The Science of Healthy Behaviors
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National Institute of Nursing Research
Office of Behavioral and Social Sciences Research

The Science of Healthy Behaviors

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Teacher's Guide

Lesson 4—Explore/Explain/Elaborate

Behavioral Specialists at Work: The Healthcare Setting

At a Glance

photo of healthcare worker

Overview

This lesson consists of two activities and should take two class periods to complete. Students role-play behavioral clinicians in a hospital scenario to investigate factors that may have influenced the health of a fictitious person, Joe M., who has been admitted to the hospital for heart disease. In Activity 1, student teams analyze and evaluate various data for Joe, including his behavioral history and his own and his family’s medical histories. In Activity 2, students develop recommendations for changes in specific behaviors that should decrease Joe’s risk of continued health problems. These activities allow students to combine their understandings of what behavior is and how behavior is studied from Lessons 1 and 3 and their understanding of influences on behavior from Lessons 2 and 3. Students develop an awareness that behaviors can have long-term, health-related outcomes and that behaviors can be modified. This lesson can be done on the Web or with printed materials.

Major Concepts

Health is influenced by factors that we may not be able to modify (such as genetics) and by factors that we may be able to modify by changing behaviors (such as being physically inactive). Behaviors have both positive and negative effects on health. Behaviors can have both short-term and long-term effects on health. Behaviors can be modified to affect health positively.

Objectives

After completing this activity, students will

Teacher Background

See the following section in Information about the Science of Healthy Behaviors:

  1. 3 Influences on Behavior
  2. 4 Behavioral and Social Science Research and Cardiovascular Disease

In Advance

Web-Based Activities
Activity Web component?
1 Yes
2 Yes

Photocopies
Activity Master Number of copies
1 (Web version) Master 4.1, The First Memo
Master 4.2, Behavioral Sciences Evaluation Form, Page 1
1 copy per team or 1 transparency
1 copy per student
1 (print version)

Master 4.1, The First Memo
Master 4.2, Behavioral Sciences Evaluation Form, Page 1
Master 4.3, Patient Notes
Master 4.4, Reference Manual

1 copy per team or 1 transparency
1 copy per student
1 copy per team
1 copy per team
2 (Web version) Master 4.2, Behavioral Sciences Evaluation Form, Page 2
Master 4.5, The Second Memo
Master 4.6, Prescription Pad
1 copy per student
1 copy per team or 1 transparency
1 transparency
2 (print version)

Master 4.2, Behavioral Sciences Evaluation Form, Page 2
Master 4.5, The Second Memo
Master 4.6, Prescription Pad
Master 4.7, Joe M.’s Environment

1 copy per student
1 copy per team or 1 transparency
1 transparency
1 copy per team

Materials
Activity Materials
1 (Web and print versions)
  • None
2 (Web and print versions)
  • None

Preparation

Activity 1

For classrooms using the Web version of this activity, you will need computers with an Internet connection. Verify that the computer lab is reserved for your classes or that classroom computers are ready to use. To save time, have computers online and at the correct URL: http://science.education.nih.gov/supplements/healthy/student. This is a main menu page that contains links to this unit’s Web activities.

For classrooms using the print version of this activity, you will need to create enough “patient files” so that each student team has both a copy of Master 4.3, Patient Notes, and a copy of Master 4.4, Reference Manual. You can place each team’s materials in a manila folder.

Activity 2

Students using the Web version of this activity will continue to work on the computer for a portion of the class.

For classrooms using the print version of this activity, no additional preparations are required.

Procedure

Activity 1: What’s the Problem?

Web activity icon

In classrooms using the Web version of this activity:

  1. Tell students that their preliminary training as behavioral scientists is complete. Ask them to tell you the key concepts of their work from Lessons 1, 2, and 3.

Write student responses on the board. The list should include the following:

  • a definition of behavior,
  • scientists have tools they can use when they study behavior,
  • some behavior has health-related outcomes, and
  • various factors influence behavior.

This review should be done quickly.

Assessment icon
Assessment:
Step 1 will stimulate thinking about the topic and give you an opportunity to assess informally students’ understanding of key concepts from Lessons 1, 2, and 3.

National Science Education Standards icon
Content Standard F:
Individuals can use a systematic approach to thinking critically about risks and benefits.
  1. Tell the class that they are ready to put their training to the test. In a clinical (that is, health-related) setting, they will use the knowledge gained by behavioral and social scientists to investigate behaviors that may have influenced the health of a person who has been admitted to the hospital for heart problems.
  1. Organize students into teams of three or four and distribute one copy of Master 4.1, The First Memo, to each team. Tell students to read the memo. Alternatively, show the transparency of the memo and read it with the class.

The memo sets up the scenario. Student teams play behavioral-health-team members at a hospital. The students’ task is to evaluate the behaviors of a fictitious patient and determine which behaviors may have been factors in the patient’s heart disease. In Activity 2, students will make recommendations to the hospital’s behavioral sciences review board for changes in specific behaviors that should decrease the patient’s risk of continued health problems.

  1. Explain to students that their first task is to identify factors that may have contributed to the patient’s heart disease.

They will have access to a reference manual (see Step 6) and a patient file (see Step 8).

  1. Direct the teams to their computer stations and ask them to wait for instructions.

Computers should be at the URL http://science.education.nih.gov/supplements/healthy/student. This is a main menu page that contains a link for this activity.

  1. Students should then click on the link to Lesson 4—The Healthcare Setting, Activity 1—What’s the Problem?

Students view a short animation, in which they enter County Hospital and are given a file labeled “Joe M.” As the animation sequence ends, students see the reference manual’s Table of Contents overlaying the information contained within Joe M.’s file.

  1. Before students begin their work, point out the topics covered in the manual. Emphasize that the manual contains valuable information that students need to complete their tasks.

The reference manual contains the information students need to complete this activity. It provides a definition of heart disease and brief discussions of the risk factors for heart disease that are relevant to this lesson.

tip iconTip from the field test: Reviewing the reference manual with students at this time is important; otherwise, they may not consult it and will have difficulty completing the activity satisfactorily.

  1. Ask students to close the reference manual for now (they may open it again at any time as they review the information in Joe’s file). Point out the information students must review to complete their tasks.

Information accessed on this page sets the stage for the students’ work. Students see links to the following:

  • patient information, including a statement of the patient’s health problem,
  • medical history,
  • family medical history, and
  • behavioral history.
National Science Education Standards icon
Content Standard F:
Regular exercise is important to the maintenance and improvement of health.
  1. Ask students to click on the link to “Patient Information.”

Information on the Patient Information page introduces students to Joe M.

  1. Give each student one copy of Master 4.2, Behavioral Sciences Evaluation Form, Page 1, and tell students to proceed with their evaluation.

Student teams should begin by determining which factors may have contributed to the patient’s heart disease. They can do this by evaluating the information on the Medical History, Family Medical History, and Behavioral History pages. Students can view this information in any order they want. Allow students 20 to 30 minutes to complete this part of the activity. Students should consult the reference manual for help with their evaluation. For example, if they read in the patient’s chart that he is overweight, they may check the manual to see whether being overweight is a risk factor for heart disease. Students will make recommendations for behavioral changes in Activity 2.

Assessment icon
Assessment:
Collect and review Master 4.2, Behavioral Sciences Evaluation Form, Page 1, from each student. Students will need the information on Master 4.2, Page 1, to complete Activity 2.

Students can identify the following risk factors as those the patient may not be able to modify:

  • family history of heart disease (genetics) and
  • the high blood cholesterol if it is due to genetics and not the patient’s diet.

Students can identify the following risk factors as those the patient may be able to modify by changing behaviors:

  • smoking,
  • physical activity,
  • nutrition,
  • weight control, and
  • stress.

Note that while an individual cannot modify the genes they inherit from their parents, one can modify an inherited health risk, such as heart disease, by modifying behaviors. This should become clear as students consider a behavioral modification program for Joe M.

print activity iconIn classrooms using the print version of this activity:

  1. Tell students that their preliminary training as behavioral scientists is complete. Ask them to tell you the key concepts of their work from Lessons 1, 2, and 3.

Write student responses on the board. The list should include the following:

This review should be done quickly.

Assessment icon
Assessment:
Step 1 will stimulate thinking about the topic and give you an opportunity to assess informally students’ understanding of key concepts from Lessons 1, 2, and 3.

National Science Education Standards icon
Content Standard F:
Individuals can use a systematic approach to thinking critically about risks and benefits.
  1. Tell the class that they are ready to put their training to the test. In a clinical (that is, health-related) setting, they will apply the knowledge gained by behavioral and social scientists to investigate behaviors that may have influenced the health of a person who has been admitted to the hospital for heart problems.
  1. Organize students into teams of three or four and distribute one copy of Master 4.1, The First Memo, to each team. Tell students to read the memo. Alternatively, show the transparency of the memo and read it with the class.

The memo sets up the scenario. Student teams play behavioral-health-team members at a hospital. The students’ task is to evaluate the behaviors of a fictitious patient and determine which behaviors may have been factors in the patient’s heart disease. In Activity 2, students will make recommendations for changes in specific behaviors that should decrease the patient’s risk of continued health problems.

  1. Give each team a “patient file” containing one copy of Master 4.3, Patient Notes, and one copy of Master 4.4, Reference Manual.
  1. Explain to students that their first task is to identify factors that may have contributed to the patient’s heart disease.

Students have the following information available to them:

  1. Ask students to look at their copy of the reference manual. Point out the topics covered in the manual. Emphasize that the manual contains valuable information students need to complete their tasks.

The reference manual contains the information students need to complete this activity. It provides a definition of heart disease and brief discussions of the risk factors for heart disease that are relevant to this lesson.

tip iconTip from the field test: Reviewing the reference manual with students at this time is important; otherwise, they may not consult it and will have difficulty completing the activity satisfactorily.

  1. Ask students to read the information provided on the Patient Information form.

Information on the Patient Information form introduces students to Joe M.

National Science Education Standards icon
Content Standard F:
Regular exercise is important to the maintenance and improvement of health.
  1. Give each student one copy of Master 4.2, Behavioral Sciences Evaluation Form, Page 1, and tell students to proceed with their evaluation.

Student teams should begin by determining which factors may have contributed to the patient’s heart disease. They can do this by evaluating the information on the Medical History, Family Medical History, and Behavioral History pages. Students can view this information in any order they want. Allow students 20 to 30 minutes to complete this part of the activity. Students should consult the reference manual for help with their evaluation. For example, if they read in the patient’s chart that he is overweight, they may check the manual to see whether being overweight is a risk factor for heart disease. Students will make recommendations for behavioral changes in Activity 2.

Assessment icon
Assessment:
Collect and review Master 4.2, Behavioral Sciences Evaluation Form, Page 1, from each student. Students will need the information on Master 4.2, Page 1, to complete Activity 2.

Students can identify the following risk factors as those the patient may not be able to modify:

Students can identify the following risk factors as those the patient may be able to modify by changing behaviors:

Note that while an individual cannot modify the genes they inherit from their parents, one can modify an inherited health risk, such as heart disease, by modifying behaviors. This should become clear as students consider a behavioral modification program for Joe M.

Activity 2: Changing Behaviors

Note to teachers: This activity presents a simplified view of how professionals would design a behavioral intervention for a patient. For example, professionals would work with a patient directly to design and implement a plan with the greatest chance of success, rather than simply designing an intervention for a patient as students do here.

Web activity icon

In classrooms using the Web version of this activity:

  1. Reconvene the class while students are at their computer stations. Ask students to share with the class some risk factors for heart disease that they believe the patient cannot modify.

Write responses on the board.

Note to teachers: Steps 1 to 3 should be done quickly, even though there are opportunities for longer discussions.

  1. Ask students to share with the class some risk factors for heart disease that they believe the patient can modify.

Write responses on the board.

  1. Ask students if they believe it is possible for people to change their behaviors.

Students may respond with more than yes or no. They may qualify answers and respond, for example, that people can change their behaviors, but it is not easy to do. Listen to what students have to say and make notes on the board, if necessary. In Lesson 5, students will deal with the results of Joe M.’s attempts to modify his behaviors.

  1. Give one copy of Master 4.5, The Second Memo, to each team. Tell students to read the memo. Alternatively, show a transparency of the memo and read it with the class.

The memo asks the students to prepare a behavioral intervention, or a plan outlining behavioral changes, for Joe M. to help decrease his risk for continued heart disease.

  1. Have students proceed to the URL http://science.education.nih.gov/supplements/healthy/student and click on the link to Lesson 4—The Healthcare Setting, Activity 2—Changing Behaviors.

Clicking on this link brings up information about Joe M.’s environment. For example, there are maps detailing the locations of Joe’s house, Joe’s office, restaurants, and places where Joe can exercise and catch the bus (see “Overhead View” map). The general environment around Joe’s house is depicted. Bus schedules and local restaurant menus are available by clicking on the appropriate links.

  1. Give each student a copy of Master 4.2, Behavioral Sciences Evaluation Form, Page 2. Assign students the following tasks:
  • review the behavioral risk factors for heart disease that Joe M. may be able to modify;
  • decide how Joe M. should change specific behaviors in general (that is, do more or less of something);
  • consult the information on the Web about Joe M.’s environment; and
  • on the prescription form (Master 4.2, page 2), make specific recommendations for behavioral changes to lower Joe’s risk of further complications from heart disease.
National Science Education Standards icon
Content Standard C:
Disease is a breakdown in structures or functions of an organism.

Assessment icon
Assessment:
Collect each student’s completed copy of Master 4.2 to formally assess understanding of the major concepts of this lesson.

Move among groups as students complete this activity and ensure that recommendations are specific. For example, recommending that Joe stop smoking is specific. However, recommending that Joe increase his physical activity is not specific. Information is provided for students to evaluate a number of very specific ways for Joe to increase his physical activity, including walking to work, taking the bus to work (this would involve walking to and from bus stops), and taking the stairs to his office instead of the elevator. Many other recommendations can be made as well from the information provided. If necessary, students can consult the information in Joe’s patient file.

Note to teachers: Students may be unsure of what to do with the information provided in the restaurant menus, since it is beyond the scope of this unit to provide detailed information about human nutrition and the nutritional content of foods. However, it is sufficient at this time that students recognize that some diets are more healthful than others. For example, if students indicate that Joe should eat at Souvlaki Shack rather than Quick Burger, ask them, “Why?” If students respond that the food at Souvlaki Shack is better for Joe than eating a cheeseburger, accept that response as an indication that students are thinking about differences among foods and relationships between diet and health.

  1. Reconvene the class. Ask groups to share their recommendations for changes to Joe’s behavior. Write responses on the transparency of Master 4.6, Prescription Pad.

Encourage discussion and have students question the recommendations of their classmates. Ensure that students provide reasons to back up their recommendations.

print activity iconIn classrooms using the print version of this activity:

  1. Reconvene the class. Ask students to share with the class some risk factors for heart disease that they believe the patient cannot modify.

Write student responses on the board.

Note to teachers: Steps 1–3 should be done quickly, even though there are opportunities for longer discussions.

  1. Ask students to share with the class some risk factors for heart disease that they believe the patient can modify.

Write responses on the board.

  1. Ask students if they believe it is possible for people to change their behaviors.

Students may respond with more than yes or no. They may qualify answers and respond, for example, that people can change their behaviors, but it is not easy to do. Listen to what students have to say and make notes on the board, if necessary. In Lesson 5, students will deal with the results of Joe M.’s attempts to modify his behavior.

  1. Give one copy of Master 4.5, The Second Memo, to each team. Tell students to read the memo. Alternatively, show a transparency of the memo and read it with the class.

The memo asks the students to prepare a behavioral intervention, or a plan outlining behavioral changes, for Joe M. to help decrease his risk for continued heart disease.

National Science Education Standards icon
Content Standard C:
Disease is a breakdown in structures or functions of an organism.

Assessment icon
Assessment:
Collect each student’s completed copy of Master 4.2 to formally assess understanding of the major concepts of this lesson.
  1. Give each student one copy of Master 4.2, Behavioral Sciences Evaluation Form, Page 2. Give one copy of Master 4.7, Joe M.’s Environment, to each group. Assign students the following tasks:

Move among groups as students complete this activity and ensure that recommendations are specific. For example, recommending that Joe stop smoking is specific. However, recommending that Joe increase his physical activity is not specific. Information is provided for students to evaluate a number of very specific ways for Joe to increase his physical activity, including walking to work, taking the bus to work (this would involve walking to and from bus stops), and taking the stairs to his office instead of the elevator. Many other recommendations can be made as well from the information provided. If necessary, students can consult the information in Joe’s patient file.

  1. Reconvene the class. Ask groups to share their recommendations for changes to Joe’s behavior. Write responses on the transparency of Master 4.6, Prescription Pad.

Encourage discussion and have students question the recommendations of their classmates. Ensure that students provide reasons to back up their recommendations.

Web activity icon Lesson 4 Organizer: Web Version
Activity 1: What’s the Problem?
What the Teacher Does Procedure Reference

Ask students to reflect on their preliminary training as behavioral scientists and explain to you what they have learned during the previous lessons.

Step 1

Explain to students that they will use their training to investigate behaviors of an individual who has been admitted to the hospital with heart problems.

Step 2

Divide the class into groups of three or four students.

  • Give each group one copy of Master 4.1, The First Memo.
  • Display a transparency of Master 4.1, The First Memo, and ask a volunteer to read it aloud.
  • Instruct students to identify factors that may have contributed to the patient’s heart disease.
master iconSteps 3 and 4

transparency icon

Have students log on to the Web site and click on the link to Lesson 4—Healthcare Setting, Activity 1—What’s the Problem?

Steps 5 and 6

Acquaint students with the reference manual and explain how it will help them accomplish their task.

Step 7

Acquaint students with the following activity links:

  • Patient Information
  • Medical History
  • Family Medical History
  • Behavioral History
Step 8
Instruct students to click on the Patient Information button. Step 9

Give each student one copy of Master 4.2, Behavioral Sciences Evaluation Form, Page 1.

  • Instruct students to proceed with their evaluation.
master iconStep 10
Activity 2: Changing Behaviors
What the Teacher Does Procedure Reference

Reconvene the class in groups of three or four students. Ask students to suggest risk factors for heart disease that a patient cannot modify.

  • Write their suggestions on the board.
Step 1

Ask students to suggest risk factors for heart disease that a patient can modify.

  • Write their suggestions on the board.

Step 2

Ask students if they believe that people can change their behaviors. Step 3

Give each group one copy of Master 4.5, Second Memo. Display a transparency of the master and ask a student to read it aloud.

master iconStep 4

transparency icon

Have students log on to the Web site and click on the link to Lesson 4—Healthcare Setting, Activity 2—Changing Behaviors.

Step 5

Give each student one copy of Master 4.2, Behavioral Sciences Evaluation Form, Page 2. Instruct groups to

  • review the modifiable risk factors for heart disease,
  • decide how Joe M. should change specific behaviors,
  • consult the information about Joe’s environment, and
  • record on page 2 of Master 4.2 specific behavioral recommendations aimed at lowering Joe’s risk for heart disease.
master iconStep 6

Reconvene the class. Ask groups to share their recommendations. Write the responses on a transparency of Master 4.6, Prescription Pad.

transparency iconStep 7
master icon= Involves copying a master.
transparency icon= Involves making a transparency.

print activity iconLesson 4 Organizer: Print Version
Activity 1: What’s the Problem?
What the Teacher Does Procedure Reference

Ask students to reflect on their preliminary training as behavioral scientists and explain to you what they have learned during the previous lessons.

Step 1

Explain to students that they will use their training to investigate behaviors of an individual who has been admitted into the hospital with heart problems.

Step 2

Divide the class into groups of three or four students.

  • Give each group one copy of Master 4.1, The First Memo.
  • Display a transparency of Master 4.1, The First Memo, and ask a volunteer to read it aloud.
master iconStep 3

transparency icon

Give each group one copy of Master 4.3, Patient Notes, and one copy of Master 4.4, Reference Manual.

master iconStep 4

Instruct students to identify factors that may have contributed to the patient’s heart disease.

  • Acquaint students with the reference manual and explain how it will help them accomplish their task.
Steps 5 and 6

Ask students to read the General Patient Information found on Master 4.3, Patient Notes.

Step 7

Give each student one copy of Master 4.2, Behavioral Sciences Evaluation Form, Page 1.

  • Instruct students to proceed with their evaluation.
master iconStep 8
Activity 2: Changing Behaviors
What the Teacher Does Procedure Reference

Reconvene the class in groups of three or four students. Ask students to suggest risk factors for heart disease that a patient cannot modify. Write their suggestions on the board.

Step 1

Ask students to suggest risk factors for heart disease that a patient can modify.

  • Write their suggestions on the board.

Step 2

Ask students if they believe that people can change their behaviors.

Step 3

Give each group one copy of Master 4.5, Second Memo. Display a transparency of the master and ask a student to read it aloud.

master iconStep 4

transparency icon

Give each student one copy of Master 4.2, Behavioral Sciences Evaluation Form, Page 2. Give each group one copy of Master 4.7, Joe’s Environment. Instruct groups to

  • review the modifiable risk factors for heart disease,
  • decide how Joe M. should change specific behaviors,
  • consult the information about Joe’s environment, and
  • record on page 2 of Master 4.2 specific behavioral recommendations aimed at lowering Joe’s risk for heart disease.
master iconStep 5

Reconvene the class. Ask groups to share their recommendations. Write the responses on a transparency of Master 4.6, Prescription Pad.

transparency iconStep 6
master icon= Involves copying a master.
transparency icon= Involves making a transparency.

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