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1. Peter John P. Gono, RN, MANc
THEORIES IN
HEALTH EDUCATION

2. TYPES OF THEORIES IN HEALTH
EDUCATION
1. BEHAVIORIST
2.COGNITIVE
3.SOCIAL

3. BEHAVIORAL THEORY
 Seeks to explain human behavior by analyzing the
antecedents and consequences present in the
individual's environment and the learned associations
he or she has acquired through previous experience.
 Contiguity
 Classical conditioning, and
 Operant conditioning

4. CONTIGUITY THEORY (Edwin Guthrie)
 Psychological theory of learning which emphasizes that
the only condition necessary for the association of
stimuli and responses is that there be a close temporal
relationship between them. It holds that learning will
occur regardless of whether reinforcement is given, so
long as the conditioned stimulus and the response occur
together. Psychologists John Watson and E.R. Guthrie
were both proponents of the theory of contiguity.

5. CLASSICAL CONDITIONING
 (also known as Pavlovian or respondent conditioning) is learning
through association and was discovered by Pavlov, a Russian
physiologist. In simple terms, two stimuli are linked together to
produce a new learned response in a person or animal.
 Everything from speech to emotional responses was simply
patterns of stimulus and response.
 The biologically potent stimulus is an involuntary
response also known as reflex.
 Example:
 Every Friday is a quiz day so the students are prepared
for the assessment.

6. OPERANT CONDITIONING
 Sometimes referred to as instrumental conditioning, is
a method of learning that employs rewards and
punishments for behavior.
 Through operant conditioning, an association is made
between a behavior and a consequence (whether
negative or positive) for that behavior.
 Ex: reinforcement

7. COGNITIVE THEORY
 is an approach to psychology that attempts to explain human
behavior by understanding your thought processes.
 is about understanding how the human mind works while
people learn. The theory focuses on how information is
processed by the brain, and how learning occurs through that
internal processing of information.
 3 Main Cognitive Theories
1. Piaget's cognitive developmental theory
2. Vygotsky's sociocultural theory, and
3. Information-processing theory

8. PIAGET'S COGNITIVE
DEVELOPMENTAL THEORY
 Jean Piaget's theory of cognitive development suggests that
intelligence changes as children grow. A child's cognitive
development is not just about acquiring knowledge, the child
has to develop or construct a mental model of the world.
 Cognitive development occurs through the interaction of
innate capacities and environmental events, and children pass
through a series of stages.

9. Stages
 SENSORIMOTOR STAGE: Birth to 18-24 months
 PREOPERATIONAL STAGE: 2 to 7 years
 CONCRETE OPERATIONAL STAGE: 7 to 11 years
 FORMAL OPERATIONAL STAGE: Ages 12 and up

10. 1. Sensorimotor Stage of Cognitive
Development
 The sensorimotor stage is the first of the four stages in Piaget's
theory of cognitive development.
 It extends from birth to approximately 2 years, and is a period of
rapid cognitive growth. During this period, infants develop an
understanding of the world through coordinating sensory
experiences (seeing, hearing) with motor actions
(reaching, touching).
 The main development during the sensorimotor stage is the
understanding that objects exist and events occur in the world
independently of one's own actions ('the object concept', or
'object permanence').

11. 2. Preoperational Stage of
Cognitive Development
 This stage begins around age two and lasts until approximately age
seven. During this period, children are thinking at a symbolic level but
are not yet using cognitive operations.
 The child's thinking during this stage is pre (before) operations. This
means the child cannot use logic or transform, combine or separate
ideas.
 The child's development consists of building experiences about the
world through adaptation and working towards the (concrete) stage
when it can use logical thought. During the end of this stage children
can mentally represent events and objects (the semiotic function), and
engage in symbolic play.

12. The Key Features Of The Preoperational
Stage Include:
 1. Centration is the tendency to focus on only one aspect of
a situation at one time. When a child can focus on more
than one aspect of a situation at the same time they have
the ability to decenter.
 During this stage children have difficulties thinking about
more than one aspect of any situation at the same time;
and they have trouble decentering in social situation just as
they do in non-social contexts.

13.  2. Egocentrism refers to the child's inability to see a
situation from another person's point of view.
 The egocentric child assumes that other people see,
hear, and feel exactly the same as the child does.
 In the developmental theory of Jean Piaget, this is a
feature of the preoperational child. Childrens'
thoughts and communications are typically
egocentric (i.e. about themselves).

14.  4. Play. At the beginning of this stage you often find
children engaging in parallel play. That is to say they
often play in the same room as other children but they
play next to others rather than with them.
 Each child is absorbed in its own private world and
speech is egocentric. That is to say the main function of
speech at this stage is to externalize the child’s thinking
rather than to communicate with others.
 As yet the child has not grasped the social function of
either language or rules.

15.  5. Symbolic Representation
 The early preoperational period (ages 2-3) is marked by a dramatic
increase in children’s use of the symbolic function.
 This is the ability to make one thing - a word or an object - stand
for something other than itself. Language is perhaps the most
obvious form of symbolism that young children display.
 However, Piaget (1951) argues that language does not facilitate
cognitive development, but merely reflects what the child already
knows and contributes little to new knowledge. He believed
cognitive development promotes language development, not vice
versa.

16.  6. Pretend (or symbolic) Play. Toddlers often pretend to be
people they are not (e.g. superheroes, policeman), and may
play these roles with props that symbolize real life objects.
Children may also invent an imaginary playmate.
 As the pre-operational stage develops egocentrism
declines and children begin to enjoy the participation of
another child in their games and “lets pretend “ play
becomes more important.
 For this to work there is going to be a need for some way
of regulating each child’s relations with the other and out
of this need we see the beginnings of an orientation to
others in terms of rules.

17.  7. Animism. This is the belief that inanimate objects (such as toys and
teddy bears) have human feelings and intentions. By animism Piaget
(1929) meant that for the pre-operational child the world of nature is
alive, conscious and has a purpose.
Piaget has identified four stages of animism:
 Up to the ages 4 or 5 years, the child believes that almost everything
is alive and has a purpose.
 During the second stage (5-7 years) only objects that move have a
purpose.
 In the next stage (7-9 years), only objects that move spontaneously
are thought to be alive.
 In the last stage (9-12 years), the child understands that only plants
and animals are alive.

18.  8. Artificialism. This is the belief that certain aspects of
the environment are manufactured by people (e.g.
clouds in the sky).
 9. Irreversibility. This is the inability to reverse the
direction of a sequence of events to their starting
point.

19. 3. Concrete Operational Stage
 The concrete operational stage is the third stage in Piaget's
theory of cognitive development. This period lasts around
seven to eleven years of age, and is characterized by the
development of organized and rational thinking.
 The child is now mature enough to use logical thought or
operations (i.e. rules) but can only apply logic to physical
objects (hence concrete operational).
 although children can solve problems in a logical fashion,
they are typically not able to think abstractly or
hypothetically.

20. 4. Formal Operational Stage
 The formal operational stage begins at approximately age
twelve and lasts into adulthood.
 As adolescents enter this stage, they gain the ability to
think in an abstract manner by manipulating ideas in their
head, without any dependence on concrete manipulation
(Inhelder & Piaget, 1958).
 He/she can do mathematical calculations, think creatively,
use abstract reasoning, and imagine the outcome of
particular actions.

21. Formal Operational Thought
Inclusions
 Hypothetico Deductive Reasoning
o Hypothetico deductive reasoning is the ability to think scientifically through
generating predictions, or hypotheses, about the world to answer questions.
o The individual will approach problems in a systematic and organized manner,
rather than through trial-and-error.
 Abstract Thought
 Concrete operations are carried out on things whereas formal operations are
carried out on ideas. The individual can think about hypothetical and
abstract concepts they have yet to experience. Abstract thought is important
for planning regarding the future.

22. Vygotsy’s Cognitive Theory
 Lev Vygotsky (1896-1934) was a Russian teacher who is considered a pioneer in
learning in social contexts. As a psychologist, he was also the first to examine
how our social interactions influence our cognitive growth.
 He was convinced that learning occurred through interactions with others in our
communities: peers, adults, teachers, and other mentors.
 He determined that teachers have the ability to control many factors in an
educational setting, including tasks, behaviors, and responses. As a result, he
encouraged more interactive activities to promote cognitive growth, such as
productive discussions, constructive feedback, and collaboration with others.
 Vygotsky also stated that culture was a primary determinant of knowledge
acquisition. He argued that children learn from the beliefs and attitudes modeled
by their culture.

23. SOCIAL THEORY
 Social learning theory is a theory of learning process
and social behavior which proposes that new behaviors
can be acquired by observing and imitating others.
 Health Promotion Model
Bandura’s Social Learning Theory
PRECEDE-PROCEED MODEL

24. Health Promotion Model
 According to Nola J Pender (1982; revised,
1996)
 The health promotion model (HPM) was
designed to be a “complementary counterpart
to models of health protection.”

25. It defines health as a positive dynamic
state not merely the absence of disease.
 Health promotion is directed at
increasing a client’s level of wellbeing.

26.  The health promotion model describes the multi
-dimensional nature of persons as they interact
within their environment to pursue health.

27.  The model focuses on following three areas:
1. Individual characteristics and experiences
 prior related behavior and personal factors
2. Behavior-specific cognitions and affect
 perceived benefits of action, perceived barriers to
action, perceived self-efficacy, activity-related affect,
interpersonal influences, and situational influences
3. Behavioral outcomes
 commitment to a plan of action, immediate competing
demands and preferences, and health-promoting behavior

29. Person Environment
Health Nursing
METAPARADIGM

30. PERSON
 Refers to individuals, families and
communities
 It includes:
 Biologic: Age, BMI, Pubertal Stat,
Menopausal Stat, Aerobic Capacity, str, agi
and balance
• Socio-cultural: Race, Ethnicity, Acculturation,
Education, socioeconomic stat.
• Psychological Fx: Self-esteem, Self motivation,
perceived health stat

31. ENVIRONMENT
Where a person spends most of time
Nursing centers
Occupational health settings
Community

32. NURSING
Health promotion services
Health promoting interventions
Empowerment for self care
Clients capacity for self care

33. HEALTH
Health responsibility
Physical activity
Nutrition
Interpersonal relations
Spiritual growth
Stress management

34. Health Promotion Process
Planning
Implementing
Evaluating the health
plans/programs

35. Steps in Developing A Health
Education/Promotion Program
 ASSESSING the needs of the target population
 Developing appropriate GOALS & OBJECTIVES
 Creating an INTERVENTION
 IMPLEMENTING the intervention
 EVALUATING the results

36. Purpose of Patient Education
To increase the
competence &
confidence of clients for
self-management

37. Benefits of Patient Education
 Increase consumer satisfaction
 Improve quality of life
 Ensure continuity of care
 Decrease patient anxiety
 Effectively reduce the incidence of complications of
illness
 Promote adherence to healthcare treatment plans

38. Benefits ……..
Maximize independence in the
performance of ADL
Energize and empower
consumers to become actively
involved in the planning of their
care

39. Goals of Patient & Staff Education
 To support patients through the transition from
being invalids to being independent in care
 From being dependent recipients to being
involved participants in care in the care process
 From being passive listeners to active learners

40. Goals ………..
To prepare patients and their families for
self –care
Involve patients in exploring and
expanding their self – care abilities
through interactive patient education
efforts

41. Purpose of Staff Education
 To be exposed to up- to-date & ongoing
information with the ultimate goal of enhancing
(their) practice
 To increase the competence & confidence of
nurses to function independently in providing
quality of care to the consumer

42. ……..Staff Education
 Improving the nation’s health
 Recognize the importance of lifelong learning
to keep their knowledge and skills current

43. BANDURA’S SOCIAL LEARNING THEORY
 is a theory of learning process and social behavior
which proposes that new behaviors can be
acquired by observing and imitating others. In
addition to the observation of
behavior, learning also occurs through the
observation of rewards and punishments, a
process known as vicarious reinforcement.
 Bandura asserts that most human behavior is
learned through observation, imitation, and
modeling.

45. PRECEDE-PROCEED
 PRECEDE/PROCEED is a community-oriented, participatory model
for creating successful community health promotion interventions
 Since behavior change is voluntary, health promotion is more
likely to be effective if it’s participatory.
 Health and other issues must be looked at in the context of the
community.
 Health and other issues are essentially quality-of-life issues.
 Health is itself a constellation of factors that add up to a healthy
life for individuals and communities.

46. PRECEDE
 Phase 1: Social diagnosis
 Phase 2: Epidemiological diagnosis
 Phase 3: Behavioral and environmental diagnosis
 Phase 4: Educational and organizational
diagnosis
 Phase 5: Administrative and policy diagnosis

47. PROCEED
Phase 6: Implementation
Phase 7: Process evaluation
Phase 8: Impact evaluation
Phase 9: Outcome evaluation

48. How do you use PRECEDE/PROCEED?
 IN PHASE 1, SOCIAL DIAGNOSIS
You ask the community what it wants and needs to improve its quality of
life.
 IN PHASE 2, EPIDEMIOLOGICAL DIAGNOSIS
You identify the health or other issues that most clearly influence the
outcome the community seeks.
In these two phases, you create the objectives for your intervention.

49.  IN PHASE 3, BEHAVIORAL AND ENVIRONMENTAL
DIAGNOSIS,
You identify the behaviors and lifestyles and/or
environmental factors that must be changed to affect the
health or other issues identified in Phase 2, and determine
which of them are most likely to be changeable.
 IN PHASE 4, EDUCATIONAL AND ORGANIZATIONAL
DIAGNOSIS
You identify the predisposing, enabling, and
reinforcing factors that act as supports for or barriers
to changing the behaviors and environmental factors
you identified in Phase 3.
 In these two phases, you plan the intervention.

50.  IN PHASE 5, ADMINISTRATIVE AND POLICY DIAGNOSIS
You identify (and adjust where necessary) the
internal administrative issues and internal and
external policy issues that can affect the successful
conduct of the intervention.
Those administrative and policy concerns include
generating the funding and other resources for the
intervention.

51.  IN PHASE 6, IMPLEMENTATION
You carry out the intervention.
 IN PHASE 7, PROCESS EVALUATION
You evaluate the process of the intervention – i.e., you
determine whether the intervention is proceeding according to
to plan, and adjust accordingly.
 IN PHASE 8, IMPACT EVALUATION
You evaluate whether the intervention is having the intended
impact on the behavioral and environmental factors it’s aimed
at, and adjust accordingly.
 IN PHASE 9, OUTCOME EVALUATION
You evaluate whether the intervention’s effects are in turn
producing the outcome(s) the community identified in Phase
1, and adjust accordingly.