Role of Service-Learning Pedagogy in Enhancing Health Education Competencies

Janea Snyder and Amar Kanekar, University of Arkansas at Little Rock

Abstract: Service-learning provides a multitude of benefits to students including: increased engagement of civic responsibility and the development of effective communication, leadership, and social skills. The current narrative review highlights various applications of service-learning pedagogy such as traditional vs. online classroom approaches to service learning, application of service-learning strategies in the context of health education and health promotion, via internship courses and funded service projects and the role of service-learning in enhancing core areas of responsibilities for certified health education specialists (CHES). Additionally, explored are options to apply service-learning in interdisciplinary work and collaborations.

Key words: service-learning, pedagogy, application, interdisciplinary

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Research has demonstrated that techniques such as active and experiential learning can generate or enhance students’ understanding and interest in a particular subject and may also engage the students in the classroom (Brown & King, 2000; Lundenberg &Yadav, 2006; Newmann & Twigg, 2000, p. 249). Experiential education by definition deals with a “learner-centered approach” where “students are directly engaged in the phenomenon” to be studied (Carver et al., 2007). Service-learning an integral aspect of experiential education, and, among various definitions attributed to this pedagogical technique, “is a credit-bearing educational experience in which students participate in an organized service activity that meets identified community needs and reflects on the service activity in such a way as to gain further understanding of course content, a broader appreciation of the discipline and an enhanced sense of civic responsibility” (Bringle, & Hatcher, 1996, p.222). Despite course delivery, e.g., traditional classroom settings or online, students’ benefits of service-learning on a spectrum range from enhanced learning to the development of civic-engagement skills.

Service-Learning: Traditional vs Online Approaches

Traditional classroom settings have notably been effective in implementing service-learning activities and providing students with an array of positive learning outcomes and impactful experiences. However, online courses can be just as effective (Harasim, 1996; Markus, Howard & King, 1993; McGorry, 2012). It has also been concluded that there was no difference in students’ service-learning experiences whether they were delivered completely online or in a traditional classroom setting (McGorry, 2012). For faculty who teach health-education courses online or are considering incorporating a service-learning component within their courses, it is important for them to know that service-learning experiences in an online course will be just as effective. This will grant future health-education specialists with impactful experiences, while also increasing their knowledge of health education core responsibilities.

Areas of Responsibility for Health Education and Service-Learning Initiatives

The National Commission for Health Education Credentialing (NCHEC) indicates 8 Areas of Responsibility of a Certified Health Education Specialist (CHES), and these responsibilities include: I. Assessment of needs and capacity II. Planning, III. Implementation, IV. Evaluation & Research, V. Advocacy, VI. Communication and VII. Leadership, and Management, VIII Ethics and Professionalism (NCHEC, 2020). Health-education faculty often use these CHES responsibilities as a foundation when it comes to assessing their course curriculum in preparing undergraduate and graduate healtheducation students in their programs. Service-learning in health education holds tremendous promise as a curricular strategy for preparing students for their roles as health professionals and changing the way faculty teach (Seifer, 1998).

Yet, some faculty still question this approach, because research, in general, is the domain of the academy; the service learning research agenda has been driven by academic concerns, not only about student learning but also about faculty perceptions of this pedagogy. Thus, the focal question has been, “Where’s the learning in service-learning?” (Cruz & Giles, 2000, p.28). The answer is: it takes a faculty member who has an interest in wanting to provide their students with such experiences to commit to taking the initiative to make it happen. Faculty will also need support from the administration of their university. Service-learning continues to develop as an integral component of higher-education curricula, with administrators embracing the positive impact that it can have on the communities involved. The higher-education environment, however, has changed in recent years (Klentzin & Wierzbowski-Kwiatkowak, 2013). Despite the varying approaches to course instruction (online, hybrid, face-to-face) in today’s society, service-learning should be a requirement in higher-education health-education programs. The academic benefits and enhanced social responsibility that students derive from service-learning, defined as experiential learning that ties community service to academic courses, have been well documented. However, Chamberlin (2015) concludes that for a college to fully institutionalize service learning, a high proportion of faculty need to include service-learning in their courses.

Faculty at the University of Arkansas at Little Rock in the health education and promotion degree program agreed to this importance and provided their online health-education students the opportunity to participate in a variety of community service-learning activities. With established partnerships with local community-based organizations, health professionals, and grant-funded projects, faculty have been able to provide excellent opportunities for service-learning, volunteerism, and professional experiences for their students. Another definition of service-learning states that it is a form of community-centered experiential education that places emerging health professionals in community-generated service projects and provides structured opportunities for reflection on the broader social, economic, and political contexts of health (Sabo et al., 2015). It moves students beyond cultural awareness toward the development of cultural competence that is grounded in both health education and in the realities and complexities of a multicultural community (Flannery & Ward, 1999). This cultural awareness is what faculty have realized to be of importance for health-education students, being exposed to diverse communities, while also gaining the importance of embracing cultural competence, which is very important for health-education specialists.

Application of Service-Learning in Health Education/Health Promotion

The literature on generalist student learning outcomes when they are engaged in service-learning projects include but are not limited to personal growth and leadership skills, a sense of personal and social responsibility, ability to apply theory to practice, enhanced critical-thinking skills, interpersonal and communication skills and finally enhanced cultural and racial understanding (Jacoby, 2015). Some of the salient student-learning outcomes when a service-learning approach is incorporated in health-education/promotion courses include: change in attitudes towards various health issues prevalent in the community (Rukavina, Li, & Rowell, 2008), promoting social and health advocacy (Wyatt, & Peterson, 2008), and building cultural competence (Housman et. al., 2012). Please see Fig 1 for the intersection of service-learning with diverse academic and interdisciplinary areas.

Examples of how Health Education Responsibilities are Enhanced for Health Education Students through Service-Learning Online Courses:

Online community health agency course. When enrolled in the online Community Health Agency course, students are required to complete 20 hours of community service at a health-related organization over the course of the 15-week semester. Students are provided a list of established partnerships of community health agencies who meet our course criteria in granting students an opportunity to complete service hours. Online health education students who live a greater distance from the University of Arkansas at Little Rock’s main campus, including those in other states, can complete their service hours at a health-related organization where they live upon approval from faculty. They are encouraged to complete their service hours at non-profit agencies similar to that of the American Heart Association. However, all students are open to select any agency that meets the criteria of the course requirements. Faculty are required to confirm the credibility of the placement. Students are also required to submit a contract to the faculty for approval before completing their hours.

For example, the University of Arkansas at Little Rock Children International is a non-profit program close to the University of Arkansas at Little Rock’s main campus that provides services to low-income families. Many students enrolled in the Community Health Agency course have been able to complete their service hours with Children International’s after school programs, personal health classes for children, and physical education programs, while also learning the professional roles and responsibilities of a health education specialist. Upon completion of their 20 hours of service, students are required to write multiple reflection papers that focus on their service-learning experiences. This reflection approach grants students the opportunity to reflect on their experiences. There is evidence to suggest that service-learning programs that thoroughly integrate service and academic learning through continuous reflection promote the development of knowledge, skills, and cognitive capacities necessary for students to deal effectively with the complex social issues that challenge citizens (Eyler, 2002).

Students are also encouraged to share a photo of themselves serving in the community and a brief description of their experience to the online course discussion board. This allows students the opportunity to learn about the various service -learning experiences of their peers and grants them the opportunity to learn about health agencies in different communities. According to Seifer (1998), students engaged in service-learning are expected not only to provide direct community service but also to learn about the context in which the service is provided, the connection between the service and their academic coursework, and their roles as citizens.

Online health education internship course. Academic programs can also engage students in the community given that they create a variety of experiential-learning opportunities for their students, for example, clinicals, internships, field experiences, practicums, and student teaching (Bringle & Hatcher, 1996). The following example illustrates this point: students enrolled in the online Health Education and Promotion 200-hour internship course are granted the opportunity to select an internship based on their interest, but it must meet the expectations of being a health-related organization. Students often complete their internships at various places, including but not limited to campus health services, hospitals, community-based and non-profit organizations, K-12 schools, medical research centers, and fitness-wellness centers. Formal and informal education about service-learning is important for site supervisors, directors of volunteer services, and agency directors (Bringle & Hatcher, 1996). Therefore, internship supervisors are informed about the expectations before they supervise a student. Students provide a copy of their internship packet to their internship supervisor upon their initial meeting. It details the expectations and responsibilities of the student and internship supervisor, includes a contract that must be signed by both the student and internship supervisor, and includes evaluation forms required to be completed near the completion of the internship. Both student and internship supervisor are instructed to email their evaluations directly to the faculty. This evaluation strategy grants both the student and internship supervisor the opportunity to rate each other.

The internship supervisor indicates which of the 8 Areas of Responsibility of a Certified Health Education Specialist the student achieved and or was exposed to during the internship. The faculty then uses this information for assessment purposes for the program. Students in return evaluate if their internship supervisor and overall experience were beneficial to them and confirm whether the placement would be suitable for future health-education interns. A month before a semester concludes, the faculty, student, and internship supervisor convene in person at the internship placement, a conference call, and/or engage in an interactive virtual meeting such as FaceTime or Skype. This approach allows for the faculty, student, and internship supervisor to converse about the student’s experience and progress regarding the internship. However, the most common methods of measuring service-learning outcomes are self-administered scales where students report what they have learned in a service-learning experience (McGorry, 2012; Yin, 2009). Thereby, students before the conclusion of the semester are required to compile a written report and prepare a PowerPoint presentation highlighting their overall internship experience. All students are required to post their presentations to the discussion board. Students who live close to the University of Arkansas at Little Rock’s main campus are invited to present in person, and those who are not close to campus are required to video record their presentations or voice narrate their PowerPoint presentation before posting it to the online discussion board.

Faculty grant-funded service projects. Another approach that has contributed to increasing participation of service for the University of Arkansas at Little Rock online health education students is granting them opportunities to get involved in service-learning through faculty grant-funded projects. Given that a large portion of the online health education students enrolled in the online health education and promotion program live in Little Rock, students with limited distance to the campus have the benefits of being granted the opportunity to engage with classmates and faculty in serving their community.

For example, on behalf of health education and promotion faculty the University of Arkansas of Little Rock was awarded an Arkansas Coalition for Obesity Prevention grant, which funded projects that were designed to help increase access to healthy foods and increase physical activity to help combat obesity. Faculty granted online health education students the opportunity to work on various growing healthy communities’ projects, which focused on growing a healthier university district community (comprising neighborhoods near the University of Arkansas main campus). Health education students, as well as nursing students, have volunteered for annual campus community wellness fairs, farmers markets, delivering and setting up raised bed gardens to area residents, and taking on the role of a health education specialist in educating the community about health-promoting behaviors like healthy eating, and the importance and benefits of regular physical activity. For faculty, service-learning methods can lead to increased student-teacher reciprocity, address a variety of student learning styles, promote community-engaged research and lead to new collaborations for research and publication, provide students with real-world experiences, and enhance course discussions and scholarly discourse by connecting theory and practice in a meaningful, relevant way (Hall & Pelco, 2015).

Role of Service-learning Pedagogy- Interdisciplinary Teaching and Learning Tool

The above examples delineate the role of service-learning as a course-based tool, a field-experience tool, and a faculty application-based tool. Service-learning is an effective pedagogical tool, which transcends specific fields and can be jointly used as an “interdisciplinary” teaching and learning tool in fields of engineering and health (Najem et al., 2019), social work and law (Boys, Quiring, Harris, & Hagan, 2015), and nursing and dental hygiene (Allen, Gunaldo & Schwartz, 2019) or to implement team-based learning in remote places (Craig, Phillips, & Hall, 2016).

Implications for Practice for Health Education Specialists

Service-learning often benefits five important stakeholders: students, faculty, academic institutions, community organizations, and community members (Seifer, 1998). Given the popularity of online education today and its potential future, faculty who teach online or will eventually teach online should strive to incorporate service-learning activities into their online health-education courses. E-service learning (Strait & Nordyke, 2015), which is a comparatively newer area in the field of service-learning, has a potential of taking various turns and advancements in future areas. Three areas are: a) pedagogy: having more technology integrated into the course work in terms of group work, media-based presentations, asynchronous and synchronous 3-way communications between community partners, faculty, and students and generation of richer student narratives of their experiences. There is also a potential for having a model where both the service and the instruction for this course that could happen online. In terms of b) scholarship: richer contextual and qualitative and quantitative data about student learning outcomes and experiences can enhance scholarship. Finally, c) service: Opportunities to develop a future workforce with civic, leadership, communication, and strong value-based skills can develop.

Faculty who use service-learning often discover that it brings new life to the classroom, enhances performance on traditional measures of learning, increases student interest in the subject, teaches new problem-solving skills, and makes teaching more enjoyable (Bringle & Hatcher,1996). Service-learning practitioners must begin to explore the design of effective and sustainable university/community partnerships and how to optimize the intersection between online learning and service-learning (Waldner, McGorry & Widener, 2010). Furthermore, the impact of this strategy globally deals with developing engaged citizenship, cross-cultural understanding of health and ethical issues and engagement in research across international boundaries (Howard, Rao & Desmond, 2010; additional skills such as teamwork and communication are built inherently as well (Zhang, et al., 2011). Future health-education specialists would greatly benefit from such skills and experiences as well as the communities in which they serve.

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