We interviewed 11 key informants including policy makers and teachers. We conducted two focus group discussions with curriculum developers and teachers, respectively. We observed ICT infrastructure for teaching and learning in five schools. We reviewed seven documents that included curricula and ICT for education. We sent the online survey questionnaires to all 250 secondary schools in Kisumu County and received responses from 175 schools. We judged all the key findings to have a CERQual assessment of “high confidence” (7). These confidence assessments are reported in parentheses, following the corresponding finding statement, and are described in more detail in (S4 Appendix).
Interest in learning resources for teaching critical thinking about health in secondary schools in Kenya
Kenya has a national goal to promote health through education (high confidence). One of the objectives of the Kenyan national goal for education is to integrate health in education. The policy indicates a need to empower learners with skills and knowledge in health, and states that “Education should inculcate in the youth the value of good health in order to avoid indulging in activities that will lead to physical or mental ill health’’
Teachers, health officials and curriculum developers recognized the importance of teaching critical thinking about health in secondary schools in Kenya, noting that it will empower the learners with skills to make informed health choices (high confidence). Curriculum developers suggested that many students are missing the necessary skills.
“There are so many influences on choice of diet. Therefore, the teaching is very important to facilitate making informed choices.” Curriculum expert 1.
“Students require decision making skills and application of critical thinking, which are lacking among most of our learners”. Curriculum expert 2.
Findings from the stakeholders are corroborated by reviews of the Kenya Curriculum Reforms Report (29) and the Curriculum Needs Assessment Report (20). These reports identify the need to include critical thinking competencies and health subjects in the curriculum (high confidence). For instance, the Curriculum Reform Report recommends the need for a reformed curriculum that adopts a competency-based approach, with critical thinking and problem solving among the core competencies intended to enable the learners to apply learnt skills in life situations. Additionally, the Curriculum Needs Assessment Report identifies health education as one of the missing pertinent issues affecting learners, recommending that it should be included in the proposed curriculum
Teachers pointed out that the IHC Key Concepts learning objectives appear to be in line with the goal of critical thinking competencies that are described by both the current and proposed competency-based curriculum (high confidence). For instance, the proposed curriculum framework describes critical thinking and problem solving as competencies that will enable learners: “to avoid subjectivity, to use logic and evidence in arriving at conclusions; facilitate learners to explore new ways of doing things and gain autonomy; take account of multiple perspectives when addressing issues; be open-minded to, listen and appreciate information and opinions that may sometimes conflict with their prior beliefs” (30). However, teachers and curriculum experts indicated that it does not appear that these skills are being taught, as teaching is exam-focused, and examinations tend to assess rote memorization.
Furthermore, teachers and curriculum developers noted that the IHC learning resources could contribute to the achievement of the Kenya national education goals for critical thinking and health.
Curriculum links to critical thinking about health
We explored how critical thinking about health is represented in the curriculum. Our review of the current curriculum and proposed curriculum framework found no direct link between IHC Key Concepts and any of the subjects in lower secondary school (high confidence). Our discussions with curriculum experts confirmed this finding. However, we found that critical thinking and health both appear across subjects in the curriculum (high confidence), with the intention of equipping learners with skills and knowledge that can support their health. Additionally, subjects like home science and mathematics have broad objectives that may implicitly link to the IHC learning objectives.
“Interpret and use advertisements wisely; Identify sources of consumer information and Acquire awareness on Consumer Education and be able to utilize it wisely.” home science course outline.
We reviewed Kenya’s current and proposed reformed curricula and found that both include health topics that provide opportunities for teaching IHC Key concepts. Four (English, home science, mathematics, and business studies) of the total 14 subjects in the current curriculum host health topics (high confidence) (see Table 2). Home science and business studies include standalone health topics, while English and mathematics use health examples to illustrate other concepts in the curriculum.
Table 2
Health related topics for lower secondary school
Subject
|
Level
|
Topics
|
English
|
Form 1
|
Reading (health passages): Recall, comprehension, application, and analysis; extensive reading on literary materials on contemporary issues
|
Mathematics
|
Form 1
|
Fractions
|
Rates ratios, percentages, and proportions
|
Form 2
|
Statistics (interpretation of data)
|
Home science
|
Form 1
|
Safety in the home and first aid; medicine use and abuse
|
Personal hygiene (choice, use and misuse of cosmetics)
|
Form 2
|
Consumer education (importance of consumer education)
Environmental hygiene (common communicable diseases)
Advertisements; consumer awareness (effects of advertisements on consumers; sources of consumer information)
|
Business studies
|
Form 2
|
Government (need for and methods of consumer protection)
|
In the reformed curriculum, health is proposed taught as a standalone subject (health education) in addition to being included as a topic in three other subjects (home science, business studies, and physical education). Teachers and curriculum developers confirmed these findings while at the same time suggesting four additional subjects (biology, chemistry, Christian religious education, and geography) in which IHC Key Concepts could potentially be taught.
“Health is a cross-cutting topic in many subjects. For example, in mathematics, the exercises cover health related aspects such as disease prevalence proportions.” Mathematics teacher.
“Health is a cross-cutting topic in subjects which may offer opportunities for linkage of IHC concepts.” Curriculum expert 4.
Critical thinking is currently taught in Kenya using different approaches (high confidence). Teachers and curriculum developers indicated using methods such as exposing learners to open-ended questions, use of photos, songs, videos, and public speaking. However, our document review and interviews with teachers and curriculum developers suggest that critical thinking is only taught to a limited extent (high confidence). Some of the reasons for this include inadequate pre-service training, lack of guidance on how critical thinking should be taught, inadequate resources, a crammed school schedule, and fear that students will challenge teachers.
The review of the current curriculum and findings from interviews showed that there were no available resources for teaching critical thinking about health (high confidence). The lack of these resources was cited as one of the reasons for limited teaching of critical thinking about health.
“It comes up as a debate. However, it is not sufficient. It is not emphasized, but it will be in the competency-based curriculum.” Mathematics teacher.
“The delivery approach is teacher-centered. Hence the learner expects the teacher to bring in the solutions. The content is also rigid.” Curriculum expert 3.
According to the national examiners we interviewed, critical thinking assessment is not implemented in the current curriculum (high confidence). They reported that the Ministry of Education is phasing out the current curriculum – which they described as rigid, exam-oriented, and leading to rote learning – and will replace it with a reformed, competency-based curriculum to be rolled out from 2024.
“The current examination has focused more on how much content students are able to give back. The proposed curriculum will test high order skills.” National home science examiner.
They also reported that testing will shift to include critical thinking skills. The reformed curriculum describes how the formative assessment of competencies will be conducted as described in the quote below:
“Competencies shall be assessed over a period of time using projects, journaling, profiles and portfolios. The teacher shall document the learner’s achievement that shall show the progress towards the achievement of the learning outcomes identified in the subjects using a rating scale. The teacher and other observers shall be trained on how to create criteria for the assessment of competencies. The assessment shall involve teachers, parents and other stakeholders who shall look for opportunities where the learners can apply the competency in all areas of their life.” Kenya curriculum framework.
Conditions for introducing new learning resources
The Kenya Institute of Curriculum Development (KICD) regulates learning resources that are used in schools by approving textbooks and digital learning content (high confidence). The approved resources are listed in what is referred to as the ‘Orange Book’. Schools are not allowed to purchase textbooks outside the approved list. Subject teachers choose the resources needed from the KICD’s approved list.
“KICD come up with suggested resources at the development stage. However, the teachers decide resources to use from the Orange Book.” Curriculum expert 5.
The current school timetable presents a challenge for introducing new content in the curriculum (high confidence), as it is full, with no space for additional content during regular school hours. According to the Basic Education Act, official school hours for secondary school are from 8:00 am to 3:30 pm (7.5 hours), per day; Monday to Friday, with an additional 1.25 hours for games and clubs (from 3:30 pm to 4:45 pm) (31).
Teachers and curriculum developer that we interviewed suggested that new content, such as the IHC Key Concepts, could potentially be taught in school health clubs and games, although they felt it would be better to teach them during regular school hours. Further, they noted that the proposed curriculum may provide a better opportunity than the current curriculum for introducing the IHC Key Concepts, noting that it would likely be easier to incorporate new content as revisions before the new curriculum is implemented.
We explored how critical thinking about health should be taught with curriculum developers and teachers. They indicated that teachers should be provided with guidance, because they have little or no experience teaching the IHC Key Concepts (high confidence). They also suggested using current and relatable health claims that learners can understand in the learning resources, such as COVID-19 claims and context-specific reproductive health claims.
Availability and use of ICT for teaching and learning
There are policies and guidelines to promote ICT in education (high confidence). Kenya has a progressive national ICT policy which aims to "encourage the use of ICT in schools, colleges, universities, and other educational institutions in the country to improve the quality of teaching and learning" (19). However, according to teachers and digital content developers, the ICT policy plan to set up computer laboratories in all public secondary schools in the country has not been fully operationalized. They did note that digital literacy is incorporated across all subjects in the proposed competence-based curriculum (19) and presents an opportunity for use of digital learning resources.
Most schools have inadequate ICT infrastructure for teaching and learning (high confidence).
According to our survey, 63% of secondary schools had at least one laptop or desktop computer, 35% of the schools owned a projector, and only 17% had an internet subscription (see Figure #). Teachers we interviewed reported that students have limited access to computers. Teachers also mentioned that few students owned phones and students are not permitted to bring phones to school. In schools we visited, we observed some students using computers in groups, and some teachers using projectors to display digital learning materials to the class.
To cope with inconsistent internet connectivity in schools, teachers described using their personal smartphone or computer to search for and download digital material. Then they would either print the material or display it offline during class, for example using a projector, if available.
“Sometimes we rely on our phone internet to complement the teaching resources, we use e-material downloaded from YouTube to explain concepts when teaching. For instance, in History topics such as World Wars, I download YouTube videos from my phone to complement theory”. History teacher that uses ICT
Teachers that we interviewed said that reasons for low internet subscription in schools included high subscription costs, power outages, and poor network connections. Additional challenges that were identified by teachers and are also mentioned in the National Council of Science and Technology report the report (2010) included teachers’ lack of ICT skills, lack of digital content, and fear of internet misuse, such as accessing pornography or cyber bullying (NCST, 2010).
We found that a variety of Internet browsers are in use, including Google Chrome, Microsoft Internet Explorer, Mozilla Firefox, and Opera Mini. Based on school visits, we did not identify any standard software applications used across schools.