Chapter 12. Educating for health
Chapter Contents
Principles of learning for health163
Facilitating health learning164
Guidelines for giving talks170
Improving patient education173
Teaching practical skills for health174
Summary
The first section of this chapter involves a discussion on the principles of learning. An exercise is used to analyse the qualities and abilities of an effective health educator, and some principles of facilitating health learning are outlined. Subsequent sections contain guidelines on giving talks, strategies for patient education and teaching practical skills for health. A role-play exercise is used to focus on skills of effective patient health education.
This chapter is about the skills and methods of educating for health, when the aims are primarily concerned with enabling people to acquire health knowledge and skills. Examples are: giving a talk on a health topic to a large community group; teaching an adult education class in food safety or a school class in sexual health; running cardiac rehabilitation sessions for patients recovering after heart attacks; giving information to a patient on a one-to-one basis about diagnosis, treatment and self-care; or teaching a small group of colleagues about the techniques and procedures used in a smoking cessation programme.
Principles of Learning for Health
Some aspects of education, teaching and learning are relevant for health promoters.
Health promoters generally have credibility because of their training and expert knowledge which is likely to be valued and respected by clients, but expertise alone does not make a good health educator. In order to get results in the form of measurable learning achievements, such as greater retention and application of health information and skills, health educators need to understand some principles of learning, such as the importance of participative learning. The basic principles of learning as applied to health are summarised in Box 12.1. For more details on adult learning see Rogers (2001); for an example of how the principles of learning can be applied in practice see Suter & Suter (2008); for a broader perspective on teaching and learning in nursing health promoting practice see Bastable (2002); and for health settings generally see Bastable (2004).
BOX 12.1
Principles of learning as applied to health education
▪ Learning for health is most effective when the learner identifies their own learning needs and sets their own goals.
▪ The health educator’s role is to enable or facilitate learning rather than to direct it. Health educators who adopt this approach often refer to themselves as facilitators.
▪ Learners are generally most ready to learn things that they can apply immediately to existing health problems or to their own situation.
▪ Learners bring with them life experience, which should be seen as a resource and to which new learning should be related.
▪ Learners can help each other, because of their experiences, and should be encouraged to do so.
▪ Learning is best when active (not passive), by doing and experiencing, for which learners need a safe environment where they feel accepted.
▪ Learners should be encouraged to carry out continuous evaluation of their own learning. Health educators should use this evaluation to fit the learning process to the learners’ needs.
Facilitating Health Learning
Exercise 12.1 will help you to identify factors that have helped and hindered your learning, and to assess your own qualities and abilities. The following recommendations apply to health education with individuals or groups.
EXERCISE 12.1
What helps and hinders learning?
Think of two occasions when you have been a learner, such as when you were a health promotion student in class, or in the audience listening to a health talk, or when you were being taught on a one-to-one basis. These learning occasions need not have been connected with work, for example listening to an art lecture or taking a driving lesson. One should be when you felt, overall, that the session was good and the other when it was bad. The aim of the exercise is to identify the factors that made them good or bad for you.
In each of your two situations in turn, identify factors that helped you to learn, and factors that hindered your learning. Think of these factors in three categories:
1. Those to do with the environment (e.g. too hot? noisy? hard chairs? a spacious, comfortable room?)
2. Those to do with the qualities of the teacher (e.g. sense of humour? appeared bored? contagious enthusiasm? seemed unfriendly?)
3. Those to do with the presentation (e.g. talked too long? used relevant illustrations? involved audience? muddled? used words you didn’t understand? used audiovisual aids effectively?)
Enter these factors on the chart:
| Environment | Teacher | Presentation | |
|---|---|---|---|
| Factors that helped | |||
| Factors that hindered |
If you are working in a group, compare your chart with those of other people.
▪ What have you learnt about the importance of the environment?
▪ What qualities of a good health educator do you think you already possess?
▪ What helpful points about presentation do you think you already use, or will use, in your own work?
▪ What points about your own qualities or presentation would you like to improve?
Plan Your Session
However skilled and knowledgeable you are about the health topic, it is vital to put thought and time into preparation. You need to think through what you aim to achieve, how you are going to introduce and develop your session and how you will involve your audience. Preparation is especially important when facilitating health learning is new to you, but even the most experienced and self-confident health educator needs to spend some time in preparation. Active participation is a more complex process and will require greater attention to planning.
Work from the Known to the Unknown
Time is wasted in teaching people something they already know so the starting point is finding out what your clients know. If you cannot do this in advance, spend some time at the beginning of the session asking a few questions. If you have a mixed audience with varying degrees of knowledge, it may be best to acknowledge that some people know more than others, and you will have to make a decision about the level at which to pitch your information: ‘Some of you will probably know this, but I’ll talk about it briefly because it will be new to others …’.
Your aim is to impart new health information, or new skills, onto what is already known.
Aim for Maximum Involvement
People learn best if they are actively participating in the learning process, not just passive listeners (see Jenson & Simovska 2005 for an interesting discussion of two models of participation).
First, where appropriate, involve your clients in deciding the aim and content of the session. If you are running a course, such as a series of antenatal classes or one on food hygiene, you might begin by explaining your aims, asking for comments and suggestions, and then going on to discuss the content. This will help to increase motivation by stimulating clients to think about their own needs and to take some responsibility for their own learning. The goals and content of a one-to-one session can be established by mutual agreement at the outset. As a general rule, it is worth considering how much room for negotiation there is in your health education role, and spending time to find out what people really want. Ask yourself ‘Is what I cover what I want to teach or what my clients want to learn?’
Second, keep your clients involved as much as possible during sessions. This is a challenge if you are giving a talk or a lecture to a large audience, but there are possibilities, such as asking people to respond to a question, such as ‘I’d like you to put your hand up if you made a new year resolution to take more exercise this year’. Or ask them to respond to a series of statements: for example, as an introduction to a talk on nutrition, ask the audience to stand up, then ask them to sit down if they: usually eat white bread … add sugar to tea and coffee … regularly eat fried food … add salt at the table … Most of them will be sitting down by now but will feel alert and involved. Another way of keeping an audience involved is to give them time to talk. This can be done by having question-and-answer sessions, or by allowing short breaks when they can talk about something in groups of two or three for a few minutes. In a talk on passive smoking, for example, you could give your audience a couple of minutes to tell their neighbours how they are affected by other people’s smoke.
You can also keep people involved with eye contact. Make sure that you look round at everybody, not just the people immediately in front of you.
Vary Your Learning Methods
It is natural to consider health educating from the health educator’s point of view but it may be more helpful to look at it from the learner’s point of view. For example, talking for half an hour demands concentrated effort and total involvement on your part; but all your audience is doing is listening, which involves only one of their senses and is highly unlikely to hold their full attention.
Variety can be brought into health teaching in many ways, including strategies that can be used with individuals, groups, large audiences, children or adults; see Table 12.1 for ideas.
| For discussion of some of these methods, see Chapters 13 and 14; for discussion on the use of audiovisual aids, see Chapter 11. | |
| CLIENT INVOLVEMENT | MATERIALS AND METHODS |
|---|---|
| Listen | Lectures, audiotapes |
| Read | Books, booklets, leaflets, handouts, posters, whiteboard, flip-chart, PowerPoint slides |
| Look | Photographs, drawings, paintings, posters, charts, material from media (such as advertisements) |
| Look and listen | DVDs, PowerPoint, demonstrations |
| Listen and talk | Question-and-answer sessions, discussions, informal conversations, debates, brainstorming |
| Read, listen and talk | Case studies, discussions based on study questions or handouts |
| Read, listen, talk and actively participate | Drama, role-play, games, simulations, quizzes, practising skills |
| Read and actively participate | Programmed learning, computer-assisted learning |
| Make and use | Models, charts, drawings |
| Use | Equipment |
| Action research | Gathering information, opinions, interviews and surveys |
| Projects | Making health education materials – DVDs, leaflets, etc. |
| Visits | To health service premises, fire station, sewage works, playgroups, voluntary organisations |
| Write | Articles, letters to the press, stories, poems |
Devise Health Education Activities
Listening is passive; activities are the means by which you help learners to think through what is being said and act on it, in their own way. It is not sufficient to ask a group ‘What do you think?’ at the end of a talk or after viewing a DVD; planned activities are necessary to help people to explore and apply ideas, feelings, attitudes and behaviour. It is more effective to have a mix of activities that are specifically tailored for a particular group of learners, so where possible develop the skill of devising your own activities rather than relying on learning aids made for general audiences. There is an almost infinite range of possibilities. Some of the more common types of activity are set out in Table 12.2. There are also ideas in some of the exercises used throughout this book.
| TYPE OF ACTIVITY | EXAMPLE |
|---|---|
| Guidelines for discussions with particular people about particular topics | Guidelines on ‘what to do if you think your child is offered drugs’ for discussion at a parent–teacher meeting |
| Analysing and discussing diary records | Ask people to keep a diary or write down what they ate or the alcohol units they consumed in the last 24 hours. Ask them to talk about what they are pleased about and not pleased about |
| Sentence completion | Ask people to complete a sentence such as ‘I feel really stressed when …’ |
| Using checklists | Have a list of ‘ways to make small changes to my lifestyle’ such as taking the stairs and not the lift, walking (or cycling to work), joining an exercise class, and discuss how many you use |
| Identifying your own thoughts/feelings/behaviour in particular situations | Ask people to think about and discuss what they feel when visitors to their home ask if they can smoke, and how they respond |
| Generate lists | Ask a group to make a list of all the ways they could deal with an obese client who will not comply with advice on healthy eating |
| Answer sheets | A quiz with yes/no or multiple answers on ‘How much do you know about sensible drinking?’ |
| Drawing charts or bubble diagrams | Draw a stick-person picture of yourself in a supermarket in the middle of a page. Draw bubble thoughts about all the things that influence what food you buy |
| Writing instructions | Ask a group learning about food hygiene to write down instructions for someone else on how to store food safely in a fridge |
| Practical skills development | Practise bathing a baby using a doll or a real baby. |
Ensure Relevance
You should ensure that, as far as possible, what you say is relevant to the needs, interests and circumstances of the clients. For example, recommendations about health-promoting activities that cost money may not be useful to an audience which has no money for extras. A discussion on childhood vaccination may be irrelevant to a pregnant woman whose overwhelming concern is the birth itself; she may not relate to an issue that will not meet her immediate needs.
You will help your clients to see the relevance of your subject if you use concrete examples, practical problems and case studies to explain and illustrate your points. It may be more difficult for your clients to relate to abstract generalisations, quotations of statistics or epidemiological evidence. For example say ‘one person in ten’ instead of ‘X million people in this country’, tell the story of a home accident rather than describe a list of risk factors, and describe ‘increasing the risk’ by saying ‘It’s like driving a car with faulty brakes, there’s no guarantee that you will have an accident, but your chances of having one are greater’.
Identify Realistic Goals and Objectives
In Chapter 5 there was a discussion on the importance of clearly identifying health promotion aims and objectives, but it is worth emphasising again that it is essential to be clear about what you are trying to do (raise awareness of a health issue? give people more health knowledge?) and what you want your clients to know, feel and/or do at the end of your session. As mentioned above, your clients should be involved in these decisions.
See Chapter 5, section on setting aims and objectives.
Three or four key points are all that clients can be expected to assimilate from a session. Including more than that does not mean that they learn more; it usually means that they forget more. For example, if you are asked to give a talk on a huge theme, such as food for health, avoiding accidents, first aid or pollution, you will need to select what you feel to be the few points most relevant for your audience, and avoid the temptation to include everything.
Use Learning Contracts
In some educational settings the learner is told what objectives or targets to work towards. This can conflict with some people’s psychological need to be self-directing and may induce resistance, apathy or withdrawal. Learning contracts are an agreement, decided together, about what is to be learnt. By participating in the process of diagnosing needs, formulating goals, choosing methods and evaluating progress, learners can develop a sense of ownership of the plan, and feel more committed and empowered.
The stages of developing a learning contract are described below.
Step 1: Diagnose health learning needs with the learners
First, decide the competencies required to carry out actions, behaviour or roles. A competency can be thought of as the ability to do something, and it is a combination of knowledge, understanding, skills, attitudes and values.
For instance, the ability to ride a bicycle from home to school involves knowledge of how a bicycle works and of the route from home to the school; understanding of the risks inherent in riding a bicycle; skills in mounting, pedalling, steering and stopping. It is useful to analyse competencies in this way, even if it is crude and subjective, because it gives the learners a clearer sense of direction.
Next, assess the gap between where learners are now and where they should be in regard to each health-related competency. Learners may wish to draw on the observations of friends, family or experts to make this assessment. Each learner will then have an idea of the competencies needed and a map of their health learning needs.
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