Pedagogy in Health Promotion

The COVID-19 pandemic precipitated a deluge of scholarly publications and scientific outreach. Information about the novel coronavirus has spread rapidly through both traditional news and social media platforms. Timely scientific literature is paramount to public health, but it must be paired with nuanced and tailored outreach and messaging. Despite being a core public health competency, not all public health science students receive training in these skills. The media response to the COVID-19 pandemic reveals a fundamental misunderstanding by the general public about the scientific process and cultivates a narrative that too often places blame on individuals for structural inequities. An influx of research without audience-appropriate interpretations, coupled with a lack of representation in the news media, threatens to erode trust in science. To address these challenges, schools and programs of public health might reflect on their curricula and consider placing a greater emphasis on health communication.

We believe a harm reduction framework offers guidance for managing the student-teacher relationship in pandemic situations. This commentary defines the six principles of harm reduction (humanism, pragmatism, individualism, autonomy, incrementalism, and accountability without termination) and describes how these principles can be applied within the public health higher educational system in the COVID-19 era. The key points are intended to stimulate thought and discussion about how to balance general uncertainty, concerns about what is best for population and personal health, the tensions between collectivism and individualism, and our commitment to training and protecting the health of the next generation of public health professionals. We recommend that educators, in public health and other higher education settings, use the harm reduction principles to guide their interactions with students and to build more compassionate and collectivist communities that allow people to learn and thrive.

Coronavirus disease 2019 (COVID-19) realities have demanded that educators move swiftly to adopt new ways of teaching, advising, and mentoring. We suggest the centering of a trauma-informed approach to education and academic administration during the COVID-19 pandemic using the Substance Abuse and Mental Health Services Administration’s (SAMHSA) guidance on trauma-informed approaches to care. In our model for trauma-informed education and administration (M-TIEA), SAMHSA’s four key organizational assumptions are foundational, including a realization about trauma and its wide-ranging effects; a recognition of the basic signs and symptoms of trauma; a response that involves fully integrating knowledge into programs, policies, and practices; and an active process for resisting retraumatization. Since educators during the pandemic must follow new restrictions regarding how they teach, we have expanded the practice of teaching in M-TIEA to include both academic administrators’ decision making about teaching, and educators’ planning and implementation of teaching. In M-TIEA, SAMHSA’s six guiding principles for a trauma-informed approach are infused into these two interrelated teaching processes, and include the following: safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice, and choice; and cultural, historical, and gender issues. M-TIEA’s organizational assumptions, processes, and principles are situated within an outer context that acknowledges the potential influences of four types of intersectional traumas and stressors that may occur at multiple socioecological levels: pandemic-related trauma and stressors; other forms of individual, group, community, or mass trauma and stressors; historical trauma; and current general life stressors. This acknowledges that all trauma-informed work is dynamic and may be influenced by contextual factors.

With new COVID-19 infections still of concern in the United States, teaching will continue to be affected in the foreseeable future. It is imperative to consider lessons learned from the Spring 2020 semester and adapt future teaching accordingly. The primary audience for this article includes those who are teaching, and mentoring those who teach, quantitative methods courses to MPH and doctoral students in programs focused on behavioral, social, and health education sciences. While some of what we present is specific to teaching statistics, many points transfer to other methods courses and beyond. Thus, we are sharing our experiences and propose some recommendations for teaching in the future while social distancing.

Schools and programs of public health are expanding online course offerings, particularly in response to the transition to remote learning due to COVID-19. While previous research in the health professions suggests that online and in-person modalities are equally effective in supporting student learning, there is minimal evidence of this in public health education. This evaluation examines the effectiveness of newly developed online or hybrid course sections offered to Master of Public Health (MPH) and Master of Science in Public Health (MSPH) students enrolled in on-campus programs. We compared the effectiveness of these new offerings with that of the on-campus in-person courses and hybrid courses in the Executive MPH program. The purposes of this mixed-methods evaluation were to (1) assess student learning across the three course modalities and (2) examine student, instructor, and staff experiences with the modalities. The data included pre- and postcourse student surveys on 17 sections of five courses (precourse response rate: 51% to 98%; postcourse response rate: 12% to 57%), the participating students’ grades, five student focus groups, one focus group with academic advisors, and 11 instructor interviews. The findings indicate that the new online modality was equivalent to the in-person sections for student learning, satisfaction, and engagement. Mean student ratings of confidence in meeting the course learning objectives increased from the beginning to the end of the semester in all sections for all courses. Regardless of the modality, the students reported that the course improved their understanding of key concepts and that they were satisfied with their course. We discuss the lessons learned and recommendations for ensuring high-quality online learning experiences.

The core skills taught in the subject “Health Education Development” at La Trobe University are essential for students studying health promotion. As part of this subject, students are supported to adopt the role of a health education and development facilitator in delivering tailored sessions to their peers. In these simulated sessions, students engage in the practice (and teaching) of cooperative learning addressing the needs of vulnerable population groups across different settings. COVID-19 forced the delivery of this subject to an online-only model with little time for preparation. Changes that were introduced as a response to this transition included online workshops replacing face-to-face (F2F), modification of the F2F component of assessments to online, F2F workshop content adapted to online version, implementation of a “coteaching” model for the initial 3 weeks post-COVID-19 lockdown, and weekly online sessions held with the teaching team. The use of innovative activities provided ongoing feedback, which informed timely actions to improve and continue with the successfully delivery of the subject.

Community immersion is an effective way of bringing concepts to life while nursing students are engaged with community members in the real world. Opportunities to apply, observe, and clarify abstract health promotion ideas, including social determinants of health, abound when seen in everyday interactions with individuals outside of an acute care setting. This article details the experiences of a community immersion class as it responded to the COVID-19 pandemic and had to transition mid-semester from an in-person course to a virtual format. Lessons learned from this unique experience provide a case for how to minimize disruptions to a health promotion class, maintain existing commitments with different community organizations, and adapt meaningful engagement to community needs during the pandemic.

There is little guidance on which behavior change theories should be taught in undergraduate courses addressing health behavior change. Delphi consensus methods provide a formal, systematic, and reproducible method for establishing consensus among experts. Objective. Use a Delphi methodology to establish consensus regarding behavior change theories that should be taught to undergraduate students enrolled in health behavior change courses. Method. An online Delphi consensus exercise was completed by instructors who were identified through a systematic search of 94 University course calendars to be teaching health behavior change content to undergraduate students in Canada. In Round 1, 22 participants generated a list of theories taught in undergraduate courses. In Rounds 2 and 3, participants indicated their level of agreement using an 11-point Likert-type scale as to which theories should be taught. Theories that reached predetermined consensus criteria were retained in each round. Results. In Round 1, participants listed over 50 different theories being taught in undergraduate courses. After Round 2, nine theories met consensus criteria which were refined to only six theories in Round 3 (i.e., behavior change wheel, self-determination theory, self-efficacy theory, social ecological model, social cognitive theory, theory of planned behavior). Conclusions. A wide range of theories are taught in undergraduate courses. However, only a minority of these theories reached consensus criteria as being theories that should be taught to undergraduate students enrolled in courses addressing health behavior change. Findings can be used to improve the consistency and quality of instruction of behavior change theories at the undergraduate level.

Introduction. Teaching evolutionary principles in a health promotion course may increase the relevance of evolutionary theory to students, enrich biological understanding of disease, and provide a unique perspective on how evolution can affect human health and disease. This pilot study examined the extent to which evolution instruction in an undergraduate college-level health promotion course affects learning the fundamental concepts of evolution by natural selection, student misconceptions of evolution, and student acceptance of evolution, compared with evolution instruction in a biology course. Methods. Pre–post course surveys measured student understanding of evolution measured with the Conceptual Inventory of Natural Selection, student misconception related to endorsement of teleological reasoning, and student level of acceptance of evolution, along with several demographic variables. Ninety-four (n = 94) undergraduate student participants were enrolled in one of three courses: an Evolution-Health course, an Evolution-Biology course, and a Human Physiology course. Results. Students significantly improved their Conceptual Inventory of Natural Selection scores in both Evolution-Health (p = .0005) and Evolution-Biology (p = .015). Student misconceptions of evolution significantly decreased (p = .0034), and acceptance of human evolution increased (p = .031) in the Evolution-Health course only. Change in natural selection understanding over the course of the semester was modestly negatively correlated with change in teleological reasoning (r = −.21, p = 0.047), such that students with larger decreases in teleological reasoning had greater learning gains in natural selection understanding. Conclusions. This study provides preliminary evidence that evolutionary instruction in a college-level health promotion context improves understanding of fundamental evolutionary concepts, decreases student misconceptions related to teleological reasoning, and improves acceptance of human evolution.

There has been much discussion recently about the potential of Community Health Champions (CHCs) to promote universal health coverage in the United Kingdom. Among refugee and migrant groups, there is concern that untrained community workers miss out on understanding the major causes of poor health outcomes. This study aims to examine the challenges and opportunities that influence the designing of an effective curriculum to help CHCs develop the necessary knowledge and skills. A qualitative evaluation of a collaborative public health curriculum with this primary objective, focused on aspiring CHCs drawn from refugee and migrant populations, was conducted. The 5-week curriculum was delivered as a community partnership between a local university, three metropolises, and three refugee and migrant centers, all located in the West Midlands, United Kingdom. We found no evidence of existing curriculums that target refugees and migrants to develop knowledge and skills for influencing health services utilization by individuals within their own community. It is an opportune time to introduce such a curriculum because health providers occasionally use CHCs for some roles in their activities. Important challenges in this curriculum concerned generating consensus on content, dealing with power structures in negotiating the content, and agreeing on boundaries in curriculum activities. There is evidence of CHCs from refugee and migrant backgrounds having an interest in developing skills for helping reduce health inequalities in the United Kingdom. This study concludes that significant challenges exist in designing a CHC curriculum that all stakeholders can easily accept, but not having consensus on content may be detrimental to their learning.