Community Engagement: Whatʼs the Difference Between Service Learning, Community Service, and Community-Based Research?

Over the past 20 years there has been a push in higher education to develop and implement more community outreach programs. Several forces have precipitated this movement. First, Ernest Boyer1,2 noted in several of his ground-breaking publications a pervasive criticism from the public about higher educational institutions detachment from communities at a time when they are needed to help develop solutions for social, civic, and economic problems. Second, there has been a growing concern again from the public regarding the professorates' narrowing the description of research to the science of discovery in pursuit of new knowledge that is not typically directed towards public good.2 The third influencing factor was the recognition that higher education, in spite of its best effort, was failing to prepare students to be engaged citizens and assume their social responsibility roles in society.3 Trends towards increased community participation by physical therapists are seen both in the educational preparation of physical therapists and physical therapist assistants and in the recently developed APTA document Professionalism in Physical Therapy: Core Values4 for practicing clinicians. Graduates of accredited physical therapist education programs are expected to be able to “advocate for the health and wellness of society, show leadership in community organizations and volunteer service”5(p32) and “participate in organizations and efforts that support the role of the physical therapist in furthering the health and wellness of the public.”5(p29) These themes also emerge in APTA's Code of Ethics6: “A physical therapist shall endeavor to support activities that benefit the health of the community.” The profession's Standards of Practice7 state, “The physical therapist demonstrates community responsibility by participating in the community and community agency activities, educating the public, formulating public policy, or providing pro bono physical therapy services.” As a result of the increased emphasis on community engagement in our core documents, the utilization of service-learning pedagogy for the professional preparation of physical therapists is being discussed more frequently at conferences and in published literature. At times, however, the terms service learning, community service, and communitybased research are used interchangeably. The purpose of this paper is to: (1) define and differentiate community-engaged teaching (service learning, clinical practice), community service (volunteerism), and community-based research (community-based participatory and/or action research); (2) detail the steps in community-based research projects for social change with examples; and 3) examine briefly how community engagement can meet scholarship criteria. There is no consistently used definition for community-engagement associated with the health professions. The term community refers to local neighborhoods, the state, the nation, and/or the global community. Human and community needs are then defined by the specific community.8 Community-Campus Partnerships for Health defines community engagement as “the application of intuitional resources to address and solve challenges facing communities through collaboration with these communities.”9(p12) Institutional resources may include (but are not limited to) the expertise and knowledge of students, faculty, and staff; the use of the campus' buildings and land; the institution's political position within their community; and influences on local schools, economy, and government. Venues that academic institutions may use for community engagement include (but are not limited to) community service, service learning, community-based research, training and technical assistance, coalition building, organizational capacity building, and economic development. Figure 1 represents how teaching, research, and service are each linked within community engagement and are differentiated.9Figure 1. Community-Engaged Teaching, Research, and ServiceCOMMUNITY-ENGAGED TEACHING AND SERVICE Service learning is a structured teaching and learning experience that meets identified needs in the community “with explicit learning objectives, preparation, and reflection. Students engaged in service learning are expected not only to provide direct community service but also to learn about the context in which the service is provided, the connection between the service and their academic coursework, and their roles as citizens.”10(p274) Also, “unlike practica and internships, the experiential activity in a service-learning course is not necessarily skill-based within the context of professional education.”11(p222) Service learning differs from volunteerism, community service, traditional practica, clinical rotations, field experiences, and internships.12 Volunteerism and community service benefit the recipient of the service, not the learner, and are not generally connected to the curriculum. However, volunteerism and community service can arouse a powerful sense of altruism that can be easily expressed. Traditional practica, clinical rotations, field experiences, and internships include specific instructional learning objectives and focus on the development of students' skills essential to their profession and education. In contrast, service learning emphasizes an equal balance between the service and the learning components12—instructional learning objectives are matched with communityidentified needs. Implementation of service learning into coursework can also include advocacy and policy-level work on issues such as access to health care, housing, poverty, the environment, education, and other human services.8 Gelmon13 notes that the effect of servicelearning experiences on students was much more evident in courses that did not focus exclusively on community-based clinical skill development. Students were strongly influenced when they worked with individuals in non-clinical settings and when they learned about the context of patients'/clients'/service recipients' daily lives and the complex and delicate network of support services upon which they depended. Although service learning in the clinical setting can be valuable, issues of clinical skill development and application usually impede realization and recognition of the potential service experience benefits.13 Reciprocal learning is the second factor that distinguishes service-learning programs from other community-service programs.8 The student and the patient/client/service user are both teachers and learners. Community organization partners play a crucial role in designing the service-learning experiences in accord with community interests and priorities.10-12 It is this element of reciprocity that moves service learning to the level of a philosophy, “an expression of values—service to others, community development and empowerment, reciprocal learning—which determines the purpose, nature and process of social and educational exchange between learners (students) and the people they serve.”14(p67) Reflection is the third crucial component of service learning. Reflection activities are active-learning processes that facilitate students' connection between their service in the community and instructional objectives.8,15,16 Reflection is the mechanism for moving students toward recognition of achieving specific terminal behavioral objectives.8,15-17 Service-learning experiences also can facilitate the development of students' professionalism skills and understanding of their social responsibility role as health professionals and citizens within a larger social context.10-11,15-16 Service-learning objectives can include educational outcomes in the areas of leadership, ethical or spiritual development, critical thinking, increased understanding of human diversity and commonality, understanding one's professional social responsibility role, and learning to advocate for issues of social justice and social change.8,16 Studies have reported that when students became cognizant of the many challenges potential patient/clients faced in their everyday lives, their views on their professional roles and citizenship in the community were transformed.11-13,15 COMMUNITY-BASED RESEARCH (COMMUNITY-ENGAGED RESEARCH) The word “research” first entered the dialogue of higher education in 1870 at Cambridge and Oxford in England. Academicians wanted to emphasize that higher education was not just a place of teaching, but also learning. The term was introduced in American higher education in 1906.2 Today, research is recognized as a systematic, objective process of inquiry that generates results and new knowledge that are observable, measurable, documented, reproducible, and assessed through a peer or external review process.3,18,19 Community-based research is a more recent iteration of service learning in higher education.20,21 It involves a collaborative approach to research that equitably involves community members, organizational representatives, and academic researchers in the design and accomplishment of research projects aimed at meeting community-identified needs. Parallels exist between service learning and community-based research in: (1) principles, (2) benefits to students, faculty, community partners, and academic institutions, (3) challenges, and (4) application processes. Strand and colleagues3 delineate 3 principles of community-based research that contrast with traditional academic research approaches. Community-based research is the systematic creation of knowledge, which involves a collaborative approach to research that equitably involves community members, organizational representatives, and academic researchers in the design and accomplishment of research projects aimed at meeting community-identified needs and objectives. The research is conducted with rather than on a community partner. Second, traditional assumptions about who should be allowed to participate in the creation of new knowledge are challenged due to the collaborative nature of community-based research. Participation by nonspecialists in decisions about research processes and priorities is valued. Multiple methods of discovery and dissemination are acknowledged. All stakeholders or parties are invited to be involved in identifying, defining, and struggling to solve the problem. The methods are selected or developed because they have the potential for pulling out useful and pertinent knowledge.3 Dissemination of research results in a peer-reviewed journal article is not necessarily beneficial to the community, thus researchers need to be flexible and adaptable in how they communicate these research results. Last, community-based research has a critical social action and social change goal, such that the knowledge gained is combined with the purpose of enhancing the well-being of the community and its constituents and achieving social justice.15,16 The measure of the significance or value of a community-based research project “is its potential to bring about social change. And the research questions that drive communitybased research do not come from the mandate to build theory in a discipline, but rather from a need for information that might help advance the social justice and social action agenda of a community organization or agency.”3(p14) Johnson, Maritz, and Lefever22 offer an example of a community-based research project recently completed by physical therapists. It began as a pro bono physical therapy clinic in Philadelphia for the uninsured. It started with a staff of 1 physical therapist and a couple of student volunteers offering services 1 night a week. From this humble beginning it evolved into the Mercy Circle of Care initiative that brought together a collaboration of citizens, health care providers, social services, the Philadelphia Department of Public Health, and 3 universities in Philadelphia that provide the core curriculum for 3 physical therapist education programs. The Mercy Circle of Care was formed using all of the components of a traditional research project—a purpose, research questions, design/method, data collection and analysis, and dissemination.22,23 The information generated by the study helped to advance the social action agenda for this community clinic. The overall purpose of the Mercy Circle of Care was to address the lack of health insurance, uncoordinated care, and underresourced health programs in this particular area of Philadelphia. The Oversight Committee for the Mercy Circle of Care recognized and acknowledged early in its inception that the uninsured use fewer preventative and screening services and were sicker when initially diagnosed; therefore, their health issues were more complex and an interdisciplinary model of care was imperative. 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