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Health promotion
• Introduction
• WHO, 1946: ‘Health is a state of complete physical, mental & social
well-being and not merely the absence of disease or infirmity’.
• SMITH, TANG & NUTBEAM, 2006: ‘Wellness is the optimal state of
health of individuals and groups (including) the realization of the
fullest potential of an individual physically, psychologically, socially,
spiritually and economically, and the fulfillment of one’s role
expectations in the family, community, place of worship, workplace
and other settings.’

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• HEALTH PROMOTION The process of enabling people to
increase control over their health and determinants and thereby
improve their health (WHO 2006) in Bankok charter .
• 1986 Ottawa charter for health promotion, WHO defined health
promotion as ‘the process of enabling people increase control over,
and to improve their health.’
• The above definition clearly states that individuals should be engaged
in supporting their own health.

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Health promotion: individual and community activities to promote
healthful lifestyles e.g. improving nutrition, preventing alcohol and drug
misuse, maintaining fitness and exercising.
Health protection: actions by government and industry to minimize
environmental health threats e.g. maintaining occupational safety,
controlling radiation and toxic agents and preventing infectious diseases
and accidents.
Preventive health services: actions of health care providers to prevent
health problems e.g. control of high blood pressure, control of STDs,
immunization, family planning and health care during pregnancy and
infancy
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CONCEPTS OF HEALTH PROMOTION
Process enabling individually and collectivelly increase control over
determinants of their health, and improve health status. (WHO, 1998)
It does not mean only responsibility of the health care system, but
also individual responsibility for health expressed via life style.
(Kebza, 2005)

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Determinants of Health
Life style (50%)
Environment (cultural, economic, social and physical conditions
of life) (20%)
Genetic background (20%)
Health care system (10%)

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Components of Health Promotion

Health protection implemented by public health policy

Health education

Intervention programmes

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Health Promotion
Important Policy Documents
Ottawa Charter (1986)
Health for All 21 and WHO key strategies
European Health Policy ( 1999)
National Health Programme (1995)
National Environment and Health Action Plan of CR (1998)
Law No. 258/2000 on Public Health Protection (2000)
Longterm Programme on Improving Health Status of Inhabitants
of CR – Health for All 21 (2002)
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WHO - Key strategies of health promotion
Strategy on environment and children health (2002)
Global strategy on nutrition, physical activity and health (2003)
Framework convention on tobacco control (2003)
European action plan against alcohol (2003)
Declaration on mental health for Europe (2005)

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National Health Programme
Increase the knowledge of people on healthy life style
Increase the knowledge of people on possibilities of disease
prevention
Encourage changes of behaviour
Create coalitions for health promotion in the society

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Health Promotion includes
• Promoting healthy lifestyles.
• Getting people involved in their own health care.
• Creating an environment that makes it possible to live a healthy
life.
• Recognition of lifestyle diseases as major causes of illness and
death.
• Strengthening community participation.

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Health promotion in Kenya;
• Started in 1953 and fully functional in 1955
• Aimed at educating Kenyan population on matters related to
their health so that they can:-
• Protect self from diseases
• Promote health by adopting good health practices
• Becomes aware of health services to be utilized
• Adopt and practice environmental sanitation
involvement and participation of community.

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• Health promotion takes a wider perspective. For health promotion to
be effective, it is essential that health workers begin by actively
listening and finding out why people do things the way they do

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Concepts of Health promotion
• There are three levels of health promotion:
• Primary prevention: focuses of health promotion and
protection against specific health problems. There4, primary
preventive measures are directed towards the ‘well’ individuals
in the prepathogenesis period to promote their health and to
provide specific protection from diseases e.g. immunization
against diseases such as Diphtheria, tetanus, pertussis (DPT)
AND Polio. The purpose of primary prevention is to reduce
the risk of exposure of the individual or community to disease.
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Secondary prevention
• Focuses on early identification of health problems and prompts
intervention to alleviate health problems.
• Its goal is to identify individuals in an early stage of a disease process
and to limit future disability.
• Secondary preventive measures are applied to diagnose or treat
individuals in the period of pathogenesis.

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Tertiary prevention
• Focuses on restoration and rehabilitation with the goals of returning
the individual to an optimum level of functioning.
• Therefore, tertiary prevention addresses rehabilitation and the return of
people with chronic illness to a maximal ability to function.

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Background of Health promotion
• Health promotion received a big boost at the Alma Ata International
Conference on Primary Health Care (PHC) in 1978.
• PHC was identified as an approach that would ensure health services
are accessible, acceptable, affordable and available to all people in the
world
• The Alma Ata declaration identified various key elements for PHC
implementation, with health education being ranked as the most
important approach for effective health promotion and disease
prevention.

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OTTAWA CHARTER FOR HEALTH
PROMOTION
• Following Alma Ata declaration, the first international conference on
health promotion was held in 1986 in Ottawa, Canada.
• The Ottawa charter for health promotion adopted by 38 countries was
primarily a response to growing expectations for a new public health
movement across the world
• The charter called for the active role of the community which
emphasizes that people cannot achieve their fullest health potential
unless they are able to take control of those things which determine
their health

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• Ottawa charter defines health promotion broadly as ‘the process of
enabling people to increase control over and to improve their health’.

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IMPORTANT AREAS FOR CONSIDERATION
IN HEALTH PROMOTION

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Health promotion priority action areas
identified in the Ottawa Charter include:-
• Build healthy public policy- health promotion policies include
legislation, fiscal measures, taxation and organization change. This
requires identification of obstacles to the adoption of healthy public
policies in non-health sectors and the development of ways to remove
them.
• Promotes healthy policies in all sectors , eg healthy workplaces,
schools, homes, buildings, villages and communities.
• Health aspect should be thought of and included in the policies of the
various sectors.
• Health Policies should also emphasize the prevention and promotion.
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• Create supportive environments- the protection of the environments
and the conservation of natural resources must be addressed in any
health promotion strategy.
• Healthy physical, social and economic environment.
• All development activities should aim for a healthy environment –
healthy buildings, roads, workplaces, homes, surroundings and
schools.

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• Strengthen community actions- to develop systems for strengthening
public participation in health matters. Requires full and continuous
access to information and learning opportunities for health, as well as
funding support.
•

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• Develop personal skills- enabling people to learn and cope with
chronic illness and injuries. Has to be facilitated in schools, home,
work and community settings.
• Information and education for personal and family health.
• Take account of values, beliefs and customs of the community.
• Continuous process at all stages of life.
• Guided and supported in developing skills (not imposed on them).
• Build on existing knowledge and attitudes.

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• Re-orient health services- the role of the health sector must move
increasingly in a health promotion direction, beyond its responsibility
for providing clinical and curative services.
Since lifestyle is linked to many of today’s health problems, prevention
and promotion should decrease the burden on secondary (curative)
health care.
• Greater emphasis and resources placed on health promotion and primary
health care.
• Less emphasis on purchase of high tech equipment for secondary health care.
• Equity in health care.

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Empowering communities to achieve well-
being
• Moving into the future- women and men should become equal
partners in each phase of planning, implementation and evaluation of
health promotion activities
• Involvement of the community in health decisions, a multisectoral and
participatory approach.
• Provide communities with the information and tools to take actions to
improve health and well-being.

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Principles of health promotion
• Empowering – enabling individuals and communities to ensure more power
over the determinants of health
• Participatory – involving all concerned at all stages of the process
• Holistic – fostering physical mental and spiritual health
• Inter-sectoral – involving the collaboration of agencies from relevant sectors
• Equitable – guided by a concern for equity and social justice.
• Sustainable – bringing about changes that individuals and communities can
maintain once funding has ended
• Multi-strategy – use of a variety of approaches including policy development
organizational change community development, legislation (root man 2001 )
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Strategies of health promotion
• There are three main strategies used in the implementation of health
promotion:
a) ENABLING
• In health promotion, enabling means taking action in partnership with
individuals or groups to empower them, through the mobilization of
human and material resources, to promote and protect their health
• Seeks to strengthen people’s knowledge and the skills required to
prevent ill health, enhance and protect healthy behavior. Achieved
mainly through education, IEC and social mobilization interventions
among individuals and communities.
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2. Creating environments that
are supportive of health
• In order to create and sustain environments that are supportive of
health, health promotion facilitates mediation in society.
• Mediation- process through which the different interests of individuals
and communities and different sectors, both public and private, are
reconciled in ways that promote and protect health
• Achieved through legal, economic and environmental policies and
legislation.

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Advocacy to create the essential
conditions for health
• Advocacy for health implies a combination of individual and social
actions designed to gain political commitment, policy support, social
acceptance and systems support for a particular health programme.
• Advocacy may be carried out through lobbying, social marketing, IEC
and community organizing.

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APPROACHES TO HEALTH
PROMOTION
• Medical or Preventive approach
• Behaviour Change Approach
• Educational approach
• Self-Empowerment approach
• Societal Change approach

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THE MEDICAL APPROACH
• Aim is freedom from medically-defined diseases and disability such as
infectious diseases.
• Involves medical intervention to prevent or ameliorate ill-health
• Values preventive medical procedures and the medical profession’s
responsibility to ensure that patients comply with recommended
procedures

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THE BEHAVIOUR CHANGE APPROACH
• Aim is to change people’s individual attitudes and behaviour so that
they adopt a healthy lifestyle
• Examples include teaching people how to stop smoking, encouraging
people to take exercise, eat the right food, look after their teeth etc
• Proponent of this approach will be convinced that a healthy lifestyle is
in the interest of their clients and that they are responsible to
encourage as many people as possible to adopt a healthy lifestyle

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THE EDUCATIONAL APPROACH
• Aim is to give information and ensure knowledge and understanding
of health issues and to enable well-informed decisions to be made
• Information about health is presented and people are helped to explore
their values and attitudes and make their own decisions
• Help in carrying out those decisions and adopting new health practices
may also be offered

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THE CLIENT-CENTRED APPROACH
(EMPOWERMENT)
• Aim is to work with clients in order to help them to identify what they want
to know about and take action on and make their own decisions and choices
according to their own interest and values
• Health promoter’s role is to act as a facilitator in helping people to identify
their own concerns and gain the knowledge and skills they require to make
things happen
• Clients are valued as equal who have knowledge, skills and abilities to
contribute, and who have an absolute right to control their own health
destinies
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THE SOCIETAL CHANGE APPROACH
• Aim is to effect changes on the physical, social and economic
environment, in order to make it more conducive to good health
• Focus is on changing society not on changing the behavior of
individuals
• Proponent of this approach will value their democratic right to change
society and will be committed to putting health on the political agend

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AIMS OF HEALTH PROMOTION
1. health awareness goal
2. Improving knowledge
3. Self empowering
4. Changing attitude and behavior/lifestyles
5. Societal /environmental change changing social or physical
environment

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AIMS AND METHODS IN HEALTH
PROMOTION

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Elements of health promotion
1. good governance for health
2. Healthy cities
3. Healthy

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Good governance for health
• Strengthening governance and policies to make healthy choices that
are Accessible and affordable to all
• To create sustainable system that make whole of a society
• It is about the role of the government in health and its relation to other
actors whose activities impact on health. This involves overseeing and
guiding the whole health system, private as well as public in order to
protect the public interest” (WHO, 2008)

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Principles of good governance
• Stewardship
• Transparency
• Accountability
• Participation
• Fairness
• The rule of law

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HEALTHY CITIES

• Creating greener cities that enable people to live,work and play in

harmony and good health

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HEALTH LITERACY

• Increasing knowledge and social skills to help people to make the

healthiest choices

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Methods of health promotion
assignment
1. Audio
2. Visual aids
3. Role play
4. Songs
5. Barazas
6. Schools
7. Groups

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An organized Community Dialogue
• A community dialogue is a process of joint problem identification
and analysis leading to modification and redirection of community and
stakeholders’ actions towards preferred future for all.
• A community dialogue is an interactive participatory communication
process of sharing information between people or groups of people
aimed at reaching a common understanding and workable solution.
Unlike debate, dialogue emphasizes on listening to deepen
understanding.
• It develops common perspectives and goals and allows participants to
express their own views and interests.
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Dialogue
• Allows expression of different views.
• Participants listen to understand and gain insight.
• Questions are asked from a position of curiosity.
• Participants speak with free minds.
• New information surfaces.

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CONCEPTS AND PRINCIPLES OF COMMUNITY
DIALOGUE

• Community dialogue is based on the following two main

principles:
a) Problem based adult learning
• Individuals will go for things that are relevant to them.
• Individuals have a lot of knowledge, skills and
experience, which can be built on or improved.
• People like to be respected and will eagerly participate in
issues that affect their lives.
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Negotiation (dialogue is a
process of bargaining, give and
take)
• Dialogue focuses on the problem to be solved together with all
parties based on existing experience, capabilities and opportunities
rather than pre-determined messages that must be communicated
by one party and received by the other.
• All partners involved, service providers and the community may
experience behavior change in the process of dialogue.

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OTHERS
• Sensitivity to local, family and community experiences: working by
invitation and commitment and not imposition.
• Facilitation rather than intervention of experts.
• Use of participatory approaches with space for listening, inclusion,
agreement and expressions of concerns.
• Respect for differences and mutual trust.
• Willingness of facilitators to engage in a process of self–development.
• Working in partnerships with non-governmental and community based
organizations
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Objectives for conducting
community dialogue
Generating deeper understanding of the nature of the epidemic among
individuals and communities in order to influence change.
Surfacing common issues and the resources to address them, (helps
identify barriers to positive change and uncover innovative ideas).
Building a pool of resource persons with transformative leadership
abilities and facilitation skills to scale up the community response to
HIV and other related development issues.

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Providing a forum for the unheard to be heard.
Promoting social contacts among various groups in the community.
Promoting self-esteem, self-confidence, tolerance, trust,
accountability, introspection and self-management.
Promoting ownership and accountability.

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Characteristics and key
components of a community
dialogue
• It is firmly rooted in a common set of core values (inspiring,
harmonizing).
• It is directed towards a freely agreed common purpose.
• It is based on mutual respect, recognition and care.
• It is enabled by a safe environment and based on integrity.
• It entails genuine listening and acceptance of feedback even if it is
different from what is expected.

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Benefits of conducting
community dialogue
• It helps to identify and enlist key individuals for sustainable partnerships.
• It helps solicit community participation, support and commitment in
problem solving for sustainable behavior change.
• It promotes sharing of information and ideas between individuals of
different cadres and backgrounds.
• It facilitates joint community assessment to identify community problems
and effective solutions
• It promotes deeper understanding of communities, their situation, current
practices, interests, existing opportunities and challenges for sustainable
behaviour change.
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A good dialogue offers those
who participate the opportunity
to:
• Listen and be listened to so that all speakers can be heard.
• Speak and be spoken to in a respectful manner.
• Develop or deepen understanding.
• Learn about the perspectives of others and reflect on ones own views.

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Challenges of community
dialogue
• Dialoguing is time consuming; therefore timing for dialogue should be
appropriate.
• It requires good facilitating skills.
• It requires a good and suitable venue, which is free from any
disruption and where the participants are comfortable.
• Poor preparation and planning affects the quality of discussions during
dialogue sessions.

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Problem identification
• The first step in conducting a community dialogue is to identify the
problem or issue at hand. In this case the issue could be HIV and AIDS
focusing on HIV testing and counselling (HTC), human rights or gender.
It could be poor hygiene and sanitation due to lack of clean water and
sanitary facilities.
• At this point the team will identify current problems/ issues. What the
community is doing about these issues, whether the actions are giving
the required outcomes and what are the constraints / challenges faced by
the community.
• The gaps between the preferred behaviour and current practices will
determine what will be required to address the problem.
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Problem analysis
• Problem analysis involves a thorough analysis of the issue /situation at hand.
Questions that can be asked under this section include:
• What are the causes of the problem /issue at hand?
• Is the issue /problem a shared problem in this community or it is perceived as
a problem for only a few?
• How is the community responding to the problem? What is the community’s
current knowledge? What are current attitudes, practices and beliefs about the
issue at hand?
• Has the community previously dialogued on the issue?
• Have traditional, religious and political leaders been involved in trying to
address the problem /issue at hand?
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Identification of the best option
• This section shall assist the user to identify the best options. In doing
this, emphasis is placed on actions to be taken to achieve the intended
behaviors and how to sustain them.
• Identified options are prioritized based on their effectiveness,
feasibility, relevance and appropriateness within the community’s
context

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Priotization and joint planning
• At this planning stage participants will examine the priorities set
during the previous step before designing an appropriate Community
or Village Action Plan. The plan will include the following elements:
• What will be done.
• When it will be done.
• Who will do what.
• Resources required and potential challenges.
• Measures or indicators of success.
• Participatory tools for monitoring and evaluating actions.
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Acting together
• After collectively developing an action plan, implementation of the
plan should be conducted in a participatory manner, with each member
recognizing her/his role in the project.
• It is therefore important to build commitment of the various
community members and stakeholders in order to ensure the success
of the project.

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Monitoring evaluation and feedback
• Participatory evaluation involves a collective reflection of achievements,
identifying what went well and why particular actions did not go well.
• Participatory evaluation creates a learning process for the program
recipients, which helps them in their efforts.
• After the evaluation process the necessary feedback should be provided.
• This promotes ownership of the process and the will to do better next
time.
• Reinforcement is also important to motivate participants to do better or
sustain the desired behaviour.

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HEALTH EDUCATION
• Education= It’s an act or process of imparting or acquiring
general knowledge, developing power of reasoning and judgement.
• Health education
• Is a combination of learning experiences designed to help individuals
and community improve their health by increasing their knowledge or
influencing their attitude.
• Is a process that informs, motivates and help people to adopt and
maintain healthy practices and lifestyles

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Health education
any combination of planned learning experiences based on
sound theories that provide individuals, groups, and
communities the opportunity to acquire information and
the skills needed to make quality health decisions.
A process of learning in an individual through which he alters his
behavior or changes his altitude towards healthy practices as a result
of new experiences he has gained

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The World Health Organization defined Health
Education
•
comprises of consciously constructed opportunities
for learning involving some form of communication
designed to improve health literacy, including
improving knowledge, and developing life skills which
are conducive to individual and community health.

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Health education It includes
• Raising awareness on health issues and factors contributing to health
• Providing information
• Motivating and persuading people to make changes in their lifestyle
for health
• Equipping people with the skills and confidence to make those
changes.

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Purpose/aim of Health education
1. To enable people to change their perceptions to disease
causation
2. To enable them to change attitudes towards the various
aspects of disease causation and subsequently change
their lifestyle towards the aspect of the environment and
lifestyle that can cause disease
3. To change people’s knowledge and understanding on
disease prevention and control
4. To help people to acquire skills that can help in change
of behavior
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5. To encourage people to adopt and sustain healthful
life patterns to use judiciously and wisely the health
services available to them and to make their own
decisions, both individually and collectively to improve
their health status and environment

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Objectives of health education
W.H.O (1954) stated the objectives of H/E as follows:
 To make health an asset valued by the individual, family and community.
 Help individual, family and community become competent in identifying
their health problem and assume responsibility in solving them.
 Help them find ways and take appropriate action to prevent illness.
 Promote the development and proper use of available health services.

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PRINCIPLES OF HEALTH
EDUCATION
A principle is a fundamental truth or guide post on which you base your
policies and actions
• Health education should be based on felt needs of the community ( relevant
needs )
• It should be based on the principle of active learning.
• Learning goals must be realistic
• Always start from the known to the unknown
• Identify the level of understanding , education or literacy of the audience.
Use language and symbols which are easily understood by the people.
• Reinforce the message by repeating them using different methods.
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• Consider resources available to help motivate the people to desire a
change in their practices.
• Provide opportunities for demonstration and return demonstration.
• Health workers should have prior knowledge of people’s cultural
background i.e. customs traditional practices, health seeking habits etc.
• Choose appropriate instructional strategy or approach e.g. one-to-one ,
group meetings in various settings etc.
• Maintain good human relations with the audience
• Community leaders must be involved in the programme.
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Health promotion models assignment
• Medical
• Motivational
• Social intervention

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Theories of Learning
Classical Conditioning by Ivan Pavlov
Operant Conditioning by B.F. Skinner
Cognitive Learning by Jean Piaget
Social Learning by Albert Bandura

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Classical Conditioning
 By Ivan Pavlov,(1849-1936). Was a Russian Physiologist who experimented on
dogs.
 Pavlov demonstrated that dogs could be conditioned to salivate in response to new
stimulus, such as ringing bell or light, if this had been paired or presented together
with food several times.
 The food is the unconditioned stimulus (US) & the bell is the conditioned
stimulus (CS). Salivation is the conditioned response (CR).
 Bell + food led to salivation; Salivation on eating and smell of food; Later,
salivation after ringing the bell without food, after several episodes where the bell
preceded the food.
De-conditioning:
 Ringing of bell followed with electric shock or pain will dissociate bell with food.
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Operant conditioning
• B.F. Skinner studied the relationship between behaviour and their
consequences.
• Animals and people learn to operate on the environment to produce
desired consequences.
• Learning in this case is under the control of the individual, who
operates or influences the environment, hence the term operant
conditioning
• There is a reward or a punishment for behaviour, hence learning
occurs.

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Cognitive learning
 According to Jean Piaget, learning can occur without reinforcement
of overt actions, a process he called latent learning.
 The proponents of this theory argue that human being is not a
passive organism, but is capable of processing information and
comprehending the relationship between cause and effect. The
processed information is stored and may be retrieved later when
required.
 One actively constructs knowledge through negotiation and social
interaction with the immediate environment.

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Social Learning Theory
• Albert Bandura.
• Considers how individuals learn through observing the behavior of
others. i.e. most human behavior is learnt observationally through
modeling.
• This theory proposes that people learn by imitating the behavior of
other people. Other terms used are role modelling and identification.

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COMPONENTS OF HEALTH
EDUCATION
1. Motivation – is the process of creating an interest and desire in a
person to do something. For successful motivation, the health provider
must;
• Give accurate and complete information.
• Hold the attention and stimulate the interest of the individual.
• Use of the leaders and ‘satisfied adopters’ in the community.
• Provide encouragement to the individual.
• Make available the necessary facilities.
• Ensure that the services are of high quality.
• Provide follow-up to the individual.
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Approaches to health education
2. Communication-refers to giving and receiving of verbal and non-
verbal messages or information. During health education the health
provider must follow the following rules;
• Do not give too much information at one time.
• Choose a topic that is closely related to the needs of the people.
• Choose a time and place that is convenient to the people.
• Use simple language.
• Use a combination of different strategies e.g. lecture/talk, demonstration and
return demonstration, to keep the people interested.
• Use of relevant teaching aids.

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3. Decision making- is deciding in advance/planning for health
education. When planning the health education program, take the
following measures;
• Know the problem/felt need of the community by observing, interviewing,
record review and conducting surveys.
• Know the type of people (youth, children, adults) and the place.
• Find out the available resources i.e. funds, staff and equipments.
• Select the method of teaching and the appropriate materials.

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LESSONPLAN
• Systemic planned summary of teaching/learning process which consist of the
topic to be taught, objectives, content and teaching /learning resources
Learning objectives
• The description of the behavior expected of a client after instructions.
• Objectives are behavioral in nature and must be SMART
• SPECIFIC
• MEASURABLE
• ACHIEVABLE
• REALISTIC
• TIME BOUND
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SIMPLE LESSON PLAN
Components of a lesson plan
1. Date and time of the day
2 Topic or subtopic
3 Venue
4 Audience
5 Language used
6 Method of teaching

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5 Objectives or aims of the teaching
6 Content (body)
7 Evaluation –assess behavior change based on the set objectives
8 summary-highlighting the main points
9 Teaching/learning resources

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Content
a) Introduction
• Definition of the topic and its importance
• Assess the patients’ knowledge on the topic
b) Body
• Describe the three classes of food i.e. proteins, carbohydrates &
vitamins
• Demonstration & return on a balanced meal
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c. Evaluation
• Allow patients to ask questions or clarifications.
• Ask them a few questions to assess their new knowledge
d) Summary
• Briefly go through the main points

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APPROACHES/STRATEGIES OF
HEALTH EDUCATION
Individual teaching (one-to-one)
• At the personal level , teaching must be practical, realistic and
appropriate to the actual problem that concerns the individual e.g.
malnourished child.
Group teaching
• This involves sharing health messages with a group of people with
similar problems e.g. diabetic patients , family planning clients etc.
Mass media
• Use of radio , TV sets to reach many people eg message on an
important disease like cholera, HIV/AIDS etc.
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STEPS OF INITIATING A HEALTH EDUCATION
PROGRAMME IN THE COMMUNITY
• Assessing individual and community health education needs
• Meeting the health facility staff to lay the strategies
• Interaction with community leaders
• Plan for collection of baseline data i.e. baseline survey
• Involve the SCHMT (Sub-County Health Management Team), as your
supervisors to assist you with technical knowledge and material
support e.g. medical supplies, logistics etc.

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• Meeting with community members to decide the plan of action e.g.
venue, dates & time.
• Identify the available community resources.
• Discuss the evaluation mechanisms .
• Preparation of teaching /learning resources
• Implementation of the programme
• Evaluation of the programme i.e. to assess the effectiveness of the
programme
• Discuss with the community leaders any follow-up action required
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Learning-teaching resources
and learning experiences
Teaching Resources
• Audio- visual aids are more effective and provide lasting experience. They are more interesting with
greater depth of learning e.g.
• Models
• Specimens
• Apparatus
• Television films Posters
• Photographs
• Flash cards, slides, overhead projector
• Radio and tape recorder
• Maps
• Diagrams and printed materials
• Real objects like food stuff
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Assignment
• Differentiate between audio and non audio teaching aids
• State different examples on each teaching aid

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• Different ways of presenting the information to enhance learning include:
• Lecture Method.
• Discussion
• Demonstration
• Dramatization or role play
• Field trip
• Exhibitions
• Group work
• Assignments
• Story telling,
• Experiments
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STEPS IN DEVELOPING A HEALTH
TALK
1 Assessment of client’s needs
The nurse assess the client’s specific needs e.g.
• What is the actual problem?
• How can the person be taught?
• Can I help the person change his/her attitude for better healthy living?

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2 Planning and formulating learning
objectives
• Objectives will depend on the problems or the needs identified in the
individual or group of clients. They are behavioral in nature
(SMART)
• Allocate adequate time for learning and ensure a conducive
environment.
• Select suitable time for both the nurse and the clients.
• Select and prepare teaching resources i.e teaching aides to facilitate
the teaching/learning
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3 Implementation
• Organization at the venue
• Consider the content presentation. Do not keep the clients waiting
for too long .
• Choose appropriate method for teaching e.g. discussions, role play,
demonstrations and return demonstration

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4 Evaluation and summary
• Allow clients to ask questions and clarifications
• Assess how much learning has taken place by asking the clients
questions i.e. check for behavior and attitude change. Ask for a
return demonstration where applicable.
• Summarize the topic by highlighting the important issues, or the
main points.

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SUMMARY OF HEALTH
EDUCATION STEPS
1)Initiating the session
 Welcomes the patient/client and introduces oneself
 Determines expectations or objectives
 Determines and prioritizes problem/need
 Assesses the patient’s starting point: prior knowledge and the extent
of client’s wish for information.

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2)The process of giving information
• Gives information in a simple language
• Checks the understanding and uses patient’s response as a guide on how to
proceed.
• Gives a message which is timely, meaningful, acceptable and applicable to the
situation.
• Involves patient by making suggestions rather than being directive or
judgmental
• Encourage the patient to contribute ideas, suggestions, preferences, beliefs etc.
• Negotiates a mutually acceptable plan
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3) Closing the session
Asks the patient/client questions based on expectations /objectives
Summarizes main points
Arrange with client/patient for next steps
Closes the session and thanks the patient /client.

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Behavior Change and
Communication (BCC)
• Communication is about exchanging information, sharing ideas and knowledge. It is
a two-way process in which information, thoughts, ideas, feelings or opinions are
shared through words, actions or signs, in order to reach a mutual understanding.
• Behavior change communication (BCC) is an interactive process with communities
to develop tailored messages and approaches using a variety of communication
• Health promotion. It involves increasing people’s knowledge and awareness,
enabling them to take action to improve their health, and ensuring that their
circumstances allow them to make healthy choices. Aims to help people to live
healthy lives
• Health education any combination of learning experiences designed to pre-dispose,
enable, and reinforce voluntary adoption of behavior conducive to health.

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Principles of Effective Behavior Change
1. Target and Build Specific Knowledge and Specific Skills
• New knowledge creates the foundation for new behaviors. To increase
the likelihood of actual incorporation of knowledge into participants'
lives, however, it is important to identify and support the specific
knowledge and skills needed to support new behaviors. This can be
done through demonstration of how to do the new expected behavior.

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2. Reduce the Environmental Conditions That Support Negative
Behaviors, and Increase the Conditions That Support Positive or
Desired Behaviors
• Physical and social environments affect learning and behavior. In fact,
the basic premise of behavior modification is operant conditioning,
which maintains that behavior can be changed by altering both the
antecedents (cues) that precede behavior and the consequences that
follow a behavior.

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3. Modify Behavior Sequentially and Reward Progress
• Effective behavior change must be realistic; educators should help
participants set small very specific targets that can be achieved over a
realistic time frame (e.g., hug your child once a day; add one fruit a
day to your diet; park and walk from the far side of your work parking
lot) rather than focus on bigger longer-term results

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4. Train in Naturalistic Conditions and Settings
• When an individual learns new behaviors outside of his or her normal
environment, it can be difficult to transfer those new behaviors to
everyday life. That is why best practice programs emphasize
application in naturalistic settings.

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5. Teach Specific Cognitive Rules or Principles That Can Guide
Behavior in New Settings
• Cognition is a term referring to the mental processes involved in
gaining knowledge and comprehension. These processes include
thinking, knowing, remembering, judging, and problem-solving. These
are higher-level functions of the brain and encompass language,
imagination, perception, and planning

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6. Model and Offer Many Opportunities for Participants to Practice
the Desired Behavior
• Instructors who are excellent role models are inspirational. Moreover,
providing many opportunities to observe and practice new behaviors
within the educational setting increases the likelihood of behavior
change. Role-playing is one way to practice behaviors; however, some
participants may feel uncomfortable in role-playing. In such situations,
an instructor may model the new behavior alone or with a volunteer.

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BCC THEORIES
• Ecological Models
• The Health Belief Model
• Stages of Change Model (Transtheoretical Model)
• Social Cognitive Theory
• Theory of Reasoned Action/Planned Behavior

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The Health Belief Model

The Health Belief Model (HBM) was developed in the early 1950s by
social scientists at the U.S. Public Health Service in order to understand
the failure of people to adopt disease prevention strategies or screening
tests for the early detection of disease vulnerability to an illness or
disease.
Later uses of HBM were for patients' responses to symptoms and
compliance with medical treatments.

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The HBM suggests that a person's belief is a personal threat of
an illness or disease together with a person's belief in the
effectiveness of the recommended health behavior or action
will predict the likelihood the person will adopt the behavior.

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The HBM is derived from psychological and behavioral theory with two
components of health-related behavior
1. the desire to avoid illness, or conversely get well if already ill
2. the belief that a specific health action will prevent, or cure, illness

 an individual's course of action often depends on the person's

perceptions of the benefits and barriers related to health behavior.

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There are six constructs of the HBM.
1. Perceived susceptibility - This refers to a person's subjective
perception of the risk of acquiring an illness or disease. There is
wide variation in a person's feelings
2. Perceived severity - This refers to a person's feelings on the
seriousness of contracting an illness or disease (or leaving the illness
or disease untreated). There is wide variation in a person's feelings
of severity, and often a person considers the medical consequences
(e.g., death, disability) and social consequences (e.g., family life,
social relationships) when evaluating the severity.
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3.Perceived benefits - This refers to a person's perception of the effectiveness
of various actions available to reduce the threat of illness or disease (or to cure
illness or disease). The course of action a person takes in preventing (or
curing) illness or disease relies on consideration and evaluation of both
perceived susceptibility and perceived benefit, such that the person would
accept the recommended health action if it was perceived as beneficial.
4. Perceived barriers - This refers to a person's feelings on the obstacles to
performing a recommended health action. There is wide variation in a person's
feelings of barriers, or impediments, which lead to a cost/benefit analysis. The
person weighs the effectiveness of the actions against the perceptions that it
may be expensive, dangerous (e.g., side effects), unpleasant (e.g., painful),
time-consuming, or inconvenient.
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4. Cue to action - This is the stimulus needed to trigger the decision-
making process to accept a recommended health action. These cues can
be internal (e.g., chest pains, wheezing, etc.) or external (e.g., advice
from others, illness of family member, newspaper article, etc.).
7. Self-efficacy - This refers to the level of a person's confidence in his
or her ability to successfully perform a behavior. This construct was
added to the model most recently in mid-1980. Self-efficacy is a
construct in many behavioral theories as it directly relates to whether a
person performs the desired behavior.

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The Transtheoretical Model (Stages of Change)

The Transtheoretical Model (Stages of Change)

• The Transtheoretical Model (also called the Stages of Change Model),
developed by Prochaska and DiClemente in the late 1970s, evolved through
studies examining the experiences of smokers who quit on their own with
those requiring further treatment to understand why some people were
capable of quitting on their own. It was determined that people quit smoking
if they were ready to do so.
• Thus, the Transtheoretical Model (TTM) focuses on the decision-making of
the individual and is a model of intentional change. The TTM operates on the
assumption that people do not change behaviors quickly and decisively.
Rather, change in behavior, especially habitual behavior, occurs continuously
through a cyclical process.
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• The TTM posits that individuals move through six stages of change:
precontemplation, contemplation, preparation, action, maintenance,
and termination. Termination was not part of the original model and is
less often used in application of stages of change for health-related
behaviors. For each stage of change, different intervention strategies
are most effective at moving the person to the next stage of change
and subsequently through the model to maintenance, the ideal stage of
behavior.

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• Precontemplation - In this stage, people do not intend to take action in the
foreseeable future (defined as within the next 6 months). People are often
unaware that their behavior is problematic or produces negative
consequences. People in this stage often underestimate the pros of changing
behavior and place too much emphasis on the cons of changing behavior.
• Contemplation - In this stage, people are intending to start the healthy
behavior in the foreseeable future (defined as within the next 6 months).
People recognize that their behavior may be problematic, and a more
thoughtful and practical consideration of the pros and cons of changing the
behavior takes place, with equal emphasis placed on both. Even with this
recognition, people may still feel ambivalent toward changing their
behavior.
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• Preparation (Determination) - In this stage, people are ready to take
action within the next 30 days. People start to take small steps toward
the behavior change, and they believe changing their behavior can lead
to a healthier life.
• Action - In this stage, people have recently changed their behavior
(defined as within the last 6 months) and intend to keep moving
forward with that behavior change. People may exhibit this by
modifying their problem behavior or acquiring new healthy behaviors.

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• Maintenance - In this stage, people have sustained their behavior
change for a while (defined as more than 6 months) and intend to
maintain the behavior change going forward. People in this stage work
to prevent relapse to earlier stages.
• Termination - In this stage, people have no desire to return to their
unhealthy behaviors and are sure they will not relapse. Since this is
rarely reached, and people tend to stay in the maintenance stage, this
stage is often not considered in health promotion programs.

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The Social Cognitive Theory

• Social Cognitive Theory (SCT) started as the Social Learning Theory

(SLT) in the 1960s by Albert Bandura. It developed into the SCT in
1986 and posits that learning occurs in a social context with a dynamic
and reciprocal interaction of the person, environment, and behavior.
• The unique feature of SCT is the emphasis on social influence and its
emphasis on external and internal social reinforcement. why a person
engages in that behavior.

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• SCT considers the unique way in which individuals acquire and
maintain behavior, while also considering the social environment in
which individuals perform the behavior.
• The theory takes into account a person's past experiences, which factor
into whether behavioral action will occur. These past experiences
influences reinforcements, expectations, and expectancies, all of which
shape whether a person will engage in a specific behavior and the
reasons

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Theory of Reasoned Action/Planned Behavior

• Two closely associated theories – The Theory of Reasoned Action and

the Theory of Planned Behavior – suggest that a person's health
behavior is determined by their intention to perform a behavior.

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 A person's intention to perform a behavior (behavioral intention) is
predicted by
1) a person's attitude toward the behavior
2) subjective norms regarding the behavior. Subjective norms are the
result of social and environmental surroundings and a person's
perceived control over the behavior. Generally, positive attitude and
positive subjective norms result in greater perceived control and
increase the likelihood of intentions governing changes in behavior.

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Ecological Models

• Theory at a Glance: A Guide for Health Promotion and Practice frames

the ecological perspective as
• “...the interaction between, and interdependence of, factors within and
across all levels of a health problem. It highlights people’s interactions
with their physical and sociocultural environments.”
• Ecological models recognize multiple levels of influence on health
behaviors, including:
• Intrapersonal/individual factors, which influence behavior such as
knowledge, attitudes, beliefs, and personality.

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• Interpersonal factors, such as interactions with other people, which can
provide social support or create barriers to interpersonal growth that
promotes healthy behavior.
• Institutional and organizational factors, including the rules, regulations,
policies, and informal structures that constrain or promote healthy behaviors.
• Community factors, such as formal or informal social norms that exist
among individuals, groups, or organizations, can limit or enhance healthy
behaviors.
• Public policy factors, including local, state, and federal policies and laws
that regulate or support health actions and practices for disease prevention
including early detection, control, and management.
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Steps indeveloping behaviour change strategies

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Bcc strategies
These are strategies that help people make and maintain change.
• Consciousness Raising - Increasing awareness about the healthy
behavior.
• Dramatic Relief - Emotional arousal about the health behavior,
whether positive or negative arousal.
• Self-Reevaluation - Self reappraisal to realize the healthy behavior is
part of who they want to be.
• Environmental Reevaluation - Social reappraisal to realize how their
unhealthy behavior affects others.
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• Social Liberation - Environmental opportunities that exist to show
society is supportive of the healthy behavior.
• Self-Liberation - Commitment to change behavior based on the belief
that achievement of the healthy behavior is possible.
• Helping Relationships - Finding supportive relationships that
encourage the desired change.

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• Counter-Conditioning - Substituting healthy behaviors and thoughts
for unhealthy behaviors and thoughts.
• Reinforcement Management - Rewarding the positive behavior and
reducing the rewards that come from negative behavior.
• Stimulus Control - Re-engineering the environment to have reminders
and cues that support and encourage the healthy behavior and remove
those that encourage the unhealthy behavior.

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Assignment
• Read and make notes on the factors affecting
behavior change

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ADVOCACY AND NETWORKING
•Advocacy is the act or process of supporting a cause or issue.
•An advocacy campaign is a set of targeted actions in support of a
cause or issue. We advocate a cause or issue because we want to:
1. build support for that cause or issue;
2. influence others to support it; or
3. try to influence or change legislation that affects it

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Continuation ……..
Advocacy is speaking up, drawing a community’s attention to an
important issue, and directing decision-makers toward a solution.
•Advocacy is working with other people and organizations to make a
difference.

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Continuation ……..
• Advocacy is an action directed at changing the policies,
• positions or programs of any type of institution.
• Advocacy is putting a problem on the agenda,
• providing a solution to that problem and building
• support for acting on both the problem and solution.

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Continuation ……..
• Advocacy can aim to change an organization internally or to alter an
entire system.
•Advocacy can involve many specific, short-term activities to reach a
long-term vision of change.
• Advocacy consists of different strategies aimed at influencing
decision-making at the organizational, local, provincial, national and
international levels

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Advocacy strategies can include
1. lobbying,
2. social marketing,
3. information, education and communication (IEC),
4. community organizing,
•Advocacy is the process of people participating in decision-making
processes which affect their lives.
•Advocacy is a continuous process which leads to positive change in
attitudes, behavior, and relationships within the family, workplace, and
community, and state and society, i.e. all social institutions
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Benefits of advocacy

•Challenging the structural causes of ill-health; moving away from

addressing the symptoms.
•More sustainable approach to achieving organization's mission.
•Greater continuing impact on the living conditions of beneficiaries.
•Increased awareness of the issues.
Better informed and enabled supporters.
•Involvement in civil society, acting on ethics by encouraging action.
•Opening up new sources of funding.

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•Increased profile of organization.
•Improved links with other organizations through networks and
coalitions.
•Wider relations and improved dialogue with decision making bodies.
•Better understanding of our organization and its role in wider policy
debates.

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Risks of advocacy

•Diversion of scarce resources.

•Over extended capacity.
•Loss of organizational focus.
•Duplication of effort amongst agencies.
•Alienation of existing support by becoming overtly political.
•Creation of an internal elite of advocates.
•Distortion of message because of oversimplification.

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• Conflict of interest with partners.
•Reduction in partner security
• Damage to reputation.
•Loss of external and internal legitimacy if program work is displaced
by advocacy.

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Types of advocacy

1.Policy advocacy
2.Public advocacy
3.Media advocacy

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 Policy advocacy
• Policy advocacy initiatives focus exclusively on the policy agenda
and a specific policy goal by directly influencing policymakers. This
type of advocacy usually assumes that policy change will produce real
change on the ground.

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.Public advocacy
• Public advocacy utilizes the strength of numbers of citizens affected
by a policy issue by relying on their organized efforts to bring to the
attention of policymakers the necessity of policy change.

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Media advocacy
• Media advocacy is utilizing the various media forms to obtain
visibility to a policy issue in order to inform the public of its content,
gain allies, and influence opinion leaders and policymakers.
•The crucial element in media advocacy is to tap media practitioners
who are already sympathetic to the cause and to educate and inform
those who are still new to the issue for them to provide more coverage
and space to it in the news, opinion and feature stories.

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Advocacy process

1.Issue identification
2.Stakeholder analysis
3.Scanning the environment
4.Analysis of problems, objectives and strategies
5.Interrelated steps to determine cause-effect,
6.Message development and identifying channels of communication

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7. Advocacy action planning

8. Advocacy implementation

9. Data collection and analysis

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NETWORKING
• A network as used consists of organizations, groups and/or
individuals who are willing to assist each other and collaborate in the
advocacy of a policy issue.
•It is often temporary and is disbanded after the success or failure of
the advocacy initiative.
•The lowest form of a network is that which is banded together in a
communication relationship.

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PRINCIPLES
1. Equity
2.Transparency
3.Mutual Benefit

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• Equity means an equal right to in terms of interests, power,
influence and resources and decide and be recognized for the
contributions that an organization imparts to the network or
partnership that are not just measured by the amount of cash or role in
the advocacy initiative.
•Equity is not the same as equality.
•Treat people in a way that is appropriate to their needs

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Transparency
• Transparency includes honesty and openness as its most important
ingredients and are vital to the success of any network or
partnership.
• These are the necessary pre-conditions in building trust and
confidence among its members.
•With transparency, responsibility and accountability to its members, as
well as to the final beneficiaries, target groups and other stakeholders.

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 Mutual Benefit
• Why do organizations come together in the first place? It is to optimize
in a network or partnership what it could not do if acting alone.
•Therefore, what an organization brings and contributes to the network or
partnership it most certainly expects to have an entitlement to its
benefits. •Aside from realizing success for the common goals that will be
beneficial to all members of the network or partnership it must also create
the condition to bring specific benefits to everyone of its members.
• •In this way, continuing commitment is developed among the members
and makes the network or partnership sustainable.
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Advantages of Working Through Networks and Partnerships

•Enlarges your base of support . You can win together what you
cannot win alone.
•Provides safety for advocacy efforts and protection for members
who may not be able to take action alone.
•Magnifies existing resources by pooling them together and by
delegating work to others in coalition
•Increases financial and programmatic resources for an advocacy
campaign.
•Enhances the credibility and influence of an advocacy campaign as
well as that of individual coalition members
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• Helps develop new leadership
•Assists in individual and organizational networking.
•Broadens the scope of work.

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Disadvantages

•Distracts you from other work. Can take too much time away from
regular organizational tasks
•May require you to compromise your position on issues or tactics

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• May require you to give in to more powerful organizations. Power is
not always distributed equally among coalition members. Larger and
wider organization can have more say in decision making.
• You may not always get credit for your work sometimes the coalition
as a whole gets recognition rather than individual members. Well
run coalitions should strive to highlight their members as often as
possible.
• •If the coalition process breaks down it can harm everyone’s
advocacy by damaging members credibility.

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Sources of obstacles to networking

1.The general public

2.Actual or perceived negative sectoral characteristics
3.Personal limitations of individuals leading the network or partnership
4.Organizational limitations of partner organizations

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Information, Education &
Communication (IEC)

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• REFERENCES
1. Basavanthappa, B.T(2013). Community health Nursing 2 nd Ed.
New Delhi: Jaypee
2. Clark, C.C (2014). Health promotion for nurses, A practical
guide, Massachusetts: Jones and Bartlett publishers

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 The End
Thank You

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