This is an excerpt from Lesson Planning for Skills-Based Elementary Health Education With Web Resource by Holly Alperin & Sarah Benes.
At its core, a skills-based approach to health education is one that emphasizes the National Health Education Standards and shifts the focus away from giving students lots of new content and information to one that allows students to develop the competencies needed for leading a health-enhancing life. The skills of the National Health Education Standards include the following (Joint Committee on National Health Education Standards, 2007):
- Accessing valid and reliable information, products, and services
- Analyzing influences
- Interpersonal communication
- Decision making
- Goal setting
We know from health behavior theory that knowledge alone will not change behaviors. Knowing is not, on its own, going to help us change behaviors or adopt new ones. Just think: How often do you engage in a behavior or behaviors that you know aren't the healthiest option? We all do sometimes! We aren't doing it because we don't know better; it is usually because other factors are, in those moments, affecting and influencing our behaviors.
Let's look at an example. You ask your students what they would do if they saw a classmate being bullied at recess. Students can choose between the following options: (a) do nothing, (b) tell a teacher or other trusted adult, or (c) step in and try to help. There may be some students who would be honest and choose (a), do nothing. The teacher then leads a discussion about why a student might choose (a). Students might share how they were nervous or scared to step in, they were afraid to be labelled as a tattletale or they were afraid they might get bullied themselves. These are all valid reasons that might make the less healthy option appealing to students. The teacher can now facilitate a discussion about the barriers to options (b) and (c) (the “right” answers that students probably would have chosen on a multiple-choice exam or when asked what they “should” do in this situation). This discussion is at the heart of a skills-based health education program. Students know that they can be honest in their answers and that you, as the teacher, will meet them where they are and help them address their real-life challenges.
As health educators, we need to provide space for students to consider their realities and engage in thoughtful conversation about what supports and resources will help or encourage their abilities to make healthy choices and what barriers might prevent them from making those choices. In this case, maybe students needed more confidence in their abilities to advocate or identify and weigh options in decision making, or maybe they needed more self-efficacy in communicating with trusted adults or support in being an ally in this situation. No matter what these students needed, it wasn't the knowledge about the healthier choice; they needed something else to implement the healthy decision in this situation. When we teach from a skills-based approach, we are keeping these other considerations at the forefront in order to help our students overcome the barriers holding them back from making the health-enhancing choice.
Research also supports a focus on skill development. While it is beyond the scope of this chapter to dive deep into the research, some brief highlights are included here. The Centers for Disease Control and Prevention (CDC) highlights the inclusion of skill development. In its 2015 Characteristics of Effective Health Education Curriculum, CDC notes that “an effective curriculum builds on previously learned concepts and skills and provides opportunities to reinforce health-promoting skills across health topics and grade level” (CDC, 2018). The World Health Organization, in the 2003 Skills for Health document, promotes this approach and highlights strategies for teachers to use in the classroom. In addition, research examining effective health education programs reveals that skill development is a key element and programs that address a variety of behaviors through a skills-based approach are more effective and efficient (Hale, Fitzgerald-Yau, & Vine, 2014, p. e19).
Alignment with the National Health Education Standards means that the skills become the emphasis of the curriculum. They frame not only the written curriculum but also its implementation and assessment. In a skills-based approach, your goal is to support the development of skills that will aid students in leading health-enhancing lives now and in the future. In practice, these skills become the units of instruction, and the traditional topic areas become the context through which students learn and develop the skills. While some information does need to be taught, the best use for this information is as a means for developing the skills and supporting the students in applying the information to their lives rather than being taught something for the sake of students' knowing about a topic. In effect, it means including information that is functional, relevant, and meaningful. We encourage you to include functional information that aids students in determining the healthiest path and guides them toward how to be healthy as opposed to knowing multiple risk factors or negative outcomes of poor behavior. For example, instead of offering units on nutrition, hygiene, and puberty, you could offer units on analyzing influences, decision making, and advocacy that discuss topics such as how to analyze the influence of peers, culture, and family on dietary choices or how to make hygiene-related decisions and advocacy for puberty-related ideas and topics. You still would be covering the same topics, but you would be delivering the information in such a way that students will apply it during skill practice and performance. This switch ensures not only that the skills are emphasized but also that the curriculum is designed such that it supports students' development of skill proficiency as a primary purpose of health education.