|ORIGINAL RESEARCH PAPER
|Year : 2012 | Volume
| Issue : 1 | Page : 4-10
Teaching Women's Health from a Public Health Perspective: Development of an Innovative Undergraduate Course
CA Vamos1, AR Richman2, S Noel-Thomas3, EM Daley1
1 Department of Community and Family Health, Center for Transdisciplinary Research in Women’s Health (CTR-WH), College of Public Health, University of South Florida, USA
2 Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, USA
3 Department of Health Education and Promotion, College of Public Health and Health Professions, University of Florida, USA
|Date of Submission||24-Oct-2010|
|Date of Revision||11-Apr-2012|
|Date of Acceptance||19-Apr-2012|
|Date of Web Publication||30-Jul-2012|
C A Vamos
Research Assistant Professor, Department of Community and Family Health, Associate Director, Center for Transdisciplinary Research in Women’s Health (CTR-WH), College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, FL 33612,
Source of Support: None, Conflict of Interest: None
Introduction: A review of women's health courses across academic disciplines revealed gaps in addressing the full range of issues that impact women throughout the lifespan. Methods: We designed an undergraduate course in women's health that is taught from a public health perspective, but includes a multidisciplinary approach that addresses health issues across the lifespan. Details related to syllabi, curriculum development, and course delivery are reviewed. Results: Curriculum and topics were developed by reviewing existing women's health courses and identifying strengths and gaps. Course readings are drawn from a textbook, peer-reviewed scientific literature, news/media articles, and popular press. Classes included a mix of lectures, class/group discussions, group activities, videos and/or short media clips, student presentations (individual and group), and invited guest speakers. Of special interest are the innovative and varied student assessments that this course offers and the breadth of knowledge and critical skills that students acquire. Discussion: Although the particular health topics women face may vary by geographic location, the theoretical underpinnings and lifespan approach will stay the same. Students learn health literacy and critical appraisal skills, appreciate the many dimensions of health, and recognize diverse antecedent factors and disparities that influence health. Utilizing this type of course structure, coupled with innovative and flexible student assignments, would be applicable to other courses in any country or setting such as men's, population, or mental health. The presented framework and experiences can facilitate college health professionals in future course development activities and assist in enabling students to be informed health advocates.
Keywords: Health education, public health, undergraduate, women′s health
|How to cite this article:|
Vamos C A, Richman A R, Noel-Thomas S, Daley E M. Teaching Women's Health from a Public Health Perspective: Development of an Innovative Undergraduate Course. Educ Health 2012;25:4-10
|How to cite this URL:|
Vamos C A, Richman A R, Noel-Thomas S, Daley E M. Teaching Women's Health from a Public Health Perspective: Development of an Innovative Undergraduate Course. Educ Health [serial online] 2012 [cited 2020 May 26];25:4-10. Available from: http://www.educationforhealth.net/text.asp?2012/25/1/4/99192
| Introduction|| |
Despite considerable attention to women's health since the Women's Health Initiative in 1991,  women's health courses have not been uniformly incorporated into curricula at schools of public health in the United States at the undergraduate and graduate levels. Additionally, as the number of free-standing maternal and child health departments in U.S. accredited schools of public health now dwindles to one, it becomes even more important that women's health curricula are not lost.
Women's Health Defined
Employing a global perspective, The United Nations Population Fund  defines women's health as the following:
Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Women's health involves their emotional, social and physical well-being and is determined by the social, political and economic context of their lives, as well as by biology (paragraph 89).
As included in the United Nation's definition, women's health from a global perspective is very much dependent on social, political, and economic environments. In countries where women are disadvantaged, discriminated against, and lack power within society, they also experience poorer health and a higher burden of disability, disease, and death. Other factors associated with poverty, violence, low education and employment rates, and women being reduced to their reproductive functions further exacerbate ill health. 
According to the Office of Women's Health at the Centers for Disease Control and Prevention,  women's health involves all functions related to mental and physical wellness from puberty through the elder years. Based on this holistic view of women's health, it is important that women's health courses address health across the lifespan.
Why Women's Health is Important
In the U.S., women comprise approximately 51% of the total population.  In 2007, women comprised 46% of the total workforce and are projected to account for 47% of the workforce by 2016.  Despite these advances and contributions that women make to society, women tend to experience greater barriers to optimal health. Poor women are at even greater risk for negative health outcomes. Davis and Brandt  noted that women are more likely to have lower incomes than men, utilize more health care services, have higher out-of-pocket costs, and as a result, are more likely to avoid necessary care. Women also have higher levels of morbidity, suffer from more chronic conditions, and experience greater disability than men. Moreover, women live approximately 5 years longer than men,  thus necessitating awareness of the multidimensional nature of health issues that women experience across their lifespan. 
The importance of women's health is also evident in the differential health outcomes experienced by women. Women are more likely to die from heart attacks than men (42% vs. 21%, respectively); and after age 75, the rates of cardiovascular disease (CVD) are higher among women.  Even though heart disease is the leading cause of death among women, the symptoms are often overlooked. In addition, while the leading cause of cancer deaths for women is lung cancer, medical professionals are less likely to offer smoking cessation information to women,  and one study found that only 8% of physicians knew that more women die from CVD each year compared to men.  Since many research studies either excluded women or retained an under-representation of women, less is known about the different ways in which diseases may be manifested in women. In fact, much of the care that women currently receive is based on research on men. 
Why a Public Health Perspective is Needed
According to the Institute of Medicine,  the mission of public health is to fulfill society's interest in assuring conditions in which people can be healthy. Other core values of public health include health promotion and disease prevention and a commitment to reducing suffering and improving the quality of life.  These values should naturally translate into the curricula and courses offered within schools of public health.
Teaching women's health is even more important in the current uncertainties of the healthcare and economic environments in the U.S. Despite advances in public health and medicine that have created improvements in disease prevention, diagnosis, and treatment, women still experience disparities in healthcare access. Moreover, women face significant challenges in obtaining and maintaining good health and quality of life, both in the U.S. and globally.  Public health students should be aware of these issues and prepared to face these challenges upon entering the workforce.
In response to the importance of providing women's health education within public health, we developed an undergraduate women's health course from a public health perspective, applying a holistic approach to women's health across the lifespan. The purpose of this article is to describe the development of the undergraduate women's health course.
| Methods|| |
The course was developed in an accredited College of Public Health situated in a large public university in a southeastern region of the U.S. Established in 1984, the College of Public Health offers bachelor's, master's, and doctoral degrees, along with several dual degrees and graduate certificates, with courses including traditional classroom and distance-learning (online) formats. In total, approximately 3,000 public health professions (master's, doctoral, and graduate certificates) and 300 undergraduates (public health minors) have graduated through the college. Due to the college's success in offering several undergraduate classes and a public health minor, the first undergraduate (bachelor's) degree in public health in the state was offered in 2010. The undergraduate course described in this paper was first introduced in 2006, with course development occurring the year before implementation. The course is offered about two semesters per year and includes approximately 45 students per class.
In an effort to understand existing curricula on women's health, we retrieved and reviewed undergraduate women's health syllabi that were posted online from various U.S. postsecondary institutions. Reviewing syllabi assisted in identifying overall strengths and weaknesses in other women's health courses from a variety of disciplines. For instance, curriculum identified was often framed from an isolated discipline depending on where that course was taught (e.g., medicine). Such an isolated philosophy and lens restricted the multidimensional underpinning of the factors influencing health and was reflected both through the scope and how the content was covered (i.e., pain management in childbirth). This exercise also provided us with an understanding of the range of women's health topics that were currently being addressed, as well as demonstrating the gaps in course instruction (i.e., women in the workforce, mental health). Upon completing a comprehensive review of existing courses, we generated a list of topics for the proposed course, which was reviewed by six women's health experts. These experts had experience in academia, community, and practice-based settings, as well as teaching portfolios in population and demography, reproductive health, and adolescent health. Furthermore, the disciplines from the academic experts were diverse (i.e., public health, medicine, nursing, women's studies, and anthropology). Revisions to the curriculum based on input from the experts included adding separate topics on women with disabilities and women's health from a global perspective. Moreover, input from the experts underscored the importance of having an element of a "field experience" assignment where students are required to interact with professionals in the field who are working on women's health issues.
We examined a total of eight textbooks from a variety of publishers, disciplines, (e.g., medicine, nursing, and social sciences), and academic levels (undergraduate versus graduate). After a thorough review, one textbook was identified as being a good match for this course and thus was selected as a required textbook. We retrieved additional readings from peer-reviewed journal articles to engage students in primary scientific literature as well as news and other media sources. Articles posted online and in popular press (i.e., New York Times, Glamour Magazine, Cosmopolitan Magazine, and local newspapers) were incorporated into course readings to highlight local, national, and international women's health stories, to examine current topics presented in the media and to appraise what was being portrayed in the popular press regarding women's health matters.
| Results|| |
As mentioned above, the philosophical underpinnings of this course are rooted both within a public health perspective and the multidimensional, multidisciplinary, and holistic nature of women's health. We have provided a conceptual diagram of this multidimensional approach to women's health [Figure 1].
|Figure 1: Conceptual framework of a public health perspective to women's health|
Click here to view
Keeping these philosophical underpinnings in mind, we developed the following course description:
The female population has special needs and concerns that merit study. However, within the female population itself, diversity of women's health exists as women come in different colors, shapes, sizes, and predispositions. In addition, women are exposed to epidemiological, historical, psychosocial, cultural, legal, political, and economic influences. This course will provide the student with an overview of women's health across the lifespan. From a public health perspective, this course will explore the multidimensional and multidisciplinary dimensions of women's health, which include physical, mental, social, intellectual, and spiritual aspects. The course will also emphasize health promotion, disease prevention, and overall well-being. The focus of the course will be to provide the student with the tools and techniques to make informed decisions about their own health and lives. Men and women will leave this class with an understanding of the diversity that exists within women's health, and will possess the knowledge to become stronger women's health advocates.
The course objectives articulated the actions and outcomes that students are expected to perform as a result of taking this course, and included students' being able to identify women's health issues throughout the lifespan, explain factors influencing "women's wellness", and understand population-based approaches to the assessment of women's health issues.
The topics presented in this course each semester are provided in [Table 1]. However, it should be noted that topical areas are flexible and often dependent upon students' interests and topics that students choose for class presentation assignments. In addition, because other undergraduate public health courses taught within the same institution also cover similar topics and some but not all students take more than one of these courses, it was important to review such topics from a women's health perspective.
|Table 1: List of lecture topics covered in the undergraduate women's health course|
Click here to view
Classes included a mix of lectures, class/group discussions, group activities, videos and/or short media clips, student presentations (individual and group), and invited guest speakers. PowerPoint slides were utilized in the course; however, they were not the main focus. PowerPoint slides included with the instructor's copy of the textbook were used as a template for lectures and provided a foundation for discussions, but were adapted and modified to fit the scope and aims of this course as well as the instructor's teaching style.
Guest speakers were invited to assist in extending content outside of the classroom, to provide an example of research-to-practice and/or practical experiences in the field and to provide a voice to various pertinent women's health issues. For instance, a nutritionist, a sexual health educator, a midwife, and a lecturer on global reproductive health were popular invited guest speakers that received positive responses from students. Moreover, several short in-class participation activities were also delivered throughout the course to ensure interactivity between students and the instructor and to provide a constructive learning environment where students could apply content learned.
The original student assessments for this undergraduate course consisted of three exams, a group project, a critical website review project, a lifespan project, and an attendance/class participation grade. Although this course was developed and implemented in a traditional "in-classroom" format, we were aware of the various public health courses that were available online and of the pressures institutions experience in meeting the evolving technological needs of online learners. Thus, during the development of this course, efforts were made to develop assessments that could be transferable to an online format in future semesters.
The composition of the student assessments has remained intact since development; however, certain assignments, such as the group project and the lifespan project, have taken various forms. One version of the group project consisted of student groups identifying a women's health issue, which could take any form of the holistic definition of "health" and did not necessarily have to be the identification of a medical disease or condition (i.e., female sex workers). Groups were instructed to research and present information on their chosen topic via a group poster and presentation that was to be delivered to the class. A second version of the group project consisted of group debates in which two groups were assigned a different controversial women's health issue, with one of the group pairs assigned to discuss and argue "for" or "against" the topic, respectively. Regardless of which version of the group project was employed that semester, groups were to prepare and reference the following criteria: definition of issue, implications of issue for women throughout the lifespan, current studies/controversies surrounding the issue, presence of health disparities, social, economic, and political implications, and synopsis of interview conducted with local/state/national/international agency that provides hand-on technical or practical support for the issue.
The lifespan project  also took various forms with the product consisting of a women's health calendar or encyclopedia, depending on the size of the class and student preferences. Regardless of the chosen format, students were to choose one lifecycle stage and identify and classify health issues that are prevalent during that stage according to the seven dimensions of health: physical, emotional and psychological, intellectual, spiritual, social and interpersonal, environmental, and occupational.  In addition, students were to identify health disparities and present any political, legal, economic, and cultural implications that were relevant for each health issue identified.
With the abundance of online media and the increasing popularity of health consumers researching health topics through this medium, a critical website review assignment was incorporated into the course. This assignment required students to research and report on websites that they deemed as being "credible" and "not credible" for a chosen women's health topic. Such critical assessment allowed students to practice hands-on skills of evaluating the credibility of online information and to discriminate between various criteria that can assist them in being educated health consumers.
Course evaluations were conducted formally and informally (designed by the instructors). Student feedback was very positive, with repeated expressions by students of their thorough enjoyment of the course and their appreciation of the range and diversity of the topics that were often not included in other health-related courses that they had taken. In addition, students appreciated the flexibility of the course and the emphasis of the various epidemiological, historical, psychosocial, cultural, political, legal, and economic factors, which advanced their knowledge on basic health-related facts. Perhaps of greatest significance was students' acknowledgement of how they themselves felt informed and equipped with the necessary tools to advocate for women's health.
| Discussion|| |
Public health by its very nature is a multidimensional discipline that is particularly well-suited for a course such as women's health. For example, the first three lectures of this course present students with the definition and overview of women's health from a public health perspective, including such topics as wellness, health promotion, disease prevention, and data-driven and population-based research, as well as the overarching model of the lifespan approach. Furthermore, this women's health course embraced the overlapping issues presented in our conceptual framework of women's health from a public health perspective.
The course provided students with the tools and techniques required to make informed decisions about their own health and lives as well as other populations in which they may serve in future years through public health careers. For instance, the topics covered in the course as well as the projects and assignments facilitated skills needed to critically collect, examine, and apply women's information to various health topics (i.e., lifespan project and critical website review assignment). Such tools and techniques applied in the course are congruent with a health literacy approach, which identifies the following domains deemed necessary for individuals to be active participants in health: access (accessing information/resources/services), comprehend (understanding the multifactorial nature of health behaviors and outcomes), evaluate (critically analyzing information according to particular contexts), and communicate (effective interacting with individuals, institutions, and systems to be informed health consumers and agents). 
Over the past few years, this course was successfully developed, implemented, sustained, and instituted into the academic catalogue. In addition, the course has undergone the standard confidential course and instructor evaluations that include general items that are anonymous. Thus, course evaluations by students' age, gender, and discipline major/minor could not be assessed. Therefore, future efforts that the course developers are instituting specific to this course include a new dynamic system of student evaluations. Such evaluations will be based on self-reflection and the application of knowledge and skills learned. For instance, at the beginning of the semester a formative evaluation will be administered to elicit information regarding students' existing knowledge, what they hope to learn and other gaps which the course may fulfill. Midway through the semester, a process evaluation will be administered, where students will identify whether learning modalities are facilitating their understanding of women's health issues. At the end of the semester, a metacognitive evaluation will be administered to assess how students have integrated knowledge and skills learned from the course into individual behaviors/actions. Examples of evaluation items at the end of the semester include the following: 1) What concrete knowledge and skill(s) have you learned in this class? Consider these both from a personal standpoint and from a women's health advocacy standpoint; 2) Develop your own personal health plan based on the seven dimensions of health; 3) How will you continue learning on your own?; and 4) A women's health issue that I'm concerned about or think about a lot since taking this course is [Fill in the blank].  Methods for the evaluations will include short surveys, group exercises, and written reflections.
Several limitations were inherent when developing this new academic course. For instance, only those syllabi that were publicly available on the internet were identified and reviewed. Unfortunately, curricula from other countries were not identified during our curricula review process. However, an international perspective is woven into many of the topics covered throughout the course, in addition to the specific Women's Health from a Global Perspective unit/topic. Several topics such as contraception, sexually transmitted diseases, and pregnancy are also included in other undergraduate public health courses offered by the institution; therefore, it was important to minimize curriculum duplication while maximizing the unique dimension and perspective to these topics from a women's health across the lifespan perspective. Moreover, only a short-term evaluation of the course is implemented as characteristic to academic course evaluations; thus, the long-term impact of this course on the professional and personal health attainment of students was not evaluated.
Various lessons learned were revealed during the course development and implementation processes. For instance, new innovative and effective courses must fill a gap in the current curriculum subject program, be reflective of emerging research, needs, and trends in practice and truly embrace multidisciplinary underpinnings to facilitate critical discourse of important topics that affect the health of women and families across the globe. Moreover, effective public health courses focused on controversial topics necessitate a reciprocal learning and respect between instructors and students - a teaching philosophy that nurtures students as both active learners and teachers.
Similar to the dynamic nature of women's health, this course continually evolves with the changing politics, medical advances, emerging research, economic challenges, and changing demographics. However, because the initial approach to course development was from a public health perspective, such modifications to the course are both welcomed and easily integrated. There is a need for women's health education within public health. Schools of public health and other comparable disciplines can use our course development experiences and perspectives as a guide to develop similar courses.
This course was developed in the U.S.; however, our experience is applicable to any country or setting. The principles of this course are compatible with global initiatives, such as The Network: Towards Unity for Health Women and Health Taskforce (WHTF),  that strive to improve women's health. For instance, the WHTF objectives include "teaching health providers the skills and knowledge necessary to improve care to women, encouraging universities to partner with community women's groups, promoting the inclusion of women's rights and gender issues in curricula, and cultivating leadership among female health professions students."  These elements reflect the importance of academic-community partnerships, a rights-based approach to women's health and gender empowerment - elements which are often absent in courses that lack a multidisciplinary, holistic, skill-based, and action-oriented perspective.
In conclusion, the development of this course presented a unique challenge of providing a comprehensive and holistic approach to this important area of study. The review of existing women's health courses in other disciplines showed the breadth of approaches and topics that are offered - and provided a variety of examples of how women's health is multidisciplinary in its scope of topics. Conducting this review reinforced the importance of a population-based, comprehensive approach to a women's health course, and influenced our decision to use a lifespan approach. Utilizing this type of course structure, coupled with innovative and flexible student assignments, would be applicable to other courses such as men's health, reproductive issues, or mental health. Women's health can and should be taught in a variety of disciplines. Moreover, to be truly inclusive, a transdisciplinary approach, where paradigms from multiple disciplines are synthesized and a new framework emerges, including the recognition of social, economic, and political structures is needed to critically examine women's health.  A public health approach provides additional richness to this field of study. Our framework and experience is offered to help college health professionals and practitioners in their own course development and assist in enabling students to gain the knowledge and skills needed to fully understand the range of issues encompassed within women's health.
| References|| |
|1.||National Institutes of Health, Department of Health and Human Services. The Women's Health Initiative. Retrieved September 16, 2010, from http://www.nhlbi.nih.gov/whi. |
|2.||United Nations Population Fund. Summary of the ICPD Programme of Action. 1995. Retrieved from http://www.vrouwen.net/vweb/wcw/contents.html |
|3.||World Health Organization. Women's health. Retrieved September 16, 2010, from http://www.who.int/topics/womens_health/en/. |
|4.||Centers for Disease Control and Prevention. CDC/ATSDR Office of Women's Health. Retrieved September 18, 2010, from http://www.cdc.gov/women/about/. |
|5.||U.S. Census Bureau. Women and men in the United States, March 2002. Retrieved September 18, 2010, from http://www.census.gov/prod/2003pubs/p20-544.pdf |
|6.||U.S. Department of Labor. Quick stats 2007. 2008. Retrieved from http://www.dol.gov/wb/factsheets/Qf-laborforce-07.htm |
|7.||Davis K, Brandt EN. Health policy and women's health: Current status and future priorities. 2008. Retrieved from http://www.jiwh.org/attachments/Davis_BrandtGWU_11-12-08v2.pdf |
|8.||National Center for Health Statistics. Health, United States, 2006: With chartbook trends in the health of the Americans. 2006. Retrieved September 19, 2010, from http://www.cdc.gov/nchs/data/hus/hus06.pdf#027. |
|9.||Vamos CA, Vamos SD. Dimensions of women's health across the lifespan. American Journal of Health Education. 2008; 39:370-373. |
|10.||Alexander LL, LaRosa JH, Bader H, Garfield S. New dimensions in women's health. Sadbury, MA: Jones and Bartlett; 2007. |
|11.||Palley ML, Palley HA. Rethinking a women's health care agenda. Women & Politics. 2000; 21(3):75-99. |
|12.||Mosca L, Linfante AH, Benjamin EJ, Berra K, Hayes SN, Walsh BW, Fabunmi RP, Kwan J, Mills T, Simpson SL. National study of physician awareness and adherence to cardiovascular disease prevention guidelines. Circulation. 2005; 111(4):499-510. |
|13.||Sinclair BP. Women and the health care system. In: Youngkin E, Szmania Davis M, editors. Women's health: A primary care clinical guide. 3 rd ed. Upper Saddle River, New Jersey: Pearson Prentice Hall; 2004. p. 3-37. |
|14.||Institute of Medicine. The future of public health. 1988. Retrieved September 15, 2010, from http://www.iom.edu/Reports/1988/The-Future-of-Public-Health.aspx. |
|15.||American Public Health Association. What is public health? Our commitment of safe, healthy communities. Retrieved September 18, 2010, from http://www.apha.org/NR/rdonlyres/C57478B8-8682-4347-8DDF-A1E24E82B919/0/what_is_PH_May1_Final.pdf. |
|16.||Bennett T. Women's health: The right to life. Women's Health Issues. 2004; 14(4):115-117. |
|17.||Wisotzki N. Fitness and lifestyle management for law enforcement. 3 rd ed. Toronto, ON: Emond Montgomery Publications Limited; 2008. |
|18.||Rootman I, Gordon-El-Bihbet D. A vision for a health literate Canada: Report on the Expert Panel on Health Literacy. Ottawa, ON: Canadian Public Health Association; 2008. |
|19.||Silberman M. Teaching actively: Eight steps and 32 strategies to spark learning in any classroom. Boston, MA: Pearson Education, Inc.; 2006. |
|20.||Gonzalez de Leon D, Lewis J. Experiences of the Network: Towards Unity for Health Women and Health Taskforce. Education for Health. 2009; 22(2):274. Retrieved in 2009 from: http://www.educationforhealth.net/articles/subviewnew.asp?ArticleID=274 |
|21.||Rosenfield PL. The potential of transdisciplinary research for sustaining and extending linkages between health and social sciences. Social Science & Medicine. 1992; 35(11):1343-1357. |