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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

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

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

14. Physiological Variables
Capacity to perform required behavior

15. Experiential Variables
Previous successful experiences

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

17. Teacher-Learner Relationship System
Prediction of positive relationship

18. 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.

19. 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

20. 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

21. 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

22. 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.

23. 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.

24. 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

25. 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

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

27. 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

28. Health belief model

29. 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.

30. 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

31. 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.

32. Health promotion model

33. 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

34. 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

35. Stages of Change model

36. Stages of Change model

37. Stages of Change model

38. 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.