Download Planned Change

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
employer-sponsored health promotion
– Patient satisfaction with health care provider
communication
– Community-based health promotion
– Culturally appropriate health education
– Senior health education
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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
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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.
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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)
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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 people’s
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
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.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Principles for Effecting Positive Change
• Participation
• Resistance to change
• Proper timing
• Interdependence
• Flexibility
• Self-understanding
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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)
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Learning Theories : Behavioral
• Stimulus-response
– Pavlov: certain causes evoke certain effects
• Conditioning
– Thorndike: conditioning without reinforcement
– Skinner: conditioning with reinforcement
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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 learner’s
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
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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
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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
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
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
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 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.
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Teaching-Learning Principles
• Client readiness
• Client perceptions
• Educational environment
• Client participation
• Subject relevance
• Client satisfaction
• Client application
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Teaching Process
• Interaction
• Assessment and diagnosis
• Setting goals and objectives
• Planning
• Teaching
• Evaluation
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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/Volume1
/11HealthCom.htm
• McGraw Hill: Teaching Methods Web Resources:
http://www.mhhe.com/socscience/education/methods/re
sources.html#teaching
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins