The university’s philosophy and mission of community engagement
All participants defined community engagement in terms of direct interaction with people in underserved contexts. These interactions were described in terms of reaching out to communities to enrich their lives by identifying their needs, providing advocacy and offering support. The definition of community engagement differed across disciplines as their activities were determined by discipline curricula, which was particularly evident in Dentistry, Nursing and Pharmacy participants who mentioned that applying theoretical knowledge and skills, pertaining to a specific profession, in a practical setting was also a form of CE.
Three disciplines (Occupational therapy, Pharmacy, Physiotherapy) elaborated on different groups of people such as community members, representatives, peers and other healthcare workers who work collaboratively to reach a common goal which is usually to benefit the patient, or, to improve awareness of social injustice such as “gender-based violence” (N1) and “occupational injustices” (OT2).
“So, the community is the people you engage with, whether it’s your peers, patients or other healthcare workers” (P3).
Occupational Therapy and Physiotherapy participants expressed a strong belief relating to implementation of projects, based on the needs of the community, where existing resources from the community were used to achieve a self-sustainable outcome in the practice of CE. Occupational therapy participants emphasized that accountability in addressing health related and social issues in the community were a major ethic behind the definition and practice of CE.
“What we do when we go into a community’s very doorstep is to look at what we call occupational injustices. That for us is where our discipline becomes unique because of what that term covers. We look at anything ranging from chronic diseases in the community to gangsterism in the community, to any sort of broad topic that fits occupational engagement of the community” (OT2).
Synonyms for CE where primarily discipline and task specific. These words included “Awareness programs” (D & P); “Outreach programs” (D, N, P); “Community involvement” (N); “Education” (D); “Occupational potential, occupational consciousness, occupational engagement, occupational choice, occupational injustices” (OT); “Community integration and community reintegration” (PT).
The three CE terms that participants were asked to specifically define included service-learning, work-integrated learning and volunteerism. Participants were most familiar with service learning (in contrast to work integrated learning), which was embedded into the formal curriculum. Volunteerism was associated with co-curricular activities and its prominence was negated when compared to the importance of ‘marks’ and graduating.
Pharmacy, Dentistry and Nursing participants defined service-learning as undergraduates offering services to communities for free by applying their theoretical knowledge in a practical environment. Pharmacy and Physiotherapy participants agreed that during service-learning, students gain more knowledge from the community which they serve—through “hands on” (PT5) learning. The Occupational therapy participants defined service-learning by contextualizing theory to practical experiences which were supported by additional literature, assignments and research.
The five groups had different interpretations of work-integrated learning, which converged in the workplace. Pharmacy and Dentistry participants defined work-integrated learning as knowledge which is gained in the workplace after students have graduated. Nursing participants equated work-integrated learning with service-learning. Physiotherapy participants referred to work-integrated learning as professionals working together towards a common goal as well as having the ability to apply critical skills in the field by “thinking on your feet” (OT2).
Volunteerism was the least practiced among the participants, because it was associated with personal or co-curricular activities. Pharmacy, Nursing, Dentistry and Occupational Therapy participants collectively indicated that there were no volunteerism programs within their curricula. However, some participants revealed scenarios where some students have taken their own initiative to volunteer outside of their discipline. In contrast, Physiotherapy participants mentioned that volunteerism was an extended part of their curriculum which allowed students to lend their time at sports events, outreach programs and fundraising.
“We have a sports function like the Cape Town Cycle Tour, they ask for students to volunteer at the massage stations, as well as the Two Oceans Marathon. And as a class, we started an outreach at one of the Church Highs disability homes” (PT3).
None of the participants had any knowledge regarding the vision ad mission of UWC and how CE was incorporated. Participants noted that this information might have been included in some of the UWC emails that they chose not to read.
Respondents from three disciplines (Dentistry, Nursing and Physiotherapy) mentioned that they were quite isolated from campus UWC so that they don’t know much about CE activities across disciplines at the university.
Student involvement in CE
Participants associated preparation for CE in their disciplines with the service learning, community projects, clinical placements and outreach activities emanating from their formal curriculum, which would automatically include all students in CE activities. Participants could not really comment on CE preparation outside of their disciplines/curriculum except for their experiences in the interprofessional courses and activities presented by the Interprofessional Education (IPE) unit on campus. However, participants also noted that these activities were limited to health science disciplines, despite them being able to extrapolate the social injustices observed in communities to issues pertaining to non-health disciplines such as education and law.
Most groups did not speak much about leadership and advocacy in terms of CE. Dentistry and Occupational therapy participants believed their curricula provided ample opportunities for CE and advocating for community needs, thereby fulfilling an academic requirement for their discipline. Physiotherapy participants believed it was the responsibility of the students to undertake a CE initiative to address issues of inequity.
While participants noted that their marks and subsequently graduating was of prime importance, a feeling of self-satisfaction was identified as the ‘reward and incentive’ which prompted students to participate in CE.
“No [there are not any rewards or incentives for participating in CE]. But I think if you want to do it for the community you do it, you don’t really do it to get something out” (N1).
Respondents from four disciplines (Nursing, Occupational therapy, Pharmacy and Physiotherapy) expressed that CE is embedded as a part of the academic requirements towards obtaining their degree or “getting marks” (OT3), which could be seen as the primary objective.
“I do …see the need to give back to the community, but I need to ensure that I pass and graduate one day to do so effectively” (P3).
In addition, participants also mentioned personal rewards which arise from CE such as self-satisfaction, getting public exposure, obtaining knowledge and learning about diversity through their direct interactions with the community.
Faculty involvement and rewards
Participants generally identified faculty, clinical coordinators and supervisors associated with their CE modules and activities and not others not involved in these modules and activities. Students from all the disciplines highlighted that their lecturers who coordinate CE at their disciplines may have personal community-based initiatives going on within communities, such as “providing students with sandwiches on a Friday at their own expense” (N1) and being “involved with the taxi committee” (D6). However, all five disciplines indicated that these “stories” are not shared with students openly and the only form of exposure all disciplines have of these lecturers’ participation is seen in their research projects, publications or presentations. Pharmacy and Nursing participants mentioned that they do not know of staff members who participate in CE outside of their discipline-based programs.
Participants could give isolated examples of these lecturers advocating for CE, which was generally appreciated by students and fostered a connection between some students and faculty. The Pharmacy participants felt that staff did not advocate enough for CE in the classroom, which would interest students greatly. Nursing participants mentioned that lecturers shared their own experiences during lectures. Occupational therapy and Dentistry participants stated that CE was advocated by lecturers during their discussions with the class. The Occupational therapy participants mentioned further that discussions were held in particular “after the community block about the experiences and lessons they acquired” (OT3).
Occupational therapy, Pharmacy and Nursing participants explained that the coordinating lecturers were also the ones that maintained the relationship between the communities as well as encourage the ethics and principles behind CE practice. Nursing participants further expressed that in order for CE to be implemented throughout the curriculum it would be beneficial if lecturers could receive support from other colleagues. Dentistry participants believed that the implementation of CE was done too late in their curriculum, while the Nursing participants also felt CE activities should start in fist year. Physiotherapy participants explained how they have seen and experienced the integrative work of academic staff in implementing their CE activities—ensuring that all the students receive equal exposure to learning opportunities with the community.
“…when a group had missed hydrotherapy, all the staff worked together to allow the students to have that opportunity” (PT4).
All participants indicated that no CE coordinating lecturers were given rewards and incentives for performing CE initiatives, as their intention was to provide valuable work as “acts of kindness” out of their “passion” for CE. However, Dentistry respondents mentioned that through research publications, CE is recognised within the discipline and profession. Occupational therapy participants mentioned that supervisors do “get paid extra” for the additional work they perform at facilities. Pharmacy participants felt that lecturers should be recognised and rewarded for the valuable work they do; while Physiotherapy participants believed that it is “in the best interest of the students” to not have any rewards or incentives for CE. Overall, there seems to be varied interpretation about how rewards were offered to lecturers.
Community participation and partnerships
All participants could describe some form of collaborative partnership that was in place for them to access their community placements. Respondents from four disciplines (Dentistry, Nursing, Occupational therapy and Pharmacy) referred to the community-university partnerships in terms of the learning sites which was spread amongst underserved communities in the Cape Town Metropole (including one semi-rural site), while Physiotherapy participants seemed unsure of the partnerships that were made between their discipline and the communities, but have always felt well received. The Dentistry, Occupational therapy and Physiotherapy participants described the inclusion of the communities in their training and education, and such community-university partnerships ensured the sustainability of their respective discipline-based projects.
Dentistry, Occupational therapy and Physiotherapy participants stated that students built relationships with the communities to whom they have been assigned. Occupational therapy participants further expressed that when students entered these communities, there were already “key role-players” (OT3) who welcomed them in as a “co-steering group” (OT1) who facilitated the projects, ideas and student work. Physiotherapy participants elaborated on students being involved in various campaigns held in the community they worked with and that the Physiotherapy department advertised for student assistance during sports events.
The CE approach for engagement activities was mostly based on community needs, with only Occupational therapy participants identifying with an assets-based approach.
“if you are not basing it [the project] on the [community] needs, what are you really doing?…”The only way to their [the community’s] involvement if you look at their needs” (PT4).
Pharmacy participants mentioned that their involvement via their Service Learning in Pharmacy (SLiP) program across many health facilities in Cape Town does take the communities’ needs into account before their visits. This is usually done in the form of meetings prior to the commencement of the SLiP blocks.
Occupational therapy participants expressed that their approach when partnering with the community was an “assets-based approach” (OT1) which allowed them as a team of stakeholders to come up with sustainable solutions for the problems they collectively identify with the community. Their practice was primarily based on an ethic of “release versus relief where it is important to release the community with their own strengths from their challenges rather than coming in with a short-term relief, which isn’t empowering for the community and can create dependency” (OT4). Therefore, the community was always included from beginning to end with regards to the CE activities which students undertake on site.
Occupational therapy participants noticed that if both needs and assets-based approaches were used within the same communities by different health disciplines, it caused problems for them because “expectations are created” (OT1) from the funding that was provided by other groups rather than them using the strengths used in their approach. Therefore Occupational therapy participants attested that the approach to community engagement should be congruent across health disciplines to avoid such hurdles.
Participants noted that communication and feedback between the discipline and community were important for ensuring good outcomes. Pharmacy and Physiotherapy participants stated that there was orientation and training of community members, whilst the participants from the other three disciplines indicated they do not have any form of collaborative preparation. Nursing participants mentioned that there is only a booklet that is given to students for their referral. However, they were aware of the coordinating lecturers going to their sites or facilities before the students’ activities commence, but were uncertain of any specific inclusion that occurred between the community and lecturers.
Participants expressed concerns about the apparent lack of continuity of projects they initiate in communities and questioned the sustainability of the projects and resultant social change. They also mentioned that some communities seemed fatigued from hosting students on an on-going basis. Participants also noted that the current siloed approach taken with CE at university reduced the impact projects have on communities. Pharmacy participants recognized that there were a lot of “missed opportunities” (P2) in their discipline with respect to public health campaigns when it came to social and health related issues, for example HIV-testing. Nursing participants mentioned that surveys were given out to the community as a requirement of their final assignment. Since no feedback was returned to the community, they felt such an imbalanced engagement benefits neither their discipline nor the community.
The silo approach was further reflected when none of the participants could articulate their awareness of the university’s goals for CE. Occupational therapy participants however also felt they lacked an “understanding of the student community within UWC” (OT3) itself and health- related discussions taking place outside of their discipline. They also felt that the university needs to do more to be involved in advocating for “especially nearby communities who are need of support, like Kasselsvlei is just up the road and yet as a university, we don’t do enough. Or speak enough” (OT1).
Institutional support for CE
The monitoring, coordination and evaluation of community engagement activities that students described was executed at the discipline level and primarily aimed at assessment of the engagement activity. Pharmacy and Nursing participants were unsure of a specific process for monitoring of their CE activities. However, Pharmacy students acknowledged that their lecturers may have a means of “recording statistics somewhere” (P4). Nursing participants had reported that the rigour of the assessment of each CE activity depended on the presence and quality of the supervision, which varied between activities, since they often “lack direction and supervision when sent to community sites” (N2). On the other hand, Occupational therapy and Physiotherapy participants expressed that student activities were monitored and communicated between the relevant lecturers and supervisors, which is transparent to students. With Occupational therapy, participants described a “hand-over process takes place” (OT2), where community partners and spokespersons also get involved in approving the outcomes of the projects that students will then convey to forth-coming groups to the site. In Physiotherapy, the participants indicated that supervisors perform International Clinical Frameworks for their examinations, which serves as a monitoring process during their engagement with the community at facilities.
“We have a clinical coordinator that we can refer to if we do experience any problems when we are on block. Then if there are any external problems, then, one would go to the lecturer introduced us to the site” (PT4).
All participants had claimed that they had no knowledge of a central coordinating entity for community engagement at UWC; and if they referred to a central system, they meant the IPE unit that is located on campus. Despite this, participants could articulate a clear need for such an entity at the University of the Western Cape and stated that a central CE system would be beneficial for the students. Pharmacy participants attested that it would create CE awareness, while Nursing and Occupational Therapy participants felt that it would encourage the much needed collaboration between the health disciplines, which does not operate optimally among the health disciplines. In addition to the collaboration, Occupational therapy respondents mentioned that such a central body could minimize communication barriers between the health disciplines which hindered the collaboration that would be beneficial to students. Physiotherapy participants stated that the central body would be able to provide additional CE activities outside the curriculum.
“Yes there should be [a central unit for CE]. Because we go into a community as OTs, but communities don’t just need OTs. If we have a central body within the university that will link everyone together and give a more holistic approach into the community instead of putting band aids everywhere. As a team we could make more of a difference” (OT2).
Respondents from four disciplines (Dentistry, Nursing, Pharmacy, Physiotherapy) believed that funding for CE was insufficient. Nursing, Physiotherapy and Dentistry participants believed that funding for CE seemed insufficient as was evident from the many financial cutbacks in various CE activities or site visits. Nursing participants stated that they often times have to raise their own funds for various CE activities in very short time frames. Occupational therapy participants believed that the funding within their discipline towards CE is sufficient, as it is conducive to the assets-based approach to which they accustomed.
“Solving community based issues with money from the discipline is not a good solution. Instead projects that generate the needs for the community by the community end up being more sustainable with long-term benefits” (OT1).
However, the Occupational therapy participants felt that from a university perspective additional funding is necessary for the university to invest more effort in strengthening campus-based teaching and learning in CE, rather than offering the funds to communities as a gesture of goodwill.
All participants were not aware of public discussion about CE at the university level, in part, because either they did not either read or recall the university’s emails, yet they had suggested that the university’s CE promotion or advertising should be enhanced to advance CE across all faculties.
In terms of CE goals for each discipline, all participants mentioned that exposure to real issues was a goal for the students, as well as becoming community conscious. The Pharmacy participants mentioned that CE activities “make students aware of challenges that the communities face” (P3); Nursing participants recognised their profession having a health promotion role within the community in “promoting prevention rather than cure” (N2); and Physiotherapy participants believed it essential “to be community focussed or community based” (PT5). The depth of engagement across the disciplines seemed to vary.
Suggestions to improve CE broadly covered: the allocation of more time in the academic time table towards CE activities to ensure sustainability and social change, the coordination of CE projects across disciplines to maximise impact, the inclusion of the student community on campus as part of CE activities, and the measurement of the impact on the community. Pharmacy participants suggested that students spend more time doing practical work to allow for more interaction with patients and to increase student involvement with communities on medication and health related discussions. Occupational therapy participants emphasized that communities may also “feel like they are being recycled” (OT5) due to the numerous groups of students entering their sites, resulting in community members to “switch- off to an extent” (OT5) and become “desensitized or passive to a degree from all the projects” (OT4) that were implemented. Hence, Occupational therapy participants also felt that students need to spend more time in the community to make a more beneficial impact through a multidisciplinary approach.
“Even if looking at the Kasselsvlei community we worked with in our second year. They then allowed us to do our exams during the Fees Must Fall protest because we have formed that relationship with them. They opened their doors to us to do our exams there. That’s building relationships” (OT3).
Second level analysis
Themes that emerged continuously regardless of the section of the interview during the first level of analysis included; siloism in the university, interprofessional education and monitoring and evaluation for impact of CE. Siloism was most evident in the unawareness of students for the university policies, such as the students being unaware of the university’s vision and mission for CE, the central office for CE as well as the absence of public discussion of CE. In addition, siloism was implicit from participant responses as it related to the focus of curriculum. The primary drive for student involvement in CE activities was obtaining the marks that were required for them to graduate, because CE was embedded in their curriculum. As a consequence the synonyms students gave for CE was discipline specific. Indeed, volunteerism was a relatively foreign phenomenon for students, which was firstly extra-curricular and perceived as a personal preference. This split between professional (embodied by the discipline/curriculum) and personal was in a way reinforced by the way the students perceived the faculty members involved in CE, which was described as discipline specific and a personal passion of these lecturers. The participants could subsequently also not identify or articulate a reward for this.
Interprofessional interactions was the second most prominent theme which surfaced most explicitly in the participants responses to questions relating to the university. Indeed most groups thought that the IPE was the central community engagement unit. In addition to the discipline specific service learning, their only other reference for CE was the activities that they completed through the IPE unit. IPE also surfaced as one of the factors that could affect impact of CE, since they felt that could improve the continuity of community-based activities. Participants recommended that interprofessional coordination of projects could improve the outcomes of community activities since “…Communities don’t just need OTs” (OT2). Another suggestion from the respondents was that students from other disciplines on campus should be involved in CE activities.
The last cross cutting theme that was more subdued in the responses was the desire for students to see impact or change in the communities. Students became very disheartened when they went to communities did their project, gave feedback, but nothing seemed to change as evident from " .. so many students are recycling the places” (OT 5). Students noted that the continuity of the CE project was important, and sustainability was cornerstone.