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Ethical Challenges in GH Education: David Dudok
 

Ethical Challenges in GH Education: David Dudok

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The Ethics of Short-term Reproductive Health Education: A perspective

The Ethics of Short-term Reproductive Health Education: A perspective
from Arusha, Tanzania

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    Ethical Challenges in GH Education: David Dudok Ethical Challenges in GH Education: David Dudok Presentation Transcript

    • Presented by: David Dudok Olga Wrezel Principal Investigator: Dr. Michael John Co-investigator: Jessica Wylie The Ethics of Short-term Reproductive Health Education – A Perspective from Arusha, Tanzania
    • Out of Africa…
      • MedOutreach 2006 members
        • Student-run organization
        • Medical, dental, nursing students
        • Based in Arusha, Tanzania
        • Summer volunteer project
      • Project component = health education in secondary schools
    • Health education
      • Topics
        • Reproductive health
          • HIV/AIDS, STIs, puberty
        • Substance abuse
        • Nutrition
        • Oral hygiene
      • Three urban secondary schools
      • Two 90 minute sessions
      • Sessions taught in English
      • Over 590 students
        • age range 13-20
        • Form II-IV
    • Is our teaching effective, furthermore ethical?
    • To ethics and beyond…
      • Target age group
      • Ability to apply information (e.g., access)
      • Length of teaching term
      • Language barrier
      • Cultural differences
      • Teaching methods
      • School teaching restrictions
      • Redundancy
      • Teaching from the curriculum
    • Methods Draft survey, ethics submission June 2006 Ethics approval, Swahili translation in TZ July 2006 Teaching sessions + survey admin August 2006 Data analysis Manuscript preparation ongoing
    • Survey sample
      • SURVEY OF EDUCATIONAL EFFECTIVENESS
      • REPRODUCTIV E HEALTH
      • Form/ kidato ________
      • Age / umri _________
      •  Male/ mwanamume  Female/ mwanamke
      • dogo/hata moja a kadiri ingi
      • Little/none Some A Lot
      • 1 2 3 4 5
      • 1. How much did you know about the subject before the presentation? ( Ulikuwa unajua kwa kiasi gain kabla ya kufundishwa somo hili?) 1 2 3 4 5
      • 2. Who told you about the subject? ( Nani aliyekufundisha?)
      • __ Family/ jamaa __ Teacher/ mwalimu __ Friend/ rafiki __ Doctor/ daktari __ TV __ Other/ ingine
      • 3. How comfortable did you feel talking about the subject before? ( Ulifurahiaje kuzungumzia somo hili kabla?)
      • 1 2 3 4 5
      • 4. Before the presentation, to whom did you feel comfortable talking about the subject? ( Kabla ya mjadala huu, ni nani ambaye ulizunguma naye kwa uhuru juu ya somo hili?) (Check all that apply/ Teua zaidi ya moja iwapo a kuhusu )
      • __ Family/ jamaa __ Teacher/ mwalimu __ Friend/ rafiki __ Doctor/ daktari __ Other/ ingine __ No one/ hapana mtu
      • 5. How much did you understand about the subject before the presentation? ( Ulifahamu kwa kiasi gain kabla ya somo hili?)
      • 1 2 3 4 5
      • 6. How comfortable would you feel asking the presenters questions? ( Unadhari unajisikiaje kuwauliza maswali wafundishaji?)
      • 1 2 3 4 5
      • 7. If any demonstrations were used, how much did they help you understand the subject? ( Iwapo vingetumika vielelezo au mifano, inge kusaidiaje kuelewa vizuri zaidi somo hili?) 1 2 3 4 5
      • 8. Do you feel you need more information on the subject? ( Unahitaji ufafanuzi zaidi kuhusu somo?) Yes Ndiyo No Hapana
      • If yes, what more would you like to know about this topic? ( Kama ndiyo, ungependa kufahamu nini zaidi kuhusa mada hii?)
      • ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
      • 9. How much do you feel you know about the subject now (Umeelewa kwa kiasi gani baada ya somo hili)? 1 2 3 4 5
      • 10. If you have had sex ( Iwapo umewahi kufanya mapenzi):
      • a. how old were you the first time (vaginal or anal sex) ( Ulikuwa na umri gain)? _______________
      • b. how many sexual partners have you had ( Umekuwa na wapenzi wangapi) ? _______________
      • c. every time, have you used a condom ( Kila wakati ultumia condom) ? Yes Ndiyo No Hapana
      • d. if you have not used a condom, why not ( Kama hukutumia condom, kwa nini) ? ____________________________________________________________________________________________________________________________________________________________­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­____________________________________
      • 11. If you needed a condom ( Iwapo unahitaji condom) :
      • a. where could you get one ( unaweza kuipata wapi) ? _____________________________________________________
      • b. are they difficult to get ( je, ni vigumu kuzipata) ? Yes Ndiyo No Hapana
      • c. if yes, why ( kama ndiyo, kwa nini) ? ________________________________________________________________________________________________
      • ________________________________________________________________________________________________
    • Results
      • N=479 (M 217, F 221, 41 blank)
        • Mean age = 16.2 ± 1.2
        • 117 Form II , 289 Form III, 73 Form IV
      • 78 reported having had sexual intercourse;
        • mean first age = 13.29 ± 4.32
        • mean number sexual partners = 2.45 ± 2.60
    • Q1: How much did you know about the subject before the presentation? Q3: How comfortable did you feel talking about the topic before the presentation? Q5: How much did you understand about the topic before the presentation? Q6: How comfortable did you feel asking the presenters questions? Q7: How useful were the demonstrations used? Q9: How much do you know about the subject after the presentation?
    • Knowledge Improvement On knowledge of reproductive health before and after the presentations, 307 ( 70.6% ) reported improvement.
    •  
    •  
    •  
    • Self-rated Accessibility of Condoms Accessibility in sexually-active individuals = 73.1% Accessibility in abstinent individuals = 60.6%   all individuals sexually active individuals sexually active - always use condom sexually active - don't always use condom difficult 40 15 7 8 not difficult 300 57 23 34 no answer 139 6 3 2 Total 479 78 33 44
    •  
    • To ethics and beyond…(again)
      • Target age group
      • Ability to apply information (e.g., access)
      • Length of teaching term
      • Language barrier
      • Cultural differences
      • Teaching methods
      • School teaching restrictions
      • Redundancy
      • Teaching from the curriculum
    • Conclusions
      • ● The presentations were effective as measured by subjective knowledge improvement
      • ● Teachers are a major source of reproductive health information
      • ● A significant majority reported abstinence
      • ● Most sexually-active students rated condoms accessible
      • From an ethical perspective, short-term presentations appear to be an appropriate vehicle of reproductive health education in this student population.
    • Questions? Thank you