Heart Disease and Stroke: Individual Education

Background on Individual Education

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expandWhat are individual education strategies?

collapseWhat are individual education strategies?

  • Intervention strategies used to increase knowledge, skills and self-efficacy related to heart disease and stroke prevention, management and rehabilitation behaviors (e.g., lifestyle changes to reduce weight or increase healthy behaviors, monitoring and taking medications to regulate blood pressure and cholesterol).
  • These strategies are designed to provide information, training and support to individuals through individual counseling sessions or self-help materials such as chronic disease self-management courses, newsletters, brochures, fact sheets, CDs, automated voice messages, interactive computer or video games, emails, videos or posters. Information, training, and support are frequently provided by trained health professionals or lay persons from the population who have received some training. Previous studies have shown it is important to provide information about heart disease and stroke risk factors, signs and symptoms and prevention and management strategies (e.g., monitoring blood pressure and cholesterol levels, adhering to medication regimens, tobacco cessation, improving nutrition and increasing physical activity).
  • Providing information, training, and support through individual education can:
    • increase knowledge and detection of signs and symptoms related to heart disease, heart attack and stroke;
    • promote behavior change to prevent heart disease and stroke (e.g., increasing skills and self-efficacy related to healthy eating, physical activity, tobacco cessation); and
    • minimize the impact of heart disease and stroke by improving knowledge, skills and behaviors related to self-management and rehabilitation (e.g., increasing skills and self-efficacy related to monitoring blood pressure and cholesterol, medication compliance).

expandHow can I use individual education strategies in heart disease and stroke interventions?

collapseHow can I use individual education strategies in heart disease and stroke interventions?

  • Individual education, when used alone, can help to enhance an individual’s capacity to prevent or manage heart disease and stroke as well as improve their overall health and quality of life. These strategies are usually tailored to an individual’s readiness to change, health status, risk factors and other physical, mental, social, cultural or spiritual characteristics, as relevant.  
  • Individual education interventions may help to change behaviors in order to prevent  heart disease and stroke from occurring (primary prevention), or work with those who have already developed heart disease or stroke to decrease the negative effects of that condition through changing behaviors or rehabilitation (secondary  prevention).
  • Previous work has suggested that individual education intervention strategies may work best when combined with strategies that act to create changes in policies, environments, support, or awareness related to heart disease and stroke (see Campaigns and Promotions and Environments and Policies for Heart Disease and Stroke). For example, individual education strategies may provide referrals to places to access healthy foods or get physical activity, help individuals manage their medication through recommendations from their provider, or offer self-help materials as part of a larger tobacco cessation campaign.
  • Most individual education interventions provide information to individuals, with some offering opportunities to ask questions or get clarification (e.g., through a face-to-face session with a health educator or other health professional).
  • The content of the education messages may include: information (e.g., risk factors, signs and symptoms, ways to monitor blood pressure and cholesterol levels, medications, tobacco use, nutrition, physical activity), skill-building (e.g., food purchasing and preparation, physical activity as part of daily living, tobacco cessation, self-management of medication), support and resources (e.g., changing family eating patterns, getting a walking partner, obtaining referrals for support groups), goal-setting (e.g., setting a quit date to discontinue tobacco use, increasing physical activity by 10 minutes each day), and relapse prevention (e.g., substituting healthy food alternatives, taking medication at a regular time each day).

expandWhat are the different types of individual education strategies and messages?

collapseWhat are the different types of individual education strategies and messages?

  • Individual education on self-management can increase knowledge (giving individuals information about heart disease and stroke), skills (teaching skill-building techniques), and self-efficacy (offering informational, tangible, emotional, and appraisal support).
    • Self-management takes individuals through a process of identifying an issue (e.g., high blood pressure), assessing routines through self-monitoring (e.g., keeping track of blood pressure levels), making sense of a routine (e.g., what causes blood pressure levels to vary), identifying and setting a goal, contracting a change and developing an action plan to achieve goal. This action plan may include how to overcome barriers, develop specific skills to overcome these barriers, work to develop alternative coping skills and reward changes.
    • Previous work suggests that self-management interventions may be more effective with regular reinforcement than one-time or short-term education.
  • Individual education interventions may work best when information is tailored or matched to the individual.
    • Tailored messages take into account specific individual characteristics in creating a message about heart disease and stroke.
    • Tailored health education materials may be developed specifically to meet an individual’s characteristics in terms of readiness to change, attitudes, beliefs, current heart disease- and stoke-related behaviors and other lifestyle characteristics. The concept of readiness to change (drawn from the Transtheoretical Model or Stages of Change) suggests that individuals may need different kinds of interventions depending on how ready they are to change their behaviors. For example, some older adults may not be ready to walk 30 minutes a day, so it may be more useful to encourage them to walk for shorter periods of time until they build up the strength and energy.
    • Tailored materials are developed based on characteristics that are unique to each individual; therefore, an individual assessment (e.g., survey, interview) is required in order to collect information specific to the individual.
    • There may be some advantages of an interactive, web-based tailored intervention over a more traditional print version, including the ability to receive immediate feedback, an interactive nature similar to interpersonal counseling and the ability to use graphics and other features to increase interest and attention. Furthermore, once on the web, the tailored intervention can reach a relatively larger group of people making it more cost-effective. In addition, it can be updated easily and continuously to include the most recent knowledge.
  • Alternately, other materials or strategies may be targeted or geared toward a specific subgroup of the population of interest (e.g., parents, lower income adults, employees, Hispanics).
    • Targeted messages consider the specific needs of the subpopulation. In a similar manner, these strategies can be used to influence groups of people, but the messages are not specific to each individual.
    • Targeted materials are developed based on characteristics of subpopulations (e.g., language, cultural traditions, social activities, or preferences for food, physical activity, body image).
    • Targeted materials may be limited in their capacity to address individual needs or preferences.

Example of a tailored message

  • A recommendation to change existing patterns may take into account the following information about the individual: Harry, a fifty-year old automotive worker who has recently been diagnosed with high blood pressure, has thought about increasing his physical activity because he knows it will help him stay healthy. Yet, he is always physically tired, so it is difficult for him to get motivated to be active. At work, he rides a cart instead of walking down the factory floor. When he gets home, he doesn’t feel like exercising. He has thought about walking at lunch, but there is no place around his work to walk and he does not have the flexibility to leave work to exercise. Other people with high blood pressure have told him that being physically active can help to prevent or reduce the negative complications. While Harry knows that in the long run being physically active can improve his health, he does not really see that as a significant issue to worry about at the moment. He feels fine. 
  • In this case, a message can be designed for Harry as follows: “Harry, being more physically active now can help increase your energy and keep you feeling your best. The first step is to think about incorporating more physical activity into your daily routine. There are easy ways to increase your activity. Consider walking to and from different places at work instead of using carts or elevators or park in the back of the parking lot. Get small amounts of physical activity to help you keep your blood pressure under control and reduce your risk for the negative health complications. You can start today. Keep reading to find out some specific tips you might find helpful in thinking through how to be more physically active at home and work in order to increase your energy!”

expandWhat should I consider when developing individual education strategies for my heart disease and stroke intervention?

collapseWhat should I consider when developing individual education strategies for my heart disease and stroke intervention?

  • Individual education interventions should be culturally sensitive, involve family and friends and incorporate the individual’s readiness to change behavior, as appropriate. The content of the message may focus on a wide variety of topics, including: resources (e.g., places to be active or get nutritious foods),barriers (e.g., cost of visits to health care providers or medications to reduce high blood pressure or cholesterol) or benefits (e.g., reduced risk for heart disease and stroke, increased quality of life).
  • Various individuals and groups may have different perspectives on their role in managing their illness. This may influence their interest in and ability to engage in individual education interventions.
  • Individual education interventions are also affected by the individual’s access to healthy food options, places to be physically active, or medical care and supplies. Likewise, these interventions are also influenced by the media and broader social and cultural norms in the community (e.g., perceptions of overweight and obesity, trust in health care providers, racial disparities).
  • Tailored and targeted messages can be delivered once or at regular intervals (e.g., weekly, monthly, quarterly) and appear in the form of print, video, internet-based, telephone or computer kiosk messages.

expandWith whom should I work to create individual education strategies for heart disease and stroke interventions?

collapseWith whom should I work to create individual education strategies for heart disease and stroke interventions?

  • To develop your individual education strategies or to determine the most appropriate messages, it is often helpful to work with different community partners. Examples of potential partners include:
    • Local health departments (e.g., health educators or providers)
    • health care services (e.g., providers in clinics or hospitals)
    • schools (e.g., teachers, coaches)
    • coalitions
    • civic organizations/ community organizations (e.g., Head Start, Boy/ Girl Scouts, YMCA, 4H Club)
    • worksites (e.g., wellness staff, Human Resource Directors)
    • senior/ independent living facilities
    • faith-based organizations
    • neighborhood organizations and community members
    • Regional Arthritis Centers
  • To promote and support your individual education services and materials, it is often helpful to work with other community partners. Examples of potential partners include:
    • researchers and evaluators
    • celebrities and professional athletes
    • advocacy organizations (e.g., AHA, clean air, green space preservation)
    • elected officials/ policy-makers/ decision-makers/ community leaders
    • government agencies (e.g., transportation, planning, WIC, food stamps, social services, parks and recreation, community development, economic development)
    • consumer organizations (e.g., supermarkets, restaurants, gyms)
    • producers, distributors, and manufacturers (e.g., food, tobacco, active/sedentary recreation)
    • metropolitan centers
    • media (e.g., newspaper, billboards, television, radio)
    • communications or advertising agencies

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