Graduate Public Health Research Articles

Perceptions, experiences, expectations, and challenges of Indian public health programs

The COVID-19 pandemic has served as a wake-up call for India’s public health system. Public health if aided by strong political will, academic reforms, and awareness among youth (as a career choice) – will get a boost. Skilled public health professionals would be expected to play a key role in strengthening public health systems. Thus, to bring deep structural health reforms, it is imperative to analyse the perceptions of key public health stakeholders. In this study, we explored stakeholders’ perspectives about public health, and their views regarding the current state of public health education. Thirty-nine semi-structured in-depth interviews were conducted during 2017–2018 across India among stakeholders that included students of public health programs, public health professionals (PHPs), faculty of public health institutions, employers of public health graduates, and policymakers. Thematic analysis of the data was undertaken focusing on 10 themes emanating around the focus areas of the study. Public health stakeholders suggested that for building a competent public health workforce there is a need to match supply and demand of PHPs, create job opportunities, institutionalising a large body of guidance such as a separate Ministry or Council of public health (for educational institutions, quality assurance of curriculum etc.). Within India, the public health profession & education remains under-researched. This study is the first from a lower middle income country (LMIC) & from Asia to offer insight about public health programs – from policy, education, and professional perspective.

Impact of Transitioning to Remote Learning on Student Learning Interactions and Sense of Belonging Among Public Health Graduate Students

Student learning interactions and a sense of belonging are imperative to academic success within distance education settings. In March 2020, during the COVID-19 pandemic, students who intended to be educated through in-person learning environments had to shift to remote learning suddenly. In public health, a field that emphasizes experiential and interactive learning, instructors and graduate students enrolled in residential in-person programs transitioned to remote learning with limited knowledge of how this transition would impact student learning interactions and a sense of belonging. To address these gaps, we examined how remote learning impacted Master of Public Health students’ learning interactions with peers, instructors, course content, as well as their sense of belonging in an overall sample and stratified by program year. We found that students perceived challenges interacting with peers, content, and instructors, such as a lack of community and an inability to interact with instructors during course discussions. Students reported not feeling a sense of belonging when engaging with peers and instructors. Findings from this study shed light on the challenges that emerged after students transitioned to remote learning, namely disrupted student learning interactions and a decreased sense of belonging. The study provides recommendations for future remote teaching, which may be of utility to university instructors and administrators tasked with creating and implementing an interactive remote learning curriculum that provides students with a community to foster learning.

Racial and Ethnic Diversity Among Students, Graduates, and Faculty in Biostatistics and Epidemiology, 2010-2020.

This study is a follow-up to a study in 2020 that reviewed changes in the racial and ethnic composition of public health students, graduates, and faculty among Association of Schools and Programs of Public Health (ASPPH)-member institutions. In the current study, we evaluated how the racial and ethnic composition among biostatistics and epidemiology students, graduates, and faculty changed from 2010 to 2020. We analyzed data on race and ethnicity of enrolled graduate students, graduates (master's and doctoral), and faculty at ASPPH-member institutions by using institutionally reported data from the ASPPH Data Center. We tabulated frequencies, percentages, and percentage-point changes by race and ethnicity. We measured differences between groups by using a test for difference in 2 proportions. The number of enrolled students, graduates, and faculty in all departments increased during the study period, while the number of tenure-track faculty in biostatistics decreased. The percentage of enrolled Hispanic/Latino biostatistics graduate students increased from 5.6% in 2010 to 10.2% in 2020 (P = .007), and the percentage of epidemiology graduates increased from 8.8% to 13.8% (P = .008). We found no differences among other underrepresented racial and ethnic groups. Most biostatistics and epidemiology professors at all ranks were non-Hispanic White, despite substantial decreases. The percentage of underrepresented racial and ethnic minority biostatistics and epidemiology professors was constant across all ranks. Although more Hispanic/Latino students are enrolled in and graduating from biostatistics and epidemiology departments at ASPPH-member institutions, we found no change among faculty. More work is needed to recruit and retain other (American Indian/Alaska Native, Black or African American, Native Hawaiian/Other Pacific Islander) underrepresented students and faculty.

An Anti-Racism Public Health Graduate Program: Mentoring of Students and Igniting Community

Black, Indigenous, and other people of color (BIPOC) are underrepresented in the public health workforce. Strengthening the public health pipeline through graduate institutions of public health is a necessary anti-racist approach to address health disparities. Programs that provide effective mentoring are one strategy for evidence-based anti-oppressive instructional practice, proven to help racial and ethnic students historically targeted by oppression in propelling career trajectories, professional development, and overall institutional experience in graduate school. The Mentoring of Students and Igniting Community (MOSAIC) program was founded in 2019 as a comprehensive and anti-racist faculty-to-student mentorship initiative for BIPOC and first-generation students. Through a scoping review of mentorship programs at schools of public health and an iterative feedback process that included faculty, students, and staff, the MOSAIC model was created. Built on the tenets of successful mentorship approaches, MOSAIC focuses on increasing equity and educational justice with a focus on professional development and academic success through faculty-to-student mentorship. The growth of MOSAIC has demonstrated it fills a critical gap for students of color and first-generation students in a school of public health. MOSAIC intends to act as a programmatic model for replication at other schools of public health to provide necessary support and mentorship for BIPOC students.

Examination of Online Interprofessional Education to Develop Graduate Students’ Interprofessional Socialization and Collaborative Competencies

ABSTRACT Interprofessional education (IPE) is important to prepare graduate students for collaborative practice. This mixed methods study sought to evaluate a full-semester, asynchronous online IPE course for graduate students. Thirty-one graduate social work, nursing, public health, and health administration students participated. Interprofessional socialization and collaborative competencies were measured at three points in the semester. There were statistically significant improvements in self-reported socialization and competencies. Qualitative analysis revealed participants experienced new perspectives, developed appreciation of interprofessional collaboration, practiced communication and teamwork skills, and used course lessons in clinical practice. Study findings indicate that online IPE can help improve graduate students’ interprofessional socialization and collaborative competencies. Further, students indicated they applied course lessons to their school and work clinical practice sites.

The Impact of Student Debt on Career Choices among Doctor of Public Health Graduates in the United States: A Descriptive Analysis.

(1) Background: As gaps in the public health workforce grow in the wake of the COVID-19 pandemic, graduates of the schools of public health, especially Doctors of Public Health (DrPH), are poised to offer relief. While there are some known recruitment issues, student debt and debt impact on career choices are understudied. (2) Methods: In the present study, we perform a descriptive analysis of the potential impact of student debt on career choices among DrPH students and alumni in the United States using a cross-sectional national online survey. A total of 203 participants (66: alumni and 137: current students) completed the survey. Descriptive statistics, a chi-squared test of independence, and content analysis were used to analyze the funding situation and its impact on career choices. (3) Results: We found that (1) 72% of current DrPH students have zero funding support for their degree, (2) scholarship opportunities for a DrPH degree are limited, especially when compared to PhD programs, and (3) student debt impacts 59% of DrPH students’ and 29% of DrPH graduates’ career choices (about 49% of all respondents). (4) Conclusions: Student debt and a misunderstanding of DrPH are likely impediments to DrPH graduates participating in the public health workforce.

Making the Switch: Experiences and Results from Converting a Biostatistics Course to Flipped and Online Formats for Public Health Students

The recent rise in online learning in statistics has made it essential for instructors to teach effectively in that modality. In this retrospective, we reflect on how online course content was added to an introductory statistics course in a graduate public health program and how it was updated over time based on student feedback and instructor experiences. The impetus for the inclusion of online learning as well as the consequences of specific implementations are discussed for hybrid and fully online class formats. We found that while online learning seemed to be beneficial as a whole for public health students learning health statistics, identifiable differences in the design or implementation of lectures, software demonstrations, online discussion, computer lab activities, active learning, and homework assignments had a substantial effect on learning outcomes and student satisfaction.

A perspective on Master of Public Health (MPH) Graduates in India: Current role and way head

The public health sector of any country deals on the forefront and utilizes the multidisciplinary approach. In India the Masters of Public Health graduates are trained in unstandardized manner and lack a regulatory body. The gap created in serving the unserved can easily be fulfilled by utilization of this workforce in systematic manner, The emerging competition in the field, undervalued sector in terms of monitory benefits, poor demand and limited training institutions for MPH graduates along with the contribution of MPH during COVID 19 pandemic has been emphasized in the article. The perception of those working in the field has been highlighted with the way ahead of MPH program in India.

Public Health Graduates' Perceptions of the Educational Environment Measured by the DREEM

ObjectiveStudents' perceptions of the educational environment have a significant impact on their behavior and academic progress. This study aims to measure medical graduates' perception of the educational environment within the School of Public Health at Wuhan University in China.MethodsThe survey was conducted by emails sent to 119 graduates, and 93 valid questionnaires were returned. The DREEM was used to assess the medical graduates' satisfaction with the educational environment.ResultsThe average score on the scale was 126.02 (±18.27). The scoring rate of the areas ranged between 61.06 and 67.11%. The area with the highest score was “perception of teachers.” The area with the lowest score was “academic self-perception.” No difference was found between genders. Except for “perception of atmosphere,” the total scores and other areas showed differences in graduation time.ConclusionThe educational environment at the School of Public Health at Wuhan University was satisfactory. The program contributed to the graduates' later careers. The information obtained in this study identified some areas for improvement.

Opportunities and constraints in the job search by public health graduates in their opinion

Strengthening of the professionalism of public health (PH) specialists may be the response to changes in health care systems. The aim of the study was to explore the potential and restrictions associated with job search by PH graduates, as well as to examine their opinions on their position on the labor market. The survey was conducted using questionnaire (CAWI) on 107 respondents from two medical universities in 2019. The average age of the respondents was 24.5. 5.61% and 17.76% of graduates from both universities respectively declared that the university prepared students well. Most respondents indicate internships, apprenticeships organized by employers (78%) and accepting graduates without professional experience (64%) as employers’ activities which facilitate entering the labor market. Graduates considered the most important obstacles in finding work to be: low interest in PH graduates work, insufficient contacts and relationships and insufficient professional experience. Their competencies do not coincide with the expectations of employers. Employers and universities do not establish sufficient cooperation. Although the dependency between the place of study and the graduates’ perception of the role of university and employers facilitating entry into the labor market and re-selection of the study is not strong, it should not be ignored in shaping education programs.

From tensions to transformation: Teaching food systems in a graduate dietetics course

Dietitians are deeply embedded within food systems, so food systems concepts are becoming an essential component of dietetic education in Canada. Yet how can we, as educators, better prepare future dietitians to embrace the complexity of food systems and be forces of change towards equity? In an effort to explore this question in a practical way, we integrated food systems concepts into a mandatory course of a public health graduate dietetics program. This field report shares our experiences teaching food systems over five years based on our notes kept, student feedback, and course evaluations. Our learnings have been in three key areas: intentions, facilitation, and tensions.
 We recognized that teaching about food systems is value-laden. Hence we have been explicit with the students about our positionality and our intentions in designing the course, partly to meet the management of food systems competency requirements, but also to stimulate thinking about alternative options for purpose, structures, and processes in food systems. Our facilitation approaches aimed to foster a critical consciousness towards social justice and systems change. Using teaching and evaluation methods such as experiential learning, community projects, and reflection assignments, students have encountered the complexity of food systems and the challenges-opportunities they pose. 
 As educators, we have grappled with the tensions of challenging dominant positivist discourses in public health nutrition. Politicized topics such as migrant farm-worker regimes, industrial food production, regulation of food marketing, and mitigation of the impact of colonization have generated debates in the classroom about the role and scope of dietetic practice. Most students have situated themselves more explicitly within a food system, and some began to question hidden structures of power. While it remains challenging to address this breadth within the constraints of one course, we believe it worthwhile to model and stimulate critical reflexivity with the next generation of dietitians as critical food learners-teachers themselves. Even though the course is no longer offered using this food systems approach, course components can be integrated throughout the dietetic curriculum.

A Pipeline to Increase Public Health Diversity: Describing the Academic Enrichment Components of the Summer Public Health Scholars Program

A public health workforce that reflects the increasing diversity of the U.S. population is critical for health promotion and to eliminate persistent health disparities. Academic institutions must provide appropriate education and training to increase diversity in public health professions to improve efforts to provide culturally competent care and programs in the most vulnerable communities. Reaching into the existing talent pool of diverse candidates at the undergraduate level is a promising avenue for building a pipeline to advanced training and professional careers in the field of public health. The Summer Public Health Scholars Program (SPHSP) at the Columbia University Irving Medical Center (CUIMC) is a 10-week summer internship program with a mission to increase knowledge and interest in public health and biomedical sciences. Funded by the Centers for Disease Control and Prevention’s (CDC) Undergraduate Public Health Summer Programs, sponsored by the CDC’s Office of Minority Health and Health Equity, SPHSP aims to pipeline underrepresented students into public health graduate programs and careers by providing mentorship, academic enrichment, professional development, and field-based placements. The SPHSP is uniquely positioned to offer scholars a program that exposes them to core public health training components through the joint effort of all four CUIMC schools: public health, dentistry, nursing, and medicine. Here, we describe the program’s academic enrichment components, which provide advanced and multifaceted public health training opportunities. We discuss the impacts of the program on student outcomes and lessons learned in developing and refining the program model.

Learning from Graduate and Undergraduate Public Health Virtual Internship Experiences with State Title V Agencies During COVID-19, Summer 2020

BackgroundSince summer 2014, the National MCH Workforce Development Center has placed students from MCH public health graduate (Centers of Excellence and Catalyst) and undergraduate (MCH Pipeline) programs, all funded by the Maternal and Child Health Bureau, in summer internships with state and territorial Title V agencies. In 2020, due to the COVID-19 pandemic the Title V MCH Internship Program was offered virtually.Participants and MethodsThis manuscript includes quantitative and qualitative data from 2017 to 2020 generated by both Title V MCH Internship student interns (n = 76) and their preceptors (n = 40) with a focus on a comparison between the 2020 virtual year and the 2017–2019 years.ResultsEvaluation data from the 2017 to 2020 Title V MCH Internship Program from both students and preceptors revealed the implementation of a robust and successful internship program in which students increased their confidence in a variety of team, mentorship, and leadership skills while gaining direct exposure to the daily work of state Title V agencies. However, students and preceptors identified more challenges during 2020 compared to previous years.ConclusionsThe COVID-19 Pandemic was both a disruption and a catalyst for change in education. While there were clearly some challenges with the pivot to a virtual Title V MCH Internship Program in summer 2020, students were able to participate in meaningful internship experiences. This success can be attributed to the ability of the internship sponsor to engage in best practices, including extensive planning and provision of ongoing support to the students. Going forward, it is recognized that virtual internships may facilitate access to agencies in distant locales, eliminating issues related to housing and transportation. When both virtual and in-person relationships are available, those responsible for internship programs, including the Title V MCH Internship, will need to weigh these type of benefits against the potential missed opportunities students may have when not able to participate in on-site experiences.

Public health moves to innocence and evasion? Graduate training programs' engagement in truth and reconciliation for Indigenous health.

Indigenous peoples are the first peoples of what is now called Canada. Canadians have benefitted from their largesse and contributions in a myriad of ways that remain unacknowledged. Indeed, ongoing colonization and systemic anti-Indigenous racism in all quarters of our society have had heinous impacts on their health and well-being. Despite this reality and multiple calls for redress, Indigenous health is still missing from the Core Competencies for Public Health in Canada, having obvious implications for public health training programs and subsequent practice. Our objective in this paper is to critically explore the reasons behind institutional apathy for reconciliation in Indigenous health. Interviews were conducted with 19 leaders in Canadian Graduate Public Health Programs (CGPHPs) at 15 universities to explore the extent to which CGPHPs engage with Canada's 2015 Truth and Reconciliation Commission's Calls to Action to address Indigenous health. We used thematic discourse analysis to illuminate the landscape and make recommendations. Participants agree that Indigenous health is important, but our data reveal an uneven landscape for addressing the Calls to Action. Curriculum was limited though we noted modest positive change. On the whole, the non-Indigenous (white) professoriate still needs to educate themselves while not all see the need to do so. Many deflected responsibility. Yet anecdotally, there is desire among CGPHP students who are already unsettling themselves to see such competency in their training. It is a settler evasion to claim lack of expertise, to express a desire to limit the burden on Indigenous academics, and to stand on the sidelines of institutional inertia. Our findings are a call to CGPHPs to do better.

Lessons From a Community Driven Experiential Public Health Course

Applied practice opportunities are essential in both undergraduate and graduate public health programs, and are emphasized in the 2016 changes to the Council on Education for Public Health (CEPH) accreditation requirements. To generate and implement solutions to challenges our communities face, there is an increased need for public health training that includes both rigorous coursework and experiential learning opportunities. We share here a framework and scaffolding from a class that has provided a supportive structure for public health students to conduct applied practice activities in response to expressed needs of community organizations. Guiding Principles: The practicum is grounded in theories of practice-based learning, community based participatory research, and community engaged research with a vision of preparing students to participate in community knowledge generation partnerships to more effectively address health disparities. Lessons learned: Advance planning creates a foundation for success. Community partner and student interests are aligned; teams share the common goal of promoting sustainable long-term impact through their projects. Students are prepared for success through the development of instrumental tools (e.g., logic models, program impact pathways, and work plans) that guide project development and implementation. Students learn to adapt to evolving partner needs. Students have a unique learning experience that is practice-based. Future work to understand key functions of different course elements will add quantitative metrics to the existing qualitative metrics in the preceptor evaluation, work with other practicum instructors to develop common best practices and will include a qualitative analysis of student reflections.

Are We Prepared for Precision Public Health? An Examination of Genomics Content in Graduate Public Health Programs.

With the completion of the Human Genome Project and swift development of genomic technologies, public health practitioners can use these advancements to more precisely target disease interventions to populations at risk. To integrate these innovations into better health outcomes, public health professionals need to have at least a basic understanding of genomics within various disciplines of public health. This descriptive study focused on the current level of genomics content in accredited master of public health (MPH) programs in the United States. We conducted an internet search on all 171 Council on Education for Public Health (CEPH)-accredited MPH programs in the United States for genomics content in required and elective courses using the search terms "genetics," "genomics," and "molecular." Of the 171 CEPH-accredited MPH programs examined, 52 (30.4%) schools and programs in 34 states offered some type of genomics education. Thirty-five (20.5%) schools and programs had a course in genetic epidemiology, 29 (16.9%) had a course in genetic biostatistics or bioinformatics, and 17 (9.9%) had a course in general public health genomics. The remaining 119 offered no course with a focus on genetics or genomics. In addition, some electives or specifically focused courses related to genomics were offered. We found inadequate training in public health genomics for MPH students. To realize the promise of precision public health and to increase the understanding of genomics among the public health workforce, MPH programs need to find ways to integrate genomics education into their curricula.

Hotspots and Trends of Graduate Public Health Education Research in China

Academic research trends involving public health education may reflect a certain degree of talent construction status. This study systematically reviews the data for published literature on graduate public health education, aiming to provide evidence for the optimization of public health postgraduate training mechanisms in China. Keyword cooccurrence analysis was performed based on high-frequency keywords. From 1992 to 2008, the annual number of publications in this field was relatively low in China, averaging fewer than 5 articles. The number of publications showed a steep increase after 2009. The publications were mostly from single research institutions, including comprehensive universities and military medical universities, concentrated in Beijing and Shanghai. The high-frequency keywords were public health and preventive medicine, postgraduate training, professional degree, MPH, curriculum, and teaching reform. Hotspots consisted of practical teaching research, training, educational reform and comparative education research. Research on public health postgraduate education has not reached scale and has insufficient support. Moreover, many problems in graduate public health education still cannot be solved by existing studies: authentic and practical learning, a unified approach to cultivate graduate students, organizational change of graduate public health education, and international cooperation and public health education.

5.M. Skills building seminar: How to integrate social identities in public health education – an intersectional approach

Abstract Members of minoritized population groups are exposed to higher burdens of morbidity and mortality and face barriers to accessing health care systems and other critical resources to achieve optimal health. Intersectional perspectives that emphasize the dimensions of social power and discrimination are just beginning to emerge in public health research. These perspectives contextualize longstanding patterns of health inequalities but are rarely translated into public health curriculum. Concepts like “cultural competence” or “diversity, equity and inclusion” do address the importance of awareness and respect for (cultural) diversity in (patient/client) populations. The research and teaching examples available are largely limited to a USA context, tend to consider specific identities, rather than intersectional characteristics, are not systematically integrated in public health curricula and are usually not rooted in a theoretical approach of teaching. It is imperative that Europe bridges the knowledge-to-teaching gap and begins introducing similar programs, while learning from the limitations of USA efforts. Two steps are needed to strengthen public health educational institutions and improve population health: first, to systematically incorporate an intersectional paradigm into public health curricula; and second, to provide faculty members in public health programs with transformative teaching skills. In this skills building seminar, we aim to 1) discuss the need for incorporating intersectionality into public health curricula in Europe; 2) provide an experiential learning opportunity on social identities and health; and 3) create a space for self-reflection. We first present the introductory course on social identities and their importance in public health (Wandschneider et al.) which has been developed in collaboration with the Association of Schools of Public Health in the European Region (ASPHER) (15 minutes). Secondly, we will have an interactive session to apply an exemplary teaching method (25 minutes). To conclude, we will moderate a discussion guided by the questions “What is needed to integrate such efforts more sustainably in public health teaching practices?” and “How do we address potential barriers?” (20 minutes). This workshop addresses persons who engage in teaching in undergraduate or graduate Public Health programs or provide training to public health and health care professionals. It also invites researchers to reflect on how to frame research on health inequalities. Key messages To address health inequities, we need to incorporate an intersectional paradigm into public health curricula and provide faculty members in public health programs with transformative teaching skills. A model teaching module that is open access could provide the necessary tools to meet this need.

Willingness-to-pay tuition and risk-taking proclivities among public health students

Objective: To quantify students’ risk tolerance for in-person classes and willingness-to-pay for online-only instruction during the COVID-19 pandemic. Participants: 46 Columbia University public health graduate students. Methods: We developed a survey tool with a “standard gamble” exercise administered online by an interactive chat bot with full anonymity by students. Students were asked to trade between the risk of infection with COVID-19 and: (1) attending classes in-person, and (2) attending community parties. We also assessed willingness-to-pay for online-only tuition. Results: Students accepted a 23% (standard error [SE]: 4%) risk of infection to attend classes in-person and 15% of them expressed willingness to attend community parties even if the COVID-19 prevalence were high. Students were willing-to-pay only 48% (SE: 3%) of the regular, in-person tuition fees for online instruction. Conclusions: Public health students with a strong knowledge of COVID-19 transmission were willing to accept a significant risk of infection for in-person instruction. Trial registration: NA.

Aligning Public Health Training and Practice in Evaluation: Implications and Recommendations for Educators

Objective. This study aimed to understand the extent to which master of public health (MPH) graduates engage in evaluation on the job, to learn how MPH graduates implement evaluation, and to hear from MPH graduates about how their academic training prepared them for the evaluation work they perform. Methods. Using the Centers for Disease Control and Prevention’s Evaluation Framework, this convergent mixed-methods study included an online survey with 89 public health practitioners and follow-up interviews with 17 survey respondents. The study was performed in the United States during summer 2020. Results. In addition to participating in evaluation activities related to all six Centers for Disease Control and Prevention framework steps, MPH graduates engage in evaluation capacity building, evaluating for health equity and social justice, and funding activities. Participants noted a disconnect between academic preparation and community practice, were least confident in focusing the evaluation design, and most often used surveys to collect data. Conclusions. Public health practitioners commonly engage in evaluation activities but do not feel fully prepared to do so given their MPH training. Many opportunities exist to enhance graduate/postgraduate training through connecting public health with the broader professional practice of evaluation.