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Community as Classroom: Teaching and Learning Public Health in Rural Appalachia

Florence, James DrPH, CHES; Behringer, Bruce MPH

Journal of Public Health Management and Practice: July/August 2011 - Volume 17 - Issue 4 - p 316–323
doi: 10.1097/PHH.0b013e3182140be7
Original Article

Traditional models for public health professional education tend to be didactic, with brief, discrete practica appended. National reports of both practitioners and academicians have called for more competency-driven, interdisciplinary-focused, community-based, service-oriented, and experientially-guided learning for students across the curriculum. East Tennessee State University began its own curricular revisioning in health professions education nearly 2 decades ago with a grant from the W.K. Kellogg Foundation, emphasizing competencies development through community-based learning in community-academic partnerships. This article describes 3 examples that grew from that initiative. In the first example, students in multiple classes delivered a longitudinal community-based employee wellness intervention for a rural county school district. BS public health students conducted needs assessments and prepared health education materials; MPH students conducted health assessments and worked with school wellness councils to deliver client-centered interventions; DrPH students supervised the project and provided feedback to the schools using participatory methods. In the second example, MPH students in a social-behavioral foundations course used experiential learning to investigate the region's elevated cancer mortality ranking. Following meetings with multiple community groups, students employed theoretical constructs to frame regional beliefs about cancer and presented findings to community leaders. One outcome was a 5-year community-based participatory research study of cancer in rural Appalachia. In the third example, MPH students in a health-consulting course assessed local African Americans' awareness of the university's health and education programs and perceptions of their community health issues. Students learned consultation methods by assisting at multiple regional African American community meetings to discover issues and interest that resulted in the organization of a regional African American health coalition, multiple community health interventions, and the region's first health disparities summit. Lessons learned are presented which identify key elements of success and factors that influence adoption of community-based teaching and learning in public health.

This article describes 3 examples of how community-based instruction has been used in the preparation of public health professionals at East Tennessee State University.

Department of Community Health, College of Public Health (Dr Florence), and Office of Rural and Community Health and Community Partnerships (Mr Behringer), East Tennessee State University, Johnson City.

Correspondence: James Florence, DrPH, CHES, Department of Community Health, College of Public Health, East Tennessee State University, Johnson City, TN 37614 (

The authors wish to acknowledge the able assistance and unflagging attention to detail provided by Antonia Adinolfi in editing and assisting in the preparation of the manuscript. Antonia served her field practicum, in one of the experiences described in this article. She graduated from the East Tennessee State University College of Public Health with her MPH in Community Health.

Copyright © 2011 Wolters Kluwer Health, Inc. All rights reserved.