Chapter 8

Community Health Education

Health Education in the Community

● Health teaching is one of the most fundamental nursing principles: "a nurse, in even the
most obscure position must be a teacher of no mean order."
-Gardner (1936)

● Health education is any combination of learning experiences designed to:

○ Predispose
○ Enable
○ Reinforce voluntary behavior conducive to health in:
■ Individuals
■ Groups
■ Communities

● Goals
○ Translate health knowledge into interventions for health enhancement, disease
prevention, and chronic illness management
○ Enhance wellness and decrease disability
○ Actualize the health potential of individuals, families, communities, and society
○ Influence individuals within their sociopolitical environment for improved health
and well-being
■ Place value on contribution of community member strength

● Goals (Cont.)
○ Sustain cognitive and behavioral changes by engaging learners to become
partners in their own behaviors (example):
■ Generate sexual health discussions (young people age 11 to 19)
■ Make topics more visible
■ Address complex tensions in designing and delivering acceptable health
care service

Learning Theories, Principles, and Health Education Models

● Learning theories assist in understanding how individuals, families, and groups learn.
● Learning is an enduring change that involves the modifications of:
○ Insight
○ Behaviors
○ Perceptions
○ Motivations
-Bigge and Shermis (2004)
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

● Learn better in a facilitative, nonrestrictive, and non-structured environment

● Characteristics that affect learning:
○ Need to know
○ Concept of self
○ Experience
○ Readiness to learn
○ Orientation to learning
○ Motivation
Health Education Models

● In addition to theories application of education theories and principles to situations

involving individuals, families and groups illustrate:
○ How ideas fit together
○ Offer explanations for health behaviors or actions
○ Help to direct community nursing interventions
-Padilla and Bulcavage (1991)

● Health Belief Model (HBM):

○ Perceived susceptibility ○ Self-efficacy

○ Perceived severity ○ Demographics
○ Perceived benefits ○ Cues to action
○ Perceived barriers

● Health Promotion Model (HPM)

○ Aims to explain why individuals engage in health actions
■ Individual characteristics and experience
■ Behavior-specific cognitions and affect
■ Behavioral outcomes
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)

● Process includes examining:

○ Education
○ Health literacy
○ Gender Racism
○ Social Justice
○ Class
● Recognizes the structural and foundational changes that are needed to elicit change for
socially and politically disenfranchised groups

Freire: A Focus on Problem-Solving Education

● Brazilian educator Paulo Freire

○ Empowerment among the poor and oppressed promotes literacy
○ Problem-solving approach to education
■ Contrasts with what he called the "banking education approach," which
placed the learner in a passive role.

● Active participation and ongoing dialog

● Learners are critical and reflective about health issues.
● Uses 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 help to
facilitate strategies reached
collectively
Community Empowerment

● Community members take on greater power to create change.

● Based on community cultural strengths and assets
● Community is an engine of health promotion and a vehicle for empowerment.
● Health education activities that respond to McKinlay's (1979) call to study "upstream"
examine:
○ Underlying causes of health inequalities through multilevel education and
research that allow nurses to be informed by critical perspectives from:
■ Education
■ Anthropology
■ Public health

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

Enhancing Communication

● Inclusion establishes the base for possible health action; it sets the relationship.
● Nurses need to be cognizant to the first introductory oral exchanges and interactions.
● Nurses need to enhance their knowledge and skills to provide culturally effective care.
● Culturally competent care exhibits sensitivity to individuals based on their experiences
and their responses.
● "Essence of health nurses"
○ Explanatory system that values diversity
○ Expert assessment skills to plan appropriate educational intervention
○ Aware of diversity of communication patterns and how language and
communication influence "trust in the relationship
-Meleis (1991)

Framework for Developing Health Communications

● NCI framework to create a variety of health education messages and programs

● Has four stages and is depicted by a circular loop that offers the opportunity for
continuous:
○ Assessment
○ Feedback
○ Improvement
4 Stages

● Stage I: Planning and strategy selection

○ Foundation for a communication program's process
○ Sets the stage for creating salient communication

● Stage II: Developing and pretesting concepts, messages, and materials

○ Select appropriate communication channels
○ Produce effective and relevant materials

● Stage III: Implementing the program

○ Introduce the health education message and program to the intended audience
○ Review and revise necessary components

● Stage IV: Assessing effectiveness and making refinements

○ Evaluate the outcome to determine whether or not changes in knowledge or
behavior occurred

Health Education Resources

● Educational materials, media, and resource are available from local, state, and national
organizations and agencies.
● 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.

● Definition is consistent with Healthy People 2020: "the capacity to obtain, interpret and
understand basic health information and services and the competence to use such
information and services to enhance health."
● 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.
● Increases community member's abilities to successfully manage their everyday
situations
● 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
 ● Three levels of intervention that have individual and population benefits:
1. Functional/basic literacy (reading and writing skills
2. Communicative/interactive literacy
3. Critical literacy

● Nation Academy of Medicine, formerly Institute of Medicine (IOM) (2004) report titled:
Health Literacy: A Prescription to End Confusion relates to millions of U.S. adults who
are unable to read and act on health instructions and messages.
● Very low literacy skills are at increased risk for poor health, which contributes to health
disparities.
● Paasche-Orlow and Wolf (2007) describe a conceptual causal model to explain
associations between limited health literacy and health outcomes that center on three
distinct aspects of care:
1. Access and utilization of health care
2. Patient-provider relationships
3. Self-care

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
● Summarize often
● Be creative
● Use appropriate resources and materials
● 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.
○ Be used as an adjunct to health instruction
○ Be appropriate for intended audience in community education initiatives

Assessment of Reading Level

● Assess readability of educational resources

○ SMOG readability formula
○ Flesch-Kincaid formula (on most computers)
○ Search "readability statistic"

Learner Verification

● Learner verification engages intended members in dialog and helps uncover unsuitable
aspects of material.
● Process helps identify that the message is well suited to the audience.

Social Media

● Social media refers to interactive Internet-based communication channels.

● Numerous platforms now available:
○ Blogs
○ Online discussion boards
○ Microblogs (Twitter)
○ Video-sharing (YouTube, Vimeo, Flickr)
○
● 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