Eye health promotion and the prevention of blindness in developing countries: critical issues.

This review explores the role of health promotion in the prevention of avoidable blindness in developing countries. Using examples from eye health and other health topics from developing countries, the review demonstrates that effective eye health promotion involves a combination of three components: health education directed at behaviour change to increase adoption of prevention behaviours and uptake of services; improvements in health services such as the strengthening of patient education and increased accessibility and acceptability; and advocacy for improved political support for blindness prevention policies. Current eye health promotion activities can benefit by drawing on experiences gained by health promotion activities in other health topics especially on the use of social research and behavioural models to understand factors determining health decision making and the appropriate choice of methods and settings. The challenge ahead is to put into practice what we know does work. An expansion of advocacy-the third and most undeveloped component of health promotion-is essential to convince governments to channel increased resources to eye health promotion and the goals of Vision 2020.

Understanding behaviour: the key to successful health education.

PIP: Effective health education requires an understanding of the factors which underlie a person's behavior. This paper describes "BASNEF," a simplified approach to understanding behavior, which is based on the PRECEDE model and on Value Expectancy Theory. Value Expectancy Theory holds that people will only perform a given behavior if they themselves see that it will provide benefits according to their perception of their situation and needs. Community beliefs and values may differ from those of health care workers. The perceived likelihood of different consequences of an act and the relative values of those outcomes determine the individual's attitude towards that act. The subjective norm consists of the net balance of the perceived attitudes of other people concerning the act. The person's attitude and the subjective norm must be balanced to arrive at the behavioral intention, the decision of whether or not to perform a behavior. Applying the BASNEF approach requires determining community perspectives regarding the behavior. The behavior must be defined as specifically as possible, and the materials and knowledge required for a motivated person to carry out the behavior must be considered. Some behaviors can be identified in which it is unrealistic to expect a change. The 1st priority must be toensure that all the enabling factors required for a motivated person to carry out the behavior, such as time, materials and education, are available. Social pressures must be addressed, particularly the opinions of influential persons. Changing the individual's beliefs and attitudes must come last. The proposed behavior may need to be modified to be acceptable. It is difficult to change beliefs which arise from direct experience, wider belief systems or which have been held for a long time. This BASNEF model can be used to design health education programs based on an understanding of the community.^ieng

Training for prevention of HIV / AIDS.

PIP: When developing and implementing training programs for field workers and community members in HIV/AIDS prevention programs, it is essential to know what they need to learn and how it should be taught. Both the needs of participants as individuals as well as their role in prevention must be considered and accommodated. To impart the knowledge and skills needed for individuals to function at their best in the prevention programs, the author suggests creating job descriptions and task analyses as guidelines for what should be taught. Personal agendas should also be set. Participants should be allowed to express their expectations at the beginning of an actual training course, then reflect upon the training and how to put what they learned into practice at its close. Multidisciplinary groups, problem-solving approaches, and teaching in blocks are possible. Educational methods may involve brainstorming, buzz groups, and/or demonstrations. Finally, participant feedback should be secured during and immediately after the course as well as in follow-up workshops and questionnaires.^ieng

Guidelines for action.

PIP: This article provides guidelines for people presenting AIDS education. Identify safe sex: avoid multiple partners and sexual partners who have many partners; avoid oral and anal sex and penetration without a condom. Work through local groups: identify the target audience; identify influentials and talented teachers; identify incorrect beliefs; and try to provide payment. Develop realistic messages: use the advice of community leaders; choose messages relevant to local behavior; and do not make moral judgments. Use effective communication channels: keep groups small; use audiovisual materials; use traditional oral communication methods and puppets; use local entertainers; work with local groups to produce appropriate leaflets; use posters only with other technics; and use the mass media. Choose messages carefully: avoid using fear; advertise safe sex as something positive; use local idiom; and do not be too scientific. Emphasize the disease prevention role of condoms: be sure they are available and noticeable in shops; be sure information is available on correct use; and encourage both men and women to insist on their use. Be prepared to share your experiences and to evaluate and modify your program.^ieng

Use effective communication channels. Health education.

PIP: This article describes different ways of communicating health education. Individual and group counseling are the most effective ways of changing people's behavior. It is a method by which, it could relieve anxieties, and offer better ways that explain information and help people make decisions on sexual and risk behavior subjects. Drawings, cartoons, visual aids and magazines could be of help in discussions. In the discussion of sensitive and embarrassing topics, it is much better for the use of traditional drama, storytelling, puppets etc. Leaflets and poster use are useful in the back up on counseling and health education programs. Establishing a health education regarding the struggle on AIDS takes time and effort, and it is best that counselors or educators are able to share their experiences and evaluate limited programs on this matter.^ieng