DISTANCE LEARNING CENTRE

AHMADU BELLO UNIVERSITY

ZARIA, NIGERIA

COURSE MATERIAL

FOR

Course Code &Title: COMM 871 (Training Methods in Health Promotion and
Education)

Programme Title: Master of Public Health

1
 ACKNOWLEDGEMENT
We acknowledge the use of the Courseware of the National Open University of Nigeria
and the University of Cape Town as the primary resource. Internal reviewers in the
Ahmadu Bello University who extensively reviewed and enhanced the material have
been duly listed as members of the Courseware development team.

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 COPYRIGHT PAGE
© 2018 Ahmadu Bello University (ABU) Zaria, Nigeria

All rights reserved. No part of this publication may be reproduced in any form or by any
means, electronic, mechanical, photocopying, recording or otherwise without the prior
permission of the Ahmadu Bello University, Zaria, Nigeria.

First published 2018 in Nigeria.

ISBN:

Ahmadu Bello University e-Learning project,

Ahmadu Bello University
Zaria, Nigeria.

Tel: +234

E-mail:

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COURSE WRITERS/DEVELOPMENT TEAM
Editor
Prof. M.I Sule
Course Materials Development Overseer
Dr. Usman Abubakar Zaria
Subject Matter Expert
Dr. M. Auwal Ibrahim
Subject Matter Reviewer
Rahamatu Shamsiyyah Iliya
Language Reviewer
Enegoloinu Ojokojo
Instructional Designers/Graphics
Dr. M. Auwal Ibrahim
Proposed Course Coordinator
Rahamatu Shamsiyyah Iliya
ODL Expert
Prof. Adamu Z. Hassan

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 TABLE OF CONTENTS
Title Page…………………………………………………………….……?
Acknowledgement Page…………………………………………… ……?
Copyright Page………………………………………………………..… ?
Course Writers/Development Team…………………………………… ?
Table of Content………………………………..……………………… ?

COURSE STUDY GUIDE

i. Course Information ?
ii. Course Introduction and Description ?
iii. Course Prerequisites ?
iv. Course Learning Resources ?
v. Course Objectives ?
vi. Activities to Meet Course Objectives ?
vii. Time (To complete Syllabus/Course) ?
viii. Grading Criteria and Scale ?
ix. OER Resources ?
x. ABU DLC Academic Calendar ?
xi. Course Structure and Outline ?
xii. STUDY MODULES ?
Module 1:…………………….…… ?
Study Session 1:……………………. ?
Study Session 2:…………………… ?
Study Session 3:…………………… ?
Study Session 4:……………………. ?

Module 2:…………………………… ?
Study Session 1:……………………. ?
Study Session 2:…………………… ?
Study Session 3:…………………… ?
Study Session 4:……………………. ?

Module 3:…………………………… ?
Study Session 1:……………………. ?
Study Session 2:…………………… ?
Study Session 3:…………………… ?
Study Session 4:……………………. ?

XIII. Glossary ?

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 COURSE STUDY GUIDE
i. COURSE INFORMATION
Course Code: COMM 871
Course Title: Training Methods in Health Promotion
Credit Units: 2
Semester: First

ii. COURSE INTRODUCTION AND DESCRIPTION

Introduction:
As an expert in public health, you may be involved in a number of health-related
programmes and campaigns. Therefore, you need to equip yourself with requisite skills to
enable you successfully plan, execute, evaluate and monitor these programmes as an
integral part of health promotion. This course has been so designed to equip you with the
training methods, practices and ethical issues in relation to health promotion and
education. The course is divided into three modules with each of the module containing 4
study sessions. You are expected to read each study session, watch the videos and other
additional activities. I hope you are going to enjoy the course as we move.

Description:
This course will equip you with the skills as trainers to design and implement innovative
programs in agency settings for personnel development. Different approaches to training
will be reviewed, including needs assessment, curriculum development and training
logistics. Evaluation of various government and private training and teaching
programmes and their pedagogical element will be reviewed. Students would have
opportunity to organize actual training program.

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iii. COURSE PREREQUISITES
You should note that although this course has no subject pre-requisite, you are
expected to have:
1. Satisfactory level of English proficiency
2. Basic Computer operations proficiency
3. Online interaction proficiency
4. Web 2.0 and Social media interactive skills
5. Basic understanding of health as a concept

iv. COURSE LEARNING RESOURCES

i. Course Textbooks
a. Ewles, L. & Simnett, I. (1995). Promoting Health: A Practical Guide. Third
Edition. London: Scutari Press.
b. Naidoo, J. & Wills, J. (1994). Health Promotion: Foundations for Practice.
Bailliere Tindall.
c. MM Barry, AM Clarke, I Petersen, and R Jenkins (2019). Implementing mental
health promotion. Springer.
d. H.Curtis (2018). Sexual Health Promotion in General Practice. CRC Press.
e. Tones, K. & Tilford, S. (2001). Health Education: Effectiveness, Efficiency and
Equity. Third edition. Cheltenham, UK: Nelson Thornes.

ii. Course Journals

a. Global Health Promotion published by SAGE Journals
(https://journals.sagepub.com/home/ped)
b. CL. Holt, EK., Tagai, S.L., Zara Santos, M.A., Scheirer, J. Bowie, M. Haider, and
J., Slade (2018). Translational Behavioral Medicine, Vol 9(4) P573–582.

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 c. Docherty, G., Fraser, E., Hardin, J. (1999). Health promotion in the Scottish
workplace: A case for moving the goalposts. Health Education Research, 14, 565-
573.
d. Health Research Policy and Systems published by Biomed Central (https://health-
policy-systems.biomedcentral.com/)
c. American Journal of Health Promotion published by SAGE Journals
(https://journals.sagepub.com/home/ahp)

v. COURSE OBJECTIVES
This course is designed to ensure that you are able to:
1. Extensively understand the concept of health promotion
2. Successfully design and implement training methods for health promotion
3. Successfully design and conduct robust research activity about a health promotion
programme

vi. ACTIVITIES TO MEET COURSE OBJECTIVES

Specifically, this course shall comprise of the following activities:
1. Studying courseware
2. Listening to course audios
3. Watching relevant course videos
4. Field activities
5. Course assignments (individual)
6. Forum discussion participation
7. Tutorials (optional)
8. Semester examinations (CBT and essay based)

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 vii. TIME (TO COMPLETE SYLLABUS/COURSE)
To cope with this course, you would be expected to commit a minimum of 4 hours
daily/weekly for the Course (study, assignments, watching videos & forum discussions).

viii. GRADING CRITERIA AND SCALE

Grading Criteria
A. Formative assessment
Grades will be based on the following:
Individual assignments/test (CA 1,2 etc) 20
Group assignments (GCA 1, 2 etc) 10
Discussions/Quizzes/Out of class engagements etc 10

B. Summative assessment (Semester examination)

CBT based 30
Essay based 30
TOTAL 100%
C. Grading Scale:
A = 70-100
B = 60 – 69
C = 50 - 59
D = 45-49
F = 0-44

D. Feedback
Courseware based:
1. In-text questions and answers (answers preceding references)

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 2. Self-assessment questions and answers (answers preceding references)

Tutor based:
1. Discussion Forum tutor input
2. Graded Continuous assessments

Student based:
1. Online programme assessment (administration, learning resource, deployment, and
assessment).

ix LINKS TO OPEN EDUCATION RESOURCES

OSS Watch provides tips for selecting open source, or for procuring free or open
software.
SchoolForge and SourceForge are good places to find, create, and publish open software.
SourceForge, for one, has millions of downloads each day.
Open Source Education Foundation and Open Source Initiative, and other organisation
like these, help disseminate knowledge.
Creative Commons has a number of open projects from Khan Academy to Curriki where
teachers and parents can find educational materials for children or learn about Creative
Commons licenses. Also, they recently launched the School of Open that offers courses
on the meaning, application, and impact of "openness."
Numerous open or open educational resource databases and search engines exist. Some
examples include:
• OEDb: over 10,000 free courses from universities as well as reviews of colleges
and rankings of college degree programmes

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• Open Tapestry: over 100,000 open licensed online learning resources for an
academic and general audience
• OER Commons: over 40,000 open educational resources from elementary school
through to higher education; many of the elementary, middle, and high school resources
are aligned to the Common Core State Standards
• Open Content: a blog, definition, and game of open source as well as a friendly
search engine for open educational resources from MIT, Stanford, and other universities
with subject and description listings
• Academic Earth: over 1,500 video lectures from MIT, Stanford, Berkeley,
Harvard, Princeton, and Yale
• JISC: Joint Information Systems Committee works on behalf of UK higher
education and is involved in many open resources and open projects including digitising
British newspapers from 1620-1900!
Other sources for open education resources
Universities
• The University of Cambridge's guide on Open Educational Resources for Teacher
Education (ORBIT)
• OpenLearn from Open University in the UK
Global
• Unesco's searchable open database is a portal to worldwide courses and research
initiatives
• African Virtual University (http://oer.avu.org/) has numerous modules on subjects
in English, French, and Portuguese
• https://code.google.com/p/course-builder/ is Google's open source software that is
designed to let anyone create online education courses

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• Global Voices (http://globalvoicesonline.org/) is an international community of
bloggers who report on blogs and citizen media from around the world, including on
open source and open educational resources
Individuals (which include OERs)
• Librarian Chick: everything from books to quizzes and videos here, includes
directories on open source and open educational resources
• K-12 Tech Tools: OERs, from art to special education
• Web 2.0: Cool Tools for Schools: audio and video tools
• Web 2.0 Guru: animation and various collections of free open source software
• Livebinders: search, create, or organise digital information binders by age, grade,
or subject (why re-invent the wheel?)

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 ABU DLC ACADEMIC CALENDAR/PLANNER
PERIOD
Semester Semester 1 Semester 2 Semester 3
Activity JAN FEB MAR APR MAY JUN JUL AUG SEPT OCT NOV DEC
Registration
Resumption
Late Registn.
Facilitation
Revision/
Consolidation
Semester
Examination

N.B: - Semester Examinations 1st/2nd Week January

- All Sessions commence Mid-February
- 1 Week break between Semesters and 4 Weeks vocation at end of session.
- Semester 3 is OPTIONAL (Fast-tracking, making up carry-overs & deferments)

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 XI. COURSE STRUCTURE AND OUTLINE
Course Structure
WEEK MODULE STUDY ACTIVITY
SESSION
Study Session 1: 1. Read Courseware for the corresponding Study Session.
Title: Basic 2. Listen to the audio for this session.
Week1 Concept of Health 3. View the Video(s) on this Study Session
Promotion
Study Session 2 1. Read Courseware for the corresponding Study Session.
Title: Approaches 2. View the Video(s) on this Study Session
Week 2 to Health 4. Listen to the audio for this session.
Promotion
Study Session 3 1. Read Courseware for the corresponding Study Session.
Title: Healthcare 2. View the Video(s) on this Study Session
Week3 settings for Health 3. Listen to the audio for this session.
Promotion
STUDY
MODULE Study Session 4 1. Read Courseware for the corresponding Study Session.
Title: Health 2. View the Video(s) on this Study Session
Week4 1 Promotion Theories 3. Listen to the audio for this session.
and Models
Study Session1 1. Read Courseware for the corresponding Study Session.
Week 5 Title: Training in 2. View the Video(s) on this Study Session
Health Promotion 3. Listen to the audio for this session.
Study Session2 1. Read Courseware for the corresponding Study Session.
Title: Practices and 2. View the Video(s) on this Study Session
Week 6 Methods in Health 3. Listen to the audio for this session.
Promotion I
STUDY Study Session3 1. Read Courseware for the corresponding Study Session.
MODULE Title: Practices and 2. View the Video(s) on this Study Session

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 2 Methods in Health 3. Listen to the audio for this session.
Week7 Promotion II
Study Session4 1. Read Courseware for the corresponding Study Session.
Title: Ethical Issues 2. View the Video(s) on this Study Session
Week8 in Health 3. Listen to the audio for this session.
Promotion
Study Session1 1. Read Courseware for the corresponding Study Session.
Title: Introduction 2. View the Video(s) on this Study Session
Week 9 to Research in 3. Listen to the audio for this session.
Health Promotion
Study Session2 1. Read Courseware for the corresponding Study Session.
Week 10 Title: Key Steps in 2. View the Video(s) on this Study Session
STUDY Research Process 3. Listen to the audio for this session.
MODULE Study Session3 1. Read Courseware for the corresponding Study Session.
3 Title: Qualitative 2. View the Video(s) on this Study Session
Week 11 and Quantitative 3. Listen to the audio for this session.
Research
Methodologies
Study Session4 1. Read Courseware for the corresponding Study Session.
Week 12 Title: Advances in 2. View the Video(s) on this Study Session
evidence-informed 3. Listen to the audio for this session.
policy and practice
Week 13 REVISION/TUTORIALS (On Campus or Online)& CONSOLIDATION
WEEK

Week 14 & 15 SEMESTER EXAMINATION

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Course Outline
MODULE 1: Understanding Health Promotion
Study Session 1: Basic Concept of Health Promotion
Study Session 2: Approaches to Health Promotion
Study Session 3: Health Care Settings for Health Promotion
Study Session 4: Health Promotion Theories and Models

MODULE 2: Critical Practice and Perspectives in Health Promotion

Study Session 1: Training in Health Promotion I
Study Session 2: Practices and Methods of Health Promotion I
Study Session 3: Practices and Methods of Health Promotion I
Study Session 4: Ethical Issues in Health Promotion

MODULE 3: Health Promotion Research Methods and Skills

Study Session 1: Introduction to Research in Health Promotion
Study Session 2: Key Steps in Research Process
Study Session 3: Qualitative and Quantitative Research Methodologies
Study session 4: Advances in evidence-informed policy and practice

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 xii. STUDY MODULES
MODULE 1: Understanding Health Promotion
Study Session 1: Basic Concept of Health Promotion
Study Session 2: Factors Affecting Health Promotion
Study Session 3: Approaches to Health Promotion
Study Session 4: Health Care Settings for Health Promotion

Introduction:
I expect that you are now ready to commence your study on the course aimed at
training methods in health promotion and education. However, before we proceed
directly in to the methods, it is important for you to have a good understanding of the
concept of health promotion including definitions, objectives, models, principles,
approaches, healthcare settings for health promotion as well as factors affecting the
health promotion. Furthermore, as we move through these basic concepts to provide
an overview of health promotion, you will also be indirectly introduced to some of the
training methods. I implore you to read the module carefully and reflect about the
concepts within your locality. I hope the module will form the solid foundation needed
in the subsequent modules.

STUDY SESSION 1
Basic Concept of Health Promotion
Section and Subsection Headings:
Introduction
1.0 Study Session Learning Outcomes
2.0 Main Content
2.1 – What is Health promotion?
2.3- health promotion and health education; the difference
2.2- Objectives of health promotion

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 2.3- Principles of health promotion
2.4- Key concepts in health promotion
3.0 Study session Summary and Conclusion
4.0 Self-Assessment Questions
5.0 Additional Activities
6.0 References/Further Reading

Introduction
You are welcome to study session 1, I believe by now you should have been familiar
with the course guidelines in your tablet or the hard copy sent to you. In this session,
you will be introduced to the concept of health promotion. We will develop an
overview of health promotion; explore its objectives and principles.

1.0 Study Session Learning Outcomes

After you have finished studying this session, you should be able to:
1. Describe health promotion and its concepts
2. Explain the principles of health promotion
3. Explain the objectives of health promotion

2.0 Main Content

2.1 What is Health Promotion?
We all know that health promotion is about raising the health status of individuals and
communities. Promotion in the health context means improving, advancing,
supporting, encouraging and placing health higher on personal and public
agendas.

40
Given that major socioeconomic determinants of health are often outside individual or
even collective control, a fundamental aspect of health promotion is that it aims to
empower people to have more control over aspects of their lives that affect their
health.
These twin elements of improving health
and having more control over it are
fundamental to the aims and processes of
health promotion. The World Health
Organization (WHO) definition of health
promotion as it appears in the Ottawa
Charter (Figure 1.1) has been widely
adopted and neatly encompasses this:
‘Health promotion is the process of
enabling people to increase control over,
and to improve, their health’ (WHO
1986). The Ottawa Charter sets out five Figure 1.1: Key elements of the Ottawa charter

core areas for health promotion: healthy public policy, personal skills
development, the creation of supportive environments, community participation
and the re-orientation of health services. It also recognised as mechanisms for
health promotion, enablement, advocacy and mediation (Keheller, 1996).
Health promotion as a term was used for the first time in the mid-1970s (Lalonde
1974) and quickly became an umbrella term for a wide range of strategies designed to
tackle the wider determinants of health. There is no clear, widely adopted consensus of
what is meant by health promotion. Some definitions focus on activities, others on
values and principles.
The WHO (1986) definition defines health promotion as a process but implies an
aim (enabling people to increase control over, and improve, their health) with a
clear philosophical basis of self-empowerment. In summary, health promotion is

41
 the process of enabling people to increase control over, and to improve their health
(Health Promotion Glossary, 1998).

In-text Question
1: What is health?
Answer: Health is a state of complete physical, mental, and social well-being and not
merely the absence of disease or infirmity. It is a positive concept emphasizing social and
personal resources, as well as physical capacities.

2.2 Health Education and Health Promotion; The Difference

There has been considerable debate about the difference between Health Promotion
and Health Education. Discussions have focused on the difference in their definitions,
the scope of their activities and on their underlying philosophies. Whilst Health
Education and Health Promotion both have the same aim, namely “to improve or
protect health”, the scope of their activity varies. In the case of Health Education,
most activity centres on providing learning opportunities for individuals and
communities so that they are able to voluntarily change their behaviour. In other
words, they acquire information and skills to help them initiate a change that enhances
their well-being and their health. Educational activities range from individual
counselling and self-development to the use of mass media and communication
campaigns.
Health Promotion activity is much broader and includes both Health Education
And:
▪ The provision of preventative health services.
▪ Measures to protect the physical environment
and make it conducive to health
▪ The mobilisation of community resources.
▪ The implementation of organisational policies
which promote health.
▪ Economic and regulatory activities.

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The two concepts, Health Education and Health Promotion are symbiotic
strategies. This means that they are closely associated or related and that they
benefit from each other. (Catford, J. & Nutbeam, D. (1984)
Naidoo and Wills (1998) suggest that a key feature that
Figuredistinguishes Health
1.2: Depiction of components Promotion
of health promotion
(Ewles & Simnett, 1999: 25)
from Health Education is that Health Promotion involves environmental and political
action. Similarly, Tones and Tilford (2001) have suggested that it is possible to distil the
concept of Health Promotion into an essential formula:
Health Promotion = Health Education x Healthy Public Policy
This formula suggests that Health Promotion is the product of both Health Education
and Healthy Public Policy.
Health Promotion is thus seen as the umbrella term that includes a whole range of
activities, such as policy development, environmental or social action and
organisational development (Figure 1.2).

In-text Question 2: What is health promotion?

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

2.3 Objectives of Health Promotion

The WHO major goal for
health promotion is to
improve equity in health,
reduce health risks,
promote healthy lifestyles
and settings, and respond
to the underlying
determinants of health
(Figure 1.3).

Figure 1.3: Objectives of Health Promotion

Who.int
43
The Objectives are: the WHO objectives for health promotion are as follows
i. To develop and implement multisectoral public policies for health,
ii. integrated gender- and age-sensitive approaches that facilitate community
empowerment together with action for health promotion,
iii. self-care and health protection throughout the life course in cooperation with the
relevant national and international partners these objectives are thus achieved
through the following means:

Good Governance
Strengthening policy-makers across all governmental departments to make
decisions and to create sustainable systems which promote the health and well-
being of all.
Health promotion requires policy makers across all government departments to make
health a central line of government policy. This means they must factor health
implications into all the decisions they take, and prioritize policies that prevent people
from becoming ill and protect them from injuries.
These policies must be supported by regulations that match private sector incentives
with public health goals. For example, by aligning tax policies on unhealthy or
harmful products such as alcohol, tobacco, and food products which are high in salt,
sugars and fat with measures to boost trade in other areas. Legislation can also support
healthy urbanization by creating walkable cities, reducing air and water pollution, and
enforcing the wearing of seat belts and helmets.

Health Literacy
Increasing the degree to which individuals and communities have the capacity to
obtain, process and understand the basic health information and services needed
to make appropriate health decisions.

44
People need to acquire the knowledge, skills and information to make healthy choices,
for example about the food they eat and healthcare services that they need. They need
to have opportunities to make those choices. And they need to be assured of an
environment in which people can demand further policy actions to further improve
their health.

Healthy Cities
Promoting well-being and multi-disciplinary approaches to health within the
setting of everyday urban life.
The Healthy Cities programme is the best-known example of a successful Healthy
Settings approach. Cities have a key role to play in promoting good health. Strong
leadership and commitment at the municipal level is essential to healthy urban
planning and to build up preventive measures in communities and primary health care
facilities. From healthy cities evolve healthy countries and, ultimately, a healthier
world.

Health Promoting Schools

Strengthening the capacity of schools to be healthy settings for living, learning
and working.
WHO promotes school health programmes as a strategic means to prevent important
health risks among youth and to engage the education sector in efforts to change the
educational, social, economic and political conditions that affect risk.

Social Mobilisation
Engaging and galvanising people, whether at a national or local level, to take
action towards the achievement of good health and well-being in a way that gives
ownership to the community as a whole.

45
 Social mobilisation is the process of bringing together all societal and personal
influences to raise awareness of and demand for health care, assist in the delivery of
resources and services, and cultivate sustainable individual and community
involvement. In order to employ social mobilisation, members of institutions,
community partners and organisations, and others collaborate to reach specific groups
of people for intentional dialogue. Social mobilisation aims to facilitate change
through an interdisciplinary approach.
In-text Question 3: List 4 objectives of health promotion.
Answer: 1. Good governance
2. Social mobilisation
3. Healthy cities
4. Healthy schools.

2.4 Principles of Health Promotion

The Ottawa Charter remains a source of global guidance and continues to shape
the development of health promotion, alongside other important documents
including the Jakarta Declaration (WHO, 1997) and the Bangkok Charter
(WHO, 2005).
The World Health Organisation identified seven key principles of health promotion
(cited in Rootman, 2001) as follows:

Empowerment: Health promotion initiatives should enable individuals and

communities to assume more power over the personal, socio-economic and
environmental factors that affect their health.
Participative: Health promotion initiatives should involve those concerned in all
stages of planning, implementation and evaluation.
Holistic: Health promotion initiatives should foster physical, mental, social and
spiritual health.
Inter-sectoral: Health promotion initiatives should involve the collaboration of
agencies from relevant sectors.

46
Equitable: Health promotion initiatives should be guided by a concern for equity and
social justice.
Sustainable: Health promotion initiatives should bring about changes that individuals
and communities can maintain once initial funding has ended.
Multi-strategy: Health promotion initiatives should use a variety of approaches in
combination with one another, including policy development, organisational change,
community development, legislation, advocacy, education and communication.

Key concepts in Health Promotion

The concept is driven by the concern for
equity in health and calls for true
participation of individuals, families and
communities as key actors in improving a
population’s health. Any proposed
solutions should be adapted to the local
needs. To improve health - in its biological,
psychological and social dimensions - it is, Figure 1.4: Main Determinants of Health

however, not enough to focus on people’s behaviour, or on users or providers of health

services. The Health Promotion concept is deeply rooted in the more socio-ecological
concept of the determinants of health (Figure 1.4), where the individual (with the
individual determinants of genetic/hereditary factors, sex and age) adopts health
related behaviours and leads a lifestyle, influenced by social and community networks
and wider socio-economic aspects, the physical environment (food, water, home,
workplace, etc.), and cultural and environmental conditions. Social services, such as
health, education, or water and sanitation, are important, but overall, to be seen as
pieces in a much wider puzzle of factors that determine a persons’ or a group’s health.
Other prerequisites for health include, among other things, food, income, a stable
ecosystem, shelter, and social justice. The Health promotion concept encompasses

47
all these dimensions when acting on behalf of the health of people and
populations.

3.0 Study session summary and conclusion

In this session, we have seen health promotion as the process of enabling people to
increase control over, and to improve their health. This is in addition to understanding
the objectives, determinants and principles of health promotion. It was also noted that
health promotion also encompasses health education and policy making. Therefore,
we have set the base for the next session and I believe that you are now ready to study
health care. I also hope you enjoyed this study session. Now let us attempt the
questions below.

4.0 Self-Assessment Questions

1. Describe the WHO principle of health promotion.
2. Critically analyse how social mobilization is used in health promotion in your
locality

5.0 Additional Activities

Visit Youtube:

1. https://www.youtube.com/watch?v=G2quVLcJVBk

2. https://www.youtube.com/watch?v=4dDrqHtAW8U

3. https://www.youtube.com/watch?v=60UXj6XjZMM)

Watch the videos and summarise in three pages

6.0. References/Further
Watch the videos andReading
summarise in 3 pages
▪ Baum, F. (1998). The New Public Health: An Australian Perspective. Oxford
University Press: Melbourne

48
▪ Coulson, N. Goldstein, S. & Ntuli, A. (1998). Promoting Health in South Africa:
An Action Manual. Heinemann, Sandton.
▪ Ewles, L. & Simnett, I. (1995). Promoting Health: A Practical Guide. Third
Edition. London: Scutari Press.
▪ Naidoo, J. & Wills, J. (1994). Health Promotion: Foundations for Practice.
Bailliere Tindall.
▪ Tones, K. & Tilford, S. (2001). Health Education: Effectiveness, Efficiency and
Equity. Third edition. Cheltenham, UK: Nelson Thornes.
• Tones, B.K. (1986). Health education and the ideology of health promotion: a
review of alternative approaches. Health Education Research 1(1): 3-12.

39
 STUDY SESSION 2
Approaches to Health Promotion
Section and Subsection Headings:
Introduction
1.0 Study Session Learning Outcomes
2.0 Main Content
2.1 – Definition
2.2- Types of approaches to health promotion
3.0 Study summary and conclusion
4.0 Self-Assessment Questions
5.0 Other Activities
6.0 References/Further Reading

Introduction
You are welcome to study session 2, in the preceding session, we described the concept
of health promotion, the difference between health education and health promotion and
the principle of health promotion. In this session, we will build on the preceding session
by discussing extensively the approaches to health promotion. So seat tight and enjoy
your studies.

1.0 Study Session Learning Outcomes

After you have finished studying this session, you should be able to:
1. Describe approaches to health promotion
2. Describe the types of approaches.

40
2.0 Main Content
2.1 Approaches to Health Promotion
Diverse approaches to Health Education have emerged over the last century. These
approaches are not theories or
models but descriptions of the
practice of health promotion.
Ewles and Simnett
distinguish five approaches to
health promotion, each
necessitating the use of
different kinds of activities. Slideplayer.com

These approaches are: Figure 1.6: Approaches to Health Promotion

medical; behavioural change; educational; client-centred, and societal change (Figure
1.5).

2.1.1 Educational approach

Let us look at educational approach.
The aim of the education approach is to provide individuals with information,
ensure knowledge and understanding of health issues, and to enable well-informed
decisions to be made. Information about health is presented, and people are helped to
explore their values and attitudes and to make their own decisions. Help in carrying out
those decisions and adopting new health practices may also be offered. The educational
approach encourages individuals to make their own decisions and at the same time health
professionals will see it as their responsibility to raise with clients the health issues which
they think will be in the client’s best interests. The Educational Approach aims to
provide individuals with understanding and knowledge, facilitate a process of belief

41
and value clarification, and develop and practise the skills to make informed
decisions. A key component of this approach is the recognition given to the value of
voluntarism, i.e. that individuals should be free to make their own decisions, either now
or at some future time, about their choice of action.
This kind of approach would be suitable as a basis for running workshops where
individuals are or will be faced with having to make a choice. For example, the approach
could be used in the various stages of a smoking cessation program or in a dieting
program. It was also the Educational Approach which was used in South Africa to inform
health staff about their role in supporting the implementation of the Choice on
Termination of Pregnancy Act (Act 92 of 1996). This controversial Act was not well
received by all health workers and thus required a series of value clarification workshops.
Through such workshops, staff was able to express their personal reservations about
offering termination advice and were able to develop strategies for dealing with the
legislation

2.1.2 Behavioural change approach:

The behavioural change approach is based upon changing people’s individual attitudes
and behaviours so that they adopt a “healthy lifestyle”. Examples include teaching people
how to stop smoking, look after their teeth, eat the “right food”, and so on. In this
approach it is argued that a healthy lifestyle is in the best interest of individuals and
health professionals promoting this approach will see it as their responsibility to
encourage as many people as possible to adopt the healthy lifestyle they advocate.

2.1.3 Medical approach or preventive approach:

Let us discuss the medical approach.

42
The medical approach aims to enable people to be free from medically defined disease
and disability, such as infectious diseases, cancer and heart disease. The approach
involves medical interventions to prevent or ameliorate ill health. Possibly using a
persuasive paternalistic method, persuading for example middle age people to be
screened for high blood pressure. This approach values preventive medical procedures
and the medical profession’s responsibility to ensure that patients comply with
recommended procedures. Preventive approach aims to provide individuals with
knowledge, facilitate a change in attitude and, if successful, to galvanize the individual
into action or into the practice of preventive behaviours. The approach supports the use of
a variety of persuasive communication strategies, for example, mass media campaigns, or
individual educational sessions at a local clinic, to influence behaviour change.

In-text Question
4: List the approaches to health promotion

Answer: societal change approach, client based approach, educational approach,

medical approach and behavioural change approach

2.1.4 Client cantered approach:

Within the client centred approach, the health professional works with clients to help
them identify what they want to know about and take action on, and make their own
decisions and choices according to their own interests and values. The role of the health
professional is to act as a facilitator. They help people to identify their concerns and gain
the knowledge and skills they require making changes happen. Self-empowerment of the
client is seen as central. Clients are valued as equals. They have knowledge, skills and
abilities to contribute, and they have an absolute right to control their own health
destinies.

43
This approach supports the idea of providing individuals with an opportunity to critically
reflect upon their environment, as they acquire knowledge, to clarify their values and
develop skills. This enables them to maximise their chances of managing the
environmental constraints - constraints over which individuals might find it difficult to
exercise some degree of control, if they did not have adequate life skills.
This approach is very much a bottom-up approach and is like the process of community
development - with the health promoter as facilitator. An example of how this approach
might be used could be a health promoter working with teachers to develop programmes
aimed at building the self-esteem of young girls, so that they are able to actively
participate in their studies and to enter into relationships with greater self-confidence.

2.1.5 Societal change approach:

Rather than changing the behaviour of individuals, the societal change approach modifies
the physical and social environment in order to make it more conducive to good health.
Those using this approach will value their democratic right to change society, and will be
committed to putting health on the political agenda at all levels and to the importance of
shaping the health environment instead of shaping the individual lives of people who live
in it

3.0 Summary and Conclusion

In this session, we noted the different approaches to health promotion; defining what each
approach is about. In the end, these approaches are geared towards behavioural change,
societal change and policy making. We hope you enjoyed your studies. Now let us
attempt the questions below.

4.0 Self-Assessment Questions

44
1. Distinguish between educational approach and medical approach to health promotion

5.0 Additional Activities

a. Visit Youtube:

https://www.youtube.com/watch?v=XiI3tY200v0

and https://www.youtube.com/watch?v=VcC3lqR1FkQ

https://www.youtube.com/watch?v=y9THQTEqMaU

Watch the videos and summarise in 1 page.

6.0 References/Further Reading
▪ Baum, F. (1998). The New Public Health: An Australian Perspective. Oxford
University Press: Melbourne
▪ Coulson, N. Goldstein, S. & Ntuli, A. (1998). Promoting Health in South Africa: An
Action Manual. Heinemann, Sandton.
▪ Ewles, L. & Simnett, I. (1995). Promoting Health: A Practical Guide. Third Edition.
London: Scutari Press.
▪ Naidoo, J. & Wills, J. (1994). Health Promotion: Foundations for Practice. Bailliere
Tindall.
▪ Tones, K. & Tilford, S. (2001). Health Education: Effectiveness, Efficiency and
Equity. Third edition. Cheltenham, UK: Nelson Thornes.

45
 STUDY SESSION 3
Healthy Settings for Health Promotion
Section and Subsection Headings:
Introduction
1.0 Study Session Learning Outcomes
2.0 Main Content
2.1 – What is Health Settings?
2.2- Development of health settings
2.3- Types of health settings
3.0 Study session summary and conclusion
4.0 Self-Assessment Questions
5.0 Other Activities
6.0 References/Further Reading

Introduction
You are welcome to study session 3, previously we did studied the concept of health
promotion and the approaches to health promotion so far. It is important for you to note
that there are settings for health promotion and we will be looking at that briefly. Enjoy
the session

1.0 Study Session Learning Outcomes

After you have finished studying this session, you should be able to:
1. Describe health settings for health promotion
2. Explain the types of settings

46
2.0 Main Content
2.1 What is Health Setting?
Healthy Settings, the settings-based approaches to health promotion, involve a
holistic and multi-disciplinary method which integrates action across risk factors.
The goal is to maximize disease prevention via a "whole system" approach. The settings
approach has roots in the WHO Health for All strategy and, more specifically, the Ottawa
Charter for Health Promotion. Healthy
Settings key principles include
community participation, partnership,
empowerment and equity.
What is a setting?
A setting is where people actively use
and shape the environment; thus it is also
where people create or solve problems
relating to health. Settings can normally be Figure 1.7: Description of a healthy setting
identified as having physical boundaries, a range of people with defined roles, and an
organizational structure. Examples of settings include schools, work sites, hospitals,
villages and cities (Figure 1.7).
Action to promote health through different settings can take many forms. Actions often
involve some level of organizational development, including changes to the physical
environment or to the organizational structure, administration and management. Settings
can also be used to promote health as they are vehicles to reach individuals, to gain
access to services, and to synergistically bring together the interactions throughout the
wider community.

47
In summary, setting for health can be defined as the place or social context in which
people engage in daily activities in which environmental, organisational, and personal
factors interact to affect health and wellbeing (Health Promotion Glossary, 1998).

2.2 History of the Healthy Settings Movement

The Healthy Settings movement came out of the WHO strategy of Health for all in 1980.
The approach was more clearly laid out in the 1986 Ottawa Charter for Health
Promotion. These documents were important steps towards establishing the holistic and
multifaceted approach embodied by healthy Settings programs, as well as towards the
integration of health promotion and sustainable development.

In-text Question
What is setting?

Answer: A setting for health can be defined as the place or social context in
which people engage in daily activities in which environmental, organizational,
and personal factors interact to affect health and wellbeing

Building on the Ottawa Charter, the Sundsvall Statement of 1992 called for the creation
of supportive environments with a focus on settings for health. In 1997, the Jakarta
Declaration emphasized the value of settings for implementing comprehensive strategies
and providing an infrastructure for health promotion. Today, we observe that there are
various settings are used to facilitate the improvement of public health throughout the
world.

Development of Healthy Settings

Following the Ottawa Charter and Jakarta Declaration, healthy setting programs took off
predominantly in Europe and the Americas. The primary form of implementation has

48
been the Healthy Cities program; however, via pilot projects and expansion efforts, many
other Healthy Settings have been established throughout the two regions. Today, efforts
have been made in all WHO regions to expand the movement.

2.3 Types of Healthy Settings

Healthy Setting approaches have been implemented many different ways in multiple
areas. They are:
Healthy Cities
A healthy city is one that is continually creating
and improving those physical and social
environments and expanding those community
resources (Figure 1.8) which enable people to
mutually support each other in performing all the
functions of life and developing to their maximum
Figure 1.8: An example of a healthy city by WHO
potential (Health Promotion Glossary, 1998)
Healthy Cities are arguably the best-known and largest of the settings approaches. The
program is a long-term international development initiative that aims to place health high
on the agendas of decision makers and to promote comprehensive local strategies for
health protection and sustainable development. Basic features include community
participation and empowerment, intersectoral partnerships, and participant equity.

A Healthy City aims to:

• To create a health-supportive environment,
• To achieve a good quality of life,
• To provide basic sanitation & hygiene needs,
• To supply access to health care.

49
Being a Healthy City depends not on current health infrastructure, rather upon, a
commitment to improve a city's environs and a willingness to forge the necessary
connections in political, economic, and social arenas.
Today, thousands of cities worldwide are part of the Healthy Cities network and exist in
all WHO regions in more than 1,000 cities worldwide.
Evaluations of Healthy Cities programmes have proven them successful in increasing
understanding of health and environment linkages and in the creation of intersectoral
partnerships to ensure a sustainable, widespread programme. The most successful
Healthy Cities programmes maintain momentum from:
• The commitment of local community members;
• A clear vision;
• The ownership of policies;
• A wide array of stakeholders;
• A process for institutionalizing the programme.
Lack of programme permanence and other outcomes-related issues have developed with
little commitment from public officials or stability of local coordinators. Additionally,
many studies have identified that cities, particularly in developing countries, lack the
resources to develop good guidance to lead the project, via the development of health
profiles and sufficient evaluation time prior to starting.

Healthy Villages
The Healthy Villages program addresses similar
directives as the Healthy Cities program simply in
rural areas as opposed to urban areas. Health is
again defined by the area's residents (Figure 1.9); Figure 1.9: Healthy village

however, the generally accepted definition of a Source: The World Bank/Curt Carnemark/WHO

50
healthy village includes a community with low rates of infectious diseases, access to
basic healthcare services, and a stable, peaceful social environment.
Programs attempt to foster a holistic approach to health management through fostering
communication among community leaders and members. Communication throughout the
various social ranks of the village and a village health plan are necessary components of
all programs. Thus, the program is vulnerable to similar issues as the Healthy Cities
program, such as providing the necessary resources and maintaining momentum to
succeed.
In the WHO African Region, approximately 30 Healthy Villages have been set up.
Program initiatives continue to be established, often with the support of the recent
Healthy Villages publication to facilitate implementation.
In the WHO South-East Asia and Eastern Mediterranean Regions, initiatives have been
widespread and relatively successful at improving local awareness and improving health
and social conditions. For example, Egypt, Nepal, Pakistan, and Sudan have Healthy
Village initiatives. In addition, countries like Malaysia and Sri Lanka have adopted
policies, bringing the estimated number of Healthy Villages throughout the world in
between 50 to 100.

Health Promoting Schools

The Health Promoting Schools program may well
be the second most widespread settings-based
approach. The tenets of the program are to generate
awareness of the linkages between health and the
environment, to improve upon the school Figure 1.10: Health Promoting School

environment given these concepts, and to facilitate Source: The World Bank/John Isaac/WHO
the inclusion of best practices the wider community.

51
Our Health Promoting School program states that schools have various roles and
responsibilities in communities which go beyond simply imparting knowledge. Thus,
capitalizing on these roles to ensure the creation of a sustainable social health model
provides a benefit to the entire community. To meet Health Promoting School criteria,
the community must be committed to working for a healthy living, learning, and working
environment.
Similar to other Healthy Settings approaches, the Health Promoting Schools movement
relies heavily upon committed community members to maintain momentum and
accomplish lasting change. Health Promoting School program are flexible to allow
individual schools to address their most pressing needs. Trends have been identified
along the socio-economic platforms of communities, however, which enable the WHO
and associated regional networks to publish strategies for implementation and specific
interventions.
Evaluations of the Health Promoting Schools initiatives point out several strengths and
weaknesses of the programs. Overall, the most successful and sustainable programs
include:
• Total school support.
• Outside support, like that from local officials, NGOs, and community members,
and multi-sectoral partnerships.
• Long term planning.

Healthy Workplaces
With the global trend of increasing hours spent at the workplace over recent decades, the
importance of protecting and promoting health at the workplace is becoming pivot to a
fully functioning global economy. The program aims to improve public health conditions

52
and awareness through multi-sectoral cooperation and to directly involve the workers and
employers in introducing a health-promoting culture at the workplace.
Several fundamental principles underpin action on workers' health. First, the workplace
should not be detrimental to health and well-being. Second, priority should be given to
prevention of occupational health hazards over treatment and rehabilitation. Furthermore,
an integrated response to the specific health needs of working populations should
encompass all components of health systems and all representatives of the workplace
community.

Healthy Markets
The Healthy Food Markets and Healthy Marketplaces programs have emerged from the
umbrella of the Healthy Settings approach. The Markets programmes point to market
places as increasingly important venues for growing urban populations as a source of
goods and as a culturally significant gathering point for social interaction.
The Healthy Food Markets programme entails the provision of safe and nutritious food,
the promotion of food safety from production to consumption, and facilitation of
cooperation among suppliers, governments, and
consumers. A Healthy Food Market (Figure 1.11)
is one that seeks to protect health by eliminating
disease and other hazards at all places along the
farm-to-consumption continuum.

Figure 1.11: A healthy food market

Healthy Homes
The Healthy Homes programmes are not as well-established as other Healthy Settings
approaches. Healthy Homes programmes are often mentioned as part of broader Healthy

53
Cities initiatives or other health promotion agendas rather than specifically being referred
to.

Healthy Islands
This was first drafted by the Ministry of Health of Pacific Island Countries in 1995, the
Healthy Islands concept unifies efforts for health promotion and health protection in
island countries. It provides a framework within which health issues are analysed,
prioritized, and implemented in order to achieve a healthy state on the islands, as
reflected in the lives of children, adults and the aged.
Like other Healthy Settings programmes, the success of Healthy Islands initiatives is
strongly linked to community commitment and buy-in from health-related organizations
and institutions at the highest level.

Health Promoting Hospitals

We get to understand that the Health Promoting Hospitals (HPH) project and network
began in 1988 and 1993, respectively; we observe that this was to promote the total
quality management of hospitals. The project also aims at addressing the health of staff
and the link of the hospital to its community. The programme objectives are:
• To improve the inter-disciplinary nature and transparency of decision-making in
hospital care;
• To evaluate and compile evidence on healthy promotion activities in the health
care setting;
• To better incorporate health promotion into quality management systems at the
hospitals and nationally.

54
Health Promoting Prisons
The Health Promoting Prisons (HPP) project (also called the Health in Prisons Project,
HIPP) began in 1995 in the WHO EURO region, in view of the recognition of inequality
between public health and prison health.
Prisoners tend to have poorer health in comparison to the general public due to common
prison issues, like bullying, mobbing, and boredom. Prisons provide a unique opportunity
for accessing the hard-to-reach with important aspects of health promotion, health
education and disease prevention. The project's goal is to improve public health by
addressing health and health care in prisons.
The settings approach to promoting health in prisons draws on:
• Prison policies that promote health;
• A prison environment that is supportive of health;
• Health promotion initiatives specific to individual prisons.

Health Promoting Universities

Part of the wider movement for Healthy Settings, the Health Promoting University (HPU)
initiative was launched in 1995 by the University of Central Lancashire (UCLan), and
remains active today.
The HPU initiative aims to integrate
processes and structures within the
university's culture supportive of a
commitment to health and health
promotion (Figure 1.12).
Additionally, the initiatives promote
the health and well-being of staff,

Figure 1.12: A health Promoting University

students and the wider community.

55
Healthy Ageing
Ageing is a privilege and a societal achievement, while also a challenge presenting
imminent impact on all aspects of 21st century society. It is a challenge that cannot be
addressed by the public or private sectors in isolation; it requires joint approaches and
strategies. The main aims of Healthy Ageing initiatives include fostering policy advocacy
(e.g. encouraging age-friendly policies), promoting healthy lifestyles, and reducing health
risks and increasing quality of life.
WHO is running Healthy Ageing program that focus on different activities such as:
• Promoting active and healthy ageing, with special focus on physical activity and
nutrition;
• Training of primary health care workers in old age care;
• Assessing the effects of HIV/AIDS on older people in Africa and their ability to be
care providers;
• An initiative on prevention of elder abuse world-wide;
• Implementing ageing friendly standards.

In-text Question
9: List some healthy settings?

Answer: Healthy city, healthy village, healthy schools, healthy island

3.0 Study Session Summary and Conclusion

In this session, we discussed settings for health promotion. Setting is simply an organized
place that allows interaction. It could be an open or enclosed environment. Settings
approach is important in health promotion. We looked at the various types of settings and
how it is involved in health promotion. I hope you enjoyed the session. Now let us
attempt the questions below.

56
4.0 Self-Assessment Questions
1. Discuss the importance of settings in health promotion
2. Briefly describe healthy city as a setting for health promotion
3. Do you consider your city/village a healthy setting? Discuss

5.0 Other Activities

a. Visit Youtube: https://www.youtube.com/watch?v=IktJQPcTBFc and

https://www.youtube.com/watch?v=bDwGy7GUNmg

Watch the videos and summarise in 1 page.

6.0 References/Further Readin

Deschenes et al. (2003) Comprehensive approaches to school health promotion: how to
achieve broader implementation. Health Promotion International. 18(4): 387-396.
Rowling, L. (1996) The adaptability of the health promoting schools concept: A case
study from Australia. Health Education Research. 11(4): 519-526.
Burton J. (2006) Creating Healthy Workplaces. Industrial Accident Prevention
Association.
Chu et al. (2000) Health-promoting workplaces - International settings development.
Health Promotion international. 15(2): 155-167.
Galea G. et al. (2000) Healthy Islands in the Western Pacific - international settings
development. Health Promotion International. 15(2): 169.
Nutbeam, D. (1996) Healthy Islands - A truly ecological model of health promotion.
Health Promotion International. 11(4): 263.
Whitehead, D. (2004) The European Health Promoting Hospitals (HPH) project: How far
on? Health Promotion International. 19(2): 259.

57
Whitehead, D. (2005) Health Promoting Hospitals: The role and function of nursing.
Journal of Clinical Nursing. 4: 20.
https://www.who.int/healthy_settings/en/

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 STUDY SESSION 4
Health Promotion Theories and Models
Section and Subsection Headings:
Introduction
1.0 Study Session Learning Outcomes
2.0 Main Content
2.1 – The concept of Health promotion theory and models
2.2- Types of health theory and models
3.0 Study session summary and conclusion
4.0 Self-Assessment Questions
5.0 Other Activities
6.0 References/Further Reading

Introduction
You are welcome to study session 4, in the previous session, we studied the settings for
health promotion. As we have seen, there has been shift from individual focused health
education to community and environment based health promotion, hence, the need for
guiding theories and models. In this session, we will discuss some of these models and
how they are applied in health promotion. Enjoy the session.

1.0 Study Session Learning Outcomes

After you have finished studying this session, you should be able to:
1. Discuss the models and theories used in health promotion
2. Understand when to use the appropriate theory
3. Articulate how health promotion theory is important

59
2.0 Main Content
2.1 The Concept of Health Promotion Theory and Models
Theories provide a roadmap and step by step factors of what to consider when designing,
implementing and designing a health promotion program. Given the complexity of health
promotion practice, comprehensive interventions are needed to develop effective
program. Theories helps explain why thee intervention is necessary, how to intervene and
evaluate the success of intervention.
There are several theories and models that support the practice of health promotion and
disease prevention. Theories and models are used in program planning to understand and
explain health behaviour and to guide the identification, development, and
implementation of interventions.
When identifying a theory or model to guide health promotion or disease prevention
programs, it is important to consider a range of factors, such as the specific health
problem being addressed, the population(s) being served, and the contexts within which
the program is being implemented. Health promotion and disease prevention programs
typically draw from one or more theories or models.

2.2 Types of Theories and Models

It is important we examine various practical theories that are able to provide guidance to
practice, education and research. Selected theories and models that are used for health
promotion and disease prevention programs include:
2.2.1 Ecological Model
Ecological model presents health as an interaction between the person and their
ecosystem which include their family, community, culture and physical environment.
This interaction contributes to both health and illness
Ecological models recognize multiple levels of influence on health behaviours, including:

60
 • Intrapersonal/individual factors, which influence behaviour such as knowledge,
attitudes, beliefs, and personality.
• Interpersonal factors, such as interactions with other people, which can provide
social support or create barriers to interpersonal growth that promotes healthy
behaviour.
• Institutional and organizational factors, including the rules, regulations,
policies, and informal structures that constrain or promote healthy behaviours.
• Community factors, such as formal or informal social norms that exist among
individuals, groups, or organizations, can limit or enhance healthy behaviours.
• Public policy factors, including local, state, and federal policies and laws that
regulate or support health actions and practices for disease prevention including
early detection, control, and management.
Example of the ecological model is the CDC's Colorectal Cancer Control Program
(CRCCP) . It was designed to address multiple factors of influence on colorectal
cancer prevention, using ecological model components.
The ecological perspective is a useful framework for understanding the range of factors
that influence health and wellbeing. It is a model that can assist in providing a complete
perspective of the factors that affect specific health behaviours, including the social
determinants of health. Because of this, ecological frameworks can be used to integrate
components of other theories and models,
thus ensuring the design of a comprehensive
health promotion or disease prevention
program or policy approach.

2.2.2 The Health Belief Model

The Health Belief Model is a theoretical

61
model that can be used to guide health promotion and disease prevention programs. It is
one of the earliest and most influential models developed by Irwin Rosenstock in 1966. It
is used to explain and predict individual changes in health behaviours. It is one of the
most widely used models for understanding health behaviours.
Key elements of the Health Belief Model focus on individual beliefs about health
conditions, which predict individual health-related behaviours as captured in Figure 1.13.
The model defines the key factors that influence health behaviours as an individual's
perceived threat to sickness or disease (perceived susceptibility), belief of consequence
(perceived severity), potential positive benefits of action (perceived benefits), perceived
barriers to action, exposure to factors that prompt action (cues to action), and confidence
in ability to succeed (self-efficacy).
Example of health belief model is the Michigan Model for Health. The curriculum is
designed for implementation in schools. It targets social and emotional health challenges
including nutrition, physical activity, alcohol and drug use, safety, and personal health,
among other topics.
The Health Belief Model can be used to design short- and long-term interventions. The
five key action-related components that determine the ability of the Health Belief Model
to identify key decision-making points that influence health behaviours are:
• Gathering information by conducting a health needs assessments and other efforts
to determine who is at risk and the population(s) that should be targeted.
• Conveying the consequences of the health issues associated with risk behaviours in
a clear and unambiguous fashion to understand perceived severity.
• Communicating to the target population the steps that are involved in taking the
recommended action and highlighting the benefits to action.
• Providing assistance in identifying and reducing barriers to action.

62
 • Demonstrating actions through skill development activities and providing support
that enhances self-efficacy and the likelihood of successful behaviour changes.

In-text Question 9: What are the key elements of health belief model?

Answer: self-efficacy, perceived susceptibility, perceived severity, perceived

benefits and cues to action

2.2.3 Stages of Change Model (Transtheoretical Model)

The Stages of Change Model is also called the Transtheoretical Model. It explains an
individual's readiness to change their behaviour considering concepts like self -
efficacy, change process and decision criteria. It describes the process of behaviour
change as occurring in stages. These stages include:
• Pre-contemplation: There is no intention of taking action.
• Contemplation: There are intentions to take action and a plan to do so in the near
future.
• Preparation: There is intention to take action and some steps have been taken.
• Action: Behaviour has been changed for a short period of time.
• Maintenance: Behaviour has been changed and continues to be maintained for the
long-term.
• Termination: There is no desire to return to prior negative behaviours.
The Stages of Change Model describes how
an individual or organization integrates new
behaviours, goals, and programs at
various levels. At each stage, different
intervention strategies will help
individuals progress to the next stage and
through the model. Individuals within a
Figure 1.14: Stages of change models

63
population will likely vary in their readiness to change. In addition, it is important to
recognize that movement through this model is cyclical individuals may progress to the
next stage or regress to a previous stage.
The Stages of Change model can be applied to health promotion and disease prevention
programs to address a range of health behaviours, populations, and settings. It may be an
appropriate model for health promotion and disease prevention programs related to
worksite wellness, tobacco use, weight management, medication compliance, addiction,
and physical activity, among other health topics.

2.2.4 Social Cognitive Theory

What do you understand by Social Cognitive Theory (SCT)? SCT is also known as
Social Learning Theory (SLT) developed by Bandura in 1989. The theory is based on
learning and describes the influence of individual experiences, the actions of others,
and environmental factors on individual health behaviours. The theory suggests that
people learn by noticing the benefits of actions that they observe people performing
(Bandura, 1989). SCT provides opportunities for social support through instilling
expectations, self-efficacy, and using observational learning and other reinforcements to
achieve behaviour change.
Key components of the SCT (Figure 1.14) related to individual behaviour change
include:
• Self-efficacy: The belief that an individual has control over and is able to execute a
behaviour that is, confidence in one’s ability to take action.
• Behavioural capability: Understanding and having the skill to perform behaviour.
• Expectations: Determining the outcomes of behaviour change.
• Expectancies: Assigning a value to the outcomes of behaviour change.
• Self-control: Regulating and monitoring individual behaviour.

64
 • Observational learning: Watching and observing outcomes of others performing
or modelling the desired behaviour.
• Reinforcements: Promoting incentives and rewards that encourage behaviour
change.
Example of this theory is the Healthy Relationships program implemented by
Chattanooga CARES. It is a small-group intervention for people living with
HIV/AIDS. The program is based on the Social Cognitive Theory and uses skill-
building exercises to increase independence and develop healthy behaviours among
participants.
The SCT can be applied as a theoretical framework in different settings and populations.
It is frequently used to guide behaviour change interventions. It may be particularly
useful in rural communities for
examining how individuals interact with
their surroundings. The SCT can be used
to understand the influence of social
determinants of health and a person's past
experiences on behaviour change.

Figure 1.14: The Social Cognitive Model

2.2.5 Theory of Reasoned Action/Planned Behaviour
Two closely associated theories: The Theory of Reasoned Action and the Theory of
Planned Behaviour suggest that a person's health behaviour is determined by their
intention to perform behaviour. According to this theory, three factors influence intent:
1) A person's attitude toward the behaviour.
2) Subjective norms regarding the behaviour.
3) The degree of the perceived behavioural control.

65
Subjective norms are the result of social and environmental surroundings and a person's
perceived control over the behaviour. Generally, positive attitude and positive subjective
norms result in greater perceived control and increase the likelihood of intentions
governing changes in behaviour.
Example is the SIPsmartER a health promotion program implemented in rural southwest
Virginia. The goal of the program is to decrease sugar-sweetened beverage consumption
among adults. The intervention strategy is based on the Theory of Planned Behaviour and
includes education through small-group classes and teaches back methods.
The Theory of Reasoned Action/Planned Behaviour provides useful information for
predicting health behaviours and for planning and implementing health promotion and
disease prevention programs. Subjective norms can be used to describe the behaviours of
healthcare providers, patients, care providers, and others in the community. These
theories have been used to guide health promotion and disease prevention asthma
counselling and treatment compliant, tobacco use interventions, and anti-drug media
campaigns, among other topics.

In-text Question
10: State which theory is based on a person’s intent

Answer: The theory of reasoned action/planned behaviour

3.0 Conclusion
In this session, theory for health promotion is seen as an important factor in health
promotion intervention. Considering the complexities of interventions, a road map is
needed in the form of theory and models to guide and help bring about successful
intervention programs. I hope you can choose appropriate model or even design your
model to achieve a successful health promotion campaign. I hope you enjoyed your
studies. Now let us attempt the questions below.

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4.0 Self-Assessment Question
1. Which is your favourite theory? Why is it your favourite?
2. Which theory is likely to be of value in facilitating the promotion of health at
community level? Give reasons
3. Think of a health related behaviour you would like to change and discuss the best
model you would use to implement that change

5.0 Additional Activities

a. Visit Youtube: https://www.youtube.com/watch?v=rNlz8zCxnTE

https://www.youtube.com/watch?v=OexKKEUIgSU and
https://www.youtube.com/watch?v=sNV7FrrlGs4. Watch the videos and
summarise in 3 page.

6.0 References/Further Reading

B. Raingruber. Health promotion theories. Jones and Barltlett learning LLC
A. Bandura. (1989). Social cognitive theory. In R.vasta (Ed). Annals of child
development. Vol 6. Six theories of child development (pp.1-60).
Milio, N. (1988). Making Health Public Policy: developing the science by learning the
art: an ecological framework for policy studies. Health Promotion. 2(3): 263-
74.
https://www.ruralhealthinfo.org/toolkits/health-promotion/2/theories-and-models
https://rcni.com/hosted-content/rcn/first-steps/stages-of-change-model

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 MODULE 2
Critical Practice and Perspectives in Health Promotion
Contents
Study Session 1: Training
Study Session 1: Practices and methods of health promotion I
Study Session 2: Practices and methods of health promotion II
Study Session 3: Ethical issues in health promotion

Introduction:
In the first module, you explored a number of issues and perspectives which have
influenced the way we understand the field of Health Promotion. We discussed the
concept of health promotion, approaches and health promotion settings. This module
builds on the first module where we will have a deeper and more direct look at training,
practices, methods and ethical issues in health promotion.

STUDY SESSION 1
Training
Section and Subsection Headings:
Introduction
1.0 Study Session Learning Outcomes
2.0 Main Content
2.1 – What is Training?
2.2- Phases of Training
2.3- Choosing Training Methods
3.0 Study session summary and conclusion

68
4.0 Self-Assessment Questions
5.0 Other Activities
6.0 References/Further Reading

Introduction
You are welcome to study module 2 of this course, in this session, we will explore
training as part of health promotion activities. We will see training approaches that are
relevant to health educator roles and activities. In the context of the professional role of
health educator, training is of vital importance. The health educator has to play the role of
trainer for training various categories of health personnel and other development workers.

1.0 Study Session Learning Outcomes

After you have finished studying this session, you should be able to:
1. Describe what training is
2. Discuss types and phases of training
3. Explore the methods of training
4. Discuss evaluation of training process

2.0 Main Content

2.1 What is Training?
Training is the process of education in which
both the mind and body are brought under
exercise and discipline (Figure 2.1). It is the
act of acquiring necessary qualification or
occupation or feat of physical skill or
endurance. Figure 2.1: Depiction of a training event

Source: Highlandohservices.co.uk

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Types of training
• Pre-service: involves the preparation in general of any trainee for qualifying for a
certain set of professional or specific job oriented roles.
• Orientation training: refers to a preparation for the specific job to be performed in a
particular position.
• In service training: It is a refresher course given with a view of updating knowledge and
skills of the workers in any department or organization.

In-text Question 11: list the types of training.

Answer: pre-service, orientation training and in service training

2.2 Phases of Training

• Preparation (pre-training) phase
• Training phase
• Post-training (follow-up component)
a. Preparation phase
This phase involves several activities to be carried out.
• Conducting training need assessment. This is to ask whether there is a need gap for a
certain kind of health workers to carry out some work
• Identify aims of the training program.
• State needs or problems that are expected to be solved
• Identification of the trainees. Recruiting and selecting learners is the single most
important step in any training program.
This is because the problems to be solved primarily rests on their attitude and behaviour
when they are deployed for services. Quite often recruitment of community health
workers is effected through political leaders.

70
Therefore, the community members must have an important part in choosing who is
going to be trained.
• Know who the learners are. Their educational and training background experiences they
have with this problem, topic or subject, their interests, and their social and cultural
background.
• Identify resources available- time, equipment, space, trainers and written materials
including books, handouts
• Determine the four important areas (domains) of learning going to be changed
(knowledge, belief, attitude and skill)
• Determine the teaching methods to be used depending on the targeted domain of
learning.
• Arrange living condition of the trainees and facilitators (food, lodging, transportation,
recreation, financial support).
• Determine how the learners and the program be evaluated.
This may include pre-test and post-test, feedback from the trainees at the end, follow-up
for the graduates.

2.3 Choosing Training Methods

Some of the important questions to ask ourselves to determine the type of methods to use
are:
• What are the learning objectives? Is it to influence or change thinking, believing,
feeling or doing?
• Who are the learners? It is important for you to note the educational, cultural,
motivational, future role, experience status of the learners.

71
• How much time do we have? Noting
the time available for the training is
necessary
• What other resources are
available?
• How can active involvement by the
participants be made certain?

Figure 2.2: Components of a training

After ascertaining the questions above, the following methods or combinations of them
can be used in training.
• Lecturing the most common and easiest method but the least efficient especially in
addressing how to do a job.
• Lecture and discussion: this is more of an interactive session and highly effective
method. This involves asking of questions and encourages participation. It gives more
opportunity to learn.
• Provision of textbooks /handouts.
• Learner presentations
• Demonstrations: this is an essential tool of training in task learning
• Audio-visual support: it involves the use of flipcharts, posters, slides, models.

b. Training Phase
In the actual training phase, training curriculum is to be followed and the necessary
arrangement has to be made for concurrent monitoring and evaluation. The training
curriculum should be modified now and then by making mid-course correction and
change to suit the objectives and needs. The training phase must ensure the opportunities

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for learning by doing and also creating necessary climate or environment in which
learning can take place effectively.

c. Evaluation of Training
Evaluation is a process of determining the degree or amount of success with pre-
determined objective.

Steps for evaluation

• Input evaluation- examines what resources were used based on which we can calculate
the cost per graduate-efficiency.
• Process evaluation- looks at what methods are used; see how trainees are progressing,
training run as per the schedule…

• Output evaluation- reviews the quality and numbers of people trained to see if they meet
standards and the targets or objectives set during the planning process. This includes the
knowledge and skill tests.

• Outcome/Impact evaluation- examines what the results or effects the graduates have
achieved in the work they are trained for. This is performed using field assessment
through observations and surveys.

In-text Question 12: State the objective of output evaluation in training process
Answer: It reviews the quality and numbers of people trained to see if they meet
standards and the targets or objectives set during the planning process

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3.0 Study Session Summary and Conclusion
In this session, you did studied training as a process in health promotion. You also looked
at the types and phases of training. I believe that you are now ready to look at other
process and methods in health promotion activities. We hope you enjoyed your studies.
Now, it is time to assess ourselves by attempt the answer the question below.

4.0 Self-Assessment Question

1. List down the types and phases of training.
2. What are the steps to follow in the evaluation of training?

5.0 Additional Activities

a. Visit YouTube https://www.youtube.com/watch?v=Xy5bWhGcEmA

Watch the videos and summarise in 1 page.
b. Visit a primary health care centre in your community and write a
comprehensive report on how they train health personnel

6.0 References/Further Reading

Getnet Mitike. Health Education for Health Science students, Addis Ababa University,
Department of Community Health, January2003.
Challi Jira, Amsalu Feleke, Getnet Mitike. Health service management for Health science
students, Jimma University, Faculty of public Health, 2003 January.
Randall R. Cottrell, James T. Girvan and James F. McKenzie. Principles and foundations
of Health Promotion and Education. Publishers: Allyn and Bacon, 1999.

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 STUDY SESSION 2
Practices and Methods of Health Promotion I
Section and Subsection Headings:
Introduction
1.0 Study Session Learning Outcomes
2.0 Main Content
2.1 – Planning health promotion program
2.2- Selecting teaching methods for health promotion
2.3- Implementation of health promotional activities
3.0 Study session summary and conclusion
4.0 Self-Assessment Questions
5.0 Other Activities
6.0 References/Further Reading

Introduction
You are welcome to study session, in your previous session, you were made familiar with
training as an aspect of health promotion. This session builds on the previous one where
we will explore the planning of health promotion activities proper.

1.0 Study Session Learning Outcomes

After you have finished studying this session, you should be able to:
1. Develop a plan for the health promotional program for the community
2. Identify the community needs
3. List the target groups in the community for promotional activities
4. Describe the methods of mobilizing resources for promotional activities.
5. Select appropriate health promotion tool

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6. Implement health promotion plans

2.0 Main Content

2.1 Planning Health Promotional Program for the Community
Planning is the process of determining in advance what one wishes to accomplish in
a program or activity. Planning allows for proper organisation, implementation and
evaluation of a health education
program. Planning a health education
program is like planning a journey. In
planning a journey, you know where
you are and have to decide where to
go. Then you must decide the best way of
getting to your destination. This is
essential for health education.
Figure 2.3: Steps in planning health promotion programmes

Source: Henk Van Stokkom

The four basic steps to effective planning of health promotional program are:
• Establishment of the main objective,
• Collection of information required,
• Development and implementation of the program and evaluation.
We shall discuss each of the steps one after the other

2.1.1 Establishment of the main objective

The health problem to be planned for is first identified according to its community health
importance and economic consequences. The objectives are clearly stated before
undertaking the health education program. These include the following:

76
 • Identification of the learning needs
• Setting learning (educational) objectives.

Identification of the learning needs

Learning needs comprises of the knowledge, attitudes and skills required by an individual
learner or the community to enable him or her or the community maintain or deal with
the health problems. For example; to correct the ideas and perceptions of the people;
what specific information the community or individual should be given; what they feel
and do about health problem; what specific attitude to be developed; and what actions of
the people are desired either as individual family community group. The learning need of
individual must be related to the disease or illness. There are two approaches to the
learning needs of the community and that of the individual.

Setting learning (educational) objectives

This is the statement of the outcome to be achieved by the learner at the end of the
learning session. It guides the health practitioner to the content, the right methods to use
and sets a standard for assessing the achievement during evaluation. The learner should
be aware of what he/she should achieve at the beginning of the learning session. It directs
the learner to focus on the exact knowledge, attitude and skills he/she is expected to
acquire during the health promotion session. A properly written objective should be
learner-oriented, observable, measurable, (behaviour) attainable (achievable), within the
available time and resources.

2.1.2 Collection of Information Required

This involves the collection of information about the health problem to be addressed and
information about the community.

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About the Health Problem
All relevant information regarding the problem should be collected this is done through
listening to their problems and complaints through history taking, physical examination,
observation and laboratory investigations in the health facilities. Enquiry and collection
of data on vital and social statistics of the disease (problem), age-groups involved or
affected, types of health facilities available and potential ones for the future and the level
of acceptance of the health program in the community. All these information are obtained
and collected through situation analysis. These methods bring into focus the learning
needs for planning an effective health education program.

About the community

This includes information on the administrative and social structure of the community
such as knowledge and understanding of the people about the problem, their
misconception, beliefs and superstition, local customs, culture and habits that have a
bearing on the problems, channels of communication, communication barriers and other
social program operating in the area and the attitude of people towards these program and
availability of resources. These determinants of health could be identified through
community diagnosis.

In-text Question
12: List the steps in planning a health promotion program

Answer: Establishment of the main objective, collection of information, development,

implementation of program

Development and implementation of the program

This includes the following:

78
 • Selecting topics for the health education session and master plan
• Identifying contents of session plans
• Selecting teaching methods for the health session
• Selecting teaching aids for the health session

In addition to the points discussed so far, it is also important to consider the below for
proper planning and implementation

Identifying the Health Issues in the Community

In order to start planning you need to identify the health issues in the community. Your
findings will help you to:
• Get more information to share with community members and help to
explain why the project is needed
• Get funding and other resources you will need to run your project
• Find out more about the problem
• Work out what you want to do to address the problem
• When talking to people about health issues, remember:
• Tell people what will happen with the information they give you
• Treat personal information as confidential unless you have the
person‘s written permission to share it
• Don‘t use names or other information that could identify people with
a story or comment
• If you take notes while talking to a person show them or read them
back to check that they agree with what you have written. If they are
not happy or want to change anything, let them do this.
• Have respect for what people say at all times.

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The target group(s) in the community
In any activity to be carried out in any community, you must know first and foremost
that, you have to work hard to improve the health and wellbeing of your community. It is
very important to take time to make sure you are clear about who you want to listen to
your health promotion messages. In determining who your target audience(s) is, you
should answer these questions:
• Who will benefit most from the health messages? (primary target
audience)
• Who can influence these people? (secondary target audience)
With projects aimed at children‘s health, parents or care giver will often be the primary
target audience because they make decisions that affect children‘s health. However, it
will depend on the age of the children and the health issue you are trying to tackle.
Once you have identified your target audiences, you need to find out more about them.
The more you understand about the people you are targeting, the more likely it is that
your project will succeed.

Having established the basic in terms of who is to be involved, you should probe further
on the following:
• Their sexes and lifestyle
• Their ages?
• Where do they live?
• How many of them are there?
• Who can influence their behaviour (family, Elders, health workers)?
• Their knowledge about the health issue to be promoted?
• Their beliefs, attitudes and behaviours about the health issue?
• What things might help them to change their behaviour?

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 • What things might stop them from changing their behaviour

In-text Question 13: List the basic information to collect to know your target
audience in a health promotion campaign
Answer: sex, age, total number, influences, beliefs, behaviours

The Resources Required for Health Promotional Activities

Most people need support to develop and run projects. You will work out what resources
you will need for your project. These resources are people, materials, equipment and
products. You also need to think about which resources you will have to pay for and
which resources you can get for free.

2.2 Selecting Teaching Methods for Health Promotion

Remember health education is an integral part of health promotion. You will learn about
teaching methods as well as some of the teaching materials you will be using in health
promotion. Teaching methods refers to ways through which health messages are used to
help solve problems related to health behaviours. Teaching materials or aids are used to
help you and support the communication process in order to bring about desired health
changes in the audience.

“You may” is often the most natural way of

communicating with people to share health
knowledge and facts. In the part of your job
that involves health education; there will
always be consider that the best way of Figure 2.4: A typical health talk Source: Cehjournaorg

communicating your health messages in certain situations is by using health talks. Group

81
size is also important. The number of people who you are able to engage in a health talk
depends on the group size. However, you will find talks are most effective if conducted
with small gatherings (5–10 people), because the larger the group the less chance that
each person has to participate. Talking to a person who has come for help is much like
giving advice. But as you will see, advice is not the same as health education. To make a
talk educational rather than just a chat you will find it beneficial if it is combined with
other methods, especially visual aids, such as posters or audiovisual material. Also a talk
can be tied into the local setting by the use of proverbs and local stories that carry a
positive health message.

Lecture
You may have the opportunity to give a lecture, perhaps in your local school (Figure 2.5)
or in another formal setting. A lecture is
usually a spoken, simple, quick and traditional
way of presenting your subject matter, but
there are strengths and limitations to this
approach. The strengths include the efficient
introduction of factual material in a direct and
logical manner. However, this method is Figure 2.5: A lecture demonstration

generally ineffective where the audience is passive and learning is difficult to gauge.
Experts are not always good teachers and communication in a lecture may be one-way
with no feedback from the audience. However there are also strengths and limitations to
this approach. It is always useful to involve your audience after the lecture in asking
questions, seeking clarification and challenging and reflecting on the subject matter. It’s
important though to make sure discussion does happen and not just points of clarification.

82
Group Discussion: This involves the free flow of communication between a facilitator
and two or more participants. Often a discussion of this type is used after a slide show or
following a more formal presentation. This type of teaching method is characterised by
participants having an equal chance to talk freely and exchange ideas with each other. In
most group discussions the subject of the discussion can be taken up and shared equally
by all the members of the group. In the best group discussions, collective thinking
processes can be used to solve problems. These discussions often develop a common goal
and are useful in collective planning and implementation of health plans. Group
discussions do not always go smoothly and sometimes a
few people dominate the discussion and do not allow others
to join in. Your job as the facilitator is to establish ground
rules and use strategies to prevent this from happening.
Demonstration
In your work as a health educator you will often find
Figure 2.6: A typical group discussion
yourself giving a demonstration (Figure 2.6). This form of
health education is based on learning through observation.
There is a difference between knowing how to do
something and actually being able to do it. The aim of a
demonstration is to help learners become able to do the
skills themselves, not just know how to do them.
Role play
In role play, some of the participants take the roles of Figure 2.7: A typical demonstration

other people and act accordingly. Role play is usually a spontaneous or unrehearsed
acting out of real-life situations where others watch and learn by seeing and discussing
how people might behave in certain situations. Learning takes place through active
experience; it is not passive. The purpose of role play is that it is acting out real-life

83
situations in order that people can better understand their problems and the behaviour
associated with the problem.
Health Learning Materials: these are those teaching aids that give information and
instruction about health specifically directed to a clearly defined group or audience. The
health learning materials that can be used in health education and promotion are usually
broadly classified into four categories: printed materials, visual materials, audio and
audio-visual materials.
In-text Question 14: State the purpose of role play as a mode of teaching in health
programs
Answer: role play acts out real life situation as such the people can relate and thus,
creates better understanding of the problem

2.3 Implementation of Health Promotional Activities

Implementation involves the field work itself. It entails the use of health practitioners,
and community mobilisation. This emphasises the skills needed and an understanding of
concepts required to enable you to mobilise a community and promote community
participation.

2.3.1 Types of Health Teams

In the health team, there are many
professionals, each expected to play his/her
role for the ultimate purpose of providing
optimal health care. The team is made up
of the following:
• Medical doctors
• Nurses and Midwives Figure 2.8 A typical health team Source: Ohsu.edu

84
 • Pharmacists
• Community Health Practitioners
• Environmental Health Officers
• Laboratory Technologist and Technicians
• Radiologists and Radiographers
• Health Records
The role of each category of health worker is well explained by the nature of the work
they do. The team members are also found in all the three levels of health care namely
primary, secondary and tertiary. The expectation is that if the practitioners work as a team
(whether at primary, secondary or tertiary level), the recipients of the health care across
the three levels will be happily served.
However, it is worth mentioning here that, the primary level provides preventive care; the
secondary level provides curative care while the tertiary level engages in referral services
from the primary and secondary levels, training of manpower and research.

In-text Question 15: list some health practitioners involved in health promotion

Answer: Nurses, doctors, technicians, radiologist

2.3.2 Community Mobilisation

Principles of Community Mobilization
● Social change is more sustainable if the individuals and communities most affected
own the process and content of behaviour-centred approaches;
● Communication for social change should be an empowering, horizontal (versus top-
down) approach;
● Community Mobilization should give voice to the previously unheard members of the
community and be centred on local content and ownership;
● Parents, families, and communities should be the agents of change;

85
● Emphasis should shift from persuasion and the transmission of information from
outside technical experts to support for dialogue, debate, and negotiation on issues that
resonate with members of the community;
● Emphasis on outcomes should shift from only focusing on individual behaviour to a
greater emphasis on social norms, policies, culture, and the supporting environment

Steps in Community Mobilization

1. Identifying Key Issues and Analysing Determinants- the first step is a
situational analysis examining the factors that would draw out pertinent issues to
be addressed through the intervention. Background research like epidemiological
analysis, a policy analysis and a behavioural analysis to identify the barriers for
adopting the desired behaviours, as well as factors that favour change (Figure 2.9).
2. Selecting Target Groups- The members of a community can be divided into
specific groups, or segments of participants, for a community out-reach
programme based on information
made available. This can be based
on their demographics, lifestyle,
traditional beliefs and practices.
3. Establishing
Figure 2.9 Components of community mobilization Existing Levels of Knowledge,
Ohsu.edu
Attitudes, and Practices- Health
promotion activities are concerned
with eliciting specific behaviour changes in what they know (knowledge of
nutrition and health, food beliefs and superstitions, taboos and misconceptions);
what they feel (attitudes, values, and preferences for certain foods and food
preparation and child-feeding practices); and what they do (food habits, food

86
 preparation practices, customs and traditions, child-feeding practices, cropping
system, etc.).
4. Setting Communication Objectives- Setting communication objectives is an
important step in planning nutrition education and communication programmes.
The foremost consideration is that the participants, the planners, and the message
and media developers, define together the specific outcomes expected over a given
period. There must be agreement among the participants on the problem to be
addressed, the need for change, the need to take action to prevent or reduce the
problem, the strategy by which the change can take place, and the indicators by
which such change could be recognized (Valdecanas, 1991).
5. Developing and Pre-Testing Messages and Materials- With adequate
background information about the target groups and properly defined objectives,
the next step is to develop a socially and culturally appropriate communication
strategy, consisting of approaches, messages, and methods. Approaches chosen are
those appropriate for each group. These could be a combination of any of the
following: individual, group, or mass approaches using information,
education/training, motivation, entertainment or advocacy. Messages vary
according to the kinds of behaviour-change specified in the objectives, the
available resources and services, technologies, other relevant information,
participant needs, and method of delivery. In order that each approach be used,
activities must be defined according to the programme objectives. Appropriate
messages, media, and methods should be designed and pre-tested according to the
audience's abilities, resources, and preferences.
6. Mobilizing Social Support and Community Participation- Social mobilisation
serves as the strategy for motivating mothers, children, families, groups, and
communities to become active participants in meeting their food, nutrition, and

87
 health needs. It provides the framework for action that links up various sectors at
all levels in making available all possible means and resources toward improving
the nutritional and health status of women and children (UNICEF, 1995). The five
components of social mobilisation can, in turn, enhance the positive contribution of
the above five factors. These five components are: (i) advocacy; (ii) Information,
Education, Communication (IEC); (iii) community organising; (iv) training; and
(v) monitoring and evaluation.
7. Strengthening Community Action and Participation- It is a multi-directional
process which can cause a synergism among the target groups, field-workers,
implementers, and local leaders, toward participation, empowerment, and
sustainable development interventions (Figure 2.9). Participation happens when
people concerned are committed to organise themselves so that they can
collectively get involved in making decisions about various economic, social,
spiritual, environmental, and political spheres of community life. Participation
helps them realise a true sense of empowerment when they are in control of their
talents, time, resources, and achievements that in turn ensures the sustainability of
their initiatives (Stuart, 1994).

3.0 Study Session Summary and Conclusion

The value of health promotion and intervention programs to improve health and
reduce illness has been amply demonstrated in this unit. However, to improve the
health of the greatest number of individuals, the expertise of others who are invested
in advancing our ability to promote health and prevent illness is needed. Their
involvement, as well as that of the targets of our research, will necessarily contribute
to our understanding the most effective ways to initiate and sustain health behaviour
change. Identifying the health needs of the community, the target group and resources

88
 required for any health program are necessary to achieving good success in providing
promotional activity at all levels of health care.

4.0 Self-Assessment Question

1. What are the reasons for setting health promotional objectives?
2. List the four basic steps of developing a health promotion plan?

5.0 Additional Activities

a. Visit Youtube: https://www.youtube.com/watch?v=8-aRZksVmaA

Watch the videos and summarise in 1 page.

b. write a comprehensive report on how you would plan a hand washing
intervention

6.0 References/Further Reading

Collins, Mattie. (1983): Communication in Health-care. The Human Connection in Life
Cycle. Toronto C.V. Mosby Company; 1983.
Gbefwi NB (2004): Health Education and Communication Strategies: A practical
approach for Community-based health practitioners and rural health workers.
West African Book Publishers Ltd. Ilupeju
Ottawa Charter for Health Promotion WHO, 1986
Wole Alakija, (2000) Essentials of Community health care and health management.
Benin, Nigeria Medisuccess Publication

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 STUDY SESSION 3
Practices and Methods of Health Promotion II
Section and Subsection Headings:
Introduction
1.0 Study Session Learning Outcomes
2.0 Main Content
2.1 – What is evaluation and monitoring?
2.2- Evaluation of health promotional activities
2.3- Elements of evaluation process
3.0 Study session summary and conclusion
4.0 Self-Assessment Questions
5.0 Other Activities
6.0 References/Further Reading

Introduction
You are welcome to study session 3, in the previous session, we discussed planning of
health promotion activities, selecting the right mode of education, community
mobilization and implementation of health promotional activities. In this session, we
build on the last session. We will explore the evaluation of health promotional activities
and feedback mechanism of health promotional activities.

1.0 Study Session Learning Outcomes

After you have finished studying this session, you should be able to:
1. Describe the concept of evaluation
2. Describe the importance of evaluation

90
2.0 Main Content
2.1 What is Evaluation and Monitoring?
The definition and importance of monitoring as a prelude to evaluation; the evaluation of
health promotional activities and the elements of evaluation process will be discussed
will be discussed.
Monitoring is defined as the day-to-day follow-up of activities during their
implementation stage, to ensure that they are proceeding as planned and are on schedule.
It is a continuous process of observing, recording, and reporting on the activities of the
organization or project. Monitoring, thus, consists of keeping track of the course of
activities and identifying deviations and taking corrective action if deviations occur.
Monitoring is "the performance and analysis of routine measurements aimed at detecting
changes in the environment or health status of population". Thus we have monitoring of
an air pollution, water quality, growth and nutritional status of children etc. It also refers
to the measurement of performance of an ongoing health service or a health professional,
or of the extent to which patients comply with or adhere to advice from health
professionals.
Monitoring refers to the continuous overseeing of activities to ensure that they are
proceeding according to plan. It keeps track of
performance of health staff, utilization of
supplies and equipment, and the money spent
in relation to the resources available so that if
anything goes wrong immediate corrective
measures can be taken.

2.1.1 What is Evaluation?

Evaluation is the process of looking back over

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what has been done to be sure that things were done the way they should. Evaluation is
the process by which results are compared with the intended objectives, or more simply
the assessment of how well a program is performing. Evaluation should always be
considered during the planning and implementation stages of a program or activity.
Evaluation may be crucial in identifying the health benefits derived (impact on morbidity,
mortality, squelae, patient satisfaction). Evaluation is not a one-time event. It is a
continuous process how the program is progressing according to a set time table in the
action plan. Information for evaluation program would be obtained from observations,
interviews, and records.

Following each step or activity, ask questions such as:

• How well did we do?
• Did the plans work?
• Why did we succeed? Or fail?
• What do we do next?
• Did we learn from our mistakes or successes?
By the end of the educational activities, you should be able to measure their successes by
counting how many people are behaving according to the original objectives: is this
number more than before the program started?
At the end of the program, a final meeting can be held to discuss how far the program
succeeded.
Changes in attitude may be assessed by answering the following questions:
• Did people participate in the project as expected?
• Did people gain new skills and learn from the program?
• Was there less opposition by groups in the village who had previously been against the
program?

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 In-text Question 16: what is evaluation?

Answer: Evaluation is the process by which results are compared with the intended
objectives, or more simply the assessment of how well a program is performing.

Types of Evaluation in Health Promotion

Several types of evaluation designs and frameworks can be used to assess health
promotion and disease prevention programs. Each design and framework uses different
approaches for assessment, data collection, and measurement. The types of frameworks
that have been used for rural health promotion and disease prevention program
evaluations include:
• Formative Evaluation: Formative evaluation occurs during program development
and implementation. It provides information on achieving program goals or
improving your program.
• Process Evaluation: Process evaluation is a type of formative evaluation that
assesses the type, quantity, and quality of program activities or services.
• Outcome Evaluation: Outcome evaluation can focus on short- and long-term
program objectives. Appropriate measures demonstrate changes in health
conditions, quality of life, and behaviours.
• Impact Evaluation: Impact evaluation assesses a program's effect on participants.
Appropriate measures include changes in awareness, knowledge, attitudes,
behaviours, and/or skills.

2.2 Evaluations of Health Promotion Activities

Evaluation plan outlines the evaluation approach, including the focus of the evaluation
(i.e., an activity, intervention, program, or policy), evaluation design, evaluation research
questions, data collection methods, evaluation activities, stakeholders that should be
engaged, timeline, performance measures, key milestones, and costs.

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It is important you establish an evaluation plan before the program starts to make sure
that the evaluation research questions, measures, and methods align with the evaluation's
goals.

Questions to Consider When Planning the Evaluation Include:

• What are the goals of the program?
• What are the evaluation research questions that need to be answered?
• Who are the key stakeholders in the program?
• What types of resources and inputs are necessary to implement the program?
• What structures and processes are in place to implement program?
• What activities are conducted by the program?
• What are the anticipated outputs of the program?
• What are the anticipated outcomes of the program?
• What contextual factors may affect the program?
• What are the barriers or challenges to implementing the program?
• Is there a return on investment for the program?

In-text Question 16: list the types of evaluation in health promotion

Answer: formative evaluation, process evaluation, impact evaluation and outcome

evaluation

Evaluation Design
There are different designs that can be used to evaluate programs. Given that each
program is unique, it is important to choose an evaluation that aligns with:
• Program goals
• Evaluation research questions
• Purpose of the evaluation

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 • Available resources
Your evaluation should be designed to answer the identified evaluation research
questions.
To evaluate the effect that a
program has on participants’ health
outcomes, behaviours, and
knowledge, there are three different
potential designs:
• Experimental design: Used
to determine if a program or
intervention is more effective
than the current process. Figure 2.11: Evaluation Design

Involves randomly assigning participants to a treatment or control group. This type

of design is often considered to be the gold standard against which other research
designs are judged, as it offers a powerful technique for evaluating cause and
effect. Fully experimental designs are unusual in evaluation research for rural
community health programs, but may be feasible.
• Quasi-experimental Design: Does not have a random assignment component, but
may involve comparing a treatment group to a similar group that is not
participating in the program. Quasi-experimental methods are used to estimate the
effect of a treatment, policy, or intervention when controlled experiments are not
feasible.
• Non-experimental Design: Does not involve a comparison group. Non-
experimental designs may include pre- and post-intervention studies with no
control or comparison group, case study approaches, and post-intervention-only
approaches, among others. The key feature of a non-experimental design is the

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 lack of a control group. While non-experimental evaluation studies are likely to
produce actionable findings regarding program outcomes, best practices, and
performance improvement, they cannot control for extraneous factors that could
influence outcomes, such as community contextual factors or selection bias.

Other frameworks that have been used to evaluate rural initiatives or programs include:
• Process Evaluation: Process evaluation is a systematic, focused plan for
collecting data to determine whether the program model is implemented as
originally intended and, if not, how operations differ from those initially planned.
It seeks to answer the question, “What services are actually being delivered and to
whom?” This framework also gathers information on stakeholders' perceptions of
the program.
• Outcome Evaluation: Outcome evaluation examines how well a project achieved
the outcomes it set at the beginning. It is generally a summative evaluation of the
program which can be used to make recommendations for future program
improvements.
• Impact Evaluation: Impact evaluation reviews the effect that a program had on
participants and stakeholders of the project. It measures the outcomes, but also the
changes that resulted from those outcomes.
• Performance Monitoring: Performance monitoring is ongoing evaluation of the
program to have data at the baseline and at key milestones in the work plan. This
provides continuous, real-time feedback on program progress so that changes to
the program can be made to better align with the program objectives and goals.
• Cost-benefit Evaluation: Cost-benefit evaluations study the cost-effectiveness of
the program by reviewing the relationship between the project costs and the
outcomes (or benefits) from the program. Data collected is used to determine

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 whether the program outcomes were worth the investment in program development
and operation.

2.3 Elements of Evaluation Process

Elements of Evaluation process
Evaluation is perhaps the most difficult task in the whole area of health services. The
components of the evaluation process are:
a. Relevance: Relevance or requisiteness relates to the appropriateness of the Service,
whether it is needed at all. If there is no need, the service can hardly be of any value.
Example, vaccination against smallpox is now irrelevant because the disease no longer
exists in the world.
b. Adequacy: It implies that sufficient attention has been paid to certain previously
determined courses of action. For example, the staff allocated to a certain program may
be described as inadequate if sufficient attention was not paid to the quantum of work-
loan and targets to be achieved.
c. Accessibility: It is the proportion of the given population that can be expected to use a
specified, facility, service, etc. The barriers to accessibility may be physical (e.g.
distance, travel, time): economic (e.g. travel cost, fee charged); or social and cultural (e.g.
caste or language barrier).
d. Acceptability: The service provided may be accessible, but not acceptable to all, e.g.
male sterilization, screening for cervical or rectal cancer, insertion of copper T if the
professional worker is male/female as the case may be.
e. Effectiveness: It is the extent to which the underlying problem is prevented or
alleviated. Thus it measures the degree of attainment of the predetermined objectives and
targets of the program, service or institution-expressed, if possible, in terms of health
benefits, problem reduction or an improvement of an unsatisfactory health situation. The

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ultimate measures of the effectiveness will be the reduction in morbidity and mortality
rates.

In-text Question
17: list the elements of evaluation process in health promotion
Answer: Adequacy, relevance, accessibility, acceptability, effectiveness, efficiency and
impact

f. Efficiency: It is a measure of how well resources, money, men, material and time are
utilized to achieve a given effectiveness. The following examples will illustrate: the
number of immunizations provided in a year as compared with an accepted norm using
cotton and gauze to clean the windows or chairs during personal work on project time, a
medical officer who cannot speak the language of the client or a professional nurse who
cannot insert a copper T or health personnel proceeding on long.

g. Impact: It is an expression of the overall effect of a program service or institution, on

health status and socioeconomic development. For example, as a result of malaria control
in Nigeria, the incidence of malaria dropped.

3.0 Study Session Summary and Conclusion

Monitoring and evaluation must be viewed as a continuous interactive process, leading to
continual modification both of objectives and plans. Successful evaluation may also
depend upon whether the means of evaluation were built into the design of the program
before it was implemented.

4.0 Self-Assessment Question

Discuss the relevance of evaluation to measles immunization program in your country

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 5.0 Additional Activities

a. Visit Youtube: https://www.youtube.com/watch?v=XJdwUVzlYWM

and https://www.youtube.com/watch?v=YpK3xxobmmQ. Watch the videos

and summarise in 1 page.

6.0 References/Further Reading

Frances, A. Maurer Community/Public Health Nursing: Claudia Smith Google Books
(Microsoft Entries)
John Hubley. Communicating Health, An action guide Health Education and Health
promotion, 2002.
WHO, Education for Health. A manual on Health Education in Primary Health Care,
1988, Geneva, WHO.
Jannie N., Jane W. Health Promotion Foundations for Practice, 2nd edition, UK, 1995.
Ramachandran L., Dharmalingam T. Health Education, A new approach, New Delhi
1998.

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 STUDY SESSION 4
Ethical Issues in Health Education and Health Promotion
Section and Subsection Headings:
Introduction
1.0 Study Session Learning Outcomes
2.0 Main Content
2.1 – Definition of ethics
2.2- Ethical principles
2.3- Ethics for the performance of health extension workers as health educators
3.0 Conclusion
4.0 Session Summary
5.0 Self-Assessment Questions
6.0 Other Activities
7.0 References/Further Reading

Introduction
You are welcome to study session 4, in the previous session we did discussed the
evaluation of health promotion activities. In this session, we will look at ethics in health
promotion. From a profession point of view, ethical behaviour is expected from
professionals. Ethical conduct is particularly important for health educators, since they
are working with a mission to serve the individual. This session will try to address that.
Enjoy the session.

1.0 Study Session Learning Outcomes

After you have finished studying this session, you should be able to:
1. Define ethics

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2. State basic principles of ethics
3. Describe the responsibilities of health extension workers to community.
4. Describe the responsibilities of health extension workers to the health extension
package.

2.0 Main Content

2.1 Definition
Ethics is the philosophical study of the moral value of human conduct and the rules that
govern it. It is the right thing to do for society and self. Moral refers to those beliefs about
how people ought to behave. Ethics is the study of what should be done: a prescriptive,
systematic analysis of what is required for human well-being (Kerridge et al., 2009). The
International Union for Health Promotion and Education, the body representing health
promotion professionals internationally, is beginning to put into consideration a code of
ethics for health promotion.
This advancement recommends that explaining the ethics of practice is now perceived as
an essential issue by health promotion professionals.

2.2 Basic Ethical Principles

1. The principle of autonomy
This principle means that people, being individuals with individual differences must have
a freedom to choose their own ways and means of being moral with the framework of the
other four principles. Respect for autonomy involves respecting another person’s rights
and dignity such that a person reaches a maximum level of fulfilment as a human being.
In the context of health promotion and health care this means that the relationship
between health extension worker and community member is based on a respect for him or
her as a person and with individual rights.

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Rights in relation to health care are usually taken to include:
• The right to information
• The right to privacy and confidentiality
• The right to appropriate care and treatment

2. Beneficence
Beneficence means doing or promoting good as well as preventing, removing and
avoiding evil or harm. E.g. provide information about emergency first aid to reduce the
risks of HIV infection or accident.

3. Non-maleficence
Non-maleficence holds a central position in the tradition of medical ethics and guards
against avoidable harm to subjects. In short, it refers to non-infliction of harm to others.
E.g. use of sterile needles.

4. Justice (fairness)
This principle states that human being should treat other human being fairly and justly in
distributing goodness and badness among them. In other words justice should include:
• Fair distribution of scarce resources
• Respect for individual and group rights
• Following morally acceptable laws

5. Honesty
At the heart of any moral relationship, there is communication. A necessary component
of any meaningful communication is telling the truth, being honest.

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 In-text Question 18: What is ethics?

Answer: Ethics is the study of what should be done: a prescriptive, systematic

analysis of what is required for human well-being

2.3 Ethics for the Performance of Health Extension Workers as Health Educators
Health extension workers as health educators assume profound responsibility in using
educational processes to promote health and influence human well-being. They are also
responsible for the implementation of health extension package program. Ethical precepts
that guide these processes must reflect the right of individuals and communities to make
decisions affecting their lives.

Health extension workers responsibilities as a health educator

• Affirm an equal right, believing that health is a basic human right for all.
• Provide people with relevant and accurate information and resources to make their
choices freely and intelligently.
• Support change by freedom of choice and self-determination, as long as these decisions
pose no threat to the health of others.
• Be advocates for healthful change and legislation, and speak out on issues deleterious to
public health.
• Avoid and take appropriate action against unethical practices and conflict of interest
situations
• Respect the privacy, dignity and culture of the individual and community and use skills
with these values.
• Share their skills, experience and vision with their clients and colleagues.
• Observe principles of informed consent and confidentiality of individuals.

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• Maintain their highest levels of competence through continued study, training and
research.
• Accurately represent their capabilities and education as well as training and experience
and act within the boundaries of their professional competence;
• Ensure that no exclusionary practices be enacted against individuals on the bases of sex,
marital status, colour, age, social class, religion, ethnic background, national origin, or
other Non-professional attributes in rendering service, employing, training, or promoting
others.

3.0 Conclusion
In this session, you have learnt the ethics of health promotion, principles of ethics. It is an
important virtue as a health educator to be able to win the trust of the communities and
people being educated. I hope now we are set for the next module. Hope you enjoyed
your studies. Now let us attempt the questions below.

4.0 Self-Assessment Question

1. Mention basic principles of ethics
2. What are your responsibilities to the community as a health educator?

5.0 Other Activities

a. Visit Youtube: https://www.youtube.com/watch?v=YplpfNf7GeA

Watch the videos and summarise in 3 pages.

6.0 References/Further Reading

Kerridge I, Lowe M, Stewart C. Ethics and Law for the Health Professions. 3rd ed
Annandale, Australia: The Federation Press; 2009

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Public Health Leadership Society Principles of the ethical practice of public health. 2002.
EPHA. Public Health Code of Ethics for Ethiopia, July 2003.
Urban Jonsson. Human rights Approach to development programming, published by
UNICEF, 2003.
Mittelmark MB. Setting an ethical agenda for health promotion. Health Promot Int.
2008;23(1):78–8

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 MODULE 3
Health Promotion Research Methods and Skills
Contents
Study Session 1: Introduction to Research
Study Session 3: Research Methodologies
Study Session 2: Key Steps in Research Process
Study session 4: Ethical consideration in Research

STUDY SESSION 1
Introduction to Research
Section and Subsection Headings:
Introduction
1.0 Study Session Learning Outcomes
2.0 Main Content
2.1 – Introduction to research
2.2- Characteristics of a good research
2.3- Types of research
3.0 Study session summary and conclusion
4.0 Self-Assessment Questions
5.0 Other Activities
6.0 References/Further Reading

Introduction
You are welcome to study session 1, in the previous modules, we have acquainted
ourselves with health promotion concepts and execution of health promotion programs.
The ultimate goal of health promotion is to enable people reach a level of health that

106
enables them to make meaningful participation in the social and economic life of the
community in which they live and this is majorly achieved through health education and
health policies. To make the right policies, detailed and accurate information on the
existing health systems is required as decisions based on assumptions and unjustified
conclusions often result in inappropriate policy choices. In this regard, research and
appropriate research methods is required.

1.0 Study Session Learning Outcomes

After you have finished studying this session, you should be able to:
1. Define research in general and health systems research in particular
2. List the characteristics of research
3. Types of Research

2.0 Main Content

2.1 Introduction to Research
Research is a scientific inquiry aimed at learning new facts, testing ideas, etc.
It is the systematic collection, analysis and interpretation of data to generate new
knowledge and answer a certain question or solve a problem. Research in the context of
health promotion thus aims to provide all aspects of information necessary for planning
and the effective implementation of a health system. The research questions are
formidable: how to join with policy makers and communities in assessing priority needs,
planning, financing and implementing programs, and evaluating them in terms of
coverage, efficiency and effectiveness.
A great deal of time and attention should be devoted to research agendas before health
promotion programs are designed and widely implemented (Figure 3.1).

107
In-text Question
19: Define research
Answer: Research is a scientific inquiry which involves systematic collection, analysis
and interpretation of data aimed at generating new knowledge or solving problems.

2.2 Characteristics of Research

i. It demands a clear statement of the problem
ii. It requires a plan
iii. It builds on existing
data, using both
positive and negative
findings
iv. New data should be
collected as required
and be organized in
such a way that they
answer the research
Figure 3.1: A Summary of Health Research
question(s)

2.3 Types of Research

Research can be divided into two main broad categories:

a) Basic Research- This type of research is designed to generate new knowledge and
technologies to deal with new or unresolved problem. It provides information required
for planning heath care and monitoring events among others, e.g.

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1) Identifying factors that can influence certain behaviour in the community
2) Determining risk factors of a disease in the population.

b) Applied Research- It focuses on finding solutions to immediate problems. It involves

identifying, prioritizing of problems, designing and evaluating policies and eventually
programs that will deliver the greatest health benefit, making optimal use of available
resources.
It is concerned with testing and applying existing theories in solving problems.

Other categories of research include:

c) Operation Research: Method of identifying service problems and developing
effective solutions for them. It provides a practical and systematic way to improve
management, delivery, develop program policies and improve satisfaction.

d) Health research
Health research is the application of principles of research on health. It is the generation
of new knowledge using scientific method to identify and deal with health problems
(Figure 3.2).
Worldwide and local knowledge is essential
for effective action on health. Worldwide
knowledge is the basis on which new tools,
strategies, and approaches are devised that is
applicable to health problems facing many
countries. Local knowledge is specific to the
particular circumstances each country can
inform decision regarding which health

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problems are important, what measures should be applied and how to obtain the greatest
health benefit from existing tools and limited resources. In this regard, health research is
both global and local in nature.
In most cases, health research has been divided into three overlapping groups.

Essential Health Research: Consists of activities to define the health problems of a

given country or community, to measure their importance and to assure the quality of
activities to deal with them. The obtained information is essential and specific to each
country for planning and monitoring health services. Some of the research conclusions,
however, may be generalised and applicable to other areas.

Clinical Research: This largely involves topics ranging from studies of the prevention
and diagnosis of diseases through new methods of treatment to problems of care and
rehabilitation. The use of tools varies depending on the problem being solved and this
may overlap with biomedical researches.
Examples include clinical trials of disease prevention and the design of new
chemotherapeutic agents.

Biomedical Research: It is the most basic part of

health research which demands more resources,
facilities and skilled investigators. The results of
biomedical research are more often of universal
importance and thus of general significance (Figure
3.3).
Figure 3.3: A Biomedical Researcher

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d) Health System Research- Health research is the application of principles of research
on health. This is concerned with improving the health of the community by enhancing
the efficiency and effectiveness of the health system as an integral part of the overall
process of socio-economic development. It looks at existing system of health service to
note their failures and successes.

A health system is an institutional arrangement within which the health promoting

behaviour occurs. It include the individual, family, community, health care services,
health related sectors, the international sectors (UNICEF, WHO).

In-text Question
20: List the broad classification of research?

Answer: Basic research and applied research.

3.0 Study session summary and conclusion

In this session, we discussed research. Research was viewed as a scientific enquiry which
involves the systematic collection, analysis and interpretation of data to generate new
idea.

4.0 Self-Assessment Questions

1. The health of any community depends on the interaction and balance between the
health needs of the community, the health resources that are available, and the
selection and application of health and health related interventions. Discuss!
2. What is health system research?

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 5.0 Additional Activities
a. Visit Youtube: https://www.youtube.com/watch?v=sQi5IjMsPZg
Watch the videos and summarise in 1 page.
b. Take a walk and engage any 5 people on how they research in health and
summarise their opinion in 2 paragraphs.

6.0 References/Further Reading

Getu D., Tegbar Y., Ethiopia public health training initiative, University of Gonda
Abdella FAY and Levine Eugene (1979). Better Patient Care through Nursing Research
(2nd ed.). New York: Macmillan Publishing Co INC.
Akinsola H, A. (2005). Research Methods in Medical and Nursing Practice. Ibadan:
College Press and Publishers LTD.
Alakija Wole (2000). Essentials of Community Health and Primary health Care and
Health Management. Ambik Press, Benin City.
Araoye Margaret Olabisi (2004). Research Methodology with Statistics for Health and
Social Sciences. Ilorin: Nathandex Publishers.
Brownie A: Promoting health Systems Research as a management tool. Health Systems
Research Volume 1.
Council for International Ethical Guidelines for Biomedical Research Involving Human
Subjects. Prepared by CIOMS in Collaboration with WHO, Geneva, 1999. Jones
W.P. (1981). Writing Scientific Papers and Reports, W.M.C. Brown Company
Publishers IOWA. (8th ed.).
WHO (1984). Health Services Research Course- How to develop Proposals and Deign
Research to Solve Primary Health Care Problems. Geneva.

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 STUDY SESSION 2
Research Design
Section and Subsection Headings:
Introduction
1.0 Study Session Learning Outcomes
2.0 Main Content
2.1- Research design
2.2 – Qualitative design
2.3- Quantitative design
3.0 Study session summary and conclusion
4.0 Session Summary
5.0 Self-Assessment Questions
6.0 Other Activities
7.0 References/Further Reading

Introduction
You are welcome to session 2, in the previous session, you were introduced to the
concept of research in health promotion, its importance, characteristics and various types
of research in health practices. For a successful research process, it is pertinent to decide
the right methodology to use. In this session, we will look at the various methodologies
of research. Enjoy the session.

1.0 Study Session Learning Outcomes

After you have finished studying this session, you should be able to:
1. Describe methodologies of research
2. Choose the right methodology to carry out research

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2.0 Main Content
2.1 Research Methodology
Research methodology is important in achieving the objectives of study either in the form
of research questions and hypothesis being made. The research design can be categorised
into two:
1) Qualitative Method
2) Quantitative Method

2.1.1 Qualitative research

Qualitative research is a form of scientific research consists of an investigation that:
• Seeks answers to a question
• Utilizes a predefined set of systems to respond to the inquiry
• Collects proofs
• Produces findings that were not pre-determined
• Produces findings that are applicable beyond the immediate boundaries of the study
Qualitative research is very effective in getting information about the values,
opinions, behaviours, and social contexts of particular populations.
The strength of qualitative research is its ability to provide complex textual descriptions
of how people experience a given research issue. It provides information about the
“human” side of an issue that is, the often contradictory behaviours, beliefs, opinions,
emotions, and relationships of individuals. Qualitative methods are also effective in
identifying intangible factors, such as social norms, socioeconomic status, gender
roles, ethnicity, and religion, whose role in the research issue may not be readily
apparent (Figure 3.4). Qualitative research can help us to interpret and better understand
the complex reality of a given situation when used along with quantitative methods.

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Essentially, there are five characteristics of qualitative research that make it “qualitative”:
(1) it is naturalistic, (2) the data are descriptive, (3) there is concern with process, (4) it is
inductive, and (5) meaning is the goal (Bogdan and Biklen, 1998). In any given
qualitative research study it is not necessary to have all five features weighted equally to
signify that the research is
qualitative.
The types of data this method
generates include field notes,
audio/visual files and transcripts.
The most common qualitative

Figure 3.4: Components of Qualitative Research

methods are:
• Participant observation- this is
appropriate for collecting data on
naturally occurring behaviours in their normal contexts.
• In-depth interviews- this method is useful for collecting data sensitive topics. It enables
individuals to give insight into their personal histories, perspectives, and experiences.
• Focus groups are effective in providing data on the cultural norms of a group.
Others include methods include:
Case study method
• Rapid community profiling method

Advantages of Qualitative methods

Let is discuss the advantages of qualitative methods
1. Qualitative methods are very flexible. In that, they spontaneous and free flow of
interaction between the researcher and the study participant. The researcher asks

115
 mostly “open-ended” questions that are not necessarily worded in exactly the same
way with each participant. This allows participants to respond in their own words.

2. Qualitative methods allows relationship between the researcher and the participant;
giving room for a less formal environment. This allows Participants respond more
elaborately and in greater detail. In turn, researchers have the opportunity to
respond immediately to what participants say by tailoring subsequent questions to
information the participant has provided.

Sampling in Qualitative Research

It is not possible to get feedback from a target population hence, the need to get a
subset/representation of the target population. The study’s research objectives and the
characteristics of the study population (such as size and diversity) determine which and
how many people to select. The most common sampling methods appropriate for
qualitative research are: purposive sampling, quota sampling, and snowball sampling.
• Purposive sampling: this involves the use of preselected criteria relevant to a
particular research question in grouping participants. Sample sizes, which may or
may not be fixed prior to data collection,
depend on the resources and time available,
as well as the study’s objectives.
• Quota sampling: this uses particular
characteristics in selecting participants.
Characteristics might include age, place of
residence, gender, class, profession, marital
status, use of a particular contraceptive
method, HIV status, etc.
Figure 3.5: Depiction of Snowball Sampling

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 • Snowball sampling: also known as chain referral sampling – is considered a type
of purposive sampling. In this method, social networks like a community head are
used in selecting participants. The social networks refer the researcher to other
people who could potentially participate in or contribute to the study. Snowball
sampling is often used to find and recruit “hidden populations,” that is, groups not
easily accessible to researchers through other sampling strategies (Figure 3.5).

In-text Question
21: List two advantages of qualitative research method

Answer: i. it is flexible as it allows open ended questions. ii. Allows relationship

between the participants and the researcher

Recruitment in Qualitative Research

A recruitment strategy is a project-specific plan for identifying and enrolling people to
participate in a research study. The plan should specify criteria for screening potential
participants, the number of people to be recruited, the location, and the approach to be
used. The principal investigator and qualitative research team members work together, in
close consultation with community leaders and gatekeepers to develop a plan to identify
and recruit potential participants for each site.

2.1.3 Quantitative Method

Quantitative method involves the collection of
data that can be counted or expressed
numerically. Quantitative data might include
frequency of responses or occurrences, or it
might entail a process whereby participants’
verbal or written responses are quantified by Figure 3.7: Quantitative Research

117
transforming them into numerical values
Quantitative method can be:
a) Experimental Method: This is developed to carry out an experiment to test the
validity of a hypothesis (Figure 3.7). There are two types: True experiment designs
and Quasi-Experiment.
i. True experiment- Can be on the field or in the laboratory. The three
characteristics are randomization, control and manipulation.
ii. Quasi-experiment- There is no randomisation. Advantages of experimental
design are: i. helps to establish causality. ii. Offers the ultimate in control
which is important for data analysis hypothetical testing. iii. Longitudinal
analysis allows for opportunity to study change in time.
b) Non–Experimental Method: It is employed in studies where the investigation set to
describe an event as it naturally occurs. The major advantage is the ability to generate
ideas that could be further explored in controlled condition. Non- Experimental methods
are divided into:
i. Epidemiological Studies
Epidemiology is the study of distribution, determinants and deterrents of health related
events in a human population. It may involve distribution of diseases or health related
characteristics in groups (descriptive) surveys or it could deal with factors influencing
this distribution (analytical surveys, experimental or quasi- experiments).
ii. Survey
It is a non-experimental research method conducted in a natural setting in which there is
less control over the study subjects. It is a collection of data from a defined population in
order to make description of the existing phenomenon with the aim of employing the
results to justify current conditions in practices. Survey can be categorised into two: a)
Cross sectional studies b) Longitudinal surveys.

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 In-text Question
22: List two classification of quantitative research method

Answer: i. Experimental method ii. Non experimental method

3.0 Conclusion
The right methodology is very important in carrying out a research. This helps in finding
appropriate method that will answer the research questions. Research methodology can
be qualitative or quantitative. I hope you would be able to choose the right research
method after the session. I hope you enjoyed your studies. Now let us attempt the
questions below.

4.0 Self-Assessment Questions

1. Differentiate between qualitative and quantitative research methodologies.
2. Discuss the various types of qualitative research method.

5.0 Additional Activities

a. Visit Youtube: https://www.youtube.com/watch?v=2wdfl6CiKk0,
https://www.youtube.com/watch?v=fjIc7Ijm4K0
and https://www.youtube.com/watch?v=IsAUNs-IoSQ. Watch the videos
and summarise in 3 page.
b. Suggest a research you can use qualitative methods for. Explaining how
you will go about it

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6.0 References/Further Reading
Getu D., Tegbar Y., Ethiopia public health training initiative, University of Gonda
Salazar F.L., Crosby R.A., DiClemente R.J. research methods in health promotion. Jossey
Bass, second edition, 2015
Abdella FAY and Levine Eugene (1979). Better Patient Care through Nursing Research
(2nd ed.). New York: Macmillan Publishing Co INC.
Akinsola H, A. (2005). Research Methods in Medical and Nursing Practice. Ibadan:
College Press and Publishers LTD.
Alakija Wole (2000). Essentials of Community Health and Primary health Care and
Health Management. Ambik Press, Benin City.
Araoye Margaret Olabisi (2004). Research Methodology with Statistics for Health and
Social Sciences. Ilorin: Nathandex Publishers.
Brownie A: Promoting health Systems Research as a management tool. Health Systems
Research Volume 1.
Council for International Ethical Guidelines for Biomedical Research Involving Human
Subjects. Prepared by CIOMS in Collaboration with WHO, Geneva, 1999. Jones
W.P. (1981). Writing Scientific Papers and Reports, W.M.C. Brown Company
Publishers IOWA. (8th ed.).
WHO (1984). Health Services Research Course- How to develop Proposals and Deign
Research to Solve Primary Health Care Problems. Geneva.

120
 STUDY SESSION 3
Key Steps in Research Process
Section and Subsection Headings:
Introduction
1.0 Study Session Learning Outcomes
2.0 Main Content
2.1- Steps in research process
3.0 Study session summary and conclusion
4.0 Self-Assessment Questions
5.0 Other Activities
6.0 References/Further Reading

Introduction
You are welcome to study session 3, in the previous sessions, we discussed the concept
of research, types of research and methodologies of research. We will be building on the
previous sessions in this session. We will be discussing the research processes itself. The
development of research process goes through lots of process. The problem needs to be
identified, review of literature and other processes. Enjoy the ride as we go through these
key steps in researches.

1.0 Study Session Learning Outcomes

After you have finished studying this session, you should be able to:
1. List the criteria for selecting a research topic
2. Describe clear statement of research problem
3. Describe the resources and importance of reviews
4. Formulate objectives and hypothesis

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 5. Choose the right design, analyse and report findings

2.0 Main Content

Research process involves a number of stages. Formulation of the research proposal is the
major task in the process of developing a research project.
Was the given health problem
identified by relevant groups of
the health system? Was the
problem adequately analysed to
include all possible contributory
factors from different sectors?
Was it clearly stated? These
questions need to be clearly
answered. After which there is
identification, selection, analysis
and statement of the given problem. Figure 3.8: The Process of Research

2.1 Topic Selection/Problem Identification

If the answer to the research question is obvious, then there is no need for further
research. A number of research questions could be presented that may be posed at the
various levels of the health system.
Three conditions qualifies whether a problem requires research
I) There should be a perceived difference between what it is and what it should be II) the
reason(s) for this difference should be unclear (so that it makes sense to develop a
research question); and
III) There should be more than one possible and plausible answer to the question

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The selection and analysis of the problem for research involve managers in the health
services, health-care workers, and community leaders, as well as researchers.
The guideline given below can help in the process of selection.
1. Relevance: The topic you choose should be a priority problem:
2. Avoidance of duplication: Investigate whether the topic has been researched.
3. Feasibility: Consider the complexity of the problem and the resources you will require
to carry out the study.
4. Political acceptability: It is advisable to research a topic that has the interest and
support of the authorities. This will facilitate the smooth conduct of the research and
increases the chance that the results of the study will be implemented.
5. Applicability of possible results and recommendations
Is it likely that the recommendations from the study will be applied? This will depend not
only on the blessing of the authorities but also on the availability of resources for
implementing the recommendations.
6. Urgency of data needed: How urgently are the results needed for making a decision?
Which research should be done first and which can be done late?
7. Ethical acceptability: We should always consider the possibility that we may inflict
harm on others while carrying out research.

2.2 Analysis/Statement of Research Problem

A systematic analysis of the problem, completed jointly by the researchers, health
workers, managers, and community representatives is a very crucial step in designing the
research. This enables those concerned to bring together their knowledge of the problem,
clarify the problem and the possible factors that may be contributing to it.
After identifying, selecting and analysing the problem, the next major section in a
research proposal is “statement of the problem”

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It enables the researcher to systematically point out why the proposed research on the
problem should be undertaken and what you hope to achieve with the study findings. It
contains a basic description of the research problem, the discrepancy between what it is
and what it should be as well as the severity and distribution.

Points that need to be considered for justifying the selected research problem
A health problem selected to be studied has to be justified in terms of its:
• Being a current and existing problem which needs solution
• Being a widely spread problem affecting a target population
• Effects on the health service programs
• Being a problem which concerns the planners, policy makers and the communities
at large.
After defining the problem, it is now easier for you to justify the research problem by
pointing out the major factors that may influence the problem and a convincing argument
that available knowledge is insufficient to answer a certain question and to update the
previous knowledge. A brief description of any solutions that have been tried in the past,
how well they have worked, and why further research is needed and description of the
type of information expected to result from the project and how this information will be
used to help solve the problem will justify the research.

In-text Question
22: List two conditions for a good research problem

Answer: i. There should be a clear gap between what it is and what it should be
ii. There should be more than one way of solving the research problem

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2.3 Use of Literature Review
It is important to consult literatures before embarking on a research process. This helps to
take care of the following:
• It prevents duplication of work.
• It increases your knowledge on the problem you want to study and this may assist you
in refining your "statement of the problem".
• It gives you confidence why your particular research project is needed.
• To be familiar with different research methods

Information for reviews can be gotten from:

• Card catalogues of books in libraries
• Organizations (institutions)
• Published information (books, journals, etc.)
• Unpublished documents (studies in related fields, reports, etc.)
• Computer based literature searches such as Medline
• Opinions, beliefs of key persons

Some Examples of Resources Where Information Could Be Obtained Are:

• Clinic and hospital based data from routine activity statistics
• Local surveys, annual reports
• Scientific conferences
• Statistics issued at region and district levels
• Articles from national and international journals
• Internet
• Documentation, reports, and raw data from the Ministry of Health, Central
Statistical Offices, Nongovernmental organizations, etc.

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 2.4 Formulation of Research Objective
The explicit formulation of study objectives is an essential step in the planning of a study.
It is said that “a question well-stated is a question half-answered”, but a question that is
poorly stated or unstated is unlikely to be answered at all.
The formulation of objectives will help us to:
• Focus the study
• Avoid collection of data that are not strictly necessary for understanding and solving the
identified problem
• Organize the study in clearly defined parts
We have to make sure that our objectives:
• Cover the different aspects of the problem and its contributing factors in a coherent
manner and in a logical sequence
• Are clearly expressed in measurable terms
• Are realistic considering local conditions
• Meet the purpose of the study
• Use action verbs that are specific enough to be measured

2.5 Research Methods

A study design is the process that guides researchers (you) on how to collect, analyse and
interpret observations. It is a logical model that guides the investigator in the various
stages of the research.
Several classifications of study types are possible, depending on what research strategies
are used.

1. Non-intervention (Observational) Studies in which the researcher just observes and

analyses researchable objects or situations but does not intervene; and

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2. Intervention studies in which the researcher manipulates objects or situations and
measures the outcome of his manipulations (e.g., by implementing intensive health
education and measuring the improvement in immunisation rates.)

Study Designs could be Exploratory, Descriptive or Analytical

1. Exploratory studies
An exploratory study is a small-scale study of relatively short duration, which is
carried out when little is known about a situation or a problem. It may include
description as well as comparison.
If the problem and its contributing factors are not well defined it is always advisable to do
an exploratory study before embarking on a large-scale descriptive or comparative study.

2. Descriptive studies:
Descriptive studies may be
defined as studies that describe Figure 3.9: Study designs in health Research
the
patterns of disease occurrence and
other health-related conditions by
person, place and time (Figure 3.9).

Types of descriptive studies

a) Case reports and case series
Case report: A careful, detailed report by one or more clinicians of the profile of a single
patient. The individual case report can be expanded to a case series, which describes
characteristics of a number of patients with a given disease.

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b) Ecological studies: Data from entire populations are used to compare disease
frequencies between different groups during the same period of time or in the same
population at different points in time.
c) Cross-sectional studies
A cross-sectional (prevalence) study provides information concerning the situation
at a given time. In this type of study, the status of an individual with respect to the
presence or absence of both exposure and disease is assessed at the same point in time. It
usually involves collection of new data; measure prevalence rather than incidence (Figure
3.9).

A cross-sectional study can be either analytical or descriptive, according to its purpose.

1. Analytic studies
Analytic studies may be defined as studies used to test hypotheses concerning the
relationship between a suspected risk factor and an outcome, magnitude of the
association and its statistical significance.
Analytic study designs can be divided into two broad design strategies: Observational and
intervention.

Observational studies
No human intervention involved in assigning study groups; simply observe the
relationship between exposure and disease.
Examples of observational studies: comparative cross-sectional, cohort and case control
studies.
a) Comparative Cross-Sectional Studies: Depending on the purpose of a given study, a
cross-sectional survey could have an analytical component.

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b) Cohort Studies: Study groups identified by exposure status prior to ascertainment of
their disease status and both exposed and unexposed groups followed in identical manner
until they develop the disease under study, they die, the study ends, or they are lost to
follow up.
c) Case-Control Studies: Group of subjects with the disease (cases) and group of
subjects without the disease (controls) are identified. Information, about previous
exposures is obtained for cases and controls, and frequency of exposure compared for the
two groups.
Intervention studies
In intervention studies, the researcher manipulates a situation and measures the effects of
this manipulation. Usually (but not always) two groups are compared, one group in which
the intervention takes place (e.g. treatment with a certain drug) and another group that
remains ‘untouched’ (e.g. treatment with a placebo).
The two categories of intervention studies are:
• Experimental studies and
• Quasi-experimental studies
In-text Question:
Research method can be?
Answer: i. Non intervention. ii. Intervention studies

2.6 Study Population

At an early stage in the planning of any investigation decisions must be made concerning
the study population. That is, concerning the population of individual units (whether they
are persons, households, etc.) to be investigated. The population under consideration
should be clearly and explicitly defined in terms of place, time, and other relevant
criteria. If the study population comprises cases of a disease the procedures to be used for

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case identification should be stated. If controls are to be chosen their method of selection
should be stated.
Often the investigator will have implicitly chosen his study population when he defined
the topic of his investigation, by reason of his interest in a specific community or a
specific health program.
In other instances, particularly when an analytic survey or an experiment is being
planned, the investigator may require purposively to select a study population. In so
doing he must consider questions of appropriateness and practicability.
The selection of study population on the basis of suitability usually affects the validity of
subsequent generalisations from the findings. This situation requires a close attention at
the early stage of the given study.

Practical questions such as the following could also arise.

- Is the proposed population the one that would give the required information?
- Will the population cooperate to participate in the study, or will it be a 'resistant' one?

2.7 Determining the Variables That Must Be Measured

First and foremost, the immediate goal is to be absolutely sure that every variable
required for a rigorous study is identified. A variable is anything that changes, meaning it
must assume a range of values. The research question and the literature review will
inform variable selection. For example, suppose that the literature review indicated that
minors can often easily purchase tobacco from convenience stores when the manager is
off-duty (night-time hours). Therefore it would be incumbent upon the researchers to
record the time of day when participants purchase or attempt to purchase tobacco, in
addition to other critical variables.

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Selecting the right mix of variables (correlates/predictors, mediators, moderators, and
outcomes) is a tricky task only because once your study has begun you cannot go back
and annex questions to the assessment modules. In essence, you have just one chance to
gather all that you will need.

2.8 Selecting the Sampling Procedure.

As in other aspects of the research process, there are choices to be made among numerous
sampling procedures as you conduct your research. Sampling exists across a continuum
of complexity and rigor. The sampling procedure employed is one of the most critical
determinants of external validity. External validity refers to the ability to generalise
study findings to the population of individuals with similar characteristics represented in
the study sample.
It should be noted, however, that not all research studies need to use a sampling
procedure that yields high external validity. Although taking the time to engage the use of
probability sampling techniques (simple random sampling, systematic sampling and
stratified sampling) will enhance the external validity of your study while the use of non-
probability methods (convenience sampling, quota sampling) may be far more prudent
and loss of external validity.

2.9 Implementing the Research Plan.

A basic requirement of internal validity is consistency in the implementation of all study
protocols.
Internal validity implies that the study is not confounded by design, measurement, or
poor implementation of study procedures. Protocols spell out key procedures such as the
sampling procedure to be used, how participants will be assigned to intervention
conditions, when and where assessments will occur, who will provide the assessments,

131
what participants will be told or not told about the research study, and how participants
will be enticed to return for follow-up programs or assessments.
Because protocols are generally quite detailed, subtle departures from these detailed plans
can be a common problem and may throw you off your planned route.

2.10 Analysing the Data.

Your journey, even if it occurred in a Ferrari, has not been an easy one, so when you
finally reach the destination (a complete dataset), you’ll want to be sure that you will
benefit from your work. In other words, do what you came to do fulfil the goal of the trip.
Once all the assessments have been conducted, a dataset can be established.
The dataset consists of the variables measured for each participant. The dataset is, of
course, quite valuable, as it can subsequently be used to answer the research questions
that were formulated in step 2. After the data are checked for logical inconsistencies, the
research process becomes dependent on the statistical skills of the research team. Again,
perform an analysis that provides a rigorous and fair test of the research questions while
avoiding the introduction of artificially imposed procedures.

2.11 Disseminating the Findings

Although memories from your trip will stay with you forever, it is important to document
your journey for others. Just as you would want to show family members and friends
where you went on your trip (and how you got there), a research journey deserves equal
attention. In fact, the process of historically chronicling your journey is a longstanding
tradition when it comes to research. Rigorous research clearly warrants widespread
dissemination, and this is achieved through oral presentation of findings (at professional
meetings) and through peer reviewed publications. Indeed, this step elevates the project.

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Besides, remember one of the goals of health promotion is for policy making hence, the
research reports will come in handy.

3.0 Study session summary and conclusion

As you can see, there are quite a number of steps required for research process. This
helps to make the process easy while on the research journey and also not make your
efforts futile. I believe that you are now ready to carry out a research on a health problem
in your environment.

4.0 Self-Assessment Question

Comment on the statement: “A question well-stated is a question half-answered”.

5.0 Additional Activities

a. Visit Youtube: https://www.youtube.com/watch?v=miMnSowiq4s
and https://www.youtube.com/watch?v=IMXO77h-838
Watch the videos and summarise in 1 page.
b. Design a research proposal following the steps explained

6.0 References/Further Reading

Getu D., Tegbar Y., Ethiopia public health training initiative, University of Gonda
Salazar F.L., Crosby R.A., DiClemente R.J. research methods in health promotion. Jossey
Bass, second edition, 2015
Abdella FAY and Levine Eugene (1979). Better Patient Care through Nursing Research
(2nd ed.). New York: Macmillan Publishing Co INC.
Akinsola H, A. (2005). Research Methods in Medical and Nursing Practice. Ibadan:
College Press and Publishers LTD.

133
Alakija Wole (2000). Essentials of Community Health and Primary health Care and
Health Management. Ambik Press, Benin City.
Araoye Margaret Olabisi (2004). Research Methodology with Statistics for Health and
Social Sciences. Ilorin: Nathandex Publishers.
Brownie A: Promoting health Systems Research as a management tool. Health Systems
Research Volume 1.
Council for International Ethical Guidelines for Biomedical Research Involving Human
Subjects. Prepared by CIOMS in Collaboration with WHO, Geneva, 1999. Jones
W.P. (1981).
Writing Scientific Papers and Reports, W.M.C. Brown Company Publishers IOWA. (8th
ed.).
WHO (1984). Health Services Research Course- How to develop Proposals and Deign
Research to Solve Primary Health Care Problems. Geneva.
Community health nursing. National Open University.

134
 STUDY SESSION 4
Ethical Consideration in Research
Section and Subsection Headings:
Introduction
1.0 Study Session Learning Outcomes
2.0 Main Content
2.1 – Introduction to research ethics
2.2- Principle of research ethics
3.0 Study session summary and conclusion
4.0 Self-Assessment Questions
5.0 Other Activities
6.0 References/Further Reading

Introduction
You are welcome to study session 4, in the previous session, we discussed the steps in
embarking on the journey of research. It is important to note that human subjects will be
used in health promotion research thus, leading to some guiding principle in handling
human subjects. We will be looking at these ethical principles shortly. Enjoy the session.

1.0 Study Session Learning Outcomes

After you have finished studying this session, you should be able to:
1. Explain the need for ethical consideration
2. Describe the principles of ethics
3. Enumerate stages of getting an ethical clearance.

135
2.0 Main Content
2.1 Introduction to Research Ethics
Before you embark on research with human subjects, you are likely to require
ethical approval. You may wonder why all this bureaucracy is needed. But history
shows us that prior to the development of ethical and human rights over the last 40 years,
patients’ rights were often ignored and many individuals were seriously harmed by
medical experimentation.
• Atrocities committed during World War II in the Nazi Germany which led to the 1947
Nuremberg Code of Practice and in turn the 1964 Declaration of Helsinki
• Tuskegee Syphilis Study in USA (1932-1970s) to study the long-term effects of
untreated syphilis- 400 men out of the 600 participants were never told about the
infection and were never treated despite the fact that treatment became available
• A study to examine the natural progression of cervical carcinoma in New Zealand
(1980s)-conventional treatment was withheld from women in trial and women were not
asked for their consent

Ethical decisions are based on three main approaches: duty, rights and goal-based.
The goal-based approach assumes that we should try to produce the greatest possible
balance of value over disvalue. Discomfort to one individual may be justified by the
consequences for the society as a whole. According to the duty-based approach, your
duty as a researcher is founded on your own moral principles. As a researcher, you will
have a duty to yourself and to the individual who is participating in the research. So even
if the outcome of the proposed research is for a good cause, if it involves the researcher
lying or deceiving his subjects in some way, then this would be regarded as unethical.

136
In the rights-based approach, the rights of the individual are assumed to be all-important,
thus a subject’s right to refuse must be upheld whatever the consequences for the
research.

In-text Question
23: Ethical decisions are based on three main approaches. They are?

Answer: Duty, Right and Goal Based Approaches.

2.2 Ethical Principles

Autonomy- we ought to respect the right to self-determination
In research autonomy is protected by ensuring that any consent to participate in the
study is informed or real. This means it is not enough to explain something about your
project to a particular subject, it is the understanding and free choice whether or not to
participate that is the key issue. There must be no coercion of any sort (Figure 3.10).

Non-Maleficence- we ought not to

inflict evil or harm
This principle states that we may not
inflict harm on or expose people to
unnecessary risk as a result of our
research project. This is particularly
important if our subjects may not be
competent in some way, such as, the
ability to give informed consent
(Figure 3.10).
Figure 3.10: Ethical Principles of Research

Beneficence – we ought to further others’ legitimate interests

137
This is the principle that obliges us to take positive steps to help others pursue their
interests. These interests clearly have to be legitimate.

Justice-we ought to ensure fair entitlement to resources

This principle is concerned with people receiving their due. This means people should be
treated equally in every way since not all people are equally competent or equally
healthy.

2.2.1 Ethical rules

The ethical rules of research, like principles, are not absolute in that one may override
another although clearly this must be justified. These rules are essential for the
development of trust between researchers and study participants. Like the ethical
principles on which the rules are based, there are four:

Veracity
All subjects in any research project should always be told the truth. There is no
justification for lying, but this is not the same non-disclosure of information should it, in
particular, invalidate the research.

Privacy
When subjects enrol in a research study, they grant access to themselves, but this is not
unlimited access. Access is a broad term and generally includes viewing, touch or having
information about them.

Confidentiality

138
Although someone may grant limited access to him or herself, they may not relinquish
control over any information obtained. Certainly, no information obtained with the
patient’s or subject’s permission from their medical records should be disclosed to any
third person without that individual’s consent. This applies to conversations too.

Fidelity
Fidelity means keeping our promises and avoiding negligence with information. If we
agree for example, to send a summary of our research findings to participants in a study
we should do so.

Applying to Ethics Committee

Remember that the key questions that the Ethics Committee will be asking are:
• Is the research valid?
• How important is the research question?
• Can the question be answered?
• Is the welfare of the research subject under threat?
• What will participating involve?
• Are the risks necessary and acceptable?
• Is the dignity of the research subject upheld?
• Will consent be sought?
• Will confidentiality be respected?

In-text Question
24. Mention three rules of ethics

Answer: 1) Veracity, 2) Confidentiality and 3) Fidelity

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3.0 Study Session Summary And Conclusion
In this session, we were able to look at the need for ethics in research and why it is
important to preserve the subjects of research. I hope you enjoyed the session. Now let us
attempt some questions.

4.0 Self-Assessment Question

1. Discuss the need for ethical consideration in a research.

5.0 Additional Activities

a. Visit Youtube: https://www.youtube.com/watch?v=Uihjety2d5M
and https://www.youtube.com/watch?v=_QTZEtEo08s. Watch the videos
and summarise in 1 page.
b. Describe how you will abide by ethical principles while carrying out a
research on the use of mosquito treated nets in your town
6.0 References/Further Reading
Getu D., Tegbar Y., Ethiopia public health training initiative, University of Gonda
Pope C, Mays N. Qualitative Research in Health Care. London: BMJ Books, 2000.
Salazar F.L., Crosby R.A., DiClemente R.J. research methods in health promotion. Jossey
Bass, second edition, 2015
Abdella FAY and Levine Eugene (1979). Better Patient Care through Nursing Research
(2nd ed.). New York: Macmillan Publishing Co INC.
Akinsola H, A. (2005). Research Methods in Medical and Nursing Practice. Ibadan:
College Press and Publishers LTD.
Alakija Wole (2000). Essentials of Community Health and Primary health Care and
Health Management. Ambik Press, Benin City.

140
Araoye Margaret Olabisi (2004). Research Methodology with Statistics for Health and
Social Sciences. Ilorin: Nathandex Publishers.
Brownie A: Promoting health Systems Research as a management tool. Health Systems
Research Volume 1.
Council for International Ethical Guidelines for Biomedical Research Involving Human
Subjects. Prepared by CIOMS in Collaboration with WHO, Geneva, 1999. Jones
W.P. (1981).
Writing Scientific Papers and Reports, W.M.C. Brown Company Publishers IOWA. (8th
ed.).
WHO (1984). Health Services Research Course- How to develop Proposals and Deign
Research to Solve Primary Health Care Problems. Geneva.

141