Several schools have developed training experiences to encourage students to increase social responsibility and improve community service attitudes. Although service learning is being integrated into college and university classrooms at an ever-increasing pace, it is not clear whether these experiences reinforce pre-existing interests or can motivate previously uninterested students to consider careers in healthcare.

Research has found that participation in volunteer service positively corresponds to promoting cultural competency and continuous community service involvement. The findings of the current study were consistent with previous research on service learning, although this study explored two additional specific outcomes: social responsibility and cultural competency.

The purpose of the quantitative causal-comparative study was to identify differences in attitudes toward service learning, cultural competence, and social responsibility of undergraduate health professions students at a southeastern university in Tennessee, before and after they participated in an outside classroom service-learning activity. Pre and post-surveys were administered to participants assessing their attitudes toward community service, using the Community Service Attitudes Scale, social responsibility development, using the Scale of Service Learning Involvement, and cultural competence, using the Cultural Competence Awareness model. 

Academic centers that advocate and adopt service-learning policies as an integral part of higher education in health promotion and disease prevention provide health professionals with opportunities for reflection on the broader social, economic, and political contexts of health (Sabo et al., 2015).

The collaboration between communities and academic centers can improve community-based health education programs, through the use of health fairs, while meeting the goals of health promotion and disease prevention in underserved communities (Kamau-Small, Joyce, Bermingham, Roberts, & Robbins, 2015.).

Service-learning programs are a response to the all-encompassing social determinants and health education needs of underserved community populations providing both an educational benefit to the public and a service learning component to students (Lichtenstein et al., 2017). When the educational system begins to embed the social responsibility concept within the health care system, the collaboration becomes a focused health agenda to address needs, such as cultural competency and social determinants of health, by teaching awareness, compassion, and social responsibility to the public and students (Lichtenstein et al., 2017).  

Researchers revealed that partnerships between academic centers and underserved communities can successfully address the health care and health education needs of these communities (Phillips et al., 2015; Sabo et al., 2015), while at the same time addressing the cultural competency and social responsibility needs of health professions students.

Researchers indicated that a well-structured, mentored experience that involved medical students and underserved populations had a positive impact on medical students’ attitudes and interest in servicing underserved populations, while at the same time providing access to health care and health education for underserved communities (LaVeist & Pierre, 2014). Rural communities have many different characteristics from urban communities regarding proximity access to health facilities and health promotion programs (Phillips, Street, & Haesler, 2015).

The need for rural underserved communities to increase health literacy and have sustainable programs is dependent upon the outreach of knowledgeable health professionals (Phillips et al., 2015; Sabo et al., 2015). Increased knowledge and health outcomes in underserved communities is dependent upon partnerships and collaborations that can address the knowledge deficiency in underserved communities while providing best practices and prevention methods to promote healthy lifestyles (Phillips et al., 2015). 

Service learning is being integrated into college and university classrooms at an ever-increasing pace; however, it is not clear whether these experiences reinforce pre-existing interest or have the ability to motivate previously uninterested students to consider careers in underserved communities (Sabo et al., 2015).

Community service prepares students for adulthood and citizenship by sensitizing them to community needs and showing them how their time and talents can make a difference in their community (Warren & Smalley, 2014). The problem was past studies have not addressed the development of social responsibility, awareness of cultural competence, and changes in attitudes towards service learning in health professions students (Sabo et al., 2015; Warren & Smalley, 2014).

Current research on community service to date lacked exploration of how attitudes about community service and other dispositional characteristics, such as social responsibility and cultural competence that are indicative of volunteering and helping are impacted in those who volunteer (Washington-Brown & Ritchie, 2014). Research exists on the impact of service learning on students within particular professional programs, or variables that impact student decisions regarding lifelong community service, cultural competency, and social responsibility.

The purpose of this quantitative causal-comparative study was to identify differences, if any existed, in the attitudes towards community service, cultural competence, and social responsibility development of undergraduate health professions students at a southeastern university in Tennessee, before and after they participated in a service learning activity in an underserved community in comparison to undergraduate health professions students that did not participate in the service learning activity. However, due to the COVID-19 pandemic impacting the recruitment of study participants, thereby limiting the number of participants, it was not possible to have a comparison group of undergraduate health professionals who did not participate in the service learning activity for the current research. Students’ attitudes toward community service, social responsibility development, and cultural competence were compared between pre-and post-intervention.

The benefits of this study included measuring change in students’ attitudes of participation in service-learning programs, awareness of social responsibility, and cultural competence skills. This could ultimately benefit communities, through health education provision within communities and greater collaboration between universities to assist in problem-solving and solution/capacity building in communities, which provides students with learning sites and communities with education, resources, and tools to helps residents. Sustainable models for community-based educational programs have been recommended as one resolution to reduce the problem of health disparities in the United States (Santos et al., 2017).


Astin, A. W. & Sax L., (1998). How undergraduates are affected by service participation, 

Journal of College Student Development, 39 (3), 251-263. Retrieved from 

Bakshi, S., James, A., Hennelly, M. O., Karani, R., Palermo, A. G., Jakubowski, A., et al. (2015). The human rights and social justice scholars program: A collaborative model for preclinical training in social medicine. Annals of Global Health, 81(2), 290-297. Retrieved from 

Bhate, T., and Loh, C. (2015). Building a generation of physician advocates: The case for 

including mandatory training in advocacy in Canadian medical school curricula. Academic Medicine, 90(12), 1602-1606. doi:10.1097/ACM.0000000000000841 

Brandes, K., & Randall, K. (2011). Service learning and civic responsibility: Assessing aggregate and individual level change. International Journal of Teaching and Learning in Higher Education, 23(1), 20-29. Retrieved from 

Brandão, C., Rego, G., Duarte, I., & Nunes, R. (2012). Social responsibility: a new paradigm of

hospital governance? Health care analysis: HCA: journal of health philosophy and policy, 21(4), 390-402. Retrieved from 

Campbell, D. T., & Stanley, J. C. (1963). Experimental and quasi-experimental designs for

research. Handbook of research on teaching. Chicago, IL: Rand McNally.

Creswell, J. W. (2002). Educational research: Planning, conducting, and evaluating quantitative (pp. 146-166). Upper Saddle River, NJ: Prentice Hall.

Davies, M., & Hughes, N. (2014). Doing a successful research project: Using qualitative or 

quantitative methods. Basingstoke England: Palgrave Macmillan.

Dewey, J. (1916). Democracy and education: An introduction to the philosophy of education

New York: MacMillan.

Dharamsi, S., Espinoza, N., Cramer, C., Amin, M., Bainbridge, L., & Poole, G. (2010). Nurturing social responsibility through community service-learning: Lessons learned from a pilot project. Medical Teacher, 32(11), 905-911. Retrieved from 

Dharamsi, S., Richards, M., Louie, D., Murray, D., Berland, A., Whitfield, M., & Scott, I. 

(2010). Enhancing medical students’ conceptions of the CanMEDS HealthAdvocate Role through international service-learning and critical reflection: A phenomenological study. Medical Teacher32(12), 977-982. doi:10.3109/01421590903394579

Essa-Hadad, J., Murdoch-Eaton, D., & Rudolf, M. (2015). What impact does community service learning have on medical students’ appreciation of population health? Public Health, 129(11), 1444-1451. Retrieved from 

Ezeonwu, M., Berkowitz, B., & Vlasses, F.R. (2014). Using an academic-community partnership

model and blended learning to advance community health nursing pedagogy. Public Health Nurs. 31(3), 272-280. doi:10.1111/phn.12060

Faul, F., Erdfelder, E., Lang, A. G., & Buchner, A. (2007). G*Power3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39(2), 175-191. doi:10.3758/BF03193146

Goodall, J. (2012) Beyond the ward and waiting room: A community-based non-clinical 

placement programme for Australian medical students, Medical Teacher, 34(12), 1070-1074. doi:10.3109/0142159X.2012.719655 

Haq, C. (2017). The Path to Health Equity Through Multidisciplinary Collaboration. Journal of Patient-Centered Research and Reviews4(4), 208-210. doi: 

Haubert, J., & Williams, G. (2015). The rocha Nicaragua project: Using research to build

relationships in international service learning. Humanity & Society, 39(2), 170–188. 


Hayward, L. M. & Charrette, A. L. (2012). Integrating cultural competence and core values: An international service-learning model. Journal of Physical Therapy Education(26)1, 78-89. Retrieved from 

Heck, J., Currie, C., & Fagan, E. B. (2017). Mountain area health education center

expands training in family medicine and adds new programs in psychiatry and 

general surgery. North Carolina Medical Journal, 78(1), 67-70. doi: 10.18043/ncm.78.1.67

Hines-Martin V & Nash W (2017). Social justice, social determinants of Health, 

interprofessional practice and community engagement as formative elements of a nurse practitioner managed health center. International Journal of Nursing & Clinical Practices, 4, 218-223. doi: 10.15344/2394-4978/2017/218

Howell, D. (2012). Statistical Methods for Psychology (8th ed.). Boston, MA: Cengage Learning.

Johnson, L. G., & Baker, B. L. (2015). Implementing service-learning through a community-

based fitness program. Kinesiology Review, 4(4), 398–402. Retrieved from 

Jones, K., Blinkhorn, L. M., Schumann, S. A., & Reddy, S. T. (2014). Promoting sustainable

community service in the 4th year of medical school: a longitudinal service-learning elective. Teach Learn Med. 2014;26(3):296-303. doi:10.1080/10401334.2014.911698

Kamau‐Small, S., Joyce, B., Bermingham, N., Roberts, J., & Robbins, C. (2015). The impact of the care equity project with community/public health nursing students. Public Health Nursing, 32(2), 169-176. doi:10.1111/phn.12131

Kim, S. H., & Kim, S. (2016). National culture and social desirability bias in measuring public

service motivation. Administration & Society, 48(4), 444-476. Retrieved from 

Kohn-Wood, L., & Hooper, L. (2014). Cultural competency, culturally tailored care, and the primary care setting: Possible solutions to reduce Racial/Ethnic disparities in mental health care. Journal of Mental Health Counseling, 36(2), 173-188. Retrieved from

Kratzke, C., & Bertolo, M. (2013). Enhancing students’ cultural competence using cross-cultural experiential learning. Journal of Cultural Diversity, 20(3). Retrieved from

Kwenani, D., & Yu, X. (2019). Maximizing international students’ service-learning and community engagement experience: A case study of student voices on the benefits and barriers. Journal of Higher Education Outreach and Engagement, 22(4), 29-52. Retrieved from

Lahav, O., Daniely, N., & Yalon-Chamovitz, S. (2018). Interpersonal social responsibility model of service learning: A longitudinal study. Scandinavian Journal of Occupational Therapy25(1), 61-69. doi: 10.1080/11038128.2017.1335775

Lai, K. H. (2009). Developing leadership and cultural competency through service exposure

attachment program. New Horizons In Education, 57(3) [Special Issue] Retrieved from

LaVeist, T. A., & Pierre, G. (2014). Integrating the 3Ds–social determinants, health disparities, and health-care workforce diversity. Public Health Reports (Washington, D.C.: 1974), 129 Suppl 2, 9-14. doi:10.1177/00333549141291S204

Lichtenstein, C., Hoffman, B.D., Moon, R.Y (2017). How do US pediatric residency programs teach and evaluate community pediatrics and advocacy training. Academic Pediatrics, 17(5), 544-549. doi:10.1016/j.acap.2017.02.011

Martinek, T., & Hellison, D. (2016). Teaching personal and social responsibility: Past,

present and future. Journal of Physical Education, Recreation & Dance, 87(5), 9-

13. doi:10.1080/07303084.2016.1157382 

McDonough, M. L., Marks, L., & Harris, L. (2017). A truly inspiring notion: A case-study of project-based graduate service-learning. Partnerships: A Journal of Service-Learning and Civic Engagement, 8(2), 63-78. Retrieved from

McMenamin, R., Mc Grath, M., Cantillon, P., & Mac Farlane, A. (2014). Training socially responsive health care graduates: Is service learning an effective educational approach? Medical Teacher, 36(4), 291-307. Retrieved from

McQueen, A., Kreuter, M. W., Kalesan, B., & Alcaraz, K. I. (2011). Understanding narrative effects: The impact of breast cancer survivor stories on message processing, attitudes, and beliefs among African American women. Health Psychology, 30(6), 674-682.

Meili, R., Fuller, D., & Lydiate, J. (2011). Teaching social accountability by making the links: Qualitative evaluation of student experiences in a service-learning project. Medical Teacher, 33(8), 659-666. Retrieved from

Meurer, L. N., Young, S. A., Meurer, J. R., Johnson, S. L., Gilbert, I. A., & Diehr, S. (2011). The urban and community health pathway: Preparing socially responsive physicians through community-engaged learning. American Journal of Preventive Medicine, 41(4), S228-S236. Retrieved from

Nicoll, K. L., Richards-Schuster, K., & Ruffolo, M. C. (2018). Beyond service-learning: 

helping undergraduates define and plan for lives of civic engagement at the University of Michigan. In T. D. Mitchell & K. A. Soria (Eds.). Educating for citizenship and social Justice: Practices for engagement at research universities (pp. 99-112). London: Palgrave Macmillan. doi :10.1007/978-3-319-62971-1_8

Oelke, N. D., Thurston, W. E., & Arthur, N. (2013) Intersections between interprofessional practice, cultural competency and primary healthcare. Journal of Interprofessional Care, 27(5), 367-372, doi: 10.3109/13561820.2013.785502

Olney, C., & Grande, S. (1995). Validation of a scale to measure development of social responsibility. Michigan Journal of Community Service Learning, 2, 43-53. doi: 


Palombaro, K., Dole, R. and Black, J. (2015). Curricular integration and measurement of cultural

competence development in a group of physical therapy students. Journal of the Scholarship of Teaching and Learning, 15(5), 82-96. Retrieved from

Papadopoulos, I., Shea, S., Taylor, G., Pezzella, A., & Foley, L. (2016). Developing tools 

to promote culturally competent compassion, courage, and intercultural communication in health care. Journal of Compassionate Health Care3(1), 1-10. doi:10.1186/s40639-016-0019-6

Papadopoulos, I., Tilki, M., & Lees, S. (2004). Promoting cultural competence through a 

research based intervention in the UK. Diversity in Health and Social Care. 1. 107-116. Retrieved from

Papadopoulos, I., Tilki, M., & Taylor, G. (1998). Transcultural care: A guide for health care professionals.  New York, NY : Quay Books. doi:10.1177/1043659614524790

Pearl, A. J., & Christensen, R. K. (2017). First-year student motivations for service-learning: An exploratory investigation of minority student perceptions. Journal of Higher Education Outreach and Engagement21(4), 117-138. Retrieved from

Phillips, N. M., Street, M., & Haesler, E. (2015). A systematic review of reliable and valid tools for the measurement of patient participation in healthcare. BMJ Quality & Safety, 25(2), 110-117. doi:10.1136/bmjqs-2015-004357 

Rife, J. E. (2015). The effects of service-learning courses and traditional lecture courses on students’ academic achievement and level of course engagement (Doctoral dissertation, Liberty University, United States). Retrieved from

Ritten, A., Waldrop, J., & Wink, D. (2015). Nurse practitioner students learning from the

medically underserved: Impact on attitude toward poverty. Journal of Nursing Education, 54(7), 389-393. Retrieved from

Sabo, S., de Zapien, J., Teufel-Shone, N., Rosales, C., Bergsma, L., & Taren, D. (2015). Service learning: A vehicle for building health equity and eliminating health disparities. American Journal of Public Health, 105(S1), S38-S43. doi:10.2105/AJPH.2014.302364 

Santos, S.L.Z., Tagai, E.K., Scheirer, M.A., Bowie, J, Haider, M, Slade, J, Wang, M.Q., & Holt, C.L. (2017). Adoption, reach, and implementation of a cancer education intervention in African American churches. Implementation Science, 12(36), 1-11. doi:10.1186/s13012-017-0566-z

Setó-Pamies, D., & Papaoikonomou, E. (2016). A multi-level perspective for the

integration of ethics, corporate social responsibility and sustainability (ECSRS) in

management education. Journal of Business Ethics, 136(3), 523-538.

doi: 10.1007/s10551-014-2535-7 

Shiarella, A. H., McCarthy, A. M., & Tucker, M. L. (2000). Development and construct validity of scores on the community service attitudes scale. Educational and Psychological Measurement60(2), 286-300. doi:10.1177/00131640021970510 

Tabachnick, B.G. & Fidell, L.S. (2012) Using Multivariate Statistics (6th ed.), Boston: Person Education.

Tucker, B. G., Kazmer, D. O., Bielefeldt, A. R., Paterson, K., Pierrakos, O., Soisson, A., et al. (2014). Principles of sustaining partnerships between higher education and their larger communities: Perspectives from engineering faculty engaged in learning through service. [Special Edition]. International Journal for Service Learning in Engineering, 48-63. doi: 10.24908/ijsle.v0i0.5131

Ventres, W., Kravitz, J. D., & Dharamsi, S. (2018). PEARLS+: Connecting societal forces, social determinants, and health outcomes. Academic Medicine93(1), 143. doi: 10.1097/ACM.0000000000002012

Voss, H. C., Mathews, L. R., Fossen, T., Scott, G., & Schaefer, M. (2015). Community–academic partnerships: Developing a service–learning framework. Journal of Professional Nursing, 31, 395-401. doi: 10.1016/j.profnurs.2015.03.008 

Warren, J. C., & Smalley, K. B. (2014). Rural public health: Best practices and preventive models. New York, NY: Springer Publishing Company. 


Wartman, S. A., & Steinberg, M. J. (2011). The role of academic health centers in addressing social responsibility. Medical Teacher, 33(8), 638-642. Retrieved from

Washington-Brown & Ritchie (2014). The fundamentals of integrating service in a post-licensure RN to BSN program. ABNF Journal, 25(2), 46. Retrieved from

Yun and Weaver (2010) Yun, S. H., Weaver, R. (2010). Development and validation of a short 

form of the attitudes toward poverty scale. Advances in Social Work, 11(2), 174–187. Retrieved from