METTU UNIVERSITY

Faculty of Public Health and Medical Sciences

Department Of Public Health

Health Education Module

For Summar Public Health Students

Writter

 Ebissa Negera (BSc, MPH)

Content Editor

 Muluneh Shuramu(BSc, MPH)

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 English Editor

 Tayimu Balango(BA,MA)

January, 2016

Mettu University, Ethiopia

MODULE DESCRIPTION

This module is considered as a pre-requisite supporting course for

CBTP I, and TTP. The module is designed to equipe students with
knowledge and skills needed to plan and implement health teaching
for individual patients or groups of clients in any setting to bring the
necessary health behaviors. This module is a prerequisite for team
training program and clients teaching. Module contents include
introduction, definitions, communication, planning, teaching aids,
and research in health education as well as evaluation methods.

Module Objectives

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By the end of the Module the student will be able to:

1. Explain the objectives and basic principles of health education

2. Described the role and the characteristics of health education in
PHC
3. Describe the health education policy of the country
4. Define the role of human behavior in health
5. Explain the basic characteristics of individual and group
behavior and behavioral changes
6. Describe the concept and principles of community participations
7. Explain the principles of communications leadership in health
care organizations
8. Describe the major issue and approaches to research in health
education.

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 TABLE OF CONTENTS
MODULE DESCRIPTION.........................................................ii
Module Objectives......................................................................ii
TABLE OF CONTENTS...........................................................iii
UNIT ONE: INTRODUCTION TO HEALTH EDUCATION...1
1.1. Introduction.......................................................................1
1.1. Definition and concepts of health......................................2
1.1.2. Health...........................................................................2
1.1. 3. Health Education.........................................................4
1.1.4. Health Promotion.........................................................5
Elaboration of the definition:...................................................5
Health promotion employs two approaches .These are;........5
1.1. 5. Health Information......................................................6
1.2. Rationale for health education...........................................7
1.3. The ultimate goals and educational objectives of health
education..................................................................................7
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 [Link] of health Education.........................................7
1.5. Basic assumptions and principles of health education.......8
1.6. Targets of health education..............................................10
1.7. Health education settings.................................................10
1.8. The role of health education and promotion in Primary
Health Care.............................................................................12
1.9. Who is responsible to provide health education?.............13
1.10. Challenges to the process of health education...............13
Unit summary...........................................................................14
Exercise.....................................................................................15
References.................................................................................15
UNIT TWO: HEALTH AND HUMAN BEHAVIOR..............16
Unit objectives.........................................................................16
2.1. Introduction.....................................................................16
2.2. Behavior definition..........................................................16
2.3. Behavior components......................................................17
2.4. Factors affecting human behavior....................................17
2.4.1. Predisposing factors...................................................17
2.4.2. Enabling factors.........................................................18
2.4.3. Reinforcing factors.....................................................18
2.5. Changes of Behavior........................................................18

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 2.6. Behavior change approaches...........................................18
2.7. Types of health behaviors................................................19
Unit Summary...........................................................................20
Exercise.....................................................................................20
References.................................................................................21
UNIT THREE: THEORIES AND MODELS OF BEHAVIOR
CHANGE..................................................................................22
3.1. Introduction.....................................................................22
3.1. 1. What is theory?.........................................................22
3.2. What are Models?............................................................22
3.3. Community theories........................................................29
Unit Summary...........................................................................33
Exercise.....................................................................................34
References.................................................................................35
UNIT FOUR: HEALTH COMMUNICATION........................36
4.1. Introduction.....................................................................36
4.1. 1. Definition..................................................................36
4.2. Relevance to Health Education........................................37
4.3. Principles of communication...........................................37
4.4. Components of communication.......................................38
4.3.1. Source (sender)...........................................................38

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 4.3. 2. Receiver/audience.....................................................38
4.3.3. Message......................................................................38
4.3.4. Channel......................................................................41
4.3.5. Effect & feedback.......................................................41
4.4. Communication process...................................................42
4.5. Message distortion in communication process................43
4.6. Communication stages.....................................................43
4.7. Communication models...................................................45
4.8. Types of communication.................................................46
4.9. Barriers to effective communication................................52
4.10. Inconsistencies between verbal & non- verbal
communication.......................................................................53
4.11. Main characteristics of effective communication..........53
Unit summary...........................................................................54
Exercise.....................................................................................55
References.................................................................................55
UNIT FIVE: TEACHING METHODS AND MATERIALS. . .56
5.1. Introduction.....................................................................56
5.2. Some prerequisites for putting educational methods into
practice...................................................................................57
5.3. Teaching methods............................................................58
5.3.1. Heal talks....................................................................58
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 5.3.2. Lecture.......................................................................59
5.3.4. Lecture with discussion..............................................60
5.3.5. Group discussion........................................................60
5.3.6. Buzz group.................................................................61
5.3.7. Brainstorming.............................................................61
5.3.8. Demonstration............................................................62
4.3.9. Role-play....................................................................63
5.4. Health Learning Materials (HLMs).................................65
5.4.1. Types of health learning materials.............................66
5.5. Visual health learning materials......................................70
5.5.1. Real objects................................................................71
5.5.2. Models..........................................................................71
5.6. Audio Health Learning Materials....................................72
5.7. Audio visual Health Learning Material...........................72
5.7.1. Projected materials.....................................................72
5.7.2. Over head projectors (OHP).......................................73
5.8. Traditional means of communication (“Popular art
forms”).................................................................................74
Unit summary...........................................................................75
Exercise.....................................................................................76
References.................................................................................76

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UNIT SIX: GROUP DYNAMICS............................................77
6.1. Types of groups...............................................................77
6.2. Health Team....................................................................83
6.2.1. Why do we need teamwork?......................................83
6.3. How to establish good relationship with the community. 84
6.3.1. Leading a health Team...............................................84
6.4. HIV /AIDS Related Issue in Health Education
(Introduction, Counseling, Prevention and Control................86
Unit Summary...........................................................................87
Exercise.....................................................................................88
References.................................................................................88
UNIT SEVEN: HEALTH EDUCATION PLANNING............89
7.1. Introduction.....................................................................89
7.2. Some of the Most Common Health Education Planning
Models....................................................................................90
1. Comprehensive Health Education Model..............................90
2. Model for Health Education Planning...................................91
3. Model for Health Education Planning and Resource
Development.............................................................................91
4. Generic Health/Fitness Delivery System..............................93
5. Community Wellness Model.................................................93
6. PRECEDE-PROCEED Model..............................................94
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7. THE PEN-3 MODEL............................................................96
8. APEXPH and PATCH..........................................................98
9. Formative Evaluation, Consultation, and Systems Technique
................................................................................................100
Unit Summary.........................................................................100
Exercise...................................................................................100
References...............................................................................101
UNIT EIGHT: RESEARCH METHODS IN HEALTH
EDUCATION.........................................................................102
8.1. Introduction...................................................................102
o There are two major types of researches quantitative &
qualitative types. The former type of research is descriptive in
its nature, objective, & deals with measurable behavior &
attitude....................................................................................103
8.2. Comparisons of qualitative and quantitative research....103
8.3.K. A. P. Surveys.............................................................104
8.3.1 How to develop KAP questionnaire..........................104
8.3.2. Critique of KAP studies..............................................105
8.4. Basic Techniques of Data Collection.............................105
Unit summary.........................................................................105
Exercise...................................................................................106
References...............................................................................106

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 UNIT ONE: INTRODUCTION TO HEALTH
EDUCATION

Unit objectives

At the end of this chapter the students are expected to:

o Define health
o Differentiate among health education on and health
promotion.
o Discuss t he rationale of health education
o Explain the ultimate goals and educational objectives of
health education.
o List principles of health education.
o Describe levels of health education in diseases prevention.
o List the settings of health education
o Explain the role of health education in Primary Health Care
o Mention some of the challenges to the practice of health
education

1.1. Introduction

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Health education is a part of health care which are concerned
with promoting healthy behaviors. It is through health education
we help peoples to understand their behaviors and how it affect
their health and encourage them to make their own choices for
healthy life.
Health education is one of components of primary health care
and plays paramount roles in achieving the goal health for all.
Many people use health education and health promotion
interchangeably. However, there are differences in their concept
and application, and many authors provide different definition of
health education and health promotion. In this unit the concept
of health education and other related terms are described. The
unit mainly focuses on the ultimate goals and objectives of
health education, its scope, dimensions, the basic working
principles which guides the planning, implementation and
evaluation of health education activities and its role in primary
health care.

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1.1. Definition and concepts of health

Before looking at the definition of health education, it is helpful

to discuss the definition of health and related terms.

1.1.2. Health

Health is a very abstract concept to conceptualize and measure

and it is too difficult to put in words. It is a broad concept and its
definition also differs among social classes, cultures, religion
and ethnic groups. Generally, there are two opposing models
concerning the definition of health:
I. Negative (narrow) model
II. Positive (broad) model
I. Negative model
This model views health as:
o Absence of diseases or disability or infirmity
o Biological integrity of the individual
o Physical and physiological capabilities to perform
routine tasks.

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  According to this definition individual is healthy if all the
body parts; cells, tissues, organs, organ systems are
functioning well.
 The human body is often thought of in the same terms as a
car or other mechanical devices when something wrong
you take it into experts who put it right. Doctors tend to go
along with this idea and are keen on active intervention
with drugs or surgery rather than educational intervention
to change behavior
 Despite its narrowness, it is a widely held view among lay
people by equating health with the absence of diseases.
Disease “A” + Medical treatment health
II) The positive model
 It is broader and more holistic concept. Probably the most
widely known of such models is that of the constitution of
World Health Organization (1948), which defines health,
as: “A state of complete physical, mental, and social
well-being not merely the absence of disease or
infirmity.” This classic definition is important, as it
identifies the vital components of health. To more fully

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 understand the meaning of health, it is important to
understand each components of health
1. Physical health
o It is the absence of diseases or disability on the body
parts (negative definition).
o It is the biological integrity and the physiological well
functioning of the human body
o It is the ability to perform routine tasks without any
physical restriction.
2. Mental health
o Termed as psychological health by Goldstadt, etal,
1987, and it is subjective sense of well being.

It has two major components:

A) Cognitive component
o It is the ability of an individual to learn, perceive and, think
clearly. E.g. A person is said to be mentally retarded if
he/she cannot learn something new at a pace in which an
ordinary person learns.
B) Emotional component

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 o Is the ability of expressing emotions (e.g. fear, happiness,
and to be angry) in an “appropriate” way. Appropriate here
is to emphasis that the response of the body should be
congruent with that of the stimuli.
o It is the ability to maintain one’s own integrity in the
presence of stressful situations (tensions, depression and
anxiety). E.g. if somebody gets into coma during an
examination.
3. Social health
o Is the ability to make and maintain “acceptable” and
“proper” interaction and communication with other people
and the social environment; satisfying interpersonal
relationship and role fulfillment. For example, to mourn
when close family member dies, to celebrate festivals, to
create and maintain friendship etc.
o Mahler extends the WHO definition; accordingly he
defined health as;
o “The ability to lead socially and economically
productive life” and he come up with five components of

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 health by adding the concept of emotional health and
spiritual health.

Emotional health –the same definition as WHO; but put as

separate component.
Spiritual health
o It is also called personal health and is a reflection of self-
actualization.
o It is a relation of health with religion or cultural values and
beliefs and is a way of achieving mental satisfaction in
stressful or in other ill- health conditions.
o A number of years after the writing of the WHO definition,
Hanlon (1974) defined health as
o “a functional state which makes possible the achievement
of other goals and activities.” And more recently, the WHO
(1986) has restated that “health is a resource for
everyday life, not the objective of living.” In other words,
good health should not be the goal of life, but rather a
vehicle to reach one’s goal in life.

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 o Despite it is said a broader paradigm as to what health;
different scholars criticize this (WHO) definition.

Activity
1. What is difference between positive and negative
definition of health?
2. Is WHO definition of health holistic? Why?
3. Explain the relationship between mental health and
physical health?
4. Suppose Mr. “X” was not celebrating on new Ethiopian
millennium (meskerem 1) while all of his neighbors did so.
Can we say Mr. “x” is healthy? Why?

1.1. 3. Health Education

“Any combination of learning experiences designed to

facilitate voluntary action conducive to health”
Elaboration of the definition:-
o Combination: it emphasizes on the importance of
matching multiple determinants of behaviors with
multiple learning experiences or educational
intervention
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 o Designed: distinguishes health education from
incidental learning experiences as a systematically
planned and organized activity.
o Facilitate: creating favorable condition such as
predispose, enable, reinforce.
o Voluntary: with full understanding and acceptance of the
purpose of the action. Without use of coercion or any
manipulative approaches. In health education we do not
force the people to do what we want them to do, instead our
effort is to help people to make decisions and choices by
themselves.
o Action: behavioral steps/measures taken by individuals,
groups or community to achieve the desired health effect.

1.1.4. Health Promotion

o To reach a state of complete physical, mental and social

well being it is beyond the activity of health education and
even health sectors. In other words health is not just the
responsibility of health sector alone. But the responsibility
of every sectors working for development .Thus, the

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 concern for health outside to the healthcare sector is the call
for health promotion
o GREEN AND KRUETR (1991) Defined health promotion
as: “A combination of educational and environmental
supports for actions and condition of living conducive to
health.”

Elaboration of the definition:

o Combination: refers to the necessity of matching multiple
determinants of health with multiple intervention or sources
of supports.
o Educational: refers to the communication part of health
promotion. That is health education.
o Environmental: refers to the social, political, and
economic, organizational, policy and regulatory
circumstances influence behavior or more directly health
Health promotion employs two approaches .These are;
[Link] approach (health education):- which
attempt to influence predisposing factors through direct
communication, reinforcing factors through indirect
communication in social environments to create norms and
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 values that support life style conducive to health and
enabling factor through trainings and organization. This
need to commitment to an educational approach to health
promotion is part practical necessity, and part ethical
concern to provide informed consent and voluntary change
before attempt to change social structures and
environments.

B. The ecological /environmental approach (political action)

o It employs policy, organization, and regulation to influence
the enabling and reinforcing factors for environmental and life
style changes supportive of health. Because behaviors and
environmental have a fully cause –effect relationship what
can be affected in one through either educational or ecological
approaches will inevitably affect the other.
o Health education is one of the most important component of
health promotion .It is a means of promoting health. It
provides consciousness-raising, concern-arousing, action
stimulating impetus for public involvement and commitment
to social reform essential to its success. Therefore, without

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 health education; health promotion would be manipulative
social engineering enterprise.

1.1. 5. Health Information

o It is health facts disseminated to the target audience

focusing on the basic facts related to the health issue under
consideration. In dissemination of health information, base
line information or data (currently existing level of multiple
determinants of behaviors) is not necessarily required.

Activity
1. Why do you think health education is a component of
health promotion?
2. Can health education exist without health promotion?
How?
3. What is t he role of health information in health
education?
4. Is there any difference between health education and
health information? Explain
5. Have you have ever conducted health education? If yes,
justify how it was different from health information
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1.2. Rationale for health education

o “We must recognize that most of the world’s major Health

problems and premature death are preventable through
changes in human behaviors and at low cost .We have the
know – how and technology but they have to be
transformed into effective action at the community level”.
[Link] Nakajiima, Director – General, WHO, 1998.

1.3. The ultimate goals and educational objectives of health

education

A) The ultimate goals of health education

 In simple words the ultimate goals of health education are:
o To help each individual and family exercise the right to
achieve a harmonious development of the physical, mental
and social potential.
o To promote health, prevent illness, self-adjust to live with
disabilities and decrease morbidity and mortality.
B) Educational objectives of health education

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 o There are many types of objectives in health education
depending on the stage and/or level of interventions. The
following are broad educational objectives of health
education:
o To provide appropriate knowledge: provision of correct
knowledge, facts and information. For example, facts
about HIV/AIDS.
o To help develop positive attitude: has a lot to do with
changing opinions, feelings and beliefs of people.
o To help exercise health practice/behavior: concerned with
helping people in decision-making and actually performing.

[Link] of health Education

o ·Health education is an eclectic in nature. As applied

science, it drives its body of knowledge from a verity of
discipline.
o ·Health education is life long process. It is not one time
affair. The concern caring about a child begins while the
fetus is in the mother’s womb.
o ·Health Education is concerned with people at all points of
health and illness continuum.
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o Health education is not limited to patients in clinical
setups. It includes those who are apparently healthy and who
want to minimize the risk of having a problem.

1.5. Basic assumptions and principles of health education

o The practice of health education is based on the assumption

“that beneficial health behavior will result from a
combination of planned, consistent, integrated learning
opportunities and scientific evaluation of programs in
different settings.”
The following points are few working principles of health
education:
1. Principle of educational diagnosis
o The first task in changing behaviors is to determine its
causes. Just as physicians must diagnose an illness before it
can be properly treated, so, too, must a behavior be
diagnosed before it can be properly changed. If the causes
of the behaviors understood health educator can intervene
with the most appropriate and efficient combination of
education, reinforcement and motivation.
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2. Principle of Participation
o The prospect for success in any attempt to change
behaviors will be greater if the individuals, families,
community groups,, etc…have been participated in
identifying their own needs for change and have selected
the methods that will enable them to take action.
3. Principle of multiple methods
o This principle follows from the principle of educational
diagnosis. In so far as multiple causes will invariably be
found for any given behaviors. For each of the multiple
predisposing, enabling, and reinforcing factor identified a
different methods or components of comprehensive
behavioral change must be provided.
4. Principle of planning and organizing
o Planning and organizing are fundamentals for health
education which distinguishes it from other incidental
learning experiences. It involves deciding in advance the
when, who, what, how, what and why of health education.
It also requires the planning for resources, methods and
materials to be used, identification of target groups etc. It is
very difficult and often unsuccessful when carrying out
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 health education program that are not planned and
organized appropriately.
5. Facts
o Health education is given based on scientific findings/facts
and current knowledge. It is unthinkable to provide health
education without scientific and knowledge related to the
topic or issues to be [Link]. Health educator must
know the current scientific knowledge how HIV/ADS
transmitted and prevention methods. This is because
scientific knowledge is changing with time. For example, it
is incorrect to say I think FGM is harmful.
6. Segmentation
o Health education should be designed for a specific group of
people/ specific target groups
7. Need based
o Health education is primarily educational and its purpose is
to ensure a desired health related behavior after real need
identification.
8. Culture
o Health education should not consider as artificial situation
or formal teaching –learning process.
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9. Principle of motivation
o Motivation is mental direction /desire for doing or rejecting
something. It is something that happens within the person,
not something done to a person by others. It is internal
dynamics of behaviors, not external stimuli such as
incentives. In strictly speaking, in health education, we can
appeals to people’s motives through motive arousing
appeals but not through external stimuli.
10. Principle of reinforcement states that those individuals,
group who started to undertake health behaviors should verbally
encouraged or received positive feedback (positive
reinforcement ) until the started health behaviors will develop
its full potential and on the other hand, unhealthy behaviors
should be discouraged until it disappear(negative
reinforcement )

11. Principle of feedback

o It is a mechanism of assessing what has been happened in
the target Population after receiving the message.
Therefore, the two way communication particularly of
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 important in health education to help people in getting
proper feedback (where the communicate/receiver become
a communicator/sender and vice versa) to get the doubts
cleared.

1.6. Targets of health education

Needs for health education are ubiquitous. Every stages of life,

every person or social group and all occupations are appropriate
targets of health education programs. Depending on the type of
the problem there are three broadly classified targets of health
education programs.
Individuals: this includes clients of services (contraceptive or
VCT users), patients and healthy individuals. E.g. diabetic or
hypertensive patients.
Groups: includes gatherings of two or more people who have a
common interest.
· A family planning service for a couple,etc.
Community: include a collection of people who have common
interests, a feeling of belongingness, and who usually share
common values, culture, beliefs and interests. It is not limited by
area and it may be a town or a country in sparsely populated
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areas or the school, work site, or neighborhood in more
populous metropolitan areas.
E.g. a village community about the protection of spring water,
dangers of FGM

1.7. Health education settings

Health education takes place in:

1. Schools,
2. Worksites,
3. Health care settings and
4. Community settings
5. Special communities: such as prisons and refugee
settings
o These settings differ in their organizational structure, the
mission of the organization, and the centrality of the
mission to health education. However, the process of health
education is the same across settings, although the
emphasis on content areas and the target population for
health education will differ.
1. Health education activities in school

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o School health education, as the name implies, primarily
involves instructing school-age children about health and
health-related behaviors. School children are groups of young
people with similar background and environment. They pass
significant proportion of their time in the school environment.
There are a potential for occurrence of spread of
communicable diseases that needs to be addressed. School
health programme is an opportunity for the health care system
to include this young community in their health programme.
o School based health promotion is the most crucial
approach needed to improve the wellbeing of the
children and the adolescent.
o Education and health are interrelated. Hence, health
promotion and education efforts should be centered in
and on school.
o Schools are the only institutions that involve all children
and their families for the community services to be
directed to this population.
Objectives of school health
o Protect and promote health of children and staff

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 o Promote safe and healthful environment
o Educate on public health practices
2. Health education activities in worksites
o The work site health promotion programs are of recent
origin when compared to other settings.
o Health promotion encourages worksites to offer programs
in physical activity and fitness, nutrition and weight
control, stress reduction, worker safety and health, alcohol
and smoking reduction, blood pressure and cholesterol
education and control, and back pain protection.
o Majority of the activities reported at the worksites are
injury prevention, job hazards, smoking control, stress
management, physical fitness, and alcoholism and drug
control.

3. Health education activities in health care institutions

o Health educator working in health care settings is involved in
varied activities. The actual responsibilities can vary from one
health care setting to another.

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o Planning, implementing and evaluating health education
programs are the major tasks. Health educators may also be
involved in one-to-one or group patient education services,
public relations.
o In addition to in hospital patient education, hospitals often
sponsor health promotion programs for their employees, for
the general public, and for corporations.
o The focus of these programs is on life-style health behaviors
and risk assessment. For primary care settings, the emphasis
is on the implementation of preventive services.
o The activities include routine assessment and counseling
regarding physical activity, nutrition, tobacco use etc.

1.8. The role of health education and promotion in Primary

Health Care

o Primary health care is a means of achieving health for all.

This is possible if all individuals, families, communities,
health professionals, government and NGOS are involved in
the programs. Primary health care is therefore very much
concerned with health promotion and education.

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o One of the core principles of primary health care is
community participation. To achieve effective community
participation two things need to be done.
o First: the political issues or government decision: the
government should commit itself for community participation
in health and development, and he should create favorable
climate which facilitate more community involvement in
decision making.
o Second: educational issues (health education):- people need
to know how to carry out this mandate for their benefits. This
involves the adoption of certain types of behaviors and styles
of living beneficial to health in individuals, families and
community. No components of primary health care can
successfully implemented without health education. That
means all components of primary health care have health
education.
o One thing that makes health education unique from the rest of
PHC component is that, in fact it does not replace the other
health services, but it is needed to promote the proper use of
these services. One examples of this is immunization:
scientists have made many vaccines to prevent diseases, but
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 this achievement is of no value unless people go to receive the
immunization.

1.9. Who is responsible to provide health education?

o It is true that some people are specially trained to do health

education work. We may refer to those as specialists.
o But since all health workers are concerned with helping
people to improve their health knowledge and skills, all
health workers should practice health education in their job.
o If health and other workers are not practicing health
education in their daily work they are not doing their job
correctly. Health education, then, is really the duty of
everyone engaged in health and community development
activities.

1.10. Challenges to the process of health education

o Good health education does not just happen. Much time,

effort, practice, and on-the-job training are required to be
successful. Even the most experienced health educators find
program development challenging because no two days are

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 the same in health education (the constant changes in
settings, resources, and priority population).
The following points justify common challenges of health
education:
1. Health education is not considered as important during
relatively healthy status as people are often concerned about
diseases.
2. Changing health behavior is conditioned by factors such as
social, psychological, economical, cultural, accessibility and
quality of services, political environment, etc. which are difficult
to deal with simultaneously.
3. People are preoccupied with many daily activities to support
their life which impedes them to give their ear to the messages
of health education.
4. Health education does not have high prestige. In schools it is
treated as subordinate subject or as optional chore to be passed
to a teacher.
5. In general, the people charged with health education programs
lack special training and are not qualified and even if the value
of health education is well understood by many health

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professionals, few make it part of their routine professional
practice.
6. Health education is much more than “transfer of
information.” Without changes in attitudes and actions it
remains a futile exercise.

Unit summary

Health is a very abstract concept which is very difficult to put in

words. It is a broad concept and its definition also differs among
social classes, cultures, religion and ethnic groups. The holistic
definition (positive definition) is important in health education
and promotion since health is not only the absence of diseases or
infirmity. Health information is the scientific facts (eg. the
causes, mode of transmission, sign and symptoms, prevention
methods of particular diseases) content of health education
which primarily aimed at increasing of knowledge on that
particular health problems; but health education address the
other factors that affect health behaviors ot her than knowledge
such as beliefs, attitude, reinforcing factors etc. In other words,
Health information is not necessarily health education. But

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correct health information is certainly a basic part of health
education and hence, in t urn, health promotion .Health
education is beyond health information. Whatever conceptually
different, the ultimate goal of health education and health
information is to change behaviors of the target audience. The
scope of health education is not limited to patients in clinical set
up rather it is required at all setting, f or all people and at all
levels of diseases prevention. Health education is the primary
means of achieving health for all if it is planned, implemented
and evaluated in accordance with t he principles of health
education and is a vital duty of health and other community
workers who take part in primary health care.

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Exercise

1. What is the role of health information in health

education?
2. Explain the place of health education in health
promotion?
3. Can health education exit without health promotion?
Justify
4. Can health promotion exist without health education?
Explain.
5. Discuss the role of health education in primary health
care?
6. In which level of disease prevention health education is
least important?
7. Are all types of educational objectives of health
education necessary each time for each client? Why? Or
why not?

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References

1. WHO, 1988 Education for health. A manual on health

education in PHC, WHO, Geneva.
2. Reidulf K. Molvaer 1989. Education f or better health. A
manual for senior health educators. UNI CEF/MOH, Addis
Ababa
3. John Hubley 1993. Communicating health. An action
guide to health education and health promotion.
4. Ramachandran L. and Dharmalingam. T. 1995. Health
education’s new approach.
5. Randall R. Cottrell, James T. Girvan, James F. McKenzi
e 2006. Principles& foundations of health promotion and
education. Third ed. USA.

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 UNIT TWO: HEALTH AND HUMAN BEHAVIOR

Unit objectives
At the end of this chapter the students will be able to:
 Define human behavior.
 List components of behavior.
 Discuss factors that affect human behavior.
 Explain approaches of behavior change.
 Discuss types of health behaviors.

2.1. Introduction

o An important justification for health education and health

promotion comes from the fact that health is determined, not
only by medical services and drugs, but also by ordinary
human actions and behaviors.
o Many health education programs have failed because they put
too much emphasis on individual behavior and neglected to
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 understand the cultural, social, economic and political factors
that influence his/her behaviors or actions.

2.2. Behavior definition

o Behavior- is an action that has specific frequency,

duration, and purpose, whether conscious or
unconscious. It is associated with practice. It is both the
act and the way we act.
 Action – drinking/smoking
 To say a person has drinking/smoking behavior
 Duration –is it for a week/month
 Frequency- how it is repeated
 Purpose –is he/she doing consciously or not

2.3. Behavior components

Basically our behavior has 3 domains

A) Cognitive domain- “stored information”
Knowledge, Perception, Thinking

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B) Affective domain-cognition +feeling (connation)
Attitude, Beliefs, Value
C) Psychomotor domain
Psycho-mind, Motor – action

2.4. Factors affecting human behavior

o Lawrence Green describes the PRECEDE framework, an

acronym that stands for Predisposing, Reinforcing,
Enabling factors in Educational Diagnosis and
Evaluation.
o From this we can identify three categories of factors
affecting individual or collective behavior, each of which
has a different type of influence on behavior:

2.4.1. Predisposing factors

Are antecedents or prior to behavior that provide the rationale

or motivation for the behavior to occur. This type of factor
include:
-Knowledge -Confidence/self-efficacy
-Perception - Outcome efficacy
-Belief -Behavioral intention

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 -Attitude -Values

Activity
1. Ask someone in your locality, may be an elderly people, their
beliefs about the cause of HIV/AI DS and how they have
developed these beliefs
2. List harmful, neutral and helpful traditional beliefs in your
locality
3. Suppose you have identified a tradition for which there is no
previously established fact whet her it is harmful, helpful or
neutral. What action do you take with regard to that belief?
Why?
4. If you have come across a belief which is neither harmful nor
useful to health in your community, what will be your measure?
Why?

2.4.2. Enabling factors

o Enabling factors are those antecedents to behavior that

facilitate a motivation to be realized.

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 o They help individuals to choose, decide and adopt
behaviors and may be barriers and assets to needed
changes. This category of factors include: The health-care
environment: Availability, accessibility and affordability

2.4.3. Reinforcing factors

Reinforcing factors are those factors subsequent to a behavior

that provide the continuing reward or incentives for the behavior
to be persistent and repeated. Are those consequences of
actions that determine whether the actor receives positive or
negative feedback and is supported socially or by significant
others after it occur.

2.5. Changes of Behavior.

 Our behavior changes all the time, some are natural while
others are planned changes.
Natural changes: When changes occur because of natural
events in the community around us, we often change without
thinking much about it.
Planned changes: When changes occur deliberately and/or
planned.

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2.6. Behavior change approaches

o The persuasion approach:-the deliberate attempt to

influence the other person to do what we want them to do.
(Often called the ‘directive’ approach or, when done
forcefully, coercion). Such approach is used in situations
where there is serious treat such as epidemics and natural
disasters, and the actions needed are clear-cut.
o The informed decision making approach:- giving people
information, problem solving and decision-making skills to
make decision but leaving the actual choice to the person
(‘open’ or ‘non-judgmental’ approach). Such approach is
used with groups who have been disadvantaged or
oppressed by promoting awareness-‘conscious-raising’ and
‘building confidence’ that they have the power to make
their appropriate decisions and control their own lives
called empowerment.

2.7. Types of health behaviors

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Health behaviors- are actions that healthy people undertake to
keep themselves or others healthy and prevent disease. Broadly
health behaviors can be classified as follows.
1) Promotive behaviors. For example, Physical exercise,
reduction/cessation of unhealthy practices such as cigarette
smoking and excessive alcohol consumption
2) Preventive behaviors. For example, Condom use
3) Utilization behaviors
Is concerned with utilization of health services. For example,
ANC utilizations.
4) Illness behaviors
o The action people take before consulting health care
workers, including recognition of symptoms, taking home
remedies (self-medication), consulting family and healers
are called illness behaviors. It is recognition of early
symptoms and prompt self-referral for treatment before the
disease becomes serious.
Illness behavior Self-medication
o Decision to go for treatment (either to traditional healer or
health facility)
o Doctors –patient consultation
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Following advice and taking prescribed drugs.
Compliance
Behavior Returning for follows up
5) Compliance behaviors
o A behavior following a course of prescribed drugs (taking
too much drug or too less or no drug because of severity
and short recovery). Best example is TB –prolonged drug
use.
6) Rehabilitation behaviors
o A type of behavior that prevent further disabilities after a
serious illness.

7) Community action
o Action undertaken by the individuals and groups to change
or improve their surroundings to meet special needs. For
example community participation in installation of
improved water supply.

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Unit Summary

o Any given behavior can be explained as a function of the

collective influence of these three factors. The notion of
collective causation, or contributing causes, is particularly
important because behavior is multifaceted phenomenon.
o This idea suggests that no single behavior, or action, is caused
by just one factor. “Behavior is a tangled web that we weave.”
Occasionally, exceptions to the combination rule do happen: a
highly motivated ( predisposing factor) can sometimes
overcome a deficit of resources and rewards (enabling and
reinforcing factors) , a highly rewarded behavior( reinforcing
factor) could occur in the absence of personal beliefs about its
value or correctness ( predisposing factor).
o But for the average person the three f actors must be aligned
for the behavior to occur and persist. So any plan to influence
behavior must consider all the set s of causal f actors. For
example, a program for disseminating health information to
increase awareness, interest and knowledge about
immunization services (predisposing factors) that does not
recognize the availability and social support (enabling and

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 reinforcing f actors) most likely will fail to influence except in
the segment of the population that has resources readily at
hand.

Exercise

1. Define human behavior?

2. Discuss the f actors that affect human behavior?
3. Is perception the same as understanding? Justify your answer.
4. Explain the difference between health behavior and illness
behavior?
5. What are significant others?
6. Do you think all human behaviors are due to self-satisfaction?
Explain
7. Which one is more important to predict action? Self -efficacy
or outcome efficacy? Explain

References

1. Karen G., Barbara K. & Frances M. Health Behavior and

Health Education: Theory, Research and Practice. 3rdedition
2002.

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2. Glanz K., Leuin F.M, & Reiner B.K, 1997. Health Behavior
& Health Education, Theory, Research & practice, 2 nd ed.
Jossey, Bassy, Inc.
3. John Hubley. Communicating Health. An action gui de t o
health education & heal th promotion. Reprinted, 1993
Published by The MACMI LLAN PRESS LTD.
4. Molvar, ReIdulf K., (Recent ed.). Education f or Better
Health: A Manual f or Senior Health Educators, Addis Ababa:
UNI CEF/MOH.
5. UNICEF, (Recent ed.). Facts for Life: A Challenge for
Communicators All Kinds.
6. Helman,C. (Recent ed.). Health and Illness: An Introduction
for Health Professionals, London: Wright PSG.

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UNIT THREE: THEORIES AND MODELS OF
BEHAVIOR CHANGE

Unit objectives
At the end of this chapter students are expected t o:
o Define theory and model in health education.
o Explain the importance of theories and models in
health education.
o Discuss t he different theories and models of behavior
change.
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3.1. Introduction

3.1. 1. What is theory?

o Theory: Is a set of inter-related concepts, definitions and

prepositions that describe, explain, predict, or control
behavior. It is a general explanation of why people act or
do not act to maintain and or promote the health of
themselves, their families, organizations and communities.
Theories explain why, what, how, and when a particular
behavior occurs.
o Describe-the behavior aggressive (what)
o Explain- the causes of aggressive behavior (why)
o Predict- we predict the behavior aggressive (when)
o Control/change-then we change the behavior aggressive
(how)

3.2. What are Models?

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 o A model is a subclass of a theory. Models draw a number
of theories to help people understand a specific problem in
a particular set ting or context.
Importance of theories and models in health education and
promotion

1. It helps to guide the practice of health education at various

Stages (planning, implementation, and evaluation)
2. It provides a platform for understanding why people engage
in health risk or health compromising behaviors and how People
adopt health protective behaviors.
3. Help to organize our thinking about a given health problem &
human behaviors related to it.
4. Help to set priorities for health education interventions.
5. Prevent the planner from overlooking important factors.
1- Those used in planning, implementing and evaluating health
education/ promotion program are ref erred t o as
theories/models of implementation or in short planning models.
e.g. -PRECEDE-PROCEED model

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2- Those theories and models that focus on behavior change ref
erred to as change process theory or theories of behavioral
changes.
Intrapersonal (individual) Theories
o Focus on f actors within the individuals such as knowledge,
attitude, belief s, self-concept, and mental history, past
experience, motivation, skills, and behavior.
e.g. -Health belief model (HBM)
-Theory of reasoned action (TRA) and
-Trans theoretical model (TTM)
These intera individual theories/models can be further
subdivided into two groups’ continuum theories and stage
theories
Continuum theory: is to identify variables that influence action
(such as perception, attitude, belief s) and to combine t hem is
prediction equation. E.g. HBM, TRA,
Stage theories : it is the one t hat comprised of an ordered set of
categories into which people can be classified and which
identifies f actors that could induce movement from one
category to the next. E.g. TTM.

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A) The Health Belief Model (HBM)
o The oldest and one of the most widely used model
specifically developed to explain why people didn’t use
health services (utilization behavior), but has been applied
to many aspects of health behavior as well.
o As the name implies, this model focuses almost exclusively
on cognitive influences (belief s) of health behaviors. It was
originally developed by Rosenstock in 1966 to explain
preventive health behaviors such as check-ups (screenings)
and immunizations.
o And further developed by Becker (1974) and applied to
several areas of health psychology including sick-role
behavior, adherence to medical regiments, and health
promotion behaviors.
o There are four major types of beliefs that influence the
likelihood of taking action that is relevant to a given
disease or condition. These are:
Perceived susceptibility
Perceived seriousness (severity)
Perceived benefits of taking action
Perceived barriers of taking action
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1) Perceived susceptibility = the subjective probability
(individual perception) that ‘I’ could get the disease rather than
other people or society as a whole. e.g. A person, who has
observed a young friend suffered from HIV/AIDS (cue to
action) he/she will begin t o think that whether he is at risk of
getting t he disease or not. Because of this, he/she may start to
examine his sexual behavior.
2) Perceived seriousness = the subjective perception about the
potential seriousness of the condition in terms of pain or
discomfort, disability, economic difficulties, death, etc. if action
was not taken.
o It may or may not be related to the actual severity of the
disease X.
o The model states that t he perceived severity is much more
influential on behavior than the actual severity of the
disease which may be measured in mortality rate. e.g. The
person has already observed the suffering and ultimately
death of his friend. The person then realizes that HIV/AIDS
is a killing disease. This is how the individual perceives
severity.

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Susceptibility and severity combine to form the overall
perceived threat of the disease. e.g. If he feels susceptible to a
serious disease HI V/AIDS then he should be motivated to take
action because the level of the treat is high, if he does not feel he
is at risk from a less sever disease such as flu he is unikely to
take action because he perceives the treat as minimal.
3) Perceived benefits=the subjective perception about the
benefits of taking health action and its effectiveness. It is similar
to Bandura’s concept of outcome efficacy. e.g. One of the
healthy behavior measures that could be given by the individual
could be to refrain from unprotect ed sexual intercourse and the
benef its is perceived as having less risk or not getting
HIV/AIDS.
 Behaviors like taking anti-pain are more likely to be
perceived as effective, since they have a noticeable
immediate effect than those behaviors which have long
term effect such as eating fiber to reduce the risk of colon
cancer and TB drugs to relieve from pain.

4) Perceived barriers=the barriers such as cost, side effects,

culture, and convenience also influence the likely hood of taking
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action. Following the above example, the possible barriers for
using condom could be: are condoms available? Is the cost
reasonable? Is morally and socially acceptable to buy condoms
from shop? Is it comfortable to use it?

o When the benefits of health action out weight the barriers

in the minds of a given person the likely hood of taking
action increases and vice versa.

In short,

Threat of disease = perceived (susceptibility+ severity)

Perception of behavior = perceived (benefit – barriers)

Likely hood of action=percepti on of threat + perception of the

behavior.

o Thus, the likely hood of taking action is high when,

-the perceived threat of the disease is high and

-the benefits of the behavior out weight the barriers

Activity

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1. According to health belief model, what are the major beliefs
that can influence the likely hood of using condom?

2. List the basic constructs of health belief model.

3. What is the role of cues to action in health belief model?

4. List some of the possible cues to action in promotion of bed

net use in your locality?

5. Explain how health belief model can be applied in condom

promotion.

6. Develop questionnaires that can address t he constructs of

Health Belief Model for malaria prevention behavior.

B) Theory of Reasoned Action (TRA)

o The theory of reasoned action was developed by social

psychologists Icek Ajzen and Martin Fishbein in 1980. It
was designed to explain all human behavior that has been
applied extensively in health fields.
o Major assumption= people are usually rational and make
predict able use of the information available to them. The
theory states that intentions are the basis and the most

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 immediate influences for the behavior to be adapted. i.e.
reasons behind t he action determine the practice.
o Behavior: is the conversion of intention to action
o Behavioral intention: is the function of both attitude
towards to the behaviors and subjective norm towards to
that behaviors, which has been found to be predict the
actual behaviors.
o Thus, if a person intends to perform a behavior then it is
likely he/she will do so. If, the person does not intend to
perform a behavior it is unlikely to be performed
o Attitude: are determined by the perceived consequences of
performing the behaviors.

Subjective norm:

o Is the influence of people (significant people such as

family, friends, peers, teachers et c.) in one’s social
environment on his /her behavioral [Link]. you might
have some friends who are involved in regular exercise and
constantly encourage you to join them.
o Prediction: a person most likely to perform a behavior
when he/she feels good about the behavior (positive
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 attitude) and f eels the social pressure favorable to perform
the behavior (if perceive significant people will like the
behaviors if it occurs).

C. Putting it all together- BASNEF model.

o Dr. John Hubley on his book of Communicating Health

puts together the BASNEF model (the name comes from
the 1st letters of Beliefs, Attitude, Subjective norm, and
Enabling Factor) by combining the approach of Fishbone
and the concept of enabling factors introduced by Lawrence
Green.
o Behavioral intention –Intention is converted to action only
if the enabling factors are readily available.

Activity

1. List the constructs of the theory of reasoned action, planned

behavior and BASNEF model.

2. What are the strengths and limitations of the theory of

reasoned action, planned behavior and BASNEF model?

3. What is the basic assumption of the theory of reasoned

action?
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4. Compare and contrast the theory of reasoned action and
planned behavior.

5. If you want to plan health education program in district to

promote latrine utilization behavior, which theory or model do
you prefer most? Why?

D. Transtheoretical model (TTM)

o It is developed by James Prochaska and Carols Diclemente

(1979).I n their observation of psychotherapy people
appeared to go through similar stages of change no matter
what therapy was being applied.
o Assumptions: No matter happen to the individual the
changes are the same and sequential. But the time of
change differs from individual to individual. In other word,
some people move more rapidly while others may “stuck”
at one stage for a long time. The Trans theoretical model
uses stages of change to integrate the processes and
principles of change across major theories of intervention;
hence the name “Transtheoretical” is applied.

The core constructs of the model are:

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 1. The stages of change and

2. The process of change.

1. Stages of change

I. Pre contemplation phase

Who have no intention to change a behavior (whet her he/she

recognizes it or not).

II. Contemplation phase

Who recognizes the problem and seriously thinking about

making changes. They are intended to change within six months.

III. Preparation phase

Actively planning for change and intending to take action in the

next month.

IV. Action phase

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Who are involved in consistent behavior changes for less than 6
months/overt making changes.

V. Maintenance phase

Who have been successful in maintaining or sustaining a change

for 6 months or more.

VI. Termination phase

It is the time when the individual s who have changed have zero
temptation to return to their old behavior and have 100% self –
efficacy (lifetime maintenance). E.g. smokers becomes non-
smokers.

The model suggests that:

“People move from precontamplation= not intending to change,

to contemplation = intending to change within 6 months, then to
preparation = actively to change, to action= overtly making
changes, and into maintenance= taking steps to sustain change
finally to termination= resist temptation to relapse.” In short, the
model not only implies that different intervention approaches are
needed for also suggests which processes are most appropriate at

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each stage. This is a promising aspect of the model, but it has
not been fully tasted. The rationale behind “staging”

3.3. Community theories

o This group of theories includes three categories of factors

from the ecological perspective-institutional, community,
and public policy. Institutional factors – include rules,
regulations and policies of an organization that can impact
health behavior. Community factors-include social
networks and norms t hat can impact health behavior.
Public policy fact ors-Includes legislations (laws) that can
impact health behavior.

A. Diffusion of innovation theory

According to Evert Rogers, there are 4 elements in the diffusion

of innovation:

1. Innovation -means an idea, practices or objects perceived

as new by the people.

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 2. Communication channel s -the means by which the new
idea is communicated or message gets from one individual
to the other. E.g. ‘iqub’, ‘idir’ (social system)

3. Time-takes to accept the innovation.

4. Social system- a set of interrelated units that are engaged

in joint problem solving to accomplish a common goal.

There are five segments (adopter categories) in the diffusion

process based on the amount of time it took to adapt an
innovation. These are;

1. Innovators 2. Adopters [Link]

majority

4. Late majority [Link]

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Characteristics by Rogers identified in categories :

1. Innovators

o Are first to adapt an innovation (they want to be first to do

something)
o Control substantial a financial resource to absorb possible
loses if the innovation is unprofitable.
o They are venturesome, independent, risky, daring and
desire for rush.
o They have the ability to understand and apply complex
technical knowledge (mostly they are literates).
o Have the ability to cope with high degree of uncertainty
about the innovation.
o Are few and changed very earlier.
o They have higher socioeconomic status than any other
group
o They require a shorter adoption period than any other
category

2. Early adopters

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 o Are very interested in innovation, but they do not want to
be first to be involved.
o Are integrated part of the local social system.
o Possess greatest degree of opinion leader ship in most
social systems (are respected by peers)
o And are usually successful.
o Serve as role model for other members or society

3. Earl y majority

o May be interested in innovation, but will need some

external motivation to get involved.
o Interact frequently with peers (sociable and jockey)
o Seldom held the position of opinion leadership.
o Deliberate (check and discuss) before adopting a new idea.
o One-third of the members of a system, making the early
majority the largest category.

4. Late majority

o Are skeptical and cautious and will not adopt an innovation

until most people adopt.
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 o One-third of the members of a system
o Pressure from peers.
o And adapt because of economical necessity.

5. Laggards

o Will be the last to get involved in an innovation, if they get

involved in an innovation at all.
o Posses no opinion leadership.
o Isolated in the social systems
o Point of reference is in the past.e.g. ‘Diro kere diro eko!
Doro 25 santim neber’.

· Suspicious of innovation E.g. what if the ‘whites’ put virus in

the condom?

o Not all people change their behavior. Some are apt to change
and others are reluctant. Based on research’ findings, in any
given society, there are four types of people.
o A very small percentage of people (2-3%) accept any ideas
without any question.

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o This includes people who come up with new ideas
(innovators) and those who are early adopters of the behavior.
For example community leaders belong to this group.
o Some do not take the new ideas readily (14%).
o But they prefer to observe the behavior from other people
who are accepted by the community like opinion leaders.
o The great majority (about 68%) Says---Ok----later on, but it is
not usually easy to see them practicing the new behavior. This
is the group that is difficult to change.
o No matter what one says or does, about 16% will not accept
the new idea. This group includes older peoples such as
grandparents.

Activity

1. What is the parameter to classify people as into five

categories of adopters?

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2. What are some of the factors that affect the rate of adoption of
an innovation?

3. To which category do you classify people who hold the

following beliefs about bed net use?

A, a man who believe bed net cause suffocation and shouldn`t

be used.

B, a religious leader who advocate bed net use

C, a man who want to cheek the effectiveness of bed net in

malaria prevention from his neighbors before using bed net for
himself.

4. What is the difference between adoption process and

innovation process?

5. Suppose W/r Tirunesh fear that Tetanus Toxoid vaccine will

cause infertility in the long run, but she believes in its immediate
protection then after, she denied to be vaccinated. At what
adoption process you classify w/ r Tirunesh? What should be
your intervention to move her to the next adoption process?

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Unit Summary

· Theory is a set of inter-related concepts, definitions and

prepositions that describe, explain, predict, or control behavior.
Theories explain why, what, how, and when a particular
behavior occurs. A model is a subclass of a theory. Models draw
a number of theories to help people understand a specific
problem in a particular setting or context. The Health Belief
model provides insights for why people make health decisions
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and creates a process for encouraging change. It is also useful in
understanding how to design health education programs and
persuasive messages. Social Cognitive theory helps a health
educator understand the complex relationships between the
individual and his or her environment, how actions and
conditions reinforce or discourage change, and t he importance
of believing in and knowing how to change. The
Transtheoretical model views behavior change as a process in
which individuals are at various stages of readiness to change.
The Stages of Change Model is not linear. People can enter and
exit at any point and some people may repeat a stage several
times. Generally, theories and modeles in health education and
promotion are classified into two major categories .Behavior
change theories/models and planning theories/models. Countless
theories have been developed that attempt to explain human
behavior yet no single there model has been universally
accepted models are constantly modified in response to new
situations. In addition, if a model were a perfect model, it would
predict with 100% accuracy who would do the behavior.
Unfortunately, behavior is very complex and there are no perfect
models in health educations. It is important for health educators
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to keep revising their models to improve understanding of heath
behavior. Furthermore, a question now f acing the profession is
weather the theories presently available to health educators are
adequate and should continue to be used, or should t here be a
movement toward the development of new theoretical models to
help guide health educators’ work.

Exercise

1. Define theory?

2. How theory is diff e rent from model?

3. Explain the difference and similarity between stage

theory/model and continuum/model theory?

4. Which health education theory /model is the best to use?

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5. Discuss the difference among individual s’ theories/models,
inter-individuals theories/models and community theories and
models?

6. What are the unique features of the following theories/models

in relation to the factors affecting human behaviors?
(Predisposing, enabling and reinforcing)

A) Theory of reasoned action

B) Theory of planned behavior

C) BASNEF model

7. What is constructs in theory/model? Does act ion or behavior

construct? Why? Or why not?

8. Explain the limitation of health belief model?

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References

1. Glantz K, Lewis FM, Rimer BK, eds. Health Behavior and

Health Education: Theory, Research, and Practice. 2nd ed. San
Francisco, CA: Jossey-Bass, Inc.; 1997.

2. Baranowski T. Beliefs as motivational influences at stages in

behavior change. International Quarterly of Community Health
Education.1992;13: 3-29.

3. Ajzen I, Fishbein M. Understanding Attitudes and Predicting

Social Behavior. Englewood Cliffs, NJ: Prentice-Hall; 1980

4. Oldenburg, B., Glanz, K. and Ffrench, M. (1999) The

application of staging models to the understanding of health
behavior change and the promotion of health. Psychology and
Health. 1999, Vol. 14, pp. 503-516

5. Karen G., Barbara K. & Frances M. Health Behavior and

Health Education: Theory, Research and Practice. 3 rd edition
2002.
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UNIT FOUR: HEALTH COMMUNICATION

Unit objectives

At the end of this chapter students are expected t o:

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 o Define health communication.
o List the principles of health communication.
o Explain components of communication.
o Discuss stages of communication.
o Describe models of health communication
o Explain types of health communication.
o Identify the barriers to effective communication.

4.1. Introduction
4.1. 1. Definition

The word communication is derived from the Latin word

“communis” which means to make common ground of
understanding, to share information, ideas or attitude, to impart,
to transmit.

o Communication is the process by which two or more

people exchange ideas, facts, feelings or impressions in
ways that each gains a common or mutual understanding of
the meaning and the use of the message.

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 o Evert M. Rogers (1993), defined “communication as the
process by which an idea is transferred from a source to a
receiver with intent to change his/her behavior.
o Allen Louis A. defines communication as “the sum total of
the thing one person does when he wants to create
understanding in the mind of another’s.”
o Health communication is the art and technique of
informing, influencing, and motivating individuals,
institutions, and large public audiences about important
health issues based on sound scientific and ethical
consideration.

4.2. Relevance to Health Education

o It helps to mobilize the community, to implement health

education programs & to coordinate with different
agencies. The ultimate goal of all health communication is
to create behavioral change.

Activity

1. Is talking necessarily communication? Why?

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2. What is the difference between health education and health
communication?

3. What is the role of health communication in health education

program which is going on in your district?

4.3. Principles of communication

1) Perception: For communication to be effective the perception

of the sender should be as close as possible to the perception of
the receiver. The extent of understanding depends on the extent
to which the two minds come together.

2) Sensory involvement: The more sensory organs involved in a

communication the more is its effectiveness from their
cumulative effect.

3) Face to face: The more communication takes place face-to-

face the more its effectiveness.

4) Feedback (two-way): Any communication without two-way

process is less effective because

of lack of opportunity for concurrent, timely & appropriate

feedback.

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5) Clarity: Ideas, facts, opinions in the mind of communicator
should be clear before communication. It should be direct,
simple, easily understandable language.

6) Information: the sender should have at in hand correct,

current and scientific information before communicating it.

7) Completeness: the subject matter to be communicated must

be adequate and full which enable the receiver to understand the
central theme or idea of message. Incomplete message may
result misunderstandings.

4.4. Components of communication

4.3.1. Source (sender)

The source can be from an individual or groups, an institution or

organization. The sender is the originator of the messages. The
sender (source) should be the one who share similar
backgrounds with the receivers. People are more likely to
believe and trust person or organizations that share some
characteristics with them.

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4.3. 2. Receiver/audience

o The person or the group for whom the communication is

intended other person who receive the message.
o The 1st step in planning any communication is to consider
the intended audience.
o A method which is effective wit h one audience may not
succeed with another.
o Therefore, the communicator always has to consider the
culture, age, educational level, visual literacy and media
habits of the receiver while design the message
o Factors which should be considered about the audience
o Educational factors

4.3.3. Message

It is a piece of information, ideas, facts, opinion, feeling, attitude

or a course of action that passed from the sender to the receiver.
I t is the subject matter of communication. Something that is
considered important for the audience to know or do. It exist s in
the mind of the communicat or. It is what to say. The content of
the message could be organized in different ways so that it can

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persuade or convince people. These are called appeals. Not
everyone respond, in the same way. What might persuade you
might be quite different from what might persuade another
person. For example what type of appeals might convince
persons with little or no schooling; persons with high
educational level; children; and health workers? One big wrong
in many health education communication is the tendency to use
logical argument s that rely heavily on medical detail s.
However, as shown below, many other approaches are possible.

Types of appeals in health communication

A/ Fear arousal appeal

The message is conveyed to frighten people into action by

emphasizing the serious out come from not taking action.
Symbols such as dying persons, coffins, grave stones, skulls
may be used. It is good for a person with litt le or no school.
Evidence suggests that: Mild fear can arouse interest, create
concern & lead t o change. However, too much fear is not
appropriate for two reasons;

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1st: It can lead to denying & rejecting the message and results in
laughter & failure to take action

2nd: It also involves ethical issues. Fear might be aroused but a

person may not able to take action t o change this can lead to
considerable stress, panic responses and anxiety. Therefore
many health educators feel that it is wrong to try to frighten
people into action –unless there is clear evidence that a benefits
in health would result and that the means (i.e. enabling factors)
are readily available to perform the action.

B/ Humour

The message is conveyed in a funny way such as cartoon.

Humour very good way of attracting interest & attention. It can
also serve a useful role to lighten the tension when dealing with
serious subjects. Enjoyment & entertainment can result in highly
effective remembering and learning. However, humor does not
always lead to changes in beliefs & attitudes. Humour also very
subjective. What one person finds funny another person may
not.

C/ Logical / factual appeal

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The massage is conveyed to convince people by giving facts,
figures and information, e.g. facts related to HI V/AIDS; its
causes, route of transmission, prevention methods etc. Telling
people the percentage of people living with HIV virus. It carries
weight with a person of high educational level. Information on
its own is usually not enough to change behaviors.

D/ Emotional appeal

The message is conveying to convince people by arousing

emotions, images & feelings rather than giving facts & figures,
e.g. by showing smiling babies, wealthy families with latrine
etc, and associating with FP education. A Person with less
education will often be more convinced by simple emotional
appeals from people they trust. Despite this, many health
educators still feel that it is important to present some f actual i n
formation because it allows people to make informed-decision.
But it is important to be realistic about the limitations of just
relying on facts to persuade people.

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E/ One sided message

Only presents the advantages of taking action & does not

mention any possible disadvantages. E.g. educating the mothers
only about benefits of oral contraceptive pill. One sided
compared with two sided messages Presenting only one side of
an argument may be effective: 1) If your audience will not be
exposed to different views. However, if they are likely to hear
opposing information, it may create suspicion to take your
advice such as the side-effects from a drug. It is better to be
honest to t ell them rather than let people find them out for
themselves. 2) If our communication is through mass media
such as radio, TV, newspaper etc. because the audience may
only grasp part of the message or selectively pick up the points
that t hey agree with.

F/ Two sided message

Presents both the advantages & disadvantages (pros’ & cons’) of

taking action. Appropriate

if:

o The audiences are exposed to different views.

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 o The audiences are literates.
o We are in face to face with individuals or groups: it is easy
to present both sides and make sure that the audience
understands the issues.

G/ Positive appeals

Communications that ask people to do something, e.g. breast

feed your child, use a latrine.

H/ Negative appeals

Communications that ask people not to do something, e.g. do

not bottle feed your child, do not defecate in the bush.

Positive compared with negative appeals. Negative appeals use

terms such as “avoid” or “don’t” to discourage people from
performing harmful behaviors. But most health educators agree
that it is better to be positive & promote beneficial behavior.

4.3.4. Channel

A channel is the physical bridge or the media by which the

message travels from a source to a receiver. The commonest

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types of channel are audio, visual, printed materials or combined
audio visual & printed materials.

4.3.5. Effect & feedback

Feedback: - is the mechanism of assessing what has happened

on the receivers after the communication has occurred. A
communication is said t o have feedback when t he receiver of
the message gives his/her responses to the sender of the
message. The sender must know how well the messages have
been received by the receiver, understood, interpreted, and act
up on it. It completes the process of communication.

Effect:-is the change in the receiver’s knowledge, attitude &

practice or behavior.

· Positive effect: when desired change in knowledge, attitude,

practice occurs;

· Negative effect: when desired change in knowledge, attitude &

practice does not occurs.

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Activity

1. Based on activity mentioned under the principles of health

communication, during your visit to the nearby health
institution;

a) Who was/were the source(s) of the message

b) What was/were content(s) of the message

c) What was/were the channel of communication

d) Who was/were the receiver(s)

e) Was there feedback from the receiver(s)?

f) Identify the type of appeal used

g) Evaluate t he appropriateness of the components of

the communication.

4.4. Communication process

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 o Is the whole sequence of transmission and interchange of
facts, ideas, feeling, etc.
o As a process it is routine and continues forever. It is an ever
ending process, cycle.
o Code: is a group of symbol s that can be structured in a way
that is meaningful to others .e.g language.
o Encoding: is the process of conversion of the subject matter
into symbol.
o Encoding process translates ideas, facts, feelings, opinions
etc. into symbols, signs, actions, pictures, audio-visuals etc.
o Decoding: is a mental process by which the stimuli that has
been received through the sensory organs are given a
proper meaning according to the individual’s way of
thinking.
o The receiver converts the symbols, signs, words, pictures
etc. received from the sender to get the meaning of the
message.

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4.5. Message distortion in communication process

o The message that is sent may not be the message that is

received. Messages are misunderstood both because of the
limitations of the agents interpreting them, and because the
very process of communication itself is limited.
o The effectiveness of the communication between the agents
is dependent upon several things - the nature of the
channel, the state of the individual agents, the knowledge
possessed by the agents, and the cont ext wit hi n which the
agents find themselves.

4.6. Communication stages

o In health education and health promotion we communicate

for special purpose –to promote improvement /change in
health through the modification of the human, social and
political factors that influence behavior. To achieve these
objectives, a successful communication must pass through
several stages.

Stage1. Reaching the intended audience

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 o Communication cannot be effective unless it is Seen or
heard by its intended audience. A common cause of failure
in this stage is preaching the converted, e.g. posters placed
at the clinic or talks given at antenatal clinics.
o These only reach to the people who are already motivated
& attended the service. But the groups you are trying to
reach may not attend clinics, nor have radios and
newspapers. They may be busy at times the health
education programs are broad cost.
o Communication should be directed where people are going
to see or hear them. This requires sound study of your
intended audience to find out where t hey might see
posters, what there is listening & reading habits are.

Stage2. Attracting the audience’s attention

o Any communication must attract attention so that people

will make the effort to listen and read it.
o Attention: is the process by which a person selects part of
the message to focus on while ignoring others f or the time
being. Examples of failure at this stage are:
o Walking past the poster without bothering to look at it;
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 o Not paying attention t o the health talk or
demonstration at the clinic;
o Turning off the radio programs or switching over.

Stage 3. Understanding the massage

o Once the person pays attention to a message he/ she then

tries to understand it. Another name for this stage is
perception. Perception is a highly subjective process. For
example, two people may hear t he same radio program or
see the same poster and interpret the message quite
differentially from each other and from the meaning
intended by the sender. A person’s interpretation of a
communication will depend on many things. Examples of
failures at this stage can take place when;
o Complex language & unfamiliar technical words are
used;
o Pictures containing complicated diagrams and
distracting details
o Pictures containing unfamiliar/strange subjects.
o Too much information is presented and people cannot
absorb it at all.
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Stage 4: Promoting Change (acceptance)

o A communication should not only be received and

understood – it should be believed & accepted. · It is
usually easier to promote a change when its effects can be
easily demonstrated.
o For example, ventilated improved pit latrines do not smell,
if people become green in color when they get HIV/AIDS it
is easier to promote change.

Stage 5. Producing a Behavior Change

o A communication may result in a change in beliefs and

attitudes but still not influence behavior/action. This can
happen when the communication has not been aimed at the
belief that has most influence on the person’s behavior.
e.g. A person may have favorable attitude & want to carry
out the action e.g. using FP but the people around may
prevent from doing it or no means (enabling fact or) such
as money, skill and availability of the service to do as a
result there will be no behavior change.

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Stage 6. Improvement in Health

Improvement in health will only take place if the behaviors

have been carefully selected so that they really influence health.
If your messages are based on out dated & incorrect ideas,
people could follow your advice but their health would not
improve.

4.7. Communication models

A) Linear (one –way) model

o The flow of information from the sender (source) to the

receiver i s one-way or unidirectional.
o The communication is dominated by the “sender’s
knowledge”. “Information is poured out ”.
o This model does not consider feedback and interaction with
the sender. A familiar example is the lecture method in
class rooms.

Advantages Disadvantages

-Faster -Little audience

participation

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-Orderly -Learning is
authoritative

-No feed back

-Does not influence

behavior

o Classically messages from “experts”, “educators” or people

who know more about a specific content are included in
this type of communication.
o Note that: Unless mechanisms are set to get feedback from
the audience many mass media communication are one-
way.

B) Systems (Two –way)

o Information f lows from the source to the receiver & back

from receiver to the source. This is reciprocal in which the
communicant (audience) becomes the communicator

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 (sender) & the communicator (sender) in turn becomes a
communicant (audience). Roles are interchanged.
o It is more appropriate in problem solving situations.

Advantages
Disadvantages

-More audience participation -

Slower (time taking)

-Learning is more democratic - Not

orderly

-Open for feed back

-Influence behavior change

4.8. Types of communication

· There are two main types;

1. Face-to-face (‘interpersonal’)

2. Mass media

A) Interpersonal (face-to-face)

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 o Face-to-face or interpersonal methods include all those
forms of communication involving direct interaction
between the source & receiver. In most instances the
decisive criterion f or personal communication is.

a. Communication at the same time and/or

b. Communication at the same place.

o Examples of face-to-face communication with increasing

audience size are; one-t o-one & counseling; small group
(less than 12 persons); intermediate group/lecture (between
12 and 30); and large group lecture/ public meeting (more
than 30).
o The powerful advantage of face-to-f ace communication
over mass media is, it gives the opportunity to ask the
audience questions and obtain their feedback.
o In this case, it is possible to cheek t hat you have been
understood & give further explanations. However, as the
size of the group increases, it is more difficult to have
feedback & discussion.

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 o So public meetings share many characteristics of mass
media in that they involve limited participation & feedback.

Main effect=changes in attitude and behavior

= acquisition of problem solving skill.

Advantages

1. Dynamic or bi-directional

o The communication takes place in both directions

from the source to the receiver & vice versa.
2. Feed back
o There is a chance to raise question & discuss so that the
idea is understood at the same time and/ or place.

3. Multisensory (channel)

o Since the communication is active & interactive there is

high chance of utilizing more than two senses such as
seeing, hearing & touching.

4. Useful is all stages of adoption of innovation

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 o Adoption of a behavior passes through different stages and
interpersonal communication has paramount importance
through all these stages.

5. Useful when the topic is taboo or sensitive.

o For example, it is usually difficult t o discuss about sexual

matters in a group meeting as these issues require
expressions of personal feelings & experience.

6. Can fit to local needs

o It is possible t o make the message appropriate to the

special situation of the local communities, as it provides
open-room for discussion & feed back

Limitations

1. Easily distorted – as we mostly rely on word-of-mouth.

2. Often needs multi-lingual

3. Needs personal status/ credibility

4. Needs professional knowledge & preparation

For effective interpersonal communication

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 o Exchange of ideas with clients;
o Realize the importance of 1st impression when meeting a
person. A saying ‘1st impression last long’
o Learn to observe the person & drive useful information.
o Keep in mind the same words mean different things to
different persons; perception is highly subjective.
o Pay attention body language there is a saying “action
speaks louder than words”.

B) Mass media communication

o Mass communication is a means of transmitting messages,

on an electronic or print media to a large segment of a
population. The word media is currently used to refer not
only broad cast media such as radio & TV and print media
such as papers, magazines, leaf lets & wall posters but also
folk media such has art, town criers, songs, plays, puppet
shows & dance.
o The powerful advantage of mass media over face-to-face is
rapid spread of simple of facts to a large population at a
low cost.

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·

Main effect of this type of communication are:

o Increased knowledge/awareness
o Influence behaviors at the early stages.
o Useful to communicate new ideas to early adopters
(opinion leaders).

Advantages

1. They can reach many people quickly.

2. They are accurate and believable e.g. article on a
newspaper, or “voice” of highly respected person.
3. They can provide continuing reminders and
reinforcement.
Limitations
1. One sided /no feedback
o The broad caster transmits his message without
knowing what is going on in the receivers mind.
2. Selective perception:

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 o Because the audience may only grasp part of the
message or selectively pick up the points that they
agree with and ignore other
3. Does not differentiate the target
o In mass communication some may develop “this
does not concern me type of attitude.
4. Only provides non-specific information
o As mass media are broad cast to the whole
population, it is difficult to make the message to fit
to the local needs of the community whose
problems and needs may be different from the rest
of the country.
For an effective mass media communication
o The message / advice should be realistic and pre
tested so that it is transmitted accurately without
distortion.
o While they are useful in creating awareness, it has to
be followed by individual & group approach for an
effective feedback & in turn for attitudinal &
behavioral change.

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According to the way of expression there are three types of
communication.

1. Verbal/oral communication

2. Non-verbal communication and

3. Written communication

Oral or Verbal communication

o It is communication by Word of mouth. In oral

communication, speech or talk is the widely adopted tool of
communication.
o The message is received through our ear. May also use
mechanical devices such as telephone, radio, PAS (Public
address system) etc.

Written communication

o It involves the exchange of facts, ideas, and opinions

through a written instrument /materials. Individuals or
groups come in touch with each other and share meaning
and understanding with each other through written

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 materials such as letters notes, leaflets, reports, handouts,
bulletins, newspaper.

Non-verbal communication

o Much communication also takes place through non-verbal

communication. But most of us think a great deal about
choosing the words we say (verbal) when taking with
another person and forget to plan for our non-verbal
communication.
o The fact is, the gestures we use, how we look at people, our
tone of voice, how we are seated and our clothes can all
have an impact on the way people interpret what we say.

Sounds accompanying spoken words.

· Pitch of voice

· Laughing, angry, groaning

· Pauses, speed of talking

· Stresses on particular words

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 · Loudness or softness of voice

Body talking

o Body contact – touching, holding hands, , greetings,

shaking hands.
o Closeness – distance between persons.
o Posture- sitting up, leaning forward
o Orientation – angle at which people put themselves.
o Gestures – hand movements, raising eyebrows, shape of
mouth.
o Appearance – clothes, hair, cleanliness.
 In your face- to – f ace communication you have to be
sensitive to t he impact our non-verbal communication might
be having.
 Non- verbal communication can be interpreted in different
ways according to the culture of the community. For example,
in western culture much importance is given to looking
people straight at some ones eye. In other cultures looking at
some ones eye can be considered rude and showing lack of
respect.

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4.9. Barriers to effective communication

1. Physical

· Difficulties in hearing, seeing

· In appropriate physical facilities

2. Intellectual

· The natural ability, home background, schooling affects

the perception/ understanding of the receiver for what he
sees & hears.

· The ability of the facilitator/ education/ instructor.

3. Emotional

· Readiness, willingness or eagerness of the receiver

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 · Emotional status of the educator

4. Environmental

· Noise, invisibility, congestion,

5. Cultural

Customs he belief s, religion, attitudes, economic and

social class differences, language variation.

6. Status of the source

Status of the source either too high or too low as compared

to the audience al so affects effectives

4.10. Inconsistencies between verbal & non- verbal

communication

.Qualities of communication

· The communicator should be knowledgeable, positive

attitude, skilled and have credibility.

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 · The message should be simple (or brief & clear)
meaningful, appropriate, relevant, and timely (SMART).

· The channel should be familiar, appropriate, available &

accessible.

· The receiver should al so be responsible wit h proper

attitude to receive the information.

4.11. Main characteristics of effective communication

· Promotes actions that are realistic feasible with t he

constraint faced by the community.

· Builds on beliefs and practices t hat people already have.

· Repeated & reinforced over time using different methods

· Adaptable, and uses the existing channels of

communication for example, songs, drama & story telling.

· Entertaining & attracts community’s attention.

· Uses simple, clear & straight forward language with local

expression.

· Emphasizes short term benefits of taking action

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 · Uses demonstrations to show the benefits of adopting
practices.

· Develop natural style; although we can l earn how to

present, each person has his/her own natural way of
presenting ideas.

· Provides opportunities f or dialogue and discussion to get

the feedback on understanding and implementation.

Unit summary

o As we have seen, health education helps people to make

wise choices about their health and the quality of life of
their community. To do this, accurate information must be
presented in an understandable form.
o Health Communication is an essential part of health
promoting activities in order to inform, influence and
motivate the individuals, groups, families, institutions,
organizations and the public about important health issues.
Communication has five elements the sender, the message,

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 the channel, the receiver and the feedback which completes
the communication.
o Even though there are a number of communication types
and forms a well planned health program will involve a
carefully chosen mix of approaches to exploit t heir
different advantages and to bring sustainable behavior
change.
o Mass communication has the powerful advantage over
face-to-face in spreading of simple of f acts to a large
population at a low cost. It is a cost effective
communication methods to influence behaviors at early
stage. But group and individual approach should follow to
influence the attitude and change behaviors.

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Exercise

1. Define health communication?

2. What is the role of communication in health education and

promotion?

3. Discuss communication components?

4. In planning health education and promotion, which

communication component should be considered first? Why?

5. Which communication appeal is most appropriate in health

education to use?

6. Explain the difference between communication stages and

communication component?

7. In which communication stage, communication failure will

not occur? Why?

8. What is decoding and encoding? Illustrate it with example.

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9. Discuss interpersonal and mass media communication. Which
one is best for effective behavior change? Why? or why not?

10. Identify a body language in your community and try to

communicate with your friends. Is the meaning is the same for
you and your friend?

11. Identify traditional means of communication in your

society?

References

1. John Hubley 1993. Communicating health. An action guide to

health education and health promotion.

2. Ramachandran L. and Dharmalingam. T. 1995. Health

education’s new approach.

3. Getnet Mitike 2003 health education for health science

student s. Lecture note series. Addis Ababa University, Ethiopia.

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UNIT FIVE: TEACHING METHODS AND MATERIALS

Unit objectives

At the end of this chapter students will be able to:

o Explain the things to be considered before choosing

health education method.
o Identify the pre requisites for putting educational
methods into use.
o Discuss t he different types of teaching methods.
o Differentiate between teaching methods and teaching
materials.
o Discuss t he different types of health l earning
materials.

5.1. Introduction

o Teaching methods refers to ways through which messages

are conveyed to help solve problem related to health
behaviors where as teaching materials/aids refers to all
teaching materials t hat are used as teaching aids to support
the communication process and bring about desired

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 changes on the audience. In health education it is not
enough t o decide what will be done; by whom and when,
we also need to decide how it will be done (methods).
o There are many methods to be used in health education,
because there are many ways of solving problem. Therefore
there are some important points that to be taken into
consideration when choosing a method. First of all the
method must suit the situation and the problem and before
choosing a method the person practicing health education
must understand the problem at hand. Visual, action
oriented, audiovisual, audio or some combination of these
materials or activities /IEC materials/ can be creative and
effective ways to reach an audience.
o Using educational methods and forms of communication
that is natural for the people that you are working with can
greatly enhance the delivery of the health message. The
materials and activities developed should be compatible
with the community's culture, age, sex, and educational
status.

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5.2. Some prerequisites for putting educational methods into
practice

There are three things to consider when putting educational

methods into use

o When to find people

o Where to find people
o How to involve people

A) Choosing the right time

 For a meeting or discussion with women or farmers, find out

when they are at work and when they are free.
 For education with children, you must know when they are at
school, when they are helping their parents and when they are
free. If a display is to be set up in, it must be done when
people are gathered there.
o Get together with the people concerned and plan a time
that is best for everyone.

B) Choosing a convenient place

o Find out where people normally gather-markets, schools,

work places, churches, mosques or temples.
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 o Gather together with the people and decide a place for
everyone to reach.

C) Involve people

o Promoting participation is very important because people

learn better when they are not passive.

Activity

1. Suppose you are assigned to conduct health education session

on personal hygiene in your district , then :

A, which setting do you chooses? why?

B, what time do you prefer? Why?

C, how do you involve people in the session?

D, who is your target group? Why?

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5.3. Teaching methods
5.3.1. Heal talks

 When talks are on health agenda we call it health talks. It is

the most natural way of communicating with people to
share health knowledge and facts. In health education, there
are many opportunities to talk with people. The talks can be
conducted with one person or with a family or group of
people.
 It can be conducted through mass communication like
radio, TV etc. Too often however this method is used by
itself. Talking al one is much like giving advice. But advice
is not the same as health education.
 To make a talk educational it must be combined with other
methods, especially visual aids, such as posters, project ors
and flannel graphs. Also a talk should be tied into the local
setting by the use of proverbs, for example. Group size
o The group could be small or large. For example a
talk broad cast over the radio may reach everyone
in the country.

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 o Talks are good if conducted with small
gatherings (5-10 people).
o But the larger the group the less chance for each
person to participate.
o In preparing a talk consider the following
o Know the group
o Find out their needs and interests.

Select an appropriate topic

 The topic should be single, simple topic. Nutrition is too big
topic it should be broken down into simple topics such as
breast feeding, weaning foods, body building foods, food
needs of older people, etc.
 Have correct and up-to-date information
 Look for sources of recent information.
 List the points you will talk
 Prepare only few main points.
 Write down what you will say
 If you do not like writing, you must think carefully what
to include in your talk.
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  Think of examples, proverbs and stories to emphasize
your points.

Think of visual aids

 Well chosen posters, photos, etc. will help people learn.

 Practice your all talk
 This should include the telling of stories and the showing
of posters and pictures.
 Determine the amount of time you need
 The all talk including showing of visual aids should take
about 20 minutes.
 Allow another 15 minutes or more for questions and
discussions. If the talk is too long people will be bored.

5.3.2. Lecture

 It is oral, simple, quick and traditional way of presentation of

the subject matter
Strengths:
o Efficient
o Good for introduction
o Presents factual material in direct, logical manner

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 o Contains experience which inspires
o Stimulates thinking to open discussion
o Useful for large groups
o
Limitations:
o Ineffective
o Audience is passive
o Experts are not always good teachers
o Learning is difficult to gauge
o Communication in one way

5.3.4. Lecture with discussion

o Incorporate discussion into lecture

Strengths
· Involves audience at least after the lecture
· Audience can question, clarify & challenge
Limitations
o Time may limit the discussion period
o Its quality is limited to the quality of questions
and discussion

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5.3.5. Group discussion

o The participants have equal chance to express freely and

exchange ideas.
o The subject of discussion is taken up and shared equally by
all the members of the group.
o It is collective thinking process to solve problems.
o Have been found extremely useful because of the
commonness of goal and collective planning and
implementation.

Strengths

o Pools ideas and experiences from group

o Effective after a presentation, film or experience that needs
to be analyzed
o Allows everyone to participate in an active process

Limitations:

o Not practical with more that 20 people

o Few people can dominate
o Others may not participate

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 o Is time consuming
o Can get off the track

5.3.6. Buzz group

o A large group is divided into small group, of not more than

10 or 12 people in each small group and they have given a
time to discuss the problem. Then, the whole group is
reconvened and the reporters of the small groups will report
their findings and recommendation.

5.3.7. Brainstorming

o Is a means of eliciting from the participant s their

ideas and solution on health issues.
o Instead of discussing the problem at great length the
participant s encouraged to make a list in a short
period of time all the ideas that come to their mind
regarding the problems without discussing among
themselves

Strengths

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 o Listening exercise that allows creative thinking for
new ideas
o Encourages full participation because all ideas equally
recorded
o Draws on group's knowledge and experience
o Spirit of congeniality is created
o One idea can spark off other ideas
Limitations
o Can be unfocused
o Needs t o be limited to 5 - 7 minutes
o People may have difficulty getting away from known
reality
o If not facilitated well, criticism and evaluation may
occur

5.3.8. Demonstration

o Demonstration is a pleasant way of sharing skill s and

knowledge. Although basically focuses on practice it
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 involves theoretical teaching as well. “Showing how is
better than telling how.” The following concept is derived
from the Chinese proverb
o If I hear, I forget symbol s
o If I see, I remember visuals
o If I do, I know experience
Not e that,
o You remember 20% of what you hear
o You remember 50% of what you hear and see
o You remember 90% of what you hear, see and do
and with repetition close to 100% is remembered.

Purpose

o Help people learn new skills e.g. ORS preparation, how to

use condom, etc.

Group size

o Demonstration can be used with individuals and small

groups.
o If the group is too large, members will not get a
chance to practice the skill s and ask questions.
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For effective demonstration

o It must be realistic.
o It should fit with the local culture.
o Use familiar materials.
o Have enough materials f or everyone to practice.
o Space-adequate space is needed for everyone to see or
practice.
o Time-choose convenient and enough time for everyone. Do
not rush.
o Checking-check that everyone can practice the skill.
o Holding the demonstration
o The demonstration by itself has four steps
o Explain the ideas and skill s that you will be
demonstrating.
o Do the demonstration.
- Give an explanation as you go along.
- Do one step at a time
o Ask one person to repeat the demonstration.
o Give every one chance to practice

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4.3.9. Role-play

o A type of drama in a simplified manner. It portrays

expected behavior of people.
o A role-play is a spontaneous and/or unrehearsed acting out
of real-life situations. A script is not necessary.
o It is a very direct way of learning; you are given a role or
character and have to think and speak immediately without
detailed planning.
o Learning takes place through active experience; it is not
passive. It uses situations that the members of the group are
likely to find themselves during their lives.
o And in a role-play people volunteer to play the parts in
natural way. Other people watch carefully and may offer
suggestions to the players and some of these watching may
decide to join into the play.

Purpose

o By acting out real-life situation, People can better

understand their problem and the behavior associated with
the problem

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 o Explore ways of improving relationships wit h other people
and gaining people support (cooperation) to do something.
o To give people experiences in communication, planning
and decision making. E.g. to practice a particular event s
such as counseling, meeting or interview.
o To develop empathy.
o To develop sympathy to the points of view of other people.
o Finally, it helps people to reconsider their values and
attitudes.

Group size

o Usually done with small group, 2-3 people e.g. a

health worker and 1 or 2 other people.
o Can also be done with 1 individual. e.g. the health
worker may ask a person who come i n private to act
out his own situation.

For a good role-play

-Have a relaxed atmosphere

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 -Make members of the group know each other.

-Make sure everyone understands the purpose of t he play.

-Select 2-3 volunteer/not embarrassed people.

-Involve every one.

-Remind them they are playing only roles.

-Give clear instruction, what they have to do.

-Allow time for discussion.

Ideal time requirement for a role play

o Few minutes for instruction and 5-10 minutes f or

them to plan & think
o A role play should last about 20 minutes
o Allow to continue or to repeat the play if the audience
is interested.
· Stop the ply if:
(a) The players have solved the problem that is
presented.
(b) The players are conf used and can’t solve their
problems.

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 (c) The audience look bored.

· Allow another 20-30 minutes for discussion

N.B. this is the ideal time requirement but a rol e-play may
range from 10 minutes to an extended session lasting the whole
day.

Conditions to consider during a role-play

o Role-play work best when people know each

other.
o Don’t ask people to take part that might
embarrass them.
o Role-play involves some risk because people may
interpret things differentially.
o Generally, there are seven things to consider
before choosing health education methods.
o How ready and able are people to change?

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 o Your ‘learning’ objectives. Do you need to
convey simple fact, complex information,
problem-solving skills, attitudes and behavior
change?
o How many people are involved?
o Is the method appropriate to the local culture?
o What resources are available?
o What mixture of methods is needed?
o What methods fit the characteristics (age, sex,
religion, etc.) of the target group?
Note that:
o It is important to remember that effective health
education is seldom achieved through the use of
one method al one.
o Therefore a combination of variety of methods
must be used to accomplish the education
purposes.

5.4. Health Learning Materials (HLMs)

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 o Health learning material s: are those teaching aids which
give information and instruction about health specifically
directed to a clearly defined group of audience.

5.4.1. Types of health learning materials

There are four types of health learning materials:

1. Printed HLM

2. Visual HLM

3. Audio HLM

4. Audio-visual HLM

1. Printed health learning materials: is the production of multiple

copies of an original image usually using ink pressed on to
paper. It can be used as a medium in its own right or as support
for other kinds of media.

1.1. Poster

Poster is a large sheet of sheet paper ranging in size from large

bill boards to small notices.

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But often it has a size of 40cm wide and 60cm high. A poster
consists of words and pictures or symbols that include a message
on it. Posters are widely used by commercial firms f or
advertising their products. However, in recent years, the use of
posters in communicating health has increased dramatically.

Purpose of posters

· To reinforce/remind a message the public is receiving through

other channels.

· To give information and advice. E.g. learn more about malaria!

· To give directions and instructions for actions. E. g. a poster

about malaria prevention methods.

· To announce important events and programs. E.g. World

Malaria Day.

Group size

· Posters can be used for both small and large group. It can be
also be used by the whole community.

· Sometimes can be used during counseling an individual. E.g.

PLWHA

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Content

· All words in a poster should be in local language or two

languages.

· The words should be few and simple to understand slogan -

contain a maximum of 7 words.

· The symbols used should be understood irrespective of

educational stat us.

· The colors and pictures should be ‘eye-catching’ and

meaningful to the local people.

· Put only one idea on a poster. If you have several ideas to pass
on use a flip chart.

· The poster should encourage practice-action oriented.

· It is better to use life picture if possible.

· It should attract attention from at least 10m away.

Posters announcing events should contain the following

information

o The name of the event

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 o The date and time
o The place
o The organization sponsoring t he event.

Placing posters

· Post them in a place where many people can see them when
passing by (e.g. market places, meeting halls, etc.)

· Ask permission before putting poster on a house or building.

· Never put posters on sacred or worshipping places.

· Do not leave a poster up for more than one month. Otherwise

people will become bored of seeing the same thing and begin to
ignore it.

Activity

Indentify one poster available in your area, then;

1. What was its purpose?

2. What is its message?

3. Do you think the poster is understandable to the local people?

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4. Evaluate its contents

1.2. Charts

There are of three main types:

1- Wall chart e.g. growth monitoring chart

2- Teaching chart e.g. diarrhea treatment chart

3- Flip chart

Flip chart

· Are a series of pictures that are bound together, usually at the

top, and can be turned over by the educator.

· A flip chart is made up of a number of post ers on a related

subject t hat are shown one after the other.

· Are good to present several steps or aspects of a central topic

such as ‘prevention of burns’ or how to dress a small wound’.

· Flip charts with blank sheet of paper are also useful for
recording suggestions out of group meetings and discussions.

Group size

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· Flip charts are best used with small groups. They are not put
around the community like posters.

Purpose

· To give information and instructions

· To record ideas

Content

· There should be a single separate idea on a chart.

· The arrangement should follow a logical order.

How to use a flip chart

o Each chart or poster must be discussed completely

before you turn to the next one.
o Make sure that everyone understands properly each
idea.
o At the end, go back to the charts to review and help
people remember the ideas

1.3. Flannel graphs

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· Flannel graphs are pictures with a rough back which allows the
picture t o stick to a cloth.

· The picture can be printed on a cloth or paper with a rough

backing such as sand paper.

Purpose

· Help people see clearly what you are talking during a health
talk.

Group size

· Mostly used with small groups.

· Can also be used with individuals who come for help in the
office.

How to use flannel graphs

· Carefully place the pieces of pictures, words (flannel graphs)

in the order near the flannel board so that you can see and reach
them easily.

· Be careful not to turn your back to the audience.

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· Be careful on where you put t he pieces. If you put a chicken
on the top of man’s head or something people will laugh and not
concentrate on the message.

· Encourage participation. When you make a point ask someone

to come up and select the right piece and place on the board.

1.4. Leaflets

These are the most common way of using print media in health
education. The simplest leaf let is a single sheet of paper, printed
on both sides and folded in 1/2 or 1/3. Leaf lets can be larger wit
h two or more sheets of paper. Once there are more than five
sheets it is common to use the term ‘booklets’.

Purpose

Leaflets can be a useful reinforcement for individual and group

sessions and serve as a reminder of the main points that you
have made. They are also helpful for sensitive subjects such as
sex when people are too shy to ask they can pick up a leaflet and
read personally.

Group size

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The target group f or leaflets can be individuals, groups and
community and can be distributed throughout the whole country.

Content

In general, leaflets, booklets or pamphlets are best when they are

brief, written in simple words and understandable language,
familiar pictures, provide specific information and the address
should be included at the back to indicate where people can get
further information.

5.5. Visual health learning materials

 Include something seen, for example models, real objects, and

photographs. Written words are not included under visuals.
 Visuals are one of the strongest methods of communicating
messages, especially where literacy status is low. They are
good when they are accompanied with interactive methods.

The following are among the outstanding characteristics of

visuals health learning materials

o Arouse interest if of high quality

o Provide clear mental picture of the message

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 o Speed up and enhance understanding
o Stimulate active thinking and learning
o Help develop memory
o However, pictures are not universal language and all people
may not see them the same way.

5.5.1. Real objects

o Are just those-real. If your display is on ‘family planning

methods’, you would display real IUDs, pills, condoms,
diaphragms, and foams.
o If your display is on weaning foods you would display the
real foods and tools used to prepare them.

5.5.2. Models

Are three dimensional objects which look like the real objects.
Models might be used for 3 reasons:

1- If the real objects are not available. E.g. out of season fruits,
foods which are easily spoiled if displayed.

2- If the real object is too big to display. E.g. lorry, well or VIP
latrine.
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3- If the real object is too small to be seen easily. E.g. many
insects, bacteria, etc.

In most cases models are expensive. However one of the most

advantages is that if handled properly they could serve f or a
long time. Models are also useful because details of the object
can be seen from any direction.

o The problem with scale models is t hat they may wrong

impression and understanding on the part of the audience. e.
g. a scale of magnified mosquito may be imagined as bi g as
bird.
o Therefore you must write on the display that the object is a
model so that the people will understand the display. E.g.
‘model of a malaria mosquito 25 times larger than the life-
size’. Be sure to tell the people if the model is larger or
smaller than the real object. This will help people know what
the real object is like.

5.6. Audio Health Learning Materials

o Includes anything heard such as spoken word, health talk,

music, sound, etc. Radio and audio cassettes are audio aids.

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These types of teaching methods have the following main
characteristics:

o Are effective when t hey are based on similar or known

experience
o Could be distorted or misunderstood when translated
o They are easily forgotten.

5.7. Audio visual Health Learning Material

o Audio visuals are multi-sensory materials.

o They make possible wide range of interest, convey
messages with high motivational appeals, realistic,
meaningful and simulating leaning experiences.
o It shows real life situation and entertaniable.
o They combine both seeing and listening. These materials
include TV, projected materials, films or videos.

5.7.1. Projected materials

o Projected materials are those materials that are shown to

people using projectors.

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 o Project ors are machines that can be used where there is
electricity, and an experienced person to operate them.
Purpose
· To underline the most important point in a talk or lecture.
· To help people learn new skills.

5.7.2. Over head projectors (OHP)

o The over head projector is becoming increasingly

popular used as a learning aid.
o They are used in educations, conferences, seminars and
trainings of higher level.
o In most cases it is cheap to buy, simple to use and
maintain.
o Depending on the type of markers used (permanent or
water washable types), the transparencies can be reused
by washing with water.
o Unfortunately many people do not use the overhead
projector to it s best advantage and words are too small,
crowded and not clear.
Guidelines to use OHP
Making the transparencies
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 1- Plan before you put marker on the transparencies.
 Aim for not more than 10 lines per transparency and
maximum of 7 words on a line.
 Use different colors to emphasize your points (but do
not use too many).
2- Present one main idea on each sheet.
3- Always check t hat the words and diagrams are large
enough to be seen from the back of the room.
 Use lower case letters whenever possible as they are
easier to read.
4- Whenever possible try to replace words with pictures.
5- Use a piece of lined paper under the transparency to
keep your writing straight.
6- Margin-leave 2cm round the edge and draw the border
around the transparency as it focuses attention on the
content.

Showing transparencies

1- Position your self-make sure that you face the audience and
the screen is not blocked.

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2- Switch off between transparencies-switching on OHP is a
signal to bring the people’s attention to the screen.

3- Adequate time to see the transparency- leave the transparency

up long for the audience too absorbs the information. Do not
rush to the next transparency.

4- Pointing- point out details on the transparency not on the

screen.

o You can use a pen as a pointer.

5- Some of the different ways of using transparency include:

o Transparency rolls-writing down as you go on the rolls of

the transparency.
o Reveal method- covering up the transparency with a paper
and lowering step-by-step to reveal the contents as you talk
about them.
o Masking method-masking of areas and revealing in turn as
appropriate.
o Overlay method-one sheet of transparency is laid over
another to build up information and more details.
Activity
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 1. Write the advantages and disadvantages of the following
types of health learning materials
a. Audio
b. Visual
c. Audio visual
d. Projected materials
2. In which of these health materials learning is higher?
Why?

5.8. Traditional means of communication (“Popular art

forms”)

o It is usually put under mass media communication and yet

it differs. Traditional means of communication exploits
and develops the local means, materials and methods of
communication.

Examples of such type of communication include:

-Drama -Poems

-Role-play -Songs

-Proverbs -Dances with songs

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-Fables -Games

-Stories -Puppets, etc.

Local Medias are useful for the following reasons

1- They are realistic and based on the daily lives of average

citizens.

2- They can communicate attitudes, beliefs, values and

feelings in powerful ways.

3- They do not require modern education in the majority of

instances.

4- They can communicate problems of community life.

5- They can motivate people to change behavior.

6- They can show ways to solve problems.

7- They can improve participation and self-esteem

development.

8-Usually they are very interesting. They can be funny, sad,

serious or happy.

9. They are easily understood and captured.

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 10- They usually cost little or no money. Only imagination
and practice

Unit summary

o Using the right methods and materials for the right target
group in your health education program helps you to convey
messages to individuals and communities easily and may
facilitate behavior change.
o We have discussed different types of methods and materials
used in health education and communication. But to decide to
use which type of material needs to understand who are your
target groups, the resources that you have at hand and your
communication objective.
o And triangulation of methods and materials or using different
methods and materials is effective approach in health
communication. As a health communicator, it is not
recommended to use health learning methods and materials
without pre-testing.

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Exercise

1. What is the difference between role play and drama?

2. What are the purposes of using poster in health education?

3. List some of the advantages of using traditional means of

communication

4. What is t he main difference between leaflet and booklet?

5. Compare contrast buss group and group discussion?

6. What is the difference between leaflet and poster?

7. Discuss the difference between audio health learning

materials and visual health learning materials and give example
for each?

References

1. Rei dulf K. Molvaer 1989. Education for better health. A

manual for senior health educators. UNICEF/MOH, Addis
Ababa

2. John Hubley 1993. Communicating health. An action guide to

health education and health promotion.
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3. Ramachandran L. and Dharmalingam. T. 1995. Health
education’s new approach

4. Getnet Mitike 2003 health education for health science

students. Lecture note series. Addis Ababa University, Ethiopia.

5. Randall R. Cottrell, James T. Girvan, James F. McKenzie

2006. Principles& foundations of health promotion and
education. Thirded. USA.

UNIT SIX: GROUP DYNAMICS

Unit objectives

At the end of this unit students will be able to:.

o Discuss t he difference between formal and

informal groups.
o Mention the importance of group education.
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 o Explain behaviors in a group.
o Discuss the types of group function/roles.
o Identify the determinants of effective functioning
of group dynamics.
o Explain stages of group formation.
o Define community.
o Define community participation.
o List benefits of community participation.

Group - number of persons gathered and their interactions

e.g. Family, Class, Association, patients, etc.

6.1. Types of groups

1. Formal groups (Very well organized) e.g. farmers-

cooperative, peasant associations, classes, etc.

2. Informal groups (Those that are not organized) e.g.

people attending market, patients attending an OPD of a
health center/ hospital, etc.

Characteristics

Formal group

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 1. Purposeful

2. There is always membership

3. There are recognized leaders

4. Organized activities and regular meetings

5. There are rules

6. Attention to the welfare of the members

Informal group (gathering)

1. No special membership

2. People come and go at well

3. Has no special leader within the group

4. No special activity is planned together

5. No special rules

6. More concern for self

In a group where there is coherence and achievement we

expect success. On the other hand, if disagreement and no
achievement prevail, there will be a failure.

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Examples of helpful behavior

Making suggestions
Encouraging each other to talk
Responding politely to the suggestion of others
Helping make points clear - elaborating
Giving information
Showing concern for each other
Volunteering to help with work
Attending meetings regularly and on time
Thanking each other for suggestions given

i) Group building or maintenance functions

1. Encouraging - being friendly, warm responsive to

others.

2. Mediating

- Helping people to work together

3. Gate Keeping

Stimulating people to participate or facilitating

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 E.g. "we haven't heard from Abeba yet,"

4. Relieving tension

- Draining off negative feelings by making a joke or

- Diverting attention from unpleasant to pleasant

matters

ii) Task or getting the job done functions

1. Initiating

- Suggesting new ideas or a different way of looking at

the group problem or goal.

- Proposing new activities

2. Information seeking

-Asking for relevant facts/or authoritative information

E.g. Do you have any information that HIV infection

cannot be transmitted through mosquitoes' bite?

3. Information giving

- Providing relevant facts or

- Personal experience pertinent to the group task.

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 E.g. I know a child who died of severe dehydration.

4. Clarifying

- Probing for meaning and understanding.

E.g. Marasmus - skin and bone appearance rather than

saying weight for height is < 60% of the standard.

5. Elaborating

- Building on a previous comment

- Enlarging on it, giving examples. About HIV/TB -

"the cursed couples." In the case Marasmus, one may
say - "little old man appearance."

6. Coordinating

- Directing the discussion in terms of the group goals

- Raising questions to redirect

7. Testing

- Checking the readiness of the group to take decision

or action

8. Summarizing
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 - Reviewing the content of past discussion

iii) Non-helpful, nonfunctional roles:

1. Blocking

- Interfering with group process

- Diverting, citing of personal experience unrelated to

the problem

- Arguing too much on a point that the rest of the

group has resolved

- Rejecting ideas

- Preventing a decision

2. Aggression

- Criticizing/blaming others

- Showing hostility

3. Seeking recognition

- Call attention she's self by excessive talking,

boasting

4. Withdrawing
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 - Become indifferent or passive

- Whispering to others

5. Dominating

- Excessive manipulation or authority

- Interrupting or undermining the contribution of other

Conflict

 When people come together in groups expect

disagreements.
 The most important point is that how we handle
these disagreements or conflicts.
 If we fail - No solution to our problems ---->
Task failure
 If we succeed - There will be a solution to our
problem -----> Task achievement.
Education with informal Groups

Find-out the common interests and needs of each

individual in the group

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 Develop relationships and encourage
participation
Education with formal groups

It is possible to plan educational programs, since they:

Have definite purpose and interests

Have group leaders
Have commitment to meet regularly and take
action, and
Members know each other

Activity
1. Indentify formal and informal group in your area. Justify
how you have classified as formal or informal.
2. Have you ever worked in a group? If so,
a. What were the helpful and non- helpful behaviors
you have faced?
b. Identify the various roles/functions individual
members played in the group.
c. The effectiveness of a group dynamics.

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 d. Some of the obstacles you have observed in
decision making process.
e. To which type of group member you ascribe
yourself during the group functioning?
f. What is the style of leadership in the group?
3. With which type of group is more challenging to conduct
health education program? Why?
4. What are the challenges that can be faced during group
formation?
5. What are the advantages and disadvantages of group
decision making through voting and consensus?

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6.2. Health Team

o A health team is a special type of group and the main

purpose is to improve and maintain the health of the
community.
o Composition - composed of members with special skill
depending on their training. For example, a health center
staff is composed of:
Medical doctor/Health officer
Nurse
Sanitarian
Pharmacist/technician
Midwife
Lab. technician
Health assistant
Supportive staff

6.2.1. Why do we need teamwork?

Many health problems are difficult to deal with alone.

E.g. for a patient with tuberculosis;

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 MD,
Lab tech,
X-ray tech,
Nurse,
Pharm tech,
Administrative staffs have special roles to play.
Value of a team

1. Provides support and encouragement

2. To share experience and skills

3. To over-come difficult or complex tasks which

cannot be done by individuals

4. A source of resource

For effective Team work

1. Team spirit

2. Small group

3. Participation from each member

4. Frequent and two-way communication

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 5. Continuity - support

A health team must

1. Work in the community

2. Understand/ communicate with community

3. Encourage people participation

6.3. How to establish good relationship with the community

a) Listen, learn, and understand

b) Ask, discuss and decide

c) Encourage, organize and participate

6.3.1. Leading a health Team

1. Setting and showing objectives

2. Motivating - maintain the action of a person in a

certain desired way.

Positive Factors (Motivating)

Success or achievement
Recognition

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 Giving value to the work
Sharing responsibility
Promotion
Self-development
Negative (Dissatisfiers)

Insufficient administration
Incompetent supervision
Poor interpersonal relations-not treating people
fairly
Personal qualities of the leader E.g. do what I say
Inadequate pay
3. Delegating authority and responsibility

Advantage

Saves time
Decisions on the spot
Avoids delay
People become interested in their job
Disadvantage

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 Insufficient experience of delegated individual -
wrong decisions
4. Supervising

Leadership styles

a. Autocratic - do what I say

b. Anarchic - do what you like

c. Participatory- final decision by the leader

d. Consensus- all members should agree

*Participatory and consensus styles motivate people

6.4. HIV /AIDS Related Issue in Health Education

(Introduction, Counseling, Prevention and Control

BEHAVIOR CHANGE INTERVENTION (BCI): A

combination of activities/interventions tailored to the needs of a
specific group and developed with that group to help reduce risk
behaviors and vulnerability to HIV by creating an enabling
environment for individual and collective change.

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Behavior Change Communication (BCC): An interactive
process with communities (as integrated with an overall
program) to develop tailored messages and approaches using a
variety of communication channels to develop positive
behaviors; promote and sustain individual, community and
societal behavior change; and maintain appropriate behaviors.

The Role of Behavior Change Communication

BCC is an integral component of a comprehensive HIV/AIDS
prevention, care and support program. It has a number of
different but interrelated roles. Effective BCC can:

 Increase knowledge. BCC can ensure that people are

given the basic facts about HIV and AIDS in a language or
visual medium (or any other medium that they can
understand and relate to).
 Stimulate community dialogue. BCC can encourage
community and national discussions on the basic facts of
HIV/AIDS and the underlying factors that contribute to the
epidemic, such as risk behaviors and risk settings,
environments and cultural practices related to sex and
sexuality, and marginalized practices (such as drug use)

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 that create these conditions. It can also stimulate discussion
of healthcare-seeking behaviors for prevention, care and
support.
 Promote essential attitude change. BCC can lead to
appropriate attitudinal changes about, for example,
perceived personal risk of HIV infection, belief in the right
to and responsibility for safe practices and health
supporting services, compassionate and non-judgmental
provision of services, greater open-mindedness concerning
gender roles and increasing the basic rights of those
vulnerable to and affected by HIV and AIDS.
 Reduce stigma and discrimination. Communication about
HIV prevention and AIDS mitigation should address
stigma and discrimination and attempt to influence social
responses to them.
 Create a demand for information and services. BCC can
spur individuals and communities to demand information
on HIV/AIDS and appropriate services.
 Advocate. BCC can lead policymakers and opinion leaders
toward effective approaches to the epidemic.

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  Promote services for prevention, care and support. BCC
can promote services for STIs, intravenous drug users
(IDUs), orphans and vulnerable children (OVCs); voluntary
counseling and testing (VCT) for mother-to-child
transmission (MTCT); support groups for PLHA; clinical
care for opportunistic infections; and social and economic
support. BCC is also an integral component of these
services.

 Improve skills and sense of self-efficacy. BCC programs

can focus on teaching or reinforcing new skills and
behaviors, such as condom use, negotiating safer sex and
safe injecting practices. It can contribute to development of
a sense of confidence in making and acting on.

Information, Education and Communication (IEC):

Development of communication strategies and support
materials, based on formative research and targeted at
influencing behaviors among specific groups.

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Unit Summary

o Group is a gathering of two or more people who have a

common interest. Formal group has a purpose or a goal
that everyone in the group knows, accepts and tries to
achieve by working together. Such group is important for
health education and it also easy to work with them.
o Because if the members the group feel a sense of
belonging and well coming, they tend to give up their
resources f or group success.· Informal group has no
special membership or feeling belonging.
o Simply it is a collection of people-no interdependency.
Before dealing with such group it is important to find out
what the common interests and needs of its members may
be. Therefore health education with informal group should
be based on a common interest, whatever they may be.
Group dynamics is the functioning of groups. It is the
parameter to determine the effectiveness of group
functioning. The f unction of the group will depend on the
size of the group, the membership, the nature of the tasks
undertaken, the decision making process, the roles of
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 group members, group process and the pattern of
leadership.

Exercise

1. What is group?
2. Differentiate between formal and informal group?
3. What is the value of group education?
4. Discuss the determinants of group functioning?
5. What is health team?
6. Explain the diference between group and health team?
7. Explain the difference among the following terminologies?

a) Social mobilization

b) Advocacy

c) IEC/BCC

References

1. WHO, 1988 Education for health. A manual on health

education in PHC, WHO, Geneva.

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2. Ramachandran L. and Dharmalingam. T. 1995. Health
education’s new approach.

3. Reidulf K. Molvaer 1989. Education for better health. A

manual for senior health educators. UNICEF/MOH, Addis
Ababa

4. John Hubley 1993. Communicating health. An action guide to

health education and health promotion.

UNIT SEVEN: HEALTH EDUCATION PLANNING

Learning objectives
At the end of this chapter students will be able to:
o Define planning
o Explain the steps of planning.
o Identify the different models used in heal th education
planning.
7.1. Introduction

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 o In the process of health education, there is a generic set of
tasks that should be accomplished in planning regardless of
the model selected or designed:

1. Assess the needs of the target population.

2. Identify the problem(s).
3. Develop appropriate goals and objectives.
4. Create an intervention that is likely to achieve
desired results.
5. Implement the intervention.
6. Evaluate the results.

o A model should provide direction and supply a frame on

which to build. Health status can be changed

1. Disease occurrence theories and principles can be

understood.
2. Appropriate prevention strategies can be developed to
deal with the identified health problems.
3. An individual's health is affected by a variety of
factors, not just lifestyle, such as heredity,
environment, and the health care system.

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 4. Changes in individual and societal health behaviors
and lifestyles will affect an individual's health status
positively.
5. Health behavior changes occur in stages.
6. Individuals, families, small groups, and communities
can be taught to assume responsibility for their health,
which in turn changes their health behaviors and
lifestyles.
7. Individual responsibility should not be viewed as
victim blaming.
8. Health behavior change is a process, not an event.

7.2. Some of the Most Common Health Education Planning

Models

1. Comprehensive Health Education Model

The Comprehensive Health Education Model (CHEM) has six

major steps and several recommended procedures within each
one of these steps.

The first step, Involve People, includes identifying the target

population and the personnel required to carry out the program,

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determine their roles, and create working relationships between
people in related programs.

Step 2, Set Goals, involves outlining appropriate goals that will

mirror health status as well as health education practices and
resources in the target population.

In Step 3, Define Problems, planners determine the gaps

between what is and what could be. After these problems have
been identified, the planners will need to decide what specific
components of the health problem(s) should be tackled.

In the fourth step, Design Plans, the design of program plans

includes identifying the most appropriate approach; setting
program objectives, defining a timetable, activities and
resources; conducting a pretest; and developing evaluation
procedures.

Step 5, Conduct Activities, mainly focuses on obtaining the

necessary resources in order to implement the program and then
actually implementing the plans.

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In the last step, Evaluate Results, planners use the program
objectives to evaluate the program. The results of this evaluation
should provide the data for making later decisions on continuing
or changing the program.

2. Model for Health Education Planning

The Model for Health Education Planning (MHEP) analyzes

planning in six phases. Under each phase, there are three
dimensions, which include the dimensions of content (subject
matter), method (steps and techniques) and process
(interactions).

Phase 1 (Initiate) is the beginning of the planning activity. In

order to carry out this phase, the planner(s) must 1) understand
the target population problem(s) and its system, 2) enter into an
initial contract, and 3) make the client aware that a problem or
problems exist.

The second phase, Needs Assessment, involves completing an

assessment of the target population's needs. In order to do this,
planner(s) should identify how the problem was measured in the
past, determine what data needs to be collected now and how
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best to do this, then collect and analyze the data and finally
describe the nature and scope of the problem.

In Phase 3, Goal setting, goals should be based on those

problems identified in the needs assessment. They should be
appropriate and realistic. In addition, input from those who will
be affected should be gathered. Strategies should also be
developed in this phase for implementing these goals.

In Phase 4, Planning/Programming, the planner(s) take these

agreed upon strategies and translate them into a rational
implementation plan or program, design systems and tools for
managing the activity, and arrange for commitments among all
of those involved.

The last two phases of MHEP are Implementation (Phase 5)

and Evaluation (Phase 6). In Phase 5, the planner(s) offer
assistance to facilitators and participants and track the progress.
The final phase of Evaluation includes the steps of: 1) clarifying
the evaluation measures, 2) collecting and analyzing the
evaluation data, 3) providing the necessary feedback and 4)
redefining the problem(s) and standards.

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3. Model for Health Education Planning and Resource
Development

The Model for Health Education Planning and Resource

Development (MHEPRD) is not as well known as some of the
models previously discussed, but this model has some very
distinguishing characteristics. It separates process from the
results, and its inclusion of the evaluation process throughout the
entire model is unique. There are five major components in the
MHEPRD:

1. Health Education Plans

2. Demonstration Programs
3. Operational Programs
4. Research Programs and
5. Information and Statistics

o In the first phase of the model, Health Education Plans are

an end result of a needs assessment, which Bates and
Winder refer to as a "Policy-Analysis Process" and an
ongoing "Evaluation Process" of Information and Statistics.
The plans, which are developed in Phase 1, provide the

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 hypotheses to be tested in Phase 2, the "Development
Process" where planners create Demonstration Programs.
o In Phase 3, the "Validation Process," the results of the
Demonstration Programs are examined to determine which
should be continued and become Operational Programs.
This phase also includes the development of an
implementation plan that should reflect the experiences
learned during the development and validation of the
Demonstration Programs.
o Therefore, this process should yield Operational Programs
that are based on sound research, planning and
demonstrations. In Phase 4, Implementation of the
Operational Programs occurs. The problems that arise
during the "Implementation Process" provide the basis for
research questions for the program planners.
o The possible answers to these questions are formulated and
tested through appropriate experimentation in their
Research Programs. The data that are generated by these
experimentations are used for future "Policy Analysis" and
planning.

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 o The planning process thereby becomes a cycle since it is
always building on previous planning. Hopefully, as the
process continues, the results should be better-organized
and more effective health education services.

4. Generic Health/Fitness Delivery System

o The Generic Health/Fitness Delivery System (GHFDS) was

not developed specifically for health education as its name
suggests, but it can be easily applied to health education.
This goal-oriented planning model has five steps or stages:

1. Needs Assessment
2. Goal Setting
3. Planning (choice of strategies to meet goals)
4. Program Implementation (delivery of program) and
5. Evaluation

o Each of these steps has two components--education and

service. The education component provides a cognitive
(awareness, knowledge) experience in each step, while the
service component provides a "hands-on" experience.

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5. Community Wellness Model

o In the 1980's at a time when less money was available to

fund health services for a population with increasing
numbers of sicker, older and uninsured individuals, the
University of Georgia Cooperative Extension Service
responded with the Community Wellness Model for its
rural communities.
o This is a planning model program designed to help
communities use their local resources to find solutions to
some very complex health issues.
o Community Wellness is considered to be a "process-
oriented program" which provides the means to "assess,
identify, and find workable solutions to community
problems." County Extension agents and other leaders
(both in the health and non-health sectors) serve as
"catalysts" in order to involve members progressively in
community problem solving.
o Planned health interventions are based on the assessment of
specific community health needs. This whole process

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 should empower the community and help to develop a
community-wide support system.

6. PRECEDE-PROCEED Model

o At a first glance, this revised model looks much like its

earlier version. However, there are changes that make it a
more useful model. The title summarizes the phases within
the model. PRECEDE has been modified and is now an
acronym for Predisposing, Reinforcing and Enabling
Constructs in Educational/Environmental Diagnosis and
Evaluation. PRECEDE is the diagnostic or needs
assessment phase. PROCEED, a new acronym, stands for
Policy, Regulatory and Organizational Constructs in
Educational and Environmental Development.
o As a follow-up, PROCEED is the developmental stage of
planning and begins the implementation and evaluation
process. The new model now contains nine phases or steps.
o It is much more comprehensive than the 1980 framework
and also further subdivides the evaluation component.
Similar to PRECEDE, the PRECEDE-PROCEED model

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 begins with the final consequences (or end) and works back
to the causes.

The first phase of this model is also called Social Diagnosis.

Similar to the 1980 framework, this model attempts to define
subjectively the quality of life (problems as well as priorities) of
those in the target population. This is best accomplished by
involving individuals in the target population in a self-study of
their own needs. These subjective quality of life social indicators
could include illegitimacy, welfare, discrimination, happiness,
self-esteem along with many other possibilities.

Phase 2, Epidemiological Diagnosis, is once again the stage

where health goals or problems are identified and prioritized
Epidemiological data, as well as clinical and investigative data,
are used in order to reach these decisions about which health
problems are most deserving of scarce resources.

In Phase 3, Behavioral and Environmental Diagnosis, the

behavioral and environmental risk factors that might be linked to
the health problems in Phase 2 are determined and ranked.
Environmental risk factors are defined as the factors outside an

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individual that have any affect on behavior, health and quality of
life.

Phase 4, Educational and Organizational Diagnosis, of this

model, like its predecessor, identifies and classifies the
predisposing, reinforcing and enabling factors, which can
potentially influence behavior. These factors have already been
described in this document. Once again, priorities must be set,
and those ranked highest in these three categories will help to
determine the focus of the intervention(s).

In the fifth step, Administrative and Policy Diagnosis, a

determination is made if the capabilities and resources are
available to develop and implement the program. Limitations or
constraints of resources, policies, abilities and time are assessed.
This completes the final phase of PRECEDE (the diagnostic
portion) as PROCEED (implementation and evaluation) begins.

In Phase 6, Implementation, with the proper resources in hand,

the appropriate methods and strategies of the intervention are
selected.

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Phases 7 (Process Evaluation), Phase 8 (Impact Evaluation)
and Phase 9 (Outcome Evaluation) focus, of course, on
evaluation and are based upon the earlier phases of the model
when the program objectives were outlined in the diagnostic
process.

Activity

1. Go to the nearby health institution and assess:

a. Whether they do have a plan for health education

program.

b. How the program was planned?

c. Did they conduct community need assessment during

planning?

d. Were their objectives SMART?

e. How do they monitor and evaluate the program

2. Think of any health problem in your community and develop

a hypothetical health education plan using the PRECEDE-
PROCEED model of planning.

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7. THE PEN-3 MODEL

The PEN-3 Model was originally developed to be used as a

framework for health education and disease prevention in
African countries. It has been successfully applied in child
survival interventions in these countries. This model consists of
three dimensions of health beliefs and behavior that are
interrelated and interdependent: 1) Health Education, 2)
Educational Diagnosis of Health Behavior and 3) Cultural
Appropriateness of Health Behavior. The model is illustrated in
categories that form the acronym PEN for each of the three
dimensions. The first dimension of the PEN-3 model is Health
Education. An explanation for the acronym in this first
dimension is:

P - Person. Health education should be committed to

improving the health of everyone. Therefore, individuals
should be empowered to make informed decisions, which
are appropriate to their roles in their families and
communities.

E - Extended Family. Health education should be targeted

to not only the immediate family but also to the extended
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family or kinships. When the program is designed to target
a particular member of the family, the individual should
become the focus within the context of that person's
environment.

N - Neighborhood. Health education should be committed

to promoting health and preventing disease in
neighborhoods and communities. Involvement of
community members and their leaders is critical to
providing culturally appropriate health programs. The
second dimension of the PEN-3 model is the Educational
Diagnosis of Health Behavior. Researchers have used
educational diagnosis in an attempt to determine what
factors affect individual, family and/or community health
actions. According to its author, this dimension has evolved
from three models in health education: 1) Health Belief
Model; 2) Theory of Reasoned Action; and 3) the
PRECEDE framework. The factors in the second
dimension are:

P - Perceptions. These are the knowledge, attitudes, values

and beliefs that may facilitate or hinder personal motivation
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to maintain or change health beliefs and/or practices. Two
examples of this might be that being overweight is not
necessarily associated with a negative body image for many
African Americans or those teenage pregnancies among
African Americans may, in fact, be desired. Appropriate
health education interventions should begin with the
person's "perceived" needs and desires rather than those
"real" needs as defined by planners.

E - Enablers. These are societal, systematic or structural

influences (forces) that may enhance or create barriers to
maintain or change health beliefs and/or practices. These
could include available resources, accessibility, referrals,
skills or types of services.

N - Nurturers. These are the reinforcing factors that an

individual may receive from significant others. These
important others could include extended family, peers,
employers, health personnel, religious leaders or
government officials.

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The third and most crucial dimension of the PEN-3 Model is the
cultural appropriateness of health beliefs. This is essential to
developing a culturally sensitive health education program for
ethnic minority cultures. The three factors in these final
dimensions are:

P - Positive. These are the perceptions, enablers and

nurturers that may cause an individual, family or
community to engage in health practices that contribute to
improved health status and must be encouraged. These
positive health practices are essential to the empowerment
of people, families, neighborhoods and communities. One
example is the traditional practice of eating green
vegetables.

E - Exotic. These unfamiliar practices have no harmful

health consequences and therefore do not need to be
changed. Programs should address "what is" instead of
"what ought to be."

N - Negative. These perceptions, enablers and nurturers

may lead individuals, families or communities to follow

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health practices that are harmful to their health. An
example would be unprotected sexual intercourse.

Health educators should focus on both the positive

(empowerment process) and the negative behaviors in a health
program. This can lead to a higher level of sensitivity when the
planner(s) are selecting the most culturally appropriate
educational intervention.

8. APEXPH and PATCH

o Assessment Protocol for Excellence in Public Health

(APEXPH) and Planned Approach to Community Health
(PATCH) are two planning processes developed by the
Centers for Disease Control & Prevention.
o These two models differ in what they are designed to
accomplish and also in how they are used. Both may be
used in the same community. However, it is not
recommended that these two processes begin at the same
time. APEXPH was designed for use by local health
departments in meeting the public health needs of their

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 communities. A workbook is available to health
departments, which is divided into three major parts:

In Part I, Organizational Capacity Assessment, the director

of the health department and a team conduct an internal self-
assessment and create an action plan for the organization. This
plan should set priorities and build on strengths to correct
perceived weaknesses in meeting the public's health needs.

During Part II, a community advisory committee should be

formed. This committee identifies and prioritizes health
problems, which require attention. Health status goals and
program objective are also outlined. Depending on the public
health objectives, certain community resources are activated.
The Community Process should include the collection and
analysis of health data, the community's perception of its health
status, and the involvement of the health advisory committee
throughout the development of a community health plan.

In Part III, Completing the Cycle, the basic monitoring and

evaluation tools must be used to ensure that the Organizational
Action Plan (in Part I) and the Community Health Plan (in Part

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II) are carried out with the desired results. By performing these
tasks, the assessment, policy development and assurance
functions should become an on-going cycle in the health
department (i.e. institutionalized).

PATCH is a process designed to increase a community's

capacity to organize its members, collect and use community
data, set health priorities, select and implement appropriate
interventions, and perform both process and impact evaluations.
This model has been described as a "bottom-up" rather than a
top-down approach to health education program planning and
follows the PRECEDE Model (1980) fairly closely. It is
primarily intended for chronic disease prevention and health
promotion programs.. Although applicable to either rural or
urban settings, in the past PATCH has been used more in rural
populations than in urban. Urban and minority populations were
less likely to be targeted. There are five phases in this process:

Phase I: Mobilizing the Community - A community group is

formed to define the community, address health issues, and
create working groups to carry out the remaining phases.

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Phase II: Collecting and Organizing Data - Data (mortality,
morbidity, behavioral, community opinion) are gathered and
analyzed. The community group uses these analyses to
determine health priorities and program planning. One criticism
at this stage was that the gathering and analyzing of data
required so much time that several communities involved in this
process lost momentum.

Phase III: Choosing Health Priorities and Target Groups -

Health priorities are identified, existing community resources,
policies and programs are identified, target groups are selected,
and objectives for the community are set by the community
group. It has been recommended from studies of communities
where PATCH has been implemented that a community capacity
assessment should be conducted before the community needs
assessment.

Phase IV: Choosing and Conducting Interventions - Target

groups are involved in the design and implementation of health
intervention activities. Volunteers are recruited and trained, and
these planned interventions are conducted.

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Phase V: Evaluating PATCH Process and Interventions -
Just like Phase I, this phase is an on-going part of this process.
The impact of the intervention activities, as well as the impact of
the process of PATCH, upon the community should both be
evaluated.

Other suggestions for improving the PATCH process include:

1. Technical assistance should be provided

throughout a project, not just at the beginning
by CDC.
2. At least one full-time community coordinator
should be funded.
3. Multiple interventions centered around one
chronic condition at a time should be stressed.
4. Institutionalization of the program must be
emphasized.

9. Formative Evaluation, Consultation, and Systems

Technique

Formative Evaluation, Consultation, and Systems Technique

(FORECAST) is a system of formative evaluation designed to

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aid in the development, planning, and implementation of
community health projects. Formative evaluation would be any
evaluation that produces information used in the developing
stages of a health education program in order to improve it. This
systematic analysis of the program provides ongoing
information to affect decision-making, action on policy,
allocation of resources, and program operations. In this process,
the evaluators would be most effective by providing "frequent
feedback" on the development of the project. This may require
years of feedback since some community health programs are in
a contact state of development after their initial start-up.
FORECAST has previously been applied to community-based
program initiatives in South Carolina with the aim of & quto;
preventing and reducing alcohol, tobacco, and other drug
abuse." A

Unit Summary

o In this unit you should have to remember about: -

o The definition of planning
o Steps in planning

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 o Models of planning
o The PRECEDE-PROCEED model of planning and its
constructs.

Exercise

1. What is planning?

2. Explain the steps of health education planning

3. Discuss each phases of PRECEDE-PROCEED mode

References

1. Lawrence W. Green et al. 1980. Health education planning a

diagnostic approach

2. Getnet Mi tike 2003 health education for health science

students. Lecture note series. Addis Ababa University, Ethiopia

3. WHO 1969. Planning and evaluation health education

services. Report of WHO expertcommittee. TRS 409. WHO,
Geneva

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4. Pisharoti K.A. 1975 Guide t o the integration of health
education in environmental health programs. WHO.

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 UNIT EIGHT: RESEARCH METHODS IN HEALTH
EDUCATION

Unit objectives

At the end of this chapter students will be able to:

o Define research.
o Explain the role of research in health education.
o Compare qualitative and quantitative research
methods.
o Explain the purposes of doing qualitative researches.
o Identify the different keys to successful qualitative
researches.
o Identify the different types of data collection methods
used in qualitative researches.
o Explain the techniques of developing KAP
questionnaire in quantitative research methods.

8.1. Introduction

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 o Research is a process which involves a systematic
collection of pieces of information required to answer
particular questions t hat are helpful in understanding a
certain issue in a detailed and scientific manner.
o As one of the various health programs, health education
programs should be guided and directed by scientific
evidences drawn from researches.
o One important reason why many health education
programs fail to achieve their purposes is that often the
activities are planned and implemented with a poor
understanding of the health problem we are dealing with
and poorer understanding of the factors responsible for the
problem.
o Hence, for health education programs to be effective, their
planning, implementation and evaluation should be directed
with scientific evidences drawn from the systematically
conducted research. Therefore, this unit will give you a
brief description of qualitative research methods in health
education and promotion.

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 o There are two major types of researches quantitative &
qualitative types. The former type of research is
descriptive in its nature, objective, & deals with measurable
behavior & attitude.
 Qualitative research is a type of formative research that
offers specialized techniques for obtaining in-depth
responses about what people think & how they feel. The
following is comparison of the two methods:

8.2. Comparisons of qualitative and quantitative research

Qualitative research Quantitative

Research

Subjective - Objective
Explanatory - Definitive
Obtains in-depth responses about - Level of
occurrence
what people think & how they feel

To gain insight into attitude beliefs, -

Measures level & action
motives & behavior
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 One of discovery research - Pursues
proof
Interpretive - Descriptive
Deals with emotional & contextual - Objective,
measurable
aspects of human responses behavior &
attitude.

Answers the question why - How many, when,

where, how often.
Involves small number of participants - Large
probability sampled
who are not sampled on probability sample

The two primary qualitative research techniques are:

Individual depth interview (in-depth
interview), &
Focus group discussion (FGD)
FGD capitalizes on group dynamics & allow a small
group of respondents to be guided by a skilled
moderator into increasing levels of focus & depth on
the key issues of the research topic.

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 In-depth interview – are characterized by extensive
probing & open ended questions which are conducted
on a one – on – one basis between the respondent &
highly skilled interviewer.

8.3.K. A. P. Surveys

o Knowledge, attitude, & practice are thought to be important

determinants of health, in addition to biologic & health
service factors.
o Practice refers to health behaviors. Because of the importance
attributed to KAP in health, researchers want to find out what
people know, feel, & practice. KAP questionnaires are
designed usually in the order of PAK.

Practice – is assessed by asking what a person currently does &

giving an exhaustive list of options, to each of which the person
responds yes or no. Important guidelines:

Be specific about behavior

Ask most recent practice
Include all practices not only good ones.
Vary through observation or questioning.

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Attitude: is asked in terms of:

What a person prefers to do

What they would do if they had the choice
How favorable – unfavorable, or positive –negative they
are to the object.

8.3.1 How to develop KAP questionnaire

o Operationally define what is meant by knowledge, Attitude,

& Practice. Keep to these definitions when you make up
the items
o Develop items systematically to include all the relevant
ones
o Phrase items in lay terms not in professional terms.
o Combine items that bear on the same practice
o To improve the reliability, include at least 10 items for each
K, A, & P
o Order items as follows – PAK – to minimize contaminating
P answers with K items.

8.3.2. Critique of KAP studies

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 o It is often assumed that K + A = P & that to change P,
one must first change K & A. However, this equation is
faulty. Changing K & A does not always lead to a
change in P. Also other variables enter the question,
such as access & social pressure.
o Respondent’s answers to KAP questions are often biased
by their limited recall & their desire to please the
interviewer.
o The questionnaires are limited to KAP that are being
questioned; items must be continuously improved to
reflect the new situation. Add items that are found to be
predictive of practices, even though they do not fit the
categories of K & A.

8.4. Basic Techniques of Data Collection

1) Health service records (registration books)

2) Interview
3) Surveys
4) Observation
5) Focus Group Discussion (FGD)

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Unit summary

o Generally, research is a process which involves a

systematic collection of pieces of information required t o
answer particular questions in scientific manner and the
practice of health education should be guided and directed
by scientific evidences drawn from researches.
o Qualitative research method is the most commonly used
research methods in health education and promotion. It
offers specialized techniques for obtaining in- depth
responses about what people think and how they feel.

Exercise

1. What is research?

2. What is the importance of research in health education?

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3. Compare contrast quantitative and qualitative research
methods

4. Differentiate between the two qualitative research data

collection methods

References

1. WHO 1969. Research in Health education Report of a WHO

scientific group. TRS 432. WHO Geneva

2. Ramachandran L. and Dharmalingam. T. 1995. Health

education’s new approach.

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