Contents and Models in Health Education + IEC in Health Education

MODELS OF HEALTH EDUCATION

1. Medical Model

• Most health education in the past relied on knowledge transfer to achieve behaviour changes.
• The medical model is primarily interested in the recognition and treatment of disease (curing) and technological advances to facilitate the process.
• It is concerned with disease (as defined by the doctor) as opposed to illness (as defined by the client).
• Originally, health education developed along the lines of bio-medical views of health and disease.
• Emphasis was on dissemination of health information based on scientific facts.
• The assumption: people would act on the information supplied by health professionals to improve their health.
• Social, cultural and psychological factors were thought to be of little or no importance.
• The medical model did not bridge the gap between knowledge and behaviour.

2. Motivation Model

• When people did not act upon information received, health education started emphasizing "motivation" as the main force to translate health information into desired health action.
• The adoption of a new behaviour or idea is not a simple act - it is a process consisting of several stages through which an individual is likely to pass.

1. Awareness - Individual first gets general information about the subject. Public information programmes create awareness of health needs and problems.
2. Motivation - Includes stages of:
   • Interest - individual seeks more detailed information about usefulness, limitations or applicability of the new idea.
   • Evaluation - evaluates social, psychological, economic aspects of information received, possibly by consulting others - a mental exercise leading to decision-making.
   • Decision-making - decides whether to accept or reject the new idea/programme/proposal. Interpersonal communication (friends, kinship groups, technical persons) is vital here.
3. Action/Adoption - The new idea or acquired behaviour becomes part of his own existing values - this is called internalization.

• The stages are not necessarily rigid; there may be skipping of stages.
• In the same community, people may be in different stages of the adoption process.
• Effective communication strategy should be evolved to help the individual pass from one stage to another.

3. Social Intervention Model

• The public health problems facing us today are so complex that the traditional motivation approach is insufficient to achieve behavioural change (e.g., reducing smoking, adoption of small family norm, raising the age of marriage, elimination of dowry).
• The motivation model ignored the fact that in many situations, it is not the individual who needs to be changed but the social environment which shapes behaviour.
• People will not readily accept something new until it has been "legitimated" (approved) by the group to which they belong.
• Most people prefer to do only things commonly done by their group.
• Adoption of new ideas (e.g., vasectomy, loop insertion) is facilitated if there is group support.
• This gave birth to the social intervention model - an effective model is based on precise knowledge of human ecology and understanding of interaction between cultural, biological, physical and social environmental factors.

CONTENTS OF HEALTH EDUCATION

Since health education has a limited impact when directed from general education, most of the needed information must be integrated into the educational system (books, classroom material, etc.) with the young population as the principal target.

1. Human Biology

• Understanding health demands an understanding of human biology - structure and functions of the body.
• How to keep physically fit: need for exercise, rest and sleep.
• Effects of alcohol, smoking and drugs on the body.
• Cultivation of healthy lifestyles.
• Reproductive biology is another area of current interest.
• UNICEF's "State of the World's Children Report 1989" drew up a basic list of health information every family has a right to know: child spacing, breast-feeding, safe motherhood, immunization, weaning and child growth, diarrhoeal disease, respiratory infections, house hygiene.
• Best place to teach human biology is the school - only the school, through its sequential health curriculum, can provide continuous in-depth learning experiences for millions of students.

2. Nutrition

• Aim: guide people to choose optimum and balanced diets, remove prejudices and promote good dietary habits - not to teach the familiar jargon of calories and biochemistry of nutrients.
• Nutritional problems such as: ignorance about value of breast feeding beyond first year, misconceptions about proper weaning, ignorance of appropriate diets for infants and pregnant women, traditional food allocation patterns within families - all can be best solved by nutrition education.
• In recent years, link between dietary habits and chronic diseases of middle age (obesity, diabetes, cardiovascular diseases) has been established.
• Nutrition education is a major intervention for prevention of malnutrition, promotion of health and improving quality of life.

3. Hygiene

• Personal hygiene: promote standards of personal cleanliness - bathing, clothing, washing hands after toilet, care of nails/feet/teeth, spitting, coughing, sneezing.
• Environmental hygiene: proper lighting and ventilation, hygienic storage of foods, hygienic disposal of wastes, need to avoid pests, rats, mice and insects.
• In developing countries, emphasis is on improvement of basic sanitary services: water supply, disposal of human excreta, other solid/liquid wastes, vector control, food sanitation and housing.
• Poor sanitary practices have roots in centuries-old customs, styles of living and habits - not easily altered.
• An environmental sanitation programme should include health education. It is not enough to provide sanitary wells, latrines and waste collection facilities - people must be educated to use them.

4. Family Health

• The family is the first defence as well as chief reliance for well-being of its members.
• Health largely depends on the family's social and physical environment, lifestyle and behaviour.
• One of the main tasks of health education is to promote the family's self-reliance, especially regarding: childbearing, child rearing, self-care, and influencing children to adopt healthy lifestyles.

5. Disease Prevention and Control

• Drugs alone will not solve health problems - without health education, a person may fall sick again and again from the same disease.
• Experiences of western countries show the role of education in eradication of cholera, typhoid, malaria and tuberculosis.
• Education of people about prevention and control of locally endemic diseases is the first of eight essential activities in primary health care.
• Several national public health programmes are in operation to eradicate diseases such as malaria, tuberculosis, leprosy, filaria, goitre, etc.
• Experience of malaria eradication has indicated that anti-malarial spray with insecticides cannot solve the problem without health education.

6. Mental Health

• Mental health problems occur everywhere; they become more prominent when major killer diseases are brought under control.
• Prevalence of mental diseases increases during change from an agricultural to an industrial economy, and when people move from village communities to isolation in big cities.
• Aim: help people to keep mentally healthy and to prevent a mental breakdown. People should enjoy relationships with others and learn to live and work without mental breakdown.
• Special critical situations when mental health is of great importance: mother after childbirth, child entering school for the first time, student entering secondary school, deciding on future career, starting a new family, at the time of widowhood.

7. Prevention of Accidents

• Accidents are a feature of the complexity of modern life.
• Accidents occur in three main areas: the home, road and the place of work.
• Safety education should be directed to these areas.
• Management must provide a safe environment and promote general order and cleanliness.
• The predominant factor in accidents is carelessness and the problem can be tackled through health education.

8. Use of Health Services

• Many people, particularly in rural areas, do not know what health services are available in their community, and many more do not know what signs indicate a visit to the doctor is necessary.
• Public attitude towards health services is still apprehensive.
• There is a communication gap between the public and the state health administration in the form of "feedback" for further improvement of health services.
• One declared aim of health education is to inform people about available health services (e.g., screening programmes, immunization, family planning services) and how to use health care resources.

IEC IN HEALTH EDUCATION

Principles of Health Communication (IEC Principles)

1. Credibility - The message must be perceived as trustworthy by the receiver. Good health education is based on facts - consistent and compatible with scientific knowledge and also with local culture, educational system and social goals. Unless people have trust and confidence in the communicator, no desired action will follow.
2. Interest - People are unlikely to listen to things which are not to their interest. Health teaching should relate to the interests ("felt needs") of the people. Health slogans such as "Take care of your health" or "be healthy" are useless. Health educators must find out the real health needs ("felt needs") of people. If a health programme is based on felt needs, people will gladly participate.
3. Participation - Key word in health education. Based on psychological principle of active learning. Health education should aim at encouraging people to work actively with health workers in identifying their own health problems and developing solutions. A high degree of participation creates a sense of involvement, personal acceptance and decision-making. The Alma-Ata Declaration states: "The people have a right and duty to participate individually and collectively in the planning and implementation of their health care."
4. Motivation - In every person, there is a fundamental desire to learn. Awakening this desire is called motivation. Two types of motives:
   • Primary motives (sex, hunger, survival) - inborn driving forces.
   • Secondary motives - based on desires created by outside forces (praise, love, rivalry, rewards, punishment, recognition).
   • Positive incentives (carrot) and negative incentives (stick).
   • Motivation is contagious - one motivated person may spread motivation throughout a group.
5. Comprehension - Must know the level of understanding, education and literacy of people to whom teaching is directed. Communicate in the language people understand. Never use words which are strange or too technical.

Audio-Visual Aids in IEC

• (a) Non-projected - Charts, posters, flashcards, flannel-graphs, blackboard, models, specimens, photographs.
• (b) Requiring projection - Slides, film strips.

A knowledge of the advantages, disadvantages and limitations of each audio-visual aid is necessary for proper use. Audio-visual aids are means to an end, not an end in themselves.

Methods of Health Communication

• Personal contact
• Home visits
• Personal letters

• Lectures
• Demonstrations
• Discussion methods (group discussion, panel discussion, symposium, workshop)

• Panel discussion: 4 to 8 qualified persons sit and discuss a given problem in front of a large audience. A chairman/moderator opens and guides discussion. After main aspects are explored, the audience is invited to take part.
• Symposium: A series of speeches on a selected subject. Each expert presents one aspect briefly. No discussion among members (unlike panel discussion). Audience may raise questions at end.
• Workshop: A novel experiment for intensive group study of practical problems.

1. Newspapers and magazines - Widest coverage; but health articles must be written by trained communicators with language appropriate for the target audience.
2. Radio - Reaches large, illiterate audiences; effective for rural populations.
3. Television - Most powerful mass medium; combines audio and visual.
4. Films - Effective for reaching large audiences; entertainment value enhances retention.
5. Posters - Widely used; but indiscriminate use by pasting on walls serves no useful purpose. In health education, posters have much less effect in changing behaviour than enthusiastic users would hope.
6. Exhibitions and Health Museums - If properly organized, can attract large numbers. Photographic panels attract more persons than graphic panels. 3D models with lighted visuals are even more effective than photos. Offer a package of both personal and impersonal methods of communication.
7. Folk Media - "Mass communication" includes not only electronic media but also folk (indigenous) media such as keerthan, katha, folk songs, dances and dramas and puppet shows which have roots in Indian culture. Muslims have traditional folk forums like ghazals and qawwali.

"The mass media are only instruments. As such they are neither good nor bad; what matters is the message they carry and the way the message is delivered."