This site includes questions and answers on Adult
Education that were written by students in the course 'Outline of Adult Education' at
OISE/UT. The questions are first raised in class by the students themselves.
Then they organize in teams in order to research and answer them. New entries
are added regularly. This website is intended to provide information about the
field to new students and to those who have a general interest in Adult
Education. Anyone is welcome to submit a question and/or answer.
How
are changes in health behaviour facilitated through adult education
interventions?
By
Amy Diniz, Lisa Schmidt and Sandra Stothers,(OISE/University
of Toronto)
Adult
education is a complex and diverse field of practice which yields itself to a
number of disciplines including that of health education. As a result, many of
the principles and theories that have formed the basis for health education and
promotion programs can be directly linked to the theories of adult education,
and more specifically to the theories of behaviour change.
Malcolm
Knowles is one such theorist whose work and ideas have influenced health
education throughout the years.Knowles’
model of adult learning advocates that education must be learner-centred and
build on the needs and interests of learners. More specifically, Knowles bases
his model on three main assumptions: adults are self-directed learners, adults
require a readiness to learn and their orientation to learning is problem- or
life-centred.
These
assumptions formed the basis for many of the health education programs
throughout the 1970’s and 80’s and are reflected in the Health Belief Model
as developed by Hochbaum, Kegels and Rosenstock. This model suggests that adults
are more likely to adopt healthy practices and behaviours when the following
four criteria are met:
the
individual perceives themselves at risk of developing a specific condition;
the
condition is perceived to be serious with negative consequences;
the
risk will be reduced with specific behaviour changes; and
the
barriers to behaviour change can be overcome or managed.
For
example, a smoker who recently suffered a heart attack and attributes the
episode to smoking may be more easily influenced to adopt a non-smoking
lifestyle than a teenager who cannot relate or disassociates himself from the
potential harmful effects of smoking.
Influencing
or facilitating behaviour change creates many challenges for the adult educator
and goes far beyond assessing one’s readiness to learn or the provision of
information. More advanced models of health education in recent years state that
adult educators must also address a number of other factors including: the
availability of resources, effectiveness of community leadership, social support
systems, level of self-help skills, environmental issues or changes and health
care policy.
The
complexity and challenge of these issues became more clear to us when we
reviewed Mezirow’s Theory of Transformative Learning. In a nutshell, Mezirow
states that transformative learning occurs when individuals change their frame
of reference by critically reflecting on their assumptions and beliefs. Based on
this process of critical reflection, the adult learner then consciously changes
their behaviour to accommodate their newly defined world.
This
process of critical reflection and action is referred to by Freire as dialogue,
a two-way process occurring between teachers and learners in which each takes a
role of teacher and learner. The teacher can encourage the learner to examine
the underlying issues behind the problems they identify and armed with this new
self-knowledge, make changes that are relevant and meaningful to the learner.
To
illustrate these concepts and processes, let’s take the example of the
marketing strategies against smoking.The
focus of awareness campaigns has evolved from highlighting the health
consequences to emphasizing the practices of tobacco companies and their
marketing strategies. In some instances, this has been proven to be a motivating
factor in creating a behaviour change. The Canadian
Coalition for Action on Tobacco has adopted a strategy of public criticism of
the tobacco industry in a federally sponsored mass media campaign to
reduce smoking. Tobacco industry denormalization is a new approach to
anti-smoking campaigns that has proven to be effective several jurisdictions,
including California, Florida and Massachusetts. This approach is to simply
inform the public regarding the truth about tobacco industry behaviour.
In
recent years, the field of health promotion has gained ground throughout the
world as governments struggle with issues such as HIV/AIDS, obesity and cancer.Campaigns to improve safe-sexpractices,
health eating practices and smoke-free lifestyles often hinge on the creation of
education programs, support systems and the creation of public policy.Much headway has been achieved in all three of these areas
but for momentum to continue in our current economy and health care system,
large scale programs will need to demonstrate that not only is change possible
but that the efforts will be cost-effective.
In
an era of cuts to healthcare and competing social and political priorities, the
willingness and support of governments and NGOs for health lifestyle programs
may be rationed and in jeopardy of future funding.Without the support and assistance of these institutions,
adult educators will be left to fend for themselves and for the learners they
support.
References:
Derek
Rutter, Lyn Quine. (2002). Changing Health
Behavior. Open University Press. USA