Teaching Techniques

Using Cooperative Learning Groups to Develop Health-Related Cultural Awareness Eva I. Doyle, Chris French Beatty, Mary Walker Shaw

Health-related Cultural Awareness

Secondary students (grades 7- 12). Health education, social studies, history, sociology, psychology, consumer/family sciences, and interdisciplinary studies.

After participating in this technique, students will be

1 ) describe the major health problems prevalent among

2) use the PRECEDE model to assess health needs

3) describe the health of communities from a multicul-

4) develop potential solutions to health needs within a

able to:

age- and ethnicity-specific groups in the United States;

within a community;

tural perspective; and

community.

Students demonstrate health-related cultural awareness through this collaborative or cooperative learning group project. They are graded individually for the work completed in their groups. They may be required to present their findings to the rest of the class in a group presentation, submit individually written summaries of the project, or both.

For the team presentation, each team member can present a component and be graded individually regarding the quality of presentation delivery and accuracy of infor- mation provided. Group presentations allow students to

Eva I . Doyle, PhD, MSEd, CHES, Associate Professor and Undergraduate Program Coordinator, Dept. of Health Studies, <edoyle@twu.edu>; Chris French Beatty, PhD, RDH, Chair, Dept. of Dental Hygiene; and Mary Walker Shaw, PhD, CHES, Assistant Professor and Internship Coordinator, Dept. of Health Studies, Texas Wornan’s University, P.O. Box 425499, Denton, TX 76204-5499. This article was submitted June 3, 1998, and revised and accepted for publica- tion November 20, 1998.

explore the presentation experience from within a support group. It also allows the teacher to actively involve students while covering specific health topics such as diabetes or cancer.

Each team member also may be asked to submit an indi- vidually written summary of the entire group presentation for an additional grade. The written summary provides incentive for individual students to actively participate in group discussions and the whole process rather than only focus on individually assigned components. A paper- pencil exam over multicultural health issues also may be administered.

Cooperative learning and collaborative group projects are effective strategies for teaching health-related cultural awareness topics.’ The cooperative learning experience introduces students to health problems prevalent among specific U.S. groups and the community health methods commonly used to address those problems. Students at all educational levels need to acquire a community perspective of health and understand the interrelationship between community and individual health decisions, especially given their future roles as community decision-makers and responsible members.’

Students are assigned to work in teams of four. Introductory in-class, team building activities in which teams discuss rules and expectations can foster a positive learning experience. Several good resources can guide the teacher in this effort.2

Each group is assigned a specific health problem within an age-, ethnicity-, or economic-specific target population (referred to as a “community”). Topics are assigned by allowing team representatives to draw from a “Health Concerns Hat.” Example topics include infant mortality among pregnant teens, hypertension among African Americans, obesity among elementary school children, diabetes among Mexican Americans, bulimia among young adult females, alcoholism among Native Americans, HIV/AIDS among Asian Americans, and smoking among African American male teens.

Each team applies a modified form of the PRECEDE model: as illustrated in Figure 1 and described in Figure 2. Teams use the model to develop: a) a description of factors that may contribute to the health problem within the assigned community, and b) some suggested ways to address those factors and reduce the targeted health prob-

Journal of School Health February 1999, Vol. 69, No. 2 73

lem. Within that process, students are encouraged to explore multicultural factors related to the community that may affect the community’s health in positive and negative ways.

To prepare for the team presentation and/or written summary, each team member collects and synthesizes information relevant to one specific aspect of the project: a) community; b) health problem or issue; c) factors contribut- ing to the health problem; and d) ways to address the health problem. Because each part depends on the others, team members are encouraged to support each other and make decisions as a team during in-class meetings. Students can access information through library and Internet sources, local agencies and organizations such as health depart- ments, and health departments in local universities. Approximately five in-class meetings are scheduled with each of the following sequential decision-making tasks assigned to a different meeting. Project expectations can be adjusted according to student grade or ability levels.

SEQUENTIAL PROJECT TASKS The sequential tasks described can be provided for team

members in handout form as a guideline for in-class meet- ings and project development. A suggested time frame for completing each task is advised. Class meetings can be scheduled to coincide with several subject areas to provide an interdisciplinary project such as health and social stud- ies.

Task f l . Develop Preliminary Visual: Each team creates a visual similar to the one in Figure 1. This task is accomplished by writing into each model box one to two possible contributors to the assigned health problem within the team’s assigned age- or ethnicity-specific community (Figure 2). Students may guess at this point.

Task #2. Verify Guesses Through an Information- Gathering Process: Students make a list of resources such as library sources, local organizations, knowledgeable professionals, national hotlines, and Internet sources for verifying model content. They assign a different resource to each team member and submit to the teacher a list of team member names and their specific information-gathering assignments.

Task #3. Adjust Visual to Match Information Sources: Students discuss the information brought to the meeting by each team member and adjust their model visual as needed. They identify missing information and ask the teacher for advice about where to search further. They show the teacher the resulting visual and explain how each box contributes to the health problem.

Task #4. Brainstorm Action Plan: Students create a “wish list” of activitiedstrategies they could use to address factors identified in their model as contributors to the health problem. For example, in Figure 2, “peer pressure” is listed as a reinforcing factor to indicate that peers often influence adolescent smoking decisions. Thus, the program “wish list” should include some strategies or activities designed to influence peer pressure in a positive way or, at least, to reduce its negative influence.

Task #5. Prepare Team Presentations (teacher’s option): Once the modified PRECEDE visual is complete, the group can prepare a team presentation of what was learned. They may use approximately 15 minutes to present an overview of the model to the entire class. The teacher

can convert each team’s visual model to an overhead trans- parency to be used in the presentation. A suggested presen-

Figure 1 Filling in the Modified PRECEDE Model Boxes

Following these steps, brainstorm as a team about what you think influences your assigned health problem in your assigned community. Examples provided on this page and in the attached visual describe things that influence adolescents to smoke and how smoking affects their lives. Fill in the boxes on the transparency provided.

Most health professionals start with this box when studying a community health problem. Write into your team’s “health box” the health problem you’ve been assigned. Example: lung cancer (Figure 2).

Write in this box 1-2 ways the health problem you listed in the health box can affect a person’s life. Example: a person with lung cancer might miss a lot of work due to illness (absentee- ism) and would likely have to restrict physical activity (reduced activity).

1- Write in this box any behaviors or

Health

of Life

habits that may be practiced by I Behavior I your community that can lead to the health problem-. Example: smoking (leads to lung cancer).

Write in this box at least one factor that contributes to the health

ment (example: air pollution) andlor the social environment (example:

problem from the physical environ-

Predisposing Factors

knowledge attitudes, beliefs ...

cigarette advertising that targets adolescents).

Write in this box 1-2 examples of what community members know, feel, or believe about the health behavior or health problem. Example: Some adolescents don’t realize how addictive cigarettes are “not addictive”), think smoking is cool (“smoking is cool”), and don’t believe lung cancer will happen to them (“It won’t happen to me.”). These predisposing factors contrib- ute to smoking which, over time, can lead to lung cancer.

I I List the DeoDle who influence

Reinforcing Factors peers, family,

teachers.. .

Enabling Factors resources

skills

community members’ attitudes and behaviors. This could include peers, family members, teachers, health professionals, etc., depending on the community and the behavior targeted. These individuals should be identified so health professionals could work on changing their attitudes and behaviors in a positive way. Example: Adolescent smokers are influenced by their smoking peers and, sometimes, by smoking parents.

This box should include any “inanimate objects,” buildings, services, etc., that make performing the targeted behavior easier to accomplish. Example: Availability of cigarettes to minors through stores that don’t check IDS is a factor enabling more adolescents to smoke.

74 Journal of School Health February 1999, Vol. 69, No. 2

tation breakdown for a four-member team is listed. These descriptions are worded as instructions to the students for easy transfer to a student handout.

1) Describe the community. Name some health concerns or issues common to your assigned age- or ethnicity- specific population. Describe some traditional health beliefs you learned about. However, be careful to explain to your audience about the dangers of stereotyping and how indi- viduals within that community differ from each other.

2 ) Describe the health problem or issue. Describe the

prevalence of the health problem within the assigned community (quote rates or percentages). Provide justifica- tion for focusing on this particular health problem by explaining how it affects the community’s quality of life.

3) Describe factors that contribute to the health problem. Use the modified PRECEDE model in Figure 1 to identify behavioral, environmental, predisposing, enabling, and reinforcing factors that contribute to the prevalence of the health problem. Explain to your audience that finding ways to change these influencing factors such as improving

Figure 2 Filling In the Modified PRECEDE Model Boxes

Predisposing Factors

An example: Smoking among adolescents

“It‘s not addictive.” “Smoking is cool.” “It won’t happen to

Behavior Cigarette smoking

Reinforcing

Smoking peers Smoking parents

\ I

Air pollution Enabling Cigarette advertising Factors Cigarette availability through stores where IDS aren’t checked

Health Lung cancer

Your Team’s Turn: Fill in the boxes below to describe the health problem in your assigned community.

Quality of Life Absenteeism Reduced activity 7

Predisposing Factors

\ (knowledge, attitudes, . . . . . .)

Reinforcing Factors (influential people)

Enabling Factors (resources and skills)

i /

Behavior [practiceslhabits)

Health (health concern)

I Quality of Life (Lifestyle factors affected by the health problem)

Journal of School Health 9 February 1999, Vol. 69, No. 2 75

knowledge and attitudes or providing needed resources could help reduce the health problem in the community.

4) Describe suggestions for addressing the health issue. Describe ideas your team brainstormed that could help reduce the health problem. These ideas could include naming some existing community organizations, volunteer groups, and other potential resources that could help.

Throughout the project, the teacher should strive to foster mutual respect and comradeship among team members. Stereotyping entire groups of individuals is possible when describing health problems within broadly defined communities such as Mexican A m e r i c a n ~ . ~ The teacher should communicate the dangers of stereotyping individuals and carefully monitor student presentations so individual differences within communities are respectfully described. Prior to project initiation, in-class activities fostering cultural sensitivity are beneficial.

This project: a ) provides an interesting hands-on approach to learning about health problems among diverse groups; b) encourages students to develop teamwork skills; c) allows students to use their creative abilities toward problem solving; d) fosters cultural awareness and sensitiv- ity; and e) provides a forum for understanding health prob- lems from a communi tywide perspective. An understanding of the multicultural aspects of health can contribute to student appreciation for and value of diversity within communities and our multicultural society. Teachers who enjoy a learner-centered classroom that promotes creativity and critical thinking will find this a worthwhile project.

WEBSITE RESOURCES Centers for Disease Control. <http://www.cdc.gov>

provides information about prevalence of specific health problems.

Ethnomed. <http://www.hslib.wushington.edu/clinical/ ethnomed> lists descriptions of various ethnicity-specific communities.

Institute of Health Promotion Research. <http://www. ihpr.ubc.ca/precede. h t m b provides information about the PRECEDE model.

Office of Minority Health. <http://www.omhrc.gov> l ists information about minority health issues and resources. H

References I . Lynch EW. Instructional strategies. In Morey AI, Kitano MK, eds.

Multicultural Course Tramrforrnation in Higher Education: A Broader Truth. Boston, Mass: Allyn and Bacon: 1997.

2. McKenzie JF, Pinger RR. An Introduction to Community Health. web enhanced edition. Sudbury, Mass: Jones and Bartlett Publishers.

3. Harvey T, Drolet B. Building Teams, Building People. Lancaster, Pa: Technornic Publishing; 1994.

4. Green LW, Kreuter MW. Health Promotion Planning: A n Educational and Ecological Approach. Mountain View, Calif: Mayfield: 1999.

5 . Spector RE. Cultural Diversity in Health and Illness. 4th ed. Stamford, Conn: Appleton and Lange; 1996.

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