06/08-14/2021

1:00-3:00 Health Education and Health Promotion

T, M Preventive, Community, and Family Medicine
Zoom Nemia Lizada, M.D.

OUTLINE o It provides support and assistance necessary to help other

people to carry out choices regarding their health.
I. Objectives o The health educators would act as facilitators to give support
II. Definitions and assistance to the people.
III. Scope of Health Education  Leading out what people already know and believe and do about
IV. Health Promotion their health; modifying those that are undesirable, and developing
V. Basic Processes Involved in Health Education and desirable behaviors that are conducive to health (CPH- UP
Promotion Manila, Department of Health Promotion and Education)
VI. Methods of Health Education o Health education is not just telling people what to do, but it is
VII. Training of Health Workers a process of providing learning experiences in order for the
VIII. Health Education Plan people to define their own health problems, and to take the
IX. The Physician as a Health Educator needed action to solve their problems.
X. Sources o Based on this definition. The health educators would help
people in identifying and prioritizing their health problems,
and also help them to find solutions in order to address their
OBJECTIVES health problems.
 The Keywords in the definition are:
1. Explain the basic concepts in health education and health o Process:
promotion  A series of learning experiences
2. Discuss the categories of health behavior  Does not mean a one-shot deal or one-time activity
3. Differentiate health education and health promotion  The activity should be conducted not only once, but
4. Describe the scope of health education and health promotion several times, with a goal in mind that these activities
5. Discuss the various settings where health education and health will affect people’s behavior towards health
promotion can take place o Combination:
6. Discuss the basic processes in health education and promotion  Connotes that there is no single best method rather a
such as: combination is desirable
a. Learning process  Because we are doing adult-learning, combination of
b. Communication process methods is done
c. Change process o Designed:
7. Formulate a health education plan  It is planned, not a hit or miss process
8. Define and explain the different strategies/methods in health  Formulate health education plan before you conduct the
education activity because there are factors to consider
 Consider content, resources, place, etc.
DEFINITIONS o Facilitates:
 Assisting, helping, and supporting role of educator, not
Health Education just telling
 We are dealing with adults and not all adults have the
same level of understanding, thus we assist them to
 A process that bridges the gap between health information and
understand the concepts we want to covey
health practice (Presidents Committee on Health Education, 1973)
o Voluntary adaptations:
o In other words, health education provides people with
 Not manipulated or coerced
enough information, as well as motivation in order to help
 Related to the outcome/goal of activity: change the
them understand the factors that would promote or threaten
behavior of people
their health.
 Willingness on the part of the learner to change his
 A process of bringing about behavioral changes in individuals,
behavior
groups and larger populations from behaviors that are presumed
o Behaviors:
to be detrimental to health, to behaviors that are conducive to
 Target outcomes
present and future health (Simmonds, 1976)
 Change unhealthy behavior to the one that would bring
o The aim is to change the unhealthy behavior to the one that
about a good quality of life in terms of health, wellness
is conducive to present and future health
and well-being, free from diseases and other infirmities.
o A process wherein the concern is to influence the behavioral
factors
3 Categories of Health Behavior
 Any combination of learning experiences designed to facilitate
voluntary adaptations of behavior conducive to health (Green,
1980) 1. Preventive Health Behavior
 The process of assisting individuals, acting separately or  Any activity undertaken by the individual who believes
collectively, to make informed decisions about matters affecting himself to be healthy for the purpose of preventing or
the personal health and that of others (National Task Force on detecting illness in an asymptomatic state
the Preparation and Practice of Health Educators, 1983)  Ex: immunization, screening tests, executive checkups,
o This shows that the definition is evolving from the 1970s to periodic examinations in order to detect diseases early
1980s and there are already additional information that are
added to the definition

CPU College of Medicine | Revised By: Victores Valetudinis | 2022

2. Illness Behavior
 Any activity undertaken by an individual who perceives
himself to be ill; to define the state of his health and to
discover suitable remedy
 Ex: when the px complains of headache would consult a
doctor to know whether his condition is serious or not.
3. Sick Role Behavior
 Any activity undertaken by an individual who considered
himself to be ill for the purpose of getting well.
 Ex: receiving treatment from medical providers; A patient
who has fever and cough would consult a doctor to obtain
prescriptions for the relief of symptoms

SCOPE OF HEALTH EDUCATION

 Health education is an important component of all the phases of

the levels of prevention – from the primordial, primary, secondary
and tertiary levels: from health promotion, specific protection,
early diagnosis and treatment, disability limitation to rehabilitation.
(all the program thrusts of the health care delivery system have NICE TO KNOW
corresponding health education/promotion components- e.g.
HIV/AIDS prevention and control, in the absence of possible Health education is not limited to the settings mentioned above.
treatment, educating people on how to prevent risk behaviors Giving out flyers containing health infographics is already a form
become of utmost importance) of health education.
 Health Education can take place in various settings, either
formally or informally
HEALTH PROMOTION

Settings for Health Education  Started in the 1986 because of the paradigm shift of prevailing
diseases – from communicable to non-communicable diseases
 Health Centers (lifestyle-related)
 Clinics  Health promotion implies: behavioral change through health
 Hospitals education + supportive environment
 HMOs
Health Promotion Definition (Ottawa Charter for Health
1. Schools Promotion, International Conference on Health Promotion, 1986)
 Desirable health behavior is installed from the lower grades
up through health teaching  The process of enabling people to increase control over and to
 Supportive hygienic school environment. improve, their health
o There should supply safe and adequate water for o Broader scope compared to health education
drinking and washing. o Strategies recommended by the Ottawa Charter:
o There should be appropriate garbage disposal, etc.  Develop personal skill
 School health services.  Create supportive environment
o There should be availability of school physicians, nurses  Societal level
and other health personnel.  Community involvement
 Teacher’s training  Re-orient health services:
 Training of health professionals  Reassess health services.
2. Communities  This was after the declaration of Alma Ata in 1978
 Through the community organization approach, communities where health for all was not achieved; to add
are able to identify their health problems and through group services/enhance score, not only the 8 primary
decision and action, find solutions to their problems services stipulated in the Alma Ata Declaration
o Ex: community exposure with the target population, such  Build supportive public policies
as elderly group, mothers or even the whole community  Health promotion works through concrete and effective
o In order to affect behavior, there should be series of community action in setting priorities, making decisions, planning
activities strategies and implementing them to achieve better health; at the
o Engage the people, do community organizing, doing heart of the process is the empowerment of communities, their
assemblies to enable them to make group decisions with ownership and control of their own endeavors and destinies
regard to understanding and solving their health
problems Key Strategies to create supportive environments (Sundsvall
3. Worksite Conference in 1991)
 Include industries, offices, food establishments, hotels, etc.:
groups with specific health problems that are common to  Strengthening advocacy through community action particularly
each group those organized by women.
 The retainer doctor’s responsibility is not limited to doing  Enabling communities and individuals to take control over their
consultation, but there is also a need to do health education health and environment through education and empowerment.
activities for the whole organization aside from the individual  Building alliances for health and supportive environments to
patient education during consultation, particularly with regard strengthen cooperation between health and environmental
to occupational hazards and diseases. campaigns and strategies.

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 o Sundsvall conference strategies are directed towards policy-  Environmental change
makers and decision-makers  Policy changes
 Mediating between conflicting interests in society to ensure  Economic changes
equitable access to supportive environments for health.  Shifts in societal norms
 The two concepts are symbiotic strategies.
NICE TO KNOW o They are closely associated or related and that they benefit
from each other.
This conference emphasized the role of supportive environment
action in maintaining health promotion activities BASIC PROCESSES INVOLVED IN HEALTH EDUCATION AND
PROMOTION
Health Promotion Definition (WHO) 1. Learning Process
2. Communication Process
 A mediating strategy between people and their environments, 3. Change Process
synthesizing personal choice and social responsibility in health
(WHO) Learning Process
o WHO principles regarding health promotion:
 Involves the population as a whole in their everyday
 Case: The pregnant Mrs. Ramos cried as her sick child is
life, rather than focusing on people at risk
wheeled to the emergency room. She thought the measles was a
 Directed towards action on the determinants or
natural childhood experience which every child had to go through.
causes of health – social determinants of health, like
Never did it cross her mind that bronchopneumonia was a
families, etc.
possible sequelae. Thus she never brought her son, Robert, to
 It combines diverse, but complimentary methods or
the health center for immunization. The doctor explains Robert’s
approaches, including communication, education,
condition to Mrs. Ramos and discusses how her future child can
legislation, fiscal measures, organizational change,
be protected against it. The following year, she brings her new
community development and spontaneous local
daughter, Rina, to the health center for vaccination.
activities against health hazards.
 Learning: change in behavior as a result of the experience
 The same with health education, health promotion
calls for combination of efforts, but this time in  Elements of Learning:
contrast to health education, the methods are more 1. Goal
comprehensive and societal in nature and it is now  Aim or purpose
legislative  Behavior change must be relevant to the needs and
 It aims particularly at effective and concrete public concerns of the person
participation.  In the case:
 It is primarily a societal and political venture and not a o Goal of Mrs. Ramos: bring the new daughter to health
medical service center for vaccination
 Why? so the child will not contract the disease
Keywords in the Definition of Health Promotion  1st child not vaccinated --> 2nd child now brought
for vaccination (Mrs. Ramos has learned from her
experience)
 Process
2. Readiness: a person must be “physically, mentally, and
 Empowerment of people and communities emotionally prepared” to handle the change in behavior
 Control over their health  In the case:
 Supportive environment o Readiness of Mrs. Ramos:
 Community involvement  being a mother, she wanted to take care of her
 Advocacy child and prevent the illness of her child
 Social Change  Previous experience with her first child
3. Situation
Health Education vs Health Promotion  A condition where a person can make a choice
o A person can think and evaluate his/her options
 Health education:  Must provide the learner with viable alternatives
o Brings about desirable changes in attitudes and behavior  In the case:
of individuals, families and communities o Mrs. Ramos still has a choice whether to bring her
o Giving information and teaching individuals and second child to be vaccinated or not
communities how to achieve better health. o She must think of the pros and cons of each choice as
o Seeks to motivate individuals to accept a process of well as her alternatives
behavioral change through directly influencing their 4. Interpretation
values, beliefs, and attitude systems.  The way a person perceives things/interpret a situation is
o Learner directed affected by her background and previous experiences
 Health promotion: (greatest factor affecting interpretation)
o Brings about social change, i.e. changes in the physical,  A person may accept or reject a health practice depending
social, political environment, through advocacy, people on his/her own interpretation
empowerment, networking, etc. in order to establish  In the case:
supportive environment o Interpretation of Mrs. Ramos will be affected by her
o Involves social, economic, and political change to ensure experience with her first child
that the environment is conducive to health. 5. Response: the person will then act according to what he/she
o More comprehensive and broader in scope. perceives & expects will bring the best result
o Broader concept directed toward advocating health:
 Individual and community education

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  In the case: Communication Process
o Mrs. Ramos decides to bring her second child to be
vaccinated because she perceives that her second  A process by which information is exchanged & understood by
child will be protected against measles. two or more people usually with the intent to motivate or influence
6. Consequence behavior
 The result of his/her response would either be a confirmation  Effectiveness of the communication process is important
or a contradiction of his/ her expectations o Will influence the competency of the health educator in the
 If the consequences are favorable, there is a high probability delivery of the health information
of repeating the same response  Elements of the Communication Process:
 In the case: 1. Source or sender
o After the vaccination against measles, her second child  Initiates the process of communication
did not develop the disease (favorable consequence).  Individual/group/organization who has a purpose,
7. Reaction to Thwarting information and/or need to communicate with one or
 If the consequence is unfavorable or not consistent with more people
his/her expectations, he/she could either:  Ex. The midwife when she is conducting a class for the
o Explore other alternatives (usually done) or mothers
o Completely give up and lose hope 2. Message
 If the consequences are favorable, there is a high probability  Physical form into which the sender encodes the
of repeating the same response information Individual/group/organization who has a
 In the case: purpose, information and/or need to communicate with
o There is learning. This learning will be reinforced if she one or more people
will have a third child. 3. Channel: mode of transmission
 How People Learn (Four ways to consider): 4. Interpretation: target of the sender’s message
1. Content 5. Feedback: reaction of the receiver to the message sent by
 Areas which interest the learners & which respond to their the sender;
needs, desires & problems  can be in the form of spoken acknowledgement that the
 People learn quickly if it is relevant and meaningful to message has been received, documentation or actions
them
2. Learning Situation:  Steps in the Communication Process:
 Physical environment 1. Thinking: formation/framing of the idea in sender’s mind
 Should be conducive for learning 2. Encoding
 Learners can express themselves freely within reasonable  Putting the thought into some form for possible
boundaries communication ways of communicating:
3. Method o Language (words)
 People learn in a variety of ways: o Actual physical touch
o Providing real learning situations o Body movements
o Engaging in practical activities (ex. Demonstration) o Symbols: audible or visible
o Recreating actual setting (ex. Simulation activities) 3. Transmitting: broadcasting the message via some medium
o Group interactions (orally or in writing)
o Formal schooling (least effective for adult learning) 4. Perceiving
 Receiver must perceive the incoming communication
with one or more senses: sight, hearing, feeling, taste,
smell
5. Decoding: receiver puts the incoming communication into
some form that will make it understandable
6. Understanding
 Receiver understands the message as it was intended
to be understood by the sender

 Principles of Communication
1. People select what they see or hear
2. The receiver interprets selectively what they see & hear
3. People choose what they want to remember & what they want
to forget
4. Words do not have meanings (they are only the form through
which messages are encoded)
5. Meanings are in people (the real meanings are developed by
the receiver)
6. Meanings are in contexts (influenced by setting where the
communication took place)
7. Meanings are in relationships (influenced by the relationship
4. People (learners): each person has the ability to learn, of the sender and the receiver; ex. Good relationship which
regardless of age, sex or environment condition allows the receiver to trust them; credibility of the source)
 During health education activity, one important consideration
is the level of understanding of the learners
 Tailor the activity to the level of understanding of the
population

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 Barriers to Communication 2. Encourage feedback
1. Environmental barriers  Important so that you will be able to assess whether
 Noise the receiver was able to understand what you were
trying to convey, as you wish him to understand
3. Simplify message language
 Don’t use complex words or languages
4. Listen actively
 Don’t talk when someone else is talking. Let him/her
finish first before you speak
5. Restrain emotions (you may say something you’ll regret
later)
6. Use nonverbal cues (use multiple channels)

 Competition for attention: multitasking

 Time: amount of time that is available to absorb the
information
2. Terminology & complexity of the message
 Simplify the language that the receiver can
understand
 Use layman’s terms
 You can use multiple channels e.g. visual aids
3. Personal barriers
 Frame of reference
o Totality of one’s socioeconomic background
and previous experiences Change Process
o E.g. a person who has not experienced child
birth may not understand the pain during  Steps in the Communication Process: what may be changed?
delivery 1. Cognition: knowledge &/or perception
o E.g. Rich people may not be able to fully relate 2. Attitude: beliefs, predispositions, intentions, & tendencies
to malnutrition; not being able to eat 3x a day 3. Behavior: knowledge, attitude, & practices
 Beliefs, values, prejudices, preconceived opinions  Would also include both the cognition and the attitude
o This can lead to distortion of messages  Levels of change:
o Different interpretation of messages o Health education can affect behavior change among
 Selective participation individuals and intermediate groups
o The tendency to screen o Health promotion activities can affect behavior change in the
unfavorable/destructive information and society
amplify/magnify words, actions, and meanings 1. Individual
that are flattering  Change in health knowledge, attitudes, values and
o Screen out the bad and retain only the good of behavior of the individual
the message 2. Intermediate or group
4. Other barriers:  Change in the normative beliefs, values and behaviors
of intermediate social groups of people such as the
family, naturally occurring groups (ex. cultural
minorities, indigenous people, specific sectors) and
communities
 Categorized through either political or natural
boundaries
 “Studies have shown that several health behaviors are
resistant to change without active participation of family
members. In fact the power to decide on whether to
accept the innovation or not is vested on some
members of the family” – Doc Lizada
 Example 1: A mother would like to bring her child to the
health center for vaccination but cannot do so without
the approval of the grandmother.
 Example 2: A couple who would like to practice artificial
family planning cannot do so without the approval of
 Ways to overcome barriers to effective communication the mother-in-law
1. Regulate the flow of information
 Deliver information in correct pace: not too fast nor
too slow

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 3. Societal  Pride & dignity
 Change affecting the region, state or nation o It is fundamental in our culture to have an innate
 Change can be accomplished through health dignity in our way of life or personal bearing.
legislations, technological innovations, and massive o People would not want to fail to fulfill their societal
movements roles and expectations. Changes that would affect
 Affected through health promotion activities pride and dignity will be rejected
 Elements of change: o For example: during a feeding program, some
1. Innovation: mothers of malnourished children won’t register to
 An idea, a set of behaviors, a new technology, a project, not be labeled as mothers who do not know how
a program introduced to effect change to take care of their children.
 Example: In a community level, the construction of  Norms of modesty
community/communal toilets in remote or rural o Usually related to manner of dressing, decorum or
barangays decency of behavior.
2. Targets of Change: o In Muslim areas, this could pose a problem in the
 An individual, a group of people, a segment of a health programs’ implementation wherein male
community or the entire community doctors are not allowed to do pre-natal care of
 Example: community members, residents of the area pregnant woman or the delivery.
that would benefit from the communal toilets 2. Social barriers: interpersonal relationships among
3. Change Agent: individuals, families and communities
 A person or a group of people introducing the  Mutual obligations within the framework of family,
innovation fictive kin & friendship patterns
 Example: local government officials, health center staff o In example, Filipinos are expected to send their
4. Strategies of Change: younger siblings to school after they have
graduated and found a job.
 Deliberate actions, set of activities, approaches, tactics
o When that person who has now the burden of
or processes designed to effect change
responsibilities gets promoted on their job, their
 Example: specific procedures and activities to be done
obligations extend (not just to immediate family
in the course of the construction; must have a plan as
but also their distant relatives).
to what the objectives would be in effecting the change
o Sometimes these people reject their promotions
 Strategies: definite actions or processes to be done for they think they have become the “milking cow”
 Specific activities should have evaluation of their relatives and if they do not give help, they
 Factors affecting change will be heavily criticized.
1. Barriers to change  Small group dynamics
2. Motivation to change o People who gets involve in small groups (i.e.
 Barriers to Change barkadas) feel a sense of psychological security
1. Cultural barriers: values, attitudes, culture structures, and and satisfaction in their daily work when they are
motor patterns identified with a group.
 Tradition: o In example, in some areas in Mindanao,
o Explains why innovations are easily adopted in Schistosomiasis is endemic, and women in
urbanized and industrialized areas in comparison certain areas are fond in washing their laundries
to rural areas in the river (forming their own small group)
o Old myths and health beliefs are already however this gives them higher risk of
engrained in the minds of the people transmission.
o Tradition is handed down from generation to o The LGU in order to address the Schistosomiasis
generation and have proven to be effective. The cases, opted to construct water pumps (bomba),
strong influence of tradition to the way of life of wherein women should now be used to do their
the people give no place for innovation laundry but despite this project they still go back
 Fatalism and prefer to wash in the river..
o “Lazy man’s way of accepting the inevitable.” –  Public opinion
Natalie Clifford Barney o Can be a very strong force that can upset an
o Fatalistic outlook: similar to “what happens is the innovation
will of God.” o Can be a very strong resistance against change
o “Bahala na” attitude o Ex: A couple cannot practice or advocate the use
o Fatalistic people are not keen or not agreeable of artificial family planning methods because they
to adopt change despite the promise of a better belong to a community that strongly believes that
life due to the belief that they cant do anything to these practices are a sin against God.
change their destiny  Factionalism
 Cultural ethnocentrism o When you are having innovations, the change
o or simply Ethnocentrism, is the emotional attitude process involves people and when we are doing
that one’s own race, nation, or culture is superior our health education activities, the innovation
to others. would likely be accepted if there is community
o Belief in the superiority of one’s culture wherein participation
they think that their way of providing healthcare is o Factions can hinder the implementation of
the best for a given situation. innovations
o They tend to reject change that would question o Ex: If some members of a faction would exhibit
the elements of their culture. interest to the innovation, the members of the rival
o “My culture is the most important culture in faction would tend to dissociate or would no
the world” , “My culture’s beliefs are the most
valid”

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 longer cooperate in the implementation of the because during the patient interview, the doctor
innovation. would ask a lot of questions that would take a
 Vested interest long time. This would cause disappointment to
o Particularly in persons who are interested in the these people wherein when they go to traditional
innovation healers, these healers would already have their
o Changes or innovations which are perceived as ready diagnosis even without asking questions.
threatening to the personal interest of influential o Very common among people in rural areas
people in terms of their wealth or power, the  Different perception of purpose
change would be strongly rejected. o Need to evaluate if the perception of the change
o Ex: Traditional healers, such as hilots, would agents is the same as the
resent health programs because these would perception/interpretation of the targets of change
affect their professional practice. If people are in terms of the purpose and goal of the program
already more knowledgeable, they would tend to o Need to consider also their background
seek consult to medical professionals rather than experiences and their frame of reference
traditional healers. 4. Language difficulties
 Loci of authority within the family  Verbal communication barriers: normal to experience
o In doing health education, you need to identify o Can cause health education concepts to be
first who are the key leaders in the community misinterpreted
and the major decision-makers in the family o Can lead to inferiority among people to the point
because the decisions of the elders (usually the where they will refrain from asking questions
decision makers) are usually followed by the rest  Under this category:
of the family members. Thus, changes that are o Conduct of Demonstration
not approved by the elders will also not be  Ex making ORS
followed by the member.  Make sure that this is being done skillfully
 Loci of authority in the political structure  If difficult, they may not follow
o There are political leaders who may offer 5. Motor patterns
resistance to change if this change would affect  Involves our own traditional way of doing things
their personal interest.  Ex. Bathing, cooking:
o Similar to vested interest, but this time it involves o your patterns in doing these activities become a
a political figure. habit
o A very strong resistance to innovation especially if o This can be rejected
the one resisting change is a politician who is very o Ex. House to house construction of latrines
influential.  People at the start would tend to reject this
o Ex: Years ago, there was a news about a innovation. They would not use these
particular subdivision in Paranaque that didn’t latrines because this has affected their motor
have their own pipe water supply. They were patterns (they are used to squatting when
supplied with water by a company owned by a they are defecating).
congressman. People could not install pipe water  Motivation to change
because it was resisted by that congressman 1. Desire for prestige
since it would negatively affect his business.  Ex. A mother has shifted from brestfeeding to formula
3. Psychological barriers feeding because of the prestige associated with
 Perception of the problem formula feeding (labeled as rich if they can buy milk
o People have different perception of the barriers formula)
depending on their background and experiences. 2. Desire for economic change
o Ex: People in a rural area may see infection not  Most important consideration for people to change
as a health problem, but rather a condition 3. Competitive situation
caused by evil spirit. Because of this they would  Ex. Search for cleanest barangay
not seek consult to a health professional, but  Incentives
would rather go to a traditional healer. 4. Obligation of friendship
 Perception of the role of the government  True if change agent is a friend
o Most problems are being channeled through  People cannot simply say no
government agencies so people may
 People will participate out of friendship and not out of
perceive/suspect that these problems arise from
being convinced of the utility or effectiveness of the
motives of self-serving people.
program
o Ex: as part of election campaigns
5. Play motivation
 Perception of gifts
 People want to have fun
o Most of these health programs and projects are
 People would derive satisfaction in innovations which
given for free – in terms or manpower and
are being implemented as a form of play
resources so people would also perceive the gifts
6. Religious appeal
as without value
o “Ningas kugon” effect  Can also be a motivator
 Differential role perception  Conscious appeal to religious values
o People would sometimes set or attach a set of  If align with their religious aspect, most people would
prescribed behavior in a given situation follow
o Ex: Differences in perception between the doctor
and the traditional healer. People who are used to
the ways of a traditional healer would sometimes
be disappointed when they go to the doctor

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 METHODS OF HEALTH EDUCATION treatment plans, and to cope with problems of
maintenance and relapse
 Health education is done both in the clinical and community  Physician should assess the patient’s knowledge first
setting. and determine what is most important to the patient, and
 Clinical setting: In the form of patient education or pre-patient then start educating at that point
education  Focus: self-management (patient should take
o Patient education responsibility for self-care)
 The patients and their family members are informed  Physician should individualize by determining what is
about their health problems and the need for them to essential, realistic and achievable
participate in the decision making and management of  He can use open-ended questions and probing
their illness questions, which should allow the patient to talk
 Patient education is used in getting informed consent,  Physician must demonstrate a genuine interest in health
giving pretreatment instructions, compliance education education and be willing to invest some personal time if
o Pre-patient education he expects to motivate the patient to participate
 Directed at non-patients or pre-patients o Community setting: use variety of methods
 Education on disease prevention and health promotion  Lecture
 Use brochures, newsletters, magazines, videos, self-  A verbal presentation on a single topic
instructional materials  Can give a large volume of information in a
 Community setting relatively short time, simplify and clarify difficult
o Done as part of a community project material
o Physician should have knowledge of the behavioral  Advantageous when resources are scarce and the
determinants and of the strategies to deal with them, as well information is imparted to a large number of people
as the skills to help people evaluate possible alternatives for  Disadvantage: fosters a passive attitude but can be
action, which may or may not result in any health-related addressed by making it interactive
behavior  A good lecture includes: planning, knowing the
o Facilitation and coordination are important level of one’s audience, and maintaining
enthusiasm
Activities Involved in Health Education  Ensuring good presentation skills- posture,
movement, gestures, eye contact and voice
 Flexibility when the audience is in need of a change
1. Priming
of pace, activity or merely a break
2. Presenting
 Role playing
o Individual patients: informal teaching
 An activity where participants act out a situation and
o Community setting multidisciplinary approach
the facilitator lead the discussion of ideas and
 Lecture
feelings that emerge.
 Role Play
 Used to show the emotional reaction of people
 Demonstration
involved in the situation
 Small-group discussion
 Guide questions must be very clear in order to
 Training
come up with the desired output
3. Probing and Prying
 Demonstration
4. Pinpointing and Pondering
 Used to teach a particular skill
5. Pursuing
 Physician shows the procedure to the participants
and then ask them to do a return demonstration,
Priming
then a feedback is given on what they have just
done
 The introduction designed to establish mood and content and to  Example: administering immunization, and taking
stir the imagination the blood pressure
 Individual patients: physician introduce himself, his purpose and  Small-group Discussion
involve the patient in establishing the goal for the session  An educational process in which a group of 8-10
 Community setting: use icebreakers or energizers which will help people interact with one another to achieve the
introduce participants to each other, foster interaction, illustrate objectives
new concepts or introduce specific materials; requires 5-10 min  Encourages the members of the group to ask
and are simple to implement questions, share experiences, observations and
 E.g. of activities: participants are asked about the topic, insights, and get feedback
participants are asked to describe themselves, storytelling, role  Promotes critical thinking, communication skills and
playing, or sketching relating among the members of the group
 Physician acts as the facilitator, provides a structure
within which the group can discuss the agenda in a
Presenting productive manner, and gives encouragement to
the members of the group
 The main content of the health education  The learning activities must provide opportunity for
 Physician introduces facts and presents information interpersonal interactions, experiential learning,
o Individual patients democratic leadership, and reliance on participants’
 Informal teaching using one-to-one discussion in a face- previous experience
to-face situation  Problems and conflicts within the group should be
 Should begin with the initial visit addressed and processed
 Physician helps his patient to understand and accept his  Tips for Facilitators
illness, to recognize and acknowledge risk behaviors, to  Have a good grasp of the subject matter being
make informed treatment decisions, to develop discussed

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  Encourage sharing of ideas Make the Presentation Visual
 Observe time management
 Address conflicts  Consider how your message is designed to appeal to the senses
 Monitor the discussion of the trainee
 Recognize the contributions of each participants  Use an innovative approach to achieve your objective
 Know your limits  Choose wisely the frequency and variety of your visual aids
 Other Methods
 Mass media: include print and electronic media
Coach and Give Feedback
such as newspapers, radio, TV, film, video, etc.
 Social marketing: health promotion programs that
are developed to satisfy consumer needs  Highly emotional tasks
 Folk media: channels for traditional messages that  In coaching, discuss the task in question
affect folk values and worldview, e.g. literary and  Whether the task is positive or negative, trainees deserve and
theatrical presentations need support , which may be expressed in a show of confidence
 Enter-educate approach: use of entertainment for or a willingness to help
educational purposes  Work with the trainee in making the solution tangible and realistic
 In giving feedback, ask the trainee about areas that he felt he did
Probing ang Prying well and areas he felt he could improve in
 Give the trainee your observations; start with his strengths
 Stretching the mind by asking patients questions followed by his weaknesses
 In a community setting, an open forum helps clarify things not  Make sure that the feedback is specific and behavioral
understood
HEALTH EDUCATION PLAN
Pinpointing and Pondering
 Components
o Objectives
 This is the summary and conclusion wherein the physician or
o Content
facilitator highlights the key points of the health education
o Learning activities
program
o Resources
o Evaluation
Pursuing
Objectives (Should be SMART)
 This is the task to be done after the session
 Ask individual patients to do what was stated in the expected  Should describe the behavior which the educator hopes to
outcome observe (health-consciousness, self-awareness, knowledge,
 In the community setting, assignments may be given attitude change, decision making, behavior change, and social
change)
TRAINING OF HEALTH WORKERS  All health education programs seek to improve the learners’
knowledge and attitudes in a way that will improve their health
 Guidelines behavior, and eventually their health status
o Set definite goals  Ideally, needs assessment should be done first (includes
o Describe the approach to training identifying risks and establishing priorities) before formulating the
o Make your presentation visual objectives
o Coach and give feedback
Content
Set Definite Goals
 Should be congruent with the objectives
 Goal setting focuses the direction of the trainees  Should be organized for easy comprehension
 This gives them the “road map” of what to expect and reduces
the chances of aggressive behavior Learning Activities
 Example:
o To demonstrate how to get the blood pressure  Must take into consideration the following:
o To distinguish a normal from an abnormal blood pressure o Nature of the content (objectives)
 If objective calls for learning of simple facts : lecture or
Describe the Approach to Training handouts
 Complex task: group discussion
 Give the trainees a better idea of how you expect to achieve the  Psychomotor skill: hands-on experience
goals  Affective: role-playing and values clarification activities
 This includes the what and the how; the what is the content, the o Characteristics of learners
how is the process or teaching method  Audience is literate: lecture or discussion
o E.g. (what) ‘To accomplish this, I will give an overview of the  Audience has no previous knowledge or experience
parts of the sphygmomanometer. Then I will discuss what is regarding the topic: film-showing
normal and abnormal blood pressure’ o Instructor ability
o E.g. (how) ‘I will start with a mini-lecture for the overview. A  Must seek ways to be effective in the dissemination of
demonstration will follow. Then it is your turn to do the task. I information
will give you feedback on the task.’ o Available materials

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  Use materials that are readily available and less  Review medical records, give treatment algorithm, and
expensive behavior strategies
o Use language understood by the patient and his family
Resources  Psychomotor skill: hands-on experience
 Use layman’s terms and not medical jargons
 This is the task to be done after the session  Employ specific rather than general instructions
 Include facilities, equipment, budget and manpower  Give examples
 Speak in the patient’s dialect
 Various forms of instructional media such as handouts,
audiovisual aids, computer  Summarize and check for patient’s comprehension
o Facilitate learning through a variety of methods
 Educational aids should be appropriate to the learning objectives
 Can use other techniques aside from lecturing or
and should be utilized appropriately
advising: games, interactive sessions, visual aids, etc.
 Example objective: To demonstrate how to get the blood
o Enlist the reinforcement of social support
pressure; best resource: sphygmomanometer
 Invite family members to participate in the discussion
 Printed materials can be used to create awareness, provide and the treatment process
factual information or reinforce or review key points  In the community setting, involve the existing support
 Two types: groups
o Prescriptive: usually given by a physician to a patient with a o Evaluate change and give feedback
specific goal in mind, which is triggered by the onset of a  Schedule a follow-up appointment to verify the diagnosis
medical problem  Evaluate patient’s progress and give feedback
 E.g. for a patient with asthma, a brochure on the nature
and course of the disease and how to use an inhaler
SOURCES
may be given
o Nonprescriptive: given to patients to freely read while
waiting for consultation; they are more of goal and topic-  Doc’s notes
oriented printed materials  Module on Public Health Education. UP College of Public Health.
 E.g. brochures on STD’s, basic food groups in nutrition  The Filipino Physician Today. 2nd ed. Eva Irene Yu-Maglonzo,
M.D., FPAFP, MHPed
Evaluation  MAM Trans
 Zoom Recording
 Involves finding out how much learning has taken place based on
the objectives
 Must be done at the end of learning events, at key points in a
group at least once a month, or at regular times a year when
doing a project
 Done to assess if the activity had been a success, assess
weaknesses of the activity, and to clarify what needs to be
changed or strengthened
 Results must be fed back to the members of the group
 Techniques/methods include: written examinations (pre- and
post-test), oral interviews, group discussions, survey, and
anecdotal records

THE PHYSICIAN AS A HEALTH EDUCATOR

 There is no specific personality or set of characteristics that

typifies a health educator
 Most health educators are greatly interested in health, in health
behavior, and in education
 The physician is the role model of the patient; if the physician
advises the patient against smoking, he must not smoke too
 Basic Principles:
o Establish rapport with the people
 Effective communication will facilitate patient
understanding, satisfaction and cooperation
o Assess the patient’s beliefs and perceptions about the
illness
 Physician must ask the patient what he thinks of his
illness, what his concerns and fears are, what results he
hopes to receive from treatment
 He should provide explanations for the causes,
symptoms, pathophysiology and management of the
patient’s illness, including cost
o Actively involve the patient in the decision-making
process
 After explaining to the patient the nature and the
management of the illness, the physician should give
therapeutic options

CPU College of Medicine | Revised by: Victores Valetudinis | 2022 Page 10 of 10