In Study Session 12, you learnt about the purposes and principles of planning your health education activities. You also learnt that the first important step in planning was a needs assessment. In this study session, you will learn the next steps of planning, which are problem identification, setting priorities, and how to develop appropriate objectives and strategies. In addition, you will learn how to develop the components of a work plan. As you discovered in Study Session 12, one of the reasons to conduct a needs assessment is to identify community health problems and their causes. This study session begins by identifying and prioritising the problems which were discovered by needs assessment.
When you have studied this session, you should be able to:
13.1 Define and use correctly all of the key words printed in bold. (SAQ 13.1)
13.2 Describe the process for identifying and prioritising problems to focus on during your health education activities. (SAQ 13.1)
13.3 Describe the four categories of objectives for health education interventions, and explain how to write good objectives. (SAQs 13.2, 13.3, 13.4 and 13.5)
13.4 List the components of a work plan. (SAQ 13.6)
By the end of your needs assessment work, you will have identified a number of health problems in your community. These problems may include a high incidence of malaria, TB, HIV/AIDS, and childhood diarrhoea. You should ensure that you have a list of all the problems you have identified.
You may also have identified some of the possible causes of health problems (Figure 13.1). These could include unhealthy practices such as smoking cigarettes or excessive alcohol consumption. Another possible cause that you might have been able to identify is unhelpful beliefs, such as that malnutrition is caused by bad spirits, or that dirty water causes malaria. Peer influences could also be identified as a cause of some health problems (Figure 13.2). For example, an individual who has malaria may want to visit the health facility to get treatment. However, his friend may want him to go visit a traditional healer.
Once you have identified and listed the main community health problems and their causes, the next step is to prioritise these problems — because it may be difficult for you to address all of these problems at the same time. Prioritisation is the process of arranging the problems in order of the urgency in which they need to be addressed. Highly urgent and important problems are put at the top of your list — and less important and less urgent problems put at the bottom. During needs assessment you may identify as many as 20 different community health problems, but you cannot address all of these at the same time. You now have to prioritise and put them in the order of importance to the health of the community.
Problem prioritisation is not arbitrary, but should use certain established criteria. There are five basic criteria you can use to prioritise problems. Look carefully at Box 13.1. It describes the criteria you can use to prioritise the problems you have identified in your community, in order to decide which ones should be tackled first.
Knowing the criteria alone cannot help you to set priorities. This activity will demonstrate to you how to score these five criteria, so that you are able to arrange your problems in order of their importance. In the example set out in Table 13.1, each health problem has been scored on a range of one to five. A minimum score would be one. This indicates that there is very little concern for that health problem. The maximum score of five would be given for a problem that was thought to be very severe. The scores for each problem have been added up in the final column, and a rank has been given for each problem. The rank indicates the priority — a problem that is ranked 1 is the most important.
|Problem identified||Score for each criterion||Total score||Rank|
|Magnitude||Severity||Feasibility||Government concern||Community concern|
Now answer these questions on the data in Table 13.1:
Table 13.1 gives a lot of information about this situation:
The second option you have available in prioritising health problems is to ask a group of stakeholders, such as community members or other health workers, to prioritise the problems according to their knowledge and experience.
How many problems do you select to address? That really depends on your capacity, and the resources you have to deal with them.
Once you have identified the specific problems you intend to address, the next step is to prepare the goals and objectives for your health education activities (Box 13.2). Without goals and objectives your activities may lack direction, and it may be difficult to monitor and evaluate how effective your health education interventions have been.
A goal is a broad statement that can clearly describe what your health education activity is designed to achieve. It provides an overall direction for your activities. Your health goals might be something very general like: ‘My goal is to improve the health of women and children in my locality.’
An objective is more specific than a goal, and it should be achievable. It is the outcome that you want to accomplish through a health education intervention (Figures 13.3 and 13.4). If you do not have objectives, you cannot evaluate the effectiveness and efficiency of your health education activities. An objective has five elements. A good objective must include all of these five elements. Box 13.2 describes them.
Objective statements must be written in a way that will answer the following questions:
Now read Case Study 13.1.
If your needs assessment has shown that malaria is a problem in your locality, your goal might be very general. You might say something like, ‘My goal is to reduce the amount of malaria in my kebele.’
You may also discover that one of the reasons for the malaria is that the uptake of insecticide-treated bed nets (ITN) is quite low in your kebele, so your objective would be something more specific and detailed. You might decide that your objective should be: ‘To increase the number of households who use bed nets properly in my kebele from 100 to 200 within six months.’
You could look in more detail at this objective:
|● What?||More people should use bed nets to prevent malaria|
|● Where?||Throughout my kebele|
|● Who?||Households, especially those with pregnant women|
|● When?||Within the next six months|
|● Extent of achievement||The number should increase by at least 100 households.|
It is important to note that the objective should have a deadline, and it should be achievable. Now try this out with the two examples below.
Bilise is a Health Extension Practitioner. She is working in a village called Sato. She always plans her health education activities clearly. One of the objectives in her plan is: ‘To increase the number of pregnant women who attend for antenatal care in Sato village from 15 now to 35 by the end of three months.’ Has she included all the elements of an objective in her statement? Identify each element that she has used. The bullet points in Case Study 13.1 will help you to organise your answer.
Yes, Bilise’s objective is correctly written. It addresses all the elements that should be included when writing an objective. Each element could have been expressed like this:
|● What?||Increased uptake of antenatal care|
|● Where?||In Sato village|
|● Who?||Pregnant women|
|● When?||Within three months|
|● Extent of achievement||Increase by another 20 pregnant women.|
Suppose Ayisha is a Health Extension Practitioner working at her health post in a village called Deneba. She wants to plan her health education activities on the subject of female genital mutilation (FGM) for village mothers. She intends to educate 100 mothers within the next four months. Based on this information, how do you think Ayisha should write her objective?
Ayisha’s objective could be written as: ‘To provide health education on FGM for 100 mothers who live in Deneba within the next four months.’
In health education and promotion activities, there are four types of objectives. Health objectives tell you how big the health problem is, and how much it should be improved. As you learnt in Study Session 12, the first step in a needs assessment is to identify a health problem. Here in the health objectives stage, you should decide by how much you want to reduce that problem.
A typical health objective might be:
The next step is to look at the health-related behavioural objectives. The term ‘behavioural objective’ refers to the actions that you encourage people to perform, or not perform (Figure 13.5). For example, health-related behaviour may include using condoms to reduce the risk of diseases caused by unprotected sex, or using an insecticide-treated bed net, or taking anti-malaria drugs properly, and so on. Since the primary objective of health education is to change people’s behaviour; behavioural objectives are very important. You should determine by how much you want to increase healthy behaviours or, conversely, by how much you want to reduce unhealthy behaviours in the community.
Examples of behavioural objectives might include the following:
Using bed nets or using condoms are behaviours that we want to encourage through health education. Therefore, you should have behavioural objectives for all behaviours that you want to change through health education.
Learning objectives refer to educational or learning tools that are needed to achieve desired behavioural changes. Learning objectives describe the knowledge, attitude, beliefs or skill development that leads to the desired behaviour change. If learning objectives are achieved, then behavioural objectives will be achieved. An example of a learning objective could include:
Sometimes learning objectives can be developed for health education activities which will be undertaken for a longer period. For example, you might have a learning objective such as: ‘By the end of 2013, 90% of the households in my kebele will be able to identify three means of HIV/AIDs prevention.’
The fourth type of objective is a resources objective. During a needs assessment, you may also identify a lack of resources or services without which behaviour change could not take place. For example, without a mosquito net you cannot expect households to use bed nets properly (Figure 13.6). In general, if there is a lack of resources or services which are important for behaviour change, you should make these services available, and you should have objectives for doing so. Such an objective is called a resource objective. For example ‘by the end of this year all mothers of children under two in this village should have access to oral rehydration salts’.
Now try to identify the four different types of objectives. What kind of objective are each of the following?
Answer 1 is a learning objective. 2 is a behavioural objective. 3 is a resource objective. 4 is a health objective.
Now try this out for yourself. Write an example of one behavioural objective and one learning objective for your health education activities on HIV/AIDS.
A behavioural objective might be something like: ‘To increase the number of couples who use condoms in my kebele from 20% to 40% over the next two years.’ A learning objective could be: ‘70% of the people who attend the health education session in my kebele will be able to identify three ways of HIV/AIDS transmission.’
To achieve each of your stated objectives, you need to choose the best educational method, because not all health education methods are appropriate to achieve each of your objectives — some methods are better than others. For example, if one of your learning objectives is to increase knowledge about a particular health subject, you should choose a method which is appropriate for this objective (Figure 13.7). If one of your objectives is to influence attitudes, you need a different way of getting your message across.
Table 13.2 shows health education methods that are appropriate for each learning objective.
|Learning objective||Health education method|
|Raising awareness and passing on knowledge||Lecture with discussion, talks at public meetings or social gatherings, and the distribution of materials such as posters and leaflets|
|Changing attitudes||Individual approaches such as counselling or discussion, using visual and audio-visual materials|
|Skill development||Training and demonstrations involving practice|
When you are choosing the educational method that you will use, you should also consider:
A plan of work is simply putting together all the components you have worked out to deliver your health education messages, such as your objectives and the activities you will use. Your plan should specify the roles of the different people involved, the time in which the particular activities have to be carried out, and the different methods you plan to use. Look carefully at Box 13.3 which describes the components of a work plan.
Your plan of work should include the following components:
As you can see from Box 13.3, an indicator is one of the components of a work plan. An indicator is used to measure changes related to each of your health education interventions. A variable is something that changes over time. For example, knowledge, attitudes, beliefs, skills and health behaviours are all variables, because they can change over time, and you hope that all these things will improve as a result of your work in the community.
For instance, a person’s attitude is not static — it can change. So the variables can indicate, or show, the extent of your achievements. For example, if you educate households about the proper use of bed nets to prevent malaria, your indicator could be the number of households who have used a bed net properly after they have received your health education messages. The variable in this example is people’s behaviour.
To understand how a work plan is developed, look at Table 13.3. This table helps you to visualise how the components of your work plan could be put together, and the relationship between each component. (Note that IEC materials involve Information, Education and Communication).
|To increase the number of households who use bed nets properly from 20% to 60% over the next year.||Home visits.Training each household on the proper use of bed nets Demonstration of bed net use, practising with mothers and families.|
Conducting home visits.
Identifying barriers to using bed nets, giving advice to families, and helping them to hang bed nets properly. Preparing training materials, selecting participants, giving training.
|Community health practitioners, community malaria workers.||IEC materials. Posters, leaflets, papers, pen, pencils, bed nets. Materials to demonstrate use of bed nets such as rope.||August 2012 to September 2013 (International Calendar).||Number of households who received training. Number of households who use bed nets properly after training.|
Creating a work plan takes time and effort. So we are not asking you to do one here and now. But it is useful to familiarise yourself with its shape. So look at Table 13.3 carefully now, and think of a health problem you are aware of in your area. Try just mapping out a work plan in a very preliminary way. Think how you would turn the problem into an objective. Imagine the sorts of activity you would want to undertake. Who do you think would be responsible people to involve? What sorts of resources would you need? What would a reasonable time frame be? What sorts of indicators of change do you think would be helpful?
As we have noted, a work plan is not something which you can just put together in half an hour, but beginning to think about the issues you would need to deal with to construct one is a useful exercise. If you want, you could try it with a number of health problems, and begin to get a feel for what exactly you are going to need to do.
In Study Session 13, you have learned that:
Now that you have completed this study session, you can assess how well you have achieved its Learning Outcomes by answering these questions. Write your answers in your Study Diary and discuss them with your Tutor at the next Study Support Meeting. You can check your answers with the Notes on the Self-Assessment Questions at the end of this Module.
Prioritisation is the process of placing problems in the order of urgency: highly urgent and important problems are put at the top, and less important and less urgent problems are put at the bottom.
There are five criteria to prioritise health problems for health education interventions. They are magnitude of the problem, severity of the problem, feasibility to solve the problem, community concern and government concern.
List the five elements of an objective.
These are the five elements of an objective:
What type of objective are each of the following?
Are these learning objectives correctly written? In each case, explain why the objective is correct or incorrect.
A At the end of the learning session, participants should understand what malaria is.
B At the end of the learning session, participants will be able to identify three methods of malaria prevention.
C At the end of the learning session, 80% of the participants will be able to identify prevention methods against malaria.
D At the end of the learning session, 80% of the participants will be able to identify three methods of malaria prevention.
A is incorrect because it does not show all the elements of the objective. For example, there is no extent of achievement. The word ‘understand’ is not used to write objectives, as it is difficult to pin down.
B is incorrect because it lacks the extent of achievement.
C is incorrect because the number of prevention methods the participants are supposed to identify is not specified.
D is correct because it includes all the elements of an objective.
Write an example of one behavioural objective and one learning objective for health education activities on the subject of HIV/AIDS.
You can write a lot of behavioural objectives related to health education on HIV/AIDS. For example, ‘to increase the number of people who use condoms from 20% to 40%’, ‘to increase the number of people tested for HIV/AIDS by 70 within six months’, and so on.
For a learning objective, you may write that: ‘70% of the people who received health education will be able to identify three means of HIV/AIDS transmission’ or ‘90% of those who received health education should develop the belief that condom use can prevent HIV transmission’, and so on.
What components should you include in your work plan for a health education programme?
These are the elements you should include in your work plan: