Chapter 11 Health Promotion: Achieving Change Through Education

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 11Health Promotion: Achieving Change

Through Education


Healthy People 2010: Educational & Community-Based ProgramsHealthy People 2010: Educational & Community-Based Programs

• Emphasis: health status, longevity, quality of life

– High school completion; school health education

– Undergraduate health risk behavior information

– Worksite health promotion; participation in employer-sponsored health promotion

– Patient satisfaction with health care provider communication

– Community-based health promotion

– Culturally appropriate health education

– Senior health education


Health Promotion Through ChangeHealth Promotion Through Change• CHN educator: goal of effecting change in people’s

behavior

• Changing behavior

– Many different reasons for change

– Attempts and failure several times before success

– Working at some changes possibly lifelong

– Most change on own without special programs

– People are different; what works for one may not work for another


Definitions and Types of ChangeDefinitions and Types of Change• Definitions

– An imbalance or upset equilibrium requiring adjustments

– Process of adopting innovation

• Disruptive; generally new roles are adopted

• Types of change

– Evolutionary: gradual; adjustments are made on an incremental basis

– Revolutionary: rapid, drastic, threatening type; possible complete upset of balance of system


QuestionQuestion

Is the following statement true or false?

• Individuals often have similar motives or reasons for change.


AnswerAnswer

• False

– People decide to change for many different reasons.


Stages of ChangeStages of Change• First described by Kurt Lewen

• Stages:

– Unfreezing (when desire for change develops)

– Changing/moving (when new ideas are accepted and tried out)

– Refreezing (when the change is integrated and stabilized in practice)


Planned ChangePlanned Change

• Purposeful and intentional

• Change by design, not default

• Improvement as the aim for planned community health change

• Accomplished through an influencing agent


Planned Change (cont.)Planned Change (cont.)

• Equilibrium: driving forces = restraining forces

• For change: increase driving forces, decrease restraining forces, or both (see Fig. 11.2)

– Use of force field analysis

• Evaluate both sets of forces

• Develop strategies to influence forces in favor of change


Planned Change Strategies Planned Change Strategies

• Empiric-rational (similar to technostructural, data-based, and communication-related strategies)

– People are rational; will adopt new practices that appear to be in their best interest

• Normative-reeducative (similar to educational, facilitative, and persuasive strategies)

– New information; direct influence on people’s attitudes and behaviors through persuasion

• Power-coercive (similar to coercive strategy)

– Use of coercion based on fear


QuestionQuestion

Which of the following characterizes normative-reeducative strategies for change?

a. Persuasion

b. Coercion

c. Rationality

d. Best interests


AnswerAnswer

a. Persuasion

• The normative-reeducative strategy involves providing new information that directly influences people’s attitudes and behaviors through persuasion. Empiric-rational strategies are used to effect change based on the assumption that people are rational and when presented with information will adopt new practices that appear to be in their best interest. Power-coercive strategies use coercion based on fear to effect change.


Principles for Effecting Positive ChangePrinciples for Effecting Positive Change

• Participation

• Resistance to change

• Proper timing

• Interdependence

• Flexibility

• Self-understanding


Change Through Health EducationChange Through Health Education

• Health education as foundation of practice

• Teaching: specialized communication process for achieving desired behavior changes

• Learning: goal of all teaching; assimilation of new information that promotes a permanent change in behavior


Domains of LearningDomains of Learning• Cognitive: mind and thinking processes

– Knowledge

– Comprehension

– Application

– Analysis

– Synthesis

– Evaluation (see Table 11.2)

• Affective: emotion, feeling, affect (see Table 11.3)

• Psychomotor: visible demonstration of performance skills requiring some type of neuromuscular coordination (see Table 11.4)


Learning Theories : BehavioralLearning Theories : Behavioral

• Stimulus-response

– Pavlov: certain causes evoke certain effects

• Conditioning

– Thorndike: conditioning without reinforcement

– Skinner: conditioning with reinforcement


Learning Theories: CognitiveLearning Theories: Cognitive• Jean Piaget (see Table 11.5)

– Assimilation

– Accommodation

– Adaptation

• Gestalt-field

– Insight theory

– Goal-insight theory

– Cognitive field theory


QuestionQuestion


• Skinner was a behavioral theorist who used conditioning with reinforcement.


AnswerAnswer

• True

– Skinner was a behavioral theorist who addressed conditioning with reinforcement, such that successive systematic changes in a learner’s environment enhance the probability of the desired response.


Learning Theories: SocialLearning Theories: Social

• Bandura

– Coincidental association

– Inappropriate generalization

– Perceived self-inefficacy


Learning Theories: HumanisticLearning Theories: Humanistic• Abraham Maslow

– Hierarchy of human needs

• Physiologic safety and security love and sense of belonging self-esteem self-actualization

• Carl Rogers

– Self-directed

– Client-centered, warm, positive, & empathetic


Learning Theories: Knowles’ “Adult Learning” Learning Theories: Knowles’ “Adult Learning”

• Adult learners are different from children.

• Characteristics of adults with implications for learning (see Display 11.2):

– Self-directed

– Life experience

– Readiness to learn

– Problem-centered time perspective


Health Teaching ModelsHealth Teaching Models• Cloutterbuck Minimum Data Matrix (CMDC) (see Fig. 11.3)

– Life circumstances or chain of events jeopardizing client’s health

– Empiric variables

• Health Belief Model (HBM)

– Readiness to act on behalf of a person’s own health predicated on 6 concepts: perceived susceptibility; perceived seriousness; perceived benefits of action; barriers to taking action; cues to action; self-efficacy


Health Teaching Models (cont.)Health Teaching Models (cont.)

• Pender’s Health Promotion Model (HPM), revised

– Individual characteristics and experiences

– Behavior-specific cognitions

– Behavior outcomes (see Display 11.3)

• PRECEDE and PROCEED models (see Fig. 11.5)

– Predisposing, Reinforcing, and Enabling Constructs in Educational/Ecological Diagnosis and Evaluation

– Policy, Regulatory, and Organizational Constructs for Educational and Environmental Development


QuestionQuestion

Which of the following health teaching models uses empiric variables?

a. Health Belief Model (HBM)

b. Cloutterbuck Minimum Data Matrix (CMDM)

c. Health Promotion Model (HPM)

d. PRECEDE model


AnswerAnswer• b. Cloutterbuck Minimum Data Matrix

– The CMDM model comprises a set of empiric variables associated with consumer health status, behavior, and outcomes. The HBM proposes that readiness to act on behalf of a person’s own health is predicated on six concepts. The HPM includes three general areas: individual characteristics and experiences, behavior-specific cognitions, and behavioral outcomes. The PRECEDE model involves social, epidemiological, and education/ecological assessments followed by administrative and policy assessment and intervention alignment, and implementation.


Teaching-Learning Principles Teaching-Learning Principles

• Client readiness

• Client perceptions

• Educational environment

• Client participation

• Subject relevance

• Client satisfaction

• Client application


Teaching ProcessTeaching Process

• Interaction

• Assessment and diagnosis

• Setting goals and objectives

• Planning

• Teaching

• Evaluation


Teaching Methods and MaterialsTeaching Methods and Materials• Formal or informal, planned or unplanned

• Methods

– Lecture

– Discussion

– Demonstration

– Role playing

• Materials (visual images, anatomic models, equipment, printed support materials, examples)

– Content, complexity, reading level, culturally appropriate


Clients With Special Learning NeedsClients With Special Learning Needs

• Cultural or language differences

• Hearing impairment

• Developmental delay

• Memory loss

• Visual-perception distortions

• Problems with fine or gross motor skills

• Distracting personality characteristics

• Demonstrations of stress or emotions


QuestionQuestion


• Assessment and diagnosis is the first step in the teaching process.


AnswerAnswer

• False

– The first step in the teaching process is interaction, establishing basic communication patterns between clients and the nurse. Assessment and diagnosis follows.


Internet ResourcesInternet Resources• American Medical Informatics Association (AMIA):

http://www.amia.org

• Healthy People 2010 objectives for educational, community-based programs: http://www.healthypeople.gov/Document/HTML/Volume1/07Ed.htm

• Healthy People 2010 objectives for health communications: http://www.healthypeople.gov/Document/HTML/Volume1/11HealthCom.htm

• McGraw Hill: Teaching Methods Web Resources: http://www.mhhe.com/socscience/education/methods/resources.html#teaching

Chapter 11 Health Promotion: Achieving Change Through Education

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