Community Health Nursing

3979NRS
Health Education In the Community

Lecture 10

Learning Objectives
By the end of this lecture, Students will be able to:
1. Identify the theoretical bases of H. education in
communities.
2. Apply the concepts of health education process in
this domain.
3. Identify the various situations in CHN in which
health education for behavior change can be
incorporated.( H.E. in Communities, beyond.)
4. Discuss the major ethical issues that may emerge
from current health education environment.
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Health Education-Introduction
To change behaviors that put people at risk for
injury, disease, disability, or death.
To increase the knowledge ,skills,& confidence
needed to make decisions.
Health Education targets:
Managing current illness
Cost containment
Health maintenance
Disease Prevention
Health Promotion

CH-Nurses, are particularly best suited to H.E-Tasks.

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Theoretical Bases
Theories describe, explain,& predict
behaviors within a functional
framework.
Theories about health education &
behavior change can help nurses
understand behavior & thereby help
them develop useful strategies that
influence peoples health.
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Theoretical Bases-CONCEPTS
Absolutism:
This is what you must do?
Requires ABSOLUTE adherence to prescribed strategies
We as health care workers are doing it or at least have done

it at a time...
Always based on clear evidencee.g. Smoking & Ca ,HTN &

Obesity??
The Problem: Complete adherence is .not EASY!
E.g: Trying to loose weight & exercise regularly??

Theoretical Bases-CONCEPTS
Paternalism:
when healthcare or other experts decide what a pt.
should do
Paternalism & absolutism demand compliance &
adherence
If patients didnt do exactly what providers tell them
they are then labeled as : non-compliant.
Non-Compliance reflects patients responsibility for
failure.
Holistic approach toward patients increase their
compliance and adherence to fulfill change
requirements
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Theoretical Bases-IMPORTANT CONCEPTS

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Concept

Definition

Advocacy

Patients informed & supported to make best possible decisions

Empowerment

Helping people to develop their ability to control independently

their situation &/or meet their needs

Barriers

Individually determined things associating COSTs with particular

behavior

Benefits

Individually determined things that reinforce or reward a

particular behavior

Cognitive Dissonance Tension or discomfort accompanies actions opposing personal

beliefs ( doings opposes sayings)

Motivation

Forces /drives , acting within or on an organism to initiate, direct

,& maintain behavior

Readiness

Potentials & motivations to do a particular action at a particular

time

Self-Efficacy

Personal conviction of ability to carry out specific behavior in

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order to achieve a desired end (I KNOW I CAN DO IT)

Adult Learning Theory

Provides important information for health
education.
This theory holds that motivation to learn is based
on four assumptions:
1. Adults perceive themselves to be self-directed: they
want to HAVE THEIR SAY.. in what they learn.
2. Adult have a variety of life experiences & are insulted
if these experiences are ignored BUILD ON THEM.
3. Adults learn better when they see an immediate need
& goal directed education.
4. Timing education to coincide with an immediate need
is more effective because the learner will see the
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immediate goal & be ready to learn.

# THEORY

Behavioral Change Theories/Concepts

1 Health Belief Model

Individuals take action to improve health if they feel susceptible,

their health problem is serious, high expected benefits if actions
taken,& able to perform assigned actions .

2 Harm Reduction Model

Health risks can be decreased by having patients ASK, what is

healthier, safer, or less risky .

3 Goal-Setting Theory

Setting goals can help people change health-related behaviors by

focusing efforts, persistence and concentration

4 Reasoned Action
Theory

To act, behavior must be based on personal beliefs, attitudes,

values, evaluations, as well as motives

5 Social Learning Theory

Individual behavior, personal factors,& environment create a set

of components that interact to influence health behaviors

6 Diffusion Theory

Diffusion more likely to occur if innovations/new ideas, practices

or services to improve health are cost-efficient, low risk, simple
,flexible & compatible with social, economic,& value systems into
which it is introduced

7 Social Marketing
Theory

Public acceptance of programs to improve health can be

enhanced through marketing techniques including offering
benefits that are valued by consumers.
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Marketing needs the best use of various communication channels

Health Education Process

Is a process of planned teaching and support activities
that help people to learn. It follows the format of the
nursing process :
1.
2.
3.
4.

Assessment
Planning
Implementation
Evaluation

Meticulous documentation should be considered

throughout all the nursing process stations.
Process succeeds if education was patient centered.
Keep in mind that patients belong to a complex social
& culturally defined environment. Therefore, Involving
families..& significant others can always promote
learning .
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Health Education Process

ASSESSMENT
It is to gather information.
Information then used to prioritize needs.
It requires active nurse-patient interaction.
Establish long term relationships in the community.
Establish an environment of trust.
Choose the right time & place.
Use open-ended questions.
Use active listening skills. Ask for clarification, use open
body language like nodding,smiling..etc
Assess reading and literacy level..+..Thank the patient.
H. Education needs evolve from pts actual & potential
problems & categorized as :Psychomotor, Affective &
Cognitive
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Domains of learning

1. Cognitive: (subdomains)
Knowledge (to know): To state, list, define
Comprehension (to understand): To explain, label,
describe
Application (to use): To apply, give examples
Analysis (to identify elements): To compare,
contrast, differentiate
Synthesis (to use in new way): To prepare, to
create, formulate
Evaluation (to judge): To assess, justify, measure
2. Psychomotor (to perform): To demonstrate, assemble,
manipulate
3. Affective (to feel): to tolerate, accept, appreciate,
value
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Health Education Process

PLANNING
Discuss learning needs & potential goals with the patient.
(Goals are broad statements of desired outcome)
Set a prioritized list of learning objectives.
Having the patient to help in prioritizing objectives?
The most pressing ( causing most discomfort to him/her)
The patient most willing to work on.(estimate readiness)
Consider literacy level while prioritizing.

Objectives must be specific , detailed, and measurable with

clear statements.
Objectives can be called cognitive, psychomotor, or affective
objectives, they refer to (knowledge, behaviors, or attitude)
Objectives must describe what the patient will do, define,
how it will be done, timeframe for task completion & clear
evaluation guide.
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Health Education Process

IMPLEMENTATION
Make decisions with the patient.
Base decisions on the collected data & planned
objectives.
Learning activities to focus on objectives to be
established.
Interventions tailored to patients needs & abilities.
Putting teaching plans into action is a dynamic process.
NEVER STATIC.
Discuss any problems, modify plans as needs change
Adjust the format of education as teaching progress
this is called FORMATIVE EVALUATION.
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Health Education Process

EVALUATION
The process of gathering information to assess the
extent to which learning objectives have been met?
All evaluation methods must be based on the learning
objectives.
Written objectives with appropriate action verbs will
tell you easily how to evaluate outcomes.
Summative evaluation: is a summary of patient's
accomplishments the nurse is closing the case.

E.g..To list the steps of ...To perform some thing..

Use quizzes, direct observations, monitor physiological
changes ,patient self-report & self-monitoring or having
input from other healthcare team members.
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Effective Health Education Strategies

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.

Design teaching based on holistic assessment.

Set learner-validated objectives.
Create learning environment.
Keep things simple.
Focus on one issue at a time.
Written and similar materials must be appropriate.
Be very specific.
Avoid threatening messages.
Explain the importance & ensure understanding.
Use variety of teaching methods.
Provide visual learning materials.
Role play skills, give chance for practice.
Provide immediate feedback, be constructive.
Develop mechanisms of support like involving family
Review major points of each learning session
Ask for feedback & evaluation, have learners input always.

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Health Education In Communities

It is to improve health of an aggregate
population.
This includes Teaching / Educating :
Individuals
Families
Groups
As well as Community .
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Community Health Learning

Occurs when knowledge, attitudes,&/or behaviors
change within an entire community
E.g. seat belt use, smoking in public areas.
Such changes need EMPOWERMENT & SUPPORT.

Health Education in Communities uses the same

previously mentioned process:
1.
2.
3.
4.

Community Assessment.
Planning for the community
Implementing Community Plans
Evaluating Community Programs.

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Beyond Community
CHN may realize that some problems are TOOOOO
BIGGGGGG to deal with them on community level.
Changes ,sometimes need to be made at country
level, federal levels..etc
Political advocacy then will be a significant part of
health education agenda
Examples:
Drunk driving laws
Motorcycle helmet requirement
School based educational programs
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Ethical Issues -DISCUSSION

Influencing change vs Respecting clients autonomy.
Health education manipulates clients to change
behavior.
E.g. Giving whole spectrum of choices for a pregnant
adolescent vs Encouraging her to have abortion.
I watched a documentary about exercise causing joint
deterioration vs You are encouraging me to exercise :
Science impact??it self??
Financially secure vs the very poor : who is more ready
for change.
Can you spot the light on a UAE based issue?
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Discussion questions
Have you seen community education efforts in action?
Have you ever attended a community education
session?
Have you noticed educational materials anywhere?
Are there any efforts at health education on campus or
at your educational institution? In the community
where you live? In alternative locations like public
transportation, stores, public areas?
Share experiences of yourselves or people you know
who have benefited from health education in a
community setting.
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References
Lundy,K.S & Janes,S. (2009). Community Health Nursing : Caring For The Publics Health.(2th ed.).
Sudbury,Massachusetts : JONES AND BARTLETT PUBLISHERS

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