A Direct Observation Study of Health Education Classes for Uninsured Primary Care Patients

Lifestyle related health issues are a significant concern in the United States. In safety-net primary care clinics such as free clinics, health education programs have the potential to reduce the prevalence of lifestyle related health issues amongst vulnerable, low socioeconomic populations. The purpose of this study is to describe health education programs for underserved populations at a free clinic using direct observations based on the Theory of Planned Behavior (TPB). The primary data source of this study was field notes based on observations of health education classes at a free clinic. Nine health education classes were observed in October and November in 2016 (total number of participants=55). Participants were most receptive when conversations were dialogue instead of lecture based within the informal classes. Within the formal class, the lecture format proved to be effective. In both types of classes, participants felt they had adequate information on certain topics but lacked the accountability or will power necessary to make health-related behavior changes. Participants explained that the health education classes were effective in reminding them about certain aspects of health that they did not think about daily. The TPB seems to be a useful model to study health behavior change within the setting of free clinic informal waiting room classes. To promote behavioral changes, perceived behavioral control would be one of the key areas to focus on in health education classes. Future projects should develop health education programs which respond to the results of this study and evaluate the programs.