Health Education: Some Principles and Practice

  • Committee on Public Education of the Commission on Cancer Control
Conference paper
Part of the UICC Monograph Series book series (UICC, volume 5)

Abstract

For a comprehensive yet manageable review of the principles of health education, as derived from behavioural studies, we can do no better than refer the reader to Section III of Health Education Monographs, Supplement No. 1, published by S. O. P. H. E.1 This excellent work reviews the “Methods and Materials in Health Education (Communication)” with separate sections on: (a) fear — arousing communications; (b) pretesting and readability; (c) audio-visual methods and materials (d) group techniques, and (e) the comparative effectiveness of different methods. Perhaps even more important than the section on methods and materials is Section IV of the Monograph dealing with programme planning and evaluation. We have not repeated references included in the S.O.P.H.E. review.

Keywords

Manifold Europe Influenza Income Radium 

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References: Principles of health education

  1. Aitken-Swan, J., and Paterson, R. (1959). Assessment of the resuts of five years of cancer education. Brit. med. J. i, 708. The assessment of five years of cancer education showed that the number of patients with breast cancer who delayed more than one month decreased. No such decrease was noted in a control area, nor did the delay for cancer of the cervix uteri decline. There was an increase in the experimental area of those with breast and cervix uteri cancer who presented themselves when the growths were of limited extent. Finally, from an interview inquiry it was found that the campaign made more impact on those with breast cancer than with cancer of the cervix uteri. One third of the patients in contact with the campaign were too afraid to act upon the advice given. Talks were more influential than articles, but reached a smaller public.CrossRefGoogle Scholar
  2. Baric, L., and Wakefield, J. (1965). A reappraisal of cancer education. Int. J. Hlth Educ. 8, 78. After reviewing the present scientific knowledge, the authors make a clear case for the role of education in cancer prevention, and pinpoint five areas where further testing and evaluation are urgently needed.Google Scholar
  3. Bharara, S. S. (1963). Joining science and tradition. Int. J. Hlth Educ. 6, 106.Google Scholar
  4. Biocca, S. M., and Joly, D. (1960). Fighting cancer in Argentina. Int. J. Hlth Educ. 3, 174. To succeed in the battle against cancer it is necessary to have available: (1) a qualified medical staff, able to make an accurate diagnosis; (2) a well-informed population, aware of the importance of early diagnosis; (3) a medical network that provides the essential facilities for such a diagnosis. The authors describe a campaign carried out in Argentina.Google Scholar
  5. Blokhin, N. N. (Ed.) (1962). Methodological Handbook of anti-cancer propaganda. Moscow: Institute of Health Education (Russian Text). This book contains articles on aetiology, pathogenesis, diagnosis, treatment and prophylaxis. It also deals directly with cancer education in two chapters and four appendices.Google Scholar
  6. Bogolepova, L. (1962). The people’s health culture. Proceedings of the Internat. Conf. on Health and Health Education, vol. 5, p. 520. Geneva: Int. J. Hlth Educ. (French text, English and Spanish Summaries).Google Scholar
  7. Bond, B. W. (1958). A study in health education methods. Int. J. Hlth Educ. 1, 41. This study compared the effectiveness of the two methods of education, namely group-discussion plus decision and a straightforward lecture, in a health education programme concerned with breast cancer. (See page 52, col. 1 of this monograph.)Google Scholar
  8. Brotherston, J. (1963). Aimless benevolence. .. . a box of tricks. .. . or? Int. J. Hlth Educ. 6, 158. In a compact but pertinent article the author considers the aims and methods of health education. The objectives are both particular and general. “The real difficulty is not to find good deeds to do, but to know where, when and with what to begin”. The author is in favour of tackling the “more circumscribed but necessary area [of] the quality and efficiency of the communication between the health worker and his patient or client”. He condemns the authoritarian attitude of nurse and doctor; they must be made to realise the need to educate — the rest will follow. With respect to the behavioural sciences, “the need now is for a statement of applied social science carefully related to the needs of health practitioners.” Training is a cornerstone to progress, and a scientific approach to the choice of objectives is required.Google Scholar
  9. Burton, J. (1964). Three uses of health education in clinical preventive and public health practice. II. The role of education in cancer prevention. Int. J. Hlth Educ. 7, 68. This is a background paper prepared by the author for the Who expert committee responsible for the technical report from which we have quoted extensively in the text of this chapter. The author’s paper is used almost in its entirety for the sections on health education within the technical report.Google Scholar
  10. Cameron, C. S. (1956). The truth about cancer, New York: Prentice-Hall, Inc., A thoughtful round up of information about cancer and its control by the then medical director of the American Cancer Society. A vigorous expression of an aggressive philosophy of public education in cancer with emphasis on the concept that “only when everyone recognizes and accepts the importance of personal responsibility will the control of cancer become a living reality.” The book has been brought up to date by the author and will be reissued by Collier Books (paperback) in 1966.Google Scholar
  11. Clemmesen, J., and Stancke, B. (1965). The effect of a cancer campaign in Denmark. S. A f r. Cancer Bull. 9, 100. Analysis of the long-term effects of an educational campaign for breast self-examination conducted between 1951 and 1955. The years of the campaign saw more cases, and more of them suited to treatment, than previous years. An improvement in survival was observed over the subsequent 9-year follow-up.Google Scholar
  12. Costalat, P. (1958). Survey on Health Attitudes. Int. J. Hlth Educ. 1, 207. The inquiry proved that the health assumptions of the young Moroccan women interviewed fitted in neither with modern concepts nor with the former popular traditions. They generally combine both, with resulting incoherence and a stagnant health behaviour. Group education is the best method in these circumstances to crystallize the information spread by mass media. Simultaneous education of parents and children is needed. The author stresses the value of interviews, and the value of sometimes appealing to ideas already accepted by some numbers of the group or basing arguments on a related subject.Google Scholar
  13. Derryberry, M. (1958). Some Problems Faced in Educating for Health. Int. J. Hlth Educ. 1, 178. Why are people so willing to take chances with their health? There is evidence of an educational need to help people relate in a more positive way to their doctors. The “teachable moment” was immediately after the condition was diagnosed: information was sought from many sources at this point, and this, as well as misinformation, was exchanged. We must prepare people to react intelligently and healthfully when they or their relatives and friends are sick; we must help people find the information they want from a reliable source. There are many examples of the risks people take with their health, why do they do so? The author takes smoking as an example of this and considers it in terms of habit formation and society. There is need for more than a statistical demonstration; the chance element is not referred to self, the emotional, irrational elements weigh strongly against the intellectual, rational arguments. We do not know nearly enough about the factors involved. There is a need for research into methods, and careful planning.Google Scholar
  14. Derryberry, M. (1960). Research: Retrospective and Perspective. Int. J. Hlth Educ. 3, 164. The primary goal of health education is to increase people’s knowledge of the scientific facts about health and to stimulate them to apply the knowledge in improved health practices. Research in health education is concerned with the process by which people change their health behavior. It includes study of all the various factors in the process and the dynamics of the relationship between these factors..... The importance of knowledge, .... of social factors; .... individual factors. It is also concerned with the character of the action that is being advocated. We need to learn what educational methods work with what kinds of people to produce what kinds of actions. It is in the dynamics of these interrelationships that much intensive work is needed. We must not mistake effort for accomplishment: evaluation is essential both in pretesting and in objective evidence of the increased information and for performance of the recommended action.Google Scholar
  15. Derrberry, M. (1960). Health education — its objectives and methods. Hlth Education Monographs No 8. The author draws an analogy between health education and medicine in their diagnostic and therapeutic processes. He further considers health education as involving forces which must be analysed, a thorough consideration being given to existing “knowledge, attitudes, goals, perceptions, social status, power structure, cultural traditions and other aspects of whatever public is to be reached. Only in terms of these elements can a successful program be built”.Google Scholar
  16. Donaldson, M. (1962). The cancer riddle: a message of hope. London: Arthur Barker. A broad presentation of information about cancer and its treatment for the general public. It includes a discussion (Chapter 18) of the role of “cancer education among the public”. Dr. Donaldson’s ardent advocacy of public education in Britain began in the early 1930s, when his views received little or no support from professional colleagues. Such programmes as exist in Britain today stem from Donaldson’s pioneer work. A number of his articles are listed in other sections.Google Scholar
  17. Ennes, H. (1958). Teachable Moments. Int. J. Hlth Educ. 1, 70. The educational component of health activity, although continous, may vary in intensity, as, for example, in emergencies. At such moments people are potentially more amenable to education. “Our experience in 1957–58 with the influenza outbreak indicates to us that a specific health threat increases public receptivity to information, and facilitates programs of action for improving general health behavior as well as protection against the present danger.”Google Scholar
  18. Erdmann, Fr. (1960). Öffentliche Krebsaufklärung als Mittel zur Prophylaxe. [Inf ormation on Cancer as a Prophylactic Means in the Fight against Cancer]. Krebsarzt 15, 240. The author describes the educational aims and methods of his department for “inf ormation on cancer and advanced training in oncology”.PubMedGoogle Scholar
  19. Hammond, E. C. (1959). Cancer education for the public in the U. S. A. In: Cancer, vol. 3, ed. by R. W. Raven. London: Butterworth & Co. (Publ.) Ltd.Google Scholar
  20. Hochbaum, G. M. (1959) Some implications of theories of communication to health education practice. Paper presented at the Seminar on Communication in Public Health Education Practice, School of Public Health and Center for Continuation Study, University of Minnesota, Minneapolis, Minnesota, June 1959 (Mimeo). In this excellent paper the author deals with “some practical implications of some of the principles of effective communication”. He begins by considering the meaning of “communication”, which can be looked on as having three levels, depending on its purpose — the mere communication of information, the performance of some fairly immediate and specific action, and, thirdly, the more fundamental change of the communicant’s attitudes, beliefs, and motivational patterns leading eventually to behavioural changes. Of fundamental importance is the subjective meaning of a message and how it fits into the already existing frame-work of a person’s attitudes, interests and needs; information may be necessary in bringing about rational behaviour, but it is not usually sufficient by itself. The author continues with a very useful consideration of the timing of a communication and the best use of the “teachable moments”, which are those moments created by certain circumstances (e.g. an epidemic) when there is an increased readiness to learn. Of importance for the continued effect of health communications is the sustaining of the emotional impact not only by correct timing but also by correctly spaced follow-up communications. Action should be provided while motivation is still close to the peak. Motivation is strengthened when an action is carried out freely and for reasons that are perceived by the individual as good and acceptable, especially where such reasons are explicitly stated. These considerations also have implications for the long-term planning and integration of programmes. The author goes on to consider the role of anxiety in health communications, its uses and abuses, and its use in cancer education. An important principle in this connection is that “the anxious person looks for reasurance and not for facts”. The advantages and drawbacks of mass media are critically reviewed. Finally a very useful section considers the relative merits of educating the public to accept broad principles concerning health, and programmes aimed at producing isolated actions.Google Scholar
  21. Hochbaum, G. M. (1960a). Research relating to health education. Hlth Education Monograph No 8. The author considers his topic in two parts. Firstly, the importance of discovering the attitudes, beliefs, needs, fears etc. of the individuals and social groups, prior to any attempt to influence them educationally: such factors influence what will be accepted or rejected, by whom, and under what circumstances. Having thus considered the “whys” of human behaviour, the author goes on to consider the ways and means of changing it: topics covered include mass media, group dynamics, and the theory of cognitive dissonance.Google Scholar
  22. Hochbaum, G. M. (1960b). Modern Theories of Communication. Children 7, 13. Based on Hochbaum (1959a).Google Scholar
  23. Hochbaum, G. M. (1960c). Behavior in response to health threats. Paper presented at the 1960 Annual Meeting of the Amer. Psychol. Ass. in Chicago, September 2nd. 1960. (Mimeo). See text of this chapter for summary.Google Scholar
  24. Hochbaum, G. M. (1962). Evaluation: A diagnostic procedure. Proceedings of the Internat. Conf. on Health and Health Education, vol. 5, 636. Geneva: Int. J Hlth Educ. The author summarizes the critical aspects in the evaluation of health education programmes as:” (1) Decisions on programme goals and methods, and decisions on evaluation techniques should go hand—in— hand. (2) Both the .... goals and the evaluation measures should be concerned with human behaviour. Non-observable aspects of behaviour, such as changes in knowledge and attitudes are only intermediary or substitute criteria. (3) Evaluation should be carried out as a continuous process [i. e. before, during and after the programme]. (4) Evaluation should not be considered as a measure of success, but as a diagnostic procedure that helps to identify effective and ineffective aspects of the programme”. Health education objectives differ from those of a health programme: the former is concerned with the behaviour which is of help in achieving the latter (which are more concerned with medical statistics).Google Scholar
  25. Hochbaum, G. M. (1965). Research to improve health education. Int. J. Hlth Educ. 8, 141. Insufficient attention is paid to differentiating between the two kinds of research: (1) aimed at improving health education, and (2) aimed mainly at advancing knowledge. The two may differ in objectives, methodology, design, and analysis and treatment of data. Much health educational research fails because it does not adhere to principles of sound scientific research; but much fails because it adheres to them too compulsively, despite the obvious limitations imposed by field conditions. In this case compromise is necessary, but with a clear realization of how compromise will affect the interpretation of data.Google Scholar
  26. Hopper, J. M. H. (1960). The value of various forms of publicity. Int. J. Hlth Educ. 3, 143. This study supports the view that “the best way of publicising health problems is to use all the forms available, as when the four selected forms of publicity [press, bus posters, hoardings or posters at place of work, and letter to parents of tuberculin positive children] were used, attendance dropped to 88 per cent of the total attendance when the sixteen forms” as used in the 1957 campaign were employed. The results also showed that some forms of publicity attract the attention of far greater numbers of people (the first three mentioned above); prominence should be given to these in future campaigns.Google Scholar
  27. Horn, D. (1956). The attitudes of psychiatrists on the effect of cancer propaganda. Amer. Cancer Soc. (Mimeo). The results of a survey of 387 psychiatrists carried out in 1955 show that since 1949 (when there was also a “deliberate effort .... to de-emphasize the more fear-provoking aspects of cancer and to emphasize a “note of hope. ...”) there has been a significant decrease in the number of psychiatrists that believe American Cancer Society literature has increased anxiety among psychiatric patients (from 35 % to 25 %). Among those believing that there has been an increase in anxiety, there has been a decrease in the number believing that such anxiety results in greater harm than good.Google Scholar
  28. Hyman, H. H., and Sheatsley, P. B. (1958). Some reasons why information campaigns fail. In: Readings in social psychology, ed. by E. E. Maccoby et al. New York: Holt, Rinehart & Winton.Google Scholar
  29. James, W. (1964). The American Cancer Society’s school education program. J. Sch. Hlth 34, 466. The ACS public education director outlines concepts in a continuing programme aimed first at school administrators and teachers, to bring cancer instruction to students (down to Junior high school) “while they are in an active learning situation and before they have developed obstructive fears and misconceptions”.CrossRefGoogle Scholar
  30. Johns, E. (1962). The Los Angeles evaluative study. Proceedings of the International Conference on Health and Health Education, vol. 5, 514. Geneva: Int. J. Hlth Educ. This study was designed to evaluate the effectiveness of school health education. The effectiveness of health education was judged by means of an appraisal of the programme activities and the health behaviour of pupils in terms of knowledge, attitudes and practices.Google Scholar
  31. Katsunuma, H. (1958). Before planning: a survey. Int. J. Hlth Educ. 1, 151. To help determine the best health education approach in a rural community, a survey on family attitudes regarding health problems was recently undertaken in a district near Tokyo.Google Scholar
  32. King, S. H. (1958). What we can learn from the behavioural sciences. Int. J. Hlth Educ. 1, 194. The author stresses the importance of familiarity with the major concepts of the behavioural sciences, and their integration across the biological, psychological and social-cultural levels. “They [public health workers] also need to be introduced to the findings of research projects that are pertinent to an understanding of disease and of social factors that inhibit or facilitate health programmes.” The major concepts considered are: social perception or definition of the situation, homeostasis or a striving towards a balance, beliefs and attitudes, and political structures and communication lines.Google Scholar
  33. Knutson, A. L. (1952a). Evaluating health education. Publ. Hlth Rep. 67, 73. In the evaluation of any health education programme one should consider the following points: adequate preliminary investigation should be made to ascertain needs and behaviour; goals must be specified, but evaluated in relation to the overall aims; concrete evidence that an objective has been achieved is the only realistic criterion for measuring effectiveness; methods of evaluation must be chosen in terms of the specific goals; a baseline of zero cannot be presumed; evaluative measurements are nearly always indirect measures; long-term needs should be borne in mind apart from the immediate goals.CrossRefGoogle Scholar
  34. Knutson, A. L. (1952b). Pretesting: A positive approach to evaluation. Publ. Hlth Rep. 67, 699. A critical review should be made prior to pretesting a programme so that the needs, objectives, methods, and subject matter are clearly defined, accurate and likely to be most successful. The pretest should be planned in terms of certain specific conditions that need to be satisfied in order to achieve programme goals; the programme will then be more likely to succeed. The conditions to be satisfied include: amount of public exposure, attention and interest, motivation, pattern of behaviour, comprehension, understanding of purpose, learning and retention.CrossRefGoogle Scholar
  35. Knutson, A. L., Shimberg, B., Harris, J. S., and Derryberry, M. (1952). Pretesting and evaluating health education. Publ. Hlth Monograph No 8. Washington, D. C.: United States Public Health Service Publication No 212.Google Scholar
  36. Koch, F., and Stakemann, G. (1964). A population screening for carcinoma of the uterus with the irrigation smear technique. Dan. med. Bull. 11, 209. A remarkable project in the borough of Frederiksberg, Copenhagen, appears to demonstrate the acceptability of self-obtained smears (by pipette) without major educational effort. Of 11,192 selected women, 82.2 % used and returned the pipettes. Propaganda limited to one 3-minute interview on T. V. and a few items in newspapers. The authors suggest this success is due to the fact that women can undertake the procedure in the privacy of their homes, and without the inconvenience or embarrassment of making an appointment for examination.PubMedGoogle Scholar
  37. La Pointe, J. L., Wittkower, E. D., and Lougheed, M. N. (1959). Psychiatric evaluation of the effect of cancer education on the lay public. Cancer (Philad.) 12, 1200. The authors believe that cancer education and many other forms of health education have relatively little effect considering the amounts of time, money and skill spent on them. There is a reliance on the mass media, merely presenting material to large groups of individuals regardless of their receptivity. A more personal approach through discussion groups and the like may produce a lessening of resistances and thus reduce the blocking reactions. Once the general public has allowed itself to be exposed to education, greater resistances might be overcome if other factors, such as the different needs of the population, or which person is more liable to be heard and understood in specific groups, were known. “The real problem is not whether enough information is put across to the general public, but how and how successfully the information is communicated. There is little doubt in our minds, for instance, that propaganda based on curability through early treatment is more likely to be successful than is propaganda based on fear.”CrossRefGoogle Scholar
  38. Lifson, S. S. (1958). Do they understand what they read? Int. J. Hlth Educ. 1, 100. Giving literature to patients in hospitals is not enough. We must find out if they understand what they read. An interesting survey was carried out in this connection by the U. S. Tuberculosis Association, making use of reading tests. It proved two things: the need for hospital personnel to be aware of the level of vocabulary comprehension of their patients; and, secondly, that we should not rely mainly on the printed word for our educational effort.Google Scholar
  39. McCormick, G. (1964). Programme planning — An organized approach. Int. J. Hlth Educ. 7, 91. The author discusses how he used the W. H. O. guide to programme — planning when he was co-ordinator of a community nursing-home demonstration programme. The W. H. O. guide enumerated the following five steps:(1) collecting information essential for planning; (2) establishment of objectives; (3) assessing the barriers to health education and how they may be overcome; (4) appraising apparent and potential resources (organisations, personnel, materials and funds); (5) developing the detailed educational plan of operations (including a definite mechanism for continuous evaluation).Google Scholar
  40. Maclaine, A. G. (1965). Lay education in cancer control. Med. J. Aust. 2, 171. A succinct review of experience elsewhere and discussion of possible applications to the situation in Australia. This article is not written from a limited parochial point of view, and its interest is therefore not confined to the country of origin.PubMedGoogle Scholar
  41. McNickle, d’ A., and Pfrommer, V. G. (1959). It takes two to communicate. Int. J. Hlth Educ. 2, 136.Google Scholar
  42. Nix, M. E. (1961). Health education and human motivation. Int. J. Hlth Educ. 4, 192. Although the importance of health and illness has global significance, attitudes regarding these will vary according to the cultural ideals of a community. Therefore, although the problem of the control of tuberculosis is universal, it can be solved by giving careful consideration to the fixed customs of the group. The author considers the different types of atmosphere of a group associated with the types of leadership, and the consequences for human motivation and behaviour. If the leader is authoritarian or laissez—faire the positive results, if any, are unlikely to be permanent. Ideally the relationship should be one of educated self-determination, in which a person follows a responsible leader with understanding and the realization that the programme will benefit him and those around him.Google Scholar
  43. Osborn, G. R., and Leyshon, V. N. (1966). Domiciliary testing of cervical smears by home nurses. Lancet 1, 256.PubMedCrossRefGoogle Scholar
  44. Public health nurses in Derby were used in a cervical cytology programme (a) to identify the high-risk women (multiparous, low on socio-economic scale) in their care; (b) to persuade them to have a smear taken; (c) to take smears (after careful training) in the home. The value of this highly personal form of selective health education was shown by results. Moreover, a positive smear rate of 26.5 per 1000 was found in this group, almost four times greater than the rate recorded for the general population at clinics in the same town.Google Scholar
  45. Paterson, R., and Aitken-Swan, J. (1954). Public opinion on cancer: A survey among women in the Manchester area. Lancet ii, 857. A report of the first survey carried out at the beginning of the experimental cancer education programme by the Manchester Committee on Cancer. (See Chapter I of this Monograph).CrossRefGoogle Scholar
  46. Paterson, R., and Aitken-Swan, J. (1958). Public opinion on cancer: Changes following five years of cancer education. Lancet ii. 791. This is a repeat survey of the one carried out in 1953 (Paterson and Aitken-Swan 1954) and showed a good general improvement in attitudes to cancer. (See Chapter I of this Monograph).CrossRefGoogle Scholar
  47. Paterson, R., Brown, C. M., and Wakefield, J. (1954). An experiment in cancer education. Brit. med. J. ii, 1219. This is an early article describing the cancer education programme of the Manchester Committee on Cancer.CrossRefGoogle Scholar
  48. Phillips, A. J. (1955). Public opinion on cancer in Canada. Canad. med. Ass. J. 73, 639. (See Chapter I of this report).PubMedGoogle Scholar
  49. Phillips, A. J., and Taylor, R. M. (1961). Public opinion on cancer in Canada; a second survey. Canad. med. Ass. J. 84, 142. This is a report on a repeat of the 1955 survey (Phillips 1955), and shows an improvement in public opinion concerning cancer after a carefully planned educational campaign. (See Chapter I of this report).PubMedGoogle Scholar
  50. Popma, A. M. (1962). Public education and cancer control. Acta Uni. int. Cancr. 18, 723. The author deals with the history of public cancer education both in the United States and Great Britain. Fear of cancer needs to be eradicated by education organised by the medical profession. Much evidence is cited to show the value of early diagnosis of cancer of all sites, especially asymptomatic cancer. Cancerophobia, the most common objection to education, is not a true problem. It should be guided by education into a salutary fear of undue delay in seeking adequate treatment.Google Scholar
  51. Price-Williams, D. R. (1962). New attitudes emerge from the old. Proceedings of the International Conference on Health and Health Education, vol. 5, 554. Geneva: International Journal of Health Education. The author emphasizes the importance of taking into account the background of ideas and practices in health education. New ideas must be seen in relation to the old ones that they are disrupting or replacing. The author illustrates his points with examples from a tribe he studied in Nigeria.Google Scholar
  52. Rankin, D. W., and Brown, A. J. (1964). Cancer education in Victoria. Med. J. Aust. 1, 357. A description of five years of intensive cancer education of the public by the Anti-cancer Council of Australia, its organization objectives, methods and evaluation.PubMedGoogle Scholar
  53. Raven, R. W., (1953). Cancer and the community. Brit. med. J. ii, 850. Among other topics, he discusses a cancer education programme. Telling the public the symptons is not enough, they must also be told how to act in certain circumstances, and what can be done to help them. This must be done wisely and in stages throughout the country.CrossRefGoogle Scholar
  54. Read, C. R. (1965). The control of neoplasia — education for prevention. In: The social responsibility of gynecology and obstetrics. Baltimore: Johns Hopkins Press. The American Cancer Society’s vice president for public education and information reviews his and the Society’s experience in many years of education against cancer of the uterus. He emphasizes the need for physician leadership, the importance of terminology acceptable to the media and meaningful to the public, the need to use both media and person-to-person approaches through informal networks of communication, (churches, unions, women’s clubs, neighbourhoods, etc.), the educational stress on “hope, on the peace of mind the Pap test can give”. Many millions in America have learned a new health habit, but there has been too little success with low-income groups and women over the age of 65. The diffusion process in health education is slow.Google Scholar
  55. Roberts, B. J. (1965). A framework for consideration of forces in achieving earliness of treatment. Hlth Education Monographs No 19. A stimulating analysis of the motivational and other forces involved in achieving early detection and treatment, particularly of breast cancer, by health educational methods. Invaluable because it offers for the first time a holistic view of the decision-making forces that lead to action, rather than the usual fragmentary examination of some aspects of the problem.Google Scholar
  56. Roberts, B. J. (1962). Concepts and methods of evaluation in health education. Int. J. Hlth Educ. 5, 52. In this article the author attempts to clarify the concepts surrounding evaluation in health education, and considers the problems of measurement involved in such evaluation.Google Scholar
  57. Rosenstock, I. M., Hochbaum, G. M., and Kegeles, S. S. (1960). Determinants of health behavior. Golden Anniversary White House Conference on Children and Youth. See the text of this chapter for a summary.Google Scholar
  58. Rosenstock, I. M. (1960). Gaps and potentials in health education research. Hlth Education Monographs No 8. The author considers that applied research is needed to “develop simple, economical and valid methods for diagnosing health education problems; [and also] ... to develop valid methods for educating individuals and groups in a real life health setting”. Further “basic research is needed to increase our growing knowledge of why people do what they do”. Finally, much more programme evaluation is required to help in improving programmes.Google Scholar
  59. Rosenstock, I. M. (1961). Decisionmaking by individuals. Hlth Education Monographs No 11. See the text of this chapter for summary.Google Scholar
  60. Rosenstock, I. M. (1962). Many opinnions.. . Few Hard Facts. Proceedings of the International Conference on Health and Health Education, vol. 5, 565. Geneva: Int. J. Hlth Educ. The author is of the opinion that “what we still do not know .... is how best to diagnose and use existing motivational states and existing social structures to change behaviour”.Google Scholar
  61. Rosenstock, I. M. (1963). Public response to cancer screening and detection programs. J. chron. Dis. 16, 407. In the second part of the paper, Rosenstock attempts to apply the behavioural model already developed (see text of chapter) to cancer detection. The research that is required should be directed at the groups shown to be in need of it by a consideration of their health behaviour status — e. g. the undermotivated. The author concludes with recommendations for (a) a fact-finding phase; and (b) an action phase.PubMedCrossRefGoogle Scholar
  62. Ross, W. S. (1965). The climate is hope — How they triumphed over cancer, New York: Prentice-Hall, Inc. The book reports the personal attitudes to cancer of physicians, their patients, most of whom have been cured, and researchers. Sixteen rambling chapters — largely taped interviews — reflect the fears and guilt of some patients, the courage of others. Physicians speak candidly of their limitations as well as their successes: one is deeply interested in problems of stress and cancer, another in the value of a cancer detection examination, a third in the philosophy of radical operations, a fourth in the unbearable family tensions that often develop when a child has cancer. “Cancer is a highly complex group of diseases, each with its own course and prognosis ... Hence the reactions and the judgements of both patients and therapists often vary greatly and may be controversial.”Google Scholar
  63. Sandman, I. (1962). Parent education in the U. S. A: Some impressions on methods. Int. J. Hlth Educ. 5, 34. The author examined whether group discussions would produce better results than the traditional courses in health education of expectant mothers. The answer appears to be in the affirmative. Although factual information is important, an understanding of one’s feelings is also important and both are achieved in discussions.Google Scholar
  64. Seppilli, A. (1962). A community survey — First step towards a film. Proceedings of the International Conference on Health and Health Education, vol. 5, 527. Geneva: Int. J. Hlth Education. (French text, English and Spanish Summaries).Google Scholar
  65. Spillius, J. (1962). The impact of social structure. Proceedings of the International Conference on Health and Health Education, vol. 5, 560. Geneva: Int. J. Hlth Educ. The author suggests “(1) that the health educator may have to redefine the kind of system he is dealing with; (2) that a health education programme may constitute a direct attack on some of the individuals in the community, especially those who hold some kind of medical lore; (3) that it is necessary to study the customary ways of imparting information, recognizing that there may be an informal [social] structure, such as a network of kin which is just as potent as the formal structure in imparting information and shaping opinion; (4) that it is necessary to make a distinction between decision-making and choices ...,(5) that cultures change, customs change, and in some societies at a more rapid rate than in others .... it should [therefore] be possible to change ideas on health and disease if we analyse the social patterns, see who is responsible for health practices, and whether or not the community’s ideas are really as irrational as they appear. In attempting to promote change, we should obviously use the existing social structure as much as possible”. Society should not be looked at in terms of social structure alone; health education programmes affect the social, economic and technological structures, and these three aspects must be included in the planning and execution of the programme. The physical and economic burden placed on the people of a developing country must be borne in mind in any health education programme.Google Scholar
  66. Steuart, G. (1965). The physician and health education. Brit. med. J. ii, 590. The author considers that the passive role of the patient is not conducive to good health education via the doctor, and recommends that the relationship be changed to a more patient-oriented one, in which the latter plays an active part. Steuart deals with the reasons why a patient should be educated, possible objections to his proposals, and the part played in all this by basic medical education of the doctor.Google Scholar
  67. Steuart, G. (1959). The importance of programme planning. Int. J. Hlth Educ. 2, 94. Systematic and intelligent planning are essential for successful health education. (See text of this chapter). Illustrations are taken from a programme concerning ante-natal and maternity care in a South African Indian community.Google Scholar
  68. Steuart, G. (1962). A slender store of studies.. . Proceedings of the International Conference on Health andHealth Education, vol. 5, 608. Geneva: Int. J. Hlth Educ. In this very instructive article the author reviews the studies of the educational content of health education programmes. Such studies are concerned with evaluation of the effectiveness of programmes, the existence and extent of the problem in the community or group, the establishment of criteria or baselines against which to measure and compare results, the comparative effectiveness of methods and the use of methods appropriate to the population and problem. More such studies are needed, and the help of the pure scientist must be used wherever possible. This article includes a bibliography of nearly fifty articles.Google Scholar
  69. Suchman, E. (1962). More scientific rigour is needed. Proceedings of the International Conference on Health and Health Education, vol. 5, 533. Geneva: Int. J. Hlth Educ. A great deal more thought might be given to the problem of classification of research findings, but this would involve the clarification of the basic dimensions underlying its fundamental concepts. Only by attempting to relate findings to such concepts will the results of applied research be of use outside the limited experimental situation. The research design of most health education studies is weak, owing to lack of underlying theory; they also lack scientific rigour. There are many possible criteria for the evaluation of an educational programme — in terms of effort, performance, adequacy, efficiency —, effort is the most common. Health education must develop its objectives more specifically according to different degrees of immediacy; this will necessitate an examination of the basic assumptions concerning the goals involved.Google Scholar
  70. Sustaita Seeber, A. de (1963). Changing attitudes to cancer. Int. J. Hlth Educ., 6, 88. The results of a cancer education campaign in Argentina showed that attitudes to cancer have improved: information was sought and accepted more frequently, there was less delay by patients, conversations about cancer were considered more natural, and the educational approach is much more optimistic in outlook.Google Scholar
  71. Tentori, F. V. (1962). Their needs and knowledge. Int. J. Hlth Educ., 5, 10. With ample illustration the author emphasizes the importance of preliminary research and evaluation in the careful planning of a programme. The research should include an examination of the characteristics and attitudes of the cornrnunity.Google Scholar
  72. Tentori, F. V. (1963). Audio-visual materials: an experiment in pretesting. Int. J. Hlth Educ., 6, 180. This article sums up ... the results of a study carried out by the author in Mexico. The purpose was to pretest audio-visual materials being planned to support a public health programme.. .. The results emphasize the value of such tests and pinpoint some important principles.Google Scholar
  73. Wakefield, J. (1959). The case for cancer education. Monthly Bulletin of the Ministry of Health and the Public Health Laboratory Service 18, 146. The arguments for and against public education about cancer are presented and examined in the light of available evidence. The evidence shows that a carefully conceived and tactfully executed programme of education does not have undesirable effects, and that it can favourably influence public attitudes to cancer.Google Scholar
  74. Wakefield, J. (1963). Cancer and public education. London: Pitman Med. Publ. Co. Ltd; Springfield (Ill.): Ch. C. Thomas. This volume summarizes many years in the field of cancer education in England. Probably the only work devoted solely to cancer education. Topics covered in the different chapters include: the principles and practice of cancer education — the problem, delay in seeking treatment, the content of a programme, informing the public by mass-media and person-toperson methods, cancer education in schools and the smoking problem —, and the organization of public education schemes. The appendices contain notes for lecturers, a reprint of the Paterson and Aitken-Swan (1954) survey, notes on the use of visual aids, and a list of educational materials and sources.Google Scholar
  75. Wakefield, J. (1966). The role of public education in cancer detection. In: Chap.-VI., UICC Monograph Ser., vol. 4. Berlin-Heidelberg-New York: Springer 1966. The author emphasises that detection programmes must be accompanied by public education. The objectives of such education must be “to persuade people to seek prompt medical advice when certain warning signs appear; and to persuade them particularly those in high-risk groups, to take part in screening programmes”; emphasis on the hopeful and reassuring aspects of cancer and cancer detection tests is important. The author deals with the functions of the physician, other medical staff, and mass-media in education for detection of cancer. Crucial, however, in any such education is the state of the attitudes, beliefs and health practices in the community or group being educated. Wakefield draws attention to the need for examining the qualities of detection tests that attract or repel an individual, and cause him to accept or reject the test. The article is supported with evidence from a number of relevant studies.Google Scholar
  76. Wakefield, J., and Davison, R. L. (1958). An answer to some criticisms of cancer education: A survey among general practitioners. Brit. med. J. i, 96. This is a report of a survey carried out after five years of public education. It was designed to test the validity of the criticisms “that cancer education would create cancerophobia among the public and add unnecessarily to the work of the general practitioners”. Such criticisms were shown to be invalid for the kind of educational programme used.CrossRefGoogle Scholar
  77. WHO (1963). Cancer control. Wld Hlth Org. Tech. Rep. Ser. No 251M. This report contains a short section on education of the public, in which a few notes are made on the most important points of such education: necessity, form and operation of cancer education.Google Scholar
  78. WHO (1964). Prevention of cancer. Wld Hlth Org. Rep. Ser. No 276. This report contains an excellent section on public education, which we have quoted extensively in the text of the chapter.Google Scholar
  79. Young, M. A. C., Dicicco, L. M., Paul, A. M., and Skiff, A. W. (1963). Review of research related to health education practice. Hlth Education Monographs, Suppl. No 1. New York: Society of Public Educators, Inc.Google Scholar
  80. Zabolotskaia, L. (1965). The integration of health education in preventive and curative medicine in the U.S.S.R. Int. J. Hlth Educ., 8, 41. Prophylactic examination of healthy people is carried out in various selected categories of the population. A widespread educational effort precedes such examination programmes to ensure maximum participation. Follow-up of the chronic sick revealed by examination is tackled systematically, with health education playing a major role.Google Scholar
  81. Ministry of Health, London (1964). Health education. Report of a Joint Committee of the Central and Scottish Health Services Councils. London: Her Majesty’s Stationery Office. This excellent report deals with the aims and achievements of health education. The need for evaluation is stressed and the future organization of health education in Britain is considered. Finally, the report deals with the techniques of health educators, the part played by general practitioners, and health education in schools. An appendix on health education in the United States is included. There are several lengthy comments on health education about cancer. Many methods useful for evaluation in health education. Int. J. Hlth Educ. 5, 93. [Editorial annotation]. Lists ten of a variety of methods that have been used to check changes in knowledge, attitudes and behaviour of students relating to health. Health Education: a selected bibliography prepared by the World Health Organization. (1956). Educational Studies and Documents. No XIX. Paris: UNESCO. 174 entries on (1) General background; (2) Health education; (3) Methods and techniques; (4) Training; (5) Evaluation (6) Periodicals.Google Scholar
  82. Health Education (1962), Education Abstracts, vol. XVI, No 1, compiled by Winifred Warden. Paris: UNESCO. An annotated bibliography of 398 entries on (1) Philosophy and background; (2) school health; (3) Programme planning; (4) Problems in special fields (including smoking); (5) Books for children; (6) Periodicals of interest.Google Scholar

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© Springer-Verlag Berlin Heidelberg 1967

Authors and Affiliations

  • Committee on Public Education of the Commission on Cancer Control

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