Fourth Year

First Year
2021-2022
 HEALTH EDUCATION

Contents
Vision & Mission ________________________________________________2

Book Introduction _______________________________________________4

Course Specification _____________________________________________5

Introduction to Health Education ___________________________________35

Health and human behaviors ______________________________________55

Communication in Health Education ________________________________76

Health Education Methods and Materials ___________________________ 106

Teaching and Learning _________________________________________135

Ethical issue in health education __________________________________169

Counseling in Health Education __________________________________194

Health Education and Health Promotion ____________________________ 221

Health Education Process _______________________________________243

References ___________________________________________________ 328

1
HEALTH EDUCATION

2
 HEALTH EDUCATION

Faculty Vision: To be a pioneer and distinguished faculty in the field of

nursing education, practices, scientific research and community services to
contribute in the advancement of health system and achieving sustainable
development goals at the local, national, regional and international level.

Faculty Mission: Preparing a qualified and competent graduate in the field of

nursing education, practices, scientific research, and community services capable
to innovate and a competitor locally, nationally, and regionally taking into
consideration professional and ethical values.

Department Vision: Family and Community Health Nursing Department is

looking forward to be one of the leading departments in providing competency
based education, applied researches and community services to achieve the goals
of sustainable development at the local and regional levels.

Department Mission: Family and Community Health Nursing Department

is concerned with preparing graduates who can apply the competencies required
to provide evidence-based nursing care, research, and community services in
accordance with reference standards to achieve sustainable development goals.

3
 HEALTH EDUCATION

ealth education as a tool for health promotion is critical for

improving the health of populations and promotes health capital.
Yet, it has not always received the attention needed. The limited
interest stems from various factors, including: lack of understanding
of health education by those working in this field; lack of knowledge of and
consensus on the definitions and concepts of health education and promotion;
and the difficulty health educators face in demonstrating the efficiency and
showing tangible results of the practice of health education. Of course, there are
many success stories relating to health education, particularly in the settings
approach, such as health-promoting schools, workplaces, clinics and
communities. However, where boundaries are not well defined, implementing
health education becomes more challenging. This publication is intended to fill
the gaps in knowledge and understanding of health education and promotion and
provide student with knowledge of the wide range of tools available.

he modules' objectives identify the content and skills that should be

mastered through reading the modules, answering the end-of-module
questions, and completing the activities. To use the objectives
effectively, it is suggested that they be reviewed before and after
reading the modules. This review will help the students focus on the major points
in each module and facilitate answering the questions and completing the
activities at the end of each module.

4
5
 )12( ‫نموذج رقم‬
‫توصيف مقرر دراسى‬
‫بناء على المعايير االكاديميه المبنيه على الكفايات‬
2017 ‫ابريل‬
Menoufia University ‫ المنوفية‬:‫جامعة‬
Faculty of Nursing ‫ التمريض‬:‫كلية‬
Family &Community Health Nursing : ‫قسم‬
:‫تاريخ اعتماد التوصيف‬

: ‫ بيانات المقرر‬-1

First year : ‫ المستوى‬/ ‫الفرقة‬ Health Education : ‫اسم المقرر‬ 110 N:‫الرمز الكودي‬

- ‫تطبيقى بالمعامل‬ - ‫عملى‬ ‫نظرى‬

2 hour /week :‫عدد الساعات المعتمدة‬ : ‫التخصص‬

)‫ ساعة‬-( ‫ تطبيقي‬- )‫ ساعة‬- ( ‫ساعة)– عملى‬30( ‫ نظرى‬:‫عدد الساعات الكلية‬

2-Aim of the course:
Intended to provide the students with knowledge, skills, principles, concepts and process that help them to assume the role of
the nurse as health educator in designing and implementing health education for clients and their caregivers in all community
settings for the purpose of promoting and restoring health and preventing disease.

6
 Competencies :‫المعايير األكاديمية المبنية على الكفايات‬ -1

Domain No.1: Professional and Ethical Practice

Competency Key elements Course subjects Course objectives Teaching Media used Assessment
Methods or Evaluation

1.1. Demonstrate 1.1.1 Demonstrate - online -50% using -Quizzes

• Introduction to • Define terms
knowledge, understanding of the health related to learning WebEx, MS
education heath -Periodic
understanding, legislative framework and Team and
education clinical exam
responsibility and the role of the nurse and Google class
accountability of the its regulatory functions room.
legal obligations for
-PowerPoint
ethical nursing
presentation
practice.
1-1-2 Apply value - online -50% using -Quizzes
• Ethical issue in • Apply
statements in nurses’ health education communication learning WebEx, MS
skills and -Periodic
code of ethics and Team and
ethical clinical exam
professional conduct for consideration Google class
when providing
ethical decision making room.
care to
individuals,
-PowerPoint
presentation

7
1.1.3 - Practice nursing • Health education • Determine - online -50% using -Midterm exam
based on policies and and health principles of
learning Webex, MS
procedural guidelines promotion health
education and Team and
considering patient/ client
health
rights. Google class -Final written
promotion
room. exam

-PowerPoint
presentation

1.1.4 - Demonstrate • Human and • Recognize the - online -50% using -Midterm exam
responsibility and health roles and learning WebEx, MS
accountability for care behavior responsibilities
of nurse in Team and
within the scope of
providing health
professional and Google class -Final written
education
practical level of room. exam
competence.
-PowerPoint
presentation

8
Domain No.2:Holistic Patient-Centered Care
Competency Key elements Course Course Teaching Media used Assessment or
subjects objectives Methods Evaluation

2-1- Provide 2.1.1. Conduct holistic

holistic and and focused bio-
evidence-based psychosocial and
nursing care in environmental
different practice assessment of health and
illness in diverse settings

2.1.2. Provide holistic - online -50% using WebEx, -Midterm exam

• Health • Explain the
nursing care that education essential learning MS Team and
addresses the needs of process. components of
Google class room.
individuals, families and health
communities across the education PowerPoint -Final written
life span process.
presentation exam

2.1.3. Provide holistic

patient-centered care
respecting people
diversity.

9
 Competency Key elements Course subjects • Course Teaching Media used Assessment or
objectives Methods Evaluation

2.1.4. Advocate the

patient/client
needs/problems within the
Egyptian health care
system and the personal
context.

2.1.5. Utilize different

community resources for
referral to assist the
patient/client and family
through transitions across
the continuum of care.

2.1.6..Examine evidence
that underlie clinical
nursing practice to offer
new insights to nursing
care for patients, families,
and communities.

2.2. Provide health 2.2.1. Determine health • Evaluate - online -50% using -Midterm exam
• Teaching and
education based on the related learning needs of characteristics learning team-
learning
needs/problems of the patient/client within the of effective -Final written
patient/client within a health learning PowerPoint
context of culture, values exam
nursing framework materials
and norms

10
Competency Key elements Course subjects Course objectives Teaching Media used Assessment or
Methods Evaluation

2.2.2. Assess factors • Health education • Integrate - online -50% using -Midterm exam
that influence the and health learning WebEx, MS
principles and
patient’s and family’s promotion
methods of health Team and
ability, including
readiness to learn, promotion and Google -Final written
preferences for learning health education class room. exam
style, and levels of
in nursing care of
health literacy. -PowerPoint
individuals, groups presentation
and communities.
2.2.3. Participate in - online -50% using -Midterm exam
• Health education • Integrate the
informal and formal process. essential learning Webex, MS
components of
methods of teaching Team and
health education
that correspond to the process. google class -Final written
health of patient/client room. exam
needs and abilities in
-PowerPoint
different healthcare
presentation
settings.

11
Competency Key elements Course objectives Teaching Media used Assessment or
Course subjects
Methods Evaluation

2.2.4. Use educational - online -50% using -Midterm exam

• Counseling • Demonstrate
principles and skills that are learning Webex, MS
counseling techniques applied during Team.
health education
appropriately and and counseling -Final written
-PowerPoint
effectively with. with diverse exam
populations presentation

2.2.5. Communicate • Apply appropriate - online -50% using -Midterm exam

• Communication
health information and interpersonal
learning Webex, MS
coordinate health communication -Final written
skills. Team.
education/promotion exam
activities effectively
-PowerPoint
according to
presentation
patient/client needs.

[Link] information • •
from variety of reliable
sources for planning
and improving health

promotion and health

education activities

12
Domain No.3:Manage People- work environment and quality
Competency Key elements Course subjects Course objectives Teaching Media used Assessment or
Methods Evaluation

3.1- Demonstrate 3.1.1. Apply leadership •

effective managerial skills to manage
and leadership skills in personnel to maximize
the provision of quality health, independence
nursing care. and quality of life for
individuals, families,
and communities.

3.1.2. Plan and • •

implement change
conducive to the
improvement of health
care provision

3.1.3. Organize own

workload and apply
time-management
principles for meeting
responsibilities.

13
 Competency Key elements Course Course Teaching Media used Assessment or
subjects objectives Methods Evaluation

3.1.4. Demonstrate • •
controlling techniques for
the work flow and patient
outcomes through
delegating and supervising
members of the nursing
team.

3-2-Provide a safe 3-2-1. Apply leadership

working environment skills to recognize and
that prevents harm for manage risks to provide
patients and workers safe care that best meets
the needs and interests of
individuals, families and
communities.
[Link] to protect
patients and their families
from unsafe, illegal, or
unethical care practices in
different work settings

3-2-3. Create a research • •

environment that help in
maintaining safe
environment

14
Competency Key elements Course Course Teaching Media used Assessment or
subjects objectives Methods Evaluation

3-2-4. Apply research • •

methods related to area of
practice that enable and
use the best
evidences to maintain safe
work environment.

3-3-Review health care 3-3-1. Apply leadership

outcomes in the light skills, and decision making
of quality indicators
and benchmarks in improving the quality of
achieve the ultimate nursing care by using the
goals of improving the
quality of nursing care. existing resources.

3-3-2. Participate in quality

improvement process to
enhance nursing care
rendered and patient/client
outcomes.
3-3-3. Utilize quality
indicators and benchmarks
to evaluate the effect of
improvements in the
delivery of nursing care..

15
3-3-4. Implement - online -50% using -Midterm exam
• Health • Integrate
standardized protocols education and strategies for learning Webex, MS
when providing nursing health control health
Team and
care considering quality promotion education
improvement and patient's process. google class -Final written
safety room. exam

-PowerPoint
presentation

16
Domain No.4:Informatics and Technology

Competency Key elements Course subjects Course objectives Teaching Media used Assessment or
Methods Evaluation

4-1-Utilize information 4.1.1. Use different sources

and technology to of data related to advanced
underpin health care standards of practice and
delivery, patient care.
communicate,
4.1.2. Apply technology • Applied advanced - online -50% using -Midterm exam
manage knowledge • Health
and support decision and information methods of health learning Webex, MS
educational
making for patient management tools to education to
material Team and
care. support safe care and promote high quality
and
evaluate their impact on nursing practic google class -Final written
methods
patient outcomes room. exam

-PowerPoint
presentation

17
 Course subjects •
Competency Key elements Course objectives Teaching Media used Assessment or
Methods Evaluation

Health education and•

4.1.3. Evaluate the -Evaluate evidence - online -50% using -Midterm exam
impact of computerized based knowledge to learning Webex, MS
health promotion
information promote high quality
Team and
management on the family care
role of the nurse in • google class -Final written
providing holistic room. exam
patient-centered care.
-PowerPoint
•
presentation
•
4.1.4. Use and evaluate •
information
management
technologies for
providing the holistic
patient care in different
health care settings.

18
 Competency Key elements Course Course objectives Teaching Media used Assessment
subjects Methods or Evaluation

4-2-Utilize 4.2.1-. Recall, and manage data to

information and make decisions using information
communication management system for providing
technologies in holistic patient care.
the delivery of
patient/client 4.2.2- Apply communication
care. technologies that support clinical
decision making, care
coordination, and protection of
patients' right s.

4.2.3. Apply technologies and • Evaluate the - online -50% using -Midterm
information systems to support impact of
learning Webex, MS exam
provision of safe nursing care practice • Health computerized
education information Team and
to individuals, families, and
and management google class
communities
health on the role of
promotion the nurse in room. -Final written
• Teaching providing
exam
and health -PowerPoint
learning education and presentation
counseling.

19
Domain No.5:inter-professional Communication
Competency Key elements Course Course objectives Teaching Media used Assessment
subjects Methods or Evaluation

5-1-Collaborate 5.1.1. Maintain inter-professional Counseling - online 50% using -Midterm

-Works effectively
with colleagues collaboration, in a variety of settings to learning Webex, MS exam
and members of maximize health outcomes for the with a team to provide
the health care Team and
patients, families and communities health education and
team to facilitate google class
and coordinate counseling.
care provided room. -Final written
for individuals, •
exam
families and -PowerPoint
communities presentation

5.1.2- Interact within behavioral Communication Summarize the - online -50% using -Midterm
norms related to the interdisciplinary principles of learning Webex, MS exam
communication and the health care communication that is Team and
organizations required to deal with google class
people of different room. -Final written
age and culture exam
-PowerPoint
presentation

5.1.3.. Use standardized •

communication approach to transfer
care responsibilities to other
professionals to facilitate experience

20
transitions across different healthcare
settings

5.1.4Utilize communication styles that •

diminish the risks associated with
authority gradients among healthcare
team members.

21
 No. of No. of Practical/ 4-Course
Topic hours lecture tutorial contents
(theory) (theory)
‫محتوى المقرر‬
1- Introduction to health education. 4hrs 2 (Hours No.)
- -
2- Human and health behavior. 2hrs 1 - -

3- Communication. 4hrs 2 - -

4- Health educational material and methods 2hrs 1 - -

5- Teaching and learning 2hrs 1 - -

6- Ethical issue in health education 4hrs 2 - -

7. - Counseling 4hrs 2 - -

8- Health education and health promotion 4hrs 2 - -

9- Health education process 4hrs 2 - -

Total 30 hours 15 - -
lectures

22
 :‫ أساليب التعليم والتعلم‬-5
1.5-Blended learning using Webex, MS Team and google class :Teaching and Learning Methods

2.5-Modified lecture for discussion with small groups of students

3.5-case presentation

4.5-Brain storming

‫ أساليب التعليم والتعلم‬-6

Teaching ‫المحدودة القدرات ذوي‬

and Learning Methods of
Disables
Students Assessment
‫تقويم الطالب‬

7.1- Mid-term exam to assess the knowledge and understanding.

Used ‫المستخدمة‬ ‫االساليب‬-‫ا‬
7.2- Final written exam to assess the knowledge and intellectual skills. Methods

Assessment Schedule Time : ‫التوقيت‬-

23
- Assessment 1 Mid-term exam 7th Week

Assessment2 Final written exam

14th Week

Weighting of Assessments (for each semester)

Final term exam (80) 80 %

: ‫توزيع الدرجات‬-‫ج‬
Midterm exam (20) 20 % Mark Distribution

Total 100 %

List of References ‫ قائمة الكتب الدراسية والمراجع‬-8

Course Notes: (Notes in health education.). Course note ‫ مذكرات‬-‫أ‬

1. - International technical guidance on sexuality education: (2018): an evidence- ‫ كتب مقترحة‬-‫ب‬

informed approach (PDF). Paris: UNESCO. p. 82. ISBN 978-92-3-100259-5.
Recommended Books
2. Taiwan Health Promoting Schools". Taiwan Health Promoting Schools. Archived
from the original on 2014-11-25.

24
3. Arizona State University (26 November 2019). "Caring for family is what motivates
people worldwide - International study including 27 countries shows people prioritize
loved ones over everything else". EurekAlert!. Retrieved 30 November 2019. Ko,
Ahra. (14 July 2019). "Family Matters: Rethinking the Psychology of Human Social
Motivation". [Link]. Retrieved 30 November 2019.
4. "WHO | The WHO Health Promotion Glossary". WHO. Retrieved (2020)-08-11.
5. Routledge Falmer, (2009 ). Enhancing Personal, Social, and Health Education: enging
Practice, Changing Worlds 3rd edition, Lippincott company, USA.
6. Mary Louise, O'Connor-Flemingand Elizabeth Parker; (2011).Health Promotion:
Principles and Practice in the Australian Context, 3rd edition, schuster company.
7. Wise, Marilyn; Signal, Louise (2000). "Health promotion development in Australia
and New Zealand". Health Promotion International. 15 (3): 237–248.
8. Walton, Mat; Waiti, Jordan; Signal, Louise; Thomson, George (2010). "Identifying
barriers to promoting healthy nutrition in New Zealand primary schools". Health
Education Journal. 69 (1): 84–94. doi:10.1177/0017896910363152. ISSN 0017-8969
9. Ko, Ahra. (14 July 2019). "Family Matters: Rethinking the Psychology of Human
Social Motivation". [Link]. Retrieved 30 November 2019.

25
10. "WHO | The WHO Health Promotion Glossary". WHO. Retrieved (2020)-08-11.
11. Routledge Falmer, (2009 ). Enhancing Personal, Social, and Health Education:
Challenging Practice, Changing Worlds 3rd edition, Lippincott company, USA.
12. Mary Louise, O'Connor-Flemingand Elizabeth Parker; (2011).Health Promotion:
Principles and Practice in the Australian Context, 3rd edition, schuster company.
13. Wise, Marilyn; Signal, Louise (2000). "Health promotion development in Australia
and New Zealand". Health Promotion International. 15 (3): 237–248.

‫رئيس القسم‬ ‫منسق المقرر‬

‫بهيجة جالل عبدالعال‬/‫د‬.‫أ‬

26
 Module 1
Introduction to Health Education
 Module 1
Introduction to Health Education

Introduction to health education

Aim:

Describe the concepts of health education

Learning Objectives:

By the end of this lecture the student will be able to:

1. Explain concept of health

2. Integrate health education in nursing practice.
3. Define health education.
4. Summarize purpose of health education.
5. List goals of health education
6. Identify the importance of health education
7. Name aims of client education
8. Classify principles of health education.
9. Identify who are the health educators.
[Link] characteristics of excellent nurse-educator
[Link] basic principles that guide effective educators
[Link] basic roles for the health educator
[Link] suitable setting for health education.

36
 Module 1
Introduction to Health Education

Table of Content

Topic

Concept of health

Health education in nursing practice.

Definition of health education.

Purpose of health education.

Goals of health education

The importance of health education

Aims of client education

Principles of health education.

Who are the health educators?

Characteristics of excellent nurse-educator

Basic principles that guide effective educators

Basic roles for the health educator

Suitable setting for health education.

37
 Module 1
Introduction to Health Education

Introduction to health education

Concept of health

Many people view the health as the opposite of illness or health means
to be free from any kind of illness. World Health Organization (WHO) defines
health as a state of complete physical, social and mental well-being and not
merely the absence of disease or infirmity.

The aspects of health according to WHO definition include:

Figure 1: Aspects of health according to WHO.

Physical health:

Physical health means not to have any kind of disease or deformity in the
body organs and systems. This aspect of health can be achieved through the
protection of structure and functions of the body organs.

38
 Module 1
Introduction to Health Education

Mental health:

Mental health means to be free of any mental illness stress, tension anxiety,
depression and so on. Also, the human being can be realized own abilities, cope
with the normal life stresses, work productively, and able to make sound decision
and judgments.

Social health:

Social health means to have the capacity to live as a social creature and as
an integral part of the society. It also involves the ability to form satisfying
interpersonal relationships with others, to adapt comfortably to different social
situations and act appropriately in a variety of settings and situations. Social
health is an essential component in to maintaining one's health.

Health education is considered as an effective tool that helps to improve

the health of the population. Health education helps to provide teaching about
prevention of diseases and improving living condition as well as positively help
to re-shape everyday habits of people with unhealthy lifestyles. Health education
can play an important role in control and prevention of many health problems
through increase the awareness of population about many areas that may affect
the heath. Health education is a key component of health promotion programs
and is emphasized as the major strategy for the achievement of health for all.
Health education assist clients in making appropriate health related decisions.

Health education in nursing practice

According to health care system, nurses are spending much of the time in
patient's care more than any other healthcare providers and play the most critical
role to observe, detect, advocate, and ensure that the patients receive high-quality
care. Nurses are not only dispensing medication or administering treatments, but
also they are responsible for providing health education to the patients about

39
 Module 1
Introduction to Health Education

preventing and managing medical conditions and preventing complication.

Recently, nurses assume a lot of the responsibility in providing health education
for patients to help them to take responsible for their own health status.

Therefore, health education becomes a major aspect of nursing practice and an

important independent nursing function.

Client education is multifaceted that involving promoting, protecting

and maintaining health. It involves teaching about reducing health risk
factors, increasing a person’s level of wellness, and taking specific protective
health measures.

Definition of health education

• Health education is the continuum of learning which enables people to

voluntarily make decisions, modify behaviors and change social conditions in
ways which are health enhancing.

• Health education is an activity involving communication with individuals or

groups aimed at changing knowledge, beliefs, attitudes and behavior in a
manner conducive to the promotion, maintenance, or restoration of the
health (e.g., education of schoolchildren about health consequences of
smoking).

Purpose of health education

The purpose of health education is to positively influence

the health behavior of individuals and communities. Also, positively influence the
living and working conditions that may influence their health. Therefore, health
education improves the health status of individuals, families and communities in
large.

Goals of health education:

40
 Module 1
Introduction to Health Education

• Provide support and correct misconceptions to improve the health of the

individuals, families and community.
• Provides knowledge and information on health-related aspects and help the
people to maintain sound health.
• Disseminate concepts of sound health knowledge in the community.
• Enable people to identify their health problems and needs.
• Help the people to solve their health problems using their potential.
• Reduce the incidence of disease.
• Reduce disabilities and deaths.
• Improve the quality of life for the individual and society.
The importance of health education

1. Health education helps the people to follow

the healthy habits like personal hygiene,
exercise, rest, and balance diet.
2. Health education provides the people with
health-related knowledge and the ways to
keep them healthy.
3. Health education provides the people with
ways to keep smart, methods of being protected from diseases and promoting
efficiency.
4. Health education makes people realize that the health is their own
responsibility.
5. Health education provides the people with information and behaviors that
help them to maintain environmental sanitation.
6. Health education encourages people to follow hygienic and healthy habits
and practices to reduce mortality rate and other health hazards.
7. Health education encourages people to use preventive and curative health
services appropriately.

41
 Module 1
Introduction to Health Education

8. Health education helps people to change their attitudes and behavior

and adopt better health habits.
9. Health education encourages people to build up correct awareness on health
and reduce health risk factors.
Aims of client education

1- Health promotion

Nurse educator can help the clients to develop healthy practices that
promote wellness such as intake of proper nutrition, practice of regular exercise,
proper personal hygiene. Also, she can help them to change their attitudes and
behavior and adopt better health habits.

2. Prevention of illness

Illness prevention is a major concern of health education. Nurse educator

can provide health education about many areas that lead to prevention of acute
and chronic illness. These areas many include practices of healthy lifestyle
behaviors, use the curative and preventive health services appropriately, first aid,
safety, immunization, environmental health and identification and management
of risk factors.

3. Restoration of health

Health education can focus on developing self-care practices that

facilitate recovery from illness and restoration of health.

4. Facilitating coping:

Health education can focus on how to help people to cope with lifestyle
changes associated with acute, chronic and terminal illness.

Principles of health education

42
 Module 1
Introduction to Health Education

1. Health educator must be aware of the customs, health problems, health needs
and attitudes of the local community.

2. Health educator should be acceptable to the local community.

3. The time, place of education and people to be educated must be carefully

considered.

4. The people should feel that the action required is a basic need for them.

5. The topic and method must be chosen to meet the needs of people.

6. The most essential and important topics should be given priority.

7. Health educator must motivate the people to the action required.

8. The best method of teaching should be chosen based on nature of the group, their
previous knowledge, place and time available and the cultural background.

9. The information given should be appropriate for the client's age, literacy level,
education, and language skills.

10. Use of medical terminology or jargon should be avoided.

11. Health educator must assist the clients to build up a feeling of responsibility
to prevent illness and maintain health.

Who are the health educators?

Any person who has at least baccalaureate-level in health-related

disciplines, who has the academic preparation and qualifications of health
educator, who serves in a variety of health care settings and is able to use
appropriate educational strategies and methods to facilitate the development of
policies, procedures, interventions, and systems conductive to the health of
individuals, groups, and communities. So that, each member of the health team

43
 Module 1
Introduction to Health Education

needs to assume the role of health education, but nurses are in critical position to
be health educator. Client education is an essential aspect of nursing practice.
The nurses can teach the clients how to get out of bed following surgery, how to
change dressing, the exercise in maintaining health. This role can be expanded
to include educating clients, families, workers, and communities about the
possible adverse effects of exposure to environmental hazards and how to reduce
or eliminate such exposure. The health educator should know what to teach, who
is in need for teaching, and how teaching will be achieved.

Characteristics of excellent nurse educator

Nurse as health educator should have the following characteristics:

• Have good listening skills.

• Have strong leadership and communication skills.
• Have outstanding theoretical and clinical knowledge.
• Be creative, intelligent, competent, resilient and fair.
• Have cultural competency.
• Use current evidence and a variety of learning styles to meet their clients’
needs.
• Have the ability and interest for lifelong learning.
• Give specific and honest feedback.
• Be sensitive to client’s mood.
• Able to ensure the client’s safety during health education.
• Accurately prepare appropriate teaching plan and material.
• Able to speak patient’s language.

44
 Module 1
Introduction to Health Education

Basic principles that guide effective educators

1- Sending a clear and specific message

2- Selecting appropriate learning format

3- Selecting suitable learning environment

4- Organizing learning experiences

5- Encouraging learner participation in learning

6- Providing evaluation and feedback

Basic roles for the health educator:

• Assessing individual and community needs for health education.

• Planning for health education strategies, interventions, and programs.
• Implement health education strategies, interventions, and programs.
• Conduct evaluation for implemented health education strategies, and
programs.
• Conduct research related to health education.
• Facilitate cooperation among personnel of health education program and
between different programs.
• Serve as a resource person for health education.

• Serve as advocator for health and health education

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Introduction to Health Education

Suitable setting for health education

1. Hospitals and clinics

Group or individual teaching can take place in

antenatal and family planning clinics,
outpatient clinics and hospital wards.

2. Home

Individual teaching or group teaching can take place at family’s home during
home visiting. Home visit give the nurse great chance to teach the family and its
members about healthier lifestyle, disease risk, environmental health and other
health topics according to their needs.

3. Schools

Schools in which children are taught how to keep themselves healthy at

school and what to do in common illnesses, first aid, nutrition and other important
topics, Also, children will go home and teach their parents and care for the other
children at home (child-to-child schemes).

4. Worksites

Each occupation has its own adverse effects on the health of the workers.
Health education is efficient tool for promoting and maintaining the health of the
workers. Important topics for health education include first aid, early detection
of occupational diseases, proper nutrition, and exercise.

5. Community

Health teaching can be given effectively to the community as a whole in the

topics that essential to large number of people in the community. Mass media as
TV, radio, newspapers and magazines can reach large number of people in wildly
scattered areas in the community.

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Introduction to Health Education

Follow up activities:

1-Complete the following:

• List three basic roles for the health educator.

…………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………
…………………………………………………………………………………………

• Enumerate three goals of health education.

…………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………
…………………………………………………………………………………………

• Explain five of the characteristics of excellent nurse-educator.

…………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………
…………………………………………………………………………………………

2- Choose the one best answer to each of the following:

1- Which of the following is the role of health educator?

a. Assessing individual and community needs for health education.

b. Coordinating provision of health education services.
c. Communicating health and health education needs and resources.
d. Ensure client satisfaction during the teaching-learning process.
2- Which of the following are principles of health education?

a. Educate patients about medical procedures, operations, services to

encourage use of services by high-risk patients.
b. Assess, planning, implementing coordinate, promotes, and evaluate heath
education programs and write funding proposals.
c. Know the customs, health problems, health needs, and attitudes of the local
community and motivate people to take action .
d. Reduce or eliminate health risk factors and good personal conduct.

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 Module 2
Health and Human Behavior
 Module 2
Health and Human Behaviors

Health and human behaviors

Aim:

Describe the concepts of health behavior and the effect of human

behavior on health

Learning Objectives:

By the end of this lecture the student will be able to:

1. Define the basic terms related to human behavior including health behavior,
unhealthy behavior and behavioral risk factors.
2. Determine the role of the health education in behavior change.
3. Differentiate between the different types of health behaviors.
4. Illustrate the factors that affecting behavior.
5. Summarize the role health education in behavior change.
6. Explain the focus of transtheoretical model of behavior change.
7. Categorize the stages of behavior change according to transtheoretical
model of behavior change.
8. Acquire the basic concepts of behavior change.
9. Realize the role of behavior change in health promotion, disease prevention,
maintenance of health and health rehabilitation.

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Health and Human Behaviors

Table of Content

Topic

Definition of related terms

- Healthy behavior

- Unhealthy behavior

- Behavioral risk factors

Purpose of motivating health behavior

Types of health behavior

Factors affecting behavior

The role of health education in behavior change

Stages of behavior changes according to transtheoretical model of

behavior change

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Health and human behavior

Introduction

The health of the people in a community refers that one lies on the health
continuum between optimal health and death. In this health continuum, the
people may be exposed to many risk factors and conditions that considered as
the determinants of health (i.e. social and economic environment, individual
capacity and coping skills, personal health practices, health services, biology and
genetics). The quality of people's lives and health are influenced by the physical,
economic, social and environment conditions. As well, their personal behaviors
that places them at great risk and increases the chance of developing health
problems (e.g. unhealthy eating practices, smoking, sedentary life style…).

Human behavior is a one of the major factors affecting the health of

individuals, families and communities. Healthy behaviors contribute to the
overall health of individuals and communities and unhealthy behaviors adversely
affect the quality of people' life at different levels. Most of health problems and
diseases cannot be managed by treatment alone, but adopting healthy behaviors.
Health behaviors can play an important role in management most of health
problems and diseases as well as promotion of health and prevention of diseases.

Definition of related terms

• Health behavior

Health behavior is the actions performed by individuals, groups, and community

for the purpose of preventing disease or detecting it in an asymptomatic stage,
maintaining or regain good health. Health behavior can include exercising
regularly, eating balanced diet, avoidance or cessation of smoking, having good
night sleeping, and seeking medical help and so on.

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Figure 1: Healthy lifestyle

• Unhealthy behavior

Unhealthy behavior is a pattern of behavior which affected negatively on

individuals' physical and mental health and it can be associated with increased
risk of diseases and death. It is often like to a lack of self-control.

Unhealthy behavior included smoking, lack of physical activity, poor diet,

overeating and so on.

Figure 2: Unhealthy behavior

• Behavioral risk factors

Behavioral risk factors are the leading causes of the increased morbidity and
mortality due to chronic health conditions and injuries.

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Purpose of motivating health behavior

1- Enable people to achieve their optimal level of health through control over
unhealthy behavior.
2- Increase positive health behaviors
3- Motivate health seeking behavior
4- Delay the onset of chronic disease
5- Preventing or detecting disease in early stage
6- Extending active lifespan and improve quality of life
7- Reduce the cost of management of diseases
8- Reducing incidence and burden of diseases
9- Reduce mortality rates
Factors affecting behaviour

The factors affecting human behaviour include:

1. Predisposing factors

a- Knowledge b- Beliefs c- Values

d- Attitudes e- Self-efficacy.
2. Enabling factors: Resources, living conditions, social support and
development of certain skills

3. Reinforcing factors.

1- Predisposing factors

Predisposing factors are the characteristics of the individuals that motivate

behaviour before its occurrence. Predisposing factors always affect the way that
the individuals behave either positive or negative. These characteristics are:

a. Individuals’ knowledge:

Knowledge is all the information that the individuals have learned and
synthesised during their life.

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To have health related knowledge is essential for any individuals, but is not
enough to change their behaviour. So that it should be accompanied with
awareness of health needs and the effect of certain behaviour as well as
reinforcing message through health education to help the individuals to use the
knowledge they have and change their behaviour.

For example, if a woman knows in general knowledge about breast self-

exam, she may need reinforcing messages about its role in early detection of
breast cancer to motivate her to actually use the knowledge that she has and do
regular breast self-exam.

b. Belief

Belief is conviction or acceptance that certain things or behaviors are true,

real or good.

Positive health beliefs affect the individual health status positively, while
negative health beliefs affect the individual health status in negative way.

Example for positive health beliefs: If the individual believe that exercising
daily will improve his health.

Example for negative health beliefs: If the individual believe that overweight
is indicator of good health. To help the individual to change the negative health
beliefs and thus change the unhealthy behavior, through health education, the

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educator should provide a sense of fear and anxiety about the severity of the
health threat and one’s susceptibility to it. So that, the individual can changes the
negative health beliefs.

c- Values

Values are the moral and ethical reasons or justifications that people use to
justify their actions. Values are an important element that affects individuals and
how they behave. They determine whether people consider various health-
related behaviours to be right or wrong. The people often hold conflicting values.
For example, a teenage male may place a high value on living a long life; at the
same time, he may engage in risky behaviours such as smoking and drinking
alcohol. Health education programmes help the people see the conflicts in their
values, or between their values and their behaviour.

d. Attitudes

Attitudes are relatively constant feelings directed toward certain behaviour

that contains a judgment about whether that behaviour is good or bad. Attitudes
can always be categorised as positive or negative. For example, a woman may
feel that using contraception is unacceptable.

e. Self-efficacy

Self-efficacy refers to an individual's perception in his or her capacity to

successfully perform a particular behavior. Self-efficacy reflects confidence in
the ability to exert control over one's own motivation, behaviour, and social
environment.

Self-efficacy is learning why particular behaviours are harmful or helpful.

It includes learning how to modify behaviour and keep performing that to

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maintain good health. Health education and behavioural change programmes

help the individual to perform the desired behaviour under his or her self-control.

2. Enabling factors

Enabling factors are factors that help and facilitate to the individuals or
populations to change their behaviour or their environment. Enabling factors
include resources, living conditions, social support and the development of
certain skills.

Types of health behaviors

Common ways of classifying different health behaviors are:

1. Preventive health behaviors

Preventive health behaviors are any activities undertaken by an individual

who believes himself/ herself to be healthy. The purpose of these activities is to
prevent diseases and protect the health. Examples, hand washing with soap after
toilet.

2. Promotive health behaviors:

Promotive health behaviors are any activities undertaken by an individual

who believes himself/ herself to be healthy. The purpose of these activities is to
enhanced levels of wellness and quality of life. Example, exercising regularly to
maintain ideal body weight.

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3. Illness behavior

Illness behaviors are any activities undertaken by individuals who perceive

themselves to be ill, The purpose of these activities is to define the state of health,
and to discover a suitable remedy. Example, consulting with the doctor or other
health workers.

4. Sick-role behaviors or compliance behaviors

Sick-role behaviors are the activities that undertaken by individuals who

consider themselves as ill. The purpose of these activities is to, recover and get
well. Example, taking treatment regularly as prescribed by medical providers.

5. Rehabilitation behaviors:

Rehabilitation behaviors are the activities that people need to do after a

serious illness to get themselves better and prevent further disability.

6. Utilizations behaviors:

Utilization’s behaviors are the behaviors that indicate that people use the
health services. Examples, antenatal care, family planning, immunization, taking
a sick person for treatment.

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Changing risky behaviors

Risky behaviors are the leading causes of the occurrence of the most
prevalent chronic health conditions and injuries all over the world include cancer,
cardiovascular diseases, lung diseases, obesity and diabetes. All of these diseases
have in their web of causation at least one predominant risk factor related to
unhealthy lifestyles or habits. These habits as smoking, lack of physical exercise,
high caloric intake and excessive alcohol consumption leading to obesity, high
cholesterol levels and high blood pressure as precursors of the occurrence of
many chronic diseases. Therefore, reducing the burden of chronic diseases,
injuries and mortality as well as increasing the social welfare of any community
is becoming very essential and urgent issue because many of these risk factors
are preventable and modifiable through practicing health behavior or changing
unhealthy behaviors.

Behaviour change

The behaviour change refers to approaches used to bring about changes in

people's habits, attitudes way of thinking, perception, practices and help them
make their own health-related decisions. This approach can be applied using
health education, local available services and mass media such as leaflets and
posters.

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The role health education in behavior change

Health education is an essential component of health care provided care by health

care professionals, especially nurses. Health education yields better health
knowledge which is important to the people to understand the health effects of
their behaviors. Health Education can be applied at all types of behaviours and
can be of great help in maximising the level of wellness, prevent diseases, restore
the health and improve the quality of life.

Stages of behaviour Change

Transtheoretical Model is one of numerous models that developed to guide

health professional when developing educational programs to help people to
change their risky behaviours. The Transtheoretical Model developed by
Prochaska and DiClemente in the late 1970s. The focuses this model is on
intentional change and decision-making of the people. The model operates on the
assumption that people do not change behaviours quickly and decisively.

The transtheoretical model of behaviour change is an integrative theory of

therapy that assesses an individual's readiness to act on a new
healthier behaviour, and provides strategies, or processes of change to guide the

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individual. The model is composed of constructs of stages of behaviour change

that include precontemplation stage, contemplation stage, preparation stage,
action stage and maintenance stage.

Figure: Stages of change according to transtheoretical model of behaviour

change:

1. Precontemplation stage (The people are not ready)

At this stage, the people do not intend to start the healthy behaviour in the
near future and may be unaware of the need to change. So that, people should
learn more about healthy behaviour and should be encouraged to think about the
need of changing their behaviour and to feel emotions about the effects of their
negative behaviour on their health.

The most effective step at this stage is to encourage the people to become more
mindful of their decision making and more conscious of the multiple benefits of
changing an unhealthy behaviour.

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2. Contemplation Stage (The people are getting ready)

In this stage, people are ready to start the healthy behaviour during the
nearest future (within the next 6 months) and they are more aware of the need to
changing, but they have a sort of discrepancy about changing that can cause them
to keep putting off taking action. Others can influence and help effectively at this
stage by encouraging them to work at changing their behaviour.

3. Preparation stage (The people are ready)

People at this stage are ready to start taking action within the next 30 days.
They take small steps that they believe it helpful to them make the healthy
behaviour as part of their lives. For example, they tell their friends and family
that they want to change their behaviour.

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People in this stage should be encouraged to seek support from friends they trust,
tell people about their plan to change the way they act, and think about how they
would feel if they behaved in a healthier way.

4. Action stage (The people are at current action)

People at this stage have changed their behaviour and need to work hard
to keep moving ahead in the new behaviour. The people need to learn how to
strengthen their commitments to change and to fight urges to slip back.

5. Maintenance stage (The people are monitoring)

People at this stage changed their behavior, able to sustain that behavior
and are working to prevent relapse into previous unhealthy behaviors. It is
important for people in this stage to seek support from the others and talk with
people whom they trust, spend time with people who behave in healthy ways, and
remember to engage in healthy activities to cope with stress instead of relying on
unhealthy behavior.

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Follow up activities:

1-Complete the following:

-List three factors affecting behaviour

…………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………
…………………………………………………………………………………………

- Illustrate three of purpose of motivating health behavior

…………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………
…………………………………………………………………………………………

-List three types of health behaviors

…………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………
…………………………………………………………………………………………

2-Choose the one best answer to each of the following:

1- Which one of the following stages of the Transtheoretical Model is

suitable for a person who attends a smoking cessation program because
he/she is really interested in quitting?

a. precontemplation

b. action

c. contemplation

d. maintenance

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2- Which one of the following stages, the new behavior is sustained and the
person moves into a healthier lifestyle ?

a. Contemplation.

b. Preparing to stage.

c. Maintenance.

d. Making the change.

3- Which one of the following is a characteristic of health-related behaviors?

a. Innate and avoidable.

b. Learned and changeable.
c. Flexible and positive.
d. Acquired and concrete.

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Communication in Health Education
 Module 3
Communication in Health Education

Communication in health education

Aim:

Illustrate the concept, types and barriers of communication and apply

communication skills effectively.

Learning objectives:-

By the end of this lecture the student will be able to:

1. Define concept of communication.

2. Explain concept of health communication.

3. Define therapeutic communication.

4. List importance of communication.

5. Identify methods of heath communication.

6. Recognize principles of communication.

7. List steps of communication process.

8. Classify forms of communication.

9. Recognize barriers to effective communication.

[Link] characteristics of successful communication.

[Link] communication skills in health education

[Link] different communication channels in providing health education to

different groups.

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Communication in Health Education

Table of Content

Topic

Definition of communication.

Health communication.

The role of health communication in health education.

Therapeutic communication.

Importance of communication.

Principles of communication.

Types of communication.

Communication process.

Steps of communication process.

Forms of communication.

Methods of communication.

Barriers to effective communication.

Characteristics of successful communication.

Therapeutic techniques for nurse client relationship.

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Communication in health education

Introduction

Communication is an essential part of human life; all meaningful

social interaction can be labeled ‘communication’. Without
communication an individual could never become a fully functioning
human being. Reading, writing, listening, speaking, viewing and creating
images are all acts of communication. There are also many more subtle
communication activities that may be conscious or unconscious. These
include expression, gesture and ‘body language’. Through communication
people transfer facts, ideas, emotions, knowledge, attitudes and skills to
make informed decisions about their health.

Concept of communication

The word communication comes from the Latin verb communicate

"to make common, share or participate". Communication means to form
a common ground of understanding, to share information, ideas or
attitudes and to impart or transmit information. The common feature of
these definitions is the transmission or exchange of information.
Communication implies the sharing of meaning among those who are
communicating. To engage in communication is therefore to engage in the
process by which two or more people exchange ideas, facts, feelings or
impressions, so that each gains a common or mutual understanding of the
meaning and use of a message. Communication simply defined as the act
of transferring information from one place, person or group to another.

It is the most powerful tool a nurse can have. It is considered to be

the basic component of the therapeutic nurse-client relationship and
medium through which the nursing process occurs. Any nurse who wishes
to be effective caregiver must first learn to communicate. Good

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communication skills enable the nurses to get to know their clients and,
ultimately, to diagnose and meet their needs for nursing care.

Health communication

The art and technique of informing, influencing and motivating

individuals or larger audiences about important health issues based on
scientific and ethical considerations. It includes the study and use of
communication strategies to inform and influence individual and
community decisions that enhance health. Health communication is
recognized as a necessary part of efforts to improve personal and public
health.

The role of health communication in health education and promotion

• Increases knowledge and awareness of a health issue, problem, or its

solution

• Influences perceptions, beliefs, attitudes and social norms about health

• Generates effective action

• Demonstrates or illustrates health related skills

• Shows the benefit of behavior change

• Increases appropriate use and demand for health services

• Reinforces knowledge, attitudes and behavior

• Refutes myths and misconceptions

• Advocates for a health issue or a population group.

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Therapeutic communication

Therapeutic Communication promotes understanding and can help

establish a constructive relationship between the nurse and the client. It is
helping relationship that has a specific purpose and direction. It helps the
client cope with stress, get along with other people, adapt to situations that
cannot be changed, and overcome emotional and mental blocks that prevent
evolution of one’s potential as a human being. The nurse needs to respond not
only to content of client’s verbal message but also to feelings expressed. It is
important to understand how the client views the situation and feels about it
before responding.

Importance of communication

1. Help; motivate people to accept ideas and to bring about change of

behavior.

2. Lead to personality development through socialization and relationship

with others.

3. Important for continuing survival.

4. Help the researcher to know the up to date knowledge, skills in all fields by
channel of communication.

Principles of communication:

• Identify what is to be communicated.

• Set the climate according to the goals for intended interaction.
• The climate includes the factors which influences physical, emotional
and environmental condition.
• Choose words to convey the massage accurately. The nurse should
avoid technical or difficult words or words with more than one

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meaning that are to be misinterpreted. Choose familiar words and

use them correctly.

• Be aware of nonverbal communication being transmitted. The meaning

of message may be altered by tone of voice and inflection by facial
expression and by gestures and other body movement.
• The time of the message to be sending must be suitable and limited.
• Wait for feedback from the other individuals. This will aid in
determining whether or not the message has been correctly understood.
The response verbal or nonverbal will give clues regarding the
accuracy of transmission and interpretation of the message.
• Listen, observe and give full attention to receive and correctly
interpret the other individual’s response and try to understand their
point of view without interrupting them.

• Consider the other individual and how he may react the wards
chosen for the message.

• Evaluate the effectiveness of the communication process in the

intended goals.

Types of Communication

1. One-way communication
This is a linear type of communication in which information flows from
the source to the receiver. There is no input (feedback) from the receiver. It is
commonly used in advertising; the message is designed to persuade the receiver
to take action prescribed by the sender. The model is best used by organizations
when the message is simple and needs to be communicated quickly, for example,
the date and time of a public meeting. There is no opportunity to clear up
misunderstanding and meaning is controlled by the receiver.

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Sender Message Channel Receiver

Figure 1: One way communication

2. Two-way communication
As the message is more complex, two-way communication becomes
essential. In this type of communication, information flows from the source to
the receiver and back from the receiver to the source. The addition of feedback
allows the sender to find out how the message is being received and so it can be
monitored and adapted to better suit the receiver’s needs.

Feedback

Sender Message Channel Receiver

Figure 2: Two-way communication

Communication process

Communication involves a sender, a message, a receiver, and a response,

or feedback. Communication is a two-way process involving the sending and
receiving of a message. Because the intent of communication is to elicit a
response, the process is ongoing; the receiver of the message then becomes
the receiver. The components of the communication process (figure 1)
include:

• A sender of the message

• The message itself

• A receiver of the message

• Feedback (Response)

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Sender (encoder) Receiver (decoder)

Relationship

Message

Channel

Feedback

Figure 3: Communication process

The sender of the message:

The sender is a person or a group who wishes to convey a message to

another. He can consider the source-encoder. The sender of the message must
have an idea or reason for communicating. Encoding involves the selection
of specific signs or symbols (codes) to transmit the message, such as which
language and words to use, how to arrange the words, and what tone of voice
and gestures to use.

The message is influenced by sender knowledge and attitudes about its

subject matter. Attitudes person pre-dispositions toward a subject and will
affect the tone that the message takes. The receiver will know by listening to
or reading the words the sender feeling about their content.

The function of sender is to prepare and send to the receiver a message that
can be decoded with complete accuracy.

The message:

The second component of communication process is the message itself.

The message consists of the ideas, information (spoken or written), feelings,

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and body language that accompanies the words that the person wish to
communicate.

The medium used to convey the message is the channel, and it can target any
of receiver’s senses. It is important for the channel to be appropriate for the
message and it should help make the intent of the message clearer.

At first the sender must ask himself about the goals that he hope to
accomplish through communication and outline his thoughts. Choice of
words will be in part by receivers and their point of view with regard to the
subject matter of the message. The sender phrase the message depends upon
what the receiver already knows about the subject.

A receiver of the message:

The receiver is the third component of the communication process is the

listener, who must listen, observe and attend. This person is the decoder: who
must perceive what the sender intended (interpretation). To decode means to
relate the message perceived to the receiver’s stored knowledge and
experience and to sort out the meaning of the message. If the meaning of
decoded message matches the intent of the sender, the communication has
been effective. If the message is misinterpreted by the receiver, the
communication has been ineffective. By knowing receivers and how they are
view the message, sender can tailor message words, ton and method of
delivery to fit the circumstances.

The nurse who is an effective communicator needs to consider the receiver at

all times, seeking to select a message that appeals to the client interests, is
phrased in words the client understands and requires minimal effort and time
to decode.

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Feedback:

Feedback is the fourth component of the communication process. Feedback

or response is the message that the receiver returns to the sender. It can be
either verbal, nonverbal or both. Feedback is very important because:

- It permits the sender how the receiver receives the message.

- It gives opportunity for sender and receiver share information rather than
giving information.

- It allows the sender to correct or reword a message and knows that the
message was interpreted accurately.

Steps of communication process

The process of communication consists of four steps. The nurse must be able
to diagnose communication difficulties in any of the steps.

a. Input: Input involves taking information from outside the individual or

group. Once the information taken in, input must be transformed in some
manner to be used. Example: food must be broken down for use energy, and
symbols must be translated into ideas

b. Flow: the flow and transformation of processed input refers to the way
information is analyzed and stored within the individual or the way it is
transmitted from person to person within human system before
communication with the external environment occurs.

c. Output: the outcome of information processed involves further exchange

with the environment or other person.

d. Feedback: the person controls the internal and external responses to

behavior (output) and accommodates appropriately. Feedback shows the
dynamic nature of communication. When the interpersonal communication is
analyzed, two types of feedback can be identified:

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Positive feedback: (encouraging change).

Negative feedback: (encouraging homeostasis or no change).

Rather than meaning “good or "bad”, positive and negative feedback refer
to promotion of system change and stability, which is the process of
balancing the direction and magnitude of change. Both types of feedback
are needed depending on the situation.

Forms of communication

Communication is generally carried out in two different but interdependent

forms of communication; Verbal and nonverbal.

Verbal Non-verbal

Speech Body
behavior

Facial
Writing
expression

Eye contact
Signs

Paralangua
ge
Appearance

Figure 4: Forms of communication

1. Verbal communication:

Verbal communication is an exchange of information through the use of

spoken or written words. The wards used vary among individuals
according to culture, socioeconomic background, age, and education.

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Verbal communication is largely conscious because people choose the

words they use. People who are deaf or hard of hearing often use sign
language to communicate. Signs, like spoken or written words used
consistently to represent a particular meaning.

Words also may spell out through finger spelling in a manner parallel to
written communication. For example, Braille assists blind and visually
challenged people to read. Touch is used to interpret meanings that represent
letters and words. Sign language and Braille blend are aspects of verbal and
nonverbal communication. The verbal form of communication is used
extensively by nurses are speaking with clients, giving oral reports to other
nurses, writing care plans, and recording in nursing progress notes

2. Nonverbal communication:

Nonverbal communication is the exchange of information without the use of

words; it is what is not said. Sometimes referred to as body language. It helps
us to understand the subtle and hidden meanings in what is being said
verbally. It covers a wide range of human activities, from body movements
to responses to the messages of others. Often people have more conscious
awareness of their verbal and less awareness of their nonverbal behaviors.
Therefore, the nurse must be aware of both nonverbal messages they send and
nonverbal messages they receive from clients. The verbal message is
sometimes referred to as the content of message, and the nonverbal behavior
is called the process of the message. It is generally accepted that nonverbal
communication expresses more of the true meaning of a message than dose
verbal communication. When the content (verbal message) agrees with the
process (nonverbal behavior), the communication is more clearly understood
and is considered healthy. If, however, the verbal message is not reinforced
or is in fact contradicted by the nonverbal behavior, the message is confusing.

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Nonverbal communication encompasses all massages that are not spoken

or written. Movement, facial and eye expressions, gestures, appearance and
vocalization or paralanguage all constitute nonverbal modes of
communication. All communication has the potential of being misunderstood
because it does not always reflect the sender conscious intent. Nonverbal
communication has great power to transmit information about another’s
thoughts and feelings, the nurse must observe carefully; even a silent client
can reveal much.

Nonverbal communication involves all the five senses. The ability to see,
hear, smell, touches and taste assists in the perception of messages.

Methods of nonverbal communication

1. Body behaviors:

Body behavior includes posture, gestures and gait.

Posture: The way the person walks and holds their bodies are reliable
indicators of self-concepts, current mood, and health. People in good health
and with a positive attitude usually hold their bodies in good alignment.
Depressed or tired people are more likely to slouch. Tense posture and a rapid,
determined gait suggest anxiety or anger. The nurse must clarify the meaning
of the observed behavior.

Gesture: hand and body gestures may emphasize and clarity the spoken word
or they may occur without words to indicate a particular feeling or to give a
sign. For example, waving hand serves to beckon someone to come, if waved
another way, signifies that someone should leave. Gestures are used
extensively when two people speaking different language attempt to
communicate with each other, or communicating with people with special
communication problems as deaf people.

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Gait: A bouncy, purposeful walk usually carries a message of well-being.

Certain gaits are associated with illness or abnormal feelings (as, sad, anxiety,
fear), for example, client recovering from recent abdominal surgery usually
walk slightly bent over and slowly and may need assistance.

2. Facial expression: The face is the most expressive part of the body. Facial
expression will either complement or contradict verbal communication,
giving away real emotion and attitudes. Facial expression can be include
frowns, smiles, and grimaces, raised eyebrows, and pursed lips, licking lips
and tongue movements. Facial expression is a very important tool for nurses
to use when communicating with clients as it will reinforce or negate the
verbal message. Clients with a sensory deficit such as difficulty in hearing
will require clear and unambiguous facial expression to be made. So, when
observing facial expression, the nurse should notice if the person appears
happy or sad, alert, distracted or sleepy or contented, or agitated or anxious.

3. Eye contact:

Communication often begins with eye contact. Eye contact suggests

respect and a willingness to listen and to keep communication open. The
eye allows observation of another person’s total nonverbal signal. It can
inform as to whether the massage is being received and give extra
information about the other’s message. When two people talk to each
other, they look at each other primarily in the region of the eyes between
25%-75% of the time. Eye contact covey messages mean that the other is
listening and wants the speaker to proceed. Too much eye contact can
make the participants feel uneasy. Lack of eye contact can imply lack of
interest or anxiety. Eye contact can regulate the flow of conversation, help
provide feedback on how the speaker is performing, express emotion and
communicate person’s emotional state.

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4. Appearance:

Appearance is an overall notion of how people present themselves such as

Grooming, dress and hygiene. Appearance can be rich source of information
about a person’s social status, financial status, culture, religion, group
association, and self -concept. The nurse must consider whether the person’s
appearance seems appropriate to the context. Because most illnesses cause at
least some alterations in general physical appearance. Observing for changes
in appearance is an important nursing responsibility in detecting a particular
illness or in evaluating effectiveness of care and therapy.

5. Paralanguage

Paralanguage is vocalization other than expression of words and includes

many aspects of sound. Sounds as crying, moaning, gasping and sighing are
oral but nonverbal forms of communication.

Silence: Period of silence during communication often carry important

nonverbal messages. Silence between two persons may indicate complete
understanding or angry.

Methods of Communication :

1. Intra - Personal communication

2. Inter - Personal communication

3. Mass communication

1. Intra-Personal communication

It takes place inside a person. It includes the beliefs, feelings, thoughts and
justification we make for our actions. E.g. a person may look at an object and
develop a certain understanding. However, this could be affected by a number
of factors including previous experience, language, culture, personal needs,
etc.

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2. Interpersonal Communication

It means interaction between two or more people who are together at the
same time and place; e.g. between health extension worker and community
member, a teacher and students in a class. The decisive criterion for personal
communication is that communication happens at the same time and place .

Advantages:

• Two way communication

• The communication could utilize multi-channels (verbal and non -verbal)
i.e. far more channels are involved than is possible in mass
communication.
• Useful when the topic is a taboo or sensitive .
Limitations

• Requires language ability of the source.

• Requires personal status.

• Needs professional knowledge and preparation.

3. Mass communication

It is a means of transmitting messages to a large audience that usually reaches

a large segment of the population. It uses mass media. Mass media includes
broadcast media (radio and television) as well as print media (newspapers,
books, leaflets and posters( .

Advantage:

• Reach many people quickly

• They are believable especially when the source is a credible one

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Barriers to effective communication

1. Ineffective techniques 2. Anxiety

3. Attitudes 4. Gaps between the nurse and client

5. Resistance 6. Sensory barrier

7. Failure to address concerns or 8. Setting (environment)

needs

Communication barriers are responses that affect communication in a

negative way. There are a number of barriers to effective communication
that can originate with the nurse, client or both. These barriers are:

1. Ineffective techniques:

The most obvious barrier is the nurse’s failure to use the types of
therapeutic techniques. Lack of knowledge or experience can limit the
nurse’s ability to assess the client needs and repertoire of skills. Failure to
send a clear message, receive and interpret the message correctly or
provide useful feedback can interfere with communication. It is the nurse’s
responsibility to diagnose the source of the communication breakdown and
take steps to correct it by using knowledge of communication process and
appropriate therapeutic techniques.

2. Anxiety:

When the nurse or client is highly anxious during an interaction,

perception is altered and the ability to communicate effectively is sharply
curtailed. The use of defense mechanisms such as denial, projection, or
displacement reduces understanding of true meaning of an interaction.
Anxiety and the use of defense mechanism distort reality and lead to
disordered communication. The nurse should identify the anxiety and its

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source and use anxiety-reducing interventions to enhance interpersonal

communication.

3. Attitudes

If the nurse fails to examine her attitude toward the client, negativity may
be communicated and the interaction may be distorted.

4. Gaps between the nurse and client

Gaps in gender, age, socioeconomic background, race, religion, ethnicity,

or language can block functional communication between the nurse and
the client. The nurse can help the client to recognize how perceptions may
different and to clarify meanings.

5. Resistance

Resistance comprises all phenomena that inhibit the flow of thoughts, feeling,
and memories in an interpersonal encounter, as well as behaviors that interfere
with therapeutic goals. Resistance arises from anxiety when a person feel
threatened. To reduce this anxiety, the person implements resistance such as
being late, changing the subject, forgetting, blocking, or becoming angry.

6. Sensory barrier

When the client has any sensory limitations, the nurse may need to use
extra skill in communicating. Use the other senses to send or receive messages
attempted. Special help is often should be available.

7. Failure to address concerns or needs

The failure to meet client’s needs or recognize the client’s concerns is the
most serious barrier to effective interaction. It can arise from

- Inadequate assessment

- Lack of knowledge

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- Inability to separate the nurse’s needs from the client’s needs

- Confusion between friendship and a helping relationship.

The nurse should determine the source of the problem and take corrective
actions such as obtaining more information, or performing self-assessment
with values clarification and examination of reactions, biases and
expectations.

8. Setting (environment)

The setting of a nurse client interaction can affect the goals and the nature
of the communication. The most important aspect of any setting that the
nurse and client are able to attend to each other. The nurse’s attention to
the client helps create such atmosphere. The nurse should assess the
possible influence such as lighting noise, temperature, comfort, physical
distance and privacy; potentially disturbing factors can be controlled
within the limits of the setting.

In 5 minutes, the students provide real examples for situations have

occurred and caused in barriers of communication.

Characteristics of successful communication:

1. The message conveyed by the sender should be clear.

2. Provide feedback at appropriate time and place.

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3. The content of the message (verbal message) should be appropriate

with the nonverbal message to ensure clarity.

4. Communication must have a goal and not left to chance.

5. Establishing an appropriate climate for communication (ensure privacy

and confidentiality).

In 5 minutes, the student provides one or more scenario on how to

maintain effective communication

Therapeutic techniques for nurse client relationship

The following approaches should be viewed as guidelines for effective nurse

client relationship:

1. Keep client in focus: the nurse must focus on the client’s needs by
orienting the client to who they are and the purpose of the interaction.

2. Assisting the client to acquire new knowledge and develop skill to explain
events to change and to solve problems.

3. Clarify content and meaning: helping the client to observe, describe,

analyze, formulate and validate.

4. Use reflection: the nurse restatement of what the client has said or
summarizing the main point to indicate interest and to focus the discussion.

5. Use constructive confrontation: the nurse points out a specific behavior

and assists the client to examine its meaning or consequences.

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6. Use silence: Silence at interval help the client to talk at his own pace
without pressure to perform for the nurse.

7. Accept communication: allowing the client to communicate verbally and

nonverbally in his own fashion make the client feel safe and respected.

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Follow up activities:

1- Choose the one best answer to each of the following:

1- …………..It is a means of transmitting messages to a large audience

that usually reaches a large segment of the population.
a-Intra-Personal communication b- Inter-personal communication.
c- Mass communication. d- Non-verbal communication.

2- …………..It means interaction between two or more people who are

together at the same time and place.

b- Intra-Personal communication b- Inter-personal communication.

c- Mass communication. d- Non-verbal communication.

3. Another name for feedback is ----------

a- Audience Response b- Reply c- Both (a) and (b) d- Message

4. ------------- is a type of communication which uses accepted form, rule or

custom

a. Formal communication

b. Informal communication

c. Non-verbal communication

d. None of these

5. In ------------method of group teaching there is no discussion by experts.

a. Panel discussion b. Symposium c. Group discussion d. Seminar

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6. In a------------- method of group teaching, there is no active participation

from learners.

a. Lecture b. Group discussion c. Symposium d. Role play

7. In ----------method of health education people learn by exchanging their

views and experiences.

a. Symposium b. Work shop c. Role play d. Group discussion

8. Optimum number of members in an effective group.

a. 10-12 b. 6-12 c.10-20 d.10-15

2-Complete the following questions:

1- list three methods of communication :

------------------------------------------------
------------------------------------------------
------------------------------------------------
2- Enumerate three forms of communication:

------------------------------------------------
------------------------------------------------
-------------------------------------------------
3- List three barriers of communication :

----------------------------------------
----------------------------------------
-----------------------------------

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Health Education Methods and Materials
Health education methods and materials

Aim:

Recognize the teaching methods and materials of health education.

Learning Objectives:

By the end of this lecture the student will be able to:

1. Define teaching methods and materials.

2. Explain types of teaching methods.
3. Identify advantages and disadvantages of each teaching methods.
4. Define teaching materials.
5. Recognize characteristic of effective health learning materials.
6. Distinguish between different types of teaching methods.
7. Differentiate between different learning materials in health education.
8. Understand advantages and disadvantages of each type of teaching
methods.
9. Summarize the role of health learning materials in behavior change
communication.
10. Identify selection methods for health education.
11. Utilize different educational methods and materials in providing
health education in different setting.

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Table of Content

Topic

Types of teaching methods.

Common teaching methods in health education.

Selection methods for health education.

Role of health learning materials in behavior change communication.

Types of health learning materials.

Characteristics of effective health learning materials.

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Health Education Methods

Introduction

Teaching strategies are chosen to accomplish patient education objectives.

The teacher should decide which type of teaching method is better suited to
the learning situation. Expert in the field of education generally agree that the
use of a combination of more than one teaching strategy in the learning
situation can provide learning experiences and meet different type of
objectives.

In health education it is not enough to decide what will be done; by whom

and when, we also need to decide how it will be done (methods). Methods
refer to ways through which messages are conveyed to achieve a desired
behavioral change in a target audience.

Teaching methods refers to ways through which health messages are used to
help solve problems related to health behaviors. Teaching materials or aids
are used to help and support the communication process in order to bring
about desired health changes in the audience.

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Types of teaching methods

1. Individual teaching

Individual instruction (or face to face teaching) is ideal for continued

assessment of the learner and technical skill training such as urine analysis,
insulin injection. It promotes sharing of confidential information and
problems, tailoring of teaching plan, learning by persons hindered by a low
literacy level, physical impairment, cultural barriers, anxiety or depression.
Common methods used for individual education such as counseling,
interview and home visits.

2. Group teaching

Group teaching is economical method of teaching that can be selected

for patient's education. It is carried out for a group of patients or family
members. It provides the members with an opportunity to share with and
learn from each other. It is important that all members involved in group
teaching have a need in common (e.g. prenatal health, preoperative

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instruction). It is also important that socio cultural factors be considered in
the formation of group. Common methods used for group teaching such as
lecture, group discussion, demonstration, role play, drama …..Etc.

Group teaching may be:

• Small group teaching: the group size is 2-5 members. It may be

able to offer some the advantages of individual teaching. It more
effective for medication teaching, activities of daily living and
discussion about post discharge concerns.
• Medium-sized group teaching: group size is 6-30 members. It is
may be used effectively for prenatal care, pediatric care, stress
reduction, safety, and diabetes review.
• Large group teaching: the group size is 30 or more learners. It is
appropriate for lectures technique or use of videos, slides or role-
playing by teachers.
Common teaching methods in health education:

i.. Informal methods:

1- Health talks

When talks are on health agenda, we call it health talks. It is the

most natural way of communicating with people to share health
knowledge and facts. Can be conducted with one person or with a family
or group of people or through mass communication.

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Group size is also important. The number of people who you are able
to engage in a health talk depends on the group size. However, you will
find talks are most effective if conducted with small gatherings (5–10
people), because the larger the group the less chance that each person has
to participate.

When you are preparing a talk there are many things to consider:

1. Begin by getting to know the group. Find out its needs and interests
2. Then select an appropriate topic. The topic should be about a single issue
or a simple topic.
3. List the points you will talk about: Prepare only a few main points and make
sure that you are clear about them.
4. Next, write down what you will say.
5. Visual aids are a good way to capture people’s attention and make messages
easier to understand.
6. Practice your talk beforehand: This should include rehearsing the telling of
stories and the showing of posters and pictures.

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7. Determine the amount of time you need: The complete talk including
showing all your visual aids should take not more than about 20 minutes.
Allow another 15 minutes or more for questions and discussions. If the talk
is too long people may lose interest.

2- Lecture

Lecture is a particular type of education in which a teacher transmits

information to a group of learners. In using lecture as a teaching method,
the teacher was doing most of the talking and the learners mainly listening
or writing. Lecture is the method that can be used by the nurse in
instructing or transmitting information to varying group sizes of clients.

Advantages of lecturing

1. Lecture is an effective method for teaching cognitive behaviors.

2. One teacher can communicate with a large number of learners.

3. A will presented lecture combined with media may enhance learning.

4. Lecture is good for introducing a new topic.

5. Teacher can integrate the subject matter better than learners.

Disadvantages

1. Lecturing is less effective than other methods for the promotion of

thinking skills and the changing of attitudes.

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2. Lengthy lecture may cause loss of attention.

3. Long lecture also may create the impression that the patient’s problem
is so complicated that he will be unable to manage it.

4. Lecture is not effective in achieving affective or psychomotor learning

objective. ( example, teaching insulin injection)

5. Recall of information from lecture is relatively inefficient, falling to

around 20 per cent recall after one week

6. Audience feedback is limited.

7. It requires organizational skills and ability to highlight key points in

interesting and creative way

Forms of lecture

1. Traditional lecture: Teacher is the only speaker.

2. Participatory lectures: Begins with learner brainstorming and
use pause in between.
3. Feedback lecture: Mini lectures followed by small group
discussion, it gives opportunity to manipulate lecture content.
4. Mediated lecture :Use of media such as films, slides along with
traditional methods
3- Group discussion

Discussion involves the two-way exchange of information, ideas and

feelings between the teacher and learners. It is frequently directed by the

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teacher who asks specific questions or proposes problem situations. It is
an effective method when used by nurse who is comfortable with leading
a group and knowledgeable in group process.

Size of a group

For sharing of ideas an ideal group is the one with 5-10 members. If the
members are large every one may not have a chance to speak.

Strengths of group discussion

▪ Pools ideas and experiences from group.

▪ Effective after a presentation, film or experience that needs to be
analyzed.
▪ Allows everyone to participate in an active process.

Limitations

▪ Not practical with more than 20 people .

▪ Few people can dominate.
▪ Others may not participate.
▪ Time consuming.
4- Buzz group

A buzz group is a way of coping if a meeting is too large for you. 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. You can then
give each small buzz group a certain amount of time to discuss the

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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. A buzz group is also something you can do after giving
a lecture to a large number of people, so you get useful feedback.

5- Brainstorming
▪ Instead of discussing the problem at great length the participants
encouraged to make a list in a short period of time all the ideas that
come to their mind regarding the problems without discussing
among themselves
▪ Is a means of eliciting from the participants their ideas and solution
on health issues.

Strengths of Brainstorming

▪ Allows creative thinking for new ideas

▪ Encourages full participation because all ideas equally recorded
▪ Draws on group's knowledge and experience

Limitations

▪ If not facilitated well, criticism and evaluation may occur .

6-Demonstration

Demonstration is useful for cognitive and psychomotor learning. It is most

often used to teach skills and present standers for performance.

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Demonstration may be done in person or in videotaped programs. It should
be performed slowly and the teacher should be certain that the learner can
see and hear well. This strategy shows the learner that the behavior is
possible.

In this method the instructor goes through procedures, simulating

real-world performance, so the learners can see the procedure correctly
carried out. Although basically focuses on practice/skill it involves
theoretical teaching as well. Chinese proverb; If I hear, I forget , If I see, I
remember . Note that,

• You remember 20% of what you hear

• You remember 50% of what you hear and see
• You remember 90% of what you hear, see and do and with
repetition close to 100% is remembered.

Advantages:

• Illustrate application of theory or principles .

• Emphasize correct procedures
• Clarify the important points or steps
• Interesting to the learners

Disadvantages

• Require careful preparation.

• Large group of learners may not be able to see will

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7- Role-play:

This strategy gives the learner a chance to experience, relive, or

anticipate an event. The nurse explains the situation and then allows the client
to play out the view with the teacher or with one or more clients.

Role play involves doing or practicing. It helps the learners to apply

knowledge or skills, usually after demonstration. Role play tailor the learning
to the patient’s past or present life experiences while the teacher there to offer
guidance and feedback.

In role play the learner acts out (experiencing) of problems, incidents and
procedures by learners in a protected, risk-free environment. Other learners
observe and analyze performance. Clear instruction must be given to the
learner about what to do and how to do. Enough practice time should be
allowed for learner to repeat the exercise until he has mastered it. It is an
effective strategy for teaching cognitive, affective, and psychomotor
behaviors.

Advantages

1. Useful for interpersonal skills as interview, and counseling patient

relations.

2. Encourages problem-solving and critical thinking skills.

3. Learners are actively involved.

4. Helps to changes attitudes and behaviors

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5. Permits learners to try out new skills

6. Provides realistic demonstrations of real-life situations.

Disadvantages

1. Require careful advance preparation and planning.

2. May appear artificial to the learner.

3. Requires skillful leadership.

8- Drama

Drama is a presentation, in which the subject matter or topic is

studied well either written or in words, and then presented in educative
and recreating manner. Needs detail planning and script development,
practicing.

Audiences identify with characters and settings

▪ In a serial drama, for example, if the characters and settings are

familiar to audiences, they can identify with the situations, and
feelings of the characters.
▪ Drama is very effective in behavior change communication.

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9- Case study

Case study is an in-depth analysis of real or simulated problems that help

audiences to identify problems and suggest solutions according to their
own contexts.

10. Traditional media

Traditional Medias such as Poems, Songs, Proverbs, Dances with

songs, Fable, Games, Stories, Town criers are useful for the following
reasons:

• They are realistic and based on the daily lives of local people
• They can communicate attitudes, beliefs, values and feelings
in powerful ways.
• They can motivate people to change behavior.
• They can show ways to solve problems.
• Usually, they are very interesting.

Selection methods for health education:

Consider the following things before choosing health education methods.

1. How ready and able are people to change?

2. Your ‘learning’ objectives.

3. How many people are involved?

4. Is the method appropriate to the local culture?

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Note that: It is important thing to remember that effective health
education is seldom achieved through the use of one method alone. The
best method of teaching combines the various methods.

II. Formal methods:

1. Seminar:

• A seminar is a lecture or presentation delivered to an audience

on a particular topic or set of topics that are educational in nature.
• Seminars are educational events
• It is usually held for groups of 10-50 individuals for about an
hour though usually not in practice .

2- workshop:

• Is a period of discussion and practical work on a particular subject in

which a group of people share their knowledge and experiences?
• It is a series of educational and work sessions (where manual work is
done).

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• Small groups of people meet together over a short period of time to
concentrate on a defined area of concern .
• It also means a group working together, on a creative project,
discussing a topic, or studying a subject. Workshops tend to be
more intense than seminars.

3- Symposium:

Is typically a more formal or academic gathering, featuring multiple

experts delivering short presentations on a particular topic. It is an
academic in nature where experts (academicians) present their views on a
particular theme .

4- Conference:

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Conference refers to meeting for lectures of discussion where
representative of various stakeholders participate. Conference has a far
broader spectrum of meaning than the other three (seminar, workshop, and
symposium). Not limited to academic activities only; beyond academic
where many diverse participants participate.

6- Panel discussion:

Is a meeting where experts (two or more) are invited to make short

presentation or speak on different aspect of the same subject area or
theme? e.g., Theme-mental health in Ethiopia.

Health learning materials

Teaching materials include all materials that are used as teaching aids to
support the communication process and bring desired effect on the audience.
The following are some selected teaching aids that are commonly used in health
education programs. Are those teaching aids which give information and
instruction about health specifically directed to a clearly defined group of
audience?

Role of health learning materials in behavior change communication.

• Can speak to the people without the presence of communicator.

• It serves as transferring of health message or acts as channel to carry
a message to target audiences.

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• Can enhance the understanding, the credibility and the believability
of health message.
• It can remind the public the message they can received from
different sources .
• It can motivate the public to seek for further information.
• Some health learning materials serve as means of delivering health
message on very sensitive issues. For example, leaflets.

Health Learning Materials There is four types of health learning

materials:

1. Printed Health learning materials

2. Visual Health learning materials

3. Audio Health learning materials

4. Audio-visual Health learning materials

1- Printed health learning materials:

Printed health learning materials can be used as a medium in their own

right or as support for other kinds of media. Some printed health learning
materials that you will already be familiar with include posters, leaflets and flip
charts.

• It is the production of multiple copies of an original image usually

using ink pressed on to paper.
• It involves the exchange of facts, ideas, and opinions through a
written instrument /material.
• It can be used as a medium in its own right or as support for other
kinds of media.

Examples of printed materials such as Poster, flipcharts, leaflets, booklets,

cards, Newspaper etc.

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a- Posters:

Poster is a large sheet of paper ranging in size from large bill boards to
small notices. But often it has a size of 40cm wide and 60cm high. A poster
consists of words and pictures or symbols that include a message on it.

Content of poster

• All words in a poster should be in language the community

understand or in two languages.
• The words should be few and simple to understand slogan -contain
a maximum of 7 words .
• The symbols/ picture used should be understood irrespective of
educational status
• Put only one idea on a poster .
• The poster should encourage practice- action oriented .
• It is better to use life picture if possible .
• The picture/message should not be out of reality
• The synchronize between the text and picture and color should be
eye catching.
• It should attract attention from at least 10 meters away.
Posters should contain the following information:

The year of publication, the place and the sponsoring organization.

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Purpose of posters

▪ To reinforce/remind a message the public is receiving through

other channels.
▪ To give information and advice. E.g. learn more about malaria!
▪ To give directions and instructions for actions. E.g. a poster about
malaria prevention methods.
▪ To announce important events and programs. E.g. World Malaria
Day.

Poster storage and utilization

▪ Store poster in safe place

▪ Post them in a place where many people can see them when
passing by (e.g. market places, meeting halls, etc.)
▪ Ask permission before putting poster on a house or building.
▪ Use as teaching aid to support your communication
▪ Never put posters on sacred or worshipping places.
▪ Do not leave a poster up for long time .
b- Flip chart

• Flip chart Are a series of pictures that are bound together, usually
at the top, and can be turned over by the educator.

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• A flip chart is made up of a number of posters on a related subject
that are shown one after the other.
• Are good to present several steps or aspects of a central topic.

Purpose of flip chart

• To give information and instructions Content

• There should be a single separate idea on a chart.

• The arrangement should follow a logical order.

• Five is a good number of charts to put in a flip chart.

c- Leaflet or flyer (handbill)

• Leaflet or flyer is usually a short, often urgent, written message printed

on just one side of single a standard weight paper.
• Once there are more than five sheets it is common to use the term
‘booklets’.
• They can be a useful reinforcement for individual and group sessions and
serve as a reminder of the main points that you have made.

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• 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, booklets or pamphlets are best when they are
brief, written in simple words and understandable language.
• A relevant address should be included at the back to indicate where people
can get further information.
d- Brochure

▪ A brochure is a glorified/modified leaflet.

▪ It is still a single sheet of paper but it's longer, folded up in ½ or
1/3 and printed on both sides.
▪ It can explain things in more detail. It is useful for long-term use
and is less likely to be thrown away.
▪ We can fit more material into a brochure.
▪ Leaflet and brochures are the most common way of using print
media in health education .

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Purpose of flyers and brochures

▪ They are useful reinforcement for individual and group sessions

▪ Serve as a reminder of the main points that you have made.
▪ They are also helpful for sensitive subjects.
▪ Can provide people with enough basic information to encourage
them to ask for more .

The content of the leaflet/brochures should CARE

• C be clear – have something to say and say it

• A be accurate – aim at precise
• R make it readable – use familiar words, and active verbs
• E have empathy – never forget that you are writing for another
person

2- Visual health learning materials

Visual health learning materials include something seen, for example

models, real objects, and photographs. Written words are not included under
visuals. Visuals are one of the strongest methods of communicating messages,
especially where literacy status is low .They are good when they are accompanied
with interactive methods. It is said that a picture tells a thousand words. Real
objects, audio and video do the same. They are immediate and powerful and
people can play with them! For example: If your display is on ‘family planning
methods’, display real contraceptives, such as pills, condoms, diaphragms.

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a- Real objects
• Are just those-real? If your display is on ‘family planning methods’,
you would display real IUDs, pills, condoms, diaphragms, and
foams .
b- Models

Are three dimensional objects which look like the real objects.
Models might be used for 3 reasons:

1. If the real objects are not available

2. If the real object is too big to display.

3. If the real object is too small to be seen easily .

3- Audio Health Learning Materials

Audio Health Learning Materials includes anything heard such as spoken

word, health talk, music, sound, etc.

• Radio and audio cassettes are common

audio aids.
• They are easily forgotten .

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• Radio is a very powerful tool because no other mass media reaches
more people than radio.
• Radio can reinforce the advice that people receive through other
channels .

4- Audio visuals Health Learning Materials

• Audio are multi-sensory materials- combine both seeing and

listening.
• They convey messages with high motivational appeals.
• It show real life situation.
• They may also speed up and enhance understanding or stimulate active
thinking and learning and help develop memory.

• These materials include TV, projected materials, films or videos.

Characteristic of effective health Learning Materials

• Create a distinct look and personality — Effective learning

materials are vivid, having an appealing personality.
• Messages and design all must speak with the same voice — in
design, color, text and narrative.

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• Stress the most compelling benefit. Address real needs and
problems facing the target audience.
• Generate trust. Credible and believable images and a solid
information foundation.
• Appeal to both the heart and the head. Thus, effective health
education materials and messages should be designed to appeal to
both the heart or emotions, and the head or reason.

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Follow up activities:

1-Complete the following questions:

- List three methods of transmitting health information.

------------------------------------------------
------------------------------------------------
------------------------------------------------
-List three teaching aids used for effective communication levels of
disease prevention:

------------------------------------------
-------------------------------------------
------------------------------------------
2-Choose the one best answer to each of the following:

1- Which of the following is a health education method that the people

learn by exchanging their views and experiences?

A. Symposium
B. Work shop
C. Role play
D. Group discussion

2- Which of the following learning material that combine both seeing

and listening for education?

A. Printed Health learning materials

B. Visual Health learning materials
C. Audio Health learning materials
D. Audio-visual Health learning materials

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Teaching and Learning
 Module 5
Teaching and Learning
Teaching and learning

Aim:
Illustrate the concept, types and barriers of learning and differentiate
between teaching and learning.

Learning Objectives:

By the end of this module the student will be able to:

1. Define the teaching.

2. State Key terms of learning domains.
3. List Types of learning.
4. Summarize nature and characteristics of learning.
5. Illustrate barriers of teaching.
6. Apply phases of teaching.
7. Select type of domains suitable for type of learning.
8. Appraise importance of teaching and learning.

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Teaching and Learning
Table of Content

Topic

• Introduction
• Definition of teaching
• Aim of teaching
• Principles of teaching
• Types of teaching
• Phases of teaching
• Teaching environment
• Barriers of client education
• Definition of learning
• Nature and characteristics of learning:
• Types of learning
• Factors influencing learning
• Domains of Learning
• Teaching versus learning

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Teaching & Learning
Introduction

Teaching is an important part of the process of education. Its special

function is to impart knowledge, develop understanding and skill. Teaching is
communication between two or more persons, who influence each other by ideas
and learn something in the process of interaction. Teaching is a process in which
learner, teacher curriculum and other variables are organized in a systematic way
to attain some pre-determined goals.

Teaching includes all the activities of providing education to other. The

basic purpose of teaching is to help clients and families develop the self-care
abilities in the form of knowledge, attitude and skills that enables them to
maximize their functioning and quality of life. When teaching is skillfully used
by nurses, teaching is a power for achieving nursing goals. The nurses assume
the role of teacher in a variety of learners in various settings. They teach clients
and their families in their homes or significant others in the hospital.

Definition of teaching

Teaching is the process of providing a person or groups with the

knowledge and skill necessary to make appropriate choices and decisions.

Teaching can be defined as engagement with learners to enable their

understanding and application of knowledge, concepts and processes. It includes
design, content selection, delivery, assessment and reflection.

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- Through teaching, the teacher aims to:

1- Give some knowledge to the learners

2- Pass some information to them

3- Make the students acquire some skill

4- Change the attitude of the learners

5- Modify the behavior of the learners

6- Give some experiences of life

Principles of teaching:

1- Encourage contact between learners and faculty.

2-Develop reciprocity and cooperation among learners.

3-Encourage active learning.

4-Give prompt feedback.

5-Emphasize time on task.

6-Communicate high expectations.

7-Create an environment that is conductive to learning.

8-Respect diverse talents and ways of learning

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9-Ensure client satisfaction during the teaching-learning process.

10-Determine client’s perception about subject matter before and during

teaching.

Types of teaching

1) Formal teaching:

It is the planned teaching done to fulfill learner objectives. It usually

occurs in a group setting or at a prearranged individual or family appointment.
For example, during a family visit, a nurse might schedule another visit
specifically to discuss technique of breast feeding. Both forms are effective when
the nurse uses them appropriately.

2) Informal teaching:

Most nurse-client interactions result in informal teaching being done by

the nurse. These unplanned teaching sessions are often effective because they
deal with the client’s immediate learning needs and concerns. Informal teaching
often leads to additional planned, formal sessions. It is also occurs during
interactions with individual clients and families in spontaneous, one-to-one
teaching sessions or conferences.

Phases of teaching

Teaching is a complex task. For performing this task, a systematic planning

is needed. Teaching is to be considered in terms of various steps and the different
steps constituting the process are called the phases of teaching.
If we want to obtain a complete description of the teaching activities, we must
consider what the teacher does before and after his regular teaching in the class.

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The teaching can be divided into three phases

a) Pre active phase

In pre-active phase of teaching, the planning of teaching is carried over.

This phase includes all those activities which a teacher performs before class-
room teaching or before entering the class-room.

Suggested activities in the pre active phase

1) Determining goals / objectives

2) Selection of the content to be taught

3) Sequencing the elements of content for presentation

4) Selection about the instructional methodology

5) Decision about the strategies of teaching.

6) Distribution of teaching strategies.

b) Interactive phase of teaching

The second phase includes, the planning of teaching is carried over. This
phase includes all those activities which a teacher performs before class-room
teaching or before entering the class-room.

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The following activities are suggested for the inclusion in the inter-active
phase:

1) Sizing up of the class

2) Diagnosis of the learners

3) Abilities of the learners

4) Interests and attitudes of learners

5) Academic background of learners

c) Post active phase

The post active phase concerns with the evaluation activities. This can be
done in a number of ways including tests or quizzes or by observing learners
reaction of questions verbally or written form, comments. So that their
achievements may be evaluated correctly.

The following activities are suggested in the post active phase

1) Defining the exact dimensions of the changes caused by teaching.

2) Selecting appropriate testing devices and techniques.

3) Changing the strategies in terms of evidences gathered.

Teaching Environment

There are several factors of physical learning environments that affect the
teaching experience. These factors include: space, temperature, visual, auditory
and olfactory stimuli, equipment, resources, furniture arrangement, physical
comfort and time. If the space in which the teaching is to take place is too small,
the client may find the closeness uncomfortable. If the instruction is to occur in
a public place, such as a waiting room, privacy may be lacking and noise
intrusive. An environment that is too hot or too cold would constitute a

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distraction in the form of the related physical discomfort. The nurse can solicit
the help of the client in creating a suitable teaching environment

Barriers of client education:

1. Shortage of time

2. Lack of proper communication between learners and teacher

3. Lack of access to the conference room

4. Poor educational planning

5. Lack of suitable motivation in trainers

6. Being unfamiliar with educational methods

7. Uncooperativeness of the patient and neglecting education

Teaching methods for each leaning domain

Teaching is directed toward one or more of the three learning domain that
mentioned in the nature of learning. The domains are cognitive, psychomotor
and affective.

Cognitive learning:

Methodologies appropriate for cognitive learning include lectures or

discussion, group discussion, audio-visual materials, printed materials,
games, computer assisted programs, and modules. These methods support
teaching that is focused on transmitting information and changing behaviors
as a result of greater mental understanding.

Psychomotor domain:

Teaching of psychomotor skills to perform procedures, treatment or

health behaviors independently. Demonstrations, audio-visual materials,

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practice times, games, role-playing and peer teaching represent effective
teaching modes for this area.

Affective domain:

Learning the affective domain involves a changing in attitudes or

emotions that will affect behaviors. Suggested teaching methods include
group discussion, simulations, role-playing and field experiences.

The teacher can evaluate the effectiveness of the teaching-learning in all

domains by written or oral testing, demonstrations, observation, self-reports,
printed materials and self-monitoring. Teaching methods for one domain may
overlap with teaching methods for another domain.

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Learning

Introduction

The term learning originated from the Old English word “leornian” which
is translated as “to get knowledge” or “to think about”. Indeed, people learn by
getting new knowledge and when they gain insights from thinking about
something. Specifically, learning is the acquisition of new information or the
modification of existing knowledge, preferences, expertise, and other aspects of
behavior.

Definition of learning
Learning is the process of acquiring new, or modifying existing,
knowledge, behaviors, skills, values, or preferences

Nature and characteristics of learning:

1. Learning is the change in behavior.

2. Learning is a continuous life long process.
3. Learning is a universal process.
4. Learning is purposive and goal directed.
5. Learning involves reconstruction of experiences.
6. Learning is the product of activity and environment.
7. Learning is transferable from one situation to another.
8. Learning helps in attainment of teaching – learning objectives.

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9. Learning helps in the proper growth and development.
[Link] helps in the balanced development of the personality.
[Link] helps in proper adjustment.

[Link] helps in the realization of goals of life.

[Link] does not necessarily imply improvement.
Specifically, learning is the acquisition of new information or the
modification of existing knowledge, preferences, expertise, and other aspects of
behavior.

The following are other criteria of learning:

1. More or less permanent change:

Genuine learning is characterized by an individuals’ change in

behavior which lasts for a fairly long time. For instance, students who get zero
in a quiz or test are often perceived to have not learnt anything from the
lessons as the new knowledge was not retained after the teaching process.
2. Positive or negative

Ideally, an individual should change positively after being taught.

However, it is a well-known fact that negative behaviors are commonly
learned.
3. Brought about by experience

It should also be noted that learning is not due to passive causes such
as illness, maturation, and injury.
Types of learning

1. Motor learning:

Most of our activities in our day-to-days life refer to motor activities.

The individual has to learn them in order to maintain his regular life, for

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example walking, running, skating, driving, climbing, etc. All these activities
involve the muscular coordination.

2. Verbal learning:

This type of learning involves the language we speak, the

communication devices we use. Signs, pictures, symbols, words, figures,
sounds, etc, are the tools used in such activities. We use words for
communication

3. Concept learning:

It is the form of learning which requires higher order mental processes

like thinking, reasoning, intelligence, etc. we learn different concepts from
childhood. For example, when we see a dog and attach the term ‘dog’, we
learn that the word dog refers to a particular animal. Concept learning
involves two processes, viz. abstraction and generalization. This learning is
very useful in recognizing, identifying things

4. Discrimination learning:

Learning to differentiate between stimuli and showing an appropriate

response to these stimuli is called discrimination learning. Example, sound
horns of different vehicles like bus, car, ambulance, etc.

5. Learning of principles:

Individuals learn certain principles related to science, mathematics,

grammar, etc. in order to manage their work effectively. These principles
always show the relationship between two or more concepts. Example:
formulae, laws, associations, correlations, etc.

6. Problem solving:

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This is a higher order learning process. This learning requires the use
of cognitive abilities-such as thinking, reasoning, observation, imagination,
generalization, etc. This is very useful to overcome difficult problems
encountered by the people.

7. Attitude learning:

Attitude is a predisposition which determines and directs our behavior.

We develop different attitudes from our childhood about the people, objects
and everything we know. Our behavior may be positive or negative
depending upon our attitudes. Example: attitudes of nurse towards her
profession, patients,

Factors influencing learning:

1- Learner related factor

2- Learner’s physical and mental health
3- The basic potential of the learner
4- The level of aspiration and achievement motivation
5- Goal of life
6- Readiness and will power.
7- Teacher Related Factor
8- Mastery over the subject matter
9- Art and skill teaching
10- Personality traits and behavior of the teacher
11- Level of adjustment and mental health of the teacher
12- Type of discipline and interaction maintained by the

Domains of Learning

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There are three main domains of learning and all teachers should know
about them and use them to construct lessons. These domains are cognitive
(thinking), affective (emotion/feeling), and psychomotor (physical/kinesthetic).

Figure: three main domains of learning

Key terms:-

• The cognitive domain outlines the progression toward acquiring intellect.

• The affective domain describes the development of values, emotions, and
attitudes.
• The psychomotor domain defines the processes involved in motor skill
development.
Cognitive domain include:-

• Involves intellectual abilities

• Refers to process of thinking
• Learning takes place in the head
• Not necessarily observable events
Affective domain include:-

• Interests, feelings, attitudes and values fall into this category

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• Humanistic theories focus on this domain
Psychomotor domain include: -

• Involves Psychomotor functions of the human body

• Ability to use hands, arms, legs and body
• External movements
Levels of Learning domains: -

• Cognitive domain
- Knowledge
- Comprehension
- Application
- Analysis
- Synthesize
- Evaluation
• Affective domain
- Receiving -like to become aware of something
- Responding-active participation
- Valuing -accept that it is important
- Organizing -bring together different values (compare, complete, modifies)
- Characterization –practices cooperation in group activities
• Psychomotor domain
- Perception-use of the sense organs
- Set-readiness to take a particular type of action
- Guided response-imitates the specific skills
- Mechanism-increased confidence and proficiency in the new skill
- Complex overt response - quick, smooth, accurate performance
- Adaptation-well developed skills
- Origination-creating new movement patterns

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Teaching versus learning

Teaching and learning are vital processes in survival as they comprise the
very foundations of growth. Both of these methods are necessary in achieving
development by seeking to actualize significant changes in behaviors.

Equally, they have various styles and theories that guide the education
system. They are also essentially interconnected in a way that you have to learn
something before you can actually teach it and that the act of teaching can make
you learn something. Teaching and learning are highly crucial and related
progressions.

Differences between Teaching and Learning

1. Goal of teaching and learning

The primary goal of teaching is to impart knowledge and to monitor

change in behavior while learning aims to understand and apply knowledge. A
teacher seeks to share what he knows whereas a learner intends to receive new
information.

2. Authority in teaching and learning

As compared to learners, the teachers possess higher authority.

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3. Dependence in teaching and learning

For the teaching process to be actualized, teachers need to have students

as recipients of novel knowledge. On the other hand, learners do not always need
teachers to learn something as mere solitary experiences can bring about
realizations; hence, learning.

4. Expertise in teaching and learning

Teaching is characterized by a higher level of expertise as compared to learning.

5. Curiosity in teaching and learning

The learning process is improved by piquing students’

curiosity. Alternatively, the teaching process is improved by looking for a way
to arouse learners’ curiosity.

6. Feedback in teaching and learning

Generally, teaching helps others by observing and aptly pointing out which
behaviors should be retained and altered while the learning undertaking is
marked by being able to understand the feedback as well as apply it to future
behavior.

7. Extent (with respect to existence) of teaching and l earning

Largely, learning is possible until our last breath. As for teaching, people
can still learn from the teachings of someone who has already passed away.

8. Directive in teaching and learning

Essentially, learning cannot be mandated. Students are directed to study

but the act of learning is more of an internal process. On the contrary, teaching
can be assigned and verified through syllabi, lesson plans, curricula, and the like.

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9. Population in teaching and learning

As compared to learners, the population of teachers is often less. There are

usually fewer individuals involved in the teaching process than those at the
learning end.

10. Autonomy in teaching and learning

The teaching course is more imbued with autonomy as compared to the

learning exercises. For instance, students usually have to ask the permission of
the teacher before engaging in a certain class-related behavior.

11. Performer of teaching and learning

In a typical classroom setting, the act of facilitating the lessons is

performed by the teacher while the learners are responsible for acquiring
knowledge.

12. Consciousness in teaching and learning

Most often, the teaching process is a conscious task while learning can be
conscious as well as unconscious. For example, we usually learn to fear
something from a negative experience from the past especially during childhood.

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Follow up activities:

1-Complete the following questions:

-List the difference between formal teaching and informal teaching.

……………………………………………………………………………
……………………………………………………………………………
……………………………………………………

- List three barriers of client education.

……………………………………………………………………………
……………………………………………………………………………
……………………………………………………

- List what are the types of learning.

……………………………………………………………………………
……………………………………………………………………………
……………………………………………………

- Illustrate three factors influencing learning.

……………………………………………………………………………
……………………………………………………………………………
……………………………………………………

2-Choose the one best answer to each of the following:

1. At the knowledge level students will:

a. Argue the point
b. Recall information
c. Categorize topics
d. Calculate distances

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2. What questions would you ask Nelson Mandela in an
interview? What level of domains is this question?
a. Application
b. Analysis
c. Evaluation
d. None of the above
3. What ways could you change the plot of the story? Is this question
a. Synthesis
b. Comprehension
c. Knowledge
d. Application
4. Infer, follow, interpret, summarize, demonstrate, cite and interpolate
are all verbs representing what level
a. Application
b. Knowledge
c. Synthesis
d. Comprehension

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Ethical issue in Health Education
 Module 6
Ethical issue in Health Education
Ethical Issue in Health Education
Aim:

Explain basic principles of nurse ethics and responsibility to provide patient

education to each and every patient regardless of their beliefs and values, or
educational back ground.
Learning objectives:
By the end of this module the student will be able to:
• Define ethics and principles of ethics.
• List basic principles of ethics.
• Explain the elements of code of ethics.
• Apply principles of ethics on your practice.
• Explain Patient’s Bill of Rights.
• Utilize ethics and legality of health education to make patient self-
dependence in his / her clinical decisions and informed consent.

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Table of Content

Topic page

Introduction

Element of international code of ethics for nurse

Patient’s Bill of Rights

Basic principles of ethics:

Health Education about informed consent

Who may consent to treatment

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Ethical Issues in Health Education

Introduction
Ethical and legal aspects of human rights justify patient teaching,
particularly as teaching relates to self – determination and informed consent. The
role of the nurse as teacher is evident through the definition of nursing found in
the nurse act in the states where nurses reside and practice.
From a profession point of view, ethical behavior is expected from
professionals. Ethical conduct is particularly important for health educators,
since they are working with a mission to serve the individual.

Ethics is the philosophical study of the moral value of human conduct and
the rules that govern it. It is the right thing to do for society and self. Moral refers
to those beliefs about how people ought to behave.

An international code of ethics for nurse was first adopted by the

International Council of Nurses (ICN) in 1953.
The nurse has a legal responsibility to provide patient education to each
and every patient regardless of their beliefs and values, or educational back
ground.

An international code of ethics for nurse was first adopted by the International
Council of Nurses (ICN) in 1953. It has been revised and reaffirmed at various
times since, most recently with this review and revision completed in 2005.
Nurses have four fundamental responsibilities: to promote health, to
prevent illness, to restore health and to alleviate suffering. The need for nursing
is universal. Inherent in nursing is respect for human rights, including cultural
rights, the right to life and choice, to dignity and to be treated with respect.
Nursing care is respectful of and unrestricted by considerations of age, color,
religion, culture, disability or illness, gender, nationality, race or social status.

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Elements of the code

1. Nurses and people

• The nurse’s primary professional responsibility is to people requiring
nursing care. In providing care, the nurse promotes an environment in
which the human rights, values, customs and spiritual beliefs of the
individual, family and community are respected.
• The nurse ensures that the individual receive sufficient information on
which to base consent for care and related treatment.
• The nurse shares with society the responsibility for initiating and
supporting action to meet the health and social needs of the public, in
particular those of vulnerable populations.
• The nurse also shares responsibility to sustain and protect the natural
environment from depletion, pollution, degradation and destruction.
2. Nurses and practice
• The nurse carries personal responsibility and accountability for nursing
practice, and for maintaining competence by continual learning.
• The nurse maintains a standard of personal health such that the ability to
provide care is not compromised.
• The nurse uses judgment regarding individual competence when accepting
and delegating responsibility.
• The nurse, in providing care, ensures that use of technology and scientific
advances are compatible with the safety, dignity and rights of people.

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3. Nurses and the profession
• The nurse assumes the major role in determining and implementing
acceptable standards of clinical nursing practice, management, research
and education.
• The nurse is active in developing a core of research-based professional
knowledge.
• The nurse, acting through the professional organization, participates in
creating and maintaining safe, equitable social and economic working
conditions in nursing.
4-Nurses and co-workers
• The nurse sustains a co-operative relationship with co-workers in nursing
and other fields.
• The nurse takes appropriate action to safeguard individuals, families and
communities when their health is endangered by a co-worker or any other
person.
Patient’s Bill of Rights

In 1972 the American Hospital Association (AHA) issued a “statement on

patient’s Bill of Rights”. The statement listed 12 patients’ rights:

1. The patient has the right to considerate and respectful care.

2. The patient has the right to obtain from his/her physician complete
current information concerning his/her diagnosis, treatment, and
prognosis

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3. The patient has the right to receive from his/her physician information
necessary to give informed consent prior to the start of any procedure
and/or treatment, except in emergencies.
4. The patient has the right to refuse treatment and to be informed of the
medical consequences of his/her action.
5. The patient has the right to every consideration of his/her privacy
concerning his/her own medical care program.
6. The patient has the right to obtain information as to any relationship of
the hospital where he/she is treated; to educational institutions insofar as
his/her care is concerned.
7. The patient has the right to expect that all communications and records
pertaining to his/her care should be treated as confidential.
8. The patient has the right to be advised if the hospital engages in or
performs human experimentation affecting his/her care or treatment.
9. The patient has the right to refuse to participate in such research projects.
(ethical consideration)
[Link] patient has the right to expect reasonable continuity of care.
[Link] patient has the right to examine and receive an explanation of his/her
bill regardless of source of payment.
[Link] patient has the right to know what hospital rules and regulations
apply to his/her conduct as a patient.

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Basic principles of Ethics:

o Non-maleficence (“First...Do No Harm”; If you cannot “help” them, at

the very least do not harm them.)
o Beneficence (“Do Good”; put the patient’s interests first...even above
your own)
o Autonomy (The patient has the right to make an “informed” decision
without being pressured.)
o Fidelity (“Be True”; confidentiality; differentiate between their wishes &
your own)
o Justice (“Fair to All”; treat all patients the same whether or not you hold
the same values or beliefs; do not judge them).
1. Autonomy
• Autonomy literally means self-control or self-determination.
• Autonomy means that people have the freedom to choose whether or not
to seek and accept health care.
• It also implies that people have the right to refuse treatment, and to do so
even if that treatment is life-saving.
• Although health teaching is not directly mentioned in the principle of
autonomy,

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• It is an important part of ethical concept of assisting people to gain more
independence to avoid illness, and to keep them well.
• In fact, all nurse practices address patient teaching as a legal responsibility
of the registered nurse.
2. Veracity and Truth-Telling
• Veracity is honesty.
• The duty of veracity correlates with the patient’s right to know and
includes a strong obligation not to lie or deceive.
• There is a difference between telling the truth in all cases and altering the
truth in those cases in which the facts may be harmful.
• The Patient’s Bill of rights affirms that “the patient has the right to obtain
from his physician or care giver complete information concerning his/her
diagnosis, treatment and prognosis in terms the patient can reasonably be
expected to understand”. However, that same clause continues, “when it is
not medically advisable to give such information to the patient, the
information should be made available to an appropriate person on his
behalf”
3. Beneficence
• Beneficence in Latin means “good”, and means “to do or make”
• Beneficence means “to do good”.
• The principle of beneficence means that we should always do good for the
patients.
• The principle of beneficence means that we should always providing
adequate and up – to – date patient teaching.
• The act of beneficence validates the nurse's commitment to do what is in
the best interest of the patient, emphasizing patient safety and providing
sufficient information to allow for optimal independence in self –care.

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4. non-maleficence:
• The principle of non-maleficence is the opposite of the principle of
beneficence.
• Non means “not” and mal means “bad”.
• Non-maleficence means “not to do or inflict harm”.
5. Justice
• It states that everyone is entitled to equal care.
• Justice is an ethical principle regulating the distribution of social benefits
and burdens.
• The principle of justice is an easy concept to define but is a difficult one
to carryout.
6. Equity and equality in health care
• The right to equal access to health care raises questions of distributive
justice and how benefits and burdens ought to be distributed.
Health Education about informed consent
Informed consent means that clients must receive adequate information
about their illnesses and proposed treatments. Informed refers to information
given to the patient about a proposed procedure or treatment. Consent refers to
the patient’s agreement to the procedure or treatment.
Patient Consent
-General (implied) consent = you came to the hospital because you were
seeking treatment
-Informed Consent= patient knows: diagnosis, purpose of treatment, expected
outcomes, alternatives, who will do treatment, prognosis if treatment is not
done, & patient has had questions answered (done by physician)
-Authorized consent= Parents authorize treatment for their children and also
consent, also mentally ill, their parents authorize treatment and consent

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Implied consent
Many of the nursing procedures are performed through implied consent
which occurs when the patient has had the nursing procedure explained and the
patient’s actions, such as exposing an injection site, indicating a willingness to
proceed. The more intrusive the procedure, the greater likelihood that a written
and signed consent form will be in the client’s and nurse’s best interest.
Who may consent to treatment?
Generally, it is the patient who decides whether or not to consent to
treatment or procedure.
This general proposition assumes two things:
o Patient is competent to consent to treatment.
o An emergency situation is not present.

For patients who are legally incompetent e.g., minors or comatose, an

authorized person (guardian) may consent to or refuse treatment on the
patient’s behalf (substitute consent). Medical or surgical emergencies a
doctor can legally provide immediate treatment without consent to save a
patient’s life or to prevent loss of an organ, a limb, or a function if the patient
is unconscious or, in the case of a minor, if the family cannot be reached.
- These exceptions do not apply if:
(a) the doctor knows that the patient has previously indicated that he/she
would refuse such treatment, and if
(b) the doctor can wait for a proper consent from the patient or her/her
family without increasing the patient’s risk.

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Follow up activities:
1-Complete the following questions:

• Enumerate three basic principles of ethics in health education:

--------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------
---------------------------------------------------------------------------
• Enumerate three patient rights.
--------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------
---------------------------------------------------------------------------
• Ethics means…………………………..
2-Choose the one best answer to each of the following:

• Providing equality of resources and opportunity for all people upholds

the ethical principle of: …………………….
a. Veracity .
b. Autonomy .
c. Beneficence .
d. Justice.

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 Module 7
Counseling in Health Education
Counseling in health education

Aim:

Describe the concepts of counseling and appraise its importance as a method

of health education.

Learning Objectives:

By the end of this lecture the student will be able to:

1. Explain the key concept of counselling.

2. Differentiate between counselling and advice.
3. Determine the importance of counselling.
4. Illustrate steps of counseling.
5. Identify types of counselling.
6. Apply characteristics of an effective counsellor.
7. Recognize rules for counselling.
8. Explain Function approaches to counselling.
9. Practice Counselling guidelines and its process.

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Table of Content

Topic

Introduction

Definition of counseling

Difference between counseling and advice.

Who are counselors?
Importance of counseling

Steps of counseling

Counseling process

Types of counseling

Who is the user of counseling skills?

Characteristics of effective counselor

Rules for counseling

Approaches to counseling

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Counseling in health education

Introduction

Counseling is one of the educational methods most frequently used in

health education to help individuals and families. During counseling, a person
with a need (the client) and a person who provides support and encouragement
(the counselor) meet and discuss in such a way that the client gains confidence
in his or her ability to find solutions to their problems.

Counseling is often performed face to face in confidential sessions

between the counselor and client(s). However, counseling can also be undertaken
by telephone, in writing and, in these days of the Internet, by email or video
conferencing. It can therefore be seen that counseling can be of benefit to a
person experiencing problems in finding, forming, and maintaining relationships.

Definition of counseling

Counseling (one-to-one communication) is a helping

process where one person explicitly and purposefully gives his
or her time to assist people to explore their own situation, and
act on a solution.

It is the process of assisting and guiding clients,

especially by a trained person on a professional basis, to
resolve especially personal, social, or psychological problems and difficulties.”

It is the ability to listen and respond in a way that will help others solve
their own problems and attain their potential. It is the art of helping others arrive
at the right answer by their own analysis of the situation and the facts. It has to
be done skillfully without an attempt to influence the values and beliefs of the
client.

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Difference between counseling and advice

Counseling is not advice — it is a helping process in which people are

helped to make choices.

Advice — is usually based on opinions or suggestions about what could

be done about a situation or problem. It is an opinion given by someone who is
considered to be an expert. With advice, the decision is made by the health
worker — and then the clients are expected to follow that decision. In counseling,
the decisions are made by the clients themselves.

Who Are Counselors?

• Counselors are trained in helping

others to work through the problems.
They help people to determine the root
cause of e.g. addiction or behavioral
issues and focus on healing. They can
guide and direct people through a variety of situations and help them to
focus on what really matters.
• Counselors also help people determine which career they are interested
in and how to plan their education and job search. They guide the
person through the required education and studies and the testing
process as well as the interview process and landing the job.
• There are also other issues that counselors are helpful in such as
guidance, employment, and how to deal with such issues as depression
or feelings of anxiety. Everyone needs a little bit of help now and again.
It doesn’t make a person stupid, bad or dumb or weak to require a
counselor; it is a brave step to resolving problems.

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Importance of counseling

• There are many reasons for the importance of counseling. As the world
becomes busier and busier, the need for counseling increases. People are
faced with many challenges in life, can be very isolated, need trauma
counseling or just need support. Add to this list the need for addiction
counseling, depression, mental and behavioral health and you have a many
of reasons for the need of counseling.
• Counseling may help those who are struggling in the world. They may
help them to deal with personal issues such as loss of a job or a divorce.
This can be a very stressful time for anyone. A counselor can help the
person to get back on their feet and feel empowered and stronger than ever.
Counseling may help the person to let go of the past and start over without
feeling guilty.
• The counselor may help an addict or alcoholic to give up their drug of
choice and their drinking in an effort to lead a normal life. They may help
guide the person through the difficult transition of going from addict to
functional person in society. Not all addicts or alcoholics are bad, many
have had serious issues in getting to where they are at and just need a bit
of encouragement and help to make it back up to the top.
• Counselors will focus on individual treatment as well as group therapy to
help others in similar situations. The field of counseling offers up many of
great opportunities to help others lead a healthy, happy, and normal life.
There are positions from working with children in hospital settings to
working in more public settings.
Steps of counseling

1. Helping the person to identify his or her problem

2. Helping the person to discover the cause of the problem
3. Encouraging the person to look at several possible solutions to the problem

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4. Encouraging the person to choose the most appropriate solution.

Counseling process

The counseling
process is a planned,
structured dialogue between
a counselor and a client. It is
a cooperative process in
which a trained professional
helps a person called the
client to identify sources of
difficulties or concerns that
he or she is experiencing.
Steps in counseling process:

o Establishing rapport
and relationship
o Assessing or defining of the presenting problem
o Identifying and setting the goals
o Choosing and initiating interventions
o Planning and introducing termination and follow up.
Types of counseling

• Directive counseling
• Non directive counseling /client centered counseling
• Short term counseling
• Long term counseling
• Psychological counseling
• Clinical counseling

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• Student counseling
• Placement counseling
Who uses counseling skills?

Counseling skills are really ‘the art of listening’ and are practiced by any
number of people in any number of work roles, not just in counseling.
Some professions where counseling skills would be useful such as:

• Nursing
• Social work
• The medical profession
• Police and Ambulance service to name a few

Characteristics of an effective counselor

1. Communication Skills
Effective counselors should have excellent communication skills.
Counselors need to be particularly able to listen effectively, giving their full
attention to the client. They need to be aware of body language and other non-
verbal communication. Clients will often communicate far more non-verbally
than verbally, so this is an important area of skill. They will also use reflection to
show that they have heard the client, and to validate the client’s feelings and
words.

2. Acceptance
Being nonjudgmental and accepting are important attributes in any of the
helping professions. But professional counselors must be able to "start where the
client is at." This phrase is often used in counseling to describe the ability to
relate to clients with an open, nonjudgmental attitude – accepting the client for
who she is and in her current situation. Counselors need to be able to convey
acceptance to their clients with warmth and understanding.

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3. Empathy
This means that they are aware of their client’s feelings and emotions.
Counselors help people through some of the most difficult and stressful times of
their lives. They must be able to display empathy – the ability to feel what another
person is feeling. Empathy means that you are truly able to imagine what it's like
to stand in someone else's shoes. Compassion and empathy help your clients feel
understood and heard.

4. Problem-Solving Skills
It's not up to a counselor to solve her clients' problems, no matter how
much she might want to help. But counselors must have excellent problem-
solving skills to be able to help their clients identify and make changes to
negative thought patterns and other harmful behaviors that might be contributing
to their issues.

5. Rapport-Building Skills
Counselors must possess a strong set of interpersonal skills to help
establish rapport quickly with clients and develop strong relationships. They
must give their undivided attention to clients and be able to cultivate trust.
Counselors need to be able to place all of their focus on what their clients are
saying and avoid being distracted by their own personal problems or concerns
when they are in a session.

6. Flexibility
Flexibility in counseling is defined as the ability to adapt and change the
way you respond to meet your clients' needs. You don't stay rigid and stick to a
predetermined treatment path when your clients require a different approach.
Being flexible is one of the most important attributes of a professional counselor.

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7. Self-Awareness
Self-awareness is the ability to look within and identify your own unmet
psychological needs and desires, such as a need for intimacy or the desire to be
professionally competent. This ability prevents your issues from affecting or
conflicting with those of your clients.

8. Multicultural Competency
Counselors help people from all walks of life. They must display
multicultural competency and adopt a multicultural worldview. Multicultural
competency means that you try to relate to and understand your clients regardless
of their race, ethnicity, religious or political beliefs or socioeconomic
background.

9. Knowledgeable
Counselors should have good knowledge on the topic /problem e.g.
compliance to medication. Some people do not take medication for one reason
or the other, while others demand drugs/medication.

10. Confidentiality
The patient/client would feel greatly offended if you disclose any
information about him or her to other people. This means that counseling must
be done individually and privately.

Rules for counseling

- Good relationships: A counsellor must build a good relationship from the

beginning with the person they are trying to help.

-Feelings: A counsellor should develop empathy (understanding and acceptance)

for people’s feelings, not sympathy (sorrow or pity). The counsellor’s task is to
listen carefully. Empathy is the ability to imagine yourself in someone else’s
situation so you can get a better sense of what they are feeling and experiencing.

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It involves understanding the client’s verbal and emotional behaviour. It requires
comprehending another person’s feelings, emotions and perspective, rather than
imposing your own.

-Identifying needs: A counsellor seeks to understand a problem as the client sees

it from their point of view. The clients must identify their own problems for
themselves. The use of open questions will help here, not just those questions
requiring a yes or no answer.

-Participation: As a counsellor you should work with the clients towards finding
their own solution. A counsellor should never try to persuade people to accept
their advice.

-Privacy and confidentiality: Information that you might gather during your
work, especially during counselling, must be kept secret from all other people,
even from the client’s relatives. The places where you do counselling should be
arranged in such a way that no one can listen to your private discussions.

-Provide information: Although counsellors do not give advice, as a health

worker you should share information and ideas on resources which the clients
may need in order to make an informed decision.

Approaches to counseling

Some counselors use the ‘GATHER’ approach to counseling and find it

effective.

• Greet: the individual people you are working with by name: show
respect and trust; tell them that the discussion is always confidential.
• Ask: about their problems as well as listening to any measures they
have already taken to solve the problem. Ask them how they believe
that you can help them.

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• Tell: them any relevant information that they need to know.
• Help: them to make their own decisions and guide them to look at
various alternatives. Help them to choose solutions which best fit
their own personal circumstances.
• Explain: any misunderstandings. Ask some questions in order to
check your understanding of important key points and repeat those
key points in their own words if necessary.
• Return: for follow-up and make arrangements for further visits, or
referral to other agencies. If a follow-up visit is not appropriate then
you should give them the name of someone they can contact if they
need help

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Follow up activities:
1-Complete the following questions:

- Enumerate approaches to counselling

..………………………………………………………………
.………………………………………………………………
……………………………………………………………….
-State the rules of counselling.
..………………………………………………………………
.………………………………………………………………
……………………………………………………………….
2-Choose the one best answer to each of the following:

1-Counselors need to be particularly able to listen effectively, giving their

full attention to the client. This statement best describe which characteristic
of good counselors:-
a. Acceptance
b. Empathy
c. Problem-Solving Skills
d. Communication
2- The ability to feel what another person is feeling. This characteristic is
related to:-

a. Problem-Solving Skills
b. Rapport-Building Skills
c. Empathy
d. Knowledgeable

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Health Education and Health Promotion
 Module 8
Health Education and Health Promotion

Health Education and Health Promotion

Aim:

Recognize the relationship between health education and health promotion and
apply basic strategies for health promotion through health education.

Learning Objectives:

By the end of this lecture the student will be able to:

1. Define important terms related health education and health promotion.

2. Identify health promotion priority areas
3. Select basic strategies for health promotion
4. Summarize purpose of health education
5. Compare between health education and health literacy
6. Illustrate health promotion overlapping components
7. Assemble suitable setting for health education.
8. Examining the relationship of health education and health promotion
9. Analyze lifestyles conducive to health
10. Relate criteria of health literate person

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Table of Content

Topic

Definition of health education and related terms

Three basic strategies for health promotion

Health promotion priority areas

The relationship between health education and health promotion

Health promotion overlapping components (Health promotion

model)

Health education settings

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Introduction

Health:

The WHO Constitution of 1948 defines health as a state of complete physical,

social and mental well-being, and not merely the absence of disease or
infirmity. In addition, the Ottawa Declaration states an individual or group
must be able to identify and realize aspirations, to satisfy needs, and to change
or cope with the environment.

Health is, therefore, seen as a resource for everyday life, not the objective of
living. Health is a positive concept emphasizing social and personal resources,
as well as physical capacities.

Figure 1: concept of Health

Wellness:

The optimal state of health of individuals and groups; involves the realization
of the fullest physical, psychological, social, spiritual and economical
potential of an individual: the fulfillment one’s role expectations in the family,
community, place of worship, workplace and other settings.

Health Education:

WHO health promotion glossary describes health education as not limited to

the dissemination of health-related information but also "fostering the

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motivation, skills and confidence (self-efficacy) necessary to take action to
improve health'', as well as "the communication of information concerning the
underlying social, economic and environmental conditions impacting on health,
as well as individual risk factors and risk behaviors, and use of the health care
system."

Health education 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.

Figure 2: WHO, definition of health education

So, A broad purpose of health education:

Is not only to increase knowledge about personal health behavior but also to
develop skills that “demonstrate the political feasibility and organizational
possibilities of various forms of action to address social, economic and
environmental determinants of health.”

Health Literacy:

The degree to which people are able to access, understand, appraise and
communicate information to engage with the demands of different health
contexts in order to promote and maintain good health across the life-course.

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A health literate person is one who:

✓ Can think things through and make health choices in solving his/her own
problems as well as family member problems.
✓ Is responsible and makes health choices that benefit him/her and family
members.
✓ Is in charge of his/her own health learning and teaches family members to
do the same.
✓ Can use communication skills to express needs, questions and concerns
to health care providers and staff.
Lifestyle (lifestyles conducive to health):

WHO defines lifestyle as a way of living based on identifiable patterns of

behavior which are determined by the interplay between an individual’s
personal characteristics, social interactions, and socioeconomic and
environmental living conditions.

Figure 3 Lifestyle

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Quality of Life:

An individual’s perceptions of their position in life in the context of the

culture and value system where they live, and in relation to their goals,
expectations, standards, and concerns.

Primary Health Care:

Essential health care based on practical, scientifically sound and socially

acceptable methods and technology made universally accessible to
individuals and families in the community through their full participation and
at a cost that the community and country can afford.

In many countries primary health care involves incorporating curative

treatment given by the first-contact provider along with promotional,
preventive and rehabilitative services provided by multidisciplinary teams of
health care professionals working collaboratively.

Prevention:

Prevention is defined as "anticipatory action taken to reduce the likelihood of

some future undesired event or condition or to increase the likelihood of some
future desired event or condition". Disease prevention covers measures not only
to prevent the occurrence of disease, such as risk factor reduction, but also to
arrest its progress and reduce its consequences once established

Health Promotion:

Is the process of enabling people to increase control over, and to improve,

their health.

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Three basic strategies for health promotion

These are:

1. Advocacy for health to create the essential conditions for health indicated
above ;

2. Enabling all people to achieve their full health potential ;

3. Mediating between the different interests in society in the pursuit of

health.

Health Promotion Priority Areas:

Figure 4 Health promotion priority areas

1- Create supportive environments: Ensure physical and social

environments support people’s abilities to live healthy lives. Make
healthy choices the easy choices.
2- Strengthen community action: Support activities that increase groups’
abilities to organize around and act upon those things in their physical and
social environments that affect health.

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3-Develop personal skills: Enable people to learn throughout life and prepare
themselves for all its stages. Skill areas may encompass personal/familial or
group dynamics, organizing, political action and social analysis.

4-Build healthy public policy: Most health determinants lie outside the
medical/illness sector (income, housing, environmental protection, work,
agriculture). These sectors must begin to take conscious accounting of the
health impacts of their policies. Health must be on the agenda of all policy-
makers.

The Relationship between Health Education and Health Promotion

Health promotion is concerned with improving health by seeking to

influence lifestyles, health services and, above all, environments (which are
not limited to the physical environment but encompass as well the cultural
and socioeconomic circumstances that substantially determine health status).
There are several recognized definitions of health promotion, most of which
embrace the tenets of health, community participation and individual
empowerment.

Health Promotion Comprises Three Overlapping Components:

• Health education,

• Health protection and

• Prevention.

These overlapping areas, as illustrated in Figure 5, are potentially substantial.

For example, includes educational efforts to influence lifestyles that guard
against ill-health as well as efforts to encourage participation in prevention
services.

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Figure 5 Health promotion model.

Health protection addresses policies and regulations that are preventive in

nature, such as fluoridation of water supplies to prevent dental caries. Health
education aimed at health protection measures among the public and policy-
makers. The combined efforts of all three components stimulate a social
environment that is conducive to the success of preventive health protection
measures such as intensive lobbying for seat-belt legislation.

WHO describes health education as not being limited to the dissemination of

health-related information but also “fostering the motivation, skills and
confidence (self-efficacy) necessary to take action to improve health” as well
as “the communication of information concerning the underlying social,
economic and environmental conditions impacting on health, as well as
individual risk factors and risk behaviors, and use of the health care system ”.

A broad purpose of health education therefore is not only to increase

knowledge about personal health behaviors but also to develop skills that
“demonstrate the political feasibility and organizational possibilities of
various forms of action to address social, economic and environmental
determinants of health”.

Health promotion = health education × healthy public policy

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Health education, according to this formula, focuses on building
individuals’ capacities through educational, motivational, skill-building and
consciousness-raising techniques .

Healthy public policies provide the environmental supports that will

encourage and enhance behavior change.

By influencing both these intrinsic and extrinsic factors, meaningful and

sustained change in the health of individuals and communities can be realized.

Health Education Settings

Health education occurs in many settings, including the following:

Figure 6 Health education settings

❖ In schools health educators teach health as a subject and promote and

implement coordinated school health programs, including health
services and student, staff and parent health education; and promote
healthy school environments and school–community partnerships. At
the school district level they develop education methods and materials;
coordinate, promote and evaluate programs and write funding

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proposals. A health education component should be incorporated into
both basic and continuing teacher training, regardless of subject.
❖ College/university campus health educators are part of a team effort
to create an environment in which students feel empowered to make
healthy choices and create a caring community. They identify needs,
advocate and do community organizing, teach whole courses or
individual classes, develop mass media campaigns and train peer
educators, counselors and/or advocates. They address issues related to
disease prevention; consumer, environmental, emotional and sexual
health; first aid, safety and disaster preparedness; substance abuse
prevention; human growth and development; and nutrition and eating
issues .
❖ In companies health educators perform or coordinate:
1-Employee counseling as well as education services, employee health
risk appraisals, and health screenings .
2- They design, promote, lead and/or evaluate programs about weight
control, hypertension, nutrition, substance abuse prevention, physical
fitness, stress management and smoking cessation.
3-They may also develop educational materials and write grants for
money to support these projects.

4-They help companies meet occupational health and safety

regulations, work with the media

5-Identify community health resources for employees.

❖ In health care settings health educators:

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1- Educate patients about medical procedures, operations, services and
therapeutic regimens, and create activities and incentives to encourage
use of services by high-risk patients.

2-They conduct staff training and consult with other health care providers
about behavioral, cultural or social barriers to health, and promote self-
care .

3-They develop activities to improve patient participation on clinical

processes, educate individuals to protect, promote or maintain their
health and reduce risky behavior.

4- Make appropriate community-based referrals and write grants.

❖ In community organizations and government agencies health

educators :
1- Help a community identifies its needs, draw upon its problem-solving
abilities and mobilize its resources to develop, promote, implement and
evaluate strategies to improve its own health status.
2- Health educators do community organizing and outreach, grant-
writing, coalition-building and advocacy .

3-They develop, produce and evaluate mass media health campaigns

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Follow up activities:
1-Complete the following questions:

- List three basic strategies for health promotion.

…………………………………………

...………………………………………

……………………………....................

-List three health education settings.

…………………………………………

...………………………………………

……………………………....................

- List three health promotion priority areas.

…………………………………………

...………………………………………

……………………………....................

2-Choose the one best answer to each of the following:

1-Which of the following is the definition of Health promotion?

a. The process of enabling people to increase control over, and to

improve, their health.

b. A combination of learning experiences designed to facilitate

voluntary actions conducive to health.

c. A state of complete physical, mental, and social wellbeing and not

the mere absence of disease.

d. An approach of promoting change through demonstration and

working with opinion leader.

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Health Education Process
 Module 9
Health Education Process
Health education process

Aim:

Implement the principles and components of health education process when

dealing with client, family, and all community groups. Also, perform nursing'

responsibilities of each nursing process component in case studies and in real

situations.

Learning Objectives

By the end of lecture, the students will be able

1. Define the components of health education process.

2. Recognize the purpose of implanting of effective health education
process.
3. Differentiate between needs & problems, goals &objectives and process
objectives and outcome objectives the steps of leaning needs assessment.
4. Recognize the purpose of planning phase.
5. Distinguish between the types of evaluation.
6. Summarize the steps of leaning needs assessment
7. Differentiate between the dimensions of diagnosis
8. Illustrate the Tasks of planning phase
9. Follow systematically the components of health education process
[Link] the role of health educator when needed.
11.- Utilize the knowledge into practice in required situations

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Table of Content

Topic

Introduction

Purpose of implanting of effective health education process

Dimensions model of health education

Components of health education process

Assessment phase

Diagnosis phase

Planning phase

Implementation phase

Evaluation phase

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Health education process

Introduction

Health education is a fundamental aspect of patient care and recognized as

an essential function and one of the professional standards in nursing practice.
Health education is considered as a dynamic and continuous process including
formal and informal interactive activities performed to improve patients’
knowledge and behaviors in ways to achieve better health care outcomes.
Designing effective health education process is a vital task to the success of all
health education activities.

Purpose of implanting of effective health education process:

1. Enhancing client’s level of empowerment.

2. Improve client’s abilities of self-care behaviors.
3. Increase client’s compliance with health care recommendations.
4. Improve client’s satisfaction in health care settings.
5. Improve client’s quality of their life.
6. Reducing client’s level of anxiety.
The health educator can use the Dimensions Model to design a
health education program (figure: 1); the steps of dimension model are
similar to those of nursing process.

Components of health education process

The health education process consists of:

• Assessment
• Diagnosis
• Planning
• Implementation
• Evaluation.

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Assessment

Healt
h

Diagnosis

Evaluation Planning

Implementation

Figure 1: Dimensions model of health education

[Link]

1. Assessment phase

Assessment phase is involving the assessment of client's learning needs.

The assessment of learning needs is important in developing health education
program for individuals, families and community. First of all, effective
communication must take place between nurse, and the clients and families.

The nurse educator need to develop good questioning techniques and

listening skill to determine the clients’ learning needs, and the clients’ level of
readiness and determined clients’ present health status.

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The nurse educator can use several methods to identify client's learning needs, as
interviews, surveys, observation and health statistics. It is important to involve
the clients in identifying their learning needs.

Steps of leaning needs assessment

1. Use all appropriate sources of information.

2. Determine the characteristics and learning capabilities of the client.
3. Identify the client’s needs for health promotion, risk reduction, or health
problems.
4. Identify current information that the client already knows relevant to his
needs.
5. Identify client's motivation to change any unhealthy behavior change.
6. Identify the barriers and facilitators of health behavior change.
1. Use all appropriate sources of information

Clients are the best source of assessment information in most instances.

By using effective interviewing techniques and observation a nurse can obtain
the data needed to identify client’s learning needs.

2. Determine the characteristics and learning capabilities of the client.

The assessment of the learner’s characteristics includes biological,
psychological, social, and behavioral characteristics.

• Biological characteristics: Include the learning needs, age, level of

maturation, physiologic function and learning capabilities and skills
of the client.
• Psychological characteristics: Psychological characteristics can
influence client’s willingness and ability to learn. Psychological
factors such as attitude toward health and health behavior, stress and
anxiety.

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• Social characteristics: Social characteristics can influence client’s
ability to learn health related information. These characteristics
include client’s level of education, language, religious, cultural
beliefs and practices and occupation.
• Physical characteristics: Physical characteristics include the
client’s current health status and client’s physical environment
• Behavioral characteristics: behavioral characteristics influence
client’s needs for health education. For example, overeat client will
need dietary education, smokers need smoking cessation education.
3. Determine the client’s needs for health promotion, risk reduction,
or health problems.

The information resources on the health problem of a population

group are epidemiological reports, community needs assessment reports.
Individuals, families and small group's sources of information are medical
record, assessment through interview, referral system. Nursing and
medical texts often provide the nurse with lists of information and skills
that a client need to learn about health problems and to comply with a
treatment plan.

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4. Identify current information that the client already knows relevant
to his needs
The methods used for assessing the learner’s current knowledge and
skills include individual and group interviews, questionnaires or pretest,
skill demonstration and observation of problem-solving behavior
competencies.

5. Identify client's motivation to change any unhealthy behavior

change.

Client's motivation to change any unhealthy behavior change can be

assessed by assessing the client's perception of his health problems and the
factors that indicate his desire to take preventive actions. The nurse always
should create the learning environment that encourages the client to learn.

6. Identify the barriers and facilitators of health behavior change.

The barriers of health behavior change are the factors that may
inhibit learning process; while the facilitators are the factors that enhance
the learning process. Barriers and facilitators of health behavior change
should be assessed. The may be related to client himself (e.g age, physical
abilities, maturation) or the learning environment (temperature, noise
level).

N.B: The health care providers who engage in health education element
of health care may influence client’s ability to learn. So that health care
providers who engage in health education are in need to hold a strong
background in both educational principles and health content.

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2. Diagnosis phase

Diagnosis is the second component of the health education process.

Dimensions of diagnosis:

1. Social diagnosis: It is the assessment of learner’s quality of life,

healthy and unhealthy behavior.
2. Epidemiological diagnosis: It is identification of the extent the
health problem.
3. Behavioral and environmental diagnosis: It is include identifying the
environmental and behavioral risk factors underlying the health
problems targeted for intervention.
4. Educational diagnosis: It involves identification of predisposing factors
that influence motivation for healthy behavior such as knowledge,
attitude and values. Reinforcing factors that affect the learner
motivation to act in a healthy way. Enabling factors that facilitate
change to the desired healthy behavior.
5. Administrative and policy diagnosis: It involves identify administrative
and organization resources and capabilities for developing a health
education program to promote the targeted behavior.
3. Planning phase

Planning phase is central to health education process.

Purpose of planning phase

• Facilitates the use of resources more efficiently

• It helps to avoid duplication of activities
• It helps in prioritization of needs and activities .
• It helps to develop the best course of action.
Tasks of planning phase

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Several tasks to be accomplished in planning a health education
encounter. These tasks include:

• Prioritizing learning needs

• Setting learning goals
• Developing learning objectives
• Classifying learning objectives
• Selecting and sequencing learning contents
• Selecting appropriate teaching strategies
• Preparing teaching materials
• Planning for evaluation of the effect of educational intervention.
1. Prioritizing learning needs

a. The planner begins with a list of clients’ current unhealthy behaviors

that are the target of health education.
b. Determine the effects of current unhealthy behaviors on the health
and the benefits to achieve by changing these behaviors.
c. The planner and the client decide which learning needs is given
priority and which learning needs should be addressed later as time
permits.
2. Setting learning goals

Setting learning goals involve specifying the broad purpose of health

education. Identifying the goals help the planner to identify the intervention
strategy.

3. Developing learning objectives

Learning objectives are statement of behaviors expected from the

health education program

Types of learning objectives:

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Health Education Process
a. Process objectives

The process objectives are statements that define the process of

client education and describe the action to be taken by the educator in
educating the client.

b. Outcome objectives

Outcome objectives are statements of behaviors the client is expected

to perform as a result of the health education.

Components of learning objectives:

• Identification of the learners

• The action to be performed (presentation)
• Learning requirements (contents)
• The conditions for the performance of action (The content should
be consistent with the client’s cultural performance)
• The criteria for judging the accomplishment of the objectives
4. Selecting and sequencing learning contents

The educator needs to select content that is most appropriate and

relevant to clients’ needs and that is most likely to result in accomplishing
the stated learning objectives.

• The content must be organized in logical sequence so that new

learning is based on previous learning.
• The content must be sequenced from simple to complex
• The content must be sequenced from most important to least
important.

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5. Selecting appropriate teaching strategies

Selection of teaching strategies depends on the characteristics of

the learners, type of learning, the content involved and the availability of
resources needed to implement specific strategies.

General principles for selecting teaching strategies

• Strategies should contribute to total learning.

• Strategies should include learner participation
• The more complex the content, the more activities needed
• Strategies should graduate from simple to complex
• Strategies should include audiovisuals as possible.
6. Preparing teaching materials

Any materials needed for the health education must be either

developed or obtained. Materials selected should be appropriate to the
learners and to the content presented (for example, if the learners are a
group of children, a coloring book might be an effective teaching material
in a lesson on nutrition).

7. Planning for evaluation of the effect of educational intervention.

Developing plan for evaluation is the last task in planning phase of

health education process. Criteria for evaluating the outcomes of health
education are derived from the stated outcome objectives. Criteria for
evaluating the performance of the educator and educational process used
arise from the stated process objectives.

The educator should also identify the mechanisms for formative evaluation
which involves assessing the effects of the presentation as it is given and
the learner understanding of what is being presented.

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4. Implementation phase

In implementing health education program the educator must remember

to:

▪ Speak the learner language

▪ Be specific
▪ Keep the health message short, compete and clear
Consideration in implementing a health education program

1. Focusing event

A specific teaching strategy designed to gain learners' attention and

to focus that attention on the material to be presented. For example, a focus
event in a presentation on diarrhea in children might be involved showing
several slides of the children with diarrhea or pictures to children with
dehydration.

2. Content presentation

The presentation of content should include learners' participation as

much as possible. Learner participation can be facilitated by group
discussion, role play or asking questions that summarize the previous
content.

3. Summary of the presentation

The presentation should close with a summary to restate and

reinforce the most important points of the presentation.

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5. Evaluation phase

Evaluation takes place throughout the presentation and as the last

step of the educational process.

The types of evaluation are: formative, outcome, and process.

1. Formative evaluation

During presentation of the grogram, the educator should

periodically assesse the program and its effects to detect any need for
immediate modification by using feedback.

2. Outcome evaluation

After the health education program, the educator should evaluate the
effects of the presentation to determine whether stated outcome objectives
have been met (Example: The learners are able to perform the state
behaviors at the expected level of performance).

3. Process evaluation

The educator should also evaluate the presentation in terms of the

use of educational process. Also, if the presentation the contents maintain
the interest of the audience and if the teaching strategies, materials and
content selected appropriate to the learning needs of learners.

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Follow up activities
1-Choose the one best answer to each of the following:
-In which phase of health education process the educator should plan for
evaluation?

a) Assessment phase
b) Diagnosis phase
c) Planning phase
d) Implementation phase
e) Evaluation phase
-Which statement of the following best describes the formative evaluation?
a) Conducting evaluation at appropriate time and place
b) Assessment if the presentation the contents maintain the interest of
the audience.
c) Periodically assess to detect any need for immediate modification
d) Assessment if the stated behaviors is performed at the expected level
-Which statement of the following best describes Behavioral diagnosis?
a) Assessment of learner’s quality of life
b) Identification of the extent the health problem.
c) Identification the risk factors underlying the health problems
targeted for intervention.
d) Identification of organization resources and capabilities for
developing a health education program to promote the targeted
behavior.
2-Complete the following questions:

-Illustrate the types of learning objectives

…………………………………………………………………..
…………………………………………………………………..
…………………………………………………………………..

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