HEALTH EDUCATION PERSPECTIVE

Health • Ancient India (medicine): “Ayurveda”

• Old English: “to heal” • Science of Life

• Middle English: “to be sound in body, • Holistic Approach to

mind and spirit” Healthcare

Health is a highly subjective concept. It’s Similar to Hippocratic Philosophy

meaning varies according to individual
Helps people to live a healthy and
and community expectations and content.
balanced life:good health and prevention
Many people may consider themselves and treatment of illness through lifestyle
healthy in the absence of disease, while practices (such as massage, meditation,
people with disability or disease may still yoga, and dietary changes) and the use of
consider themselves healthy if they were herbal remedies
able to manage their conditions, in such a
Ayu= Time from birth to death
way that they it does not impact greatly
on their quality of life Veda=knowledge or learning

• Classic Greek (medicine): “prolong • 17th Century (medical books):

life and prevent disease” “restoration”
Hippocratic philosophy: “ Healthy mind • 19th Century: “hygiene”
in a healthy Body”
9th century-health considered colloquial,
Greeks believed that a person has it replaced with the word hygiene as
means, it was a punishment from GOD considered being more scientific
and they pray in the special healing
temple named Asclepeia to be treated
(Asclepius= Greek God of Medicine) Health
Another way is animals are being After World War II, WHO (1948)
sacrificed in the temple and the skin of
the animals are being offered to GODs “It is a state of complete physical, mental
then, when the patient is asleep and and social well being and not merely the
ready for treatment, snakes will be sliding absence of disease or infirmity.”
across their bodies and touching them It is a dynamic state.
with their tongue
Health is dynamic and changes from time
Hippocrates emphasized on to time
environmental causes and natural
treatments of diseases, the causes and
therapeutic importance of psychological
Physical health
factors, nutrition and lifestyle,
independence of mind, body and spirit, ⚫ Anatomical integrity and
and the need for harmony between the physiological functioning of
individual and the social and natural the body.
environment
 • Presence of all body
parts
Illness
• all of them are in their
Subjective state of a Person who feels aware
natural place and
of not being well
position
Sickness
• absence of pathology
state of social dysfunction
• proper physiological
function

• working harmoniously Factors in the ecosystem which affect the

optimum level of functioning (OLOF)

Political factors - power and authority to

Mental health
regulate the environment
⚫ Ability to learn and think
Behavioral - habits, their lifestyle, health care
clearly.
and child rearing practices
• able to handle day-to-
Hereditary - congenital defects, strengths, and
day events and
health risks which can be familial, ethnic or
obstacles
racial
• work towards
Health care delivery system - primary health
important goals
care is a partnership approach to the effective
• function effectively in provision of essential health services that are
society community-based, accessible, acceptable,
sustainable and affordable

Environmental influences - the menace of

Social health pollution, communicable diseases due to poor
⚫ Ability to make and maintain sanitation, poor garbage collection, smoking,
acceptable interactions with utilization of pesticides
other people. Socio-economic influence - families in lower
• Empathy income group are the ones mostly Served

• build relationship
with others Education
• connect to positive • It is the communication of
social network information about knowledge, skills
• dealing with conflict and values of the society to each
appropriately succeeding generation to help them
acquire the intellectual and practical
methods to function in society.
Disease Health Education
Existence of some pathology or abnormality Joint Committee (2001)
of the body, which is capable of detection
using, accepted investigation method.
 “any combination of planned learning develop self-efficacy to adopt healthy
experiences based on sound theories that lifestyles resulting to healthy communities.
provide individuals, groups, and communities
the opportunity to acquire information and
the skills needed to make quality health
decisions
IMPORTANCE OF HEALTH EDUCATION
Health education is indispensable in
achieving individual and community health. 1. EMPOWERS people
It can help to increase knowledge and to 2. EQUIPS people with knowledge and
reinforce desired behavior patterns. But competencies to prevent illness, maintain
there is no single acceptable definition of health
health education.
3. ENHANCES the quality of life by promoting
Health education is the part of health care healthy lifestyles.
that is concerned with promoting healthy
behavior. 4. CREATES awareness regarding the
importance of preventive and promotive care.

• WHO (1998)
Legal Basis of Health Education in the
“Process of providing information and advice Nursing Curriculum
related to healthy lifestyle and encouraging
the development of knowledge, attitudes and One of the more important functions of the
skills aimed at behaviour change of nurse is as a health educator and this is
individuals or communities.” explicitly stated in the Duties of a Nurse in
Rule IV, Sec 28 of the Philippine Nursing Act of
(WHO) comprises of consciously constructed 2002 (RA 9173), among which are to:
opportunities for learning involving some
form of communication designed to improve 1. “provide health education to individuals,
health literacy, including improving families and communities
knowledge and developing life skills which are 2. “teach, guide and supervise students in
conducive to individual and community nursing education;
health.
3. Implement programs including the
The scope of health education extends administration of nursing services in varied
beyond the conventional health sector. It settings like hospitals and clinics.
covers every aspect of family and community
health.

Process that informs, motivates, and help Some of the FUNCTIONS of a Professional
people to adopt and maintain healthy Health Educator
practices and life styles.
1. Assess individual & community needs and
capabilities & identify both internal and
external resources in the community
Purpose of Health Education
2. Plan, develop & coordinate with the
Health Education aims to positively influence different health & government agencies and
the health behaviour and health perspectives NGOs regarding the health education
of individuals and communities for them to programs.
3. Do community organizing & outreach ⚫ PRE-HISTORIC ERA
4. Conduct staff training and consult with ⚫ Trial and error
other health care providers about
behavioural, cultural or social barriers to ⚫ Medical lore passed down
health from generation to
generation
5. Conduct regular periodic evaluation of
health education programs ⚫ Throughout history people
have always turned to some
6. Make referrals; type of medicine man or
7. Develop audio, visual, print and electronic physician for counsel
materials to be used for training and conduct Some one may have eaten a particular
of health education classes; plant or herb and become ill. That person
8. Conduct research work and write scholarly would then warn (educate) others against
articles. eating the same substance. Conversely,
someone may have ingested a plant or
herb that produced a desired
Teaching effect. That person would then encourage
 an interactive process that (educate) others to use this substance.
promotes learning
 a system of activities intended to
produce learning ⚫ ANCIENT CULTURES
 mixture of an art and science
⚫ Good hygiene practices

⚫ Code of Hammurabi
Learning
⚫ Before science enabled us to
• involves mental activity by means of determine pathogenic causes
which knowledge, skills, habits, of disease, spiritual
attitudes, ideals, appreciations and explanations and leadership
ideas are acquired, retained and prevailed
utilized resulting in the progressive
The Code of Hammurabi is a well-preserved
adaptation and modification of
Babylonian law code of ancient Mesopotamia,
behaviour
“an eye for an eye”
there should be a change in behaviour,
utilisation or adaptation of learning.
knowledge, attitudes and skills are • MIDDLE AGES
consciously or unconsciously acquired.
• Overcrowding and sanitation
The success of medtech educators endeavour
is measured not by how much content has • Little emphasis on cleanliness
been imparted but rather how much the in early Christianity
person has learned • Disease was caused by sin or
disobeying God

Historical Development of Health Education • Time of great epidemics –

bubonic plague
 Medieval towns and cities are extremely that diseases and sicknesses come from
overcrowded causing lack or poor breathing in a miasma. The miasma cloud
sanitation resulted to spread of disease. would infect you with a sickness and you
would die. People thought these miasmas
Bubonic Plague wiped Europe’s ⅓ of
occurred in only filthy places or off things that
population (1347-1351)-- BLACK DEATH of
smelled bad like rotten food or sewage.
Middle Ages (bubonic plague,
overcrowding, lack/poor of sanitation, Edward Jenner discovered vaccine procedure
malnutrition and poor hygiene) for smallpox

Innovative contribution to immunization and

eradication of smallpox
• RENAISSANCE
Done by INOCULATION ( subcutaneous
• Beginning of change
instillation of smallpox virus into nonimmune
• Disease and plague still individuals)
rampant
The inoculator usually used a lancet wet with
• Bloodletting popular fresh matter taken from a ripe pustule of
some person who suffered from smallpox. The
• “water casting” material was then subcutaneously introduced
• Leeuwenhoek discovered the on the arms or legs of the nonimmune person
microscope

• Hygiene of royalty • 1800’s (Bacterial period of public

• OK to study the human body Health)
and anatomy advanced • 1842 Edwin Chadwick’s report
First form of transfusion is animal to human • Louis Pasteur – Germ theory
transfusion (usually goat/lamb to human) of disease
Simple light microscope- one lens and used
natural light to view objects • Joseph Lister – antiseptic
method

Chadwick’s report on Sanitary condition.

• AGE OF ENLIGHTENMENT Edwin Chadwick is most associated with
• Disease and plagues still public health improvements during the
raged era of Queen Victoria.

• Miasmas theory of disease Edwin Chadwick was commissioned by

took hold the government to undertake an
investigation into sanitation and make
The miasma theory (also called the miasmatic recommendations on improving
theory) held that diseases such as cholera, conditions. Chadwick found that there
chlamydia, or the Black Death were caused by was a link between poor living standards
a miasma (μίασμα, ancient Greek: and the spread and growth of disease. He
"pollution"), a noxious form of "bad air", also recommended that the government
known as night air. should intervene by providing clean
It supposedly could be recognized by its smell water, improving drainage systems and
of decomposition. The miasma theory states enabling local councils to clear away
refuse from homes and streets.
 The germ theory of disease states that • Report of Joint Committee on
many diseases are caused by Health Education &
microorganisms. These small organisms, Promotion Terminology
too small to see without magnification,
• Outcome-Based Education &
invade humans, animals, and other living
Practice
hosts. Their growth and reproduction
within their hosts can cause a disease. • Patient Protection &
Affordable Care Act (expands
Lister is now known as the 'father of
health care coverage)
antiseptic surgery'. search for a way of
preventing infection CUP=6 yr project to reverify the entry-level
health education responsibilities,
competencies and subcompetencies and to
• 1970’s: The Era of Prevention verify the advanced-level competencies and
subcompetencies
• CDC was established
Identifies Three Levels of practice:
• Healthy People: The Surgeon
General’s Report on Health a. Entry- performed by health educators
Promotion and Disease with BS and MS and less than 5 yrs of
Prevention was published experience

• 1980’s b. advanced 1- BS and MS with more

than 5 yrs of experience
• Initial Role Delineation study
for Health Education c. advanced 2- Health educators with
PHD and 5 or more years of
• First Certified Health
experience
Education Specialists (CHES)
recognized

ROLE of the HEALTH EDUCATOR

CDC = Center for Disease Control and • The HEALTH EDUCATOR’S ROLE is to
Prevention. Concerned with occupational help promote, enhance, and maintain
safety and health the health of others.

major operating components of the • The primary role of Health Educators

Department of Health and Human Service in is to develop appropriate health
USA education programs in consultation
with the people they serve through:
Standards and guidelines primarily related to
infection control and safe work practices • a) Planning

• b) Implementing

• 1990’S • c) Evaluating the health

plans/programs
• Competencies Update Project
(CUP)

• 2000’S Evolution of the Teaching Role of Nurses

• Unified Code of Ethics

  Teaching as function within the scope goals
of nursing practice
- must provide challenge
 Educating their colleagues
 Training the trainer - explain the connections between

learning goals, learning activities and

assessment tasks
SEVEN AREAS OF RESPONSIBILITY
GOAL SETTING
Seven Areas of Responsibility for Health
Education Specialist - the broad entry-level Specific
skills necessary for the practice of health
Measurable
education in all settings.
Achievable
I: Assess needs, assets and capacity for health
education Realistic
II: Plan health education Timely
III: Implement health education To let student understand the success criteria,
commit to learning, and provide the
IV: Conduct evaluation and research related
appropriate mix of success and challenge
to health education

V: Administer and manage health education

Teaching-Learning Process
VI: Serve as a health education resource
person deliver structured lessons which incorporate
a series of clear steps and transitions between
VII: Communicate and advocate for health
them, scaffold learning to build students’
and health education
knowledge and skills

Involves the teacher and student behavior

Dimensions Of Teaching-Learning Process begin with overviews and/or review
objectives call attention to main ideas Use
• Teaching objectives & Learning Needs
explicit teaching to provide instruction,
• Teaching-Learning Process demonstrate concepts teachers show what to
do and how to do it create opportunities in
• Instructional Content lessons for students to demonstrate
• Teaching Strategies understanding and apply the learning

• External Conditions

• Inter-Intra personal relationships Education Process

• Outcome of Health Education Process It is a systematic, sequential, planned course

of action consisting of two major
interdependent operations, teaching and
Teaching objectives & Learning Needs learning This process forms a continuous cycle
that also involves two interdependent players,
What do the students need to know? the teacher and the learnor. jointly perform
teaching and learning activities, the outcome
• setting and communicating clear
lesson
of which leads to mutually desired behavior  Determine behavioral changes
changes. (outcomes) in knowledge, attitudes,
and skills
Teaching/ Instruction

Teaching is a deliberate intervention that

involves the planning and implementation of
instructional activities and experiences to
meet intended learner outcomes according to
a teaching plan. Instruction is a component of
teaching that involves the communicating of
information about a specific skill in the ASSURE MODEL
cognitive, psychomotor, or affective domain. The Assure model is a paradigm to assist
nurses to carry out and organize and
Education Process
Difference of Nursing Process and Education
Process  Evaluate/revise the teaching and
learning process.
NURSING PROCESS  Requires learner performance.
 Appraise physical and psychosocial  Use Teaching materials
needs Develop care plan based on  Select instructional materials and
mutual goal setting to meet individual tools
needs.  State the objectives
 Carry out nursing care interventions  Analyze the learner
 using standard procedures
 Determine physical and psychosocial
outcomes HOW SHOULD EDUCATION BE CONDUCTED?

 Demonstration - most useful method

where the process of doing a
ASSESSMENT procedure is shown and the skills or
PLANNING techniques are practiced through
return demonstration
IMPLEMENTATION  Word of mouth - is the most
influential way of transmitting
EVALUATION
especially of oral traditions which are
usually conveyed by means of
puppets or puppet shows,
EDUCATION PROCES3
dramatization, or sociodrama, role-
 Ascertain learning needs, readiness to playing, storytelling, music and songs
learn and learning styles  Use of audio -visual aids - leaflets,
 Develop teaching plan based on charts, posters, flashcards, flip charts
mutually predetermined behavioral and flannel graphs
outcomes to meet individual needs  Film - showing - the use of modular
 Perform the act of teaching using instruction is also an effective
specific teaching methods and medium of instruction where the
instructional materials learner uses his/her senses of sight,
hearing, touching, smelling and even
tasting
 inter= learning behavior involved in
interacting with others
Instructional Content
intra= learners try to understand their inner
Should Contain:
feelings, dreams, relationships with others
-visuals that establishes the purpose of the and strengths and weaknesses; evaluating
lesson thinking patterns, reasoning with themselves

-organization of the lesson

- Modeling to the teacher’s performance Outcome Of Health Education Process

expectations
• COGNITION CHANGE

• knowledge or perception of a
Teaching Strategies person

The relationship between what is taught and • ATTITUDE CHANGE

how it is taught is critical in order to maximise
• beliefs, predisposition,
student learning.
intentions and tendencies
Example of teaching strategies
• BEHAVIOR CHANGE
1. Direct teaching - highly structured and
• individual / group’s
explicit teaching - Drill, practices
knowledge, attitude and
2. interactive teaching - supports practice
students in working collaboratively
Brain function determines our personality,
and productively in active, hands-on
emotions, and intellect (cognition)— the
and participatory learning - whole-
attributes that make us unique. Cognitive
class discussion
abilities are the mental skills you need to carry
3. indirect - learner-centered and gives out any task.
students opportunities to make
• Attitude is the driving force in our
decisions and choices about their
lives, and can either push us to
learning - problem-based learning
greatness, or to our demise.
4. experiential learning - enables student
• Behavior change can refer to any
to learn and construct meaning
transformation or modification of
through experiences - field
human behavior. It may also refer to:
experience, simulation
Behavior change (public health), a
broad range of activities and
approaches which focus on the
External Conditions individual, community, and
Technology, facilities, time, learning environmental influences on
environment behavior.

Inter-Intra personal relationships PROCESSES THAT DETERMINE THE EXTENT

TO WHICH A PERSON MAY BE PERSUADED
Three major relationship influence in students TO CHANGE
are parents/ guardians, teachers and peers
 • Attention • Lack of Time – rapid
discharge+ amount of
• Comprehension
information
• Acceptance
• Presence of illness
• Retention
• Low literacy

• Hospital Environment

• Personal Characteristics of the

• BARRIERS TO CHANGE learner

• Cultural barriers • OBSTACLE TO LEARNING

• Social barriers • Extent of behavioral changes

• Psychological barriers • Lack of support

• Language difficulties • Denial of learning needs

Beliefs and values differ from person to • Inconvenience in healthcare

person so it is hard to categorize what is and facilities
is not a cultural norm within a grouptraditions
and values conflicting with the innovation
Characteristics of Effective Health Education
Social Barriers to Change: group psychology
factors inhibiting implementation. Group • It is directed at people who have influence
solidarity. Rejection of outsiders, Conformity in the community who are also the opinion
to norms, Conflict makers

Psychological Barriers to Change: individual • The lessons are repeated and reinforced
traits and reactions discouraging adoption. over time using different methods
Perception, Homeostasis, Conformity and
• The lessons are adaptable and use existing
commitment, Personality factors
channels of communication like songs, drama
and story telling

• BARRIERS TO TEACHING • It is entertaining and attracts the

community's attention
• Lack of Time to teach
• Uses clear, simple language with local
• Lack of competence or
expressions
confidence with teaching
skills • It emphasizes short term benefits of action

• Lack of motivation • It provides opportunities for dialogue,

discussion, and learner participation
• Low priority to patient and
staff education • It uses demonstrations to show the benefits
of adopting the practices
• Environment – conducive

The Nurse as an Educator

• OBSTACLE TO LEARNING
• Should possess the necessary attitude and 9. The scientific, social, and economic aspects
competencies to effectively create a of community and ecological health;
productive atmosphere related to the
10. Communicable and degenerative diseases
teaching-learning process (Alegado, 1996)
including STI;
• Good teachers know how to help people
11. Disaster preparedness;
become conscious of their own values, to
examine these values and to build for 12. Safety & driver education;
themselves those values that are more
satisfying to society 13. Environmental factors and how those
factors affect an individual’s or
population’s Environmental health
(ex: air quality, water quality, food
5 Levels of Competency in Nursing Practice
sanitation); life skills; choosing
PATRICIA BENNER'S MODEL
professional medical and health
• Novice - no exposure; task/skilled services; and choices of health
focused; rule follower careers.
 Advanced Beginner - has some
experience; past experience guides
action Theories of Health Education
 Competent - 2-3 years experience;
a. Health Belief Model
good time management; planning;
thinks analytically • The model is based on the theory that
• Proficient - holistic understanding; a person's willingness to change their
uses experiences to anticipate needs health behaviors primarily comes
 Expert - flexible; intuitive; lots of from their health perceptions.
experiences; just comes naturally
• According to this model, your
individual beliefs about health and
health conditions play a role in
Teaching of Health Education related to
determining your health-related
critical health issues:
behaviors.
1. Emotional health and a positive self-image;
Components of the Health Belief Model
2. Appreciation and care of the human body
1. Perceived Severity
and its vital organs;
The probability that a person will change
3. Physical fitness;
their health behaviors to avoid a
4. Health issues of alcohol, tobacco, drug use consequence, depends on how serious
and abuse; they believe the consequences will be.

5. Health misconceptions and myths; 2. Perceived Susceptibility

6. Effects of exercise on the body systems and People will not change their health
on general well-being; behaviors unless they believe that they
are at risk.
7. Nutrition & weight control
3. Perceived Benefits
8. Sexual relationships & sexuality
It refers to the perceived effectiveness of
taking action to improve a health
condition. It's difficult to convince interaction between personal factors,
people to change a behavior if there isn't behavior, and the environment.
something in it for them. People don't
It is a theory of learning process and social
want to give up something they enjoy if
behavior which proposes that new
they don't also get something in return
behaviors can be acquired by observing
and imitating others.

SCT emphasizes observational learning,

self-efficacy (belief in one's ability to
4. Perceived Barriers
perform a behavior), and outcome
It refers to the perceived impediments to expectations (anticipated consequences
taking action to improve a health of behavior) in shaping health behaviors.
condition.

One of the major reasons people don't

C. Theory of Planned Behavior (TPB):
change their health behaviors is that they
think doing so is going to be hard. The Theory of Planned Behavior posits
Changing health behaviors can require that behavioral intentions are influenced
effort, money, and time. by attitudes toward the behavior,
subjective norms (perceived social
5. Cues to Action
pressure to perform or not perform the
It refers to the inducement necessary to behavior), and perceived behavioral
generate the decision-making process to control (belief in one's ability to perform
admit a recommended health action. the behavior).

One of the best things about the Health TPB emphasizes the importance of
Belief Model is how realistically it frames attitudes, subjective norms, and perceived
people's behaviors. It recognizes the fact control in predicting and understanding
that sometimes wanting to change a health behaviors.
health behavior isn't enough to actually
make someone do it
D. Transtheoretical Model (TTM) or Stages of
6. Self-Efficacy
Change Model:
Self-efficacy refers to the self- confidence
The Transtheoretical Model proposes that
in one’s ability to take action.
behavior change occurs through a series of
Self-efficacy wasn't added to the model stages: precontemplation, contemplation,
until 1988. Self-efficacy looks at a person's preparation, action, maintenance, and
belief in their ability to make a health- termination.
related change. It may seem trivial, but
It emphasizes that individuals move through
faith in your ability to do something has
these stages cyclically and may require
an enormous impact on your actual ability
different interventions at each stage to
to do it.
facilitate behavior change.

B. Social Cognitive Theory (SCT):

E. Ecological Model:
Social Cognitive Theory, developed by
The Ecological Model, also known as the
Albert Bandura, highlights the reciprocal
Socio-Ecological Model, considers the
complex interplay between individual, It emphasizes the importance of perceived
interpersonal, community, and societal self-efficacy, perceived barriers, and
factors that influence health behaviors. perceived benefits in predicting and
explaining health behaviors.
It emphasizes the importance of addressing
multiple levels of influence and creating
supportive environments for behavior change.

F. Diffusion of Innovations Theory:

These theories provide valuable frameworks
Diffusion of Innovations Theory explains how for understanding the determinants of health
new ideas, products, or behaviors spread behaviors, designing effective interventions,
within a population over time. and promoting positive health outcomes
across diverse populations and contexts.
It identifies different adopter categories
Health educators often draw upon multiple
(innovators, early adopters, early majority,
theories and models to tailor interventions to
late majority, laggards) and factors influencing
the unique needs and characteristics of their
the adoption process, such as relative
target audiences.
advantage, compatibility, complexity,
trialability, and observability.

G. Behaviorist Learning Theory:

It states that behaviors are learned from the

environment and says that innate or inherited
factors have very little influence on behavior.

Teachers can implement behavioral learning

strategy techniques including: Drills, Question
and answer, Guided practice, Regular review,
Positive reinforcement (most common).

It also helps teachers understand that a

student’s home environment and lifestyle can
be impacting their behavior, helping them see
it objectively and work to assist with
improvement.

H. Health Promotion Model:

The Health Promotion Model focuses on

promoting health and preventing illness by
addressing individual characteristics and
experiences, behavior-specific cognitions and
affect, and behavioral outcomes.