Health education and multimedia learning: educational psychology and health behavior theory (Part 1)

When health education researchers began to investigate how individuals make decisions related to health and the factors that influence health behaviors, they referred to frameworks shared by educational and learning research. Health education adopted the basic principles of the cognitive revolution, which were instrumental in advancing the field. There is currently a new challenge to confront: the widespread use of new technologies for health education. To better overcome this challenge, educational psychology and instructional technology theory should be considered. Unfortunately, the passion to incorporate new technologies too often overshadows how people learn or, in particular, how people learn through computer technologies. This two-part article explains how educational theory contributed to the early development of health behavior theory, describes the most relevant multimedia learning theories and constructs, and provides recommendations for developing multimedia health education programs and connecting theory and practice.     

Cognitive styles: Characteristic modes of individuality and diversity

Cognitive styles are dimensions integrated in the individuals' psychological differentiation, which determine a person's response and functioning in all situations. Cognitive style is one approach to characterize individual differences; it includes stable attitudes, preferences, or habitual strategies distinguishing individual styles of perceiving, remembering, thinking and solving problems. There are several different dimensions of cognitive styles (e.g., field-dependence-independence, impulsiveness-reflectiveness, breadth of categorization, leveling-sharpening). Individuals differ in the characteristics of these dimensions. Some researchers suggest that persons acquire characteristics in cognitive style that will help them acquire “cognitive flexibility,” the ability to change information processing strategies concerning certain experiences. However, the existing theory and research on cognitive style is incomplete. More research needs to be conducted within a cohesive psychological framework.     

Towards effective evaluation and reform in medical education: a cognitive and learning sciences perspective

Health professions education is dealing with major transformations in light of the changing nature of the health care delivery system, including the use of technology for “just in time” delivery of care, evidence-based practice, personalized medical care and learning, as health professionals strive to integrate biomedical advances and clinical practice. This has forced the medical education community to reassess the current teaching and learning practices and more importantly, the evaluation of the medical education process. There have been recent advances in cognitive and learning sciences theories, some of which can inform medical educators about best teaching and learning practices and their impact on the evaluation process. An understanding of these theories provides a sound rationale for choosing specific instructional strategies and choosing evaluation measures that assess the curricular objectives. The review begins with an overview of evaluation and assessment in education, followed by an overview of major theories from the cognitive and learning sciences. Next, the role of cognitive and learning sciences theories in informing the process of medical education evaluation is discussed, including its impact on student learning, performance and professional competence, as well as recommendations for reform of medical curricula based on such theories. The paper continues with the elaboration of current trends in health sciences education, particularly medical education, and available evidence for the impact on student learning and performance as well as areas where more research is needed.     

Applying the cognitive theory of multimedia learning: an analysis of medical animations

Context Instructional animations play a prominent role in medical education, but the degree to which these teaching tools follow empirically established learning principles, such as those outlined in the cognitive theory of multimedia learning (CTML), is unknown. These principles provide guidelines for designing animations in a way that promotes optimal cognitive processing and facilitates learning, but the application of these learning principles in current animations has not yet been investigated. A large‐scale review of existing educational tools in the context of this theoretical framework is necessary to examine if and how instructional medical animations adhere to these principles and where improvements can be made. Methods We conducted a comprehensive review of instructional animations in the health sciences domain and examined whether these animations met the three main goals of CTML: managing essential processing; minimising extraneous processing, and facilitating generative processing. We also identified areas for pedagogical improvement. Through Google keyword searches, we identified 4455 medical animations for review. After the application of exclusion criteria, 860 animations from 20 developers were retained. We randomly sampled and reviewed 50% of the identified animations. Results Many animations did not follow the recommended multimedia learning principles, particularly those that support the management of essential processing. We also noted an excess of extraneous visual and auditory elements and few opportunities for learner interactivity. Conclusions Many unrealised opportunities exist for improving the efficacy of animations as learning tools in medical education; instructors can look to effective examples to select or design animations that incorporate the established principles of CTML.     

Better learning through instructional science: a health literacy case study in "how to teach so learners can learn"

Health education and behavior change interventions typically pay little attention to the intervention's instructional foundation. Combining the fields of health literacy, cognitive psychology, and adult learning theory, this article provides an integrative scientific approach, called the BEAN (Better Education and iNnovation) model, to creating an instructional foundation based on how individuals acquire knowledge and skills. The article uses a case study example from an adult literacy center's health literacy class to explore how environmental factors and instructional strategies can be applied to health education and behavior change interventions. Data for this case study were derived through 20 hours of classroom observation and qualitative interviews with 21 adult education students and 3 instructors. Results provide practical examples of environmental factors and instructional strategies designed to facilitate learning, such as fostering autonomy, activating prior knowledge, and fostering perspective change. Results also describe the resulting health behavior changes of students attending the health literacy class, such as increased medication adherence and physical activity, improved nutritional habits, and increased question asking of health practitioners. This article serves as a first step to encouraging researchers and educators to consider the importance of drawing on cognitive psychology and theories of adult learning to create a scientifically based instructional foundation for health behavior change programs. Additionally, by drawing on the expertise of adult educators well versed in the science of instructional design, this article also demonstrates that the adult education classroom is an excellent setting for conducting health education and behavior change interventions.     

Prevention Neuroscience: A new frontier for preventive medicine

Prevention neuroscience may be defined as follows: an interdisciplinary field concerned with the neurobiological factors that influence susceptibility to preventable disease, disability or mortality. It includes, but is not limited to: examination of brain health as an outcome, brain activity as a predictor of health outcomes, brain structures/systems as causal determinants of health outcomes (e.g., health behaviours), and the brain as a mediator of other causal influences (e.g., social conditions) on health outcomes. This commentary describes concepts, theory and research illustrating each of these scenarios using exercise, smoking cessation, dietary behaviour, and health disparities as examples. It is argued that neuroscience may provide both concepts and methods that may be possible (even fruitful) to incorporate into preventive medicine research and health promotion practise. Although public health practitioners and cognitive neuroscientists have not traditionally crossed paths outside of the context of neurodegenerative diseases such as Alzheimer's and other dementias, it is easy to envision a future where many common disease prevention activities involve collaboration between the two disciplines, and the cache of tools available to the preventive medicine expert includes neuroimaging and neuromodulation techniques.     

Cognitive load theory in health professional education: design principles and strategies

Context Cognitive load theory aims to develop instructional design guidelines based on a model of human cognitive architecture. The architecture assumes a limited working memory and an unlimited long‐term memory holding cognitive schemas; expertise exclusively comes from knowledge stored as schemas in long‐term memory. Learning is described as the construction and automation of such schemas. Three types of cognitive load are distinguished: intrinsic load is a direct function of the complexity of the performed task and the expertise of the learner; extraneous load is a result of superfluous processes that do not directly contribute to learning, and germane load is caused by learning processes that deal with intrinsic cognitive load. Objectives This paper discusses design guidelines that will decrease extraneous load, manage intrinsic load and optimise germane load. Discussion Fifteen design guidelines are discussed. Extraneous load can be reduced by the use of goal‐free tasks, worked examples and completion tasks, by integrating different sources of information, using multiple modalities, and by reducing redundancy. Intrinsic load can be managed by simple‐to‐complex ordering of learning tasks and working from low‐ to high‐fidelity environments. Germane load can be optimised by increasing variability over tasks, applying contextual interference, and evoking self‐explanation. The guidelines are also related to the expertise reversal effect, indicating that design guidelines for novice learners are different from guidelines for more experienced learners. Thus, well‐designed instruction for novice learners is different from instruction for more experienced learners. Applications in health professional education and current research lines are discussed. Medical Education 2010: 44 : 85–93     

Medical education: a particularly complex intervention to research

Previous debate has explored whether medical education research should become more like health services research in terms of frameworks, collaborations and methodologies. Notable recent changes in health services research include an increasing emphasis on complex interventions, defined as interventions that involve more than one component. The purpose of this study was to explore the extent of thinking about medical education as a complex intervention and to analyse medical education research to determine whether its collaborations and methodologies are becoming more like health services research. Research articles published in three journals over 2 years were analysed to determine the purpose of the research in relation to a framework for evaluating complex interventions, the degree of collaboration, and the methodology. Most studies aimed to develop theory or assess effectiveness and many categories of the complex interventions framework were not represented in the medical education research literature. Studies usually involved only one research site and were predominantly quantitative but not experimental or quasi-experimental. Whilst medical education research has not moved significantly in the direction of health services research over recent years, the complex interventions lens provided insights into why this might be so (namely the significant challenges associated with researching medical education). We recommend that medical education researchers work within a complex interventions framework and look to research fields with similar challenges (e.g. the study of chronic illness in a changing context) for ideas about theories, frameworks, methodologies and collaborations that can illuminate the field of medical education research.     

Employment relations,social class and health: A review and analysis of conceptual and measurement alternatives

Employment relations, as a theoretical framework for social class, represent a complementary approach to social stratification. Employment relations introduce social relations of ownership and control over productive assets to the analysis of inequalities in economic (e.g., income), power (occupational hierarchy), and cultural (e.g., education) resources. The objectives of this paper are to briefly clarify the theoretical background on socio–economic indicators used in social epidemiology and to conduct a review of empirical studies that adopt relational social class indicators in the socio-epidemiological literature.Measures of employment relations in social determinants of health research can be classified within two major conceptual frameworks: 1) “Neo-Weberian”, like the National Statistics Socio–Economic Classification (NS–SEC) which is widely used in the United Kingdom; and 2) “Neo-Marxian”, like Erik O. Wright’s social class indicators, which are being used by social epidemiologists in the Americas and Europe. Our review of empirical findings (49 articles found) reveals that the relation between employment relations and health does not necessarily imply a graded relationship. For example, small employers can exhibit worse health than highly skilled workers, and supervisors can display worse health than frontline workers. The policy implications of employment relations research are therefore different, and complement those of income or education health gradient studies. While the latter studies tend to emphasize income redistribution policy options, employment relations implicate other factors such as workplace democracy and social protection. Our analysis confirms that the current transformation of employment relations calls for new social class concepts and measures to explain social inequalities in health and to generate policies to reduce them.     

Leveraging Geospatial Data,Technology, and Methods for Improving the Health of Communities: Priorities and Strategies from an Expert Panel Convened by the CDC

In 2008, CDC convened an expert panel to gather input on the use of geospatial science in surveillance, research and program activities focused on CDC’s Healthy Communities Goal. The panel suggested six priorities: spatially enable and strengthen public health surveillance infrastructure; develop metrics for geospatial categorization of community health and health inequity; evaluate the feasibility and validity of standard metrics of community health and health inequities; support and develop GIScience and geospatial analysis; provide geospatial capacity building, training and education; and, engage non-traditional partners. Following the meeting, the strategies and action items suggested by the expert panel were reviewed by a CDC subcommittee to determine priorities relative to ongoing CDC geospatial activities, recognizing that many activities may need to occur either in parallel, or occur multiple times across phases. Phase A of the action items centers on developing leadership support. Phase B focuses on developing internal and external capacity in both physical (e.g., software and hardware) and intellectual infrastructure. Phase C of the action items plan concerns the development and integration of geospatial methods. In summary, the panel members provided critical input to the development of CDC’s strategic thinking on integrating geospatial methods and research issues across program efforts in support of its Healthy Communities Goal.     

广州市505名初中学生认知曲解与暴力倾向的关系研究

目的分析广州市初中生认知曲解与暴力倾向的联系，为学校开展心理健康教育及预防校园暴力事件的发生提供理论依据。方法采用认知曲解量表和校园暴力倾向量表，对广州市初二年级学生505名进行问卷调查。结果男生认知曲解程度及暴力倾向程度均较女生高；父亲文化水平居中的学生勒索行为因子程度较其他学生高；母亲文化程度高的学生强迫行为因子程度较其他学生高：学习成绩差的学生负向思考因子程度最高，学习成绩优秀的位居第2；认知曲解程度与暴力倾向程度各因子均存在正相关。对校园暴力行为发生预测作用最强的是自我中心，性别、学业成就、责备他人、母亲文化程度次之。结论认知曲解程度与暴力倾向程度各因子均存在正相关，因此可以有针对性地对有认知曲解的学生加强心理教育，预防及控制暴力行为的发生。     

The role of computers in health education: some lessons from instructional technology.

There is an emerging consensus on the potentially positive applications of computers in health and patient education. Microcomputers are losing their novelty and gaining popularity with the general and professional public. There is a tendency to rush to computerize the classroom or other educational setting, while bypassing certain basic questions. Health educators should investigate in what areas the computer can help, in what areas use of computers may prove counterproductive, and the proper place of computers in education. Computers will not bring sudden changes in health and patient education. Computers will not, by themselves, create innovation in health and patient education practice. Computers will neither solve educational problems nor play a role as panacea. For educators to effectively use computers in health education, studies should be designed that provide practical suggestions in designing instructional materials and give answers to questions raised in the classroom setting. Longitudinal studies should be emphasized rather than short-term research which provides only limited implications. Individual subject differences should be considered in these studies, not in relation to learning speed but in terms of processing information. Effectiveness should be verified, while considering the interaction of computer attributes, learner cognitive style, and subject matter. On the basis of these research studies, health educators should collaborate on formulating goals, providing guidelines, designing and developing software, and incorporating computers into the existing curriculum. In this way, health educators can benefit from this new educational medium, which undoubtedly will be an integral part of future learning environments.     

Instructional design of a clinical photography course for undergraduate dental students

Medical and health educators in South Africa are facing many problems. These are caused by the diverse communication characteristics and socioeconomic, as well as educational, differences of its communities. Visual literacy is often ignored when audiovisual media are used in medical and health education. Consequently, communication and education fail because some target groups, e.g. illiterate patients from rural areas, are unable to interpret visual messages correctly. This study determined to what extent illiterate female patients were able to interpret instructional illustrations on breast feeding. Findings indicate that visual literacy is a key factor in effective medical and health education. There was a distinct variation in the visual literacy skills of this particular target group. The implication is that extreme care must be taken when visual materials are designed for health education in South Africa.     

影响老人院老年人认知功能的相关因素分析

[目的]了解老人院老年人认知功能的现状及影响因素,作为老人院健康教育和实施认知康复的依据.[方法]对唐山市6家老人院60岁及以上老年人,应用简单智力状态检查法(MMSE)的中文译文进行评测.[结果]402名老年人认知障碍患病率29.1％,与老年人认知功能相关较大的因素有文化程度、看书读报、年龄、ADL、社会支持水平、爱...     

Promoting professional knowledge, experiential learning and critical thinking for medical students

It has been recognized internationally that undergraduate medical education must adapt to changing needs, as illustrated by the Tomorrow's Doctors recommendations from the General Medical Council. This paper aims to relate contemporary educational theory to under-graduate medical educational requirements, specifically highlighting conditions (e.g. experiential learning) for: professional knowledge acquisition; critical thinking, problem-solving and clinical problem-solving; and lifelong professional learning. Furthermore, problem-based learning (PBL) is highlighted as potentially providing such conditions. There are lessons from contemporary educational theory for the reform of undergraduate medical education. These include valuing prior knowledge and experience; promoting learner responsibility through facilitating rather than directing learning; encouraging learners to test out and apply new knowledge, and using small-group work to foster explicitly the elusive skills of critical thinking and reflection. Contemporary educational theory contributes valuable insights, but cannot dictate the ultimate 'mix'; at best it provides some principles for reflective analysis of the learning experiences created for tomorrow's doctors.     

Media Use,Cognitive Performance,and Life Satisfaction of the Chinese Elderly

Media use and aging is an important interdisciplinary topic pertaining to communication, gerontology, and psychology, among others. Integrating research on media-induced recovery and life satisfaction, the present study examined media uses and effects in the context of health and aging. Specifically, data from a large random sample were analyzed to investigate the relationships between media use, cognitive performance, and life satisfaction among the Chinese elderly. Results, in general, lent support to the slightly modified structural model. Specifically, media-induced recovery outcomes can be categorized into proximate (e.g., cognitive performance), intermediate (e.g., health satisfaction), and distal levels (e.g., life satisfaction). Also, situational factors (e.g., disease history) had statistically significant effects on media-induced recovery outcomes. Theoretical and practical implications of the research findings were discussed, and future research directions were suggested.     

Changing emphases in public health and medical education in health care reform

Globalisation of economies, diseases and disasters with poverty, emerging infectious diseases, ageing and chronic conditions, violence and terrorism has begun to change the face of public health and medical education. Escalating costs of care and increasing poverty have brought urgency to professional training to improve efficiency, cut costs and maintain gains in life expectancy and morbidity reduction. Technology, genetics research and designer drugs have dramatically changed medical practice. Creatively, educational institutions have adopted the use of: (1) New educational and communication technologies: internet and health informatics; (2) Problem based learning approaches; Integrated Practice and Theory Curricula; Research and Problem Solving methodologies and (3) Partnership and networking of institutions to synergise new trends (e.g. core competencies). Less desirably, changes are inadequate in key areas, e.g., Health Economics, Poverty and Health Development, Disaster Management & Bioterrorism and Ethics. Institutions have begun to adjust and develop new programs of study to meet challenges of emerging diseases, design methodologies to better understand complex social and economic determinants of disease, assess the effects of violence and address cost containment strategies in health. Besides redesigning instruction, professional schools need to conduct research to assess the impact of health reform. Such studies will serve as sentinels for the public's health, and provide key indicators for improvements in training, service provision and policy.     

A computerized approach to discipline-specific bibliographies in the allied health sciences

The traditional subject headings in Index Medicus and other standard indexes have frequently proved too broad for researchers in the allied health sciences. Therefore, the Physician Assistant Program at the University of Florida has developed a computerized bibliography program designed to expedite research by using a selected list of keywords as subject headings and subheadings tailored to the interests and concerns of the physician assistant profession. Each subject heading and subheading is translated into a numerical coding system that permits efficient data entry and rapid identification of items in the professional literature as well as reducing the incidence of operator error in data entry. The program can be used for review of the literature, curriculum design, identification of supplementary reading material for education courses, and identification of appropriate resources to enhance the study of the physician assistant profession. Through the development of discipline-specific keywords, the program can be tailored to the educational and research interests of any discipline in the allied health sciences or other educational fields.