Community sheet # 4 - maha

[Shadi Jarrar]

بسم الله الرحمن الرحيم

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note : file format that was send to me is of special extension.. most of u won't be able to open the file .. so copy the text below and paste it in a word file instead
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lecture number #4



we finished discussion ,defining ,structure ,character , & importance of PHC services .
You can remember as set of activity of PHC we put MCH (maternal child care ),nutrition ,
providing essential drugs ,& education . unless we put health education in no 5 last time ,it is I importance is the first of PHC services ,why ?
Because health education is :
skeleton of PHC services
first line of contact between the community members & health services
the first line of health prevention


the health education is not only to educate medical students ,so if you open health education in Jordan you find medical school has been started in university of Jordan in 1970 ,but this is not we want ,health education must be for all population &communities before medical students .
you are learning about PHC community medicine ,but this is not the health education we need
for our life style ,although it include most of them as I mention before .

Health education is knowledge should be transfer from medical ¶medical stuff to the community members .
It is essential for health promotion & prevention services helping people to understand what dose healthy life style could be


what is the main goal of health education ????
main goal (purpose ) is to improve quality of life individual &communities in all aspects :
health , social , economic , & political ,taking in consideration that health is state of complete
physical , psychological , & social well being not absence of disease .
first line of health promotion is we know , it is to know how to prevent the diabetes in all
communities to decrease the prevalence of diabetes by knowing the causes , specially in Jordan
(one of the common countries in diabetes % or have increase prevalence in diabetes ) .
note : prevalence differs from incidence !!!
incidence :general talk about all community ,ex: incidence of of diabetes in 10 years ago 12%
but now it is 27%
prevalence : is time now , at the point of time ,ex :prevalence of diabetes in Jordan in 2009
(usually in years ) ,but theres prevalence in months

prevalence is more sensitive measurement than the incidence ,so the prevalence of diabetes
in Jordan is higher & higher :
2010>2009>2008
retain back to causes of dia b et e s :
firstly you must know that diabetes have high prevalence in Arab countries & sensitive
diagnosed ,it is chronic disease so the etiology not known 100% (uncertain origin ) ,
but theres some risk factors make person more susceptible to have disease than other
persons .
risk factors:
genetics :if the person have family history of diabetes
nutrition :(obesity in general )
note :the risk factor of chronic disease ( coronary heart disease ,hypertension ,diabetes , cardiovascular diseases ) overlap each other .

T he most important risk factors is obesity & family , although now some theories said it could be viral infection ,other said it could be due immunity suppression risk factors / theories add some risk factors but the main etiology is conserve .

I t is like other noncommercial diseases ( CVD , hypertension, psychiatric diseases have unknown diseases etiology&have risk factors which highly sensitive in some diseases &middle or low in others . FOR EXAMPLE : obesity is relatively high sensitive in diabetes but moderate in cardiovascular diseases .


Smoking is very important as a risk factor in lung diseases (obstructive air way diseases ) it >10% of death causes .



health education make healthy life to avoid risk factors (avoid nutrition risk factors , make exercises more when needed , avoid smoking , change the behavior , …., for example )
so health education is not only the knowledge, is also (in last stage of it ) change the behavior so it is the first line of health promotion & prevention in general .

WHO IS THE HEALTH EDUCATOR ???
is it the physician or doctor in university ?
Definitely not , there must be a specialist s who can spread the knowledge , they called health educators ,may be those are not doctors but can spread the knowledge of [your weight under certain body index ] better than a physician




health educator usually are specialist in how to make information reach big part of
community & to reach all communities .

At the same time health education should be by all community members (mothers teach her
children , fathers teach his children , teachers in schools to students , the nurses counselor I
in PHC setting ).
conclusion : ALL ARE RESPONSIBILITY TO HAVE A ROLE IN HEALTH
EDUCATION IN GENERAL .


Health education in JORDAN is department of PHC ,so it must be one of it is objectives
or department of ( 3yadat alr3aia als7ia al2walia w mkaf7t al2amrad ) .


there are many approaches for health education in general ,they are insert directly under
PHC & they are needed & available .


The approaches of health education :

it could be through specialist as we mention & usually specialist in mass media ,spread the
knowledge ,not only for 40-50 students as the doctor do in lecture , there must be mass media
program of health education (like : newspapers ,magazines , radio , television ) under the
control of the specialists , take the knowledge , put it in right way fin the mass media for
community . In Jordan there is something called 1. medical approach
what is the medical approach ? Doctors to patients approach , it is the most common approach
because the patient usually take the knowledge from the doctors not from the teachers & nurses
is it a good approach ? It is very sensitive & very good ,but it has disadvantage ; the doctor
can not give enough time for every patient .
The doctors have role in medical approach , but do not have all the responsibility ,because
because the doctor have only 20 minutes for each patient :
5 minutes for history & complain
10 minutes for diagnosis
5 minutes for telling the patient abut the disease ….. only

so doctors are not the only responsible persons about medical approach , Y know there is a big
portion of approach of health education through counselors ( al2ershad als7ei , al2egtema3i ,
altrbwei )

most important in PHC & there must be in secondary & tertiary health care services .
EX: of tertiary services level : in where breast cancer patient know what to do from beginning
( chemotherapy , radiotherapy ) & how to change the life style to make her acceptable
and hooping with disease .


EX : of primary serves level : know who are the higher risk female to get breast cancer
so if her mother or sister has breast cancer , she need special education about disease
more than others .
medical approach most common applying by doctors (physician) in Jordan ,& it is very weak
because we do not have counselor who are the main member in medical approach .


educational approach
A. through schools (in where something called ,,, life style , common health education ,
& some international programs like biology camping , sexual life camping, productive
health ) must be found to allow to student to finish the school with general ideas .
B. through universities , is not only for dentists or medical students ,but for all colleges in
order to cover the biggest proportion of students in university .
But this educational approach not common , EX:before 20 years the students take the implant science
in biology but they do not where is the spleen or liver for example !!!!!!!!!

3.the change in behavior approach
change of behavior approach
EXAMPLES :
it is not enough to tell you that obesity is the higher risk factor in diabetes ,
but to tell how to prevent over weight by having proper nutritional diet .

You are in a high risk to be hypertensive patient or CVD ,if your physical exercises
is not fitting at least ½ hour three times weekly , it is not enough to know that
you should change your behaviors & put exercises playing in your priorities .

It is not enough to know that smoking is the higher risk factor in chronic
bronchitis & lung cancers , you have to change & stop smoking .



the individual -centered approach
you can consider it like the medical approach but it is form one person to another
not from one person to other .,it is useful but you can not benefit a lot of people by this approach because it is for one person not a group & it is time consuming .

5. change the society believes
how is it practice in Jordan ? Change behaviors then come to society .
It is the most difficult approach & least practice in Jordan .




WHO IS THE TARGET OF HEALTH EDUCATION PROGRAME ?
every member in society is responsible but some times there are people at higher risk ,those are in need to know about them .
Mothers for there children (taking care about there nutrition,hygiene , vaccination)
counselors
teachers in schools
women
children
elderly, because they exposed to diseases ( degenerative diseases ,diabetes , hypertension, CVD)

programs that hold in world :

psychological programs
cancer programs
diabetes
educational
fitness
exercise
health screening
in Jordan there are certain programs that we have to improve them ,& they are under control of health educational department ( plz see them in the hand out page 32) for example (yawm al2asnan ) ,the aim of this day is promotion of education about teeth cleaning ,hygiene, ...etc )
note : the proportion of decay cases in 6 years old children in Jordan is < 70%,the same as
ophthalmic problems .




Note : you do not have to know the date in hand out .(page 32)


Jordan has also special programs which save children health through special centers .
There are another camps of programs for the Jordan breast
cancer ,the most common .
Camps where they teach women how to examine themselves at certain age & after certain
age(around 40 years ) to do mammogram .
every October there is one day to making screening for all community (screen breast cancer
in all ladies in Jordan ) by opening of medical centers , JU clinic .


The end





Done by : maha
date of lec : February20
lec .# 4