The Effectiveness of Leaflets and Posters as a Health Education Method

DOI: 10.5455/msm.2020.32.135-139
Received: MAR 19 2020; Accepted: MAY 20, 2020

© 2020 Nino Hasanica, Aida Ramic-Catak, Adnan Mujezinovic, Sead Begagic, Kenan Galijasevic, Mirza Oruc

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-
nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ORIGINAL PAPER Mater Sociomed. 2020 Mar; 32(2): 135-139

The Effectiveness of Leaflets and

Posters as a Health Education Method
Nino Hasanica1,2, Aida Ramic-Catak3, Adnan Mujezinovic2, Sead Begagic1, Kenan
Galijasevic2, Mirza Oruc2
1
Institute for Health
and Food Safety Zenica,
Department for School ABSTRACT Keywords: health education, HBSC, healthy life-
Hygiene, Zenica, Bosnia
and Herzegovina
Introduction: Health education is a process of ac- styles, public health.
2
Medical Faculty, quiring knowledge and skills in order to improve
Unversity of Zenica, the health of the individual and the community. It
Health Care Study
Section,
is considered the most effective, most economical 1. INTRODUCTION
3
Institute for Public and most rational aspect of health care and health Health education is a process of acquiring
Health FB&H; Bosnia culture. Aim. To provide data on the effectiveness knowledge and skills in order to improve the
and Herzegovina, Zenica,
of printed health-educational materials. Methods. health of the individual and the community. It
Bosnia and Herzegovina
This is a quantitative, applied, descriptive-analyti- is considered the most effective, most economi-
Corresponding author: cal study. According to the type of research, it pres- cal and most rational aspect of health care and
Nino Hasanica. Institute
for Health and Food ents a public health evaluation manipulative study health culture. The goals of health education are
Safety Zenica Fra Ivana with triple testing. The research was conducted in to expand knowledge of one’s own health, change
Jukića 2, 72000 Zenica,
Bosnia and Herzegovina.
elementary schools in the Zenica-Doboj Canton. attitudes and apply a useful daily practice of a
Phone: +387 32 448 027; The total number of students participating in the healthy life (1). Educational methods in the health
fax: +387 32 448 000.
research is divided into groups: examined, control care of the population need to be applied equally
E-mail: nino_hasanica@
hotmail.com; nino. group. The research consisted of four phases. The with all other methods of health promotion. When
[email protected]. ORCID research tool is a modified questionnaire The health problems are more complex, the methods of
ID: http//www.orcid.
org/0000-0002-7571- Health Behavior in School-aged Children (HBSC) health education have to be more numerous and
0467. with 38 questions, 8 modules. Results. The total subtle, and therefore more necessary in modern
number of respondents was 120. The method of health care (2). Didactic methods include medi-
distribution of health-educational posters shows cal lectures, health films, leaflets, posters, radio,
a lower but still present statistical significance television, multimedia advertising. In the use of
(p<0.05) in relation to the acquired knowledge didactic methods in health education, the starting
and a change in attitudes between the conducted point is that the person is an “empty vessel” that
surveys at different time points. There is no statis- needs to be “filled” with knowledge and that it will
tically significant change (p>0.05) in the level of integrate, interpret, reproduce and, accordingly,
knowledge and attitudes using leaflets between adopt and apply in practice (1).
conducted surveys at three different times. In the Morrow in 2001 states that in the UK health
control group without education, there was a low promotion specialists have greatly realized that
statistical significance (p<0.05) in terms of chang- health-related behaviors are closely linked to
ing the level of knowledge and attitudes. Conclu- the social environment and community (3).
sion. The distribution of health-educational posters Singh and associates in 2016 state that there is
is recommended in situations where it is necessary a significant difference in the impact of health
to reach a wide audience for a long period of time, education using integrated leaflet distribution
if the site of the poster is protected. According to models, demonstrations and the use of audio-
this study, there is no evidence that the leaflet dis- visual devices, compared to isolated leaflet
tribution method should be used when it comes to distribution (4). Gupta and associates in 2016
the promotion of healthy lifestyles among healthy on a sample of students come to the data that
children. Alternative methods and ways of health students prefer audio-visual media and Power
education need to be identified. Point presentations, rather than leaflets (5).

Mater Sociomed. 2020 Mar; 32(2): 135-139 • ORIGINAL PAPER 135

The Effectiveness of Leaflets and Posters as a Health Education Method

2. AIM healthy lifestyles due to their own illness; b) students with

The purpose of this research is to provide data on the ef- whom it is not possible to establish adequate cooperation
fectiveness of printed health-educational materials, posters (intellectual, speech problems); c) students for whom the
and leaflets, as a method of health education. The aim of parents gave written act to refuse participation in the
the research was to evaluate changes in the knowledge and research. The approval of the Pedagogical institute Ze-
attitudes of school children who received printed health- nica (Ministry of education, science, culture and sports of
educational materials on healthy lifestyles. Zenica-Doboj Canton) was obtained.
The tests used for statistical processing are: The Co-
3. METHODS chran’s Q test is suitable for comparing the results at three
This is a quantitative, applied, descriptive-analytical points of time when it comes to dichotomous variables; The
study. According to the type of research, it presents a public McNemar’s test is suitable for comparing the results of a
health evaluation manipulative study with triple testing group observed at two points of time (in a control, B group,
(determining the condition at three time points). without education). Questions in which the students did not
The research was conducted in elementary schools in participate in each survey and questions that the students
the Zenica-Doboj Canton. The total number of students did not answer were not taken into account at any point in
participating in the research is divided into the following time, and were presented as null data. Standard software
groups: examined group - A, control group (without edu- statistical tools have been used (Microsoft Access, Microsoft
cation) - B. Group A is further divided into the following Excel, and Microsoft Excel Plugin – Real Statistics).
subgroups: distribution of health education posters - A1,
distribution of health education leaflets - A2. 4. RESULTS
The research consisted of four phases: a) The first survey The total number of respondents was 120; 63 (52.5%)
about healthy lifestyles to analyze and determine the level boys and 57 (47.5%) girls. The age structure of the subjects
of student’s knowledge and attitudes before participating ranged from 10 to 14 years of age. The most common year
in a health education program; b) Implementing a health- of birth was 2005; 33 (52.38%) boys and 26 (45.61%) girls.
educational program in relation to healthy lifestyles by the Table 1 shows the distribution of respondents by groups /
method of distribution of health-educational posters and methods of health education and time points of the survey.
leaflets, depending on the group of subjects; c) The second Selection of some questions from the questionnaire
survey about healthy lifestyles to determine the level of A total of 37 (58.73%) boys and 36 (63.15%) girls believe
knowledge and attitudes of the same students as first time their body weight is about good. A total of 9 (14.28%) boys
a day after participating in a health education program; the think their body is skinny. A total of 42 (35%) students
control group of the subjects did not have this phase of the answered that they were physically active every day dur-
study; d) The final survey in both group A and group B to ing the last week at least 60 minutes, while 36 (30%) stu-
determine which of the health education methods leaves the dents had such physical activity for 1-2 days a week. Boys
longest cognitive information, attitudes and eventual be- are more often physically active every day. A total of 74
havioral changes; The final survey was conducted a month (61.66%) students answered that they had breakfast every
after health education program. day. The difference is shown: 15 (23.8%) boys take breakfast
The research tool is a modified questionnaire The Health Number of students by time points of
Behavior in School-aged Children (HBSC), conducted by Group Method
survey
the United States Department of Health and Human Ser- The first The second The third
vices, the National Institute of Health, with over 200,000 round of round of round of
young people in over 40 countries around the world. The survey survey survey
questionnaire is anonymous. The questionnaire contains A1 Poster 31 31 31
38 questions distributed in 8 modules. Research instrument A2 Leaflet 37 37 37
modules are based on general information and questions B Control group 52 no 52
about the knowledge and attitudes of school children about
Total 120 68 120
healthy lifestyles, such as: nutrition and physical activity,
hygiene and health, social negative behavior and school Table 1. Distribution of students by groups / methods of health
safety, life skills and communication, nicotine – alcohol – education and time points of the survey
drugs, reproductive health. Questions in the questionnaire
Time point of
are: questions with a determined choice, questions that Number (%) of correct answers
survey
define the frequency, questions that offer a list of answers
Poster Leaflet Control group
and a scale of priorities (descriptive grades that replace
The first round of
grades 1 to 5), and one open-type question. survey
1076 (58,07) 1376 (56,34) 1487 (45,98)
The theme of health education processed in the health-
The second round
educational leaflet and on the poster on the one hand and of survey
1150 (62,06) 1377 (56,39) no
questions from the questionnaire on the other hand de-
The third round of
pended on one another – they are in agreement – so they 1163 (62,76) 1364 (55,86) 1569 (48,52)
survey
were created simultaneously.
p value < 0,01 > 0,05 < 0,01
The criteria for exclusion from the research were as
follows: a) students who undergo intensive education on Table 2. Changes in the responses of students

136 ORIGINAL PAPER • Mater Sociomed. 2020 Mar; 32(2): 135-139

 The Effectiveness of Leaflets and Posters as a Health Education Method

Number
Change (%) of students and attitudes565
of knowledge 485 1064
Poster 1058 1399 Leaflet Control group

who did not know but did (30,49) 1. → 2. survey

(26,17) (43,57) 2. → 1. → 2. survey
3. survey (43,25)
(43,32) 2. → 3. survey 1. → 2. survey
Number (%) of students who changed their
not even learn 212 (11,44) 218 (11,76) 2 (0,08) 7 (0,28) 348 (10,76)
knowledge and attitudes positively
Number
Total (%)(%) of students who 1853
changed
(100)their
1853 (100)
1382442
(7,44)(100) 2442
205(100) 3234 (100) 1 (0,04)
(11,06) 20 (0,81) 266 (8,22)
knowledge and attitudes negatively
Number (%) of students whose knowledge
938 (50,62) 945 (50,99) 1375 (56,30) 1357 (55,56) 1221 (37,75)
and attitudes remained the same
Number (%) of students who did not know
565 (30,49) 485 (26,17) 1064 (43,57) 1058 (43,32) 1399 (43,25)
but did not even learn
Total (%) 1853 (100) 1853 (100) 2442 (100) 2442 (100) 3234 (100)

Table 3. Change of knowledge and attitudes of students between surveys at different time points

of the subjects was 3234. The calculated hi-square value was

10.685 (p<0.05). In the control group without education,
there was a low statistical significance in terms of changing
the level of knowledge and the change of attitudes between
the surveys at two different times. In the first survey, re-
spondents gave 45.98% of the correct answers to questions
from the questionnaire, and after a month without any edu-
cation the percentage of correct answers increased slightly
to 48.52% (Table 2, Table 3, Graph 1).

5. DISCUSSION
The HBSC study in Moldova from 2014 presents the
results of 6642 respondents in age of 11, 13 and 15 (6). In
Figure1.1.Change
Figure Changeofof knowledge
knowledge andand attitudes
attitudes of students
of students betweenbetween
surveys at different time15-year-old
points
surveys at different time points Europe, girls consider themselves overweight
(7, 8). Only 23% of adolescents in Europe carry out mini-
1-2 times a week, and this is claimed by only 3 (5.3%) girls. mum physical activity of 60 minutes per day, and 4.6% do
In total 81 (67.5%) students (more often boys) believe that not have physical activity on a daily basis (7, 9). In Europe,
friends on social networks are their real friends, or they are only 60% of the respondents have breakfast every day, and
undecided on this matter. every tenth jumps out the breakfast. A total of 13.1% of girls
Evaluation of the effectiveness of health education do not take breakfast in working days (8, 10). The frequency
methods of electronic media contacts shows a significant increase of
The total number of valid answers in the group of stu- over 15% between 11 and 15 years of age in Europe (more
dents using posters as a method of health education was often among girls and rich families) (8, 11).
17
1853. The calculated Q value was 8.620513, so the value In other surveys, most respondents answered that they
of p was 0.003324 (p<0.05). The method of distribution receive entertainment information via television (72%),
of health-educational posters shows a somewhat lower followed by counseling (14%), and educational informa-
but still present statistical significance in relation to the tion (14%). A total of 74% of respondents prefer to watch
acquired knowledge and a change in attitudes between educational television series, 26% movies. Television could
the conducted surveys at different time points. In the first be considered to be method by which a wide range of audi-
round of the survey students gave 58.07% of the correct ences can be reached, if health-educational content were
answers to questions from the questionnaire. After the incorporated into other television content (12).
poster distribution was carried out, the percentage of cor- The reason for increasing knowledge and positively
rect answers increased to 62.06%, and a month later to changing attitudes in applying posters in this research can
62.76% (Table 2, Table 3, Graph 1). be the simplicity of providing information on the poster.
The total number of valid responses in the group of stu- The poster stays in the long term in the place where it is
dents using the health-education leaflet was 2442. The cal- set up, which allows for a long-term retention of knowledge
culated Q value was 1, so the p value was 0.317311 (p>0.05). and positive attitudes at approximately the same level as
There is no statistically significant change in the level of after the education. In the UK in 2001, research on health
knowledge and attitudes between conducted surveys at behavior of population was conducted, and it was concluded
three different times. In the first round of the survey stu- that it is closely related to the social environment and the
dents gave 56.34% of the correct answers to the questions community (3).
from the questionnaire. After the distribution of leaflets, The reason for the fact that there is no increase in
the percentage of the correct answers increased negligibly knowledge and a change in the attitude after the distribu-
to 56.39%, and a month later the students answered cor- tion of leaflets in this research can be the overload with
rectly to 55.86% of the questions (Table 2, Table 3, Chart 1). the distribution of leaflets of various kinds, from market-
The total number of valid responses in the control group ing to health education. There is even a decrease in the

Mater Sociomed. 2020 Mar; 32(2): 135-139 • ORIGINAL PAPER 137

The Effectiveness of Leaflets and Posters as a Health Education Method

knowledge of students after the distribution of leaflets. The of the Institute for Health Protection Zaječar has shown
overloading with this type of printed material could be a that physicians are not the best health educators, for the
demotivating factor for learning. The knowledge and atti- simple reason that they are preoccupied with the phenom-
tudes are changed in an extremely small and insignificant enon of disease (19). In 2000, the research was carried out
number of questions, between the first and second survey, in the state of Illinois, USA. As many as 81% of respondents
and between the second and third survey. In most issues, consider it is necessary to introduce health education into
knowledge remained the same, and there were also a large schools as a separate teaching subject, and 83% think that
number of students who did not have prior knowledge but the school should have a nurse in their team (20).
did not even learn. Health education work does not provide Health education is often an unheard and unjustifiably
significant results regarding the acquired knowledge of stu- neglected health care measure, both by the population and
dents by the method of distribution of health-educational by health professionals of all profiles and levels of educa-
leaflets. According to this study, there is no evidence that tion. Health education has unlimited possibilities and an
the leaflets distribution method should be used when it unmatched number of different methods and a combination
comes to promotion of health and healthy lifestyles among of methods for work (21).
healthy children, which are not even interested in such According to this research, the distribution of health-
knowledge by their nature. However, it can be used in situ- educational posters is recommended in situations where it
ations where it is necessary to reach a wide audience, the is necessary to reach a wide audience for a long period of
information being presented is not particularly important, time, if the site of the poster is protected, although this is
or it is sufficient to be in the form of a notice (as a notice for not a guarantee that the increase in knowledge will be high.
a lecture, a workshop, a brief information about the results The distribution of health-educational leaflets does not
achieved in some work etc.). Different from healthy chil- give significant results regarding the acquired knowledge
dren, the method of distributing health-education leaflets of students. According to this study, there is no evidence
may have potential in work with newly discovered cases of that the leaflet distribution method should be used when
chronic mass non-communicable diseases when individuals it comes to the promotion of health and healthy lifestyles
are most motivated to learn about their illness (13). In the among healthy children, which, by their nature, are not
research of Singh and associates, the distribution of leaflets even motivated for this kind of knowing.
with the simultaneous use of practical demonstrations and Alternative health education methods need to be identi-
audio-visual means in health education have much better fied. Experts in nursing and health sciences in the field of
results than the isolated distribution of printed materials, health education have all the possibilities for professional
leaflets (4). In a study carried out by Gupta and associates realization.
among the student population, it was concluded that stu-
dents consider PowerPoint presentations and audio-visual 6. CONCLUSION
means as incomparably more acceptable methods of acquir- Health education of the population in general, and espe-
ing knowledge, opposed to printed materials, leaflets (5). cially for children, through the activity of specific preven-
The reason for increasing the percentage of accurate tive-promotional health care for young people in schools
responses in the control group may be the fact that stu- and faculties, should be given priority in order to influence
dents were interested in this topic after the first survey, but the more positive and healthy lifestyles of the population,
also that they listened some topics in the field of healthy thereby reducing the negative health outcomes and high
lifestyles in other teaching subjects in schools (e.g. “Physi- costs of health care (19).
cal and health education”, “My environment” and similar
teaching subjects). The essence of health education is in • Authors contribution: Each author were included in all steps of prepara-
long-term knowledge retention and changing attitudes. tion this article. Final proof reading was made by the first author.
People who are not health care workers as the most common • Conflict of interest: None declared.
source of health information suggest conversations with • Financial support and sponsorship: Nil.
friends (14). Among health workers, a common source of
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