Health promotion and

health education
.
 Objectives

• By the end of this lecture, you will be able to:

• Define health promotion and identify its core elements, principles and
areas of action
• Define health education and identify its methods, materials and skills
• Identify health preventive messages and its applications
 Introduction

• Dental diseases affect a large number of people and are costly to

treat.
• Their impact is considerable, to both the individual and wider society.
• The causes of dental diseases are well known and effective preventive
measures have been identified. However, treatment services still
dominate oral health systems around the world.
• There is growing recognition within the dental profession to the need
to reorient dental services towards prevention
 What preventive approach should
be adopted to promote oral health
and reduce inequalities?
.
• It is essential that preventive interventions address the underlying
determinants of oral disease and inequalities to achieve sustainable
improvements in population oral health.
• Effectiveness reviews of clinical preventive measures and health
education programmes have highlighted that these approaches only
achieve short-term positive outcomes.
• A radically different preventive approach is therefore needed.
• In recent decades, the health promotion movement has arisen, partly
in response to the recognised limitations of treatment services to
improve the health of the public.
 health promotion
• Health promotion is the process of enabling people to increase control
over and to improve their health. "WHO
 Core elements of health promotion
Health promotion has three important core elements:
1-Focus on tackling the determinants of health.
2-Working in partnership with a range of sectors.
3-Adopting a strategic approach utilizing a complementary range of
actions.
 Determinants of health
• Health promotion focuses on the determinants of health,
socioeconomic, environmental and individual behavioural factors.
• In the past, health professionals assumed that individuals always can
control the elements of their lifestyle, ignoring the complex array of
factors that influence and determine human behaviour.

• Such a narrow approach has most often not achieved the desired
changes in behaviour.
• Therefore, a major emphasis in health promotion is to make the
healthy choices the easy choices.
• The fundamental determinants of oral health:
1. The consumption of non-milk extrinsic sugars (NMES)
2. The effective control of plaque in the mouth.
3. Optimal exposure to fluoride
4. The appropriate use of good-quality dental care. Sugar
consumption
5. Limiting alcohol consumption and smoking
Dental Plaque
services removal
Major Oral
health
determinants

Alcohol
and fluoride
tobacco
• Although all of these factors can be modified at an individual level to
promote oral health, they are also influenced by complex socio-
environmental factors that are outside the control of many
individuals.
 Working in partnerships
• Community participation in all aspects, from the identification of the
health issue to ways of initiating change, is a central principle.
• Many sectors in society, for example, government departments,
education, health and social services have a significant influence on
health.
• It is essential that these different agencies work together to ensure that
health promotion policies are established, implemented, monitored,
and evaluated.
 Strategic action
• A strategic approach is required for the development of effective
health promotion policies.
• A strategy should be based on an appropriate assessment of local
needs and resources
• Health promotion can utilize a combined whole-population strategy
and a high-risk strategy
 Principles of health promotion
1. Empowerment: interventions should enable individuals and communities
to exert more control over factors that affect their oral health.
2. Participatory: key stakeholders should be encouraged to be actively
involved in all stages.
3. Holistic: interventions should adopt a broad approach.
4. Intersectoral: partnership working across all relevant agencies and
sectors is essential
5. Equity: focus on attaining the highest level of health for all people
6. Sustainable: achieving long-term improvements in oral health that can be
maintained by individuals and communities is crucial.
 The five areas for action in health
promotion
1. Developing personal skills
The development of health knowledge and skills can be achieved
through health education.

Health education can be defined as any educational activity that aims to

achieve a health-related goal
Basic educational objectives :
1. Cognitive: concerned with giving information and increasing
knowledge.
2. Affective: concerned with forming, or changing attitudes and values.
3. Behavioural: concerned with the development of skills and actions.

health education aims to equip individuals

and/or communities with the necessary
knowledge, attitudes, and skills to
maintain and improve health.
 2. Strengthening community action
• It is a process in which the community defines its own health needs,
decides how these can be best tackled, and then takes appropriate
action.
• The advantages of this approach are that it starts with people’s
concerns and is therefore likely to gain support
• The problems of adopting this approach include the time-consuming
work, the difficulty of evaluation, and the potential conflicts that may
arise within communities on setting priorities and identifying possible
solutions.
• Health professionals involved in community development projects
need to adopt a different style of working for this approach to be
successful.
• Rather than be the expert, they instead act as a facilitator within the
community.
• This requires skills in consultation and communication.
3. Reorienting health services
• There is a need to shift resources away from the dominant treatment
and curative services towards those that promote health and prevent
disease.
• A reorientation towards health promotion requires training and
education of health professionals and appropriate resources to support
their efforts
4. Building healthy public policy
• placing health onto the policy agendas of influential decision-makers.
• oral health examples is:
1-The legislation required to fluoridate public water supplies.
2- Strict regulation on food labelling of processed food and drink.
 5. Creating supportive environments
Supportive environment achieved by:
1-Healthy public policies
e.g. water fluoridation.
2-Policies within local organizations such as schools, workplaces,
and hospitals that seek to promote the health of clients and staff
e.g. establishment of non-smoking areas, exercise facilities, and
catering services with sugar-free foods and drinks
 Health education
Health education is defined as any educational activity that aims to
achieve a health-related goal (WHO 1984).
Activity can be directed at individuals, groups, or even populations.
Basic educational objectives :
1. Cognitive: concerned with giving information and increasing knowledge.
(for example, the knowledge that sugary snacks are linked to dental decay).
2. Affective: concerned with forming, or changing attitudes and values. for
example, the belief that baby teeth are not important).
3. Behavioral: concerned with the development of skills and actions. skills
development (for example, skills
required to effectively floss teeth)
 Oral health preventive messages
1. Sugar-containing foods and drinks should be limited to mealtimes
and on no more than four occasions in the day.
2. Brushing teeth effectively twice a day, preferably last thing at night
and on one other occasion. Use a small-headed brush and change when
the bristles appear worn. Powered toothbrushes are also effective.
3. Use a family-strength fluoridated toothpaste with 1,350 ppm
fluoride or above (for children under 3 years of age use fluoridated
toothpaste containing 1,000 ppm fluoride).
4. Spit do not rinse after brushing.
5. Do not smoke.
6. Visit the dentist regularly.
 Implementing oral health preventive
messages
• Although these preventive oral health messages may appear relatively
simple, in reality, each message has considerable detail behind it,
which can differ for different stages in the life course.

• To successfully implement oral health preventive messages and ensure

patients’ adherence to recommendations, several steps should be
followed:
 1. Understand your patients and their needs
Do not assume every patient has the desire, ability, and support to
change his or her behaviours.
 2. Tailor advice and support
• Every patient is different and any advice offered to them must be
tailored to their circumstances and characteristics.
• It is also important to consider the timing of when to offer advice and
support.
• Understanding patients’ motivation for change is important to help
them. Do not assume everyone is concerned about changing
behaviours to avoid diseases. Other motivations such as improving
appearance and social confidence and saving money are strong
motivations for changing behaviour for many people.
 3. Communicate well
• A range of communication skills should be used in advising patients to
change behaviours:
• Active listening
• Use of open questions
• Encouraging and caring tone
• avoid use of threatening approaches
4. Review the benefits of changing and past experiences
Exploring the personal benefits of changing a particular behaviour can
help a person to become more motivated to change.
.Learning from past experiences can help to increase people’s self-
confidence and insight.
 5. Formulate SMART objectives
• Once a person has decided to change, it is important to agree with the
patient on a clearly defined objective or goal.
Objectives should be SMART:
1-Specific —clear and focused goals.
2-Measurable —goals that can be easily measured and quantified.
3-Achievable —goals that are challenging but within the patient’s ability.
4-Relevant — related to the patient’s circumstances and needs.
5-Timely —Setting a clear time frame to help maintain motivation and
monitor progress.
 Oral health education methods

Individual Group Mass

Approach Approach Approach

-Lecture -Television
-Personal -Group discussion -Radio
contact -Demonstration -Newspaper
-Home visit -Roleplay -Printed materials
-Internet
1-personal contact
2-home visits
• 3-lecture
 .
• 4-group discussion
• 5-demonistration
6-role play
• 7-Mass media
 Health education materials
1. Computer programs
2. Information sheets
3. Flipcharts
4. Black/whiteboards
5. Leaflets
6. Posters
7. Display boards
8. CDs and DVDs
9. Audio cassettes
10. Overhead projector transparencies
 Health education skills
1. Communication skills
1. Appropriate questioning
2. Active listening
3. Summarizing information
4. Giving feedback
2. Assessing needs
3. Motivational interviewing
4. Presentational skills
5. Goal-setting
6. Teaching skills
7. Working with small groups
8. Measuring and monitoring change
•