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Guinea worm control: testing the efficacy of health education in primary care.

Health education has been advocated as a major foundation for primary health care. However, the value of this approach is yet to be fully proven. An experimental PHC programme in ten Nigerian farm hamlets using methods such as community organization, participatory training and village meetings, put health education to the test. Significant short term improvements in community health knowledge resulted after training of a village health worker from each hamlet. Positive intermediate results in water sanitation behaviours were later observed. Three years after initial intervention, long term health outcomes included the reduction in prevalence of guinea worm, a locally endemic water borne disease. The programme also encountered certain organizational and technological issues. For example, integration with existing health care systems and local well construction capabilities surfaced as problems. Consequently efforts are currently underway to expand research into these areas.

Dracunculiasis↗

Health education, behavioural change and social psychology: nursing's contribution to health promotion?

AIMS: To critically review the complex processes that underpin the modification of a client's health-related behaviour. This paper also seeks to contextualize the operational differences between health-educating and health-promoting activities - as a means of rationalizing current practice. BACKGROUND: In "health promotional" encounters, there is a plethora of evidence that suggests that nurses work predominantly within a "traditional" preventative framework of practice. The prevalence of a culturally inherent biomedical framework, governing most nursing practice, tends to reduce health-related client interventions to little more than one-off, reductionist information-giving exercises. The expectation on clients to respond to and subsequently modify their health behaviour, when presented with such information, is unrealistic in most cases. Nurses are often unaware of the extremely complex human phenomena associated with modifying health-related behaviours and the resultant change processes. In nursing-related health encounters, the planned or unplanned intervention and the subsequent outcomes are mostly viewed within a too simplistic and superficial context. DESIGN: A selective review of the relevant literature. CONCLUSION: Where many nurses believe themselves to be health promotionalists, the likelihood is that they are instead more likely to be traditional health educationalists. Not that this is the main problem, in itself--but if nursing is to progress on this issue, it must first become more effective in delivering its current health education initiatives. Armed with further knowledge and understanding of their practices, health educators are far more likely to achieve a degree of success in their behavioural-change encounters as well as approach the intervention with a far more realistic expectation of outcome. Without this further understanding, it is argued that the integration of health educational initiatives into nursing practice will generally do little or nothing to change the health status of clients.

Culture↗

[Health education and environmental education: an integrated experience].

This paper reports on work with elementary school teachers from different types of Brazilian municipalities, from the coast to the interior and from capitals to small towns. With the larger purpose of facilitating teachers' perception of the identity between environmental education and health education, the study focuses on local issues related to quality of life, as well as local teachers' concepts concerning health and the environment. Finally, the study analyzes the importance of intersectorial cooperative programs facilitating long-term educational projects.

Attitude to Health↗

The impact of health education on frequency and cost of health care use by low income children with asthma.

A sample of 310 low income urban children with asthma from 290 families was randomized into a control group and an experimental group that received health education to improve asthma management at home. No significant decreases in subsequent health care use were observed when the experimental group was compared to the control group without regard to previous hospitalization. When the comparison was restricted to children who had been hospitalized during the preceding year, however, the experimental group was found to have decreased its use of the emergency room significantly more than the control group (p less than 0.05) and to have experienced a significantly greater reduction in the mean number of hospitalizations (p less than 0.05) during the year of follow-up. The program reduced health care costs for children with one or more hospitalizations, saving $11.22 for every $1.00 spent to deliver health education.

Adolescent↗

The role of the health facilitator in community health education.

A community health education program has been established by the Department of Community Health Sciences of Duke University Medical Center in two target areas of Durham County, North Carolina. The program trains unpaid lay people, "health facilitators", to whom others already turn for help, to increase their competency for advising and referring community residents to appropriate community resources. Several methods for identifying potential health facilitators have been developed. Evaluation of the role of health facilitators hinges upon designing measures to demonstrate their existence in the community and the impact that they make. To be successful, the training of health facilitators should result in improving the quality of the advice they give their fellows. It is also important to assess the cultural acceptability of the facilitators' advice and to ensure that their helping role in the community is not disturbed by the possible professionalization of their role due to the training program.

Adolescent↗

A participatory process for developing quality assurance tools for health education programs.

There is a constant need to find methods and tools for achieving high quality in health education and health promotion programs. The aim of this initiative was to develop standards and criteria for quality assessment of health education programs. Health educators participated in a process to develop these standards and criteria. A consensus was reached regarding the list of standards by participation of the health educators in two workshops. This list consisted of the three main stages of health education programs: planning, implementation and evaluation. Operational criteria for each standard were developed in order to be able to measure the standards. Four different subjects were chosen for the development of the criteria: menopause, smoking cessation, cardiac rehabilitation and prenatal care. A consensus regarding these criteria was reached by discussions in workshops. The tools developed were tested by interviewing health educators who were planning and running these programs. The tools built were found acceptable by the health educators as they provided information on the quality of the programs.

Attitude of Health Personnel↗

The West Virginia Health Education Assessment Project.

Well-designed school health education should provide students with the knowledge and skills to prevent the health risk behaviors most responsible for the major causes of morbidity and mortality. This paper reports the methodology and findings of a West Virginia statewide health education assessment initiative and describes how the findings are used to design professional development training for school health educators. Selected response items from the State Collaborative on Assessment and Student Standards, Health Education Assessment Project were used to develop a 40-item assessment instrument for 6 health education content areas. In West Virginia, 51 counties and 242 schools were recruited (county response rate = 93%; school response rate = 53%); 17,549 students were tested in grades 6, 8, and high school health education classes. Mean total scores by grade were 30.61 (grade 6), 26.55 (grade 8), and 26.53 (high school), indicating a slight decline in scores as grade level increased. Females in each grade level scored higher on total Health Education Assessment Project (HEAP) scores and subtest scores than males. The results suggest notable differences across grade levels. High school students failed to meet the standard on any health education content areas, indicating the need for enhanced knowledge and skill development. During professional development training, HEAP scores were examined in the context of results from the West Virginia Youth Risk Behavior Survey to underscore the importance of providing quality skills-based health education in West Virginia schools.

Adolescent↗

Health educators in HMOs: a study of utilization and effectiveness.

This study examined the status of health educators in Health Maintenance Organizations (HMOs). Specifically, the investigation described the utilization of health education personnel in HMOs, the way in which health education services were provided, and the effectiveness of health educators in HMOs as perceived by HMO administrators. Data from a national study showed that health educators were employed by all HMO types except Independent Practice Associations. Health education services tended to be provided in-house rather than through contractual services. HMO administrators were generally favorable toward the presence of health educators in their organizations and were satisfied with their performances, believing that they were cost effective and well educated for their position. The belief that health educators could be better utilized if they possessed additional skills apparently existed.

Allied Health Personnel↗

One voice for health education: can this be achieved?

The need for one voice for health education and health educators has been discussed for some time. Recently, it has become a more prevalent topic at professional meetings. This article discusses the role of professional associations and the process of professionalization, professional associations for health educators, the Coalition of Health Education Organizations, and current issues with possible alternative solutions. The solutions proposed include merging existing associations, fostering greater understanding of the purposes of various professional organizations, adopting a new approach for selecting memberships, and strengthening the role and function of the Coalition of National Health Education Organizations. A final point discussed is the importance of health educators belonging to at least one professional association to indicate their support of the profession.

Health Education↗

Challenges in teacher preparation for school health education and promotion.

The health education and promotion profession is facing a series of teacher preparation challenges related to the delivery of quality school health education/promotion programmes. The challenges occurring in the United States are also present in a variety of other regions as the education structure attempts to ensure that students receive a sound preparation in health education and promotion during their school experience. The challenges can be categorised into the following areas: Quality and quantity of professional preparation for teachers during their pre-service university training; Need for in-service of teachers already in the K-12 workforce (in the USA grades K-12 are broadly equivalent to ages five to 17 years); University faculty workforce professional development needs; Research to provide baseline data for future standards development. Because there is a direct connection between community and school and parents and teachers at the K-12 level of education, the demand for highly skilled teachers and professional development is playing out at that level much more rapidly than at the university level. The relative isolation of some university faculty and programmes has developed an interesting situation in which many administrators and master teachers at the K-12 level of education have a better grasp and understanding of new teaching and learning strategies and tools than professors at the university level. This has happened at the same time when there is also a shortage of university professors entering school health education/promotion teacher education. This confluence of realities may predicate the need for a radical change in university based teacher preparation in health education/promotion. The overwhelming challenge for many countries including the United States remains the large number of teachers in the current workforce who must be provided professional development experiences. Currently both the National Health Education Standards for K-12 students and teacher preparation standards in health education reflect best practice theory only. There is no national data to support the standards. During the next ten years it is imperative that nationwide data be collected, compiled and analysed on actual learning outcomes for both K-12 students and health education teacher candidates. This will allow the next set of standards at both of the above-mentioned levels to reflect the knowledge and skills that have been actually attained and demonstrated. It will also be a basis for creating revisions and expansions in such a way that national standards can be an actual measure by which student performance can be judged. It is hoped that the rising tide of both national and international interest in having an increasingly health literate population will inspire members of the profession to be creative in the development of educational approaches, strategic partnerships, and funding to put strong systems of teacher preparation in place for the future.

Faculty↗