February 17, 2025

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Public health education using social learning theory: a systematic scoping review | BMC Public Health

Public health education using social learning theory: a systematic scoping review | BMC Public Health

Main findings and results of studies

First, offline education environments in PHE interventions led by governments, schools, communities, or other organizations can effectively enhance health education and promote the dissemination of PHE. Providing educational guidance or courses to the public or to specific patients and their families has a positive impact on their health. Implementing PHE in communities and schools can promote students’ physical and mental health and reduce unhealthy behaviors.

On the other hand, online PHE has played an effective role in disseminating health knowledge, bridging social gaps, and promoting timely prevention. Online platforms, including websites, apps, communities, forums, and knowledge bases, effectively share PHE information. Social media and apps are effectively delivering health education messages.

Finally, adult health behaviors can influence adolescent health behaviors, making it crucial for adolescents to establish positive examples of healthy behaviors. Monitoring and screening health information on social platforms is essential to prevent minors from accessing inaccurate information. Therefore, the elimination of boundaries between academic education, schools, students, and classrooms has enhanced the effectiveness of public health communication in the school environment.

PHE in a social learning environment

In the implementation of the PHE project, we may face various challenges, such as dealing with diverse individuals from different backgrounds 12. Factors contributing to intervention failure include changing views due to external circumstances. This makes it necessary to adapt interventions to evolving conditions and diverse educational goals. The target populations in PHE interventions are broad and diverse. To promote acceptance and comprehension of complex public health knowledge among diverse audiences, relying solely on traditional classrooms is insufficient. PHE should be implemented in a diverse social environment to attract a wider audience and provide comprehensive health education. This will help PHE reach a wider audience and achieve the best educational outcomes.

PHE should be conducted in a wider and inclusive social setting, with community public spaces being suitable venues. Community public spaces are commonly chosen by researchers for PHE implementation. These spaces allow people to engage in their daily activities and seek assistance conveniently from local community organizations. Communities share commonalities, including the natural and social environment, and may face similar public health problems. Therefore, implementing quick, easy, and flexible PHE measures in the community environment is a suitable solution to address the complexity of the target population during implementation.

Studies show that community-based public health engagement programs are feasible and effective 23. particularly in addressing regional diabetes issues 25. Community cohesion and a sense of belonging promote active participation in community activities. Successful implementation of PHE in community settings requires collaboration among community workers, government or non-governmental organizations, health workers, and community members. Community participatory PHE enhances health literacy and has been proven effective. The advantage of PHE in a social setting is the opportunity for full participation and interaction. Creating a conducive educational environment and supporting observational learning are crucial for PHE effectiveness. Participatory art education, such as participatory theater, has shown beneficial impacts on health education [49].

SDOH also have a significant effect on PHE. SDOH refers to the economic and social conditions that affect changes in the health status of individuals and groups [50]. The influence of individual behavior on social learning in SLT is closely related to the economic and social conditions that affect changes in individual and group health status in SDOH. Individual learning behavior is influenced not only by the learning environment, motivation, and other factors but also by personal income, education level, occupation, and other factors. Therefore, utilizing SDOH to examine PHE can assist us in accurately identifying the key factors influencing health and implementing appropriate health education and interventions. The distribution of social perception factors is often influenced by mainstream political ideology and public policies in the region [51]. The Special Health Status Report highlights the impact of social inequalities on health, including differences in factors such as income, education level, occupation, and living environment that contribute to inequitable health outcomes. Hollederer et al. mentioned that the unemployed are a vulnerable group in society, and the health status of the unemployed is often worse. However, reaching the unemployed with prevention and health promotion efforts is challenging 34. In PHE, the application of SDOH helps to promote equitable and inclusive health education, focusing on the health needs of vulnerable groups and reducing health inequalities. Parents of children with specific diseases belong to the category of vulnerable groups who have limited access to equitable health resources and require additional support from society, government, and policymakers 17. SDOH emphasizes multifaceted influences, including individual, societal, and system-level factors. Cross-sectoral and interdisciplinary partnerships are essential for the public health sector to effectively respond to health challenges. Lamb et al. applied an interdisciplinary participatory art approach to community PHE research with indigenous youth 19. Promote cooperation among all stakeholders from a health and wellness perspective to create a healthy environment and enhance public health. Based on PHE, comprehensive health intervention strategies can be developed. These strategies may include improving socio-economic conditions, promoting education and career development, enhancing the living environment, and strengthening community support. Such integrated intervention strategies can influence individual health behaviors and outcomes more comprehensively. Therefore, the application of SDOH in PHE contributes to a deeper understanding of the root causes and influencing factors of health problems. It can also contribute to the effective implementation of public health policies and interventions, ultimately achieving the goal of promoting overall social health and equity.

Observational learning based on SLT is significant in PHE, particularly in AIDS prevention education 28. Research supports the effectiveness of observational learning in health education. Adolescents’ health concepts and behaviors are strongly influenced by their external environment, with parents or caregivers having the greatest influence 30. Minors acquire public health knowledge through observational learning in social settings and may adopt unhealthy behaviors from adults. However, they may not have the ability to discern whether adults’ decisions are right or wrong. Studies show that even if parents smoke, it may not necessarily impact minors’ behavior. Nevertheless, adults play a vital role in educating minors about healthy behaviors and should serve as positive examples 38.

Offline interventions for PHE with SLT

In this review, offline PHE interventions were commonly used. Offline interventions refer to PHE initiatives and behaviors carried out by local communities, schools, or organizations. These include the development of intervention policies, strategies, and models by the government, communities, schools, or relevant private organizations. Implementing appropriate health measures, educational models, or activities through offline modes can enhance the success and reach of PHE. Additionally, health intervention programs have been effective in addressing spiritual and mental health issues in specific populations 33. Offline interventions are also effective on campus, with integrated interventions successfully preventing youth violence in schools 20. Implementing offline interventions in school communities can reduce unhealthy habits and promote students’ mental health, behavior control, and wellness. Furthermore, PHE interventions can also influence the behavior of health workers and target groups 14.

Offline implementation of PHE can also be achieved through organizing PHE activities, campaigns, workshops, courses, and conferences. These methods are commonly utilized in research. Through organizing various offline PHE activities, the enthusiasm of the public to participate in health education can be effectively enhanced, and the learning efficiency of health knowledge can be improved in an atmosphere of interactive learning. Studies have shown that when people participate in interactive learning, their ability to discover, imagine, and construct is improved, and their learning enthusiasm is enhanced [52].

The implementation of PHE guidance and curricula can have a positive impact on the general public, as well as on patients with specific diseases. Studies have found that short-term public health classroom learning programs based on SLT can effectively improve children’s understanding of health knowledge and influence their health attitudes and behaviors 26. Other studies suggest that PHE in schools should aim to eliminate the divisions between health education and academic education, teachers and students, classrooms and schools, and schools and families 14. In other words, it is necessary to break the traditional classroom education mode and overcome the limitations of the traditional classroom in space, time, form, and content through more flexible and diversified education methods.

Online interventions for PHE with SLT

Online PHE interventions are widely used and offer several advantages. They provide flexibility in terms of time and location, enabling individuals to access public health knowledge at their convenience. Online platforms have a broader reach compared to offline interventions, which are limited by the number of participants. Online PHE interventions can be continuous, allowing for updates and improvements in educational content. These interventions are particularly important for individuals facing mobility barriers and caregivers who struggle to attend offline activities. Research shows that online platforms serve as essential resources for health information and social support for people with specific diseases and their caregivers. Users rely on these platforms to gain knowledge, make informed decisions, and learn from the experiences of others 16. Online health education platforms have proven effective in supporting parents of children with special diseases and treatment needs 37 [53]. Optimizing digital health literacy among young people is critical due to their heavy use of the internet 27. Enhancing online platforms is necessary to cater to the educational needs of young people. Studies have also demonstrated the effectiveness of providing distance health education to young individuals 24.

Online platform researchers and designers gather user feedback to understand their needs and preferences, enabling them to create customized tools 30. Creating online virtual multidisciplinary communities of practice is an innovative approach to PHE, ensuring high-quality public health services for patients with specific diseases in specific areas 20. It is crucial for the online platform to fully meet user needs in order to retain users 22. Educational video games can complement other media in child health education programs, positively impacting children’s health education 18. Videos and programs distributed through social media or other online platforms also contribute positively to PHE 18.

Individual social learning behavior and PHE

According to the research, PHE interventions can be categorized into two forms: online and offline. These interventions have different impacts on individual learning behaviors in the social environment, which can be further classified into two main aspects:

PHE interventions can be categorized into online and offline forms. In the societal learning environment, an individual’s learning behavior in PHE is influenced by two objective factors: the temporal factor and the spatial factor. Offline PHE requires individuals to go to a specific location at specific times, which limits their ability to participate in and complete their education. Offline interventions also have limited coverage and lack long-term continuity. On the other hand, online PHE provides flexibility and is not significantly impacted by timing and location restrictions. It requires more preparation, but it offers learners more control and convenience. Online platforms enable a focus on evolving social dynamics, as well as individual and group differences, in public health and service delivery.

In the social learning environment, the distinction between active and passive learning affects individual learning behaviors in PHE. Participants in PHE activities need to have a high level of learning initiative in order to successfully complete the educational process. Offline PHE requires individuals to actively seek out and participate in educational activities, contributing to their own learning initiative. Additionally, offline interventions organized by reputable institutions enhance participation and interactivity, thereby improving learners’ efficiency and motivation. Incorporating participatory visual arts activities in offline interventions for dementia patients has shown positive impacts on cognitive, social, and psychological functioning [54]. Jensen et al. study also supports the benefits of participating in artistic and cultural activities for sexual health [55]. On the other hand, online health education interventions do not require a high level of learning initiative, as individuals can access knowledge whenever needed. However, accessing health information online carries the risk of encountering incorrect information, which is a disadvantage of online PHE.

Online and offline forms of PHE have their own advantages and disadvantages, and integrating both forms can fully leverage their strengths. Some studies have integrated online learning modules with traditional face-to-face courses to educate learners on cancer and health. The results showed that participants who engaged in both online and offline learning were motivated to modify their health behaviors in order to reduce the risk of cancer 29. Whether PHE is conducted online or offline, both the intervener and education recipients need to have motivation and enthusiasm to promote the completion of educational activities. To enhance the effectiveness and engagement of PHE initiatives, researchers and government personnel should consider integrating multiple health education models. This approach will help achieve PHE goals and maximize its impact.

Future trends in exploration

Future PHE research can focus on several areas, including prevention of large-scale infectious diseases, basic public health knowledge, health education for individuals with specific diseases and their families, as well as for vulnerable groups such as ethnic minorities and persons with disabilities. There is a lack of studies on the elderly population, despite the increasing global aging trend and the health challenges they face. Researchers should prioritize addressing the health concerns of the elderly and develop strategies for providing convenient and comprehensible PHE for this age group, particularly in chronic diseases, underlying conditions, and self-care. Adolescent health education and sex education remain important topics, but research may also shift towards including special patients, minority groups, and members of the broader community. The focus should be broadened to not overlook the health interests of minority populations. Additionally, PHE in the social environment should expand to include mental health, given the increasing mental and psychological pressures people face and their impact on personal and professional lives. Spiritual and mental health education should be emphasized in PHE.

In the future, the focus on social learning environments can be on enhancing public enthusiasm and participation in PHE by creating engaging and participatory educational atmospheres in community spaces. PHE interventions may combine online and offline approaches and collaborate with comprehensive intervention models to develop educational materials. Offline PHE can promote interaction and participation, increasing learners’ motivation. Online PHE can enhance the dissemination of public health knowledge through user-friendly platforms and multimedia forms like AI interactive video games and electronic comics/animations. This combination of online and offline education, along with appropriate PHE materials, can greatly enhance understanding and facilitate widespread dissemination of PHE. The integrated use of these three forms can have a significant impact on PHE behavior in the social environment.

Strengths and limitations

Introducing SLT into the field of PHE, the study explores the relationship between individual learning and behavior in social settings, focusing on the effectiveness of offline and online PHE. The study highlights the importance of removing boundaries in school settings and promoting cross-cutting PHE. This perspective on cross-disciplinary implementation offers a novel approach to enhancing the comprehensiveness and dissemination of PHE. It also presents a clear focus and direction for future PHE research based on SLT, which includes an emphasis on preventing large-scale infectious diseases, providing health education for patients with specific diseases, and addressing health issues among the elderly population. It is unique in the selection of research topics, methodological framework, and prospects of research conclusions, providing distinctive contributions and values for the research and practice of PHE. However, this review has several limitations. First, this review does not include non-English publications or gray literature from related fields. As a result, some pertinent studies may have been overlooked. Secondly, while each scope review is subject to our assessment, no individual quality assessment score is provided for each sample article. The reason for this is that such an assessment would not add value to the review.

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