1. Communication for
health education
Sherzad Ali Ismail
MBChB, FIBMS/CM
Community Medicine Department
College of Medicine
Halwer Medical University
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Contents
References.
Communication & communication skills
Communication process.
When we use communication skills.
Importance of Communication.
Needs of effective communication.
Barriers of communication.
Types of communication.
Categories of studying NVC.
How to be a good communicator.
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References
1. Park, K. Textbook of Preventive & Social Medicine. 16th edition. India: M/s
Banarsidas Bhanot; 2000.
2. Lucas Adetokunbo O, Gilles Herbert M. Short Text Book of Public Health Medicine
for the Tropics. 4th edition. London: Arnold; 2003.
3. Devito, A. Joseph. Essentials of human communication. 5th edition. US: Pearson
Education, inc.; 2005
4. Arends, I. Richard. Learning to teach. 4th edition. US: McGraw-Hill; 1998.
5. Dent, A.John. & Harden, M. Ronald. A practical guide for medical teachers. 2nd
edition. UK: Elsevier Churchill Livingstone; 2005.
6. Al-Youzbaki, B. Dhafer. Medical communication skills. 2nd edition. Mousul: No
publication year.
7. Santrock, W. John. Educational Psychology. US: McGraw-Hill; 2001.
8. Bensley J Robert and Brookins-Fisher Jodi (Editors). Community Health Education
Methods a Practical guide. 2nd edition. USA: Jones and Bartlet Publishers; 2003.
9. Microsoft® Encarta® Reference Library 2005 (CD).
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Objective of the lecture
The FM graduates will acquire the
knowledge and skills and able to apply
these skills with:
Themselves
Patients
Medical staff (Doctors and paramedics)
Family & friends
Community
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Introduction
Subjects of communication skills are
comparatively new.
Good doctor-patient communication has
been described as the cornerstone of
good medical practice.
Need include CS training in medical
school curricula
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Communication (Literary meanings)
Exchange of information.
Message.
Act of communicating.
Rapport (Closeness).
Access.
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What is communication?
Process of transferring information from a
sender to a receiver with the use of a
medium in which the communicated
information is understood by both sender
and receiver.
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Communication skills (CS)
is the set of skills that “enables a person to
convey information so that it is received
and understood”.
CS are the proficiency in the interchange
of information.
Can be acquired and improved by learning
and training.
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Effective communication
Transmitting the message to someone so
that he is fully understood with the way
you were wished-for.
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When we use C.S.?
The communication skills used when one
informs,
explains,
persuades,
listens &
demonstrates.
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Importance of CS
Health education & Health Promotion:
Integrated with the core public health disciplines,
especially health education and health promotion.
Medical Education:
Maximize student‟s learning opportunities.
Develop better teacher-student relationship.
Enhance classroom management.
Medical practice:
Doctor-patient relationship.
Doctor-doctor relationship.
Doctor- nurse relationship.
Doctor-staff relationship.
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Effective communication needs
You need to listen effectively.
You need to clarify and confirm effectively.
You need to respond effectively.
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14. Types of Communications
Verbal:
One-way (Didactic).
Two-way Socratic).
Non-verbal.
Telecommunication & internet
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One-way (Didactic).
Example: Lecture in the classroom.
Drawbacks:
Imposed knowledge.
Little audience participation.
No feedback.
Doesn‟t affect human behaviors.
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Two-way (Socratic)
Both the communicator and the audience
take part.
Process of learning is active and
"democratic“.
More likely to influence behavior.
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Telecommunication & internet.
Point – to – Point system.
telephone, telex (or teletype) and telegraph
Mass communication media.
Examples: Radio, TV and internet etc.
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19. Non-verbal communication
Sometimes-called body language or Silent Signals.
More than 50% of first impressions is based on the non-
verbal element.
About 26 muscles are responsible for facial expression.
Those who used the least eye contact where judged as
defensive, cold, and immature, while those who used the
most eye contact were judged as friendly, mature,
sincere, and self-confident.
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Categories of Non-verbal
communication
Bodily contact.
Proximity.
Body movement.
Orientation.
Level.
Posture. (sitting, standing)
Physical appearance.
Facial appearance.
Hand & head movements.
Direction of gaze & eye contact.
Use of time. (on time)
Environmental cues (location)
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21. Mehrabian Myth
21
Perceiving what peoples
say?
55% body language.
38% the way it‟s said. Body
7% language
7% the actual words
spoken. How its
55%
communicating 38% said
feelings and
Actual
Attitude words
Fore more information:
http://www.youtube.com/
watch?v=7dboA8cag1M
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Barriers of communication
1. Physiological e.g. visual or hearing
difficulties.
2. Psychological e.g. emotional
disturbances, levels of intelligence…etc.
3. Environmental (Noise)
4. Cultural (Illiteracy, level of knowledge &
education, language, customs &
believes).
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Categories of studying NVC
1. Kinesics. (It is the study of how we use facial
expressions, gestures, postures, and eye behavior
in communication.)
2. Eye contact.
3. Paralanguage. (paralanguage =your voice - your
words.)
4. Haptics. (The study of tactile communication- the
language of touch)
5. Proxemics. Personal space, and the study of how
we structure and claim this space is called
proxemics.)
6. Chronemics. (The study of how we use time to
communicate is called chronemics).
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Approaches of
communication skills
Core communication skills approach.
Advance communication skills
approach.
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Core communication skills
• Essential skills that help the doctor to
reach the diagnosis and provide
appropriate treatment.
– Divided into the following types:
1) Doctor-patient interpersonal skills.
2) Information gathering skills.
3) Information giving skills.
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1) Doctor-patient interpersonal
skills
Doctor-patient interpersonal skills refer to
the basic skills which help to create
effective helping relationships.
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Importance of effective doctor-
patient interpersonal skills
1. It is an essential part of diagnosis.
2. Contributes to patient satisfaction.
3. Increases patient compliance to treatment
plan.
4. Contributes to cost effectiveness.
5. Contributes to doctor clinical
competence.
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Elements of
doctor-patient interpersonal
skills
1. Appropriate physical environment.
2. Greeting patients.
3. Active listening.
4. Empathy, respect, interest, warmth &
support.
5. Language.
6. Non-verbal communication.
7. Collaborative (shared) relationship.
8. Closing the interview.
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2) Information gathering
skills:
Are skills which help to facilitate the
patients‟ involvement in the medical
interview in a way that enables the doctor
to reach the diagnosis.
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Elements of
Information gathering skills
1. Using appropriate balance of open to
closed questions
2. Silence.
3. Clarifying the information given by the
patient.
4. Sequencing of events.
5. Directing the flow of information.
6. Summarizing.
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3) Information giving skills:
Are the skills that used by the doctor to
provide information to the patient about
their illness and proposed treatment plan.
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Elements of
Information giving skills
1. Provide clear & simple information.
2. Putting important things first.
3. Using repetitions.
4. Summarizing.
5. Categorizing information to reduce
complexity & aid recall.
6. Using tools.
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Breaking Bad News
Regarding breaking bad news, the
following steps are proposed:
Preparation and Delivery of News.
Patient’s Response to Difficult/Bad News.
Plan for the Next Steps.
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Preparation and Delivery of News
Ask permission to talk
Ask about patient‟s understanding of the
problem
Determine how much patient knows
Determine how much patient wants to know
Preparation: “I am afraid I have some
bad/difficult news”
Deliver the news, no medical jargon.
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Patient‟s Response to Difficult/Bad
News
Allow time for patient to hear the news and
react
Check to be sure patient understood
Respond to patient‟s emotions.
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Plan for the Next Steps
Offer support to the patient
Ask whether patient wants more information
about diagnosis and prognosis
Make a plan for follow-up and referral
Tell patient you will stick with him.
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38. Communication models in
medical practice
The biomedical model
Doctor is in charge of the consultation.
Focus is on disease management.
Patient-centered communication
Power and decision-making is shared.
Address and treat the whole patient.
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How to be a good communicator?
I. Developing good speaking & listening
skills.
II. Avoid barriers to effective verbal
communication.
III. “You” & “I” messages.
IV. Communicates nonverbally.
V. Being assertive (confident).
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I. Developing good speaking
& listening skills.
1. Becoming an effective speaker.
Connect with the audience. (Talk directly)
State your purpose.
Effectively deliver your speech.
Organize your speech.
Include evidence that supports the speech.
Use media effectively.
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I. Developing good speaking
& listening skills.
2. Becoming an effective listener:
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II. Avoid barriers to effective
verbal communication
Criticizing.
Labeling.
Ordering.
Threatening.
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III. “You” & “I” messages
“You” messages: are undesirable style in
which speakers appear to judge & to place
peoples in a defensive position.
“I” messages: a desirable style, less
provocative, reflect the speakers true
feelings‟.
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V. Being assertive
Act confidently, ask for what you want, &
say no to things you don‟t want.
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Conclusion
Understanding the silent signals of body
language is essential to becoming a better
and more efficient communicator.
CS can be learned & taught.
To be an effective communicator; you
have to:
Practice.
Practice.
Practice.
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47. “If you have not good
communication skills, no matter
what you say”
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Health communication
"health communication" is often used
synonymously with health education.
It is a downward & outward
communication of knowledge
Communication strategies can enhance
learning
The ultimate goal of all communication is
to bring about a change in the desired
direction of the person who receives the
communication
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Functions of health
communication
Information
Education
Motivation
Persuasion
Counseling
Raising morals (Confidence & optimism)
Health development
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51. Health Education
Health: Is a complete state of
physical, mental and social wellbeing
and not merely the absence of
disease or infirmity
Education: informing and acquiring of
knowledge through teaching and
learning, especially at a school or similar
institution
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Health Education
"a process aimed at encouraging people:
to want to be healthy,
to know how to stay healthy,
to do what they can individually and collectively
to maintain health,
and to seek help when needed“ WHO, Declaration of Alma - Ata (1978).
The process by which individuals and groups of
people learn to behave in a manner conducive
to the promotion, maintenance or restoration of
health . (John Last)
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Features of Health Education
1. Health promotion and education directed
at populations rather than individuals
2. Health education is much more than
factual information
3. It includes all those experiences and
skills that affect the way people think and
feel about their health, and it motivates
them to put information into practice.
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Goal of Health Education
To make realistic improvements in the basic
quality of life
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Objectives of Health Education
Health consciousness
Motivation
Knowledge
Attitude change
Behavior
Decision making
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Importance of Health education
A large number of diseases could be
prevented with little or no medical
intervention if:
people were adequately informed about
them and if
they were encouraged to take necessary
precautions in time.
H/E is the most important PHC activity.
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Importance of Health education
Giving patients handouts about tetanus
increased the rate of immunization against
tetanus among adults threefold. (Cates CJ, BMJ,
1990; 300 (6727):789-90)
An educational booklet on back pain for
patients reduced the number of
consultations made by patients over the
following year & 84% said that they found
it useful. (Ronald M, Dixon M, JR Coll GP, 1989; 39(323):244-6).
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Targets of Health Education
Individual
Family
Small groups
Community or general public
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59. History of Disease
Period of Pre-Pathogenesis Period of Pathogenesis
Before man is involved Course of disease in man
Health
Education
Primary Prevention Secondary Prevention Tertiary Prevention
Health Specific Early diagnosis & Disability
promotion protection Treatment limitation Rehabilitation
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Health Promotion
Promotion is encouragement for activity
Is the use of a combination of health
education and specific interventions,
at the primary level of prevention
designed to facilitate behavioral and
environmental changes helpful to health
enhancement
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Health Promotion Program
(intervention)
Any program aimed at improving health
through behavior and lifestyle changes
alcohol awareness month,
cancer prevention week,
obesity reduction seminar,
or dental health week,
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Health protection
The implementation of strategies that focus on
environmental rather than behavioral
determinants of health.
environmental hazards such as:
toxic waste sites, industrial chemicals, and exposure to
lead, food and drug safety
occupational health and safety:
wearing protective clothing, goggles, and gloves when
working with dangerous chemicals
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Health education versus
propaganda
Health Education Propaganda
Knowledge & skills actively acquired Knowledge instilled in the mind of the
people
Make people think for themselves Prevents thinking by readymade
slogan s
Discipline primitive desire Stimulate primitive desire
Calls to reason Calls to emotion
Knowledge acquired (active) Knowledge is spoon-fed (passive)
The process is behavior center The process is information center
Develop reflective behavior Develops reflexive behavior
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Contents of Health Education
1. Human biology
the structure and functions of the body;
how to keep physically fit - the need for
exercise, rest and sleep;
the effects of alcohol, smoking and drugs on
the body.
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66. Contents of Health Education
2. Nutrition
Nutrition education is a
major intervention for the
prevention of malnutrition
& promotion of
health, aims to:
Guide people to choose
balanced diets.
Promote good dietary
habits
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Contents of Health Education
3. Hygiene
Personal:
aims to promote standards of personal
cleanliness.
Include: bathing, clothing, washing hands and
toilet; care of nails, feet and teeth;
spitting, coughing, sneezing, …etc.
Environmental:
Domestic
Community
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Contents of Health Education
4. Family health
Health largely depends on the family's social
and physical environment.
Role of the family in health promotion and in
prevention of disease, early diagnosis and
care of the sick.
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Contents of Health Education
5. Disease prevention and control
Prevention and control of locally endemic
diseases is the first of eight essential
activities (elements) in primary health care.
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Contents of Health Education
6. Mental health
7. Prevention of accidents.
8. Use of health services.
9. More..
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Principles of Health Education
1. Credibility
2. Interest
3. Participation
4. Motivation
5. Comprehension
6. Reinforcement
7. From known to unknown
8. Learning by doing
9. Good human relationship
10. Leaders.
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Principles of Health Education
Credibility (Believability)
Ability to inspire belief or trust.
In health education, it is the degree to
which the message to be communicated is
perceived as trustworthy by the receiver.
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Principles of Health Education
Interest
people are unlikely to listen to those things
which are not to their interest
If a health program is based on "felt needs“
people will gladly participate in the program;
and only then it will be a people's program.
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Principles of Health Education
Participation
Participation is a key word in health
education. it is based on the psychological
principle of active learning.
"The people have a right and duty to
participate individually and collectively in the
planning and implementation of their health
care' . (Alma Ata declaration)
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Principles of Health Education
Motivation
Is stimulating behavior or awakening desire to
learn
Primary(Sex, hunger, survival)
Secondary (praise, love, reward)
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Principles of Health Education
Comprehension
In health education we must know the level of
understanding, education and literacy of
people to whom the teaching is directed.
within the mental capacity of the audience
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Principles of Health Education
Reinforcement
Few people can learn all that is new in a
single period
Repetition at intervals is necessary.
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Principles of Health Education
From known to unknown
In health education work, we must proceed
"from the concrete to the abstract"; "from the
particular to the general"; "from the simple to
the more complicated;" "from the easy to
more difficult”.
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Principles of Health Education
Learning by doing
Learning is an action - process ; not a
"memorizing" one in the narrow sense
Chinese proverb : "lf I hear, I forget; if I see, I
remember; if I do, I know"
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Principles of Health Education
Good human relationship
Sharing of information, ideas and feelings
happen most easily between people who
have a good relationship
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Principles of Health Education
Leaders
Psychologists have shown that we learn best
from people whom we respect and regard.
In the work of health education, we try to
penetrate the community through the local
leaders
Leaders are agents of change and they can
make use of health education work.
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Characteristics of Health
Educator
1. Have technical qualifications in health
education
2. Be familiar with the traditions & popular
customs of the recipient society
3. Be a good example for the message of
H/E he is presenting
4. Believe in & be actively committed to the
message of health education
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Characteristics of Health
Educator
5. Have initiative & motivation as well as
the capacity to communicate &
convince others with his message
6. Speak the recipient’s language
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Criteria of good message
1. In line with the objective (s).
2. Based on felt needs.
3. Meaningful.
4. Clear and understandable.
5. Specific and accurate.
6. Timely and adequate.
7. Fitting the audience (listener).
8. Interesting.
9. Culturally and socially appropriate.
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Changing concepts in health
education
Prevention of disease to promotion of
healthy lifestyle.
Modification of individual behavior to
modification of “social environment” in
which the individual lives.
Community participation to community
involvement.
Promotion of individual & community “self-
reliance”.
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Health education theories
1. The Health Belief Model
2. Theory of Planned Behavior
3. Transtheoretical Stages of Change Model
4. Social Cognitive Theory
5. Diffusion of Innovation Theory.
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Health education theories
The Health Belief Model (HBM)
Emphasizes the “role of perceptions of
susceptibility to an illness & the potential
effectiveness in treatment”.
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Health education theories
Theory of Planned Behavior
Based on the assumption that “intention to
behave in a certain way, is determined by the
person‟s attitude toward the
behavior, subjective norms & apparent
behavioral control”.
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Health education theories
Transtheoretical Stages of Change Model
Behavior change is a process & individuals
are at varying levels of motivation or
readiness to change.
People may relapse or return to a previous
stage.
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Health education theories
Social Cognitive Theory
Peoples not only learn through their own
experiences, but also by observing the
actions of others & the results of those actions
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Health education theories
Diffusion of Innovation Theory
Diffusion: distribute, or spread widely.
Innovation: something that is new or different.
Community –level theory.
It means integrating innovative ideas,
products, or programs that have proved to be
successful into health education initiatives.
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Individual approach
Example: Counseling
Capitalizes on warmth & understanding
Opportunity for involvement, asking
questions, expressing fears & learning
more
More effective for changing personal habit
(behavior).
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Counseling
is 'giving advice': 'opinion or instruction
given in directing the judgment or conduct
of another'.
In the clinical context „It is the therapeutic
process of helping a patient to explore the
nature of his or her problem in such a way that
he or she determines his or her decisions about
what to do, without direct advice or reassurance
from the counselor'.
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Specific areas of counseling
Any crisis situation.
Terminal illness
Marital problems, family problems, sexual
problems, sexual abuse, infertility,…etc.
Chronic pain, severe illness
Anxiety & stress, depression, intellectual
handicap.
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Patient-centered counseling
Non-directive counseling technique
Patients can realize their own solutions for
their problems.
The counselor is more like a facilitator
Patient-centered Doctor-centered
Counseling
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Group approach
Group teaching is an effective way of
educating the community
Should be based on groups‟ interest &
concern
Appropriate methods should be used.
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Methods of health education in
group approach
1. Lecture (Chalk & talk):
Defined as carefully prepared oral
presentation of facts, organized thoughts and
ideas by a qualified person
Its effectiveness depends to a large extent on
the speaker's ability to write readably and to
draw with chalk on a black board
The group should not be more than 30 and the
talk should not exceed 15 to 20 minutes.
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Methods of health education in
group approach
2. Demonstrations:
a carefully prepared presentation to show how
to perform a skill or procedure
Ex: lumber puncture, disinfection of a
well, ORS,..etc
clinical teaching in hospitals is based on
demonstrations.
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Advantages of demonstrations
dramatizes by arousing interest
persuades the audiences to adopt
recommended practices
upholds the principles of "seeing is
believing" and "learning by doing", and
can bring desirable changes in the
behavior with high motivations
relating to the use of new practice.
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104. Methods of health education in
group approach
3. Group discussion:
A "group" is an "aggregation of
people interacting in a face - to -
face situation"
This contrasts sharply to the group
of students in a class room
situation
the group should be >6 <12
members.
Example: Smoking cessation, weight
reduction, ..etc
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Advantages of Group
discussion
permits the individuals to learn by freely
exchanging their knowledge, ideas and
opinions
provides a wider interaction among members
A well-conducted group discussion is effective
for changing attitudes and the health behavior of
people
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Methods of health education in
group approach
Panel discussion:
4 to 8 persons who are qualified to talk about
the topic sit and discuss a given problem, or
the topic, in front of a large group or audience
Chairman or moderator
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Methods of health education in
group approach
Symposium:
a series of speeches on a selected subject
Each person or expert presents an aspect of
the subject briefly.
There is no discussion among the symposium
members.
In the end, the audience may raise questions.
The chairman makes a comprehensive
summary at the end of entire session
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Methods of health education in
group approach
Workshop:
consists of a series of meetings, usually four
or more, with emphasis on individual
work, within the group, with the help of
consultants and resource personnel
The total workshop may be divided into small
groups and each group will choose a
chairman and a recorder.
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Methods of health education in
group approach
Role playing:
socio-drama is based on 2 assumptions:
many values in a situation cannot be expressed in words,
communication can be more effective if the situation is
dramatized by the group
size of the group is thought to be best at about 25
It is a particularly useful educational device for
school children. (human relationship)
It is followed by a discussion of the problem.
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Methods of health education in
group approach
Conferences and seminars:
They are usually held on a regional, state or
national level
They range from once half-day to one week in
length
and may cover a single topic in depth or be
broadly comprehensive
usually use a variety of formats to aid the
learning process from self instruction to multi -
media.
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Mass approach
(education of general public)
Up till the early 1920s, mass
communication depended largely on what
was printed - posters, pamphlets, books
Radio then TV
Mass media are a "one-way“
communication.
transmitting messages to people in the
remotest places.
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Mass approach
(education of general public)
Mass media alone are generally
inadequate in changing human behavior
Advantages of mass media include:
creating a political will,
raising the health consciousness,
setting norms,
delivering technical messages,
popularizing health knowledge &
encouraging community involvement .
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Mass approach
Television:
the most popular of all media
effective creating awareness & health comm.
also to an extent influencing the public opinion
and introducing new ways of life
helping people familiarize with things they
have not seen before
a one - way channel
Cannot cover all areas of learning
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Mass approach
Radio:
Both radio and TV can reach illiterate
population not accessible through printed
word.
It is a purely didactic medium!
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Mass approach
Internet:
holds very large potential to become a
major health education tool
Web sites:
Governmental
Non-governmental
Personal
Others (NGO, UN,…etc)
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Mass approach
Newspapers:
They are the most widely disseminated of all
forms of literature
They should, provide more factual, detailed
and even statistical material
Unfortunately, health problems have little of
value to newspapers.
They have limitation of having low readership
in rural areas. (reach only a limited group)
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Mass approach
Printed material:
Examples: Magazines, pamphlets, booklets
and hand-outs
convey detailed information.
can be produced in bulk for very little cost
can be shared by others in the family and
community.
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Mass approach
Direct mailing:
The intention is to reach the remote areas of
the country with printed word (e.g., folders
and newsletters and booklets on family
planning, immunization and nutrition etc)
It is possibly the most personal of mass
communication.
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Mass approach
Posters, billboards and signs:
These are intended to catch the eye and
create awareness
the message to be communicated must be
simple, and artistic
Motives such as humor and fear are
introduced into posters in order to hold the
attention of the public
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Mass approach
Posters, billboards and signs:
The right amount of matter should be put up
in the right place and at the right time.
The life of a poster is usually short;
As a media of health education, posters have
much less effect in changing behavior
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Mass approach
Health museums and exhibitions:
It can attract large numbers of people.
Increase knowledge and awareness
Photographic panels attract more than
graphics
Personal & impersonal communications
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Mass approach
Folk media:
folk songs, dances and dramas
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Conclusions
There is no single way to do public
education.
Health education is still art rather than a
science.
Each community and country should
develop techniques that meet its own
needs.
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124. Planning of health education
Any plans should be suitable with socio -
cultural, psycho-social, political, economic
and situational characteristics
The planners should be fully conversant
with the health education needs of the
particular program
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125. Steps of planning of HE
1. Collecting information on target population
2. Identify the problem (s)
3. Decide on priorities
4. Develop appropriate goals & objectives
5. Assess resources
6. Create an intervention that is likely to achieve
the desired results
7. Implement the intervention
8. Monitor & evaluate the results
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Objectives features
SMART!
Specific
Measurable
Attainable
Relevant
Time period
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