HEALTH EDUCATION
PRELIMINARY TOPICS
ROSARIO E. RAMIREZ, RN,RM,MSN
HISTORICAL DEVELOPMENT & CONCEPTS IN
HEALTH EDUCATION
Health Education is any combination of learning
experiences designed to facilitate voluntary
adaptations of behavior conducive to health.
H.E. is a science and a profession of teaching
health concepts to promote, maintain and
enhance one’s health, prevent illness, disability,
and premature death through the adoption of
healthy behavior, attitudes and perspectives.
It draws health models and theories from the
- biological - physical
- environmental - medical
-psychological
Any combination of planned learning
experiences based on sound theories that
provide individuals, groups , and
communities the opportunity to acquire
information and the skills needed to make
quality health decisions.
WHO definition “ comprises of consciously
constructed opportunities for learning
involving some form of communication
designed to improve health literacy,
including improving knowledge and
developing life skills which are conducive
to individual and community health.
ISSUES AND TRENDS IN HEALTH
EDUCATION
SOCIAL – demographic trends like aging
of the population requires emphasis on
self reliance and maintenance of a
healthy life status over an extended
lifespan particularly dealing with
degenerative diseases and disabilities;
lifestyle-related diseases which are the
major cause of morbidity and mortality
and highly preventable and will need
more intensive health education
efforts.
ECONOMIC –the shifts in payer coverage ,
emphasis on managed care and earlier hospital
discharge, and the issue on reimbursement for
health services provided require more intensive
patient education to allow the patient and his
family a more independent , compliant and
confident management of care
POLITICAL – THE FEDERAL
GOVERNMENT HAS FORMULATED
NATIONAL GOALS AND
OBJECTIVES DIRECTED TOWARDS
THE DEVELOPMENT OF
EFFECTIVE HEALTH EDUCATION
PROGRAMS WHICH WILL CREATE
AWARENESS OF HEALTH RISKS
AND ENCOURAGE THE ADOPTION
OF HEALTHY LIFESTYLES.
HEALTH ISSUES
Biological, Psychological
and Sociological Aspects of
Health and Disease.
GEORGE L. ENGEL
A psychiatrist at the University of Rochester
Introduced the Biopsychosocial model or BPS in
1977.
He advocated the need for a new medical model
to explain health and disease
BPS application was already found in ancient
Asian (2600 B.C.) and Greek (500B.C.) prior to
Engel’s BPS
THE BIOPSYCHOSOCIAL MODEL (BPS)
AN approach that states that human experience
of health or illness is greatly affected or
determined by the interplay or interrelatedness
of the following factors:
BIOLOGICAL- immunity level, genetic
susceptibility or predispoistion
PSYCHOLOGICAL
Feelings, affect, and person’s ability to express
these
Beliefs in one’s worth
Long term stress affects the body systems and
anxiety affects health habits
Calm acceptance and relaxation can actually
change body responses to illness
PERCEPTIONS, THOUGHTS,
EMOTIONS, ATTITUDES
BEHAVIORS
SOCIAL FACTORS
SOCIO ECONOMIC STATUS
CULTURAL BELIEFS AND PRACTICES
POVERTY
TECHNOLOGY
ENVIRONMENTAL INFLUENCES AND
CONDITIONS
THE BPS model shows a direct link between the
mind and the body and an indirect link with the
intervening social or environmental factors to
explain disease causation.
The BIOLOGICAL component seeks to explain
the cause of illness or disease as a result of the
breakdown in the physical or physiological
malfunctioning in the body.
The PSYCHOSOCIAL aspect deals with how the
individual perceives the health threats and the
state of emotional control, discipline, and
motivation to stay healthy. Psychosocial factors
can cause a biological effect by predisposing the
patient to risk factors and risk taking behaviors.
Example: A depressed person may become alcoholic
to temporarily forget his/her problems which may
lead to liver cirrhosis and even death.
CHARACTERISTICS OF EFFECTIVE HEALTH
EDUCATION
It is directed at people who are directly involved with health
related situations and issues in the home and the community like
parents and people who have influence in the community or the so-
called opinion makers;
The lessons are repeated and reinforced overtime using different
methods ;
The lessons are adaptable and use existing channels of
communication. Ex. Songs, drama & storytelling
It is entertaining and attracts the community’s attention;
Uses clear, simple language with local expressions
Emphasizes short term benefits of action
Provides opportunities for dialogue, discussion and
learner participation
Uses demonstration to show the benefits of adopting
the practices.
CONTEMPORARY
MODERN
CURRENT
UP TO DATE
FASHIONABLE
PRESENT DAY
MODERN DAY
EXISTING
CONTEMPORARY HEALTH AND
PROMOTION OF OPTIMAL HEALTH
THROUGHOUT THE LIFESPAN
Health Educator is faced with enormous
challenges as well as opportunities due to
increasing demand of the society.
A return to population-based health promotion
and maintenance vis-à-vis the hospital- based
emphasis and emphasis is on health of the
community and the adaptation of healthy
behaviors and lifestyle through health
empowerment of the people.
Health educator is also considered as the
COMMUNITY HEALTH WORKER whose main
concern is to improve the health of the people by
using different methods and strategies.
THE call for developing global health strategies
with the integration of health education and
action is now a clamor that can no longer be
ignored.
GLOBALIZATION WAR
TERRORISM SOCIAL INSTABILITY
DISEASE POVERTY
ENVIRONMENTAL DEGRADATION
FACILITATING LEARNING AND
TEACHING ON CRITICAL HEALTH
CHALLENGES IN THE 21ST CENTURY
EMERGING TRENDS IN HEALTH CARE
1. New “Health Care economics”
a. emphasis on primary health care
-managed care → early discharged of clients
↓
reduced healthcare insurance costs &
prevent overtreatment of patients which are
unethical practices of some doctors in the
hospitals.
b. establish centers of excellence to provide
services effectively and at moderate cost
c. Decentralization of care also known as Medical
Prosumerism, is an emergent issue.
Prosumerism is a movement away from purchasing
completed goods and services in favor of
purchasing portions of them piecemeal similar to
do it yourself movement in health improvement.
=significant patient opportunities to gain
knowledge through the internet and medical
databases.
= Patients now frequently make their own choices
as to diagnoses, treatments, medical products
and practitioners.
D. Alternative Medicine is another form of
Prosumerism.
= consumers use a wide variety of folk practices to
promote health and potentially cure disases
=ACUPUNTURE, ACUPRESSURE,
AROMATHERAPY, YOGA and MASSAGE
THERAPY
MEDICAL GLOBALIZATION
Termed as MEDICAL TOURISM where centers
of excellence or hospitals and centers with world
class facilities and amenities have become one of
the foremost tourist attractions in the country.
People from other countries obtain services and
costs of treatments and medications at a very
reasonable and affordable price.
2. ADVANCES IN MEDICAL TECHNOLOGY
THE MOST CURRENT DEVELOPMENT IN
MANAGED CARE IS DISEASE MANAGEMENT
“SEEK TO IMPROVE PATIENT COMPLIANCE
WITH OPTIMAL HEALTH BEHAVIOR BY
PROMOTING PROPER ATTAINMENT
KEEPING, SELF ADMINISTRATION OF
TREATMENTS AND PROPER GENERAL
HEALTH BEHAVIOR IN TERMS OF
LIFESTYLE ISSUES.
FUTURE DIRECTIONS FOR PATIENT
CARE
New settings and environmental linkages
New Technologies
Greater emphasis on wellness
Increased third party reimbursement as cost
benefit ratios demonstrate the cost
effectiveness of consumer education as shown
by shorter hospital stay, effective and efficient
home and self-managed-care, lesser incidence
of complications and hospital readmissions
THEORIES IN HEALTH EDUCATION
MODELS OR THEORIES WHICH EXPLAIN
HUMAN BEHAVIOR IN RELATION TO
HEALTH EDUCATION.
CLASSIFIED ON THE BASIS OF BEING
DIRECTED AT THE LEVEL OF:
A. Individual (Intrapersonal)
B. Interpersonal
C. Community
4 MOST COMMONLY USED HEALTH
THEORIES
PENDER’S HEALTH PROMOTION THEORY
BANDURA’S SELF EFFICACY THEORY
BECKER’S HEALTH BELIEF MODEL
GREEN’S PRECED-PROCEED MODEL
HEALTH PROMOTION THEORY
Developed in 1987 revised by Pender in 1990.
To increase the utility of its predictions and
interventions
SALIENT POINTS
- This model emphasizes “actualizing health
potential and increasing the level of well being
using approach behaviors rather than
avoidance of disease that is why it has been
classified as a health promotion model rather
than a disease prevention model
5 MAJOR COMPONENTS &THEIR VARIABLES
A. INDIVIDUAL CHARACTERISTICS AND
EXPERIENCE
B. BEHAVIOR-SPECIFIC COGNITIONS AND
AFFECT
C. BEHAVIORAL OUTCOME
D. ACTIVITY RELATED AFFECT
E. COMMITMENT TO PLAN OF ACTION
Results showed that the modifying factors of age,
income, education, and selected biological
characteristic of body mass has indirect effects on
health-promoting lifestyles as proposed by this
model.
BANDURA’S SELF-EFFICACY THEORY
SOCIAL LEARNING THEORY
BANDURA renamed the theory SOCIAL
COGNITIVE THEORY to emphasize the
cognitive aspect of learning which explains
human behavior by citing three factors which are
in continuous interaction resulting in a process
of reciprocal determinism or triadic reciprocal
causality namely:
Personal factors
Behavior
Environmental influences
SOCIAL COGNITIVE THEORY
Emphasizes that cognition plays a critical role in
people’s capability to construct reality, self
regulate, encode information and perform
behaviors.
In 1077, he introduced the concept of self efficacy
SELF –EFFICACY - is the single most
important aspect of the sense of self that
determines one’s effort to change behavior
according to Bandura. It is equated with self-
confidence in one’s ability to successfully perform
a specific type of action.
Example: A person may experience high level of
self-efficacy in preparing low salt, low cholesterol
diet but very little self-efficacy.
A person can increase self-efficacy through:
a. Personal mastery of a task
b. Observing the performance of others(vicarious
experience)
c. Verbal persuasion such as receiving suggestions
from others
d. Arousal of her/his emotional state. In the
construct of emotional coping responses, a
person must be able to deal with any sources of
anxiety surrounding that behavior in order to
learn.
BECKER’S HEALTH BELIEF MODEL
Health belief model was one of the first models
originally introduced by a group of psychologists
in the 1950’s to find out why people refused to
use available preventive services such as chest x-
rays for TB screening and immunizations for
influenza.
HBM was originally developed to help explain
certain health related behaviors, it has also
helped to guide the search for why these
behaviors occur and to identify points for possible
change and to design change strategies like
developing messages that are likely to persuade
an individual to make a healthy decision.
4 CONSTRUCTS WHICH REPRESENT THE
PERCEIVED THREAT AND NET BENEFITS
Perceived susceptibility – a person’s opinion of
the chances of getting a certain condition.
Perceived severity – a person’s opinion of how
serious the condition is
Perceived benefits- a person’s opinion of the
effectiveness of some advised action to reduce the
risk or seriousness of the impact
Perceived barriers – a person’s opinion of the
concrete and psychological costs of this advised
action
GREEN’S PRECED-PROCEED MODEL
It was based on epidemiological perspective on
health promotion to combat the leading causes of
death. The acronym stands for
PRECEDE –Predisposing, Reinforcing and
Enabling Constructs in Educational Diagnosis
and Evaluation (developed by Green in 1980)
PROCEED – Policy, Regulatory and
Organizational Constructs in Education and
Environmental Development (added component
by Green in 1999)
Any combination of learning experiences
designed to facilitate voluntary actions conducive
to health.
Health Education is aimed primarily at planning
experiences that are designed to predispose,
enable and reinforce voluntary behavior
conducive to the health of the individuals groups
and the communities.
PRECEDE = priorities and objectives
PROCEED =address criteria for policy,
implementation and evaluation as influenced by
the diagnoses in the PRECEDE phases
9 PHASES OF THE PRECEED-
PROCEDE MODEL
1. Social Diagnosis-begins with population self
study/assessment relative to the quality of life.
2. Epidemiologic diagnosis
3. Behavior and Environmental diagnosis
4. Educational and Organizational diagnosis-
addresses issues dealing with education
5. Administrative and Policy diagnosis – addresses
issues dealing with education
6. Implementation
7. Process evaluation
8. Impact Evaluation
9. Outcome Evaluation
