A service learning master's thesis on asthma.

Abstract

Is a master's thesis an appropriate venue for service learning? Are all students equally equipped, given proper training, to manage the increased pressures of working on efforts for the benefit of a community partner? This article explores the practical challenges and successes emerging from a community based master's thesis. This paper will also provide a window into the personal reflections of a student that continues to be transformed by the experience.

Introduction

When we experience something we act upon it, we do something with it; then we suffer or undergo the consequences. We do something to the thing and then it does something to us in return: such is the peculiar combination. The connection of these two phases of experience measures the fruitfulness or value of the experience. Mere activity does not constitute experience. ~John Dewey, 1944

According to survey results published in the Higher Education Service learning Sourcebook, over 320 colleges and universities around the country offered service learning programs or coursework as of 2000 (Crews, 2002). At its basic level, service learning expands on coursework by challenging students to apply academic skills to immediate, real-world issues. Often in tandem with service learning, higher institutions are developing community-university partnerships and engaging in community-based research (CBR) as a process for increased civic engagement. CBR is "collaborative, change oriented research that engages faculty members, students, and community members in projects that address a community-identified need" (Strand et al., 2003). CBR can be considered an intensive form of service learning, where community collaboration and research becomes the focal point for academic learning (Willis et al., 2003). Despite an increase of integrated programs, and a sizable community based research literature in several disciplines, there are few published accounts of graduate experiences in the service learning literature.

This article is a reflection on a community-based research, service learning project exploring adult asthma knowledge. The experience was unique in that the project occurred within the normally narrow confines of traditional master's research training. The primary purpose of this article is to discuss the strengths and weaknesses of combining service learning methods with a master's research process. It should be noted that each section is written initially with a third person voice, followed with a first person reflection. This practice allows for crucial understanding to come through intentional reflexive thinking about the service process in light of research learning objectives (Honnet & Poulson, 1989; Eyler, 2002).

Reflection

John Dewey's quote resonates with my experience conducting research within a service learning context for a master's thesis; I "suffered" and have undergone the consequences. I inquired, collected information, analyzed data, and developed recommendations within a research experience. In turn, I felt the impact of learning how to conduct science for a local community. The "peculiar combination" of my service and my learning added momentum to what had been a faint interest for research. The content, scientific process, pedagogy, community experience, and reasoned findings of my master's thesis nudged me into a new life stage as a researcher.

The Initial Project

Any service learning veteran will attest to its inherent unpredictability. Students may lose interest and leave a project incomplete; community partner expectations may exceed student abilities; a student's lack of preparation may lead to frustration for all involved, and so forth. The community based research, action research and community based participatory research fields have thoroughly explored the pitfalls of conducting research pairing external researchers with community groups. Conducting a master's thesis using a service learning model introduces additional unique challenges and considerations. The author set out to engage in service learning as action research. She intended to craft a master's project that would be practical and of use to someone or some community. Her advisor assisted her in establishing a relationship with a local environmental health and social justice non-profit who had experience with undergraduate service learning projects. Initially, the project was intended to be an evaluation of a community asthma program.

Asthma is a unique and critical issue for racial and ethnic minorities living within urban inner cities as they suffer disproportionately high morbidity and mortality risks (Grant, Alp, & Weiss, 1999). The asthma rate in Northeast Portland, home to many African Americans, is twice as high (14%) as in other Oregon counties (Multnomah County Health Department, 2003). At the same time, many toxic releases and contaminated brown-field sites occur in the North Portland Enterprise Community, an area that has a 35% poverty rate in 11 of 15 census tracts (US EPA Brownfields, 2003). The author surveyed participants in community asthma program workshops. The community asthma program was designed to reach vulnerable adults in 13 neighborhoods in North/Northeast Portland during 2002-2003 that were either sufferers of asthma, or had children with the chronic condition. Surveys were administered before and after each workshop to see if knowledge and attitudes shifted based on the program. Unfortunately, summer activities reduced the number of participants in the final workshops to fewer than 30--the minimum required for statistical data analysis in the author's thesis program.

Reflection

After spending five months building relationships with individuals at the non-profit, I was disappointed when, at summer's end, I did not have enough data. I wanted to feel like my effort was of use to this partner, whose work I believed in and supported. Despite the presence of strong service learning criteria including a solid partnership, a clearly stated goal, and partner-driven research questions, the unpredictability of working with communities forced me to identify a new question and data source. The timeline of a master's program did not include having to develop, investigate, and collect data on two different questions. But this is what happened.

The Final Project: Methods and Findings

Before beginning the initial data collection, the author began an extensive literature review on asthma, asthma education, at-risk populations, health disparities, inner city risk factors, African American communities, surveys to assess asthma knowledge, and educational approaches for at-risk populations. In the context of this preparatory work, she learned that little information had been collected regarding the general public's awareness, attitudes and perceptions about asthma in Multnomah County, Oregon. This is despite the fact that the lifetime asthma rate in Oregon is 13%, higher than the 11% nation-wide rate (CDC MMWR, 2003). Currently, a population-based education program does not exist in Oregon even though less than half of adults (45%) consider asthma a serious disease (ODHS, 2001).

Her advisor recommended she assess general adult knowledge of asthma to see if North Portland residents, given their increased experience with asthma, knew more than other individuals. Two groups of college students (109 participants), a sample of North Portland residents attending a local health fair (70 participants) and a sample of health workers presenting at the same fair (30 participants) were surveyed. The author was able to use an adapted version of the Chicago Community Asthma Survey-32 (CCAS-32) she had selected from her initial project. The CCAS-32 is a validated survey developed to measure the knowledge, attitudes and perceptions of the general population regarding asthma CCAS-32 (Grant et al., 1999). The author directly administered a paper version of the survey to college students. At the health fair, she trained a group of North Portland teens to disseminate the paper survey.

Responses to the CCAS-32 indicate that all groups need more information regarding asthma signs and triggers; misconceptions exist relating to asthma medications and treatment. Chi-square was used to evaluate group differences on dichotomous knowledge items. The surveyed health workers had the highest level of overall knowledge (74.8% correct, p < .05), followed by North Portlanders (57.9%), with college students having the lowest reported knowledge (52.8%). None of the participants could correctly distinguish that mosquito bites and poor diet do not trigger attacks, while dampness and cockroaches do. Direct asthma experience significantly impacted North Portlanders' knowledge about six items. Individuals with asthma experience were more likely to know that asthma limits exercise, asthma is related to school absences, tightness in the chest is a sign of an asthma attack, dampness and pollen are asthma triggers, and poor diet is not. The asthma educator of the original project had suggested adding a survey item, "asthma medications can stunt a person's growth (T/F/Don't know)." Of the North Portland sample, 65% reported that this was true; a misconception that can lead to individuals not using preventative medications. This finding would not have come to light without input from the original community partner. The author recommended peer educators for all groups, a neighborhood asthma health clinic staffed with community health workers in North Portland, and continuing education for health workers based on survey findings and asthma education literature.

The Peculiar Combination: The Benefits

This experience revealed that the practice of relationship building can strengthen a CBR process that switches directions. Months of trust building practice with the first nonprofit enabled the author to comfortably consult several health agencies and other nonprofit representatives before going forward with her new research direction. This step helped her to formulate a question that was broadly applicable. Recently, the author conducted interviews with concerned community groups who were interested in the findings. Each of the individuals expressed finding the results useful. This work validated assumptions and the personal experience of several asthma educators in the region, has become a resource for asthma program development and expansion by at least two non-profits, and is being used as a model of local community-based asthma research for at least one PSU faculty member.

So What? Lessons Learned

Despite the potential for experiencing growth as a researcher and member of a larger community, working within the service learning framework while completing a master's thesis may not be the best option for everyone. The practice of scientific research involves dealing with circumstances beyond the control of the researcher. Any researcher within the physical sciences can describe problems with experimental procedure or a finding that led to a new research path. Social research is additionally complicated by human data that shifts, like opinions and attitudes. In service learning, the unique fusion of research for immediate, practical use by a community adds further complexities to an already involved process. Experienced undergraduate researchers note that successful CBR projects require realistic goals, realistic expectations and time frames, clear support systems, and the need for prior relevant student experience and skills to facilitate personal investment in the project (Willis et al., 2003). Experienced degree-holding researchers also note that community based research challenges involve dealing with the constraints and requirements of academic research funding, bridging the goals of academics and community members, and functioning within academic institutional structures (Polanyi & Cockburn, 2003).

Successful graduate research with community partners is no exception to these cautions. The stakes are high in a master's program when a degree is based on the ability of completing a project that is dependent on community processes. Faculty and students should consider the challenges of using this approach. This project contributed to increased levels of fear and anxiety for the author due to a concern about maintaining solid community partnerships in addition to using a rigorous approach to her research. It is difficult to identify realistic time frames required to build trust in relationships. An appropriate level of student experience and skills is also challenging to judge. It is the author's opinion that students with patience, tenacity, drive, a strong ability to work independently, a willingness to ask questions, and a solid support base will succeed in community based research.

Reflection

This project experience encouraged me to become a researcher. Years of taking courses and conducting projects that had no immediate use gave way to a sense of accomplishing something practical. Classes cannot teach how to build authentic partnerships, impart what trust feels like, or give students a sense of admiration and appreciation when a group of teenagers becomes the crucial link in collecting data in a community. I felt awe when the personal was shared across cultural and ethnic divides. I learned to confront my arrogance as an educator and student of higher academe. I realized I have a strong desire to contribute to a network of individuals who experience discrimination, residential segregation, and economic inequity. Using my thesis as an avenue to learn more about local environmental justice and public health issues provided me with a breadth and depth of knowledge that would be impossible to match through a year of coursework.

At the same time, I felt additional pressure to be responsive and responsible to my community partners. I worried about committing the type of errors that could affect my work as a researcher or those that could negatively impact tenuous bonds of trust in relationships (these were not covered in my statistics course). I felt I had to rely on myself; not an advisor or direct community partner support, to make all the different phases of this project work. This is the reality of a master's research process, but working in community partnerships to address social justice issues increased the pressure to do things the right way, and thus elevated the risk for making careless errors. Time frames in service learning and community-based research are not always in alignment with those of traditional higher education. Community workings do not run by a clock. My initial project had a realistic goal and time frame, however delays occurred. Had my advisor not helped me in setting my goals for data collection, analysis and writing, I would have overshot my two-year program.

Conclusion

Combining a master's thesis with service learning introduces added complexities because a researcher in training must learn to conduct research in balance with community partner needs. Each community partner in this project had multifaceted and complex needs, and the author learned to tailor her research to address them. Over a year following the defense of her thesis, the researcher is still completing work she agreed to in exchange for access to each community group. In contrast, a traditional, non service learning master's thesis would not have exposed the researcher to the same opportunities and multifaceted challenges. For example, had she analyzed secondary asthma knowledge data collected through a standardized survey instrument, an error in methods would not have impacted any other individual or group. In this alternate design, the author would not have learned to create trust with project partners. Human relationships are a fundamental component to public health and social research; however, using a master's thesis as a conduit for understanding these realities embodied more risk and led to heightened anxiety for the author. The process of gaining mastery as a researcher combined with a unique "real-world" setting provides unusual opportunities for student development and an expanded potential of useful work for community partners. Students who are independent and passionate about their subject matter will most likely be successful in meeting community partner expectations on top of master's degree requirements.

References

Centers for Disease Control (CDC) (2003). Self Reported Asthma Prevalence and Control Among Adults--United States, 2001. May 2, 2003 MMWR, available online: www.cdc.gov/mmwr/preview/mmwrhtml/mm5217a2.htm

Crews, R. J. (2002). Higher Education Service learning Sourcebook. Westport, Connecticut, Oryx Press.

Dewey, J. (1944). Democracy and Education: An Introduction to the Philosophy of Education. New York, The Free Press.

Eyler, J. (2002). Reflection: Linking service and learning--linking students and communities. Journal of Social Issues, 58(3), 517-534.

Grant, E.N., Alp, H., & Weiss, K.B. (1999). The challenge of inner-city asthma. Current Opinion in Pulmonary Medicine, 5, 27-34.

Grant, E.N., Turner-Roan, K., Daugherty, S.R., Li, T., Eckenfels, E., Baier, C., McDermott, M.F., & Weiss, K.B. (1999). Development of a survey of asthma knowledge, attitudes and perceptions: The Chicago Community Asthma Survey. Chest, 116, 178S-183S.

Honnet, E.P., & Poulsen, S. (1989). Principles of good practice in combining service and learning. Wingspread Special Report. Racine Wl: The Johnson Foundation.

Oregon Department of Human Services (ODHS) (2001). Update: Asthma in Oregon, 1998-2000 from Oregon Asthma Program. Retrieved online on October 21, 2003 from http://www.oshd.org/asthma

Polanyi, M. & Cockburn, L. (2003). Opportunities and pitfalls of community-based research: A case study. Michigan Journal of Community Service Learning, 9(3), 16-25.

Strand, K., Marullo, S., Cutforth, N., Stoecker, R., & Donohue, P. (2003). Principles of best practice for community-based research. Michigan Journal of Community Service Learning, 9(3), 5-15.

US EPA Brownfields Clean up and Redevelopment. Brownfields Cleanup Revolving Loan Fund Pilot Fact Sheet: Portland, Oregon (last updated July, 2003. Retrieved on April 12, 2004 from http://www.epa.gov/brownfields/html-doc/rlf/portland.htm

Willis, J., Peresie, J., Waldref, V., & Stockmann, D. (2003). The undergraduate perspective on community-based research. Michigan Journal of Community Service Learning, 9(3), 36-43.

Notes

This research process took place under the guidance of my advisors Linda A. George, Ph.D., Associate Professor in the Center for Science Education, and Stephanie A. Farquhar, Ph.D., Assistant Professor of Community Health in the School of Community Health at Portland State University.

Tia Henderson, Portland State University

Tia Henderson, M.S., is a doctoral student in the School of Urban Studies and Planning at Portland State University