Optimizing Skill Instruction in Sexual and Reproductive Health Education

By Karin Coyle, PhD | March 3, 2015
Senior Research Scientist, ETR

Most evidence-based sexual health programs include skill development as a core element. This underscores the value of optimizing instruction for skills.

 

Programs often teach skills such as:

• Refusing unwanted or unprotected sex
• Using delay tactics or alternative actions to avoid sex or avoid unprotected sex
• Communicating sexual limits
• Initiating and sustaining conversations with a partner about using birth control
• Using condoms correctly 

Education literature provides guidance on the optimal instructional sequence for teaching behavioral skills. 

Phases of Optimal Skill Instruction

We typically use 6 or 7 phases to teach behavioral skills. Some phases may not be viable in some settings—for example, practice phases for condom use instruction with younger populations—and some skills may not lend themselves to all phases.

Phase 1: Input

Explain the skill and demonstrate each part or characteristic. This phase includes naming the skill, stating its purpose, and explaining and demonstrating essential characteristics. As a result, participants should be able to describe the skill properly and recognize effective and ineffective uses of each skill step.

Phase 2: Demonstrate

Demonstrate the skill in its entirety. This phase includes modeling the skill to enable participants to recognize effective use of the skill. It’s helpful to model ineffective versus effective examples (always ending with the effective model). This allows students to see and hear the difference and distinguish between ineffective versus effective illustrations. Using tools such as observer checklists with key skill characteristics can help students analyze skill demonstrations and discuss them afterwards.

Phase 3: Structured Practice—Large Group

Conduct large-group practice with feedback. This phase features practice for all students as a whole group before providing participants with opportunities to practice on their own. This might be as simple as providing a situation or line and asking all participants to respond using the new skill. Or they might write down a response or do a pair-share with a classmate. The most important part of this phase is to ensure all students have an opportunity to respond, rather than only asking for volunteers.

Phase 4: Structured Practice—Individual

Provide opportunities for individual practice with monitoring and feedback. This phase gives participants an opportunity to practice individually to prepare for small-group practice of the skill. For interpersonal skills, this phase typically includes asking participants to complete partially scripted roleplays using the new skill steps. (Note: Some skills may not lend themselves to this phase.)

Phase 5: Guided Practice

Conduct small-group practice. This phase helps participants ensure skill mastery. It typically involves roleplays or pair practice with opportunities for feedback among the small practice groups. This phase and Phase 6 are often combined.

Phase 6: Debrief

Conduct large-group discussion on the experience of using the skill. This phase guides participants through a discussion regarding their experience using the new skill. This allows participants to begin to personalize using the skill outside of the classroom. They can reflect on what worked for them. They can identify support they may need or steps they want to practice to better use the skill outside of class.

Phase 7: Independent Practice

Provide independent practice/application outside the classroom with continued monitoring and feedback. Ideally, participants are able to practice the skill outside the classroom setting (e.g., as a homework activity), and then discuss their experiences and receive more feedback in a later session. This type of practice further contributes to skill mastery and allows participants to try a skill in context.

Other Considerations

There are a number of other important considerations for skill instruction that compliment this type of instructional sequence.

For example, it’s important to include opportunities for repeat practice of each skill throughout a curriculum. The goal of practice is to ensure that the use of the skill is automatic for participants. Without this repetition, participants may have only one chance to learn and master a skill. Success in these circumstances is not likely.

Further, for interpersonal skills, initial roleplays should be partially scripted to ensure that students focus on practicing the skill itself rather than on creating both sides of the roleplay conversation. Later in a curriculum, the practice should include unscripted roleplays or opportunities to practice in unscripted situations. This allows participants to use the skill in more difficult and realistic contexts, and helps build a sense of efficacy.

Pitfalls to Avoid

These are the most common pitfalls in skill instruction:

• Skipping entire phases in the instructional sequence. Teachers might explain and model a skill, but not offer youth a chance to practice it. Or they might allow only a few volunteers to practice the skill for others to observe.
• Covering a skill in one session and never coming back to it, or dropping lessons that allow for repeat practice of a skill.
• Truncating phases in the instructional sequence—for example, naming a skill but not providing a purpose or description of its essential characteristics, or providing an opportunity for individual practice but skipping the feedback.

Working with Context: Relationships Matter!

In our work at ETR, we are now trying to contextualize and expand the skills typically included in most evidence-based sexual health programs. In particular, we are emphasizing the role of romantic relationships and the influence they have on sexual choices and risk behaviors. This additional focus on relationship and situational context appears to enhance the relevance and impact of skill instruction, but also changes the way we’ve typically taught skills.

Here are some of the questions we are asking ourselves and addressing in new program efforts:

• How do typical skills, such as refusal skills, need to change when taught in the context of relationships, where most sexual activity occurs? How might these skills need to be adapted to address communication using new technologies (texting, social media, etc.)?
• How do we change each phase in skill instruction noted above to contextualize the skill and enable participants to practice it as they are likely to need to use it with a partner?
• What skills should we add to address both internal and indirect pressures that may influence young people’s decisions around sexual health? Can we do more with strategies such as using self-talk or mental imaging?
• Given the value of social and emotional learning, how can we extend our typical skills for addressing direct pressures to include social and emotional skills essential for healthy relationships? For example, managing emotions that stem from fear of losing a relationship, the impact of an actual relationship break-up, or initiating and sustaining conversations about birth control in the face of partner opposition.

We welcome your thoughts and conversation about these and other questions regarding skills for sexual health!

Karin Coyle, PhD, is a senior research scientist at ETR who specializes in the development and evaluation of health prevention programs, particularly HIV, other STD and pregnancy prevention. She can be reached at karinc@etr.org.