LEARNING THEORY

Learning Strategy: Just-In-Time Learning
This tool employs the strategy of Just-In-Time learning in that it
capitalizes on the patient's moment of need. At this point, the patient
turns to the tool for confirmation or information and the design seizes this
moment of teachability to educate the patient about the broader picture
of their condition. It uses the medical record as a navigational map to
direct the patient through the large body of medical data. The patient is
initiated into a learning community by the provision of relevant solutions
offered by fellow patients. Relationships are established in the context of
common problems and solutions

Experiential Learning ( C. Rogers )
Rogers distinguished two types of learning: cognitive (meaningless) and experiential (significant). The former corresponds to academic knowledge such as learning vocabulary or multiplication tables and the latter refers to applied knowledge such as learning about engines in order to repair a car. The key to the distinction is that experiential learning addresses the needs and wants of the learner. Rogers lists these qualities of experiential learning: personal involvement, self-initiated, evaluated by learner, and pervasive effects on learner.
To Rogers, experiential learning is equivalent to personal change and growth. Rogers feels that all human beings have a natural propensity to learn; the role of the teacher is to facilitate such learning.

This includes:
(1) setting a positive climate for learning,
(2) clarifying the purposes of the learner(s),
(3) organizing and making available learning resources,
(4) balancing intellectual and emotional components of learning, and
(5) sharing feelings and thoughts with learners but not dominating.

According to Rogers, learning is facilitated when:
(1) the student participates completely in the learning process and has control over its nature and direction,
(2) it is primarily based upon direct confrontation with practical, social, personal or research problems,
and
(3) self-evaluation is the principal method of assessing progress or success. Rogers also emphasizes the importance of learning to learn and an openness to change.

Application to Project:
ExpertPatient employs the patientÕs point of crisis to drive the patient education process. It seizes the moment of learnabilty to present relevant information that is directly applicable to the "learning" problem. The patient is alert and teachable to the process of symptom articulation and specification because they have a real-life body of information to draw from. RogerÕs point of giving the student "control over its nature and direction" aligns itself with the self-efficacy goals for the learning. By knowing more about his symptoms and management prior to his visit he can communicate with his doctor with confidence and assertiveness.

Problem Based Learning
"People learn best when engrossed in the topic, motivated to seek out
new knowledge and skills because they need them in order to solve the
problem at hand"
Learner-Centered Education
Donald A Norman and James Spohrer

Application to Project
Consistent with Problem Based Learning's assertions to "focus education around a set of realistic and intrinsically motivating problems" 13 26), this tool enables the learner to participate in their own problem: their present medical condition. Instead of passively sitting and telling the physician their symptoms and letting the doctor process and understand their condition, this tool forces the patient to be a knowledgeable and useful source of information about their symptoms. It also challenges the user to explore and understand their condition with a set of keywords to as navigation. By situating medical education in the crucial process of diagnosis, online triage) we ensure the motivation of patients to learn more about their health.

Functional Context (T. Sticht)
The functional context approach to learning stresses the importance of making learning relevant to the experience of learners and their work context. Making it possible for the learner to relate it to knowledge already possessed and transform old knowledge into new knowledge facilitates the learning of new information. By using materials that the learner will use after training, transfer of learning from the classroom to the "real world" will be enhanced.
The model of the cognitive system underlying this approach emphasizes the interaction of three components: (1) knowledge base (i.e., long term memory) of what the individual knows, (2) processing skills including language, problem solving, and learning
strategies, and (3) information displays that present information. The performance of a task requires knowledge about what one is reading or writing, processing skills for comprehension and communication, and displays of information to be processed.

Application to Project:
Utilizing the context of the patient’s point of crisis to maximize learning. Placing
health information within the context of a health condition and need motivates the patient-student to learn.


Elaboration Theory
According to elaboration theory, instruction should be organized in increasing order of complexity for optimal learning. For example, when teaching a procedural task, the simplest version of the task is presented first; subsequent lessons present additional versions until the full range of tasks are taught. In each lesson, the learner should be reminded of all versions taught so far (summary/synthesis). A key idea of elaboration theory is that the learner needs to develop a meaningful context into which subsequent ideas and skills can be assimilated.

Elaboration theory proposes seven major strategy components:
(1) an elaborative sequence,
(2) learning prerequisite sequences,
(3) summary,
(4) synthesis,
(5) analogies,
(6) cognitive strategies,
(7) learner control.

Application to Project
Using the patient medical record as a navigation tool for the patient getting further elaboration about their symptoms and presumptive diagnosis.

Inquiry Based Learning
Scardamalia and Bereiter in their Higher Levels of agency for children in knowledge building, a challenge for the design of new knowledge media Article, highlighted the agency and learning that comes about by asking questions; and how the act of asking and answering questions is an integral part of formulating a mental model for knowledge. This article backs up the learning that occurs in the symptom-input activity. It argues that asking the patient to confirm their symptoms and asking them to clarify their symptoms not only solidifies the body of knowledge they just authored, but also gives them a glimpse into how physician is processing the information they are inputting. E.g. Rephrasing their symptoms into key words and asking them about certain symptoms to rule out occurrences.

Other Theories
Social Theory of Learning
Student as agent and a constructor of knowledge.
This is especially poignant in this context because the patient is the constructor of knowledge. He is the expert on his own body and symptoms. The physician can only carry out his diagnosis with the information gotten from the patient.

A database that is composed of text and graphical notes that the
students produced themselves and a means of searching and
commenting on one another's contributions.
This is inspiration to the support group feature of the site. This positions the patient as "author" of knowledge in another dimension: sharing solutions and strategies for managing their medical condition. Allowing the patient to search this peer-authored body of information is empowering as well as effective as a learning tool.

Social Theory of Learning
Student as agent and a constructor of knowledge.
This is especially poignant in this context because the patient is the constructor of knowledge. He is the expert on his own body and symptoms. The physician can only carry out his diagnosis with the information gotten from the patient.
A database that is composed of text and graphical notes that the students produced themselves and a means of searching and commenting on one another's contributions.
This is inspiration to the support group feature of the site. This positions the patient as "author" of knowledge in another dimension: sharing solutions and strategies for managing their medical condition. Allowing the patient to search this peer-authored body of information is empowering as well as effective as a learning tool.

Persuasion Theories
Health Belief Model
Health Belief Model is a "value-expectancy" model in which behavior is seen as a function of the subjective value of an outcome and of the subjective probability or expectation that a particular action will achieve its outcome (Rosenstock 1991 p.40)

Application to Project
In ExpertPatient the persuasive argument hinges on the fact that if the patient is persuaded that his detailed articulation of his symptoms will inform his physician in making a more speedy and accurate diagnosis, he will commit to the task of learning about them with the application. In the "Specify Your Symptom" section, it demonstrates that combining any one the different symptoms with the others on his symptom list produces very different diagnosis possibilities. This persuasive strategy of "Perceived Severity" attempts to drive home the fact that a patient can actively expedite the diagnosis process if he notices related symptoms in addition to the ones initially documented. The specific presentation of diagnosis possibilities such as bronchitis and asthma and the warning " If any of the symptoms apply to you, please see your doctor immediately" attempts to utilize the "perceived severity" and "perceived threat" principles of the HBM.
This strategy translates into Marwell and Schmitt’s Expertise (negative) strategy where they attempt to define a causal relationship between the action and negative outcome.

Bandura’s Self Efficacy Model
Bandura’s Self-Efficacy theory reinforces this causal relationship by its belief that "if someone does not expect to be able to take the action, they will have little reason to attempt it".

Application to Project
ExpertPatient’s persuasive goal is to put the patient in the empowerment position. It attempts to do so by educating them about the importance of accurate symptom articulation and how crucial that is in the diagnosis process. By "pregiving" them with the knowledge of specific medically relevant symptoms, and showing them how each symptom can drastically change their diagnostic outcome, it attempts to persuade them to take a more proactive role in managing their healthcare. This activates Marwell and Schmitt’s "Esteem (Positive" strategy as well. By helping the patient articulate his symptoms beforehand, and educating him about the possible diagnosis and rationale behind diagnosis, it raises the patient’s self of self-esteem and empowerment.
According to the table in Skinner and Krueter’s article p.40, the strategies used in this application are a combination of asymptomatic screening and lifestyle modification. By interacting with ExpertPatient, the patient is motivated to learn more about his condition to alleviate his discomfort but is "enticed" into further education by informational pop-boxes.
In this scenario the Elaboration Likelihood model applies perfectly, in that while the patient actively seeks the answers for his specific condition via his central route, other educational exerpts are presented in his peripheral route. While he carefully considers whether certain symptom protocols apply to his current condition, he is unconsciously educated about other protocols as well.

Attribution Theory
Attribution theory addresses the persuasive strategy used in the "Manage Your Symptoms" screen. In this interaction, the application drive home the self-efficacy Bandura talks about by addressing the Controllability attribution in the Attribution theory. Not only does the patient learn that they can effect the outcome of their diagnosis (Causation) but "Manage Your Symptoms" goal is to teach the user how to bring the symptoms under control until they see their physician.
Lastly, the whole premise of ExpertPatient utilizes the Heuristic-Systematic Model of persuasion. Hopefully, after multiple uses of this application, the patient will internalize the process and protocols of symptom analysis; so that in a scenario where they lack the cognitive resources to analyze and rationalize clearly -- this heuristic model of symptom evaluation will come to mind. This achieves the targeted changed behavior of the patient taking a more systematic and informed approach to starting the diagnosis process.