Learning theories related to Health Care Practice

Learning is defined in this chapter as a relatively permanent change in thinking, emotional functioning,
skill, and/or behavior as a result of experience. It is the process by which individuals gain new knowledge
or skills and change their thoughts, feelings, attitudes and actions.

Learning Theory is a logical framework describing, explaining, or predicting how people learn. Whether
used singly or in combination, learning theories have much to offer to the practice of health care.
(Braungart et al.,

1. Behaviorist Learning Theory

According to the behaviorist learning theory, learning is the result of connections made between the
stimulus conditions in the environment (S) and the individual’s responses (R) that follow –
sometimes termed as S – R model of learning.

To encourage people to learn new information or to change their attitudes and responses, behaviorists
recommend altering conditions in the environment and reinforcing positive behavior after they occur.

Two ways to change behavior and encourage learning using the behaviorist principles of respondent
conditioning and operant conditioning:
 Respondent conditioning – first identified and demonstrated by Russian psychologist, Ivan
Pavlov, respondent conditioning (also termed classical or Pavlovian conditioning)
emphasizes the importance of stimulus conditions in the environment and the associations
formed in the learning process (Ormrod, 2016).
 Operant Conditioning – Developed primarily by B. F. Skinner (1974, 1989), focuses on the
behavior of the organism and the reinforcement that occurs after the response.
The basic principles of behaviorist principle are:
 Focus on the learner’s drives, the external factors in the environment that influence a
learners associations, and on reinforcements that increase or decrease responses.
 The teacher’s task is first to assess conditions in the environment that lead to specific
responses, the learner’s past habits and history of S – R connections, and what is
reinforcing the learner. Then teachers must manipulate conditions to build new
associations, provide appropriate reinforcement, and allow for practice to strengthen
connections between stimuli in the environment and a person’s responses or behavior.
2. Cognitive Learning Theory
Cognitive learning theory focuses on what goes on inside the mind of the learner. According to this
perspective, for individuals to learn, they must change their perceptions and thoughts and form new
understandings and insights. Unlike the behaviorists, cognitive psychologists maintain that rewarding
people for their behavior is not necessary for learning. More important are learner’s goals and
expectations, which creates tensions that motivate them to act.

Several well-known perspectives included in the cognitive learning theory:

 Gestalt perspective – emphasizes the importance of perception in learning (Kohler 1974,
1969; Murray, 1995). Rather than focusing on individual stimuli, gestalt refers to the
configuration or patterned organization on cognitive elements, reflecting the maxim that “the
whole is greater than the sum of its parts.”
  Information processing – is a second cognitive that emphasizes thinking, reasoning, the
way information is encountered and stored, and memory functioning (Gagne َ, 1985; Stenberg
& Stenberg, 2012).
Stages:
 Attention. Certain information is focused on while other information in the
environment is ignored. Attention is viewed as the key to learning.
 Processing. Information is processed using one or more of the senses. Here
it becomes important to consider the clients preferred mode of sensory
processing (visual, hearing, or by using touch or motor skills).
 Memory storage. Information is transformed and incorporated (encoded)
briefly into short term memory, after which it suffers one of two fates: the
information is disregarded and forgotten, or it is stored in long term
memory.
 Action. The action or response that the individual makes is based on how
the information was processed and stored.
 Cognitive development – heavily influenced by gestalt psychology, is a third perspective in
learning. It focuses on advancements and changes in perceiving, thinking, and reasoning as
individual grow and mature (Crandell et al., 2012; Santrock, 2013).
 Social cognition – the fourth perspective in cognitive psychology, which emphasizes the
effects of social factors on perception, thought, and motivation. According to this view, the
players in any healthcare setting would be expected to have differing perceptions,
interpretations, and responses to a situation that are strongly colored by their social and
cultural experiences.
3. Social Learning Theory
According to the social learning theory, much of learning occurs by observing – watching other
people and determining what happens to them. This theory is largely based on Albert Bandura’s
(1977, 2001) work where he mapped out a perspective on learning that includes consideration of the
personal characteristics of the learner, behavior patterns, and the environment.

Development Stages of the Learners Across Lifespan

The different stages of childhood are divided according to what developmental theorists and educational
psychologists define as speci fic patterns of behavior seen in particular phases of growth and
development. One common attribute observed throughout all phases of childhood is that learning is
subject centered.

1. Infancy (First 12 Months of Life) and Toddlerhood (1-2 Years of Age)

Cognitive stage: Sensorimotor
General Characteristics: Dependent on environment, Needs security, Explores self and
environment, Natural curiosity
Teaching Strategies: Orient teaching to caregiver, Use repetition and imitation of information,
Stimulate all senses, Provide physical safety and emotional security, Allow play and
manipulation of objects.

2. Early Childhood (3 – 5 years old)

Cognitive stage: Preoperational
 General Characteristics: Egocentric, Thinking precausal, concrete, literal, Believes illness self-
caused and punitive, Limited sense of time, Fears bodily injury, Cannot generalize, Animistic
thinking (objects possess life or human characteristics), Separation anxiety, Motivated by
curiosity, Active imagination, prone to fears
Teaching Strategies: Use warm, calm approach, Build trust, Use repetition of information,
Allow manipulation of objects and equipment, Give care with explanation, Reassure not to blame
self, Explain procedures simply and briefly, Provide safe, secure environment, Use positive
reinforcement, Encourage questions to reveal perceptions/feelings, Use simple drawings and
stories, Use play therapy, with dolls and puppets.

3. Middle and Late Childhood (6 – 11 years old)

Cognitive stage: Concrete operations
General Characteristics: More realistic and objective, Understands cause and effect,
Deductive/inductive reasoning, Wants concrete information, Able to compare objects and events,
Variable rates of physical growth, Reasons syllogistically, Understands seriousness and
consequences of actions
Teaching Strategies: Encourage independence and active participation, Be honest, allay fears,
Use logical explanation, Allow time to ask questions, Use analogies to make invisible processes
real, Establish role models, Use subject-centered focus, Use play therapy, Provide group
activities, Use drawings, models, dolls, painting, audio- and videotapes.

4. Adolescence (12 – 19 years old)

Cognitive stage: Formal operations
General Characteristics: Abstract, hypothetical thinking, Can build on past learning, Reasons
by logic and understands scientific principles, Future orientation, Motivated by desire for social
acceptance, Peer group important, Intense personal preoccupation, appearance extremely
important (imaginary audience), Feels invulnerable, invincible/immune to natural laws
Teaching Strategies: Establish trust, authenticity, Know their agenda, Address fears/concerns
about outcomes of illness, Identify control focus, Include in plan of care, Use peers for support
and influence, Negotiate changes, Focus on details, Make information meaningful to life, Ensure
confidentiality and privacy, Arrange group sessions, Use audiovisuals, contracts, reading
materials, Provide for experimentation and flexibility.

5. Young Adulthood (20 – 40 years old)

Cognitive stage: Formal operations
General Characteristics: Autonomous, Self-directed, Uses personal experiences to enhance or
interfere with learning, Intrinsic motivation, Able to analyze critically, Makes decisions about
personal, occupational, and social roles, Competency-based learner
Teaching Strategies: Use problem-centered focus, Draw on meaningful experiences, Focus on
immediacy of application, Encourage active participation, Allow to set own pace, be self-
directed, Organize material, Recognize social role, Apply new knowledge through role playing
and hands-on practice.

6. Middle-aged Adulthood (41 – 64 years old)

Cognitive stage: Formal operations
General Characteristics: Sense of self well-developed, Concerned with physical changes, At
peak in career, Explores alternative lifestyles, Reflects on contributions to family and society,
Reexamines goals and values, Questions achievements and successes, Has confidence in abilities,
Desires to modify unsatisfactory aspects of life
 Teaching Strategies: Focus on maintaining independence and reestablishing normal life patterns,
Assess positive and negative past experiences with learning, Assess potential sources of stress
caused by midlife crisis issues, Provide information to coincide with life concerns and problems.

7. Older Adulthood (65 years and over)

Cognitive stage: Formal operations
General Characteristics: Decreased ability to think abstractly, process information, Decreased
short-term memory, Increased reaction time, Increased test anxiety, Stimulus persistence
(afterimage), Focuses on past life experiences
Teaching Strategies: Focus on maintaining independence and reestablishing normal life patterns,
Assess positive and negative past experiences with learning, Assess potential sources of stress
caused by midlife crisis issues, Provide information to coincide with life concerns and problems.

Principles of Teaching
1. Credibility
It is the degree to which the message to be communicated is perceived as trustworthy by the receiver.
Good health education must be consistent and compatible with scientific knowledge and also with the
local culture, educational system and social goals.

2. Interest
Health teaching should be related to the interests of the people
Health programme should be based on the “FELT NEEDS”, so that it becomes “people’s programme
Felt needs are the real health needs of the people, that is needs the people feel about themselves.

3. Participation
A high degree of participation tends to create a sense of involvement, personal acceptance and
decision –making. It provides maximum feedback.

4. Motivation
In every person, there is a fundamental desire to learn. Awakening this desire is called motivation.

There are two types of motives:

 Primary motives – are driving forces initiating people into action.
 Secondary motives –are created by outside forces or incentives.
Incentives may be positive or negative. Need for incentives is a first step in learning to change.
Main aim of motivation is to change behavior. Motivation is contagious: one motivated person may
spread motivation throughout a group.

5. Comprehension
Health educator must know the level of understanding, education and literacy of people to whom the
teaching is directed. Always communicate in the language people understand. Teaching should be
within the mental capacity of the audience.

6. Reinforcement
Repetition of message at intervals is necessary. If the message is repeated in different ways, people
are more likely to remember it.
7. Learning by doing
The importance of learning by doing can be best illustrated by the Chinese proverb “if I hear, I forget;
if I see, I remember; if I do, I know”.

8. Known to unknown
We must proceed,
“from the concrete to the abstract”
“from the particular to the general”
“from the simple to the more complicated”
“from the easy to more difficult”
“from the known to unknown”

Here health communicator uses the existing knowledge of the people as pegs on which to hang new
knowledge.

9. Setting an example
The health educator should set a good example in the things he is teaching.

10. Good human relations

Sharing of information, ideas and feeling happen most easily between people who have a good
relationship. Building good relationship with people goes hand in hand with developing
communication skills.

11. Feedback
The health educator can modify the elements of the system (e.g., message, channels) in the light of
feedback from his audience. For effective communication, feedback is of paramount importance.

12. Leaders
Leaders are agents of change and they can be made use of in health education work.

The attributes of a leader are:

 He understands the needs and demands of the community
 Provides proper guidance, takes the initiative, is receptive to the views and suggestions of the
people;
 Identifies himself with the community;
 Selfless, honest, impartial, considerate and sincere;
 Easily accessible to the people;
 Able to control and compromise the various factors in the community;
 Possesses the requisite skill and knowledge of eliciting cooperation and achieving
coordination of the various official and non-official organizations.
 Principles of learning

Principles of learning, also known as laws of learning, are readiness, exercise, effect, primacy,
recency, intensity and freedom.

1. Readiness
Readiness implies a degree of willingness and eagerness of an individual to learn something
new. Individuals learn best when they are physically, mentally and emotionally ready to learn
— and they do not learn well if they see no reason for learning.

2. Exercise
The principle of exercise states that those things that are most often repeated are the ones that
are best remembered.
Your audience will learn best and retain information longer when they have meaningful
practice and repetition. It is clear that practice leads to improvement only when it is followed
by positive feedback.

3. Effect
The principle of effect is that learning is strengthened when accompanied by a pleasant or
satisfying feeling — and that learning is weakened when associated with an unpleasant
feeling. The learner will strive to continue learning as long as it provides a pleasant effect.
Positive reinforcement is more likely to lead to success and motivate the learner — so as a
health educator you should recognize this feature and tell your audience how well they are
doing.

4. Primacy
Primacy, the state of being first, often creates a strong impression which may be very
difficult to change.

Things learned first create a strong impression in the mind that is difficult to erase.
‘Unteaching’ or erasing from the mind incorrect first impressions is harder than teaching
them correctly in the first place. The learner’s first experience should be positive, functional
and lay the foundation for all that is to follow.

5. Recency
The principle of recency states that things most recently learned are best remembered.
Information acquired most recently generally is remembered best; frequent review and
summarising will help fixing in the audience’s mind topics that have been covered. To that
end, the health educator should repeat, restate or re-emphasise important points at the end of
a lesson to help the audience remember them.
 6. Intensity
The more intense the material taught, the more likely it will be retained.

A sharp, clear, dramatic, or exciting learning experience teaches more than a routine or
boring experience. The principle of intensity implies that a learner will learn more from the
real thing than from a substitute.

Likewise, a learner is likely to gain greater understanding of tasks by performing them —

rather than merely reading about them.

7. Freedom
The principle of freedom states that things freely learned are best learned. Conversely, if the
audience is forced to learn something, the more difficult it is for them to learn.

Compulsion and forcing are not favorable for personal growth. For example, if you force a
family to construct a latrine in their compound, they may not be interested to do that.
However if you motivate them to do that through proper education of the family, they are
more likely to construct the latrines and use them properly.

References

(2021). Retrieved 13 March 2021, from

http://samples.jbpub.com/9781284104448/Sample_CH03_Bastable.pdf
Bastable, S., & Myers, G. (2016). Developmental Stages of the Learner. Retrieved from
https://nursekey.com/developmental-stages-of-the-learner/
Health Education Advocacy and Community Mobilisation Module:6. Principles of Learning. Retrieved
from https://www.open.edu/openlearncreate/mod/oncontent/view.php?id=163
Nimbalkar M. (August 21, 2019). Principles of Health Education. Retrieved from
https://www.slideshare.net