A Case Study of Adolescent Peer Leadership and Lifestyle Choice in the Health Education Curriculum of a Western Australian High School

S.M. Carter and D.S.G. Carter

Faculty of Education, Curtin University of Technology

Western Australia

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Paper presented at the British Educational Research Association Annual Conference

(September 11-14 1997: University of York)

Abstract

A group of adolescent peer leaders, together with members of their peer group(s), was identified. Peer leaders participated in an intervention involving the acquisition of authentic health and sexuality knowledge, the development and strengthening of social and interpersonal skills, valuing activities and outdoor education. Follow-up school based activities, designed to prepare peer leaders for peer support activities and cross age tutoring, were effected. Teacher development also took place in parallel with the adolescent peer leader intervention while parents of peer leaders followed "Being an askable parent" programme. Data were collected via questionnaire, semi-structured interviews and observation, and analysed using quantitative and qualitative techniques. The project has had an influence upon the whole curriculum of the school far exceeding its initial health related terms of reference. health education, adolescence, curriculum

Contemporary views of sexuality education incorporate the exploration of the whole person as a sexual being which goes well beyond knowledge of the biological functioning of the human organism to include the examination of values, attitudes, personal and interpersonal behaviour and the development of attendant social skills. From this vantage point, the incidence of sexually transmissible diseases (STDs) in young people, and the advent of Acquired Immune Deficiency Syndrome (AIDS), has provided high school teachers and administrators with an imperative in which sexuality education has to be accorded a high profile either in its own right, or as an important component of health education and human relations oriented curricula.

Australian research (Gallois, Kashima and McCamish, 1989; Ross and Rosser, 1989) has shown that young people are knowledgeable about HIV/AIDS; know that safer sex practices will protect them, but do not perceive themselves as being vulnerable or incurring personal risk if they disregard these practices. This observation accords with the findings of Petosa and Jackson (1991) who suggest that "educational efforts should be made to address factors relevant to the motivational schema under which older adolescents are operating" (p.474).

Adolescents, 13-18 years of age, have been identified by Greig and Raphael (1989) as a group whose frame of reference does not include sickness or disease. A disease prevention focus such as that promoted by the health belief model must also, if it is to be authentic, identify and address the issues, concerns and motives for sexual behaviour that are important to adolescents. Further, it has been advocated by Rosenstock, Strecher and Becker (1988) that the continued use of this model should incorporate the concept of self-efficacy (Bandura, 1986) in order to incorporate the acquisition or modification of complex lifestyle practices. The inclusion of self-efficacy, they believe, will provide a "more powerful approach to understanding and influencing health-related behaviour than has been available to date" (p.182). In particular, an area that needs to be addressed is that of the perceived control adolescents believe they have in given social situations associated with risk-taking behaviours such as injecting drug use or unprotected sexual activity.

Self-efficacy is concerned with the judgements people make about their capabilities to organise and execute course of action to desired levels of performance. Perceptions of self-efficacy can affect choice of activities, effort expended and perseverance with difficult problems (Bandura, 1986). It is a concept that embraces self-esteem, self-concept and self-worth.

Self-efficacy has been the subject of research in the areas of preventive and rehabilitative health behaviour. In particular, it has been shown to be an important variable in studies of smoking (DiClemente, Prochaska, and Gilbertini, 1985), alcohol and heroin use (Marlatt and Gordon, 1985), pain control (Manning and Wright, 1983) and adherence to medical regimens (Beck and Lund, 1981). All of these studies found that well developed self-efficacy was the single most important measure that could validly predict abstinence, adherence to regimen, avoidance of relapse, or pain tolerance on the part of the subjects studied. Self-efficacy, as a situation-specific measure, can be used to identify high risk situations. It can also be used to measure outcomes of health interventions. "A strong sense of efficacy for behaving in a health fashion is central to self-regulation of one's life" (Schunk and Carbonari, quoted in Lawrence and McLeroy, 1986, p.320).

The application of the concept of self-efficacy to the control of risk situations associated with possible HIV infection was proposed by Bandura in 1990. According to Bandura: "Translating health knowledge into effective self-protection action against AIDS infection requires social skills and a sense of personal power to exercise control over sexual situations" (p.10). A longitudinal study of gay men's sexual behaviour, undertaken by McKusick, Wiley, Coates and Morin (1986) identified and examined several psychology factors associated with sexual risk-taking behaviour. Some of the factors included in this study were the perceived threat of AIDS infection, social skills in negotiating safer sex practices, peer support for those practices, level of self-esteem and perceived self-efficacy in the adoption of protective behaviour. The researchers concluded that the best predictor in relation to sexual risk-taking behaviour was that of self-efficacy, but social skills for negotiating safer sex were also found to be very important. This study was conducted using an adult population which already had a high incidence of HIV/AIDS infection and was considered to be a high risk group. The general community of adolescents, however, do not see themselves to be at risk (Chapman and Hodgson, 1988; Greig and Raphael, 1989) and this seems particularly to be the case for those who are vulnerable because of their active participation in associated risk-taking behaviour, for example, drug use and unprotected sex. Those who were most at risk frequently exhibited poor social skills for resisting peer pressure and for negotiating the adoption of protective behaviour which are indicators of low levels of self-efficacy (Dryfoos, 1985).

Healthy adolescent sexuality is defined by Chilman (1990) as that which is based on esteem and respect for the self and others, thus,

It embraces the view that both males and females are essentially equal, though not necessarily the same. Sexually healthy adolescents take pleasure and pride in their own developing bodies. As they mature, they have an increasing ability to communicate honestly and openly with persons of both sexes with whom they have a close relationship. They accept their own sexual desires as natural but to be acted upon with limited freedom within the constraints of reality considerations, including their own values and goals and those of significant others.

(p.124)

The curricular implications of this are that, in order to link knowledge with action, self-efficacy and its promotion should be a central organising element in the design of sexuality education curricula, where its development is more likely to be instrumental in facilitating focussed student learning opportunities across the context, content and process dimensions of the curriculum.

A number of studies support the view that students would like the opportunity to discuss more sexuality and human relations topics within their school curriculum (Herold, Kopf and de Carlo, 1974; Yarber, 1979; Szriom, 1983; Goldman and Goldman, 1984). Although students rank their parents as the preferred source for gaining sexual information (Siedlecky 1979), many admitted their parents were not able or willing to fulfil that role (Kaye 1981). Where this was the case, school programs were ranked highly, and regarded by adolescents as essential sources of information about sexuality, especially in the area of controversial social issues where values were perceived to be in conflict.

Most older children expressed indirectly a need to cut through some of the controversial topics, such as abortion, birth control, and homosexuality, and to know what the controversies are about. In other words they want to know what choices are open to them and on what principles and values they should base their choices. They perceive, however crudely, that informed choice is what education is all about.

(Goldman and Goldman, 1984, p.31).

Studies in the area of sexuality education have verified the relationship between knowledge and understanding and the formation of attitudes and contingent social behaviour (Vacalis, Hill and Gray, 1979; Collins and Robinson, 1986). Hope (1987) refers to sexuality education which "in combination with work to improve decision-making and communication skills, values identification and self-esteem" will enable students to be "well-equipped to make decisions about their sexual behaviour knowing the full consequences for their health and lifestyle" (p.49). School based sexuality education programs thus serve the two fold purpose of attending to both the developmental social-emotional needs of adolescents and youth, and addressing societal imperatives within the ambit of national prevention goals (Carter and Carter, 1995).

To enhance their effectiveness as health and social educators, teachers need to consider the use of strategies which will increase student receptivity to sexuality and contingent health knowledge and practice. The acquisition of health knowledge skills and values be developed via cross-curricular approaches, or involve the use of programs that build on adolescent self-esteem and self-efficacy, or via cooperative learning practices in peer leader programs. Classroom strategies which involve social and cooperative learning such as group work, socio-drama, social simulations, role plays and other experiential learning activities can be employed which will encourage students to examine their values and attitudes, as well as provide them with opportunities to develop skills that may predispose them to adopt sexually responsible behaviours (Carter, 1992; Carter, Butorac and Carter, 1996). It is important to ensure that health education curricula (of which sexuality education is an integral part) are readily available and easily accessible to all students. Also that teachers are adequately prepared and re-skilled as necessary, through the provision of timely and on-going INSET activity, in order that they may be effective in their role(s) as health and sexuality educators. In seeking to realise these ideals the Adolescent Sexuality and Awareness Project (ASAP) was designed to further the following objectives:

Objectives

  • To predispose adolescents to act responsibly and with concern for the well being of others in their sexual relationships.
  • To equip students with the necessary knowledge, skills and social support to successfully deal with close interpersonal and sexuality-oriented social situations.
  • Identify ways of developing good interpersonal relationships and skills especially through the health and social education curriculum domain and the pastoral care system.
  • Provide professional development opportunities for teachers in order to facilitate students' social and interpersonal skills development in the area of sexuality and health education.
  • Equip parents with authentic information, personal knowledge and skills as sexuality educators in the home.
  • Use the adolescent peer group and cooperative learning for the dissemination of accurate health information supporting student maturation and values development for making responsible lifestyle choices.

The Case Study

What came to be known as the Adolescent Sexuality and Awareness Project (ASAP) was a collaborative initiative undertaken between a State senior high school, the Community Nursing Division of the South West Health Region of the Health Department of Western Australia, and the (then) AIDS Bureau of the Health Department of Western Australia.

The secondary school was selected because it was outer suburban, coeducational and had a wide range of programs and student ability. It had a population of twelve hundred students and was the recipient of supplementary funding from the Federal Government under the Priority Schools Program (PSP). Extra funds are directed to schools under the PSP which meet a number of criteria that are associated with disadvantage. One of these is that there is a high threshold of students in the school population deemed to be at risk.

The aim of this initiative was to develop, implement and evaluate a comprehensive program which sought to influence adolescents in relation to health and lifestyle choices, particularly those associated with sexuality and sexual risk-taking behaviour. The intent was to expand on the work reported by Carter (1992) where adolescents, who were identified as peer leaders, received intensive training in issues related to sexuality education in the expectation that they would exert a positive influence, through the dynamics of the peer group, on the risk-taking behaviour of their peers associated with sexual activity and drug use.

The framework adopted by ASAP included not only the development of peer leaders but also, and most importantly, the development of a strong school and community support base in which both the peer leader group and school community, were mutually interactive and mutually supportive of each other. This was facilitated by working closely with the school administration; providing in-service and professional development programs for the teaching staff, focused on those with responsibility for pastoral care and health education teaching; implementing sexuality education programs with the school parent body; and seeking to involve community organisations and agencies either through the provision of funding or human resources, such as community youth workers.

The peer leader program focussed on Year 10 students (aged 14-15 years) for two reasons: Year 10 marks the end of compulsory schooling, and the Education Department of Western Australia’s State wide K -10 Health Education Syllabus includes a major educational component on HIV, sexually transmissible diseases and sexual relationships in which is generally offered to students in Year 10. The intent in working with peer leaders selected from the Year 10 population was, not only to seek to develop adolescent peer groups via peer leadership, but also to develop adolescents as peer tutors to assist subsequently as mentors in the Senior high school’s two feeder primary schools as well as the Year 8 and 9 Health Education classes in the High School.

Many of the students perceived as being vulnerable to unwanted pregnancy, sexually transmissible diseases or illegal drug use were identified by the School Health Officer as also being those who were recurrent members of the Managing Student Behaviour (MSB) program. The number of students who repeatedly were subject to 'time-out' or even suspension was a major concern expressed by many of the teaching staff. Equally, the practice of ‘putting down’ those students who were acknowledged as having been successful in some endeavour (known in Australia as 'the tall poppy syndrome') was considered by staff as having a debilitating effect on the morale of the school as a whole. It was hoped that the ASAP, although it originated from a concern about the transmission of HIV, STDs and related sexuality issues, would, as a side effect, contribute to the School's program of building up the self-esteem of at-risk students.

A Management Committee was appointed, the role of which was to oversee the sequential unfoldment of the Project, monitor the timing for the different phases and allocate the various participants to each intervention. Early in the life of the Project it was agreed that no intervention would take place with students until teacher and parent sexuality workshops had been implemented. This strategy was regarded as crucial to the success of the Project in which close integration and careful sequencing of the various components was essential for the cumulative effects across the school community were to be maximised.

Interventions

Teacher Development

A number of staff development workshops for teachers were conducted over the course of the Project. The initial workshops in its first year of ASAP were carried out with participants invited from each subject department in the School, as well as administrative staff and members of the parent body.. The thirteen teachers who attended the first three day residential workshop on the first round of staff development activity included all staff from the Physical Education department, one teacher from each of English, Science, Home Economics, and two teachers from Social Sciences. Several of the participants also had responsibility for pastoral care.

The involvement of teachers from areas other than Physical and Health Education resulted in the formation of a substantial group of teachers in the School who became committed to Health Education, but who normally might not have been interested and involved with student learning in this area. This cadre of teachers, at their request and agreed to by the Principal, became the reformed Management Committee thereby assuming the role of guiding the development and further implementation of the Project.