Long-Term Impact of an Interprofessional Health Promotion Curriculum in Healthcare Students.

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Learn more: PMC Disclaimer | PMC Copyright Notice Med Sci Educ . 2025 Mar 3;35(3):1529–1536. doi: 10.1007/s40670-025-02347-2 Long-Term Impact of an Interprofessional Health Promotion Curriculum in Healthcare Students Magdalena Pasarica 1, 2, ✉ , Katherine Daly 1 , Asli C Yalim 1 , Denise Kay 1 , Ardhys DeLeon 1 , Laurie C Neely 1 , Desiree A Díaz 1 , Monica Bailey 1 Author information Article notes Copyright and License information 1 University of Central Florida, Academic Health Science Center, Orlando, FL USA 2 UCF College of Medicine, 6850 Lake Nona Blvd, Orlando, FL 32827-7408 USA ✉ Corresponding author. Accepted 2025 Feb 20; Collection date 2025 Jun. © The Author(s) under exclusive licence to International Association of Medical Science Educators 2025. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. PMC Copyright notice PMCID: PMC12228853  PMID: 40625945 Abstract Introduction Health promotion (HP) curricula are essential for health professions education but currently lack strong long-term evidence for effectiveness. This project aimed to evaluate the multilevel long-term impact of an HP curriculum on healthcare students. Methods An HP curriculum incorporating ten evidence-based interventions was implemented for healthcare students. Participants’ reactions and impact on learning, HP behaviors, and well-being change were collected through electronic surveys administered pre-, post-, and 6 months post-curriculum. Data analysis was conducted using STATA, Mplus, and ATLAS.ti. Results A total of 552 students (medical, nursing, counseling, physical therapy, and social work) completed the HP curriculum. Participants demonstrated improved awareness of distress factors ( p < 0.01) and perceived value of ( p < 0.01) and willingness to engage in HP behaviors ( p < 0.01). Willingness to try HP interventions correlated significantly with perceived value ( r = 0.73, p < 0.05). Most students (92%, n = 505) adopted HP interventions, with the highest rates for healthy sleep (23%, n = 146) and exercise (18%, n = 117). Six months post-curriculum, 92% of 153 respondents confirmed improved health and well-being, particularly in mood (33%, n = 51) and reduced stress (19%, n = 29). Overall, 47% ( n = 258) valued the HP curriculum. Interestingly, medical students reported the lowest perceived value among professions ( p < 0.01). Discussion This study demonstrates the long-term effectiveness of an interprofessional HP curriculum, addressing all levels of the Kirkpatrick pyramid (reaction, knowledge, behavior, and results). Conclusion This HP curriculum offers a scalable solution for academic institutions aiming to enhance and sustain the health and well-being of healthcare students. Keywords: Health promotion, Interprofessional, Curriculum, Interventions, Kirkpatrick pyramid Introduction Healthcare professionals serve on the frontlines during natural emergencies and crises and are required to continually adapt to dynamic situations while maintaining their professional roles under significant threats to their well-being. The impact of these unavoidable threats can be mitigated by developing and applying resilience skills for health promotion [ 1 ]. Within the context of healthcare, it is essential to recognize engagement in health promotion as a protective factor for overcoming adversity during crises, but also as a dynamic process of transformation, learning, and development [ 2 ]. Recent data shows that healthcare students report higher stress and lower well-being compared to professionals in practice [ 3 ], highlighting the urgent need to focus on health promotion (HP) for students. Without learning effective coping mechanisms for professional challenges and strategies for sustaining healthy functioning, these students, who represent the future healthcare workforce, may become increasingly vulnerable to stress and related health issues. Healthcare students report using various health-promoting behaviors to manage stress, such as exercising, listening to music, and practicing mindfulness. However, they also divulge engaging in disruptive behaviors, including substance use (drugs, alcohol), smoking, excessive social media involvement and eating, and pornography [ 3 ]. While they perceive these behaviors as temporarily relieving stress, these strategies are not sustainable or beneficial in the long term. This underscores the critical need for a curriculum that integrates evidence-based health-promoting strategy to help students effectively manage the high demands characteristic of healthcare professions. HP curricula for healthcare professionals and students have gained momentum over the years [ 4 ]. Individual-level interventions were proven to improve medical student well-being including well-being, stress, anxiety, depression, suicidal ideation, positive feelings, burnout, and resilience [ 5 ]. However, as clearly demonstrated by a recent review of individual-level interventions, the evidence of effectiveness is of low quality and often studied for short periods (immediately post interventions, and up to 4 to 8 weeks after intervention), lacking long-term effectiveness [ 5 ]. Additionally, previous studies have largely examined HP interventions within single health profession [ 5 – 8 ] rather than assessing the benefits of an interprofessional approach. For example, in the past two decades, 94 wellness studies were conducted for medical students, involving more than 17,000 students worldwide [ 5 ] and 36 studies were conducted for nursing students, involving almost 3000 students [ 8 ]. Given that healthcare delivery increasingly relies on interprofessional collaboration, there is a pressing need to investigate whether a shared HP curriculum can effectively promote well-being across different disciplines. Most often, only one intervention for HP is offered to study participants. Phan et al. described 77 wellness studies using mindfulness [ 9 ]; Cohen et al. described 13 studies using yoga [ 10 ]; Donnelly et al. described 58 physical activity studies [ 11 ]; Rachman et al. describe 13 studies focused on nutrition [ 12 ]. However, offering a variety of interventions targeting both mind and body may appeal to more students, depending on their preferences and resources and ultimately increase engagement and the likelihood of sustained behavior change. To address this gap, we designed an HP curriculum for students across multiple health professions, fostering interprofessional collaboration while engaging in eight mind and body interventions. This study evaluates both the short-term effects and, more importantly, the long-term impact at 6 months post-curriculum. The purpose of this project was to study the multilevel long-term effects of an evidenced based, interprofessional HP curriculum designed by an interprofessional team of faculty represented by nursing, social work, counseling, medicine, and physical therapy for their students. The goal was to address the unique challenges faced by health professional students across these disciplines. Our long-term goal was to equip future healthcare providers with skills shown to be effective in promoting their health during day-to-day challenges and/or in crisis situations, in other words, to put health back in health professions. Methods Setting and Participants The HP curriculum was developed and implemented at the University of Central Florida Academic Health Science Center as a component of the interprofessional curriculum with medical, nursing, physical therapy, social work, and counseling students. The study was approved by the University of Central Florida’s Institutional Review Board (IRB ID #STUDY00004564). HP Curriculum Description The development and content of the HP curriculum were previously described [ 13 ]. Briefly, the HP curriculum addressed competencies of the Interprofessional Education Collaboration and Lifestyle Medicine and focused on ten evidence-based HP interventions (body interventions—nutrition, sleep, yoga, physical activity, active rest, and mindfulness/cognitive behavior, emotional freedom, acceptance and commitment, emotional intelligence, psychological detachment). The HP curriculum lasted 5 weeks and contained asynchronous interactions between students and faculty. Students were asked to individually review two out of ten educational modules depicting scientific evidence for the HP interventions chosen, then practice each one for 1 week and reflect on their experience. As a team, students were asked to identify signs and sources of distress in healthcare team members, evaluate the evidence for each of the HP interventions selected, identify signs of team distress in a simulated case, recommend appropriate HP interventions, and finally promote one HP intervention with a mini poster. Study Design The study was part of the quality improvement intervention of the educational program and, therefore, required participants to complete the pre- and post-assessment data but not the post-6 monthly data. Data was collected from January to March 2023, using de-identified electronic surveys (Appendix) on the Qualtrics platform which was linked to the course materials. Pre-HP curriculum students reported their demographics, beliefs, and attitudes about HP interventions. Post-HP curriculum, the effect of the educational intervention was studied using the Kirkpatrick four-level approach [ 14 ], which studies outcomes based on four hierarchical “levels” of HP curriculum outcomes. We studied the perception of students about the HP curriculum value (level 1), changes in beliefs and attitudes about HP interventions (level 2), and changes in adopting HP behaviors for their own health (level 3). Six months post-HP curriculum, students reported the impact of the HP curriculum on their health and well-being (level 4). Survey items included either a 5-point Likert scale ranging from strongly agree [ 5 ], agree [ 4 ], neutral [ 3 ], disagree [ 2 ], and strongly disagree [ 1 ] or allow for free text answers (as in Appendix). Data Analysis Descriptive statistics, paired sample t -tests, and correlation analyses were performed using STATA v16.1. Statistical significance was set at p < 0.05. Additionally, latent change scores were analyzed using Mplus v8.5 to assess the magnitude of change from pre- to post-HP curriculum. The model accounted for both measurement error and the temporal nature of the data. Qualitative data was analyzed using the Braun and Clarke method for reflexive analysis [ 15 ], a methodology appropriate for analyzing narrative comments are personal narratives that explore lived experiences. First, all responses were reviewed to identify initial patterns. Key phrases and recurring concepts were then systematically coded using ATLAS.ti 23. These coded data were grouped into broader themes reflecting changes in health behaviors and well-being. Emerging themes were refined and validated by the authors to enhance consistency and credibility. Once finalized, the themes were clearly defined and named to represent students’ lived experiences with the HP curriculum. Finally, qualitative findings were synthesized with quantitative results to provide a comprehensive understanding of the curriculum’s long-term impact. Results Participant Demographics A total of 552 students completed the HP curriculum, which included the pre-post surveys, leading to a 100% response rate for these time points. Most students were between 20 and 29 years old (91%, n = 503) and women (68%, n = 276) representing a variety of races and ethnic backgrounds. Most participants were medical students (39.5%, n = 218) and nursing students (36.4%, n = 201) who worked in interprofessional teams with social work, counseling, and physical therapy students (Table 1 ). Table 1. Demographics from participants ( n = 552) who completed the Interprofessional Education Health Promotion HP curriculum offered at the University of Central Florida, Academic Health Sciences Demographic characteristics Age n (%) 19 and under 7 (1.27%) 20–29 years 503 (91.1%) 30–39 years 20 (3.6%) 40–49 years 10 (1.8%) 50–59 years 2 (0.4%) 60 and over 10 (1.8%) Sex Male 163 (29.5%) Female 376 (68.1%) Gender not reported 13 (2.4%) Race American Indian or Alaska Native 2 (0.4%) Asian 98 (17.8%) Black or African American 35 (6.3%) Native Hawaiian or Pacific Islander 4 (0.7%) White 345 (62.5%) More than one race 37 (6.7%) Race not reported 31 (5.6%) Ethnicity Hispanic/Latino 97 (17.6%) Non-Hispanic/Latino 433 (78.4%) Ethnicity not reported 22 (4%) Health profession Medical students 218 (39.5%) Nursing students 201 (36.4%) Physical therapy students 29 (5.3%) Counseling students 23 (4.2%) Social work students 78 (14.1%) Disadvantaged background Economically disadvantaged 58 (10.5%) Educationally disadvantaged 8 (1.5%) Environmentally disadvantaged 10 (1.8%) Non-disadvantaged background 467 (84.6%) Not reported 9 (1.6%) Open in a new tab Perception of Value for the HP Curriculum (Kirkpatrick Level 1) Almost half of the students (47%, n = 258,) strongly agreed/agreed that the HP curriculum was valuable for the promotion of their health and well-being, while only 28% ( n = 157) disagreed/strongly disagreed with the value of the HP curriculum. There is a greater value reported among women ( p < 0.05), older students ( p < 0.001), and Hispanic students ( p < 0.05). Of all the professions, counseling students appreciate the HP curriculum the most and medical students the least ( p < 0.001). Impact on Beliefs and Attitudes About HP Post-HP Curriculum (Kirkpatrick Level 2) The HP curriculum significantly improved awareness of the factors that contribute to distress in health professional teams ( p < 0.01, Cohen’s d = 0.4) and beliefs about the value of ( p < 0.01, Cohen’s d = 0.5) and willingness to try the health promotion interventions ( p < 0.01, Cohen’s d = 0.5) as in Fig. 1 . Willingness to try health promotion interventions was significantly correlated with the perceived value of the interventions reported post-HP curriculum ( r = 0.73, p < 0.05). Fig. 1. Open in a new tab Beliefs and attitudes immediately post- and pre-the HP curriculum. The HP curriculum significantly improved awareness of the factors that contribute to distress in health professional teams ( p < 0.01) and beliefs about the value of ( p < 0.01) and willingness to try the health promotion interventions ( p < 0.01) Impact on Students’ Behavior for HP Post- vs. Pre-HP Curriculum (Kirkpatrick Level 3) When asked about an intervention they implemented as a result of the HP curriculum (Fig. 2 ), the majority of students (92%, n = 508) reported implementing interventions, and only 8% ( n = 44) indicated that they had not implemented any intervention for HP following the curriculum. Some students reported one, while others reported more interventions, for a total of 625 reports for 552 students. Most reports involved interventions targeting the body (72%, n = 457) vs. interventions targeting the mind (20%, n = 121). The interventions with the highest implementation were sleep (23%, n = 146), including changes such as implementing sleep hygiene or taking naps and exercise (18%, n = 117), including working out and walking. These were followed from most to least by the other interventions learned in the HP curriculum: yoga, active rest, mindfulness, nutrition, psychological detachment, emotional intelligence, emotional freedom, and acceptance and commitment. Fig. 2. Open in a new tab Change in students’ health promotion behaviors as a result of the HP curriculum. Students answered the free text question: What is one health-promoting practice that you started or plan to implement in the next four weeks as a result of this course? A total of 625 codes were gathered from the respondents Impact on Health and Well-Being 6 Months Post-HP Curriculum (Kirkpatrick Level 4) A total of 153 students responded to the survey 6 months post-HP curriculum (27% response rate) about the impact of the HP curriculum. The majority of students (92%, n = 141) reported long-term improvements and only 8% ( n = 12) reported no improvement. Most reported improvements in mood (33%, n = 51) and decreased stress (19%, n = 29), followed by increases in energy, well-being, relaxation, productivity, work-life balance, and sleep (see Fig. 3 ). Fig. 3. Open in a new tab Impact of the HP curriculum 6 months after implementation. Students answered the free text question: How has the health promotion HP curriculum affected your well-being? A total of 153 codes were gathered from the respondents Discussion This study demonstrates the long-term effectiveness of a comprehensive interprofessional HP curriculum, achieving measurable outcomes across all levels of the Kirkpatrick pyramid—an exceptional accomplishment for an educational program [ 16 ]. As a result of the HP curriculum, students improved their knowledge and attitude towards evidence-based HP interventions and changed their behavior to incorporate HP interventions, which resulted in improvement in their health and well-being in only 6 months. A strength of the HP curriculum is the large number of students participating (552) from multiple health professions. While many health promotion HP curricula are focused on time-limited stress (i.e., coping with anatomy, preparing for exams), this HP curriculum offers a step-up approach to give future healthcare professionals skills to adapt to the stressors encountered now but also later in their professional careers. A 6-month improvement in mood and stress (among other health benefits) is very encouraging and represents a strong indication that the HP curriculum may enhance the health and well-being of our students for years to come in their professional lives. The long-term findings of this study highlight the sustained impact of the HP curriculum on students’ behaviors and well-being, reinforcing its effectiveness beyond immediate implementation. Even if only a small percentage of students (8%) report no improvements in their health, future studies should investigate the characteristics and perhaps preferences of this population. Adapting the curriculum to the habits of those who valued the curriculum least (men, young students, and medical students) could offer some viable solutions. Additionally, we do acknowledge that sustainable change requires addressing structural and organizational barriers [ 17 – 19 ]. Institutions can use these findings to inform policies that integrate health-promoting practices into the educational and clinical environments, such as incorporating protected time for self-care, optimizing workload distribution, and fostering a culture that prioritizes well-being alongside productivity. Additionally, leadership engagement in well-being initiatives, increased access to mental health resources, and curriculum adjustments that normalize self-care behaviors could enhance the systemic impact of such programs. It is interesting to note the differences in the perception of value for medical students vs. counseling students. Counseling students would likely appreciate the HP curriculum more because it aligns more closely with their professional focus on behavior change, mental health, and holistic well-being. On the other hand, medical students might appreciate it the least because their curriculum is heavily focused on diagnosis, treatment, and acute care, often leaving little room for broader health promotion principles. Perhaps the overall expectations from the profession or the approach of the HP curriculum should be adjusted. Moreso, this study shows the importance of HP integration into the curriculum, as most students agreed that making time for engagement in HP behaviors is important. It is a reason for hope for the future generation of healthcare providers. Interestingly, the gain in willingness for HP interventions is higher in those who valued the HP interventions more. This shows that the focus on demonstrating the evidence-based value of HP interventions was an effective approach. The participants in this study gravitated towards adopting interventions targeting the body such as sleep and exercise. Onsite fitness areas, napping lounges, and tower gardens may be an important first step for buy-in. Perhaps this is in part due to the control students have over their physical well-being and the less control they have over the other domains if the learning environment isn’t adjusted to allow for health-promoting behaviors. Institutions should focus on interventions targeted at changing the learning environment to allow for the development and sustainability of targeted skills in the domains of cognitive behavior, acceptance and commitment, and emotional intelligence. Even though this study reports the effects of the HP curriculum at all four levels of educational impact, a limitation of this study is that it relies on self-reported data. The next step is to study the outcomes that are objectively measured for a longer period after graduation and employment. Including protected health information and turnover in healthcare systems may shed additional light on the long-term impact. The findings of this study are also limited by implementation in only one institution. However, the variety of professions and diversity of demographics may alleviate this limitation and may represent an opportunity for future large national studies. Only one-third of the participants answered the 6-month follow-up assessment, which is a big percentage considering that the prompt was an email. Nevertheless, this may impact the generalizability of the long-term findings. While this study did not specifically analyze differences between those who participated in follow-up and those who did not, future research could explore demographic or professional differences in follow-up engagement. One hypothesis is that the most healthy and motivated participants may continue with the health-promoting efforts. Understanding which populations are more or less likely to participate in long-term assessments could help identify systemic or environmental barriers to sustained health-promoting behaviors. Factors such as institutional culture, hidden curricula discouraging self-care, or work-life balance challenges may contribute to differential participation rates. We designed this curriculum to prepare future healthcare professionals to successfully adapt to the stressors they may encounter at different points in their professional continuum by considering the well-being of themselves and those around them, and this is a strength. This aligns with trends in well-being interventions, shifting from individual to broader environmental, cultural, and system-level influences that degrade well-being [ 20 ]. Shanafelt eloquently describes the evolution of health well-being in healthcare by dividing it into three eras: the era of distress, the era of well-being, and the future era, focusing on organizational systems that support health and well-being and promote characteristics such as vulnerability, compassion, and work-life integration [ 21 ]. The next step is to deliver the HP curriculum to healthcare professionals, healthcare teams, and administrators to address the issues at a system level. This HP curriculum provides a scalable approach for academic institutions seeking to enhance and sustain the health and well-being of healthcare students. While individual well-being is crucial, its long-term sustainability is also influenced by broader systemic factors. Larger national studies are needed to develop robust, generalizable strategies that not only support individual health-promoting behaviors but also address structural barriers within healthcare systems. These efforts can contribute to a more balanced approach of wellness-minded healthcare systems that benefit healthcare professionals, their teams, and the patients they serve. Appendix. Survey Items for HP Curriculum Survey Deployed Pre-HP HP Curriculum Multiple Choices Provided 1. What is your discipline? 2. What is your age? 3. What is your gender identity? 4. What is your race? 5. What is your ethnicity? 6. Do you have a disadvantaged background (economically, educationally, or environmentally)? Economically disadvantage is defined as a person whose environment inhibited them from obtaining the knowledge, skills, and abilities required to enroll in and graduate from a health professions school. Educationally disadvantaged is defined as a person who comes from a social, cultural, or educational environment that has demonstrably and directly inhibited the person from obtaining the knowledge, skills, and abilities necessary to develop and participate in a health professions education or training HP curriculum. Environmentally disadvantaged is defined as a person from a family with an annual income below a level based on low-income thresholds, according to family size established by the U.S. Census Bureau, adjusted annually for changes in the Consumer Price Index, and adjusted by the Secretary of the U.S. Department of Health and Human Services, for use in all health professions HP curriculum s. A family is a group of two or more people. 7. Do you reside in a rural area? Please Rate your level of agreement with the following statements. A 5 item Likert scale was used and coded as Strongly agree = 5, agree = 4, neutral = 3, disagree = 2, strongly disagree = 1). 8. I am aware of the factors that contribute to distress in health professions’ teams. 9. I value the interventions for promoting my own health and well-being. 10. I am willing to try the interventions to promote my own health and well-being. 11. Making time for health-promoting behaviors is important for personal well-being. 12. Making time for health-promoting behaviors is important for my professional functioning. 13. Making time for health-promoting behaviors is important for the well-being of the healthcare team. Survey Deployed Post-HP HP Curriculum Please Rate your level of agreement with the following statements. A 5 item Likert scale was used and coded as Strongly agree = 5, agree = 4, neutral = 3, disagree = 2, strongly disagree = 1). 14. I believe that this HP curriculum is valuable for promotion of my own health and well-being. Narrative Answer 15. What is one health-promoting practice that you started as a result of this HP curriculum ? 16. If you could change one aspect of the HP curriculum, what would it be and how would you change it? Survey Deployed 6 Months Post-HP Curriculum Narrative Answer Item: How has the health promotion HP curriculum affected your well-being? Funding This project was supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS) under grant number 6 U3NHP45418 of the Health and Public Safety Workforce Resiliency Training HP curriculum. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the US Government. Declarations Ethical Approval The study was approved by the University of Central Florida’s Institutional Review Board as a non-human research study (IRB ID #STUDY00004564). Conflict of Interest The authors declare no competing interests. Footnotes Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. References 1. Bonanno GA, Westphal M, Mancini AD. Resilience to loss and potential trauma. Annu Rev Clin Psychol. 2011;7:511–35. [ DOI ] [ PubMed ] [ Google Scholar ] 2. Henshall C, Davey Z, Jackson D. Nursing resilience interventions-a way forward in challenging healthcare territories. J Clin Nurs. 2020;29(19–20):3597–9. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 3. Yalim AC, Daly K, Bailey M, Kay D, Zhu X, Patel M, et al. Wellness and stress management practices among healthcare professionals and health professional students. Am J Health Promot. 2024:8901171241275868 [ DOI ] [ PubMed ] 4. 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