Motivation, Compliance, and Health Behaviours of the Learner

1. Motivation, Compliance, and Health Behaviours of the Learner Dr. Belal M. Hijji, RN, PhD April 3 & 10, 2012

2. Learning Outcomes • Define the term motivation and discuss motivational factors and axioms relevant to learning. • Define compliance and adherence and differentiate between both. • Have an overview of some of the models and theories of behaviours.

3. Motivation • Is defined as a psychological force that moves a person to act and as a willingness of the learner to embrace learning. • Can be viewed in positive or negative terms. In case of illness, forces of approach or avoidance may come into play. If avoidance was the preference of choice, there would be a negative movement away from the goal. • Is influenced by factors that serve as incentives or barriers to achieve desired outcomes. Educators can be facilitators or blockers. • Motivational incentives are influenced by the context of an individual; what may be a motivational incentive for one learner may be an obstacle for another. For example, a student who is assigned to work with elderly woman may be motivated if she treats him in high regard. Another student may be motivationally blocked because previous experiences with older women were unrewarding.

4. There are 3 major categories that facilitate or block motivation to learn. These are: • Personal attributes such as developmental stage, age, gender, emotional readiness, values and beliefs, sensory functioning, cognitive ability, educational level, state of health, and severity of illness. One’s perception of disparity between current and expected state of health can be motivating factor in health behaviour and can drive readiness to learn. • Environmental influences such as physical characteristics of the learning environment, accessibility and availability of human and material resources, rewards, noise, confusion, interruption, and lack of privacy. The environment can create, promote, or detract from a state of learning receptivity. • Learner’s relationship systems including family or significant others, work, school, community roles, and teacher-learner interaction. Individuals are viewed in the context of family/ community/ cultural system that have lifelong effects on the choices that individuals make, including healthcare seeking and healthcare decision making.

5. Motivational Axioms • These are rules that set the stage for motivation. They include: • Sate of optimum anxiety • Learner’s readiness • Realistic goals • Learner’s satisfaction/ success • Uncertainty-reducing or uncertainty-maintaining dialogue

6. Sate of optimum anxiety • Learning occurs best when a state of moderate anxiety exists where the learner’s ability to observe, focus attention, learn, and adapt is operative. • If anxiety is severe, the ability to perceive the environment, concentrate, and learn is reduced. For example, a patient with recently diagnosed IDDM who has a high level of anxiety would not be able to retain information when instructed about insulin injections. • The nurse’s role in this situation is to reduce the client’s anxiety through techniques like guided imagery, use of humor, or relaxation tapes. Anxiety reduction will help the patient respond with higher level of information retention.

7. Learner’s readiness • Desire to move toward a goal and readiness to learn influence motivation; desire cannot be imposed. • The nurse educator and external factors can influence the learner’s desire through using incentives that are specific to the learner, offering positive perspectives and encouragement, making information relevant and accessible, and creating an environment that is conducive to learning,

8. Realistic goals • The learner should address goals that are within one’s grasp, reasonable, and achievable. • Unrealistic goals are a waste of time and energy and unproductive • Setting a realistic goal is a motivating factor as it facilitates behaviour geared to ward achieving that goal

9. Learner’s satisfaction/ success • Success motivates the learner; it is self-satisfying and enhances self-esteem. When the learner feels good about step-by-step accomplishment, motivation is enhanced. • Clinical evaluation, when focused on demonstration of positive behaviours, can encourage movement toward performance goals.

10. Uncertainty-reducing or uncertainty-maintaining dialogue • Uncertainty and certainty can motivate the learner. • Individuals have ongoing internal dialogues that can either reduce or maintain uncertainty. • When one want to change state of health, behaviours will often follow a dialogue that examines uncertainty. “smoking cessation would reduce the risk of ca lung”. • However, when the outcome of the health behaviour is more uncertain, then behaviours may be uncertainty maintaining. “I am not sure if I need this surgery; it make no difference in the survival rate”

11. Compliance • Compliance is the term used to describe submission [الإذعان] or yielding to pre-determined goals. As such, compliance has a authoritative undertone in which the educator is viewed as the authority and the learner as submissive. • Compliance has not been received well in nursing may be because patients have the right to take healthcare decisions and to not follow pre-determined course of action as set by healthcare providers. • Commitment to a regimen is known as adherence [التزام], which may belong-lasting. Both compliance and adherence refer to the ability to promote health promoting activities which are determined largely by healthcare provider.

12. There are subtle [غير واضحة] differences between compliance and adherence. A patient may comply with a regimen without being committed to it. For example, a patient who experiences sleep disturbances may comply with prescribed medication for one week, and may not adhere to the regimen for an extended period of time even why sleep disturbance persists. 12

13. Health Behaviours of the Learner Motivation and compliance are concepts relevant to health behaviours of the learner The nurse educator focuses on health education and the expected health behaviours. Therefore: The nurse educator will have an increased range of the health-promoting strategies if s(h)e is aware of the models and theories that describe, explain, or predict health behaviour. 13

14. Health Behaviour Models and Theories • Health Belief Model (Slides 15 & 16) • Was developed in the 1950s to examine why people did not participate in health-screening programmes • Was later modified to address compliance to therapeutic regimen • Is built on the premise that disease prevention and curing regimens will eventually be successful and the belief that health is highly valued. Both premises need to be present in the model to be relevant in explaining health behaviour

17. Revised Health Promotion Model (Slide 18) • Has been primarily used in nursing • Describes major components and variables that influence health promoting behaviours • Emphasises actualisation of health potential and an increase in the level of wellbeing rather than avoidance of disease • Has three major components of individual characteristics and experiences, behaviour-specific cognition and affect, and behavioural outcome

19. Theory of Reasoned Action (TRA) (Slide 20) • Emerged from a research programme that began in 1950s and is concerned with prediction and understanding of any form of human behaviour within a social context • Is based on the premise that humans are rational decision makers who make use of whatever information is available to them. • Specific bahaviour is determined by (1) beliefs, attitude toward the bahaviour, and intention and (2) motivation to comply with influential persons. • This theory was supported by a nursing research on AIDS risk behaviour among 103 young unmarried sexually active black men. The results indicated that attitude toward condom use was the strongest predictor of behaviour, followed by increased support from significant others for the intention to use condoms.

20. Theory of Reasoned Action (TRA)