ACC RAC ACC RAC 20132013

Promoting health in the third world through very Promoting health in the third world through very low-cost, open-access, online education: an low-cost, open-access, online education: an

innovative learning methodologyinnovative learning methodology Ron Kirk MA , DC Life University- peoples-uni.orgRon Kirk MA , DC Life University- peoples-uni.org

DescriptionDescriptionThis presentation describes:1. An innovative, open-

access, online health promotion module (MPH embedded)

2. Designed to help lessen the health equity gap and build public health capacity in developing nations, especially sub-Saharan Africa

Background: Background: Problems/The Health Equity GapProblems/The Health Equity Gap

1. The gap in health and quality of life between the well-off (people and nations) and the poor (people and nations)

2. Tragically, with rapid globalization (international trade/trade liberalization) and urbanization, the health equity gap is widening. (1-5, 9-11)

Problems: Problems: Resource LimitationsResource Limitations

1. Sub-Saharan African nations lack well-trained public health professionals. (9-11)

2. Resource shortages undercut the ability to build public health capacity and infrastructure. (9-11)

Possibilities: Possibilities: People/Health PromotionPeople/Health Promotion

1. The process of enabling people to gain control of their health and its determinants

2. WHO defines health as a state of complete physical, mental and social well-being not merely the absence of disease

Possibilities: Open-Access, Online Education1. Spreading rapidly globally2. Providing unrestricted access to articles,

monographs and book chapters3. Creating learning resources to increase knowledge

and expertise by minimizing cost and access barriers (12-18)

4. Accessing an extensive network of free, open-source public health educational materials (17)

5. 19,500 open-access scholarly articles in 2000 191,500 in 2009.

6. Open-access journals increased from 740 to 4769 in same period. (17)

Peoples-uni.org: Innovative Peoples-uni.org: Innovative Public Health Education Public Health Education

1. Building public health capacity and health literacy in developing nations

2. Founded in 2007 by innovative public health scholars/advocates/Dick Heller MD, PhD (18)

3. Inaugurated globally in the Bulletin of the World Health Organization

4. Sponsored and accredited through the Royal Society of Public Health (UK)

5. Offered 6 very low cost ($75 each) modules in 2008. Initial modules included: biostatistics, disaster management and emergency planning, introduction to epidemiology, evidenced-based practice, maternal mortality, and prevention of child mortality

6. Currently 18 modules in MPH program/Moodle platform (249 learners/term from 30+ countries)

7. Health promotion module launched in 2011.

ObjectiveObjective• Develop and

implement a successful health promotion module for third world learners

Methods and MentorsMethods and Mentors1. Online discussions, the module coordinator, the program

coordinator, and volunteer mentors developed and organized the health promotion module

2. Structured5 sequential topic units with objectives and open-access learning resources.

3. Mentors facilitate discussion forums through the Moodle platform. (20)

4. Using open-ended key theme questions, mentors/learners engage in interactive learning discussions, enriched by divergent multi-cultural perspectives.

5. Initial mentors-an American clinical psychologist, a UK medical doctor, three health promotion education specialists-UK National Health Service, and a chiropractor/health promotion professor.

6. DC coordinates the module.

LearnersLearners1. Culturally diverse2. Health professionals and

health workers from Africa (Nigeria, Kenya, Ethiopia, Cameroon, Rwanda, Uganda, Zimbabwe, Malawi, Zambia, Sudan, South Sudan, Cote D Ivoire, Botswana), the Mideast (Turkey), Southeast Asia (India, Nepal), Latin America (British Guyana, Trinidad/Tobago) and Europe (United Kingdom)

3. Most learners live in poverty’s steel grip in sub-Saharan Africa.

Learning ResourcesLearning Resources1. Online learning materials include mentor-developed topic

introductions, overviews and more detailed subject delineations.

1. Supported by open-access resource learning materials/links/websites/public health consortiums, such as the Public Health Agency of Canada (http://www.phac-aspc.gc.ca/sehs-acss/index.html) and the Victoria (Australia) government health promotion website http://www.health.vic.gov.au/healthpromotion/evidence_res/evidence_index

1. Zipped learning resource files for off-line study, necessitated by learners’ frequent power outages/loss of web services

Learning Learning Methodologies/TopicsMethodologies/Topics

• 1. Introduction; basic concepts and overview of health promotion

• 2. Values, principles and determinants of health• 3. Theories and strategies of health promotion• 4. Health promotion in practice; planning and implementation• 5. Design your own health promotion project.

• Topics begin with introductory overviews, progress to delineation of theoretical concepts, and then finish with action-oriented, interventions to increase health promotion empowerment. (21-23)

• Include a headline competence (learning outcome) supported by a series of learning assessments/objectives.

• Learner competence is assessed through completion of final assignments, including a detailed health promotion project/plan and 3 topical essays with references.

Big Picture Learning Strategies/ Experiential Empowerment1. Personal leadership in

healthy lifestyle choices2. Lifestyle inventories for

self-assessment (Topic 1)

3. Healthy practitioners are most effective in lifestyle/health promotion counseling (24-28)

Learning Competences• Abridged health promotion learning competences include:• Topic 1• Headline Competence (learning outcome): Develop a systematic understanding

of basic definitions, concepts and key features relating to health promotion and differentiate between different concepts and perspectives, including how to distinguish between Health Education, Health Promotion and Health Promoting Policies.

• Topic 2• Headline Competence (learning outcome): Develop a systematic understanding

of the values and principles underlying the way in which Health Promotion might influence the determinants of health.

• Topic 3 • Headline Competence (learning outcome): Apply knowledge and understanding

of the key health promotion theories, models and strategies for action.• Topic 4 • Headline Competence (learning outcome): Develop a systematic understanding

of the Health Promotion Planning and Implementation Process.• Topic 5 • Headline Competence (learning outcome): Synthesize the learning from previous

topics and apply to the design and implementation of a detailed pilot health promotion plan.

Final Assignment/Project Plan and Essays

1. Pragmatic application2. A detailed, action-oriented, health

promotion plan (1100 to 1400 words) worth 40/100 marks.

3. A well-delineated planning format/cycle including: project overview, issues addressed, rationale, resources, project preparations, situational assessments, goals and objectives, populations of interest, work plan and timeline, identification of strategies and associated activities, outcome indicators, planning review, implementation and monitoring, evaluation and impact.

4. 3 referenced topical essays delineating: a local or regional health issue, a successful health promotion practice and a key social determinant of health.

5. Detailed transparent marking grid

Outcomes: Completion Rates and Marks

• Course Completion Rates 2011/2012• Fall 2011, 13/26 learners (50%) completed

module.• Spring 2012, 15/23 initial learners (65%)

completed module.• Spring term final marks ranged from 56 to 74

(UK System). A mark of 50 is passing. Grades above 70 represent an outstanding effort.

Outcomes: Health Promotion Plans

Personal plans included: 1. Increasing exercise/activity2. Improving dietary choices3. Reducing weight and decreasing

alcohol consumption Community plans included

preventing/treating: 1. Vitamin A deficiency and growth

stunting in children2. Diabetes3. Cervical cancer4. HIV/AIDS5. Malaria6. Chlamydial infections7. Tuberculosis8. Infant diarrhea and guinea worms

Plans also included:• Development of community

gardens1. Initiation of hand-washing and

adult male circumcision campaigns

Discussion: Feedback Surveys and Final Assignments

1. Learner feedback very positive. 2. Most course survey respondents

reported learning more than in a traditional educational setting. Learner responses in this category were the highest of the 18 peoples-uni.org modules.

3. Outcome attributed to the pragmatic health promotion project and detailed structure of the final assignment/ marking grid.

4. Final project plans were inspirational, holding promise for steps towards transformation and health empowerment.

5. Essays were generally well-written and supported by evidence.

Limitations

1. Though learner course feedback responses are positive and promising, they comprise a small sample (approximately 50% of those completing the module).

1. Language issues remain the chief challenge. English is often a second, third or fourth learner language.

1. As expected, learner attrition rates in very low cost, open-access education were high.

1. Barriers include full-time work/extensive social/family commitments/significant health-related disorders common in sub-Saharan Africa and the third world.

Conclusions

1. This health promotion module has been an inspirational experience for learners/ mentors.

2. Open access, online education has potential to empower learners from poverty-stricken areas.

3. The Moodle delivery platform is adaptable and user-friendly

4. Volunteering to teach third world learners can be a transformational experience.

5. Peoples-uni.org is alive and well, fulfilling its mission to build public health capacity in the third world.

References1. Marmot, M., et al., Closing the gap in a generation, Health Equity through action on the social determinants of health; Commission on Social Determinants of

Health, WHO 2008.2. Marmot, M.; Friel, S., Evidence-based public health policy and practice; Global health equity: evidence for action on the social determinants of health, J

Epidemiology/Community Health 2008;62:1095-1097. 3. Vandemoortele, M., (2010) The MDGs and Equity, Overseas Development Institute.4. Human Rights, Health and Poverty Reduction Strategies: World Health Organization (2005).5. World Bank. World Development Report 2012: Gender Equality and Education. (Washington DC: World Bank, 2012). 84.6. John Mirowsky and Catherine E. Ross, Education, social status, and health (New York: Walter de Gruyter, Inc., 2003), 1-50. 7. Woolf, S. H.; Braveman, P. (5 October 2011). "Where Health Disparities Begin: The Role Of Social And Economic Determinants--And Why Current Policies

May Make Matters Worse". Health Affairs 30 (10): 1852–1859. 8. Gee, GC; Payne-Sturges D.. "Environmental health disparities: A framework integrating psychosocial and environmental concepts. Environmental Health

Perspectives". 2004 112: 1645–1653.9. Mohiddin, A.; Johnston, D., HIV/AIDS mitigation strategies and the State in sub-Saharan Africa – the missing link?, Globalization and Health 2006,

Published: 17 January 2006, 10. Shacter, M.; Monitoring and Evaluation Capacity Development in Sub-Saharan Africa: Lessons from Experience in Supporting Sound Governance, Issue

Date: 26-Feb-2009, Publisher - The World Bank.11. Hyder, A. A., et al., The pervasive triad of food security, gender inequity and women's health: exploratory research from sub-Saharan Africa, African Health

Sciences, Vol. 5 - No. 4 (2005).12. Hyder, A. A., et al., The pervasive triad of food security, gender inequity and women's health: exploratory research from sub-Saharan Africa, African Health

Sciences, Vol. 5 - No. 4 (2005).13. Tosh, D., Light, T., Fleming, K., & Haywood, J. (2005). Engagement with electronic portfolios: Challenges from the student perspective. Canadian Journal of

Learning and Technology, 31(3), 89-110 promotes open access education.14. Swan, Alma (2006) The culture of Open Access: researchers’ views and responses. In: Neil Jacobs (Ed.) Open access: key strategic, technical and economic

aspects, Chandos.15. Suber, Peter: Open Access Overview (definition, introduction).blog entry, Earlham.edu. April.16. Iiyoshi, T., Kumar, M. S. V. “Promoting Technology-Enabled Knowledge Building and Sharing to Promote Sustainable Open Educational Innovations -

Opening Up Education: The Collective Advancement of Education through Open Technology, Open Content, and Open Knowledge (Cambridge: MIT Press, 2008).

17. Brown, J. S., Adler R. P., Minds on Fire Open Education The Long Tail and Learning 2.0, Educause Review, January/February 2008. 18. Laakso, M.; Welling, P.; Bukvova, H.; Nyman, L.; Björk, B. C.; Hedlund, T. (2011). Hermes-Lima, Marcelo. ed. "The Development of Open Access Journal

Publishing from 1993 to 2009". PLoS ONE 6 (6): e20961. doi:10.1371/journal.pone.0020961. PMC 3113847. PMID 21695139.19. Heller, R. F., et al., The People's Open Access Education Initiative, Capacity-building for public health, vol.85 no.12, Bulletin of the World Health

Organization, Print version ISSN 0042-9686, Geneva, Dec. 2007.20. Nutbeam, D., Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century,

Health Promotion International, (2000) Volume 15, Issue 3, Pp. 259-2, Oxford University Press (2000).21. Graf, S., List B. - An evaluation of open source e-learning platforms stressing adaptation issues, Learning Technologies, 2005. ICALT 2005.22. Tang KC, Beaglehole R, O’Byrne D, Policy and partnership for health promotion-addressing the determinants of health, Bulletin of the World Health

Organization, December 2005.23. Braunack-Mayer A., The ethics of Community Empowerment: tensions in health promotion theory and practice, Promotion & Education, Vol. 15, No. 3, 5-8

(2008) DOI: 10.1177/1025382308095648.24. Laverick G., Health Promotion Practice-Power and Empowerment, 2004, Sage Publications.25. Frank E., Rothenberg R., Lewis C., Belodoff B.F., Correlates of physicians' prevention-related practices. Findings from the Women Physicians' Health Study.

Arch Fam Med. 2000;9:359-367.26. Nimalasuriya K., Frank E.., Perspectives in Prevention from the American College of Preventive Medicine: A New Key to Improving the Health of Patients and

of the Whole Population: Physicians Preach What We Practice, Medscape Public Health & Prevention. 2006;4(1) ©2006 Medscape.27. Frank E, Breyan J, Elon L. Physician disclosure of healthy personal behaviors improves credibility and ability to motivate. Arch Fam Med. 2000;9:287-290.28. Abramson S, Stein J, Schaufele M, Frates E, Rogan S. Personal exercise habits and counseling practices of primary care physicians: a national survey. Clin J

Sport Med. 2000;10:40-48.29. M. Cifuentes, D.H. Fernald and L.A. Green et al., Prescription for health: changing primary care practice to foster healthy behaviors, Ann Fam Med 3 (2S)

(2005), pp. S4–S12.