Running head: REFLECTION JOURNAL 1

Chizoba Anyimukwu

PHS 750

Public Health Practicum: The Field Experience

Reflection Journal
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Public Health Practicum: The Field Experience

Pre- Immersion Reflection Journal

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The purpose of this pre-immersion reflection paper is to provide a critical reflection of

what was learnt in previous personal and professional work experience. This will be presented in

a reverse chronological order. The paper will also help in providing detailed information on how

these previous experiences will assist in current and long-term professional development.

Identifying Skills, Strengths and Knowledge

I currently work as a graduate assistant and have been on this role for nine months. I

conduct literature reviews and collaborate with faculty to prepare peer reviewed publications.

To read and properly synthesize the retrieved research papers involves applying quantitative,

qualitative and mixed methods research knowledge. On the course of this job, I am also

expected to assist multiple professors with their research which entails prioritizing tasks and

working towards assigned timelines.

I was previously employed as a Project Director on a prematurity prevention project.

During my 10 weeks experience, I exhibited leadership and management skills. I was fortunate

to have experienced first-hand, different sides of disseminating a public health intervention. This

involved the process intervention planning, development, coordination and strategically

implementation such that a successive hire can continue with the project successively. I was also

able to plan and prepare for meetings and trainings, make valuable decisions, and tactfully

manage other project staff in a way that does not impede the progress of the project or insult the

judgement of other colleagues.

Another valuable lesson I learned as a Project Director was flexibility and adaptability

skills. Being able to adapt in different federally qualified healthcare settings was a big advantage.

There were multiple healthcare intermediations and the conditions of each environmental setting

was ever changing due to varied circumstances, including the availability or unavailability of a
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particular healthcare provider. Most of the patients who utilize federally qualified healthcare

settings also have low literacy level. I had to adjust my health messaging to enable the patients

understand the health information. This made the patient happy despite the mood they were in

prior to my health education session.

Reflecting back to my 16 months employment as the first and only Program Evaluation

and Curriculum Coordinator on a United States Department of Agriculture (USDA) nutrition

education and obesity prevention grant brought back interesting memorable days. After formal

introductions, I was led to my office and handed a pile of documents. It came as a shock, because

I have never had to deal with such enormous paper work in my life. However, I was able to sort

through the massive stack of documents to select what was needed right away. I had to analyze

and synthesize the operationalized theoretical model, and also the policies and systems outlined

in the program manual. A valuable lesson I learned was that in the early stages of a project

development, things can change very quickly, therefore critical thinking and time management

skills are apt.

The diverse program evaluation team had the Program Director, Manager, Program

agents and other coordinators. This range of practitioners had different strengths and

qualifications. I had to strategically ensure that everyone worked in sync with one another to

create a good atmosphere that fosters positive productivity. As a visionary leader, I designed the

evaluation matrix by focusing on the needs of the community; negotiating with other program

staff and stakeholders; and consolidating the required program measures based on feedback from

the team. I also prepared reports for dissemination to various stakeholders. However, I dialogued

with the Program Director and Program Manager before any submissions were made. This
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ensured that ethical and legal principles pertaining to human subjects and project policies were

protected from start to finish.

Working on the development of three toolkits as an intern for the Tennessee Office of

Minority Health and Disparities Elimination was enjoyable. I was able to practice my public

health skills while working towards graduating with a Master’s in Public Health. With the

support of the Director and other networks, I made connections and built partnerships with

community and faith-based organizations to ensure that the toolkits were culturally competent. I

attended the partnership meetings independently, accepted responsibilities and worked under

minimal supervision.

While working as an intern, I also served as a Community Engagement Personnel on a

childhood obesity prevention grant housed in the Tennessee State University Center for

Prevention Research. I recruited local corner stores, collected data, tracked outreach logs and

delivered health education to low income and minority community residents. I had the

opportunity to develop multitasking skills while working with an ethnically diverse population

household. This was probably the most enjoyable part. I was always energized and had a sense of

fulfillment practicing what I had been taught in the classroom.

The foundation of my professional experience was a four-year clinical experience as a

student nurse in Malaysia. I was part of a clinical and community healthcare management team

that provided direct patient care, reported and documented information as outlined by the clinical

unit policies. Although the work I had to complete varied year-to-year, being a part of a

healthcare team while living 17 hours away from home enabled me to develop teamwork, self-

confidence and resilience skills. I also learned a great deal about dealing with difficult requests

from people who might be in pain or a bit irritated about their health status.
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Areas for Growth and Stretching

I understand that organizational structures, operations and decision-making processes

ensure that all parties involved are able to function in an ethical manner. However, I easily get

discouraged when I encounter organizational processes or policies that require extensive

documentations before a project can be conceded. Professionally, I am constantly working on

strengthening my ability to understand and adapt to workplace culture. Biggio and Cortese

(2013) purports that mental flexibility will assist in overcoming workplace barriers. Mental

flexibility involves ability to tolerate uncertainties in organizational context, and actively

participate in leadership’s goals and visions (Biggio and Cortese, 2013).

As a visionary leader, I get more excited and attached to new ideas and direction,

therefore repetitive systems that are also beneficial get less attention. However, to refine and

strengthen this weakness, I will ensure that my vision is collaborative. A mentor, other

members of the team or another colleague who gets satisfaction from results will be invited to

share in the idea and serve as an accountability partner. This partner will assist in creating

capacities needed for establishing realistic milestones, conducting progress reviews and

adjusting visions and goals accordingly (Hoe, 2007).

I have a very charismatic personality which tends to define what I look for in a work

setting. My ideal work setting is a fast-paced and organized environment that is centered

around working as a team, while allowing team members skills and talents to flourish.

Although I enjoy learning from other team members, I also prefer working on my own, in a

quiet setting that values problem solving, creativity, and decision making. I function efficiently

in any work setting; however I thrive best in a work setting where I am less micromanaged, and

excellence is rewarded.
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Goals Beyond the Required Competencies

One of my clearly defined goals is to learn the principles and application of health

promotion and disease prevention interventions within a private, not-for-profit organization. I

have experience working with state and federally funded programs, consequently, I hope to gain

an in-depth perspective of how departments within non-for-profit organizations provide public

health services. This will support new skill acquisition and knowledge that promote

dissemination of health intervention practices in not-for-profit settings.

Another valuable goal is to address any training gaps needed in advancing health

equity. As a budding public health professional, my previous experience created an awareness of

professional praxis; the gap between classroom theoretical experience and real-life setting. My

goal is to learn how to develop outreach programs within healthcare and non-healthcare settings.

I hope to leverage this opportunity to practice how outreach programs that address health

disparities, community development, education and resources are initiated and sustained.

Network of People who may Provide Information and Referrals

In achieving my short term and long-term goals, I will leverage the support of my

internal and external professional networks. My main internal support system is my

professional mentor, Dr. Mary Shaw-Ridley. She is the Department Chair of Behavioral and

Environmental Health at the Jackson State University, School of Public Health. Dr. Mary

Shaw-Ridley has extensive experience working with diverse populations and programs in

varied public health academic and non-academic settings. Dr. Shaw-Ridley will provide

professional guidance towards structuring a health equity committee. She will also provide

professional advice to support recruitment and retention of participants in my assigned

cholesterol and blood pressure community projects.

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I will also seek the support of Dr. Banner who is the field placement coordinator at

the Jackson State University, School of Public Health. She has a background in business,

marketing and public health. Dr. Banner will provide professional advice to enable smooth

transition into my new environment. She will assist in devising the social marketing

structure that will support communicating public health science to diverse stakeholders.

Ms. Rosa Wilson is a valuable connection within my external network. She will

serve as my field placement supervisor. Ms. Wilson is the Director of Community Impact at

the American Heart Association in Jackson Mississippi. She will provide professional

guidance towards achieving the set deliverables.

Mrs. Rochelle Fields is a former colleague within my external network. Mrs. Fields

is a native of Mississippi and has worked on community capacity building projects for over

20 years. She is currently a lactation consultant, teaches nutrition classes to mothers and

leads a smoking cessation grant project. All three projects are housed in a federally

qualified healthcare center. She will assist with valuable connections to others that will

assist in achieving my short term and long term goals.

As a member of the American Public Health Association and Mississippi Public Health

Association, I am opportune to attend conferences at subsidized rates. At professional

conferences, emerging public health advancements are presented and concurrently, long term

networks are formed. I also receive free access to published research articles and news reports

which showcases major advances in health promotion. Exchanging information with my

classmates and other public health students will also present opportunities for professional

advice, constructive criticisms and feedback.

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References

Biggio, G., & Cortese, C. G. (2013). Well-being in the workplace through interaction between

individual characteristics and organizational context. International Journal of Qualitative

Studies on Health and Well-Being, 8. doi:10.3402/qhw.v8i0.19823

Hoe, S.L. (2007). Shared vision: a development tool for organizational learning. Development

and Learning in Organizations: An International Journal, 21(4), 12-

13. doi:10.1108/14777280710758817
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Public Health Practicum: The Field Experience

Immersion Reflection Journal

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The purpose of this immersion reflection paper is to provide a critical reflection of the

ongoing practicum experience. This paper will (a) identify leadership skills that support

innovation and ideas within the organization; (b) characterize the organizational culture that

promotes teamwork and problem solving; (c) identify linkages with other community

partners/organizations; and (d) present the challenges and opportunities to contribute to the

advancement of the organization project(s).

Identifying leadership skills that support innovation and ideas within the organization

AHA achieves its innovation and ideas through the leadership strength of its leaders.

AHA’s leaders understand and respect the cultural norms and political climate of the community

while supporting policy, systems and environmental changes in socially disadvantaged

communities. A perfect scenario is the Health in All Policies framework adapted for the

“MoveBR proposal” in Baton Rouge, Louisiana. The enacted MoveBR bill authorized the levy

and collection of a sales tax of one-half of one percent for providing funds to construct and

improve public roads and streets, including sidewalks, crosswalks, and bike paths. AHA, Metro

Jackson partnered with the Mayor Sharon Weston Broome (East Baton Rouge (EBR) parish

mayor), Sustainable Transportation Action Committee (STAC), AARP Louisiana and Center for

Planning Excellence (CPEX)] to move the bill. However, the Government Relations Vice

President reviewed the policy analysis and response mechanisms, and communication strategies

to ensure that the public health information presented supports the right decisions for the

particular political ideology and addresses health equity.

AHA has a strong entrepreneurial orientation. I was opportune to work on two innovative

projects established by the AHA: Target BP and Check.Change.Control Cholesterol. Prior to

implementation of the Target BP and Check.Change.Control Cholesterol programs, the

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organization leaders conducted primary and community based research and partnered with

multiple heart research institutes and academic organizations to ensure that both programs are

evidence based and practice tested.

The AHA also utilized a combination of transformation ethics and systems thinking

approach to create the first Metro Jackson Health Equity Committee. The mission of HEC is to

“address social determinants of health by aligning with key partners to support initiatives,

programs and resources that safeguard health equity”. HEC is currently working on food

insecurity strategies in the Metro Jackson Area. To achieve improvements in food security and

close the health disparity gap, the HEC collaborates with complex systems to formulate ethically

unbiased approaches to achieving health equity.

However, the organization has some weakness. AHA’s leaders lack public health

education and skills which has increasingly led to slow pacing of projects. Competitive

advantages is also one of the weaknesses of AHA. AHA is a non-profit and depends on funders

for its financial resources, as such various community projects that require small funding streams

or has little or no potential to generate large revenues are placed on wait list or never pursued.

AHA’s projects always require many levels of approvals which has led to limited project

delivery within specified times.

Characterizing the organizational culture that promotes teamwork and problem solving

The American Heart Association (AHA) remains the nation’s oldest and largest voluntary

organization dedicated to fighting heart disease and stroke. To fight these diseases, AHA funds

innovative research, advocate for stronger public health policies, harnesses the skills of

community volunteers and provides critical tools and information to save and improve lives.
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AHA also provides public health education through “strategic collaboration” between partners

and employees to address:

1. the “Life’s Simple 7: smoking, physical activity, healthy body weight, healthy diet, blood

pressure, cholesterol and blood sugar;

2. cardio pulmonary resuscitation (CPR) education and training; and

3. health disparities (AHA, 2016).

AHA problem solving approach is well vested in teamwork. AHA Metro Jackson’s

working group culture involves a diversity of capabilities from the highest (Regional Vice

Presidents) to the lowest levels. To increase the success of projects, team members brainstorm

solutions and find ways to eliminate barriers. Each team member is allowed to work within their

strengths and skills without being micromanaged. Depending on the project working group,

whether local or national, meetings are scheduled to highlight team goals, progress and

problems. For instance, I delivered an action progress report in a meeting with other employees

of AHA South East region. As part of AHA’s reward based organizational culture, team

successes are mentioned in company publications, websites and social media; in departmental

meetings and at AHA’s conferences and meetings.

To address social and cultural factors in healthcare research, AHA supports highly

promising healthcare and academic professionals, to explore innovative questions or pilot studies

that will provide preliminary data for research. AHA strongly encourages application from

women, underrepresented minorities in the sciences, and those who have experienced diverse

and non-traditional career trajectories. The career development award research is broadly related

to cardiovascular disease and stroke, within the scope of clinical, translational, behavioral,

population or basic science, bioengineering or biotechnology, and public health.

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Identifying linkages with other community partners/organizations----Who are the principal

stakeholders that the support the organization’s vision, mission, initiatives, revenue?

AHA’s Metro Jackson Health Equity Committee (HEC) works in partnership with other

agencies and organizations including the Mississippi Department of Health to create sustainable

community initiatives targeting blood pressure and cholesterol risk factors. AHA also partners

with community clinics in the Metro Jackson area to implement the Target BP and C.C.C.

cholesterol initiatives. Target BP™ and Check. Change. Control. Cholesterol™ are national

initiatives formed by the American Heart Association (AHA) and the American Medical

Association (AMA) in response to the rising incidence of uncontrolled blood pressure (BP)

(AHA, 2016b; AHA, 2019). Target BP helps health care organizations, at no cost, improve BP

control rates through an evidence-based quality improvement program. AHA launched the

Check. Change. Control. Cholesterol with support from Sanofi and Regeneron, to improve the

identification and management of cholesterol across the nation. C.C.C. cholesterol aims to

reduce the number of Americans who have heart attacks and strokes by urging medical practices,

health service organizations, and patients to screen and treat this important risk factor.

Participating clinics receive access to the latest guidelines, clinical research tools,

resources and support to help them optimize how adult patients with hypertension and abnormal

cholesterol levels can be managed. With empowered care teams helping to achieve better health

outcomes, more patients will avoid life-altering events, such as heart attacks and strokes, leading

to a healthier America. The “Target: BP and C.C.C. Cholesterol Recognition Program” also

celebrates physician practices and health systems, achieving blood pressure and cholesterol

control rates at or above 70 percent within the populations they serve.

AHA partners with local volunteers, local nonprofit organizations and private companies
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to organize walks, marathons and community health fairs, to increase its revenue for initiatives

such as the Go Red for Women that aims to create awareness of heart disease in women.

Challenges and opportunities to contributing to the advancement of the organization

project(s) and making meaningful contributions that advance the organizations’ priorities,

mission, and vision.

One of the challenges to meeting AHA’s Target BP and the C.C.C. cholesterol mission

and priorities is health insurance. Uninsured are less likely than those with insurance to receive

preventive care and services for major health conditions and chronic diseases (Kaiser Family

Foundation, 2019). The last measured uninsured rates for Mississippi was 21.90% in 2014.

Mississippi experienced an average growth rate of -0.59% from the first statistic recorded in

2008. If past trends continue, the forecasted percent without health insurance in 2019 is

estimated at 21.23 percent (Socrata, 2019). Given that 1 in 5 people or more do not have health

insurance in Mississippi, the Target BP and the C.C.C. cholesterol initiatives remain limited in

its ability to reach intended audience. An inclusive system approach could create a beneficial

opportunity for reaching underserved and uninsured populations.

Another major challenge is educational qualification of project staff. AHA was formed as

a revenue oriented and research funding organization, thus employees are well trained in

business and analytical skills. However, with recent public health drive towards addressing social

determinants of health and closing health equity gap, AHA is expected to address the

circumstances, distribution of money, power and resources that impact the conditions in which

people are born, grow, work, live and age at the global, national and local level. With my

education and experience in the field of public health, AHA’s mission, vision and priorities could

be advanced by organizing public health training workshops for employees.

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References

American Heart Association (2016). Innovation at heart. Retrieved from

https://www.heart.org/idc/groups/heart-

public/@wcm/@cmc/documents/downloadable/ucm_490853.pdf

American Heart Association (2016b). Target BP™. Retrieved from https://targetbp.org/

American Heart Association (2019). About Check. Change. Control. Cholesterol™. Retrieved

from https://www.heart.org/en/health-topics/cholesterol/cholesterol-tools-and-

resources/about-check-change-control-cholesterol

Kaiser Family Foundation (2018). Key facts about the uninsured population. Retrieved from

https://www.kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/

Socrata (2019). Percent uninsured. Retrieved from

https://www.opendatanetwork.com/entity/0400000US28/Mississippi/health.health_insura

nce.pctui?year=2014&age=18%20to%2064&race=All%20races&sex=Both%20sexes&in

come=All%20income%20levels
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Public Health Practicum: The Field Experience

Post-immersion Reflection Journal

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The purpose of this post-immersion reflection paper is to provide a critical reflection of

my practicum experience. This paper will (a) discuss the lived experience of how I met my own

professional and personal goals during the field experience. Here I will discuss how I achieved

the goals, any challenges I had working in the team, with organizational leaders, and

stakeholders; and what I would do differently if I could repeat the field experience? (b) the

relevance of my project to my understanding of public health/community health problem. This

section will discuss how the project advanced the organizations priorities; how I feel about the

approach the organization is taking to address the problem; and what I would do differently if I

could influence the leadership.

The lived experience of how I met my own professional and personal goals during

the field experience.

How goals were achieved

The first goal of my field experience at the American Heart Association was to plan and

implement initiatives that improve blood pressure and cholesterol behaviors. to achieve this goal,

I was engaged in implementing the established Target BP and Check.Change.Control.

Cholesterol programs. The aim of these programs was to improve awareness, detection, and

management of high blood pressure and cholesterol among Americans. To achieve this goal, I

participated in the AHA video conference training and also studied the training manuals. I

assisted my preceptor in recruiting target clinics were the programs can be effectively delivered.

I also prepared and distributed Target BP and C.C.C. Cholesterol evidence-based tools and

resources to the recruited target clinics. To increase awareness blood pressure and cholesterol, I

conducted presentations at two health fairs; Jackson State University Health Fair and the Jackson

Medical Mall health fair.

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The second goal was to achieve health equity in Metro Jackson area through the

establishment and monitoring of a local health equity committee. To achieve this goal, I

collaborated with the Preceptor in planning and implementing the first Metro Jackson Health

Equity Committee (HEC). I prepared the meeting reports that were presented to Preceptor, HEC

members and the Vice President of AHA. I also collaborated with the Preceptor to ensure that

the vision, and objectives of HEC meet AHA’s criteria for quality improvement programs and

key performance indicators. This was achieved by developing a logic model which served as an

evaluation matrix and guided the implementation of the key performance indicators. I prepared

meeting reports on the health equity initiatives identified by HEC members, assisted in

identifying the top priority and designed a checklist of key performance indicators to track the

progress of the health equity market strategies.

Challenges encountered while working in the team, with organizational leaders, and

stakeholders

As a resident, I collaborated with the preceptor to organize the first HEC meeting and two

subsequent HEC meetings thereafter. During the first HEC meeting, eleven of us were asked to

deliberate on the priority issues mentioned and make recommendations for alternative

approaches. Early on we floundered in an effort to find a focus. I suggested that we look at food

insecurity and its impact on cardiovascular disease. With my previous research experience in

food insecurity, I led a discussion about the pros and cons of that topic and encouraged a couple

of the more reticent members to chime in. Two of the group members did not initially embrace

the original proposal. However, the HEC workgroup leader was able to draw consensus and the

team agreed to focus on food insecurity among college students. We ended up working hard as a
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group, receiving very positive feedback from our Colleges and Universities Anti-hunger

Coalition partners – Extra Table and Partnership for healthy Mississippi.

I have two years of experience as a program evaluator at my previous public health job.

This helped me develop into a strong listener who can resolve conflict and ensure timely

completion of projects. My Preceptor was always re-directed to work on other projects unrelated

to my practicum and with tight deadlines. I always sat down with her and listened to her

concerns, and together we came up with a way that I could assist as a great input on the projects.

By being flexible, I assisted my preceptor to complete external projects successfully and on time.

Working in the nonprofit sector, I encountered things that interchangeably excite and

discourage me. As a non-profit organization, there is increased bureaucracy and constant focus

on fundraising. Project leaders are constantly pressured on the next fundraised dollar. This

constant pressure led to certain internal issues that sometimes lent itself to my mission drift.

What I would do differently if I could repeat the field experience?

If I could repeat the field experience, I would take extra time and get to know the

organizational culture and coworkers. I will take some time to shadow other AHA staff members

or sit through their workshops. I will also review an opportunity to focus on my own personal

goals, whether it is to empower my leadership team more or grow my understanding of the

evolving systems, and consequently build it into my plan.

The relevance of my project to my understanding of public health/community

health problem.

How the project advanced the organizations priorities

American Heart Association’s impact goal is to see a world of longer, healthier lives. The

priorities of the AHA in the United States is to fund cardiovascular medical research, educate
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consumers on healthy living and foster appropriate cardiac care in an effort to reduce disability

and deaths caused by cardiovascular disease and stroke (AHA, 2019). I recruited 15 clinics

which assisted my preceptor to meet her goal of 100,000 patients or more, The clinics received

evidence-based information and tools to support educational activities aimed at managing at least

70 percent of their patients with cardiovascular disease. The recruited clinics were required to

send their yearly data to AHA’s national office. The data will be used to improve efficiency of

the program and assess program efficacy.

The Metro Jackson Health Equity Committee supported AHA to implement initiatives,

programs, and resources that reduce cardiovascular health disparities in Jackson, Mississippi.

This project leveraged the efforts of strategic partners and community leaders, to support and

develop programs that will eliminate food insecurity particularly among college students in

Metro Jackson. This preventive approach aimed at improving health eating behaviors and

subsequently reduce cardiovascular disease.

How I feel about the approach the organization is taking to address the problem

AHA is taking a positive and comprehensive approach to tackle cardiovascular disease.

AHA partners with community clinics in the Metro Jackson area to implement the Target BP and

C.C.C. cholesterol initiatives to already diagnosed patients. Target BP helps health care

organizations, at no cost, improve BP control rates through an evidence-based quality

improvement program. AHA launched the Check. Change. Control. Cholesterol with support

from Sanofi and Regeneron, to improve the identification and management of cholesterol across

the nation. C.C.C. cholesterol aims to reduce the number of Americans who have heart attacks

and strokes by urging medical practices, health service organizations, and patients to screen and

treat this important risk factor.

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AHA also seeks to address the social determinants of health (SDOH) – the conditions in

the places where people live, learn, work, and play that affect a wide range of health risks and

outcomes (Centers for Disease Control and Prevention, 2018). HEC works in partnership with

other non-profit agencies (Extra Table and Partnership for Healthy Mississippi) and

organizations including the Mississippi Department of Health to create sustainable community

driven initiatives targeting cardiovascular disease risk factors.

What I would do differently if I could influence the leadership

Encourage the leadership to organize public health training workshops for non-public

health degree employees. This will expand their working knowledge of their field, broaden their

skill sets, and add new challenges and responsibilities to the public health programs being

initiated by AHA. This will also reinforce employees to fully understand their roles, influence

process ownership and accountability in AHA.

I would encourage the leadership to devise sustainable means of reaching non-insured

populations. In 2014, 21.90 percent adults aged 18 to 64 in Mississippi had no health insurance

compared to 8.7 percent of all U.S. adults (Open Data Network, 2019). This could suggest that

about 1 in 5 adults with cardiovascular disease may not have access to healthcare until a health

emergency occurs, thereby increasing rate of death and disability from heart disease.
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References

American Heart Association (2019). Professional heart daily: Research. Retrieved from

https://professional.heart.org/professional/ResearchPrograms/UCM_316889_Research.js

Centers for Disease Control and Prevention (2018). Social Determinants of Health: Know what

affects health. Retrieved from https://www.cdc.gov/socialdeterminants/index.htm

Open Data Network (2019). Data for Mississippi. Retrieved from

https://www.opendatanetwork.com/entity/0400000US28/Mississippi/health.health_insura

nce.pctui?year=2014&age=18%20to%2064&race=All%20races&sex=Both%20sexes&in

come=All%20income%20levels