19.2 Developing a Health Education Plan

Learner Experiences, Perspectives, and Needs

While identifying the client, it is important for the nurse to examine the learning considerations for the intended target population. Nurses should consider many population characteristics when developing educational materials and deciding on delivery methods. Developmental level, for example, may dictate how the population should receive the information. Young children learn best when the information is delivered in small chunks with supporting visuals and audio. As children move into school age, they are often able to obtain and comprehend more information with increased complexity. At this time, the family is the largest influence on a child’s behavior, so the family could be included in the educational program. As clients enter adolescence, they respond best when treated with respect and provided the information directly. Peer influence is much stronger at this stage as an adolescent’s autonomy increases (National Institute of Mental Health, 2023). Education should move from generalized to more individualized components related to their specific stage of life, so nurses may incorporate peer activities into the learning process for this population.

The general adult population seeks learning that is convenient and specific to their needs. Depending on their age and background, some adults may prefer printed forms of education versus solely electronic, while some may prefer the speed and convenience of electronic information. In today’s world, the use of and reliance on technology is ever increasing. While the increased use of technology has many advantages, specific populations may lack access, understanding, or a desire to use these learning methods. Additionally, adult learners appreciate pulling from their previous experiences and life circumstances. The more teaching can utilize adults’ past experiences, the more effective it will be. Some older adults may require additional time to become comfortable using technology for communication and information sharing (Ahmad et al., 2022). It is essential to remember that age does not directly correlate to developmental level. Development is multifactorial, so nurses should base education on how clients obtain, comprehend, and use information instead of their biological age.

Health literacy is another crucial factor when creating community education plans and resources. As discussed in detail in Assessment, Analysis, and Diagnosis, personal health literacy is the degree to which individuals can find, understand, and use information and services to inform health-related decisions and actions for themselves and others. Assessing population health literacy begins with evaluating how well clients use everyday written materials to accomplish common tasks and progresses to assessing more conceptual ideas of mathematical and problem-solving concepts. This evaluation is often completed via a survey, and these surveys have been adapted over time to improve concepts and match the language of those being evaluated. Community health and public health nurses can view statistics within the United States to gain a broad view of national health literacy levels and can furthermore complete evaluations within a selected community or population to determine local literacy levels. According to the U.S. Department of Health and Human Services, in 2019, 12 percent of Americans measured proficient in health literacy from the National Assessment of Adult Literacy (NAAL). Survey data show a marked gap between the portion of the population who are highly health literate and those who are well below average for health literacy levels. This gap creates additional complications when planning for health education that meets clients at their current health literacy level or fills gaps in literacy levels to improve understanding.

While developing educational materials, the nurse should consider the target population’s general and health literacy and tailor the materials accordingly. Nurses must be able to adjust their education styles to match the health literacy of the populations in which they work. This often means creating educational materials at the lowest level of literacy identified within the community to ensure all clients can understand and apply the information. Additionally, nurses should present education in multiple forms to capture the audience and convey meaningful information they can utilize. Thus, not only should the materials used to evaluate health literacy be considered, but so should the rigor and skills of the educator who is providing the information. Nurses should consider sociocultural factors regarding access to information and how it is disseminated within a community. Furthermore, any practices and policies used within the population in question should be considered to produce effective communication. If the norm of a particular community is that clients do not read or use written information to gain knowledge, then providing only written material will not best serve this community. Finally, with the growing diversity of the general population, preferred language must be considered for all forms of education and educational materials. The nurse should consider the preferred language for each client and the extent to which the client is fluent in this language. For example, some clients may be able to speak English but may not be able to read in this language, and vice versa.

The nurse should evaluate the client’s abilities or limitations and health literacy levels. For example, if clients have any hearing or vision deficits, this must be considered in the creation and distribution of educational information.

Understanding the specific culture of the community and those within the community is imperative, as many cultures view health and illness differently. Thus, communities will have different ideas of what is important. Linking back to the recipe for a successful education plan, buy-in from interested parties and participants is crucial for overall program success.

Cultural sensitivity entails an awareness of similarities and differences between cultures while not placing value on or ranking these similarities and differences. Nurses can take steps to apply cultural sensitivity when planning health education practices. The nurse must begin with awareness of different cultures. Next, the nurse can learn about their own culture and the cultures of others. When nurses show openness to and interest in a client’s background and culture, listening and allowing the client to express their views, they can build trust and rapport with clients from other cultures. This may require bridging language barriers to educate clients about medical practices and options. Nurses should demonstrate active listening to provide a safe and effective space. Active listening involves preparing to hear what the other person is saying, receiving the sent message, and responding thoughtfully. These steps can help health care providers gain an appreciation for what education the community may need and the most effective ways to provide it. This may also help the nurse to determine which methods would impede learning. Unit 5, Culturally Congruent Care, discusses these topics in greater detail.

Individual, Family, Group, and Community as Client

Client education occurs at individual, family, group, or community levels. The nurse must define at which client level education will occur because the level can alter the planning for and implementation of health education interventions. For example, nurses providing education for an individual client establish a more personal relationship with a single individual and cater only to their needs, wants, and learning styles. Individual health screenings and one-on-one education are examples of education at the individual level. Education at the individual level includes the person experiencing the problem or condition and can provide subjective information from their specific point of view. For example, the community health nurse may provide education to individuals on how to take blood pressure, healthy nutrition, and weight loss during a clinic visit for clients at risk for hypertension.

As noted, education may also occur at the family level. Everyone defines family differently. Some people define family as blood relatives, while others consider those closest to them, such as friends or neighbors, their family. Additionally, there are many ways in which a family is formed, all of which should be respected and acknowledged. One example of respecting this idea is for nurses to clarify family roles before assuming what they are. Not all adults with a child are the child’s parents, so clarifying these roles before engaging the family will build trust and respect. Generally, caregiver is a more encompassing term when addressing those helping provide care for a client. This concept is discussed further in Caring for Families.

As the nurse provides education to multiple people at a time, the scope of the intervention and teaching strategies can change dramatically. Education plans and strategies at the group and community levels are not personalized for individuals but rather for identified health problems of populations at risk and of the community as a whole. An example of a community program that includes family education is the Help Me Grow Program. In this program, the nurse determines family concerns and needs during home visits and provides education and support to new parents and caregivers. Educational topics include healthy pregnancy, safe sleep practices, breastfeeding, newborn and child growth and development, nutrition, immunizations, and safety.

Education may occur at the group level to community members who share a common health need or problem. In this circumstance, the nurse provides education to a group of community members at the same time in the same place. For example, a nurse may provide a breastfeeding class to 10 pregnant clients, as shown in Figure 19.1. Teaching at the group level allows the nurse to educate several individuals simultaneously, increasing program impact and reducing needed resources. Additionally, group members share experiences and perspectives, leading to an enhanced learning environment. The nurse providing education at the group level must have knowledge and experience in group processes.

Finally, education can occur at the community level. In this instance, education is usually large-scale and includes the use of media, such as flyers, billboards, newspapers, television, radio, or social media platforms to disseminate educational materials. Often, this takes the form of public service announcements (PSA) or national campaigns to reach a wider audience. A PSA is a message, video, or broadcast authorized by a government agency or nonprofit organization to provide information about an issue at the public level. A national campaign is a series of planned activities or marketing offerings to communicate information to the public on a national scale.

Goals and Objectives of the Educational Program

The nurse identifies the goal of the educational program during the first stages of planning following a needs assessment. Goals are broad, long-term statements about the educational program’s purpose and what it will accomplish. For example, a goal for an educational program on breastfeeding is “mothers receiving education will breastfeed their infant for the first 6 months following birth.” Goals stem from prioritizing needs identified during the community health needs assessment and learner assessment, if available, focusing on health promotion and illness prevention. The nurse considers learning needs, motivation for learning, and available resources to conduct the educational program.

Next, the nurse identifies the educational program’s objectives. Objectives are specific, short-term statements demonstrating progress toward the goal. Written in SMART format, they signify a change in learners’ knowledge, skill, or attitude. For example, an educational program on breastfeeding might use these SMART objectives:

• Knowledge: At the end of the class, mothers will state three benefits of breastfeeding.
• Skill: At the end of the class, mothers will demonstrate three methods to effectively position the infant for breastfeeding.
• Attitude: At the end of the class, mothers will state increased motivation to breastfeed their newborn.

Planning Health Promotion and Disease Prevention Interventions provides detailed information on writing goals and objectives.

Finally, the nurse uses the identified goals and objectives to plan curriculum, materials, and other resources to help learners accomplish them.

Available Evidence-Based Materials and Curriculum

The nurse searches for educational curricula, materials, and other resources that have been proven effective in achieving the identified educational program goals and objectives. This reduces the planning time and resources it would take to create new curriculum and materials, increases the likelihood that the program will succeed, and provides supporting evidence for curriculum and material decisions. Evidence-based practice and evidence-based decision-making are discussed in detail in Evidence-Based Decision-Making.

Evidence-based health education programs are found by searching published journals, national and state websites dedicated to public health, and local organizations, schools, and agencies providing health services. Additionally, the nurse may contact experts who work in public health or education and experts on the health topic. Healthy People 2030 is a good starting point because it includes evidence-based resources and programs for national health topics and objectives. The CDC is also a good resource. For example, it describes evidence-based community health programs focusing on chronic diseases such as stroke, heart disease, and obesity. Finally, the National Institutes of Health (NIH) provides an updated list of links to current, evidence-based programs and resources. Ultimately, education tactics should utilize the best available research and noted experience from experts in that field.