Abstract
The role of community colleges in training public health professionals is of growing importance to the continuum of public health education. Some 5 years have passed since the Framing the Future initiative outlined curricular models at community colleges, and colleges deploying these models are serving as learning sites for public health education at community colleges. While past research has focused on capturing insights from community college executives and program administrators, this study captures perspectives from teaching faculty. Drawing on a national sample of teaching faculty at community colleges and universities accepting transfer students throughout the United States, an online survey of teaching faculty affiliated with public health programs was coupled with follow-up interviews. This study characterizes the nature and scope of public health programming in community colleges and transfer settings, and highlights associated challenges and opportunities as public health becomes further integrated into health professions pathways in 2-year settings and beyond.
Background
The role of community colleges in U.S. public health education has been gaining attention in recent years. U.S. community colleges, also often described as junior colleges or technical colleges, typically focus on providing general education and vocational training through certificates and 2-year postsecondary associate’s degrees. Community college students represent an estimated 38% of all undergraduates in the United States (Community College Research Center, 2020; National Center for Education Statistics, 2018). Close to one third of community college students are first-generation-to-college and more than half self-identify with non-White race/ethnicities (American Association of Community Colleges, 2020). Community colleges thus offer an important opportunity to extend public health education to new audiences and affirm efforts to diversify the public health workforce.
This study builds on prior work by examining the perspectives of teaching faculty on public health programming at community colleges and affiliated universities accepting transfer students from community college programs. Past research has provided insights from community college executives and high-level program overviews, and presented models for new program development (Beebe et al., 2016; Haywood et al., 2017; Johnson, 2016; Petersen, 2016; Riegelman et al., 2014). The aim of this current exploratory research was to capture perspectives from faculty currently teaching public health within these settings, in order to provide classroom-level insights on public health education.
Method
Mixed-methods procedures were used to gain insight into the perspectives of teaching faculty across a range of public health program types in community colleges and affiliated transfer programs. The study design was submitted to the institutional review board at Elon University as expedited research and was approved in March 2019. The quantitative portion of this study consisted of an online survey of teaching faculty teaching public health and health professions coursework within a convenience sample of community colleges and affiliated universities accepting transfer students across the United States (n = 27). Participants were solicited from a community of practice comprising community colleges and universities participating in public health program development that has been previously described; this community of practice represents community colleges and universities located in a range of settings, many serving underrepresented communities throughout the United States (Johnson et al., 2019). Invitations were sent via email through public health program managers at each community college and university to help assure that invitations reached intended faculty. The qualitative portion consisted of follow-up interviews with a subset of study participants (n = 5). Survey data were collected from April to May 2019, with follow-up interviews occurring in two waves beginning in August 2019 and January 2020. While small in scope due to relative newness of public health programs at the 2-year college level, this exploratory study provides a first descriptive snapshot of teaching faculty perspectives on evolving forms of public health education at community colleges and universities accepting transfer students.
Quantitative Results
Respondent Characteristics
To preserve the anonymity of respondents within this small exploratory data sample, demographic data were not examined. However, Table 1 provides a summary of respondents’ reported program affiliation and teaching profile. A majority of respondents came from community college settings, that is, institutions of higher education offering associate’s degrees (81%) and certificates for academic credit (39%). Beyond community college coursework, approximately one third of respondents worked at transfer institutions offering bachelor’s degrees (31%), master’s degrees (27%), or doctoral degrees (23%). Only 8% of respondents indicated that their employers offer noncredit certificate programs. The specific teaching profile of respondents shows a similar distribution. Close to two thirds of respondents reported teaching in associate degree programs (65%), followed by academic certificate programs and bachelor’s degree programs (each 31%). A smaller proportion of respondents indicated teaching in master’s programs (15%), noncredit certificate programs (8%), and doctoral programs (4%). A majority of respondents reported teaching two to three courses per semester (58%), followed by those teaching four to five courses (27%). Smaller proportions teach one course or fewer, or six courses or greater (12% and 4%, respectively). Throughout the survey, participants were free to skip any question they chose not to answer, causing the n to vary by line item in Tables 1 and 2.
Self-Reported Profile of Survey Respondents.
Note. Values presented as % (n).
Public Health Coursework at Community Colleges and 4-Year Universities.
Note. Values presented as % (n). N/A = not applicable.
Public Health Coursework at Community Colleges and Transfer Universities
Faculty were asked to report teaching load for the Spring 2019 semester, including course titles, course format, time of day offered, and whether courses were unique to a public health program or offered as general education. A total of 57 distinct courses were described for Spring 2019. Of these, three quarters were taught in community colleges, with the remainder reported at bachelor’s degree–granting universities articulated with community colleges.
For both community college and transfer settings, a majority of coursework was offered in hybrid or fully online formats, with only one third of coursework in a traditional format of fully face-to-face instruction (33% and 29%, respectively). Community colleges reported a higher proportion of course offerings scheduled later in the day (weekdays after 4 p.m.) compared with universities (30% vs. 14%, respectively). Yet community colleges also reported a slightly greater proportion of weekday courses before 4 p.m. (49%) when compared with universities (43%). Both settings reported close to 90% of courses as program-specific instead of general education. That is, most of the courses are designed for specific professional training as compared with courses for general liberal arts and sciences.
Table 2 provides further delineation. The table also highlights the range of course titles reported in both settings, from topics in health care and epidemiology to health promotion and communication. The most commonly reported course title for the community college sample was Introduction to Public Health (n = 9), and for universities, internship experiences (n = 3). In both community college and transfer settings, the majority of respondents reported that their programs use guided pathways, a comprehensive approach to program design focused on student success. A guided pathways approach focuses on systematically aligning efforts to assign all college courses and programs to a pathway, map pathways to student end goals, help students select and stay on a pathway, and monitor student learning and success (Bailey, 2017; Jenkins et al., 2018). Ninety-two percent of community college respondents and 57% of respondents from a 4-year university setting reported that guided pathways were in use. An additional 8% of community college respondents and 43% of transfer setting respondents reported that guided pathways were being considered or in development. For transfer scenarios, only 12% of teaching faculty in transfer settings indicated receiving notification when transfer students from community colleges enroll in their courses.
The survey also queried faculty on the impact of students’ real-world experience on the classroom. Fully 86% of respondents indicated that teaching class content was “often” easier because of the life experience shared by students, consistent across community college and transfer settings. When asked inversely (if teaching class content was perceived as harder based on student life experiences), 66% of community college and 83% of transfer faculty indicated that this was “rarely” the case (Table 2). Finally, a majority of community college faculty reported “often” providing career advice to students during class (69%) and outside class (73%), compared with 4-year university faculty during class (43%) and outside class (57%). These figures further reinforce the interconnections between classroom learning and professional growth.
Qualitative Results
Challenges and Opportunities for Public Health
A small selection of follow-up interviews was conducted to provide additional context regarding faculty perspectives on public health education (n = 5, 19% of survey sample). Within this sample, respondent data from community colleges (n = 3) and 4-year universities (n = 2) were pooled to preserve anonymity. A thematic analysis was conducted to explore faculty perspectives on teaching within public health programs through a process of compiling, disassembling, reassembling, interpreting, and concluding (Castleberry & Nolen, 2018). Three central themes are presented below that further contextualize the survey findings: (1) tradeoffs in online learning, (2) guided pathways integration, and (3) jobs and career advising. Given the small data sample, further thematic analysis was beyond the scope of this study.
Tradeoffs in Online Learning
Follow-up interviews with survey respondents highlighted varied perspectives on the role of online learning in public health programs. Not surprisingly, the most commonly reported benefit of online learning highlighted by participants was that it provides greater access and flexibility for working students and students geographically distanced from the learning site. As one participant summarized, we still have a lot of students who are working two to three jobs or have four kids, are coming quite a distance to come to school, so we have students that really appreciate if some of those introductory courses could be done online because it is one less trip to campus.
Other participants reported that certain students simply excel in online formats and that it allows students to take greater ownership of their learning. For example: “I think the good thing with online is that it really forces the student to take more ownership instead of passively learning the material” or “I think sometimes stronger students are drawn to the online classes.”
From an administrative standpoint, it was also noted that online courses are popular among students and fill quickly, a powerful incentive for online program growth. As one participant noted, “they just sell.”
However, challenges persist. Respondents noted that not all material is equally suited to online learning, and not all students succeed in this format. In an applied discipline like public health, certain material may not transfer well to online platforms, requiring intentional selection of online versus in-person coursework. For example: “sometimes I am concerned about when we are making choices about what goes online and what doesn’t . . . Sometimes I worry if that gets lost when it is being done online.” It was also noted that the convenience of online formats may be perversely incentivizing on-campus students to enroll in online formats “because they don’t want to get out of bed.” Respondents also noted that while online learning allows students to enroll from anywhere, the downside is that “having good Wifi is a challenge.”
Guided Pathways Integration
A second theme was guided pathways. Participants underscored two key benefits from integrating public health into preexisting guided pathways initiatives taking place in their settings. First, public health fills a perceived need. It was noted that not all students will thrive in traditional clinical and allied health programs, and public health provides an academic and professional home for students who need or want an alternative to these clinical health degrees. For example: So the nursing majors, they have to take [two bio courses] which can be hard for some students, I think also pharmacology is hard for some students. Some students will take it three times in hopes that eventually they are going to pass it. So with the public health major we have [a different bio course], and that is like biology basically for non-majors and it is a mix of information from [nursing bio courses] but it is just for non-majors. So I think it could be easier for some students. I’m not sure what else is different, but those are the big gateway courses that end up blocking students out of nursing, and public health could come in and we are more than happy to give students credit if they have taken [nursing bio courses], we would totally waive the [bio for non-majors] requirement.
And second, some participants noted that it provides a platform for broader support of student transitions across the continuum of public health education and the health professions workforce. Not only do students join public health from allied health, but students may also use public health as a springboard into clinical professions. For example, one participant noted: Public health degrees can be utilized in various other fields also like medical, dental, wherever you go. So we really keep track of what the students are doing after the degree. After they complete it we always encourage the student to go for at least a bachelor’s degree, because then only they can earn a decent sum and get a decent job.
Participant interviews also articulated challenges. Respondents noted that while guided pathways can help students identify public health out of a suite of programs, current structures do not always provide the same level of support for students not entering the pathway in their first year. Another challenge noted was that sometimes public health programs may be too “rigid” in programming sequences, or siloed within old organizational structures that can be challenging to shift. For example: “Our new part of our strategic plan is going to be guided pathways. And so our school is trying to get there but our school is siloed and we are working to break down some of these barriers.”
These conversations also highlighted the program-specific knowledge required to sufficiently support movement within pathways, and that these details can vary widely by program. For example, one participant noted that because their program is small, they are able to individually guide students through these questions: “We have limited students but that is also an advantage because we know our students on a personal basis and level so we try to reach out and guide them.” It is worth noting that the concept of guided pathways is deployed in varying ways across institutional contexts, further reinforcing the need for clear program-specific advising.
Jobs and Career Advising
Job placement and career advising was a third core theme explored in the interviews. Many participants saw both challenges and opportunities within this area. An important challenge highlighted by participants was the need to balance enthusiasm about program growth and fittingness with uncertainties pertaining to job availability. For example: “We have had some success [in students getting hired], but in thinking about growing our program I don’t feel as though we have enough nor the capacity to place large numbers of students in jobs.” Another participant noted, This transition [from school to the workforce] has been challenging for some people and because of budget issues all around; it’s not unusual for employers to have part-time jobs. I see that across the US and I definitely see it here.
Other associated challenges were noted regarding a need to better understand and articulate the role of public health in health care and to encourage students to consider additional skillsets to supplement public health degrees: I think that helping our students to see and understand that just getting a public health degree may not open all the doors that are possible and [they] need to explore how you can have a public health degree plus nutrition or computer science or marketing so they are more marketable when they graduate. Just figuring out the role of public health in this health care system and emerging system, I feel like we don’t have a really good solid handle on that, which I think is important as we think about graduating students and ushering them into the workforce.
On the other hand, some participants were more optimistic about career opportunities in public health. Some noted receptive local job markets that “love our students either for internships or for jobs,” while others focused on helping students tell their story and creating opportunities for leveraging alumni networks. For example: And once a semester, the department hosts what is called a “Meet and Greet” and the next one is coming up in a couple of weeks. As of right now there are 30 different employers, organizations in this area who typically hire our students. They are coming to meet with students, and field resumes, talk about internships, volunteer/job opportunities. So I think probably the meet and greet is the most important aspect for students who are preparing to graduate, and those early informational interviews are important when students first come to us. Many people who have graduated are now working here doing public health work in the community so we stay in touch and I find that many agencies are willing to work with students and they benefit from that opportunity, versus if we were in a large place, I don’t know if there would be that kind of connection.
Discussion
This small cross-sectional study provides only a snapshot of public health programming and may not represent the broader community of public health education across diverse 2- and 4-year program contexts. Yet the study provides an encouraging snapshot of public health programming in 2-year settings. Robust course offerings and a commitment to student learning are evident with the survey findings, and follow-up interviews suggest that teaching faculty within public health programs are motivated to help students navigate challenging environments within the academic context and beyond.
The survey and follow-up interviews highlight considerable variation in program models, ranging in degree type, classroom format, and course requirements. While this phenomenon increases individual programs’ capacity to tailor program offerings to local employer needs and articulation arrangements across 2- and 4-year partner settings, this variability may be confusing to students and pose challenges if they seek to transfer to colleges or universities beyond the local context. This aligns with existing research highlighting structural barriers associated with successfully completing bachelor’s degrees (American Association of Community Colleges, 2012; Fink & Jenkins, 2017; Goldrick-Rab, 2010; Jenkins & Fink, 2016; Monaghan & Attewell, 2015). Diversity in programming will likely continue, particularly as no standard accreditation for public health currently exists at the 2-year college level.
It is interesting to note the differences in hybrid and fully online course offerings were nearly complete opposite for community colleges as compared with 4-year universities. Whereas more 4-year programs are currently offering a greater percentage of fully online courses, 2-year colleges are offering a greater percentage of hybrid online courses within this sample. Given the potentially long-term impacts of the coronavirus pandemic, these differences may change further in the future. As trends toward online and hybrid learning continue, it will be important for new programs to be fully aware of the benefits and drawbacks of varied forms of fully or partially online learning highlighted in this study and in past research (Goldrick-Rab, 2010; Jaggars & Xu, 2016; James et al., 2016; Kauffman, 2015; Means et al., 2009; Xu & Jaggars, 2013). These are important considerations for programs wishing to support the success of all students. It will also be necessary to delineate practices for “emergency remote teaching” and learning that is intentionally designed for online formats (Hodges et al., 2020).
The higher level of survey respondents reporting use of guided pathways at community colleges (92%) as compared with 4-year universities (57%) may be due to current national initiatives focused on guided pathway development in community college settings. It is encouraging to note that in 4-year university settings where guided pathways are not yet in use, survey respondents consistently reported that guided pathways are being considered or are in development. As greater emphasis is placed on supporting successful transfer practices across 2- and 4-year settings, it is hoped that guided pathways work will also become aligned in the future.
While diversity in programming appears a benefit at this stage in public health degree development, these questions will surely need to be addressed in the future. Furthermore, continued political and economic support is needed to have ongoing job placement and career opportunities for graduates of 2-year and 4-year degree programs. More research is needed to better understand how program variation and student outcomes relate to one another in public health settings.
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.
