International Service Trips: Student Motivations, Paradigms of Engagement, and Global Health Equity

Abstract: This study focuses on short-term international medical service trips carried out in Ghana, Honduras, Nicaragua, and Panama by an undergraduate student group affiliated with a university in the United States and in collaboration with an international non-profit organization. Specifically, the research team designed a conceptual framework, the Paradigms of Engagement Motivational Matrix (PEMM), with a twofold purpose: first, to examine student motivations for participating in international service trips, and second, as a practical tool for guiding students in critical reflection on the interface between their own motivations and different paradigms of engagement. A mixed methods approach was used in this study in which students from three different international trips, in 2019 and 2020, completed pre-trip and post-trip surveys. The data gathered included a multi-point question in which students were asked to indicate the degree of importance for each of 20 different potential motives underlying their desire to participate in the trip as well as an open-ended question on their main motivation. The results reflected the complex and fluid movement among multiple self-oriented and other-oriented motivations—spanning different paradigms of engagement from direct service and charity to social change, transformation, and social justice—and the need to involve students in exploring this interface in a nuanced manner. In addition to providing an adaptable tool for framing critical reflection, the study addresses key implications with regards to the development of guiding concepts and practices of ethical solidarity for collective action aimed at social justice and global health equity.

Narrative: This study focuses on short-term international medical service trips carried out in Ghana, Honduras, Nicaragua, and Panama by an undergraduate student group affiliated with a university in the United States and in collaboration with an international non-profit organization. The trips studied here, which last 7-10 days, can be seen as part of a broader series of related types of activities within the general area of global health, often described with a wide range of terms, such as short-term experiences in global health (STEGH) (Arya & Evert, 2018); short-term medical missions (STMMs) (Roche et al., 2017); medical service trips (MSTs) (Sykes, 2014); and medical volunteerism (McLennan, 2014), among others. In addition, these activities can be examined in relation to other overlapping phenomena, including international development volunteering (Tiessen, 2012), volunteer humanitarianism (Sandri, 2018), international service learning (Green & Johnson, 2014; Larsen, 2017), global service learning (Morrison, 2015), alternative breaks (Sumka et al., 2015), international experiential learning (Tiessen & Huish, 2014), and community-based global learning (Hartman et al., 2018), among others. Each of these functions within different paradigms of engagement with their own conceptualizations, definitions, and practices. The present study joins a growing body of literature that critically interrogates the paradoxes, possibilities, and varying degrees of convergence among these paradigms as well as their connections to broader international phenomena such as humanitarianism, development, and human rights.
Our research team designed a conceptual framework, the Paradigms of Engagement Motivational Matrix (PEMM), with a twofold purpose: first, to examine student motivations for participating in international service trips, and second, to develop a tool for guiding students in critical reflection on the interface between their own motivations and different paradigms of engagement. Ultimately, a primary underlying objective is to create spaces and practices for perspective transformation in students that leads to their understanding of and commitment to long-term collective action aimed at addressing (global) socio-economic and health inequities. The PEMM includes eight different categories of motivations, including both self- and other-oriented subgroupings. The matrix also reflects different paradigms of engagement (spanning the other-oriented motivational categories) and critical reflection (spanning all motivational categories), building upon previous theories and studies by Freire (1970), Morton (1995), Kiely (2004), Bringle et al. (2006), Mitchell (2008), Brookfield (2009), Hartman et al. (2018), and Norris et al., (2018), among others. For the present study, we then posed three primary research questions: 1) What are the most significant motivations for students to participate in international service trips? 2) Do the students’ motivations for participating in the international service change significantly upon completing the service? 3) Upon completing the service, are there any significant differences in motivations between students who indicate interest in participating in a future service trip and those who do not?
A mixed methods approach was used in this study in which students from three different trips, two in 2019—Ghana in January and Panama in June—and another to Ghana in January of 2020, were invited to participate by completing pre-trip and post-trip surveys. The surveys were conducted on-line using Qualtrics, and all responses were recorded anonymously. Each survey gathered information on the respondent’s age, gender, major, minor, class rank, career plans, international experience, community engagement experience, and language skills. The data gathered also included a multi-point question in which students were asked to indicate the degree of importance for each of 20 different potential motives underlying their desire to participate in the trip. In addition, participants were also asked to identify and explain in detail their most important motive for participating. The two survey instruments created for this study were sent to a total of 88 participants, of which 61 pre-trip respondents and 25 post-trip respondents completed them fully.
The research team used the PEMM as a tool to analyze both the quantitative data and the qualitative data following two distinct paths. For the former, the twenty motives were first ranked by mean independently of their placement in the matrix. Then the motives were sorted into the eight categories of the matrix. Each motivational category included 2-3 motives from which a composite mean was derived using the five-point scale. In addition, the Mann-Whitney U test was used to determine if a statistically significant relationship exists between the dichotomous independent variable on the post-experience survey question in reference to their desire to participate in a future trip and ratings of the importance of each of the 20 proposed motives for participating in the trip. For the qualitative data, the responses to the open question were coded using the eight categories from the PEMM, and frequency counts served to determine the distribution of motives in the matrix.
In the quantitative results, the other-oriented categories collectively scored higher than the self-oriented categories, and there was not a significant change from the pre-trip survey to the post-trip survey. The post-trip results indicated five other-oriented motivations for which there were significant differences between students who indicated interest in participating in a future service trip and those who did not. The five motivations, which collectively represent all four other-oriented categories in the matrix—from direct service and charity to social change, transformation, and social justice—were rated significantly more important by students who expressed a desire to participate in a future trip. However, in response to the open question, the overall frequency of self-oriented motives was greater than that of other-oriented motives.
Overall, the data reflect the complex and fluid movement among multiple self-oriented and other-oriented motivations and the need to involve students in exploring their interface in a nuanced manner. The study points to the imperative of implementing a critically reflective practice—utilizing tools such as the PEMM—throughout all stages of these programs with an emphasis on root causes and origins of inequities, the legacy of colonialism and ongoing effects of coloniality, and the existing hierarchies and power dynamics. The study addresses key implications with regards to the development of guiding concepts and practices of ethical solidarity for collective action aimed at social justice and global health equity.
(The university’s IRB approved this study.)