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Health Education, Advocacy and Community Mobilisation Module: 6. Principles of Learning

Study Session 6  Principles of Learning


This study session examines the principles of learning and why they are important within your role as a Health Extension Practitioner. It considers the key characteristics of learning and how they influence the health education activities that you will develop. In doing so it illustrates the similarities and differences in the ways both adults and children learn and how consideration of these can inform your practice in the delivery of health education. Drawing upon psychological, physical and environmental factors and teaching methodologies, this session identifies the factors that influence the learning process and how knowledge of these will help you when you are planning your health education programmes.

Learning Outcomes for Study Session 6

When you have studied this session, you should be able to:

6.1  Define and use correctly all of the key words printed in bold. (SAQ 6.1)

6.2  Describe the characteristics of learning. (SAQ 6.1)

6.3  Explain the principles of adult learning. (SAQ 6.2)

6.4  Describe the steps in learning. (SAQ 6.3)

6.5  Understand some of the most important factors affecting learning. (SAQ 6.4)

6.1  Characteristics of learning

There are three key concepts that will be used to help you learn in this study session: ‘learning’, ‘training’ and ‘education’. The term ‘learning’ refers to a process resulting in some modification, relatively permanent, of the ways of thinking, feeling, and doing of the learner (Figure 6.1). It includes both of the concepts ‘education’ and ‘training’.

Women gathered around listening intently.
Figure 6.1  These women are learning about health issues that are important to them. They are concentrating hard. (Photo: Lindsay Stark)

Training usually means the act of being prepared for something, of being taught or learning a particular skill and practising it until the required standard is reached.

The word education means to gain general theoretical knowledge and this may or may not involve learning how to do any specific practical work, tasks or skills. Education also refers to a process of training or receiving tuition. Usually basic training in health services is a combination of theoretical, educational and practical learning skills.

As a Health Extension Practitioner a large part of your work will involve teaching people in your local community about health matters. This is why you need to be able to understand the key characteristics of the learning process and the learner. Although some aspects of learning really are very simple and straightforward — for example if you don’t get bitten by a mosquito you won’t catch malaria — other aspects of learning are more complicated. In this respect learning is considered to be unitary the learner responds as a ‘whole person’ in a unified way to the whole situation. They respond intellectually, emotionally, physically and spiritually at the same time.

Learning is also social, because it takes place in response to the environment in which there are other individuals as well as physical things. Each learner is unique and has needs and problems not exactly like others. In other words, some have well developed intellectual abilities and others may be less able; some are skilled in self-expression, while others have difficulty; some are slow to learn, but others may be quick; some are sociable while others are shy and retiring. An effective health educator must consider the variations and differences among learners and provide health information accordingly.

Learning is self-active this principle embodies the idea that a learner learns through their own activities. Learning is a personal process. Self-active learning includes listening, visualising, recalling, memorising, reasoning, using your judgment and thinking. In your role as a health educator you will be expected to guide, direct and select different types of learning activities based on what you want your audience to learn from your health education session. Hence, you are expected to encourage active engagement of the audience in the learning process.

Learning is purposive. That means that learning is moving toward a goal or end result. Learning experiences are meaningful when they are related to the individual’s interests. It follows from this that as a health educator you are expected to involve the members of your community throughout the health education activity so that they feel ownership of the programme.

Four children play together with building blocks.
Figure 6.2  These young children are learning while being creative — and having fun at the same time. (Photo: SOS Children’s Villages)

Learning is creative. For each individual, learning is not merely a summing up of previous knowledge and experience, it is a creative putting together of all the knowledge and experience of the learner (Figure 6.2).

Learning is transferable: Transferable learning means that whatever is learned in one context or situation will also apply in another context or situation. For example, the knowledge about the utilisation of some services such as antenatal care (ANC) will also be applied to the utilisation of other health services as well. This characteristic of learning strongly implies that Health Extension Practitioners should be very careful while passing out information since bad or inaccurate information about one issue may be transferred to other types of knowledge, and it may seriously affect the future health behaviour of individuals in your community.

  • In the last six paragraphs some characteristics of learning that have important implications for your health education activities have been outlined. List at least three of those characteristics of learning, making sure you are clear about what each of them imply. If you are not sure then go back and read the paragraphs again.

  • There are six key characteristics of learning. Learning is:

    • unitary
    • individual
    • social
    • self-active
    • purposive
    • creative
    • transferable.

    Most of these terms are self-explanatory; however, make a point of being sure you are clear what ‘unitary’ means as it is an overarching idea, with most of the other characteristics actually being under its ‘umbrella’.

6.2  Steps in learning

As a member of your community, you have been living closely with mothers and children and you will have also observed how children explore and learn from their surroundings. Based on that you can get some useful ideas about learning by thinking about how babies and young children learn. They often have confidence in themselves and are still full of the joy of learning (Figure 6.3). At their best adults also learn in similar ways.

A mother with her child in the home.
Figure 6.3  This young child is learning all the time — even from simple activities in the home. (Photo: Lindsay Stark)
  • Next time you have a chance to observe small children learning and playing, see if you can identify some the steps they go through.

  • Box 6.1 gives you some idea of the sequence of children’s learning. Read it through and compare it to your own observations.

Box 6.1  Steps in childhood learning

  1. The first step is observation, (watching) very carefully.
  2. Next, they also try to use other sensing methods like listening, touching or tasting.
  3. They will start to ask ‘why?’ ‘how?’ when something happens.
  4. The next step is to imitate or copy the same action saying, ‘Let me do it myself’.
  5. Learning takes place by repeating the action again and again (Figure 6.4).
  6. Children usually start to ask others to observe them so they can show that they are able to do the activity they have just learnt.
  7. Perform the action for themselves, having learnt something.
A father teaching his daughter to swim.
Figure 6.4  Learning is an enjoyable activity for this child — and for her teacher. (Photo: Tedla Mulatu)

6.3  Principles of adult learning

Most of the time adults follow the same general patterns of learning as children do. Just read through Box 6.1 again and think about the sequence of learning. But while there are similarities between child and adult learning, there are also additional features of adult learning, that will help you while planning and conducting your health education sessions.

Principles of learning, also known as laws of learning, are readiness, exercise, effect, primacy, recency, intensity and freedom. These are discussed below and they should help you in designing and conducting your health education sessions.

6.3.1  Readiness

Readiness implies a degree of willingness and eagerness of an individual to learn something new. Individuals learn best when they are physically, mentally and emotionally ready to learn — and they do not learn well if they see no reason for learning. Getting the audience ready to learn, creating interest by showing the value of the subject matter and providing continuous mental or physical challenge is usually the health educator’s responsibility. Since learning is an active process, the audience must have adequate rest, health, and physical comfort while learning.

6.3.2  Exercise

The principle of exercise states that those things that are most often repeated are the ones that are best remembered. Your audience will learn best and retain information longer when they have meaningful practice and repetition. It is clear that practice leads to improvement only when it is followed by positive feedback.

The human mind is forgetful and it can rarely retain, evaluate, and apply new concepts or practices after a single exposure. Audiences will not learn complex tasks in a single session. They learn by applying what they have been told and shown. Every time practice occurs, learning continues. The health educator must repeat important items of subject matter at reasonable intervals and provide opportunities for the audience to practice while making sure that this process is directed towards learning something new.

6.3.3  Effect

The principle of effect is that learning is strengthened when accompanied by a pleasant or satisfying feeling — and that learning is weakened when associated with an unpleasant feeling. The learner will strive to continue learning as long as it provides a pleasant effect. Positive reinforcement is more likely to lead to success and motivate the learner — so as a health educator you should recognise this feature and tell your audience how well they are doing.

One of the important obligations of the health educator is to set up the learning situation in such a manner that each person being taught will be able to see evidence of their own progress and achieve some degree of success.

6.3.4  Primacy

Primacy, the state of being first, often creates a strong impression which may be very difficult to change. Things learned first create a strong impression in the mind that is difficult to erase. ‘Unteaching’ or erasing from the mind incorrect first impressions is harder than teaching them correctly in the first place. If, for example, a mother is taught a faulty technique about preparation of replacement feeding (formula, instead of breastfeeding), you as a health educator will have a difficult task correcting bad habits and ‘reteaching’ correct ones.

The learner’s first experience should be positive, functional and lay the foundation for all that is to follow. As a health educator you should present your subject matter in a logical order, step by step, making sure the audience has already learned and understood the preceding step.

6.3.5  Recency

The principle of recency states that things most recently learned are best remembered. Conversely, the further a learner is removed time-wise from a new fact or understanding, the more difficult it is to remember. For example, it is easier for a mother to recall what children were fed this morning than to remember what they were fed three days ago.

Information acquired most recently generally is remembered best; frequent review and summarising will help fixing in the audience’s mind topics that have been covered. To that end, the health educator should repeat, restate or re-emphasise important points at the end of a lesson to help the audience remember them.

6.3.6  Intensity

The more intense the material taught, the more likely it will be retained. A sharp, clear, dramatic, or exciting learning experience teaches more than a routine or boring experience. The principle of intensity implies that a learner will learn more from the real thing than from a substitute.

Likewise, a learner is likely to gain greater understanding of tasks by performing them — rather than merely reading about them. The more immediate and dramatic the learning is to a real situation, the more impressive the learning is upon the learner. Demonstrations and role playing will do much to increase the learning experience of your audience. Examples, analogies, and personal experiences also make learning come to life. For example, a mother will learn more from demonstration of bed net utilisation which is shown to her in her own house than from teaching her just by a talk at your Health Post (Figure 6.5).

A community gather to watch a demonstration on erecting bed nets.
Figure 6.5  Although it is a good idea to show people the new bed nets, each family will need a demonstration in their own home to make the teaching more realistic and effective. (Photo: UNICEF Ethiopia/Indrias Getachew)

6.3.7  Freedom

The principle of freedom states that things freely learned are best learned. Conversely, if the audience is forced to learn something, the more difficult it is for them to learn. Compulsion and forcing are not favorable for personal growth. For example, if you force a family to construct a latrine in their compound, they may not be interested to do that. However if you motivate them to do that through proper education of the family, they are more likely to construct the latrines and use them properly.

  • This has been a long section and there are a lot of things to remember. But, just as with teaching others, you will improve your chances of absorbing all of this by thinking about it again now. So assume that you are planning to conduct a health education session on a new technology, such as how to use a new insecticide for the prevention of malaria in your community. Which of the principles of adult learning would be best for you to use when planning your health education sessions if the following situations were to occur?

    1. People in your village are not willing to learn new skills on malaria prevention.
    2. You have a difficulty in demonstrating the new technology in the real situation in the village because of limited time.
    3. The community has failed to appreciate the benefits of conducting the new prevention methods.
    4. People could not practice the new technology again and again because of the limited samples of the new technology.
    5. People were forced by the kebele leader to apply the new technology, but they didn’t really want to do it.
    6. A few weeks ago, people have heard a false rumour that the new technology has some serious side effects and as a result you have difficulty in removing this misconception.
  • All of these things are examples that you should make notes about — what works and what doesn’t that will help you to build up a broader picture of the patterns of successful learning.

    1. Readiness: that is you need to find a way of helping them get to the stage of being ‘ready’.
    2. Intensity: a demonstration or a role play will increase the intensity.
    3. Effect: you need to make sure they can actually see and understand the good effects of the new technology.
    4. Exercise: even though there is limited technology around you need to find a way for people to be able to use it, possible by time limiting practice sessions by ringing a bell, or by timing people … so that even though they only have limited time they stay interested because they do know they will get a turn.
    5. Freedom: if you can bring about readiness (see 1 above) then you can undo the problems of people feeling forced. If they feel ready they won’t have felt bullied.
    6. Primacy: you may have to do something to try and break the pattern of misconceptions here. Say ‘We are starting again’ or circulate a leaflet that explains how the misconceptions came about.

6.4  Factors affecting learning

As you plan and carry out your health education sessions you should be aware of the factors that affect the learning process. These may be classified into four categories:

  • Physiological factors
  • Psychological factors
  • Environmental factors
  • Teaching methodology.

6.4.1  Physiological factors

The physiological factors include how people feel, their physical health, and their levels of fatigue at the time of learning, the quality of the food and drink they have consumed, their age, etc.

  • Think of some physiological factors that are important when you try to study or learn something new for yourself.

  • Although everyone has a different pattern, most people need to feel safe and secure and not be hungry or tired. Many people are aware of the time of day they learn best — some at night, others early in the morning. It is a blend for each individual.

Physical health is important because ill health hampers learning, and so can fatigue. Studying for a long time can cause fatigue, which affects your audience’s learning capacity. The time of learning also influences how much new knowledge is acquired. The quantity and quality of healthy food and drink also plays a crucial part because nutrition is responsible for efficient mental activity. Poor nutrition adversely affects learning. Alcoholic drinks and caffeine, as well as tobacco, all have an adverse effect on the capacity of people to learn. Good physiological factors promote effective learning.

People find it very difficult try to learn new things if they are in a difficult environment. Atmospheric conditions such as high temperature and humidity tend to lower mental efficiency. Studying in conditions of poor ventilation, the lack of proper lighting, where there is noise and physical discomfort, all hamper learning capacity. Good conditions make it easier to learn (Figure 6.6).

Children in a classroom during a lesson.
Figure 6.6  These children are comfortable and are learning in an ideal environment. (Photo: SOS Children’s Villages)
  • Imagine that you are teaching a family about the importance of environmental sanitation. What would you say about the following statements in regard to their effect on the effectiveness of your teaching? Which of the physiological factors are responsible for their effect on the learning process for each of the following?

    • a.What if you are teaching the family at 2.00pm on a fasting day when they do not eat until the sun goes down?
    • b.What if a member of the family is seriously ill?
    • c.What if there are children in the house making a lot of noise?
    • d.What if the room is very hot and hasn’t got much air?
  • Poor learning could result from the following conditions:

    • a.Lack of food and drink on a fasting day may affect the learning process, as good nutrition is necessary for efficient mental activity. If you do need to conduct a teaching session on a fasting day, make sure that it happens after the family has eaten.
    • b.Physical health — an illness would hamper the learning process for the person who is ill, but also the rest of the family might be worried about that person and not be able to learn effectively. Put off your teaching until the person is recovered and the whole family can learn together.
    • c.Perception — the noise from the children may affect the learning capacity of the audience. Try to include the children in your teaching session or make sure they can play safely away from the house.
    • d.Atmospheric conditions the non-ventilated and warm air conditions will make learning very difficult. Make sure that wherever you do your teaching there is fresh air and the temperature isn’t too hot or too cold.

6.4.2  Psychological factors

You will know from your own study that if you are anxious or worried you will not be able to learn very efficiently. Psychological factors such as mental ill-health or mental tension and conflict all hamper learning. A related psychological factor is motivation — no learning can take place in the absence of motivation. Purposeless learning is not learning at all. Motivation can energise, select and direct positive behaviour.

  • Can you think of a time when you had a lot of motivation to study?

  • Most people have times in their life when they are particularly motivated to study. Perhaps this was while you were at school and really wanted to get good grades? Or now, as you are developing your role as a Health Extension Practitioner?

In general, for motivation to take place in health education sessions, learning should be purposeful and meaningful, and the audience should be interested in the health issue being discussed during the session. Encouragement and praise stimulate learning of health-related skills (Figure 6.7). You will need to encourage the people to whom you are giving your health education messages.

A young child writes on a blackboard with chalk.
Figure 6.7  Children — and people of all ages — need encouragement to learn most effectively. (Photo: SOS Children’s Villages)

6.4.3  Environmental factors

The key environmental factors when delivering your health education messages are the conditions where the learners have to sit to do their learning. Learning is hampered by bad environmental conditions such as distraction, noise, poor illumination, bad ventilation, overcrowding and inconvenient seating arrangements.

  • Can you think of a time when you had to endure poor conditions to do your learning?

  • Most people can remember a bad classroom or a situation where learning was difficult. Often it is noone’s fault and can be as simple as being in a classroom next door to a very noisy set of people, or under a corrugated iron roof in the rainy season. Such things can make a learning environment very difficult.

The location of the health education setting, the internal set up, the accommodation, decoration and sanitary conditions are all very important for efficient learning. The organisational set up of the health education setting also influences learning. For example, if you are giving a health education session in your Health Post, and if the room is very overcrowded with healthy as well as sick individuals, some of them sitting on the floor and others by the door, this would hamper the learning among all of the attendants.

6.4.4  Teaching methodology

Your health education teaching materials should be properly planned and organised. They should suit the mental level of the audience. For example, if you are planning to educate a rural family on personal hygiene, a poster or picture could be good health learning material if it is supported with talks. But a leaflet with lots of text would not be a good teaching aid because a large number of rural people are unable to read. All your teaching should be presented in a meaningful and interesting manner. It is also important to encourage learning-by-doing. When we talked about the characteristics of learning, we referred to self-active learning — learning-by-doing is one very good way of active learning. For example, if you are teaching a family about the utilisation of bed nets, it would be good to encourage them to demonstrate back to you how they would attach them — after you show them how to do it for the first time. Saying things again and repeating them in a meaningful manner, as well as practice, are important for learning and the audience must be encouraged to learn through activity. Consequently, the use of lectures and health talks should be kept to a minimum. Learning can then be reinforced by simple testing, which is informal, but includes feedback. In this way, the audience would know how well they are doing and they will also be encouraged to learn new skills.

For example, if you want to teach a mother about proper position and attachment for breastfeeding, it is good first to demonstrate the correct position to the mother. You can then test whether she has learnt this correctly by asking her to demonstrate the proper positioning and attachment back to you. You should encourage her to practice it until she gets it right. This should continuously be accompanied by your comments and feedback on her level of achievement.

  • We’ve just given two examples of active learning. Now think about it yourself. Assume that you are planning to educate a family about proper utilisation of insecticide treated bed nets (ITNs). Consider the following questions:

    • a.What types of health learning materials could you use to deliver your health education session?
    • b.Where would you prefer to teach them about ITN? At their home or at the Health Post?
    • c.After you teach them about ITN utilisation, how would you plan to test your audience about what they have learned in the session?
  • You may have suggested the following answers:

    • a.Health education information could be reinforced with flip charts that are continuous pictorial presentations that demonstrate the steps of using the bed nets, and posters that would demonstrate how to solve problems related to torn nets.
    • b.Home would be preferable, so that it could be a very realistic demonstration for them in how they can use the nets based on the real bed, floor and roof arrangement in their own households.
    • c.The best way to test whether they have learnt the skill is to ask them to put up the bed nets while you are observing them. Remember to give them feedback and encouragement on their practice.

Summary of Study Session 6

In Study Session 6, you have learned that:

  1. Learning is a process that results in some modification in the learner’s ways of thinking, feeling and doing. The characteristics of learning include the idea of learning as a unitary process: it is both an individual and a social experience that is self-active, purposive and can be creative and transferable.
  2. Steps in the learning process include:
    • Observation (watching) very carefully.
    • Using other sensing methods like listening, touching or tasting.
    • Speaking and asking for responses to questions such as ‘why?’ and ‘how?’ something happens.
    • Imitating or copying the same action saying, ‘Let me do it myself’.
    • Repeating the action again and again.
    • Performing the action while others are observing you.
  3. Principles of learning include readiness, exercise, effect, primacy, recency, intensity and freedom.
    • Readiness implies a degree of willingness and eagerness of an individual to learn something new.
    • Exercise states that those things most often repeated are best remembered.
    • Effect implies that learning is strengthened when accompanied by a pleasant or satisfying feeling.
    • Primacy the things you learn first often create a strong impression which can be very difficult to change.
    • Recency states that things most recently learned are best remembered.
    • Intensity implies that a learner will learn more from the real thing than from a substitute.
    • The principle of freedom states that things freely learned are learned best.
  4. In the day to day activities of health education, the factors that influence learning may be classified into four categories: physical factors, psychological factors, environmental factors and teaching methodology.

Self-Assessment Questions (SAQs) for Study Session 6

Now that you have completed this study session, you can assess how well you have achieved its Learning Outcomes by answering these questions. Write your answers in your Study Diary and discuss them with your Tutor at the next Study Support Meeting. You can check your answers with the Notes on the Self-Assessment Questions at the end of this Module.

SAQ 6.1  (tests Learning Outcomes 6.1 and 6.2)

Imagine that you are teaching a postnatal mother on appropriate techniques of breastfeeding, including the correct position and attachment of her baby. How would you apply the following characteristics of learning as you plan and conduct your teaching session with the mother?

  • Learning is self-active.
  • Learning is purposive.

As you have seen in this study session, learning-by-doing is a key aspect of self-active learning, so in the case of a breast feeding mother: If you want to teach a mother about proper position and attachment for breastfeeding, it is good first to demonstrate the correct position to the mother. You can then test whether she has learnt this correctly by asking her to demonstrate the proper positioning and attachment back to you. You should encourage her to practice it until she gets it right. This should continuously be accompanied by your comments and positive encouragement and feedback on her level of achievement.

For breastfeeding mothers, this type of learning is purposive because each mother will really want to make sure that their baby is getting the right amount of breastmilk to help it grow and develop properly.

Correct positioning and attachment for breastfeeding is taught in the Postnatal Care Module.

SAQ 6.2  (tests Learning Outcome 6.3)

Read again the principles of learning. Make a list of three ways in which you could help people to learn how they could use their insecticide treated bed nets (ITNs) in the correct way.


You could try role play, so people can really see how using their ITNs is done correctly. You could hold a competition for who can attach a net best and fastest to keep people interested, but at the same time emphasising, that there is no point in doing it fast if you don’t do it properly. You could photograph people under an ITN that has been attached correctly, and pin up photos to show how it is done.

SAQ 6.3  (tests Learning Outcome 6.4)

Imagine that you are teaching a group of mothers about oral rehydration salts (ORS) preparation. How would you apply the principles of adult learning in planning and conducting your health education sessions?


The sequence is first observe, then add other senses like listening, ask questions like why and how, imitate, repeat, ask others to observe, and finally be able to do it. So firstly you get them to observe you and listen to you as you prepare and administer oral rehydration salts. Then you encourage people to ask questions. Then ask people to try it out for themselves (that is, imitate you), and repeat this several times. Then they can either ask you to watch them do the preparation and administration for themselves, or they can ask each other, and by this time they will have learned and should be able to do it.

SAQ 6.4  (tests Learning Outcome 6.5)

Suppose that you are planning to teach various groups of the community in different settings and during different seasons of the year. Based on the local situation in your community, try to list the most common factors that may influence the effectiveness of your teaching, using the following broad categories of factors to organise your answers:

  • Physiological factors
  • Psychological factors
  • Environmental factors.

We list below factors which have been mentioned in this study session. It is not a total list, and depending on your circumstances and environment you may have encountered others too.

Physiological factors

  • How people feel
  • Their physical health
  • Their levels of fatigue and the time and day of learning
  • The quality of the food and drink they have consumed
  • Their age
  • The conditions they are learning in.

Psychological factors

You will know from your own study that if you are anxious or worried you will not be able to learn very efficiently. Psychological factors also certainly do influence the learning process.

  • Tensions and anxiety may inhibit learning
  • Mental ill-health, or mental tension and conflict, all hamper learning.
  • A related factor, absence of motivation, prevents learning
  • Motivation can energise, select and direct positive behaviour
  • Lack of purpose prevents learning.

Environmental factors

Learning is hampered by:

  • Distraction
  • Noise
  • Poor illumination
  • Bad ventilation
  • Overcrowding
  • Inconvenient seating arrangements.