Abstract
Student perceptions and opinions regarding the relevance of course content can influence their desire and motivation to learn. Instructors can benefit from including content relevant to students’ lives, possibly leading them to take a greater interest in gaining knowledge and applying the material. This study aimed to investigate the health topics included in an introductory health course offered at a medium-sized, public liberal arts university in Tennessee and to explore perceptions of current undergraduate students regarding the relevance of those topics. Over the 2018–2019 academic year, four focus groups were conducted with 14 students who discussed their perceptions, opinions, and experiences of the course and offered suggestions regarding topics they thought should be incorporated in future iterations of the course. Participants wished that topics currently covered in the course, such as nutrition and fitness, would incorporate more experiential learning to provide greater applicability to their lives as college students. Students also expressed a desire for greater coverage of topics that they considered particularly relevant to their lifestyle and health, such as mental health, sleep, time management, and decision making. Information from this study can be used to help develop course content for undergraduate personal health courses so students can feel more connected to the material.
The number of students enrolled in postsecondary institutions grew by 14% between 2005 and 2015 (National Center for Education Statistics, n.d.), and with that growth, student populations continue to diversify. As enrollment increases among racial and ethnic minority populations, colleges and universities must adapt curricular approaches to reflect students’ diverse values. Furthermore, the idea of health as a multidimensional concept has expanded and complicated discussions about what topics are considered relevant to health. Instructors no longer focus solely on teaching hygienic practices and disease identification, but their curricula have expanded to include topics such as mental health, preventive care, emotional wellness, and social health, among others. However, there is no consistency in what students are being taught in the K–12 system across the United States.
Although there are attempts to encourage comprehensive and standardized health education curricula across the nation using recommendation and guidelines—such as Whole School, Whole Community, Whole Child and the National Health Education Standards—many states do not adhere to these recommendation, meaning that students begin their collegiate careers with inconsistent knowledge on a variety of health topics. The National Health Education Standards (Birch & Videro, 2014; Centers for Disease Control and Prevention [CDC], 2019) provided a framework of best practices for K–12 health education and encouraged states to follow the guidelines to ensure consistency in education. However, these guidelines are not necessarily required, as states each have their own varying policies and standards, as confirmed by the CDC’s School Health Policies and Practices Study (CDC, 2016a, 2016b). Students thus begin their collegiate careers with wide variations in knowledge, history, and exposure to health education and promotion.
Many colleges and universities offer an introductory health course as a means to assist students’ decision making during a period of life when they begin making autonomous decisions regarding nutrition, physical activity, sex and sexuality, mental health, stress management, and other personal habits—all of which fall under the scope of comprehensive health (Kulinna et al., 2009). Much as with high schools, though, there is little uniformity among colleges and universities in how these courses are presented and offered to students; for example, the department in which the course is taught, its status as a required or elective course, and whether it is taught by a professor or graduate student all vary depending on the institution and its priorities and values. According to the American College Health Association’s (2018) National College Health Assessment II, students report that the information they receive from their college campuses about various health outcomes does not always match up with what they desire to learn. With this discrepancy in mind, colleges could easily incorporate the desired topics into introductory health courses’ curricula, thereby increasing the relevance and interest of the course content for students. But how do we, as educators, know what students perceive as relevant to their health? We simply need to ask them.
Multiple studies have examined the impact of student perceptions on curriculum development and relevance of content to the learner, finding that students are interested in having input on topics they find relevant and that when they believe those topics to be relevant and applicable to their lives, they are more engaged learners (Gonzalo et al., 2016; Hilton, 2007; Lanning et al., 2012). Models such as the ARCS (Attention, Relevance, Confidence, and Satisfaction) Model of Motivation have been developed to improve motivational appeal of instructional materials (Keller, 1987). The ARCS model identifies the impact that relevancy can have on motivational learning and can be used to help answer the question, “Why do I need to know this?” asked by learners of their instructors. Although studies have shown that capturing attention and establishing topical relevancy can have a positive impact on students’ motivation to learn and learning outcomes, introductory health courses often focus on statistics or long-term health effects that do not adequately emphasize practical, relevant information for college students (ChanLin, 2009; Chen, 2014; Frymier & Shulman, 1995; Hodges & Kim, 2013; Huett et al., 2008; Keller, 1987). Accordingly, the purpose of this study was to gain insight into the topics college students would like to see incorporated into an introductory health course.
Method
The present study was conducted at a medium-sized, public liberal arts university located in Tennessee, and prior to data collection, the study was approved by all relevant institutional review boards. Since the study’s guiding research questions focused on uncovering students’ perceptions on topical selection and personal relevance, the research team decided on a qualitative case study design using focus groups to allow students the capacity to discuss with each other various topics and insights, which could then be captured for thematic analysis. The use of focus groups as a qualitative approach can be highly beneficial as a tool to gather data regarding the insights and perceptions of participants regarding a specific issue or experience (Basch, 1987). For the present study, the focus groups were guided by a semistructured set of questions, and questions were designed around the ARCS Model of Motivation construct of “relevance” (Table 1).
Semistructured Focus Group Question Guide.
Members of the research team visited introductory health courses (located in a single university department) and read a prepared institutional review board–approved script that explained the goals of the study to recruit undergraduate students purposively into focus groups. Students were entered into a drawing for a gift card as an incentive for participation. After a week of recruitment, 66 students indicated interest in participation, and after deciding on a date and time of the focus groups, the number of available students was reduced to 14. These students were placed into four groups based on their availability: three groups had four participants, and one had two participants. Although the ideal size of focus groups usually falls between five to six participants, smaller groups can be beneficial and are increasing in popularity due to the increase in comfortability among participants. Although this may mean an increase in the number of groups conducted to ensure saturation, it helps the participants feel more comfortable during the groups, which can lead to deeper insights (Krueger & Casey, 2014). The focus groups were held in an empty departmental classroom and lasted about 45 minutes each. Groups were heterogeneous, including both males and females, and students ranged from freshman to seniors.
Focus group questions were guided by a semistructured interview guide, and students were given the opportunity to answer, discuss, debate, suggest, and share their opinions, perceptions, and experiences related to their introductory health course. Focus groups were audio-recorded, and the moderator made notes regarding specific phrases, body language, and clarifications. Recordings were transcribed verbatim, and transcripts were individually open coded by two members of the research team using a structural coding method. After completion of individual coding, the research team met to make comparisons and examine potential areas of disagreement. Interrater reliability was high initially, at 94.55% (Hallgren, 2012), and the third member of the research team assisted in achieving consensus. The final set of codes were then analyzed to uncover overarching and crosscutting themes.
Results
During the focus groups, 14 current undergraduate students discussed their perceptions regarding the topics included in their introductory to health course and how they related to the health of college students. Through the analysis of these discussions, the following themes emerged.
Theme 1: Satisfaction With Current Topics
Students discussed topics covered in the course that they enjoyed, as well as those they felt were repetitive. Regarding topics students found satisfying, one remarked, “A lot of the fitness and flexibility and stuff we touched on [in high school] but didn’t go nearly as in depth as we did in the [introductory health] class.” Students also appreciated discussing general topics, such as body mass index (BMI), sexually transmitted diseases, and nutrition: Taking this course actually gives like a brief reminder, like a refresher, saying, “Oh, OK, this is something that happens to us, and it’s good to be informed about it again so that you remember later on in the future.”
However, students also reported that they found some of the topics covered to be redundant. One commented that the curriculum “can be repetitive and overlapping too much.” Another student agreed, saying, “A lot of what we talked about nutrition seems to be repeated over and over again, and it’s never new information.” Continuing with this theme, yet another participant remarked: For me, it was a repeat because in my high school we had broken up classes like PE and then health education, so the health part of it with, like, the BMI, we touched on in high school, and then with the anatomy, I took anatomy in high school and college, and so those were a repeat.
From the students’ responses, it was clear that materials were not being taught at an advanced or mastery level.
Theme 2: Relevance
The second theme uncovered from the focus groups related to specific health topics: those that were currently included in the course, those they wished would be included, those they felt related to them, and those they perceived to be relevant to their peers. Some of these responses included topics students specified they would like to see included in future curriculum.
Students responded in different ways about how they felt the course was relevant to their interests and current lifestyles. For example, though the course focused heavily on personal health, one student expressed a desire for more of a global focus, commenting, “We talk about health, [but] we’re just typically talking about health in the United States . . . but I was kinda hoping it would be more on a global scale.” Another expressed a desire for course information that reflected the institutional resources available to college students: Maybe it [is not covered] because there’s a nutrition class that’s offered, but . . . I feel like [the course] needs to hit on more of what a healthy college diet could be based on what we have here on campus.
Finally, other students simply found some material to be boring, “. . . like the nervous system and stuff like that, heart valves and the brain anatomy and all the stuff.”
Students also listed topics they would like to see included that were more related specifically to student health. In particular, multiple students suggested that mental health was not being given sufficient attention, one noting that “mental health seems to be a prevalent issue that isn’t really being addressed.” Another expounded on some typical stressors common among college students, commenting, “I would say that [it] includes who you’re hanging around with, the influence . . . like what they make you do, and [drinking] alcohol too.” Regarding health behaviors, one student recalled, “I remember going over smoking and things that contributes to, but I don’t remember doing anything with vaping, with how popular that is today,” suggesting that course materials might not have been adequately keeping up with student behavioral trends. Other general student health topics for which students expressed a desire to learn more included “exercising and eating right” and “time management [and] lack of sleep.”
Last, students noted that topics were taught based on what their instructors expected for their future careers. One participant remarked: As far as prevention and just general sexuality, it was stated in the class that we’re just going to skip it because we weren’t expected to teach it in Tennessee. So, we kind of fell short on that whole topic which was kind of disappointing.
Another student concurred, indicating feeling as if their education were lacking when compared with peers at other institutions as a result: So, in order to be competitive, you would want every student to have the same information and you could almost argue students outside of the Bible Belt or southern region are getting a better education on certain topics than we would be [receiving].
In these cases, students expressed a desire for education that would benefit them in multiple settings and locales, not just regional ones.
Theme 3: Applicability
One final theme that was mentioned by several participants related to applicability. Participants discussed the desire for “hands-on” approaches to the topics. Though, in general, they enjoyed the exercise and diet aspects of the course, they expressed a desire to have spent more time practicing and being guided on proper form for exercises, as well as being shown how to eat healthfully as a college student on campus. One student stated, “I feel like it needs to be hit on more of what a health college diet could be, based on what we have here on campus.” This sentiment indicates students are interested in nutrition and find the need to eat healthy relevant to their lives, but educators may be focusing on the topic in a way that does not correspond to the current environments in which students live.
Discussion
The aim of this study was to understand student perceptions regarding topics included in introductory health courses and the relevance of those topics to undergraduate interests and health. For this particular case study, the course syllabus was heavily designed around exercise, physical activity, and nutrition, with very little mention of other dimensions (i.e., social, emotional, intellectual, spiritual) of wellness. Furthermore, students felt as if the existing topics were not taught in a way that helped them apply what they learned in their everyday lives. For example, lessons on tobacco were heavily focused on cigarettes rather than vaping, and discussions about nutrition were generalized and not specific to college health. While it is important to provide students with information that may become more relevant as they age, it is equally necessary to “meet them where they are” currently.
Though discussions initially focused primarily on levels of satisfaction with existing course topics, when asked by the moderator about what health topics they felt were relevant to college students, participants identified many other areas and factors of health, such as “sleep,” “decision making,” “stress,” “social influences,” “time management,” and “mental health” issues. Several students indicated they did not have enough time to sleep, eat healthy meals/snacks, exercise, complete class assignments, work, and socialize. They discussed how this lack of available time exacerbates stress, which can lead to anxiety and mental health issues. As most of these topics can be taught using a skills-based approach, there is an opportunity for instructors to use the ARCS model to develop lessons regarding these health topics. Skills-based lessons can be developed with the intention of capturing students’ attention, illustrating the relevance of the topics to their current lifestyle and environment and allowing them to develop confidence and satisfaction with their new skills on included topics. For example, when addressing exercise and physical activity in such a course, the instructor could hold the course in the university recreation center. One of the facility trainers could walk the students through a workout showing how to adapt each move based on fitness level or other restrictive factors, and students could practice this as a weekly assignment. This can help ensure their attention is better captured since they are actively learning a skill, the use of the campus recreation center is timely and relevant to where they are in their lives, and the trainer is helping them gain the confidence to perform the new workout, which should lead to the students being satisfied with their learning of an applicable concept. Skills-based learning should simulate the students’ natural environment, allowing them to gain experience in practicing these skills (World Health Organization, 2003). Such teaching approaches have previously been found to be successful in helping students develop skills, including those specifically related to the health field (Barsuk et al., 2012).
Students shared various opinions about the inclusion of mental health as a topic. Many agreed it should be included, and one mentioned a desire to be educated on how to identify and address mental health issues using experiential approaches. However, when it was brought up by a student in one group, another argued he felt it was not relevant to health and should be covered in a psychology course instead. This led to the moderator posing the question of what students thought of when they thought of the term health. All stated “physical health,” while fewer students mentioned “mental health” and “stress.” These findings emphasize the need to address health as a multidimensional concept, as students in this particular study tended to associate other nonphysical dimensions of health as secondary considerations. This could be an indicator of environmental and cultural norms, or it could have simply just not been something these students had considered prior to this study. Future studies should investigate how students define and conceptualize “health.” Additionally, health educators need to continue to work within the K–12 system to ensure health issues are addressed throughout middle and high school, including the nonphysical dimensions of health, as suggested by the National Health Education Standards and the CDC’s School Health Policies and Practices Study (CDC, 2016a, 2016b, 2019). Some participants in the present study felt that by the time they were hearing some of the health information, it was “too late.”
Furthermore, it is critical that health educators emphasize standardization of content. When several students discussed something that was covered in their course, other students would indicate they had not covered that topic in their course. One such example was sexual health. One student indicated their instructor briefly mentioned STIs but would not cover the topic in depth, because as future educators in Tennessee, they would not be expected to teach it. One student mentioned that their instructor seemed uncomfortable with the topic and asked someone else to teach the topic for him, yet another talked about her instructor being very informative regarding sexual health, discussing prevention, testing, and treatment. Taken together, these conflicting reports suggest instructors may choose not to teach certain topics, like sexual health, based on their own personal comfort. If so, students thus receive unstandardized, unequal educations that may not adequately prepare them to teach certain topics, particularly if they seek employment in a different state.
Limitations
As with any qualitative research study, these findings must be interpreted with a few limitations in mind. Participants were undergraduate students from a single university who were majors in the department that housed the course. Although this selection criterion was intentional because relevancy to future coursework in the program was included in the research questions, the findings can be generalized only to this specific case. Additionally, as with all qualitative studies, transferability to other populations/institutions is not possible nor intended. Furthermore, the number of participants and the timing of the study may also be limitations. The focus groups were conducted in November, meaning that Thanksgiving break and final exam preparation may have affected the number of students who had time to meet during the scheduled times.
Conclusion and Implications
This study provided insight into what health topics students find relevant to their lives and how they would like to see them incorporated into an introductory health course. In general, students felt the course included topics they expected to see (e.g., diet, nutrition, fitness), but they would have liked the delivery to be more hands-on and applicable to their lives as college students. They also identified topics they would have liked to have covered (e.g., mental health, sleep, time management, decision making) that they believed to be relevant to their lifestyle and health. This study can be helpful for administrators and departmental curricular committees in determining what topics college students perceive as relevant and needed in a comprehensive introductory health course. Moreover, our findings underscore the need to conduct formative research prior to implementing curriculum to ensure students feel connected to the course material, motivated to learn, and interested in developing healthy behaviors that can serve them throughout their lives.
Footnotes
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.
