Adult Learning Theory in Diabetic Education Settings

Introduction: Adult Learning in a Diabetes Clinic

At my previous place of employment, I worked in a clinic that provided education to individuals who had just been diagnosed with Type II diabetes. While this condition is increasingly common among children in the United States as well as in other Western countries, the clinic at which I worked served only an adult population. While I believe that our patients were generally served well by the clinic, looking back from the perspective of adult learning techniques, I can see that a number of our strategies could have been shifted to be even more helpful.

The population was split between Spanish and English speakers, with clinicians assigned according to the patient's native language. While many of the individuals were in fact bilingual, the language of instruction was always the patient's first language. This is one of the things I would change about the clinic's approach. One of the key elements of adult learning is that the learner must be allowed a sense of agency — a sense that he or she has some control over the process.

By selecting the language of instruction with little consultation with the clients, the staff created a degree of hierarchy that was not appropriate. Adult learners must be treated, first and foremost, as adults. There are a number of other aspects of adult learning theory that must be considered when establishing the most effective diabetic education system; however, they must all be grounded in the recognition that adults must make a personal commitment to learning in a way that schoolchildren do not.

Learner Agency and the Problem of Assumptions

One of the assumptions we made as educators was that because diabetes is such a serious disease, the clients we were working with would automatically be as attentive as possible and would therefore be able to integrate the information to which they were being exposed. This was not the case for a variety of reasons.

The first is that not all of the patients were equally committed to healthy habits. It was, in fact, one of our tasks to convince them of the importance of establishing new ways of living. However, this assumption, I now see, was based on a faulty premise that arose because we were using models of teaching more appropriate for younger learners than for adult learners. In a pre-algebra class, for example, a teacher can set a goal that all students will correctly solve a certain number of problems within a specific period of time. No such uniformity is likely to exist in a group of adult learners — and certainly not among adult learners who are setting their own goals for living with diabetes.

In other words, when teaching children, the teacher is allowed — and generally even required — to determine the goals of the teaching session. Because we were addressing a key element of healthy living for our patients, we assumed it was our job to ensure that each patient agreed with our assessments of what was most important to learn and how that new knowledge should be implemented. However, this is simply not appropriate for such a wide range of adult learners. Not only were their physical conditions very different from one another, but they also came from a variety of communities. The cultural and related medical differences between these communities require that instruction be tailored accordingly.

Piaget, Problem-Finding, and Adult Cognitive Development

If I were in a position to work with a similar population again — teaching comparable material and skills — I would alter the program in a number of ways to ensure that my methods of presenting material better meet the needs of adult learners with different learning styles. The basis for adult learning models, or at least one of the most important bases, is the four-stage learning model developed by the Swiss researcher Jean Piaget. Piaget's final learning stage took place in early adolescence. Arlin (1975) and Merriam and Caffarella (1999) argued that this fourth stage of "formal operations" should be divided into two. The first would remain in the realm of childhood and adolescent learning and be designated as a problem-solving phase. The new final, or fifth, stage — a further stage of abstraction and sophistication — would be understood as a "problem-finding stage." This concept has been debated and sometimes rejected, but it is seen as a key development in the theory of adult learning practices.

It might seem slightly odd at first to consider the discovery of problems to be a form of learning. After all, isn't learning what we do to solve problems? However, problem-finding is in fact a key element of a number of human activities, including science, art, philosophy, and theology. As instructors in the clinic, we were very much stuck at the problem-solving stage, and because we were stuck there, we were unable to help our clients move on to the problem-finding stage.

In our defense, I believe this is a problem throughout the medical field. Medical personnel — in part because of their greater expertise and training, but also in part because of the culture of medicine — tend to act as if their own knowledge defines the universe of potential answers as well as questions. It should also be noted that there is a lack of consensus among researchers and practitioners about exactly how best to serve adult learners.

There is even some question about whether there should be any consistent differences between the way children are taught and the ways adults are taught. I would not argue this position, but I would argue that it is generally not useful to draw a sharp educational line between strategies for teaching children and those for teaching adults. The distinction should not be discrete but continuous — not a question of choose-A-or-B, but a question of what to emphasize.

Conclusion: Applying Adult Learning Theory Going Forward

One of the key differences between adult and young learners is the distinction between problem-finding and problem-solving. We focused on problem-solving without ever realizing how frustrating such a focus was to our patients. In the future, I will present material in a way that encourages adult learners to begin asking their own questions — for example, what health means to them personally, how they deal with the issue of change, and what ongoing goals are of greatest importance to them.

Just as children are not simply small adults, adults are not simply large children when it comes to what they need in terms of effective learning environments. Incorporating adult learning theory as I go forward will allow me to serve adult populations far better than was possible under our previous approach.

References

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