Evaluating Educational Materials that Teach the Risks of Prenatal Alcohol Exposure
| Sponsor: | National Organisation for FASD |  |
| Sponsor Liaison: | Joanna Buckard, Katie Liddle | |
| Student Team: | Kenneth Doan, Kaelie Newell, Katherine Tse, Aidan Watkins | |
| Abstract: | The National Organisation for FASD works to spread awareness of Fetal Alcohol Spectrum Disorder (FASD) in the UK. Despite the high prevalence of FASD in the UK, there is little formal education about the risks of prenatal alcohol exposure including FASD. The goal of this project was to evaluate the effectiveness of National FASD’s educational materials on FASD for young adults ages 16-18. We recruited three lecturers in Furthering Education colleges to pilot the lesson. Through the assessments and lecturer interviews, we determined that the lesson was engaging and successful in conveying key concepts. We also found that the lesson was easy to implement and suitable for the age group. Drawing on student and lecturer feedback, we recommend adjustments in the lesson plan. | |
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Executive Summary
Prenatal alcohol exposure can lead to many problems, causing lifelong effects such as Fetal Alcohol Spectrum Disorder (FASD). The varying effects of FASD and the secondary disabilities associated with it can have large impacts on the lives of those with FASD. FASD is strikingly common, with 2% to 4% of the UK population estimated to have FASD (National Organisation for FASD, 2020). Among young adults, a low level of knowledge about FASD combined with a high rate of regular alcohol consumption and potential for unsafe sexual behaviour creates risk.
The National Organisation for FASD (National FASD) is a UK-based charity organisation working to increase public awareness about FASD. They have a RISK lesson plan to help educate young adults on common misconceptions and facts regarding prenatal alcohol exposure (National FASD, 2020). Although the UK does not currently mandate FASD education in post-16 schools, National FASD would like to see this lesson plan implemented in schools that work with young adults ages 16-18. In order to evaluate the effectiveness of National FASD’s educational materials for young adults, we completed the following objectives:
- Designed a pre-assessment and post-assessment to test student FASD knowledge.
- Worked with lecturers in Furthering Education colleges to pilot National FASD’s lesson materials and implement testing.
- Identified receptiveness to the lesson and resulting changes in student knowledge and attitude.
- Created supplemental educational materials to further student learning on FASD.
Methods
We identified key concepts from the lesson and created assessments that tested for student change in knowledge and attitude. Additionally, we added questions on the post-assessment to prompt student feedback. We recruited and prepared three health lecturers in Furthering Education colleges in northern England to pilot the lesson and distribute the assessments to their classes. The lesson involves viewing a brief film, interspersed with discussion, leading into a lecture on prenatal alcohol exposure and FASD. The lesson has both a 60-minute or 90-minute version. A total of 38 students completed the pre- and post -assessments. We interviewed lecturers after they taught the lesson to gain their perspective. Lastly, we created a leaflet based on content from the lesson as well as feedback from lecturers and students.
Student Learning and Receptiveness
Students’ knowledge and understanding of FASD increased after taking the lesson. Students demonstrated knowledge gain after the lesson, with 95% of students getting a higher score on the post-assessment. In addition, the average score for selected-response assessment questions was 7.2 out of 12 points before the lesson and 10.1 out of 12 points after the lesson (Figure I). The Wilcoxon Signed-Rank Test, which tested the paired student responses for a statistically significant change in score, revealed a significant difference, z = 5.3 and p < 0.001. These results suggest that the lesson advanced students’ knowledge about prenatal alcohol exposure and FASD.
Figure I: The average correctness score of the selected-response knowledge questions, where each question is worth one point for a total of 12 points.
While most students had a basic knowledge of FASD on the pre-assessment, there was significant knowledge gain in content related to correcting some common misconceptions. These high knowledge gains are highlighted in Figure II, where the percentage of correct answers increase greatly between the pre-assessment and post-assessment data. Additionally, after receiving the lesson, students were able to provide more detailed and accurate responses to open-ended questions that asked about the definition of FASD and its symptoms.
Figure II. The percentage of students that correctly answered the pre- and post-assessment questions, demonstrating high knowledge gains.
Some concepts of the lesson were not well understood by students. One question asked students to compare the long-term harmfulness of heroin and alcohol to a developing foetus, which only 53% of students correctly answered on the post-assessment. Another example is that only 58% of students identified that a pint of beer possesses similar risk to a shot of a spirit on the post-assessment. These questions demonstrate low student understanding at the end of the lesson, suggesting that the lesson was not as effective in addressing these points.
When prompted to provide feedback, a majority of students reported the lesson to be educational, relevant, and impactful. Sixty-nine percent of students agreed or strongly agreed that the lesson taught them something new about FASD and 64% agreed or strongly agreed that the lesson cleared up a misconception about FASD. Eighty-four percent of students agreed or strongly agreed that the content was relevant to their age group, due to their tendency to drink, party, and have sex. Lastly, 74% of students indicated that the lesson prompted them to think more about the risks of sexual activity and drinking. Some students additionally gave feedback that asked to increase the amount of content in regards to symptoms, treatment, and real-life examples of someone living with FASD.
Lecturer Perspectives on the Lesson
Lecturers found the lesson plan comprehensive and suitable for a variety of classes. The lecturers generally described the lesson implementation as being simple and understandable.
They all claimed to follow the lesson plan closely. They also appreciated the content warnings embedded in the lesson plan since they recognised the sensitivity of the topics.
Lecturers found the content relevant and impactful for the age group. During the moment in the film when the pregnancy is revealed, all lecturers reported the students being surprised. When it came to discussions about the choices of the pregnant woman in the film, lecturers reported high levels of student engagement. Lecturers noted that students were especially engaged in the discussion about the risk of being a fighter while pregnant. In addition, the lecturers brought up various points of the lesson being particularly impactful, such as the analogy of comparing one round of drinks to one round in the ring.
However, some portions of the lesson were less effective in keeping the students engaged. One of the lecturers brought up how there were a lot of discussion points in the beginning, but less activities to engage the students towards the end. They claimed “there was quite a lot of, like, information overload.” Another lecturer also noted that much of the introduction in the RISK film felt slow. However, this lecturer had previously taught about FASD to their class, which may have made a lot of the beginning section feel redundant.
Supplemental Material
We created a leaflet designed to reinforce concepts from the lesson or act as a stand-alone informational brochure on the risks of prenatal alcohol exposure and FASD for young adults ages 16-18. The material is titled “Drinking, Sex, and You” and includes an illustration of alcohol and condoms, meant to draw the attention of teen audiences and persuade them to read further. Sections such as “Alcohol and Pregnancy” and “What is FASD?” include information that is taught in the RISK lesson in order to reinforce these key concepts and help students recall what they learned. Another section of the leaflet, “Life with FASD”, responds to feedback from lecturers and students who wanted to know more about lived experiences of people with FASD. Lastly, the common misconceptions section covers five misconceptions. The questions in the assessments related to these misconceptions demonstrated a low initial understanding of these concepts. Additionally, some students identified these misconceptions as commonly held among their peers or as the key fact that they learned from the lesson.
Lesson Improvements and Implementation Recommendations
The RISK lesson is best suited as an introductory lesson about prenatal alcohol exposure and FASD, and may not be engaging for those with prior knowledge. As stated earlier, the lecturer who had previously taught FASD found the introduction to the lesson to be “superfluous.” Multiple students from that class stated that the lesson was not as in-depth as they would have preferred. However, the lecturers who had not previously taught FASD material reported high levels of engagement throughout the lesson. Additionally, we found that most students from those classes did not report wanting more content within the lesson. Therefore, we believe that the National FASD should consider advertising that the RISK lesson is intended to be an introductory lesson to prenatal alcohol exposure and FASD.
We recommend that National FASD consider adding at least one interactive activity towards the end of the lesson. The discussion sections earlier in the lesson were found to be engaging for the students, however, interactivity noticeably dropped afterwards. The lecturers noted that the end of the lesson was an “information overload” and came abruptly. Therefore additional interactive activities could be used to break up the information, act as a closing for the lesson, or both.
Limitations and Recommendations for Further Research
The pre- and post- assessments that we designed were not formally tested for validity and reliability. We largely relied on the students having put at least some effort into completing the assessment and participating in the lesson, and despite an option to select “unsure,” they might have guessed correct responses. In addition, some of the post-assessment responses could have been affected by social desirability bias, which is a tendency for respondents to answer as they believe others would want. All of the classes that this lesson was piloted in were health & social care classes, meaning that the students may have been more receptive to the lesson or could have been more likely to deduce a correct answer on a pre-assessment. Similarly, the students were 90% female, which could affect their opinions on how relatable the lesson is to the 16 to 18 year old population.
This research has provided insight into the use of National FASD’s RISK lesson with health and social care students in Furthering Education colleges, but this is only a small portion of the total 16-18 year old population. To further spread this information and reach the young adults who would likely not learn about prenatal alcohol exposure and FASD before graduating, these materials should be tested with larger groups of 16-18 year old students. Furthermore, this project only measured short-term knowledge gain. In the future, testing this material in a longer time-span would allow National FASD to see the long-term effectiveness of the lesson. For long-term testing, it would also be ideal to keep developing the pre- and post- assessments to get more accurate gauges of student learning and engagement.