October 18-21, 2010 Service Learning to Enhance Cross Cultural - - PowerPoint PPT Presentation

Kim Bullock, M.D. Associate Professor, Community Health Division Director, Service-Learning Assistant Director, Beverly Roberson Jackson, Ed. D. Adjunct Professor, Department of Family Medicine Georgetown University Medical Center Washington, DC Pooja Sodha, Georgetown Medical School student

Seventh National Conference on Quality Health Care for Culturally Diverse Populations Baltimore, MD October 18-21, 2010

Service-Learning as a Strategy to Enhance Collaborative Cross-Cultural Learning, Understanding and Synergy Presentation ID#: 2755

 Service Learning to Enhance Cross

Cultural Communication

What is the potential for synergy in Service Learning? Structured intentional reflection before, during and after Service Learning experiences often builds a bridge between the concrete and the abstract; between practice and theory. It utilizes health to frame the problems into solutions and a practical action strategy. In this case; it involves interactive developments with the families who illuminate and frame the issues surrounding immunization.

Service-Learning as a Strategy to Enhance Collaborative Cross-Cultural Learning, Understanding and Synergy Presentation ID#: 2755

 Project Goals

To increase community health literacy among parents of preschool children and increase awareness of and involvement in public health policy for medical students and parents through campus community service learning projects. Long-term Georgetown University Medical School/ MACECD Service Learning Partnership Goal:

Service-Learning as a Strategy to Enhance Collaborative Cross-Cultural Learning, Understanding and Synergy Presentation ID#: 2755

Course Overview

 The Service Learning course at the

School of Medicine provides an

• pportunity for the students to

examine the environmental and social context in which a targeted group of the city’s population makes health

• decisions. Service Learning experiences

challenge student's assumptions about community issues, and marginalized communities.

Service-Learning as a Strategy to Enhance Collaborative Cross-Cultural Learning, Understanding and Synergy Presentation ID#: 2755

 Health literacy has recently been

infused in the medical school curriculum in order to promote awareness and sensitivity by future doctors as part of a social- determinant framework.

Service-Learning as a Strategy to Enhance Collaborative Cross-Cultural Learning, Understanding and Synergy Presentation ID#: 2755

 Students come to an appreciation of the

strengths, capacities, and assets of diverse people groups that are often considered at-risk or displaced.

 Service Learning is an opportunity for

students to move from their comfort zones to their contact zones, and thus redefine what is "comfortable and/familiar to them.

 This addresses the sense of

connectedness, the nexus that binds all humanity.

Service-Learning as a Strategy to Enhance Collaborative Cross-Cultural Learning, Understanding and Synergy Presentation ID#: 2755  Added to this approach is the use of student

reflection which when linked to knowledge enriches student response and responsiveness.

 Reflection brings out "cognitive dissonance,"

and allows students to explore through reflective assignments and exercises how to resolve or dispel these often erroneous

• beliefs. This is part of the cornerstone of

effective Service Learning pedagogy and stimulates cognitive growth and inquiry about people, cultures, nationalities, and differences.

Service-Learning as a Strategy to Enhance Collaborative Cross-Cultural Learning, Understanding and Synergy Presentation ID#: 2755

 Effective Service Learning classes

are those which allow service and civic engagement to become integrated and enhanced as part of the academic learning experience; not take the place of it.

Service-Learning as a Strategy to Enhance Collaborative Cross-Cultural Learning, Understanding and Synergy Presentation ID#: 2755

 Process for Immunization Experience

 At the beginning of the course the students

created a community asset map and learned to recognize health resources and health impediments in targeted communities.

 Students studied general factors related to

various neighborhoods within the city (e.g., income, housing patterns, environmental toxins and the availability of fresh whole foods) and then selected a critical problem and target neighborhoods for exploration.

Service-Learning as a Strategy to Enhance Collaborative Cross-Cultural Learning, Understanding and Synergy Presentation ID#: 2755

 Research Methods

 Within the course module, the community study was

followed by an introduction to qualitative research methods with a community based social science researcher.

 The students in the team assigned to the Mayor’s

Advisory Committee on Early Childhood Development learned and practiced conducting focus groups and key informant interviews and were matched with Head Start parent groups to study a health issue/problem that the students selected.

 Students develop a deeper understanding of the

community-decision-making processes, ethical and critical reflection and practical utilization in practice.

Service-Learning as a Strategy to Enhance Collaborative Cross-Cultural Learning, Understanding and Synergy Presentation ID#: 2755  The problem selected in 2007 was the recent

decline in early childhood immunizations as noted in the 2007 Child Trends report below.

Figure 2. The students selected a Health Literacy project in health promotion that encouraged targeted parents to get their children immunized on schedule and reverse the declining trend shown.

Service-Learning as a Strategy to Enhance Collaborative Cross-Cultural Learning, Understanding and Synergy Presentation ID#: 2755

 The medical students completed

additional research on the topic before applying qualitative research strategies.

Service-Learning as a Strategy to Enhance Collaborative Cross-Cultural Learning, Understanding and Synergy Presentation ID#: 2755

Qualitative Research with Community Partners enhances Synergy

 Service

Learning allows students, teachers and community leaders to dialogue and deliberate together as a primary mode

• f

developmental

• learning. In curricular terms, it draws upon student

experiences, creative ideas and "funds

• f

knowledge" that are diverse in order to improve the diversification

• f

intellectual resources. Faculty integration

• r

synergy promotes meaningful engagement, commitment to teaching and a greater connection to the community-based experience.

Service-Learning as a Strategy to Enhance Collaborative Cross-Cultural Learning, Understanding and Synergy Presentation ID#: 2755

 Lessons Students Learned

• Public policy development regarding child health

care involves many branches of government and civil servants. There is no clearly defined role for each player.

• Ineffective methods to monitor the immunization

deficiencies.

• Immunization deficits are due primarily to

presumed lack of affordability. Citizens believe that insurance is required in order to access vaccines.

Service-Learning as a Strategy to Enhance Collaborative Cross-Cultural Learning, Understanding and Synergy Presentation ID#: 2755

 Lessons Students Learned from parents

• Dangerous mentality: "If I didn't get

them, {shots} my kids don't need them."

• Parents would like to get information

about the vaccines: What do vaccines protect against?

• i. Physician involvement is vital.
• ii. Parents express concern over potential

side effects.

• iii. Assistance with language barriers

Service-Learning as a Strategy to Enhance Collaborative Cross-Cultural Learning, Understanding and Synergy Presentation ID#: 2755

 Service Learning Lessons Learned

• How to apply textbook knowledge of health literacy

to encounters with parents who need to access the health system

• How to work with parents and community leaders in

problem solving

• Relating to parents with different cultural

backgrounds

• Perspective taking to resolve community problems

 In an unplanned part of the course, the students developed a number of strategies to try to bridge the gap between the parent perspectives and the health policy approaches

Service-Learning as a Strategy to Enhance Collaborative Cross-Cultural Learning, Understanding and Synergy Presentation ID#: 2755

Class Product

The students designed an information brochure for parents based on the issues uncovered in the focus groups.

Service-Learning as a Strategy to Enhance Collaborative Cross-Cultural Learning, Understanding and Synergy Presentation ID#: 2755

THE IRB (Institutional Review Board)

Parents and child care providers who participated in focus group sessions completed a 6-page IRB form adapted for parent use from traditional Georgetown University forms. The first 30 minutes of each focus group session focused on an explanation of the form. Special attention was paid to the voluntary aspect of participation in the focus group.

Service-Learning as a Strategy to Enhance Collaborative Cross-Cultural Learning, Understanding and Synergy Presentation ID#: 2755

 Key Informant Interviews

 Key Informants were staff of the DC

Department of Health or the Office of the State Superintendent of Education with responsibility for enforcing city regulations related to preschool immunization. Additional key informants were added to the team from child advocacy and Head Start to enable the medical students to understand barriers parents faced in securing timely immunizations.

Service-Learning as a Strategy to Enhance Collaborative Cross-Cultural Learning, Understanding and Synergy Presentation ID#: 2755

An unusual feature of this project was the exchange of information between the students and key informants up to a year after the completion of the Service Learning activity. This created synergistic classrooms where the locus of teaching and learning was shared by students and community key informants.

Service-Learning as a Strategy to Enhance Collaborative Cross-Cultural Learning, Understanding and Synergy Presentation ID#: 2755

 Results  Service Learning

 Students developed a personal understanding of information through

a process of interpersonal co-construction and problem solving dependent on interacting with others, including faculty, staff at the community centers, and community partners.

 Community

 In the community, families accepted and stated that they used the

newly explained periodicity schedule and the immunization information brochure developed by the medical students. The Federal Program Information report showed a small percentage increase in immunization compliance which may have been related to the project.

Questions may be directed to Dr. Jackson and the team will respond to them during the conference. Email: beverlyjack390@yahoo.com

 Thank You

Service-Learning as a Strategy to Enhance Collaborative Cross-Cultural Learning, Understanding and Synergy Presentation ID#: 2755

Parental concerns expressed in the focus groups motivated students to test out the resources publicized as provided for

• parents. They visited the clinics and reported the ones that were

non-functioning.

Service-Learning as a Strategy to Enhance Collaborative Cross-Cultural Learning, Understanding and Synergy Presentation ID#: 2755

They developed a slide presentation for the Mayor’s Advisory Committee on Early Childhood Development Health Promotion Subcommittee members analyzing the resources provided for parents seeking information and services relative to early childhood immunizations. Representatives from government agencies attended the presentation and procedures were changed.

Service-Learning as a Strategy to Enhance Collaborative Cross-Cultural Learning, Understanding and Synergy Presentation ID#: 2755

 Lite

teratur rature e cite ted



Bright Futures (2007) Health Professionals, Tools and Resources



Carrier, D. (2007, Nov. 14) New Analysis Finds Early Childhood Vaccination Rates Have Stalled: Twenty-one States Have Vaccination Rates Lower Than the National Average. Child Trends



The District’s State of the Workforce Report (2003) Washington DC Workforce Investment Council.



Ishikawa, H., Takeuchi, T., Yano, E. (2008, May 1) Measuring Functional, Communicative and Critical Health Literacy Among Diabetic Patents. Diabetes Care. 31:5, 874-879.



Kickbusch, I., Maag, D., Saan, H. (2005). Enabling healthy choices in modern health societies, European Health Forum: Partnerships for Health.

Service-Learning as a Strategy to Enhance Collaborative Cross-Cultural Learning, Understanding and Synergy Presentation ID#: 2755

 Li

Literature rature cit ited



McAllister, M. (2005) Transformative teaching in nursing education: leading by example, Journal of the Royal College of Nursing Australia. 12:2, 11-16.



Morton, L. (2002) Building Local Knowledge for Developing Health Policy Through Key Informant Interviews, Journal of

• Extension. 40:1



Nutbeam, D. (2008) The evolving concept of health literacy, Social Science and Medicine. 67:12, 2072-2078.



Nutbeam, D. (2000) Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century, Health Promotion International. 15:3, 259-267.



Ratzan, S. (2001) Health literacy: communication for the public good, Health Promotion International, 16:2, 207-214.



Shalini, S. Ed. (2008) Service Learning Perspectives and

• Applications. Hyderbad, India: Icfai University Press.

Service-Learning as a Strategy to Enhance Collaborative Cross-Cultural Learning, Understanding and Synergy Presentation ID#: 2755

Ackno knowledg ledgmen ents Many groups deserve thanks for project assistance: Donna Cameron, Ph.D. Director of Service-Learning, Georgetown University School of Medicine Matthews Memorial Baptist Church United Planning Organization Head Start Programs, Washington, DC Select students who have participated in the Service-Learning activities described here.

 For

For further ther informa

• rmatio

ion

 Please contact beverlyjack390@yahoo.com. More information on

this and related projects can be obtained at: http://www.familymedicine.georgetown.edu/44511.html