St. Paul's Hospital MMC

St.
Paul's Hospital MMC

Department of Public Health
Takele Gezahegn
(MPH, Asst. Professor)
November 2019
takele.gez44@gmail.com A.A, Ethiopia
Course Syllabus - Health Education and Promotion
Module Title: HEALTH PROMOTION AND DISEASES PREVENTION

 Course Name: HEALTL EDUCATION AND PROMOTION
Module Code: SPHM-4112
Credit Hours: Cr. Hrs: 2 (ECTS:
( 4 ECTSs (108hrs))
Mode of Delivery: Semester based
Duration: 10Wks
2 By Takele G. (Asst. Prof.) 01/26/22

Course Description
This course is intended to provide learners/candidates
with;
 The concepts of Health Education and promotion
 The concepts of health behaviour and theories/models of
behaviour change ;
 Communication and health communication;
 Materials and methods in health promotion and communication;
 Health education planning, implementation and Evaluation;
 Health promotion strategies;
 Application of HE,HP Theories/Models and Strategies

Course Objectives
At the end of the course, the students will be able
to:
 Define main terms used in health education and health promotion
 Describe the relationship between health promotion and health
education.
 Describe the relationship between health and behaviour and
factors that influence individual health behaviour.
 Explain communication process and factors influencing effective
communication.
 Explain the various models and theories used in health
promotion and communication.
 Apply principles and methods of health promotion to improving
the health of a population.

Teaching Learning Methods
Teaching Methods
1) Class Room Lectures 4) Home take Assignments
2) Term Paper Presentation
5) Self-reading
3) Seminar/Project work
6) Questioning &
Materials required for teaching learning for Answering
this course:
a) LCD projector with PC
b) White board and marker
c) Reference materials (books, handouts/and journals); students always
should read the required texts
d) And other audio-visual aids

Summary of Assessment Methods
Evaluation Tools:
 Home take (self-reading) assignments;
 Term paper/project work
 Grp. assignments with presentation;
 Attendance with class participation (Optional);
 Final examinations.

Required Texts/References
 Getnet M; Health Education for Health Science Students, Lecture Series,
Department of Community Health, Addis Ababa University, 2003.
 Karen G (etal); Health Behavior and Health Education, Theory, Research
and Practice, third edition, 2002.
 John H; Communicating Health,
Health An Action Guide to Health Education
and Health Promotion, second edition, 2004.
 Leiyu S; Health Sciences Research Methods,
Methods Delmar publishers, online
service, 1997. Zewdu dagnew lecture note series
 John Habby: Community health; 3rd edition, 1994.
 Mar Ellen Wunzbach: Community health promotion and education:
education A
guide to programme design & evaluation, 3rd edition, 2001.
 James.F. Mackenzie et al. Implementing and evaluating health
promotion programmes.
programmes 4th edition, 2005.
 Lawrence. W. Green et al. Health programme planning and evaluation,
and ecological approach,
approach 4th edition.
Required Texts/References
 Carl Fertman and Diane Allensworth. Health promotion programs: from theory to practice.
2010
 Lawrence Green, Marshall Kreuter. Health program planning: an educational and ecological
approach. Volumes 1-2. 2005
 Jackie Green, Keith Tones. Health promotion: planning and strategies. 2010.
 behavior social and behavioral theory in public health.
Mark Edberg. Essentials of health behavior:
2007
 Salem, R.M., Bernstein, J., Sullivan, T.M., and Lande, R. “Communication for Better Health,”
Population Reports, Series J, No. 56. Baltimore, INFO Project, Johns Hopkins Bloomberg
School of Public Health, January 2008.Available online:
http://www.populationreports.org/j56/
 Salem, R.M., Bernstein, J., and Sullivan, T.M. “Tools for Behavior Change Communication.”
INFO Reports, No. 16. Baltimore, INFO Project, Johns Hopkins Bloomberg School of Public
Health, January 2008. Available online at: http://www.infoforhealth.org/inforeports/
 deFossard, E., and Lande, R. “Entertainment-Education for Better Health,” INFO Reports,
No. 17. Baltimore, INFO Project, Johns Hopkins Bloomberg School of Public Health,
January 2008. Available online at: http://www.infoforhealth.org/inforeports/
Introduction to HEHP
Contents
 History concepts evolution and of health promotion
and health education

 Definitions of major concepts
 Health education in PHC
 Basic principles of health education
 Aims, Goals and Objectives of health education

INTRODUCTION
HE is a part of health care which are concerned with promoting
healthy behaviors.
 help peoples to understand their behaviors and how it affect their health
and
 encourage them to make their own choices for healthy life.
Many people use HE and HP interchangeably.
However, there are differences in their concept and application,

application
and many authors provide different definition of HE & HP .

Definition of HE
“Health education is any combination of learning opportunities
and teaching activities designed to facilitate voluntary adaptation
of behavior that is conducive to health.”
Green, 1985
Elaboration
 Combination: it emphasizes on the importance of matching
multiple determinants of behaviors with multiple learning
experiences or educational intervention
 Designed: distinguishes HE from incidental learning experiences
as a systematically planned and organized activity.
 Facilitate: creating favorable condition such as predispose,
enable, reinforce.

Definition of HE …
 Voluntary: - with full understanding and acceptance of the
purpose of the action.
- Without use of coercion or any manipulative
approaches.
- In HE we do not force the people to do what we want
them to do,
 Action (Behavior): behavioral steps/measures taken by
individuals, groups or community to achieve the desired health
effect.

“Health education is the transaction of what is known about
health into desirable individual,
ndividual group and community behavior
patterns by means of an educational process.”
Griffiths, 1972
“Health education is a process aimed at encouraging people to

want to be healthy, to know how to stay healthy to do what they
can individually and collectively to maintain health and to seek
health when needed.”
Alma-Ata, 1978

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

Definition of HP
“Health promotion is any combination of educational, political,
regulatory and organizational supports for actions and conditions
of living conducive to health of individuals,
individuals groups or
communities”
communities
Green & Kreuter, 1991
Elaboration
Combination: refers to the necessity of matching multiple
determinants of health with multiple intervention or sources of
supports.
Educational: refers to the communication part of HP. i.e. HE.
Environmental: refers to the social, political, and economic,
organizational, policy and regulatory circumstances influence
behavior or more directly health.
Definition of HP …
“Health promotion is the process of enabling people to increase
control over, and to improve, their health”
Ottawa Charter, 1986
To reach a state of complete physical, mental and social well
being it is beyond the activity of HE and even health sectors.
In other words health is not just the responsibility of health sector
alone.
But the responsibility of every sectors working for development .
Thus, the concern for health outside to the healthcare sector is

the call for health promotion.
HE and its Relationships with PH and HP
Three of the disciplines share common primary goal that is
promoting health and quality of life.
PH, the science and art of promoting health, preventing

disease, and prolonging life through the organized efforts of
society by it self.
PH encompass Preventive Medicine,

Medicine HE and HP,
HP Control of
Communicable Diseases, Application of Sanitary Measures,
Monitoring of Environmental Hazards;
Hazards etc.)

HE and its Relationships … cont.
HE is sub-disciplines of public health, particularly from
Epidemiology and Nursing,
Nursing in addition to other disciplines, such
as psychology, behavioral & social sciences.
Three public health revolution in USA.
 The 1st PH Revolution (Fight against communicable/infectious diseases,
malnutrition and environmental Problems)
Problems
 The 2nd PH Revolution (Fight against non-communicable diseases ).
 The 3rd PH Revolution (Era of health promotion)

promotion in which health is
“resource for everyday life”
life

Relationships of HE …cont
Health Education and Health Promotion,
These two concepts remain closely linked and over lapping,
lapping
share common historical and philosophical foundation.
Health promotion = Health Education + Political Action to

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

PRECEDE-PROCEED Model.
See next slide

Health Promotion
Health Promotion
Predisposing factors
Lifestyle/ behavioral
Causes
Health Education
Reinforcing factors
Quality of Life
Health
Policy Environmental Causes

&
Regulation Enabling factors

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

 It employs policy, organization, and regulation to influence the enabling and
reinforcing factors for environmental and life style changes supportive of
health.

Approaches…
Health education
 is one of the most important component of HP.
 It is a means of promoting health.
 It provides consciousness-raising, concern-arousing, action stimulating
impetus for public involvement and commitment to social reform essential to
its success.
without HE; HP would be manipulative social engineering
enterprise.
without the policy support for social change, Health education is
often powerless to help people to reach their health goals, even
with successful individual change efforts.
Approaches…
HP is a structural (laws, regulation, organizational...) support for
HE to develop its full potential.
HE is primarily focused at voluntary action people can undertake

on their own to improve their own health, their families’ health and
the community as whole.
But HP aimed at social and political action that will facilitate the
necessary organizational, economical and other environmental
supports for the conversion of individual action into health
enhancement.

Health Education/Health
Promotion
Health
Health Promotion
Promotion
Health Education
Examples of HP intervention to prevent diseases and to
promote health of the community

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

Elements/Component of HP
Health education
Political environment
Social environment
Economic environment
Organizational environment

Health promotion tools
Important health promotion tools are the following ones
 Health education and health counseling
 Advocacy,
 Social and/or community mobilization,
 Social marketing, and
 Building partnerships and Net working

Scope of Health Promotion
Two sets of activities
1) Illness and disability services
 Personal & social services
 Health care services which include major work of the health services
treatment, cure and care in primary and hospital settings.
2) Positive health activities
 Health education programs
 Primary health education
 Secondary health education
 Tertiary health education

Scope of Health Promotion...
Preventive health services:
services medical services such as FP and
immunization
 Community based work:
work bottom up approach working with and
for people
Organizational development:
development promoting health of staff and
customers
 Healthy public policies:
policies equal opportunities, housing, reducing
stress, good public transport
Environmental health measures (provision of clean water and so
on)
Economic and regulatory activities (advertising for alcohol and
tobacco taxation)
Priority Behaviors for Health
Promotion

T
Tobacco
 obacco 
H
Human
 uman sexuality
sexuality

A
Alcohol/drug
 lcohol/drug use
use 
F
Family
 amily development
development

N
Nutrition
 utrition 
S
Stress
 tress management
management

P
Physical
 hysical Activity
Activity 
C
Coping/adaptation
 oping/adaptation

D
Driving
 riving 
E
Enhanced
 nhanced self-esteem
self-esteem

R
Risk
 isk management
management
Historical Development of HE
The concept of educating about health has been since the
down of human
The history of HE as an emerging profession is only a little over
100 years old.
1850th, Lemuel Shattuck write a book about “every child should
be taught health principles in schools by a qualified educator”
educator
this take part for the emerging of HE.
The concept of HE in Ethiopia have no clear point when it start,

but after the declaration of PHC

Historical Development of HE
Around the end of the 18th century (1779):
 A German physician, Johan Peter Frank, propagate the importance of
supervising health of school children as part of school education program.
At the beginning of the 20th century:

 Official formulation of education policies has been started in Europe and
USA.
At the Global level PHC (primary health care) was designed and
many countries show their commitment to the strategy at the
time of declaration at alma- Ata in 1978.

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

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

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

declared at Alma-Ata.
 Ethiopia has hosted the first HE technical meeting of OAU

in Addis Ababa.

Definition of HE Related Terms
Information, Education and Communication (IEC) is a term
originally from family planning and more recently HIV/AIDS
control program in developing countries.
Information: A collection of useful briefs or detailed ideas, processes,
data and theories that can be used for a certain period of time.
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.

Definition of HE Related Terms
IEC is a process of working with individuals, communities and
societies to develop communication strategies to promote
positive behaviors which are appropriate to their settings.
BCC is a process of working with individuals, and communities

to develop communication strategies to promote positive
behaviors which are appropriate to their settings; and provide a
supportive environment which will enable people to initiate and
sustain positive behaviors
IEC is a part of BCC while BCC builds on IEC.

Definition of HE Related Terms …
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.

Social mobilization is a term used to describe a

campaign approach combining mass media and working
with community groups and organizations.
Health extension is an approach of promoting change

through demonstration, working with opinion leaders and
community based educational activities.

Nutrition education is education directed at the promotion of
nutrition and covers choice of food, food-preparation and
storage of food.
Family Life Education refers to education of young people in a

range of topics that include family planning, child rearing and
childcare and responsible parenthood.
Patient education is a term for education in hospital and clinic

settings linked to following of treatment procedures, medication,
and home care and rehabilitation procedures.

Advocacy: refers to communication strategies focusing on policy
makers, community leaders and opinion leaders to gain
commitment and support.
 It is an appeal for a higher-level commitment, involvement and
participation in fulfilling a set program agenda.
Health information: It is any health message disseminated to
the group of peoples focusing on the basic facts related to the
health issue under consideration.
 It is health facts disseminated to the target audience focusing on the basic
facts related to the health issue under consideration.
 In dissemination of health information, base line information or data is not
necessarily required.
Comparison of HE and HI
Health Education Health Information
Baseline information on current level of - are not necessarily required
multiple determinant of behaviors are
necessarily requires
Assumption- people are not relational all Assumption- people are rational and make
the times but they rationalize all the times predictable use of information available to
them (unhealthy behavior is due to
knowledge gab)
Appropriate for old problems (Problems Appropriate for newly emerging health
known to the people for long period of time) problems and during epidemics
Required at all stages in behavior change -One time telling facts provided that the
continuum (it is continues, even to prevent information reaches at all the intended
defaulter after adoption encourage people to audiences and understanding takes place ----
make their own choices for healthy life Merely telling to people to follow health
behaviors
Focus on the reason behind behaviors Blinded to the reason behind the behaviors
People not blamed for un healthy behaviors People blamed for unhealthy behaviors
Use variety of methods or educational strategy May not use a variety of methods
as appropriate
43 01/26/22
By Takele G. (Asst. Prof.)
Think-Pair-Share
What are the Rationale for HE?
Why do you think HE is important?
What are the aims, goals and objectives
of HE?

Rationale for Health Education
“We must recognize that most of the world’s major Health
problems and premature death are preventable through changes
in human behaviors and at low cost .
We have the know – how and technology but they have to be
transformed into effective action at the community level”.
Dr.Hiroshi Nakajiima, Director – General, WHO, 1998.
1) The continued existence and spread of CD,

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

Rationale …
 About 75% of childhood illnesses are preventable.
E.g. measles by immunization, malnutrition and diarrhea by teaching
mothers about good weaning foods and promoting breast feeding up until
age of two.
 Today’s children contain all of tomorrow’s productive public.
3) For some diseases HE is the only practical choice:

 in order to prevent the spread of the disease or to lead a normal life.
E.g. HIV/AIDS.
4) Increasing the tendency of chronic conditions and other
emerging agendas,
E.g. Hypertension, diabetes mellitus, coronary heart diseases, obesity
and lung cancer

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

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

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

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

Rationale …
8) Increasing threats to the young from new and harmful
behaviors.
E.g. Tobacco use, teen-age pregnancy, substance use etc.
9) Increased awareness of people on chronic health problems

and the need to know preventive actions.

Aims, Principles, and Approaches to HE
Aims
Motivating people to adopt health-promoting behaviors by
providing appropriate knowledge and helping to develop

positive attitude.
Helping people to make informed decisions about their
health and acquire the necessary confidence and skills to put

their decisions into practice.
The Goals and Objectives of HE
A) The Ultimate Goals of HE
o The ultimate goal of all service professionals (including
health educators) is to improve the quality of life
o The goal of HE is to promote, maintain and improve
individuals and community health.
o In simple words the ultimate goals of HE are:
 To help each individual and family exercise the right to achieve a
harmonious development of the physical, mental and social
potential.
 To promote health, prevent illness, self-adjust to live with
disabilities and decrease morbidity and mortality.
B) Educational Objectives of HE
Many types of objectives depending on the stage and/or level of
interventions.
The following are broad educational objectives of HE:
 To provide appropriate knowledge::provision of correct

knowledge, facts and information.
o E.g. facts about HIV/AIDS.
 To help develop positive attitude: has a lot to do with changing

opinions, feelings and beliefs of people.
o E.g., to develop positive attitude towards the practice of HIV/AIDS
prevention behaviors such as condom use.
B) Objectives of HE…
 To help exercise health practice/behavior:
practice/behavior concerned with
helping people in decision-making and actually performing.
o E.g. helping people choosing alternatives (weather to

abstain, be faithful, or use condom)
Decision-making: means choosing between and/or
among alternatives in the future about health.

Approaches to HE
The Persuasion Approach
 Deliberate attempt to influence the other persons to do
what we want them to do.
 It is good in situations where there is serious threat
such as an epidemic,
epidemic and the actions needed are clear
cut.
The Informed Decision-making Approach:
 Giving people information,
information problem solving and decision
making skills to make decisions but leaving the actual
choice to the people.
E.g.: FP

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

Health Education:
• is eclectic (varied) in nature.
• is an applied science.
• has a body of knowledge that comes from
other disciplines (Galli, 1976).
• is bigger than a discipline.
• is smaller than a profession.
Dimensions of Health Education
Health Education
Education
Behavioral Public
Sciences Health
Dimensions of HE …
NB:- No level of disease prevention can operate
with no HE successfully!
 Healthy individuals without Sign and symptom
of disease
o To prevent the onset of illness
 Disease (illness)
o To develop Illness behavior and compliance behavior
 Disability (Impairment)
o To prevent further disability (tertiary prevention)
 Death

Dimensions of HE …
 HE is not an end by itself.
itself
 Rather a way of empowering people to understand their

own problems, identifying its solution and take appropriate
action.
 HE is not limited to patients in clinical setups.

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

to minimize the risk of having a problem.

The Practice of Health Education
• Understand and engage priority population
• Assess needs and assets of priority population
• Develop goals and objectives
• Create an intervention (plan)
• Implement the intervention
• Evaluate the results
Vision/Mission of Health Education
• The health education profession promotes,

supports, and enables healthy lives and
communities.
Premises of Health Education
1. Grounded in the values and needs of the community,
health education promotes social and environmental
justice.
2. The health education profession promotes health

literacy and enables and supports healthy lives and
communities.
3. Many of the leading causes of morbidity and mortality
are behaviorally based.
4. Health literacy is an enabling factor in promoting

healthy behavior.
Basic Assumptions and Principles of HE
Basic Assumptions
 The practice of HE is based on the assumption:
“beneficial health behavior will result from a combination of

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

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

Principles of HE
2) Principles of Educational Diagnosis
 The first task in changing behaviors is to determine its causes.

 If the causes of the behaviors was understood, HE professional can
intervene with the most appropriate & efficient combination of education,
reinforcement & motivation.
3) Principle of Planning and Organizing
 Planning and organizing are fundamentals for HE which
distinguishes it from other incidental learning experiences.
 It involves deciding in advance the when, who, what, how, and why
of HE.
 It also requires the planning for resources, methods and materials
to be used, identification of target groups etc.
Principles of HE …
4) Principles of Participation
 Individual, families, community groups, etc. have been participated in
identifying their own needs for change and have selected the methods
that will enable them to take action.
5) Principle of Multiple Methods

 For each of the multiple predisposing, enabling, and reinforcing factor
identified, a different methods or components of comprehensive
behavioral change must be provided.
6) Principles of Segmentation
 HE should be designed for a specific group of people or
specific target groups
7) Principles of Facts
 HE is given based on scientific findings/facts and current
knowledge.
 This is because scientific knowledge is changing with time.
E.g., it is incorrect to say I think FGM is harmful.
8) Principles of Culture
 HE should not consider as artificial situation or formal teaching –
learning process.
 Therefore HE starts from where people are and slowly build up the
talking point to avoid any clash of ideas to allow for people
understanding, appreciation and internalization of fresh ideas.
9) Principle of motivation
 Motivation is mental direction /desire for doing or rejecting something.
 It is internal dynamics of behaviors, not external stimuli such as
incentives.
 In HE, we can appeals to people’s motives through motive arousing
appeals but not through external stimuli.
11)Principle of Feedback
 It is a mechanism of assessing what has been happened in the target
Population after receiving the message.
 the two way communication particularly of important in HE to help people
in getting proper feedback to get the doubts cleared.

11) Principle of Reinforcement
 individuals, group who started to undertake health behaviors should
verbally encouraged or received positive feed back (positive
reinforcement )
 Unhealthy behaviors should be discouraged until it disappear (negative
reinforcement )
12) Principle of Interest

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

13) Principle of Credibility
 Good HE is based on facts; and must be consistent and compatible with
scientific knowledge, local culture, educational system as well as social
goals.
14) Principle of Comprehension
 in HE, we must know the level of understanding, educational status or
literacy of the people to whom the teaching is directed.
15) Principle of Learning by Doing
16) Principle of Known to Unknown
17) Principle of Setting an Example (using role
model)
18) Principle of Good Human Relations
Questions
1) Do you think that HE activities going on
your locality consider these principles
of HE?
2) Which principles of HE have impressed

you more? Why?

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

your local community. During your teaching you say ‘I think
female genital mutilation (FGM) is harmful’ or ‘I think tobacco
causes cancer’. What would be a better way of putting this?

Targets of HE
 Needs for HE are ubiquitous.
 Every stages of life, every person or social group and all occupations are
appropriate targets of health education programs.
 Depending on the type of the problem there are three broadly

classified targets of HE programs (Individuals, Groups and
Community);
1)Individuals: this includes clients of services (Ex. contraceptive or

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

Targets of HE
Groups includes gatherings of two or more people who have a
2) Groups:
common interest.
 a FP service for a couple
 a youth club about HIV/AIDS
 a farmers association about nutritious foods
 a class of school students about dental health
 a factory workers about occupational health hazards
 ANC attendants about dangers signs of pregnancy
3) Community:
Community include a collection of people who have common
interests, a feeling of belongingness, and who usually share common
values, culture, beliefs and interests.
 It is not limited by area and it may be a town or a country in sparsely
populated areas or the school, work site, or neighborhood in more
74 populous metropolitan areas. 01/26/22
The Levels of HE in Disease Prevention
There are three distinct levels of disease prevention in HE:
1) Primary,
2) Secondary, and
3) Tertiary health education.
1) Primary HE
 Is comprised of those preventive measures that forestall the
onset of illness or injury during the prepathogenesis period
(before the disease process begins),
E.g. Wearing safety belt
Immunization
Brushing one’s teeth
Breast feeding
75 01/26/22
The Levels of HE …
2) Secondary HE
 Illness and injury can not always be prevented.
 In fact, many diseases such as cancer and heart diseases can
establish themselves in humans and cause considerable damages
before they are detected and treated.
 Aimed at promoting early diagnosis and prompt treatment of a
disease to cure or to limit disability and prevent more serious
pathogenesis or death
E.g. Breast-cancer screening
Blood pressure examination
Cholesterol level examination
Treating malaria patients.

The Levels of HE …
3) Tertiary HE
 To retain, reeducate, and rehabilitate the individual who has
already incurred disability, impairment, or dependency, and
 Aimed at patients with irreversible, incurable, and chronic
condition for social and psychological adjustment
E.g. Educating after lung cancer surgery
Working with the diabetes individual to ensure the daily Injections are
taking

The Level of Disease Prevention in Relation to Health Status
78 01/26/22
Source:
Source J.F. McKenzie, B.L. Nieger, and J.L. Smeltze,
Classify the following health education activities
whether it is primary, secondary or tertiary
a) Health education on physical exercise __________
b) Health education on tooth brushing ____________
c) Early treatment seeking behavior for malaria
________
d) Post test counseling of HIV positive person
_________
e) Health education for TB patients on drug
compliance________

HE Settings
HE is delivered in almost every conceivable setting including;
hospital, Schools, prison, etc.
 Formal vs. informal, political vs. religious, New vs.

established
[
Differ in their organizational structure, the mission of the

organization, and the centrality of the mission to HE.
The process of HE is the same across settings,
HE takes place in the f.f. common settings:
1) Schools,
2) Worksites,
3) Health care settings and
4) Community settings
5)
80
Special communities:
By Takele G. (Asst. Prof.) such as prisons and refugee settings01/26/22
Role of Health Education in PHC
Almost all developing countries health policies have been found
emphasizing that Primary Health Care (PHC) as the key
strategy.
HE is the first and foremost component of PHC and is placed at
the prominent stage among the PHC components.
Primary health care is a means of achieving health for all.
PHC is therefore very much concerned with HP and HE.

PHC is Based on Five Main Principles
1. Equity
2. Community Participation
3. Inter- Sectoral Approach
4. Appropriate Methods and Technology
5. Health Promotion and Prevention
6. Decentralization
 HE is central to PHC which in turn is the primary

means of achieving health for all, and no components
of primary health care can successfully implemented
without health education. i.e. all components of
primary health care have HE
Responsible Bodies and Their Roles in HE
Who is responsible to provide health education?
Do you think environmental health professional are responsible

to HE programs? What about other HCWs?
What are the roles and responsibilities of qualified HE and HP

professionals in HE program?

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

community
3) At the individual and/or professional level

 Health care providers, teachers, Agriculture and HEW, political &
community leaders, religious leaders, volunteers, mothers/household
heads)
 Giving health education
 Facilitating and mobilizing community
 Being role model
Responsibilities of Health Educators
Program
Program Planning
Planning
Implementation
Implementation
Program
Program Delivery
Delivery
Program
Program Administration
Administration
Evaluation
Evaluation
HE as related to Health policy of Ethiopia
Health Policy
A formal statement or procedure within institutions
(notably government) which defines priorities and the

parameters for action in response to health needs,
available resources and other political pressures.

Health Policy and Health Education
General Policy
 Development of the preventive and promotive components of health
care.
 Promoting and strengthening of intersectoral activities.
 Promotion of attitudes and practices conducive to the strengthening
of national self-reliance in health development by mobilizing and
maximally utilizing internal and external resources.
 Working closely with neighbouring countries, regional and
international organizations to share information and strengthen
collaboration in all activities contributory to health development
including the control of factors detrimental to health.

Health Policy and Health Education…
Priorities of the Policy

 1st. Information, Education and Communication
(I.E.C) of health shall be given appropriate
prominence to enhance health awareness and to
propagate the important concepts and practices of
self-responsibility in health.

General Strategies
 4th. Health Education shall be strengthened generally
and for specific target populations through the mass
media, community leaders, religious and cultural
leaders, professional associations, schools and other
social organizations for:-
 Inculcating attitudes of responsibility for self-care in health and
assurance of safe environment.
 Encouraging the awareness and development of health promotive
life-styles and attention to personal hygiene and healthy
environment.
General…
Enhancing awareness of common communicable and
nutritional diseases and the means for their prevention.
Inculcating attitudes of participation in community health
development.
Identifying and discouraging harmful traditional practices
while
encouraging their beneficial aspects.
Discouraging the acquisition of harmful habits such as
cigarette smoking, alcohol consumption, drug abuse and
irresponsible sexual behavior.
Creating awareness in the population about the rational
use of drugs
Challenges to the Process of HE
Much time, effort, practice, and on-the-job training are required
to be successful.
No two days are the same in HE (the constant changes in settings,
resources, and priority population).
Common challenges of health education:

1) Peoples don’t worry about their health status when they are healthy (HE is
not considered as important)
2) Health education is much more than “transfer of information.”

Challenges to the Process of HE
3)Changing health behavior is conditioned by factors and difficult

to deal with it simultaneously.
4)People are preoccupied with many daily activities
5)HE does not have high prestige (treated as subordinate subject/

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

professionals.
7)The people charged with HE programs lack special training and
are not qualified
Reference
Barnes, H. M. (2000). “Collaboration in community action: a successful
partnership between indigenous communities and researchers.” Health
Promotion International 15(1): 17-25.
Boutilier, M., S. Cleverly, et al. (2000). Community as a Setting for Health
Promotion. Settings for Health Promotion. B. D. Poland, L. W. Green and I.
Rootman. Thousand Oaks, Sage Publications Inc.
Boutilier, M., R. Mason, et al. (1997). “Community action and reflective
practice in health promotion research.” Health Promotion International
12(1): 69-78.
Cousins, M. and M. I (1995). “Use of Medical Care After a Community-Based
Health Promotion Program - A Quasi-Experimental Study.” American
Journal of Health Promotion 10(1): 47-53.
Defriese, G. and C. Crossland (1995). “Strategies Guidelines, Policies And
Standards - The Search For Direction In The Community Health
Promotion.” Health Promotion International 10(1): 69-74.

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Module Title: HEALTH PROMOTION AND DISEASES PREVENTION

2 By Takele G. (Asst. Prof.) 01/26/22

3 By Takele G. (Asst. Prof.) 01/26/22

4 By Takele G. (Asst. Prof.) 01/26/22

5 By Takele G. (Asst. Prof.) 01/26/22

6 By Takele G. (Asst. Prof.) 01/26/22

 History concepts evolution and of health promotion

and health education

 Health education in PHC

 Basic principles of health education

 Aims, Goals and Objectives of health education

10 By Takele G. (Asst. Prof.) 01/26/22

Many people use HE and HP interchangeably.

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

11 By Takele G. (Asst. Prof.) 01/26/22

12 By Takele G. (Asst. Prof.) 01/26/22

13 By Takele G. (Asst. Prof.) 01/26/22

“Health education is a process aimed at encouraging people to

14 By Takele G. (Asst. Prof.) 01/26/22

15 By Takele G. (Asst. Prof.) 01/26/22

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

PH, the science and art of promoting health, preventing

PH encompass Preventive Medicine,

18 By Takele G. (Asst. Prof.) 01/26/22

 The 2nd PH Revolution (Fight against non-communicable diseases ).

 The 3rd PH Revolution (Era of health promotion)

19 By Takele G. (Asst. Prof.) 01/26/22

Health promotion = Health Education + Political Action to

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

20 By Takele G. (Asst. Prof.) 01/26/22

Policy Environmental Causes

21 By Takele G. (Asst. Prof.) 01/26/22

2) The Ecological/Environmental Approach (Political Action)

22 By Takele G. (Asst. Prof.) 01/26/22

HE is primarily focused at voluntary action people can undertake

24 By Takele G. (Asst. Prof.) 01/26/22

26 By Takele G. (Asst. Prof.) 01/26/22

27 By Takele G. (Asst. Prof.) 01/26/22

28 By Takele G. (Asst. Prof.) 01/26/22

 Social and/or community mobilization,

 Social marketing, and

 Building partnerships and Net working

29 By Takele G. (Asst. Prof.) 01/26/22

30 By Takele G. (Asst. Prof.) 01/26/22

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

33 By Takele G. (Asst. Prof.) 01/26/22

At the beginning of the 20th century:

34 By Takele G. (Asst. Prof.) 01/26/22

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

35 By Takele G. (Asst. Prof.) 01/26/22

 HE was considered as major components of the PHC

 Ethiopia has hosted the first HE technical meeting of OAU

36 By Takele G. (Asst. Prof.) 01/26/22

Education: A complex and planned learning experiences that aims to

37 By Takele G. (Asst. Prof.) 01/26/22

BCC is a process of working with individuals, and communities

IEC is a part of BCC while BCC builds on IEC.

38 By Takele G. (Asst. Prof.) 01/26/22

Behavior Change Communication (BCC): Is an interactive

 different communication approaches, which are linked to

39 By Takele G. (Asst. Prof.) 01/26/22