Health Education in India: Enhancing British-Indian Co-operation.
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Health Education in India:
Enhancing British-Indian
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Health Education in India:
Enhancing British-Indian
Co-operation.
Colin Brydon
September 1994
Health Education in India
Health Education in India:
Enhancing British-Indian
Co-operation.
Colin Brydon
September 1994
Dr Colin Brydon is a lecturer in Health Psychology in the Department of
Management and Social Sciences, Queen Margaret College, Edinburgh. His
special interest is Health Education. This report is based on his visit to India
from March to June 1994 during which time he explored current practices in
Health Education.
The report, which draws particularly on work in the fields of leprosy and
AIDS, notes some of the obstacles there are to western style health
education in India. Against this background some suggestions are made as
to how we might foster co-operation in the future.
Amongst these
suggestions two specifically relate to worker education of a type undertaken
by Queen Margaret College, details of these courses are given in two
Appendices.
Community Health Cell
Library and Information Centre
# 367, “Srinivasa Nilaya”
Jakkasandra 1st Main,
1st Block, Koramangala,
BANGALORE - 560 034.
Phone : 553 15 18 / 552 53 72
e-mail : chc@sochara.org
Health Education in India
Contents
Page
1
Introduction
Section One
1)
2)
3)
4)
5)
6)
7)
Obstacles to Western Style Health Education in India.
The relative power positions of men and women
Social hierarchies and structures.
The special status, qualifications and non-medical employment of
members of the medical profession.
The way certain government bureaucracies are perceived as
performing poorly.
The relationship between government and non-government
organisations
The rich diversity of languages and cultures
(For the specific issue of AIDS) The relative reticence of Indians on
sexual matters.
Section Two
1)
2)
3)
Action to Enhance Co-operation on Health Education
Liaison between British and Indian organisations
Dissemination of western skills.
a) Processes of management
b) The understanding of behavioural change
c) A problem solving orientation
d) Communication skills
e) Skills of monitoring and evaluation
Developing advantages
a) The ability of charismatic figures to lead large sections of
the population over matters of important principle
b) The ability of women's movements to be formed, gain
ground and change the law, in very short periods.
c) The Hindu ethic of respect and equality between living beings,
and the family and social values which stem from that ethic.
d) A wealth of human energy and talent that responds well to
creative leadership.
Conclusion
Appendix 1
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Individuals and organisations who contributed to the ideas
in this paper
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Appendix 2
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Course on Management in Health Care
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Appendix 3
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Course on Health Behaviour and Health Education
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Health Education in India
Health Education in India: Enhancing British-Indian
Co-operation.
Introduction.
It was a rare and delightful opportunity to be able to have four months exploring
current work on health education in India. My thanks to my college for
allowing me to go, and to my hosts for such a warm and accommodating
reception. Within the field of health education I concentrated on two areas:
AIDS and leprosy. Besides illustrating many aspects of health education, these
diseases are both associated with complex reactions within our societies, and
they also require that health professionals try to help people change their
behaviour. Thus they are of central importance to anyone, such as myself,
teaching in the area of health education.
My period in India allowed me the opportunity to review the way in which
health workers teach, train, instruct and persuade in their daily practice and to
reflect on the implications of my observations for the training we give to health
workers. The visit also allowed my review to go from 'bottom to top': from
the activities of unpaid community health workers, to the work of national co
ordinating bodies. The topic of AIDS had an additional advantage for my
explorations; it is still a relatively new area of work in India, and so the
organisations involved have not yet grown to be as complex as they are in some
older fields.
A short visit, coupled with a lack of knowledge of India, is scarcely a recipe for
acuity. I can only offer that it is hard to stand back and regain an overview of
our daily work; the visitor just might catch a glimpse of something we can no
longer see. The following notes bring together points from observations,
discussions and reflections made with the help of many individuals, projects and
organisations. All those who so kindly helped me are listed in Appendix 1; and
this document is being sent to them all by way of thanks. I believe that the
points made here have been fully discussed with Indians in the context of their
work. However, as the content is addressed to many people, there will be
some readers who would wish for more illustration or argument; naturally I
would be very glad to elaborate or discuss any matter further.
In this paper I have taken as read two valuable publications of Voluntary Health
Association of India: State of India's Health and Health for All .
I also found,
as a foreigner, the Tata Institute's book Prevention of AIDS helpful and lucid.
The material below is divided into two sections. The first section selects
features of Indian society which impinge on health education, and which make
the direct application of western style techniques problematic or inappropriate.
These points tend to come over as difficulties for the health educator, but they
Colin Brydon
September 1994
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Health Education in India
are only difficulties if you start from a certain perspective. I think it is more
helpful to treat them as warnings to us that the job of 'translating' ideas from
one culture to another is not simply a matter of language; I have given an
example of the point with reference to one well known manual. This first
section is therefore necessarily tentative. In contrast the second section
suggests three areas where the extension of co-operation between our two
countries would seem to promise best reward.
Section One
-
Obstacles to Western Style Health Education in India.
By health education I mean those efforts which the state, or voluntary
organisations, make to help individuals, groups and communities, improve their
health status through the provision of information, instruction, training,
education, or even persuasion. As a stranger to India I saw health education
work which benefited enormously from the intelligence, creativity and industry
of the workers involved.
The ideas, information and quality of discussions
never ceased to be stimulating. But a question, to which I found myself being
brought back repeatedly, was the extent to which India had to contend with
additional obstacles in her work of promoting health; that is obstacles in
addition to the ones we encounter in Britain. In the second section of this
paper I will take up the point of India's positive additional resources. Here my
concern is the kind of extra burdens that health education encounters. Below
seven such additional weights are indicated.
1) The relative power positions of men and women. The position and power
of women is central to the effectiveness of health education. This point is well
illustrated by the problem of controlling AIDS. Women are more likely to
become HIV positive from contact with men, than are men from women.
Women may pass it on to their unborn children. It is women who introduce
children to appropriate health practices. It is women who provide the first line
of defence against disease for their families. Women's power is crucial.
The
1991 census returns tell the sad story of how powerless women are in India.
The different situations in each State of India make any generalisation
misleading. In certain States women have considerable power, in certain
organisations they have taken power, and the fundamental equality assigned to
them in the Hindu ethic is patent. This means that good models abound.
Nevertheless, in many areas it is not possible for men to initiate health
education directly with women in the community; and this same social structure
means that too few women come to be trained as health workers; in turn there
are then too few women to persuade others to come forward; and so on.
Problems of co-education, of women travelling away from their homes, and of
women's social deference to the point of view of a man, all conspire against the
development of health education.
Colin Brydon
September 1994
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Health Education in India
2) Social hierarchies and structures. People I met within organisations and
within communities were very clear about their relative positions in these
groups.
The distinctions and differences were, to an outsider, subtle, but they
serve to give individuals a very exact and very secure place in life.
Such
security is of great psychological value. Its cost can be in terms of flexibility,
response to change, and the way we accept the truth of new ideas.
The AIDS problem provides a good example of the need there may be in health
education for a rapid response. Such a response is inhibited: by the niceties of
protocol (for example, by spending time giving thanks and praise to individuals
rather than exchanging ideas at meetings); by the way such systems channel so
much business through high status bottle necks (for example, the way a senior
person in an organisation kindly gives time to visitors, or must discuss a detail
with which they are less familiar than would be one of their juniors); and, by the
way status wins over relevant knowledge and experience (this area, which is
crucial for health education, is expanded upon below in point 3). It is as
though there is a balance to be struck between giving security to individuals,
and allowing a flexible response to changes. In Britain we clearly err in failing
to provide sufficient security for individuals; as a visitor to India I sometimes
wondered if a price had to be paid for individual security in terms of a lack of
flexibility to a new challenge like AIDS.
In health education there is another aspect to the problem of status. The aim
of much work is to change behaviour. We change our behaviour thoroughly
only when we believe it is in our power to do so. This so called 'self-efficacy'
depends on seeing the problem in terms we can understand, and seeing it as
our own problem. Being told to do something by someone, however important
a figure they are, has no lasting effect. Successful health education requires
the health professional to be seen as the aide and assistant to the solution of
the problem. Interestingly, here there are direct implications for the way we
train health workers. If workers are to engage patients as their aides, then,
while students, they must also have been aided by their teachers in the
enterprise of their studies. This point links with the one about problem
orientation below on page 10.
3) The special status, qualifications and non-medical employment of members
of the medical profession. To a non-medical observer technical western
medicine in India seems well developed. Knowledge of diseases, prognosis and
treatments are encompassing, competent and seem well updated.
However, a
number of problems arise around medically trained workers. In India, as
elsewhere, the medical practitioner is of very high status in the eyes of much of
the population. This confers an authoritarian power which is inimical to helping
people take responsibility for their own diseases and for changing behaviour.
The professional complaint, I often heard, was that patients did not do what
they had been told. We tell small children what to do and expect it to be done.
The status differential between doctors and patients is often rather similar, but
of course patients are mostly adults with their own world views which are equal
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September 1994
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Health Education in India
in status to those of the doctors; whatever the external social order.
The
problem has two facets: the way that medical workers misuse the status given
to them and emphasise inequality, and the methods of training students which
promote knowledge and its use as the basis of good practice, rather than
problem solution and negotiation.
The British medical establishment has had
very similar problems and only in the last generation has sought to provide a
more relevant education for students.
The status of medical workers in India is also bound up with Westernisation.
Western techniques and technology are given a priority which often appears to
be at odds with the health problems facing India. Many workers did not seem
to value India's diversity of traditional approaches to health, although VHAI, and
its excellent work, show how rich the blending of traditions can be. A twist to
the status problem, and Westernisation, is the demarcation between those who
are 'qualified' and those who are 'quacks'. The system of degrees and
conferments in India has not managed to separate, in the public eye, the
distinction between those with relevant training and those without it. This
seems partly a technical problem of feasibility, or appropriateness, in
establishing a legal register of qualified persons, and partly a wish of the less
well qualified ('quacks') to be able to share in some of the very large rewards
that medical practitioners can earn. I did see excellent examples of trained
physicians working in partnership with those less well trained, lending them
support and information, so that the 'quack' could direct more serious illnesses
to the medical doctor.
But this was exceptional; too often there is no such
harmony as status, and financial gain, rule. These difficulties are increasingly
affecting work with AIDS.
A further problem connected with medical workers is the way that medicine has
attracted many able young people, providing them with a means to a good, and
socially valuable, livelihood; it has been a key way of gaining high status and of
'getting on'. This means that many projects and organisations are headed by
people with medical qualifications chosen for their social eminence.
Some of
these people are naturally able administrators, managers, leaders and educators.
But of course most of us are not naturally able at any of these things, we have
to learn; and medicine does not help us learn how to manage, or how to
organize, or how to educate. Medical practitioners are no better or worse at
any of these things than any other interested person. Curiously medical
workers often believe that while their own training made them good doctors, no
analogous training would make them good managers, educators, etc.
This
blindness to other professions did show in a number of projects and
organisations I visited. As a result they were not always as efficiently
managed as they might have been, the health education being provided was not
as good as it might be and the understanding of behavioural change was
sometimes limited. This point is continued in the note on management on page
9 below.
There is another allied problem here which is delicate for a foreigner to raise. It
is the appearance that, in certain cases, some medical workers may not be so
Colin Brydon
September 1994
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Health Education in India
concerned with their patients' future well being as with the personal rewards
they receive themselves. Of course this is a problem in every country and is
presumably no different in India. What is different, is the large number of
stories I was told about professionals' own self interest. Examples include:
failure to attend conferences on AIDS as it conferred no status or financial
reward; applications for grant money in AIDS related work by individuals who
appeared to have nothing to offer the problem, but a great deal to gain from
receipt of the position and money; and the appointment of senior workers
without proper procedures that would have ensured that the best person was
found for that job.
This whole set of problems surrounding medical workers does seem to make
health education harder. For example, projects and organisations concerned
with AIDS need leadership which can co-ordinate a range of resources, be they
medical, behavioural, educational, social, or that provided by 'quacks'. The
high status of a single profession works against this process. The fact based
approach to learning, which is used in much medical education, also hinders
problem solution and flexibility of developments. Added to this is an over
enthusiasm for western approaches to problems; approaches which are as yet
unproved in India, and which narrow the opportunities for locally appropriate
solutions.
4) The way certain government bureaucracies are perceived as performing
poorly. The myth of the poorly performing Indian bureaucracy was presented
to me by Indians everywhere I went. Such beliefs, whether based in fact or
not, are in themselves a handicap. Able workers, especially the young, seem
to seek to work for independent organisations such as the NGOs to escape the
stagnation they foresee in working for the government. If this does happen, it
is sad that the official offices should be deprived of enthusiastic workers. This
theme is continued directly below in point 5. The stories of slow decision
making and mismanagement of money, by official bodies, also seem universal,
and expressed the keen frustration of those telling them. Again, whatever the
facts of the matter, the myths in themselves have effects which make getting
on with health education that much harder.
5) The relationship between government and non-qovernment organisations.
Because of the problems that the NGOs perceive as appertaining to government
based bureaucracies, many of those doing the most creative, sound and fruitful
work wish to keep their distance from these government bureaucracies; indeed
to the extent, in some cases, that they do not seek government funds because
these are seen as more of an impediment, than an aid to good work. There are
a number of effects of this distancing. One of the results is the fragmentation
of effort which leaves the hundreds of AIDS NGOs in ignorance of one
anothers' work, and at the same time strongly resistant to being drawn into any
bureaucratic framework. This means that work on AIDS control and
prevention, which is of the highest quality by world standards, is too often
poorly disseminated.
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September 1994
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Health Education in India
The picture I gained in India was one of small, highly successful and
independent projects which have no prospect of being generalised. Indeed,
some team members I have talked to are sceptical as to the generalisability of
their work, for the very factors that make for the success of the truck drivers'
project at ARFI, or the quality of the broadcasts by Chitrabani, or the techniques
of training health workers in Apnalya, are the individual creativity and integrity
of the workers, not any generalisable formulae. Nevertheless if the most
promising work is going on out in these NGOs, it presumably must be all our
wishes that the work be fostered and strengthened. The problem with such
myths is that it takes slow and painstaking work to dispel them. 1 did see fine
models of efficient and supportive management free of tales of corruption, and
well respected, in government offices, and we have continuously to remind
ourselves of such good models and treat them as the norm. There are some
general points made about the training of workers, and in particular managers,
in the second section of this paper which apply equally to government and non
governmental organisations. But, more specifically, there are tasks for a
central body that would increase confidence: the provision of digestible,
accessible, and up to date information, the setting up of open fora for the
exchange of ideas, and the provision of unfettered technical support are all
examples of ways in which the central authority can increase trust.
6) The rich diversity of languages and cultures. India's rich diversity is widely
acknowledged. No one denies the need for translation and 're-standardisation'
in health education work, be it of language or social norms. I was, however,
struck by the gap there appeared to be between the general acceptance of the
need for such translation, and the feelings of those involved in service provision
who continuously seemed to suffer from being on the receiving end of materials
and ideas which were not tailored to their specific social/cultural/linguistic
needs. Somehow the good intentions do not work out.
One noticeable
example is how the best set of language translations of AIDS related material
comes not from Delhi, but from Sol publications in Bombay, and that is simply
into the main 13 languages. Service providers are never funded to undertake
the local normalisation of materials, but this is one of the real costs of India's
rich diversity, and it was quite often Indians from central organisations who
seemed rather unconscious of this diversity. I suppose as a foreigner one is
sensitive to such matters - I expect I would be clumsy about the diversity in my
own country.
There is a specific training problem connected to this diversity which I often
met. It is the sight of a class in which at least two of the students had no
language in common. This was as true of institutions which explicitly catered
for students from all India as it was at more local centres. Often it was as
though people in, maybe distant, administrative offices of an organisation did
not quite appreciate that saying that English or Hindi would be the medium of
study did not in itself guarantee the fluency of students in these languages.
Colin Brydon
September 1994
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Health Education in India
The teachers are then left to pick up the pieces.
to be wasteful of resources.
The outcome often appeared
7) (For the specific issues of AIDS) The relative reticence of Indians on
sexual matters. All the projects I visited noted the poor level of understanding
of sexual matters among their client groups.
Sex education is not common,
and young people do not, in general, have access to a thorough, clear and
balanced view of human sexuality. This ignorance becomes the base on which
AIDS workers must teach. So discussion of AIDS has to be preceded by much
ground work, which again absorbs additional resources. Connected to the lack
of open discussion of sexual matters are misleading myths and beliefs about
sexuality. For example, two which have a direct affect on AIDS education are:
the notion of 'good' and 'bad' women; and the idea that masturbation is
harmful. The same reticence also means that evidence about sexual behaviour
is poor. What evidence we have points to behaviour which conflicts with safe
sex messages. For example: a very high incidence of the use of prostitutes;
low incidence of masturbation; clandestine, furtive, and very rapid sexual acts.
Another aspect to this problem, which is a little amusing to a western eye, is
the fact that many of those who engage in sex education as a basis for AIDS
education are themselves not as well versed in sexual matters as their western
counterparts might be. It was clear, for example, that few workers, whom I
heard talking about the advantages of the use of condoms, had actually used
condoms themselves. This meant that as educators they were at a clear
disadvantage compared with their British counterparts.
Reticence about sexuality is not just a simple matter cured by education. As in
Britain there is a hypocrisy that surrounds sexuality and which can prevent work
from even being undertaken. Many politicians and some authorities have still
to be convinced that Indian sexuality is not in fact any different from any other
human sexuality.
*
*
♦
These are seven points which I repeatedly encountered in my travels from Delhi
to Trivandrum. They become problems if it is appropriate to apply health
education in India as it is applied in Britain - it may or may not be so. The
complexity of some of these areas is such that to label them problems is
disfiguringly reductionist. I propose them more as warnings for our co
operation on matters of health education. Sometimes we need such warnings;
let me give one illustration of this need by referring to a book, which I think is
most excellent and useful.
The WHO manual: AIDS Home Care Handbook I thoroughly recommend as a
source book for those working in health education in the AIDS care field. But if
we check it against the list I have given above, do we not feel its inadequacies?
It leaves all the complex problems of social translation unattended. Project
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September 1994
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Health Education in India
workers do not have the time, energy, or resources to do the kind of translating
that is necessary and work out the implications of the books' contents. There
will be problems of implementation due to any of my seven points, and these
problems will vary from State to State, and even from District to District; and
there will be many other points that a local worker would add to my list.
Just
from that list, however, such questions as these might arise: what part can
women decently play in care for non-family members?; what of the problems of
giving care to someone of differing social status?; what of the influence of
control of care by inappropriately trained medical personnel?; how can the
distribution of the handbook by a state organisation be done through an NGO
when it wishes no contact with the state?; how do you get round the simple
fact that the key workers involved do not read any of the languages in which
the book is printed?; how can you give instructions like "Couples should talk
about sex" in a society where there is no history of such talk? That is a good
book; there are plenty less well thought out.
On my visit I often saw good materials, like that book, being laid aside because
the sorts of problems I raised in the last paragraph are greater than any possible
benefits. Extending British-Indian co-operation in health education must include
helping address such 'problems’ and 'translations'. This section has dealt with
general cultural differences that strike a Westerner for the implications they
have for health education in India. We can call these implications obstacles
and try to overcome them, but that is a particular construction. They are at
any rate challenges which present opportunities and possibilities which may not
have been thought of in health education as it is practised in Britain. I believe
this foregoing section relates very simply to British Indian co-operation. In all
our dealings over health education we have to take these points on board;
points which cost money and take energy to address.
During my visit it was
rare to see sufficient account being taken of these factors.
Section Two
-
Action to Enhance Co-operation on Health Education.
The factors presented in the last section, which impinge on health promotion,
are not ones for specific action.
All the work we do in either Britain or India
must seek to promote the equal status of women, must recognise the diversity
of cultures in our countries, and should aim to reduce the burdens of
bureaucracy. Rather, they are points which we must remember in our
exchanges, teaching and writing. However, there are aspects of health
education where specific action seems more appropriate. Such actions, which
are often channeled through the British Council, seem widely appreciated and
the scarce resources well spent. The impression I gained from British Council
officials in India was that policy was evolving, as it always must, and that now
was a good time to make suggestions about its future direction.
And so this section makes some specific suggestions for co-operation on
matters relating to health education. Below three areas are discussed: liaison
between parallel organisations and projects, in the two countries; the exchange
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September 1994
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Health Education in India
of certain skills; and the offering of support to India in furthering its own
advantages.
1) Liaison between British and Indian Organisations.
There are many ways in
which we can exchange ideas between our two countries.
The British Council
is active in promoting these exchanges.
The linking of academic institutions,
supporting student study in Britain, and funding visits to India by individuals are
all valuable services in the cause of co-operation. There are advantages and
disadvantages to all such links. One type of link I did not meet was the pairing
of non-academic organisations or projects; for example providing support for an
NGO, like the West Bengal Voluntary Health Association, in finding a sister
organisation in Britain with whom a partnership could be established. Such a
link would then serve as the conduit for visits and studentships, so obviating
some of the problems with, for example, experts from Britain who are unable to
translate their ideas to fit the Indian context, or with students whose British
education fails to benefit more than the individual. This type of twinning was
suggested to me by a number of organisations. The benefits were seen in
terms of exchange, information, and potential accreditation and stimulation for
workers. But projects in India have no way of building such bridges alone,
they need the pro-active help of an organisation like the British Council to set up
the links with appropriate bodies.
2) Dissemination of Western Skills. Despite being a teacher and trainer I have
no strong beliefs about the effectiveness of the processes with which I am
involved. We learn best by doing the job alongside someone who does it very
well.
But training is fashionable, and if we believe that good doctors can be
made by their training, then we should also acknowledge that good managers,
educators and communicators can be trained as well.
Western style health
education requires a range of skills some of which, at this particular time, may
be better developed in Britain than they are in India.
Below I have selected
five examples where I was told that development of skills could be beneficial,
and where I also observed the scope for such development.
a)
Processes of management. From a western perspective it did seem that
the quality of management of organisations I visited was not as high as
might be expected given the great resources of creativity and intelligence
that are clearly in evidence amongst the workers wherever I went. It
may be that notions of effective management do not transpose sensibly
between our two societies.
The problems I saw of managers swamped
by trivial decisions and responsibilities, by failures of prioritization and
selection, and by failures of providing adequate support for staff, may
arise as part of a wish by workers not to be burdened by management
worries, and a wish to keep patriarchal organisations as a protection to
the workers. Certainly, questions of efficient practice must be placed in
their social context. However, at present management practice in nearly
every project and organisation I visited used financial resources poorly.
I was not led to believe that alternatives had been examined and rejected,
and I was not shown that the social context really demanded these
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September 1994
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Health Education in India
apparent inefficiencies.
I believe rather this lack of training is connected
with point 3 in the previous section on medical personnel. Appointments
of senior people are sometimes made, not because the person has the
skills or experience for the job, but for other reasons.
It would seem helpful if more people amongst senior management in the
field of health education were offered western management training to
see if they felt it was of any value to them. Even if it did no more than
provide a breathing space for managers to reflect on their own practice, it
might be useful. Queen Margaret College has a number of short courses
related to the needs of such health professionals, some further details are
given in Appendix 2.
b)
The Understanding of behavioural change. Our understanding of human
behavioural change is still tentative, we have a great deal to learn. But
we do know processes which are not effective in bringing about change,
and others which may be of some value. The health educator needs to
share in the experience we have gained, or past mistakes may be
repeated. I did see quite senior people in health education who were
possibly unsure of basic distinctions, as, for example, between the notion
of giving information on the one hand, and education on the other (as in
the phrase Information, Education and Communication), or between the
concept of attitude and that of behaviour. Again it might be that
effectiveness could be increased if more training in these areas was
available. This is my own special area of interest and since my return
from India I have been developing a set of postgraduate courses that are
intended to be of value to workers in health education from South Asia,
some details of which are given in Appendix 3.
c)
A problem solving orientation The first section of this paper, on obstacles
to health education, illustrates how necessary it is for health workers to
have a problem solving orientation to their work. As a visitor I did
wonder if some of the health worker training lacked this orientation.
Fact based learning is useful for classification and aspects of diagnosis,
but not much help in developing problem solving skills. To help us solve
problems, whether it be the problem of coping with 200 patients each
morning, or the problem of standing all morning on an anaesthetic foot
while cutting hair, we have to see the problem as a challenge which we
will solve. Instilling this attitude of mind can turn the whole process of
training students into a much more enjoyable experience for all
concerned. It may be that some trainers and teachers have not had
enough of this pleasure, and when it comes to sharing our skills we
should, therefore, ensure that everyone has more of it!
d)
Communication skills. The importance of two specific skills was repeatedly
pointed out to me: listening and sympathising. The reasons why we are
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September 1994
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Health Education in India
unable to listen or sympathise are many. (Having 200 patients waiting
to be seen is not a bad excuse for their lack!) Health education requires,
for many reasons, a facility in both of these.
We can be helped to be
better listeners, and we can be helped to express our sympathy
appropriately. I saw workers being trained in these areas by progressive
staff, and in progressive projects, but such training was not common.
Ways should be found to support and promote those already skilled in
this type of training.
e)
Skills of monitoring and evaluation. Monitoring and evaluation are skills
continuously exercised by all good managers and teachers in their
endeavours to improve effectiveness and efficiency. Increasingly we are
also asked to provide evaluation in a documented and official manner.
Good evaluations are worth a great deal, for however splendid a project
might be, its splendour is enhanced if others have access to learning from
its strengths and weaknesses. In India I saw excellent examples of
insightful evaluation of projects, notably again from VHA1. However I
also saw, and not least at a national level, documents claiming to be
evaluations, but which gave the appearance of being aimed at reassuring
senior managers, rather than improving future performance. I did meet
quite a number of senior workers who were a little rusty on notions of
setting objectives, or monitoring processes. In the light of the pressure
on many organisations to produce evaluations of an internationally
acceptable standard, our experience of developing evaluation techniques
could be more widely shared.
These five areas provide specific examples of training which is available in
Britain, and could be tailored to Indian needs; that is, of course, if it is felt to be
appropriate for India to take on the style of health education that we have
adopted in Britain.
3) Developing advantages. From a western perspective, it would seem that
India has certain disadvantages in health education as outlined in the last
section. My reaction to this is two-fold. Firstly, people seem far too willing to
accept western ideas and techniques, in particular to accept that western health
education could and should be imported, more or less as it stands. Personally I
am not convinced it can, or should be, so easily accepted. Secondly, I met a
tendency to concentrate on 'disadvantages'. Steps are taken to re-educate
doctors, or to reduce status distinctions, or to involve women in decision
making, or to improve sex education: and this is all surely well and good. But
what about looking the other way? What are India's strengths for health
education? This was not a question which came easily into discussions - it
was, I think, always novel to those hearing it. I wish simply to suggest four
important strengths that I believe India has for the promotion of health; t
strengths I did not hear discussed except at my instigation.
Il f
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ano
OOCUMcNTATION
Colin Brydon
September 1994
\\
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j
-
Health Education in India
The ability of charismatic figures to lead large sections of the population
over matters of important principle. India has a history rich with
charismatic figures. Repeatedly people appear who seem to act from the
highest of motives to help fight oppression and mis-government, and
who, at the same time, promote the best of human moral values. We
have a lack of such figures in Britain. India has charismatic leaders and
people who are willing to listen to them which, from a health education
point of view, seems a great advantage. I wonder to what extent those
concerned with health education have tried to identify and work with
such leaders, to understand how their charisma works, and to see if there
are ways in which it might be of use in the face of present problems?
The ability of women's movements to be formed, gain ground and change
the law in very short periods. Whatever the generally poor status of
women in terms of social power, it does seem that on certain occasions
very strong movements flourish. Obvious examples include the tree
hugging of women protecting their environment in North India and the
ban on alcohol sales in Andrea Pradesh villages in South India. Neither
of these movements were in states where women's voices are thought to
be strong. Many features of the alcohol sale ban are fascinating. The
speed of the whole process, the anti-political nature of it (the women
were very clearly only concerned with their own villages), and the fact
that it attacked a male preserve, are all intriguing pointers. Nowhere did
I meet workers in health education trying to understand the principles of
these powerful movements, principles which might well have bearing on,
for example, the AIDS problem.
The Hindu ethic of respect and equality between living beings, and the
family and social values which stem from that ethic. One of the clearest
contrasts between Indian and British society is the place that a
systematic code of ethics has in the society. In India religion, in a broad
sense of the word, permeates every conversation and event. To an
outsider this would appear to be an enormous advantage in the promotion
of health, for apposite Hindu stories and parables abound and are known
to all. Environmentalists are already making use of traditional beliefs in
their work of protection. Surely there must be a rich fund that could be
used to help society defend itself against the attack of AIDS? In Britain
the puritan Christian ethic seems to have rather worked against the
control of AIDS; much Hindu literature is not so puritanical. I did not
hear workers speaking of dialogues with Hindu priests to explore the joint
work that they might do together.
A wealth of human energy and talent that responds well to creative
leadership. Such a wealth that I can only assume that somewhere in
India any points I might make have already been fully debated and
explored.
Colin Brydon
September 1994
page 12
Health Education in India
While it is important to address weaknesses, it is also important to 'play to our
strengths'. Understanding strengths and the ways that we can use them was
not a strategy I saw being adopted. I wonder why? In the burgeoning field of
AIDS work in India, I only met two teachers (at the Tata Institute in Bombay),
who seemed to be thinking along these lines. Exploring ways of exploiting
strengths should not be expensive and might bring quick results, whereas re
educating doctors, or encouraging women to more public participation, may
take generations.
Conclusion.
The points made about obstacles to health education, and areas for enhancing
co-operation, are largely based on observation of leprosy and AIDS work.
However, from my discussions with a range of organisations I believe these
points may be more generally true of health education.
They are clearly points
made by me with one eye on our education and training systems, for this is my
particular area of interest.
And I would stress that it is indeed a particular
perspective. More widely, exciting programmes and initiatives in health work
abound in India, some stem from national agencies, some from foreign
institutions (such as the British Councils programme of AIDS work in West
Bengal) and some from the creative NGOs that have already been mentioned
(Chitibani, Apnalya, and ARFI). Nothing that has been said in this paper is
meant to subtract from our expectations from such sound work. Rather as
these programmes mature, the place of health education and training becomes
more central. The points I have made are intended as prompts in that context.
Health education is a key area in any developmental health work. It is a
fascinating area where Britain and India have so much to learn from, and give
to, each other. I do hope I can be part of our increasing co-operation.
Colin Brydon
September 1 994
page 13
Health Education in India
Appendix 1 - Individuals and organisations who
contributed to the ideas in this paper.
Anjiabag, Mrs Ferulie, Xavier Institute of Communications,
St Xavier College, Mahapalika Marg,
Bombay
Antia, Dr N.H.,
Foundation for Research in Community Health, 84-A, R.G.Thadsni Marg, Worii,
Bombay
Arole, Drs Raj & Maybel,
Comprehensive Rural Health Project
Jamkhed, District Ahmednagar, Maharastra 423 201
Attawell, Kathy,
AHRTAG, 1 London Bridge Street,
London SE1 9SG
Bailey, Mr Mike, HIV & Develop't Specialist, 111 Addiscombe Court Road,
Croydon, Surrey CRO 6TX
Balaji, Dr L.N., Health Section,
United Nations Children's Fund, India Country Office,
Unicef House, 73 Lodi Estate,
New Delhi 110 003
Bjerregaard, Donna,
Programme Officer Regional Project on HIV/AIDS,
U.N.Development Programme, C-199 Defence Colony,
New Delhi 110 024
Buchannan, Dr Douglas, Lead Consultant,
Health Department,
British Council, Medlock Street,
Manchester M15 4AA
Chand, Dr A.Dyal,
Insititue of Health Management,
Pachod, District Aurangabad Maharastra 431 121
Chitale, Ms Vineeta, Lecturer Medical and Psychiatric Social Work,
Tata Institute of Social Sciences, Post Box No 8313, Sion-Trombay Road,
Bombay 400 088
Colin Brydon
September 1994
page 14
Health Education in India
Chowdhury, Dr Shankar,
NGO AIDS Cell, Centre for Community Education,
All India Institute of Medical Sciences, Ansari Nagar,
New Delhi, 110 029
Cross, Hugh, Department of Podiatry,
Queen Margaret College,
Edinburgh
Cutting, Dr William,
Department of Child Health, 17 Hatton Place,
Edinburgh EH9 1 UW
Dandekar, Mr Ramesh, Development Services Offcer,
British Council Division, British Deputy High Commission,
Mittal Tower, 'C' Wing, Nariman Point,
Bombay, 400 021
Dasgupta, Mr P.R., Secretary,
National AIDS Control Organisation, Second Floor, Red Cross Building,
1 Red Cross Road,
New Delhi 110 001
Ganesh, Mr A.K., Project Manager,
AIDS Research Foundation of India, 124/1 G.N. Chetty Raod, T.Nagar,
Madras 600 017
Gilada, Dr I.,
Indian Health Organisation, Municipal School Building,
J,J,Hospital Campus, Byculla,
Bombay
Glick, Mr Robert,
Programme Officer Regional Project on HIV/AIDS,
U.N.Development Programme, C-199 Defence Colony,
New Delhi 110 024
Gopinath, Mr C.Y.
Sol Features, 5 'Y' Wing, Sai Kirti Building, Anant Patil Marg, Dadar,
Bombay 400 028
Goswami, Dr P.K.,
Voluntary Health Association of India, Tong Swasthya Bhavan,
40 Institutional Area, Near Qutab Hotel,
New Delhi 110 016
Colin Brydon
September 1994
page 15
Health Education in India
Gross, Dr Bob, Senior Health and Population Advisor,
ODA,
94 Victoria Street,
London SW1E5JL
Hubbard, Mr John, Project Manager,
The HIV/STD Advisory Centre, 75 York Road,
London SE1 7NJ
Hubly, Dr John, 21 Arncliffe Road,
Leeds LS16 5AP
Jah, Dr Shiras,
Advisor on Health Promotion for South Asia,
W.H.O., Room 213, World Health House, Indra Prash Estate,
New Delhi
Jeyakumar, Mr Daniel,
Finance Officer,
The Leprosy Mission, CNI Bhavan, 16 Pandit Pant Marg,
New Delhi 110 001
Kannapiran, Mrs Chandra, Head of Communications,
Voluntary Health Association of India, Tong Swasthya Bhavan,
40 Institutional Area, Near Qutab Hotel,
New Delhi 110 016
Kavi, Ashok Row,
Bombay Dost, Flat 10 Riviera, 15th South Road,
Off North Avenue, Santa Cruz (West),
Bombay 400 054
Khodakevich, Dr Lev,
Medical Officer Global Programme on AIDS,
World Health Organisation, IRCS Building, Second Floor, 1 Red Cross Road,
New Delhi 110 001
Kickbush, Dr Ilona,
Head of Division, Room 5182,
Division of Health Education and Promotion,
W.H.0. 20 Ave Appia,
1211 Geneva 27
Krishna, Dr Nandutha,
Director C.P.R.Environmental Education Centre,
C.P.Ramaswami Aiyar Foundation, A Eldams Road,
Madras 600 018
Colin Brydon
September 1994
page 16
Health Education in India
Kumar, Mrs Usha,
British Council Division,
British Deputy High Commission, 737 Anna Salai,
MADRAS 600 002
Lakhumalani, Ms Veena, Programme Officer,
Brtish Council, British Deputy High Commission, 5 Shakespeare Sarani,
Calcutta 700 071
Larivee, Ms Carol,
Health Education Specialist, Global Programme on AIDS,
World Health Organisation, IRCS Building, 2nd Floor, 1 Red Cross Road,
New Delhi 110 001
Lucas, Sue,
UK NGO AIDS Consortium, 37/39 Gt. Guilford Street,
London SE1 OES
Mahalingam, Mahesh,
NACO,
IRCS Building, 2nd Floor, 1 Red Cross Road,
New Delhi 110 001
Majumdar, Mr Dilip,
Producer Adult Education Through Radio, Chetana,
Chitrabani, 76 Rafi Ahmed Kidwai Road,
Calcutta 700 016
Manorama, Dr Bawa,
Member-in-Charge Environment, Training & Seminars,
All India Women's Conference, S-66 Panchshila Park,
New Delhi 110 017
Mehta, Mrs Annabel,
APNALAYA, 75 Bhulabhai Desai Road,
Bombay 400 026
Menon, Mr Manjoo,
Advisor Soc for care of Children with multiple handicaps,
RAKSHA, c/o International Services, XXIV/499 Marar Road, P.B. No 626,
Wellington Island, Cochin 682 003
Meshram, Dr Deepak,
Senior Programme Co-ordinator,
Christian Medical Ass of India, Plot No 2, A/3 Local Shopping Center,
Janakpuri,
New Delhi 110 058
Colin Brydon
September 1994
page 17
Health Education in India
Moore, Ms Maureen,
Scottish AIDS Monitor, 26 Anderson Place,
Edinburgh EH6 5NP
Nadkarni, Prof Vimla V.,
Head of Dept Medical and Psychiatric Social Work,
Tata Institute of Social Sciences, Post Box 8313, Sion-Trombay Road,
Bombay 400 088
Naidu, Mr,
Association for the Physically Handicapped, Hennur Road, Lingarajapuram,
Bangalore 560 084
Nandini, Mrs Rao,
APNALAYA, 75 Bhulabhai Desai Road,
Bombay 400 026
Naryan, Drs Ravi & Thelma,
Community Health Cell, 367 Srinivasa Nilaye, Jakkasandra,
1 Main, 1 Block Koramangala,
Bangalore 560 034
Neill, Ms Maryanne,
Management Training Officer, Room M 315,
GPA, WHO,
20 Ave Appia,
1211 Geneva 27
Nesargi, Mr Vijay,
Head Developmental Service British Council Division,
British Deputy High Commission, Mittal Tower, 'C Wing, Nariman Point,
Bombay 400 023
Pachuri, Dr Saroj,
Program Officer,
The Ford Foundation, 55 Lodi Estate,
New Delhi 110 003
Panicker, Mr P.N.,
KANFED, Saharadha Bhavan, Kannayattu Muleu, near DPI,
Trivandrum 695 010
Patil, Ms Shilpa,
Manager HIV/AIDS Project,
Population Services International,
Cursondas Natha Gorgaon Sanitorium, Trust Building,
House No 149/151, Raja Rammohan Roy Road, Behind Khadi Stores,
Bombay
400 004
Colin Brydon
September 1994
page 18
Health Education in India
Paul, Mr,
Head of Department Department of Physiotherapy,
The Leprosy Hospital, Naini, Allahabad,
Utter Pradesh
Pett, Ian,
British Council Division, British High Commission, 17 Kasturba Gandhi Marg,
New Delhi
Poddar, Dr D.P.,
Executive Secretary,
West Bengal Voluntary Health Association,
19A Dr Sunari Mohan Avenue, 1st Floor,
Calcutta 700 014
Prakash, Mr Jnan,
Chief Coordinating Officer,
Indian Institute of Training and Development, Srijani, P.O. Joka,
P.S. Thakurpukur, Dist. 24 Parganas (South),
(Opp Thakurpukur Cancer Hospital),
West Bengal
Roberge, Father Gaston,
Director,
Chitrabani, 76 Rafi Ahmed Kidwai Road,
Calcutta 700 016
Rohde, Dr Jon,
UNICEF Regional Office, 73 Lodi Estate,
New Delhi 110 003
Roy, Mr P.K.,
Superintendant,
The Leprosy Mission Hospital, P.O. Naini, District Allahabad,
Uttar Pradesh
211 008
Sabherwal, Mrs Veena,
NACO, IRCS Building, 2nd Floor, 1 Red Cross Road,
New Delhi 110 001
Salunke, Dr Subhash,
Add Director Health Services,
Directorate of Health Services, Govt Dental College Bldg,
4th Floor, P D'Mello Raod,
Bombay 400 001
Colin Brydon
September 1994
page 19
Health Education in India
Samson,Dr P.D.,
Richardson Leprosy Hospital,
Miraj. Sangli District,
Maharastra 416 410
Sen, Mrs Papiya,
Co-ordinator AIDS Control Programme,
West Bengal Voluntary Health Association, 48 Gorachand Road,
Calcutta 700 014
Singh, Mr Kartar,
Senior Projects Officer British Council Division,
British Deputy High Commission, 737 Anna Salai,
MADRAS 600 002
Singh, Mrs Gail, Country Representative,
DKT India, Ameya, 4th Floor, 346-B Linking Road, Khar (West),
Bombay 400 052
Singh, Dr Bir,
Associate Professor Centre for Community Medicine,
All India Institue of Medical Sciences,
New Delhi 110 029
Singh, Dr, Health Section,
British Council Division, British High Commission, 17 Kasturba Gandhi Marg,
New Delhi
Singh, Drs Sukant & Sherin, 73 Karam Chand Lay Out,
10th Cross, Hennur Road, Ligarajapuram,
Bangalore 540 084
Solomon, Dr Suniti, Director,
Y.R.G. Centre for AIDS Research & Education, 1 Raman Street,
Madras 600 017
Subramoni, Mr T.K., The Librarian,
The British Library, YMCA Building,
Thiruvananthapuram, 695 001
Sundararaman, Dr S., Director,
AIDS Research Foundation of India, 124/1 G.N.Chetty Road,, T.Nagar,
Madras 600 017
Taylor, Drs Sandy & Chris,
C/o Action Health 2000, The Gate House, 25 Gwydir Street,
Cambridge CB1 2LG
Colin Brydon
September 1994
page 20
Health Education in India
Tekur, Dr Shirdi Prasad, Co-ordinator,
Community Health Cell,
367 'Srinvasa Nilaya', Jakkasandra, 1st Main,
1st Block, Karamangala,
Bangalore 560 034
van Dam, Dr Johannes,
Medical Officer Global Programme on AIDS,
World Health Organisation, IRCS Building, 2nd Floor, 1 Red Cross Road,
New Delhi 110 001
Walter, Dr Cornelius, Director for South Asia,
The Leprosy Mission, CNI Bhavan, 16 Pandit Pant Marg,
New Delhi 110 001
Watson, Jean,
Leprosy Mission International, 80 Windmill Road,
Brentford, Middlesex TW8 OOH
Zavriew, Laurence,
PANOS, 9 White Lion Street,
London N1 9PD
3)
HfC l\0
Colin Brydon
September 1994
page 21
Health Education in India
Appendix 2
-
Management in Health Care.
This course for managers in health care has been designed for health workers who
come from a variety of cultural backgrounds. The course is in two parts. Each part
is equivalent to a postgraduate level module in the Queen Margaret College scheme,
that is twelve such modules make up a masters degree. Successful completion of
part one is a precondition for starting the second part. It is intended that the course
be available through different delivery patterns. These include an intensive two week
period in the summer, with appropriate preparatory and succeeding work, and the
possibility of intensive local delivery in other countries.
Part I
- Principles of Human Resource Management as Applied to Health
Care. This part of the course is designed for those who have responsibilities
towards other managers or staff in the health professions. It examines human
resource management, exploring major developments from the traditional human
relations approach developed in the sixties, through to critical consideration of
recent fashions in management.
Principles drawn from psychological and
sociological traditions are shown to underlie many aspects of modern work in
health management.
1
Personal
Development
2
Managing
Competently
3
Managing the
Selection and
Development of
Staff
Self management, (e.g. Schoen's work on reflective
practice). Personal development plans in health care
work: e.g. Boydell and Pedler (Self-development),
Woodcock and Francis ('Blockages'). Managing self in
order to manage others - theories of learning and
management practice (Argyris).
Managing in health and social care - inter-agency co
operation. Problems of interprofessional language and
cultures. The contribution of Human Resource
Management Theory (McGregor) in the context of
modern health organisations: Taylorism to Contingency
Theory. Models of management: Mintzberg, 'Change
Masters', 'Gurus' of the 90's, empowerment.
Equality of opportunity and the recognition of diversity
within health work - problems of countering
discriminatory practices (e.g. sexism, racism) in the
workplace. Theories of recruitment and selection.
The use of equal opportunities selection procedures,
skills involved in producing job analyses, the practice of
interviewing and the science of selection in health care.
Staff development, strategies of performance appraisal.
The implementation and evaluation of appraisal
schemes. Feedback and support mechanisms,
including mentoring.
Continued
Colin Brydon
September 1994
Page 22
Health Education in India
Principles of Human Resource Management.
(Continuation)
Part 1
4
Manager-Employee
Relationships
5
Teamwork
Power relationships in the work situation. Unitary,
radical and pluralist perspectives on health organisations.
Managing effectively in conflict situations. Sources of
interpersonal conflict; eg change, role conflict,
resourcing, inequality. Models for handling conflict such
as: Conflict Management (Thomas), Conflict Resolution
(Bertinasco), and Assertive/Co-operative (Whetter and
Cameron). Personnel management, organised workers'
unions; negotiating and bargaining in the context of
health care.
The formation of teams in the workplace: from Bion to
Belbin. Group size and effectiveness; Belbins typology
for the recognition of roles. Use of Leavitt's
communication network.
Part II
-
-
Managing the Organisation.
This part of the course enables the use
of skills, expertise and theory developed in Part I to be translated directly into
the changing organisation. This second part of the course can, therefore, be
regarded as the macro view of organisations, while Part I presented the micro
view.
1
Managing Change
2
Managing for
Quality
3
Managing for
Customers
4
Planning Quality
Services
Colin Brydon
Causes, consequences and challenges of organisational
change. Recent western need for increased
effectiveness in health delivery.
'Death of Bureaucracy'
(Bennis) and the creation of 'adaptive structures'. 'Fast,
flat, flexible' organisations. Modern challenges to
Weber's view of organisations. The impact of
managerialism on health organisations.
Explorations of Donabedian's work (TQM) and its
applications to health management. Concepts of
quality, applicable in health and social care. Total
Quality Management and its place in health work.
Relationship between 'quality care', equity, and value for
money.
Organisational cultures. Ideas, values, attitudes and
beliefs within the client/patient oriented culture.
Recognition of changing organisation with specific
reference to (i) power shifts in doctors' management
roles, (ii) power shift between patient and provider.
Strategies to promote 'customer' services and to further
develop customer orientated approaches in health care.
Explorations of means of obtaining the views of the
'consumer' on satisfaction with services.
Organisational analysis of the working environment to
enable delivery of quality services including:
environment, task, people, technology, communications,
policies, socio-demography, resources, structures,
cultures, power imbalance, and professionalisation.
September 1994
page 23
Health Education in India
Appendix 3 - Course on Health Behaviour and Health Education.
This course has been designed for health workers who come from a variety of cultural
backgrounds. The course is in two parts. Each part is equivalent to a postgraduate
level module in the Queen Margaret College scheme, that is twelve such modules
make up a masters degree. Successful completion of part one is a precondition for
starting the second part. It is intended that the course be available through different
delivery patterns. These include an intensive two week period in the summer, with
appropriate preparatory and succeeding work, the normal weekly delivery over a 12
week period, and the possibility of intensive local delivery in other countries.
Part I
-
Principles of Human Change.
This part of the course examines the
psychological basis of bringing about change in human health related behaviour
through education, training and persuasion.
1
Definitions,
Concepts and
Issues
2
Ethical Problems
3
Theories of Health
Behaviour Change
Related Theories
of Change
4
5
Roles and Control
6
Learning
7
Groups
8
Learning in
Groups
The Community
and Change
9
10
Communications
11
Social and
Organisational
Change
Topics
12
Colin Brydon
Health education, health promotion, health, wellness,
behavioural change, education, persuasion, attitude
change, models of change, research and relation to other
disciplines.
Ethics of health education and persuasion, conflicts of
interest, education versus indoctrination, advertising
health; specific issues concerning: children, schools,
AIDS, nutrition and mental health.
Health belief model. Reasoned action model, Attribution
theory, attitude-behaviour controversy.
Classical conditioning. Learning theory, consistency.
Dissonance and balance. Conflict theory, attitude change,
Information-integration, Elaboration theory.
Patient-provider interactions, compliance, health
behaviour, illness behaviour, control and helplessness.
How we learn, teachers and learners, learning as adults,
teachers' roles.
Social learning theory, social support, interpersonal
persuasion, group dynamics and communications.
Ways of learning together, participation, adult groups in
education.
Community organisation, social exchange theory, citizen
participation, effects of customs and beliefs, action
research.
Models of communication, Yale model, persuasive
communication, information, factors in communication,
proof and reasoning.
Persuasion in organisations, diffusion of innovation,
marketing, social marketing, advertising, propaganda,
occupational health and worksite.
AIDS, nutrition, mental health, smoking drugs, alcohol,
cancer, pain, exercise, stress, cardiovascular system.
September 1994
Page 24
Health Education in India
Putting Principles of Change into Practice. This part of the course is
concerned with the implications for practice of the ideas that were examined in
part I. In it aspects of health promotion are examined for the help that
psychological principles can be to their success.
Part II
1
Needs and Goals
2
Evaluation
3
Planning
4
Settings
5
Client Groups
6
Facilitating
Learning
7
Group Learning
8
Learning in the
community
9
Mass Media
10
Presenting the
Message
Institutional
Change
11
12
Topics
Colin Brydon
Assessing needs and priorities, diagnosis of needs in
behaviour, education, organisations, administration and
epidemiology. Developing objectives and learning goals.
Why evaluate? The effectiveness of health education.
The evaluation of: needs, processes, effects, impact,
learning and teaching. Methods: surveys,
questionnaires, literature reviews, focus groups and
consultants.
Sessions, programmes, schemes of work, campaigns.
Planning for different settings. PRECEDE - PROCEED.
Who does the health education? Specific consideration
of: schools, community, occupation, health care, and
local authority.
The special needs of: mothers and infants, children,
adolescents, young adults, middle age, later life; life
span considerations. Ethnic groups, physical disability,
chronic disease, mental disability, communication
disorders.
Learning in groups, blocks to learning, activity and
learning, techniques for facilitating learning, visual and
other aids, learning in extension and at a distance.
Communications skills, discussion skills, leadership, team
building.
Learning and working with the community, working
collectively, case studies of community learning, the role
of the media.
Working with mass media, broadcasting, media
advocacy, press releases, journalism and propaganda.
Visual design and presentation, visual aids, stories, role
playing, puppets, drama, local resources.
National health education plans, implementation of
health education in Scotland, implementation of health
education in developing countries, agencies of health
education, the World Health Organisation and health
education.
AIDS, nutrition, mental health, smoking drugs, alcohol,
cancer, pain, exercise, stress, cardiovascular system.
September 1 994
Page 25
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