General

The roles of the health educators in our society: A gospel that has attracted few converts

Introduction

McKinzie, Neiger and Thackeray (2009) defined a health educator as a professional who engages in educating people about health, which include education in areas concerning environmental health, physical health, social health, emotional health, intellectual health, and spiritual health. Health educators can also be referred to as an individual or a group of people teaching others to learn and behave in a manner conducive to the promotion, maintenance, or restoration of health. However, as there are multiple definitions of health, there are also multiple definitions the role of a health educator (Donatelle, 2009).

The Joint Committee on Health Education and Promotion Terminology of 2011 defined health educator as an individual who possess any combination of planned learning experiences based on sound theories that provide individuals, groups, and communities the opportunity to acquire information and the skills needed to make quality health decisions.

World Health Organization (WHO, 2008) identifies the role of a health educator as an individual who consciously constructed opportunities for learning which involve some form of communication designed to improve health literacy, including improving knowledge, and developing life skills which are conducive to individual and community health.

In order to maintain optimum condition of public health and control harm from infectious diseases, there is a clear need to understand the need and means for preventing occurrence of illness, death, and rising health care costs which could best be achieved through a focus on health promotion and disease prevention. At the heart of the new approach was the role of a health educator. A health educator is “a professionally prepared individual who serves in a variety of roles and is specifically trained to use appropriate educational strategies and methods to facilitate the development of policies, procedures, interventions, and systems conducive to the health of individuals, groups, and communities” (Joint Committee on Terminology, 2011).

Conceptual framework

According to Cottrell, Girvan and McKenzie (2009), a health educator is professionalwho possesses knowledge and skills based upon theories and research to promote health education behaviour change in individuals and populations. Health educators draw from various sciences to promote health and prevent disease, disability, and premature death.

Simons-Morton, Greene and Gottlieb (2010) stated that health educators provide information on health and health related issues. They assess health training needs and plan health education programmes. They may also specialize according to specific health concerns, illnesses, or work or training setting. Health educators may work as independent consultants or in health departments, community organizations, businesses, hospitals, schools, or government agencies.

Health educators in the opinion of Bundy (2006) perform health training needs assessments, design and develop health education programs, publish health education materials, information papers, and grant proposals, develop health education curriculum and teach health in public and private schools.A health educator is responsible for educating people about the importance and development of healthy behaviours and to implement programs and/or strategies to improve overall health in a community or of an individual. They collect information and target health concerns with individuals, communities or of a specific population to develop programs of wellness and the utilization of available health care services (Patterson & Vitello, 2006).

Kann, Brener and Allensworth (2011) describes health educators as professionals who promote, maintain, and improve individual and community health by assisting individuals and communities to adopt healthy behaviours. They collect and analyze data to identify community needs prior to planning, implementing, monitoring, and evaluating programs designed to encourage healthy lifestyles, policies and environments.

The role of health educators in health promotion

A health educator is a professionally prepared individual who serves in a variety of roles and is specifically trained to use appropriate educational strategies and methods to facilitate the development of policies, procedures, interventions, and systems conducive to the health of individuals, groups, and communities (Joint Committee on Terminology, 2011). The roles of health educators in health promotion can be outlined into seven areas of responsibilities which are:

Assessing individual and community needs for health education:

Provides the foundation for programme planning
Determines what health problems might exist in any given groups
Includes determination of community resources available to address the problem
Encourages the population to take ownership of their health problems
Includes careful data collection and analysis

Plan health education strategies, interventions, and programs

Carry out health needs assessment for the community.
Development of goals and objectives which are specific and measurable.
Develop interventions that meet health goals and objectives

Implement health education strategies, interventions, and programs

Implementation is based on a thorough understanding of the priority population
Utilize a wide range of educational methods and techniques

Conduct evaluation and research related to health education

Depending on the setting, utilize tests, surveys, observations, tracking epidemiologicaldata, or other methods of data collection
Health educators make use of research to improve their practices.

Administer health education strategies, interventions, and programs

Administration is generally a function of the more experienced practitioner
Involves facilitating cooperation among personnel, both within and between programs

Serve as a health education resource person

Involves skills to access needed resources, and establish effective consultative relationships.

Communicate and advocate for health and health education

Translates scientific language into understandable information
Address diverse audience in diverse settings
Formulates and support rules, policies and legislation
Advocate for the profession of health education

Unhealthy lifestyle concern for health educators

The major concern of health educators is to practice and encourage other people to lead a healthy lifestyle by making healthy choices. Despite the increased effort of health educators in the promotion of a healthy lifestyle, McKenzie, Neiger and Thackeray (2009) lamented that there are still a lot of people who follow unhealthy lifestyle practices. Some people would try some healthy practice, but still cling on to their unhealthy habits. They mistakenly believe that their healthy lifestyle choice would be enough to cancel out the negative effects of their bad habits. Some of the unhealthy habits as pointed out by Donatelle (2009) are:

Smoking
Inadequate sleep
Poor eating habits
Poor personal hygiene
Having too much stress
Wrong use of alcohol

Smoking:Smoking tops any list of all the major unhealthy lifestyle concern to health educators in the quest to health promotion. Smoking has numerous negative effects on the body. It can cause numerous diseases. Emphysema, lungs’ cancer, the throat and the mouth diseases, birth defects and other ailments of the respiratory system are direct results of smoking making it very difficult for smokers to maintain a good health status (Donatelle, 2009).
Inadequate sleep:One thing that a lot of people overlook when it comes to living a healthy lifestyle is getting enough sleep. It is during sleep that the body repairs the cells that have been damaged through the day of activity. Obviously, it is also the time that the body gets its rest. But some people do not give that much importance to it as they should. They are more focused on healthy eating or on getting enough exercise (Donatelle, 2009).
Poor eating habits:The common unhealthy lifestyle practice today that predisposes people to poor health status is their eating habits. The body needs nutrients which are derived from food that we eat, but the kind of food we consume has tremendous impact on our health. Most people eat food that are bad for their health such as food that are heavy on trans-fat and cholesterol and some other unhealthy foods which include processed foods that are high on preservatives and other bad chemicals (Donatelle, 2009).
Poor personal hygiene: Poor hygiene can be a sign of self-neglect, which is the inability or unwillingness to attend to one’s personal needs. Poor hygiene often accompanies certain mental or emotional disorders, including severe depression and psychotic disorders. Dementia is another common cause of poor hygiene. Other people may develop poor hygiene habits due to social factors such as poverty or inadequacy of social support. Physical disabilities can also interfere with one’s ability to care for oneself and may result in an individual being unable to attend to personal hygiene (Longo, 2011).
Having too much stress: Stress is a natural body reaction. When something in the environment threatens a person, the body feels stress which is a way of preparing it to fight or to flee at a moment’s notice. That reaction of the body was developed by our ancestors, but unfortunately in today’s modern world it can also cause problems. In a developed setting where there are few physical dangers, emotional triggers are what often cause stress and there are so many of those emotional triggers (Donatelle, 2009).
Wrong use of alcohol: Wrong use of alcohol is usually associated with various health and mental problems to users. Alcohol can damage cells in the body, especially those in the liver. It is alsoaddictive which means that a person can become dependent on it. Alcoholics can no longer function without drinking, but the alcohol that they drink is also slowly killing them (Pavlou & Lachs, 2008).

Health education core competencies

Health education, as a social science, draws from the biological, environmental, psychological, physical and medical sciences to promote health and prevent disease, disability and premature death through education-driven voluntary behaviour change activities. Health education is the development of individual, group, institutional, community and systemic strategies and focuses specifically on ways to improve health knowledge, attitudes, skills and behaviour using various approaches, including the healthy settings approach (Centre for Disease Prevention and Control (CDC), 2007).

The purpose of health education is to positively influence, through the educational process, the health behaviour of individuals and ultimately the health of communities. Health education has a long and diverse history with roots that go back hundreds of years. Today health education occurs in many settings, which according to Longo (2011) including the following:

In schools health educators teach health as a subject and promote and implement coordinated school health programmes, including health services and student, staff and parent health education; and promote healthy school environments and school–community partnerships. Working on a college/university campus health educators are part of a team effort to create an environment in which students feel empowered to make healthy choices and create a caring community. They identify needs; advocate and do community organizing; teach whole courses or individual classes; develop mass media campaigns; and train peer educators, counsellors and/or advocates. They address issues related to disease prevention; consumer, environmental, emotional and sexual health; first aid, safety and disaster preparedness; substance abuse prevention; human growth and development; and nutrition and eating issues. They may manage grants and conduct research.
In companies health educators perform or coordinate employee counselling as well as education services, employee health risk appraisals, and health screenings. They design, promote, lead and/or evaluate programmes about weight control, hypertension, nutrition, substance abuse prevention, physical fitness, stress management and smoking cessation. They may also develop educational materials and write grants for money to support these projects. They help companies meet occupational health and safety regulations, work with the media and identify community health resources for employees.
In health care settings health educators educate patients about medical procedures, operations, services and therapeutic regimens, and create activities and incentives to encourage use of services by high-risk patients. They conduct staff training and consult with other health care providers about behavioural, cultural or social barriers to health, and promote self-care. They develop activities to improve patient participation on clinical processes, educate individuals to protect, promote or maintain their health and reduce risky behaviour, and make appropriate community-based referrals and write grants.
In community organizations and government agencies health educators help a community identify its needs, draw upon its problem-solving abilities and mobilize its resources to develop, promote, implement and evaluate strategies to improve its own health status. Health educators do community organizing and outreach, grant-writing, coalition-building and advocacy. They develop, produce and evaluate mass media health campaigns.

Causes of poor adherents to advice of health educators

Health education and promotion has repeatedly suffered from several setbacks whichhave resulted to poor health status especially among the poor and people leaving in underdeveloped and developing nations in the world. According to Mayhew (2006), poor adherents to health educators can be linked to some factors which include:

Low health literacy level.
Poor socio-economic status
Inadequate health education media
Government lack of political will.

Low health literacy level: Health literacy is the ability of an individual to obtain, read, understand and use healthcare information to make appropriate health decisions and follow instructions for treatment (Pleasant & McKinney, 2011). Health literacy involves both the context (or setting) in which health literacy demands are made (e.g., health care, media, internet or fitness facility) and the skills that people bring to that situation. Low health literacy reduces attention to health education, the success of treatment and increases the risk of medical error (McMurray, 2007).
Poor socio-economic status:The socio-economic status of an individual determines his health seeking tendency and also adherent to health educators’ advices. Deaton (2012) stated that people with poor socio-economic status tend to have poor attitude toward leading a healthy lifestyle, stressing that people of high socio-economic status pay more attention to health professional advice and live longer than their counterparts with poor socio-economic status.
Inadequate health education media:Inadequate health education media hinders the ability of the populace to seeking health information. Fuchs, McClellan and Skinner (2011) stated that low ratio poor health educators to inhabitant of a community lead to poor health information dissemination which results to poor health status of the entire community.
Government lack of political will:The stance of government in health education and promotion Africa and some other under-developing and undeveloped countries in the world has become an issue of great concern.William (2009) stated that government has repeated shown lack of political will in nearly all the sectors of the economy, including health education and promotion.William (2009) claimed that government officials pay lip service to health education and promotion, divert funds means for health promotion programmes and pay lesser attention to issues of public health.

Implications of poor adherents to health education

Poor adherence to health education exposes an individual to several health challenges which affect health status of an individual. Zarcadoolas, Pleasant and Greer (2006) stated that poor adherent to health education has several implications which include:

Poor personal and environmental hygiene
Poor individual and community health status
High prevalence of communicable diseases
Low life expectancy
Exposure to epidemics
Poor health seeking tendency

Poor personal and environmental hygiene: Poor adherents to health education leads to poor personal and environmental hygiene. Nutbeam (2010) opined that health literacy of a public health necessity as people with adequate health literacy maintain a high standard of personal and environmental hygiene as opposed to those whose with adequate health education.
Poor individual and community health status: Individuals with little or no health education are more likely to face poor individual health status which in extension lead to poor community health status. Ratzan (2011) stated that the amount of health education possessed by an individual is directly related to the health status of the individual.
High prevalence of communicable disease:Communicable diseases thrive in communities where the populace lack adequate health education and poor environmental hygiene which leads to high prevalence of communicable diseases through a contaminated food (salmonella, E. coli), blood (HIV, hepatitis B), or water (cholera), bites from insects or animals capable of transmitting the disease (mosquito: malaria and yellow fever; flea: plague); and travel through the air, such as tuberculosis or measles (Glazier, 2014).
Low life expectancy: Life expectancy at birth reflects the overall mortality level of a population. The life expectancy level can be reduced or increases with the health consciousness of the people living in a community. When people maintain healthy practices, their life expectancy is increased while those with lesser healthy practices experience lower life expectancy (Rootman & Wharf-Higgins, 2007).
Exposure to epidemics: Epidemics relating to the spread of infectious diseases are caused by the lack of knowledge on specific ways a germ is transmitted and the ability for treatments to be effective in controlling the spread of the disease. There are viruses, bacteria, fungi, and protozoa classifications of disease organisms. Each strain can mutate when exposed in the human body or other living organisms and form new strains of that disease. So because of this, until new sanitation preventive measures and treatments are discovered, many diseases spread quickly resulting in an epidemic (Power, Trinh & Bosworth, 2010).
Poor health seeking tendency: Health-seeking behaviour, representing decisions and actions to seek help from the healthcare system, one of the direct causes.Acquiring adequate health education is crucial to understanding decision-making mechanisms in health related issues (Rudd, 2009).

Measures to promote health education in our society

In order to achieve effective health education and promotion, Pancer and Nelson (2009) suggested measures to improve health education to include the following:

Participant involvement: Community members should be involved in all phases of a programme’s development: identifying community needs, enlisting the aid of community organizations, planning and implementing programme activities and evaluating results. Wide and comprehensive representation of community members on programme planning bodiesprovides for a sense of ownership and empowerment that will enhance the programme’s impact.
Planning: Planning involves identifying the health problemsin the community that are preventable through community intervention, formulating goals, identifying target behaviour and environmental characteristics that will be the focus of the intervention efforts, deciding how stakeholders will be involved and building a cohesiveplanning group.
Needs and resources assessment: Prior to implementing a health education initiative, attention needs to be given to identifying the health needs and capacities of the community and the resources that are available.
A comprehensive programme:The programmes with the greatest promise are comprehensive, in that they deal with multiple risk factors, use several different channels of programme delivery, target several different levels (individuals, families, social networks, organizations, the community as a whole) and are designed to change not only risk behaviour but also the factors and conditions that sustain this behaviour (e.g. motivation, social environment).
An integrated programme: The programme should be integrated; each component of the programme should reinforce the other components. Programmes should also be physically integrated into the settings where people live their lives(e.g. worksites) rather than solely in clinics.
Long-term change: Health education programmes should be designed to produce stable and lasting changes in health behaviour. This requires longer-term funding of the programme and the development of a permanent health education infrastructure within the community.
Altering community norms: In order to have a significant impact on an entire organization or community, the health education programme must be able to alter community or organizational norms and standards of behaviour. This requires that a substantial proportion of the community’s or organization’s members be exposed to programme messages, or preferably, be involved in programme activities in some way.
Research and evaluation: A comprehensive evaluation and research process is necessary, not only to document programme outcomes and effects, but to describe its formation and process, and its cost-effectiveness and benefits.

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