WHO This paper has been prepared as a reference document for the development of a briefing package on skills-based health education. The term ''skills-based health education" has been used to highlight the focus on health issues here, rather than the broader umbrella term of ''life skills-based education". Comments welcomed: send to firstname.lastname@example.org Inside Cover:
Under contract with UNICEF and WHO, Cheryl Vince Whitman, Senior Vice President EDC, Director HHD, and Carmen Aldinger, Associate Project Director, of Health and Human Development Programs (HHD) at Education Development Center, Inc. (EDC), have worked with Amaya Gillespie of UNICEF and Jack Jones of WHO and others as lead authors to prepare this paper. HHD/EDC is the WHO Collaborating Center to Promote Health through Schools and Communities.
This paper drew on extensive reviews of the research literature and consultation with experts contained in a previous paper "Life Skills Approach to Child and Adolescent Healthy Development", (Mangrulkar, L, Vince Whitman, C, and Posner, M, published by PAHO, 2001), on a survey questionnaire administered to many international agencies at the global, regional and national levels, and on material developed by UNICEF and WHO. The draft for this paper was circulated widely to UNAIDS co-sponsoring organisations and other partners identified below:
David Clarke-, Department for International Development, London, UK
0.4. What are skills-based health education and life skills? 7
0.5. What is the focus of this paper? 9
1. UNDERSTANDING SKILLS-BASED HEALTH EDUCATION AND LIFE SKILLS 10
1.1. CONTENT AREAS AND TEACHING METHODS 10
1.1.1. Content 13
1.1.2. Teaching and learning methods for skills-based health education 18
2. Theories and Principles supporting Skills-Based Health Education 23
2.1. Child and Adolescent Development Theories 23
2.2. Multiple Intelligences 24
2.3. Social Learning Theory or Social Cognitive Theory 24
2.4. Problem-Behaviour Theory 25
2.5. Social Influence Theory and Social Inoculation Theory 25
2.6. Cognitive Problem Solving 26
2.7. Risk and Resiliency (or Protective) Theory 26
2.8. Theory of Reasoned Action and Health Belief Model 27
2.9. Stages of Change Theory or Transtheoretical Model 27
3. EVALUATION EVIDENCE AND LESSONS LEARNED 29
3.1. Major research evidence concerning the effectiveness of skills-based health education 29
3.2. Which factors contribute to effective programs? 31
3.2.1. Figure VII: Critical success factors in school based approaches 32
3.3. Which factors can create barriers to effective skills-based health education? 35
4. Priority Actions for Quality and Scale 37
4.1.1. Going to scale 37
4.1.2. Skills-based health education as part of comprehensive school health 39
4.1.3. Effective Placement within curriculum 41
4.1.4. Using existing materials better 45
4.1.5. Linking content to behavioural outcomes 45
4.1.6. Professional Development for Teachers and support teams 48
5. Planning and Evaluating Skills-based Health Education 52
5.1. Situation analysis 52
5.2. Participation and ownership of all stakeholders 53
5.3. Program objectives 53
5.3.1. A planning tool: the logic model 54
5.4. Advocating for your program 56 5.5. Evaluating Skills-based Health Education 58
5.5.1. Process Evaluation 59
5.5.2. Outcome Evaluation 60
5.5.3. Assessing skills-based health education and life skills in the classroom 63
Appendix 1 Documents in the WHO Information Series on School Health………………68
Appendix 2 Resources for Advocacy……………………………………….………….……..69 Appendix 3 Selected school-based health education interventions……………...………...71
Purpose: This section describes the rationale and audience for the paper, some key definitions and how skills-based health education fits into the broader context of what schools can do to improve education and health.
As we enter the 21st century, the learning potential of significant numbers of children and young people in every country in the world is compromised by conditions and behaviours that undermine the physical and emotional well-being that makes learning possible. Hunger, malnutrition, micronutrient deficiencies, parasite infections, drug and alcohol abuse, violence and injury, early and unintended pregnancy, and infection with HIV and other sexually transmitted infections threaten the health and lives of children and youth (UNESCO, 2001).
Children and adolescents around the world can benefit from acquiring the knowledge, attitudes, and skills to lead healthy lives. Such knowledge and skills can lead to behaviours that prevent disease and injury, foster healthy relationships, and enable young people to play leadership roles in creating healthy environments. From pre-school through young adulthood, the developing young person can be engaged actively in learning experiences that will enable him/her, for example, to practise basic hygiene and sanitation; practise abstinence or safe sex; listen and communicate effectively in relationships; or advocate for a tobacco free school or community.
Ensuring that children are healthy and able to learn is an essential component of an effective education system. As many studies show, education and health are inseparable. Research has shown that a child’s nutritional status affects cognitive performance and test scores; illness from parasitic infection results in absence from school, leading to school failure and dropping out (Vince Whitman et al., 2000). Besides individual factors, improvements in structures and conditions of the learning environment are equally important to address. The availability of water and sanitation at school can affect girls' attendance. Children cannot attend and concentrate if they are emotionally upset or in fear of violence. On the other hand, children who complete more years of schooling also tend to enjoy better health and other opportunities in life. Equipping young people with knowledge, attitudes and skills through education is similar to a vaccination, providing a degree of protection against health threats, both behavioural and environmental. Educating young people for health is an important component of any education and public health program, complementing and supporting policy, services, and environmental change.
Over the decades, educating people about health has been one strategy to prevent illness and injury. This strategy has drawn heavily from the fields of public health, social science, communications and education. Early experiments with education relied heavily on the delivery of information and facts. Gradually, educational approaches have turned more to skill development and to addressing all aspects of health, including physical, social, emotional and mental health. Educating children and adolescents in the early years can instil positive health behaviours and prevent risk and premature death. Prevention can cost less than treatment (World Bank, 1993). Such education can also produce informed citizens, able to seek services, and to advocate for policies and environments that affect their health. The challenge for policy makers and program planners is to understand and select those educational methods and approaches that are most cost effective. Education for health is an important and essential component, but insufficient alone. Complementing education with health-related policies, services and healthy environments is key to achieving intended outcomes.