Health Promotion and Education

MPH Ist Year
Health Promotion and Education
Prabesh Ghimire
Health Promotion and Education MPH 1st
Year
Table of Contents
UNIT 1: INTRODUCTION................................................................................................................................................. 4
Concepts of Health Promotion and Education .......................................................................................................... 4
Philosophy of Health Promotion and Education ................................................................................................... 4
Scope/ Settings of Health Promotion and Education ........................................................................................... 7
Principles of Health Promotion and Education ......................................................................................................... 8
Responsibilities and competencies of health promotion and education professionals............................................ 9
Code of ethics and standard for health promotion and education professional .................................................... 10
Role of Theory in Health Promotion: ...................................................................................................................... 11
UNIT 2: National and International Disclosure in Health Promotion and Education .................................................. 12
Historical Developments- Milestones in Health Promotion and Education ............................................................ 12
Overview of International Declarations, Statements, Charter and Recommendations Supporting the Action Areas
of Health Promotion................................................................................................................................................ 13
The Ottawa Charter for Health Promotion ......................................................................................................... 13
The Adelaide Recommendations on Healthy Public Policy ................................................................................. 15
The Sundsvall Statement on Supportive Environment ....................................................................................... 16
Jakarta Declaration on Health Promotion .......................................................................................................... 17
The Mexico Charter: Mexico Ministerial Statement for the Promotion of Health ............................................. 18
The Bangkok Charter for Health Promotion in a Globalized World .................................................................... 18
The Nairobi Declaration ...................................................................................................................................... 19
International Union for Health Promotion and Education (IUHPE) ........................................................................ 21
Victoria Health Promotion Foundation ................................................................................................................... 22
UNIT 3: FRAMEWORKS/ MODELS/THEORIES OF HEALTH PROMOTION AND EDUCATION ......................................... 23
Differences between Theories, Models and Frameworks of Behaviour Change (Q: 2072/12)............................... 23
PRECEDE/PROCEED MODEL ................................................................................................................................ 24
Health Belief Model ............................................................................................................................................ 29
Theory of Reasoned Action/ Theory of Planned Behaviour................................................................................ 30
Transtheoritical Model ....................................................................................................................................... 31
Social Cognitive Theory ....................................................................................................................................... 32
Diffusion of Innovation Theory ........................................................................................................................... 33
Rogers Adoption Model ..................................................................................................................................... 34
Freires Model of Adult Education ...................................................................................................................... 35
Kurt Lewins Model of Planned Change .............................................................................................................. 36
Cognitive Dissonance Theory .............................................................................................................................. 37
Prabesh Ghimire Page | 2

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Theories of Stress and Coping............................................................................................................................. 38

Intervention Mapping ......................................................................................................................................... 39
Multilevel Approach to Community Health (MATCH) ........................................................................................ 40
UNIT4: VARIOUS APPROACHES TO HEALTH PROMOTION AND EDUCATION .............................................................. 41
UNIT 5: Fundamental Factors Involved in Health Education Process .......................................................................... 49
Learning in Health Education .................................................................................................................................. 49
Perception ............................................................................................................................................................... 49
Motivation ............................................................................................................................................................... 51
UNIT6: HEALTH COMMUNICATION ............................................................................................................................. 53
Meaning, Definition, Types, Process and Principles of Communication ................................................................. 53
Behaviour Change Communication and Application............................................................................................... 55
Meaning, Types, Importance and Selection Criteria of Health Education Methods ............................................... 56
Criteria for selecting appropriate methods and media of health education ...................................................... 56
Individual, Group and Mass Methods of Health Education .................................................................................... 57
Individual Methods of Health Education ............................................................................................................ 57
Group Methods of Health Education .................................................................................................................. 58
Mass Methods of Health Education.................................................................................................................... 63
Meaning, Types, Importance and Selection Criteria of Health Education Media ................................................... 64
Audio, Visual and Audiovisual Media ...................................................................................................................... 64
Audio Media........................................................................................................................................................ 64
Visual Media ....................................................................................................................................................... 65
Recent Advances in Use of Social Media (Internet) in Health Promotion and Education ....................................... 70
UNIT 7: SETTINGS IN HEALTH PROMOTION AND EDUCATION .................................................................................... 72
UNIT 8: Roles of Health Education and Promotion in Public Health Programmes ...................................................... 76
Role of Health Education in Primary Health care programs.................................................................................... 76
Role of Health Education and Promotion during emergencies (disasters) ............................................................. 76
UNIT 9: Community Health Development ................................................................................................................... 77
Community organization ......................................................................................................................................... 77
Community Development ....................................................................................................................................... 78
Group Dynamics ...................................................................................................................................................... 81
Miscellaneous.......................................................................................................................................................... 82

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UNIT 1: INTRODUCTION
Concepts of Health Promotion and Education
Health Promotion
The process of enabling people to increase control over, and to improve, their health- WHO, 1986
Any combination of health education and related organizational, political and economic interventions
designed to facilitate behavioral and environmental changes that will improve health Green 1980
Health Education
Health Education is a process of growth in an individual by means of which he alters his behavior or
change his attitude towards health practices as a result of new experiences he has had. -Dorothy B
Nyswander, 1949
Health education is defined as any combination of learning experiences designed to facilitate voluntary
actions conducive to health (Green and Kreuter 2005).
Philosophy of Health Promotion and Education

A New Oxford American Dictionary, 2005 defines Philosophy as the study of the fundamental nature of
knowledge, reality and existence. Education philosophy helps define views about learners, teachers, and
schools.
There are three branches of philosophy
Metaphysics: What is the nature of reality?
Epistemology: What is the nature of knowledge?
Axiology: What is the nature of values?
Existing stand of health education philosophy/ Philosophical basis of health education (past question-
2072/3, 2068/7)
There are five philosophies of health education.
Philosophy Description
1 Cognitive-based Content focused
Emphasizes factual information and the expansion of knowledge base of the
individual
Goal is to increase a person or groups knowledge, enabling them to make
better decisions about their health.
2 Decision-making Emphasizes critical thinking and lifelong learning
Designed to teach systematic problem-solving skills and decision making
processes that can be applied to health related decisions
3 Behaviour change Emphasizes behavioural modification through such methods as self-monitoring,
behavioural contacts and goal setting.
Program objectives are quantifiable and measurable
4 Freeing/functioning Focuses on freeing people to make best health decisions based on their needs
and interests- not necessarily on the interests of society.
Designed to help learners make self-directed and autonomous health decisions.
Emphasizes concepts of freedom, individuality and lifelong learning
5 Social change Proposes education as a force for achieving social change.
Emphasizes the role of health education in creating social, economic and
political change that benefit all.
Health education is closely connected with emphasis on raising awareness for
responsible social action.

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Coherence of philosophy in theories, principle and practice (past question-2072/3, 2068/7)

Philosophy
- Health education and philosophy are fundamentally inseparable.
- Philosophy within an educational context attempts to explain the means and ends of education in
order to develop principles and guidelines for practice.
- Philosophy results from the sum of knowledge, experience (practices) and principles and helps to
address the purpose, parameters, and content of the health education discipline.
- The health educator must answer the question, What are the appropriate ways and means of health
education in order to receive guidance for educational action? The answer lies in the philosophical
approach one chooses and its corresponding underpinnings of theories.
Theory
- Theory derives from philosophy.
- In health education, we are often concerned with theories which describe various elements of human
behaviour. Theories typically derive from various disciplines; however, theories from behavioural
sciences and psychology have been commonly used to inform practice in health education.
- Theories provide explanatory constructs that helps to structure action by identifying key relationships
that can be used to explain, predict or change a phenomena.
Philosophy and theory are perpetually linked; philosophy influences how one sees the world, theory
shapes how one intentionally interacts with that world. A philosophy impacts the definition of important
problems and theories provide strategies to arrive at solutions to those problems. Together, philosophy
and theory guide principles and practice in health education.
Principles and Practice

Overall philosophy and theories determine the principles and ethics to be applied to health education and
promotion practice. Some of the practical applications of health education theories and philosophy
include:
- Teaching and learning
- Professional practice
- Design, implementation and evaluation of educational programs
- Conscientization
- Research in health promotion and education
- Selection and use of educational methods and media, etc.

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Ayurveda and Eastern Philosophy is appropriate to health promotion. Discuss with suitable examples
(past question-2072/12)
- Eastern philosophy follows the broad traditions which originated from, or were popular within India,
China, Japan and South East Asia. There is a major differences between the Eastern (Asian) and
Western philosophical approaches to health care and health promotion. In Eastern and Ayurvedic
medicine, the emphasis is on health promotion or stabilization, as opposed to Western concepts of
illness intervention and treatment of symptoms.
- Methods of healing are drastically different, with Western medicine being much more unnatural than
Eastern. Eastern philosophy uses whole-food formulas to nourish the bodys natural healing abilities,
while Western philosophy isolates and forces therapeutic actions to treat disease.
- Eastern examination works with the elements earth, fire, wood, metal, and water to interpret the
relationship between the physiology and pathology of the human body and the natural environment.
Western medicine uses vital signs like height, weight, and body temperate, and general appearance
for health examination. Due to the harsh, ineffective, and dependency-driven aspects of Western
medicine, Eastern medical philosophies are regaining popularity.
- In Eastern philosophy, two forms of medicine are widely practiced, an Indian-Ayurvedic medicine and
Traditional Chinese Medicine. In both Ayurveda and Chinese philosophies, preventive effect assumes
a great importance. The philosophy of eastern medicine is similar to the philosophy of health
promotion.
- Through analysis of the Eastern medicine, one discovers that the Eastern philosophy is very similar to
the theory of health promotion. Their principles fit the concept of health promotion. Ayurveda and
TCM are historically of differing origin, but comprise common features.
- It is important to note that while Eastern and Western medicine purport to achieve similar objectives
namely, the overall health of an individual the perspectives and approaches are markedly different.
The Western approach attempts to divide a persons health from the disease, focusing on the
elimination of the symptoms of an illness, rather than its root. Contrastingly, the Eastern approach to
medicine considers a persons health as a balanced state, and illness or disease creates

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an imbalance. Eastern philosophy seeks to reestablish the natural, balanced state of the human body
through channeling the bodys own healing mechanisms.
- The contrast in approach leads Western medicine to be reactive, fighting illness and disease after it
strikes. Through harmonization, strength, and balance of the bodys natural state, Eastern medicine is
preventative, thus helping individuals avoid illness and disease, while still providing them the tools
and combat illness, should it occur.
Scope/ Settings of Health Promotion and Education

The settings for health education are important because they provide channels for delivering programs,
provide access to specific populations and gatekeepers, usually have existing communication systems for
diffusion of programs, and facilitate development of policies and organizational change to support positive
health practices.
Seven major settings are particularly relevant to contemporary health education: schools, communities,
worksites, health care settings, homes, the consumer marketplace, and the communications environment.
i. Schools
- Health education in schools includes classroom teaching, teacher training, and changes in school
environments that support healthy behaviour.
- To support long-term health enhancement initiatives, theories of organizational change can be used,
for example to encourage adoption of comprehensive smoking control programs in schools.
ii. Communities
- Community-based health education draws on social relationships and organizations to reach large
populations with media and interpersonal strategies.
- Community interventions in households, temples/churches, clubs, recreation centers, and
neighborhoods can been used to encourage healthful nutrition, reduce risk of cardiovascular disease,
and use peer influences to promote breast cancer detection among minority women.
iii. Worksites
- Because people spend so much time at work, the workplace is both a source of stress and a source
of social support.
- Effective worksite health promotion programs can harness social support as a buffer to stress, with
the goal of improving worker health and health practices.
- Today, many businesses, particularly large corporations, provide health promotion programs for their
employees.
- Both high-risk and population wide strategies have been used in programs to reduce the risk of
occupational diseases. Integrating health promotion with worker safety and occupational health may
increase effectiveness.
iv. Health Care Settings

- Health education for high-risk individuals, patients, their families, and the surrounding community, as
well as in-service training for health care providers, are all part of health care today.
- The changing nature of health service delivery has stimulated greater emphasis on health education
and provider-focused quality improvement strategies in health care organizations, public health
clinics, and hospital.
- Primary care settings, in particular, provide an opportunity to reach a substantial number of people.
Health education in these settings focuses on preventing and detecting disease, helping people make
decisions about primary health care, and managing acute and chronic illnesses.

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v. Homes
- Health behavior change interventions are delivered to people in their homes, both through traditional
public health means, like home visits, and through a variety of communication channels and media
such as Internet, telephone, and mail.
vi. The Consumer Marketplace

- The advent of home health and self-care products, as well as use of health appeals to sell
consumer goods, has created new opportunities for health education but also can mislead consumers
about the potential health effects of items they can purchase.
- Social marketing is used increasingly by health educators to enhance the salience of health
messages and to improve their persuasive impact
vii. The Communications Environment

- There have been rapid changes in the availability and use of new communications technologies,
ranging from mass media changes to personalized and interactive media and a host of wireless tools
in homes, businesses, and communities.
- These channels are not settings and can be used in any of the settings described earlier. Yet they are
unique and increasingly specialized, providing opportunities for intervention.
Principles of Health Promotion and Education
The World Health Organization identified seven key principles of health promotion as follows:
SN Principles Description
1 Empowerment Health promotion initiatives should enable individuals and communities to
assume more power over the personal, socio-economic and environmental
factors that affect their health.
2 Participative Health promotion initiatives should involve those concerned in all stages of
planning, implementation and evaluation.
3 Holistic Health promotion initiatives should foster physical, mental, social and spiritual
health.
4 Inter-Sectoral Health promotion initiatives should involve the collaboration of agencies from
Collaboration relevant sectors.
5 Equitable Health promotion initiatives should be guided by a concern for equity and
social justice
6 Sustainable Health Promotion initiatives should bring about changes that individuals and
communities can maintain once initial funding has ended
7 Multi-strategy Health promotion initiatives should use a variety of approaches in combination
with one another, including policy development, organizational change,
community development, legislation, advocacy, education and communication.
Principles of Health Promotion (Adapted from a Discussion Document on the Concept and Principles of
Health Promotion, Copenhagen, 9-13 July 1984)
i. Health promotion involves the population as a whole in the context of their everyday life, rather than
focusing on people at risk for specific diseases.
ii. Health promotion is directed towards action on the determinants or causes of health. Health
promotion, therefore, requires a close cooperation of sectors beyond health services, reflecting the
diversity of conditions which influence health.

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iii. Health promotion combines diverse, but complementary, methods or approaches, including
communication, education, legislation, fiscal measures, organizational change, community
development and spontaneous local activities against health hazards.
iv. Health promotion aims particularly at effective and concrete public participation.
v. Health professionals should work towards developing their special contributions in education and
health advocacy.
Responsibilities and competencies of health promotion and education professionals
Responsibility 1: Assessing individual and community needs for health education

Competency A: Obtain health-related data about social and cultural environments, growth and
development factors, needs and interests.
Competency B: Distinguish between behaviour that fosters and that which hinders wellbeing.
Competency C: Infer needs for health education on the basis of obtained data.
Responsibility 2: Planning effective health education programs

Competency A: Recruit community organizations, resource people and potential participants for
support and assistance in program planning.
Competency B: Develop a logical scope and sequence plan for a health education program.
Competency C: Formulate appropriate and measurable program objectives.
Competency D: Design educational programs consistent with specified program objectives.
Responsibility 3: Implementing health education programs

Competency A: Exhibit competence in carrying out planned educational programs.
Competency B: Infer enabling objectives as needed to implement instructional programs in specified
settings.
Competency C: Select methods and media best suited to implement program plans for specific
learners.
Competency D: Monitor educational programs, adjusting objectives and activities as necessary.
Responsibility 4: Evaluating effectiveness of health education programs

Competency A: Develop plans to assess achievement of program objectives.
Competency B: Carry out evaluation plans.
Competency C: Interpret results of program evaluation.
Competency D: Infer implications from findings for future program planning.
Responsibility 5: Coordinating provision of health education services

Competency A: Develop a plan for coordinating health education services.
Competency B: Facilitate cooperation between and among levels of program personnel.
Competency C: Formulate practical modes of collaboration among health agencies and
organizations.
Competency D: Organize in-service training programs for teachers, volunteers and other interested
personnel.
Responsibility 6: Acting as a resource person in health education

Competency A: Use computerized health information retrieval systems effectively.
Competency B: Establish effective consultative relationships with those requesting assistance in
solving health-related problems.
Competency C: Interpret and respond to requests for health information.
Competency D: Select effective educational resources materials for dissemination.

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Responsibility 7: Communicating health and health education needs, concerns and resources
Competency A: Interpret concepts, purposes and theories of health education.
Competency B: Predict the impact of societal value systems on health education programs.
Competency C: Select a range of communication methods and techniques in providing health
information.
Competency D: Foster communication between health care providers and consumers.
Code of ethics and standard for health promotion and education professional
A code of ethics is a set of guidelines that is designed to set out acceptable behaviour for members of a
particular group, association or profession. The Code of Ethics provides a framework of shared values
within the professions in which Health Promotion and Education is practiced.
Health educators work is directly concerned with communities and individuals. It is crucial that the rights
and privacy of individuals and communities are respected, and that programmes are developed on an
equitable basis, addressing the needs of the most vulnerable population groups and embracing the
following principles:
respect for human dignity and rights
client full consent
confidentiality
non-discrimination or stigmatization
equity in access, coverage and service delivery
respect for cultural values and cultural diversity
refraining from conflict of interest, particularly commercial interest
integrity and good personal conduct
Although there are no formal ethical codes and standards for health education and promotion in Nepal,
ideally all health education professionals should abide by the following guidelines irrespective of job title,
professional affiliation, work setting, or population served.
i. Responsibility to the Public

- Health Education and promotion professional support the right of individuals to make informed
decisions regarding their health.
- Health Education and promotion professional accurately communicate the potential benefits, risks
and/or consequences associated with the services and programs that they provide.
- Health Education and promotion professional are ethically bound to respect and protect the privacy,
confidentiality, and dignity of individuals.
ii. Responsibility to the profession

- Health Educators maintain, improve, and expand their professional competence through continued
study and education; membership, participation, and leadership in professional organizations.
- Health Educators contribute to the profession by refining existing and developing new practices, and
by sharing the outcomes of their work.
- Health Educators are aware of real and perceived professional conflicts of interest, and promote
transparency of conflicts.

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iii. Responsibility to employers

- Health Educators use and apply current evidence-based standards, theories, and guidelines as
criteria when carrying out their professional responsibilities.
- Health Educators accurately represent potential and actual service and program outcomes to
employers.
- Health Educators maintain competence in their areas of professional practice.
iv. Responsibility in the Delivery of Health Education

- Health Educators are sensitive to social and cultural diversity and are in accord with the law, when
planning and implementing programs.
- Health Educators are committed to rigorous evaluation of both program effectiveness and the
methods used to achieve results.
- Health Educators communicate the potential outcomes of proposed services, strategies, and pending
decisions to all individuals who will be affected.
v. Responsibility in Research and Evaluation

- Health Educators adhere to principles and practices of research and evaluation that do no harm to
individuals, groups, society, or the environment.
- Health Educators respect and protect the privacy, rights, and dignity of research participants, and
honor commitments made to those participants.
- Health Educators report the results of their research and evaluation objectively, accurately, and in a
timely fashion to effectively foster the translation of research into practice.
Role of Theory in Health Promotion:
Various researches indicate that health promotion interventions that apply theoretical principles and
associated constructs to their design are more effective than those that do not. This provides a powerful
argument for the importance of theory in principles and practice of health education and promotion.
One of the greater effectiveness of intervention based on the theoretical principles and associated
constructs may be that theories help us understand behaviors and the process by which behavior change
may occur. For example, the Theory of Reasoned Action postulates that attitudes and beliefs influence
intentions and that positive intentions influence behaviours.
Theories describe and explain how and why attitudes, beliefs, and social influences such as friends,
family, and the media, as well as the environment, influence our health behaviours and ultimately our
health. This information is used to create models that predict future health behaviours and thus are
relevant to health promotion efforts in that they identify potential targets for change.
A health promotion theory offers a number of benefits and its roles can be seen as the following
Theory serves as a toolbox for moving beyond intuition to designing and evaluating health education
interventions that are based on understanding of why people engage in certain health behavior.
Theory also provides foundation for program planning and development that is consistent with the
current emphasis on using evidence-based interventions.
It provides a road map for studying problems, developing appropriate interventions, identifying
indicators and evaluating impacts.
It helps to explain the processes for changing health behavior and the influences of many forces that
affect it, including social and physical environments.
Theory also plays a role in guiding planners identify the most suitable target audiences, methods for
fostering change and outcomes for evaluation.

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UNIT 2: National and International Disclosure in Health Promotion and Education
Historical Developments- Milestones in Health Promotion and Education

SN Year Milestones
1 1978 Global meeting of WHO at Alma-Ata, Kazak with the Declaration of Alma-Ata
formally adopted Primary Health Care. Health Education was identified as one of its
principles
2 1981 WHO Global Strategy "Health for All by the Year 2000" provided the right
environment for the concept of health promotion to foster
3 1984 WHO called a special meeting in Copenhagen Denmark to provide some clarity and
direction which led to the first substantive document on health promotion
3 1986 First World Conference for Health Promotion (Ottawa Charter)
4 1988 Building healthy public policy was explored in greater depth at the Second
International Conference on Health Promotion in Adelaide, Australia. Adelaide
Recommendations on Healthy Public Policy was created
5 1991 Third International Conference on Health Promotion in Sundsvaal, Sweden, in 1991
was on creating supportive environments.
Sundsvall Statement on Supportive Environments for Health stressed the
importance of sustainable development
6 1997 The Fourth International Conference on Health Promotion held in Jakarta,
Indonesia. Five priorities were identified in the Jakarta Declaration on Health
Promotion into the 21st Century
7 2000 Fifth Global Conference on Health Promotion in Mexico focused on health
inequalities both within and between countries. The Mexico Ministerial Statement for
the Promotion of Health: from Ideas to Action.
8 2005 Sixth Global Conference on Health Promotion in Bangkok was organized; Bangkok
Charter for Health Promotion in a Globalized World identified four new commitments
were identified
9 2009 Seventh International Conference on Health Promotion in Kenya resulted in Nairobi
Call to Action.
10 2013 Eight Global Conference on Health Promotion; Helsinki, Finland. Health in All
Policies
11 2016 Ninth Global Conference on Health Promotion; Shanghai, China. Healthy Cities,
Good Governance and Health Literacy
Factors that Necessitated the Changes in International Disclosures of Health Promotion

International Factors that necessitated corresponding changes
Disclosures
Ottawa Charter for - This conference was primarily a response to growing expectations for a new
Health Promotion public health movement around the world.
- It built on the progress made through the Declaration on Primary Health Care
at Alma-Ata, the World Health Organizations Targets for Health for All
document, and the recent debate at the World Health Assembly on inter-
sectoral action for health.
Adelaide - This conference was an outcome of the need to explore building healthy
Recommendations public policy in greater depth.

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Sundsvall Statement - Armed conflict, rapid population growth, inadequate food, lack of means of
on Supportive self determination and degradation of natural resources were among the
Environments for environmental influences as being damaging to health
Health - Convened to allow health professionals from all over the world to consider
how environments, whether physical, social, economic, or political, can be
made more supportive for health.
Jakarta Declaration - The evidence found that health promotion strategies can contribute to the
on Health Promotion improvement of health and the prevention of diseases in developing and
into the 21st developed countries alike.
Century - Convened to engaged new players including developing world to meet global
challenges.
Mexico Ministerial - To demonstrate and communicate more widely to developing countries that
Statement for the health promotion action can achieve greater equity in health and can close
Promotion of Health: the health gap between population groups.
from Ideas to Action
Bangkok Charter for - To address opportunities and challenges of new millennium which were not
Health Promotion in thought of in 1986 such as the Internet, the human genome project, climate
a Globalized World change, terrorism, geopolitical change, third world debt, and of course
globalization of people, money, products and services.
Overview of International Declarations, Statements, Charter and Recommendations

Supporting the Action Areas of Health Promotion
The Ottawa Charter for Health Promotion

The Ottawa Charter for Health Promotion is the name of an international agreement signed at the First
International Conference on Health Promotion, organized by the World Health Organization (WHO) and
held in Ottawa, Canada, in November 1986.
The Charter defined health promotion as

Health promotion is the process of enabling people to increase control over, and to improve, their health.
To reach a state of complete physical, mental and social well-being, an individual or group must be able
to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. Health
promotion is not just the responsibility of the health sector, but goes beyond healthy life-styles to well-
being.
The Charter is based on the belief that a secure foundation in society- the fundamental conditions of
peace, shelter, education, food, income, a stable eco-system, sustainable resources, social justice and
equity - are prerequisites for health improvement.
Strategies for Health Promotion (Q:2072/12)

i. Advocacy
- Good health is a major resource for social, economic and personal development and an important
dimension of quality of life. Political, economic, social, cultural, environmental, behavioural and
biological factors can all favour health or be harmful to it.
- Health promotion action aims at making these conditions favourable through advocacy for health.

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ii. Enabling
- Health promotion focuses on achieving equity in health. Health promotion action aims at reducing
differences in current health status and ensuring equal opportunities and resources to enable all
people to achieve their fullest health potential. This includes a secure foundation in a supportive
environment, access to information, life skills and opportunities for making healthy choices.
- People cannot achieve their fullest health potential unless they are able to take control of those things
which determine their health. This must apply equally to women and men.
iii. Mediating
- The prerequisites and prospects for health cannot be ensured by the health sector alone. More
importantly, health promotion demands coordinated action by all concerned: by governments, by
health and other social and economic sectors, by nongovernmental and voluntary organization, by
local authorities, by industry and by the media.
- People in all walks of life are involved as individuals, families and communities. Professional and
social groups and health personnel have a major responsibility to mediate between differing interests
in society for the pursuit of health.
Areas of Action
i. Building Healthy Public Policy
- Health promotion puts health on the agenda of policy makers, directing them to be aware of the
health consequences of their decisions and to accept their responsibilities for health.
- Health promotion policy combines diverse but complementary approaches including legislation, fiscal
measures, taxation and organizational change.
- Health promotion policy requires the identification of obstacles to the adoption of healthy public
policies in non-health sectors, and ways of removing them.
- Example: Legislation on tobacco
ii. Creating Supportive Environment

- The overall guiding principle for the world, nations, regions and communities is the need to encourage
reciprocal maintenance - to take care of each other, our communities and our natural environment.
- Systematic assessment of the health impact of a rapidly changing environment - particularly in areas
of technology, work, energy production and urbanization - is essential and must be addressed in any
health promotion strategy
- Example: Development of healthy cities
iii. Strengthen Community Actions

- Health promotion works through concrete and effective community action in setting priorities, making
decisions, planning strategies and implementing them to achieve better health. At the heart of this
process is the empowerment of communities.
- There should be flexible systems for strengthening public participation in and direction of health
matters. This requires full and continuous access to information, learning opportunities for health, as
well as funding support.
iv. Develop Personal Skills

- Health promotion supports personal and social development through providing information, education
for health, and enhancing life skills.
- Enabling people to learn, throughout life, to prepare themselves for all of its stages and to cope with
chronic illness and injuries is essential. This has to be facilitated in school, home, work and
community settings.

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v. Reorient Health Services

- The responsibility for health promotion in health services is shared among individuals, community
groups, health professionals, health service institutions and governments.
- They must work together towards a health care system which contributes to the pursuit of health.
The role of the health sector must move increasingly in a health promotion direction, beyond its
responsibility for providing clinical and curative services.
The Adelaide Recommendations on Healthy Public Policy

Second International Conference on Health Promotion, Adelaide, South Australia, 5-9 April 1988. It
generated a number of recommendations in the pursuit of healthy public policy commonly known as
Adelaide Recommendations on Healthy Public Policy and identified four key areas of action.
The conference called for a political commitment to health by all sectors. Policy-makers in diverse
agencies working at various levels (international, national, regional and local) were urged to increase
investments in health and to consider the impact of their decisions on health.
Recommendations: Areas of Action

The Conference identified four key areas as priorities for health public policy for immediate action:
i. Supporting the health of women
- Womens networks should receive more recognition and support from policymakers and established
institutions.
- For their effective participation in health promotion women require access to information, networks
and funds.
- This Conference proposed countries to start developing a national womens healthy public policy in
which womens own health agendas are central.
ii. Food and nutrition

- The elimination of hunger and malnutrition is a fundamental objective of healthy public policy.
- A food and nutrition policy that integrates agricultural, economic, and environmental factors to ensure
a positive national and international health impact should be a priority for all governments.
- The Conference recommended governments to take immediate and direct action at all levels to use
their purchasing power in the food market to ensure that the food-supply under their specific control
gives consumers ready access to nutritious food.
iii. Tobacco and alcohol

- The use of tobacco and the abuse of alcohol are two major health hazards that deserve immediate
action through the development of healthy public policies.
- This Conference called on all governments to commit themselves to the development of healthy
public policy by setting nationally determined targets to reduce tobacco growing and alcohol
production, marketing and consumption significantly.
iv. Creating supportive environments

- Policies promoting health can be achieved only in an environment that conserves resources through
global, regional, and local ecological strategies.
- The Conference advocated that, as a priority, the public health and ecological movements should join
together to develop strategies in pursuit of socioeconomic development and the conservation of our
earths limited resources.

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The Sundsvall Statement on Supportive Environment

The Third International Conference on Health Promotion: Supportive Environments for Health with
participants from 81 countries called upon people in all parts of the world to actively engage in making
environments more supportive to health.
The Sundsvall Conference identified many examples and approaches for creating supportive
environments that can be used by policy-makers, decision-makers and community activists in the health
and environment sectors. The Conference recognized that everyone has a role in creating supportive
environments for health.
In a health context the term supportive environments refers to both the physical and the social aspects of
our surroundings. The action to create supportive environments has many dimensions: physical, social,
spiritual, economic and political. Each of these dimensions is inextricably linked to the others in a dynamic
interaction. Action must be coordinated at local, regional, national and global levels to achieve solutions
that are truly sustainable.
Proposals for action

Sundsvall Conference believed that proposals to implement the Health for All strategies must reflect two
basic principles:
i. Equity must be a basic priority in creating supportive environments for health. All policies that aim at
sustainable development must be subjected to new types of accountability procedures in order to
achieve an equitable distribution of responsibilities and resources. All action and resource allocation
must be based on a clear priority and commitment to the very poorest, alleviating the extra hardship
borne by the marginalized, minority groups, and people with disabilities.
ii. Public action for supportive environments for health must recognize the interdependence of all living
beings, and must manage all natural resources, taking into account the needs of future generations. It
is essential, that indigenous peoples be involved in sustainable development activities, and
negotiations be conducted about their rights to land and cultural heritage.
Action Strategies
The Conference identified four key public health action strategies to promote the creation of supportive
environments at community level.
i. Strengthening advocacy through community action, particularly through groups organized by women.
ii. Enabling communities and individuals to take control over their health and environment through
education and empowerment.
iii. Building alliances for health and supportive environments in order to strengthen the cooperation
between health and environmental campaigns and strategies.
iv. Mediating between conflicting interests in society in order to ensure equitable access to supportive
environments for health.

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Jakarta Declaration on Health Promotion

The Fourth International Conference on Health Promotion was held in Jakarta, Indonesia on 21-25 July
1997. It is the first to be held in a developing country, and the first to involve the private sector in
supporting health promotion. It has provided an opportunity to re-examine the determinants of health, and
to identify the directions and strategies that must be adopted to address the challenges of promoting
health in the 21st century.
Priorities for health promotion in the 21st Century

i. Promote social responsibility for health
- Decision-makers must be firmly committed to social responsibility. Both the public and private sectors
should promote health by pursuing policies and practices that:
avoid harming the health of individuals
protect the environment and ensure sustainable use of resources
restrict production of and trade in inherently harmful goods and substances such as tobacco and
armaments, as well as discourage unhealthy marketing practices
safeguard both the citizen in the marketplace and the individual in the workplace
include equity-focused health impact assessments.
ii. Increase investments for health development

- In many countries, current investment in health is inadequate and often ineffective. Increasing
investment for health development requires a truly multisectoral approach including, for example,
additional resources for education and housing as well as for the health sector.
- Greater investment for health and reorientation of existing investments, both within and among
countries, has the potential to achieve significant advances in human development, health and quality
of life.
iii. Consolidate and expand partnerships for health

- Health promotion requires partnerships for health and social development between the different
sectors at all levels of governance and society.
- Existing partnerships need to be strengthened and the potential for new partnerships must be
explored.
- Partnerships offer mutual benefit for health through the sharing of expertise, skills and resources.
iv. Increase community capacity and empower the individual

- Health promotion improves both the ability of individuals to take action, and the capacity of groups,
organizations or communities to influence the determinants of health.
- Improving the capacity of communities for health promotion requires practical education, leadership
training, and access to resources.
- Empowering individuals demands more consistent, reliable access to the decision-making process
and the skills and knowledge essential to effect change.
v. Secure an infrastructure for health promotion

- To secure an infrastructure for health promotion, new mechanisms for funding it locally, nationally and
globally must be found.
- Incentives should be developed to influence the actions of governments, nongovernmental
organizations, educational institutions and the private sector to make sure that resource mobilization
for health promotion is maximized.

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The Mexico Charter: Mexico Ministerial Statement for the Promotion of Health
The Fifth Global Conference on Health Promotion was organized at Mexico City on 5-9 June 2000.
Areas of Action
By acknowledging that the promotion of health is a central duty and responsibility of governments, the
ministers of health present at the conference committed to the following:
i. To position the promotion of health as a fundamental priority in local, regional, national and
international policies and programs.
ii. To take the leading role in ensuring the active participation of all sectors and civil society, in the
implementation of health promoting actions.
iii. To support the preparation of country-wide plans of action for promoting health. These plans will
follow a basic framework agreed upon during the Fifth Global Conference on Health Promotion, and
may include among others:
The identification of health priorities and the establishment of healthy public policies and
programs to address these.
The support of research which advances knowledge on selected priorities.
The mobilization of financial and operational resources to build human and institutional capacity
for the development, implementation, monitoring and evaluation of country-wide plans of action.
iv. To establish or strengthen national and international networks which promote health.
v. To advocate that UN agencies be accountable for the health impact of their development agenda.
The Bangkok Charter for Health Promotion in a Globalized World

The Bangkok Charter for Health Promotion in a globalized world has been agreed to by participants at
the 6th Global Conference on Health Promotion held in Thailand from 7-11 August, 2005. This charter
identifies actions, commitments and pledges required to address the determinants of health in a
globalized world through health promotion.
Strategies for health promotion in a globalized world

Effective Interventions
- Progress towards a healthier world requires strong political action, broad participation and sustained
advocacy.
- Health promotion has an established repertoire of proven effective strategies which need to be fully
utilized.
Required actions
To make further advances in implementing these strategies, all sectors and settings must act to:
advocate for health based on human rights and solidarity
invest in sustainable policies, actions and infrastructure to address the determinants of health
build capacity for policy development, leadership, health promotion practice, knowledge transfer and
research, and health literacy
regulate and legislate to ensure a high level of protection from harm and enable equal opportunity for
health and well-being for all people
partner and build alliances with public, private, nongovernmental and international organizations and
civil society to create sustainable actions.

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Commitments for Health Promotion:

i. Make the promotion of health central to the global development agenda
- Strong intergovernmental agreements that increase health and collective health security are needed.
Government and international bodies must act to close the health gap between rich and poor.
- Effective mechanisms for global governance for health are required to address all the harmful effects
of trade, products, services, and marketing strategies .
- Health promotion must become an integral part of domestic and foreign policy and international
relations, including in situations of war and conflict.
ii. Make the promotion of health a core responsibility for all of government
- All governments at all levels must tackle poor health and inequalities as a matter of urgency because
health is a major determinant of socioeconomic and political development.
- Local, regional and national governments must:
give priority to investments in health, within and outside the health sector
provide sustainable financing for health promotion
iii. Make the promotion of health a key focus of communities and civil society
- Communities and civil society often lead in initiating, shaping and undertaking health promotion.
- They need to have the rights, resources and opportunities to enable their contributions to be amplified
and sustained. In less developed communities, support for capacity building is particularly important.
iv. Make the promotion of health a requirement for good corporate practice
- The corporate sector has a direct impact on the health of people and on the determinants of health
through its influence on:
local settings
national cultures
environments, and
wealth distribution.
- The private sector has a responsibility to ensure health and safety in the workplace, and to promote
the health and well-being of their employees, their families and communities.
The Nairobi Declaration

The Nairobi Call to Action was developed by participants at the 7th Global Conference on Health
Promotion, Nairobi, Kenya, in October 2009.
The Nairobi Call to Action identifies key strategies and commitments urgently required for closing the
implementation gap in health and development through health promotion.
The following strategies and actions are presented under the five sub-themes of the Conference:
i. Building capacity for health promotion

- Building sustainable health promotion infrastructure and capacity at all levels is fundamental to
closing the implementation gap.
- Actions the make difference:
Strengthening leadership
Secure adequate financing
Grow practitioner skill base
Enhance system-wide approaches
Improve performance management

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ii. Strengthening health systems

- To be sustainable, health promotion interventions must be embedded in health systems that support
equity in health and meet high performance standards.
- Integrating health promotion in all health systems functions and at all levels improves the overall
performance of health systems.
- Actions the make a difference:
Strengthen leadership
Enhance policy
Achieve universal access
Build and apply the evidence base
iii. Partnership and intersectoral action

- Effectively addressing the determinants of health and achieving health equity requires actions and
partnerships that extend beyond the health sector to implement forms of collaboration, cooperation
and integration between sectors.
- Actions that make a difference:
Strengthen leadership
Enhance policy
Enhance implementation
iv. Community empowerment

- Communities must share the power, resources and decision-making to assure and sustain conditions
for health equity.
- Action that make a difference:
Enable community ownership
Develop sustainable resources
v. Health literacy and health behaviours

- Basic literacy is an essential building block for development and health promotion.
- Health literacy interventions need to be designed based on health, social and cultural needs.
- Actions that make a difference
Support empowerment
Enhance information and communication technologies

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International Union for Health Promotion and Education (IUHPE)
The International Union for Health Promotion and Education (IUHPE) is a unique worldwide, independent
and professional association of individuals and organizations committed to improving the health and
wellbeing of the people through education, community action and the development of healthy public
policy.
As a membership organization, the International Union for Health Promotion and Education (IUHPE)
gathers people and institutions from all over the world, working in all areas that health promotion
encompasses.
The mission of the IUHPE is to promote global health and wellbeing and to contribute to the achievement
of equity in health for all countries of the world.
Goals
The IUHPE aims to achieve the following goals:
Greater equity in the health of populations between and within countries of the world;
Effective alliances and partnerships to produce optimal health promotion outcomes;
Broadly accessible evidence-based knowledge and practical experience in health promotion;
Excellence in policy and practice for effective, quality health promotion; and
High levels of capacity in individuals, organizations and countries to undertake health promotion
activities
Objectives
To achieve its goals the IUHPE will pursue the following objectives:
Increased investment in health promotion by governments, intergovernmental and non-governmental
organizations, academic institutions and the private sector;
An increase in organizational, governmental and inter-governmental policies and practices that result
in greater equity in health between and within countries;
Improvements in policy and practice of governments at all levels, organizations and sectors that
influence the determinants of the health of populations;
Strong alliances and partnerships among all sectors based on agreed ethical principles, mutual
understanding and respect;
Activities that contribute to the development, translation and exchange of knowledge and practice
that advance the field of health promotion;
A strong and universally accessible knowledge base for effective, quality health promotion;
Capacity-building opportunities for individuals and institutions to better carry out health promotion
initiatives and advocacy efforts.
Activities/Projects
i. Advocacy
ii. Capacity building, education and training
iii. Communications and marketing
iv. Finance and internal control
v. Partnership and institutional affairs
vi. Strategy and governance

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Victoria Health Promotion Foundation
The Victorian Health Promotion Foundation (Vic Health) was the world's first health promotion foundation
established by the State Parliament of Victoria as a part of the Tobacco Act in 1987 with the funding from
the state government collected tobacco tax. Vic health was provided an independent statutory authority
and had a mandate to support health promotion activities with funds received from earmarked taxes.
Vision: to support and enhance the wellbeing of all Victorians.
Objectives
The objectives of VicHealth as set out in the Act are to:
fund activity related to the promotion of good health, safety or the prevention and early detection of
disease
increase awareness of programs for promoting good health in the community through the
sponsorship of sports, the arts and popular culture
encourage healthy lifestyles in the community and support activities involving participation in healthy
pursuits
fund research and development activities in support of these activities
Strategies
VicHealth's Action Agenda for Health Promotion 20132023 focuses on five strategic imperatives with
associated goals and three-year priorities.
Promoting healthy eating
Encouraging regular physical activity
Preventing tobacco use
Preventing harm from alcohol
Improving mental wellbeing
Examples of Activities of Vic Health

Anti-smoking campaigns
Buy out tobacco company sponsorship of sport and the arts -1988
Ban on all tobacco advertising in Victorian print media. Smoking bans in public places.
Food and Nutrition Program
Active for Life - in schools to teach children about making exercise a healthy lifetime habit to prevent
heart disease.
Funding to various programs:
o Cancer Council Victoria (Sun Smart, Quit)
o Victorian Breast Cancer Screening Programs
o Mental Health Research Institute
Learning from Vic Health

The results of Vic Health's approach to tobacco control were very impressive. Prevalence of smoking
in Victoria declined significantly. Over 17,000 premature deaths are being averted each year in
Australia. This shows that tobacco control can be the best buy in terms of health care costs, health
status improvements and longevity gains.
The dedicated (hypothecated) tax was the efficient way to raise funds to buy out the tobacco
industrys sponsorship of sport and the arts. This was possible due to the partnership between Vic
Health and the Cancer Council Victorias Quit campaign and support of successive ministers and

Year
governments for legislative change. One of the major learning of Vic Health is that sustained
funding, healthy public policy, political commitments and effective partnership are essential for better
health impacts.
Vic Health's partnership with unique stakeholders like sports and art provided an important message
that health promotion is everyone's business including health agencies, political parties, sports, art,
media, community and general public.
Another important message relayed by Vic Health is that it was successful because it could sustain
various political environments to secure continued funding. So, an important takeaway message is
that Vic Health model may not be applicable to all countries. This is because finance ministries may
not always be positive towards earmarked taxes. Also tobacco control and other non-communicable
diseases may not be the country's priorities. If Health Promotion Foundation is to be modeled in any
country, it needs to be established and run differently, according to respective cultural, political and
economic contexts.
UNIT 3: FRAMEWORKS/ MODELS/THEORIES OF HEALTH PROMOTION AND EDUCATION
Differences between Theories, Models and Frameworks of Behaviour Change (Q: 2072/12)
When distinguishing among theory, model and framework, it is helpful to think of the term 'Theory'.
Kerlinger (1973) defines theory as a set of interrelated constructs (concepts), definitions and propositions
that presents a systematic view of phenomena by specifying relations among variables or constructs, with
the purpose of explaining and predicting phenomena.
Theories are used in health promotion to understand, guide and explain health promotion at the
individual, family and community level.
Several terms are important to understand when discussing about theories of behavior change. These
includes: i) Construct ii) Models and iii) Frameworks
i. Constructs:
- Constructs are the main concepts of a theory. They are the elements of the theory used to describe,
explain and predict behavior
- For example, the constructs of the Health Belief Model include perceived susceptibility, perceived
severity, perceived benefits, perceived barriers, cues to action and self efficacy.
ii. Models
- Models outline the structural components for a health promotion and hence present and explain
relationships between constructs.
- If theory's goal is to determine how and why phenomena occur, the goal of modeling is to identify the
structure or composition of the phenomenon under investigation.
- For example, the Health Belief Model explains how attitudes and beliefs influence behavior
iii. Framework
- Framework provides a way of viewing the behavior but does not explain relationships between
constructs.
- For example, the Social Ecological Framework (SEF) describes different levels that influence
behaviour but does not necessarily explain the specific constructs and how these interact.

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From the above classification, its been clear that Models and Frameworks can exist within theories, the
former by outlining a specific set of constructs and how they are related to a behavior, while the latter by
providing a general idea of what influences behavior. Despite differences in the terms theory, model and
framework, they are often used interchangeably to describe the processes of behavior change.
Some of the common theories, models and framework of behavior change have been summarized in the
table below:
Theories Models Framework

Theory of Planned Behaviour or
Health Belief Model Social Ecological Framework
Theory of Reasoned Action
Diffusion of Innovation Theory Precede-Proceed Model
Social Cognitive Theory Transtheoritical Model (Stages of
Change)
List of different behaviour change models and planning frameworks

SN Models/Frameworks Developed by
1 PRECEDE/PROCEED Model LW Green, M. Kreuter
2 Health Belief Model Hochbaum, Rosenstock and Kegels
3 Transtheoritical Model Prochaska, DiClemente, & Norcross
4 Theory of Reasoned Action/ Theory of Planned Ajzen and Fishbein
Behaviour
5 Social Cognitive Theory Albert Bandura
6 Cognitive Dissonance Theory Leon Festinger
7 Transactional Model of Stress and Coping Lazarus and Folkman
8 Diffusion of Innovation Theory E.M. Rogers
9 Force Field Analysis Kurt Lewin
10 Model of Adult Education/ Conscientization Paulo Freire
Theory
PRECEDE/PROCEED MODEL
PRECEDE- PROCEED model is a nine steps planning process that begins at the end, focusing on the
health related outcomes of interest and working backward to diagnose which combination of intervention
strategies will best achieve the objectives.
PRECEDE is the acronym for Predisposing, Reinforcing and Enabling Constructs in Educational/
Environmental Diagnosis and Evaluation. PROCEED stands for Policy, Regulatory and Organizational
Constructs in Educational and Environmental Development.
Phases of PRECEDE- PROCEED model:

i. Social diagnosis
- The social assessment determines peoples participation of their own needs and quality of life (Green
and Kreuter).
- In this phase, need assessment techniques are use to determine the quality of life by identifying the
social problems in target populations.
- These subjective quality of life social indicators could include illegitimacy welfare, discremination,
happiness, self esteem, along with many other possibilities.

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ii. Epidemiological diagnosis

- Epidemiological Assessment helps to determine which problems are most important for which groups
in a community (Green and Kreuter, 1999).
- Epidemiological data is used to determine what specific problems are contributing to the social
problems previously identified.
- This data might include mortality, morbidity, fertility, and disability and their dimensions such as
incidence, prevalence, distribution, intensity and duration.
iii. Behavioural and Environmental Diagnosis

- The behavioral and environmental diagnosis involves assessing factors that contribute to the health
problems under consideration (Green and Kreuter).
- Behavioral factors are those behaviors or lifestyles of the individuals at risk that contribute to the
occurrence and severity of the health problems.
- Environmental factors are those social and physical factors external to the individual often beyond his
or her personal control that can be modified to support the behavior or influence the health outcome.
- Modifying environmental factors usually requires strategies other than education.
iv. Educational and organizational diagnosis

- After selecting the appropriate behavioral and environmental factors for intervention, this step
identifies the antecedent and reinforcing factors that must be in place to initiate and sustain the
change process. These factors are classified as predisposing, re-enforcing and enabling and they
collectively influence the likelihood that behavioral and environment change will occur.
a. Predisposing factors
Pre-disposing factors are antecedents to behavior that provide the rationale or motivation for the
behavior (Green and Kreuter, 1999).
This includes individuals knowledge, attitudes, beliefs, personal preference, existing skills and
self- efficacy beliefs.
b. Reinforcing factors
Reinforcing factors are the factors following behaviour that provide continuing reward or incentive
for the persistence or repetition of the behavior (Green and Kreuter).
Examples include social support, peer influence, significant others and vicarious awards.
c. Enabling factors
Enabling factors are antecedents to behavior that allow a motivation to be realized (Green and
Kreuter).
Enabling factors can affect behavior directly or indirectly through environmental factors.
They include programs, services and resources necessary for behaviour and environmental
outcomes to be realized and in some cases, new skills that are needed to enable health
behaviour change.
v. Administrative and Policy diagnosis

- In this stage, determination is made if the capabilities and resources are available to develop and
implement the program.
- Barriers to implementation, such as staff motivation or lack of space should be assessed and plans to
address them put in place.
vi. Implementation
- With the proper resources in hand, the appropriate methods and strategies of the intervention are
selected.

Year
vii. Process Evaluation

- At this level of evaluation, the main focus is upon professional practice.
- Quality in health education programming is monitored by such methods as audit, peer review,
accreditation, certification and government or administrative overview of contracts and grants.
viii. Impact Evaluation

- This level of evaluation assesses change in predisposing, reinforcing and enabling factors, as well as
in the behavioural and environmental factors.
- Cost effectiveness is one standard of acceptability in impact evaluation.
ix. Outcome evaluation

- It determines the effects of programs on health and quality of life.
PRECEDE PROCCED framework as a comprehensive framework

The PRECEDE/PROCEED model is a comprehensive health promotion planning framework often used
as theoretical framework from health program planning to implementation and evaluation.
- PRECEDE/PROCEED model is multidimensional and is grounded in a variety of disciplines such as
social/behavioural sciences, epidemiology, education and administration.
- It is comprehensive also because it operates on the notion that health behaviours have multiple
causations that must be evaluated in order to assure appropriate interventions

Year
Advantages of PRECEDE PROCEED framework over classical health belief and behavior frameworks
- Health belief model and other classical frameworks are particularly useful for planning programs for
disease avoidance and injury prevention but it does not lend itself very well to promotion of
behaviours, particularly long-term behavior change.
- These models lack consistent predictive power mainly because it focuses on limited factors. Cultural
factors, socioeconomic status, and previous experiences also shapes behaviours, and those factors
are not accounted for in the model.
- In contrast, PRECEDE PROCEED model necessitates a systematic and comprehensive assessment
of the social environment, the epidemiology of the problem, the behavior or behaviours that are
affecting the health problem in question, educational and ecological factors and administrative and
policy factors.
- PRECEDE PROCEED framework also considers a wide range of potential outcome determinants at
the needs assessment stage before the program is developed.
- Unlike classical frameworks where behavior change interventions are imposed to target groups, this
model emphasizes on community participation so as to foster community ownership in the process,
the proposed solutions and the implementation of resulting programmatic interventions.
- The ultimate benefit of the model is that appropriate interventions are likely to result and the likelihood
of a rigorous evaluation design is enhanced.
Key distinction between PRECEDE/PROCEED and classical frameworks
PRECEDE/PROCEED Health belief and other classical models

- Considers variety of factors: social, - Limited to few considerations: beliefs and
epidemiological, ecological, administrative, attitudes
behavioural, educational - Factors like socio-economic factors, previous
experiences etc. are not considered
- Encourages community/ target groups - Interventions are rather imposed by outsiders
participation at all levels
- Encourages feedback and flexibility enough to fit - Relatively less flexible
the needs of a specific environment and
community
- Focuses on outcome and impacts - Mainly focused on output only
- Introduces long-term behavior change - Influences but does not lend to long-term
behavior change
- Comprehensive and scalable framework - Rather specific with limited applications
- Evidence based process with phased evaluation - Lack evaluation process
Applications
- PRECEDE/PROCEED model has a wide range of applications. Fewer examples are listed below:
Coalition building
Enhancing community participation
Cost-benefit evaluation of health education programs
Family planning studies
Immunization campaign
Combating domestic violence
Planning health programs in school settings
Ensuring compliance behaviours

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Limitations
- This model is too comprehensive to be fully implemented in many situations
- Health promotion and education funding may be allocated in specific area with no provision for social
and epidemiological assessment
- PRECEDE phase can take a long time, delaying the beginning of programs.
PRECEDE/PROCEED Framework for Malaria Prevention
PRECEDE/PROCEED Framework for Prevention of RTAs

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Health Belief Model

The Health Belief Model (HBM) is a psychological model that attempts to explain and predict health
behaviors by focusing on the attitudes and beliefs of individuals.
The key phases and construct of Health Belief Model are:

Concept Definition Application
Perceived Belief about the chances of - Define population at risk
susceptibility experiencing a risk or getting a - Personalize risk based on a persons
condition or disease characteristics or behavior
- Make perceived susceptibility more
consistent with individuals actual risk
Perceived Belief in the extent of harm that can - Mention consequences of risks and
severity result from the acquired disease or conditions
harmful state as a result of particular
behavior
Perceived Belief in the advantages of the methods - Define action to take; how, where, when;
benefits suggested for reducing the risk of - Clarify the positive effects to be expected
seriousness of the disease or harmful
state resulting from a particular
behavior
Perceived Belief about the tangible and - Identify and reduce perceived barriers
barriers psychological costs of the advised through reassurance, correction of
action misinformation, incentives and assistance
Cues to action Precipitating force that makes a person - Provide how to information, promote
feel the need to take action awareness, use appropriate remainder
system
Self-efficacy Confidence in ones ability to acquire - Provide training and guidance in
the new behavior performing recommended action
- Use progressive goal setting
- Give verbal reinforcement
- Reduce anxiety

Year
Applications
i. Applications in behavioural research
- AIDS health belief scale
- Factors associated with infant mortality
- Modeling for physical activity behavior
- Modeling of sexual behavior
- Predictors of health behaviours in college students
ii. Applications in primary prevention

- Condom use in female sex workers
- Dietary behavior
- Health counseling
- Pesticide safety
- Immunization
- Prevention of periodontal disease
iii. Applications in secondary prevention

- Adherence to malaria chemoprophylaxis
- Breast self-examination and mammography
- Cervical cancer screening
- Anxiety reduction in pregnant women
- HIV testing
Limitations
- Cultural factors, socioeconomic status, and previous experiences that shape behaviours are not
accounted for in this model.
Theory of Reasoned Action/ Theory of Planned Behaviour

The theory of planned behaviour asserts that achieving and maintaining behaviour change requires intent
to adopt a positive behaviour or abandon a negative one.
The theory holds that intent is influenced not only by the attitude toward the behaviour but also the
perception of social norms (the strength of others opinions on the behaviour and the persons own
motivation to comply with those significant others) and the degree of perceived behavioural control.
The constructs and phases of the theory of planned behavior are

Concept Definition Example statements How to modify?
Behavioural intention Perceived likelihood of I am going to quit Brainstorming all
performing behavior smoking this Monday possible outcomes
Attitude Personal evaluation of the You know what? I think By influencing
behavior smoking is dangerous behavioural beliefs and
for my health outcome evaluations
Subjective norm Beliefs about whether key I wonder if my friends By influencing
people approve or would like me to quit normative beliefs and
disapprove of the smoking? motivation to comply
behaviour; motivation
to behave in a way that
gains their approval
Perceived Belief that one has, and can I can quit smoking, By influencing control
behavioural control exercise, control over even if Im hooked on beliefs and perceived
performing the behaviour cigarettes power

Year
Applications in health promotion and education

- Colorectal cancer screening
- Condom use
- Modeling alcohol use
- Promoting healthy diet
- Violence prevention
- HIV prevention program in adolescent mother
- Exercise/ physical activity behavior
Limitations:
- This model predicts behavioural intention and behavior but do not provide detailed and specific
guidance for behavior change.
- They do not consider personality related factors, cultural factors and demographic variables, which
also shape behavior
- This theory assumes that perceived behavioural control predicts actual behavioural control, which
may not always happen.
- It does not take account of irrational thoughts and behavior
Transtheoritical Model
The Transtheoretical Model (TTM) uses stages of change to integrate processes and principles of change
across major theories of intervention,
Behaviour change is viewed as a progression through a series of five stages:
Stages Definition Example for physical Potential change strategies

activity promotion
Pre-contemplation Has no intention of taking It isnt that I cant see the Increase awareness of
action within the next six solution, I just cant see need for change;
months the problem personalize information
about risks and
benefits
Contemplation Intends to take action in I want to stop feeling so Motivate; encourage
the next six months stuck making specific plans
Preparation Intends to take action I just took out a Assist with developing and
within the next 30 days membership to a fitness implementing concrete
and has taken some facility action plans; help set
behavioural steps in this gradual goals
direction
Action Has changed behaviour Ive started exercising and Assist with feedback,
for less than six months while I enjoy it, sometimes problem-solving, social
I find it a chore support and reinforcement
Maintenance Has changed behaviour Exercising three times a Assist with coping,
for more than six months week has become a part reminders, finding
of my lifestyle alternatives, avoiding
slips/relapses (as
applicable)
Applications of transtheoritical model

- Adherence to antiretroviral therapy in AIDS
- STI screening

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Limitations
- The stages in the model are arbitrary and classifying a population into different stages has little utility.
- Validity of self-reported behaviour with regard to stage is questionable.
- A significant number of people cannot be assigned to recognized stages.
Social Cognitive Theory

- Proposed by Albert Bandura
- Social learning theory is based on the idea that people not only self-regulate their environments and
actions, they are also acted upon by their environments.
- This theory explains human behaviour as a triadic reciprocal causation among behaviour,
environment and personal factors.
The phases and constructs of social cognitive theory are:

Concept Definition Potential change strategies
Reciprocal The dynamic interaction of the person, Consider multiple ways to promote
determinism behaviour, and the environment in behaviour change, including making
which the behaviour is performed adjustments to the environment or
influencing personal attitudes
Behavioural Knowledge and skill to perform a given Promote mastery learning through skills
capability behaviour training
Expectations Anticipated outcomes of a behaviour Model positive outcomes of healthful
behaviour
Self-efficacy Confidence in ones ability to take action Approach behaviour change in small
and overcome barriers steps to ensure success; be specific
about the desired change
Observational Behavioural acquisition that occurs by Offer credible role models who perform
learning watching the actions and outcomes of the targeted behaviour
(modelling) others behaviour
Reinforcements Responses to a persons behaviour that Promote self-initiated rewards and
increase or decrease the likelihood of incentives
reoccurrence
Applications
- HIV risk reduction program
- Better walking performance in older adults
- Smoking cessation
- Understanding sexual behaviour
- Studying childrens eating behaviour

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Limitations
- Ignores the maturation throughout the life span
- No considerations for biological and hormonal predispositions that could influence behaviors
- It is not a unified theorythat the different aspects of the theory do not tie together to create a
cohesive explanation of behavior.
- It does not provide a full explanation or description of how social cognition, behavior, environment,
and personality are related, although there are several hypothesis.
Diffusion of Innovation Theory

- Diffusion of innovations is the process by which an innovation is communicated through certain
channels over time among the members of a social system.
- Diffusion can be thought of as a special type of communication in which messages are about a new
idea, product or service.
- If a health education programme is viewed as an innovation, this theory could describe the pattern the
target population would follow in adopting the programme.
- The process of adoption is viewed as a classic bell curve, with five categories of people as adopters:
innovators, early adopters, early majority adopters, late majority adopters, and laggards.
- The categories are characterized as follows:
innovators are active information seekers of new ideas
early adopters are very interested in the innovation but not the first to sign up
early majority need external motivation to get involved
late majority are sceptics and will not adopt an innovation until most people in the social system
have done so
laggards typically have limited communication networks and are the last to become involved,
usually with the help of a mentoring programme or through constant exposure.
- When an innovation is introduced, the majority of people will either be early majority adopters or late
majority adopters; fewer will be early adopters or laggards, and very few will be innovators (the first
people to use the innovation).
- By identifying the characteristics of people in each adopter category, practitioners can more
effectively plan and implement strategies that are customized to their needs.

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Four main elements for diffusion of innovation

Elements Description
1 Innovation An innovation is an idea, practice, or object that is perceived as new by an
individual or other unit of adoption.
The rate at which the innovation get adopted by members of a social system
depends on number of characteristics of innovation: relative advantage,
compatibility , complexity, triability, observability
2 Communication Communication channels are the carriers of the diffusion process, the road along
channel which the innovation travels through the social system
These channels can be mass media or interpersonal.
3 Time The role of time in the diffusion process manifests itself as the point in time at
which an individual decides to adopt the innovation.
In addition, time plays a role in the speed with which an innovation is being
diffused: rate of adoption
4 Adopters Rogers identified five adopter categories based on their relative innovativeness:
innovators, early adopters, early majority, later majority and laggards
5 Social System The social system is the environment within which the diffusion process takes
place
It includes communication networks, values and culture, various roles of members
of social system (e.g. opinion leaders), etc.
Rogers Adoption Model

Stages of Rogers Adoption (Innovation-Decision) Process
Earlier Roger had identified five stages of adoption as
Awareness Interest Evaluation Trial Adoption
In his later editions of Diffusion of Innovation, Roger changed his terminology of five stages to
Knowledge Persuasion Decision Implementation Confirmation
Stage Description
1 Knowledge In this stage, the individual is first exposed to an innovation, but lacks
information about the innovation.
During this stage the individual has not yet been inspired to find out more
information about the innovation
2 Persuasion The individual is interested in the innovation and actively seeks related
information/details such as
- Relative advantages
- Social norms
- Expected outcomes
3 Decision The individual takes the concept of change and weighs the advantages/
disadvantages of using the innovation.
4 Implementation The individual employs the innovation to a varying degree depending on
the situation.
During this stage the individual also determines the usefulness of the
innovation and may search for further information about it.
5 Confirmation Individual finalizes his/her decision to use, continue, or discontinue
adoption

Year
Freires Model of Adult Education
Paulo Freire was a Brazilian educator and philosopher who worked in the area of adult literacy.
His book Pedagogy of the Oppressed, was first published in 1970 and is influential in the education
field.
Freire criticized the traditional Banking concept of education and focused on problematizing or problem
posing education.
Construct of Freires Model

Constructs Definition Methods of education
1 Dialogue Two way exchange between learners Group discussions
and educator Online discussions
2 Conscientization Identifying the underlying systemic Discussion
forces of oppression Brainstorming
Role play
Simulation
Team building exercise
3 Praxis Reflective action (tying up theory to Pilot project
practice)
4 Transformation Relationship that identifies one as a Case study
political and social being Field visit
5 Critical consciousness Political organization of those Group formation
adversely affected Coalition building
Formation of non-profit
organization
Freire model of adult education uses a three-phase approach

i. Naming phase (What is the problem?)
- The facilitator is listening to the group talking about the issue at hand.
- For example, when discussing underage drinking, rather than delivering a lecture, the facilitator would
pose a question such as, Is there a problem with underage drinking at our community?
- This initiates a critical dialogue among members.

Year
ii. Reflection phase (How do we explain this situation?)

- The emphasis is on bringing out the inner emotions of the participants as much as possible.
- For example, the facilitator would pose a question such as Why do people that are under age drink
alcohol even though it is illegal?
- Facilitator is prepared with follow up questions to ensure all levels of the issue have been explored.
iii. Action phase (What can be done to change this situation?)

- The goal here is to follow the approach advocate by the group.
- For example, the facilitators goals is to decrease the prevalence of underage drinking, but the
participants understanding the multiple levels of the issue, come up with the plans and strategies for
accomplishing this.
Applications of Freires Model

i. General applications: ii. Individual & community level behaviour change
Adult education Breast cancer control
Community organization Community organization
Health education HIV/AIDS prevention
Social work Oral health promotion
Peer to peer approach in reproductive health
Limitations
Contorted manner of writing and his vagueness makes interpretation of concepts difficult and
measurement complex
Complex terminologies: not very easy to understand and lends to multiple interpretations
Equal hierarchy of learners and educators is seldom achieved in real world settings
Difficult to differentiate the constructs so that they are mutually exclusive.
Kurt Lewins Model of Planned Change
- Kurt Lewin (1890-1947) is considered as the father of social psychology

- His field theory states that "ones behavior is related both to ones personal characteristics and to the
social situation in which one finds oneself."
- Kurt Lewin theorized a three-stage model of change that is
known as the unfreezing-freezing-refreezing model that
requires prior learning to be rejected and replaced.
- Lewin's theory states behavior as a dynamic balance of
forces working in opposing directions. These are driving
and restraining forces.
i. Driving forces
- Driving forces are forces that push in a direction that
causes change to occur.
- Driving forces facilitate change because they push the
person in the desired direction.
- E.g. knowledge about disease, perceived severity,
economic progress, etc.

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ii. Restraining forces

- Restraining forces are forces that counter driving forces.
- Restraining forces hinder change because they push the person in the opposite direction.
- E.g. superstition, lack of awareness, misconception, poverty, etc.
Lewins change model consists of three distinct phases

i. Unfreezing
- Unfreezing is the process which involves finding a method of making it possible for people to let go of
an old pattern that was counterproductive in some way.
- Unfreezing is necessary to overcome the strains of individual resistance and group conformity.
- Unfreezing can be achieved by the use of three methods.
First, increase the driving forces that direct behavior away from the existing situation or status
quo.
Second, decrease the restraining forces that negatively affect the movement from the existing
equilibrium.
Third, find a combination of the two methods listed above
ii. Movement
- This stage involves a process of change in thoughts, feeling, behavior, or all three, that is in some
way more liberating or more productive.
iii. Refreezing
- Refreezing is establishing the change as a new habit, so that it now becomes the standard operating
procedure.
- Without this stage of refreezing, it is easy to go back to the old ways.
Cognitive Dissonance Theory

Cognitive dissonance theory was developed by Leon Festinger in 1957. Cognitive dissonance theory is
based in three fundamental assumptions:
i. Humans are sensitive to inconsistencies between actions and beliefs.

ii. Recognition of this inconsistency will cause dissonance and will motivate an individual to resolve the
dissonance.
iii. Dissonance will be resolved in one of the three basic ways
a. Change beliefs
b. Change actions
c. Change perception of action

Year
Theories of Stress and Coping

Transactional Model of Stress and Coping
The Transactional Model of Stress and Coping is a framework for evaluating processes of coping with
stressful events.
Constructs Definition
Primary Appraisal Evaluation of significance of a stressor or threatening event
Secondary Appraisal Evaluation of the controllability
of the stressor and a persons coping resources
Coping efforts Actual strategies used to mediate primary and secondary appraisals
Problem management: active coping, problem solving and information
seeking
Emotion regulation: venting feelings, avoidance, denial, and seeking social
support
Meaning based coping Coping processes that induce positive emotion.
Positive reappraisal, revised goals, spiritual beliefs, positive events
Outcome based Coping strategies may result in short and long term positive or negative
coping adaptation

Year
Intervention Mapping
- Intervention Mapping is a protocol for developing effective behavior change interventions.
- Intervention Mapping is not a new theory or model; it is an additional tool for the planning and
development of health promotion interventions
- The Intervention Mapping (IM) protocol (Bartholomew et al., 2016) describes the iterative path from
problem identification to problem solving or mitigation.
- Each of the six steps of IM comprises several tasks each of which integrates theory and evidence.
i. Step 1: Logic Model of the Problem

- Establish and work with a planning group
- Conduct a needs assessment to create a logic model of the problem
- Describe the context for the intervention including the population, setting, and community
- State program goals
ii. Step 2: Program Outcomes and Objectives Logic Model of Change

- State expected outcomes for behavior and environment
- Specify performance objectives for behavioral and environmental outcomes
- Select determinants for behavioral and environmental outcomes
- Construct matrices of change objectives
- Create a logic model of change
iii. Step 3: Program Design

- Generate program themes, components, scope, and sequence
- Choose theory- and evidence-based change methods
- Select or design practical applications to deliver change methods
iv. Step 4: Program Production

- Refine program structure and organization
- Prepare plans for program materials
- Draft messages, materials, and protocols
- Pretest, refine, and produce materials
v. Step 5: Program Implementation Plan

- Identify potential program users (implementers, adopters, and maintainers)
- State outcomes and performance objectives for program use
- Construct matrices of change objectives for program use
- Design implementation interventions Implementation
vi. Step 6: Evaluation Plan

- Write effect and process evaluation questions
- Develop indicators and measures for assessment
- Specify the evaluation design
- Complete the evaluation plan

Year
Multilevel Approach to Community Health (MATCH)

The Multilevel Approaches toward Community Health (MATCH) model provides a representation of the
ecological levels in conjunction with the planning, implementation, and evaluation stages of a community
organization process.

Year
UNIT4: VARIOUS APPROACHES TO HEALTH PROMOTION AND EDUCATION
Pedagogy vs Andragogy
According to Connor, Pedagogy literally means the art and science of educating children and is often
used as a synonym for teaching.
- More accurately pedagogy embodies teacher-focused education where teachers assume
responsibility for making decisions about what will be learned, how it will be learned and when it will
be learned.
By contrast, Andragogy, a theory of adult learning, attempts to explain why adults learn differently to
younger learners.
- Andragogy is defined by Knowles as the art and science of helping adults learn.
Distinction in the characteristics of the andragogical and pedagogical approaches to health education
Features Pedagogy Andragogy
The learner - The learner is dependent upon - The learner is self-directed
the instructor for all learning - The learner is responsible for her own learning
- The teacher/instructor assumes - Self-evaluation is characteristics of this approach
full responsibility for what is
taught and how it is learned
- The teacher/instructor evaluates
learning
Role of - The learner comes to the activity - The learner brings a greater volume and quality
learners with little experience that could of experience
experience be tapped as a resource for - Adults are the richest resources or one another.
learning - Different experiences assure diversity in groups
- The experience of the instructor of adults.
is most influential - Experience becomes the source of self-identity.
Readiness - Students are told what they have - Any change is likely to trigger a readiness to
To Learn to learn in order to advance to the learn.
next level of mastery. - The need to know in order to perform more
effectively in some aspect of ones life.
- Possesses the ability to assess gaps between
where one is now and where one wants and
needs to be.
Orientation - learning is process of acquiring - Learners want to perform a task, solve a
To Learning prescribed subject matter problem, and live in a more satisfying way.
- Content units are sequenced - Learning must have relevance to these tasks.
according to the logic of the - learning is organized around life/work situations
subject matter. rather that subject matter units
Motivation - Learners are motivated by - Learners are primarily motivated by internal
external forces forces
Importance and Applications of Andragogical Approach in Health Education

- Most of the target groups in a community health education program are adults, theoretical
foundations therefore must include an understanding of the principles of educating adults.
- The central purpose of health education is to bring valid knowledge to bear on the decision that
clients must make. In doing so, it is aimed at achieving the needs and goals that individuals specifies
and, if possible, to satisfy the needs and goals of the community and society. The importance of a
need assessment becomes instantly apparent to those subscribing to this approach

Year
- In the process of health education, adults take part in the planning and assessment of their own
education. Each lesson must be explained. Learners must be aware and understand the rationale
behind certain procedures or information.
- Andragogy in practical terms means that adult education must concentrate more on the methods
more than lessons. And the most useful of these applied in health education includes simulations,
role playing, discussions, case-studies and self-evaluation.
Formal and Non-Formal Education Approach

Formal education corresponds to a systematic, organized education model, structure and administered
according to a given set of laws and norms, presenting a rather rigid curriculum as regards objectives,
content and methodology.
- It corresponds to the education process normally adopted by our schools and universities.
- Various components of health issues have been a part of curriculum at each levels of formal
education system in Nepal.
Non-formal education approach

Non formal education is an organized educational activity outside the established formal system- whether
operating separately or as an important feature of some broader activity- that is intended to serve
identifiable learning clients and learning objectives.
- Non-formal approach to health education is an alternative way of providing educational opportunity to
those who could not get education from formal systems.
Characteristics of non-formal education approach (Fordham, 1993)

- Non-formal education should be relevant to the needs of disadvantaged groups
- It should concern with specific categories of person
- Non-formal education should focus on clearly defined purposes.
- There should be flexibility in organization and methods.
Non-formal education approach in Nepal

- NFEC under Ministry of Education has been extensively implementing various educational programs
targeting adult men, women and children who have been deprived of getting access to and
opportunity to formal education.
- Basic (health) literacy, post-literacy, alternative schooling and life and livelihood skills training
programs are the major initiatives being taken in Nepal.
Features Formal education Non-formal education

Purpose Long term and general Short-term and specific
Credential based Non-credential based
Timing Long cycle/ full time Short cycle/part time
Content Standardized Individualized
Academic Practical
Delivery system Institution based Community based
Control External/hierarchical Self governing/ democratic

Year
Theory of Adult Learning

According to Malcolm Knowles
i. Learners need to know:
- As one becomes mature, a persons self-concept changes from being dependent into an independent
one.
- It is important that adult know the reason for learning something. Adults learn when they perceive a
need to learn.
- Learners can employ scientific, rational and critical thinking when making decisions.
ii. Role of Experience

- As an individual becomes mature, he/she increases his/her experience which ultimately becomes a
potent source for learning.
- To truly learn a thing, an adult must experience that thing.
- Learning takes place when the learner is able to relate a previous experience to the context of
learning.
iii. Readiness to learn

- As a person matures, his readiness to learn becomes oriented increasingly to the developmental
tasks of his social roles (Knowles et al., 1984).
- Adults approach learning as problem-solving.
iv. Orientation to learning

- As one matures, the perspective of a person shifts from suspended use of knowledge to immediate
use, likewise, his/her learning orientation changes from subject-oriented learning into one that
focuses on problems.
- If the lesson is of immediate importance, adults learn the fastest.
v. Motivation to learn
- As one matures, the motivation of a person to learn is within him/her.
- Since motivation is the most important part of learning, appropriate motivation is imperative to support
learning.
Conscientization Approach (Paulo Freire)

Paulo Freire was a Brazilian educator and philosopher who worked in the area of adult literacy.
He was a critic of the banking model of education, in which the elite own and construct the knowledge,
and the poor are excluded.
- According to Paulo Freires critical view of education, non-formal adult education should be viewed as
conscientization.
- Conscientization is the process of developing a critical awareness of one's social reality through
reflection and action.
- Freire maintains that adult education can be used to effect radical social change and liberate the
oppressed.
- Freire advocates for education that develops learners consciousness of their rights along with their
critical presence in the real world.
- In other words, for Freire, conscientization as a critical element of the field of adult education should
help adult learners to examine the nature of their oppressive situation as well as their capacity to
influence the situation.

Year
- Consciousness implies that the oppressed will overcome the culture of silence and begin to apply
pressure on those who oppress them so that they might attain their freedom.
- Conscientization enlightens people about the obstacles preventing them from attaining all sorts of
freedom in a dialogical manner (through dialogue) as opposed to a prescriptive ways which is
characteristic of a domesticating educational process.
- In conscientization, learners are not regarded as mere recipients of the educators wisdom.
- On the contrary, learners are invited to participate creatively in the process of their learning.
Process of conscientization:
Why the approach gained momentum in developing world?

- Freires Pegadogy of the Oppressed and conscientization was developed in the late 1960s. It
radically criticized the unjust social relations between South and North and advocated social
transformations that included dismantling of powerful social institutions. This work of liberating
education was widely used in Brazil, Chile and other Latin American countries.
- The concept of conscientization was exported to South Africa around 1970s and was eagerly
embraced by black consciousness activists. From 1970s to 1980s, South African activists used this
term to describe the process of spreading political awareness. As such conscientization was linked to
protest, and a communitys readiness to engage in struggle was seen as the degree to which it has
been successfully conscientized.
- This approach was adopted by Latin American CEBs (non-political, religious organizations) in the
1980s for engaged criticism towards the violations and injustices of politics.
- This approach gained momentum around the world. The approach was also used in many South
Asian countries. For example: After the independence of Bangladesh in 1971, one of the largest NGO
of Bangladesh had developed a functional literacy programme based on Paulo Freires
conscientization approach. This literacy intended to transform into political empowerment of the rural
people.
Social Marketing Approach
- Social marketing applies commercial marketing strategies to promote public health.

- Andreasen defines social marketing as the application of proven concepts and techniques drawn
from the commercial sector to promote changes in diverse socially important behaviors such as drug
use, smoking, sexual behavior.
- Social marketing is widely used to influence health behaviour.
- Social marketers use a wide range of health communication strategies based on mass media; they
also use mediated (for example, through a healthcare provider, social mobilizer), interpersonal, and
other modes of communication; and marketing methods such as message placement, promotion,
dissemination, and community level outreach.
- They develop brands and market these products using socially appealing messages.

Year
- The social marketer must consider each of the four marketing elements: product, place, price and
promotion
Price: What consumer must offer in order to receive benefits?
Product: What products are offered for behaviour change?
Promotion: What strategies are used for promotion (mass media, interpersonal
communication)?
Place: where the behaviour is performed?
- Social marketing products/services are provided in substantial cost to the target groups.
- Successful examples of social marketing campaigns in Nepal are
Promotion of iodized salt
Promotion of family planning devices (condom, pills, depo and IUCDs)
Oral rehydration salt
Water purification (e.g Piyush)
Distance Learning Approach
Distance education is any educational process in which all or most of the teaching is conducted by
someone separated in space and/or time from the learner, with the effect that all or most of the
communication between teachers and learners is through an artificial medium, either electronic or print.
- Distance education can be used in general as well as professional education in all sectors
Characteristics of distance learning

- Teacher and learner are separated in time and space.
- Distance learning requires the independent style of learning.
- The principal means of communication is technology (print or electronic)
- Distance learner may study at a time and place convenient to him/her
- Learning materials are prepared and produced should be of very high quality.
Forms of distance learning

i. Synchronous: Telecourses, teleconferencing, telemedicine, etc.
ii. Asynchronous: e-mails, audio cassette courses, videotape courses, correspondence courses, web-
based courses.
Advantages
- Convenience
- Flexibility
- Effectiveness
- Affordable
- Saves time
Disadvantages
- Absence of live academic environment
- Lack of instant feedback
- Isolation
- Difficult to monitor the learning process

Year
Child to Child Approach
The Child to Child approach to health education was first introduced in 1978 by David Morley.
Child-to-Child is a rights-based approach to childrens participation in health promotion and development.
- It is based on the belief that children can be actively involved in their communities and in solving
community problems.
- Through participating in Child-to-Child activities the personal, physical, social, emotional, moral and
intellectual development of children is enhanced.
- The Child-to-Child approach is an educational process that links childrens learning with taking action
to promote the health, well-being and development of themselves, their families and their
communities.
The child to child step approach

Using a series of linked activities or steps, children think about health issues, make decision, develop
their life-skills and take action to promote health in their communities, with the support of adults.
i. Children identify and assess their problems and priorities
ii. Children research and find out how these issues affect them and their communities
iii. Based on their findings children plan action that they can take individually or together
iv. Children take action based on what they planned
v. Children evaluate the action they took: What went well? What was difficult? Has any change been
achieved?
Risk Approach
Risk Approach in health education involves appraisal of health risk among individual and communities
and managing those issues from risk perspective.
- It is a process of gathering, analyzing and comparing and individuals prognostic characteristics of
health with a standard age group, thereby predicting the likelihood that a person may develop
prematurely a health problem associated with a high morbidity and mortality rate.
- An assessment tool is used by health promoters to evaluate a persons health.
- The appraisal usually takes the form of an extended questionnaire that enquires into personal
lifestyle, and personal and family medical history.
- The appraisal may also include physical examinations, laboratory tests or environmental
assessments.
- The specific risks are identified in groups and strategies are developed to reduce such risks.
- Major health risks in Nepal include, tobacco use, indoor smoke, deficiency of maro/micro nutrients,
unsafe sexual behaviour, alsoholism etc.
Steps in risk assessment and management
i. Hazard assessment
ii. Exposure assessment
iii. Risk characterization
iv. Risk communication
v. Risk management

Year
Life Skill Approach

Life skills are abilities for adaptive and positive behaviour that enable individuals to deal effectively with
the demands and challenges of everyday life.
Life Skills-based health education is an approach to creating or maintaining healthy lifestyles and
conditions through the development of knowledge, attitudes, and especially skills, using a variety of
learning experiences, with an emphasis on participatory methods.
Life skills based health education can be applicable in wide areas

- Peer pressure, drug abuse and gender based violence
- Sexual violence
- Teenage pregnancy and unsafe abortion
- HIV/AIDS prevention
- Consumer education
- Career opportunities
Essential life skills for skills-base health education:

i. Communication skills and interpersonal skills
a. Interpersonal communication skills
- Verbal/non-verbal communication
- Active listening
- Expressing feelings (asking parents not to smoke)
- Giving feedback (without blaming)
b. Negotiation/refusal skills
- Negotiation and conflict management (e.g. condom negotiation)
- Refusal skills (e.g. refusal of smoking requests)
c. Empathy building
- Ability to listen, understand anothers need and circumstances
d. Co-operation and team work

- Expressing respect for others contribution
- Assessing ones own abilities and contributing to groups
e. Advocacy skills
- Influencing skills and persuasion
- Networking and motivation skills
ii. Decision-making and critical thinking

a. Decision making skills/ problem solving skills
- Information gathering skills
- Evaluating future consequences
- Determining alternative solutions to problems
b. Critical thinking skills

- Analyzing peer and media influences
- Analyzing attitudes, values, beliefs and factors affecting them

Year
iii. Coping and management skills

a. Skills for increasing personal confidence
- Building self esteem and confidence
- Creating self-awareness skills
- Setting goals
b. Skills for managing feelings

- Managing anger
- Dealing with grief and anxiety
- Coping with loss, abuse and trauma
c. Skills for managing stress

- Time management
- Positive thinking
- Relaxation techniques
Health education methods and techniques for promoting life skills

- Class discussions
- Role play
- Demonstration
- Case studies
- Debates
- Games and Simulations
- Brainstorming, etc.
Life skills education in Nepal

UNICEF adopted three strategies to reach young people for improving life skills:
i. Chatting with my best friend (sathi sanga mann ka kura) radio program
ii. Catmandu- TV program
iii. Supplementary communication materials- life skills booklets, photo novels etc.
BNMT has been providing life skills training to youths on HIV/AIDS and STIs
Which approach will be appropriate in Nepalese Health Care System? (past question)
The major challenge for health promotion in Nepal remains on which approach to chose and how best to
apply the correct approach to the appropriate Nepalese context. In Nepal health promotion programs
often cover a range of issues, target groups, settings and cultural contexts. Therefore when planning a
program, it is necessary to choose a simple strategy or approach as the focus for the work. Health
agendas of the Government of Nepal and other I/NGOs have been typically promoting healthy behavior
approaches and are using interventions to change unhealthy individual behavior. This is probably
because this approach offers easily quantifiable and achievable results within a short time frame.
According to my viewpoint, ideally there is no approach which can function in isolation. Taking into
considerations, the diversity in socio-cultural contexts, target groups and range of health promotion
needs, the health planners and experts need to choose appropriate approaches, relevant to the particular
context. Health promotion in Nepal can only operate with a mix of different approaches. For examples:
Risk approach is relevant for promotion against non-communicable disease.
Life skills approach seems relevant for educating youths on issues such as SRH.
Social Marketing is appropriate to increasing the uptake of modern family planning methods.

Year
UNIT 5: Fundamental Factors Involved in Health Education Process
Learning in Health Education
Meaning and definition

Learning is defined as any relatively permanent change in behaviour that occurs as a result of practice
and experience. This definition has three important elements.
- Learning is a change in behaviourbetter or worse.
- It is a change that takes place through practice or experience, but changes due to growth or
maturation are not learning.
- This change in behaviour must be relatively permanent, and it must last a fairly long time.
Principles of Learning
Principles Description
1 Readiness - Individuals learn best when they are physically, mentally, and emotionally ready to
learn, and do not learn if they see no reason for learning
2 Exercise - Those things most often repeated are best remembered.
- It is the basis of drill and practice
3 Primacy - Things learned first create a string impression in the mind and that is difficult to
erase.
4 Recency - The things that are learned most recently are best remembered.
- Conversely, the further a student is removed time-wise from a new fact or
understanding, the more difficult it is to remember.
5 Intensity - The more intense the material taught, the more likely it will be retained.
- A student will learn more from the real thing than from a substitute.
6 Freedom - Things freely learned are best learned.
- Conversely, the further a student is coerced, the more difficult is for him to learn.
Perception
This process of interpretation of stimulus is known as perception. So perception involves two processes:
sensation and interpretation. But interpretation of any stimulus requires past experience also.
Hence, perception may be defined as a process of interpretation of a present stimulus on the basis of
past experience. In another words, perception is a process which involves seeing, receiving, selecting,
organizing, interpreting and giving meaning to the environment.
Principles of perception:
i. Figure ground relationship
- According to this principle any figure can be perceived more meaningfully in a background and that
figure cannot be separated from that background.
- For example, letters written with a white chalk piece are perceived clearly in the background of a
blackboard.

Year
ii. Grouping of stimuli

- The objects can be perceived meaningfully when they are grouped together.
a. Proximity
- The objects which are nearer to each other can be perceived meaningfully
by grouping them.
- For example, Stars which are nearer to each other are perceived together
as giving particular shape.
- In the figure, the objects in the left square are perceived as separate elements and objects in the right
square are perceived as belonging to three groups.
b. Similarity
- The similarity principle states that object with similar shape, size, color, orientation
and texture are perceived as belonging to the same group.
- In the adjoining figure, the objects of same size are perceived as belonging to the
same group.
c. Closure
- The closure principle states that when an object is not complete, or the space is
not completely enclosed, and enough elements are present, then the parts tend to
be grouped together and we perceive the whole figure.
d. Continuity
- The continuity principle states that if an object appears to form a continuation of another
object, beyond the ending points, we perceive the pieces as part of a whole object.
- In the figure, the viewers eye naturally follows the curved line, although it is interrupted
and joined to another segment.
Factors Affecting Perception

i. Psychological Factors
- Moods
- Motives
- Self-concept
- Interest, attitudes, feelings, thoughts
- Cognitive structure
- Expectations
- Level of intelligence
- Emotional state (worries, fear, anxiety)
ii. Socio-cultural factors

- Education level
- Level of understanding
- Customs, religions, and belief system
- Language variation
iii. Environmental factors

- Invisibility, noise, congestion, etc.

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Motivation
Motivation is a process by which a need or desire is aroused and a psychological force within our mind
sets us in motion to fulfill our needs and desire.
According to William G Scott, "Motivation means a process of stimulating people to action to accomplish
desired goals".
Characteristics of motivation
- Motivation is an psychological phenomena
- Motivation is related to needs
- Motivation produces goal-directed behaviour
- Motivation can be either positive or negative
Motives and Drives

Motives
In general a motive is generally defined as a state of physiological or psychological arousal which
influences how we behave. E.g. hunger motivates us to eat something.
Drives
- According to a drive reduction theory, any imbalances in homeostasis create needs, which are
biological requirements for well-being. In responding to needs, the brain tries to restore homeostasis
by creating a psychological state called drive
- Drive is a feeling that prompts an organism to take action to fulfill the need and thus return to a
balanced state.
- There are two kinds of drives:
i. Primary drives:
- Primary drives stem from physiological or survival needs, such as the needs for food or water.
- People do not have to learn these basic needs to satisfy them.
iii. Secondary drives:

- Secondary drives are those that are learned through experience or conditioning, such as the needs
for money, social approval, or the need of recent former smoke to have something to put in their
mouths.
- E.g. having little money motivates many behaviours- from hard working to stealing.
Theories of Motivation
Maslows Need Hierarchy Theory
According to Abraham Maslow, a U.S psychologist, man is a wanting animal. He has a variety of wants or
needs. All motivated behaviour of man is directed towards the satisfaction of his needs.
The theory postulated that people are motivated by multiple needs, which could be arranged in a
hierarchy. The features of his theory are as follows:-
i. People have a wide range of needs which motivate them to strive for fulfillment.
ii. Human needs can be definitely categorized into five types:
a. Physical needs: e.g., food, water, shelter, etc.
b. Safety or security needs: e.g. safety, security, protection against danger, etc
c. Affiliation or social needs: e.g. Love, affection, acceptance, friendship, etc.
d. Esteem needs: e.g. prestige, power, recognition, etc.
e. Self-actualization needs: e.g. growth, achievement, advancement, etc.

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iii. These needs can be arranged into a hierarchy. Physical needs are at the base whereas self-
actualization needs are at the apex.
iv. People gratify their physical needs first, when the need is satisfied, they feel the urge for the next
higher level need.
v. Relative satisfaction of lower level need is necessary to activate the next higher level need.
vi. A satisfied need does not motivate human behaviour. It only triggers or activates the urge for the next
higher level of needs.
Rosenstocks Theory of Motivation

Rosenstocks Theory of Motivation includes three components that are necessary for an individual to get
motivated.
i. Perceived susceptibility
- In order to get motivated, it is necessary that a person understand that he is susceptible or already
under the influence of some disturbing force.
- Unless somebody realizes that he is either susceptible or already undergoing the disease process, it
is very unlikely that he will think of any treatment or preventive measures.
ii. Perceived severity

- The perception of the person towards the severity of the condition is the key factor for motivation and
hence called the trigger point of motivation.
- Motivating the persons to take necessary action to solve the problems becomes easier when the
person becomes aware of the severity or intensity of discomfort that may result from the condition.
iii. Awareness of possible solution

- For a person to get motivated to seek treatment or a solution to the problem, he should be aware of a
possible solution within his reach.
- Otherwise he may not be well motivates and not try to seek treatment.
Bunchmans Theory of Motivation

Bunchman has given five principles of human motivation which are described below
i. Motivation is based on ones personal needs. Changes that satisfy his or her needs are likely to be
accepted. The needs are in conformity with Maslows hierarchy of human needs.
ii. Skill development is necessary for motivation. Meanwhile, appropriate environmental situation must
be provided so that necessary action can be taken to solve the problem. Hence, motivation depends
upon both persons skill and appropriate environment.
iii. Motivational efforts should be based on persons interest and emphasize on those which he/she
values more.
iv. Motivation depends on individuals perception of problems and solution. If a couple perceives
overpopulation as a threat or risk to the welfare of the family and society, they may be easily
motivated to adopt birth control measures.
v. Motivation depends upon and individuals perception of himself and his relation with others. A
tuberculosis patient can be motivated to keep himself isolated if he is made to accept that and
exposure to him may affect others.

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UNIT6: HEALTH COMMUNICATION
Meaning, Definition, Types, Process and Principles of Communication
According to Newman and Summer, "Communication is an exchange of fact, ideas, opinions or emotions
by two or more persons".
The process of communication generally involves five steps:

i. Sender
- The process of communication begins when the person with whom the message originates (sender)
has an idea.
- The form of idea will be influences by complex factors surrounding the sender: mood, background,
culture, context of situation, frame of reference, etc.
ii. Encoding
- The next step in the communication process involves encoding.
- This means converting the idea into words, gesture or symbols that will convey meaning.
- A major problem in communicating any message is that words, symbols have different meanings for
different people.
iii. Channel
- The medium over which the message is physically transmitted is the channel.
- Messages may be delivered by different channels such as radio, telephone, letters, face to face
discussions, presentations, etc.
iv. Decoding
- After the target person receives the message, it is broken down to a level that will enhance
understanding.
- Communication is successful only when the receiver successfully decodes and understands the
meaning intended by the sender.
v. Feedback
- The receivers response to the senders message is referred to as feedback.
- Without feedback, it is difficult to know whether a message has been received and clearly
understood.
Types of communication
One the basic of persons involved
i. Intrapersonal communication
- Intrapersonal communication occurs when an individual talks to himself/herself, pondering over an
activity or examining self to assess something.
ii. Inter-personal communication

- Inter-personal communication occurs in both a one to one and a group settings.
- It is an exchange of information, idea or facts between two or more people or groups of people eager
of accomplishing some goals.
- In interpersonal communication there is face-to-face interaction between two persons, that is, both are
sending and receiving messages.

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- In interpersonal communication, it is possible to influence the other person and persuade him or her to
accept our point of view.
- Since there is proximity between sender and receiver, interpersonal communication has emotional
appeal too.
iii. Group communication

- Group communication involves two or more people who come together to communicate.
- The groups share some common attributes such as age, health status, educational background etc.
(e.g. group of pregnant women).
iv. Mass communication

- Mass communication occurs when certain messages are sent to a large number of people through
mass-media approaches.
- Radio, television, newspapers, social media etc. are media that helps in mass communication.
On the basis of direction of message flow

i. One way communication
ii. Two way communication
On the basis of modes of communication

i. Verbal communication: use of words
ii. Non-verbal/ symbolic communication: facial expressions, gesture, body positions, eye contacts,
symbols, etc
On the basis of lines of authority

i. Formal communication
ii. Informal communication
Principles of effective communication

i. Completeness
- The message is complete when it contains all facts the reader or listener needs for the desired
reaction.
- A message must be organized appropriately in the sense that it must include all the important ideals
and its details.
- All the aspects of the message must be grouped and brought together in logical sequence to prepare
meaningful thought units.
ii. Clarity
- The writing should be correctly planned and expressed in a logical way, and the writer should make
sure that the ideas flow smoothly from beginning to end.
- Also, the communicator must be clear about the selection, suitability and usage of the medium.
iii. Coherence
- Coherence means, tying together of several ideas, under one main topic in any paragraph.
- Smooth flow, lucidity and transition aspects should be given effect to and there should not be any
scope for the reader to misinterpret, mis-read or mis- spell the message.

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iv. Conciseness
- Conciseness refers to thoughts expressed in the fewest words consistent with writing.
- Unnecessary superlatives, exaggeration and indirect beginning should be avoided.
- Care should be taken to use adjectives judiciously, avoiding irrelevant details, unnecessary
expression and mumbling sentences.
v. Credibility
- Clarity in writing brings about credibility because it ensures that others understand the message
easily and quickly.
- A clear and direct approach in writing makes it possible to achieve the principle of credibility in writing.
- Other essentials of writing like correctness and completeness add to the strength of credibility in the
writing.
vi. Correctness
- Communication must be correct in tone and style of expression, spelling, grammar, format, contents,
statistical information, etc.
- There should not be any inaccurate statements in the message.
- The subject matter of communication must be correct or accurate.
Behaviour Change Communication and Application
- Behaviour change communication or BCC is a set of organized communication interventions and

processes aimed at influencing social and community norms and promote individual behavioural
change or positive behaviour maintenance for a better quality of life.
- BCC is one of the strategic components of communication for health and development along with
advocacy, social mobilization, community mobilization and social marketing.
Importance of behaviour change communication in health promotion

- Increases knowledge
- Stimulate community dialogue
- Promote essential attitude change
- Reduces stigma and discrimination
- Creates a demand for product and services
- Promotes services for prevention, care and support
- Improves skills and sense of self-efficacy
Behaviour Change Communication (BCC) Strategy

BCC strategy is a coordinated and comprehensive plan for guiding multiple actions or activities that are
aimed at achieving BCC goal and objectives.
A well-designed BCC strategy should include:
- Clearly defined BCC objectives
- An overall concept or theme and key messages
- Identification of channels of dissemination
- Identification of partners for implementation (including capacity-building plan)
- A monitoring and evaluation plan

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Applications of BCC
Behavour Change Communication strategies have been widely used in numbers of public health
programs in Nepal. Some of them are listed below:
- Malaria control
- Kala-azar elimination
- Dengue & JE control
- WASH behaviours
- HIV/AIDS prevention and control
- Family Planning
- Birth preparedness and complication readiness
Meaning, Types, Importance and Selection Criteria of Health Education Methods
Methods of health education are the techniques or ways in which series of activities are carried out to
communicate ideas, information and develops necessary skills and attitude.
Types of health education methods
Individual methods Group methods Mass methods
- Interview - Mini-lecture - Exhibition
- Counseling - Demonstration - Lecture
- Symposium - Health campaign
- Brain storming - Advertisement
- Role-playing - Drama
- Workshop
- Field trips
- Buzz-session
- Fishbowl session
- Puppet-show
- Group-discussion
- Panel discussion
- Forum
Criteria for selecting appropriate methods and media of health education

- A particular method or media may get failure to achieve its educational objective simply because of its
inappropriateness and impracticability in certain situation.
- The appropriateness of particular method or media should be determined on the light of certain
criteria.
- These criteria should be well considered in choosing and applying a particular method or media.
- The criteria are described below:
i. Feasibility or practicability:
- A method or media should be feasible to apply from the point of view of transportation, economic
factor, availability of necessary equipment and other facilities.
- For example, we cannot use electrical devices where there is no electricity
ii. Nature of the audience

- A method or media should be chosen to suit the educational status, culture etc of the target group.

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- Teaching about the importance of eating meat will mean nothing to the vegetarian group who has
taboo against taking meat.
- In the same way distributing pamphlets to illiterate people will not help to provide information to them.
iii. Peoples attitude and belief on the method or media:

- People have different kinds of interest for different kinds of methods or media. - So, each method or
media should be chosen according to the interest and belief of people on them.
- People take radio broadcasting, television telecast, government published pamphlets, etc as valid
messages and tend to ignore individual lectures.
iv. Accessibility
- The method or media that a health educator chooses must be able to reach to the people concerned.
- In fact a health education program or message should be accessible to each member of the target
group in the community.
v. Subject or purpose of health education:

- The purpose of health education also affects in the selection of particular method or media.
- The subject and purpose of the teaching will be based on audience need.
- If it is for conveying some health message or knowledge a lecture can help but when there is a need
of skill and attitude development, demonstration method has to be applied.
Individual, Group and Mass Methods of Health Education
Individual Methods of Health Education

Interview
- Interview is the process of asking questions to collect information and ideas.
- It is a process or method of providing health education through the means of question and answer
between the health educator and the learner.
- In this process, interviewees, knowledge, attitude, feeling and health practices are studied and
essential suggestions are given to bring about the positive change.
Advantages of interview
- Helps to assess knowledge, attitude and practice
- Helps for intensive and systematic teaching with exchange of ideas and feelings
- Help to reach a better conclusion for solution of a problem.
- Easy to conduct with less cost and limited facilities.
- Even illiterate persons can be interviewed and taught
- Easy to make follow-up
- It is a two way communication
- The expression and gestures can be observed.
Disadvantages of interview
- Time consuming
- Difficult to cover wide range of target people
- Tedious if has to be repeated to many people.

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Counseling
Counseling is a process of encouraging and helping an individual in identifying his or her health problem,
the cause of the problem, the ways of its solution and also encourages taking necessary actions to solve
it.
- The decision of actions strategies is made on his own choice with least of advice from the counselor.
- A counselor will have to play a serious role of helping the client in identifying the actual problems and
the appropriate method to solve it. So he/she must encourage adequate interaction between client
and counselor.
Techniques of counseling
- Building rapport
- Identifying clients needs or problems
- Encouraging discussion and providing appropriate information
- Maintaining patience
- Keeping secret
Advantage of counseling
- It is helpful in dealing with individual clients and motivate him/her to take necessary action to solve
health problem
- Provides maximum opportunity for feedback.
- Helps to maintain two way communications.
- Illiterate people can be taught by this method.
- Easy to make follow up studies on the basis of counseling records.
Disadvantage of Counseling
- Counseling takes long period of time.
- Counseling is a difficult process and requires experienced counselor
- It is difficult to cover wide range of people through counseling method.
Group Methods of Health Education

Demonstration
Demonstration is the process of providing knowledge and skills as well as developing attitude of a small
group of people through the manipulation of appropriate teaching devices or materials.
- Teaching by demonstration involves verbal and visual explanation.
- It is a mixture of theoretical and practical teaching.
- It is organized to teach about the specific topics and it should take less than 45 minutes to complete
the demonstration but it slightly varies according to the topic.
- The numbers of learners in the group may be about 15 to the maximum.
- The learners are given opportunity to see and manipulate the device or materials used in
demonstration and also give opportunity to practice the process and questions and answers to clarify
doubts.
Advantages of Demonstration
- It is the effective teaching method which involves varied learning experiences like seeing, hearing,
feeling, testing and smelling depending upon the subject of demonstration.
- It is interesting and draws attention of the learners because of the active learning process.
- It helps to develop not only knowledge and attitude but also skills for required work performance.
- Students achievement could be immediately assessed through verbal expression and skill practice.

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- Provides concrete and realistic visual picture of what is being taught resulting in a more lasting
impression.
- It is cheap, practicable, accessible and useful for different categories of learners. It needs only limited
materials and object. It can be used at different teaching-learning situations at different places.
Disadvantages of Demonstration
- Sometimes it may be difficult to get necessary equipment and materials for certain demonstration.
- May not be appropriate to conduct demonstrative teaching on certain topics especially when there will
be only cognitive gain.
Mini lecture
Minilecture is the method of giving information about any subject matter with the help of short lecture or
speech, maintaining the exchange of ideas between the speaker and the audience, as well as evaluating
about what the audience perceived in between the speech.
Advantages of Mini lecture

- Two way communication is maintained between the speaker and audience
- The audience gives maximum concentration on the speech.
- Since there is quick evaluation in between the speech , the mini-lecture can be changed according to
fit to the knowledge condition of the audience
- It can be effective in small groups within short time interval
Disadvantages of Mini Lecture

- It will be difficult for the speaker to present mini-lecture in short time, as well as to evaluate and
change the mini-lecture according to the perception of the audience.
- The audience feels shy and embarrassed when they cannot answer the questions asked by the
speaker.
- It can be applicable only for small groups.
Brain Storming
Brain storming is also called Creative Ideation. This is a modern method of eliciting from the participants,
their ideas and solutions on debatable issues or current problems. Instead of discussing a problem at
great length the participants in brain storming session are encouraged to make a list in a short period of
time all the ideas that come to their mind regarding some problems without debating amongst themselves
about the pros and cons of their own ideas.
Advantages of brain storming

- Provides varieties of useful ideas in short time for quick group decision
- Enables individuals to think and respond quickly
- Decision made by group thinking is better than by individual thinking.
Disadvantages of brain storming

- Ideas pulled out may not always be relevant and helpful to make group decision. It may happen
especially with the new learners.
- It might take some longer time and may not be appropriate for packed programmes.

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Role Playing
Role play is a socio drama which can be carried out by individual or a group of people taking different
roles and acting out problem situation similar to that they encounter in their real life situation.
- They enact roles as they have observed or experienced and act or pretend to be a sick. Person, as a
mother, child, health worker etc.
- In a role playing there will be about 5 to 6 characters and 15-20 audience but the number may be
slightly vary according to situation.
Advantages
- Gives learners opportunity to express their ideas based on real life situation and can learn from each
other.
- Enables the learners to see things through the eyes of others. Start learning how knowledge and
attitude affect health behaviour.
- Develops the power of quick thinking and expression .Helps the characters to explore their
potentialities and come to a better decision. They can apply those skills in their real life situation while
dealing with health problems.
- Develop careful listening habit.
- Makes people think in a more constructive way.
- It interesting and provides active learning opportunity in a realistic way.
- It simple and inexpensive and can easily be conducted at different situation.
- The best way to teach people about health in order to make them understand it.
Disadvantages
- It may lead to only a recreational activity not educational.
- Everybody cannot successfully act due to shyness, lack of experience, lack of confidence and
expression skills.
- Every learner may not get opportunity to participate as role player.
Group Discussion
It is a method of teaching through the direct share of knowledge, ideas and experiences among small
group of persons about a particular subject or problem within a limited period of time with a view to solve
the problem.
- Any discussion should take only an hour or less to avoid boredom.
- An ideal group may consist of Six to Twelve members depending upon the situation so that each
person is able to communicate with all the others face to face to reach to a decision and achieve the
common goal.
- There are three types of members in a group discussion. They are Leader or moderator, Recorder or
Note-taker and Participants.
Advantages
- Develops creativity, confidence and ability of judgment in the members or learners.
- Helps learners to come to a group decision and solve their common problem. Group decision is better
than individual decision.
- Helps members to become active learners and learn new knowledge, ideas and experiences about
their subject of concern through a cooperative process.
- Provides adequate communication among all the members with exchange of ideas and experiences.
- The health educator can make a closer study of the members of target group regarding their need,
interest, attitude, ability and other potentialities.

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Disadvantages
- Some self-conscious members may not venture to bring forth their valid idea "for fear of disapproval
by other members.
- Sometimes discussion may be prolonged without any fruitful result, or it may take longer time to come
to the conclusion or decision.
- Somebody may not feel personally responsible for the result of discussion. So, they may not
participate well.
Fish Bowl Session

- The fishbowl is a method to organize presentations and group discussions that offers the benefits of
small group discussions within large group settings.
- This is done by arranging the room so that the speakers are seated in the centre of the room with
other participants sitting around them in a circle watching their conversation in the fishbowl.
- Best used in conferences, workshops and town hall-type meetings, the Fishbowl focuses the entire
groups attention on a discussion among 3 - 6 people. Other people present become observers,
active listeners, and potential participants through a rotation process which reduces the distance
between speakers and audience.
- A fish-bowl session may include 12-30 participants and take place for 45-90 minutes
Rationale of use
Fishbowl can be used to
- Foster dynamic group interactions and active participation.
- Discuss or introduce controversial health topics
- Showcase expert panel discussion
- Avoid power point presentation
Process of fishbowl session

- An engaging health education topic that is compelling to the audience is chosen
- 3-6 experts or noteworthy participants who can initiate fishbowl conversations are identified.
- The chairs are arranged in two circles. The inner circle (fishbowl) consists of 6-7 chairs for experts
and outer circle of chairs are arranged for remaining participants, leaving enough space for
movement in between two circles. One or two chairs in the inner circles are left empty.
- The moderator describes the topic for discussion and fishbowl participants are invited for discussion.
The participants in outer circle observe the discussion as active listeners.
- After about 10-15 minutes, a participant from outer circle is invited to join the fishbowl. Only the inner
circle can speak or contribute to discussion.
- The discussion is continued in a rotation process
- In order to keep the discussion lively and informative, the participants from fishbowl are encourage to
step away once they have contributed their thoughts so that other participants from outer circle can
join the discussion.
Panel discussion
Panel discussion is one of the methods of group teaching. It can be adopted both for school students and
community people in order to provide health education.
- The panel members will be a group of experts normally 3 or 4 persons who themselves enter into
question and answer process regarding a specific topic of discussion.
- The health educator can manage to identify and bring the experts. He can work as a coordinator to
introduce topic and the experts, and also help conduct the discussion.

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Advantages
- Provides varied knowledge, ideas and experiences about the subject of concern to the learners.
- Interesting and .can draw attention of the audience or learners.
- Learners get opportunity to ask questions and pass comments, which help, in teaching learning
process.
Disadvantages
- Sometimes it is difficult to get the appropriate experts.
- Difficult to set definite time to suit the experts.
Buzz Session (past question- 2070/3)

A buzz session consists in dividing large group of audience into small groups of 2 to 15 people to discuss
for specified time on specific question, problem or issue.
- The groups work simultaneously in the same room (the word buzz comes from the resulting noise).
- The task is brief and relatively simple.
Steps of conducting a buzz session

- The session is incorporated into a large group activity, such as a conference.
- Groups may be set up in advance or on the spot. For example, in a banquet-style room, participants
sit at round tables with each table constituting a discussion group. This is most appropriate
arrangement
- The leader introduces the issue or problem to be discussed. The issue can be the same for all
groups, or each group can have a different phase or sub-problem to discuss.
- Once the problem or issue is clarified and understood by each group, the groups should be asked to
choose their leaders and recorders.
- The groups are left for discussion to no more than 20 minutes. Leader tries to get all the members of
the group to participate.
- The recorder takes notes and prepares a summary to be presented when all the groups come
together.
- The summaries are submitted in writing and reported at the plenary session in the form of synthesis.
Rationale for use of buzz session

- To create an opportunity for discussion even in a large group. A buzz session gets more people to
participate and is less intimidating than a forum.
- To identify an audiences needs and points of interest.
- To encourage the contribution of participants who would be reluctant in a large group.
- To obtain participants feedback on the conduct of the activity.
Advantages
- A large number of ideas, issues and recommendations can be collected in a short time.
- Each participant has an opportunity to share their point of concerns.
- Because members are expressing opinions, it is good for dealing with controversial subjects.
Disadvantages
- Effectiveness of the group may be lowered by the immature behaviour of the few participants.
- It may not be effective for young groups or groups that know each other well to take each others
opinions seriously.

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Workshop
- The workshop is the name given to a novel experiment in education.
- It consists of a series of meetings; usually four or more, with emphasis on individual work, within the
group, with the help of consultants and resource person. Workshop group may consists of about
fifteen participants.
Steps of conducting workshop

- In the beginning of the workshop, the organizers give opportunity for the participants to introduce
each other.
- The purpose and schedule of the workshop is discussed.
- Workshop session is begun. There may be one or two sessions a day. Chairperson is selected for
each session or for the entire day by the participants.
- The workshop organizer may throw some light on the objectives of the workshop. The experts may
also express their opinion and provide necessary information during the discussion period. Such need
may arise at the time of confusion, misunderstanding and conflicts of opinion among the participants.
- Sometimes a full discussion on specific topics may be needed and it will be done through small group
discussions.
- The decision made by the small groups will be reported to the chairperson of the respective group to
the plenary session.
- After conduction of the workshop, it is necessary to prepare a workshop report.
Advantages
- Helps to provide up-to-date knowledge and skills as well as to develop appropriate attitude.
- Provides opportunity for participatory learning.
- Provides varied learning experiences like listening, speaking,, seeing, discussing, etc.
Disadvantages
- Takes long time to organize the workshop. It might take weeks or even months.
- Sometimes it is difficult to get appropriate experts (resource person.
Mass Methods of Health Education

Exhibition
Exhibition is the systematic and meaningful display of educational materials with an intention to educate
large number of people within a limited period of time and at a particular place.
- Exhibition can sometimes be organized to provide health education to the community people.
- Exhibition consists of the use of different teaching materials and methods to illustrate and explain the
points of teaching.
- They are posters, charts, graphs, models, real objects, cassette playing with some health message,
demonstration, puppet show, videocassette, etc.
Advantages
- Provides better learning through varieties of experiences like hearing, seeing, touching, feeling and
tasting.
- Opportunity may be provided for practical learning through demonstration, manipulation of objects
and through practice.
- Interesting and attractive because of decorations, good setting, and other lively displays.
- Helps students to develop creativity.
- Organizing exhibition can also help learn some new knowledge and skills.

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Disadvantages
- Difficult to organize in terms of money, materials and manpower.
- Difficult to organize to suit different kinds of people w ith different needs, background, interest, etc.
- Difficult to get appropriate place and adjust to the available time due to lack of resources, unfavorable
weather, etc.
Meaning, Types, Importance and Selection Criteria of Health Education Media
Media refers to those aids or teaching materials using sight or sound to present information. Media
includes audio-visual aids like film show, documentary show, television, etc.
Objectives of using media in health education

- To increase the effectiveness of the health education programs
- To hold the attention span of the learner for the duration of instruction
- To save time
- To use all the relevant information available from different sources
- To make learning experiences last longer
In order to employ the audiovisual aids, user should be aware of

- Different audio, visual and audio-visual teaching aids
- Criteria of selection of the aids
- Methods of preparing aids
- Using suitable aid at appropriate time.
Types of media for health education (Q: 2072/12)

Audio Media Visual Media Audio-Visual Media
- Radio - Posters/Pamphlets - Projector
- Cassette player/ Tape recorder - Flip charts - Motion pictures
- Flash cards - Television
- Photographs - Internet & Social media
- Charts, maps
- Silent motion pictures
- Bulletin boards,
- Flex charts, etc.
Audio, Visual and Audiovisual Media
Audio Media
Radio
Radio is the audio aids through which messages are relayed to a heterogeneous and large number of
people at one time, who are not physically present before the communicator.
- It is a mass media, which provides one-way communication.
- The concerned audience are informed and asked to attend the broadcast at the particular time and
place.
Advantages
- It is very much helpful for illiterate people; the message should be simple to understand.
- It leaps the barriers of distance and space.

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- Radio transmitter can be carried with and attend the radio health programme anywhere the individual
goes.
- One can give up to date information to a large number of people in a very short period of time.
Disadvantages
- It is one-way communication system.
- The communicator cannot be sure of it people sure listening to and understanding his message.
- There may be electricity and batteries problems & broadcasting facilities are available only in the
limited area.
- It is difficult to evaluate the impact of radio teaching.
- Sometimes there may be language barrier to certain group of people.
- Message received only through verbal teaching so it is easy to forget.
- Difficult in timing to fit the convenience of the specific target people.
Cassette Player/Tape Recorder

Cassette player is a small portable audio machine or equipment, which can be operated with the help of
the electricity or batteries.
- It is useful for providing health education (message) to a group of audience.
- These days cassette player or tape recorder is commonly used media.
- Different cassettes can be recorded with different health messages and be used according to the
need and interest of the audience group.
Advantages
- Useful for group teaching session and make discussion.
- It can be recorded and played easily at various place.
- The recorded message can be pre -tested before using for actual teaching session
- It can be played at learner 's speed of learning by stopping in between or by playing over.
- It can be played with the help of batteries where there is on electricity supply.
- It is portable and easy to carry at different places of teaching
Disadvantages
- Some people become confused about the operation of equipment
- Break of electricity supply or lack of batteries might pose problem.
- Learning by hearing only is not effective.
Visual Media
Poster
- Poster is a pictorial and graphical non-projected visual combination of bold design, color and
message, which is intended to catch attention of learners from long distance to implant a significant
idea in his/her mind.
- Sometime, poster is made even without picture, such poster is not useful for the illiterates, and a
perfect poster should be good for both literate and illiterate.
Steps of preparing a poster

i. The headline or verbal message
- Must be concise and direct to the point
- A catchy phrase that sticks to peoples mind is used.
- Headline consists of not more than 7 words.
- Lettering should be simple, clear, large and evenly spread

Year
ii. Image or pictorial content

- Images visualize the idea or message clearly and directly.
- It should be appealing and attractive
iii. Composition/ layout or visual organization

- Dynamic arrangements of verbal and pictorial content to direct the viewers attention
- Verbal and pictorial contents must complement each other to create a pleasing effect.
iv. Colours
- The colours can be used to focus the main idea/message
- Colour combinations should be appealing. Not more than 2-3 colours should be used.
Qualities of poster
- A good poster should carry only one unit of message
- Colored poster is more natural, attractive and clear
- An ideal size of the poster is (6060) cm but it may be different in size.
- The picture and letters should be big enough to be seen clearly from a distance of about five meters.
- Message should be based on the need of target of people and should confirm the existing culture of
the community concerned.
Advantages
- Pictorial and colored posters are attractive and effective.
- It can be carried easily from one place to another.
- Can be locally prepared in limited number to meet immediate and local health education needs
- Many People can learn something from limited number of posters on display.
- Even illiterate people can learn something by looking at the picture of the poster.
- Helps to develop creativity of in the learners by involving them in designing and making posters
- Can be saved for future use.
Disadvantages
- It provides one-way communication.
- Color printing of poster is very expensive and printing services may not be available in rural area or
place.
- It can damage easily.
- Difficult to make sure that intended group have seen or read the displayed posters.
Pamphlet
Pamphlet is a visual media. It is considered as mass media of health education.
- The message can be written in the form of poem, song, and diagram. It can also be written in the
form of dialogue.
- It can also be introduced in the form of leaflets, folders to convey health related message.
- A pamphlet should be as brief as possible, it should be not exceed mote that four pages
Advantages
- Helps in propagating messages rapidly in mass scale through wide distribution.
- Pamphlets are very easy to carry from place to place.
- The first reader can pass the read pamphlets to others.
- It covers the large number of people place through wide distributions for the purpose of propaganda

Year
- It is easy to prepare and not costly

- People can read them at them free time and understand the message well.
- It can be kept safely to read again and again, which helps remainder of the information.
Disadvantages
- Provides only one-way communication.
- Not useful for illiterates.
- There is no sure either the people have read and understood the distributed pamphlets.
- Printing service may not be available everywhere especially in remote or back ward areas.
Flash Card
- Flash card is a set of visual aid that consists of messages in series or steps by consecutive pictures,
which convey certain message about a specific topic.
Steps of preparing a Flash card

- Plan the units of message to be conveyed through each card. Each card should contain only one unit
of message.
- Normally eight to twelve cards can make a set. However, the number may vary according to the
nature of subject or content.
- Obtain few sheets of drawing paper or cardboard paper. The paper should be thick enough to keep
the individual cards rigid while showing the audience by holding on its side.
- Cut the cardboard paper to the desired number and size. The good size of the card is 12 x 10 cm.
The size may vary according to the size of the learners group.
Size of the flash card No. of audience Distance
8 cm x 12 cm 4 to 8 60-80 cm
12 cm x 18 cm 9 to 12 80-100 cm
18 cm x 18 cm 13 to 19 100 cm to 125 cm
18 cm x 25 cm 20 to 25 125 cm to 150 cm
- Two cover cards can be kept either of the same paper or of different thick paper. Write down the title
of the set on the front cover to make it easier to identify the set for use.
- Appropriate drawing or picture is drawn on one side of each card. Appropriate pictures can also be
cut from magazines and paste rightly on the card.
- The units of message should be numbered serially which will be accompanied by appropriate pictures
on the cards.
- The number should be written on the back of the cards. The caption of the first card should be written
on the back of the front cover card. The caption of second card should be written on the back of the
first card and so on.
- The set of flash cards can be wrapped up with the help of rubber band or a piece of strong thread to
keep it safe. The cards can even be hinged together at the top loosely so that they can be easily
flipped over when using.
Use of flash card

- Keep the cards together in a sequential order by keeping one on the top of the other with the pictures
face up. First card should be on the top of the second, and so on.
- Prepare the audience by letting them sit properly. Give an introduction on the topic of teaching.
- Hold the set of flash cards at appropriate height so that all the learners can see the picture while
teaching.

Year
- Show the title page and introduce the topic. Put it on the back and show the first card. Explain the
picture by looking at the caption written on the back of the title page. Be sure the picture is not
covered by the fingers while holding or showing the card.
- Put the first card behind the package and explain the second by looking its caption on the back of the
first card.
- Continue changing all the cards in this way until all of them have been explained.
- A question and answer session should be held on the spot to address confusion and
misunderstandings. Necessary corrections or explanations should be given for better learning.
- Store the flash card set properly for future use.
Flip Chart
A flip chart is a visual teaching aid, which is just like photo album. It is the series of related charts or
poster assembled in a booklet form.
- It is also called flipbook or turnover chart.
- A set of flip chart normally consists of 6-8 charts the size of individual sheet of chart should be
approximately 50cm70cm is normal size. But it may also vary depending upon the available paper
size.
- A flip chart is mainly used in classroom teaching, training program, Group teaching in community etc.
Steps of preparing flip chart

- Plan for health education messages to be conveyed through individual charts in a logical order.
- Get appropriate and required number of paper sheets to write down the units of message.
- Write down the units of messages. Each unit of message should be brief. The pictures and letters
should be bold enough to be seen clearly from a short distance.
- Two or three colours may be used to make the pictures and captions look attractive.
- Individual charts are hinged together at the top.
- The title of flip chart is written in the front side of the cover.
Techniques of using flip chart

- A group is seated in front of the health educator in such way that no one blocks the other in looking at
the chart
- The flip chart is placed high enough so that it can be seen clearly.
- The topic of presentation is introduced
- Each chart is explained well before going the next.
- Participants are encouraged to ask questions
- Care should be taken so that any part the picture or message is not blocked during presentation.
Advantages of flip charts

- It helps to show abstract information visually. Pictorial explanation is better and more effective.
- It is portable and easy to carry from place to place for providing health education at different
situations- clinics, classroom, community group, etc.
- It is helpful to make systematic presentation. Helps the educator to explain points clearly and
comfortably within the limited period of time.
- A health educator can make flip chart by himself by utilization of local resources and materials.
- Flip charts are economical. They do not require us to use any special films or printers to produce
them.
- It can be used repeatedly whenever needed.
- It can be used to illustrate information so that the audience can follow the sequence.
- It is helpful for both literate and illiterate person to learn.

Year
Disadvantages
- Flip chart is expensive to produce in large scale.
- There may be difficult to draw the appropriate picture.
- Ready-made flip chart may not achieve education goals.
- It doesn't cover the large number of people at once.
Flannel-graph
A flannel-graph consists of flannel board and a series of cut pieces or cut-outs. The use of flannel-graph
helps the health educator to illustrate the points of teaching and reinforce the message presented. The
edges should be fixed on the board with the help of thumb-pins or appropriate nails.
Steps in preparing flannel board and graph (Q:2072/12)

- A plyboard, cardboard or similar material is cut into desired size
- The board is covered with a flannel cloth
- The cloth is folded over one edge of board and fastened using a stapler.
- Graphic materials are illustrated; lettering can be done by freehand or with the help of lettering
guides.
- Strips of sandpaper are attached irregularly at the back of the graphic materials.
- For a successful display and to avoid districting drop-offs (falling of flannel graph), the adhering
power of the graphic materials are tested in advance.
Using a flannel graph

- The flannel board is tilted slightly backward at the top so that materials are less likely to fall.
- Windy locations such as near the window or an electric fan are avoided.
- The sequence of the presentation is carefully planned.
- Health educator is stood beside the board to avoid blocking the presented graphs.
- Graphs or materials are left on the board only for as long as they are needed.
- The presentation is kept simple.
Advantages
- The pictorial explanation is interesting and attractive.
- Organized and systematic display of cut pieces can make the teaching impressive and effective.
- Could be used at different teaching situations in the classroom, community group, group of
mothers attending Family Planning /Maternal and Child Health clinic etc.
- It is easy to carry the sets of cut pieces to distant places.
- It is durable and can be preserved well for future use.
- It is not expensive to make a flannel graph.
Bulletin Board
Bulletin board is a non-projected visual aid, which health education message and any other information is
displayed with view to informing people.
- The board is made of sheet of light plank or plywood, card -board sheet or similar rigid material
usually set within a frame.
- Different education material like cuttings, picture, graphs, chart, leaflets and other appropriate
teaching aids are displayed with the help of thumb pin or sellotape.
- Bulletin board can be kept in library section, waiting hall, offices, hospitals, health post, nursing home
etc.
- The normal size of the bulletin board is 60cm40cm.

Year
Advantages
- It is attractive, simple and economical way of providing information and message
- Stimulate learners' thoughts when they are involved in the preparation of display.
- People get opportunity to learn something while waiting in the hall, passing through corridors, etc.
- Students learn through share of knowledge and skills among fellow learners while preparing for the
displays
- Helps to provide up -to date information
- Learners learn through share of knowledge and skills among learners while preparing for the display.
Recent Advances in Use of Social Media (Internet) in Health Promotion and Education
The term social media generally refers to Internet-based tools that allow individuals and communities to
gather and communicate; to share information, ideas, personal messages, and in some cases, to
collaborate with other users in real time. This may include
- Social networking (facebook, twitter, google plus)
- Professional networking (linkedIn)
- Media sharing (Youtube, Flickr)
- Content production (blogs)
- Knowledge aggregation (Wikipedia)
By its unique nature, social media is a tool for

- Interaction with individual audiences
- Multi-way interactions with sizable group of audiences
- Mass message dissemination
Advantages of social media in health education and promotion

The following advantages make social media viable channels for public health education and
communication:
i. Through social media, we can target and reach diverse audiences
- Just as some audiences may prefer to receive health information via print materials, or from their
peers, there are increasing numbers of audiences who prefer to receive health information online.
- With the number of social media users growing so rapidly, social media present an opportunity to
reach diverse group audiences in a very short period of time.
ii. Social media allows to share health information in new spaces

- Social media allow us to share relevant content in new and emerging channels, test how our
messages resonate in different spaces, and provide opportunities for multiple exposures to
messages.
- Through the use of social media channels, public health organizations can share relevant content
where users are already spending their time.
- Sharing health content in new spaces allows public health educators to potentially tap into the large
audiences of social media channels relatively at a very cheaper cost.
iii. Feedback can be listened to and collected in real time

- Social media give us insights into what health information may be important and interesting to users,
in the moment.
- This real-time aspect of social media is a key component to ensuring that our communication efforts
are relevant, meaningful, and useful to our audiences.

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iv. Social media permits direct engagement

- Due to the multi-way, interactive functionality that is inherent to these platforms, social media can
allow us to increase direct engagement to maintain and increase trust and credibility.
Challenges of social media to health education and promotion in present context (past question: 2072/3)
i. Poor quality of information
- The main limitation of health information found on social media and other online sources is a lack of
quality and reliability.
- Authors of health information found on social media sites are often unknown or are identified by
limited information.
- In addition, the health information may be unreferenced, incomplete, or informal.
- While evidence-based public healrh de-emphasizes anecdotal reports, social media tend to
emphasize them, relying on individual patient stories for collective health knowledge.
ii. Loss of message control

- Potential risks of and fears related to social media engagement for health education includes loss of
control of the message, giving credibility to junk science and reputational concerns.
- There are large concerns about negative comments misdirecting and reshaping the message and
conversations.
- The tendency of messages being shared to numbers of users is very rapid and the health educator
loses control to correct or withdraw messages if misguided or shared with distorted meanings.
iii. Breaches of client privacy

- Concerns regarding the use of social media by health education professional frequently center on the
potential for negative repercussions resulting from the breach of client confidentiality.
- Such infractions may expose health educators and health care entities to liability under privacy laws.
iv. Damage to professional image

- A major risk associated with the use of social media is the posting of unprofessional content that can
reflect unfavorably on health education professional.
- Behavior that could be taken as unprofessional includes violations of client privacy; the use of
profanity or discriminatory language; posting photos without consent; negative messaging, etc.
v. Overlooking disadvantaged groups

- Social media users usually represent groups that are relatively affluent, literate and more or less
aware of particular health concerns.
- While most of the health education campaigns intend to target disadvantaged groups, use of social
media typically tends to overlook these groups.

Year
UNIT 7: SETTINGS IN HEALTH PROMOTION AND EDUCATION
Historical Evolution of Setting Approach

- The setting approach has its origin within the World Health Organization (WHO) Health for All
movement, which was instrumental in the development of new public health, with its focus on how
physical, social, economic and political environments affect health and well being.
- Within this context, the Ottawa Charter presented a framework for health promotion with explicit focus
on setting.
- The charter stated: Health is created and lived by people within the settings of their everyday life;
where they learn, work, play and love.
- The Ottawa Charter stimulated WHO to prioritize the settings approach in its health promotion
programmes.
- From the late 1980s, the settings approach emerged across Europe and globally launched by WHO
in 1987 as a Healthy City initiative.
- Drawing on this experience, developments took place within settings such as schools, prisons,
hospitals and universities.
- Subsequent international health promotion conference served to legitimize further the settings
approach.
Concept of Setting Approach in Health Promotion and Education (Q: 2072/12)

- Healthy settings or the setting based approach to health promotion is a holistic and multidisciplinary
method which integrates action across risk factors.
- The setting approach for health promotion provides an opportunity for a more comprehensive and
organized approach through integration of health promotion activities and interventions into all areas
of the setting.
- The setting approach is a whole system approach and recognizes that health is multifaceted and it
determined by a complex interaction of factors operating at a personal organizational and
environmental levels.
- A setting based approach has roots in the WHO health for all strategy and more specifically, the
Ottawa Charter for Health Promotion.
- The key principles of healthy setting include community participation, partnership, empowerment and
equity.
Advantages:
- A significant advantage of working through a setting approach is that it provides a more integrated
and cohesive mechanism for addressing multiple health issues and their determinants.
- The setting approach enables whole system planning for health across the relevant sectors.
Types of healthy settings

A setting based approach has been implemented in multiple areas such as:
i. Health City/Village approach
ii. Health Promoting Schools Approach
iii. Healthy Workplace Approach
iv. Health Promoting Hospitals
v. Health Promoting Universities
vi. Healthy Aging Approach
vii. Health Promoting Correctional Centres (prisons)

Year
Elemental and Contextual settings

- Contextual settings are larger units that hold smaller elemental settings. Elemental settings are
contained within a broader contextual setting.
- For example, city may contain important elements such as schools, hospitals, markets and
workplaces.
- Elemental settings directly affect the life of people that live within them
i. Healthy City
- Healthy Cities are arguably the best-known and largest of the settings approaches.
- A healthy city seeks to promote policies and action for health and sustainable development, with an
emphasis on determinants of health, on people living in poverty and the needs of vulnerable groups.
- A healthy city provides communities with a framework for multi sectoral planning for health.
- In essence, the healthy city is not just a place in which health promoting activities take place but one
in which all sectors of society place a priority on improving health and plan together, in a coordinated
way to meet community and population health needs.
- A Healthy City aims to:
to create a health-supportive environment,
to achieve a good quality of life,
to provide basic sanitation & hygiene needs,
to supply access to health care.
- Being a Healthy City depends not on current health infrastructure, rather upon, a commitment to
improve a city's environs and a willingness to forge the necessary connections in political, economic,
and social arenas.
ii. Healthy Village

- Healthy village includes a community with low rates of infectious diseases, access to basic healthcare
services, and a stable, peaceful social environment.
- Programmes attempt to foster a holistic approach to health management through fostering
communication among community leaders and members.
- Communication throughout the various social ranks of the village and a village health plan are
necessary components of all programmes.
- Countries like Egypt, Nepal, Pakistan, and Sudan have Healthy Village initiatives.
iii. Health Promoting Schools

- A Health-Promoting School views health as physical, social and emotional wellbeing. It strives to
build health into all aspects of life at school and in the community.
Characteristics of health promoting schools

- Fosters health and learning with all the measures at its disposal.
- Engages health and education officials, teachers, teachers' unions, students, parents, health
providers and community leaders in efforts to make the school a healthy place.
- Strives to provide a healthy environment, school health education, and school health services along
with school/community projects and outreach, social support and mental health promotion.
- Strives to improve the health of school personnel, families and community members as well as pupils;
and works with community leaders to help them understand how the community contributes to, or
undermines, health and education.

Year
Components of health promoting schools

- Healthy school policies
- School physical environment
- School social environment
- Individual health skills and action competencies
- Community links
- Health services
Health Promoting School vs School Health Program (Q:2072/12)
School Health Program Health Promoting Schools
- School health program are traditionally considered - Health promoting schools are the
the exclusive responsibility of health sector responsibility of the school family with inputs
from health sector and communities
- Schools are regarded as passive receptors of - Schools are active components determining
interventions implemented by health sector interventions through participatory process
- Vertical, medicalized and care-oriented programs - Horizontal, socialized and system oriented
programs
- Basically characterized by the cognitive and - Characterized by need based educational
didactical transmission of health information on process with regard to affective processes and
isolated subjects emotional intelligence
- Strives to improve the health of students only - Whole of school approach
- Does not consider actively the health and well-being - Strives to improve the health of school
of staffs in the school personnel, families and community members
as well as pupils
- Sporadic in nature particularly focusing on - Continuous in nature incorporating overall
vaccination campaigns, health campaigns, vision issues from policy development to provision of
screening, health talks etc. wider school health services.
- Generally related to specific diseases or physical - Also related to development of abilities and
aspects of health skills to live a full and healthy life.
- Carried out by external agents - Carried out by school community

- Neither of the members of the educational - Promotes interaction among the school,
community nor local health teams or other members community, parents and local health services.
of community have much influence on decisions with
regard of or the approach to such interventions
- Components of school health program - Components of health promoting schools
Health instruction Healthy school policies
School health services School physical environment
Healthful school environment School social environment
School Community Joint Activities Individual health skills and action
competencies
Community links
Health services

Year
iv. Healthy Workplaces

- Workplace health promotion can be defined as the combined efforts of employers, employees and
society to improve the health and well-being of people at work.
- This vision of workplace health promotion places particular emphasis on improving the work
organization and working environment, increasing workers' participation in shaping the working
environment, and encouraging personal skills and professional development.
- Workplace health promotion focuses on a number of factors that may not be sufficiently covered in
the legislation and practice of occupational health programmes, such as
the organizational environment,
the promotion of healthy lifestyles,
and non-occupational factors in the general environment.
- Non-occupational factors include family welfare, home and commuting conditions, and community
factors which affect workers' health.
- Workplace health promotion supports a participatory process to help promote a stronger
implementation of occupational and environmental health legislation
- To be successful, workplace health promotion has to involve the participation of employees,
management and other stakeholders in the implementation of jointly agreed initiatives and should
help employers and employees at all levels to increase control over and improve their health.
v. Health Promoting Hospitals

- A health promoting hospital (HPH) is defined as one that incorporates the concept of health
promotion into its organizational structure and culture by means of organizational development.
(WHO, 2005)
- The goal is to improve the quality of health care, the relationship between the hospital and
community, and the conditions for and satisfaction patients, staff and relatives.
- Based on Health for all strategy, Ottawa Charter for Health Promotion and the Budapest Declaration
on Health Promoting Hospitals, a health promoting hospitals should:
Promote human dignity, equity and solidarity and professional ethics, acknowledging differences
in the needs, values and culture of different population groups.
Be oriented toward quality improvement, the well-being of patients, relatives and staffs and
protection of environment.
Focus on health with a holistic approach and not only on curative services
Be centered on people providing health services in the best way possible to patients and
relatives.
Use resources efficiently and cost-effectively and allocate resources on the basis of the
contribution to health improvements.
Maintain close links as possible with other levels of the health care system and community.

Year
UNIT 8: Roles of Health Education and Promotion in Public Health Programmes

Role of Health Education in Primary Health care programs
Primary Health Role of Health Education and Promotion with Examples
Care Programs
Family Planning - FP demand generation through interpersonal communication (IPC) and home
visits (e.g. BCC campaigns by MSI/SPN, HC3, PSI)
- Promoting informed choice of contraceptives through counseling services. (eg.
By HFs, MSI, FPAN)
- Promotion of women's control over family planning, men's involvement, and the
importance of long-acting methods through radio, television and print media with
targeted family planning messages (for e.g. smart dampati campaign by USAID,
OK campaign by PSI)
- Promotion of contraceptive access and use through social marketing approaches
(for e.g. social marketing of condom, pills and sangini (depo) by Nepal CRS
company)
Nutrition - Promotion of homestead food production as a way to promote balanced and
healthy diet through SBCC.
- Delivering nutritional information including promotion of exclusive breastfeeding
through radio programs (e.g. Bhanchhin aama radio program by Suaahara)
Maternal and child - Education on danger signs of pregnancy, neonatal care, immunization
health schedules, etc. through use of IEC materials.
- Promotion of birth preparedness and complication readiness
- Promotion of oral rehydration and zinc supplementation (radio jingles on nawa
jeevan and baby zinc)
- Awareness on navi care after delivery (BCC by chlorhexidine care program)
Infectious - Promoting LLIN use for malaria control through IPC and mass media (Global
diseases fund).
- Awareness for prevention and control of infectious diseases like influenza,
dengue, scrub typhus, cholera, etc.
Water and - Promotion of effective hand-washing techniques (by UNICEF)
sanitation - Promotion of water disinfection through social marketing (e.g.piyush)
- Promotion of toilet use and sanitation through SBCC. (e.g Global Sanitation
programme by UN habitat)
Role of Health Education and Promotion during emergencies (disasters)
Public health education and promotion play an essential role in reducing disaster vulnerability by:
- increasing public awareness of environmental health hazards;
- informing people how future risks of epidemics can be prevented or how their impact can be reduced;
- increasing peoples awareness of the threats to health and safety that may result from a disaster, or
that may exist and intensify during an emergency;
- encouraging people to participate in protecting themselves, their environment and their health
services from disaster and the effects of disaster.
Role of health education and promotion during emergencies
i. In some cases, there may be a good deal of misinformation and rumour regarding disease and
outbreaks, and it is essential that people have access to authoritative information through means of
health education.
ii. There may be many unfamiliar arrangements for water and food supply, excreta disposal, etc.,
especially when people are forced to evacuate their homes. Health education helps to provide rapidly,
the information about the new arrangements and the importance of complying with them (e.g. the
importance of using designated defecation fields).

Year
UNIT 9: Community Health Development
Community organization
MURRAY G. ROSS in 1955 defined community organization as, A process by which community identifies
its needs or objectives, orders (or ranks) these needs or objectives, develops the confidence and will to
work at these needs or objectives, finds the resources (internal and/or external) to deal with these needs
or objectives takes action in respect to them and in so doing extends and develops co-operative and
collaborative attitudes and practices in the community.
Characteristics of community organization

- Community organization is a process of achieving community needs.
- Community organization helps to identify the needs and resources
- In the process of community organization, entire community is considered as a client.
- Community organization is a means not an end.
Objectives of community organization

- To organize the community scientifically
- To help the community to identify its needs and to work on it
- To empower the community to identify the resources within and outside the community for
development.
- To equip the community to plan, implement, monitor and evaluate development initiatives.
Role of community organization in health promotion and education (past question 2072/3 MHP&E)
Roles of CO Description
1 Build capacity - Build capacity of members and groups to work together to identify
community health problems and well-being needs
2 Involve people - Involve people in designing, developing and implementing health promotion
collectively interventions against issues affecting health of communities
3 Build awareness - Build awareness of community members on health contexts and availability
of services.
4 Enable groups - Enabling groups to analyze those health relates issues or problems that are
neither their responsibility nor within their ability to solve.
- It enables groups to consider and agree on how they will activate and get
those with responsibility to move and focus on the problem and get the
problems addressed.
5 Build confidence, - Build knowledge, skills and confidence of marginalized groups to advance
knowledge and from an experience of powerlessness to state of health promotion.
skills

Year
Community Development
Community Development is a process designed to create a condition of economic and social progress for
the whole community with its active participation and the fullest possible reliance upon the community
initiative. (UN Bureau o Social Affairs, 1955)
Characteristics of community development

- It focuses on the whole community rather than on any one area or a group or a segment or of
population.
- It concentrates on the overall development of the community and attends the needs of the whole
community.
- It promotes problem-solving approach
- It is always concerned with bringing social change
- The foundation of community development is self-help and participation of local people, in whatever
manner they can.
- Community development usually involves utilization of local resources.
Process of community development
Ways of Viewing Community Development

Sanders (1958) presents community development in four different typologies
i. Community Development as a process
- Community development as a process moves by stages from one condition or state to the next.
- It involves a progression of changes in terms of specific criteria. For example, a change from state
where one or two people or a small elite group make decisions for the rest of the people to the state
where people themselves make these decisions about matters of common concern.
- The emphasis of community development as a process is upon what happens to people, socially and
psychologically.

Year
ii. Community Development as a method

- Community development as a method puts the emphasis on both the process and objectives.
- It is a means to an end; a way of working so that some goal is attained.
- Those who subscribe to community development as a method applies centrally advised programs
which are inevitably less attentive to the needs of each community.
iii. Community development as a program

- Community development can also be viewed as a program consisting of a set of procedures and
activities.
- It is as a program that community development comes into contact with subject-matter specialties
such as health, welfare, agriculture, education, etc.
- Community development as a program emphasizes on activities.
iv. Community development as a movement

- Community development is a crusade, a course to which people become committed.
- It is not neutral, but carries an emotional charge; one is either for it or against it.
- Community development as a movement is dedicated to progress of the community.
Techniques of Community Development and their application in public health programs

Murray G. Ross identifies three techniques/ approaches of community development
i. Single Function Approach (External Agent Technique)
- In this technique, community health development programmes are implemented by the external
agents.
- The external agent convinces the people through his personal skills and experience and motivate
them to work for the development of community health.
- He identifies various health problems and seeks suitable solutions for it.
- He organizes the people to discuss the situation, arrange meetings, forms committee to highlight the
hindrances in the developmental procedures.
- Al last this agent presents a policy for the community and the whole community adopt it for
development.
- This technique neglects the attitudes of community members to the innovation towards winning the
support of the community for the subject.
ii. Multiple Agent Technique

- In this technique, the community development experts try to provide various facilities including health,
education, sanitation, recreation etc. to control the causative factors in the way of community
development.
- The basic philosophy of multiple agent technique is to convert centuries into decades.
- In this technique, some members are selected from the whole community. They try to make a
combined policy for the improvement and betterment of people.
- This approach is also called representative because these people work in the community as
representative of the whole locality.
iii. Internal Resource Mobilization Technique

- In this technique, stress is laid on the needs to encourage people to identify their own needs and
work cooperatively for satisfying them.
- The community members are encouraged and motivated to use their resources for the improvement
of the areas.

Year
Differences between community organization and development (past question- 2072/3)
Community Organization Community Development

Community organization is a method of social work Community development is a programme planned
to bring social change
In community organization, emphasis is on process Community development focuses on end/goals
It is a continuous process, without any time bounds Community development is time-bound and one
and it is achieved as per the pace and participation has to take action within a stipulated time to
of people achieve the goals
Community organization emphasizes peoples Community development focuses on peoples
participation development
Assistance of government and/or other agencies In community development, external assistance is
does not matter in community organization sought and considered as important
In community organization, people are involved in In community development, external agencies plan
planning and executing the programmes to solve the programme. Peoples participation is optimal
their problem
Community organization is universal to all Community development differs from community to
community community, people to people, according to the
nature of the problems, needs, situations, etc.
Community organizers are usually people who Community development personnel can be from
bring social change (social change agents) any professional field other than social work such
as public health, livelihood, agriculture, technology,
etc.
Role of community organization for post-disaster re-construction work (past question- 2072/3)
Reconstruction begins at community level. A good re-construction strategy promotes community
organization to bring about rapid and sustainable solutions.
Roles of community organization can range from assessment to implementation and evaluation of re-
construction works.
Reconstruction Roles of community organization
activities
1 Assessment - Conducting
Housing assessments and census
Community-led need assessments
Local environmental and health assessments
Mapping of affected areas, damages and changes
Stakeholder analysis
2 Planning and design - Prioritizing and planning re-construction projects
- Carrying out participatory site planning and site evaluations
- Identifying targeting criteria and qualifying households
- Participating in training (DRR and re-construction methods)
- Assisting with grievance procedures
3 Project development - Carrying out/or overseeing
and implementation - Housing reconstruction, including housing of vulnerable households
- Infrastructure reconstruction
- Reconstruction of public facilities (health centres, schools, community
buildings, etc)
- Managing community warehouses
4 Monitoring and - Supervising reconstruction
evaluation - Participating in monitoring and social audit committees
- Conducting participatory evaluations

Year
Group Dynamics
Group Dynamics
- A group can be defined as several individuals who come together to accomplish a particular task or
goal. Group dynamics means the study of forces within a group. The social process by which people
interact with each other in small groups can be called group dynamics.
- Group dynamics refers to the attitudinal and behavioural characteristics of a group.
- It concerns how groups form, their structures and process, and how they function.
- Group dynamics are relevant in both formal and informal setting and therefore it is an important area
of study in both professional teaching-learning (e.g. training programs) as well as community health
education processes.
Importance of group dynamics

- The members are always influenced by the interactions of other members in the group.
Understanding group dynamics can help influence the thinking of members in health education
process.
- A well functional group can give the effect of synergy.
- Even the attitude, perceptions and behaviour of members depend on group dynamism. For example,
person with negative attitude can be converted to positive attitude with the help of appropriate
interaction in the group.
Group dynamics is primarily concerned with the following:

1. Process of group formation
2. Structure of group
1. Process of group formation

- According to Tuckman, there are five stages of group development.
i. Forming: Team acquaints and establishes ground rules. Members treat each others as strangers.
ii. Storming: Members start to communicate their feelings but still view themselves as individual
rather than a part of team. They resist control by group leaders.
iii. Norming: People feel part of the team and realize that they can achieve work if they accept each
others viewpoint.
iv. Performing: The team works in an open and trusting atmosphere where flexibility is the key.
v. Adjourning: A team conducts an assessment and implements a plan for transitioning roles and
recognizing members contributions.
2. Structure of Group
- Group structure is a pattern of relationship among members that hold group together.
- Group structure is concerned with group size, group roles, group norms, and group cohesiveness.
i. Group size
- Group size varies from 2 people to a very large number.
- Small groups of 2-12 are thought to be more effective with ample opportunities of participation.
- Increasing size of group beyond 10-12 members results in decreased satisfaction among group
members.

Year
ii. Group roles

- Group roles can be classified into task roles, maintenance roles and individual roles.
Task Roles Roles Building & Maintenance Roles Individual (Blocking) Roles
Coordinator Compromiser Aggressor
Elaborator Encourager Arguer
Energizer Follower Blocker
Evaluator/ Critic Gatekeeper Dominator
Information Giver/ Harmonizer Player
Seeker Observer Recognition Seeker
Opinion Giver/ Seeker Standard Setter Self-confessor
Orienteer
Recorder
iii. Group norms

- Each group creates its own norms defining group standards, boundaries of acceptable and
unacceptable behaviour.
- Norms often should reflect the level of commitment, motivation and performance of the group.
iv. Group Cohesiveness

- Cohesiveness refers to the bonding of group members or unity, feelings of attraction for each
other and desire to remain part of the group.
- Many factors influence the amount of group cohesiveness agreement on group goals,
frequency of interaction, inter-group competition, favourable evaluation, etc.
Miscellaneous
Evaluation of health education program

Evaluation is a systematic way of learning from experience and using the lesson learnt to improve current
activities and promote better planning by careful selection of alternatives for future action. (WHO)
Evaluation is the process of determining the amount of success in achieving the predetermined
objectives. (American Public Health Association)
Types of health education program evaluation

i. Process Evaluation
- Process evaluation can be defined as the assessment of policies, materials, personnel, performance,
quality of practice or services, and other inputs and implementation experiences. (Green &
Kreuter,2000)
- At this level of evaluation, the main focus is upon professional practice.
- This is the time to experiment with methods, to pilot new programs components, and to solve
problems in new materials such as their readability, cultural sensitivity and/or acceptability to target
population.
- Quality in health education programming is evaluated by such methods as adult, peer review,
accreditation, certification and government and administrative overview of contracts and grants.
ii. Outcome Evaluation

- Outcome evaluation can be defined as assessment of the effects of a program on the ultimate
objectives, including changes in health and social benefits or quality of life. (Green & Kreuter, 2000)

Year
- Outcome evaluation is centered upon mortality and morbidity, such as the incidence and prevalence
of the condition(s) affected by the program.
- The information gathered in outcome evaluation determines whether a program has had an impact on
health status and quality of life.
- Outcome evaluation is a long term consideration requiring large population samples.
iii. Impact Evaluation

- Impact evaluation assesses the immediate effect a program has on the behaviors of the program
participants.
- This level of evaluation assesses change in pre-disposing, reinforcing and enabling factors, as well as
in the behavioural and environmental factors.
- Cost-effectiveness is one standard of acceptability in impact evaluation.
Evaluation can also be classified into following types

i. Formative Evaluation
- Formative evaluation is done during the planning and implementing processes to improve or refine
the program.
- For example, validating the needs assessment and pilot testing are both the forms of formative
evaluation.
- Possible evaluation measures: number of sessions held, attendance, participation, staff performance,
adequacy of resources, etc.
ii. Summative evaluation

- Summative evaluation begins with the development of goals and objectives and is conducted after
implementation to determine the programs impact on the priority population.
- Possible evaluation measures include: increase in knowledge, awareness and skills, quality of life
improved, morbidity and mortality, etc.
Criteria for Evaluation

While evaluating a health education program, four criteria or components of evaluation should be
considered as recommended by WHO.
i. Adequacy
- The evaluation should try to get adequate information about methods and media used, resources
utilized, objectives fulfilled, target population covered, subjects or contents dealt, peoples response to
health education program etc.
- Attention should be given on the adequacy of implementation strategies applied.
ii. Relevancy
- The evaluation should also consider the relevancy of activities against set objectives, relevancy of
contents with objectives, relevancy of objectives with the needs etc.
-
iii. Efficiency
- Evaluation should also emphasized to know how efficiently the health education workers have
worked, how economically the progress is made etc.
- Attention should also be given on if the goals and objectives are achieved in scheduled time or not.
iv. Appropriateness

Year
- The evaluation should also study the appropriateness of health education program to the need of
target group, to the time the program is implemented etc.
Supervisory system of Health Education Activities in Nepal

- Supervision of health education activities in Nepal is done in integration with other national health
programs. Integrated supervision has been followed as one of the priority programs of Ministry of
Health.
- In District Health System, it has been recognized as a key management practice and the tool for
effective implementation of health service interventions.
- In district, supervision schedule should be planned at all levels before the program implementation for
upcoming fiscal year.
- Staffs from district to HP levels have, as a part of their responsibility, a significant supervisory role to
perform.
- It includes preparation of supervision checklists, its use during supervisory visit to its proper recording
and reporting, its review by the concerned higher authorities and appropriate feedback system, all at
appropriate time period.
- Necessary supervision trainings are provided to all staffs from time to time for maintaining effective
supervision system.
Routine supervisory system at National Level

Supervising Organization Organization to be supervised Frequency of Supervision
Department of Health Services Regional Health Directorate Three times a year
(Including its Divisions and District (Public) Health Office Mountain/ Hilly Region: at least
Centres) once a year
Terai: At least two times a year
Primary Health Centre As per need
Health Post As per need
Regional Health Directorate District (Public) Health Office At least three times a year
(RHD) District Hospital At least three times a year
Primary Health Centre At least two once a year
Health Post As per need
District (Public) Health Office Primary Health Centre At least three times a year
Health Post At least two times a year
Primary Health Centre and EPI Clinic, PHC-ORC, FCHVs Monthly (for VDC based)
Health Post Once a year (for HP based)
Other community based health As per need
activities

Health Promotion and Education

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MPH Ist Year

Health Promotion and Education

Prabesh Ghimire Page | 2

Theories of Stress and Coping............................................................................................................................. 38

Prabesh Ghimire Page | 3

Concepts of Health Promotion and Education

Philosophy of Health Promotion and Education

Prabesh Ghimire Page | 4

Coherence of philosophy in theories, principle and practice (past question-2072/3, 2068/7)

Principles and Practice

Prabesh Ghimire Page | 5

Prabesh Ghimire Page | 6

Scope/ Settings of Health Promotion and Education

iv. Health Care Settings

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vi. The Consumer Marketplace

vii. The Communications Environment

Principles of Health Promotion and Education

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Responsibilities and competencies of health promotion and education professionals

Responsibility 1: Assessing individual and community needs for health education

Responsibility 2: Planning effective health education programs

Responsibility 3: Implementing health education programs

Responsibility 4: Evaluating effectiveness of health education programs

Responsibility 5: Coordinating provision of health education services

Responsibility 6: Acting as a resource person in health education

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i. Responsibility to the Public

ii. Responsibility to the profession

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iii. Responsibility to employers

iv. Responsibility in the Delivery of Health Education

v. Responsibility in Research and Evaluation

Role of Theory in Health Promotion:

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UNIT 2: National and International Disclosure in Health Promotion and Education

Historical Developments- Milestones in Health Promotion and Education

Factors that Necessitated the Changes in International Disclosures of Health Promotion

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Overview of International Declarations, Statements, Charter and Recommendations

The Ottawa Charter for Health Promotion

The Charter defined health promotion as

Strategies for Health Promotion (Q:2072/12)

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ii. Creating Supportive Environment

iii. Strengthen Community Actions

iv. Develop Personal Skills

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v. Reorient Health Services

The Adelaide Recommendations on Healthy Public Policy

Recommendations: Areas of Action

ii. Food and nutrition

iii. Tobacco and alcohol

iv. Creating supportive environments

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The Sundsvall Statement on Supportive Environment

Proposals for action

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Jakarta Declaration on Health Promotion

Priorities for health promotion in the 21st Century

ii. Increase investments for health development

iii. Consolidate and expand partnerships for health

iv. Increase community capacity and empower the individual

v. Secure an infrastructure for health promotion

Prabesh Ghimire Page | 17

The Bangkok Charter for Health Promotion in a Globalized World

Strategies for health promotion in a globalized world