Are Basic Assumptions We Hold About Health Education Defensible? William C.Sechrist, MA Herb Jones, HSD
ABSTRACT
Underlying numerous programs designed to promote healthfulness are several implicit and/or overlooked assumptions. These suppositions are considered to be “understood. *’ However, more often they lack validation in an empirical sense. The article is intended to prompt a systematic appraisal of certain presumptions about health, health education and health educators.
INTRODUCTION
Health educators who have made other people’s health their concern have, over the years, undoubtedly become rather confident that certain assumptions they have made about health and health education are “correct” or, at the very least, defensible. To the extent that these assumptions are perceived as valid, the practitioners in the associated health professions have made decisions about: 1. the types of health problems which will be addressed (coronary heart disease, drug abuse, malnutrition, sexually transmitted diseases . .); 2. the origins of those problems (genetic, microbial, behavioral . . .); 3. the relative importance of those problems (which are most urgent, which receive the most resources . . .); 4. the “preferred” approaches to the problems (legislative, educational . . .); 5 . the kinds of specialists and skills most likely to
.
MAY 1979
achieve program objectives (public health nurses, school health educators . . .). Many, probably most, of the assumptions health educators make about health and health education have not been critically and systematically examined. This means that evidence has not been sought in the professional literature to support or refute the validity of the assumptions being made. If the assumptions were innocuous or powerless in their influence, there would be little reason to be concerned with them. But the authors’ view is that this is not the case. They believe that the effects of assumptions made by people in the health-related professions invade (broadly and deeply) the decisions made regarding which programs are offered and how those programs are designed, implemented and evaluated. Health educators are encouraged to uncover, specify and analyze the assumptions they make. ASSUMPTIONS The list of assumptions presented here is illustrative and not exhaustive. They have been chosen because it is believed that they are widely held. These assumptions could be “operative” either covertly or overtly. They have been categorized under three headings: assumptions about health; assumptions about health education; and assumptions about health education practitioners. The working definition of an assumption is “a supposition that something is or is not the truth.” The authors suggest that if practitioners are unable to mention at least five references from the professional THE JOURNAL OF SCHOOL HEALTH
275
literature citing evidence supporting the assumption as valid, perhaps our professional practices related to the assumption are unwarranted or at least not well-based. Remember, the interest here is in stimulating the critical analysis or reanalysis of some of our most cherished and fundamental suppositions. The reader’s first task is to decide whether the statement is or is not an assumption he/she makes. If it is, he/she should be able to justify holding it. If it is not an assumption he/she makes, evidence should be cited which defends hidher refusal to adopt it when so many other professionals have done so. The following assumptions are among the more popular: A. Health 1. Illness reduction, disease prevention and health promotion are individual responsibilities. 2. Knowledge, attitudes and values are prerequisites for sustained healthful behavior. 3. Health is a necessary condition for happiness. 4. People want to achieve high levels of health. 5 . Knowledge about health is esoteric unless applied. 6. It is difficult to arrive at a universally accepted definition of health. B. Health Education 1. The positive effects of health education interventions outweigh the negative effects. 2. It is ethical and efficient to use fear in an attempt to get people to stop doing something harmful to their health and start doing something to enhance their health. 3. In order for health education to be value free, it must be requested and not imposed; and it must restrict its interventions to the dissemination of information and clarification of attitudes and values with the application of the principles of behaviorism being clearly inappropriate. 4. To achieve and maintain legitimacy among the associated health professions, health education will have to demonstrate that its most significant contribution to people’s health is in the realm of the primary prevention of health problems. 5 . Health education is a counter-active measure against societal sources of misinformation and conditioning. 6. Health education aims to persuade people to adopt healthful practices including the wise use of health care services. 7. Health education is considered by the general public to be a second-rate or semi-profession, 8. Becoming health educated is pretty much a common sense process, and specialists are not really necessary. 9. Health education actually improves an individual’s decision-making and problem-solving skills. 276
THE JOURNAL OF SCHOOL HEALTH
10. Successful health education establishes a variety of positive health behaviors, especially in youth. 11. Health education is a lifelong process not limited to formal education experiences. 12. Because health education is an applied field, it is a hodgepodge of the disciplines from which it has evolved; and no unifying philosophical core can be formulated. 13. Health education has been denied its proper recognition and growth because of its historical connection with physical education. 14. Professional preparation programs are effectively training competent health education specialists. C. Health Educators 1. Health educators have a clear and common definition for health education. 2. Health educators have common goals. 3. Health educators have effective methods for accomplishing their program objectives. 4. It doesn’t matter much whether practitioners are called health educators, health scientists, allied health professionals or anything else that seems to fit right or feel good. 5 . Health educators in schools are not much different than health educators in other community settings. 6. Health educators have a moral obligation to impose their remedies when health problems and poor health practices are apparent. 7. Most health educators are well-versed in health education philosophy and have a well-defined practicing philosophy. 8. Health educators must be humanistic and caring people to be successful.
DISCUSSION The readers are encouraged to add their assumptions to the preceding lists. They are further encouraged to be reflective, to examine the domain which comprises their professional activity and participate in the identification of suppositions related to the professional practice of health education and then analyze them individually. Perhaps the professionals can convince the editors of health education journals to devote space in some of their upcoming issues to the presentation, analysis, confirmation or negation of an assumption that permeates health education programs (what an excellent project for a professional preparation class). Such a column could be the forum for the exchange of ideas on some of the issues at the very core of professional behavior. Some critical questions relating to the validity of health education remain unanswered. For instance, are there reliable methods for identifying and assessing the assumptions held? Is the validity of assumptions made MAY 1979
variable . . . that is, are they sometimes true and sometimes not true? What are the consequences of NOT periodically airing out and shaking up our basic suppositions? To what degree are the assumptions “cultivated” during one’s professional preparation in the universities verified by community-based experiences? Is it really possible to effectively analyze the assumptions underlying professional work and amend or jettison those which are not defensible?
SUMMARY Some will probably conclude that “assumption analysis” is largely a waste of time. Some may feel that the results of health education aren’t measurable because they appear in the distant future and could even be attributed to forces other than the health education intervention. The authors disagree with those who conclude that assumption analysis is unproductive, but
believe the state of the art of health education can improve if programs are based a little more on science and a little less on intuition. It is hoped the readers will concur and begin this exciting and challenging enterprise soon.
William C. Sechrist, MA, isAssistant Professor, Health Department, State University of New York, Corrlana’, NY 13045 (Corresponding author). Herb Jones, HSD, & Professor, Physiology/Health Science, Ball State University, Muncie, IN 47306.
The authors wish to acknowledge the participation of graduate students at Ball State University where the process of investigating some of our fundamental suppositions began.
ABOUT THE COVER
PERU In Peru, one important government goal is to improve basic health services for children and youth. Objectives of health programs: to raise the health standards of the entire population, but particularly for mothers and children and to improve and extend the infrastructure. Pilot programs have been developed for isolated or previously neglected communities, reflecting the government’s emphasis on benefitting all Peruvians. Projects involve training of educational and other personnel (including older school children) in health, nutrition and family orientation and having them work as teams in the various committies to improve family life and child-care habits. Home improvement and the preparation of educational toys from locally available materials are also stressed. Children under five years of age receive food supplements. Working with the Peruvian government, financial and technical assistance have been provided by WHO and UNICEF. Equipment and supplies for health centers and sanitary posts, equipment for educational activities and mother’s clubs meeting in health centers and transportation for inspeaion purposes have been provided by these organizations. Technical assistance
MAY 1979
through regional experts, a nutrition expert, a public health nurse, a sanitary engineer and short-term consultants are available. Dramatic changes in attitude and child-care habits have been noted in the population. As experience is gained, all the programs are to be expanded to benefit all the Peruvians.
The cover artwork for THE JOURNAL OF SCHOOL HEALTH been provided the courfes,, of the United Children’s Fund, United Nations, New York. Photograph is by R . cottrol.
THE JOURNAL
OF SCHOOL HEALTH
277
ABSTRACT
Underlying numerous programs designed to promote healthfulness are several implicit and/or overlooked assumptions. These suppositions are considered to be “understood. *’ However, more often they lack validation in an empirical sense. The article is intended to prompt a systematic appraisal of certain presumptions about health, health education and health educators.
INTRODUCTION
Health educators who have made other people’s health their concern have, over the years, undoubtedly become rather confident that certain assumptions they have made about health and health education are “correct” or, at the very least, defensible. To the extent that these assumptions are perceived as valid, the practitioners in the associated health professions have made decisions about: 1. the types of health problems which will be addressed (coronary heart disease, drug abuse, malnutrition, sexually transmitted diseases . .); 2. the origins of those problems (genetic, microbial, behavioral . . .); 3. the relative importance of those problems (which are most urgent, which receive the most resources . . .); 4. the “preferred” approaches to the problems (legislative, educational . . .); 5 . the kinds of specialists and skills most likely to
.
MAY 1979
achieve program objectives (public health nurses, school health educators . . .). Many, probably most, of the assumptions health educators make about health and health education have not been critically and systematically examined. This means that evidence has not been sought in the professional literature to support or refute the validity of the assumptions being made. If the assumptions were innocuous or powerless in their influence, there would be little reason to be concerned with them. But the authors’ view is that this is not the case. They believe that the effects of assumptions made by people in the health-related professions invade (broadly and deeply) the decisions made regarding which programs are offered and how those programs are designed, implemented and evaluated. Health educators are encouraged to uncover, specify and analyze the assumptions they make. ASSUMPTIONS The list of assumptions presented here is illustrative and not exhaustive. They have been chosen because it is believed that they are widely held. These assumptions could be “operative” either covertly or overtly. They have been categorized under three headings: assumptions about health; assumptions about health education; and assumptions about health education practitioners. The working definition of an assumption is “a supposition that something is or is not the truth.” The authors suggest that if practitioners are unable to mention at least five references from the professional THE JOURNAL OF SCHOOL HEALTH
275
literature citing evidence supporting the assumption as valid, perhaps our professional practices related to the assumption are unwarranted or at least not well-based. Remember, the interest here is in stimulating the critical analysis or reanalysis of some of our most cherished and fundamental suppositions. The reader’s first task is to decide whether the statement is or is not an assumption he/she makes. If it is, he/she should be able to justify holding it. If it is not an assumption he/she makes, evidence should be cited which defends hidher refusal to adopt it when so many other professionals have done so. The following assumptions are among the more popular: A. Health 1. Illness reduction, disease prevention and health promotion are individual responsibilities. 2. Knowledge, attitudes and values are prerequisites for sustained healthful behavior. 3. Health is a necessary condition for happiness. 4. People want to achieve high levels of health. 5 . Knowledge about health is esoteric unless applied. 6. It is difficult to arrive at a universally accepted definition of health. B. Health Education 1. The positive effects of health education interventions outweigh the negative effects. 2. It is ethical and efficient to use fear in an attempt to get people to stop doing something harmful to their health and start doing something to enhance their health. 3. In order for health education to be value free, it must be requested and not imposed; and it must restrict its interventions to the dissemination of information and clarification of attitudes and values with the application of the principles of behaviorism being clearly inappropriate. 4. To achieve and maintain legitimacy among the associated health professions, health education will have to demonstrate that its most significant contribution to people’s health is in the realm of the primary prevention of health problems. 5 . Health education is a counter-active measure against societal sources of misinformation and conditioning. 6. Health education aims to persuade people to adopt healthful practices including the wise use of health care services. 7. Health education is considered by the general public to be a second-rate or semi-profession, 8. Becoming health educated is pretty much a common sense process, and specialists are not really necessary. 9. Health education actually improves an individual’s decision-making and problem-solving skills. 276
THE JOURNAL OF SCHOOL HEALTH
10. Successful health education establishes a variety of positive health behaviors, especially in youth. 11. Health education is a lifelong process not limited to formal education experiences. 12. Because health education is an applied field, it is a hodgepodge of the disciplines from which it has evolved; and no unifying philosophical core can be formulated. 13. Health education has been denied its proper recognition and growth because of its historical connection with physical education. 14. Professional preparation programs are effectively training competent health education specialists. C. Health Educators 1. Health educators have a clear and common definition for health education. 2. Health educators have common goals. 3. Health educators have effective methods for accomplishing their program objectives. 4. It doesn’t matter much whether practitioners are called health educators, health scientists, allied health professionals or anything else that seems to fit right or feel good. 5 . Health educators in schools are not much different than health educators in other community settings. 6. Health educators have a moral obligation to impose their remedies when health problems and poor health practices are apparent. 7. Most health educators are well-versed in health education philosophy and have a well-defined practicing philosophy. 8. Health educators must be humanistic and caring people to be successful.
DISCUSSION The readers are encouraged to add their assumptions to the preceding lists. They are further encouraged to be reflective, to examine the domain which comprises their professional activity and participate in the identification of suppositions related to the professional practice of health education and then analyze them individually. Perhaps the professionals can convince the editors of health education journals to devote space in some of their upcoming issues to the presentation, analysis, confirmation or negation of an assumption that permeates health education programs (what an excellent project for a professional preparation class). Such a column could be the forum for the exchange of ideas on some of the issues at the very core of professional behavior. Some critical questions relating to the validity of health education remain unanswered. For instance, are there reliable methods for identifying and assessing the assumptions held? Is the validity of assumptions made MAY 1979
variable . . . that is, are they sometimes true and sometimes not true? What are the consequences of NOT periodically airing out and shaking up our basic suppositions? To what degree are the assumptions “cultivated” during one’s professional preparation in the universities verified by community-based experiences? Is it really possible to effectively analyze the assumptions underlying professional work and amend or jettison those which are not defensible?
SUMMARY Some will probably conclude that “assumption analysis” is largely a waste of time. Some may feel that the results of health education aren’t measurable because they appear in the distant future and could even be attributed to forces other than the health education intervention. The authors disagree with those who conclude that assumption analysis is unproductive, but
believe the state of the art of health education can improve if programs are based a little more on science and a little less on intuition. It is hoped the readers will concur and begin this exciting and challenging enterprise soon.
William C. Sechrist, MA, isAssistant Professor, Health Department, State University of New York, Corrlana’, NY 13045 (Corresponding author). Herb Jones, HSD, & Professor, Physiology/Health Science, Ball State University, Muncie, IN 47306.
The authors wish to acknowledge the participation of graduate students at Ball State University where the process of investigating some of our fundamental suppositions began.
ABOUT THE COVER
PERU In Peru, one important government goal is to improve basic health services for children and youth. Objectives of health programs: to raise the health standards of the entire population, but particularly for mothers and children and to improve and extend the infrastructure. Pilot programs have been developed for isolated or previously neglected communities, reflecting the government’s emphasis on benefitting all Peruvians. Projects involve training of educational and other personnel (including older school children) in health, nutrition and family orientation and having them work as teams in the various committies to improve family life and child-care habits. Home improvement and the preparation of educational toys from locally available materials are also stressed. Children under five years of age receive food supplements. Working with the Peruvian government, financial and technical assistance have been provided by WHO and UNICEF. Equipment and supplies for health centers and sanitary posts, equipment for educational activities and mother’s clubs meeting in health centers and transportation for inspeaion purposes have been provided by these organizations. Technical assistance
MAY 1979
through regional experts, a nutrition expert, a public health nurse, a sanitary engineer and short-term consultants are available. Dramatic changes in attitude and child-care habits have been noted in the population. As experience is gained, all the programs are to be expanded to benefit all the Peruvians.
The cover artwork for THE JOURNAL OF SCHOOL HEALTH been provided the courfes,, of the United Children’s Fund, United Nations, New York. Photograph is by R . cottrol.
THE JOURNAL
OF SCHOOL HEALTH
277
