- Email: [email protected]
Roles and relationships in health education
PubL Hlth, Lond. (1982), 96, 105-112
Roles and Relationships in Health Education Fmda Eskin M.B.. Ch$.. D.P H_. D.Obsl P.:C.O.G.F.F.C.M.. M.Ed.
Unit Director, L/nit for Continuing Education, University of Manchester, Department of Community Medicine, Stopford Building, ~vford Road, Mancheszer M23 9PT Introduction This article describes the results of a workshop in which community physicians and area health education officers met to consider ways in which they might work more collaboratively, in order to enhance the effectiveness of health education in the health service. The idea for this workshop arose out ofa multidisciplinary meeting on the smoking-related diseases, at which it became obvious that there were a number o f issues impeding effective interdisciplinary collaboration. Although a large number of disciplines have an interest in health education, those of most importance in terms of potential for influencing the system, are community medicine and health education. The community physicians occupy a central position within the managerial framework, which empowers them to influence the allocatio,~ of resources to health education. Their training also enables them to understand the philosophy and concepts underlying the practice o f health education. Health education officers are the practitioners of the discipline and possess the expertise necessary to affect health behaviour. Originally it was hoped that community physicians and health educators would be matched for health area. However, this was not possible, except in two or three instances. The workship was residential and extended over 3 days.
The Design of the Workshop The design was based on the ""learning by doing'" model, ~which is considered tobe the most effective way of achieving permanent learning in adults. =.s This model demands a high level of participation from workshop members. In this situation the teacher moves from the position of being an "'all-powerful" authority figure, 4 to one of being a "'low-profile" facilitator, available to enable participants to use their own knowledge and expertise. Because of this it is not usually necessary for tutors to have more than a superficial knowledge o f the subject matter. Their role is to help the participants to work out the problem rather than to become involved in the problem itself. Such an event is participantcentred rather than teacher-centred,
The Programme When the programme finished, each participant had an action plan which he/she intended to apply on returning to work. The events that preceded this final stage enabled the formulation o f these action plans. It is n o t proposed to describe the methods in detail, although brief descriptions will be provided where appropriate. Attention will be mainly focussed on the data and information provided by the 0033-3506/82/020105+ 08 $02.00/0
© 1982 Academic Press Inc. (London) Limited
106
F. Eskin
participants personally which enabled them t o go through the successive stages leading to the production of action plans. These stages are defined as follows. (a) Problem identification. (b) Role clarification and negotiation. (c) Collaboration. (d) Action Planning. Problem identification During this first stage data was elicited which determined the direction o f the programme. These data were gathered by focusing the attention of the participants on three questions. The sequence of sharing individual answers in unidisciplinary small groups and presenting small group data to the large group, permitted identification of the ma:~n concerns of the participants. The questions and responses are summarized in Table 1. The major issues identified were concerned with the roles of the two disciplines in relation to health education, and in particular the confusion that both health educators and community physicians had about the role of the community physician in health education, both in its development and provision. Role clarification and negotiation Within this stage two sub-stages emerged, one concerned with role conflict and confusion, and the second concerned with role clarity. (1) Role conflict. The role conflict and confusion issues arose out of the problem identification data. Using an exercise known as "role clarification", s participants worked in groups to analyse their interdisciplinary perceptions. Each group remained unidisciplinary and spent some time on the exercise which required answers to the following questions: (A) Identify five adjectives which describe yourselves. (B) Identify five adjectives which describe the other group. (C) Identify five adjectives which you think describe how the other group see you. (D) How would you like the other group to change? What would you like them to do differently? The adjectives are summarized in Table 2. The issues identified by each group for change in the other group are listed below. (i) What the health educators wanted the coramunity physicians to do (a) To fight for prevention as their prime role. (b) To accept health education officers.as an equal profession. (e) To accept the contribution that health education can make and to value it, e.g. incorporate health educators at the decision-making stage. (d) To stop making decisions using methods defined by them alone. (e) To use conflict co/astructively in the decision-making process, i.e. don't keep avoiding issues. (ii) What the community physicians wanted health educators to do (a) To be less strident and sin~e-minded (b) To help develop mutual respect. (c) To consider modifying training. ((t) To broaden the perspectives of health education.
Re,les and Relationships in Health Education
107
TAstE I. E~xctations and main problems o f workshop ,participants. A summary of information elicited in the first session Question,s asked in the first session (a) What are )'our expectations of this workshop?
Community physicians (I) To find out how other health education services work apart from our own (2) To sort out the organisational problems involved in the provision .and development of a health education sea-ice
Health educators (l) "1o find out how community physicians see their role in headtt education and in health education ~departments (2) To sort out the role o f the community physician visa vis health education
(3) To explore altitudes o f health education ofl~ccrs in relation to the role o f the community physician. (b) What are your main problems in relation to your role in health education?
(t) Training problems, e.g. should health education officers know more medicine (2) ls our involvement in health education inadequate'?. (3) What is our role? (a) Public relations. (b) Influencing the DMT for
(1) What is our role? We should be independent officers ! (2) Who is in charge of health education? (3) We are not inv~ved in health planning and policy making
~:t;ources.
(c) Arc we the boss, the client, or the adviser? (4) Should there be a prevention planning team in each district? (c) Why are health educators so keen on this topic and not the community physicians? (Six community physicians and 14 health education officers at the workshop)
(I) We may give health education a low priority (2) We trust our health education
officers (3) We are (not) threatened!
(!) Community physidans do not see health education as an important part of their work, but aim fear that it might be and they are not doing enough
The exercise then ,continued by asking each group to select one of the desired changes, and to negotiate with the other group for some movement towards change. In the process of doing this, participants decided that their main problem was lack of role clarity within their own discipline which they felt had to be sorted out before they could negotiate their role across disciplines. (2) Role clarification. Each discipline spent some fime cladf~ng its own role and determining a perspective of each other's role, e.g. the community pliysicians established a summary of their own role and also identified their perspective of the health educator's role. Each group then presented their work to each other, as follows. (A) The community physician role as identified by community physicians (i) Relating Health Services to health needs. (ii) Relating the N.H.S. to other health related services.
108
F. Eskin TAB~ 2. Adjectives used by participants to describe self and other discipline
Adjectives Used by health ,educators
Used by community physicians
To describe community physicians Inert Pedantic Mercenar3' Omniscient Demoralised Conservative Autocratic Simplistic Uninterested Frustrated Anxious Undervalued Too management concerned
To describe health educators Radical Emphatic Manipulative Innovative Resourceful Liberal Adaptive
lnsccure Limited by resources Enthusiastic Poor managers Widely variable ability
(iii) Administrative responsibilities. (iv) Preventive medicine: (a) health campaigning; (b) health education; (c) public health; '(d) screening. (B) The community physician role as seen by health educators (i) Administrative medical officers, e.g. report editors, attenders of meetings, financial resource negotiators, service monitors. (ii) Medical officers (proper officers), e.g. environmental health, epidemiology, collator of routine stittistics. (iii) Policy m~tkers. (C) The health educator's role as seen by health education (i) Planners, policy activities. (ii) Trainers/teachers. (iii) Researchers/evaluators. Ov) Resource obtainers. (v) Liaison/consultation functions. (vi) Managers of their service. (D) The health educator's role as seen by community physicians (i) Concerned with community needs in health and health services. (ii) Concerned with the W.H.O. model of positive health. (iii) Concerned with identification of problems, with support and development. This work allowed misunderstandings to be rectified and the joint identification of role problems created a climate for the collaborative stage of the workshop.
Roles and Relationships in Health Education
109
Collaboration Following the work on roles, participants divided into mixed discipline small groups, their brief being to identify common areas ofconeern that they mightjointly be able to influence. A summary of these areas is as follows. Common areas of concern Autonomy of health educators by default. O) (ii) Isolation of the discipline of health education. Oil) Lack of a pro-active approach by health education officers to improve working relationships. (i~,) Training for health education officers and community physicians and the extent of disparity and commonality. (v) Who's in charge of health education? (vi) The status of the area health education officer. (~d~) The multidisciplinary nature of health education. (viii) Health education as an independent profession. (ix) The lip-service attitude of the N.H.S. towards health education. (x) The need for a legitimated wide role for both community physicians and health education officers in influencing the health status of individuals and the community. Each of these areas of concern was considered to be of equal importance in enhancing and influencing the impact of health education as a major health-providing force. Participants decided to explore these in greater depth in order to produce some practical proposal for dealing with them. In order to do this five groups were convened and eventually a summary of the proposals from each group was presented to the whole group for consideration and discussion. These summaries are presented for each group. Group l This group chose to discuss the two related areas of enforced autonomy and isolation. The following proposals were offered. (a) An examination of present health education services provided by health education officers to ensure that the right image is being projected. (b) Improvements in and development of relationships of health education officers with community physicians by positiveaction on the part of the health educators. (c) The development of regular meetings with community physicians on an individual basis to promote a collaborative effort for health education. (d) The encouragement of health education as an official agenda item at formal meetings of community physicians in each area or district, i.e. at local level. (e) The recognition of the practical power and influence of the area medical officer (or district medical officer of the future) in the allocation of resources to health education. Health education officers Should make sure {hat their area medical officers are well-briefed. Group 2 This group chose to explore the problem of the National Health Service paying lip-service to health education. Their proposals were (a) To make every attempt to overcome lethargy and to be positively assertive in promoting health education.
110
F. Eskin
(b) To ensure that the area or district health education officer would in future be incorporated as an integral member of health planning teams and working parties. (c) To encourage and promote the right of the health education officer to be considered an independent officer. (d) To ensure that health education is as efficient as possible in its recognised areas of expertise before it expands its boundaries. (e) To change attitudes towards health education and its role. (f) To explore and identify the major problems in the training of all health disciplines in relation to health education. Group 3 This group chose to discuss the issue of the legitimation of a wide role in society for both community physicians and health education officers. Figure 1 describes the extent of this role which encompasses all activities which impinge upon health and health status at an individual and community level. As an example of this, the group decided to explore the ideal role of both disciplines in housing. Basically this was shown to involve achieving input into the planning of housing in the community, requiring research and the acquisition of information, as well as consultation, advice and integration of both disciplines into the appropriate local authority planning framework. Group 4 This group chose to consider the problems of training and how to overcome the present problems of separate training programmes. Essentially it was felt that a joint training programme for both community physicians and health educators was important and that to achieve this a number of steps were required, these included the following. (a) The use of informal and formal networks to explore views on training. (b) Discussion with the professional organisations concerned, e.g. Association e f A.M.O.s, Society of Community Medicine, Association of A.H.E.O.s, Guild of H.E.O.s, etc. (c) Making a formal approach to academic boards involved in training. (d) A joint meeting of all organizations, institutions and bodies involved to agree on the principles o f joint training and to begin to make provision for curriculum content. Group 5 This group took on the task of looking at the problem of " Who's in Charge'" in relation to health education. They decided that no one was in charge (except bureaucratically), and that in terms of achievement it had to be a collaborative effort between the two major disciplines involved. This group diagrammatically represented the roles of health educators and community physicians (Figure I). This quite'clearly showed the commonality ofinterest and concern. The group made a number of important comments which were that a team collaborative approach does not require structured change; rather that it requires cooperation and joint commitment and that collaboration can only be achieved if the disciplines concerned believe that their relationship is one of peers and equals and are prepared to jointly assert themselves to promote health education.
Action planning In the final stage o f the workshop individual participants considered their own particular local problems, related the work achieved in the workshop to their own problems and each
~
Broad lover view \ Health care \ needs and ~sefvice rovision _ + . Information 1 research [ Epidemiology Consultation
i
Obtoin 'reso'urces "' i .t,O Optimize healt h j
[ advice other
.
.
.
to Brood overview I Information Health attitudes research and perceptions Market research surveys Consultation Epidemioloqy SOCiOI services
j resources allocation [in society to optimize hearth
.
.
.
.
.
.
.
.
]
individual behaviour
Madi~y~.; 'I j J
[deve,opmo°,J
health | ; behoviour |
X_
Relationship to
.
}
,..~.ervice chGnge]
lOeo~ino" ..]
_ .............
t
, ,J
iEOOcote Communit'y1
_lin the use of ___ _ j~lserv,ces Optimize use 1 of services ,,kj~Fe~b~c~- tar
Health educohon ofhcer
Figure 1. The roles of the community physician and health education.
.
campaigning | and environmental I health
com~mtJnity} and other agenci esto I priori! . ~ health ...... I
'Pressurize
Relate N.H.S. to 1 Olher agenc,ie$
~,empt to |. iMana<;ementl evaluate, plan r l and planning} and allocate ( l teams and [ resources in |~"wheeler the N,H.S,. . . . . . .J. J deohng • " ]
Community physician
112
F. Eskin
person designed their own action plan on a short, medium and long-term basis, to be acted upon at work. Participants were given the opportunity to discuss their own action plans with colleagues in their small groups. Conclusion
The summary of this workshop does not give the total picture of all the activities that t o o k place and which encouraged participants to produce the ideas and plans outlined above. Nor is it possible to do justice to the enthusiasm and energy which everyone gave to a very difficult task. The crucial stage in the whole process is, of course, the one which comes after the workshop is disbanded; that of implementing proposed action plans in the work situation. Follow-up of participants after a 3-month period will indicate whether or not this has been accomplished or at least begun. Hopefully some of the excitement and enthusiasm of the workshop will have been retained at a sufficiently high level to give impetus to action. Furthermore, it is also hoped that the ideas generated by this particular group of people will inspire those who were unable to participate to give some thoughts as to how they might tackle their own interdisciplinary roles and relationships in health education. References
1. Kotb, A. D. & Fry, R. (1975). Towards an applied theory of experiential learning. In Theories of Group Processes. G. L. Cooper (Ed.) Chichester: Wiley. 2. Stein, L.S. (1981). The effectiveness of continuing medical education: eight research reports. Journal of Medical Education 56, 103-10. 3. Miller, G. E. (1967). Continuing Education for what? Journal of Medical Education 42, 320-6. 4. Miller, G. E. (1975). Why continuing medical education? Bulletin of~,he New York Academy of Medicine 51, 701-6. 5. Jones, J. E. (1975). Role clarification. A team building activity. In A Handbook of Structured Experiences for Human Relations Training, Volume V, J. W. Pfeiffer & J. C. Jones (Eds). University Associates Publications.
Roles and Relationships in Health Education Fmda Eskin M.B.. Ch$.. D.P H_. D.Obsl P.:C.O.G.F.F.C.M.. M.Ed.
Unit Director, L/nit for Continuing Education, University of Manchester, Department of Community Medicine, Stopford Building, ~vford Road, Mancheszer M23 9PT Introduction This article describes the results of a workshop in which community physicians and area health education officers met to consider ways in which they might work more collaboratively, in order to enhance the effectiveness of health education in the health service. The idea for this workshop arose out ofa multidisciplinary meeting on the smoking-related diseases, at which it became obvious that there were a number o f issues impeding effective interdisciplinary collaboration. Although a large number of disciplines have an interest in health education, those of most importance in terms of potential for influencing the system, are community medicine and health education. The community physicians occupy a central position within the managerial framework, which empowers them to influence the allocatio,~ of resources to health education. Their training also enables them to understand the philosophy and concepts underlying the practice o f health education. Health education officers are the practitioners of the discipline and possess the expertise necessary to affect health behaviour. Originally it was hoped that community physicians and health educators would be matched for health area. However, this was not possible, except in two or three instances. The workship was residential and extended over 3 days.
The Design of the Workshop The design was based on the ""learning by doing'" model, ~which is considered tobe the most effective way of achieving permanent learning in adults. =.s This model demands a high level of participation from workshop members. In this situation the teacher moves from the position of being an "'all-powerful" authority figure, 4 to one of being a "'low-profile" facilitator, available to enable participants to use their own knowledge and expertise. Because of this it is not usually necessary for tutors to have more than a superficial knowledge o f the subject matter. Their role is to help the participants to work out the problem rather than to become involved in the problem itself. Such an event is participantcentred rather than teacher-centred,
The Programme When the programme finished, each participant had an action plan which he/she intended to apply on returning to work. The events that preceded this final stage enabled the formulation o f these action plans. It is n o t proposed to describe the methods in detail, although brief descriptions will be provided where appropriate. Attention will be mainly focussed on the data and information provided by the 0033-3506/82/020105+ 08 $02.00/0
© 1982 Academic Press Inc. (London) Limited
106
F. Eskin
participants personally which enabled them t o go through the successive stages leading to the production of action plans. These stages are defined as follows. (a) Problem identification. (b) Role clarification and negotiation. (c) Collaboration. (d) Action Planning. Problem identification During this first stage data was elicited which determined the direction o f the programme. These data were gathered by focusing the attention of the participants on three questions. The sequence of sharing individual answers in unidisciplinary small groups and presenting small group data to the large group, permitted identification of the ma:~n concerns of the participants. The questions and responses are summarized in Table 1. The major issues identified were concerned with the roles of the two disciplines in relation to health education, and in particular the confusion that both health educators and community physicians had about the role of the community physician in health education, both in its development and provision. Role clarification and negotiation Within this stage two sub-stages emerged, one concerned with role conflict and confusion, and the second concerned with role clarity. (1) Role conflict. The role conflict and confusion issues arose out of the problem identification data. Using an exercise known as "role clarification", s participants worked in groups to analyse their interdisciplinary perceptions. Each group remained unidisciplinary and spent some time on the exercise which required answers to the following questions: (A) Identify five adjectives which describe yourselves. (B) Identify five adjectives which describe the other group. (C) Identify five adjectives which you think describe how the other group see you. (D) How would you like the other group to change? What would you like them to do differently? The adjectives are summarized in Table 2. The issues identified by each group for change in the other group are listed below. (i) What the health educators wanted the coramunity physicians to do (a) To fight for prevention as their prime role. (b) To accept health education officers.as an equal profession. (e) To accept the contribution that health education can make and to value it, e.g. incorporate health educators at the decision-making stage. (d) To stop making decisions using methods defined by them alone. (e) To use conflict co/astructively in the decision-making process, i.e. don't keep avoiding issues. (ii) What the community physicians wanted health educators to do (a) To be less strident and sin~e-minded (b) To help develop mutual respect. (c) To consider modifying training. ((t) To broaden the perspectives of health education.
Re,les and Relationships in Health Education
107
TAstE I. E~xctations and main problems o f workshop ,participants. A summary of information elicited in the first session Question,s asked in the first session (a) What are )'our expectations of this workshop?
Community physicians (I) To find out how other health education services work apart from our own (2) To sort out the organisational problems involved in the provision .and development of a health education sea-ice
Health educators (l) "1o find out how community physicians see their role in headtt education and in health education ~departments (2) To sort out the role o f the community physician visa vis health education
(3) To explore altitudes o f health education ofl~ccrs in relation to the role o f the community physician. (b) What are your main problems in relation to your role in health education?
(t) Training problems, e.g. should health education officers know more medicine (2) ls our involvement in health education inadequate'?. (3) What is our role? (a) Public relations. (b) Influencing the DMT for
(1) What is our role? We should be independent officers ! (2) Who is in charge of health education? (3) We are not inv~ved in health planning and policy making
~:t;ources.
(c) Arc we the boss, the client, or the adviser? (4) Should there be a prevention planning team in each district? (c) Why are health educators so keen on this topic and not the community physicians? (Six community physicians and 14 health education officers at the workshop)
(I) We may give health education a low priority (2) We trust our health education
officers (3) We are (not) threatened!
(!) Community physidans do not see health education as an important part of their work, but aim fear that it might be and they are not doing enough
The exercise then ,continued by asking each group to select one of the desired changes, and to negotiate with the other group for some movement towards change. In the process of doing this, participants decided that their main problem was lack of role clarity within their own discipline which they felt had to be sorted out before they could negotiate their role across disciplines. (2) Role clarification. Each discipline spent some fime cladf~ng its own role and determining a perspective of each other's role, e.g. the community pliysicians established a summary of their own role and also identified their perspective of the health educator's role. Each group then presented their work to each other, as follows. (A) The community physician role as identified by community physicians (i) Relating Health Services to health needs. (ii) Relating the N.H.S. to other health related services.
108
F. Eskin TAB~ 2. Adjectives used by participants to describe self and other discipline
Adjectives Used by health ,educators
Used by community physicians
To describe community physicians Inert Pedantic Mercenar3' Omniscient Demoralised Conservative Autocratic Simplistic Uninterested Frustrated Anxious Undervalued Too management concerned
To describe health educators Radical Emphatic Manipulative Innovative Resourceful Liberal Adaptive
lnsccure Limited by resources Enthusiastic Poor managers Widely variable ability
(iii) Administrative responsibilities. (iv) Preventive medicine: (a) health campaigning; (b) health education; (c) public health; '(d) screening. (B) The community physician role as seen by health educators (i) Administrative medical officers, e.g. report editors, attenders of meetings, financial resource negotiators, service monitors. (ii) Medical officers (proper officers), e.g. environmental health, epidemiology, collator of routine stittistics. (iii) Policy m~tkers. (C) The health educator's role as seen by health education (i) Planners, policy activities. (ii) Trainers/teachers. (iii) Researchers/evaluators. Ov) Resource obtainers. (v) Liaison/consultation functions. (vi) Managers of their service. (D) The health educator's role as seen by community physicians (i) Concerned with community needs in health and health services. (ii) Concerned with the W.H.O. model of positive health. (iii) Concerned with identification of problems, with support and development. This work allowed misunderstandings to be rectified and the joint identification of role problems created a climate for the collaborative stage of the workshop.
Roles and Relationships in Health Education
109
Collaboration Following the work on roles, participants divided into mixed discipline small groups, their brief being to identify common areas ofconeern that they mightjointly be able to influence. A summary of these areas is as follows. Common areas of concern Autonomy of health educators by default. O) (ii) Isolation of the discipline of health education. Oil) Lack of a pro-active approach by health education officers to improve working relationships. (i~,) Training for health education officers and community physicians and the extent of disparity and commonality. (v) Who's in charge of health education? (vi) The status of the area health education officer. (~d~) The multidisciplinary nature of health education. (viii) Health education as an independent profession. (ix) The lip-service attitude of the N.H.S. towards health education. (x) The need for a legitimated wide role for both community physicians and health education officers in influencing the health status of individuals and the community. Each of these areas of concern was considered to be of equal importance in enhancing and influencing the impact of health education as a major health-providing force. Participants decided to explore these in greater depth in order to produce some practical proposal for dealing with them. In order to do this five groups were convened and eventually a summary of the proposals from each group was presented to the whole group for consideration and discussion. These summaries are presented for each group. Group l This group chose to discuss the two related areas of enforced autonomy and isolation. The following proposals were offered. (a) An examination of present health education services provided by health education officers to ensure that the right image is being projected. (b) Improvements in and development of relationships of health education officers with community physicians by positiveaction on the part of the health educators. (c) The development of regular meetings with community physicians on an individual basis to promote a collaborative effort for health education. (d) The encouragement of health education as an official agenda item at formal meetings of community physicians in each area or district, i.e. at local level. (e) The recognition of the practical power and influence of the area medical officer (or district medical officer of the future) in the allocation of resources to health education. Health education officers Should make sure {hat their area medical officers are well-briefed. Group 2 This group chose to explore the problem of the National Health Service paying lip-service to health education. Their proposals were (a) To make every attempt to overcome lethargy and to be positively assertive in promoting health education.
110
F. Eskin
(b) To ensure that the area or district health education officer would in future be incorporated as an integral member of health planning teams and working parties. (c) To encourage and promote the right of the health education officer to be considered an independent officer. (d) To ensure that health education is as efficient as possible in its recognised areas of expertise before it expands its boundaries. (e) To change attitudes towards health education and its role. (f) To explore and identify the major problems in the training of all health disciplines in relation to health education. Group 3 This group chose to discuss the issue of the legitimation of a wide role in society for both community physicians and health education officers. Figure 1 describes the extent of this role which encompasses all activities which impinge upon health and health status at an individual and community level. As an example of this, the group decided to explore the ideal role of both disciplines in housing. Basically this was shown to involve achieving input into the planning of housing in the community, requiring research and the acquisition of information, as well as consultation, advice and integration of both disciplines into the appropriate local authority planning framework. Group 4 This group chose to consider the problems of training and how to overcome the present problems of separate training programmes. Essentially it was felt that a joint training programme for both community physicians and health educators was important and that to achieve this a number of steps were required, these included the following. (a) The use of informal and formal networks to explore views on training. (b) Discussion with the professional organisations concerned, e.g. Association e f A.M.O.s, Society of Community Medicine, Association of A.H.E.O.s, Guild of H.E.O.s, etc. (c) Making a formal approach to academic boards involved in training. (d) A joint meeting of all organizations, institutions and bodies involved to agree on the principles o f joint training and to begin to make provision for curriculum content. Group 5 This group took on the task of looking at the problem of " Who's in Charge'" in relation to health education. They decided that no one was in charge (except bureaucratically), and that in terms of achievement it had to be a collaborative effort between the two major disciplines involved. This group diagrammatically represented the roles of health educators and community physicians (Figure I). This quite'clearly showed the commonality ofinterest and concern. The group made a number of important comments which were that a team collaborative approach does not require structured change; rather that it requires cooperation and joint commitment and that collaboration can only be achieved if the disciplines concerned believe that their relationship is one of peers and equals and are prepared to jointly assert themselves to promote health education.
Action planning In the final stage o f the workshop individual participants considered their own particular local problems, related the work achieved in the workshop to their own problems and each
~
Broad lover view \ Health care \ needs and ~sefvice rovision _ + . Information 1 research [ Epidemiology Consultation
i
Obtoin 'reso'urces "' i .t,O Optimize healt h j
[ advice other
.
.
.
to Brood overview I Information Health attitudes research and perceptions Market research surveys Consultation Epidemioloqy SOCiOI services
j resources allocation [in society to optimize hearth
.
.
.
.
.
.
.
.
]
individual behaviour
Madi~y~.; 'I j J
[deve,opmo°,J
health | ; behoviour |
X_
Relationship to
.
}
,..~.ervice chGnge]
lOeo~ino" ..]
_ .............
t
, ,J
iEOOcote Communit'y1
_lin the use of ___ _ j~lserv,ces Optimize use 1 of services ,,kj~Fe~b~c~- tar
Health educohon ofhcer
Figure 1. The roles of the community physician and health education.
.
campaigning | and environmental I health
com~mtJnity} and other agenci esto I priori! . ~ health ...... I
'Pressurize
Relate N.H.S. to 1 Olher agenc,ie$
~,empt to |. iMana<;ementl evaluate, plan r l and planning} and allocate ( l teams and [ resources in |~"wheeler the N,H.S,. . . . . . .J. J deohng • " ]
Community physician
112
F. Eskin
person designed their own action plan on a short, medium and long-term basis, to be acted upon at work. Participants were given the opportunity to discuss their own action plans with colleagues in their small groups. Conclusion
The summary of this workshop does not give the total picture of all the activities that t o o k place and which encouraged participants to produce the ideas and plans outlined above. Nor is it possible to do justice to the enthusiasm and energy which everyone gave to a very difficult task. The crucial stage in the whole process is, of course, the one which comes after the workshop is disbanded; that of implementing proposed action plans in the work situation. Follow-up of participants after a 3-month period will indicate whether or not this has been accomplished or at least begun. Hopefully some of the excitement and enthusiasm of the workshop will have been retained at a sufficiently high level to give impetus to action. Furthermore, it is also hoped that the ideas generated by this particular group of people will inspire those who were unable to participate to give some thoughts as to how they might tackle their own interdisciplinary roles and relationships in health education. References
1. Kotb, A. D. & Fry, R. (1975). Towards an applied theory of experiential learning. In Theories of Group Processes. G. L. Cooper (Ed.) Chichester: Wiley. 2. Stein, L.S. (1981). The effectiveness of continuing medical education: eight research reports. Journal of Medical Education 56, 103-10. 3. Miller, G. E. (1967). Continuing Education for what? Journal of Medical Education 42, 320-6. 4. Miller, G. E. (1975). Why continuing medical education? Bulletin of~,he New York Academy of Medicine 51, 701-6. 5. Jones, J. E. (1975). Role clarification. A team building activity. In A Handbook of Structured Experiences for Human Relations Training, Volume V, J. W. Pfeiffer & J. C. Jones (Eds). University Associates Publications.