I need a detailed summary of this text. thank you 🙂
HEALTH EDUCATION
Health education provides the decision-making
foundations needed to become and stay healthy.
Defined as “learning opportunities or educational
interventions designed to help individuals or recipients have the ability and resources to start
and maintain the desired behavior change on
their own
In contrast,
the interpersonal
approach
focuses on groups as the targets of change.
This has been referred to as a “people help-
ing people” approach to health education in
which small group strategies between families,
neighbors, peers or work groups try to achieve
behavioral change. A health education pro-
gram that focuses on the group as the target of
change is based on the belief that interpersonal
interactions and characteristics are the forces
that initiate and reinforce behavioral change in
group members. Group dynamics are a factor in
the effectiveness of these educational programs.’
An example of this type of program is a chemi-
cal dependency support group in which group
members give each other reinforcement
A community approach to health educatica
focuses on the impact of economy, polities. a
other factors within the community on betavig
Health education efforts that include decising,
makers in regulatory or legislative bodies illustrade
this level of focus. Community-focused educatin
programs take advantage of community strengel
to manage problems that cannot be effectively
addressed by the individual or small group
Community organizing and social marketing are
examples of change strategies at the communit
level of focus. Table 9-1 further describes these
levels of focus and gives examples.
HEALTH BEHAVIOR THEORIES
Theories from sociology, education, and psychol
ogy that describe learning and behavioral change
can help oral health educators in designing and developing eduentional efforts. Some basic theor.
hey and principles are presented here
Theories with intrapersonal Focus
HEALTH BELIEF MODEL
The Health Belief Model is useful in predict-
my the hikelihood of an individual’s compliance
will professional recommendations for preven-
me health behaviors. Based on experiences with
pable participation in a screening program for
rubergnlosis, this model was first introduced in
the 1950s by I,M. Rosenstock” and other psy-
chologists working with the U.S. Public Health
do semice. It remains a major construct that is still
ennonlted for understanding behaviors.
This model is based on the theory that behav-
iors are directed by perceptions and beliefs, It
suggests that whether or not a person engages in
preventive health actions depends on these beliefs.
In short, it provides an outline of the essential fac-
tors involved in behavioral change. The belief
components of this model are as follows:
Susceptibility: The individual must believe
that they are susceptible to a given disease or
condition.
Severity: The individual must believe that the
disease will have an impact of at least moder.
ate severity, or seriousness, on their life.
Beneficial: The individual must believe that
there are effective actions that can be taken
to reduce the risk of, or control, the disease. Benefits outweigh barriers to action: The indi-
vidual must believe that the benefits of taking
the recommended action exceed any difficul-
ties they might encounter,”
The stronger these beliefs are, the higher the
probability that an appropriate health action will
be taken. If oral diseases are not perceived as a
serious health threat, it is unlikely that a person
will participate in daily preventive dental behav-
iors, proceed with professional interventions, or
accept professional recommendations.
Cues to action that activate readiness to change
and stimulate overt behavior change are a con-
cept that has been added since the model was
first described. The concept of self-efficacy, or
confidence in one’s ability to successfully perform
an action, was added by Rosenstock and others in
1988. It helps this model better fit the challenges
of changing unhealthy habitual behaviors, such as
overeating, smoking, or sedentary lifestyles. 15
Observations and questioning during assess-
ment give clues to a person’s existing health
beliefs. Other factors that play a role in modi-
fying beliefs and the potential for compliance
with health recommendations are patient demo-
graphics (age, gender, race, ethnicity), peer or
reference group influences, and prior knowledge
about health problems.
The Health Belief Model can be used to help
identify leverage points for changing behaviors
It can also be a useful tool when designing
change strategies. Developing persuasive health
messages that can guide individuals toward mak-
ing healthy decisions is one promising application.
STAGES OF CHANGE MODEL
The Stages of Change Model, introduced by
Prochaska and DiClemente in 1979, grew from
their work with smoking cessation and drug and
alcohol addiction. It has recently been applied to
a variety of other health behaviors. This theor
is concerned with an individual’s readiness to
adopt a behavioral change for a healthier life. It
views behavior change as a process rather than an
event, with people at varying levels of motivation,
or readiness to change.”
The primary concept of this theory is that
people cycle through different stages of readi-
ness and that an individual can be in any stage
at any given point in time. This is a circular,
not a linear model. People can enter or exit the
circular cycle at any point and may often recycle
through the stages. The oral health educator can
use this theory to assess the individual’s readi-
ness to make a change and match health educa-
tion efforts accordingly. The major stages of this
model and their explanations are as follows:
Precontemplation: unaware of the health
problem, without any thought of need for
change
Contemplation: aware of a problem and think-
ing about the possibility of making change Preparation: making a plan for change
Action: practicing the behavior
Maintenance:
continuing desired
health
action
Relapse: resumption of old behaviors.1
Observing the patient and listening carefully
to responses given to the questions asked during
assessment can provide clues about a patient’s
stage of readiness. Educational efforts that match
a person’s readiness stage are more likely to
result in behavioral change. A major concept in
this model is that a person can move through
the stages over time. The person who isn’t ready
to adopt a new behavior this week may be at a
different stage, and ready to make a change, the
next time you see them.
CONSUMER INFORMATION PROCESSING MODEL
The Consumer Information
Processing Model, which evolved out of the study of human problem solving and information processing,
addresses the ways consumers take in and use
information in their decision making. It makes two Key assumptions.1-people are limited in
how much information can acquire, use, and remember, 2-people combine bits of information into useable summaries and create decision rules to make Faster and easier choices
James R. Bettman, a marketing theorist
developed one of the best known models of con-
sumer information processing. In it, he describes
a cyclical process of information search, choice
use and learning, and feedhack for future deci-
sions.” The model has been extended to address
the information environment and the
way it affects how people obtain, process, and use information . The application for health education is
that, before people will use health information, it
must be available, user-friendly, and thought of
as useful and new.
A major concept in this model is that oral
health educators must evaluate the information
environment and ensure that the target audi
ence finds the information materials convenient,
attractive and easy-to-use. Theories with Interpersonal Focus
SOCIAL LEARNING THEORY
The Social Learning Theory assumes that
people and their environments are continuously
interacting. Its basic premise is that people learn
through their own experiences and by observ-
ing the actions of others.” The dominant ver-
sion of Social Learning Theory, named Social
Cognitive Theory, was developed by Albert
Bandura in the 1970s.’ It proposes that behav-
iors are learned in social contexts through direct
or vicarious experiences, and through obser-
vations of others’ behaviors and their results.
Reactions to a behavior provide reinforcements,
negative or positive, that can perpetuate or ter-
minate a behavioral change.
In this theory, self-efficacy (confidence in
one’s ability to successfully perform and persist
in an action) is the most important factor deter-
mining one’s effort to change behavior. Greater
self-efficacy promotes higher motivation to over-
come obstacles, and increases the chances that a
behavior will persist over time in the absence of
formal supervision.
Modeling and behavior reinforcement are
two more concepts in this theory. Modeling is a
type of observational learning. It allows people
to observe others and see the good or bad
consequences of an action. Modeling is most
effective when the person being observed is
powerful, is respected, or shares common char-
acteristics with the observer. Reinforcement is
a response to a behavior that affects the chances
of its being repeated. Positive reinforcements
increase the chances that a behavior will be
repeated. Tangible rewards, as well as praise
and encouragement for self-reward, encour-
age people to establish positive health habits.
Extrinsic rewards are often useful motivators
for persisting in a behavior, but they do not sus-
tain long-term changes. Use these with caution
to avoid developing dependence on the reward
to stimulate the behavior. Punishments and the
absence of a response are examples of negative
reinforcements. Theories with Community Focus
COMMUNITY ORGANIZATION THEORY
Identifying common problems, developing and
implementing methods for reaching goals that
have been collectively set, and activating resources
are the constructs upon which the Community
Organization Theory is built,”? it
emphasizes active participation and the develop
ment of communities to evaluate and solve health
and social problems. In contrast to professionally
designed and implemented activities, this is a pro-
cess of self-led improvement within the group.
The community (or group) is the medium for
change. In this theory, group members
participate in, and have ownership of, the
change process
believe that they have control over their lives
and the lives of those in their group (empow
erment)
assume responsibility for, and take leadership
roles in, change
effectively collaborate to identify problems,
achieve consensus on goals and priorities, and
implement actions. DIFFUSION OF INNOVATIONS THEORY
Before new ideas, behaviors, products, or services
become part of society, they must be communi-
cated, accepted, and adopted. The Diffusion of
Innovations Theory, introduced in Chapter 2,
describes how new ideas, social practices,
or
products spread through and between societies
helps us understand how this happens. The theory
was pioneered by Rogers in 1962 to describe the
acceptance of a hardier corn variety by Midwest
farmers in a depression-era rural society. It is
general enough to be useful in addressing many
contemporary public health challenges, such as
disseminating new early detection and treatment
methods, or new disease prevention ideas. It is
general enough to be helpful in increasing utiliza-
tion of beneficial programs. How well an innovation is received, or how
quickly it is accepted and adopted, is determined
by several factors. Involving the target population
in innovation development is critical. Their val-
ues, needs, experiences, and habits are important
considerations. This theory also suggests that it is
important to identify community opinion lead-
ers and to gain their support for nèw ideas and
experiences. When a community leader restates
information that has been provided through the
mass media, the chances that people will accept
a new idea or practice are increased. Another important aspect of this theory is
that it views communication as a two-way pro-
cess. Instead of one person or group persuad
ing a targeted population to accept or adopt an
idea, communication flows reciprocally in two
directions. When applying this theory, all for-
mal and informal communication channels and
social systems should be identified and used to
disseminate new knowledge. This theory will be
explored in Chapter 15 relating to scientific lit-
erature and innovations. Box 9-7 describes using
the Diffusion of Innovations Theory.
Not all community members will adopt or
even accept new ideas. For those that do, adop-
tion occurs at varying rates and within the catego-
ry descriptions shown in Table 9-2. Determining
where group members are on the adopter curve
helps health educators select the best interven-
tion strategies to use for individuals within a
particular category,?
Various factors increase acceptance and adop-
tion of a new idea, behavior, product, or ser.
vice innovation. The characteristics that improve
chances of adoption include
relative advantage (is it superior to a past
idea?)
compatibility (is it consistent with the adopt-
ers’ experiences and values?)
complexity (ease of use). trialability (can it be experimented with, or
tried on a limited basis?)
observability (the visibility of successful tan-
gible results) is
ORGANIZATIONAL CHANGE THEORY
The Organizational Change Theory is applied
to improve the problem-solving and renewal
processes of large organizations or entire com-
munities. Its premise is that organizations move
through stages, or a series of steps, as they ini
tiate and adopt changes.# By recognizing the
stages, strategies to promote change can be
developed to match various points in the process
of change. These four stages are as follows:
Defining the problem: recognize and analyze
problems; seek and evaluate solutions
Initiating action: formulate policies and direc-
tives; allocate resources
Implementing change: put the change into
action Institutionalizing change: the new policy of
change becomes integrated into the organiza-
tion.
For organizational change to be complete,
new policies must become entrenched within the
organization as new goals and values are inter-
nalized. SOCIAL MARKETING
Kotler and Andreasen discuss social marketing
techniques and describe ways to apply commer-
cial marketing principles to education program
development.? A marketing mix of the “four Pg”
summarizes the formula for marketing success:
product, place, promotion, and price. The for-
inula advocates promoting a product, making it
available at the right place, and at the right cost.
In health education, the product is an education-
al program that has been developed for the needs
and interests of the target population. Promotion
refers to the strategies used to make it familiar,
acceptable, and desirable. Place refers to the
logistics of accessing the program, its availability
and distribution. Price refers to the time, money,
or energy costs of participating in the program.
A social marketing strategy may include focus
groups, a marketing technique for understanding consumer behavior. This technique can be a
useful tool for collecting information on commun-
ity needs, attitudes, norms, and other issues. A
tocus group usually consists of 6 to 12 people with
similar backgrounds who meet for 1 to 2 hours for
guided discussion. A moderator leads the discus-
sion, asking a series of questions to stimulate the
group’s reactions to various issues. The session
may be audiotaped or videotaped for later review
and analysis. Generalizations can be inferred to
the larger group from which the focus group is
drawn. Information collected can be helpful in
developing new educational programs.
Campaigns against social behaviors or prac-
tices that are not conducive to health (such as
substance abuse, drinking and driving, or abusive
behaviors) are examples of programs grounded in
social marketing theory. Credible organizations
with a public image of integrity and account-
ability are successful social marketers.
PRECEDE-PROCEED MODEL
Green and Kreuter published the PRECEDE
PROCEED planning model for health education
and health promotion programs.?. It is use-
ful because it provides a format for identifying
factors related to health problems, behaviors,
and program implementation. PRECEDE refers to predisposing, reinforcing, and enabling constructs in ecosystem diagnosis and evaluation. This portion of
the model considers the behavioral factors that
are relevant to the emergence and occurrence d
a health problem.
Three categories of factors (predisposing
enabling, and reinforcing) make it passible to sort behaviors into segments for program plan-
ning. Predisposing factors provide the reason
behind, or motivation for, a behavior. They include knowledge, beliefs. Attitudes, values, cultural mores and folkways, and existing skills. Enabling factors include the personal skills and
available resources needed to perform a behav-
or. They enable, or make it possible for, actions
to occur. The extent to which their absence will
prevent an action from occurring is the key to
identifying enabling factors. Reinforcing fac-
tors provide incentives for repetition or persis-
tence of health behaviors once they have begun.
Praise, reassurance, symptom relief, and social
support are examples of reinforcing factors.
The ability to classify health behaviors in
terms of the factors that predispose their occur-
rence, give reinforcement for repetition, and
enable their expression is useful in program
planning. Once categorized, priorities must be
identified. Priority is assigned to factors on the
basis of their importance in effecting the desired
behavior, the degree to which the factor can be
changed, and the resources available to address
the causative factor(s). Priority factors provide
the basis for developing the objectives that direct
the future action of the program.
The PROCEED portion of this planning
model involves the administrative and policy
components of the planning model. It refers to the political, regulatory and organizational con-
struts affecting educational and environmental
development.
MOTIVATION AND LEARNING
Motivation, which can be explained as the will
to act, is an important factor in learning. Human
motivation theory offers several models for
understanding the internal and external forces
that can move an individual into action. Some
useful models are included here.
Maslow’s Hierarchy of Needs
Psychologist Abraham H. Maslow combined a
large body of research related to human motiv-
ation in his conceptualization of a hierarchical
arrangement of needs as motivating factors. His
work, first published in 1954, has become one of
the most popular and most cited theories of human
motivation. Oral health educators may find it help-
ful in identifying motivational factors that can be
targeted for facilitating behavioral changes.
Maslow’s Hierarchy of Needs suggests that
inner forces (needs) drive a person into action and
that some needs take precedence over others. It provides a framework for identifying, clas-
sitying, and assigning priorities to human needs
and values. In this concept, needs are classified
into a pyramid arrangement according to their
importance to the individual, and the importance
associated with their satisfaction. Based on their
power and strength, the most imperative needs
are positioned at the base of the pyramid and
the least imperative needs are at the top. The
relative importance of each level to the others in
the hierarchy is represented by its size within the
pyramid. According to Maslow’s theory, a person
can become concerned about higher level needs
only when lower level needs are met; once needs
for a level are satisfied, they are no longer moti-
vators. If a situation arises that causes deficits in
lower level needs, the drive to satisfy those needs
reverts to the predominant motivator. Figure 9-1
illustrates Maslow’ arrangement.
The hierarchical arrangement used by Maslow,
in ascending order, is as follows:
1. Physiologie Needs: These are basic survival
needs, and include oxygen, food, water, and
rest. This is the dominant and most power-
ful need level; these needs must be satisfied
before any others can become relevant. If not
reasonably satisfied, all other categories of
needs become irrelevant or are relegated to
low priority.
2. Security and Safety Needs: This level repre-
sents human requirements to be safe from
harm and for protection against physical or
psychological injury. It includes needs for
the stability of a well-organized environment
(shelter), economic self-sufficiency (job), pro-
tection, and freedom from fear and anxiety.
These needs are paramount in times of danger;
everything else loses importance. Examples
of threats to safety include: war, the loss of
parental protection, new tasks, strangers, and
illness.
3. Social Needs: These are love and social belong
ing needs (to love and belong). They include
needs for affectionate relationships and a
place within one’s culture, group or family;
they are expressed in a desire for face-to-face
contacts, intimacy, and a desire to overcome
feelings of alienation or aloneness.4-A
Esteem or Ego Needs: This level refers to feel.
ings of self-worth (competence, achievement
mastery, or independence) as well as to the
need for gaining the respect (status, esteem
of others.
Deprivation leads to feelings of
inferiority, helplessness, and discouragement,
fulfillment leads to feelings of capability and a
willingness to contribute to society.
5. Self-Actualization or Self-Realization: This
level represents the state of fully achieving
one’s potential, and the ability to control one’s
needs rather than being controlled by them. It
is achieved as needs to reach the top of one’s
chosen areas of interests are satisfied.2
Since Maslow’s work was first published,
materials and goods have become increasingly
available to many people while personal con-
cerns about their basic safety and survival have
decreased. Generations born after the 1950s
have been able to devote more and more energy
to esteem and self-fulfillment needs. To mirror
these changes in needs, the pyramid configura-
tion morphs. An inverted pyramid shape, emerges as greater emphasis isplaced on fulfillment of higher order needs,”
To apply Maslow’s Hierarchy of Needs, the
oral health educator identifies where oral health fits into this arrangement for each individual.
Certain people may value oral health because
they relate to their need for loving human rela-
tionships. For them, dental appearance may be
important in making friends, getting a job, dat-
ing, and sex appeal. For others, a desire for white
teeth may be tied in with a need for status within
one’s culture.
The main point is that identifying and target-
ing a person’s Or group operative needs, and
then addressing those needs in an educational
plan, may lead to behavioral changes.
The Learning Ladder also known aS the Decision-Making Continuum, is based on the
concept that people learn in a linear series of
sequential steps. It illustrates progress away
from ignorance toward acquisition of information
and on to the adoption of new behaviors,The
learning ladder steps, in sequence from lowest to highest: Unawareness
Awareness
Interest
Involvement
Action
Habit.
In this theory, the learner must move through
each step on the continuum to acquire and make
commitment to a new behavior. If a step is omit-
ted, long-term behavior change (habit) will not
occur. To apply the theory, the educator identi-
fies the learner’s entry level on the continuum
and develops a plan for movement up the steps
in sequence.
Assessing location on the Learning Ladder
Decision-Making Continuum helps educators
develop educational plans that address the learn-
er with messages designed specifically for their
particular stage of educational readiness.
Learning Styles
Not everyone learns in the same way. A learning
style is the way one processes information, feels
and behaves in learning situations; it describes how the person learns.” Understanding the way
someone learns helps coordinate teaching stra?.
egies with learning, styles. Ideally, health educ
ton programs will use educational strategies
that match the predominant learning style of the
target audience.
Certain people are self-learners who leam
best through solitary study methods, such as
reading. They like to be able to read instructions
texts, or other written information to increasé
their understanding. Many of these learners
prefer to work on their own. Others may lear
better in group learning situations. They benefit
from group activities and from being paired with
another person when possible. These people are
peer learners.
Auditory learners learn best through listening
activities. These learners do well with lectures
and discussions. Extraneous noises may be more
distracting to them, however. Others are visual
learners who learn best when they are exposed
to a variety of visual stimuli. For example, color
is a powerful visual stimulus. These learners
often find it helpful to use different color high-
lighters or pens as they are reading and taking
notes. Visual learners do well with observational experiences, such as demonstrations. However.
they may be more sensitive to visual distrac-
tions.
Still others learn best when they have an
opportunity to actively participate in hands-on
activities and other types of movement-related
experiences. These people are kinetic learners.
Their potential for learning is maximized when
provided with learning situations that allow, or
require, them to physically perform a task
Learning styles determine how much, and how
fast, learning occurs. People typically remember
10% of what they read, 20% of what they hear,
30% of what they see, 70% of what they see and
hear, and 90% of what they see, hear and do.
These percentages demonstrate that the more
effective formats for retaining knowledge appear
to be hands-on, interactive multimedia formats
as compared to simple reading or listening to a
message,’
Most groups will be composed of people with
an assortment of learning styles. Oral health edu-
cators are advised to use a variety of teaching strat-
egies in an effort to reach everyone in the group.
This increases the probability that most learners
will have the opportunity to learn in at least one
way that best matches their learning style.
Learning Principles
A search of the literature that explains how
people learn reveals a large collection of teaching
methods for learning situations. Several general
principles are found repeatedly in the methods
that have been described. Oral health educa-
tion, for an individual or for a group, that is built
around these principles is more likely to result
in positive outcomes. Some important highlights
are as follows:
Learning is faster and retained longer when
the content has meaning, organization, and
structure.
Repetition,
review.
and reinforcement
enhance learning.
Learning is most effective when many chan-
nels of information. or senses, are stimu-
ated.
People learn by doing; learners need to be
actively involved.
Learner responses should be immediately
reinforced.
There is greater investment and involvement
in learning when learners have participated in
selection and planning of the learning project.
For best transfer of learning between settings
and situations, behaviors should be learned in
the way they will be used.
Without readiness, learning may be ineffi-
cient, impaired, or even harmful.
Without motivation, there will be no learning
Identify and exploit the motives a person may
have for learning, such as desire for recogni
tion, security, new experiences, satisfaction of
basic needs or wants.
Learners will progress only as far as they
believe they need to achieve their purposes.*
Teaching Methods
Oral health educators make choices and have
options when deciding on a teaching method
for oral health messages.
