community medicine

1. Health education
DEPT of Community Medicine
ESIC MC GULBARGA

2. Topic division
1. Need for Health Education
2. Definition of Health Education
3. Aims and objectives of Health Education
4. Principals of Health Education
5. Area or contents of Health Education
6. Places of Health Education
7. Materials of Health Education
8. Methods of Health Education
9. Planning and evaluation of Health Education
10.Measures of Health Education

3. Need for Health Education
• It is the essential tool for the community
education
• It is a step of healthy living as majority of
diseases preventable if people prepare to learn
protective healthy living.
• It is the concept that binds the bricks of health
services.
• It brings about change in KAP in health and
health related diseases.
• Bring along in behavior change towards health.

4. Dr V.Ramakrishnan father of health
Education
• Health education is nothing but when it is
connected with public health programmes it is
something, and when associated with the
community it is everything.
• Health education is translation of what is known
about health into desirable individual, family
and community behavior pattern by means of
education process.

5. • Education dEf: It is a process by which behavioral
changes take place in an individual as a result of series of
learning experiences which he has undergone
• LEarning dEf: it is the process of acquiring knowledge
• KnowLEdgE: Knowing things, objects, events, persons,
situations and every thing in the universe.
Or it is the collection and storage of information or
experiences. (the means of acquiring the knowledge by
brain is by perception)
• Motivation: a combination of forces which initiate
direct and sustained behavior towards a goal.
• BEhavior: Voluntary movements and the passive acts
arising out of decision taken by the individual.

6. diffErEncEs:
• Learning is positive and incidental while
education is deliberate effort.
• Learning is wealth to the poor and honor to the
rich an aid to the young and support and
comfort to the aged,

7. • hEaLth Education is the door into the
twentieth century, the means of improving the
quality of life achieving social mobility and
participating in the world affairs.
• attitudE: A mental habit acquired from serial
experiences that predisposes us to specific
objects, persons or situation in a definite way.
• or: It is relatively enduring organization of belief
around an object or situation predisposing one to
respond in some preferential manner
• { Attitude = Knowledge + Feeling }

8. • coMMunity: it is group of people lining in social
organization and group in which people share varying
degree of political, economical, social and cultural
characters as well as interest.

9. ALMA ATA DECLARATION 1978
DEFINITION
“The 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 Health When
Needed.”

10. Changing concepts:
• Historical information TO 
• Prevention of disease TO
• Modification of individual TO 
behavior
• Community participation TO
• Promotion of individual TO 
and community
• Change in human behavior.
• Promotion of healthy lifestyle.
• Modification of social envt in
which the individual lives.
• Community involvement.
• Self reliance.

11. aiMs and oBjEctivEs:

12. Aims
• To encourage people to adopt and sustain health promoting
lifestyle and practices.
• To promote the proper use of health services available to
them.
• To arose interest provided new knowledge improve skill and
change attitudes in making rational decision to solve their
own problems.
• To stimulate individual and community self reliance and
participation to achieve health development through
individual and community involvement at every step from
indentifying problems to solving them..

13. Objectives
• To inform to come out from prejudge, ignorance
misconception
• To motivate them to change their KAP and also
to guide for health educational personnel to use
health facilities, judiciary, luxury
• To take active part in community
• To make the national program a success.

14. Principals of Health Education
Success of health education depends upon effective
utilization of principals of health education.
1.Credibility:
It is the degree to which the message to be
communicated is perceived as trust worthy by the
receiver i.e. based on facts with local culture
education system and social goals. Unless the people
have trust and confidence in the communicator no
desired action will be ensured after receiving the
message.

15. Principals of health education
2. Interest creation i.e. it should be felt need of the community
and slogan orientate. This is based on psychological principal
that people are not interested to listen to those things which
are not to their interest e.g. Formula for happy family formula
to long life “ learn how to stop worry
3. Opportunity for participation: It is the key word of health
education it is based on the psychological principal of active
learning i.e. involve people to come out with suggestion with
better acceptant.

16. Cont….
4. Stimulation for motivation: Motivation is a
awakening desire to learn. Types: Primary in born
desire or forces to accept and practice. Secondary
desire created by auricle forces in the form of
incentive. Incentive praise or love, rewards or
recognizable or revelry.
5. Comprehension: It should be comprehensive and
precise up to the capacity to understand in their
language the people speak and in simple words
which they are familiar
6. Reinforcement: It is like a booster dose by
repeated telling to remember practices.

17. Cont….
7. Chances for learning by doing: If I hear I forget
if I see I remember if I do I know. E.g. creep
bandage in varicose veins.
8. Asses the knowledge before you starts. i.e.
From known to unknown. To understand in a
better way. Go in search of people begin with
what they know and built with what they have.
E.g. Level of understanding. Their education.
Literacy status of audience
9. Setting an examples: The health educator should
set a good example in the things he is teaching e.g.
smoking ,FP.

18. Cont….
10.Should be on Good human relation: Be kind
and sympathetic to those who come and ask.
Kindness is such a language which the deaf can
hear and the blind can read.
11. Feedback : One of the key component of health
education . Helps to modify elements of the system

19. Cont….
12. Search for leader: he who makes the thing happen for group ace for health.
Practice search for leader and convenience the
leader first because we learn best from whom we
respect and regard: “there are three kinds of
people in the world those who don’t know what is
happening those who watch were is happening and
those who make things happen”

20. coMMunication
• Communication can be regarded as two way process of
exchanging or shaping idea feeling and information.
Broadly it refers to the countless ways that human have
of keeping in touch with one another.
• Communication Is Defined As Direct Or Indirect
Exchange Of Information Or Idea As A Means Of
Understanding And Education.

21. • The ultimate goal of all communication is to
bring about a change in the desired direction of
the person who receives the communication.
• This may be.
▫ Cognitive level ---- increase in knowledge
▫ Affective ------- changing existing pattern of
behavior and attitudes
▫ Psychomotor -------- acquiring new skills
• Our ability to influence others depends on our communication skill
e.g. Speaking, writing, listening, reading and reasoning.

22. Elements of communication
Communicator  Message  Media Receiver
Feed back
Awareness
Interest
Evaluation
and
Adaptation

23. COMMUNITER
• He is the originator of the message
• He should know what he wants to communicate
• He should know to whom is he communicating i.e. the needs
and interest and ability or capacity of the audience
• He should know the importance and usefulness of his
message
• He should know how he is communicating or channel if his
communication

24. Message
• It is the information a communicator wishes his audience to
receive, understand and accept and act upon.
• A good message should be:
▫ In line with the objective
▫ Simple, Clean, Accurate and Specific or
▫ In tune with mental, social and economic level of the audience
▫ Significant, Applicable or Practical
▫ Attractive, Appropriate and timely

25. CHANNEL OF COMMUNICATION
• It may be anything used by the sender of message to
connect him with the receiver or audiences:
▫ It may be interpersonal
▫ Mass Media or
▫ Traditional folk Media

26. Audience
• These are the consumers of message without them message is
mere noise
▫ Controlled type or target population: i.e. one who are held
together with common interest ( ANC )
▫ Uncontrolled Type or Total population: it is one gather
from motive or curiosity. This may poses a challenge to the
ability o the educator
• More homogeneous the audience greater are the chances of
an effective communication outcome. i.e. audience can accept
or reject or remember or forget it.

27. Feed back
• It is the flow of information from audience to the
sender. It provides an opportunity to the sender to
modify his message and render its acceptability.
• It is generally obtained through option polls,
attitude survey and interviews.
• It can rectify transmission errors.

28. Barriers of communication
• SEMATIC PROBLEMS: Words are merely symbols used to convey
certain meaning and they are often found to be in exact. The meaning
attached to words is likely to differ from place to place and from time to
time. New words are continuously being derived originating in certain
groups and some of them eventually become common. The tone the way
words are uttered the gesture and the simultaneous facial expression tend
to give new significance to a word
• DIFFERENCE IN PERCEPTION: Difference individual differ in
their perception frame of reference attitude experience etc. The
interpretation of the message and attaching meaning to it therefore varies
from individual to individual. They cannot look beyond their own limited
sphere of activities or specialization and see things in the wider or
difference perspective.
• STATUS IN HIERARCHY: Upward communication filtered to make it
more acceptable an in line with the expectation of the superior .
unpleasant or incrimination aspects tend to get deleted in upward
communication.

29. Cont…
• Physiological: Difficulty in listening, visualizing, speaking
expressing habits, stress and stains
• Psychological: Emotional disturbances, nervousness, instability
lack of concentration pre occupation
• Environmental: Overcrowding, poor lighting, noise, thermal
discomfort, bad odors, ill maintained channel of communication
• Social cultural: Poor knowledge of customs, practices, attitudes,
habits and belies, language, level of understanding and illiteracy.
social economic class difference, cultural difference, rural and
urban, as well as national and international.

30. AIDS: - Materials of Health Education
• Three types of materials
▫ Audio: - Spoken words , public audio system,
radio, micro phone amplifier ear phone
▫ Visual : -Written words, Pictorial presentation:
posters, flannel graph, flash cards flip charts
photograph exhibitions
▫ Audio visual materials/ Combined A.V Aids: - TV,
Films, slide tape combination

31. Criteria for audio visual aid:
▫ They are only tools and end result not dependent on it
▫ Its selection is based on program objectives
▫ Suitable for groups
▫ Scientifically accurate in their content
▫ Should have good eyes for appeal

32. • Advantages :-
▫ They created and maintain interest
▫ Motivation can be achieved
▫ Information can be given in short time and methodically
▫ Continuity of thought and information can be maintained
• Disadvantage: -
▫ Educator can become dependent on it
▫ It is not easy to correct the wrongly stated massage, as incorrect
information can lead to in correct motivation
▫ Expensive
▫ Inexperienced handling can damage of aids
▫ Educate looses confidence in education

33. Topics of health education
• Human biology: Structure, system, need of exercise,
sleep and rest and also effect of bad habits on health
system.
• Nutrition: Guide to choose nutritive food, nutritive
value, food storage preparation services etc, to make
best use of available food.
• Hygiene: it is the science of health and embraces all
factors which contribute to healthful living.
Personal, environmental[Domestic and community],
Food hygiene.

34. Cont….
• Family health care: MCH, IMM, nutrition and other related
activity and population dynamics.
• Control of Communicable diseases: mode of spread of diseases
and prevention.
• Mental health: to learn to live with others and to enjoy the
life. Stress situation leading to mental breakdown such
situation should be handled with sympathy understanding
and social contact.
• Prevention of accident: If accident is a disease than health
education is vaccine for it.
• Effective use of health service facilities:

35. Places of Health Education:
• Private and public dispensaries and PHC center: causes
of diseases importance and modes of spread.
• Hospitals: stay regularity of treatment and rehabilitation
• Schools: community hygiene, sex, nutrition disease
prevention, parent care.
• Factory: Prevention of accidents and occupational
diseases.
• Maternal and child clinics: Mother crafts, New child care
and Immunization.
• In National health programs: All National health
programs have health education and failure of program
is due to lack of health education.

36. Methods of Health Education
One way (didactic) method: It is based on
assumption that the “learns is more or less an empty vessel
into which information is poured” so that he will then
integrate, interpret, reproduce : i.e. the flow of information
is one way from the communicator to audience E.g. lecture
method in class rooms.
• Disadvantages:
▫ Passive learning or knowledge is imposed
▫ Learning is autonetave
▫ Little audience participation
▫ No feed back
▫ Does not influence human behavior

37. Two way (Socratic) method:
• Based on the feeling that people already posses
information, feeling, interest and belief which
profoundly influences the learning process and
which must be taken into account before they
can be modified or even left alone.
• Advantages:
▫ doubts can be cleared,
▫ active learning and democratic
▫ motivation to think talk and participate
• Disadvantages: time consuming

39. Individual approach
• Advantages :-
▫ One get acquainted with individual to deal more effectively with health problems
▫ One can discuss argue and peruse the individual to change his behavior
▫ It provides opportunity to ask questions in terms of specific intrest
• Disadvantage: -
▫ Educator can given it only to those who come in contact
▫ It reaches only small number of people
▫ Message spreads slowely

40. Group Approach
• Lectures: defined as carefully prepared oral
presentation of facts organized thoughts and
ideas by a qualified person.
• Demonstrations: it is carefully prepared
presentation to show how to perform a skill or
procedure.
• Group discussions: it is an aggregation of people
interacting in a face to face situation

41. Con…
• Panel discussion: 4-8 qualified persons talk in front of a
large group on a given topic one after the other. There is
no specific agenda no order of speaking and no set
speeches. The successes depend on chairman. After main
aspect of the subject are explored the audience is invited
to take part
• Symposium: it is a series of speeches on a selected
subject subjected unlike panel discussion. Each person
presents an aspect of the subject briefly there is no
discussion among members and at the end audience may
raise their questions. The chair-man makes a
comprehensive summary at the end of the entire session

42. Cont….
• Work shop: it consists of a series of meetings i.e.
4or more where emphasis on individual work
within the group with the help of cosultants and
resource personnel.
• Role playing: or social drama based on the
assumption that many values in a situation
cantn’t be expressed in words and the
communication can be more effective if the
situation is dramatized by the group
• Conferences and Seminars: this category
contains a large component of commercialized
continuing education they cant be head at
regional. State or National level

43. Planning and evaluation of Health
Education
• Steps of planning
1.Survey and Identification of problems and deciding on
priorities and setting up of goals.
2.Definition of objectives
3.Assessment of resources procurement of Man Money and
Material
4.Preparation of plan of action
5.Implementation of plan or campaign proper
6.Evaluating
7.Reassessment
8.Measures of Health Education

44. SOCIAL MARKETING
• PhilosoPhy behind social marketing “if you can
sell a tooth paste why can’t you sell good health”
• The first social marketing of contraceptives started
in 1967 with NIRODH condom program in India
• Kotler and Gerald Zaitman 1971 1st
presented the
idea of social marketing

45. Definition
• The design, implementation and control
program aimed at increasing the acceptability of
a social idea or practice in one or more group of
target adopters.
• Social marketing is the systematic application of marketing, along with
other concepts and techniques, to achieve specific behavioral goals for a
social good

46. TYPES
• Emphasis on selling a product: -
Eg, sale of social beneficial product like condom, OCPS etc
• Emphasis on selling an Idea or social advertising
i.e. no object to sell / money to transfer but rather there is a
traditional education strategy to reflect a consumer
orientation
eg: stop smoking, eat less salt, self examination of breast etc

47. ADVANTAGE
• Govt. takes care of products and hence available at
almost cheaper rate
• Accessibility is made
• Takes away inhibitions gradually and improve
acceptability
• Underprivileged and target group get free of cost

48. Difference between social and
commercial marketing
Marketing Social Commercial
Controversial ideas More Less
Complexity of products More Less
Consumers LSE class HSE class
Literacy Low High
Utilization rate High Less
Consumer satisfaction Less High
Examples Mala D,
Women Hygiene kit
Nirod
Ice cream,
Pizza, etc

50. Planning and evaluation of Health Education
Steps of planning
Survey :Before the campaign survey is to be conducted for following information:
 The location of the place: its topography conditions of the roads
and the availability of on all weather approach road
 The size of the population and its age and sex composition
 People beliefs and customs and taboos in general
 Their KAP with reference to the subject concerned
 The names and addresses of the local leaders and the extent of
their influences on the people
 Place where and the and time when people congregate and place
where public meetings can be held or films exhibited or the
important or auspicious days
 Base line data i.e. vital statistics like births deaths maternal and
infant mortality preventable communicable diseases existing
health facilities and its utilization etc

51. Identification of problems and deciding on
priorities and setting up of goals
• Planning is an administrative instrument to
provide rational basis for decision making
• Objective is planned end point of all activities
• Goal ultimate desired state towards which all
objectives and resources are directed.
• Educational diagnosis study of level knowledge
of understanding attitude and belief
• #######

52. Definition of objectives:
• The next step is the definition of the objectives in
terns of what exact changes in the behavior of
people are the envisaged and within what period.
• This will depend on the subject of education and current practices.
E.g. if education is about ANC coverage and currently only 30% of
pregnant women are attending the ANC clinic the objective may be
defined as within 6 months of the campaigning the % of pregnant
women attending the ANC clinic will be raised by 50% . this will go
up to 80% with in one year and to 100% in 2 years.

53. Assessment of resources
procurement of Man Money and Material
• The expanses to be incurred on the implementation of
the program are estimated, sufficient funds are procured
before the commencement of the campaign
• All required health education materials like pamphlets
leaflets and handouts etc. are procured or got prepared
locally. Similarly the requirement of the amplifiers
microphones projector vehicle etc are estimated and
requisitioned
• Adequate number of health educators is requited from
the staff of PHC DHO or NGO. They are given training
and briefed about the objectives of the campaign and
their respective share in the implementation of the
program.

54. • Consideration of possible solutions

55. Preparation of plan of action
• Scheduling and phasing this is the final part of
the preparatory phase and involves the framing
of time table of activates giving for each day of
the campaign i.e. what will be done? i.e. group
discussion, film public meeting etc When and
where it will be held and by whom? The people
are then made aware of the details of the
campaign and their co-operation in making it
successful

56. Implementation of plan or
campaign proper
• Campaign proper begins with a formal
inauguration ceremony. The work proceeds as
per the schedule drawn. The person in charge of
it ensures team sprit among the staff working in
the field. He effectively supervises them and
carries out checks to see if they are having any
problem and offers constructive advice and
guidance.

57. Evaluating:
• The degree to which stated objectives have been
achieved assessed periodically and the mid term
evaluation and at the end of the campaign i.e. end phase
evaluation may indicate the success of the campaign e.g.
increase in ANC attendance going on satisfactorily or not
etc.
• Special survey in case of nutrition education done by
repeated survey for decrease of prevalence of deficiency
disease
• Action: if mid term evaluation indicates that the
program is mot succeeding the reasons for the non
acceptance are determined and the campaign is suitable
modified.

58. Reassessment
• The area is revisited a year of so after or so the
conclusion of education campaign and to way
done to see whether the gain made during it are
continuing or whether the people have reverted
to their original practices.

59. Measures of Health Education
• Effective index = p2-p1/100-p1 where p1= % of
people who have adopted the sesired behavior
before health education and p2= % of people
who have adopted the sesired behavior after
health education.
• Cost benefit index: = EI ( B/N - C/N)
• Where B = potential benefit measured in dollars
• C= cost of health education program
• N = number of people adopting delivered
behavior

60. Dr I Amruta swati
Assistant Professor
Dept of Community Medicine

61. Definition
• It is an educational program; provides for the study
of the population situation in the family, community,
nation and world with the purpose of developing in
the students the rational and responsible attitude
and behavior towards the situation

62. Need
1. To prepare young for adult life.
2. To bring about change in attitude and values
that shape individual and social life
3. To introduce and encourage the idea of
responsible parent hood and smaller family to
both male and female before reproduction begins

63. Need
4. To prepare social leaders and officials of future by
providing background information of population
5. Form major portion of population, 40% below 14
years
6. Legitimate subject concerned with society to
improve the health, preserve the family value and
environmental awareness

64. Need
7. Planning for population education: Depending up
on the type of programme objectives and goals as
given in needs which in turn depend upon the
needs

65. Pre-requirements
1. Potential financially organizationally
feasibility
2. Presents of National Population Policies
3. Govt. approval to start in school
4. Acceptability to the community and Govt.
regarding content and grades
5. Resources

66. Pre-requirements
6. Availability of books, pamphlets, manuals,
chats lesson out line
7. Inclusion in biological science curriculum
(syllabus)
8. Co-ordination for all departments community
and parents
9. Curriculum planning by team of experts

67. Content of population education
1. Current population situation
2. Basic demographic concept
3. The consequences of the population change and
human reproduction, family planning, family life and
size of family
4. Population and economic
5. Population and environment
6. Sex education
7. Population polices and programmes

68. In India it includes
1. Population trend and quality of life
2. Changing trend in population in India
3. Indian population in world prospective
4. Projection of population change
5. Influencing factors for population change

69. In India it includes
6. Relation between population and resources
7. Population and agriculture production
8. Population and nutrition
9. Population and resources
10. Population and environmental pollution

70. Muslim country avoid sex education
Emphasis
• Concern about family
• Relation between parent and children’s
• Need to preserve land for future generation

71. Levels of students
It many be preferred to be both at primary and secondary level
Because:
• Primary :
▫ Better environment
▫ Many discontinue after primary
▫ Villages do not have secondary school
▫ Children are older compared to urban
• High school
▫ Can understand in a better way
▫ Closer to child bearing age
▫ Ultimately decision making people for tomorrow
▫ Small in number

72. Teachers training
1. Face to face training: By export in short course or
work shop to the head of the institute
2. Expert to principal to teachers to student By
the time it reaches the students it is only definition level
3. Pear training: In this trained teachers train in return to
other teachers. But it needs high motivation and better
understanding among teachers
4. Self learning educational model. Book lets; modules;
5. Correspondences courses. Study population education
training material

73. Hurdles
 Many do not have confidence,
 lack of knowledge,
Afraid of student questions,
 Large class,
 Overburden poor facilities.

74. In India population education
• Initiation in the year 1960,
• Implementation limited to NCERT,( National
Council And Educational Research Training).
• Conducted seminar in 1969, and conclude to
teach population education at all levels..

75. • Ministry of health passed circular stating “ It must be
only to create a right attitude to family size, need of family
planning and not to mix sex education and methods of family
planning
• 1970 Govt. brought pressure on all state to start and
released fund to start
▫ State population education cell
▫ Prototype circular
▫ Publishing quarterly news paper
▫ Preparation of instructors to teach
• 1980 ten states started and remaining in 1981

76. Evaluation
• Teacher deleted this topic with fear of
community
• Many teachers felt un qualified to teach
• In spite of awareness towards family size,
problems of population still they prefer 3or more
children
• Lack of guidelines
• Lack of time and founds

77. SOCIAL MARKETING
• philosophy behind social marketing “if you can
sell a tooth paste why can’t you sell good health”
• The first social marketing of contraceptives started
in 1967 with NIRODH condom program in India
• Kotler and Gerald Zaitman 1971 1st
presented the
idea of social marketing

78. Definition
• The design, implementation and control
program aimed at increasing the acceptability of
a social idea or practice in one or more group of
target adopters.
• Social marketing is the systematic application of marketing, along with
other concepts and techniques, to achieve specific behavioral goals for a
social good

79. TYPES
• Emphasis on selling a product: -
Eg, sale of social beneficial product like condom, OCPS etc
• Emphasis on selling an Idea or social advertising
i.e. no object to sell / money to transfer but rather there is a
traditional education strategy to reflect a consumer
orientation
eg: stop smoking, eat less salt, self examination of breast etc

80. ADVANTAGE
• Govt. takes care of products and hence available at
almost cheaper rate
• Accessibility is made
• Takes away inhibitions gradually and improve
acceptability
• Underprivileged and target group get free of cost

81. Difference between social and
commercial marketing
Marketing Social Commercial
Controversial ideas More Less
Complexity of products More Less
Consumers LSE class HSE class
Literacy Low High
Utilization rate High Less
Consumer satisfaction Less High
Examples Mala D,
Women Hygiene kit
Nirod
Ice cream,
Pizza, etc