Health Education Research, Vol. 14, No. 5, 685-696,
October 1999
© 1999 Oxford University Press
Teaching community diagnosis: integrating community experience with meeting graduate standards for health educators
Department of Health Behavior and Health Education, School of Public Health, Rosenau Hall, CB#7400, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7400, USA
 |
Abstract |
|---|
 Top Abstract IntroductionDescriptionChoosing communitiesCourse contentSteps in the CD...TeamworkEvaluationOperational details and...DiscussionObstacles and lessons learnedImplications for professional...References |
|---|
In 1996, the American Association for Health Education and the Society for Public Health Education developed new Standards for the Preparation of Graduate Level Health Educators. Learning to work effectively with communities is an essential part of graduate level health education. This article provides an overview of the community diagnosis (CD) class, a component of the Master's in Public Health program in the Department of Health Behavior and Health Education, School of Public Health, University of North Carolina. CD is a required two-semester class in which student teams work with preceptors to define a client community, assess its needs and strengths, and establish a foundation of quantitative and qualitative data for future community action. This experience provides a strong foundation for development of graduate level competencies and fosters an appreciation for the complexity of partnerships with communities.
|
Introduction |
|---|
|
TopAbstractIntroductionDescriptionChoosing communitiesCourse contentSteps in the CD...TeamworkEvaluationOperational details and...DiscussionObstacles and lessons learnedImplications for professional...References |
|---|
Health education literature has long discussed the importance of community participation in health education programs and there is a growing emphasis on enabling health education practitioners to facilitate successful community involvement. Two recent government publications elucidate the need for engaging the community effectively and mobilizing community efforts in support of prevention activities (CDC/ATSDR Committee on Community Engagement, 1997
; Substance Abuse and Mental Health Services Administration, 1997). Wallack et al. [(Wallack et al., 1993), p. 5] reinforce this with their view that `contemporary public health is as much about facilitating a process whereby communities use their voice to define and make their health concerns known as it is about providing prevention and treatment'. In this context, communities may be defined as geographic- or locality-based entities or as communities of identity that share a common culture or characteristics.
Involving the community is not a new concept, however. Guy Steuart (Steckler et al., 1993) called for a partnership between community members and health educators in program planning and evaluation with community diagnosis (CD) as a critical part of program planning. In contrast to needs assessment, Steuart stated that:
Diagnosis is much broader and aims to understand many facets of a community including culture, values and norms, leadership and power structure, means of communication, helping patterns, important community institutions, and history. A good diagnosis suggests what it is like to live in a community, what the important health problems are, what interventions are most likely to be efficacious, and how the program would be best evaluated [(Steckler et al., 1993
Steuart sought to incorporate the community's voice into field training because he felt that `the ends of health education are achieved best where they are harnessed to the felt needs and motivations of the community itself' [(Steckler et al., 1993), p. S19]. Therefore, the CD process is a core requirement of all Master's in Public Health (MPH) students in the Department of Health Behavior and Health Education at the University of North Carolina at Chapel Hill.
Developing health education programs with communities requires a number of competencies, many of which were elucidated in the new Graduate Standards, developed by a Joint Committee of the American Association for Health Education and the Society for Public Health Education with representatives from the National Commission for Health Education Credentialing and the Council on Education for Public Health (Dennison, 1997). The CD process addresses many of these competencies in a unique and integrated manner, and provides a ready opportunity for experiential learning in the complex environment of local communities (see Table I for a selected, not exhaustive list of competencies).
|
The purpose of this article is to discuss the operationalization and implementation of the CD process in the graduate curriculum. The article will discuss choosing preceptors and communities, course content, team process and development, the steps of the CD process and specific competencies, outcomes and challenges, and lessons learned.
|
Description |
|---|
|
TopAbstractIntroductionDescriptionChoosing communitiesCourse contentSteps in the CD...TeamworkEvaluationOperational details and...DiscussionObstacles and lessons learnedImplications for professional...References |
|---|
CD spans two semesters, bringing first year graduate students together in the field in approximately nine teams of four or five. Four credit hours are given per semester. Although the field component of the MPH degree has evolved since its inception in 1944, its philosophy has remained constant: that an understanding of the multiple levels that characterize a community's `health' comes through investigating primary and secondary data sources. For a typical class of 35–45 first year students, CD requires one full-time faculty member (the field coordinator) and two teaching assistants. The CD process consists of four distinct but related parts: an examination of secondary data on social and health indicators and the community's history and geography; an exploration of health and human service organizations serving the community; an identification of perceived needs, assets and community dynamics through qualitative interviews with community members; and a community forum.
CD incorporates characteristics of field placements, such as being `intricately tied to departmental curricula', putting `classroom concepts and learning into practice' and `integrating the real and academic worlds' [(Center for Public Health Practice, 1993), p. 3]. However, unlike traditional field placements and internships, the CD student works in communities during the first year in the graduate program, not as a culminating or capstone experience.
|
Choosing communities |
|---|
|
TopAbstractIntroductionDescriptionChoosing communitiesCourse contentSteps in the CD...TeamworkEvaluationOperational details and...DiscussionObstacles and lessons learnedImplications for professional...References |
|---|
Prior to the start of the fall semester, the field coordinator recruits field team preceptors from communities within approximately an hour's driving distance of the School. Some, but not all, of the preceptors are graduates of the HBHE program who are working in county health departments or agencies. Additionally, communities may request that a team conduct a CD and health educators frequently contact the field coordinator with requests to consider specific communities. The preceptors decide, in consultation with their agencies and the field coordinator, where to place field teams. The CD process allows local agencies to learn about unfamiliar communities and foster new relationships with community members. Agencies may select communities because they are interested in expanding their services or better understanding communities that are changing dramatically. For example, recently, North Carolina has experienced tremendous growth in the Latino population and several preceptors have requested CDs to learn more about these new populations. Similarly, the Triangle region of NC, the location of the university, is experiencing a rapidly growing population of retirees and two preceptors have requested that CD teams focus on the elderly within a specific geographic area.
|
Course content |
|---|
|
TopAbstractIntroductionDescriptionChoosing communitiesCourse contentSteps in the CD...TeamworkEvaluationOperational details and...DiscussionObstacles and lessons learnedImplications for professional...References |
|---|
During the fall semester, students enroll in HBHE 240, Community Diagnosis and Needs Assessment. The objectives of the course include:
- To provide an opportunity for students to apply the concepts, principles and methods of a CD in a field setting.
- To develop skills in gathering, understanding and presenting secondary data.
- To develop skills in interviewing and other forms of field observation in community settings.
- To establish a conceptual foundation for the understanding of community.
- To explore issues of culture, race and class as they impact on health education practice in community settings.
- To explore ethical issues involved in CD.
- To establish a conceptual foundation for health education practice in a community setting.
Readings and class activities focus on the history of public health, the evolution of health education, definitions of health and its determinants, definitions of community, philosophical issues related to CD, ethics, cultural sensitivity, and community competence. The required text, Community Organizing and Community Building for Health (Minkler, 1997), is supplemented by selected journal articles (for a complete reading list, please contact the author).
Although the major emphasis of the spring semester course is the completion of the CD, course content extends to different types of community interventions. Course objectives for HBHE 241, the spring course, include learning to: analyze qualitative data; apply concepts from health education to the data collection and analysis; and critically examine the conceptual foundations of community health, interventions and their evaluation. Class sessions address qualitative data analysis, preparation for community forums, community-based health promotion, community organizing and community building, community coalitions, Healthy Cities, community assets and mapping, and social capital. In both semesters, lectures, small group discussion and activities, role plays, and other learning activities provide opportunities to integrate learning from CD with broader concepts.
|
Steps in the CD process |
|---|
|
TopAbstractIntroductionDescriptionChoosing communitiesCourse contentSteps in the CD...TeamworkEvaluationOperational details and...DiscussionObstacles and lessons learnedImplications for professional...References |
|---|
Table II
presents a timetable for the steps of the CD process. To prepare for assignment to teams and communities, students complete a background questionnaire to assess their community experience, personal characteristics, language abilities, computer capabilities and type of community in which they would prefer to work. The field coordinator uses this information to form teams and to match student teams to specific communities. She considers students' strengths and areas of expertise in team assignments as well as their potential compatibility with the working style of individual preceptors.
|
Preceptors provide entree into the communities, help identify resources and meet with their field teams regularly. Teams typically meet with their preceptors twice a month; however, the frequency of these meetings may depend somewhat upon the preceptor's availability and the team's needs. These meetings offer the preceptors opportunities to discuss team process, tasks and significant learning; to process critical incidents; and to anticipate relevant issues. The field coordinator meets with preceptors 4 times each semester to discuss the process and monitor progress of the teams.
Most field teams are assigned geographically defined communities such as a neighborhood or town. Sometimes, a field team's assignment may be a bit more unusual. For example, one team worked in the Chapel Hill public housing community, a non-contiguous geographic community with housing sites spread throughout town. Public housing sites can be considered a community and this perspective was illustrated during the teams' interviews when the residents talked as much about what it means to be living in public housing as they did about living in Chapel Hill. Recently, teams have focused on populations within specific geographic locales, such as Latinos in three different counties, the elderly in two different towns and adolescents in one local community.
Windshield tour
A first task for students is to perform a `windshield tour': students drive around their selected communities, looking through their car windshields, to familiarize themselves with the area. Many teams walk through their community, sometimes informally chatting with residents and visiting shops. The purposes of the windshield tour are to observe conditions within the community, looking for verification of secondary data; to identify local resources and activities not captured through more formal means; and to differentiate different segments of the population in the community by residential clustering. During the fall, the professor encourages students to begin attending community events (barbecues, festivals, town meetings, etc.). Many students begin attending local churches, a practice they continue throughout the two semesters.
Collection of secondary data
The fall semester begins with secondary data collection and analysis; later in the semester, interviewing begins and continues concurrently with collection of secondary data. Teams initially focus their investigation on sources such as the US Census, LINC (Log In to North Carolina, a database of extensive demographic information for North Carolinians), county data books prepared by the North Carolina State Center for Health Statistics, newspapers and local government documents. Increasingly, students tap the resources of state, local and federal agencies through the Internet. During class time, expert librarians conduct sessions on accessing data through the US Census and LINC, and other readings and class sessions focus on understanding and presenting secondary data.
The goal of this research from secondary data sources is to understand the community's history, geography, socio-demographics, education, economy, political and governmental structure, transportation, and, of course, health. Classes and activities facilitate the development of related competencies from the Graduate Standards such as obtaining health-related data about social and cultural environments, growth, and development factors, needs and interests; analyzing social, cultural, economic and political factors as they impact health behaviors; inferring needs for health education on the basis of obtained data; assessing the merits and limitations of qualitative and quantitative research methods and apply those methods; and employing electronic technology for retrieving references.
Interviewing
In the fall, teams begin conducting interviews with community members to discover the community's perceived needs, its pertinent issues, strengths, units of identity, level of community competence and readiness to take action on shared concerns. To prepare, several class sessions focus on interviewing techniques and skills, developing interview guides, and analysis of qualitative data. Teams prepare semi-structured interview guides with primarily open-ended questions, and work jointly with other teams and faculty to critique the questions prior to their first community interviews. Typical areas of questions include daily community life, relationships between groups within the community, how the community has come together to solve problems in the past, community assets and current concerns.
Teams typically begin their interviews with contacts provided by their preceptors. Teams make an effort to interview a wide range of people in order to capture diverse perspectives. During each interview, the team solicits names of other interviewees (using the snowball method of sampling); many teams have found that their ongoing participation in church services and community centers has provided an excellent means of recruiting community members for interviews. There is no set number of required interviews as the number is dependent upon the size and type of communities. However, it is rare that teams conduct less than 30 interviews.
Each team also interviews service providers, which are defined broadly to include not only health care professionals, but also town officials, librarians, police, educational system representatives, local clergy, elected officials and others. A pair of students conduct all interviews, enabling one to take comprehensive field notes while the other asks questions. The interviewers tape each session to facilitate retrieval of salient quotations to illustrate themes. Teams also gather primary data through focus groups, participation in community events and informal interviews on the street. Additionally, teams will frequently supplement their qualitative data collection with short surveys they design to gather close-ended data on their communities.
The process of interviewing and establishing relationships with community members and providers is an opportunity to practice sub-competencies from Responsibility VI, Competency B of the Graduate Standards: to apply networking skills to develop and maintain consultative relationships, and to foster communication between health care providers and consumers.
The complexity of entering communities necessitates several classes on developing relationships with communities and cultural sensitivity prior to beginning interviewing. Classroom discussion focuses on community etiquette which includes issues related to appropriate dress, how to address residents, adjustments to working according to a community's schedule and other concerns. A session entitled `Entering the Community' explores the assumptions students make about their communities and the impact that their own social identity (race, class, sexual orientation, religion) may have on their interactions with community members.
Community forums
In late January and early February, as the interview process winds down, the teams work with community members to plan and conduct community forums. During the forums, teams present their findings, facilitate discussions about priorities and future steps, and provide an opportunity for the community to begin to organize itself around an issue. The process of planning and conducting the forums provides ample opportunities to build a number of competencies: apply principles of community organization in planning programs; organize and facilitate groups, coalitions and partnerships; facilitate collaborative efforts among health agencies and organizations with mutual interests; and demonstrate proficiency in oral presentations.
CD documents
Throughout both semesters, teams work on the development of a document that incorporates observations of the windshield tour, secondary data and primary data collected through interviews, focus groups, and other strategies. After the forum, each team compiles the final CD document from drafts of sections written during the fall and spring semesters. In the document, teams integrate the qualitative data from interviews with secondary data, and include an examination of whether the community perceptions and secondary data are congruent. This document contains the following sections: history, geography and economic profile; socio-demographic profile; community services, resources and assets; health; chapters according to the major themes emerging from primary data collection; executive summary; and conclusions including implications for health education. Each team gives a copy of the entire document to its preceptor and makes a copy accessible to community members via the town hall, library or other designated location.
Other competencies addressed through CD
One of the new competencies added to the Graduate Standards is the application of ethical principles as they relate to the practice of health education. During the fall semester, one class focuses on the implications and application of the Belmont Report (US National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, 1978), and the Codes of Ethics from SOPHE (SOPHE, 1983) and AAHE (AAHE, 1994) to the conduct of CD. In addition, each team must submit a proposal to the Institutional Review Board (IRB) of the School of Public Health prior to any qualitative data collection. This proposal includes the development of informed consent procedures and provides another opportunity to relate ethical principles to actual practice. Throughout both semesters, ongoing discussions on CD in class require students to meet one sub-competency, analyzing the inter-relationships among ethics, values and behavior, as they grapple with issues emerging through their experience.
Through the overall experience of CD, students gain experience in these additional competencies: applying appropriate research principles and methods in health education; identifying target populations; and estimating future health education needs based on changing demographics.
|
Teamwork |
|---|
|
TopAbstractIntroductionDescriptionChoosing communitiesCourse contentSteps in the CD...TeamworkEvaluationOperational details and...DiscussionObstacles and lessons learnedImplications for professional...References |
|---|
Throughout the first year, students will have to grapple with work style and personality differences among team members. This `team process' is a critical component of CD and provides opportunities to practice sub-competencies of Responsibility V, Competency B of the Graduate Standards which focuses on facilitating cooperation between and among program personnel: (1) promote cooperation and feedback among personnel and (2) apply various methods of conflict reduction as needed.
The field coordinator takes several additional steps to facilitate effective team functioning. At the start of the semester, all students complete a Myers–Briggs Type Inventory (MBTI), and through a class presentation and readings on the MBTI, they examine implications of personality traits for team functioning. Early in the fall semester, one class meeting is extended to 3 h to accommodate exercises in which team members work on communication exercises, discuss effective team functioning and explore personal dynamics that impact team interaction. Students also receive readings and handouts on conducting productive meetings and developing effective teams. An outside expert on conflict resolution conducts a 4-h session on conflict and communication in early October.
Students frequently struggle with what the CD process means to them. How important is it? What is their commitment to the process? What does it mean to be working in communities? How do they resolve differing expectations and standards among team members? Team members wrestle with process issues because of various levels of commitment, understanding and expectations during an intense, stressful period of learning. Team members must develop a team contract to help clarify each others' goals and expectations, and discuss this contract with their preceptor.
The field coordinator requires that each team meet at least once, by early November, with her or with a teaching assistant to assess team process, respond to specific concerns about their experience and address questions.
|
Evaluation |
|---|
|
TopAbstractIntroductionDescriptionChoosing communitiesCourse contentSteps in the CD...TeamworkEvaluationOperational details and...DiscussionObstacles and lessons learnedImplications for professional...References |
|---|
The field coordinator grades all CD documents and other class requirements. Additionally, preceptors grade the final CD document. Besides the major documents, evaluation of student performance in the fall class is based on two peer evaluations and class participation. In the spring semester, requirements include a synthesis paper which provides students an opportunity to reflect upon their community and integrate concepts with experience, two peer evaluations and the community forum.
|
Operational details and resources |
|---|
|
TopAbstractIntroductionDescriptionChoosing communitiesCourse contentSteps in the CD...TeamworkEvaluationOperational details and...DiscussionObstacles and lessons learnedImplications for professional...References |
|---|
Coordination of the CD requires a major commitment of time and resources. Class preparation, contact with students outside of class, review of lengthy documents and coordinating with preceptors demand a large time commitment from the field coordinator. Having one professor who oversees the whole field component provides continuity for students between class and field work. The field coordinator is able to foster positive relationships with the surrounding communities and their health and social service agencies. Additionally, a portion of the time of the department's financial manager and other administrative staff is necessary for administrative tasks.
Costs associated with CD are covered through a required student fee of $600 in 1997–1998. Additionally, the Area Health Education Center supports travel to local communities for CD. Fees cover the cost of maintaining four state-owned cars and to defray other expenses associated with the CD process including: local and long-distance telephone use, extensive copying costs, refreshments for community meetings, publicity and other costs related to community forums, reimbursement for personal car use, cassette tapes, preceptors' travel expenses and refreshments for their meetings, and copying/binding documents. The departmental financial manager oversees the financial operations; she is supervised by the field coordinator, who sets policies for expenditures and monitors the budget.
|
Discussion |
|---|
|
TopAbstractIntroductionDescriptionChoosing communitiesCourse contentSteps in the CD...TeamworkEvaluationOperational details and...DiscussionObstacles and lessons learnedImplications for professional...References |
|---|
The outcomes associated with CD fall into several categories: preparation of proposals and new program development; formation of new community action groups; informing other initiatives; new connections within communities; and, finally, student growth and development.
Since 1995, CD documents have been donated to the Health Sciences Library on University of North Carolina's campus, where students, faculty and staff have access to them. In addition, the Field coordinator provides copies of documents upon request to agencies, the local media, and local governments. In 1998, executive summaries of CD documents were included in SERV-NC's web page. Within the next year, entire documents will be available on the department's web site for downloading by interested individuals.
Grants and proposals
Communities, local government, agencies and university faculty utilize documents from CD for the preparation of funding proposals. For example, in one community, they utilized the CD process to come to consensus on the need for a recreation facility and, with the document as its foundation, successfully applied for funding to build a park. Following completion of the park, the same community this year requested another CD to help them to assess directions for future activities. In several local counties, CD documents have provided justification for funding of resource centers for local Latinos. Local agencies and other universities frequently request documents for use in proposal preparation, and UNC faculty have readily used them to prepare proposals for a variety of projects.
New programs
Some CD lay the foundation for new program development and specific needs assessments. Following the CD in one town, the health department conducted specific needs assessments on the issues identified in CD. In another community, community members identified two concerns for elderly citizens, lack of affordable medications and lack of nursing care. The community, working with the local health department and other agencies, is moving forward to develop a community nurse position and exploring options for access to low cost medications. Contact between providers and community members at forums also results in improvement of service delivery and access to care. In one forum in a Latino community, Latino women requested that health department clinics put bus route information in Spanish on program brochures. While seemingly an easy request, the providers had never thought of this and were readily willing to make a simple adjustment that could have significant impact on the ability of women to access services.
Formation of community action groups
In a number of communities, the CD has stimulated the development of a new community action group that proceeds to address issues raised during the CD process. In one African-American community, `Us in Action' formed as a result of the CD process, achieved a number of its early goals and is currently working on two projects that grew out of a second CD they requested. In another community, the forum, held in a local church, provided a safe opportunity for community members to raise passionate concerns about housing standards with the county health director. An ongoing group is now working to address the housing problem in that community. In a recent community forum for senior citizens in a local incorporated town, the student team facilitated a lengthy discussion of specific needs and next steps. In attendance was a Town Council member who explained concrete strategies the seniors could take to access a previously undisclosed town budget surplus.
In 1994–1995, one team worked with the Latino population in a small city in Chatham County. The team believed that the Latino community would benefit from the translation of the CD document into Spanish which was provided to a new task force on Latino issues that had grown out of the community forum. The task force was composed of `action groups' to tackle a number of significant issues, including the availability of bilingual services at the Department of Motor Vehicles.
Informing other initiatives
Community diagnosis has long been a major component of the Department of Health Behavior and Health Education and the School of Public Health's service to local communities. Student teams are often called upon to present their findings to boards of health or the staff of local health departments. For example, in Chatham County, the health department has supported CD teams for a number of years; at the end of the year, each team makes a formal presentation to the board of health and the health director; this assists the board in program planning and allocation of resources.
In recent years, a local county agency utilized CD to inform their development of Smart Start, a state-funded initiative to improve early childhood education. Local Healthy Carolinians task forces and local health departments in surrounding counties utilize CD as a means to supplement their own data collection efforts and to assist in priority setting. In 1998, when a local member of the US House of Representatives formed a task force on Latino issues, the task force requested existing CD documents on Latino communities.
Facilitating new connections within the community
Anecdotal reports indicate the importance of CD as the foundation for `small successes'. It might bring different factions in communities together for the first time to work on common concerns. In one community, African-American and Latino activists had never met to discuss mutual concerns until the CD team brought them together at a meeting to plan the community forum. In another town, several groups had informally gathered to discuss the potential for a residential facility for senior citizens, yet they had not been aware of one another until the forum. Not infrequently, providers and community members come together for the first time at forums in which community members feel free to express their voices.
Ongoing student involvement
Finally, students may continue to be involved in their communities through a variety of mechanisms. In one community, students from the CD team volunteered throughout the summer in a summer day camp that community residents organized as a result of the CD. In another community, two team members continued throughout their second year to work with youth at the neighborhood center. Other students chose to complete their Individual Projects, a 200 h requirement to work on a specific intervention during the summer after their first year, on projects that address issues from the CD they have just completed. For example, after one community had identified lack of recreation as a major concern, one student worked with the recreation department to develop programs in the community center.
Student growth and development
Community diagnosis has become a cornerstone of the Department of Health Behavior and Health Education. Although it is frequently stressful for those students in the midst of the experience, it fosters respect and a commitment to community-based assessments among students. In 1996, the Department's Curricula and Competencies Committee surveyed alumni from 1990 to 1996 as part of an evaluation of the field training component of the MPH program. The survey found that for many students, CD provides a strong orientation toward community involvement, the opportunity to develop a number of skills, and to thoroughly examine and understand public health concerns from the community's perspective.
Graduates working in both practice and research settings also report that CD has helped them in their careers. One graduate wrote:
I think the CD approach is very relevant to health educators today. Because CD offers students first-hand experience with comprehensive needs assessments in community settings, HBHE graduates are equipped to work in community settings and, moreover, to advocate for working with communities. Working in a research setting as I do, the skills I acquired through the field class have proven invaluable: problem-solving, teamwork and collaboration, community outreach, coalition building, and the ability to work with diverse populations.
One former student commented, `CD will be always my foundation for research and interventions in communities'. Other former students commented on specific skills they had learned, such as `CD has allowed me to put theory into practice . . . incorporate new skills in quantitative and qualitative assessment' and from a second student, `I became more confident in my abilities, especially communicating with community members'.
The intensity of working in communities from which the students may differ by class, race or religion frequently stimulates personal reflection and growth. One student saw CD as an opportunity for enhancing her cultural sensitivity, `Doing a CD in an African-American community forced me to critically examine what I knew about cultural sensitivity'. The combination of classroom discussion and experience in the field prompted one student to remark, `Until we talked about race and culture [in class], I never really thought about separating the two but I did experience how they differ during CD'.
Despite the challenges of the CD experience, many alumni appreciate its value more once they have entered the job market. One graduate commented that:
. . . the more I think back on the CD experience, the more I realize how valuable it was, despite the frustration at the time in actually doing it! . . . I have used a modified process of CD in most of my jobs since I graduated. [(DHBHE, 1996), p. 15]
A 1991 graduate noted that `just having [CD] on my resume impresses employers. Having `local' experience seems very valuable in this field. The skills learned were applicable in many settings in addition to the field' [(DHBHE, 1996), p. 13].
|
Obstacles and lessons learned |
|---|
|
TopAbstractIntroductionDescriptionChoosing communitiesCourse contentSteps in the CD...TeamworkEvaluationOperational details and...DiscussionObstacles and lessons learnedImplications for professional...References |
|---|
Maintaining the CD process as a part of the curriculum requires grappling with numerous challenges. For the Department of Health Behavior and Health Education, faculty and staff time required by CD represent a significant fiscal commitment. The current field coordinator is an assistant professor in a tenure track line, and the time commitments of CD conflict with pressures on her for more typical activities such as seeking external funding and publication. Certainly, these dual expectations emphasize the crucial importance of full departmental support that recognizes the field coordinator's contribution to practice and service. While the School of Public Health has changed its promotion and tenure guidelines to enable faculty promotion through practice, successfully balancing the CD process and other requirements for promotion will prove to be a significant challenge.
Since communities must be located within a reasonable driving distance, there is a risk of overusing and exhausting nearby counties and communities that may also be working with other university programs (i.e. City and Regional Planning, Social Work, Medicine, Nursing, etc.). To address this issue, the field coordinator tracks which communities have had a prior CD and teams only return to a community when there is a specific request to do so. The field coordinator works closely with potential preceptors to determine whether there has been or is ongoing student involvement in a community prior to the final decision to work in that community. Additionally, the University of North Carolina is in the process of developing a web page and database, SERV-NC, that will specifically facilitate faculty awareness and collaboration on placement of students in community settings. The field coordinator has been an active participant in shaping that initiative. However, the concern about potential burdens on the community is one that the entire university will continue to discuss as more emphasis on community-based education occurs in a variety of academic programs.
For the students, CD demands a significant time commitment and work on a student team, and can increase students' general stress level. The field coordinator utilizes formal and informal evaluation strategies to assess student reactions, and to institute any changes that will make the process more manageable. Within the Department of Health Behavior and Health Education, an ongoing tension has been the enormous amount of student time and energy involved in CD. Since 1995, the field coordinator and other faculty members have made substantial efforts to better integrate core courses, coordinate dates of examinations and papers, and clearly distinguish course content to avoid duplication. Informal surveys of students that assess the amount of time they spend on their core courses indicates some success in the past 3 years in reducing the average amount of time. Undertaking a CD process as a component of any curricula requires continual examination of the impact on that curriculum.
A potential but rare challenge occurs when teams encounter community organizations or members that do not want to work with them. To avoid this possibility, the field coordinator works with preceptors in meeting with community members and agencies, as appropriate, prior to the start of the CD, and asks preceptors to actively work to engage teams and key community members very early in the process. However, the complexity of who speaks for a community can sometimes create difficult situations. Recently, one community group requested a CD team without prior consultation with the local Community Advisory Committee. That Committee, angered by a previous researcher's mistreatment, slowed the team's access to many community members. Following extensive discussions with the preceptor, the Community Advisory Committee, the team and the field coordinator, it was decided that the team should persist in its work while respecting the Committee's wishes about which community members to interview; the team worked closely with their preceptor to develop an alternative interviewing plan. In another community near the university, students encountered some verbal hostility from a very active community member about the frequency of student research in the community without any demonstrable change. The students were able to respectfully and successfully hear this concern, and built a strong relationship with the most vocal initial opponent to the CD. This is the context in which the CD process offers opportunities to gain an appreciation for local politics and the complexity of interactions with multiple community members. The challenge of who speaks for a community and, therefore, who has the right to invite a team presents a learning opportunity for the teams as they deal with turf issues and community autonomy. However, this also demands some flexibility from the team and the field coordinator who may need to modify the process to accommodate community concerns.
|
Implications for professional preparation |
|---|
|
TopAbstractIntroductionDescriptionChoosing communitiesCourse contentSteps in the CD...TeamworkEvaluationOperational details and...DiscussionObstacles and lessons learnedImplications for professional...References |
|---|
Minkler states:
As we approach the twenty-first century, health educators...who work at the interface of health systems and communities face unprecedented new challenges and opportunities. [(Minkler, 1997
To face these formidable responsibilities, students must be skillful in working with communities while fully prepared with academic skills. The newly adopted Graduate Standards address a breadth of competencies, propelling the profession of health education to a new level of professional recognition. While CD is only one component of the department's curricula that aims at building competencies, the faculty of the Department of Health Behavior and Health Education believes it constitutes a strong experiential foundation for development of a variety of competencies. While teaching CD as a core of a graduate program requires a significant commitment of resources, its value in the preparation of health educators ready to work in complex interactions with communities is worthy of exploration by other professional preparation programs.
|
Acknowledgments |
|---|
I would like to acknowledge Amy Vincus, MPH, who worked with me on the preparation of a case study from which portions of this article have been drawn. In addition, I wish to thank Catherine Harbour, Allan Steckler and the reviewers for their helpful suggestions.
|
References |
|---|
|
TopAbstractIntroductionDescriptionChoosing communitiesCourse contentSteps in the CD...TeamworkEvaluationOperational details and...DiscussionObstacles and lessons learnedImplications for professional...References |
|---|
Association for the Advancement of Health Education (1994) Code of ethics for health educators. Journal of Health Education, 25, 196–200.
CDC/ATSDR Committee on Community Engagement (1997) Principles of Community Engagement. Centers for Disease Control and Prevention, Atlanta, GA.
Center for Public Health Practice (1993) Practica: A Guide to Field Placements of Students from Schools of Public Health to Public Health Agencies. School of Public Health, University of Illinois at Chicago, Chicago, IL.
Dennison, D. (1997). Health Education Graduate Standards: expansion of the framework. Journal of Health Education, 28, 68–73.
Department of Health Behavior and Health Education (1996) Alumni Survey. School of Public Health, University of North Carolina, Chapel Hill, NC.
Minkler, M. (1997) Community Organizing and Community Building for Health. Rutgers University Press, New Brunswick, NJ.
National Task Force on the Preparation and Practice of Health Educators, Inc. (1985) A Framework for the Development of Competency-Based Curriculum for Entry Level Health Educators. National Commission for Health Education Credentialing, Inc., New York.
Society for Public Health Education (1983). Code of Ethics. SOPHE, Washington, DC.
Steckler A., Dawson L., Israel B. and Eng, E. (1993) Community health development: an overview of the works of Guy W. Steuart. Health Education Quarterly, Suppl. 1, S3–S20.
Substance Abuse and Mental Health Services Administration (1997) Effective Community Mobilization: Lessons from Experience-Implementation Guide. USDHHS, Rockville, MD.
Tyler E. and Morgan L. (eds) (1966) Field Training for Public Health Educators. Health Educators at Work. Department of Public Health Education, School of Public Health, University of North Carolina, Chapel Hill, NC, pp. 28–40.
US National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (1978) The Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research. USNCPHSBBR, Bethesda, MD.
Wallack, L., Dorfman, L., Jernigan, D. and Themba, M. (1993) Media Advocacy and Public Health: Power for Prevention. Sage, Newbury Park, CA.
Received on February 23, 1998; accepted on September 11, 1998
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  K. A. Kemper, C. R. Dye, W. W. Sherrill, and R. M. Mayo Guidelines for Public Health Practitioners Serving as Student Preceptors Health Promot Pract, April 1, 2004; 5(2): 160 - 173. [Abstract] [PDF]
|
|
|
|
|
|
S. C. Quinn Professional Development of Health Educators through a Community Diagnosis Training Experience: Observations and Perspectives Health Promot Pract, April 1, 2000; 1(2): 159 - 167. [Abstract] [PDF]
|
|
|
|
 |
|
 A. Gielen Graduate training in health education: integrating classroom and community Health Educ. Res., October 1, 1999; 14(5): 581 - 582. [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||