Pat Pridmore

Images of health: exploring beliefs of children using the 'draw-and-write' technique

can be adapted for use in different cultural contexts. Two case studies are included which provide an empirical demonstration of the high quality and sophisticated nature of data which can be collected from young children using an innovative method called the ’draw-and-write’ technique. This technique inverts the more traditional ’top-down’ methodology to a ’bottom-up’ approach and has the potential to enable all children to participate and to improve the quality and relevance of the curriculum. However, the technique needs to be used carefully and sensitively if it is truly aiming to treat children

Social capital and healthy urbanization in a globalized world.

This paper critically reviews the extent in which social capital can be a resource to promote health equity in urban contexts. It analyzes the concept of social capital and reviews evidence to link social capital to health outcomes and health equity, drawing on evidence from epidemiological studies and descriptive case studies from both developed and developing countries. The findings show that in certain environments social capital can be a key factor influencing health outcomes of technical interventions. Social capital can generate both the conditions necessary for mutual support and care and the mechanisms required for communities and groups to exert effective pressure to influence policy. The link between social capital and health is shown to operate through different pathways at different societal levels, but initiatives to strengthen social capital for health need to be part of a broader, holistic, social development process that also addresses upstream structural determinants of health. A clearer understanding is also needed of the complexity and dynamics of the social processes involved and their contribution to health equity and better health. The paper concludes with recommendations for policy and programming and identifies ten key elements needed to build social capital.

Exploring children's perceptions of health: does drawing really break down barriers?

A study was conducted in primary schools in London to explore the idea that involving children in drawing as well as writing provided greater insights into their health perceptions than writing alone. Three approaches were used: write only, draw-and-write and label-and-write. All methods provided roughly the same number of categories of response but write-only identified categories more quickly while draw-and-write revealed more on how ideas were interlsnked. Label-and-write provided more information on physical signs of health or ill health and the appearance and use of drugs and foodstuffs. Drawings helped to decipher poor hahdwriting. These findings imply that no single method is best in all contexts and that an imaginative combination of drawing and writing can balance the strengths and limitations of each method. However, the choice of methods must be determined primarily by the questions to be answered and the situational constraints.

Multigrade schooling in 'remote' areas of Vietnam

This paper provides an initial examination of the nature of ‘remote’ multigrade schools and the particular challenges which face teachers in such schools. While multigrade schools in general are recognised as being demanding teaching contexts (Commonwealth Secretariat, 1997), this paper is specifically concerned with contexts where multigrade teaching is further compounded by geographical distance from the hub of the education system and the fact that the students have linguistic and cultural traditions different from those in which the curriculum is embedded. The paper considers the nature of the ‘remoteness’ in this context through an examination of examples from the mountainous region of Northern Vietnam. The paper examines the nature of the different dimensions of ‘remoteness’ and considers how the remoteness can be alleviated for both teachers and students so that multigrade schooling for ethnic minority children can be a qualitative and relevant basic education. This examination is carried out by looking in turn at the characteristics identified by Thomas and Shaw (1992) for the smooth-working of multigrade schools: appropriate texts and materials; effective teaching practices; and teachers who are supported through training programmes.

Tackling the drivers of child undernutrition in developing countries: what works and how should interventions be designed?

OBJECTIVE The present paper presents a synthesis of available evidence to support action on the interventions that can effectively address the main drivers of child undernutrition in developing countries. It also discusses how interventions should be designed and identifies policy-relevant areas for further research. DESIGN A structured literature review of fifty-eight controlled evaluations and studies in developing countries were selected because they are methodologically sound, recent (reported within the past 10 years), report on nutritional status, cover a wide range of interventions and are implemented by a range of different agencies. SETTING Indirect interventions in developing countries, which address the underlying and basic causes of child undernutrition and can potentially be implemented in the short to medium term. SUBJECTS Children under 5 years of age and their mothers across a range of developing countries. RESULTS Evidence has now accumulated to guide action on a range of indirect interventions that can reduce child undernutrition, but for all these interventions context is all-important. There is less evidence on how these interventions can be effectively implemented on a large scale. CONCLUSIONS Efforts should be directed towards improving implementation of effective interventions on a large scale. Donors need to keep commitments both in dollar terms and in terms of the Paris Declaration so that the push for improved nutrition does not become donor driven. At the country level, there is a need for enabling governance structures, institutions and evidence-based decision making. Within countries there is a need for well-trained personnel with delegated authority, accountable to local people. It is essential for chains of accountability to be transparent and for active involvement of households in decision-making processes.

The attitudes of primary schoolchildren in Northern Thailand towards their peers who are affected by HIV and AIDS

Abstract After more than a decade of the AIDS epidemic in Thailand, the number of children whose parents are living with HIV or have died from AIDS is increasing significantly and it has been reported that these children are often discriminated against by their peers. In order to better understand the current situation and to explore possible strategies to support HIV-affected children, this study examined childrens attitudes towards HIV and AIDS using questionnaires and focus group discussions with children in Grades three–six in five primary schools in a northern province in Thailand. A total of 513 children (274 boys and 239 girls) answered the questionnaire and five focus groups were organised. The findings showed a strong positive correlation between childrens belief that HIV could be transmitted through casual contact and their negative attitudes towards their HIV-affected peers. Most children overestimated the risk of HIV transmission through casual contact and this made their attitudes less tolerant and less supportive. After HIV prevention education (which included information on HIV transmission routes) was given in three of the study schools, the same questionnaire and focus groups were repeated and the findings showed that childrens attitudes had become more supportive. These findings suggest that HIV prevention education delivered through primary schools in Thailand can be an effective way to help foster a more supportive and inclusive environment and reduce the stigma and discrimination that decrease educational access and attainment for HIV-affected schoolchildren.

Disrupting patterns of educational inequality and disadvantage in Malawi

Abstract This paper is concerned with the gap in educational provision for vulnerable learners in Malawi who are at risk of falling behind and dropping out of school due to irregular attendance. It draws on a study in high HIV-prevalence areas that explores the patterns of inequality and disadvantage that disrupt learning and uses this knowledge to design a school-based intervention to complement conventional schooling with more open and flexible delivery of the curriculum and increased school and community support. The intervention was implemented over one school year and evaluated using a randomized controlled design. The findings show that the intervention reduced dropout overall by 42% in intervention compared to non-intervention group. These findings suggest that there is a role for more open and flexible models of schooling and support in reducing educational inequalities. However, transforming established practice would require an integrated strategy supported by national policies that recognize the need for schools to change.

Children's Participation in Development for School Health

This paper presents a rationale for childrens participation and argues that their capacity for participation is determined not only by age and by stage of development but also by such factors as gender, religion, ethnicity, wealth and disability. It critically reviews a range of models to measure childrens participation and uses one of these models to analyse the level of participation illustrated in case studies of school health in Nepal, Zambia and Botswana. Finally, it identifies strategies for increasing the level of childrens participation through developing health-promoting schools. It concludes that among the main barriers to childrens participation are the attitudes of adults who have yet to fully realise the value of childrens participation and to develop the skills needed to work with them as partners for health.

Promoting the spiritual development of sick children

This paper considers whether there are aspects of spiritual pedagogy specific to the education of children who are sick and asks how these concerns are to be addressed. The context of the enquiry is England and Wales where the promotion of the spiritual development of children is a legislative requirement. The focus of the study is on sick children whose treatment requires extended stay in hospital. Such children have hardly been noticed in the continuing debate about spiritual education. Our enquiry has involved analysing literature published in English in the UK and North America. We have supplemented this analysis with primary data from semi-structured interviews with three hospital schoolteachers, two hospital chaplains and the founder of a hospice for children and a ‘respice’ for young people. We argue that what emerges as important in the spiritual education of the sick child has significant implications for the spiritual education of all children.

Adapting the curriculum for teaching health in multigrade classes in Vietnam

Multigrade schools play a crucial role in helping countries reach the Millennium Development Goals to reduce poverty by increasing access to education, especially for girls. These schools are often located in remote and disadvantaged areas of the world where teachers live and work in very difficult circumstances with little support from the education system. The multigrade teachers’ workload is increased because they are teaching across more than one grade level in one timetabled period using national curriculum materials that are generally developed with the needs of monograde classes in mind. The curriculum content is presented grade by grade and textbooks are written for teachers to lead whole-class learning through direct teaching. Such monograded presentation of the curriculum greatly increases the workload for teachers, who have to single-handedly take on the work of adapting the curriculum for use in their multigrade classrooms. This chapter asks whether it is fair to expect multigrade teachers to take on this heavy burden and explores how curriculum developers might work with teachers to help share the burden. It reports on a curriculum development exercise undertaken between June 2001 and May 2002 by the National Institute of Educational Sciences (NIES) in Hanoi, in collaboration with multigrade teachers, in response to concerns that multigrade teachers spend too much time preparing lessons and that the quality of the teaching– learning interactions is frequently poor (APEID, 1995; Aikman and Pridmore, 2001; Hargreaves et al., 2001; Son, forthcoming). In this exercise curriculum developers reorganised the primary curriculum for health and developed lesson plans for multigrade teachers using an enquiry-based approach. The reorganised curriculum and piloted lesson plans were then included in a guide to teaching health for teachers of multigrade classes (Son et al., 2002). The aim was that this guide would act as a model for adapting the curriculum in other subjects to meet the needs of multigrade teachers. We would like to acknowledge the strong support given to this initiative by Dr Chau, Director of NIES, and by the British Council in Hanoi.