Health Services. The Balancing Act Theory Report (Assessment)

Health education programs represent a main strategy in health care activity. However many of these programs have failed due to the complexity of the issues involved. Theoretical and practical aspects and constraints are not fully considered and planned. It is not always easy to change the life style and behavior of a client just so that he remains healthy all his life (Whitehead, 2004). Systematic and concerted efforts are required to achieve success.

Behavioral change education programs aimed at the community should be structured after critically examining the theoretical considerations and balancing them with practically achievable considerations (Whitehead, 2004).This is the balancing act.

The effectiveness of health education programs depend greatly on their manner of delivery and the intention. Most nursing related programs are targeted on traditional behavioral changes (Whitehead, 2001). The main factor that must be kept in mind is that clients may not be in a situation to change their behavior or their mindset is not accepting such a change. Whatever the difficulties, nurses should continue attempting the programs by becoming more conversant with them and be more realistic about their approach.

The term health education refers to the behavioral-focused medical or preventive health program interventions with the aim of avoiding or reducing illness. Nurses should not confuse this with health promotion activities which are broader in concept (Whitehead, 2004). The most sustained and concerted efforts to implement the detailed and focused education programs may thwart success (Norton, 1998). The reluctance of clients to receive new information is an accepted view.

However we should never forget that there are several barriers to overcome. Hence clients should never be blamed for the failure of the program (Whitehead, 2004). It is always good to remember that conforming to your views and changing his health-damaging behavior is not going to give him absolute health (Cribb and Duncan, 2002). Clients have a habit of ignoring information even if they had been asking you for it. Usually they filter the information provided and accept only what validates their present behavior. Sometimes they misapply it ( Niven, 2000). Lack of information or misinformation also can prevent their accepting it. Dines (1994) has described the health education activity of nurses as ‘a constrained activity logically limited in its impact’.

The ‘Law of Effect’ (Thorndike, 1989) is a landmark in the field of behavior modification. This theory says that the success of programs depends on the consequences. However it did not consider emotions and cognitions and the difficulties experienced practically.

Cognitive theories came by in the 1970s. Later we learned that human decision making and behavior have several cognitive inconsistencies and biases (Taylor and Brown, 1988). The biases are the common ones due to irrational thought (Nisbet and Ross, 1985) and the psychological defense mechanisms like denial and repression (Russell, 1993). Summarizing, we should never expect decision making to be rational and objective.

Health resistance is another problem. Repeated health messages sometimes irritate. Some people start resisting even before listening fully and resort to “anticipatory counter-arguing” (Jacks and Devine, 2000). Teenagers resist when they sense a ‘moral good’ (Crossley, 2002). Brown (2001) describes four forms of resistance: repression, defensive processing, downward comparison and reactance. Brehm’s (1966) theory of reactance states that it is an unwelcome and uncomfortable motivational reaction to the threat of removal of one’s freedom.

The ‘protection motivation theory’ (Maddux and Rogers, 1983) says that ‘any risk to health is the starting point in any behavioral change activity’. “Health risk is the ‘balancing act’ that individuals have to regularly perform in relation to their health behavior” (Joffe, 2002). However the risk assessing capabilities of people may be faulty.

Their overestimation of the ability to face health risks themselves (optimistic bias or unrealistic optimism) may be dangerous. Understanding the clients’ social world is essential. Risk must be seen as a function of social and cultural organization of a society and a normal feature of behavior.

“Nurses play a significant role in determining a client’s health-related behavior through the social support that they offer” (Callaghan, 1998). They have to be familiar with all the possible unfavorable reactions of the clients before embarking on the education programs. Presenting the information fully (without filtering it), refraining from stressing on ‘moral good’ but putting it simply without the authoritarian touch, without coercion, providing a few options facilitates the health educator’s job.

Interaction with the clients on beliefs, emotions, previous health experiences, acknowledging their culture could be instrumental in building a relationship with the client. Planning the education program targeting theory-based cognitions, realistic goals and outcomes and using effective designs (from experience) would ensure a successful health education program. Health promotion activities before the education activities help to put clients in a favorable mood.

References

Brehm (1966). J.A. Brehm. A Theory of Psychological Reactance, Academic Press, New York.

Brown (2001). S.L. Brown, Emotive health advertising and message resistance. Australian Psychologist 36 3, pp. 193–199.

Callaghan (1998). P. Callaghan, Social support and locus of control as correlates of UK nurses’ health-related behaviours. Journal of Advanced Nursing 28, pp. 1127–1133.

Cribb and Duncan (2002). A. Cribb and P. Duncan. Health Promotion and Professional Ethics, Blackwell, Oxford.

Crossley (2002). M.L. Crossley, Introduction to the symposium ‘health resistance’: the limits of contemporary health promotion. Health Education Journal 61 2, pp. 101–112

Dines (1994). A. Dines, What changes in health behavior might nurses logically expect from their health education work?. Journal of Advanced Nursing 20, pp. 219–226.

Jacks and Devine (2000). J.Z. Jacks and P.G. Devine, Attitude importance, forewarning of message content, and resistance to persuasion. Basic and Applied Social Psychology 22 1, pp. 19–29.

Joffe (2002). H. Joffe, Representations of health risks: what social psychology can offer health promotion. Health Education Journal 61 2, pp. 153–165.

Maddux and Rogers (1983). J.E. Maddux and R.W. Rogers, Protection, motivation and self-efficacy: a revised theory of fear appeals and attitude change. Journal of Experimental Social Psychology 19 (1983), pp. 469–479.

Nisbett and Ross (1985). R.E. Nisbett and L. Ross. Human Inferences; Strategies and Shortcomings of Social Judgements, Prentice-Hall, Englewood Cliffs, NJ.

Niven (2000). N. Niven. Health Psychology for Health Care Professionals (3rd Edition ed.), Churchill Livingstone, Edinburgh.

Norton (1998). L. Norton, Health promotion and health education: what role should the nurse adopt in practice. Journal of Advanced Nursing 28, pp. 1269–1275.

Russell (1993). G. Russell, The role of denial in clinical practice. Journal of Advanced Nursing 18, pp. 938–940.

Taylor and Brown (1988). S.E. Taylor and J.D. Brown, Illusion and well-being: a social psychological perspective on mental health. Psychological Bulletin 103 2, pp. 193–210.

Thorndike (1989). Thorndike, E.L., 1989 as cited in Schwartz, B., 1984. Psychology of Learning and Behavior, 2nd Edition. Norton, New York.

Whitehead, (2004) D. Whitehead, “How effective are health education programs’, International Journal of Nursing studies, Vol 41, issue 2, Pgs 163-172.

Whitehead (2001). D. Whitehead, “Health education, behavioral change and social psychology: nursing’s contribution to health promotion” Journal of Advanced Nursing 34, pp. 822–832.