Title: Principles for health education
Course: Level 3 - Health Education and Promotion > Section: Principles and challenges of health education

Health Extension Workers should know the major principles of health education and follow them while delivering a health education session. These principles should guide health education activities toward achievement. The principles of health educations are ground rules and regulation that should be followed while delivering health education. They explain desirable and undesirable behaviours while giving health education to a particular audience.

The practice of health education is based on the assumption "that beneficial health behaviour will result from a combination of planned, consistent, integrated learning opportunities in different settings."

Take a moment to think about the principles of health education during your health education sessions. Every individual learns and through learning develops the behaviour by which he lives. Learning takes place not only in the classroom but also outside in the wider world. There is an internal learning by which a man grows. There are certain principles of learning used in different areas of education.

The following points are the major working principles of health education:

Principle of Educational Diagnosis

The first task in changing behaviours is to determine its causes. Just as doctors first must diagnose an illness before it can be properly treated, as a health educator, HEWs must diagnose behaviour before he/she can be properly plan to be changed. If the causes of the behaviours are well understood, the HEWs/health educator can intervene with the most appropriate and efficient combination of education, reinforcement and motivation methods.

This educational need assessment provides the foundation for a health education program planning. It also determines what health problems might exist in any given group, which directly help in selecting the accurate target population. The other significant input of educational diagnosis is it helps in collection of community resources available to address the problem. This principle needs careful data collection and analysis.

Health education is primarily educational and its purpose is to ensure a desired health related behaviour. Therefore, before involving any individual, group or the community in health education, the need of the community should be ascertained. It has to be accurate and relevant to the community problems and available solutions.

It is a psychological principle that people do not listen to those things which are not to their interest. That is why health teaching should relate to the people interests. E.g., People, are not interested in health message such as "take care of your health" or "be healthy". Health educators must find out the real health needs of the people.

These broad areas of individuals interests are called "felt needs" i.e. "needs" the people's feels about themselves. If a health programme is based on "felt needs", the public will willingly participate in the plan and only then it will be a public programme. The health educator/ Health Extension Worker will have to bring about recognition of the needs before he proceeds to tackle them.

Principle of Participation

Participation is a key concept in health education. It is based on the principle of active learning. The viewpoint for success in any attempt to change behaviours will be greater if the individuals, families, community and groups have participated in identifying their needs for change and have selected the methods that will enable them to take action.

Fig 2.1 Effective health education is based on community participation.

Health education must include not only the personal element but also social components. However, personal and community health are interrelated and interdependent, the involvement of each member of the community in their affairs is mandatory.

Participation should aim at encouraging people to work actively with health extension workers and others in identifying their own health problems and also in developing solution and plans to work them out. Generally public participation seeks and facilitates the involvement of those potentially affected by particular problems should be interested in a making decision. The principle of public participation holds that those who are affected by a decision have a right to be involved in the decision-making process. So the Health Extension Workers should realize this concept and engage the community member during health education activities.

Principle of Multiple Methods

This principle follows from the principle of educational diagnosis. In so far as various causes will invariably be found for any given behaviors. For each of the multiple factor identified different methods or components of comprehensive behavioral change must be provided.

After educational diagnosis completed, you should segment your audiences into various groups according to their need. Specific health education session should be designed to address needs of a particular group of people. During this, some individuals learn by discussion rather than role play and others may prefer the role-play.

Principles of Comprehension:

In health education, one must know the level of understanding, educational status or literacy of the people for whom the health education is directed. One barrier to communication is the use of words which cannot be easily understood while you provide health education.

Therefore, Health Extension Workers should be led to practice individual health behaviour through visible goals, rather than communicate certain abstract rules of health which are difficult to understand. So health education should be within the mental capacity of the audiences.

Principle of Motivation:

In every person, there is a fundamental desire to learn. Awakening of this desire is called motivation. There are two types of motivation: Primary and secondary. Primary reasons satisfy basic biological needs for survival including food and water which initiate people into action. However, primary reasons do not always motivate all the community. For instance, food may not be driving someone who has just completed a five-course meal. These motives are inborn desires!. But secondary reasons are based on desires created by the outside forces or incentive.

Some of the secondary motives are praise, competition, rewards, punishment and recognition. In health education motivation is an important' factor. The incentives may be positive or negative, but the positive must be emphasised as against the negative.

For conveying health education, fear should not be used as a motive regularly. Because fear of disease cannot be a goal of health education, but to exist most effectively and to serve society in the best possible way should be set up as an ideal. However, fear arousal messages are sometimes used during outbreak and epidemic for illiterate peoples.

As a HEW you will be able to motivate people while giving health education or during group discussion. This motivation may involve appraisal or verbal encouragement. Motivation is a mental direction or desire for doing or rejecting something. It is something that happens within the person, not something done to people by others. But, other activities may stimulate someone to be motivated. We can appeal to people's motives through reason arousing appeals.

For example, during a health education session in the community, you should able to motivate those who actively participate by using a motive arousal word like "excellent", "very good" and the likes. By doing so, you will encourage not only the active person but also others to participate. An individual who is not motivated will gain or learn nothing.

Think about your kebele and assume that you are giving health education on child immunisation. What methods can you use to reinforce the message? How can you motivate them? Your answer may be asking them a question, forming a group discussion to support them to draw their mental picture about the issue. You can use motive arousing words after each participant's trial.

Principles of Known to Unknown

For imparting health education, one should proceed from the known to the unknown. While providing health education, health extension workers should start from where the peoples are and with what they can understand easily and then proceed to new knowledge. The existing knowledge of the community should be used as a hook on which to build up new knowledge.

In this way, new knowledge will bring about a new enlarged understanding which can give increase to an insight into the problem. To go through this principle, as we discuss in the principles of comprehension, Health Extension Workers should now understand the knowledge level of their community. This is important when we want to change our community's attitude about harmful traditional practice. You should first discuss their beliefs and attitudes; then you can easily change their attitude by giving new knowledge and helping them to develop a new attitude.

Health education should start from the existing indigenous knowledge and efforts and aim at small changes in a graded fashion and not be too ambitious. People will learn step by step. For every change of behaviour, a personal trail is required and, therefore, health education should provide opportunities for trying out improved practices.

What will happen if you start with a concrete/unknown part? Think for a moment. To avoid any clash of ideas, health education should start from where people are and slowly build up the talking point to allow for people understanding, appreciation and internalisation of fresh ideas.

Principle of Credibility

Health education is given based on scientific findings, facts and current knowledge. Good health education is based on facts, and must be consistent and compatible with the current scientific knowledge. It is unthinkable to provide health education without scientific knowledge related to the addressed topic.

For example, Health Extension Workers must know the current scientific knowledge how HIV/ADS is transmitted and the prevention methods. This is because scientific knowledge is changing with time. (e.g. It is incorrect to say "I think FGM is harmful". The health educator should say FGM is a harmful practice. And he/she should list the scientific reasons and evidence behind it).

This principle of credibility guides you to present your health education to your community based on scientific facts and currently updated knowledge.

Principle of Planning and Organising

Planning and coordination are fundamental activities in health education, which distinguishes it from other incidental learning experiences. It involves deciding in advance when, who, what, how, what and why of health education. It requires the planning for resources, methods and materials to be used, identification of target groups, etc.

Let consider a proverb that says "failing to plan is planning to fail." This proverb tells you that it is very difficult and often unsuccessful to carry out a health education program that is not planned and organized appropriately. If you do not plan you session, you will mix the starting points, the knowledge you want to transfer and, in the end, you will not able to assess your achievement. Plan is a framework that will guide you from the starting of the session until you determine the possible outcomes of your health education.

Principle of Cumulative Learning

Behaviours result from the collective learning experiences of an individual's. It is the product not only of a planned health education programmes but all prior education, formal and informal education, life experiences, etc. Thus, to affect the behaviours of individuals, group or community, Health Extension Workers must plan a series of learning experiences in a sequence that takes into account the prior learning experiences and concurrent incidental experiences to which the community is exposed.

Behaviour change does not occur in a vacuum. Behaviour is the sum of a lifetime of personal and cultural experiences.

You should also need to consider that people will not learn at the same pace, according to their experience, cumulative learning, and participation. You need to adapt the learning process to each rather than speeding up only with the active participants.

Principle of Feedback

Feedback is a mechanism by which you assess what has happened in the target population after receiving the message. Therefore, the way communication is planned is of particular importance in the health education process to help people give proper feedback.

This can be either positive when expected understanding occurs or negative when desired change of opinion does not occur. Feedback does not need to be a written message but it can be expressed with gestures, symbols or signs. For effective communication, feedback has a paramount importance. Health Extension Workers must ask for feedback at the end of every health education session. It helps you to address any misunderstandings and to plan you next session correctly.