Motivating Adult Learners

by Jasmine Ebron, PharmD, Pharmacy Practice Resident at Kaiser Permanente

As an ambulatory care pharmacist, I am responsible for monitoring and optimizing drug therapy regimens in the clinic setting, while providing chronic disease state management. I also have the privilege of managing a pharmacist-led diabetes clinic, where I outreach to patients on a weekly basis to obtain blood glucose readings, assess the need for dosage adjustments, assess drug-related problems, and promote medication safety. Managing chronic diseases such as diabetes, hyperlipidemia, and hypertension require patient participation to improve patient outcomes. Part of soliciting patient participation includes motivating my patients, or my adult learner if you will, to take an active role in developing a care plan with me.

When a patient first learns they have diabetes, they often have a lot of anxiety and can feel overwhelmed by all of the lifestyle changes required to tightly control their diabetes. Motivating my patients to stay engage in the treatment plan, and empowering them to feel like they can be successful requires an understanding of how to motivate the adult learner. During diabetes education classes, it is essential to incorporate the ‘Principles of Adult Learning’ into the lesson plan, ensuring that information is delivered effectively.

Adult learners have many responsibilities and must balance the demands of life with the desired to participate in various learning activities. Barriers such as lack of time, money, and scheduling conflicts can lead to lack of participation in the care plan.¹ Having empathy for the adult learner when life does not work out as planned goes a long way to build rapport with patients. When the adult learner, or in my case my diabetic patient, feels that I care about them as a whole person versus just focusing on medication optimization, they typically are more likely to be engage in and adhere to the care plan.

When teaching the adult learner, it is important to present meaningful information in “bite-size chunks” rather than presenting a lot of information that the adult learner has no connection to.¹ I try to first draw the link between a high carbohydrate diet and poor glycemic control, before discussing dietary modifications. I use charts and visual reinforcements to explain these concepts before discussing better food choices that should be incorporated into their diet. It is important for adult learners to see the value in dietary modifications by understanding how it will aid in tighter glycemic control. This understanding will hopefully encourage them to follow their new diet.

Dietary changes can sometimes be very difficult for a patient to make and a patient may be a bit resistant. The way the concept of change is introduce is a critical element as to how well change will be received. If the adult learner feels that they can contribute to the way things are changing versus just being told what to change, the patient may perceive the plan to change as ours plan that we developed together versus having the perception that it is my plan that I told them to adapt. Planning between the instructor and the adult learner gives the adult learner more control of the learning and often leads to easier adaptation of the care plan.²

When a patient’s care plan includes adding insulin to their treatment regimen it is important to provide patients with the proper support and counseling instructions. This phase in diabetes management is even more involved and takes even more participation from the adult learner. Teaching concepts such as how to draw up and inject their insulin, when they should take their insulin, how to adjust their insulin, and what symptoms to monitor for are all important concepts that I review. During this review, I often encourage active participation to help them master these learning concepts. One adult learning principle is that adult learners need to learn by doing.¹ I apply this principle by first demonstrating how to properly draw up and inject their insulin during diabetes education class, then I give my patient an opportunity to use the demo vial and syringe and practice on their own. 

Adult learners learn better in an informal and personal environment,² which is why I offer diabetes training in either a one on one setting, or in a small group setting. When I host a group class I am mindful of the room/environment and seating arrangement. I try to stay away from teaching in a classroom for fear of it being an intimidating setting for some adult learners. Instead I prefer to use a small conference room where I can rearrange the chairs in a circle to create an informal and personal environment if possible. For my elderly patients, who have different learning needs, or for my patients with a lower health literacy level, I encourage a one on one training approach so that I can teach at a slower pace and provided step by step instructions.

Ultimately when addressing the adult learner it is important to understand the different principles that need to be used to reach this audience. Techniques such as providing information in “bite size chunks”, allowing the adult learner to feel that they are a part of the decision making, giving the adult learner an opportunity to actively participate in the learning process, and keeping the learning environment informal and personal are all important principles that will aid in teaching the adult learner.

References:

1. Thomas, KJ. They're Not Just Big Kids: Motivating Adult Learners. ERIC [Internet]. 2001 Apr 8 [cited 2017 March 14] IR012:139. Available from:  http://files.eric.ed.gov/fulltext/ED463720.pdf

2. Collins J. Education Techniques for Lifelong Learning: Principles of adult Learning. Lifelong Learning [Internet]. 2004 March 29 [cited 2017 March 14] 24:1483-1489. Available from:http://pubs.rsna.org/doi/pdf/10.1148/rg.245045020