Abstract
Public health graduate students can benefit from exposure to both qualitative methods and health communication strategies early in their training. However, effective methods of integrating these constructs in an introductory course assignment have not been fully explored. This article describes a graduate public health assignment that engaged students in qualitative freelisting data collection and analysis to understand the health concerns of graduate students. Results of the freelisting exercise then informed the creation of infographics. Classroom sessions focused on instruction in freelisting data collection, data analysis, health communication principles, and infographic creation. A total of 73 MPH (Master of Public Health) students completed 355 freelisting interviews, examining the health priorities of graduate students. The most salient student priorities were sleep, exercise, eating, social/family time, balance, and mental health. Students worked in small groups to create infographics on one of the identified community priorities. Infographics were presented in class, posted in campus buildings, and shared through social media. The assignment offered students an experiential learning activity that integrated qualitative research and health communication strategies that provided a benefit to their community.
Introduction
Qualitative research methods can enable effective collaborations between public health researchers and communities and inform program planning, implementation, and evaluation (Frasso, Keddem, & Golinkoff, 2018). With recent, updated public health program competencies emphasizing cross-cutting and emerging public health areas (Council on Education for Public Health [CEPH], 2016), public health students may benefit from didactic approaches to qualitative data collection, analysis, and dissemination methods early in their academic careers in required coursework. In addition, learning the principles of effective health communication is important for future public health professionals. There are a handful of examples of incorporating both qualitative and health communication approaches into public health and health sciences coursework in the literature (Booth-Butterfield, 2003; Gutierrez & Wolff, 2017; Massengale, Strack, Orsini, & Herget, 2016; Seitz et al., 2012), but the application of these concurrent constructs in a general public health requirement is unknown.
Freelisting is an efficient qualitative data collection approach that has become increasingly popular in public health, social work, and other fields (Decker-Palmer, Thompson, George, & Frasso, 2018; Frasso et al., 2018; Lucan, Barg, & Long, 2010; Quinlan, 2017). In freelisting, participants list as many items as they can in response to a question or prompt (Quinlan, 2005). Researchers then analyze responses to identify the most salient (relevant) responses (Schrauf & Sanchez, 2008). This technique allows researchers to quickly identify community priorities and compare stakeholder perspectives. Freelisting can be used as a stand-alone method or to inform subsequent data collection (Frasso et al., 2018). Freelisting requires little training for interviewers, making it easy to incorporate into curricula, although the application of this specific qualitative technique to public health coursework is sparse (Frasso, 2014; Oberne, 2015).
Infographics present data in a visual form (graphics, maps, and/or diagrams) with limited accompanying text. Infographics are a popular and widely implemented tool for communicating public health information (Centers for Disease Control and Prevention, 2016) because they are visually appealing, designed to be quickly processed by an audience, and can easily be shared through digital and print forms (Otten, Cheng, & Drewnoski, 2015). Development of infographics allows students to gain skills in evaluating health information, extracting key insights, and applying design principles to concisely communicate those insights to a primary audience using clear goals and objectives (Shanks, Izumi, Sun, Martin, & Byker Shanks, 2017). The purpose of this article is to describe best practices from a graduate public health assignment that utilized qualitative freelisting to inform the creation of infographics focused on community health concerns. This authentic assignment offered students an experiential learning experience in an introductory course (Introduction to Public Health) that applied concepts from both qualitative research methods and health communication, topics that students may or may not have additional exposure to in either required or elective public health coursework. This activity aligns with the following CEPH MPH foundational competencies:
Apply epidemiological methods to the breadth of settings and situations in public health practice
Analyze quantitative and qualitative data using biostatistics, informatics, computer-based programming, and software, as appropriate
Interpret results of data analysis for public health research, policy, or practice
Assess population needs, assets, and capacities that affect communities’ health
Select communication strategies for different audiences and sectors
Communicate audience-appropriate public health content, both in writing and through oral presentation (CEPH, 2016)
Methods
Graduate students at a large urban university in the United States who were enrolled in “Introduction to Public Health” 1 completed the freelisting and infographic assignment as part of the course offered in fall 2017 and again in spring 2018. The goal was to create community-informed infographics for dissemination across campus. Three sections were taught in the fall and one in the spring, with a total of 73 students. 2 The institutional review board (IRB) was consulted prior to data collection, and no review was required.
Introduction to Qualitative Freelisting and Data Collection
The freelisting process was first introduced in a brief lecture. Topics covered included the assumptions behind the freelisting method, its advantages, and freelisting data collection and analysis, including sample freelisting projects from the peer-reviewed literature. We then introduced the class to the topic of the freelisting project: to understand student priorities for staying healthy while in school. 3 Students practiced conducting freelisting interviews with their classmates. Each student then collected five intercept interviews with undergraduate and graduate students not enrolled in this course. Over the course of 1 week, students approached individuals on campus in communal spaces to ask if they were willing to participate in a brief, in-person interview about staying healthy. If an individual agreed to participate, the student identified a convenient location where others could not hear to conduct the brief interview. Each student approached between five and seven prospective participants. Refusal rates were not captured; however, based on classroom debrief, we estimate that approximately 450 were approached, and 80% agreed to participate. Participants answered several demographic questions (program of study, age, gender, and campus) and responded to one freelisting question, “What comes to mind when you think about staying healthy while in school?” Interviews took an average of 3 to 5 minutes. Students entered their interview data in a shared Google spreadsheet.
Introduction to Qualitative Data Analysis
Once the interviews were complete, the instructors conducted data cleaning of the freelisting responses by standardizing words and combining synonyms. For example, “sleeping,” “getting rest,” “sleep,” and “going to bed” were combined into “sleep,” while “stressing,” “anxiety,” “stress relief,” “mindfulness,” and “de-stressing,” were combined into “mental health.” Next, the spreadsheet was converted to a “.txt” file (which meets the Anthropac format) and uploaded to Anthropac Version 4.9. Anthropac is free software for cultural domain analysis, including freelisting. Using Anthropac, Smith’s salience index was calculated. Briefly, Smith’s salience index ranges in value from 0 to 1 and is a function of both term frequency (how often a response comes up) and rank (the order in which that response appears on participants’ lists). Salience scores were calculated using the following formula: S = ([L − Rj + 1)/L)/N, where L denoted the length of each list, Rj denoted the rank of item J in the list, and N denoted the total number of lists per question (Barg, Keddem, Ginsburg, & Winston, 2009; Borgatti, 1999).
Based on a previously published approach, the terms from each free list were sorted from high to low salience scores and plotted on a scree plot with salience scores on the y-axis (Barg et al., 2009; Frasso et al., 2018; Schrauf & Sanchez, 2008). The final list of salient domains can be created by inspecting the scree plot for a natural inflection point in the slope, or by choosing a given number of salient terms (Borgatti, 1999). The standardized words were overlaid on the scree plot for easier identification of salient terms. The scree plot was presented to students, and the analysis of the findings was discussed in class. Students were shown the data screening process and discussed the multitude of phrases and terms included in each standardized word to better understand interviewee priorities.
Introduction to Health Communication and Infographics
Students were next given an introductory lecture on health communication and design best practices. Students were shown examples of LATCH (location, alphabet, time, category, and hierarchy) criteria for organizing information (Wurman, 1996). For example, information could be displayed using location as conveyed by maps, the human body, or parts of another system. Alphabetizing lists of information, such as a list of diseases, could make them easier to read. Change over time could be shown by linear visual timelines, such as the physical changes that occur with regular exercise. If comparisons were being made, information could be divided into categories, such as healthy versus unhealthy habits. Finally, informational hierarchies could be conveyed by ordering concepts from largest to smallest, such as foods from most to least number of calories.
Students were shown existing public health infographics from an internet search of ones from the Centers of Disease Control and Prevention, which they critiqued using the LATCH criteria. They were also given resources to further explore principles of data visualization (ferdio, 2018; McCandless, 2018; Tufte, 2018) and instructed on the selection of a focused infographic topic; appropriate, evidence-based public health information sources; and identification of their audience. Students then completed a group in-class activity to create hand-drawn infographics based on a topic related to that week’s lecture on violence prevention. Their infographics captured the scope of their chosen problem, who was at risk, and how to reduce or eliminate the problem. At the end of class, students shared their violence prevention infographics and received feedback from their instructors and classmates.
Infographic Creation and Dissemination
Once freelisting was completed and the salient topics were identified, students were divided into small groups of two to three students to create infographics to be disseminated across campus. Each group selected one of the salient topics as the focus of their infographic. They were provided with links to free or widely accessible software for infographic creation (Canva.com, Easel.ly, and PowerPoint). For the assignment, students were required to conduct a literature search on their selected topic and develop a detailed outline and American Psychological Association–style reference list. Each group decided what information from its outline was most relevant to include in its infographic and were required to include a small source list at the bottom of the infographic. Students submitted infographics for grading in a pdf or png/jpeg format. The students presented their infographics at the conclusion of the term. The assignment rubric addressed quality and accuracy (10 points), design (4 points), organization and layout (4 points), and compliance with assignment requirements (2 points; accounting for 20% of the overall course grade). Quality and accuracy were evaluated based on the topic clarity and specificity and the use of relevant public health data. Design was assessed based on the layout, which included objects, font, and color choices. Organization and layout were evaluated based on the inverted pyramid (main point on top, secondary point next, etc.) and the LATCH criteria. The final piece of the rubric was technical components, as judged by compliance with assignment guidelines, American Psychological Association style, and absence of spelling, grammar, or syntax errors.
Results
A total of 73 MPH students completed 355 freelisting interviews with members of the Thomas Jefferson University student body. The most salient topics related to staying healthy while in school were sleep, exercise, eating, social/family time, balance, and mental health. Infographics examples are displaced in Figures 1 and 2.
Sitting is the new smoking infographic.
Dream on infographic.
For dissemination, infographics were displayed at a college monthly lecture series and disseminated on social media. Copies of the infographics were also posted in common spaces across campus, including the campus recreation center and the student counseling center. In class, this provided an additional opportunity to introduce students to additional dissemination venues such as exhibits, reports, and community presentations.
Discussion
We found that our freelisting and infographic assignment was feasible to implement in an introductory graduate public health course. Several best practices emerged from our pedagogical exercise, which allows students to
Complete an assignment combining qualitative and health communication
Analyze data early in their academic careers
Learn to take a project from beginning to end
Learn the value of community-informed action
Make a contribution to their community
Learn how to communicate health information to a lay audience
Understand the potential need for IRB approval and the IRB’s role
Understand the importance of working with your communications or media relations office regarding the acceptable use of logos, photographs, and other trademarked or copyrighted materials
Freelisting and infographic software are freely available and easy for students and instructors to use. In addition, the assignment addresses multiple MPH foundational competencies related to evidence-based approaches to public health and communication (CEPH, 2016). Furthermore, the activity is an authentic assignment that allows students to complete a project from beginning to end, identify community priorities, and deliver relevant information to the community. Student and community feedback on the assignment was overwhelmingly positive.
Footnotes
Acknowledgements
The authors thank Renee Walker, assistant professor of graphic design communication at Thomas Jefferson University, for sharing her expertise on design best practices and the students in our PBH 501 course.
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.
