A psycho-cultural approach to health education
Katsivo, Melanie Nyambura
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Health education was officially recognized as an important component of Primary Health Care by the World Health Organization in 1978. Over a long period of time, it has been approached from the point of view of giving people information. The expectation has been that people's health behavior would change, as a result of receiving the information that they are given by health personnel. However, this expectation has failed to materialize, leading to a re-examination of the whole practice of health education. This study was concerned with the methods used to deliver health education to a rural community in Kiambu, a district of Kenya. The objectives of the study were: a) To investigate and identify the traditional methods of education practised by one ethnic group of Kenya. b) To develop a health education model for that particular ethnic group, based on adaptations from the traditional methods of education. c) To determine the knowledge, attitudes and practices as an indicator for necessary change. d) To apply the remedial health education messages to the model developed. e) To implement the health education model containing the remedial messages. f) To determine the effect of the model on the knowledge, attitudes and practices related to diarrhea in the study community. The study focused on identifying how the various life processes such as childcare, hinting, animal and crop husbandry, the transition from boyhood to manhood, or girlhood to womanhood, were passed on from generation to generation. Specifically, detail was sought on how the ''classes'' were organized, like who taught the various processes to the various age groups through which media. The study also attempted to find whether there were special times for handling the teaching of different materials and whether all the people of different age groups would be given the lessons while sitting together in one group. The interviewees were 86 men and women aged 55 years and over. These teaching methods were adopted in the formulation and implementation of a teaching model. Knowledge, attitudes and practices regarding definition, causation, treatment and prevention of diarrhoea disease were established in 741 child caretakers at the beginning of the study. Based on these findings, remedial health education messages were formulated and applied in Thigio Village. Conventional educational methodology was used in Kamirithu Village whilst Rironi was the control village where no health education was applied. Trained field workers taught health education, recruited from the study area. At the end of the study, another 'Knowledge. Attitudes and Practices' study was carried out on a sample of 417 of the same child caretakers, in order to assess any changes that might have occurred. Sources of data were all the subjects of the study, and supportive research material was obtained from published material from the College of Health Sciences of the University of Nairobi, Kenyatta University, Ministry of Health and available local and international journals. The results showed that after health education, the child caretakers in Kamirithu had more knowledge of the signs of diarrhoea than those from Thigio. They also mentioned a wider range of possible ways that diarrhoea can be caused, and all leading to contamination (of food, utensils and environment) and infection whilst those from Thigio focused their responses on unsuitable food and uncleanliness as the major causes of diarrhoea. A significant percentage of child caretakers from Thigio mentioned incorrect methods of preventing occurrence of diarrhoea, as compared to the more focused and correct responses given by the Kamirithu child caretakers. Oral Rehydration Therapy was defined correctly by a significant percentage of child caretakers in both Kamirithu and Thigio but at the same time, more caretakers in Thigio than Kamirithu gave descriptions that were not related to Oral Rehydration Therapy. A lot more child caretakers heard about Oral Rehydration Therapy at home in Thigio than in Kamirithu. Diarrhoea was recognized as an illness by a significantly higher percentage of caretakers in Kamirithu than in Thigio, and this could also be linked to their preference for a combination of self administered home therapy and a health facility based one. On the type of substances that were administered to children when diarrhoea occurred, Clinical solution, Sugar/Salt solution and a combination of Clinical and Sugar/Salt solution were the fluids of choice for the Kamirithu child caretakers, whilst those of Thigio preferred a wide range of combinations of fluids and solids. The practice of rehydrating children suffering from diarrhoea was good in both villages. Further, the child caretakers in Thigio were more knowledgeable on the frequency of administering fluids to a child suffering from diarrhoea. Balanced diets were given by a significantly higher percentage of caretakers in Kamirithu than in Thigio. Thigio child caretakers preferred to feed children with diarrhoea on a wider variety of foodstuffs, unlike the Kamirithu ones. The caretakers from both villages disposed of household waste either indiscriminately, in the garden or into compost pits before and after health education. There was very little change between the two patterns. In conclusion, health related messages were received more correctly by the child caretakers in Kamirithu village, where the conventional approach to health education was used. The responses were better defined and more focused. This group also gave the most of correct responses pertaining to the various aspects of diarrhoea. In Thigio, the messages seemed distorted judging by the great diversity and unfocussed nature of the responses. The following recommendations were made: 1. Use of existing cadre of Family Health Field Educators should be continued. However, they need strengthening through training, provision of equipment and supervision. 2. Use of Audio-Visual aids that have been adapted to the local situation should be encouraged and intensified. 3. Teaching adults in groups as opposed to individually, achieves better results. 4. Emphasis should be placed on the place of educational methodologies in the context of modern socio-economic-political environment, rather than on traditional forms of education.