AMIS AND PRINCIPLES OF HEALTH EDUCATION-FIVE

19. Usually the health educator is a technical person who possesses technical information. It is not easy for the lay people to understand the technical aspects and the scientific facts on health matters easily. The health educator has, therefore, to use terms which can be immediately understood. He should avoid highly scientific jargon. For example, he should not say arthropod vector, he should say disease carrying insect. Terms like protozoa, parasite, virus, etc., should be avoided when talking to illiterate people. The word germ which can not normally seen by naked eye may convey something. Even that word will have to be properly applied and demonstrated.

20. Health education has for its ultimate goal to bring about the desired health related behaviour and practices. There may be many habits, customs etc., based on traditions, beliefs, attitude, etc., in the community. Any attempt of drastic or quick change of behaviour will not only be difficult but may generally cause unnecessary mental conflict and resentment particularly because the expected behaviour may be much contrary to existing cultural pattern. Health education should, therefore, start from the existing culture and gradually try at change of habit and practices. Moreover, the health education effort should aim at small changes in a graded fashion and not be too ambitious. People will learn step by step and not everything together. For every change of behaviour a personal trial is required and therefore the health educator should provide opportunities for trying out changed practices.

21. The use of suitable and objective audio visual aids is of great importance in any health education effort because the people will not evince sufficient interest towards lecture, talks and discussions. The aids provide not only a comfortable diversion but help in focusing attention on the essentials and giving the eye and ear a greater role in perception.

22. The basis of any education is communication. For people to understand and appreciate ideas, messages, methods, procedure, etc., with proper reasoning him communication should be simple, clear, brief and crisp. There are many principles of effective communication which require be carefully remembering and practicing by the health educator.

AMIS AND PRINCIPLES OF HEALTH EDUCATION-FOUR

 

14. It has already been mentioned that the health education should be need based. It has, therefore, to be specific and relevant to the problems and the available solution. It is a wasteful exercise or occupation if unwanted details and information are included in the content. The content should always aim at the focus or s\essence. Otherwise, the client will not only show lack of attention or interest but may miss the essential points.

For example, there is no need for telling the lay people about all the latest research on a particular health problem. It is a common tendency of many professionals and para-professional health workers to try to impress the audience with all the scientific knowledge and reach details which they have learnt. The common man is only interested in knowing what the problem is and its solution.

15. Related to health and daily way of life there may be many practices and behaviour which may or may not have any basic connected knowledge and attitude. It is the essential function of any health educator to find out the existing behavioural patterns and their basis. If any change of behaviour is required from a wrong practice to a supposed right practice the process of health education should aim at removing the wrong idea and its connected attitude and then introducing correct ideas, attitude and practices.

16. It must be remembered that people are not absolutely without any information or ideas. There is always some perception or belief, etc. which should be studied first before health education can be started. The health educator should remember that he is not merely passing information but he is giving an opportunity for the clients to analyses fresh ideas with old ideas compare by past experience and take decisions which are found favorable and beneficial.

 

17. A grave danger with health education programmes is the pumping in of a bulk of information in one exposure or enthusiasm to give all possible information. Since it is essentially a learning process the process of education should be done step by step and wite due attention to the different principles of communication.

18. Health education can be for individual, group or community. As has already been mentioned it should provide an opportunity for the client or clients to go through the stages of identification of problems, planning, implementation, evaluation and so on. This is of special importance in the health education of the community. The principles of community organization, viz., the identification of opinion leaders, identification of problems and planning, implementing and evaluating are to be done with full involvement of the community to make it the community’s own programme.

AMIS AND PRINCIPLES OF HEALTH EDUCATION-THREE

 

6.      It is necessary to have a free flow of communication. The two way communication is particularly of importance in health education to help in getting proper feed back and to get doubts cleared.

7.      The health educator has to make himself acceptable. He should realize that he is an enabler and not a teacher. He has therefore to win the confidence of his clients.

8.      The health educator should not only have correct information with him on all matters that he haws to discuss but also should himself practice what he professes. Otherwise he will not enjoy credibility.

9.      The health educator has to adjust his talk and action o suit the group for whom he has to give health education. This is particularly necessary when the health educator has to deal with illiterates and poor people. He has to get down to their level of conversation and human relationships so as to reduce any social distance. It is only when he can identify himself with the group that there can be any meaningful interaction and exchange of ideas, felling, opinions, etc., needed for promotion of attitudes and behaviour.

 

10.   A health educator has to employ all possible methods of education. He should also have a basic knowledge and should be fully familiar with all the learning principles. He should therefore apply the teaching-learning methods appropriately to different groups and individuals by using his judgment.

         All principles of education and leaning are fully applicable in health education. All methods of education have to be fully explored and exploited for different situations. A variety or diversity of methods is essential not only for effective teaching learning process but for creating interest and for involvement of the learner or the client.

11.  Since the ultimate aim of health education is to bring about desired health related behaviours, the health educator should as far as possible make every effort to reason out and rationalize, so that the client is able to internalize the relevant ideas.

12.   Unplanned health education is a wasteful effort. Health education without proper educational diagnosis will not be able to match the need with the solution and resources.

 

            Programmed health education will have much more effect than unplanned ad hoc attempts. To ensure a full understanding of the problems and its solution by the clients a well planned programme is necessary. The content of the programme and the method of approach will have to be based on the educational diagnosis and care should be taken to include the implementation and evaluation along with the clients. In other words, the health education effort is not a mere one time talk or discussion but a continuous programme and identifying problems with the clients and working out its solution and reviewing from time to time to ensure enduring behaviour.

13. The use of A.V. aids for support and reinforcement is of particular significance in health education because of the different illiterate and literate groups that have to be involved and also because of the technical nature of the subject matter.

 

AMIS AND PRINCIPLES OF HEALTH EDUCATION-TWO

 

3. It is necessary to discuss freely on the health problems and the solution and to ensure that all the good and bad points, advantages and disadvantages, difficulties, tec., are thoroughly dealt with. The educator should not be emphasizing only the good points and concealing any bad points. Otherwise the community may feel disturbed when their doubts are not fully cleared.

4. Education is the process or act employed to develop the mind, character and body by planned discipline. It is a methodical socialization of an individual. Since education aims at change of behaviour, the science of sociology, psychology and anthropology are essentially required in understanding human behaviour. A close study and application of these behavioural sciences becomes necessary for health education because it is concerned with individuals by themselves and in groups and society.

The educational process has to take into account the learning process and the teaching process. For this the educational content has to be developed based on the diagnosis of the socio psychological factors. Methods of teaching or providing learning opportunities also form part of the educational process. Lastly the media of communication has to be considered carefully for effective propagation of ideas.

5. The importance of a close, friendly and sympathetic attitude has been very much emphasized on the part of doctors, nurses, etc., while dealing with patients. Treating the sick has always been considered as a noble act and veterans in the medical profession have given special importance to bed-side manners and ethics, good doctor-patient relationship and a patient understanding of the suffering of the patients. A successful doctor or nurse puts the patient at ease and explains as much about the diagnosis, treatment, diet, precautions, etc., as possible not only to win the confidence of the patient but to ensure proper adherence to the treatment and all precautions necessary for getting cured or relieved.

 

It is common knowledge that patients like a particular doctor or nurse or para-professional health worker mainly because of that person’s good qualities and capability for discussing matters freely and in a helpful manner.

While it is not difficult to understand that a good doctor-patient relationship is of the essence, it is however, quite common to see the majority of doctors and nurses not realizing the need for health education in the daily activities in clinics and hospitals, etc.

 

Preventive and promotive care is not generally followed with dramatic results as curative care. Therefore, even without much effort at health education there is a possibility of people appreciating the objective of treatment if and when they undergo it. There is a great need for health education to make people understand the curative aspects of many diseases but in times of sickness people do resort to some care by and large. But in the matter of preventive and promotive care which include personal hygiene, healthy habits, maintenance of proper environmental health, medical cheek up, immunization, etc., people are not by themselves sufficiently aware of the various things that they have to do. Generally it is also difficult to demonstrate the beneficial effects of preventive and promotive care to enable people to realize their importance. A continued education is necessary in every community to help people to identify their health problems and to help them to understand what steps they have to take to prevent any sickness.

AMIS AND PRINCIPLES OF HEALTH EDUCATION-ONE

 

Essentials of Health Education

If we understand that the aim of Health Education is to ensure health related behaviour it should not be difficult to appreciate the following  essential points which are relevant and applicable to health education in all possible situations.

1. Health education may be required for almost every one at some time or the other.
2. Health education is not a one time affair. It is a continuing education.
3. Health education can be organized as a self learning process.
4. Health education can be a process of learning from others.
5. Any one who knows what is good for preservation of health can impart health education.
6. Health education consists of proper communication of ideas.
7. All the principles and theories of education and learning are fully applicable in health education.
8. Since health education has to do with health, correct knowledge about various aspects of health and disease is highly essential for communicating or disseminating ideas of the purpose of producing necessary attitude and behaviour.
9. It must be borne in mind that human behaviour is governed by various influences and therefore, health education must take full cognizance of all the influencing factors in any given situation. A good health educator has, therefore, to combine in himself knowledge and skills of behavioural sciences with sufficient rational understanding of the health problems and their solutions from a scientific and logical stand point.

Principles, In view of what has been understood so far about health education we can evolve a few working principles.

1.      Health education is primarily education and its purpose is to ensure a desired health related behaviour. Therefore, before involving any individual, group or the community in health education with a particular purpose or for a programme the need should be ascertained and if there is no need the education will be wasted. It is in trying to ascertain the need, creating the need and awareness and creating the interest, etc., that the principle and concepts of behavioural sciences for learning and education are applied. All health education should be need-based. If the problem is severe or serious from the health persons point of view but is not felt as much by the individual or the group then a proper diagnosis should be made about the different influences.

 

2.      Health education should not become an artificial situation or formal teaching-learning. There are many points to be observed to make health education acceptable and meaningfully utilized. One has to get into the culture of the community and introduce novel ideas with a natural case and caution. Dogmatic statements particularly contrary to existing belief, culture, practices will not be liked. It is, therefore, better to start from where people are and slowly build up the talking points to avoid any clash of ideas and to allow for peoples understanding, appreciation and internalization of fresh ideas that the health educator wants to seed in the community.

 

THEORIES AND PRINCIPLES OF LEARNING

 

 We have understood that learning is a process of inquiry or understanding, enlightenment or education. It can take place individually. It can also take place in group situations. There are advantages for individual learning as well as group learning. In individual learning the mind is able to cast its sensorial net wide apart and catch the impulses and also the process of analysis can take place at leisure or in a relaxed mood or undisturbed. But the group earning has the advantages of sharing experience, exchange of ideas and sense of security or assurance, when there is a commonness of goal or agreement. In a group it is quite possible that the individual learning is somewhat hindered or curbed but the group consensus or acceptance gives more credibility and strength of conviction. As far as behaviour is concerned and learning for behaviour, the first prerequisite is that a person wants to learn and improve. Unless there is an inherent desire on the part of the individual or group to acquire some knowledge for the sake of change of behaviour, a learning situation will not obtain.

It must be understood that learning can be a process by which a person acquires knowledge, information and skills. For this process the individual may be able to undergo the learning process all by himself as in the case of reading or seeing things, feeling, hearing, etc. He can also be helped by another person and in that situation he is being taught.

For the health educator it is essential to know certain theories and principles which have been scientifically discussed by social psychologists. These theories have been evolved from a number of experimental approaches to the study of learning and most of these experiments have been done with animals. The very first theory that is usually referred to is the classical conditioning or stimulus response type of research on learning, which was demonstrated by Pavlov, a famous Russian scientist. In his experiment, Pavlov noted salivation of the dog in response to the sight or smell of food. He called this natural or native response as unconditioned response of salivation to an unconditioned stimulus of food. This is a natural instinctive response common to all living organisms. Pavlov introduced a bell to precede the offering of food to the dog. Every time the bell rang he produced food and thereby trained the dog to establish an association between the bell and food. Subsequently the dog expected food whenever the bell rang. This became a conditioned response to a conditioned stimulus.

 

Further, pavlov demonstrated by addition of similar stimuli like making noise with the plate or making noise with the spoon, etc., the conditioned stimulus becomes generalized and the dog responds to similar stimuli in the same manner. Afterwards Pavlov extended his experiment by withdrawing the food or reinforcement further and gradually made the dog doubt the offering of food with the result that the dog lost interest in this kind of a stimulus. He called this extinction of the conditioned response. In other words, the organism gets so bored or so very much used to the stimulus that it does not show any special interest in the reward or result.

The application of this theory is that in teaching learning process the teacher should either give encouragement to step up the interest of the listener, or if any change in behaviour is desired the teacher must provide the facilities and resources and demonstrate the beneficial results.

Krech and Krutchfield have used the same Pavlov's theory and suggested the learning or memorizing principle based on the concept of reinforcement of ideas. According to them, the acquisition of ideas in the brain by storage and recall depend on the process of frequent memorizing by repetition.

Edward L. Thorndike has further developed on the theory of conditioned response and repetitions and propounded three laws of learning.

1.       Law of readiness. 2. Law of exercise. 3. Law of effect.

Law of readiness. Any living being does not respond to a stimulus unless it is mentally ready and prepared to receive the same. Thorndike experimented with cats in cages. He made the cat hungry and kept enticing food in another compartment. The cat learnt to let itself out and reach the other compartment for the food. A fully fed cat did not respond the stimulus of food and therefore did not learn how to get out to reach the food.

According to this, any learner has to be mentally prepared and be ready to learn. Unless there is a desire to learn neither the individual is going to seek the information or knowledge nor can the educator involve the person in learning. In other words, before any learning can take place the learner has to be motivated for learning or the educator should find out the people who are ready and wanting to learn and help them to learn. The horse can be taken to the water but cannot be made to during. In learning also the readiness to learn decides whether learning takes place or not.

Law of exercise. Repetition of stimulus and its response has reinforcement or strengthening effect depending on the utility and gain or pleasure experience or the contrary of it. In the same experiment described above the acquiring of food was a gainful and pleasurable experience. So the cat's mind was trained to the fact or experience that by opening a particular latch it was possible to go out and reach the food and the food could satisfy the hunger. There were two exercises in these experiments. One was the opening of the door. The cat learnt by frequent trail and error that a particular latch was able to let him out. By the law of exercise or repetition of trial and error the cat went straight to the particular latch on later occasions and did not waste time in trying any other latch. By repeatedly doing a thing we learn to do it better in a shorter time and with greater confidence, it becomes a practice.

Law of effect. In the above experiment because the food was available to satisfy the hunger the

cat was inclined to open the latch very time. If no food had been kept the cat would not have shown the same eagerness on subsequent occasions. If instead of food, it got a beat by a stick when it came out it would not have come out by opening the latch any more.

This is only reinforcing what has been meant in the exercise. When the association between a particular stimuli and response is resulting in a satisfying state of affairs, the bond between the response and stimulus is strengthened. Conversely, when the resultant state of affairs is painful or unpleasant or annoying, the bond is weakened. In daily life we find that we often tend to repeat what is pleasant or helpful to us and avoid what is unpleasant or painful.

Similarly the law of effect has relevance by giving successful experience, encouragements, and also provision of services and resources. It is only the demonstration of good results that will give a sense of conviction and assurance to the individual or group. Therefore, they have to be enabled by learning to experience tangible and advantageous results.

THEORY OF LEARNING

 

Learning is the process of acquiring knowledge. Knowledge may be acquired and stored merely for information or may help in developing any skill or technique of doing various things in life. To learn according to the oxford Dictionary is to acquire knowledge of to commit to memory; to develop skill or technique by practice, to understand; experience, to Endeavour by practice. Learning in the dictionary means the act of studiously acquiring knowledge; information; scholarship, the whole body of knowledge possessed by a scholar.

Most of our actions are done with cognition and consciousness. The involuntary movements within the body are to a large extent governed by the autonomic nervous system and specially designed by nature for preservation of the life processes. The motor movements and reflex actions are either instinctive or purposeful and deliberate. Throughout our life w keep on learning what to do and how to do. All living beings including plant life learn many things for their survival and for adjustment with the environment.

Some of the primary and biological needs for existence and security are met by instinctive behaviour which is difficult to understand. Instinctive behaviour is something endowed by nature and it is in most cases difficult to explain how it happens. For instance a baby which was growing as a foetus in the womb knows how to such the breast of the mother as soon as it is born and put to the breast of the mother. Who taught it to suck the breast? How did the baby know that it would get milk by sucking? Why does the baby cry when it is hungry or when it is uncomfortable? How did the baby know that it would get milk by sucking? Why does the baby cry when it is hungry or when it is uncomfortable? How does the Kangaroo young one which is dropped into the ground climb through the tail and reach the abdominal pouch of the mother where the teats with milk are present? Beyond being a marvel and a wonder thins kind of a phenomenon in various life processes in this universe is difficult to explain. In submission to the working of the nature we call these things as instinctive behaviour.

 

Behaviour can become learned behaviour after experience gives a gain or reward or the result is painful or unpleasant. Any voluntary behaviour other than instinctive has got a component of learning in it. Apart from the discussion we have already had under Knowledge, Attitude and Behaviour, we have to recognize that every voluntary act occurs with the permission of the brain where there is essentially learning in it. Even the involuntary movements or action like defecation, micturition, vomiting, coughing, etc., which are totally involuntary in childhood become more or less voluntary acts as age advances. This is due to development of sphineteric action and also controlling influence within the brain to inhibit a particular action and execute the same action when it is required. They are also learned by experience

From birth to death there is a never ending process of learning going on which influences our every action and inaction. How to eat? How to move about? How to speak and what to speak? When to work and when to rest? All these are decided by the learning process. The answer to the questions raised by the mind on the what, when, where, why and how of anything concerned with the individual’s life in this world is derived by a process of learning.

Learning is undergone by the whole body whether unicellular or multi-cellular. The nervous mechanism is able to receive stimuli and impulses and perception enables the acquisition of knowledge which in other words is learning. Learning is governed essentially by perception. In the case of the individual we can call learning is the first step or stage in which information is drawn and absorbed. It must be appreciated that learning does not stop with acquiring information. It is an active process of transformation of ideas, translation of meaning, formation of attitudes, skills and values. It must also be appreciated in this context that behaviour, and learning are complementary to each other. Before the behaviour, learning process is supporting it and after the behaviour takes place it may further help the learning are complementary to each other. Before the behaviour, learning are complementary to each other. Before the behaviour, learning process is supporting it and after the behaviour takes place it may further help the learning from the experience gained from the behaviour. It is, therefore, a cyclical process of learning, predisposition to act, behaviour, experience, learning, change of behaviour and so on.

 

Another point to be appreciated is that all the senses are involved in learning. There can hardly be any difference between perception and learning because sum total effect of either perception or learning is to give meaning to the various sensory stimuli that are impinging on the sense organs and transmitted to the sensory cortex of the brain.

At the same time we have to differentiate between learning and perceiving in the sense that learning is the end point of perception.In other words the process of perception helps in gathering and storage of information which again helps the individuals to acquire skill, develop attitude, etc.

We can recapitulate by saying that perception precedes learning and for learning perception is inevitable or indispensable. While learning is facilitated by perception, perception is necessitated by learning; because of the need to learn, the mind perceives.

The living organism whether a tiny germ, a crawling animal or a flying bird or the four-footed animal or man all have to live together in this universe in their own group or in the community or in the midst of the species and classes. Within a particular society or group the ability to adjust or live is built up by the process of socialisation. The mind is constantly trying to perceive what is good for itelf from the selfish point of view and also in relation to others for the sake of secutity, acceptability, recognition and stability. It is constantly learning to live a life which will be accepted by others around.

It will be interesting to note that every cell in the body learns and the sum total of this learning is shown by the tissues and organs. If we take very hot food continuously the cells of the gastro-intestinal tract learn how to receive that food and they get used to hot irritant food. It is only when physiologically the cells become incapable of coping with and altered situation that there is a breakdown. Otherwise the cells in any part of the body or organ learn how to adjust to the environment and to the various influences that they are subjected to.

PLANNED CHANGE

 

Revolutionary change can by itself be considered as one form of planned change because it takes place at the instance of either a leader in the form of dictator of elder statesman or group of people or sometimes due to the mass uprising of the entire society. The change is deliberately attempted and achieved.
In sociology and particularly in the context of community organization or community development for improvement of conditions of life, the types of social change that are planned for and implemented are generally known as planned change. Planned change is defined as a deliberate predetermined change for which necessary planning is done for its implementation. Since it implies a planning for a change, it follows that there will be a scientific methodological approach to achieve results and definite goals and objectives will be set and also the resources available will be matched to meet the objectives.
For all intents and purposes planned change can be considered to be the same as pro-gramme planning or community organization because they also imply or include the same philosophy and purpose and methodology.
In any community social change takes place by itself in a continuous manner. Sometime it is desired by the community itself or by some one outside the community who has a special mission to work in the community to bring out certain desired changes somewhat rapidly to make the life of the community better in quality and quantity. Communities are often best with problems and they are either able to solve them by themselves or require the guidance and assistance of an outside expert or resource person. In either case the problem solving involves a planning. The change that is effected by a process of planning is known as planned change.
Planned change requires initiation of ideas and pooling of resources from within the community or procurement of resources from outside. Needless to say the change is the result of the need for a change. A need has to be perceived and the problems have to be appreciated and felt in all its severity and dimensional. In other words, the community has to feel a certain degree of dissatisfaction or disturbance in order to feel the need for altering a particular situation.
As we already studied under motivation unless the individual feels a sence of discomfort or inadequacy he is not likely to divert his attention towards the solution of the problem. The problem has to bother him, otherwise the problem does not apper to him as a problem at all. And the individual is either indifferent to it or complacent.
Kurt Lewin has described the different forces that act on the mind of the person as a result of which there is a possibility of motivation or a state of inactivity and indifference. Kurt Lewin extends the same theory to the group or community also. For a planned change to occur in a community Kurt Lewin has described three stages of mental preparation for manifestation of behaviour. The first stage is known as unfreezing. In this stage the community feels uncomfortable about a situation which is definitely not to the advantage. In order words, a problem is identifies as a problem and it bothers the people. The next stage is moving. Just like in the Rosenstock principle of motivation the community becomes aware of a means of solution of the problems. It gathers information about how the problems can be solved and also takes into account the resources available. This is actually the planning stage in which all the members of the society are involved in a collective thinking and an agreement for action. The second stage of planning is immediately followed by an action programme or implementation to reach the desired goal or solution or status. Henceforth the III stage takes place which is known as refreezing. The society which was put to some kind of change of behaviour to reach a higher level of performance or quality of live gets established in the new changed order and sustains that behaviour. Tgus us tge oricess if refreezing according to Kurt Lewin.

 

We have only considered the stages in the planned change. We have also to bear in mind that in any community or society Planned change can take place as a result of innovation. There should be one person or group of persons in the community or society planned change can take place as a result of innovation. There should be one person or group of persons in the community to suggest, practice and demonstrate or in other words, set an example to others. Alternatively there has to be an outside agent who has to work for the community and introduce new useful ideas and innovations for diffusion and adoption. In extension education and community organization usually the extension worker plays the role of change agent. The planned change that the change agent introduces into the society is through a process of extension education. He has to identify the clients and sell his ideas to them and motivate them. In the beginning he carefully selects responsive, potential clients and uses them as diffusion agents or satisfied adaptors. He has also to employ all the technique of extension approach required in community organization like, individual approach, family approach, group approach, kinship approach, mass approach, leadership approach.

Fundamentally the planned change has to be a community affair or a total responsibility of the community itself. The change agent has to play only a catalytic role. He is not supposed to effect the change by his own efforts. He is not supposed to thrust his ideas or dogmatise. The planning has to be done by the people by themselves and the change agent should function as a resource person and initiate the motivation. The same principles essentially required for community organization or extension education have a direct application and are necessary in the process of planned change. Otherwise, there is a danger of the change not being permanent or sustained. The agent has therefore, to motivate the people in such a way that they reach the 3 stage of refreezing and he is able to withdraw from the scene and allow them to enjoy the benefit of the change and appreciate it. However, it does require a few occasional visits on the part of the change agent to follow and see that the community is fully cognizant f the change that has been effected, the purpose and the outcome. It may sometimes be necessary for the change agent to re motivate people if adoption gets changed into discontinuance or rejection.

 

It is common to develop a system of change agent and client. The change agent may be within the community or outside. Planned change can be considered to be a successful planned change only if the changed behaviour of the community or the acceptance of change in the community is sustained and enduring, without any fear of reversal or discontinuance. It, therefore, implies that the change agent has to direct his educational effort in such a way, that the clients as a whole adopt the change by a proper process of internalization and rationalization.