Education for Health

ORIGINAL RESEARCH ARTICLE
Year
: 2016  |  Volume : 29  |  Issue : 1  |  Page : 30--34

EpiAssist: Service-learning in public health education


Jennifer A Horney1, Sanjana Bamrara1, Maria Lazo Macik2, Melissa Shehane3,  
1 Department of Epidemiology and Biostatistics, Texas A and M University Health Science Center School of Public Health, College Station, USA
2 Center for Teaching Excellence, Texas A and M University, College Station, USA
3 Department of Student Activities, Texas A and M University, College Station, USA

Correspondence Address:
Jennifer A Horney
Department of Epidemiology and Biostatistics, Texas A and M University Health Science Center School of Public Health, 1266 TAMU, College Station, TX 77843
USA

Abstract

Background: Although public health degree programs typically require practica and other field experiences, service-learning courses, with a focus on civic engagement and the application of classroom learning in real world settings, can go beyond these requirements and provide benefits to students and community-based practice partners. The goal of this paper is to assess potential benefits of service-learning programs for both graduate-level public health students and state and local public health agency partners. Methods: EpiAssist is a new service-learning program developed at the School of Public Health of the Texas A and M University Health Science Center, USA, in January 2015. EpiAssist was integrated into a new course, Methods in Field Epidemiology. The integration of service-learning was guided by a partnership with the Texas A and M Center for Teaching Excellence. Results: State, regional, and local public health partners requested EpiAssist via email or telephone. A listserv was used to recruit student volunteers to meet requests. 54 of 86 registered EpiAssist students (63%) participated in at least one of ten service-learning and three training activities between January and June, 2015. Service-learning activities included questionnaire development, in-person and telephone data collection, and data analysis. Training topics for students included the Epi Info software, community assessment and communicable disease reporting. Students and partner organizations provided generally positive assessments of this service learning program through an online evaluation. Discussion: Service-learning provides students with enhanced classroom learning through applied public health experience in state, regional and local health departments. These experiences provide both needed surge capacity to public health departments and valuable hands-on field experience to students.



How to cite this article:
Horney JA, Bamrara S, Macik ML, Shehane M. EpiAssist: Service-learning in public health education.Educ Health 2016;29:30-34


How to cite this URL:
Horney JA, Bamrara S, Macik ML, Shehane M. EpiAssist: Service-learning in public health education. Educ Health [serial online] 2016 [cited 2020 Aug 10 ];29:30-34
Available from: http://www.educationforhealth.net/text.asp?2016/29/1/30/178925


Full Text

 Background



Students at accredited U.S. Schools of Public Health (SPHs) are required to complete internships, practica or field experiences as part of their graduation requirements. While many SPHs also offer students the opportunity to participate in student epidemiology surge capacity programs known as Graduate Student Epidemiology Response Programs (GSERPS), most of these programs' activities are ad hoc in nature and requests for assistance cannot be predicted.[1] GSERPS tend not to be integrated into the curriculum of any course and could more accurately be described as field experience rather than service-learning.[2] Unlike required internships, practica and field experiences such as GSERPS, service-learning emphasizes reciprocity, promoting a balance between meeting the needs of the community and those of learners. More specifically, service-learning is defined as “a form of experiential education in which students engage in activities that address human and community needs, together with structured opportunities for reflection designed to achieve desired learning outcomes” (pp. 1-2).[3] Researchers have emphasized the importance of service-learning to the field of public health as well as suggested ways that it can be incorporated into public health education.[4] However, the additional benefits that may accrue to both students and organizations from service-learning in public health need further evaluation and assessment to quantify.

Published research on the use of service-learning in medical and nursing schools has demonstrated that the integration of service-learning into curricula has benefits to students that complement more traditional classes.[5],[6] In addition to the benefit to students, service-learning can also strengthen relationships between universities and local agencies and communities.[7] Partnerships between practice-based university courses and local communities can be productive arrangements that can accomplish mutual goals, marry teaching with research and service, and facilitate linkages in all directions.[8]

EpiAssist is a service-learning program that began in January2015 at the Texas A and M University Health Science Center School of Public Health, in the southern U.S. EpiAssist gives enrolled public health students the opportunity to work with local, regional and state public health staff on applied public health projects. While EpiAssist is open to all students enrolled in the School of Public Health, participation is a required element of a new course, Methods in Field Epidemiology. This course teaches applied epidemiology skills such as public health surveillance and outbreak investigation. In partnership with the instructor, community partners from local, regional, and state public health agencies provide students with both classroom-based learning (e.g. lectures and demonstrations) as well as service-learning and training opportunities with their agencies on applied epidemiology projects. By engaging students with local public health agencies to work on needs that are community identified, EpiAssist also encourages students to recognize the value of locally-generated knowledge, and agencies to come away more empowered to address their own needs.

Service-learning programs like EpiAssist are an example of collaboration between academia and public health practice and a potential recruitment strategy. Numerous reports by national groups, including the Association of State and Territorial Health Officers and the National Association of County and City Health Officials, have described the current shortage and uncertain future of the public health workforce in the U.S.[9],[10] Severe shortages in certain public health fields, including epidemiology, continue at the federal, state, and local level in the U.S. Recent state budget reductions have likely intensified these problems. Globally, the public health workforce shortage is perhaps even more serious: The World Health Organization anticipates a worldwide shortage of nearly 13 million public health workers by 2035.[11] Helping to address the public health workforce shortage – both in the short-term through service-learning projects that support unmet public health needs and in the long-term by potentially funneling students into applied public health careers –mutually benefits students, local agencies and communities.[9],[10] This study aims to document some of these benefits by evaluating the impact of a new epidemiology service-learning program on both student volunteers and partner agencies.

 Methods



Methods in Field Epidemiology was developed and taught in the spring 2015 semester. It is offered to public health graduate students (who have previously completed four-year undergraduate college degrees) who have completed the introductory epidemiology methods and biostatistics courses, typically during their second or fourth semester of enrollment. The course syllabus was designed using a rubric that incorporated elements specific to service-learning instruction.[3] Such syllabus elements include a rationale for service-learning, clear expectations about the service experience, explicit connection between the course content and service activities, and structured opportunities for reflection. The course integrates didactic lectures with five individual case studies, two group projects, and a midterm and final project simulating the workings of an outbreak investigation team. In-class activities, such as critiquing outbreak investigation questionnaires, are included in most class sessions to ensure learner engagement. One of the 14, three-hour class sessions was led by public health practitioners and focused on field data collection and analysis using the U.S. Center for Disease Control and Prevention's Community Assessment for Public Health Emergency Response (CASPER) method.

Student recruitment

Concurrent with the development of the course, a website and online registration form were developed for students to register for EpiAssist. An email was sent to all students enrolled at the SPH in January 2015 making them aware of the opportunity to sign up. A listserv was developed using Google Groups and messages were sent to EpiAssist students when requests were received from community partners.

Partner recruitment

The recruitment of community partners included both formal and informal approaches. Formal recruitment included the development and mailing of an informational letter with a promotional magnet and a presentation on a conference call of local and regional epidemiologists. Informal recruitment included various personal contacts (e.g. email, telephone, in-person networking) between the EpiAssist advisor and potential partners.

Evaluation of EpiAssist

Upon completion of each EpiAssist project, participating students and partners received an email request to complete a brief online evaluation survey. The survey was administered via Qualtrics ® survey software (Provo, UT). Non-respondents were contacted with a follow-up email reminder. The student survey collected data on the total number of hours spent on the activity, the types of activities completed (e.g. data collection, data analysis, questionnaire design, surveillance, interviews), how much the activity improved students' ability to do various field epidemiology tasks, ways in which the activity augmented classroom training, classroom skills that were applied to the activity, and new skills that were learned as part of the activity. Students were also asked about barriers encountered as well as areas for improvement.

The partner survey included questions related to the activities performed by students, partner satisfaction with process and outcome measures, potential future need for assistance, and how effective EpiAssist was at meeting goals related to partnership building, meeting partner needs, providing students with applied experience and training, and helping students develop professional networks.

This research was determined to be exempt by the Texas A and M University of Institutional Review Board (2014-0785).

 Results



Descriptive results

Eighty-six SPH students signed up for EpiAssist during the spring 2015 semester, including 19 students enrolled in the Methods in Field Epidemiology course and 67 other students. Fifty-four of 86 registered students (63%) participated in at least one of ten service-learning activities and three trainings offered during the semester to augment classroom content, for a total of 850 hours of service-learning activities and 220 hours of training [Table 1].{Table 1}

EpiAssist students represented each of the School's four departments [Table 2]. About half had language skills beyond English, most had statistical software skills, and most had public health professional experience.{Table 2}

Student evaluation results

Thirty of 54 students who participated in one of the 10 service-learning activities completed the student evaluation survey (56%). The most frequent activities completed by the students were interviews (n = 21), document preparation (n = 8), and surveillance (n = 8). In terms of learning, 26 students indicated that the EpiAssist activity augmented their classroom trainings, 24 reported applying classroom skills to their EpiAssist work, and 27 reported learning new skills. EpiAssist students felt that the program was effective at meeting its goals of 1) providing insight into applied public health (n = 26); 2) sparking an interest in a career in applied public health (n = 24); and 3) making contacts useful for future employment (n = 21) [Table 3]. A follow-up qualitative study to track graduating students' job placements is planned. Eight students reported barriers, with 7 of 8 mentioning low response rates when conducting interviews. The most frequently suggested improvement to EpiAssist activities was having an opportunity to participate in other aspects of the project beyond data collection (n = 16).{Table 3}

Partner evaluation results

Nine partner surveys were completed for the 10 service-learning activities (90%). All respondents indicated that they would request assistance from EpiAssist in the future. Most partners reported being very satisfied with the seven process and outcome measures, with an overall mean of 3.94 out of a possible 4.00, where 1 was unsatisfied and 4 was very satisfied. In addition, all respondents felt that EpiAssist met each of its four goals – (1) Creating effective partnerships between SPH and health departments; (2) supplying needed surge capacity; (3) providing students with applied public health experience; and (4) helping students develop professional networks in public health practice.

 Discussion



The EpiAssist service-learning program showed positive evidence of meeting its goals for both students and community partners at Texas A and M University. According to student evaluations, expanded service-learning opportunities through EpiAssist were an important way to enhance their academic experiences. According to partners, EpiAssist also helped establish and strengthen collaboration between students and faculty and public health practitioners, while at the same time, addressing unmet needs in the community. This supports previously published findings on the impact of GSERP programs on participants' choice of a career in applied or governmental public health and highlights the potential impact that service-learning programs can have on the training of the future public health workforce in graduate programs of public health in the U.S., beyond more formal and longer-term practica and internships.[1],[12]

Limitations

There are several limitations to the reported findings. The students who participated in EpiAssist, as well as the ones who completed the evaluation survey, are potentially different from non-participants and non-respondents, which could result in selection bias. Partners who requested assistance may also reflect those who are predisposed to working with students on applied public health projects, which could have skewed the results of our evaluation. For example, potential partners with lower levels of resources, including funding and staffing, may not feel that they have the ability to train, supervise, or mentor a student volunteer. Additional follow-up to better understand barriers, particularly among students who did not participate in any EpiAssist activities or trainings could address this issue in part. A more in-depth annual student and partner satisfaction survey is planned for January 2016. Longer-term follow up is needed to track whether EpiAssist participants are more likely to go on to a career in applied public health than non-participants.

 Conclusions



Students enrolled in public health programs are eager to gain applied experience through service-learning opportunities like EpiAssist, while community partners have unmet needs that can be addressed through the surge capacity provided. A sizable number of students signed up for EpiAssist – 86 out of the SPH's total enrollment of approximately 400 students. This may indicate that elements of service-learning programs like EpiAssist, including reciprocity and a focus on civic engagement, offer a benefit to students that other required field experiences do not. Community partners indicated strong support for EpiAssist as well, which may point to partners' needs for more students for shorter-term projects, needs that are not met with internships or practica that offer fewer students to agencies over longer periods. Community projects, such as CASPERs, that require more people are well-suited for programs like EpiAssist. The results of this evaluation can be used not only to improve the EpiAssist program, but also to further the interdependency of education and practice at the SPH.

Financial support and sponsorship

This publication was supported in part by a grant from the Service-Learning Faculty Fellows Program at the Texas A and M Center for Teaching Excellence, Office of the Associate Provost for Undergraduate Studies, Department of Student Activities Leadership and Service Center. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of these organizations.

Conflicts of interest

There are no conflicts of interest.

References

1MacDonald PD, Davis MK, Horney JA. Review of the UNC team epi-aid graduate student epidemiology response program six years after implementation. Public Health Rep 2010;125 Suppl 5:70-7.
2Furco A, editor. Service-learning: A balanced approach to experiential education. In: Expanding Boundaries: Serving and Learning. Washington, DC: Corporation for National Service; 1996. p. 2-6. Available from: http://www.shsu.edu/academics/cce/documents/Service_Learning_Balanced_Approach_To_Experimental_Education.pdf. [Last retrieved on 2015 Aug 01].
3Jacoby B. Service-learning Essentials: Questions, Answers, and Lessons Learned. San Francisco, CA: Jossey-Bass; 2014.
4Cashman SB, Seifer SD. Service-learning: An integral part of undergraduate public health. Am J Prev Med 2008;35:273-8.
5Eckhert NL, Bennett NM, Grande D, Dandoy S. Teaching prevention through electives. Acad Med 2000;75 7 Suppl:S85-9.
6Moss V, Nesbitt B. Making nursing research “real”: An experiential approach. Nurse Educ 2003;28:63-5.
7Ward K, Wolf-Wendel L. Community-centered service learning: Moving from doing for to doing with. Am Behav Sci 2000;43:767-80.
8Balassiano K. Extension projects in community planning classrooms. J Ext 2012;50(4). Available from: http://www.joe.org/joe/2012august/comm1.php.
9Association of State and Territorial Health Officers. State Public Health Employee Worker Shortage Report: A Civil Service Recruitment and Retention Report; 2011. Available from: http://www.astdn.org/downloadablefiles/ASTHOworkershortage.pdf. [Last retrieved on 2015 Aug 01].
10National Association of County and City Health Officials. Local Health Department Job Losses and Program Cuts: 2008-2010; 2010. Available from: http://www.naccho.org/topics/infrastructure/lhdbudget/index.cfm. [Last retrieved on 2015 Aug 01].
11World Health Organization and Global Health Workforce Alliance. A Universal Truth: No Health Without a Workforce; 2013. Available from: http://www.who.int/workforcealliance/knowledge/resources/hrhreport2013/en/. [Last retrieved on 2015 Aug 01].
12Horney JA, Davis MK, Ricchetti-Masterson KL, MacDonald PD. Fueling the public health workforce pipeline through student surge capacity response teams. J Community Health 2014;39:35-9.