Real-World Health Education: Putting the 15 Characteristics to Work

By Susan Telljohann, HSD, CHES | April 11, 2016

I want to talk to you about power—the power you have to influence students and support them in choosing healthy behaviors. I also want to tell you about one of the most effective tools you can use to put that power to work in the real world of your classrooms and schools.

This is a concrete, research-proven resource that educators can put to work simply, right now, to build greater success with students. And yes, as you may have guessed from the title of this post, that tool is the 15 Characteristics of An Effective Health Education Curriculum.

Where Did These Characteristics Come From and Why Are They Important?

I’ve seen checklists and guides that almost seem to have come out of thin air. It’s as if some group got together and said, “Well, what do we think these guidelines should say?”

This most definitely is not the story of the 15 Characteristics. No one made them up. Instead, a group of top-of-the-field researchers took a look at the best studies on health behavior education, across several different health content areas, and figured out what features the successful programs had in common.

They examined studies on nutrition, risk-taking, criminal behavior, teen pregnancy and sexual risk, drug prevention, the cost effectiveness of health education and more.

Intuitively, most of us would probably guess that approaches that work for one subject in health education could also work for another. The wonderful thing about the Characteristics is that we don’t have to rely on intuition or guesses. We have science backing us up. And we can use that science to make our classroom time more efficient and our programs more effective.

Beyond “Meeting My Objectives”

Health education is a unique being in the education world. In Math, History, Literature, even Physical Education classes, teachers are often considered effective if they successfully transmit to students a range of mostly information-based objectives. But in health education, the ultimate outcome is not, “Do your students know the information?” It’s, “Have you successfully influenced your students’ health behaviors?”

This is a big responsibility. Influencing behavior is more complicated than teaching facts. It also sets the bar high for health teachers. Transmitting health-based skills is considerably more challenging than teaching facts about health.

In work I’ve done all around the country, I’ve met a lot of health teachers who are not yet meeting those challenges. “I don’t have enough classroom time to cover skills practice,” people have told me.

“My curriculum doesn’t have any skills activities in it,” others have said.

“I’ve got a huge amount of information I’m required to cover, and that’s what I have to do in my classes,” say others.

A teacher once described one of her health education lessons to me and said with conviction, “This is a lesson I know is effective.”

“How do you know?” I asked.

“The students love it. They’re totally engaged. The whole lesson is fun for everyone in the room.”

Here’s the thing. A fun, engaging lesson is a great start, but it’s no proof that a lesson actually promotes and shapes healthy behaviors. This is where the 15 Characteristics can make a difference.

I love talking about these Characteristics with teachers because I’ve found that even people who are very comfortable with the lessons they’re using—teachers who’ve been working with their material for many years and are confident their approach is sound—find they can boost their effectiveness by applying the Characteristics to their lessons.

Use a Checklist

One of the best ways to bring the characteristics into your day-to-day work is to use a checklist. Go through your lessons and assess how many of the Characteristics you’re bringing to the effort. This is quicker and easier than it might sound.

We’ve even created a checklist you can use! Find it here.

The more you do this, the faster the process goes. For work in the classroom, you’ll probably find yourself focusing most on Characteristics 1–8, but several of the other Characteristics will also be relevant (9, 10, 12, 14). (If you have a role in curriculum selection, school policies and professional development for teachers, you’ll probably focus most on Characteristics 9–15.)

For each lesson, look at a Characteristic and ask yourself, “Have I applied this Characteristic? How have I done that?”

As you familiarize yourself with the list, you’ll find you can come up with small tweaks for the classroom activities or homework that can increase the efficacy of the lesson. This gives you more “bang for your buck.” You get more teaching and learning accomplished in the limited time you have.

Let’s see what that looks like with a few of my favorites.

Providing Functional Health Knowledge

Characteristic 7 is Provides functional health knowledge that is basic, accurate and directly contributes to health-promoting decisions and behaviors.

The key on this one is “directly contributes to health-promoting decisions and behaviors.” Effective health education programs address information, but it is information carefully selected to help students adopt the desired healthy behavioral outcome.

Not that many years ago, health teachers were working to justify their existence in schools by making their programs more academic. We saw a trend towards lessons based on biology, physiology and science. Teachers brought facts, figures and statistics into their lessons to give them more academic weight.

Unfortunately, many—perhaps most—of these lessons did not address functional health knowledge. If we want to impact a specific health behavior, we must ask ourselves, “Will this information shape positive attitudes or build skills that promote healthy choices?”

If it won’t, we shouldn’t teach it. This is the distinction I call Need to Know vs. Nice to Know. Health education programs today simply don’t have the time to teach nice-to-know information.

Here are some examples I’ve seen of lessons focusing on fascinating but non-functional health information:

Mental Illness Research Project: Students do a research project studying a mental illness. They write a report on what they’ve learned. They can choose to focus on schizophrenia, bipolar illness, depression, OCD or eating disorders.

Will this time-intensive project help students prevent onset of these illnesses? No. This approach cannot prevent a single instance of disease.

Consider, on the other hand, students learning about general signs and symptoms of mental health problems, where to get help if they have troublesome feelings, how to get help for a troubled friend, and how to break down negative stereotypes about mental illness and help-seeking behaviors. This information, along with activities that shape positive attitudes and offer skills practice, will have an effect. Students are more likely to seek help for themselves or a friend.

Learning About the Cardiovascular System: Students study facts about how the cardiovascular system works, the marvels of the heart, how blood transports amino acids, electrolytes and oxygen, and how it transports waste materials away from body tissues. A test measures their knowledge.

Will this study help students make healthy choices about tobacco, nutrition and exercise? No. Information that does support healthy choices might include immediate and long-term consequences of smoking, poor nutrition or sedentary lifestyles, as well as the benefits of being smoke-free, eating well and being active every day. That information can be covered fairly quickly, leaving more classroom time to build positive attitudes and practice relevant skills.

Nutrition Memorization: Students memorize the names of bones and muscles in the human body. Or the names of fat and water soluble vitamins. Or the names of the nine essential amino acids in the human diet.

Interesting? Yes. Functional? No. To make better nutritional choices, students need to understand My Plate, the general benefits of good nutrition, how to choose foods from a variety of food groups and how to read a nutrition label.

We could go on and on with these examples. Lessons on HIV that focus on the function of T-helper cells. Lessons on violence prevention that involve research at the FBI’s Uniform Crime Report database. Lessons on substance abuse prevention that ask students to list long-term consequences of heavy drinking.

We must always ask, “Am I teaching information that impacts the adoption of healthy behaviors?”

Building Competence and Self-Efficacy

Characteristic 6 is Builds personal competence, social competence and self-efficacy by addressing skills.

One of the things I love about the National Health Education Standards is the way they help us put knowledge and skill-building into perspective. Standard 1 is about knowledge. Standards 2 through 8 are about skills.

That sort of sums it up for me. Most of our time and energy in the classroom needs to focus on attitudes and skills, with a lesser amount of time given to information. But in practice, that ratio is often reversed.

Over and over again, I’ve seen health teachers delivering information, running short on classroom time, and cutting the skills practice.

For example, we tell students we’re going to learn about goal setting. But all we really do is show them how to set a goal. Then we stop. We don’t give them a chance to practice setting and meeting a goal.

Or we talk about the importance of refusal skills, demonstrate an example or two, and then we stop. We don’t have them practice (repeatedly) in class, then go out into the world and practice in real life, and then come back to talk about how it went and problem-solve challenges.

Imagine if we took this same approach with math education. We’re going to teach long division. We break it down into three steps. We say to students, “OK. Here are the three steps to long division. I’m going to model each one for you with this problem on the board. Here’s division. Here’s multiplication. Here’s subtraction. Pretty easy, right? Now you can do it yourself.”

No one would take this approach to teaching math seriously, but I see health teachers do it all the time.

Here’s what the Characteristics tell us we need to do for each skill we want students to learn:

1. Discuss the importance of the skill, its relevance, its relationship to other learned skills.
2. Present steps for developing the skill.
3. Model the skill.
4. Practice and rehearse the skill using real-life scenarios.
5. Provide feedback and reinforcement.

That’s pretty much how math is taught, and it’s how health education needs to be taught as well.

Creating Healthy Norms

Characteristic 3 is Addresses individual and group norms that support health-enhancing behaviors.

I enjoyed reading Malcolm Gladwell’s book The Tipping Point. It describes the way an idea or trend crosses a threshold and becomes wildly popular. This is similar to the way I think about the process of creating healthy norms among students. In the right situation, a single student espousing a healthy attitude or promoting a healthy choice can make a difference for an entire school or community.

We can shape healthy norms by using local or national statistics that reflect healthy choices: how many teenagers chose not to use tobacco in the past month? how many have not been sexually active in the past 3 months? We can use natural leaders in the peer community to promote healthy attitudes. We can use classroom or school survey results.

I also believe in the power of teachers to set standards and expectations that promote healthy norms. Here’s an example.

When I taught health education at the University of Toledo, I asked students in my early-morning classes how many of them had eaten breakfast before coming to class. Typically, about five of the 35 students would raise their hands. “This,” I would tell them, “is not acceptable.”

Then I’d explain the benefits of having a breakfast before class. With breakfast, they would be more alert. They would learn more effectively and retain information more easily. They would feel better and have more energy through the day. I told them that because I cared about them and their academic success, I wanted them to be sure to eat something before they showed up for the next class. The students would generate a list of breakfast strategies—eat something simple like cold cereal, grab a yogurt, bring along an energy bar.

I would survey the class regularly. Gradually the numbers would improve, and by the end of the course, 25 or 30 of the students would report having breakfast before class.

Advocacy projects addressing specific health behaviors can also be effective in schools. Ask students to text ten of their friends with healthy messages about wearing seatbelts, eating breakfast or preventing bullying. Have students create posters, music, skits or videos that are shared in the class or school wide. This kind of engagement among peers—especially for middle and high school students—can be impressively persuasive.

In a sense, health teachers are sales people—we’re selling students on the idea that choosing healthy behaviors is the norm. When students make a healthy choice, we want them to think, “I’m doing what most kids do.”

You Don’t Have to Do This Overnight

These examples show that bringing the Characteristics into classroom lessons and homework activities is practical and achievable. You can do this.

When I do trainings on the Characteristics, I always tell teachers, “Don’t expect overnight change on this. Like all good learning, it’s an ongoing process.” Each time a unit comes around, take a look at it. Think about a way to add one skill practice or one additional focus on peer norms. Make just that one change. Try it out and see how your students respond.

Over time, these strategies will help you build health education that is fun and engaging, and is also effective and responsive to your students’ needs.

A Challenge

What are your own strategies for putting the Characteristics to work? What are you doing that we haven’t described here? I’d love to hear what’s working for you.

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Susan Telljohann, HSD, CHES, is Professor Emeritus, Department of Health Education, The University of Toledo. She is also a nationally-recognized speaker, consultant and trainer.