Health Education students collaborating

Health Education in the 21st Century: A Skills-Based Approach

It is quite common to hear someone lament about “the good ol’ days.” For the field of health education, it can be argued that our best days are ahead of us.

As the field continues to shift from a content-based model of health education to a skills-based approach, we are in an era where students benefit from our efforts because we are now better preparing them to use the knowledge and skills learned in health class to navigate 21st century issues.

To do this, we must reflect on our role as health educators. Given the constraints many of us face in the health education classroom (e.g., not enough time, too many students, lots of important health topics) it becomes even more important to design learning experiences that will stick with students and are transferrable outside of our classrooms.

We must see ourselves as facilitators of learning who guide students through a journey that examines their own health and health behaviors within their personal context and environment.

However, many of us have also learned along the way that our role is to ensure students acquire as much knowledge as possible to improve or maintain their health during their short time with us.

The problem with this thinking is that, unfortunately, knowledge alone doesn’t change behavior.

Increasing Self-Efficacy Through Health Education

Having the skills, competence and motivation to change or employ a behavior is what makes a difference. In fact, research tells us that self-efficacy (one’s belief in their ability to do something) does have a direct relationship to individual behavior change and that helping students to increase their self-efficacy will make a positive difference in their ability to lead health-promoting lifestyles.

For example, if a student does not feel it is within their power to refuse a vape when offered, or that it is impractical (or impossible) to get more a physical activity because they have too much work to do or live in an unsafe neighborhood, then there is little chance they are even going to try.

No amount of teaching them about the dangers of vaping or the ways being physically active is good for the heart will change individual behavior. Rather, spending time allowing students to practice effective refusal skills, developing the language for tricky situations, and recognizing which situations make them more likely to need a refusal is far more beneficial.

Providing students an opportunity to examine their personal activity habits, role of activity on overall health, influences on their personal activity levels, and strategies and opportunities to mitigate factors leading to inactivity will be more likely to build self-efficacy of students related to increasing physical activity.

When we place student learning at the center and design our health education classrooms to support the development of self-efficacy, we set students up for success.

Skill Development in Health Education

In the newly published article, Health Education in the 21st Century: A Skills-based Approach, we provide a foundation for how a skills-based approach can work in the health education classroom, and where the emphasis of the curriculum lies.

As noted in the title, the emphasis is on students’ acquiring the skills to lead healthier lives, using participatory learning experience in the classroom, and including functional information as the context for that skill development.

Skills-Based approach to Health Education Chart

This approach recognizes, similar to what is found in physical education, that if we want students to apply a skill, we must help them develop that skill. Skill development takes time and practice, and we must provide our students with the learning opportunities to apply these skills in meaningful ways.

The below model provides the foundational steps for skill development in the health education classroom:

  • Step 1: Skill Introduction (providing relevance, purpose, and overview of the skill for the population you are working with)
  • Step 2: Presenting the Steps of the Skill (critical elements necessary to apply the skill effectively in a real-world context)
  • Step 3: Modeling the Skill (provide examples of effective skill application)
  • Step 4: Skill Practice (an opportunity for students to use the skill in relevant and realistic situations/contexts with feedback given for improvement)
  • Step 5: Feedback and Reinforcement (using a summative assessment to provide evaluative feedback and measure student’s level of skill performance in a realistic context)

When educators embrace a skills-based approach to health education, students benefit. Their time spent in health class is more relevant, meaningful and applicable to their needs.

This approach recognizes that information will change, personal circumstance may change, and life experiences shape each individual. We must design our health education programs with this in mind.

To set students up for success, let’s design learning experiences that build their foundation for making health-enhancing choices across the lifespan. When you employ a skills-based approach in your health education class, you are doing just that.

Additional Resources

Holly Alperin

Holly Alperin, Ed.M, MCHES, is clinical assistant professor at the University of New Hampshire. Her work in skills-based health education began in early 2000s when she was training health educators on assessing the National Health Education Standards and recognized it was not enough to assess students if they weren’t being taught how to develop the skills in meaningful ways.

Sarah Benes

Sarah Benes, MPH, EdD, CHES, is an assistant professor and program coordinator of the School Health Education Program at Southern Connecticut State University. Sarah works in schools locally and nationally, and writes and presents on various health education topics. She currently serves as SHAPE America president. Reach her on Twitter at @sarahbenes12 or via email at