The Adult Learner
"The adult learner seeks to improve themselves or their society by increasing their skill, knowledge or sensitiveness..."
(Ross-Gordon, Rose & Kasworm, 2017, p. 40)
Specific to health education, expect that adults will differ in their responsiveness to illness, wellness and learning. Their capacity to manage health relates to their interactions and day-to-day living practices which are set in the context of social, cultural and environmental settings (Hill & Ziegahn, 2010) Preferences for how they learn about health will also vary (Coady, 2014). Consider the following adult characteristics as you embark on your journey as a health educator.
To know an adult's life schedule, is to know their learning schedule (Merriam & Baumgartner, 2020).
-
Previous education is the best predictor of engagement in adult learning.
-
Low literacy (about 25% of the adult population) (Hill & Ziegahn, 2010) and economic status reduce the likelihood of participation in adult learning.
-
Low health literacy, or the ability to process, obtain and understand basic health information in order to make health decisions impacts those with low literacy more, but can also impact those with adequate literacy skills (Hill & Ziegahn, 2010).
-
-
Job-related training is the number one reason for participation in learning; health accounts for 5% of adult learning (Merriam & Baumgartner, 2020).
-
Barriers to adult engagement in learning are situational (lack of time or money, or other life responsibilities), institutional (conflicts with scheduling classes, location of learning event, or lack of information) and dispositional (attitudes and self-perceptions such as confidence)(Merriam & Baumgartner, 2020).
-
Historically, white, affluent older adults were the most likely to engage in learning events. Today, participation in learning events by culturally diverse groups is increasing. Continuing education needs to consider native culture (Ross-Gordon, Rose & Kasworm, 2017).
-
Health education is often initiated through self-directed learning as the individual gathers information from written materials, internet-based content, videos or audio sources (Hill & Ziegahn, 2010). This information can be conflicting, and/or inaccurate.
.png)
Figure 1: Factors influencing food choices and behaviors. Adapted from Nutrition Education: Linking Research, Theory and Practice (p. 62), by I. Contento, 2016, Jones and Bartlett.
Responding to Needs of the Adult Learner in Health Education
1
Ways of Knowing
While literacy was acknowledged as a consideration for health educators, it is also important to recognize that intelligence ("being smart") and wisdom ("insight and knowledge of one's world; sound judgment to life problems") are socially constructed definitions (Merriam & Baumgartner, 2020). For example, Western culture often defines intelligence by the number of years in formal education or a higher level of cognitive development. Eastern culture values ways of knowing that demonstrate sociability, interpersonal relationships and introspective attitudes (Merriam & Baumgartner, 2020). Very different perspectives and understanding of health will come from different ways of knowing.
Strategy for the educator: Diversify assessment methods to allow demonstration of learning that reflects individual strengths and different ways of knowing. Howard Gardner's theory of multiple intelligences is one example of how to diversify teaching (Wlodkowski & Ginsberg, 2017). Diverse assessments begin with diverse frameworks and taxonomies for learning. Use Bloom's taxonomy to accommodate varying levels of cognition - while also incorporating objectives to accommodate psychomotor and affective learning, such as Fink's taxonomy (Davis & Arend, 2013).
2
Health Beliefs
The Health Belief Model suggests that readiness to change is influenced by health beliefs and convictions. Health beliefs arise from a variety of sources including culture/family and past experience/learning. Health beliefs are an example of our way of knowing. In health, they shape our perceptions of susceptibility, severity, risk, benefits, barriers and self-efficacy (Contento, 2016).
Strategy for educators: Develop your cultural competence as a health educator, tailor education to use appropriate language, meet people where they are at, correct misconceptions, and start with easy-to-do action steps.
Example of cultural competence: Many Black women grow up with the health belief that "big is beautiful". A healthy weight is described as "when your jeans fit". The term "really big" is preferred over "obese", which is viewed as a dirty word (Contento, 2016).
Practice #1: How would you communicate about weight loss if working with an African American woman?
Practice #2: Read Cultural competence an important goal in dietetics (Kemneck, J, 2017). Can you identify the health belief in this story?
3
Readiness to Learn
The Transtheoretical Model (TTM) or Stages of Change proposes people progress through various stages of readiness to change. Depending on where people are can help determine your educational and/or coaching strategy (Contento, 2016). These stages are not always linear, or separate. For example, one might be in the action stage of adding fruits and vegetables to their diet, but only contemplating reducing fat.
Strategy for educators: Learn to identify the client's stage and communicate appropriately to help them move forward.
Sample of how you communicate differently during different stages
Readiness to learn may also be determined by Maslow's Hierarchy of Needs motivation theory. This theory suggests the following human needs, each of which is required to achieve the next: physical (food, water), safety (health care, protection), social (connection, love), self-esteem (respect, achievement) and self-actualization (personal growth, education). While there is no empirical evidence supporting Maslow's theory (Wlodkowski & Ginsberg, 2017), it is worth noting the commonality between barriers to adult engagement (social determinants of health) and needs identified by Maslow. As an example, an individual struggling with food insecurity is unlikely to be ready to learn about the importance of eating five servings of fruits and vegetables a day.
Strategy for educators: Build rapport through positive regard, empathy, authenticity, and consistent follow-through (Moore, Jackson & Tschannen-Moran, 2016). A trusting relationship helps uncover barriers and promote self-actualization.
4
Personal Relevance
Se
