23-04-21 1

N115Health Education and Healthy Behaviors

Focus:Health Education and Health Behavior

Learning PrinciplesTheories and Models

Health Literacy

Health Education

Health Behavior

Learning Domains

Health Literacy

Learning Principles

Learning opportunities designed to encourage or promote the adoption of healthy behaviors (Center for Disease Control & Prevention)

An action taken by an individual or group of individuals to change or maintain their health status or prevent illness or injury (Center for Disease Control & Prevention)

Type of learning:Three Learning Domains:1.Cognitive2.Affective &3.Psychomotor

Health literacy is an individual's ability to gain access to, understand and use health information for promoting and maintaining health. (WHO, 2009).

Learning depends on:1.Learning environment

2. Ability to learn, a)Emotional capacity,b) Intellectual capacity c) Physical capacity & d).Developmental stage

3. Learning style & preference

4.Motivation to learn

2

23-04-21 3

Goals Client Education

1. Promoting, protecting, maintaining and restoring health & helping clients cope with illness or altered health status.

2. Reducing health risk factors, increasing a persons level of wellness. Taking specific protective health measures, coping with diagnostic procedures and treatments, managing symptoms of illness, & optimizing health status

Nurse’s Role Clients have a right to have sufficient knowledge to

make an informed decision. Present information in a clear and concise manner. Anticipate the client’s needs for information based

on physical condition and treatment Clarify information Carry out the nursing process i.e. assessment, nursing

diagnosis, planning, implementation and evaluation

23-04-21 5

LEARNINGConsider …

Without LEARNING, our ability to grow to change to adapt to our environment

would not be possible.

23-04-21 6

There are 3 Learning Domains/Taxonomies

(ways to LEARN according to Bloom) Cognitive: knowledge and development of

intellectual skills. Affective : growth in feelings/emotions

(Attitude) Psychomotor: motor skills http://udlhcpss.wordpress.com/blooms/

23-04-21 7

LEARNING DEPENDS UPON:LEARNING DEPENDS UPON:

Learning Environment Ability to Learn Learning Style & Preference Motivation to Learn

23-04-21 8

The The Learning EnvironmentLearning Environment Should: Should:

be characterized by : physical comfort mutual trust respect mutual helpfulness freedom of

expression acceptance of

difference

Also:

1) Well lit and well ventilated

2) Appropriate furniture and comfortable temperature.

3) Few distractions

4) Consider family involvement

23-04-21 9

Ability To Learn Emotional Capability- how does a person’s

level of anxiety affect learning? Intellectual Capability Physical Capability-consider a persons’ size,

energy, strength, coordination and sensory acuity, physical condition.

Developmental Stage: Consider learning in children vs. adult learning

23-04-21 10

Conditions for effective learning are enhanced if Adult Learners:

Feel a need to learn … Perceive the goals of a learning experience to be

their goals … See that the learning process is related to, and

makes use of, their experience

23-04-21 11

Learn To Do By Doing“Tell me and I forget.

Teach me and I remember. Involve me and I learn.”

Benjamin Franklin (1706 - 1790)  

23-04-21 12

Learning Style and Preferences (Some Examples) Visual learners understand new

information best by seeing it in the form of pictures, demonstrations, diagrams, charts, films and so on.

Verbal learners understand new information best through written and spoken words.

Intuitive learners discover new relationships and can be innovative in their approach to problem solving.

http://www.tss.uoguelph.ca/resources/idres/packagels.html#understandls

Others learn best (Active learners) when they are able to manipulate tools and find out how they work.

Reflective learners prefer to think about new information before they act on it.

Sequential learners understand new information in linear steps where each step follows logically from the previous one.

23-04-21 13

Clients may be Motivated to Clients may be Motivated to Learn/Change if theyLearn/Change if they

PERCEIVED SELF-EFFICACY-Perceived ability to successfully complete a task.

Perceive Disease as a Threat

PERCEIVE BENEFITS OF HEALTH PROMOTING BEHAVIOR

PERCEIVE Ways to overcome BARRIERS TO HEALTH PROMOTING BEHAVIOR

23-04-21 14

Motivation: Social Motives: Connection, Social Approval

and Self Esteem Task Mastery Motives: Driven by the desire

for achievement. Physical Motives: Desire to Maintain and

Improve Health

23-04-21 15

Definition of Teaching Teaching - is an interactive process that promotes

learning. Engagement in a set of activities that helps individuals to gain new knowledge that may lead to change.

Most effective when it responds to the learner’s needs.

How Do The Nursing Process And Teaching Process Differ?)

StepsSteps Nursing ProcessNursing Process Teaching ProcessTeaching Process

(Teaching Plan)

AssessmentAssessment Collects all client data – physical, Collects all client data – physical, psychosocial, cultural, developmental psychosocial, cultural, developmental & spiritual, test etc& spiritual, test etc

Collects client data re learning needs, Collects client data re learning needs, learning style, motivation, ability to learn learning style, motivation, ability to learn available teaching resourcesavailable teaching resources

DiagnosisDiagnosis Nsg diagnosis based on assessment Nsg diagnosis based on assessment findingsfindings

Id client learning needs based on one or Id client learning needs based on one or more of the 3 learning domains: more of the 3 learning domains: Cognitive, Cognitive, Affective & Psychomotor.. Educational diagnosisAffective & Psychomotor.. Educational diagnosis

PlanningPlanning Dev. individualized care plan; Set Dev. individualized care plan; Set diagnostic priorities based on client diagnostic priorities based on client needs; Collaborate with clientneeds; Collaborate with client

Establish learning objectives (outcomes), Establish learning objectives (outcomes), s, prioritized learning needs, select content s, prioritized learning needs, select content and time frame, select teaching strategies, and time frame, select teaching strategies, Collaborate with clientCollaborate with client

ImplementationImplementation Perform nursing & client Interventions Perform nursing & client Interventions

Include client/ familyInclude client/ family

Implement teaching methodsImplement teaching methods

Actively involve client & othersActively involve client & others

EvaluationEvaluation Id success in meeting client goals & Id success in meeting client goals & outcomes of nsg careoutcomes of nsg care

Alter interventions if goals not metAlter interventions if goals not met

Evaluate client learning based on achieve Evaluate client learning based on achieve of learning outcomes.of learning outcomes.

16

Teaching Processes First step

Assessment of learning needs Determining what information is critical to teach and

best ways to teach it…in consideration of the principles of learning (learning environment, ability to learn, learning style, motivation)

Health LiteracyHealth literacy is the ability to:

1. Access

2. Understand and

3. Act on information for health.

Health professionals, who provide clear, reliable, understandable information, are essential to helping people manage their health.

http://www.cpha.ca/en/portals/h-l.aspx18

…Literacy Levels of Canadian Adults

22% of adult Canadians fall in the lowest literacy, level 1. Ex: unable to read the medicine label to determine the amount to administer

26% of adults read at a level 2. They can only deal with material that is simple and familiar to them.

33% of adults can read well enough to get along from day to day.

20% of adults can read complex reading material

Why is Health Literacy Important? Literacy facilitates access to information, and

enables individuals to make informed health decisions, to influence events, and to exert greater control over their lives. People who are not literate tend to be poor, live & work in less

healthy environments, & more at risk at many levels & less likely to engage in health promotion & disease prevention since survival is their priority.

20

Clues to Problems Client’s Health LiteracyBehaviour: Failing to complete written forms Frequently missing appointments Non-adherence with medication prescriptions Inability to name medications, explain their

purpose, or the timing of their administration Comments related to forgetting glasses or taking

written instructions home for family members to read.

Healthy people (2010) http://www.iha4health.org/default.aspx/MenuItemID/184/MenuGroup/_IHA+Books.htm

Class 4 January 16, 2013 21

23-04-21 22

Communication Strategies to Consider Present information that clients can easily

understand, multiple teaching methods Use simple terminology Keep session short Repetition Relate example to personal life experiences,

actively involve Frequently ask if clients understand what is being

communicated, obtain feedback

Planning Creating learning goals and outcomes

identify the expected outcomes for clients and establish learning priorities.

Timing Organizing teaching material Maintaining learning attentions and participation Building on existing knowledge Selecting teaching methods and resources

Intervention and Evaluation Implementing teaching approaches

e.g. one-on-one discussions, demonstrations, role playing

Evaluating teaching-learning Evaluating outcomes and interventions – client and

nursing perspectives

Nurses are Change AgentsNurses are Change Agents Nurses Need To Know When Change is

Most Likely to Occur How & When to Influence/Motivate What has worked in the past for client

We use behavior change

models to help encourage positive change25

Behavior Change ModelsBehavior Change Models Behavior Change models attempt to change an individual’s

or a specific target population’s behavior toward a more healthy lifestyle.

The majority of these models focus on modifying diet, exercise, smoking, addictions, sexual practices, drinking and driving and the use of seat belts

The Trans-theoretical Model (change theory) is a good example of a

Behavior Change ModelClass 4 January 16, 2013 26

Application Of Theories And Models For Health-promoting Behavioral Outcomes

Nurses need to use Motivation & Social Learning Theories & Models when helping people to change behaviour, attitudes & values associated with their state of health.

Examples:1. Pender’s Health Promotion Model-considers motivational source for

behavioral change that is based on how the client perceives the benefits of changing the given health behavior.

2. Transtheoretical Model of Change 5 stages: Precontemplation, Contemplation, Preparation, Action,

Maintenance (Kozier ,pg. 148)27

Class 4 January 16, 2013 28

http://mdm.sagepub.com/content/28/6/845.full.pdf

Transtheoretical Model Change Is A "Process Involving Progress Through Six Stages (Kozier p.149)

1. Precontemplation – does not intend to take action2. Contemplation – acknowledges having a problem, intends to

change, not ready to commit to action3. Preparation – plans to take action in the immediate future, has

taken steps to begin the behavioral change4. Action – people/client have made specific overt modifications in

their life styles5. Maintenance – people/client are working to prevent relapse," a

stage which is estimated to last "from 6 months to about 5 years“, integrates new behavior into lifestyle

6. Termination – people/client have zero temptation and 100% self-efficacy... they are sure they will not return to their old behaviour/habit

29

Explain why theories on health promotion and human behavior are important for nurses to understand and use?

Why doesn’t one model fit all?

Also see tools/strategies for promoting behavioral change. http://healthpromotiontips.com/tools-for-achieving-behavior-change/ 30

The Idea Behind Most Behaviour Change Models Is That:

Behavior change does not happen in one step People tend to progress through different stages on

their way to successful change Each of us tend to progress through the stages at

our own rateSince in most cases the goal of education is behavioral

change, the understanding of behavior provided by behavioral change theories provides insight into the

formulation of effective teaching methods.

31

Health Promotion: Successful Change

Above all else, change depends on the individual’s belief that he/she can and will succeed.

Self-efficacy and optimism

32

Health Promotion: Behavior Change

Change isn’t easy!

Knowledge alone is not enough for most people to change their behavior Knowledge combined with Knowledge combined with

positive positive attitudes, beliefs, attitudes, beliefs, values, perceptions , values, perceptions ,

support, and motivation is support, and motivation is mighty!mighty!

33

23-04-21 34

Socio-Ecological ModelsThe most successful approaches to behavior change are

the ones that take into consideration multiple factors that influence behavior and health. These successful approaches have been defined as socio-ecological as behavior is determined by a number of factors that include interpersonal and intrapersonal processes, institutional and community factors and public policy (McLeroy et. al., 1988)

23-04-21 35Retrieved from: http://www.balancedweightmanagement.com/TheSocio-EcologicalModel.htm

23-04-21 36

Individuals do not live in vacuums, they are embedded within complex and multilevel environments. Part of families, work at worksites, learn in schools, live in neighborhoods and are influenced by polices in each of these sectors.

Each of these environments influence a persons health.

23-04-21 37

Case Example: Clark (pg. 51)

23-04-21 38

A Summary Health Education and Health BehaviorHealth Education and Health Behavior

Nurse’s Role Learning Learning

Principles Domains

Application of Theories and Models Health Literacy