CHAPTER 7: How to teach attitudes

What is an attitude? Think about health workers in rural centres. They may know all about aseptic methods and have the skill to follow them. But when they are working by themselves, they may be tempted to take short cuts and not be very thorough. The way they behave will depend on their attitudes. So an attitude is a tendency to behave in a certain way.

7.1 Are attitudes important?

It has often been said that the attitudes learned during training are the most important part of the training. At the same time other people say that attitudes cannot be taught. What is the truth?

Certainly attitudes are formed or changed during training. This is quite clear to anyone who has worked with students and watched them develop over a period of time. Compare the attitudes of students who have completed a long period of training with the attitudes of a group who are just starting. The differences will usually be obvious. But how has this change taken place? Has the change been caused by the course? Can teachers control changes in attitude?

One of the problems for teachers is that attitudes are not easy to measure. You can set out to teach students how to inject a patient and at the end of the teaching session you can easily find out whether they have learned the skill. On the other hand, you may try to change their attitudes to patients by explaining that they should respect the patients' opinions. But at the end of the explanation it is very difficult to find out whether the students' attitudes have changed.

Another problem is that attitudes are hard to define or explain. Because of this, very few teachers would be able to list all the attitudes that they would like their students to have. So it is not clear what the students need to learn.

Attitudes are very important, however, and teachers must try to make sure that the students learn the right attitudes.

Attitudes are rather vague things

This is especially important if the students will be working in remote villages or will not be closely supervised after training. In such situations, they may be tempted to take life easily and not work very hard. This would cause a fall in the overall standard of health of the community. This drop in standards can only be avoided if health workers have the right attitudes.

7.2 How to teach attitudes

There are no guaranteed methods of teaching attitudes. Teachers must be aware that all of the experiences that students have may change their attitudes. But no single experience can be certain of having a specific effect on all students.

There are five general methods which teachers can use. These are discussed in the following sections.

· providing information (Section 7.3)
· providing examples or models (Section 7.4)
· providing experience (Section 7.6)
· providing discussion (Section 7.6)
· using role-playing exercises (Section 7.7)

Even if you use all these methods, you must be aware that students' attitudes may be shaped by events which you have no control over. For example, students will read books, talk to people outside the school, and spend time with their families. The students will also have formed many of their attitudes before they start their training.

It is important therefore that you try to influence their attitudes as much as possible and that you do so correctly.

7.3 Providing information to shape attitudes

Information is not always enough to change people's attitudes but it may help. For example, the relationship between smoking and the risks of cancer and heart disease is well known by many people. For some people this information has been enough to persuade them to change their attitude to smoking and to give up the habit. For many other people, the information has not been enough.

Teachers can present information about attitudes in many ways. Lectures are one obvious method. Films are often more effective because they can also be used to show examples of the correct attitudes (see Section 7.4).

The important point is to show how the facts are relevant to the attitude.

Exercise

List the information you would provide to students if you wanted to teach them about the importance of following aseptic techniques. How would you make these facts relevant to the attitude of thoroughness in cleaning hands and sterilizing equipment?

As another example, what facts would you provide if you wanted to persuade a mother to have a more positive attitude towards breast-feeding?

Comments

You might have made the following points:

· The dramatic fall in mortality rates when aseptic methods were introduced in hospitals.
· The need for health workers to set a good example to the community.
· The ways in which infections can be transmitted.

These facts all show why aseptic techniques are important. They appeal to the reason in students. Sometimes less logical and more emotional facts may be more effective. For example, you might tell the students about an experience that you have had which shows what happens when aseptic techniques are not followed. This single experience will not have much logical importance, but you can make the story so dramatic and vivid that it has more effect.

7.4 Providing examples or models to shape attitudes

Most advertising is designed to change attitudes. A common technique is to show an "ideal person" (who is usually young and goodlooking) using a certain product. The advertiser aims to provide a model or an example which will be followed by the reader. This technique is generally very effective.

What has this got to do with teaching? Well, for many students their teacher is a very powerful model. Students often copy the way their teacher behaves. If teachers are rude to patients or careless in handling equipment, then their students will tend to follow their example.

On the other hand, if teachers are considerate to the people they work with, then their students are likely to behave in a similar way. Therefore it is essential that you always set a good example for your students.

Other people will also influence the students' attitudes. Other health workers, nurses, and doctors all provide models for the students to copy. You should therefore make sure that, as far as possible, these staff also set a good example.

7.5 Providing experience to shape attitudes

Throughout the students' training they will have experiences which will shape their attitudes. They may see patients with sores that have not been treated and that have become septic and possibly disabling. This direct experience of seeing the patients' suffering will have far more impact on shaping students' attitudes than a whole bookful of facts about the need for early treatment of sores and superficial wounds.

The teacher should provide students with as much direct experience as possible. For example, many health workers are responsible for improving nutrition in a community. In some schools the students grow all the vegetables that they eat and look after animals themselves. This experience will help them to have more positive attitudes to doing the work themselves. In these schools teachers also join in with the digging and cultivation so that students learn that manual work is not undignified.

Other useful experiences can also be provided. For example, students should see the benefits of an uncontaminated water supply in a village. They should see how good nutrition can lead to a better life.

Do you think that students should have the experience of cooking their own food during the course - or should the food be prepared for them? What attitudes would you expect the students to have in these two situations?

Exercise

List 3 experiences which you think your students should have that would help them to form good attitudes to patients.

1.
2.
3.

Comments

You may have written down ideas such as:

· Working with an experienced health worker who has a caring attitude to patients.
· Talking to patients about their worries concerning health.
· Meeting people who suffer from some disabling but preventable disease.

Note: It is always a good idea to discuss these experiences with your students so that you can make clear the kinds of attitudes that you want them to learn.

7.6 Providing discussion to shape attitudes

Discussion in small groups is generally thought to be helpful in shaping students' attitudes. Discussion also helps to make the previous three methods more effective. For example, it is helpful for students to describe and discuss the experiences that they have had with patients. During the discussion they will share experiences, so that the experience that one student has had may influence all the other members of the group.

Providing discussion to shape attitudes.

Another important feature of the discussion is the way in which the students' attitudes change when they talk about their own opinions. The process of putting their ideas into words and seeing the reaction of the other students can be a powerful way of changing attitudes. For this to happen, the group size must be small enough to give every student a chance to talk. A group of 7 or 8 students is best and 15 the maximum number for this technique to be effective. Note that it is not what the teacher says that is important, but what each student says. Teachers should speak very little in these small-group sessions. They may encourage the quieter students to give their opinions and have to stop the talkative students from talking too much. But only in exceptional situations (for example, when the group runs out of ideas) should teachers give their own opinions or take an active part in the discussion.

When there are very large numbers of students, it may be impossible to have one teacher for every group of ten or so students. One solution is to let the students meet without a teacher. This is possible because the teacher's role is only to help the students to talk. You can help your students to talk by providing some written guidance for their discussion. For example, you might give them a list of questions to discuss in their groups. You could then ask one student from each group to describe to the other students in the class what happened during the discussion.

Examples of questions for a discussion

Imagine that each of you has been sent to a different village to persuade the local people to build a piped water supply.

1. How would you start to persuade the local people? Would you try to make a speech to a large meeting or would you talk to individuals? If you choose a large meeting, who would you want to attend the meeting and how would you persuade them to come?

2. What rumours and objections about piped water supplies might you hear?

3. How would you respond to these rumours and objections?

4. What advantages would be likely to persuade the people to build a piped water supply?

5. Why do you think some people might object to the idea of piped water?

6. Would you arrange for a piped water supply to be built against the wishes of the village people?

Note that these questions are specific enough to start the students talking and to provide some structure for the discussion. But they also allow students to express different opinions and begin to form or change their attitudes.

Exercise

Write down the questions you would give to a small-group discussion. The questions should help the group to think about parts of their job where attitudes are as important as knowledge or skills. The aim of the discussion should be to encourage the students to talk about your questions and so develop their attitudes. For example, write down some questions that would encourage students to be more careful in their use of medical equipment.

7.7 Role-playing exercises

Attitudes are very important in communications with people. If you respect people, you will listen to them and speak to them in a different way.

Attitudes to people will often be improved if you understand the other person's point of view. One way of teaching attitudes is to give the students some experience of what it is like to be a patient or a mother with a poorly nourished child, or a shopkeeper who thinks that the health inspector is unreasonable. This can be done by using a technique called role-playing.

Role-playing is an exercise in which the students act the parts of different people and so begin to experience some of the feelings of these people.

The technique is also very useful in teaching communication skills and is described in more detail in Chapter 8.

7.8 Conclusion

Attitudes are important although they are difficult to define, test or teach. The ideas given in this chapter are only suggestions, because there are no widely accepted methods of teaching attitudes. It is certain that what you do will change students' attitudes. It is less certain exactly what that change will be.

Summary

1. An attitude is a tendency to behave in a certain way. For example, a person who has an attitude of thoroughness will generally keep full and correct records of his or her work.

2. Attitudes like this are not developed easily. For example, the teacher must do more than say "You should be thorough in keeping records".

3. Attitudes can be shaped by:

- providing the relevant background Information
- providing models or examples
- providing experience
- encouraging discussion among students
- using role-playing exercises.