HCA 3306, Community Health 1
Course Learning Outcomes for Unit V
Upon completion of this unit, students should be able to:
1. Determine strategies to address prevalent community health issues facing the United States.
1.1 Identify how to use the health belief model (HBM) and visual-aural-read/write-kinesthetic
(VARK) to confront prevalent community health issues.
1.2 Explain appropriate teaching mechanisms that can be used to provide health education.
Course/Unit
Learning Outcomes
Learning Activity
1.1
Unit Lesson
Chapter 8
Unit V Essay
1.2
Unit Lesson
Chapter 9
Unit V Essay
Required Unit Resources
Chapter 8: Theories in Health Education and Health Promotion
Chapter 9: Methods in Health Education and Health Promotion
UNIT V STUDY GUIDE
Theories and Methods in
Health Promotion
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Unit Lesson
Health Belief Model and Visual-Aural-Read/Write-Kinesthetic Model
When we try to influence human behavior for
positive change, we begin with the client’s beliefs.
There is probably no surprise there because what
we believe is so important in our lives and for our
health.
For example, for generations, most Americans
believed that cigarette smoking was harmless and
not a concern in terms of health. Cigarettes were
even touted as a treatment for various breathing
problems!
Americans enjoyed smoking, and they kept doing it,
but over time the consequences became all too
clear. The surgeon general’s report on tobacco in
1964 presented the truth. Smoking destroys health
and destroys human lives (Centers for Disease
Control and Prevention, n.d.).
This lecturer/author is an administrator for a health
system that recently launched pulmonary
rehabilitation programs in several facilities.
Firsthand experience with those programs revealed
that the majority of today’s smokers believe that
smoking is harmful, and they want to quit, but the
actual quitting is difficult. Nicotine is a powerfully addictive chemical. Meanwhile, professional community
health educators can help, and we can make the difference. Let’s consider that process in this unit’s lesson.
Health Belief Model
Health beliefs can be considered the client’s cumulative ideas, convictions, beliefs and attitudes regarding
health and illness. They are the result of a lifetime of learning from parents, teachers, friends, coworkers,
media, and the Internet. Beliefs are so important for health and disease prevention.
The health belief model (HBM) has been around for a long time. It was developed in the 1950s by health care
professionals in the United States public health service. Officials in the public health service were puzzled
about why Americans were not participating in positive health behaviors, even when they had been well
documented. So they applied some principles from sociology and psychology, the operant and cognitivebehavioral theories, and they created health belief model.
The health belief model theorizes that clients will take positive action to prevent illness or control an existing
illness if the following conditions are met.
• The client must believe that he or she is personally susceptible to the illness. “It can happen to me.”
• The client must believe that the illness has serious consequences.
• The client must believe that there is a course of action to reduce susceptibility or the seriousness of
the illness.
• The client must believe that the costs of taking positive action are outweighed by the benefits.
Therefore, the health belief model focuses on those four aspects, and all of them must be present in order to
effect positive change. Some of the most successful disease prevention programs in the world are based
upon these four key principles. Smoking cessation programs, weight-loss programs, asthma education
programs, type 2 diabetes education programs, and cardiac rehabilitation programs are just a few examples
of the impact of the health belief model today.
Asthmatic Cigarettes. (Asthma Management, via
Felix Khusid and the American Association for
Respiratory Care’s Virtual Museum, n.d.)
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Perceived susceptibility is our starting point. Unless the client truly believes that he or she is susceptible to the
disease, positive change will not take place. Let’s use the example of type 2 diabetes here, a disease that is
so prevalent in our communities today. We can share statistics on type 2 diabetes prevalence with the client;
explain the pathophysiology; and ask the client to think of family, friends, or coworkers who are affected by
the disease. This step is not a high hurdle to get over today, simply because there is so much type 2 diabetes
in the community. Often, type 2 diabetes is related to individual choices such as sedentary lifestyle and a high
fat, high carbohydrate diet.
Some families have higher type 2 diabetes risk than others, but it can happen to anyone. Typically, we can
achieve client perception of susceptibility. Several good susceptibility survey instruments are now available to
help with this step.
Perceived severity comes next. The client must believe that the health condition at hand can be serious if left
untreated and could lead to life-changing consequences and limitations. Continuing with our type 2 diabetes
example, we can point to the severe, long-term consequences of poorly managed type 2 diabetes that can
include kidney failure and the need for dialysis treatments, vascular disease and possible amputations, and
diabetic ketoacidosis. These circumstances can land the client in the emergency room and truly be lifethreatening. Excellent teaching resources are available today to assist us in educating clients about the
severity of the disease.
The combination of perceived susceptibility and perceived severity leads to the human emotional response,
which we call fear. In this case, fear turns out to be a very positive and necessary thing. It is fear that drives
positive change in health education.
Perceived benefit comes next, and it is easier to achieve today than ever before because of the wealth of
research now available and published online regarding the effectiveness of positive actions on human health.
We must get the client to correctly believe that the positive changes that we recommend for them will actually
work, reducing risk or reducing the impact of an existing disease. The American Diabetes Association
provides outstanding resources about this and clearly documents which behavioral changes have welldocumented positive effects and which do not (American Diabetes Association, n.d.).
Perceived barriers must be addressed. Clients will naturally perceive certain barriers or impediments to
action. “I don’t have time.” “I can’t afford it.” “I don’t have transportation.” “I don’t know if my insurance will pay
for it.” All of these are legitimate, real-world issues that the client can experience. If we are to be successful as
health care educators, we must help the client to address them, one by one. Successful health education
programs already have the answers to many client questions. It is very clear that we must make it easy for
clients to participate! That aspect is so important.
The good news is that communities and payers are finally getting the point here. Health insurance coverage
for things like type 2 diabetes education, cardiac rehabilitation, and pulmonary rehabilitation has never been
better, and many communities are now providing free transportation services to and from health care facilities.
That has been a tremendous positive step. Our continuing challenge is on the prevention side of things. The
Affordable Care Act has improved coverage for some preventive services, but there are still gaps.
In short, we must make it feasible for clients to participate in positive change, or it will not happen. Thankfully,
many positive changes can take place right in the client’s home, including dietary changes, well-designed
exercise, and careful monitoring of key indicators such as blood sugar for diabetics and peak flow for
asthmatics.
Cues to action is next, which leads to a brief discussion of disease management, a fascinating new aspect of
health care today. What we have learned is that even a well-educated client who really understands his or her
disease is unlikely to stay the course of positive changes without help. Clients need follow-up, they need
reminders, and they need to know that someone is going to be checking up on them to see their progress.
The good news is that many payers are providing for disease managers to follow-up with clients and make
sure that they are still on track. The payers are not doing that out of the goodness of their own hearts, they
are doing disease management because they have learned that it saves them money on ER visits and
hospitalizations! It is also the right thing for the client. Even without formal disease management, client
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smartphones can be a great help, providing reminders, cueing activities and appointments, and helping the
client to achieve self-efficacy (the realization that they can sustain the needed positive changes for health)!
VARK: Visual-Aural-Read/Write-Kinesthetic Learning
VARK stands for visual, aural, read/write, and kinesthetic, which are different ways that clients learn (VARK
Learn Limited, n.d.). There is definitely overlap among them, but most clients have one preferred or dominant
way of learning.
Visual (V). Clients who learn in this way like depictions of information, for example, in maps, charts, flow
charts, diagrams, and hierarchies. When teaching, a whiteboard can be used to draw a diagram with
meaningful symbols, and that will greatly help visual learners.
Aural (A). Clients who prefer aural learning learn best from lectures, group discussions, radio, mobile phones,
just talking with others, and web chats. Email is included in this area because it is often used for chat
purposes. The aural learning preference includes talking out loud and talking to oneself. Often, clients with
this preference learn by speaking first. They like to repeat what has already been said, hearing themselves
speak, in their own way.
Read/Write (R). This client-learning preference is for information displayed as words, such as reading an
article or reading from a textbook. Many teachers and students have a strong preference for this mode, and
this modality brings attributes sought out by many employers of graduates. The focus is on text-based input
and output. PowerPoint is a key way that read/write learners get their information. Google is made for these
folks.
Kinesthetic (K). Here, the focus is on using experience and practice to facilitate learning. Although these
real-world or laboratory experiences may use visual, aural, or written tools, the key is that people who prefer
this mode want concrete personal experiences or simulations. They need to actually do it and not just read
about it or hear about it.
Multimodality (MM). The reality is that today’s world is definitely multimodal, and so are many clients. But a
key to success is that our teaching in health care must involve all modes of learning in order to be most
effective!
Conclusion
There is a great deal of science surrounding the education of clients in health care today. That is because it is
so very important! The next improvements in American community health will not come from some new
technology or new medical procedures. The improvements ahead will come from better educated patients
who make better choices in their own lives. This is an exciting time to be involved, and the health care
organizations that you aspire to lead are definitely getting more and more involved in this aspect. It is a good
and positive thing to teach clients to stay well rather than just treating them in the ER and hospital when they
are acutely ill. Hopefully, this lesson has helped you to understand a bit more about health education as a key
part of health promotion!
References
American Diabetes Association. (n.d.). Home page. https://www.diabetes.org/
Asthma Management. (n.d.). Dr. Guild’s asthmatic cigarettes [Image]. http://museum.aarc.org/gallery/asthmamanagement/
Centers for Disease and Control Prevention. (n.d.). History of the surgeon general’s reports on smoking and
health. U.S. Department of Health and Human Services.
https://www.cdc.gov/tobacco/data_statistics/sgr/history/index.htm
VARK Learn Limited. (n.d.). The VARK modalities. http://vark-learn.com/introduction-to-vark/the-varkmodalities/
