Designing Effective Health Education Programs

1
Designing Effective Health Education Programs

• Extension Health Institute
• November 7 and 8, 2002
• Presenter
• Dr. Bobbi Clarke, Professor, Extension Health
  Specialist, and Co-Director for The University of
  Tennessee Center for
• Community-based Health Initiatives

2
Why You Are Here? Participant Outcomes

• 1. Describe the complex interacting
  factors that influence health.
• 2. Utilize behavior change models in planning,
  implementing and evaluating health programs.
• 3. Develop an evaluation plan.

3

• When you hear the term health education what
  comes to mind?

4
Definition of Health Education

• Any combination of learning experiences designed
  to facilitate voluntary adoptions of behaviors
  conducive to health.
• Educate, motivate, refer, follow-up
• Complex health care system
• Targets knowledge, attitudes, behaviors

5
What is the ultimate goal of health education?
6
Ultimate Goal of Health Education?

• Enable people to increase control over their
  health and quality of life.
• Empowerment Empowered learners feel competent
  and confident about making health decisions that
  are right for them. (Extension goal)

7
Health Education Produces Health Literacy

• Capacity of individuals to obtain, interpret, and
  understand health information and services.
  (Extension Impart Knowledge)
• Competence to use such information and services
  in ways which enhance/maintain health of self and
  family members. (Extension Develop Decision
  Making Skills)

8
Health Literate Person Is One Who

• Can think things through and make health choices
  in solving his/her own problems as well as family
  member problems.
• Is responsible and makes health choices that
  benefit his/herself and family members.
• Is in charge of his/her own health learning and
  teaches family members to do the same.
• Can use communication skills to express needs,
  questions, and concerns to health care providers
  and staff.

9
How Can Extension Develop Health Literate
Clientele?

• Develop knowledge and skills related to
• Concepts related to healthy lifestyles, self-care
  and disease prevention/management
• Accessing health information and health-promoting
  products and services
• Analyzing the influence of media, technology, and
  other factors on health
• Using interpersonal skills to enhance or maintain
  health

10
How Can Extension Develop Health Literate
Clientele? (cont.)

• Develop knowledge and skills related to
• Using self-assessment, goal-setting and decision
  making skills to maintain and/or enhance health
• Advocating for personal, family, and/or community
  health
• Engaging in health enhancing behaviors
• Engaging in risk reduction behaviors

11
Extensions Goal?

• Develop Savvy Health Care Consumers (Health
  Literate Consumers) through
• Health Inservice training of county Extension
  educators and volunteers---Health Literate
  Professionals (multi state, Health Institute,
  National Extension Priester ConferenceApril
  22-24) on health topics, health literacy, and
  cultural health literacy
• Health education programs
• Media (radio, TV, exhibits, newspaper
• Publications
• Internet information information, interactive
  programs, linking to credible information
• Community partnerships

12
Is there a difference between health education
and health promotion?

• Health education learner directed
• Health promotion broader concept directed
  toward advocating health
• Individual and community education
• Environmental change
• Policy changes
• Economic changes
• Shifts in societal norms

13
Source for Professional Updating/Credible
Information

• UT Extension Health Program Web Site is a source
  designed for Extension educators
• http//www.utextension.utk.edu/health

14
Key Point The learners actions take place in a
systemthe world they live in---with elements
that are controllable and uncontrollable.
15
Value of Behavior Theory Models?

• Try to explain why people do what they do.
• Provide a framework for how the trainer can best
  design a program for learner success and trainer
  accountability.

16
Individual Change Models

• People learn through their own experiences
• Health Belief Model
• Stages of Change Model
• Consumer Information Processing Model

17
Health Belief Model (Table 1, p. 3)

• Explains noncompliance to health
  recommendations---why people dont act on health
  recommendations.
• Dont understand the seriousness of disease
• Dont feel susceptible to disease
• Dont see benefits/Do see barriers to action
• Need a cue to action

18
Compliance Occurs If

• Person is motivated by
• Individual perceptions factors that affect their
  perception of the illness/problem
• Perceived susceptibility
• Perceived seriousness
• Modifying factors
• demographic variables (ethnicity, culture, age,
  gender, education, income, etc.
• Perceived threat of the health problem
• Cue to action media, friends, relative
• Compilation of these factors leads to cue to
  action
• Likelihood of action perceived benefits (less
  pain) minus the perceived barriers (time, cost)

19
Health Belief Model

• Impact to Trainer Readiness to act by
  self-selecting educational program
• Design programs that affect the learners
  perceptions
• People perceive the seriousness of health problem
• But dont perceive themselves as susceptible
• Competing with advertising and media that
  promotes negative perceptions (easy fast weight
  loss)
• Self-assessment tools (level of risk) and action
  plans, group process (sharing experiences)
  problem-solving

20
Action Plan/S.M.A.R.T. Plan

• Specific state concrete goal(s)
• Measurable tell when achieved goal
• Agreed Upon state what you will do and who will
  help you
• Rewarding Reward for achieving goal(s)
• Trackable Keep track of progress

21
Stages of Change Model(Transtheoretical/Prochaska
s Model--Table 2, p. 3 )

• Self-changers follow 6 stages
• Precontemplation
• Contemplation
• Preparation
• Action
• Maintenance
• Termination

22
Six Stages of Change

• 1. Precontemplation not even thinking about
  changing
• 2. Contemplation thinking about changing (weight
  lossfrustration with clothes, arthritis)/New
  Years resolutions fall here!
• 3. Preparation getting ready/planning to do it
  (weight loss---developing a plan/, telling
  others)
• 4. Action making a change (steps to control
  behavior, avoid barriers, reset realistic goals,
  plan for relapse)
• 5. Maintenance maintaining the change,
  developing strategies to prevent relapse,
  behavior rewarding, behaviors now automatic
  (weight loss has occurred)
• 6. Termination establish change as part of
  lifestylehabit formation, new self-image, not
  temptation, solid self-efficacy, healthier
  lifestyle

23
Impact on Trainer

• Self-changers follow these 6 stages
• Not linear but spiral---lots of
  recycling/slipping
• Problem learners in a program are at different
  levels/causes negative learner outcomes
• Trainer tools
• Individualize the learning through
  self-assessment and action plans
• Act for learner expectations and tailor learning
  to match expectations
• Learner needs time to practice
• Design time for learner sharing/interaction with
  experiences
• Multi-sessions which build on previous session
• Design evaluation for success

24
Consumer Information Processing (Table 3, p. 7)

• People can handle a limited amount of information
  at one time
• Process of gaining and using information
• Information must be user-friendly---easy to use
• Impact to trainer issues addressed in the
  design of the training program
• Focus information on most relevant
• Design information tailored to the audience
• Place in convenient siteschannels
• People not empty vessels---exposed to information
• Pilot testing program (formative evaluation)
  attractive, interesting, understandable, relevant

25
Interpersonal Level Models(Table 4, p. 10)

• Social Learning Theory Very complex
• People dont learn in a vacuum
• People learn by observing actions of others and
  results of those actions
• Multi-dimensional learning self (personal
  factors and behavior as a result of these
  factors), and the environment
• Self-efficacy empowerment, build competency and
  confidence
• Impact on Trainer
• Lots of interactive activities between learners
  and trainer (case studies, scenarios, sharing of
  experiences, group problem solving)
• Multi-sessions for reinforcement, support groups

26
Community Level Models(Table 7)

• Use with comprehensive health promotion efforts
  to solve a health problem or reach underserved
  populations
• Initiatives planned and led by organizations
• Diffusion of Innovation Theory share with
  society new research findings, ideas or health
  recommendations
• Community Organization Theory solve problems
  through community---such as coalitions

27
Four Factors Surface Among These Models

• Perceptions of expected benefits
• Perceptions of expected costs/barriers
• Community-level effect collective
  impact---people will do it if others are
• Self-efficacy confidence in the ability to take
  action
• Impact to trainer These forces guide the
  learners ability to change behavior

28
So What! Include These Four Factors in Your
Programs

• Knowledge facts, controversies, problems
• Self-efficacy develop competency and confidence
• Skills practice skills to successfully
• use them away from the learning environment
• Environmental support/influence support use of
  skills in daily living

29
How?

• Needs assessments
• Diagnosing educational delivery problems/barriers
• Shaping the design of the intervention
• Shaping the design of the evaluation

30
Characteristics of the Adult Learner (Andragogy)

• As a person matures
• His/her self-concept moves from dependency to
  self-directing
• Accumulates a growing reservoir of experience,
  which is a rich resource for learning
• Change in time perspective from future
  application of knowledge to immediacy of
  application---more problem-centered than
  subject-centered in learning
• Motivated to learn by internal factors rather
  than external ones

31
Health Education Program Planning Models

• Used for designing, implementing and evaluating
  health education programs.
• Two models
• 1. Social Marketing Model
• 2. PRECEDE-PROCEED Model

32
Social Marketing Model

• Uses principles of segmentation of target
  audience
• Four Ps of marketing
• Right Product (health message) backed by the
  right Promotion (appeal) and put in the right
  Place (go where audience ischannels) at the
  right Price (tangible and non-tangible costs)
• Examples
• Food Advertisements
• Medications Advertisements Over-the-Counter and
  Prescribed

33
Used in Health Promotion Campaigns

• Effective in producing knowledge change and
  short-term behavior change new medication for
  arthritis pain and get the flu shot
• Not effective in long-term or major behavior
  change diet, exercise, smoking, alcohol
  consumption

34
Social Marketing Uses Mediaand Follows 7 Steps

• Segmenting target audience
• Marketing mix 4 Ps
• Selecting channels and materials
• Developing program
• Pretesting
• Implementation and Refinement
• Monitoring and Evaluation

35
Health Program Plan

• Establish planning group
• Assess need
• Identify problem
• State goals and objectives trainer/learner
• Create intervention
• Identify methods
• Develop evaluation plan
• Implement plan
• Evaluate program

36
What is a goal?

• Broad statement of expectations
• Short-term measurable, achievable
• Example Provide influenza vaccine in November
  and December of 2001 to protect the community
  against influenza
• Long-term idealistic, timeless
• Examples Improve health status, reduce breast
  cancer, increase influenza rates

37
What is an objective?

• Map out what learner and trainer need to do to
  achieve goal how it will be done
• Address specific knowledge, attitudes and
  behaviors
• Must be Specific, Measurable, assigned to
  specific target Audience, Realistic and reflect a
  specific Timeframe (SMART)
• Clear objectives map out the evaluation How
  will I know they can do this (or I got there?)

38
How to make objectives measurable?

• Action verbs discuss, identify, list, state,
  write, demonstrate
• Vague verbs believe, understand, comprehend, be
  familiar with, acknowledge

39
Using the SMART Rule

• Upon completion of this session, the participant
  will be able to acknowledge eight sources of
  calcium in her diet.
• (Specific, Measurable, Audience, Realistic,
  Timeframe)

40
Apply the SMART Rule

• Specific? ---addresses knowledge of calcium
  sources
• Measurable? ---acknowledge eight calcium sources
• Acknowledge is long word, consider using list,
  state, write down
• Audience? ---assigned to participant
• Realistic? ---eight sources may not be realistic,
  consider 2 or 3 sources
• Timeframe? ---upon completion of this session

41
Measurable Objectives?

• Upon completion of this session, the learner will
  
• be able to
• Believe that influenza is a serious disease
• Understand what influenza is
• Be familiar with who is at risk for getting the
  flu
• Acknowledge the importance of getting the flu
  shot

42
Classification of Educational Objectives

• Knowledge easiest to measure
• Comprehension
• Application
• Analysis
• Synthesis
• Evaluation most difficult to measure