Chapter 11
Health Promotion Through
Education
Healthy People 2020/2030
Vision
o “A society in which all people can achieve their
full potential for health and well-being of all
people” (U.S. Department of Health and Human
Services [USDHHS], 2020, para. 6)
Objectives
o Address social determinants of health and health
equity
o Can be used to identify client needs and align
educational efforts
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Social Determinants of Health
Factors that influence an individual’s ability to
maintain good health include social, economic, and
physical factors such as:
o Access to social and economic opportunities
o Safe housing
o Quality education
o Clean water, food, and air
o Safe workplaces
o Equitable social interactions
o Adequate community resources
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Socioeconomic Gradient in Health
Correlation between health status and
socioeconomic factors (income, education, social
status)
o Lower socioeconomic status: worse health
o Higher socioeconomic status: better health
Global phenomenon
Pertains to:
o Morbidity and mortality (e.g., infant mortality,
life expectancy)
o Behaviors (e.g., smoking)
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Health Disparities
Differences among populations in:
o Quantity of disease
o Burden of disease
o Age and rate of mortality due to disease
o Health behaviors and outcomes
o Other health conditions
o Access to health care
o Quality of health care
Avoidable, unfair, unjust
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Health Promotion
Encouraging client behaviors that improve health
Key goal of C/PHNs
Primary level of prevention
Focus on health protection rather than disease
prevention
A common focus of education
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Definitions and Types of Change
Definitions
o An imbalance or upset equilibrium requiring
adjustments
o Process of adopting innovation
Disruptive; generally new roles adopted
Types of change
o Evolutionary: gradual, incremental
o Revolutionary: rapid, drastic, threatening;
possible complete upset of balance of system
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Question #1
Is the following statement true or false?
Evolutionary change is typically rapid, drastic, and
threatening.
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Answer to Question #1
False
Rationale: Revolutionary change is typically rapid,
drastic, and threatening. Evolutionary change is
typically gradual and incremental.
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Stages of Change
First described by Kurt Lewin
Stages:
o Unfreezing (when desire for change develops)
o Changing/moving (when new ideas are accepted
and tried out)
o Refreezing (when the change is integrated and
stabilized in practice)
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Planned Change
Purposeful and intentional
Change by design, not default
Improvement as the aim for planned community
health change
Accomplishment through an influencing agent
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Planned-Change Process
1. Recognize symptoms.
2. Diagnose need.
3. Analyze alternative solutions.
4. Select a change.
5. Plan the change.
6. Implement the change.
7. Evaluate the change.
8. Stabilize the change.
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Question #2
In which stage of change is the change integrated and
stabilized in practice?
A. Unfreezing
B. Changing
C. Moving
D. Refreezing
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Answer to Question #2
D. Refreezing
Rationale: In the refreezing stage of change, the
change is integrated and stabilized in practice. In the
unfreezing stage of change, the desire for change
develops. In the changing/moving stage of change,
new ideas are accepted and tried out.
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Six Phases of Basic Health Communication
1. Problem definition and description
2. Problem analysis/market research
3. Planning communication/market strategy
4. Program planning/interventions
5. Program evaluation
6. Implementation
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Principles for Effecting Positive Change
Participation
Resistance to change
Proper timing
Interdependence
Flexibility
Self-understanding
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Domains of Learning
 Cognitive: mind and thinking processes
o Remember
o Understand
o Apply
o Analyze
o Evaluate
o Create
 Affective: emotion, feeling, and affect
 Psychomotor: visible demonstration of skills requiring
some type of neuromuscular coordination
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Learning Theories: Behavioral
Stimulus–response
o Pavlov: certain causes evoke certain effects
Conditioning
o Thorndike: conditioning without reinforcement
o Skinner: conditioning through reinforcement
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Learning Theories: Cognitive
Jean Piaget
o Assimilation
o Accommodation
o Adaptation
Gestalt-field
o Insight theory
o Goal–insight theory
o Cognitive-field theory
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Question #3
Is the following statement true or false?
Skinner is a behavioral theorist who used conditioning
through reinforcement.
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Answer to Question #3
True
Rationale: Skinner is a behavioral theorist who
addresses conditioning through reinforcement, such
that successive systematic changes in a learner’s
environment enhance the probability of the desired
response.
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Learning Theories: Social
Bandura
o Coincidental association
o Inappropriate generalization
o Perceived self-inefficacy
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Learning Theories: Humanistic
Abraham Maslow
o Hierarchy of human needs
 Physiologic  safety and security  love and
belonging  self-esteem  self-actualization
Carl Rogers
o Self-directed
o Client centered, warm, positive, and empathetic
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Learning Theories: Knowles’ “Adult
Learning”
Adult learners are different from children.
Characteristics of adults with implications for
learning
o Self-directed
o Life experience
o Readiness to learn content related to roles
o Problem-centered time perspective
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Health Teaching Models #1
Health Belief Model (HBM)
o Factors affecting readiness to make a change
 Perceived susceptibility
 Perceived seriousness
 Perceived benefits of action
 Barriers to taking action
 Cues to action
 Self-efficacy
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Health Teaching Models #2
Pender’s Health Promotion Model (HPM), revised
o Individual characteristics and experiences
o Behavior-specific cognitions and affect
o Behavioral outcomes
PRECEDE and PROCEED Models
o Predisposing, Reinforcing, and Enabling
Constructs in Educational/Ecological Diagnosis
and Evaluation
o Policy, Regulatory, and Organizational
Constructs for Educational and Environmental
Development
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Question #4
Which health teaching model explains the behaviors
and actions taken by people to prevent illness and
injury?
A. Health Belief Model (HBM)
B. Health Promotion Model (HPM)
C. PRECEDE model
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Answer to Question #4
A. Health Belief Model (HBM)
Rationale: The HBM is useful for explaining the
behaviors and actions taken by people to prevent
illness and injury.
The HPM includes three general areas: individual
characteristics and experiences, behavior-specific
cognitions and affect, and behavioral outcomes.
The PRECEDE model involves social, epidemiological,
and education/ecological assessments followed by
administrative and policy assessment and intervention
alignment, and implementation.
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Teaching–Learning Principles
Client readiness
Client perceptions
Educational environment
Client participation
Subject relevance
Client satisfaction
Client application
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Teaching Process
1. Interaction
2. Assessment and diagnosis
3. Setting goals and objectives
4. Planning
5. Teaching
6. Evaluation
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Teaching Methods and Materials
Formal or informal, planned or unplanned
Methods
o Lecture
o Discussion
o Demonstration
o Role-playing
Materials (visual images, anatomic models,
equipment, printed support materials, examples)
o Content, complexity, reading level, culturally
appropriate
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Clients With Special Learning Needs
Cultural or language differences
Hearing impairments
Developmental delays
Memory losses
Visual perception distortions
Problems with fine or gross motor skills
Distracting personality characteristics
Demonstrations of stress or emotions
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Question #5
Is the following statement true or false?
Assessment and diagnosis is the first step in the
teaching process.
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Answer to Question #5
False
Rationale: The first step in the teaching process is
interaction, establishing basic communication patterns
between clients and nurse. Assessment and diagnosis
follows.
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