One day, as we were leaving the hospital clinical site, a nursing student commented, “This is boring to me. I'd rather be elsewhere. What's nursing like outside the hospital?” This honest evaluation prompted me, as his preceptor, to encourage him to stay in our nursing program for his community health rotation the following semester. He was glad he did. He later became a dedicated community health nurse. It also motivated our nursing faculty to add innovative educational strategies to the community health curriculum in our school of nursing and health sciences. The nursing education model (Stanley & Dougherty, 2010) recognizes the importance of incorporating active-learning experiences into nursing curricula where the learner and instructor work together toward shared outcomes. One component of this model involves community partnerships that provide a direct link for students to critically integrate their foundational knowledge into real-world solutions.
Health care professionals and educators, alarmed by the regional trend in symptomatic cardiovascular disease among young adults, met in 2012 to discuss ways to promote adolescent health. National data from 2015–2016 indicated that 20.6% of adolescents aged 12 to 19 in the United States were obese (Hales, Carroll, Fryar, & Ogden, 2017). This led to collaboration between interested parties from a private university, a health care foundation, a public high school, and the community. Because the strongest evidence for reducing adolescent obesity supported combining diet and physical activity interventions administered in school settings with collaboration and involvement from the community (Wang et al., 2015), the stakeholders designed and implemented a 5-year health promotion–obesity prevention plan in a local high school called the Ambassador program. University faculty focused on leveraging opportunities to integrate creative learning and teaching strategies into the curriculum for nursing, exercise science, and public health students. This article presents an overview of the collaborative, strategies, and learning activities that undergraduate students incorporated into the school-based program to promote healthy lifestyles.
Organization of Collaborative
For the university faculty, this collaborative was an opportunity to immerse their students in innovative classroom and clinical experiences that contributed equally to learning and real-world problem solving in their own community. Faculty for community health and nursing research courses developed teaching–learning strategies for senior-level nursing students that fostered the application of concepts and principles addressed in those courses through practical clinical experiences in the high school and community setting. Such principles included patient education, child growth and development, health promotion, and risk-factor reduction to prevent illness.
Faculty and students from the university's departments of exercise science and public health were also active within the collaborative in ways relevant to their program learning outcomes, as well as to the university's core value of meaningful service to the community. Exercise science students were involved in family-focused events in the high school, whereas public health students identified strategies for engagement in community events. The net result of the health profession programs' student and faculty involvement was dynamic and interprofessional education that contributed noticeably to the overarching goal of the collaborative (Figure 1).
Key activities of partners. A = university faculty; B = nursing and health profession students; C = health foundation; D = high school teachers; E = community wellness committee; F = high school students.
Creative Learning Activities
The university's prelicensure nursing students and other health profession students, guided by experienced faculty members, facilitated high school classroom sessions that focused on healthy living skills. University nursing students designed and delivered interactive educational lessons in high school English and science classes related to nutrition and physical activity. These unique lessons complemented the existing high school curriculum through references to literature and scientific principles. Topics included the negative aspects of fast food, for which both high school and university students read “Chew on This: Everything You Don't Want to Know About Fast Food” (Wilson & Schlosser, 2006). They also discussed the risks of eating disorders and the effects of exercise and proper sleep on health. Although the initial phase of the program targeted traditional in-class learning activities, partners gradually implemented an entire program of healthy living instruction during school-wide activities. These included calorie counts for the student coffee products, daily health announcements, and permanent poster displays in the halls.
University students were able to use their natural connections to youth culture to engage high school students in interactive healthy lifestyle activities. During the 5-year collaborative, university students hosted an annual health fair at the high school during the 2-hour lunch period. Bridging from topics discussed in the classrooms, nursing students created and presented a wide variety of interactive healthy-living exhibits at the health fair. These included cell phone activities and games using Bingo, Jeopardy!, and ice-breaker formats. This annual health fair provided high school students with the opportunity to engage with university students on relevant health topics.
As a required curricular assignment in the university exercise science class, small groups of students chose a health topic to present at the health fair. Beyond the traditional display of posters, the university students created hands-on interactive activities for the high school students in an effort to reinforce positive change in health behavior. These included a climbing wall, calisthenics, and mobility exercises. This mode of active learning presented a real-world opportunity for near peer-to-peer education.
The semester after the university nursing students led classroom learning sessions, they engaged in research projects at the high school based on previously taught lessons. Aided by student ambassadors (high school students selected yearly to be health ambassadors for the school), the researchers gathered demographic and healthy living information based on the Centers for Disease Control (2018) Youth Risk Behavior Surveillance System. After analyzing the results, students presented their findings via poster presentations at the university's research day and to the entire high school student body in the cafeteria during lunch periods. This collaborative research enabled both the high school ambassadors and the university students to better understand the value of survey research in the field of preventive health care.
With momentum building, the high school student ambassadors invited the university partners to enter a team into the high school's annual teacher–student all-star competition involving carnival-like games of physical agility. In addition, the university and the collaborating health foundation provided posters, literature, health screening booths, and healthy snacks for the event. Additional examples of active-learning experiences to promote physical activity included involvement in the community parade, where university and high school students marched and distributed literature on healthy lifestyles, and participation in the community-wide Constitution Festival.
To continue to build rapport within the community, the university exercise science students participated in an annual tailgate party prior to the high school's first home fall football game. In partnership with the university's food service provider, these students prepared and provided healthy chili to the community tailgaters, along with recipe cards and information about the Ambassador program. The healthy food tailgate booth inspired other high school participants to incorporate healthy food choices at their booths. For example, teachers altered the traditional root beer float giveaway to offer diet root beer and sugar free ice cream. The community tailgate party provided an outstanding opportunity for the high school and university healthy living collaborative to expand beyond the high school building and include the wider community.
To evaluate the effectiveness of the collaborative and activities therein, data were collected on a cohort of students over 4 years, from their entry into high school in ninth grade through the completion of their senior year. A control group was established by assessing outgoing seniors prior to the launch of the collaborative. Due to multiple factors, the sample size varied slightly each year, from a maximum of 220 (freshmen) to a minimum of 168 (seniors). To explore lifestyle patterns reflective of the collaborative foci—nutrition and physical activity—survey and physical assessment data were analyzed across senior levels (pilot versus control groups). The pilot group's senior survey included open-ended questions inviting students to comment on any changes made during the previous 4 years.
Ninety-two percent of senior students (n = 154) reported adopting or reviving positive physical activity habits, such as walking or running, yoga, or lifting weights. Further, 84% (n = 141) reported improved nutritional habits, such as drinking more water, eating fruit and vegetables daily, and eliminating fried foods. Forty-three students (21%) in the senior-year control group met the criteria as obese, compared with 22 (14%) students in the senior-year intervention group—a 7% difference between the two groups.
Benefits of the School-Based Program Promoting Adolescent Health
This cooperative venture between the university, high school, and the health foundation facility had benefits beyond obesity reduction and improved lifestyle habits among high school students. University students, high school students, teachers, and the community at large provided feedback that affirms the value of these interprofessional educational experiences. One nursing student stated:
It showed how upstream thinking (the idea of preventive medical care instead of reactive medical care) could take place within the community. This project made the concept tangible and easier to understand. It also helped show that there was still a need for greater use of the concept in the nursing profession.
Another nursing student commented:
Working with the [high school] students was a rewarding yet challenging experience. Attaining the focus and attention of everyone was a difficult task, but it helped me as a nurse to understand the importance of teaching my patients in ways they can understand.
Another nursing student noted:
It was difficult to educate teenagers. Many may not participate or think they need to pay attention to information about their health at this age. However, it can be fun as well as rewarding to spark passion or interest for them in their own health. Nursing or any position in the medical field could possibly turn out to be a future career. They may be able to make a difference in someone else's life one day.
High school students benefited from this program by learning from teams of university students who created lesson plans emphasizing healthy lifestyles. One adolescent said:
I really enjoyed learning about nutrition from college students. They were just a few years older and understood how we felt sitting in the classroom. Their activities were fun, but they had real health facts that made me pause and think about the decisions I was making.
Additionally, high school students were introduced to several health professions through contact with university students and faculty, thus prompting them to consider a college education in various health-related careers.
High school teachers also recognized the value of this program. A social studies teacher stated:
I encouraged my students to participate in the Ambassador health fair, so they could become more health conscious. In addition, as a social studies teacher, I wanted them to become more aware of public and private community resources that provide valuable services in health care in [this] county. The students enjoyed the interactive activities but may not have been consciously aware of how much they were learning about their communities.
An English teacher stated:
As a result of the Ambassador program, the high school students improved their nutritional awareness and diet because of the engaging lessons and activities constructed by nursing students.
Overall, the collaborative produced a synergistic school-based program, as faculty, students, and teachers learned from each other. From the initial in-class activities, involvement grew to include a wide variety of community events. During each step of the process, adjustments led to improved communication, collaboration, and outreach. With a growing reputation for being a dynamic model that promotes community well-being, other universities in the region have taken measures to integrate similar interprofessional education partnerships in their health profession programs.
- Centers for Disease Control. (2018). Youth risk behavior surveillance system (YRBSS). Retrieved from https://www.cdc.gov/healthyyouth/data/yrbs/index.htm
- Hales, C.M., Carroll, M.D., Fryar, C.D. & Ogden, C.L. (2017). Prevalence of obesity among adults and youth: United States, 2015–2016, NCHS data brief, No. 288 (pp. 1–8). Washington, DC: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics.
- Stanley, M.C. & Dougherty, J.P. (2010). Nursing education model. A paradigm shift in nursing education: A new model. Nursing Education Perspectives, 31(6), 378–380.
- Wang, Y., Cai, L., Wu, Y., Wilson, R.F., Weston, C., Fawole, O. & Segal, J. (2015). What childhood obesity prevention programmes work? A systematic review and meta-analysis. Obesity Reviews, 16, 547–565. doi:10.1111/obr.12277 [CrossRef]
- Wilson, C. & Schlosser, E. (2006). Chew on this: Everything you don't want to know about fast food. New York, NY: Houghton Mifflin.