The LEARNER

Motivation and Behavior Change

• For education to be effective, the nurse must not only be
knowledgeable about the subject matter
• Being taught, but also about the teaching/ learning process. An
effective health education intervention
• Encompasses more than just the giving of new information, for
information alone does not always result
• In behavior change, compliance, or improved health status.
Successful educational interventions
• Increase compliance with medical regimens and improve health
outcomes. They are based on learner
• Characteristics, his or her educational needs ,theory and a sound
educational plan.
• Learner Characteristics
• There are many factors that influence a client’s ability, motivation,
and desire to learn.
• These factors when planning educational interventions is essential,
because the effectiveness of the intervention can be at stake.
• Learner characteristics include, among others culture, /ethnicity,
literacy, age health status, educational level, and socio economic
status.
• Culture
• Culture is defined as invisible patterns that form the normal ways of
acting, feeling, judging,
• Perceiving, and organizing the world.
• Culture affects health behaviors and the teaching/Learning process in
many ways.
• Culture influences gender roles, sexual behavior, diet, personal
hygiene , body image (ex. Obesity, slimness etc.), drug use ( alcohol,
hallucinogens, coffee, tea),
• Exercise and communication among others. (latino.. Influenced other mem of fam)
• Literacy
• The client’s ability to read and understand what is being read is an
essential component of learning .
• Establishing the reading level and using materials that are consistent
with the client’s ability is paramount.
• Materials at too high a level will be useless, as they will not
understood. Materials at too low a level, while of some value, maybe
too simplistic and maybe seen insulting.
• For those who are illiterate, written communication obviously cannot
be used. What is not obvious is who is illiterate
• AGE
• Teaching the older adult presents some challenges , although none
are insurmountable.
• The older adult usually needs more time to learn. Educational session
either need to be for a longer period of time or broken down into
more sessions for a shorter time covering less information.
• Bear in mind that older adults tend to learn best when information is
relevant to them, and has a practical application.
• As with all clients, emotional or mental status should be
acknowledged and taken into account when planning an educational
intervention for this population.
• Depression, denial, fear and anxiety can all have an impact on the
effectiveness of teaching .
• Older adults often enjoy learning in a group. Plan group sessions with
time allotted for socialization. This may improve the outcome of the
educational intervention.
• Be cognizant of possible hearing and visual deficits. Deficits can be
addressed by making sure always to face the client while speaking
clearly, slowly, and loudly if necessary while avoiding shouting.
• To address visual impairments, use a large- print materials or print in
larger letters if using a flip chart or chalk board.
• For those whose eyesight is such that reading is not possible, making
a tape recording of pertinent instructions.
• Education Level and health status
• It has been well documented that education level is significantly
associated with health status.
• When teaching, it is important to established the client’s level of
knowledge or depth of understanding his / her condition. This will
enable you to provide information at an appropriate level. – basic or
in great medical detail.
• Using medical terminology, anatomical levels for body parts,
abbreviations for medical procedures, or just” big words “ may hinder
the learning process for some.
• Socioeconomic Level
• The impact of socioeconomic level on learning has more to do with
being able to use the information being taught rather than the
process of learning. Simply, the resources needed to comply with the
medical regimen may not be available. (change in diet fresh/not available)
• Socioeconomic level may dictates where a client lives. Although this
may not seem to be related to learning or changing behavior. (cardiac
prog. Walk sev times/wk in high area.)

• Planning for Learning

• Learning is a complex process. Having people learn new information
and skills and change their behavior can be daunting.
• Approaching this with a plan that incorporates factors that increase
the likelihood of learning, and base on a theory that explains why
people behave the way they do, increases the chances that learning
will take place, change will occur, compliance will improve and
education will be effective.
• To increase the likelihood of compliance, it is helpful to understand
the basics of how people learn or those factors that impact on
learning. Approaching the educational process from a theoretical
basis enables the nurse educator to identify methods most likely to
produce the best results.
• Learning Principles:
• There are number of factors that affect the learning process. Some
we have control over, such as the learning environment or the rate at
which information is taught or presented.
• Others we don’t have control over, such as the client’s innate ability
to learn, interest in the information, or desire to learn.

• The following learning principles by Breckon, Harvey and Lancaster

1998; moss, 1994 are helpful in motivating people to learn and in
planning for the most effective educational experience possible.
These are:
• 1.) Use several senses
• People retain 10% of what they read, 20 % of what they hear, 30% of
what they see, 50% of what they hear and see, 70% of what they say
and 90% of what they say and do.
• Based on this principle, learning is more likely to occur if clients are
allowed to practice what they are being taught.
• 2.) Actively involved the patients or clients in the learning process
• This principles relates to the teaching methods used, whether they
are passive or active. Passive methods include lecture, videos, and
print materials. While these do allow for learning, learning is much
enhanced if more active methods are used.
• The more interactive the educational experience, the greater the
likelihood of success. Used methods that engage the participants ,
such as discussion, role- playing, small group discussion, question and
answer, rather than lecture.
• 3.) Provide an environment conducive to learning.
• The room should have good lighting and temperature control and
comfortable seating with enough space between seats. It should be
free of unpleasant odors (mold, mildew, cigarrete smoke, heavy
perfume) and signs of deterioration ( falling ceiling tiles, peeling
paint, graffiti, dirty carpeting.)
• It should adequate acoustics, that is no echo, and if it is a large space,
a sound system. While attention to these factors may seen trivial,
they can make difference between a successful education program
and an unsuccessful one.” Creature features “ do count.
• 4.) Asses the extent to which the learner is ready to learn
• The first step in educational process is to asses client readiness for
learning. Assessment data can be obtained directly from the clients
or families(Primary Data), or it can be gathered from a variety of
other sources such as charts or reports (secondary data).
• Primary data have an advantage over data from other sources in that
the sources can directly answer questions about the needs of specific
client or group for whom the educational intervention is being
planned.
• Readiness assessment aims to provide information about what clients
want to know and want to learn, their beliefs, family dynamics,
housing situation, skills, educational level, fears or concern about
their condition or the effect of their condition on others.
• 5.) Determine the perceived relevance of the information
• People generally are willing to learn what they perceived as being
important. Sometimes this is not consistent with what we think is
important. The easiest way to determine what is important and what
is not is to simply ask.
• 6.) Repeat information
• Repetition enhances learning . When new information is presented ,
it should be presented several times, in a variety of ways.
• Reword the information, discuss a practical application of the
information and have the person provide a situation in which the
information could be used. Repetition is particularly important when
the information is complex or completely new. Information can also
be repeated throughout the educational session by referring back to
material that was previously discussed.
• 7.) Generalize information
• Information is more readily learned if it is applied to more than one
situation. Using a variety of examples and applying the information to
specific situations in the clients life promotes learning and contributes
to a better chance of compliance.
• 8.) Make learning a pleasant experience
• This can be accomplished through frequent encouragement and
positive feedback. People usually enjoy learning, and learning
enhanced when obvious progress is being made. Frequent
recognition of accomplishment, even for seemingly small successes,
can go along way toward a successful education intervention.
• 9.) Begin with what is known; move toward what is unknown
• Information should be presented in an organized fashion. It should
begin with the basics or general information that is known and move
toward new information, or that which is unknown.
• 10.) Present information at an appropriate rate
• Nothing is more frustrating for learners than to have new
information presented at such a rapid pace that they cannot keep up.
The rate at which information is taught must be tailored to the client.
Depending on the clients knowledge level, a faster or slower pace
maybe necessary.
• Motivation and Behavior Change Theories
• Theories are used by the nurse educator to plan and implement the
most effective educational intervention possible.
• A theory is “a set of interrelated concepts, definitions, and
propositions that presents a systematic view of events or situations
by specifying relations among variables in order to explain and predict
the events of the situations” (Glanz, Lewis, & Rimer ,1997).
• Theories help us to understand why people do or don’t do certain
things in a given situation.
• The purpose of most educational interventions is to change behavior.
Behavior change is often at the root of increasing compliance with
treatment regimens or preventing complications or further illness.
• The following are among the most commonly used theories for health
education interventions.
• Health Belief Model
• Explain behavior or predicts whether behavior change will occur
based on a set of beliefs or perceptions, which include perceived
seriousness, susceptibility, benefits and barriers. These perceptions
are modified by cues to action ( Elkder, Ayala, & Harris,1999: Glanz
1997). (hpn.. No symptoms, fine therefore compliance to tx low, cig smooking)
• Social Cognitive Theory
• Originally introduced as (Social Learning Theory) explains that
behavior is the result of an interaction among the person (
characteristics, personality), the environment (physical, social,etc.) ,
and the behavior itself (Baranowski , Perry and Parcel 1997).
• A change in one of these factors change all of them a phenomenon
called “reciprocal determinism “.
• Using this theory to elicit behavior change requires that one or more
of the person, environment, or behavior, factors be modified.
• Factors that affect behavior include the anticipated outcomes of
engaging in the behavior, learning by observing others, self efficacy,
and self –control (Bandura, 1986).
• Self – Efficacy Theory
• Is a very powerful determinant of health behavior, as is seen from its
use in the Social Cognitive Theory.
• Self efficacy on its own has been presented as a means by which
behavior can be predicted or explained.
• Self –efficacy is a determinant of motivation.
• The stronger someone’s belief in his or her ability to accomplish
something, the more effort will be exerted and the longer he or she
will persevere ( Bandura , 1989).
• The theory of Self- Efficacy proposes that behavior change occurs
because of the expectations or expected result of the new behavior
and one’s belief about his or her ability to perform a specific
behavior in a specific situation ( Strecher, De Villis, Becker, &
Rosenstock, 1986).
• 4 Sources from which a person‘s degree of self efficacy arises:
a. Performance accomplishments
• refers to learning that occurs through personal mastery of a
particular skill or task.
b. Vicarious experience
• learning through observation.
c. Verbal persuasion
• involves acting as the coach and providing encouragement
d. Physiological state
• TRANSTHEORETICAL MODEL/ STAGES OF CHANGE THEORY:
• Is useful when the targeted behavior change is the discontinuation of
an healthy behavior. It is often used for smoking cessation and weight
management interventions. This theory postulates that people go
through stages before a change in behavior occurs.
• Stages include :
a. Precontemplation stage –
• there is no serious thought being given to changing the behavior in
the next six months. (see but not imp/undecided)
• b. Contemplation stage
• people are at least aware of the need to change their behavior and
are thinking about making a change in the next six months. Weighing
the pros and cons of the new behavior. This stage can last for long
periods , and when it does it is termed “ behavioral procrastination”(
Prochaska et al,1997)(quit, good effect.decide)
• c. Preparation or Planning Stage
• during this time people are planning to make the behavior change in
the immediate future, often within the next month ( Prochaska et al
,1997). The plan of action or means by which they will implement
the change has been identified.(use nic patch,consult dr, cessation prog)
• d. Action stage
• the person is actively involved in the behavior change or adopting
the new behavior.(smoker=quit/hpn=low salt)
• e. Maintenance stage
• It begins after six months of adherence to the new behavior. It is a
period of constant attention to the new behavior to prevent relapse,
although relapse is less likely to occur in this stage than in the
previous one.
• f. Termination stage
• When the new behavior has become a habit, and they require no
further intervention.
• Theory of Reasoned Action
• Proposes that adoption of a new behavior results from individual
intention to engage in the behavior. Behavioral intention is
determined by attitude toward the behavior and the associated
subjective norm (Montano, Kasprzyk, & Taplin,1997).
• Attitude toward the behavior is determined by beliefs about the
outcome or attributes of the behavior.(pos/neg)
• Subjective norm
• Determined by normative beliefs, or whether important others
approve or disapprove of the targeted behavior (Montano et ,al
1997) Important others maybe family members or significant
others
• BEHAVIOR MODIFICATION THEORY:
• First proposed by B. F. Skinner in 1938, is based on the premise that
behavior occurs because of its consequences ( ex. Reinforcement or
rewards.) Changing the consequences , reinforcements or reward
( Skinner, 1938, 1953), then, can change behavior.
• The consequences of a behavior can be a positive reinforcer, giving
something that is not wanted or taking away something that is
wanted ( Hergenhahn, 1994). Parents commonly used this approach
they may not know they are using Skinner’s Theory.(go t the street/punishment)