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Sexual Health Exchange, 1995 - no. 4 Problem-posing HIV/AIDS/STD education: learning = critical thinking Judi Aubel and Jean Sia In most countries, there is a significant gap between those who are "informed" about the danger of HIV/AIDS/STDs and those who have made behaviour changes to protect themselves. Usually, before any behaviour change can take place, individuals must critically analyse new information in the light of their own values and situation. Then they must decide whether and how they can integrate that information into their own lives. Many AIDS education activities merely provide people with information. However, certain types of educational activities develop critical thinking skills required to analyse systematically situations and problems. The National AIDS Committee in Côte d'Ivoire (Ivory Coast) used this insight as well as lessons from adult education to conduct a five-day workshop for health personnel focusing on the development of critical thinking skills. Based on that experience, we describe how similar workshops can be organized to develop participatory learning experiences for community groups. Background The workshop in Côte d'Ivoire was held near the capital city for 22 teams of community health workers from rural health centres throughout the country. Each team consisted of an Ivorian nurse or midwife and an American Peace Corps volunteer. On the first two days, an update was given on the AIDS/STD epidemic in the country, and basic concepts of adult education and participatory communication were discussed. The participants then formulated the following goal for their own community education strategies: "to analyse with the community the problems related to AIDS and to identify together strategies for preventing AIDS and other STDs." During the last three days, they developed problem-posing education materials, practised using them with the different community groups and then developed education action plans for their own communities. Principles underlying the workshop Critical thinking is a reflective process in which the individual decides what to do or what to believe. The following characteristics of learning materials and of the learning environment have been shown to be important for the development of critical thinking skills. Educational materials must reflect individuals' or groups' socio-cultural values and reality. Such materials are beneficial insofar as they require learners to analyse new information relative to their own prior knowledge and values. The incorporation of community knowledge and values into the content of materials encourages learners to analyse new information in the light of their previous experiences and learning. Educational materials must be problem posing and open-ended rather than provide set solutions. Problem-posing materials encourage analysis of alternative approaches rather than rote learning of pre-defined solutions. Educational activities need to involve "learners" in actively analysing real HIV/AIDS-related situations. Facilitators must be skilled in using questioning strategies which encourage critical thinking rather than rote learning. Facilitators must stimulate learners to analyse critically situations and problems and to identify their own strategies for dealing with those situations. This requires the use of carefully formulated questions. In the learning context, all participant opinions must be encouraged and respected. Participants can only feel confident to share their ideas openly and creatively if the learning environment fosters respect for all points of view. Discussions among groups of peers are especially effective insofar as they encourage the exchange of views and consideration of alternatives in an atmosphere of confidence. Such discussions can allow participants to reflect together on group values and behaviour and develop the confidence necessary to put new ideas into practice. Group learning experiences can potentially contribute to changing group norms. These five principles can be incorporated into an eight-step workshop in which participants learn how to use simple educational activities to develop critical thinking skills.
Step 1: choose topics to be addressed in activities Based upon what is already known about community AIDS-related concerns, choose a topic for each activity to be developed. As some communities have not yet identified AIDS-related problems as priority concerns, the choice of a topic can also stem from concerns of the Ministry of Health (MOH) related to HIV/STD prevention and care. Brainstorming with participants can identify a range of possible topics such as: HIV-positive pregnant women's attitudes to breastfeeding; young men's attitudes towards condom use; teenagers' knowledge of AIDS and STDs and attitudes to preventive behaviour. Participants can then be organized into teams who choose target groups and topics for activities they will develop. Step 2: collect information from the community and MOH First, gather information from target group community members, such as female traders, students, men drinking at bars. Small informal group interviews can be conducted in the community settings to determine people's knowledge, attitudes and experiences related to the chosen topics. A set of interview questions can be prepared using guidelines provided by the workshop facilitators. Next, collect information on MOH priorities related to that same topic. These can be obtained from the National AIDS Committee or Programme. Step 3: define the problems to be tackled Based on the information collected in community interviews, identify a "problematic" aspect of each topic to be addressed in educational activities. The "problem" can be associated with a lack of knowledge, attitudes which are inappropriate or a situation which community members identify as being difficult to handle. The workshop teams can then define objectives for their educational activities. Examples of such objectives are: increasing knowledge about STDs; discussing attitudes towards multiple sexual contacts; discussing strategies for negotiating condom use.
Step 4: develop a problem-posing code In this step, participants develop a story, skit (role-play or very short play), game, drawing or song which incorporates both the community's perspective and MOH priorities. These "problem-posing codes" should reflect a problem and alternative attitudes toward that problem but should not propose solutions. According to the well-known adult educator Paulo Freire, "the code should reflect people's reality like a mirror" so that they see their own lives in it. Step 5: develop questions to elicit problem analysis For individuals to learn, they must actively and critically reflect on the situations and problems presented in the open-ended codes. It is the type of questions asked that determine whether target group members merely repeat what they have heard in an educational activity or whether they systematically analyse the content in terms of their own attitudes, experience and priorities. For this reason, a carefully planned series of questions must be developed to accompany each code. To develop such questions, the "experiential learning cycle" provides a useful framework. Following this framework, three levels of questions are developed which stimulate participants to:
Step 6: present the code to a group of 15-20 people Based on the principle that involvement facilitates learning, problem-posing codes are most effectively used with small groups because all participants can then be involved actively in discussion. Workshop participants can return codes developed to groups at the sites where they conducted their community interviews (e.g., performing a song or skit). Step 7: facilitate discussion of the code Immediately following presentation of the code, the workshop participants invite members of their target group to discuss what they have seen and heard using the questions prepared in step 5. As facilitators, they must have skills in group dynamics and inter-personal communication to ensure that all group members feel comfortable contributing their feelings and ideas to the discussion. Group discussions should be seen as learning experiences not only for the target group members but also for the workshop participants. Each group session is an opportunity for facilitators to understand progressively more about target group members' attitudes, experiences and constraints. When group members state that the situation presented in the code could occur in their community, participants know that they have succeeded in developing codes that reflect "community realities". The workshop practice sessions might even lead to immediate results. In Côte d'Ivoire, for example, this approach elicited such enthusiasm and lively debate that one target group immediately asked for copies of skits and questions to use with neighbourhood groups while another asked for a repeat presentation of the skit code for their friends. Step 8: evaluate the educational activity The last step is for facilitators to evaluate the educational activities they conduct. This should be done at two levels and simple techniques can be used. First, before the target group to whom they presented the code disperses, ask for their feedback on the session and their suggestions for improving such sessions in future. Second, carry out an evaluation of the activity with the other session facilitators. This can take the form of an informal group discussion addressing three questions: 1) What went well with the activity? 2) What problems or constraints were encountered? 3)How could future educational sessions be improved? Conclusion Behaviour change is more likely when learning activities require people to analyse actively and critically their own values and behaviours. The eight-step workshop described here can help those responsible for AIDS education programmes to develop problem-posing, participatory educational activities based on critical thinking. Acknowledgement: The workshop held in Côte d'Ivoire was supported by the US Peace Corps. The other workshop trainers were: Carol Squires-Diomande, Eliane Dogore, Estelle Garner and Esther Lodji. Judi Aubel, B.P. 3746, Dakar, Senegal; Fax: 221-241-919; and Jean Sia, National AIDS Committee, Ministry of Health, Abidjan, Côte d'Ivoire. |
Facilitators can use games and diagrams to help group members identify problem-posing codes
Secondary school students discussing a problem- |
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