Creating Cultures of Health in the Academy: Bringing Together Top-Down and Ground-Up Approaches

Abstract

This article reports on a 3-year longitudinal study focused on the impact of cross-sector, collective impact approaches to creating cultures of campus health. The study sought to understand the integration of health and well-being concepts into university operations, including business practices and policies, as well as the contribution of public health initiatives focused on health-promoting universities to creating cultures of campus health for students, staff, and faculty. Research was carried out from spring 2018 to spring 2020 via focus group data collection and rapid qualitative analysis involving template and matrix analysis. A total of 18 focus groups were conducted across the 3-year study, six with students, eight with staff, and four with faculty. The initial cohort included 70 participants: 26 students, 31 staff, and 13 faculty. Qualitative analysis findings indicate a general pattern of change over time from a primary focus on well-being characterized by programs and services (e.g., fitness classes) to policy and structural-level interventions (e.g., stairwell beautification and hydration stations) promoting well-being for all. Grass-top and grassroots leadership and action were instrumental to changes in working and learning environments, policies, and campus environment/infrastructure. This work contributes to the growing literature on health-promoting universities and colleges and demonstrates the critical role of both top-down and ground-up approaches and leadership efforts to create more equitable and sustainable cultures of campus health and well-being.

Keywords

cultures of health healthy campus health-promoting universities and colleges leadership health equity sustainability

Introduction

Institutions of higher education are an ideal place for public health education and promotion. Akin to small communities or even cities, they serve diverse groups (e.g., students, service workers, senior level faculty, and administrators) and have established governing structures to institute policies and communication channels to disseminate information. Members of these communities spend significant time within the confines of the institution: students often live, work, and study within its borders and employees (administrators, faculty, staff) spend significant time within classrooms, departments, and offices (American Time Use Survey, n.d.; Goetzel & Ozminkowski, 2008; Hill-Mey et al., 2015). Many institutions of higher education have fitness centers, health and medical facilities, and faculty, staff, and student well-being departments and programs (Linnan et al., 2010). Despite being environments germane to public health and well-being initiatives, there has been limited attention to health promotion for all (Travia et al., 2020). Historically, efforts have focused on student health with some, but limited, attention to employee health.

Scholars have only recently implemented whole systems and collective impact approaches, a model that brings together diverse stakeholders across multiple sectors to collaborate and enact large-scale social change (Kania & Kramer, 2011), to promote healthy working, learning, and physical campus environments for all (Black, 2019; Cheney et al., 2020; Slusser et al., 2018; Suarez-Reyes & Van den Broucke, 2016). Leaders within such movements use collective impact approaches to develop and implement environmental interventions intended to foster cultures of health across the entire institution. These healthy campus movements focus on embedding and integrating health and well-being practices and policies into business operations, academia, and overall campus life, creating healthy norms, values, and ultimately cultures. Healthy beverage initiatives aimed to reduce the consumption of sweetened beverages have utilized such approaches to change policy and implement structural-level changes to promote behavior change and reduce consumption of sugar-sweetened beverages, resulting in a positive impact on both health and the environment (Di Sebastiano et al., 2021; Patel & Schmidt, 2021; Rickrode-Fernandez et al., 2021).

To date, much of what we know about campus health is based on students’ perceptions and experiences as well as research on workplace health (Goetzel et al., 2014; Travia et al., 2020). While there is understanding and recognition of institutions of higher education as building and promoting cultures of health, there is a continued need to understand how these institutions can serve as catalysts of change by fostering and maintaining cultures of health within college and university settings (Seifer, 2018).

Given the need for additional research on this topic, we conducted a longitudinal qualitative research study assessing the perceived impact of collective approaches promoting well-being for all and creating healthy campus cultures. Our concept of “cultures of campus health” is informed by definitions and conceptualizations of a culture of health put forth by the Robert Wood Johnson Foundation (RWJF) Culture of Health Framework and the Health Enhancement Research Organization (HERO) which includes 24 key elements (e.g., norms, values, communication, and leadership behavior) that foster employee health and well-being (HERO, 2016; Seifer, 2018). Cultures of campus health refers to learning and working environments within institutions of higher education that are intentionally designed to foster health and well-being among faculty, staff, and students. This article summarizes the key findings of our study involving cohorts of students, staff, and faculty who participated in focus group discussions over three years. The following questions guided this research:

Research Question 1 (RQ1): How are health and well-being concepts integrated into university operations (e.g., business practices and policies)?

Research Question 2 (RQ2): How do public health initiatives focused on health promotion and well-being for all (students, staff, and faculty) contribute to creating cultures of campus health?

Methods

Setting

The research presented in this article is based on a 3-year longitudinal study carried out at the University of California Riverside (UCR), a 4-year public research institute located in the inland region of southern California with ~24,000 students (20,500 undergraduate and 3,350 graduate and professional students), 8,800 staff, and 1,950 faculty. UCR is part of the Healthy Campus Network (HCN), a UC system-wide initiative promoting innovative reforms in all dimensions of health and well-being with the goal to “make the UC system the healthiest place to work, learn, and live.” The HCN is a robust network of diverse coalitions across all 10 campuses working together to promote both individual campus and system-wide changes that advance a culture of health and well-being. In response to a request for improved collaboration across the campuses, in 2017 former President of the UC system endorsed and provided funding to support healthy campuses across the education system. The original request, put forth by faculty, staff, and students sought to improve communication around food insecurity and incorporate health and well-being in campus activities, programs, business practices, and policies. The initiative set out to build an inter-campus foundation and coordinating structure that provided support, resources, and lessons learned to each campus within the system as they developed their locally specific healthy campus initiatives (Slusser et al., 2018).

The HCN organizes its campus-level population and public health promotion efforts into four RWJF Culture of Health Framework action areas: (a) making health a shared value; (b) fostering cross-sector collaboration; (c) creating healthier, more equitable communities; and (d) strengthening integration of health services and systems (Seifer, 2018); and engages stakeholders both on-campus (administrators, faculty, staff, and students) and off-campus (e.g., public health departments and community-based organizations) in developing and implementing strategies to infuse health into everyday operations, business practices, and academic life. Elsewhere, we report on the UCR Healthy Campus infrastructure, our approach to fostering cross-sector collaborations and initiatives to make health a shared value and build healthier and more equitable campus communities (Cheney et al., 2020).

Longitudinal Study

This 3-year longitudinal study involved the impact of healthy campus efforts on the (a) integration of health and well-being elements into daily operations, (b) promotion of health and well-being for all, and (c) creation of a campus culture of health and well-being. The University of California Riverside Institutional Review Board approved all procedures, measurement tools, and consent forms prior to the start of research.

From spring 2018 to spring 2020, we conducted a total of 18 focus groups, including six with students, eight with staff, and four with faculty. Focus group sizes varied from 2 to 13 participants (most included 6–8 participants). Participants had to be 18 years or older, an active member of the UCR community (e.g., current student or employee, retirees, and alumni), and speak English. Following the guidelines set forth by Guest et al. (2017), we sought to conduct two to three focus groups with each stakeholder group (students, staff, and faculty) per year of the study to accurately identify patterns/themes and reach data saturation. A facilitator and a note-taker attended each focus group: the facilitator read over a consent form, responded to participant concerns and questions, and obtained verbal consent prior to beginning the focus group discussion, while the note-taker took notes on what was shared. In Years 1 and 2 of the study, interviews were conducted in person in a private group space, but Year 3 interviews were conducted via Zoom video conference due to COVID-19 pandemic restrictions. Interviews were audio-recorded and transcribed by professional services and in-house dictation software. Student participants received a US$10 gift card and faculty and staff participants a US$20 gift card to thank them for their time and participation.

Trained team members used a semi-structured interview guide with open-ended questions to elicit information on current health and wellness resources, perceptions of current health and wellness efforts, visions for creating a campus culture of health, and perceptions about the role of leadership, as well as students, staff, and faculty in creating healthy campus cultures. In Years 2 and 3 of the study, an additional question about perceived changes in campus health and well-being was added. In Year 3, a question about COVID-19 was added.

Data Analysis

Template and matrix analysis, a rapid analytic approach used in public health and health services research, was used to conduct cross-case analyses within and across each year of the study (Averill, 2002; Hamilton, 2013). Per year of the study, trained team members read transcripts line by line and inserted data into templates organized by the semi-structured interview questions. The templates summarized the key findings and exemplar quotes per focus group. Then, a matrix (Focus Group × Domain/Interview Question) was created. Template summary data were transferred to the matrix and analyzed to identify themes in responses to each question as well as across the focus group discussions. Data from the matrices created per year of the study were then transferred to a final matrix that enabled an analysis of thematic change over time.

Results

Our initial sample included 70 participants, including 26 students, 31 staff, and 13 faculty, of whom six students, 14 staff, and five faculty participated in the final year of the study. The majority of participants across all 3 years of the study were female staff. Table 1 provides an overview of the total number of focus groups and participants per year of the study.

Table 1.

Focus Groups and Participant Characteristics Per Year of Data Collection.

Participants by year in study	Focus Group 1		Focus Group 2		Focus Group 3
Participants by year in study	Female	Male	Female	Male	Female	Male	No. of participants
Year 2 (2018)
Student	6	1	3	3	6	7	26
Staff	7	2	11	1	8	4	31
Faculty	5	2	4	2	NA	NA	13
Total 70
Year 2 (2019)
Student	0	2	5	2	NA	NA	9
Staff	6	1	3	1	3	2	15
Faculty	2	1	NA	NA	NA	NA	3
Total 29
Year 3 (2020)
Students	4	2	NA	NA	NA	NA	6
Staff	6	1	5	2	NA	NA	14
Faculty	4	1	NA	NA	NA	NA	5
Total 26

Not applicable (NA) indicates that a second or third focus group was not conducted during that year of the study.

Overview

A general pattern of change exists across the 3 years of the study. The shift was from a primarily focus on health and well-being programs and services (e.g., fitness classes and health care services primarily for students) to policy (e.g., smoke and tobacco free) and structural-level interventions involving changes to the built environment (e.g., stairwell beautification, hydration stations, and access to healthy food options) that benefits all—faculty, staff, and students. Over time, participants noted an increase in programs for faculty and staff, campus leadership support for large-scale health events as well as participation in competitions (e.g., healthy departments), and department chairs, faculty, and staff modeling health promotion (e.g., leadership walk and talks, walking meetings). As we describe below, findings indicate that both grass-top action involving leadership enforcement of policy and commitment to campus infrastructure change, and grassroots leadership and advocacy from faculty, staff, and students are necessary to create cultures of campus health. Tables 2 and 3 provide illustrative quotes of how concepts of health and well-being changed over time through public health initiatives (e.g., stairwell beautification and hydration stations), as well as the integration of health and well-being into university operations (e.g., business practices and policies)?

Table 2.

Changes in Notions of Health and Well-Being.

Concept	Theme	Participant perspectives
Health and well-being programs
	Student-centered health focus	“There is counselling for students but not faculty. I was going to talk about mental health . . . I think like, I feel like there’s not enough opportunity to create supportive space, especially for like faculty who maybe like, are first gen, that come from like low income background etcetera. . . . Navigating the academy can be very challenging.” ~faculty focus group, Year 1
		“I heard a lot as a student; there is a lot available to students. It feels like there is . . . maybe it’s not that there is more available to students, maybe it’s better publicized.” ~faculty focus group, Year 1
		“Healthy campus offers healthy options for students. Whether they want to exercise or grab a lunch to eat which means . . . healthier options, as well as easy access to the gym. . . . I’ve been to other colleges where their gym is like a 15-minute walk from like the main part of Campus. So, I know that I have friends of other colleges that are like: ‘I don’t want to exercise at the gym because that itself is already like so much work.’” ~student focus group, Year 2
	Health and well-being for employees	“The whole idea of health and wellness and practices has been more integrated in the area I work in. I think that from a change in leadership. For example, when we do training, we incorporate health and wellness activities. It’s much more integrated than it was in the past. It has changed because it is supported from the top down. There is incentive and support to make changes.” ~staff focus group, Year 3
		“Building it into the culture. Expectations of staff to have a healthy activity once a quarter where managers and supervisors are expected to contribute to the health and wellness of their staff. It should be built into job expectations that people have time to prioritize their health.” ~staff focus group participant, Year 3
		“When we do training, we’re much more intentional about integrating health and wellness activities in our training. When we’re doing programming, it’s not just the office, [it is] the wellness office that does it, but we’re integrating it in all of our offices. So it’s much more integrated then it had been in the past. ~staff focus group participant, Year 3
Health in policy
	Healthy food access	“I noticed changes in catering options. I see they have [a] changed menu. But the first thing I noticed on campus was that it was tobacco free and that’s really big for me. Personally, for my health issues knowing that I can walk anywhere freely, and I don’t have to worry about others smoke. That was the first thing that interested me and healthy campus.” ~ staff focus group participant, Year 1
		“There is like food options for everyone so it’s not like you’re just eating hamburgers or drinks. They [students] are also eating their veggies, juice or water so they have alternatives to like the classic hamburger soda and fries. There is like steps being made to get there. But it just needs to be worked on to get more variety of food options. Because that’s a big part of our everyday lives just what we eat and how it affects us.” student focus group participant, Year 2
		UCR does like fit my vision of a healthy campus. Again, it does have like all of the resources in terms of like mental wellness and physical wellness. . . . . And just a lot of healthy food resources. ~student focus group participant, Year 3
		“I participated in the dining, Seed for change . . . It talked about the sustainability of food and . . . providing more vegan and more vegetarian options, and helping out our, like our local farmers with food that had like that wasn’t processed as much. So just more natural organic food. The fact that they put an invitation out for everyone just to not only taste, but to learn what the dining hall unit was doing. [It] was just a huge, it was a really good learning experience. We tried out some other new recipes and it just goes to, it really showed a lot of us that the campus is really looking for healthier options for not just students, but for staff, everyone on campus.” ~staff focus group participant, Year 3
	Vending machines	“I worked here [UCR] before for few years and left but came back. And since I have been gone, I noticed that there are much more healthier options. And there is the bookstore downstairs, the vending machines seemed to have changed to offer healthier options. So, I see an effort to help improve wellness in that case.” ~ staff focus group participant, Year 1
	Tobacco-Free Campus	“Another thing that I know they do indirectly about health is talks about tobacco free campuses. We promote nonsmoking and non-vaping. We have a policy . . . I don’t want to say zero tolerance we are a dry campus officially although we do have a permit process with partners that want to have alcoholic events but I know there is a big educational push to raise awareness on alcohol abuse as well as smoking and drug abuse. ~ staff focus group participant, Year 1
		“There is no, like, tobacco products or any marijuana or anything.” ~student focus group participant, Year 2
		“The smoking campaign, or I don’t remember what it’s called, but it’s the anti-smoking on campus.” ~staff focus group participant, Year 3
Environmental interventions
	Stairwell beautification and take the stairs campaign	They improved the stairwell of the building I work in and the lighting, the painting is very clean and there is graphics to motivate you to take the stairs as opposed to taking the elevator. Directions on breathing and but what’s nice is sometimes you may be in a rush and you do have to take the elevator. It happens to be open as you are getting there. And then there is signage inside the elevator. Things you could do to improve your health you know taking a deep breath, relaxing your mind, talking to a colleague, smiling, so just instead of having that idle time. ~staff focus group participant, Year 1
		“Last year I felt like there wasn’t as much as there is this year. . . . When I was coming here. I saw on the elevator there was the healthy campus thing that said: ‘You should take the stairs.’ I think it is a healthy reminder that you usually don’t think about sometimes when you are taking the elevator.” ~student focus group participant, Year 1
		“On the elevator it says: ‘Don’t wait here.’ And then: ‘Take the steps.’ And you have the footsteps going to the stairs. So that [initiative] says to be more active. So, it’s like a good reminder that you know, I can just take the stairs, because it’s probably faster than waiting for the elevator. ~student focus group participant, Year 2
		“I’m taking the stairs rather than the elevator.” ~staff focus group participant, Year 3
	Hydration stations and sugary beverage campaign	“The hydration stations coming up around campus. . . . So, some of those things are pretty passive and can really reach out to a lot of the campus even though they [campus community members] are not doing anything.” ~staff focus group, Year 1
		“I have seen, is that taking out a lot of the sodas in the HUB [Highlander Union Building—student union] like fruit juices or like carbonated drinks like bubbly, those items so that’s good. At least a healthier way to drink, just to incorporate carbonated water. So that’s pretty healthy.” ~student focus group participant, Year 2
		“. . . the increase of the water initiative of putting more hydration stations around campus or kind of encouraging more water intake, whether it’s like spa water, just regular ice. So I think those are also characteristics [of a healthy campus], making sure it’s accessible to everyone.” ~staff focus group, Year 3

Table 3.

Action to Create Cultures of Campus Health.

Concept	Theme	Participant perspectives
Grass top leadership and engagement
	Institutional investment and top-down messaging	“The messaging has to come from the top down. If the message is coming from supervisors and managers that they don’t care about your health and wellness, it is going to affect your work. How things are prioritized sends a strong message about if health and wellness are valued. The top of the organization has to value it for healthy culture to sustain itself.” ~staff focus group
		“[The] recipe for success is: “top down” approach—chancellors, VC [vice chancellors] . . . top-down priority for leadership so they can hold directors accountable.” ~staff focus group
		“If you really want your staff being, moving towards healthy [behavior], and well then it needs to be recognized and supported by the campus. . . . If there is something like you participate in several wellness activities to a certain level you get like a $100 HSA [health savings account] card or something, or its required by your department and its on your evaluation. . . I would participate more if it was expected by my institution and/or rewarded by my institution.” ~staff focus group
		“But if you [institution] just gave every department like a thousand bucks to do something healthy in your department then you will create this kind of nice atmosphere . . .” ~staff focus group
		“Another thing that you could do for people, some kind of letter to have say: ‘You [faculty] need at least one healthy campus service you know to be promoted . . . Not to put more pressure on faculty, but you know like that might make them think: ‘What can I do [for service]?’ You need some service [work], anytime that you go for some kind of promotion. So, one of those service items, no matter how small, could count. Like you know, handing [out] that red folder [mental health resources] to a graduate students . . .” ~faculty focus group
Ground-up leadership and advocacy
	Grassroots leadership—wellness ambassadors	“She [wellness ambassador] was always there promoting all the events and games. And say let’s go for a walk and it was, she was constantly there. Now I don’t have a health ambassador at my office. And you know I am like well no one is pushing me so I don’t have to do it. I will get to it later and eventually I never get to it. But it will be very helpful for, I mean I think about it someone that works with you will be helpful for somebody to be a health ambassador the same time having someone whose job is to be a health ambassador gives them more of a focus.” ~staff focus group
	Grassroots leadership—wellness ambassadors	“And if you had somebody who was responsible for every college so like [college of humanities, arts and social sciences] gets a person, [college of natural and agricultural sciences] gets a person, and that person is responsible for telling everybody in that college what’s going on . . the more personal connection, maybe on the college level, will help.” ~staff focus group
	Healthy classroom practices	“I used to have all my assignments due Friday at 11:59 pm on blackboard. . . and I switched that to a 6 pm due date. In the sense that, we know that students will be working up until that deadline or they start before the deadline . . . if you want them to get sleep, then don’t make the deadline midnight.” ~faculty focus group
		“And then for my students, you know, I used to have assignments due like on a Friday, but then some students, say nontraditional students, they want to work over the weekend. That’s the one time they have. So, I make it [the assignment] due the following Sunday, so they have a week plus three days . . . these are the small things that I can do to shift that culture.” ~faculty focus group
		“I think faculty could address health in their syllabi and during classes to offer resources and check in with their students.” ~staff focus group
		“Professors could—in their iLearns—give information on common resources. All professors need to do this. Since they know their students, they know what they need, and they could upload information for what their students can have access to if they need help.” ~student focus group
	Healthy work habits	“In terms of the culture aspect for your respective departments, I think you could be the change that you want to see in the world. So, don’t be the guy who sends out an email on Friday or Saturday. . . . I don’t send any emails after 5:00 pm. So that’s my attempt to stop that.” ~faculty focus group
		“My advisor is an extremely understanding [person] and I know a lot of people who are not. [Their] approach for example, as grad students, [they] do not check when I come in. . . but [they] expect me to finish a job. And I have other friends who have extreme pressure from their advisors. . . .” ~student focus group
		“Hybrid work plan - working from home a couple times a week, [it] helps with the environment and sustainability, and mental health.” ~staff focus group

Health and Well-Being Programs and Services

In the first year of the study, participants often discussed programs (i.e., individual level services/resources), whereas in Years 2 and 3 participants tended to discuss more so collective campus practices and the integration of health into classroom and business practices. For instance, across all years of the study, there was a strong awareness of student-centered programs, including physical health (student recreation center), mental health (counseling and psychological services), and basic needs (e.g., food pantry)—all services that focused on individual level behavior or services/resources. Similarly for staff and faculty the focus was on the limited services (wellness programs, preventive services) and resources offered to employees. In Years 2 and 3, participants, especially faculty and staff, discussed changes in wellness such as the integration of health into classroom (e.g., healthy deadlines), office (sending emails during business hours), and campus (leaders promoting health) practices.

The focus on programs such as student recreative services, student wellness and mental health care services, and campus-wide health initiatives was linked to campus investment in the services/resources and physical on-campus visibility. Participants were aware of the resources offered by the student wellness department (e.g., running groups) and large-scale staff/faculty wellness activities such as system-wide walks involving campus leadership. They were much less aware of department and campus-level programs for faculty/staff. For instance, a staff member commented: “As far as, faculty and staff goes, I don’t hear very much.” Faculty and staff commented on the lack of access to fitness and recreation services, on-campus preventive care (e.g., flu shots only available for students), and mental health resources.

However, discussion of health and well-being and their existence on campus, as well as awareness and access changed over time. Comments such as “People I talk to take health seriously . . . Healthy Campus is making an impact on staff, faculty, and students” were more present in Year 3 of the study. This change was likely spurred by shifts to campus and system-wide changes in policy, development of a cross-departmental and campus collaborative structure as party of health initiatives, and changes to the built environment (e.g., stairwell beautiful in buildings across campus, implementation of hydration stations).

Policy

Over the 3 years of the study, several policies were either made more visible or implemented by the HCN and UCR Healthy Campus. For instance, since 2014 UC campus policy dictates that all campuses are smoke and tobacco free: “Another thing they [Healthy Campus] do indirectly about health, is, talks about tobacco free campuses. We promote nonsmoking and non-vaping.” UCR Healthy Campus efforts made this policy more visible through signage in strategic locations where smokers were known to gather, as well as annual events held in collaboration with the county public health department to pick up discarded cigarette butts. Participants also discussed healthier options in vending machines and from catering. Such changes were seen as improving individual and campus health. Others discussed the importance of the zero-alcohol tolerance policy and the educational push to raise awareness of alcohol, tobacco, and drug abuse on campus.

Structural Level Interventions

Over the 3 years of the study, the HCN provided funds to change aspects of the built environment of all UC campuses, in particular stairwell beautification and implementation of hydration stations. UCR Healthy Campus also led initiatives to delineate walking, running, and biking paths as well as increase visibility of healthy food options in highly frequented stores. Participants commented on the improvements to the built environment, emphasizing the value of such changes to individual and community health: “They [Healthy Campus] improved the stairwell of the building I work in and the lighting, the painting is very clean and there is graphics to motivate you to take the stairs as opposed to taking the elevator.”

Others mentioned the increase in hydration stations on campus as part of HCN efforts to reduce the consumption of sugary beverages. This illustrates that changes to the built environment collectively benefit the campus community—they extend beyond individual behavior and action to integration of health and well-being as part of daily life and practice. Participants viewed changes to the built environment as evidence of health as a campus value helping move toward a healthy campus community as they “encourage [UCR] communities to be more healthy.” They recommended continued efforts to change the built environment to include more campus spaces for rest, relaxation, and mindfulness activities (e.g., quiet spaces surrounded by natural beauty), shaded walking/running trails for physical activity and stress management, as well as more visible health care services for whole campus preventive health. In addition, staff members advocated for better and more flexible staff mental health services.

Creating Healthy Campus Communities

The findings highlight the importance of grass-top and grassroots leadership and engaged action in creating healthy campus communities, as well as the value of both top-down and ground-up approaches to advance change.

Grass-Top Leadership and Engagement

Participants stressed the importance of campus leadership, those in decision-making positions such as Presidents/Chancellors, Vice Presidents, Provosts, Deans, as well as system-wide leadership in communicating the value of campus health. Participants discussed the importance of openly discussing and modeling health values. For instance, participants discussed campus leadership publicly advocating for increased access for those with disabilities, commenting on senior leaderships participation in walks to recognize “undulating hills to understand what access was like for people.” Such top-level leadership support and commitment formalizes action and sends messages that the campus prioritizes health and well-being across all levels of the organization, recognizing health as a strategic priority across the institution. Staff and faculty participants frequently referred to the importance of UC walks, an annual event across the UC system to promote physical activity: “with the whole campus walks, they’re encouraging staff and students to come out, walk with the chancellor and the provost, and being able to meet people.” High-level leadership engagement in campus activity elevates the profile of health-related events and sends the message that health is valued.

Staff and faculty participants also talked about the importance of department chairs and supervisors in communicating the value of health through ongoing health-related messages and the promotion of resources and services. For instance, staff participants consistently discussed healthier work environments characterized by supervisor accountability, flexible work schedules, work from home options, and mental health breaks.

Creating healthy campus cultures requires top-level leadership support, investment in health resources and infrastructure, and the promotion and encouragement of utilization of programs and services focused on health and well-being.

Ground-Up Leadership and Advocacy

Across the 3 years of the study, participants discussed the role of instructors/professors, wellness ambassadors, and student leaders in creating healthier campus environments. Participants, specifically students and faculty, discussed ways to create healthier classroom environments (e.g., by instating deadlines that promote well-being and selfcare), such as ones that do not encourage late nights and rather promote time management and sleep as well as ones that accommodate diverse student needs (e.g., nontraditional students). Being mindful of diverse student needs and their role in modeling health and well-being in the classroom was also discussed. Comments about health and well-being, as students mentioned, have a lasting impression as they can model healthy behavior: “They [instructors] can just say . . . ‘Take care of yourself’. Something so that students can be like, ‘Okay you know my professor is doing this, let me try eating healthy’.” Instructors/professors can play an instrumental role in changing classroom learning environments by incorporating elements of health into grading, teaching, and scheduling.

Participants also discussed work practices to promote work-life boundaries and respect for others. This included not sending emails outside of business hours (Monday to Friday, 8–5 p.m.), being mindful of others’ competing demands and the expectations on diverse roles in the academy. For instance, graduate students are expected to study and work and must simultaneously prioritize both coursework and research.

Finally, participants discussed grassroots leadership and advocacy for healthy cultures through wellness ambassadors. Faculty and staff participants were aware of existing networks of wellness ambassadors embedded in campus departments/units whose mission is to improve the sense of belonging, community, and well-being.

Discussion

Both ground up and top-down approaches are needed to create a cultural shift toward health as a shared value and movement toward healthier and more equitable campus communities. The findings from this research illustrate the importance of integrating health and well-being practices into educational and work settings, daily operations, and business practices. Our findings reinforce the transformative vision for health-promoting universities and colleges put forth by the Okanagan Charter in that concepts of health and well-being need to be holistic and capture mental and physical well-being, as well as equitable and sustainable for the health of communities, places, and the environment (International Conference on Health Promoting Universities & Colleges, 2015).

Student, staff, and faculty recommendations align with the objectives of Health Promoting University that by definition “promotes healthy and sustainable policies and planning throughout the university” (Suarez-Reyes & Van den Broucke, 2016). This framework also emphasizes personal and social development of campus community members, a broad interest in health promotion, and healthy working and physical environments. Participants in our study similarly discussed more holistic concepts of health and well-being and embedding them into existing learning and working practices and policies (e.g., student orientation, staff recognition, and faculty advancement) in an effort to build cultures of health and healthier and more equitable communities.

Changes to policy is one example of a top-down approach that can be used to initiative culture change. For instance, participants consistently discussed access to healthy food as a key aspect of a healthy campus. Administrators and university leadership can lead efforts to increase access to healthy food options for students, staff, and faculty by setting policy around healthier options in residential halls, retail stores, catering services, and vending options (Rickrode-Fernandez et al., 2021). UC Berkeley was one of the first universities in the nation to enact a campus-wide nutrition policy. The Food and Beverage Choice policy established nutrition standards for retail foodservice and markets, vending machines, athletic concessions, dining halls, and university-sponsored meetings. The policy ensured that in addition to promoting healthier choices through marketing and advertising standards, there were accessible whole, fresh foods and healthier alternatives to sugar-sweetened beverages present in all university food environments.

Another approach is to subsidize healthier options by taxing high sugar drinks (e.g., soda). Researchers at the University of Illinois-Chicago studied the implementation of sugar-sweetened beverage taxes in the city of Seattle, Washington, where the tax was implemented in 2018. They found that the Sweetened Beverage Tax had a sustained impact 2-years post-tax implementation suggesting that sugar-sweetened beverage taxes may yield permanent reductions in demand for sugary beverages and associated health harms (Powell & Leider, 2021; Powell et al., 2021).

As participants indicated, top-down approaches are necessary to better understand the systemic and institutional norms that contribute to stress and poor mental and psychological health such as burnout. Inefficient managers and processes, as well as lack of attention to diversity and inclusion, contribute to high workloads, microaggressions, and burnout. University leadership and administrators can work toward creating healthier campus communities by providing management trainings focused on creating healthy workplace environments that integrate and align with diversity, equity, and inclusion standards to ensure accessibility, inclusivity, and equity to build an organizational culture that improves the employee experience and advances positive health outcomes.

From a ground-up perspective, students, staff, and faculty can begin to take “mental health days” in an effort to prioritize mental health and reduce burnout. Furthermore, ground-up approaches can contribute to creating healthier and more equitable classroom and office cultures. Faculty play an especially critical role in the health and well-being of students and staff as they shape both classroom and office culture through their daily practices. Participants in our study offered ways to create healthy classroom cultures by being mindful of deadlines and considering how some deadlines (e.g., Fridays at midnight) negatively affect sleep patterns, where nonflexible deadlines may have negative impacts on nontraditional students, a student population underrepresented in higher education who may experience competing societal, family, and work demands as well as structural inequities to academic success (Hughes, 1983).

Similarly, faculty discussed setting communication parameters specifically around email to maintain boundaries between work and home life. Deciding not to send emails after 5 p.m. sets a precedent and shapes others’ responses. Sorensen et al. (2018) identified such practices as representative of “best practices” to foster workplace safety, health, and well-being because they promote positive working conditions. They recommend that those in leadership positions (e.g., managers) set policies/practices with parameters around email communication. For instance, managers should not send emails over weekends or expect responses from employees on leave or vacation. This speaks to participants’ recommendations that middle management (e.g., principal investigators and supervisors) need to develop their leadership skills and identify ways to create more flexible and family friendly learning and working environments. Such approaches are critical to accommodate the needs of students, staff, and faculty in higher education in the current COVID-19 pandemic (Vazquez et al., 2022).

Implications of Our Work

This research advances understanding of the ways higher education can integrate health and well-being into institutional practices, accomplished through top-down and ground-up approaches. There has been a strong international and state-wide movement for health-promoting universities and colleges guided by the Okanagan Charter. Its purpose is to guide colleges and universities to be leaders in developing and modeling health-promoting strategies; moving beyond traditional approaches of influencing individual behavior; and moving upstream to systems level and environmental strategies that influence the health and well-being of person, place, and planet (http://ushpcn.org/about/). As our work illustrates, cross-sector collaborations and buy-in from both grass tops (administrators) and grassroots (faculty, staff, and students) is critical to changing politics and everyday practices that incorporate health, which ultimately spur culture change.

Limitations

There are several limitations of study findings. First, there was significant participant attrition especially among students and faculty across the 3 years of the study. For students, this is likely due to graduation; for faculty and staff it may be departure from the university setting. Despite attrition, there was sufficient participation from each stakeholder group (faculty, staff, students) to obtain data saturation across the study period. Second, the overrepresentation of female-identified participants compared to male-identified participants may result in gender response bias and more so reflect the positions they hold within the institutions (e.g., administrative assistants, financial analysts). Third, culture change takes time. A period of 3 years is not sufficient to see a substantial cultural change, which can be undermined when leadership/turnover results in losing trustful grass-tops and grassroots leaders and champions, which was the case at our university. Finally, Year 3 of our study occurred in the context of COVID-19, which shaped conversations of hybrid models of remote and in-person work and learning cultures. We noticed a stronger emphasis on holistic health and emotional well-being, including mental, social, and physical health, and the need for campus leadership to prioritize campus health in the pandemic and postpandemic period.

Conclusion

Health-promoting institutions can infuse health into everyday operations, business practices, and academic mandates (Suarez-Reyes & Van den Broucke, 2016). University administrators and leadership need to communicate the value of health via ongoing health messages as well as promote health-related resources, policies, and practices. By doing so, institutions can create campus cultures of care, compassion, well-being, equity and social justice, enhancing the potential success of all members of its community while also strengthening the social and economic sustainability of our surrounding communities and society more generally (International Conference on Health Promoting Universities & Colleges, 2015). The COVID-19 pandemic has necessitated new models of learning and working (e.g., hybrid teaching and tele-commuting), creating classroom and workplace flexibility (Vázquez et al., 2022). In this context, higher education must consider how remote learning/working and social distancing impacts social connection, psychological well-being, and healthy habits. Institutions of higher education, especially public research universities, generate and disseminate new knowledge through scholarship and scientific discovery, making them ideal settings to promote health, well-being, and shared values of health among learners and workers, which can influence the health of families, communities, and society more generally (WHO: https://www.who.int/).

Footnotes

Acknowledgements

The authors thank Jo Gerrard at the University of California, Riverside School of Medicine, for her editorial support, as well as all Healthy Campus team members, advisory board members, subcommittee co-leads and student assistants, and healthy campus champions.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was, in part, funded by the University of California Office of the President system-wide funding for the development and implementation of healthy campus infrastructures.

ORCID iD

Ann Marie Cheney

References

American Time Use Survey . (n.d.). Bureau of labor statistics. https://www.bls.gov/tus/charts/

Averill

J. B.

(2002). Matrix analysis as a complementary analytic strategy in qualitative inquiry. Qualitative Health Research, 12(6), 855–866. https://doi.org/10.1177/104973230201200611

Black

(2019). Designing healthy and supportive campus communities: An example from Simon Fraser University. In Cassidy

Faucher

Jackson

(Eds.), Cyberbullying at university in international contexts (pp. xvii, 228 pages). Routledge; Taylor & Francis.

Cheney

A. M.

Chobdee

McCulloh

Vázquez

Jara

Deas

(2020). Engaging stakeholders in the healthy campus movement. Progress in Community Health Partnerships: Research, Education, and Action, 14(3), 299–306. https://doi.org/10.1353/cpr.2020.0035

Di Sebastiano

K. M.

Kozicky

Baker

Dolf

Faulkner

. (2021). The University of British Columbia healthy beverage initiative: Changing the beverage landscape on a large post-secondary campus. Public Health Nutrition, 24(1), 125–135. https://doi.org/PiiS136898002000331610.1017/S1368980020003316

Goetzel

R. Z.

Henke

R. M.

Tabrizi

Pelletier

K. R.

Loeppke

Ballard

D. W.

Grossmeier

Anderson

D. R.

Yach

Kelly

R. K.

McCalister

Serxner

Selecky

Shallenberger

L. G.

Fries

J. F.

Baase

Isaac

Crighton

K. A.

Wald

Exum

Shurney

Metz

R. D.

(2014). Do workplace health promotion (wellness) programs work? Journal of Occupational and Environmental Medicine, 56(9), 927–934. https://doi.org/10.1097/JOM.0000000000000276

Goetzel

R. Z.

Ozminkowski

R. J.

(2008). The health and cost benefits of work site health-promotion programs. Annual Review of Public Health, 29, 303–323. https://doi.org/10.1146/annurev.publhealth.29.020907.090930

Guest

Namey

McKenna

(2017). How many focus groups are enough? Building an evidence base for nonprobability sample sizes. Field Methods, 29(1), 3–22. https://doi.org/10.1177/1525822x16639015

Hamilton

(2013, December). Rapid qualitative methods in health services research: Spotlight on women’s health national cyberseminar series: Spotlight on women’s health. https://www.hsrd.research.va.gov/for_researchers/cyber_seminars/archives/780-notes.pdf

10.

Health Enhancement Research Organization. (2016). Defining a culture of health: Key elements that influence employee health and well-being. https://hero-health.org/wp-content/uploads/2017/11/CoH-Definition-and-Elements_REVISED-FINAL_-9-5-17.pdf

11.

Hill-Mey

P. E.

Kumpfer

K. L.

Merrill

R. M.

Reel

Hyatt-Neville

Richardson

G. E.

(2015). Worksite health promotion programs in college settings. Journal of Education and Health Promotion, 4, 12. https://doi.org/10.4103/2277-9531.154019

12.

Hughes

(1983). The non-traditional student in higher education: A synthesis of the literature. NASPA Journal, 20(3), 51–64. https://doi.org/10.1080/00220973.1983.11071851

13.

International Conference on Health Promoting Universities & Colleges. (2015). Okanagan Charter: An international charter for health promoting universities & colleges. https://open.library.ubc.ca/cIRcle/collections/53926/items/1.0132754

14.

Kania

Kramer

(2011). Essentials of social innovation: Collective impact. Stanford Social Innovation Review: Informing and Inspiring Leaders of Social Change. https://ssir.org/articles/category/essentials_social_innovation

15.

Linnan

Brooks

Haws

Benedict

Birken

French

Gizlice

Britt

(2010). Community colleges as settings for promoting employee health. American Journal of Health Studies, 25(2), 86–91.

16.

Patel

A. I.

Schmidt

L. A.

(2021). Healthy beverage initiatives in higher education: An untapped strategy for health promotion. Public Health Nutrition, 24(1), 136–138. https://doi.org/10.1017/S1368980020003766

17.

Powell

L. M.

Leider

(2021). Impact of a sugar-sweetened beverage tax two-year post-tax implementation in Seattle, Washington, United States. Journal of Public Health Policy, 42(4), 574–588. https://doi.org/10.1057/s41271-021-00308-8

18.

Powell

L. M.

Leider

Oddo

V. M.

(2021). Evaluation of changes in grams of sugar sold after the implementation of the Seattle sweetened beverage tax. JAMA Network Open, 4(11), e2132271. https://doi.org/10.1001/jamanetworkopen.2021.32271

19.

Rickrode-Fernandez

Kao

Lesser

M. N. R.

Guess

(2021). Implementation of a healthy food and beverage policy at a public university. Journal of Nutrition Education and Behavior, 53(10), 891–899. https://doi.org/10.1016/j.jneb.2021.06.009

20.

Seifer

(2018). Higher education as catalysts: Building a culture of health on campus and in communities. https://www.rwjf.org/content/dam/farm/reports/reports/2018/rwjf447427

21.

Slusser

W. M.

Malan

Watson

Goldstein

M. S.

(2018, March 12). Collective impact for health and wellbeing. Standford Social Innovation Review: Informing and Inspiring Leaders of Social Change. https://ssir.org/articles/entry/collective_impact_for_health_and_wellbeing

22.

Sorensen

Sparer

Williams

J. A. R.

Gundersen

Boden

L. I.

Dennerlein

J. T.

Hashimoto

Katz

J. N.

McLellan

D. L.

Okechukwu

C. A.

Pronk

N. P.

Revette

Wagner

G. R.

(2018). Measuring best practices for workplace safety, health, and well-being: The workplace integrated safety and health assessment. Journal of Occupational and Environmental Medicine, 60(5), 430–439. https://doi.org/10.1097/JOM.0000000000001286

23.

Suarez-Reyes

Van den Broucke

(2016). Implementing the Health Promoting University approach in culturally different contexts: A systematic review. Global Health Promotion, 23, 46–56. https://doi.org/10.1177/1757975915623933

24.

Travia

R. M.

Larcus

J. G.

Andes

Gomes

P. G.

(2020). Framing well-being in a college campus setting. Journal of American College Health, 70, 758–772. https://doi.org/10.1080/07448481.2020.1763369

25.

Vázquez

Chobdee

Nasrollahzadeh

Cheney

(2022). Personal freedom and social responsability in slowing the spread of COVID-19: A rapid qualitative study. Health Education & Behavior: The Official Publication of the Society for Public Health Education, 49(1), 26–34. https://doi.org/10.1177/10901981211033241