Going Beyond Informing
So much of patient education is about sharing information – about risks, symptoms, treatment options, lifestyle changes and so much more. However, it is critical to go deeper than merely informing patients if we expect substantive changes in their thinking and behavior. We must acknowledge what patients bring to a learning situation: their hopes and fears, their motivations, and the questions that indicate their priorities and problems. By using adult learning principles to underpin our skill-building efforts, we can more successfully help patients identify and address their needs – and be successful in managing their health.
Let’s imagine a typical scenario: Ellen has had diabetes for several years. She has been doing her best to manage her diet and exercise plan, and always takes her oral medications. However, at her most recent visit to her doctor, she learned that she now needs to add insulin to her routine. How can we address this situation using an approach that combines adult learning with skill building?
What is Adult Learning?
Adult learning theory, sometimes called andragogy, includes a number of principles. Three of these are clearly related to helping patients build skills to manage their health.
- Readiness to learn: Adults become ready to learn when they need information to effectively cope with real challenges they are having.
- Motivation: For adults, there is no “test” that will reflect a certain grade, but there are real life outcomes which may result from this learning. This means that adults are driven by internal motivation, such as the desire for maintaining or improving their health or quality of life, or avoiding worse health.
- Task-centered learning: For everyday learning, adults want to figure out how to acquire a skill or solve the problem at hand, rather than needing to learn everything about a topic.
Back to our scenario: At a quick glance, it would seem that the next step for Ellen is to have a healthcare professional demonstrate how Ellen can give herself insulin injections. We can imagine a caring educator seated with Ellen in the provider’s office. They probably have a somewhat limited time in which to meet and review the device use. How can the educator build Ellen’s confidence and skills in that initial demonstration? How will the educator know that Ellen will be able to do the injections on her own?
- Assess Ellen’s readiness to learn by talking about what she thinks and feels about starting insulin and, perhaps for the first time, must inject herself. While this might seem like a time-consuming discussion that could take away from “training” time, it is critical to Ellen’s success that she identify and share her concerns and hopes so that the educator can dispel misconceptions and support her emotionally. This can clear the way for Ellen to be open to learning about the device and her new phase of treatment. And, it’s not a conversation that can be had until this time in her treatment, so having it earlier will not benefit her learning.
- Understand Ellen’s health goals related to using the device. How does Ellen see the use of insulin and this particular device as supporting her diabetes management? Will it help her control symptoms? Will it enable her to do more of what she wants to do? Tying the use of the device to this internal motivation is another layer of preparation for active learning.
- Now, demonstrate the tasks and involve her in each step. This is where the step-by-step instructions come in handy, and offer the educator tools to demonstrate each step of the process, such as how to safely and effectively choose her dose and deliver her medication. As part of this process, the educator will ask Ellen to verbalize and demonstrate the key steps required to show that she has learned each skill. And, to continue with the support for task-based learning, a final step is to show the trouble-shooting guide or tips to empower Ellen in her continued use of the device at home.
This skill-building approach allows for the acknowledgement of the patient’s emotions and desires as part of the practical adoption of skills. This recognition and balanced approach not only enhances the physical skills, but builds confidence as well. This combination, called self-efficacy, is the true end goal of patient education.