20141217040140_10. MPU3313 MPU2313 Topic 6

� INTRODUCTION

Health education is an essential tool of community health and it is vital because the promotion, maintenance, and restoration of health requires that individuals, families and the community at large understand health care requirements. Health education is an integral part of health services and it is an important task for all health personnel who are responsible for providing health care.

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� Health Education and Health Promotion

LEARNING OUTCOMES

By the end of this topic, you should be able to:

1. Explain the concept of health education and health promotion;

2. Describe the aims, objectives and principles of health education;

3. Discuss the theories and models of health education and healthpromotion.

TOPIC 6 HEALTH EDUCATION AND HEALTH PROMOTION �

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Similar to general education, health education is a learning process where changes in knowledge, feelings and behaviour of people are taken into account. This approach deals with teaching the client and their families how to deal with past, present and future health problems. The knowledge that they have gained enables them to make informed decisions in order to better cope with temporary or long term alterations in their health and lifestyle, and to assume greater responsibility for their health. Now, let us look at the definition of health education.

DEFINITION OF HEALTH EDUCATION

Health education can be defined as follows:

Health education is also defined as follows:

In the promotion, maintenance and restoration of health, this means that community health clients (individuals, families and communities) must receive a practical understanding of health-related information. An individual is any person, regardless of age, gender or other characteristics. Families are groups of individuals linked by ancestry, marriage or household and may be nuclear, extended, biological, adoptive or other alternative structures.

A community may be a small group support system, club, school or neighbourhood that share a common interest or cause. The clients have varying needs and abilities, and they are in a variety of settings. Therefore, health education is important in order to enable the clients to make knowledgeable decisions, cope more effectively with alterations in their health and lifestyles, and thus assume greater personal responsibility for their health.

Health education is a process which brings about changes in the knowledge and attitude of people and thereby affects change in their health practices.

Health education is a process that informs, motivates and helps people to adopt and maintain healthy practices and lifestyles, and advocate environmental changes as needed.

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� TOPIC 6 HEALTH EDUCATION AND HEALTH PROMOTION 72

As lifespan increases, people are more likely to experience chronic illnesses related to aging that require complex changes in diet, exercise, and lifestyle and medical treatment (see Figure 6.1). Health education becomes crucial because of such social changes.

Figure 6.1: Those with illnesses related to aging need to make changes

DEFINITION OF HEALTH PROMOTION

The field of health promotion has provided a new way of thinking about the root causes of health and well-being. This thinking has sparked the development of new approaches towards improving the health of individuals and communities. However, before we can look at health promotion, we need to be clear on what we mean by the term „health‰, which is what we are trying to promote. So, let us review the definition of health.

Health has been described as follows:

A state of complete physical mental and social well-being, and not merely the absence of disease of infirmity, is a fundamental human right. The attainment of the highest possible level of health is a most important worldwide social goal whose realisation requires the action of many other social and economic sections in addition to the health sector.

(WHO, 1978)

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This definition contains the concept of positive health. The concept of positive health is used to describe not only physical fitness but the ability to meet mental stresses, solve life problems and maintain emotional stability, as well as an individualÊs ability to improve his or her own well-being. To achieve this, it requires the adoption of a social model of health recognising a holistic and positive approach and highlighting socio-cultural, economic, political and key environmental determinants of health.

Health promotion has been defined as follows:

Furthermore, in order to reach a state of complete physical, mental and social well-being, an individual must be able to identify and realise aspirations, to satisfy needs, and change along with the environment. Therefore, health is seen as a resource for everyday life, not the objective of living. Health is a positive concept that emphasises social and personal resources, as well as physical capabilities. This means that health promotion is not just the responsibility of the health sector but goes beyond a personÊs lifestyle to include his well-being.

Health promotion extends to the maintenance and enhancement of existing levels of health through the implementation of effective policies, programmes and services. Tones (2005) states that health promotion is „any planned measure which promotes health or prevents disease, disability and premature death‰.

Heath promotion is a process directed towards enabling people to take action. Thus, promotion is not something that is done on or to people; it is done by, with and for people, either as individuals or as groups (see Figure 6.2). The purpose of this activity is to strengthen the skills and capabilities of individuals to take action and the capacity of groups or communication to act collectively to exert control over the determinants of health and achieve positive change. It suggests that people and communities can bring about positive changes in their health and well-being, and that improvement is achieved through personal endeavour and the support of others.

Health promotion is the process of enabling people to increase control over, and to improve, their health.

(WHO, 1995:5)


Figure 6.2: Among health promotions that can bring about positive change

This provides an alternative to a traditional medical model of health care addressing the symptoms rather than the causes of ill health. It places medicine, and indeed health, in a wider social context. This context acknowledges, accepts and reveals the causes of ill health and health inequalities as not the sole responsibility of individuals or health care services but that of a range of public and private organisations including national and local government (Amos & Munro, 2002).

It puts health on the agenda of decision makers in all sectors and at all levels, directing them to be aware of the health consequences of their decisions and to accept their responsibilities for health. This broadens the debate to include identification of problems and possible solutions for promoting health.

Health promotion differentiates between those factors which are more within the control of individuals, such as individual health-related behaviour and the use of health services, and those factors which are outside the control of individuals, which include social, economic and environmental factors, and the provision of health services (Tones & Green, 2004). Health promotion addresses both areas. It helps in providing individuals and groups with the knowledge, values and skills that encourage effective action for health. It also helps to generate political commitment for health-supportive policies and practices, the provision of services and increased public interest, and demand for health.


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AIMS OF HEALTH EDUCATION

Earlier, we discussed the concepts of health education and health promotion. Let us now look at the purpose, the aims and the objectives of health education. The purpose of health education is to help people to achieve health through their own actions and efforts. The aaims of health education are as follows:

(a) To help people understand that health is the most valuable community asset, and to help to achieve health through their own activities and efforts;

(b) To develop a sense of responsibility for improvement of their health as individual members of families and communities;

(c) To develop scientific knowledge, attitudes and skills regarding health matters to enable people to develop correct habits;

(d) To educate people about the proper use of health services in whatever form it is made available to them by the government; and

(e) To alter behaviour which may have a direct or indirect influence on the occurrence of spreading diseases in a given cultural setting. A culturally relevant health education programme can be planned only after understanding the behaviour in all its manifestations.

Therefore, health education begins with peopleÊs interest in improving their conditions of living and aims at developing a sense of responsibility for their own health betterment as individuals, and as members of families, communities or government.

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ACTIVITY 6.1

What are other aims of health education? Discuss this in a group andpresent your findings at your next tutorial.

SELF-CHECK 6.1

1. Define health education.

2. Define health promotion.

3. Explain the differences between health education and health promotion.


The objectives of health education are as follows:

(a) To inform people or disseminate scientific knowledge on the prevention of diseases and promotion of health;

(b) To motivate people to change habits and lifestyles that are harmful to their health to adopt a more conducive way of living that is healthy; and

(c) To guide those who need the help to implement and maintain a healthy way of living by showing proper community resources.

A health education programme should aim at bringing about changes in knowledge, attitude, behaviour, habits and customs. Therefore, the focus of health education is on people and on action. Health education is an integral part of national health goals. Effective health education has the potential for saving many more lives.

PRINCIPLES OF HEALTH EDUCATION

There are certain principles of learning that are used in health education. They are as follows:

(a) Credibility � This is the degree to which the message to be communicated is perceived as trustworthy by the receiver. Therefore, good health education is based on facts, so it must be consistent and compatible with scientific knowledge and also with the local culture.

People will have trust and confidence if the health educator (e.g., the nurse or doctor) is the communicator.

(b) Interest � This is the principle that people will most probably not listen to things that do not interest them. It should be kept in mind that health teaching should relate to the interest of the people.

(c) Participation � Participation plays an important role in health education. It is based on the principle of active learning. Health education should aim at encouraging people to work actively with health workers in identifying their own health problems and in developing solutions and plans to work them out. A high degree of participation tends to create a sense of involvement, personal acceptance and decision making.

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(d) Motivation � In every human being, there is a fundamental desire to learn. In health education, motivation is an important factor. For example, if you tell a woman who is overweight to reduce her weight because she might develop a heart disease or her life span might be reduced, this may have little effect. However, if you tell her that by reducing her weight she might look more charming and beautiful, she might accept the advice. Motivation is contagious, and one motivated person can spread motivation to the rest of the group.

(e) Comprehension � In health education, one must know the level of understanding, education and literacy of people (to whom the teaching is directed). For example, a barrier to communication is using words which cannot be understood. Therefore, we need to consider the mental capacity of the audience before teaching.

(f) Reinforcement � Very few people can learn something new and retain it in a very short time. That is why repetition is very important. Messages need to be repeated in different ways in order to make people remember it.

(g) Learning by doing � Learning is an action-process; not only memorisation. It is important to integrate learning by doing.

(h) Known to unknown � Start health education with what people understand and then proceed to new knowledge. Use existing knowledge and never expect health education to have quick results.

(i) Setting an example � The health educator must set a good example in what he/she is teaching. For example, in explaining the hazards of smoking, the health educator will not be very successful in his teaching if he himself smokes.

(j) Good human relations � Sharing of information, ideas and feelings is easier between people who have good relationships. Building a good relationship with others goes hand-in-hand with developing communication skills.

(k) Feedback � Feedback is one of the key concepts of the system approach. For effective communication, feedback is very important.

(l) Leaders � People learn best from people they respect and regard highly.


HEALTH PROMOTION PRACTICE

Health promotion practice is fundamentally concerned with addressing the determinants of health. This includes the lifestyle factors related to peopleÊs actions, such as health-related behaviours (e.g., smoking, diet and physical activity) and broader factors such as income, education, employment and working conditions, and social and physical environments. These factors combined create the conditions which determine health status at the individual and community level.

Lifestyle is taken to mean „a general way of living based on the interplay between living conditions in the wide sense and individual patterns of behaviour as determined by socio-cultural factors and personal characteristics‰ (Hood & Leddy, 2003: 211). The range of behaviour patterns may be limited by environmental factors and also by the degree of individual self-reliance. The way an individual lives may produce behaviours that are beneficial or detrimental to health.

Health promotion is often seen as activities which focus on particular issues. However, it is much more than that. Health promotion also covers the principles that underlie a series of strategies that seek to foster conditions that allow individuals and the population to be healthy and to make healthy choices (Naidoo & Wills, 2005), for example, developing personal skills, strengthening community action, and creating supportive environments for health, backed by public health policy.

However, good health is not equally shared (Woodward & Kawachi, 2000) and health inequalities exist within and across communities and are influenced by social, cultural and economic factors. Health promotion aims at reducing differences in current health status and ensuring equal opportunities and resources to enable everyone to achieve their fullest health potential (Lucas & Lloyd, 2005). Health promotion strategies and programmes should be adapted to the local needs and possibilities of individual countries and regions, to take into account differing social, cultural and economic systems (WHO, 2006). This includes a secure foundation in a supportive environment, access to information, life skills and opportunities for making healthy choices.

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SELF-CHECK 6.2

1. State the objectives of health education.

2. Discuss the principles of health education.


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What makes good health promotion? There are several aspects that make good health promotion. Below are the aspects that need to be considered.

(a) Building Healthy Public Policy Health promotion activities should encourage and support all agencies and workers to consider the consequences of their decisions on health. Health promotion policy requires the identification of obstacles to the adoption of healthy public policy in non-health sectors, and ways of removing those obstacles. Joint action contributes to ensuring safer and healthier goods and services, healthier public services and cleaner environments.

(b) Creating Supportive Environments Health promotion activities recognise that health cannot be separated from other areas of life. Therefore, the priority is to create ways of living, environmental conditions, working conditions and social structures which are safe, stimulating, enjoyable, satisfying and conducive to good health.

(c) Strengthening Community Action Health promotion activities should be developed side-by-side with the community to identify priorities for action and to develop strategies that will work. This involves supporting, encouraging, informing and skilling the community to take control of issues that are importance to them and to determine how these issues will be dealt with.

(d) Developing Personal Skills Health promotion activities aim to support an individualÊs personal and social development in their private and work lives. This is to ensure that they have the skills and information to make choices which will promote their health. This includes activities which will increase their capacity to carry out actions in other areas such as in school, home, work and community settings. Action is required through educational, professional, commercial and voluntary bodies, and within the institutions themselves.

ACTIVITY 6.2

1. Does the government have the right to tell people how to managetheir own health?

2. Discuss the possible reasons why some people might not beprepared or not be able to engage in initiatives and activities toimprove their health.


(e) Reorienting Health Services Health promotion activities support the health system and all stakeholders in the system to move beyond clinical and curative services to services which aim at increasing and improving the health of the community. Health services also need to embrace an expanded mandate that is sensitive and respects cultural needs.

Health promotion strategies can develop and change lifestyles and the social, economic and environmental conditions which determine health. Health promotion is a practical approach to achieving greater equity in health.

To take health promotion into the twenty-first century and meet new challenges, there are several priorities that need to be acknowledged.

(f) Promoting Social Responsibility for Health

(i) Avoid harming the health of other individuals;

(ii) Protect the environment and ensure sustainable use of resources; and

(iii) Restrict production and trade in inherently harmful goods and substances.

(g) Increasing Investments for Health Development Investment for health should reflect the need to address health and social inequities, focusing on groups such as women, children, older people, indigenous people, those in poverty and marginalised populations.

(h) Consolidating and Expanding Partnerships for Health Health promotion requires health and social development partnerships among the different sectors at all levels of governance and society. This also involves strengthening existing partnership and exploring potential new partnerships.

(i) Increasing Community Capacity and Empowering the Individual There are several key strategies at a community level, which are listed as follows:

(i) Strengthening advocacy through community action, particularly through groups organised by women;

(ii) Enabling communities and individuals to take control over their health and environment through education and empowerment;


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(iii) Building alliances for health and supportive environments to strengthen the cooperation between health and environmental campaigns and strategies;

(iv) Mediating between conflicting interests in society to ensure equitable access to supportive environments for health;

(v) Improving the capacity of communities for health promotion, which requires practical education, leadership training and access to resources; and

(vi) Empowering individuals, which demands more consistent, reliable access to the decision-making process and the skills and knowledge essential to effect change.

(j) Securing an Infrastructure for Health Promotion In order to secure an infrastructure for health promotion, new mechanisms for funding it locally, nationally and globally must be found. Incentives should be developed to influence the actions of governments, non-governmental organisations, educational institutions and the private sector in making sure that resource mobilisation for health promotion is maximised.

„Setting for health‰ represents the organisational base of the infrastructure required for health promotion. New health challenges mean that new and diverse networks need to be created to achieve inter-sectoral collaboration. Such networks should provide mutual assistance within and among countries and facilitate exchange of information on which strategies have proved effective.

Training in and practice of local leadership skills should be encouraged in order to support health promotion activities. Documentation of experience in health promotion through research and project reporting should be enhanced to improve planning, implementation and evaluation. All countries should develop the appropriate political, legal, educational, social and economic environments required to support health promotion. In order to achieve this, governments and individuals must work together in collaboration to meet the world-wide health agenda.

ACTIVITY 6.3

What health promotion activities have you been involved in to date? Ina group, reflect on the activities done and their effectiveness.


THEORIES OF HEALTH EDUCATION AND HEALTH PROMOTION

A theory is a set of interrelated concepts, definitions and propositions that present a systematic view of events or situations by specifying relations among variables in order to explain or predict events or situations. Theory reflects ways of knowing and understanding that may be tested in various ways.

There are a number of psychological theories that attempt to explain the different variables that exert influences on an individualÊs behaviour. Psychological theories of health-related behaviour have contributed a great deal and offered ways of helping people to change their behaviour. Understanding the process that takes place in relation to health-related behaviour is an important tool in planning health promotion activities (Tones & Green, 2004). There are a number of psychological theories that attempt to explain the different variables that exert influences on an individualÊs behaviour.

(a) Belief � The information a person has about a particular object. It usually links the objects to some particular attribute. Information can influence beliefs, which in turn can influence behaviour.

(b) Values � Values are an important part of every culture. They are acquired through socialisation and are the emotionally-charged beliefs about those things that a person regards as important. Values are often broad and influence the way we think about things in life. For example, values relating to gender give rise to a number of attitudes towards motherhood or employment for women.

(c) Attitudes � These are more specific than values and describe relatively stable feelings towards particular issues or objects. The link between a personÊs attitudes and their behaviour is an unclear one. Sometimes changing attitudes may cause a behaviour change, and sometimes behaviour change may lead to attitude change (e.g., stopping smoking).

Theories and models provide a blueprint for planning, implementing and evaluating health education programmes and activities. Theories and models of health behaviour help us understand the nature of targeted behaviours and guide health education and health promotion strategies.

Theories and models:

(a) Help us understand better the nature of the problem being addressed;

(b) Describe the needs and motivations of the target population;

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(c) Explain how to change health status, health-related behaviours and their determinants; and

(d) Inform the methods and measures used to monitor the problem and the programme.

Health education and health promotion programmes that are most likely to succeed are those based on a clear understanding of the targeted health behaviour. A number of health education models have been developed, as described below:

(a) Medical model � Most health education in the past has relied on knowledge transfer to achieve changes. The medical model is primarily interested in the recognition and treatment of disease and technological advances to facilitate the process. The assumption of this theory is that people would act to improve their health based on the information supplied by health professionals.

(b) Motivation Model � Health education started emphasising motivation as the main force to translate health information into the desired health action. However, the adoption of a new behaviour or idea is not a simple act; it is process consisting of several stages through which an individual is likely to pass before adoption. There are three stages in the process of change in behaviour as follows:

(i) Awareness: Interest;

(ii) Motivation: Evaluation and decision-making; and

(iii) Action: Adoption or acceptance.

(c) Social Intervention Model � An effective health education model is based on precise knowledge of human ecology and understanding of the interaction between the cultural, biological, physical and social-environmental factors.

SELF-CHECK 6.3

1. What are the components most theories have in common?

2. What are the different models of health education?


HEALTH PROMOTION THEORIES AND MODELS

There are a number of significant theories and models that underpin the practice of health promotion. A theory is an integrated set of propositions that serves as an explanation for a phenomenon. The use of theory can help in the planning and delivery of health promotion programmes in several ways.

The main theories and models utilised are elaborated as follows:

(a) These theories attempt to explain health behaviour and health behaviour change by focusing on the individual. Examples include:

(i) Health Belief Model;

(ii) Theory of Reasoned Action;

(iii) Stages of Change Model; and

(iv) Social Learning Theory.

(b) Theories that explain change in communities and community action for health. Examples include:

(i) Community mobilisation

� Social planning;

� Social action; and

� Community development.

(ii) Diffusion of innovation

(c) Models that explain changes in organisations and the creativity of health supportive organisational practices. Examples include theory organisational change.

The main theories and models utilised can be summarised as follows:

(a) Health Belief Model This model was originally designed to explain health behaviour by better understanding beliefs about health. It is still one of the most widely recognised and used models in health behaviour applications. The rationale is that even though an individual recognises the consequences of certain

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health behaviours, his/her decision to take action will be based on the following factors. This model addresses the individualÊs perceptions of the threat posed by a health problem (susceptibility and severity), the benefits of avoiding the threat and factors influencing the decision to act (barriers, cues to action and self-efficacy).

(i) Susceptibility The individualÊs beliefs about whether they are likely to contract the illness.

(ii) Severity This represents the degree to which an individual perceives the consequences of having the illness to be severe. Together, the two elements of susceptibility and severity comprise what is known as the perceived threat of illness, sometimes known as vulnerability.

The next two factors are concerned with the pros and cons of taking some action to combat the illness.

(iii) Benefits The degree of physical, psychological or financial benefit associated with any form of action (benefits need to be achievable and assessable).

(iv) Barriers Any decision to act will have a number of consequences. There may be a degree of physical, psychological or financial distress associated with any form of action.

The next two factors may stimulate action.

(v) Cues to Action Cues are stimuli which can trigger appropriate health behaviour. They can either be internal (perception of bodily symptoms or states) or external (stimuli from the environment, e.g., health professionals, media campaigns, etc.)

(vi) Diverse Factors These include factors like environment, culture, class and personality factors that may influence health behaviour.


(b) Theory of Reasoned Action and Theory of Planned Behaviour Theory of Reasoned Action and Theory of Planned Behaviour (Fishbein & Ajzen, 1975; Ajzen & Fishbein, 1980; Ajzen & Madden, 1986) explore the relationship between behaviour and belief, attitudes, and intentions. Both theories assume behavioural intention is the most important determinant of behaviour.

According to these models, behavioural intention is influenced by a personÊs attitude toward performing a behaviour, and by beliefs about whether individuals who are important to the person approve or disapprove of the behaviour (subjective norm). The Theory of Planned Behaviour differs from the Theory of Reasoned Action in that it includes one additional construct, perceived behavioural control. This construct has to do with peopleÊs beliefs that they can control a particular behaviour. Ajzen and Madden (1986) added this construct to account for situations in which peopleÊs behaviour, or behavioural intention, is influenced by factors beyond their control. He argued that people might try harder to perform a behaviour if they feel they have a high degree of control over it.

(c) Stages of Change or Transtheoretical Model The Stages of Change, or Transtheoretical, Model was initially published in 1979 by Prochaska. In the 1980s, Prochaska and DiClemente worked further on this model in outlining the stages of an individualÊs readiness to change, or attempt to change, toward healthy behaviours (Prochaska & DiClemente, 1986).

The Stages of Change Model evolved from research in smoking cessation and also the treatment of drug and alcohol addiction. More recently, it has been applied to other health behaviours, such as dietary changes. Behaviour change is viewed as a process, not an event, with individuals at various levels of motivation or „readiness‰ to change. Since people are at different points in this process, planned interventions should match their stage this process.

There are six stages that have been identified in the model:

(i) Pre-contemplation � (Not thinking about changing behaviour) The person is unaware of the problem or has not thought seriously about change;

(ii) Contemplation � (Can stay at this stage for quite a while) The person is seriously thinking about a change in the near future;


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(iii) Preparing to change � The person is planning to take action and is making final adjustments before changing behaviours;

(iv) Making the change � The person implements some specific action plan to overtly modify behaviour and surroundings;

(v) Maintenance � The person continues with desirable actions (repeating the periodic recommended steps while struggling to prevent lapses and relapse; and

(vi) Termination � The person has no temptation and has the ability to resist relapse.

Prochaska et al. (1992) argue that whilst few people go through each stage in an orderly way, they will go through each stage, which is helpful as it enables us to understand that relapse is a part of the process and not necessarily a „failure‰ on behalf of the person or health promoter. In fact, individuals can go both backwards and forwards through a series of cycles of change � like a revolving door. For example, many people who give up smoking may actually stop and then relapse a number of times before they achieve the change permanently.

It appears that there are certain conditions required for change to take place:

(i) The change must be self-initiated;

(ii) The behaviour must become salient (one must recognise that behaviour is harmful);

(iii) The salience of the behaviour must appear over a period of time;

(iv) The behaviour is not part of the individualÊs coping strategy;

(v) The individualÊs life should not be problematic or uncertain; and

(vi) The social support needed is available.

(d) Social Learning Theory or Social Cognitive Theory Social learning Theory (Bandura, 1977), later renamed Social Cognitive Theory, proposes that behaviour change is affected by environmental influences, personal factors and attributes of the behaviour itself. Understanding of this interaction can offer important insight into how behaviour can be modified through health-promotion interventions.


A person must believe in his or her capability to perform the behaviour (i.e., the person must possess self-efficacy) and must perceive an incentive to do so (i.e., the personÊs positive expectations from performing the behaviour must outweigh the negative expectations). A person must value the outcomes or consequences that he or she believes will occur as a result of performing a specific behaviour or action. Outcomes may be classified as having immediate benefits (e.g., feeling energised following physical activity) or long-term benefits.

(e) Community Organisation and Other Participatory Models We will look at the community level of change models. Initiatives serving communities and population, not just individuals, are at the heart of public health approaches to preventing and controlling diseases.

Community-level models explore how social systems function and change and how to mobilise community members and organisations. They offer strategies that work in a variety of settings, such as health care institutions, schools, worksites, community groups and government agencies.

Communities are often understood in geographical terms, but they can be defined by other criteria too. For instance, there are communities for shared interests (e.g., neighbourhood watch, accident prevention, and slimmerÊs world) or collective identity.

Community organising is not a single mode of practice; it can involve different approaches to effecting change. Tropman et al. (1995) produced the best known classification of these change models, describing community organising according to three general types: locality development, social planning and social action. These models sometimes overlap and can be combined.

(i) Locality development ((or community development) � This is process oriented. With the aim of developing group identity and cohesion, it focuses on building consensus and capacity;

(ii) Social planning � This is task oriented. It stresses on problem solving and usually relies heavily on expert practitioners; and

(iii) Social action � This is both process and task oriented. Its goals are to increase the communityÊs capacity to solve problems and to achieve concrete changes that redress social injustices.


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In a social action approach to community organising, self-interest is seen as the motivation for action; community members become involved when they see that it will benefit them to take action, and targeted institutions are willing to make changes when they believe it is in their self-interest to do so.

Community organising seeks to expand participantsÊ sense of self-interest to an ever wider sphere, from the individual or family level to their block, neighbourhood, city, region and so on. Participants grow through this process, learning to take an active role in shaping the future of their communities.

Community organising is a process through which community groups are helped to identify common problems, mobilise resources and develop and implement strategies to reach collective goals. Comprehensive health promotion programmes often use advocacy techniques to help support individual behaviour change with organisational and regulatory change.

In recent years, innovative tools and methods for evaluation and measurement have been developed to capture the successes of community-level health promotion efforts. Tobacco control/smoking prevention is one area where programmes have been extensively evaluated.

Local tobacco control initiatives typically pursue four concurrent goals:

(i) Raising the priority of smoking as a health concern;

(ii) Helping community members to change smoking behaviour;

(iii) Strengthening legal and economic deterrents to smoking; and

(iv) Reinforcing social norms that discourage smoking.

(f) Diffusion of Innovations Theory Diffusion of Innovations Theory provides an explanation for how new ideas, products and social practices diffuse or spread within a society or from one society to another. Diffusion of Innovations Theory addresses how ideas, products, and social practices that are perceived as „new‰ spread throughout a society or from one society to another. According to the late Rogers (1995), diffusion of innovations is „the process by which an innovation is communicated through certain channels over time among the members of a social system‰. Diffusion theory has been used to study the adoption of a wide range of health behaviours and programmes, including condom use, smoking cessation and use of new tests and technologies by health practitioners.


Rogers (1995) describes the process of adoption as following a classic „bell curve‰, with five categories of adopters:

(i) Innovators (active information seekers of new ideas);

(ii) Early adopters (very interested in the innovation but not the first to sign up);

(iii) Early majority adopters (need external motivation to get involved);

(iv) Late majority adopters (are sceptics and will not adopt an innovation until most people in the social system have done so); and

(v) Laggards (last to become involved by a mentoring programme or through constant exposure and have limited communication networks).

Usually when an innovation is introduced, the majority of people will either be early majority adopters or late majority adopters, fewer will be early adopters or laggards, and very few will be innovators (the first people to use the innovation). By identifying the characteristics of people in each adopter category, practitioners can more effectively plan and implement strategies that are customised to their needs.

Another aspect of time considers the rate of adoption, which is the speed at which an innovation is adopted by members of a social system. At the individual level, adopting a health behaviour innovation usually involves lifestyle change. At the organisational level, it may entail starting programmes, changing regulations or altering personnel roles. At a community level, diffusion can include using the media, advancing, policies or starting initiatives.

(i) A number of factors determine how quickly, and to what extent, an innovation will be adopted and diffused. These factors are listed below:

(ii) The relative advantage of an innovation shows its superiority over whatever it replaces;

(iii) Compatibility �an appropriate fit with the intended audience;

(iv) Complexity � has to do with how easy it is to implement the innovation;


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(v) Trialability � pertains to whether it can be tried on an experimental basis; and

(vi) Observability � reflects whether the innovation will produce tangible results.

(g) Organisational Change Theories-Stage Theory Among the many theories of organisational behaviour, two have shown special promise in the area of public health: Stage Theory and Organisational Development. Stage Theory of Organisational Change helps to explain how organisations plan and implement new goals, programmes, technologies and ideas. Organisations are believed to pass through a series of stages with each stage requiring a unique set of strategies if the innovation is to progress. A strategy that may be effective at one stage may be wrongly applied at the next. An innovationÊs current stage of development must be correctly assessed and the proper strategies selected in order to be successful in the application of Stage Theory.

Stage Theory can be said to comprise four stages:

(i) Awareness � problems are recognised and analysed and solutions are suggested and evaluated;

(ii) Adoption � policies are formulated, and resources for beginning change(s) are allocated;

(iii) Implementation � the innovation is implemented, reactions take place and changes in roles occur; and

(iv) Institutionalisation � the policy or programme becomes an integral part of the organisation, and new goals and values are a part of its structure.

These stages are „in sequence‰. However, movement can be forward, backward or abandoned at any point in the process. There are some criticisms of Stage Theory. First, the stages need to be better defined. Second, the stage model is not yet complete since beyond institutionalisation, there should be renewal, when a well-established programme evolves to meet changing demands. Lastly, the factors known to contribute to the programmeÊs development at each stage need to be expanded.


(h) Organisational Development Theory Human relations and the quality of life at work are often the targets of Organisational Development Theory. This theory has been divided into two main sections:

(i) Change Process Theories � deal with the underlying dynamics of change; and

(ii) Implementation Theories � used to make sure the change is successful.

Again, four stages can be identified for producing change in the organisation:

(i) Diagnosis � a specially-trained person, usually an outside consultant, helps the organisation identify its most striking problems which interfere with its functions;

(ii) Action Planning � strategies are developed for addressing these diagnosed problems;

(iii) Intervention � the consultant usually does not offer specific solutions but will aid in problem solving among the organisationÊs members in group interactions; and

(iv) Evaluation � the effort of the planned changes is assessed, and these changes in the organisation are allowed to settle.

The Stage Theory and Organisational Development Theories have the greatest potential for creating positive health changes in organisations when used together. One example would be using consultation (Organisational Development) as the intervention in both the adoption and institutional stages (Stage Theory) in an organisational change.

SELF-CHECK 6.4

1. Explain the Diffusion of Innovations Theory.

2. Discuss the differences between organisational change theory andorganisational development theory.

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Amos, L. M., & Munro, J. (2002). Promoting health: Politics and practice. London: Sage Publications.

Bandura, A. (1977). Social learning theory. New York: General Learning Press.

Ewles, L., & Simnett, I. (1999). Promoting health: A practical guide (4th ed.). Edinburg: Bailliere Tindall.

Fishbein, M., & Ajzen, I. (1975). Belief, attitude, intention, and behavior: An introduction to theory and research. Reading, MA: Addison-Wesley.

Gianz, K., Rimer, B. K., & Lewis, F. M. (2002). Health behavior and health education theory: A conceptual integration. American Journal of Health Promotion, 1, 58�63.

Hood, L. J., & Leddy, S. K. (2006). Conceptual bases of professional nursing (6th ed.). London: Lippincott, Williams and Wilkins.

Jadad, A. R., & OÊGrady, L. (2008). How should health be defined? BMJ, 337: 2900.

Kirsch, J. P., Haefner, D. P, .Kegeless, S. S., & Rosenstock, I. M. (1966). A national study of health beliefs. Journal of Health and Human Behaviors, 7, 248�254.

Lucas, K., & Lloyd, B. B. (2005). Health promotion: Evidence and experience. London: SAGE.

Naidoo, J., Wills, J., & Naidoo, J. (2005). Public health and health promotion: Developing practice. Edinburgh: Baillie �re Tindall.

Nutbeam, D. (1998). Evaluating health promotion � progress, problems and solutions. Health Promotion International, 13, 27�43.

Nutbeam, D., & Harris E. (2004). Theory in a nutshell. A practical guide to health promotion theories. London: McGraw Hill.

Prochaska, J. O., & DiClemente, C. C. (1986). The transtheoretical approach. Handbook of eclectic psychotherapy. J. Norcross. New York: Brunner/ Mazel..

Prochaska, J. O., DiClemente, C. C., et al. (1992). Comments on DavidsonÊs Prochaska and DiClementeÊs model of change: A case study? British Journal of Addiction, 87, 825�828.


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Rogers, E. M. (1995). Diffusion of innovations (4th ed.). New York: The Free Press.

Tones, B. K. (2005). Health promotion, affective education and the personal-social development of young people. In K. David and T. Williams (Eds.). Health Education in Schools. London: Harper & Row.

Tones, K., & Green J. (2004). Health promotion: Planning and strategies. London: Sage Publications.

Tropman, J., Erlich, J., & Rothman, J. (1995). Tactics and techniques of community intervention. Itasca, IL: Peacock Publisher.

Woodward, A., & Kawachi, I. (2000). Why reduce health inequalities? Journal of Epidemiology and Community Health, 54, 923�929.

World Health Organization. (2006). Working together: The world health report. Geneva: WHO.

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