Enhancing HIV/AIDS Care: Adult Learning Theory Application

1. Building global capacity to improve the care of people living with HIV/AIDS Building global capacity to improve the care of people living with HIV/AIDS Building global capacity to improve the care of people living with HIV/AIDS Application of Adult Learning Theory to Educational Settings in Africa • Ann Downer, EdD • International Training and Education Center on HIV (I-TECH), University of Washington, Seattle • Job Bwayo, MD, PhD • Regional AIDS Training Network (RATN), Nairobi • Anastasia Ndiritu, MSc Regional AIDS Training Network (RATN), Nairobi

2. Building global capacity to improve the care of people living with HIV/AIDS Learning Objectives • At the end of this workshop, you will be able to: • describe how traditional principles of adult learning theory are applied to educational design and effective group facilitation. • observe principles in practice by identifying behavioral examples in a training videotape and transcript. • judge the relevance of principles in varying cultural contexts and educational settings. • adapt the principles of adult learning theory as needed in order to improve training practice.

3. Building global capacity to improve the care of people living with HIV/AIDS Workshop Outline • Part 1: participants will examine contemporary training practice and discuss the assumptions upon which it is based. • Introductions and personal observations • Reviewing the historical origins of adult learning theory • Identifying principles in practice • Part 2: participants will critically analyze principles of adult learning theory and suggest ways to improve training practice in diverse educational settings. • Challenging assumptions about teaching and learning • Refining or adapting principles for different settings • Improving the practice of training

4. Reflection Exercise • Take a moment to remember a good teacher – someone you knew recently or long ago. • Share with another person: In your opinion, what were the personal characteristics that made him/her a good teacher?

5. Building global capacity to improve the care of people living with HIV/AIDS Origins of Modern Learning Theory • The values associated with modern Western education stem from the written works of the early Greeks and are closely associated with the study of rhetoric – the art of expression and the persuasive use of language. • Logos • Pathos • Ethos • These ideas resonate through the centuries and create the foundation for Western philosophies about education today.

6. Building global capacity to improve the care of people living with HIV/AIDS Origins (continued) • Educational planning is also influenced by the development of psychology and ideas derived from research conducted in predominantly American, European, and northern cultures. Strong influences include: • Behavioral psychology • Cognitive psychology* • *Today's cognitive psychologists tend to be "universalists," assuming that everyone • perceives, thinks, and reasons in the same way. We will return to this issue later in the workshop.

7. Building global capacity to improve the care of people living with HIV/AIDS Emergence of Andragogy • Thorndyke (Adult Learning, 1928) challenged long-held assumptions that people don’t learn much after childhood and re-directed discussion toward how adults learn. Research on preferences and styles of learning (Jung, 1969) also advanced knowledge of adult learning. • Perceiving information: sensing and intuiting • Decision making: feeling and thinking How does knowledge of learning preferences and styles of learning affect the practice of training?

8. Teaching Methods & Learning Styles • Intuiting • Practice • Apply concepts • Simulations • Feeling • Personal Experience • Role plays • Group exercises Strive for Diversity • Thinking • Reading • Questioning • Independent activities • Sensing • Lectures • Discussion • Problem solving

9. Building global capacity to improve the care of people living with HIV/AIDS Principles of Andragogy Research focusing on adult learning expanded greatly in the 1950s, 60s, and 70s with the infusion of insights from psychology and further exploration of the differences between adult and child cognition. Key assumptions about adult learning emerged from this research: • Immediacy • Self-direction • Experience • Motivation Knowles (1998), Vella (1995), and others popularized these principles, resulting in broad dissemination and adoption into practice.

10. Building global capacity to improve the care of people living with HIV/AIDS Compare principles from Knowles and Vella with principles from cognitive psychology:

11. Transition- from Principles to Practice Building global capacity to improve the care of people living with HIV/AIDS Andragogy greatly influences the practice of training throughout the world today. We look next at how design, delivery, and evaluation of training programs put these principles into practice.

12. Video Observation with Discussion • End of Part One • Break

13. Building global capacity to improve the care of people living with HIV/AIDS Critical Analysis "There has long been a widespread belief among philosophers and, later, cognitive scientists that thinking the world over is basically the same." -psychologist Howard Gardner, Harvard University Although there have always been dissenters, the prevailing wisdom holds that a Masai hunter, a corporate raider, and a farmer all see, remember, infer, and think in the same way. Some researchers now question whether the cognitive processes that are central to Western thought are universally operational.

14. Building global capacity to improve the care of people living with HIV/AIDS Analysis (continued) • "Human cognition is not everywhere the same." • psychologist Richard E. Nisbett, University of Michigan, The Geography of Thought: How Asians and Westerners Think Differently ... And Why (2003) • This book compares the cognitive differences between people from East Asia (Korea, China and Japan) and Westerners (from Europe, the British commonwealth and North America). • Examples of East-West differences from the book.

15. Challenge assumptions about adult learning by providing a counter argument to the “rules” Minimize lecture because it induces passivity and stifles critical thinking. Use a warm-up exercise to establish a good climate for learning. Involve learners in diagnosing their own learning needs. Choose interactive teaching methods because they make participants feel respected and involved. A respectful facilitator plays down his/her position of authority and treats participants as co-instructors. Sitting in a circle is an effective and democratic technique.

16. Building global capacity to improve the care of people living with HIV/AIDS Analysis (continued) • However, at least some studies in developing countries (Diouf, 2000) suggest that: • while cultural norms and values strongly influence what adults learn; when they learn; why they learn; and who provides the instruction, • they do not affect how adults learn. Framing educational research and practice as Western or non-Western may create false dichotomies, but perhaps allows us to raise important questions about the assumptions we make as trainers.

17. What do you think?Consider the following questions in your discussion group: • In your experience, are there some “universal” principles about all people and how people learn? • In what ways might cultural norms and values affect what, when, why, from whom, and even how people learn differently?

18. Building global capacity to improve the care of people living with HIV/AIDS Application Exercise • Translate ideas from the workshop into practical suggestions for training. In small groups: • Discuss a few ways in which a trainer’s practice might be influenced by increasing his or her sensitivity to the cultural norms and values that impact a participant’s preferences and needs for learning. • Share these ideas with the larger group.

19. Building global capacity to improve the care of people living with HIV/AIDS Respectful Engagement of Group Participants • Start with questions. • Ask about local culture in order to improve teaching and facilitation of learning. • Encourage application of material by providing examples, posing job-based problems, and asking learners to consider how to apply what they are learning. • Pose alternative, thought-provoking questions and scenarios to encourage critical thinking and questioning.

20. Building global capacity to improve the care of people living with HIV/AIDS Respectful Engagement(continued) • Use both visual and aural (hearing) modes of learning. • Use organizing techniques (e.g., “We’ve just addressed...now let’s move to...”) to help learners track where they are and what they’ve learned. • Request local stories and examples to enhance teaching. • What else? Deming, B., Ten Steps to being Positively Engaging, Training and Development, January 2001, pp. 18-19.

21. Building global capacity to improve the care of people living with HIV/AIDS The Role of Trainer Debate the following statement with two or three people sitting near you. Trainers are not entertainers. They are professionals who are tasked with providing accurate, quality information so that learners can perform their jobs effectively once they leave a training program. It is the learners’ responsibility to pay attention. They should not expect a trainer to motivate them to listen and learn.

22. Building global capacity to improve the care of people living with HIV/AIDS Workshop Summary • Now that you have completed this workshop, you should be able to: • describe how traditional principles of adult learning theory are applied to educational design and effective group facilitation. • observe principles in practice by identifying behavioral examples in a training videotape and transcript. • judge the relevance of principles in varying cultural contexts and educational settings. • adapt the principles of adult learning theory as needed in order to improve training practice.

23. Will you do anything differently the next time you plan and deliver training?

24. Building global capacity to improve the care of people living with HIV/AIDS Workshop Follow-up: Feedback on this Workshop • Please complete the workshop evaluation formin order to help us evaluate whether this workshop will affect how you develop and deliver training programs in the future. • Thank you.