AN EVALUATION OF A STUDY ABROAD PROGRAM
THAT OFFERS CULTURAL AND INTERNATIONAL
IMMERSION HEALTH CARE
Penelope Caldwell
University of Wyoming, USA
February 2013
This paper fills a gap in the literature by
addresing the question: Do short-term
study abroad learning services provide
students with learning opportunities for
long-term transformation?
The Program’s Significance

The underlining intention for developing this program was to increase
students’ awareness of health inequities from a global perspective and
increase student global competencies (ASPH, 2011) while delivering
health care and health education to a village whose access to health care is
minimal at best.
Program significance continued..


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Students who participate may enroll in a three-credit course and receive
clinical practicum hours.
The program offers a ten-day hands-on clinical and educational
experience to students within the across campus.
Interdisciplinary and inter-professional teams have taken more than 160
UW students and included 11 faculty on 12 brigades since 2007.
On average the teams provide health care and education to over 500
people on each brigade. All together adding up to more than 6000
encounters in five years.
Theoretical framework
This paper uses transformative learning as a theoretical framework developed
by Jack Mezirow (2000) and further developed by Patricia Cranton (2006).
Mezirow (2000) defines transformational learning as,
The process by which we transform our taken-for-granted
frames of reference (meaning perspectives, habits of mind,
mind-sets) to make more inclusive, discriminating, open,
emotionally capable of change, and reflective so that they may
generate beliefs and opinions that will prove more true or justified to
guide action. (p. 8)
Cranton (2006) elaborates on Mezirow’s theory by describing the process of
transformational learning as:
a) awakening or sensitizing students to issues of social justice and
impressing upon them their role in making a difference; b)
engaging students with innovative, action-based, powerful
learning modes that develop critical, creative, and constructive
skills; and c) reflection to make meaning of the learning
experience and to revise and replace unhelpful habits of mind.
Literature Review
A review of the literature revealed two approaches that increase the quality
of learning outcomes from study abroad programs.
One approach is to prepare students ahead of time by providing them with
concepts of global health care and inequalities prior to immersion The
literature encourages institutions to offer courses to help prepare students
before immersions. Reflection is cited frequently as the most common
teaching modality. (Abrams & Maltby, 2009; Carpenter & Garcia, 2012;
Edmonds, 2012; Evanson & Zust, 2006; Levine, 2009; Kirkham, et al.,
2009; Larson & Reif, 2010; Levi, 2009; Levine, 2009; McAllister, 2005).
The other approach speaks to the importance of creating partnerships and
long-term commitments with the host community, explicitly avoiding
invading a vulnerable community and causing more harm than good (Bond,
et al., 2012; Flint, et al., 2010; Leffers, et al., 2010; Levi, 2009; Fitzgerald &
Wasunna, 2005).
Project Design
The methodologies this evaluation study uses are
descriptive and qualitative interviewing and written
statements with participants who have previously
participated on one or more of the immersion trips at
least a year or more prior to the interview.
 This evaluation reports on results from eight student
responses, which strongly suggest emerging themes
are congruent with criteria (Mezirow, 2000; Cranton,
2006) for long-term transformational learning.

Sample and interview tool
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The inclusion criteria for choosing participants is that they must
have participated on at least one trip to Honduras, and that their
trip took place at least one year prior to the interview.
The recruitment question is, “May I interview you about your
immersion experience in Honduras?”
Limitations in this program evaluation are, this author knows
most of the students being interviewed. The interviewer will
address this limitation by having each participant review the
reported response to assure it is consistent with the interviewee’s
perceptions (member check) immediately after each interview;
A second limitation is the small sample. Further interviews are
planned and the evaluation process will continue until saturation
is apparent.
TRANSFORMATIONAL CHANGE DISCUSSION:
Awakening students to issues of social justice and
making a difference. (first criteria)

‘Alex’, an engineering student, who went to Honduras to
assess the water conditions in the village, wrote, “My
experience in Honduras brought me to pursue a different
direction ... it made me start asking myself how I could make
a difference ... (the trip) presented me with the task of figuring
out what it was that I was good at and how I could better
apply it in a way that it would do the most good to as many as
I could around me. After much profound thought, I decided
that I wanted to, rather than be an engineer, dedicate myself to
helping those Hispanic people that have a difficult time
because of a lack of education, resources, or sometimes a lack
of legal documents. I decided that the way to best do this
would be with a law degree.”
Responses that pointed to developing
critical, creative, and constructive skills
(second criteria).
‘Bea’ was a nursing student at the time of her trip. Bea develops an holistic perspective
from her immersion experience. She writes: “My experience in Honduras … helped shape
me to be the nurse I am today. It taught me to take care of my patients as a whole, keeping
in mind their physical, emotional, spiritual and cultural needs. Everyone is unique they
may have the same diagnosis but they don’t have the same needs. It is my passion to take
care of my patients as a whole and treat them all as individuals. It took this trip for me to
realice the impact and importance of this.”
 ‘Cathy’ is a medical student who became acutely aware of the lack of access to health care
while in Honduras. Cathy writes: “I have been struck by the suffering of people without
access to care. In Honduras, I met a woman who ground up acetaminophen to press into a
large, gaping wound in her ankle, her home remedy searing her open flesh. I hope to one
day provide a community with access to regular medical attention, not only curing
sickness but also promoting good health.”
 ‘Deena’ was a nursing student at the time of her immersion in Honduras. She also had an
appreciation for access to preventitive care, she writes: “Being in Honduras opened my
eyes, made me truely appreciate the importance of preventitive care. It also raised my
awareness of access issues to healthcare not only globally but locally. I'm excited to work
with people who struggle to get quality preventitive healthcare.”

Students reflected on the ‘meaning’ of their
experience in Honduras and showed signs of
revising habits of mind (third criteria).
‘Heather’, a
family nurse practitioner student, wrote: “I learned that despite
the cultural differences, people are people, and despite the lack of ability to
communicate verbally you are still able to see that their ultimate goal is to
care for their families. Daily I work with patients who have very little English
speaking skills. I think my service trip helped me learn to have patience to
figure out a way to communicate with these patients. What it boils down to is
they are just like me, or just like the people that we served in Honduras, they
are looking for a better way of life or a way to better care for a loved one.”
Felicia’, a nursing student during her immersion writes, “I learned that being
a good nurse is so much more than having good technical skills, it requires a
passion and a love for people.”
Students reflected on the ‘meaning’ of their
experience continued….(third criteria).
‘Gina’, now a nurse practitioner, writes: “The way I perceive the world and
myself within it has changed. I was humbled when I came to the stark
realization that I needed the people of Agua Salada much more than they
needed me.”
‘Edith’, a nursing student, was inspired by working within an
interdisciplinary team. She writes: “I was transformed by the holistic nursing
that was practiced and inspired by the cultural reverence within our team of
students, nurses, and doctors. The experience I had in Honduras through the
University of Wyoming was more beneficial to my education and career than
any time spent within the walls of a classroom. It was truly life changing.”

Conclusion
In
conclusion, though the sample is small, this initial response from eight
participants strongly reflects Mezirow (2000) and Cranton’s (2006)
transformational learning critieria. These eight students found new ways to see
the world they live in and new ways to act within their scopes of practice. They
became deeply self-reflective, leading to new discoveries about who they are and
how they can make a difference in their communities. One participant, Alex, saw
his new role in the larger global picture and made significant change in order to
‘make a difference’ globally.
This program’s approach, which aligns with literature recommendations, which
are preparing students prior to emerging, and creating mutual trust with host
communities, may prove to be crucial elements that laythe foundation for longterm transformational learning.
This evaluation will continue interviewing participants of the program until
saturation is clearly evident. The results will help show whether this small
sample of eight responses is only a cluster, or if this sample represent the
program’s ability to successfully achieve long-term transformational learning by
offering short-term study abroad learnign services.
Thank-you
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