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International Research on School-Based Health Education

International Research on School-Based Health Education. Carmen Aldinger Health Promoting Schools Conference 14-16 September 2006, Cape Town, South Africa. My Background.

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International Research on School-Based Health Education

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  1. International Research on School-Based Health Education Carmen Aldinger Health Promoting Schools Conference 14-16 September 2006, Cape Town, South Africa

  2. My Background • Project Director at Education Development Center (EDC), an international NGO with about 1000 employees, and more than 325 projects in 50 countries • The mission of EDC’s division of Health and Human Development Programs is to create innovations that promote healthy human development worldwide • We are a WHO Collaborating Center to Promote Health through Schools and Communities • Ph.D. student at Lesley University

  3. Outline • The link between health and education • Research on school-based health education • Success factors • Limitations/Challenges • Systems for identifying effective health education interventions • Skills-based teacher training program to prevent HIV infection and related discrimination in African countries

  4. The Link between Health and Education Research over many years has shown: • Improvements in health are linked to improvements in learning • Improvements in general education are associated with improvements in health • School-based health education is associated with improvements in health

  5. Research on School-Based Health Education • Some studies have shown that school-based health education programs can have long-term effects • School-based programs that address specific health issues have shown changes in knowledge, attitudes, intentions, behaviors and/or biomedical risk factors, though sometimes not in all of these aspects or only in the short term

  6. Example: Bayne-Smith et al. (2004) • Target population: 442 multi-ethnic urban teenage girls in the United States • Intervention: School-based intervention on cardiovascular disease: 12-week program of vigorous exercises integrated with heart health-related lectures and discussions on diet, exercise, stress, and smoking • Evaluation: Controlled design: Experimental and control group, pre- and post-test • Results: Significant differences in body fat, blood pressure, heart health knowledge, and eating breakfast

  7. Research on School-Based Health Education • Some school-based programs have not shown long-term effects on health outcomes • Some school-based programs have shown positive changes in knowledge or attitudes, but not in behavior or health status

  8. Example: Villalbi (2000) • Target population: 1,215 students in 10th and 11th grade in Spain • Intervention: Standardized educational intervention of 7 hours, focused on changing a number of determinants of AIDS risks and preventive factors • Evaluation: Quasi-experimental, pre-and post-test 100 days apart • Results: Significant changes in knowledge scores, attitudes toward condom use, and behavioral intentions, and actual condom use (in those who were not sexually active at baseline) – short follow-up

  9. Health Education Interventions: Success Factors • Gaining commitment • Advocacy • Engage stakeholders • Theoreticalunderpinnings • E.g., social cognitive theory, health belief model • Relevant content • Relevance to health-related risk and protective factors • Participatoryteaching methods • Skill-building activities http://www.who.int/school_youth_health/media/en/sch_skills4health_03.pdf

  10. Health Education Interventions: Success Factors • Timingand Sequence • Prior to the onset of risk behaviors • Multiple coordinated strategies • Consistent with other strategies • Teacher training and professional development • Crucial importance of teacher and peer leader training • Relevance • Relevant to developmental level and address relevant risk factors • Participation • Active involvement of various stakeholders

  11. Health Education Interventions: Limitations/Challenges • Fidelityof implementation • Avoid improper or incomplete implementation • Length and qualityof the intervention • Aim for longer term and comprehensive interventions • Validityof the questionnaire • Use validated or standardized questionnaires • Limitations of self-reported behavior • Confirm self-reported behavior • Attritionof students most at risk • Make sure those most at risk are included

  12. Systems for identifying effective health education interventions • National Registry of Evidence-Based Programs and Practices (NREPP) – United States • Cochrane Review – Global • Leeds Health Education Effectiveness Database – Developing Countries

  13. Systems for identifying effective health education interventions National Registry of Evidence-Based Programs and Practices (NREPP) of the U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration (SAMHSA)

  14. National Registry of Evidence-Based Programs and Practices (NREPP) • http://modelprograms.samhsa.gov/ • Content Focus Academic Achievement, Alcohol Use/Abuse, Antisocial/Aggressive Behavior, HIV/AIDS, Illegal Drugs, Psychological Trauma, Social and Emotional Competency, Tobacco, Violence, others (not specifically addressing substances)

  15. National Registry of Evidence-Based Programs and Practices (NREPP) - Example • Program: Lions-Quest Skills for Adolescence • Description: A comprehensive positive youth development and prevention program designed for schoolwide and classroom implementation. • Target Population/Setting: 10 to 14 years olds, in rural, suburban, and urban middle schools • Key Outcomes: Deter initiation of regular cigarette smoking, experimental marijuana use, monthly use of alcohol and binge drinking; delay progression of regular cigarette smoking and marijuana use among students who had initiated alcohol use • Key Program Strategies: Classroom curriculum, Parent and family involvement, positive school climate, community involvement • Cost Estimates: contract workshop (2 days) $4,500-4,500 for 12 participants; regional workshop $425-500 per person; Materials $5.95 per student

  16. Systems for identifying effective health education interventions • Cochrane Review The Cochrane Collaboration is an international non-profit and independent organization, dedicated to making up-to-date, accurate information about the effects of healthcare readily available worldwide.

  17. Cochrane Reviews • http://www.cochrane.org • Content includes: Many clinical interventions, but also some prevention and behavioral interventions for: Drugs and Alcohol Abuse HIV/AIDS Injuries Tobacco Addiction

  18. Cochrane Reviews - Example • School-based programs for preventing smoking (Thomas, 2005) • Objectives: To review all randomized controlled trials (RCTs) of behavioral interventions in schools to prevent children (5-12 yrs) and adolescents (13-18 yrs) starting smoking • Search Strategy: 13 databases, bibliographies, MEDLINE searches of 133 authors • Selection Criteria: By types of studies, types of participants, types of interventions, types of outcome measures • Data collection and analysis: Assessed quality of design and execution, narrative systematic review, no meta-analysis • Main results: Of 76 RCTs, 16 were “most valid.” 15 of them were social influences interventions. Of these, 8 showed some positive effect on smoking prevalence, 7 failed to do so • Author’s conclusions: There is little evidence that information alone is effective. There are well-conducted RCTs of social influences interventions: half of them showed less smoking in intervention group. There is a lack of high-quality evidence of combinations of interventions and multi-modal programs that include communities.

  19. Systems for identifying effective health education interventions • Leeds Health Education Effectiveness Database: Evaluations of health education programs in developing countries By Dr. John Hubley, independent consultant, principal lecturer at Leeds Metropolitan University, UK

  20. Leeds Health Education Effectiveness Database • http://www.hubley.co.uk/listing.htm • http://www.hubley.co.uk/1schools.htm • Content includes: • AIDS and STDs; Family Planning; Breastfeeding Promotion; Immunization; Oral rehydration; Nutrition; Infectious diseases; Water, sanitation and hygiene education; Oral Health; Eye Health; Chronic diseases, substance abuse and mental health; Miscellaneous health topics, safety education

  21. Leeds Health Education Effectiveness Database - Example Evaluation of a comprehensive school-based AIDS education program in rural Uganda (Kinsman et al., 2001) • Target group: Schoolchildren in primary and secondary school in southwest Uganda • Intervention methodology: Curriculum adapted from WHO/UNESCO School Health Education Resource Package; training workshop for teachers; 12-month intervention, based on a model closely related to Theory of Reasoned Action • Evaluation method: More than 2,000 students from 20 intervention schools and 11 control schools completed baseline and follow-up questionnaires; 93 students in 12 focus group discussions • Impact achieved: Data from questionnaires suggest overall program effect was minimal and not statistically significant. Data from focus groups suggest that the program was incompletely implemented and key activities such as condoms and role play exercises were covered only superficially.

  22. Teacher training program to prevent HIV infection and related Discrimination For information: http://www.who.int/school_youth_health/hivaids_project/en/index.html http://www.hhd.org/globalwork/examplesofwork.asp http://www.ei-ie.org/efaids/en/programme.htm

  23. Teacher training program to prevent HIV infection and related Discrimination • Partners: Education International (EI), World Health Organization (WHO), Education Development Center (EDC) • Since 2000 in 15 African countries, now being expanded • Participatory learning activities aiming to: • Help teachers gain knowledge and skills to avoid HIV infection • Help teachers and young people advocate for effective HIV prevention efforts in schools • Help young people acquire knowledge and skills to prevent HIV infection

  24. Teacher training program to prevent HIV infection and related Discrimination • Independent evaluation in Rwanda, Senegal, and South Africa showed: • Teachers’ HIV related knowledge improved • Teachers’ confidence to perform and teach HIV preventive skills increased • Teachers’ intentions to implement training program activities increased • Focus groups revealed: • Improved awareness and confidence • More skills to survive and teach • More comfortable addressing sensitive issues • Teachers confronting HIV related discrimination • Teachers recognize the impact of the program

  25. Contact Information Carmen Aldinger Education Development Center, Inc. Health and Human Development Programs 55 Chapel Street Newton, MA 02458 USA Tel. +1-617-618-2362 Fax +1-617-527-4096 Email caldinger@edc.org Website www.hhd.org

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