FOUNDATIONS OF HEALTH EDUCATION

1. FOUNDATIONS OF HEALTH EDUCATION By Bonni C. Hodges Professor of Health SUNY College at Cortland

2. Introduction Goals of Health Education Health Education Philosophies Relationship between Philosophies & Health Instruction Theoretical Foundation for Behavior Change

3. Let�s begin by asking What is a goal? Anyway.

4. Goal Statements Goal: a broad statement of direction, used to present the overall intent of the program provides overall direction is general in nature is often not measurable (vs. an objective which has measurable criteria) Sample objective: Upon completion of this session, the student will be able to describe one goal of health education.

5. National Health Goals Healthy People 2010 Increase Quality and Years of Healthy Life To help individuals of all ages increase life expectancy & improve their quality of life Eliminate Health Disparities To eliminate health disparities among different segments of the population Sets the stage for the national health agenda

6. Health-Related Goals for School-Aged Youth: CDC 6 Categories of risk behaviors Six risky behavior categories that put our young people at-risk for illness, injury, death or lack of success (academic or other) Linked to the Healthy People movement Based on state and national data

7. The 6 behavior categories are Unintentional and Intentional Injuries Tobacco Use Alcohol and Other Drug Use Sexual Behaviors that Result in HIV, STDs, & Unintended Pregnancy Dietary Patterns that Contribute to Disease Insufficient Physical Activity

8. Goals & the Standards Movement National Standards in Health Education 1995 National Health Education Standards: Achieving Health Literacy 2006 National Health Education Standards

9. National Standards/Outcomes Goals National Health Education Standards improved educational achievement for students and improved health in the U.S. help young people become �health literate� being a critical thinker & problem solver a responsible, productive citizen a self-directed learner an effective communicator

10. Summary Healthy People 2010, CDC6, and much of National Health Education standards illustrate major goal of HE for all ages is health-enhancing behavior Creation of health literacy supports behavior and skills needed to successfully support, choose and engage in health-enhancing practices self and others

11. Let�s take a look at Health Education Philosophy

12. HE Philosophy Given: Goal of HE is promotion and maintenance of health-enhancing behaviors to create healthy individuals and communities Need to figure out, philosophically, what your role as a classroom teacher is in supporting the goal of HE

13. What is the difference between a �goal� of HE and a philosophy? Goal = result, outcome, long(er) term Philosophy = how to get to the result

14. 4 Approaches to Consider Cognitive Based Decision Making Behavior Change Social Change

15. Cognitive Based Just the facts, Ma�am! Get individuals to know more about health, risk factors, etc. Content focused Large amounts of stuff in a relatively short amount of time Evaluate knowledge levels A starting point for many

16. Cognitive with a Twist-Gold (w/Kelly) 1988 Knowledge plus Not facts per se but ability to understand and to use them Critical thinking Self-correcting and dynamic Information, knowledge, & understanding are not synonymous

17. Making Decisions Teach skills to allow individuals to make health-enhancing choices e.g. Decision-making Problem-solving Focus on the performance of the skills rather than the decision itself--the process rather than the product Evaluate performance of skills

18. DM- Kolbe, Iverson, Kreuter, Hochbaum, Christensen (1981) Effectiveness of HE activities determined by process of making decisions (phase 1) For those inclined to change behavior effectiveness (phase 2) determined by degree skills exhibited These two usually occur together

19. Kolbe et al HE program will contribute to actually engaging in health-enhancing behaviors Basically setting students up for the potential to engage in health-enhancing behaviors Or to continue�

20. Behavior Change Focus on behavior modification Usually employs such strategies as behavior modification, contracting, goal setting Evaluate change in behavior Supported by Hochbaum

21. Social Change (O�Rourke, Minkler) Macro level changes to foster health Politics, social norms, environment change Focuses on trying to change forces that contribute to health behaviors and status CSHP supports this approach Give students skills to do above

22. Determining your philosophy Goal of HE is focused on behavior Parts/steps/strategies to promoting and maintaining behavior Deciding where to stop

23. Challenges Some schools and/or districts may only �allow� teaching of health content knowledge Not enough time for �full� health curriculum Knowledge is �safe� View mission of school as knowledge dissemination Some schools, district, and/or communities may prevent discussions of, or fostering of particular behaviors, skills Your overall philosophy may not be appropriate for all grades Age appropriate skill development Level of control of determinants of own behavior

24. To think about Philosophy and lessons need to be congruent If your philosophy is DM & PS skills you can�t just teach facts Should assess your intended outcome If your philosophy is behavior-related skills you must assess achievement of these skills not just knowledge or DM Philosophy for your classroom MAY be different from that of CSHP CSHP designed to support behavior and skill development

25. Theoretical Foundation for Behavior Change The Basics

26. Why Bother Looking at Theories and Models? Roadmap Support for strategies and activities Credibility Success

27. Exploring Precede-Proceed Social Cognitive Theory Self-Efficacy Health Belief Model

28. Precede-Proceed Planning and Assessment Model Green and Kreuter (2005) Widely Used School health education focus on 3 categories of determinants of the ecosystem In ideal situation have local NA information about 3 areas

29. Predisposing �in one�s head� Perceptions, attitudes, values, knowledge, beliefs, self-efficacy Find out what these are for students Own data General info Develop lessons to address �problematic� areas

30. Predisposing Example-Nutrition You find out that typical students at your grade level believe that skim or 1% milk is not as healthy as whole and would taste bad Need to develop a strategy to address the beliefs Nutrition label comparison Milk fat display Low fat milk challenge

31. Reinforcing Internal or external factors Rewards and feedback received from others following adoption of a behavior May encourage or discourage Internal too e.g. pain, pleasure External-generally considered to be attitudes, behaviors, support-levels of persons or institutions influential to our population in interest e.g. family members, teachers, employers, church; also media messages

32. Reinforcing Example-Nutrition Fast food advertisements �looks good� Healthy claims promotions Need to develop awareness of advertising techniques Knowledge of advertising purpose and use of �tricks� Analysis of fast food ads advertisements Use of techniques to create ad for health choices

33. Enabling Availability, accessibility, policy/regulation enforcement/existence, skills Skills, resources, barriers that can help or hinder desired behavior as well as environmental change Created mainly by social forces or systems Includes facilities and community resources; existence and enforcement of laws, policies, & statutes; skills required for a desired behavior to happen

34. Enabling Example-Nutrition School cafeteria only serves whole milk and has ice cream available every day. Need to decrease accessibility and availability Work to include/change to low fat and skim milk Work to decrease ice cream availability to one day Have students develop milk/ice cream policy suggestion that would improve ability to make healthy choices

35. Social Cognitive Theory Albert Bandura Big concepts, will focus on a few Reciprocal Determinism Behavioral Capability Self-Efficacy

36. Reciprocal Determinism

37. Reciprocal Determinism We learn through our own experiences AND through observing others and the results of their actions Reminds us of the importance of environment in shaping behavior Reminds us of the importance of people�s behaviors in shaping the environment CSHP Cafeteria All components supporting same message

38. Behavioral Capability Concept = Need both knowledge and skills to adopt or change behavior Use knowledge building strategies appropriate for participants� characteristics About the recommended behavior AND teach skills necessary to adopt, change, and/or maintain behavior Appropriate to participants Being able to list ways to manage stress needs to be accompanied by practicing some strategies Will increase chances to using stress management when needed

39. Self-Efficacy Belief or confidence in one�s own ability to perform and maintain a specific behavior Considered the most important �person characteristic� Those with higher self-efficacy more likely to have motivation to adopt a behavior when confronted with barriers and to maintain it over time

40. Self-Efficacy & Program Planning Bandura (1977) discussed ways to increase self-efficacy that have been supported in subsequent research Hierarchical Provide strong foundation for program and curricular planning activities

41. Building Self-Efficacy Teach people to control negative emotional responses to performing the new behavior Stress management Emotional coping responses Provide verbal persuasion, encouragement, and reinforcement to engage in and maintain the behavior �cheerleading�

42. Building Self-Efficacy Provide modeling of the behavior Through �live� or other means Observational learning Role Models Direct experience with the behavior Opportunities to practice in a way that provides positive reinforcement and success May be broken down into parts

43. Improving Self-Efficacy creating vicarious experiences video role modeling peer education using agents of change for verbal persuasion stress management and fear/anxiety reduction role plays

44. Self-Efficacy Example-Tooth Brushing Principal comes in and tells class that they can all be great tooth brushers Students watch DVD/video that includes �cheerleading� for brushing teeth appropriate #times and length of time. Also includes demonstration Teacher demonstrates Hand out new tooth brushes and everyone practices Teacher provides direction and positive reinforcement Tooth brushing �practice� occurs for several days

45. Self-Efficacy Building-You Try Building confidence in properly putting on a walking away from a bully/potential fight Stress management/fear reduction Persuasion activity Vicarious experience activity Direct Experience activity

46. Self Efficacy Planning-Suggestions Stress management/fear reduction Refer to, and have booster practice of stress management technique practiced before Deep breathing Persuasion activity Older peers communicate that walking away is easier than they think and the �cool� thing to do Vicarious experience activity Older peers role play Direct Experience activity Students practice in role play Playground monitors have reinforce students who walk away from potential fights

47. Health Belief Model The big picture � it�s all about perceptions Perceptions about personal risk for experiencing a health problem Perceptions about how large a negative effect a health problem will have on one�s health and quality of life Perceptions of the benefits of and barriers to engaging in the recommended health-enhancing action Self-efficacy (again!)

48. Health Belief Model-In Elementary HE Elementary level HE is the foundation of the creation and maintenance of appropriate perceptions Acquisition and understanding of appropriate concepts Finding and evaluating sources of information By upper elementary moving toward using and adding to the foundation to address perceived benefits and barriers of maintaining and/or adopting health-enhancing behaviors Decision-making Problem solving Creating self-efficacy for health-enhancing behaviors

49. Looking a little closer Perceived benefits �What�s in it for me?� Make sure �rewards� of the healthy behavior relate to student developmental level Physical, social, relational, familial Need to discover what their perceptions are first-don�t assume, you are likely to be surprised Want them to know and to perceive all the actual benefits Some teachers �stack the deck�

50. Looking a little closer Perceived barriers What gets in the way of performing the recommended health enhancing behavior? Need to discover what their perceptions are first-don�t assume, you are likely to be surprised Work on identification of real vs. perceive barriers Some barriers may not be able to be removed Strategies to address or work around

51. Strategies Lower grades Ask students what they think Record in some manner Have teacher-led discussion for clarification Teacher-led weighing of benefits and barriers Upper grades �Ask� students what they think Record in some manner Class discussion Student research Real benefits Removal of barriers

52. Strategies-General Writing letters Pointing out benefits Suggestions for removing barriers Art-Posters Decision-making trees

53. Concluding Thoughts

54. Why do I need this information? Value of knowing the goals of health education Value of philosophies to health education Value of understanding key concepts in behavioral theories and models