Community nursing discussion

Chapter 8 Community Health Education Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. Health Education … … is any combination of learning experiences designed to predispose, enable, and reinforce voluntary behavior conducive to health in individuals, groups or communities. – Green and Kreuter, 2004 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 2 Health Education’s Goals   To understand health behavior and to translate knowledge into relevant interventions and strategies for health enhancement, disease prevention, and chronic illness management To enhance wellness and decrease disability Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 3 Health Education’s Goals (Cont.) Community nursing discussion

  Attempts to actualize the health potential of individuals, families, communities, and society Includes a broad and varied set of strategies aimed at influencing individuals within their social environment for improved health and well-being Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 4 Learning Theories    Humanistic theory helps individuals develop their potential in a self-directing and holistic manner. Cognitive theory recognizes the brain’s ability to think, feel, learn, and solve problems; theorists in this area train the brain to maximize these functions.

Social learning is based on behavior that explains and enhances learning through the concepts of efficacy, outcome expectation, and incentives. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5 Adult Learners       Need to know Concept of self Experience Readiness to learn Orientation to learning Motivation – Knowles (1980, 1989) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 6 Health Education Models Health Belief Model (HBM)        Perceived susceptibility Perceived severity Perceived benefits Perceived barriers Self-efficacy Demographics Cues to action Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 7 Health Education Models (Cont.) Health Promotion Model (HPM)  Individual characteristics and behaviors ➢  Behavior—specific cognitions and affect ➢  Prior behaviors, personal factors Activity-related affect, interpersonal influences, situational factors, commitment to plan of action, perceived self-efficacy, immediate competing demands and preferences, perceived benefits of health-promoting behaviors, perceived barriers to health-promoting behaviors Behavioral outcome ➢ Health-promoting behavior Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 8 Model of Health Education Empowerment … nurses cannot assign power and control to the individual within the community but rather … the “power” must be taken on by the individual and community with the nurse guiding this dynamic process. – Van Wyk, 1999 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

9 Model of Health Education Empowerment (Cont.)  Process includes examining ➢ Education ➢ Health literacy ➢ Gender ➢ Racism ➢ Class  Recognizes the structural and foundational changes that are needed to elicit change for socially and politically disenfranchised groups Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 10 Problem-Solving Education …  …centers on empowerment (Freire, 2005) ➢ Allows active participation and ongoing dialogue ➢ Encourages learners to be critical and reflective about health issues ➢ Involves individuals as subjects, not objects ➢ Increases health knowledge through a participatory group process  Involves activism on the part of the educator

➢ ➢ Facilitator-educator is a resource person and is an equal partner with the other group members Leads to sustainable lateral relationships Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 11 Participatory Action Research (PAR)   Goal of PAR is social change Embraces the use of community-based participatory methods ➢ Participation and action from stakeholders and knowledge about conditions and issues helps to facilitate strategies reached collectively Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 12 Community Empowerment    Community members take on greater power to create change Based on community cultural strengths and assets Attention must be given to collective rather than individual efforts to ensure that outcomes reflect voices of the community and truly make a difference in people’s lives Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 13 The Nurse’s Role in Health Education       Become a partner with individuals and communities Serve as catalyst for change Activate ideas Offer appropriate interventions Identify resources Facilitate group empowerment Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 14 Framework for Developing Health Communications Figure 8-1 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 15 Health Education Model Stage I: Planning and strategy selection  Questions to Ask ➢ Who is the intended audience? ➢ What is known about the audience and from what sources? ➢ What are the communication and education objectives and goals?

➢ What evaluation strategies will the nurse use? ➢ What are the issues of most concern? ➢ What is the health issue of interest? Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 16 Health Education Model Stage I: Planning and strategy selection (Cont.)  Collaborative Actions to Take ➢ Review the available data. ➢ Get community partners involved. ➢ Obtain new data. ➢ Determine perceptions of health problems. ➢ Determine the community’s assets and strengths. ➢ Identify underlying issues and knowledge gaps. ➢ Establish goals and objectives. ➢ Assess resources. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 17 Health Education Model Stage II: Developing and pretesting concepts, messages, and materials  Questions to Ask ➢ What channels are best? ➢ What formats should be used? ➢ Are there existing resources? ➢ How can the nurse present the message? ➢ How will the intended audience react to the message? ➢ Will the audience understand, accept, and use the message? ➢ What changes may improve the message? Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 18 Health Education Model Stage II: Developing and pretesting concepts, messages, and materials (Cont.) Community nursing discussion

  Collaborative Actions to Take ➢ Identify the messages and materials. ➢ Decide whether to use existing materials or produce new ones. ➢ Select channels and formats. ➢ Develop relevant materials with the target audience. ➢ Pretest the message and materials and obtain audience feedback. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 19 Health Education Model Stage III: Implementing the program  Questions to Ask ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ How should we launch the health education program? How do we maintain interest and sustainability? How can we use process evaluation? What are the strengths of the health program? How can we keep on track within timeline and budget? How do we know if we have reached our intended audience? How well did each step work (process evaluation)? Are we maintaining good relationships with partners? Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 20 Health Education Model Stage III: Implementing the program (Cont.)  Collaborative Actions to Take ➢ Work with community organizations to enhance effectiveness. ➢ Monitor and track progress. ➢ Establish process evaluation measures. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 21 Health Education Model Stage IV: Assessing effectiveness and making refinements  Questions to Ask ➢ What was learned? ➢ How can outcome evaluation be used to assess effectiveness? ➢ What worked well, and what did not work well? ➢ Has anything changed about the intended audience? ➢ How can we refine methods, channels, and formats? ➢ What lessons were learned? What modifications could strengthen the health education activity? Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 22 Health Education Model Stage IV: Assessing effectiveness and making refinements (Cont.)  Collaborative Actions to Take ➢ Conduct outcome evaluations. ➢ Reassess and revise goals and objectives. ➢ Modify unsuccessful strategies or activities. ➢ Generate continual support from community groups. ➢ Provide justification for continuing/ending the program. ➢ Summarize in an evaluation report. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 23 Health Literacy Definitions Evolved Over Time

 National Literacy Act (1991) ➢  Literacy is operationally defined as the ability to read and write at the fifth-grade reading level in any language and can be measured according to a continuum. IOM Report (2004) ➢ The capacity to obtain, interpret, and understand basic health information and services and the competence to use such information and services to enhance health Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 24 Health Literacy In 1999, the AMA’s Report of the Council on Scientific Affairs reported that patients with the most health care needs are often the least able to read and understand information that would enable them to function successfully within the health care system. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 25 Health Literacy (Cont.)  Health literacy is about empowerment … ➢ ➢ ➢ Having access to information, knowledge, and innovations Increasingly important for social, economic, and health development A key public health issue in the delivery of safe, effective care Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 26 Low Literacy        Increases the use of health care services Decreases self-esteem; increases shame and stigma Adversely affects outcomes and treatment of some medical conditions Poses barriers to obtaining informed consent Impacts participation in research Leads to health care and linguistic isolation Impedes patient-provider communication Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 27 Literacy Concerns    Serious mismatch exists between the reading levels of materials and patient’s reading skills. Materials often fail to incorporate the intended audience’s cultural beliefs, values, languages, and attitudes. Community nursing discussion

Low literacy prevents many from gaining the full benefits of health care. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 28 Literacy Concerns (Cont.)   Inability to read and understand instructions influences self-care abilities and health and wellness. Individuals with very low literacy skills are at an increased risk for poor health, which contributes to health disparities. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 29 Levels for Interventions  Functional/basic literacy ➢  Communicative/interactive literacy ➢  Increasing basic reading/writing skills Understanding and using information with providers Critical literacy* ➢ Analyzing and using information in life situations *Most important because it increases empowerment and success in everyday situations Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 30 Helpful Tips for Effective Teaching       Assess reading skills Determine what client needs to know Identify motivating factors Stick with essentials Set realistic goals and objectives Use clear and concise language      Develop a glossary of common words Space teaching over time Personalize health messages Incorporate methods of illustration, demonstration, and real-life examples Give and get Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. Community nursing discussion

31 Helpful Tips for Effective Teaching (Cont.)         Summarize often Be creative Use appropriate resources and materials Put patients at ease Praise patients Be encouraging Allow time for questions Employ teach-back methods    Remember that comprehension and understanding take time and practice Conduct learner verification Evaluate the teaching plan Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 32 Assess Materials  Become a Wise Consumer and User ➢ Evaluate health materials, including websites, before disseminating them ➢ Materials should strengthen previous teaching ➢ Materials should be used as an adjunct to health instruction Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. Community nursing discussion

33 Assessing the Relevancy of Health Materials      Do materials match the intended audience? Are materials appealing and culturally and linguistically relevant? Do they convey accurate and up-to-date information? Are messages clear and understandable? Do messages promote self-efficacy and motivation? Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 34 Assessment of Reading Level  Assess reading levels of intended audience ➢ Rapid estimate of adult literacy in medicine (REALM) ➢ Single Item Literacy Screener (SILS) ➢ Short Assessment of Health Literacy for SpanishSpeaking Adults (SAHLSA)  Assess readability of educational resources

➢ ➢  SMOG readability formula Flesch-Kincaid formula (on most computers) Verify understanding of learner Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 35 Role of Social Media    Numerous platforms now available May reach diverse community constituents with important public health messages Potential to… ➢ ➢ ➢  Facilitate interactive communication Increase sharing of health information Personalize and reinforce health messages Can empower community members to make Community nursing discussion