professional community health educator

HCA 3306, Community Health 1

Course Learning Outcomes for Unit V Upon completion of this unit, students should be able to:

1. Determine strategies to address prevalent community health issues facing the United States. 1.1 Identify how to use the health belief model (HBM) and visual-aural-read/write-kinesthetic

(VARK) to confront prevalent community health issues. 1.2 Explain appropriate teaching mechanisms that can be used to provide health education.

Course/Unit Learning Outcomes

Learning Activity

1.1 Unit Lesson Chapter 8 Unit V Essay

1.2 Unit Lesson Chapter 9 Unit V Essay

Required Unit Resources Chapter 8: Theories in Health Education and Health Promotion Chapter 9: Methods in Health Education and Health Promotion

UNIT V STUDY GUIDE

Theories and Methods in Health Promotion

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Unit Lesson

Health Belief Model and Visual-Aural-Read/Write-Kinesthetic Model When we try to influence human behavior for positive change, we begin with the client’s beliefs. There is probably no surprise there because what we believe is so important in our lives and for our health. For example, for generations, most Americans believed that cigarette smoking was harmless and not a concern in terms of health. Cigarettes were even touted as a treatment for various breathing problems! Americans enjoyed smoking, and they kept doing it, but over time the consequences became all too clear. The surgeon general’s report on tobacco in 1964 presented the truth. Smoking destroys health and destroys human lives (Centers for Disease Control and Prevention, n.d.). This lecturer/author is an administrator for a health system that recently launched pulmonary rehabilitation programs in several facilities. Firsthand experience with those programs revealed that the majority of today’s smokers believe that smoking is harmful, and they want to quit, but the actual quitting is difficult. Nicotine is a powerfully addictive chemical. Meanwhile, professional community health educators can help, and we can make the difference. Let’s consider that process in this unit’s lesson.

Health Belief Model Health beliefs can be considered the client’s cumulative ideas, convictions, beliefs and attitudes regarding health and illness. They are the result of a lifetime of learning from parents, teachers, friends, coworkers, media, and the Internet. Beliefs are so important for health and disease prevention. The health belief model (HBM) has been around for a long time. It was developed in the 1950s by health care professionals in the United States public health service. Officials in the public health service were puzzled about why Americans were not participating in positive health behaviors, even when they had been well documented. So they applied some principles from sociology and psychology, the operant and cognitive- behavioral theories, and they created health belief model. The health belief model theorizes that clients will take positive action to prevent illness or control an existing illness if the following conditions are met.

• The client must believe that he or she is personally susceptible to the illness. “It can happen to me.”

• The client must believe that the illness has serious consequences.

• The client must believe that there is a course of action to reduce susceptibility or the seriousness of the illness.

• The client must believe that the costs of taking positive action are outweighed by the benefits. Therefore, the health belief model focuses on those four aspects, and all of them must be present in order to effect positive change. Some of the most successful disease prevention programs in the world are based upon these four key principles. Smoking cessation programs, weight-loss programs, asthma education programs, type 2 diabetes education programs, and cardiac rehabilitation programs are just a few examples of the impact of the health belief model today.

Asthmatic Cigarettes. (Asthma Management, via Felix Khusid and the American Association for Respiratory Care's Virtual Museum, n.d.)

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Perceived susceptibility is our starting point. Unless the client truly believes that he or she is susceptible to the disease, positive change will not take place. Let’s use the example of type 2 diabetes here, a disease that is so prevalent in our communities today. We can share statistics on type 2 diabetes prevalence with the client; explain the pathophysiology; and ask the client to think of family, friends, or coworkers who are affected by the disease. This step is not a high hurdle to get over today, simply because there is so much type 2 diabetes in the community. Often, type 2 diabetes is related to individual choices such as sedentary lifestyle and a high fat, high carbohydrate diet. Some families have higher type 2 diabetes risk than others, but it can happen to anyone. Typically, we can achieve client perception of susceptibility. Several good susceptibility survey instruments are now available to help with this step. Perceived severity comes next. The client must believe that the health condition at hand can be serious if left untreated and could lead to life-changing consequences and limitations. Continuing with our type 2 diabetes example, we can point to the severe, long-term consequences of poorly managed type 2 diabetes that can include kidney failure and the need for dialysis treatments, vascular disease and possible amputations, and diabetic ketoacidosis. These circumstances can land the client in the emergency room and truly be life- threatening. Excellent teaching resources are available today to assist us in educating clients about the severity of the disease. The combination of perceived susceptibility and perceived severity leads to the human emotional response, which we call fear. In this case, fear turns out to be a very positive and necessary thing. It is fear that drives positive change in health education. Perceived benefit comes next, and it is easier to achieve today than ever before because of the wealth of research now available and published online regarding the effectiveness of positive actions on human health. We must get the client to correctly believe that the positive changes that we recommend for them will actually work, reducing risk or reducing the impact of an existing disease. The American Diabetes Association provides outstanding resources about this and clearly documents which behavioral changes have well- documented positive effects and which do not (American Diabetes Association, n.d.). Perceived barriers must be addressed. Clients will naturally perceive certain barriers or impediments to action. “I don’t have time.” “I can’t afford it.” “I don’t have transportation.” “I don’t know if my insurance will pay for it.” All of these are legitimate, real-world issues that the client can experience. If we are to be successful as health care educators, we must help the client to address them, one by one. Successful health education programs already have the answers to many client questions. It is very clear that we must make it easy for clients to participate! That aspect is so important. The good news is that communities and payers are finally getting the point here. Health insurance coverage for things like type 2 diabetes education, cardiac rehabilitation, and pulmonary rehabilitation has never been better, and many communities are now providing free transportation services to and from health care facilities. That has been a tremendous positive step. Our continuing challenge is on the prevention side of things. The Affordable Care Act has improved coverage for some preventive services, but there are still gaps. In short, we must make it feasible for clients to participate in positive change, or it will not happen. Thankfully, many positive changes can take place right in the client’s home, including dietary changes, well-designed exercise, and careful monitoring of key indicators such as blood sugar for diabetics and peak flow for asthmatics. Cues to action is next, which leads to a brief discussion of disease management, a fascinating new aspect of health care today. What we have learned is that even a well-educated client who really understands his or her disease is unlikely to stay the course of positive changes without help. Clients need follow-up, they need reminders, and they need to know that someone is going to be checking up on them to see their progress. The good news is that many payers are providing for disease managers to follow-up with clients and make sure that they are still on track. The payers are not doing that out of the goodness of their own hearts, they are doing disease management because they have learned that it saves them money on ER visits and hospitalizations! It is also the right thing for the client. Even without formal disease management, client

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smartphones can be a great help, providing reminders, cueing activities and appointments, and helping the client to achieve self-efficacy (the realization that they can sustain the needed positive changes for health)!

VARK: Visual-Aural-Read/Write-Kinesthetic Learning VARK stands for visual, aural, read/write, and kinesthetic, which are different ways that clients learn (VARK Learn Limited, n.d.). There is definitely overlap among them, but most clients have one preferred or dominant way of learning. Visual (V). Clients who learn in this way like depictions of information, for example, in maps, charts, flow charts, diagrams, and hierarchies. When teaching, a whiteboard can be used to draw a diagram with meaningful symbols, and that will greatly help visual learners. Aural (A). Clients who prefer aural learning learn best from lectures, group discussions, radio, mobile phones, just talking with others, and web chats. Email is included in this area because it is often used for chat purposes. The aural learning preference includes talking out loud and talking to oneself. Often, clients with this preference learn by speaking first. They like to repeat what has already been said, hearing themselves speak, in their own way. Read/Write (R). This client-learning preference is for information displayed as words, such as reading an article or reading from a textbook. Many teachers and students have a strong preference for this mode, and this modality brings attributes sought out by many employers of graduates. The focus is on text-based input and output. PowerPoint is a key way that read/write learners get their information. Google is made for these folks. Kinesthetic (K). Here, the focus is on using experience and practice to facilitate learning. Although these real-world or laboratory experiences may use visual, aural, or written tools, the key is that people who prefer this mode want concrete personal experiences or simulations. They need to actually do it and not just read about it or hear about it. Multimodality (MM). The reality is that today’s world is definitely multimodal, and so are many clients. But a key to success is that our teaching in health care must involve all modes of learning in order to be most effective!

Conclusion There is a great deal of science surrounding the education of clients in health care today. That is because it is so very important! The next improvements in American community health will not come from some new technology or new medical procedures. The improvements ahead will come from better educated patients who make better choices in their own lives. This is an exciting time to be involved, and the health care organizations that you aspire to lead are definitely getting more and more involved in this aspect. It is a good and positive thing to teach clients to stay well rather than just treating them in the ER and hospital when they are acutely ill. Hopefully, this lesson has helped you to understand a bit more about health education as a key part of health promotion!

References American Diabetes Association. (n.d.). Home page. https://www.diabetes.org/ Asthma Management. (n.d.). Dr. Guild’s asthmatic cigarettes [Image]. http://museum.aarc.org/gallery/asthma-

management/ Centers for Disease and Control Prevention. (n.d.). History of the surgeon general's reports on smoking and

health. U.S. Department of Health and Human Services. https://www.cdc.gov/tobacco/data_statistics/sgr/history/index.htm

VARK Learn Limited. (n.d.). The VARK modalities. http://vark-learn.com/introduction-to-vark/the-vark-

modalities/