1. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 11 Health Promotion: Achieving Change Through Education

2. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Healthy 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

3. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Health 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

4. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Definitions 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

5. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Individuals often have similar motives or reasons for change.

6. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False –People decide to change for many different reasons.

7. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Stages 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)

8. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Planned Change Purposeful and intentional Change by design, not default Improvement as the aim for planned community health change Accomplished through an influencing agent

9. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

10. 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

11. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

12. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following characterizes normative- reeducative strategies for change? a.Persuasion b.Coercion c.Rationality d.Best interests

13. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer 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.

14. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Principles for Effecting Positive Change Participation Resistance to change Proper timing Interdependence Flexibility Self-understanding

15. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Change 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

16. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Domains 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)

17. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Theories : Behavioral Stimulus-response –Pavlov: certain causes evoke certain effects Conditioning –Thorndike: conditioning without reinforcement –Skinner: conditioning with reinforcement

18. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Theories: Cognitive Jean Piaget (see Table 11.5) –Assimilation –Accommodation –Adaptation Gestalt-field –Insight theory –Goal-insight theory –Cognitive field theory

19. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Skinner was a behavioral theorist who used conditioning with reinforcement.

20. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer 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.

21. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Theories: Social Bandura –Coincidental association –Inappropriate generalization –Perceived self-inefficacy

22. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning 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

23. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

24. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Health 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

25. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

26. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question 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

27. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer 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.

28. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Teaching-Learning Principles Client readiness Client perceptions Educational environment Client participation Subject relevance Client satisfaction Client application

29. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Teaching Process Interaction Assessment and diagnosis Setting goals and objectives Planning Teaching Evaluation

30. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Teaching 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

31. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Clients 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

32. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Assessment and diagnosis is the first step in the teaching process.

33. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False –The first step in the teaching process is interaction, establishing basic communication patterns between clients and the nurse. Assessment and diagnosis follows.

34. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Internet Resources American Medical Informatics Association (AMIA): http://www.amia.org http://www.amia.org Healthy People 2010 objectives for educational, community-based programs: http://www.healthypeople.gov/Document/HTML/Volume1 /07Ed.htm 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 http://www.healthypeople.gov/Document/HTML/Volume1 /11HealthCom.htm McGraw Hill: Teaching Methods Web Resources: http://www.mhhe.com/socscience/education/methods/re sources.html#teaching http://www.mhhe.com/socscience/education/methods/re sources.html#teaching