Assessment of the effectiveness of using student nurses on community deployment as health instructors in rural secondary schools of Zimbabwe

Zimbabwe has been active in attempting to develop health instruction at the various school levels. However, to date, efforts to implement health instruction have not been entirely successful, especially in rural areas of the country because of manpower shortages. Student nurses in Zimbabwe are presently deployed at two different intervals of 10 weeks each during their 3 year training program to assist in providing primary care to respective rural populations. The purpose of this study was to assess the impact of instruction on health knowledge, attitudes and practices, specifically, addressing sexually transmitted diseases (STDs) including AIDS and drug use/abuse prevention education provided by student nurses on community deployment to rural hospitals of Zimbabwe. Attitudes of student nurses, secondary school teachers and nursing tutors toward the use of student nurses as health instructors in the school setting were determined. Further, pupils evaluated student nurses' performance (communication skills, motivational skills and classroom leadership skills) as health instructors. Pupils from five secondary schools (N = 285) in Masvingo Province and student nurses (N = 12) from two state referral hospitals in Harare participated in this study. A quasi-experimental (pre and posttest) with a non equivalent control group design was used. Pupils from 3 schools (N = 141) were assigned as the experimental group while pupils from two schools (N = 144) were assigned to the control group. Pupils attending forms 2 and 3 (compares to grades 10 and 11 in the United States) were selected to participate in this study. An ANCOVA was used to determine group equivalence. Prior to the implementation of this study, student nurses underwent inservice training on methods and procedures related to health instruction. Three inventories were developed, namely, the knowledge, attitudes and practices (KAP); the student nurses self-assessment (SNS); and the school teachers and nursing tutors (STNT) inventories. The KAP inventory also had a facilitator instructional skills rating section. Health instruction was conducted over a period of 7 weeks, meeting twice a week. A follow up was conducted six months later using a focus group technique to collect data. Results showed that knowledge gains (posttest) were pronounced in the experimental group as compared to the control group. Also, scores on decision making skills were greater among the experimental group. Further, attitudes of more than 70% of pupils and over 80% of teachers and tutors indicated health instruction by student nurses in the school setting was successful. Although both groups indicated intentions to engage in sex and to use alcohol in the future, this finding was more pronounced in the control group than the experimental. Future research should incorporate a behavior changed model and also determine the cost-effectiveness of using student nurses as health instructors in the school setting.