Implementation of the e-Bug Project in Greece

Abstract

The e-Bug pack and web site educational material has been translated and adapted to the Greek language and educational background, and implemented throughout Greece as a supplementary educational resource in elementary and junior high schools. Elementary and junior high school teachers in Greece have actively participated in the development of the e-Bug educational resource and supported the implementation of all e-Bug activities. Dissemination to all key national stakeholders has been undertaken, and endorsement has been obtained from educational and medical associations, societies and institutions. Independent evaluation has been carried out, as part of dissertation thesis projects, for postgraduate studies. The e-Bug educational resource provides all the essentials for the dissemination of good health behaviours in hygiene, monitoring the spread of infection and the prudent use of antibiotics, to the youth of this country. Its contribution is expected to be evident in the next adult generation.

Introduction

There is evidence that antibiotic overuse or misuse has been associated with increasing bacterial resistance in Europe.^1,2 Since 2005, 80% of the national consumption of antibiotics in Greece was in the community; this is amongst the highest in Europe.³ Overuse and misuse is especially high in children.⁴ National campaigns on hygiene (hand, food and respiratory hygiene) and sexually transmitted infections are mainly focused on adults, who may have already established health-related attitudes and behaviours. Childhood and adolescence are the periods in human development during which beliefs, behaviours and attitudes are adopted, and, if established, are maintained throughout adulthood.^5,6 Therefore, the e-Bug Project has provided an excellent opportunity to expand health education to children and adolescents in Greece, focusing on high-priority public health issues, such as essential hygiene, the spread of infections and prudent antibiotic use.

Curriculum structure

Education in Greece is compulsory for all children. Children aged 6–12 years old attend elementary school (six grades) and 12–15 year olds attend junior high school (three grades). School life for students, however, may start at the age of 2.5 years (pre-school education). Post-compulsory education, according to the reform of 1997, lasts for 3years in senior high school and 2years (a′ level) or 3years (b′ level) in technical vocational educational schools,⁷ followed by studies in higher education (universities, technological educational institutes).

Based on the 2001 Census,⁸ there are ∼11 million people living in Greece (75% in urban areas and 25% in rural areas). According to the Department of Statistics at the Ministry of Education,⁹ in 2008–09 there were 5803 elementary school units (all six grades) with 640 036 students and 66 616 teachers (317 648 students in the three upper grades), and 2022 junior high school units (all three grades) with 345 755 students and 43 796 teachers.

A national curriculum exists and is mandatory in all school grades, but it is flexible enough to allow additions, extensions and supplements, depending on the willingness and background of the students and the aptitude and proficiency of the teachers. In such a setting, e-Bug fits as a supplemental educational resource into the Life Sciences (e.g. Nature), Environmental Studies, Physics, Chemistry, Biology and Physical Education components of the curriculum of both elementary and junior high school.

Children and adolescents in Greek schools are taught about essential hygiene measures, in Life Sciences, as required by the already established national curriculum (‘Parts of the Ecosystem’ and ‘Agents of Disease’ in elementary school; and ‘Cells: Structure and Function', ‘Human Tissues and Organs', ‘Forms of Life' and ‘Infections and Disease Agents' in junior high school). Nevertheless, the students don't actually ‘know’ and ‘understand’ why the application of the above measures is crucial, not only in the maintenance but also for the improvement of their health, as they are not obligated to perform practical exercises and/or experiments. Moreover, rarely do the students perceive the importance of the rational use of antibiotics and medicines in the treatment of diseases that are caused by certain microorganisms. The development and the implementation of the e-Bug educational resource are expected to support and enhance the acceptance and adoption of beneficial health behaviours, through interactive, innovative and up-to-date means. This complements national antibiotic and hygiene educational campaigns, thereby hopefully reducing morbidity.

Partnerships and stakeholders

Elementary and junior high school teachers in Greece agreed to participate actively in the development of the e-Bug educational resource. They will highlight e-Bug to elementary and junior high school teachers' associations; thus promoting the dissemination of the educational and web site-based material amongst their members and several schools. This has been a key partnership, as regardless of the extracurricular educational resources available or endorsements by national institutions and scientific bodies, teachers have the final say on what is actually implemented in schools.

The Department of Pedagogics, the School of Pedagogic and Technological Education (ASPAITE), Athens, Greece and the faculty of the annual ‘Counselling and Vocational Orientation Certification Programme’ for teachers in both elementary and high school units supported e-Bug. They agreed to inform the teachers attending the course about the pack and web site, and involve them in the implementation of e-Bug activities.

Dissemination of the educational resource

e-Bug was presented at the 19th Pan-Hellenic Congress of the Greek Society for Social Paediatrics and Health Promotion, in October 2007,¹⁰ and the eRA–4 International Scientific Conference for the Contribution of Information Technology to Science, Economy, Society and Education, in September 2009.¹¹

The section of the pack entitled ‘Treatment of Infection: Antibiotics and Medicine’ was translated ahead of schedule and then sent to the Ministry of Education to distribute to schools all over the country, in time for the first European Antibiotic Awareness Day (EAAD) activities on 18 November 2008. The teachers implemented it in class that day, both in elementary and junior high schools, and provided feedback to the e-Bug group in Greece. An article featuring the e-Bug educational material was accepted for publication in the official journal of the high school teachers' association,¹² and mirror sites and references to e-Bug have been developed and appear on several education-related web sites in Greece.^13–16 e-Bug also participated in the preparation of the second EAAD (2009) activities in Greece, contributing to the production of a folded leaflet that was distributed all over Greece in January 2010.

Implementing the completed resource

Elementary and junior high school packs (2100 copies of each) along with an introductory letter from the National School of Public Health were distributed to all regions of the country through the Departments of Health Education in the 54 Regional Offices of the Ministry of Education. The packs are available to teachers as printed material. Moreover, an invitation to visit the www.e-bug.eu web site and download the material was included in the letter, increasing the accessibility of the educational resource.

The e-Bug pack and web site material was presented as an educational activity to 20 elementary and 20 high school teachers of the Dodecanese Regional Department of the Ministry of Education, in Rhodes, on 11 December 2009. During this seminar, teachers were guided through each section of the educational resource in the morning and had the chance to teach four of the eight sections in the evening, which involved the participation of actual-size classes of elementary and junior high school students.

Endorsements

The e-Bug pack and web site in Greece has been endorsed by the Ministry of Education and the Ministry of Health and Social Solidarity of Greece, and logos of both Ministries are included on the printed packs.

Independent evaluation

The topic ‘The Evaluation of e-Bug as an Educational Resource in Elementary Schools in Greece' was assigned to three elementary school teachers as two separate postgraduate dissertation thesis projects [one at the National School of Public Health (NSPH) and the other at ASPAITE]. Evaluation questionnaires used in the UK evaluation study were translated and applied during this pilot implementation of the pack in 10 elementary schools in urban and rural areas in Greece. Preliminary results of these studies (G. Barbatsis and E. Karageorgou, ASPAITE, personal communication; and S. Chaidemenos, NSPH, personal communication) confirm that the e-Bug educational resource has been accepted by both teachers and students as useful, informative, enjoyable, user friendly and extremely interactive.

Since the pack reached all teachers in December 2009, feedback from junior high school units that used e-Bug in their classes is currently being collected. However, several teachers from all over Greece have expressed an interest to implement the resource, based on personal communication of the Greek e-Bug group with the Regional Departments of Health Education of the Ministry of Education.

Future of e-Bug in Greece

e-Bug has been the fruit of excellent collaboration among experts and professionals in health and education. As such, it fulfils all the requirements of valid and reliable public health information in an educational format and structure. It has been adapted to the national, cultural and educational background of Greece, and provides all the essentials for the dissemination of good health behaviours to the youth of this country. It spreads as a ‘benign virus’ from one school to another and, although sometimes it is difficult to follow its path, its contribution is expected to be evident in the next adult generation. Even if no institution in Greece decides to support the maintenance of the e-Bug web site in Greece, due to a lack of financial resources, the educational community seems to have taken over, since they are not only implementing the existing educational resource, but are also adapting it and bringing it closer to the needs of the students and to the facilities and infrastructure of the school units.

Funding

This project was funded by DG SANCO of European Commission (2005211) and has been financially supported by the National School of Public Health and the Ministry of Health and Social Solidarity, in Greece.

Transparency declarations

This article is part of a Supplement sponsored by the European Commission Health and Consumer Protection Directorate-General DG SANCO (grant number 2005211).

Acknowledgements

The e-Bug working group in Greece would like to thank the Ministry of Education and especially the Office of Health Education, the Department of Public Health of the Ministry of Health and Social Solidarity in Greece, educational and health institutes, and scientific societies for their endorsement of this educational resource and their support throughout the entire project.

Needless to say, the translation and adaptation of this educational resource into Greek would not be feasible without the constructive suggestions and contributions from students and teachers in all the schools that implemented the resource prior to its publication.

References