Developing Online Modules for a “Health and Wellness” Course: Adapting Active Learning Strategies to the Online Environment

Abstract

Active learning refers to activities that engage students in the learning process. To make the learning process more active, instructors should add opportunities for reflection. However, reflection is not limited to the classroom environment. Instruction is shifting toward incorporating opportunities for active learning through online platforms. We developed four online health topic modules—sexual health, nutrition, environmental health, and alcohol awareness—and evaluated 1,090 student responses to course content. Students provided feedback on the activities that aided in learning course content. Thematic analysis was conducted to systematically review the data and elicit meaning. Using an inductive approach to students’ feedback, we synthesized the excerpts, quotations, and entire passages from students’ open-ended responses. Three major themes constructed from the data were (a) mode of delivery of the course content, (b) applicability of the content to students’ lives and the community, and (c) structure of the modules. The design and implementation resulted in six lessons for educators: students were engaged when the content was applicable to their personal life, students valued learning about how public health affects their community, course content must provide opportunities for critical thinking and self-reflection, students valued the hybrid nature of the course, student feedback of the online modules promoted self-reflection, and students and instructors appreciated the worksheet that guided the online class.

Keywords

health and wellness qualitative research active learning online course development

In traditional learning environments, students learn from paying attention to the instructor and reading textbooks and other materials. Today, higher education is in a revolution of knowledge. With technology advancing at a fast pace and a large array of health information available on the Internet, educators must adapt to the changing environment and be creative in their approaches to student learning. Research in pedagogy indicates that students learn more and retain information longer if knowledge is acquired actively (Fink, 2003, 2013). Active learning refers to instructional methods that engage the students in the learning process; it can happen in the classroom and through online activities. To increase active learning, educators must add opportunities for reflection and application (Barkley, 2009; Fink, 2003).

Active learning creates a learner-centered environment, influencing students to move beyond taking notes and memorizing course content. This environment strengthens the process of understanding the content, and most important, aids in developing critical thinking skills. The goal is to engage students in solving problems, discussing possible controversial aspects of the topics, making applications beyond the classroom, interacting with the content to create their own knowledge, and creating a self-paced learning environment (Lumpkin, Achen, & Dodd, 2015). In other words, higher education should evoke a paradigm shift that gives responsibility to students for their own knowledge creation. For instance, Grebennikov and Shah (2013) found that guided reading questions, the use of personal response systems, process-oriented guided learning, and inquiry learning activities facilitated active learning and transformed the classroom experience to a learner-centered environment. Traditionally, educators have used active learning strategies in face-to-face teaching. However, higher education is shifting toward active learning strategies applied online.

This study addresses the need to provide instructors with strategies to improve student engagement with online resources and ways to present course information through multiple media sources (Young & Hoerig, 2013). The objective of this study is to describe the construction and evaluation of four online health topic modules for students in an undergraduate health promotion course, “Health and Wellness.” This study contains three sections. The first section describes the transformation of the four modules from in-person to hybrid, using a flipped classroom model. Thus, each module had an online component to increase knowledge and an in-class component to discuss the topic in further detail. The second section describes the students’ evaluation of the online modules. The purpose of this evaluation was to identify which aspects of the modules were most useful in the learning process from the students’ perspectives. The last section details the lessons learned in this process.

Course Development: From In-Person to Hybrid

The Department of Health Promotion at a large Southeastern university offers an introductory health promotion course, “Health and Wellness,” for undergraduate students. For decades, instructors have taught this course as face-to-face only. The course covers the most relevant topics related to individual and population health, including personal behavioral choices and social determinants of health. This section describes the process of creating the online content for four health-related topics: sexual health, nutrition, environmental health, and alcohol awareness. Two instructors with experience teaching the course developed the first draft of the online modules. A team of instructors revised and created the final draft. After implementing the modules, students from multiple sections of this course provided feedback.

Using Fink’s Guide to Designing Courses for Significant Learning (Fink, 2003), the research team identified the situational factors, learning goals, feedback and assessment methods, and teaching/learning activities for the online modules. Table 1 provides a sample of goals and learning activities for each module.

Table 1.

Examples of Learning Goals and Learning Activities for Each Health Topic Module.

Online modules	Examples of learning goals	Examples of learning activities
Sexual Health	Identify key anatomical structures in the male and female reproductive system	Label structures on male and female reproductive organs.
	Compare and contrast various contraceptive methods	Navigate bedsider.org and view contraceptive methods. Choose two methods and conduct side-by-side comparisons.
Nutrition	Explain patterns of healthy food consumption	Read article “Knowing What to Eat, Refusing to Swallow It” by David Katz and answer questions.
	Describe strategies to combat food insecurity	What are ways we can combat food insecurity? List and describe two food assistance programs provided by the government.
Environmental Health	Describe the characteristics of the natural and the built environmentIdentify and value the university’s sustainability initiativesSummarize three strategies to influence environmental change	Navigate the Prevention Institute website, select one of the built environment project profiles and answer questions.
Environmental Health		Watch videos on recycling, water, energy, and local foods narrated by the Director of the Office of Sustainability and answer questions.
Alcohol	Define a standard drink of alcoholDescribe drinking trends among college students in the United States	Rank drinks in order of (1) most alcohol to (3) least alcohol. Reflect on responses.
Alcohol		Read a New York Times article on drinking among college students in the United States and reflect on drinking norms on your campus.

Situational factors refer to special instructional challenges and expectations by students and department administrators. The department offers five sections of this course each semester; each has between 20 and 80 students. A particular challenge is that students come to this course with diverse levels of interest, because the course is required for health promotion majors and is an elective for many disciplines across campus. An ultimate goal of the course is that students increase their knowledge about health, but most important increase the value that they give to health and improve their health-related behaviors. Another challenge—shared by many educators—is that health decisions are not guided solely by knowledge but also by cultural traditions, attitudes, self-efficacy, outcome expectations, support from family and friends, and social determinants (Bandura, 2004). Thus, blended or hybrid modules were chosen because students could learn content and reflect on the topics during the online portion of each module, while devoting class time for in-depth discussion.

To develop the learning goals for each module, we emphasized the information that students could and should use beyond the course, as well as topics that would pique their overall interest in health. According to Fink (2003), to promote significant student learning, educators must integrate foundational knowledge, components of caring, application, and human dimensions. The team of researchers identified learning goals that could potentially heighten emotions about health-related behaviors and help students reflect about the impact of those behaviors and the impact of the environment on themselves and others.

Feedback and assessment refers to two different components. First, it is an outcome evaluation—what students must do to show they achieved the learning goals. In addition to low-stake quizzes and exams, each module had a worksheet that students completed and uploaded to the university’s electronic course management system. The worksheet included diverse questions in which students applied their knowledge and reflected on what they learned. Responses to the worksheet allowed the instructors to verify that the student completed the module and identify areas that the instructor should reinforce or discuss in class. Second, it is a process evaluation—the evaluation of students’ satisfaction with the online modules. As the course was shifting toward a learner-centered approach, the last section of the worksheet asked questions to identify the activities that aided in the students’ learning process from their perspective.

The learning activities for each online module encompassed actively seeking information and providing opportunities for reflection (Fink, 2003). Using the course textbook (White, 2015) as the baseline resource, the research team created activities designed for students to actively seek course information. The learning activities focused primarily on accessing online resources that coincided with information presented in the textbook. Each activity was designed to address at least one of the stated learning objectives of the module. Activities in each module involved students in doing things and thinking about their own behaviors. Students sought information by navigating websites, watching short video clips, and reading articles. They identified opportunities to promote their own health, as well as factors that facilitate or challenge promoting health among others and on campus. Students engaged in in-depth reflective dialogue by writing responses to videos and articles discussing what they learned.

Evaluation of Online Modules

At the end of each module, students answered a few questions related to their interest and satisfaction with the online module. Students answered to the following question: “What aspects of the module were most useful in the learning process?” Responses were collected from 1,090 undergraduate students across the four modules: sexual health (429), nutrition (275), environmental health (174), and alcohol (212).

The research team used thematic analysis to systematically review and evaluate student responses. Thematic analysis is a method of qualitative research that allows researchers to identify, analyze, and report patterns within the data (Braun & Clarke, 2006). Data were synthesized from the students’ feedback using excerpts, quotations, or entire passages uploaded into the software MAXQDA, Version 12. A three-step process was used to skim, read, and interpret the data. Two researchers analyzed the data separately and then as a team. Researchers used an inductive approach to determine the codes and themes represented in the data. Individually, they skimmed, read, and organized student feedback into categories related to the research question. Because each module contained different activities, they coded each activity based on the frequency of appearance in the feedback provided by students. Together, the research team adjusted and created categories to reflect similarities and differences in the data. Last, the research team identified patterns from the categories to construct overarching themes. Depending on the written feedback, responses could have contained more than one code.

Results

The research team generated three themes from 903 coded segments: (a) delivery methods, (b) applicability, and (c) structure of module. Table 2 presents the themes, codes, frequency of each code, and examples of student comments. The frequency portion of the table identifies the counted segments of data, which included phrases and sentences.

Table 2.

Themes, Codes, and Examples.

Theme	Code	Frequency	Examples
Delivery methods	Videos	255	“I really liked the videos from the Director of Sustainability! I thought they were very interesting and easy to follow and they helped me learn a lot about the topic.”
			“I really liked the video with John Oliver. I thought he presented the topic of sexual education in an amusing manner while also addressing that it is not taught the same throughout the country nor is it taught correctly.”
Delivery methods	Websites	239	“The information about contraceptive methods. It was nice to have elaborate detail about what’s available and the effectiveness of each.”
			“The interactive websites were brief and concise in presenting the information. I was able to retain more information due to the way it was presented.”
Delivery methods	Textbook	171	“The textbook explained subjects very clearly.”
			“I felt that reading and then rewriting what I read was helpful for my knowledge. I was able to fully write down what I was reading rather than only writing down incomplete sentences like I do when I am quickly writing notes in class.”
Delivery methods	Visual image(s)	42	“I found learning the different parts of the female/male anatomy useful with the visual diagrams.”
			“I think the visual aspects were the most helpful for me. I like seeing things, instead of just talking about them.”
Delivery methods	Articles	42	“I also liked how we were reading from different articles and not just the book. It mixed it up a bit instead of it getting boring.”
			“The Huff Post article was also very enjoyable for that is a topic I really enjoy reading about.”
Applicability	Personal	39	“I think reading all the different information and putting that into real life and knowing what I can do to make the world a healthier place.”
Applicability	Community	34	“I really liked that aspects that related to the university, so you could really see how what we’re learning matters even on our own campus.”
			“I thought learning about the various ways the university is active in keeping its community thriving were the most informative because they directly impact my life as a student.”
Structure of module	Format	81	“Having to answer questions required me to not only read the text, but reread it several times as I’m developing and writing my answers, which I found helpful in really learning the information.”
			“The different types of media used was effective (videos, book material, and websites) this helped me to ‘dig’ for the answer and solidified the information in my brain in an effective way.”
			“Having an outline of questions to answer as I did the reading was really helpful in learning the materials.”

Delivery methods referred to comments associated with the types of media used to examine the topics. This theme includes the following codes: videos, interactive websites, visual images, articles, and textbook (White, 2015). For example, in one of the interactive websites, students calculated their carbon footprint. Students answered a number of questions related to their use of transportation, waste, and home energy expenditure. Then, students compared their footprint with national averages of CO₂ emitted per household.

Applicability referred to comments that the online content aided in the learning process because students were able to apply it to their lives, the lives of others, or their community. This theme included two codes: community and personal. We differentiated between student comments that related to changes in their personal habits and ways to interact with their community. Students reported that they enjoyed activities that were applicable to their own life because it put into perspective how the health topics discussed affected them personally. When students were able to connect with the material, they became more interested in learning about the topic.

Structure of the module encompassed comments related to the format of the online module, including the questions used to evaluate a particular topic. This theme had one major code: format. For example, students mentioned the worksheet as a tool that guided them through the module content.

The large majority of the coded segments were classified under the theme Delivery Methods (83%), followed by Applicability (8%) and Structure of the Module (8%). Although these themes were classified separately, a strong overlap existed between delivery methods and applicability. For example, students enjoyed watching the videos and navigating the websites the most. However, those activities also represented a sense of personal and community affiliation that contributed to students learning the module content.

Lessons Learned

The process of developing and evaluating the online modules resulted in six lessons for educators who would like to add online content into their courses. The first four are related to the design of the modules and the last two are about both design and evaluation.

Students Were Engaged When the Content Was Applicable to Their Personal Life

Student responses highlighted the value of having online activities that used real-life examples related to their lives. When students could apply scenarios to their personal lives or develop strategies they could implement in their daily routines, they indicated that those activities helped with the learning of course content. Other researchers have highlighted the value of making assignments applicable to students’ lives and the importance of self-reflection (Holley & Taylor, 2009; Meyers, 2008; Mincey, 2015; Pinahs-Schultz & Beck, 2016).

Students Valued Learning About How Public Health Affects Their Community

Although students may not have actively participated in gardening on campus, based on their responses, they felt a sense of community by learning about the sustainability efforts occurring on campus and ways they could get involved in the local community. Findings highlight that active learning activities should be purposeful and evoke meaning for students.

Active learning as a pedagogical practice helped students generate a sense of community and social integration. In their review of literature, Bonwell and Eison (1991) also reported similar findings regarding college course feedback from students. They proposed that students felt a sense of community within the classroom when instructors used active learning strategies. Students from this project reported a similar sense of community, although it was based on larger ecosystems of community and society. Students mentioned that they retained course content because they could apply the information to themselves or others in their community.

Course Content Must Provide Opportunities for Critical Thinking and Self-Reflection

Students emphasized the importance of making online content more than just reading and comprehension. Beyond receiving information, students applied information and integrating opportunities for self-reflection, which are key components of the active learning process (Fink, 2003). Students connected class content to previous experiences. In doing so, they expanded their prior knowledge of content and related key public health topics to the communities and populations they will one day serve as health professionals. The online modules created opportunities for students to envision themselves as influencers of health and wellness from personal, community, and societal perspectives.

Students Valued the Hybrid Nature of the Course

Blended classes combine the best of the technological world and the value of the instructor–student interaction. Technology is particularly useful for increasing knowledge of the content, but the in-person interaction can help challenge values, examine conflicting ideas, and think about problems from different perspectives (Bowen, 2012). Simpson and Richards (2015) found that a blended classroom resulted in improved understanding of the relevance of population health and better course evaluations. Similarly, Luna and Winters (2017) found that students in blended classes improved their pre-to-post grades significantly more than students in lecture classes; this result was particularly strong among students of color. Blended classes have an additional value for the educators. In a study of undergraduate education, instructors who taught online or hybrid courses reported less stress than those teaching solely in-person classes (Cameron et al., 2016).

Student Feedback of the Online Modules Promoted Self-Reflection

Student feedback is an integral component of a learner-centered approach to teaching. Grebennikov and Shah (2013) emphasized that student feedback is traditionally quantitative, with less emphasis on qualitative feedback. Our study highlights the value of receiving qualitative feedback from students. This information was useful for both students and instructors. Asking open-ended questions gave students the freedom to express their opinions in a nonconstricting way. Student feedback also allowed instructors to reflect on course content, examine their role in facilitating the learning process, and make feasible adjustments to course content.

Students and Instructors Appreciated the Worksheet That Guided the Online Class

The worksheet that students completed as they followed the online class had several advantages. First, it guided students on which elements of the book, readings, or videos were most important. Thus, students were not stressed about the learning process. Second, questions in the worksheet prompted application to their lives, which facilitated learning. Third, after completing the worksheet, students uploaded it to the electronic course management system. Thus, instructors were certain that students completed the online class. Finally, the questions at the end of the worksheet were about the learning process; this information is valuable for improving the online class in subsequent semesters. Most important, instructors could identify areas that they needed to clarify or reinforce during the in-person class. To reduce the instructors’ workload, they did not grade the worksheet but gave students extra points toward the exam.

Footnotes

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: University of Georgia, Center for Teaching and Learning.

References

Bandura

(2004). Health promotion by social cognitive means. Health Education & Behavior, 31, 143-164. doi:10.1177/1090198104263660

Barkley

E. F.

(2009). Student engagement techniques: A handbook for college faculty. San Francisco, CA: Wiley.

Bonwell

C. C.

Eison

J. A.

(1991). Active learning: Creating excitement in the classroom. Washington, DC: School of Education and Human Development, George Washington University.

Bowen

J. A.

(2012). Teaching naked: How moving technology out of your college classroom will improve student learning. San Francisco, CA: Jossey-Bass.

Braun

Clarke

(2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77-101. doi:10.1191/1478088706qp063oa

Cameron

G. D.

Wagenfeld

Danawi

Gordon

Heick

Crommett

(2016). Occupational stress and health outcomes comparison of faculty teaching in online, on-ground, and mixed working environments. Pedagogy in Health Promotion, 2, 108-116. doi:10.1177/2373379916640549

Fink

L. D.

(2003). A self-directed guide to designing courses for significant learning. Retrieved from https://www.deefinkandassociates.com/GuidetoCourseDesignAug05

Fink

L. D.

(2013). Creating significant learning experiences: An integrated approach to designing college courses. San Francisco, CA: Jossey-Bass.

Grebennikov

Shah

(2013). Student voice: Using qualitative feedback from students to enhance their university experience. Teaching in Higher Education, 18, 606-618. doi:10.1080/13562517.2013.774353

10.

Holley

K. A.

Taylor

B. J.

(2009). Undergraduate student socialization and learning in an online professional curriculum. Innovative Higher Education, 33, 257-269. doi:10.1007/s10755-008-9083-y

11.

Lumpkin

Achen

R. M.

Dodd

R. K.

(2015). Student perceptions of active learning. College Student Journal, 49(1), 121-133.

12.

Luna

Y. M.

Winters

S. A.

(2017). “Why did you blend my learning?” A comparison of student success in lecture and blended learning introduction to sociology courses. Teaching Sociology, 45, 116-130. doi:10.1177/2373379915606454

13.

Meyers

S. A.

(2008). Using transformative pedagogy when teaching online. College Teaching, 56, 219-224.

14.

Mincey

K. D.

(2015). Development of an online course in public health for undergraduates. Pedagogy in Health Promotion, 1, 47-52. doi:10.1177/2373379914559219

15.

Pinahs-Schultz

Beck

(2016). Development and assessment of signature assignments to increase student engagement in undergraduate public health. Pedagogy in Health Promotion, 2, 206-213. doi:10.1177/2373379915606454

16.

Simpson

Richards

(2015). Flipping the classroom to teach population health: Increasing the relevance. Nurse Education in Practice, 15, 162-167. doi:10.1016/j.nepr.2014.12.001

17.

White

L. B.

(2015). Health Now: An integrative approach to personal health (Version 2.0). Washington, DC: Flat World Knowledge.

18.

Young

Hoerig

(2013). Utilizing student feedback to inform faculty development activities for online course development and delivery. International Journal on E-Learning, 12, 439-453.