Professional development in HIV prevention education for teachers using flexible learning and tutor support

Abstract

HIV prevention programs in schools are acknowledged as one of the best prospects for controlling the world HIV epidemic. Epidemiological evidence indicates that deaths world-wide from AIDS are yet to peak. Although HIV notifications and AIDS deaths in the total Australian population have decreased', there has been an increase in rates in the Australian Indigenous population. There is also some evidence of complacency in HIV prevention vigilance in Australia which indicates a need for continued focus on prevention programs. The knowledge levels, attitudes toward HIV risk, and risk-taking behaviours of young Australians place them at risk of exposure to HIV. Appropriate prevention programs can be delivered to these vulnerable young people through the school setting. Programs delivered in schools have been shown to have a positive effect and teachers are vital to the delivery of these education programs. Without appropriate training, however, teachers may not optimise the outcomes of these programs. While it would be desirable for teachers to be trained in HIV prevention education in pre-service training this has not been the case in Western Australia (WA). When there is not an opportunity for pre-service training, professional development programs can be implemented to provide additional training required by teachers. Traditionally this professional development has been provided through workshops. These face-to-face delivery methods, however, do not always adequately serve the needs of all teachers, and in particular the needs of teachers in rural and remote areas. In an attempt to address the needs of these teachers, alternate methods of professional development delivery may be appropriate. The aim of this study was to test an alternate method of delivery.The study designed, disseminated and evaluated the implementation of a flexible learning professional development program for teachers of HIV education. The program was based on print-based distance learning, supported by a video and tutors. Five objectives were developed for the study. These objectives were: Objective One - To determine factors associated with teachers' enrolment in the Protect Yourself Program (PYP). Objective Two - To determine the association between factors related to entry characteristics, social integration, external attribution, academic integration and incompatibility and amount of PYP completed. Objective Three - To determine the association between amount of PYP completed and factors related to the teaching of HIV lessons. Objective Four - To examine the context in which intervention and comparison group teachers were operating for this study. Objective Five - To evaluate the process of teacher recruitment to PYP, satisfaction with the flexible learning methodology, satisfaction with the PYP materials and completion of PYP. A comprehensive theoretical framework was constructed to guide the development of the empirical study and the professional development program, as little evidence was found in the literature of similar empirically evaluated studies. This framework incorporated: Adult Learning Theory; the Model of Student Progress; the PRECEDEPROCEED Model; the Health Promoting Schools Framework; Diffusion of Innovation and the Communication Behaviour Change Model. The study was conducted in two parts. Firstly, an exploratory study was conducted which provided a basis upon which to implement the second, larger empirical study.A quasi-experimental study design was implemented due to restrictions placed upon the study by the WA Department of Health, the funding agency. The study sample was made up of teachers from government and independent, primary and second schools in WA. In total, 126 teachers were recruited to the intervention group and enrolled in the professional development program, and 128 to the comparison group, who completed some of the evaluation instruments, but did not participate in a professional development program. The professional development intervention program incorporated four comprehensive work modules, which were delivered in print form. A video and tutorial support supplemented the print materials. To evaluate the professional development program, seven instruments were developed. From these instruments five categories of variables were created, namely demographic, contextual, teacher characteristics, process and dependent. These variables were developed as single item variables, scales or indices. Quantitative data were analysed using the Statistical Package for the Social Sciences and a combination of univariate, bivariate, and multivariate techniques (logistic regression and analysis of covariance) were conducted. Qualitative data were analysed for themes. A binary logistic regression was conducted to evaluate Objective One: to determine factors associated with teachers’ enrolment in PYP. The analysis identified four factors which were associated with enrolment in PYP.The teachers most likely to enrol in PYP had no pre-service training in health education and did not consider themselves to be a specialist or coordinator of health education. The majority of program participants had been teaching health education for between three and seven years and displayed a high level of acceptance of the flexible learning methodology. Objective Two: to determine the association between factors related to entry characteristics, social integration, external attribution, academic integration and incompatibility and amount of PYP completed was evaluated using a nominal logistic regression analysis with the intervention group sample only. Completion of the PYP program by participants was related to circumstances which were often beyond the control of the program, such as events occurring in a teacher’s personal life. However, teachers who showed a preference for flexible learning were found to be more successful in completing the program. The effects of PYP were measured by Objective Three: to determine the association between amount of PYP completed and factors related to the teaching of HIV lessons. Three of the six factors considered by this objective returned a significant association with program dose. Teacher perceived access to HIV education resources was found to be positively related to the dose of materials a participant completed.Participants who completed a high dose of the program considered HIV resources to be relatively easier to access than participants completing a low dose. Teachers who completed a high dose of PYP reported being more comfortable to teach HIV lessons than teachers completing a mid dose. In addition, intervention group teachers showed a significant change in comfort with their ability to teach HIV lessons and specified HIV topics to Years 8, 9, and 10 classes and intervention group teachers of Year 8 students thought the HIV topics were less important for this level of students. The final variable to show a significant change over time when dose of the program was considered was teacher sexual conservativeness. Both high and mid dose participants reported being less sexually conservative than low or no dose participants from pre to midtest. The context of the teachers participating in the PYP study was investigated through Objective Four: to examine the context in which intervention and Comparison group teachers were operating for this study. Two factors were found to be associated with gender, six with school location and eleven with level of teaching. These associations provided important contextual information for interpreting the findings of the study. Objective Five evaluated the process of teacher recruitment to PYP, satisfaction with the flexible learning methodology, satisfaction with the PYP materials and completion of PYP. The recruitment strategies implemented for PYP were effective in having teachers from government and independent schools in WA recruited to PYP.However, more than 90% of the intervention group were from government schools. Schools encouraged more than one teacher from a school to enrol, with nine primary schools, four district high schools, one community high school, one secondary college, four senior high schools and one combined independent primary and high school enrolling more than one teacher in the program. The flexible learning methodology was reported to be suitable for the needs of teachers who enrolled in PYP, as they felt comfortable with the learning methodology and appreciated the opportunity to choose when and where they completed the program. The opportunity for face-to-face contact, however, was still preferred by some teachers. The materials within the program were considered to be appropriate and useful. The writing style and activities were well received and the efforts of the tutors were welcomed by the majority of the intervention group. One third of teachers who enrolled in PYP completed at least some of the materials, but less than 10% completed the entire program. The most frequent suggestions made for increasing program completion rates were to set dates for completion of the program modules and to allow time release to complete the program. At baseline, this research showed that teachers considered it important for their students to have access to HIV education, but many of these teachers did not feel comfortable providing HIV education for their students.As positive effects were observed in the PYP program of impact of program dose on factors affecting the implementation of HIV education, it would appear that flexible learning professional development was a suitable alternative to face-to-face professional development. Teachers' acceptance of flexible learning professional development as an alternate methodology, however, appears to be in its infancy and will require more empirical research. Future research, study design improvements and intervention design improvements can be informed by the following recommendations. Future research Recommendation 1: There be more rigorous investigation of flexible learning as a methodology for provision of professional development for teachers of health education. Recommendation 2: The status of claiming credit for professional development toward postgraduate qualifications for teachers continue to be investigated. Recommendation 3 : Further research be undertaken to evaluate available technologies and their acceptance by teachers as a delivery method for flexible learning professional development. Study design improvements Recommendation 4: design limitations of the PYP study. Future research be designed to overcome the study Intervention design improvements Recommendation 5: The findings of the PYP study and suggestions made by PYP participants be used to improve future health education professional development programs.