Abstract
Experiential learning is a critical aspect of undergraduate public health education. However, there is limited literature on the implementation of experiential learning in undergraduate public health programs. The course “Biology in Public Health” was developed to better link population-level public health concepts with the biological sciences through multiple experiential learning opportunities. The course provides students opportunities to apply concepts of population health and biological sciences to their own lives and the lives of others. The course includes several experiential learning components and over its tenure has been adapted to increase the emphasis on experiential learning. Three core experiential components that have been the basis for the class since its inception are: (1) weekly mindfulness and meditation practice, (2) guest presentations by individuals living with the week’s health condition, and (3) participation in an optional 10-day whole-food plant-based diet intervention. Data from course evaluations and surveys of diet intervention participants show impacts on students’ health behaviors and attitudes. Thirty-eight percent of students self-reported utilizing meditation outside of class to manage stress at the end of the semester, and all participants in the diet intervention stated that they would decrease their animal protein and dairy intake at the end of the intervention. This article provides an overview of the course structure and details the experiential learning strategies utilized to promote students’ active experimentation with health behaviors, improve student comprehension of the impact of stress and diet on health outcomes, and foster the utilization of this knowledge in their future public health careers.
Introduction
While biology focuses on the study of living organisms, public health more broadly involves the study of communities to fulfill the goal of “preventing disease, prolonging life and promoting health through the organized efforts of society” (Acheson, 1988). Public health practice largely takes place in communities, which requires training and education that mirror the “unpredictable dynamics of real-world challenges” (Frenk et al., 2015 ).
The Council on Education for Public Health (CEPH) developed foundational domains for bachelor’s degree programs in public health. In addition to learning about population health approaches and interventions, students are expected to learn about “the underlying science of human health and disease” and the “socioeconomic, behavioral, biological, environmental, and other factors that impact human health and contribute to health disparities” (CEPH, 2016). CEPH also requires that all students have “opportunities to integrate, synthesize, and apply knowledge through cumulative and experiential activities” (CEPH, 2016), often gained through experiences outside of the classroom, such as service-learning courses or internships.
Experiential learning was most notably described by Kolb (1984), who highlighted the influence personal experience and environment have on learning and knowledge construction. Kolb noted that greater academic learning happens when coupled with intentional opportunities for students to reflect and act upon concepts addressed in their coursework (Mukhalalati & Taylor, 2019). Kolb’s experiential learning theory states that learning happens, and knowledge is gained, through a combination of both grasping and transforming experience (Kolb, 1984). Grasping experience happens through both feeling (Concrete Experience) and thinking (Abstract Conceptualization), while transforming experience happens through watching (Reflective Observation) and doing (Active Experimentation) (Kolb et al., 2001). These experiential learning components are seen as a four-stage cycle, with learners experiencing a new situation (Concrete Experience), reflecting upon this new experience (Reflective Observation), developing new ways of understanding the world based on the experience (Abstract Conceptualization), and ultimately applying this new understanding to the world around them (Active Experimentation).
As was addressed by Chorazy and Klinedinst (2019), there is limited literature about the implementation of experiential learning in undergraduate public health programs. However, there is evidence that integration of experiential learning components into traditional lecture-based university courses increases knowledge and integration of learning in public health (Bliss & Marsh, 2021; Dundas et al., 2017; Gardner et al., 2018; Nelson-Hurwitz & Lee, 2021; Payán, 2021), as well as in medical education (Hutchinson & Liben, 2020; Pérez-Cornejo et al., 2021), allied health (James et al., 2019), and the biological sciences (Jeffery et al., 2016).
Students traditionally learn the biological sciences outside of a college of public health. The course “Biology in Public Health” was developed to better link population-level public health concepts with the biological sciences, through experiential learning opportunities both in and out of the classroom. In an effort to improve learning and comprehension, the course provides students opportunities to apply concepts of population health and biological sciences to their own lives and the lives of others. This builds empathy and compassion for the topics addressed and the people they affect, and better prepares students for careers in health promotion.
This article builds upon previous research done on the course (Valdez et al., 2018), which showed that engagement in the course’s optional 10-day plant-based diet intervention impacted student participants’ understanding of the influence of diet on multiple health conditions, caused them to change their diet in some way, and significantly changed their key biometric indicators of cardiovascular health. This article provides an overview of the course structure and details the experiential learning strategies utilized to promote students’ active experimentation with health behaviors, improve student comprehension of the impact of stress and diet on health outcomes, and foster the utilization of this knowledge in their future public health careers.
Overview of Course Structure
Biology in Public Health is an undergraduate course designed for non-biology students and is focused on the biology and public health implications of selected common conditions across the lifespan (Figure 1). The conditions are discussed at each level of the social-ecological model (Centers for Disease Control and Prevention, 2022), from the individual who has the condition (including the biology and physiology), to the families and immediate communities impacting and impacted by the condition, to the influences of society and public policy.
Biology in Public Health course topics.
In addition to learning the biological processes involved in key diseases and conditions addressed in public health efforts, the course focuses on two critical mitigating factors that offer opportunities for public health intervention—stress and nutrition. The course highlights the role of epigenetics in disease manifestation, emphasizing the reality that the genes you received from your parents are not “your destiny” but, instead, are greatly influenced by your environment. Students learn about the physiological impacts of stress and diet on disease manifestation and discuss strategies for promoting these concepts at the personal, interpersonal, and societal levels. Rather than utilizing a traditional biology textbook, the course pulls from several texts focused on the influence of stress, nutrition, and epigenetics on disease manifestation, including The China Study (Campbell & Campbell, 2016), Why Zebras Don’t Get Ulcers (Sapolsky, 2004), The Biology of Belief (Lipton, 2016), Undo It (Ornish & Ornish, 2019), and Blue Zone Solutions (Buettner, 2015).
Each course session follows the same structure (Figure 2),beginning with 5 minutes of guided meditation as an example of managing chronic stress. Students then have the unique opportunity of listening to a guest speaker share their story of living with the health condition being discussed. The students ask questions to further clarify what it is like to have the condition, learning its effect on the individual, family, and community. Following the discussion with the guest, a health science faculty member presents the basic biological information of the week’s condition. The presentation is broken into two 20-minute segments, each followed by the instructor posing two questions related to the readings and what was presented orally. The students break into groups of four or five to discuss the questions. In the small groups, students are encouraged to tell their peers what they gained from the readings and presentations. One or two of the groups summarize their comments and present them to the whole class. After an additional 20 minutes of presentation by the guest lecturer, the students again break into small groups to reflect on two additional questions.
Course session format.
During the last segment of each session, the student groups apply their knowledge gained about the week’s topic by researching three thought-provoking questions developed by the instructor. Question topics span the social-ecological model, from individual-level health outcomes (e.g., What effects do adverse childhood experiences have on aging?) to public health policy-level changes (e.g., Should there be limits on what can be purchased with SNAP benefits?). The session ends with student groups sharing their findings.
Each week students write a reflection on the assigned readings, answering three reflection questions. This includes two questions answered prior to the week’s class (What did you think you knew about this condition prior to the readings and the presentation? What do you want to know about this condition?) and one following the class (What did you learn and add to your knowledge base?).
Key Experiential Learning Components
Three core experiential components that have been the basis for the class since its inception are: (1) weekly mindfulness and meditation practice, (2) guest presentations by individuals living with the condition being discussed, and (3) optional participation in a 10-day whole-food plant-based diet intervention.
Mindfulness and Meditation
Chronic stress has been identified as a key pathway through which social determinants of health can lead to poor health outcomes (Prather, 2020). Exposure to stress is influenced by our environment. As a result of structural inequities, individuals from historically marginalized groups are more likely to experience chronic stress. In addition to policy-level efforts to address the root causes of chronic stress, there is a need for programs targeted at helping individuals cope with stress.
Meditation practice has been identified as one useful strategy for reducing psychological stress in individuals and has been linked to potential epigenetic changes that can improve overall health and well-being (Venditti et al., 2020). The first session of the class sets the stage for the focus on mindfulness and meditation as key strategies for managing stress, with an hour of discussion on the science of stress and mindfulness, followed by 2 hours of practicing different mindfulness meditation strategies. Thereafter, each session of the class begins with 5 minutes of guided meditation. Each week’s meditation is different, with the goal of introducing students to multiple styles of meditation to assist them with finding the style that best fits their needs. By learning and practicing mindfulness techniques alongside learning the biology of stress response, the aim is to help students experience the potentially positive effects mindfulness can have on their own health and the health of others, and to center the influence of stress on health outcomes in their future public health work.
Guest Speakers
Storytelling is a valuable experiential learning strategy and has been noted as a particularly useful strategy in the education of future healthcare professionals to promote positive and empathetic engagement with patients (Day, 2009). Prior to a lecture on the biology of the week’s condition, a guest speaker is invited to tell their story, describing the impact of the condition on their personal health, their family, and the broader impacts the condition has on society. For example, a 23-year old guest told his story of being diagnosed with leukemia in high school and later contracting several opportunistic bacterial infections that landed him in the intensive care unit for 3 months. The impact on his family was significant and continues. After the guest shared his personal story and answered questions from students, a faculty member with expertise in infectious disease drew upon the stories told to convey the biology of infectious disease and immune response. Each week’s guest story provides students a face to connect with the biological and physiological processes the students would traditionally read about in textbooks. They also humanize the realities of health inequities and the influences of social determinants of health, showing the effect factors like poverty, education, and access to healthcare can have on health outcomes.
Diet Intervention
Ensuring access to a healthy and nutritious diet is key to reducing chronic disease risk and has been identified as a critical target for public health intervention (Office of Disease Prevention and Health Promotion, n.d.). The course’s primary text, The China Study (Campbell & Campbell, 2016), details multiple research studies on the role one’s diet, and particularly a whole-food, plant-based diet, can play in reducing one’s risk for several of the conditions discussed in the course and identified as key targets for public health intervention, including Type 2 Diabetes, cardiovascular disease, autoimmune conditions, obesity, and cancer (bowel, breast, and prostate). Outside of class, students have the opportunity to participate in a voluntary 10-day whole-food, plant-based diet. The experience focuses on eliminating their consumption of animal protein and minimizing their consumption of processed foods. The students are provided a catered lunch and dinner from a local vegan restaurant. To promote broader participation of students and reduce financial barriers, grant funding is utilized to subsidize half of the cost of meals and students pay for the other half. The intervention provides students the opportunity to experience the physical effects of a whole-food, plant-based diet and to understand how key biometric markers related to some chronic conditions (lipid profile and blood glucose levels) can be impacted with even a brief diet intervention.
Methods
Participants
Data was collected during the Spring 2019 semester to understand the impact of the experiential learning components on students enrolled in the class. A total of 60 students were enrolled, including 53 upper-level undergraduate students and seven graduate students. Of the 57 students who provided demographic information, 43 (77%) were female and 13 (23%) were male. A total of 15 individuals, including 12 students and three community members affiliated with the class, volunteered to enroll in the 10-day diet intervention. Diet intervention participants were also predominantly female (n = 11, 73%), with a smaller proportion identifying as male (n = 4, 27%).
Course Evaluation
Formative evaluation data was collected midway through the semester using an anonymous, paper-based “Stop, Start, Stay” evaluation. The evaluation encouraged students to share what course components the instructors should stop (Stop), what new practices or components to implement (Start), and what course components the instructors should keep (Stay). Summative evaluation data was collected as part of the course final exam (since changed to a paper), which was disseminated using Desire2Learn (D2L), an online learning platform, and included an open-response question asking what strategies students were using to decrease the stress in their lives.
Diet Intervention
Recruitment and coordination of the diet intervention was overseen by a public health graduate assistant who was not involved with the course. Midway through the semester, the graduate assistant presented to the course about the diet intervention opportunity and interested students were provided contact information to enroll in the study. The graduate assistant obtained written consent from all participants. The intervention was approved as human subjects research by the University of Arizona Institutional Review Board with the expectation that the graduate assistant did not inform instructors of which students volunteered in the intervention until after grades were posted to avoid potential bias.
Key biometric markers related to chronic conditions were measured by the graduate assistant at baseline and on the 11th day, after completion of the 10-day diet. Blood samples were obtained from each participant to measure total cholesterol, glucose, triglycerides (TRG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and non-high-density lipoprotein (non-HDL). Following an eight-to-ten hour fast, blood was obtained by capillary finger-stick and was analyzed utilizing the Alere Cholestech LDX Analyzer and Alere Lipid profile GLU cassette. Prior to running any time-sensitive samples for testing and analysis, the Alere Cholestech LDX Analyzer was performed to establish controls using the specific control kits. IBM SPSS (Statistical Package for the Social Sciences) Statistics 27 (IBM Corporation, Armonk NY) was used for data analysis. Related-Samples Wilcoxon Signed Rank tests were conducted to measure change in biometric markers pre- to post-intervention.
Pre-, post-, and 5-week post-intervention semi-structured interviews were also conducted to understand the impact of the intervention on participants’ attitudes and behaviors. Participants were asked a series of questions about their reasoning for participating in the diet intervention, perceptions of how the diet intervention impacted their health, barriers or benefits they saw to adopting a plant-based diet, and intentions to continue a plant-based diet after the intervention. Interview transcripts were coded for major themes.
Results
Course Evaluation
Course evaluation data shows the influence of the course on students’ health behaviors and attitudes. Fifty-two students anonymously completed the “Stop, Start, Stay” evaluation to provide feedback about the course structure. In addition to recommendations about improving course logistics, such as providing more time for breaks and encouraging the instructor to use a microphone, 26 class respondents (50%) specifically said they wanted to keep the meditation portion of the class, while only six respondents (12%) said the meditation should be eliminated. Sixty students completed the course final exam. When asked what they were doing to decrease the stress in their lives in the course final exam, 23 (38%) wrote specifically about meditation, nine (15%) of whom spoke about establishing a daily meditation practice. Students also discussed other common strategies for reducing stress, including exercise (n = 33, 55%), spending time with friends and family (n = 14, 23%), and sleep (n = 13, 22%).
Diet Intervention
Mean total cholesterol showed a significant decline, from 168.2 to 146.2 mg/dL (Table 1). Mean HDL also significantly decreased from 57.73 to 48.93 mg/dL. All other changes in lipid profile variables were non-significant. Interestingly, pre- and post-intervention mean values of all lipid profile variables were within the desirable or normal ranges, based on recommendations established by the National Lipid Association and the National Cholesterol Education Program.
Biometric Screening of Observed 10-Day Jumpstart Participants.
p ≤ .05.
Only six participants (40%) had previously tried a plant-based diet. Eight participants (53%) identified as having a health-related issue, seven (47%) of whom believed the diet intervention would aid or relieve their health issue. Common barriers that participants saw to adhering to the diet included time to prepare meals (n = 10, 67%) and cost (n = 8, 53%). After the 10-day intervention, six participants (40%) expressed having more energy, five (33%) felt healthier overall, and two (11%) felt similar to pre-intervention. Participants said their perspectives on health conditions changed as they became more aware of the health benefits of a plant-based diet, with 12 participants (80%) agreeing that the diet was supportive of general health and 10 participants (67%) stating that they were more aware of the health benefits of a plant-based diet after the intervention. All participants (n = 15, 100%) stated that they would decrease their animal protein and dairy intake, with 12 participants (80%) stating that they would continue to eat a diet comprised of mostly plant-based foods.
Conclusions and Future Opportunities
Through engagement in multiple experiential learning activities, students in Biology in Public Health are encouraged to make connections between their own personal health behaviors, the stories and experiences of others, and the biological and public health concepts they traditionally learn in textbooks and lectures. Particularly for non-biology majors, strategies like those utilized in this course to promote active experimentation with health behaviors and self-directed learning are critical for promoting student engagement with what can often be challenging scientific concepts and integration of these concepts into their understanding of population-level health. This course continues to benefit from iterative changes each year that shift away from the traditional lecture style and toward more student-directed learning. While experiential learning is often thought of in the context of opportunities outside of the classroom, Biology in Public Health provides a meaningful example of how experiential learning strategies can and should be integrated into the classroom to promote student success and engagement. Future public health curricula will benefit from this shift away from traditional pedagogy, embracing the adaptation and benefits of active experimental engagement and self-directed learning.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the University of Arizona Mel and Enid Zuckerman College of Public Health’s Dean’s Fund and participants paid for half of the meal costs for the duration of the 10-day whole-food, plant-based diet intervention.
