Using the 7C Framework for Teaching & Learning Health Education

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Authors: Craig M. Becker, PhD Department of Health Education & Promotion East Carolina University Greenville, NC 27858 Email: [email protected] Telephone: 252-328-5312

Lei Xu, PhD Department of Health Education & Promotion East Carolina University Greenville, NC 27858 Email: [email protected] Telephone: 252-328-1611

Beth Chaney, PhD, MCHES Department of Health Education & Promotion East Carolina University Greenville, NC 27858 Email: [email protected] Telephone: 252-328-4238

ABSTRACT Health Professionals are needed to address and improve health status. This paper presents a teaching technique that will help students acquire and develop applied health education and promotion skills. This paper introduces a 7C Framework to encourage teachers to use Challenge, Courage, Commitment, Competence, Connection, Contribution, and Consequences. The results of three innovative student initiated health promotion projects, provoked by these methods, are provided as evidence of its effectiveness. The innovative 7C framework provides a preparatory framework educators can use to help future health professionals not just meet, but exceed expectations.

KEYWORDS: Scholarship, Teaching, Learning, Pedagogy

INTRODUCTION strategies for improving the quality of life of individuals in communities, there is limited Educators preparing the next generation of research on evidence-based approaches for health educators should continually update teaching and preparing entry-level and teaching methods to ensure students are advanced level professionals to be effective prepared for the tasks and skills needed to be practitioners in public health (Becker, Johnson, successful practitioners in the field. In Warren & Barber, 2007; Becker & Loy, 2004; comparison to the wealth of information and Becker, Rager, & Wright, 2013). Until recently, research available on health issues and effective the professional literature in the field was

Using the 7C Framework for Teaching & Learning Page 32 Journal of Health Education Teaching, 2016; 7(1): 32-38 Copyright: www.jhetonline.com All rights reserved relatively absent of articles related to prescribes an innovative 7C Framework for pedagogical practices for training health enhancing information retention and absorption professionals. by students. A framework, rather than pedagogical rules that require discipline, is Rapid societal changes and the developing offered to inspire innovative and creative state of health education and promotion result in adaptation of these techniques (Sinek, 2009). the need to frequently examine professional Specifically, the 7C Framework, developed from preparation techniques to ensure students are research and practice, instigates students to not only being challenged to develop needed become actively involved in issues, as skills, such as critical thinking skills, but are also experiences to be described document. The prepared to adapt, meet, and possibly exceed framework excites students by challenging them the ever changing future needs of the field. to courageously become better versions of Therefore, the primary purpose of this is article themselves by gaining competencies through is to describe how to use an innovative 7C connections with involved groups and taking framework for teaching so the learning of inform- actions that exceed expectations. With ation is retained and absorbed by students in a adaptation, health educators at all levels can public health education professional preparation use the 7C Framework to help students learn program. how to apply health promotion concepts. The Health is an enabling capacity and health examples provided in this article resulted from a professionals positively impact society by professor teaching a capstone class for a cohort developing potential to reach desired goals, of senior students earning a Public Health improving health status, and by helping to Studies degree in a Department of Health resolve preventable problems (Thacker et al., Education and Promotion. The setting was a 2006). New knowledge is essential in creating a large Division 1, 27,000 plus student South East positive societal impact. As suggested by University in the U.S. McDonough and Braungart (2010; 2013), learning new knowledge has become more TEACHING METHOD AND RESULTS difficult. They explain this learning difficulty using an underground water replenishment analogy. Desirable outcomes evolving from students Both underground water replenishment and exposed to this technique suggest it is effective learning take time and require the right in helping students meet and exceed conditions. They describe how modern society expectations of future health professionals. has replaced the natural terrain with concrete Noted results occurred during times when class and that this created a societal design that projects expanded beyond the classroom and causes water to move faster than natural. They into the community through student initiatives, then describe how this quickened speed of though the professor encouraged. While water movement disrupts the underground water experiences resemble service-learning absorption and replenishment cycle. Relatedly, initiatives, these projects came about through modern society moves so fast and fills our world student-driven initiatives that were above and with new information so quickly, it disrupts the beyond any class assignments. The examples retention and learning cycle. This quickened include: (1) an after school health promotion pace, they suggest, compromises the learning initiative that led to healthier snack choices for process that requires absorption and translation participants; (2) a collaboration project with a of new information into knowledge. Just as water local city council to expand walking trails, and needs time to absorb into underground aquifers, (3) a project that developed health promoting students need time to absorb and translate new university policy for on-campus vendors. information into knowledge and possibly wisdom. The empirically derived systematic 7C Framework for teaching health education and Given the time constraints within academic promotion uses the connected and overlapping programs to train students to be proficient in the foci of Challenge, Courage, Competence, knowledge, skills, and processes necessary to Commitment, Connection, Contributions and be an effective practitioner, academicians need Consequences. efficient and innovative approaches that encourage, support and enhance learning and Challenge absorption of new information. This article Health promotion challenges the profession to improve health by using science and art to Using the 7C Framework for Teaching & Learning Page 33 Journal of Health Education Teaching, 2016; 7(1): 32-38 Copyright: www.jhetonline.com All rights reserved help people engage in actions that enable and p. 106). In other words, educators must see and promote better health (O’Donnell, 1989). As a treat students as who they can become. business leader and entrepreneur, Simon Sinek proclaims, “If the challenge we face doesn’t Two examples where students accepted a scare us, then it’s probably not that important” challenge, initiated efforts, and exceeded (2009). Experience with students indicates that expectations occurred when students were real projects, with actual outcomes possible, inspired to not just complete a program help students overcome loss aversion by evaluation, but also to develop and publish the inspiring them to accept a challenge and engage results (Amerando, Becker, & Johnson, 2010; more fully. Decker, Ronay, Telfer, Becker, et. al. 2013). Working toward recognized results connected Teaching Method students to the shared health profession’s larger The first step to encourage students is to purpose of developing conditions conducive for have them notice circumstances where healthy a state of complete physical, mental and social actions are not, but could be, nurtured and well-being and not merely the absence of encouraged and/or situations that discourage disease and infirmity (World Health healthy behavior or cause discomfort and Organization, 1946). challenge them to make it better. Assignments that require a review of current “health” or Courage employee assistance programs offered in the Accepting a challenge means both educators area provides a good way to discover, learn and students will need courage. As Mark Twain about and review current programs. Change is made known, “Courage is resistance to fear, often resisted because as Prospect Theory mastery of fear - not absence of fear” (Twain & documents, there is a preference for the status Blaisdell, 2013, p. 139). Courage is needed to quo, also called the endowment effect. There is help students challenge, not only their thoughts a desire to keep things as they are, due to and values, but also societal norms or the inherent loss aversion (Kahneman, 2011). Risk contention that this is the way it has always Homeostasis Theory also supports a human’s been done. As Charles Kettering explained, “If natural tendency to avoid taking too many you have always done it that way, it is probably chances without expecting an improvement or wrong” (Blaydes, 2003 p. 75). A thriving state is recognition of future benefits (Wilde, 2006). In defined as one in which the participants have an other words, none of us like to be wrong or to do improved ability to accomplish its goals and or things that are not reinforced or recognized. mission. Future health professionals should be However, risks are omnipotent and it is prepared with the skills needed to help necessary to try new ideas. Without new ideas, community settings thrive, not just survive. we could never advance. Teaching Method To guide students, have them evaluate To help students develop these skills, class current health programs being offered to assignments should be designed to require determine which use scientifically grounded students to work with both the university and or methods to promote health and behavior to community personnel to discuss a goal that overcome the temptation of society’s status quo would help both thrive. Using this idea means and other non-health promoting actions. Then, teaching efforts should support student attempts challenge students to artistically develop ways to help organizations within the university or these programs could not just prevent the wrong community do better by accomplishing its action but actually promote a measurable benefit mission more effectively. Of course, a or gain that would also help prevent problems. coincidental outcome would be lower problem Giving students ownership of programs occurrence, but the main instigator should be intrinsically inspires and involves them with the improved outcomes beyond the absence of a issues (Kohn, 1993; Pink, 2009). To help problem. students see what is possible, educators should follow Johann Wolfgang Von Goethe’s advice by To support these efforts, student projects treating them as if they are what they could must develop and use a measurable, research become. In his words, “If I accept you as you supported, thriving outcome corresponding to are, I will make you worse; however if I treat you stated missions. Courage also includes the as though you are what you are capable of resolution to challenge what we have known in becoming, I help you become that” (Mayo, 1995 the field of health education. To facilitate this, Using the 7C Framework for Teaching & Learning Page 34 Journal of Health Education Teaching, 2016; 7(1): 32-38 Copyright: www.jhetonline.com All rights reserved educators must provide students with a venue to about related successes to gain enhanced develop innovative solutions and also provide an competence. opportunity to share these new ideas in at least a class and preferably a public setting. Teaching Method Competence is developed through To help students develop the courage to assignments that review and analyze existing challenge ideas and focus on a thriving, not just programs with theoretical concepts. Most a surviving outcome, a class assignment should notably, having students develop and present require students to gather evidence using their own programs that build on existing efforts scientific methods to support solutions that could develops competence. It is important students result in improved outcomes. Students will need outline how their programs are an improvement to be encouraged to draw supported inferences on existing efforts, and they must document how related to improved outcomes. Using this they build on the literature. To complement technique will also help students realize every these efforts, students must relate their time they develop a program they are really experiences to what they are learning in class. making a prediction of its desired outcome. For example, if students are learning about Understanding that programs are predictions nutrition and development, students should be helps students realize the need to design and required to explain how and why better nutrition complete an evaluation of programmatic efforts. and health would help an organization fulfill its Using these techniques to discover and use mission more effectively. evidence-backed literature to support their programs, students develop confidence. A related example evolved from a students’ Confidence is an additional resulting C from this involvement in an after school program. This process. Doing this also means these class initiative was triggered by students’ service projects effectively help prepare students to be learning experience at a Boys and Girls Club more effective professionals. facility where the young participants were not achieving their full potential. Not helping Students who developed innovative ways to participants achieve their full potential meant the expand walking trails at the university and in the organization did not achieve its mission (Boys community provides an example. In this and Girls Club of America, 2014). The students situation, the students discovered university, city observed that the club provided unhealthy and county operated paths and greenways were processed food to participants so they attempted in close proximity, however they found university to improve food choices. After gaining and community members were not aware of competence about the topic through research, these options. To improve the situation, students they proposed and then helped this program presented their idea to connect all the trails to transition to a local plant-based snack program. expand and improve walkways for university and Completion of this project led to the community residents. Their proposal offered a development of on-site gardens that provided solution that benefitted all involved parties by both an ongoing educational opportunity, a creating a trail network that connected the sustainable food source for the facility, and university trails, the city trails and county better health status and knowledge about greenways. Their ideas were first presented to healthy choices for the people and the planet. the class, adjusted with feedback, and then courageously presented at City Hall to the Commitment council members. The Internet, cell phones, and social media have created instantaneous information. Despite Competence the quickened 21st century pace, new skills do Of course, to effectively challenge existing not just happen; a commitment toward the norms and have courage, students need development of new abilities is needed. As Colin knowledge about an existing situation and about Powell, former Secretary of State, explains, possible documented options that could lead to “There are no secrets to success. It is the result improved outcomes. W. Edwards Deming, the of preparation, hard work, and learning from quality management expert explained, learning failure” (Boyce, 2011 p. 63). Commitment is is not compulsory, but neither is survival devotion or dedication represented by persistent (Deming, 2013). All projects, therefore, must effort and thought. facilitate investigations of the literature to learn

Teaching Methods Center, Career Services and the Volunteer and To develop commitment, opportunities to Service Learning Center. Classes are learn from failures must be provided through encouraged to develop strategic alliances that discussions and realistic feedback of ideas with would help facilitate the acquisition of class, classmates, professors and involved personnel. project, and job skills. These connections can Student projects should require them to talk with improve the class experience by helping both involved professionals to gather information the aligned organization and the class each about how to accomplish desired objectives. accomplish its stated objectives more effectively. While it may be necessary for the professor to Assignments need to encourage students to find assist this process, it is vital that students handle other groups that provide related resources so most arrangements related to these contacts they can serve as strategic partners. By and meetings with involved personnel. providing complementary strengths, both parties are stronger because of the alliance. Examples of persistence were provided by the committed students who had to overcome These connections provide students with initial concerns to develop improved food venues that allow them to work on their options for the after school program. The challenge by courageously committing to and expanded walking trails provided another reward using their developed competencies to make from committed efforts. To gain support, these contributions that help organizations better students had to diligently and regularly achieve their desired missions. The connection communicate with stakeholders to gain with the after school program provided students agreement and feasibility of different options. with an opportunity to develop innovative ideas These efforts required a commitment to ongoing based on the basics learned in class. communication and self-education beyond what could be considered class credit or time. Another example was provided when a Momentum and inspiration were achieved in student partnered with the policy committee to these projects as more and more stakeholders design a policy that prescribed the type of with whom they contacted and met with offered promotional items to be given at on-campus their support. events by vendors. In this example, the student had collected an item provided at an on-campus Connections event attended and was discouraged because The need for connections can be best the item was contradictory to the stated mission understood by quoting Helen Keller. She stated, of the university. The item given to her at this “Alone we can do so little, together we can do so event discouraged healthy behavior. This event much” (Chang, 2006 p. 126). To help create a sparked her to take initiative and propose a new thriving outcome, students must connect by policy that stated promotion items provided making strategic alliances with other groups. during on-campus events should positively Strategic alliances are synergistic connections to represent the university and the participating other resources, people and groups with shared organization and that it should support a health goals yet different roles. These alliances or promoting behavior. The contradictory item partnerships can be instigated from a university provided by an apartment complex at an on- setting to provide benefits to involved groups campus event was a lighter that also could be a (Becker, Johnson, McNeil, & Warren, 2006). Any bottle opener. The student saw this as organization entering a strategic alliance has to encouraging behaviors that would hinder the be better because of that alliance. university from the goal of graduating students and also encouraged disruptive students to live Teaching Methods at the apartment complex. Regular guiding informal conversations between educators and students help overcome The new proposed promotional item was a foreseeable and unexpected difficulties with study aid that also promoted the facility. The creative ideas. Working to develop connections new promotion item would encourage more is imperative for helping students develop responsible behavior at the complex and support collaborative ideas that assist involved parties. the academic mission of the university. In this To demonstrate the value of strategic way, the promotional item helps all organizations collaborations, this class demonstrated the value better achieve its goals. This effort reinforced of strategic alliances by making connections with what they learned in the classroom while the school library, the Wellness Education Using the 7C Framework for Teaching & Learning Page 36 Journal of Health Education Teaching, 2016; 7(1): 32-38 Copyright: www.jhetonline.com All rights reserved showing them how their efforts can contribute to DISCUSSION health promotion. Incorporating the 7C framework into the Contribution pedagogy of health promotion helps students Contributions resulting from using the learn more than just facts. Integrating ways to described 7C framework resulted from applying use what they learn helps both educators and classroom knowledge into practice. Beyond students realize the value of teaching and scholarship gains to future health promotion learning health education because they can see professionals, contributions to the community how using the information helps improve partners included healthier snacks at an after communities and people’s health and lives. As school program. This contribution also provided Albert Einstein warned, “One should guard an educational opportunity related to against preaching to young people success in understanding the relationship between food the customary form as the main aim in life. The choices and personal and planetary health by most important motive for work in school and in those involved. Presenting ideas to city council life is the pleasure in work, pleasure in its result, members to expand walking trails with existing and the knowledge of the value of the result to university trails contributed to these students’ the community” (Swainson, 2000 p. 305). It is by professional development and physical activity accepting the Challenge, having Courage, being options for university and community members. Committed to learning new Competencies and It also helped all involved parties get better use making Connections that help students of taxpayer funded resources. The new policy Contribute to individuals, groups and society. for on campus events contributed to a more Some beneficial Consequences of these efforts health supporting environment for that resident include feelings of pride that evolve from facility and promoted a positive public image for knowing their actions helped benefit society. the university. Each project also contributed to the students’ development of health professional This 7C Framework can help educators skills beyond what could be learned in the continue to learn, grow and improve their classroom. Accepting the challenge, using teaching abilities. This framework makes courage, developing competence, being teaching a more interactive process because it committed, and making connections so stimulates student driven initiative. Educators contributions can be made provides cannot make students learn, but these consequences to build upon. techniques and philosophy help students want to learn. As General Patton explained, “Never tell Consequences people how to do things. Tell them what to do, Consequences of these projects have and they will surprise you with their ingenuity.” provided benefits that have and will continue to (Murray, 2010 p. 128). Great pedagogy in health be built upon. The afterschool nutrition program education provides value because it helps created jobs for coordinators and interns. 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