@2024 Afarand., IRAN

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ISSN: 2228-5468    Education Strategies in Medical Sciences 2015;7(6):381-389

Background
…[1-7] The emphasis of community-based education is on the health needs as well as social and cultural dimensions of health [8] and can contribute to the complete physical, psychological, and social welfare [5]. Students and faculty members have a positive approach to community-based teaching [9, 10]. They believe that this approach increases learning [11], improves students` self-confidence [4] and promotes the public health [12, 13]. Medical students should be aware of prevention and treatment of diseases caused by lack of environmental sanitation after graduation [10]… [14-18]. Most medical graduates lack the required skills for educational need analysis and the prevention of diseases [19, 20]. One of the reasons for this problem, is the traditional teaching and less attention to the course of environmental health in the universities by students and the educational system [21, 22]….[23, 27].
Previous Studies
In various studies determining the effectiveness of community-based education has been proposed [28, 29]. The result of limited descriptive research in Iran shows that community-based teaching is more effective for medical students in comparison with its teaching in the hospital [9].
Aim(s)
The aim of this study was to evaluate the effectiveness of community-based teaching on the students` satisfaction of teaching and their understanding of environmental health.
Research type
This is a quasi-experimental study.
Research society, place and time
Fifth semester nursing students in Birjand University of Medical Science were studied in 2011.
Sampling method and number
All students were selected by census method. Inclusion criteria for this study were as follows: not participating in community-based teaching, not attending the course of society health 3 in previous semesters and signing the consent for participating in this study.
Used devices&materials
The number of the sessions for the course of environmental health during the week, teaching topics and the sources of teaching, the instructor, and duration of teaching during the semester was equal for both groups. The students consisted of two groups, each including 36 male and female students studying in the same semester, but they were divided into two independent groups. Randomly, group one was selected for community-based teaching (experimental group) and the other group was selected for group-discussion teaching. The intervention included two activities. Firstly, all topics of the course of environmental health were taught using real pictures of social environment and secondly the research was conducted and the training was presented for two environmental health problems based on teamwork [30] and during the sessions 2-5 teaching of environmental health was done based on community-based training [2, 5, 7]. The first health problem was the risk of spreading hepatitis/HIV in the barbershops and the second problem was the risk of spreading Brucellosis by unpasteurized products in food stores. Two questionnaires were prepared for training needs assessment with respect to the risk of spreading inflection/AIDS and Brucellosis according to team working standards [30] with the guidance of instructors and collaborative working of students. Guidelines for the prevention of transmission of above diseases were determined by teachers and group of students. Hairdressers and sellers of high risk products were privately taught according to the results obtained using group discussion by students and teachers. Data collection tools were two pretest and posttest questionnaires of students` knowledge and satisfaction and two questionnaires about the information of businesspeople. Two questionnaires about spreading and controlling hepatitis/HIV and brucellosis in barbershops and the shops offering unpasteurized dairy products, which were prepared based on previous studies [14, 17] and pre-studies, were used to conduct the research in society aimed at the business operators. Randomly a set of 16 questions were used as pretest questions and remaining 16 questions was used in final exam which were associated with students` knowledge of the risk factors, and each correct answer received score 1. The total score of knowledge was calculated as the sum of the scores in each question from zero to 16. For students` knowledge of environmental health, two sets of questions including 10 similar questions were chosen with a total score between zero and 10 respectively. ..[31] The students’ satisfaction in two groups was measured through 17 items related to teaching characteristics in three dimensions of community-based education, research and health education in the society with a 1-5 scores on the Likert scale in form of totally agree (5) to totally disagree (1) for each item [32]. In the questionnaire used at the end of the study, mean GPA of the last academic semesters, the score in the epidemiology related to the principles of research in public health and the gender of the students were determined with 3 questions. The content validity of pretest and posttest questionnaires for assessing knowledge and satisfaction of students and the two questionnaires of gathering information about business operators were confirmed by 10 members of the faculty in the field of health teaching, medical teaching, infectious diseases and public health and its reliability was calculated using Cronbach`s alpha with 12 similar students, 10 hairdressers and 10 suppliers of unpasteurized daily products. Principles of community-based teaching were taught to control group. Data was analyzed, using SPSS 16 software, Kolmogorov-Smirnov test (to confirm the normality), Chi-square test (to compare the gender of control and experimental group), Independent T-test (to compare the scores of knowledge and satisfaction of control and experimental group) and Paired T-test (to compare the score of knowledge in each of observed and control groups before and after the intervention in that group).
Findings by Text
From 36 participants in the experimental group, 10 people (27.8%) and from 36 participants in control group, 13 people (36.1%) were men, and there was no significant difference with respect to gender in two groups. There was no significant difference between the mean GPA scores of the last academic semesters in experimental group (16.03±0.91) and control group (16.04±0.93). There was no significant difference between the mean score of epidemiology in experimental group (15.64±1.09) and control group (15.68±1.10). Before intervention, there was no significant difference between the mean scores of knowledge of risk factors for transmitting hepatitis/ HIV at the barberries and brucellosis in food stores in experimental group (1.38± 0.37) and control group (1.11± 0.35). Before intervention, there was no significant difference between the mean scores of knowledge of principles of environmental health in experimental group (1.47± 0.20) and control group (1.83± 1.81). Before intervention, there was no significant difference between the mean values of total score of knowledge of environmental health, risk factors for HCV/HIV and brucellosis in experimental group (2.86±0.50) and control group (2.94±0.46). After intervention, there was a significant increase in the mean values of total score of knowledge about environmental health, risk factors for hepatitis/AIDS and brucellosis in experimental group (9.38±1.10) than control (4.25± 0.59) group. After intervention, there was a significant increase in mean score of knowledge of risk factors for hepatitis/AIDS and brucellosis and understanding the principles of environmental health in experimental group than control group (Table 1). There was a significant increase in the mean score of total scores of knowledge of risk factors for Hepatitis/AIDS and brucellosis after intervention (7.17±5.11) in comparison to before intervention (1.38± 0.37). There was a significant difference between the mean score of total scores of knowledge of environmental health after intervention (4.39±4.27) and before intervention (1.47±0.20). In control group, the mean score of total scores of knowledge of risk factors for hepatitis/HIV and brucellosis was 4.91±1.94 after intervention, which was significantly higher than the mean score before intervention (1.11±0.35). However, there was no significant difference between the mean value of total score of knowledge of environmental health before (1.83±1.81) and after (2.30±3.77) intervention in control group. After intervention, mean value of total scores of knowledge about principles of environmental health, risk factors for transmitting hepatitis/AIDS and brucellosis (9.38±1.10) was significantly increased comparing to the condition before the intervention (2.86±0.50) in experimental group. There was a significant difference between the mean value of total scores of knowledge about principles of environmental health, risk factors for transmitting hepatitis/AIDS and brucellosis after intervention (4.25±0.59) and the mean value before intervention (2.94±0.46) in control group. The mean value of total score of teaching satisfaction in experimental group (54.05±9.54) was significantly higher than control group (46.02±12.06) (Table 2).
Main comparison to the similar studies
The overall score of teaching satisfaction was higher in experimental group comparing control group in terms of society-based teaching, research, and health education in the community. The results of previous studies indicate satisfaction and students` more learning in society-based teaching [24, 25]. The learning scores of medical and nursing student are between 7 and 9 from the total score of 10. According to students` view, society-based teaching has been effective to improve social skills and teamwork and to improve the ability to recognize social factors affecting health and practical work and to acquire and utilize knowledge [7]. According to students, society-based learning is better than teaching in the hospital in terms of patients` referral to required services, better education for clients and more attention based on to three levels of prevention of diseases [9]. In a descriptive study, society-based teaching for students and teachers has been preferred due to higher awareness of the society, group interaction, real and behavioral objectives of teaching and empathy between teachers and students. In addition, students considered society-based teaching as leading to higher interest, information storage, problem solving and communicative skills enhancement [10]. The results of this study are consistent with the attitude of experimental group in terms of community-based teaching. After intervention, the mean of total score of awareness of experimental group regarding environmental health, risk factors for HCV/AIDS and brucellosis significantly increased in comparison with the control group. The above results have been confirmed by the recent studies [18, 24]. The results of an experimental research regarding conducting research by students and teachers in the society show that it can be a solution for higher efficiency of teaching-learning process [18]. In this study, attending the small groups of students and teacher in the society, doing a research during the teaching process and training people to prevent the diseases is similar to the present study. However, there was no assessment of business operators’ learning after health education due to the purpose of this study, which is its main difference with that study. In an intervening study, medical students’ knowledge of chronic diseases after four weeks training (including visiting and working in the society) and their understanding of social health skills after the study have been significantly higher than those before the study [24]. Scores of medical students in public health who have taught the society-based course in all dimensions has been higher than those received the course through traditional method [12]. Health problem-based learning in the society in small groups of students and with permanent presence of the teacher increases learning of biochemistry and promotes motivation in the students [27]. The results of these studies are in accordance with the findings of the present study and it can indicate the importance of health problem-based teaching of the society and creating interest in small groups of students even in the class environment.
Suggestions
Designing and implementing research by students and teacher in the society can improve the educational relationship between the teacher and students [18] and leads to the students` satisfaction. … [33-35]
Limitations
One of the limitations of this study was the lack of control over the exchange of information between groups of students.
Conclusions
Society-based teaching and educational needs assessment of the risk factors of spreading hepatitis/ HIV in barbershops and brucellosis in the food stores is effective in order to design health education and prevent the above diseases through students’ team-working in small groups and via observation, recognition of the causes of the diseases and preventative planning and implementation.
Acknowledgments
Researchers appreciate the participants.
Conflict of interest
Non-declared
Ethical Permissions
All the processes were confirmed by the Medical University of Birjand.
Funding Sources
Non-declared

TABLES and CHARTS

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