AN EXPLORATION OF HOW HEALTH PROFESSIONALS CREATE eHEALTH AND mHEALTH ...

246 Pages·2012·1.31 MB·English

by  Suha Tamim

AN EXPLORATION OF HOW HEALTH PROFESSIONALS CREATE eHEALTH
AND mHEALTH EDUCATION INTERVENTIONS
by
Suha Rahif Tamim

A Dissertation
Submitted in Partial Fulfillment of the
Requirements for the Degree of
Doctor of Education

Major: Instruction & Curriculum Leadership

The University of Memphis
August 2012
ACKNOWLEDGEMENTS
I would like to thank my Advisory Chair, Dr. Michael Grant for his guidance and
support in this journey. The high standards you set were my drive to give the best I can.
Your teaching and coaching transformed me.
I would like to thank Dr. Marian Levy and Dr. Michelle Stockton for their advice
and encouragement in pursuing a topic for my dissertation that is very close to my heart.
I would like to thank Dr. Trey Martindale for his support and advice.
To my husband and children, thank you for the love, patience, and encouragement
you gave as I pursued my doctoral studies and completed my dissertation. This journey
would not have been possible without your unconditional support.
Finally, thank you to my classmates and colleagues, especially, Dr. Joanne Gikas
who generously shared with me her experience on the dissertation process.

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ABSTRACT
Tamim, Suha Rahif. EdD. The University of Memphis. August 2012. How
Health Professionals Create eHealth and mHealth Education Interventions. Major
Professor: Michael M. Grant, PhD.

The purpose of this study was to explore how health education professionals
create ehealth and mhealth education interventions. Three research questions led this
qualitative study. The first research question focused on the use of learning theories,
instructional models, and instructional design models. The second research question
focused on the use of elearning and mlearning design principles. The third research
question focused on the use of health behavior theories and models. Twelve health
professionals selected for their involvement in the creation of ehealth and mhealth
education interventions participated in this study.
The themes emerging from the research questions showed a variability in how the
participants used education theories and models, principles of elearning and mlearning
design, and health behavior and health education theories and models to create
ehealth and mhealth interventions. On education theories and models, the participants
used elements of instructional design (i.e., analysis, design, evaluation) but did not use
any specific instructional design model. Moreover, they invested efforts in creating
instructional strategies that reflected instructional models of different learning theories
but did not specify particular models or theories. Four themes emerged on the
instructional strategies they used in the interventions: (1) connections to behaviorist
approaches to learning, (2) connections to cognitivist approaches to learning, (3)
connections to constructivist approaches to learning, and (4) unspecified learning
theories. On the use of elearning design principles, seven patterns emerged: (1)
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interaction, (2) learner control, (3) provision of help, (4) use of multimedia, (5)
engagement, (6) user friendliness, and (7) visual appeal. On the use of health behavior
theories and models, three themes emerged (1) no use of health behavior theory or model,
(2), use of a mix of health behavior theories or models, and (3) use of a particular health
behavior theory or model.
The variability of the findings and the resulting themes suggested implications for
practice and further research. These implications concern all health professionals creating
ehealth and mhealth interventions as well as scholars in the field of instructional design
and health education and health behavior. The implications and limitations of the study
were also discussed.

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TABLE OF CONTENTS

Chapter Page

1. Introduction 1
Definitions of Health Behavior and Health Education 2
Health Education Delivery 2
The Foundations of Health Education 3
The Roles of Behavioral Sciences and Education in Health
Education 4
Designing eHealth and mHealth Education Interventions 4
Purpose of Study 6
Research Questions 7
Significance of Study 7

2. Literature Review 8
Methodology 8
Learning and Instruction 9
Learning Theories 9
Behaviorism 10
Cognitivism 11
Constructivist learning theory 11
Summary 12
Instructional Models 13
Behavioral Instructional Models 13
Cognitivist Instructional Models 14
Constructivist Instructional Models 16
Summary 19
Instructional Design Models 20
ADDIE 21
Dick, Carey, and Carey 21
Smith and Ragan 24
Morrison, Ross, and Kemp 26
Summary 31
The Interplay Between Learning Theories, and Instruction
and Health Education 31
eLearning 32
Definition of eLearning 32
Benefits of eLearning 33
Characteristics of eLearning Design 34
Collaboration 34
Learner Control 35
Navigation 35
Interaction 35
Other considerations 36
The Use of Media in eLearning 36
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Multimedia Principle 37
Contiguity Principle 37
Modality Principle 37
Redundancy Principle 37
Coherence Principle 37
Summary 38
Health Behavior and Health Education 38
Health Belief Model 40
Origins 40
Constructs 40
Applications 42
Limitations 42
Link to Learning Theories 42
Social Cognitive Theory 43
Origins 43
Constructs 43
Applications 45
Limitations 46
Link to Learning Theories 46
Transtheoretical Model 46
Origins 46
Constructs 47
Applications 51
Limitations 52
Link to Learning Theories 52
Difficulties Associated with Health Behavior
Theories and Models 53
Summary 54
The State of Technology in Health Education Interventions 55
Definitions of Terms 55
Potentials of eHealth and mHealth in Health Education
Interventions 56
Effectiveness of eHealth and mHealth Education Interventions 57
Examples of eHealth and mHealth Education Interventions 59
Advantages of eHealth and mHealth Interventions
to the Learner 60
Instructional Design Features in eHealth and mHealth Education
Interventions 62
Design Features Necessary in eHealth and mHealth
Interventions. 62
Design and Development Process of eHealth and mHealth
Interventions. 63
Summary 66
Chapter Summary 67

3. Methodology 68
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Design 68
Participants 70
Profiles of Participants 74
Description of the Participants’ eHealth and mHealth
Interventions 83
Data Collection Methods 87
Interviews 89
Interview Protocol 92
Unobtrusive Measures 93
Planning Materials Protocol 94
Artifact Protocol 96
Pilot Study 99
Changes Made 99
Procedures 103
Data Analysis 104
Rigor and Trustworthiness 111
Triangulation 111
Member Checks 112
Peer Debriefing 112
Audit Trail 112
Researcher’s Subjectivities 114
Limitations 115
Delimitations 116
3. Findings 117
Analysis 118
Choice of the Health Behavior Problem and the Related Target
Audience 118
Assessment of Health Behavior Needs 119
Determination of Learning Outcomes 123
Goal Analysis 126
Learner’s Analysis 127
Design 133
Design Process 133
Content Design 137
Learning Activities Design 139
Evaluation 144
Formative Evaluation 144
Summative Evaluation 148
Chapter Summary 153
4. Discussion 155
RQ 1: How Do Health Professionals Use Theories and Models
from the Field of Education to Create eHealth and mHealth
Education Interventions 155
Connections to Behaviorist Approaches to Learning 156
Connections to Cognitivist Approaches to Learning 157
Connections to Constructivist Approaches to Learning 158
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Unspecified Learning Theories 164
Summary 165
RQ 2: How Do Health Professionals Use Principles of eLearning
and mLearning Design to Create eHealth and mHealth
Education Interventions 166
Interaction 167
Learner Control 170
Provision of Help 171
Use of Multimedia 172
Engagement 173
User Friendliness 174
Visual Appeal 174
Summary 175
RQ 3: How Do Health Professionals Use Theories and Models
from the Field of Health Behavior and Health Education to
Create eHealth and mHealth Education Interventions 175
No Use of Health Behavior Theory or Model 176
Use of a Mix of Theories or Models 178
Use of a Particular Health Behavior Theory or Model 180
Summary 181
Chapter Summary 182
5. Implications and Limitations 183
Implications 183
Limitations 192
Chapter Summary 193
References 194

Appendices
A. Interview Protocol 224
B. Planning Protocol 229
C. Artifact Protocol 234

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LIST OF TABLES

Table Page

1. Methods and Criteria of Selection of Participants 73
2. Profiles of Participants 76
3. Description of the Participants eHealth and mHealth Interventions 84
4. Data Collection Methods 88
5. Interview Protocol for Research Question 1 90
6. Interview Protocol for Research Question 2 91
7. Interview Protocol for Research Question 3 92
8. Planning Material Protocol for Research Question 1 94
9. Planning Material Protocol for Research Question 2 95
10. Planning Material Protocol for Research Question 3 96
11. Artifact Protocol for Research Question 1 97
12. Artifact Protocol for Research Question 2 98
13. Artifact Protocol for Research Question 3 99
14. Procedures 104

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LIST OF FIGURES

Figure Page

1. Selection of participants 73
2. Open Coding in NVivo 105
3. The Folders Organizing the Open Codes According to ADDIE 106
4. Creation of Categories 107
5. Creation of Patterns 108
6. Peer Debriefing 109
7. Coding of the planning materials 110
8. Coding of Artifacts 111
9. Memos Created in NVivo 113
10. Handwritten Memos 114

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