Hany Hachem200600081

Educ 264Seminar on health educationsubmitted to Dr. Faysal el Kak

1. The need for health educationa. Evolution of health education

During the nineteenth century epidemics took a drastic toll among the school population around the world. Some of the children who survived these epidemics, their capacity to learn and lead an academic life diminished drastically… the first direction towards solving the problem was a crisis oriented task rather than preventive which made the solutions ineffective, especially where some of the teachers were taught to perform some routine skills tests and report serious cases. Formal health education took the form of instruction in anatomy and physiology, where health was given as a scientific matter purely. With the evolution of health education, teachers were more concerned with the attitudinal and behavioral aspects of students’ health, and now the emphasis is on the preventive type of education opposed to crisis oriented tasks. All in all, health education provides students with the opportunity for personal growth and enhancement, which are not found elsewhere in the school curriculum.

b. Definition of healthIn the year 1900, life expectancy was 47 years old, and by 1980 it increased to 73 years old; this fact is supported by the discovery of insulin, penicillin, mass production of antibiotic, development of open heart surgery, polio vaccination and many other discoveries… nonetheless, diseases are still present in our world, as there is an ongoing struggle to fight diseases such as heart diseases, cancer, AIDS and substance abuse. Health is defined by “WHO” as being “a state of complete physical, mental and social well being and not merely the absence of disease or infirmity. So, health has three domains, ranging on a continuum from desirable to undesirable, this is what makes health as a not a state, but a continually evolving process resulting from behaviors. Therefore, the individual’s ability to make decisions and interact socially, psychologically and physically with society determines wellness. Levels of wellness are described in the following table:

Optimal well being (peak)High level wellnessWellness (average)Minor illnessMajor illness

Critical illnessDeath

c. Definition of health educationThe term of health education took new meaning over the years, until now when health education is the process of providing learning experiences which favorably influence understanding, attitudes, and conduct relating to individual and community health. So, as a person develops awareness of the many components of health education and incorporates them into his own life he would also:

i. Assumes responsibility of his healthii. Respects the benefits of medical technology

iii. Seeks information regarding health mattersiv. Tries new behaviors and modifies othersv. Be an active partner with the physician in the decision making process

vi. Is skeptical of health fads and trendsvii. Asks questions, seeks evidence and evaluates information

viii. Strives for self-reliance in personal health mattersix. Voluntarily adopts practices consistent with a healthy lifestyle.

d. A comprehensive School Health Programi. The school nurse

ii. Teacher coordination with school nurse1. observation2. record keeping3. referral4. follow-up

iii. Healthful school environmentThe teacher can play a tremendous role in conveying the appropriate message regarding healthful environment, where if teachers demonstrate interest in the environment, students are more likely to do the same, where teachers may be seen as role model outside the family frame. Other than the physical environment it is important that teacher be able to provide a healthful psychological environment which include the following:

1. Call each student by name2. Give positive reinforcement for appropriate academic and

classroom behavior3. Try to talk with each student every day4. Correct student behavior in one-to-one conference5. Ask feeling questions and knowing the answer questions as well

6. Make sure every student gets to perform as a helper in classroom maintenance activities

7. Be pleasant, smile and use direct eye contact when talking with students

iv. School health instructionIn this aspect information is presented to students in ways that foster desirable health knowledge, attitudes, and practices. Therefore, health educators should consider themselves as part of a team with the mission to provide students with optimal conditions to enhance the wellness of each student.

2. The role of teacher in health instructiona. Challenge of health education

The philosophy that should be dominating in the mind of a health education teacher, is that every teacher is a health education teacher, regardless of what discipline she/he is actually teaching. Hence, the main goal is to make an impact on your students through your behavior. Since you happen to be the teacher, you are exposed to the display, as in students will regard you in a positive way, if you are ready to be portrayed as such, that’s why it is important to keep a positive attitudes to impress and motivate your students.

b. Barriers to successful health teachingMany problems stand in the way of effective health teaching, these barriers could be summarized by the following:

i. Health behavior gap: when there is a discrepancy between personal health knowledge and general health behavior

ii. The multidisciplinary nature of health educationiii. Some of the information could be contradicting, where different

researches have different results about the same topic!iv. Controversial issues, and the fear of insulting students or their parentsv. negative image of health educators, as being “fun sucker”

c. Professional preparationIdeally a health teacher should be an expert in this area, but many reasons prevent this from happening, because already elementary teachers teach many subjects, so they fail to be as experts as are the secondary health education teachers. Health educators should be experts because they are responsible of greater and wider areas of subjects and disciplines which all are under the word “health”, plus the behaviors expected to show, are different from these expected in regular subjects. Adding to this, the difficulty of measuring the health outcomes proclaims the necessity for deep practice and training. According to the national task force on the preparation and practice of health educators, the prospective health educator should be sufficiently prepared, through a course of study to be able to:

i. Assess individual and community needs for health education

ii. Plan effective health education programsiii. Implement health education programsiv. Evaluate the effectiveness of health education programsv. Coordinate provision of health education services

vi. Act as a resource person in health educationvii. Communicate health and health education needs, concerns, and

resources.d. Personal qualities of a health educator

The following is a list of characteristics and actions that will help you as prospective teachers to become quality health educators:

i. Know yourself, be motivated and energizedii. Be open-minded

iii. Be secure; develop your own health self-concept so that you will be willing to change and grow and ask for help when needed

iv. Always look for new ideas and model programsv. Work with goals and objectives, be aware of your direction

vi. Keep curriculum updatedvii. Be aware of your own lifestyle, that could be open to public

viii. See students as the central focus of your energy, effort and enthusiasmix. Live the curriculum; see lessons everyday in every newscast, newspaper,

relationship and decision.e. Teacher as part of a health team

Health Teachers should be responsible for his actions, in front of the school, the parents and the students themselves, that’s why teachers should take every step and every actions responsibly.Health Teachers should work with students in counseling, which should be straightforward and free of moral judgment, preaching and scare tactics.Health Teachers should notify the parents when an illness or serious problem occurs; school policy should be followed to contact them, and it is advisable that in every Parent-Teacher conference, a health educator should be present.Health Teachers should keep other teachers informed of health matters related to community and students, this will allow other teachers to understand better their students and their physical needs. One of the primary duties of health educators is to plan, and recommend a curriculum of health education, and to present it to the administration.Health educators should be in direct contact with the students; this means that a health educator is able to depict any changes in the health of the students, hence helping the school nurse in the diagnosis process, should a problem occur.A health educator is also responsible to educate the community in which he/she lives, and this could be done through contacts with NGOs, which could develop community-wide projects to promote the state of health in that community.

3. Planning for health instructiona. Content area

Teachers, like in any other different subject, they should know what to teach, how to teach and when to teach so students internalize or personalize the content. Therefore, each topic, or content area should be tailored specifically to specific needs, differing with age. The main agreed-on topics in health education are:

i. Mental educationii. Body systems and the senses

iii. Nutritioniv. Family lifev. Alcohol, drugs and tobacco

vi. Safety and first aidvii. Personal health (sexual health)

viii. Consumer healthix. Diseases: communicable vs. chronicx. Environmental health

Under each topic, there are many subtopics, which could range from deep to shallow depending as it was said above on the needs of students and on age.

b. Developing scope and sequenceContent areas are not only to be identified, but also to be organized and ordered, these two actions relate to the scope and sequence of the health education curriculum. Scope by definition is the depth or the difficulty of the material, in other terms it is the “what to teach”. On the other hand, sequence by definition is the order in which the material is to be covered in other terms “the when to teach”. Each planned health instruction should be designed in a way that it forms the basis for the following learning experiences. Hence topics should be built one on another, concepts in a certain lesson should relate to each other, and lessons within a certain unit should be cohesive, and units within a course should relate to each other also. This will lead to a better perception, where children will regard health education as a continuum, and not as fragments or independent pieces.

c. Determining what to teach Scope and sequence could be regarded as the main aids that help teachers determine what to teach, but there are also other important factors such as:

i. Social considerations: the curriculum which is taught in schools should be accepted by the nearby community. Good judgment on what to teach is a crucial part in the decision, teachers assume the responsibility of anything taught in the classroom settings, without the approval of both the administrator and the public community, or else conflict will arise.

ii. Student interest: children are more interested in certain health topics than in others, depending on their age. For example young children prefer topics that are related to their body parts functions, because they are self centered, therefore they care less about social problems, which form the basic interest of the older adolescents. How to determine the interests of students? Many ways could be in the form of questionnaires, checklists and direct questioning which remains the most effective in determining students’ interests.

iii. Health needs: all children regardless of what community they come from have basic needs that could be summed up by love, affection, and nurturing, sound nutrition and intellectual stimulation, proper dental care and safety. But also some other needs depend on the cultural background, so any planned curriculum should take into account the diverse cultural and communal difference among the children.

iv. Textbooks and Courses of study: national books usually do not take into account the specifics of different cultural communities present everywhere in the country, so the role of the health educator is to supplement the book with visual aids, such as movies, film strips etc… Being relevant to the specific needs of the students. Any use of material to supplement the book should take into account appropriateness, unbiased and up-to-date states.

d. Teaching for valuesMembers of a certain society share almost the same values, but differences rise from families and individuals where values become specific, nonetheless, they should be considered when planning health instruction. Failure to do so will result in both, failure of the learning experience and opposition from parents and community organizations. Values are learned through many experiences facilitated by the family, peer groups, schools, religious establishments and media. Therefore, it is important to know that value formation is a continual process. The role of a health educator is not to impose his/her values, rather to help students develop their own values through making wise decisions about health related matters. How? Students are going to develop their own values either way, but teachers help them make positive decisions, that will lead to high-level wellness by providing factual knowledge about health and by allowing children to clarify their own feelings. Then students will be able to weigh the importance or the value of a certain decision against perceived rewards and costs involved.

e. Developing a health curriculumA health education curriculum is a comprehensive K-12 plan designed to encompass pertinent health concerns and provide learning experiences through the school years. Such plan should help promote responsible decisions and practices regarding personal, family and community health. Designing a

comprehensive program requires a great deal of expertise, time and effort, plus input from community leaders, parents, teachers, students and administrators. Therefore, it is important to respect the following steps:

i. Development and writing of the first draft by grade-level experts, who coordinate the lessons and units through scope and sequence

ii. Evaluation and rewriting of the first draftiii. Field testing of the second draft in representative schoolsiv. Evaluation and rewriting of the second draftv. Printing and distribution of the final draft for classroom use

vi. Workshops and in-service training sessions to make the most effective use of the developed curriculum

vii. Ongoing evaluation.A resource unit is a plan that can be used by teachers for presenting topics in an effective scope and sequence; it is an aid, rather than a teaching unit. Usually it contains general objectives, content suggestions, suggestions for learning objectives, evaluation procedures and appropriate references for the teacher and the students.A teaching unit is an organized method for developing lesson plans for a particular group of students and thus can be tailored for each classroom. A resource unit serves as a guide, but a teaching unit is the plan for students learning:

i. Title of unit: it should describe what the unit is about, it’s a motivational tool that suggests what direction the teaching will take… ex: Good food, for good growth.

ii. Grade level: it indicates the grade level for which the unit is intended.iii. Conceptual statement: it defines the major concepts emphasized in

the unit, and it serves as a general information organizer and/or abstract. Every conceptual statement should have a main theme, a consequent behavior and a future ramification…ex: it is essential to conserve (theme) our existing natural resources (consequent behavior) if we are to maintain a high-quality lifestyle (ramification).

iv. Objectives: they should describe what the students will be able to do after completing the unit.

v. Content: it should contain a summary of the facts needed to teach the unit, it is like an outline of the whole instruction process

vi. Learning activities: they are activities that help students internalize the content and hence form solid concepts. No unit can be effective if the learning activities are poorly planned…

vii. Evaluation: it comes out of two reasons, to determine if the student has developed the skill or assimilated the concepts of the unit, and the second is to enable the teacher to assess their own teaching effectiveness. It is also important to evaluate almost all the objectives.

viii. References: usually books, pamphlets, magazines or chapters from texts.

f. Teaching controversial topicsControversial topics are sensitive issues that could lead to major conflicts if not dealt with, with great concern. Schiller proposed 11 steps that are to be followed when dealing with controversial areas in a certain topic, they are the following:

i. Administration and parent leader should both agree on the subjectsii. Questions and concerns of parents should be replied to by

professionals, in case of oppositioniii. An advisory committee should be formed to help the team of

professionals in defending the program, its concepts and approachesiv. The advisory committee should hold meetings where parents can

express their opposition or concernsv. After the meeting, a questionnaire is distributed to parents where they

write their opinionsvi. Technical experts should help in addressing concerns by necessary

changesvii. Educator training should be done through in-service programs,

workshops, college coursesviii. Educators are to be evaluated depending on their values and their

ability to relate to students and parentsix. Pilot testing and evaluation of programx. In case the program is successful, it should be broadened

xi. Education of the parents and other significant groups of the community is to be considered.Once the support of the community is there, the following steps are taken:

i. Needs assessment: which is assessment of the students needs and interests while taking into consideration society’s needs and priority

ii. Statement of problems: which is translating the results of the needs assessment into statements that should be tackled in the curriculum

iii. Curriculum designiv. Goal formulationv. Objectives formulation

vi. Selection of subject mattervii. Strategy selection

viii. Selection of resourcesix. Evaluation component.

Teacher sensitivity: teachers should be sensitive to their qualifications and must prepare themselves before attempting to teach a controversial

topic, and should teach only accurate and factual information. Teachers should not express shyness, and they should stay impartial in dealing with points of view, while never giving more attention to one on the account of another one.

g. Developing objectivesThere is a difference between the term, goals, instructional objective and behavioral objectives. Goals are long-range and may take years to accomplish. Behavioral objectives are for more than one lesson, and written for long term, they provide a framework for selecting the appropriate content, learning activities and evaluation procedures. Instructional objectives indicate the learning or the behavior that should be demonstrated in a particular lesson, by the students; they are specific and short ranged.Classification of objectives:

i. Cognitive domain: deal with objectives of recalling or recognition of knowledge and the development of intellectual abilities and skills.

1. Low level:a. Knowledge: recognize, recall

information: indicative verbs: Define, recall, describe, identify, list, match, name and recite.

b. Comprehension: interpret what has been learned: indicative verbs: Explain, summarize, interpret, rewrite, estimate, convert, infer, translate, rearrange and paraphrase.

2. High level:a. Application: use of knowledge in new

situations: indicative verbs: change, compute, demonstrate, operate, show, use and solve.

b. Analysis: deduction, understanding relationships: indicative verbs: outline, break down, subdivide, discriminate, diagram, order, categorize, and distinguish.

c. Synthesis: combining elements into new wholes, induction, and integration: indicative verbs: combine, compile, compose, create, design, rearrange, plan and produce.

d. Evaluation: judging materials and methods, qualitative and quantitative: indicative verbs: justify, appraise, criticize, compare, support, conclude and contrast.

ii. Affective domain: it emphasizes the emotional processes of feelings, attitudes, values and judgments.

1. Low level: a. Receiving: passive attention to stimulib. Responding: reacting to stimuli

2. High level: a. Valuing: taking action which is

consistent with a belief or valueb. Organizing: commitment to a set of

values (formulate values)c. Characterizing: total behavior abides by

the internalized values and the integration of beliefs and attitudes into a philosophy of life.

iii. Action domain: it deals with what the students do, and what they should be able to exhibit shortly or on a long term period. There are three kinds of action behaviors; they are observable health behaviors, non-observable health behaviors and delayed behaviors.

1. Observable health behaviors: they are those that can be seen and evaluated to some extent in the school environment…ex: students’ relationships with others.

2. Non-observable health behaviors: these behaviors cannot be observed in the school settings, rather questionnaires are to be developed regarding the intended behaviors.

3. Delayed behaviors: they are behaviors that cannot be done, or reached until adulthood.

How to write instructional objectives?An instructional objective should have five components, which are the following:

1.Who: who is going

to exhibit the action: students, pupils, learners

2.Expected behavior: what students will do to show that learning has taken place

3.Learning requirement: what the students will feel, know, do when the lesson unit is complete

4.Conditions: the

condition under which the students will be expected to do the activity

5.Standard of performance: the minimum level of achievement, qualitative or quantitative expected to be scored by the students.

Ex: The students (Who) will demonstrate (expected behavior) correct CPR technique (learning requirement) utilizing resuscitation (condition) for 2 minutes with 100% accuracy (standard of performance).

4. Strategies for implementing health instruction

a. Relationship of strategies to learningA strategy is by definition any activity or experience that the teacher uses to interpret, illustrates, or facilitates learning. To have the most effective strategies, the teacher should seek strategies that are student-centered and provide group involvement. Hence, the teacher should treat the students equally and fairly to facilitate learning and creating a proper classroom atmosphere. Other useful strategies are present in the following table:

Audio Audiovisual VisualTape recording Plays

Puppet GamesBulletin boardsMagazinesMotion picturesComputers

GamesRecords Bulletin boardsDebates TransparenciesRadio NewspapersBuzz group Charts/mapsStories, story telling

Field trips

Brainstorming FlannelValues clarification Magnetic boardsDiscussionsTelevisionFilm stripsSlide tapesTalking tapes

Teachers should try to address the following:i. Select strategies that contribute to total learning, these strategies

should help the students develop the ability to reason and assess information being presented to them.

ii. The more complex the concept is, the more strategies are needed, so at least two strategies or two activities are needed when the material is difficult.

iii. The selected strategies should flow from the most simple to the most complicated and students should all be involved in group work.

iv. Audiovisual aids should be used whenever possible, because they reinforce learning.

b. Values clarification strategies: Normally students relate to the topic through its affective domain, so to engage students, teachers should use value clarification activities; this will lead to student fostering a better positive health behavior. This concept is not too far from controversies, so teachers should recognize that values are relative, personal, and often situational. So, the goal of teachers should be assisting students to assess and develop their own values. In order to make health behavior evolve, therefore teachers should take into account the following:

i. Student must perceive the issue as being important

ii. Students must believe that they are susceptible to the problemiii. Student should believe that the problem is seriousiv. The intensity of the topic should not be paralytic to the learning processv. The action which should be taken by the students, must be thought of

as effectivec. Other verbal and discussion-oriented strategies

Some strategies to be used: Decision stories, brainstorming, buzz groups, case studies, debate, committee work, lecture, group, panel discussion, and resource speakers.

d. Action orientated strategiesSome action oriented strategies could be: dramatization, storytelling, crossword

puzzles, demonstrations, experiments, exhibits, field trips and games.e. Use of media, and selecting appropriate one

i. Computer assisted instruction: it is the trend of nowadays, and could be in the following forms:

1. Drill and practice2. Tutorial3. Demonstration4. Simulations5. Instructional games6. Problem solving

ii. Television and videotapeiii. Filmsiv. Slidesv. Transparencies

vi. Records and tape recording.How to select appropriate type? These strategies will ensure that teachers will select the most suitable type of media:

1. Choose instructional media that fit specific objectives of the instruction

2. Prepare yourself in advance3. Prepare the class in advance4. Prepare the physical facilities in advance5. Ensure students participation either before, during or after the

presentation6. Follow up the use of instructional media with related activities

and an evaluation of the materials by the class7. Evaluate the materials that you have used.

5. Measurement and evaluation of health educationa. Measurement and evaluation

Definition of measurement: it is the construction, administration and scoring of tests, usually resulting in quantitative numerical data.

Definition of evaluation: it is the process of interpreting, analyzing, and assessing the data obtained from measurement. The purpose of evaluation is to determine the current status of the students. All in all, the goals behind measurement and evaluation are:

i. To assess the effectiveness of the learning activitiesii. To motivate the students

iii. To help develop the scope and sequence of teaching.b. Teacher skills needed for measurement and evaluation

To be competent at measuring and evaluating, teachers must know the following essentials:

i. the educational use and limitations of testsii. the criteria by which the quality of a test should be judged and how to

secure evidence related to these criteriaiii. how to plan and write a testiv. how to select a standardized test that will be effective in a particular

situationv. how to administer a test properly, efficiently and fairly

vi. how to interpret test scores correctlyvii. knowledge of typical behaviors of students

viii. knowledge of atypical behaviors of studentsix. knowledge of methodologies used in teaching healthx. Organize observations in order to recognize how instruction is affecting

studentsxi. Ability to interpret observations of student behaviors.

Tests to measure the three different domains in health education, which are affective, cognitive and behavior, are divided into standardized and teacher made tests.

c. Standardized testsThese tests are already prepared so, they are easy to grab and administer to students, but more importantly they are developed and refined carefully before publication. Teachers should make sure that the test is measuring what is intended to measure, this is called test validity. As for the reliability, similar results should be obtained when the test is given to different groups of the target population. The higher the reliability, the more likely the test will provide accurate measurements of student learning. This kind of test is usually used to pretest and posttest; to remark any changes in students’ attitudes.

d. Teacher-made testsTeacher made tests could be tailored specifically according to the teacher intention, but the main drawback is that they may lack validity and reliability, that’s why experience is crucial to be able as a teacher to prepare tests. Teachers should take into account many factors while preparing their tests; these factors could be the following:

i. Validityii. Reliability: which would be greater in:

1. A long test than in a short one2. A test with homogenous content rather than heterogeneous

content3. A set of scores from a group of examinees with a wide ability

range rather than from a group which has members much alike4. A test composed of well-written and appropriate items5. Measures with few scoring errors than for measures which vary

from test to test or paper to paper because of scoring problems6. Test scores obtained by proper conditions for testing and

students with optimum motivation.iii. Objectivity: tests should be fair to all studentsiv. Discrimination: tests should not differentiate between good and poor

studentsv. Comprehensiveness: tests should not be too short nor too long, in order

to cover well the materials in questionvi. Administration and scoring: tests should be easy to administer, use and

score.Developing tests: this task is not easy to accomplish, but it could be facilitated using the following steps:

i. Prepare the table of specifications based on the unit objectives: this table of specifications is about putting clearly the objectives, then the content and the percentage that they should take in the test.

ii. Draft the test itemsiii. Decide on the lengthiv. Select and edit the final itemsv. Rate the items in terms of difficulty

vi. Arrange items according to difficulty, easiest to most difficultvii. Prepare instructions for the test

viii. Prepare the answer key and decide the rule for scoringix. Produce the test.

Some types of tests that could be useful in health education are: true/false tests, MC tests, matching tests, fill in the blank tests, essay-question tests. Usually these kinds of tests are used to assess cognitive domain.

e. Measuring health attitudesIn health education it is more important to measure attitudes than in any other subject area. Some attitude scales are:

i. Forced-choice scale: is a scale that provides only two options about each statement. The major disadvantage is that students can easily know what the correct answer should be, even if the answer does not

reflect the conviction of the students. This could be overcome by establishing a trust atmosphere in the classroom.

ii. Likert-scale: is more sophisticated scale than the one before, because it gives more than two possible answers. For small children it gives only three, but for older students it gives up to five answers.

iii. Observation and anecdotal record keeping: this would help both scales in bringing out best results in attitudinal assessment, because observation is done on a daily basis, whenever there is interaction between the teacher and his/her students.

Reference: Teaching today’s health, third edition, David j. Anspaugh, Gene Ezell.