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Promoting Health Literacy through Reflective Practice: A shift in thinking

Making the shift from education to reflection is the subject of a workshop I presented at the
Parents As Teachers (PAT) national conference this week in St. Louis.  PAT is on the cutting
edge of health literacy promotion. Three PAT programs in SE Missouri are participating in a
two-year demonstration project   (2010-12) funded by Missouri Foundation for Health to integrate
health literacy promotion into the PAT curriculum. I’m a trainer for that project.  PAT also
is retraining all its parent educators in reflective practice. This shift from education to
reflection is key to promoting health literacy.  

Here’s why: The traditional education model, like the clinical model, puts parent educators,
and healthcare professionals, on the sidelines telling parents/patients what to do – giving
information, dispensing advice, rescuing them from their conditions, and fixing their behaviors.
But parents/patients often ignore expert advice and instructions. This is frequently misinterpreted
as a cognitive deficit or disinterest in health.  The more likely explanation is that parents/patients
recognize intuitively that the dispensers of expert advice consciously or unconsciously consider
them a problem to be fixed or an incompetent person in need of rescue.

Shifting from education to reflection means shifting from telling to asking.  In reflective practice,
instead of telling parents what to do, “parent educators” ask reflective questions.  Reflective
questions are designed to stimulate critical thinking. They enable parents to make meaning from
information, figure out how they can apply it in their real life situations, and plan action steps
they are ready to take.  Reflective questions guide reflective conversations and planned actions
through which parents/patients experience themselves as capable problem solvers and decision
makers, “responsive parents” and “activated patients” who can manage personal and family
health and healthcare; they see themselves becoming increasingly “health literate”.  

To see how reflective questioning works to promote health literacy, see Dora’s Story; it is an
interview with a home visitor written as part of an independent review of evidence from my study
“Does Home Visitation Improve Maternal Health Literacy“.  For more on facilitating the shift from
telling to asking, see David Emerald’s work on TED*, The Empowerment Dynamic.
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