Conflicts in ethical problems of patient education: strategies for hypertension control explore contractual approach

Experiences in the training of health education interviewers for an intervention strategy in a study which utilized health education strategies for control of hypertension afforded the opportunity for examining the relationship of research to practice and for addressing a recurring concern of health educators in practice, i.e., concern over the ethics of adopting a directing role with patients. This concern, which results in ambivalence in presentation and extreme postures of authoritativeness or passivity as educators, detracts from the potential of a health education intervention. While not evaluated comparatively with other strategies as to outcome, one method of addressing this problem, namely explication of the contractual approach in health education, was utilized informally and has implications for health education interventions. This approach utilizes the patient as a truly active partner and sharpens the use of the educational diagnosis. The outcome has potential positives for patients in personal growth and for educators in the sharpening of skills and in more effective use of their resources. These observations and the ensuing discussions come as an unplanned output of the study from which they derived. However, a variety of experiences in health education lend weight to the impression that the concerns addressed are not atypical of universal concerns among practitioners. Such conclusions suggest the timeliness of testing out the approach in an experimental fashion in an effort to document its use as technique as well as its effectiveness in ultimate outcome.