Health Education

Prepared by: Tsion Dessalegn

Augest,2022
 Planning, implementing and evaluating
health education

Learning Objectives
At the end of this unit the students will be able to:
Explain the model of precede-proceed and its phases
Describe different methods and materials used for
health education
Discuses about adult learning theory
Define the term peer education and its relevance
 PRECEDE-PROCEED Model

The PRECEDE-PROCEED model is originally

developed in the 1970’s by Lawrence Green and
colleagues
Those who plan health education should:
 begin from the desired outcome and
 work backward to identify factors that precede it and
then
 proceed systematically to design ways to modify
these factors
 Cont.….

Green saw health education as

 a process which bridges the gap between health
information and health practices
 Health education motivates the person to take the
information and do something with it
 To keep people healthier by avoiding actions that are
harmful and by forming habits those are beneficial
 Cont.….

Several basic principles underlie Green’s model:

 Success in achieving change increases when the target
audience actively participates:
‐ in identifying health issues,
‐ defining goals and
‐ implementing solutions
 The media, political and social forces are important
environmental influences on health behavior
 Health behavior must be voluntary
‐ rigid criteria should not be imposed on health behaviors
 Cont.….

The PRECEDE-PROCEED Model is used for:

 delivery programs in practice settings and to conduct
behavior change interventions
 a tool for designing, implementing and evaluating health
behavior change programs
 The model direct initial attention to outcomes rather than
inputs
 This forces planners to begin the planning from the outcome
point of view
 In other words, as a program planner begin with the desired
outcome and work backwards to determine what causes it,
what precedes the outcome
 Cont.….

PRECEDE is an acronym for “Predisposing,

Reinforcing and Enabling factors and Causes in
Educational Diagnosis and Evaluation”
 Its a diagnostic approach for deciding what type of
intervention is likely to be useful in changing
behavior
 Shows the importance of careful preparation before
any intervention program is launched
 Cont.….

 assumes that many factors that influence health

behaviors should be identified in order to plan an
appropriate educational intervention
 In this model, appropriate health education is
considered to be the intervention/treatment for a
properly diagnosed problem in a target population
 Cont.….

There are five phases in PRECEDE:

Phase 1 - Social Assessment: What do the
people think?
program planners must collect information on how
population members perceive broad issues facing
them, including health issues and what factors they
identify as causing these
Community evaluation of “which health issues or
problem have a negative impact on their quality of
life”?
 Cont.….

In order to conduct a social assessment, you select a

small community group who can speak for the entire
community/ represent the community
Several methods may be used to collect information:
community forums, focus groups, interviews and
surveys
 Cont.….

Phase 2 - Epidemiological Assessment: What's

the actual problem?
The subjective matters identified in Phase 1 can be
objectively confirmed as serious health issues
Determine the magnitude or impact of the problem
by using epidemiological tools such as mortality,
morbidity or disability indicators
 Cont.….

The combination of phases 1 and 2 results in the

program objectives, indicating the goals to be
achieved
Epidemiological assessment serves three functions:
1. To confirm the top priority identified in Phase 1 or if
this is not possible, to re-rank those concerns based
on objective indicators of health status
2. To be able to justify your program's Phase 1 rank
and
3. To help allocate resources
 Cont.….

Phase 3 - Behavioral & Environmental

Assessment: What's the cause?
For each health problem identified, this phase identifies
behaviors and other factors in the environment that
contribute to the problems, whether or not these are
modifiable
Phase 4 - Educational & Organizational
Assessment: What's the solution?
The objective of this Phase is to develop learning and
other solutions to form the basis of your intervention
program
 Cont.….

Phase 5 - Administrative & Policy Assessment:

What's the level of support?
This considers administrative and organizational issues to
be addressed (that could facilitate or hinder
implementation of the program) before an educational
program is implemented
 What resources are available?
 What personnel is available and how many will be required?
 What budget is required and available?
 What timetable is suitable?
 What other departments and agencies need to be involved?
 Cont.….

 Assess the compatibility of your program goals and

objectives with those of the organization and its
administration; does it fit into the mission
statements, rules and regulations?
 Cont.….

The PROCEED Model is an acronym for Policy,

Regulatory, Organizational Constructs in
Educational and Environmental Development
It was added to the PRECEDE in the later 1980s,
because Green recognized a need to broaden the
scope of health education to effectively change health
behaviors
Phases 6-9 make up PROCEED part
 Cont.….

Phase 6 - Implementation stage

A combination of interventions
Phase 7 - Process Evaluation: Was it set up
correctly?
It begins as soon as you start planning
Ensuring you are doing the things you planned to do
Processes are the activities that were undertaken to plan,
implement and conduct the program or the manner in
which the program was conducted
If the processes don't work, there is a good chance that the
program will not work
 Cont.….

Phase 8 - Impact Evaluation: Did it have an

immediate impact?
You expect something to happen to people as soon as
your program ends e.g. if there is a change in their
knowledge. so u should conduct it right at the end of your
program
Phase 9 - Outcome evaluation
long term view of the success of your program it can take
time, years or even decades
E.g. look a change in the quality of life of the community
after many years
Methods and materials for health education

If the health education program is done well it will

help to improve the health of the people for whom
you are responsible
Teaching methods- ways through which health
messages are used to help solve problems related to
health behaviors
Teaching materials or aids- used to help and support
the communication process in order to bring about
desired health changes in the audience
 Cont.….

Teaching methods
There is a wide variety of teaching methods that can be used in health
education
1. Lecture
 An organized verbal presentation of a subject matter often supported by
visual aids
 A lecture is usually a spoken, simple, quick and traditional way of
presenting your subject matter
 Use of visual aids can make the lecture more informative, bright and
provide variety
 The oldest teaching method and still the method most widely used in
universities throughout the world
 The objective of lecture is to provide information, create awareness and
knowledge
 Cont.….

Advantage of Lecture method

Help to present many facts or ideas in a relatively
short time (Saves time)
Helps to cover many topic for a larger group of
audience or allows a large number of students to
receive information
 Cont.….

Disadvantages of lecture method

 It does not lead to maximum achievement in specific type of
learning
 A great burden of the total lesson rests on the instructor
 It is difficult to see the student’s progress before an examination
 Difficult to hold attention of the students
 It tends to foster passiveness or keeps students in passive
situation
 Audience may be busy in taking notes and usually have little time
to clarify misunderstanding
 Communication in a lecture may be one-way with no feedback
from the audience
 Cont.….

2. Group discussion
Group is a gathering of two or more people who have a
common interest
Group discussion involves the free flow of communication
between a facilitator and two or more participants
This type of discussion is used after a slide show or
following a more formal presentation
Characterized by;
 participants having an equal chance to talk freely and
exchange ideas with each other
 Cont.….

 allows people to say what is in their mind

‐ to talk about their problems,
‐ support and encourage each other to solve problems
(collective thinking processes can be used to solve
problems)
‐ share ideas and
‐ change their behavior
 Cont.….

Group discussions do not always go smoothly and

sometimes a few people dominate the discussion and
do not allow others to join in
Facilitator of group discussion is to establish ground
rules and use strategies to prevent this from
happening
 Cont.….

Handling group members requires

 Patience and politeness,
 the avoidance of arguments
 an ability to deal with different people without
excessive authority
 prevent a few people from dominating a group
discussion by encouraging full participation of
everyone in the group
 Cont.….

Group disruption: groups can be disrupted by several

types of behavior:
 just keeps talking
 would like to help
 focuses on small details
 insists on their own agenda
 just not interested
 seems afraid to speak
 Cont.….

It is a valuable educational method because:

It create more interaction among the members
All members of the group have common goal and
equal chances of participation
Develop collective planning and problem solving
ability
Size of a group
If the members are large every one may not have a
chance to speak. So it is recommended to have 5-10
members in each group
 Cont.….

3. Buzz group
A buzz group is a way of coping if a meeting is too large for you
Its also something you can do after giving a lecture to a large
number of people , so you get useful feedback
In this situation it is better to:
 divide the group into several small groups, of not more than 10 or
12 people, these are called buzz groups
 give each small buzz group a certain amount of time to discuss the
problem
 then, the whole group comes together again and
 the reporters from the small groups report their findings and
recommendations back to the entire audience
 Cont.….

4. Demonstration
Learning through observation
The aim of a demonstration is to help learners
become able to do the skills themselves, not just
know how to do them
The whole process of measuring blood pressure, how
to use a mosquito net, putting on a condom, giving a
child some medicine…can be best illustrated through
a demonstration
 Cont.….

A pleasant way of sharing skills and knowledge and focus on

practice
It also involve theoretical teaching as well showing how is better
than telling how
(Chinese proverb)
Note that:
You remember 20% of what you hear (If I hear, I forget)

You remember 50% of what you hear and see (If I see, I remember)

You remember 90% of what you hear, see and do. With repetition
close to 100% is remembered (If I do, I know)
 Cont.….

There are four steps to a demonstration:

1. Explaining the ideas and skills that you will be
demonstrating
2. Giving the actual demonstration
3. Giving an explanation as you go along, doing one
step at a time
4. Asking one person to repeat the demonstration and
giving everyone a chance to repeat the process
 Cont.….

Qualities of a good demonstration

For an effective demonstration consider the following
features:
 The demonstration must be realistic, it should fit with
the local culture and it should use familiar materials
 Arrange to have enough materials for everyone to
practice and
 Have adequate space for everyone to see or practice
 People need to take enough time for practice and for you
to check that everyone has acquired the appropriate skill
 Cont.….

Advantage
 Help people to learn new skills e.g. taking vital sign
 It activates several senses
 It gives an opportunity for observational learning
 Gives interest to the participants
 It correlates theory with practice

Disadvantage
 Takes time & needs skilled person
 Materials / equipment are necessary
 Difficult to conduct it for large groups
 Cont.….

5. Role play
A spontaneous or unrehearsed acting out of real-life
situations where others watch and learn by seeing
and may offer suggestions to the players
Learning takes place through active experience; it is
not passive
Direct way of learning; participants are given a role
and act accordingly without detailed planning,
because there is usually no script
 Cont.….

Advantage
People can better understand others problem and the behavior
associated with the problem
They can develop empathy or sympathy with the points of view
of other people
It give people experiences in communication, decision making
and opportunity to practice a particular activity
Help people to reevaluate their attitudes E.g. ask a person to get
into a wheelchair and move around a building to develop an
understanding of what it feels like to have limited mobility
Sometimes role play involves some risk of misunderstanding,
because people may interpret things differently
 Cont.….

6. Drama
It is a suitable teaching method for people who
cannot read, because they often experience things
visually
It is a very valuable method that basic ideas, feelings,
beliefs about health can be communicated to people
of different ages, education and experience
However the preparation and practice for a drama
may cost time and money
 Cont.….

7. Traditional means of communication

Use and develop the local means, materials and methods of
communication
Such as poems, stories, songs and dances, games, fables and puppet
shows
Advantage
 realistic and based on the daily lives of people
 communicate attitudes, beliefs and feelings in powerful ways
 they do not require understanding that comes with modern education
 communicate problems of community life
 motivate people to change their behavior and they can show ways to
solve problems
 Cont.….

 easily understood
 cost little or no money
 All they require is imagination and practice
Effective health education is rarely achieved through
the use of one method alone. Therefore, a
combination of methods should be used to make
sure that people really understand your health
education messages
 Cont.….

Health learning materials

They are those teaching aids that give information
and instruction about health to a clearly defined
group or audience
broadly classified into four categories:
1. Printed materials
2. Visual materials
3. Audio and
4. Audio-visual materials
 Cont.….

1. Printed materials
 Used as a medium in their own right or as support for
other kinds of media. such as posters, leaflets and flip
charts
Posters
 While a poster consists of pictures or symbols and
words, it communicates health messages both to literate
and illiterate people because it can serve as a visual aid
Main purposes
 To give information and advice
 Cont.…

 To reinforce or remind people of a message received

through other channels
 To give directions and instructions for actions, such
as a poster about practical malaria prevention
methods
 To announce important events and programs such as
World Malaria Day
 Explain key points of your health messages
 To see ideas in picture and word form
 Cont.….

Figure 1: Posters don’t always have to be serious to catch

the eye and transmit important messages
 Cont.….

Tips in preparing a poster

Written messages should be synchronized with pictures or symbols
All words should be in the local language or two languages
The words should be few and simple to understand. A slogan might
contain a maximum of seven words
The symbols used should be understood by everyone
The colors and pictures should be eye-catching and meaningful to
people
Put only one idea on a poster. If you have several ideas, use a flip chart
The poster should encourage practice
It is better to use real-life pictures if possible
It should attract attention from at least 10 meters away
 Cont.….

Flip chart
Useful to present several steps or aspects that are
relevant to a central topic e.g. demonstration of the
proper use of mosquito nets
Discuss each page completely before you turn to the
next and then make sure that everyone understands
each message
At the end, you can go back to the first charts to
review the subject and help people remember the
ideas
 Cont.….

Leaflets
The most common print media in health education
Useful reinforcement for individual and group sessions and
serve as a reminder of the main points that you have made
They are also helpful for sensitive subjects such as sexual health
education
When people are too shy to ask for advice they can pick up a
leaflet and read it privately
In terms of content, leaflets or booklets are best when they are
brief, written in simple and understandable language
A relevant address should be included at the back to indicate
where people can get further information
 Cont.….

2. Visual materials
They are one of the strongest methods of communicating
messages, especially where literacy is low
They are good when they are accompanied with interactive
methods
In visuals there is something in common both the source and
the receiver can see
A picture tells a thousand words. Real objects, audio and video
do the same. They are powerful
For example; if your display is on family planning methods
display real contraceptives, such as pills, condoms,
diaphragms...
 Cont.….

Figure 2: using real visual materials will help you deliver

your health messages
 Cont.….

Characteristics of visuals
Visuals arouse interest
Speed up & enhance understanding
Help memory or easily remembered
Create opportunities for active thinking
Provide a clear mental picture of the message
3. Audio
They includes anything heard such as the spoken word, a
health talk or music
Radio and audio cassettes are good examples of audio aids
  
 Cont.….

Characteristics of audios
They are effective when based on similar or known
experience. When the speakers and listeners who
share the same language and background, can
understand each other’s words easily because their
common culture provides common meaning for
things
Could be distorted or misunderstood when
translated
They can be easily forgotten
 Cont.….

4. Audio-visual materials
Materials by which learning process carried on or encouraged
through the sense of hearing and sight
These materials include TV, films or videos which provide a wide
range of interest and can convey messages with high
motivational appeal
They are good when they are accompanied with interactive
methods
Objectives of using audiovisual aids
To increase the effectiveness of the teaching-learning process
To hold the attention span of the learner for the duration of
instruction
 Cont.….

Advantage
Arouse interest and motivates learners
Helpful in capturing and sustaining attention of students
To supplement and enrich teaching methods
Strengthen or reinforce communication
They may also speed up and enhance understanding or stimulate
active thinking and learning and help develop memory
Disadvantage
They are expensive; It is impossible to make adequately available of
such aids in every classroom (the availability of technology and
materials limits its usage)
preparing of them may require substantial amount of time for those
who prepare the program
 Adult Learning Theories

Learning is acquiring and processing of knowledge or skills to

varying depths (understand, apply and communicate the
skill/knowledge)
It is helpful to think of learning as a continuum. one end is
non-reflective learning, while at the other lies reflective
learning
Non-reflective learning
surface level learning
demands very little thinking such as, when we memorize
something or perform a simple task
E.g. simply memorizing the formula for calculating percentages
 Cont.….

Reflective learning
Deep level processing of learning
Requires far more thinking
We understand something/develop knowledge, can
break it down into its component parts and reassemble
it in a new form and so on
E.g. look at what other mathematical operations could
be used in calculating of percentages, how calculating
percentage could be combined with other mathematical
operations to produce more complex information?
 Cont.….

Deeper level would mean that:

 students would be able to explain the process to
others,
 consider and assess alternatives,
 use the skill/knowledge to decide on a course of
action…
 Cont.….

Figure 3: categories of learning

 Cont.….

What Is Andragogy?
Adult learning theories provide insight into:
 how adults learn
 help instructors be more effective in their practice and
 more responsive to the needs of the learners they serve
Malcolm Knowles has been a pioneer in the field of adult learning
and is a strong proponent of the position that adults do not learn
like children
In attempting to document differences between the ways adults and
children learn, Knowles (1980) popularized the concept of
andragogy (“the art and science of helping adults learn”) contrasting
it with pedagogy (“the art and science of teaching children”)
 Cont.….

Table1. Contrasting andragogy (teaching adults) with pedagogy (teaching

children)
 Cont.….

 He posited a set of assumptions about adult learners that the

adult learner;
1. Adults have a need to know why they should learn
something
They are motivated to put time and energy into learning if they
know the benefits of learning and the cost of not learning
2. Adults have a deep need to be self-directing
being in charge of his or her own life, being responsible for
making his or her own decisions and living with the
consequences
Adults develop a deep need to be seen by others as being
capable of taking responsibility for themselves
 Cont.….

3. Adults have a greater volume and different

quality of experience than youth
 Adults bring into the learning experience that is a rich in
resource
Adults have a broader base of experience on which to
attach new ideas and skills and give them richer meaning
4. Adults are ready to learn when the need arises or
when they choose and commit to learn
Some of the greatest goofs of learning have occurred as a
result of forcing people into learning activities before they
perceived a need for them
 Cont.….

5. Adults enter into a learning experience with a task-

centered (problem-centered) orientation to learning
Youth have a subject-centered orientation to learning where they
focus on learning content to pass a test
Adults by work experiences and life develop a task-centered or
problem-centered orientation to learning
Thus, adult teaching should be multidisciplinary rather than subject-
oriented
Focus activities on doing something with information rather than
simply knowing the information
Adults expect to use what they learn immediately or make the
information applicable
.
 Cont.….

6. Adults are motivated to learn by both

extrinsic and intrinsic motivators
Adult learners respond to extrinsic motivators like
promotion, bonuses …. up to the point that they are
reasonably well satisfied
But the more potent and persistent motivators are
such intrinsic motivators as the need for broadened
responsibilities and achievement
 Cont.….

Also Knowles (1984) suggests that adult educators;

Work collaboratively with the learner
Design sequential activities to achieve the objectives
Set a cooperative climate for learning
Assess the learner’s specific needs and interests
Evaluate the learning experience and make
adjustments as needed, while assessing needs for
further learning
 Cont.….

Figure 4: Direct Vs Facilitated learning

Cont.….
 Peer education

In the olden days of kings and queens of England, peers

were nobleman, aristocrats, lords, titled men and patricians
The English term “peer” refers to "one that is of equal
standing with another; one belonging to the same societal
group especially based on age, grade or status".
In modern times, the term has come to mean fellow, equal,
like, co-equal or match
Recently the term is used in reference to education and
training
Peer education is now viewed as an effective behavioral
change strategy
 Cont.….

Peer education is the exchange of information

between people with similar backgrounds and
experiences and designed for youth by youth
Peer education has been used in many areas of
public health, including nutrition education, family
planning, substance use, violence prevention and it
is particularly useful in exploring issues around HIV
and sexual health with youth
 Cont.….

Peer Education for Young People

In most societies, young people often find it difficult to obtain clear
and correct information on issues that concern them. such as:
 sex,
 substance use,
 reproductive health,
 HIV/AIDS and STIs
This happens for many reasons. E.g. socio-cultural norms and
taboos, economic deprivation or lack of access to information
Many times, information is available but it may be given in a
manner that is authoritarian, judgmental or non-adapted to the
young people's viewpoints and lifestyle
 Cont.….

Relevance of peer education

A dialogue between equals. It involves members of a particular
group educating others of the same group. And it works very well
for students and young people.
 It is participatory and involves the young people in discussion and
activities
 It empowers young people to take action
 Create a relaxed learning environment
 Young people feel free to ask questions on taboo subjects
 Able to discuss issues without the fear of being judged and labeled
 Discuss issues that are difficult to discuss with an adult and
mutual sharing of experiences, knowledge and information
 Cont.….

Peer Educator
The basic requisite for becoming a peer educator is to be a
peer
Take some training in group facilitation or peer education
For example, a sex worker peer educator will be more
comfortable working with sex workers
If you are a peer, you can speak the same language and
are familiar with the cultural norms and values of the
group/community
Shared language and common culture help build the trust
that is essential to peer-education
 Cont.….

Role of the peer educator

 help the group members define their concerns and seek
solutions through sharing of information
 disseminate new information and knowledge to the group
members
 become a role model to others
 understand the emotions, thoughts, feelings, language of the
participants
 not only tells the peers about a desired risk reduction practice
but also models it
 able to inspire and encourage their peers to adopt health-
seeking behaviors
 Cont.….

 needs to have an overall knowledge of the subject. It is not

necessary to be an expert. It is generally better to refer people
to organizations or leaflets where more information can be
found
 updating knowledge and skills in group facilitation
continuously
 be aware of where more information and support can be
accessed
 be open minded, a good listener, a good communicator,
acceptable to the community, be trust worthy and possess
good interpersonal skills
 develop leadership and motivation skills
 Cont.….

Organizing a Peer Education Program

Use the six helpers in organizing your program:
1. Who are the participants?
2. Why is the program/session being organized; define
specific objectives
3. What are the needs of the participants and the content of
the program/session?
4. Where will the program/session be held (venue)?
5. When will the program/session be held (time)?
6. How will the program/session be conducted
(methodology)?
 Cont.….

Starting a Peer Education Session

A session can be started in several ways, there is no fixed
rule
Sometimes it can be done with a game, which is great to
get people laughing and relaxed. At other times, it can be
through relevant exercises. This gets everyone involved
and discussing
Whatever topic the session is, it should include everyone
and be simple enough to understand
Every session should be a combination of listening,
speaking, seeing and doing
 Cont.….

Facilitating Participation within Members

Facilitating and enabling maximum participation by the group
members is the prime responsibility of the peer educator
This is possible with the use of various tools, such as small
group discussions, games, role-plays and others
It is always useful to divide people into small groups, as this
increases interaction between people and encourages shy
people to contribute
At the end of the program- ask participants to fill out the
evaluation forms you have prepared
It makes the work much easier the next time around
Thank you