Principles of health education

Before moving to principles of health education, we shall see some basic definitions i.e. Health & Education. Health is defined as a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity (WHO1948). During earlier years health was considered as a biological phenomenon, at that time other two factors which were totally ignored. Absence of disease or infirmity was considered to as health. The definition of education which is in common usage, that education is merely the delivery of knowledge, skills and information from teachers to students, it is inadequate to capture what is really important about being and becoming educated. In other words education can also be defined as a process of cognitive cartography, mapping your experiences and finding a variety of reliable routes to optimal states when you find yourself in non-optimal states. So what is meant by health education? Health education is defined as the principle by which individuals and groups of people learn to behave in a manner conducive to the promotion, maintenance, or restoration of health. The three primary aims of health education are defined as: to make health a valued community asset, to equip the individual with knowledge and skills that will help him to solve his own health problems, and to promote the development of health services. It hopes to motivate them with whatever interests they may have in improving their living conditions. It develops a sense of responsibility in people for health conditions related to themselves as individuals or members of communities. We know that education is never an one time affair, it is a continue process. Same is the case with health education. It is required by almost each & every person throughout the different stages of life. Health education can be an initiative from individual himself or from some other individual who has better knowledge about the health, its preservation or restoration. All the theories of education & learning are fully applicable in Health education. Main aim of health education is to spread knowledge about how to preserve health & when health is not in equilibrium state then how to restore it? Health education is not like regular medical teaching done to the undergraduate or post graduate medical students, nurses or para-medicals etc. Health education is not only concerned with communication of information, but also with fostering the motivation, skills & confidence necessary to take action to improve health. So, Health education is an essential component to improve the health of a community.

Some of the principles of health education are as follows:

1. Purpose of the health education is to ensure a desired health related behavior. If the education is without purpose then people will not be interested in it. So health education programme should always be decided with involvement of community. Health educations should be decided on need based approach of community. If need based approach is not followed then there are chances of wastage of human efforts, monetary resources etc. For eg. As we know Tribal population is more prone to Sickle Cell Anemia, the health educating campaigns should be more active in tribal areas, if those ran in urban areas then very few people will show interest. It is need of community that there should be a health education programme related to sickle cell disease in tribal region. As in tribal region there is high illiteracy so people dont know about the spread of disease, disease carriers etc. people should be told about who is carrier? What are the chances of child having Sickle cell anemia if couple getting married is a carrier couple, what will be its consequences? Information regarding Sickle cell disease should be explained to tribal people through health worker or Doctors at PHC. Then the change in behavior can be observed, whether the marriages between carriers are reduced or not?, are people willing to perform the blood solubility test before getting married ? From this we infer whether Health education which we are providing is beneficial to the community or not, Whether it is having its intended effect? When changes are seen in behavioral pattern then we can definitely say that Health education is having its desired effect. 2. Health education should not be just like formal teaching or training programme, it should be interactive. In Health we just cant give training to people & move away with expecting them to follow everything which we have told or asked them to do. If as health education trainer we are not involving the target population then the result of session wont come positive. People will just listen to session but we cant tell whether there will be a behavioral change. But when trainer involves people with

interactive session then people take interest & they come to know why & how the session is important for them? They tend to follow the changing pattern. For e.g. in case of diarrheal disease of infants when mothers are asked to give the ORS to children then most of mothers dont know how to prepare the ORS. So when health worker gives training to them about preparing ORS just like reading instruction manual then mothers wont be able to understand much. But if there is a health trainer gives proper demo to the women with all required material to prepare ORS then women will understand it better. Suppose the health trainer teaches with 1 standard glass, 1 liter bottle, 1 standard spoon & 1 packet of ORS sachet, showing how to mix ORS in water then definitely women are going to understand better. Health worker should also involve women in making ORS. That will give them better understanding. Learning by doing is very successful, especially when communities can be stimulated to improve local conditions & achieve behavior change. 3. Health issues should be properly discussed with community & when finding out a solution both positive as well as negative sides of the solution should be properly explained to the community. It should not be just only emphasizing on positive outcomes. For e.g. In case of OCP(oral contraceptive pills) the health educator should tell the user about how t o use the pills, what will be its benefits. But a good health educator should always tell that what can be possible side effects or ill effects of taking OCP for longer duration or discontinuing in between. In case of immunization, the community should be given proper instruction about what are the benefits of immunization, but at the same time they should also be informed about AEFI i.e. Adverse Effects Following Immunization. Health worker should not just focus on positive aspects, but she can tell about negative aspects also & how to counter them. 4. Friendly & sympathetic approach of health provider. Health providers behavior plays an important role in health education. If provider conveys the message related to health in friendly manner then community will definitely accept it in better manner.

For e.g. In medical practice it is always observed that patients necessarily dont go to the doctor who is very highly qualified. Patients always prefer doctor who spends some time with them, explains them what is their disease, what precautions are to be taken?, shows them some friendly attitude. Sometimes it is observed that there is always rush of patients in particular hospital & the other nearby hospital is having very few patients, why this happens? When patient gets admitted in hospital his main points of contact are nurses, paramedical staff, helpers etc. It is generally observed that these people behave rudely with patients. If they work in friendly & sympathetic manner then it makes a lot of difference to the patient & his relatives who are mentally & emotionally disturbed. So nowadays many of the corporate hospitals are working on this aspect, there are HR development & soft skill training programmes being run for the staff. Health education is mainly related to behavioral change. If the person who is telling about health education is not showing any involvement & just dictating it mechanically then the target population will not be showing any attachment to the educator, which will finally result in failure of health education programme. But if the educator is very friendly & sympathetic then target population shows attachment to the person. Population listens to that person & tries to follow what the educator has told. Its just a small behavioral change on the part of health provider which will give miraculous outputs. 5. Two way communication is necessary. Health provider should never be autocratic. He should be open to ideas. Proper feedback is necessary to implement the health education. Educator should always know whether people are getting the essence of health education. For e.g. when monthly/quarterly meeting of ASHA happens at PHC the medical officer should not only give them directions for health education of community but also ask them what they have understood from the meeting? MO should clear their doubts, ask for their suggestions on some issues. This will give them some sense of ownership of the system.

6. Acceptance of Health educator into the community. Health educator will be able to produce the results only when he is accepted by the community. Sometimes health educator needs to win the confidence of the community first then only he is able to do his work of health education. For e.g. For better results in health educational strategy the educator should be from the community itself, which will give the people a sense of belief. This type of strategy is seen in selection of ASHA & we have seen how ASHAs are easily accepted by communities. Compatibility of ASHA with community is more than ANM, MPWs because she is form the community & most of the times ANM, MPW come from outside. So ASHAs are able to produce excellent results in behavioral changes of rural population, they are doing the role of enabler than the teacher. 7. Health educator should lead by example. Health educator is expected to follow what he is telling to others. If it happens then it makes a greater impact. It sets the example for community. For e.g. If a doctor tells a patient not to smoke & doctor himself is a smoker then it is not going to create an impact on patient. In this case doctor has lost his credibility or he has lost his moral right to guide the patient to not smoke. 8. Adjusting with target population. Health educator should adjust to the community which he is going to serve, otherwise the community may not accept him at all. For e.g. If a person from upper class of society is going to community of poor people for the purpose of health education then the educator should not be dressed like rich person, he should wear simple clothes, he should talk their local language, when in community person should not carry bottles of drinking water. So basic reason behind telling all this is, educator should not by any chance through his behavior indicate that the community in which he is working is inferior to him because, that causes a sense of discrimination in community. So it is a must that health educator should adjust to the community & try to become part of it, then & then only community will be ready to accept health education from him.

9. Use of all possible methods for health education. Health educator should have basic knowledge of his subject & should know how to teach people about health educational behavior change. Use of various methods by educator will depend on what population he is addressing. For e.g. educator should be wise enough to use various methods according to the status of the population. If he is involved in training illiterate people then he should understand that use of pictorial or audiovisual instruments will be beneficial. If possible in these groups the educator should have interpersonal communication. If educator is dealing with literate people then the use of pamphlets will be more beneficial. Here educator to group communication sessions can be used. When there is need to communicate large population regarding health education then use of electronic or print media can be done. 10. Planned health education will be more fruitful. For bringing out change in community the health education should be a planned intervention. Health educators should have proper training about what they will be teaching in community? How they will be doing that? What instruments they are going to use for that? If health education is unplanned then there are chances that the efforts put by educators will be wasted. For e.g. AHSAs, ANMs should be properly trained to deliver the health education message. For that they need to get timely training. As in one of the points we have discussed that educator should tell the beneficiary about positive & negative both the aspects of the health intervention. Suppose if ASHA is not properly trained to emphasize on positive aspects of the immunization, then she will just tell both the aspects to the beneficiary. Then person will not be interested in getting his child immunized. So it is of primary importance that health educator should be trained in such a manner that he should be able to focus on positive aspects. If we want to use printed material for health education then it should be properly planned that where it should be displayed, at what timings it should be displayed? If we are using electronic media for health education then prior planning should be done about timing of display, channel of display etc. for e.g. advertisements for condoms or i-pills cant be telecasted on childrens channels like Pogo or Cartoon Network. It doesnt make any sense. In spite of that those ads

should be telecasted on news channels or other national channels. So planning becomes an important part of health education. 11. Use of simple language & non-technical terms. Language used by health educator should be very simple to understand for common people. He should not use any technical term which cause problem to the people or not easy to make it understand to the beneficiary. Community is never interested in too much of technical knowledge, it only takes out what is beneficial for it. For e.g. If health educator tells that malaria occurs due to female anopheles mosquito then the common people dont have any specific significance for that, for them malaria is caused by mosquito. There is no use of giving knowledge to the community which is not useful for them. To give extra knowledge is not also a wise move, as community is going to use only some part of that. So its always better to give only that much knowledge with which community requires or what basic. At a single time too much of information should also not be infused into peoples mind. In that case sometimes it happens that they are not able to retain anything. 12. Waiting for desired results. Health education has its ultimate goal to bring about the desired change in health related behavior & practices. Any attempt of making drastic or quick change is going to fail, change is a slow procedure & when it happens in its own way then its sustainable. Sometimes what the health educator tells is in contradiction with current culture then it is opposed from community. In such cases health educator should not lose the hope & continue to work. He should always focus on right thing. *******************************