UNIVERSITY OF THE CORDILLERAS

College of Nursing

NCM 102: HEALTH EDUCATION

MODULES 1 & 2: WHAT IS HEALTH EDUCATION & HEALTH EDUCATION PERSPECTIVES

Learning Objectives: 1. Know the definition and purpose of health education.

2. Determine the issues and trends in health education
3. Understand the different perspectives in health education
4. Describe the different theories in health education and its
application in the assessment of client learning need and
development of health education plan.

 Overview of Health Education

 DEFINITION OF TERMS
a. Education process – is a systematic, sequential, planned course of action
consisting of two major interdependent operations; Teaching and Learning.
b. Teaching - is a deliberate intervention that involves the planning and
implementation of instructional activities and experiences to meet intended
learner outcomes according to a teaching plan.
c. Instruction –is a component of teaching that involves the communicating of
information about a specific skill in the cognitive, psychomotor, or affective
domain
d. Learning - is defined as a change in behaviour (knowledge, skills, attitudes)
that can occur at any time or in any place as a result of exposure to
environmental stimuli.
e. Patient Education – is a process of assisting people to learn health related
behaviours (knowledge, skills, attitudes, values) so that they can incorporate
those behaviours into everyday life.
f. Staff Education –is a process of influencing the behavior of nurses by
producing changes in their skills, attitudes, knowledge, and values
 Teaching & Instruction is:
 Formal
 Structured
 Organized activities
 Produces learning

FIGURE 1: Education process parallels nursing process

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HEALTH EDUCATION or client teaching is a system of activities intended to produce health or
illness related learning. Health education may promote a change in knowledge or ways of
thinking. It may clarify values or bring about a shift in belief attitude. It may facilitate the
acquisition of skills. It may cause changes in behavior or lifestyle.

Role of Nurse in HE:

- Health education is considered a function of nursing. Article VI, section 28 of the RA
9173 (Philippine Nursing Act of 2002) states that one of the duties of a nurse is to
“provide health education to individuals, families and communities.”
- The role of nurse educator evolved from healer to expert advisor/teacher to facilitator
of change.
- Another role of nurses educator is training the trainer.

Historical Development:

a. Mid- 1800’s
 Nursing was recognized as unique discipline. Teaching has been recognized as
an important health care initiative assumed by the nurses.
 Focus is not only on the care of the sick but also on education other nurses for
professional practice.
 Florence Nightingale is the ultimate educator because she dedicated a large
portion of her career in educating those who are involve in the delivery of
health care (Physicians, nurses, health officials)
 Teaching today is now within the scope of nursing practice responsibilities.
 Nurses are expected to provide instruction to assist the consumers in:
 Maintaining optimal level of wellness
 Prevention of diseases, manage illness, and
 Develop skills to give supportive care to family members.
 From disease oriented. . . we now focus on prevention-oriented patient
education to ultimately become health-oriented patient education.

b. Early 1900s
 public health nurses in the US began to understood the importance of
education in the prevention of disease and maintenance of health
 1918 – NLNE (National League for Nursing Education) observed the importance
of health teaching as a function within the scope of nursing practice.
 1950 – the course content dealing with teaching skills, developmental and
educational psychology, and principles of educational process of teaching and
learning as areas in the curriculum common to all nursing schools.
 Today – state nurse practice acts (NPAs) universally include teaching within the
scope of nursing practice.

Nurse Educator’s role evolved from:

 Disease-oriented approach to Prevention-oriented approach
 Wise healer to expert advisor/teacher to facilitator of change.

Socio-Eco-Political Factors Affecting Nursing Practice And Health Care System:

 Growth of managed care, shifts in payer coverage, & reimbursement issues for
provision of health care
 Health providers are beginning to recognize the economic and social values in
practicing preventive medicine through health education.
 Political emphasis is on productivity, competitiveness in the marketplace, and
cost-containment measures to restrain health services expenses.
 The focus of nursing practice is now on patient education.

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  Consumers are demanding increased knowledge and skills about how to care
for themselves and how to prevent disease.
 Demographic trends are requiring an emphasis to be placed on self-reliance
and maintenance of a healthy status over an extended lifespan.
 Causes of morbidity and mortality are now recognized as lifestyle-related and
preventable through educational intervention.
 Increase in the incidence of chronic and incurable conditions leads the people
to become informed participants to manage their own illnesses.
 Advanced technology
 Earlier hospital discharge
 Increased number of self-help groups

Purpose of Research in Health Education:

 Research must be conducted on the benefits of patient education as it relates
to:
 Potential of increasing the quality of life
 Leading a disability-free life
 Decreasing the costs of healthcare; and
 Managing independently at home through anticipatory teaching
approach.
 Research must be conducted on the benefits of teaching methods & tools
using the following:
 Computer-assisted instruction
 Distance learning
 Video and audiotapes for home use
 Internet access to health education

Ethical Principles:
 Autonomy - it refers to the capacity of a rational individual to make an
informed, un-coerced decision.
 Veracity - the state of being in accord with a particular fact or reality, or being
in accord with the body of real things, real events or actualities
 Beneficence - is action that is done for the benefit of others. Beneficent actions
can be taken to help prevent or remove harms or to simply improve the
situation of others.
 Nonmaleficence - means to “do no harm.” Physicians must refrain from
providing ineffective treatments or acting with malice toward patients. This
principle, however, offers little useful guidance to physicians since many
beneficial therapies also have serious risks. The pertinent ethical issue is whether
the benefits outweigh the burdens.
 Confidentiality - means keeping information given by or about an individual in
the course of a professional relationship secure and secret from others.
 Justice - fair treatment of individuals to the equitable allocation of healthcare

Legality of Patient Education and Information

 The patient’s right to adequate information regarding his or her physical
condition, medications, risks, and access to information regarding alternative
treatments is specifically spelled out in the Patient’s bill of Rights.

Documentation
 Health teaching should be properly documented in the patient’s
record. Unfortunately, this is probably the most undocumented skill because
nurses do not recognize the scope and depth of the teaching they do.

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THEORIES IN HEALTH EDUCATION

A. Pender’s Health Promotion Theory

 Pender’s health promotion model defines health as “a positive dynamic state
not merely the absence of disease.” Health promotion is directed at increasing
a client’s level of well-being. It describes the multi-dimensional nature of persons
as they interact within the environment to pursue health.
 Major Concepts of the Health Promotion Model:
 Health promotion is defined as behavior motivated by the desire to increase
well-being and actualize human health potential. It is an approach to
wellness. On the other hand, health protection or illness prevention is
described as behavior motivated desire to actively avoid illness, detect it
early, or maintain functioning within the constraints of illness.
 Individual characteristics and experiences (prior related behavior and
personal factors).
 Behavior-specific cognitions and affect (perceived benefits of action,
perceived barriers to action, perceived self-efficacy, activity-related affect,
interpersonal influences, and situational influences).
 Behavioral outcomes (commitment to a plan of action, immediate
competing demands and preferences, and health-promoting behavior).
 Subconcepts of the Health Promotion Model
 Personal Factors. These factors are predictive of a given behavior and
shaped by the nature of the target behavior being considered.
- Personal biological factors
- Personal psychological factors
- Personal socio-cultural factors
 Perceived Benefits of Action - anticipated positive outcomes that will occur
from health behavior.
 Perceived Barriers to Action - anticipated, imagined or real blocks and personal
costs of understanding a given behavior.
 Perceived Self-Efficacy - judgment of personal capability to organize and
execute a health-promoting behavior. Perceived self-efficacy influences
perceived barriers to action so higher efficacy results in lowered perceptions of
barriers to the performance of the behavior.
 Activity-Related Affect - subjective positive or negative feeling that occurs
before, during and following behavior based on the stimulus properties of the
behavior itself. Activity-related affect influences perceived self-efficacy, which
means the more positive the subjective feeling, the greater the feeling of
efficacy. In turn, increased feelings of efficacy can generate a further positive
affect.
 Interpersonal Influences - cognition concerning behaviors, beliefs, or attitudes
of the others. Interpersonal influences include norms (expectations of significant
others), social support (instrumental and emotional encouragement) and
modeling (vicarious learning through observing others engaged in a particular
behavior).
 Situational Influences - personal perceptions and cognitions of any given
situation or context that can facilitate or impede behavior. Include perceptions
of options available, demand characteristics and aesthetic features of the
environment in which given health promoting is proposed to take place.
 Commitment to Plan of Action - the concept of intention and identification of a
planned strategy leads to the implementation of health behavior
 Immediate Competing Demands and Preferences
 Competing demands
 Competing preferences

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  Health-Promoting Behavior - a health-promoting behavior is an endpoint or
action outcome that is directed toward attaining positive health outcomes
such as optimal wellbeing, personal fulfillment, and productive living.

B. Bandura’s Self Efficacy Theory

 According to Albert Bandura, self-efficacy is "the belief in one’s capabilities to
organize and execute the courses of action required to manage prospective
situations." Self-efficacy is a person’s belief in his or her ability to succeed in a
particular situation.
 How does self-efficacy develop?
 Mastery experiences
 Social Modeling
 Social Persuasion
 Psychological Responses
C. Health Belief Model
 The Health Belief Model (HBM) is a tool that scientists use to try and predict
health behaviors. It was originally developed in the 1950s and updated in the
1980s. The model is based on the theory that a person's willingness to change
their health behaviors is primarily due to their health perceptions. According to
this model, your individual beliefs about health and health conditions play a role
in determining your health-related behaviors.
 Major Concepts:
 Perceived Severity: The probability that a person will change their health
behaviors to avoid a consequence depends on how serious they believe
the consequences will be.
 Perceived Susceptibility: People will not change their health
behaviors unless they believe that they are at risk.
 Perceived benefits: It's difficult to convince people to change a behavior
if there isn't something in it for them. People don't want to give up
something they enjoy if they don't also get something in return.
 Perceived barriers: One of the major reasons people don't change their
health behaviors is that they think doing so is going to be hard. Changing
your health behaviors can cost effort, money, and time.
 Cues to action and Self-efficacy
- Cues to action: are external events that prompt a desire to make a
health change. They can be anything from a blood pressure van being
present at a health fair, to seeing a condom poster on a train, to
having a relative die of cancer. A cue to action is something that helps
move someone from wanting to make a health change to actually
making the change.

- Self-efficacy: is an element that wasn't added to the model until 1988.

Self-efficacy looks at a person's belief in their ability to make a health-
related change. It may seem trivial, but faith in your ability to do
something has an enormous impact on your actual ability to do it.

D. Green’s Precede-Proceed Model

 PRECEDE-PROCEED provides a comprehensive structure for assessing health and
quality of life needs, and for designing, implementing, and evaluating health
promotion and other public health programs to meet those needs. It guides
planners through a process that starts with desired outcomes and then works
backwards in the causal chain to identify a mix of strategies for achieving those
objectives

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  In this framework, health behavior is regarded as being influenced by both
individual and environmental factors, and hence has two distinct parts.
 First is an “educational diagnosis” (Predisposing Reinforcing Enabling
Constructs Educational Diagnosis Evaluation) P R E C E D E
 Second is an “ecological diagnosis” (Policy Regulatory Organizational
Constructs Educational Environmental Development) P R O C E E D
 The model is multidimensional and is founded in the social/behavioral sciences,
epidemiology, administration, and education
 The PRECEDE framework was first developed and introduced in the 1970s by
Green and colleagues. PRECEDE is based on the premise that, just as a medical
diagnosis precedes a treatment plan, an educational diagnosis of the problem
is very essential before developing and implementing the intervention plan.
 In 1991, PROCEED was added to the framework in consideration of the growing
recognition of the expansion of health education to encompass policy,
regulatory and related ecological/environmental factors in determining health
and health behaviors. As health-related behaviors such as smoking and alcohol
abuse increased or became more resistant to change, so did the recognition
that these behaviors are influenced by factors such as the media, politics, and
businesses, which are outside the direct control of the individuals.
 PRECEDE-PROCEED model is a participatory model for creating successful
community health promotion and other public health interventions. It is based
on the premise that behavior change is by and large voluntary, and that health
programs are more likely to be effective if they are planned and evaluated with
the active participation of those people who will have to implement them, and
those who are affected by them.

References:
Health Education for Nursing and other Allied Professions, 1st edition, 2011; C. Castro
Teaching Strategies in Health Education; L. Ramos, et.al
Nurse as Educator, 5th edition; S. Bastable

Prepared by:

Owen Mari L. Domondon, BSPsych, RN

Jocelyn Pulmano, RN
Professors

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