CHAPTER 14: Writing and evaluating the teaching material

This chapter describes ways of writing and evaluating the teaching material, while Chapter 15 describes how the words should be spaced on the page and how illustrations can be used to make the meaning clearer. Some writers prepare the words and layout at the same time, but for the sake of clarity, these processes are described separately.

14.1 Deciding on the objectives

Manuals and teaching materials are written to help people to do things. For example, one manual called Obstetric emergencies is designed to enable rural health workers to treat women with obstetric emergencies and to know when to refer them to hospital. Another much smaller piece of teaching material has the title Recording the administration of drugs. In both cases the general purposes of the materials are clear. The purposes were probably decided during the initial planning when the need for the manual or teaching material was identified.

You must then work out exactly what the health worker must be able to do. Which obstetric emergencies should be covered? Exactly how should rural health workers deal with each type of emergency? Probably the best way to do this is to carry out a task analysis of the work. (The author has carried out several task analyses of the work done by teachers of health workers so that this book would be helpful to teachers.)

Task analysis will help you to:

- include all necessary information
- leave out unnecessary information
- give information in the correct order
- describe all situations in decision-making
- avoid vague instructions.

Examples of how task analysis can be used in writing manuals are given in Sections 14.2-14.5.

14.2 Including all necessary information

Teaching materials and manuals should include all the information that the health workers need in order to do a job.

This point may seem obvious, but often manuals do miss out essential steps or facts. Look at the example of poor instructions below and try to find out what information is missing.

Example - Information missing from a manual

Taking a patient's rectal temperature

Follow the four stages described below:

1. Ask the patient to insert the small part of the thermometer into his or her anus. If the patient is a small child or is unable to do this, insert the thermometer yourself.

2. Leave the thermometer in this position for about 2 minutes. If the patient is an adult, he or she should be lying on one side. If the patient is a child, he or she should be lying face downwards and should be held.

3. Take the thermometer out and read up to which mark the line inside the thermometer has reached. If the line is above 37.5 °C the patient is feverish.

4. Clean the part of the thermometer that has been inside the anus with some cotton wool and soapy water. Put the thermometer away in a safe place.

You will probably have noticed that a health worker following these instructions would not:

- lubricate the thermometer
- shake down the mercury in the thermometer.

This error could have been avoided if a task analysis had been done, especially if it had been checked by watching a health worker doing the task.

14.3 Leaving out unnecessary information

There is a great temptation for writers to put down everything they know about a subject. This is bad practice because the unnecessary information distracts the reader from the essential facts.

Exercise

Think about health workers who are responsible for storing vaccines. Which of the following facts do they need to know?

1. The definition of an attenuated vaccine.
2. Which vaccines are absorbed on alum.
3. How vaccines are freeze-dried.
4. How long a vaccine will last at room temperature.
5. How long a vaccine lasts in a refrigerator.

You will probably agree that health workers need to know how long each vaccine will last at different temperatures. They do not need to know what "attenuated" or "freeze-dried" or "absorbed on alum" means. Nor is it useful for them to know which of these types of vaccines they are using. Again, task analysis is a good method for deciding whether some information is necessary or not.

14.4 Giving information in the right order

When a procedure is being described, the description should follow the order in which the actions are done.

Exercise

Try to rewrite these instructions in a more sensible order.

Instrucitions for cleaning a wound

Put antiseptic on and around the wound after shaving off any hair round the wound and washing the wound with soap and water.

These instructions would have been written much more clearly as a list.

Instructions for cleaning a wound

1. Shave off any hair round the wound.
2. Wash the wound with soap and water.
3. Put antiseptic on and around the wound.

Often, writing instructions in the wrong order makes them difficult to understand. Sometimes it can be dangerous. Look again at the poor instructions for taking a patient's rectal temperature. What is bad about the order in which the instructions are given?

The patient is asked to insert the thermometer and then the instructions say that the patient should be lying on one side (adult) or face-down (child). Obviously the first instruction should be to ask the patient to lie in the correct position. Only then should the thermometer be inserted.

This kind of error is very common and occurs even in respected manuals written by very experienced health workers. It can be avoided by doing a task analysis.

14.5 Describe all situations in decision-making

Sometimes manuals tell health workers what to do in a specific situation, but do not tell them what to do if the situation is a little different.

Example - Some possible situations are not described

1. A patient has been coughing and spitting for a few days

Take the patient's temperature.

1.1 The patient's temperature is less than 38°C. Other symptoms:

- a runny nose (with a discharge like water or a thicker discharge like milk) or
- a sore throat

Give the patient aspirin for 3 days and tell him or her not to cough on other people (especially children) or spit on the floor.

This manual tells the health worker what to do in two situations when patients have been coughing and spitting for a few days. The two sets of additional symptoms are:

- low fever and a runny nose or
- low fever and a sore throat.

It fails to mention another common situation when, in addition to coughing and spitting, the patient also has:

- low fever with no other symptoms.

A health worker using the manual can therefore come across a common condition that the manual does not cover. The least harmful effect of this will be dissatisfaction with the manual, but more serious effects are also possible, such as failing to recognize possible cases of tuberculosis.

A task analysis of the diagnosis of cough might have shown that all situations were not covered.

14.6 Avoid vague instructions

Vague instructions like "be careful" should be avoided. They do not say in what way care should be taken and are therefore a waste of time. Other examples which are commonly used are:

- "assemble correctly"
- "record the weight properly".

Example - Vague instruct/on
Treatment of cough
To treat people with a cough, see "Respirarory diseases" on page 25 and tell the people living in your village:

1. To stay at home when they have a cough and runny nose.

2. To take care of the children and old people and to return to the health centre immediately if....

What does it mean to "take care of the children and old people"? The health worker may not know what kind of care should be provided and so much more specific advice should be given.

14.7 Structuring the material

This paragraph refers to longer teaching materials such as manuals. The structure of these materials depends on how they are to be used.

For a manual that will be used for reference, the order of the sections is important but it will not be the same as the order in which the pages will be read. This is because the manual will not be read like an ordinary book. Health workers will look at the few pages they need and then put the manual away. So it is extremely important to have a good index that helps them to find the part of the manual they need at that particular time.

To make this possible, the manual will probably consist of a series of sections relating to the tasks to be performed, such as:

- treating patients with diarrhoea
- treating patients with respiratory diseases
- treating patients who are pregnant
- developing water supplies
- educating village people about nutrition.

Other ways of organizing sections are:

A. Systems of the body:

- respiratory system
- cardiovascular system.

B. The setting in which the worker will use the manual:

- dispensary
- health centre.

It is important that the structure of the manual is clear to the health workers, and that they can find the information they require quickly.

Manuals used in training will be read through from start to finish, and so the order of the sections is much more important. Points to note are:

1. Early sections should not depend on skills or knowledge covered in later sections.

2. Common techniques such as giving an intravenous injection or bandaging should be described in a separate section. The health worker can then be referred to the relevant section when necessary.

14.8 Writing simply
It is essential that manuals and teaching materials are written so that they can be understood easily. There is no point in writing if health workers find the material so difficult to understand that they are unwilling, or even unable, to read it.

This is particularly important if the material will be translated into another language or if the material is not written in the mother tongue of the health workers. For example, manuals written in English need to be especially easy to understand if the health workers normally talk in a different language. There are also serious difficulties with languages such as English or Arabic because several different levels of language exist. For example, the writer may use a higher form of Arabic than the health worker usually uses.

Some guidelines for writing simply are given below.

Guidelines for writing simply

1. Use of words

(i) Use simple, short, common words not complicated, long or unfamiliar ones. For example, use "tie" not "ligate". Use "press with your finger" not "apply digital pressure".

(ii) Be careful using idioms. If the manual is for local use then idioms may make it more interesting and "punchy" to read. But health workers from other countries may find it difficult to understand. For example, do you understand what "punchy" means?

(iii) Explain technical words. Where it is essential to use technical words, these should be explained fully and an example given. Then you should make a point of using the word several times so that the health worker can practice using it.

2. Sentence construction

(i) Use positive statements. The sentence "You should avoid negative statements" means almost the same as "You should use positive statements". The use of the negative makes it much more difficult to understand.

(ii) Use active verbs. Health workers will find it easier to understand sentences written using active verbs, for example:

"Ask the patient whether he or she feels feverish" is easier to understand than "the patient should be asked by the health worker whether he or she feels feverish".

(iii) Do not use pronouns. When pronouns such as "he", "she", "it" or "they" are used, the health worker has to decide exactly what or who the pronouns refer to. It is often better (but sometimes clumsy) to write out the full noun.

(iv) Use short sentences and paragraphs. Long sentences are difficult to understand. It is often better to rewrite a long sentence as two or more shorter ones. Long paragraphs are also boring and tiring to read. Simply break them down into shorter ones.

You should test what you write to see whether it is sufficiently easy to read. The aim of the testing is to see whether what you write can be understood by the health worker. Methods for doing this are explained in more detail in Section 14.12.

14.9 Writing

Everybody finds it very difficult to write. They may have good ideas about what they would like to say, but when they are faced with an empty sheet of paper, they cannot get started.

Different people use different techniques to help themselves. Some examples are given overleaf. None of these techniques is guaranteed to help, but you could try them. If you find that they are helpful, use them.

1. Set a target of so many words or pages for each day.

2. Arrange a meeting for 10 days ahead to discuss what you have written. Then you will have to prepare something for that meeting.

3. Give yourself a reward after doing a certain amount of writing - for example, a cup of coffee or tea.

4. Start anywhere in the manual. Often it is best to start on the part that you find most easy. This at least gets some words down on paper. 5. Do not worry about the quality of what you write. Once you have something written, you can then improve it.

The process of writing is always difficult, but the more you write, the easier it becomes.

14.10 The reasons for evaluation

There are two general reasons for evaluating teaching materials. The first reason is to find out how useful the material is to the health workers. This is called summative evaluation. You might use summative evaluation on manuals written by other people to decide whether your students would find them helpful. Or you might use summative evaluation on material you have produced to give other people guidance on how useful the material is.

The second reason for evaluation is to improve the teaching material. This is called formative evaluation. You should use formative evaluation on all teaching material you produce (even simple handouts) so that you can improve the quality.

14.11 What should you evaluate?

The basis for evaluation is to find out whether the teaching material achieves its purpose. For example, do students learn better if they use a handout? Do health workers do a better job if they use a manual?

To find out the answers to questions such as these, you should use your experience and look at the teaching materials. Think about the following questions:

· Are the important techniques covered? Are the important points made? Is the content right?

· Is the language used simple enough? Are the diagrams clear?

· Are all instructions correct? Do the methods suggested in the material fit in with current practice for your students?

· Can the health workers understand the instructions? Are they given in the correct order?

· Can the health workers find the information that they need? Is the index suitable?

· Can the health workers do the tasks described when they use the manual or material?

Obviously some of these questions are only appropriate when you are evaluating manuals. But most of the questions apply to teaching materials in general.

14.12 Methods of testing

When you are evaluating teaching materials, you should find out what the health workers think about the materials. You should also observe the students or qualified health workers using the material and find out for yourself whether they can use it. This is called performance testing.

For example, a section of a manual or handout describing how to give a patient an injection could be tested by watching a student perform the task. If the student gives the injection correctly, then the manual is satisfactory.

This kind of performance testing can be carried out by asking the health worker to perform specific skills in a test situation. It can also be done by observing health workers working in their normal workplace and seeing whether they follow the method described in the manual.

The manual can also be evaluated by looking at the results over a longer period. Manuals explaining how to convince village people about the need for a good diet can be evaluated by looking at the number of cases of malnutrition and diseases related to poor diet. If the number of cases decreases, then the manual can be considered to be effective. However, if there is no change or the number increases, you need to investigate the reasons and possibly change the manual.

14.13 When should you evaluate the teaching material?

Teaching materials and manuals should be evaluated before the final version is produced. This will allow you to improve the material before it is widely used.

It may also be useful to evaluate materials after they have been used for some time. If there are important weaknesses a revised version should be produced.

14.14 Summary

· Use task analysis:

- to decide on the objectives of the material.
- to include all necessary information and leave out unnecessary information.
- to give the information in the order in which it will be used.
- to describe all the possible situations.

· Avoid vague instructions.
· Write simply.
· Evaluate all teaching materials using performance testing when ever possible.