of the space to conduct
health education sessions.
• The community may be able to contribute the
Kebele administrative office, schools, or other
places such as mehber, ider, equib and others.
• Equipment such as audio equipment, for
example a megaphone, may also be available
in the community.

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 1.4. Identifying target groups

• Each individual and every community

needs to think about what will bring
them a healthy life.
• There are different risk factors in each
locality that expose people to unhealthy
conditions and lead to sickness and
disease.
• Health education activities are expected
to reduce these risk factors and
maintain the health of your community.

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• Every stage of life, each and every individual
or social group in the community and all
occupations are appropriate targets of health
education programs.
• The following sections cover the main target
groups for health education programs.
• It is important to adapt health education
methods and activities to fit the group or
audience in which the health educations are
targeting.

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 I. Individuals

• Individuals include all health service users

such as women receiving antenatal care,
school children, adolescents and young
children.
• Deliver health education messages at both
household and at a community level.
• For example, it is likely there will be TB
patients in your community who are receiving
anti-TB drugs.
• Health education for these individuals will
include giving advice to cover their mouth
while coughing, adhere to the full course of
their treatment as well as a variety of other
educational issues that will help them get
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 II. Groups

• Groups are gatherings of two or more people

with a common interest; they are a good
target for health education sessions.
• To understand the concept of group health
education, imagine that there is a gathering
of an HIV/AIDS peer educator group at the
local secondary school.
• You may well be invited by the school
administrator to deliver health messages on
HIV/AIDS to help train groups such as these.

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 1.5. Preparing health education plan
1.5.1. Planning health education program
• A health education plan outlines the work of a
health department's health education staff
over a certain period, for example, one year.
• A plan organizes the health education work
and helps to prioritize it.
• It is a way of making health education
understood by other staff, and of clarifying the
department's health education commitments
reflected in contract addenda and program
guides or policies.
• It gives direction and sets limits on workload.
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• The plan helps eliminate the danger of
becoming overextended, superficial or
unfocused.
• It helps the health educator to carry out
planned rather than spontaneous reactive
work.
• A plan provides the basis for documenting,
reporting and monitoring progress

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 1.5.2. Planning process

There are six steps to completing health

education plan:
STEP 1: Identifying Public Health Program Goals
and Primary Target Groups
STEP 2: Identifying the Causes of the Health
Problem
STEP 3: Analyzing the Causes of the Health
Problem
STEP 4: Determining Health Education Objectives
and Activities
STEP 5: Determining Evaluation Measures and
Procedures
STEP 6: Determining Needed Resources
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• The first three steps provide direction and content;
that is, they define the health education
components of the program.
• Beginning with STEP 4, it describes the work that
actually wishes to accomplish; that is, it will list
specific educational objectives and the activities
that will use to carry out these objectives.
• In STEP 5, developing an evaluation plan will
proceed.
• It will outline how to monitor the program's quality
and its effect on target group behavior.
• The concluding step, STEP 6 is reviewing the
results of all the previous steps and prepare for
implementation.
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STEP 1: Identifying Public Health Program
Goals and Primary Target Groups
• The health education components of public health
programs are developed within the context of
program's goals, that is, their intended long-
range outcomes.
• In consultation with the supervisors, the first task
is to review the program(s) that will be working
with and identify their long-range outcomes or
goals.
• Public health programs are in place in response to
identified public health issues, problems and
opportunities, and their intention is to affect
these issues and problems.
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• Thus, public health program goals are typically
aimed at changing a particular health status
indicator.
• Examples of public health goal: Reducing
overall injury, mortality; increasing
immunization levels, especially among younger
children, persons at risk and older adults.
• Public health problems are further analyzed for
those who are at risk, for example, adolescent
mothers, and preteen youth.
• These individuals are the target for and the
beneficiaries of educational interventions, and
thus are the primary target group.
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• Information on this target group should be
assembled and include:
Geographical distribution
Occupational, economic and educational
status
Age and sex composition
Ethnicity; and
Other appropriate health indicators such as
age-specific morbidity and service-
utilization patterns.

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STEP 2: Identifying the Causes of the
Health Problem
• In this step, the causes of health problems will
be identified.
• The causes of health problems that are
changeable by educational interventions are
behaviorally or environmentally based.
• In carrying out this diagnosis, do the following:
Create a list of as many possible causes as
you can imagine;
conduct a review of evidence that the
identified causes are amenable to change
through educational interventions and that
such change will improve the health problem
in question.
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• Consult experts and review the literature!;
and In consultation with other members of the
health department as well as representatives
of the target group, select the one or two
causes that you feel you can most influence,
for example, not smoking and using alcohol
during pregnancy.
• Once selected, these causes become the
target of your educational interventions.

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• When selecting causes for educational
intervention, the two most important criteria
are the evidence that:
A. The prevention of the cause will reduce
the health problem; and
B. The cause is amenable to change.
• Beyond these two criteria, the selection
process is often influenced by policies
governing the services, legal and economic
factors, resources and expertise, the political
viability of the educational interventions and
the chance of continued funding.

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STEP 3: Analyzing the Causes of the
Health Problem
• The next step is to analyze the causes of the
behaviors or environmental conditions
selected in STEP 2.
• This diagnosis will identify those factors that
must be changed to initiate and sustain
behavioral or environmental change; these
factors will become the immediate targets or
objectives of your program.
• It is at this point that the educational
component of public health programs emerges
as an entity distinct from other technologies
and services.
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• Consider the following factors when analyzing
each behavior or environmental condition:
PREDISPOSING FACTORS - (which include
knowledge, attitudes, beliefs, values and
perceived needs and abilities) - relate to the
motivation of an individual or group to act.
• They include the cognitive and affective
dimensions of knowing, feeling, believing, valuing,
and having self-confidence or a sense of efficacy.
• Predisposing factors are the ‘’personal’’
preferences that an individual or group brings to a
behavioral or environmental choice, or to an
educational or organizational experience.
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• ENABLING FACTORS - (often conditions of the
environment) facilitate the performance of an
action by individuals or organizations.
• Enabling factors include the availability,
accessibility and affordability of health-care and
community services.
• Also included are conditions of living that act as
barriers to action, such as the availability of
transportation or work release to participate in a
health program.
• Enabling factors also include new skills that a
person, organization or community needs to
carry out a behavioral or environmental change.
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• REINFORCING FACTORS - which include:
social support,
peer influences,
advice from health-care providers,
recognition, and relief of discomfort or pain,
economic benefits or avoidance of cost
follow the adoption of desired behavioral or
environmental change and serve to strengthen
the motivation for continued change.

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 STEP 4: Determining Health Education Objectives and Activities

• Health educators aspire to bring about

worthwhile changes in a program's target
audience or in their environment through
planned health education initiatives.
• These initiatives focus primarily on altering
behaviors via the factors thought to
contribute to behavior.
• Put most simply, an educational objective
for a health education program should
describe the post program knowledge,
attitudes, values, beliefs, skills, resources
and environmental changes that the
program seeks to promote.
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• Identifying a program's educational objectives
can lead to identifying the decisions on which
it will focus the evaluation.
• Having researched and identified predisposing,
enabling and reinforcing factors, the next step
is to word these factors as educational
objectives.
• Remember, an objective should answer the
questions: who is expected to achieve or
become how much of what by when?
WHO - the target group(s) or individual(s) expected
to change;
HOW MUCH - the extent of the condition to be
achieved;
WHAT - the action or change in behavior or health
practice to be achieved; and
WHEN - the time in which the change is expected to
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• In preparing educational objectives, it is
important to be guided by the principle that
"using multiple interventions is more effective
than using any one type of intervention alone."
• This means that to make health education
programs more effective, a person should
write educational objectives to cover all of the
"causes of behavior and environmental
conditions“ (that is, predisposing, enabling and
reinforcing factors).
• The second task in STEP 4 is to identify the
activities will be used to carry out your
objectives.
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• The selection of activities should be done
with care and thoughtfulness.
• Representatives of the various segments
and community who will be affected by the
educational interventions should be
consulted throughout this process.
• Further, you should select, if possible, those
activities that have been tried and tested.

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STEP 5: Determining Evaluation Measures
and Procedures
• There are, of course, any numbers of reasons
that public health professionals might
evaluate some or all aspects of the health
education programs they carry out.
• Fundamentally, however, evaluation
techniques and the resulting data are used to
make decisions about program quality and
program effectiveness.

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Program Quality
• The quality of educational interventions is best
assured by a formal and periodic analysis of the
following factors:
The skill and performance of program
providers;
The adequacy of program resources;
The appropriateness of the programs
selected interventions,
The degree to which the program's
educational activities are being accomplished
and the nature of the barriers to program
implementation; and adherence to health
education standards of practice.
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Program effectiveness
• The effectiveness of educational interventions
is best assured by a formal and periodic
analysis of the following factors:
Changes in behavior and environmental
conditions (Impact Evaluation); and
Changes in mortality, morbidity and
disability (Outcome Evaluation)

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STEP 6: Determining Needed Resources
Step 6 consists of three tasks:
A. Task 1: Determining needed resources,
B. Task 2: Assessing available resources and
C. Task 3: Assessing the barriers to the
implementation of your program.

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A. Task 1: Determining needed resources
• This first task consists of two parts:
developing a timeframe and determining
personnel requirements.
• First, you develop a timeframe to accomplish
program‘s educational objectives.
• The first and most critical resource is time.
• Time has been stated as an integral part of
educational objectives.
• It is a must to examine these educational
objectives, identify the specific tasks required
to accomplish the objectives and assess
whether or not these tasks can be
accomplished within the timeframe stated in
the objective.
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• Second, determine the types and numbers of
people needed to carry out the program.
• The next most critical resource is program
personnel.
• Each month's tasks require certain types of
skills, e.g., professional, technical,
administrative and clerical.
• The estimate of personnel hours enables a
cost analysis of personnel and permits the
consideration of reassigning or hiring
personnel.

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B. Task 2: Assessing available resources
• At this point, it is a must to look at resources in
light of what needed and what's available.
• When reviewing the program costs, if the available
resources are not sufficient, then consider these
options: Seek part-time commitments from other
department or unit personnel within your agency;
Train staff to take on tasks outside their usual
scope of responsibility; Recruit and use volunteers
from the community; Seek cooperative
agreements with other agencies or
• organizations in the community; Develop and
submit grant proposals; or Seek cost-recovery via
charging fees to some or all users of program
services.
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• If sufficient resources cannot be found, it may
need to modify program plan but not without
considering the consequences for its integrity.
• When modifying program, certain basic tenets
should not be compromised, such as
providing multiple interventions that cover all
the determinants of behavior (predisposing,
enabling and reinforcing factors).

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• C. Task 3: Assessing the barriers to program
implementation
• Besides resource constraints, there will be other
barriers to the smooth implementation of
educational objectives.
• Having a realistic view of carrying out educational
objectives requires assessing any factors that may
interfere.
• These barriers can take several forms: Social,
psychological and cultural barriers (for example,
citizen and staff bias, prejudice, misunderstanding,
taboos, unfavorable past experiences, values,
norms, social relationships, official disapproval,
rumors), Communication obstacles (for example,
illiteracy, local vernacular, local radio/television
policies and procedures),
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• Economic and physical barriers (for example,
low income, the inability to pay for or access
services, or travel over long distances and
difficult terrain for services at agency
facilities), Legal and administrative barriers
(for example, residence requirements to be
eligible for services, existing agency policy
and procedures, existing agency organization
and allocation of resources)

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 1.6. Designing methods and
approaches of health communication
• Teaching methods range from what is heard to
what is seen and done.
• They include modern methods and materials
(teaching methods) and different combination
of tools.
• In this context, methods refer to ways
messages are conveyed.
• Teaching materials include all materials that
are used as teaching aids to support the
communication process and bring desired
effects on the audience.
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•The methods and the materials could
be classified broadly as audio, written
words, visuals, audio-visuals, direct
experience, and multi-sensory
modalities.
•These classifications, in turn, are
categorized into three (3) general
domains taking the desired and
expected educational objectives into
consideration, and these are discussed
in the method part.
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 1.6.1. Health education methods

• Methods of Health Education are simply

strategies or approaches used by a health
educator to deliver the health education
program or session.
• Health education provides opportunity for
people to learn, practice and experience
health and health related behaviors.
• It has a large element of education of
individuals and groups to acquire information,
to identify problems, and to adapt new
behavior and to realize better ways of living
and so on.
• It should be noted that for any change of
behavior to be sustained and purposeful,
there is a need for proper internalization of
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• Learning is, therefore, a totality of change of
behavior through acquisition of knowledge; a
subtle difference between education and
learning is that learning can be passive or
incidental while education is a deliberate effort.
• A properly motivated person may learn by
his/her own effort.
• Learning, in general, is a process by which
individuals acquire information and idea which
may latter result in change in attitude and
behavior.
• Education can be, simply, taken as a process by
which learning is facilitated.
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• Note: The three most important factors that
affect learning in general are: teaching-
Learning methods employed motivation of the
learner and differences in individual learner‘s
background, intelligence quotient (IQ) and sex.
Domains of learning
• Domain of learning is one of the important
factors that affect health education method
choice.
• Bloom has identified three domains of or areas
of learning: Cognitive, affective and
psychomotor domains.
• Each of these domains has a well-developed
hierarchical classification systems and health
educators should include each of these
domains in their audience/client teaching plan.
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A. Cognitive domain
• This is an educational objective which is
concerned with all knowledge (cognition,
mental) creation processes, and
teaching method; appropriate for this
domain includes lecture (talks),
discussion, etc.
• The hierarchical classifications are:
knowledge, comprehension, application,
analysis, synthesis and evaluation:

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Knowledge: refers to remembering
previously learnt materials; for example,
recalling name of a person, defining a certain
term, listing a sort of learnt materials, etc.
Comprehension: refers to the ability to
grasp the meaning of some learnt materials.
For example, translation of graphs, providing
examples after definition of terms, etc.
Application: refers to the ability to use learnt
materials in a new or unfamiliar situation for
example, calculating area of a plot of land,
developing a tailored(handmade) bill board
which influence attitude of the public after a
certain lesson ,etc.
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Analysis: refers to the ability to break down
learnt materials into its component parts so that
its organizational structure may be understood.
It is a bit complicated level ; for example,
analyzing the relationship that exists,
identifying what may be relevant and irrelevant,
stating the difference between
components ,etc.
Synthesis: refers to the ability to put parts
together to form a new whole(summarizing) ;
for example, Producing a new idea, formulating
a procedure or principle, summarizing learnt
material in few words as possible ,etc.
Evaluation: refers to the ability to judge the
value of something ; for example, presentation
of some material, statement making such as
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 Lecture method

•The most natural way of communicating

with people is to talk with them.
•A spoken word is a symbol standing for an
object or covering an idea, when talks are
on health agenda, we call them health
talks.
•Health talks are the most common ways of
sharing health information and knowledge.
•The word “Lecture” is driven from a Greek
word called “lecare” which means
“speaking louder”

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• When preparing a talk (lecture), you should
consider the following important points:
• Make sure whether you speak the local
language or find a good interpreter.
Words may not mean the same for all people
Know about the listeners
Build on what the listeners know.
Encourage listeners to challenge, raise
questions and comments
Choose the appropriate time
Pay attention to both verbal and non-verbal
communication
Know that some error is inevitable and admit
Lack of understanding is not because of
stupidity of audience
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• Note: Talks (lecture) become effective when
combined or supported by teaching aids.
• In addition to the above considerations,
health educators should also pay attention
for the following issues:
 Know the group: find out their needs and
interests
 Select an appropriate topic, should be
single, simple topic
 Have correct and up-to- date information:
look for sources of facts and recent
information

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List the points you make: prepare only few
main points
Write down what you will say: If you don‘t like
writing, think carefully about what to include in
your talk. Think of examples and proverbs and
stories to emphasize your points.
Think of visual aids; well-chosen posters,
photos, etc. will help people learn
Practice your whole talk; this should include
telling of stories and showing of posters and
pictures.
Determine the amount of time you need; the
talk, including visual aids, should take about
15-20 minutes.
Allow 15 minutes or more for question and
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discussion.
 Group Discussion method
• Discussion is exchange of ideas among
many individuals (group members) to
reach at agreement or consensus,
whereas meetings is conducted to discuss
and solve problems.
• In meeting, the purpose is to gather
information, share ideas, make decision
and plans.
• In discussion, learning takes place among
learners partly as receptive and partly as
productive the educator leads the process
through questions, impulses and answers.
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• The process has three functions:
The educator asks and the learner answers and
this form are used to cheek learners‘ memory of
the previously learnt materials /matters/ points.
The educator asks and learner‘s answer but
finally the educator summarizes, and this form is
used to make learners get new idea/knowledge.
The educator asks and the learners answer.
• Then the educator asks opinion on the answers
given, finally the learners themselves summarize,
and this form is used to make learners gain new
knowledge and form attitude and argument skill.

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 Figure 1.1: Group discussions
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 B. Affective Domain

• This is the second category of educational

objective which is related to attitude, feeling,
appreciation, interest and other emotional
acts.
• Methods appropriate for this domain include
drama, experience sharing, etc.
• The hierarchical classifications are: Receiving,
responding, valuing, organization of value &
characterization by a value:

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Receiving: refers to the willingness to attend a certain
session or information or phenomena ; for example,
Giving attention to a given session ,etc.
Responding: refers to the willingness to actively
participate or interact in a certain session or
information or phenomena ; for example, participating
or involving a given session ,etc.
Valuing: refers to displaying a behavior that is
consistent with a particular issue or value that a person
or a community holds ; for example, value of helping or
supporting poor people ,etc.
Organization: refers to the state of bringing together
different extreme values resolving the conflict between
them(harmonizing conflicting values) ; for example,
Value of helping or supporting poor people even at
times of shortage of money to oneself(at times of
difficulty) ,etc.
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• Drama: In drama, ideas, feelings, beliefs and
values are communicated by participants to
spectators.
• They are very valuable in subjects when
personal and social relationships are often
more important than detailed appearance.
• Basic ideas like health can be communicated
to people of different ages, education, and
experience.
• They are suitable teaching methods specially
for people who can‘t read because they often
present ideas dramatically.

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• The duration of the drama can be short or long, and
drama could be used during training of CHWs,
special meetings, festivals, teachings of school
children, for people in a village, etc. guide line for
drama include: choosing an appropriate theme,
identifying an appropriate place, preparing for the
drama and practicing, using health team as a main
character, making sure that everybody hears,
presentation should be based on local culture,
language, dressing style, etc.,
• mixing the serious with the funny, including songs
and teaching the song to the audience (if possible),
conducting discussion after the drama and planning
to repeat the drama in other community.

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• Role play: Role play is a type of drama but in a
simplified manner. It portrays behavior of
people and, it is unrehearsed acting out of real-
life situation; a script is not necessary.
• Here, an individual takes the part of some other
character; and also can explore one‘s own
emotions and reactions in specific situation.
• Experience sharing method: This method
focuses on sharing experiences of a behavior
change or experience which leads to a behavior
change; usually, inviting known and respected
people to explain their previous hardships and
ups and downs and successes to share to
people of the same back ground or exposure
helps a lot in the attitude and behavior change
process.
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 C. Psychomotor Domain

• This an educational objective which is

concerned with skill or practice development,
performance ability of the learner, and methods
appropriate for this domain are demonstration
and re-demonstration.
• The hierarchical classifications are: Perception,
set, Imitation, manipulation, precision,
articulation and naturalization:
• Perception: refers to the use of sense organs to
obtain cues that guides to motor activity(here
there is no activity but simply observation) ; for
example, closely observing at a computer key
board ,etc.
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Set: refers to readiness to take a particular
action. This could be mental or physical or
emotional set ; for example, properly positioning
fingers on a computer key board ,etc.
Guide Response/Imitation: refers to earlier
stage of learning complex skills ; for example,
initiation, trial and error of typing on a computer
key board ,etc.
Manipulation/Mechanism: refers to acting
when learning responses become habitual and
movements can be performed with some sort of
confidence and proficiency ; for example,
exhibition of a given skill to mass of people ,etc.

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Precision/Complex Overt: refers to skill full
performance of motor function or acts that involve
complex movements. It is higher in degree of
performance than mechanism level ; for example, very
proficient & synchronized motor activity in
performance, etc.
Articulation/Adaptation: refers to well-developed
skill level where the learner can modify movement
patterns to fit special requirements or problem
situations ; for example, developing one‘s own style of
doing things ,etc.
Naturalization/Organization: refers to creating
entirely new pattern of movement to fit a particular
situation or a specific problem ; for example,
performing the activity even with sub-conscious mental
status ,etc.

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 Demonstration Method

• A demonstration is a pleasant way of sharing

skills and knowledge .Although it basically
focuses on practice, it additionally involves
both theoretical and practical teaching
(showing how!!)!
• Recall the Chinese proverb for better
explanation: “When I hear, I forget; when I
see, I remember, and when I do, I know!!”
• Note: For effective demonstration,
demonstration should fit in the local culture
must be realistic, use materials and objects
that are familiar to the people, have enough
materials for everyone to use during the
practice, and finally make the learners re-
demonstrate.
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Figure 1.2:- Demonstrations how to use
bed net
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 Other Methods of Health Education

• Other methods of health education are

Symposium, panel discussion, forum,

workshop, conference, brain storming, buzz

session, and colloquy.

• The major similarities and differences of these

methods are briefly described as follows:

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Symposium: is a formal presentation method
of health education, and it is a type of lecture
in which different speakers are asked to give
lecture on the same subject.
 The speakers, here, prepare the talk in such a
manner that each of them presents a
particular aspect of a subject which ultimately
makes the audience get the benefit of
understanding the subject with its different
aspects dealt by different speakers separately.
In symposium, we don‘t expect the audience
to be allowed to participate and give feedback.

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Panel discussion: is a formal presentation
method of health education, where a small
group of people get around a table in the
presence of audience and discuss among
them on the subject or subject which is
relevant to the audience and in which the
panel members (panelists) have specialized
knowledge.
Like symposium, panel discussion also doesn‘t
allow audiences to participate and give
feedback normally.

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Forum: is a formal presentation method of
health education where opportunity is given to
audience to participate by raising questions
and doubts at the end of a lecture, panel
discussion or symposium.
Workshop: is a group discussion method of
health education where a large number of
people belonging to a particular discipline or
allied discipline are collected together to take
up specific issues and problems for making
recommendation for future action.
• It usually lasts for 3 days to 3 weeks.

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Seminar: is a group discussion method of
health education where large groups are
convened amongst persons with common
discipline and interest , with reference to
learning or academic institution to come
together to exchange views on current
problem or to share experience from one
another; pooling experiences.
Conference: is a type of seminar which can
be held around a big table with reference to
other institutions including religious
institutions that are still used to exchange
views and pool experience.
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Brain storming: is a modern method of
eliciting from the participants their ideas and
solution on debatable issues or current
problems.
Buzz session: is group discussion method of
health education where a large group is
divided into smaller groups of not more than
10-12 people in each small group that will be
given time to discuss a problem.
• Finally, the whole large is reconvened and the
reporters of the large group will report their
findings & recommendation.

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Colloquy(A conversation or dialogue) is a
formal presentation method of health
education where a few members from the
audience made to stimulate discussion by
presenting problems or raising questions to
group of experts on the stage and the experts
give their comments and answers on the
various aspects.
• If the problems raised are controversial in
nature, the experts would be able to pinpoint
solution within the available time for
discussion.

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Selection of methods and materials

• For any teaching learning process,

methods and supporting materials should
be selected, and the selection depends on:
The type of the message
The purpose of the teaching
The people addressed
The circumstance
Availability of resources
Availability of skills

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 1.6.2. Health education approaches

• 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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• Many health educators feel that instead of
using persuasion it is better to work with
communities to develop their problem solving
skills and provide the information to help them
make informed choices.
• However in situations where there is serious
threat such as an epidemic, and the actions
needed are clear cut, it might be considered
justified to persuade people to adopt specific
behavior changes.

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 1.6.3. Health education materials

• Health education materials include all

materials that are used as teaching aids to
support the communication process and
bring desired effect on the audience.
• The following are some selected teaching
aids that are commonly used in health
education programs:

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I. Audios: Audios include anything heard
such as spoken-word (talk), music or any
other sounds.
• Talks are the most commonly used audio
teaching methods.
• Characteristics of audios:
Effective when based on similar or known
experience
Could be distorted or misunderstood when
translated
Easily forgotten

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• Health talks: The most natural way of
communicating with people is to talk with
them.
• In health education, this could be done with
one person, a family, or with groups (small or
large).
• Health talks have been, and remain, the most
common way to share health knowledge and
facts.
• However, we need to make it more than advice
and make effective by combining it with other
methods, especially visual aids, such as
posters, slides, demonstrations, video show
etc.
• In principle, it should be given to smaller group
(5 to 10 people) though it could be given for
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• In preparing a talk, consider the following
points:
Know the group: their interests and needs
Select single and simple topic: e.g.
Nutrition is too big as a topic. Thus, select
subtopic such as breast-feeding, weaning
diet etc.
Have corrected and up-to- date
information.
Limit the points to only main once.

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Write down what you will say, use
examples, proverbs and stories to help
emphasize points.
Make use of visual aids.
Practice your whole talk
Make the talk as short as possible - usually
15-20 minutes talk and 15 minutes
discussion.

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II. Visual aids
• Visuals are objects that are seen.
• They are one of the strongest methods of
communicating messages; particularly when
accompanied with interactive methods.
• Advantages
 They can easily arouse interest
 Provide a clear mental picture of the message
 Speed up and enhance understanding
 Can stimulate active thinking
 Create opportunities for active learning
 Help memory and provide shared experience.

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• Visuals are more effective than words alone,
and it will be rather more effective when
extended to practice (action).

• It is a common understanding that you

remember 20% of what you hear, 50% of
what you hear and see, and 90% of what you
hear, see and do.

• With repetition close to 100% is remembered.

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Non-projected materials (aids) or graphics

• They are shown or displayed and do not

necessarily depend on any projected equipment.
I. Leaflet
• Leaflets are unfolded sheet of printed material.
• Leaflets can be very appealing if their message
is simple and clear, and if the language is
understood by the reader.
• In preparing them, short sentences and
paragraphs should be used, illustrated with
simple drawings or pictures that are easily
understood.
• They need to be pre-tested before distributed to
the villagers.
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II. Newspapers/Newsletters
• Newspapers might be of some help in reaching
the villagers.
• Very often, though, the national or regional
newspapers do not reach smaller communities,
or the people are unable to read them.
• In this case, newsletters, written by the
villagers themselves, teachers and extension
workers can become the communities‘
newspaper.
• Place copies on a bulletin board or wall in a
public meeting places (market, well, bar).

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III. Photographs
• Photographs can be used to show people new
ideas or new skills being practiced.
• They can also be used to support and
encourage new behavior.
• They are best used with individuals and small
groups.
• People can compare photos taken of
malnourished children in the village before
and after receiving treatment.
Advantages
They can be photographed in the town where you
work thus assuring familiarity and recognition by the
people.
They are relatively inexpensive and reproducible for
different uses (posters, flipcharts)
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IV. Posters
• A poster is a large sheet of paper, often about
60 cm wide by 90cm high with words and
pictures or symbols that put across a message.
• It is widely used by commercial firms for
advertising products, but can also be used for
preventive purposes.
Advantages
Give information and advice, e.g. beware of
HIV/AIDS!
Give directions and instructions, e.g. how to
prevent HIV / AIDS
Announce important events and
programmers, e.g. World AIDS day
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• Standard rules in making posters:
All words should be in the local language
Words should be limited and simple
Symbols that illiterate people will also understand
should be used
Mix of colors should be used to attract attention
Only put one idea on a poster.
• General principles:
They should contain the name of the event, date,
time, and place
They should be large enough to be seen from some
distance;
They could be used for small or larger groups
Should be placed where many people are likely to
pass
Do not leave them up for more than one month, to
avoid boredom
Never use them before pre-testing.
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V. Flipchart
• A flipchart is made up of a number of posters
that are meant to be shown one after the
other.
• In this way, several steps or aspects of a
central topic can be presented such as about
family planning.
• Their purpose is to give information and
instructions, or record information when
prepared with blank pieces of paper.

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VI. Flannel graphs
• A flannel graph is a board covered with flannel
cloth.
• The flannel graph is one of the most effective
and easily used teaching aids because it is
cheap and portable.
• Pictures and words can be placed on the
board to reinforce or illustrate your message.
• It is very useful with people who do not read
and in groups of less 30 people.

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VII. Displays
• A display is an arrangement of real objects,
models, pictures, poster, and other items,
which people can look at and learn from.
• Like a poster, it provides ideas and
information but whereas a poster contains
only one idea, a display has many. E.g. how a
child develops and grows

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Projected aids: Projected materials are simply
educational materials that are shown to people
using a projector.
They are used to facilitate lectures or
seminars/trainings.
• The group should not be more than 30.
• The commonly utilized once are slide projectors
(color pictures on a transparent object), overhead
projectors (display written or drawn materials on a
transparency), and power point projectors.
• They are expensive, requires expertise and electric
power.
• They are useful to underline the most important
points in a talk or lecture.
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Mass Media: It is one way of giving health
education.
• The communication that is aimed to reach the
masses or the people at large is called mass
communication.
• The media that are generally used for mass
communication go by the name of mass media.
• The commonly used mass media are microphones
or public address system, radio, television, cinema,
newsprints, posters, exhibitions.
• Mass media are the best methods for rapid spread
of simple information and facts to a large
population at low cost.
• However, the major concerns with this method of
communication are availability, accessibility and
popularity in a given community.
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 Selection of Teaching Methods and Materials

The selection of the teaching methods and

aids depends on:
The type of the message
The purpose
The people addressed
Availability of resources
Availability of skills.

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 1.6.4. Effective communication skills

• For effective communication, the following five

general points should be considered;
we should communicate when we have to
communicate;
communication is purposeful; it is not
important to communicate unless there is a
need and a purpose behind it.
ideas must be clear to one self before
communicating to others; if we are
communicating ideas in which we are not
clear, it will be very difficult to create
understanding.
Thinking of the behavior, its causes and
effects will be helpful.
We have to also try to find out the most
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 Get prepared first

• Preparation is one quality of effective

communication, and this should include:
 knowing the purpose or objective or
relevance of the ideas,
identifying the targets,
assessing the extent and scope of the idea to
be communicated,
the place where the communication takes
place, and how best the idea could be
communicated,
making it clear and brief, and making
presentation short and clear as this facilitates
easy and more capturing of ideas than long
and complex presentation-[The issue of KISS!]
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Develop natural style: Although we can learn
how to present, each person has his/her own
natural way of presenting ideas.
• Some communities commonly understand most
reactions in similar way.
• Therefore, expression of emotions should be
natural and understandable.
Check whether you are understood or not:
The communicator (sender) should develop a
mechanism of checking that he/she is being
understood by the audience for effectiveness,
and this is usually done by getting feedback!
Posing questions and listening to the audience.
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Use simple straight forward language:
Remember that your audience could be of
different background.
• Even with the same background, people
understand things not the same way; simple
language helps communicate the ideas in
understandable way.

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Listen to ideas of people: Careful listening
to the problems and talking to people is
important as it helps to identify their feelings
and establish good rapport.
• Note: The 5Cs of effective communication are
Clear, Concise (Brief), Complete, Convincing
and Capable of being duplicated.

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 1.7. Providing health education service

• Health education is regarded as an instrument

for health promotion.
• It is critical for bringing about improvements in
the health of the populations and promotion in
health capital.
• It has not received the attention of the
individuals, when required.
• The reason being, the individuals still lack the
information and understanding of health
education.
• The health educators experience problems and
challenges in demonstrating efficiency and
showing tangible outcomes in the
implementation of this area.
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• Health education is primarily aimed to generate
awareness among the masses in terms of
methods and approaches to promote good
health and well-being.
• To promote good health and lead to well-being,
one of the factors that is of utmost significance
for the individuals is to augment their
understanding and put into operation the
measures and strategies in a well-organized
manner.
• Health education is concerned with establishing
or inducing changes in personal and group
attitudes and behavior to promote a healthier
lifestyle.
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• It is the sum of experiences, which influences
the habits, attitudes and knowledge of the
individuals.
• These are related to individual, community and
social health.
• When the individuals generate adequate
awareness in terms of measures and strategies
to promote good health and well-being and
implement them in a well-organized manner,
they will be able to render a significant
contribution in promoting good health and
enrich their lives.
• In providing health education it is very
important to Provide Information in terms of
Health as Community Asset; maintain norms of
good health and developing a sense of civic
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1.8. Monitoring of service utilization and evaluation
of behavioral change

1.8.1. Health education models

• Models: are generalized hypothetical concepts
that directly or indirectly interact one another
in an organized manner.
• Models are important to propose a working set
of determinants or factors in situations where
there are too many determinants or factors,
which differ by various characteristics, so that
different scholars can have a certain workable
guideline.

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• Theories: are explanations or accounts of
some phenomenon, a way of making sense
out of things.
• When trying to understand a given health
behavior or design a certain program to
change behavior (health behavior), the
behavior change models such as Health Belief
Model, help to organize thinking, prioritize
Issues, prevent planners form overlooking
important factors, and guide the development
and enforcement of health education.

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 Health Belief model (HBM)

• Health Belief model is a behavior change model

which has been developed by a group of
psychologists in the 1950s to help explain “why
people would or would not use health
services”.
• It is one of the most frequently used and being
used in health behavior applications of health.
• The theory has helped explain different
behaviors related to health.
• This model has four well formulated
components known as perceived susceptibility
or risk, perceived severity, perceived benefit
and perceived barrier, and two being evaluated
components known as cues to action and self-
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efficacy.
• Perceived susceptibility (risk) refers to the
individual‘s perception of the risk of
contracting a health problem, which may,
finally, lead the individual to examine his own
behavior.
• Perceived severity refers to an individual‘s
perception on the potential seriousness of the
condition (a health or health related problem)
in terms of pain or discomfort, disability,
economic difficulties, death, etc. which help
the individual seriously consider his behavior
and its consequences.

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• Perceived benefit includes the perceived
benefits of taking health action and its
helpfulness which lead the individual to
maintain the act and raise his/her confidence.
• Perceived Barriers are events which may act
as obstacle in adopting the recommended
behavior leading the individual not attaining
the behavior.
• For a health action to take place, therefore,
barriers should be either removed or reduced
to the minimum.
• Some of the barriers could be cost, side
effects, cultural influences, inconvenience,
etc.
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• Cues to Action are Events, either bodily (e.g.,
physical symptoms of a health condition) or
environmental (e.g., media publicity) that
motivate people to take action.

Figure 1.3: Health Belief model

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 Theory of Reasoned Action

• This theory is also called behavioral intention,

and assumes that behavioral intention is a
basis for a behavior to be adapted.
• Reasons or intentions behind an action
determine the practice.
• The intention comes from the values attached
to the behavior.
• Behavior performance is a function of attitude
towards behavior and perception of social or
subjective norms favorable to the behavior.

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 Figure2: Theory of reasoned action
model
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• Note: It would be very important to note that
for a behavior change to be sustainable, the
change in behavior should necessarily come
after change in attitude; a behavior change
without change in attitude is less likely to be
sustainable

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 Social learning (Cognitive) Theory

• Unlike the two theories explained above, the

Social learning (Cognitive) theory examines
behavior in relation to the environment.
• Social learning theory (SLT) believes in that
behavior is dynamic.
• It emphasizes that people self-regulate their
environments and actions.
• The interaction of people with their
environment is multilateral (environment,
people, and behavior) interaction.
• Self-efficacy is the core concept in Social
learning theory (SLT).

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• Self-efficacy is a perception of one‘s own
capacity for success in organizing and
implementing a pattern of behavior that is
new, based largely on experience with similar
action or circumstances encountered or
observed in the past.
• According to this theory, learning takes place
through the following ways:
Direct experience; learning through doing
Indirect experience; learning through
observing others doing the job
Cognitive learning; storing and processing
of complex information (evidence based).
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 Trans theoretical model

• This model critically assumes that behavior change is

Complex and a process that involves sequences of
change.
• The stages are both stable and open to change.
• The model has two dimensions: stage of change and
process of change.
• The constructs of the model are stage of change,
process of change, decisional balance and self-
efficacy.
• The stage of change includes:
Pre contemplation stage: Force able, resistance to
change
Contemplation stage: Willing but poor commitment
Preparation stage: Intending change(in one month)
Action Stage: Overt modification of behavior(For
greater than six months)
Maintenance stage: Sustainable behavior change
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1.8.2. Monitoring of service utilization

• It is said that human being is a social animal

because people live in social groups in need of
security.
• Human being is also called a social animal that
actually thinks and acts logically.
• The issue of accessibility, affordability, and
acceptability health service doesn‘t guarantee
health care service utilization for the social
aspects of human life is equally important
factor in this regard.
• The community, itself, cares for its members in
all cases where there is acceptable and proper
social intercalation.
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• Behavioral sciences such as psychology,
anthropology, sociology, etc. are highly
related to health education in one or another
way; a group has a behavioral pattern which
is called human behavior.
• Social sciences and medicine are concerned
with their own ways with human behavior;
social science is applied to disciplines like
sociology, anthropology, psychology,
economics, politics, etc., and these influence
medical practices.

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 1.8.3. Evaluation of behavior
change
• Change in behavior could be natural or
planned in its nature based on natural events
or based on plan respectively.
Natural change in behavior-people‘s behavior
changes all the time; some changes take place
because of natural events or processes such
as age and sex related behaviors.
Planned change in behavior – people make
plans to improve their life or to survive, for
that matter, and they act accordingly.
• Planned change in behavior can be faster or
slower depending on the response of the
adapter or accepter.
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• Readiness to change behavior- is experienced
after the stages of unawareness, awareness,
concern, acquisition of knowledge and skill,
and motivation are attained one after the
other or overlapping one over the other.
• Readiness to behavior change, usually, is
followed by stages known as trial.
• Helping people change their lifestyle will be
effective and efficient when done in
accordance with the behavior change stage
processes attained by the individual or group
of individuals.
• Therefore, it is very important to identify the
level of behavior stage attained by individual
or group of individuals before a giving
behavior change intonation is implemented
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Figure1.4: Stages of behavior change
process
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1.9. Developing, promoting, implementing
and reviewing strategies for internal and
external dissemination of information
1.9.1. Disseminate relevant information
• The process of information dissemination is a
strategic study in information and
communication science since a successful
information dissemination process will enable
to provide significant multiplying effects.
• The goal of information dissemination is to
share knowledge and information on program
implementation, sustainability, and
evaluation.
• Sharing best practices can help other
programs to be successful.
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• It is important to consider the target audience
when developing a plan to disseminate
information about the program.
• For example, flyers or handouts can be useful to
share at a regional meeting or conference, but
they may not be a good way to share information
with a funder who is interested in learning more
about program outcomes.
• It is also important to consider who will be a
trusted messenger for the information being
disseminated.
• For example, a former program participant or
patient may be able to share a compelling and
meaningful story about their experience with the
program, which would convey the value they see
in the program easier than written reports.
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• Common methods for sharing and
disseminating information include:
Participation at local, state, or national
conferences and workshops
Publications
Presentations at provider or hospital staff
meetings
Social media
Virtual meetings such as webinars,
teleconferences, and expert panels
Local, state, or national peer network
groups
Community outreach activities
Word of mouth
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 1.9.2. Relevant, policies and regulations

• Ethiopia‘s Information Revolution is an example of

a national, system-wide digital health
transformation.
• It addresses multiple building blocks of
sustainable, impactful digital health systems, and
demonstrates how a holistic, systematic approach
to digital health can strengthen a health system.
• In 2015, Ethiopia‘s Ministry of Health introduced
the Information Revolution in the country‘s Health
Sector Transformation Plan.
• The Information Revolution prioritizes two pillars
of actionable and measurable interventions to
develop better, more accessible health services,
strengthen health systems, and improve health
outcomes.
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• The initiative focuses on digital
transformation of the country‘s health system
in service of the goal to “ensure high quality,
equitable, sustainable, adaptive, and efficient
health services to meet the health needs of a
changing population”.
• It is widely acknowledged that government
ownership over digital transformation is
critical for sustainability and long-term
success.
• The Information Revolution entails a radical
shift from traditional ways of data utilization
to a systematic information management
approach powered by corresponding levels of
technology... it is also about bringing
fundamental cultural and attitudinal change
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• By centering the digitalization process on
government priorities, donors and supporting
partners have greater clarity and
accountability.
• This approach also increases buy-in from
government stakeholders and promotes
engagement from stakeholders of all types.
• The Information Revolution Roadmap is a
strong example of how digital transformation
can support broad health system goals while
also defining near-term digital priorities.
• Both are necessary for success, but the
importance of near-term priorities is less often
recognized.
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• Digital transformation is a significant
undertaking that requires years of large-scale
effort and change.
• To make this feasible, government and their
partners should establish shorter-term
strategies or work plans with prioritized
activities.
• The Information Revolution Roadmap
continues to guide Ethiopia‘s digital
transformation, ensuring that all efforts to
digitize health systems contribute to the
country‘s long-term vision.

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1.10. Maintaining work related network
and relationship
• Networking isn't merely the exchange of
information with others — and it's certainly not
about begging for favors.
• Networking is about establishing, building, and
nurturing long-term, mutually beneficial
relationships with the people you meet,
whether you're waiting to order your morning
coffee, participating in an intramural sports
league, or attending a work conference.
• You don't have to join several professional
associations and attend every networking
event that comes your way in order to be a
successful networker.
• In fact, if you take your eyes off your smart
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• Experts agree that the most connected people
are often the most successful.
• When you invest in your relationships —
professional and personal — it can pay you
back in dividends throughout the course of
your career.
• Networking is essential since it will help you
develop and improve your skill set.

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1.11. Approaches to meet communication
needs
• Communication is the process of exchanging of
ideas, messages and information between two
or more than two people with the help of any
means or channel.
• But, just knowing the definition only is not
enough, rather, the cause of defining
communication in a particular way (approach)
should also be known.
• There are four models of communications
approach:

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 Communication as transmission: This approach
defines communication as the process of transmission
of message as intended by the source.
• Here, initiation of the communication is considered as
an important factor for the communication to take
place.
• Those adopting this view define communication by
various terms: imparting, sending, transmitting or
giving information.
• The center of this idea of communication is the
transmission of signals or messages over distance for
the purpose of control.
• This model is termed as engineering model because
the medium plays central role in communication
according to this approach and sender is highly
emphasized in comparison to receiver.
• It is in line with linear models.
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 Communication as Ritual: This approach defines
communication as participation.
• The communication is defined in the terms such as sharing,
participation, association, fellowship and the possession of
common faith.
• The ritual model is referred as expressive model.
• This view sees communication in terms of the representation
of shared beliefs.
• Ritual view of communication is not directed towards the
extension of message in space but the maintenance of society
in time.
• In other words, ritual view does not confine communication to
mechanistic understanding of transmission of information
from one geographical point to the other.
• Both sender and receiver has active role in the
communication process as the culture is important in the
communication.
• It does not exclude the process of information transmission.
• Rather, all engaged in communication gains something more
than information.
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Communication as publicity: This approach
defines communication as the process of
influencing the mind of others through
messages.
• It is called audience-capturing or display
attention model because it looks
communication from the viewpoint of catching
visual or aural attention of the users.
• It acknowledges the significance of audience
in the process and considers that audiences
can be manipulated.
• Grabbing the attention is crucial in this
approach.
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Communication as reception: This view has
its root in critical theory and reception analysis
where the approach has shifted the
importance from technical to semiotic
approach.
• The communication is defined from the
perspective of receiver.
• Audience is highly emphasized because it is
audience who gives meaning to the message.
• Encoding and decoding are considered as the
crucial moment in communication.
• It is not necessary that audience receive
message or understand it as intended.
• Rather, messages are polysomic and it is
receiver who draws meaning that depends
upon his/her cultural and context.
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 THANK YOU!

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