health informatics

Running head: LEARNING THEORIES 1

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LEARNING THEORIES

Learning Theories

Abstract

The implementation of Health Informatics throughout the health care system has allowed the patient to receive higher quality of care with safer outcomes. As health informatics continues to grow at a rapid pace the question as to what the most effective way is to train its users has been considered. The patient is now expected to utilize technology to communicate with providers and evaluate their health through equipment and data portals. Healthcare workers must understand health informatics to both teach the patient and do their job effectively. It is important to note that health informatics is ever evolving and the learning, teaching for those involved in healthcare is never ending. Through research of different learning theories and styles this paper seeks to identify how the adult can most effectively be taught to utilize health informatics whether as a patient or healthcare provider

Keywords: Health informatics, learning theory, behavioral theories, Cognitive learning theories, adult learning theories, and learning styles.

Learning Theories

Health informatics can be defined as the practice of studying, acquiring, and controlling health data and the application of various medical concepts together with health information technology systems to enable healthcare professionals to provide patients with the best healthcare, it can also mean the application of informatics and information technology to deliver better healthcare to clients (Nelson & Staggers, 2016). Technology has been growing very fast in the past years and it has changed the way things are done in many fields and so is the healthcare system. Health informatics therefore has changed the way things are done in healthcare system hence ensuring that patients receive safe and effective healthcare services. This field of study makes use of theories that are used in other fields of study such as computer science, information science, and the science of the specific discipline such as nursing, medicine, or pharmacy. People who work as health informatics specialists make use of learning theories to guide them in their roles which include; designing and implementing online health records, offering training to other medical stuff on the use of the electronic health records (EHR), give the right information to those who consult them, come up with policies in the health institutions where they work, and also manage and analyze the impacts of those policies. This paper will therefore discuss how different learning theories relate to current practices, policies, and regulations in health informatics.

Learning theories are coherent frameworks of integrated principles and constructs that explain, describe, and predict how people learn. These theories are the main guide for systems of education in the classroom and also in the training included in specific disciplines in healthcare such as nursing, medicine, or pharmacy. Health informatics has changed the way things are done in healthcare to provide patients with the best health care. Therefore, to implement those practices, specialists integrate the following learning theories in their study as they explain how the specialists can acquire, organize, and deploy knowledge and skills. They include behavioral theories, cognitive learning theories, adult learning theories, and learning styles.

Behavioral Theories

Behavioral theory states that learning is a change in observable behavior, and it takes place when the communication takes place between two events, a stimulus, and response. Behaviorists also believe that it is important to practice more and also embrace repetition in learning. According to this theory, a positive reaction to an experience encourages repetition of the same behavior. However, negative or bad experiences lead to fear and anxiety in the future when the person is exposed to similar situations. This theory relates to healthcare informatics in that; health professionals like nurses and doctors can perform procedures using mannequins to get access to skills.

For example, in a nursing class set up, students use the harmless trial and error methods to gain the desired skills. If the results are satisfactory, the student will strengthen that particular skill but if the results are unpleasant, the student will look for other alternatives until he or she gets the right desired outcome. Whether a skill is satisfying or unpleasant can be done through observation of client satisfaction or the reaction of the teacher. This theory helps the students to gain the best skills that they can apply in real life situations and provide the best healthcare to patients.

When people think about how behavioral theory works, they look at the two words; behavior and theory. Behavior is considered as an action in how one presents or conducts themselves, it can be used as a form of study to observe. Theory is way people try to explain something. A system based on the general principalities of trying to explain. Behavioral Theory is seen as a way to present behaviors in a learning-based way to condition how people interact with the environment. The way people conduct themselves will have a life standing report on who people are. Behavioral Theories in a healthcare informatic setting can be challenging. Healthcare professionals like doctors and nurses have been trained to provide a professional environment and careful explain to the patient what is going on with privacy and confidentiality. Healthcare providers have to maintain a privacy and confidentiality relationship their patients. “Healthcare providers are accountable to federal laws and professional standards that protect the privacy of patients’ protected health information (PHI)” (Nelson & Staggers, 2018, pg. 226).

If a healthcare provider goes against the patient’s privacy and confidentiality, there are serious consequences the healthcare provider could face. Inappropriate behavior among healthcare professionals is considered to be very risky. “Healthcare providers are also in danger of openly engaging in inappropriate behaviors. The danger arises from a healthcare provider’s “dual citizenship” in the social arena” (Nelson & Staggers, 2018, pg. 227). This is when a healthcare provider’s professional and personal borderlines have been crossed. What is discussed in privacy and confidentiality cannot be discussed within the general public. Another form of inappropriate behavior is trying to have a personal relationship outside of the professional one. “Inappropriate behaviors can include questionable blog and photo postings, unprofessional commenting, and projecting attitudes unbecoming of respectable healthcare

personnel” (Nelson & Staggers, 2018, pg. 227). This type of behavior is considered unacceptable. It can damage not only the healthcare professional’s reputation, but it can also place a stain on the healthcare organization the healthcare professional represents.

There is relevant theory that behavioral theories serve as sufficient evidence to develop a significant hypothesis for self-improvement. Work is needed to provide the necessary information to provide for self-improvement. The need to evaluate behavioral changes is to focus on what steps must be taken for self-improvement to take place. For example, self-monitoring has been considered as a great way for intervention. It has been vastly used to effort the change in some behaviors that may have been closely observed. “Monitored behaviors are compared to some standard or goal, and deviations from the standard are subsequently rectified” (Kersten-van Dijk, Westerink, Beute, & Ijsselsteihn, 2017). Change behavior through insight will propose that changed beliefs or values will lead to a significant change in one’s behavior. “Behavior change typically requires more than simply knowing what to do; it has been shown that even if people have a specific intention to perform a certain behavior” (Kersten-van Dijk et al., 2017). Behavior change does takes time. The long-term process to go through a full metamorphosis of behavior change reflects upon the reaction from the individual. “When people enter the preparation stage, they have made a decision to change their behavior and are making specific plans to implement their change” (Kersten-van Dijk et al., 2017).

Another way to promote behavior change within health and health care is developing and evaluating digital interventions. The challenges this presents will provide suggestions that will quickly rate the progress of research and practice of behavioral change through digital

inventions. “Developing and evaluating these digital interventions presents new challenges and new versions of old challenges that require use of improved and perhaps entirely new methods for research and evaluation” (Michie, Yardly, West, Patrick, & Greaves, 2017). Digital interventions provide the potential to test behavioral change by producing real-time data that is unbiased and recognized. To further improve the client on behavior change, educating the client on how to improve knowledge, modify attitudes, and support change behavior are examples of mHealth interventions (Nelson & Staggers, 2018).

Information Processing and Cognitive Learning Theories

Unlike behaviorists, cognitive learning theories state that learning is targeted internal processes which focus on understanding, thinking, consciousness and organizing. This kind of learning cannot be achieved by observing directly, and it is associated with the change in capability and capacity of the person to respond. In cognitive theories, learning is not just the result of behavioral change. In addition, learning merged with understanding and not mechanical repetition of behavior need to be consistent with past experiences or with current knowledge thus creating new awareness. David Ausubel is one of the contributors to cognitive learning theories. His perspective of cognition is helpful more so in teaching the introduction of difficult or unfamiliar issues, or relationships between concepts (Tian et al., 2019). Therefore, cognitive learning theories are related in health informatics in that; they can be applied in teaching the healthcare personnel on the new practices in the healthcare system which is a result of the new technology in the healthcare system.

Cognitive theories believe in the aspect of repetition and rehearsing of information to hold the information for long. Cognitive theorists believe that upon rehearsing and repeating information, the long-term memory stores the information and is prepared to live there to be used whenever it is required in the future. Therefore, using this theory, health professionals can learn the new practices, policies and regulations in healthcare informatics and use them in the future to provide good and high-quality healthcare to their clients

Information processing is a theory that can be divided into four different steps. First, the learner takes the information into the nervous system. Second, this information now is processed and formulated. Third, the body might reflect a diversified style of behaviors as an output of this process. Fourth, feedback is created to correct the behavior that was created by the system and with the process of information. When learning new content, information is taken through the nervous system. There are limits to the data that can be collected and retained by the brain. When a learner is under stress the amount of data that can be retained is less. If an individual is anxious about learning about something specific a limit in retained data will be experienced, therefore it will be more challenging to master the desired topic. Once all information is processed and taken into the nervous system, all collected data is retained in one of the following common formats; hierarchical order, episodic order and linked. Hierarchical order is related to cognitive learning and episodic order is interconnected to life events. Finally, some information might be related to other or “linked”, for example, people may recognize that kitchen is related to cooking (Nelson & Stagger, 2018).

If several senses are simultaneously stimulated during a learning process, it is more likely that the individual may process and retain new information. For example, if a new concept is presented to an individual by an instructor, while going step by step on how to apply it whit hands-on experience, it is more likely that most of the information will be retained. Previous intellectual acquirements have an important role when interpreting and structuring new data. For example, when an individual is experienced using a software and has to learn how to use a new version of it, the cognitive structure that has been previously developed information will have easier understanding of the new data. Under other conditions, if all new information cannot relate to previously learned data, the individual has to interpret structure as new information is being processes (Nelson & Stagger, 2018).

As it was identified in the article “The Role of Cognitive and Learning Theories in Supporting Successful EHR System Implementation Training”, “effective training programs must move beyond technical approached and incorporate social and cultural factors to make a difference in implementing success” (McAlearney, A. S., Robbins, J., Kowalczyk, N., Chisolm, D. J. & Song, P. H., 2012). When a new system is introduced into a person’s knowledge, it might be easier for each individual to retain the desired information if cultural background and social factors are taken under considerations. When a new electronic medical record system is being implemented, the cultural and social background of the learning group has influence in the training success. These factors determine different education levels, and different learning styles from the individuals to engage in the learning process. Social factors such as motivation and goals may also influence in data retention.

When approaching a diverse group of learners there are different key methods that can be used to achieve success in the learning process. The setting can be one of the key factors that influence when a clinical group want to translate or accomplish retention of any medical knowledge. Another factor can be how often is all new content being practiced or if the learned content is being tested to prove retention of information. When identifying if the is any previous connection between the information presented and existent knowledge, learners can create a link between both and have a deeper understanding of it. Requesting learners to cerebrate how the recent information relates to previous knowledge assists in the facilitation process of transferring knowledge and perception (McSparron, Vanka and Smith, 2019).

Learning is strengthened when the individual has come with a solution to a problem, rather than just have substantially amount of information provided. McSparron & Vanka (2018) identify 6 key aspects of cognitive learning theory that can be applied when teaching in the clinical environments. These key aspects are defined as; retrieval practice and spaced learning, interleaving, generation, deliberation of self-practice and self-reflection, and elaboration. Learners benefit greatly when experimental learning is applied. With generation, learners are encouraged to use and apply all acquired knowledge into challenging scenarios and problem solution. When information is provided without any guidance or challenges presented, learners don’t have the same result as when they tend to think and discover information be themselves. Deliberate practice is intended to serve as motivation to learners, it is when learners are pushed to reach certain goals and the necessary feedback is provided. With this practice, learning objectives are defined and performance is measured in a specific manner. Depending on the group composition, creating a link with prior knowledge to the material that is being taught might allow a deeper and easier understanding of the content (McSparron & Vanka, 2018).

Understanding the different aspects of the brain functions requires a variety of diverse approaches. Due to the nature of the different studies of the brain and the challenges that are faced because these are unseen, to better understand these methods that are refer “ghost”. There are three different ghosts, which will be discussed in more details. First, identifying what information is important and which is less applicable to the topic that is being learned. Second, the information processing of the brain may difficult the procedure and how the information is being presented and used in the brain. Third, the limited ability of distinguishing information that can be processed by the brain and retained from information that is easily forgotten. Understanding these restrictions can make the learning process and computation of information in the human brain an uncomplicated task (Carlson, Goddard, Kaplan, Klein & Ritchie, 2018).

When learners are approached with cognitive learning, it engages individuals in the learning process, and they are able to actively use their brains in an effective manner to connect new things with previous knowledge. Cognitive learning encourages individuals to have a hands-on approach to learning a topic, allowing them to have a vast understanding of the material that is being studied or implemented. It also promotes long-term learning, with helpful skills that individuals can apply to the subject and build a strong problem solving. With this being said, cognitive learning allows a person to have a more confident and deeper understanding of the desired topic. This process in which information can be absorbed and retained in the long-term memory may be augmented when using a variety of teaching methods.

Although long-term memory is able to retain generous amount of knowledge, there are two different processes that might inhibit the storage of unfamiliar or recent information. One factor may be that new information can replace old knowledge or memories. For example, when an electronic healthcare record is being used for an extended period in a clinical practice, individuals may tend to forget some details on how to use the manual method. Secondly, knowledge that has been previously stored can interfere with new information. Lastly, retention has many variables that depend on the person. Some factors are the style of learning that individuals have the most success at retention. Also, how frequently is that task being completed will have an impact on the learning process.

Learning Styles

Learning styles are a range of various contested and competing theories that aim to explain the differences in individual’s learning. People do not learn the same way, even if they are given similar content because every individual has his or her own learning style. The similar concept in the various learning styles is that people differ in how they learn. These styles affect education programs because every individual has a unique way in which he or she prefers to receive information. Therefore, tutors need to adjust and settle for learning styles that fit everyone. This is related in healthcare informatics in that, there are health professionals that play the role of training others on the new practices in healthcare. In addition, physicians also need to train their patients on self-care and to do so effectively, they need to deliver the information in such a way that the patient will understand. Therefore, the healthcare professionals should learn the learning styles preferred by different clients to serve them effectively and efficiently

Three are many different styles of learning methods that has been created to make learning easier through the way someone may perceive information. According to the visual, auditory, reading/writing, and kinesthetic (VARK) model, there are four main types learning styles, which are known to be visual, auditory, reading and writing, and kinesthetic. “Learning style is broadly defined as the beliefs, habits, and preferences that affect how an individual navigates the learning environment” (Knoll, Otani, Skeel, & Van Horn, 2017, p. 544). Everyone does not prefer to learn the same way, but typically prefer the best way they receive and comprehend new information. VARK only relates to how information is acquired and does not reflect intelligence (Bokhari & Zafar, 2019). An individual’s social, emotional, and physiological factors can also play a factor in how they perceive information and their preferred method for learning (Knoll, Otani, Skeel, & Roger Van Horn, 2016). According to the British Journal of Psychology “a recent survey of British teachers revealed that 93% of respondents agreed that learning is optimized when information is presented in accordance with each student’s preferred mode of learning, such as auditory, visual, or kinesthetic,” (Knoll et al, 2016, p. 544). If students are not pleased with the style of learning because of inattention, dissatisfaction and a disorder in the learning process may occur for the students and instructor (Vizeshfar & Torabizadeh, 2018).

Visual Learning

Visual learners are able to process new information better by observing (Khanal, Shah, & Koirala, 2014). Visual learners are the most common type of learner because it is the most common method in the classroom setting (Thepsatitporn & Pichitpornchai, 2016). Instructors tend to use lecture formats to teach new information because information is easier to present (Khanal, 2014). Even though visual learning is common, it does not mean that it is preferred by all learners. Those who are visual learners tend to be more observant and are able to recall words that are visually presented versus listening to a lecture. Charts, diagrams, visual lectures, are the common concepts that are presented for visual learners. These learners may also take notes to become well organized and to physically observe written directions. Visual learning has been shown to “increase retention by 29% to 42%, develop higher-order thinking skills, hone fundamental abilities that enable students to see and conceptualize visual clearly, enhance tactile hand-eye mind connections that improve the ability to recall facts and retain learning, provide new opportunities to some students with learning differences and challenge students who are gifted or twice exceptional, and be an integral part of best-practice intervention methods with individuals on the autism spectrum” (Daniels, 2019, p. 1). The Visual Trade Model developed by Daniels (2019) involves “decoding, which is to understand and translate communications made with visual imagery; imaging, which creates, interprets, and manipulates mental models of imagery; and encoding external images that people create” (p. 1).

Auditory Learning

Auditory learners, as known as aural learners, prefer to listen to information for comprehension so they tend to record lectures and tutorials (Khanal, et al., 2014). “These learners prefer verbal lectures and discussions, role-playing exercises, structured session and reading aloud” (Busan, 2014, p. 104). Auditory learners may talk to self in order to hear concepts aloud for comprehension, prefer verbal instructors versus reading, mouthed words while reading, and are good with remembering names, but they forget faces (Busan, 2014). Background music can also be beneficial for auditory learning, as it influences a relaxed mental state to assist information to become comprehensible (Busan, 2014).

Reading and Writing learning

There are learners who prefer to read or write new material for comprehension (Hallin, 2014). These learners read and write information verbatim as it is presented to them in order to comprehend the meaning (Vizeshfar & Torabizadeh, 2018). According to the VARK website, out of the general population of 45,826, 27.4% of the respondents preferred to learn by reading and writing (Khanal et al., 2014). This percentage was the second highest number for preferred style of learning. When learning new material or instructions on how to complete a task, it is common for individuals who prefer to read and write to accumulate written notes on the steps needed to take in order to complete the task successfully, if informed of those instructions verbally. Some learners who prefer to read or write, may only prefer written instructions in order to acquire new information.

Kinesthetic Learning

Kinesthetic learners acquire information through experience and practice because they prefer to learn information that has a connection to reality (Khanal, et al., 2014, p. 2). It is the least common learning style identified by learners. Busan (2014) conducted a study with 230 medical students to assist with identifying their style of learning and only 19% identified to be kinesthetic learners. Hands on experience allows individuals to understand the routine of completing a process through moving and touching (Busan, 2014). Kinesthetic learners try things out through touching and feeling. These learners use a lot of hand gestures, movement, and active listening, if their learning requires them to listen. If these learners are required to remain still, they commonly begin to fidget in order to help them concentrate (Busan, 2014). Certain tasks and subjects require students to be more hands on, such as informatics or computer technology. Students must possess the ability to learn in a hands-on environment in order to obtain the proper amount of training and experience.

VARK Combined Analysis

Even though the number for preferred learning styles continues to change through different studies, it all depends on the way an individual better perceives and comprehends new information. Some studies have shown that students may prefer a combination of different methods when it deals with learning. There are some universities that allow students to pick their preference on how they want to register for new courses, such as online or on campus. Some universities also offer lab courses in person or virtually in order to accommodate the student’s mode of learning. “According to Russian Open Medical Journal, 166 first year medical students that attending Wayne State University of Medicine, 36.1% of students preferred a single mode of learning, while 63.8% of students preferred multiple methods for learning (Khanal, et al., 2014).

Adult Learning Theories

Adult learning theories state that learning is the process of creating new information or knowledge on the foundation of knowledge that is already existing. They play a very important role in the design and implementation of programs in the education field which includes healthcare professional programs (Lavoie et al., 20118). Adult learning theories are divided in many different categories which include humanistic, instrumental, social, reflective, motivational, constructivist, and transformative. For example, for someone to advance to the role of a nursing informatics specialist, he or she is required to at least hold a Bachelor of Science in Nursing degree. The period of completing a course in Bachelor of Science in nursing degree is four years. The course involves patient care, chemistry, anatomy, health assessment, psychology, and pharmacology. Therefore, adult learning theories help individuals to reach the levels required for them to function as specialists in healthcare informatics. They have to build up information as they advance in their level of education. Different levels of education teach different units, but some content keeps advancing as the student advances their levels in education.

All individuals learn differently, right and left brain, visual versus auditory and so on, that is why there are so many different learning theories and methods. Adults learners present as a different type of student than a child. The adult brain is not a blank slate like a child and therefore learns differently. (Chen, 2012). An adult cannot forget what they know or their experiences this creates a unique mental learning environment as no two people have the same experiences. This thought process follows a constructivists view, the belief that new knowledge is constructed based on old knowledge (Taylor & Hamdy, 2013). This broken down means the brain has a harder time learning isolated facts, it has also been noted that memories tied to emotion are easier to remember. Therefore, knowledge that can be linked to multiple sensory experiences such as a known piece of information and a positive emotion is learned more quickly and retained easier (Dionsyssopoulos, 2014).

“Andragogy is the art and science of helping adults to learn” (Nelson &Staggers, 2018 p. 27). This term coined by Knowles to differentiate adults from children. He believed that there were 6 differences in how adults and children learned; the most important being motivation (Taylor & Hamdy, 2013). Evidence suggests that certain factors can promote neuroplasticity, of the adult human brain making learning easier. Socialization and feeling part of a group can motivate one to want to learn to collaborate, feel more connected to the individuals so that one can assist in reaching a common goal. This can stimulate neuronal branching, making learning easier (Dionsyssopoulos, 2014).

There are several different learning theories, as stated above, all with their research to support that theory. The fact is most learning theories overlap in some nature, there are even multi-model learning theories. (Taylor & Hamdy, 2013). The different learning theories will be broken down. One major point is that despite what learning theory is used it is vital to plan for long term retention of new information (Nelson & Staggers, 2018, p. 27). Learning is not just memorizing information but understanding it and being able to apply it (Taylor & Hamdy, 2013).

By the time an individual has reached adulthood and education in healthcare they normally have a preferred learning style. Learning styles are defined by perception and ordering (Rogowsky et al, 2015). While some schools, groups, and organizations attempt to teach to individuals preferred style it is not always possible in the healthcare world. Data to back up if an individual learns better in their preferred style is sparse. One study did suggest that there was a correlation, however, it could not be determined if the individuals truly learned better that way or just preferred to learn that way. Intuitively, individuals who want to learn a certain way would perform better if allowed to learn in their way of choice. There was zero correlation between learning style and retention (Rogowsky et al, 2015).  

The adult learner is vital to the medical field as they will have to choose, set up, learn, teach, and lead organizations through information technology (IT) changes (Nelson & Staggers, 2018, p.38). The medical field seeks to train the community on how to utilize new technology as it is presented to them (Badyal & Singh, 2017). Health care workers need to remember when teaching that adults have their learning characteristics based on each individual (Nelson & Staggers, 2018, p. 28). It is not always possible to accommodate everyone to their preferred method of learning or to engage them in social learning, however, the “teacher” must attempt to motivate the individual to want to learn. Once the individual has identified their motivation for wanting to learn it is important to actively involve them in the learning. Active involvement is one area that all learning styles and theories can agree upon as vital (Badyal & Singh, 2017). In community education such as teaching about certain healthcare issues or informing patients on a facility’s new IT program the sociocultural theory would be appropriate. In this situation as well as in many situations the adult healthcare worker finds themselves in, the once student must now be a teacher. “The teacher must model new roles, guide in behaviors and provide learners the chance to practice” (Badyal & Singh, 2017).  

Employees of the medical community must continue to learn throughout their lifetime. It is not limited to just their basic education to receive their credentials. Healthcare workers continue to learn in a variety of settings for many reasons. A professional will be required to learn by completing continuing education credits, facility-specific training, as well as training on any newly released medications, treatments, procedures, and technologies that relate to their positions (Chen, 2012). The healthcare community has seen a lot of growth over the last decade in health informatics and it will only continue to grow as facilities seek to receive ACO incentives and the healthcare model evolves. The healthcare community is excited as they feel that health informatics can positively benefit the healthcare community (Braunstein, 2014, p. 29 p. 217-219). The important fact about healthcare technology is that it builds on itself, it is an ever-evolving application that will continue to work toward improving the healthcare delivery system. As the healthcare system grows and evolves there will always be more knowledge to learn and teach. 

Conclusion

Healthcare informatics is a multi-disciplinary field that uses health information technology to improve the healthcare system. Employees of the medical community must continue to learn throughout their lifetime. It is not limited to just their basic education to receive their credentials. Healthcare workers must learn in a variety of settings for many reasons. A professional will be required to learn by completing continuing education credits, facility-specific training, as well as training on any newly released medications, treatments, procedures, and health information technologies that relate to their positions (Chen, 2012). The new technology has brought a lot of improvements in the health care sector. They have changed the way activities are done and the workflow in healthcare institutions. Following the changes in healthcare practices, health care professionals need to learn new practices, rules, and regulations to function effectively. The important fact about healthcare technology is that it builds on itself, it is an ever-evolving application that will continue to work toward improving the healthcare delivery system. As the healthcare system grows and evolves there will always be more knowledge to learn and teach. Different ideas of learning theory tend to provide the framework to extensively comprehend how human learns and a viable way to describe and analyze the learning process relating to healthcare. Further research is needed to establish the best learning methods for both the patient and healthcare provider in actual settings such as researching how a nurse is teaching the patient about the health portals in a short visit and how that knowledge is retained and if the system changes if they can build upon that original knowledge. More research is needed for healthcare workers to see if they can learn in the work settings or if a more classroom-style learning would be effective. As well as to find what is needed to allow to retain and build upon basic knowledge while continuing to provide a safe and effective healthcare environment.

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