Interdisciplinary Community Partnership for Health Professional Students: A Service-Learning Approach

By Scott, Sherry B.; Harrison, Adrienne D. et al. | Journal of Allied Health, Spring 2005 | Go to article overview

Interdisciplinary Community Partnership for Health Professional Students: A Service-Learning Approach


Scott, Sherry B., Harrison, Adrienne D., Baker, Thelma, Wills, Joylynne D., Journal of Allied Health


This paper presents a qualitative approach to studying the reflective learning experiences of health professional students after they participate in an interdisciplinary community-based healthcare course. Over a 2-year period, health professional students from various health-related disciplines voluntarily took an interdisciplinary community-based health course offered at an urban, mid-Atlantic, private university. Through didactic and experiential opportunities, students in the course learned the importance of providing health care services to underserved populations at urban community-based sites. Throughout the semester, students kept journals, completed community response forms, and participated in documented class discussions. A research team of health professional faculty applied constant comparative analyses to the journal entries and community site-visit response forms. Four central themes were identified as the students engaged in learning experiences at various community sites: (1) the need for preventive healthcare; (2) the importance of health services and resources; (3) the awareness of student attitude and behavioral changes; and (4) increased awareness of student and client expectations for health care services. Interpretations of these findings and recommendations for future research are presented. J Allied Health 2005; 34:31-35.

CURRENT TRENDS of Healthcare service delivery support the shift to clinical rotations in community-based healthcare.1 Rotations in community settings promote opportunities for increased student awareness of the health needs of underserved populations and foster student interest for service delivery in urban community sites after graduation.2 These settings may include community mental health centers, free medical clinics, hospice, day treatment centers, boarder baby homes, and homeless shelters.1 Targeted populations typically served at these settings encompass historically disenfranchised individuals, as distinguished by such factors as poverty, race/ethnicity, and education. These underserved populations also includes demographically diverse persons in urban and rural areas.3

Previous literature revealed that neither students nor clinicians were seeking clinical rotations or employment in these community-based settings.4,5 Universities are positioned to play a major role, not only in educating health care professionals, but also in establishing partnerships between academic programs and community-based health care centers. Health professional educational programs infuse experiential opportunities during clinical rotations and internships. However, the majority of these traditional experiences do not incorporate a reflective learning process toward community-based health care service delivery. As healthcare professionals provide services in a variety of settings, it becomes necessary to reflect critically on the interrelationships and interactions that best meet the needs of the clients. Health professional educators and fieldwork coordinators must adapt to the changing practices and prepare students to be on the cutting edge. Incorporating a service-learning approach into the classroom serves as a bridge to transition health professional students to become more committed to the population being served, because they are able to reflect on the appropriateness and integrate didactic learning through hands-on experiences.6

Service-learning promotes educational experiences in which students participate in organized service activities that meet identified community needs.7 Through service-learning, educators can infuse experiential learning and reflective thinking in the classroom and community settings.8-10 According to Jacoby and associates," service-learning combines students' achieving learning goals with meeting community needs. This approach ultimately results in educational growth and empowerment for all those involved.11 Anderson et al. proposed three criteria for determining the worth of service experiences: (1) individual student growth intellectually and morally; (2) the larger community henefiting from learning; and (3) experiences resulting in strengthening initiative, desires, and purposes in academia and the community.9

Health education and other health and social services are desperately needed for underserved populations.12 As allied health educators, applying service-learning fosters an interdisciplinary platform for a variety of interventions and community partnerships that reflect client-centered health care service delivery. The health-underserved population in the urban inner city areas is vulnerable to an array of health problems.13-15 These include substance abuse, alcoholism with associated liver disease, mental illness, infectious diseases, circulatory disorders, and hypertension.15-19

Allied health faculty are acknowledging the need for providing health care services to underserved populations and the need for performing clinical rotations in urban community-based settings. The purpose of this study was to determine whether students taking the interdisciplinary community-based health care course would become more aware of the health needs of the underserved population after didactic and clinical experiences in urban communitybased settings. Additionally, in this study, we investigated whether students were more aware of and motivated to address the needs of the health-underserved population and provide services after taking this course.

Methods

An interdisciplinary community-based health care course was added to the allied health core curriculum offered at a mid-Atlantic private university. This course assists health professional students in identifying and examining the impact of socioeconomic and cultural influences on health services to the health-underserved population in urban community-based settings. On completion of the course, students should understand the importance of health care service delivery in such urban community settings. Additionally, the students actively engaged in service delivery to meet health care needs of underserved communities.

A descriptive analysis was used to interpret the results of students' journal entries, site-visit response forms, and documented in-class discussions acquired over a 2-year period. This interdisciplinary course was designed to promote student awareness and participation in community-based service delivery in urban nontraditional sites. Health professional students received 6 weeks of didactic in-class discourse and lectures and 8 weeks of community experience that included group reflection through in-class discussions. Before and after the community visits, students reflected on their feelings, expectations, and approaches regarding their experiences. After each site visit, students documented their experiences and recommendations from lived experiences. Raw data were reflected in the form of journal entries, group discussion documentation, and community site-visit response forms.

The duration of the course per semester was 15 weeks. During the first class session, the students voluntarily completed a demographic form to identify background information and previous experiences toward working or volunteering with underserved populations in community-based settings. Between weeks 2 and 7 of the class sessions, guidelines were provided for working with the health underserved. During the second half of the course (weeks 8 through 14), students engaged in experiential learning opportunities.

Students spent 8 weeks visiting, observing, and developing intervention projects at the various preselected sites. The students were exposed to content regarding the health underserved population, cultural competence, and interpersonal communication strategies in various settings. Interdisciplinary health professional faculty members supervised the site visits. Students received consultation from the faculty members and site administration. Faculty were responsible for providing assistance with interdisciplinary assessments and intervention projects. Once the assessments were completed, each team of students worked closely with a faculty member to design and implement client-centered health-related projects.

PARTICIPANTS

Participants in this study consisted of 60 full-time students over a 2-year period. Students were from the departments of clinical laboratory sciences, health management, nutritional sciences, nursing, occupational therapy, physical therapy, physician assistant, and radiation therapy. The academic level ranged from juniors to graduate students in the professional phase of their matriculation. The mean age was 23.5 yrs, ranging from 18 to 31 yrs. Most students were African-Americans (95.5%), with the remainder European-American (4-5%). Thirty-one percent of the participants were males; 69% were females. Students' previous experiences in volunteering or working with underserved populations ranged from 3 months to 5 years. Eighty-five percent of the students had previous clinical experience in a traditional hospital and/or clinic setting. The students voluntarily participated in the course since it was offered as an elective course.

SETTINGS

The settings for this community-based course included five sites: boarder baby homes, homeless shelters, community mental health clinic, community health clinics, and AIDS clinics. The numbers of accessible clients at each location were enough to provide rich descriptive data regarding the community experiences and health care services delivery systems. Through telephone conversation and preplanning site visits to each setting, rapport was established with the administration personnel of these programs. A memorandum of agreement was also initiated in order to ensure safety for both students and clients. Each program had its own mission and purpose: to provide health services for underserved clients. Most of the programs offered limited health care services, such as physical and occupational therapy, nutrition counseling, and health education or promotion. The facilities were very open to receiving student volunteers and health care services.

The client ages ranged from 5 mos to 80 yrs. Students were randomly selected and grouped for the various sites. There were approximately four to five students per group. This course was not a replacement for clinical rotations. The course was designed to enhance student reflective learning experiences and augment student performance and readiness skills with the underserved populations in community-based settings.

CONSTANT COMPARATIVE QUALITATIVE ANALYSIS

In this qualitative study, a constant comparison method was used. This method enables the researchers to identify recurring behaviors which, when analyzed, reveal emergent thematic categories. This approach explicitly shows how to determine what data to collect, how to handle the data, how to code and conceptualize field data, and when to stop gathering data.20

The entries and response forms were examined in three stages. In the first stage, open coding was used to look for recurring themes that provided information about the journal entries and community response forms. Each entry unit of analysis was cut out from a copy of entries and community response forms and transferred to index cards. Piles of cards from individual entries were gathered. From the first pile (self-identified), one card was selected, read, and noted for its content. The first card represented the first entry in the yet-to-be-named category. It was placed to the side. A second card was selected, read, and noted for its content. In the second stage, if the card was similar, then it was put on top of the first card. If it was not similar, it was put next to the first card. When the cards accumulated to a large pile (25 to 30 cards), efforts were made to identify similarities from each pile. Finally, if the pile had fewer than 10 cards, efforts were made to collapse smaller piles into a larger one, if there were similarities.

After collapsing the data, several recurring behaviors were identified. These consistent behaviors generated four themes that are supported by raw data from student response forms. This analytical approach proved to be an effective method for revealed themes based on student learning experiences. 20 One hundred percent of the data was used for the purpose of checking inter-coder reliability. Two independent coders provided reliability, which confirmed the four themes. This resulted in 81% agreement.

Findings

The four themes identified by the independent coders as central to the students' learning experiences are as follows: (1) the need for preventive Healthcare; (2) importance of health services and resources; (3) awareness of student attitude and behavioral changes; and (4) increased awareness of student and client expectations for health care services.

NEED FOR PREVENTIVE HEALTH CARE

The students who participated in the community site visits often mentioned the need for preventive health care. Of particular note was the frequency with which they documented that clients would benefit from health screening. Eighty percent of the students documented the need for screenings such as musculoskeletal, Denver Developmental, cancer, and medical screenings. Several students included the need to perform a needs assessment to identify which health factors were important to the clients. Coupled with needs assessments, these students realized the benefits of holistic preventive measures in order to not only prevent illness but also promote wellness. One student described it by noting, "As an interdisciplinary team, all are needed to provide holistic care." This same student stated, "Prevention is the primary goal in the community."

Another prevention area noted by the students was the need for health education. The use of health education is illustrated with the following student excerpts: "The interdisciplinary team should work together to provide health education programs for the urban community. More information and education about health problems, resources, screenings and available referral services are needed. Education is the key to intervention and prevention. Training and education are needed about nutrition and social habits." Health education was provided in the areas of general nutrition education, cancer screenings, and video presentations of dietary management for hypertension and diabetes.

IMPORTANCE OF HEALTH SERVICES AND RESOURCES

A significant relationship was formed between students and clients, most notably when the clients expressed the importance of health services and resources. Many students documented that the clients needed additional health services and resources other than those they were already receiving. The primary services offered at the sites were consulting physicians, part-time nurses, social workers, and case managers. None of the sites provided such services as physical and occupational therapy, a nutritionist, or a health manager. The community facilities did have part-time social workers who provided information on housing opportunities for those with low-incomes. However, health education, promotion, and resources were not readily available. According to student entries and site response forms, the majority of the clients requested assistance with health care services either for themselves or a family member. The following examples support this finding:

I now see the many different ways 1 can provide some kind of [health care] service.

I feel good and I see the importance of volunteering my therapy services.

We need to lobby on behalf of these programs for the underserved. They need to be aware of available health services, jobs, food, and clothing.

There is a need for basic health care supplies in this facility.

I can see the benefit of food support, finance counseling, and free legal advice.

There is a problem because many clients do not have health insurance. There is a need for more resources, support, and better service.

Now 1 understand we need to help others in need who cannot afford health services.

It is important to inform others about better resources and options in order to have healthy lives.

Finally, one student documented, "All health care services offered is a step in the right direction." The students realized that the lack of services and resources further contributed to the lack of insight and ability to eliminate disparity and achieve healthy communities.

AWARENESS OF STUDENT ATTITUDE AND BEHAVIORAL CHANGES

Service-learning also fostered a change in the students' behavior and attitude toward continuing to provide health services to the underserved. One of the goals for the interdisciplinary community-based healthcare course was to enhance students' sensitivity and awareness to meeting the needs of the health underserved. By the end of the course, according to the community response forms, 95% of the students said they wanted to help and provide health care services to the underserved beyond graduation.

Reflections from the students' journal entries consistently revealed that the attitude and behaviors regarding understanding the need for service had improved. These students realized that there were clients who were not receiving adequate services. The entries revealed an initial comfort to address the need for health services. However, according to the latter half of the entries, the students transitioned from a casual knowledge base to a commitment to help those who are health underserved. This commitment reflected strong positive outcomes for serving others and promoting community health. Some of the documented entries were as follows:

I didn't realize the need was so great.

I would like to work or volunteer in the community because more people fall through the cracks in the urban settings.

I was somewhat nervous at first but now I am interested in finding out what could be done.

I want to learn more about the health underserved.

I feel good and I want to volunteer more as my skills improve.

If no one takes the time then who will? Giving back to the community is my motto in life.

It is a great feeling to help and watch someone gain from something I did.

I understand they were just like me just less fortunate financially. I was very fortunate to be a part of this group and to see so many different ways we can provide help.

Working with the health underserved will help others to become aware of preventive health care.

My prejudgments about underserved clients in the community were wrong. I became sensitive to the plight of the underserved and aware of their need for health services. I feel a sense of empowerment that I can help people. I feel enlightened about the needs of the underserved.

These entries reflect how the students emerged from cognitive to a motivational change and increased their sensitivity to the needs for the health underserved. This finding supports the purposes of this study: to encourage students to be more sensitive to the underserved healthcare needs and to motivate them to work in community-based settings. The results indicated that 81% of the students would consider working in community-based settings after graduation, whether in volunteer, part-time, or consultative capacities. Fifty percent of the students had an interest in working at a pediatric community setting, 18% at a boarder baby home, 13% at homeless shelters, and 4-5% at an H1V/AIDS clinic.

INCREASED AWARENESS OF STUDENTS' AND CLIENT'S EXPECTATIONS

Students documented their expectations in journal entries and site-visit response forms. One student noted that the expectations became more realistic once at the site. For example, this student could not immediately determine what the client's needs were until a therapeutic alliance was formed. A few student entries revealed these comments: "They expected us to do stuff and leave." "They wanted to know how long were we staying and did we really care." "I felt they wanted us to come back" [after the course is completed]. "They were resistant at first." "The staff was happy to educate the students. They wanted to know what we could do." "They expected us to give services and provide care. I thought the initiative taken by the clinic was healthy."

The students also documented entries regarding the client's expectations. The students commented on how many of the clients were seeking help: "The staff was trying to help but lacked the developmental and health care skills to assist their clients." "People were motivated and talked with their social worker about seeking housing." "The clients want to become drug-free and go back into the workforce. They want to have a home, job, and be back with their families."

Discussion

Utilizing a service-learning approach fostered interactions between students and clients, allowing both groups to become more aware of each others' needs. Thus, the students were able to plan more effectively for the service-learning projects during the latter half of the community experience. A service-learning approach in this interdisciplinary course, through the use of reflective journaling, proved to be beneficial to the student community experiences. Journaling, documenting class discussions, and completing community-site response forms were helpful for attitude awareness and validating critical health needs. These results support the findings of Corbie-Smith et al.21 and Kember.6

Through constant comparative analysis, four important themes were identified and found to be vital to improving health care services. These findings support current literature on the need for health care services in community settings.1,2,15,17 The themes identified the importance of health education, preventive health care services and resources, and awareness of student attitude and behavior, as well as better understanding of individual and clients' expectations. Health professional students in this course saw the need, had the opportunity to think critically, and addressed that need. As reflected in the findings, toward the end of the site visits, students' positive attitudes enhanced their service delivery performance.

This qualitative analysis supported several service-learning theories as purported by Dewey and Anderson.8,9 These theoretic threads identified through the data included: critical reflection, addressing community needs, education to prepare for civic responsibility, and experiential learning.9 The data provided opportunities to focus on the attitudes and behaviors that students developed while addressing client needs and provided opportunities to accomplish integrated community service-learning.

Conclusion

In order to instruct effectively and introduce the importance of eliminating health care disparities among diverse populations, it is essential for those in academia to have requisite knowledge and sensitivity toward promoting healthy people in healthy communities. Utilizing service-learning in the classroom has benefited clients and students in understanding how to interact and serve persons with disabilities and/or persons who are health-underserved. A service-learning approach fosters student dedication and commitment to serving others.

Health professional practitioners have also realized the benefits of incorporating a service-learning approach to identify and address the healthcare needs of underserved groups in urban communities. The students developed a better understanding of how to interact and work with clients. A sense of trust had to be cultivated, sensitivity toward clients' needs had to be demonstrated, and a genuine interest in empowering the clients developed. One of the advantages for the students was becoming aware of employment opportunities in nontraditional community settings. Future studies could examine specific factors such as the impact of gender, race, or class regarding service delivery for urban and rural underserved in communitybased settings.

[Reference]

REFERENCES

1. Wojtusik L, White MC. Health status, needs, and health care harriers among the homeless. J Health Care Poor Undeserved 1998; 9(2):104-151.

2. Scott SB. Community-based fieldwork opportunities. OT Practice 2000; 5(11):21-26.

3. Phelan JC, Link BG. Who are "the homeless"?: reconsidering the stability and composition of the homeless population. Am J Public Health 1999; 89:1334-1338.

4. American Occupational Therapy Association. Education data survey final report. Bethesda, MD: American Occupational Therapy Association; 1997.

5. Moyer P. Guide to OT practice. AmJ Occup Ther 1999; 53(3):13-17.

6. Kember D. Reflective Teaching and Learning in the Health Professions. Maiden, MA: Blackwell Science Publishers; 2001.

7. Zlotkowski E. Successful Service-Learning Programs. Bolton MA: Anker Publishing; 1998.

8. Dewey J, Bentley AF. Knowing and the Known. Boston: Beacon Press; 1949.

9. Anderson JB, Swick KJ, Yff J. Rationales for integrating servicelearning in teacher education. In: Service-learning in Teacher Education: Enhancing the Growth of New Teachers, Their Students, and Communities. Washington DC: AACTE Publications, 2001.

10. King PM, Kitchener KS. Developing Reflective Judgment: Understanding and Promoting Intellectual Growth and Critical Thinking in Adolescents and Adults. San Francisco: Jossey-Boss; 1994.

11. Jacoby B. Service-Learning in Higher Education: Concepts and Practices. San Francisco: Jossey-Boss; 1996.

12. Gourley M. Maintaining career competence. OT Practice 2001; 6(5):30-35.

13. U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. Washington, DC: GPO; 2000.

14. Kyler P, Merrvman M. Healthy People 2010. OT Practice 2000; 5(22):11-15.

15. National Coalition for the Homeless. Who is homeless? NCH Fact Sheet, 1999: Available from: http://nch.ari.net/who.html. Accessed Mar 2002.

16. Bowdler JE. Health problems of the homeless in America. Nurse Practitioner 1989; 14(7):44-51.

17. Clarke PN, Williams CA, Percy MA, Kirn YS. Health and life problems of homeless men and women in the southeast. J Community Health Nurs 1995; 12:101-110.

18. Lam J, Rosenheck R. Street outreach for homeless persons with serious mental illness: is it effective? Med Care 1999; 37:894-906.

19. Ringwalt C, Greene JM, Robertson M, McPheeters M. The prevalence of homelessness among adolescents in the United States. AmJ Public Health 1998; 88:1325-1329.

20. Lincoln YS, Guba EG. Naturalistic inquiry. Thousand Oaks, CA: Sage Publications; 1985.

21. Corbie-Smith G, Thomas SB, Williams MV, Moody-Ayers S. Attitudes and beliefs of African Americans toward participation in medical research. J Gen Intern Med 1999; 14:537-546.

[Author Affiliation]

Sherry B. Scott, PhD, OTR/L

Adrienne D. Harrison, MS, RT(T)

Thelma Baker, PhD, RD

Joylynne D. Wills, MGA, OTR/L

[Author Affiliation]

Dr. Scott is an Associate Professor in the Department of Occupational Therapy; Ms. Harrison is a Program Director in the Department of Radiation Therapy; Dr. Baker is an Associate Professor in the Department of Nutritional Sciences; and Ms. Wills is an Instructor in the Department of Occupational Therapy, Division of Allied Health Sciences, Howard University, Washington, DC.

This study was sponsored and funded by a grant from the U.S. Department of Health and Human Services.

Received January 24, 2003; revision accepted May 3, 2004.

Address correspondence and reprint requests to: Sherry B. Scott, Ph.D., OTR/L, Department of Occupational Therapy, Division of Allied Health Sciences, Howard University, Washington, DC 20059. Telephone 202-806-5719; fax 202-462-5248; e-mail sscott@howard.edu.

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Interdisciplinary Community Partnership for Health Professional Students: A Service-Learning Approach
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.