Bringing Service Into Science: Community-Engaged Service-Learning for Undergraduate and Graduate Epidemiology Students

Abstract

Service-learning is an effective and important teaching pedagogy for public health students that bridges classroom learning with meaningful practice in an effort to meet a community’s needs. Undergraduate and graduate epidemiology courses provide unique opportunities for experiential service-learning in public health education. However, best practices and effective examples for implementing and evaluating such experiences have been limited, leaving instructors seeking guidance. The purpose of this study was to describe the methods for developing and evaluating community-partnered service-learning activities in introductory graduate and undergraduate epidemiology courses. We present qualitative and quantitative findings from student assessment evaluations of three distinct service-learning activities over three separate semesters. Findings suggest that service-learning activities are highly valued by students and often represent their first experiences in population health research and primary data collection. Our findings also indicate that these initial experiences are opportune times for students to learn effective and important lessons for conducting health research as well as meaningfully engaging in their community. For health course instructors, the authors provide a timeline for developing such service-learning projects and describe techniques for overcoming challenges that arise in service-learning activity development and implementation.

Keywords

pedagogy service-learning epidemiology

Introduction

Experiential learning is a teaching pedagogy that facilitates student opportunities to bridge classroom learning with practice. Experiential learning opportunities can fulfill many integral application components of public health core competencies as described by the Council on Education for Public Health (CEPH; 2016) and the Council on Linkages Between Academia and Public Health Practice (2014). One type of experiential learning, 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” (Jacoby, 2014, pp. 1–2). This type of learning engages students with practical experiences, extends classroom learning, and meets the needs of the community (McIntire & DiVito, 2017).

Several theoretical approaches, such as that first described by Kolb (1984) and then expanded by Cone and Harris (1996), describe a “best practices” approach to service-learning. First, educators must first define and structure the task so that the student is prepared to learn from the experience. The student must be prepared cognitively by acknowledging perceptions and prepared pragmatically through training sessions. Throughout and after the service-learning experience(s), the student should be engaged in critical reflection through written and oral responses. The goal of service-learning is mediated learning, whereby the learner has bridged theoretical concepts and community experiences (Cone & Harris, 1996).

Recently, several reports have demonstrated successful approaches to service-learning in public health education that resulted in personal and professional student growth (Bill & Casola, 2016; Celio, Durlak, & Dymnicki, 2011; Essa-Hadad, Murdoch-Eaton, & Rudolf, 2015; Horney, Bamrara, Macik, & Shehane, 2016; Sabo et al., 2015). Throughout much of the 20th century, public health education was largely reserved for graduate students; however, in 2003, the Institute of Medicine recommended that all undergraduate students have access to education in public health, and specifically training in epidemiology (Gebbie, Rosenstock, & Hernandez, 2003). Accordingly, the past decade has seen strong development and growth in undergraduate public health education (Resnick, Selig, & Riegelman, 2017; Riegelman, 2008). At both undergraduate and graduate levels, introductory epidemiology courses provide a unique opportunity for experiential service-learning. The purpose of this article is to describe the methods for developing and evaluating community-partnered service-learning activities in introductory graduate and undergraduate epidemiology courses. We also present the evaluation results of three service-learning activities, implemented in four separate undergraduate or graduate epidemiology courses, and describe challenges and lessons learned from conducting these activities within traditional 15-week semesters.

Method

Epidemiology/Vital Statistics is an introductory epidemiology course open to all undergraduate students at Baylor University. Public Health Concepts in Epidemiology is an introductory epidemiology course for graduate students pursuing an MPH in Community Health at Baylor University. Baylor University, located in Waco, Texas (USA), was established in 1845 and is home to more than 16,000 students and approximately 1,000 full-time faculty. Both epidemiology courses use a range of teaching techniques, including didactic lectures, in-class group exercises, and community-based service-learning projects. For service-learning projects, students are provided clear expectations and projected time commitments about the project at the beginning of the semester, and online “peer-to-peer” discussion forum opportunities for reflection throughout the semester. Project activities generally included primary data collection that benefited a community partner (Table 1).

Table 1.

Examples of Community-Partnered Service-Learning in Public Health Education.

Course name	Project	Community partner	Preparation prior to semester by instructor	Preparation activities for students during semester	Project activities for student	Supplemental activities	Learning objectives
Public Health Concepts in Epidemiology	Community health needs assessment	Local public health district	Survey design; IRB submission/approval; Geographic maps of survey area(s); Notification of law enforcement	Human subjects training (CITI); In-class group training	Data collection day (e.g., one Saturday during the semester); Data entry; Reflection	Generate descriptive statistics; Written report for community partner; Design of epidemiologic study addressing identified community needs	• To understand human subjects research • To understand strengths and limitations of primary data collection • To understand factors that affect the quality and contribute to sources of error in data • To describe methods for improving interviewer bias • To describe community-level social determinants of health
Epidemiology/Vital Statistics	Customer intercept survey at mobile farmers market	Local nonprofit organization focused on food access	Survey design; IRB submission/approval	Human subjects training (CITI); In-class group training	Data collection throughout semester; Data entry; Data analysis; Reflection	Reflection on experience; Design an intervention to address customer needs	• To understand human subjects research • To understand the strengths and limitations of primary data collection and factors that affect the quality of epidemiologic data • To understand the barriers and facilitators of healthy eating behavior
Public Health Concepts in Epidemiology	Patient survey on physical activity	Local federally qualified health center	Survey design; IRB submission/approval	Human subjects training (CITI); In-class group training	Data collection throughout semester; Data entry; Data analysis; Reflection on experience	Create a written report for community partner; Design an epidemiologic study that addresses community needs	• To understand human subjects research • To understand the strengths and limitations of primary data collection and factors that affect the quality of epidemiologic data • To understand the barriers and facilitators of physical activity behavior

Partner Recruitment

Recruitment of community partners is essential for quality service-learning opportunities and can involve a formal or informal process. For our epidemiology courses, faculty member participation in local community health coalitions served as the foundation for personal contacts and networks that yielded the described course-based partnerships. In the semester preceding the initiation of the epidemiology student service-learning course, faculty members worked with community partners to identify needs and design appropriate projects, submitted and obtained institutional review board (IRB) approval for each project, and outlined the parameters of project activities for students in the syllabus.

This article details three service-learning projects. For the first service-learning project, the local public health department sought to conduct a community needs assessment to identify “priority” areas for potential interventions for increasing household and family healthy eating and physical activity behaviors. Public health faculty, trained public health district staff, and graduate students participated in the Community Assessment for Public Health Emergency Response (CASPER), a Centers for Disease Control and Prevention–led methodology used to quickly assess households in a defined geographic area. Participating epidemiology students were required to complete Collaborative Institutional Training Initiative (CITI) training (9 training modules to fulfill the Social & Behavioral Research—Basic Course), participate in just-in-time CASPER training, spend one Saturday during the semester on a data collection team in the target geographic neighborhood, give household participants a $10 gift card incentive for participating, and enter the collected survey data into an Excel database.

For the second service-learning experience, undergraduate and graduate students worked with a local nonprofit organization that had implemented a mobile community farmers market distribution service called the Veggie Van. This Van makes approximately 10 weekly stops to sell fruits and vegetables throughout a 5-mile radius surrounding the university. The organization sought information about customer characteristics to improve the delivery of services and increase consumption of fruits and vegetables in low-income “food deserts,” or geographic areas where a substantial number of residents have low access to grocery stores, surrounding the university. In partnership with epidemiology faculty, a brief survey was designed to assess sociodemographic and health characteristics of Veggie Van customers. Students enrolled in a graduate epidemiology course and students enrolled in an undergraduate epidemiology course participated in data collection; undergraduate and graduate students were enrolled in separate courses during the semester. Participating students were required to complete CITI human subjects research certification, spend at least 5 hours on-site with the Veggie Van conducting verbal informed consent and data collection, give customer participants a $5 “Veggie Bucks” incentive for participating, and enter survey data into an Excel database. Data were analyzed as a culminating semester project in the undergraduate course and in the graduate course.

For the third service-learning project, graduate students were involved with a local, federally qualified, health center that developed a Wellness Center to initiate an Exercise Is Medicine approach to chronic disease prevention and management. The Center sought information from patients about perceived barriers and facilitators of physical activity to design Wellness Center operations and activities that would most benefit the patient population. Participating epidemiology graduate students were required to complete CITI training, spend approximately 10 hours at the health clinic collecting 20 patient surveys each, give patient participants a $5 gift card incentive for participating, enter survey data into an Excel database, and generate a summary report for health center staff.

The primary goal of all three service-learning projects was to assist the local organization with primary data collection and generate a useable report that could be used by the organization internally for improved service delivery or externally to secure additional grant funding. The secondary goals of the projects were to facilitate students training and experience of primary data collection and analysis, to facilitate community health assessment procedures, and to exemplify the social determinants of health within the context of community and research. Both primary and secondary goals were attained.

Student Recruitment and Evaluation

Students enrolled in 2016-2017 undergraduate and graduate epidemiology courses participated in service-learning projects as a component of three distinct 15-week semester courses and were thus eligible to participate in the subsequent evaluation presented in this study. We implemented a mixed methods approach to evaluate student service-learning experiences in the epidemiology courses. Students wrote reflective narratives of project experiences on a shared online discussion board through the Canvas Learning Management System at two time points during the semester, one prior to the project start date and one after the project end date. At the start of the semester, and prior to the research experiences, the students were prompted to respond to the question: Before you begin: What is your concept of research? What do you expect to learn from this project? Do you have any concerns? Do you feel prepared for primary data collection? The second entry was to be completed after their experiences, usually near the end of the semester. They were prompted by the questions: During/after: What went well and what did you wish you knew prior to the experience? What did you learn from your experience(s), either about yourself, the specific project/community, or about the research process?

Additionally, students completed an anonymous 13-question survey at the end of the semester. On the final class day of each semester, the instructor verbally explained the purpose of the survey, gave a paper survey to every student, and then vacated the classroom. Students who chose to participate were instructed to complete the survey and place it in an envelope; students who chose not to participate could turn in a blank survey. There were no incentives or individual benefits for participation and no penalties for nonparticipation, and 100% of students completed the survey (N = 62). Survey questions included four questions about personal characteristics and experiences, and nine questions about perceived usefulness of the community-based service-learning experiences. The four questions about personal characteristics and experiences included undergraduate- versus graduate-level status, degree/major at the time of the survey, language skills, and previous public health work experiences. Perceived usefulness of the community-based experiences, adapted from Horney et al. (2016), was assessed with nine agree/disagree statements about whether the activity augmented class content, provided an opportunity to learn or apply new skills, and was beneficial to the student and the community.

Data Analysis

One researcher (KRY) downloaded all student narratives from the discussion board from the three activities and de-identified narratives by replacing student author names with numbers, and a second researcher (ARM) analyzed the de-identified narratives for emerging themes and compared student experiences within, between, and across cohorts. Our content analysis followed consistent textual analysis guidelines (Frey, Botan, & Kreps, 2000). Text was coded into thematic units and an online textual analysis tool (http://voyant-tools.org/) was used to determine the top five key words of each semesters written responses. We used these qualitative analysis assessment procedures to more fully understand the experiences of the student service-learning, for as Maxwell (2012, p. 30) states, “The strengths of qualitative research derive significantly from . . . process orientation toward the world.” We then examined the frequency and context in which these key words were used by the students.

Survey data were managed and analyzed with Microsoft Excel. Frequencies and proportions were used to describe student characteristics and the perceived usefulness of the service-learning project for all student participants, and by student status (undergraduate vs. graduate). This project was determined to be exempt by the Baylor University Institutional Review Board.

Results

In total, 62 students were enrolled across the three undergraduate or graduate epidemiology courses and all agreed to participate in this study to evaluate service-learning activities. Most graduate students (n = 34) were pursuing MPH degrees in Community Health. Undergraduate students (n = 28) were mostly pursuing public health or health-related degrees, as shown in Table 2. Many students (40.3%) had language skills beyond English, although foreign language skills were not required for community-based projects. Approximately two thirds (62.9%) of the students did not have any previous public health work experience (Table 2).

Table 2.

Characteristics of Students Participating in Community-Partnered Service-Learning Activities, 2016-2017, n = 62.

Characteristics	n
Student Characteristic
Classification
Undergraduate	28
Graduate	34
Degree
Health Science Studies	6
Bachelor of Science in Public Health	8
Master of Public Health	31
Other	8
Missing	2
Language skills beyond English
Yes	25
No	37
Languages among those who responded “yes” (n = 25)
Malayalam	1
Spanish	9
Korean	1
German	1
Chinese	2
Vietnamese	1
Hmong	1
American Sign Language	1
Arabic	1
French	2
Two languages (in addition to English)	3
Missing	4
Previous public health work experience
Yes	23
No	39
Service-Learning Project Participation
Community needs assessment	23
Mobile farmers market customer survey	36
Health clinic survey	16

Type of service-learning activity varied from semester to semester, and many students participated in more than one activity: 37.1% of the students participated in the community needs assessment with door-to-door household surveys, 58.1% of the students participated in the customer interviews at the mobile farmers market, and 25.8% of the students participated in the patient surveys and data entry at a federally qualified health center. A large proportion of students agreed with statements that were designed to assess perceived usefulness of community-based service activities in epidemiology. For example, all (100.0%) students reported that community-based service activities provided insight into applied public health, perceived the activities as beneficial to the community, and activities provided an opportunity for the student to learn more about the community (Table 3).

Table 3.

Proportion Agreement With Perceived Learning and Outcome Statements of Community-Partnered Service-Learning Activities, 2016-2017, n = 62.

Student learning outcomes	Total, n (%)	Undergraduate (n = 28), n (%)	Graduate (n = 34), n (%)
The activity augmented classroom training.	61 (98.4)	27 (96.4)	34 (100.0)
The activity provided an opportunity to apply skills learned in the classroom.	60 (96.8)	26 (92.9)	34 (100.0)
The activity provided an opportunity to learn new skills.	61 (98.4)	27 (96.4)	34 (100.0)
The activity provided insight into applied public health.	62 (100.0)	28 (100.0)	34 (100.0)
The activity was beneficial to me as a student.	60 (96.8)	27 (96.4)	33 (97.1)
The activity was beneficial to my future career in public health.	57 (91.9)	24 (85.7)	33 (97.1)
The activity was beneficial to the community.	62 (100.0)	28 (100.0)	34 (100.0)
The activity provided an opportunity to learn more about my community.	62 (100.0)	28 (100.0)	34 (100.0)
The activity increased my awareness of health disparities and equity gaps.	61 (98.4)	28 (100.0)	33 (97.1)

From the community health needs assessment, the top five words revealed in the student written responses were Research (83), Survey (70), Data (67), Experience (48), and People (45). This cohort also shared other themes in their responses, including their limited personal perception of research, minimal to no survey distribution experiences, uneasiness with incentive money, challenges posed due to language barrier, unpredictability of participant compliance (inconsistent responses to the researcher), and appreciation for the community impact they were having. The second cohort of students distributed a customer survey for the mobile farmers market customers used similar top five words: Van (162), Veggie (138), Research (92), People (82), and Experience (77). These undergraduate students also discussed similar themes to the first group, such as making human subject connections, being new to this kind of research (especially compared with lab/bench), lower response rate than expected, and inaccurate preconceived notions about survey collection. One theme that was also observed in this sample was the identification and articulation of the “Campus Bubble,” discussed by eight of the students. Student responses surrounding the distribution of a patient survey at a federally qualified health center revealed the top five words to be the following: Research (117), Survey (87), Data (78), Experience (69), and People (60), the same top five (as well as order) as the first cohort of graduate students. They also identified other key themes, including the importance of background information on the site and sample population prior to data collection, challenges due to language barriers, awareness of bias, and that research is “messy.” The “Campus Bubble” was also discussed by four of the students. Results of the textual analysis are presented in Table 4.

Table 4.

Use of Key Words in Student Narratives, 2016-2017.

	Community health needs assessment	Mobile farmers market	Patient survey
Total words of student narratives, n	6,947	9,965	9,756
Specific words, n (%)
Research	83 (1.2)	92 (0.9)	117 (1.2)
Survey	70 (1.0)	—	87 (0.9)
Data	67 (1.0)	—	78 (0.8)
Experience	48 (0.7)	77 (0.8)	69 (0.7)
People	45 (0.6)	82 (0.8)	60 (0.6)
Veggie	—	138 (1.4)	—
Van	—	162 (1.6)	—

Note. n is the frequency of word use; % is the proportion of word use in the overall narrative.

Across all semesters, using a keyword search, three themes emerged related to the student’s articulation through written narratives of the service-learning experiences. First, many students experienced a change in their perceptions of research. They identified how they came to more deeply appreciate the challenges and benefits of conducting health-related research, to better understand and navigate the health needs of their community members. Students also discussed the importance of the experience of the service-learning projects, as beneficial to classroom learning. For undergraduate students, these projects were often their first experience of research, of any kind. This led them to appreciate and better understand the role of public health educators and health initiatives that shaped their self-perceptions and their community more deeply. For graduate students, they experienced service-learning as part of their chosen field of study and obtained real-world experiences before employment. People was the third most identified theme of the service-learning experience in the written responses. Many students wrote about feeling empowered and positive when interacting and engaging with their communities through the service-learning projects and acknowledged the altruism of public health professionals for communities. Many also stated that it forced them to engage with community members not usually encountered on their campus. Through the online pre- and post-written responses, we observed the students’ acknowledgement of how they were challenged to critically examine their own biases and prejudices, resulting in a deeper sense of what public health research looks like and who they are as emerging professionals.

Discussion

Public health education, and particularly epidemiology courses, provides a unique opportunity to facilitate service-learning activities. Such activities, including those described in this article, help local organizations with systematic evaluations and benefit students by extending learning opportunities beyond the classroom. For approximately two-thirds of our students, epidemiology service-learning experiences were the first public health experience outside of the classroom, and student perceptions of project usefulness were overwhelmingly positive. Almost all students reported that they believed the service-learning projects augmented classroom learning, were beneficial to them as students, and were beneficial to the community. These activities, particularly among undergraduate students, may be a student’s first experience in research and exposure to public health field work.

Our quantitative survey findings about student perceptions of project usefulness were similar to other work on experiential learning in epidemiology courses. Our survey questions were modeled after the work of Horney et al. (2016), who found that the majority of graduate epidemiology students believed service-learning activities augmented classroom training (86.7%), provided an opportunity to apply skills learned in the classroom (80.0%), provided an opportunity to learn new skills (90.0%), provided insight into applied public health (86.7%), and sparked an interest in applied public health as a career (80.0%). Similarly, our findings indicated that almost all epidemiology students, at both undergraduate and graduate levels, viewed service-learning projects as opportunities to augment classroom learning, learn and apply new skills, and benefit their future career and their community. Of note, 98.4% of students (61 of 62) reported that service-learning projects increased their awareness of health disparities and equity gaps. This is an important finding, as it provides evidence that service-learning projects can facilitate the shared public health values of social justice, cultural humility, and elimination of health disparities (Sabo et al., 2015).

As recommended by Sabo et al. (2015) and Cone and Harris (1996), one important component for effective service-learning includes student opportunities for structured reflection. From the instructor perspective, student reflection narratives throughout the semester served as an informal assessment and allowed the instructor to “check in” with students, identify potential fears or problems, and provide immediate feedback to the individual student or class. From the student perspective, opportunities to reflect on activities and view other student narratives meant that students could help each other reflect on the larger experiences of service-learning, including systems-based thinking, cultural competence, and the social determinants of health (Buckner, Ndjakani, Banks, & Blumenthal, 2010; Essa-Hadad et al., 2015; Kratzke & Bertolo, 2013). These discussion board narratives sought to discover student perspectives on research and reflect how students were processing their experiences of service-learning. We adhered to the findings of previous scholarship, which posit that most of the lasting effects of impactful experiences come after the event and on reflection (O’Cathain, Knowles, & Nicholl, 2010; Sutton & Austin, 2015). Thus, multiple, open-ended student narratives provided students with a space and freedom to reflect and explore their personal experiences.

All three semesters of student narratives indicated that service-learning projects were highly valuable experiences for students. Enthusiasm for learning outside the classroom was expressed both by graduates and undergraduates alike, using statements such as “excited,” “enjoyment,” and “future opportunities for engagement.” At the same time, these positively enthusiastic terms were used in conjunction with statements such as “hard,” “difficulty of social science,” and “disappointment in number of surveys collected.” While the sample did include three different semesters, and thus three iterations of a pedagogical project, the three emerging themes (“research,” “experience,” and “people”) demonstrate that service-learning experiences in health-related courses are meaningful and effective for students’ professional growth.

Qualitative Theme 1: Research

The changes in student perceptions toward research was an important finding and was facilitated by the inclusion of a pre- and post-written response. One undergraduate student stated that, pre-project, they thought “research was very boring and that it was ultimately very impersonal.” After the service-learning experience, they stated, “I realized that research and the participation of others depends highly on the people running the research, and that my attitude with research has changed pretty significantly” (2/18/1).

Graduate students also expressed this change toward perceptions of research. One graduate student stated at the beginning of the semester that, prior to the experience, “I haven’t always been a fan of research because I felt like it was too much tedious work.” And while this student did not come to love research, they did develop insights about what kind of research they might enjoy better. They state,

I definitely do not want to do this again if I don’t have to. I loved interacting with the patients . . . , but not soliciting their participation in surveys. I think I’d be more interested in conducting focus groups or using casual conversations to better understand their needs. (3/40/1+2)

Especially for graduate students, who will become community health professionals on graduation, service-learning projects offer experiences for them to learn about their preferences and skill sets so they can more effectively serve their future communities. Whether their preconceived notions of research were reinforced or challenged, students expressed how these service-learning experiences changed their perceptions of research and increased their appreciation of health-related social science investigations.

A second finding, related to the theme of research among these service-learning projects, was that students derived an appreciation for the difficulty of social scientific work, as many students expressed their frustration with survey-based research. Course-based service-learning projects in these epidemiology classes were often a student’s first time conducting surveys. Many students articulated the uncomfortableness of doing such research at first but came to appreciate the difficulty of recruiting participants to complete surveys. Ultimately, both graduates and undergraduates expressed a recognition of their own experiences of personally avoiding surveyors. Reflective narratives allowed the students to critically examine their own perceptions of survey research and the overall difficulty of social science research, including a variety of factors leading to the unpredictable nature of a survey collection (weather, language barriers, survey participant time constraints, and participant health conditions).

Ultimately, student narratives indicated that they began to think about how to improve their own personal performance for future systematic data collection. Through their reflections, many students offered suggestions for how they, or future student researchers, could approach surveying to maximize its utility. The instructor discussed the concept of selection bias in the classroom and these considerations found their way into how the students reflected on and thought about survey research, throughout the service-learning experience. This not only demonstrated the ability of service-learning experiences to enhance student learning of classroom concepts but also offered them an opportunity to reflect and share their processing of conceptually difficult health-related constructs. The reflective process, facilitated by the instructor and discussed in an open online forum, allowed students to think critically about how to deal with issues as they arose and collectively develop strategies to address common survey sampling issues. Service-learning experiences provided students an opportunity to extend these epidemiology classroom concepts, which is a particularly important component of such experience since these students represent the future of health scientists and practitioners.

Qualitative Theme 2: Experience

The theme of experience also emerged across all three semesters, and as with research, the students expressed a change from the first written entry to the second. Many at first found that, while these may be hard and laborious research experiences, service-learning and the actual data collection experience was invaluable. As seen in the representative sample of responses below, these experiences beyond the classroom were prevalent themes discussed by graduate and undergraduate students.

I really did enjoy my experience with the data collection because I got to interact with people from different cultures and learned a lot about the community in only two hours. (1-5-1)

This has provided a unique experience for us to engage with community members about their health and the resources they utilize. . . . I have truly enjoyed this experience and how it has sparked my interest in data collection. I look forward to my time at the [mobile farmers market] in the future and the lessons I am able to continue to learn. (1-9-1)

Experiences through the service-learning projects not only added to the student understanding of concepts and research processes but also allowed them to develop learning strategies they could use in their eventual careers. Learning experiences beyond the classroom are an invaluable element for public health students as they provide opportunities to develop the skills necessary for quality public health researchers and practitioners.

Qualitative Theme 3: People

The final theme that emerged from the student written responses, across all three semesters, was that the service-learning projects brought the students out of their comfort zone and into interactions with the people of their community. One clear concept that relates to the theme of people was that students articulated the service-learning projects provided opportunities for them to leave the “Campus Bubble” and do meaningful work beyond their university. One undergraduate student stated,

I don’t find myself interacting with [local residents] outside of the [Campus] Bubble often, but this helped open my eyes to how necessary it is for us to reach out to those in need, rather than confine ourselves to what we find comfortable. (2/22/2)

On many college and university campuses in the United States, students never integrate with or experience the community beyond their campus border. Service-learning projects allow students to engage with other members of the community, particularly public health priority populations that may not be well represented on university campuses.

These projects challenged student biases and prejudices, and as one student reflected on her own identity, and her “introverted” nature, she expressed the challenges faced and heightened awareness of herself in the research setting. She stated,

I’m also concerned about bias from both myself and the patients. I gravitate towards people who look more welcoming/friendly so I’ll have to monitor that. I also think patients may choose to participate (or not participate) based on who I am [and how I look] . . . all in all, I think I’m prepared for this project . . . which has given me more exposure to data collection, and I can adapt to different situations so I’m sure I can bounce back even if I encounter a setback or two (or a few). (3/40/1)

This narrative is particularly poignant in that not only was the student thinking about the people with whom she was engaging, but she was also reflecting on her own self-identity, demonstrating a deeper level of processing.

Preparation

The constraint of the traditional 15-week academic semester is one challenge of service-learning for the instructor. We make three recommendations to ameliorate this universal challenge: First, identify a community partner and project in the semester prior to the course in which the project will be implemented. Clearly define the goals, scope of work, and outcomes and/or deliverables with the partner. We list the preparation activities for epidemiology service-learning in Table 1. The goals, scope, and outcomes for the community partner will be different than the goals, scope, and outcomes for the students. Separating each role will manage expectations and deliverables at the end of the project for all parties involved.

Second, if the project is defined as human subject research, submit through the university’s IRB using a timeline that allows for any necessary revisions. All epidemiology activities described in this article received IRB approval or exemption for primary data collection in the semester prior to the project initiation. CITI training (or related human subjects training, as required) was the first student assignment in the course, due the first week of the semester. As soon as students submitted completion certificates, an amendment was submitted to the IRB to include CITI-trained students as project research staff so that all students were approved to collect and manage data.

Third, once the semester begins, get started early and integrate the project often. Use the first hour of the semester meeting time to explain the purpose of the project, anticipated time requirements, and deliverables. Throughout the semester, integrate the project into lectures, classroom discussions, and other assignments. For example, in an epidemiology course, the students’ experience with primary data collection can be used in discussions of selection bias and misclassification. Students can analyze data, even with simple 2 × 2 tables, using the data that they collected. Design of an epidemiologic study, a common culminating course paper for undergraduate or graduate epidemiology students, can be linked to the content or lessons learned from the service-learning project.

Challenges

The application of our roadmap for community-partnered service-learning projects and/or evaluation methods may be limited. Undergraduate public health courses at our university typically have a student enrollment under 30, and graduate public health courses typically have an enrollment under 20. We recognize that service-learning projects and evaluation methods may be more feasible within the context of smaller programs like ours. At public health programs or universities/colleges with larger enrollment, we suspect that the personnel management of large numbers of enrolled students in a course may have an unfavorable cost–benefit balance for the instructor; on campuses with larger student bodies, electives, or content-specific classes may be smaller and more appropriate opportunities for service-learning projects.

The service-learning projects that we described in this article are all examples of local community engagement. Nonlocal service-learning projects may be challenging for many students and instructors. The feasibility of time requirements and student transportation options are important instructor considerations. In the examples presented here, several project locations were within walking distance of the university campus. For other projects, students self-organized ride sharing or other transportation to locations as necessary, which may not be available for non-local projects and partnerships.

The service-learning projects presented in this article were based in epidemiology courses, and the epidemiology faculty members had professional relationships with community partners. In our public health program, many other courses and public health disciplines use community-engaged service-learning projects as well. The feasibility of service-learning projects is easier when faculty have ongoing community partnerships; however, many faculty in our program open an “all-call” for local organizations to submit projects for student involvement.

Conclusions

Introductory epidemiology courses provide a unique opportunity for service-learning projects, which are beneficial to both instructors and students. For the instructor, service-learning experiences can be mapped to new CEPH competencies. For example, CEPH guidelines indicate that graduate public health students should demonstrate competence in evidence-based approaches to public health, including applying epidemiological methods to a breadth of public health settings, selecting appropriate quantitative data collection methods, analyzing quantitative data using computer-based programming and software, and interpreting the results for public health research or practice (CEPH, 2016). At the undergraduate level, public health students should have multiple learning experiences that facilitate an understanding of the methods and tools used for public health data collection and identification of factors that impact human health and contribute to health disparities (CEPH, 2016). Service-learning experiences can fulfill these and multiple other CEPH learning competencies and provide students with valuable public health experience in the community.

Projects described in this article represent partnership with local organizations needing data for program planning to inform future service delivery. Data collection was conducted as a service to the organization allowing students to interact with community members, identify community assets and needs, and enhance their cultural competence and humility. Additionally, service-learning projects provided students’ an opportunity to move beyond traditional academic settings and participate in community-engaged scholarship and service. Students reported positive experience and perceived these projects as extremely useful, both personally and for the community. Epidemiology instructors in other public health programs should consider service-learning projects as useful teaching pedagogical approaches to public health education.

Footnotes

Acknowledgements

The authors gratefully acknowledge Baylor Public Health Program faculty members Eva Doyle, Beth Lanning, M. Renée Umstattd Meyer, and Margo Shanks for their leadership by example with public health service learning activities.

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.

ORCID iD

Kelly R. Ylitalo

References

Bill

Casola

(2016). Developing, implementing, and evaluating a Latino service learning project in an accelerated MPH community health course for health education students. Pedagogy in Health Promotion, 2, 184-192. doi:10.1177/2373379916633716

Buckner

A. V.

Ndjakani

Y. D.

Banks

M. B.

Blumenthal

D. S.

(2010). Using service-learning to teach community health: The Morehouse School of Medicine Community Health Course. Academic Medicine, 85, 1645-1651. doi:10.1097/ACM.0b013e3181f08348

Celio

C. I.

Durlak

Dymnicki

(2011). A meta-analysis of the impact of service-learning on students. Journal of Experiential Education, 34, 164-181. doi:10.1177/2F105382591103400205

Cone

Harris

(1996). Service-learning practice: A theoretical framework. Michigan Journal of Community Service Learning, 3(1), 31-43.

Council on Education for Public Health. (2016). Accreditation criteria: Schools of public health & public health programs. Retrieved from https://ceph.org/assets/2016.Criteria.pdf

Council on Linkages Between Academia and Public Health Practice. (2014). Core competencies for public health professionals. Retrieved from http://www.phf.org/resourcestools/Documents/Core_Competencies_for_Public_Health_Professionals_2014June.pdf

Essa-Hadad

Murdoch-Eaton

Rudolf

M. C. J.

(2015). What impact does community service learning have on medical students’ appreciation of population health? Public Health, 129, 1444-1451. doi:10.1016/j.puhe.2015.05.009

Frey

Botan

C. H.

Kreps

(2000). Investigating communication: An introduction to research methods (2nd ed.). Needham Heights, MA: Allyn & Bacon.

Gebbie

Rosenstock

Hernandez

L. M.

(2003). Who will keep the public healthy? Educating public health professionals for the 21st century. Washington, DC: National Academy Press.

10.

Horney

J. A.

Bamrara

Macik

M. L.

Shehane

(2016). Epi-assist: Service-learning in public health education. Education for Health, 29(1), 30-34. doi:10.4103/1357-6283.178925

11.

Jacoby

(2014). Service-learning essentials: Questions, answers, and lessons learned. San Francisco, CA: Jossey Bass.

12.

Kolb

D. A.

(1984). Experiential learning: Experience as a source of learning and development. Englewood Cliffs, NJ: Prentice-Hall.

13.

Kratzke

Bertolo

(2013). Enhancing students’ cultural competence using cross-cultural experiential learning. Journal of Cultural Diversity, 20(3), 107-111.

14.

Maxwell

J. A.

(2012). Qualitative research design: An interactive approach (3rd ed.). Thousand Oaks, CA: Sage.

15.

McIntire

R. K.

DiVito

B. M.

(2017). An experiential service-learning project on observed smoking behavior to teach practical epidemiologic skills to MPH students, Philadelphia, 2015. Public Health Reports, 132, 392-396. doi:10.1177/0033354917698115

16.

O’Cathain

Knowles

Nicholl

(2010). Testing survey methodology to measure patients’ experiences and views of the emergency and urgent care system: Telephone versus postal survey. BMC Medical Research Methodology, 10(1), 52. doi:10.1186/1471-2288-10-52

17.

Resnick

Selig

Riegelman

(2017). An examination of the growing US undergraduate public health movement. Public Health Reviews, 38, 4.

18.

Riegelman

R. K.

(2008). Undergraduate public health education: Past, present, and future. American Journal of Preventive Medicine, 35, 258-263.

19.

Sabo

De Zapien

Teufel-Shone

Rosales

Bergsma

Taren

(2015). Service learning: A vehicle for building health equity and eliminating health disparities. American Journal of Public Health, 105(Suppl. 1), S38-S43. doi:10.2105/AJPH.2014.302364

20.

Sutton

Austin

(2015). Qualitative research: data collection, analysis, and management. Canadian Journal of Hospital Pharmacy, 68, 226-231. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4485510/