Daniel Ganu • Susan M. Baker • Josephine Ganu

Data Matters:

Health Statistics Can Empower Knowledge, Attitude, and Practice

Seventh-day Adventist educators worldwide get excited about pedagogies that increase students’ knowledge skills and influence their attitudes and beliefs. Taylor asserts that one of the defining characteristics of Seventh-day Adventist education is commitment to excellence, which promotes whole-person development. This wholistic development is constructed when strong linkages are forged between knowledge and practice,1 supported by positive attitudes and beliefs.

To make learning transformational, the developmental process connecting knowledge, attitude, and practice (KAP) must be intentional. We know that knowledge acquisition alone may not be powerful enough to change practice in a positive direction.2 For example, the development of spirituality demands synchrony between these factors to be mature and authentic. Another critical area for the melding of KAP skills is in health education.

The objective of Adventist health education is to deliver knowledge in a manner that also shapes the student’s attitudes regarding adopting good health habits and practicing a healthy lifestyle. This objective builds on the words of Ellen White: “In teaching health principles, keep before the mind the great object of reform―that its purpose is to secure the highest development of body and mind and soul.”3 The Seventh-day Adventist Church has a rich history of creating and promoting health and science education initiatives, textbooks, and curriculum resources that are used by educators at all levels to activate and accelerate learning. Examples of Adventist health education approaches are CELEBRATIONS®,4 NEWSTART,5 and CREATION.6

Research substantiates the benefits of Adventist health teachings but only when knowledge is translated into positive attitudes and practices by individuals. Findings from health research conducted among Seventh-day Adventists have indicated that Adventists who embrace healthy practices, as taught by the church, have increased life expectancy7 and decreased risk for some types of cancer,8 cardiovascular diseases,9 and metabolic syndrome.10

In a 2016 study, Galvez et al. measured KAP variables among 1,442 Seventh-day Adventists in seven Adventist churches in metro Manila, Philippines. Of these respondents, more than half (55 percent) were between the ages of 18 and 35, with 70 percent having completed a college degree. The researchers found that knowledge of Adventist teachings about physical activity, as one example, was poor to average. Again, related to physical activity, attitudes were found to range between neutral and positive. Practice, in the area of physical activity, was poor to average.11 This study is just one example that highlights the need for knowledge to be transformed into attitude and practice to gain benefits.

In 2019, researchers at the Adventist University of Africa, a General Conference postgraduate institution in Kenya, conducted a study within the geographical territories of the three Seventh-day Adventist divisions in Sub-Saharan Africa: East-Central Africa Division (ECD), Southern Africa-Indian Ocean Division (SID), and West-Central Africa Division (WAD). (See Figure 2.) The purpose of the study was to collect and analyze primary data from African Adventists related to their general health status and KAPs based on the CELEBRATIONS® health-education acronym. CELEBRATIONS® is a program created by the General Conference Health Ministries Department for health education in churches and schools (Figure 1).

Methods

This descriptive study utilized a cross-sectional analytical design with data collected using a questionnaire and, thus, relied on self-reported data. The 213-item questionnaire contained closed- and open-ended items and was administered by trained research assistants.

Participants were randomly recruited from persons who met inclusion criteria at the various locations. Inclusion criteria were: (1) African ethnicity; (2) baptized member of the Seventh-day Adventist Church; (3) residence in one of the Seventh-day Adventist divisions in Africa; (4) 18 years of age or older; and (5) ability to commit approximately one hour to complete the questionnaire.

Recruitment of participants was based on grouping clusters of Adventist populations from the 34 African unions and church populations from rural and urban settings with small, medium, and large membership sizes. Proportional random sampling was used to recruit participants from each conference and resulted in collecting completed questionnaires from 15,434 participants (Figure 2). Incomplete or damaged questionnaires (2,437) were not included in data analysis.

Permission for research with human participants was approved by the ethics committee of the National Commission for Science, Technology, and Innovation in Nairobi, Kenya. Each participant signed an informed-consent form before being allowed to take part in the study, after which he or she completed the questionnaire, which was available in English, Portuguese, French, and Swahili to accommodate the diverse language groups. Statistical analysis was performed using IBM SPSS version 23.

Results

The African Seventh-day Adventist Health Study used the acronym CELEBRATIONS® to assess the level of KAP of the health principles among Adventists in Africa. As shown in Table 1, 50.6 percent of participants were male, and 41.4 percent were female (8.0 percent did not answer the question regarding gender). The largest group of respondents was between 18 and 30 years of age (46.2 percent) and single in regard to marital status ((46.0 percent single; 44.5 percent married or separated; and 9.5 percent other or missing). Slightly more than half of the participants had either no formal education (3.0 percent) or a primary or secondary education (50.6 percent). Participants with bachelor’s and professional degrees made up 30.4 percent of those surveyed, while 7.2 percent had a postgraduate degree, and 8.8 percent did not respond to this question. In regard to employment status, 48.4 percent were employed; 26.5 percent were students.

Table 2 shows the level of participants’ knowledge about health principles taught by the church. Overall, the participants showed an good level of knowledge, with a mean score of 3.94 on a 5-point Likert Scale (SD = 0.58). This indicates that the respondents had above-average knowledge of the health principles, with knowledge about certain CELEBRATIONS® principles being slightly higher than about others.

As depicted in Table 3, the participants showed an overall positive attitude toward the health principles taught by the church (mean score = 3.99 on a 5-point Likert scale; SD = 0.72). Having a positive attitude toward a health principle plays a critical role in whether the health principle is practiced. From these results, it is reasonable to expect good translation of knowledge and attitudes into practice behavior, which is examined in the next section. Similar to results in the area of knowledge, variation existed among CELEBRATIONS® principles, with slightly larger differences in several areas. It is interesting to note that there were four extremely positive findings for attitude regarding choices, liquids, belief, and rest. Comparing this to the level of knowledge, attitudes toward liquids is the only finding on which the majority of respondents achieved a score of excellent. Also, temperance was rated lowest in the level of knowledge, although it was rated highest in practice. The attitude of the participants toward integrity and nutrition was neutral.

Table 4 reveals that the practice of health principles received a lower rating (mean score of 3.61 on a 5-point Likert Scale, SD = 0.73) than knowledge and attitude. The score for practice of exercise, environment, and nutrition was average, although exercise and environment scored positive attitude.

The Knowledge, Attitude, Practice model is a common method for understanding and analyzing human responses to particular phenomena, especially in the field of health studies. The connection between people’s attitudes and practices is well established in psychology and health-behavior theory.12 The implication of the positive relationship between KAPs is that it will equip the individual to accept the challenge of educating, motivating, and adopting Adventist health principles in order to modify his or her lifestyle.

Discussion

This study revealed information regarding knowledge about, attitudes toward, and practice of Adventist health principles among Seventh-day Adventists in Africa. Although participants reported a good level of knowledge of general health principles and positive attitudes toward them, this was not fully reflected in their practice. Other studies have corroborated that differences exist between the levels of knowledge, attitude, and practice.13 Our findings demonstrated that respondents’ overall attitudes toward CELEBRATIONS® were slightly higher than their overall knowledge. This shows an overlap between knowledge and attitudes. It is likely that even if respondents lacked complete or accurate knowledge about CELEBRATIONS®, they could still develop a positive attitude toward health principles because they believe in the health teachings of the church. In fact, our results showed that “liquids” was the only health principle about which the respondents had excellent knowledge. This clearly indicates a need to deliberately place greater emphasis on health education to improve the health literacy of church members in Africa. Lack of accurate or complete information can lead to misguided information, particularly in an infodemic14 era.

A review of the age of participants shows that many were relatively young, which is reflective of the population throughout the continent of Africa. It is imperative, therefore, that educators use their opportunities with students to forge connections between health education and KAPs as part of formative wholistic education.

Furthermore, the success of health education depends on the extent to which educators use a variety of pedagogies to integrate health principles with academic learning at all levels. An example of this type of interdisciplinary instruction is found in the Ariel Trust, located in Liverpool, United Kingdom. The Trust is an educational charity that uses mathematics lessons to teach students about the misuse of alcohol.15 Students learn about the dangers of alcohol (a health principle) by exploring alcohol consumption statistics (an evidence-based approach) and associated risks (a health practice) within math lessons (an interdisciplinary approach to a non-health subject). Similarly, Youth Alive, a Seventh-day Adventist program, is designed to build resilience among adolescents and young adults by inspiring and equipping them to make healthy choices.16

Targeting youth at all educational levels is practical, sustainable, and strategic. For educators in Africa, and elsewhere, this is relevant—Africa has the largest concentration of young people in the world, and the African Adventist membership is largely made up of youth.17 However, Adventist educators in all parts of the world should commit to integrative health education as an intentional pedagogy. Historically, teachers have played a significant role in influencing students. They can generate enthusiasm, confidence, and joy in students in a way that will motivate them to adopt a consistently healthy lifestyle throughout their lifetime. Committed Adventist teachers who are passionate about God and health principles are a resource to Adventist education of inestimable worth.18

Recommendations

Based on the findings from the composite data generated in the study,19 there is no doubt that education is a potential cornerstone for enhancing knowledge-attitude-practice regarding CELEBRATIONS®. We recommend that teachers at all levels use a variety of approaches to promote Adventist health teachings, including CELEBRATIONS®, in an attempt to build on positive attitudes, while reinforcing knowledge about the importance of various health principles and how they can be better translated into behavior. For example, educators need to explain to students that temperance is not only applicable to people who have a health crisis (whether obesity, addiction, or any other health challenge), but for everyone. Other specific areas that need to be underscored and clarified include proper knowledge regarding optimism, social support, rest, nutrition, integrity, and environment and how they influence health.

Following are three practical classroom recommendations designed to be implemented relatively easily and not requiring additional courses or a new curriculum:

1. Use critical-thinking approaches to integrate health principles in your teaching. The classroom setting is a favorable ground to foster deep, substantive thinking about health. Critical thinking is a form of reflective thinking that can stimulate deep self-assessment about students’ health choices and lifestyle. Asking questions that require synthetic, analytic thinking is a key characteristic of teaching critical thinking. Educators can facilitate strategic conversations in the classroom by asking questions and actively listening to students to understand their attitudes toward and understanding of Adventist health principles. Such approaches enable the instructor to connect with students and stimulate deep thinking and lasting learning. Best-practices use of critical-thinking methods demands that teachers cultivate sensitivity, alacrity, and emotional intelligence.20

2. Model healthy behavior. Role modeling is “teaching by example and learning by imitation.”21 Adopting a healthy lifestyle cannot be accomplished just by acquiring knowledge, although the value of factual and practical knowledge must not be ignored. Students also need to be inspired to do more than have a good attitude about health principles, although attitudes can pave the way for behavior change. Students are constantly evaluating their teachers to see if they are “walking the talk.” As a teacher, practice the health principles that you teach. For instance, students should see educators drinking pure water habitually, regularly engaging in some form of exercise, demonstrating a positive outlook, having an abiding trust in God, etc. In this way, the teacher’s behavioral commitment to health principles can show students how healthy living looks.

3. Integrate teaching of health principles into academic calendars/curricula. Educational institutions must endeavor to create opportunities for health promotion, health literacy, and awareness based on health-education acronyms such as CELEBRATIONS®. Thinking about effective pedagogy should include using multidisciplinary, interdisciplinary, and transdisciplinary approaches,22 as well as collaboration with Health Ministries Departments, hospitals, clinics, and healthcare personnel.

Conclusion

The African Seventh-day Adventist Health Study identified the level of knowledge, attitude, and practice of health principles among Adventists in Africa, who reported a good knowledge of and a positive attitude toward health principles. It is easy to assume that all Adventists have the right knowledge about health teachings and practice accordingly. However, there is a need to deliberately place greater emphasis on health education to improve health literacy and further translate knowledge and attitudes into maximized practice. This need exists throughout Adventist education at all levels, where educators have an opportunity to introduce knowledge, cultivate its conversion to positive attitudes and encourage transformational practice that is vital for effective health education outcomes. Since educators play a critical role in moving change initiatives forward successfully, it is incumbent on Adventist educational institutions and educators to explore the recommendations suggested by this study and utilize evidence to integrate health principles and academic learning.


This article has been peer reviewed.

Daniel Ganu

Daniel Ganu, DrPH, is a Professor of Public Health and currently serves as the Coordinator for the Master of Public Health degree program at the Adventist University of Africa, Nairobi, Kenya. He has published research articles in international peer-reviewed journals. His research interests are in children’s health, drug and substance abuse, spiritual health, mental health, and health promotion.

Susan M. Baker

Susan M. Baker, DSc, PT, is a physical therapist and educator who was the former Director of Research and Faculty Development and an Associate Professor in Public Health at the Adventist University of Africa, Nairobi, Kenya. She has worked in various health-care sectors, and public and private universities. Her research interests are rehabilitation, SOTL, and health education/promotion.

Josephine Ganu

Josephine Ganu, PhD, is an Associate Professor of Management and currently serves as the Director of Research and Grants at the Adventist University of Africa, Nairobi, Kenya. Dr. Ganu received her PhD in Commerce from the University of Santo Tomas, Philippines. Her current research interest includes employees’ health and wellbeing, corporate social responsibility, organizational behavior, and workplace spirituality.

Recommended citation:

Daniel Ganu, Susan M. Baker, and Josephine Ganu, “Data Matters: Health Statistics Can Empower Knowledge, Attitude, and Practice,” The Journal of Adventist Education 83:1 (2021): 9-15. https://jae.adventist.org/en/2021.83.1.3.

NOTES AND REFERENCES

  1. John Wesley Taylor V, “What Is the Special Character of an Adventist College or University?” The Journal of Adventist Education 79:2 (January-March 2017): https://jae.adventist.org/en/2017.2.5.
  2. Jamilah Ahmad et al., “Investigating Students’ Environmental Knowledge, Attitude, Practice and Communication,” Asian Social Science 11:16 (2015). doi.org/10.5539/ass.v11n16p284.
  3. Ellen G. White, The Ministry of Healing (Mountain View, Calif.: Pacific Press, 1905), 146.
  4. Kathleen Kiem Hoa Oey Kuntaraf et al., CELEBRATIONS®: Living Life to the Fullest (Silver Spring, Md.: Adventist Review Ministries, 2018). Online resources available at https://www.healthministries.com/celebrations.
  5. NEWSTART online resources are available at https://www.newstart.com/about/.
  6. CREATION Life online resources are available at https://www.adventhealth.com/creation-life.
  7. Gary Fraser and David Shavlik, “Ten Years of Life: Is It a Matter of Choice?” Archives of Internal Medicine 161:13 (2001): 1,645-1,652. doi.org/10.1001/archinte.161.13.1645.
  8. L. C. Thygesen et al., “Cancer Incidence Among Danish Seventh-day Adventists and Baptists,” Cancer Epidemiology 36:6 (2012): 513-518.
  9. Tao Huang et al., Cardiovascular Disease Mortality and Cancer Incidence in Vegetarians,” Annals of Nutrition & Metabolism 60:4 (2012): 233-240.
  10. Nico Rizzo et al., “Vegetarian Dietary Patterns Are Associated With a Lower Risk of Metabolic Syndrome,” Diabetes Care 34:5 (2011): 1,225-1,227.
  11. C. A. Galvez et al., “Influence of Knowledge and Attitude on Lifestyle Practices Among Seventh-Day Adventists in Metro Manila, Philippines,” Journal of Religion and Health (2020). doi.org/10.1007/s10943-020-01091-8.
  12. Icek Ajzen, “Perceived Behavioral Control, Self-efficacy, Locus of Control, and the Theory of Planned Behavior,” Journal of Applied Social Psychology 32:4 (2002): 665-683. doi.org/10.1111/j.1559-1816.2002.tb00236.x.
  13. Bao-Liang Zhong et al., “Knowledge, Attitudes, and Practices Towards COVID-19 Among Chinese Residents During the Rapid Rise Period of the COVID-19 Outbreak: A Quick Online Cross-sectional Survey,” International Journal of Biological Sciences 16:10 (2020): 1,745-1,752: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7098034; see also: Oluwaseyitan Adesegun et al., “The COVID-19 Crisis in Sub-Saharan Africa: Knowledge, Attitudes, and Practices of the Nigerian Public,” The American Journal of Tropical Medicine and Hygiene 103:5 (2020): 1,997-2,004. doi:10.4269/ajtmh.20-0461.
  14. World Health Organization, “Infodemic”: https://www.who.int/health-topics/infodemic#tab=tab_1.
  15. Tara Tancred et al., “Integrating Health Education in Academic Lessons: Is This the Future of Health Education in Schools: A Commentary,” Journal of School Health 87:11 (2017): 807-810. doi.10.1111/josh.12554.
  16. https://www.healthministries.com/wp-content/uploads/2020/08/YA-Participant.Final.NoMarks.pdf.
  17. United Nations Economic and Social Council, “#Youth2015: Realizing the Future They Want” (2014): https://www.un.org/en/ecosoc/youth2014/pdf/summary.pdf; General Conference of Seventh-day Adventists, “Research Projects Commissioned by General Conference Officers” (2018):
    https:// www.adventistresearch.org/research_reports
    . These statistical reports revealed from demographic data collected by researchers at the University of Eastern Africa, Baraton, Kenya, that in 2018, people under 30 years old made up 40.9 percent of the church’s membership in the Southern Africa-Indian Ocean Division, 38.6 percent in the West-Central Africa Division, and 32.9 percent in the East-Central Africa Division. This is an average youth membership of 37.4 percent in Sub-Saharan Africa
  18. Carol Tasker, “Teachers: The People Who Make the Difference in Adventist Education,” The Journal of Adventist Education 81:3 (July-September 2019): 3, 47: https://jae.adventist.org/en/2019.81.3.1.
  19. Caveat: This study had potential limitations. The self-report methodology could result in social desirability bias and impact results. A strategy to address this is to use interval options for responses. This approach was used in questionnaire development.
  20. Derya Oktar Ergur makes a cogent case for the necessity of teachers possessing emotional intelligence in “How Can Education Professionals Become Emotionally Intelligent?” Science Direct Procedia Social and Behavioral Sciences 1 (2009): 1,023-1,028.
  21. S. Boettcher-Dale and J. Taylor, “Do as I Do: The Importance of the Clinical Instructor as Role Model, The Journal of Extra-corporeal Technology 26:3 (1994): 140-142: https://www.semanticscholar.org/paper/Do-as-I-do%3A-the-importance-of-the-clinical-as-role-Boettcher-Dale-Taylor/d0cc1447766cfd2ead18110c43802b01d69f216e.
  22. Education researchers encourage the use of multidisciplinary, interdisciplinary, and transdisciplinary approaches to facilitate wholistic learning among students. Unpacking these terms can show why they are an important tool for educators. See the work of Ineta Helmane and Ilze Briška, “What Is Developing Integrated or Interdisciplinary or Multidisciplinary or Transdisciplinary Education in School?” Signum Temporis 9:1 (2017): 7-15. doi.10.1515/sigtem-2017-0010.