Strengthening HFLE

STRENGTHENING
HEALTH AND FAMILY LIFE EDUCATION

IN THE REGION
The Implementation, Monitoring, and Evaluation of
HFLE in Four CARICOM Countries
UNICEF|BECO|2006|McClean-Trotman
UNICEF|BECO|2003|Baldeo
UNICEF|BECO|2009|King
Published by the
United Nations Children’s Fund, Barbados and the Eastern Caribbean Office
First Floor, UN House, Marine Gardens, Christ Church, Barbados.
Tel |246| 467-6000 Fax |246| 426-3812

email bridgetown@unicef.org
website www.unicef.org/barbados
© UNICEF. All rights reserved 2009
The statements in this publication are the views of the author(s) and may not necessarily
reflect the policies or the views of UNICEF.
STRENGTHENING
HEALTH AND FAMILY LIFE EDUCATION
IN THE REGION
The Implementation, Monitoring, and Evaluation of

HFLE in Four CARICOM Countries
Acknowledgements
The UNICEF Barbados and Eastern Caribbean Office wishes to express appreciation for the input
from numerous teachers, HFLE Coordinators and other technical staff and consultants whose
valuable expertise and insights helped in the design and implementation of this Evaluation.
These include:
The Technical Team in Health and Human Development Programs at Education Development Center,
Inc.who served as Lead Consultants for the Curriculum Development and Evaluation, namely: - Ms.
Connie Constantine, Senior Project Director; Dr. Ann Stueve, Senior Evaluator; Dr. Lydia O’Donnell,
Principal Investigator; Dr. Gail Agronick, Evaluator; Dr. Cheryl Vince-Whitman, Technical Monitor
Dr. Jennifer Crichlow, HFLE Consultant and Ms. Elaine King, UNICEF/BECO Adolescent and HIV/
AIDS Specialist who worked closely with countries in developing lessons, facilitating teacher training
and carrying out classroom observations and relevant informant interviews.
Dr. Morella Joseph, Deputy Programme Manager, Human Resource Development, CARICOM who
provided technical inputs and worked with countries to support the implementation process.
HFLE Country Coordinators – Ms. Maureen Lewis, Antigua; Ms. Patricia Warner, Barbados;
Ms. Hermione Baptiste, Grenada; Ms. Arthusa Semei, HFLE Coordinator, St. Lucia – who supported
national processes and provided invaluable leadership in training teachers as well as classroom
monitoring and support.
The contribution of myriad teachers in CARICOM countries who worked tirelessly to develop, review
and test the lessons in classroom.
A special thanks is due to the many teachers and students in participating schools who provided input
and made this project possible.
Concept, design and layout of this study was done by Cullen J. Kong of Whirlwind Designs-Barbados.
UNICEF|BECO|2008|Knight
Table of Contents
I. Executive Summary ………………………………………………………. 1
II. Introduction to Study and Goals………………………………………… 13
III. Evaluation Methodology………………………………………………….. 17
IV. Findings from Process Evaluation……………………………………... 23

V. Monitoring Student Health Indicators………………………………….. 38

VI. Findings from Impact Evaluation……………………………………….. 44
VII. Challenges and Recommendations ……………………………………. 60
Student Survey Data

»» Appendix 1 Antigua & Barbuda Form 1 Student Baseline Survey 64
»» Appendix 2 Antigua & Barbuda Form 3 Student Baseline Survey 84
»» Appendix 3 Barbados Form 1 Student Baseline Survey 104
»» Appendix 4 Barbados Form 3 Student Baseline Survey 124
»» Appendix 5 Grenada Form 1 Student Baseline Survey 144
»» Appendix 6 Grenada Form 3 Student Baseline Survey 164
»» Appendix 7 St. Lucia Form 1 Student Baseline Survey 184
»» Appendix 8 St. Lucia Form 3 Student Baseline Survey 204

I. Executive Summary
1
Rationale for Study

Globally, several studies have pointed to the positive impact that life skills-based health
education programmes have on the attitudes and behaviours of young people, but
no such evaluation had been conducted in the Caribbean. With the development of
a Regional Curriculum Framework to support the delivery of Health and Family Life
Education (HFLE) in CARICOM countries, it was considered an opportune time to not
only monitor the implementation of the Framework but to also assess its impact on
students. This evaluation was therefore designed to document the implementation and
impact of the initial roll-out of the revised HFLE Curriculum for students in Forms 1, 2, and
3 of secondary/junior secondary schools in selected countries - Antigua and Barbuda,
Barbados, Grenada, and St. Lucia. To ensure comparability of data, specific lesson plans
- referred to as the Common Curriculum - were developed for use in these countries.
Curriculum Development
Building on learning and resources from programmes in the region, a Common
Curriculum, with specific interactive, life skills-based classroom lessons, was developed
for two HFLE themes Self and Interpersonal Relationships and Sexuality and Sexual
Health, which addressed the issues of violence and HIV and AIDS. Taken together, these
Themes aimed to provide students with the knowledge and skills to not only promote
healthy behaviours but contribute to success in school and beyond. Using the Regional
Curriculum Framework as a guide, HFLE Coordinators and educators worked together
to develop and then refined coordinated lesson plans for Forms 1-3. Lessons in Form 1
provided a foundation that was reinforced and built on as students got older and faced
new challenges. This “spiralling” assured that content and core skills were covered each
year at developmentally appropriate levels.
Research on health promotion and education shows that benefits are more likely to be
achieved when programmes have a strong theoretical grounding. The foundation for a
life skills approach is based on multiple theories of child and adolescent development,
cognitive learning, and social influences. These have depicted how knowledge, attitudes,
and skills can help youth avoid problem behaviours and foster personal resiliency to
counter risks and negative peer pressures. Previous studies have demonstrated that
competence in the use of life skills may reduce the chances of young people engaging in
2 STRENGTHENING HEALTH AND FAMILY LIFE EDUCATION IN THE REGION
aggressive and anti-social behaviours, substance use, and related risks, including early
and unprotected sexual intercourse. These, in turn, have serious and often life-long
health and social consequences (UNICEF, 2000; World Health Organization, 2003).
By providing life skills education in Forms 1-3, students had opportunities to practice skills
they needed, both then and in the future. In addition to being theoretically grounded,
the extensive, collaborative development process helped to ensure that the Common
Curriculum was culturally appropriate to the life experiences of adolescents in the
Caribbean. Critical health issues are tackled through participatory activities that are both
timely and relevant—for schools, families, and students. Care was also taken to ensure
that lessons addressed gender differences in both development and challenges faced.
Finally, the fully-scripted lessons were designed so they can be used by teachers, even
if they have relatively little experience delivering health education or leading interactive
activities, as was often the case.
To support teachers, a companion training manual was developed, and training sessions
were offered annually in the participating countries. Back in their classrooms, these
trained teachers facilitated interactive exercises designed to build life skills, including
critical thinking, problem solving and decision making; communication, negotiation and
refusal skills; healthy self-management, coping, and help-seeking. This focus is supported
by research that shows that youth who fail to acquire these skills are more likely to
engage in unhealthy behaviours, such as violence, early sexual risk taking, and abuse of
alcohol and drugs, and to be at higher risk of poor academic performance.
Evaluation Study Objectives

By implementing the Common Curriculum in diverse school settings and countries, the
overarching goal was to have a positive impact on student health. Consistent with a logic
model that guided the development of the curriculum and its evaluation, improved student
health would, in turn, ultimately improve students’ school attendance and enhance their
learning outcomes. Toward this end, this evaluation study sought to:
◊ Monitor the implementation of the Common Curriculum
◊ Assess the impact of this curriculum on student outcomes

3
Methodology
Two types of evaluation were conducted. The process evaluation
documented the Common Curriculum lesson development, teacher training
and implementation. This generated information to guide refinement of the
curriculum and training materials for dissemination. The impact evaluation
assessed student outcomes resulting from curriculum implementation. The
data collected also provided useful information about student knowledge,
attitudes, skills and behaviours at the regional level. These data can be used to
monitor student health and inform programme and policy initiatives.
The process evaluation included interviews with school administrators and

HFLE Coordinators, periodic observations of teachers delivering Common
Curriculum lessons, and teacher and student unit assessments completed in
the intervention schools after each unit was taught. Teachers were asked to
provide feedback about what worked and what needed to be improved.
The impact evaluation employed a quasi-experimental pre-post matched pairs

design to examine the impact of the Common Curriculum implementation on
students. This sought to answer the question: Do students in intervention
schools report more positive attitudes and norms, greater knowledge, more
life skills, and fewer risky behaviours than students in their paired comparison
schools?
Two critical factors shaped the context in which this question was addressed. The evaluation
First, the Common Curriculum was designed to supplement - not supplant - compares
other ongoing efforts in the region to train teachers on the HFLE Framework
“standard
and support the delivery of life skills education. Thus, the evaluation compares
“standard practices” that, in most schools, includes delivery of health education practices”
with the provision of “enhanced” Common Curriculum lessons. While this that, in most
comparison may mute differences in student outcomes between delivery schools,
of standard practices and the new intervention, it acknowledges that health
includes
education efforts, guided by the Regional Framework, have been underway in
the Caribbean. Second, this curriculum was developed in tandem with carrying delivery
out evaluation activities. That is, lessons were developed, revised, and refined, of health
informed by the process evaluation. Teachers were trained and delivered education with
lessons for the first time during the impact evaluation period, while they still the provision
were becoming familiar with the new content and pedagogy. of “enhanced”
Common
Curriculum
lessons.
Country Coordinators and Ministries in Antigua and Barbuda, Barbados,

Grenada and St. Lucia each identified three pairs of schools that were
similar in terms of size, urban/rural location, academic performance,
gender composition, and perceived student behavioural risk. All schools
selected were willing and had the capacity to implement the intervention and
evaluation procedures. Administrators agreed to:
◊ Assign teachers to lead two forty-minute HFLE periods per week

“[HFLE Class]
(timetabled).
teaches you
about life and
◊ Expose students to three years of the reinforcing, spiralling Common
mostly about
Curriculum.
yourself, and
it teaches you
◊ Ensure that teachers who teach the Common Curriculum would
how to handle
receive basic training in HFLE provided annually by the HFLE Country
situations
Coordinator.
which may
occur in life.”
Form 2 Student
Intervention schools began implementing the new HFLE Common
Curriculum with all Form 1 students during the 2005–2006 school
“I enjoyed
year. Form 2 was implemented during the 2006–2007 school year, and
seeing the
Form 3 was implemented during the 2007–2008 school year. Thus, the
students
Common Curriculum was introduced in stages. Each year, teachers
come alive
in the intervention schools were offered training on the new Self and
with authentic
Interpersonal Relationships and Sexuality and Sexual Health lessons. In
pedagogy
the comparison schools, students received standard HFLE or other health
as opposed
classes that were already part of the curriculum. As with the Common
to text book
Curriculum, what was taught in the comparison schools was often guided by
information
the HFLE Regional Curriculum Framework.
that is dry
and boring.” -
HFLE Common
Curriculum
Teacher.
5
Process Evaluation
With input from teachers and HFLE Coordinators the HFLE Regional Curriculum
Framework was translated into fully scripted, interactive, skills-based, spiralling lessons
for Forms 1-3 on the selected content themes - Self and Interpersonal Relationships
and Sexuality and Sexual Health. A total of 40 Form 1 lessons were initially developed
for the two units, based on initial in-country assessments of what was possible and
important to cover. However, based on teacher feedback and observations, it became
apparent that less classroom teaching time was available than at first assumed.
Therefore, 10 lessons per unit were developed for Forms 2 and 3. Throughout the study,
feedback from teachers and Country Coordinators was incorporated into a final, revised
package of lessons for dissemination, with 10 lessons per unit for each Form.
During Year 1, a Training of Trainers was attended by Country Coordinators,

representatives of teacher colleges, and others. Following this event, multi-day trainings
in each country were led by Country Coordinators; training days were observed by
UNICEF and EDC staff. Based on feedback from the first-year implementation, a Training
Manual was created to help assure teachers were prepared similarly across countries.
In the intervention schools, student and teacher unit assessments were collected at
five different points in time. Participating students per assessment ranged from 714 to
1279 and participating teachers ranged from 9 to 17. Periodic classroom observations
in intervention and comparison classrooms were conducted, although due to resource
constraints, fewer observations were held than planned. Baseline and follow up teacher
surveys were conducted; 42 teachers completed baseline surveys. At follow up, 21
teachers completed surveys. Administrator and Country Coordinator end-of-year surveys/
interviews were conducted as time and resources allowed. Taken together, these
evaluation activities documented the process of implementation and its challenges.
Overall, teachers were very enthusiastic about the Common Curriculum; most were
comfortable with lesson content. Teachers reported students were engaged in activities
and learned new things. They felt lessons were developmentally and culturally
appropriate and covered important topics. Results for student unit assessments are
consistent with these findings. Further, most teachers felt that the lessons would have a
“moderate” or “large” impact on students, and a majority said they would be “very likely” to
recommend lessons to their peers.
Examples drawn from classroom observations conducted by Coordinators document this

enthusiastic reception.
For example, as one observer noted:
“The students demonstrated their knowledge of the skill using the scenario, but
more important were their attitudes and opinions on cell phone availability, use and
misuse, and the rules they believe should be put in place. They then utilized critical
thinking and highlighted a number of other issues… peer pressure to have the
latest and more expensive [things], envy and conflict, stealing, bullying, breakup of
friendships because of gossip, inappropriate ways of acquiring the phones or the
money to do so. The discussion was spirited, but focused. The continuing activity
was for them to write letters to authorities on the topic of whether cell phones should
be allowed in schools.”
Despite enthusiasm, teachers expressed concerns throughout the study about

Nearly 60 per
whether there was enough time to complete lessons. Indeed, only 20-35 per
cent of the
cent of teachers said lessons fit teaching time. Teachers had ongoing problems
intervention
with scheduling HFLE class time, disruptions and time management. This
school
raises issues about whether sufficient time is allocated for HFLE (or can be,
teachers, but given other priorities and school schedules). Many teachers had little classroom
less than 20 experience, or any experience using the pedagogic, interactive strategies that
per cent of are integral to Common Curriculum. Further, there was substantial teacher
comparison turnover from year to year, as well as some turnover within a year that impeded
school lesson completion. Late teacher assignments made advanced planning for
teachers, said training difficult.
HFLE is more
important Despite these challenges, the Common Curriculum had a positive impact on
than other practice at the intervention schools. Overall, these teachers reported receiving
subjects. At more HFLE training than comparison school teachers (even though teachers
the end of the in the intervention schools had reported less training at baseline). They also
study, virtually reported higher levels of preparedness to teach HFLE, and greater comfort
teaching HFLE topics.
all teachers
By follow up, nearly 60 per cent of the intervention school teachers, but less
wanted
than 20 per cent of comparison school teachers, said HFLE is more important
additional
than other subjects. Also, fewer reported administrative barriers to teaching
training on
HFLE. Moreover, at the end of the study, virtually all teachers—in both
HFLE. intervention and comparison schools—wanted additional training on HFLE.
7
Impact Evaluation
Over 4000 student surveys were collected to inform the impact evaluation. As shown
below, during Fall 2005, 2364 Form 1 students completed baseline surveys. During
Spring 2008, 1909 Form 3 students completed follow up surveys.
Country Form 1 (2005) Students Form 3 (2008) Students
Antigua and Barbuda 299 135
Barbados 698 488
Grenada 525 583
St. Lucia 842 703
TOTAL SAMPLE 2364 1909
Students were an average age of 12.0 years at the baseline Form 1 Survey; students surveyed at
the Form 3 follow up were an average age of 14.7 years. All students present on the day of survey
administration completed surveys. In addition to informing impact evaluation, results from surveys
provide the region with information about the attitudes, knowledge, and behaviours of youth as they
advance from Form I to Form III.
The curriculum was intended to be a three-year programme. However, more students than
expected may not have attended the same school for Forms 1, 2 and 3, making it difficult to assess
level of exposure to the Common Curriculum, which was intended to be a three-year intervention.
Nonetheless, there is a significant and positive difference in HFLE exposure: Virtually all students in
the intervention schools (96 per cent) reported they had HFLE in prior years, compared to 81 per cent
of those in the comparison schools.
Planned analyses, comparing matched pairs of schools, reveal no pattern of significant positive
effects of the Common Curriculum on Form 3 students’ self-reported attitudes, behaviours, and skills
in health domains related to the themes of Self and Interpersonal Relationships and Sexuality
and Sexual Health. Multiple outcomes were examined, including peer norms, attitudes, and refusal
skills related to substance use, violence, and sex; lifetime and recent reports of risk behaviours; HIV/
AIDS related knowledge and stigma; and self-reported life skills related to interpersonal relationships,
sexual relationships, and help-seeking from adults. Findings from additional descriptive and
multivariate analyses provide similar results.
While this evaluation of HFLE has not identified a consistent pattern of positive effects on
student health outcomes, there are no significant negative effects either. That is, student
reports are very similar across conditions. However, it is important to note that there may
be benefits that were not assessed. Moreover, findings may reflect initial implementation
difficulties that were experienced during the roll-out of the Common Curriculum, as well
as the difficulty of showing differences between the “standard” health education provided
to students in the comparison condition and the “HFLE enhanced” lessons in the new
curriculum. Once a programme is institutionalized and teachers have experience
in its delivery, more benefits may be identified. This calls for ongoing monitoring of
implementation, fidelity, and outcomes.
Limitations and Challenges of the Study

Multiple factors can influence the outcome of a study, particularly in the real-life settings
of schools and classrooms, where there are competing priorities and complex demands.
Here, attribution of outcomes to the intervention was complicated by a number of
significant implementation challenges. These include the fact that lessons were not
fully implemented in any year, finding time to teach remained problematic, and ongoing
problems with teacher selection, turnover, and training persisted. Further, all teachers
in intervention schools and comparison schools received basic training in HFLE. Topics
taught in intervention and comparison schools were at times similar, placing the emphasis
on discerning differences in pedagogy. Although information was obtained on the process
of lesson implementation during each Form (i.e., through unit assessments completed
by teachers and students and a small number of classroom observations), process
information was relatively limited. For example, there was not systematic collection of
data on such variables as what lessons—or pedagogy—worked best or were preferred
by teachers and students, what social and environmental factors may have influenced
effectiveness (e.g., frequency/length of classes, classroom composition). In future studies,
examination of these factors may yield important information for supporting implementation
and improving student outcomes.
At this time, there is insufficient evidence to conclude that implementation of the Common
Curriculum in the four countries has resulted in a measurable impact on student health
indicators. However, this does not mean that HFLE is not working or that it is unimportant
for students’ health and well-being. Rather, during the initial years of developing
and implementing the Common Curriculum, the evaluation did not detect significant
improvements over standard HFLE practices (as delivered in comparison schools).
9
However, many lessons were learned about the process of classroom implementation
and challenges faced by schools and teachers in the initial stages of programme
adoption. Future evaluation will help document progress in meeting these challenges
and monitor the benefits to students when lessons are fully implemented and effectively
delivered.
In addition to focusing on differences between schools adopting the Common Curriculum

and those in the comparison condition, there are multiple ways that information
obtained can be used to further efforts in the region. Each of the participating countries
has obtained valuable data on student health indicators to inform policy and practice
directions; these data can also be used to establish a baseline for monitoring trends over
time. Finally, documentation of both the successes and obstacles faced by schools and
teachers as they implemented the programme can inform dissemination efforts.
Recommendations
The evaluation of the implementation and impact of efforts to introduce a Common
Curriculum that supports the HFLE Regional Curriculum Framework has provided
many lessons for informing future directions. It also raises critical questions that need
to be addressed at the Ministry level to maximize the success of dissemination and
provide the infrastructure needed for full delivery. The findings in the preceding sections
identify challenges both with regard to the scope of the HFLE Common Curriculum and
with regard to the process of school adoption and implementation. Addressing these
challenges is critical if schools are to be effective in teaching students the life skills that
will promote their health and well-being and contribute to school success.
One set of challenges pertains to the curriculum. Documentation of implementation

challenges raises questions regarding: How many units (and lessons within a unit) can be
realistically taught per year? Can and should this time allotment be the same for all three
Forms? What “dosage” of HFLE is likely to maximize benefits for students? Should the
health targets of units and lessons be narrowed to assure that priority health problems,
such as violence and HIV/AIDS, are sufficiently addressed?
Another set of challenges pertains to implementation. Difficulties of achieving full

implementation raise questions that must be considered at the Ministry and school level.
For example: How can a cadre of teachers be identified, trained, and retained to deliver
effective lessons?
How can lesson delivery be monitored to support fidelity and increase

effectiveness? What Ministry and school administrative support is needed to assure
implementation? Since students change schools, how can school programmes,
such as this curriculum be implemented country-wide?
As these broader questions are being addressed, there are several concrete steps that
can be taken to move HFLE efforts forward:
First, this study has shown that implementation issues are a major factor in all pilot
countries. Therefore, the success of HFLE relies on the ability of Ministries to sustain
support for HFLE and ensure that HFLE is timetabled into classroom schedules and that
this schedule is adhered to. In addition, both Ministry and local school administrator
support is needed to ensure early selection of teachers and allow time for training.
Training is critical to success, given the sensitivity of much of the content covered and the
fact that many teachers had not previously led interactive, participatory exercises.
Second, observations and documentation of classroom delivery support the importance

of providing a standardized curriculum, as done here. The availability of a fully scripted
curriculum facilitates lesson delivery in a way that a Regional Curriculum Framework alone
does not. This is especially important when, as is often the case, there is teacher turnover
and many teachers assigned to HFLE have limited experience either with the content or
pedagogy. It is notable that teachers and students welcomed the interactive, participatory
approaches of HFLE as well as the activities that were incorporated in the Common
Curriculum.
Third, even with specified lessons, classroom delivery varied across countries, schools,
and classrooms. To maximize benefits to students, monitoring and documenting classroom
implementation is important for assuring that the goals of the Regional Curriculum
Framework and Common Curriculum are addressed and the lessons are taught with
sufficient fidelity to maximize effectiveness.
11
Fourth, competing priorities for classroom time must be balanced with the goals of
HFLE. In this evaluation, only two HFLE units were developed, delivered and evaluated;
it was difficult for many teachers to implement 10 lessons per theme. However, two other
themes — one addressing eating and fitness and the other, managing the environment —
are also regional priorities. For these four themes to be addressed, it will be important to
make hard decisions about what and how much can be covered in each Form.
Finally, findings point out the need to better understand the many factors that influence
implementation, fidelity to the Common Curriculum, and outcomes achieved. In addition
to documenting effectiveness as dissemination proceeds, it is important to learn from
and attend to the realities of what happens in classrooms, and how teachers can be best
prepared and supported in the delivery of life skills-based health education.
In sum, this evaluation marked a positive step forward in developing and documenting
classroom implementation of a HFLE Common Curriculum. Findings are the result of
successful, multi-year, collaborative efforts across the region and within each participating
Ministry and school, and underscore both the challenges and potential of coordinated
curriculum and training approaches to meet student health needs.
UNICEF|BECO|2009|Beckles
II. Introduction to Study

and Goals
13
G
lobally, several studies have pointed to the positive impact that life skills-based
health education programmes have on the attitudes and behaviours of young
people, but no such evaluation has been conducted in the Caribbean. While a
Regional Curriculum Framework to support Health and Family Life Education (HFLE)
guides country efforts, CARICOM, UNICEF, and the Ministries of Education and HFLE
Coordinators in four countries (Antigua and Barbuda, Barbados, Grenada, and St.
Lucia) identified the need for a Common Curriculum to support the delivery of classroom
lessons. This evaluation was designed to document the development, implementation
and impact of the initial roll-out of this Common Curriculum for youth in Forms 1, 2, and 3,
when life skills become critical in helping students avoid risks and make healthy choices
that protect their futures.
HFLE is a comprehensive, life skills-based programme, which focuses on the

development of the whole person in that it:
»» Enhances the potential of young persons to become productive and contributing adults/
citizens.
»» Promotes an understanding of the principles that underlie personal and social well-being.
»» Fosters the development of knowledge, skills and attitudes that make for healthy family life.
»» Provides opportunities to demonstrate sound health-related knowledge, attitudes and

practices.
»» Increases the ability to practice responsible decision-making about social and sexual
behaviour.
»» Aims to increase the awareness of children and youth of the fact that the choices they make
in everyday life profoundly influence their health and personal development into adulthood.
Research on health promotion and education shows that benefits are more likely to be
achieved when programmes have a strong theoretical grounding. The foundation for a
life skills approach is based on multiple theories of child and adolescent development,
cognitive learning, and social influences. These have depicted how knowledge, attitudes,
and skills can help youth avoid problem behaviours and foster personal resiliency to
counter risks and negative peer pressures. Previous studies have demonstrated that
competence in the use of life skills may reduce the chances of young people engaging in
aggressive and anti-social behaviours, substance use, and related risks, including early
and unprotected sexual intercourse. These, in turn, have serious and often life-long health
and social consequences (UNICEF, 2000; World Health Organization, 2003).
Building on learning and resources from past efforts in the region, a Common Curriculum,
with specific interactive, life skills-based classroom lessons, was developed for two HFLE
content themes: Self and Interpersonal Relationships, and Sexuality and Sexual Health.
Selected in collaboration with the Ministries of Education, these two themes address
priority health issues of violence and HIV /AIDS. Taken together, they aim to provide youth
with knowledge and skills that promote healthy behaviours and contribute to school and
future success. Using the Regional Curriculum Framework as a guide, HFLE Country
and Regional Coordinators and educators came together to develop and then refine
coordinated lesson plans for Forms 1-3. Lessons in Form 1 provide a foundation that
is supplemented and reinforced as students get older and meet new challenges. This
“spiralling” assures that content and core skills are covered each year at developmentally
appropriate levels, as students’ sophistication to apply these skills increases.
By providing life skills education in Forms 1-3, students have opportunities and hours to
practice skills they need, both now and in the future. In addition to being theoretically
grounded, the extensive, collaborative development process helped assure that the
Common Curriculum is culturally appropriate to the life experiences of adolescents in the
Caribbean. Critical health issues are tackled through participatory activities that are both
timely and relevant—for schools, families, and students. Care was also taken to assure
that lessons address gender differences in both development and challenges faced.
Finally, the fully-scripted lessons are designed so they can be adopted by teachers, even
if they have relatively little experience delivering health education or leading interactive
activities, as is often the case.
15
The study builds upon a foundation of ongoing collaborative efforts among CARICOM,
UNICEF, and EDC. Whilst EDC/HHD is providing overall technical guidance, key
CARICOM stakeholders are actively involved in the study. It was essential to engage
decision makers in the implementation process and to obtain their commitment of
resources needed to successfully develop, implement, and evaluate the Common
Curriculum. Thus, leaders from each country—Ministers of Education, Chief Education
Officers, representatives from National AIDS Committees, HFLE Coordinators, and
principals from participating schools—were brought on board as early as possible in the
evaluation design. Responsibilities and outcomes for participation in and support of the
project were agreed to and finalised at the highest level. As a result, a strong network of
sub-regional support is being established to monitor HFLE curriculum implementation
and to provide more immediate hands-on technical assistance to the countries. The
participation of these stakeholders is helping to build capacity in the region to develop
and implement similar studies in the future. It is also contributing to a continuity of
leadership in this work that will ease the curriculum’s expansion to other Caribbean
countries.
By implementing the curriculum in diverse school settings and countries, the study’s
over-arching goal is to have a positive impact on student health. Improved student health
will, in turn, improve students’ school attendance and enhance their learning outcomes.
Toward this end, the study seeks to achieve two major goals:
◊ To finalize, implement, and monitor a standardized, Common Curriculum that

conforms to the HFLE Regional Framework and has two content themes:
Sexuality and Sexual Health and Self and Interpersonal Relationships. Together,
these themes address the critical need for HIV and violence prevention within the
region.
◊ To study the impact of this curriculum on student outcomes, along with the process
of implementation in the four countries.
III. Evaluation Methodology

17
T
he purpose of the evaluation was two-fold. First, process evaluation activities were
designed to document HFLE Common Curriculum lesson implementation and to
provide data to guide the refinement of the curriculum and training materials for
subsequent dissemination. Second, impact evaluation was designed to assess student
outcomes resulting from curriculum implementation. In addition, data collected over the
course of the study served a monitoring function, providing useful information about student
knowledge, attitudes, skills and behaviours at the regional level.
Below, the key features of the process and impact evaluation are outlined. These components
include the utilization of a logic model, a comprehensive approach to process evaluation, and
a rigorous approach to outcome evaluation that employed quasi-experimental methodology.
Logic Model. The HFLE logic model provides a framework that links the key components of
the intervention (in this case HFLE instruction that fosters interactive, skills-based learning) to
key determinants of important behaviours, the behaviours themselves, and health goals. The
logic model guiding the HFLE Common Curriculum follows:
LOGIC MODEL GUIDING THE HFLE COMMON CURRICULUM EVALUATION
Chosen Health Goals

Specified Determinants Targeted
Intervention (Risk and Student
Behaviors
Components of Protective Health and
HFLE Factors) That Which Well-being
Affect Substance
Affect Lead To
Use
Interactive Adolescents’ School
Risky Sex
Skills-Based Knowledge Attendance
Violence
Learning Attitudes &
Skills Performance
The logic model guided the selection of evaluation activities and measures used for both
the process and impact evaluation.
Process Evaluation
The process evaluation focused on a set of interrelated tasks to document the fidelity of
Common Curriculum implementation and identify challenges and successes in key areas
including teacher preparation/training, student receptivity, and administrative support. This
information was collected in order to identify areas for improving the Common Curriculum
and its delivery and determining what, if any, additional content, resources, and materials
might be needed.
This process evaluation included interviews with school administrators and HFLE
Coordinators, periodic observations of teachers delivering the Common Curriculum units,
and teacher and student unit feedback forms completed in the intervention schools after
lessons were taught. Teachers were asked to provide feedback about what worked and
what needed to be improved. Information gathered from participants can serve to inform
and improve the programme. Process data were collected by Country Coordinators and
the UNICEF consultant, and sent to EDC for data entry and analysis. Frequencies were
calculated on student and teacher quantitative assessments, and qualitative interview
data were examined for common themes, identified challenges, barriers, and potential
solutions. Findings were compiled and summarized in interim reports to UNICEF.
Impact Evaluation
The impact evaluation employed a quasi-experimental pre-post matched pairs design
to examine the impact of the Common Curriculum implementation of two HFLE units on
students. The primary question addressed was: Do students in intervention schools report
more positive attitudes and norms, greater knowledge, more life skills, and fewer risky
behaviours than students in their paired comparison schools?
Two critical factors shaped the context in which this question was addressed. First, the
Common Curriculum was designed to supplement --not supplant--other ongoing efforts in
the region to train teachers on the HFLE Framework and support the delivery of life skills
education. Thus, the evaluation compares “standard practices” that, in most schools,
includes delivery of health education with the provision of “enhanced” Common Curriculum
lessons. Second, this curriculum was developed in tandem with carrying out evaluation
activities. That is, lessons were developed, revised, and refined, informed by the process
evaluation. Teachers were trained and delivered lessons for the first time during the
impact evaluation period, while they still were becoming familiar with both the content and
pedagogy.
19
Methods
Country Coordinators and Ministries in Antigua and Barbuda, Barbados, Grenada and
St. Lucia each identified three pairs of schools that were similar in terms of size, urban/
rural location, academic performance, gender composition, and perceived student
behavioural risk. All schools selected were willing and had the capacity to implement the
intervention and evaluation procedures.
Schools in each of the 12 pairs were randomized to either the intervention or comparison
condition and HFLE Coordinators and Ministry representatives were notified of
randomization results in time for the start of the 2005/2006 school year. Intervention
schools began implementing the new HFLE Common Curriculum with all Form 1 students
during the start 2005/2006 school year. Form 2 was implemented during the 2006/2007
school year, and Form 3 was implemented during the 2007/2008 school year. Thus, the
Common Curriculum was introduced in stages. Each year, teachers in the intervention
schools were offered training on the new Self and Interpersonal Relationships and
Sexuality and Sexual Health lessons.
In the comparison schools, students received standard HFLE or other health classes
that were already part of the curriculum; this curriculum was often drawn from the HFLE
Common Framework. However, it was assumed that comparison teachers would not
have access to the new lessons developed for the project, and would not receive special
training in curriculum delivery and, especially, skills-based interactive learning activities. It
was also assumed that the great majority of students in both intervention and comparison
schools would remain in the same school from Form 1 through Form 3. Thus, students in
intervention schools would receive multi-year exposure to the Common Curriculum, and
there would be little cross-over of students between conditions.
During October 2005, Form 1 students in intervention and comparison schools were
asked to complete an anonymous baseline survey of attitudes, norms, knowledge, and
behaviours. Items on the student survey were drawn or adapted from instruments used
previously with similarly aged students. Drafts were reviewed by Country Coordinators
and piloted for reading level and length. Teachers also completed a brief survey at this
time. Teachers were asked about their HFLE-related training and experience, as well
as their plans for implementation and anticipated barriers and challenges. A follow up
1-month post-intervention survey was planned for all Form 3 students and teachers in
spring 2008. (Unfortunately, difficulties completing lessons during the term prohibited a
1-month follow up prior to the end of school, so the impact evaluation is an immediate
assessment following completion of lessons.)
Items assessing life skills learned were added to student survey; life skills covered were
added to the teacher survey. Neither students nor teachers were individually tracked. That
is, all surveys were anonymous and did not contain any personal identifiers.
EDC provided Country Coordinators with an evaluation implementation manual that

outlined procedures for collecting surveys from teachers and students. The manual
provided information on procedures for informing parents about the study and collecting
data from school administrators, teachers, and students. Specific instructions were
provided for assuring confidentiality. Country Coordinators were responsible for organizing
and overseeing data collection; completed forms were returned to EDC for data entry and
analysis.
Analysis Plan
The analysis plan was designed to evaluate whether students enrolled in schools
implementing the Common Curriculum reported greater knowledge, more positive health
attitudes, greater life skills, and fewer risky behaviours. Because of the multi-year
design, it was not possible to randomize individual students, teachers, or classrooms to
intervention or comparison conditions. Therefore, schools were the unit of randomization,
and analyses were conducted at the school level. The a priori design called for a paired
school comparison of student outcomes by condition. This analysis considers whether
there are significant differences across pairs of schools assigned to the intervention
and comparison conditions. The design balances demands for rigor with practicality and
resources. A matched pairs design was chosen in consideration of the relatively small
number of schools participating in the study and the need to randomize within each of
the four countries to assure even distribution within countries of the two conditions. This
also helped control for potential differences across countries and increased the likelihood
that intervention and comparison schools within a country would be similar at baseline.
Further, the design took into account the fact that students were not individually tracked
from baseline (Form 1) to follow up (Form 3), due to confidentiality concerns and the
difficulties of such data collection. Therefore, baseline data from Student X cannot be
linked with his/her outcome data, collected almost three years later.
Paired analyses were used to detect whether there is a consistent pattern on each
outcome measure (i.e., positive or negative) that differentiated intervention from
comparison schools. The Wilcoxon test for two related samples was used to assess
significance, with a two-tailed p at <.05. Outcome measures included both single
items (e.g., recent use of alcohol, recent sexual intercourse) and scales (e.g., attitudes
supporting violent behaviours, HIV/AIDS knowledge) across the domains. Given the
relatively small number of pairs overall (n=12), there is insufficient power to perform paired
analyses within countries; many more schools in each country would be needed. Further,
the random assignment of one pair was reversed and deleted from these impact analyses.
21
In addition to these paired analysis described above, we also conducted regression

analyses at the school level, controlling for the baseline measure corresponding to
the outcome (e.g., mean score or proportion reporting attitude or behaviour at Form 1
and Form 3). We examined the intercept as the indicator of intervention effect. These
analyses controlled for potential differences within school pairs at baseline.
Results were cross-checked in several ways. We explored potential intervention effects

using individual level data. Because individual students were not tracked over time,
these bivariate and multivariate logistic and linear regression analyses could not control
for baseline reports. However, they do take advantage of the large number of student
participants, controlling for potential influences of gender, age, academic performance,
and country, as measured at follow up. We conducted these analyses using student
reports from the four countries combined and pair by pair. Because the matched pairs
design with a small number of pairs is relatively conservative (that is, small effects are
difficult to detect), the purpose of these additional analyses was to determine whether
there were patterns of results suggesting intervention effects that were detected in our
primary analyses.
In addition to providing data for the impact evaluation, student surveys were also used
to provide Ministries with a “snapshot” of students’ knowledge, attitudes, life skills and
behaviours at Form 1 and Form 3. Further, student surveys were used as a starting place
to identify, with Ministries, items that could be included on a brief monitoring tool that
can be used to identify emergent student health needs and help assess the success of
regional and country health promotion efforts. An administrator tool was also developed to
monitor implementation of HFLE dissemination.
Evaluation
IV. Findings from Process
23
T
his section provides a summary of activities that were undertaken to develop the
standardized Common Curriculum and train teachers and reports on data from the
process evaluation of implementation. These data come from multiple sources,
including teachers, administrators, and students.
Implementation was monitored in multiple ways. First, in the intervention schools,

quantitative unit assessments were collected from both students and teachers at five time
points (twice in Form 1 after each unit; twice in Form 2 after each unit; once in Form 3
following the Self and Interpersonal Relationships unit). Teachers completed written
surveys that asked their level of preparation/training, number of lessons taught, skills
covered, appropriateness of material, and changes made or suggestions for the future.
Students were asked about their past exposure to HFLE, their participation in classroom
activities and homework assignments, skills learned, and appropriateness of the material.
The numbers of participating students per assessment ranged from 714 to 1279; the
numbers of participating teachers ranged from 12 to 17.
Second, periodic classroom observations in both intervention and comparison classrooms

were conducted by the Country Coordinators and the HFLE Regional Coordinator, who
also conducted end-of-year interviews with administrators. Due to resource constraints,
fewer observations were held than originally planned. Observation checklists and interview
protocols were prepared by EDC and included in the evaluation manual. Because the
number of classroom lessons observed was small, a survey of comparison school teachers
was conducted at the end of Form 2 to obtain additional information on what was being
implemented and to help sustain administrator and teacher interest in the project.
Finally, baseline and follow up teacher surveys were conducted in both intervention
and comparison schools. At baseline, 42 teachers completed the baseline survey,
22 from intervention schools and 20 from comparison schools. Eleven of the 12
intervention schools were represented and 10 of the 12 comparison schools. At follow
up, fewer teachers (n=21) completed the survey, 13 from intervention schools and 8
from comparison schools. Eleven of the intervention schools were represented, but
only 7 of the comparison schools. Several teachers, especially those from comparison
schools, skipped questions. Thus, information is less complete at follow up, especially
for comparison schools. Although the teacher sample is too small and unrepresentative
for conducting statistical analyses, their responses add to understanding the process,
success, and challenges of implementation.
Curriculum Development
Beginning in Year 1, EDC worked with the Regional Coordinator, Country Coordinators
and teachers to transform the HFLE Regional Curriculum Framework into scripted,
interactive skills-based lessons. EDC moderated multiple meetings over the course of four
years to draft outlines for lessons for two themes for Forms 1-3. The selection of themes
was based on regional needs as determined by Country Coordinators and UNICEF. The
first set of lessons focuses on Self and Interpersonal Relationships, and includes
violence prevention. The second focuses on Sexuality and Sexual Health, and includes
HIV/AIDS prevention. The HFLE Regional Framework also includes two additional
themes, one on Eating and Fitness, and the other on Managing the Environment. Given
limited resources and time, a decision was made to restrict curriculum development
as well as initial “core” implementation to the two themes: Self and Interpersonal
Relationships and Sexuality and Sexual Health.
Unit content was developed based on the latest research in the area and the HFLE
Regional Curriculum Framework. EDC facilitated the curriculum development process.
A curriculum development team, comprised of the Regional Consultant, the four Country
Coordinators, representatives from CARICOM and UNICEF and teachers worked
to develop lessons. For Form 1, 18 lessons were initially prepared for the Self and
Interpersonal Relationships unit and 22 lessons were completed for Sexuality and
Sexual Health unit. The number of lessons and the learning activities within each
lesson were guided by in-country assessments of what was developmentally appropriate
and what Country Coordinators thought was possible to cover during the available time
during school year. This process was repeated for lessons for Form 2 and 3. Indeed,
at the outset, it was assumed that these two themes could be completed, leaving time
for additional lessons addressing the themes of Eating and Fitness and Managing the
Environment. The multi-year curriculum was intended to “spiral,” building on previous
lessons by adding developmentally-appropriate topics and skill areas as students
progressed from Form 1 to Form 3.
Given this was the first time that the curriculum and lessons were being implemented,
input on the challenges and successes of classroom delivery were invaluable in informing
mid-stream refinements. For example, based on the initial feedback from teachers and
observations by the Country and Regional Coordinators during Year 1, it became apparent
that less classroom teaching time was available than initially assumed. Therefore, the
number of lessons in each unit was reduced and the activities were substantially pared
back in a major revision. A set of 10 shorter, “core” lessons for Self and Interpersonal
Relationships were identified, along with 7 lessons for Sexuality and Sexual Health.
Based on the Year 1 experience, 10 lessons per theme were subsequently developed for
Forms 2 and 3. Some content originally developed for Form 1 was moved into the Form
2 lessons. At the end of each school year, input from teachers and Country Coordinators
was incorporated into a final, revised package of lessons available for dissemination.
25
Training
During Year 1, a regional five-day training of trainers was conducted with teams from
the pilot countries as well as other countries across the Caribbean. Representatives
came from Antigua, Barbuda, Barbados, Belize, British Virgin Islands, Dominica,
Grenada, Guyana, Jamaica, Montserrat, St. Kitts and Nevis, St. Lucia, St. Vincent and
the Grenadines, Suriname, Trinidad and Tobago. The event was co-led by UNICEF,
CARICOM, and EDC facilitators. The purpose was to prepare a small cadre in each
country to deliver in-country training.
Following the training of trainers, multi-day trainings were scheduled in each country
to prepare teachers to implement the new curriculum. Trainings were led by Country
Coordinators; UNICEF and EDC staff attended selected days of training; they observed
what was covered and learned about how teachers were selected, what HFLE experience
they had, and their other course assignments. As summarized in a report to UNICEF,
teachers overall were very enthusiastic about being part of the project. Most said they
were comfortable with the unit content. However, as illustrated in the box below, during
this initial year of training on Form 1, coordinators and observers noted that teachers
across countries would benefit from a more structured training, given their relative
inexperience both with the health content of lessons and the pedagogy. Few teachers had
previously led interactive skills-based activities; many had little classroom experience, and
some were young, first time recruits. They, too, expressed that additional training would be
welcome.
Coordinator/Observer Feedback on Form 1 In-Country Teacher Training
“Teachers needed more in-depth training in delivering lessons by the skills method. There
were deficiencies in knowledge/content also. Some are not familiar with some of the con-
tent.”
“The training time was a bit short, but the participants accomplished more than expected.
There was a request for practicing more sexuality lessons, but there was not enough time.”
“Teachers gave good evaluations of the training, and wished there was more time. They
recognized the need to match the students’ development and not treat them as ‘babies’,
especially since some students would reach the legal age of consent to participate in
sexual activity.”
Across countries, it was noted that there was considerable inconsistency in

content of training and, perhaps most critically, individual lessons were not
covered or practiced in any detail. To address issues that arose during the
initial training year, a training manual was created for the beginning of Year 2
in order to help assure that teachers were prepared similarly across countries
and provided with more in-depth training on the delivery of lessons and
exercises. This training manual is provided in the Appendices. To respond to
As one
teacher training issues, Coordinators also offered onsite training and technical
Coordinator assistance with lesson delivery over the course of the school year, although
commented: their time availability for this activity was often limited.
“The
teachers felt Despite the addition of the manual, several training issues still were apparent
that more during teacher preparation for Form 2 and Form 3. As one Coordinator
time was commented: “The teachers felt that more time was needed. They were not
needed. accustomed to modifying their teaching approaches, strategies and delivery
They to match the changes in child development (particularly mid-adolescence) in
were not secondary school. They usually focus on curriculum content. Practice delivery
accustomed was most appreciated.” Teachers and trainers both noted that practice in
to modifying leading participatory exercises is especially needed, since “These methods are
their teaching not seen in regular classrooms.”
approaches,
strategies Throughout the three years of implementation, teachers in the intervention
and delivery schools were not necessarily selected in time to receive training. Second, there
to match was substantial teacher turnover, meaning that each year some new teachers
the changes had to be trained. Trainings had to accommodate the needs of both new and
in child experienced teachers. Third, training on delivery of individual lessons often
development was not provided. In addition, in some schools, there was teacher turnover
in secondary during the course of the year, resulting in several untrained teachers assuming
school. HFLE classroom responsibilities. Interviews with Country Coordinators and the
They usually Regional Consultant consistently raised concerns about the priority of HFLE in
focus on both teacher assignment and class time allocation.
curriculum
content. Despite these challenges, most teachers tried to implement the lessons. An
additional challenge faced in one country—St. Lucia—was the retirement of the
Practice
Country Coordinator by Form 3. Although a replacement was designated, this
delivery
was not her sole responsibility. As a result, some activities, including training
was most
and technical assistance, were not completed during the final study year.
appreciated.”
27
Lesson Implementation
As discussed above, based on interviews and observations of lessons, during Year 1, it
became readily apparent not only that teachers could not implement the original full set of
18-22 lessons per unit. They also had trouble completing the pared down “core” lessons
for each unit. In addition, within lessons, activities were at times omitted due to time
constraints; some lessons were spread over multiple periods. Disruptions to class periods
assigned to HFLE were also documented. These implementation problems persisted in
Forms 2 and 3. However, despite difficulties implementing all lessons as intended, as
illustrated in the box below, teachers and students were enthusiastic about the curriculum
throughout the study.
Teacher Unit Assessments: Common Curriculum

Training and Implementation
Overall, teachers and students reported positive experiences each year. For example,
on each of the unit assessments, a majority of the teachers would be “very likely” to
recommend the lessons to their peers. (However, Form 1 teachers completing surveys
were somewhat more likely to say they would recommend the lessons than Form 2 and
Form 3 teachers). In addition, most teachers felt that the lessons would have a “moderate”
or “large” impact on students. Consistently, students as well as most teachers thought the
lessons were at the right level and culturally appropriate. Teachers thought the students
were very engaged in most lessons, and students reported being involved and most
reported their homework was useful. (Summaries of unit assessments were submitted to
UNICEF in regular reports.) Teacher surveys also indicated that over the project period,
the proportion of teachers in the Common Curriculum schools who reported they have
experience teaching HFLE, increased.
Examples of Teacher Comments on the Common Curriculum:
“The evident enthusiasm of the children was delightful. Students actually looked forward
to having the session.”
“The children appreciated learning more about the changes they were experiencing and
what they could do to deal with these changes.”
“All the lessons are necessary because our students are faced with many sexual
pressures daily.”
“Students are really trying to implement skills learned.”
“[HFLE allows] students to formulate their own opinions and express them in a safe
environment.”
“I enjoyed seeing the students come alive with authentic pedagogy as opposed to
textbook information that is dry and boring.”
Overall, teachers reported that students were engaged in activities and learned new things; most
felt that the lessons were developmentally and culturally appropriate and covered important topics.
However, only a minority thought the lessons fit the teaching time: “My greatest problem was trying to
fit everything into a 40-minute class period. However, I have been getting better at it over the past few
months.”
Observations of classroom delivery by the HFLE Regional and Country Coordinators confirmed
teacher reports that the lessons were, for the most part, enthusiastically received by students.
29
Examples of Coordinator Observations of Classroom Delivery
“The worksheets, role play were very suitable, and the language was at an appropriate level.
The children enjoyed the lessons and were very exuberant.”
“Two very good lessons were observed in the Sexuality and Sexual Health theme. One on
abstinence and one on puberty. Both teacher and students were energized, and students
demonstrated commitment to choosing abstinence.”
“Skill practice was evident in all the intervention schools and generated much interest and
excitement. Skits on ‘saying No’ was one of the outstanding lessons. The portfolios were very
good.”
“This lesson was on friendships; children participated well and wanted to continue after the
session was due to end. It was very exciting to watch all the activity.”
“The lesson on ‘use of cell phones’ was also very successful. The students demonstrated
their knowledge of the skill using the scenario but more important were their attitudes and
opinions on cell phone availability, use and misuse, and the rules they believe should be put
in place. They then utilized critical thinking and highlighted a number of other issues which
are arising from the existence of cell phones: peer pressure to have the latest and more
expensive, envy and conflict, stealing, bullying, breakup of friendships because of gossip,
inappropriate ways of acquiring the phones or the money to do so. The discussion was
spirited, but focused. The continuing activity was for them to write letters to authorities on the
topic of whether cell phones should be allowed in schools.”
“The lesson plans were very detailed and properly constructed. The objectives were
achievable.”
“I enjoyed the class discussions as it helped me to understand students’ reasoning and ways
of thinking.”
The observers also noted some difficulties. Some of these related to time management of
the lessons. For example, in one classroom it was noted that “The Self and Interpersonal
lessons had some areas which went a bit slowly and concepts were a bit abstract for some
students. Almost two terms were spent on this theme. The Sexuality and Sexual Health
lessons were very appealing to the students but had to be rushed because of a late starting
date.”
Several others commented that the lessons overall went “fairly well” but
implementation success was “mixed.”
One issue was that the intended spiralling of the units sometimes made the
content seem repetitious, even if the activities to promote skills-building were
different. This is an issue that can be addressed through refinements as well
as in teacher training that highlights the progression of lessons as students get
older. Training is also important to address classroom management issues that
teachers faced, including “trying to work along with students who were a little
too immature”; “students who were disruptive and not interested in learning
...about half about topics that will in some way impact their lives”; and “students sometimes
the teachers excess-talking because of excitement.”
reported
completing Despite the reduction to 10 lessons per unit for Forms 2 and 3, there continued
most or all to be substantial difficulty with completion. Consistent with observations
of lessons and interviews by the Regional and Country Coordinators, by the final unit
7-9, and assessment, about half the teachers reported completing most or all of
only a third lessons 7-9, and only a third completed lesson 10. Teachers continued to have
completed problems with scheduling HFLE class time and disruptions. Despite extending
lesson 10. the time allocated for these two units each year, completion remained
Teachers problematic. Only 20-35 per cent of teachers said the lessons fit the teaching
continued time allocated to HFLE throughout the study. This clearly presents challenges
to have for interpreting findings from the impact evaluation. In addition, it raises issues
problems with about whether sufficient time is allocated for HFLE (or can be) to cover the
additional content of the HFLE Regional Curriculum Framework, e.g., Eating
scheduling
and Fitness and Managing the Environment.
HFLE class
time and
disruptions. Potentially related to ongoing implementation issues, the proportion of teachers
Despite who reported getting four or more days of training appears to have declined
extending the over time (from 50 per cent in Form 1 to 9 per cent in Form 3). One reason
may be that Coordinators felt that teachers were better prepared as the study
time allocated
went on; however, the proportion of teachers reporting they got enough training
for these
fluctuated between 45 per cent and 60 per cent. Interestingly, although
two units
Coordinators reported that most teachers had little HFLE training when they
each year, were recruited at the beginning of each year, by Form 3, many of the teachers
completion who completed the assessments said they had three or more years teaching
remained HFLE.
problematic.
31
Comparison Schools: Documentation of “Standard

Practices”
At baseline, teacher surveys were collected from comparison schools along with student
baseline surveys. At the end of Form 2, to keep comparison schools engaged, teachers
were asked to complete a brief questionnaire on their teaching and health education
experience, teaching methods, topics and life skills they taught. As part of the process
evaluation, efforts were made to collect information on health classes being taught at the
comparison schools. Unfortunately, resources limited collection of annual information
to the intervention schools only, so similar information is not available from comparison
schools across all four countries. That is, there is limited documentation of what “dosage”
HFLE students in comparison classrooms, schools, and countries received.
In all countries, there are some requirements to address content covered in HFLE, at least
in Forms 1 and 2. As illustrated in the box below, throughout the study, the HFLE Regional
and Country Coordinators said similar topics were taught in the comparison schools but
consistently reported that teachers in the comparison had less training in health/HFLE and
used fewer skills-building interactive activities in their classroom lessons.
Coordinator Comments on HFLE in Comparison Classrooms
“The comparison schools addressed some of the same topics such as puberty and HIV/
AIDS. However, the skills practice was not a component. The lessons were mainly lecture
and discussion.”
“There were similar lessons or rather lessons dealing with similar topics. However, they
were more knowledge based and did not focus on demonstrating the life skills. This was so
for both themes.”
“Some of the topics are similar, but a great portion of the programme was assigned to
career guidance. The lessons include some skills but these are not delivered as skill
learning as in the common lessons.”
“Some similar topics are being done in these schools but the focus is more on cognitive
skills of reasoning and rationalization. The lessons are mostly teacher directed with little
student participation in activities.”
As discussed in Section VI (Impact Evaluation), in their baseline and follow up surveys,

students in comparison schools, like those in the Common Curriculum schools, provided
information on the health lessons they received.
Teacher Surveys at Baseline and Follow Up: Cumulative

Experiences
At baseline, 42 teacher completed surveys, 22 from intervention schools and 20 from
comparison schools. Fewer teachers (n=21) completed surveys at follow up and fewer
comparison schools are represented.
Teacher Experience and Training on HFLE

Confirming observations of Country Coordinators, at baseline a sizeable proportion of
teachers reported relatively little teaching experience or training in HFLE; however, lack of
preparation was especially notable in intervention schools. Intervention school teachers
were:
• Twice as likely to report less than one year’s experience teaching HFLE (46 per
cent vs. 24 per cent of comparison school teachers)
• Less likely to report 6 six or more years of teaching experience in general (55
per cent vs. 72 per cent of comparison school teachers)
• Less likely to report taking health education classes while training to become a
teacher (24 per cent vs. 53 per cent of comparison school teachers); and
• More likely to report a day or less of continuing education training on HFLE (45
per cent vs. 18 per cent of comparison school teachers).
By the end of the study, fewer teachers in both intervention and comparisons schools
reported being novices at teaching HFLE. In contrast to baseline reports, however, Form
3 teachers in intervention schools reported more days of continuing education training in
HFLE, while respondents in comparison schools reported less. At follow up over 90 per
cent of teachers in both intervention and comparison schools wanted additional training on
HFLE.
Preparedness and Comfort Levels

Teachers were asked to rate their overall level of preparation to teach HFLE as well as
how prepared and how comfortable they were teaching specific topics. Consistent with
their more limited teaching experience, at baseline intervention school teachers were
less likely to say their level of preparation was “very good” or “excellent” (40 per cent of
intervention school teachers vs. 82 per cent of comparison school teachers). They were
also somewhat less likely to feel prepared to teach topics related to self and interpersonal
relationships, sexuality and sexual health, and alcohol and substance abuse, and
somewhat more likely to feel prepared to teach the less sensitive themes of environment,
nutrition and exercise. By contrast, at follow up teachers in intervention schools (67 per
cent) were more likely than comparison school teachers (20 per cent) to report their level
of preparation as “very good” or “excellent.”
33
Intervention school teachers were more likely to report feeling “mostly” or “very” prepared
to teach the content of HFLE at follow up.
Table IV.1. Percentages of Teachers Reporting They Are “Mostly” or “Fully” Prepared to Teach Topic
Follow Up
Comparison Common Curriculum
Adolescent Growth & Development 38 % 69 %
Self-Concept 38 % 62 %
Healthy Relationships 25 % 69 %
Violence Prevention 25 % 69 %
Sexuality & Sexual Health 50 % 77 %
HIV Prevention 12 % 69 %
Alcohol and other Substance Use 12 % 69 %
Environment 25 % 39 %
Nutrition & Exercise 12 % 46 %
Personal Living & Household Management 0% 38 %
A similar pattern occurs for reports of being “very comfortable” teaching these topics.
Table IV.2. Percentages of Teachers Reporting They Are “Very Comfortable” Teaching Topics
Follow Up
Adolescent Growth & Development 38 % 69 %
Self-Concept 38 % 54 %
Healthy Relationships 38 % 54 %
Violence Prevention 12 % 69 %
Sexuality & Sexual Health 25 % 54 %
HIV Prevention 12 % 46 %
Alcohol and other Substance Use 25 % 69 %
Environment 12 % 23 %
Nutrition & Exercise 38 % 38 %
Personal living & household 12 % 23 %
management
Teaching Methods
The Common Curriculum emphasized the use of interactive teaching methods, and these
were reinforced in training held by the Coordinators. To assess teaching intentions at the
outset of the study, Form 1 teachers were asked how often they planned to use different
teaching methods in their HFLE classes. At the end of the study, Form 3 teachers were
asked how often they actually used these methods. At baseline and especially follow
up, teachers in intervention schools reported planning to use or using more interactive
methods.
Table IV.3. Percentages of Teachers Reporting Using Technique “Very Often” or Always”
Follow Up
Lecturing 25 % 15 %
Classroom discussions 50 % 85 %
Written exercises 12 % 38 %
Role plays 0% 54 %
Games 0% 15 %
Surveys, other data collection 0% 15 %
Use of media 25 % 31 %
Brainstorming 38 % 62 %
Small group activities 25 % 58 %
Story telling 12 % 54 %
Case studies/real life scenarios 38 % 54 %
Lessons Devoted to Common Curriculum Topics and

Coverage of Skills
At the outset of the study, Form 1 teachers were asked to estimate how many lessons
they would devote to topics stressed by the Common Curriculum. At the end of the
study, Form 3 teachers were asked how they had allocated lesson time. At baseline
intervention school teachers estimated that they would allocate more classes per
topic than comparison school teachers, perhaps reflecting their greater inexperience
and lack of appreciation of timetable constraints. At follow up, there was no common
pattern; intervention school teachers taught more of one topic (e.g., HIV prevention) and
comparison school teachers more of another (e.g., sexuality and sexual health).
35
At follow up, teachers were asked to what extent they covered a range of life skills. (Skills
questions were not asked at baseline.) In general, intervention school teachers were
somewhat more likely to indicate they had “mostly” or “fully” covered the skills, a perception
not reflected in students’ attitudinal and behavioural self reports.
Table IV. 4. Percentages of Teachers Reporting “Mostly” or “Fully” Covering Life Skill
Follow Up
Self awareness 50 % 77 %
Decision making 63 % 69 %
Critical thinking 38 % 54 %
Refusal skills 50 % 54 %
Time management skills 25 % 31 %
Study skills 25 % 31 %
Healthy self management 50 % 46 %
Social awareness 50 % 62 %
Embracing diversity 50 % 84 %
Goal setting 32 % 46 %
Assertiveness skills 25 % 62 %
Coping skills 38 % 62 %
Interpersonal relationship skills 62 % 69 %
Household management skills 0% 31 %
Help seeking skills 25 % 54 %
Advocacy skills 12 % 38 %
Creative thinking 25 % 54 %
Problem solving 38 % 54 %
Endorsement of HFLE and Barriers to HFLE

Implementation
Teachers who were involved in the implementation of the Common Curriculum register
higher levels of commitment to HFLE:
• At baseline, about one third of both intervention and comparison school teachers said
that HFLE is “more important” than other core subjects. At follow up, nearly 60 per
cent of intervention school teachers, but less than 20 per cent of comparison school
teachers, said HFLE was more important than other subjects.
• When asked at baseline whether HFLE provides students with the knowledge and
skills they need to stay healthy, intervention school teachers were less likely than
comparison school teachers to say “yes, very much”. There was little change in
the proportion of comparison school teachers saying “yes, very much” at follow up;
however, the proportion of intervention school teachers saying yes increased.
The greatest barrier noted by teachers in both conditions was inadequate or insufficient
materials, followed by insufficient time to cover lesson content. One notable difference in
barriers noted by intervention and comparison teachers is perceived administrative support.
At baseline, about one quarter of intervention teachers reported this as a moderate or
large barrier; by follow up, only 8 per cent did so (compared with a quarter of comparison
teachers).
Table IV.5. Percentages of Teachers Reporting Barrier “Moderate” or “Large”
Baseline Follow Up
Comparison Common Comparison Common
Curriculum Curriculum
Lack of student interest 15 % 23 % 37 % 30 %
Lack of administrative support/ 15 % 23 % 25 % 8%

encouragement
Inadequate/insufficient materials 55 % 68 % 63 % 53 %
Difficulty maintaining classroom 10 % 22 % 25 % 31 %

discipline/order
Insufficient time to cover material 35 % 50 % 50 % 38 %
Controversial nature of topics/ 10 % 14 % 0% 0%

activities
Training in HFLE n/a n/a 25 % 23 %

37
In sum, during Form 1, teachers from intervention schools reported being less experienced,
less well trained and prepared to teach HFLE, and less comfortable with the material. By
Form 3, this pattern appears to reverse, with Form 3 teachers from intervention schools
more likely to say they had received several days of training, were prepared to teach
and comfortable teaching some of the more sensitive HFLE topics, and had mostly or
fully covered HFLE skills. Obviously, limitations of the data – small sample sizes and
inadequate representation of comparison schools especially at follow up – are cause for
caution; none of the “findings” is “statistically significant.” Thus, the introduction of the
Common Curriculum may have nudged forward goals to promote HFLE and build a work
force that is better prepared to take on the curriculum. However, problems with fidelity and
full implementation clearly remain, and need to be considered in planning future teacher
training and dissemination.
V. Monitoring Student
Health Indicators
39
D
uring fall 2005, 2 364 Form 1 students attending intervention and comparison
schools in the four participating countries (Antigua and Barbuda, Barbados,
Grenada, and St. Lucia) completed the baseline survey. During June 2008, follow
up surveys were administered to Form 3 students in each country. At each time, all
students attending classes were surveyed to provide a “snapshot” of student attitudes and
behaviours. The surveys were conducted anonymously to protect student confidentiality.
Below, we provide summary information from the four countries combined at both baseline
and follow up. Appendices contain frequency reports for individual items for the four
countries combined and for each country separately.
Table V.1. Baseline Survey Participation by Country
Country Number of Eligible Number of Participating Response Rate

Students Students By Country
Antigua 340 299 88 %
Barbados 850 698 82 %
Grenada 698 525 75 %
St. Lucia 912 842 92 %
TOTAL SAMPLE 2800 2364 84 %
Note on Sample:
There was a decrease in the number of participating students in three of the four
countries from Form 1 to Form 3, and a slight increase in Grenada. Thus, the student
composition in the combined four country report is somewhat different at these two times.
Table V. 2. Follow Up Survey Participation by Country
Country Number of Eligible Number of Participating Response Rate

Students Students by Country
Antigua 162 135 83 %
Barbados 862 488 57 %
Grenada 764 583 76 %
St. Lucia 991* 703 71 %
TOTAL 2779 1909 69 %
* Based on 2006-07 estimate
Survey Highlights – Four Countries Combined
Average Age at Form 1 Survey: 12.0 years

Average Age at Form 3 Survey: 14.7 years
Percentage Male at Form 1: 49 per cent
Percentage Male at Form 3: 46 per cent
As youth progress from early through mid-adolescence, their attitudes about school may
change and their risk behaviors typically increase. Below are highlights from Form 1 and
Form 3 student self-reports.
Attachment to School
• At Form 1, almost all boys and girls (90 per cent) reported liking school and being happy
there. By Form 3, students overall continue to report positive school experiences, with
80-85 per cent of youth reporting they feel like they are a part of their school and happy
there.
• At Form 1, the majority of students felt there was an adult at school they could go to if
they needed help with a problem (79 per cent) and that there were teachers at school
who cared about them (84 per cent). By Form 3, a smaller proportion of students (59
per cent) report there is a teacher they could go to for help with a personal problem.
• About 12 per cent of Form 3 students say they missed five or more days of school in the
last month; this is an increase from Form 1. At Form 3, 17 per cent report they have a
paid job (with most of those working putting in less than 10 hours/week).
Substance Use
• When asked early in Form 1, about two-thirds of students reported having had more
than a sip or two of alcohol and 17 per cent had been drunk at least once. By the end
of Form 3, 88 per cent of students say they have had alcohol and over twice as many
now report (40 per cent) having been drunk at least once. In addition, the gender gap
narrows. In Form 1, boys were twice as likely as girls to report having been drunk. By
Form 3, a third of females and just under half of males (48 per cent) say they had been
drunk at least once.
41
• During Form 1, about one in ten students reported they had smoked cigarettes
and marijuana at least once. Boys were three times more likely to report these
behaviors than girls. By Form 3, 23 per cent of students report having tried cigarettes
and 28 per cent have tried marijuana. Males are twice as likely to say they have tried
marijuana (39 per cent) as girls (20 per cent), and also more likely to have smoked
cigarettes (27 per cent males; 19 per cent females).
• In Form 3, students were also asked about their recent use of substances. Over half
(55 per cent) of students say they have had more than a sip of alcohol in the last
month, and 10 per cent report having alcohol more than 10 times during this period.
In addition, 19 per cent say they recently have been drunk, 15 per cent have used
marijuana,10 per cent have used inhalants, 8 per cent have used cigarettes, and 4per
cent have used steroids or other drugs. While there are gender differences, females
as well as males are involved in substance use. For example, 53 per cent of females
and 58 per cent of males report recent drinking and 16 per cent of females and 22
per cent of males report being drunk in the last month. Females are less likely to
report recent marijuana use (10 per cent) than males (21 per cent).
• At Form 1, about half of the students believed that teenagers cause themselves great
harm by drinking alcohol once a week or more; two thirds believed this is the case for
marijuana. These numbers remain fairly consistent through Form 3, where 54 per cent
report great harm from cigarettes and 62 per cent great harm from marijuana.
At both Form 1 and Form 3, females are more likely than males to report they could say
no if peers wanted them to drink alcohol, smoke cigarettes, or use marijuana.
Violence
• In Form 1, half of the boys and a quarter of the girls reported being in a physical fight
in the past month. Physical fights are defined as fights with hitting, kicking, and
pushing. About 8 per cent said they have carried a weapon (knife, razor, ice pick or
gun) to school. In Form 3, fighting continues to be an issue for both males and
females. One third (31 per cent) of students report that most boys their age fight at
least weekly, and 18 per cent report most girls are involved in physical fights this
frequently.
• In Form 3, some attitudes continue to promote fighting: 70 per cent of students agree
that “you will be called a coward if you back down from a fight.” About half (47 per
cent) of females and 59 per cent of males agree that a boy “who refuses to fight loses
respect”; somewhat smaller percentages females (39 per cent) and males (51 per cent)
agree this is the case for girls.
• As with other refusal skills, in both Form 1 and Form 3, girls are more likely to report
they could say no to peer pressure to get into a fight or carry a weapon. However,
the difference is relatively small on such items as not getting into a fight if someone is
“pushing you around.” For example, in Form 3, only a third of females and 28 per cent
of males say they could refuse getting into a fight under these circumstances.
Sexual Risk-Taking
• At Form 1, 38 per cent of boys and 6 per cent of girls reported that they have had sex or
“gone all the way.” By Form 3, the largest jump is among girls: 28 per cent of females
say they have had sex, along with 60 per cent of boys. Overall, at Form 3, 22 per cent
of students report recent (last month) sex, or 16 per cent of females and 28 per cent of
males.
• At Form 1, among students who report having had sex, two-thirds did not use a condom
all the time; at Form 3, this figure is 69 per cent. About two-thirds (63 per cent) of those
who report recent sex did not use a condom one or more times; this figure is somewhat
higher for males than females (65 per cent and 59 per cent, respectively).
• At Form 1, most sexually initiated students said they had sex for the first time with
someone their own age. During Form 3, the majority (65 per cent) of females who had
initiated sex say their first partner was someone older; by contrast, about half (51 per
cent) of males say their first partner was someone their own age.
• At Form 1, forced sex was reported by 14 per cent of all students. At Form 3, 18 per
cent report a forced sexual experience (21 per cent of females; 15 per cent of males).
• Form 1 girls were more likely to feel they can refuse sex than boys. At Form 3, 67 per
cent of females, compared to 25 per cent of males, report they were “very sure” they
could refuse sex with someone they like very much, and 88 per cent of females and
56 per cent of boys report they could “say no” to an older person who gave them gifts or
money.
43
HIV-AIDS Knowledge and Stigma

• Between Form 1 and Form 3, students show increases in knowledge about HIV-AIDS.
For example, during Form 1, less than half knew that people can have the HIV virus but
not show signs of being sick right away, and a third did not know that a person can get
HIV by having sex just once without a condom.
By Form 3, 72 per cent of students answer the first item correctly, and 81 per cent
answer the second item correctly.
• There also appear to be some reductions in HIV-AIDS related stigma. In Form 1, less
than a third of students felt a teacher or student who has the AIDS virus should be
allowed to teach or attend school, and only half said they would be willing to remain
friends with someone with the AIDS virus. Approximately three-quarters said they would
not buy food from a shopkeeper or food seller with the AIDS virus. As assessed during
Form 3, about half feel that a teacher or student with the AIDS virus should be allowed to
attend school, and 67 per cent report they would remain friends with someone with the
AIDS virus. However, 60 per cent would still not buy food from a shopkeeper with the
virus.
• Form 3, about half feel that a teacher or student with the AIDS virus should be allowed
to attend school, and 67 per cent report they would remain friends with someone with
the AIDS virus. However, 60 per cent would still not buy food from a shopkeeper with
the virus.
UNICEF|BECO|2009|Beckles
IV. Findings from Impact

Evaluation
45
[HFLE] “teaches you about life and mostly about yourself and it teaches you how
to handle situations which may occur in life.” - Form 2 Student.
A
s described in Section III, the primary impact analyses used data from
Form 3 student follow up surveys. During Spring 2008, follow up data
were collected from 1909 Form 3 students. Primary paired analyses were
conducted on a total of 1598 youth from 22 schools (this excludes the one pair in
which randomization was reversed).
Planned
analyses,
As expected, many of the risk behaviours reported by students increased from
comparing
Form 1 to Form 3 (see Section V). Planned analyses, comparing matched pairs
matched pairs
of schools, reveal no pattern of significant positive effects of the HFLE Common
of schools,
Curriculum on Form 3 students’ self-reported attitudes, behaviours, and skills in the
reveal no
health domains related to the themes of Self and Interpersonal Relationships
pattern of
and Sexuality and Sexual Health. It is important to note that there are no
significant
significant negative effects either, and there certainly may be benefits that were
positive
not assessed. In addition, it is important to remember that the impact evaluation
effects of
was conducted simultaneously with the initial roll-out of new lessons that had
the HFLE
not been piloted. As teachers gain experience with the refined lessons, and
Common
as implementation barriers are overcome, the benefits for students are likely to
Curriculum
increase.
on Form 3
students’
The impact evaluation examined a range of outcomes: peer norms, attitudes,
self-reported
and refusal skills related to substance use, violence, and sex; lifetime and
attitudes,
recent reports of risk behaviors (e.g., alcohol, cigarette, marijuana, steroid, and
behaviours,
inhalant use; sexual intercourse, forced sex, and unprotected sex); HIV/AIDS
related knowledge and stigma; and self-reported life skills related to interpersonal
and skills in
relationships, sexual relationships, help-seeking from adults. Unfortunately, there
the health
is no consistent pattern of positive effects.
domains
related to
In addition to doing planned analyses, we also conducted regression analyses for
the themes
the combined, four-country data, comparing students attending schools assigned of Self and
to the intervention (Common Curriculum) or comparison condition. These analyses Interpersonal
controlled for gender, age of students, academic performance, and country. Relationships
These findings are consistent with the matched pairs results. Given the large of and Sexuality
comparisons, a few statistically significant results are expected by chance. and Sexual
Health.
In only a handful of cases did findings approach or reach statistical significance; however,
negative findings counterbalanced positive (e.g., students in intervention schools reported
lower peer norms regarding fighting but higher pro-violent attitudes).
Form 3 Students in Common Curriculum and

Comparison Schools: Descriptive Findings and Results
of Paired Analyses
The following section provides a descriptive account of what students in the two conditions
reported in response to survey items. First, we consider sample characteristics and
students’ reports of HFLE classes. We then move to life skills and the main health domains
addressed by the Common Curriculum units: substance use, violence, and sexual risk
taking. A final section contains information on responses to items assessing HIV/AIDS
stigma and HIV/AIDS knowledge. Each section also incorporates findings from the planned
paired analyses. Taken together, these results support the conclusion that there is no
consistent pattern of positive—or negative—findings to support the hypothesis that Form
3 students attending schools assigned to the Common Curriculum report more health-
promoting skills, attitudes, knowledge, and behaviours than students attending schools
assigned to the comparison condition.
Sample Characteristics and Students’ Reports of HFLE Classes

As shown on Table 1, there are several significant differences between students by
condition.1 Students attending intervention schools are somewhat younger than those
in comparison schools; they are also more likely to report their grades are “good” or
“excellent” (as compared to poor or fair).2 However, they are more likely to say they missed
one or more days of school in the last month.
1 Descriptive analyses include all students who attended study schools so as to represent all data collected. Paired analyses exclude
the one pair in which randomization was broken. Descriptive analyses were also conducted excluding students from this pair of schools;
whether these students are included or excluded does not alter the pattern of results.
2 Given the large number of comparisons examined, we use a modified Bonferroni correction and report as significant p values <.01.
47
Table VI.1. Form 3 Student Sample Characteristics by Condition
Item Total Comparison Common Curriculum P value
Gender (Female) 54 % 52 % 56 % ns
Age (15 years or older) 52 % 55 % 48 % <.01
Work during school year 17 % 16 % 18 % ns
Grades good-excellent 63 % 60 % 66 % <.01
No missed days of school 43 % 48 % 39 % <.001
Not shown, in separate analyses by gender, age and reports of grade differences are
significant only among females: for example, 54 per cent of girls in the comparison
schools are 15 years or older, compared to 42 per cent in the intervention schools
(p<.01). This is important to consider in interpreting findings, since involvement in many
risk behaviors (e.g., most substance use, sexual intercourse) typically increases with age.
That is, as a group, the older females in the comparison schools might be expected to
report higher levels of risk than those in intervention schools; some differences may thus
be age-related and not primarily attributable to condition.
Efforts to adopt the Common Curriculum have resulted in the intervention schools
delivering more HFLE lessons. Table 2 shows that students in the intervention schools
are more likely to report having HFLE classes both during the current school year and in
prior years. In addition, among those who say they had HFLE classes, students in the
intervention schools are more likely to report they received two or more classes per week.
Counter to expectations, however, only about 60 per cent of students said they had
attended the same school in a previous year. This makes it difficult to assess the level
of exposure to the Common Curriculum or other HFLE lessons in prior Forms; that is,
to answer the questions: What proportion of Form 3 students in the comparison schools
were exposed to some Common Curriculum lessons in Form 1 or Form 2, or what
proportion of Form 3 students did not receive a full, three-year “dose” of the intervention?
Despite this limitation, however, there is a significant difference in HFLE exposure:
Virtually all students in the intervention schools (96 per cent) reported they had HFLE in
prior years, compared to 81 per cent of those in the comparison schools.
Table VI.2. Form 3 Student Reports of HFLE lessons and School Attendance by Condition
Item Total Comparison Common P value

Curriculum
Had HFLE before this year 89 % 81 % 96 % <.001
HFLE class this year 84 % 69 % 96 % <.001
Two or more HFLE classes per week* 43 % 40 % 46 % <.01
Attended same school in prior year 59 % 54 % 64 % <.001
Attended same school Form 1 84 % 83 % 86 % ns
*among those getting HFLE classes
Students Reports of Life Skills

Students were asked a set of 24 questions assessing the extent to which they perceive
they can apply life skills highlighted in the Common Curriculum units. Each item was
assessed on a 4-point scale, with response categories ranging from disagree strongly to
agree strongly. In addition to considering individual items, a summative life skills scale was
created. Because females report significantly higher levels of life skills, results in Table 3
are provided by gender. As shown, despite differences by gender, scores on the life skills
scale is similar for youth in the two conditions (mean=72.7 for males and 77.8 for females).
Note there are no significant differences on any of the 48 individual items. Indeed, there
are only two items that even approach significance, and only among females (understand
other people’s ideas and perspectives; always treat others with respect, even if they are
different).
49
Table VI.3. Form 3 Student Reports of Life Skills by Gender and Condition: Means for Life Skills
Scale and Items
MALES FEMALES
Life Skills Scale Mean Score 72.7 72.7 77.3 78.0
Individual Items:
In school learned I can disagree with what others say 3.11 3.10 3.18 3.28
In school learned I can help my community by what I do 3.22 3.20 3.31 3.32
Set positive and realistic goals 3.29 3.22 3.41 3.45
Thought hard about values and what is important to me 3.24 3.26 3.44 3.45
Try to get know myself better 3.23 3.28 3.40 3.45
Aware of my feelings and how they influence what I do 3.19 3.21 3.32 3.38
Think about consequences before acting 2.92 2.86 2.91 2.90
Remember my way isn't only way 3.06 3.00 3.03 3.09
Try to understand other people’s ideas and 3.01 3.03 3.07 3.17
perspectives
Always treat others with respect even if different 2.94 3.00 2.99 3.11
Always treat others with respect even if I am angry 2.60 2.64 2.54 2.63
If someone is being teased or bullied I take 2.76 2.76 2.95 2.84
positive action to stop it
Encourage peers to wait to have sex 2.43 2.41 3.21 3.25
Do not pressure anyone to have sex or do anything sexual 2.93 2.88 3.44 3.43
Protect myself from HIV/AIDS or other STIs 3.38 3.36 3.62 3.63
Don’t let friends talk me into doing things I do not want to 3.26 3.18 3.44 3.50
Have friends to go if I need help with problem 2.92 2.89 3.11 3.19
Adult at school to go to if having personal problem 2.56 2.67 2.67 2.69
If adult or someone older wants me to do 2.99 2.92 3.31 3.33
something sexual I know where to get help
Suggest activities that will not lead to something sexual 2.72 2.82 3.22 3.29
Find ways to have fun that do not lead to drinking or sex 2.91 2.92 3.32 3.42
Teachers at school who care about me 2.94 2.87 3.07 3.04
Remember goals when things get tough 3.09 3.07 3.14 3.13
Work hard and get what I want 3.46 3.47 3.64 3.65
In addition to the above skills, 8 questions specifically addressed refusal skills, as shown
in Table 4. Again, females score higher than males, and there is only one significant
difference by condition. Females in the intervention schools are somewhat more likely to
report they can say no to using alcohol when pressured by peers. At a trend level (p<.05),
females in the intervention schools report slightly higher refusal skills, especially with regard
to substance use (but not sexuality). However, this finding does not hold once age is
adjusted
Table VI.4. Form 3 Students Reports of Refusal Skills: Means for Refusal Scale and Items
MALES FEMALES

Refusal Skills Scale 17.85 18.08 19.40 19.90
Individual items, Can say no to:
Alcohol 3.12 3.18 3.24 3.43*
Marijuana 3.24 3.37 3.51 3.65
Cigarettes 3.28 3.50 3.57 3.69
Sex with a person you really like 2.20 2.22 3.38 3.37
Sex with older person gifts/money 3.02 2.91 3.70 3.74
Peer pressure to fight 2.93 3.00 3.21 3.36
Peer pressure to carry weapon 3.34 3.32 3.59 3.69
Fight if someone pushes you around 2.29 3.25 2.48 2.60
*p<.01 among females; however, not significant when adjusted for age
Scales of life skills and refusal skills were examined as outcomes in planned paired
analyses. Consistent with the above results, there were no significant differences by
condition.
51
Substance Use, Violence, and Sexual Risk-Taking

The next set of tables presents student reports of substance use norms, attitudes and
behaviours by condition. Table 5 provides student reports of substance use norms and
attitudes. There are only marginal (p<.05) differences on two items; however, these are
in opposing directions and influenced by gender and age differences in the sample. For
example, 41 per cent of males and 55 per cent females in comparison schools say that
drinking alcohol can result in “great harm” to youth their age; fewer students (35 per cent
of males and 50 per cent of females) in the intervention schools perceive this high level
of harm. Although students in the intervention schools are somewhat less likely to report
that females their age have ever smoked marijuana, there is no difference in perceived
norms regarding how many girls smoke weekly. Overall, most striking is the similarity of
student reports across the two conditions.
Table VI. 5. Form 3 Student Reports of Substance Use Norms and Attitudes by Condition

Curriculum
Most/all males the same age:
Have had more than sip of alcohol 55 % 53 % 57 % ns
Drink weekly 40 % 40 % 39 % ns
Have smoked marijuana 23 % 24 % 21 % ns
Smoke marijuana weekly 26 % 27 % 24 % ns
Most/all females the same age:
Have had more than sip of alcohol 25 % 25 % 26 % ns
Drink weekly 15 % 15 % 16 % ns
Have smoked marijuana 8% 7% 9% ns
Smoke marijuana weekly 9% 9% 9% ns
Great harm to students from using:
Alcohol 46 % 48 % 44 % ns
Marijuana 62 % 62 % 62 % ns
Cigarettes 54 % 52 % 55 % ns
Table 6 provides student accounts of substance use behaviours. Again, accounts by

condition are remarkably similar. Of all the behaviours assessed, only lifetime—but not
recent—use of cigarettes is significant. Although students in the comparison schools are
somewhat older, they report similar levels of recent substance use.
Table VI. 6. Form 3 Student Reports of Substance Use Behaviours

Curriculum
Had more than sip of alcohol 88 % 88 % 88 % ns
Had alcohol 10 or more times 37 % 39 % 36 % ns
Ever been drunk 40 % 39 % 40 % ns
Ever smoked marijuana 29 % 30 % 27 % ns
Ever smoked cigarettes 23 % 26 % 21 % <.01
Ever used steroids 5% 5% 5% ns
Ever used inhalants 20 % 19 % 21 % ns
Recently used alcohol 55 % 54 % 56 % ns
Recently been drunk 19 % 20 % 18 % ns
Recently smoked marijuana 15 % 15 % 15 % ns
Recently smoked cigarettes 8% 9% 6% ns
Recently used steroids 4% 5% 4% ns
Recently used inhalants 10 % 9% 11 % ns
This pattern of findings is confirmed in the planned analyses. Outcomes considered include:
a scale of peer norms; a scale of attitudes towards substance use (i.e., harm); and recent
use (yes/no) of each of the substances listed above. Not surprisingly given the descriptive
results above, there are no significant differences on any of these outcomes using the
Wilcoxon paired test.
In relation to students’ reports of norms and attitudes related to fighting and aggression.
Here, there are several significant differences but the direction of findings is inconsistent.
As shown on Table 7, students in the intervention schools are somewhat (p<.05) less likely
to feel you would be perceived as a coward if you backed down from a fight (67 per cent
compared with 73 per cent). However, they are also more likely to endorse pro-violent
items that relate fighting to respect; for example, 49 per cent of comparison school students
compared to 55 per cent of intervention students agree that a boy who doesn’t fight loses
respect. Thus, on half the attitude items, there is virtually no difference between the
groups; on the other three, results neither support nor counter the hypothesis that students
in the intervention schools will report less violent, more prosocial norms and attitudes
53
Table VI.7. Form 3 Student Reports of Violence-Related Norms and Attitudes by Condition

Curriculum
Most/all males the same age:
In physical fight 56 % 55 % 56 % ns
Fight weekly 31 % 33 % 30 % ns
Most/all females the same age:
In physical fight 25 % 28 % 22 % <.01
Fight weekly 18 % 20 % 16 % ns
Agree with pro-violence attitudes
Coward if back down from fight 70 % 73 % 67 % ns
Okay to fight if really angry 35 % 34 % 35 % ns
Not fighting doesn’t show strength 33 % 32 % 33 % ns
Girls who don’t fight lose respect 44 % 41 % 47 % ns
Boys who don’t fight lose respect 52 % 49 % 55 % <.01
Okay to hit girl if she hits first 40 % 40 % 40 % ns
Okay to hit boy if he hits first 61 % 61 % 62 % ns
Two additional survey items addressed anger management. Youth were asked to rate
on a four-point scale how often they “felt angry at the world” and how often they felt like
they could “hardly keep their temper.” On the first item, there was a difference at p<.01 in
mean scores by condition, with students in the comparison schools reporting less anger
(mean=2.00) than those in intervention schools (mean=2.14). However, there are no
differences on the second.
Paired analyses were conducted for two outcomes: a scale of pro-violent attitudes and a
scale of peer norms. At a trend level, students in the intervention schools are marginally
less likely (p<.05) to report that peers were engaged in fighting, but more likely to endorse
pro-violent attitudes.
The final health domain addresses sexuality. As shown on Table 8, only a minority of Form
3 youth—less than 30 per cent--feel that boys and girls their age are “old enough to have
sex.” This does not vary by condition. On three normative items—whether same-age
peers have had sex—there appear to be differences by condition. However, not shown
are analyses by gender, showing this is true only for females. Not surprisingly, given age
differences, 71 per cent of girls in the comparison schools perceive that most or all females
their age have had sex, compared to 60 per cent of those in the intervention schools. They
also think more boys their age have had sex. However, this is not the case when youth
report on their friends. Overall, youth indicate that fewer of their male and female friends
have had sex than the larger peer group of all males and females their age.
In terms of attitudes, students in the intervention schools are somewhat more likely to
say that boys having sex are popular (53 per cent agree compared to 46 per cent in the
comparison condition) and get respect (49 per cent compared with 40 per cent). Not shown,
these differences are apparent for both genders.
Table VI. 8. Form 3 Student Reports of Sex-Related Norms and Attitudes by Condition

Curriculum
Agree “yes”:
Boys same age old enough to have sex 29 % 29 % 29 % ns
Girls same age old enough to have sex 26 % 28 % 26 % ns
Answering most/all:
Males the same age have had sex 64 % 69 % 60 % <.001
Male friends have had sex 57 % 60 % 54 % <.01
Females the same age have had sex 53 % 58 % 49 % <.001
Female friends have had sex 42 % 44 % 40 % ns
Agree with Pro-Sex Attitudes
Girls my age having sex are popular 32 % 30 % 33 % ns
Girls my age having sex get respect 13 % 14 % 13 % ns
Girls my age are usually forced 37 % 35 % 38 % ns
Boys my age having sex are popular 50 % 46 % 53 % <.01
Boys my age having sex get respect 45 % 40 % 49 % <.01
Boys my age are usually forced 14 % 14 % 15 % ns
55
Table 9 provides data on sexual behaviours. On the six items, including four measures of
lifetime sexual encounters (sexual intercourse; sex without a condom; forced sex; more
than one lifetime partner) and two recent measures (sexual intercourse in the last month
and sex without a condom), there are no significant differences by condition.
Not shown, reports of recent sex are higher among males (29 per cent) than females (22
per cent). Examining behaviours by gender, among males, there are no differences in
behaviours by condition. Only one of the six behavioural items is significant for females;
at p<.01, females in the comparison schools are more likely to report having lifetime sex,
again consistent with the fact they are somewhat older. However, there is no difference
by condition in females’ reports of recent sex.
Table VI.9. Form 3 Student Reports of Sex Behaviours by Condition

Item Total Comparison Intervention P value
Ever had sex 42 % 45 % 40 % ns
Ever had sex without condom 33 % 36 % 31 % ns
Ever forced to have sex 18 % 17 % 18 % ns
More than 1 partner 31 % 33 % 30 % ns
Recent (last month) had sex 22 % 22 % 21 % ns
Recent sex without condom 16 % 19 % 14 % ns
Finally, five items assessed youths’ intentions to engage in risk behaviours in the coming
year. There are no differences by condition either in individual intention items or on a
summative scale of intentions (mean, intention scale score, comparison=2.47; mean,
intention scale score intervention=2.41, ns). Differences are also not significant within
gender, although males, overall, report higher intentions (males, comparison=2.63,
intervention=2.36; females, comparison=2.17, intervention=2.24).
Multiple sex-related outcomes were considered in paired analyses. These include a

scale of pro-sex attitudes, a scale of peer norms, recent sex, and condom use among
those who reported sex. Students in the Common Curriculum schools were marginally
(p<.05) more likely to report pro-sex attitudes, which is consistent with item reports
above. Supporting findings on the other behavioural domains, there were no significant
differences on norms or behaviours by condition.
HIV/AIDS Stigma and Knowledge

The first set of items on Table 10 address student knowledge about HIV and sexually transmitted
infections. Overall, only one in ten students answered all items correctly. For example, 81 per
cent of youth know that you can get HIV/AIDS from having sex once without a condom and
66 per cent know that HIV could be transmitted through breast milk. By contrast, only about
a quarter know that some STI can make a woman not able to have a baby, and just over half
(58 per cent) know that a women could have an STI and not know it. As shown, there are no
differences by condition in correct answers on these items. There are, however, small but
statistically significant differences on two items. Students in the Common Curriculum schools
are more likely to report the correct answers to the following items: Only people having sex
with gay people can get AIDS; and you can get AIDS through casual contact. This is consistent
with the fact that more students in the intervention answered more items correctly: 57 per
cent got 5 or more items correct, compared to 46 per cent of those in the comparison schools
(p<.01). However, once again, this finding is based on differences among females; 64 per cent
of females in the intervention schools got 5 or more answers correct, compared to 51 per cent in
the comparison schools (p<.001). These figures are substantially lower among males and do not
differ by condition (47 per cent and 42 per cent, respectively, ns).
Also shown on the table are items assessing HIV/AIDS stigma. Levels of stigma remain high;
for example, only 17 per cent of students say they would buy food from a shopkeeper with AIDS,
and just under half say a teacher with AIDS who is not sick should still teach. There are no
significant differences by condition on these items or on a composite scale of HIV/AIDS stigma
(comparison mean=10.67; intervention mean=10.76).
Table VI.10. Form 3 Student Reports of HIV/AIDS and STI knowledge and Rejection of HIV/AIDS Stigma

Curriculum
Correct answers on the following:
Can get HIV from sex once without a condom (true) 81 % 82 % 80 % ns
People with AIDS look sick right away (false) 72 % 70 % 74 % ns
Only people having sex with gay people get AIDS (false) 76 % 72 % 79 % <.001
You can get AIDS through casual contact (false) 78 % 75 % 80 % <.01
HIV can be transmitted through breast milk (true) 66 % 64 % 68 % ns
A woman can have an STI and not know it (true) 58 % 57 % 58 % ns
STI can make woman not able to have a baby (true) 25 % 25 % 26 % ns
Endorsement of HIV/AIDS Stigma
Teacher with AIDS but not sick should still teach 47 % 45 % 48 % ns
Would buy food from shopkeeper with AIDS 17 % 17 % 18 % ns
Would not keep secret if family member with AIDS 20 % 20 % 19 % ns
Remain friends with someone with AIDS 67 % 67 % 67 % ns
Child with AIDS allowed to go to your school 53 % 50 % 55 % ns
57
Evaluation Limitations and Challenges

As noted in Section III (Evaluation Methodology), this evaluation had multiple purposes.
The process evaluation was designed to document the initial delivery of a new curriculum,
with lessons learned quickly turned around to inform mid-course refinements. These
refinements reflected teachers’ experiences addressing the challenges of implementation,
with the positive result that an empirically-informed Common Curriculum is now available
for dissemination. However, starting evaluation activities so early has implications for
interpreting findings from the impact evaluation. That is, during the delivery of new
lessons in each Form, teachers and schools were in the initial stage of programme
adoption, testing lessons that were still being “piloted” and revised. Educational research
shows that as teachers become more familiar with curriculum, especially when new
pedagogy as well as new content are incorporated, they are more likely to implement
lessons with fidelity. Thus, the impact of lessons delivered for the first time may be
muted, both by lack of teachers’ experience and by not benefiting from the curriculum
refinements resulted from field lessons learned.
As with any evaluation, there are also limitations to both study design and
implementation. As discussed, a high standard was set for showing differences between
“standard HFLE practices” underway after years of effort in each country and the
new Common Curriculum that was developed to enhance ongoing health education.
There was not, therefore, a “do-nothing” control; rather, the evaluation compared
“HFLE standard” to “HFLE enhanced.” In such situations, variations in schools,
student compositions, teacher experience and a host of other factors (such as teacher
comfort with interactive pedagogy) may influence outcomes and, especially, present a
conservative bias, that is, make it more difficult to detect differences between the two
study conditions.
There were also difficulties and limitations related to evaluation resources and
implementation issues. For example, because delivery of lessons took longer than
anticipated, follow up surveys were not conducted, as planned, one month after the
completion of the classes in the intervention schools, and consistent with CDC and other
requirements for showing evidence of effectiveness. This resulted from the fact that most
teachers were not able to complete the lessons (even with additional time) and many were
teaching until the very end of the school term. The tradeoff was between teachers not
completing even a majority of the Form 3 lessons or conducting an immediate post-test.
We opted for an immediate post-test to assure that end-of-year surveys were completed
and students received as many lessons as possible.
There were other issues at the school and country-levels that influenced the rigor of the
evaluation and call for caution in interpreting. These include greater than anticipated
changes in school size and/or demographic composition from baseline to follow up and
lower response rates at follow up. Given these changes, it would have been useful to have
conducted end-of-year surveys after each form, not just at the end of Form 3. However,
this was not feasible, given resources available. Unfortunately, this restriction limited the
detection of problems midstream, reduced the ability to detect interim effects or to increase
statistical power by using data across multiple time points.
In addition, the evaluation design assumed that most students would remain in the same
schools from Form 1 to Form 3. However, substantial proportions of Form 3 students
reported that they were in a different school during Form 2 across the four countries.
Since the intervention was conceived as a three-year program, students in the intervention
schools may not, therefore, have received a “full dose” of intervention. In addition, there
may have been significant cross-over, with students from the comparison schools exposed
to the Common Curriculum in prior years. Our ability to examine these patterns is limited
by not having baseline and follow up surveys linked, through a unique identification code for
each student. While this is often done in longitudinal research, it was not practical to track
students in this way across the countries.
59
Finally, implementation issues limit interpretation of results and pose challenges for future
implementation. The units were not implemented fully in any year, and topics taught in
intervention and comparison schools may be similar, placing the emphasis on discerning
differences in pedagogy. Further, fewer classroom observations were conducted
than planned, making it difficult to quantify differences in health lessons delivered in
intervention and comparison schools. Given these problems plus the limitations of the
study design, it may not be surprising that there are not consistent, clear positive findings.
While teachers’ efforts to implement interactive skills-oriented lessons may not have
translated into measurable changes at the student level, this may be more than one
should expect during the initial years of adoption of a new curriculum being implemented
by relatively inexperienced teachers.
Taken together, these limitations suggest that caution be used in interpreting results
from the impact evaluation. Findings should not be interpreted to mean that HFLE is
not working or that it is unimportant for students’ health and well-being. Rather, the data
reported above show only that, during the initial years of developing and implementing
the Common Curriculum, we were not able to detect significant improvements over
standard HFLE practices, as delivered in comparison schools. Further, findings point
to the importance of addressing challenges in implementation as the programme is
disseminated, so that students may benefit from the impact of full delivery of HFLE
lessons.
UNICEF|BECO|Balldeo
UNICEF|BECO|Balldeo
VII. Challenges and

Recommendations
61
T
he evaluation of the implementation and impact of efforts to introduce a Common
Curriculum that supports the HFLE Framework has provided many lessons
for informing future efforts. It also raises critical questions that need to be
addressed at the Ministry level to maximize the success of dissemination and provide
the infrastructure and support needed for full delivery. The findings in the proceeding
sections identify challenges both with regard to the scope of the HFLE Common
Curriculum and with regard to the process of school adoption and implementation of
lessons. To be effective in teaching students the life skills that will promote their health
and well-being as well as school success, addressing these challenges is critical.
As the evaluators of these ongoing efforts, we note that challenges are to be expected
in the early stages of adoption of any new curriculum. Evaluation research often points
to the need to extend the examination of effectiveness until a programme has been up
and running for a longer time, so that start-up hurdles are overcome and early barriers
are identified and overcome. This does not negate the importance of conducting rigorous
evaluation from the outset, because valuable lessons are learned, as pointed out here, to
help strengthen the dissemination, delivery and impact of HFLE in the future.
Recommendations
The evaluation of the implementation and impact of efforts to introduce a Common
Curriculum that supports the HFLE Regional Curriculum Framework has provided many
lessons for informing future directions. It also raises critical questions that need to be
addressed at the Ministry level to maximize the success of dissemination and provide
the infrastructure needed for full delivery. The findings in the preceding sections identify
challenges both with regard to the scope of the HFLE Common Curriculum and with
regard to the process of school adoption and implementation. To be effective in teaching
students the life skills that will promote their health and well-being as well as school
success, addressing these challenges is critical.
One set of challenges pertains to the curriculum. Documentation of implementation

challenges raises questions regarding: How many units (and lessons within a unit) can
be realistically taught per year? Can and should this time allotment the same for all three
Forms? What “dosage” of HFLE is likely to maximize benefits for students? Should the
health targets of units and lessons be narrowed to assure that priority health problems,
such as violence and HIV/AIDS, are sufficiently addressed?
Another set of challenges pertains to implementation. Difficulties of achieving full

implementation raise questions that must be considered at the Ministry and school level.
For example: How can a cadre of teachers be identified, trained, and retained to deliver
effective lessons? How can lesson delivery be monitored to support fidelity and increase
effectiveness? What Ministry and school administrative support is needed to assure
implementation? Since students change schools, how can school programmes, such as
this curriculum be implemented country-wide?
As these broader questions are being addressed, there are several concrete steps that
can be taken to move forward HFLE efforts:
• First, this study has shown that implementation issues are a major factor in all pilot
countries. Therefore, the success of HFLE relies on the ability of Ministries to sustain
support for HFLE and ensure that HFLE is time-tabled into classroom schedules
and that this schedule is adhered to. In addition, both Ministry and local school
administrator support is needed to ensure early selection of teachers and allow
time for training. Training is critical to success, given the sensitivity of much of the
content covered and the fact that many teachers had not previously led interactive,
participatory exercises.
• Second, observations and documentation of classroom delivery support the

importance of providing a standardized curriculum, as done here. The availability
of a fully scripted curriculum facilitates lesson delivery in a way that a Regional
Curriculum Framework alone does not. This is especially important when, as is
often the case, there is teacher turnover and many teachers assigned to HFLE have
limited experience either with the content or pedagogy. It is notable that teachers and
students welcomed the interactive, participatory approaches of HFLE as well as the
activities that were incorporated in the Common Curriculum.
• Third, even with specified lessons, classroom delivery varied across countries,
schools, and classrooms. To maximize benefits to students, monitoring and
documenting classroom implementation is important for assuring that the goals of the
Regional Curriculum Framework and Common Curriculum are addressed and the
lessons are taught with sufficient fidelity to maximize effectiveness.
63
• Fourth, competing priorities for classroom time must be balanced with the goals
of HFLE. In this evaluation, only two HFLE units were developed, delivered and
evaluated; it was difficult for many teachers to implement 10 lessons per theme.
However, two other themes—one addressing eating and fitness and the other,
managing the environment—are also regional priorities.
For these four themes to be addressed, it will be important to make hard decisions
about what and how much can be covered in each Form.
• Finally, findings point out the need to better understand the many factors that
influence implementation, fidelity to the Common Curriculum, and outcomes achieved.
In addition to documenting effectiveness as dissemination proceeds, it is important
to learn from and attend to the realities of what happens in classrooms, and how
teachers can be best prepared and supported in the delivery of life skills-based health
education.
In sum, this evaluation marked a positive step forward in developing and documenting
classroom implementation of a HFLE Common Curriculum. Findings are the result of
successful, multi-year, collaborative efforts across the region and within each participating
Ministry and school, and underscore both the challenges and potential of coordinated
curriculum and training approaches to meet student health needs.
ANTIGUA & BARBUDA Health And Family Life Education
Form 1 Student Baseline Survey
APPENDIX 1
ANTIGUA & BARBUDA
Health And Family Life Education
65 ANTIGUA & BARBUDA Health And Family Life Education
299 students in Antigua and 16 students in Barbuda participated in this survey.
This is a survey about you and your health. Other students like you across the Caribbean are also doing
this survey. Your answers will be used to develop better school health programs. The survey asks questions
about what you know as well as what you think (your opinion). There are also questions about things you may
or may not have done. You will be able to choose from several answers for each question. There is always an
answer for you.
Some of the questions ask about personal things. We want you to know that no one at your school or home
will see your answers. Your answers and the answers of your classmates are private. It is important that
you work by yourself and do not talk with others. Please answer as many questions as you can. If there are
questions you don’t want to answer, leave them blank.
This is not a test. There are no right or wrong answers. Your grade or mark in this class will not be affected by
whether or not you answer the questions. If you have any questions, raise your hand and someone will come
over and help you.
DO NOT write your name anywhere on the survey.
You answer some questions by putting an “x” in the box to the right of your answer choice, like this:
A. How many brothers and sisters do you have?
You answer other questions by circling your choice, like this:

Please circle the answer that best describes what you Strongly Disagree Agree Strongly Agree
think. Disagree
B. Chocolate ice cream tastes better than strawberry ice 1 2 3 4
cream.
C. I like orange juice better than apple juice. 1 2 3 4
1. Are you a boy or a girl? 5. What kind of student are you?

Girl 36 per cent Boy 64 per cent I get excellent grades 30 per cent
I get good grades 42 per cent
2. What country do you live in? I get fair grades 9 per cent
I get poor grades 10 per cent
Antigua 95 percent Barbuda 5 per cent
Barbados Grenada
6. In the past month (30 days), how many times
St. Lucia Other did you miss school?
I did not miss any days of school 49 per cent

3. How old are you?
One or two days 32 per cent
Three or four days 10 per cent
9 years old 0 per cent 10 years old 0 per cent
Five or more days 10 per cent
13 years old 38 per cent
14 years old or older 8 per cent
7. Do you have trouble getting your homework
done?

4. During the school year, do you have a job? Never 16 per cent
(working for your family or someone else) Sometimes 77 per cent
Always 8 per cent
No, I don’t have a job 74 per cent
Yes, I work 1-4 hours a week 17 per cent
Yes, I work 5-9 hours a week 6 per cent 8. What is the name of your school?
(Please write in the name below):
Yes, I work over 20 hours a week 1 per cent
School: ________________________________
Circle the answer

Strongly Strongly
that best Disagree Agree
Disagree Agree
describes you
9. I am happy to be at this school 11 % 14 % 37 % 38 %
10. I feel I am part of this school 10 % 13 % 46 % 31 %
11. I feel close to people at this school 14 % 26 % 37 % 24 %
12. I like school 11 % 6% 36 % 47 %

This section is about alcohol and other drugs. Alcohol is beer, wine, rum, and other
hard liquors. The first questions are about boys.
Both boys and girls should answer this.
1
Think about your friends who are boys. How many of them
have had more than a sip or two of alcohol?
None of them 28 per cent
Some of them 37 per cent
Most of them 18 per cent
All of them 10 per cent
I don’t have friends who are girls 6 per cent
2
How many boys your age do you think drink alcohol once a
week or more?
3
have ever smoked marijuana (ganja, pot, grass, weed)?
4
How many boys your age do you think smoke marijuana once a
week or more?
The next questions are about girls. Both boys and girls should answer.
5
Think about your friends who are girls. How many of
them have had more than a sip or two of alcohol?
6
How many girls your age do you think drink alcohol
once a week or more?
7
them have ever smoked marijuana (ganja, pot, grass,
weed)?
8
How many girls your age do you think smoke marijuana
9
How many friends do you have at this school?
None 5 per cent
1 6 per cent
2 to 4 9 per cent
5 to 9 9 per cent
10 or more 72 per cent
10
How much do you think teenagers harm themselves if
they drink alcohol once a week or more?
No harm 18 per cent
Little harm 18 per cent
Medium harm 14 per cent
Great harm 50 per cent
11
they smoke marijuana once a week or more?
No harm 19 per cent
How would you act if these things happened to you?

12
Your friends are drinking alcohol. They want you to
drink with them. If you do not want to drink alcohol,
how sure are you that you could you say no?
Not at all sure 32 per cent
A little sure 12 per cent
Somewhat sure 6 per cent
Very sure 50 per cent
13
Your friends are smoking marijuana (ganja, grass, pot, weed).
They want you to smoke with them. If you do not want to
smoke marijuana, how sure are you that you could say no?
14
Your friends are smoking cigarettes. They want you to
smoke cigarettes with them. If you do not want to smoke
cigarettes, how sure are you that you could say no?
I have
3 or 4 5 to 10 more than 10
HAVE YOU EVER… never 1 or 2 times
times times times
done this
15. Had more than a sip or two of 40 % 31 % 9 % 4 % 16 %

alcohol (beer, wine, rum, or hard liquor)
16. Gotten drunk on alcohol 76 % 14 % 2 % 4 % 3 %
17. Smoked marijuana (ganja, weed, 75 % 15 % 3 % 4 % 4 %

pot, grass)
18. Smoked cigarettes 84 % 12 % 2 % 1 % 2 %
19. Use steroids or other drugs like 88 % 4 % 2 % 2 % 3 %

speed or downers
This part is about fighting. We want to know about physical fights. These are fights
with hitting, kicking, or pushing. The first questions are about boys.
Both boys and girls should answer all the questions.
1
Think about your friends who are boys. How many of
them have been in a physical fight?
I don’t have friends who are boys 4 per cent
2
How many boys your age do you think are in a
physical fight once a week or more?
The next questions are about girls.

3
4
How many girls your age do you think are in a
Circle the answer that

Strongly Strongly
best describes Disagree Agree
Disagree Agree
what you think
5. If you back down from a fight, everyone will 21 % 14 % 29 % 36 %

think you are a coward
6. It’s okay to hit someone if you get really 23 % 24 % 29 % 24 %

angry
7. You can show you are strong by refusing to 18 % 20 % 32 % 24 %

fight.
8. A girl who doesn’t fight back when other 22 % 22 % 32 % 24 %

children push her around will lose respect
9. A boy who doesn’t fight back when other 19 % 25 % 28 % 27 %

children push him around will lose respect
10. If a girl hits a boy, he shouldn’t hit her 23 % 16 % 27 % 34 %

back
11. If a boy hits a girl, she shouldn’t hit him 32 % 20 % 24 % 24 %

back

1
You are mad at or vexed with someone your age. Your
friends want you to get into a physical fight with this
person. If you do not want to fight, how sure are you
that you could say no?
2
Your friends ask you to carry a weapon like a knife or
razor to school. If you do not want to do it. How sure
are you that you could say no?
3
Another student your age starts pushing you around
the street. How sure are you that you could stay out of
a physical fight?
Here are some things you may or may not have done. They ask about the past month, or 30
days.
4
Have you ever been in a physical fight?
No 35 per cent
Yes, once 23 per cent
Yes, 2 or 3 times 20 per cent
Yes, 4 or more times 22 per cent
5
During the past month (30 days), how many times were
you in a physical fight?
Never 39 per cent

Once 27 per cent
2 or 3 times 21 per cent
4 or more times 13 per cent
6
Have you ever carried weapon such as a knife, razor,
ice pick, or gun to school?
Never 79 per cent
A few times 15 per cent
Almost all the time 6 per cent
7
Have you ever carried a weapon at times other than
at school?
Never 64 per cent

8
In the past month (30 days) have you stayed away
from school because you felt unsafe being there or
getting there?
No 73 per cent
Yes, 1 day 13 per cent
Yes, 2 or 3 days 6 per cent
Yes, more than 5 days 6 per cent

9
Have you ever been badly hurt in a physical fight?
Badly hurt means very sore, bleeding a lot, or worse.
Never 73 per cent
Once 14 per cent
THESE QUESTIONS ARE ABOUT SEX. HERE, SEX MEANS SEXUAL INTERCOURSE OR
“GOING ALL THE WAY.” These questions are about boys your age.
1
Do you think a boy your age is old enough to have sex?
2
How many boys your age do you think have ever had
sex?
3
How many of your friends who are boys do you
think have had sex?
These questions are about girls your age.

4
Do you think a girl your age is old enough to have sex?
Maybe 15 per cent
Yes 29 per cent
5
How many girls your age do you think have ever had
sex?
3
How many of your friends who are girls do you
think have had sex?

Strongly Strongly
Disagree Agree
what you think
1. Girls my age who have sex are popular 36 % 27 % 14 % 22 %
2. Girls my age who have sex get respect 30 % 35 % 21 % 14 %
3. Girls my age who have sex are usually 15 % 21 % 31 % 33 %

forced to
4. Boys my age who have sex are popular 28 % 23 % 20 % 29 %
5. Boys my age who have sex get respect 25 % 28 % 24 % 22 %
6. Boys my age who have sex are usually 28 % 27 % 14 % 22 %

forced to
These questions are about things you may or may not have done. Whether or not you
have had sex, there is an answer for you.
Yes, Yes, more

Circle the correct answer No
once than once
1. Have you ever had any kind of sexual experience (such as kissing, 72 % 28 %
kissing and hugging a long time, petting) with a male?
kissing and hugging a long time, petting) with a female?
3. Some students have had sex and others have not. Have you ever
had sex (“Gone all the way”)? 61 % 15 % 24 %
4. Sometimes young people are forced to have sex against their will.
Have you ever been forced to have sex? 74 % 14 % 12 %
5
Young people may have sex for the first time with a
partner who is older, younger or about the same age.
By younger or older, we mean three or more years
different than you. Which describes you?
I have never had sex 57 per cent

The first time I had sex was with
13 per cent
someone older
6 per cent
someone younger
24 per cent
someone my age
6
How many people have you had sex with in your
lifetime?
1 person 11 per cent
2 people 12 per cent
3 to 4 people 23 per cent
Have you ever had sex without a condom?

No 14 per cent
Yes, more than once 15 per cent
1
A person that you are going out with and really like
wants to have sex with you. If you do not want to have
sex, how sure are you that you could say no?
2
An older person promises you money or gifts if you
have sex. If you do not want to have sex, how sure are
you that you could say no?

The next questions are about AIDS and HIV, the virus that causes AIDS.
You can answer true, false, or don’t know to these

True False Don’t know
statements
3. A person can get HIV (the AIDS virus) by having sex just 13 % 71 % 15 %
once without a condom
4. Most people who have HIV (the AIDS virus) show signs of 27 % 40 % 33 %
being sick right away
5. You can get HIV (the AIDS virus) from kissing someone who 41 % 41 % 18 %
has the AIDS virus
6. Only people who have sex with gay (homosexual) people get 27 % 37 % 36 %
AIDS
7. A baby can get infected with HIV (the AIDS virus) through 9 % 72 % 19 %
breast milk
8. A person can get HIV (the AIDS virus) through casual

contact, like sharing food, 46 % 25 % 29 %
handshakes, hugs, or clothes, with someone who has the AIDS
virus
These questions ask about people who are living with Not
No Yes
the aids virus Sure
9. If a teacher has the AIDS virus but is not sick, should he or 71 % 17 % 12 %

she be allowed to teach in school?
10. If you knew that a shopkeeper or food seller had the AIDS 85 % 7% 8%
virus, would you buy food from them?
11. If a family member had the AIDS virus, would you want it to 42 % 48 % 10 %
be kept a secret?
12. If a friend became sick with the AIDS virus, would you be 52 % 36 % 12 %
willing to stay friends?
13. If a student has the AIDS virus, should he or she be 62 % 22 % 15 %

allowed to go to your school?
Now these are questions about you and your feelings
These questions ask about Strongly Strongly

Disagree Agree
what you are like Disagree Agree
1. When things get tough, I try to remember 12 % 15 % 44 % 28 %

my goals
2. I am able to do things as well as most 9 % 23 % 40 % 28 %

other people
3. I have a number of good qualities 7 % 23 % 42 % 28 %
4. I am satisfied with myself 8 % 8 % 39 % 45 %
5.If I work hard, I will get what I want 6 % 8 % 36 % 49 %
6. I feel angry at the world 31 % 40 % 16 % 12 %
7. I can hardly keep my temper 23 % 21 % 30 % 26 %
Strongly Strongly
Circle the choice that describes you Disagree Agree
Disagree Agree
8. It is easy for me to make new friends 15 % 18 % 40 % 27 %
9 If I want my friends to go along with me, I 10 % 20 % 41 % 30 %

know what to say to them
10. I know how to make friends with people of 20 % 21 % 36 % 23 %

the opposite gender (sex)
11. It is easy for me to get along with other 10 % 22 % 38 % 30 %

people
12. I don’t let my friends talk me into doing 18 % 17 % 30 % 35 %

things I don’t want to do
13. I have friends to go to if I need help with a 14 % 14 % 40 % 32 %

problem
14. There is an adult at school I can go to if I 8 % 13 % 37 % 42 %

need help with a problem
15. There are teachers at school who care 10 % 14 % 35 % 41 %

about me
How likely would you be to Definitely Probably Not Probably Definitely

do the following things? would would sure would not would not
16. Tell people your opinion, even if you know 20 % 16 % 40 % 7% 17 %

they will not agree with you
17. Tell someone to go to the end of the line if 27 % 26 % 23 % 12 % 11 %

they cut in line ahead of you
18. Start a conversation with someone you 27 % 28 % 24 % 10 % 11 %

would like to know better
19. Give and receive compliments without 27 % 20 % 26 % 14 % 13 %

acting or feeling stupid
20. Go to an adult for help when you are 33 % 24 % 22 % 5% 16 %

having a problem that you can’t solve yourself
These questions ask about you and your family.
1
How many times a week do you work, play, or exercise
hard enough to make you sweat or breathe hard?
Never 27 per cent
1 or 2 times a week 29 per cent
6 or more times a week 30 per cent
2
When I look at myself in the mirror, I feel:
Not happy with the way my body looks 17 per cent
Just okay with how my body looks 18 per cent
Happy with the way my body looks 66 per cent
3
Do you look younger, about the same age, or older than
other students in your Form or Grade?
Younger 31 per cent
About the same age 43 per cent
Older 26 per cent
4
How often do you go hungry because there is not
enough food at home?
Never / Hardly ever 50 per cent

Sometimes 36 per cent
A lot 15 per cent
5
How often do you eat breakfast (solid foods)?
A few times a week 31 per cent
About every day 55 per cent
6
Who do you presently live with?
Check each row. Yes No
With my mother 90 per cent 10 per cent
With my father * *
With grand parents * *

With other relatives * *
Over 25 per cent of students skipped this question.
7
In the last month, how often did you go to church
or religious services?
I have not gone 22 per cent

Once 15 per cent

The last questions are about health and Family life classes you have had. If you have
not had these classes in your primary school, Circle “4”.
I did not have

Health or
My health and family life classes have I do not Family Life
Yes No
taught me: remember classes
in primary
school
8. How to say no if my friends try to pressure 36 % 42 % 8% 14 %

me to drink alcohol or smoke marijuana
9. How to solve a conflict without getting into 37 % 32 % 13 % 18 %

a physical fight
10. How to make a good decision when 38 % 31 % 14 % 17 %

friends pressure me to do things I don’t think
are right
11. Why it is important to wait to have sex 52 % 23 % 10 % 14 %
until I’m older
12. How to get help from an adult I trust if I 51 % 21 % 13 % 15 %

have a problem I can’t solve by myself
13. How to set personal goals so I can be 55 % 16 % 14 % 16 %

successful in secondary school
Thank you for taking this survey!


APPENDIX 2
ANTIGUA & BARBUDA
135 students participated in this survey.
answer for you.
over and help you.

think. Disagree
cream.
1. What is your gender? 8. Do you have a class in Health and Family Life
Girl 46 per cent Boy 54 per cent Education (HFLE) this year?
No 4 per cent
2. What country do you live in? Yes 96 per cent
Antigua Barbuda Barbados
Grenada St. Lucia Other 9. How often did you have a classes in Health
and Family Life Education (HFLE) this year?
3. How old are you? Never 2 per cent
12 years old 0 per cent 15 years old 50 per cent Less than once a week 5 per cent
13 years old 2 per cent 16 years old 24 per cent 1 time per week 15 per cent
14 years old 22 per cent 2 times per week 37 per cent
17 years old or older 3 per cent 3 times per week 20 per cent
4 or more times per week 20 per cent
4. During the school year, do you have a job?

(working for your family or someone else) 10. What is the name of your school?
No, I don’t have a job 80 per cent
Yes, I work 5-9 hours a week 7 per cent School: ________________________________
11. Did you attend this school during Form 2
(Grade 8)?
5. What kind of student are you?
No 47 per cent
I get excellent grades 14 per cent
Yes 53 per cent
I get fair grades 32 per cent
I get poor grades 4 per cent 12. Did you attend this school during Form 1
(Grade 7)?
6. In the past month (30 days), how many times No 30 per cent
did you miss school?
Yes 70 per cent
13. How many friends do you have at your
Three or four days 11 per cent school?
Five or more days 11 per cent None 3 per cent
1 10 per cent
7. Have you had a class in Health and Family Life 2 to 4 12 per cent
Education (HFLE) before this year?
5 to 9 15 per cent
No 9 per cent
Yes 91 per cent
1
2
week or more?
3
4
week or more?
5

I don’t have friends who are girls 2 er cent
6

7
weed)?

8
1
No harm 5 per cent
2
No harm 6 per cent
3
they smoke cigarettes once a week or more?
No harm 8 per cent

4
5
6
I have 1 OR 2 3 OR 4 5 TO 10 More than 10

Have you ever…
never Times Times Times Times
1. Had more than a sip or two of alcohol 22 % 36 % 13 % 6 % 22 %

(beer, wine, rum, or hard liquor)
3. Smoked marijuana (ganja, weed, pot, 69 % 15 % 4 % 2 % 10 %

grass)
5. Use steroids or other drugs like speed 94 % 2 % 1 % 1 % 2 %

or downers
6. Used inhalants (white out, alcolada) 87 % 5 % 2 % 2 % 5 %

I have
In the past month (30 days) not done 1 OR 2 3 OR 4 5 TO 10 More than 10
have you… this in the Times Times Times Times
past
month

3. Smoked marijuana (ganja, weed, pot, 84 % 10 % 1 % 0 % 6 %

grass)
5. Use steroids or other drugs like speed 96 % 2 % 1 % 2 % 0 %

or downers
6. Used inhalants (white out, alcolada) 91 % 5 % 1 % 1 % 2 %
This part is about fighting. We want to know about physical fights. These are fights with
hitting, kicking, or pushing. The first questions are about boys.
1
2

3
4

Strongly Strongly
Disagree Agree
what you think


angry

fight.



back

back

1
2
3
a physical fight?
1
No 44 per cent
Maybe 32 per cent
Yes 25 per cent
2
sex?
3
think have had sex?

4
No 52 per cent
Maybe 25 per cent
Yes 23 per cent
5
sex?
6
think have had sex?

Strongly Strongly
Disagree Agree
what you think

forced to
6. Boys my age who have sex are usually 44 % 34 % 14 % 9 %

forced to
1
2

Yes, Yes, more

once than once
4. Have you ever had sex without a condom? 57 % 23 % 19 %
Have you ever been forced to have sex? 76 % 16 % 8 %
6
27 per cent
someone older
4 per cent
someone younger
27 per cent
someone my age
7
lifetime?
11 or more people 4 per cent
Yes, more
No Yes
than once
8. In the past month (30 days), have you had sex? 70 % 14 % 16 %
9. In the past month (30 days), have you had sex without a 76 % 12 % 12 %
condom?
The next questions are about AIDS and the virus that causes AIDS, and other sexually
transmitted infections, or STIs.

statements
has the AIDS virus
AIDS
breast milk
6. A person can get HIV (the AIDS virus) through casual 78 % 12 % 9 %

contact, like sharing food,
virus
7. An STI can make a woman not able to have a baby 22 % 41 % 37 %
8. A woman can be infected with an STI and not know it until 9 % 69 % 22 %

she gets very sick
No Yes
the aids virus Sure
2. If you knew that a shopkeeper or food seller had the AIDS 75 % 12 % 14 %


be kept a secret?

5. If a student has the AIDS virus, should he or she be allowed 26 % 58 % 16 %

to go to your school?
Circle the answer Strongly Strongly

Disagree Agree
that best describes your feelings Disagree Agree
1. I am happy to be at this school 18 % 14 % 47 % 21 %
4. I like school 9 % 12 % 45 % 34 %
5. In school I have learned I can disagree 11 % 12 % 49 % 28 %

with what others say
6. In school I have learned that I can help my 9 % 9 % 40 % 46 %

community by what I do
These questions ask about what you may or may not

No Maybe Yes
do in the next year. Do you think you will:
1. Have sex? 25 % 33 % 42 %
2. Have sex without a condom? 70 % 9 % 20 %
3. Smoke cigarettes? 95 % 2 % 2 %
4. Drink alcohol? 50 % 30 % 20 %
5. Smoke marijuana? 82 % 9 % 9 %
If you have a personal problem, how

Strongly Strongly
sure are you that you could talk about Disagree Agree
Disagree Agree
it with:
1. A friend 29 % 28 % 13 % 29 %
2. Teachers 33 % 31 % 14 % 21 %
3. Your parents or other adults in your family 18 % 21 % 15 % 46 %

Disagree Agree
1. When things get tough, I try to remember 5 % 12 % 44 % 38 %

my goals
2. I am able to do things as well as most 2 per cent 8 % 54 % 35 %

other people
3. I have a number of good qualities 2 % 4 % 45 % 49 %
4. I am satisfied with myself 4 % 9 % 29 % 58 %
5.If I work hard, I will get what I want 2 % 7 % 35 % 56 %
6. In school I have learned that I can help my 36 % 42 % 16 % 6 %

8. I have set positive and realistic goals for 2 % 7 % 43 % 48 %

myself
9. I have thought hard about my values and 2 % 7 % 39 % 52 %

what is important to me
10. I try to get to know myself better 5 % 3 % 50 % 42 %
11. I am aware of my feelings and how they 7 % 17 % 38 % 38 %

influence what I do
Strongly Strongly
Circle the best answer for you Disagree Agree
Disagree Agree
1. I think about the consequences before I act 12 % 18 % 39 % 31 %
2. I remember my way isn’t the only way 27 % 14 % 50 % 29 %
3. I try to understand other people’s ideas 8 % 20 % 50 % 22 %

and perspectives
4. I always treat others with respect, even if 8 % 12 % 44 % 36 %

they are different
5. I always treat others with respect, even 16 % 25 % 40 % 18 %

when I am angry
6. If someone is being teased or bullied, I 12 % 18 % 37 % 34 %

take positive action to stop it
Strongly Strongly
Disagree Agree
1. I encourage others my age to wait until 17 % 23 % 33 % 26 %

they are older to have sex
2. I do not pressure anyone to have sex or do 9 % 15 % 32 % 43 %

something sexual
3. I can protect myself from getting HIV/AIDS 8 % 2 % 28 % 62 %

or another sexually transmitted infection (STI)
4. I don’t let my friends talk me into doing 2 % 6 % 32 % 60 %

things I don’t want to do.
problem
am having a personal problem I can’t handle
myself
7. If an adult or someone older than me 8 % 9 % 40 % 44 %

wants me to do something sexual, I know
where to get help
8. I suggest activities my friends and I can do 10 % 18 % 36 % 35 %

that won’t lead to doing sexual things I am
not ready for
9. I find ways to have fun that do not lead to 10 % 11 % 33 % 46 %

drinking alcohol or having sex

about me
1
Never 14 per cent
2
3
Younger 30 per cent
Older 16 per cent
4
A lot 8 per cent

1. What is your gender?

Female 46 per cent Form
Male 54 per cent Baseline Survey
3 Student
2. What country do you live in?

5
Grenada St. Lucia Other
3. How old are you?
About 12 years
every dayold 0 per cent 13 years
56oldper
2 cent
per cent 14 years old 22 per cent
15 years old 50 per cent 16 years
old 24 per cent 17 years old or older 3 per cent
6
(working
Check for row.
each your family or someone else) Yes No
With my
No,mother
I don’t have a job 80 per 92
cent
per cent 8 per cent
With my father * *
5. What kind of student are you?

7 I get good grades 50 per cent
or religious
services?
7.Once
In the past month (30 days), how many times
17 per cent
One or two days 35 per cent 36 per cent
4 or more times

BARBADOS Health And Family Life Education
APPENDIX 3
BARBADOS
105 BARBADOS Health And Family Life Education
answer for you.
over and help you.

think. Disagree
cream.


3. How old are you? did you miss school?
9 years old 0 per cent 10 years old 0 per cent I did not miss any days of school 46 per cent
11 years old 64 per cent 12 years old 33 per cent One or two days 35 per cent
13 years old 2 per cent Three or four days 11 per cent
14 years old or older 1 per cent Five or more days 9 per cent
4. During the school year, do you have a job? 7. Do you have trouble getting your homework
(working for your family or someone else) done?

No, I don’t have a job 87 per cent Never 27 per cent
Yes, I work 1-4 hours a week 10 per cent Sometimes 71 per cent
Yes, I work 5-9 hours a week 1 per cent Always 2 per cent
Yes, I work over 20 hours a week 1 per cent 8. What is the name of your school?
School: ________________________________
Circle the answer

Strongly Strongly
Disagree Agree
describes you
9. I am happy to be at this school 5% 6% 47 % 42 %
11. I feel close to people at this school 8% 24 % 49 % 19 %
12. I like school 7% 8% 38 % 48 %

1
2
week or more?
3
4
week or more?
5
6
7
weed)?
8
9
None 2 per cent
1 2 per cent
2 to 4 7 per cent
5 to 9 10 per cent
10
No harm 7 per cent
11
No harm 7 per cent

12
13
14
I have
times times times
done this
15. Had more than a sip or two of 40 % 32 % 12 % 6 % 10 %

17. Smoked marijuana (ganja, weed, 90 % 5 % 1 % 1 % 3 %

pot, grass)
19. Use steroids or other drugs like 94 % 3 % 1 % 0 % 2 %

speed or downers
1
2

3
4

Strongly Strongly
Disagree Agree
what you think


angry

fight.



back

back

1
2
3
a physical fight?
days.
4
No 37 per cent
5
Never 54 per cent

Once 24 per cent
6
Never 90 per cent
7
at school?
Never 83 per cent

8
getting there?
No 92 per cent

9
Never 83 per cent
Once 13 per cent
1
No 73 per cent
Maybe 16 per cent
Yes 10 per cent
2
sex?
3
think have had sex?

4
No 75 per cent
Maybe 16 per cent
Yes 10 per cent
5
sex?
6
think have had sex?

Strongly Strongly
Disagree Agree
what you think

forced to
12. Boys my age who have sex are 40 % 25 % 20 % 14 %

usually forced to
Yes, Yes, more

once than once
had sex (“Gone all the way”)? 85 % 8% 7%
Have you ever been forced to have sex? 90 % 7% 3%
5

8 per cent
someone older
1 per cent
someone younger
7 per cent
someone my age
6
lifetime?
1 person 8 per cent
2 people 4 per cent

No 7 per cent
1
2


statements
has the AIDS virus
AIDS
breast milk

contact, like sharing food, 80 % 6% 15 %
virus
No Yes
the aids virus Sure

be kept a secret?


Disagree Agree
1. When things get tough, I try to remember 6% 9% 49 % 36 %

my goals
2. I am able to do things as well as most 4% 8% 48 % 40 %

other people
3. I have a number of good qualities 3% 7% 43 % 48 %
4. I am satisfied with myself 5% 9% 34 % 52 %
5. If I work hard, I will get what I want 5% 6% 31 % 58 %
6. I feel angry at the world 45 % 37 % 10 % 8%
Strongly Strongly
Disagree Agree
8. It is easy for me to make new friends 7% 14 % 44 % 35 %
9 If I want my friends to go along with me, I 9% 19 % 47 % 25 %


11. It is easy for me to get along with other 7% 20 % 45 % 27 %

people
12. I don’t let my friends talk me into doing 11 % 9% 31 % 49 %

13. I have friends to go to if I need help with a 9% 9% 45 % 37 %

problem
14. There is an adult at school I can go to if I 9% 11 % 35 % 44 %

15. There are teachers at school who care 7% 8% 42 % 43 %

about me

16. Tell people your opinion, even if you know 29 % 28 % 32 % 5% 6%

17. Tell someone to go to the end of the line if 37 % 22 % 26 % 7% 8%

18. Start a conversation with someone you 47 % 28 % 17 % 5% 4%

19. Give and receive compliments without 26 % 27 % 31 % 7% 9%

20. Go to an adult for help when you are 46 % 23 % 18 % 4% 8%

1
Never 21 per cent
2
3
Younger 38 per cent
Older 23 per cent
4

A lot 10 per cent
5
6
With my father * *

* Over 25 per cent of students skipped this question.
7

Once 8 per cent

I did not have

Health or
Yes No
in primary
school
8. How to say no if my friends try to pressure 45 % 28 % 8% 19 %

9. How to solve a conflict without getting into 52 % 18 % 16 % 14 %

a physical fight
10. How to make a good decision when 54 % 17 % 14 % 16 %

are right
11. Why it is important to wait to have sex 59 % 14 % 11 % 16 %
until I’m older
12. How to get help from an adult I trust if I 56 % 13 % 15 % 15 %

13. How to set personal goals so I can be 64 % 8% 14 % 13 %



APPENDIX 4
BARBADOS
answer for you.
over and help you.

think. Disagree
cream.
No 35 per cent
3. How old are you? Never 30 per cent
12 years old 1 per cent 15 years old 13 per cent Less than once a week 6 per cent
13 years old 15 per cent 16 years old 1 per cent 1 time per week 56 per cent
14 years old 71 per cent 2 times per week 2 per cent
17 years old or older 0 per cent 3 times per week 1 per cent
(working for your family or someone else)
10. What is the name of your school?
No, I don’t have a job 86 per cent (Please write in the name below):
School: ________________________________

5. What kind of student are you? (Grade 8)?
I get excellent grades 16 per cent No 34 per cent
I get good grades 52 per cent Yes 66 per cent
(Grade 7)?
6. In the past month (30 days), how many times No 11 per cent
Yes 89 per cent
13. How many friends do you have at your
school?
None 5 per cent
1 2 per cent
7. Have you had a class in Health and Family Life 2 to 4 13 per cent
Education (HFLE) before this year?
5 to 9 11 per cent
No 21 per cent
Yes 79 per cent
1
2
week or more?
3
4
week or more?
5

6

7
weed)?

8
1
No harm 8 per cent
2
No harm 7 per cent
3
No harm 7 per cent

4
5
6

Have you ever…

2. Gotten drunk on alcohol 71 % 19 % 6% 2% 3%
3. Smoked marijuana (ganja, weed, pot, 73 % 10 % 6% 4% 8%

grass)
4. Smoked cigarettes 79 % 12 % 4% 2% 3%
5. Use steroids or other drugs like speed 92 % 4% 1% 1% 2%

or downers
6. Used inhalants (white out, alcolada) 71 % 13 % 5% 2% 8%

I have
past
month
1. Had more than a sip or two of alcohol 49 % 26 % 12 % 4% 9%

2. Gotten drunk on alcohol 85 % 9% 3% 1% 3%
3. Smoked marijuana (ganja, weed, pot, 84 % 6% 3% 3% 3%

grass)
4. Smoked cigarettes 90 % 4% 2% 2% 2%

or downers
6. Used inhalants (white out, alcolada) 84 % 8% 4% 1% 3%
1
2

3
4

Strongly Strongly
Disagree Agree
what you think


angry

fight.



back

back

1
2
3
a physical fight?
1
No 38 per cent
Maybe 40 per cent
Yes 22 per cent
2
sex?
3
think have had sex?

4
No 44 per cent
Maybe 34 per cent
Yes 22 per cent
5
sex?
6
think have had sex?

Strongly Strongly
Disagree Agree
what you think
1. Girls my age who have sex are popular 26 % 30 % 29 % 15 per cent
2. Girls my age who have sex get respect 36 % 43 % 14 % 7%

forced to
6. Boys my age who have sex are usually 49 % 34 % 10 % 7%

forced to
1
2

Yes, Yes, more

once than once
4. Have you ever had sex without a condom? 77 % 14 % 9%
Have you ever been forced to have sex? 86 % 8% 6%
6
17 per cent
someone older
4 per cent
someone younger
14 per cent
someone my age
7
lifetime?
2 people 9 per cent
3-4 people 9 per cent
Yes, more
No Yes
than once
8. In the past month (30 days), have you had sex? 81 % 12 % 7%
9. In the past month (30 days), have you had sex without a 88 % 7% 5%
condom?

statements
1. A person can get HIV (the AIDS virus) by having sex just 12 % 80 % 8%
has the AIDS virus
AIDS
breast milk
6. A person can get HIV (the AIDS virus) through casual 78 % 7% 16 %

virus
8. A woman can be infected with an STI and not know it until 9% 49 % 42 %

she gets very sick
No Yes
the aids virus Sure


be kept a secret?



Disagree Agree
1. I am happy to be at this school 9% 10 % 54 % 26 %
2. I feel I am part of this school 8% 14 % 55 % 23 %
4. I like school 10 % 17 % 46 % 27 %
5. In school I have learned I can disagree 8% 9% 45 % 38 %

6. In school I have learned that I can help my 6% 6% 56 % 32 %


No Maybe Yes
1. Have sex? 39 % 30 % 30 %
3. Smoke cigarettes? 83 % 12 % 5%
4. Drink alcohol? 40 % 36 % 23 %

Strongly Strongly
Disagree Agree
it with:
1. A friend 21 % 28 % 18 % 34 %
2. Teachers 35 % 30 % 17 % 18 %

Disagree Agree
1. When things get tough, I try to remember 8% 13 % 51 % 27 %

my goals
2. I am able to do things as well as most 3% 10 % 54 % 32 %

other people
5.If I work hard, I will get what I want 4% 6% 36 % 55 %
6. In school I have learned that I can help my 23 % 49 % 15 % 8%

8. I have set positive and realistic goals for 5% 8% 45 % 41 %

myself
9. I have thought hard about my values and 4% 9% 50 % 38 %

10. I try to get to know myself better 5% 7% 47 % 41 %
11. I am aware of my feelings and how they 6% 7% 46 % 41 %

influence what I do
Strongly Strongly
Disagree Agree
1. I think about the consequences before I act 12 % 19 % 47 % 23 %
2. I remember my way isn’t the only way 6% 17 % 53 % 25 %
3. I try to understand other people’s ideas 6% 13 % 58 % 23 %

and perspectives
4. I always treat others with respect, even if 7% 15 % 52 % 26 %

they are different

when I am angry
6. If someone is being teased or bullied, I 11 % 22 % 46 % 21 %

Strongly Strongly
Disagree Agree

2. I do not pressure anyone to have sex or do 9% 13 % 40 % 38 %

something sexual
3. I can protect myself from getting HIV/AIDS 6% 7% 27 % 60 %

4. I don’t let my friends talk me into doing 8% 7% 36 % 49 %

5. I have friends to go to if I need help with a 9% 14 % 43 % 34 %
problem
myself
7. If an adult or someone older than me 10 % 11 % 36 % 42 %

where to get help
8. I suggest activities my friends and I can do 9% 14 % 44 % 33 %

not ready for
9. I find ways to have fun that do not lead to 8% 12 % 41 % 39 %


about me
1
Never 21 per cent
2
3
Younger 29 per cent
Older 26 per cent
4
A lot 8 per cent

5
6
With my father * *
7
Once 12 per cent


APPENDIX 5
GRENADA
145 GRENADA Health And Family Life Education
answer for you.
over and help you.

think. Disagree
cream.



School: ________________________________
Circle the answer

Strongly Strongly
Disagree Agree
describes you
10. I feel I am part of this school 3% 7% 49 % 41 %
12. I like school 2% 2% 29 % 67 %

1
2
week or more?
3
4
week or more?
5
6
7
weed)?
8
9
None 4 per cent
1 3 per cent
2 to 4 9 per cent
5 to 9 13 per cent
10
No harm 8 per cent
11
No harm 8 per cent

12
13
14
I have
times times times
done this
15. Had more than a sip or two of 41 % 34 % 10 % 4% 11 %

16. Gotten drunk on alcohol 88 % 9% 1% 1% 1%
17. Smoked marijuana (ganja, weed, 93 % 4% 1% 1% 1%

pot, grass)
19. Use steroids or other drugs like 96 % 1% 1% 0% 1%

speed or downers
1
2

3
4

Strongly Strongly
Disagree Agree
what you think


angry

fight.



back

back

1
2
3
a physical fight?
days.
4
No 36 per cent
5
Never 63 per cent

Once 20 per cent
6
Never 94 per cent
7
at school?
Never 84 per cent

8
getting there?
No 94 per cent

9
Never 87 per cent
Once 10 per cent
1
No 68 per cent
Maybe 22 per cent
Yes 10 per cent
2
sex?
3
think have had sex?

4
No 68 per cent
Maybe 20 per cent
Yes 12 per cent
5
sex?
6
think have had sex?

Strongly Strongly
Disagree Agree
what you think
8. Girls my age who have sex get respect 58 % 26 % 10 % 6%

forced to
11. Boys my age who have sex get respect 51 % 29 % 12 % 7%

usually forced to
Yes, Yes, more

once than once
3. Some students have had sex and others have not. Have you ever 78 % 10 % 11 %
had sex (“Gone all the way”)?
4. Sometimes young people are forced to have sex against their will. 84 % 11 % 5%
Have you ever been forced to have sex?
5

7 per cent
someone older
2 per cent
someone younger
12 per cent
someone my age
6
lifetime?
1 person 8 per cent
2 people 4 per cent
7
No 8 per cent
1
2


statements
has the AIDS virus
6. Only people who have sex with gay (homosexual) people get 59 % 8% 33 %
AIDS
breast milk

virus
No Yes
the aids virus Sure

10. If you knew that a shopkeeper or food seller had the AIDS 73 % 9% 18 %
be kept a secret?


Disagree Agree

my goals

other people
Strongly Strongly
Disagree Agree



people

13. I have friends to go to if I need help with a 9% 9% 45 % 36 %

problem


about me


17. Tell someone to go to the end of the line if 30 % 19 % 30 % 10 % 11 %


19. Give and receive compliments without 21 % 24 % 39 % 8% 9%

20. Go to an adult for help when you are 39 % 28 % 17 % 6% 10 %

1
Never 39 per cent
2
3
Younger 28 per cent
Older 16 per cent
4

A lot 8 per cent
5
6
With my father * *

7

Once 8 per cent

I did not have

Health or
Yes No
in primary
school
8. How to say no if my friends try to pressure 41 % 41 % 9% 9%

9. How to solve a conflict without getting into 55 % 26 % 12 % 7%

a physical fight
10. How to make a good decision when 52 % 27 % 14 % 6%

are right
11. Why it is important to wait to have sex 65 % 16 % 10 % 9%
until I’m older
12. How to get help from an adult I trust if I 59 % 19 % 16 % 6%

13. How to set personal goals so I can be 73 % 7% 11 % 9%



APPENDIX 6
GRENADA
APPENDIX 6
GRENADA
165
answer for you.
over and help you.

think. Disagree
cream.
No 18 per cent
3. How old are you?
Never 17 per cent
Less than once a week 5 per cent
1 time per week 48 per cent
2 times per week 23 per cent
No, I don’t have a job 78 per cent 10. What is the name of your school?
5. What kind of student are you? 11. Did you attend this school during Form 2
(Grade 8)?
No 43 per cent
Yes 57 per cent
(Grade 7)?
did you miss school? No 15 per cent
I did not miss any days of school 58 per cent Yes 85 per cent
Three or four days 8 per cent 13. How many friends do you have at your
school?
None 4 per cent
1 2 per cent
7. Have you had a class in Health and Family Life
Education (HFLE) before this year? 2 to 4 9 per cent
No 11 per cent 5 to 9 12 per cent
Yes 89 per cent 10 or more 73 per cent
1
2
week or more?
3
4
week or more?
5

6

7
weed)?

8
1
No harm 9 per cent
2
No harm 6 per cent
3
No harm 5 per cent

4
5
6

Have you ever…
1. Had more than a sip or two of alcohol 9% 26 % 16 % 10 % 39 %


grass)

or downers
6. Used inhalants (white out, alcolada) 82 % 10 % 2% 1% 5%

I have
past
month
1. Had more than a sip or two of alcohol 47 % 29 % 10 % 4% 9%


grass)

or downers
1
2

3
4

Strongly Strongly
Disagree Agree
what you think


angry

fight.



back

back

1
2
3
a physical fight?
These questions are about sex. Here, sex means sexual intercourse or “going all the
way.” These questions are about boys your age.
1
No 41 per cent
Maybe 28 per cent
Yes 30 per cent
2
sex?
3
think have had sex?

4
No 49 per cent
Maybe 23 per cent
Yes 28 per cent
5
sex?
6
think have had sex?

Strongly Strongly
Disagree Agree
what you think
2. Girls my age who have sex get respect 58 % 32 % 7% 3%

forced to
6. Boys my age who have sex are usually 63 % 25 % 7% 4%

forced to
1
2

Yes, Yes, more

once than once
Have you ever been forced to have sex? 82 % 10 % 9%
6
20 per cent
someone older
5 per cent
someone younger
20 per cent
someone my age
7
lifetime?
2 people 7 per cent
Yes, more
No Yes
than once
8. In the past month (30 days), have you had sex? 81 % 9% 10 %
9. In the past month (30 days), have you had sex without a 84 % 8% 8%
condom?

statements
1. A person can get HIV (the AIDS virus) by having sex just 9% 84 % 7%
2. Most people who have HIV (the AIDS virus) show signs of 74 % 8% 18 %
has the AIDS virus
AIDS
breast milk
6. A person can get HIV (the AIDS virus) through casual 9% 64 % 28 %

virus

she gets very sick
No Yes
the aids virus Sure


be kept a secret?
4. If a friend became sick with the AIDS virus, would you be 8% 70 % 21 %



Disagree Agree
4. I like school 5% 6% 38 % 51 %
5. In school I have learned I can disagree 7% 8% 37 % 47 %



No Maybe Yes
1. Have sex? 41 % 27 % 33 %
3. Smoke cigarettes? 90 % 7% 4%
4. Drink alcohol? 35 % 33 % 32 %
5. Smoke marijuana? 83 % 8% 8%

Strongly Strongly
Disagree Agree
it with:
1. A friend 29 % 21 % 20 % 29 %
2. Teachers 39 % 30 % 15 % 16 %

Disagree Agree

my goals
2. I am able to do things as well as most 3% 7% 48 % 42 %

other people
4. I am satisfied with myself 4% 14 % 33 % 49 %


myself


influence what I do
Strongly Strongly
Disagree Agree
1. I think about the consequences before I act 8% 18 % 45 % 30 %
2. I remember my way isn’t the only way 5% 9% 54 % 31 %
3. I try to understand other people’s ideas 3% 7% 55 % 35 %

and perspectives

they are different

when I am angry
6. If someone is being teased or bullied, I 9% 21 % 44 % 27 %

Strongly Strongly
Disagree Agree


something sexual


problem
myself
7. If an adult or someone older than me 9% 12 % 30 % 49 %

where to get help
8. I suggest activities my friends and I can do 10 % 15 % 37 % 38 %

not ready for


about me
1
Never 21 per cent
2
3
Younger 29 per cent
Older 26 per cent
4
A lot 8 per cent

5
6
With my father * *
7
Once 10 per cent


APPENDIX 7
St. Lucia
185 st. lucia Health And Family Life Education
answer for you.
over and help you.

think. Disagree
cream.
186 St. Lucia Health And Family Life Education



School: ________________________________
Circle the answer

Strongly Strongly
Disagree Agree
describes you
12. I like school 3% 4% 32 % 62 %

187 St. lucia Health And Family Life Education
1
2
week or more?
3
4
week or more?
5
6
7
weed)?
8
9
None 1 per cent
1 2 per cent
2 to 4 8 per cent
5 to 9 10 per cent
10
No harm 6 per cent
11
No harm 6 per cent

12
13
14
I have
times times times
done this
15. Had more than a sip or two of 24 % 36 % 11 % 9% 21 %

17. Smoked marijuana (ganja, weed, 90 % 6% 1% 0% 2%

pot, grass)
19. Use steroids or other drugs like 99 % 0% 0% 0% 0%

speed or downers
1
2

3
4

Strongly Strongly
Disagree Agree
what you think


angry

fight.



back

back

1
2
3
a physical fight?
days.
4
No 45 per cent
5
Never 73 per cent

Once 15 per cent
6
Never 95 per cent
7
at school?
Never 78 per cent

8
getting there?
No 95 per cent

9
Never 90 per cent
Once 7 per cent
1
No 73 per cent
Maybe 16 per cent
Yes 11 per cent
2
sex?
3
think have had sex?

4
No 74 per cent
Maybe 15 per cent
Yes 11 per cent
5
sex?
6
think have had sex?

Strongly Strongly
Disagree Agree
what you think
7. Girls my age who have sex are popular 59 % 26 % 9% 6%

forced to
10. Boys my age who have sex are popular 54 % 23 % 15 % 9%
11. Boys my age who have sex get respect 56 % 26 % 12 % 7%

usually forced to
Yes, Yes, more

once than once
3. Some students have had sex and others have not. Have you ever 79 % 9% 12 %
had sex (“Gone all the way”)?
4. Sometimes young people are forced to have sex against their will. 90 % 7% 3%
Have you ever been forced to have sex?
5

9 per cent
someone older
2 per cent
someone younger
13 per cent
someone my age
6
lifetime?
2 people 5 per cent
7
No 7 per cent
1
2


statements
has the AIDS virus
AIDS
7. A baby can get infected with HIV (the AIDS virus) through 9% 56 % 35 %
breast milk

virus
No Yes
the aids virus Sure

10. If you knew that a shopkeeper or food seller had the AIDS 78 % 8% 15 %
be kept a secret?


Disagree Agree

my goals

other people
Strongly Strongly
Disagree Agree



people


problem
14. There is an adult at school I can go to if I 9% 9% 38 % 44 %


about me


17. Tell someone to go to the end of the line if 34 % 22 % 25 % 10 % 9%


19. Give and receive compliments without 27 % 21 % 34 % 10 % 8%

20. Go to an adult for help when you are 48 % 26 % 14 % 5% 7%

1
Never 14 per cent
2
3
Younger 26 per cent
Older 17 per cent
4

A lot 9 per cent
5
6
With my father 53 per cent 47 per cent

7

Once 9 per cent

I did not have

Health or
Yes No
in primary
school
8. How to say no if my friends try to pressure 59 % 29 % 8% 4%

9. How to solve a conflict without getting into 67 % 18 % 11 % 4%

a physical fight
10. How to make a good decision when 65 % 18 % 13 % 5%

are right
11. Why it is important to wait to have sex 76 % 10 % 8% 6%
until I’m older
12. How to get help from an adult I trust if I 73 % 12 % 11 % 4%

13. How to set personal goals so I can be 81 % 7% 8% 4%



APPENDIX 8
St. Lucia
205 st. lucia Health And Family Life Education
answer for you.
over and help you.

think. Disagree
cream.
No 3 per cent
3. How old are you?
Never 1 per cent
Less than once a week 4 per cent
1 time per week 38 per cent
No, I don’t have a job 85 per cent 10. What is the name of your school?
5. What kind of student are you? 11. Did you attend this school during Form 2
(Grade 8)?
No 42 per cent
Yes 58 per cent
(Grade 7)?
did you miss school? No 16 per cent
I did not miss any days of school 35 per cent Yes 84 per cent
Three or four days 15 per cent 13. How many friends do you have at your
school?
None 4 per cent
1 3 per cent
7. Have you had a class in Health and Family Life
Education (HFLE) before this year? 2 to 4 10 per cent
No 4 per cent 5 to 9 8 per cent
Yes 96 per cent 10 or more 76 per cent
1
2
week or more?
3
4
week or more?
5

6

7
weed)?

8
1
No harm 6 per cent
2
No harm 8 per cent
3
No harm 6 per cent

4
5
6

Have you ever…
1. Had more than a sip or two of alcohol 7% 22 % 14 % 11 % 45 %


grass)

or downers

I have
past
month
1. Had more than a sip or two of alcohol 39 % 30 % 13 % 6% 11 %


grass)

or downers
6. Used inhalants (white out, Alcolada) 92 % 4% 2% 1% 2%
1
2

3
4

Strongly Strongly
Disagree Agree
what you think


angry

fight.



back

back

1
2
3
a physical fight?
These questions are about sex. Here, sex means sexual intercourse or “going all the
way.” These questions are about boys your age.
1
No 31 per cent
Maybe 36 per cent
Yes 34 per cent
2
sex?
3
think have had sex?

4
No 42 per cent
Maybe 29 per cent
Yes 29 per cent
5
sex?
6
think have had sex?

Strongly Strongly
Disagree Agree
what you think
1. Girls my age who have sex are popular 45 % 34 % 14 % 7%
3. Girls my age who have sex are usually 28 % 38 % 28 % 8%

forced to
6. Boys my age who have sex are usually 57 % 29 % 8% 6%

forced to
1
2

Yes, Yes, more

once than once
Have you ever been forced to have sex? 81 % 13 % 6%
6
22 per cent
someone older
4 per cent
someone younger
20 per cent
someone my age
7
lifetime?
Yes, more
No Yes
than once
8. In the past month (30 days), have you had sex? 75 % 14 % 11 %
9. In the past month (30 days), have you had sex without a 81 % 11 % 8%
condom?

statements
1. A person can get HIV (the AIDS virus) by having sex just 9% 84 % 7%
2. Most people who have HIV (the AIDS virus) show signs of 74 % 8% 18 %
has the AIDS virus
AIDS
breast milk
6. A person can get HIV (the AIDS virus) through casual 9% 64 % 28 %

virus

she gets very sick
No Yes
the aids virus Sure


be kept a secret?



Disagree Agree
2. I feel I am part of this school 5% 11 % 43 % 41 %
4. I like school 6% 10 % 40 % 44 %
5. In school I have learned I can disagree 4% 11 % 44 % 40 %



No Maybe Yes
1. Have sex? 32 % 31 % 37 %
3. Smoke cigarettes? 84 % 8% 8%
4. Drink alcohol? 34 % 34 % 32 %

Strongly Strongly
Disagree Agree
it with:
1. A friend 19 % 31 % 21 % 29 %
2. Teachers 38 % 32 % 17 % 13 %

Disagree Agree
1. When things get tough, I try to remember 6% 14 % 44 % 36 %

my goals

other people
4. I am satisfied with myself 4% 10 % 40 % 46 %


myself


influence what I do
Strongly Strongly
Disagree Agree
1. I think about the consequences before I act 9% 15 % 51 % 25 %
2. I remember my way isn’t the only way 4% 14 % 54 % 28 %
3. I try to understand other people’s ideas 3% 11 % 58 % 27 %

and perspectives

they are different

when I am angry
6. If someone is being teased or bullied, I 8% 25 % 43 % 23 %

Strongly Strongly
Disagree Agree


something sexual


problem
myself
7. If an adult or someone older than me 7% 13 % 36 % 44 %

where to get help
8. I suggest activities my friends and I can do 7% 14 % 40 % 40 %

not ready for


about me
1
Never 16 per cent
2
3
Younger 27 per cent
Older 18 per cent
4
A lot 7 per cent

5
6
With my father * *
7
Once 10 per cent


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Strengthening HFLE

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STRENGTHENING

HEALTH AND FAMILY LIFE EDUCATION

Tel |246| 467-6000 Fax |246| 426-3812

© UNICEF. All rights reserved 2009

The Implementation, Monitoring, and Evaluation of

II. Introduction to Study and Goals………………………………………… 13

III. Evaluation Methodology………………………………………………….. 17

IV. Findings from Process Evaluation……………………………………... 23

V. Monitoring Student Health Indicators………………………………….. 38

VI. Findings from Impact Evaluation……………………………………….. 44

VII. Challenges and Recommendations ……………………………………. 60

Student Survey Data

»» Appendix 2 Antigua & Barbuda Form 3 Student Baseline Survey 84

»» Appendix 3 Barbados Form 1 Student Baseline Survey 104

»» Appendix 4 Barbados Form 3 Student Baseline Survey 124

»» Appendix 5 Grenada Form 1 Student Baseline Survey 144

»» Appendix 6 Grenada Form 3 Student Baseline Survey 164

»» Appendix 7 St. Lucia Form 1 Student Baseline Survey 184

»» Appendix 8 St. Lucia Form 3 Student Baseline Survey 204

Rationale for Study

Evaluation Study Objectives

◊ Monitor the implementation of the Common Curriculum

◊ Assess the impact of this curriculum on student outcomes

The process evaluation included interviews with school administrators and

The impact evaluation employed a quasi-experimental pre-post matched pairs

Country Coordinators and Ministries in Antigua and Barbuda, Barbados,

◊ Assign teachers to lead two forty-minute HFLE periods per week

During Year 1, a Training of Trainers was attended by Country Coordinators,

Examples drawn from classroom observations conducted by Coordinators document this

For example, as one observer noted:

Despite enthusiasm, teachers expressed concerns throughout the study about

Country Form 1 (2005) Students Form 3 (2008) Students

Antigua and Barbuda 299 135

Barbados 698 488

Grenada 525 583

St. Lucia 842 703

TOTAL SAMPLE 2364 1909

Limitations and Challenges of the Study

In addition to focusing on differences between schools adopting the Common Curriculum

One set of challenges pertains to the curriculum. Documentation of implementation

Another set of challenges pertains to implementation. Difficulties of achieving full

How can lesson delivery be monitored to support fidelity and increase

Second, observations and documentation of classroom delivery support the importance

II. Introduction to Study

HFLE is a comprehensive, life skills-based programme, which focuses on the

»» Provides opportunities to demonstrate sound health-related knowledge, attitudes and

◊ To finalize, implement, and monitor a standardized, Common Curriculum that

III. Evaluation Methodology

LOGIC MODEL GUIDING THE HFLE COMMON CURRICULUM EVALUATION

Chosen Health Goals

EDC provided Country Coordinators with an evaluation implementation manual that

In addition to these paired analysis described above, we also conducted regression

Results were cross-checked in several ways. We explored potential intervention effects

Implementation was monitored in multiple ways. First, in the intervention schools,

Second, periodic classroom observations in both intervention and comparison classrooms

Coordinator/Observer Feedback on Form 1 In-Country Teacher Training

Across countries, it was noted that there was considerable inconsistency in

Teacher Unit Assessments: Common Curriculum

Examples of Teacher Comments on the Common Curriculum:

“Students are really trying to implement skills learned.”