Motivation Compliance and Health Behaviors of the Learner

Motivation, Compliance, and Health Behaviors of the Learner 1

Definition of Motivation defined as 1. a psychological force that moves a person toward some kind of action, OR 2. a willingness of the learner to embrace learning, with readiness to learn as evidence of motivation 2

Definition of Motivation • according to Kort, it is the result of both internal and external factors and not the result of external motivation alone. • Motivation is Movement in the direction of meeting a need or reaching a goal • Ideally, the nurse’s role is to help the learner to reach a desired goal and to prevent untimely delays 3

Motivation • Maslow (1943): The major premises of Maslow's motivation theory are integrated wholeness of the individual and a hierarchy of needs. • These needs are organized by level of potency— physiological, safety, love/belonging, Self-esteem, and selfactualization. e. g. the basic need to satisfy hunger 4

Motivational Factors • Factors that influence motivation can serve as incentives or obstacles to achieve desired behaviors. • Both creating incentives and decreasing obstacles to motivation pose a challenge for the nurse as a teacher of patients 5

Motivational Factors Facilitating or blocking factors that shape motivation can be classified Into three categories 1 - Personal attributes consist of physical, developmental, and psychological components of the individual learner 2 - Environmental influences which include the surroundings, and the attitudes of others 3 - Relationship systems: such as significant other, family, community, and teacher learner interaction 6

Motivational Factors § § § § 1 - Personal attributes Developmental stage Age Gender Emotional readiness Value and beliefs Sensory functioning Cognitive ability Educational level Actual or perceived state of health Severity and/or chronicity of illness Level of natural curiosity Capacity for short-term & long-term memory 7

Motivational Factors 2 - Environmental influences Factors that influence motivation includes: • Physical characteristics of the learner environment • Accessibility and availability of human and material resources • Different types of behavioral rewards 3 - Relationship systems such as significant other, family, community, and teacher learner interaction all influence an individual’s motivation 8

Motivational Axioms Motivational axioms are rules that set the stages for motivation. They include: § The state of optimum anxiety § Learner readiness § realistic goals setting § Learner satisfaction/success § Dialogue about uncertainty 9

Parameters of Assessment of Motivation • When collecting assessment data the nurse can ask several questions of the learner, such as those focusing on 1. previous attempts, 2. curiosity, 3. goal setting, 4. self-care, 5. stress factors, 6. survival issues, and 7. life situation 10

Parameters of Assessment of Motivation…cont. Motivational assessment needs to be comprehensive, systematic, and based on concepts: A. Cognitive variables B. Affective variables C. Physiological variables D. Experiential variables E. Environmental variables F. Educator-learner relationship system 11

A. Cognitive Variables Ø Capacity to learn Ø Readiness to learn ü Expressed self determination ü Constructive (positive )attitude ü Expressed desire and interest ü Willingness to contract for behavioral outcomes 12

B. Affective Variables Ø Expressions of constructive emotional state Ø Moderate level of anxiety (optimum state) C. Physiological Variables • Capacity to perform required behavior D. Experiential Variables • Previous successful experiences 13

E. Environmental Variables Ø Appropriateness of physical environment Ø Social support systems ü Family ü Group ü Work ü Community resources 14

F. Teacher-Learner Relationship System Prediction of positive relationship 15

Motivational Strategies • Incentives, can be either intrinsically or extrinsically generated, incentives and motivation are both stimuli to act. • When applicable incentive are absent or reduced, then the individual is likely to move away from the desired outcome. 16

Motivational Strategies (cont’d Ø When Teaching others, the nurse shall clarify communication directions and expectations are critical. Ø The nurse shall organize material in a way that makes information meaningful to learner, Ø The nurse shall give positive verbal and non-verbal feedback Ø The nurse shall provide opportunities for success. Ø In the educational situation, reducing or eliminating barriers to achieve goals helps to instill or maintain motivation 17

Motivational/Models ARCS Model: According to John Keller’s ARCS Model of Motivational Design Theories, there are four steps for promoting and sustaining motivation in the learning process: Attention, Relevance, Confidence, Satisfaction (ARCS) 18

ARCS Model of Motivational Design (Keller) 1. Attention Keller attention can be gained in two ways: (1) Perceptual arousal – uses surprise or uncertainly to gain interest. Uses novel, surprising, incongruous, and uncertain events; or (2) Inquiry arousal – stimulates curiosity by posing challenging questions or problems to be solved. 19

• Methods for grabbing the learners’ attention include the use of: q Active participation -Adopt strategies such as games, roleplay or other hands-on methods to get learners involved with the material or subject matter. q Variability – To better reinforce materials and account for individual differences in learning styles, use a variety of methods in presenting material (e. g. use of videos, short lectures, mini-discussion groups). q Humor -Maintain interest by use a small amount of humor (but not too much to be distracting) 20

q Incongruity and Conflict – A devil’s advocate approach in which statements are posed that go against a learner’s past experiences. q Specific examples – Use a visual stimuli, story, or biography. q Inquiry – Pose questions or problems for the learners to solve, e. g. brainstorming activities. 21

2. Relevance • Establish relevance in order to increase a learner’s motivation. To do this, use concrete language and examples with which the learners are familiar. Six major strategies described by Keller include: q Experience – Tell the learners how the new learning will use their existing skills. We best learn by building upon our preset knowledge or skills. q Present Worth – What will the subject matter do for me today? q Future Usefulness – What will the subject matter do for me tomorrow? 22

q Needs Matching – Take advantage of the dynamics of achievement, risk taking, power, and affiliation. q Modeling – First of all, “be what you want them to do!” Other strategies include guest speakers, videos, and having the learners who finish their work first to serve as tutors. q Choice – Allow the learners to use different methods to pursue their work or allowing s choice in how they organize it. 23

• 3. Confidence • Help students understand their likelihood for success. If they feel they cannot meet the objectives or that the cost (time or effort) is too high, their motivation will decrease. • Provide objectives and prerequisites – Help students estimate the probability of success by presenting performance requirements and evaluation criteria. Ensure the learners are aware of performance requirements and evaluative criteria. • Allow for success that is meaningful. • Grow the Learners – Allow for small steps of growth during the learning process. • Feedback – Provide feedback and support internal attributions for success. • Learner Control – Learners should feel some degree of control over their learning and assessment. They should believe that their success is a direct result of the amount of effort they have put forth. 24

4. Satisfaction • Learning must be rewarding or satisfying in some way, whether it is from a sense of achievement, praise from a higher-up, or mere entertainment. • Make the learner feel as though the skill is useful or beneficial by providing opportunities to use newly acquired knowledge in a real setting. • Provide feedback and reinforcement. When learners appreciate the results, they will be motivated to learn. Satisfaction is based upon motivation, which can be intrinsic or extrinsic. • Do not patronize the learner by over-rewarding easy tasks. 25

Definition of Compliance Terminology Compliance: Is term used to describe submission or yielding to predetermined goals. Healthcare literature suggests that: Compliance is the equivalent of achieving a goal based on a preset regimen. Compliance to health regimen is an observable behavior and as such can be directly measured 26

Definition of Compliance Terminology (cont’d) Adherence is a commitment or attachment to a prescribed, predetermined regimen. Both compliance and adherence are term used in the measurement of health outcome; interchangeably. 27

Definition of Compliance Terminology (cont’d) Noncompliance: non submission or resistance of an individual to follow a prescribed, predetermined regimen. This term carries a negative implication of the learner, but may in fact be a rigid response or defensive coping mechanism to a stressful situation. 28

Compliance/Adherence • Compliance: Ø is observable Ø Can be measured Ø Health care provider viewed as authority Ø Learner viewed as submissive Ø Refers to the ability to maintain health -promoting regimens Ø Outcomes determined largely by health-care provider Compliance can be directly measured through the health behavior while motivation measured by behavioral consequences or results Adherence: commitment to a regimen, can be used interchangeably with compliance 29

Compliance and control Concepts Impacting on Compliance Health locus of control • Internals: self directed • Externals: Others powerful in influencing health outcomes Functional literacy & locus of control influence compliance • Non compliance: resistance of the individual to follow predetermined regimen 30

Models/Theories for Health Behaviors of the Learner 1. Health Belief Model 2. Health Promotion Model 3. Change theory 31

1. Health Belief Model • HBM was developed in 1950 to examine why people did not participate in health-screening programs. • This model was modified by Becker (1974) to address compliance to therapeutic regimens. • Becker 1990 notified two major premises of the model that need to be present: • 1 - the client’s willingness to participate in disease prevention and curing regimen • 2 - the belief that health is highly valued 32

Health belief model 33

Health Belief Model • HBM used as a predictor of preventive health behavior. • HBM shows the direction and the flow of three components: 1 - the individual perception component compromises perceived susceptibility or perceived severity of a specific disease. 2 -The modifying factors component consists of (demographic, socio-psychological, and structural variables). 3 -The likelihood of action component consists of perceived benefits minus perceived barriers. 34

2. Health Promotion Model HPM developed 1987 and revised 1996 The emphasis on actualizing health potential and increasing the level of well-being Using approach behaviors rather than avoidance of disease behaviors Distinguishes this model as a health promotion rather than health a disease prevention model 35

… Health Promotion Model The three major components are as follow: 1 - Individual characteristics and experiences, which consist of two variables—prior related behavior and personal factors. 2 - Behavior-specific cognitions and affect, which consist of perceived benefit, perceived barriers, perceived self-efficacy, activity-related affect, interpersonal influence, & situational influence. 3 - Behavioral outcome which consist of health-promoting behavior. 36

… Health promotion model 37

3. Stages of Change model SC Model (1982) was developed around addictive and problem behavior. The six stages as follow: 1 - Pre contemplation stage—the individual makes no plans to change. teaching strategy—discussion 2 - Contemplation stage—identify the problem & contemplate change. teaching Strategy—clarify issues 3 - Preparation stage—plans to make change soon teaching Strategy—develop plan for action 38

… Stages of Change model 4 - Action stage—actively changes behavior teaching Strategy—create environment conductive to change 5 - Maintenance stage—maintains new behavior over time teaching Strategy—maintain environment to conductive change. 6 -Termination stage—no further risk of relapse to old behavior 39

… Stages of Change model 40

… Stages of Change model 41

… Stages of Change model 42

IN CONCLUSION: When information Is imparted, accepted, and applied, the foundation is set for change in health behaviors. When people are motivated and know that they can make a difference in their own lives, then a barrier to health has been lifted. 43