What is the Life Skills Approach? - Talking Points for Handouts

What is skills-based health education for HIV/AIDS prevention?

• Well trained and well supported teachers are able to contribute to 'good education' by applying effective teaching methods. Both of the above terms are distinguished from traditional information-based approaches because they focus on skills, and attitudes, as well as information.
  
  
• The 'skills' referred to in this context are 'psycho-social and interpersonal skills' often referred to as 'life skills', such as communication skills and negotiation skills, decision making skills, critical and creative thinking skills, skills for coping with emotions and stress and conflict, and self awareness building skills.
  
  
• Life skills-based education can be applied to a wide range of content areas or issues, of which health education is one example, and within that, HIV/AIDS education might be considered a subset.
  
  
• Skills-based health education can be utilised as well in school-based programs as non-school programs, however a particular focus here is on school-based initiatives.

• Skills-based health education is distinct from other education strategies in that changes in behaviour form at least part of the program objectives. This implies some form of change in not only knowledge, but also attitudes, and skills which contribute to and facilitate the desired behaviour change.
  
  
• Skills-based health education is but one of the many strategies required for behaviour change or behaviour development to be effective. Skills-based health education will work best in the context of other strategies such as policy development, access to appropriate health services, community development, media, and so on.
  
  
• Traditional 'information-based' approaches which tend to still dominate, although helpful, are generally not sufficient to yield change in attitudes and behaviours. More effective teaching and learning outcomes are likely to result from content and accompanying teaching processes which address a balance of skills, as well as information and attitudes that is relevant to the participants and issues.
  
  
• The emphasis in this document is on life skills within the context of 'skills-based health education' and young people. Although the approach is clearly applicable to many other content areas, populations, and settings, the term 'health education' will be used here, and the example of HIV/AIDS will be used to illustrate key points.

• The purpose is not always seen as purely 'health', and so the term 'skills-based education' may be preferred; however when applied, the term - 'health' - should be used in its broadest sense to reflect a social view of health, and so include more than physical aspects, but also mental, social and spiritual aspects.
  
  
• The purpose is two-fold, in that there is both an augmenting (positive) and a reducing (negative) side to the purpose:
  
  
• Skills-based health education is basically a 'behaviour change' or behaviour development' approach designed to address a balance of 3 areas: knowledge, attitudes, and skills. Outcomes related to all three areas can be pursued using this approach. Indeed much of the literature suggests that shifts in risk behaviour, are unlikely if knowledge, attitudinal and skills based competency are not addressed.

1. Content
2. Methods

• Skills-based health education involves a group of psycho-social and inter-personal skills.
  
  
• There is no definitive list.
  
  
• A huge number of component skills might be listed under each of the general categories of Life Skills provided.
  
  
• These three categories are an attempt to provide a logical categorisation, however the skills are not separate, but are all inextricably linked. In practice, many of these skills would be used simultaneously; eg. decision making is likely to involve creative and critical thinking components (what are my options?), values analysis (what is important to me?)
  
  
• The more detailed table of skills gives further insight into the types of (life) skills generally agreed as important in risk reduction programs - inter-personal communication skills, decision making skills, critical and creative thinking skills, skills for coping with emotions and stress, and self awareness building skills. Equally, other programs, publications or issues may utilise different categories of skills, however the basics tend to remain conceptually similar.

• To effectively influence behaviour, skills must be utilised in a particular content area, topic or subject. 'What are we making decisions about?' Learning about decision making will be more meaningful if the content or topic is relevant and remains constant or linked, such as looking at different aspects or types of decisions related to relationships, rather than considering decisions about a number of unrelated or unimportant issues. Genuine participation of the group is essential for identifying the relevance of content.
  
  
• Life Skills categories and their related teaching and learning activities can be utilised across many content areas, meaning issues, topics or subjects. For example, health issues such as drug use, HIV/AIDS/STD prevention, suicide prevention and mental health, self esteem; Other issues, such as consumer education, environmental education, peace education, or education for development; livelihood skills such as various income generating activities, vocational programs, and career guidance.
  
  
• Note that the context of this discussion does not include specific skills such as interviewing skills, agriculture skills, or animal husbandry skills, which might be called 'livelihood' skills, however the interpersonal and psychosocial skills described here as life skills might be applied to livelihoods and income generation as content areas.
  
  
• Whatever the content area, a balance of three elements needs to be considered in implementing skills based health education:
  
  
  1. Knowledge¹
  2. Attitudes², and
  3. Skills³
  
  
• The question for program designers is 'what' knowledge, attitudes and skills will be addressed?
  
  
• The balance of these three elements will be decided by gathering information from many sources, such as related literature and research, professional expertise, and the actual group, or similar group, of participants. A very general example of a possible content overview for HIV/AIDS/STD prevention is provided in the table, which can be used to frame the learning objectives and outcomes expected from the program.

• Well trained and well supported teachers use a range of methods and resources to achieve quality learning outcomes. There is a place for information focused sessions and teacher- focused or teacher-led sessions, within a varied methodology, however these methods are generally quite widespread. The greater need appears to be for the implementation of more interactive and child-centred methods. A list of some of these is provided.
  
  
• Skills-based health education is not synonymous with interactive teaching and learning methods, although it relies on the use of these methods. Skills-based health education cannot occur where there is no interaction among the participants - student to student and student to teacher.
  
  
• While changes are often measured at the individual level, it is important to acknowledge that the approach relies on groups of people to be effective. The interaction of groups of people guided through the educational processes of skills-based health education facilitates and generates the learning at individual and group level. For example, it is difficult to imagine analysing values and attitudes if only one individual's ideas are present; or, a broader field of information and a longer list of options is likely to be generated by a group of people rather than an individual in the process of decision making. Interpersonal and psycho-social skills cannot be learned from sitting alone and reading a book.
  
  
• Skills-based health education requires that all three components in place, (i) the actual (Life) Skills identified, (ii) the content area or focus for the program, and (iii) the interactive teaching and learning methods.
  
  
• A simple model for thinking about indicators for the skills-based health education is provided.

• while teachers are an obvious entry point, for many reason, a number of other possible facilitators need to be considered.

• while schools are one useful entry point, for many reasons, including maximising the reach of programs to those who need them most, other settings also need to be considered.

• This Table illustrates that skills-based health education will be most effective in achieving relatively specific knowledge, attitudes and skills outcomes. However to achieve higher level goals, and sustainable behaviour change related to those goals, a relatively narrow strategy such as skills-based health education needs to be augmented with multiple strategies.
  
  
• Behaviour change is a medium to long term goal, and skills-based health education will work best to achieve and maintain behaviour change where reinforcing strategies are in place. Given the high number of influences on young people it is unreasonable to believe that a single positive strategy might 'drown out' the many competing influences.
  
  
• Skills-based health education should be considered but one of the many strategies necessary to promote pro-social and healthy behaviour, and reduce risky behaviour. Every effort should be made to combine this strategy with other complementary strategies such as policy development, health services, and community development.

• Both process and outcome indicators are necessary for evaluation
  
  
• Process indicators focus on questions like:
  • "Did the program reach the intended audience?"
  • "Was the program acceptable to the audience?"
  • "Was the program implemented in the intended way?"
  
  
• Outcome indicators focus on questions like:
  • "How did the audience or issue change as a result of the program?"

• In addition to process indicators about acceptability of the program or client satisfaction, there is need to consider whether the program actually reached the intended audience, and whether the program elements were ever implemented at all, or were implemented in the intended way. Coverage and quality of the program are two key domains of inquiry for program level process evaluation.
  
  
• Some ideas for quality standards are provided.

• Outcome evaluation is possible at a number of levels, but the choice of evaluation should depend on the purpose.
  
  
• Three levels of evaluation are represented through more detailed examples.

1. "Carrier" Subject alone
2. Separate Subject
3. Integration/Infusion alone

• Of the three ways, the 'carrier' subject emerges as the most feasible short term option especially where little already exists, however some countries, where the conditions are amenable, have had good success with the separate subject approach.
  
  
• It is also possible to combine options, over the long term. For example, carrier subject plus infusion across the curriculum to reinforce the core concepts presented in the carrier subject. Once the issue/s have been established within the "carrier" subject, infusion of HIV/AIDS issues and the skills-based approach can be infused across other subject areas. At least initially, it is more realistic that the approach will be implemented well in the carrier subject first, and later aspects may be reinforced by infusion across other subjects.
  
  
• Combinations of the above are also possible in the longer term - for example, reinforcing the carrier subject with infusion/integration across other subjects, however this is complex and time consuming to achieve. Other settings also need to be considered in order to reach more young people, including non-formal settings and approaches, peer education, and school clubs.

• poorly understood: As explained earlier, the term 'life skills' is used in many different ways, however UNICEF uses the term to describe 'psychosocial and interpersonal skills' which help people to communicate better, to make more informed and balanced decisions, to avoid risky situations, or to cope with stress. Along with the necessary knowledge, these skills are considered important because they can shape attitudes and ultimately lead to healthy and pro-social behaviours and productive lifestyles.
  
  
• competing priorities: HIV/AIDS, other health issues and social sciences, are often considered the 'soft subjects' and not given the same status as tradition academic subjects like science or mathematics. In addition, HIV/AIDS requires people to face issues that may not be openly discussed, and some sectors of society would perhaps prefer not to address.
  
  
• poor policy support: Skills-based health education for HIV/AIDS prevention will work best where it is supported by other reinforcing strategies. Appropriate policy can be one of the most influential strategies for creating a conducive environment. Unfortunately, programs are often implemented 'vertically' or without sufficient linkages to policy, which ultimately limits the potential for success.
  
  
• poor and uneven implementation: Ongoing support to facilitators (teachers) is essential to ensure that implementation can be achieved with quality. Many programs provide only brief, or one-off training workshops and expect the trainees to go back to their schools or communities and implement, in effect, single-handedly. Practical experiences suggests over and over, that support during implementation is a critical success factor. In addition, although sufficient evidence exists to support 'going to scale', few programs make national coverage a priority from the outset, and most don't progress past pilot level.