Evidence Basis

The SHAHRP study aims to change young people's health behaviour through a classroom education approach. To do this effectively, the researchers have incorporated research evidence and best practice approaches from the health and education fields. The following summary of the research basis of SHAHRP will assist you in understanding the critical elements of the SHAHRP intervention and can also be used as a guide to assess the quality of other drug education resources.

Timing and Programming

Inoculation: requires that initial lessons be taught immediately prior to students initiating the behaviour of interest, in this case drinking alcohol. Lessons that provide knowledge and skills immediately prior to the behaviour can give students a solid basis as they enter into, for example, alcohol use situations. Prevalence of alcohol use data were used to define the placement of each phase of the SHAHRP intervention. The use of local prevalence data can also assist in defining the appropriate timing of the initial phase of other health related interventions.

Relevancy: requires that an additional phase of lessons be taught at a time when the students are initiating the behaviour of interest. The immediate relevancy of knowledge and skills during this phase in the students development makes it more likely that students will apply this new information and skills to their new behaviour. As with the above evidence based component, prevalence of alcohol use data were used to define the placement of phase two of SHAHRP intervention.

Transition period between primary and secondary school: practical considerations play an important part in this component (particularly so for research studies in schools). Students are likely to remain in the same school for a number of years, teachers are more specialised in the delivery of alcohol education, programs can be easily administrated and in research terms an intervention in one setting helps to assist with follow-up for survey purposes. Entry into secondary school also represents a milestone in the maturity of students, however, the prevalence of the behaviour of interest should be a stronger guide to the placement of an intervention.

In the context of developmentally appropriate school health curriculum: drug education should be taught in the context of a developmentally appropriate curriculum, have a sound curriculum basis, be placed alongside other related health issues and have the flexibility to target drug issues as they become pertinent to students. Programs conducted in isolation, or ad hoc programs, have limited scope to create change and can potentially have a negative effect on student drug use behaviour.

Booster sessions over time: in the past the research literature suggested that 30 to 40 hours of classroom lessons were required to impact on students health behaviours. More recent research suggests that booster sessions over a number of years, that develop and reinforce knowledge and skills, can also lead to behaviour change. This means that less classroom time is required to have an impact on behaviour, however, the lessons need to incorporate the following content and teaching methodology components to be effective.

Content and Teaching Methodology

Based on the experiences of young people / young people involved in the development of the intervention: it is very important that the content, scenarios and style of an intervention be based on the experiences and interest of the young people that it is trying to influence. The SHAHRP study conducted focus groups with young people and piloted the draft intervention with young people to ensure that their experiences were reflected in the classroom lessons. The involvement of young people in the development of an intervention helps to increase its relevancy as well as students interest and involvement in the program.

Provides accurate normative information: research suggests that presenting age related usage norms helps students to attain realistic understanding of usage rates among peers. Findings suggest that young people often have exaggerated notions of usage rates and presenting accurate normative information can assist in modifying behaviour if these norms are relatively low. In the first phase of SHAHRP the use of normative information was particularly useful.

Adopts a harm minimisation approach rather than being based solely on non-use goals: this issue is particularly relevant for alcohol where initiation of use occurs at a young age, where large amounts of alcohol are consumed during drinking occasions and where social rewards are gained from drinking. Risks and harms associated with the use of alcohol can be linked to the students own use or other peoples use of alcohol. A goal of harm minimisation provides both drinkers and non drinkers with strategies for reducing the chances of harm occurring, and the potential impact of harm after the event, as well as incorporating important non-use and delayed use strategies.

Programs should be skills and activity based: skills based teaching that involves students in practical activities increases students interest and learning. Teaching methods that allow students to practice behaviours that are relevant to their experience, in a low risk situation, using realistic scenarios, provide young people with important practice that they can take with them to real life situations. Programs that are interactive and provide a high level of activity in proportion to other aspects, such as lecture-style teaching, are more effective in gaining students interest and promoting student learning.

Programs should incorporate utility knowledge: past studies provide strong evidence that knowledge and attitude based programs have little effect on behaviour change. Nevertheless, the delivery of knowledge as part of a skills-training approach is an important aspect of a program. The type of knowledge provided, however, needs to be relevant to the students, needs to be applicable to their life experiences and needs to be of immediate practical use to them.

Teacher training

Teachers should be training to teach drug education: research suggests that teachers of health and drug education often lack adequate training and confidence when teaching drug education and other controversial health issues. However, teachers are best placed to know their students needs and developmental level and are best placed to incorporate drug education at an appropriate time and level for the students.

Teacher training should involve interactive modelling of activities: research suggests that teacher training that involves the interactive modelling of an intervention's activities increases teachers confidence and ability to teach the program. This type of training allows teachers to experience and identify classroom management and practical issues associated with the program as well as providing them with a model of good practice particularly in relation to debriefing and discussion around key issues.

Research Issues

Although less important in the context of classroom teaching, the following research considerations were adopted as part of the SHAHRP0 research study: fidelity of implementation (how well and how much of the program was taught) was measured and incorporated into analysis and understanding of change; measures of program success were based on realistic student experiences; the research was conducted over a long time period to allow for delays in behaviour change; and analysis incorporated stratification for previous use.

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