Abstract
Purpose Undergraduate dental hygiene education programs may not provide sufficient training in professional development to prepare graduates to be primary health care providers. The purpose of the year one of a two-year study was to apply the results from a strengths assessment instrument to entry-level dental hygiene students’ learning experiences and faculty instruction of students.
Methods An exploratory research design including quantitative and qualitative methods was used among a convenience sample of entry-level dental hygiene students. A validated assessment instrument (CliftonStrengths®) was used at the beginning of the academic year to determine the professional strengths of the participants. Frequencies and percentages were used to summarize the top five strengths of each participant. Focus group interviews were conducted to assess student and faculty perceptions of professional strengths based on learning experiences at the end of the first academic year. Virtual interviews were transcribed, and the codes and themes were identified. Investigator triangulation and member checks were used to validate responses.
Results Thirty-two hygiene students and 28 faculty agreed to participate in the study. The top five strengths identified for both students and faculty (n=60) were in the executing, strategic and relationship building domains. All students (n=32) participated in the focus groups and the following themes were identified: awareness, application, positive approach, successful strategies, and personal growth. Of the faculty participants (n=28), 14 participated in the focus groups. Faculty themes identified were recognition, change in perspective, personalized approach, participatory environment, and empowerment.
Conclusion Results this study highlight the potential benefits of a strengths-based approach to undergraduate dental hygiene education. Helping students utilize their professional strengths in a challenging educational setting may lead to increased empowerment, professional growth and development. Further study with year two data may offer an opportunity to understand how identification of professional strengths influences students’ learning experiences.
- professional development
- professional growth
- dental hygiene students
- dental hygiene faculty
- dental hygiene education
- professional strengths
INTRODUCTION
Traditionally, higher education institutions have focused on remediation strategies to strengthen student outcomes and success when students have struggled.1 Examples of deficit-based programs and services include directing students to remedial courses prior to taking the college course, support services to assist at risk students, and advising sessions that focus on fixing student problems.1 Although, these programs and services are designed to help students at risk, the opposite effect can occur. Students may actively avoid deficit services due to advising sessions that are focused on student shortcomings.2
Over the past several decades there has been a positive psychology movement to assess motivation and self-regulation factors that contribute to student resiliency.3 These internal factors have been incorporated into new theories including the social cognitive career theory. Social cognitive theory explains student success by creating relative experiences that increase students’ feelings of self-efficacy3 and encourage positive goal attainment.4 This movement towards positive psychology lends itself to strengths-based education where an awareness of an individual’s natural talents is leveraged to confront difficult or challenging learning situations, thereby creating resiliency and self-efficacy.5 Positive emotions support the individual’s ability to broaden their perspective and use a variety of cognitive and behavioral reasoning when approaching new or challenging situations, whereas negative emotions constrict such responses.6,7 Positive emotions are then stored to create a resource that can be drawn on for future situations.7 In addition, student learning outcomes have demonstrated awareness, appreciation and understanding of others, hope, confidence, increased problem-solving skills, and better communication when strength-based approaches are used.8
Using strengths-based assessments and educational practices to help students increase resiliency and develop professionally offers an alternative approach to the use of deficit strategies. Research has demonstrated the positive achievements of strength-based education and a pedagogical shift away from focusing on fixing the problems of a college student to focusing on using an individual’s strengths to address challenges.9,10 For example, students who were focused on their strengths were more likely to be engaged, have direction, persist in academic achievements, experience more motivation, and developed improved coping skills.9,11 The nursing profession has utilized strengths-based education to enhance student learning, demonstrating enhanced collaborative teacher-student relationships, student empowerment and growth.12
Strengths-based education has not been reported in the literature for dental hygiene students. During undergraduate dental hygiene education, student perceptions of their professional strengths may be overlooked or not self-identified. Helping students recognize their talents and develop them into strengths during educational activities may enhance their overall professional development. In this respect, professional development has been defined as the actual process of identifying strengths and skills for the ability to grow and succeed in a professional environment.
CliftonStrengths®, an online assessment instrument for identifying talents and building strengths is grounded in over 30 years of research and is commonly used in higher education for first year programs, academic courses, co-curricular involvement, and leadership courses as a means of student development.13,14,15 CliftonStrengths® assessment identifies four domains of strengths: strategic thinking, executing, influencing, and relationship building; each domain has a list of related strengths or associated behavior traits (Figure 1).13 The first domain, strategic thinking, answers the question, “How do you absorb, think about, and analyze information and situations?” This question is designed to help individuals make better decisions and create better outcomes. The second domain, executing, focuses on turning ideas into reality by implementing solutions. For the third domain, influencing, the prevailing question is “How do you influence others?” The final domain, relationship building, addresses building and nurturing strong relationships and holding teams together.5,13 Upon completion of the CliftonStrengths® assessment, participants receive a ranking of all 34 strength categories and learn their top five strengths in order of occurrence, as well as additional information about each identified strength. The purpose of the first year of this study was to apply the results from the CliftonStrengths® assessment to entry-level, first-year dental hygiene students’ learning experiences and faculty instruction of students.
CliftonStrengths® categories*
*Permission for publication obtained from Gallup, Inc.
METHODS
Study design
This mixed methods study received exempt status approval from the Idaho State University Human Subjects Committee (IRB-FY2019-182). A quantitative and qualitative design was used to answer the following research questions: What are the strengths of entry-level dental hygiene students?; What are the strengths of dental hygiene faculty?; What are the students’ perceptions of using their identified strengths in the clinic, laboratory, and didactic learning settings?; What are the faculty perceptions of using students’ identified strengths while teaching entry-level dental hygiene students?
A convenience sample of dental hygiene students accepted into the first-year class of a baccalaureate degree program in the Fall 2019 was invited to participate in this two-year study. Inclusion criteria included students who were at least 18 years of age and enrolled as a full-time student in the dental hygiene program. No control group was planned; therefore, no randomization was needed.16,17 All full-time, part-time, and adjunct dental hygiene faculty with teaching assignments in clinics, classroom and/or labs were also invited to participate.
The quantitative portion of the study used the CliftonStrengths® assessment instrument, an online tool for identifying and building professional strengths.13 CliftonStrengths® has demonstrated continued reliability, validity, and applicability to both the general population and college students in particular.13 The instrument presents 177 items consisting of pairs of potential self-descriptors and identifies themes into four domains: strategic thinking, executing, influencing, and relationship building. Participants receive a ranking of 34 strength categories and learn their top five strengths in order of occurrence. Additional information is provided about each identified strength and in-depth analysis is reported on the top five major strengths.13 This assessment instrument was selected because of its wide range of applicability, ease of use, cost effectiveness, and its alignment with the study focus. An exploratory, focus group design was used for the qualitative portion of the study since no studies were identified on entry level dental hygiene students’ perceptions of the professional strengths. In addition, faculty perceptions of strength-based dental hygiene education have not been reported in the literature; therefore, the exploratory design was selected.18-20
Procedure
The research team provided training for all faculty in CliftonStrengths® methodology, implementation of strength-based education teaching and explained the study planned for the incoming dental hygiene students. All dental hygiene faculty completed the assessment to identify and learn about their own strengths as a means of enhancing student instruction during specific clinical, classroom, and laboratory learning activities.
At the beginning of the academic year, the first-year dental hygiene students met with the research team and the study was explained in detail. Informed consent was obtained, and the students completed the online CliftonStrengths® assessment. Each student received an individualized report detailing their 34 identified strengths.
Student and faculty workshops were held during the fall and spring semesters to provide supportive instruction in the utilization of professional strengths for both student learning and teaching methodology. Examples of student workshop topics included a description of their professional strengths how to use their strengths in clinical, laboratory, and didactic settings. Faculty topics included CliftonStrengths® case studies, journaling, patient care feedback, mentoring and creating supportive learning environments. Faculty were then able to apply their knowledge of strength-based education and the identified CliftonStrengths® to engage the first-year students in a variety of clinical, classroom and laboratory learning experiences designed to provide opportunities for students to develop and apply their individual strengths.
Focus group sessions were held at the conclusion of the spring semester for both student and faculty groups. Students were randomly assigned to focus group sessions, each consisting of 5-6 students. The process was similar for faculty groups with group sessions consisting of 3-5 faculty members per session. Sessions were scheduled based on participants’ convenience and each participant selected a pseudonym that was used throughout the session to ensure confidentiality.
Focus group sessions were based on a specific set of interview questions, or questioning route, used to evoke conversation and address the primary research questions. This method includes items that are open-ended, one-dimensional, conversational, clear, and conducive to respondents understanding the questions and answering honestly.18 Five elements were included: an opening question, introductory questions, transition questions, key questions, and an ending question.18 The questioning route was reviewed and validated by two external focus group experts prior to the first sessions. Focus groups were approximately forty-five minutes to one hour in length.
One member of the research team who had no contact with the entry-level students and limited to no contact with the part-time and adjunct clinical faculty was selected to moderate the sessions, reducing the likelihood of bias by association. No other members of the research team were present for the focus group sessions. The moderator had experience conducting qualitative research and focus group interviews and followed the questioning route closely to enhance methodological rigor and reduce bias. The Principal Investigator (PI) evaluated each focus group transcript and the ending question to confirm that key concepts were represented and that the process allowed participants to restate main ideas to establish non-bias.19
Each focus group session was conducted virtually (Zoom; San Jose, CA, USA) and was audio-recorded and saved through an encrypted account. Pseudonyms were used by the moderator and participants throughout the sessions. The audio-recordings were sent to a professional transcriptionist and were reviewed by the moderator for accuracy. Lastly, the moderator sent transcribed data to each student/faculty participant to verify accuracy of their answers to the focus group questions.
Data analysis
Data analysis included both descriptive statistics and qualitative analysis. Frequencies and percentages were used to summarize the top five professional strengths for each participant. Thematic analysis was used for the qualitative aspect of the study. A qualitative research software program (Dedoose, Los Angeles, CA, USA) was used to highlight codes in the data.20 The co-investigators systematically reviewed the codes and key quotes to identify the themes. Validity for the qualitative portion of the study was established through investigator triangulation with two or more investigators individually evaluating data separately and identifying comparable results.18 Member checks and respondent validation were used to verify the qualitative data obtained and the accuracy of the quotes used for the results.19
RESULTS
Thirty-two entry-level dental hygiene students and 28 dental hygiene faculty consented to participate in the CliftonStrengths® assessment at the beginning of the fall semester. All students (n=32) participated in the student focus groups while 14 faculty participants completed the faculty focus groups at the end of the spring semester. A majority of the student participants identified as female (n=30, 93.75%); and two identified as male (6.25%). All (n=28) of the dental hygiene faculty were female. No further demographic information was obtained.
A total of six student focus groups and four faculty focus groups were hosted on a virtual platform by the moderator.
CliftonStrengths® ASSESSMENT
Descriptive analysis of the top five CliftonStrengths® for students and faculty were conducted and are summarized in Table I. A majority of participants (students and faculty) were shown to have strengths in the executing, strategic and relationship building domains. Strengths for the influencing domain were not dominant for either group but were represented as lesser strengths (individual data not shown).
Top five strengths and domains for students and faculty
Qualitative analysis: Student focus groups
Student quotes were organized into nine parent codes and fifty-two child codes based on results from the open coding system. Five themes emerged as the data were analyzed: awareness, application, positive approach, successful strategies, and personal growth.
Awareness
Students were asked to describe what they learned about themselves after completing the CliftonStrengths® assessment. Most students identified their top five strengths and felt the assessment confirmed their characteristics as representative and relatable. Katie stated, “That is pretty spot on, but there’s still room to grow within those characteristics of myself.” Paige explained, “I wasn’t super-surprised at my top strengths. I was like, oh yeah, that is totally me, but since I am more aware of my CliftonStrengths®, I’ll always reflect back and try harder to implement those.”
Application
Students were asked to consider how learning about their professional strengths influenced them and how applying these strengths became apparent. Maddie noted, “Not only have I tried to think about what my CliftonStrengths® are in school, but I’ve caught myself thinking about them doing other things.” Phoebe stated, “It gives me an arsenal that when I’m faced with a situation, I can look at those strengths and know I have the tools to face this and get through it,” while Jan explained, “It’s helped me to see where I can strengthen in other areas and also rely on those that have strengths that are different than mine to help me in my daily routine.”
Positive Approach
Using one’s identified professional strengths in different learning environments was a topic of the student sessions. Participants reported a more positive outlook regarding the various challenges in the clinical and laboratory situations they encountered. For clinic, Phoebe explained: “It helped to pick something to focus on because you’d have different struggles and different things that would go well. It helped to focus on the different strengths so I could see that it wasn’t like I was failing, but I could overcome specific challenges. That just made me feel like it wasn’t the end of the world if something didn’t go quite right.”
Louise reported her experience in the laboratory sessions stating: “Lab is probably the time when I feel most incompetent. So, looking at my CliftonStrengths® really does help because I feel like when I can’t do it, my strengths bring me back into focus and brings me perspective. I can do it. It may not come really quickly, but I can eventually do it.”
Additional quotes representing the positive approach theme from student focus groups are shown in Table IIa.
Positive approach (student participants)
Successful strategies
Students were asked to identify how they utilized their identified strengths in the classroom setting. They noted that they were less inclined to focus on these strengths in the classroom environment as compared to the clinic or laboratory setting. Rather, they focused on successful strategies that they had learned from each other. For example, Marie noted, “Well, I study with others and find it really interesting to hear what their strengths are and how they use them to succeed in the classroom setting and then learning from what they do to be successful and applying it to my work. It was really useful to learn how others work as well.”
Lucy indicated: “Knowing how some people have a similar strength, seeing how they might use that has helped me, and being able to balance that with people who share similar strengths has helped me [learn better].”
Personal growth
Lastly, students were asked to describe how they were different from when they began the program until the end of the spring semester based on their identified strengths. Personal growth was the emerging theme. Key quotes representing this theme were expressed by Katie who stated: “I feel really engaged because I enjoy what I am learning. I love working with patients and I don’t feel like I have to be there, I want to be there.” Karen noted, “I have a better understanding of myself; it’s helped to show what my full potential can be in the program.” Additional key quotes representing students’ personal growth are shown in in Table IIIa.
Personal growth (student participants)
Qualitative analysis: Faculty focus groups
Faculty quotes were organized into seven parent codes and twenty-four child codes based on the results from the open coding system. Five themes emerged as the data was analyzed: recognition, change in perspective, personalized approach, participatory environment, and empowerment.
Recognition
When faculty were asked what they learned about themselves by completing the CliftonStrengths® assessment, many recognized their personal characteristics in the top five strengths results. While they were not surprised by the results, they reflected an awareness of positive support for their attributes. For example, Anna stated, “the strengths that were my top five did not surprise me entirely. In some respects, it made me excited because I don’t think I knew that I use those as frequently as I do.” Siggy noted, “When I got the results, I felt like I was seeing myself through someone else’s eyes and it gave me positive reinforcement mentally and emotionally. It made me feel good.”
On the other hand, some participants were disappointed by the results and felt that they represented a personal weakness. Hudi stated: “It was hard for me to not take the strengths as being critical or criticism. That was difficult to get past, and I had to really be conscious of it in order to not be critical of myself in that I should’ve had some other strengths. I don’t know whether it was because there were so many strengths included, and the top five had a tendency to be in the same genre; I thought I should have had some others in there in order to make it well-rounded strengths.”
Change in perspective
Faculty were asked to consider how their top five identified strengths influenced them in their teaching. The prevailing theme was a change in perspective most notably in how faculty related to students. Carrie shared, “I think it just gave me a better sense of how to give students feedback, or being gentler with feedback; therefore, I tried to really slow down and be a little more thoughtful in the feedback that I was giving.”
Rebecca noted, “I had to take a step back and realize that maybe these are my strengths, but not their strengths, and maybe the way they would do something is different than mine.” Daisy reflected a similar view: “I kind of stopped judging the students. A lot of them are on the opposite end of where my strengths are. And stopped judging or being frustrated that they didn’t understand or get it right away, or not appreciate the way I was trying to portray something, or help. Just having more understanding that they have different strengths, and that’s okay, and it’s exciting to learn and to grow, and to find out their strengths as well.”
Personalized approach
When faculty were asked how they used their identified strengths in various learning experiences, it became clear that, like the students, they applied their strengths similarly in clinic and laboratory settings. A personalized approach was the theme that captured their responses. Daisy shared an example from clinic: “I had a student on the last day of clinic who was so thorough, and I was so impressed. She had all of her i’s dotted and t’s crossed. On the top of her daily sheet, she had consistency or something as her strength. I read about her strength and I was able to pull her aside and compliment her saying “You’re going to make an amazing clinician because your attention to detail is so awesome.” I liked that I could individualize that kind of feedback to students knowing their strengths versus just saying the same thing over and over. Sometimes I feel that I had done that before, but I like this better.”
For laboratory instruction, Anna related “Identifying that each learning atmosphere and environment is different for them and is different for their strengths and being able to pick and choose whichever one that’s the best for that situation seemed to be really effective.”
Additional supportive quotes representing this theme can be found in Table IIb.
Personalized approach (faculty participants)
Participatory environment
Faculty described that using CliftonStrengths® in the classroom setting was more challenging than in clinic and laboratory environments. The clinic and laboratory setting offers more opportunities for one-on-one instruction and feedback whereas the classroom setting is where lectures and group activities are taking place. Nevertheless, some faculty have reported they have stopped talking at the class and have begun asking more questions and have tried to incorporate discussions directed toward the strengths of students as a teaching strategy. These participants described a more active learning environment than a traditional authoritarian classroom experience. Specifically, Alison stated: “I use cooperative learning in my class. Because I had eight groups of four, it was easier for me to look at each group composition and see where they meshed [based on their CliftonStrengths®]. Ultimately, I was able to interact with them a little better.”
Hudi shared: “I have had a chance to incorporate CliftonStrengths® more on an individual basis with students who are struggling with content, and meeting with them and reviewing their strengths before talking about ways they can improve their grade has been very helpful.”
Empowerment
The final focus group question asked faculty to describe how students were different from when they started the program until the end of the spring semester based on their identified strengths. Empowerment was the theme that emerged from the responses. Rebecca stated, “I definitely agree that they are more open. It’s almost like they can connect with you better as a faculty,” while Cindy expressed: “I think it’s given them more patience and it’s opened their eyes. It’s added a level of social IQ. It’s helped them understand and become a bit more mature and more resilient professionals and helped them understand how to relate to other people better as well instead of taking for granted that everybody should relate to them.”
Anna summarized: “It is important for them to understand that who they are is going to be ultimately who leaves us and goes on and becomes this great professional. So, we’ve just instilled in them a powerful way to look at it, look at their strengths carrying on in there, and they can do a lot of things with those.”
Additional supportive quotes on personal growth and empowerment are shown in Table IIIb.
Empowerment (faculty participants)
DISCUSSION
This exploratory study investigated the incorporation of the results of a CliftonStrengths® assessment to support students’ learning experiences and faculty instruction. First year data collection suggested that students reflected a deeper level awareness on the results of their CliftonStrengths® assessment which provided a foundation for their personal growth as students in the dental hygiene program. Educational activities in the clinic, laboratory, and classroom setting integrated the application of individual student strengths to leverage challenging learning situations. Student remarks highlighted increased confidence with the use of the results of their CliftonStrengths® assessment. Increased levels of self-appreciation, and recognition of what individual students had to offer personally and professionally has been noted in other studies on strengths-based approaches in higher education.14,21 Meta-analysis research has identified a causal relationship with character strengths, knowledge, and their use with emotional well-being.22 Student participants in the current study reported using the traits identified in the CliftonStrengths® assessment for encouragement when difficulties arose, viewing challenges from a positive perspective. Student participants also indicated an awareness of others’ strengths and working together in a team-based approach. According to Ingamells et al., the use of a strengths-based approach has been shown to provide a means to address weaknesses from a positive perspective.14 Investigations of the use of CliftonStrengths® assessments in first year college students demonstrated that students who were able to see other student strengths, had a strengths development plan, and were enthusiastic about their own personal strengths, had more hope and increased flexibility.23 Other researchers have suggested that students with increased self-awareness of their personal strengths can become “confident, efficacious, lifelong learners whose work is infused with a sense of purpose.”24
From a faculty perspective, one unique aspect of this study was that the CliftonStrengths® assessment provided a blueprint for faculty to better understand students and their individual values from the beginning of students’ educational experiences. This blueprint allowed for meaningful conversations between faculty and students with a focus on using the student’s top five strengths to address a learning challenge. Positive interactions were built upon creating solutions for improvement.
Faculty perspectives changed when teaching was based on the CliftonStrengths® assessments as faculty realized that individuals get to the end point of education in many different ways based on their strengths. Faculty noticed an increase in students’ respect for differences among classmates and instructors, resulting in increased connectedness. In a similar study examining faculty use of CliftonStrengths® assessments, participants reported an increased self-understanding, which translated to better understanding of co-workers, relationship development, and work application.25
In this study, faculty participants observed greater resilience among students. This observation of flexibility further contributed to a foundational understanding of how a strengths-based approach can influence personal coping mechanisms during demanding professional programs. Faculty also identified that students were more receptive to feedback and valued progress over perfection. A developmental strengths-based approach has suggested that a growth mindset can be initiated in students.26,27 Utilizing CliftonStrengths® assessments to develop a strength-based approach to learning provides an opportunity to create a growth mindset that can be used well beyond graduation.
It is important to note that continued support, success, and reinforcement of the identified CliftonStrengths® is needed to capitalize on a strengths-based approach with students.26 Undergraduate students who participated in strengths-based conversations with advisors were significantly more engaged in their education and demonstrated greater academic self-efficacy.27 Helping students attain professional development through a strengths-based approach to teaching and conversations with students, can lead to improved outcomes. In the first year of this study, strength-based growth and development occurred, laying the foundation for future professional development in year two.
This study had limitations. The use of a purposive sample of dental hygiene faculty and students in one entry-level, baccalaureate degree dental hygiene program limits the generalizability of the study findings. However, the sampling procedure was indicative of a qualitative study, which yields rich data and an understanding of a unique cohort.18 A portion of the study was impacted by the COVID-19 pandemic, as the regular schedule of clinical and laboratory sessions were interrupted during March 2020 and some of the planned educational experiences were eliminated. Student participants also felt the application of their identified CliftonStrengths® was more difficult in the classroom setting, which provides an opportunity to expand the utilization of these strengths during year two of the study.
CONCLUSION
Results of year one of this study highlight the potential benefits of a strengths-based approach to undergraduate dental hygiene education. Themes from student and faculty focus groups indicated that a strengths-based approach appeared to contribute to a more positive learning environment. Faculty noticed improved flexibility and empowerment in students. Students reported increased self-compassion, confidence, felt positive about their potential as professionals and placed value on progress versus perfection. Further study with year two data may offer an opportunity to understand how identification of professional strengths through CliftonStrengths® assessments influences students’ learning experiences.
Footnotes
NDHRA priority area, Professional Development: Education (Educational Models).
DISCLOSURE
This research was supported by an educational grant from the American Dental Hygienists’ Association Institute for Oral Health.
- Received August 1, 2022.
- Accepted November 8, 2022.
- Copyright © 2023 The American Dental Hygienists’ Association
