Health education is promoted as an important element of primary healthcare. But how effective is it? Researchers from the UK Institute of Child Health examined mother and child health education programmes, focusing on definition, design and evaluation. They illustrated these issues using a case study of postnatal education in Kathmandu, Nepal.

They found that health education is rarely evaluated. Assessments are not always thorough and tend to focus on changes in knowledge rather than health outcomes. The researchers stress the need for more rigorous evaluation of the effectiveness of such programmes.

The Alma Ata declaration of 1978 emphasised the value of health education for primary healthcare. Although it is believed to be a potentially cost-effective intervention for tackling health risks, little is known about its real effectiveness.

Health education can refer to various formal or informal health information activities. In this study it is defined as an attempt to enable individuals, groups and communities to make sound decisions about health behaviour and to improve health outcomes. An understanding of the social context of the desire for change is central to successful health education.

The research found that assessment of health education programmes commonly involves evaluation of:

• needs assessment - including feedback on knowledge, attitudes, risk behaviours, health status and perceived needs of the target population
• process - describing implementation of the programme
• impact - assessing how effective a programme is in changing knowledge, attitudes, beliefs and behaviour of the target group
• outcome - gauging the effects of the programme on health (although changes in knowledge, behaviour and attitudes are often used as proxy measure of changes in health status).

The case study evaluated the effects of one-to-one postnatal health education on infant care and family planning practices. The rigorous study design involved 540 mothers at the Kathmandu Maternity Hospital. They received different programmes of postnatal education or none at all and were interviewed three and six months after the birth. The study showed only a minor improvement in health outcomes at three months and no impact at six months.

Policy-related implications include:

• There is a lack of firm evidence for the success of health education programmes.
• More well-designed studies are needed to guide the development of effective health education.
• Changes in knowledge and attitudes do not always lead to desired healthy behaviours.
• Even if programmes are initially successful, this may not be sustained.
• Cost-effectiveness must also be examined, as successful interventions on a small scale may not be feasible when applied to the whole population.

In the light of these negative outcomes, the authors have developed a new strategy to improve early infant care through a community-based participatory intervention. A study of the strategy, which uses a learning cycle of meetings involving mothers groups, is currently underway in a rural district of Nepal.

Source(s):
'Health education for mothers in developing countries' by A. Bolam, D. Tillen and A. Costello, discussion paper for the 'Improved care of the diseases of childhood' Research Work Programme (1997)
'The effects of postnatal health education for mothers on infant care and family planning practices in Nepal: a randomised controlled trial' by A. Bolam, D. Manandhar, P. Shrestha, M. Ellis and A. Costello, British Medical Journal 316 (1998)

Funded by: UK Department for International Development

id21 Research Highlight: 28 June 2001

Further Information:
Anthony Costello
Centre for International Child Health
Institute of Child Health
30 Guilford Street
London WC1N 1EH
UK

Tel: +44 (0) 207 905 2261
Fax: +44 (0) 207 831 0488
Contact the contributor: A.Costello@ich.ucl.ac.uk

Institute of Child Health, University of London

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