1 Teaching Writing in Public Health Disciplines

Students enter public health programs with varying backgrounds and levels of experience in writing. Additionally, although students may have experience with writing in the humanities (e.g., first-year composition, secondary school English coursework), many may lack formal training or experience with discipline-specific writing skills necessary for public health, such as scientific or technical writing, practical and audience-oriented writing, or literature reviews.^5,6 To address this gap, the U.S. Council on Education for Public Health (CEPH) has identified key communication competencies for public health students (Table 1).² The task of effectively training students in public health writing thereby falls upon instructors, who may themselves lack formal training in writing instruction or feel underprepared to teach writing.^7,8 This section of the playbook is designed to help guide faculty in teaching public health writing to undergraduate and graduate students.

Table 1. 2024 Council on Education for Public Health (CEPH) Accreditation Criteria and Degree Competencies2
Bachelor’s Degree	Master of Public Health	Doctor of Public Health
Basic concepts of public health-specific communication, including technical and professional writing and the use of mass media and electronic technology.	Select communication strategies for different audiences and sectors. Communicate audience-appropriate public health content, both in writing and through oral presentation to a non-academic, non-peer audience with attention to factors such as literacy and health literacy. Describe the importance of cultural humility in communicating public health content	Communicate public health science to diverse stakeholders, including individuals at all levels of health literacy, for purposes of influencing behavior and policies

1.1 What is “public health writing”? Why is it so unique?

Healthy People 2020 defined health communication as the “art and technique of informing, influencing, and motivating individual, institutional, and public audiences about important health issues.”^5,9 Writing is one form of health communication. The Healthy People 2020 definition begins to capture the idea that writing is not simply a technical skill, but that instead it is also an art form, a “social experience,” and a conduit through which public health students develop and adopt the language, expectations and norms of the public health community.^1,5

Public health writing is unique because it is not limited to a single tradition of writing (e.g., literary, journalism, scientific-technical) but instead spans all of them.^1,4,10 Similarly, it is not bound by a single audience or document type.¹ Alongside its diversity, public health writing is distinct in its potential to educate, influence human behavior and policy, and improve health outcomes at an individual and population level.

1.2 Teaching writing

Writing is inherently hard. Most seasoned writers across disciplines, including those who study writing pedagogy, struggle through the writing process.^11–13 This is in part because writing is a process in which the writer is creating something new and in part because writing is an iterative process, which takes time and effort through numerous revisions.⁵

Teaching writing is also difficult. Instructors are experts in their fields and often write throughout their careers, but sharing their knowledge with students can be challenging for two primary reasons. First, instructors have rarely been formally trained on how to teach writing. Second, for many instructors, writing and especially discipline-specific writing has become second nature. They have already been socialized and acculturated into the discipline, making it difficult to recognize and explicitly share their writing process.¹³

The challenges inherent in writing and teaching writing have led to the development of a range of pedagogical approaches as well as efforts to understand both the stages of writing and student cognitive development. Together, these efforts help guide instructors to move beyond the fundamentals of writing (e.g., grammar and mechanics) to help foster student metacognition, critical thinking, and the ability to adapt writing to different contexts. The following sections will discuss pedagogies, stages of student writing, and approaches to supporting students’ critical thinking.^11,13,141

1.2.1 Writing Across the Curriculum (WAC)

Figure 1. WAC pedagogies along spectrum of critical thinking skills¹⁶

First developed in the 1970s, writing across the curriculum (WAC) is a pedagogical movement that has been widely implemented in higher education in the United States.¹ WAC emphasizes and supports writing instruction across a student’s education, including in required and elective coursework.^1,13,14 This approach allows instructors to focus on writing as a tool for learning rather than requiring them to be writing experts, and further empowers instructors to teach writing in ways that are reflective of practice in the field.¹

As a movement, WAC encompasses a set of pedagogical approaches to writing instruction: Writing to Engage, Writing to Learn, and Writing in the Disciplines.¹⁵ The three WAC pedagogies are often used together as they serve different purposes for student development and critical thinking skills (Figure 1);^14–16 however, they can also be used independently. For additional clarity, Table 2 summarizes each pedagogy and provides example assignments in the public health discipline.

Table 2. Pedagogies for teaching writing in public health and example assignments
	Writing to Learn (WTL)	Writing to Engage (WTE)	Writing in the Disciplines (WTD)
Goal for students	Use writing as a tool to process, understand, and synthesize information.	Build upon retention and reflection to build connections between concepts, frameworks and processes.	Practice formal written communication within a given discipline adhering to standards and conventions.
Stakes of assignments	Low	Low to high	High
Example public health assignments	In-class responses to prompts Reflections Summaries Forum discussions	Selection and application of public health frameworks Article critiques Project proposals Brief reports	Academic manuscript (IMRaDa format) Policy brief Public health communication (e.g., infographic)
aIMRaD: Introduction, Methods, Results and Discussion This table is adapted from Table 1 in Palmquist (2020).16

1.2.1.a Writing to Learn

Writing to learn (WTL) leverages writing as a tool to process, understand, and synthesize information.^14,17 In this approach, students may be asked to reflect upon a specific subset of material or a given lesson, by writing a summary or reflection. In doing so, the focus of the approach shifts from language use and grammar to a student’s ability to retrieve and synthesize information learned in a low-stakes environment.

1.2.1.b Writing to Engage

As depicted in Figure 1, writing to engage (WTE) pedagogy expands on WTL by asking students to further engage with critical thinking by applying what they have understood and reflected upon to build stronger connections between the concepts, frameworks and processes they have learned.^14,16 WTE assignments help students solidify foundational knowledge, apply it to new contexts, and begin to draw novel connections.¹⁶ WTE assignments can range from low- to high-stakes.

1.2.1.c Writing in the Disciplines

Writing in the disciplines (WID) focuses on introducing or reinforcing writing genres and formats that professionals in the field use.^1,14,18 Students learn to meet discipline standards and conventions, as well as tailor professional communication to specific audiences. These writing assignments are usually higher stakes, take students longer to create and finalize, and adhere to discipline-specific standards.

1.2.2 Stages of writing

Knowing the stages of writing can help instructors develop supportive assignments for each stage of a student’s writing practice.¹³ A staged writing process helps students build each project progressively, while receiving feedback and revising along the way. This approach can also save time. By increasing the time allotted to early stages of writing, instructors can help identify challenges in student writing early on (e.g., choosing an appropriate topic), allowing ample time for correction before the finalized product. Leading students through staged writing processes may also help students understand and use goal setting and planning strategies.^4,13

Traditionally, the process of writing has been broken down into five distinct stages: 1) planning, 2) drafting, 3) editing/revising 4) polishing, and 5) publishing.⁴ August (2020) presents a simplified version of stages of writing for students in the health sciences with examples of writing and supportive activities (Figure 2).¹³ The August framework does not include phase 5, publishing, since it is not a requirement for all academic programs, especially while students are learning how to write. During the planning stage, students should identify the audience, purpose, and genre of the written assignment.⁴ Asking the questions, “who are my readers?”, “what am I hoping to accomplish by writing this piece?” and “what genre am I being asked to work with and how does that impact my writing?” can be helpful in defining these parameters. Drafting is the process of putting text on the paper/screen. It is usually an iterative process as the student is working to determine which information is most important and in what order. In the revising stage, students’ work should be reviewed for content, organization and overall flow. This is distinct from editing, which focuses more on grammar and syntax. Reviews can be conducted by the student themselves (self-evaluation), a peer (peer-review), or the instructors; subsequent revisions based on reviewer feedback should be conducted by the student and generally result in a new version of the written work that is more focused and readable. Finally, the polishing and publishing stages of the traditional framework or the analogous edit/format stage of the August framework, are the stages in which the final proof-reading is completed. The purpose of proof-reading is to catch any remaining grammatical or syntactical errors in the written piece.

Figure 2. Stages of writing, writing activities at each stage, and feedback and support activities for each stage.¹³

1.2.3 Steps for Better Thinking

In addition to the stages of writing, an instructor’s ability to understand student thinking, and patterns of student thinking, can help instructors meet student needs, improve the development of and effectiveness of assignments, and better evaluate student assignments and learning. Wolcott and Lynch’s (2002) Steps for Better Thinking Model is a four-step process for addressing open-ended problems by using a scaffolded critical thinking approach (Figure 3). While many definitions of critical thinking exist, for the purposes of this playbook we use the Merriam-Webster definition: “the act or practice of thinking critically (as by applying reason and questioning assumptions) in order to solve problems, evaluate information, discern biases, etc.”¹⁹

Figure 3. Steps for Better Thinking Model⁷⁸

The model can be useful in writing instruction as it can help tailor assignments to students’ current level and guide students beyond superficial responses to deeper, more analytical and reflective responses. For example, students who are new to the field of public health may need to spend additional time in the foundation and step 1 stages of the model. Assignments may ask students to draw on the foundation of knowledge they are actively gaining through coursework and identify topics to address a given public health problem in a written assignment. The task of identifying topics is not cognitively complex, but it matches student abilities, and allows them to identify and address gaps in their knowledge. This in turn provides them additional information to identify a problem and possible responses.

1.2.4 Facilitating effective feedback and revisions

1.2.4.a Supportive scaffolding

Students may be overwhelmed by large writing assignments, especially if they are new to writing generally or within the discipline. Scaffolding, or breaking assignments into smaller manageable parts with increasing complexity, reduces the pressure on students to generate an entire assignment. Simultaneously, scaffolding often has built in review/revision, which provides students with multiple opportunities to learn from, synthesize and incorporate feedback.²⁰ Peers or instructors may serve as external reviewers, offering helpful suggestions to improve the clarity and content of the written assignment. In a scaffolded assignment, instructors usually provide more guidance to students at the beginning of a writing project and gradually reduce the amount of guidance and support as the students learn and gain confidence.¹³ This allows for student growth and iterative development of the written assignment in a supportive environment.

1.2.4.b The power of the peer review

Educational peer review can be a powerful tool for student writers and peer reviewers at any stage and affords numerous benefits. First, peer review helps students learn how to give, request and receive feedback, which they can later apply to working with instructors and in the workplace.¹ Second, incorporating peer reviews allows students to receive feedback throughout the writing process and continuously improve their writing, without necessitating all feedback come from instructors. Third, the peer review process exposes students to others’ ideas or approaches to writing, improving their own writing through a reflective process.¹³ Lastly, the peer review process can also be beneficial to instructors by cutting down on their overall review time, especially for large courses.

1.2.4.c Instructor feedback

Instructor feedback is a key component to student learning and development as a writer. Giving effective feedback takes practice as it can be tricky to determine the appropriate amount of feedback to share. Students can feel overwhelmed by too much feedback;^21,22 yet it is also common for a student to receive very little effective feedback.²³ Common recommendations for providing effective feedback can be seen in Table 3.

Table 3. General recommendations for providing effective feedback on student writing
Recommendation	Reasoning
1. Match your feedback to the student’s stage of writing.	By tailoring instructor feedback and comments to the student’s stage of writing, instructors allow students to focus on the process and the challenges the student is currently experiencing.13,21 Helpful tip: Inviting students to add a sentence or two at the beginning of their submitted work that details what aspects of the assignment they are having challenges with, can help the instructor focus their feedback.
2. Align your comments with the assignment’s goals and learning objectives.	Comments that align with assignment goals and learning objectives help students make connections between their writing and broader course content.
3. Use concise and direct language.	Direct language prevents students from misinterpreting instructor feedback as a suggestion and results in more substantiative revisions.21
4. Provide positive as well as constructive feedback.	Students learning to write may try different writing styles or approaches. Providing positive feedback on the aspects they have done well not only reinforces the skills they are developing but also encourages them to continue applying those techniques.23
4. Respond with reasoning.	Sharing the reason behind instructor revisions or comments can help students understand the rationale behind the suggested change, which they can then apply to future writing.23 Providing explanations for common, repeated mistakes can be especially helpful. When students understand the instructor’s rationale, they can identify and address similar issues in subsequent writing sections or assignments.

1.3 Designing and implementing writing assignments

1.3.1 Framework for designing effective writing assignments in public health

August and Anderson (2022) designed an 8-step framework for creating effective writing assignments in the field of public health.²⁰ The framework recommendations also align with prior work by August, which found six features of effective writing assignments across disciplines: 1) clear explanation of expectations; 2) specified purpose; 3) allow for process (e.g., brainstorming, multiple drafts); 4) posing an authentic disciplinary problem; 5) specified audience; and 6) disciplinary writing with disciplinary conventions.²⁴ The framework is outlined below in Table 4 and an example real-world writing assignment developed by Anderson & August can be seen in the Example Assignments section A.1.1.

The recommendations and details found in Table 4 are also useful in providing scaffolding for an assignment outline. Outlines provide students with a roadmap for understanding the assignment and expectations, while also allowing for critical thinking and adaptation if appropriate.⁵

Table 4. August & Anderson framework for designing effective writing assignments in public health.
Framework recommendation	Rationale
Present a real-world disciplinary problem to be addressed through critical thinking.	By characterizing the problem that students should address, it helps build their professional knowledge and identity, and sharpens their critical thinking skills.
Describe the purpose of writing.	Setting a purpose gives the student a goal, as well as allows both student and instructor to have a benchmark for understanding what student success will look like for the assignment.
Identify the intended readers.	Identifying the audience helps students understand: 1) how to craft an appropriate tone, style, language, and use of jargon; 2) identify what language/information is important and appealing to the audience; 3) identify the appropriate level of complexity of information to present.
Require a document format used in the workplace.	Allows the student to better understand how knowledge is created, translated into documents used in public health, and disseminated.
Allow for a process to support writing through specific tasks.	Implementing processes like scaffolding can help support the writing process by providing multiple opportunities for students to observe effective strategies, receive and respond to feedback, and create a meaningful product rather than just completing an assignment.
Explain the assignment requirements and criteria for evaluation.	Thorough explanation allows the student to understand the guidelines for success.
Require a visual element.	A required visual element (e.g., figure, map) helps students learn the importance of non-textual arguments, as well as how to tailor visuals to specific audiences.25
Require a thoughtful title for the document.	Helps students understand that a title is often the first piece of a given document most audiences read. A good title can influence whether the rest of the document is read.26
This table was created from the framework outlined and explanations provided in August & Anderson (2022).20