Seniors' learning preferences, healthy self-care practices and computerized education implications.

ABSTRACT

Health promotion uses an increasing amount of Internet-based education. Understanding seniors' learning orientation and self-care practices can inform instructional designers how to use the Internet with this population. A correlational, descriptive study of community-based seniors' (n=87) learning orientation and healthy self-care practices was conducted in a western state. Implications for Internet-based health promotion include associations between rural and urban location, age, health condition, self-care practices, informational preferences, and learning orientation factors. Difference between urban and rural populations and illness severity were identified. Respondents used the Internet as much as they did television and friends for health promotion materials. Transforming learners used the Internet while conformers did not and yet conformer learners performed the most self-care practices. Implications for designing differentiated health promotion materials based upon learning orientations are discussed.

Keywords: Learning Orientation, Health Promotion, Computers, Rural, Self-care

INTRODUCTION

Anticipating a budget cut, a regional department of aging in a western U.S. state considered developing a centralized health promotion program. Using the Precede-Proceed Model (Green & Kreuter, 1999), a health promotion assessment was initiated to explore how community-based elders learn about and then practice self-care strategies. Program leaders questioned how seniors examined and experienced health education according to age, residence, and health status.

The Need

Policy makers consider health promotion an important strategy for reducing the expected costs of chronic disease in an elderly baby boomer generation (Department of Health and Human Services, 2003). Educators and health care providers search for methods of teaching people disease prevention while attempting to control costs. One strategy is to adopt "cheaper" computerized health education programs, but understanding who benefits from online curriculum is not well understood (Gore, 2002).

A major reason for developing computerized education programs is to reach more people using fewer dollars (Gore, 2002). Providers feel pressured by economics to shorten the time spent with clients, which limits educational opportunities and leaves patients wanting more information (Frank, 2003). At the same time, the need for health care is expected to grow. The anticipated cost of chronic disease management for the baby boomer generation constitutes the highest single health care cost in the United States. The cost is expected to exceed 906 billion dollars by 2050.

Prevention of chronic disease through self-care is a major public health strategy (National Center for Chronic Disease Prevention and Health Promotion, 2003). Informal self-care accounts for 75% of all health care in the United States (Levin, 1976). Self-care is based upon health care information. The public longs for inexpensive, reliable information that is not always available. The lack of insurance prevents some people from accessing providers, while others postpone provider visits until a crisis occurs (Staff, 2004). The Internet can meet several health promotion information needs if more is understood about its role in health care (Voelker, 2005).

The prevention of chronic illness entails aggressive self-care, providing information that people will incorporate into their lives, demands attention to complex, interrelated issues. According to the "Precede" portion of the Precede-Proceed Model (Green & Kreuter, 1999, p 11), program planning depends on understanding the predisposing, reinforcing, and enabling conditions impacting lifestyle, health decisions, and quality of life. Chronic disease results from intertwined and synergistic play of many risk factors (Public Health Works, 2003). For instance, the single concept of health literacy includes knowledge, motivation, attitudes, behavioral intentions, personal skills, and self-efficacy (Nutbeam, 1999; Bruhn, 1997). Understanding the computer's role in health literacy requires cross discipline study of health, education, and informatics.

Promoters rank Internet technology with antibiotics, genetics, and computers as among the most important changes in health care delivery history. Researchers find the Internet an effective communication and educational tool (Hern, Weitkamp, Hillard, Trigg, Guard, 1998; Colombet & Chatellier, 2001). Access to the tool increases each year. Forty percent of elders in 1996 reported using computers (Marks, 1996), and researchers expected the use of electronic health strategies "to expand exponentially" (Coile, 2000). Twenty-two percent of people over age 65 were found to use the Internet in 2001 (Fox, 2004). Twenty-one percent of seniors were found to use online health …