Community Health Nursing Department

Zagazig University Faculty of Nursing

Health Education

By
Community Health Nursing
Department

2022
 Health Education

Zagazig University Faculty of Nursing

Health Education

By

Community Health Nursing

Department

i
 Health Education

Zagazig University Faculty of Nursing

Community Health Nursing Department

To prepare student to work effectively in a

multidisciplinary team to build healthy communities,
achieve health equity, and improve quality of life for all
communities.

To equip students with knowledge, skills and

attitudes to promote, preserve and rehabilitate
community health within the context of evidence based
practice in the science of community health nursing.

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 Health Education

Egypt’s Vision 2030, Health Education and Health Promotion

Egypt’s Sustainable Development Strategy (SDS), known as

Egypt’s Vision 2030, has been aligned with the 2030 Agenda which
identifies 17 Sustainable Development Goals (SDGs) that aim to “ensure
that all human beings can fulfill their potential in dignity and equality in a
healthy environment. Health and well-being are at the center of the
Sustainable Development Goals. Transforming our world to the 2030
agenda for sustainable development (SDG) sets the scene for
innovative approaches to tackling inequities in health.

Health education comprises 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. It is one
strategy for implementing health promotion and disease prevention
programs. Health promotion, that is, the process of enabling people to
increase control over, and to improve, their health, has a potentially
transformative role to play. As an approach, it aims to alter the economic,
environmental, institutional and social contexts in which decisions
relating to health and well-being are made, while sharing the SDGs’ focus
on equity.

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 Health Education

Contents

Page

Unit One: Introduction to Health Education……………… 1

Unit Two: Health and Human Behavior…………………. 16

Unit Three: Communication……………………………… 33

Unit Four: Health Communication and Health Information 54

Technology……………………………………………

Unit Five: Educational Methods and Materials…………… 69

Unit Six: Health Education Program Planning…………… 90

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 Health Education

List of Figures
Page

Figure One: Meikirch Model of health and its components 5

Figure Two: Illness- Wellness Continuum ………………… 7

Figure Three: Characteristics of utilization of services…… 22

Figure Four: Factors affect human behaviors……………… 28

Figure Five: Levels of Prevention………………………… 30

Figure Six: Components of Communication Process……… 37

Figure Seven: One-way Communication…………………… 42

Figure Eight: Two-way Communication…………………… 42

Figure Nine: Process of Behavior Change………………… 57

Figure Ten: Approaches of health education……………… 72

Figure Eleven: Steps in planning health education activities 95

Figure Twelve: Types of Evaluation Used in Health 100

Education……………………………………………………

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 Introduction to Health Education

UNIT ONE
Introduction to Health Education

1
 Introduction to Health Education

Introduction to Health Education

Out lines:
 Definition of health.
 Limitations of the WHO definition of health.
 Meikirch model of health.
 Health continuum: Wellness-Illness.
 Definition of Health Education.
 Aim of health education.
 Principles of health education.
 Approaches of health education.
 Targets for health education.
 Settings of health education.
 Duties and responsibilities of health educator.

Learning objectives:

By the end of this lecture the undergraduate students should be able

to:

 Define health.
 Illustrate the limitations of the WHO definition of health.
 Identify the Meikirch model of health.
 Describe the health continuum: Wellness-Illness.
 Define Health Education.
 Recognize aim of health education.
 Explain the principles of health education.
 Determine approaches of health education.
 Explore settings of health education.
 List duties and responsibilities of health educator.

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 Introduction to Health Education

Introduction

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. 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.

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 Introduction to Health Education

Definition of Health:
In 1948, World Health Organization (WHO) defined health in its
constitution as “a state of complete physical, mental, and social well-
being and not merely the absence of disease or infirmity”. But this
definition of has limitations.

Limitations of WHO definition of health:

1. The use of the word state is misleading because of the health is
dynamic and changes from time to time, so For example, a person
may be healthy in the morning and then develop a headache in the
afternoon and thus not be in the “state” of health.

2. The dimensions mentioned in the definition are inadequate to

capture the variations in health. As the spiritual, environmental, and
political dimensions are not included in WHO definition.

3. The word well-being is very subjective, the definition must be more

objective, and subjectivity should be minimized.

4. The measurement of health is difficult.

5. The definition presents an idealistic or utopian view. It would be

impossible to find anyone who embodies all the attributes presented in
the definition. Thus the definition of health lacks practical
applications.

6. In the WHO definition health is presented as an end product,

whereas most people perceive health as a means of achieving
something that they value more highly. For example, people want to
be healthy so that they can raise their families.

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 Introduction to Health Education

7. The definition is written from individualistic perspective in which

health is defined for one person. It lacks a community orientation,
which is much needed for something as complex as health.

Conference on Health Promotion was held in Ottawa, Canada. At

that conference the Ottawa charter for Health Promotion was drafted.
Health was defined more broadly, health has been considered less as an
abstract state and more as a means to an end which can be expressed in
functional terms as a resource which permits people to lead an
individually, socially, and economically productive life. Health is a
resource for everyday life, not the object of living. It is a positive concept
emphasizing social and personal resources as well as physical
capabilities.

New concept of health:

According to Meikirch Model
Health is a dynamic state of wellbeing characterized by a physical,
mental and social potential, which satisfies the demands of a life
commensurate with age, culture, and personal responsibility. If the
potential is insufficient to satisfy these demands the state is disease.

Five components of Meikirch model:

1. Demands of life
2. Biologically given potential
3. Personally acquired potential
4. Social determinants of health
5. Environmental determinants of health
 These five components are interacting with
each other by ten complex interactions.

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 Introduction to Health Education

According to Meikirch Model

In order to be healthy each human being has to fulfill all demands of
life such as adequate nutrition, assurance of personal safety, hygiene,
social integration and possibly procreation. For this purpose each human
being has received abilities at birth and must also develop further abilities
as life progresses. These abilities have to serve also in our future.
Therefore they are called potentials. If the biologically given and the
personally acquired potentials together suffice to cover all the vital
demands of life a person is healthy. If they are insufficient she or he is
diseased. Consequently, each individual has the responsibility to take
good care of his or her biologically given potential and to continuously
acquire new personal potential

The Illness- Wellness Continuum:

 Continuum means something that changes gradually without any
clear points, and Health is a variable component which changes time
to time to make adjustment with the internal or external variables.
 The Health illness continuum is a graphic representation of the
wellness of an individual. This concept was first proposed by John W.
Travis. According to him a person is not only considered to be
healthy based on the absence of disease but also wellness of mental
and emotional health. In this Travis model right side shows a high
level of wellness i.e. achievement of optimum health and the left side
shows premature death.

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 Introduction to Health Education

Figure 2: Illness- Wellness continuum

 Travis explained that, treatment paradigm can only move health to a

neutral point where all can see no sign of illness. After this neutral
point, it depends on the individual how he can move himself to
optimum health which is a high level of wellness.
 To achieve high level of wellness individual need to pass through
three stages like awareness, education and growth. Individuals
attitude towards health also affect. If individual have positive attitude,
he moves towards right side that means to achieving good health. But
if individual have negative attitude he will move left side.
 For example, if a person has a fever, and he thinks he will be better in
few days and continue the treatment person will have both mental
wellness and physical wellness. In case of a negative attitude, the
individual will be in mental distress and there may be a delay in
recovery from illness.

Role of nurse in achieving health: the Nurse can:

 Determine the clients' stage of health and position at health illness
model.
 Recognize the risk factors that are causing degradation in health of
client, it may be genetics, or physiological.
 Prevent the illness through awareness, educating the client.

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 Introduction to Health Education

Health education
Health education has been defined in several ways:
 Definition 1: Any combination of learning experiences designed to
help individuals and communities improve their health, by increasing
their knowledge or influencing their attitudes.

 Definition 2: A process that informs, motivates, and helps people to

adopt and maintain healthy practices and lifestyle, advocates
environmental changes needed to facilitate this goal and conducts
professional training and research to the same end.

 Definition 3: An educational process where the individual and

community behavior patterns will be changed into desirable manner,
by enhancing the health information through health professionals,
mass media and by community itself.

Aim of health education:

1. Motivating people to adopt health-promoting behaviors by providing
appropriate knowledge and helping to develop positive attitude.
2. Helping people to make decisions about their health and acquire the
necessary confidence and skills to put their decisions into practice.
3. Help the people to understand that health is their fundamental right
and community asset.
4. To provide healthy environment by enriching the people with
scientific information about health and disease.
5. To make people aware of their needs and health problems.
6. To arouse interest and provide new knowledge.

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 Introduction to Health Education

Principles of health education:

1. Credibility
 It is the degree to which the message to be communicated is
perceived as trustworthy by the receiver.
 Good health education must be consistent and compatible with
scientific knowledge and also with the local culture, educational
system and social goals.
2. Interest
 Health teaching should be related to the interests of the people,
based on the “FELT NEEDS”, so that it becomes “people’s
program.
 Felt needs are the real health needs of the people, that is needs
the people feel about themselves.
3. Participation
 The Alma- Ata Declaration states “The people have a right and
duty to participate individually and collectively in the planning
and implementation of their health care”.
 A high degree of participation tends to create a sense of
involvement, personal acceptance and decision –making.
4. Motivation
 Need for incentives is a first step in learning to change.
 Incentives may be positive or negative.
 Main aim of motivation is to change behavior.
5. Comprehension
 Health educator must know the level of understanding, education
and literacy of people to whom the teaching is directed.
 Always communicate in the language people understand.
 Teaching should be within the mental capacity of the audience.

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 Introduction to Health Education

6. Reinforcement
 Repetition of message at intervals is necessary.
 If the message is repeated in different ways, people are more
likely to remember it.
7. Learning by doing
 The importance of learning by doing can be best illustrated by
the Chinese proverb “if I hear, I forget; if I see, I remember; if I
do, I know”.
8. Known to unknown
 “From the known to unknown”, Here health educator uses the
existing knowledge of the people as pegs on which to hang new
knowledge.
 Health educator must proceed as the following:
“from the concrete to the abstract”
“from the particular to the general”
“from the simple to the more complicated”
“from the easy to more difficult”
9. Feedback
 For effective communication, feedback is of paramount
importance.
 The health educator can modify the elements of the system (e.g.,
message, channels) in the light of feedback from his audience.
10. Leaders
Leaders are agents of change and they can be made use of in
health education work. Leader can:

 Understands the needs and demands of the community

 Provides proper guidance, takes the initiative, and is receptive to
the views and suggestions of the people.
 Identifies himself with the community.
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 Introduction to Health Education

 Selfless, honest, impartial, considerate and sincere.

 Easily accessible to the people.
 Able to control and compromise the various factors in the
community.
 Possesses the requisite skill and knowledge of eliciting
cooperation and achieving coordination of the various official
and non-official organizations.

11. Good human relations

 Interaction of health educator with audience will go a long way
in how they listen to you as the health educator. Having the right
attitude and coordination will also give room for improvement
and adoption.

12. Setting an examples

 Be careful with what you do because your attitude might be
Manuel others read. Lead by example and practice what you
teach so doing your audience can adopt your healthy lifestyle.

Approaches of health education:

A. The persuasion approach or (Directive approach): Deliberate
attempt to influence the other persons to do what we want them to do.
B. 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.

N.B. 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,

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 Introduction to Health Education

and the actions needed are clear cut, it might be considered justified to
persuade people to adopt specific behavior changes.

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.

Settings of health education:
Settings are used because interventions need to be planned in the
light of the resources and organizational structures particular to each.
Thus, health education and promotion takes place amongst other locations
such as in:

 Health care facilities.

 Work sites.
 Schools.
 Prisons.
 Refugee camps ...etc.
 Whole Community.

The health educators:

 Health educators are professionals who educate people about
health promotion and disease prevention.
 Health education is the duty of everyone engaged in health and
community development activities.
 Health educators, also known as health education specialists,
have different duties depending on their work setting. Most of them

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 Introduction to Health Education

work in healthcare facilities, colleges, public health departments,

nonprofits, and private businesses.

General responsibilities and duties of health educator:

1. Assess the health needs of the people and communities they serve.
2. Develop programs, materials, and events to teach people about
health topics.
3. Teach people how to manage existing health conditions.
4. Evaluate the effectiveness of programs and educational materials.
5. Help people find health services or information.
6. Provide training programs for community health workers or other
health professionals.
7. Supervise staff who implements health education programs.
8. Collect and analyze data to learn about a particular community and
improve programs and services.
9. Advocate for improved health resources and policies that promote
health.

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 Introduction to Health Education

References

Alem, Y.M. (2004). Introduction to Health Education. Jimma University

In collaboration with the Ethiopia Public Health Training Initiative,
The Carter Center, the Ethiopia Ministry of Health, and the Ethiopia
Ministry of Education. P.p. 1, 7-12.
Bircher, J., and Wehkamp, K. (2011). Health care needs need to be
focused on health. Health, 3 (6): 378-382.
Bricher, J. (2005). Towards a dynamic definition of health and disease.
Medicine, Health care and Philosophy, 8: 335-341.
Idealmedhealth. (2021). Best 12 principles of health education.
Retrieved (August 18, 2022), from https://idealmedhealth.com/
principles-of-health-education.
Janov, A. (2018). Key Concept 1: The Illness-Wellness Continuum.
Retrieved (July 7, 2018), from http://www.thewellspring.com/
wellspring/introduction-to-wellness/ 357/.

Neeraja, K.P. (2011). Textbook of Communication and Education

Technology for Nurses. India: Jaypee Brothers Medical Publishers (P)
LTD. P.p. 197, 206-207, 217, 514.

Park, K. (2007). Park’s text book of Preventive and Social Medicine,

Banarsidas Bhanot publishers, India.
Sharma, M. (2017). Theoretical Foundations of Health Education and
Health Promotion. (3rd ed). USA: Jones & Bartlett Learning, LLC.
Chapter one. p.p.2-3, 7, and 15-16.

World Health Organization. (2017). Health Education. Retrieved

(August 18, 2017), from http://www.who.int/topics/health
_education/en/.

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 Introduction to Health Education

Quiz:

1. Define health and health education?

2. Describe the health continuum: Wellness-Illness?
3. List health education settings?
4. Identify the principles of health education?
5. Discuss the approaches of health education?
6. Explain the responsibilities of health educator?

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