Health Education and Prevention

By Frank Pizon

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.

• Language: English
• Publisher: Wiley
• Release date: Apr 10, 2019
• ISBN: 9781119611950

Book preview

Table of Contents

Cover

Introduction: Health Education: a Vast Enterprise

1 Conceptions and Deciding for One’s Health

1.1. Conception and decision: what do they mean?

1.2. Is educability in health possible?

1.3. What are the factors of efficacy in prevention at the international level?

1.4. Why speak of leading practices in health?

1.5. What are the unwavering links between research and intervention?

2 Social Representations of Health Conceptions

2.1. Can we speak of quantitative preponderance?

2.2. What qualitative studies are available to us at the international scale?

2.3. Why is there still a paradox in health education?

2.4. What meaning should be given to the terms used in publications?

2.5. What are the benefits and limits of the notion of social representation in the field of health?

2.6. What are the preliminaries for a new theorization of conceptions in health?

3 A Renewed Theory of Conceptions in Health

3.1. What are the paradigmatic foundations of health conceptions?

3.2. Why combine health paradigms?

3.3. How to avoid the pitfall of simplified thinking?

3.4. Theorization of conceptions in health

4 Qualitative Methodologies for the Investigation of Health Conceptions

4.1. What are the main qualitative methodologies used in international publications?

4.2. Which biopsychosocial interpretative model of conceptions should we use?

4.3. How to model the biopsychosocial dimensions of conceptions on addictions?

4.4. Are there many health conceptions from infancy?

4.5. Should we fear what children and adolescents have to tell us?

4.6. What are the elements to prioritize for intervening in health?

4.7. What are the advantages for public health from this approach to health conceptions?

5 The Convergence of Research Tools, Interventions and Training

5.1. How is a tool an inseparable element from human activity?

5.2. Why is the transferability of good practices a fantasy?

5.3. How to expand the notion of tools in prevention?

5.4. Why talk about the tool syndrome in health education and prevention?

5.5. What is the real process of conception of a prevention tool?

5.6. How does using photographs enable a reconciliation of research and intervention?

6 Formative Perspectives for More Effective Prevention Actions

6.1 What are the andragogic foundations for better apprehending the complexity of systems of conceptions?

6.2. In teaching, how can a better apprehension of the complexity of systems of conceptions be developed?

6.3. What foundations of an explicit pedagogy should teaching follow?

Conclusion

Appendix

References

Index

End User License Agreement

List of Tables

Chapter 2

Table 2.1. Qualitative or mixed scientific publications looking at how children,...

Table 2.2. Qualitative or mixed scientific publications looking at how children,...

Table 2.3. Qualitative or mixed scientific publications looking at how children,...

Table 2.4. Classification of types of knowledge (K = knowledge) and associated c...

Table 2.5. Definitions according to Clément (2010) of situated conceptions, conc...

Chapter 3

Table 3.1. Conditions of transformation of social representations (Abric, 2001, ...

Table 3.2. Summarized presentation of the seven criteria that enable the charact...

Chapter 4

Table 4.1. Distribution of items in domains following 19 categories of indexing ...

Table 4.2. Categorization in domains of health conceptions in children in CE2, C...

Chapter 5

Table 5.1. Methodological advantages of Photoelicitation (Whiting, 2015)

Table 5.2. Nature of the data collected because of the use of a Photoelicitation...

Table 5.3. The different approaches using photographs (historical and theoretica...

Chapter 6

Table 6.1. Proposal for a model of indexing of situations of health conception c...

List of Illustrations

Chapter 1

Figure 1.1. Magnified schematic of the factors of intervention efficacy in the s...

Chapter 2

Figure 2.1. Beliefs and knowledge of teachers according to A. Vause (2010)

Figure 2.2. Alcohol kills! or when the French postage stamp becomes an object ...

Figure 2.3. Construction phases of a representation according to Moscovici (1961...

Figure 2.4. Six points of view on the construction of a social representation ac...

Figure 2.5. Conceptions result from the conjugation of several situated concepti...

Chapter 3

Figure 3.1. The four health paradigms (according to Fortin, 2005) from the least...

Chapter 4

Figure 4.1. Biopsychosocial model applied to obesity

Figure 4.2. Biopsychosocial model applied to anorexia and bulimia

Figure 4.3. Biopsychosocial model applied to health (work inspired by Smith, 200...

Figure 4.4. Biopsychosocial model applied to sexuality (Picot and Pelège, 2010)

Figure 4.5. Biopsychosocial model targeting the empowerment of the subject in hi...

Figure 4.6. Biopsychosocial model targeting the empowerment of the subject in hi...

Chapter 5

Figure 5.1. Possible structure of a teaching and support mechanism for professio...

Figure 5.2. The three levels of teaching that allow the establishment of a preve...

Figure 5.3. The five phases that prevail on the validation of a corpus of the e....

Figure 5.4. Sleeves of two French e.Photoexpressions dedicated to the collection...

Figure 5.5. Example no. 1 of a photonarration (collection carried out by Milène ...

Figure 5.6. Example no. 2 of a photonarration (collection carried out by Milène ...

Chapter 6

Figure 6.1. Structuring elements of a pedagogy founded on the explanation of sit...

Health and Patients Set

coordinated by Bruno Salgues

Volume 1

Health Education and Prevention

Frank Pizon

First published 2019 in Great Britain and the United States by ISTE Ltd and John Wiley & Sons, Inc.

Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents Act 1988, this publication may only be reproduced, stored or transmitted, in any form or by any means, with the prior permission in writing of the publishers, or in the case of reprographic reproduction in accordance with the terms and licenses issued by the CLA. Enquiries concerning reproduction outside these terms should be sent to the publishers at the undermentioned address:

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© ISTE Ltd 2019

The rights of Frank Pizon to be identified as the author of this work have been asserted by him in accordance with the Copyright, Designs and Patents Act 1988.

Library of Congress Control Number: 2018967378

British Library Cataloguing-in-Publication Data

A CIP record for this book is available from the British Library

ISBN 978-1-78630-410-0

Introduction

Health Education: a Vast Enterprise

We will not mince our words: the terms education and health do not go hand in hand so easily. Their proximity deserves to be constantly questioned. We owe it to ourselves to always seek to identify what does or does not allow these terms to resonate. Associating the terms education and health highlights the irrevocable tension between giving way to the person who has the capacity to make decisions, and the temptation to educate for a health whose characterization is itself debated in the social sphere.

What can we do? How can we avoid seeking freely given and behaviorist submission? How can we ensure that the subject retains this decision-making position, taking into account their life environment and their own uniqueness? How should we react to the recurring challenges in public health that question the role of the subject in terms of much larger societal problems? These questions are sources of doubt, and doubt contributes to removing what is taken for granted.

The fundamental epistemological posture for health education probably consists of placing the person and groups at the heart of the approach, followed by integrating the weight of living contexts. It is not knowledge that prevails, but what the subject does with it. Knowledge, both heterogeneous and composite, functions such that allows the person to build their own rationality to lead (or not) a possible life. This will be the focus of this book, which endeavors to shed light on a number of points that constantly call into question health education practices.

This book, based on previous work on social health representations and concepts, aims to see how a renewed theorization could allow us to form a link between the subject (in their biological, psychological and social dimensions) and an educational approach that integrates their singularity.

After a decade of work in health education, our reflection therefore falls into a perspective of theorization of one of its constitutive aspects, potentially the most important: that of comprehending and taking into account health concepts.

The author’s thesis work, carried out in 2008, was one of the first to look at health education in the school environment using a psycho-ergonomic view of development within the wider framework of education sciences and activity analysis. Nearly 10 years later, the scientific field of health education has developed. It has even percolated in the scientific sphere, questioning scientific objects with diverse approaches in the fields of public health, sociology, anthropology, psychology, management and, of course, the educational sciences. As proof of this evolution in the university environment, teacher–researcher posts are now dedicated to health education, journals are devoted to it, a scientific network has been reinforced (UNIRéS, university network for health education), symposiums are multiplying and the hexagonal bibliography has expanded, even though it struggles to cover its delay at the international level.

This field of research inherently calls for multidisciplinarity. Although collaborations of this kind are always modest (similar to other fields of research in education), the various insights that current health education benefits from allow a step back to be taken after 10 years, following the appearance of this field of research. While certain people reproached it for not being a discipline, we now see that it has disciples through the development of an interesting and much more diffuse movement within the scientific community than at its initial appearance. It is almost amusing that this field of research that remained marginal for several years has now found its place, notably in university disciplines where it was not expected nor wanted. However, we will retain from this evolution the positive character generated by this gradual movement of multidisciplinary appropriation. What ensued was the redefinition of the health education profile, even a shift from education for… (confined to teaching problems and centered on education science), toward a contrast of the terms education and health at the crossover of educational and health theoretical foundations. Nevertheless, the juxtaposition of these two terms allows the description of a reciprocity, which also pushes for the consideration of convergences. It is in this perspective that this book’s approach belongs: identifying what will push forward the theorization of a field that is currently scientifically wellestablished, without necessarily focusing on a disciplinary approach which in no way allows for the apprehension of the entire complexity. It is therefore necessary to include psychology, social psychology, sociology, education sciences and, of course, public health.

In order to address what could be considered as fundamental in this field of research, several red lines will be unraveled in the following lines. Indeed, putting education and health into perspective is not neutral, whether from epistemological or epistemic points of view, notably with the integration of public health issues. This questions the role of the subject, on the one hand, and their position within groups or society, on the other hand. Looking at understandings of health places a set of elements in tension. In this process of analysis and theorization, we must therefore fall back on a variety of disciplines to which the frames, models and methodologies refer. By approaching the health of educational preoccupations, it then quickly becomes necessary to understand from where the author speaks, from where the author questions, observes and collects, then analyzes and discusses. The researcher himself benefits from adopting a posture that allows him to reinterrogate the objects of research that he manipulates. The objectification of methodologies, for collection as well as analysis, becomes a gauge of scientific rigor. Linking education and health pushes the researcher in his entrenchment, sends him back to his role as a citizen, to what he is himself. Describing these links jostles him in terms of his personal and professional history. He cannot extract himself completely from what he is. It is on this point that human and social sciences lack, it seems, hardness.

But what hardness do we mean? That which distinguishes so-called soft sciences from so-called hard sciences. Jacques Ardoino (1993) attempted to clarify these aspects: While this notion (‘soft’) designated, more traditionally, that which remained entangled, still waiting to be ‘unraveled’ through a reduction of elements that are increasingly simple, and increasingly ‘pure’, the modern meaning, enriched by contributions from cybernetics, developed in the context of a systemic approach and not without link to the Lewinian theory of the ‘field’ (borrowed from the physical electromagnetic model), suggests a more ‘molar’, global, indecomposable, grasp. However, at a second, more detailed reading, ‘molar’ could be profitably replaced by ‘holistic’, better characterizing the complexity of human phenomena. Effectively, ‘molar’, from ‘mole’ (gram molecule, molecular mass of a substance), in chemistry, is in opposition to atomics (simple decomposed elements), whereas holistic, derived from holism (general epistemology), designates, in contrast with atomics, a position according to which we cannot understand the parts without knowing the whole. In this perspective, ‘complex’ should be carefully differentiated from ‘complicated’ (the latter notion has the potential to allow the decomposable and irrevocable characteristic of its objects).

By thus exposing our posture and research process which has led to the theorization of concepts in health, we once again highlight the entire complexity inherent to our objects, their contexts, the subjects themselves and the researchers who encounter them. Edgar Morin (1977) specifies that complexity first imposes itself as impossible to simplify; it occurs there where the complex unit produces its appearance, where distinction and clarity become lost, where disorder and uncertainty disturb phenomena, where the subject-observer surprises himself in the object of his observation, where antinomies cause reasoning to diverge… Complexity is not complication. That which is complicated can be reduced to a simple principle such as a tangled coil or a sailor’s knot. Certainly, the world is very complicated, but if it were only complicated, that is to say tangled, multi-dependent, etc., it would only require applying well-known simplifications […]. The real problem therefore is to not relate the complication of developments to rules that have simple bases. Complexity underlies it. And he adds, such a confluence of before-then disjointed notions brings us closer to the principal core of complexity which is not only in the linking of the separate/isolated, but the association of what was considered as antagonistic. Complexity corresponds, in this sense, to the irruption of antagonisms at the heart of organized phenomena, to the irruption of paradoxes or contradictions at the heart of a theory. The problem with complex thought is then to think together, without incoherence, two ideas that are, however, contrary.

Faced with this intrinsic and extrinsic complexity linking education and health, we will look at several approaches. In other words, we seek to vary the points of view to showcase several sources of insight. This posture comes with great epistemological vigilance in order to avoid naturalizing knowledge (Berger, 2007). Multireferentiality is not considered as a research methodology: it remains a posture that guides our research activity (Ardoino, 1993) but must remain prudent. This in the interest of avoiding at all costs the articulation of heterogeneous paradigms (Monjo, 2003) and better understanding some of the overlap, sometimes revelatory of contradictions in the subjects and often difficult to elucidate. It was our object of research that led us to go through a plurality of paradigms (Fortin, 2005) in order to leave the pervasiveness of a medicalized introduction to health behind. To iterate the words of Guy Berger (2007), everything is relative to position (from where I stand, I think that…). This also brought us to consider our research practice as a social practice comparative to other social practices, carrying, as we will attempt to demonstrate, its own norms and paradigms. We are not, therefore, aiming for a syncretism that would push us to take from everywhere simply to oblige. Instead, we rely on the cultural and historical reading of our research object to legitimize this multireferential approach. Thus, a work path is defined, a personal walkway that attempts to state an objective with the help of different sources of insight and engaging only its author.

We are aware that the models we propose can sometimes lead to categorical thinking which then amplifies the differences between categories and minimizes the intercategorical. Our knowledge does not dispel what we do not know (Berger, 2007). This allows the definition of the complexity of things by positioning our work at different levels (subject, group, organization, institution) altered by mutual modifications.

This approach arose from the embarrassment in which practitioners always found themselves when they started to rethink their methods, no doubt to optimize them, with a more deliberate praxeological intention, but also to attempt to better understand or even to theorize them, from a perspective which is then closer to scientific curiosity, notwithstanding ethical preoccupations.

Where women and men undertake and achieve projects together, they interact. The social link thus becomes the object of research, questioning the practices. The issue of power which is always associated concerns the lived and tangible experience of subjects (a term that has been favored over individual from the beginning of this work, increasingly used in the field of public health), as much as the functioning of the social body, organizations and institutions or the interpersonal relations of domination and submission. It may seem that, behind a common language, words have a shared meaning. This is not always the case, and the underlying paradigms propel us into a form of complexity of which the multireferentiality enables the measurement of what separates and what unites within a melting pot of concepts fed by knowledge of varied nature, which we will return to. It is this melting pot that interests us in our work: the differences then take on as much importance as the common points. Adopting this multireferenced view means moving away from simplistic views and ways of thinking. In the face of complexity, mediatization can generate undifferentiating linguistic productions, to use the words of Ardoino, but can also spread knowledge and open up for the necessary expression of these differences.

"We are at constant risk of remaining prisoners of the unidimensional