Malcolm Knowles was the first to theorize how adults learn. A pioneer in the field of adult learning, he described adult learning as a process of self-directed inquiry. Six characteristics of adult learners were identified by Knowles (1970) (see Table 1 ). He advocated creating a climate of mutual trust and clarification of mutual expectations with the learner. In other words, a cooperative learning climate is fostered.
The reasons most adults enter any learning experience is to create change. This could encompass a change in (a) their skills, (b) behavior, (c) knowledge level, or (d) even their attitudes about things (Adult Education Centre, 2005). Compared to school-age children, the major differences in adult learners are in the degree of motivation, the amount of previous experience, the level of engagement in the learning process, and how the learning is applied. Each adult brings to the learning experience preconceived thoughts and feelings that will be influenced by each of these factors. Assessing the level of these traits and the readiness to learn should be included each time a teaching experience is being planned.
Adults learn best when convinced of the need for knowing the information. Often a life experience or situation stimulates the motivation to learn (O'Brien, 2004). Meaningful learning can be intrinsically motivating. The key to using adults' "natural" motivation to learn is tapping into their most teachable moments (Zemke & Zemke, 1995). For example, a patient concerned about how stress urinary incontinence (SUI) is affecting her lifestyle might be motivated to learn about Kegel exercises more so than her counterpart who is not experiencing SUI. Lieb (1991) described six factors which serve as sources of motivation for adult learning (see Table 2 ). Health care providers involved in educating adults need to convey a desire to connect with the learner. Providing a challenge to the learner without causing frustration is additionally important. Above all, provide feedback and positive reinforcement about what has been learned (Lieb, 1991).
Adults have a greater depth, breadth, and variation in the quality of previous life experiences than younger people (O'Brien, 2004). Past educational or work experiences may color or bias the patient's perceived ideas about how education will occur. If successfully guided by the health care provider, former experiences can assist the adult to connect the current learning experience to something learned in the past. This may also facilitate in making the learning experience more meaningful. However, past experiences may actually make the task harder if these biases are not recognized as being present by the teacher. In the case of the patient with SUI, it may be helpful for the teacher to ask whether other women in her family or her life have encountered continence problems and their experiences with Kegel exercises. This would be an opportune time to address any erroneous or preconceived ideas.
Level of Engagement
In a classic study, Rogers (1969) illustrated that when an adult learner has control over the nature, timing, and direction of the learning process, the entire experience is facilitated. Adults have a need to be self-directed, deciding for themselves what they want to learn. They enter into the learning process with a goal in mind and generally take a leadership role in their learning. The challenge for teachers is to be encouraging to the learner but also reinforce the process of learning. The endpoint of learning cannot always occur quickly or on a pre-set timeline.
For the patient with SUI, the health care provider should assess her understanding of SUI, expectations for treatment, and the level of motivation to learn and practice the recommended Kegel exercises. According to Rogers (1969), the adult-learning process is facilitated when:
The learner participates completely in the learning process and has control over its nature and direction.
It is primarily based upon direct confrontation with practical, social, or personal problems.
Self-evaluation is the principal method of assessing the progress or success.
It is important to remember that in order to engage the adult learner and facilitate the transfer of knowledge, patience and time on the part of the teacher and patient are needed.
Applying the Learning
As skills and knowledge are acquired, it is paramount to include return demonstrations by the learner. The primary purpose is to verify the ability of the patient to perform the skill. Return demonstrations enable the teacher to view, and the patient to experience, the progress in their understanding and application of the education. Seeing progress and realizing a tangible movement forward in the learning process may increase the patient's motivation to learn even more. Information that goes into the learner's memory will likely be remembered if the teacher provides opportunities in the session for activities such as application exercises and discussions (Zemke & Zemke, 1995).
In the case of the patient with SUI, return demonstration of Kegel exercises via connection to a biofeedback monitor is optimal. As an alternative, the health care provider might ask about the frequency of the exercises and whether her continence has improved. Depending on the patient's response, it may be necessary and beneficial to reinforce the teaching done in the initial session.
Urol Nurs. 2006;26(5):349-352, 370. © 2006 Society of Urologic Nurses and Associates
Cite this: An Overview of Adult Learning Processes - Medscape - Oct 01, 2006.