HEALTH EDUCATION

Course Code: NCM 102

SECOND SEMESTER F.Y. 2020-2021

Glaiza P. Salvador, RN
Clinical Instructor
COURSE DESCRIPTION:
The course includes discussions of concepts, principles, theories, and strategies of clinical and
classroom teachings. It provides critical thinking activities for students to apply concepts of learning
and teaching and appreciate the nurse's role as a teacher in various settings. It further provides
experiences to develop beginning skills in designing and applying a teaching plan using the nursing
process as a framework in the Related Learning Experience and classroom settings.
VALUE AIMS:
This course shall guide the students to develop genuine love and service by demonstrating the proper
attitude, knowledge, and skills in care of clients. Specifically, the students will be able to show
compassion, charity, kindness and respect to the individual client, family, and community noble in
serving the people of the world specially the underserved, poor and marginalized Filipinos. Moreover,
the students will manifest higher level of political, social, spiritual and health related consciousness,
and to develop patience, diligence, assertiveness, and efficiency within the standard of nursing practice
that will maintain and sustain the Culture of Excellence.
COURSE REQUIREMENTS:
• Portfolio (for ILG students) and e-portfolio (for LMS students)
• Unit or chapter exams
• Completion of LMS/ILG hours
• Attendance and participation to synchronous classes
• Written Requirements (Journals, research paper and reaction paper)
• Quizzes, Term and Comprehensive exams

GRADING SYSTEM: MG – Midterm Grade

Lecture Grading System CMG – Cumulative Midterm Grade
Preliminary grade: SFG – Semi – Final Grade
PG = AQ+CS+TT CSFG – Cumulative Semi – Final Grade
3 CTTP – Cumulative Term Test Percentage
Where: TTP – Term Test Percentage
PG – Preliminary Grade CEP – Comprehensive Examination Percentage
AQ – Average Quiz FG – Final Grade
CS – Class Standing CFG – Cumulative Final Grade
TT – Term Test

For Learning Management System (LMS)

• A permanent official LMS account provided by the administration should be used by the student
throughout the course.
• All students must be at least logged-in 15 minutes before scheduled synchronous classes.
• All students must conduct themselves with discipline throughout the entire class and during
consultation hours.
• No profane, indecent, and vulgar words should be used in the LMS interface and in the ILG.
For Institutional Learning Guide (ILG)
• Sharing of materials to other students and individuals outside the institutions is strictly prohibited.
• Submission of requirements and outputs should be on the date or schedule set by the instructor.
• Cheating in any form is PROHIBITED

Table of Contents
PRELIMINARIES – COURSE DETAILS
PRELIMS COVERAGE
CHAPTER 1: HEALTH EDUCATION PERSPECTIVE
LESSON 1: Historical Development in Health Education
LESSON 2: Issues and Trends in Health Education
LESSON 3: Theories in Health Education

CHAPTER 2: PERSPECTIVE ON TEACHING AND LEARNING

LESSON 1: Overview of Education on Health Care
LESSON 2: Concepts of teaching, learning, education process vis-à-vis nursing process, historical
foundations for the teaching role of the nurse
LESSON 3: Role of the Nurse as a Health Educator

PRELIM COVERAGE
CHAPTER 1
HEALTH EDUCATION PERSPECTIVE

Intended Learning Outcomes:

After studying this chapter, the student is expected to:
1. Define health education and related terms
2. Identify the major developments in health education
3. Discuss the different proponents and their contributions to health education
4. Determine the assumptions of the different theories related to health education
5. Discuss the different aspects of health and disease
6. Discuss the different trends and issues related to health and disease
7. Discuss the different ways to promote health throughout the lifespan

KEY TERMS:
Biopsychosocial model patient education
Health belief model Precede-proceed model
health care economics Prosumerism
health education Self-efficacy model
Health promotion theory Theory
LESSON 1: HISTORICAL DEVELOPMENT IN HEALTH EDUCATION AND RELATED CONCEPTS
 “Patient education has been a part of health care since the first healer gave the first patient
advice about treating his/her ailments”

 Patient education – not specifically used; efforts of first healers to inform, encourage and
caution patients to follow appropriate hygienic and therapeutic measures happened even in
prehistoric times

 Education was one of the most common interventions (Barlett, 1986)

Mid-1800s through the turn of 20th century

• Formative years (Barlett, 1986)
• First phase in the development of organized health care (Dreeben, 2010)
• Growth of patient education
• Emergence of nursing and other health professions, technological developments, emphasis of
patient-caregiver relationship, spread of TB and other CDs and growing interest in welfare of mothers
and children
• Florence Nightingale – advocate; author of “Health Teachings in Towns and Villages” (school and
home teaching)

First 4 decades of 20th century

• Second phase of organized health care
• Support of maternal and child health (US)
• PHNs instruct mothers on how to keep their infants healthy
• Diagnostic tools, scientific discoveries, new vaccines, new antibiotics, effective treatment, and
surgeries
• PHNs’ teachings were considered “precursor to modern patient and health education”
• Led to education programs in sanitation, immunization, prevention and treatment of infectious
diseases, growth of public health system

Post-World War II (late 1940’s-1950’s)

• Third phase of organized health care
• Significant scientific accomplishments and profound change in health care delivery system
• Patient education was overshadowed by technological orientation
• First references to literature in the early 1950s
• 1953: Veterans Administration hospital issued technical bulletin, “Patient Education and Hospital
Program”
1960s-1970s
• Patient education was a specific task
• General education to individual patient
• Civil rights movements, women’s movement and consumer and self-help movement
• Hospitals became involved in various education programs
• Patients are health care consumers
• Health care is a right
• Teaching is based on individual patient needs
• 1971: (1) “The Need for Patient Education”
• (2) Pres Nixon used the term health education
• Heath education was involved in Patient’s Bill of Rights

1980s-1990s
• Disease prevention and health promotion
• Established educational and community-based programs
• Nursing standards on health education
• Staff education to improve nursing care interventions
• Interdisciplinary team approach, and patients and SOs participate
• Competencies set

Competencies
• Embrace personal ethic of social responsibility and service
• Provide evidence-based, clinically competent care
• Incorporate multiple determinants of health in clinical care
• Rigorously practice preventive health care
• Improve access to the health care for those with unmet health needs
• Practice relationship-centered care with individuals and families
• Provide culturally sensitive care to diverse society
• Use communication and information technology effectively and appropriately
• Continue to learn and help others

CONCEPTS IN HEALTH EDUCATION

-Health Education is any combination of learning experiences designed to facilitate voluntary
adaptations of behavior conducive to health.
-H.E. is a science and a profession of teaching health concepts to promote, maintain and enhance one’s
health, prevent illness, disability, and premature death through the adoption of healthy behavior,
attitudes, and perspectives.
-it draws health models and theories from the
- biological - physical
- environmental - medical
-psychological
• Any combination of planned learning experiences based on sound theories that provide individuals,
groups, and communities the opportunity to acquire information and the skills needed to make quality
health decisions.
• WHO definition “comprises of consciously constructed opportunities for learning involving some
form of communication designed to improve health literacy, including improving knowledge and
developing life skills which are conducive to individual and community health.
• SOCIAL – demographic trends like aging of the population requires emphasis on self-reliance and
maintenance of a healthy life status over an extended lifespan particularly dealing with degenerative
diseases and disabilities; lifestyle-related diseases which are the major cause of morbidity and
mortality and highly preventable and will need more intensive health education efforts.
• Increase in knowledge, prevention
• ECONOMIC –the shifts in payer coverage, emphasis on managed care and earlier hospital discharge,
and the issue on reimbursement for health services provided require more intensive patient education
to allow the patient and his family a more independent, compliant, and confident management of care
• More comprehensive, cost-effective, accessible, quality health care

HEALTH ISSUES
• Biological, Psychological and Sociological Aspects of Health and Disease.
• Chronic, incurable diseases
• Political – the government has formulated national goals and objectives directed towards the
development of effective health education programs which will create awareness of health risks and
encourage the adoption of healthy lifestyles.

GEORGE L. ENGEL
• A psychiatrist at the University of Rochester
• Introduced the Biopsychosocial model or BPS in 1977.
• He advocated the need for a new medical model to explain health and disease
• BPS application was already found in ancient Asian (2600 B.C.) and Greek (500B.C.) prior to Engel’s BPS
The BIOPSYCHOSOCIAL MODEL (BPS Model)
• An approach that states that human experience of health or illness is greatly affected or determined by the
interplay or interrelatedness of the following factors:

A) BIOLOGICAL
• immunity level, genetic susceptibility, or predisposition

B) PSYCHOLOGICAL FACTORS
• Feelings, affect, and person’s ability to express these
• Beliefs in one’s worth
• Long term stress affects the body systems and anxiety affects health habits
• Calm acceptance and relaxation can actually change body responses to illness
• Perceptions, thoughts, emotions, attitudes, behaviors

C) SOCIAL FACTORS
• SOCIO ECONOMIC STATUS
• CULTURAL BELIEFS AND PRACTICES
• POVERTY
• TECHNOLOGY
• ENVIRONMENTAL INFLUENCES AND CONDITIONS

- THE BPS model shows a direct link between the mind and the body and an indirect link with the
intervening social or environmental factors to explain disease causation.

- The BIOLOGICAL component seeks to explain the cause of illness or disease as a result of the
breakdown in the physical or physiological malfunctioning in the body.

- The PSYCHOSOCIAL aspect deals with how the individual perceives the health threats and the
state of emotional control, discipline, and motivation to stay healthy. Psychosocial factors can
cause a biological effect by predisposing the patient to risk factors and risk-taking behaviors.
Example: A depressed person may become alcoholic to temporarily forget his/her problems which may
lead to liver cirrhosis and even death.

PURPOSES, GOALS AND BENEFITS OF PATIENT EDUCATION

PURPOSE:
To increase the competence and confidence of clients for self-engagement
PRIMARY GOAL:
To increase the responsibility and independence of clients for self-care

CHARACTERISTICS OF EFFECTIVE HEALTH EDUCATION

- It is directed at people who are directly involved with health-related situations and issues in the
home and the community like parents and people who have influence in the community or the
so-called opinion makers.
- The lessons are repeated and reinforced overtime using different methods.
- The lessons are adaptable and use existing channels of communication. Ex. Songs, drama &
storytelling.
- It is entertaining and attracts the community’s attention.
- Uses clear, simple language with local expressions.
- Emphasizes short term benefits of action.
- Provides opportunities for dialogue, discussion, and learner participation.
- Uses demonstration to show the benefits of adopting the practices.

LESSON 2: ISSUES AND TRENDS IN HEALTH EDUCATION

CONTEMPORARY HEALTH and PROMOTION OF OPTIMAL HEALTH THROUGHOUT THE LIFESPAN

Contemporary means:
• modern
• current
• up to date
• fashionable
• present day
• modern day
• existing

- The Health Educator is faced with enormous challenges as well as opportunities due to
increasing demand of the society.
- A return to population-based health promotion and maintenance vis-à-vis the hospital- based
emphasis and emphasis is on health of the community and the adaptation of healthy behaviors
and lifestyle through health empowerment of the people.
- Health educator is also considered as the COMMUNITY HEALTH WORKER whose main concern
is to improve the health of the people by using different methods and strategies.
- The call for developing global health strategies with the integration of health education and
action is now a clamor that can no longer be ignored.
CONCERNS AND ISSUES FACED IN THIS CONTEMPORARY PERIOD
- Globalization
- War and terrorism
- Social instability
- Disease and poverty
- Environmental degradation
- Facilitating learning and teaching on critical health
- Challenges in the 21st century

EMERGING TRENDS IN HEALTH CARE

1. New “Health Care economics”
a. Emphasis on primary health care
-managed care → early discharged of clients
↓
reduced healthcare insurance costs and prevent overtreatment of patients which are unethical
practices of some doctors in the hospitals.
b. Establish centers of excellence to provide services effectively and at moderate cost
c. Decentralization of care also known as Medical Prosumerism, is an emergent issue.

Prosumerism
- is a movement away from purchasing completed goods and services in favor of purchasing portions
of them piecemeal similar to do-it-yourself movement in health improvement.
- significant patient opportunities to gain knowledge through the internet and medical
databases.
- patients now frequently make their own choices as to diagnoses, treatments, medical products,
and practitioners.

d. Alternative medicine (another form of Prosumerism)

- consumers use a wide variety of folk practices to promote health and potentially cure diseases
- ACUPUNTURE, ACUPRESSURE, AROMATHERAPY, YOGA and MASSAGE THERAPY

2. Medical Globalization
- Termed as MEDICAL TOURISM where centers of excellence or hospitals and centers with world class
facilities and amenities have become one of the foremost tourist attractions in the country.
- People from other countries obtain services and costs of treatments and medications at a very
reasonable and affordable price.

3. Advances in medical technology

- The most current development in managed care is disease management “seek to improve patient
compliance with optimal health behavior by promoting proper attainment keeping, self-administration
of treatments and proper general health behavior in terms of lifestyle issues.
FUTURE DIRECTIONS FOR PATIENT CARE
- New settings and environmental linkages
- New Technologies
- Greater emphasis on wellness
- Increased third party reimbursement as cost benefit ratios demonstrate the cost effectiveness
of consumer education as shown by shorter hospital stay, effective and efficient home and self-
managed-care, lesser incidence of complications and hospital readmissions

LESSON 3: THEORIES IN HEALTH EDUCATION

- models or theories which explain human behavior in relation to health education.
- classified on the basis of being directed at the level of:
A. Individual (Intrapersonal)
B. Interpersonal
C. Community

FOUR MOST COMMONLY USED HEALTH THEORIES

1.) HEALTH PROMOTION THEORY
- Developed in 1987 revised by Pender in 1990.
- To increase the utility of its predictions and interventions
- SALIENT POINTS

*This model emphasizes “actualizing health potential and increasing the level of wellbeing using
approach behaviors rather than avoidance of disease that is why it has been classified as a health
promotion model rather than a disease prevention model

5 MAJOR COMPONENTS AND THEIR VARIABLES:

A. INDIVIDUAL CHARACTERISTICS AND EXPERIENCE
B. BEHAVIOR-SPECIFIC COGNITIONS AND AFFECT
C. BEHAVIORAL OUTCOME
D. ACTIVITY RELATED AFFECT
E. COMMITMENT TO PLAN OF ACTION

Results showed that the modifying factors of age, income, education, and selected biological
characteristic of body mass has indirect effects on health-promoting lifestyles as proposed by this
model.

2.) BANDURA’S SELF-EFFICACY THEORY

- SOCIAL LEARNING THEORY
- BANDURA renamed the theory, SOCIAL COGNITIVE THEORY to emphasize the cognitive aspect
of learning which explains human behavior by citing three factors which are in continuous interaction
resulting in a process of reciprocal determinism or triadic reciprocal causality namely:
- Personal factors
- Behavior
- Environmental influences
 SOCIAL COGNITIVE THEORY
- Emphasizes that cognition plays a critical role in people’s capability to construct reality, self-
regulate, encode information, and perform behaviors.
- In 1977, he introduced the concept of self-efficacy

SELF –EFFICACY
- is the single most important aspect of the sense of self that determines one’s effort to change
behavior according to Bandura. It is equated with self-confidence in one’s ability to successfully
perform a specific type of action.
Example: A person may experience high level of self-efficacy in preparing low salt, low cholesterol diet
but very little self-efficacy.

A person can increase self-efficacy through:

a. Personal mastery of a task
b. Observing the performance of others (vicarious experience)
c. Verbal persuasion such as receiving suggestions from others
d. Arousal of her/his emotional state. In the construct of emotional coping responses, a person
must be able to deal with any sources of anxiety surrounding that behavior in order to learn.

3.) BECKER’S HEALTH BELIEF MODEL

- Health belief model was one of the first models originally introduced by a group of
psychologists in the 1950’s to find out why people refused to use available preventive services such as
chest x-rays for TB screening and immunizations for influenza.
- Health Belief Model was originally developed to help explain certain health related behaviors,
it has also helped to guide the search for why these behaviors occur and to identify points for possible
change and to design change strategies like developing messages that are likely to persuade an
individual to make a healthy decision.

FOUR CONSTRUCTS WHICH REPRESENT THE PERCEIVED THREAT AND NET BENEFITS

- Perceived susceptibility – a person’s opinion of the chances of getting a certain condition.

- Perceived severity – a person’s opinion of how serious the condition is
- Perceived benefits- a person’s opinion of the effectiveness of some advised action to reduce the
risk or seriousness of the impact
- Perceived barriers – a person’s opinion of the concrete and psychological costs of this advised
action

4.) GREEN’S PRECED-PROCEED MODEL

- It was based on epidemiological perspective on health promotion to combat the leading
causes of death. The acronym stands for
 - PRECEDE –Predisposing, Reinforcing and Enabling Constructs in Educational Diagnosis and
Evaluation (developed by Green in 1980)
- PROCEED – Policy, Regulatory and Organizational Constructs in Education and Environmental
Development (added component by Green in 1999)
- Any combination of learning experiences designed to facilitate voluntary actions conducive to
health.
- Health Education is aimed primarily at planning experiences that are designed to predispose,
enable, and reinforce voluntary behavior conducive to the health of the individuals, groups, and
the communities.
- PRECEDE = priorities and objectives
- PROCEED =address criteria for policy, implementation and evaluation as influenced by the
diagnoses in the PRECEDE phases

9 PHASES of the PRECEED-PROCEDE MODEL

1. Social Diagnosis
2. Epidemiologic diagnosis
3. Behavior and Environmental diagnosis
4. Educational and Organizational diagnosis-addresses issues dealing with education
5. Administrative and Policy diagnosis – addresses issues dealing with education
6. Implementation
7. Process evaluation
8. Impact Evaluation
9. Outcome Evaluation

REFERENCES: 4. Payne (2012). Understanding your Health

Seventh edition
TEXTBOOK:
Bastable, S. B. (2019). Nurse as Educator: Website:
Principles of Teaching and Learning for Nursing 1.
Practice. www.amazon.ca/exec/obidos/ASIN/007105480
4
Other References: 2.
1. Bastable (2017). Essentials of Patient www.harcourt-international.com/surgicalnursin
Education Second edition g
2. Iwasiw (2017)/ Curriculum Development in 3. www.medicine.htm
Nursing Education Third edition 4. www.nursingguide.htm
3. Hahn (2012). Focus on Health by Hahn, Tenth 5. www.nursingscribd.com
edition 6. www.healtheducationforteens.com