Chapter 11

Health Promotion: Achieving Change

Through Education

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 employersponsored health promotion
Patient satisfaction with health care provider communication
Community-based health promotion
Culturally appropriate health education
Senior health education

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Health Promotion Through Change

CHN educator: goal of effecting change in peoples
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
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
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.

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer
False
People decide to change for many different
reasons.

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)

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

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Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

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

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Planned Change Strategies

Empiric-rational (similar to technostructural, databased, 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 peoples
attitudes and behaviors through persuasion
Power-coercive (similar to coercive strategy)
Use of coercion based on fear
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question
Which of the following characterizes normativereeducative strategies for change?
a. Persuasion
b. Coercion
c. Rationality
d. Best interests

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer
a. Persuasion
The normative-reeducative strategy involves
providing new information that directly influences
peoples 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.
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Principles for Effecting Positive Change

Participation
Resistance to change
Proper timing
Interdependence
Flexibility
Self-understanding

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

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)
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

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
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.

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 learners
environment enhance the probability of the
desired response.

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Learning Theories: Social

Bandura
Coincidental association
Inappropriate generalization
Perceived self-inefficacy

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 selfactualization
Carl Rogers
Self-directed
Client-centered, warm, positive, & empathetic

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
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
clients health
Empiric variables
Health Belief Model (HBM)
Readiness to act on behalf of a persons own health
predicated on 6 concepts: perceived susceptibility;
perceived seriousness; perceived benefits of action;
barriers to taking action; cues to action; self-efficacy

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Health Teaching Models (cont.)

Penders 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
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

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 persons 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.

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

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Teaching Process
Interaction
Assessment and diagnosis
Setting goals and objectives
Planning
Teaching
Evaluation

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
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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
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.

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.

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Internet 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/Volume
1/11HealthCom.htm
McGraw Hill: Teaching Methods Web Resources:
http://www.mhhe.com/socscience/education/methods/res
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ources.html#teaching