Motivation, Compliance, and Health Behaviors of the Learner Chapter 6

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

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

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 self-actualization. e.g. the basic need to satisfy hunger

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

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

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

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

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

Parameters of Assessment of Motivation In collecting assessment data the nurse can ask several questions of the learner, such as those focusing on previous attempts, curiosity, goal setting, self-care, stress factors, survival issues, and life situation

Parameters of Assessment of Motivation Motivational assessment needs to be comprehensive, systematic, and based on concepts: Cognitive variables Affective variables Physiological variables Experiential variables Environmental variables Educator-learner relationship system

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

Affective Variables Expressions of constructive emotional state Moderate level of anxiety (optimum state)

Physiological Variables Capacity to perform required behavior

Experiential Variables Previous successful experiences

Environmental Variables Appropriateness of physical environment Social support systems Family Group Work Community resources

Teacher-Learner Relationship System Prediction of positive relationship

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.

Motivational Strategies (cont’d When teaching others, clarify communicating directions and expectations is critical. Organizing material in a way that make information meaningful to learner, give positive verbal and feedback , and Provide opportunities for success. In the educational situation, reducing or eliminating barriers to achieve goals helps to instill or maintain motivation

Motivational/Models ARCS Model: focus on creating and maintaining motivational strategies used for teaching Attention (awareness) introduces opposing positions Relevance refers to focusing on learner’s experiences, usefulness, needs, and personal choices Confidence of the learner affected by difficulty, expectations, sense of accomplishment Satisfaction (use of rewards, praise, ability to use new skill

Definition of Compliance Terminology 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

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.

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.

Compliance/Adherence Compliance: is observable Can be measured Health care provider viewed as authority Learner viewed as submissive Refers to the ability to maintain health -promoting regimens 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

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

Models/Theories for Health Behaviors of the Learner Health Belief Model Health Promotion Model Change theory

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

Health belief model

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.

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

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.

Health promotion model

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

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

Stages of Change model

Stages of Change model

Stages of Change model

Finally 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.