THE DEVELOPMENT OF A CONCEPTUAL FRAMEWORK AND MODEL OF SEXUAL HEALTH EDUCATION IN UPPER SECONDARY SCHOOLS IN NORTHERN VIET NAM Birmingham City University 2013 Dissertation Submitted in part fulfilment of the requirements for the degree of Doctor of Philosophy Nguyen Thi Lan Anh ii Abstract The development of a conceptual framework and model for sexual health education in upper secondary schools in Northern Viet Nam Nearly half the Vietnamese population is under 25years, and among this group, there is a rapidly rising incidence HIV and STD’s. There is an urgent need to develop strategies to improve young people’s knowledge and understanding of sexual health. Currently, teachers lack the knowledge and confidence to effectively teach sexual health and there was no conceptual framework underpinning the curriculum (Thanh, 2010). This study developed a conceptual framework and model for sexual health education programmes for upper secondary schools in North Viet Nam and made recommendations for education policy and practice.
The study methods were based on the first cycle in action research, an approach recognised in Viet Nam for changing professional practice. Key to this study was Jarvis’ (2004) description of lifelong learning, Kolb’s (1984) experiential learning cycle and Problem Based Learning teaching documentation and discussions with Vietnamese government officials and NGO’s working in sexual health. The findings revealed that most pupils did not understand or did not practice safe sex, and all wanted more knowledge and information. Teachers reported limited knowledge and a reluctance to teach this subject.
When the new conceptual framework and models were piloted, they were seen as accessible, acceptable and appropriate for the education system in Viet Nam, and demonstrated measurable changes in teaching and learning. The study is unique, in that it was designed with ministerial support for strategic implementation and sustainability. The Vietnamese government has accepted it. At their instigation, the research is already being used by an international working group for sexual health education in schools.
It is also being used by a second international group, working to improve nurse education, and as a result is being piloted in undergraduate nursing programmes. i ii Acknowledgements First of all, I would like to express my sincere and deep appreciation to Prof. Joy Notter my major advisor for her guidance, invaluable advice, and supervision throughout. I am deeply grateful to my co-advisor, Dr.
Malcolm Hughes in reading and correcting my grammar I am indebted to my co-advisor, Ms. Joy Hall, for her kindness and valuable guidance, and encouragement with earnest attitude always. I would like to express my sincere gratitude and deep appreciation to my local supervisor, Dr. Nguyen Tran Hien for his valuable advice during thesis defence.
My sincere gratitude goes to all my colleges and the staffs in Hanoi Medical University and Nursing University in Nam Dinh province, which has been a major support in completing this thesis in all aspects. My deepest is a gratitude to my mother, parents in-laws and my husband in supporting me through my study. I also would like to thank the Nuffic project Director, Dr. Do Dinh Xuan, Rector of Nam Dinh Nursing University and Dr.
Nguyen Xuan Viet, from the Ministry of Health their encouragement and support. Finally, I wish to express my special thanks and deep gratitude to director Prof. Nguyen Duc Hinh, Rector of Hanoi Medical University in Viet Nam and Vice- Director of Nursing and Midwifery Faculty in Hanoi Medical University Dr. Hoang Cong Chanh for their moral support and enabling many opportunities during my entire stay in United Kingdom.
iii iv TABLE OF CONTENT ABSTRACT. A PROJECT WITHIN A PROJECT. OUTLINE OF THE STUDY. 14 THE CONTEXT OF VIET NAM.
EDUCATIONAL SYSTEM IN VIET NAM:. HEALTH CARE IN VIET NAM:. EDUCATION AND TRAINING FOR HEALTH CARE IN VIET NAM:. 41 SECTION 1: SEXUAL HEALTH AND HIV SITUATION.
THE SEXUAL HEALTH AND HIV/AIDS SITUATION IN ASIAN COUNTRIES AND VIET NAM:. SEXUAL HEALTH EDUCATION FOR YOUNG PEOPLE:. SEXUAL HEALTH SERVICES FOR ADOLESCENTS AND SINGLE YOUNG PEOPLE IN VIET NAM:. Social policy factors:.
From needs to demands-the way that the language of curriculum changed:. 71 SECTION 2: POSITIONING THE STUDY: THE EDUCATION SITUATION .4 METHODOLOGICAL ISSUES FOR DATA COLLECTION AND ANALYSIS. Sample size calculation and sampling technique for pupils from Tuan (2001):. Sample for teachers:.
APPROVAL AND ETHICAL ISSUES:. Choice of data collection method for the pupil survey:. Reliability and validity:. THE TEACHERS: INITIAL QUALITATIVE DATA SETS:.
Choice of data collection methods for gathering information from teachers:. Focus group discussions:. Rigour of the processes used for the qualitative data:. DOCUMENTARY DATA SOURCES:.
THEORIES OF LEARNING: A REVIEW. INDIVIDUAL INTERVIEWS WITH KEY INFORMANTS:. FEEDBACK TO PUPILS:. Sample for feedback to pupils:.
Data collection and analysis:. 109 RESULTS OF BASELINE MEASURES. SCHOOL SURVEY RESULTS:. BASELINE MEASURES FROM THE TEACHERS:.
DISCUSSION AND CONCLUSION:. 133 DATA COLLECTION TO SUPPORT THE DEVELOPMENT OF THE CONCEPTUAL FRAMEWORK. A REVIEW CONTENT OF TEXT BOOKS RELATED TO SEXUAL HEALTH IN NORTH SCHOOL IN VIET NAM:. INTERVIEWS WITH NGO’S AND GOVERNMENT DEPARTMENTS:.
145 DEVELOPING THE CONCEPTUAL FRAMEWORK. DEVELOPING THE CONCEPTUAL FRAMEWORK:. MODELS AND THEORIES OF LEARNING:. Models of learning:.
Theories of learning:. THE TEACHER’S MODEL:. 175 PILOTING AND EXPLORING THE MODEL. FEEDBACK FROM THE PUPILS:.
EXPLORING THE POSSIBLE MODEL FOR EDUCATION FOR THE TEACHERS:. Step 1: Identifying the content. Step 2: Formal presentation of results of the survey and feedback from the pupils. Step 3: Discussion of issues arising from the survey.
Step 4: Finding the solution. Step 5: Making a practical plan for teaching. Step 6: Practical activities for implementing the new lesson. CONSIDERING THE APPLICATION OF THE MODEL OF SEXUAL HEALTH EDUCATION:.
WIDER USE OF THE CONCEPTUAL FRAMEWORK AND MODEL:. 204 CONCLUSIONS AND RECOMMENDATIONS. REFLECTIONS ON THE APPROACH USED IN THE STUDY:. Specific methodological issues:.
Methods used for data collection and analysis:. REFLECTIONS ON THE PHD EXPERIENCE:. 225 APPENDIX 1: ETHICAL APPROVAL. 242 APPENDIX 2: QUESTIONNAIRE IN ENGLISH.
249 APPENDIX 3: QUESTIONNAIRE IN VIET NAM. 261 APPENDIX 4: PROGRAM OUTLINE FOR SECONDARY SCHOOLS. 278 APPENDIX 5: CHARACTERISITCS OF THE SAMPLE FROM THE PUPILS QUESTIONNAIRE. 281 APPENDIX 6: MAIN QUESTIONS FOR GROUP DISCUSSIONS.
283 APPENDIX 7: NON GOVERNMENT AND GOVERNMENT ORGANIZATION IN VIET NAM. 291 APPENDIX 9: EXTRACTS FROM TRANSCRIPTS. 297 vii Figures and tables Tables Table 5-1: Characteristics of the study sample:. 109 Table 5-2: Knowledge of preventing pregnancy.
111 Table 5-3: Numbers reporting being sexually active. 112 Table 5-4: Attitudes and behaviour of sexual health among pupils. 114 Table 5-6: Distribution for pupil’s attitude of talking sexual health with their parents. 115 Table 5-7: Distribution for pupil’s seeking advice from their parents.
115 Table 5-8: Pupils talking about sex. 118 Table 5-9: Knowledge and attitude of HIV/AIDS. 120 Table 5-10: Extract of process of analysis. 123 Table 5-11: Emergent themes.
124 Table 5-12: Characteristics of respondents:. 126 Table 6-1: Review of the text books from 4 schools in North of Viet Nam information reproduced with permission MOH. 134 Table 6-2: Process for analysis. 136 Table 6-3: Emergent themes.
136 Table 7-1: Terms used in theories of learning in Western and Asian countries Source: The theory and practice of learning. 148 Table 7-2: Summary of teaching style. 166 Table 7-3: Summary of relation between approach of learning and teaching. 167 Table 7-4: Summary of opportunities and learning approaching.
168 Table 8-1: Initial Coding. 176 Table 8-2: Searching for connections across emergent themes. 177 viii FIGURES Figure 2-1: The map of Viet Nam.14 Figure 2-2: Viet Nam’s population pyramids in 1989 and 2009 included with permission of (MOH) .16 Figure 2-3: Education system in Viet Nam.22 Figure 2-4: Structure of health system in Viet Nam .33 Figure 2-5: Structure of external aid commitments for health included with permission from the MOH .36 Figure 2-6: Sub-sectors receiving external assistance, 2001-2008 included with permission from the MOH .37 Figure 3-1-1: HIV in Asia and the Pacific, 1998-2009 (reproduced from UNAIDS 2011) .42 Figure 3-1-2: People living with HIV in Asian and the Pacific 1990-2009 (reproduced from UNAIDS, 2011) .43 Figure 3-1-3: Distribution of reported HIV cases by age group and by year, 1993-2009 reproduced with permission from MOH .44 Figure 3-1-4: Estimated percentage of people ages 15-49 living with HIV by provincial cluster, 2005 reproduced with permission from MOH .48 Figure 3-1-5: A curriculum planning model of the education of adults (Jarvis, 2004:258 ) .61 Figure 4-1: The Action Research Spiral .82 Figure 4-2: Detailed Action Research Model .84 Figure 4-3: Study design .85 Figure 4-4: Diagram illustrating sampling technique .90 Figure 5-1: Knowledge of reproductive health .111 Figure 5-2: The first age for sexual intercourse .113 Figure 5-3: In latest sexual intercrourse, did you or your partners use any contraceptive methods .113 Figure 5-4a: Average times for watching Western films .116 Figure 5-4b: Average times for listening to Western films music .117 Figure 5-5: Knowledge of STDs .119 Figure 7-1: A stereotypical picture of teaching based on (Jarvis, 2008: ) .149 Figure 7-2: Current (traditional) framework utilized by state approved schools ix for curriculum design in Viet Nam .151 Figure 7-3: The proposed framework for state and private education organizations in Viet Nam.154 Figure 7-5: Kolb’s experiential learning cycle (Kolb and Fry, 1975:33:37) .155 Figure 7-6: A model of the learning process (Jarvis, 1987:40) .156 Figure 7-7: A learning sequence/cycle (Mezirow, 1977:158) .160 Figure 7-8: A learning and teaching cycle. A facilitative learning and teaching cycle (Dewey, 1938:71) .164 Figure 7-10: Modifying Problem Based model for training teachers in Viet Nam .170 Figure 7-11: Completed or finalnew framework for teaching in Viet Nam in the future .171 Figure 7-12: Model of Learning for the pupils .174 Figure 8-1: Diagram of using triangulation in the study.185 Figure 8-2: Bruner cycle of intellectual development (1966:44).195 Figure 8-3: Proposed programme for nurse education (Hanoi Medical University,2009) .199 x GLOSSARY OF TERMS AND ABBREVIATIONS Glossary Viet Nam: written documentation reveals that in many countries Vietnam is written as a single word.
A practice accepted by Vietnamese nationals, although the correct format to use is Viet Nam, and therefore throughout this study the country is referred to as Viet Nam. ‘The West’ or Western Countries: In Viet Nam these terms are used to refer to every country outside Viet Nam which is not seen as Asian (English–Vietnamese dictionaries (lac viet mtd2002-EVA)). In this study the terms refer to those English speaking countries which have been most influential in nursing and healthcare development in Viet Nam. Community nurse: The title community nurse can be used by any individual who has studied a nursing course at level 4.
This is equivalent to an undergraduate level in the U. They therefore can not be compared to specialist community health nurse in the U. Asian Disaster Preparedness Centre AIDS. Acquire Immunise Deficiency Syndrome ARH.
Adolescent Reproductive Health BOET. Buereau of Education and Training CHC. Commune Health Centre DOET. Department of Education and Training DST.
Department Science and Training Gos. Government Organization HIV. Human Deficiency Virus H5N1. Avian influenza A IDU.
Injecting Drug Use IMR. Infant Mortality Rate ISO. International Organization for Standardization MMR. Maternal Mortality Rate MOET.
Ministry of Education and Training MOH. Ministry of Health MSC. Manpower Services Commission NGOs. Non Government Organization PBL.
Problem Base Learning RH. Reproductive Health RTIs. Reproductive Tract Infections SARS. Syndrome Acute Respiratory Severe SAVY.
Second Survey Assessment on Vietnamese Youth SDL. Self -Directed Learning Skills SH. Sexual Health STIs. Sexually Transmitted Diseases TB.
Tuberculosis Bacteria UNAIDS. United Nations Population Fund in Viet Nam WHO .