Health Educ

• Educators frequently focus on the learner's level of motivation as an indicator of potential involvement in health education programs
• As early as 1974, Becker, Drachman, and Kirscht found motivation to be significantly related to measures of compliance with a medical regimen
• A thorough understanding of the relationship between the reception of information and the application of information, as well as those factors that impede or promote desired health outcomes, is essential for the nurse as educator
• Motivation


  A psychological force that moves a person toward some kind of action and as a willingness of the learner to embrace learning, with readiness as evidence of motivation
• Motivation is the result of both internal and external factors and not the result of external manipulation alone
• Implicit in motivation is movement in the direction of meeting a need or toward reaching a goal
• Lewin's theory of motivation


  Motivation is conceptualized in terms of positive or negative movement toward goals, and there is a critical time factor relative to motivation
• Motivational factors


  • Personal attributes
  • Environmental influences
  • Learner relationship systems
• Personal attributes


  • Physical, developmental, and psychological components of the individual learner
• Environmental influences


  • Physical and attitudinal climate
• Learner relationship systems


  • Significant other, family, community, and teacher-learner interaction
• Personal attributes that shape motivation


  • Developmental stage
  • Age
  • Gender
  • Emotional readiness
  • Values and beliefs
  • Sensory functioning
  • Cognitive ability
  • Educational level
  • Actual or perceived state of health
  • Severity or chronicity of illness
• Environmental influences that shape motivation


  • Physical characteristics of the learning environment
  • Accessibility and availability of human and material resources
  • Different types of behavioral rewards
• Relationship systems that influence motivation


  • Family or significant others in the support system
  • Cultural identity
  • Work, school, and community roles
  • Teacher-learner interaction
• Motivational axioms


  Premises on which an understanding of motivation is based
• State of optimum anxiety


  • Learning occurs best when a state of moderate anxiety exists, as this allows for effective observation, attention, learning, and adaptation. High or severe anxiety reduces the ability to perceive the environment, concentrate, and learn.
• Learner readiness


  • Desire to move toward a goal and readiness to learn are factors that influence motivation. Desire cannot be imposed but can be influenced by external forces and promoted by the nurse as educator. Incentives can be tangible or intangible, external or internal.
• Realistic goals


  • Goals that are within one's grasp, reasonable, and possible to achieve are motivating. Goals that are beyond one's reach are frustrating and counterproductive.
• Learner satisfaction/success


  • The learner is motivated by success, as it is self-satisfying and feeds one's self-esteem. Success and self-esteem escalate in a cyclical process, moving the learner toward goal accomplishment.
• Uncertainty reduction or maintenance


  • Uncertainty (as well as certainty) can be a motivating factor in the learning situation, as individuals have ongoing internal dialogues that can either reduce or maintain uncertainty.
• Areas assessed in motivational assessment


  • Level of knowledge
  • Client skills
  • Decision-making capacity
  • Screening of target populations for educational programs
• Cognitive variables assessed in motivational assessment


  • Capacity to learn
  • Readiness to learn
  • Expressed self-determination
  • Constructive attitude
  • Expressed desire and curiosity
  • Willingness to contract for behavioral outcomes
  • Facilitating beliefs
• Affective variables assessed in motivational assessment


  • Expressions of constructive emotional state
  • Moderate level of anxiety
• Physiological variables assessed in motivational assessment

  • Capacity to perform required behavior
• Experiential variables assessed in motivational assessment


  • Previous successful experiences
• Educator-learner relationship system variables assessed in motivational assessment


  • Prediction of positive relationship
• Environmental variables assessed in motivational assessment


  • Appropriateness of physical environment
  • Social support systems (family, group, work, community resources)
• Assessment of learner motivation involves the judgment of the educator, because teaching-learning is a two-way process
• Motivation can be assessed through both subjective and objective means
• ARCS Model of motivational strategies


  • Attention (using opposing positions, case studies, variable instructional presentations)
  • Relevance (capitalizing on learners' experiences, usefulness, needs, personal choices)
  • Confidence (addressing learning requirements, level of difficulty, expectations, attributions, sense of accomplishment)
  • Satisfaction (timely use of new skills, use of rewards, praise, self-evaluation)
• Compliance


  Submission or yielding to predetermined goals, an observable behavior that can be directly measured
• Adherence


  Commitment or attachment to a regimen, which may be long-lasting
• Compliance and adherence refer to the ability to maintain health-promoting regimens, which are determined largely by a healthcare provider
• Locus of control


  The concept that individuals can be categorized as "internals" (self-directed health behavior) or "externals" (believing that others or fate determine health outcomes)

  
• Locus of control has been related to compliance with therapeutic regimens
• Noncompliance describes resistance of the individual to follow a predetermined regimen
• The educator's self-awareness relative to the learner's personality characteristics and previous history of compliance to health regimens could play an important role in the educational process
• The learner may use "time-outs" as a mechanism of temporary withdrawal from the learning situation, which may actually prove beneficial
• Health behavior frameworks serve as tools for the nurse as educator to maintain desired patient behaviors or promote changes
• Health Belief Model


  • Based on the premises that disease prevention and curing regimens require the client's willingness to participate, and that health is highly valued. It predicts health behavior based on individual perceptions, modifying factors, and likelihood of action.