CHAPTER 1: CONCEPTS, THEORIES, &
PRINCIPLES IN HEALTH EDUCATION/
PROMOTION (TOPIC 1)
-------------------H e a l t h---------------------
Old English: haelen – “to heal”
Middle English: helthe – “to be sound in
body, mind and spirit”
Greek – “to prolong life and prevent
disease” or “to keep people healthy”
India – “Ayurveda” – the science of life
or health
• 1948 – “A state of complete physical,
mental, and social well – being and not
merely the absence of disease or
infirmity “(WHO, 1974 p.29)
------------P u b l i c H e a l t h-----------
• Art of applying science in the context of
politics so as to reduce inequalities in
health while ensuring the best health
for the greatest number (World Health
Report, 98)
• Science & Art of:
– Preventing disease;
– Prolonging life; and
– Promoting health & efficiency through
organized community effort for the:
✓ Sanitation of environment;
✓ Control of communicable infections;
✓ Education of the individual in personal
hygiene; organization of medical and
nursing services for the early diagnosis
and preventive treatment of disease;
and
✓ Development of a social machinery to
ensure everyone a standard of living
adequate for the maintenance of health
SCOPE OF PUBLIC HEALTH:
❖ Health Services systems
❖ Health behavior and motivation
❖ Environmental hazards
-----------H e a l t h B e h a v i o r------------
• “Any activity undertaken by an
individual regardless of actual or
perceived health status, for the purpose
of promoting, protecting and
maintaining health, whether or not
such behavior is objectively effective
towards that end”. (WHO, 1998)
• “Personal attributes such as beliefs,
expectations, motives, values,
perceptions and other cognitive
elements, personality characteristics,
including affective and emotional states
and traits and behavioral patterns,
actions and habits that relate to health
maintenance, to health restoration and
to health improvement”. (David
Gochman, 1982)
-----------H e a l t h E d u c a t i o n-----------
Disseminating information
Teaching people how to take care of
their health.
Telling people what to do to protect
themselves from disease, etc.
 Health education according to:
1. Green, et al 1980:
Health education is any combination of
learning experiences designed to
facilitate voluntary adaptations of
behavior conducive to health.
2. Joint Committee on Health Education
and Promotion Terminology of 2001:
"any combination of planned learning
experiences based on sound theories
that provide individuals, groups, and
communities the opportunity to acquire
information and the sum needed to
make quality health decisions."
The areas of concern are physical
health, social health, emotional health,
intellectual health, environmental
health and spiritual health.
3. World Health Organization:
“comprises of consciously constructed
opportunities for learning involving
some form of communication designed
to improve health literacy, including
improving knowledge and developing
life skills which are conducive to
Individual and Community health.”
• Facilitates modification of health
behaviors
4. Downie, Fyfe and Tannahill – 1990:
Communication activity aimed at
enhancing positive health and
preventing or diminishing ill –health in
individuals and groups through
influencing beliefs, attitudes and
behavior of those with power and of
the community at large”
5. Green & Kreuter – 2005:
Any planned combination of learning
experiences designed to predispose,
enable and reinforce voluntary behavior
conducive to health of Individual, Group
& Community.
• Should be viewed w/in the changing
context of health & disease; w/in the
changing health picture where lifestyles
play an important role & w/in the
accepted definition of health. Not just
telling people what to do. Rather, it is
leading out what people already know
& believe & do about their health;
modifying those that are undesirable, &
developing desirable behaviors that are
conducive to health. Not a “one shot”
deal, but is a process of providing
learning experience to people in order
that they may be able to define their
health problems, personal, family &
community - & to take the needed
actions for solving these problems.
• The principle by which individuals and
groups of people learn to behave in a
manner conducive to the promotion,
maintenance, or restoration of health.
6. Presidents Committee 1973:
The process that bridges the gap
between health information and health
practice.
 7. Simmonds, 1976:
The process of bringing about
behavioral changes in individuals,
groups, and larger populations from
behaviors that are presumed to be
detrimental to health, to behaviors that
are conducive to present and future
health
8. Green, 1980:
Any combination of learning
experiences designed to facilitate
voluntary adaptations not behavior
conducive to health
9. National Task Force on the Preparation
and Practice of Health Educators, 1983:
The process of assisting individuals,
acting separately or collectively to make
informed decisions about matters
affecting the personal health and that
of others
Key words in the definitions of
Health Education
• Process- means a series of learning
experiences.
• Combination – connotes that there is no
single best method, rather a combination is
desirable.
• Designed – means it is planned, not a hit or
miss process.
• Facilitates – emphasizes educator-learner
relationship such as assisting, helping and
supporting role of educator not just telling.
• Voluntary adaptation – not manipulated or
coerced.
• Behavior – as the target outcome
Lessons from Global &
National History of Health
Education/Promotion
Pre-historic Era
Industrial Revolution
Post-Civilized Stage
1. Pre-Historic Era
Characteristics of Health Education in the
earlier periods:
a. Firstly, it was based on Authority and
tradition. Its sources were the classical,
medical authors, empirical knowledge
and folklore.
b. Secondly, it was closely linked to the
literacy of the people. As more people
learned to read, more health literature
was produced for them.
c. Thirdly, the audience for health
literature was affected by the rise of
new social and political orders.
d. Finally, Health education was directed
to the individual and was not
concerned with the community except
when the need arises in times of
epidemics.
2. Industrial Revolution
❖ The 18th century endeavored to project
hygiene from a personal to a public
plane.
John Howard showed that
people are galvanized into
action when facts about social
disease are made available to
them and that an aroused and
informed public opinion could
be a lever of social reform.
 ❖ The 19th century illustrated how health
education has included the concept of
arousing public opinion in support of
legislative action for improved public
health.
19th Century advanced 3 requirements for
Health Education
1. Purpose to drive it forward powered by
self-interest.
2. Knowledge to make it effective. It
leaped forward from the darkness of
the middle ages to the scientific outlook
of the modern world.
3. Means to get it across. Means to
educate that the most striking change
was to take place.
❖ Health Education has turned to social
sciences for a better understanding of
how to work with people individually or
in groups.
❖ Objectives of Health Education has
changed. Simply presenting information
is not enough. What counts is whether
and how this knowledge is applied.
3. Post-Civilized Stage
❖ It reflects the changing patterns of
health and a growing understanding of
the social, biological, and physical
environment that influence health.
❖ It has adopted the principle that Health
Education is working “with” rather
than “for” the people.
❖ It has marked the shift in emphasis to
Health Promotion
----------H e a l t h P r o m o t i o n-----------
is the process of enabling people to
increase control over, and to improve,
their health. It moves beyond a focus
on individual behavior towards a wide
range of social and environmental
interventions.
As a core function of public health,
health promotion supports
governments, communities and
individuals to cope with and address
health challenges. This is accomplished
by building healthy public policies,
creating supportive environments, and
strengthening community action and
personal skills.
-----------H e a l t h E d u c a t i o n-----------
➢ Central concern is Health behavior
3 categories of Health Behavior
(Kasl and Cobb):
A. Preventive Health Behavior: Any
activity undertaken by an individual
who believes himself to be healthy for
the purpose of preventing or detecting
illness in an asymptomatic state.
B. Illness Behavior: any activity
undertaken by an individual who
perceives himself to be ill; to define the
state of his health and to discover
suitable remedy.
C. Sick Role Behavior: any activity
undertaken by an individual who
considered himself to be ill for the
purpose of getting well. It includes
receiving treatment from medical
providers, generally involves a whole
range of dependent behaviors, and
 leads to some degree of exemption of
one’s usual responsibilities.
HEALTH EDUCATION
Various settings of Health
Education:
Health care settings
Schools
Communities
Work settings
Foundations of Health Education:
❖ Philosophical foundation – it serves as
a beacon light so that health educators
may be properly guided in their work.
For example, one philosophy of
health education is that it
should be people centered, not
program or organization
centered. The welfare of the
people is uppermost rather
than organizational goals.
❖ Biomedical foundation – it gives health
educators the content or the what of
health education programs. This is
based on the finding of biomedical
sciences. Health educators must be
updated in the recent findings in this
field so that messages that are
disseminated may be scientifically
accurate.
❖ Behavioral Science foundation – it
provides the educator the how or the
theories or methods of bringing about
behavioral change.
HE is a systematic, planned application
Delivery of HE involves set of
TECHNIQUES rather than just one
Purpose of Health Education
1. Primary purpose of HE: Influence
antecedents of behavior so that health
behaviors develop in voluntary fashion
- Awareness
- Information
- Knowledge
- Skills
- Belief
- Attitudes
- Values
2. Health education equips people with
knowledge and competencies to
prevent illness, maintain health or apply
first aid measures to prevent
complications or premature deaths and
improves the health status of
individuals, families, communities,
states, and the nation.
3. Health education creates awareness HE is performed in several levels
regarding the importance of
preventive and promotive care thereby One – on – one
avoiding or reducing the costs involved
Group
in medical treatment or hospitalization.
Organizational

Community level
Role of Health Educator

In January 1979, the Role Delineation

Project was undertaken to better
-------------------Synthesis----------------------
understand the role of a health
educator. A Framework for the
Health Education may be defined from
Development of Competency-Based
different perspectives and may use
Curricula for Entry Level Health
different communication models;
Educators (NCHEC, 1985) and the
however, behavior change remains
revised version, A Competency-Based
their ultimate targets.
Framework for the Professional
Development of Certified Health Health education evolved overtime
Education Specialists (N CHEC, 1996), parallel with the history of public health
identified the framework which consists & development of science.
of Seven Areas of Responsibility Of The
Health Educator:
Health Education & Health Promotion
1) Implement health education strategies,
interventions and programs The campaign from prevention of
communicable diseases shifted to
2) Administer health education strategies,
lifestyle related diseases, but sustaining
interventions and programs
the first, especially emerging & re-
3) Conduct evaluation and research in emerging diseases.
relation to health education
From HE w/ HP as one of its ribs,
4) Serve as a health education resource through time and turn of events, HP
person gained prominence & became the
umbrella & HE has become one among
5) Assess individual and community needs
its core actions.
for health education

6) Plan health education strategies,

interventions and programs

7) Communicate and advocate for health

and health education
CHAPTER 1: CONCEPTS, THEORIES, &
PRINCIPLES IN HEALTH EDUCATION/
PROMOTION (TOPIC 2)
-------------------Characteristics------------------
of an Effective Curriculum
1. Focuses on clear health goals and
related behavioral outcomes. Instructional
strategies and learning experiences are directly
related to the behavioral outcomes.
2. Is research-based and theory driven. An
effective curriculum has instructional strategies
and learning experiences built on theoretical
approaches (for example, social cognitive
theory and social inoculation theory) that have
effectively influenced health-related behaviors
among youth. The most promising curriculum
goes beyond the cognitive level and addresses
health determinants, social factors, attitudes,
values, norms, and skills that influence specific
health-related behaviors.
3. Addresses individual values, attitudes,
and beliefs. It provides instructional strategies
and learning experiences that motivate
students to critically examine personal
perspectives,
thoughtfully consider new arguments that
support health-promoting attitudes and values,
and generate positive perceptions about
protective behaviors and negative perceptions
about risk behaviors.
4. Addresses individual and group norms
that support health-enhancing behaviors.
An effective curriculum provides instructional
strategies and learning experiences to help
students accurately assess the level of risk-
taking behavior among their peers (for example,
how many of their peers use illegal drugs),
correct misperceptions of peer and social
norms, emphasizes the value of good health,
and reinforces health-enhancing attitudes and
beliefs.
5. Focuses on reinforcing protective factors
and increasing perceptions of personal and
harmfulness of engaging in specific
unhealthy practices and behaviors. An
effective curriculum provides opportunities for
students to validate positive health-promoting
beliefs, intentions, and behaviors. It provides
opportunities for students to assess their
vulnerability to health problems, actual risk of
engaging in harmful health behaviors, and
exposure to unhealthy situations.
6. Addresses social pressures and
influences. An effective curriculum provides
opportunities for students to analyze personal
and social pressures to engage in risky
behaviors, such as media influence, peer
pressure, and social barriers.
7. Builds personal competence, social
competence, and self-efficacy by
addressing skill by addressing skills. An
effective curriculum builds essential skills —
including communication, refusal, assessing
accuracy of information, decision-making,
planning and goal-setting, self-control, and self-
management — that enable students to build
their personal confidence, deal with social
pressures, and avoid or reduce risk
behaviors.
For each skill, students are guided through a
series of developmental steps:
a. Discussing the importance of the skill, its
relevance, and relationship to other learned
skills.
b. Presenting steps for developing the skill.
c. Modeling the skill.
d. Practicing and rehearsing the skill using real–
life scenarios.
e. Providing feedback and reinforcement.
8. Provides functional health knowledge
that is basic, accurate, and directly
contributes to health-promoting decisions
and behaviors. An effective curriculum
provides accurate, reliable, and credible
information for usable purposes so students can
assess risk, clarify attitudes and beliefs, correct
misperceptions about social norms, identify
ways to avoid or minimize risky situations,
examine internal and external influences, make
behaviorally relevant decisions, and build
personal and social competence. A curriculum
that provides information for the sole purpose
of improving knowledge of factual information
will not change behavior.
9. Uses strategies designed to personalize
information and engage students. An
effective curriculum includes instructional
strategies and learning experiences that are
student-centered, interactive, and experiential
(for example, group discussions, cooperative
learning, problem solving, role playing, and
peer-led activities). Learning experiences
correspond with students’ cognitive and
emotional development, help them personalize
information, and maintain their interest and
motivation while accommodating diverse
capabilities and learning styles. Instructional
strategies and learning experiences include
methods for:
Addressing key health-related concepts.
Encouraging creative expression.
Sharing personal thoughts, feelings, and
opinions.
Thoughtfully considering new
arguments.
Developing critical thinking skills.
10. Provides age-appropriate and
developmentally-appropriate
information, learning strategies, teaching
methods, and materials. An effective
curriculum addresses students’ needs, interests,
concerns, developmental and emotional
maturity levels, experiences, and current
knowledge and skill levels. Learning is relevant
and applicable to students’ daily lives. Concepts
and skills are covered in a logical sequence.
11. Incorporates learning strategies,
teaching methods, and materials that
are culturally inclusive. An effective
curriculum has materials that are free of
culturally biased information but includes
information, activities, and examples that are
inclusive of diverse cultures and lifestyles (such
as gender, race, ethnicity, religion, age,
physical/mental ability, appearance, and sexual
orientation). Strategies promote values,
attitudes, and behaviors that acknowledge the
cultural diversity of students; optimize
relevance to students from multiple cultures in
the school community; strengthen students’
skills necessary to engage in intercultural
interactions; and build on the cultural resources
of families and communities.
12. Provides adequate time for instruction
and learning. An effective curriculum provides
enough time to promote understanding of key
health concepts and practice skills. Behavior
change requires an intensive and sustained
effort. A short-term or “one shot” curriculum,
delivered for a few hours at one grade level, is
generally insufficient to support the adoption
and maintenance of healthy behaviors.
13. Provides opportunities to reinforce
skills and positive health behaviors. An
effective curriculum builds on previously
learned concepts and skills and provides
opportunities to reinforce health-promoting
skills across health topics and grade levels. This
can include incorporating more than one
practice application of a skill, adding “skill
booster” sessions at subsequent grade levels,
or integrating skill application opportunities in
other academic areas. A curriculum that
addresses age-appropriate determinants of
behavior across grade levels and reinforces and
builds on learning is more likely to achieve
longer-lasting results.
14. Provides opportunities to make
positive connections with influential
others. An effective curriculum links students
to other influential persons who affirm and
reinforce health–promoting norms, attitudes,
values, beliefs, and behaviors. Instructional
strategies build on protective factors that
promote healthy behaviors and enable students
to avoid or reduce health risk behaviors
by engaging peers, parents, families, and other
positive adult role models in student learning.
15. Includes teacher information and plans
for professional development and training
that enhance effectiveness of instruction
and student learning. An effective curriculum
is implemented by teachers who have a
personal interest in promoting positive health
behaviors, believe in what they are teaching,
are knowledgeable about the curriculum
content, and are comfortable and skilled in
implementing expected instructional strategies.
Ongoing professional development and training
is critical for helping teachers implement a
new curriculum or implement strategies that
require new skills in teaching or assessment.
--------------Issues and Trends-------------
in Health Education
Social – demographic trends like
aging of the population requires
emphasis on self –reliance and
maintenance of a healthy life status
over an extended lifespan particularly
dealing with degenerative diseases and
disabilities; lifestyle related diseases
which are the major causes of morbidity
and mortality are highly preventable
and will need more intensive health
education efforts.
Economic -the shifts in payer
coverage, emphasis on managed care
and earlier hospital discharge, and the
issue on reimbursement for health
services provided require more
intensive patient education to allow the
patient and his family a more
independent, compliant management
of care.
Political- the federal government has
formulated national goals and
objectives directed towards the
development of effective health
education programs which will mate
awareness of health risks and
encourage the adoption of healthy
lifestyles. The role of health education
in promotion of health and prevention
of illness in containing the cost of
hospitalization and healthcare expenses
has already been recognized by
politicians and healthcare
administrators.
----------------------Theories---------------------
in Health Education
Health Promotion
Theory (Revised)
This model emphasizes
“actualizing health potential
and increasing the level of
well-being using approach
behaviors rather than
avoidance of disease that is
why it has been classified as
a health promotion model
rather than a disease
prevention model.
The Health Promotion Model
developed in 1987 and
revised by Pender (1996) has
been primarily used in the
discipline of nursing. It was
originally published in 1982 and
later improved in 1996 and
2002.
Pender’s health promotion
model defines health as “a
positive dynamic state not
merely the absence of
disease.” (increasing a client’s
level of well-being) It describes
the multi-dimensional nature of
persons as they interact within
 the environment to pursue
health.
The three major components are as
follows:
1. Individual characteristics and
experiences- prior related behavior and
personal factors.
2. Behavior-specific cognitions affect-
consists of perceived benefits of action,
perceived barriers to action, perceived self
efficacy, activity-related affect,
interpersonal influences, and situational
influences.
3. Behavioral outcome- consists of
commitment to a plan of action, immediate
competing demands and preferences, and
the health-promoting behavior.
Subconcepts of the
Health Promotion Model
Personal Factors - Personal factors are
categorized as biological, psychological,
and socio-cultural. These factors are
predictive of a given behavior and
shaped by the target behavior’s nature
being considered.
Personal Biological Factors - Include
variables such as age, gender, body
mass index, pubertal status, aerobic
capacity, strength, agility, or balance.
Personal Psychological Factors -
Include variables such as self-esteem,
self-motivation, personal competence,
perceived health status, and definition
of health.
Personal socio-cultural factors- Include
variables such as race, ethnicity,
acculturation, education, and
socioeconomic status.
Perceived Benefits of Action-
Anticipated positive outcomes that will
occur from health behavior.
Perceived Barriers to Action -
Anticipated, imagined, or real blocks
and personal costs of understanding a
given behavior.
Perceived Self-Efficacy - The judgment
of personal capability to organize and
execute a health-promoting behavior.
Perceived self-efficacy influences
perceived barriers to action, so higher
efficacy results in lowered perceptions
of barriers to the behavior’s
performance.
Activity-Related Affect - Subjective
positive or negative feeling occurs
before, during, and following behavior
based on the stimulus properties of the
behavior itself. Activity-related affect
influences perceived self-efficacy, which
means the more positive the subjective
feeling, the greater its efficacy. In turn,
increased feelings of efficacy can
generate a further positive affect.
Interpersonal Influences - Cognition
concerning behaviors, beliefs, or
attitudes of others. Interpersonal
influences include norms (expectations
of significant others), social support
(instrumental and emotional
encouragement), and modeling
(vicarious learning through observing
others engaged in a particular
behavior). Primary sources of
interpersonal influences are families,
peers, and healthcare providers.
Situational Influences - Personal
perceptions and cognitions of any given
situation or context can facilitate or
impede behavior. Include perceptions
of options available, demand
characteristics, and aesthetic features
of the environment in which given
health-promoting is proposed to take
place. Situational influences may have
direct or indirect influences on health
behavior.
Commitment to Plan of Action - The
concept of intention and identification
of a planned strategy leads to the
implementation of health behavior.
Immediate Competing Demands and
Preferences - Competing demands are
those alternative behaviors over which
individuals have low control because of
environmental contingencies such as
work or family care
responsibilities. Competing
preferences are alternative behaviors
over which individuals exert relatively
high control, such as choice of ice
cream or apple for a snack.
Health-Promoting Behavior - A health-
promoting behavior is an endpoint or
action-outcome directed toward
attaining positive health outcomes such
as optimal wellbeing, personal
fulfillment, and productive living.
Self-Efficacy
Theory
Psychologist Albert Bandura has
defined self-efficacy as people's beliefs
in their capabilities to exercise control
over their own functioning and over
events that affect their lives. One's
sense of self-efficacy can provide the
foundation for motivation, well-being,
and personal accomplishment.
People's beliefs in their efficacy are
developed by four main sources of
influence, including (i) mastery
experiences, (ii) vicarious experiences,
(iii) social persuasion, and (iv)
emotional states.
Self-Efficacy is a person’s particular set
of beliefs that determine how well one
can execute a plan of action in
prospective situations (Bandura, 1977).
To put it in more simple terms, self-
efficacy is a person’s belief in their
ability to succeed in a particular
situation.
Albert Bandura (1977) states individuals
develop their self-efficacy beliefs by
interpreting information from four
main sources of influence:
1. Performance accomplishment
evidenced in self-mastery of similarly
expected behaviors.
"Mastery experiences are the most
influential source of efficacy
information because they provide the
most authentic evidence of whether
one can muster whatever it takes to
succeed. Success builds a robust belief
in one's personal efficacy. Failures
undermine it, especially if failures occur
before a sense of efficacy is firmly
established" (Bandura, 1997).
2. Vicarious experiences (Social Role Models)
such as observing successful expected
behavior through the modeling of
others
Bandura (1977) posits that "Seeing
people similar to oneself succeed by
sustained effort raises observers' beliefs
that they too possess the capabilities to
master comparable activities to
succeed."
3. Verbal persuasion (Social Persuasion)
by others who present realistic beliefs
that the individual is capable of the
expected behavior
Self-efficacy is influence by
encouragement and discouragement
pertaining to an individual’s
performance or ability to perform
(Redmond, 2010)
4. Emotional arousal
through self-judgment of physiological
states of distress
For example, if you are struggling with
depression or anxiety, one might find it
harder to have a healthy level of well-
being. Is it impossible to build self-
efficacy while suffering from some of
these struggles? Of course not, but
boosting your self-efficacy is a much
easier task when one is feeling healthy
and well (Bandura, 1982).
However, Bandura (1977) states, "it is
not the sheer intensity of emotional
and physical reactions that is important
but rather how they are perceived and
interpreted. People who have a high
sense of efficacy are likely to view their
state of affective arousal as an
energizing facilitator of performance,
whereas those who are beset by self-
doubts regard their arousal as a
debilitator."
Becker Health Belief
Model
developed in the 1950s from a social
psychology perspective to examine why
people did not participate in health-
screening programs (Rosenstock, 1974).
It was modified by Becker (1974) to
address compliance to therapeutic
regimens.
two major premises on which the
model is built (Becker, 1990):
1. the eventual success of disease
prevention and curing regimens that
involve the clients’ willingness to
participate;
2. and the belief that health is highly
valued
The model is grounded on the
supposition that it is possible to predict
health behavior given three major
interacting components:
- individual perceptions,
- modifying factors
- likelihood of action
It has been the predominant
explanatory model since the 1970s for
uncovering differences in preventive
health behaviors as well as differences
in preventive use of health services.
HBM Constructs:
Perceived susceptibility
- Definition: Beliefs about the chances of
getting a condition;
- Example: Individual perceptions of
personal susceptibility to specific
illnesses or accidents often vary widely
from the realistic appraisal of their
statistical probability. The nature and
intensity of these perceptions may
significantly affect their willingness to
take preventive action.
- Strategies: Define what population(s)
are at risk and their levels of risk; (2)
Tailor risk information based on an
individual’s characteristics or
 behaviour; (3) Help the individual
develop an accurate perception of his
or her own risk.
Perceived severity
- Definition: Beliefs about the
seriousness of a condition and its
consequences.
- Example: People may not respond to
suggestions that they obtain flu shots
because they do not view influenza as a
serious disease. The person must
perceive the potential seriousness of
the condition in terms of pain or
discomfort, time lost from work,
economic difficulties, etc.
- Strategies: Specify the consequences of
a condition and recommended action.
Perceived benefits
- Definition: Beliefs about the
effectiveness of taking action to reduce
risk or seriousness.
- Example: Individuals generally must
believe that the recommended health
action will actually do some good if they
are to comply. Some long-time cigarette
smokers, for example, seem to believe
that, “I’ve smoked for so many years
that it’s too late to quit. It couldn’t help
now anyway, so why bother?”
- Strategies: Explain how, where, and
when to take action and what the
potential positive results will be.
Perceived barriers
- Definition: Beliefs about the material
and psychological costs of taking action.
- Example: If the change is perceived as
difficult, unpleasant or inconvenient
and outweighs the perceived benefits, it
is less likely to occur.
- Strategies: Offer reassurance,
incentives, and assistance; correct
misinformation.
Cues to action
- Definition: Factors that activate
“readiness to change” – a trigger
mechanism.
- Example: A reminder note from a
dentist that it is time for a check-up
may be sufficient to prompt action.
- Strategies: Provide “how to”
information, promote awareness, and
employ reminder systems.
Self-efficacy
- Definition: Confidence in one’s ability
to take action.
- Example: One’s opinion of what one is
capable of doing is based largely on
experience with similar actions or
circumstances encountered or observed
in the past.
- Strategies: Provide training and
guidance in performing action; Use
progressive goal setting; Give verbal
reinforcement; Demonstrate desired
behaviour.
PRECEDE-PROCEED
Model
emerged from an epidemiological
perspective on health promotion in the
hopes of combating leading causes of
death (Green & Kreuter, 1999).
The model acronym PRECEDE stands for
Predisposing, Reinforcing, and
Enabling Constructs in Educational
Diagnosis and Evaluation, as originally
developed by Green, Kreuter, Deeds,
and Partridge (1980).
PROCEED, which means Policy,
Regulatory, and Organizational
Constructs in Educational and
Environmental Development (Green
and Kreuter)
Core: Health education, defined as “any
combination of learning experiences
designed to facilitate voluntary actions
conducive to health” (Green & Kreuter,
1999, p. 27)
Green and Kreuter further emphasize
that health education is aimed primarily
at planning learning experiences that
are designed to “predispose, enable,
and reinforce voluntary behavior
conducive to the health of individuals,
groups, or communities”
THEORY OF REASONED
ACTION
emerged from a research program that
began in the 1950s and is concerned
with prediction and understanding of
any form of human behavior within a
social context (Ajzen & Fishbein, 1980)
It is based on the premise that humans
are rational decision makers who make
use of whatever information is available
to them.
In a two-pronged linear approach,
specific behavior is determined by (1)
beliefs, attitude toward the behavior,
and intention and (2) motivation to
comply with influential persons known
as referents, subjective norms, and
intention.
Four Concepts:
1. Behavioral Intention –
perceived likelihood of
performing behavior.
2. Attitude – personal evaluation
of the behavior
3. Subjective Norm – beliefs
about whether key people
disapprove of the behavior;
motivation to behave in a way
that gains their approval.
4. Perceived Behavioral Control –
belief that one has and can
exercise control over
performing the behavior.
TRANSTHEORETICAL
MODEL OF CHANGE
Another model that informs the
phenomenon of health behaviors of the
learner is the Stages of Change Model
(Prochaska & Di Clemente, 1982).
Originating from the field of
psychology, this model was developed
around addictive and problem
behaviors.
Prochaska (1996) notes six distinct
stages of change: precontemplation,
contemplation, preparation, action,
maintenance, and termination.
Stages of Change:
1. Precontemplation – has no intention of
taking action within the next six months.
2. Contemplation – intends to take action in the
next six months.
3. Preparation – intends to take action within
the next 30 days and has taken some behavioral
steps in this direction.
4. Action – has changed behavior for less than
six months.

5. Maintenance – has changed behavior for

more than six months.

The final stage, termination, occurs

when the problem no longer presents
any temptation. However, some experts
note that termination does not occur,
only maintenance becomes less vigilant.
CHAPTER 2- CONCEPTS OF EDUCATION IN RELATION TO HEALTHCARE

1. OVERVIEW OF EDUCATION ON HEALTHCARE

“Health education is a process concerned with designing, implementing and evaluating

educational programs that enable families, groups, organizations and communities to
play active roles in achieving, protecting and sustaining
health.
Its purpose is to contribute to health and well-being by promoting lifestyles,
community action and conditions that make it possible to live healthful lives” (The
Code of Ethics for Health Educators, Association for the Advancement of Health
Education).
Education for health begins with people. It hopes to motivate them with whatever
interests they may have in improving their living conditions, Its aim is to develop in
them a sense of responsibility for health conditions for themselves as: individuals, as
members of families, and as communities.

Strategies in Health Teaching

Components of an Educative Process

1. Learner and the teacher
2. Things to be learned
3. The way it is to be learned
4. Setting in which it is to be learned

Dimensions of the Educational Process

A. SUBSTANTIVE
◆ This pertains to what is taught and what has to be learned.
◆ The curriculum including the content (knowledge, values and skills) and planned
activities directed by the faculty is for a particular purpose.

B. ENVIRONMENT
◆ This pertains to all of the setting which may be used for learning experience which
can be:

1. AUTOCRATIC
◆ The teacher has little freedom to explore her area of interest and to use the
methods which best lead her and her students toward the attainment of their
objectives .

2. DEMOCRATIC
◆ The teacher is free to contribute to her specialized knowledge and capabilities
to the common goal of the school as well as for her own teaching goals.

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 3. PSYCHOSOCIAL
◆ This correspond to the ff:
a) The number , type and organization of personnel
b) Other students from allied health fields
c) Patients (socioeconomic status, type of illness, medical treatment, nursing
problems.
d) The kind and size of institution

C. PROCEDURAL
◆ This pertains to the different practices or standard operating procedures being followed.

D. HUMAN RELATIONS
◆ This refers to the learner, teacher, administrator, group of learners, patients and their
interactions.

2. CONCEPTS OF TEACHING AND LEARNING

Teaching is a deliberate intervention involving the planning and implementation of

instructional activities and experiences to meet the intended learner outcomes based
on the teaching plan.
o It is concerned with the growth and development of the whole personality of
the student.
o It is a mixture of arts and science.
o It starts with the experience of a learner .

Instruction is just one aspect of teaching which involves communicating information

about a speciac skill .It is sometimes used interchangeably with teaching.

Learning is a change in behavior (knowledge, skills and attitudes ) that can occur at
any time or in any place as a result of exposure to environmental stimuli.
o It is an action by which knowlge skills and attitudes are consciously and
unconsciously acquired and behavior is altered which can be seen or observed.
o A process of apprehension, clarification, and application of meanings.
o It entails the use of mental function, like conceptualizing, abstracting,
reasoning, judging and generalizing.
o It includes mental activities wherein knowledge, skills, attitude and
appreciation and ideas are acquired resulting into modification of behavior
(mental, social, emotional and physical)

Staff education –amidst all these mandates and requirements that health educator
faces is the need to be knowledgeable about the principles of teaching and learning.
The three pillars of the teaching – learning process are the: teacher, learner, and
subject-matter.

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3. IMPORTANT CHARACTERISTICS OF A TEACHER

Processes of Being an Effective Teacher

◆ Knowledge of educational theory and research

◆ Willingness to learn new roles and teaching methods

◆ Ability to reflect on one’s own performance

Six Major Categories Effective Teaching in the Medical Laboratory Science

Profession

1. Professional competence

enjoys his professional competence

shows genuine interest to his patients
displays confidence in his professional abilities
excites the students interest in the profession by being creative, stimulating and can
demonstrate clinical skills with expertise.

Several aspects of professional Competence

he or she develops a thorough knowledge of subject matter.

polishes clinical skills throughout his or her career.
maintains and expands knowledge through reading, research , clinical practice, and
continuing education

2. Good interpersonal relationships

taking personal interest in the learners.

being sensitive to the feelings and problems of the learners.
conveying respect for them.
alleviating their anxieties
accessible for conferences
allowing learners to express their points of view.
creating an atmosphere in which they feel free to ask questions.
conveying a sense of warmth
being fair

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 Basic Therapeutic Approaches to Maintain Self - esteem and Minimize Anxieties

a. emphatic listening
b. acceptance
c. honest communication

3. Personal characteristics

personal magnetism
enthusiasm( strong feeling of interest)
cheerfulness
self – control
patience
flexibilty (adapt to various types of personalities and changing environment)
a sense of humor
a good speaking voice
self-confidence
willingness to admit errors
caring attitude

4. Teaching processes

JACOBSON defined it as “the mechanics, methods and skills in classroom and

clinical teaching.”
Teaching subject matter in a stimulating way and inspiring learner interest is based
on several factors like the teacher’s style, personality, personal interest in the
subject, use of a variety of teaching strategies, and thorough knowledge of the
subject matter.

5. Evaluation practices

Evaluation includes the following:

Clearly communicating expectations

Provides timely feedback on students progress
Corrects students misconceptions
Being fair in the evaluation process
Gives examination/tests pertinent to the subject matter

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 6. Availability to students

Instructor is physically present

Being there in stressful situation

Helping students give patient care
Giving appropriate amounts of supervision
Freely answering questions
Acting as a resource person during clinical learning experiences.
Learners should be told at the beginning of instruction what they should do if they
need assistance and the instructor is not available.
The teacher should have a backup plan for assistance by a staff MT, another
instructor or a head MT who can be “on call” when the need arises.

OTHER IMPORTANT CHARACTERISTICS OF A TEACHER

1. Teaching Clarity

◆ It is defined as “the mosaic of behaviors that teachers use in order to make what is
to be learned intelligible, comprehensive, and learnable.”

◆ It has the ff. characteristics; logically organizes instruction, explains what is to be

learned, uses simple terms, assess students understanding, gives examples whenever
possible, allows students to have time to think about what is being taught.

◆ Repeats information and then summarizes.

2. Time on Task

◆ Effective teachers provide students with relevant academic activities and see to it
that students spend an adequate amount of time actually engaged in these learning
activities.

3. Class time / management

◆ Instructors make sure students know what they expect.

◆ They make certain that students know what to do if they need help.

◆ They follow through with reminders and rewards to enforce rules.

4. Questioning

◆ Effective teachers ask appropriate questions in a manner that ensures participation

and facilitates mastery of academic content.

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 ◆ Questioning focuses on both facts and abstract thinking.

5. Comprehension Instruction

◆ Effective teachers emphasize independent learning and learning to learn.

◆ They teach students to apply concepts, solve problems, and monitor their own
comprehension.

6. Grouping

◆ Effective teachers are able to group students for individualized and smallgroup
instruction.

◆ They are able to work with more than one student or group at a time.

7. Level of Cognitive Instruction

◆ Most instruction for low-achieving students emphasizes mechanical rote learning.

◆ Effective teachers try to move toward high order thinking skills and independent
learning by motivating students to learn and by using appropriate materials and
activities.

TEACHING STYLE

◆ This is an outgrowth of the teacher’s personality and character.

◆ It is a process by which the teacher delivers the subject matter to the students.

◆ This maybe the primary cause of the students boredom or excitement.

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4. PRINCIPLES OF GOOD TEACHING PRACTICE

7 Principles of Good Teaching Practice in the Undergraduate Education

1. Encourage student-faculty contact

2. Encourage cooperation among students

3. Encourage active learning

4. Give prompt feedback

5. Emphasize time on task

6. Communicate high expectations

7. Respect diverse talents and ways of learning

5. THE LEARNERS

Seven Types of Intelligences According to Gardner’s

1. Linguistics- This area has to do with words, spoken or written. People with high
verbal linguistic intelligence display a facility with words and languages. They are
typically good at reading, writing, telling stories and memorizing words along with dates.
They tend to learn best by reading, taking notes, listening to lectures, and by discussing
and debating about what they have learned Those with verbal-linguistic intelligence learn
foreign languages very easily as they have high verbal memory and recall, and an ability
to understand and manipulate syntax and structure.

2. Logical mathematical- This area has to do with logic, abstractions, reasoning and
numbers and critical thinking. While it is often assumed that those with this intelligence
naturally excel in mathematics, chess, computer programming and other logical or
numerical activities, a more accurate definition places less emphasis on traditional
mathematical ability and more on reasoning capabilities, recognizing abstract patterns,
scientific thinking and investigation and the ability to perform complex calculations.

3. Spatial- This area deals with spatial judgement and the ability to visualize with the
mind's eye. Careers which suit those with this type of intelligence include artists,
designers and architects. A spatial person is also good with puzzles.

4. Musical- This area has to do with sensitivity to sounds, rhythms, tones, and music.
People with a high musical intelligence normally have good pitch and may even have

Page 7 of 9
absolute pitch, and are able to sing, play musical instruments, and compose music. Since
there is a strong auditory component to this intelligence, those who are strongest in it
may learn best via lecture. Language skills are typically highly developed in those whose
base intelligence is musical. In addition, they will sometimes use songs or rhythms to
learn. They have sensitivity to rhythm, pitch, meter, tone, melody or timbre. Careers
that suit those with this intelligence include instrumentalists, singers, conductors, disc
jockeys, orators, writers and composers.

5. Bodily kinesthetic- The core elements of the bodily-kinesthetic intelligence are

control of one's bodily motions and the capacity to handle objects skillfully. Gardner
elaborates to say that this intelligence also includes a sense of timing, a clear sense of
the goal of a physical action, along with the ability to train responses so they become
like reflexes.

In theory, people who have bodily-kinesthetic intelligence should learn better by

involving muscular movement (e.g. getting up and moving around into the learning
experience), and are generally good at physical activities such as sports or dance. They
may enjoy acting or performing, and in general they are good at building and making
things. They often learn best by doing something physically, rather than by reading or
hearing about it. Those with strong bodily-kinesthetic intelligence seem to use what
might be termed "muscle memory", drawing on it to supplement or in extreme cases
even substitute for other skills such as verbal memory.

Careers that suit those with this intelligence include: athletes, pilots, dancers, musicians,
actors, surgeons, builders, police officers, and soldiers. Although these careers can be
duplicated through virtual simulation, they will not produce the actual physical learning
that is needed in this intelligence

6. Interpersonal- This area has to do with interaction with others. Interpersonal

intelligence is the ability to understand others. In theory, individuals who have high
interpersonal intelligence are characterized by their sensitivity to others' moods, feelings,
temperaments and motivations, and their ability to cooperate in order to work as part of
a group.

According to Gardner in How Are Kids Smart: Multiple Intelligences in the Classroom,
"Inter- and Intrapersonal intelligence is often misunderstood with being extroverted or
liking other people..." Interpersonal intelligence means that one understands what
people need to work well. Individuals with this intelligence communicate effectively and
empathize easily with others, and may be either leaders or followers. They typically learn
best by working with others and often enjoy discussion and debate. Careers that suit
those with this intelligence include sales, politicians, managers, teachers, counselors and
social workers.

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 7. Intrapersonal- This area has to do with introspective and self-reflective capacities.
This refers to having a deep understanding of the self; what your strengths/ weaknesses
are, what makes you unique, being able to predict your own reactions/emotions.
Philosophical and critical thinking is common with this intelligence. Many people with this
intelligence are authors, psychologists, counselors, philosophers, and members of the
clergy.

8. Naturalistic- This area has to do with nurturing and relating information to one’s
natural surroundings. Examples include classifying natural forms such as animal and
plant species and rocks and mountain types; and the applied knowledge of nature in
farming, mining, etc. Careers which suit those with this intelligence include naturalists,
farmers and gardeners.

Medical Technologists/Pubic Heath Professionals as Teachers

◆ MT/PHs take on the teaching role in many settings.

◆ They may be patient or client teachers, school MTs/PH worker, staff development
instructors, or collegiate educators.

◆ MT/PHs who spend the majority of their time as staff development instructors, or
collegiate educators must have formal preparation for the educator role and need to
become expert teachers to prepare the next generation of patient educators.

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CHARACTERISTICS OF LEARNING

1) Learning is a process which is continuous & it never stops at any phase. It is a lifelong process hence
learning starts from birth & ends only with the death of an individual. Hence, we can say that learning
proceeds from womb to tomb.
E.g. when a child takes birth he first learns to cry for food, and at each phase of life at every step the
child learns to walk, run, talk, write alphabets etc.

2) Learning is the process which leads to mental growth of an individual. The growth takes place along with
the learning.

3) Basically, when learning takes place the individual learns to adjust & adopt with the environment.

4) Learning is purposeful. Though learning takes place at every place & at every moment all the learnings are
not useful. Hence those learning which are useful & meaningful are learnt.

5) Learning is active process. Learning by doing is the best part of learning

e.g. it becomes easy for the science students to learn the concepts in science when they perform
practical.

6) Learning takes place individually & as well as socially

e.g. When a seminar or workshop is conducted, then all the members of the group learn to share their
thoughts, each one learns something new from the other individual.

7) Last but not the least learning brings about the change in the behavior in individual
e.g. a child is always taught values & manners, & due to these teachings, a child learns to respect their
elders & teachers, learns to speak politely etc., which bring about the change in his behavior as the child
grows.

STEPS IN THE LEARNING PROCESS

Learning is a process and knowing the various aspects of learning helps the teacher in ensuring & making the
learning effective.

1. Need: Learning takes place as a result of response to some stimulation. Unless the individual has some
unsatisfactory need or derive which causes him to act in an attempt to satisfy the need, no learning will take
place. When the need of the learner is strong, the learner sets definite goals for achievement of his needs &
this makes learning more concrete.
E.g. A student, who wants to score a good grade, starts working right from the beginning. Need should
be made by the teacher by creating interest. The teacher should also help the child in setting attainable
goals for himself.

2. Readiness: Every child is not ready to learn at a particular time. The child needs physical & mental maturity in
order to learn. There should be mental & physical willingness to learn. We tend to pay less attention to this
type of maturity. Many a time, we impose learning situations on a child before he is ready.

3. Situation: Learning depends on the situation provided at school & at home. In school, the learning
environment should be conducive or congenial. The teacher’s attitude should be encouraging & the teacher
should use suitable teaching methods & techniques. The type of situation provided by the teacher contributes
towards the speed & quality of learning.
E.g. Special methods can be provided depending upon the age of the child.

4. Interaction: The child with this needs & goals learns to interact in a learning situation. Interaction is a process
of responding to a situation and getting a feedback from it. Interaction may be in the form of observations,
emotional reactions, verbal reactions or physical reactions. Teacher should find ways & means to involve the
students in the learning activity / process.
 5. Exploration of the situation: Exploration is the way the learner explores / interprets the stimuli in the
environment. The correct responses cannot be determined at once. They require to be thought over;
i.e. the whole situation needs to be explored. After trial & error, the learner comes to the right solution.

6. Perception: Perception is to give some meaning to what you are seeing. Sensing + Meaning = Perception. Each
one perceives the environment differently. As a teacher, one wants the class to perceive uniformly, so the
teacher should use visual aids, diagrams, etc. Because of the individual differences among the students, each
student perceives whatever is taught, differently, so teacher should cater to the need of every individual.

7. Response: Response is the actual outcome of the learner. It is the outcome of interaction, exploration &
perception of the situation. He may give a trial by direct attack to overcome the barrier in his way.

8. Reinforcement: If the response is successful in action, in satisfying the need, that response is reinforced and
on subsequent occasions the individual will tend to repeat it.

9. Integration: Learning implies the selection & organization of correct responses. The last step of the learning
process consists in integrating the successful responses of the individual’s previous learning, so that it becomes
part of a new functional whole.

LESSON: TEACHING APPROACHES, METHODS, STRATEGIES, & TECHNIQUE

What is teaching?

Teaching – is a deliberate intervention involving the planning and implementation of instructional activities and
experiences to meet the intended learner outcomes based on the teaching plan.
It is concerned with the growth and development of the whole personality of the student.
It is a mixture of arts and science.
It starts with the experience of a learner

The How’s of Teaching

I. APPROACH

Approach - It is a set of principles, beliefs, or ideas about the nature of learning which is translated into the
classroom.
A teacher’s personal philosophy of teaching
An approach gives rise to methods, the way of teaching something, which use classroom activities or
techniques to help learners; guiding principle
Learning approaches can be divided into TWO APPROACHES are student-centered approach and teacher-
centered approach.

MAIN APPRAOCHES OF TEACHING LEARNING

a. Teacher-centered approach - are more traditional in nature, focusing on the teacher as instructor.
They are sometimes referred to as direct instruction, deductive teaching or expository teaching, and
are typified by the lecture type presentation.
In these methods of teaching, the teacher controls what is to be taught and how students are
presented with the information that they are to lean.

b. Student-centered approach - Student centered approaches (sometimes referred to as discovery learning,

inductive learning, or inquiry learning) place a much stronger emphasis on the learner’s role in the learning
process.
When you are using student- centered approaches to teaching, you still set the learning agenda but
you have much less direct control over what and how students learn.
TEACHER-CENTERED VS. STUDENT-CENTERED APPROACH

Teacher- centered approach Student-centered approach

Subject-centered Learner-centered

Teacher-dominated Interactive

Banking-approach Constructivist

Direct teaching-approach Indirect teaching-approach

OTHER APPRAOCHES OF TEACHING LEARNING

i. Herbartian approach: This approach is given by John Fredric Herbart. He advocated that teaching should be
planned actively if we intend to make it.
This approach is based on appreciative mass theory of learning. Therefore, he gives more emphasis of
teacher presentation.
The proposition of that theory is that the learner is like a clean slate and all the knowledge is given from
outside

ii. Evaluation Approach or Bloom’s Approach: The concept of evaluation approach is given by B.S. Bloom.
His main emphasis was that testing should be based on teaching and both these activities should be
objectives centered.
Just like today, teaching is organized by using the evaluation approach.
Under this approach yearly plan and unit plan are prepared. It has three main steps:
a) Formulating Educational Objectives
b) Creating Learning Experiences
c) Evaluating the Change behavior

iii. Research-based approach - as the name implies, teaching and learning are anchored on research findings.

iv. Whole-child approach – the learning process itself takes into account not only the academic needs of
learners, but also their emotional, psychological, spiritual and developmental needs.

v. Spiral progression – the same concept is taught from one level to another in increasing complexity

ADDITIONAL NOTES: (from video)

Teaching Approaches in the K-12 Curriculum
1. Learner-centered approach – enables life long learning & independent problem-solving
2. Inclusive approach – education for all; everyone is included
3. Developmentally-appropriate approach – tasks are within the developmental stage
4. Responsive & relevant – teaching is meaningful when related to student’s life; it is responsive because it
answers the needs or the challenges that a student is facing currently in his life
5. Culture-sensitive – teaching should respect cultures
6. Contextualized & global – exerting effort beyond the classroom
7. Research-based – teaching and learning are anchored on researches
8. Constructivist – students build upon their prior knowledge
9. Inquiry-based – learning through student-generated questions
10. Reflective teaching – teacher thinks over his/her teaching
11. Collaborative approach – the use of teamwork, groupwork, and partnership
12. Integrative – intradisciplinary, interdisciplinary, & transdisciplinary
Intradisciplinary – only concerned with one subject
Interdisciplinary - concerned with the relationship between the different subjects
Transdisciplinary – learning can be transmitted in real life
13. Mother tongue-based MLE – teaching uses more than one language & starts with the mother tongue
 14. Spiral progression – the same concept is thought from one level to another in increasing complexity

II. TEACHING METHOD

Method - A systematic way of doing something. It implies an orderly logical arrangement of steps in teaching.
It is more procedural.
It refers to the general principles, or pedagogy used for classroom instruction. Your choice of teaching
method depends on what fits you- your educational philosophy, classroom demographic, subject area(s) and
school mission statement.

Types of Teaching Methods

a. Inductive Method - students moves towards specified (example) to general (rules). At first many examples
are put forward to student and then he draws out a conclusion on the basis of these examples; specific to
general

b. Deductive Method - is opposite to inductive approach because in it, first a principle or rule is put in front of
students and then it is clarified by giving examples; general to specific

c. Direct Method - It is teacher-centered. The teacher is the sage on stage

d. Indirect Method - It is student-centered. The teacher becomes the guide on the side.

OTHER TEACHING METHODS

Lecture method
Discussion
Reporting
Demonstration
Self-pacing
Investigatory
Integrated/Blended

III. TEACHING STRATEGY

Strategy - a method of approaching the task of teaching, mode of operation to achieve a goal
skill full planning of a working system by which the objectives can be achieved easily.
According to E. Stones and S. Morris teaching strategy is a generalized plan for a lesson which includes
structure, desired learner behavior in terms of goals of instruction and an outline of planned tactics
necessary to implement the strategy.

TEACHING STRATEGIES
Reciprocal learning: 2 students work with each other and learn from each other
Jigsaw: concepts are divided by the number of students that you have and they try to put the pieces
together by learning with each other
Philips 666: 6 groups, 6 members, 6 topics, 6 mins; all the things that they are doing is based on number 6
Think-Pair share: students think by themselves, be paired, and share ideas with each other
Fishbowl: draw names and make the person answer that question
Roleplay: students play role
Debate: made to speak minds out about a topic

IV. TEACHING TECHNIQUE

Techniques - the unique ways of carrying out a particular task, in the teaching and learning process. Thus, it’s
the individual teachers’ unique way of applying a strategy.
Tricks that can be taught to another teacher.
For instance, two teachers may decide to use small group discussions as their means of delivering a lesson
but each may have a unique way of conducting the process of the discussion. One may decide to use two
pupils to conduct the discussion; the other may decide to employ four pupils for that. 0Furthermore, each
teacher will definitely have a unique way of delivering his lesson
LESSON: LEARNING THEORIES AND LEARNING STYLE MODELS
What is Learning?
• Learning is defined as a relatively permanent change in mental processing, emotional functioning, and/or
behavior as a result of experience.
To assess the learning of a person look unto their Change of behavior
• It is the lifelong, dynamic process by which individuals acquire new knowledge or skills and alter their
thoughts, feelings, attitudes, and actions.

LEARNING THEORIES
• Behaviorist theory
• Cognitive theory
• Social learning theory

Learning Theory
• A learning theory is a coherent framework and set of integrated constructs and principles that describe,
explain, or predict how people learn.
• Whether used singly or in combination, learning theories have much to offer the practice of health care.

A. BEHAVIORIST THEORY
• Focusing mainly on what is directly observable, behaviorists view learning as the product of the stimulus
conditions (S) and the responses (R) that follow—sometimes termed the S-R model of learning.
• Learner is passive
Respondent conditioning by Ivan Pavlov
Operant conditioning by B.F. Skinner

i. Respondent Conditioning
• Respondent conditioning (also termed classical or Pavlovian conditioning) emphasizes the importance of
stimulus conditions and the associations formed in the learning
Unconditioned stimulus - elicits response without learning
Unconditioned response - unlearned, inborn response
Conditioned stimulus - elicits response after being learned; unconditioned stimulus + neutral
stimulus = conditioned stimulus (association)
Conditioned response - automatic response after being learned

• In this basic model of learning, a neutral stimulus (NS)—a stimulus that has no particular value or meaning
to the learner—is paired with a naturally occurring unconditioned or unlearned stimulus (UCS) and
unconditioned response (UCR)

• After a few such pairings, the neutral stimulus alone, without the unconditioned stimulus, elicits the same
response. Often occurring without thought or awareness, learning takes place when the newly conditioned
stimulus (CS) becomes associated with the conditioned response (CR).

• Respondent conditioning highlights the importance of the “atmosphere” and staff morale in health care.
• Besides influencing the acquisition of new responses to environmental stimuli, principles of respondent
conditioning may be used to extinguish a previously learned response.
 ii. Operant Conditioning
• Operant conditioning, developed largely by B. F. Skinner (1974, 1989), focuses on the behavior of the
organism and the reinforcement that occurs after the response (Alberto & Troutman, 1990).
• Reward/reinforcement and punishment system.
Reward/reinforcement - strengthens the behavior (good behavior)
– Positive reinforcement - application of a pleasant stimulus. Occurs after a response and increase
the likelihood of a response to occur again.

– Negative reinforcement - removal of an aversive or unpleasant stimulus that increase the

likelihood of a response occurring again.

Punishment - reduce the likelihood of a behavior (bad behavior)

– Positive punishment - occurs following a behaviour and reduce the likelihood of the behavior
Addition of reprimand or unpleasant stimuli

– Negative punishment - removal of a desirable condition following a behavior that reduces the
likelihood of that behavior.
Removal of pleasant stimulus

• According to operant conditioning principles, behaviors may be decreased through either nonreinforcement
or punishment.
• Operant conditioning techniques provide relatively quick and effective ways to change behavior. Carefully
planned programs using behavior modification procedures can readily be applied to health care.
• Operant conditioning and behavior modification techniques also have been found to work well with some
nursing home and long-term care residents (Proctor, Burns, Powell, & Tarrier, 1999).

B. COGNITIVE LEARNING THEORY

• Cognitive learning theorists stress the importance of what goes on “inside” the learner (Brien & Eastmond,
1994; Lambert &McCombs, 1998; Palincsar, 1998).
• The key to learning and changing is the individual’s cognition (perception, thought, memory, and ways of
processing and structuring information).
• A highly active process largely directed by the individual, learning involves perceiving the information,
interpreting it based on what is already known, and then reorganizing the information into new insights or
understanding.
• Cognitive learning theory includes several well-known perspectives
– gestalt
– information processing
– cognitive development/human development
– social constructivism
– social cognition theory

a. Gestalt Perspective
Gestalt perspective emphasizes the importance of perception in learning (Garcia, Baker, & deMayo,
1999; Hilgard & Bower, 1966; Kohler, 1947, 1969).
A principal assumption is that each person perceives, interprets, and responds to any situation in his
or her own way. While there are many GESTALT PRINCIPLES worth knowing (Hilgard & Bower, 1966)

1. A basic principle is that psychological organization is directed toward simplicity, equilibrium, and
regularity.
Example: the bewildered faces of some patients listening to a detailed, evasive explanation about their
disease, when what they desire most is a simple, clear explanation that settles their uncertainty and
relates directly to them and their familiar experiences.

2. Another central gestalt principle is that perception is selective, which has several ramifications. First,
because no one can attend to all the surrounding stimuli at any given time, individuals orient themselves to
certain features of an experience while screening out or habituating to other features.
 Example: Patients in severe pain or worried about their hospital bills may not attend to well-intentioned
patient education information.

3. What individuals pay attention to and what they ignore are influenced by a host of factors: past
experiences, needs, personal motives and attitudes, reference groups, and the particular structure of the
stimulus or situation (Sherif & Sherif, 1969; Sherif, 1976).

b. Information Processing
Information processing is a cognitive perspective that emphasizes thinking processes: thought,
reasoning, the way information is encountered and stored, and memory functioning (Bigge &
Shermis, 1992; Gagne,1985; Sternberg, 1991, 1996).
How information is incorporated and retrieved is useful for health professionals to know, especially
in relation to older people’s learning (Hooyman & Kiyak, 1999).

Information Processing Model

External processes
Stage 1 ATTENTION: orienting stimuli, physical and emotional properties arouse interest
Stage 4 ACTION: response

Internal processes
Stage 2 PROCESSING: sensory memory
Stage 3 MEMORY STORAGE: short-term memory or long-term memory (may cause problem on retrival)

• Education involves assessing how a learner attends to, processes, and stores the information that is
presented as well as finding ways to encourage the retention and retrieval processes.

9 ELEMENTS THAT ACTIVATE LEARNING EFFECTIVELY:

– Gain the learner’s attention (reception)
– Inform the learner of the objectives and expectations (expectancy)
– Stimulate the learner’s recall of prior learning (retrieval)
– Present information (selective perception)
– Provide guidance to facilitate the learner’s understanding (semantic encoding)
– Have the learner demonstrate the information or skill (responding)
– Give feedback to the learner (reinforcement)
– Assess the learner’s performance (retrieval)
– Work to enhance retention and transfer through application and varied practice (generalization)
 c. Cognitive Development
Cognitive development is a third perspective that focuses on qualitative changes in perceiving,
thinking, and reasoning as individuals grow and mature (Baltes, Staudinger, & Lindenberger, 1999;
Vander Zanden, Crandell, &Crandell, 2000).
Its principal assumption is that learning is a developmental, sequential, and active process that
transpires as the child interacts with the environment, makes “discoveries” about how the world
operates, and interprets these discoveries in keeping with what she knows (schema).

Piaget (Piaget & Inhelder, 1969) identified FOUR SEQUENTIAL STAGES OF COGNITIVE DEVELOPMENT:

(1) the sensorimotor stage during infancy, where infants explore their environments and attempt to coordinate
sensory information with motor skills;

(2) the preoperational stage during early childhood, where youngsters are able to mentally represent the
environment, regard the world from their own egocentric perspective, and come to grips with
symbolization;

(3) the concrete operations stage during the elementary school years, where children are able to attend to
more than one dimension at a time, conceptualize relationships, and operate on the environment;

(4) the formal operations stage during adolescence, where teenagers begin to think abstractly, are able to deal
with the future, and can see alternatives and criticize.

d. Social Constructivism
Reflecting the influence of postmodernism, social constructivists posit that learning and human
development are richly colored by the ever-fluid social and cultural context in which people find
themselves.

CENTRAL TENETS OF THIS PERSPECTIVE are (Berliner & Calfee, 1996):

1. the learning process is influenced strongly by the culture
2. effective learning occurs through social interaction, collaboration, and negotiation

Learning is facilitated by sharing beliefs, by acknowledging and challenging differing conceptions,

and by negotiating new levels of conceptual understanding (Marshall, 1998).
Cooperative learning and self-help groups are examples of social constructivism in action

e. Social Cognition Theory

The social cognition perspective highlights the influence of social factors on perception, thought,
and motivation. A host of scattered explanations can be found under the rubric of social cognition
(Fiske & Taylor, 1991), which, when applied to learning, emphasize the need for instructors to
consider the dynamics of the social environment and groups on both interpersonal and
Intrapersonal behavior.
A significant benefit of the cognitive theory to health care is its encouragement of a recognition
and appreciation of the individuality and rich diversity in how people learn and process
experiences (Farnham-Diggory, 1992; Lewis & Daltroy, 1990).

C. SOCIAL LEARNING THEORY

• According to early social learning theory, much of learning occurs by observation—watching other people
and discerning what happens to them.
Presence of role models; we learn by watching others
• Learning is often a social process, and other individuals, especially “significant others,” provide compelling
examples or role models for how to think, feel, and act.
• While Miller and Dollard (1941) viewed social learning as a mixture of behaviorist and psychodynamic
influences, Bandura (1977, 1986, 2001) is credited with outlining the behaviorist, cognitive, and, more
recently, social cognition dimensions of the theory.
Social Learning Theory Based on Bandura (1977)

Cognitive Principles
1. The first phase is the ATTENTIONAL PHASE, a necessary condition for any learning to occur. Research
indicates that role models with high status and competence are more likely to be observed, although the
learner’s own characteristics (needs, self-esteem, competence) may be the more significant determiner of
attention.

2. Second is the RETENTION PHASE, which involves the storage and retrieval of what was observed.

3. Third is the REPRODUCTION PHASE, where the learner copies the observed behavior. Mental rehearsal,
immediate enactment, and corrective feedback strengthen the reproduction of behavior.

4. Fourth is the MOTIVATIONAL PHASE, which focuses on whether the learner is motivated to perform a
certain type of behavior. Reinforcement or punishment for a role model’s behavior, the learning situation,
and the appropriateness of subsequent situations where the behavior is to be displayed all affect a learner’s
performance (Bandura, 1977; Gage & Berliner, 1998).
ADDITIONAL NOTES:
LEARNING STYLE METHODS
A. Kolb’s Learning Style Inventory
B. Gregorc Style Delineator
C. Gardner’s Seven Types of Intelligence
D. Field-Independent/Field-Dependent Embedded Figures Test

A. KOLB’S LEARNING STYLE INVENTORY

David Kolb (1984), a management expert from Case Western Reserve University, developed an experiential
learning model in the early 1970s. Kolb believes knowledge is a transformational process that is continuously
created and recreated.
Kolb’s theory on learning style is that learning is a cumulative result of past experiences, heredity, and the
demands of the present environment.
Learning is a continuous process grounded in the reality that the learner is NOT a blank slate. Every learner
approaches a topic to be learned with preconceived ideas.
Kolb’s model, known as the Cycle of Learning, includes four modes of learning, which reflect TWO MAJOR
DIMENSIONS OF PERCEPTION AND PROCESSING.
He hypothesized that learning results from the way learners perceive as well as how they process what they
perceive.

1. The DIMENSION OF PERCEPTION involves two opposite perceptual viewpoints.

a. Concrete experience (CE mode) - learners tend to rely more on feelings than on a systematic approach
to problems and situations. Learners who fall into this category like relating with people, benefit from
specific experiences, and are sensitive to others.

b. Abstract conceptualization (AC mode) - learners rely on logic and ideas rather than on feelings to deal
with problems or situations. People who fall into this category use systematic planning and logical
analysis to solve problems.

2. The PROCESS DIMENSION involves two opposite orientations.

a. Active experimentation (AE mode) - learning is active, and learners like to experiment to get things
done. They prefer to influence or change situations and see the results of their actions. They enjoy
involvement and are risk takers.

b. Reflective observation (RO mode) - learners rely on objectivity, careful judgment, personal thoughts,
and feelings to form opinions. People who fall into this category look for meaning of things by viewing
them from different perspectives.

The Four Learning Style Types by Kolb’s (formed through combination of perception and process dimensions
mentioned above)

1. Diverger - People with this learning style are good at viewing concrete situations from many points of view.
They like to observe, gather information, and gain insights rather than take action.
Working in groups to generate ideas appeals to them.
They place a high value on understanding for knowledge’s sake and like to personalize learning by
connecting information with something familiar in their experiences
They have active imaginations, enjoy being involved, and are sensitive to feelings.
Divergent thinkers learn best, for example, through group discussions and participating in
brainstorming sessions.

2. Assimilator - people with this learning style demonstrate the ability to understand large amounts of
information by putting it into concise and logical form.
They are less interested in people and more focused on abstract ideas and concepts.
They are good at inductive reasoning, value theory over practical application of ideas, and need time to
reflect on what has been learned and how information can be integrated into their past experiences.
 They rely on knowledge from experts.
Assimilative thinkers learn best, for example, through lecture, one-to-one instruction, and self-
instruction methods with ample reading materials to support their learning.

3. Converger - people with this learning style type find practical application for ideas and theories and have the
ability to use deductive reasoning to solve problems.
They like structure and factual information, and they look for specific solutions to problems.
Learners with this style prefer technical tasks rather than dealing with social and interpersonal issues.
Kolb postulates that individuals with this learning style have skills that are important for specialist and
technology careers.
The convergent thinker learns best, for example, through demonstration– return demonstration
methods of teaching accompanied by handouts and diagrams.

4. Accommodator - people with this learning style learn best by hands-on experience and enjoy new and
challenging situations.
They act on intuition and “gut feelings” rather than on logic. These risk takers like to explore all
possibilities and learn by experimenting with materials and objects.
Accommodative thinkers are perhaps the most challenging to educators because they demand new
and exciting experiences and are willing to take risks that might endanger their safety.
Role-playing, gaming, and computer simulations, for example, are methods of teaching most preferred
by this style of learner.

B. GREGORC STYLE DELINEATOR

Anthony Gregorc’s extensive research on learning style (1982) identifies four sets of dualities: perception,
ordering, processing, and relating.
Based on his research, Gregorc developed an instrument called the Gregorc Style Delineator. This self-
analysis instrument is designed to assess a person’s learning style.

FOUR LEARNING PATTERNS ARE IDENTIFIED BY GREGORC:

• Concrete sequential (CS)
• Abstract sequential (AS)
• Abstract random (AR)
• Concrete random (CR).

1. Concrete sequential learners tend to operate in a highly structured, conservative manner in which specific
details and time schedules are critical.
objectives are important to CS learners
they do not tolerate being interrupted during the performance of a skill
they learn better in a quiet environment
they like recognition or a compliment on
they interpret words and labels literally.
learning can be enhanced by using handouts, demonstration teaching, hands-on opportunities with
guided practice, lectures with visual aids, and computer- aided instruction.
 2. Abstract sequential learners are global thinkers and surround themselves with language and other symbols
of knowledge.
they like to deal with abstract ideas, and their style of learning continually leads to further
understanding.
they do not learn well when sequence is interrupted.
they need facts and written documentation to refer to, such as statistics and resource references.
When learning, the AS individual typically does not display emotion and has difficulty picking up
subtle verbal and nonverbal cues.
they need a quiet environment to concentrate and learn.
Learning can be enhanced by audiotapes, lectures, and supplemental reading.

3. Abstract random learners value relationships over time-bound structures. They think in global terms, and
their thinking processes are anchored in feelings.
they direct attention to information that has personal meaning to them.
they like a busy environment for learning
Learning can be enhanced with color, music, pictures, drawings, symbols, poetry, and humor. Learning
is best achieved in groups, with the opportunity for discussion and question-and-answer sessions.

4. Concrete random learners tend to seek alternatives and create choices where none existed before.
they are very inquisitive and will question motives.
their attention is focused on the process, and will make intuitive leaps or insights. The “why” is more
important than the “how.”
they do not like detail and have difficulty with step-by-step learning.
Learning for the CR individuals is enhanced with simulations, computer and board games, case studies,
and brainstorming sessions.

C. GARDNER’S SEVEN TYPES OF INTELLIGENCE

Psychologist Howard Gardner (1983) developed a theory focused on seven kinds of intelligence, which is
useful in looking at styles of learning in children.
Gardner based his theory on findings from brain research, developmental work with children, and
psychological testing.
He identified seven kinds of intelligence located in different parts of the brain: linguistic, logical
mathematical, spatial, musical, bodily kinesthetic, interpersonal, and intrapersonal.

Gardner’s Seven Types of Intelligence

1. Linguistic intelligence seems to be in the Broca’s area of the left side of the brain for most people.
have highly developed auditory skills and think in words.
like to write, tell stories, spell words accurately, enjoy reading, and can recall names, places, and dates.
learn best by verbalizing, hearing, or seeing words. Word games or crossword puzzles are an excellent
method for helping these children learn new material.

2. Logical-mathematical intelligence involves both sides of the brain. The right-side deals with concepts, and the
left side remembers the symbols.
strong in intelligence explore patterns, categories, and relationships.
in the adolescent years, they have the ability for logical thinking with a high degree of abstraction.
they question many things and ask where, what, and when.
They can do arithmetic problems quickly in their heads, like to learn by computers, and do experiments to
test concepts they do not understand. They enjoy strategy board games such as chess or checkers.

3. Spatial intelligence is related to the right side of the brain.

learn by images and pictures.
enjoy such things as building blocks, jigsaw puzzles, and daydreaming
like to draw or do other art activities, can read charts and diagrams, and learn with visual methods such as
videos or photographs.

4. Musical intelligence is also related to the right side of the brain.

 can be found singing a tune, telling you when a note is off-key, playing musical instruments with ease,
dancing to music, and keeping time rhythmically.

5. Bodily kinesthetic intelligence includes the basal ganglia and cerebellum of the brain in addition to other
brain structures. These children learn by processing knowledge through bodily sensations.
good at athletic sports and have highly developed fine-motor coordination.

6. Interpersonal intelligence involves the prefrontal lobes of the brain.

understand people, are able to notice others’ feelings, tend to have many friends, and are gifted in the social
skills.

7. Intrapersonal intelligence, like interpersonal intelligence, involves the prefrontal lobes of the brain.
have strong personalities and prefer the inner world of feelings and ideas and like being alone.
like a quiet area to learn, and many times need to be by themselves to learn.
tend to be self-directed and self-confident. They learn well with independent, self-paced instruction.

D. FIELD-INDEPENDENT/FIELD-DEPENDENT EMBEDDED FIGURES TEST

An extensive series of studies by H. Witkin and associates (1971a) identified two styles of learning in the
cognitive domain.
Learners have preference styles for certain environmental cues:

1. A field-independent person perceives items as separate or differentiated from the surrounding field
2. A field-dependent person’s perception is influenced by or immersed in the surrounding field. Structure
information in the environment.

FIELD-INDEPENDENT FIELD-DEPENDENT
Are not affected by criticism Are easily affected by criticism
Will not conform to peer pressure Will conform to peer pressure
Are less influenced by external feedback Are influenced by feedback (grades and
Learn best by organizing their own material evaluations)
Have an impersonal orientation to the world Learn best when material is organized
Place emphasis on applying principles Have a social orientation to the world
Are interested in new ideas or concepts for own Place emphasis on facts
sake Prefer learning to be relevant to own
Provide self-directed goals, objectives, and experience
reinforcement Need external goals, objectives, and
Prefer lecture method reinforcements
Prefer discussion method