Best Practices for Using Health Education to Change Behavior
Background: Noncommunicable diseases (NCDs), such as cardiovascular disease, diabetes, and chronic respiratory diseases, account for over 85% of all deaths in the United States. Two NCDs in particular, obesity and asthma, are among the leading causes of preventable deaths in the United States.[2,3] Studies have shown that preventative measures taken during childhood may reduce the incidence of these diseases in adulthood. Moreover, obesity and asthma in childhood is associated with increased spending on annual prescription drugs, emergency rooms, and outpatient costs. Unfortunately, obesity directly affects over one-sixth of all children in the United States, with nearly 17% of all children aged 2 to 19 classified as obese in 2012. In addition, over 7 million children have been diagnosed with asthma as of 2010, which can have significant consequences on their quality of life; approximately 640,000 asthma-related emergency room.[5,6] The morbidity and mortality associated with these diseases can be addressed by developing programs that incorporate effective health education geared toward behavior change.[7,8] Information related to health communication and health behavior change is extensive and is based on many behavioral change theories such as the transtheoretical model (TTM), health belief model (HBM), theory of reasoned action (TRA), theory of planned behavior (TPB), and social cognitive theory (SCT). These theories have been integrated into various health education programs with varying degrees of impact.[10,11,12] Methods: A systematic literature review examining the most effective use of health education geared toward behavior change was conducted. Inclusion criteria for search results were: 1) topic, i.e., used health education to change behavior, or addressed best practices for health education development, 2) disease focus, i.e., target of intervention was asthma or obesity, and 3) population, i.e., interventions were targeted toward children or adolescents. There were 6,128 articles that met the inclusion criteria. We then excluded articles based on the following: 1) written in a language other than English, 2) provided only vague descriptions of intervention, 3) primarily surgical or medical intervention, rather than educational, and 4) did not characterize results. Using the exclusion criteria, our results narrowed to 102 articles. We divided them into three categories: 1) asthma-related interventions, 2) obesity-related interventions, and 3) general health education. Articles pertaining to general health education were then narrowed to those that focused specifically on the development of general health education materials. Results: The review yielded several consistent themes. First, health materials should be appropriate and understandable by the target population. Second, communications are considered more effective if they are personally relevant, tailored to the audience’s needs and interests, and match their current level of reading comprehension. Finally, development and implementation of health education should be based on the behavioral change theory most appropriate for the target population and the desired intervention outcomes.[17,18] These criteria should be considered when developing health materials, as studies have shown that tailoring communication is more effective than generic messages in changing behaviors.[19,20,21] Conclusion: Health education can very effectively inspire behavior change if the education utilizes proven behavioral change theories, and is tailored toward the target population. In order to be effective, health materials should be appropriate and understandable by the target population. In addition, development and implementation of health education should be based on the behavioral change theory most appropriate for the target population and the desired intervention outcomes.[23,24] Therefore, prior to program implementation, researchers should have a strong understanding of this population in order to determine the best behavioral change theory to use during health education development. This in turn, along with researchers’ understanding of the target population, should strongly influence what and how information should be presented. By taking the proper steps to develop and present relevant health information effectively, individuals may be more inclined to make healthier decisions. If individuals are empowered to make the health behavior changes necessary to avoid premature death and chronic diseases, such as obesity and asthma, they could extend their lifespan and improve their quality of life, which ultimately can lead to reduced health care costs.