“
Frequency and exemplar quotes of themes and sub-themes that demonstrate the support of experiential learning to didactic public health education in Foundations of Public Health (Fall 2015–Spring 2018).
Theme 1: Foundational concepts of health, public health, and health systems | Social determinants of health | 59 (38.3%) | “ “ “ “ |
Theme 1 cont. | Community-based interventions | 19 (12.3%) | “ “ “ |
Theme 1 cont. | Definitions and aspects of health | 12 (7.8%) | “ “ |
Theme 1 cont. | Health disparities | 5 (3.2%) | “ |
Theme 1 cont. | Health systems and access to healthcare | 5 (3.2%) | “ |
Theme 1 cont. | Social-ecological framework | 4 (2.6%) | “ |
Theme 2: Social justice | 64 (41.6%) | “ “ “ “ “ | |
Theme 3: Beginning-level professional attitudes, behavior, and communication | Advocacy and awareness | 33 (21.4%) | “ “ “ |
Theme 3 cont. | Communication skills | 12 (7.8%) | “ “ |
Theme 3 cont. | Future public health roles | 11 (7.1%) | “ “ |
Theme 3 cont. | Teamwork | 5 (3.2%) | “ |
Theme 3 cont. | Accountability | 4 (2.6%) | “ |
Theme 3 cont. | Problem-solving | 2 (1.3%) | “ |
None | 10 (6.5%) | N/A |
In reviewing CWL evaluation data, students from Foundations in Public Health valued their service-learning experiences. Eighty-six percent of students reported that they would recommend service-learning to other students, 9% reported they might recommend, and only 5% reported they would not recommend service-learning. Of the 5%, most did not express concerns about the value of the pedagogy, but instead, their ability to meet the requirement due to time, work, or life constraints. As multiple factors can impact students' experience, we view this data point as a positive indicator for use of service-learning in public health introductory courses. In addition to students' appreciation for the experience, the following data supports service-learning as an effective tool for meeting CEPH criteria.
Criterion 1: Students should have learning experiences that address the “socioeconomic, behavioral, biological, environmental, and other factors that impact human health and contribute to health disparities” (Foundational Domains)
The foundational domains outlined in the CEPH criteria are heavily supported by the inclusion of service-learning in the Foundations of Public Health course. On the CWL evaluation survey, 88% of students agreed or strongly agreed that service-learning increased their understanding of diverse and global perspectives, which equips students with new lenses for understanding health and health behaviors. Additionally, 88% of students agreed or strongly agreed that service-learning increased their understanding of social justice, which aids students in identifying and addressing health disparities.
The contributions of socioeconomic, biological, behavioral, environmental, and other factors to the persistence and–ideally–elimination of health disparities were articulated by students in their end of semester reflections for the Foundations of Public Health course ( Table 1 ). The most commonly reported factors mentioned in student reflections were focused on social support and a sense of community or belonging, food access, language and culture, housing/shelter, education, and age/ability ( Table 1 ). The direct links to service-learning sites for many of these factors is often straightforward. For example, students were placed at organizations where there were food shelves and community gardens (food access), they tutored English-language learners (language and culture), and distributed hygiene packs and bedding at homeless shelters (housing/shelter). However, the students most frequently reflected on the role of their service-learning organization in contributing to a sense of community and belonging for the individuals it served. This factor was present across all semesters, suggesting that, regardless of community placement, students recognized the importance of social supports to individual and community health. This was most profoundly stated by one student who wrote that her organization
“was all about creating a non-judgmental environment for people in stressful situation to be apart [sic] of so they could experience what it feels like to have a positive community to belong to…If we are able to attempt to understand where people are coming from and how someones [sic] life experience can shape everything that they participate in life, it will become easier to provide help for people in disadvantaged situations.”
In spite of some grammatical errors (not uncommon as many of our students are non-native English speakers), nearly all reflection papers mentioned at least one factor related to human health and health disparities (93.6%, n = 145).
Criterion 2: Students should be involved in experiential learning activity to support didactic education (Cumulative and Experiential Activities)
Another undergraduate CEPH criterion states that students should be involved in experiential learning activities that support didactic education. According to evaluation data from students who completed service-learning as part of Foundations in Public Health between fall 2015 and spring 2018, students found service-learning to be a valuable part of their course learning. Of the 198 students who completed service-learning in the Foundations of Public Health course between fall 2015 and spring 2018, 84 responded to the evaluation survey from the CWL, for a response rate of 42%. Eighty-two percent of students agreed/strongly agreed that service-learning enhanced what they learned in the course, and 86% of students agreed/strongly agreed that course activities and assignments connected their service-learning to their classroom learning.
While there are several specific learning objectives in Foundations of Public Health, the learning objectives can be grouped into three primary themes: (1) foundational concepts of health, public health, and health systems; (2) social justice implications of public health; (3) beginning level professional attitudes, behavior, and communication. Through student reflections, it was clear that these didactic elements were supported through service learning in the course ( Table 2 ). Only ten (6.5%) students did not mention at least one of these learning objectives in their reflections. Within the first theme, examples included in the reflections focused on describing the social determinants of health, health disparities, definitions and aspects of health, health systems and access to healthcare, the social-ecological framework, and community-based interventions. Succinctly put, one student described social determinants in the homeless community as, “ The homeless community needs support, education, healthcare and jobs.”
The most frequent theme across the student reflections focused on social justice in the work of the community organization. Elements of social justice were identified in 64 (41.6%) of student reflections. One student wrote in her reflection, “ Service plays a huge role in social justice; you are taking action and as a result, moving toward a solution/something better.”
Notably, students also described specific skills and interests at their sites that would serve them well in future public health work including communication skills, advocacy, and problem-solving, and future public health roles. Many students expressed a desire to share their new knowledge with others. “ This experience gave me a stronger sense of connection to…the disabled community It strengthened my desire to support and advocate for these communities.”
One aspect of St. Catherine University's Catholic mission is the importance of reflection, and most importantly, self-reflection. Although not evaluated as a learning-outcome, many students explored relationships between their service-learning site and their own lived experiences in their reflection papers without prompting. In our undergraduate public health program, two-thirds of our traditional students and one-third of students in our adult learner program identify as students of color. More than one in four undergraduate public health students are multilingual. Throughout their reflections, students shared how they had either benefitted from similar service-learning organizations when they were younger, and what barriers they and/or their parents faced as new immigrants to the United States:
“I learned English when I was 10 years old and have experienced the struggle of learning a language and how it feels to have a language barrier…Language barrier puts limitations on an individual not living in their native land. It can cause misunderstanding can result in them being taken advantage of.”
Others mentioned having received food from food shelves because their family did not have enough food, and still others shared their experiences with domestic violence. Many described their appreciation of service-learning as a way to give back to the community.
Data supports the continued use of service-learning in St. Catherine University's undergraduate public health program to meet CEPH student outcomes related to determinants of health and experiential learning. The foundational domains of CEPH accreditation criteria state that students should have learning experiences that address the “socioeconomic, behavioral, biological, environmental, and other factors that impact human health and contribute to health disparities.” Certainly the definitions and examples of these health factors need to be introduced in a classroom setting, and service-learning does not replace the required knowledge acquisition. Rather, service-learning does reinforce concepts discussed in the classroom by provided students with examples of determinants of health as they appear in their community context. These connections were well-articulated by students in their service-learning reflections. We have also found it important to provide students with service-learning in a foundational course so that they are able to better conceptualize the breadth of what constitutes working in public health. This helps to meet the CEPH accreditation criterion related to cumulative and experiential activities that support didactic education. As described in their reflections, students reported demonstrating beginning professional attitudes, behavior, and communication skills in public health. The St. Catherine University Public Health program's application was accepted for accreditation, and we are actively completing the self-study process. Feedback from our CEPH consultation visit was overwhelmingly positive with respect to the service-learning elements of our undergraduate program.
As we recommend service-learning as a pedagogy for undergraduate public health, we recognize it may not be feasible or beneficial for all programs; as Enos and Trope ( 18 ) observe, while “it is possible to incorporate [service-learning] in any discipline,” service-learning is “not destined to be used in every course” (p. 159). Furthermore, we do not advocate that our exact model be replicated. Rather, we encourage departments to consider how this pedagogy might be applied to their program in a way that that reflects the unique needs of their student, faculty, and community stakeholders. Understanding best practices of community engagement along with the history, power and privilege at play in university-community partnerships is key to successful service-learning design and implementation. As undergraduate public health programs contemplate utilizing service-learning, the following lessons from our own experience may also be helpful.
Service-learning requires intentionality in design and relationship development, which take time. We recommend starting to plan at least 1 year in advance.
If your institution does not have a community engagement office able to cultivate community partnerships and advise on service-learning, consider whether faculty workload allows for the additional time required for relationship development with community partner organizations and researching service-learning pedagogy. Because of the commitment to partnerships and pedagogy, as well as to ensure continuity of messaging around the importance of service-learning to our public health program, we have found that primary instructional faculty are best-suited to incorporate service-learning into their courses.
Prior to considering your course or program design, we recommend reaching out to colleagues on campus with service-learning experience; consulting literature such as Service-learning Essentials ( 19 ) or The Cambridge Handbook of Service Learning and Community Engagement ( 13 ); and connecting with your regional Campus Compact office. ( 20 ) draws a distinction between service-learning that is “placed in the syllabus as something that is supplemental and periodic,” and service-learning that acts as the “experiential base of the course with a full array of activities and exercises to support it and to amplify course material” (p. 33). To achieve this latter model in a way that simultaneously seeks reciprocity for community partners, consult with extant theory and practice-based resources available; sharing on lessons learned can be particularly valuable.
As faculty approach implementation, it is important to note that service-learning may require new or unfamiliar approaches to instruction. Critical reflection should be integrated throughout the course and can occur in different formats, such as speaking, writing and classroom activities ( 19 ). We cannot stress enough the importance of thoughtful reflection design, and there is empirical evidence that the “degree of written and oral reflection influence[s] the effectiveness of service learning” [( 21 ), p. 224]. Although journaling and written reflection are popular methods, “other classroom teaching and learning activities can help students make connections as well” [( 22 ), p. 51].
The pedagogy is also not conducive to exclusively lecture-style courses, and “challenges faculty to reconsider their constructions of control and authority in the classroom and beyond” [( 18 ), p. 159]. Bringle et al. ( 14 ) describe this as a “paradigm shift in higher education because it heightens the role that students can assume as constructors of knowledge” (p. 7). Finally, service-learning may require professional development coaching from faculty as students work on communication and relationship-development skills in environments outside of the classroom. As one undergraduate public health program reported from their model of community-engaged learning in a capstone course, “faculty serve not only as instructors and mentors but also as conveners, resources, coaches, mediators, managers, assessors, and motivators” [( 23 ), p. 97].
As with most curriculum, refining service-learning in a course is an ongoing process. Our evaluation data from students and community partners informs course adjustments and is one more avenue for understanding and maintaining relationships. While we were able to retroactively draw from our evaluation data for identifying the meeting of CEPH criteria, programs just beginning to consider service-learning have the opportunity to design evaluation in a way that more explicitly assesses how service-learning advances student outcomes required by accreditation.
In completing this study, our findings support service-learning as an effective pedagogical model for introductory undergraduate public health coursework. In St. Catherine University's Foundations in Public Health course, service-learning facilitates achievement of student learning outcomes related to understanding the “socioeconomic, behavioral, biological, environmental, and other factors that impact human health and contribute to health disparities” (CEPH Foundational Domains). Furthermore, by nature of its design, the pedagogy provides students with experiential learning that enhances their didactic learning (CEPH Cumulative and Experiential Activities requirement). Although the use of extant data sources limited the opportunity to compare achievement of the first criteria with a control group of students without service-learning, our data suggests that students with service-learning achieve learning outcomes desired while also meeting the second CEPH criteria around experiential learning (something that would not happen without service-learning). The original motivation for including service-learning in St. Catherine's Foundations of Public Health course was informed by student and community partner interest in combination with the University's value for social justice and community engagement. However, we have come to realize the pedagogy offers an additional benefit of meeting multiple CEPH criteria essential to the success and accreditation of our undergraduate public health major—something other undergraduate public health programs may want to consider as well.
Ethics statement.
This study was granted exempt level approval from the St. Catherine University Institutional Review Board because it used previously collected, de-identified, evaluation data.
MM and ED both contributed to the design and implementation of the research, to the analysis of the results, and to the writing of the manuscript.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Special thanks to our community partner organizations for your collaboration; D'Ann Urbaniak Lesch (St. Catherine University's Center for Community Work and Learning) and Dr. Angela Ekwonye (St. Catherine University's Public Health Department) for encouraging this project; and the GHR Foundation's Academic Excellence Grant to the St. Catherine University Henrietta Schmoll School of Health for financially supporting publication of this study.
The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpubh.2019.00063/full#supplementary-material