Health Education, Advocacy and Community Mobilisation Module: 13. Planning Health Education Programmes: 2

Study Session 13  Planning Health Education Programmes: 2

Introduction

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.

Learning Outcomes for Study Session 13

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)

Figure 13.1  Feet that look like this are caused by contact with red clay soil and can be prevented if shoes are worn. (Photo: Henk van Stokkom)

13.1  Identifying and prioritising health problems

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.

Figure 13.2  Peer influences may be important in determining alcohol consumption levels. (Photo: Tom Heller)

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.

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.

13.2  Setting goals and objectives

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.

Figure 13.3  Giving people bed nets helps to achieve the goal of reducing malaria in certain areas of Ethiopia. (Photo: UNICEF Ethiopia/Indrias Getachew)

Figure 13.4  Your objective might be to increase the number of pregnant women who attend for antenatal care by 20% within the next year. (Photo I-TECH/Julia Sherburne)

Now read Case Study 13.1.

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.

13.2.1  Categories of objectives

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:

• Infant mortality will be reduced in our region to 30 deaths per 1,000 live births by the year 2012.

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.

Figure 13.5  The use of posters might help you achieve behavioural objectives. (Photo: Carrie Teicher)

Examples of behavioural objectives might include the following:

• To increase the percentage of households who use bed nets from 35% to 70% within six months.
• To increase the number of people who use condoms from 15% to 45% within one year.

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:

• ‘At the end of the learning session, 60% of the people who attend will have learnt how to use bed nets correctly.’

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’.

Figure 13.6  This family have been given an insecticide-treated bed net. Unless the resources are available, you will not be able to meet your objectives. (Photo: UNICEF Ethiopia/Indrias Getachew)

13.3  Selecting educational methods

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.

Figure 13.7  Individual counselling may be the best method to use for detailed and delicate health messages such as correct breast feeding. (Photo: UNICEF Ethiopia/Indrias Getachew)

Table 13.2 shows health education methods that are appropriate for each learning objective.

When you are choosing the educational method that you will use, you should also consider:

1. The number of people involved.
2. Learner preferences.
3. The appropriateness of the method to the local culture.
4. Availability of your resources.
5. A method that best fits the characteristics (age, sex, religion, etc.) of the target group.

13.4  Developing your plan of work

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.

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).

Summary of Study Session 13

In Study Session 13, you have learned that:

1. You will need to identify and use the process of problem identification and prioritisation in your work. Since it is not feasible to address all the health problems that have come out of your needs assessment, you should prioritise and select those problems which need urgent intervention.
2. You can prioritise your problems according to their magnitude, the severity of the problems, the extent of community and government concern, and the feasibility of addressing problems. You can also discuss with stakeholders, like community members and key informants, what they consider to be their priorities.
3. Once you have prioritised and selected the most important problems, the next step is to develop the goal and objectives which you are going to aim to achieve. An objective should include statements of what you want to achieve, where, who is the target group, when do you want to achieve your goal, and how will you measure the outcomes of your interventions.
4. There are four categories of objectives. These are health objectives, behavioural objectives, learning objectives and resource objectives. Whenever you prepare your objectives, make sure they are achievable within a certain period of time.
5. In order to achieve your stated objectives, you should choose health education methods that are appropriate. You should take account of your learning objectives, the preference of learners, and the culture of the community, when you select your health education methods.
6. You will need to develop a work plan to help you plan all your activities in a logical way. The work plan should include your objectives and methods, as well as a time frame.

Self-Assessment Questions (SAQs) for Study Session 13

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.