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Abstract
Thirty years after the concept of primary health care (PHC) was declared the path to health for all, a crisis continues in human resources for health in Africa. This involves the low prioritisation of education and training for primary health care personnel (PHCP) which is crucial to effective practice in severely under-resourced settings. The curriculum required for this education, involving pictures and textual materials, must meet the needs and capacities of the learners so that learning transfer can occur and community health needs are met. This research set out to establish the basis upon which text and pictures should be incorporated into curriculum to address the requirements of community health nurses (CHNs) in The Gambia.
A pragmatic, three phased, mixed methodological design was selected for this study. Curricula for African PHCP were first collected and examined using content analysis to determine the rationale for pictures and text. The second phase employed psychometric testing and statistical analysis to establish if learning style preferences for pictures and text were important in Gambian CHN learning. In the final phase, interviews with CHN students explored their preferences for pictures and text and how these preferences should be accommodated in curriculum.
The research found that much of the PHCP curriculum analysed was generic, used traditional didactic approaches and focused on written knowledge-based assessment. Learning style preferences were not found to be a consideration and were unidentifiable in this context. Socio-cultural factors significantly impacted upon student CHN learning, but were not adequately addressed in the curriculum materials examined. In addition, CHNs preferred practical learning through primary, multi-sensory experiences.
These findings support the conclusion that the localisation of CHN curriculum is required in order to provide a socio-cultural context for learning that is meaningful, rich, interactive and responsive to learner needs. This demands a reconnection with PHC principles of equity and participation which should underpin this curriculum. The thesis argues that an ecological framework better articulates the link between PHCP education and training, practice, and community needs, and should serve to guide curriculum design. Six strategies are identified that could be extended to African PHCP course design.