Health Education

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World Health Organization, Regional Office for Eastern Mediterranean. (2013). Health education: theoretical concepts, effective strategies, and core competencies. Cairo, Egypt: Author. Available online free of charge (PDF, 82 pp, 1.1 MB), ISBN: 978-92-9021-829-6 (http://applications.emro.who.int/dsaf/EMRPUB_2012_EN_1362.pdf).

This health education foundation document starts by describing its background and purposes in Section 1. The World Health Organization’s (WHO) Regional Office for the Eastern Mediterranean identifies current challenges in the health education profession and the confusion regarding health education roles and activities, and the relationship with broader aspects of health promotion including public policies and the built environment. Many of the challenges are common in today’s health education profession around the world, such as lack of a clear definition of roles and importance, appropriate evaluation or documentation of effectiveness on efforts, or access to tools and resources needed to function effectively.

This document then defines key terms to facilitate common understanding in Section 2. One key concept is that health education is not merely disseminating information but involves broader aspects of fostering motivation and skills for making healthy choices. Section 3 examines the relationships between health education, health promotion, and health literacy. Definitions and frameworks on health education and promotion from several sources were discussed and compared. For example, the Ottawa Charter for Health Promotion emphasizes five priority areas (WHO, 1986); Downie, Fyfe, and Tannahill (1990) identify related components of health education, health protection and prevention; Green and Kreuter (1991) highlight the voluntary participation in behavioral change; and Tones (1997) elaborates that health promotion includes both addressing individual capacities and healthy public policies addressing external environmental supports. Although there is still controversy on what constitute “health literacy,” health literacy has been suggested as an important outcome for effective health education (Rootman, 2002).

Section 4 overviews health behavior theories, models and frameworks. It discusses the benefits of health behavioral theories as well as the six common components of health program planning models (McKenzie, Neiger, & Thackeray, 2012). Key behavioral theories are introduced at the three levels of influence from an ecological perspective. At the intrapersonal capacity, the health belief model is among the earliest and most popular behavior change model. It explains possible reasons for health decision making especially when knowledge is not sufficient for behavior change (Green & Kreuter, 1991). The extended parallel process model is rooted in the health belief model and argues that individuals process risk messages based on perceived threat (susceptibility and severity) as well as efficacy (response efficacy and self-efficacy; Murray-Johnson et al., 2004). The transtheoretical model, on the other hand, is one of the most comprehensive and extensively researched models developed recently (Prochaska & DiClemente, 1986). The transtheoretical model proposed that behavior change does not occur overnight and individuals go through different stages during the change process. The theory of planned behavior notes that intention to change behavior is influenced by the attitudes toward the behavior, perceived social norms, and perceived behavior control (Fishbein & Ajzen, 1975).

At the interpersonal support level, the social cognitive theory introduces the concept of “reciprocal determinism,” highlighting the interaction between behavior and environment (Bandura, 1986). In addition, the principles of observational learning and vicarious reinforcement as well as self-efficacy and outcome expectancies are key factors affecting how likely the behavior change will occur. At the environmental context or the community level, two health education theories are briefed. The communication theory identifies several factors influencing how individuals receive message before action, such as the characteristics of the recipient, the messenger, the channel, in addition to the complexity of the issues and the nature of the messages (Freimuth & Quinn, 2004). The diffusion of innovations uses the normal distribution curve to illustrate five categories of adopters during the adoption process (Rogers, 1995). Diffusion of innovations also identifies five factors influencing the rate of adoption that health educators can consider in program planning and development. Each of the key models is explained with main constructs and definitions, examples, and potential change strategies or measurement approaches and followed by an empirical study applying the specific theory or model.

Section 5 covers examples of effective strategies and barriers to success in the health education planning, implementation, and evaluation process. Several components important to effective community-based health education strategies, such as participant involvement, needs and resources assessment, a comprehensive and integrated program, altering community norms, and evaluation, are discussed. The Guide to Community Preventive Services (http://www.thecommunityguide.org/about/index.html), a comprehensive set of systematic reviews, provides an evidence-based tool to help health educators and practitioners identify recommendations on population-based interventions by population, setting, and topical areas to promote the health in the communities. Some common challenges identified in implementing health education programs include the “invisible” nature of the results of prevention, time needed to show benefits, the complex factors influencing health and illness, and so on. The document also briefly covers potential strategies to overcome challenges, for example, using the story strategy to make communication personal, using needs and capacity assessment information to encourage participation, using existing cost-effectives strategies, as well as making healthy choices easy choices for people.

Section 6 discusses the core responsibilities and competencies. The National Commission for Health Education Credentialing has identified seven major areas of responsibilities and corresponding competencies for health educators: assessing individual and community need, planning effective programs, implementing programs, evaluating effectiveness, communicating needs and resources, coordinating provision of services, and acting as resource person (National Commission for Health Education Credentialing, Society for Public Health Education, & American Association for Health Education, 2010). Section 7 reviews the health education code of ethics, developed by the Society for Public Health Education (1999) in collaboration with other public health and education organizations. The code of ethics provides a framework of shared values for health educators working in various settings.

In summary, Health Education: Theoretical concepts, Effective Strategies and Core Competencies highlights the critical contribution of health education to the broader area of health promotion, reviews key theories and tools in the health education and promotion field, and describes health education core competencies and the code of ethics. The document is easy to read, with many definitions, and is a succinct yet effective summary on key theories with examples. It provides the foundation for common understanding of the health education profession, clarifies its roles and responsibilities, and serves as a quick overview of key issues for health educators and practitioners around the world.

This free and brief document serves as an important contribution to advancing the practice of health education and promotion in the global communities. This foundation document helps facilitate common understanding and clarifies roles among health educators and those in related disciplines. Public health professionals, practitioners, students, and anyone interested in health education and promotion can gain foundation understanding on key issues and concepts in the profession.