Daniel Schugurensky, Department of Adult Education and Counselling Psychology
The Ontario Institute for Studies in Education of the University of Toronto (OISE/UT)

Questions and Answers on Adult Education

Edited by Daniel Schugurensky

This site includes questions and answers on Adult Education that were written by students in the course 'Outline of Adult Education' at OISE/UT. The questions are first raised in class by the students themselves. Then they organize in teams in order to research and answer them. New entries are added regularly. This website is intended to provide information about the field to new students and to those who have a general interest in Adult Education. Anyone is welcome to submit a question and/or answer.


How are changes in health behaviour facilitated through adult education interventions?

By Amy Diniz, Lisa Schmidt and Sandra Stothers, (OISE/University of Toronto)

Adult education is a complex and diverse field of practice which yields itself to a number of disciplines including that of health education. As a result, many of the principles and theories that have formed the basis for health education and promotion programs can be directly linked to the theories of adult education, and more specifically to the theories of behaviour change. 

Malcolm Knowles is one such theorist whose work and ideas have influenced health education throughout the years.  Knowles’ model of adult learning advocates that education must be learner-centred and build on the needs and interests of learners. More specifically, Knowles bases his model on three main assumptions: adults are self-directed learners, adults require a readiness to learn and their orientation to learning is problem- or life-centred. 

These assumptions formed the basis for many of the health education programs throughout the 1970’s and 80’s and are reflected in the Health Belief Model as developed by Hochbaum, Kegels and Rosenstock. This model suggests that adults are more likely to adopt healthy practices and behaviours when the following four criteria are met:

For example, a smoker who recently suffered a heart attack and attributes the episode to smoking may be more easily influenced to adopt a non-smoking lifestyle than a teenager who cannot relate or disassociates himself from the potential harmful effects of smoking.

Influencing or facilitating behaviour change creates many challenges for the adult educator and goes far beyond assessing one’s readiness to learn or the provision of information. More advanced models of health education in recent years state that adult educators must also address a number of other factors including: the availability of resources, effectiveness of community leadership, social support systems, level of self-help skills, environmental issues or changes and health care policy.   

The complexity and challenge of these issues became more clear to us when we reviewed Mezirow’s Theory of Transformative Learning. In a nutshell, Mezirow states that transformative learning occurs when individuals change their frame of reference by critically reflecting on their assumptions and beliefs. Based on this process of critical reflection, the adult learner then consciously changes their behaviour to accommodate their newly defined world.

This process of critical reflection and action is referred to by Freire as dialogue, a two-way process occurring between teachers and learners in which each takes a role of teacher and learner. The teacher can encourage the learner to examine the underlying issues behind the problems they identify and armed with this new self-knowledge, make changes that are relevant and meaningful to the learner.

To illustrate these concepts and processes, let’s take the example of the marketing strategies against smoking.  The focus of awareness campaigns has evolved from highlighting the health consequences to emphasizing the practices of tobacco companies and their marketing strategies. In some instances, this has been proven to be a motivating factor in creating a behaviour change. The Canadian Coalition for Action on Tobacco has adopted a strategy of public criticism of the tobacco industry in a federally sponsored mass media campaign to reduce smoking. Tobacco industry denormalization is a new approach to anti-smoking campaigns that has proven to be effective several jurisdictions, including California, Florida and Massachusetts. This approach is to simply inform the public regarding the truth about tobacco industry behaviour.

In recent years, the field of health promotion has gained ground throughout the world as governments struggle with issues such as HIV/AIDS, obesity and cancer.  Campaigns to improve safe-sex  practices, health eating practices and smoke-free lifestyles often hinge on the creation of education programs, support systems and the creation of public policy.  Much headway has been achieved in all three of these areas but for momentum to continue in our current economy and health care system, large scale programs will need to demonstrate that not only is change possible but that the efforts will be cost-effective. 

In an era of cuts to healthcare and competing social and political priorities, the willingness and support of governments and NGOs for health lifestyle programs may be rationed and in jeopardy of future funding.  Without the support and assistance of these institutions, adult educators will be left to fend for themselves and for the learners they support.


Derek Rutter, Lyn Quine. (2002). Changing Health Behavior. Open University Press. USA

Government of Canada (2002) Nutrition Labelling: A Strategic Framework for Public Education. http://www.hc-sc.gc.ca/hppb/nutrition/pube/framework/e_page6.html

Habel, Maureen. (2002) Getting Your Message Across: Patient Teaching www.nurseweekce.com/courses/Nurseweek/NW0660/c1/p03.htm

Knowles, M. (1980) The modern practice of adult education. Revised ed. New York. Cambridge. The Adult Education Company.

Northern Territory Health Services Department of Health and Community Services (Australia) (2001) The Public Health Bush Book www.nt.gov.au/health/healthdev/health_promotion/bushbook/volume1/changing.html

Randall R. Cottrell, James T. Girvan, James F. McKenzie. (1999). Principles & Foundations of Health Promotion and Education. Allyn & Bacon. USA.

US Department of Education, Office of Educational Research and Improvement (OERI) Transformative Learning in Adulthood. ERIC Digest No. 200.


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Last updated on January 01, 2003.