Community Health Education – Ace Star Tutors

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Chapter 8

Community Health Education

Health Education …

… is any combination of learning experiences designed to predispose, enable, and reinforce voluntary behavior conducive to health in individuals, groups or communities.

– Green and Kreuter, 2004

Health Education’s Goals

To understand health behavior and to translate knowledge into relevant interventions and strategies for health enhancement, disease prevention, and chronic illness management

To enhance wellness and decrease disability

Health Education’s Goals (Cont.)

Attempts to actualize the health potential of individuals, families, communities, and society

Includes a broad and varied set of strategies aimed at influencing individuals within their social environment for improved health and well-being

Learning Theories

Humanistic theory helps individuals develop their potential in a self-directing and holistic manner.

Cognitive theory recognizes the brain’s ability to think, feel, learn, and solve problems; theorists in this area train the brain to maximize these functions.

Social learning is based on behavior that explains and enhances learning through the concepts of efficacy, outcome expectation, and incentives.

Adult Learners

Need to know

Concept of self

Experience

Readiness to learn

Orientation to learning

Motivation

– Knowles (1980, 1989)

Health Education Models

Health Belief Model (HBM)

Perceived susceptibility

Perceived severity

Perceived benefits

Perceived barriers

Self-efficacy

Demographics

Cues to action

Health Education Models (Cont.)

Health Promotion Model (HPM)

Individual characteristics and behaviors

Prior behaviors, personal factors

Behavior—specific cognitions and affect

Activity-related affect, interpersonal influences, situational factors, commitment to plan of action, perceived self-efficacy, immediate competing demands and preferences, perceived benefits of health-promoting behaviors, perceived barriers to health-promoting behaviors

Behavioral outcome

Health-promoting behavior

Model of Health Education Empowerment

… nurses cannot assign power and control to the individual within the community but rather … the “power” must be taken on by the individual and community with the nurse guiding this dynamic process.

– Van Wyk, 1999

Model of Health Education Empowerment (Cont.)

Process includes examining

Education

Health literacy

Gender

Racism

Class

Recognizes the structural and foundational changes that are needed to elicit change for socially and politically disenfranchised groups

Problem-Solving Education …

…centers on empowerment (Freire, 2005)

Allows active participation and ongoing dialogue

Encourages learners to be critical and reflective about health issues

Involves individuals as subjects, not objects

Increases health knowledge through a participatory group process

Involves activism on the part of the educator

Facilitator-educator is a resource person and is an equal partner with the other group members

Leads to sustainable lateral relationships

Participatory Action Research (PAR)

Goal of PAR is social change

Embraces the use of community-based participatory methods

Participation and action from stakeholders and knowledge about conditions and issues helps to facilitate strategies reached collectively

Community Empowerment

Community members take on greater power to create change

Based on community cultural strengths and assets

Attention must be given to collective rather than individual efforts to ensure that outcomes reflect voices of the community and truly make a difference in people’s lives

The Nurse’s Role in Health Education

Become a partner with individuals and communities

Serve as catalyst for change

Activate ideas

Offer appropriate interventions

Identify resources

Facilitate group empowerment

Framework for Developing Health Communications

Figure 8-1

Health Education Model Stage I: Planning and strategy selection

Questions to Ask

Who is the intended audience?

What is known about the audience and from what sources?

What are the communication and education objectives and goals?

What evaluation strategies will the nurse use?

What are the issues of most concern?

What is the health issue of interest?

Health Education Model Stage I: Planning and strategy selection (Cont.)

Collaborative Actions to Take

Review the available data.

Get community partners involved.

Obtain new data.

Determine perceptions of health problems.

Determine the community’s assets and strengths.

Identify underlying issues and knowledge gaps.

Establish goals and objectives.

Assess resources.

Health Education Model Stage II: Developing and pretesting concepts, messages, and materials

Questions to Ask

What channels are best?

What formats should be used?

Are there existing resources?

How can the nurse present the message?

How will the intended audience react to the message?

Will the audience understand, accept, and use the message?

What changes may improve the message?

Health Education Model Stage II: Developing and pretesting concepts, messages, and materials (Cont.)

Collaborative Actions to Take

Identify the messages and materials.

Decide whether to use existing materials or produce new ones.

Select channels and formats.

Develop relevant materials with the target audience.

Pretest the message and materials and obtain audience feedback.

Health Education Model Stage III: Implementing the program

Questions to Ask

How should we launch the health education program?

How do we maintain interest and sustainability?

How can we use process evaluation?

What are the strengths of the health program?

How can we keep on track within timeline and budget?

How do we know if we have reached our intended audience?

How well did each step work (process evaluation)?

Are we maintaining good relationships with partners?

Health Education Model Stage III: Implementing the program (Cont.)

Collaborative Actions to Take

Work with community organizations to enhance effectiveness.

Monitor and track progress.

Establish process evaluation measures.

Health Education Model Stage IV: Assessing effectiveness and making refinements

Questions to Ask

What was learned?

How can outcome evaluation be used to assess effectiveness?

What worked well, and what did not work well?

Has anything changed about the intended audience?

How can we refine methods, channels, and formats?

What lessons were learned? What modifications could strengthen the health education activity?

Health Education Model Stage IV: Assessing effectiveness and making refinements (Cont.)

Collaborative Actions to Take

Conduct outcome evaluations.

Reassess and revise goals and objectives.

Modify unsuccessful strategies or activities.

Generate continual support from community groups.

Provide justification for continuing/ending the program.

Summarize in an evaluation report.

Health Literacy Definitions Evolved Over Time

National Literacy Act (1991)

Literacy is operationally defined as the ability to read and write at the fifth-grade reading level in any language and can be measured according to a continuum.

IOM Report (2004)

The capacity to obtain, interpret, and understand basic health information and services and the competence to use such information and services to enhance health

In 1999, the AMA’s Report of the Council on Scientific Affairs reported that patients with the most health care needs are often the least able to read and understand information that would enable them to function successfully within

the health care system.

Health Literacy

Health Literacy (Cont.)

Health literacy is about empowerment …

Having access to information, knowledge, and innovations

Increasingly important for social, economic, and health development

A key public health issue in the delivery of safe, effective care

Low Literacy

Increases the use of health care services

Decreases self-esteem; increases shame and stigma

Adversely affects outcomes and treatment of some medical conditions

Poses barriers to obtaining informed consent

Impacts participation in research

Leads to health care and linguistic isolation

Impedes patient-provider communication

Literacy Concerns

Serious mismatch exists between the reading levels of materials and patient’s reading skills.

Materials often fail to incorporate the intended audience’s cultural beliefs, values, languages, and attitudes.

Low literacy prevents many from gaining the full benefits of health care.

Literacy Concerns (Cont.)

Inability to read and understand instructions influences self-care abilities and health and wellness.

Individuals with very low literacy skills are at an increased risk for poor health, which contributes to health disparities.

Levels for Interventions

Functional/basic literacy

Increasing basic reading/writing skills

Communicative/interactive literacy

Understanding and using information with providers

Critical literacy*

Analyzing and using information in life situations

*Most important because it increases empowerment and success in everyday situations

Helpful Tips for Effective Teaching

Assess reading skills

Determine what client needs to know

Identify motivating factors

Stick with essentials

Set realistic goals and objectives

Use clear and concise language

Develop a glossary of common words

Space teaching over time

Personalize health messages

Incorporate methods of illustration, demonstration, and real-life examples

Give and get

Helpful Tips for Effective Teaching (Cont.)

Summarize often

Be creative

Use appropriate resources and materials

Put patients at ease

Praise patients

Be encouraging

Allow time for questions

Employ teach-back methods

Remember that comprehension and understanding take time and practice

Conduct learner verification

Evaluate the teaching plan

Assess Materials

Become a Wise Consumer and User

Evaluate health materials, including websites, before disseminating them

Materials should strengthen previous teaching

Materials should be used as an adjunct to health instruction

Assessing the Relevancy of Health Materials

Do materials match the intended audience?

Are materials appealing and culturally and linguistically relevant?

Do they convey accurate and up-to-date information?

Are messages clear and understandable?

Do messages promote self-efficacy and motivation?

Assessment of Reading Level

Assess reading levels of intended audience

Rapid estimate of adult literacy in medicine (REALM)

Single Item Literacy Screener (SILS)

Short Assessment of Health Literacy for Spanish-Speaking Adults (SAHLSA)

Assess readability of educational resources

SMOG readability formula

Flesch-Kincaid formula (on most computers)

Verify understanding of learner

Role of Social Media

Numerous platforms now available

May reach diverse community constituents with important public health messages

Potential to…

Facilitate interactive communication

Increase sharing of health information

Personalize and reinforce health messages

Can empower community members to make informed health decisions

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