BEHAVIOR MODIFICATION IN HEALTH EDUCATION Health education frequently has been attacked for its failure to help individuals

develop practices and habits that prevent illness and maintain and promote good health. It often has been guilty of solely providing information of a physiological nature. However the problem of how to modify or whether to try to modify the health behavior of people has not been adequately resolved. Human health behavior is a complex process that may be resistant to change but is influenced by a variety of factors previously identifies in the concept oh health (see chapter 2) that include physiological, psychological, social/cultural, and spiritual component (holistic health). Home atmosphere, racial, ethnic, or cultural backgrounds, peer influences, adequacy of housing and food intake, affection received, achievements, selfrespect, and bias and prejudice have specific impact on children and youth. The needs, motivations, beliefs, values, experiences, and environment of people affect the health habit patterns they develop. They enable people to make responsible health decisions and to cope with or adjust to problems they face in the society in which they live. These factors are in need of recognition and use if educational programs are to aid individuals to achieve high levels of wellness. It is the purpose of this chapter to provide understanding in regard to behavior modification that will (1) help teachers to become better informed in regard to the learning process necessary for successful teaching in health education and (2) demonstrate the application of essential principles of learning to be used in the selection of methods and techniques (see Chapter 12) for effective instructional programs. WHAT IS BEHAVIOR MODIFICATION? Health behavior modification refers to the changing of health knowledges, attitudes, and practices acquired by individuals. It is an internal process that is influenced by personal needs and environmental exposures. IT is not something done to pupils but rather involves educational procedures or methods used to help individuals adapt, adjust, solve problems, or cope with situations in regard to their health. Health education should attempt to aid students to make intelligent and responsible decisions. The question of the extent to which educators should try to modify health behavior is a moot one. Should the use of alcohol or tobacco be condemned or condoned? Should all individuals exercise at regular intervals and in the same manner? Should the use of contraceptives be promoted? Should pupils reduce their consumption of foods containing high levels of sugar and cholesterol? Should the flossing and brushing of teeth be universally advocated? Hochbaum* states that in controversial aspects of health behavior, no attempt should be made to make modifications in live with rigid criteria (not to drink, not to smoke). He believes that students should be helped to develop skills and motivation that will enabled them to arrive at rational and intelligent decisions. Smith and Ojemann have identifies a four step model for decision making that is worthy of consideration.

1. Examine the motivating forces operating in a given situation; identify the needs individuals are trying to satisfy through their behavior. 2. Devise and examine the probable intermediate and remote effects of possible alternative ways of satisfying these motivations. 3. Apply your personal standard to the proposed course of action to determine if the effects of the action are compatible. 4. Decide either for or against the selected behavior at this point. In time.

WHAT IS LEARNING? Learning is a complex process that is dependent on factors taking place both inside and outside the individual. It refers to the physical, intellectual, and emotional changes that occurring human organisms as a result of their interaction with the environment. It is the growth and development process that goes on within individuals as a result of their participation in a variety of experiences, feelings, attitudes, and interest. The healtheducated pupil, having been exposed to a variety of health opportunities and activities, is better able to promote and maintain good health. There is evidence that the brains consists of two hemispheres, a left brain and a right brain, and that each has different yet coordinated functions. This should be considered in health education. It is believed that memory, reading, writing, language, and analytical thinking are responsibilities of the right brain. Despite these differences in function and organization, both brains, as a result of complex creative interaction, contribute to visual perception, voluntary movement, speech production, and other intellectual and physical procedures. The literature in educational journals indicates that the development of the right brain often has been neglected in traditional education. Health education therefore will need to consider the inclusion of appropriate learning experiences. It should be made clear the process of learning happens within the individual but is influenced by the experiences to which pupil are exposed through the teaching methods and techniques (see Chapter 12) selected by the teacher. Knowledge of the nature and conditions of learning is basic to an understanding of the teaching process in the health instruction program.

HOW DO CHILDREN LEARN? The exact nature of learning is not known. However, the process does involve a series of rewards and punishments of both a desirable and undesirable nature. Positive reinforcers may include money, candy, privileges, grades, peer approval, praise, attention, and selfinterest. Negative reinforces that result in the elimination of behavior may include loud sounds, disapproval, punishment, poor grades, and use of unpleasant substances. It is

believed that learning takes place most efficiently and effectively when someone wants to learns something (positive learning). This person is then said to be motivated to action- to be goal directed- A diagram best illustrates the learning process as it probably occurs (Fig. 11-1). The process of learning may be illustrated by example of the teacher who desires to have a student learns procedures that will help to prevent learn procedures that will help to prevent and control communicable disease. The goal having been set and the student ready to learn, the teacher provides a variety of activities that will aid in achieving the goal. These experiences may include reading about germs, discussing the hazards of respiratory infections, the importance of washing hands before lunch, and looking at bacteria under a microscope. The extent to which emotional tension, or conflict, is created in the pupil will depend on a number of factors, such as the intensity of the motivation, the difficulty encounters in reaching a solution, the amount of work required to be a completed, and the desire for a good grade. If the activities provide satisfying experiences in learning for the child, the goal will be reached and the pupil will return to a state of equilibrium. Should the goal not be reached, the pupil may react by making such excuses as, There was too much work to do, The teacher didnt help me enough, o I didnt understand what to do. Learning occurs when a learner encounters new experiences in the environment. However, teacher guidance can help to motivate this learning and reduce the error a pupil may make in the learning process by controlling, manipulating, and selecting the appropriate kinds of activities.

LEARNING AND THE CONCEPT APPROACH TO HEALTH EDUCATION. One effective approach to teaching health is through the emphasis on concepts. Today, it is important to help students develop big ideas or reach conclusions about health that will enable them to take positive action and to make wise decisions regarding their own, their families, and their communitys health. Teachers must be aware of these generalizations and help students to achieve them. Such concepts as smoking may be harmful to the human body, drugs are mood modifiers, certain foods are needed for proper growth and development, and there are ways to protect ourselves from disease help teachers to determine more relevant and effective health educations goals (see illustrative units in Chapter 9). These big ideas are more likely to be remembered and hopefully will provide greater potential for pupil action.

LEARNING AND THE GOALS OF HEALTH EDUCATION Knowledge of the objectives of health education is important to the learning and teaching processes. Goals give direction to the learning that enables pupils to acquire the concepts needed for healthful living. It is necessary therefore that teachers clearly understand the

purposes of health education for the most effective teaching. Precisely defined health objectives have particular meaning, since learning should be centered on behavior outcomes as well as on factual achievements. Learning should lead students to the acquisition of health education concepts. The present aim of health education is to develop practices and attitudes of safe and healthful living through the understanding of scientific health information. Individuals should be able to make intelligent decisions about the physical, mental, and social aspects of health. Health behaviors are therefore related to and dependent on the cognitive learning acquired by pupils. It is important that children obtain correct understanding about health. Attitudes also affect health habits. The precise interrelationships of knowledge and attitudes to practices are not known today except that they are interdependent. Present evidence, however, indicates that the possession of understanding by itself does not necessarily result in good health habits. Knowing how to brush the teeth does not mean that this practice will be followed. Knowing that some snacktime foods are more nutritious than others is no assurance that they will be eaten. Knowing that immunizations protect against diseases does not always result in these preventive measures being obtained. Knowing the physiological effects of drugs does not necessarily reduce their usage. There are also data that support appreciation and feelings as the means of bridging the gap between the knowing and the doing in health. Some authorities therefore believe that stress must be placed on the attitudinal effects of knowledge in health teaching. In any event, attitudes are significant in health education; and although knowing may not always lead to doing, there will be no doing without knowing. Consideration must be given to the fact that behavioral and attitudinal changes in health do not necessarily take place inmmediately after teaching. Cultural, social, and other values and beliefs that pupils bring from home and community relating to health habits are extremely difficult to change within short periods of time. However, some behavior changes may be observable in the classroom and are subject to measurement; those occurring in the home and elsewhere outside of school may not be seen and may be extremely difficult to assess. It should be recognized that the impact of health learning frequently takes time to have its effect on children. Despite these difficulties, health education must provide correct understanding if appropriate health behavior are to be acquired by pupils. Good health behavior is significant only in terms of its effect on the lives of pupils. Good health therefore should be a means to an end and net an end in itself. Being healthy should enable children to obtain a better education, to be happier, to have fun, to be able to play for longer periods of time without undue fatigue, to be more productive in the world, and to be better citizens in the community. When good health is an end in itself, pupils are likely to become overly concerned about their health and become health neurotics. Teachers should be aware of the fact that all students may not be able to acquire the same health levels because of hereditary and environmental factors. Children who are blind or deaf

may never have these senses restores. Pupils who are paralyzed from poliomyelitis may never be able to walk as others do. Boys and girls with uncorrectable heart defects may never have the stamina to play n strenuous games. Students without food may be hungry and malnourished. Despite these handicaps, students need to maintain the best health status possible for themselves within their own limitations. Numerous illustrations of handicapped people leading well-adjusted happy, and productive lives are found in society. The goals in health education therefore may need to be modified to fit the individual differences of children. Inspection of the specific outcomes of health education that teachers seek to achieve reveals them to be categorized into the following: 1. Practices, habits, skills- action domain 2. Attitudes, feelings, ideals, interests, appreciations- affective domain. 3. Knowledge, understanding, information- cognitive domain. Illustrations of these goals in health education that reflect the psychological, social, and spiritual as well as the physiological aspects of health (see chapter 9) include the following: Practices action domain The pupil: 1. Eats the proper foods for growth. 2. Obtains adequate sleep, rest, and exercise. 3. Acts safely. 4. Critically analyzes and evaluates health advertising and publicity. 5. Uses community health resources effectively. 6. Takes proper care of teeth. 7. Faces the realities of life. 8. Obtains proper immunizations. 9. Refrains from the use and abuse of drugs. 10. Refrains from the use of tobacco. 11. Attempts to develop a value system. Attitudes affective domain. The pupil: 1. 2. 3. 4. 5. 6. Appreciates the dangers to self and other of communicable diseases. Supports the need to have a concept of self. Realizes that health organizations are needed in society. Appreciates the need for periodic health examinations. Is aware of the health hazards of the use of tobacco. Is interested in providing for the rights of others.

Knowledge- cognitive domain

The pupil 1. 2. 3. 4. 5. 6. 7. Explains how to protect self against disease. Identifies the procedures to follow when ill. Recalls how to care for the skin, feet, ears, and eyes. Summarizes how growth and development occurs. Demonstrates how to administer first aid. Identifies the physiological, sociological, and psychological effects of drugs on individuals. Discusses ways emotions may be helpful and harmful.

The health objectives listed are not all inclusive, nor are they appropriate for all grades (see Chapter9). It is necessary to study the needs and interests of children in individual schools and school districts to determine the total program and the grade placement. The decision-making process must receive attention by teachers. Pupils are growing and developing organisms that are exposed constantly to environmental influences affecting health and about which decisions must be made. Young people must have the opportunity to make their own decisions and not be expected to follow the dictates of the teacher. However, such decisions