At Children for Health - this is what we endeavour to do across all the programmes we are involved with. Our experience in working in many countries on health education tells us that when we want to shift health behaviour from less healthy to healthier (e.g., a shift in a staple food from heavily processed to less processed – like white to ‘brown’ maize meal) – this requires a shift in identity at the individual, small group, family, school, community levels. We therefore need to enable the people whose behaviour we seek to influence (and for us it’s the children and their families) to participate in the exploration of factors contributing to the establishment and sustaining of a less health behaviour (like not washing hands with soap before eating). 

We think it possible and highly desirable to use participatory approaches when designing any health behaviour related interventions. Interventions tend not to work if we don’t. Children as young at 10 years old (ideally they are in the abstract operational thinking phase of their brain development) can be effective observers, informants on all aspects of their lives that contribute to the identification with a health behaviour. They are also effective ‘agents of change’ when they themselves have agency. 

We have unpacked these aspects of identity to include – their environment, their culture,  systems e.g., in the family and school, their biology and their thinking or cognition. Children and teacher facilitators become like detectives - working on why something is as it is and how to make the changes. On their own terms, in their own settings.

We are currently working on making our methodology – which we call ‘The Rainbow Circle’   - simple enough for undertrained teachers to use with children aged 10 and over. We think that this process could be adopted at scale in schools when the aim of a piece of learning and teaching seeks to change health behaviour. The process can be set out clearly in textbooks and taught to master trainers in teacher training colleges so becoming part of teacher training. To some extent, we achieved this in our work in Mozambique. Ideally, the process would also be taught in the training of health workers who would also come to understand that children and adolescents are resourceful and competent and able to contribute a lot to public health. 

In most educational settings , health education is already there ‘at scale’ but it comes across as bland ‘do’s and don’ts’ or simply information and is mostly disconnected to the lives of the children and their families. We all have stories like this one – ‘the teacher who teaches an excellent lesson on the dangers of smoking and then lights up a cigarette at the classroom door as the children file out.’

What we urgently need is a properly funded research project to be wrapped around our work with The Rainbow Circle so that we can start developing an evidence base around our ethnographic, participatory approach. I have been trying for very, very many years to get research off the ground and have not yet succeeded in convincing research departments or funders to take this on.  Since 2013, we have been tabled on 6 research projects so far - each of them absorbing considerable time and effort to get to the proposal stage - and none of them have been funded. Maybe the time is approaching? We’d happy to participate as a team member in such an endeavour and would have a great deal to contribute.