By Hatim Jaber MD MPH JBCM PhD 6- 12- 2017 Faculty of Medicine Introduction to Community Medicine Course (31505201) Communication and Health Education By Hatim Jaber MD MPH JBCM PhD 6- 12- 2017

Ageing and health Between 2015 and 2050, the proportion of the world's population over 60 years will nearly double from 12% to 22%. By 2020, the number of people aged 60 years and older will outnumber children younger than 5 years. In 2050, 80% of older people will be living in low- and middle-income countries. The pace of population ageing is much faster than in the past. All countries face major challenges to ensure that their health and social systems are ready to make the most of this demographic shift.

Post midterm Causation Week 8 Unit 6: Demography and Data Week 9  Midterm assessment (Exams.)15-11-2017 Week 10 Unit 8 Introduction to Epidemiology. Week 11 Unit 9: Prevention and Control of Diseases Causation Week 12 Unit 10: Communication and Health Education Week 13 Unit 11: Public Health Surveillance and Screening Week 14 Unit 12: Health Administration and healthcare management Week 15 Unit 13: Revision and Health Research Week 16 Final assessment (Exams.)

Presentation outline Health education Principles of Health Education Time Health education 08:00 to 08:15 Principles of Health Education 08:15 to 08:30 Heath education methods and materials 08:30 to 08:45 The principle of counseling 08:45 to 09:00 Health education planning models 09:00 to 09:15

Health Communication Education Counseling Information Motivation Persuasion Counseling Raising morale Health development Organization

HEALTH EDUCATION “Health education is the process by which individuals and group of people learn to “: Promote Maintain Restore health. 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.

Health education is defined as “Any combination of learning experiences designed to facilitate voluntary adaptation of behavior conducive to health”. ‐ The word “voluntary ”is significant for ethical reasons (Educators should not force people to do what they don’t want to do ) i.e. All efforts should be done to help people make decisions and have their own choices. The word “designed” refers to planned, integral, intended activities rather than casual, incident, trivial experiences.

What is health education? Process which affects changes in the health practices of people and in the knowledge and attitude related to such changes. OR Teaching process providing basic knowledge and practice of health, so as to be interpreted into proper health behavior. Health education is a process that informs , motivates and enables people to adopt and maintain healthy practices and lifestyles. It helps people to achieve health by their own actions and efforts.

Health Communication – Its intent, what it can do The intent of health communications is: To inform, influence, and motivate individuals and organizations to take action toward health Health communications can: increase awareness of a health issue; demonstrate or illustrate skills; demonstrate a demand for health services; and remind of, or reinforce, knowledge, attitudes, or behavior

Health Communication – What it can’t do Health communications can’t: compensate for lack of health care; produce behavior change without supportive program components; be equally effective in addressing all issues or relaying all messages

1-It is not enough to change peoples’ knowledge, but it is more important to change the attitude and practice that is not easy at all. 2-Health education is the responsibility of every person in the community not only the health team. 3-Health education is one of the components of PHC and of its all components (MCH, nutrition, food sanitation and immunization).

Aims of Health education Health promotion and disease prevention. Early diagnosis and management. Utilization of available health services.

Specific objectives of health education To make health an assest valued by the community. To increase knowledge of the factors that affect health. To encourage behavior which promotes and maintains health. To enlist support for public health measures, and when necessary, to press for appropriate governmental action.

Specific objectives of health education 5. To encourage appropriate use of health services especially preventive services. 6. To inform the public about medical advances, their uses and their limitations.

Contents of Health Education 1. Human biology Understanding health demands an understanding of human biology. Child spacing, breast feeding, safe motherhood, immunization, weaning and child growth, diarrheal disease, respiratory infections, house hygiene 2. Nutrition To guide people to choose optimum and balanced diets. Remove prejudices and promote good dietary habits. 3. Hygiene Personal Hygiene. Environmental Hygiene. Domestic Community. 4. Family Health Health promotion, Disease prevention, Early diagnosis, and Care of the sick. 5. Disease prevention and control: Education of the people about locally endemic diseases. Drugs alone can not solve the problem. 6. Mental Health: To help people to keep mentally healthy and to prevent a mental breakdown. Special situations: mother after child birth, decision about a future career, starting a new family etc. 7. Prevention of accidents: Three main areas: the home, road and the workplace. Safety education. 8. Uses of health services: Availability of health services When to seek medical services.

Contents of Health Education 1. Human biology Understanding health demands an understanding of human biology. – Child spacing, breast feeding, safe motherhood, immunization, weaning and child growth, diarrheal disease, respiratory infections, house hygiene 2. Nutrition To guide people to choose optimum and balanced diets. Remove prejudices and promote good dietary habits.

3. Hygiene Personal Hygiene. Environmental Hygiene. Domestic Community.

4. Family Health Health promotion, Disease prevention, Early diagnosis, and Care of the sick. 5. Disease prevention and control: Education of the people about locally diseases. Drugs alone can not solve the problem. endemic

6. Mental Health: To help people to keep mentally healthy and to prevent a mental breakdown. Special situations: mother after child birth, decision about a future career, starting a new family etc.

7. Prevention of accidents: Three main areas: the home, road and the workplace. Safety education.

8. Uses of health services: Availability of health services When to seek medical services.

Principles of Health Education 1. Credibility: Consistent and compatible with scientific knowledge, local culture, educational system. 2. Interest: Felt‐needs 3. Participation: Based on the psychological principle of active learning. Create a sense of involvement, personal acceptance and decision making; provides maximum feedback. 4. Motivation: The need for incentives is a first step in learning to change. Carrot & Stick approach and Motivation is contagious.

Principles of Health Education 5. Comprehension: Always communicate in the language people understand. 6. Reinforcement. 7. Feedback. 8. Learning by doing. 9. Known to unknown: Start where the people are and with what they understand and then proceed to new knowledge. 10. Good human relations. 11. Setting an example. 12. Leaders: Agents of change. Try to penetrate the community through the local leaders.

Components of Health Education Process Health Education has three broad components ●● Levels of Health Education ●● Methods of Health Education ●● Activities undertaken in individual methods

Practice of Health Education Audiovisual Aids Auditory aids Radio, tape‐recorder, microphone, amplifiers, earphones. Visual aids Not requiring projection: Chalk‐board, leaflets, posters, charts, models etc. Requiring projection: Slides, film strips. Combined A‐V aids Television, slide‐tape combination.

Models of Health Education Medical Model Motivational Model Social Intervention Model

Approach to Health Education Regulatory Approach (Managed Prevention) Service Approach Health Education Approach Primary Health Care Approach. Individual approach Group approach Mass approach

Mass approach Television Radio Newspapers Internet Printed material Direct mailing Posters, billboards and signs Health museums and exhibitions Folk media

Group Approach 1. Chalk and talk (Lecture) Flipcharts Flannel graph Exhibits Films & charts

2. Demonstration 3. Role play 4. Group Discussion 5. Panel discussion 6. Symposium 7. Workshop 8. Conferences and Seminars

1-Lectures: one way method 2-Group Discussions: double way method. Approach of groups: In the form of talks, lectures, meetings and seminars. They are attended by group of people who can share in discussion, give suggestion and ask questions. Disadvantage of group approach: Few points only can be retained by the general audience It is difficult to fix the attention for long time The effectiveness of lecture depends on the personality of the lecturer Forms of group approach: 1-Lectures: one way method 2-Group Discussions: double way method. 3-Demonstrations: is a mixture of theoretical teaching & practical training.

Teaching methods Lecture Lecture discussion Seminar Symposium Panel discussion Group discussion Tutorials Role play Integrated teaching (horizontal and vertical) Talking point sessions Workshops Conferences

Demonstrations • Group discussion • Panel discussion • Symposium • Workshop • Role playing • Conferences and Seminars

A Symposium is a formal gathering in an academic setting where participants are experts in their fields. small scale conference A Conference refers to a formal meeting where participants exchange their views on various topics. A Seminar is a form of academic instruction, either at a university or offered by a commercial or professional organization. A Workshop includes all the elements of the Seminar, but with the largest portion being emphasized on “hand-on-practice” or laboratory work.  A Congress - would typically be held once a year per discipline, highlighting the achievements, notable results in that field. These are typically attended by leaders in that field, and feature a series of invited talks

Research shows . . . People get health information from: TV Doctor or other health professional Newspaper Family or friends Magazines Medical or health books Health plan or health insurance company Health newsletters Radio Internet 39% 37% 28% 24% 23% 21% 15% 14% 13% NOTE: 35% spoke with a doctor about a medical condition as a result of a media report. And 54% said they changed a health-related behavior as a result of a media report!!

Adoption of new ideas or practice Five steps Awareness (know) Interests (details) Evaluation (Advantages Vs Disadvantages) Trial (practices) Adoption (habit)

Counseling Counseling is the process used to help people to take decision Counselors never try to persuade people to accept their advice they encourage them to choose the best solution Setting of counseling: - Medical center - Outpatient clinics- Schools- hospitals

Rules for counseling (GATHER) G: Greet, respect, &trust A: Ask about the problem T: Tell them relevant information H: Help them to make decisions E: Explain any understand R: Return to follow-visit

good relationship To establish a good relationship between physician and patient, rapport and communication are prerequisite Rapport is the emotional elements contributing to good relationship between physician and patient like: the atmosphere of the waiting area ,the doctor greeting to the patient, degree of confidence the physician gain, continuing relationship of the doctor with his patient  

Comparison of Personal approach versus mass media of health education: Only reach small number of people More effective and impressive as the educator faces the recipients Recipients are enrolled and share in discussion Valuable to discuss confidential matters or problems, e.g. family planning(home visits are the most suitable approach) Can influence knowledge attitude and practice (KAP )of the exposed Can reach large number of people ion no time One way method and can’t distinguish the effect of the message Recipients can’t share in the discussion . The media may not be effective due to illiteracy or time of conducting the message or non available media Give knowledge and instructions only that not necessarily influence attitude, practice and behavior of recipients

Factors considered in Health Education Predisposing factors: including traditional targets of education including KAP which often change in response to one way educational and mass communication methods or any antecedent to behavior. Enabling factors: including time, money and material resources, special skills, appropriate and accessible health services Reinforcing factors: including social support from the family, colleagues, teachers and providers of health services. They are becoming more prevalent in health education where the assumed causes of the behavior are largely social such as peer influence.

Advocacy Advocacy (Dick de Jong) Advocacy is an approach to gain support of decision-makers for interventions. "Advocacy is the action of delivering an argument to gain commitment from political and social leaders and to prepare a society for a particular issue. It involves the selection and organization of information to create a convincing argument, and its delivery through various interpersonal and media channels. Advocacy includes organizing and building alliances across various stakeholders."