Chapter III Strategies in Health Education

7/28/2019 Chapter III Strategies in Health Education

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Chapter 3

Understanding Motivation and

Behavior Change


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Culture

Age

Socio Economic Level

Emotional Status


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Culture is a learned set of shared

norms and practices of a particulargroup that direct thinking, decisions

and actions. (transcultural Nursing,2004)


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Cu ture A ects Hea t Be av or

and the TeachingLearning

ProcessCulture influences gender roles, sexual

behavior,diet,personal hygiene,body

image,drug use,exercise,communication

and educational pursuits among others.

(Nakamura,1999)


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Educational sessions need to be of longer

durations or broken down into more sessions of

shorter durations, covering less information.Regardless of how the time factor is addressed,

bear in min that older adults tend to learn best

when the information is relevant to them andhas a practical application.


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Be cognizant of possible hearing and visual

benefits. Deficits can be address by making sure to

always face the client while speaking clearly, slowlyand loudly id necessary and avoiding shouting. To

address vsual impairment, use large prints materials

or print in larger letters if using a flipchart or using a

chalkboard.


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Depression, stress, denial,fear and anxiety can allimpact the effectiveness of teaching. This issue should be

address before a teaching and learning progress.In an academic setting, the students ability to learn

can be hampered by a host of emotional or mental health

issues. This may include roommate disagreement,

relationship issues, separation or adjustment anxiety.


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SocioEconomic LevelSocioeconomic level takes into account a number of

factors including income, education level and occupation

or employment.

Socioeconomic level may dictate where a client lives.Eventhough this seeem to be related to learning or to

changing behavior, it is.

For a student, a lower socio economic level may meanthat time that could be used for studying is taken up with

working part time job.


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PLANNING FOR LEARNING

Learning is a complex process. Approaching this witha plan that incorporates factors that increase the

likelihood of learning and based on the heory that

explains why people behave the way they do,increases the chances that learning will take place,

change will occur, compliance will occur and

education will be effective.


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Learning Principles

Begin with what is known;move toward what is unknown

Repeat information

Actively involve the patients in the T-L process

Make learning a pleasant experience

Present information at an appropriate rate

Provide environemnt that is conducive to learning

Assess the extent to which the learner is ready to learnGeneralize information

Use several senses

Determine the percieved relevance of the information


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Learning is more likely to occur if

people are allowed to practice what they

are being taught. This principle is used

regularly whether teaching people with

recently diagnosed diabetes or nursingstudents how to administer insulin.


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This relates whether the teaching methods used arepassive or active.

Passive methods includes lecture videos, printmaterials. The more interactive the educationalexperience , the greater the likelihood of success.

Use methods that engage the participants such asdiscussion, role playing, small group discussion and

question and answer rather than lectures.


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Do you learn in a freezing cold or sweltering hot orone that is too noisy or in which the seats wereuncomfortable or too close to the person next to you.Learning can be affected by environment so it must takes

place when people are comfortable and extraneousinterference is kept to a minimum.

The room should have good lighting and

temperature control comfortable seating with enoughspace between seats and be free of unpleasant odors(mold, mildew, cigarette smoking, heavy perfume) andsigns of deterioration (falling ceiling tiles, peeling paint,grafitti, dirty carpenting) there should also have adequateacoustics, no echo, large spaces.


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People learn only if they are emotionally and

physically ready, Client or student readiness,

unfortunately is not often in control. An adolescent

who is in denial about a diabetes diagnosis may notbe ready to learn how to inject insulin or follow a

prescribed diet.


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The first step in the educational process is to

assess readiness for learning. Assessment data

can be obtained directly from clients families orstudents (primary data). Or it can be generated

from other sources such as charts reports

literature (secondary data).


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Determine the percieved relevance of the information

Adults are generally willing to learn if they

percieve the information or skill being taught as

relevant to their lives in some way. The easiest

way to determine this perception is simply ask.

Keep in mind that this response may vary from

person to person, depending on their readiness

to learn.


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Repeat information

Repetition enhance learning. When new

information is presented, itshould be presented

several times and in a variety of ways includingrewording of the information. Repetition is

particularly important when the information is

complex or completely new.


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Information is more readily to learn if

it is applied to more than one situation.

Using a variety of examples to demonstrate

application of the information in a number

of different situations promote learning.


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Learning is enhanced if the learning experience is

pleasant. This can be accomplished through frequent

encouragement and positive feedback. People usually enjoy

learning, and learning is enhanced when obvious progress is

being made. Frequent recognition of accomplishment, even

for seemingly small successes, can go a long way toward

succcessful educational intervention.


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Begin with what is known;move

toward what is unknown

Information should be presented in an

organized fashion. It should begin with the

basics or general information that is known and

move toward new information or that which is

unknown.This will increase the likelihood of a

pleasant experiences.


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Nothing is more frustrating for learners than to have

new information presented at such a rapid pace that

they cannot keep up. The rate at which you should

teach new informations depends on a host of thingsincluding the time frame available, physical limitations

of the learners their education level and prior

experience or familiarity with the information beingtaught.


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Motivation and Behavior Change Theories

A theory is a set of interrelated concepts, definitionsand propositions that presents a systematic view ofevents or situations by specifying relations among

variables in order to explain and predict the events ofthe situations.

Theory is a set of ideas that help to explain therelationship among factors or prdict the outcome oftheir interrelationship. They helps us to understandwhy people do or do not do certain things in a given

situations.


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Is the key to increasing preventive health behaviorss,

improving compliance with treatment regimen or avoiding

complications or further illness.

In academic setting, theories provide insights into student

motivation. They can help us understand a students desire to

master the information being taught or to avoid failure.


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Essential components of Motivations

and Behavior Change Theories

Behavior Modificatio Theory

Health Belief ModelAttribution Theory

Social Cognitive Theory

Self-Efficacy theoryTranstheoretical or Stages of Change Model

Theory of Reasoned Action


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Components:

This model is based on perceptions of

seriousness or severity of the health problem;

personal belief of susceptibility to or risk of the

illness; benefits of adopting the new behavior or

changing the old behavior and the barriers to

changing or adopting the behavior. Change istriggered by cues to action and supported or

dindered by modifying variables.


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The most commonly used theory in health education.

Perceived seriousness is the clients beliefs about

the seriousness of an illness. This is either an illness he orshe has just been diagnosed with, is at risk for, or onethat needs to be prevented, as in the case ofcomplications from failure to follow medical treatment.

example: if the client believes that hypertension isnot serious because there is no pain, discomfort orrestriction in activity, long term compliance with medicaltreatment is less apt to occur.


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Percieved susceptibility

The belief of personal risk or a threat of a particular

health problem. If the person is that there is great risk ofdeveloping or contracting to a particular disease, then thelikelihood of changing behavior to avoid or prevent thisdisease from occuring is increased.

example: if the perception is that the risk ofcontracting the virus is minimal, then the likelihood ofsafer sex behaviors being adopted is also minimal.

However, the perception of risk maybe based onmisinformation or lack of information and if corrected,the perception maybe altered and safer sex behavior isadopted


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Perception of Benefit

It could be derived from the following theprescribed course of action. The benefit of changing

behavior is impacted by the extent to which the

person believes he or she is at risk.

example: In case of cigarette smoking, a smoker

may percieve lung cancer as a very serious health

problem and may percieve him or herself as being at

risk for this disease. If the percieve benefit of quitting

smoking is a significant reduction in the risk of

developing this serious condition, the person is more

likely to quit smoking.


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Barriers to Behavior Change

These are factors that prevent the adoption of

a new behavior. Barriers might include the

perception that a treatment is expensive,

painful,not effective, embarassing or inconvenient.These beliefs may stem from misconceptions, lack

of information, previous experience or hearsay. In

order for behavior to be adopted, barriers must beaddressed and removed.


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Cues to Action

These are essentially prompts that triggerpeople to do something about their unhealthy

behavior. These are prompts like reminder cards,

billboards, educational information, and posters.

example: a woman recieving a postcard from

her gynecologist office reminding her to make an

appointment for a pap smear, or a notice in the local

newspaper about a new walking path in the park may

motivate these individuals to take action.


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Transtheoretical Model/Stages of

Change Theory

Useful when the targeted behavior change

is the discontinuation of an unhealthy behavior.

It is often used for smoking cessation and

weight management interventions. This theory

postulates that people go through stages before

a change in behavior occurs.


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Stages of Change Theory

Pre contemplation Stage

before they even begin to think about change

no serious thought is given to changing the

behavior in the next six months.This could be because

the person is unaware that the behavior is unhealthy,

he/she is uninvolved, meaning that the person knows

that the behavior needs to be changed, but does notsee it as being very important. It could also be

because the person is undecided in thinking about the

positive/negative change in behavior.

Contemplation Stage (behavioral procrastination)


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Contemplation Stage (behavioral procrastination)

least aware of the need to change their behavior

and are thinking about making a change in the next

six months.Weigh the pros and cons of the new

behavior.

Preparation

Once the decision to change has been made,

people move to preparation or planning stage. During

this time, people plan to make the behavior change in

the immediate future, often within the next month.

Action Stage


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Action Stage

The person is actively involved in the behavior

change or in adopting the new behavior. When theystart the change, they put the plan into motion.

For the smoker, this means that he or she is quitsmoking, for hypertensive patient, it means that a lowsalt diet is being followed.

Action is necessary for behavior to change, butchanging behavior and keeping it changed are twodifferent things. As many smoker how easy it is to

quit.


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Termination Stage


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Termination Stage

When the behavior becomes a habit and require nofurther intervention.

Stages of Changes

PrecontemplationContemplation

Preparation

Action

Maintenance

Termination Stage

PC PA MT


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Theory of Reasoned Action

Components:This is based on the persons intention to

do something. Intention to change behavior is

the result of the following:A persons attitude toward the behavior (-&+)

Subjective norms - SO rxn to the behavior

Behavioral control - how easy or difficult thepersons believes the new behavior to be.


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Social Cognitive Theory

This is based on the reciprocal

determinism that behavior is theresult of

an interaction between the behavior, the

person or personal factors and the

environment. If one is changed This uses

self efficacy, modeling reinforcement andlocus of control.


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Self-Efficacy Theory

This is based on the idea that people will only dowhat they think they can do.

Four variables determine the strength of apersons belief in ability:

Performance accomplishment

Vicarious experience

Verbal persuasion

Physiological state


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Behavior Modification Theory

The underlying basis is the reard and

punishment. If the person does what is

wanted then the person is given something

pleasant - a reward, then something is

unpleasant is given or something pleasant

is taken away. Although both are use tochange in behavior but rewards is more

effective.


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Attribution Theory

People want to identify the reasons why thingshappen in their lives: they want to know whatattributed to the outcome. By knowing, they can

make the outcome occur again, if it is possible orprevent it from happpening again if it is negative.

The causes or attributions have three dimensions:

a. Locus of causality

b. stability

c. controllability

Locus of causality


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Locus of causality

refers to whether the cause is internal or

external. Does the cause come from within the

person-dizziness,physical ability, artistic talent orintellectual aptitude-or from external sources such as

good teacher,weather,transportation or side effects of

the drugs.

Controllability


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Controllability

refers to the extent to which the attribution

(cause) can be affected by the person or how much

control the person has over the cause. How much

control does the person have over skill or dexterity,

the length of an examination, the physical

environment of a room, taking medications orexercising?

Stability


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Stability

the extent to which the cause is consistent.

Example: mood or fatigues maybe

unstable, whereas innate math ability or

blindness are stable.

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Chapter III Strategies in Health Education