Section Eleven:

Overview of Skills-Based Health

Education and Life Skills

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 OVERVIEW OF
SKILLS-BASED HEALTH EDUCATION AND LIFE SKILLS

Adapted from: Life Skills Approach to Child and Adolescent Healthy Human Development by
Mangrulkar, L; Vince-Whitman, C; and Posner, M. Health and Human Development Programs,
Education Development Center, Newton, MA (unpublished document).

Introduction
By the year 2010, there will be 1.2 billion youth between the ages of 10 and 19. A
growing proportion of these young people will be living Asia, Africa and Latin America.
Whether or not this generation will be able to reach its full potential depends on the
capacity of families, schools and communities to help youth acquire the skills they need
not only for their basic survival, but also for the full development of their social,
emotional and cognitive abilities. The challenge of meeting their needs is both clear
and compelling; skills-based health or "life skills" education is one way to meet this
challenge.

What is Skills-Based Health ("Life Skills") Education?

Skills-based health education focuses on the development of “abilities for adaptive and
positive behaviour that enables individuals to deal effectively with the demands and
challenges of everyday life” (WHO 1993). The acquisition of life skills can greatly affect
a person’s overall physical, emotional, social, and spiritual health which, in turn, is
linked to his or her ability to maximise upon life opportunities. The success of skills-
based health education is tied to three factors: 1) the recognition of the developmental
stages that youth pass through and the skills they need as they progress to adulthood,
2) a participatory and interactive method of pedagogy, and 3) the use of culturally
relevant and gender-sensitive learning activities.

The primary goal of skills-based education is to change not only a student’s level of
knowledge, but to enhance his or her ability to translate that knowledge into specific,
positive behaviours. Participatory, interactive teaching and learning methods are critical
components of this type of education. These methods include role plays, debates,
situation analysis, and small group work. It is through their participation in learning
activities that use these methods that young people learn how to better manage
themselves, their relationships, and their health decisions.

The foundation of this pedagogy is based on a wide body of theory-based research

which has found that people learn what to do and how to act by observing others and
that their behaviours are reinforced by the positive or negative consequences which
result during these observations. In addition, many examples from educational and
behavioural research show that retention of behaviours can be enhanced by rehearsal.
As Albert Bandura, one of the leading social psychologists in the area has explained,
“When people mentally rehearse or actually perform modelled response patterns, they
are less likely to forget them than if they neither think about them nor practice what they
have seen” (Bandura, 1977).

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 Cooperative learning or group learning is another important aspect of skills-based
programs. Many skills-based programs capitalise on the power of peers to influence the
acquisition and subsequent maintenance of positive behaviour. By working
cooperatively with peers to develop prosocial behaviours, students change the
normative peer environment to support positive health behaviours (Wodarski and Feit).
“As an educational strategy, therefore, skills-based health education relies on the
presence of a group of people to be effective. The interactions that take place between
students and among students and teachers are essential to the learning process.”∗

In addition to the use of participatory, interactive teaching methods, skills-based health

education also considers the developmental stages (physical, emotional, and cognitive)
of a person at the time of learning. Each learning activity is designed to be appropriate
to the students' age group, level of maturity, life experiences, and ways of thinking. At
the same time, participatory activities provide the opportunity for students to learn from
one another and appreciate the differences, as well as similarities, among individuals in
the classroom setting.

In general, skills-based education targets three broad categories of life skills, cognitive
skills, and emotional coping skills. Most programs incorporate each of these skills into
their lessons.

Figure 3: Examples Of Life Skills

Social Skills Cognitive Skills Emotional Coping Skills

• Communication skills • Decision making/problem solving • Managing stress

skills
• Negotiation/refusal skills • Managing feelings, incl.
- Understanding the consequences anger
• Assertiveness skills Of actions
• Skills for increasing internal
• Interpersonal skills (for - Determining alternative solutions locus of control (self-
developing healthy to problems management, self-
relationships) • Critical thinking skills (to analyse peer monitoring)
• Cooperation skills and media influences)

These three skill categories are not mutually exclusive, but rather complement and
reinforce each other. For example, a program aimed at promoting social competence in
children would teach ways to think about and determine alternatives for handling a
potentially violent situation (cognitive skills); to communicate feelings about the situation
and get help from others, if needed (social skills); and to manage personal reactions to
conflict (emotional coping skills).

To be effective in supporting quality learning outcomes, skills-based health education

must be used in conjunction with a specific subject or content area.** Learning about
decision-making, for example, is more meaningful if it is addressed in the context of a
particular issue (e.g., the decisions we make about tobacco use). In addition, while
skills-based education focuses somewhat on behaviour change, it is unlikely that a

*
“Handouts 1-5 on Life Skills Education,” Gillespie, A. UNICEF (unpublished document)
**
This paragraph adapted from “Handouts 1-5 on Life Skills Education,” Gillespie, A. UNICEF (unpublished
document)

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learning activity will affect behaviour change if knowledge and attitudinal aspects are not
addressed (e.g., a student will not try to negotiate for effective condom use if he/she
doesn’t know that they can prevent disease transmission or doesn’t believe that
condoms are necessary). Therefore, it is important for skills-based approaches to be
accompanied by activities which focus on students’ knowledge and attitude.

The following figure gives an overview of informational content on which skills-based

health education can be applied:

Figure 4: Information Content That Can Accompany Skills-based Health

Education
Examples of Informational Content
Specific Violence prevention/ • Potential situations of conflict
Conflict resolution
Content Areas • Myths about violence perpetuated by the media
• Roles of aggressor, victim, and bystander
Alcohol, Tobacco and • Social influences to use alcohol, tobacco and other drugs
other Substance Use
• Potential situations for being offered a substance
• Misperceptions about levels of alcohol, tobacco, and other
drug use in community/ by peers
Social Relationships • Friendships
• Dating
• Parent/child relationship
Sexual and • Information about STIs/HIV/AIDS
Reproductive Health
• Myths and misconceptions about HIV/AIDS
• Myths about gender roles/body image perpetuated by media
• Gender equity (or lack of it) in society
• Social influences regarding sexual behaviours
• Dating and relationships
Physical Fitness/ • Healthy foods
Nutrition
• Exercise/sports
• Preventing anaemia and iron deficiency
• Eating disorders

In addition, skills-based education emphasises the use of learning activities which are
culturally relevant and gender-sensitive. To achieve this, the learning activities offer
numerous opportunities for participants to provide their own input into the nature and
content of the situations addressed during the learning activities (e.g., creating their own
case studies, brainstorming possible scenarios, etc.). This approach ensures that the
situations are realistic and relevant to the everyday lives of participants. It is critical that
the skills youth build and practice in the classroom are easily transferable to their lives
outside the classroom.

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Why Is Skills-Based Health Education Important?

Over the last decade, a growing body of research has documented that skills-based
interventions can promote numerous positive attitudes and behaviours, including
greater sociability, improved communication, healthy decision-making and effective
conflict resolution. Studies demonstrate that these interventions are also effective in
preventing negative or high-risk behaviours, such as use of tobacco, alcohol and other
drugs, unsafe sex, and violence. The table below summarises some of the results from
research studies conducted on skills-based education programs. It is important to note
that research has also found that programs which incorporate skills development into
their curricula are more effective than programs which focus only on the transfer of
information (e.g. through lecture format).

Research shows that skills-based health education programs can:

Delay the onset age of the abuse of tobacco, alcohol, and marijuana (Botvin et al, 1995.
Hansen, Johnson, Flay, Graham, and Sobel, 1988)
Prevent high-risk sexual behaviour (O’Donnell et al., 1999; Kirby, 1994; Schinke, Blythe, and
Gilchrest, 1981)
Teach anger control (Deffenbacher, Oetting, Huff, and Thwaites, 1995; Deffenbacher, Lynch,
Oetting, and Kemper, 1996; Feindler, et al 1986)
Prevent delinquency and (Young, Kelley, and Denny, 1997)
Promote positive social adjustment criminal behaviour (Englander-Golden et al. 1989)
Improve health-related behaviours and self-esteem (Elias, Gara, Schulyer, Branden-Muller, and
Sayette, 1991)
Improve academic performance (Elias, Gara, Schulyer, Branden-Muller, and Sayette, 1991)
Prevent peer rejection (Mize and Ladd, 1990)

Who Can Teach Skills-Based Health Education?

Teachers, counsellors, psychologists, school nurses, and other health care providers
have all been involved in the delivery of skills-based health education. Key to the
success of teaching these skills is comprehensive training for program providers around
the basic characteristics of skills-based education. Such training should aim to: 1)
increase providers’ knowledge around the content of what is being taught/learned; 2)
increase providers’ familiarity and level of comfort with using participatory and
interactive teaching methodology in the classroom; 3) increase providers’ understanding
of developmental issues in learning; and 4) strengthen providers’ skills in the
management of classroom behaviour, given that skills-based education is used primarily
in a large group setting and often deals with sensitive topics.

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 EFFECTIVE TRAINING ON SKILLS-BASED EDUCATION TEACHES PROVIDERS HOW TO:
Establish an effective, safe and supportive program environment
Access resources for health information and referral
Address sensitive issues
Model the skills addressed in the program
Apply interactive teaching methodologies in the classroom
Provide constructive criticism, positive reinforcement and feedback
Manage group process

Whichever agency plays the primary role in the implementation of skills-based health
education, it is equally important for program providers to collaborate with other local
stakeholders and community members in all stages of planning and delivery. For
example, providers may want to invite parents to attend training programs to enhance
their own skills for communicating with their children or for coping with difficult personal
circumstances. Likewise, other community members (e.g., health care workers or
police officers) might be invited to participate in specific learning activities both in and
outside the classroom. The table below summarises who might be ideally suited to
teach skills-based education.

Effective Life Skills Program Providers

Can be… Should be perceived as… Should have these qualities…

• Counsellors • Credible • Competent in group process

• Peer leaders • Trustworthy • Able to guide and facilitate
• Social workers • High status • Respectful of children and
• Health workers • Positive role model adolescents
• Teachers • Successful • Warm, supportive, enthusiastic
• Parents • Competent • Knowledgeable about specific
• Psychologists content areas relevant to
• Physicians adolescence
• Other trusted adults • Knowledgeable about community
resources

What Are Some Of The Challenges To Implementing Skills-Based Health Education?

Some of the major challenges associated with implementing skills-based education are:

1. Health care providers, youth workers and teachers are often expected to help
adolescents develop skills that they themselves may not possess. Program
providers may need help building assertiveness, stress-management, and/or
problem-solving skills for themselves before being able to teach these skills in
the classroom. Therefore, an important component of any training program is
the inclusion of activities in which potential providers can also address their
own personal needs.

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 2. There is a need to train adults in using active teaching methodologies. Skills-
based health education encourages participation by all students, and as a
result, can create classroom dynamics with which some teachers are not
familiar. Research, however, has found that teachers who were initially
uncomfortable with the idea of using participatory methodologies in their
classrooms overcame their reluctance after practising these methods during
training sessions. Provider confidence is essential to the success of skills-
based education.

3. Program providers may feel uncomfortable addressing the sensitive issues

and questions that may arise. Some providers may feel unprepared to
communicate with their students about sensitive topics such as sexual and
reproductive health, violence, and relationships. They also may not know
where to go to access additional information on these topics. Again, training
teachers prior to implementation on how to best address and respond to
questions or comments about sensitive topics is key to overcoming this
challenge. Providers should also be encouraged to interact and meet with one
another throughout the school year to share ideas and suggestions.

4. Program providers are underpaid and overworked. Program providers may

not have the morale or energy to learn new teaching methodologies.
Therefore, providers need to understand how skills-based education can have
immediate and long-lasting benefits not only on their students’ lives but also
on their own personal and professional lives. Training programs should
include activities which help teachers build skills that they can use in their
daily lives, e.g., to improve relationships, avoid sexual violence or
harassment, or overcome alcohol or drug use. Studies have shown that
skills-based education programs can indeed improve attendance and morale
among providers. (Allegrante, 1998)

5. Teachers are often asked to implement many different curricula and

instructional efforts, without a clear understanding of the relationships among
them and the relative benefits of each. A lack of coordination between school
administrators, curriculum coordinators and health and education sectors can
result in a number of competing curricula. This can prove to be frustrating to
overworked teachers who may start to view new programs as just another
addition to their existing workload. Key to overcoming this challenge is a
close collaboration between all involved, including teachers, so that there is a
clear understanding of how new curricula can realistically be used to
complement what is already being implemented.

What Are Some of the Keys to Success When Implementing Skills-Based Health
Education?

At the heart of implementation is a planning process that begins with the end in mind.
Ensuring a fit between the program, the interests and needs of providers and young
people, local conditions and resources is essential. As the challenges suggest, nothing
can be implemented without the enthusiasm, buy-in and involvement of the providers.
Providers, i.e., teachers, health workers, counsellors, and volunteers, are perhaps the
most critical component to the implementation process. In fact, many programs have
been successful, even in the absence of any national policies, due to the talent and

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commitment of local level people. Examining, taking into account, and responding to
the concerns, interests and needs of providers’ personal and professional working
conditions is a major factor in program success.

Despite the challenges that may accompany the implementation of skills-based

education, the rewards and positive outcomes which may result from such programs are
immeasurable. By creating a coordinated effort between stakeholders, both local and
national, program planners and advocates can help to ensure an educational program
that is both effective and sustainable.

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