FOUNDATIONS OF HEALTH EDUCATION

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FOUNDATIONS OF HEALTH EDUCATION

• By Bonni C. Hodges
• Professor of Health
• SUNY College at Cortland

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Introduction

• Goals of Health Education
• Health Education Philosophies
• Relationship between Philosophies Health
  Instruction
• Theoretical Foundation for Behavior Change

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Lets begin by asking

• What is a goal?
• Anyway.

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Goal Statements

• Goal a broad statement of direction, used to
  present the overall intent of the program
• provides overall direction
• is general in nature
• is often not measurable (vs. an objective which
  has measurable criteria)
• Sample objective Upon completion of this
  session, the student will be able to describe one
  goal of health education.

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National Health Goals

• Healthy People 2010
• Increase Quality and Years of Healthy Life
• To help individuals of all ages increase life
  expectancy improve their quality of life
• Eliminate Health Disparities
• To eliminate health disparities among different
  segments of the population
• Sets the stage for the national health agenda

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Health-Related Goals for School-Aged Youth CDC 6

• Categories of risk behaviors
• Six risky behavior categories that put our young
  people at-risk for illness, injury, death or lack
  of success (academic or other)
• Linked to the Healthy People movement
• Based on state and national data

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The 6 behavior categories are

• Unintentional and Intentional Injuries
• Tobacco Use
• Alcohol and Other Drug Use
• Sexual Behaviors that Result in HIV, STDs,
  Unintended Pregnancy
• Dietary Patterns that Contribute to Disease
• Insufficient Physical Activity

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Goals the Standards Movement

• National Standards in Health Education
• 1995 National Health Education Standards
  Achieving Health Literacy
• 2006 National Health Education Standards

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National Standards/Outcomes Goals

• National Health Education Standards
• improved educational achievement for students and
  improved health in the U.S.
• help young people become health literate
• being a critical thinker problem solver
• a responsible, productive citizen
• a self-directed learner
• an effective communicator

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Summary

• Healthy People 2010, CDC6, and much of National
  Health Education standards illustrate major goal
  of HE for all ages is health-enhancing behavior
• Creation of health literacy supports behavior and
  skills needed to successfully support, choose and
  engage in health-enhancing practices
• self and others

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Lets take a look at

• Health Education Philosophy

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HE Philosophy

• Given Goal of HE is promotion and maintenance of
  health-enhancing behaviors to create healthy
  individuals and communities
• Need to figure out, philosophically, what your
  role as a classroom teacher is in supporting the
  goal of HE

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What is the difference between a goal of HE and
a philosophy?

• Goal result, outcome, long(er) term
• Philosophy how to get to the result

One way to think about it
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4 Approaches to Consider

• Cognitive Based
• Decision Making
• Behavior Change
• Social Change

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Cognitive Based

• Just the facts, Maam!
• Get individuals to know more about health, risk
  factors, etc.
• Content focused
• Large amounts of stuff in a relatively short
  amount of time
• Evaluate knowledge levels
• A starting point for many

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Cognitive with a Twist-Gold (w/Kelly) 1988

• Knowledge plus
• Not facts per se but ability to understand and to
  use them
• Critical thinking
• Self-correcting and dynamic
• Information, knowledge, understanding are not
  synonymous

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Making Decisions

• Teach skills to allow individuals to make
  health-enhancing choices e.g.
• Decision-making
• Problem-solving
• Focus on the performance of the skills rather
  than the decision itself--the process rather than
  the product
• Evaluate performance of skills

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DM- Kolbe, Iverson, Kreuter, Hochbaum,
Christensen (1981)

• Effectiveness of HE activities determined by
  process of making decisions (phase 1)
• For those inclined to change behavior
  effectiveness (phase 2) determined by degree
  skills exhibited
• These two usually occur together

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Kolbe et al

• HE program will contribute to actually engaging
  in health-enhancing behaviors
• Basically setting students up for the potential
  to engage in health-enhancing behaviors
• Or to continue

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Behavior Change

• Focus on behavior modification
• Usually employs such strategies as behavior
  modification, contracting, goal setting
• Evaluate change in behavior
• Supported by Hochbaum

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Social Change (ORourke, Minkler)

• Macro level changes to foster health
• Politics, social norms, environment change
• Focuses on trying to change forces that
  contribute to health behaviors and status
• CSHP supports this approach
• Give students skills to do above

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Determining your philosophy

• Goal of HE is focused on behavior
• Parts/steps/strategies to promoting and
  maintaining behavior
• Deciding where to stop

Behavior
DM PS related skills
knowledge application
behavior- related skills
knowledge
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Challenges

• Some schools and/or districts may only allow
  teaching of health content knowledge
• Not enough time for full health curriculum
• Knowledge is safe
• View mission of school as knowledge dissemination
• Some schools, district, and/or communities may
  prevent discussions of, or fostering of
  particular behaviors, skills
• Your overall philosophy may not be appropriate
  for all grades
• Age appropriate skill development
• Level of control of determinants of own behavior

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To think about

• Philosophy and lessons need to be congruent
• If your philosophy is DM PS skills you cant
  just teach facts
• Should assess your intended outcome
• If your philosophy is behavior-related skills you
  must assess achievement of these skills not just
  knowledge or DM
• Philosophy for your classroom MAY be different
  from that of CSHP
• CSHP designed to support behavior and skill
  development

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Theoretical Foundation for Behavior Change

• The Basics

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Why Bother Looking at Theories and Models?

• Roadmap
• Support for strategies and activities
• Credibility
• Success

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Exploring

• Precede-Proceed
• Social Cognitive Theory
• Self-Efficacy
• Health Belief Model

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Precede-Proceed

• Planning and Assessment Model
• Green and Kreuter (2005)
• Widely Used
• School health education focus on 3 categories of
  determinants of the ecosystem
• In ideal situation have local NA information
  about 3 areas

http//www.lgreen.net/precede.htm
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Predisposing

• in ones head
• Perceptions, attitudes, values, knowledge,
  beliefs, self-efficacy
• Find out what these are for students
• Own data
• General info
• Develop lessons to address problematic areas

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Predisposing Example-Nutrition

• You find out that typical students at your grade
  level believe that skim or 1 milk is not as
  healthy as whole and would taste bad
• Need to develop a strategy to address the beliefs
• Nutrition label comparison
• Milk fat display
• Low fat milk challenge

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Reinforcing

• Internal or external factors
• Rewards and feedback received from others
  following adoption of a behavior
• May encourage or discourage
• Internal too e.g. pain, pleasure
• External-generally considered to be attitudes,
  behaviors, support-levels of persons or
  institutions influential to our population in
  interest e.g. family members, teachers,
  employers, church also media messages

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Reinforcing Example-Nutrition

• Fast food advertisements
• looks good
• Healthy claims
• promotions
• Need to develop awareness of advertising
  techniques
• Knowledge of advertising purpose and use of
  tricks
• Analysis of fast food ads advertisements
• Use of techniques to create ad for health choices

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Enabling

• Availability, accessibility, policy/regulation
  enforcement/existence, skills
• Skills, resources, barriers that can help or
  hinder desired behavior as well as environmental
  change
• Created mainly by social forces or systems
• Includes facilities and community resources
  existence and enforcement of laws, policies,
  statutes skills required for a desired behavior
  to happen

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Enabling Example-Nutrition

• School cafeteria only serves whole milk and has
  ice cream available every day.
• Need to decrease accessibility and availability
• Work to include/change to low fat and skim milk
• Work to decrease ice cream availability to one
  day
• Have students develop milk/ice cream policy
  suggestion that would improve ability to make
  healthy choices

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Social Cognitive Theory

• Albert Bandura
• Big concepts, will focus on a few
• Reciprocal Determinism
• Behavioral Capability
• Self-Efficacy

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Reciprocal Determinism

• Underlying concept

Person
Environment
Behavior
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Reciprocal Determinism

• We learn through our own experiences AND through
  observing others and the results of their actions
• Reminds us of the importance of environment in
  shaping behavior
• Reminds us of the importance of peoples
  behaviors in shaping the environment
• CSHP
• Cafeteria
• All components supporting same message

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Behavioral Capability

• Concept Need both knowledge and skills to adopt
  or change behavior
• Use knowledge building strategies appropriate for
  participants characteristics
• About the recommended behavior
• AND teach skills necessary to adopt, change,
  and/or maintain behavior
• Appropriate to participants
• Being able to list ways to manage stress needs to
  be accompanied by practicing some strategies
• Will increase chances to using stress management
  when needed

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Self-Efficacy

• Belief or confidence in ones own ability to
  perform and maintain a specific behavior
• Considered the most important person
  characteristic
• Those with higher self-efficacy more likely to
  have motivation to adopt a behavior when
  confronted with barriers and to maintain it over
  time

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Self-Efficacy Program Planning

• Bandura (1977) discussed ways to increase
  self-efficacy that have been supported in
  subsequent research
• Hierarchical
• Provide strong foundation for program and
  curricular planning activities

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Building Self-Efficacy

• Teach people to control negative emotional
  responses to performing the new behavior
• Stress management
• Emotional coping responses
• Provide verbal persuasion, encouragement, and
  reinforcement to engage in and maintain the
  behavior
• cheerleading

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Building Self-Efficacy

• Provide modeling of the behavior
• Through live or other means
• Observational learning
• Role Models
• Direct experience with the behavior
• Opportunities to practice in a way that provides
  positive reinforcement and success
• May be broken down into parts

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Improving Self-Efficacy

• creating vicarious experiences
• video
• role modeling
• peer education
• using agents of change for verbal persuasion
• stress management and fear/anxiety reduction
• role plays

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Self-Efficacy Example-Tooth Brushing

• Principal comes in and tells class that they can
  all be great tooth brushers
• Students watch DVD/video that includes
  cheerleading for brushing teeth appropriate
  times and length of time. Also includes
  demonstration
• Teacher demonstrates
• Hand out new tooth brushes and everyone practices
• Teacher provides direction and positive
  reinforcement
• Tooth brushing practice occurs for several days

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Self-Efficacy Building-You Try

• Building confidence in properly putting on a
  walking away from a bully/potential fight
• Stress management/fear reduction
• Persuasion activity
• Vicarious experience activity
• Direct Experience activity

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Self Efficacy Planning-Suggestions

• Stress management/fear reduction
• Refer to, and have booster practice of stress
  management technique practiced before
• Deep breathing
• Persuasion activity
• Older peers communicate that walking away is
  easier than they think and the cool thing to do
• Vicarious experience activity
• Older peers role play
• Direct Experience activity
• Students practice in role play
• Playground monitors have reinforce students who
  walk away from potential fights

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Health Belief Model

• The big picture its all about perceptions
• Perceptions about personal risk for experiencing
  a health problem
• Perceptions about how large a negative effect a
  health problem will have on ones health and
  quality of life
• Perceptions of the benefits of and barriers to
  engaging in the recommended health-enhancing
  action
• Self-efficacy (again!)

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Health Belief Model-In Elementary HE

• Elementary level HE is the foundation of the
  creation and maintenance of appropriate
  perceptions
• Acquisition and understanding of appropriate
  concepts
• Finding and evaluating sources of information
• By upper elementary moving toward using and
  adding to the foundation to address perceived
  benefits and barriers of maintaining and/or
  adopting health-enhancing behaviors
• Decision-making
• Problem solving
• Creating self-efficacy for health-enhancing
  behaviors

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Looking a little closer

• Perceived benefits
• Whats in it for me?
• Make sure rewards of the healthy behavior
  relate to student developmental level
• Physical, social, relational, familial
• Need to discover what their perceptions are
  first-dont assume, you are likely to be
  surprised
• Want them to know and to perceive all the actual
  benefits
• Some teachers stack the deck

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Looking a little closer

• Perceived barriers
• What gets in the way of performing the
  recommended health enhancing behavior?
• Need to discover what their perceptions are
  first-dont assume, you are likely to be
  surprised
• Work on identification of real vs. perceive
  barriers
• Some barriers may not be able to be removed
• Strategies to address or work around

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Strategies

• Lower grades
• Ask students what they think
• Record in some manner
• Have teacher-led discussion for clarification
• Teacher-led weighing of benefits and barriers
• Upper grades
• Ask students what they think
• Record in some manner
• Class discussion
• Student research
• Real benefits
• Removal of barriers

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Strategies-General

• Writing letters
• Pointing out benefits
• Suggestions for removing barriers
• Art-Posters
• Decision-making trees

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Concluding Thoughts
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Why do I need this information?

• Value of knowing the goals of health education
• Value of philosophies to health education
• Value of understanding key concepts in behavioral
  theories and models