Exploring health education in Tonga
A Field Study Proposal
Statement of Intent
Through this field study, I hope to explore health education and health services offered at Liahona high school in Tonga. I hope to learn more about teaching and learning approaches used in health classes. By asking specific questions I am able to expand my field study to cover other relevant topics such as health education curriculum, adolescent perceptions on health, and also common health issues among adolescents. Asking different questions will help me answer my focus question. I will look into different aspects of health education to answer my focus question. Some of the questions I would like to ask include: what information and material is emphasized in a health class? What are the class learning outcomes? Where do health teachers get their teaching material from? Is the information appropriate for the age group? What are some of the teaching methods the teacher uses? How do students feel about health class? Are there physical education classes? If so, what activities are included and who participates? What kinds of sports are available? What are the top health problems among Tongan adolescents? What is being done to address those health problems? Is there a nation-wide standard or curriculum for health classes? Asking these questions will help me get an idea of what health education is like in Tonga. I hope to learn more about health education and promotion in Tonga among adolescents.
Background and Significance & Literature Review
Background
Tonga is the only remaining Polynesian kingdom in the South Pacific. Tonga comprises of 176 scattered islands of which less than half are inhabited. More than half of the population resides on the main island, Nuku'alofa. Tonga places value in education as it provides free education for all citizens. Seeing education is an important value in Tonga, I wondered if health education would have that same value. I will be conducting my research at Liahona high school which is part of the Church Education System of The Church of Jesus Christ of Latter-day Saints. Liahona high school was established in 1948 and is ranked one of the top schools in Tonga.
Like everywhere else in the world, Tonga faces its own health problems. In Tonga, non-communicable diseases are one of the main causes of mortality and morbidity. “Overeating and malnutrition are probably the most significant factors in Tonga's health agenda” (Young 2002). Tobacco use has been a growing health issue among Pacific adolescents. Phongsavan, P. et al. (2011) conducted a study examining associations between non-smoking youth and positive emotions. The study concluded that about 54% of Tongan students who participated and did not smoke, also reported feeling very happy about life, having more self-confidence and being more involved in the community. This is significant because it shows possible causes of smoking behavior among adolescents, which may include low self-esteem and not being involved. It also brings about an important point, that schools could play an important role in building self-esteem and involvement among adolescents. Another health issue among adolescents is obesity, due to overconsumption of food and dietary patterns (Fotu et al. 2011). Behaviors adolescents learn and imitate during that time of their lives will be the behaviors they will most likely adopt in the future. The health choices made during adolescent period is critical to their future, as it will shape their future lifestyles. There is one hospital on every island group, including the main hospital in Nuku'alofa. Because there are limited medical facilities in Tonga, health education has an important role in raising awareness about health issues and in preventing health conditions and diseases.
Health education is important to study because it could have a great influence on the health choices people make. In Australia a study was done targeting women at risk of heart disease. They used different strategies including primary health education, which increases knowledge of heart disease risk factors, lifestyle modifications, and examples of dietary improvements. The study concluded that health education was effective as it was shown to influence behavior and choices made by the women who participated (Crouch, R., Wilson, A., & Newbury, J. 2011). Health education leads to protective health behaviors. Another study explored the impact of education on health in relation to an individual's country of birth using the US National Health and Nutritional Examination Surveys between 2001 and 2004. The results indicated that for US residents who were foreign-born, education was associated with a greater beneficial effect on every health outcome compared to those born in the U.S. This study showed that more education is related to positive effects (Seo, B., & Senauer, B. 2011). Public health focuses on education, promotion and research to improve the health of communities. Since prevention is one of the main goals in public health, public health includes educating and promoting healthy behaviors within a community. I will specifically study one of the aspects of health promotion, which is education. Education has the power within a community to help prevent health issues later on in life. Through education, people have the knowledge to gain new skills and make better health decisions. There are different health behavior models that have been used to create public health interventions. Two of the most common strategies used in public health interventions include communication and education. Interventions begin with communication and education to raise awareness of health issues at risk and lead to education.
I hope to look at the material and information emphasized in health classes to determine if there is connection between the information and the actual health problems Tongans face. There is data on Tonga's health according to a global health survey that was taken in 2010, and I hope to compare the results from Liahona high school with the data collected in 2010. Topics which were covered through the global health survey include alcohol use, dietary behavior, drug use, hygiene, mental health, physical activity, tobacco use, and violence and unintentional injury. I also want to look at the health center on campus and look at the kinds of services and information they offer there to the students, and whether or not the center is utilized by students or faculty members. I plan to use qualitative research methods which include observations in classrooms, interviews, and the use of international and national surveys.
Tonga will be a great place to study health education for many reasons. Tonga is still a developing country as it doesn't have the same resources and technology as the U.S and other first world countries. It will be interesting to see how health education is taught and what is emphasized in classrooms. My project is a good fit for Tonga because little research has been done on health education and has the potential to benefit the high school, as it will give them accurate information about their students’ health and understanding of health material.
Methodology/Procedures
I will first have to enter the community and start to build rapport with the people. Some of the things that I could do to build that trust with the community and school include attending church, talking with people of all ages, asking them questions, and helping out in the community when it’s appropriate. I can also build rapport with the school by talking with students, teachers, and staff members and getting to know them.
The methods I will be using out in the field include interviews, observation, and surveys. The subjects in this research will mostly consist of high school students and adolescents that attend Liahona high school. Their ages will range from 13 to 19. I will also be interviewing health teachers and health workers who work at that high school. I will be recruiting students through parental consent forms in which I will be clearly stating my purpose and asking for their volunteer participation. Since I will be working with children, adolescents under 18 years of age, I will provide consent forms for them before giving them surveys and conducting the interview. I hope to conduct unstructured, semi-structured, and focus group interviews where I could ask them questions about what they think about health and the material learned in health class, and whether or not they feel it’s applicable to them. I want to sit in and observe teacher and student interaction, teaching approaches, learning methods, and activities used in health class. I also want to do participant observation and assist the teacher in lesson planning and teaching. I talked with my mentor and he suggested conducting the Global School-Based Student Health Survey which includes topics about alcohol use, dietary behaviors, drug use, hygiene, mental health, physical activity, protective factors, tobacco use, and violence and unintentional injury. I will only be taking out topics I feel will be sensitive for adolescents to answer, and only use specific parts of the survey, which will be questions about dietary behaviors, hygiene, mental health, physical activity and protective factors. The global survey was conducted in Tonga in 2010, and I would like to compare my results from the high school students at Liahona high school with the results found from that survey taken two years ago.
Ethics and Approval
There will be no more than minimal risks. If there are any risks they would come from sensitivity of questions regarding health behaviors. Students at Liahona high school are required to follow specific standards which include honesty, living a chaste and virtuous life, and abstinence from alcohol or illicit drugs. Because of this, I will remove all questions from the survey and my interviews that may be inappropriate to ask and may jeopardize subjects' standing at the school or in the home. I will approach this with the utmost sensitivity and concern of the individuals involved. I will also remind the students that their rights are protected and help them be aware that they can withdraw participation through the consent form.
Preliminary Plans for Post-field Application
This field study will add value to my previous life experiences in many ways. I have been to Tonga twice before to visit family and have developed a stronger love for the Tongan people and the land of my inheritance. Having the opportunity to return to Tonga and be able to work more closely with the people, and doing something I have a passion for, means so much more than a research project. It’s on a personal level. Being full-Tongan, raised in America with greater educational opportunities, I have a strong desire to give back to the people of my heritage. When I was in Tonga for the summer, I developed an interest in the health services that are available to the public, including health education. Through this field study, I will be able to build a network with people involved in public health. One of my long term career goals is to return to Tonga to assist in improving the quality of health services offered. This project will help serve as an introduction into the direction I want to take later on in life. I will be able to build rapport and relationships with health workers there. After completing my field study I hope to come back and further analyze the data, and give it to the high school in Tonga to use if desired.
Qualification and Limitations
I am a public health major and have taken health courses such as Health 100, 310, 335, 437 which include introduction to public health, health promotion, chronic diseases, health behavior models, and methods in health promotion. These courses have prepared me in public health, as I’ve gained more knowledge about the importance of prevention and education, and given me practice in research methods. I had the opportunity to work with adolescents in the past year and am very comfortable with them. I planned activities to help youth become more comfortable with one another and with the leaders. I also assisted in teaching youth basic first aid skills, and helping them gain leadership skills. The youth I worked with are similar with the youth I will be working with in Tonga as they are the same age group and are all members of The Church of Jesus Christ of Latter-day Saints. I am Tongan and proficient in the Tongan language. I will be able to communicate with the people there and be accepted in the community. Through my own experience of being Tongan and previous visits to Tonga, I am aware of the cultural expectations and norms, and therefore culturally competent.
Faculty Mentors and Coursework
I will be the principle researcher and will be doing all my research on my own in the field. I will be keeping in contact with an extremely qualified mentor. Randy Page, from the Brigham Young University Department of Health Science, has conducted his own research among adolescent health behaviors internationally. He has a bachelor's and master's degree in community health education, as well as a PhD. in health education. His areas of specialization include adolescent health, psychosocial risk factors in health behavior, school health, international health, drug abuse and media literacy. He has been involved in teaching health education and community health education over 20 years. Many of his research have been published in well known journals such as the Journal of Youth Studies and International Quarterly of Community Health Education. He has also published books about strategies for teaching school health. He has had international experience in Thailand, Dominican Republic, Hungary, Romania, Poland, China, Philippines and many more places. With his experience and assistance I will be more able to do my own research.
I will take the following courses while out there in Tonga:
IAS 397R
Health 403R
Health 491R
Schedule
April 23-30 Prepare and get things ready for Tonga
May 6 Departure from Honolulu, Hawaii to Auckland, New Zealand
May 9 Arrive in Nuku’alofa, Tonga
August 10 Depart from Nuku’alofa, Tonga to Auckland, New Zealand
August 12 Depart from Auckland, New Zealand to Honolulu, Hawaii
Budget
Works Cited
Albert, C., & Davia, M. (2011). Education is a key determinant of health in Europe: a comparative analysis of 11 countries. Health Promotion International, 26(2), 163-170.
Crouch, R., Wilson, A., & Newbury, J. (2011). A systematic review of the effectiveness of primary health education or intervention programs in improving rural women's knowledge of heart disease risk factors and changing lifestyle behaviours. International Journal Of Evidence-Based Healthcare, 9(3), 236-245. doi:10.1111/j.1744-1609.2011.00226.x
Fotu, K., Millar, L., Mavoa, H., Kremer, P., Moodie, M., Snowdon, W., & ... Swinburn, B. (2011). Outcome results for the Ma'alahi Youth Project, a Tongan community-based obesity prevention programme for adolescents. Obesity Reviews: An Official Journal Of The International Association For The Study Of Obesity, 12 Suppl 241-50. doi:10.1111/j.1467-789X.2011.00923.x
Jones, C. (2004). [The International Union for Health Promotion and Education's Global Programme on Health Promotion Effectiveness]. Promotion & Education, Spec no 133.
Macnab, A., Radziminski, N., Budden, H., Kasangaki, A., Zavuga, R., Gagnon, F., & Mbabali, M. (2010). Brighter Smiles Africa--translation of a Canadian community-based health-promoting school program to Uganda. Education For Health (Abingdon, England), 23(2), 241.
Phongsavan, P., Smith, B., Chey, T., Gilmete, M., Havea, D., & Bauman, A. (2011). Psychosocial profiles of adolescent nonsmokers in the Pacific. Asia-Pacific Journal Of Public Health / Asia-Pacific Academic Consortium For Public Health, 23(1), 57-69.
Seo, B., & Senauer, B. (2011). The effect of education on health among US residents in relation to country of birth. Health Economics, 20(1), 45-55. doi:10.1002/hec.1570
Young Leslie, H. (2002). Producing what in the transition? Health messaging and cultural constructions of health in Tonga. Pacific Health Dialog, 9(2), 296-302.
