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It is absurd to believe that our primary student do not know the difference between good health and bad health. It is also absurd to believe that they don't have proper nutritional practices, but whether we want to believe it or not, it is possible that many of our primary students do not know the basic tenets of maintaining a healthy lifestyle. Children in the Jamaican primary school system seem to be at greater risk these days of growing up with some kind of nutritional or health deficiency and it is on this basis that the Ministry of Education has introduced the Health and Family Life Education (HFLE) in schools. The intention of the program is to educate the children on how to adopt a healthy lifestyle and develop skills which will enable then to lead productive and economical lifestyles. Although it has only been introduced since 2007, there is a possibility that it has made a difference in the behaviour how our young children and how they view the criteria for maintaining a healthy lifestyle
Do our children know the difference between right and wrong? Do they know the difference between being in good health versus not having good health? What is the driving force behind them, encouraging them to maintain healthy lifestyles? What factors, external or internal, contribute to them not maintaining a healthy lifestyle? For many children the definition of what a healthy lifestyle entails is totally elusive. Many times we see children in the wrong places and we wonder why they are there. It appears there is a simple answer, but the simplicity of the answer is where the problem lies. The realities are that our children are living what they learn.
There have been concerns about the status of our family life and adolescent sexual activity from as far back as 1962, and in1993 when the problems of family life started to escalate; the Ministry of Education introduced family life education into the schools. This was however based on intervention and not education. Our children needed more than just intervention; they needed an education in life skills to know how to avert the problems.
In 1995 the World Health Organization defined life skills, as 'the abilities and positive behavior that enable individuals to deal effectively with the demands and challenges of everyday life'. Research shows that skills-based health education is effective in reducing high-risk sexual behaviors, interpersonal violence, and criminal behavior in young people. (www.edc.org). In 1997 when the Ministry of Education acknowledged the link between health and education in promoting wellness in our students, the framework for the development of Health and Family Life Education (HFLE) began.
The curriculum has been developed to focus on four related themes: Sexuality and Sexual Health, Self and Interpersonal Relationships, Eating and Fitness, and Managing the Environment. The education can be imparted as individual stand alone units, depending on the students needs or collectively imparted, which would be preferred as each unit has some impact on the other. The goal is to ensure that each child has an understanding of the life issues that they are surrounded by on a daily basis. It goes right back to the basics. - Children live what they learn.
The Ministry of Education targeted the primary level as the introductory stage, and included age-appropriate, interactive lessons, and continued the education throughout the educational hierarchy. The intent is to impact the life decision that our young children and adolescent make and in the long term ensure a more productive country. The ultimate goal would be for them to make healthy and responsible decisions.
I will be looking at whether the introduction to the HFLE has made any difference in the lives of our primary school students. Although the program has not been introduced in all the schools, the Ministry of Education has been pushing this program to be implemented in all schools by 2012. To do a comprehensive study proved a little more difficult than I anticipated as it was difficult to liaise with the Guidance counsellor within the target schools. This was due mainly to the fact that in most of these schools the Guidance Counsellors duties were broad based and they were always busy. The target schools were Caliber Primary and Junior High, Holy Rosary Preparatory and Holy Family Infant and primary, however I was unable to get interviews with the teachers and Guidance Counsellors due to their work schedule.
Review of the literature
What are the implications of poor nutrition and an unhealthy lifestyle on behavioral patterns of our primary level children? How is their education affected? What happens to them when they cannot attain the basic cognitive skills? We must be able inculcate proper health and nutritional values in our children and this should begin as early as pre-school.
The need for health and family life education in Jamaican schools has been recognised for a long time. In 1995, Chandler, Walker, Connelly and Grantham-McGregor conducted research on whether or not breakfast will improve verbal fluency in undernourished Jamaican Children. Four schools in a remote mountainous region of St Catherine was selected where 25% of the children had to be weight-for-age <-1 SD of the National Centre for Health Statistics (Hamil et al. 1977). A total of 200 students were selected - 100 undernourished and 100 nourished - and were given four tests, which included a visual speed test, a digispan test, a verbal fluency and a speed of information processing test. These tests were designed to measure capacity for attention, memory, verbal ability and processing time. Additionally a socioeconomic questionnaire was given to each child. The results of the testing methods showed that undernourished children owned fewer school books however; they performed better when they received breakfast. The financial constraints, coupled with the undernourishment made them targets for dropping out of school. Their finding that 'breakfast consumption improved the verbal fluency' was an indication of the importance of breakfast on the cognitive development of these children. Thus programs geared at school feeding needed to be developed to ensure that children were adequately fed.
In a more recent study looking at the long term effect of malnutrition, Matthew Jukes (2005) looked at the long term impact of preschool health and nutrition on education. He based his study on long term malnutrition and infectious diseases in infancy and early childhood and the impact it has on cognitive development in children. He looked at the effects of health and nutrition on the brain and the direct effect diseases can have on the structure of the brain. The infectious disease studies included malaria and giardia (a parasite which causes intestinal infections, such as diarrhea) and malnutrition in the form of protein energy malnutrition and iron-deficiency anemia. His study showed that the effect of chronic malnutrition can cause severe changes in behaviour. Undernourished children in Jamaica were found to lag behind nourished children and their cogitative development was affected due to the malnutrition. The resulting impact on the society was that more children were growing into adults with severe mental disorders. If the children were not able to improve on their nutrition, as they grew they would be susceptible to many other chronic illnesses such as HIV/AIDS. It was important to maintain a healthy lifestyle.
The combination of socioeconomic problems, malnutrition and the risk of infectious disease instigated corporate Jamaica to take a positive step in bringing awareness to a growing area of sociological concern. J. Griffiths-Irving (2008) in collaboration with ScotiaBank spearheaded a campaign to bring awareness of HIV and AIDS to Jamaican school children. The project targeted young children in an attempt to change the attitudes of students, teachers and other adults toward persons living with HIV/AIDS and promote the importance of living a healthy lifestyle. The project took the form of a debating competition- targeting 300 schools, including primary level - a community outreach program and corporate partnerships to disseminate brochures and give demonstration at public events. As the project continued to grow, new methods were introduced in the area of Festival of Arts performances. The debate strategy made subjects like social studies, language art and guidance more interactive and interesting.
It appears that the introduction of the health and family life education curriculum has come at the appropriate time. The studies done on the long term impact of unhealthy lifestyles gives us an opportunity to quickly assess our children to identify deficiencies and take corrective action where necessary, but this is only the first step. Recognising the problem becomes the minor aspect of the bigger problem, the next phase is to implement a program that is designed to educate the children on healthy lifestyles.
Family life education should be designed to strengthen and enrich individuals and family well-being. It was on this premise that Robert Hughes Jr. (1994), suggested in his paper 'A Framework for Developing Family Life Education Programs' that it was necessary to develop a program that was practical. He identified two possible approaches; a simulation approach for divorced and remarried families (Crosbie et al 1992) and an ethnographic approach to study human development issues (Quinn 1992). He found that there was limited discussion on the possible methodology and there was not enough attention being given to the guidelines needed to effectively impart the program. He identified that there were four critical steps in the process.
Figure 1: A framework for developing family life education
(teaching plans and presentation)
(theory, research, context, practice)
The content included the theoretical aspect, supported by the research, the context that influenced the topics and the current practices taking place; the instructional stage centered around the teaching plans of the educators and how the program would be presented; the implementation stage which encompass how the program will be introduced, recognising that this stage was trial and error and required constant review; and finally the evaluation stage. Hughes recommended the use of Jacobs (1988) evaluation strategies for family life educators, which breaks the process in about five phases, with each phase one step above the last. This appears to be a very practical approach and it is possible that there would be an impact on the students.
In 2009, Sacha-Marie Hill prepared a Health and Family Life Education information package for Guidance Counsellors in the Jamaican school system. She highlighted that the school environment was the best place to impart life skills and in conjunction with parental interaction, ensured that the lessons learnt were reinforced in the home environment. By breaking the program into two target groups- grades 1-6 and 7-9 - and using activities such as role play, storytelling, games, projects and group work the student learn to adopt the necessary values, attitude and behaviours that will prepare them for day to day challenges. The information package is useful to the guidance counsellors and it allows them to be more involved in the program. The student will see that there are other persons they can talk to in private about the issues they face daily which in comforting to the student as in a regular classroom setting they may not want to open up due to the public nature of the sessions.
In 2008, Martin Henry, Joan Black and Balford Lewis under the commission of the Ministry of Education, evaluated the pilot implementation of the HFLE curriculum. Twenty four schools participated in the pilot between January to June 2007, with only three school dropping out before the end of the pilot. The intention of the evaluation was to ensure the planning and smooth transition of the entire school system into the program. One of the findings was that children had different learning abilities from one another, therefore what is taught in grade 1 cannot be taught in grade 5, and this meant that the teachers had to be creative in their teaching methods to impart the program. Teachers and guidance counsellors had to specially trained to ensure their competency, that they were open-minded and non-judgemental and at all times treat each student with respect irrespective of socio-economic, political and religious affiliation (p.27). the overall evaluation of the program was positive, however a few changes, especially in the areas of content support and training need to be addressed. The program has continued and the ministry of Education is still planning on rolling out the curriculum to the entire school system by 2012.
The information needed for this paper was gathered by using questionnaires. These were distributed to students, teachers, guidance counsellors and a project officer within the HIV/AIDS unit of the Ministry of education. The questionnaire for the students was designed to find out how they felt about following rules, what they did during their spare time and how active or inactive they were. Whilst the teachers and guidance counsellors questionnaire was designed to get their feedback on the usefulness of the HFLE curriculum. Finally the interview held with the project officer within the Ministry of Education proved to be the most useful although somewhat biased.
The intent was to target children within the age range of six to ten years old from various schools, not necessarily those that already have the HFLE curriculum in place. The students came from a wide cross section of society and this demographic was achieved by visiting a youth centre that offers an aftercare service for children within the Windward Road community. It was not possible to visit all the target schools and coordinate the interviews with the students therefore the youth centre was the best option. Twenty questionnaires were handed out in all however I only received responses from thirteen students, and although this seems a small number to define this study properly, it was interesting to see the responses. The students were very enthusiastic to answer simple questions about their lifestyle, and I found their openness rather encouraging; especially those at the Youth Centre.
Unfortunately it was very difficult to get in contact with a Guidance counsellor or HFLE teacher. Their busy schedules made it impossible for them to allow me the time to ask them a few questions. I was able to get some feedback from a consultant, Miss Ingrid Reid Executive Director, YPM Youth Centre, who advised that the Guidance Counsellors and teachers imparting the program have been under intense pressure as some of the designated HFLE teachers have not yet gone on the special training program established by the Ministry of Education. The result is that the Guidance Counsellors who have been trained are finding that they are overwhelmed in trying to guide the HELF teachers and coordinated their other duties.
Another challenge I encountered was trying to contact Mr. Christopher Graham, who is the Coordinator for HIV/AIDS Education in the Ministry of Education. Fortunately I was able to liaise with his Project Officer, Mrs. Anna-Kaye Magnus-Watson, who provided me with some very interesting information regarding the program and the planned system wide implementation.
Based on the methodology used, I broke down the finding into two main groups. The first group consisted of children eight years old and under and the second group were children nine years old and over. I found it necessary to do this based on the fact that most of the eight year olds were still greatly influenced by their parent and it was abundantly clear that their parents did take an active part in their development. The data consist of information relating to recreation, physical activity and general wellness and is illustrated using charts.
There were seven children who fell into the eight and under age bracket and the following charts indicate the use of free time. Although it appears that a greater number of the children spent their free time watching TV and playing games, there also seem to be some balance as there was an equal amount who participated in weekly physical activities. The questions asked in relation to physical activity included playing a sport or taking part in school PE.
Figure 2: Hours spent watching TV
Figure 3: The use of PC at home
Figure 4: Number of days spent doing a physical activity
Looking at the other weekly activities it was good to know that a greater percentage of their time was spent at school and an even percentage on wholistic entertainment, which includes attending church. However I was surprise to know that one child was brave enough to sneak out of their home after 9pm and that same child experimented with alcohol. When I asked why they did this act, the explanation given was that they wanted to attend a 'wake' that was taking place in the neighbourhood and their parent was not going. This was a single occurance and has not happened since.
Figure 5: Other weekly activities
Figure 6: Wellness
The last set of questions dealt specifically with school grades and nutrition. Getting good grade is important to the majority, and those who indicated that it was a little important, had learning challenges and were unsure of their abilities. The last chart relating to nutrition indicated that the children knew the importance of having breakfast before going to school and a combined total of 72% of the children had breakfast before going to school.
Figure 7: How do they feel after eating breakfast
The next group analysed was the nine years and older and these results were a little shocking to say the least. Six children completed the questionaire and although the interest in activities were somtime different the results were somewhat similar with a few exceptions. The time spent watching tv and the use of the PC were similar to the eight and under age group,
Figure 8: Hours spent watching TV
Figure 9: The use of PC at home
however there was a variation in terms of the number of days dedicated to outdoor activity. It appears that as the children get older they are not interested partaking in physical endeavours which could subsequently lead to medical issues if they are not encouraged.
Figure 10: Other weekly physical Activities
In terms of the other activities that this age group would be interested in, the commalility shared with the youger group is attendance in school. All student attend school on a regular basis and they all felt that it was very important to get good grades in school. These student also had breakfast each morning, however 33% felt sleepy after eating and sometimes skipped breakfast.
Figure 11: Other weekly activities
Figure 12: Feelings after eating breakfast
The final aspect of wellness was cause for concern as this group placed a great amount of emphasis on having their own cell phone and experimenting with alcohol. It was abundantly clear that this age group need the extra guidance in developing healthy lifesytles.
Figure 13: Wellness
The objective of the HFLE program was to instill in the children the need for maintaining a healthy lifestyle, but can only be achieved if the program is tailored in such a way to make it interactive to reach the primary level students. According to Mrs. Anna-Kay Magnus-Watson, Project Officer HIV/AIDS, the HFLE is designed to be interactive to meet the needs of the students at all age levels and a mid term eveluation has just been completed and some changes have been made. The next evaluation will take place in 2012 when the program has been rolled out to all schools in the system and this will determine how effective the program has been.
Due to the limitations mentioned earlier regarding the data collection from the Guidance Counsellors, it is important to note that their role as a 'bridge' or 'go-between' is curcial to the effectivness of the program. Although there are specialised HFLE facilitators, the role the guidance counsellors should not be discounted and trivial. Research has indicated that student will prefer to go to a teacher instead of a Guidance Counsellor, however there will arise some situations that the teacher will not be able to handle and it will be up to the Guidance counsellor to giude the teacher or student on the correct path.
Using the pilot study (Henry, Black, & Lewis, 2008) conducted as base to determne whether the HFLE program has made any difference in the lives of our primary students, I was able to identfy that some of the deficiency with the program still pose a problem for the facilators today. The main problems identified is the training of the facilators and the restructuring of the core curriculum to allow for the effective delivery of the program. This would need to be addressed quickly if the intention is to implement approximately 220 schools each year with a full system wide implementation by 2012.
When asked about the feedback recieved regarding the program, Mrs Magnus-Watson indicated that the problem some of the parents were having was the actual content as it related to HIV/AIDS. This, she explained, is where the Guidance Counsellor would need to communicate with the parents on the objective of the material. Additional some of the teachers had difficulty in imparting the sexuality themes and relied on the Guidance Counsellor for assistance. It appears that a great feal of responsibility rest on the shoulders of the Guidance Counsellor and it is possible that all the parties influencing the implementaion knew this would be the case.
On the positive side, the guidance counsellors have received some assistance by way of an information package, prepared by the National Family Planning Board in 2009. The finding oncovered in this document indicate that a greater percentage of student are seeking assistance from teachers and guidance counsellor rather than their parents and therefore it is necessary to equip the teachers with the tools to effectively impart the life skills. With this in mind the information package provides usefull information for the Guidance Counsellor and therfore some of the problems encountered can be readily adressed without the program losing its momentum.
One recommendation I have is that the Ministry of Education fast tracks its training program for the HFLE facilitators as they could find themselve without adequate resources in 2012. I do find that this program is necessary at this time and it is definitely long overdue. The children in vunerable circumstances need to be able to understand the difference between right and wrong, they need adequate guidance on life skill to ensure that they stay on the right path and most importantly they need to understand that taking care of their bodies is not simgularily focusing on nutrition, but also includes their sexual behaviours.