Service-learning projects to enhance preparation of professional health educators.

Abstract: Community schools, colleges, universities, and faith communities promote the concept of service while learning. Opportunities for local and national service abound. This manuscript describes a successful partnership between faculty of an urban public school and undergraduate education majors completed during the spring of 2003. "Principles of good practice "were incorporated into a service-learning project aimed at teaching elementary students about personal health. Classroom teachers and university faculty rated content and methods of instruction and provided feedback to candidates.

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Experiential education was developed more than a century ago to guide instructors interested in helping students capture the meaning of their learning experiences to apply in their chosen profession. John Dewey's Theory of Experience emphasized that, "events are present and operative anyway; what concerns us is their meaning" (1963). Dewey judged the quality of an educational experience by its intellectual and moral benefits to the student and long-term benefits to the community. The instructor is responsible for creating the situation, conditions for further growth of curiosity, desire and purpose.

Lewin (1952) proposed that personal development occurs through successful realization of goals through a process of trial and error, or experimentation. This can be contrasted to a classroom in which the authoritarian teacher determines what is important and necessary to achieve. Experiential education was quite different from "traditional education" of the 19th Century due to an added emphasis on subjective, as well as objective knowledge, process of creating knowledge through action, and social rewards (National Society for Experiential Education [NSEE], 1997).

ROLE RESPONSIBILITIES AND SERVICE-LEARNING

Today, service-learning experiences are more frequently required for secondary and college students (Brown, 1998). The National Service-Learning Cooperative stated "service-learning is a teaching and learning method that connects meaningful community service experience with academic learning, personal growth, and civic responsibility" (Mintz & Liu, 1994).

Service-learning is compatible with general and discipline-specific educational standards. The National Education Goals for the year 2000 emphasized preparing students for responsible citizenship including involving America's students in community service activities (Kleiner & Chapman, 1999; Brown, 1998).

According to the National Household Education Survey of 1999, 80% of public high schools offered service-learning opportunities during that same year. Two-thirds of American schools arranged service work for students in grades 6-12, matching opportunities with volunteers. Twenty-one percent of schools required a specific number of service hours to be completed before graduation. Approximately one-half of secondary students participated in service-learning in 1999 (Kleiner & Chapman, 1999).

In the university setting, physical therapy, nursing, and medical students are also engaging in service-learning projects (e.g., Comely et al., 2001; Levy & Lehna, 2002; Young, Bates, Wolff, & Maurana, 2002). In addition, undergraduate students are also participating in service-learning opportunities in the areas of teaching, social sciences and health education (e.g., Swick & Rowls, 2000; Cashel, Goodman, & Swanson, 2003; Butcher & Hall, 1998). One program, from the University of Utah, provided candidates, from the Department of Exercise and Sport Science, Health Education, Recreation and Leisure, and Food and Nutrition, a service learning opportunity with at risk urban elementary students. The candidates assisted the elementary school with the implementation of an organized recess program. Using positive role models and organized activities, the program focused on enhancing the youths' self-esteem. The program was evaluated by interviews with the elementary students; it was considered a successful and positive learning experience for all who were involved (Butcher & Hall, 1998).

Eyler and Giles (1999) surveyed over 1,500 students selected from 20 institutions of higher education to determine cognitive outcomes of service-learning projects. Students reported enhanced understanding of course material, new awareness of complexity of personal and social issues, and practical ability to apply course content. Higher quality service-learning experiences appeared to be related to development of critical thinking skills (Dennis, 2003).

The Role Delineation Project of the National Commission of Health Education Credentialing (NCHEC) specified responsibilities and competencies for entry-level health educators. Experiential education enables candidates to implement the NCHEC's areas of responsibility and competencies in a "real world" setting. Service-learning facilitates the candidates' comprehension of these responsibilities by allowing them to assess the community needs, plan and implement effective health instruction, and act as a resource person for elementary students and teachers. Experiential education also permits the candidates to learn additional responsibilities, such as communicating the health needs, concerns and resources to the target population, applying appropriate research principles and methods, and advancing the health education profession (National Commission of Health Education Credentialing [NCHEC], 2002; Anderson, 1998).

The focus of this manuscript is to describe an effective service-learning project completed by candidates majoring in health and elementary education degree programs in a large southeastern state university within the setting of an urban public school.

METHODS

PARTICIPANTS

The school nurse and classroom teachers of a nearby elementary school invited 27 candidates enrolled in the university course Community Health Education Applications--Theories and Behaviors to prepare and present health education lessons during the spring of 2003. Candidates represented a range of ethnic groups.

DESIGN AND PROCEDURE

Service-learning is distinctive from volunteer work, since "it affords active learning through workplace experience and reflection" (Brown, 1998). Important "principles of good practice" were incorporated into this service-learning project: intention, planning, orientation, clarity, authenticity, monitoring, reflection, evaluation and recognition, and continuous improvement (NSEE, 1997). Table 1 presents application of these principles to the service-learning project.

A first step is to define the intention, i.e., specific knowledge and skills for candidates to acquire through the service-learning project (CHES Responsibility II). Two aims were to develop an awareness of learning conditions in inner city public schools and to learn how to plan and deliver age-appropriate health information to elementary students.

Ongoing communication between all parties (course instructors, candidates, and school site partners) was essential to achieve clarity of purpose for this project. Initial expectations of school site partners were overly ambitious, as they desired candidates to host a health fair and present new health lessons across all grade levels. It was necessary to restrict the focus of a service-learning project to fit within a single semester course with 27 candidates.

Planners agreed to focus on health instruction, then discussed expectations, responsibilities, timelines, and projected outcomes with candidates. The steps to planning instruction consisted of meeting with school site partners (nurse, classroom and extended day program teachers) to determine which grades would participate in health lessons and assigning dates for school site visits. All participants agreed to be flexible to arrange visits to minimize disruption to the regular school schedule. There were many opportunities for team decision-making and problem solving regarding selection of classes, materials, activities, and location (classroom, gymnasium, and schoolyard).

The instructor and school site partners provided candidates with an orientation to youth health threats and the school setting. Candidates examined issue briefs provided by the U.S. Centers for Disease Control and Prevention Division of Adolescent and School Health (CDC-DASH) and the American School Health Association (2003). Statistics on childhood nutrition, physical activity, overweight and obesity were obtained from the Alabama Department of Public Health (ADPH, 2000), National Center for Chronic Disease Prevention and Health Promotion, and the 5 A Day Surveillance Program (CDC, 2003, 2002). Candidates responded to online polls posted on the class website to comprehend youth health risks. In addition, candidates attended a guest lecture on determinants of diabetes in youth and adults presented by a community nephrologist at a nearby university.

Candidates reviewed a profile of the elementary school compiled by the state department of education (Alabama State Department of Education, 2003a). The profile contained demographic data: student attendance, academic achievement, incident reports by category, dropout rate, and family income. The state education department also provided information on school site resources: revenue by source, full-time instructional and support personnel, and access to computers and highly qualified teachers by subject area. Approximately 721 students registered to attend the elementary school during the 2002-03 academic year. Nine of 10 elementary students were African American or Hispanic. Eight of 10 were eligible for free or reduced price meals.

Candidates learned protocols and procedures to prepare and present health lessons and manage elementary student behavior. Each candidate was expected to assume an active speaking role during instruction to 11 classes of elementary students.

MATERIALS

The entire class reviewed field-tested health lessons available in print and online using professional journals and websites, such as AskERIC Lesson Plans on Health and Physical Education (now known as Educator's Reference Desk), Microsoft Schoolhouse, Education World, EdHelper.com, P.E. Central, and Teachers.net, and discussed a standard format for a complete lesson plan. Each health lesson included 12 components: (a) grade level, (b) health subject, (c) connections to other curricular areas, (d) duration, (e) general and (f) specific learning objectives compatible with state standards, (g) prerequisite knowledge and abilities, (h) materials and resources, (i) procedure, (j) assessment, (k) modifications for students with special needs; and (l) references. Some candidates adapted and improved health lessons published online, in journals or teaching guides, as long as they cited the original source.

An authentic approach was preferred to rote practice of lesson plans prepared by others (CHES Responsibility III). This included selecting methods and materials best suited for specific learners. Candidates worked in small presentation groups to select: (a) health content area, (b) student grade level, (c) activities for learners, and (d) method of assessment. Candidates learned to use the new state curriculum framework (ASDE, 2003b) and National Health Education Standards: Achieving Health Literacy (Joint Committee on National Health Education Standards, 1995) to guide their work. Several candidates participated in multiple groups and volunteered to present health lessons to additional elementary classes.

Candidates grouped health lessons by grade level and added brief summaries of developmental stages suggesting effective classroom practices for instruction of elementary-aged learners. Most considered development and learning theories developed by Piaget, Freud, Erikson, Mahler, and Vygotsky as they prepared health lesson plans (Chapman, 2002; Myers, 1991).

Candidates were encouraged to plan for active participation by elementary students. Three levels of monitoring permitted them to test assumptions about effective instructional content and strategies. This is necessary for continuous self-improvement (CHES Responsibility III). Level one required meeting with peers in small learning groups to describe and defend teaching ideas and review instructional resources. Peers asked questions and provided suggestions for improvement.

The second level of monitoring occurred over several weeks. Regular small group discussion with reviewers (university instructor, public school nurse, senior-level and graduate students) clarified expectations for student achievement. Both the nurse and college senior worked within the school site and knew all classroom teachers and administrators. All reviewers provided oral and written comments and encouraged candidates to modify intentions and content.

The final level of monitoring occurred after presenting lessons in elementary classrooms. Candidates returned to the university and reflected on student outcomes and areas for improvement, including clarifying roles of each group member, correcting grammar and spelling errors, limiting length and complexity of lesson content, and practicing lesson delivery.

Of course, monitoring is not separate from principles of evaluation and reflection. Evaluation had three components: assessing elementary students' gains in knowledge, rating candidates' written lesson plans and instructional delivery, and gathering candidates' perceptions about the university course experience. Candidates developed simple assessment tools to administer to elementary students during the elementary lessons (structured questions, worksheets, and performance tasks) (CHES Responsibility IV). Instructors determined whether candidates' health lesson plans included 12 required components.

Host teachers and university faculty rated candidates' presentation of health lessons to 11 elementary classes, ranging in size from 20-30 students. Raters provided oral and written comments to candidates using a simple rating sheet. The rating sheet included four objective items and one subjective item. Raters responded to objective items using a three-point scale. Raters indicated satisfaction with candidates' preparation and knowledge, enhancement of elementary students' understanding of health topics, use of effective teaching methods, and techniques, and opportunities for student questions and discussion.

Finally, candidates anonymously completed a university course evaluation form containing 14 objective items and 4 subjective items. Candidates replied to items about achievement of course goals and objectives, teaching effectiveness, course workload and difficulty, perceived value of the course, and individual effort. Subjective items enabled candidates to identify the most and least valuable aspects of the course and to suggest specific improvements for the class.

RESULTS

Candidates demonstrated CHES competencies related to Responsibility Areas II, III and IV, beginning with preparation of 11 elementary health lessons on the topics of nutrition and physical activity and culminating in assessment of impacts. They selected a wide variety of accurate informational resources obtained from national, state and local agencies and organizations, such as CDC, U.S. Food and Drug Administration (2003), and National Heart, Lung and Blood Institute (2003). Twenty-seven candidates presented 11 of these lessons to elementary learners in grades 1, 3 and 4 during the spring of 2003. Candidates worked in eight groups of 3-5 presenters each. A school nurse assisted candidates to obtain instructional resources and facilitated introductions to classroom teachers, elementary students and parent volunteers. Two volunteers from the parent teacher association prepared nutritious snacks (fruit and yogurt smoothies) for their children to reinforce basic concepts about healthful eating.

Host teachers, a university faculty member, and advanced health education students completed twenty presentation rating sheets. At least two rating sheets were completed for each group of candidates. Table 2 presents raters' evaluation of candidates. Overall, the raters were very satisfied with the performance of candidates. Selected responses to the final open-ended items included:

* Very energetic group of presenters

* Fourth graders were very responsive to learning game--good job!

* Your students (candidates) did a great job--acted very professionally

* What a nice break from our regular routine. My students were very excited and learned many facts. I loved the games university students taught my class.

* I was very pleased with university students' presentation. My class was very actively engaged and participated the entire time. They really enjoyed it. Activities really helped us to have a great ending to a very tiring week. Thank-you.

* Children really enjoyed the food pyramid relay.

* University students were very professional and encouraged the students to think. They incorporated a fun song into their lesson. Nice review at the end!

* University students were quite excited about the lesson they taught to my class.

* University students were well prepared for the lesson they taught to my class. They provided group reinforcement and used a variety of instructional resources, both visual and written.

* Great lesson and a perfect introduction to the nutrition unit we will begin soon. University students were very responsive to my elementary learners, directing and assisting them to complete activities. They gave precise directions.

* Wonderful job involving my elementary students in learning about health through physical activity!

* Enthusiastic song leaders! Creatively used music and visual aids to engage elementary learners.

* Having a group of presenters permitted frequent attention to elementary learners, an ideal student-teacher ratio.

* The fruit smoothies were delicious! Raters also suggested areas for improvement as health educators:

* Practice learning games thoroughly before presenting to elementary students. Be prepared for combination foods that include more than one group of nutrients.

* Presenters needed a little more practice to reduce errors in the lesson.

After completing school site visits, candidates engaged in further reflection about the effectiveness of their lessons to enhance knowledge of elementary students and changes they could make to improve their performance. The most common errors were: (a) content too advanced for ability of elementary learners, (b) lengthy lessons lasting beyond a regular class period, (c) grammar and spelling mistakes, and (d) errors in presentation due to insufficient practice.

The final step of the project was sending a letter signed by candidates and instructors to school site administrators thanking them for hosting our class. This letter also served to recognize the efforts of each university student. It was encouraging that several elementary teachers asked to retain instructional resources prepared by students in addition to health lessons to use during future classes. The majority of candidates, who replied to the course evaluation, rated the service-learning project as one of the most difficult and meaningful experiences of their undergraduate education. Many remarked upon their new understanding of the complexity of planning for and delivering health instruction.

DISCUSSION

Results from raters indicate overall satisfaction with university candidates' preparation and knowledge about the content. Raters also were satisfied with level of interaction between candidates and elementary students. Most raters (19 of 20) reported that elementary students' knowledge about health topics was enhanced because of candidates' presentations. The same number felt that presenters used effective teaching methods and techniques. In fact, classroom teachers strongly encouraged candidates to return with additional presentations in future terms.

This service-learning project was not conceptualized as a research study; rather aims were to enhance candidates' social awareness and to provide practical experiences to apply their knowledge and skills. Candidates discussed their impressions of barriers to learning in inner city schools, inquired about successful practice, desired to achieve as instructors, and exceeded their own initial expectations (Anderson, 1998).

At the conclusion of the project, presenters reflected on the activity in small groups. Initially, several candidates expressed trepidation about visiting inner-city schools and interacting with young children. Afterwards, they felt enthusiastic about their contacts with elementary students and their teachers, particularly since they had applied health knowledge to classroom instruction.

This basic service-learning project confirmed the value of experiential education as part of professional preparation programs, similar to results reported by Eyler and Giles (1999) and Butcher and Hall (1998). Candidates implemented the NCHEC's areas of responsibility and competencies in the setting of an urban public elementary school. Presenters learned to work with peers to plan in advance, use state and national health education standards, collaborate with teachers, nurses, administrators and parents, practice lesson delivery and classroom management skills, and advocate for members of the target audience. In fact, presenters learned how to directly respond to one elementary student who reported physical abuse at home. We invited the school nurse into the classroom for a clinical assessment.

There were several limitations of this service-learning project. The sample size of candidates was small. Secondly, the simple rating sheet did not use a standardized scale. Finally, classroom teachers were identified by name on the rating sheet, which may have influenced their comments. University faculty noted these as areas for future improvement.

During the subsequent semester, a second group of candidates utilized the new state health education content standards (ASDE, 2003b) to prepare 64 health lessons. The intent was to assist the same group of elementary teachers as they planned curriculum changes in the subsequent academic year. Lessons were grouped by topic: (a) nutrition (18 lessons), (b) mental and emotional health (8 lessons), (c) injury prevention (7 lessons), (d) substance use and abuse (7 lessons), (e) prevention and control of diseases and disorders (6 lessons), (f) community health (4 lessons), (g) environmental health (4 lessons), (h) personal health (4 lessons), (l) family health (3 lessons), (j) dental health, (k) first aid, and (l) social health (1 lesson each). The health lessons helped the candidates become familiar with the new required state course of study, and provided the elementary teachers with a variety of health education lessons to teach their students. Candidates were not required to present their lessons in public school classrooms due to the brevity of a spring mini-term. There was insufficient time to plan, practice, and deliver health lessons during the final few weeks of the academic year.

ACKNOWLEDGEMENT

The authors gratefully acknowledge the assistance provided by school nurse Dorothy Lai, RN, and extended day program bookkeeper Robin Lai.

REFERENCES

Alabama Department of Public Health. (2000). Healthy Alabama 2010. (Publication No. ADPH-P-BHPI184/3-00). Montgomery, AL: Bureau of Health Promotion and Information. Retrieved January 20, 2003, from http://www.adph.org/administration/ha2010.pdf

Alabama State Department of Education [ASDE]. (2003a). 2001-2002 report card profile for Glen Iris Elementary School (0270) in Birmingham City (114). Retrieved March 21,2003, from http://f6.grp.yahoofs.com/ v1/ABhdP1i8B6_Fx7s7YrFik4F8ZsueUlok Du-a-anzQtPfXamTPYGW1X20CRF-Qyu-Ld-TPCtUFzqx3hfh/ Required%20applicat%20activities/Glen%20Iris%20Schl%20Profile.htm

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American School Health Association. (2003). What is school health? Retrieved March 21,2003, from http:// www.ashaweb.org/whatis.html

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Butcher, D., & Hall, E. (1998). University students learn by helping at risk elementary students: "Team Lincoln." Social Work in Education, 20, 191-203. Retrieved September 9, 2003, from EBSCOHOST.

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Brian F. Geiger, EdD

Brian F. Geiger, Ed.D. is affiliated with the School of Education at the University of Alabama at Birmingham.

Karen Werner is a Doctoral Fellow in the School of Education at the University of Alabama at Birmingham. Address all correspondence to Brian F. Geiger, Ed.D., University of Alabama at Birmingham, School of Education, Room EB 209, 1530 3rd Avenue South, Birmingham, AL 35294-1250, PHONE: [phone], FAX: [phone], E-MAIL: [e-mail]

Table 1. Application of the NSEE (1997) Principles of Good Practice
to the Service-Learning Project.

1. Intention                  A) Candidates developed an
                              awareness of learning conditions in
                              inner city public schools.
                              B) Candidate learned how to plan
                              and deliver age-appropriate health
                              information to elementary students.

2. Planning                   A) Met with school site partners to
                              determine which grades would participate
                              in health lessons and assigned dates
                              for school site visits.
                              B) Used team approach to select classes,
                              materials, activities, and location.

3. Orientation                A) Provided candidates with an
                              orientation to youth health threats.
                              B) Presented a profile of the school
                              and its students.

4. Clarity                    A)Negotiated realistic expectations
                              and responsibilities with school site
                              partners and candidates.
                              B) Established timelines and projected
                              outcomes of the service-learning
                              project for health instruction.

5. Authenticity               A) Selected methods and materials best
                              suited for specific learners versus
                              rote application of lessons prepared
                              by others.
                              B) Considered child learning theories
                              when developing effective lessons.

6. Monitoring                 A) Reviewed draft lessons with peers
                              and discussed improvements.
                              B) Solicited comments from instructors
                              and school site partners.
                              C) Class presentation of outcomes of
                              teaching experiences.

7. Evaluation                 A) Assessed elementary students' gains
                              in knowledge.
                              B) Rated candidates' written lesson
                              plans and instructional delivery.
                              C) Solicited candidates' perceptions
                              about the university course experience.

8. Reflection & Continuuous   A) Determined lesson effectiveness.
                              B) Identified improvements to lesson
                              content and presentation.

9. Recognition                A) Delivered a thank-you letter to
                              school site administrators signed by
                              all candidates.
                              B) Presented raters' favorable comments
                              about candidates and requests for
                              materials during class and posted on
                              website.

Table 2. Raters' Evaluation of Candidates (n=20).

            Item                Completely satisfied      Satisfied

1. Satisfaction with the guest
     speakers' preparation and
     knowledge about their
     subject area                        17                   3

2. Satisfaction with
     opportunities for your
     students to ask questions
     and participate in
     discussion                          19                   1

             Item                 A great extent      A moderate extent

3. Extent to which presenters
     enhanced your students'
     understanding of health
     topics                              14                   5

4. Extent to which presenters
     used effective teaching
     methods and techniques              14                   5

            Item                Not at all satisfied

1. Satisfaction with the guest
     speakers' preparation and
     knowledge about their
     subject area                        0

2. Satisfaction with
     opportunities for your
     students to ask questions
     and participate in
     discussion                          0

             Item                    Not at all

3. Extent to which presenters
     enhanced your students'
     understanding of health
     topics                              1

4. Extent to which presenters
     used effective teaching
     methods and techniques              1