Health education and adult
learning
Professor Tarek Tawfik Amin
Public Health
Cairo University
amin55@myway.com
Objectives:
At the end of the session, trainees would be able to:
1- Define the basic rules forproviding health education....
Principles of Patient Education
Peopleareexpected to learn enough about their
own health to beableto participatein health...
Principles of Patient Education
Two important principlesfor providing patient
education aresimplicity and reinforcement.
...
Principles of Patient Education
Start by assessing what thesubject knows
beforeteaching.
Never assumethat thepatient nee...
Principles forProviding Patient Education
Simplicity
1.Teach the simple concepts about a topic first, and then move to the...
Principles forProviding Patient Education
Reinforcement
1.Teach the one concept you want yoursubjects to truly learn first...
Knowles adult learning principles
 Knowlesformulated what hecalled the "Adult
Learning Principles".
 They remain today e...
Knowles adult learning principles
1. Adultslearn best when thereisa perceived
need.
2. Progressfrom theknown to theunknown...
Knowles adult learning principles
7. Adultsrequireopportunitiesto practicenew
skills.
8. Adultsneed thebehavior reinforced...
Adult-Learning Principles Introduction
o Knowlesalso described adult learning asa
processof self-directed inquiry.
o Six c...
Characteristics of adult learners
ΩAutonomousand self-directed
ΩAccumulated afoundation of
experiencesand knowledge
ΩGoal ...
Adult-Learning Principles Introduction
 Thereasonsmost adultsenter any learning
experienceisto createchange.
 Thiscould ...
Adult-Learning Principles Introduction
 Compared to school-agechildren, themajor
differencesin adult learnersarein:
a) th...
Pillars of adult learning.
Adult Learning
MotivationExperiences
Engagement
Adult-Learning Principles 1- Motivation
o Adults learn best when convinced of the
need forknowing the information.
o Often...
Adult-Learning Principles 1- Motivation
o The key to using adults' "natural"
motivation to learn is tapping into their
mos...
Sources of motivations
1. Social Relationships: to makenew friends; to meet a
need for associationsand friendships.
2. Ext...
Motivation
Health care providers involved in
educating adults need to convey a desire
to connect with the learner.
Provi...
Experience
Adults have a greaterdepth, breadth, and
variation in the quality of previous life
experiences than youngerpeo...
Experience
However, past experiences may
actually make the task harderif these
biases are not recognized as being
present...
Level of Engagement
 When an adult learner hascontrol over the
nature, timing, and direction of thelearning
process, thee...
Level of engagement
According to Rogers(1969), theadult-learning
processisfacilitated when:
1. Thelearner participatescomp...
Level of engagement
It isimportant to remember that in order to
engagetheadult learner and facilitatethe
transfer of knowl...
Applying the Learning: readability
o Verbal patient education should alwaysbe
accompanied by written information.
o It can...
Readability
o Health education materialsdeveloped for the
general public should not exceed sixth to
eighth gradelevels.
o ...
Readability
o Somepopulationsof women havespecific
problemswith written health education
materials, especially women with ...
Readability
o Educational materialsgiven to clientsshould
beculturally competent.
References
• Saarmann L, Daugherty J, Riegel B. Patient teaching to promote behavioral change. Nurs Outlook 2000;48:281-28...
References
• http://www.medscape.com/viewarticle/478283_5
• Dowe MC, Lawrence PA, Carlson J, Kerserling TC. Patients' use ...
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Health education and adults learning.

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Health education, methods of learning among adults, components and opportunities for health education.

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Health education and adults learning.

  1. 1. Health education and adult learning Professor Tarek Tawfik Amin Public Health Cairo University amin55@myway.com
  2. 2. Objectives: At the end of the session, trainees would be able to: 1- Define the basic rules forproviding health education. 2- Get oriented with principles of adult learning. 3- Appreciate the practical roles forprocesses involved in adult learning.
  3. 3. Principles of Patient Education Peopleareexpected to learn enough about their own health to beableto participatein health caredecisions. Patient education haschanged from telling the subject thebest actionsto take, to assisting them in learning about their health care for thesakeof improvement. Racial, cultural and ethnic differencesplay a largepart in thecommunication process.
  4. 4. Principles of Patient Education Two important principlesfor providing patient education aresimplicity and reinforcement. "Simplicity" meansthat educational messages must bedelivered so thesubject can readily understand them. Health education can includeextremely intricateinformation (e.g., triplescreening, amniocentesis, and Rh incompatibility).
  5. 5. Principles of Patient Education Start by assessing what thesubject knows beforeteaching. Never assumethat thepatient needsto be taught everything about atopic. Over teaching must beavoided. It isfar better to choosethreeor four essential conceptsabout atopic.
  6. 6. Principles forProviding Patient Education Simplicity 1.Teach the simple concepts about a topic first, and then move to the more complex concepts. 2. Use language that the woman will find easy to understand and avoid medical terminology wheneverpossible. 3. Use words that mean something to the general public. The word "positive" has a good connotation formost people, but in health issues, sometimes "positive" means a bad finding; this can be very confusing forourpatients. 4. Use concrete language and tell them exactly what you want them to do, such as "call me if you feel any fluid leaking from yourvagina," not "call me if yourwaterbreaks."
  7. 7. Principles forProviding Patient Education Reinforcement 1.Teach the one concept you want yoursubjects to truly learn first in the lesson, and then teach that same concept again last. 2. Ask subjects to re-state what you have taught them, so you can be sure they understood. 3. Use visual aids forteaching; using several senses improves learning. 4. Always use written educational materials forthe subjects to take home.
  8. 8. Knowles adult learning principles  Knowlesformulated what hecalled the "Adult Learning Principles".  They remain today essential knowledgefor peoplewho teach adultsin health settings.  Theseadult learning principlescan help usto plan effectivehealth education programs.
  9. 9. Knowles adult learning principles 1. Adultslearn best when thereisa perceived need. 2. Progressfrom theknown to theunknown. 3. Alwaysassesswhat they know about atopic beforebeginning ateaching session. 4. Don't re-teach thethingsthey already understand. 5. Progressfrom thesimpler conceptsto more complex topics. 6. Adultslearn best using activeparticipation.
  10. 10. Knowles adult learning principles 7. Adultsrequireopportunitiesto practicenew skills. 8. Adultsneed thebehavior reinforced. Teaching about health topicsneedsreinforcement continually. 9. Immediatefeedback and correction of misconceptionsincreaseslearning. 10. Alwaysask thesubject to restatewhat you havetaught. Adapted fro m Kno wles, 1 98 0
  11. 11. Adult-Learning Principles Introduction o Knowlesalso described adult learning asa processof self-directed inquiry. o Six characteristicsof adult learnerswere identified by Knowles(1970). o Headvocated creating aclimateof mutual trust and clarification of mutual expectations with thelearner.
  12. 12. Characteristics of adult learners ΩAutonomousand self-directed ΩAccumulated afoundation of experiencesand knowledge ΩGoal oriented ΩRelevancy oriented ΩPractical ΩNeed to beshown respect Knowles 1970
  13. 13. Adult-Learning Principles Introduction  Thereasonsmost adultsenter any learning experienceisto createchange.  Thiscould encompassachangein (a) their skills, (b) behavior, (c) knowledgelevel, or (d) even their attitudesabout things (Adult Educatio n Centre, 2005).
  14. 14. Adult-Learning Principles Introduction  Compared to school-agechildren, themajor differencesin adult learnersarein: a) thedegreeof motivation, b) theamount of previousexperience, c) thelevel of engagement in thelearning process, and d) how thelearning isapplied.  Each adult bringsto thelearning experience preconceived thoughtsand feelingsthat will be influenced by each of thesefactors.  Assessing thelevel of thesetraits-readinessshould be included each timeateaching experienceisbeing planned.
  15. 15. Pillars of adult learning. Adult Learning MotivationExperiences Engagement
  16. 16. Adult-Learning Principles 1- Motivation o Adults learn best when convinced of the need forknowing the information. o Often a life experience orsituation stimulates the motivation to learn (O'Brien, 2004). o Meaningful learning can be intrinsically motivating.
  17. 17. Adult-Learning Principles 1- Motivation o The key to using adults' "natural" motivation to learn is tapping into their most teachable moments (Zemke & Zemke, 1995). o Lieb (1991) described six factors which serve as sources of motivation foradult learning.
  18. 18. Sources of motivations 1. Social Relationships: to makenew friends; to meet a need for associationsand friendships. 2. External expectations: to comply with instructionsfrom someoneelse; to fulfill recommendationsof someone elsewith full authority. 3. Special welfare: to improveability to servemankind; to improveability to participatein community work. 4. Personal Advancement: to achievehigher statusin a job; to secureprofessional advancement. 5. Escape/Stimulation: to relieveboredom; providea break in theroutineof homeor work. 6. Cognitive/interest: to learn for thesakeof learning to satisfy an inquiring mind. Leib, 1991
  19. 19. Motivation Health care providers involved in educating adults need to convey a desire to connect with the learner. Providing a challenge to the learner without causing frustration is additionally important. Above all, provide feedback and positive reinforcement about what has been learned (Lieb, 1991).
  20. 20. Experience Adults have a greaterdepth, breadth, and variation in the quality of previous life experiences than youngerpeople. Past educational orwork experiences may colororbias the patient's perceived ideas about how education will occur. Formerexperiences can assist the adult to connect the current learning experience to something learned in the past. This may also facilitate in making the learning experience more meaningful. (O'Brien,2004).
  21. 21. Experience However, past experiences may actually make the task harderif these biases are not recognized as being present by the teacher. This would be an opportune time to address any erroneous or preconceived ideas.
  22. 22. Level of Engagement  When an adult learner hascontrol over the nature, timing, and direction of thelearning process, theentireexperienceisfacilitated.  Adultshaveaneed to beself-directed, deciding for themselveswhat they want to learn.  They haveagoal in mind and generally takea leadership rolein their learning.  Thechallengefor teachersisto encouragethe learner with reinforcement. Rogers (1969)
  23. 23. Level of engagement According to Rogers(1969), theadult-learning processisfacilitated when: 1. Thelearner participatescompletely in the learning processand hascontrol over its natureand direction. 2. It isprimarily based upon direct confrontation with practical, social, or personal problems. 3. Self-evaluation istheprincipal method of assessing theprogressor success.
  24. 24. Level of engagement It isimportant to remember that in order to engagetheadult learner and facilitatethe transfer of knowledge, patienceand time on thepart of theteacher and patient are needed.
  25. 25. Applying the Learning: readability o Verbal patient education should alwaysbe accompanied by written information. o It can bedifficult to find information written at theappropriatereadability level, containing theappropriateinformation, and in the languagethewoman understands.
  26. 26. Readability o Health education materialsdeveloped for the general public should not exceed sixth to eighth gradelevels. o Materialswritten at readability levelsof sixth to eighth gradearemoreeffectivein conveying health messagesand havehigher ratesof recall acrossall educational levels.
  27. 27. Readability o Somepopulationsof women havespecific problemswith written health education materials, especially women with low literacy skills. o It isclear that women with low literacy skills requirespecial interventionsto help them learn. 
  28. 28. Readability o Educational materialsgiven to clientsshould beculturally competent.
  29. 29. References • Saarmann L, Daugherty J, Riegel B. Patient teaching to promote behavioral change. Nurs Outlook 2000;48:281-287. • Schillinger D, Grumbach K, Piette J, Wang F, Osmond D, Daher C, et al. Association of health literacy with diabetes outcomes. JAMA 2002;288:475-482. • Moore ML, Moos MK. Cultural competence in the care of childbearing families, March of Dimes Birth Defects Foundation, New York 2003. • Freda MC. Perinatal patient education: a practical guide with handouts for patients in English and Spanish, Lippincott, Williams & Wilkins, Philadelphia 2002. • Sabogal F. Printed health education materials for diverse communities: Suggestions learned from the field. Health Educ Q 1996;23:123-141. • Developmental Disabilites and Bill of Rights Act of 2000, pub. L. No. 106-402, 114 Stat. 1681, 1683 (2000) [Internet] [cited October 11, 2003]. Available from: www.acf.dhhs.gov/programs • Callister L, Lauri S, Vehvilainen-Julkunen K. A description of birth in Finland. MCN Am J Matern Child Nurs 2000;25:146- 150. • Davis R. The postpartum experience for southeast Asian women in the United States. MCN Am J Matern Child Nurs 2001;26:208-213. • Foss G. Maternal sensitivity, posttraumatic stress and acculturation in Vietnamese and Hmong women. MCN Am J Matern Child Nurs 2001;26:257-263. • Jones ME, Bond ML, Gardner SH, Hernandez MC. A call to action: Acculturation and family planning in Hispanic immigrant women. MCN Am J Matern Child Nurs 2002;27:26-32. • Kridli S. Women's health beliefs and practices among Arab-American women. MCN Am J Matern Child Nurs 2002;27:178- 182. • McCartney P. After birth: Who gets the placenta?. MCN Am J Matern Child Nurs 2000;25:105. • Post DM, Cegala DJ, Marinelli TM. Teaching patients to communicate with physicians: The impact of race. J Natl Med Assoc 2001;93:6-12. • Cooper HC, Booth K, Gill G. Patients' perspectives on diabetes health care education. Health Educ Res 2003;18:191-206. • Knowles M. The modern practice of adult education, Cambridge, New York 1980. • Rankin SH, Stallings KD. Patient education principles & practice, 4th ed, Lippincott Williams & Wilkins, Philadelphia 2001. • Redman BK. The practice of patient education, Mosby Year Book, Inc, St. Louis 1997. • Freda MC, Damus K, Merkatz IR. What do pregnant women know about the prevention of preterm birth?. J Obstet Gynecol Neonatal Nurse 1991;20:140-145. • Freda MC, Damus K, Andersen HF, Merkatz IR. A PROPP for the Bronx: Preterm birth prevention education in the inner city. Obstet Gynecol 1990;76:93-96. • Rising S. Centering pregnancy, 2003. [Internet] [cited October 11]. Available from: www.centeringpregnancy.com. • Freda MC, Abruzzo M, Davini D, DeVore N, Damus K, Merkatz IR. Are they watching? Are they learning? Prenatal video education in the waiting room. J Perinat Ed 1994;3:20-28.
  30. 30. References • http://www.medscape.com/viewarticle/478283_5 • Dowe MC, Lawrence PA, Carlson J, Kerserling TC. Patients' use of health teaching materials at three readability levels. Appl Nurs Res 1997;10:86-93. • Freda MC, Damus KH, Merkatz IR. An evaluation of the readability of ACOG's patient education pamphlets. Obstet Gynecol 1999;93:771-774. • Meade CD, Howser DM. Consent forms: How to determine and improve readability. Oncol Nurs Forum 1992;19:1523-1528. • Zion AB, Aiman J. Level of reading difficulty in the American College of Obstetricians and Gynecologists patient education pamphlets. Obstet Gynecol 1989;74:955-960. • Weiss BD, Coyne C. Communicating with patients who cannot read. N Engl J Med 1997;337:272-274. • Schillinger D, Piette J, Grumbach K, Wang F, Wilson C, Daher C, et al. Closing the loop: Physician communication with diabetic patients who have low health literacy. Arch Intern Med 2003;163:83-90. • Corrarino J, Freda MC, Barbara M. Development of a health education booklet for pregnant women with low literacy skills. J Perinat Ed 1995;4:23-28. • Lasch KE, Wilkes G, Montuori LM, Chew P, Leonard C, Hilton S. Using focus group methods to develop multicultural cancer pain education materials. Pain Manag Nurs 2000;1:129-138. • Lagana K, Duderstadt K. Ethical decision making for perinatal nurses. March of Dimes nursing module, March of Dimes Birth Defects Foundation, White Plains (NY) 1995. • Cady R. Informed consent for adults: A review of basic principles. MCN Am J Matern Child Nurs 2000;25:164. • Braddock CH III, Fihn SD, Levinson W, Jonsen AR, Pearlman RA. How doctors and patients discuss routine clinical decisions. Informed decision making in the outpatient setting. J Gen Intern Med 1997;12:339-345. • Chan EC, Vernon SW, O'Donnell FT, Ahn C, Greisinger A, Aga DW. Informed consent for cancer screening with prostate-specific antigen: How well are men getting the message?. Am J Public Health 2003;93:779-785. • Faden RR, Chwalow AJ, Orel-Crosby E, Holtzman NA, Chase GA, Leonard CO. What participants understand about a maternal serum alpha-fetoprotein screening program. Am J Public Health 1985;75:1381-1384. • Marteau TM, Kidd J, Michie S, Cook R, Johnston M, Shaw RW. Anxiety, knowledge and satisfaction in women receiving false positive results on routine prenatal screening: A randomized controlled trial. J Psychosom Obstet Gynaecol 1993;14:185-196. • Turner P, Williams C. Informed consent: Patients listen and read, but what information do they retain?. N Z Med J 2002;115:U218. • Paasche-Orlow MK, Taylor HA, Brancati FL. Readability standards for informed-consent forms as compared with actual readability. N Engl J Med 2003;348:721-726. • Williams BF, French JK, White HD. Informed consent during the clinical emergency of acute myocardial infarction (HERO-2 consent substudy): A prospective observational study. Lancet 2003;15:918-922.
  31. 31. Thank you

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