Increasing Doctoral Students’ Self-Efficacy to Teach Health Promotion Theory

Abstract

Health education specialists in academia and in the workplace must be effective teachers. However, doctoral programs often fail to equip students with effective teaching skills. In this study, we evaluate a first-year doctoral course that provided students the opportunity to learn how to teach health promotion theory, apply behavioral science theories and models to the development of health interventions, hone group facilitation skills, and develop their scientific writing abilities. Eight doctoral students completed a teaching self-efficacy assessment during the first and last class periods of a fall 2014 semester at a graduate school of public health in the United States. Throughout the semester, students reflected on their teaching. We applied a Wilcoxon signed-rank test to measure changes in pre- and postteaching self-efficacy scores and subjected student reflexive writings to a content analysis. The median increase in pre (Mdn = 63, range = 24-72) and post (Mdn = 76, range = 71-90) teaching self-efficacy scores were statistically significant for all participants (z = 2.523, p = .012). The students’ reflexive writings explained how this increase occurred. Students gained an awareness of skills needed to teach effectively. Students found the course challenging because it uncovered teaching role ambiguities as they became cognizant of their lack of facilitation and presentation skills. The increased awareness of their deficiencies initially decreased their teaching self-efficacy. However, continued engagement in the course allowed them to resolve deficiencies, resolve some role ambiguity, and experience a net increase in teaching self-efficacy.

Keywords

health education teacher training adult learning teacher self-efficacy

New faculty in the field of health promotion, in addition to their research work, are often expected to teach. However, doctoral programs historically offer limited pedagogical preparation for graduate students (Boman, 2013; Gardner & Jones, 2011; Valentine et al., 1998). The adage “teach the way they were taught” often applies with new faculty (Oleson & Hora, 2014), suggesting that these newly minted academics simply replicate the teaching methods of their mentors and have a poor understanding of pedagogy (Halpern & Hakel, 2003; Mazur, 2009). Some researchers suggest that the inadequate training of graduate students to be effective teachers is because of an environment that emphasizes research over teaching (Light, Calkins, Luna, & Drane, 2009). For this reason, while new graduates pursuing academic positions in the field of health promotion may be trained to be effective researchers, they might not be equally skilled as teachers (Rushin et al., 1997; Schussler, Read, Marbach-Ad, Miller, & Ferzli, 2015).

Presently, the teacher training literature suggests two broad orientations toward teaching, the information transmission orientation and the conceptual change orientation (Light et al., 2009; Mazur, 2009; Trigwell & Prosser, 2004). Faculty who rely on information transmission approach teaching as a way to organize and broadcast their accumulated knowledge to their students (Mazur, 2009; Trigwell & Prosser, 2004). This approach relegates students to a passive role in the learning process. Conversely, faculty relying on the conceptual change orientation approach teaching as a way of aiding students to construct their individual knowledge bases, which encourages their students to take a more active and participatory role in their learning (Light et al., 2009; Trigwell & Prosser, 2004). Because the prevailing culture in higher education places research at a premium, and because new faculty tend to have little exposure to teaching pedagogy, information transmission appears to be the default orientation adopted by these new faculty (Mazur, 2009; Oleson & Hora, 2014; Rushin et al., 1997). However, the prevailing research points to the conceptual change orientation as the more effective means of educating students (Kember & Kwan, 2000; Light et al., 2009). Thus, it is imperative that academics in the field of health promotion have knowledge of and appreciate the dual teaching orientations, to become more effective teachers (Kember & Kwan, 2000; Postareff, Lindblom-Ylänne, & Nevgi, 2007).

Exposure to pedagogy and participation in teacher training programs is also crucial to developing a sense of teaching self-efficacy (Postareff et al., 2007; Prieto & Meyers, 1999). Teaching self-efficacy has to do with the individual’s “judgment of his or her capabilities to bring about desired outcomes of student engagement and learning, even among those students who may be difficult or unmotivated” (Tschannen-Moran & Hoy, 2001, p. 783). Individuals with higher teaching self-efficacy show an aptitude for planning and organizing within the classroom (Allinder, 1994; Horvitz, Beach, Anderson, & Xia, 2015), applying new teaching methods to address the needs of their students (Guskey, 1984; Stein & Wang, 1988), showing enthusiasm for their subject area (Allinder, 1994; Guskey, 1984), and having a commitment to their roles as educators (Coladarci, 1992). Building doctoral students’ teaching self-efficacy is a critical component of training them to teach effectively. Given the importance of a conceptual change orientation to teaching and the significance of teaching self-efficacy to budding academics, this study presents findings from the evaluation of a 14-week course that trained a group of public health doctoral students on how to teach health promotion theory. Participants were taught alternate teaching methods and given opportunities to practice newly acquired skills with master’s-level students. We hypothesized that students exposed to teaching methods and given an opportunity to practice the methods they were learning would experience an increase in their teaching self-efficacy.

Method

Overview of the Course and Problem-Based Learning

Grounded in the conceptual change orientation, the course was held weekly for 3 hours and lasted 14 weeks in total. The course offered first-year doctoral students studying health promotion and behavioral sciences an in-depth overview of the application of selected behavioral science theories and concepts used in health education and health promotion programs directed toward individuals and groups. It was taught by one faculty, and the course’s main objectives were to provide enrolled students opportunities to (1) apply behavioral science theories and models to the development of interventions for health problems, (2) develop group leadership and teaching skills, and (3) monitor and improve scientific writing skills. In addition to the doctoral course, the students had limited participation in a separate, master’s-level, introductory health promotion theory and methods course. Their participation in the master’s-level course demanded that they present some course material and lead problem-based learning (PBL) groups.

Problem-based learning is a method that encourages students to rely on deductive reasoning (Schmidt, 1993). The master’s-level course met once each week for 3 hours over a period of 14 weeks. Each class session was structured such that the first 1.5 hours were spent in a lecture and a discussion session with an attending faculty member. In the remaining 1.5 hours of the class, the master’s students broke off into their assigned PBL groups. Once in their various PBL groups the students spent their time working through an assigned case. The PBL groups worked on the assigned cases in 2-week cycles. During the first meeting, these students worked to identify what information they knew and needed to know to resolve the case. Between classes, students conducted independent research on the case to fill-in their knowledge gaps. In the subsequent week, when the PBL group convened again, the students shared the information they had gathered with other members of their group and proceeded to work together to identify a solution to the case. The doctoral students were required to attend the PBL group sessions, where in their capacity as group leaders, they guided the master’s students through the cases. The doctoral students were observed by their course faculty in their role of PBL group leaders. Consequently, the doctoral students spent approximately half of their weekly course time interacting with master’s students. The remaining half was spent meeting once a week for their separate doctoral-level course.

During the doctoral course, the study participants were able to discuss their experiences as PBL group leaders, learn group facilitation, and learn various teaching techniques, including syllabus or course design, prioritizing class goals, planning lectures, and conducting classroom assessments (McKeachie & Svinicki, 2014). In the class period, the doctoral students were given opportunities to practice facilitation and teaching techniques, necessary to teaching behavioral science and health promotion theories on each other. Additionally, in the intervening days between the class periods, the doctoral students and their faculty were able to debrief, using the Blackboard Learn™ Learning Management System, allowing them ask questions of each other and solicit feedback about their leadership. In the latter weeks of the semester, the doctoral students developed brief lectures on emerging health promotion theories, which they then presented to the master’s students. In Figure 1, we provide a list of learning objectives for the master’s- and doctoral-level courses, and in Figure 2, we provide a list of course topics and assignments.

Figure 1.

Learning objectives for the doctoral-level course.

Figure 2.

Master’s- and doctoral-level course topics. An asterisk (*) indicates a problem-based learning group activity.

Study Procedure

Participants consisted of eight public health doctoral students enrolled in the course during the fall 2014 semester, lasting 14 weeks. In the first class meeting, they were invited to participate in the study. All eight students agreed to participate and signed the requisite informed consent form that contained an explanation that participation required no additional work other than the completion of regular course assignments and that they were also consenting to have their data analyzed and subsequent findings disseminated.

The course syllabus contained an outline of the basics of teaching theory, and the professor trained the doctoral students in various teaching techniques like course design, lecture planning, and conducting classroom assessments. In the first class period, participants completed a student information form that included items used to assess teaching self-efficacy. During the last class period, participants completed the same assessment again as part of their overall evaluation of the course.

The teaching experience was simulated through participation in the PBL course structure described above. The introductory health promotion theory and methods course geared toward master’s-level students was a larger class with nearly 60 students. For this reason, each PBL group had consisted of 6 to 8 students. The doctoral students facilitated case analysis and discussion within their various groups. They were also able to grade assignments from their respective PBL groups, using a grading rubric developed by the master’s-level course faculty. Meeting and interacting with the master’s students on a weekly basis provided opportunities for the doctoral students to answer questions relating to the master’s course material. The doctoral students were also responsible for developing and presenting brief lectures to the master’s-level students in their course in the latter weeks of the semester. These lectures exposed the master’s-level students to new and emerging theories in health promotion and behavioral sciences. Ultimately, the interactions between the doctoral students and the PBL groups they oversaw helped simulate the experience of teaching a small graduate-level class. Throughout the semester, participants reflected on their teaching experiences by responding to specific questions through the Blackboard Learn™ Learning Management System (see Measures section for more details).

Measures

Teaching Self-Efficacy

The short form of the Teachers’ Sense of Efficacy Scale (Tschannen-Moran & Hoy, 2001) assesses three factors: efficacy in student engagement, instructional strategies, and classroom management. The 12-item short form was adapted for this study. The original short form included one item that asked teachers to indicate how much they could do to assist families in helping their children do well in school; this item was removed because this study included only adult graduate students. The remaining 11 Likert-type items were retained in their original form. Response options ranged from 1 = Nothing to 9 = A great deal. Because of the small sample size, we were not able to conduct a factor analysis on the remaining 11 items. However, Tschannen-Moran and Hoy (2001) reported high internal consistency (α = .90) for the original short form scale.

Reflexivity

This is a tool used in qualitative research, and within this study we employed it to help participants objectively reflect on their experiences during the semester-long course (Koch & Harrington, 1998). The reflexive methodology allowed participants to identify preconceptions they had about teaching and represent previous personal and professional experiences they had about teaching at the university level (Malterud, 2001). Each week, participants were able to reflect on their teaching, through the Blackboard Learn™ Learning Management System, where they were required to respond to the following questions: Reflecting on this week’s problem-based learning facilitation, what went well? What could you have done to make it better? What do you still need to learn to improve your facilitation and teaching skills? During Week 1, participants were also asked to reflect on what they believed made for an effective teacher and what experiences or knowledge they had acquired to inform their belief. In Weeks 5, 9, and 13 of the course, they were asked to respond to the following questions: What previously held beliefs about teaching were challenged since your last reflective learning summary? What was the reading, lecture, or event that challenged you? Describe the context, when applicable. What feelings emerged because of this challenge? How did you resolve the challenge? Describe the resolution process—including your feelings throughout the process. Because of your process, how have your beliefs about teaching changed since your last reflective learning summary? Additionally, the students were required to write a teaching philosophy as part of an end-of-course reflection. In writing their teaching philosophy, they were asked to describe their role as a teacher and their beliefs about what qualities embody the best teachers, explain how their beliefs inform the way in which they intend to teach health promotion and behavioral science theory, and describe the types of assignments they would use to evaluate student performance. During analysis, these reflexive writings provided some qualitative context to any changes in teaching self-efficacy scores that were observed.

Data Analysis

Using STATA-IC version 12.1 (StataCorp LP, 2012), the investigators performed a related-samples Wilcoxon signed-rank test to determine if there was a statistically significant difference in baseline and end-of-the-semester teaching self-efficacy scores. The investigators then used content analysis (Weber, 1990) to examine each participants’ reflexive writings submitted through the Blackboard Learn™ Learning Management System. We hand-coded all the written responses looking for distinct themes based on the meaning of words or phrases and then came together to compare codes, in order to develop a coding taxonomy. In our analysis, we focused on the frequency, strength, and relationships between expressed themes in participant responses.

Results

Eight students enrolled in a Health Promotion and Behavioral Sciences doctoral program at a medium-sized graduate university participated in the study. Their mean age was 30 years (SD = 5 years, age range = 26-40 years). One of the participants was African-born, three were Latino, and four were non-Hispanic White. Seven of the participants were female. The majority of participants held a master’s degree in public health with concentrations in the following areas: health promotion, health behavior, community health education, health care organization and policy, and community health sciences. All participants had undergraduate degrees in the field of behavioral sciences (psychology, anthropology) or natural sciences (biology, chemistry).

Quantitative preteaching self-efficacy (Mdn = 63, range = 24-72) and postteaching self-efficacy (Mdn = 76, range = 71-90) scores suggested participation in the course elicited a statistically significant median increase in teaching self-efficacy for all participants (z = 2.523, p = .012). The submitted reflexive writings helped provide further context for this increase in teaching self-efficacy. Qualitative comments were organized by the following five teaching themes: teaching beliefs, challenges, resolution of challenges, learning experiences, and overall increase in teaching self-efficacy as a result of the course. All the qualifying comments provided below are the unaltered responses that doctoral students provided, regarding their experiences in the course.

Teaching Beliefs

Participants recognized that teaching can be difficult and that becoming an effective teacher is a gradual process. After being exposed to multiple teaching techniques and having had the opportunity to apply them in the classroom setting, participants asserted that becoming an effective teacher required extensive amounts of preparation:

Every time I am asked to reflect on teaching and how my beliefs about teaching were challenged, I come back to my thought that “teaching is hard.” It is not an easy task and it requires more planning, preparation, and understanding than I ever thought it did. I now understand that even poorly put together lectures and presentations take a lot of thought and time, not to mention those that are put together well, engaging and informative [sic]. In fact, thinking about how much work it takes brings up feelings of anxiety—how will I ever do this on a consistent basis?!

The course also prompted participants to think about their own teaching style and the teaching qualities they wished to embody:

Teaching is not easy. . . . After writing my teaching philosophy, I had the opportunity to reflect on the type of teacher I wanted to be. I want to be a teacher that [sic] presents the information well enough that my students understand and are able to apply it. Teaching is challenging. I’m learning that little by little. I’m happy that I have the opportunity however to learn to be a better teacher.

Throughout the course, participants reflected on their teaching values and philosophy. Their written responses suggested that their beliefs about teaching evolved over the course of the semester, and it was evident that their participation in the course helped further shape those beliefs:

It is my hope that. . . . I will remember that it is not necessarily the overall experience that must be good, but how to ensure that each interaction is positive or near as positive as it can get. . . . I will need to make sure to share my teaching values and goals with my students, in addition to attempting to impart academic content to them.

The course shifted participants’ beliefs about teaching by creating awareness about the extensive amount of planning teaching requires and the skills that are needed to deliver information in a way that students understand it. Participants also became more cognizant of the importance of creating a classroom environment that fosters positive student interactions. In addition to shifting participants’ teaching beliefs, the course also increased participants’ awareness of the challenges to becoming an effective teacher.

Challenges

After facing some difficulties in their roles as PBL group facilitators, participants commented on their need for additional skills to be an effective teacher. Specifically, they thought that by increasing their communication skills, setting boundaries, and settling role ambiguity, their teaching self-efficacy would further increase. For example, participants felt they needed to strengthen their communication skills to more clearly explain health behavior theory content areas to their PBL groups:

I think I still need to learn more about thinking on my feet when I am asked a question. I usually know the answer but I often find it difficult to deliver a succinct and clear response that will answer the question on the level they are asking me at, rather than taking it to the doctoral level.

Participants also acknowledged the need to gain skills in establishing student–teacher boundaries, “I am also worried I have made myself too accessible? Is that possible? I am getting questions that they could find answers to on their own or from peers—any suggestions on [sic] this?”

The course required participants to develop a teaching philosophy, an opportunity to critically evaluate their values and beliefs associated with teaching. It brought up many teaching role uncertainties for the participants:

I continue to feel unclear about my views and beliefs about what makes a good teacher, and what kind of role I see myself in. Unfortunately, nothing has been resolved, and I do not think I’m going to come out of this class having figured out what the “right” role is for me as a teacher.

The participants found the course challenging because it uncovered role ambiguity, which helped them recognize that they lacked skills in communication and in developing boundaries. This heightened awareness of the areas in which they lacked skills initially decreased their teaching self-efficacy.

Resolution of Challenges

Facilitating PBL groups on a weekly basis afforded participants the opportunity to resolve some of the challenges they encountered while teaching health promotion theory, because participants were able to gain skills in the areas in which they initially struggled. Participants continued engagement in the course’s application-based learning structure enabled them to develop effective communication skills: “I was very fortunate in that the group felt comfortable asking me for clarification when they felt they needed it. The few times they asked me questions, I knew the answer and was able to clarify for them.” Participants also learned how to set student-teacher boundaries:

I was struggling with being too accessible. I have been working on directing students to an answer, for example, I say things like, “try reviewing this part of the text,” or “read this academic website/article,” so they can work on figuring out their own answers. I got one positive response from this tactic, so that was reassuring.

Although participants did not completely resolve their teaching role ambiguity, the course increased their confidence in the direction they need to go to achieve their teaching goals: “I do feel like this course has also built some confidence in me, so that I at least know where I’m going, what I need to continue to mull over, and what I might want to aspire to.” Participants were able to resolve some of their teaching challenges because they learned how to better communicate with their students and set boundaries, which increased participants’ confidence in their teaching abilities. As a result of their newly developed confidence, participants were able to apply what they learned across different teaching situations, leading to essential learning experiences and the rebuilding of their teaching self-efficacy.

Learning Experiences

Throughout the course, participants applied what they learned in the classroom to actual teaching situations, including during their PBL group facilitation, in-class presentations to the master’s students, and any extracurricular teaching activities. By participating in this experiential learning process, participants moved beyond a basic understanding of major health behavior theories as they gained the skills necessary to teach adult learners health behavior theories:

Helming these PBL sessions has been a fascinating learning experience. Not only do I have a more in depth understanding of the so-called “big four” [Social Cognitive Theory, Health Belief Model, Transtheoretical Model, and Theory of Reasoned Action] health behavior models/theories, I think I have a better perspective on [sic] the way students learn and process what they have been taught. I hope such experiences come in handy later on in my work as a researcher and teacher.

Some participants showed excitement because they were able to successfully apply some of the teaching techniques acquired during the course in the classroom setting and from their jobs. For instance, participants were taught how to use techniques modeled after a popular TV show, Jeopardy (© 2015 Jeopardy Productions, Inc.), to facilitate teaching:

Wahooo!!!!! I have since had the opportunity to apply more of what we are learning in this class. I used Jeopardy with the community health workers at work . . . and they loved it! I got positive comments following the presentation. They informed me that playing jeopardy at the end really helped reinforce the key messages from the presentation. I am using the techniques we are learning in this class in my job, and in our presentations for this class. It’s been amazing having a supportive group of peers to practice with.

The course helped raise participants’ teaching self-efficacy to levels necessary for lifelong learning: “I am happy to say that this course is definitely helping with my teaching self-efficacy. I feel much more confident that I will be able to teach better and that I will be able to facilitate a discussion.” Throughout the semester, participants also gained insight into how students learn and process information, learned how to effectively apply teaching techniques, and gained confidence in their ability to teach and facilitate group discussions. Each of these learning experiences was instrumental in the rebuilding of participants’ teaching self-efficacy. Toward the end of the semester, participants began to reflect on their growth.

Overall Increase in Self-Efficacy

By taking the participants out of the traditional classroom setting and placing them in applied teaching situations, the participants were provided the opportunity to strengthen their teaching skills and discover more about themselves in their roles as teachers:

This course has been very challenging for me, but as we come to the end, I begin to see the benefit of my experiences through the semester, and will come out knowing more about teaching as a skill, and about myself.

Participants exited the course with a new perspective on what it takes to be an effective teacher and expressed enthusiasm at the opportunity to fulfill that responsibility in their future careers as academics:

As we close out the semester and conclude our facilitation groups, I am thinking a lot about how many different skills are required to be a good teacher, not just a lecturer. I kind of always assumed I could get up in front of a class and they could just listen to me talk, because that is the majority of my learning experience, long lectures. I wonder if any of my previous university teachers even practiced or thought about how the material is presented. I surprised myself because I really felt energized leading the facilitation group, I looked forward to it. It was really fun and rewarding.

Through the course, participants learned that becoming effective at teaching is a gradual process. Participants reflected on how their teaching beliefs were challenged, how those challenges were resolved, and how their learning experiences helped build their self-efficacy to become life-long learners.

Discussion

Exposing health promotion and behavioral sciences doctoral students to basic teaching techniques and requiring them to apply these techniques when facilitating PBL groups, grading papers, lecturing, and facilitating group discussions increased students’ teaching self-efficacy. Moreover, the increase occurred without requiring students to take additional coursework. The administrative arms of some universities and even departments that operate graduate programs may be resistant to the idea of adding courses to their degree plans, because doing so increases students’ expense and time to graduation. Thus, it is important to identify a pedagogical method for exposing students to the teaching techniques within their existing degree plan.

By integrating teaching techniques into a required course, doctoral students can acquire a basic set of teaching skills, regardless of whether they secure a teaching assistantship. At many universities, only doctoral students employed as teaching assistants acquire these skills, and the skills acquired likely vary based on the structure of the tasks assigned to the teaching assistant by the course instructor. Integrating teaching techniques into a required first-semester course has the potential advantage of providing all doctoral students with teaching skills that can be used during their tenure as graduate students who work as teaching assistants or in their pursuit of a teaching position after graduation. Future research could include a comparison between students who acquired teaching skills in an integrated course and those who only acquired the skills as teaching assistants. Future researchers could also follow-up with graduates who took the course to determine the extent to which they apply the skills taught in the first-semester course in their post-graduation employment.

We successfully employed a first-semester theory and methods course that increased students’ ability to teach, while simultaneously ensuring they understood and could apply health promotion and behavioral sciences theories to solve emerging health problems. Accomplishing this objective was not without some challenges. It required cooperation between faculty in both the master’s- and doctoral-level courses. First, the master’s course faculty had to be willing to implement the PBL technique in their classroom and allow the doctoral students to facilitate the groups. They also had to be willing to allow doctoral students to gain experience grading papers and lecturing in their course. These experiences afforded the doctoral students the opportunity to experiment with and reflect on some of the teaching techniques they were learning in the doctoral course. To facilitate cooperation, the faculty of the master’s- and doctoral-level course met weekly to discuss the progression of both courses and to make adjustments to the class schedules where necessary.

In addition to the logistical challenges resulting from convening the various faculty involved, the course was challenging for the doctoral students because of the number of competencies they were expected to master. In a regular first-semester theory and methods course, students are usually expected to understand how theoretical constructs can inform intervention development for a variety of health topics. In this course, students were still expected to meet theoretical competencies in addition to mastering teaching competencies. To aid students in the mastery of all competencies, the course was designed with the assumption that through teaching health promotion and behavioral sciences theories, students would better understand the theoretical constructs. Because this study did not have a comparison group, we could not test this assumption. Future researchers should employ a comparison group.

In this article, we provided an example of how to effectively teach doctoral students pedagogical methods within the confines of an existing health promotion and behavioral sciences degree plan. The small number of students, though typical of a first-semester doctoral course, limited both quantitative and qualitative analyses. To minimize this limitation, we triangulated longitudinal qualitative data from students’ reflective writings on the Blackboard Learn™ Learning Management System and their teaching philosophies. Despite limitations, the lessons learned from this study are probably transferable to other health promotion and behavioral sciences doctoral programs. It may be possible to modify the course design to train future academics in other disciplines, as the concept of problem-based learning and the conceptual change orientation to teaching are not unique to the field of health promotion and behavioral science.

In a field such as health promotion, which encompasses health education, it is imperative that students graduate with an understanding of teaching pedagogy and with the self-efficacy and skills needed to teach effectively. Faculty wishing to increase doctoral students’ ability to teach health promotion and behavioral sciences theory must identify opportunities in existing courses to integrate pedagogical methods. Courses that expose students to pedagogical techniques and allow them to practice and reflect on the techniques to which they are being exposed should result in increased teaching self-efficacy.

Footnotes

Acknowledgements

The authors would like to acknowledge the contribution of the late L. Kay Bartholomew Eldredge to the development of this course and the health promotion and behavioral sciences curriculum at our university.

Authors’ Note

The Center for Protection of Human Subjects (IRB) of The University of Texas Health Science Center at Houston (UTHealth) approved the research protocols.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

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