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 Table of Contents  
Year : 2020  |  Volume : 33  |  Issue : 2  |  Page : 55-60

Academia–industry collaboration to provide interdisciplinary experiential learning opportunities in public health professions education and improve health of female factory workers

1 Department of Community Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
2 Department of Community Medicine and Medical Education, Believers Church Medical College and Hospital, Thiruvalla, Kerala, India

Date of Submission21-Apr-2020
Date of Decision15-May-2020
Date of Acceptance15-May-2020
Date of Web Publication08-Dec-2020

Correspondence Address:
Thomas V Chacko
Believers Church Medical College and Hospital, St Thomas Nagar, Kuttapuzha, Thiruvalla - 689 103, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/efh.EfH_129_20

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Background: The community medicine department of our medical school, in addition to addressing its mandate to prepare undergraduate students for primary care and graduate students for careers in public health, administers several community-based interventions. An international organization involved with improving health of female factory workers globally invited us to partner in their efforts locally. We used the Precede-Proceed model to design an intervention to deliver the desired project outcomes. Activities: Recognizing that this partnership with industry would provide a learning opportunity to our Master’s degree program students, we involved them in a needs assessment survey in order to make an educational diagnosis to identify the influencing and reinforcing factors. Our faculty and students interfaced with a multidisciplinary team including mid-level factory managers, health-care staff, and peer health educators within the textile industry. Outcomes: Through this industry–academia collaboration, our health professions training institution was able to provide supplementary experiential learning opportunities to students in our Master’s degree in Community Medicine program by involving them in all the project stages from planning based on health needs assessment, to module design, implementation, and program evaluation along with interdisciplinary teams from the textile industry. Students then reflected on their learning experience using a modified Kolbe’s experiential learning cycle to improve their performance when they replicated the intervention with the next factory under the same project. Conclusion: The use of PRECEDE–PROCEED model in the industry–academia collaboration and Kolb’s framework provided supplementary experiential learning opportunities for deliberate practice, receiving feedback, and reflecting on their learning to our Master’s in Community Medicine degree students.

Keywords: Educational diagnosis, female factory workers, peer health educator training, PRECEDE–PROCEED model, program evaluation, program planning, public health education

How to cite this article:
Kannappan S, Chacko TV. Academia–industry collaboration to provide interdisciplinary experiential learning opportunities in public health professions education and improve health of female factory workers. Educ Health 2020;33:55-60

How to cite this URL:
Kannappan S, Chacko TV. Academia–industry collaboration to provide interdisciplinary experiential learning opportunities in public health professions education and improve health of female factory workers. Educ Health [serial online] 2020 [cited 2022 Aug 15];33:55-60. Available from:

  Background Top

The Department of Community Medicine at our medical school in South India is involved in a number of community-based activities and programs that cater to the health needs of different population groups in urban and rural settings and also provide hands-on experiential learning opportunities to future public health specialists. One such program is directed toward promoting the health of women in the textile industry. Tirupur, a textile city in South India, is one of the leading exporters of garments. Recent years have seen a high inflow of migrant female workers, most of whom are between 18 and 25 years old.[1] These women workers often suffer from anemia, poor hygiene, inadequate pre- and post-natal care, sexual violence, and exposure to infections and illness.[2]

Business for social responsibility (BSR) is a network of more than 250 member companies all over the world that promotes various sustainable initiatives. Among the many strategies they use for ensuring sustainability is the “peer education model,” which brings together international brands, academia, and top management of factories to educate women who work in these factories.[3] This model advocates for better conditions for workers with owners and is called “health enables returns.” The project is also known as HERproject which serves as an acronym for “health enables returns” and also refers to the targeted beneficiaries who are the vulnerable women factory workers.

The Master’s Degree program in Community Medicine (Public Health) administered by the department provides learning opportunities for acquiring core public health skills that enable graduates to function as public health consultants, educators, leader–managers, and researchers for improving the health of defined population groups.[4] The 1st year of the Master’s Degree program introduces students to the foundation courses in epidemiology, nutrition, demography, biostatistics, and environment health. The 2nd and 3rd years provide them with opportunities to apply these skills and also to further develop leadership and management skills in the defined population groups as well as research competency (a community-based thesis is required). The Master’s Degree students use structured experiential learning opportunities for deliberate practice, reflection on practice, and receiving feedback from faculty on the job as well as on their reflective log [Figure 1][5] to equip them with skills that they will be using for continuing professional development.
Figure 1: Reflective log using modified Kolb's cycle to optimize experiential learning

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  Context Top

Master’s Degree students generally get opportunities to learn about health program planning and program evaluation in health systems or community settings serving defined population groups. Workers in factories are a defined population group, so a collaborative partnership has been entered into between our medical school and BSR to address the health issues of the women workers and to promote good health. This academia–industry collaboration helped develop a need-based intervention, with academia contributing its expertise and industry, allowing its personnel and premises to function as resources to facilitate the implementation of the project. The community medicine department administering the Master’s degree program involved the students in all the stages of the program planning, implementation, and evaluation.

The entire process of how the faculty and postgraduate students in the department of community medicine systematically designed and implemented the program within the industry is described in detail. We also describe how we built upon a well-known PRECEDE–PROCEED model by incorporating the concepts of community diagnosis and educational diagnosis to design a tailor-made intervention to improve the health of factory workers and thereby benefit the factory. It is hoped that sharing our experience will provide other health professions educational institutions with an alternate model of industry-based learning experience that they may be interested in replicating or adapting as an additional venue for community-based learning.

  Activities Top

We chose to use the PRECEDE–PROCEED conceptual model to plan and apply the health behavioral theories for behavioral change.[6] We used the World Health Organization-recommended process of identifying the main health problems and their underlying social and other determinants known as “community diagnosis.”[7],[8] Based on the community diagnosis, we were able to identify the predisposing and enabling factors in the working environment. This means we could make an “ecological diagnosis” as well as identify behaviors that are contributing to ill health by making an “educational diagnosis” (PRECEDE phase 1 through 3). Once these two diagnoses were made, the tailor-made “treatment” – the health education program (Phase 4: Health promotion educational strategies, program implementation) was designed to correct the faulty behaviors and predisposing conditions in the working environment and thereby lead to improvement in health.

The “team-academia,” comprising of faculty project advisor, faculty project coordinator, consultants, Master’s Degree Public Health students, and social workers, was drawn from the department of community medicine of our medical school. Following an orientation meeting with the top and middle management of the industry, a team consisting of the top- and middle-level managers, the factory’s basic health-care nursing team, and the peer leaders as peer educators was formed at the factory level. The female factory workers were the beneficiaries or target population of the initiative. A brief summary of the various steps involved in the program implementation and expected outcomes based on the PRECEDE–PROCEED model is shown in [Figure 2].
Figure 2: Flow diagram showing planning and implementation of the educational intervention

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  Outcomes Top

Benefits and outcomes for the industry

The model as shown in [Figure 2] in its phase 6–8 guides the user to plan and put in place a system for program monitoring and evaluation. We used Kirkpatrick’s Training evaluation framework[9] to capture the effectiveness of the educational intervention program outcome. [Table 1] summarizes the different outcomes of the program in the short term.
Table 1: Effectiveness of the peer educators' training program

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[Table 1] shows how the peer educators found the program to be useful (Kirkpatrick Level 1). This influences program acceptance and its sustainability. It also captures their learning in terms of gain in knowledge (Kirkpatrick Level 2) and change in behavior (Kirkpatrick Level 3), thereby showing that capacity-building of peer educators was achieved. Successful transfer of learning to workplace (Kirkpatrick Level 4) was indicated by the peer educators being able to gain confidence and conduct several training sessions, which contributes significantly to program sustainability. Similarly, the program impact as demonstrated by bringing in return-on-investment (Kirkpatrick Level 5) in terms of health benefits to the workers translating to reduction in sickness absenteeism has convinced the factory management to institutionalize the program. Acceptance by another set of 25 factories in the region is a clear indicator of widespread recognition of the utility of the intervention and so ensures its sustainability.

Beneficial learning opportunities and outcomes for the academia

[Table 2] shows the learning opportunities for the Master’s Degree students in the industry that are unique to the project and are listed across the various phases of the model used. The concrete learning experiences in the second column are tagged with their resultant specific public health competencies and tools listed in the third column. They are effective communication, community diagnosis, educational diagnosis, training module design, working with interdisciplinary teams, use of adult learning principles, providing supportive feedback to peer educators, use of logic model for program planning, and identifying indicators to measure outcomes of any intervention.
Table 2: The PRECEDE-PROCEED model: Learning opportunities and learning outcomes for students in academia

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[Table 2] in its extreme right column captures the learning outcomes that emerged from the structured learning experiences stated in the column on its left and provides more insights about the benefits students reaped than any quantitative research would have elicited. These responses were captured from reflective logbooks students submitted after each learning experience they were involved in as part of their course. As shown in [Figure 1], these reflective observations (step 2 in the Kolb’s cycle) then provoke them to search for other conceptual frameworks that would illuminate and guide their next step in the step 3 namely “abstract conceptualization.” This helps them to be better prepared for undertaking a similar professional activity by encouraging them to go through step 4 of “active experimentation” so that improved outcomes result.

  Future Directions Top

The main factors that contributed to program sustainability are stated below and should find a place in project planning in future.

Contribution of the model for its sustainability

As indicated in [Figure 2], it is clear that in addition to serving as a model to design an intervention, it facilitates, through the component of community diagnosis, in making an ecological and educational diagnosis (Phase 3 of the PRECEDE–PROCEED model). It thus addresses “the need” for the program as reflected by the “diagnosis” and so the continuing need for the intervention (“treatment”) contributes to its sustainability. From [Figure 2], it also becomes clear that in the Phase 4–5 of the PRECEDE–PROCEED model as applied to the project, the strategy of using peer educators from among the factory workers, training them using the modules developed by academia based on the ecological and educational diagnosis described in the Phase 3 of the model, reinforcing visits for supportive supervision of the peer educators, together with advocacy and policy intervention by academia with administrative and floor managers are all program components that contribute to sustainability of the intervention.

Successful outcomes (return on investment) as a driver to ensure sustainability

Even after these phases of the program were completed, the outcomes were sufficiently compelling to convince the factory management in terms of “return on investment” to mainstream it along with other routine activities at the factory. Phases 6 through 8 of the model shown in [Figure 2] highlight this result. Team academia, by consciously involving the factory administration to devise a feasible strategy of setting up the “peer education process” as well as having master-trainers at staff level within the factory, contributes significantly to the sustainability of the program.

  Conclusion Top

Using a defined population group in an industrial setting provides a novel population group for students to apply theory to public health practice and helps them realize that irrespective of the target group they work with, the generic guiding principles are the same.

The PRECEDE–PROCEED model commonly used in health promotion program planning and evaluation was found to be helpful and demonstrated its usefulness to the students. Involving postgraduate students in the industry–academia collaboration provided supplementary experiential learning opportunities for deliberate practice, receiving feedback, and reflecting on their learning to our Master’s in Community Medicine degree students. By involving them in all the stages from project planning based on health needs assessment, to implementation starting with advocacy with top-level management, training module design, training of peer educators, leadership and management of a multidisciplinary team in industry and program evaluation, they were able to apply their knowledge in a new context. The insights about their learning captured from their reflective portfolio logs using Kolb’s experiential learning framework show that participation has enabled them to learn systematically prior to the intervention (PRECEDE phases), to implement the intervention tailored to the identified needs, and to devise program evaluation (PROCEED phases).

Use of Kolb’s framework for their reflective log helped postgraduates to reinforce their learning and encouraged them to do background reading and plan for the tasks to be accomplished. It also helped them become reflective practitioners. These enhanced personal development practices help them to engage in continuing professional development to improve the quality of health-care delivery.

In addition, the industry provided another avenue to work collaboratively with multidisciplinary teams and thereby reinforced the value of collaborative learning and respecting team members and project stakeholders for the particular competencies and contributions that they bring together to deliver care and improve service effectiveness.


We acknowledge the financial, conceptual, and business network support of BSR and HER project for providing an opportunity to do a value addition to their project and implement it on such a wide scale. The concept and intellectual inputs for designing this tailor-made health promotion intervention using conceptual frameworks and theories for health promotion interventions are our own contribution as they were neither a requirement nor part of the guideline given by BSR and their HER project.

Financial support and sponsorship

This study was financially supported by the BSR, San Francisco, USA.

Conflicts of interest

There are no conflicts of interest.

  References Top

Suhasini Singh. India Cheap Labor Garment Export Industry. Fashionable and Famous at the Garment Worker’s Cost. Global Research; 2009. Available from: [Last accessed on 2018 Sep 10].  Back to cited text no. 1
Saha TK, Dasgupta A, Butt A, Chattopadhyay O. Health status of workers engaged in the small-scale garment industry: How healthy are they? Indian J Community Med 2010;35:179-82.  Back to cited text no. 2
[PUBMED]  [Full text]  
Investing in Women for a Better World. BSR Report 2010. HERproject. Available from: [Last accessed on 2018 Feb 23].  Back to cited text no. 3
Guidelines for Competency Based Postgraduate Training Programme for MD in Community Medicine. Available from: [Last accessed on 2019 Feb 14].  Back to cited text no. 4
Elizabeth Fischer Turesky, Diane R Wood. Kolb’s experiential learning as a critical frame for reflective practice. Academic leadership. Online J 2010;8(3), Article 25. Available from: [Last accessed 2019 Feb 14].  Back to cited text no. 5
Glanz K, Rimer BK, Lewis FM, editors. Health Behavior and Health Education: Theory, Research and Practice. 3rd ed. San Francisco: Jossey-Bass; 2002.  Back to cited text no. 6
Andrea Carson Gielen CA, McDonald EM, Bone LR, Gary TL. Using the PRECEDE-PROCEED model to apply health behaviour theories. In: Glanz K, Rimer BK, Viswanath K, editors. Health Behaviour and Health Education: Theory Research and Practice. San Francisco: Jossey Bass; 2008. p. 407-34.  Back to cited text no. 7
Vaughan JP, Morrow RH, editors. Manual of Epidemiology for District Health Management. Geneva: World Health Organization; 1989. Available from: [Last accessed on 2018 Sep 10].  Back to cited text no. 8
Smidt A, Balandin S, Sigafoos J, Reed VA. The Kirkpatrick model: A useful tool for evaluating training outcomes. J Intellectual Develop Dis 2009;34:266-74.  Back to cited text no. 9


  [Figure 1], [Figure 2]

  [Table 1], [Table 2]


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