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Research Article
Issue Date: September/October 2016
Published Online: July 27, 2016
Updated: January 01, 2021
Impact of a Child-Based Health Promotion Service-Learning Project on the Growth of Occupational Therapy Students
Author Affiliations
  • Cynthia Lau, PhD, OTR/L, BCP, is Associate Professor, School of Occupational Therapy, Touro University Nevada, Henderson; cynthia.lau@tun.touro.edu
Article Information
Health and Wellness / Education of OTs and OTAs / Special Issue: Research Articles
Research Article   |   July 27, 2016
Impact of a Child-Based Health Promotion Service-Learning Project on the Growth of Occupational Therapy Students
American Journal of Occupational Therapy, July 2016, Vol. 70, 7005180030. https://doi.org/10.5014/ajot.2016.021527
American Journal of Occupational Therapy, July 2016, Vol. 70, 7005180030. https://doi.org/10.5014/ajot.2016.021527
Abstract

This phenomenological study revealed the lived experiences of occupational therapy students as they embarked on a semester-long volunteer health promotion service-learning project during their entry-level master’s program. Data analysis extrapolated themes from student journals, transcriptions of pre- and postinterviews, and field notes. Student roles were exemplified by what students wanted to learn, what they actually learned, and the unexpected benefits they experienced. In particular, issues with teaming, interprofessional development, and time management were discovered. The findings add to the growing literature about the benefits of service learning as a teaching strategy and how it facilitates mindfulness of community service, communication, and clinical reasoning of future therapists. Implications for learning and practice are discussed.

Service learning is a teaching and learning strategy that integrates meaningful community service with instruction and reflection to enrich the learning experience, teach civic responsibility, and strengthen communities (Seifer & Connors, 2007). It can also serve to move health care professionals forward to meet societal needs (Sabo et al., 2015). This method is a context-driven, hands-on approach that allows students to integrate knowledge from didactic course work with problem solving that is immediately relevant to their current environment. Students who engage in service learning provide community service and learn about the environmental context in which service is provided, therefore strengthening the connections among their academic courses, clinical experiences, and roles as citizens.
Literature Review
Researchers such as Astin et al. (2006)  and Eyler, Giles, Stenson, and Gray (2001)  have studied the benefits of service learning for students, faculty, and community members. Service learning can improve students’ learning outcomes and contribute to their personal and social development. Occupational therapy students perceived that their abilities were enhanced within the clinical skill area practiced during experiential learning opportunities (Knecht-Sabres, 2010). Public health students found that participating in service learning projects focused on health disparities helped increase their awareness of the roles of many health professions, thus gaining leadership and communication skills (Sabo et al., 2015). In addition, faculty can experience enhanced pedagogical, research, and community development opportunities (Swords & Kiely, 2010). Professors used service learning to empower demanding Generation Y students to become more active in their own learning process using real-life applications (Hart, 2015). Moreover, community partners can receive additional resources from higher education institutions that use service learning to support their goals (Kelly & Miller, 2008).
Health and human services disciplines recognize service learning as a possible method to develop interprofessional networks and strengthen communities (Horowitz, 2012). When students of different professions are in the field addressing a common issue, they develop camaraderie and have opportunities to share the common threads among their professions. A pilot study showed that interprofessional collaboration among allied health students was a major theme after an 8-day international service-learning trip (Pechak, Gonzalez, Summers, & Capshaw, 2013). Although the benefits of service learning in higher education are apparent, this approach is not mainstreamed in universities (Champagne, 2006). Common obstacles to sustaining service-learning projects include a lack of funding, time commitment, institutional support for logistics, and community interest and enrollment as well as scheduling difficulties (Bridges, Abel, Carlson, & Tomkowiak, 2010; Horowitz, 2012). Conducting further research in the area of service learning may elucidate barriers and add evidence to justify service learning as a necessary pedagogical method in higher education programs of health and human services.
Service Learning and Occupational Therapy
Some occupational therapy education programs use service-learning methodology to teach civil responsibility and a focus on the global community (Maloney, Myers, & Bazyk, 2014; Schaber, 2010; Talero, Kern, & Tupé, 2015). This method of teaching and learning is exemplified within Accreditation Council for Occupational Therapy Education® (2016)  standards and is aligned with many higher education institutional missions to teach, lead, and serve. In addition, service learning emulates the essence of occupational therapy, focusing on learning in the client’s natural environment (O’Brien & D’Amico, 2004). Students can synthesize knowledge about disability grounded in social and environmental contexts to be successful community advocates for their clients (Gitlow & Flecky, 2005).
Optimal service-learning methodology requires students to reflect on gained knowledge and growth through personal reflection, discussion, and focus groups (Astin et al., 2006; Bazyk, Glorioso, Gordon, Haines, & Percaciante, 2010). In one study, occupational therapy students increased their self-efficacy while working with an elderly population in an adult day center for 3 days (Schaber, 2010). Despite the fit between service learning and occupational therapy, the majority of service-learning opportunities have a brief duration. Allied health curricula would be insufficient without recursive and frequent service-learning experiences (Hoppes, Bender, & DeGrace, 2005). The need exists to study student experiences during service-learning participation over a longer period because participant commitment and perceived benefit may change with the duration of the experience. Investigating students’ lived experiences over time can allow faculty to optimize this teaching and learning method and to examine potential problems.
Service Learning and Health Promotion
An emerging practice area that is well suited for service learning is health promotion as part of community-based practice. Occupational therapy’s focus on preventing disease with healthy habits and routines and on management of chronic conditions can make an impact on the health of the general population (American Occupational Therapy Association, 2014). Key components of community-based care are the use of interprofessional health teams and interventions that are rooted in the context of the consumer. A central recommendation of future interprofessional education is for health professional students to link to the community and to stakeholders to have a positive impact on health (Institute of Medicine, 2015). Within a community-based context, it is necessary to have more than one health professional address the complex nature of most health problems and to make comprehensive health care more accessible and family centered.
Health promotion as a pivotal area of occupational therapy can make an impact on the health of the general population (Vroman et al., 2013). For example, obesity prevention programs for children in schools help mitigate the obesity epidemic (Wang et al., 2013). One such after-school program that used occupational therapy through student service learning demonstrated that children increased vegetable and fruit consumption after exposure to snack preparation using healthy foods (Lau, Stevens, & Jia, 2013). In another study, an interprofessional pediatric weight management program, led by a pediatrician, used occupational therapy students participating in service learning to implement a family-oriented intervention (Kuo et al., 2013). Despite the success of obesity prevention programs, childhood obesity rates are still high: More than one-third of children and adolescents are overweight or obese (Centers for Disease Control and Prevention, 2016). This health care issue still needs to be addressed in innovative ways to provide accessible health promotion for children. Service learning that targets health promotion matches the community care model well because this method allows health care students to immerse themselves in the lives of clients within their daily routines and communities.
Background
The faculty of and students in an entry-level master’s occupational therapy program at Touro University Nevada (Henderson, NV) established an ongoing service-learning project in an after-school setting, Healthy Choices for Me (HCFM; Lau, 2011), that provides health promotion activities for children at risk for obesity. The primary aim of the project is to increase children’s physical activity, healthy nutrition, and self-efficacy to make activity and nutritional choices within their environment and routines and, therefore, promote a healthy lifestyle. This unique community-based service-learning project is student led, with occupational therapy students volunteering outside of their regular coursework and running the project with a faculty mentor. The project typically runs a minimum of 10 wk to allow for intensive intervention and thus is lengthier than most university-based programs. The occupational therapy students participate as lead interventionists providing HCFM with the help of the after-school staff and students from other health professions.
After the second year of the program’s inception, a postproject focus group of the occupational therapy student interventionists indicated a need to examine their personal experiences during the project with the intention of enhancing their learning experiences. With the goal of improving service learning directed at health promotion and obesity prevention in occupational therapy education, the objective of this research project was to extrapolate the students’ lived experiences through a phenomenological study as they engaged in a semester-long service-learning project. The purpose of this study was to answer the research question “What is it like to be an occupational therapy student participating in a service-learning experience directed toward health promotion for children?”
Method
Research Design
The phenomenological approach relies on the lens of the participants, with results generated from the data with few to no assumptions made ahead of time; therefore, the design acquires data that explicates the essences of the human experience of the participants (Creswell, 2007). This type of qualitative inquiry lends itself to extrapolating participant points of view, perceptions, and assumptions within the social context of the world around them (Hissong, Lape, & Bailey, 2015).
Participants
Using criterion-based purposeful sampling to choose participants, a cohort of 36 second-year entry-level master’s occupational therapy program students were asked whether they wanted to engage as interventionists in HCFM and participate in a qualitative study examining their personal perspectives while engaging in the project. None of the students were excluded from receiving an invitation to participate regardless of academic performance or clinical area of interest. Nine students volunteered, and none were excluded from participation. They were all White women in their 20s. The study received approval from the university internal review board, and the participants signed a consent form to participate in the study.
The 9 participants used HCFM, a program that contains more than 30 manualized 90-min lesson plans for repeat use, to lead an after-school project twice each week for 2.5 mo at a school located in a lower socioeconomic status (SES) area. This particular school was chosen because it had the most children eligible for the free lunch program in the city. Thirty-two children attended the project, 5 of whom had disabilities. One of these children had a severe level of autism spectrum disorder (ASD) and needed close supervision at all times for safety and to facilitate his participation.
The 9 students met with the principal investigator (PI)/faculty mentor on campus once each week to discuss the selected lessons for the week, determine role assignment, and shop for supplies and food. During the project, the students did not have a course with the PI, so their relationship was one of mentorship. Interventionist roles rotated among leader for the week, shopper, main person to support the child with ASD, and helpers. In addition, 1 student was the main communicator with families and 2 other students met with the children individually to coach them regarding their personal goals at home.
Data Collection
Investigators in phenomenological studies are required to be reflective and suspend preconceived ideas of the phenomenon under study to fully understand the voices of the participants as they relate their lived experiences (Moustakas, 1994). For this phenomenological study, the PI used three sources of data: interviews, observation field notes, and participants’ journals. Using three sources of data served to triangulate the authentic interpretation of the lived experiences. A research assistant interviewed the participants on the university campus before the start and after the completion of their service-learning experience. The interviews were an average of 15 min long. The questions were open ended, and the answers were audio recorded and transcribed verbatim. All 9 participants were asked to check the veracity of the written transcribed interviews as a way of member checking. The questions were the same before and after the service-learning experience but were phrased in future and past tense accordingly. After the experience, the questions were
  • What did you learn from your participation in HCFM?

  • Were these anticipated learning experiences?

  • Did you bring what you thought you would to the program? Please explain.

  • Did you have any concerns regarding your participation during HCFM?

The PI took observation notes of the participants during weekly sessions on site. These notes focused on the social interactions of all the participants with the children, staff members, and other team members. The participants also completed 11 weekly journal entries regarding their ongoing experiences while working with the children. The length of the journal entries was not specified to the students. However, the average length of the journal entries was one single-spaced page. The following guidelines were given to students regarding their journal entries:
  • What happened?

  • Describe your experience.

  • What would you change about this situation if you were in charge? What have you learned about this agency, these people, or the community?

  • Was there a moment of failure, success, indecision, doubt, humor, frustration, happiness, sadness?

  • Do you feel your actions had any impact?

  • What more needs to be done? Does this experience complement or contrast with what you are learning in class? How?

  • Has learning through experience taught you more, less, or the same as the class? In what ways? (Center of Service Learning, 2012).

Following the phenomenological approach, it was important for the PI to set aside presuppositions and reach a state of openness to see data in an unfettered way (Moustakas, 1994). Getting feedback from the PI may have resulted in students feeling that some of their feelings and interpretations were more valued than others. Therefore, the students were asked to refer to the guidelines, but no feedback was given to them during the service-learning experience regarding the quality of their reflections. In addition, their interviews and journals were collected by a research assistant and assigned a participant number accordingly; therefore, the PI was blind to the exact identities associated with the data provided.
Data Analysis
The phenomenological approach emphasizes a focus on the essence of the experience of the participants and nonjudgmental procedures for analyzing data; therefore, steps were taken to manage data in a systematic and unbiased manner. The data were analyzed with a three-step coding method. The first step entailed initial coding by transcribing pre- and postinterviews verbatim with member checking. The second step was to categorically code the transcribed records of the interviews and weekly participant journals. Bogdan and Biklen (1992)  recommended breaking down qualitative data into manageable units by using codes for synthesizing and discovering what is important to be learned. Therefore, as part of an iterative process, two research assistants independently read each individual sentence of the transcribed interviews and journals and color coded each statement into one or more of the following categories: setting or environment, thinking or perspectives about people or objects, process leading to change, activity, strategies, and relationships (Bogdan & Biklen, 1992) .
To discover themes, cutting and sorting of text and quotes is a common method of qualitative analysis (Bernard & Ryan, 2010). The third step of coding thus entailed re-sorting all the data per sentence from the preinterview, postinterview, and weekly journals into the previous categories using color coding. The PI reviewed the statements in the categories 4 times over 1 mo and extrapolated recurring patterns for each category. Two participants read and verified the patterns as a means of member checking.
By looking at multiple perspectives on the same situation, a researcher can make some generalizations about the “insider’s” perspective of the lived experience (Van Manen, 1990). Therefore, the next step of analysis involved reviewing the patterns in each category and synthesizing and triangulating them with the field notes into common themes using thematic analysis. The patterns extrapolated from the pre- and postinterviews and weekly journals were compared for similarities with the weekly observation field notes of the PI. The most prevalent themes—those expressed by a majority of the 9 participants within the patterns and also exemplified in the field notes—were then identified. Moreover, 2 participants reviewed the themes, thus serving as a final member validation of the lived experience.
Results
Several patterns were found in the categories across participants.
Setting or Environment
The participants had concerns regarding the unhealthy snacks children were receiving in the after-school program. In addition, they were perturbed about the lack of training the after-school staff had regarding children with ASD. In summary, the participants felt that their knowledge in the areas of health promotion and disability positively contributed to this nontraditional setting for occupational therapy practitioners.
Thinking or Perspectives About People or Objects
Before the start of the program, the participants wanted to learn how to facilitate children to engage in healthy occupations. After the program, the participants thought the service-learning project gave them valuable exposure to typically developing children. In addition, some of the participants speculated that male role models were important for the participating children. In summary, the participants viewed this experience as one that complemented and reinforced what they learned in class regarding human development and building therapeutic relationships.
Process Leading to Change
Some of the participants expressed unforeseen time management issues they had to overcome but also improved their personal time management skills over the course of the project. The participants received validation from the children’s excitement during activities, which increased their dedication to the project. They recognized their improved ability to work and communicate with children with different abilities, behaviors, and temperaments. They improved their skills working with individual children and groups. In summary, the participants sometimes had difficulty implementing the intervention and needed to adapt and adjust to make subsequent sessions more successful. In addition, positive affirmation from the children motivated the participants.
Activity
The participants wanted to learn about how to promote nutrition and wellness in their future practice. They saw firsthand the importance of occupational therapists serving community needs. They saw the connection between health promotion and occupation performance for children and were surprised and excited about how fast the children learned the healthy concepts that were presented. In summary, the participants saw a substantial impact of the health promotion activities on the children’s well-being.
Strategies
The participants wanted to improve their leadership skills by participating in community service. They increased their knowledge of how to work with children (i.e., keeping their attention, dealing with attention-seeking behavior, dissipating disruptive behavior, and managing bullying behaviors) and recognized that the children needed repetition for mastery of some concepts. The participants realized that they needed a backup plan in case their initial plan was not engaging, too short, or overly complicated. They also needed to interact differently with children with learning disabilities, ASD, and behavioral issues. In summary, service-learning project participation allowed the students to expand on the skills that had been discussed in their university classes. They needed to use a vast array of child-based strategies, problem solve, and adjust their styles and expectations according to the different developmental levels of the children.
Relationships
The participants self-identified the components of an interpersonal relationship that can be improved upon (i.e., communication, assertiveness, flexibility, and patience) while working with children and other team members. The participants struggled with communicating with each other at times regarding planning and executing health promotion activities. They also enjoyed working with graduate students from other health professions during the project and took the opportunity to explain the unique value of occupational therapy to other future health and education professionals. In addition, the participants improved their interprofessional skills by working in close proximity with the DO (doctor of osteopathic medicine) and physical therapy students. In summary, the participants had some group conflict among themselves they needed to resolve. These problems mirrored the difficulties that are seen in group assignments in the classroom, but the stakes were higher with clients involved. The students valued the opportunity to work collaboratively with other health professional students.
Themes
After the PI synthesized the patterns with field notes, the following five themes emerged that describe the essence of the participants’ experience: (1) anticipated benefit of integrating knowledge, (2) actual learning and growth, (3) interpersonal relationships while engaging as interventionists, (4) internalization of the importance of community service, and (5) interprofessional teaming.
Anticipated Benefit of Integrating Knowledge.
The patterns within the categories of thinking or perspectives about people or objects, activity, and strategies were merged under the theme anticipated benefit of integrating knowledge. During this service project, the participants expressed different anticipated learning objectives based on their prior life experiences, but all of them wanted to put into practice what they were learning in the classroom. The 9 participants had varied experiences with children with disabilities. One participant was a certified teacher, another was a parent of a child with a disability who had died, and the 7 others had more limited experience with children. The teacher wanted to hone her leadership skills and her occupational perspective of children engaged in activities that enhance healthy living. The student who was a parent had a strong sense of social justice and wanted to contribute to children living in a low-SES area. The other students wanted more practical experience with children with and without disabilities than what was offered in their Fieldwork I placements.
Actual Learning and Growth.
The patterns within the categories of process leading to change and strategies were merged under the theme actual learning and growth. Participant learning was context driven by the particular group of parents, the after-school staff, and the children with whom the participants worked. For example, participants learned about working with children with unique needs such as the child with ASD and another with attention deficit hyperactivity disorder, both of whom required significant behavioral intervention. One participant said, “I would have liked to see a behavior intervention plan in place for the after-school setting as well. That would have been helpful information for us to have to help the children engage in the health promotion activities to the best of their abilities.” The participants also learned that different skill sets were required for managing large groups, small groups, and individual children. The larger the group, the more rambunctious the children became, and the participants had to use visual cues for attention, with loud and clear verbal directions.
The participants made connections between experiences in the program and concepts that had been discussed in class. According to 1 participant, “We learned about sensory issues surrounding food in class by listening and reading, but here, we experience what we learned in class.” For example, some of the children had aversions to particular tastes, appearances, and textures of foods. “We were taught in our child-based classes to empower our clients with tools. One little girl said to me, ‘You taught me how to read the labels so I can eat things that don’t have so much sugar’.” Moreover, family-centeredness is a mainstay of child-based occupational therapy, and 1 participant wrote, “We even had some of the parents report that the kids brought home the lessons [from HCFM] to teach to their families. As a result, the families wanted to implement different food choices into their routine to be healthier.”
Some of the participants indicated that time management was an issue during the semester. For example, 1 participant stated, “I needed to study a lot more on the weekends and other weekdays because I [was] pretty beaten at the end of the HCFM days.” Another participant, however, had another perspective: “If I was not at the school, I would probably be watching TV and not necessarily studying. It just made me more productive, and I would rather be working with the kids anyways.”
Interpersonal Relationships While Engaging as Interventionists.
The patterns within the categories of strategies and relationships were merged under interpersonal relationships while engaging as interventionists. Relationship building with peers and the children was a strong theme identified by the participants throughout the service-learning project. At times, the participants found that they had to work harder at teaming with each other. A few of the participants believed that not all participants were equally engaged in the process. For example, 1 participant wrote, “The group leader for the day failed to bring the materials [and] was unable to delegate or prepare for the activity, which made the group activity very chaotic.” A few of the participants believed that they or others were not equally competent in interacting with children or parents. For example, 1 participant wrote, “One member of our team might have offended a parent by a comment about her child’s weight.” As a result of these problems, the participants had to challenge their communication skills in several ways, such as sharing concerns with each other, modeling for peers, and building positive relationships with children and parents.
The relationships the participants had with the children with and without disabilities were overwhelmingly positive. One participant reflected, “I learn so much not only from self-reflection on my interactions with the children but through watching so many different individuals interact with the same children in their own ways.”
Internalization of the Importance of Community Service.
The patterns within the categories of setting or environment and activity were merged under internalization of the importance of community service. Social justice is one of the themes of the master’s program, and the students are encouraged to participate in the community with a focus on ameliorating social and health disparities. The participants’ level of dedication to the children was evident even when the process of providing intervention was not smooth. One participant commented,

Even though the assigned leader was not ready, we jumped in to help her, despite any slight annoyance, in order to make the day a success for the kiddos. It is a reflection of the importance of team work and client-centeredness in a program like this.

Participants also saw nurturing children to engage in a healthy lifestyle as a means to give back to the community. One participant wrote, “I hope that more programs like this one can be developed at our university to further the success of the children within our community.”
Participants were able to see the value of contributing to the community through their therapeutic use of self. As 1 participant commented, “[T]hese wonderful kids may not be going back to great home situations; [therefore,] the devoted attention, hugs, and high fives we dole out without a thought may really make a huge difference in their day.” Participants also identified people who can give back to the community in addition to themselves. For example, according to 1 participant, “Graduates of this university should stay involved in community opportunities and help build health promotion.”
Interprofessional Teaming.
The patterns within the categories of setting or environment, thinking or perspectives about people or objects, and relationships were merged under interprofessional teaming. Although this service-learning project was carried out during the third semester of the master’s program, the participants had not had much contact with other professionals in the community, except for their Fieldwork I placement. However, the participants sought to collaborate with doctor of osteopathic medicine (DO) and physical therapy students during the project. The DO students ran the Mini Med School Program, which focused on the function of different body systems, hygiene, sun protection, and nutrition. The physical therapy students developed a gross motor circuit program for the children.
These opportunities facilitated communication, collaboration, and education among the professional students. The occupational therapy students enthusiastically shared the distinct elements of their profession with the DO and physical therapy students. For example, 1 occupational therapy student stated,

I really enjoyed working with the DO and [physical therapy] students. I liked telling them what OT has to offer, and it was beneficial to learn more about what we were all learning in regards to child development in our educational program.

The occupational therapy students also reflected on their own professional philosophy and unique values compared with the other professions. For example, 1 student commented, “As the PTs led the group of children, I thought about the ways I could make the same exercises more occupation based, such as having the children teach us games for each muscle group.”
Another perspective regarding teaming was that the participants saw a need for male role models to volunteer in child-based community service. None of the 9 participants were male; however, male DO, physical therapy, and occupational therapy students occasionally helped with the project, and the children’s level of engagement was visibly higher. One participant commented, “I think the boys especially enjoyed playing soccer with some of the guys who came out today.”
Discussion
Childhood obesity remains an important health issue for occupational therapy practitioners to address because of the potential concomitant psychological and physical problems that will affect the ongoing occupational engagement of children who are obese. The aim of this research project was to extrapolate and study the lived experiences of occupational therapy students participating in a health promotion and obesity prevention service-learning project with hopes to improve their educational process. The occupational therapy literature supports service learning as a teaching method to enhance student clinical skills and to focus students on community needs (Maloney et al., 2014; Schaber, 2010; Talero et al., 2015); however, evidence that supports service-learning projects directed at health promotion and specifically at obesity prevention is limited. The results provided by HCFM were based on an 11-wk engagement that provided support for student learning and identified potential obstacles.
Because of the large amount of time spent with the children during HCFM, the participants had time to build meaningful relationships with the children. They knew the children’s learning styles and interests through ongoing discussions about healthy choices and habits. In addition, the participants met the children’s family members and talked to them about HCFM. Consequently, the children were sad to see the program end and asked when the participants would return. One participant wrote, “A young boy asked why we were leaving, and I tried to explain that this is a program that only last for a few months. He kept saying that he does not understand why.”
The dosing of the program had a significant impact on the amount of healthy living information learned and self-efficacy of the children. A participant journaled, “I was surprised how many facts and specific events the children remembered when they were asked, ‘What was your favorite part of the program?’ They also remembered their weekly health goals, too!” These goals were individualized, developed in conjunction with the children, and ultimately chosen because the children perceived them as doable within their daily routines.
Service-learning development and implementation can be time consuming but beneficial to the participants (Horowitz, 2012). The HCFM participants were forewarned about the large time obligation before they committed to the project. Although the program’s time commitment proved to be an obstacle for some of the participants, most successfully adjusted their time management and study habits. None of the participants said that the service-learning project affected their academic performance, but it did decrease the amount of time they had for leisure activity, which is a valued occupation. To encourage students to participate in impactful community service when they enter the profession, it is important to advocate for occupational balance for graduate students. Being sensitive to participants’ schedules, the faculty mentor offered rotating scheduling and honored requests for time off.
The new era of health care calls for interprofessional teaming (Institute of Medicine, 2015). Touro University Nevada, like others (Schreiber et al., 2014) with multiple health care professional programs, offers yearly interprofessional exercises on campus using a team-based learning model. These exercises are simulations of teaming that may exist in the field, which has proven to be helpful with fostering communication among different health professions. However, they are not a substitute for the personal communication that needs to take place to improve the health of patients or clients. The results of this study indicate that service learning can contribute to interprofessional teaming in a naturalistic manner, with health care students working side by side to reach a common goal of health promotion and obesity prevention. DO and physical therapy students learned about the scope of occupational therapy practice in the community, and all the students increased their understanding of the value of all the professions involved in the project.
The importance of civic engagement was indicated in another study involving occupational therapy students in a semester-long project focused on the adult homeless population (Maloney et al., 2014). Similarly, the participants in this study voiced their awareness of the social issues surrounding health promotion and obesity prevention as they progressed through HCFM. One participant wrote,

They may not be able to pick healthy options in their home environment all the time, but some of the decisions they will make may be influenced by what we have done here, and if anything, the care and attention we have shown them may help them remember that people care about them and the positive choices they make.

Moreover, occupational therapy students who immerse themselves in children’s lives while participating in a health promotion service-learning project may internalize the importance of ameliorating health disparity as practicing occupational therapists.
Limitations and Future Research
The PI, who was also the faculty mentor on the project, was blinded to the interview and journal data. However, because the study included only 9 participants, they may have withheld or tempered their negative perspectives of the experience, assuming that their opinions might expose their identity to the mentor. Inherent in phenomenological studies is the small number of participants. In addition, during recruitment for the study, the occupational therapy program had male students, but none of them volunteered to participate as lead interventionists. A small sample size and all female students limit generalizability to all occupational therapy students. Future research directions could focus on the occupational therapy students’ perspective on service-learning experiences after completing their program of study. Research questions may focus on how they translated their growth from service learning to their subsequent fieldwork experiences and even their first few years of clinical practice. A focused question may center on how their interactions with other health care students, while providing service, shaped their transition into professional practice.
Implications for Occupational Therapy Practice
The results of this study have the following implications for occupational therapy practice:
  • Occupational therapy education programs can successfully integrate health promotion and obesity prevention concepts using experiential learning experiences within a service-learning model.

  • Service learning is a viable pedagogical option to help students reflect on the clinical, communication, and interpersonal skills they need to improve upon before entering their second-level fieldwork experience.

  • Occupational therapy education programs can include service-learning opportunities in their educational curricula to benefit the interprofessional teaming and time management skills of future therapists working in a variety of practice settings.

Conclusion
This phenomenological study revealed that occupational therapy students who participated in a service-learning project over a course of months showed a high degree of benefit regarding their learning, development of interpersonal skills, and reflection about community service while representing occupational therapy. These findings are consistent with other literature on service learning pedagogy in occupational therapy; however, this study was different because the students volunteered for the project; the program involved an intensive time commitment; and most important, the intervention was student led. In addition, the program required teaming with other preprofessional students and workers. Balancing the time obligation of taking a full load in a master’s-level program and volunteering was exemplified by the data, but the students identified that the value of what they were doing overrode their concerns about time commitment. Unique to this study is participant reflections on intragroup teaming, interprofessional teaming, and the need to represent occupational therapy’s scope of practice and unique value.
Acknowledgments
I thank all the past, current, and future occupational therapy students who choose to volunteer to make a positive impact in the lives of our children.
References
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