Health Education and Prevention

Frank Pizon

• Publisher: Wiley-ISTE
• Year: 2019
• Print ISBN: 9781786304100
• eBook ISBN: 9781119611950
• Edition: 1
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

Social representations, beliefs, values and knowledge are just some of the aspects that affect how the beneficiaries of preventative health measures perceive their wellbeing. Health Education and Prevention questions and analyzes these concepts in order to consider new ways of theorizing patients' conceptions of their health. From a methodological point of view, these analyses are put into practice with the design of prevention tools and devices. The use of a corpora of photographs is particularly meaningful in this respect. This book offers an authoritative perspective by noting important points of vigilance in training, and especially by distinguishing instructive contents conducive to the development of an explicit health pedagogy for more effective prevention measures. A model for categorizing situations integrating both educational and healthcare paths is also proposed.

1
Conceptions and Deciding for One’s Health

Before intensifying the relationship between “conceptions” in health and making “decisions” in health, it is necessary to detail the meaning attached to each of these two terms. In a perspective that encompasses both research and intervention, we will therefore show what we mean through “practices”, by positioning them both in public health perspectives and with educational purposes, asking the broader question of educability.

1.1. “Conception” and “decision”: what do they mean?

The term “conception” is an essential marker in this book. Its polysemy is reminiscent of the way in which work collectives think, negotiate and gradually stabilize health intervention measures. However, this term mostly defines the perceptions in health formed by the subjects in their individual and collective dimensions, in their ways of characterizing “their” health and adopting behaviors coherent, or not, with what they are or believe to be. Finally, it evokes the conception of health intervention tools, which will be used productively between theory and practice. Since tools are regularly diverted away from their initial use (a mason’s trowel works equally well for spreading cement as for hitting cement blocks with the handle to level them), the use then reveals the way in which the user considers the instrument that he wields in his hands. The word “conception” refers to the dimensions that we have just described, but also presents the question of how to disseminate new knowledge or unprecedented tools in the social sphere. We postulate that the modular thinking that integrates a potential flexibility for the reappropriation by “users” is a channel with great interest for considering the content of training for prevention actors.

The second term, “decision”, takes on a particular character in our research works that quickly converged into a need to give it a particular emphasis.

On matters of health, “deciding” (or not) is central to a subject’s journey. It is the sign of an “ability to act” (Le Bossué, 2003), or in other words, of a power to overcome or remove obstacles, without it necessarily involving an “increased awareness of the interdependence of the structural and individual sources of change” (ibid) by the subject. This “power to act” is part of the important ideas in the analysis of activity and the field of health, notably the notion of empowerment. Jacques Leplat (2016) cited the works of Pierre Rabardel (2005) that distinguish the “capacity to act” from the “power to act”. These two possible phrases differentiate “what the subject who defines his sphere of capacity can mobilize, and what is effectively possible, what is within the power of the subject in the singularity of the situations and conditions of activity” (Rabardel, 2005, p. 18 in Leplat, 2016). For Jacques Leplat (ibid), it consists of finding “this distinction in the differences between knowing how to do a task” and “having the possibility to do it”, to which it is necessary to add “being inclined to do it”, and “finally doing it”. These words retrace, in very different ways, the paths used to apprehend the activity of the subject: “knowing how to do” essentially refers to competencies with aims and conditions of execution; “having the possibility to do” reminds us that we can know how to do it, but might not necessarily have the possibility; “being inclined to do” suggests the idea of the in fine omnipotence of the subject who can decide not to act. Jacques Leplat (ibid) added that “all these dimensions of action power are also to be examined under an angle of development”. Nevertheless, we will not talk about an allpowerful subject who conditions his decision-making on matters of health, but rather of this “power to act” (or not) based on the perceptions he has and the way he uses them in the situations he encounters, and that put pressure on him in matters of decision.

Thus, we highlight the fundamental distinction between considering the subject on the one side and the object on the other, and, in contrast (which is the posture guiding this text), considering that these two aspects form a whole which also plays a mutually transformative role; the subject transforming the object while itself being metamorphosed by the object (Ricoeur in Pastré, 2015). “The evolution of Ricoeur’s philosophy allows us to see how the theme of the subject, which was the central question of western philosophy for three centuries, takes a potentially decisive turn in the 20th Century to move from the epistemic subject to the capable subject or man” (ibid). It is a question of removing the subject from an ignorance, which he could voluntarily be given in order to accept that he positions himself to act before he has the knowledge. The subject thus “uses, at his convenience, knowledge as a resource to direct his action” (ibid).

The question that fundamentally fuels our reflection consists of clarifying the role of knowledge in the subject’s activity with regard to his life experience. It also allows us to uncover what generates a resource or obstacle for the subject, as well as recognizing its extremely constructive and transformative role in action.

1.2. Is educability in health possible?

Talking about education or health sends us back, in the first instance, to the crucial issue of social inequities. Education seeks to empower, but systems have a lot of trouble avoiding an increase in the latter. In the field of health intervention, social inequities are so strong that they push us to attempt to think differently, to mobilize intersectorality (Kempf et al., 2013) and to implement a “proportional universalism” (Lang, 2014), a notion that allows us to reason in order to rethink the principles of equity because everything is linked. For example, our level of mastery of language conditions our access to testing, our reasoning and analysis capacities, in turn fed by our culture (scientific, artistic, literary, historical, etc.), and our capacity to perceive the world that surrounds us. All these elements play a part when we make decisions on matters of health. Thus, we know that a high sociodemographic level notably increases screening for breast cancer because of more frequent check-ups (Duport et al., 2007). Environmental conditions and the quality of life show that access to a doctor and financial aspects (including the possession, or lack thereof, of accommodation) interfere with the quality of screening (Duport et al., 2008). There are many similar examples. They necessarily question the role of education in health behaviors, but by putting them in perspectives of varied and heterogeneous health determinants that are beyond the subject and refer to the quality of his environment.

Nevertheless, education allows the subject to regain his place and overcome certain obstacles. As such, in iatrogenic patients (iatrogenesis induced by Vitamin K antagonists (VKAs)), participating in activities of therapeutic education quarters their risk of hemorrhage under VKA therapy (Saint-Leger et al., 2004). “The representation of patients is linked more to belief phenomena¹ that allow for the anticipation, expectation and evidence of the emotional load of the illness” (Cannone et al., 2004; Marie et al., 2010).

However, evoking education (whether of health) is accepting to believe in the educability of the subject. But of what educability do we speak?

For Philippe Meirieu, this notion is scientifically false (Meirieu, 2009). The relationship between our health status and our learning capacity has largely been described (Bantuelle and Demeulemeester, 2008) and underlines the fact that children and adolescents cannot be reduced to “learners”. Indeed, the term educability assumes that the “part taken by the educability of all persons refers back to the existing tension between a demiurgic temptation, on the one hand, and the cessation of transmitting anything, on the other hand” (Jourdan and Berger, 2005). Even if we avoided approximating pedagogy to a demiurge, the first having nothing of the divine, it is troubling to note that the approximation of the two terms in the expression “health education” has contributed largely in rethinking the role of the subject and the intervenor. The words of Philippe Meirieu (2010) usefully complete this description of an exercise of social control when he talks about the use of Ritalin to “regulate” the concentration and learning capacity of children. At the risk of provisionally reducing health to medical treatments, he mentions “the systematic use of chemical or technical reconditioning prostheses”. In the end, we reduce the child to a set of circuits and claim to be able to “educate” him through a sum of targeted punctual interventions. The subject disappears and, with him, the only truly educational work which consists of creating the most favorable conditions for a person to become engaged in teachings and to find within himself the strength to grow. All this indicates a confusion: we think that education consists of “making” an individual – of finding in order to repair. It is therefore important not to adopt this view of care and treatment when thinking about educational actions. Nevertheless, it is not a question of adopting a pusillanimous attitude, erasing all innovative attempts to educate. Moreover, from a public health point of view, the same tension is seen when a minister forces patients suffering from Alzheimer’s to see their physician again for the renewal of prescriptions. This thus once again positions the treatment as a prescribed finality, whereas the physician can play a listening or supporting role.

Talking about education means talking about educational contexts and cultures. In France, the mechanistic and individualist perception of the subject in the educational environment is supported by pedagogy based on objectives, which follows a behaviorist vision of teaching. The subject becomes “able” on the condition that he is set steps to achieve, which are prepared for him. There, we find an epistemic approach to the subject which has heavily inspired the teaching of disciplines.

Requestioning the idea of a capable subject who is not only considered by his ability to reason, but also by what he does and experiences in situations, allows for a paradigm change favoring the approximation of “education” and “health”. Nevertheless, these questions are not new. In Greek civilization, while medicine focused on the body, philosophy explored the spirit in an attempt to resolve an existential issue. Aristotle described the “intemperate or akratic man” caught in conflict between reason and desire, “that is to say, the one who recognizes that he should change his behavior, yet whose behavior does not change” (Agostini and Mallet, 2010).

For Socrates and Plato, two models of educational relationship oppose each other. According to Agostini and Mallet (ibid), there is a democratic model that leads the subject to overcome his resistances and a more totalitarian model in which it is necessary to reach the end of all resistances regardless of the cost to the subject.

For Socrates, there is a conflict between the two discourses in reasoning. Thus, in the case of a subject giving up tobacco, “on the one hand, his reasoning tells him that smoking is no longer good for him; on the other hand, it also tells him that the pleasure of smoking is important” (ibid). The subject is described as “ignorant”. Education is responsible for engaging him in full, leading him by the entirety of his being (mentally and bodily) to identify the importance of a change in behavior. Socrates therefore advocates the development of the knowledge of self, always deeper in order to give meaning to the risks encountered.

For Plato, efficacy is prioritized in terms of personal development. It can then be considered that “what counts is not that the educated person truly adheres to the principles of the education that has been transferred to him; that his action conforms to it. And this, regardless of the price of this conformity” (ibid).

These quotations from Plato and Socrates raise an opposition: “Democratic or totalitarian, coaching or indoctrination, the educational relationship remains a manipulation. Follow...

Table of contents

• Cover
• Table of Contents
• Introduction: “Health Education”: a Vast Enterprise
• 1 Conceptions and Deciding for One’s Health
• 2 Social Representations of Health Conceptions
• 3 A Renewed Theory of Conceptions in Health
• 4 Qualitative Methodologies for the Investigation of Health Conceptions
• 5 The Convergence of Research Tools, Interventions and Training
• 6 Formative Perspectives for More Effective Prevention Actions
• Conclusion
• Appendix
• References
• Index
• End User License Agreement