Preparing the Future’sPublic Health Professionals
Students Working with Prevention Researchers
Get Essential Career Training, Community Experience
“Why do young people act the way they do?” asked Julen Harris, a Mobile Health Team Educator working with the Harlem Prevention Research Center (PRC) as part of her master’s degree at Columbia University’s Mailman School of Public Health in New York. “As a counselor, I need to answer that question for each of my teen clients—and that means helping them feel comfortable enough to talk about personal topics like their dating experiences and condom use.”
To meet with teens and counsel them, Ms. Harris and team mates board city busses and subways, carrying with them oversized book bags crammed with health education materials, test results, contact information, and condoms. During 20-minute counseling sessions, Ms. Harris talks with Harlem youth about healthy sexuality and directs them to local clinics for health screenings and primary care—services that local youth urgently need, say the researchers at Harlem’s PRC. But over the years, administrators at the school of public health learned how much the student counselors benefit from community interaction as well.
“We learned several years ago that our students wanted more in-the-field opportunities than were being provided,” said Ian Lapp, PhD, the public health school’s associate dean for academic affairs and education. “They wanted to do ‘real work,’ like what the PRCs do. Since then, we have been working to make as many hands-on experiences available to them as possible.”
On a national level, public health schools received advice from the Institute of Medicine (IOM) that was similar to the students’ feedback. A 2003 IOM report recommended that in addition to helping students master statistics, epidemiology, and other public health course work, educators also should help students become effective communicators who can collaborate with fellow practitioners, community leaders, and residents. At PRCs across the country—where today’s investigators conduct community-based studies and train tomorrow’s professionals in health promotion and the rigors of research—students gain the communication and collaboration skills they need for successful careers in preventive medicine or public health.
PRC Lesson 1: Foundations of Communication
At the University of Rochester National Center for Deaf Health Research—another PRC—medical students are learning to overcome language barriers that could interfere with their delivery of effective medical care when they become practicing physicians. For decades, people who were deaf came to Rochester, New York, to work in the city’s many manufacturing and printing plants. Residents who used American Sign Language (ASL) formed clubs and built a community and culture that thrives today at local schools and colleges and in the arts and social scenes. To strengthen relationships between deaf and hearing Rochester residents, people from both communities participate in activities that bridge their cultures. For example, in a role-reversal exercise conducted with incoming medical students and the PRC, deaf community members act as staff of the fictitious Deaf Strong Hospital, where all the medical professionals are deaf and use ASL, and new medical students are hearing patients seeking care. Through the exercise, the medical students experience how hard it is for people to get health care services when they do not use the same language as their health care providers. Members of the deaf community also work closely with the PRC and medical school to create additional learning opportunities, such as the Deaf Health Pathway, a set of classes and projects about deaf culture and basic ASL that medical students can complete for extra credit.
“The goal is to help incoming medical students develop some ASL competency and an understanding of deaf culture,” said Christopher Chang, a fourth-year medical student who coordinates the Deaf Health Pathway. “When they become doctors and a deaf person comes to them for care, at least some basic communication can begin between them until an interpreter is available.”
As part of the Pathway curriculum, students complete independent projects; one participant is working with the state’s smoking cessation hotline to develop resources to help deaf people who smoke quit the habit. Another student trained in ASL is working with a clinic that offers free health services, which helps ensure this resource is available to both deaf and hearing patients. Mr. Chang said that after training, a doctor may work at a medical practice that does not have experience with deaf patients; having completed the Pathway can make that doctor an asset to an entire medical team.
“In caring for people of any minority linguistic group, effective communication is a challenge,” Mr. Chang noted. “During any year, a doctor in any hospital’s emergency department or local medical office is almost guaranteed to interact with a patient who doesn’t use the doctor’s language. Pathway students know they should be sensitive to these patients, work together to communicate, and try to provide interpreter services whenever possible. Pathway graduates know that even something as simple as keeping paper and pens ready for quick notes can help many interactions get off to a good start.”
PRC Lesson 2: Cultural Competence
Knowing the language is just one part of building rapport with people in a community. Some students who work with the PRCs learn that speaking the same language may not be enough to win community members’ confidence and encourage them to participate in a research project.
“Even though I speak Spanish, I still had a lot of Spanish-speaking people refuse to participate in a study,” said a recent PhD graduate, Barbara Baquero, a recipient of the CDC/PRC minority fellowship that is awarded in collaboration with the Association of Schools of Public Health. Dr. Baquero works with the San Diego PRC, which studies the health needs of people who live along the U.S.-Mexico border. Residents who are undocumented immigrants or who lack a social support system (such as church membership or extended family close by) may live with a daily feeling of vulnerability.
“That was the take-home message for me,” said Dr. Baquero. “People in many communities live with a sense of fear and don’t feel comfortable trusting strangers.”
Dr. Baquero added that she learned how essential community health workers (CHWs) can be to a research team. By walking door to door with a CHW—a neighbor whom residents knew and trusted—Dr. Baquero was welcomed into homes and could talk with residents about participating in PRC studies that assessed access to health care, physical activity, and healthy foods on both sides of the border.
“To recruit participants for a study, investigators tend to go to a central location—like a school or another public place in the neighborhood,” Dr. Baquero said. “But if too many people decline to participate, researchers may not have enough participants to accurately reflect an entire community.”
Instead of going to a public place to recruit study participants, Dr. Baquero used census data to identify areas in which she wanted to interview people. Accompanied by the CHWs, she approached these residents and obtained information that she believes she would not have been able to get by using other methods of recruitment and data collection. Initial analysis suggests that residents of communities on the Mexico side of the border have easier access to health services than do people living in U.S. border communities—a finding that interests Dr. Baquero and makes her want to continue her studies in these communities.
PRC Lesson 3: Community-Based Participatory Research
Donoria Evans, MPH, started working as a research assistant at the PRC at the Morehouse School of Medicine in Atlanta, Georgia. Now, while working on a PhD at the University of Georgia, she also serves as an assistant director in the Morehouse PRC evaluation unit.
“I want to work with people as well as numbers,” Ms. Evans said. “Working with the PRC opened up a career choice I would not have known I had.”
Through the PRC, Ms. Evans helps with the implementation, management, and evaluation of a program that teaches decision-making, life skills, and sexual abstinence to African-American youth aged 12 to 18 years. As a program evaluator, she worked to assess the impact of the program on youth attitudes and behaviors regarding sexuality, education, career goals, and healthy habits.
“This is a hands-on opportunity to work with both data and community members,” she said. “I am getting experience that shows me how to incorporate both of these interests into my career path.”
Other students say participation in PRC research projects helped them develop their analytic skills. MPH graduate Amy Paxton, for example, is a nutrition counselor and former school teacher who began working with the PRC at the University of North Carolina, Chapel Hill. Ms. Paxton evaluated the national Farm-to-School program, which creates networks between communities and local farmers to increase access to healthy foods. Through the program, schools and local farmers work together to develop healthy breakfast and lunch menus for schoolchildren and to plan family education on nutrition and cooking strategies that promote good health.
Ms. Paxton focused on how the Farm-to-School program worked in Riverside, California; Eugene, Oregon; Saratoga Springs, New York; and several counties in Maine. Not only did she help write the grant proposal to evaluate the program, but she also helped design the evaluation tools used to determine the program’s success. For example, surveys assessed whether children would try more fruits and vegetables after participating in the program. She also created tests to determine if children increased their knowledge of nutrition. Ms. Paxton said her experience as a program evaluator taught her to think critically and that a program must include ways to measure its success.
“I can be a much better program manager myself because of my experience with Farm-to-School,” Ms. Paxton said. “I’ve learned that successful programs have goals and measure results to see if those goals are achieved. If you creatively design programs with these elements in mind, you increase the likelihood that your program will be successful.”
Ms. Paxton, like many of the other students working with the PRCs, said she still is deciding on her long-term career path. “My experience got me heading in the right direction,” Ms. Paxton said. “But after graduation, the PRC really was a tough place to leave.”